1
|
Parra ER, Zhang J, Duose DY, Gonzalez-Kozlova E, Redman MW, Chen H, Manyam GC, Kumar G, Zhang J, Song X, Lazcano R, Marques-Piubelli ML, Laberiano-Fernandez C, Rojas F, Zhang B, Taing L, Jhaveri A, Geisberg J, Altreuter J, Michor F, Provencher J, Yu J, Cerami E, Moravec R, Kannan K, Luthra R, Alatrash G, Huang HH, Xie H, Patel M, Nie K, Harris J, Argueta K, Lindsay J, Biswas R, Van Nostrand S, Kim-Schulze S, Gray JE, Herbst RS, Wistuba II, Gettinger S, Kelly K, Bazhenova L, Gnjatic S, Lee JJ, Zhang J, Haymaker C. Multi-omics Analysis Reveals Immune Features Associated with Immunotherapy Benefit in Patients with Squamous Cell Lung Cancer from Phase III Lung-MAP S1400I Trial. Clin Cancer Res 2024; 30:1655-1668. [PMID: 38277235 PMCID: PMC11016892 DOI: 10.1158/1078-0432.ccr-23-0251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 05/06/2023] [Accepted: 01/24/2024] [Indexed: 01/28/2024]
Abstract
PURPOSE Identifying molecular and immune features to guide immune checkpoint inhibitor (ICI)-based regimens remains an unmet clinical need. EXPERIMENTAL DESIGN Tissue and longitudinal blood specimens from phase III trial S1400I in patients with metastatic squamous non-small cell carcinoma (SqNSCLC) treated with nivolumab monotherapy (nivo) or nivolumab plus ipilimumab (nivo+ipi) were subjected to multi-omics analyses including multiplex immunofluorescence (mIF), nCounter PanCancer Immune Profiling Panel, whole-exome sequencing, and Olink. RESULTS Higher immune scores from immune gene expression profiling or immune cell infiltration by mIF were associated with response to ICIs and improved survival, except regulatory T cells, which were associated with worse overall survival (OS) for patients receiving nivo+ipi. Immune cell density and closer proximity of CD8+GZB+ T cells to malignant cells were associated with superior progression-free survival and OS. The cold immune landscape of NSCLC was associated with a higher level of chromosomal copy-number variation (CNV) burden. Patients with LRP1B-mutant tumors had a shorter survival than patients with LRP1B-wild-type tumors. Olink assays revealed soluble proteins such as LAMP3 increased in responders while IL6 and CXCL13 increased in nonresponders. Upregulation of serum CXCL13, MMP12, CSF-1, and IL8 were associated with worse survival before radiologic progression. CONCLUSIONS The frequency, distribution, and clustering of immune cells relative to malignant ones can impact ICI efficacy in patients with SqNSCLC. High CNV burden may contribute to the cold immune microenvironment. Soluble inflammation/immune-related proteins in the blood have the potential to monitor therapeutic benefit from ICI treatment in patients with SqNSCLC.
Collapse
Affiliation(s)
- Edwin Roger Parra
- Departments of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jiexin Zhang
- Department of Bioinformatics and Computational Biology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Dzifa Yawa Duose
- Departments of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Edgar Gonzalez-Kozlova
- Department of Oncological Sciences, Mount Sinai, New York, New York
- Tisch Cancer Institute, Mount Sinai, New York, New York
- Precision Immunology Institute, Mount Sinai, New York, New York
- Icahn School of Medicine at Mount Sinai, New York, New York
| | - Mary W. Redman
- SWOG Statistical Center, Fred Hutchinson Cancer Center, Seattle, Washington
| | - Hong Chen
- Department of Thoracic-Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Ganiraju C. Manyam
- Department of Bioinformatics and Computational Biology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Gayatri Kumar
- Departments of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jianhua Zhang
- Department of Genomic Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Xingzhi Song
- Department of Genomic Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Rossana Lazcano
- Departments of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Mario L. Marques-Piubelli
- Departments of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Caddie Laberiano-Fernandez
- Departments of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Frank Rojas
- Departments of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Baili Zhang
- Departments of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Len Taing
- CIMAC-CIDC Network, Pipeline Development and Portal Integration, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Aashna Jhaveri
- CIMAC-CIDC Network, Pipeline Development and Portal Integration, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Jacob Geisberg
- CIMAC-CIDC Network, Pipeline Development and Portal Integration, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Jennifer Altreuter
- CIMAC-CIDC Network, Pipeline Development and Portal Integration, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Franziska Michor
- CIMAC-CIDC Network, Pipeline Development and Portal Integration, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - James Provencher
- CIMAC-CIDC Network, Pipeline Development and Portal Integration, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Joyce Yu
- CIMAC-CIDC Network, Pipeline Development and Portal Integration, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Ethan Cerami
- CIMAC-CIDC Network, Pipeline Development and Portal Integration, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Radim Moravec
- Cancer Diagnosis Program, Division of Cancer Treatment and Diagnosis, NCI, Bethesda, Maryland
| | - Kasthuri Kannan
- Departments of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Rajyalakshmi Luthra
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Gheath Alatrash
- Department of Stem Cell Transplantation, The University of Texas MD Anderson Cancer, Houston, Texas
| | - Hsin-Hui Huang
- Precision Immunology Institute, Mount Sinai, New York, New York
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Hui Xie
- Precision Immunology Institute, Mount Sinai, New York, New York
| | | | - Kai Nie
- Precision Immunology Institute, Mount Sinai, New York, New York
| | - Jocelyn Harris
- Precision Immunology Institute, Mount Sinai, New York, New York
| | | | - James Lindsay
- Department of Data Science, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Roshni Biswas
- Department of Data Science, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Stephen Van Nostrand
- CIMAC-CIDC Network, Pipeline Development and Portal Integration, Dana-Farber Cancer Institute, Boston, Massachusetts
- Department of Data Science, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Seunghee Kim-Schulze
- Department of Oncological Sciences, Mount Sinai, New York, New York
- Tisch Cancer Institute, Mount Sinai, New York, New York
- Precision Immunology Institute, Mount Sinai, New York, New York
- Icahn School of Medicine at Mount Sinai, New York, New York
| | | | - Roy S. Herbst
- Yale Cancer Center, Yale School of Medicine, New Haven, Connecticut
| | - Ignacio I. Wistuba
- Departments of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | | | - Karen Kelly
- International Association for the Study of Lung Cancer, Denver, Colorado
| | - Lyudmila Bazhenova
- University of California San Diego Moores Cancer Center, La Jolla, California
| | - Sacha Gnjatic
- Department of Oncological Sciences, Mount Sinai, New York, New York
- Tisch Cancer Institute, Mount Sinai, New York, New York
- Precision Immunology Institute, Mount Sinai, New York, New York
- Icahn School of Medicine at Mount Sinai, New York, New York
| | - J. Jack Lee
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jianjun Zhang
- Department of Thoracic-Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
- Department of Genomic Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Cara Haymaker
- Departments of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| |
Collapse
|
2
|
Kumar G, Pandurengan RK, Parra ER, Kannan K, Haymaker C. Spatial modelling of the tumor microenvironment from multiplex immunofluorescence images: methods and applications. Front Immunol 2023; 14:1288802. [PMID: 38179056 PMCID: PMC10765501 DOI: 10.3389/fimmu.2023.1288802] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 12/07/2023] [Indexed: 01/06/2024] Open
Abstract
Spatial modelling methods have gained prominence with developments in high throughput imaging platforms. Multiplex immunofluorescence (mIF) provides the scope to examine interactions between tumor and immune compartment at single cell resolution using a panel of antibodies that can be chosen based on the cancer type or the clinical interest of the study. The markers can be used to identify the phenotypes and to examine cellular interactions at global and local scales. Several translational studies rely on key understanding of the tumor microenvironment (TME) to identify drivers of immune response in immunotherapy based clinical trials. To improve the success of ongoing trials, a number of retrospective approaches can be adopted to understand differences in response, recurrence and progression by examining the patient's TME from tissue samples obtained at baseline and at various time points along the treatment. The multiplex immunofluorescence (mIF) technique provides insight on patient specific cell populations and their relative spatial distribution as qualitative measures of a favorable treatment outcome. Spatial analysis of these images provides an understanding of the intratumoral heterogeneity and clustering among cell populations in the TME. A number of mathematical models, which establish clustering as a measure of deviation from complete spatial randomness, can be applied to the mIF images represented as spatial point patterns. These mathematical models, developed for landscape ecology and geographic information studies, can be applied to the TME after careful consideration of the tumor type (cold vs. hot) and the tumor immune landscape. The spatial modelling of mIF images can show observable engagement of T cells expressing immune checkpoint molecules and this can then be correlated with single-cell RNA sequencing data.
Collapse
Affiliation(s)
| | | | | | - Kasthuri Kannan
- Department of Translational Molecular Pathology, MD Anderson Cancer Center, Houston, TX, United States
| | - Cara Haymaker
- Department of Translational Molecular Pathology, MD Anderson Cancer Center, Houston, TX, United States
| |
Collapse
|
3
|
Mukherjee A, Kumar G, Panda S. Response to: Prognostic factors for COVID-19 infected inpatients with chronic diseases. QJM 2023; 116:887-888. [PMID: 37335860 DOI: 10.1093/qjmed/hcad128] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Indexed: 06/21/2023] Open
Affiliation(s)
- A Mukherjee
- Indian Council of Medical Research, New Delhi 110029, India
| | - G Kumar
- Indian Council of Medical Research, New Delhi 110029, India
| | - S Panda
- Indian Council of Medical Research, New Delhi 110029, India
| |
Collapse
|
4
|
Hoppe MM, Jaynes P, Shuangyi F, Peng Y, Sridhar S, Hoang PM, Liu CX, De Mel S, Poon L, Chan EHL, Lee J, Ong CK, Tang T, Lim ST, Nagarajan C, Grigoropoulos NF, Tan SY, Hue SSS, Chang ST, Chuang SS, Li S, Khoury JD, Choi H, Harris C, Bottos A, Gay LJ, Runge HF, Moutsopoulos I, Mohorianu I, Hodson DJ, Farinha P, Mottok A, Scott DW, Pitt JJ, Chen J, Kumar G, Kannan K, Chng WJ, Chee YL, Ng SB, Tripodo C, Jeyasekharan AD. Patterns of Oncogene Coexpression at Single-Cell Resolution Influence Survival in Lymphoma. Cancer Discov 2023; 13:1144-1163. [PMID: 37071673 PMCID: PMC10157367 DOI: 10.1158/2159-8290.cd-22-0998] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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] [Received: 09/07/2022] [Revised: 12/29/2022] [Accepted: 02/13/2023] [Indexed: 04/19/2023]
Abstract
Cancers often overexpress multiple clinically relevant oncogenes, but it is not known if combinations of oncogenes in cellular subpopulations within a cancer influence clinical outcomes. Using quantitative multispectral imaging of the prognostically relevant oncogenes MYC, BCL2, and BCL6 in diffuse large B-cell lymphoma (DLBCL), we show that the percentage of cells with a unique combination MYC+BCL2+BCL6- (M+2+6-) consistently predicts survival across four independent cohorts (n = 449), an effect not observed with other combinations including M+2+6+. We show that the M+2+6- percentage can be mathematically derived from quantitative measurements of the individual oncogenes and correlates with survival in IHC (n = 316) and gene expression (n = 2,521) datasets. Comparative bulk/single-cell transcriptomic analyses of DLBCL samples and MYC/BCL2/BCL6-transformed primary B cells identify molecular features, including cyclin D2 and PI3K/AKT as candidate regulators of M+2+6- unfavorable biology. Similar analyses evaluating oncogenic combinations at single-cell resolution in other cancers may facilitate an understanding of cancer evolution and therapy resistance. SIGNIFICANCE Using single-cell-resolved multiplexed imaging, we show that selected subpopulations of cells expressing specific combinations of oncogenes influence clinical outcomes in lymphoma. We describe a probabilistic metric for the estimation of cellular oncogenic coexpression from IHC or bulk transcriptomes, with possible implications for prognostication and therapeutic target discovery in cancer. This article is highlighted in the In This Issue feature, p. 1027.
Collapse
Affiliation(s)
- Michal Marek Hoppe
- Cancer Science Institute of Singapore, National University of Singapore, Singapore, Singapore
| | - Patrick Jaynes
- Cancer Science Institute of Singapore, National University of Singapore, Singapore, Singapore
| | - Fan Shuangyi
- Department of Pathology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Yanfen Peng
- Cancer Science Institute of Singapore, National University of Singapore, Singapore, Singapore
| | - Shruti Sridhar
- Cancer Science Institute of Singapore, National University of Singapore, Singapore, Singapore
| | - Phuong Mai Hoang
- Cancer Science Institute of Singapore, National University of Singapore, Singapore, Singapore
| | - Clementine Xin Liu
- Department of Haematology-Oncology, National University Health System, Singapore, Singapore
| | - Sanjay De Mel
- Department of Haematology-Oncology, National University Health System, Singapore, Singapore
- NUS Centre for Cancer Research, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Limei Poon
- Department of Haematology-Oncology, National University Health System, Singapore, Singapore
- NUS Centre for Cancer Research, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Esther Hian Li Chan
- Department of Haematology-Oncology, National University Health System, Singapore, Singapore
- NUS Centre for Cancer Research, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Joanne Lee
- Department of Haematology-Oncology, National University Health System, Singapore, Singapore
- NUS Centre for Cancer Research, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Choon Kiat Ong
- Division of Cellular and Molecular Research, National Cancer Centre Singapore, Singapore, Singapore
| | - Tiffany Tang
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore
| | - Soon Thye Lim
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore
| | | | | | - Soo-Yong Tan
- Department of Pathology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- NUS Centre for Cancer Research, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Susan Swee-Shan Hue
- Department of Pathology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- NUS Centre for Cancer Research, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Sheng-Tsung Chang
- Department of Pathology, Chi-Mei Medical Center, Tainan City, Taiwan
| | - Shih-Sung Chuang
- Department of Pathology, Chi-Mei Medical Center, Tainan City, Taiwan
| | - Shaoying Li
- Department of Hematopathology, Division of Pathology and Laboratory Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Joseph D. Khoury
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, Nebraska
| | - Hyungwon Choi
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Carl Harris
- F. Hoffmann-La Roche Ltd, Basel, Switzerland
| | | | - Laura J. Gay
- Wellcome MRC Cambridge Stem Cell Institute, Cambridge, United Kingdom
| | | | | | - Irina Mohorianu
- Wellcome MRC Cambridge Stem Cell Institute, Cambridge, United Kingdom
| | - Daniel J. Hodson
- Wellcome MRC Cambridge Stem Cell Institute, Cambridge, United Kingdom
| | | | - Anja Mottok
- BC Cancer Research Centre, Vancouver, Canada
| | | | - Jason J. Pitt
- Cancer Science Institute of Singapore, National University of Singapore, Singapore, Singapore
- NUS Centre for Cancer Research, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Genome Institute of Singapore, Agency for Science, Technology and Research, Singapore, Singapore
| | - Jinmiao Chen
- Singapore Immunology Network, Agency for Science, Technology and Research, Singapore, Singapore
| | - Gayatri Kumar
- Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Kasthuri Kannan
- Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Wee Joo Chng
- Cancer Science Institute of Singapore, National University of Singapore, Singapore, Singapore
- NUS Centre for Cancer Research, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Yen Lin Chee
- Department of Haematology-Oncology, National University Health System, Singapore, Singapore
- NUS Centre for Cancer Research, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Siok-Bian Ng
- Cancer Science Institute of Singapore, National University of Singapore, Singapore, Singapore
- Department of Pathology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- NUS Centre for Cancer Research, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Claudio Tripodo
- Tumor Immunology Unit, University of Palermo, Palermo, Italy
- IFOM ETS – The AIRC Institute of Molecular Oncology, Milan, Italy
| | - Anand D. Jeyasekharan
- Cancer Science Institute of Singapore, National University of Singapore, Singapore, Singapore
- Department of Haematology-Oncology, National University Health System, Singapore, Singapore
- NUS Centre for Cancer Research, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| |
Collapse
|
5
|
Kumar G, Rajula MP, Rao KS, Ravishankar PL, Albar DH, Bahammam MA, Alamoudi A, Alzahrani KJ, Alsharif KF, Halawani IF, Alzahrani FM, Alnfiai MM, Baeshen HA, Patil S. Antimicrobial Efficacy of Blended Essential Oil and Chlorhexidine against Periodontal Pathogen ( P.gingivalis)-An In Vitro Study. Niger J Clin Pract 2023; 26:625-629. [PMID: 37357480 DOI: 10.4103/njcp.njcp_787_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/27/2023]
Abstract
Background Essential oils (EOs) have a considerable amount of therapeutic and preventive effect in treating dental diseases due to their wider potential as antibacterial and anti-inflammatory agents. EOs like virgin coconut oil, eucalyptus oil, peppermint oil thyme oil, and clove oil, when used in combination, may further have enhanced antimicrobial effects. However, limited information exists on the synergistic effect of these oils when used in combination, especially on the primary periodontal pathogen Porphyromonas gingivalis. Aim The current study aims to compare the antimicrobial efficacy of commercially available EO on the periodontal pathogen, P. gingivalis, in comparison to chlorhexidine (CHX). Materials and Methods Antimicrobial efficacy of EO and CHX was assessed at various concentrations against the periodontal pathogen P. gingivalis, by evaluating the minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC). Results P. gingivalis was seen to be sensitive at a MIC of 100 μg/ml and 50 μg/ml concentration of the EO, which is regarded as the MIC of EO against P. gingivalis and CHX effectively inhibited microbial growth at 0.4 μg/ml. Conclusion A combination of EOs possesses a potent antibacterial activity against P. gingivalis, and the antibacterial efficacy increases with increasing concentration of EOs.
Collapse
Affiliation(s)
- G Kumar
- Department of Periodontology, SRM Kattankulathur Dental College and Hospital, SRM Institute of Science and Technology, SRM Nagar, Kattankulathur 603203, Kancheepuram, Tamil Nadu, India
| | - M P Rajula
- Department of Periodontology, SRM Kattankulathur Dental College and Hospital, SRM Institute of Science and Technology, SRM Nagar, Kattankulathur 603203, Kancheepuram, Tamil Nadu, India
| | - K S Rao
- Department of Periodontology, SRM Kattankulathur Dental College and Hospital, SRM Institute of Science and Technology, SRM Nagar, Kattankulathur 603203, Kancheepuram, Tamil Nadu, India
| | - P L Ravishankar
- Department of Periodontology, SRM Kattankulathur Dental College and Hospital, SRM Institute of Science and Technology, SRM Nagar, Kattankulathur 603203, Kancheepuram, Tamil Nadu, India
| | - D H Albar
- Department of Preventive Dentistry, College of Dentistry, Jazan University, Saudi Arabia
| | - M A Bahammam
- Department of Periodontology, Faculty of Dentistry, King Abdulaziz University. Jeddah; Executive Presidency of Academic Affairs, Saudi Commission for Health Specialties, Riyadh, Saudi Arabia
| | - A Alamoudi
- Department of Oral Biology, Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia
| | - K J Alzahrani
- Department of Clinical Laboratories Sciences, College of Applied Medical Sciences, Taif University, Taif, Saudi Arabia
| | - K F Alsharif
- Department of Clinical Laboratories Sciences, College of Applied Medical Sciences, Taif University, Taif, Saudi Arabia
| | - I F Halawani
- Department of Clinical Laboratories Sciences, College of Applied Medical Sciences, Taif University, Taif, Saudi Arabia
| | - F M Alzahrani
- Department of Clinical Laboratories Sciences, College of Applied Medical Sciences, Taif University, Taif, Saudi Arabia
| | - M M Alnfiai
- Department of Information Technology, College of Computers and Information Technology, Taif University, Taif, Saudi Arabia
| | - H A Baeshen
- Department of Orthodontics, College of Dentistry, King Abdulziz University, Jeddah, Saudi Arabia
| | - S Patil
- College of Dental Medicine, Roseman University of Health Sciences, South Jordan, UTAH, USA
| |
Collapse
|
6
|
Jahedi A, Kumar G, Kannan L, Agarwal T, Huse J, Bhat K, Kannan K. Gibbs process distinguishes survival and reveals contact-inhibition genes in Glioblastoma multiforme. PLoS One 2023; 18:e0277176. [PMID: 36795646 PMCID: PMC9934342 DOI: 10.1371/journal.pone.0277176] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 09/22/2022] [Indexed: 02/17/2023] Open
Abstract
Tumor growth is a spatiotemporal birth-and-death process with loss of heterotypic contact-inhibition of locomotion (CIL) of tumor cells promoting invasion and metastasis. Therefore, representing tumor cells as two-dimensional points, we can expect the tumor tissues in histology slides to reflect realizations of spatial birth-and-death process which can be mathematically modeled to reveal molecular mechanisms of CIL, provided the mathematics models the inhibitory interactions. Gibbs process as an inhibitory point process is a natural choice since it is an equilibrium process of the spatial birth-and-death process. That is if the tumor cells maintain homotypic contact inhibition, the spatial distributions of tumor cells will result in Gibbs hard core process over long time scales. In order to verify if this is the case, we applied the Gibbs process to 411 TCGA Glioblastoma multiforme patient images. Our imaging dataset included all cases for which diagnostic slide images were available. The model revealed two groups of patients, one of which - the "Gibbs group," showed the convergence of the Gibbs process with significant survival difference. Further smoothing the discretized (and noisy) inhibition metric, for both increasing and randomized survival time, we found a significant association of the patients in the Gibbs group with increasing survival time. The mean inhibition metric also revealed the point at which the homotypic CIL establishes in tumor cells. Besides, RNAseq analysis between patients with loss of heterotypic CIL and intact homotypic CIL in the Gibbs group unveiled cell movement gene signatures and differences in Actin cytoskeleton and RhoA signaling pathways as key molecular alterations. These genes and pathways have established roles in CIL. Taken together, our integrated analysis of patient images and RNAseq data provides for the first time a mathematical basis for CIL in tumors, explains survival as well as uncovers the underlying molecular landscape for this key tumor invasion and metastatic phenomenon.
Collapse
Affiliation(s)
- Afrooz Jahedi
- Department of Translational Molecular Pathology, UT MD Anderson Cancer Center, Houston, TX, United States of America
| | - Gayatri Kumar
- Department of Translational Molecular Pathology, UT MD Anderson Cancer Center, Houston, TX, United States of America
| | | | | | - Jason Huse
- Department of Translational Molecular Pathology, UT MD Anderson Cancer Center, Houston, TX, United States of America
- Department of Pathology, UT MD Anderson Cancer Center, Houston, TX, United States of America
| | - Krishna Bhat
- Department of Translational Molecular Pathology, UT MD Anderson Cancer Center, Houston, TX, United States of America
- Department of Neurosurgery, UT MD Anderson Cancer Center, Houston, TX, United States of America
| | - Kasthuri Kannan
- Department of Translational Molecular Pathology, UT MD Anderson Cancer Center, Houston, TX, United States of America
- Department of Neurosurgery, UT MD Anderson Cancer Center, Houston, TX, United States of America
- * E-mail:
| |
Collapse
|
7
|
Naaz S, Ravindra P, Kumar G, Venugopal R, Ramajayam G, Sasidharan A, Kutty B. Age associated changes in sleep spindle characteristics in Vipasana meditator: A whole night polysomnography study. Sleep Med 2022. [DOI: 10.1016/j.sleep.2022.05.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
|
8
|
Swathi P, Kumar G, Jeyabalan R, Nishanthini R. Perfectly antimagic total graphs. IFS 2022. [DOI: 10.3233/jifs-221279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
An one-one correspondence function λ from V (G) ∪ E (G) to the set {1, 2, …, |V (G) | + |E (G) |} is a total labeling of a finite undirected graph G without loops and multiple edges, where |V (G) |and |E (G) | are the cardinality of vertex and edge set of G respectively. A perfectly antimagic total labeling is a totally antimagic total labeling whose vertex and edge-weights that are also pairwise distint. Perfectly antimagic total (PAT) graph is a graph having such labeling. The topic of discovering perfectly antimagic total labeling of some families of graphs is discussed in this paper. We also came up with certain conclusions about dual of a perfectly antimagic total graphs. Finally, we provided that the necessary and sufficient condition for a dual of a regular and irregular PAT graph to be a PAT graph.
Collapse
Affiliation(s)
- P. Swathi
- Department of Mathematics, Alagappa University, Karaikudi, Tamilnadu, India
| | - G. Kumar
- GHS, Parayankulam, Sivaganga, Tamilnadu, India
| | - R. Jeyabalan
- Department of Mathematics, Alagappa University, Karaikudi, Tamilnadu, India
| | - R. Nishanthini
- Department of Mathematics, Alagappa University, Karaikudi, Tamilnadu, India
| |
Collapse
|
9
|
Kumar G, Pandey A. Selfish Genetic Drive of B Chromosomes in Diploid and Autotetraploid Coriander (Coriandrum sativum L.). CYTOL GENET+ 2022. [DOI: 10.3103/s0095452722050073] [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]
|
10
|
Moura A, Delforno T, Rabelo C, Kumar G, Silva E, Varesche M. Iron and Nickel nanoparticles role in volatile fatty acids production enhancement: functional genes and bacterial taxonomy in an anaerobic fluidized bed reactor. Biochem Eng J 2022. [DOI: 10.1016/j.bej.2022.108656] [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: 11/02/2022]
|
11
|
Vinayan Changaradil D, Abdulla N, Kyaw K, Kumar G, Sreedharan H, Moran N, Flores Caimanque L. 073 Posterior reversible encephalopathy syndrome (PRES) complicating anti-NMDA receptor encephalitis (NMDARE) with ovarian teratoma. J Neurol Neurosurg Psychiatry 2022. [DOI: 10.1136/jnnp-2022-abn.110] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
IntroductionAnti-N-methyl-D-aspartate receptor antibody-associated encephalitis (NMDARE) is a form of autoimmune encephalitis typically affecting young women, often associated with an ovarian teratoma. Clinical features include psychiatric disturbances, seizures, dyskinesia, dysautonomia, and cardiac dys- rhythmias. Here we present a case of NMDARE complicated by posterior reversible encephalopathy syndrome (PRES). This complication has not been reported previously.CaseA 17-year-old girl presented with acute psychosis. The neurological examination was unremark- able. MRI brain revealed left hippocampal T2 signal hyperintensity; there was a CSF lymphocytosis. NMDA-receptor antibodies in serum and CSF were detected and intravenous methylprednisolone was commenced. Progressive agitation lead to ITU admission. Plasma exchange and intravenous immuno- globulins were administered. MRI pelvis revealed a left ovarian cyst which was removed (laparoscopic salpingo-oophrectomy). Gross inspection and histopathology confirmed an ovarian teratoma. Persistently elevated blood pressure was noted for a week on ITU, associated with clinical deterioration. Rituximab was administered. A repeat MRI brain the next day revealed hyperintensities in temporo-parietal and occipital regions consistent with PRES. The second dose of rituximab was withheld. Clinical and radiologi- cal improvement was noted after a week, and the patient was discharged home.DiscussionEncephalitis mediated dysautonomia may lead to disruption of cerebral autoregulation cul- minating in PRES. The administration of rituximab may also have contributed. This case exemplifies the uncommon complications associated with NMDARE.dr.dvinayan@gmail.com
Collapse
|
12
|
Mishra V, Desai R, Chhina AK, Raina J, Itare V, Patel M, Doshi R, Gangani K, Sachdeva R, Kumar G. Cardiovascular disease risk factors and outcomes of acute myocardial infarction in young adults in two nationwide cohorts in the united states. Eur J Prev Cardiol 2022. [DOI: 10.1093/eurjpc/zwac056.045] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Acute myocardial infarction (AMI) can have considerable morbidity and devastating socioeconomic and psychological consequences in young adults. Previous studies reveal that the decline in mortality in AMI has mainly been in the older population while being comparatively less significant in younger patients. This study compares young adults (18 to 44 years) hospitalized with AMI across two nationwide cohorts, 2007 and 2017, in the United States (US). It examines the burden of AMI hospitalizations, the prevalence of comorbidities, and in-hospital outcomes in young adults a decade apart. It highlights the rise in AMI hospitalizations, lack of decrease in mortality, sex-based and racial disparities, the surge in post-MI complications, and the decline in reperfusion interventions in young AMI patients over a decade.
Purpose
Coronary heart disease prevalence is challenging to ascertain in younger adults because of limited data and frequent silent clinical presentations. AMI and its complications can cause considerable morbidity, psychological trauma, and socioeconomic burden in the young.
Methods
We identified hospitalizations for AMI in young adults in 2007 and 2017 using the weighted data from the National Inpatient Sample (NIS), which covers 20% of stratified data of all non-federal community hospitals in the US. We compared the following data between the two cohorts: admission rates, sociodemographic features, in-hospital morbidity, complications, mortality, rate of coronary interventions, and healthcare utilization between the two cohorts. We used Pearson’s Chi-square test and Mann-Whitney U test to compare categorical and continuous variables, respectively. We also applied multivariable regression analyses to assess and compare the risk of cardiovascular complications and in-hospital mortality while controlling for confounders, including age, sex, race, median household income quartile, primary insurance enrolment, and pre-existing comorbidities.
Results
AMI’s incidence was higher in males in both the cohorts, although with a decline (71.1% vs 66.1%), whereas it rose from 28.9% to 33.9% in females. Hypertension (47.8% vs 60.7%), smoking (49.7% vs 55.8%), obesity (14.8% vs 26.8%), and diabetes mellitus (22.0% vs 25.6%) increased in the 2017 cohort (Table 1). We found no significant difference in all-cause mortality (aOR = 1.01 (0.93-1.10), p=0.749). Post-AMI complications, cardiogenic shock (aOR = 1.16 (1.06-1.27), p=0.001), and fatal arrhythmias increased. Reperfusion interventions decreased in the 2017 cohort (PCI; aOR=0.95 (0.91-0.98), p<0.001; CABG; aOR=0.66 (0.61-0.71), p<0.001) (Table 2).
Conclusion
Our study highlights the rise in AMI hospitalizations, plateauing of mortality, gender disparity, the surge in post-MI complications, and a reassuring decline in the requirement of reperfusion interventions in young AMI patients over a decade.
Collapse
Affiliation(s)
- V Mishra
- Sir JJ Group of Hospitals, Mumbai, India
| | - R Desai
- Atlanta VA Medical Healthcare System, Cardiology, Atlanta, United States of America
| | - AK Chhina
- Washington D.C. Va Medical Center, Washington, DC, United States of America
| | - J Raina
- Brookdale University Hospital & Medical Center, Internal Medicine, Brooklyn, United States of America
| | - V Itare
- Brookdale University Hospital & Medical Center, Internal Medicine, Brooklyn, United States of America
| | - M Patel
- Smt. BK Shah Medical Institute and Research Centre, Medicine, Vadodara, India
| | - R Doshi
- St Joseph’s Regional Medical Center, Paterson, United States of America
| | - K Gangani
- Texas Health Arlington Memorial Hospital, Internal Medicine, Arlington, Texas, USA
| | - R Sachdeva
- Atlanta VA Medical Healthcare System, Cardiology, Atlanta, United States of America
| | - G Kumar
- Atlanta VA Medical Healthcare System, Cardiology, Atlanta, United States of America
| |
Collapse
|
13
|
Balaji G, Kumar G, Jagadevan M, Ramalingam T, Barathi D, Singh Gaur G. Impact of Structural and Physiological Changes in the Vastus Medialis Muscle Following Anterior Cruciate Ligament Injury and Reconstruction on Short Term Patient-Reported Knee Function. Muscles Ligaments Tendons J 2022. [DOI: 10.32098/mltj.02.2022.09] [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: 11/05/2022]
|
14
|
Sussman S, Linnenbach A, Harshyne L, South A, Kumar G, Alnemri A, Urdang Z, Anderson-Pullinger L, Mahoney M, Argiris A, Johnson J, Luginbuhl A, Martinez-Outschoorn U, Curry J. Differential Activation of Cancer-Associated Fibroblasts in HPV-Associated Head and Neck Squamous Cell Carcinoma Patients Detected Using Spatial Transcriptomics. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2021.12.083] [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: 11/16/2022]
|
15
|
Rajeswari G, Prabavathi N, Tamizhdurai P, Prakasam A, Kumar G. Enhancement of the structure, solar cells and vibrational studies of undoped CuCr2O4 and La-doped CuCr2O4 semiconductor compounds. Heliyon 2022; 8:e09233. [PMID: 35392397 PMCID: PMC8980336 DOI: 10.1016/j.heliyon.2022.e09233] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 10/19/2021] [Revised: 12/30/2021] [Accepted: 03/29/2022] [Indexed: 11/30/2022] Open
Abstract
In the present paper, we report the successful synthesis of spinel-type of CuCr2O4 and La doped CuCr2O4 semiconductor nanoparticles by a microwave method. Starting with the precursor complex, this technique includes the creation of homogenous solid intermediates, which reduces atomic diffusion pathways during the microwave process. CuCr2O4 and La doped CuCr2O4 were characterized by the following analytical methods for instance X-ray diffraction (XRD), transmission electron microscopy (TEM), Ultraviolet–visible (UV–Vis) spectroscopy and Fourier transform infrared spectroscopy (FTIR). The results demonstrated that modifying the precursor had a significant impact on the size, solar cell size, as well as reaction period of synthesizing CuCr2O4 and La doped CuCr2O4. The impacts of precursors on the morphological and structural characteristics of CuCr2O4 and La doped CuCr2O4 were examined for the first time in this publication.
Collapse
Affiliation(s)
- G. Rajeswari
- Department of Physics, Sri Sarada College for Women (Autonomous), Salem, 636016, India
| | - N. Prabavathi
- Department of Physics, Sri Sarada College for Women (Autonomous), Salem, 636016, India
- Corresponding author.
| | - P. Tamizhdurai
- Department of Chemistry, Dwaraka Doss Goverdhan Doss Vaishnav College (Autonomous), E.V.R. Periyar Road, Arumbakkam, Chennai, Tamil Nadu, 600 106, India
- Corresponding author.
| | - A. Prakasam
- Department of Physics, Thiruvalluvar Government Arts College, Rasipuram, Tamil Nadu, 637401, India
- Corresponding author.
| | - G. Kumar
- Department of Chemistry, Presidency College (autonomous), Chennai, Tamil Nadu, 600 005, India
| |
Collapse
|
16
|
Kumar G, Srinivasan N, Sandhya S. Profiles of Natural and Designed Protein-Like Sequences Effectively Bridge Protein Sequence Gaps: Implications in Distant Homology Detection. Methods Mol Biol 2022; 2449:149-167. [PMID: 35507261 DOI: 10.1007/978-1-0716-2095-3_5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Sequence-based approaches are fundamental to guide experimental investigations in obtaining structural and/or functional insights into uncharacterized protein families. Powerful profile-based sequence search methods rely on a sequence space continuum to identify non-trivial relationships through homology detection. The computational design of protein-like sequences that serve as "artificial linkers" is useful in identifying relationships between distant members of a structural fold. Such sequences act as intermediates and guide homology searches between distantly related proteins. Here, we describe an approach that represents natural intermediate sequences and designed protein-like sequences as HMM (Hidden Markov Models) profiles, to improve the sensitivity of existing search methods. Searches made within the "Profile database" were shown to recognize the parent structural fold for 90% of the search queries at query coverage better than 60%. For 1040 protein families with no available structure, fold associations were made through searches in the database of natural and designed sequence profiles. Most of the associations were made with the Alpha-alpha superhelix, Transmembrane beta-barrels, TIM barrel, and Immunoglobulin-like beta-sandwich folds. For 11 domain families of unknown functions, we provide confident fold associations using the profiles of designed sequences and a consensus from other fold recognition methods. For two DUFs (Domain families of Unknown Functions), we performed detailed functional annotation through comparisons with characterized templates of families of known function.
Collapse
Affiliation(s)
- Gayatri Kumar
- Molecular Biophysics Unit, Indian Institute of Science, Bangalore, Karnataka, India
| | | | - Sankaran Sandhya
- Molecular Biophysics Unit, Indian Institute of Science, Bangalore, Karnataka, India.
- Department of Biotechnology, Faculty of Life and Allied Health Sciences, M.S. Ramaiah University of Applied Sciences, Bangalore, Karnataka, India.
| |
Collapse
|
17
|
Kumar G, Singh NK, Srivastava M. Comparative Phytochemical Investigation and Antioxidant Activity in Different Parts of Acacia nilotica Seed. Indian J Pharm Sci 2022. [DOI: 10.36468/pharmaceutical-sciences.949] [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: 11/22/2022] Open
|
18
|
Aspari AR, Ramesh V, Kumar G, Narayanasamy SN, Gumber AO, Thomas PF. TP1.2.3Oncological Outcomes of Organ Preservation Strategies - Local Excision Procedures and ‘Watchful Waiting’ In Management of Low Rectal Cancers – A Systematic Review And Meta-Analysis. Br J Surg 2021. [DOI: 10.1093/bjs/znab362.002] [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: 11/13/2022]
Abstract
Abstract
Objective
To evaluate local recurrence, metastases, and survival outcomes of `wait and watch’ (WW) strategy and local excision (LE) of tumours, in comparison to the present standard practice of total mesorectal excision (TME) for locally advanced rectal cancers.
Data Sources
MEDLINE, EMBASE, PubMed databases, and sources of Grey literature.
Study Selection
Randomised and non-randomised prospective studies, retrospective studies with propensity-score-matched analyses.
Data Extraction and Synthesis
These were carried out independently by two reviewers. A random-effects methodology was used for meta-analyses. Data was presented keeping with the 27-item PRISMA checklist.
Main Outcomes
The primary outcomes of interest were local recurrence, distant metastases, disease-free-survival and overall-survival, which were assessed in comparison to those associated with radical surgeries (TME).
Results
7 of the 16 studies in the systematic review were included for the quantitative synthesis and meta-analysis. Local recurrence rates were comparable amongst patients in WW group and LE group to those undergoing TME. [Risk ratio (RR) 3.07/1.41; 95% Confidence Interval (CI) 0.86-10.95/0.66-3.01; P = 0.08/P=0.89 respectively]. Rates of distant metastases in the WW group and LE group were comparable to those undergoing TME [RR = 0.71/0.94; 95% CI 0.22-2.30/0.55-1.61; P = 0.56/ P = 0.83 respectively]. The median 3-year disease-free survival among patients undergoing WW, LE procedure, and TME were 88%, 80%, and 78.2% respectively; and the median 3-year overall survival among the three groups were 96%, 93%, and 89.5% respectively.
Conclusions and Relevance
Organ-preservation strategies appear to be a viable treatment option in the management of rectal-cancers. Further research is warranted to provide stronger levels of evidence on organ-preservation strategies.
Collapse
Affiliation(s)
- A R Aspari
- Southend University Hospital, Mid and South Essex NHS Foundation Trust, Westcliff on Sea, United Kingdom
| | - V Ramesh
- Broomfield Hospital, Mid and South Essex NHS Foundation Trust, Broomfield, United Kingdom
| | - G Kumar
- Royal Bolton Hospital, Bolton, United Kingdom
| | - S N Narayanasamy
- Queens Hospital, University Hospitals of Derby and Burton NHS Foundation Trust, Burton on Trent, United Kingdom
| | - A O Gumber
- University Hospital of Wishaw, Wishaw, United Kingdom
| | - P F Thomas
- Queens Hospital, University Hospitals of Derby and Burton NHS Foundation Trust, Burton on Trent, United Kingdom
| |
Collapse
|
19
|
Ramesh V, Aspari AR, Narayanasamy SN, Kumar G, Gumber AO, Thomas PF. TP1.2.6Functional Outcomes of Organ Preservation Strategies - Local Excision Procedures and 'Watchful-Waiting' In Management of Low Rectal Cancers - A Systematic Review. Br J Surg 2021. [DOI: 10.1093/bjs/znab362.005] [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: 11/14/2022]
Abstract
Abstract
Objective
To evaluate functional outcomes and quality of life (QOL) associated with `wait-and-watch’ (WW) strategy and local-excision (LE) of rectal tumours after neo-adjuvant therapy, in comparison to the standard practice of total-mesorectal-excision (TME) for locally-advanced-rectal-cancers.
Data Sources
Medline, EMBASE, PubMed databases, and sources of Grey literature.
Study Selection
Randomised and non-randomised prospective studies, and retrospective studies with propensity-score-matched analyses analysing outcomes of WW and LE procedures for rectal cancer.
Data Extraction and Synthesis
Risk of bias assessments and data extraction were carried out independently by two reviewers. A narrative synthesis of data was presented keeping with the 27-item PRISMA checklist.
Main Outcomes
The outcomes of interest were those of faecal-incontinence (FI), bowel and rectal-evacuatory function, sexual-function, stoma-free-survival, and quality-of-life scores, which were assessed in comparison to those associated with radical surgeries.
Results
7 studies reported functional outcomes. Faecal-incontinence, bowel, and rectal-evacuatory-function assessed by various scoring systems were found to be least affected among patients on WW strategy, followed by those undergoing local excision and most in patients undergoing TME. These reflected on the quality of life assessments (FIQOL and FACT-C questionnaires). Sexual dysfunction was not higher among patients who underwent LE compared to TME. Advantage of stoma-free-survival with organ preservation strategies was realised for up to 2 years after treatment.
Conclusions
Organ-preservation strategies appear to have a favourable functional outcome compared to the gold standard of TME for up to 2 years after the commencement of treatment. Further research is warranted to provide stronger levels of evidence regarding the same.
Collapse
Affiliation(s)
- V Ramesh
- Broomfield Hospital, Mid and South Essex NHS Foundation Trust, Broomfield, United Kingdom
| | - A R Aspari
- Southend University Hospitals, Mid and South Essex Hospitals NHS Foundation Trust, Westcliff on Sea, United Kingdom
| | - S N Narayanasamy
- Queens Hospital, University Hospitals of Derby and Burton NHS Foundation Trust, Burton on Trent, United Kingdom
| | - G Kumar
- Royal Bolton Hospital, Bolton, United Kingdom
| | - A O Gumber
- University Hospital of Wishaw, Wishaw, United Kingdom
| | - P F Thomas
- Queens Hospital, University Hospitals of Derby and Burton NHS Foundation Trust, Burton on Trent, United Kingdom
| |
Collapse
|
20
|
Abdeen B, Alaaraj M, Alkilani Y, Ahmad SB, Ahmed U, Kumar G. 483 A Quality Improvement Project: Novel Electronic Operative Note Templates to Improve the Continuity of Post-Operative Patient Care. Br J Surg 2021. [DOI: 10.1093/bjs/znab259.741] [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: 11/13/2022]
Abstract
Abstract
Introduction
Good Surgical Practice from RCS England encourages the use of e-health records and detailed typed operative notes. The Covid-19 pandemic has led to multi-site operating. ENT operations in our trust were split over three sites including the private sector leading to potential disruption in continuity of patient care. Physical operation notes are difficult to access in emergencies, telephonic clinics or for audit purposes. We aim to have operative notes available on patients’ e-records which adhere to RCSEng guidelines.
Method
In this QIP, we reviewed all ENT operations over a retrospective one-month period recording percentage of notes uploaded to patient e-record and the number of surgeons in theatre. We created two novel RCSEng compliant e-operative notes with a user guide, generic and tonsillectomy-specific, and prospectively collected data to complete the cycle.
Results
261 patients were included in both study periods. Only 36/134(27%) had e-operative pre-intervention improving to 71/127(56%) post-intervention. In the latter period, 76% of operations included a registrar and were more likely to have e-operative notes(72%) compared to when a consultant was operating alone(6%). There was low uptake of our tonsillectomy e-proforma(33%).
Conclusions
Our QIP has already proved effective with our templates increasing operative documentation on e-records. Increased use of e-template was more likely with the presence of a registrar in theatre. Room for improvement remains and we will re-audit after the introduction of further user-friendly operative templates and IT training. This QIP has also revealed additional operative training opportunities of which registrars can take advantage.
Collapse
Affiliation(s)
- B Abdeen
- Barking, Havering, and Redbridge NHS Trust, London, United Kingdom
| | - M Alaaraj
- Barking, Havering, and Redbridge NHS Trust, London, United Kingdom
| | - Y Alkilani
- Barking, Havering, and Redbridge NHS Trust, London, United Kingdom
| | - S B Ahmad
- Barking, Havering, and Redbridge NHS Trust, London, United Kingdom
| | - U Ahmed
- Barking, Havering, and Redbridge NHS Trust, London, United Kingdom
| | - G Kumar
- Barking, Havering, and Redbridge NHS Trust, London, United Kingdom
| |
Collapse
|
21
|
Kumar G, Rajani Singh. Deciphering Enigmatic Response of B Chromosomes on Genetic Recombination of Artemisia annua L. CYTOL GENET+ 2021. [DOI: 10.3103/s0095452721040083] [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]
|
22
|
Selvaraj N, Narasimhan R, Addla S, Kumar G. Perioperative outcomes of open, laparoscopic and robotic adrenalectomy: A multicenter experience. Eur Urol 2021. [DOI: 10.1016/s0302-2838(21)01072-1] [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: 10/20/2022]
|
23
|
Abstract
Trauma is a major cause of death in the United States, particularly in the younger population. Many traumatic deaths, as well as major morbidity, occur secondary to uncontrolled hemorrhage and eventual exsanguination. Interventional radiology plays a major role in treating these patients, and interventional techniques have evolved to the point where they are an integral part of treatment in these critically ill patients. This article reviews the role of interventional radiology in the treatment algorithms for traumatic injury sponsored by major societies and associations.
Collapse
Affiliation(s)
- A S Pillai
- University of Texas, Medical Branch Galveston, Galveston, Texas
| | - S Srinivas
- University of Texas, Medical Branch Galveston, Galveston, Texas
| | - G Kumar
- Southwestern Medical Center, University of Texas, Dallas, Texas
| | - A K Pillai
- Southwestern Medical Center, University of Texas, Dallas, Texas
| |
Collapse
|
24
|
Abstract
This review summarizes the transition metal-catalyzed direct C–H functionalization
of quinazolinones and quinazolines through C-C, C-N and C-O bond formations. It focuses
mainly on the C-H (sp<sup>2</sup> or sp<sup>3</sup>) bond arylation, amination, sulfamidation, acetoxylation,
halogenation, annulation of quinazolinones and quinazolines. This review illustrates the scope
of C-H activation and functionalization of various quinazolinone and quinazoline derivatives.
Collapse
Affiliation(s)
- N. Umadevi
- Indian Institute of Chemical Technology, Hyderabad, India
| | - G. Kumar
- Department of Chemistry, Yogi Vemana University, Kadapa, Andhra Pradesh, India
| | - N.C. Gangi Reddy
- Department of Chemistry, Yogi Vemana University, Kadapa, Andhra Pradesh, India
| | | |
Collapse
|
25
|
Kiran M, Alsousou J, Dalal N, Ralte P, Kumar G, Kapoor B. Is a single dose of preoperative antibiotic therapy effective for patients treated with megaendoprosthesis after metastatic bone tumour resection? Musculoskelet Surg 2021; 106:187-193. [PMID: 33400185 DOI: 10.1007/s12306-020-00692-6] [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: 09/11/2020] [Accepted: 12/16/2020] [Indexed: 10/22/2022]
Abstract
Purpose The timing and number of doses of antibiotics required for megaendoprosthetic replacement (MPR) in metastatic bone disease (MBD) is a matter of debate. The aim of our study is to present the results of a prospective cohort of MPR for MBD receiving a single dose of antibiotic at induction of anaesthesia. METHODS All patients who underwent primary MPR in MBD were included in this prospective study. All penicillin-sensitive patients received one dose of cefuroxime 1.5gm intravenous at induction. In penicillin-allergic patients, teicoplanin 1.2gm and ciprofloxacin 500 mg intravenous was administered. The patients were followed up in the wound clinic and the specialist MBD clinic at 2 weeks, 3 months, 6 months and then annually. Data collected included demographics, primary tumours, surgical procedures, complications and duration of follow-up. All calculations were performed using SPSS® 25(IBM, USA). A p value ≤ 0.05 was considered to be significant. RESULTS There were 51 patients with a mean age of 65.4 years. Procedures included proximal femoral replacement (35), distal femoral replacement (7), proximal humeral replacement (4), distal humeral replacement (3) and total femoral replacement (2). Thirty-seven patients received cefuroxime, and fourteen patients received teicoplanin and ciprofloxacin at induction of anaesthesia. The deep infection rate was 1.9%. Thirty-seven patients died with a median survival of 10 months (1 to 51 months). Mean follow-up was 18.9 months (1 to 70 months). CONCLUSION Single dose of preoperative antibiotics at anaesthetic induction seems to be safe and effective for preoperative prophylaxis in orthopaedic oncology.
Collapse
Affiliation(s)
- M Kiran
- Department of Trauma and Orthopaedics, Liverpool University Hospitals NHS Foundation Trust, Liverpool, L7 8XP, UK.
| | - J Alsousou
- Department of Trauma and Orthopaedics, Liverpool University Hospitals NHS Foundation Trust, Liverpool, L7 8XP, UK
| | - N Dalal
- Department of Trauma and Orthopaedics, Liverpool University Hospitals NHS Foundation Trust, Liverpool, L7 8XP, UK
| | - P Ralte
- Department of Trauma and Orthopaedics, Liverpool University Hospitals NHS Foundation Trust, Liverpool, L7 8XP, UK
| | - G Kumar
- Department of Trauma and Orthopaedics, Liverpool University Hospitals NHS Foundation Trust, Liverpool, L7 8XP, UK
| | - B Kapoor
- Department of Trauma and Orthopaedics, Liverpool University Hospitals NHS Foundation Trust, Liverpool, L7 8XP, UK
| |
Collapse
|
26
|
Kumar R, Rai B, Gahlyan S, Kumar G. A comprehensive review on production, surface modification and characterization of nanocellulose derived from biomass and its commercial applications. EXPRESS POLYM LETT 2021. [DOI: 10.3144/expresspolymlett.2021.11] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
|
27
|
Tortora D, Morgan R, Kumar G, Ritch E, McConeghy B, Sinha S, Johnson A, Wong J, Thaper D, Truong S, Nelepcu I, Black P, Daugaard M. Regulation of PPARγ expression in luminal muscle invasive bladder cancer. Urol Oncol 2020. [DOI: 10.1016/j.urolonc.2020.10.051] [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: 11/26/2022]
|
28
|
Matumoto T, Chen Y, Contreras-Sanz A, Ikeda K, Schulz G, Gao J, Zarni Oo H, Roberts M, da Costa JB, Nykopp TK, Kumar G, Sano T, Black PC. FBXW7 loss of function contributes to worse overall survival and is associated with accumulation of MYC in muscle invasive bladder cancer. Urol Oncol 2020. [DOI: 10.1016/j.urolonc.2020.10.048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
29
|
Peedell C, Aynsley E, Wood A, Kumar G, Masinghe S, Reynolds J, Huntley C, Blower A, Green J, Bradley J, Veeratterapillay J, Hassani A, Anderson M, Greenhalgh A, Daniel J, Swingler A, Turnbull M, Burke K. PO-0988: Is there a learning curve for SABR that affects overall survival outcomes in early stage NSCLC? Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)01005-7] [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]
|
30
|
Hanna B, Desai R, Sachdeva S, Singh S, Gangani K, Taha Y, Echols M, Paul T, Berman A, Bloom H, Kumar G, Sachdeva R. Pulmonary artery injury in left atrial appendage closure device implantation: a systematic review of a potentially fatal complication. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0667] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Pulmonary artery (PA) injury is a rarely reported complication following percutaneous left atrial appendage closure (LAAC). This study aims to systematically review all reported cases of PA injury associated with LAAC.
Methods
PubMed/Medline, SCOPUS, EMBASE, Google Scholar and the MAUDE databases were searched to find studies reporting PA injury during or after LAAC with the Amplatzer Amulet (AA), Amplatzer Cardiac Plug (ACP) or Watchman device through October 2019. Categorical data were reported in terms of numbers and/or percentages (%).
Results
We found 13 cases (mean age 71.4 yrs) with reported PA injury associated with LAAC. Of these, 9 were case reports, 3 were reported in observational studies, and 1 was in the MAUDE database. Most cases (n=8) were reported in Europe followed by Australia (n=2) and Asia (n=2). The indication for device implantation in all patients was a high bleeding risk with anticoagulation for atrial fibrillation. Five cases were reported with the ACP (1/5 patients died), 5 with AA (2/5 patients died), and 3 with the Watchman (1/2 patients died). Acute and late presentations following implantation were reported for all three devices. 69.2% of cases (9/13) occurred acutely (during or within 24 hours of intervention). Of these, 3/9 occurred during device implantation. 2/4 of the delayed cases occurred >2 weeks following implantation. The mortality rate for acute and delayed cases was 22% (2/9 patients) and 50% (2/4 patients), respectively. A majority of the cases were attributable to barb/strut/hook injury of the PA. PA injury was associated with a mortality rate of approximately 31%. All surviving patients were managed with surgical intervention.
Conclusion
PA injury is an infrequently reported complication following LAAC and is associated with high mortality. Cases can present acutely (intra-procedurally or within 24 hours) or delayed (>24 hours post-implantation). A majority of cases are due to direct injury of the PA by the struts/hooks/barbs of the device. Practitioners should be cognizant of this life-threatening complication, which requires a high index of suspicion for diagnosis and can occur weeks after device implantation.
Funding Acknowledgement
Type of funding source: None
Collapse
Affiliation(s)
- B Hanna
- Morehouse School of Medicine, Atlanta, United States of America
| | - R Desai
- Atlanta Veterans Affairs Medical Center, Cardiology, Atlanta, United States of America
| | - S Sachdeva
- Lady Hardinge Medical College and Hospitals, Department of Medicine, New Delhi, India
| | - S Singh
- Amsterdam University Medical Center, Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam, Netherlands (The)
| | - K Gangani
- Texas Health Arlington Memorial Hospital, Department of Internal Medicine, Arlington, Texas, United States of America
| | - Y Taha
- Morehouse School of Medicine, Atlanta, United States of America
| | - M Echols
- Morehouse School of Medicine, Atlanta, United States of America
| | - T.K Paul
- East Tennessee State University, Division of Cardiology, Johnson city, Tennessee, United States of America
| | - A Berman
- Augusta University, Augusta, United States of America
| | - H Bloom
- Atlanta Veterans Affairs Medical Center, Cardiology, Atlanta, United States of America
| | - G Kumar
- Atlanta Veterans Affairs Medical Center, Cardiology, Atlanta, United States of America
| | - R Sachdeva
- Morehouse School of Medicine, Atlanta, United States of America
| |
Collapse
|
31
|
Desai R, Sachdeva S, Singh S, Rajan S, Shaik A, Haider M, Fong H, Gangani K, Sachdeva R, Kumar G. Rates and causes of readmissions following index admissions for Takotsubo syndrome-a meta-analysis of 118,941 index hospitalizations. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1246] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Rising trends in takotsubo syndrome (TTS)-related complications warrant data to identify the rate, causes and predictors of readmission on a large scale. We conducted the first-ever meta-analysis to evaluate the pooled rate of short-term and long-term readmissions after index TTS admissions.
Methods
PubMed/Medline, EMBASE and SCOPUS databases were systematically reviewed to find studies through October 2019 reporting rates and causes of readmission following index TTS admissions. Random effects models were used to estimate pooled rates and causes of readmissions and I2 statistics were used to report inter-study heterogeneity.
Results
A total of 16 cohorts with 118,941 TTS index admissions (mean age 65–75 yrs; female >85%, median follow-up 272.5 days) revealed a 16.6% [95% CI-13.2%-20.3%, I2=99%] pooled rate of readmission. Short-term and long-term pooled readmission rates are displayed in Fig.1. The readmission rate was higher in cohorts with young patients (<70 vs. >70 yrs), smaller sample size (n<100 vs. n>100) and single-centres vs. multicentres. Studies published from the USA (16.4% vs. 14.9%) had a higher readmission rate as compared to Italy. The most frequent causes were cardiac (40.6%), respiratory (15.7%) and renal (7.0%). Among readmissions with cardiac diagnoses, heart failure was most common (40.1%).
Conclusions
This global meta-analysis revealed that the pooled rate of readmission following index TTS admissions was ∼17% and causes were mainly cardiac or respiratory.
Funding Acknowledgement
Type of funding source: None
Collapse
Affiliation(s)
- R Desai
- Atlanta Veterans Affairs Medical Centre, Division of Cardiology, Atlanta, United States of America
| | - S Sachdeva
- Lady Hardinge Medical college and hospitals, Delhi, India
| | - S Singh
- Amsterdam University Medical Center, Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam, Netherlands (The)
| | - S.K Rajan
- Medical City Plano, Department of Medicine, plano, Texas, United States of America
| | - A.S Shaik
- Silver Lane Medical Centre, Department of Medicine, East Hartford, Connecticut, United States of America
| | - M Haider
- New York-Presbyterian Hospital, Department of Internal Medicine, New York, United States of America
| | - H.K Fong
- UC Davis Medical Centre, Division of Cardiovascular Medicine, Sacramento, United States of America
| | - K Gangani
- Texas Health Arlington Memorial Hospital, Department of Internal Medicine, Arlington, Texas, United States of America
| | - R Sachdeva
- Morehouse School of Medicine, Atlanta VA Medical centre & Medical College of Georgia, Division of Cardiology, Augusta,Georgia, United States of America
| | - G Kumar
- Emory University & Atlanta VA Medical Centre, Division of Cardiology, Atlanta, Georgia, United States of America
| |
Collapse
|
32
|
Kumar G, Loganathan S, Paraoan M. Laparoscopic management of omental infarction mimicking acute appendicitis - a video vignette. Colorectal Dis 2020; 22:1810. [PMID: 33411394 DOI: 10.1111/codi.15259] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 04/03/2020] [Indexed: 02/08/2023]
Affiliation(s)
- G Kumar
- Department of General Surgery, Wrightington, Wigan and Leigh NHS FT, Wigan, UK
| | - S Loganathan
- Department of General Surgery, Wrightington, Wigan and Leigh NHS FT, Wigan, UK
| | - M Paraoan
- Department of General Surgery, Wrightington, Wigan and Leigh NHS FT, Wigan, UK
| |
Collapse
|
33
|
Kumar G, Srinivasan N, Sandhya S. Artificial protein sequences enable recognition of vicinal and distant protein functional relationships. Proteins 2020; 88:1688-1700. [PMID: 32725917 DOI: 10.1002/prot.25986] [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: 04/14/2020] [Revised: 06/29/2020] [Accepted: 07/26/2020] [Indexed: 11/07/2022]
Abstract
High divergence in protein sequences makes the detection of distant protein relationships through homology-based approaches challenging. Grouping protein sequences into families, through similarities in either sequence or 3-D structure, facilitates in the improved recognition of protein relationships. In addition, strategically designed protein-like sequences have been shown to bridge distant structural domain families by serving as artificial linkers. In this study, we have augmented a search database of known protein domain families with such designed sequences, with the intention of providing functional clues to domain families of unknown structure. When assessed using representative query sequences from each family, we obtain a success rate of 94% in protein domain families of known structure. Further, we demonstrate that the augmented search space enabled fold recognition for 582 families with no structural information available a priori. Additionally, we were able to provide reliable functional relationships for 610 orphan families. We discuss the application of our method in predicting functional roles through select examples for DUF4922, DUF5131, and DUF5085. Our approach also detects new associations between families that were previously not known to be related, as demonstrated through new sub-groups of the RNA polymerase domain among three distinct RNA viruses. Taken together, designed sequences-augmented search databases direct the detection of meaningful relationships between distant protein families. In turn, they enable fold recognition and offer reliable pointers to potential functional sites that may be probed further through direct mutagenesis studies.
Collapse
Affiliation(s)
- Gayatri Kumar
- Molecular Biophysics Unit, Indian Institute of Science, Bangalore, India
| | | | - Sankaran Sandhya
- Molecular Biophysics Unit, Indian Institute of Science, Bangalore, India
| |
Collapse
|
34
|
Seth G, Sundaresh A, Mariaselvam CM, Kumar G, Chengappa KG, Adarsh MB, Tamouza R, Negi VS. Immunological biomarkers in neuropsychiatric systemic lupus erythematosus: a comparative cross-sectional study from a tertiary care center in South India. Lupus 2020; 29:413-420. [PMID: 32106787 DOI: 10.1177/0961203320908940] [Citation(s) in RCA: 4] [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] [Indexed: 11/16/2022]
Abstract
INTRODUCTION The prevalence of various immunological biomarkers in neuropsychiatric systemic lupus erythematosus (NPSLE) differs among various patients with varied neuropsychiatric manifestations and different populations. We studied the prevalence of these biomarkers; especially the neuron specific autoantibodies in patients with systemic lupus erythematosus (SLE) and compared them among patients with and without neuropsychiatric involvement. METHODOLOGY This is a comparative cross-sectional study conducted in a tertiary care hospital in South India. The prevalence of immunological biomarkers including complement levels, systemic and brain specific autoantibodies (anti-myelin antibody, anti-myelin oligodendrocyte glycoprotein and anti-myelin-associated glycoprotein antibody) were assessed and compared among those with and without NPSLE and with different NPSLE manifestations. RESULTS A total of 522 SLE patients were enrolled in the study. The mean age of the study participants was 28.5 ± 8.8 years and 93.5% were women. Neuropsychiatric manifestations were seen in 167 (32%) patients. Seizure was the most common neuropsychiatric manifestation seen in 41.3%, followed by psychosis (18.6%), mood disorder (16.8%), stroke (10.8%), mononeuropathy (10.2%), headache (9.6%), acute confusional state (6.6%) and aseptic meningitis (5.4%). Patients with NPSLE had a higher SLE disease activity index score. Most of the autoantibodies, that is anticardiolipin antibody (aCL), anti-β2 glycoprotein 1 antibody (β2GP1), lupus anticoagulant (LA), anti-nucleosome, anti-ribosomal P, anti-Ro52, anti-Ro60 and anti-La, were seen in higher proportion in the NPSLE group, although the difference failed to reach statistical significance. On subgroup analysis, psychosis was significantly higher in patients with anti-ribosomal P positivity than without (11.8% versus 4.1%, p.0.007; odds ratio (OR) 3.1, confidence interval (CI) 1.4-6.8), while stroke had a higher proportion among those with positive b2GP1 IgG (6.3% versus 1.8%, p.0.03; OR 3.6, CI 1.2-11.0). A higher proportion of demyelination was seen among the LA positive than the negative (10.3% versus 0.2%, p.0.03; OR 5.39, CI 1.15-24.17) and anti-myelin oligodendrocyte glycoprotein in mood disorder (14.3% versus 3.4%, p = 0.03; OR 4.66, CI 1.13-19.13). CONCLUSION No single biomarker correlated with NPSLE. Among different NPSLE manifestations, the prevalence of IgG β2GP1 in stroke, LA in demyelination, anti-ribosomal P in psychosis and anti-myelin oligodendrocyte glycoprotein in mood disorder were higher. Further studies on the pathogenic mechanisms underlying NPSLE and its different manifestations may help us to identify better biomarkers.
Collapse
Affiliation(s)
- G Seth
- Department of Rheumatology, Aakash Healthcare Super Speciality Hospital, Dwarka, India
| | - A Sundaresh
- Department of Clinical Immunology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - C M Mariaselvam
- INSERM U955, Psychiatrie Translationnelle, Institut Mondor de Recherche Biomédicale, Créteil, France
| | - G Kumar
- Knowledge Integration and Translation Platform, Center for Health Research and Development, Society for Applied Studies, Kalu Sarai, India
| | - K G Chengappa
- Department of Clinical Immunology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - M B Adarsh
- Department of Clinical Immunology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - R Tamouza
- INSERM U955, Psychiatrie Translationnelle, Institut Mondor de Recherche Biomédicale, Créteil, France.,Fondation FondaMental, Créteil, France.,AP-HP, DHU PePSY, Department of Psychiatry, Hôpital Henri Mondor, Université Paris-Est, Créteil, France
| | - V S Negi
- Department of Clinical Immunology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| |
Collapse
|
35
|
Onwochei DN, Fabes J, Walker D, Kumar G, Moonesinghe SR. Critical care after major surgery: a systematic review of risk factors for unplanned admission. Anaesthesia 2020; 75 Suppl 1:e62-e74. [DOI: 10.1111/anae.14793] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/20/2019] [Indexed: 12/17/2022]
Affiliation(s)
- D. N. Onwochei
- Department of Anaesthesia Guy's & St. Thomas’ NHS Foundation Trust London UK
| | - J. Fabes
- Department of AnaesthesiaRoyal Free NHS Foundation Trust LondonUK
| | - D. Walker
- Centre for Anaesthesia and Peri‐operative Medicine UCL Division of Surgery and Interventional Science University College London London UK
| | - G. Kumar
- Centre for Anaesthesia and Peri‐operative Medicine UCL Division of Surgery and Interventional Science University College London London UK
| | - S. R. Moonesinghe
- Centre for Anaesthesia and Peri‐operative Medicine UCL Division of Surgery and Interventional Science University College London London UK
| |
Collapse
|
36
|
Yadav R, Ray S, Kumar G, Pal P, Kutty B. Sleep and other non motor abnormalities in Indian patients with cervical dystonia. Sleep Med 2019. [DOI: 10.1016/j.sleep.2019.11.1197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
|
37
|
Kumar G, Tewari S, Sangwan P, Tewari S, Duhan J, Mittal S. The effect of an intraorifice barrier and base under coronal restorations on the healing of apical periodontitis: a randomized controlled trial. Int Endod J 2019; 53:298-307. [PMID: 31587317 DOI: 10.1111/iej.13231] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Accepted: 10/01/2019] [Indexed: 11/30/2022]
Abstract
AIM To evaluate the effect of intraorifice barriers and bases on the healing of apical periodontitis following root canal treatment in mandibular molars. METHODOLOGY A total of 120 permanent mandibular molars with necrotic pulps and periapical radiolucencies (PAI score ≥ 3) were recruited. Root canal treatment was performed in all teeth using a standard protocol, following which they were randomly allocated to one of the three treatment groups: intraorifice barrier group: coronal 3-mm gutta-percha was removed and replaced with glass-ionomer cement (GIC) barrier. The floor of the pulp chamber was then sealed with 2-mm-thick GIC base followed by final composite resin restoration; base group: received 2-mm-thick GIC base before placement of composite resin restoration; and control group: had pulp chamber entirely filled with composite resin only. Follow-up was done at 3, 6, 9 and 12 months. Combination of clinical and radiographic parameters were used to assess treatment outcome. The data were analysed using Kruskal-Wallis, chi-square and Wilcoxon signed-rank tests and logistic regression analysis. RESULTS At the end of 12 months, the base group had the most favourable healing (97.1%), whilst the control group had the least favourable healing (83.8%). The intraorifice barrier group had healing of 92.1%. However, there was no significant difference in healing between groups at the end of the follow-up period (P > 0.05). Additional subgroup analysis revealed a nonsignificant effect of periodontal status and root filling level on periapical healing. CONCLUSION The use of an additional barrier under permanent restorations did not significantly improve the outcome of primary root canal treatment in posterior teeth after 12 months. However, its influence in the long term requires further evaluation.
Collapse
Affiliation(s)
- G Kumar
- Department of Conservative Dentistry and Endodontics, Post Graduate Institute of Dental Sciences, Rohtak, India
| | - S Tewari
- Department of Conservative Dentistry and Endodontics, Post Graduate Institute of Dental Sciences, Rohtak, India
| | - P Sangwan
- Department of Conservative Dentistry and Endodontics, Post Graduate Institute of Dental Sciences, Rohtak, India
| | - S Tewari
- Department of Periodontics and Oral Implantology, Post Graduate Institute of Dental Sciences, Rohtak, India
| | - J Duhan
- Department of Conservative Dentistry and Endodontics, Post Graduate Institute of Dental Sciences, Rohtak, India
| | - S Mittal
- Department of Conservative Dentistry and Endodontics, Post Graduate Institute of Dental Sciences, Rohtak, India
| |
Collapse
|
38
|
Mohammed SA, Nasir A, Aziz F, Kumar G, Sallehhudin W, Jaafar J, Lau W, Yusof N, Salleh W, Ismail A. CO2/N2 selectivity enhancement of PEBAX MH 1657/Aminated partially reduced graphene oxide mixed matrix composite membrane. Sep Purif Technol 2019. [DOI: 10.1016/j.seppur.2019.04.061] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
39
|
Kiran M, Donnelly TD, Armstrong C, Kapoor B, Kumar G, Peter V. Diagnostic utility of fluorodeoxyglucose positron emission tomography in prosthetic joint infection based on MSIS criteria. Bone Joint J 2019; 101-B:910-914. [PMID: 31362552 DOI: 10.1302/0301-620x.101b8.bjj-2018-0929.r2] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS Prosthetic joint infection (PJI) and aseptic loosening in total hip arthroplasty (THA) can present with pain and osteolysis. The Musculoskeletal Infection Society (MSIS) has provided criteria for the diagnosis of PJI. The aim of our study was to analyze the utility of F18-fluorodeoxyglucose (FDG) positron emission tomography (PET) CT scan in the preoperative diagnosis of septic loosening in THA, based on the current MSIS definition of prosthetic joint infection. PATIENTS AND METHODS A total of 130 painful unilateral cemented THAs with a mean follow-up of 5.17 years (sd 1.12) were included in this prospective study. The mean patient age was 67.5 years (sd 4.85). Preoperative evaluation with inflammatory markers, aspiration, and an F18 FDG PET scan were performed. Diagnostic utility tests were also performed, based on the MSIS criteria for PJI and three samples positive on culture alone. RESULTS The mean erythrocyte sedimentation rate, C-reactive protein, and white cell count were 47.83 mm/hr, 25.21 mg/l, and 11.05 × 109/l, respectively. The sensitivity, specificity, accuracy, negative predictive value, and false-positive rate of FDG PET compared with MSIS criteria were 94.87%, 38.46 %, 56.38%, 94.59 %, and 60.21%, respectively. The false-positive rate of FDG PET compared with culture alone was 77.4%. CONCLUSION FDG PET has a definitive role in the preoperative evaluation of suspected PJI. This the first study to evaluate its utility based on MSIS criteria and compare it with microbiology results alone. However, FDG PET has a high false-positive rate. Therefore, we suggest that F18 FDG PET is useful in confirming the absence of infection, but if positive, may not be confirmatory of PJI. Cite this article: Bone Joint J 2019;101-B:910-914.
Collapse
Affiliation(s)
- M Kiran
- Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK
| | - T D Donnelly
- Trauma and Orthopaedics, Royal Liverpool University Hospital, Liverpool, UK
| | - C Armstrong
- Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK
| | - B Kapoor
- Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK
| | - G Kumar
- Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK
| | - V Peter
- Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK
| |
Collapse
|
40
|
Kumar G, Akanksha Srivastava. EMS Induced Desynaptic Male Sterile Lines in Buckwheat (Fagopyrum esculentum Moench). CYTOL GENET+ 2019. [DOI: 10.3103/s009545271904008x] [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]
|
41
|
Patil H, Shah N, Hajare S, Gautam S, Kumar G. Combination of microwave and gamma irradiation for reduction of aflatoxin B1 and microbiological contamination in peanuts (Arachis hypogaea L.). WORLD MYCOTOXIN J 2019. [DOI: 10.3920/wmj2018.2384] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Aflatoxin B1 (AFB1) is a natural carcinogen commonly present in food and feed which has deleterious effects on human and animal health. Combination treatment of microwave heating and gamma irradiation has been investigated. Artificially spiked peanuts (Arachis hypogaea L.) were used with a concentration of 300 μg/kg of AFB1 to evaluate the treatment efficacy. Qualitative and quantitative analysis of AFB1 was carried out by one dimensional thin layer chromatography and enzyme-linked immune-sorbent assay (ELISA), respectively. Gamma irradiation (5, 7 and 9 kGy) alone reduced 20 to 43% of AFB1, while, only low power microwave heating (360, 480 and 600 W) reduced it by 59 to 67%. The synergistic effect of a combination treatment at 7 and 9 kGy of irradiation at any of the chosen microwave power levels and sequence of treatment was able to reduce >95% in artificially spiked peanuts. Knowing the limitation of ELISA, an Ames test was employed to determine the mutagenicity of AFB1 in combination-treated (7 kGy and 600 W) artificially spiked peanut samples, resulting in an 80-85% reduction of its mutagenicity. Quality parameters of peanuts in terms of moisture content, water activity, hardness, colour, peroxide value and free fatty acid were evaluated and observed to be retained after combination treatments. Post-treatment sensory analysis in respect of appearance, colour, texture, taste, aftertaste and overall acceptability gave satisfactory scores. The microbiological safety of treated peanuts (exclusive and combination of 7 kGy and 360-600 W) was assessed in terms of total bacterial count, aerobic spore count, and yeast and mould count. The microbiological load was completely eliminated after exclusive gamma irradiation or the combination treatments. Combination treatment (7 kGy and 600 W) demonstrated 71 to 87% reduction in AFB1 from naturally contaminated peanuts and is recommended for further commercial application.
Collapse
Affiliation(s)
- H. Patil
- Centre for Technology Alternatives for Rural Areas, Indian Institute of Technology Bombay, Powai 400 076, India
| | - N.G. Shah
- Centre for Technology Alternatives for Rural Areas, Indian Institute of Technology Bombay, Powai 400 076, India
| | - S.N. Hajare
- Food Technology Division, Bhabha Atomic Research Centre, Mumbai 400 085, India
| | - S. Gautam
- Food Technology Division, Bhabha Atomic Research Centre, Mumbai 400 085, India
| | - G. Kumar
- Department of Electrical Engineering, Indian Institute of Technology Bombay, Powai 400 076, India
| |
Collapse
|
42
|
Naveenkumar N, Kumar G, Sowdhamini R, Srinivasan N, Vishwanath S. Fold combinations in multi-domain proteins. Bioinformation 2019; 15:342-350. [PMID: 31249437 PMCID: PMC6589474 DOI: 10.6026/97320630015342] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Accepted: 05/07/2019] [Indexed: 01/21/2023] Open
Abstract
Domain-domain interactions in multi-domain proteins play an important role in the combined function of individual domains for the
overall biological activity of the protein. The functions of the tethered domains are often coupled and hence, limited numbers of domain
architectures with defined folds are known in nature. Therefore, it is of interest to document the available fold-fold combinations and their
preference in multi-domain proteins. Hence, we analyzed all multi-domain proteins with known structures in the protein databank and
observed that only about 860 fold-fold combinations are present among them. Analyses of multi-domain proteins represented in sequence
database result in recognition of 29,860 fold-fold combinations and it accounts for only 2.8% of the theoretically possible 1,036,080 (1439C2)
fold-fold combinations. The observed preference for fold-fold combinations in multi-domain proteins is interesting in the context of
multiple functions through structural adaptation by gene fusion.
Collapse
Affiliation(s)
- Nagarajan Naveenkumar
- National Center for Biological Science, GKVK Campus, Bengaluru, Karnataka, India - 560065.,Bharathidasan University, Tiruchirappalli, Tamil Nadu, 620024, India.,Molecular Biophysics Unit, Indian Institute of Science, Bengaluru, Karnataka, India - 560012
| | - Gayatri Kumar
- Molecular Biophysics Unit, Indian Institute of Science, Bengaluru, Karnataka, India - 560012
| | - Ramanathan Sowdhamini
- National Center for Biological Science, GKVK Campus, Bengaluru, Karnataka, India - 560065
| | | | - Sneha Vishwanath
- Molecular Biophysics Unit, Indian Institute of Science, Bengaluru, Karnataka, India - 560012
| |
Collapse
|
43
|
Hairudin T, Li L, Mansy T, Aynsley E, Kumar G, Masinghe S, Peedell C. The experience of immunotherapy in lung cancer: an audit of patients receiving first-line immunotherapy for metastatic small cell lung cancer in South Tees between June 2016 and December 2017. Lung Cancer 2019. [DOI: 10.1016/s0169-5002(19)30144-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
44
|
Smith E, Aynsley E, Kumar G, Peedell C, Masinghe S. Audit of outcomes of patients with stage III NSCLC (TNM VII) who were treated with radical RT or high-dose palliative radiotherapy between January 2017 and July 2017. Lung Cancer 2019. [DOI: 10.1016/s0169-5002(19)30234-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
|
45
|
|
46
|
Kumar G. Socioeconomic status and demographic assessment of advanced cancer patients in palliative care department of a tertiary care centre: Observational study. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy440.008] [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: 11/13/2022] Open
|
47
|
Roy P, Saikia B, Hazarika M, Bhuyan C, Kumar G, Mishra R, Nyuthe C. Outcome of small cell carcinoma of esophagus: An institutional experience from North-East India. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy432.040] [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: 11/13/2022] Open
|
48
|
Yarla NS, Gali H, Pathuri G, Smriti S, Farooqui M, Panneerselvam J, Kumar G, Madka V, Rao CV. Targeting the paracrine hormone-dependent guanylate cyclase/cGMP/phosphodiesterases signaling pathway for colorectal cancer prevention. Semin Cancer Biol 2018; 56:168-174. [PMID: 30189250 DOI: 10.1016/j.semcancer.2018.08.011] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Revised: 08/30/2018] [Accepted: 08/31/2018] [Indexed: 02/06/2023]
Abstract
Colorectal cancer (CRC) is one of the leading causes of cancer related-deaths. The risk of development of CRC is complex and multifactorial, and includes disruption of homeostasis of the intestinal epithelial layer mediated though dysregulations of tumor suppressing/promoting signaling pathways. Guanylate cyclase 2C (GUCY2C), a membrane-bound guanylate cyclase receptor, is present in the apical membranes of intestinal epithelial cells and maintains homeostasis. GUCY2C is activated upon binding of paracrine hormones (guanylin and uroguanylin) that lead to formation of cyclic GMP from GTP and activation of downstream signaling pathways that are associated with normal homeostasis. Dysregulation/suppression of the GUCY2C-mediated signaling promotes CRC tumorigenesis. High-calorie diet-induced obesity is associated with deficiency of guanylin expression and silencing of GUCY2C-signaling in colon epithelial cells, leading to tumorigenesis. Thus, GUCY2C agonists, such as linaclotide, exhibit considerable role in preventing CRC tumorigenesis. However, phosphodiesterases (PDEs) are elevated in intestinal epithelial cells during CRC tumorigenesis and block GUCY2C-mediated signaling by degrading cyclic GMP to 5`-GMP. PDE5-specific inhibitors, such as sildenafil, show considerable anti-tumorigenic potential against CRC by amplifying the GUCY2C/cGMP signaling pathway, but cannot achieve complete anti-tumorigenic effects. Hence, dual targeting the elevation of cGMP by providing paracrine hormone stimuli to GUCY2C and by inhibition of PDEs may be a better strategy for CRC prevention than alone. This review delineates the involvement of the GUCY2C/cGMP/PDEs signaling pathway in the homeostasis of intestinal epithelial cells. Further, the events are associated with dysregulation of this pathway during CRC tumorigenesis are also discussed. In addition, current updates on targeting the GUCY2C/cGMP/PDEs pathway with GUCY2C agonists and PDEs inhibitors for CRC prevention and treatment are described in detail.
Collapse
Affiliation(s)
- N S Yarla
- Center for Cancer Prevention and Drug Development, Department of Medicine, Hematology-Oncology Section, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - H Gali
- Department of Pharmaceutical Sciences, College of Pharmacy, and Stephenson Oklahoma Cancer Center, The University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - G Pathuri
- Center for Cancer Prevention and Drug Development, Department of Medicine, Hematology-Oncology Section, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - S Smriti
- Center for Cancer Prevention and Drug Development, Department of Medicine, Hematology-Oncology Section, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - M Farooqui
- Center for Cancer Prevention and Drug Development, Department of Medicine, Hematology-Oncology Section, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - J Panneerselvam
- Center for Cancer Prevention and Drug Development, Department of Medicine, Hematology-Oncology Section, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - G Kumar
- Center for Cancer Prevention and Drug Development, Department of Medicine, Hematology-Oncology Section, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA; VA Medical Center, Oklahoma City, OK, USA
| | - V Madka
- Center for Cancer Prevention and Drug Development, Department of Medicine, Hematology-Oncology Section, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - C V Rao
- Center for Cancer Prevention and Drug Development, Department of Medicine, Hematology-Oncology Section, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA; VA Medical Center, Oklahoma City, OK, USA.
| |
Collapse
|
49
|
Kumar G, AlMasri O, Al Mistarihi J, AlGhabra MK, Hobeldin M. Rare Cause of Bright Red Gross Hematuria in a Child. Indian J Nephrol 2018; 28:327-328. [PMID: 30158757 PMCID: PMC6094826 DOI: 10.4103/ijn.ijn_147_17] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- G Kumar
- Division of Pediatric Nephrology, Sheikh Khalifa Medical City, Abu Dhabi, UAE
| | - O AlMasri
- Division of Pediatric Nephrology, Sheikh Khalifa Medical City, Abu Dhabi, UAE
| | - J Al Mistarihi
- Department of Pediatrics, Sheikh Khalifa Medical City, Abu Dhabi, UAE
| | - M K AlGhabra
- Department of Pediatrics, Sheikh Khalifa Medical City, Abu Dhabi, UAE
| | - M Hobeldin
- Department of Pediatric Surgery, Sheikh Khalifa Medical City, Abu Dhabi, UAE
| |
Collapse
|
50
|
Ramesh K, Kumar G, Swapna K, Datta D, Rajest S. A Review of Medical Image Segmentation Algorithms. EAI Endorsed Transactions on Pervasive Health and Technology 2018. [DOI: 10.4108/eai.12-4-2021.169184] [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: 11/05/2022] Open
|