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Pradhan A, Bhandari M, Vishwakarma P, Gualtieri P, Di Renzo L, Iellamo F, Sethi R, Perrone MA. Dyslipidemia and heart failure: current evidence and perspectives of use of statins. Eur Rev Med Pharmacol Sci 2024; 28:2860-2877. [PMID: 38639527 DOI: 10.26355/eurrev_202404_35929] [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: 04/20/2024]
Abstract
Heart failure (HF) is a condition with growing morbidity and mortality. Dyslipidemia in HF is not concentrated around hypercholesterolemia as in coronary artery disease. As a corollary, the robust benefits seen with statins across the spectrum of CAD have not been replicated in HF. Multiple potential pleiotropic effects of statins include anti-inflammatory, antioxidant, endothelial stabilization, antiapoptotic, anti-thrombotic, and modulation of the autonomic system apart from lipid lowering. These benevolent actions need to be counterbalanced with the potential derangement of ubiquinone, selenoprotein and endotoxin pathways. While small randomized and non-randomized studies demonstrated a multitude of benefits in clinical and surrogate endpoints, two large RCTs failed to demonstrate unequivocal benefits. However, multiple large meta-analyses do demonstrate definite improvement in clinical endpoints including death and heart failure hospitalization. The clinical likelihood of benefit was higher in younger patients with less advanced HF and use of lipophilic statins.
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Affiliation(s)
- A Pradhan
- Department of Cardiology, King George's Medical University, Lucknow, Uttar Pradesh, India.
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2
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Ratneswaren T, Chan N, Aeron-Thomas J, Sait S, Adesalu O, Alhawamdeh M, Benger M, Garnham J, Dixon L, Tona F, McNamara C, Taylor E, Lobotesis K, Lim E, Goldberg O, Asmar N, Evbuomwan O, Banerjee S, Holm-Mercer L, Senor J, Tsitsiou Y, Tantrige P, Taha A, Ballal K, Mattar A, Daadipour A, Elfergani K, Barker R, Chakravartty R, Murchison AG, Kemp BJ, Simister R, Davagnanam I, Wong OY, Werring D, Banaras A, Anjari M, Rodrigues JCL, Thompson CAS, Haines IR, Burnett TA, Zaher REY, Reay VL, Banerjee M, Sew Hee CSL, Oo AP, Lo A, Rogers P, Hughes T, Marin A, Mukherjee S, Jaber H, Sanders E, Owen S, Bhandari M, Sundayi S, Bhagat A, Elsakka M, Hashmi OH, Lymbouris M, Gurung-Koney Y, Arshad M, Hasan I, Singh N, Patel V, Rahiminejad M, Booth TC. COVID-19 Stroke Apical Lung Examination Study 2: a national prospective CTA biomarker study of the lung apices, in patients presenting with suspected acute stroke (COVID SALES 2). Neuroimage Clin 2024; 42:103590. [PMID: 38513535 DOI: 10.1016/j.nicl.2024.103590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Revised: 03/10/2024] [Accepted: 03/13/2024] [Indexed: 03/23/2024]
Abstract
BACKGROUND Apical ground-glass opacification (GGO) identified on CT angiography (CTA) performed for suspected acute stroke was developed in 2020 as a coronavirus-disease-2019 (COVID-19) diagnostic and prognostic biomarker in a retrospective study during the first wave of COVID-19. OBJECTIVE To prospectively validate whether GGO on CTA performed for suspected acute stroke is a reliable COVID-19 diagnostic and prognostic biomarker and whether it is reliable for COVID-19 vaccinated patients. METHODS In this prospective, pragmatic, national, multi-center validation study performed at 13 sites, we captured study data consecutively in patients undergoing CTA for suspected acute stroke from January-March 2021. Demographic and clinical features associated with stroke and COVID-19 were incorporated. The primary outcome was the likelihood of reverse-transcriptase-polymerase-chain-reaction swab-test-confirmed COVID-19 using the GGO biomarker. Secondary outcomes investigated were functional status at discharge and survival analyses at 30 and 90 days. Univariate and multivariable statistical analyses were employed. RESULTS CTAs from 1,111 patients were analyzed, with apical GGO identified in 8.5 % during a period of high COVID-19 prevalence. GGO showed good inter-rater reliability (Fleiss κ = 0.77); and high COVID-19 specificity (93.7 %, 91.8-95.2) and negative predictive value (NPV; 97.8 %, 96.5-98.6). In subgroup analysis of vaccinated patients, GGO remained a good diagnostic biomarker (specificity 93.1 %, 89.8-95.5; NPV 99.7 %, 98.3-100.0). Patients with COVID-19 were more likely to have higher stroke score (NIHSS (mean +/- SD) 6.9 +/- 6.9, COVID-19 negative, 9.7 +/- 9.0, COVID-19 positive; p = 0.01), carotid occlusions (6.2 % negative, 14.9 % positive; p = 0.02), and larger infarcts on presentation CT (ASPECTS 9.4 +/- 1.5, COVID-19 negative, 8.6 +/- 2.4, COVID-19 positive; p = 0.00). After multivariable logistic regression, GGO (odds ratio 15.7, 6.2-40.1), myalgia (8.9, 2.1-38.2) and higher core body temperature (1.9, 1.1-3.2) were independent COVID-19 predictors. GGO was associated with worse functional outcome on discharge and worse survival after univariate analysis. However, after adjustment for factors including stroke severity, GGO was not independently predictive of functional outcome or mortality. CONCLUSION Apical GGO on CTA performed for patients with suspected acute stroke is a reliable diagnostic biomarker for COVID-19, which in combination with clinical features may be useful in COVID-19 triage.
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Affiliation(s)
- T Ratneswaren
- Charing Cross Hospital, London, UK; Addenbrooke's Hospital, Cambridge, UK
| | - N Chan
- Royal London Hospital, London, UK
| | | | - S Sait
- King's College Hospital, London, UK
| | | | | | - M Benger
- King's College Hospital, London, UK
| | | | - L Dixon
- Charing Cross Hospital, London, UK
| | - F Tona
- Charing Cross Hospital, London, UK
| | | | - E Taylor
- Charing Cross Hospital, London, UK
| | | | - E Lim
- Charing Cross Hospital, London, UK
| | | | - N Asmar
- Charing Cross Hospital, London, UK
| | | | | | | | - J Senor
- Charing Cross Hospital, London, UK
| | | | - P Tantrige
- Princess Royal University Hospital, Orpington, UK
| | - A Taha
- Princess Royal University Hospital, Orpington, UK
| | - K Ballal
- Princess Royal University Hospital, Orpington, UK
| | - A Mattar
- Princess Royal University Hospital, Orpington, UK
| | - A Daadipour
- Princess Royal University Hospital, Orpington, UK
| | - K Elfergani
- Princess Royal University Hospital, Orpington, UK
| | - R Barker
- Frimley Park Hospital, Surrey, UK
| | | | | | - B J Kemp
- John Radcliffe Hospital, Oxford, UK
| | | | | | - O Y Wong
- University College Hospital, London, UK
| | - D Werring
- Comprehensive Stroke Service, National Hospital for Neurology and Neurosurgery, University College Hospitals NHS Foundation Trust, London, UK; Stroke Research Centre, UCL Queen Square Institute of Neurology, London, UK
| | - A Banaras
- University College Hospital, London, UK
| | - M Anjari
- Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, UK
| | | | | | | | | | - R E Y Zaher
- Southampton General Hospital, Southampton, UK
| | - V L Reay
- Southampton General Hospital, Southampton, UK
| | - M Banerjee
- Southampton General Hospital, Southampton, UK
| | | | - A P Oo
- Southampton General Hospital, Southampton, UK
| | - A Lo
- Addenbrooke's Hospital, Cambridge, UK
| | - P Rogers
- Addenbrooke's Hospital, Cambridge, UK
| | - T Hughes
- Cardiff and Vale University Health Board, Cardiff, UK
| | - A Marin
- Cardiff and Vale University Health Board, Cardiff, UK
| | - S Mukherjee
- Cardiff and Vale University Health Board, Cardiff, UK
| | - H Jaber
- Cardiff and Vale University Health Board, Cardiff, UK
| | - E Sanders
- Cardiff and Vale University Health Board, Cardiff, UK
| | - S Owen
- Cardiff and Vale University Health Board, Cardiff, UK
| | | | - S Sundayi
- Watford General Hospital, Watford, UK
| | - A Bhagat
- Watford General Hospital, Watford, UK
| | - M Elsakka
- Watford General Hospital, Watford, UK
| | - O H Hashmi
- Norfolk and Norwich University Hospital, Norwich, UK
| | - M Lymbouris
- Norfolk and Norwich University Hospital, Norwich, UK
| | | | - M Arshad
- Norfolk and Norwich University Hospital, Norwich, UK
| | - I Hasan
- Norfolk and Norwich University Hospital, Norwich, UK
| | - N Singh
- Norfolk and Norwich University Hospital, Norwich, UK
| | - V Patel
- St Thomas' Hospital, London, UK
| | | | - T C Booth
- King's College Hospital, London, UK; School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK.
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Garg H, Whalen P, Akbar M, Bhandari M, Dursun F, Liss M, Mansour A, Svatek R, Kaushik D, Pruthi D. Urine analysis: A convenient and strong indicator for renal function assessment in surgery for renal cancer. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)00902-8] [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: 02/12/2023]
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Garg H, Bhandari M, Dursun F, Liss M, Kaushik D, Ramamurthy C, Fakhreddine M, Svatek R, Mansour A. Comparison of contemporary treatment strategies for locally advanced (stage IIIB) urothelial bladder cancer using National Cancer Database. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)01340-4] [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: 02/12/2023]
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Sharma G, Shah M, Ahluwalia P, Gautam G, Dasgupta P, Challacombe B, Bhandari M, Ahlawat R, Rawal S, Buffi N, Sivaraman A, Porter J, Rogers C, Mottire, Abaza R, Rha K, Moon D, Yuvaraja T, Parekh D, Capitanio U, Maes K, Porpiglia F, Turkeri L. Off-clamp versus on-clamp robot-assisted partial nephrectomy: A propensity-matched analysis. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)01060-6] [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: 02/12/2023]
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Garg H, Bhandari M, Noel O, Dursun F, Liss M, Kaushik D, Svatek R, Ramamurthy C, Mansour A. Impact of systemic treatments on overall survival in metastatic urothelial bladder cancer: A time-trend analysis. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)00599-7] [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: 02/12/2023]
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Chaudhary G, Pradhan AK, Shah S, Roy S, Singh V, Dwivedi SK, Sethi R, Chandra S, Vishwakarma P, Sharma AK, Bhandari M, Shukla A, Singh A. Unraveling the invisible demon: a study of the oxidative stress markers, antioxidant activities and inflammatory markers in patients admitted with complete heart block. Eur Heart J 2023. [DOI: 10.1093/eurheartj/ehac779.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Introduction
Despite the recent advancements in the management of Complete Heart Block (CHB), the aetiology of CHB is still idiopathic in most of the cases. Our study explores this hitherto untouched aspect of complete heart block.
Purpose
We aimed to assess the aetiological profile of Complete Heart Block patients in our study.
Methods
The study population consisted of 60 patients with complete heart block aged between 30 to 80 years, attending as an inpatient in ER. Oxidative stress was measured by serum MDA, serum GSH, serum Catalase activity and serum SOD activity. Antioxidant activity was obtained by measuring the levels of serum total antioxidant capacity. Inflammatory stress was measured by IL-5 and TNF-alpha levels. These values were compared to 30 healthy controls with no prior history of smoking and diabetes mellitus.
Results
The mean age of the patient was 62.48 ± 7.98 years and the gender distribution was 37 males and 23 females out of 60 patients. The mean value of serum MDA (ng/mL) in cases is 1451.26 ± 206.32, and in controls, the mean value is 1197.98 ± 234.71 (p=<0.001). The mean value of serum GSH (mcg/mL) in cases is 46.982 ± 18.613, and in controls, the mean value is 54.155 ± 10.762 (p=0.027). The mean value of serum Catalase Activity (U/min/mg protein) in cases is 10.763 ± 4.038 and in controls, the mean value is 19.878 ± 7.787 (p=0.003). The mean value of serum SOD Activity (U/g) in cases is 24.950 ± 5.4565, and in controls, the mean value is 46.214 ± 14.6309 (p=0.891). The mean value of serum Total Antioxidant Capacity (U/mL) in cases is 5.546 ± 0.620 and in controls, the mean value is 8.346 ± 2.781 (p=0.025). The mean value of serum IL-5 (pg/mL) in cases is 481.442 ± 28.8995, and in controls, the mean value is 67.347 ± 20.445 (p<0.001). The mean value of serum TNF-ALFA (pg/mL) in cases is 196.741 ± 73.771, and in controls, the mean value is 144.530 ± 42.599 (p= 0.081).
Conclusions
During a complete heart block, SOD (p=0.891), CAT (p=0.003), GSH (p=0.027) and total antioxidant (TAOC) (p=0.025) were significantly decreased in cases, compared to healthy controls, thus suggesting that the elevated levels of oxidative free radicals causes endothelial dysfunctioning. The increase in ROS was observed by a highly significant increase of malondialdehyde (MDA) (p=<0.001) showing high ROS-mediated tissue damage. Besides damage by oxidative stress, our study suggests that there are certain inflammatory markers like TNF-α and IL-5 that actively participate in causing heart block. There was a significant increase in the concentration of IL-5 (p<0.001) in the cases as compared to the controls.
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Affiliation(s)
- G Chaudhary
- King George's Medical University , Lucknow , India
| | - A K Pradhan
- King George's Medical University , Lucknow , India
| | - S Shah
- King George's Medical University , Lucknow , India
| | - S Roy
- King George's Medical University , Lucknow , India
| | - V Singh
- King George's Medical University , Lucknow , India
| | - S K Dwivedi
- King George's Medical University , Lucknow , India
| | - R Sethi
- King George's Medical University , Lucknow , India
| | - S Chandra
- King George's Medical University , Lucknow , India
| | | | - A K Sharma
- King George's Medical University , Lucknow , India
| | - M Bhandari
- King George's Medical University , Lucknow , India
| | - A Shukla
- King George's Medical University , Lucknow , India
| | - A Singh
- King George's Medical University , Lucknow , India
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Roy S, Singh V, Ahmed J, Dwivedi SK, Sethi R, Chandra S, Pradhan AK, Vishwakarma P, Sharma AK, Bhandari M, Shukla A, Singh A, Chaudhary G. The surprises in optical coherence tomography (OCT) findings in patients presenting with in-stent restenosis: the road less travelled. Eur Heart J 2023. [DOI: 10.1093/eurheartj/ehac779.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Morphological features of neointimal tissue play a pivotal role in the pathophysiology of In-Stent Restenosis (ISR) after percutaneous coronary intervention, hence understanding these features and patterns is crucial.
Purpose
The present study was designed to qualitatively and quantitatively assess neointimal characteristics of lesions using OCT in patients presenting with ISR.
Methods
This was a single-center, prospective, observational study performed between 1st August 2020 and 30th December 2021 at a tertiary-care center in India. Patients diagnosed with stable angina and acute coronary syndrome with post-procedural angiographically documented restenosis (>50%) were included. Qualitative and quantitative assessment of neointimal hyperplasia patterns was performed using OCT.
Results
A total of 34 patients with ISR were studied. Neointimal hyperplasia was classified as (i) homogenous group (n=18) and (ii) non-homogenous group (n=16). As many as 14 (77.8%) diabetics belonged to the homogenous group. Predominant plaque characteristics such as neoatherosclerosis, cholesterol crystals, and calcium were documented in 14 (77.8%), 12 (66.7%), and 11 (61.1%) patients in the homogenous group and in 10 (62.5%), 10 (62.5%), and 9 (56.2%) patients in the non-homogenous group, respectively. Unexpanded stent struts were identified in 11 (61.1%) and 11 (68.8%) patients in the homogenous and non-homogenous groups, respectively. Mean strut thickness was 93.73 ± 31.03 µm and 83.54 ± 18.0 µm, ISR was 72.50 ± 15.93% and 65.37 ± 21.69%, the neointimal thickness was 588.06 ± 167.82 mm and 666.25 ± 218.05 mm, and neointimal hyperplasia was 54.54 ± 11.23% and 59.26 ± 8.86% in the homogenous and non-homogenous groups, respectively.
Conclusion
Neoatherosclerosis and stent underexpansion was predominantly observed in our study, which was in contrast to most of the existing literature [1,2,3], and only diabetes was found to be significantly associated with homogenous neointimal hyperplasia, irrespective of the generation of the stent.
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Affiliation(s)
- S Roy
- King George's Medical University , Lucknow , India
| | - V Singh
- King George's Medical University , Lucknow , India
| | - J Ahmed
- King George's Medical University , Lucknow , India
| | - S K Dwivedi
- King George's Medical University , Lucknow , India
| | - R Sethi
- King George's Medical University , Lucknow , India
| | - S Chandra
- King George's Medical University , Lucknow , India
| | - A K Pradhan
- King George's Medical University , Lucknow , India
| | | | - A K Sharma
- King George's Medical University , Lucknow , India
| | - M Bhandari
- King George's Medical University , Lucknow , India
| | - A Shukla
- King George's Medical University , Lucknow , India
| | - A Singh
- King George's Medical University , Lucknow , India
| | - G Chaudhary
- King George's Medical University , Lucknow , India
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Bhandari M, Othus M, Kirkwood J, Sondak V, Ahmad T, Sharon E, Grossmann K, Ribas A, Patel S, Wuthrick E. Role of Adjuvant Regional Nodal Irradiation in Resected Melanoma: A Secondary Analysis of SWOG S1404. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Dohm A, Kalagotla H, Jiang S, Bhandari M, Mills M, Graham J, Khushalani N, Forsyth P, Etame A, Liu J, Tran N, Vogelbaum M, Yu H, Oliver D, Ahmed K. Stereotactic Radiosurgery and Anti-PD-1 + CTLA-4 Therapy, Anti-PD-1 Therapy, Anti-CTLA-4 Therapy, BRAF/MEK Inhibitors, BRAF Inhibitor, or Conventional Chemotherapy for the Management of Melanoma Brain Metastases. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.854] [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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Bryant J, Bhandari M, Liveringhouse C, Weygand J, Cruz-Chamorro R, Sandoval M, Sim A, Frakes J, Redler G, Andreozzi J, Nardella L, Feygelman V, Latifi K, Rosenberg S. Online Adaptive MR-Guided Radiotherapy (MRgRT) in UltraCentral (UC) Lung Lesions: Cumulative Delivered Dose as Assessed with Rigid Fusion (RF) Analysis Shows Significant Improvement in Clinically Relevant Parameters. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.2268] [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: 10/31/2022]
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Morgan LR, Weiner RS, Mahmood T, Gordon C, Bhandari M, Rodgers AH, Ware ML, Matrana M, Cosgriff TM, Friedlander P, Zou JJ. Abstract CT158: Use of 4-demethyl-4-cholesteryloxycarbonyl-penclomedine (DM-CHOC-PEN) as therapy for advanced non-small cell lung cancer (NSCLC) involving the CNS. Cancer Res 2022. [DOI: 10.1158/1538-7445.am2022-ct158] [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: 4-Demethyl-4-cholesteryloxycarbonylpenclomedine (DM-CHOC-PEN) is a poly-chlorinated pyridine cholesteryl carbonate that was designed to penetrate the blood brain barrier and be useful as therapy for brain tumors (IND 68,876). A 3-stage mechanism is proposed for drug entry into the CNS and into cancer cells via reversible binding with sialic acid on the surface of RBC’s; and transported into cancer cells with L-glutamine. DM-CHOC-PEN has a MOA via bis-alkylation of DNA @ N7-guanine and N4-cytosine. DM-CHOC-PEN has completed clinical trials involving sixty-four (64) adults and nineteen (19) adolescent/young adult subjects with advanced cancers. Long term survival, good qualities of life and minimal toxicities [AACR #1185, 2013; AACR #CT 129, 2019; AACR #CT152, 2021] have been reported. This update provides affirmation that the drug, previously described as a treatment for non-small cell lung cancer (NSCLC) involving the CNS, is well tolerated with continued durations of responses, no new toxicities, good survival and good quality of life. Primary aims of the previously reported DM-CHOC-PEN clinical trials were to assess clinical response and monitor toxicities/safety and verify the maximum tolerated doses (MTD) for the drug administered IV to subjects with cancer. Here is an update on the long term responses, tolerance and quality of survival in subjects with NSCLC involving the CNS.
Subjects & Methods: DM-CHOC-PEN was administered to adults (> 18 y/o) with NSCLC involving the CNS that lacked genetic rearrangements or tumor targets and/or had failed standard therapies as a 3-hr IV infusion once every 21 days employing a verified 2-tiered MTD schedule: 85.8 mg/m2 for subjects with liver involvement and 98.7 mg/m2 for subjects with normal livers.
Results: Sixteen (16) adult subjects with NSCLC have been treated to date, which 11 had NSCLC (adeno/large cell carcinomas) involving the CNS that lacked genetic rearrangements, had no tumor targets, and/or had failed standard therapies. Seven of the 11 subjects with NSCLC involving the CNS also possessed cerebellar metastases. The drug was well tolerated with no Gr-3 toxicities. The most common Gr-2 adverse effects were reversible fatigue (17%), reversible vasogenic edema (9%) and nausea (9%). No drug associated neuro/psychological, hematological, cardiac or renal toxicities have been observed, nor have there been any drug associated deaths reported. The pK modelling and properties for the drug have been previously reported [AACR #1185, 2013] and continue to be confirmed. Eight (8) subjects with NSCLC involving the CNS responded to DM-CHOC-PEN with documented CR/PR (RECIST 1.1) and improved OS/QOL/PFS (Kaplan-Meier) lasting 8 - 82+ mos. with survivals of 25% at 34 mos., 50% at 10 mos. and 8% at 84+ mos.
Conclusion: DM-CHOC-PEN is a bis-alkylator of DNA that is safe at the dose levels described and has produced long term objective responses with manageable toxicities and improved quality of life in subjects with NSCLC involving the CNS lacking genetic rearrangements or tumor targets and/or had failed standard therapies. Complete data on subject responses and observed toxicities will be presented. Supported by NCI/SBIR grants - R43/44CA132257 and NIH NIGMS 1 U54 GM104940 - the latter supports the Louisiana Clinical and Translational Science Center, New Orleans, LA
Citation Format: Lee Roy Morgan, Roy S. Weiner, T. Mahmood, C. Gordon, M. Bhandari, AH Rodgers, ML Ware, Marc Matrana, Thomas M. Cosgriff, Philip Friedlander, J-J Zou. Use of 4-demethyl-4-cholesteryloxycarbonyl-penclomedine (DM-CHOC-PEN) as therapy for advanced non-small cell lung cancer (NSCLC) involving the CNS [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr CT158.
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Affiliation(s)
| | - Roy S. Weiner
- 2Tulane University Health Sciences Center, New Orleans, LA
| | - T. Mahmood
- 3Roswell Park at Ellis Hospital, Schenectady, NY
| | - C. Gordon
- 4Detriot Clinical Research Center, Lansing, MI
| | | | | | - ML Ware
- 6Ochsner Medical Center, New Orleans, LA
| | | | | | | | - J-J Zou
- 9Mischer Neuroscience Associates, Houston, TX
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Sandoval M, Sim A, Bhandari M, Wuthrick E, Perez B, Dilling T, Redler G, Andreozzi J, Nardella L, Feygelman V, Latifi K, Rosenberg S. OC-0421 MR-Guided SBRT/Hypofractionated RT for Metastatic and Primary Ultracentral and Central Lung Lesions. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)02557-9] [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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Sharma P, Vohra S, Bhandari M, Sharma A, Vishwakarma P, Chaudhary G, Pradhan A, Chandra S, Dwivedi SK, Sethi R. Instantaneous wave-free ratio and fractional flow reserve: effect of variation in left ventricular end diastolic pressure. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehab849.124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Introduction
Among patients with intermediate coronary artery stenosis (50-90%), assessment of functional significance of the lesion by instantaneous wave free ratio (iFR)/ fractional flow reserve (FFR) is recommended in latest guidelines. Though iFR is not much affected by change in hemodynamics compared to FFR, the change in iFR vs FFR due to various hemodynamic factors need a validation. Left ventricular end-diastolic pressure (LVEDP) is one of the hemodynamic factors whose variation and effect on FFR vs iFR is largely unknown. In the present study we evaluated the association of change in LVEDP on the changing pattern of iFR/FFR which may hold a clinical significance especially with percutaneous coronary intervention in heart failure patients.
Methods
This was a prospective, investigator-initiated, single-center study involving 20 patients with stable coronary artery disease and at least one intermediate coronary lesion (50-90%). The enrolled patients were subjected to both iFR and FFR along with baseline LVEDP measurement. Subsequently, intravenous nitroglycerine infusion was given to reduce LVEDP and corresponding iFR and FFR were re-evaluated. The dynamic changes in iFR and FFR were studied in relation to changes in LVEDP using Pearson’s correlation analysis and linear regression analysis.
Results
The mean LVEDP was lowered from 16.20 ± 1.54 mmHg to 9.50 ± 1.10 mmHg, the mean iFR and FFR got changed from 0.80 ± 0.12 to 0.76 ± 0.12 mmHg and 0.75 ± 0.09 to 0.72 ± 0.09 mmHg respectively. On Pearson’s correlation analysis, LVEDP change did not show statistically significant correlation (linear relationship) with iFR (p = 0.105, r2 = 0.373) and FFR (p = 0.227, r2 = 0.283) changes across the entire range of stenosis severity and in all vessels. Linear regression analysis did not state any independent correlation between LVEDP and iFR and FFR changes in the study group (p >0.05). The % R2 value for iFR and FFR (as a coefficient of determination) of the regression equation were 13.9% and 8%, which means only these percentages of the total variance in iFR and FFR change were explained by LVEDP changes respectively. There was no serious adverse event related to the procedure.
Conclusion
To the best of our knowledge, this is the first study comparing the effect of changes in LVEDP on both iFR and FFR simultaneously. In our study, 1 mmHg change in LVEDP was associated with a change in FFR by 0.004 and change in iFR by 0.004 which didn’t reveal any significant association (p = 0.227 and 0.105 respectively). This helps us to put FFR at par with iFR under variable hemodynamics. So either of the variables may be used interchangeably with confidence in varied hemodynamic conditions including patients with heart failure. The correlation was non-significant across entire range of stenosis severity, irrespective of sex, age, diabetes and hypertension. This study sets platform for further research with larger number of heterogeneous patient population. Abstract Figure. Box whisker plot
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Affiliation(s)
- P Sharma
- King George"s Medical University, Lucknow, India
| | - S Vohra
- King George"s Medical University, Lucknow, India
| | - M Bhandari
- King George"s Medical University, Lucknow, India
| | - A Sharma
- King George"s Medical University, Lucknow, India
| | | | - G Chaudhary
- King George"s Medical University, Lucknow, India
| | - A Pradhan
- King George"s Medical University, Lucknow, India
| | - S Chandra
- King George"s Medical University, Lucknow, India
| | - S K Dwivedi
- King George"s Medical University, Lucknow, India
| | - R Sethi
- King George"s Medical University, Lucknow, India
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Bhandari M, Hamid A, Tyagi V, Choudhary G, Mallikarjuna C, Desai M, Srivastava A, Ahlawat R, Dubey D, Pratt C, Reddiboina M. The art of data labelling for building supervised computer Vision models for kidney surgery. Eur Urol 2022. [DOI: 10.1016/s0302-2838(22)01351-3] [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: 11/30/2022]
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16
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Kumar D, Dwivedi S, Chaudhary G, Sharma A, Chandra S, Vishwakarma P, Pradhan A, Sethi R, Bhandari M, Shukla A, Singh A. Role of oral flecainide in assessement of atrio-ventricular conduction in symptomatic bifascicular block. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Intravenous flecainide is used to stress Atrio-ventricular (AV) conduction in patients (pts) with a history of syncope & bifascicular (Bi-Fasc) block. Role of oral flecainide is unclear.
Objective
To assess effect of oral Flecainide on infra-Hisian AV conduction in patients with symptomatic Bi-Fasc block.
Methods
Pts presenting with syncope & Bi-Fasc block without advanced AVCD on ECG, 24 hr holter or treadmill exercise test were taken. Those with history suggestive of reflex syncope & positive tilt test were excluded. Remaining underwent electro-physiological (EP) study. Pts with HV interval >100ms or intra/infra-Hisian block at rest or incremental pacing were subjected to PPI. Remaining received oral Flacanide 5 mg/kg (max 300 mg) & EP study was repeated after ½ hr, 1 hr, 2 hrs and 3 hrs. Primary end-point was HV ≥100ms or infra/intra-Hisian type IIB or III block.
Results
Of 41 pts enrolled for study, 28 patients (mean age 60.0 yrs, mean LVEF 60.7%) were eligible for EP Study. Basal PR interval was 185.8±47.4 ms & mean QRS width was 130.6±18.65 ms. On EP study, 4 (14.3%) with resting HV >100 ms & 6 (21.4%) with HV >100 ms on incremental pacing underwent PPI.
Out of remaining 18 pts who were given flecainide, 11 (66.1%) achieved primary endpoint (HV >100 ms in 6, infra-hisian IIB in 2 and 2:1 block in 3 patients). At mean follow up of 6.5 months, 13 (59.1%) out of 22 with PPI had mean 59.1% VP & none of 6 remaining patients had any symptom.
Conclusion
Oral Flecainide significantly increases the diagnostic yield of EP study in patients with symptomatic bi-fasc block.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- D Kumar
- King George's Medical University, Lucknow, India
| | - S.K Dwivedi
- King George's Medical University, Lucknow, India
| | - G Chaudhary
- King George's Medical University, Lucknow, India
| | - A Sharma
- King George's Medical University, Lucknow, India
| | - S Chandra
- King George's Medical University, Lucknow, India
| | | | - A Pradhan
- King George's Medical University, Lucknow, India
| | - R Sethi
- King George's Medical University, Lucknow, India
| | - M Bhandari
- King George's Medical University, Lucknow, India
| | - A Shukla
- King George's Medical University, Lucknow, India
| | - A Singh
- King George's Medical University, Lucknow, India
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17
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Vohra S, Sethi R, Sharma P, Pradhan A, Vishwakarma P, Bhandari M, Narain VS, Dwivedi SK, Chandra S, Chaudhary G, Sharma A. Comparison of traditional versus artificial intelligence based coronary artery disease risk prediction scores in young patients with acute coronary syndrome. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Ever since the concept of preventive cardiology has come into vogue, several risk identification models have come up which combine several risk factors to create a risk prediction score for occurrence of cardiovascular (CV) event. While carrying a proven validation in Western population, none of the risk prediction model has been satisfactorily evaluated in Indians especially young <40 years old.
Objectives
To compare Artificial Intelligence based novel risk score with traditional risk scores in young (less than 40 years age) patients presenting with acute coronary syndrome (ACS) and to estimate the relative efficacy of different coronary artery disease (CAD) risk scores in young Indian Patients.
Design
Single center, Observational, Non-interventional study.
Participants
Cohort of Patients more than 20 but less than 40 years old with ACS in the department of Cardiology from 1st January 2019 to 31st October 2019.
Methods
314 young patients [mean age 36.14±4.17 years] presenting with acute coronary syndrome (ACS) were enrolled. The three clinically most pertinent risk assessment models [Framingham Risk score (FRS), World Health Organization risk prediction charts (WHO/ISH), and QRISK3 scores] and Artificial Intelligence based novel risk score (AICVD) were applied on day 1 of presentation, and tried to see whether one risk score versus other risk score could have predicted the event earlier had we applied it before the occurrence of ACS. Risk factors considered included those already in traditional scoring systems and new risk factors (diet, alcohol, tobacco, dyslipidemia, physical activity, family history of heart disease, history of heart disease, heart rate, respiratory rate, chronic heart symptoms and psychological stress).
Results
WHO/ISH provided the lowest high risk estimate with only 1 (0.9%) patient estimated to be having >20% 10-year risk. The FRS estimated high risk (>20% 10-year risk) in 3 (1%) patients. The QRISK3 estimated high risk (>10% 10-year risk) in 20 (6.5%) patient. In comparison, AICVD risk prediction model stood tall by identifying 73 (23.2%) patients as high risk and 62.74% patients as more than moderate risk for having CV events at 7 years (p<0.001).
Conclusion
Perhaps, this is the first study which has compared artificial intelligence based novel risk prediction model with the three most commonly applied models, in the young Indian patients. We found that a cohort of young Indian patients presenting with ACS, when studied retrospectively, was identified as “high risk” most likely by AICVD risk prediction model rather than the traditional counterparts. The WHO/ISH risk prediction charts and FRS were the poorest predictors. Performance of QRISK3 score also remained less than satisfactory. These findings suggested that AICVD risk prediction model is a promising tool to assess for CV risk in Indian population.
Funding Acknowledgement
Type of funding sources: None. Predictability of risk prediction models
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Affiliation(s)
- S Vohra
- King George's Medical University, Lucknow, India
| | - R Sethi
- King George's Medical University, Lucknow, India
| | - P Sharma
- King George's Medical University, Lucknow, India
| | - A Pradhan
- King George's Medical University, Lucknow, India
| | | | - M Bhandari
- King George's Medical University, Lucknow, India
| | - V S Narain
- King George's Medical University, Lucknow, India
| | - S K Dwivedi
- King George's Medical University, Lucknow, India
| | - S Chandra
- King George's Medical University, Lucknow, India
| | - G Chaudhary
- King George's Medical University, Lucknow, India
| | - A Sharma
- King George's Medical University, Lucknow, India
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18
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Chowdhury S, Bhandari M, Quake S, Ahmed I, Ibrahim B. 783 Digital Weekend Handover an Effective Documentation. Br J Surg 2021. [DOI: 10.1093/bjs/znab259.804] [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: 11/12/2022]
Abstract
Abstract
Aim
To assess quality of completion for weekend handover for surgical weekend and to plan and design a Digital handover, the implementation and effect of which is studied.
Method
Data collection from TRAKCARE for documentation completion criteriae including diagnosis, further investigations to chase (e.g., bloods, imaging), discharge plans, escalation and DNAR status identified.
First cycle collected in August 2020 for pre-implementation status and standard. Second cycle was collected after implementation and raising awareness about new system in October 2020.
Exclusion criteria: patients discharged prior to weekend
Results
32 (10f 22m) and 22 (9 f 13m) patients were studied in first and second cycle with a respective median length stay of 243 hours and 161.5 hours. Handover entries had improved from 40.6% completion rate to 77.3% these included a diagnosis and management plan. Required blood investigation plans were recorded in 54.5% patients (previously 9.4%). Escalation plans including DNACPR and ceiling of care were improved from 25% to 31%.
Conclusions
Digital Medical recording left a gap in documentation for weekend ward rounds when personnels are thinned and busy. To optimize clinical care, the use of a E weekend handover has improved documentation greatly. Future Ongoing project includes improving escalation plans further.
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Affiliation(s)
- S Chowdhury
- North Tees Hospital, Stockton, United Kingdom
| | - M Bhandari
- North Tees Hospital, Stockton, United Kingdom
| | - S Quake
- James Cook University, Middlesborough, United Kingdom
| | - I Ahmed
- North Tees Hospital, Stockton, United Kingdom
| | - B Ibrahim
- North Tees Hospital, Stockton, United Kingdom
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19
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Bhandari M, Rao M, Bussa G, Rao C. 711 Effect of Roux-En-Y Gastric Bypass on HbA1c As Well As Number of Medications in Diabetic Patients. Br J Surg 2021. [DOI: 10.1093/bjs/znab259.187] [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: 11/12/2022]
Abstract
Abstract
Aim
Roux en Y gastric bypass (RYGB) is known to ameliorate Type 2 Diabetes Mellitus (T2DM) in morbidly obese patients. We aimed to determine both the reduction in the glycosylated haemoglobin (HbA1c) and the number of anti-diabetic medications (including insulin) in diabetic patients undergoing RYGB over a five-year period.
Method
We reviewed data of diabetic patients (n = 530) who underwent RYGB from January 2012 – December 2017, including those with a minimum of a 2-year post-operative follow up (n = 47). Preoperatively, BMI, HbA1c and the number of anti-diabetic medications and the duration of T2DM since diagnosis were recorded. These measurements were repeated at the end of the two year follow up.
Results
At the time of enrolment in the bariatric programme, the median BMI was 42.5 (range, 31.7-61.5) kg/m2, mean duration of T2DM was 58 months and median HbA1c was 59 (37-118) mmol/mol. The mean number of anti-diabetic medications taken, including insulin, was 2. At the end of 2-year follow-up, the median BMI was 32 (range, 24-41) kg/m2 and HbA1c was 41(range, 33-91) mmol/mol. 15 patients (31.9%) still required anti-diabetic medication, 12 of whom had a diagnosis of T2DM for 3 years or more at time of enrolment.
Conclusions
RYGB is strongly associated with a resolution of T2DM in morbidly obese patients. In those who were not resolved, the number of anti-diabetic medications taken and HbA1c were reduced. The impact of the surgery is dependent on the duration of T2DM since diagnosis preoperatively.
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Affiliation(s)
- M Bhandari
- University Hospital of North Tees, Stockton On Tees, United Kingdom
| | - M Rao
- University Hospital of North Tees, Stockton On Tees, United Kingdom
| | - G Bussa
- University Hospital of North Tees, Stockton On Tees, United Kingdom
| | - C Rao
- Uniersity College London, London, United Kingdom
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20
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Azeem S, Gauger P, Sato Y, Baoqing G, Wolc A, Carlson J, Harmon K, Zhang J, Hoang H, Yuan J, Bhandari M, Kim H, Gibson K, Matias-Ferreyra F, Yoon KJ. Environmental Sampling for Avian Influenza Virus Detection in Commercial Layer Facilities. Avian Dis 2021; 65:391-400. [PMID: 34427413 DOI: 10.1637/0005-2086-65.3.391] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 06/02/2021] [Indexed: 11/05/2022]
Abstract
The present study was designed to evaluate the utility of environmental samples for convenient but accurate detection of avian influenza virus (AIV) in commercial poultry houses. First, environmental samples from AIV-negative commercial layer facilities were spiked with an H5N2 low pathogenic AIV and were evaluated for their effect on the detection of viral RNA immediately or after incubation at -20 C, 4 C, 22 C, or 37 C for 24, 48, or 72 hr. Second, Swiffer pads, drag swabs, and boot cover swabs were evaluated for their efficiency in collecting feces and water spiked with the H5N2 LPAIV under a condition simulated for a poultry facility floor. Third, environmental samples collected from commercial layer facilities that experienced an H5N2 highly pathogenic AIV outbreak in 2014-15 were evaluated for the effect of sampling locations on AIV detection. The half-life of AIV was comparable across all environmental samples but decreased with increasing temperatures. Additionally, sampling devices did not differ significantly in their ability to collect AIV-spiked environmental samples from a concrete floor for viral RNA detection. Some locations within a poultry house, such as cages, egg belts, house floor, manure belts, and manure pits, were better choices for sampling than other locations (feed trough, ventilation fan, and water trays) to detect AIV RNA after cleaning and disinfection. Samples representing cages, floor, and manure belts yielded significantly more PCR positives than the other environmental samples. In conclusion, environmental samples can be routinely collected from a poultry barn as noninvasive samples for monitoring AIV.
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Affiliation(s)
- Shahan Azeem
- Department of Veterinary Microbiology and Preventive Medicine, College of Veterinary Medicine, Iowa State University, Ames, IA 50011
| | - Phillip Gauger
- Department of Veterinary Diagnostic and Production Animal Medicine, College of Veterinary Medicine, Iowa State University, Ames, IA 50011
| | - Yuko Sato
- Department of Veterinary Diagnostic and Production Animal Medicine, College of Veterinary Medicine, Iowa State University, Ames, IA 50011
| | - Guo Baoqing
- Department of Veterinary Diagnostic and Production Animal Medicine, College of Veterinary Medicine, Iowa State University, Ames, IA 50011
| | - Anna Wolc
- Department of Animal Science, College of Agriculture and Life Sciences, Iowa State University, Ames, IA 50011.,Hy-Line International, Dallas Center, IA 50063
| | - James Carlson
- Department of Veterinary Diagnostic and Production Animal Medicine, College of Veterinary Medicine, Iowa State University, Ames, IA 50011
| | - Karen Harmon
- Department of Veterinary Diagnostic and Production Animal Medicine, College of Veterinary Medicine, Iowa State University, Ames, IA 50011
| | - Jianqiang Zhang
- Department of Veterinary Diagnostic and Production Animal Medicine, College of Veterinary Medicine, Iowa State University, Ames, IA 50011
| | - Hai Hoang
- Department of Veterinary Microbiology and Preventive Medicine, College of Veterinary Medicine, Iowa State University, Ames, IA 50011
| | - Jian Yuan
- Department of Veterinary Diagnostic and Production Animal Medicine, College of Veterinary Medicine, Iowa State University, Ames, IA 50011
| | - Mahesh Bhandari
- Department of Veterinary Microbiology and Preventive Medicine, College of Veterinary Medicine, Iowa State University, Ames, IA 50011
| | - Hanjun Kim
- Department of Veterinary Diagnostic and Production Animal Medicine, College of Veterinary Medicine, Iowa State University, Ames, IA 50011
| | - Kathleen Gibson
- Department of Veterinary Diagnostic and Production Animal Medicine, College of Veterinary Medicine, Iowa State University, Ames, IA 50011
| | - Franco Matias-Ferreyra
- Department of Veterinary Diagnostic and Production Animal Medicine, College of Veterinary Medicine, Iowa State University, Ames, IA 50011
| | - Kyoung-Jin Yoon
- Department of Veterinary Diagnostic and Production Animal Medicine, College of Veterinary Medicine, Iowa State University, Ames, IA 50011,
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21
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Bhandari M, Ali H, Desai M, Mallikarjuna C, Srivastava A, Dubey D, Tyagi V, Ahlawat R, Pratt C, Choudhary G, Trevor T, Reddiboina M. Complexities in annotating surgical videos for building supervised deep learning models for critical steps of laparoscopic live donor nephrectomy. Eur Urol 2021. [DOI: 10.1016/s0302-2838(21)00717-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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22
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Kirchdoerfer RN, Bhandari M, Martini O, Sewall LM, Bangaru S, Yoon KJ, Ward AB. Structure and immune recognition of the porcine epidemic diarrhea virus spike protein. Structure 2020; 29:385-392.e5. [PMID: 33378641 PMCID: PMC7962898 DOI: 10.1016/j.str.2020.12.003] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 10/12/2020] [Accepted: 12/07/2020] [Indexed: 11/29/2022]
Abstract
Porcine epidemic diarrhea virus (PEDV) is an alphacoronavirus responsible for significant morbidity and mortality in pigs. A key determinant of viral tropism and entry, the PEDV spike protein is a key target for the host antibody response and a good candidate for a protein-based vaccine immunogen. We used electron microscopy to evaluate the PEDV spike structure, as well as pig polyclonal antibody responses to viral infection. The structure of the PEDV spike reveals a configuration similar to that of HuCoV-NL63. Several PEDV protein-protein interfaces are mediated by non-protein components, including a glycan at Asn264 and two bound palmitoleic acid molecules. The polyclonal antibody response to PEDV infection shows a dominance of epitopes in the S1 region. This structural and immune characterization provides insights into coronavirus spike stability determinants and explores the immune landscape of viral spike proteins.
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Affiliation(s)
- Robert N Kirchdoerfer
- Department of Integrative Structural and Computational Biology, The Scripps Research Institute, La Jolla, CA 92037, USA
| | - Mahesh Bhandari
- Department of Veterinary Diagnostic and Production Animal Medicine, Iowa State University, Ames, IA 50011, USA
| | - Olnita Martini
- Department of Integrative Structural and Computational Biology, The Scripps Research Institute, La Jolla, CA 92037, USA
| | - Leigh M Sewall
- Department of Integrative Structural and Computational Biology, The Scripps Research Institute, La Jolla, CA 92037, USA
| | - Sandhya Bangaru
- Department of Integrative Structural and Computational Biology, The Scripps Research Institute, La Jolla, CA 92037, USA
| | - Kyoung-Jin Yoon
- Department of Veterinary Diagnostic and Production Animal Medicine, Iowa State University, Ames, IA 50011, USA
| | - Andrew B Ward
- Department of Integrative Structural and Computational Biology, The Scripps Research Institute, La Jolla, CA 92037, USA.
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23
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DiBiase S, Weiner R, Mahmood T, Harris K, Baghian A, Kawauchi R, Devisetty K, Herman J, Bhandari M, Ware M, Friedlander P, Morgan L. Phase I Clinical Trial: Results From The Use Of 4-Demethyl-4-Cholesteryloxycarbonylpenclomedine (DM-CHOC-PEN) Plus Radiation As Treatment For Cancers Involving The CNS. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.092] [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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24
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Bannuru RR, Osani MC, Vaysbrot EE, Arden NK, Bennell K, Bierma-Zeinstra SMA, Kraus VB, Lohmander LS, Abbott JH, Bhandari M, Blanco FJ, Espinosa R, Haugen IK, Lin J, Mandl LA, Moilanen E, Nakamura N, Snyder-Mackler L, Trojian T, Underwood M, McAlindon TE. OARSI guidelines for the non-surgical management of knee, hip, and polyarticular osteoarthritis. Osteoarthritis Cartilage 2019; 27:1578-1589. [PMID: 31278997 DOI: 10.1016/j.joca.2019.06.011] [Citation(s) in RCA: 1468] [Impact Index Per Article: 293.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 05/21/2019] [Accepted: 06/20/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To update and expand upon prior Osteoarthritis Research Society International (OARSI) guidelines by developing patient-focused treatment recommendations for individuals with Knee, Hip, and Polyarticular osteoarthritis (OA) that are derived from expert consensus and based on objective review of high-quality meta-analytic data. METHODS We sought evidence for 60 unique interventions. A systematic search of all relevant databases was conducted from inception through July 2018. After abstract and full-text screening by two independent reviewers, eligible studies were matched to PICO questions. Data were extracted and meta-analyses were conducted using RevMan software. Grading of Recommendations Assessment, Development, and Evaluation (GRADE) Evidence Profiles were compiled using the GRADEpro web application. Voting for Core Treatments took place first. Four subsequent voting sessions took place via anonymous online survey, during which Panel members were tasked with voting to produce recommendations for all joint locations and comorbidity classes. We designated non-Core treatments to Level 1A, 1B, 2, 3, 4A, 4B, or 5, based on the percentage of votes in favor, in addition to the strength of the recommendation. RESULTS Core Treatments for Knee OA included arthritis education and structured land-based exercise programs with or without dietary weight management. Core Treatments for Hip and Polyarticular OA included arthritis education and structured land-based exercise programs. Topical non-steroidal anti-inflammatory drugs (NSAIDs) were strongly recommended for individuals with Knee OA (Level 1A). For individuals with gastrointestinal comorbidities, COX-2 inhibitors were Level 1B and NSAIDs with proton pump inhibitors Level 2. For individuals with cardiovascular comorbidities or frailty, use of any oral NSAID was not recommended. Intra-articular (IA) corticosteroids, IA hyaluronic acid, and aquatic exercise were Level 1B/Level 2 treatments for Knee OA, dependent upon comorbidity status, but were not recommended for individuals with Hip or Polyarticular OA. The use of Acetaminophen/Paracetamol (APAP) was conditionally not recommended (Level 4A and 4B), and the use of oral and transdermal opioids was strongly not recommended (Level 5). A treatment algorithm was constructed in order to guide clinical decision-making for a variety of patient profiles, using recommended treatments as input for each decision node. CONCLUSION These guidelines offer comprehensive and patient-centered treatment profiles for individuals with Knee, Hip, and Polyarticular OA. The treatment algorithm will facilitate individualized treatment decisions regarding the management of OA.
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Affiliation(s)
- R R Bannuru
- Center for Treatment Comparison and Integrative Analysis (CTCIA), Division of Rheumatology, Tufts Medical Center, Boston, MA, USA.
| | - M C Osani
- Center for Treatment Comparison and Integrative Analysis (CTCIA), Division of Rheumatology, Tufts Medical Center, Boston, MA, USA
| | - E E Vaysbrot
- Center for Treatment Comparison and Integrative Analysis (CTCIA), Division of Rheumatology, Tufts Medical Center, Boston, MA, USA
| | - N K Arden
- Centre for Sport, Exercise and Osteoarthritis Research Versus Arthritis, University of Oxford, Nottingham, UK; MRC Lifecourse Epidemiological Unit, University of Southampton, Southampton, UK
| | - K Bennell
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, University of Melbourne, Carlton, Victoria, Australia
| | - S M A Bierma-Zeinstra
- Department of General Practice, Erasmus MC - University Medical Centre Rotterdam, Rotterdam, the Netherlands; Department of Orthopedics, Erasmus MC - University Medical Centre Rotterdam, Rotterdam, the Netherlands
| | - V B Kraus
- Duke Molecular Physiology Institute and Division of Rheumatology, Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - L S Lohmander
- Dept. of Clinical Sciences, Orthopedics, Lund University, Lund, Sweden
| | - J H Abbott
- Centre for Musculoskeletal Outcomes Research (CMOR), Dept. of Surgical Sciences, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - M Bhandari
- Dept. of Orthopedic Surgery, McMaster University, Ontario, Canada
| | - F J Blanco
- Grupo de Investigación de Reumatología, INIBIC-Hospital Universitario, A Coruña, La Coruña, Spain; CICA-INIBIC Universidad de A Coruña, A Coruña, La Coruña, Spain
| | - R Espinosa
- National Institute of Rehabilitation, México City, Mexico; National Autonomous University of México, México City, Mexico
| | - I K Haugen
- Dept. of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - J Lin
- Arthritis Clinic and Research Center, Peking University People's Hospital, Peking University, Beijing, China
| | - L A Mandl
- Hospital for Special Surgery, Weill Cornell Medicine, New York, NY, USA
| | - E Moilanen
- The Immunopharmacology Research Group, Faculty of Medicine and Health Technology, Tampere University and Tampere University Hospital, Tampere, Finland
| | - N Nakamura
- Institute for Medical Science in Sports, Osaka Health Science University, Osaka, Japan
| | - L Snyder-Mackler
- Dept. of Physical Therapy, STAR University of Delaware, Newark, DE, USA
| | - T Trojian
- Division of Sports Medicine, Drexel Sports Medicine, Philadelphia, PA, USA
| | - M Underwood
- Warwick Clinical Trials Unit, Warwick Medical School, Coventry, UK; University Hospitals of Coventry and Warwickshire, Coventry, UK
| | - T E McAlindon
- Center for Treatment Comparison and Integrative Analysis (CTCIA), Division of Rheumatology, Tufts Medical Center, Boston, MA, USA
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Tiwari A, Dwivedi S, Chandra S, Chaudhary G, Sharma A, Pradhan A, Vishwakarma P, Bhandari M, Narain V. Early Discharge after Acute ST-Segment Elevation Myocardial Infarction: Early Experience from a High Volume Tertiary Care Center in India. Indian Heart J 2019. [DOI: 10.1016/j.ihj.2019.11.075] [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: 10/25/2022] Open
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Singh A, Dwivedi S, Pradhan A, Sethi R, Chandra S, Vishwakarma P, Chaudhary G, Bhandari M, Sharma A. Isolated ST Elevation Myocardial Infarction Involving Leads I and aVL: Angiographic & Electrocardiographic Correlation from a Tertiary Care Center. Indian Heart J 2019. [DOI: 10.1016/j.ihj.2019.11.061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Tiwari A, Dwivedi S, Chandra S, Chaudhary G, Sharma A, Sethi R, Pradhan A, Vishwakarma P, Bhandari M, Narain V. Prevalence of single and double vessel disease in aVR ST-segment elevation (aVR-STE) and acute coronary syndrome (ACS) by coronary angiography. Indian Heart J 2019. [DOI: 10.1016/j.ihj.2019.11.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Alkandari A, Thayalasekaran S, Bhandari M, Przybysz A, Bugajski M, Bassett P, Kandiah K, Subramaniam S, Galtieri P, Maselli R, Spychalski M, Hayee B, Haji A, Repici A, Kaminski M, Bhandari P. Endoscopic Resections in Inflammatory Bowel Disease: A Multicentre European Outcomes Study. J Crohns Colitis 2019; 13:1394-1400. [PMID: 30994915 DOI: 10.1093/ecco-jcc/jjz075] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Inflammatory bowel disease is associated with an increased risk of colorectal cancer, with estimates ranging 2-18%, depending on the duration of colitis. The management of neoplasia in colitis remains controversial. Current guidelines recommend endoscopic resection if the lesion is clearly visible with distinct margins. Colectomy is recommended if complete endoscopic resection is not guaranteed. We aimed to assess the outcomes of all neoplastic endoscopic resections in inflammatory bowel disease. METHODS This was a multicentre retrospective cohort study of 119 lesions of visible dysplasia in 93 patients, resected endoscopically in inflammatory bowel disease. RESULTS A total of 6/65 [9.2%] lesions <20 mm in size were treated by ESD [endoscopic submucosal dissection] compared with 59/65 [90.8%] lesions <20 mm treated by EMR [endoscopic mucosal resection]; 16/51 [31.4%] lesions >20 mm in size were treated by EMR vs 35/51 [68.6%] by ESD. Almost all patients [97%] without fibrosis were treated by EMR, and patients with fibrosis were treated by ESD [87%], p < 0.001. In all, 49/78 [63%] lesions treated by EMR were resected en-bloc and 27/41 [65.9%] of the ESD/KAR [knife-assisted resection] cases were resected en-bloc, compared with 15/41 [36.6%] resected piecemeal. Seven recurrences occurred in the cohort. Seven complications occurred in the cohort; six were managed endoscopically and one patient with a delayed perforation underwent surgery. CONCLUSIONS Larger lesions with fibrosis are best treated by ESD, whereas smaller lesions without fibrosis are best managed by EMR. Both EMR and ESD are feasible in the management of endoscopic resections in colitis.
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Affiliation(s)
- A Alkandari
- Department of Gastroenterology, Queen Alexandra Hospital, Portsmouth, UK
| | - S Thayalasekaran
- Department of Gastroenterology, Queen Alexandra Hospital, Portsmouth, UK
| | - M Bhandari
- Department of Gastroenterology, Queen Alexandra Hospital, Portsmouth, UK
| | - A Przybysz
- Department of Oncological Gastroenterology, Maria Sklodowska-Curie Institute Oncology Center, Warsaw, Poland
| | - M Bugajski
- Department of Oncological Gastroenterology, Maria Sklodowska-Curie Institute Oncology Center, Warsaw, Poland
| | - P Bassett
- Statistics, Statsconsultancy, Amersham, UK
| | - K Kandiah
- Department of Gastroenterology, Queen Alexandra Hospital, Portsmouth, UK
| | - S Subramaniam
- Department of Gastroenterology, Queen Alexandra Hospital, Portsmouth, UK
| | - P Galtieri
- Department of Gastroenterology, Humanitas Research Hospital, Milan, Italy
| | - R Maselli
- Department of Gastroenterology, Humanitas Research Hospital, Milan, Italy
| | - M Spychalski
- University of Lodz, Center of Bowel Treatment, Brzeziny, Poland
| | - B Hayee
- Department of Gastroenterology, Kings Institute of Therapeutic Endoscopy, London, UK
| | - A Haji
- Department of Gastroenterology, Kings Institute of Therapeutic Endoscopy, London, UK
| | - A Repici
- Department of Gastroenterology, Humanitas Research Hospital, Milan, Italy
| | - M Kaminski
- Department of Oncological Gastroenterology, Maria Sklodowska-Curie Institute Oncology Center, Warsaw, Poland.,Department of Gastroenterology, Hepatology and Clinical Oncology, Medical Centre for Postgraduate Education, Warsaw, Poland
| | - P Bhandari
- Department of Gastroenterology, Queen Alexandra Hospital, Portsmouth, UK
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Saran M, Dwivedi SK, Sharma A, Chaudhary G, Chandra S, Sethi R, Vishwakarma P, Pradhan A, Bhandari M, Narain VS. 4300Strain parameters at rest and after exercise in symptomatically stable patients with improved heart failure - STRESS-HF. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Background
Optimal medical therapy (OMT) results in improvement in left ventricular (LV) ejection fraction (EF) and reduction in LV size in approximately 40% of patients of heart failure with reduced ejection fraction (HFrEF). Recent studies have proposed to continue treatment in all patients of this subgroup as improvement in LVEF does not indicate actual myocardial recovery. Global Longitudinal strain (GLS) is more sensitive marker of LV systolic function and better predictor of mortality than LVEF. GLS may identify probable patients in whom the therapy can be minimized or stopped.
Aim
To determine global longitudinal strain at rest and after exercise in patients with idiopathic dilated cardiomyopathy (DCM) who have improved LVEF ≥50% on guideline directed medical therapy (GDMT) and compare with resting & exercising LVEF on 3-dimesional (3D).
Material and methods
This Observational study was conducted in a tertiary care referral hospital, from February 2018 to October 2018. All patients with idiopathic DCM who had a documented LVEF of ≤40% in the past and improved LVEF (LVEF ≥50%) on GDMT were included in the study. Patients with secondary causes of HFrEF, poor echocardiographic window and inability to exercise were excluded from the study. Strain parameters were calculated at rest and after atleast 5 METS of exercise. GLS value of ≥ minus 12.6% was considered as mildly reduced strain, ≤ minus 8% as severely reduced strain and the values in between as moderately reduced strain. Post exercise, drop of >5% in absolute LVEF value or decrease in GLS >15% from baseline was considered as poor myocardial recovery.
Results
A total of 44 patients [mean age of 46.8±13.1 years and 24 males (54.5%)] constituted the study group. At the time of diagnosis, 31 (70.5%) patients were in NYHA class II and the remaining were in class III. Duration of GDMT ranged from 4 to 38 (median 12) months. Following improvement on GDMT, 25 (56.8%) were in class I and rest were in class II. Mean LVEF at diagnosis and after recovery was 33.6±4.9% and 55.1±4.5%, respectively with a mean absolute change in LVEF of 21.3±6.1%. At rest, mean 3D LVEF was 53±3.5% and GLS was −12.3±3.1. Mild, moderate and severely reduced strain was seen in 24 (54.5%), 13 (29.6%) and 7 (15.9%), respectively. After exercise, mean 3D LVEF was 51.5.±4.5% (mean decrease 1.5±2.1%) and mean GLS was −7±4.2% (mean decrease −5.3±4.6%). After exercise, none had a fall of LVEF >5% however 32 (72.7%) had a decrease of >15% in GLS. Seven (15.9%) patients had improvement in GLS, 4 (9.1%) had <15% decrease and 1 (2.3%) showed no change in GLS on exercise. The change in GLS on exercise was significant (p=0.001), but change in 3D LVEF was not significant (p=0.956).
Conclusion
Global longitudinal strain is a better marker for assessing myocardial recovery than LVEF in patients of heart failure with improved ejection fraction.
Acknowledgement/Funding
None
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Affiliation(s)
- M Saran
- King George Medical University, Lucknow, India
| | - S K Dwivedi
- King George Medical University, Lucknow, India
| | - A Sharma
- King George Medical University, Lucknow, India
| | - G Chaudhary
- King George Medical University, Lucknow, India
| | - S Chandra
- King George Medical University, Lucknow, India
| | - R Sethi
- King George Medical University, Lucknow, India
| | | | - A Pradhan
- King George Medical University, Lucknow, India
| | - M Bhandari
- King George Medical University, Lucknow, India
| | - V S Narain
- King George Medical University, Lucknow, India
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Weiner RS, Mahmood T, Morgan LR, Harris K, Baghian A, DiBiase SJ, Friedlander P, Ware ML, Kawauchi R, Herman J, Bhandari M. Abstract CT065: A Phase I clinical trial: Use of 4-demethyl-4-cholesteryl- oxycarbonyl-penclomedine (DM-CHOC-PEN) plus radiation as treatments for cancers involving the CNS. Cancer Res 2019. [DOI: 10.1158/1538-7445.am2019-ct065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Purpose: 4-Demethyl-4-cholesteryloxycarbonylpenclomedine (DM-CHOC-PEN) is a poly-chlorinated pyridine cholesteryl carbonate with a MOA via bis-alkylation of DNA @ N7-guanine and N4-cytosine that has completed Phase II studies [AACR, #CT129, 2017] in subjects with cancers involving the CNS. Four (4) subjects in the Phase I/II trials required surgery for persistent CNS lesions following DM-CHOC-PEN therapy with 39-98.8 mg/m2 of drug. DM-CHOC-PEN was identified in samples from all 4-subjects - 90-212 ng/g tumor. Thus, the drug penetrates the CNS and tumors and is available to act as a radiosensitizer; the latter has been supported with in vitro studies [AACR, #4746, 2017]. The current presentation reviews Phase I clinical data that supports the safety, dose-tolerance and use for DM-CHOC-PEN plus radiation in subjects with cancers involving the CNS - IND 68,876.
Patients & Methods: DM-CHOC-PEN was administered as a 3-hr IV infusion once to subjects with advanced cancer involving the CNS. A single dose (39 mg/m2 to 98.7 mg/m2 in escalating Phase I scheme) was administered once 3-weeks prior to receiving stereotaxic radio-surgery (SRS), gamma knife or whole brain irradiation (WBRT) therapy. Radiation was administered in doses of 15-30 Gy depending on the size and number of lesions.
Results: Thirteen (13) subjects with cancer involving the CNS have been treated to date with DM-CHOC-PEN (6-NSCLC, 1-breast, 1-melanoma, 2-GBM & 3-sarcomas). Subjects received 39, 50, 70, 86.8 or 98.7 mg/m2 and 15-30 Gy of radiation. The drug/radiation combination was well tolerated. One (1) subject with NSCLC did develop vasogenic edema and tumor necrosis which resolved and the subject is in complete remission 42+ mos. A second subject with a recurrent GBM with confusion progressed - Gr-3. Ten (10) of the thirteen (13) subjects have had objective results (OS 8-54+ mos.) Bioavailability for DM-CHOC-PEN revealed a rebound phenomenon @ ~ 50 hours post-infusion with a T-release of 26.7 h. The same phenomenon was observed with RBCs (estimation using Monolix 3.2). DM-CHOC-PEN was detected bound to RBCs for 3-days (after 70 mg/m2) and was also detected in the urine (Cmax=17.5 µg/mL) until day 15. The AUC was linear for all doses. Pre-clinical radiosensitization in vitro studies [AACR #1917, 2017] support the present trial study result. Photon induced charge transfer reactions with DM-CHOC-PEN will be discussed as a MOA.
Conclusion: Data is presented that documents effectiveness and safety of DM-CHOC-PEN plus radiation as therapy for subjects with cancers involving the CNS. Observations during Phase I/II clinical trials with DM-CHOC-PEN alone supported the drug’s persistent presence in human tumors after systemic administration and possible positive effects on response to subsequent radiation. Complete data on subject responses and observed toxicities will be presented. Supported by - NCI/SBIR grants - R43 CA213545-02 and NIH NIGMS 1 U54 GM104940 - the latter funds the Louisiana Clinical and Translational Science Center.
Citation Format: RS Weiner, T Mahmood, Lee Roy Morgan, K. Harris, A. Baghian, SJ DiBiase, P. Friedlander, ML Ware, R. Kawauchi, J. Herman, M. Bhandari. A Phase I clinical trial: Use of 4-demethyl-4-cholesteryl- oxycarbonyl-penclomedine (DM-CHOC-PEN) plus radiation as treatments for cancers involving the CNS [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr CT065.
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Affiliation(s)
| | - T Mahmood
- 2Detriot Clinical Research Center, Lansing, MI
| | | | | | | | - SJ DiBiase
- 4New York - Presbyterian Queens, Flushing, NY
| | | | - ML Ware
- 6Ochsner Medical Center, New Orleans, LA
| | - R. Kawauchi
- 2Detriot Clinical Research Center, Lansing, MI
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Shanthanna H, Paul J, Lovrics P, Vanniyasingam T, Devereaux P, Bhandari M, Thabane L. Satisfactory analgesia with minimal emesis in day surgeries: a randomised controlled trial of morphine versus hydromorphone. Br J Anaesth 2019; 122:e107-e113. [DOI: 10.1016/j.bja.2019.03.036] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 03/07/2019] [Accepted: 03/24/2019] [Indexed: 11/29/2022] Open
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Gnant M, Martin M, Holmes FA, Jackisch C, Chia SK, Iwata H, Moy B, Martinez N, Mansi J, Morales S, Ruiz-Borrego M, von Minckwitz G, Buyse M, Delaloge S, Bhandari M, Murias Rosales A, Galeano T, Fujita T, Luczak A, Barrios CH, Saura C, Rugo HS, Chien J, Johnston SR, Spencer M, Xu F, Barnett B, Chan A, Ejlertsen B. Abstract P2-13-01: Efficacy of neratinib in hormone receptor-positive patients who initiated treatment within 1 year of completing trastuzumab-based adjuvant therapy in HER2+ early-stage breast cancer: Subgroup analyses from the phase III ExteNET trial. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p2-13-01] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: The international, randomized, placebo-controlled phase III ExteNET trial showed that 1 year (yr) of neratinib 240 mg/day after trastuzumab-based adjuvant therapy significantly improved invasive disease-free survival (iDFS) in 2840 patients with early-stage HER2+ breast cancer at 2 yr (hazard ratio 0.67; 95% CI 0.50–0.91; p=0.009) [Chan 2016] and 5 yr (hazard ratio 0.73; 95% CI 0.57-0.92; p=0.008) [Martin 2017]. A prespecified subgroup analysis by hormone receptor (HR) status suggested enhanced efficacy with neratinib in patients with HR+ (2-yr hazard ratio 0.51; 95% CI 0.33–0.77) vs. HR– tumors (2-yr hazard ratio 0.93; 95% CI 0.60–1.43). The efficacy of neratinib was also greater in patients who initiated treatment within 1 yr of prior trastuzumab compared with those who started neratinib later. The European Medicines Agency's Committee for Medicinal Products for Human Use recently recommended neratinib for use in patients with HR+ tumors who initiate treatment within 1 yr of completing trastuzumab-based adjuvant therapy. Subgroup analyses from ExteNET examining iDFS benefits in this patient population are presented here.
Methods: Patients with early-stage HER2+ breast cancer who completed trastuzumab-based (neo)adjuvant therapy were assigned to oral neratinib 240 mg/day or placebo for 1 yr. Randomization was stratified by HR status (determined locally before trial entry), nodal status, and trastuzumab regimen. Endocrine therapy was allowed in patients with HR+ disease. The primary endpoint, iDFS, was tested by 2-sided log-rank test and hazard ratios (95% CI) were estimated using Cox proportional hazards models. Kaplan-Meier methods were used to estimate iDFS rates. Secondary endpoints were DFS-DCIS, time to distant recurrence, distant DFS, and CNS recurrences. The primary analysis was conducted at 2 yr, and a sensitivity analysis conducted at 5 yr. Clinicaltrials.gov:NCT00878709.
Results: Of the 2840 patients (neratinib, n=1420; placebo, n=1420), 1631 (57%) had HR+ disease (neratinib, n=816; placebo, n=815). Most (93%) HR+ patients were receiving endocrine therapy at baseline. 1334 of 1631 (82%) patients with HR+ tumors were randomized to start neratinib within 1 yr of last trastuzumab dose (neratinib, n=670; placebo, n=664). iDFS benefits from neratinib in this population are shown in the table. Secondary endpoints were also improved with neratinib vs. placebo in this population. Safety data in this subset will be presented at the meeting.
Table. iDFS in patients with an interval between last trastuzumab dose and randomization of ≤1 yr
HR+ population (N=1334)ITT population (N=2297) Hazard ratiob Hazard ratiob Δ, %a(95% CI)P-valueΔ, %a(95% CI)P-value2-yr analysisc+4.50.490.002+2.90.630.006 (0.30–0.78) (0.45–0.88) 5-yr analysisd+5.10.580.002+3.20.700.006 (0.41–0.82) (0.54–0.90) aDifference in iDFS rates between neratinib vs. placebo; bNeratinib vs. placebo; cData cut-off: July 2014; dData cut-off: March 2017
Conclusions: Neratinib may have enhanced and sustained efficacy in patients with HR+ disease who initiate treatment within 1 yr of trastuzumab-based adjuvant therapy.
Citation Format: Gnant M, Martin M, Holmes F-A, Jackisch C, Chia SK, Iwata H, Moy B, Martinez N, Mansi J, Morales S, Ruiz-Borrego M, von Minckwitz G, Buyse M, Delaloge S, Bhandari M, Murias Rosales A, Galeano T, Fujita T, Luczak A, Barrios CH, Saura C, Rugo HS, Chien J, Johnston SR, Spencer M, Xu F, Barnett B, Chan A, Ejlertsen B. Efficacy of neratinib in hormone receptor-positive patients who initiated treatment within 1 year of completing trastuzumab-based adjuvant therapy in HER2+ early-stage breast cancer: Subgroup analyses from the phase III ExteNET trial [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P2-13-01.
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Affiliation(s)
- M Gnant
- Comprehensive Cancer Centre, Medical University of Vienna, Vienna, Austria; Instituto de Investigación Sanitaria Gregorio Marañón, CIBERONC, GEICAM, Universidad Complutense, Madrid, Spain; Texas Oncology, Houston, TX; Sana Klinikum Offenbach, Offenbach, Germany; British Columbia Cancer Agency, Vancouver, Canada; Aichi Cancer Center Hospital, Chikusa-ku Nagoya, Japan; Massachusetts General Hospital Cancer Center, Boston, MA; Hospital Universitario Ramón y Cajal, Madrid, Spain; Guy's and St Thomas' NHS Foundation Trust and Biomedical Research Centre, King's College London, London, United Kingdom; Hospital Universitari Arnau de Vilanova de Lleida, Lleida, Spain; Hospital Universitario Virgen del Rocio, Seville, Spain; German Breast Group, Neu-Isenburg, Germany; International Drug Development Institute, San Francisco, CA; Institut Gustave Roussy, Villejuif, France; Christ Hospital of Cincinnati, Cincinnati, OH; Compejo Hospitalario Materno Insular de Las Palmas, Las Palmas, Spain; Magna Graecia University, Catan
| | - M Martin
- Comprehensive Cancer Centre, Medical University of Vienna, Vienna, Austria; Instituto de Investigación Sanitaria Gregorio Marañón, CIBERONC, GEICAM, Universidad Complutense, Madrid, Spain; Texas Oncology, Houston, TX; Sana Klinikum Offenbach, Offenbach, Germany; British Columbia Cancer Agency, Vancouver, Canada; Aichi Cancer Center Hospital, Chikusa-ku Nagoya, Japan; Massachusetts General Hospital Cancer Center, Boston, MA; Hospital Universitario Ramón y Cajal, Madrid, Spain; Guy's and St Thomas' NHS Foundation Trust and Biomedical Research Centre, King's College London, London, United Kingdom; Hospital Universitari Arnau de Vilanova de Lleida, Lleida, Spain; Hospital Universitario Virgen del Rocio, Seville, Spain; German Breast Group, Neu-Isenburg, Germany; International Drug Development Institute, San Francisco, CA; Institut Gustave Roussy, Villejuif, France; Christ Hospital of Cincinnati, Cincinnati, OH; Compejo Hospitalario Materno Insular de Las Palmas, Las Palmas, Spain; Magna Graecia University, Catan
| | - F-A Holmes
- Comprehensive Cancer Centre, Medical University of Vienna, Vienna, Austria; Instituto de Investigación Sanitaria Gregorio Marañón, CIBERONC, GEICAM, Universidad Complutense, Madrid, Spain; Texas Oncology, Houston, TX; Sana Klinikum Offenbach, Offenbach, Germany; British Columbia Cancer Agency, Vancouver, Canada; Aichi Cancer Center Hospital, Chikusa-ku Nagoya, Japan; Massachusetts General Hospital Cancer Center, Boston, MA; Hospital Universitario Ramón y Cajal, Madrid, Spain; Guy's and St Thomas' NHS Foundation Trust and Biomedical Research Centre, King's College London, London, United Kingdom; Hospital Universitari Arnau de Vilanova de Lleida, Lleida, Spain; Hospital Universitario Virgen del Rocio, Seville, Spain; German Breast Group, Neu-Isenburg, Germany; International Drug Development Institute, San Francisco, CA; Institut Gustave Roussy, Villejuif, France; Christ Hospital of Cincinnati, Cincinnati, OH; Compejo Hospitalario Materno Insular de Las Palmas, Las Palmas, Spain; Magna Graecia University, Catan
| | - C Jackisch
- Comprehensive Cancer Centre, Medical University of Vienna, Vienna, Austria; Instituto de Investigación Sanitaria Gregorio Marañón, CIBERONC, GEICAM, Universidad Complutense, Madrid, Spain; Texas Oncology, Houston, TX; Sana Klinikum Offenbach, Offenbach, Germany; British Columbia Cancer Agency, Vancouver, Canada; Aichi Cancer Center Hospital, Chikusa-ku Nagoya, Japan; Massachusetts General Hospital Cancer Center, Boston, MA; Hospital Universitario Ramón y Cajal, Madrid, Spain; Guy's and St Thomas' NHS Foundation Trust and Biomedical Research Centre, King's College London, London, United Kingdom; Hospital Universitari Arnau de Vilanova de Lleida, Lleida, Spain; Hospital Universitario Virgen del Rocio, Seville, Spain; German Breast Group, Neu-Isenburg, Germany; International Drug Development Institute, San Francisco, CA; Institut Gustave Roussy, Villejuif, France; Christ Hospital of Cincinnati, Cincinnati, OH; Compejo Hospitalario Materno Insular de Las Palmas, Las Palmas, Spain; Magna Graecia University, Catan
| | - SK Chia
- Comprehensive Cancer Centre, Medical University of Vienna, Vienna, Austria; Instituto de Investigación Sanitaria Gregorio Marañón, CIBERONC, GEICAM, Universidad Complutense, Madrid, Spain; Texas Oncology, Houston, TX; Sana Klinikum Offenbach, Offenbach, Germany; British Columbia Cancer Agency, Vancouver, Canada; Aichi Cancer Center Hospital, Chikusa-ku Nagoya, Japan; Massachusetts General Hospital Cancer Center, Boston, MA; Hospital Universitario Ramón y Cajal, Madrid, Spain; Guy's and St Thomas' NHS Foundation Trust and Biomedical Research Centre, King's College London, London, United Kingdom; Hospital Universitari Arnau de Vilanova de Lleida, Lleida, Spain; Hospital Universitario Virgen del Rocio, Seville, Spain; German Breast Group, Neu-Isenburg, Germany; International Drug Development Institute, San Francisco, CA; Institut Gustave Roussy, Villejuif, France; Christ Hospital of Cincinnati, Cincinnati, OH; Compejo Hospitalario Materno Insular de Las Palmas, Las Palmas, Spain; Magna Graecia University, Catan
| | - H Iwata
- Comprehensive Cancer Centre, Medical University of Vienna, Vienna, Austria; Instituto de Investigación Sanitaria Gregorio Marañón, CIBERONC, GEICAM, Universidad Complutense, Madrid, Spain; Texas Oncology, Houston, TX; Sana Klinikum Offenbach, Offenbach, Germany; British Columbia Cancer Agency, Vancouver, Canada; Aichi Cancer Center Hospital, Chikusa-ku Nagoya, Japan; Massachusetts General Hospital Cancer Center, Boston, MA; Hospital Universitario Ramón y Cajal, Madrid, Spain; Guy's and St Thomas' NHS Foundation Trust and Biomedical Research Centre, King's College London, London, United Kingdom; Hospital Universitari Arnau de Vilanova de Lleida, Lleida, Spain; Hospital Universitario Virgen del Rocio, Seville, Spain; German Breast Group, Neu-Isenburg, Germany; International Drug Development Institute, San Francisco, CA; Institut Gustave Roussy, Villejuif, France; Christ Hospital of Cincinnati, Cincinnati, OH; Compejo Hospitalario Materno Insular de Las Palmas, Las Palmas, Spain; Magna Graecia University, Catan
| | - B Moy
- Comprehensive Cancer Centre, Medical University of Vienna, Vienna, Austria; Instituto de Investigación Sanitaria Gregorio Marañón, CIBERONC, GEICAM, Universidad Complutense, Madrid, Spain; Texas Oncology, Houston, TX; Sana Klinikum Offenbach, Offenbach, Germany; British Columbia Cancer Agency, Vancouver, Canada; Aichi Cancer Center Hospital, Chikusa-ku Nagoya, Japan; Massachusetts General Hospital Cancer Center, Boston, MA; Hospital Universitario Ramón y Cajal, Madrid, Spain; Guy's and St Thomas' NHS Foundation Trust and Biomedical Research Centre, King's College London, London, United Kingdom; Hospital Universitari Arnau de Vilanova de Lleida, Lleida, Spain; Hospital Universitario Virgen del Rocio, Seville, Spain; German Breast Group, Neu-Isenburg, Germany; International Drug Development Institute, San Francisco, CA; Institut Gustave Roussy, Villejuif, France; Christ Hospital of Cincinnati, Cincinnati, OH; Compejo Hospitalario Materno Insular de Las Palmas, Las Palmas, Spain; Magna Graecia University, Catan
| | - N Martinez
- Comprehensive Cancer Centre, Medical University of Vienna, Vienna, Austria; Instituto de Investigación Sanitaria Gregorio Marañón, CIBERONC, GEICAM, Universidad Complutense, Madrid, Spain; Texas Oncology, Houston, TX; Sana Klinikum Offenbach, Offenbach, Germany; British Columbia Cancer Agency, Vancouver, Canada; Aichi Cancer Center Hospital, Chikusa-ku Nagoya, Japan; Massachusetts General Hospital Cancer Center, Boston, MA; Hospital Universitario Ramón y Cajal, Madrid, Spain; Guy's and St Thomas' NHS Foundation Trust and Biomedical Research Centre, King's College London, London, United Kingdom; Hospital Universitari Arnau de Vilanova de Lleida, Lleida, Spain; Hospital Universitario Virgen del Rocio, Seville, Spain; German Breast Group, Neu-Isenburg, Germany; International Drug Development Institute, San Francisco, CA; Institut Gustave Roussy, Villejuif, France; Christ Hospital of Cincinnati, Cincinnati, OH; Compejo Hospitalario Materno Insular de Las Palmas, Las Palmas, Spain; Magna Graecia University, Catan
| | - J Mansi
- Comprehensive Cancer Centre, Medical University of Vienna, Vienna, Austria; Instituto de Investigación Sanitaria Gregorio Marañón, CIBERONC, GEICAM, Universidad Complutense, Madrid, Spain; Texas Oncology, Houston, TX; Sana Klinikum Offenbach, Offenbach, Germany; British Columbia Cancer Agency, Vancouver, Canada; Aichi Cancer Center Hospital, Chikusa-ku Nagoya, Japan; Massachusetts General Hospital Cancer Center, Boston, MA; Hospital Universitario Ramón y Cajal, Madrid, Spain; Guy's and St Thomas' NHS Foundation Trust and Biomedical Research Centre, King's College London, London, United Kingdom; Hospital Universitari Arnau de Vilanova de Lleida, Lleida, Spain; Hospital Universitario Virgen del Rocio, Seville, Spain; German Breast Group, Neu-Isenburg, Germany; International Drug Development Institute, San Francisco, CA; Institut Gustave Roussy, Villejuif, France; Christ Hospital of Cincinnati, Cincinnati, OH; Compejo Hospitalario Materno Insular de Las Palmas, Las Palmas, Spain; Magna Graecia University, Catan
| | - S Morales
- Comprehensive Cancer Centre, Medical University of Vienna, Vienna, Austria; Instituto de Investigación Sanitaria Gregorio Marañón, CIBERONC, GEICAM, Universidad Complutense, Madrid, Spain; Texas Oncology, Houston, TX; Sana Klinikum Offenbach, Offenbach, Germany; British Columbia Cancer Agency, Vancouver, Canada; Aichi Cancer Center Hospital, Chikusa-ku Nagoya, Japan; Massachusetts General Hospital Cancer Center, Boston, MA; Hospital Universitario Ramón y Cajal, Madrid, Spain; Guy's and St Thomas' NHS Foundation Trust and Biomedical Research Centre, King's College London, London, United Kingdom; Hospital Universitari Arnau de Vilanova de Lleida, Lleida, Spain; Hospital Universitario Virgen del Rocio, Seville, Spain; German Breast Group, Neu-Isenburg, Germany; International Drug Development Institute, San Francisco, CA; Institut Gustave Roussy, Villejuif, France; Christ Hospital of Cincinnati, Cincinnati, OH; Compejo Hospitalario Materno Insular de Las Palmas, Las Palmas, Spain; Magna Graecia University, Catan
| | - M Ruiz-Borrego
- Comprehensive Cancer Centre, Medical University of Vienna, Vienna, Austria; Instituto de Investigación Sanitaria Gregorio Marañón, CIBERONC, GEICAM, Universidad Complutense, Madrid, Spain; Texas Oncology, Houston, TX; Sana Klinikum Offenbach, Offenbach, Germany; British Columbia Cancer Agency, Vancouver, Canada; Aichi Cancer Center Hospital, Chikusa-ku Nagoya, Japan; Massachusetts General Hospital Cancer Center, Boston, MA; Hospital Universitario Ramón y Cajal, Madrid, Spain; Guy's and St Thomas' NHS Foundation Trust and Biomedical Research Centre, King's College London, London, United Kingdom; Hospital Universitari Arnau de Vilanova de Lleida, Lleida, Spain; Hospital Universitario Virgen del Rocio, Seville, Spain; German Breast Group, Neu-Isenburg, Germany; International Drug Development Institute, San Francisco, CA; Institut Gustave Roussy, Villejuif, France; Christ Hospital of Cincinnati, Cincinnati, OH; Compejo Hospitalario Materno Insular de Las Palmas, Las Palmas, Spain; Magna Graecia University, Catan
| | - G von Minckwitz
- Comprehensive Cancer Centre, Medical University of Vienna, Vienna, Austria; Instituto de Investigación Sanitaria Gregorio Marañón, CIBERONC, GEICAM, Universidad Complutense, Madrid, Spain; Texas Oncology, Houston, TX; Sana Klinikum Offenbach, Offenbach, Germany; British Columbia Cancer Agency, Vancouver, Canada; Aichi Cancer Center Hospital, Chikusa-ku Nagoya, Japan; Massachusetts General Hospital Cancer Center, Boston, MA; Hospital Universitario Ramón y Cajal, Madrid, Spain; Guy's and St Thomas' NHS Foundation Trust and Biomedical Research Centre, King's College London, London, United Kingdom; Hospital Universitari Arnau de Vilanova de Lleida, Lleida, Spain; Hospital Universitario Virgen del Rocio, Seville, Spain; German Breast Group, Neu-Isenburg, Germany; International Drug Development Institute, San Francisco, CA; Institut Gustave Roussy, Villejuif, France; Christ Hospital of Cincinnati, Cincinnati, OH; Compejo Hospitalario Materno Insular de Las Palmas, Las Palmas, Spain; Magna Graecia University, Catan
| | - M Buyse
- Comprehensive Cancer Centre, Medical University of Vienna, Vienna, Austria; Instituto de Investigación Sanitaria Gregorio Marañón, CIBERONC, GEICAM, Universidad Complutense, Madrid, Spain; Texas Oncology, Houston, TX; Sana Klinikum Offenbach, Offenbach, Germany; British Columbia Cancer Agency, Vancouver, Canada; Aichi Cancer Center Hospital, Chikusa-ku Nagoya, Japan; Massachusetts General Hospital Cancer Center, Boston, MA; Hospital Universitario Ramón y Cajal, Madrid, Spain; Guy's and St Thomas' NHS Foundation Trust and Biomedical Research Centre, King's College London, London, United Kingdom; Hospital Universitari Arnau de Vilanova de Lleida, Lleida, Spain; Hospital Universitario Virgen del Rocio, Seville, Spain; German Breast Group, Neu-Isenburg, Germany; International Drug Development Institute, San Francisco, CA; Institut Gustave Roussy, Villejuif, France; Christ Hospital of Cincinnati, Cincinnati, OH; Compejo Hospitalario Materno Insular de Las Palmas, Las Palmas, Spain; Magna Graecia University, Catan
| | - S Delaloge
- Comprehensive Cancer Centre, Medical University of Vienna, Vienna, Austria; Instituto de Investigación Sanitaria Gregorio Marañón, CIBERONC, GEICAM, Universidad Complutense, Madrid, Spain; Texas Oncology, Houston, TX; Sana Klinikum Offenbach, Offenbach, Germany; British Columbia Cancer Agency, Vancouver, Canada; Aichi Cancer Center Hospital, Chikusa-ku Nagoya, Japan; Massachusetts General Hospital Cancer Center, Boston, MA; Hospital Universitario Ramón y Cajal, Madrid, Spain; Guy's and St Thomas' NHS Foundation Trust and Biomedical Research Centre, King's College London, London, United Kingdom; Hospital Universitari Arnau de Vilanova de Lleida, Lleida, Spain; Hospital Universitario Virgen del Rocio, Seville, Spain; German Breast Group, Neu-Isenburg, Germany; International Drug Development Institute, San Francisco, CA; Institut Gustave Roussy, Villejuif, France; Christ Hospital of Cincinnati, Cincinnati, OH; Compejo Hospitalario Materno Insular de Las Palmas, Las Palmas, Spain; Magna Graecia University, Catan
| | - M Bhandari
- Comprehensive Cancer Centre, Medical University of Vienna, Vienna, Austria; Instituto de Investigación Sanitaria Gregorio Marañón, CIBERONC, GEICAM, Universidad Complutense, Madrid, Spain; Texas Oncology, Houston, TX; Sana Klinikum Offenbach, Offenbach, Germany; British Columbia Cancer Agency, Vancouver, Canada; Aichi Cancer Center Hospital, Chikusa-ku Nagoya, Japan; Massachusetts General Hospital Cancer Center, Boston, MA; Hospital Universitario Ramón y Cajal, Madrid, Spain; Guy's and St Thomas' NHS Foundation Trust and Biomedical Research Centre, King's College London, London, United Kingdom; Hospital Universitari Arnau de Vilanova de Lleida, Lleida, Spain; Hospital Universitario Virgen del Rocio, Seville, Spain; German Breast Group, Neu-Isenburg, Germany; International Drug Development Institute, San Francisco, CA; Institut Gustave Roussy, Villejuif, France; Christ Hospital of Cincinnati, Cincinnati, OH; Compejo Hospitalario Materno Insular de Las Palmas, Las Palmas, Spain; Magna Graecia University, Catan
| | - A Murias Rosales
- Comprehensive Cancer Centre, Medical University of Vienna, Vienna, Austria; Instituto de Investigación Sanitaria Gregorio Marañón, CIBERONC, GEICAM, Universidad Complutense, Madrid, Spain; Texas Oncology, Houston, TX; Sana Klinikum Offenbach, Offenbach, Germany; British Columbia Cancer Agency, Vancouver, Canada; Aichi Cancer Center Hospital, Chikusa-ku Nagoya, Japan; Massachusetts General Hospital Cancer Center, Boston, MA; Hospital Universitario Ramón y Cajal, Madrid, Spain; Guy's and St Thomas' NHS Foundation Trust and Biomedical Research Centre, King's College London, London, United Kingdom; Hospital Universitari Arnau de Vilanova de Lleida, Lleida, Spain; Hospital Universitario Virgen del Rocio, Seville, Spain; German Breast Group, Neu-Isenburg, Germany; International Drug Development Institute, San Francisco, CA; Institut Gustave Roussy, Villejuif, France; Christ Hospital of Cincinnati, Cincinnati, OH; Compejo Hospitalario Materno Insular de Las Palmas, Las Palmas, Spain; Magna Graecia University, Catan
| | - T Galeano
- Comprehensive Cancer Centre, Medical University of Vienna, Vienna, Austria; Instituto de Investigación Sanitaria Gregorio Marañón, CIBERONC, GEICAM, Universidad Complutense, Madrid, Spain; Texas Oncology, Houston, TX; Sana Klinikum Offenbach, Offenbach, Germany; British Columbia Cancer Agency, Vancouver, Canada; Aichi Cancer Center Hospital, Chikusa-ku Nagoya, Japan; Massachusetts General Hospital Cancer Center, Boston, MA; Hospital Universitario Ramón y Cajal, Madrid, Spain; Guy's and St Thomas' NHS Foundation Trust and Biomedical Research Centre, King's College London, London, United Kingdom; Hospital Universitari Arnau de Vilanova de Lleida, Lleida, Spain; Hospital Universitario Virgen del Rocio, Seville, Spain; German Breast Group, Neu-Isenburg, Germany; International Drug Development Institute, San Francisco, CA; Institut Gustave Roussy, Villejuif, France; Christ Hospital of Cincinnati, Cincinnati, OH; Compejo Hospitalario Materno Insular de Las Palmas, Las Palmas, Spain; Magna Graecia University, Catan
| | - T Fujita
- Comprehensive Cancer Centre, Medical University of Vienna, Vienna, Austria; Instituto de Investigación Sanitaria Gregorio Marañón, CIBERONC, GEICAM, Universidad Complutense, Madrid, Spain; Texas Oncology, Houston, TX; Sana Klinikum Offenbach, Offenbach, Germany; British Columbia Cancer Agency, Vancouver, Canada; Aichi Cancer Center Hospital, Chikusa-ku Nagoya, Japan; Massachusetts General Hospital Cancer Center, Boston, MA; Hospital Universitario Ramón y Cajal, Madrid, Spain; Guy's and St Thomas' NHS Foundation Trust and Biomedical Research Centre, King's College London, London, United Kingdom; Hospital Universitari Arnau de Vilanova de Lleida, Lleida, Spain; Hospital Universitario Virgen del Rocio, Seville, Spain; German Breast Group, Neu-Isenburg, Germany; International Drug Development Institute, San Francisco, CA; Institut Gustave Roussy, Villejuif, France; Christ Hospital of Cincinnati, Cincinnati, OH; Compejo Hospitalario Materno Insular de Las Palmas, Las Palmas, Spain; Magna Graecia University, Catan
| | - A Luczak
- Comprehensive Cancer Centre, Medical University of Vienna, Vienna, Austria; Instituto de Investigación Sanitaria Gregorio Marañón, CIBERONC, GEICAM, Universidad Complutense, Madrid, Spain; Texas Oncology, Houston, TX; Sana Klinikum Offenbach, Offenbach, Germany; British Columbia Cancer Agency, Vancouver, Canada; Aichi Cancer Center Hospital, Chikusa-ku Nagoya, Japan; Massachusetts General Hospital Cancer Center, Boston, MA; Hospital Universitario Ramón y Cajal, Madrid, Spain; Guy's and St Thomas' NHS Foundation Trust and Biomedical Research Centre, King's College London, London, United Kingdom; Hospital Universitari Arnau de Vilanova de Lleida, Lleida, Spain; Hospital Universitario Virgen del Rocio, Seville, Spain; German Breast Group, Neu-Isenburg, Germany; International Drug Development Institute, San Francisco, CA; Institut Gustave Roussy, Villejuif, France; Christ Hospital of Cincinnati, Cincinnati, OH; Compejo Hospitalario Materno Insular de Las Palmas, Las Palmas, Spain; Magna Graecia University, Catan
| | - CH Barrios
- Comprehensive Cancer Centre, Medical University of Vienna, Vienna, Austria; Instituto de Investigación Sanitaria Gregorio Marañón, CIBERONC, GEICAM, Universidad Complutense, Madrid, Spain; Texas Oncology, Houston, TX; Sana Klinikum Offenbach, Offenbach, Germany; British Columbia Cancer Agency, Vancouver, Canada; Aichi Cancer Center Hospital, Chikusa-ku Nagoya, Japan; Massachusetts General Hospital Cancer Center, Boston, MA; Hospital Universitario Ramón y Cajal, Madrid, Spain; Guy's and St Thomas' NHS Foundation Trust and Biomedical Research Centre, King's College London, London, United Kingdom; Hospital Universitari Arnau de Vilanova de Lleida, Lleida, Spain; Hospital Universitario Virgen del Rocio, Seville, Spain; German Breast Group, Neu-Isenburg, Germany; International Drug Development Institute, San Francisco, CA; Institut Gustave Roussy, Villejuif, France; Christ Hospital of Cincinnati, Cincinnati, OH; Compejo Hospitalario Materno Insular de Las Palmas, Las Palmas, Spain; Magna Graecia University, Catan
| | - C Saura
- Comprehensive Cancer Centre, Medical University of Vienna, Vienna, Austria; Instituto de Investigación Sanitaria Gregorio Marañón, CIBERONC, GEICAM, Universidad Complutense, Madrid, Spain; Texas Oncology, Houston, TX; Sana Klinikum Offenbach, Offenbach, Germany; British Columbia Cancer Agency, Vancouver, Canada; Aichi Cancer Center Hospital, Chikusa-ku Nagoya, Japan; Massachusetts General Hospital Cancer Center, Boston, MA; Hospital Universitario Ramón y Cajal, Madrid, Spain; Guy's and St Thomas' NHS Foundation Trust and Biomedical Research Centre, King's College London, London, United Kingdom; Hospital Universitari Arnau de Vilanova de Lleida, Lleida, Spain; Hospital Universitario Virgen del Rocio, Seville, Spain; German Breast Group, Neu-Isenburg, Germany; International Drug Development Institute, San Francisco, CA; Institut Gustave Roussy, Villejuif, France; Christ Hospital of Cincinnati, Cincinnati, OH; Compejo Hospitalario Materno Insular de Las Palmas, Las Palmas, Spain; Magna Graecia University, Catan
| | - HS Rugo
- Comprehensive Cancer Centre, Medical University of Vienna, Vienna, Austria; Instituto de Investigación Sanitaria Gregorio Marañón, CIBERONC, GEICAM, Universidad Complutense, Madrid, Spain; Texas Oncology, Houston, TX; Sana Klinikum Offenbach, Offenbach, Germany; British Columbia Cancer Agency, Vancouver, Canada; Aichi Cancer Center Hospital, Chikusa-ku Nagoya, Japan; Massachusetts General Hospital Cancer Center, Boston, MA; Hospital Universitario Ramón y Cajal, Madrid, Spain; Guy's and St Thomas' NHS Foundation Trust and Biomedical Research Centre, King's College London, London, United Kingdom; Hospital Universitari Arnau de Vilanova de Lleida, Lleida, Spain; Hospital Universitario Virgen del Rocio, Seville, Spain; German Breast Group, Neu-Isenburg, Germany; International Drug Development Institute, San Francisco, CA; Institut Gustave Roussy, Villejuif, France; Christ Hospital of Cincinnati, Cincinnati, OH; Compejo Hospitalario Materno Insular de Las Palmas, Las Palmas, Spain; Magna Graecia University, Catan
| | - J Chien
- Comprehensive Cancer Centre, Medical University of Vienna, Vienna, Austria; Instituto de Investigación Sanitaria Gregorio Marañón, CIBERONC, GEICAM, Universidad Complutense, Madrid, Spain; Texas Oncology, Houston, TX; Sana Klinikum Offenbach, Offenbach, Germany; British Columbia Cancer Agency, Vancouver, Canada; Aichi Cancer Center Hospital, Chikusa-ku Nagoya, Japan; Massachusetts General Hospital Cancer Center, Boston, MA; Hospital Universitario Ramón y Cajal, Madrid, Spain; Guy's and St Thomas' NHS Foundation Trust and Biomedical Research Centre, King's College London, London, United Kingdom; Hospital Universitari Arnau de Vilanova de Lleida, Lleida, Spain; Hospital Universitario Virgen del Rocio, Seville, Spain; German Breast Group, Neu-Isenburg, Germany; International Drug Development Institute, San Francisco, CA; Institut Gustave Roussy, Villejuif, France; Christ Hospital of Cincinnati, Cincinnati, OH; Compejo Hospitalario Materno Insular de Las Palmas, Las Palmas, Spain; Magna Graecia University, Catan
| | - SR Johnston
- Comprehensive Cancer Centre, Medical University of Vienna, Vienna, Austria; Instituto de Investigación Sanitaria Gregorio Marañón, CIBERONC, GEICAM, Universidad Complutense, Madrid, Spain; Texas Oncology, Houston, TX; Sana Klinikum Offenbach, Offenbach, Germany; British Columbia Cancer Agency, Vancouver, Canada; Aichi Cancer Center Hospital, Chikusa-ku Nagoya, Japan; Massachusetts General Hospital Cancer Center, Boston, MA; Hospital Universitario Ramón y Cajal, Madrid, Spain; Guy's and St Thomas' NHS Foundation Trust and Biomedical Research Centre, King's College London, London, United Kingdom; Hospital Universitari Arnau de Vilanova de Lleida, Lleida, Spain; Hospital Universitario Virgen del Rocio, Seville, Spain; German Breast Group, Neu-Isenburg, Germany; International Drug Development Institute, San Francisco, CA; Institut Gustave Roussy, Villejuif, France; Christ Hospital of Cincinnati, Cincinnati, OH; Compejo Hospitalario Materno Insular de Las Palmas, Las Palmas, Spain; Magna Graecia University, Catan
| | - M Spencer
- Comprehensive Cancer Centre, Medical University of Vienna, Vienna, Austria; Instituto de Investigación Sanitaria Gregorio Marañón, CIBERONC, GEICAM, Universidad Complutense, Madrid, Spain; Texas Oncology, Houston, TX; Sana Klinikum Offenbach, Offenbach, Germany; British Columbia Cancer Agency, Vancouver, Canada; Aichi Cancer Center Hospital, Chikusa-ku Nagoya, Japan; Massachusetts General Hospital Cancer Center, Boston, MA; Hospital Universitario Ramón y Cajal, Madrid, Spain; Guy's and St Thomas' NHS Foundation Trust and Biomedical Research Centre, King's College London, London, United Kingdom; Hospital Universitari Arnau de Vilanova de Lleida, Lleida, Spain; Hospital Universitario Virgen del Rocio, Seville, Spain; German Breast Group, Neu-Isenburg, Germany; International Drug Development Institute, San Francisco, CA; Institut Gustave Roussy, Villejuif, France; Christ Hospital of Cincinnati, Cincinnati, OH; Compejo Hospitalario Materno Insular de Las Palmas, Las Palmas, Spain; Magna Graecia University, Catan
| | - F Xu
- Comprehensive Cancer Centre, Medical University of Vienna, Vienna, Austria; Instituto de Investigación Sanitaria Gregorio Marañón, CIBERONC, GEICAM, Universidad Complutense, Madrid, Spain; Texas Oncology, Houston, TX; Sana Klinikum Offenbach, Offenbach, Germany; British Columbia Cancer Agency, Vancouver, Canada; Aichi Cancer Center Hospital, Chikusa-ku Nagoya, Japan; Massachusetts General Hospital Cancer Center, Boston, MA; Hospital Universitario Ramón y Cajal, Madrid, Spain; Guy's and St Thomas' NHS Foundation Trust and Biomedical Research Centre, King's College London, London, United Kingdom; Hospital Universitari Arnau de Vilanova de Lleida, Lleida, Spain; Hospital Universitario Virgen del Rocio, Seville, Spain; German Breast Group, Neu-Isenburg, Germany; International Drug Development Institute, San Francisco, CA; Institut Gustave Roussy, Villejuif, France; Christ Hospital of Cincinnati, Cincinnati, OH; Compejo Hospitalario Materno Insular de Las Palmas, Las Palmas, Spain; Magna Graecia University, Catan
| | - B Barnett
- Comprehensive Cancer Centre, Medical University of Vienna, Vienna, Austria; Instituto de Investigación Sanitaria Gregorio Marañón, CIBERONC, GEICAM, Universidad Complutense, Madrid, Spain; Texas Oncology, Houston, TX; Sana Klinikum Offenbach, Offenbach, Germany; British Columbia Cancer Agency, Vancouver, Canada; Aichi Cancer Center Hospital, Chikusa-ku Nagoya, Japan; Massachusetts General Hospital Cancer Center, Boston, MA; Hospital Universitario Ramón y Cajal, Madrid, Spain; Guy's and St Thomas' NHS Foundation Trust and Biomedical Research Centre, King's College London, London, United Kingdom; Hospital Universitari Arnau de Vilanova de Lleida, Lleida, Spain; Hospital Universitario Virgen del Rocio, Seville, Spain; German Breast Group, Neu-Isenburg, Germany; International Drug Development Institute, San Francisco, CA; Institut Gustave Roussy, Villejuif, France; Christ Hospital of Cincinnati, Cincinnati, OH; Compejo Hospitalario Materno Insular de Las Palmas, Las Palmas, Spain; Magna Graecia University, Catan
| | - A Chan
- Comprehensive Cancer Centre, Medical University of Vienna, Vienna, Austria; Instituto de Investigación Sanitaria Gregorio Marañón, CIBERONC, GEICAM, Universidad Complutense, Madrid, Spain; Texas Oncology, Houston, TX; Sana Klinikum Offenbach, Offenbach, Germany; British Columbia Cancer Agency, Vancouver, Canada; Aichi Cancer Center Hospital, Chikusa-ku Nagoya, Japan; Massachusetts General Hospital Cancer Center, Boston, MA; Hospital Universitario Ramón y Cajal, Madrid, Spain; Guy's and St Thomas' NHS Foundation Trust and Biomedical Research Centre, King's College London, London, United Kingdom; Hospital Universitari Arnau de Vilanova de Lleida, Lleida, Spain; Hospital Universitario Virgen del Rocio, Seville, Spain; German Breast Group, Neu-Isenburg, Germany; International Drug Development Institute, San Francisco, CA; Institut Gustave Roussy, Villejuif, France; Christ Hospital of Cincinnati, Cincinnati, OH; Compejo Hospitalario Materno Insular de Las Palmas, Las Palmas, Spain; Magna Graecia University, Catan
| | - B Ejlertsen
- Comprehensive Cancer Centre, Medical University of Vienna, Vienna, Austria; Instituto de Investigación Sanitaria Gregorio Marañón, CIBERONC, GEICAM, Universidad Complutense, Madrid, Spain; Texas Oncology, Houston, TX; Sana Klinikum Offenbach, Offenbach, Germany; British Columbia Cancer Agency, Vancouver, Canada; Aichi Cancer Center Hospital, Chikusa-ku Nagoya, Japan; Massachusetts General Hospital Cancer Center, Boston, MA; Hospital Universitario Ramón y Cajal, Madrid, Spain; Guy's and St Thomas' NHS Foundation Trust and Biomedical Research Centre, King's College London, London, United Kingdom; Hospital Universitari Arnau de Vilanova de Lleida, Lleida, Spain; Hospital Universitario Virgen del Rocio, Seville, Spain; German Breast Group, Neu-Isenburg, Germany; International Drug Development Institute, San Francisco, CA; Institut Gustave Roussy, Villejuif, France; Christ Hospital of Cincinnati, Cincinnati, OH; Compejo Hospitalario Materno Insular de Las Palmas, Las Palmas, Spain; Magna Graecia University, Catan
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Bhandari M, Wei Ern RL, Majumder C, Ho D. Does the chromagen blue filter lens affect the reading speed, accuracy and contrast sensitivity. Med J Malaysia 2019; 74:30-33. [PMID: 30846659] [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: 06/09/2023]
Abstract
PURPOSE To determine the effects of ChromaGen blue filter lens in reading speed, accuracy and contrast sensitivity. METHODS A cross-over, randomised study was carried out on 40 individuals (11 males and 29 females) aged 21 to 30 years. The rate of reading and reading accuracy was calculated with and without ChromaGen blue filter lens in all subjects. Wilkins Rate of Reading Test was used to measure the rate of reading and reading accuracy. Contrast sensitivity was also evaluated by using with and without the ChromaGen blue filter lens. RESULTS The mean rate of reading with and without ChromaGen blue filter lens was 160.58±16.03 words per minute and 150.52±15.66 words per minute respectively, with significant difference of p<0.001. The mean of reading accuracy (words correctly read per minute) in subjects, with ChromaGen blue filter was 149.30±0.79 words and without using filter lens was 148.53±1.11 words and found to be significant (p<0.001). There was no significant difference in the contrast sensitivity between subjects with and without the ChromaGen blue filter lens (p=0.083). No significant correlation was noted between the reading speed with age, spherical equivalent, contrast sensitivity, and reading accuracy. CONCLUSION This study concludes that there was an increase of 6.68% in the rate of reading and improvement of 0.52% in accuracy among subjects with ChromaGen blue filter lens.
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Affiliation(s)
- M Bhandari
- UCSI University, Taman Connaught, Kuala Lumpur, Malaysia.
| | - R L Wei Ern
- Twintech International University Collage of Technology, Kuala Lumpur, Malaysia
| | - C Majumder
- UCSI University, Taman Connaught, Kuala Lumpur, Malaysia
| | - D Ho
- Twintech International University Collage of Technology, Kuala Lumpur, Malaysia
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Affiliation(s)
- M Bhandari
- Department of Surgery, Division of Orthopaedic Surgery, McMaster University, Hamilton, Canada
| | - D Peterson
- Department of Surgery, Division of Orthopaedic Surgery, McMaster University, Hamilton, Canada
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Abstract
AIMS The aims of this systematic review were to describe the quantity and methodological quality of meta-analyses in orthopaedic surgery published during the last 17 years. MATERIALS AND METHODS MEDLINE, EMBASE, and PubMed, between 1 January 2000 and 31 December 2016, were searched for meta-analyses in orthopaedic surgery dealing with at least one surgical intervention. Meta-analyses were included if the interventions involved a human muscle, ligament, bone or joint. RESULTS A total of 392 meta-analyses met eligibility criteria, for which the mean AMSTAR quality score was 7.1/11. There was a positive correlation between the year of publication and the quality of the meta-analysis (r = 0.238, p < 0.001). Between 2000 and 2011, the mean AMSTAR score corresponded to that of a medium quality review. However, between 2012 and 2016, the mean scores have been consistently equivalent to those of a high-quality review. The number of meta-analyses published increased 10-fold between 2005 and 2014. CONCLUSION The quantity and quality of meta-analyses in orthopaedic surgery which have been published has increased, reaching a plateau in 2012. Methodological flaws remain to be addressed in future meta-analyses in order to continue increasing the quality of the orthopaedic literature. Cite this article: Bone Joint J 2018;100-B:1270-4.
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Affiliation(s)
- A Manta
- Department of Medicine, University of Ottawa, Ottawa, Canada
| | - E Opingari
- Institute of Medical Science, University of Toronto, Toronto, Canada
| | - A Saleh
- Institute of Medical Science, University of Toronto, Toronto, Canada
| | - N Simunovic
- Department of Surgery, Division of Orthopaedic Surgery, McMaster University, Hamilton, Canada
| | - A Duong
- Department of Surgery, Division of Orthopaedic Surgery, McMaster University, Hamilton, Canada
| | - S Sprague
- Department of Surgery, Division of Orthopaedic Surgery, McMaster University, Hamilton, Canada
| | - D Peterson
- Department of Surgery, Division of Orthopaedic Surgery, McMaster University, Hamilton, Canada
| | - M Bhandari
- Department of Health Research Methods, Evidence and Impact and Department of Surgery, Division of Orthopaedic Surgery, McMaster University, Hamilton, Canada
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Gitajn IL, Titus AJ, Tosteson AN, Sprague S, Jeray K, Petrisor B, Swiontkowski M, Bhandari M, Slobogean G. Deficits in preference-based health-related quality of life after complications associated with tibial fracture. Bone Joint J 2018; 100-B:1227-1233. [DOI: 10.1302/0301-620x.100b9.bjj-2017-1488.r1] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Aims The aims of this study were to quantify health state utility values (HSUVs) after a tibial fracture, investigate the effect of complications, to determine the trajectory in HSUVs that result in these differences and to quantify the quality-adjusted life years (QALYs) experienced by patients. Patients and Methods This is an analysis of 2138 tibial fractures enrolled in the Fluid Lavage of Open Wounds (FLOW) and Study to Prospectively Evaluate Reamed Intramedullary Nails in Patients with Tibial Fractures (SPRINT) trials. Patients returned for follow-up at two and six weeks and three, six, nine and 12 months. Short-Form Six-Dimension (SF-6D) values were calculated and used to calculate QALYs. Results Compared with those who did not have a complication, those with a complication treated either nonoperatively or operatively had lower HSUVs at all times after two weeks. The HSUVs improved in all patients with the passage of time. However, they did not return to the remembered baseline preinjury values nor to US age-adjusted normal values by 12 months after the injury. Conclusion While the acute fracture and complications may have resolved clinically, the detrimental effect on a patient’s quality of life persists up to 12 months after the injury. Cite this article: Bone Joint J 2018;100-B:1227–33.
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Affiliation(s)
- I. L. Gitajn
- Department of Orthopaedics, Dartmouth
Hitchcock Medical Center, Lebanon, New
Hampshire, USA
| | - A. J. Titus
- Department of Epidemiology, and Program
in Quantitative Biomedical Sciences, Dartmouth Geisel School of
Medicine, Hanover, New
Hampshire, USA
| | - A. N. Tosteson
- Dartmouth Hitchcock Medical Center, Lebanon, New
Hampshire, USA and The Dartmouth Institute, Dartmouth
Geisel School of Medicine, Hanover, New
Hampshire, USA
| | - S. Sprague
- Division of Orthopaedic Surgery, Department
of Surgery, and Department of Health Research Methods, Evidence
and Impact (HEI), McMaster University, Hamilton, Canada
| | - K. Jeray
- Department of Orthopedic Surgery, Greenville
Health System, Greenville, SC, USA
| | - B. Petrisor
- Division of Orthopaedic Surgery, Department
of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - M. Swiontkowski
- Department of Orthopaedic Surgery, University
of Minnesota, Minneapolis, Minnesota, USA
| | - M. Bhandari
- Division of Orthopaedic Surgery, Department
of Surgery, and Department of Health Research Methods, Evidence
and Impact (HEI), McMaster University, Hamilton, Ontario, Canada
| | - G. Slobogean
- Department of Orthopaedics, University
of Maryland School of Medicine, Baltimore, Maryland, USA
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Morgan LR, Mahmood T, Weiner RS, Kawauchi R, Bhandari M, Devisitty K, Herman J, Summe R, Ware ML, Friedlander P, Rodgers AH. Abstract CT119: Early phase I clinical trial results for 4-demethyl-4-cholesteryloxycarbonylpenclomedine (DM-CHOC-PEN) plus radiation in cancers involving the CNS. Cancer Res 2018. [DOI: 10.1158/1538-7445.am2018-ct119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Purpose:4-Demethyl-4-cholesteryloxycarbonylpenclomedine (DM-CHOC-PEN) is a poly-chlorinated pyridine cholesteryl carbonate with a mechanism of action (MOA) via bis-alkylation of DNA @ N7-guanine and N4-cytosine that has completed Phase I/II studies [AACR, 58, #CT129, 2017] in subjects with cancers involving the CNS. Four (4) subjects in the Phase I/II trials required surgery for persistent CNS lesions following DM-CHOC-PEN therapy and DM-CHOC-PEN was identified in samples from all 4-subjects - 90-212 ng/g tumor [subjects had been treated with 39-98.8 mg/m2 of drug]. Thus, the drug penetrates the CNS and concentrates in tumors. It is available, therefore, to act as a radiosensitizer as demonstrated in in vitro studies [AACR, 58, #4746, 2017]. The current presentation reviews Phase I clinical data that supports the safety, dose-tolerance, and use of DM-CHOC-PEN with radiation in subjects with cancers involving the CNS - IND 68,876.
Patients & Methods: DM-CHOC-PEN was administered as a 3-hr IV infusion once every 21 days to subjects with advanced cancer involving the CNS. A single dose was administered prior to standard radiation therapy. The dose was escalated from 39 mg/m2 to 98.7 mg/m2 I.X1, then 3-weeks later the subject received stereotaxic radio-surgery (SRS) or whole brain irradiation (WBRT). Total radiation administered was 15-30 Gy depending on the size and number of lesions.
Results: Nine (9) subjects with cancer involving the CNS have been treated to date - (6-NSCLC, 1-breast, 1-melanoma & 1-sarcoma). Subjects received 39, 55, 70, 86.8 or 98.7 mg/m2 followed by 15-30 Gy of radiation. The drug/radiation combination was well tolerated. One (1) subject with NSCLC developed vasogenic edema and tumor necrosis which resolved; that subject is in complete remission 31+ mos. Six out of nine subjects have had objective responses (OS 4 - 42+ mos.) Bioavailability for DM-CHOC-PEN revealed a rebound phenomenon @ ~ 50 hours post-infusion with a T-release of 26.7 h. The same phenomenon was observed with RBCs (estimation using Monolix 3.2). DM-CHOC-PEN was detected bound to RBCs for 3-days (after 70 mg/m2); DM-CHOC-PEN was also detected in the urine (Cmax=17.5 µg/mL) until day 15. The AUC was linear for all doses. Pre-clinical in vitro studies supported the clinical data: NSCLC cells treated with DM-CHOC-PEN (0.1 -1.0 µg/mL) demonstrated 50 & 100% cytotoxicity @ 0.4 & 1.0 µg/mL. For radiation alone (6, 9 &12 Gy) - cell kill was 20 & 65% @ 6 & 12 Gy [100% kill was not observed at this dose range]; for DM-CHOC-PEN (0.25 µg/mL) plus radiation (6-12 Gy) - cell kill was 80 & 100% @ 6 & 12 Gy. Photon induced charge transfer reactions with DM-CHOC-PEN will be discussed.
Conclusion: Preliminary data is presented that supports enhanced cytotoxicity and safety of DM-CHOC-PEN plus radiation as therapy for subjects with cancers involving the CNS. Observations during Phase I/II clinical trials with DM-CHOC-PEN alone support the drug's persistent presence in human tumors after systemic administration and possible positive effects on response to subsequent radiation. Complete data on subject responses and observed toxicities will be presented. Supported by - NCI/SBIR grants - R43 CA213545-01 and NIH NIGMS 1 U54 GM104940 - the latter funds the Louisiana Clinical and Translational Science Center.
Citation Format: LR Morgan, T Mahmood, R S. Weiner, R Kawauchi, M Bhandari, K Devisitty, J Herman, R Summe, ML Ware, P Friedlander, AH Rodgers. Early phase I clinical trial results for 4-demethyl-4-cholesteryloxycarbonylpenclomedine (DM-CHOC-PEN) plus radiation in cancers involving the CNS [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr CT119.
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Affiliation(s)
| | - T Mahmood
- 2Detroit Clinical Research Center, Lansing, MI
| | | | - R Kawauchi
- 2Detroit Clinical Research Center, Lansing, MI
| | | | - K Devisitty
- 5Karmanos Cancer Center Institute at McLaren Flint, Flint, MI
| | | | - R Summe
- 4The Christ Hospital, Cincinnati, OH
| | - ML Ware
- 7Ochsner Medical Center, New Orleans, LA
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Sprague S, Bhandari M, Heetveld MJ, Liew S, Scott T, Bzovsky S, Heels-Ansdell D, Zhou Q, Swiontkowski M, Schemitsch EH. Factors associated with health-related quality of life, hip function, and health utility after operative management of femoral neck fractures. Bone Joint J 2018; 100-B:361-369. [PMID: 29589490 DOI: 10.1302/0301-620x.100b3.bjj-2017-0853.r1] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [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] [Indexed: 11/05/2022]
Abstract
Aims The primary aim of this prognostic study was to identify baseline factors associated with physical health-related quality of life (HRQL) in patients after a femoral neck fracture. The secondary aims were to identify baseline factors associated with mental HRQL, hip function, and health utility. Patients and Methods Patients who were enrolled in the Fixation using Alternative Implants for the Treatment of Hip Fractures (FAITH) trial completed the 12-item Short Form Health Survey (SF-12), Western Ontario and McMaster Universities Arthritis Index, and EuroQol 5-Dimension at regular intervals for 24 months. We conducted multilevel mixed models to identify factors potentially associated with HRQL. Results The following were associated with lower physical HRQL: older age (-1.42 for every ten-year increase, 95% confidence interval (CI) -2.17 to -0.67, p < 0.001); female gender (-1.52, 95% CI -3.00 to -0.05, p = 0.04); higher body mass index (-0.69 for every five-point increase, 95% CI -1.36 to -0.02, p = 0.04); American Society of Anesthesiologists class III ( versus class I) (-3.19, 95% CI -5.73 to -0.66, p = 0.01); and sustaining a displaced fracture (-2.18, 95% CI -3.88 to -0.49, p = 0.01). Additional factors were associated with mental HRQL, hip function, and health utility. Conclusion We identified several baseline factors associated with lower HRQL, hip function, and utility after a femoral neck fracture. These findings may be used by clinicians to inform treatment and outcomes. Cite this article: Bone Joint J 2018;100-B:361-9.
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Affiliation(s)
- S Sprague
- Division of Orthopaedic Surgery, Department of Surgery and Department of Health Research Methods, Evidence, and Impact, McMaster University, 293 Wellington Street North, Suite 110, Hamilton, Ontario L8L 8E7, Canada
| | - M Bhandari
- Division of Orthopaedic Surgery, Department of Surgery and Department of Health Research Methods, Evidence, and Impact, McMaster University, 293 Wellington Street North, Suite 110, Hamilton, Ontario L8L 8E7, Canada
| | - M J Heetveld
- Department of Surgery, Spaarne Gasthuis, 999 Vondelweg, Haarlem 2026 BW, The Netherlands
| | - S Liew
- Department of Surgery, Monash University, Level 5, Block E, 246 Clayton Road, Clayton, Victoria 3168, Australia
| | - T Scott
- Department of Health Research Methods, Evidence and Impact, McMaster University, 293 Wellington Street North, Suite 110, Hamilton, Ontario L8L 8E7, Canada
| | - S Bzovsky
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University
| | - D Heels-Ansdell
- Department of Health Research Methods, Evidence and Impact, McMaster University, 293 Wellington Street North, Suite 110, Hamilton, Ontario L8L 8E7, Canada
| | - Q Zhou
- Department of Health Research Methods, Evidence and Impact, McMaster University, 293 Wellington Street North, Suite 110, Hamilton, Ontario L8L 8E7, Canada
| | - M Swiontkowski
- Department of Orthopaedic Surgery, University of Minnesota, 2450 Riverside Avenue South, Suite R200, Minneapolis, Minnesota 55454, USA
| | - E H Schemitsch
- Department of Surgery, University of Western Ontario, 268 Grosvenor Street, Room E3-117, London, Ontario N6A 4V2, Canada
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Abdollah F, Arora S, Jindal T, Gild P, Sood A, Yuvaraja TB, Ahlawat RK, Gupta NP, Bhandari M, Menon M. Utilization of pelvic lymph node dissection in patients undergoing robot-assisted radical prostatectomy in India versus the United States - A Vattikuti Collective Quality Initiative database analysis. Indian J Cancer 2018; 54:421-425. [PMID: 29469070 DOI: 10.4103/ijc.ijc_227_17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND The utilization and extent of pelvic lymph node dissection (PLND) varies depending on the disease and practice patterns. AIMS This study compares practice patterns in utilization of PLND between Indian and United States (US) practices. SETTINGS AND DESIGN We focused on 415 patients (204 India; 211 US) prostate cancer patients treated with robot-assisted radical prostatectomy, between 2015 and 2016, within the Vattikuti Collective Quality Initiative database. SUBJECTS AND METHODS Utilization of PLND and number of nodes removed were evaluated for the entire cohort, and after stratifying for Country of treatment and D'Amico risk groups. Logistic regression tested the relationship between PLND and country of treatment, after adjusting for disease risk. RESULTS Indian patients had a higher risk distribution (D'Amico high-risk 53.4% in India vs. 27% in the US; P< 0.001) compared to their US counterparts. Overall, 193/204 (94.6%) Indian patients underwent PLND versus 181/211 (85.8%) US patients (P = 0.003). When stratified based on disease risk, PLND was performed more frequently in Indian patients with low-risk disease (81.0% vs. 41.4%,P= 0.008), but not in those with intermediate and high-risk disease. On multivariable analysis, Indian patients had a 2.57-fold higher probability of undergoing PLND than their US counterparts (P = 0.02). The analysis of the number of lymph nodes removed showed similar trends. CONCLUSIONS Indian patients are more likely to undergo PLND than US patients. This is, especially true for patients with low-risk disease, who are unlikely to benefit from this procedure. Efforts should focus on optimizing the utilization of PLND, and deliver it only when there is clinical indication.
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Affiliation(s)
- F Abdollah
- Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI, USA
| | - S Arora
- Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI, USA
| | - T Jindal
- Department of Urology and Kidney Transplant, Fortis Escorts Kidney and Urology Institute, New Delhi, India
| | - P Gild
- Department of Urology, University Medical Center, Hamburg-Eppendorf, Hamburg, Germany
| | - A Sood
- Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI, USA
| | - T B Yuvaraja
- Department of Urology, Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Mumbai, Maharashtra, India
| | - R K Ahlawat
- Department of Urology and Kidney Transplant, Fortis Escorts Kidney and Urology Institute, New Delhi, India
| | - N P Gupta
- Department of Urology, Medanta Kidney and Urology Institute, Gurgaon, Haryana, India
| | - M Bhandari
- Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI, USA
| | - M Menon
- Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI, USA
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Sprague S, Petrisor B, Jeray K, McKay P, Heels-Ansdell D, Schemitsch E, Liew S, Guyatt G, Walter SD, Bhandari M. Wound irrigation does not affect health-related quality of life after open fractures: results of a randomized controlled trial. Bone Joint J 2018; 100-B:88-94. [PMID: 29305456 PMCID: PMC6413805 DOI: 10.1302/0301-620x.100b1.bjj-2017-0955.r1] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS The Fluid Lavage in Open Fracture Wounds (FLOW) trial was a multicentre, blinded, randomized controlled trial that used a 2 × 3 factorial design to evaluate the effect of irrigation solution (soap versus normal saline) and irrigation pressure (very low versus low versus high) on health-related quality of life (HRQL) in patients with open fractures. In this study, we used this dataset to ascertain whether these factors affect whether HRQL returns to pre-injury levels at 12-months post-injury. PATIENTS AND METHODS Participants completed the Short Form-12 (SF-12) and the EuroQol-5 Dimensions (EQ-5D) at baseline (pre-injury recall), at two and six weeks, and at three, six, nine and 12-months post-fracture. We calculated the Physical Component Score (PCS) and the Mental Component Score (MCS) of the SF-12 and the EQ-5D utility score, conducted an analysis using a multi-level generalized linear model, and compared differences between the baseline and 12-month scores. RESULTS We found no clinically important differences between irrigating solutions or pressures for the SF-12 PCS, SF-12 MCS and EQ-5D. Irrespective of treatment, participants had not returned to their pre-injury function at 12-months for any of the three outcomes (p < 0.001). CONCLUSION Neither the composition of the irrigation solution nor irrigation pressure applied had an effect on HRQL. Irrespective of treatment, patients had not returned to their pre-injury HRQL at 12 months post-fracture. Cite this article: Bone Joint J 2018;100-B:88-94.
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Affiliation(s)
- S Sprague
- McMaster University, 293 Wellington Street North, Suite 110, Hamilton, Ontario L8L 8E7, Canada
| | - B Petrisor
- McMaster University, 293 Wellington Street North, Suite 110, Hamilton, Ontario L8L 8E7, Canada
| | - K Jeray
- Greenville Health System, 2nd Floor Support Tower, 701 Grove Road, Greenville, South Carolina 29605, USA
| | - P McKay
- McMaster University, 293 Wellington Street North, Suite 110, Hamilton, Ontario L8L 8E7, Canada
| | - D Heels-Ansdell
- McMaster University, 293 Wellington Street North, Suite 110, Hamilton, Ontario L8L 8E7, Canada
| | - E Schemitsch
- University of Western Ontario, 268 Grosvenor Street, Room E3-117, London, Ontario N6A 4V2, Canada
| | - S Liew
- Monash University, Level 5, Block E, 246 Clayton Road, Clayton, Victoria 3168, Australia
| | - G Guyatt
- McMaster University, 293 Wellington Street North, Suite 110, Hamilton, Ontario L8L 8E7, Canada
| | - S D Walter
- McMaster University, 293 Wellington Street North, Suite 110, Hamilton, Ontario L8L 8E7, Canada
| | - M Bhandari
- McMaster University, 293 Wellington Street North, Suite 110, Hamilton, Ontario L8L 8E7, Canada
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Kleinlugtenbelt YV, Krol RG, Bhandari M, Goslings JC, Poolman RW, Scholtes VAB. Are the patient-rated wrist evaluation (PRWE) and the disabilities of the arm, shoulder and hand (DASH) questionnaire used in distal radial fractures truly valid and reliable? Bone Joint Res 2018; 7:36-45. [PMID: 29330342 PMCID: PMC5805831 DOI: 10.1302/2046-3758.71.bjr-2017-0081.r1] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Objectives The patient-rated wrist evaluation (PRWE) and the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire are patient-reported outcome measures (PROMs) used for clinical and research purposes. Methodological high-quality clinimetric studies that determine the measurement properties of these PROMs when used in patients with a distal radial fracture are lacking. This study aimed to validate the PRWE and DASH in Dutch patients with a displaced distal radial fracture (DRF). Methods The intraclass correlation coefficient (ICC) was used for test-retest reliability, between PROMs completed twice with a two-week interval at six to eight months after DRF. Internal consistency was determined using Cronbach’s α for the dimensions found in the factor analysis. The measurement error was expressed by the smallest detectable change (SDC). A semi-structured interview was conducted between eight and 12 weeks after DRF to assess the content validity. Results A total of 119 patients (mean age 58 years (sd 15)), 74% female, completed PROMs at a mean time of six months (sd 1) post-fracture. One overall meaningful dimension was found for the PRWE and the DASH. Internal consistency was excellent for both PROMs (Cronbach’s α 0.96 (PRWE) and 0.97 (DASH)). Test-retest reliability was good for the PRWE (ICC 0.87) and excellent for the DASH (ICC 0.91). The SDC was 20 for the PRWE and 14 for the DASH. No floor or ceiling effects were found. The content validity was good for both questionnaires. Conclusion The PRWE and DASH are valid and reliable PROMs in assessing function and disability in Dutch patients with a displaced DRF. However, due to the high SDC, the PRWE and DASH are less useful for individual patients with a distal radial fracture in clinical practice. Cite this article: Y. V. Kleinlugtenbelt, R. G. Krol, M. Bhandari, J. C. Goslings, R. W. Poolman, V. A. B. Scholtes. Are the patient-rated wrist evaluation (PRWE) and the disabilities of the arm, shoulder and hand (DASH) questionnaire used in distal radial fractures truly valid and reliable? Bone Joint Res 2018;7:36–45. DOI: 10.1302/2046-3758.71.BJR-2017-0081.R1.
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Affiliation(s)
- Y V Kleinlugtenbelt
- Department of Orthopaedic and Trauma Surgery, Joint Research OLVG Oost, PO Box 95500, 1090 HM, Amsterdam, the Netherlands; Department of Orthopaedic and Trauma Surgery, Deventer Ziekenhuis, Nico Bolkesteinlaan 75, 7416 SE Deventer, the Netherlands; and Division of Ortopaedic Surgery, Department of Surgery, McMaster University, 1200 Main St, Hamilton, Ontario L8N 3Z5, Canada
| | - R G Krol
- Department of Orthopaedic and Trauma Surgery, Joint Research OLVG Oost, PO Box 95500, 1090 HM, Amsterdam, The Netherlands
| | - M Bhandari
- Division of Orthopaedic Surgery, McMaster University, 1200 Main St. West, Room 4E17, Hamilton, Ontario L8N 3Z5, Canada
| | - J C Goslings
- Department of Surgery, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - R W Poolman
- Department of Orthopaedic and Trauma Surgery, Joint Research OLVG Oost, PO Box 95500, 1090 HM, Amsterdam, The Netherlands
| | - V A B Scholtes
- Department of Orthopaedic and Trauma Surgery, Joint Research OLVG Oost, PO Box 95500, 1090 HM, Amsterdam, The Netherlands
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Tarride JE, Hopkins RB, Blackhouse G, Burke N, Bhandari M, Johal H, Guyatt GH, Busse JW. Low-intensity pulsed ultrasound for treatment of tibial fractures: an economic evaluation of the TRUST study. Bone Joint J 2017; 99-B:1526-1532. [PMID: 29092994 DOI: 10.1302/0301-620x.99b11.bjj-2017-0737] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [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: 06/13/2017] [Accepted: 07/21/2017] [Indexed: 11/05/2022]
Abstract
AIMS This 501-patient, multi-centre, randomised controlled trial sought to establish the effect of low-intensity, pulsed, ultrasound (LIPUS) on tibial shaft fractures managed with intramedullary nailing. We conducted an economic evaluation as part of this trial. PATIENTS AND METHODS Data for patients' use of post-operative healthcare resources and time taken to return to work were collected and costed using publicly available sources. Health-related quality of life, assessed using the Health Utilities Index Mark-3 (HUI-3), was used to derive quality-adjusted life years (QALYs). Costs and QALYs were compared between LIPUS and control (a placebo device) from a payer and societal perspective using non-parametric bootstrapping. All costs are reported in 2015 Canadian dollars unless otherwise stated. RESULTS With a cost per device of $3,995, the mean cost was significantly higher for patients treated with LIPUS versus placebo from a payer (mean increase = $3647, 95% confidence interval (CI) $3244 to $4070; p < 0.001) or a societal perspective (mean increase = $3425, 95% CI $1568 to $5283; p < 0.001). LIPUS did not provide a significant benefit in terms of QALYs gained (mean difference = 0.023 QALYs, 95% CI -0.035 to 0.069; p = 0.474). Incremental cost-effectiveness ratios of LIPUS compared with placebo were $155 433/QALY from a payer perspective and $146 006/QALY from a societal perspective. CONCLUSION At the current price, LIPUS is not cost-effective for fresh tibial fractures managed with intramedullary nailing. Cite this article: Bone Joint J 2017;99-B:1526-32.
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Affiliation(s)
- J E Tarride
- McMaster University, and Member, Programs for Assessment of Technology in Health (PATH), The Research Institute of St. Joe's Hamilton, St. Joseph's Healthcare Hamilton, 43 Charlton Ave. East, 2nd Floor, Hamilton, Ontario, L8N 1Y3, Canada
| | - R B Hopkins
- McMaster University, and Member, Programs for Assessment of Technology in Health (PATH), The Research Institute of St. Joe's Hamilton, St. Joseph's Healthcare Hamilton, 43 Charlton Ave. East, 2nd Floor, Hamilton, Ontario, L8N 1Y3, Canada
| | - G Blackhouse
- McMaster University, and Member, Programs for Assessment of Technology in Health (PATH), The Research Institute of St. Joe's Hamilton, St. Joseph's Healthcare Hamilton, 43 Charlton Ave. East, 2nd Floor, Hamilton, Ontario, L8N 1Y3, Canada
| | - N Burke
- McMaster University, and Member, Programs for Assessment of Technology in Health (PATH), The Research Institute of St. Joe's Hamilton, St. Joseph's Healthcare Hamilton, 43 Charlton Ave. East, 2nd Floor, Hamilton, Ontario, L8N 1Y3, Canada
| | - M Bhandari
- McMaster University, 293 Wellington St. North, Suite 110, Hamilton, Ontario, L8L 8E7, Canada
| | - H Johal
- McMaster University, 1280 Main Street West, Hamilton, Ontario, L8S 4L8, Canada
| | - G H Guyatt
- McMaster University, 1280 Main Street West, Hamilton, Ontario, L8S 4L8, Canada
| | - J W Busse
- Department of Anesthesia, and Researcher, The Michael G. DeGroote Institute for Pain Research and Care, McMaster University, 1280 Main Street West, Hamilton, Ontario, L8S 4L8, Canada
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Chandramani-Shivalingappa P, Bhandari M, Wiechert SA, Gilbertie J, Jones DE, Sponseller BA. Induction of Reactive Intermediates and Autophagy-Related Proteins upon Infection of Macrophages with Rhodococcus equi. Scientifica (Cairo) 2017; 2017:8135737. [PMID: 29230347 PMCID: PMC5688232 DOI: 10.1155/2017/8135737] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Accepted: 10/01/2017] [Indexed: 06/07/2023]
Abstract
Rhodococcus equi (R. equi) is an intracellular macrophage-tropic pathogen with potential for causing fatal pyogranulomatous pneumonia in foals between 1 and 6 months of age. In this study, we sought to determine whether infection of macrophages with R. equi could lead to the induction of autophagy. Murine bone marrow derived macrophages (BMDM) were infected with R. equi for various time intervals and analyzed for upregulation of autophagy proteins and accumulation of autophagosomes relative to uninfected controls. Western blot analysis showed a progressive increase in LC3-II and Beclin1 levels in a time-dependent manner. The functional accumulation of autophagosomes detected with monodansylcadaverine further supported the enhanced induction of autophagy in BMDM infected with R. equi. In addition, infection of BMDM with R. equi induced generation of reactive oxygen species (ROS) in a time-dependent manner. These data are consistent with reports documenting the role of ROS in induction of autophagy and indicate that the infection of macrophages by R. equi elicits innate host defense mechanisms.
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Affiliation(s)
- Prashanth Chandramani-Shivalingappa
- Department of Veterinary Microbiology and Preventive Medicine, College of Veterinary Medicine, Iowa State University, Ames, IA 50011, USA
- Division of Pulmonary, Critical Care, and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Mahesh Bhandari
- Department of Veterinary Microbiology and Preventive Medicine, College of Veterinary Medicine, Iowa State University, Ames, IA 50011, USA
| | - Sarah A. Wiechert
- Department of Veterinary Microbiology and Preventive Medicine, College of Veterinary Medicine, Iowa State University, Ames, IA 50011, USA
| | - Jessica Gilbertie
- Department of Veterinary Microbiology and Preventive Medicine, College of Veterinary Medicine, Iowa State University, Ames, IA 50011, USA
| | - Douglas E. Jones
- Department of Veterinary Pathology, College of Veterinary Medicine, Iowa State University, Ames, IA 50011, USA
| | - Brett A. Sponseller
- Department of Veterinary Microbiology and Preventive Medicine, College of Veterinary Medicine, Iowa State University, Ames, IA 50011, USA
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Iowa State University, Ames, IA 50011, USA
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Weiner RS, Morgan LR, Mahmood T, Kawauchi R, Gordon C, Ware ML, Matrana M, Cosgriff TM, Rodgers AH, Bastian G, Bhandari M, Zou JJ. Abstract CT052: Clinical trial results for 4-demethyl-4-cholesteryloxycarbonylpenclomedine (DM-CHOC-PEN) in cancers involving the CNS. Cancer Res 2017. [DOI: 10.1158/1538-7445.am2017-ct052] [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: 4-Demethyl-4-cholesteryloxycarbonylpenclomedine (DM-CHOC-PEN) is a poly-chlorinated pyridine cholesteryl carbonate with a MOA via bis-alkylation of DNA @ N7-guanine and N4-cytosine that has completed Phase I and II trials (the latter on subjects with CNS involvement) [AACR #1185, 2013; AACR #CT 129]. The primary aim was to assess clinical response and secondary aims to monitor toxicities/safety and verify the MTDs for IV administered DM-CHOC-PEN that derived in Phase I study (IND 68,876). We report here the responses and toxicities seen in all the subjects treated.
Subjects & Methods: In Phase I, DM-CHOC-PEN was administered as a 3-hr IV infusion once every 21 days to subjects with advanced cancer; cohorts received escalating doses from 39 - 111 mg/m2. The Phase II dose schedule was 2-tiered: 85.8 mg/m2 for subjects with liver involvement and 98.7 mg/m2 for subjects with normal livers.
Results: Fifty two (52) subjects have been treated to date - 25 in Phase I (cancer subjects with or without CNS involvement) and 27 in Phase II (with CNS involvement). The common tumor types treated were primary brain cancers and melanoma, breast, and lung cancers involving the CNS. The drug was well tolerated; the most common adverse effects were fatigue (17%), reversible liver dysfunction (9%) and nausea (11%). No neuro/psychological, hematological, cardiac or renal toxicities were observed. PK modeling revealed that AUCs were parallel for all dose levels (39-111 mg/m2). The Cmax for DM-CHOC-PEN and DM-PEN (4-demethylpenclomedine, a metabolite) were 3 and 24 hours, respectively. Both DM-CHOC-PEN and DM-PEN were detected 3 to 15 days after administration associated (up to 50%) with rbcs. Of interest, young adults (<40 y/o) demonstrated significant increases in Cmax and AUC vs. older subjects, supporting the need for trials in adolescents and young adults. DM-CHOC-PEN was also detected in CNS tumor tissue obtained surgically from five (5) subjects - in concentrations of 75-210 ng/g, 22 days to 9 mos. post treatments at doses of 39 or 98.7 mg/m2 of drug. To date, 16 subjects with lung cancer (11 with NSCLC involving the CNS) have been treated. Seven of the 11 subjects with NSCLC involving the CNS (incl. 6 with cerebellar disease) have responded with CR/PR (RECIST 1.1) and improved OS/QOL/PFS (Kaplan-Meier) lasting 8+ - 32+ mos. Conclusion: DM-CHOC-PEN is safe at these dose levels and has produced objective responses with manageable toxicities in subjects with cancer involving the CNS. Complete data on subject responses and observed toxicities will be presented. We propose a 3-stage mechanism for drug entry into the CNS and into NSCLC cells via reversible binding with RBCs and then associated with L-glutamine transport into cells. Supported by NCI/SBIR grants - R43/44CA132257 and NIH NIGMS 1 U54 GM104940 - the latter funds the Louisiana Clinical and Translational Science Center.
Citation Format: Roy S. Weiner, Lee Roy Morgan, T Mahmood, R. Kawauchi, C. Gordon, ML Ware, M. Matrana, TM Cosgriff, AH Rodgers, G. Bastian, M. Bhandari, J-J Zou. Clinical trial results for 4-demethyl-4-cholesteryloxycarbonylpenclomedine (DM-CHOC-PEN) in cancers involving the CNS [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr CT052. doi:10.1158/1538-7445.AM2017-CT052
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Affiliation(s)
| | | | - T Mahmood
- 3Detroit Clinical Research Center, Lansing, MI
| | - R. Kawauchi
- 3Detroit Clinical Research Center, Lansing, MI
| | - C. Gordon
- 4Detroit Clinical Research Center, Farmington Hills, MI
| | - ML Ware
- 5Ochsner Medical Center, New Orleans, LA
| | - M. Matrana
- 5Ochsner Medical Center, New Orleans, LA
| | - TM Cosgriff
- 6East Jefferson General Hospital, Metairie, LA
| | | | - G. Bastian
- 7University of New Orleans, New Orleans, LA
| | | | - J-J Zou
- 9University of Texas Health Science Center/Herman Hospital, Houston, TX
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Gandhi A, Bhandari M, Sharma D, Julka P, Rath G. PO-0633: Randomized study of adjuvant temozolomide (6 vs.12 cycle) in newly diagnosed glioblastoma multiforme. Radiother Oncol 2017. [DOI: 10.1016/s0167-8140(17)31070-8] [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: 11/28/2022]
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Kleinlugtenbelt YV, Madden K, Groen SR, Ham SJ, Kloen P, Haverlag R, Simons MP, Bhandari M, Goslings JC, Scholtes VAB, Poolman RW. Can experienced surgeons predict the additional value of a CT scan in patients with displaced intra-articular distal radius fractures? Strategies Trauma Limb Reconstr 2017; 12:91-97. [PMID: 28439818 PMCID: PMC5505880 DOI: 10.1007/s11751-017-0283-9] [Citation(s) in RCA: 3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Accepted: 04/03/2017] [Indexed: 11/29/2022] Open
Abstract
There are no clear guidelines when an additional CT scan should be obtained for the treatment of displaced intra-articular distal radius fractures (DRF). This study aimed to investigate whether surgeons can predict the usefulness of CT scans to facilitate choice of treatment plan and/or pre-operative planning for DRF. Four surgeons evaluated 51 patients with displaced DRF. The choice of treatment (operative or nonoperative) was based on conventional radiographs. Subsequently, the surgeons were asked whether they would have requested an additional CT scan to determine this treatment choice, and also whether they required a CT scan for pre-operative planning. After 4 weeks, the additional CT scan was provided and the cases were assessed again. Based on these data, we calculated the number needed to scan (NNS) and number needed to harm (NNH) for two decision models. Model 1: Only provide a CT scan if the surgeon requested one based on their judgment of the X-rays. Model 2: CT scans for all displaced intra-articular DRF. For choice of treatment, the NNS was lower for model 1 than for model 2 (2.6 vs. 4.3) and the NNH is higher for model 1 (3.1 vs. 1.3). For pre-operative planning, the NNS (1.3 vs. 1.4) and NNH (3.7 vs. 3.4) were comparable for both models. Surgeons are able to predict the usefulness of an additional CT scan for intra-articular displaced DRF for OR indication. However, for pre-operative planning the usefulness of a CT scan is much harder to predict.
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Affiliation(s)
- Y V Kleinlugtenbelt
- Department of Orthopaedic and Trauma Surgery, Joint Research OLVG, Oosterpark 9, P.O. Box 95500, 1090 HM, Amsterdam, The Netherlands. .,Department of Orthopaedic and Trauma Surgery, Deventer Ziekenhuis, Nico Bolkesteinlaan 75, 7416 SE, Deventer, The Netherlands. .,Division of Orthopaedic Surgery, McMaster University, 293 Wellington St N Suite 110, Hamilton, ON, L8L 8E7, Canada.
| | - K Madden
- Division of Orthopaedic Surgery, McMaster University, 293 Wellington St N Suite 110, Hamilton, ON, L8L 8E7, Canada
| | - S R Groen
- Department of Orthopaedic and Trauma Surgery, Joint Research OLVG, Oosterpark 9, P.O. Box 95500, 1090 HM, Amsterdam, The Netherlands
| | - S J Ham
- Department of Orthopaedic and Trauma Surgery, Joint Research OLVG, Oosterpark 9, P.O. Box 95500, 1090 HM, Amsterdam, The Netherlands
| | - P Kloen
- Department of Orthopaedic and Trauma Surgery, Academic Medical Centre, P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands
| | - R Haverlag
- Department of General and Trauma Surgery, OLVG, Oosterpark 9, P.O. Box 95500, 1090 HM, Amsterdam, The Netherlands
| | - M P Simons
- Department of General and Trauma Surgery, OLVG, Oosterpark 9, P.O. Box 95500, 1090 HM, Amsterdam, The Netherlands
| | - M Bhandari
- Division of Orthopaedic Surgery, McMaster University, 293 Wellington St N Suite 110, Hamilton, ON, L8L 8E7, Canada
| | - J C Goslings
- Trauma Unit, Department of Surgery, Academic Medical Center, University of Amsterdam, P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands
| | - V A B Scholtes
- Department of Orthopaedic and Trauma Surgery, Joint Research OLVG, Oosterpark 9, P.O. Box 95500, 1090 HM, Amsterdam, The Netherlands
| | - R W Poolman
- Department of Orthopaedic and Trauma Surgery, Joint Research OLVG, Oosterpark 9, P.O. Box 95500, 1090 HM, Amsterdam, The Netherlands
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Bhandari M, Vora P, Dugar A, Bhati S, DeFranco A, Guenther E. PO-151: Immunotherapy for refractory brain metastasis in cases of oropharangeal squamous cell carcinoma. Radiother Oncol 2017. [DOI: 10.1016/s0167-8140(17)30285-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Bhandari M, Dugar A. Nivolumab immunotherapy in malignant mesothelioma. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw525.27] [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: 11/14/2022] Open
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Nuttall J, Evaniew N, Thornley P, Griffin A, Deheshi B, O'Shea T, Wunder J, Ferguson P, Randall RL, Turcotte R, Schneider P, McKay P, Bhandari M, Ghert M. The inter-rater reliability of the diagnosis of surgical site infection in the context of a clinical trial. Bone Joint Res 2016; 5:347-52. [PMID: 27528711 PMCID: PMC5013894 DOI: 10.1302/2046-3758.58.bjr-2016-0036.r1] [Citation(s) in RCA: 4] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Accepted: 06/07/2016] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES The diagnosis of surgical site infection following endoprosthetic reconstruction for bone tumours is frequently a subjective diagnosis. Large clinical trials use blinded Central Adjudication Committees (CACs) to minimise the variability and bias associated with assessing a clinical outcome. The aim of this study was to determine the level of inter-rater and intra-rater agreement in the diagnosis of surgical site infection in the context of a clinical trial. MATERIALS AND METHODS The Prophylactic Antibiotic Regimens in Tumour Surgery (PARITY) trial CAC adjudicated 29 non-PARITY cases of lower extremity endoprosthetic reconstruction. The CAC members classified each case according to the Centers for Disease Control (CDC) criteria for surgical site infection (superficial, deep, or organ space). Combinatorial analysis was used to calculate the smallest CAC panel size required to maximise agreement. A final meeting was held to establish a consensus. RESULTS Full or near consensus was reached in 20 of the 29 cases. The Fleiss kappa value was calculated as 0.44 (95% confidence interval (CI) 0.35 to 0.53), or moderate agreement. The greatest statistical agreement was observed in the outcome of no infection, 0.61 (95% CI 0.49 to 0.72, substantial agreement). Panelists reached a full consensus in 12 of 29 cases and near consensus in five of 29 cases when CDC criteria were used (superficial, deep or organ space). A stable maximum Fleiss kappa of 0.46 (95% CI 0.50 to 0.35) at CAC sizes greater than three members was obtained. CONCLUSIONS There is substantial agreement among the members of the PARITY CAC regarding the presence or absence of surgical site infection. Agreement on the level of infection, however, is more challenging. Additional clinical information routinely collected by the prospective PARITY trial may improve the discriminatory capacity of the CAC in the parent study for the diagnosis of infection.Cite this article: J. Nuttall, N. Evaniew, P. Thornley, A. Griffin, B. Deheshi, T. O'Shea, J. Wunder, P. Ferguson, R. L. Randall, R. Turcotte, P. Schneider, P. McKay, M. Bhandari, M. Ghert. The inter-rater reliability of the diagnosis of surgical site infection in the context of a clinical trial. Bone Joint Res 2016;5:347-352. DOI: 10.1302/2046-3758.58.BJR-2016-0036.R1.
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Affiliation(s)
- J Nuttall
- Orthopaedic Resident, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - N Evaniew
- Orthopaedic Resident, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - P Thornley
- Orthopaedic Resident, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - A Griffin
- University Musculoskeletal Oncology Unit
- Mount Sinai Hospital, Toronto, Ontario, Canada
| | - B Deheshi
- Department of Surgery, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - T O'Shea
- Department of Medicine, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - J Wunder
- University of Toronto, Toronto, Ontario, Canada
| | - P Ferguson
- Division of Orthopaedic Surgery, University of Toronto, 600 University Avenue, Suite 476(G)
- Toronto, M5G 1X5, Canada
| | - R L Randall
- Department of Orthopaedics, University of Utah, 2000 Circle of Hope, Suite 4260
- Salt Lake City, 84112-5550, USA
| | - R Turcotte
- Division of Orthopaedic Surgery, McGill University, Montreal General Hospital, 1650 Cedar Avenue, Room B5.159.6, Montreal, QC, H3G 1A4, Canada
| | - P Schneider
- Department of Clinical Epidemiology and Biostatistics, McMaster University, 293 Wellington Street North, Suite 110, Hamilton, ON, L8L 8E7, Canada
| | - P McKay
- Department of Clinical Epidemiology and Biostatistics, McMaster University, 293 Wellington Street North, Suite 110, Hamilton, ON, L8L 8E7, Canada
| | - M Bhandari
- Department of Clinical Epidemiology and Biostatistics and Department of Surgery, McMaster University, 293 Wellington Street North, Suite 110
- Hamilton, ON, L8L 8E7, Canada
| | - M Ghert
- Department of Surgery, McMaster University, 711 Concession Street, Surgical Offices B3 169A, Hamilton, ON, L8V 1C3, Canada
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Abstract
Objectives Despite the fact that research fraud and misconduct are under scrutiny in the field of orthopaedic research, little systematic work has been done to uncover and characterise the underlying reasons for academic retractions in this field. The purpose of this study was to determine the rate of retractions and identify the reasons for retracted publications in the orthopaedic literature. Methods Two reviewers independently searched MEDLINE, EMBASE, and the Cochrane Library (1995 to current) using MeSH keyword headings and the ‘retracted’ filter. We also searched an independent website that reports and archives retracted scientific publications (www.retractionwatch.com). Two reviewers independently extracted data including reason for retraction, study type, journal impact factor, and country of origin. Results One hundred and ten retracted studies were included for data extraction. The retracted studies were published in journals with impact factors ranging from 0.000 (discontinued journals) to 13.262. In the 20-year search window, only 25 papers were retracted in the first ten years, with the remaining 85 papers retracted in the most recent decade. The most common reasons for retraction were fraudulent data (29), plagiarism (25) and duplicate publication (20). Retracted articles have been cited up to 165 times (median 6; interquartile range 2 to 19). Conclusion The rate of retractions in the orthopaedic literature is increasing, with the majority of retractions attributed to academic misconduct and fraud. Orthopaedic retractions originate from numerous journals and countries, indicating that misconduct issues are widespread. The results of this study highlight the need to address academic integrity when training the next generation of orthopaedic investigators. Cite this article: J. Yan, A. MacDonald, L-P. Baisi, N. Evaniew, M. Bhandari, M. Ghert. Retractions in orthopaedic research: A systematic review. Bone Joint Res 2016;5:263–268. DOI: 10.1302/2046-3758.56.BJR-2016-0047.
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Affiliation(s)
- J Yan
- Department of Surgery, McMaster University, Division of Orthopaedics, HGH 8N06, 237 Barton Street East, Hamilton, ON, L8L 2X2, Canada
| | - A MacDonald
- Michael G. Degroote School of Medicine, 1280 Main St. W., Hamilton, ON, L8S 4K1, Canada
| | - L-P Baisi
- Department of Surgery, McMaster University, Division of Orthopaedics, HGH 8N06, 237 Barton Street East, Hamilton, ON, L8L 2X2, Canada
| | - N Evaniew
- Department of Surgery, McMaster University, Division of Orthopaedics, 293 Wellington St N, Suite 110, Hamilton ON, L8L 8E7, Canada
| | - M Bhandari
- Department of Surgery, McMaster University, Division of Orthopaedics, 293 Wellington St N, Suite 110, Hamilton ON, L8L 8E7, Canada
| | - M Ghert
- Department of Surgery, Juravinski Cancer Centre, McMaster University, Division of Orthopaedics, 711 Concession Street, Level B3 Surgical offices, Hamilton, Ontario, L8V 1C3, Canada
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