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You A, Gu J, Wang J, Li J, Zhang Y, Rao G, Ge X, Zhang K, Gao X, Wang D. Value of long non-coding RNA HAS2-AS1 as a diagnostic and prognostic marker of glioma. Neurologia 2024; 39:353-360. [PMID: 38616063 DOI: 10.1016/j.nrleng.2021.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Accepted: 06/11/2021] [Indexed: 04/16/2024] Open
Abstract
BACKGROUND Glioma presents high incidence and poor prognosis, and therefore more effective treatments are needed. Studies have confirmed that long non-coding RNAs (lncRNAs) basically regulate various human diseases including glioma. It has been theorized that HAS2-AS1 serves as an lncRNA to exert an oncogenic role in varying cancers. This study aimed to assess the value of lncRNA HAS2-AS1 as a diagnostic and prognostic marker for glioma. METHODS The miRNA expression data and clinical data of glioma were downloaded from the TCGA database for differential analysis and survival analysis. In addition, pathological specimens and specimens of adjacent normal tissue from 80 patients with glioma were used to observe the expression of HAS2-AS1. The receiver operating characteristic (ROC) curve was used to analyze the diagnostic ability and prognostic value of HAS2-AS1 in glioma. Meanwhile, a Kaplan-Meier survival curve was plotted to evaluate the survival of glioma patients with different HAS2-AS1 expression levels. RESULTS HAS2-AS1 was significantly upregulated in glioma tissues compared with normal tissue. The survival curves showed that overexpression of HAS2-AS1 was associated with poor overall survival (OS) and progression-free survival (PFS). Several clinicopathological factors of glioma patients, including tumor size and WHO grade, were significantly correlated with HAS2-AS1 expression in tissues. The ROC curve showed an area under the curve (AUC) value of 0.863, indicating that HAS2-AS1 had good diagnostic value. The ROC curve for the predicted OS showed an AUC of 0.906, while the ROC curve for predicted PFS showed an AUC of 0.88. Both suggested that overexpression of HAS2-AS1 was associated with poor prognosis. CONCLUSIONS Normal tissues could be clearly distinguished from glioma tissues based on HAS2-AS1 expression. Moreover, overexpression of HAS2-AS1 indicated poor prognosis in glioma patients. Therefore, HAS2-AS1 could be used as a diagnostic and prognostic marker for glioma.
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Affiliation(s)
- A You
- The Fourth Department of Neurosurgery, Tangshan Gongren Hospital, 063000 Tangshan, China
| | - J Gu
- The Fourth Department of Neurosurgery, Tangshan Gongren Hospital, 063000 Tangshan, China
| | - J Wang
- The Fourth Department of Neurosurgery, Tangshan Gongren Hospital, 063000 Tangshan, China
| | - J Li
- The Fourth Department of Neurosurgery, Tangshan Gongren Hospital, 063000 Tangshan, China
| | - Y Zhang
- The Fourth Department of Neurosurgery, Tangshan Gongren Hospital, 063000 Tangshan, China
| | - G Rao
- The Fourth Department of Neurosurgery, Tangshan Gongren Hospital, 063000 Tangshan, China
| | - X Ge
- The Fourth Department of Neurosurgery, Tangshan Gongren Hospital, 063000 Tangshan, China
| | - K Zhang
- The Fourth Department of Neurosurgery, Tangshan Gongren Hospital, 063000 Tangshan, China
| | - X Gao
- Operating Theatre, Tangshan Central Hospital, 063000 Tangshan, China
| | - D Wang
- The Fourth Department of Neurosurgery, Tangshan Gongren Hospital, 063000 Tangshan, China.
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Brouwers B, Rao G, Tang Y, Rodríguez Á, Glass LC, Hartman ML. Incretin-based investigational therapies for the treatment of MASLD/MASH. Diabetes Res Clin Pract 2024; 211:111675. [PMID: 38636848 DOI: 10.1016/j.diabres.2024.111675] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 04/15/2024] [Accepted: 04/15/2024] [Indexed: 04/20/2024]
Abstract
Metabolic dysfunction-associated steatotic liver disease (MASLD), formerly known as non-alcoholic fatty liver disease (NAFLD), is the most common form of chronic liver disease. It exists as either simple steatosis or its more progressive form, metabolic dysfunction-associated steatohepatitis (MASH), formerly, non-alcoholic steatohepatitis (NASH). The global prevalence of MASLD is estimated to be 32% among adults and is projected to continue to rise with increasing rates of obesity, type 2 diabetes, and metabolic syndrome. While simple steatosis is often considered benign and reversible, MASH is progressive, potentially leading to the development of cirrhosis, liver failure, and hepatocellular carcinoma. Treatment of MASH is therefore directed at slowing, stopping, or reversing the progression of disease. Evidence points to improved liver histology with therapies that result in sustained body weight reduction. Incretin-based molecules, such as glucagon-like peptide-1 receptor agonists (GLP-1 RAs), alone or in combination with glucose-dependent insulinotropic polypeptide (GIP) and/or glucagon receptor agonists, have shown benefit here, and several are under investigation for MASLD/MASH treatment. In this review, we discuss current published data on GLP-1, GIP/GLP-1, GLP-1/glucagon, and GLP-1/GIP/glucagon RAs in MASLD/MASH, focusing on their efficacy on liver histology, liver fat, and MASH biomarkers.
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Affiliation(s)
| | - Girish Rao
- Eli Lilly and Company, Indianapolis, IN, USA
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Yeboa DN, Woodhouse K, Prabhu S, Li J, Beckham T, Weinberg JS, Wang C, McCutcheon IE, Swanson TA, Kim BYS, McGovern SL, North R, McAleer MF, Alvarez-Breckenridge C, Jiang W, Ene C, Ejezie CL, Lang F, Rao G, Ferguson S. MD Anderson Phase III Randomized Preoperative Stereotactic Radiosurgery (SRS) vs. Postoperative SRS for Brain Metastases Trial. Int J Radiat Oncol Biol Phys 2023; 117:e160-e161. [PMID: 37784756 DOI: 10.1016/j.ijrobp.2023.06.990] [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: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Postoperative stereotactic radiation therapy/radiosurgery (SRT/SRS) is being evaluated in comparison to Preoperative SRT for brain metastases (mets) in a limited number of prospective clinical trials. Our objective is to address the significant knowledge gap concerning the logistics of preoperative SRT in comparison to postoperative SRT in a randomized controlled study. MATERIALS/METHODS Patients with brain mets with at least 1 surgically operable met were randomized (1:1) to Preop vs Postop SRT. In this abstract, we present non-primary endpoint data on the trial concept and logistics of treatment for this data safety monitoring board reviewed study. Patients enrolled had 1-2 lesions resected and <15 lesions treated at time of SRT to best reflect the standard population that receive SRT and surgery at our institution. RESULTS From 12/2018 to 12/2022, 99 patients with 1-2 operable brain mets were enrolled and randomized to Preop (n = 49) or Postop (n = 50) SRT. Males represented 56% of the cohort compared to females, and <25% were age 18-49 years, while 27%, 29, and 19% respectively were 50-59, 60-69, and > = 70. The most frequent histologies enrolled were lung (29%), renal cell (15%), melanoma (14%), and breast (11%) cancers. The majority of patients (83%) had 1-4 brain mets on their baseline MRI and 91% subsequently had a single lesion resected. Seventy-nine patients completed both SRT and surgery, while 9% received no therapy due to drop out before study therapy initiation. Among patients receiving both therapies in the combined cohort, 68% received a non-invasive stereotactic radiosurgery instrument to the randomized cavity lesion compared to 32% receiving LINAC based SRT. Treatment of the lesion or cavity with single fraction SRT was 51% in the Preop arm vs 31% in the Postop arm. Multi-fraction (3-5 SRT) was 67% in the Postop cohort in contrast to 47% in the Preop cohort. Time from randomization to RT was 5.6 days and 33.7 days in the Preop and Postop cohorts respectively, and for surgery was 10.2 days vs 12.9 days in the Postop vs Preop cohorts. The average time from RT to surgery was 7.3 days in the Preop arm and 23.5 days in the Postop arm (to allow for incisional healing time). CONCLUSION In one of the early initiated randomized prospective cohorts of Preop vs Postop SRT, we demonstrated logistical feasibility with an efficient clinical trial workflow for study treatment. Differences in Preop vs Postop logistics reflect clinical practice differences in time-to-treatment. Therapy with various modalities reflected real-world practice and possibly provider preferences in technique when addressing the nature of delineating cavities and changes in cavity volume with regard to fractionation. Independent of the primary outcomes, our data provides insights in the practical management of patients receiving these two modalities of therapy, and further data at the completion of trial will address relevant primary outcomes.
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Affiliation(s)
- D N Yeboa
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - S Prabhu
- Department of Neurosurgery, University of Texas MD Anderson Cancer Center, Houston, TX
| | - J Li
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - T Beckham
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - J S Weinberg
- Department of Neurosurgery, University of Texas MD Anderson Cancer Center, Houston, TX
| | - C Wang
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - I E McCutcheon
- Department of Neurosurgery, University of Texas MD Anderson Cancer Center, Houston, TX
| | - T A Swanson
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - B Y S Kim
- Department of Neurosurgery, University of Texas MD Anderson Cancer Center, Houston, TX
| | - S L McGovern
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - R North
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - M F McAleer
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - W Jiang
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - C Ene
- Department of Neurosurgery, University of Texas MD Anderson Cancer Center, Houston, TX
| | - C L Ejezie
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - F Lang
- Department of Neurosurgery, University of Texas MD Anderson Cancer Center, Houston, TX
| | - G Rao
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX
| | - S Ferguson
- Department of Neurosurgery, University of Texas MD Anderson Cancer Center, Houston, TX
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Nang S, Lu J, Yu H, Wickremasinghe H, Azad M, Han M, Rao G, Bergen P, Velkov T, Sherry N, Aslam S, Schooley R, Howden B, Barr J, Zhu Y, Li J. SY4.1: COMBINATION OF BACTERIOPHAGE AND ANTIBIOTIC: IS IT AN ULTIMATE SOLUTION TO MULTIDRUG RESISTANCE? J Glob Antimicrob Resist 2022. [DOI: 10.1016/s2213-7165(22)00278-8] [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: 12/23/2022] Open
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Nang S, Lin Y, Hanafin P, Wang J, Chen K, Yu H, Wickremasinghe H, Bergen P, Chang R, Rao G, Chan H, Li J. 81: PHARMACOKINETICS/PHARMACODYNAMICS OF ANTI-PSEUDOMONAL PHAGE: LEVERAGING PRECLINCAL MODELS OF INFECTION AND MECHANISM-BASED MODELLING. J Glob Antimicrob Resist 2022. [DOI: 10.1016/s2213-7165(22)00360-5] [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: 12/23/2022] Open
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Paplikar A, Venugopal A, Ballal D, Varghese F, Ramappa R, Shekar R, Manae T, Hoskeri R, Thanissery N, Arshad F, Banavaram A, Rao G, Arora N, Alladi S. Impact of bilingualism on prevalence of dementia and MCI: A community study from India. Alzheimers Dement 2022. [DOI: 10.1002/alz.065972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Avanthi Paplikar
- National Institute of Mental Health and Neurosciences Bengaluru India
- Dr. S. R. Chandrasekhar Institute of Speech and Hearing Bengaluru India
| | - Aparna Venugopal
- National Institute of Mental Health and Neurosciences Bengaluru India
| | - Divya Ballal
- National Institute of Mental Health and Neurosciences Bengaluru India
| | - Feba Varghese
- National Institute of Mental Health and Neurosciences Bengaluru India
| | - Renuka Ramappa
- National Institute of Mental Health and Neurosciences Bengaluru India
| | - Revathy Shekar
- National Institute of Mental Health and Neurosciences Bengaluru India
| | - Tejaswini Manae
- National Institute of Mental Health and Neurosciences Bengaluru India
| | - Rakshith Hoskeri
- National Institute of Mental Health and Neurosciences Bengaluru India
| | - Nithin Thanissery
- National Institute of Mental Health and Neurosciences Bengaluru India
| | - Faheem Arshad
- National Institute of Mental Health and Neurosciences Bengaluru India
| | - Aravind Banavaram
- National Institute of Mental Health and Neurosciences Bengaluru India
| | - Girish Rao
- National Institute of Mental Health and Neurosciences Bengaluru India
| | | | - Survana Alladi
- National Institute of Mental Health and Neurosciences Bengaluru India
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Vigouroux L, Cartier T, Rao G, Berton É. Pull-up forms of completion impacts deeply the muscular and articular involvements. Sci Sports 2022. [DOI: 10.1016/j.scispo.2022.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Garcia S, Delattre N, Berton E, Divrechy G, Rao G. Comparison of landing kinematics and kinetics between experienced and novice volleyball players during block and spike jumps. BMC Sports Sci Med Rehabil 2022; 14:105. [PMID: 35690791 PMCID: PMC9188216 DOI: 10.1186/s13102-022-00496-0] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 06/01/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND The practice of volleyball requires many jumps. During landing, anterior cruciate ligament injuries may occur with high-risk lower limb kinematics and kinetics. Differences in landing strategies between experienced and novice volleyball players have not been fully explored. The purpose of the study was to compare lower limb kinematics and kinetics in experienced and novice volleyball players when performing volleyball specific jumps. METHODS A total of 30 healthy males, 15 experienced and 15 novice volleyball players, participated in the study. Participants performed block and spike jumps at a controlled jump height. Hip, knee and ankle joints angles at initial ground contact and ranges of motion in the sagittal plane, knee joint angles and moments in the frontal plane, vertical ground reaction force peak and loading rate were analyzed to investigate the expertise effect. RESULTS Experienced volleyball players landed with larger ankle dorsiflexion range of motion compared to novices. For the spike jump, experienced players landed with larger ankle plantarflexion angles at initial contact and larger ankle dorsiflexion ranges of motion, and for the block jump, they landed with larger knee flexion ranges of motion. Experienced players jumped significantly higher than novices. No difference was found in vertical ground reaction force peaks and loading rates. CONCLUSIONS Although the experienced group jumped higher than the novice group, no difference was found in ground reaction force parameters. These findings highlight that the experience of volleyball players acquired during regular trainings and competitions may play an important role in landing kinematics and kinetics to reduce the injury risk.
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Affiliation(s)
- Sébastien Garcia
- Movement Sciences Department, Decathlon SportsLab, 59000, Lille, France. .,CNRS, Insitute of Movement Sciences, Aix-Marseille University, 13007, Marseille, France.
| | - N Delattre
- Movement Sciences Department, Decathlon SportsLab, 59000, Lille, France
| | - E Berton
- CNRS, Insitute of Movement Sciences, Aix-Marseille University, 13007, Marseille, France
| | - G Divrechy
- Movement Sciences Department, Decathlon SportsLab, 59000, Lille, France
| | - G Rao
- CNRS, Insitute of Movement Sciences, Aix-Marseille University, 13007, Marseille, France
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Sundaram V, Rao G, Nandi M, Reddy V, pokhala N, Mondal K, Prakash A, Bhattacharjee M. PO-1545 Comparison of PRO and PO algorithms in Rapid arc (VMAT) delivery for Head and Neck SIB treatments. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)03509-5] [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: 10/18/2022]
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10
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Sundaram V, Rao G, Bhattacharjee M, Joseph J, Balaji B, Patil D. PO-1544 The role of dose rate and gantry speed variations in PRO and PO algorithms for rapidarc delivery. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)03508-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Uppar AM, Shukla D, Nayak N, Rao G, Dwarakanath S. Syndromic Craniosynostosis: Objective and Parent-Reported Outcome Measurements after Cranio-Facial Remodelling Surgeries. Pediatr Neurosurg 2022; 57:17-27. [PMID: 34818259 DOI: 10.1159/000518393] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2019] [Accepted: 07/07/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Syndromic craniosynostosis (SC) is a rare entity compared to the non-syndromic variant. Treatment involves a multidisciplinary approach towards a multitude of problems. Early intervention is known to be better for optimum results. We reviewed outcomes of children with SC who underwent reconstructive cranio-facial surgery. MATERIALS AND METHODS A retrospective study was conducted using data from hospital case files and the picture archival communication system. Objective data like the cephalic index (CI), both preoperatively and post-operatively, were compared. Subjective data for the cosmesis outcome - "Sloan and Whitaker outcome class" - following surgery were assessed. Also, parent-reported outcome measurement (PROM) was performed with various parameters to assess quality of life (QOL). RESULTS We had 21 operated cases of SC, with 19 needing cranio-facial remodelling. The male to female ratio was 11:10. Crouzon's syndrome was the most common syndromic association followed by Apert's syndrome. Nineteen patients underwent cranio-facial remodelling surgeries and 2 underwent the ventriculo-peritoneal shunt only - for raised intracranial pressure (ICP). Nine patients underwent cranial remodelling with fronto-orbital advancements, and 3 of these patients also received le-fort's type 3 osteotomy and advancement later. Ten patients underwent fronto-orbital advancement with parieto-occipital barrel-stave osteotomies. OUTCOMES Improvement in the CI was maximum at the 6-month follow-up. Six (37.5%) cases had Sloan class 1 outcome, 9 (56.25%) had class 2 outcomes, and 1 patient had a class 6 outcome. Whitaker cosmesis outcomes - 14 out of 16 cases (87.5%) had Category 1 outcomes. PROM was assessed. All parents reported at least a moderate improvement in cosmesis following surgery. Out of 15 cases, 10 (66%) reported significant improvement, while 4 (26.6%) cases reported moderate improvement with respect to eye and visual problems. Four parents reported snoring as a significant problem even after surgery. Most parents felt that the children were doing well, attending regular school, and social well-being was normal and had an overall good QOL. CONCLUSIONS SC cases may have a multitude of other problems like raised ICP, ophthalmological problems, poor intelligence, and cognition apart from cosmetic concerns. PROMs revealed good outcomes in terms of cosmesis, cognition, and ophthalmological and oral cavity-related problems. Significant improvement in overall QOL was seen in most patients following cranio-facial remodelling surgery.
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Affiliation(s)
| | - Dhaval Shukla
- Department of Neurosurgery, NIMHANS, Bangalore, India
| | - Nitish Nayak
- Department of Neurosurgery, NIMHANS, Bangalore, India
| | - Girish Rao
- Department of OMFS, RV Dental College, Bangalore, India
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Pollock A, Risher H, Bentzen S, Roque D, Rao G, Nichols E, Mohindra P. Clinical Outcomes of Patients Treated With Intensity Modulated Proton Therapy (IMPT) Re-Irradiation for Gynecologic Malignancies. Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.1667] [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]
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Garcia E, Muhlebach M, Sharma R, Khoei A, Rao G. 415: Antimicrobial resistance—Modeling of prolonged treatment in vitro. J Cyst Fibros 2021. [DOI: 10.1016/s1569-1993(21)01839-7] [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: 10/20/2022]
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14
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Lohith G, Sekar K, Patil S, Bandemagal M, Murugan K, M V, Thungappa S, Rao V, Kudpaje A, Ramasamy M, Ramachandrappa S, Bharathan A, Rao G, Rao D, kumar B. A Randomized Control Trial Comparing Time to Healing of Radiation Induced Acute Skin Reactions Using Biological Membrane Dressing or Topical Methyl Pararosaniline Dye. Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.626] [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]
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Martinez M, Perito ER, Valentino P, Mack CL, Aumar M, Broderick A, Draijer LG, Fagundes ED, Furuya KN, Gupta N, Horslen S, Jonas MM, Kamath BM, Kerkar N, Kim KM, Kolho KL, Koot BGP, Laborda TJ, Lee CK, Loomes KM, Miloh T, Mogul D, Mohammed S, Ovchinsky N, Rao G, Ricciuto A, Schwarz KB, Smolka V, Tanaka A, Tessier MEM, Venkat VL, Vitola BE, Woynarowski M, Zerofsky M, Deneau MR, Deneau MR. Recurrence of Primary Sclerosing Cholangitis After Liver Transplant in Children: An International Observational Study. Hepatology 2021; 74:2047-2057. [PMID: 34008252 PMCID: PMC8530456 DOI: 10.1002/hep.31911] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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] [Received: 02/08/2021] [Revised: 05/11/2021] [Accepted: 05/12/2021] [Indexed: 12/28/2022]
Abstract
BACKGROUND AND AIMS Recurrent primary sclerosing cholangitis (rPSC) following liver transplant (LT) has a negative impact on graft and patient survival; little is known about risk factors for rPSC or disease course in children. APPROACH AND RESULTS We retrospectively evaluated risk factors for rPSC in 140 children from the Pediatric PSC Consortium, a multicenter international registry. Recipients underwent LT for PSC and had >90 days of follow-up. The primary outcome, rPSC, was defined using Graziadei criteria. Median follow-up after LT was 3 years (interquartile range 1.1-6.1). rPSC occurred in 36 children, representing 10% and 27% of the subjects at 2 years and 5 years following LT, respectively. Subjects with rPSC were younger at LT (12.9 vs. 16.2 years), had faster progression from PSC diagnosis to LT (2.5 vs. 4.1 years), and had higher alanine aminotransferase (112 vs. 66 IU/L) at LT (all P < 0.01). Inflammatory bowel disease was more prevalent in the rPSC group (86% vs. 66%; P = 0.025). After LT, rPSC subjects had more episodes of biopsy-proved acute rejection (mean 3 vs. 1; P < 0.001), and higher prevalence of steroid-refractory rejection (41% vs. 20%; P = 0.04). In those with rPSC, 43% developed complications of portal hypertension, were relisted for LT, or died within 2 years of the diagnosis. Mortality was higher in the rPSC group (11.1% vs. 2.9%; P = 0.05). CONCLUSIONS The incidence of rPSC in this cohort was higher than previously reported, and was associated with increased morbidity and mortality. Patients with rPSC appeared to have a more aggressive, immune-reactive phenotype. These findings underscore the need to understand the immune mechanisms of rPSC, to lay the foundation for developing new therapies and improve outcomes in this challenging population.
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Affiliation(s)
| | | | | | - Cara L Mack
- University of Colorado School of Medicine, Aurora, CO
| | | | - Annemarie Broderick
- Children’s Health Ireland at Crumlin & University College Dublin, Dublin, Ireland
| | | | | | - Katryn N. Furuya
- Mayo Clinic, Rochester, MN and Medical College of Wisconsin, Milwaukee, WI
| | - Nitika Gupta
- Emory University School of Medicine, Atlanta, GA
| | | | - Maureen M Jonas
- Boston Children’s Hospital and Harvard Medical School, Boston, MA
| | | | - Nanda Kerkar
- University of Rochester Medical Center, Rochester, NY
| | | | - Kaija-Leena Kolho
- University of Helsinki Hospital and Tampere University, Helsinki, Finland
| | - Bart GP Koot
- Amsterdam University Medical Center Amsterdam, The Netherlands
| | - Trevor J Laborda
- University of Utah and Intermountain Primary Children’s Hospital, Salt Lake City, UT
| | | | | | | | | | | | - Nadia Ovchinsky
- Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, NY
| | | | | | - Kathleen B Schwarz
- University of California San Diego, San Diego, CA and Johns Hopkins University, Baltimore, MD
| | | | | | | | | | | | - Marek Woynarowski
- Faculty of Medicine and Health Sciences, UJK Kielce, Poland (former IP CZD Warsaw)
| | | | - Mark R. Deneau
- University of Utah and Intermountain Primary Children’s Hospital, Salt Lake City, UT
| | - Mark R. Deneau
- Department of Pediatrics University of Utah and Intermountain Primary Children’s Hospital Salt Lake City UT
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You A, Gu J, Wang J, Li J, Zhang Y, Rao G, Ge X, Zhang K, Gao X, Wang D. Value of long non-coding RNA HAS2-AS1 as a diagnostic and prognostic marker of glioma. Neurologia 2021. [DOI: 10.1016/j.nrl.2021.06.006] [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] Open
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Deneau MR, Mack C, Perito ER, Ricciuto A, Valentino PL, Amin M, Amir AZ, Aumar M, Auth M, Broderick A, DiGuglielmo M, Draijer LG, Tavares Fagundes ED, El-Matary W, Ferrari F, Furuya KN, Gupta N, Hochberg JT, Homan M, Horslen S, Iorio R, Jensen MK, Jonas MM, Kamath BM, Kerkar N, Kim KM, Kolho KL, Koot BGP, Laborda TJ, Lee CK, Loomes KM, Martinez M, Miethke A, Miloh T, Mogul D, Mohammad S, Mohan P, Moroz S, Ovchinsky N, Palle S, Papadopoulou A, Rao G, Rodrigues Ferreira A, Sathya P, Schwarz KB, Shah U, Shteyer E, Singh R, Smolka V, Soufi N, Tanaka A, Varier R, Vitola B, Woynarowski M, Zerofsky M, Zizzo A, Guthery SL. The Sclerosing Cholangitis Outcomes in Pediatrics (SCOPE) Index: A Prognostic Tool for Children. Hepatology 2021; 73:1074-1087. [PMID: 32464706 PMCID: PMC8557635 DOI: 10.1002/hep.31393] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 04/21/2020] [Accepted: 05/03/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND AND AIMS Disease progression in children with primary sclerosing cholangitis (PSC) is variable. Prognostic and risk-stratification tools exist for adult-onset PSC, but not for children. We aimed to create a tool that accounts for the biochemical and phenotypic features and early disease stage of pediatric PSC. APPROACH AND RESULTS We used retrospective data from the Pediatric PSC Consortium. The training cohort contained 1,012 patients from 40 centers. We generated a multivariate risk index (Sclerosing Cholangitis Outcomes in Pediatrics [SCOPE] index) that contained total bilirubin, albumin, platelet count, gamma glutamyltransferase, and cholangiography to predict a primary outcome of liver transplantation or death (TD) and a broader secondary outcome that included portal hypertensive, biliary, and cancer complications termed hepatobiliary complications (HBCs). The model stratified patients as low, medium, or high risk based on progression to TD at rates of <1%, 3%, and 9% annually and to HBCs at rates of 2%, 6%, and 13% annually, respectively (P < 0.001). C-statistics to discriminate outcomes at 1 and 5 years were 0.95 and 0.82 for TD and 0.80 and 0.76 for HBCs, respectively. Baseline hepatic fibrosis stage was worse with increasing risk score, with extensive fibrosis in 8% of the lowest versus 100% with the highest risk index (P < 0.001). The model was validated in 240 children from 11 additional centers and performed well. CONCLUSIONS The SCOPE index is a pediatric-specific prognostic tool for PSC. It uses routinely obtained, objective data to predict a complicated clinical course. It correlates strongly with biopsy-proven liver fibrosis. SCOPE can be used with families for shared decision making on clinical care based on a patient's individual risk, and to account for variable disease progression when designing future clinical trials.
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Affiliation(s)
- Mark R Deneau
- University of Utah and Intermountain Primary Children's HospitalSalt Lake CityUT
| | - Cara Mack
- University of Colorado School of MedicineAuroraCO
| | | | | | | | | | - Achiya Z Amir
- The Dana-Dwek Children's HospitalThe Tel-Aviv Medical CenterTel-Aviv UniversityTel AvivIsrael
| | | | - Marcus Auth
- Alder Hey Children's HospitalLiverpoolUnited Kingdom
| | - Annemarie Broderick
- Children's Health Ireland at Crumlin & University College DublinDublinIreland
| | | | | | | | | | | | - Katryn N Furuya
- University of Wisconsin-Madison School of Medicine and Public HealthMadisonWI
| | | | | | | | | | | | - M Kyle Jensen
- University of Utah and Intermountain Primary Children's HospitalSalt Lake CityUT
| | - Maureen M Jonas
- Boston Children's Hospital and Harvard Medical SchoolBostonMA
| | | | - Nanda Kerkar
- University of Rochester Medical CenterRochesterNY
| | | | - Kaija-Leena Kolho
- University of Helsinki Hospital and Tampere UniversityHelsinkiFinland
| | - Bart G P Koot
- Amsterdam University Medical CenterAmsterdamThe Netherlands
| | - Trevor J Laborda
- University of Utah and Intermountain Primary Children's HospitalSalt Lake CityUT
| | - Christine K Lee
- Boston Children's Hospital and Harvard Medical SchoolBostonMA
| | | | | | | | | | | | | | | | - Stacy Moroz
- University of Southern CaliforniaLos AngelesCA
| | - Nadia Ovchinsky
- Children's Hospital at MontefioreAlbert Einstein College of MedicineBronxNY
| | | | - Alexandra Papadopoulou
- First Department of PediatricsUniversity of AthensChildren's Hospital Agia SofiaAthensGreece
| | | | | | | | - Kathleen B Schwarz
- Johns Hopkins UniversityBaltimoreMD.,University of California San DiegoSan DiegoCA
| | - Uzma Shah
- Massachusetts General Hospital, Harvard Medical SchoolBostonMA
| | | | - Ruchi Singh
- Cincinnati Children's Hospital Medical CenterCincinnatiOH
| | | | | | | | - Raghu Varier
- Northwest Pediatric Gastroenterology LLCPortlandOR
| | | | | | | | - Andréanne Zizzo
- London Health Sciences CenterWestern UniversityLondonOntarioCanada
| | - Stephen L Guthery
- University of Utah and Intermountain Primary Children's HospitalSalt Lake CityUT
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Deneau MR, Mack C, Mogul D, Perito ER, Valentino PL, Amir AZ, DiGuglielmo M, Draijer LG, El-Matary W, Furuya KN, Gupta N, Hochberg JT, Horslen S, Jensen MK, Jonas MM, Kerkar N, Koot BGP, Laborda TJ, Lee CK, Loomes KM, Martinez M, Miethke A, Miloh T, Mohammad S, Ovchinsky N, Rao G, Ricciuto A, Sathya P, Schwarz KB, Shah U, Singh R, Vitola B, Zizzo A, Guthery SL. Oral Vancomycin, Ursodeoxycholic Acid, or No Therapy for Pediatric Primary Sclerosing Cholangitis: A Matched Analysis. Hepatology 2021; 73:1061-1073. [PMID: 32946600 PMCID: PMC8557636 DOI: 10.1002/hep.31560] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [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] [Received: 06/19/2020] [Revised: 08/21/2020] [Accepted: 08/27/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND AIMS Many children with primary sclerosing cholangitis (PSC) receive oral vancomycin therapy (OVT) or ursodeoxycholic acid (UDCA). There is a paucity of data on whether these medications improve outcomes. APPROACH AND RESULTS We analyzed retrospective data from the Pediatric PSC Consortium. Children treated with OVT were matched 1:1:1 to those treated with UDCA or managed with observation (no treatment) based on the closest propensity score, ensuring similar baseline characteristics. Two hundred sixty-four patients (88 each with OVT, UDCA, or observation) had matching propensity scores and were similar in demographics, phenotype, immunosuppression, baseline biochemistry, and hepatic fibrosis. After 1 year in an intention-to-treat analysis, all outcome metrics were similar regardless of treatment group. In OVT, UDCA, and untreated groups, respectively: Gamma-glutamyltransferase normalized in 53%, 49%, and 52% (P = not significant [NS]), liver fibrosis stage was improved in 20%, 13%, and 18% and worsened in 11%, 29%, and 18% (P = NS), and the 5-year probability of liver transplant listing was 21%, 10%, and 12% (P = NS). Favorable outcome was associated with having a mild phenotype of PSC and minimal hepatic fibrosis. CONCLUSIONS We presented the largest-ever description of outcomes on OVT in PSC and compared them to carefully matched patients on UDCA or no therapy. Neither OVT nor UDCA showed improvement in outcomes compared to a strategy of observation. Patients progressed to end-stage liver disease at similar rates. Spontaneous normalization of biochemistry is common in children receiving no therapy, particularly in the majority of children with a mild phenotype and an early stage of disease. Placebo-controlled treatment trials are needed to identify effective treatments for pediatric PSC.
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Affiliation(s)
- Mark R Deneau
- University of Utah and Intermountain Primary Children's HospitalSalt Lake CityUT
| | - Cara Mack
- University of Colorado School of MedicineAuroraCO
| | | | | | | | - Achiya Z Amir
- The Dana-Dwek Children's HospitalThe Tel-Aviv Medical CenterTel-Aviv UniversityTel AvivIsrael
| | | | | | | | - Katryn N Furuya
- Mayo ClinicRochesterMN.,University of Wisconsin-Madison School of Medicine and Public HealthMadisonWI
| | | | | | | | - M Kyle Jensen
- University of Utah and Intermountain Primary Children's HospitalSalt Lake CityUT
| | - Maureen M Jonas
- Boston Children's Hospital and Harvard Medical SchoolBostonMA
| | - Nanda Kerkar
- University of Rochester Medical CenterRochesterNY
| | - Bart G P Koot
- Amsterdam University Medical CenterAmsterdamThe Netherlands
| | - Trevor J Laborda
- University of Utah and Intermountain Primary Children's HospitalSalt Lake CityUT
| | - Christine K Lee
- Boston Children's Hospital and Harvard Medical SchoolBostonMA
| | | | | | | | | | | | - Nadia Ovchinsky
- Children's Hospital at MontefioreAlbert Einstein College of MedicineBronxNY
| | | | | | - Pushpa Sathya
- Memorial UniversitySt. John'sNewfoundland and LabradorCanada
| | - Kathleen B Schwarz
- Johns Hopkins UniversityBaltimoreMD.,University of California San DiegoSan DiegoCA
| | - Uzma Shah
- Massachusetts General HospitalHarvard Medical SchoolBostonMA
| | - Ruchi Singh
- Cincinnati Children's Hospital Medical CenterCincinnatiOH
| | | | - Andréanne Zizzo
- London Health Sciences CenterWestern UniversityLondonOntarioCanada
| | - Stephen L Guthery
- University of Utah and Intermountain Primary Children's HospitalSalt Lake CityUT
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Mohindra P, Pollock A, Patel A, Roque D, Rao G, Nichols E. First Clinical Experience of Quality Assurance CT Scan Adapted Intensity Modulated Proton Therapy for Utero-cervical Cancers. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.1537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Li J, Ludmir E, Wang Y, Guha-Thakurta N, McAleer M, Settle S, Yeboa D, Ghia A, McGovern S, Chung C, Woodhouse K, Briere T, Sullaway C, Liu D, Rao G, Chang E, Mahajan A, Sulman E, Brown P, Wefel J. Stereotactic Radiosurgery versus Whole-brain Radiation Therapy for Patients with 4-15 Brain Metastases: A Phase III Randomized Controlled Trial. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.2108] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Sridhar P, Roopesh K, Anuradha P, Deputy M, Bharathan A, Senapati M, Ram A, Gupta M, Muttagi V, Rao G, Patil S, Chirodoni Thungappa S, Hussain S, Ajai kumar B. Understanding the Immune Profile of SBRT – Could It Evolve Into Becoming A Surrogate Biomarkers To Treatment Response. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.1598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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22
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Soliman M, Wang Y, Farooqi A, Bishop A, Yeboa D, McGovern S, McAleer M, Briere T, Campbell M, Tu S, Ferguson S, Rao G, Nieto Y, Li J. Primary Management of Non-Seminomatous Germ Cell Brain Metastases with Stereotactic Radiosurgery: A Case Series. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.2035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Elisofon SA, Magee JC, Ng VL, Horslen SP, Fioravanti V, Economides J, Erinjeri J, Anand R, Mazariegos GV, Martin A, Mannino D, Flynn L, Mohammad S, Alonso E, Superina R, Brandt K, Riordan M, Lokar J, Ito J, Elisofon S, Zapata L, Jain A, Foristal E, Gupta N, Whitlow C, Naik K, Espinosa H, Miethke A, Hawkins A, Hardy J, Engels E, Schreibeis A, Ovchinsky N, Kogan‐Liberman D, Cunningham R, Malik P, Sundaram S, Feldman A, Garcia B, Yanni G, Kohli R, Emamaullee J, Secules C, Magee J, Lopez J, Bilhartz J, Hollenbeck J, Shaw B, Bartow C, Forest S, Rand E, Byrne A, Linguiti I, Wann L, Seidman C, Mazariegos G, Soltys K, Squires J, Kepler A, Vitola B, Telega G, Lerret S, Desai D, Moghe J, Cutright L, Daniel J, Andrews W, Fioravanti V, Slowik V, Cisneros R, Faseler M, Hufferd M, Kelly B, Sudan D, Mavis A, Moats L, Swan‐Nesbit S, Yazigi N, Buranych A, Hobby A, Rao G, Maccaby B, Gopalareddy V, Boulware M, Ibrahim S, El Youssef M, Furuya K, Schatz A, Weckwerth J, Lovejoy C, Kasi N, Nadig S, Law M, Arnon R, Chu J, Bucuvalas J, Czurda M, Secheli B, Almy C, Haydel B, Lobritto S, Emand J, Biney‐Amissah E, Gamino D, Gomez A, Himes R, Seal J, Stewart S, Bergeron J, Truxillo A, Lebel S, Davidson H, Book L, Ramstack D, Riley A, Jennings C, Horslen S, Hsu E, Wallace K, Turmelle Y, Nadler M, Postma S, Miloh T, Economides J, Timmons K, Ng V, Subramonian A, Dharmaraj B, McDiarmid S, Feist S, Rhee S, Perito E, Gallagher L, Smith K, Ebel N, Zerofsky M, Nogueira J, Greer R, Gilmour S, Robert C, Cars C, Azzam R, Boone P, Garbarino N, Lalonde M, Kerkar N, Dokus K, Helbig K, Grizzanti M, Tomiyama K, Cocking J, Alexopoulos S, Bhave C, Schillo R, Bailey A, Dulek D, Ramsey L, Ekong U, Valentino P, Hettiarachchi D, Tomlin R. Society of pediatric liver transplantation: Current registry status 2011-2018. Pediatr Transplant 2020; 24:e13605. [PMID: 31680409 DOI: 10.1111/petr.13605] [Citation(s) in RCA: 62] [Impact Index Per Article: 15.5] [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] [Received: 05/31/2019] [Revised: 08/08/2019] [Accepted: 09/27/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND SPLIT was founded in 1995 in order to collect comprehensive prospective data on pediatric liver transplantation, including waiting list data, transplant, and early and late outcomes. Since 2011, data collection of the current registry has been refined to focus on prospective data and outcomes only after transplant to serve as a foundation for the future development of targeted clinical studies. OBJECTIVE To report the outcomes of the SPLIT registry from 2011 to 2018. METHODS This is a multicenter, cross-sectional analysis characterizing patients transplanted and enrolled in the SPLIT registry between 2011 and 2018. All patients, <18 years of age, received a first liver-only, a combined liver-kidney, or a combined liver-pancreas transplant during this study period. RESULTS A total of 1911 recipients from 39 participating centers in North America were registered. Indications included biliary atresia (38.5%), metabolic disease (19.1%), tumors (11.7%), and fulminant liver failure (11.5%). Greater than 50% of recipients were transplanted as either Status 1A/1B or with a MELD/PELD exception score. Incompatible transplants were performed in 4.1%. Kaplan-Meier estimates of 1-year patient and graft survival were 97.3% and 96.6%. First 30 days of surgical complications included reoperation (31.7%), hepatic artery thrombosis (6.3%), and portal vein thrombosis (3.2%). In the first 90 days, biliary tract complications were reported in 13.6%. Acute cellular rejection during first year was 34.7%. At 1 and 2 years of follow-up, 39.2% and 50.6% had normal liver tests on monotherapy (tacrolimus or sirolimus). Further surgical, survival, allograft function, and complications are detailed.
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Affiliation(s)
- Scott A Elisofon
- Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, Boston, Massachusetts
| | - John C Magee
- Division of Surgery, University of Michigan Transplant Center, Ann Arbor, Michigan
| | - Vicky L Ng
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Transplant and Regenerative Medicine Center, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Simon P Horslen
- Department of Pediatrics, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, Washington
| | - Vicki Fioravanti
- Section of Hepatology and Liver Transplantation, Children's Mercy Hospital, Kansas City, Missouri
| | | | | | | | - George V Mazariegos
- Division of Pediatric Transplant Surgery, Hillman Center for Pediatric Transplantation, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
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Chadefaux D, Gueguen N, Thouze A, Rao G. 3D propagation of the shock-induced vibrations through the whole lower-limb during running. J Biomech 2019; 96:109343. [PMID: 31558309 DOI: 10.1016/j.jbiomech.2019.109343] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 09/10/2019] [Accepted: 09/11/2019] [Indexed: 11/30/2022]
Affiliation(s)
- D Chadefaux
- Aix-Marseille Univ, CNRS, ISM, Marseille, France; Université Paris 13 - Institut de Biomécanique Humaine Georges Charpak (EA 4494), Paris, France.
| | - N Gueguen
- Department of Movement Sciences, Décathlon, Villeneuve d'Ascq, France
| | - A Thouze
- Department of Movement Sciences, Décathlon, Villeneuve d'Ascq, France
| | - G Rao
- Aix-Marseille Univ, CNRS, ISM, Marseille, France
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Muhammad Adil ZA, Nur Zawani J, Hazariah AH, Rao G, Zailiza S, Mohd Nasir H. Methanol outbreak in the district of Hulu Langat, 2018. Med J Malaysia 2019; 74:413-417. [PMID: 31649218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
INTRODUCTION A methanol outbreak occurred in the district of Hulu Langat on 16 September 2018. The Hulu Langat District Health Office received 25 notifications of a suspected methanol poisoning from Kajang and Ampang Hospital. An outbreak investigation was done to determine the source followed by a preventive and control measure. METHOD Active case detection was done on cases living quarters and workplaces. Patients were interviewed, and their blood and urine samples were sent for methanol analysis. Samples of suspected alcoholic beverages were also sent for analysis. A suspected case was defined as any person presented with clinical symptoms with a history of consuming alcoholic beverages within five days before symptoms and high anion gap metabolic acidosis. A confirmed case was defined as a suspected case with positive blood and urine methanol. RESULTS In total, there were 25 suspected cases, of which 12 cases were confirmed. The calculated attack rate was 48%. There were six mortalities (50%) secondary to severe metabolic acidosis. The most common presenting symptom was vomiting (75%) and abdominal pain (41.7%). These cases were linked to consumption of illicitly produced alcohol. Samples of the alcoholic drinks were positive containing high level of methanol. CONCLUSION The methanol outbreak in the Hulu Langat was successfully managed. Appropriate control and prevention measures were taken, including health promotion and joint enforcement activities. Steps were taken successfully through collaborations with multiple agencies and cooperation with Selangor Health Departments and the Ministry of Health. Continuous surveillance on the product of liquor, and health promotion are essential to prevent a similar outbreak from happening again in future.
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Affiliation(s)
- Z A Muhammad Adil
- Ministry of Health Malaysia, Hulu Langat District Health Office, Kajang, Selangor, Malaysia.
| | - J Nur Zawani
- Ministry of Health Malaysia, Hulu Langat District Health Office, Kajang, Selangor, Malaysia
| | - A H Hazariah
- Ministry of Health Malaysia, Hulu Langat District Health Office, Kajang, Selangor, Malaysia
| | - G Rao
- Ministry of Health Malaysia, Hulu Langat District Health Office, Kajang, Selangor, Malaysia
| | - S Zailiza
- Ministry of Health Malaysia, Hulu Langat District Health Office, Kajang, Selangor, Malaysia
| | - H Mohd Nasir
- Ministry of Health Malaysia, Hulu Langat District Health Office, Kajang, Selangor, Malaysia
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Traylor JI, Bastos DCA, Fuentes D, Muir M, Patel R, Kumar VA, Stafford RJ, Rao G, Prabhu SS. Dynamic Contrast-Enhanced MRI in Patients with Brain Metastases Undergoing Laser Interstitial Thermal Therapy: A Pilot Study. AJNR Am J Neuroradiol 2019; 40:1451-1457. [PMID: 31371353 DOI: 10.3174/ajnr.a6144] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Accepted: 06/19/2019] [Indexed: 12/19/2022]
Abstract
BACKGROUND AND PURPOSE Tumor recurrence is difficult to predict in patients receiving laser ablation for intracranial malignancy. We assessed the efficacy of the initial area under the time-to-signal intensity curve at 60 seconds (iAUC60) from dynamic contrast-enhanced MR imaging in predicting progression-free survival in patients with brain metastases following laser interstitial thermal therapy. MATERIALS AND METHODS The study population was a consecutive series of patients undergoing laser interstitial thermal therapy for brain metastases. Patient demographics including age, sex, tumor histology, and Karnofsky Performance Scale were collected prospectively. Preoperative, postoperative, and 1-month follow-up dynamic contrast-enhanced MRIs were analyzed. Values of iAUC60 were computed using a trapezoidal rule applied to the time history of contrast uptake over the first 60 seconds postenhancement. The change in iAUC60 (ΔiAUC60) was calculated by taking the difference between the values of iAUC60 from 2 time points. Pearson correlation coefficients were calculated between progression-free survival, defined as the time from laser interstitial thermal therapy to tumor recurrence, and iAUC60 or ΔiAUC60 values. RESULTS Thirty-three cases of laser interstitial thermal therapy for 32 brain metastases in a cohort of 27 patients were prospectively analyzed. A significant relationship was observed between the values of iAUC60 from postoperative dynamic contrast-enhanced MR imaging and progression-free survival with Pearson correlation (P = .03) and Cox univariate analysis (P = .01). The relationship between preoperative and 1-month follow-up dynamic contrast-enhanced MR imaging was not significantly correlated with progression-free survival. Similarly, no statistically significant relationship was observed with ΔiAUC60 and progression-free survival between any time points. CONCLUSIONS Progression-free survival is difficult to predict in patients undergoing laser interstitial thermal therapy for brain metastases due to confounding with posttreatment change. iAUC60 extracted from postoperative dynamic contrast-enhanced MR imaging shows promise for accurately prognosticating patients following this operative therapy.
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Affiliation(s)
- J I Traylor
- From the Departments of Neurosurgery (J.I.T., D.C.A.B., M.M., R.P., G.R., S.S.P.)
| | - D C A Bastos
- From the Departments of Neurosurgery (J.I.T., D.C.A.B., M.M., R.P., G.R., S.S.P.)
| | | | - M Muir
- From the Departments of Neurosurgery (J.I.T., D.C.A.B., M.M., R.P., G.R., S.S.P.)
| | - R Patel
- From the Departments of Neurosurgery (J.I.T., D.C.A.B., M.M., R.P., G.R., S.S.P.)
| | - V A Kumar
- Diagnostic Radiology (V.A.K.), The University of Texas MD Anderson Cancer Center, Houston, Texas
| | | | - G Rao
- From the Departments of Neurosurgery (J.I.T., D.C.A.B., M.M., R.P., G.R., S.S.P.)
| | - S S Prabhu
- From the Departments of Neurosurgery (J.I.T., D.C.A.B., M.M., R.P., G.R., S.S.P.)
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Naik A, Ratra D, Banerjee A, Dalan D, Jandyal S, Rao G, Sen P, Bhende M, Jayaprakash V, Susvar P, Walinjkar J, Rao C. Enhanced S-cone syndrome: Clinical spectrum in Indian population. Indian J Ophthalmol 2019; 67:523-529. [PMID: 30900587 PMCID: PMC6446635 DOI: 10.4103/ijo.ijo_1480_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Purpose: Enhanced S-cone syndrome (ESCS), a rare disorder, is often misdiagnosed as other forms of retinal degenerations, which have a poorer prognosis than ESCS. The aim of this study is to report the varied clinical features of ESCS and distinguish it from other similar disorders. Methods: We retrospectively scrutinized the records of patients with confirmed diagnosis of ESCS and analyzed the findings. Results: We included 14 patients (age range 4–39 years) who were confirmed to have ESCS according to pathognomonic electroretinography (ERG) showing reduced photopic, combined responses, and 30 Hz flicker with reduced L, M cone responses and supernormal S cone responses. The disease presented in the 1st decade with night blindness and was almost stationary or minimally progressive. Mid-peripheral fundus changes in form of nummular pigmentary alterations, yellow punctate lesions, and macular schisis were noted. The vision ranged from 6/6 to 6/36 with follow-up ranging from 1month to 22 years. Conclusion: ESCS shows varied clinical features ranging from unremarkable fundus to pigment clumping and atrophic lesions. It has good prognosis with patients mostly maintaining their vision. ERG is diagnostic. More awareness and knowledge about this entity can help to differentiate it from other forms of night blindness.
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Affiliation(s)
- Anmol Naik
- Department of Vitreoretinal Diseases, Medical Research Foundation, Sankara Nethralaya, College Road, Chennai, Tamil Nadu, India
| | - Dhanashree Ratra
- Department of Vitreoretinal Diseases, Medical Research Foundation, Sankara Nethralaya, College Road, Chennai, Tamil Nadu, India
| | - Aniruddha Banerjee
- Department of Vitreoretinal Diseases, Medical Research Foundation, Sankara Nethralaya, College Road, Chennai, Tamil Nadu, India
| | - Daleena Dalan
- Department of Vitreoretinal Diseases, Medical Research Foundation, Sankara Nethralaya, College Road, Chennai, Tamil Nadu, India
| | - Sourabh Jandyal
- Department of Vitreoretinal Diseases, Medical Research Foundation, Sankara Nethralaya, College Road, Chennai, Tamil Nadu, India
| | - Girish Rao
- Department of Vitreoretinal Diseases, Medical Research Foundation, Sankara Nethralaya, College Road, Chennai, Tamil Nadu, India
| | - Parveen Sen
- Department of Vitreoretinal Diseases, Medical Research Foundation, Sankara Nethralaya, College Road, Chennai, Tamil Nadu, India
| | - Muna Bhende
- Department of Vitreoretinal Diseases, Medical Research Foundation, Sankara Nethralaya, College Road, Chennai, Tamil Nadu, India
| | - V Jayaprakash
- Department of Vitreoretinal Diseases, Medical Research Foundation, Sankara Nethralaya, College Road, Chennai, Tamil Nadu, India
| | - Pradeep Susvar
- Department of Vitreoretinal Diseases, Medical Research Foundation, Sankara Nethralaya, College Road, Chennai, Tamil Nadu, India
| | - Jaydeep Walinjkar
- Department of Vitreoretinal Diseases, Medical Research Foundation, Sankara Nethralaya, College Road, Chennai, Tamil Nadu, India
| | - Chetan Rao
- Department of Vitreoretinal Diseases, Medical Research Foundation, Sankara Nethralaya, College Road, Chennai, Tamil Nadu, India
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Room R, Callinan S, Greenfield T, Rekve D, Waleewong O, Stanesby O, Thamarangsi T, Benegal V, Casswell S, Florenzano R, Hanh T, Hettige S, Karriker-Jaffe K, Obot I, Rao G, Siengsounthone L, Laslett AM. The social location of harm from others' drinking in 10 societies. Addiction 2019; 114:425-433. [PMID: 30248718 PMCID: PMC6377290 DOI: 10.1111/add.14447] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [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] [Received: 04/26/2018] [Revised: 08/02/2018] [Accepted: 09/20/2018] [Indexed: 01/23/2023]
Abstract
AIMS Survey data from 10 diverse countries were used to analyse the social location of harms from others' drinking: which segments of the population are more likely to be adversely affected by such harm, and how does this differ between societies? METHODS General-population surveys in Australia, Chile, India, Laos, New Zealand, Nigeria, Sri Lanka, Thailand, United States and Vietnam, with a primary focus on the social location of the harmed person by gender, age groups, rural/urban residence and drinking status. Harms from known drinkers were analysed separately from harms from strangers. RESULTS In all sites, risky or moderate drinkers were more likely than abstainers to report harm from the drinking of known drinkers, with risky drinkers the most likely to report harm. This was also generally true for harm from strangers' drinking, although the patterns were more mixed in Vietnam and Thailand. Harm from strangers' drinking was more often reported by males, while gender disparity in harm from known drinkers varied between sites. Younger adults were more likely to experience harm both from known drinkers and from strangers in some, but not all, societies. Only a few sites showed significant urban/rural differences, with disparities varying in direction. In multivariate analyses, most relationships remained, although some were no longer significant. CONCLUSION The social location of harms from others' drinking, whether known or a stranger, varies considerably between societies. One near-commonality among the societies is that those who are themselves risky drinkers are more likely to suffer harm from others' drinking.
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Affiliation(s)
- R. Room
- Centre for Alcohol Policy Research, La Trobe University, Melbourne, Australia; Centre for Social Research on Alcohol and Drugs, Stockholm University, Stockholm, Sweden,
| | - S. Callinan
- Centre for Alcohol Policy Research, La Trobe University, Melbourne, Australia,
| | - T.K. Greenfield
- Alcohol Research Group, Public Health Institute, Emeryville, California, USA,
| | - D. Rekve
- Mental Health and Substance Abuse, WHO, Geneva, Switzerland
| | - O. Waleewong
- Health Promotion Policy Research Center; International Health Policy Program, Ministry of Public Health, Nonthaburi Thailand,
| | - O. Stanesby
- Centre for Alcohol Policy Research, La Trobe University, Melbourne, Australia,
| | - T. Thamarangsi
- Department of Non-Communicable Diseases and Environmental Health, World Health Organization Regional Office for South-East Asia, New Delhi, India,
| | - V. Benegal
- Centre for Addiction Medicine, National Institute of Mental Health and NeuroSciences, Bangalore, India,
| | - S. Casswell
- SHORE and Whariki Research Centre, School of Public Health, Massey University, Auckland, New Zealand,
| | - R. Florenzano
- Universidad del Desarrollo, Facultades de Psicología y de Ciencia Social; Universidades de Chile y de los Andes, Departamento de Psiquiatría, Santiago de Chile, Chile,
| | - T.M.H. Hanh
- Health Strategy and Policy Institute, Ministry of Health, Vietnam,
| | - S. Hettige
- Department of Sociology, University of Colombo, Colombo, Sri Lanka and Adjunct Professor, Globalism Research Centre, School of Social Sciences, RMIT University, Melbourne, Australia,
| | - K.J. Karriker-Jaffe
- Alcohol Research Group, Public Health Institute, Emeryville, California, USA,
| | - I. Obot
- Department of Psychology, University of Uyo, Uyo, Nigeria & Centre for Research and Information on Substance Abuse (CRISA), Uyo, Nigeria,
| | - G. Rao
- Centre for Public Health, National Institute of Mental Health and NeuroSciences, Bangalore, India,
| | - L. Siengsounthone
- Research Outcomes Management Department, National Institute of Public Health, Ministry of Health, Vientiane Capital, Lao PDR,
| | - A.-M. Laslett
- Centre for Alcohol Policy Research, La Trobe University, Melbourne, Australia; National Drug Research Institute, Curtin University, Fitzroy, Victoria, Australia,
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Shillo P, Selvarajah D, Greig M, Gandhi R, Rao G, Wilkinson ID, Anand P, Tesfaye S. Reduced vitamin D levels in painful diabetic peripheral neuropathy. Diabet Med 2019; 36:44-51. [PMID: 30102801 DOI: 10.1111/dme.13798] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/08/2018] [Indexed: 12/25/2022]
Abstract
AIM Recent studies have reported an association between low vitamin D levels and diabetic peripheral neuropathy. However, many of these did not differentiate between people with painful diabetic peripheral neuropathy and those with painless diabetic peripheral neuropathy, or assess major confounding factors including sunlight exposure and daily activity. Our study addressed these limitations and evaluated vitamin D levels in people with carefully phenotyped diabetic peripheral neuropathy and controls. METHODS Forty-five white Europeans with Type 2 diabetes and 14 healthy volunteers underwent clinical and neurophysiological assessments. People with Type 2 diabetes were then divided into three groups (17 with painful diabetic peripheral neuropathy, 14 with painless diabetic peripheral neuropathy and 14 with no diabetic peripheral neuropathy). All had seasonal sunlight exposure and daily activity measured, underwent a lower limb skin biopsy and had 25-hydroxyvitamin D measured during the summer months, July to September. RESULTS After adjusting for age, BMI, activity score and sunlight exposure, 25-hydroxyvitamin D levels (nmol/l) (se) were significantly lower in people with painful diabetic peripheral neuropathy [painful diabetic peripheral neuropathy 34.9 (5.8), healthy volunteers 62.05 (6.7), no diabetic peripheral neuropathy 49.6 (6.1), painless diabetic peripheral neuropathy 53.1 (6.2); ANCOVAP = 0.03]. Direct logistic regression was used to assess the impact of seven independent variables on painful diabetic peripheral neuropathy. Vitamin D was the only independent variable to make a statistically significant contribution to the model with an inverted odds ratio of 1.11. Lower 25-hydroxyvitamin D levels also correlated with lower cold detection thresholds (r = 0.39, P = 0.02) and subepidermal nerve fibre densities (r = 0.42, P = 0.01). CONCLUSIONS We have demonstrated a significant difference in 25-hydroxyvitamin D levels in well-characterized people with painful diabetic peripheral neuropathy, while accounting for the main confounding factors. This suggests a possible role for vitamin D in the pathogenesis of painful diabetic peripheral neuropathy. Further prospective and intervention trials are required to prove causality between low vitamin D levels and painful diabetic peripheral neuropathy.
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Affiliation(s)
- P Shillo
- Diabetes Research Unit, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield
| | - D Selvarajah
- Department of Oncology and Human Metabolism, University of Sheffield, Sheffield
| | - M Greig
- Diabetes Research Unit, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield
| | - R Gandhi
- Diabetes Research Unit, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield
| | - G Rao
- Diabetes Research Unit, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield
| | - I D Wilkinson
- Academic Unit of Radiology, University of Sheffield, Sheffield
| | - P Anand
- Peripheral Neuropathy Unit, Imperial College London, London, UK
| | - S Tesfaye
- Diabetes Research Unit, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield
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Callinan S, Rankin G, Room R, Stanesby O, Rao G, Waleewong O, Greenfield TK, Hope A, Laslett AM. Harms from a partner's drinking: an international study on adverse effects and reduced quality of life for women. Am J Drug Alcohol Abuse 2018; 45:170-178. [PMID: 30495983 DOI: 10.1080/00952990.2018.1540632] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Partners of heavy drinking individuals can be detrimentally affected as a result of their partner's drinking. OBJECTIVES The aim of this study was to identify the proportion of heterosexual intimate partner relationships with a heavy drinking male that resulted in reported alcohol-related harm and to investigate the impact of this on well-being in 9 countries. METHODS This study used survey data from the Gender and Alcohol's Harm to Others (GENAHTO) Project on Alcohol's Harm to Others in 9 countries (10,613 female respondents, 7,091 with intimate live-in partners). Respondents were asked if their partners drinking had negatively affected them as well as questions on depression, anxiety, and satisfaction with life. RESULTS The proportion of partnered respondents that reported having a harmful heavy drinking partner varied across countries, from 4% in Nigeria and the US to 33% in Vietnam. The most consistent correlate of experiencing harm was being oneself a heavy episodic drinker, most likely as a proxy measure for the acceptability of alcohol consumption in social circles. Women with a harmful heavy drinking partner reported significantly lower mean satisfaction with life than those with a partner that did not drink heavily. CONCLUSIONS Harms to women from heavy drinking intimate partners appear across a range of subgroups and impact on a wide range of women, at least demographically speaking. Women living with a heavy drinking spouse experience higher levels of anxiety and depression symptoms and lower satisfaction with life.
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Affiliation(s)
- S Callinan
- a Centre for Alcohol Policy Research , La Trobe University , Bundoora , Australia
| | - G Rankin
- a Centre for Alcohol Policy Research , La Trobe University , Bundoora , Australia
| | - R Room
- a Centre for Alcohol Policy Research , La Trobe University , Bundoora , Australia.,b Centre for Social Research on Alcohol & Drugs , Stockholm University , Stockholm , Sweden
| | - O Stanesby
- a Centre for Alcohol Policy Research , La Trobe University , Bundoora , Australia
| | - G Rao
- c Centre for Public Health , National Institute of Mental Health and NeuroSciences , Bangalore , India
| | - O Waleewong
- a Centre for Alcohol Policy Research , La Trobe University , Bundoora , Australia.,d School of Population and Global Health , University of Melbourne , Melbourne , Australia.,e International Health Policy Program (IHPP) , Ministry of Public Health , Nonthaburi , Thailand
| | - T K Greenfield
- f Alcohol Research Group , Public Health Institute , Emeryville , CA , USA
| | - A Hope
- g Department of Public Health and Primary Care , Trinity College , Dublin , Ireland
| | - A-M Laslett
- a Centre for Alcohol Policy Research , La Trobe University , Bundoora , Australia.,d School of Population and Global Health , University of Melbourne , Melbourne , Australia.,h National Drug Research Institute , Curtin University , Perth , Australia
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Mastall M, Majd N, Fuller G, Gule-Monroe M, Huse J, Khatua S, Rao G, Sandberg D, Wefel J, Yeboa D, Zaky W, Mahajan A, Puduvalli V, Suki D, Alfaro K, Weathers S, Harrison R, de Groot J, Penas-Prado M. P05.93 Adult medulloblastoma: analysis of use of chemotherapy in clinical practice. Neuro Oncol 2018. [DOI: 10.1093/neuonc/noy139.419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- M Mastall
- University of Heidelberg, Heidelberg, Germany
| | - N Majd
- MD Anderson Cancer Center, Houston, TX, United States
| | - G Fuller
- MD Anderson Cancer Center, Houston, TX, United States
| | - M Gule-Monroe
- MD Anderson Cancer Center, Houston, TX, United States
| | - J Huse
- MD Anderson Cancer Center, Houston, TX, United States
| | - S Khatua
- MD Anderson Cancer Center, Houston, TX, United States
| | - G Rao
- MD Anderson Cancer Center, Houston, TX, United States
| | - D Sandberg
- MD Anderson Cancer Center, Houston, TX, United States
| | - J Wefel
- MD Anderson Cancer Center, Houston, TX, United States
| | - D Yeboa
- MD Anderson Cancer Center, Houston, TX, United States
| | - W Zaky
- MD Anderson Cancer Center, Houston, TX, United States
| | - A Mahajan
- Mayo Clinic, Rochester, MN, United States
| | - V Puduvalli
- Ohio State University, Columbus, OH, United States
| | - D Suki
- MD Anderson Cancer Center, Houston, TX, United States
| | - K Alfaro
- MD Anderson Cancer Center, Houston, TX, United States
| | - S Weathers
- MD Anderson Cancer Center, Houston, TX, United States
| | - R Harrison
- MD Anderson Cancer Center, Houston, TX, United States
| | - J de Groot
- MD Anderson Cancer Center, Houston, TX, United States
| | - M Penas-Prado
- MD Anderson Cancer Center, Houston, TX, United States
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Mehrotra S, Sudhir P, Rao G, Thirthalli J, Srikanth TK. Development and Pilot Testing of an Internet-Based Self-Help Intervention for Depression for Indian Users. Behav Sci (Basel) 2018; 8:bs8040036. [PMID: 29565278 PMCID: PMC5946095 DOI: 10.3390/bs8040036] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [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: 01/08/2018] [Revised: 02/25/2018] [Accepted: 03/16/2018] [Indexed: 12/28/2022] Open
Abstract
There is a dearth of published research on uptake and utility of mental health apps in India, despite a rising global trend in the application of technology in the field of mental health. We describe the development and pilot testing of a self-help intervention for depression, PUSH-D (Practice and Use Self-Help for Depression) for urban Indians. This guided self-help app, with essential and optional zone sections, was developed to provide a comprehensive coverage of therapeutic strategies drawn from cognitive behavior therapy, interpersonal therapy, supportive psychotherapy, and positive psychology. Pilot testing was carried out using a single group pre-, post- and follow-up design in 78 eligible participants. Participants were typically young adults with major depression or dysthymia and significant impairment in functioning. Almost two-thirds of the participants had never sought professional mental health help. Significant reductions in depression and improvement in the functioning and well-being were notedon standardized measures in participants completing all 10 essential zone sections. These gains were maintained at follow-up. The results were similar for partial completers, who completed fiveout of the 10 essential sections. PUSH-D is one of the first indigenously developed self-help apps for depression and it shows promise in reducing the treatment gap for depression in India.
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Affiliation(s)
- Seema Mehrotra
- Department of Clinical Psychology, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka 560029, India.
| | - Paulomi Sudhir
- Department of Clinical Psychology, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka 560029, India.
| | - Girish Rao
- Department of Epidemiology, Center for Public health, NIMHANS, Bangalore 560029, India.
| | | | - T K Srikanth
- E-health Research Center, IIIT, Bangalore 560100, India.
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Abstract
Herein, the first diazomethane-mediated synthesis of azetidine-embedded tetracyclic ketal systems is reported. Reactions of norbornyl hemiaminal acetals with diazomethane afford azetidine-embedded tetracyclic ketals in good to excellent yields. The bridgehead-bromo-substituted hemiaminal acetals give higher yields compared to the corresponding bridgehead-chloro-substituted hemiaminal acetals. The hemiaminal acetals are prepared stereoselectively via nucleophilic addition of various amines to norbornyl α-diketones from the exo face.
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Affiliation(s)
- G. Rao
- Department of Chemistry, Indian Institute of Technology Kanpur
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35
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Hamdan A, Saxena A, Rao G, Ivanov M. Compression of a giant pseudomeningocele causing transient anoxic seizures-a case report. Acta Neurochir (Wien) 2018; 160:479-485. [PMID: 29299677 DOI: 10.1007/s00701-017-3446-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 12/21/2017] [Indexed: 11/28/2022]
Abstract
Transient anoxic seizure upon application of pressure on a giant pseudomeningocele has never been reported in the literature; such abrupt changes in intracranial pressure due to large volume of cerebrospinal fluid (CSF) translocation, if left untreated may lead to permanent cerebral hypoxic injury and death. Here we describe a case of a 26-year-old woman who had undergone lumbar disc surgery in another unit few months ago and developed a large lump around her back. Any pressure on the lump resulted in headaches and at times episodes of seizures. Clinical examination revealed a very large fluid-filled lump consistent with a giant pseudomeningocele, confirmed by an MRI. A video EEG while applying pressure on the lump was recorded. The patient developed a typical seizure attack with a characteristic pattern of cerebral anoxia, and a paired ECG showed irregular rhythm with junctional and ventricular ectopic beats during the latter part of the attack, raising a suspicion of asystole. Upon relieving the pressure off the lump, the patient gradually regained consciousness with no permanent neurological deficit. We then discuss the pathophysiology of anoxic seizures and highlight the need to be vigilant in managing patients with such lesions in order to prevent permanent cerebral hypoxic injury and death.
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Affiliation(s)
- Alhafidz Hamdan
- Department of Spinal Surgery, Northern General Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK.
| | - A Saxena
- Department of Neurosurgery, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - G Rao
- Department of Neurosurgery, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - M Ivanov
- Department of Spinal Surgery, Northern General Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
- Department of Neurosurgery, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
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Bashour SI, Ibrahim NK, Schomer DF, Colen RR, Sawaya R, Suki D, Rao G, Murthy RK, Moulder SL, Abugabal Y, Hess KR, Fuller GN. Abstract P6-03-04: Central nervous system miliary metastasis in breast cancer patients. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p6-03-04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Little is known regarding central nervous system (CNS) miliary metastasis (MiM), which was first described as “carcinomatous encephalitis” by Madow and Alpers in 1951. The majority of reported cases arise from primary lung and gastrointestinal adenocarcinomas, with occasional melanoma primaries and one reported case in breast cancer. Moreover, clinicopathologic correlates, disease outcomes and prognostic factors in these patients are poorly understood. Although identified most frequently on neuroimaging, radiographic criteria to objectively diagnose MiM do not exist. In this analysis of patients with brain metastasis from primary breast cancer, we propose objective, stringent radiographic criteria for CNS MiM diagnosis and identify clinicopathologic factors contributing to disease outcomes.
Methods: Using a prospectively maintained electronic database, 1,002 female patients diagnosed with brain metastasis from primary breast cancer between 2000 and 2015 were identified. Only patients with neuroimaging available for direct review (CT or MRI) were included. Our radiographic criteria for MiM diagnosis were: 1) ≥20 metastatic lesions per image slice on ≥2 noncontiguous image slices by MRI, or 2) ≥10 lesions per image slice on ≥2 noncontiguous image slices by CT, and 3) MiM lesions were required to be present bilaterally and in both the supra- and infratentorial compartments. These criteria were established upon direct review of all neuroimaging by a neuroradiologist. Number and anatomic distribution of metastatic lesions were the patterns best observed to identify cases of CNS MiM on case review; lesion size was not a reliable pattern for MiM identification. Log rank tests were used for statistical analyses.
Results: Using stringent criteria, 486 patients were included in this analysis. Twenty patients with MiM were identified (4.1%). Ten patients were diagnosed with MiM at initial brain metastasis presentation; 10 developed MiM after known brain metastasis. Biomarker based subtype distribution was as follows: HR-/HER2- (TNBC) (n=8), HR+/HER2+ (n=3), HR+/HER2- (n=4), HR-/HER2+ (n=4), unknown (n=1).
Table 1: Disease Outcomes Based on Biomarker SubtypeBiomarker SubtypeMedian Time to MiM (months) (p=0.104)Median Survival after MiM (months) (p=0.008)TNBC (n=8)32.3 (12.1-132.5)1.8 (0.5-4.0)HR+/HER2+ (n=3)44.2 (33.2-71.5)10.8 (10.2-13.3)HR+/HER2- (n=4)110.2 (23.0-156.0)4.8 (0.8-9.8)HR-/HER2+ (n=4)27.1 (3.7-39.4)4.0 (1.8-5.0)All* (n=20)37.4 (3.7-156.0)3.7 (0.4-12.3)Key: BM: Brain metastasis; * Includes 1 patient with unknown subtype.
Conclusions: Reports of MiM consist overwhelmingly of lung and gastrointestinal adenocarcinoma primaries. This retrospective, observational study is the first to establish that CNS MiM occurs in breast cancer with an incidence of roughly 4%. Review of an additional 1,600 patient charts is underway, but this preliminary study is the first to identify clinicopathologic correlates and determine disease outcomes in patients with MiM; it is also the first to propose stringent radiographic criteria for the diagnosis of CNS MiM, and further updated data will be presented at the meeting.
Citation Format: Bashour SI, Ibrahim NK, Schomer DF, Colen RR, Sawaya R, Suki D, Rao G, Murthy RK, Moulder SL, Abugabal Y, Hess KR, Fuller GN. Central nervous system miliary metastasis in breast cancer patients [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P6-03-04.
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Affiliation(s)
- SI Bashour
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - NK Ibrahim
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - DF Schomer
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - RR Colen
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - R Sawaya
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - D Suki
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - G Rao
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - RK Murthy
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - SL Moulder
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Y Abugabal
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - KR Hess
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - GN Fuller
- The University of Texas MD Anderson Cancer Center, Houston, TX
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Jenkins T, Alix J, Rao G, Hoggard N, O'Brien E, Baster K, Bradburn M, Bigley J, McDermott C, Wilkinson I, Shaw P. Imaging denervation in motor neuron disease for future clinical trials: a longitudinal cohort study. J Neurol Sci 2017. [DOI: 10.1016/j.jns.2017.08.328] [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: 10/18/2022]
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Guerrero PA, Tchaicha JH, Chen Z, Morales JE, McCarty N, Wang Q, Sulman EP, Fuller G, Lang FF, Rao G, McCarty JH. Glioblastoma stem cells exploit the αvβ8 integrin-TGFβ1 signaling axis to drive tumor initiation and progression. Oncogene 2017; 36:6568-6580. [PMID: 28783169 DOI: 10.1038/onc.2017.248] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Revised: 06/16/2017] [Accepted: 06/19/2017] [Indexed: 12/13/2022]
Abstract
Glioblastoma (GBM) is a primary brain cancer that contains populations of stem-like cancer cells (GSCs) that home to specialized perivascular niches. GSC interactions with their niche influence self-renewal, differentiation and drug resistance, although the pathways underlying these events remain largely unknown. Here, we report that the integrin αvβ8 and its latent transforming growth factor β1 (TGFβ1) protein ligand have central roles in promoting niche co-option and GBM initiation. αvβ8 integrin is highly expressed in GSCs and is essential for self-renewal and lineage commitment in vitro. Fractionation of β8high cells from freshly resected human GBM samples also reveals a requirement for this integrin in tumorigenesis in vivo. Whole-transcriptome sequencing reveals that αvβ8 integrin regulates tumor development, in part, by driving TGFβ1-induced DNA replication and mitotic checkpoint progression. Collectively, these data identify the αvβ8 integrin-TGFβ1 signaling axis as crucial for exploitation of the perivascular niche and identify potential therapeutic targets for inhibiting tumor growth and progression in patients with GBM.
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Affiliation(s)
- P A Guerrero
- Department of Neurosurgery, M. D. Anderson Cancer Center, Houston, TX, USA
| | - J H Tchaicha
- Department of Neurosurgery, M. D. Anderson Cancer Center, Houston, TX, USA
| | - Z Chen
- Department of Neurosurgery, M. D. Anderson Cancer Center, Houston, TX, USA
| | - J E Morales
- Department of Neurosurgery, M. D. Anderson Cancer Center, Houston, TX, USA
| | - N McCarty
- The Brown Institute for Molecular Medicine, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Q Wang
- Department of Radiation Oncology, M. D. Anderson Cancer Center, Houston, TX, USA.,Department of Genomic Medicine, M. D. Anderson Cancer Center, Houston, TX, USA
| | - E P Sulman
- Department of Radiation Oncology, M. D. Anderson Cancer Center, Houston, TX, USA.,Department of Genomic Medicine, M. D. Anderson Cancer Center, Houston, TX, USA.,Department of Translational Molecular Pathology, M. D. Anderson Cancer Center, Houston, TX, USA
| | - G Fuller
- Departments of Pathology, M. D. Anderson Cancer Center, Houston, TX, USA
| | - F F Lang
- Department of Neurosurgery, M. D. Anderson Cancer Center, Houston, TX, USA
| | - G Rao
- Department of Neurosurgery, M. D. Anderson Cancer Center, Houston, TX, USA
| | - J H McCarty
- Department of Neurosurgery, M. D. Anderson Cancer Center, Houston, TX, USA
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Madankan R, Stefan W, Fahrenholtz SJ, MacLellan CJ, Hazle JD, Stafford RJ, Weinberg JS, Rao G, Fuentes D. Accelerated magnetic resonance thermometry in the presence of uncertainties. Phys Med Biol 2017; 62:214-245. [PMID: 27991449 DOI: 10.1088/1361-6560/62/1/214] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
A model-based information theoretic approach is presented to perform the task of magnetic resonance (MR) thermal image reconstruction from a limited number of observed samples on k-space. The key idea of the proposed approach is to optimally detect samples of k-space that are information-rich with respect to a model of the thermal data acquisition. These highly informative k-space samples can then be used to refine the mathematical model and efficiently reconstruct the image. The information theoretic reconstruction was demonstrated retrospectively in data acquired during MR-guided laser induced thermal therapy (MRgLITT) procedures. The approach demonstrates that locations with high-information content with respect to a model-based reconstruction of MR thermometry may be quantitatively identified. These information-rich k-space locations are demonstrated to be useful as a guide for k-space undersampling techniques. The effect of interactively increasing the predicted number of data points used in the subsampled model-based reconstruction was quantified using the L2-norm of the distance between the subsampled and fully sampled reconstruction. Performance of the proposed approach was also compared with uniform rectilinear subsampling and variable-density Poisson disk subsampling techniques. The proposed subsampling scheme resulted in accurate reconstructions using a small fraction of k-space points, suggesting that the reconstruction technique may be useful in improving the efficiency of thermometry data temporal resolution.
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Affiliation(s)
- R Madankan
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Elwell M, Mahler J, Rao G. Invited Commentary. Toxicol Pathol 2016. [DOI: 10.1177/019262339802600521] [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]
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Mohindra P, Bentzen S, Giacomelli I, Scartoni D, Roque D, Rao G, Hanna N, Nichols E. Adjuvant Whole-Pelvic Radiation Therapy (WPRT) for Endometrioid Adenocarcinoma (EA): 45 Gy or 50/50.4 Gy? Int J Radiat Oncol Biol Phys 2016. [DOI: 10.1016/j.ijrobp.2016.06.1378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Mohindra P, Bentzen S, Scartoni D, Giacomelli I, Rao G, Roque D, Hanna N, Nichols E. Adjuvant Therapy for Locoregionally Advanced Endometrioid Adenocarcinoma (EA): Upfront Chemotherapy (UC) or Upfront Radiation Therapy (UR)? Int J Radiat Oncol Biol Phys 2016. [DOI: 10.1016/j.ijrobp.2016.06.1353] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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MacLellan C, Fuentes D, Espinoza H, Prabhu S, Rao G, Weinberg J, Stafford R. WE-AB-BRA-04: Investigation of MRI Derived Thermal Dose Models. Med Phys 2016. [DOI: 10.1118/1.4957733] [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: 11/07/2022] Open
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Madankan R, MacLellan C, Fahrenholtz S, Weinberg J, Rao G, Hazle J, Stafford R, Fuentes D. SU-F-J-03: Treatment Planning for Laser Ablation Therapy in Presence of Heterogeneous Tissue: A Retrospective Study. Med Phys 2016. [DOI: 10.1118/1.4955911] [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: 11/07/2022] Open
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Bieler BM, Gaughan J, Khan M, Rao G, Hunter K, Morgan FH. LACK OF AN ASSOCIATION BETWEEN BMI AND TSH IN TREATED HYPOTHYROID PATIENTS AND EUTHYROID CONTROLS. Endocr Pract 2015; 22:555-60. [PMID: 26720252 DOI: 10.4158/ep15946.or] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE The standard treatment for primary hypothyroidism is replacement with levothyroxine to achieve a thyroid-stimulating hormone (TSH) level within the normal range, (0.45-4.5 mIU/L), which is known to prevent complications including weight gain. While the normal TSH range includes the 95% confidence intervals, it is not known if there is an association between weight and TSH within this interval in treated hypothyroid patients. METHODS We conducted a retrospective analysis of patients treated within the Cooper Health System from January 1 to August 31, 2014. A sample of 245 treated hypothyroid patients and 162 euthyroid controls were studied. Data collected included age, sex, race/ethnicity, height, weight, levothyroxine dose, and diabetes and smoking history. RESULTS Hypothyroid and control groups were similar in height, weight, body mass index (BMI), and the number of patients with diabetes. There were more females, Caucasians, and nonsmokers in the hypothyroid group. The average TSH was slightly higher in the treated hypothyroid patients versus nonhypothyroid controls (median 1.87 vs. 1.55, P<.01). There was no significant relationship between TSH and BMI in the treated hypothyroid patients or the euthyroid controls. CONCLUSION Since no significant relationship was found between BMI and TSH in treated hypothyroidism, there may be no weight reduction benefit gained by adjusting TSH to the lower end of normal range. Patients should be counseled that properly treated hypothyroidism is unlikely to contribute to weight gain. Other treatments such as nutrition and exercise counseling should be offered instead.
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Lee J, Jain R, Khalil K, Griffith B, Bosca R, Rao G, Rao A. Texture Feature Ratios from Relative CBV Maps of Perfusion MRI Are Associated with Patient Survival in Glioblastoma. AJNR Am J Neuroradiol 2015; 37:37-43. [PMID: 26471746 DOI: 10.3174/ajnr.a4534] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Accepted: 05/26/2015] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Texture analysis has been applied to medical images to assist in tumor tissue classification and characterization. In this study, we obtained textural features from parametric (relative CBV) maps of dynamic susceptibility contrast-enhanced MR images in glioblastoma and assessed their relationship with patient survival. MATERIALS AND METHODS MR perfusion data of 24 patients with glioblastoma from The Cancer Genome Atlas were analyzed in this study. One- and 2D texture feature ratios and kinetic textural features based on relative CBV values in the contrast-enhancing and nonenhancing lesions of the tumor were obtained. Receiver operating characteristic, Kaplan-Meier, and multivariate Cox proportional hazards regression analyses were used to assess the relationship between texture feature ratios and overall survival. RESULTS Several feature ratios are capable of stratifying survival in a statistically significant manner. These feature ratios correspond to homogeneity (P = .008, based on the log-rank test), angular second moment (P = .003), inverse difference moment (P = .013), and entropy (P = .008). Multivariate Cox proportional hazards regression analysis showed that homogeneity, angular second moment, inverse difference moment, and entropy from the contrast-enhancing lesion were significantly associated with overall survival. For the nonenhancing lesion, skewness and variance ratios of relative CBV texture were associated with overall survival in a statistically significant manner. For the kinetic texture analysis, the Haralick correlation feature showed a P value close to .05. CONCLUSIONS Our study revealed that texture feature ratios from contrast-enhancing and nonenhancing lesions and kinetic texture analysis obtained from perfusion parametric maps provide useful information for predicting survival in patients with glioblastoma.
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Affiliation(s)
- J Lee
- From the Departments of Bioinformatics and Computational Biology (J.L., A.R.)
| | - R Jain
- Department of Radiology (R.J.), New York University School of Medicine, Langone Medical Center, New York, New York
| | - K Khalil
- Department of Radiology (K.K., B.G.), Henry Ford Hospital, Detroit, Michigan
| | - B Griffith
- Department of Radiology (K.K., B.G.), Henry Ford Hospital, Detroit, Michigan
| | - R Bosca
- Department of Medical Physics (R.B.), University of Wisconsin, Madison, Wisconsin
| | - G Rao
- Neurosurgery (G.R.), The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - A Rao
- From the Departments of Bioinformatics and Computational Biology (J.L., A.R.)
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Nathan K, Agarwal A, Kamath P, Rao G, Agrawal A, Park D. Measuring Height in the Intensive Care Unit: Can We Do Better? Chest 2015. [DOI: 10.1378/chest.2281602] [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: 11/01/2022] Open
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Chatterjee M, Ge X, Kostov Y, Luu P, Tolosa L, Woo H, Viscardi R, Falk S, Potts R, Rao G. A rate-based transcutaneous CO2 sensor for noninvasive respiration monitoring. Physiol Meas 2015; 36:883-94. [PMID: 25832294 PMCID: PMC4417034 DOI: 10.1088/0967-3334/36/5/883] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
The pain and risk of infection associated with invasive blood sampling for blood gas measurements necessitate the search for reliable noninvasive techniques. In this work we developed a novel rate-based noninvasive method for a safe and fast assessment of respiratory status. A small sampler was built to collect the gases diffusing out of the skin. It was connected to a CO2 sensor through gas-impermeable tubing. During a measurement, the CO2 initially present in the sampler was first removed by purging it with nitrogen. The gases in the system were then recirculated between the sampler and the CO2 sensor, and the CO2 diffusion rate into the sampler was measured. Because the measurement is based on the initial transcutaneous diffusion rate, reaching mass transfer equilibrium and heating the skin is no longer required, thus, making it much faster and safer than traditional method. A series of designed experiments were performed to analyze the effect of the measurement parameters such as sampler size, measurement location, subject positions, and movement. After the factor analysis tests, the prototype was sent to a level IV NICU for clinical trial. The results show that the measured initial rate of increase in CO2 partial pressure is linearly correlated with the corresponding arterial blood gas measurements. The new approach can be used as a trending tool, making frequent blood sampling unnecessary for respiratory status monitoring.
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Affiliation(s)
- M Chatterjee
- Center for Advanced Sensor Technology, Department of Chemical, Biochemical and Environmental Engineering, University of Maryland, Baltimore County, 1000 Hilltop Circle, Baltimore, Maryland 21250, United States
| | - X Ge
- Center for Advanced Sensor Technology, Department of Chemical, Biochemical and Environmental Engineering, University of Maryland, Baltimore County, 1000 Hilltop Circle, Baltimore, Maryland 21250, United States
| | - Y Kostov
- Center for Advanced Sensor Technology, Department of Chemical, Biochemical and Environmental Engineering, University of Maryland, Baltimore County, 1000 Hilltop Circle, Baltimore, Maryland 21250, United States
| | - P Luu
- Center for Advanced Sensor Technology, Department of Chemical, Biochemical and Environmental Engineering, University of Maryland, Baltimore County, 1000 Hilltop Circle, Baltimore, Maryland 21250, United States
| | - L Tolosa
- Center for Advanced Sensor Technology, Department of Chemical, Biochemical and Environmental Engineering, University of Maryland, Baltimore County, 1000 Hilltop Circle, Baltimore, Maryland 21250, United States
| | - H Woo
- Department of Pediatrics, University of Maryland School of Medicine, 685 W Baltimore St., Baltimore, MD 21201, United States
| | - R Viscardi
- Department of Pediatrics, University of Maryland School of Medicine, 685 W Baltimore St., Baltimore, MD 21201, United States
| | - S Falk
- GE Healthcare, 8880 Gorman Rd Laurel, MD 20723, United States
| | - R Potts
- Fluorometrix Biomedical, 517 Court Pl, Pittsburgh, PA 15210, United States
| | - G Rao
- Center for Advanced Sensor Technology, Department of Chemical, Biochemical and Environmental Engineering, University of Maryland, Baltimore County, 1000 Hilltop Circle, Baltimore, Maryland 21250, United States
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Jung B, Gleeton D, Daurat A, Conseil M, Mahul M, Rao G, Matecki S, Lacampagne A, Jaber S. Conséquences de la ventilation mécanique sur le diaphragme. Rev Mal Respir 2015; 32:370-80. [DOI: 10.1016/j.rmr.2014.08.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2014] [Accepted: 08/25/2014] [Indexed: 01/23/2023]
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Abstract
PURPOSE To investigate the prevalence and reconnoiter treatment modalities for Pseudoexfoliation Glaucoma (PXG) in subjects with Pseudoexfoliation Syndrome (PXF) in a rural scenario of western India. DESIGN A prospective prevalence study. METHODS Occurrence of PXG in 250 subjects with PXF was studied in the Department of Glaucoma, Shri Ganapati Netralaya, Jalna, India, from 2009 to 2011. The subject pool presented with PXF, having intraocular pressure (IOP) ≥ 20 mm of Hg, and evidencing optic nerve damage and abnormal visual fields were judiciously selected as PXG cohorts. A decision table is formulated to assist the physician in rendering medical or surgical treatment options. RESULTS The prevalence of PXG increased with increasing age at 30% (95% CI: 28.56-33.72) in the 60-year-old and older population. It was predominantly higher in cohorts involved in outdoor physical activities at 46% (95% CI: 41.24-52.38). The eminence and prevalence of nuclear cataract in subjects with PXG was 72 % (95% CI: 65.72-76.34). Visual impairment was highly prevalent in 75% (95% CI: 73.43-78.29) and 10% (95% CI: 6.87-13.21) cohorts with PXG and PXF respectively. In general, linear modelling IOP was 26.37±1.64 in subjects with PXG, which was managed to 16.50±1.32 after rendering our adapted treatment protocols. CONCLUSIONS Increased IOP, occludable angles, and glaucomatous optic neuropathy occur more frequently in the population with PXF. It is inferred that that treatment protocol of combined cataract and glaucoma surgery gives maximum reduction in IOP.
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Affiliation(s)
- Vinita Rao
- From the Departments of *Glaucoma and †Retina, Shri Ganapati Netralaya, Jalna, Maharashtra, India
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