1
|
Wieland CM, Tuin AM, Dort EJ, Hall AG, Krishnan M, Velagapudi M. Long-Term Survival Rates and Treatment Trends of Burkitt Lymphoma in Patients with HIV-A National Cancer Database (NCDB) Study. Cancers (Basel) 2024; 16:1397. [PMID: 38611075 PMCID: PMC11011134 DOI: 10.3390/cancers16071397] [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: 02/17/2024] [Revised: 03/30/2024] [Accepted: 03/31/2024] [Indexed: 04/14/2024] Open
Abstract
BACKGROUND Burkitt lymphoma (BL) accounts for 10-35% of AIDS-defining lymphoma in people with HIV (PWH). Previous research consisting of smaller cohorts has shown decreased survival for HIV-associated BL. This study aims to compare overall mortality in BL patients with and without HIV, while investigating impact of treatment modalities in HIV-associated BL. METHODS Using the 2004-2019 NCDB, we identified 4312 patients with stage 3 or 4 BL who had a known HIV status and received either chemotherapy alone or chemotherapy and immunotherapy. Time to death was evaluated using Kaplan-Meier survival estimates. Risk of death was evaluated using an extended multivariable Cox model adjusted for multiple factors and with a Heaviside function for HIV status by time period (0-3 month vs. 3-60 month). RESULTS Of the 4312 patients included, 1514 (35%) had HIV. For months 0-3 from time of diagnosis, HIV status was not associated with a statistically significant increase in risk of death (HR = 1.04, 95% CI: 0.86, 1.26, p = 0.6648). From month 3to 60, positive HIV status was associated with a 55% increase in risk of death compared to those without HIV (95% CI: 1.38, 1.75, p < 0.0001). Further, this difference in hazard rates (0-3 vs. 3-60) was statistically significant (HR = 1.49, 95% CI: 1.22-1.82, p < 0.001). CONCLUSIONS There is an increased mortality rate from months 3 to 60 in BL patients with HIV compared to patients without HIV. Additionally, risk of death in the first 3 months is significantly decreased by 45% in patients with HIV treated with combination chemotherapy and immunotherapy compared to patients without HIV receiving combination chemotherapy and immunotherapy, providing valuable clinical insight into treatment decision making in the care of HIV-associated BL.
Collapse
Affiliation(s)
- Clare M. Wieland
- School of Medicine, Creighton University, Omaha, NE 68178, USA; (C.M.W.); (A.M.T.); (E.J.D.)
| | - Ashley M. Tuin
- School of Medicine, Creighton University, Omaha, NE 68178, USA; (C.M.W.); (A.M.T.); (E.J.D.)
| | - Elizabeth J. Dort
- School of Medicine, Creighton University, Omaha, NE 68178, USA; (C.M.W.); (A.M.T.); (E.J.D.)
| | - Alexander G. Hall
- Department of Clinical Research & Public Health, School of Medicine, Creighton University, Omaha, NE 68178, USA;
| | - Mridula Krishnan
- Division of Hematology/Oncology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE 68198, USA;
| | - Manasa Velagapudi
- Division of Infectious Diseases, Department of Internal Medicine, School of Medicine, Creighton University, CHI Health, Omaha, NE 68124, USA
| |
Collapse
|
2
|
Krishnan M, Agarwal P, Pinninti R, Rajappa S. Global inequalities in availability of systemic therapies for cancer care and strategies to address them. J Surg Oncol 2023; 128:1038-1044. [PMID: 37818905 DOI: 10.1002/jso.27439] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 08/27/2023] [Indexed: 10/13/2023]
Abstract
Many Low and middle-income countries face challenges in delivering chemotherapy services due to limitations in infrastructure, inadequate healthcare facilities, and a shortage of trained medical professionals. High-income countries often have well-developed healthcare systems and advanced technology.
Collapse
Affiliation(s)
- Mridula Krishnan
- Division of Hematology and Oncology, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Priyal Agarwal
- Division of Hematology and Oncology, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Rakesh Pinninti
- Basavatarakam Indo American Cancer Hospital & RI, Hyderabad, Telangana, India
| | - Senthil Rajappa
- Basavatarakam Indo American Cancer Hospital & RI, Hyderabad, Telangana, India
| |
Collapse
|
3
|
Leiphrakpam PD, Rajappa SJ, Krishnan M, Batra R, Murthy SS, Are C. Colorectal cancer: Review of signaling pathways and associated therapeutic strategies. J Surg Oncol 2023; 127:1277-1295. [PMID: 37222698 DOI: 10.1002/jso.27295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 04/12/2023] [Indexed: 05/25/2023]
Abstract
Tumor profiling and targeted therapy revolutionized the treatment strategies of metastatic colorectal cancer (mCRC) in the last decade. The heterogeneity of CRC tumors plays a critical role in the development of treatment resistance, which underscores the need to understand the molecular mechanism involved in CRC to develop novel targeted therapeutic strategies. This review provides an overview of the signaling pathways driving CRC, the existing targeted agents, their limitations, and future trends.
Collapse
Affiliation(s)
- Premila D Leiphrakpam
- Graduate Medical Education, College of Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USA
- Department of Surgery, Division of Surgical Oncology, College of Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Senthil J Rajappa
- Medical Oncology, Basavatarakam Indo-American Cancer Hospital, Hyderabad, Telangana, India
| | - Mridula Krishnan
- Department of Internal Medicine, Division of Oncology & Hematology, College of Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Rishi Batra
- Department of Surgery, Division of General Surgery, College of Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Shilpa S Murthy
- Global Cancer Disparities Initiative, Division of Surgical Oncology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Chandrakanth Are
- Graduate Medical Education, College of Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USA
- Department of Surgery, Division of Surgical Oncology, College of Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USA
| |
Collapse
|
4
|
Patel J, Mahana I, Lam P, Hofmeyer M, Rao S, Kadakkal A, Afari-Armah N, Krishnan M, Molina E, Najjar S, Sheikh F, Rodrigo M, Gupta R. Calcineurin Inhibitor-Induced Atypical Hemolytic Uremic Syndrome after Heart Transplantation. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.505] [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: 04/05/2023] Open
|
5
|
Fahey H, Sheikh F, Afari-Armah N, Lam P, Hofmeyer M, Kadakkal A, Gupta R, Najjar S, Krishnan M, Rodrigo M, Cellamare M, Zhang C, Elliott T, Glocker S, Rice J, Balsara K, Alassar A, Rao S. The Interaction of Nutritional Status and Body Mass Index on Outcomes after LVAD Implantation. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.777] [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: 04/05/2023] Open
|
6
|
Gupta R, Bermudez F, Vora T, Kadakkal A, Afari-Armah N, Rao S, Lam P, Rodrigo M, Hofmeyer M, Krishnan M, Fajardo J, Najjar S, Sheikh F. Surveillance Imaging and Management of Cardiac Sarcoidosis after Advanced Heart Failure Therapies. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.512] [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: 04/05/2023] Open
|
7
|
Brown M, Lekan A, Hofmeyer M, Rodrigo M, Kadakkal A, Lam P, Krishnan M, Afari-Armah N, Rao S, Gupta R, Alassar A, Molina E, Sheikh F. Hemodynamic Effects of Intra-Aortic Balloon Pump as a Bridge to Durable Left Ventricular Assist Device. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.1054] [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: 04/05/2023] Open
|
8
|
Krishnan M, Ganesan V. Impurity metallic conduction below the critical concentration of metal-insulator transition in Fe1-xCo xSi. J Phys Condens Matter 2023; 35:185601. [PMID: 36854195 DOI: 10.1088/1361-648x/acbffe] [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] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 02/28/2023] [Indexed: 06/18/2023]
Abstract
Analysis on very detailed measurements of resistivity (ρ) and thermoelectric power (S) of magnetic impurity (Co) substituted iron silicide (FeSi) has been presented in this report. The impurity valence electrons of Co dominate the whole physical properties at low temperatures below 35 K, below the critical concentrationxc(≈0.02). The negative thermopower and the positive slope in the resistivity at low temperatures are exciting and show that the system is not entirely insulator below the critical concentration of metal-insulator transition (xc). So, due to the external impurity electrons, the system's magnetic ground state could change considerably compared to the parent compound FeSi. This report may help unveil the interesting low-temperature transport properties betweenx= 0 andx= 0.04 (Fe1-xCoxSi). Two band model and variable range hopping model were employed to explain the low-temperature electrical and thermal transport properties.
Collapse
Affiliation(s)
- M Krishnan
- UGC-DAE Consortium for Scientific Research, University Campus, Khandwa Road, Indore 452 001, India
| | - V Ganesan
- UGC-DAE Consortium for Scientific Research, University Campus, Khandwa Road, Indore 452 001, India
- Medi-Caps University, AB Road, Pigdamber, Rau, Indore (MP) 453331, India
| |
Collapse
|
9
|
Krishnan M. Immunogenicity of Esophagogastric Cancers: What Is in Line. JCO Oncol Pract 2023; 19:125-126. [PMID: 36763920 DOI: 10.1200/op.22.00844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023] Open
|
10
|
Krishnan M. The Evolving Landscape of Pancreatic Cancer. JCO Oncol Pract 2023; 19:35-36. [PMID: 36354334 DOI: 10.1200/op.22.00636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
|
11
|
Affiliation(s)
- S Babu
- Faculty of Allied Health Sciences, Chettinad Hospital and Research Institute, Chettinad Academy of Research and Education, Kelambakkam, 603103 Tamil Nadu, India
| | - M Krishnan
- Faculty of Allied Health Sciences, Chettinad Hospital and Research Institute, Chettinad Academy of Research and Education, Kelambakkam, 603103 Tamil Nadu, India
| | - M Chinnaiyan
- Department of Otolaryngology, University of Oklahoma Health Sciences Center, Oklahoma City 73104, USA
| | - P Daniel
- Department of Medical Biochemistry, Dr. A.L.M PG Institute of Basic Medical Sciences, University of Madras, Chennai, Tamil Nadu 600113, India
- Department of Biochemistry, Tagore Dental College and Hospital, Chennai, Tamil Nadu 600127, India
| | - A Solomon
- Department of Mental Health Nursing, Saveetha College of Nursing, Saveetha Institute of Medical and Technical Sciences, Chennai, Tamil Nadu 602105, India
| |
Collapse
|
12
|
Krishnan M, Babu S, Jayaraman S, Daniel P, Solomon A, Chinnaiyan M. MICRORNA-31 AS A POTENTIAL THERAPEUTIC BIOMARKER FOR ORAL SQUAMOUS CELL CARCINOMA: CURRENT EVIDENCE AND FUTURE PROSPECTS. Exp Oncol 2022; 44:263-264. [PMID: 36325699 DOI: 10.32471/exp-oncology.2312-8852.vol-44-no-3.18569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Affiliation(s)
- M Krishnan
- Faculty of Allied Health Sciences, Chettinad Hospital and Research Institute, Chettinad Academy of Research and Education, Chengalpattu District, Tamil Nadu 603103, India
| | - S Babu
- Faculty of Allied Health Sciences, Chettinad Hospital and Research Institute, Chettinad Academy of Research and Education, Chengalpattu District, Tamil Nadu 603103, India
| | - S Jayaraman
- Centre of Molecular Medicine and Diagnostics (COMManD), Department Biochemistry
| | - P Daniel
- Department of Medical Biochemistry, Dr. A.L.M PG Institute of Basic Medical Sciences, University of Madras, Chennai, Tamil Nadu 600113, India
- Department of Biochemistry, Tagore Dental College and Hospital, Chennai, Tamil Nadu 600127, India
| | - A Solomon
- Department of Mental Health Nursing, Saveetha College of Nursing, Saveetha Institute of Medical and Technical Sciences, Chennai, Tamil Nadu 602105, India
| | - M Chinnaiyan
- Department of Otolaryngology, University of Oklahoma Health Sciences Center, Oklahoma City 73104, USA
| |
Collapse
|
13
|
Abodunrin F, Adeoye O, Krishnan M, Silberstein PT, Tupper C. Socioeconomic disparities in the receipt of palliative care in biliary tract cancers. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.28_suppl.080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
80 Background: Biliary tract cancers are tumors arising from epithelial cells lining the biliary tract including the intrahepatic bile duct, extrahepatic bile duct, gall bladder, and ampulla of Vater. The incidence of biliary tract cancers has over the years. While there have been several advances in the diagnosis and treatment of biliary tract cancers, palliative treatment remains important in the management of these cancers. This study aims to analyze the patterns associated with the receipt of palliative care in patients with biliary tract cancers. Methods: We conducted a retrospective review of 150,007 patients in the National Cancer Database diagnosed with biliary tract cancer between 2004-2018 using ICD-O3 codes. Chi-square tests were used to assess the differences between palliative care recipients and non-recipients. Logistic regression was used to assess which variables influence the likelihood of receiving palliative care. Statistical analyses were performed using SPSS. Results: The overall palliative care utilization amongst patients with biliary tract cancers was 13%. The use of palliative care in biliary tract cancers gradually increased over the years. Patients with gall bladder cancers were less likely to receive palliative care than those with intra-hepatic biliary duct cancers (OR 0.60 p < 0.001). Our study also found significant differences in the utilization of palliative care based on race. Blacks were less likely to use palliative care than whites (OR 0.89 p = 0.001). Hispanic patients were less likely to utilize palliative care than whites (OR 0.70 95% CI 0.64-0.76). There was no statistically significant difference between the use of PC between Whites and Asians (OR 1.04 95% CI 0.95-1.13 p < 0.441). Privately insured patients were less likely to receive palliative care than uninsured patients (OR 0.88 p = 0.029). There were no statistically significant differences between the receipt of palliative care in uninsured patients and Medicare or Medicaid patients (OR 0.98 p = 0.69; OR 1.00 p = 0.93). Patients belonging to households with a median income (> $63,333) were less likely to receive palliative care than those in low-income (< $40,000) household (OR 0.67 p < 0.001). There was an increased likelihood of receiving palliative care in patients from communities with higher educational status. Patients who received treatment at academic/research programs were more likely to receive palliative care than those at community cancer programs (OR 1.18 95% CI 1.08-1.29). Conclusions: Our study identified disparities in the receipt of palliative care in biliary tract cancers based on socioeconomic status. Blacks and Hispanics were less likely to receive palliative care than whites. Interestingly, uninsured patients were more likely to receive palliative care than privately insured patients. As part of quality improvement, future research should address the drivers behind these reported disparities.
Collapse
Affiliation(s)
- Faith Abodunrin
- Department of Internal Medicine, Creighton University School of Medicine, Omaha, NE
| | | | | | | | | |
Collapse
|
14
|
Marar R, Prathivadhi-Bhayankaram S, Krishnan M. Immune Checkpoint Inhibitor-Induced Hemophagocytic Lymphohistiocytosis in a Patient With Squamous Cell Carcinoma. J Hematol 2022; 11:142-147. [PMID: 36118548 PMCID: PMC9451547 DOI: 10.14740/jh1033] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 08/22/2022] [Indexed: 11/11/2022] Open
Abstract
Programmed cell death protein 1 (PD-1) checkpoint inhibitors such as pembrolizumab are novel therapeutics used to treat various advanced malignancies and have been shown to increase patient survival in several studies. However, these drugs have a toxicity profile that ranges from mild side effects such as dermatitis to life-threatening complications. We present a case of pembrolizumab-induced hemophagocytic lymphohistiocytosis (HLH) in an 80-year-old patient with squamous cell carcinoma (SCC) of presumed cutaneous primary. This patient initially presented with weakness and pancytopenia, thought to be immune-related. She developed progressive anemia, after which further workup revealed concern for HLH. She recovered after a course of steroids, tocilizumab, and etoposide. To our knowledge, this patient’s course is among a few rare cases of immune checkpoint inhibitor (ICI)-mediated HLH. This case highlights the need for early diagnosis and recognition of HLH as a potential toxicity related to ICI therapy.
Collapse
Affiliation(s)
- Rosalyn Marar
- Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE 68198, USA
- Corresponding Author: Rosalyn Isam Marar, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE 68198, USA.
| | | | - Mridula Krishnan
- Division of Oncology and Hematology, University of Nebraska Medical Center, Omaha, NE 68198, USA
| |
Collapse
|
15
|
Krishnan M, Babu SC. Covid-19 Opens up domestic market for Indian shrimp. Aquaculture 2022; 550:737818. [PMID: 34924635 PMCID: PMC8667464 DOI: 10.1016/j.aquaculture.2021.737818] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 11/08/2021] [Accepted: 12/09/2021] [Indexed: 05/17/2023]
Abstract
COVID-19 pandemic presents both a challenge and an opportunity to the Indian shrimp sector. With revitalizing the institutional arrangements and redirecting the focus, the Indian shrimp industry can flourish just by adapting to the needs of the local demand, even when the export prospects are uncertain. This paper takes a historical perspective of Indian shrimp farming and exports and suggests a domestic alternative/supplementary market for Indian farmed shrimp, resulting from COVID-19.
Collapse
Affiliation(s)
- M Krishnan
- State Level Project Advisory Committee for Marine Resources, Andhra Pradesh, India
| | | |
Collapse
|
16
|
Krishnan M, Bociek RG, Fanale M, Iyer SP, Lechowicz MJ, Bierman PJ, Armitage JO, Lunning M, Kallam A, Vose JM. Phase 1 trial of carfilzomib in relapsed/refractory peripheral T-cell lymphoma. Ann Hematol 2021; 101:335-340. [PMID: 34668982 DOI: 10.1007/s00277-021-04692-9] [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: 09/25/2021] [Accepted: 09/30/2021] [Indexed: 11/24/2022]
Abstract
Peripheral T-cell lymphomas (PTCL) are a unique subset of lymphomas with a poor prognosis due to limited treatment options. We performed a phase 1 study of carfilzomib in patients with relapsed/refractory PTCL to determine the safety profile and the maximum tolerated dose (MTD) of this agent. The study was a classical 3 + 3 phase 1 design with intra-patient dose escalation allowed beginning on day 8 of cycle 1 and subsequently. Dose-limiting toxicity (DLT) was defined as the occurrence of any grade 3/4 adverse event. Carfilzomib was given on days 1, 2, 8, 9, 15, and 16 of a 28-day cycle. Fifteen patients were enrolled from 3 centers. The median age of patients was 62. The median number of prior therapies for subjects on this trial was five. The MTD of carfilzomib was 36 mg/m2. Dose-limiting toxicities included anemia and sepsis. Serious adverse events were seen in 45% of patients. Single-agent carfilzomib leads to a complete response in one patient and a partial response in one patient. Overall, the drug was reasonably tolerated for a heavily pretreated population, but the limited response rate and short duration of response demonstrate a lack of promise for carfilzomib as a single agent in this patient population.
Collapse
Affiliation(s)
- Mridula Krishnan
- Division of Hematology/Oncology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE, USA.
| | - R Gregory Bociek
- Division of Hematology/Oncology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE, USA
| | - Michelle Fanale
- Department of Lymphoma/Multiple Myeloma, MD Anderson Cancer Center, Houston, TX, USA
| | - Swaminathan P Iyer
- Department of Lymphoma/Multiple Myeloma, MD Anderson Cancer Center, Houston, TX, USA
| | | | - Philip J Bierman
- Division of Hematology/Oncology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE, USA
| | - James O Armitage
- Division of Hematology/Oncology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE, USA
| | - Matthew Lunning
- Division of Hematology/Oncology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE, USA
| | - Avyakta Kallam
- Division of Hematology/Oncology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE, USA
| | - Julie M Vose
- Division of Hematology/Oncology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE, USA
| |
Collapse
|
17
|
Thompson N, Hampton T, Everett S, Krishnan M. 1103 How to Report Noise in The Operating Theatre. Br J Surg 2021. [DOI: 10.1093/bjs/znab259.599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Introduction
The reporting of operating theatre noise in the surgical literature dates back almost 50 years. The existing standards for noise and sound reporting in healthcare settings is heterogenous and there is a need for greater uniformity of reporting to support our growing understanding of the significance of communication and human factors on surgical performance.
Method
This presentation summarizes the existing Surgical and Acoustic Engineering industrial expertise to provide a narrative review of literature, grey reports and guidelines and then demonstrates appropriate reporting standards during Noise level recording in an operating theatre environment.
Results
We describe LAmax, LA90and LAeq expected levels. We compare our own theatre noise levels against these recommended standards for comparison. This presentation also suggests a suitable “ambient noise” (LAeq 65dB) level over which any communication devices or communication studies should benchmark when developing interventions to overcome noise in the operating theatre.
Conclusions
This paper proposes possible unified reporting standards and expected sound pressure levels against which future studies in this field could benchmark.
Collapse
Affiliation(s)
- N Thompson
- Alder Hey Children's Hospital, Liverpool, United Kingdom
| | - T Hampton
- Alder Hey Children's Hospital, Liverpool, United Kingdom
| | - S Everett
- Alder Hey Children's Hospital, Liverpool, United Kingdom
| | - M Krishnan
- Alder Hey Children's Hospital, Liverpool, United Kingdom
| |
Collapse
|
18
|
Krishnan M, Kasinath P, High R, Yu F, Teply BA. Impact of Performance Status on Response and Survival Among Patients Receiving Checkpoint Inhibitors for Advanced Solid Tumors. JCO Oncol Pract 2021; 18:e175-e182. [PMID: 34351819 DOI: 10.1200/op.20.01055] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Clinical trials, which led to the approval of immune checkpoint inhibitors (ICI), have been almost exclusively performed in patients with good Eastern Cooperative Oncology Group performance status (ECOG PS of 0-1). However, ICI remains an attractive option for patients with advanced tumors and poor PS. We hypothesized that patients with ECOG PS ≥ 2 would have worse outcomes with ICI. METHODS We retrospectively identified patients with advanced solid tumors who were treated with ICI at our institution. The log-rank test compared the survival among patients with different ECOG PS. We used a proportional hazards model to assess association between ECOG PS and overall survival (OS) with adjustment for covariates including age, sex, malignancy type, time from advance disease diagnosis, and line of therapy. We compared overall response rates between groups with Pearson chi-square exact test. We also analyzed in-hospital mortality and hospice referral rates. RESULTS We identified 257 patients treated with ICI. One hundred eighty-two patients had ECOG PS 0-1, and 75 had ECOG PS ≥ 2. The median overall survival was 12.6 months for the ECOG PS 0-1 group compared with 3.1 months for the ECOG PS ≥ 2 group (P < .001). The overall response rate for patients with ECOG PS 0-1 was 23% compared with 8% for those with poor PS (P = .005). Patients with poor PS treated with ICI had similar hospice referral rates (67% for ECOG PS ≥ 2 v 61.9% for ECOG PS 0-1, P = .50) but were more likely to have in-hospital death as compared with the good PS group (28.6% v 15.1%, P = .035). CONCLUSION Despite the appeal of ICI in patients with advanced malignancy and poor PS, outcomes in this cohort were poor. Prospective trials defining the activity and role of ICI in poor PS are urgently needed.
Collapse
Affiliation(s)
- Mridula Krishnan
- Division of Hematology Oncology, University of Nebraska Medical Center, Omaha, NE
| | | | - Robin High
- Department of Biostatistics, University of Nebraska Medical Center, College of Public Health, Omaha, NE
| | - Fang Yu
- Department of Biostatistics, University of Nebraska Medical Center, College of Public Health, Omaha, NE
| | - Benjamin A Teply
- Division of Hematology Oncology, University of Nebraska Medical Center, Omaha, NE
| |
Collapse
|
19
|
Abughanimeh OK, Sharma S, High R, Krishnan M, Teply BA. Can patients with advanced malignancy and poor performance status benefit from nivolumab plus ipilimumab as a palliative treatment? J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.12028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
12028 Background: Performance status (e.g. Eastern Cooperative Oncology Group [ECOG] score) is a predictive tool used to determine whether a patient may benefit from cytotoxic chemotherapy. The toxicity profile of immunotherapy is different, and less is known about whether performance status (PS) is similarly associated with toxicity and benefit. Nonetheless, most clinical trials for immune checkpoint inhibitors have excluded patients with poor PS. Emerging data by our group and others has linked poor PS with lack of response and decreased survival with anti-PD-1/L1 agents, but whether combination therapy abrogates the poor outcomes of PD1 only therapy is unknown. Methods: We conducted a retrospective cohort study of patients with metastatic cancer who received ipilimumab plus nivolumab at our institution between January 2014-December 2020. We compared outcomes between those with good PS (Group A, ECOG PS 0-1) and poor PS (Group B, ECOG PS ≥ 2). Our primary outcomes were overall survival (OS) and incidence of grade 3-4 immune-related adverse events (irAEs). Other outcomes included objective response rates and need for hospitalization. We utilized the Kaplan-Meyer method for time to survival analysis and exact Pearson Chi-squared testing for response, toxicity, and hospitalization analysis. Results: A total of 129 patients were identified with a mean age of 59.9 years. Among them were 73 males (57%) and 56 females (43%). Malignant melanoma was the most common malignancy (39%) followed by renal cell carcinoma (27%), small cell lung cancers (10%), non-small cell lung cancers (9%), and the rest with other histologies. 113 patients (87.6%) were in group A and 16 (12.4%) in group B. Across all tumor types, patients in Group B had significantly worse OS compared to group A (HR 0.24 [0.13-0.48], P = < 0.0001). Group B similarly had higher rates of hospitalization compared to group A (94% vs 56%, P = 0.0048). Interestingly, irAEs were not driving these hospitalizations, with a trend toward lower rates of irAEs in the poor PS group (19% vs 46% in Group A, P = 0.057). The overall response rate in group B was numerically lower (6% vs 26% in group A, p = 0.1). Conclusions: Our study showed that using ipilimumab plus nivolumab in patients with poor PS was associated with significantly poorer OS and higher rates of hospitalizations. irAEs were not increased in the poor PS group, suggesting a lack of treatment efficacy seemed to driving these poor outcomes. Extrapolation of clinical trial data for ipilimumab-nivolumab to a broader population including those with poor PS should be done with caution. Unfortunately, our data showed that most patients with poor PS were not adequately palliated with ipilimumab-nivolumab.
Collapse
Affiliation(s)
| | | | - Robin High
- University of Nebraska Medical Center, Omaha, NE
| | | | | |
Collapse
|
20
|
Hampton T, Everett S, Sharma S, Krishnan M. Noise in the operating theatre. Br J Surg 2021; 108:e203-e204. [PMID: 33655291 PMCID: PMC8159175 DOI: 10.1093/bjs/znab059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 01/19/2021] [Accepted: 01/26/2021] [Indexed: 12/01/2022]
Affiliation(s)
- T Hampton
- Ear, Nose and Throat Department, Alder Hey Children's NHS Foundation Trust, Liverpool, UK.,University of Liverpool, Liverpool, UK
| | - S Everett
- Acoustic Engineering, Hydrock, Manchester, UK
| | - S Sharma
- Ear, Nose and Throat Department, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - M Krishnan
- Ear, Nose and Throat Department, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| |
Collapse
|
21
|
Krishnan M, Teply BA. Anticipating the Next Challenging Clinical Dilemmas in Prostate Cancer. JCO Oncol Pract 2020; 16:791-792. [PMID: 33301697 DOI: 10.1200/op.20.00908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Mridula Krishnan
- Division of Hematology/Oncology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE
| | - Benjamin A Teply
- Division of Hematology/Oncology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE
| |
Collapse
|
22
|
Abstract
Hepatosplenic γ-δ T-cell lymphoma, an exceptionally uncommon subtype of peripheral T-cell lymphomas, commonly presents with advanced-stage disease manifesting with hepatosplenomegaly, cytopenias, and constitutional symptoms. Management of this subset is challenging as a result of the unique presentation and refractory nature to conventional treatment approaches. There is a lack of consensus guidelines for up-front induction strategies, and the role of consolidative autologous or allogeneic stem-cell transplantation is controversial. Prospective studies are lacking, and treatment is often guided by literature on the basis of case series or single-institution studies, lending to expert opinions influencing treatment paradigms.
Collapse
Affiliation(s)
- Mridula Krishnan
- 1 Fred and Pamela Buffett Cancer Center, University of Nebraska Medical Center, Omaha, NE
| | - Matthew Lunning
- 1 Fred and Pamela Buffett Cancer Center, University of Nebraska Medical Center, Omaha, NE
| |
Collapse
|
23
|
Krishnan M, Teply BA, Yu F, High R. Impact of performance status on response and survival among patients receiving checkpoint inhibitors for advanced solid tumors. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.12028] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
12028 Background: Clinical trials leading to the approval of immune checkpoint inhibition (ICI) have almost exclusively been performed in patients with good performance status (ECOG PS of 0-1). However, ICI remains an attractive option for patients with advanced tumors and poor performance status, considering their overall tolerability. While use of ICI in patients with poor PS (ECOG PS of 2 or greater) has been rapidly adopted, whether these patients derive the same benefits as expected in the studied populations is largely unknown. We therefore performed an institutional retrospective analysis of all patients treated with palliative single agent anti-PD1 or anti-PDL1 to determine response and survival for those with poor performance status. Methods: We retrospectively identified patients with advanced solid tumor malignancies who were treated with ICI monotherapy with palliative intent at our institution between 2015-2019. The primary objective was to compare overall survival (OS) for patients with good PS (ECOG PS 0-1) with those with poor PS (ECOG PS 2 or 3-4). The log-rank test compared the survival among patients with different ECOG PS. In addition, we used a proportional hazards model to assess association between ECOG PS and the OS with adjustment for age, gender, and smoking status. A secondary objective was to compare overall response rates (ORR) of the three ECOG PS groups which were evaluated with a binary rate model. Results: We identified 266 patients treated with ICI, 87 with NSCLC, 34 with melanoma, 33 with RCC, 24 with bladder cancer, 22 with head/neck cancer, and the rest with other histologies. 187 (70%) were ECOG PS 0-1, 62 (23%) were ECOG PS 2, and 17 (7%) were ECOG PS 3-4. 89 of these patients (33%) were still alive at time of last follow-up. Across all tumor types, patients with ECOG PS 0-1 had superior survival compared to ECOG PS 2 (median survival 12.4 months vs 4.6 months, HR 0.41, p < 0.001). Median survival for ECOG PS 3-4 was lower at 2.3 months. The ORR for ECOG PS 0-1 (23%) was significantly higher to that of ECOG PS 2 (6%, p = 0.02). ORR for ECOG PS 3-4 was 12%. Conclusions: Despite the appeal of ICI for patients with advanced malignancy and poor performance status, outcomes were poor. Survival and objective response rates for patients with ECOG PS 2 and higher were significantly worse than those with ECOG PS 0-1. ICI treatment comes with cost, including potentially forgoing early hospice referral or optimal support at the end of life. Prospective trials defining the activity and role of ICI in poor PS are urgently needed.
Collapse
Affiliation(s)
| | | | - Fang Yu
- University of Nebraska Medical Center, Omaha, NE
| | - Robin High
- University of Nebraska Medical Center, Omaha, NE
| |
Collapse
|
24
|
Aprà E, Bylaska EJ, de Jong WA, Govind N, Kowalski K, Straatsma TP, Valiev M, van Dam HJJ, Alexeev Y, Anchell J, Anisimov V, Aquino FW, Atta-Fynn R, Autschbach J, Bauman NP, Becca JC, Bernholdt DE, Bhaskaran-Nair K, Bogatko S, Borowski P, Boschen J, Brabec J, Bruner A, Cauët E, Chen Y, Chuev GN, Cramer CJ, Daily J, Deegan MJO, Dunning TH, Dupuis M, Dyall KG, Fann GI, Fischer SA, Fonari A, Früchtl H, Gagliardi L, Garza J, Gawande N, Ghosh S, Glaesemann K, Götz AW, Hammond J, Helms V, Hermes ED, Hirao K, Hirata S, Jacquelin M, Jensen L, Johnson BG, Jónsson H, Kendall RA, Klemm M, Kobayashi R, Konkov V, Krishnamoorthy S, Krishnan M, Lin Z, Lins RD, Littlefield RJ, Logsdail AJ, Lopata K, Ma W, Marenich AV, Martin Del Campo J, Mejia-Rodriguez D, Moore JE, Mullin JM, Nakajima T, Nascimento DR, Nichols JA, Nichols PJ, Nieplocha J, Otero-de-la-Roza A, Palmer B, Panyala A, Pirojsirikul T, Peng B, Peverati R, Pittner J, Pollack L, Richard RM, Sadayappan P, Schatz GC, Shelton WA, Silverstein DW, Smith DMA, Soares TA, Song D, Swart M, Taylor HL, Thomas GS, Tipparaju V, Truhlar DG, Tsemekhman K, Van Voorhis T, Vázquez-Mayagoitia Á, Verma P, Villa O, Vishnu A, Vogiatzis KD, Wang D, Weare JH, Williamson MJ, Windus TL, Woliński K, Wong AT, Wu Q, Yang C, Yu Q, Zacharias M, Zhang Z, Zhao Y, Harrison RJ. NWChem: Past, present, and future. J Chem Phys 2020; 152:184102. [PMID: 32414274 DOI: 10.1063/5.0004997] [Citation(s) in RCA: 275] [Impact Index Per Article: 68.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Specialized computational chemistry packages have permanently reshaped the landscape of chemical and materials science by providing tools to support and guide experimental efforts and for the prediction of atomistic and electronic properties. In this regard, electronic structure packages have played a special role by using first-principle-driven methodologies to model complex chemical and materials processes. Over the past few decades, the rapid development of computing technologies and the tremendous increase in computational power have offered a unique chance to study complex transformations using sophisticated and predictive many-body techniques that describe correlated behavior of electrons in molecular and condensed phase systems at different levels of theory. In enabling these simulations, novel parallel algorithms have been able to take advantage of computational resources to address the polynomial scaling of electronic structure methods. In this paper, we briefly review the NWChem computational chemistry suite, including its history, design principles, parallel tools, current capabilities, outreach, and outlook.
Collapse
Affiliation(s)
- E Aprà
- Pacific Northwest National Laboratory, Richland, Washington 99352, USA
| | - E J Bylaska
- Pacific Northwest National Laboratory, Richland, Washington 99352, USA
| | - W A de Jong
- Lawrence Berkeley National Laboratory, Berkeley, California 94720, USA
| | - N Govind
- Pacific Northwest National Laboratory, Richland, Washington 99352, USA
| | - K Kowalski
- Pacific Northwest National Laboratory, Richland, Washington 99352, USA
| | - T P Straatsma
- National Center for Computational Sciences, Oak Ridge National Laboratory, Oak Ridge, Tennessee 37831, USA
| | - M Valiev
- Pacific Northwest National Laboratory, Richland, Washington 99352, USA
| | - H J J van Dam
- Brookhaven National Laboratory, Upton, New York 11973, USA
| | - Y Alexeev
- Argonne Leadership Computing Facility, Argonne National Laboratory, Argonne, Illinois 60439, USA
| | - J Anchell
- Intel Corporation, Santa Clara, California 95054, USA
| | - V Anisimov
- Argonne Leadership Computing Facility, Argonne National Laboratory, Argonne, Illinois 60439, USA
| | - F W Aquino
- QSimulate, Cambridge, Massachusetts 02139, USA
| | - R Atta-Fynn
- Department of Physics, The University of Texas at Arlington, Arlington, Texas 76019, USA
| | - J Autschbach
- Department of Chemistry, University at Buffalo, State University of New York, Buffalo, New York 14260, USA
| | - N P Bauman
- Pacific Northwest National Laboratory, Richland, Washington 99352, USA
| | - J C Becca
- Department of Chemistry, The Pennsylvania State University, University Park, Pennsylvania 16802, USA
| | - D E Bernholdt
- Oak Ridge National Laboratory, Oak Ridge, Tennessee 37831, USA
| | | | - S Bogatko
- 4G Clinical, Wellesley, Massachusetts 02481, USA
| | - P Borowski
- Faculty of Chemistry, Maria Curie-Skłodowska University in Lublin, 20-031 Lublin, Poland
| | - J Boschen
- Department of Chemistry, Iowa State University, Ames, Iowa 50011, USA
| | - J Brabec
- J. Heyrovský Institute of Physical Chemistry, Academy of Sciences of the Czech Republic, 18223 Prague 8, Czech Republic
| | - A Bruner
- Department of Chemistry and Physics, University of Tennessee at Martin, Martin, Tennessee 38238, USA
| | - E Cauët
- Service de Chimie Quantique et Photophysique (CP 160/09), Université libre de Bruxelles, B-1050 Brussels, Belgium
| | - Y Chen
- Facebook, Menlo Park, California 94025, USA
| | - G N Chuev
- Institute of Theoretical and Experimental Biophysics, Russian Academy of Science, Pushchino, Moscow Region 142290, Russia
| | - C J Cramer
- Department of Chemistry, Chemical Theory Center, and Supercomputing Institute, University of Minnesota, Minneapolis, Minnesota 55455, USA
| | - J Daily
- Pacific Northwest National Laboratory, Richland, Washington 99352, USA
| | - M J O Deegan
- SKAO, Jodrell Bank Observatory, Macclesfield SK11 9DL, United Kingdom
| | - T H Dunning
- Department of Chemistry, University of Washington, Seattle, Washington 98195, USA
| | - M Dupuis
- Department of Chemistry, University at Buffalo, State University of New York, Buffalo, New York 14260, USA
| | - K G Dyall
- Dirac Solutions, Portland, Oregon 97229, USA
| | - G I Fann
- Oak Ridge National Laboratory, Oak Ridge, Tennessee 37831, USA
| | - S A Fischer
- Chemistry Division, U. S. Naval Research Laboratory, Washington, DC 20375, USA
| | - A Fonari
- School of Chemistry and Biochemistry, Georgia Institute of Technology, Atlanta, Georgia 30332, USA
| | - H Früchtl
- EaStCHEM and School of Chemistry, University of St. Andrews, St. Andrews KY16 9ST, United Kingdom
| | - L Gagliardi
- Department of Chemistry, Chemical Theory Center, and Supercomputing Institute, University of Minnesota, Minneapolis, Minnesota 55455, USA
| | - J Garza
- Departamento de Química, División de Ciencias Básicas e Ingeniería, Universidad Autónoma Metropolitana-Iztapalapa, Col. Vicentina, Iztapalapa, C.P. 09340 Ciudad de México, Mexico
| | - N Gawande
- Pacific Northwest National Laboratory, Richland, Washington 99352, USA
| | - S Ghosh
- Department of Chemistry, Chemical Theory Center, and Supercomputing Institute, University of Minnesota, Minneapolis, Minnesota 5545, USA
| | - K Glaesemann
- Pacific Northwest National Laboratory, Richland, Washington 99352, USA
| | - A W Götz
- San Diego Supercomputer Center, University of California, San Diego, La Jolla, California 92093, USA
| | - J Hammond
- Intel Corporation, Santa Clara, California 95054, USA
| | - V Helms
- Center for Bioinformatics, Saarland University, D-66041 Saarbrücken, Germany
| | - E D Hermes
- Combustion Research Facility, Sandia National Laboratories, Livermore, California 94551, USA
| | - K Hirao
- Next-generation Molecular Theory Unit, Advanced Science Institute, RIKEN, Saitama 351-0198, Japan
| | - S Hirata
- Department of Chemistry, University of Illinois at Urbana-Champaign, Urbana, Illinois 61801, USA
| | - M Jacquelin
- Lawrence Berkeley National Laboratory, Berkeley, California 94720, USA
| | - L Jensen
- Department of Chemistry, The Pennsylvania State University, University Park, Pennsylvania 16802, USA
| | - B G Johnson
- Acrobatiq, Pittsburgh, Pennsylvania 15206, USA
| | - H Jónsson
- Faculty of Physical Sciences, University of Iceland, Reykjavík, Iceland and Department of Applied Physics, Aalto University, FI-00076 Aalto, Espoo, Finland
| | - R A Kendall
- Oak Ridge National Laboratory, Oak Ridge, Tennessee 37831, USA
| | - M Klemm
- Intel Corporation, Santa Clara, California 95054, USA
| | - R Kobayashi
- ANU Supercomputer Facility, Australian National University, Canberra, Australia
| | - V Konkov
- Chemistry Program, Florida Institute of Technology, Melbourne, Florida 32901, USA
| | - S Krishnamoorthy
- Pacific Northwest National Laboratory, Richland, Washington 99352, USA
| | - M Krishnan
- Facebook, Menlo Park, California 94025, USA
| | - Z Lin
- Department of Physics, University of Science and Technology of China, Hefei, China
| | - R D Lins
- Aggeu Magalhaes Institute, Oswaldo Cruz Foundation, Recife, Brazil
| | | | - A J Logsdail
- Cardiff Catalysis Institute, School of Chemistry, Cardiff University, Cardiff, Wales CF10 3AT, United Kingdom
| | - K Lopata
- Department of Chemistry, Louisiana State University, Baton Rouge, Louisiana 70803, USA
| | - W Ma
- Institute of Software, Chinese Academy of Sciences, Beijing, China
| | - A V Marenich
- Department of Chemistry, Chemical Theory Center, and Supercomputing Institute, University of Minnesota, Minneapolis, Minnesota 55455, USA
| | - J Martin Del Campo
- Departamento de Física y Química Teórica, Facultad de Química, Universidad Nacional Autónoma de México, México City, Mexico
| | - D Mejia-Rodriguez
- Quantum Theory Project, Department of Physics, University of Florida, Gainesville, Florida 32611, USA
| | - J E Moore
- Intel Corporation, Santa Clara, California 95054, USA
| | - J M Mullin
- DCI-Solutions, Aberdeen Proving Ground, Maryland 21005, USA
| | - T Nakajima
- Computational Molecular Science Research Team, RIKEN Center for Computational Science, Kobe, Hyogo 650-0047, Japan
| | - D R Nascimento
- Pacific Northwest National Laboratory, Richland, Washington 99352, USA
| | - J A Nichols
- Oak Ridge National Laboratory, Oak Ridge, Tennessee 37831, USA
| | - P J Nichols
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
| | - J Nieplocha
- Pacific Northwest National Laboratory, Richland, Washington 99352, USA
| | - A Otero-de-la-Roza
- Departamento de Química Física y Analítica, Facultad de Química, Universidad de Oviedo, 33006 Oviedo, Spain
| | - B Palmer
- Pacific Northwest National Laboratory, Richland, Washington 99352, USA
| | - A Panyala
- Pacific Northwest National Laboratory, Richland, Washington 99352, USA
| | - T Pirojsirikul
- Department of Chemistry, Prince of Songkla University, Hat Yai, Songkhla 90112, Thailand
| | - B Peng
- Pacific Northwest National Laboratory, Richland, Washington 99352, USA
| | - R Peverati
- Chemistry Program, Florida Institute of Technology, Melbourne, Florida 32901, USA
| | - J Pittner
- J. Heyrovský Institute of Physical Chemistry, Academy of Sciences of the Czech Republic, v.v.i., 18223 Prague 8, Czech Republic
| | - L Pollack
- StudyPoint, Boston, Massachusetts 02114, USA
| | | | - P Sadayappan
- School of Computing, University of Utah, Salt Lake City, Utah 84112, USA
| | - G C Schatz
- Department of Chemistry, Northwestern University, Evanston, Illinois 60208, USA
| | - W A Shelton
- Cain Department of Chemical Engineering, Louisiana State University, Baton Rouge, Louisiana 70803, USA
| | | | - D M A Smith
- Intel Corporation, Santa Clara, California 95054, USA
| | - T A Soares
- Dept. of Fundamental Chemistry, Universidade Federal de Pernambuco, Recife, Brazil
| | - D Song
- Pacific Northwest National Laboratory, Richland, Washington 99352, USA
| | - M Swart
- ICREA, 08010 Barcelona, Spain and Universitat Girona, Institut de Química Computacional i Catàlisi, Campus Montilivi, 17003 Girona, Spain
| | - H L Taylor
- CD-adapco/Siemens, Melville, New York 11747, USA
| | - G S Thomas
- Pacific Northwest National Laboratory, Richland, Washington 99352, USA
| | - V Tipparaju
- Cray Inc., Bloomington, Minnesota 55425, USA
| | - D G Truhlar
- Department of Chemistry, Chemical Theory Center, and Supercomputing Institute, University of Minnesota, Minneapolis, Minnesota 55455, USA
| | | | - T Van Voorhis
- Department of Chemistry, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, USA
| | - Á Vázquez-Mayagoitia
- Argonne Leadership Computing Facility, Argonne National Laboratory, Argonne, Illinois 60439, USA
| | - P Verma
- 1QBit, Vancouver, British Columbia V6E 4B1, Canada
| | - O Villa
- NVIDIA, Santa Clara, California 95051, USA
| | - A Vishnu
- Pacific Northwest National Laboratory, Richland, Washington 99352, USA
| | - K D Vogiatzis
- Department of Chemistry, University of Tennessee, Knoxville, Tennessee 37996, USA
| | - D Wang
- College of Physics and Electronics, Shandong Normal University, Jinan, Shandong 250014, China
| | - J H Weare
- Department of Chemistry and Biochemistry, University of California San Diego, La Jolla, California 92093, USA
| | - M J Williamson
- Department of Chemistry, Cambridge University, Lensfield Road, Cambridge CB2 1EW, United Kingdom
| | - T L Windus
- Department of Chemistry, Iowa State University and Ames Laboratory, Ames, Iowa 50011, USA
| | - K Woliński
- Faculty of Chemistry, Maria Curie-Skłodowska University in Lublin, 20-031 Lublin, Poland
| | - A T Wong
- Qwil, San Francisco, California 94107, USA
| | - Q Wu
- Brookhaven National Laboratory, Upton, New York 11973, USA
| | - C Yang
- Lawrence Berkeley National Laboratory, Berkeley, California 94720, USA
| | - Q Yu
- AMD, Santa Clara, California 95054, USA
| | - M Zacharias
- Department of Physics, Technical University of Munich, 85748 Garching, Germany
| | - Z Zhang
- Stanford Research Computing Center, Stanford University, Stanford, California 94305, USA
| | - Y Zhao
- State Key Laboratory of Silicate Materials for Architectures, International School of Materials Science and Engineering, Wuhan University of Technology, Wuhan 430070, China
| | - R J Harrison
- Institute for Advanced Computational Science, Stony Brook University, Stony Brook, New York 11794, USA
| |
Collapse
|
25
|
Krishnan M, Ganesan V. Unconventional impurity band conduction and carrier dynamics in Ni substituted FeSi. J Phys Condens Matter 2020; 32:335602. [PMID: 32289768 DOI: 10.1088/1361-648x/ab88f6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Analysis of the resistivity, thermoelectric power, and heat capacity of Fe1-x Ni x Si is presented in this report. In-spite of Ni having two extra valence electrons as compared to Fe, the physical properties are observed to be dominated by holes. In this report, we have explained this unusual hole dominant scenario by a modified two narrow-band model. According to this model, the impurity electrons which are nearer to conduction band get shifted towards lower energy level thereby leaving holes around the Fermi level, and hence a hole dominated scenario at low temperatures. Due to this hole like density of states around the Fermi level, the nickel substitution could only produce a weak ferromagnetic behavior. Such a picture may assist in understanding the thermopower of similar systems i.e. Ni substituted on Fe site, such as Fe2-x Ni x VAl. We have also found that the activation energy derived from resistivity and thermoelectric power decreases with increasing Ni concentration.
Collapse
|
26
|
Grinnell M, Krishnan M, Ganti AK. HPV and the Immune System in Head and Neck Cancers: Therapeutic Considerations. Oncology (Williston Park) 2020; 34:693630. [PMID: 32293695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Immunotherapy applications for head and neck squamous cell carcinoma (HNSCC) are rapidly evolving. The progress towards immunotherapy has demonstrated improved outcomes for patients with HNSCC. Human papillomavirus (HPV)-associated HNSCC has a much better prognosis and differs from HPV-negative HNSCC in its genomic and immunologic profile, with strikingly higher immune cell activation and infiltration. Despite an increased incidence of HPV-associated HNSCC, and differences in immune signature based on HPV status, the management does not differ from non-HPV tumors. Clinical trials are ongoing to integrate immunotherapy in the management of early- and late-stage HNSCC, and its current use is limited to the metastatic setting. This article describes the role of immune therapy in HPV-associated HNSCC along with the evidence and perspective behind differing therapeutic considerations.
Collapse
|
27
|
Kim J, Lee K, Jung E, Ha E, Krishnan M, Chun KS. Selective Wnt/β-catenin small-molecule inhibitor CWP232228 impairs tumour growth of colon cancer. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz246.124] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
|
28
|
Krishnan M, Krishnamurthy J, Shonka N. Targeting the Sanctuary Site: Options when Breast Cancer Metastasizes to the Brain. Oncology (Williston Park) 2019; 33:683730. [PMID: 31469897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Brain metastasis is a poor prognostic factor in breast cancer progression, and traditional treatment options have shown minimal response with overall low median survival rates. The incidence of brain metastasis has been increasing despite and, in part, due to advancements in treatment as a result of prolongation of survival. Targeted therapy such anti-HER2 agents have a lower efficacy in this setting compared to metastases elsewhere; however, novel therapies are emerging in this regard. In this comprehensive review, we discuss risk per subtype, special considerations for therapy selection, current focal and systemic treatments, and recent advancements and potential future targets for success. We present our treatment paradigm and multidisciplinary approach to brain metastases arising from breast cancer based on the available evidence, incorporating molecular characteristics.
Collapse
|
29
|
Abstract
Thymic carcinoma is a rare entity and can be distinguished from benign thymomas by their aggressive nature and poor prognosis. The National Comprehensive Cancer Network guidelines recommend resection followed by adjuvant platinum-based chemotherapy for resectable tumors. However, the outcomes for metastatic or relapsed thymic carcinomas are poor with no regimen showing a consistent benefit. Moreover, the relative rarity of these tumors makes clinical trials difficult. Molecular analysis of thymomas shows a high incidence of genetic mutations and targeted therapy holds promise. We will briefly outline and review the current role of targeted therapy in thymic cancer.
Collapse
Affiliation(s)
- Mridula Krishnan
- 1 Department of Hematology Oncology, University of Nebraska Medical Center, Omaha, NE, USA
| | - Apar K Ganti
- 2 Department of Internal Medicine, VA Nebraska-Western Iowa Health Care System, Omaha, NE, USA.,3 Division of Oncology-Hematology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE, USA
| |
Collapse
|
30
|
Krishnan M, Yu L, Dasgupta A, Mullen NJ, Osayande F, Berim LD, Alam M, Yu F, Oliveto J, Klute K, Singh PK. Change in body composition and survival in patients with pancreatic cancer. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.e15716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e15716 Background: The incidence of pancreatic ductal adenocarcinoma (PDAC) is on the rise and continues to have a poor overall survival despite aggressive available treatment strategies. Sarcopenia is prevalent in PDAC patients and is likely caused by both disease and treatment. We hypothesized that ongoing muscle loss during treatment with chemotherapy would be associated with shorter progression-free survival (PFS) and overall survival (OS). Methods: We measured skeletal muscle index at L3 vertebra on baseline follow-up scans in patients with PDAC treated with chemotherapy at our institution. Patients were categorized by percent SMI lost over an 8-week period (<10%, 10-20%, ≥20% loss). We compared PFS and OS between the groups. Results: We included 162 patients with stage I-IV pancreatic cancer. Baseline characteristics are listed in the Table. SMI loss was associated with shortened PFS and OS (p=0.009, p=0.032 respectively) via log-rank test for trend. Even after adjusting for confounders (age, gender, resection status, stage, baseline sarcopenia, treatment and therapy), the relative risk of death (2.0; 95% CI=1.10-3.64, p=0.023), and progression (1.83; 95% CI =1.08-3.10, p =0.024) were higher in those who lost ≥20% SMI. There was no significant association between BMI change or fat change with the survival outcomes. Conclusions: The loss of skeletal muscle during the first 8 weeks of chemotherapy is associated with shortened survival outcomes and is independent of stage and resection status in patients receiving chemotherapy for PDAC. Future studies should seek to understand mechanisms of muscle loss by both tumor and chemotherapy to improve survival in patients with PDAC. Baseline characteristics. [Table: see text]
Collapse
Affiliation(s)
| | - Lei Yu
- University of Nebraska Medical Center, Omaha, NE
| | | | | | | | | | - Morshed Alam
- University of Nebraska Medical Center, Omaha, NE
| | - Fang Yu
- University of Nebraska Medical Center, Omaha, NE
| | | | - Kelsey Klute
- University of Nebraska Medical Center, Omaha, NE
| | | |
Collapse
|
31
|
Das A, Krishna P, Goswami M, Krishnan M. Structural analysis of Al and Si substituted lithium germanium phosphate glass-ceramics using neutron and X-ray diffraction. J SOLID STATE CHEM 2019. [DOI: 10.1016/j.jssc.2018.12.038] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
32
|
Wallen T, Jagan N, Krishnan M, Depew Z. A 75 year old male with recurrent unilateral pleural effusion and positive ANA. Respir Med Case Rep 2019; 26:301-303. [PMID: 30859065 PMCID: PMC6396095 DOI: 10.1016/j.rmcr.2019.02.019] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2019] [Revised: 02/20/2019] [Accepted: 02/20/2019] [Indexed: 11/29/2022] Open
Abstract
This case report describes the clinical course and diagnostic challenges arising in a 75 year old man who initially presented with progressive shortness of breath. Imaging revealed a pleural effusion, which was recurrent following thoracentesis. While his initial workup suggested an autoimmune etiology, further diagnostic testing revealed a diagnosis of malignant pleural mesothelioma. Curiously, the patient had no known asbestos exposure, which is classically associated with acquired mesothelioma. There are a small number of similar cases with a possible overlap between positive autoimmune serologies and mesothelioma; however, the underlying pathophysiology remains elusive. It is the authors' goal to contribute this case to the few cases describing such overlap syndromes.
Collapse
Affiliation(s)
- Tanner Wallen
- Department of Internal Medicine, Creighton University School of Medicine, Omaha, NE, United States
- Corresponding author. Department of Internal Medicine, Creighton University School of Medicine, 7500 Mercy Road Omaha, NE, 68124, United States.
| | - Nikhil Jagan
- Department of Pulmonary, Critical Care, and Sleep Medicine, Creighton University School of Medicine, Omaha, NE, United States
| | - Mridula Krishnan
- Department of Oncology and Hematology, University of Nebraska Medical Center, Omaha, NE, United States
| | - Zachary Depew
- Department of Pulmonary, Critical Care, and Sleep Medicine, Creighton University School of Medicine, Omaha, NE, United States
| |
Collapse
|
33
|
Roslan A, Kamsani SH, Nay TW, Tan KL, Hakim N, Tan AM, Megat Samsudim WN, Tan KL, Jauhari AT, Krishnan M, Leong D, Supramaniam T, Tan LK, Nuruddin AA. Echocardiographic and electrocardiographic presentations of patients with endomyocardial biopsy-proven cardiac amyloidosis. Med J Malaysia 2018; 73:388-392. [PMID: 30647209] [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
OBJECTIVE Cardiac amyloidosis is under diagnosed and its prevalence is unknown. This is a retrospective, nonrandomised, single centre study of patients with endomyocardial biopsy-proven cardiac amyloidosis focusing on their echocardiographic and electrocardiogram (ECG) presentations. This is the first case series in Malaysia on this subject. METHODS We identified all of our endomyocardial biopsyproven cardiac amyloidosis patients from January 2010 to January 2018 and reviewed their medical records. All patients echocardiographic and ECG findings reviewed and analysed comparing to basic mean population value. RESULTS In total there are 13 biopsy-proven cardiac amyloidosis patients. All of the biopsies shows light chain (AL) amyloid. Majority of the patients (8, 61.5%) is male, and most of our patients (8, 61.5%) is Chinese. All seven patients on whom we performed deformation imaging have apical sparing pattern on longitudinal strain echocardiogram. Mean ejection fraction is 49.3%, (SD=7.9). All patients have concentric left ventricular hypertrophy and right ventricular hypertrophy. Diastolic dysfunction was present in all of our patients with nine out of 13 patients (69.2%) having restrictive filling patterns (E/A ≥2.0 E/e' ≥15). On electrocardiogram, 12 (92%) patients have prolonged PR interval (median 200ms, IQR 76.50ms) and 9 (69.2%) patients have pseudoinfarct pattern. CONCLUSION Echocardiography plays an important role in diagnosing cardiac amyloidosis. The findings of concentric left ventricular hypertrophy with preserved ejection fraction without increased in loading condition should alert the clinician towards its possibility. This is further supported by right ventricular hypertrophy and particularly longitudinal strain imaging showing apical sparing pattern.
Collapse
Affiliation(s)
- A Roslan
- Institut Jantung Negara, Department of Cardiology, Non Invasive Cardiac Laboratory, Kuala Lumpur, Malaysia.
| | - S H Kamsani
- Institut Jantung Negara, Department of Cardiology, Non Invasive Cardiac Laboratory, Kuala Lumpur, Malaysia
| | - T W Nay
- Institut Jantung Negara, Department of Cardiology, Non Invasive Cardiac Laboratory, Kuala Lumpur, Malaysia
| | - K L Tan
- Institut Jantung Negara, Department of Cardiology, Non Invasive Cardiac Laboratory, Kuala Lumpur, Malaysia
| | - N Hakim
- Institut Jantung Negara, Department of Cardiology, Non Invasive Cardiac Laboratory, Kuala Lumpur, Malaysia
| | - A M Tan
- Institut Jantung Negara, Department of Cardiology, Non Invasive Cardiac Laboratory, Kuala Lumpur, Malaysia
| | - W N Megat Samsudim
- Institut Jantung Negara, Department of Cardiology, Non Invasive Cardiac Laboratory, Kuala Lumpur, Malaysia
| | - K L Tan
- Institut Jantung Negara, Department of Cardiology, Non Invasive Cardiac Laboratory, Kuala Lumpur, Malaysia
| | - A T Jauhari
- Institut Jantung Negara, Department of Cardiology, Non Invasive Cardiac Laboratory, Kuala Lumpur, Malaysia
| | - M Krishnan
- Institut Jantung Negara, Department of Cardiology, Non Invasive Cardiac Laboratory, Kuala Lumpur, Malaysia
| | - D Leong
- Institut Jantung Negara, Department of Cardiology, Non Invasive Cardiac Laboratory, Kuala Lumpur, Malaysia
| | - T Supramaniam
- Institut Jantung Negara, Department of Cardiology, Non Invasive Cardiac Laboratory, Kuala Lumpur, Malaysia
| | - L K Tan
- Institut Jantung Negara, Department of Cardiology, Non Invasive Cardiac Laboratory, Kuala Lumpur, Malaysia
| | - A A Nuruddin
- Institut Jantung Negara, Department of Cardiology, Non Invasive Cardiac Laboratory, Kuala Lumpur, Malaysia
| |
Collapse
|
34
|
Wagner K, Wong B, Byrne B, Sweeney H, Jacobsen L, Tirucherai G, Rabbia M, Dukart J, Kletz H, Krishnan M, Bechtold C. DMD CLINICAL THERAPIES I. Neuromuscul Disord 2018. [DOI: 10.1016/j.nmd.2018.06.151] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
35
|
Abstract
We present a model for calculating the net and effective electrical charge of globular
macromolecules
and linear polyelectrolytes such as proteins and DNA, given the concentration of monovalent
salt and pH in solution. The calculation is based on a numerical solution of the
non-linear Poisson-Boltzmann equation using a finite element discretized continuum
approach. The model simultaneously addresses the phenomena of charge regulation and
renormalization,
both of which underpin the electrostatics of biomolecules in solution. We show that while charge
regulation addresses the true electrical charge of a molecule arising from the acid-base
equilibria of its ionizable groups, charge renormalization finds relevance in the context of a
molecule’s interaction with another charged entity. Writing this electrostatic
interaction
free energy in
terms of a local electrical potential, we obtain an “interaction charge” for the molecule
which we demonstrate agrees closely with the “effective charge” discussed in charge
renormalization
and counterion-condensation theories. The predictions of this model agree well with direct
high-precision measurements of effective electrical charge of polyelectrolytes such as
nucleic acids and disordered proteins in solution, without tunable parameters. Including the
effective interior dielectric
constant for compactly folded molecules as a tunable parameter, the
model captures measurements of effective charge as well as published trends of
pKa
shifts in globular proteins. Our results suggest a straightforward general framework to
model electrostatics in biomolecules in solution. In offering a platform that
directly links theory and experiment, these calculations could foster a systematic
understanding of the interrelationship between molecular 3D structure and conformation,
electrical charge and electrostatic
interactions in
solution. The model could find particular relevance in situations where molecular crystal
structures are not available or rapid, reliable predictions are desired.
Collapse
Affiliation(s)
- M Krishnan
- Department of Chemistry, University of Zurich, Winterthurerstrasse 190, CH 8057 Zurich, Switzerland and Department of Physics, University of Zurich, Winterthurerstrasse 190, CH 8057 Zurich, Switzerland
| |
Collapse
|
36
|
Affiliation(s)
- F. Ruggeri
- Department of Chemistry, University of Zürich, Winterthurerstrasse 190, CH 8057 Zürich, Switzerland
| | - M. Krishnan
- Department of Chemistry, University of Zürich, Winterthurerstrasse 190, CH 8057 Zürich, Switzerland
- Department of Physics, University of Zürich, Winterthurerstrasse 190, CH 8057 Zürich, Switzerland
| |
Collapse
|
37
|
Arunadevi R, Kavitha B, Karthiga R, Krishnan M. Effect of Fe and Cu codoped NiMoO4 nanopartcles on the photocatalytic degradation of methylene blue under visible light irradiation. ACTA ACUST UNITED AC 2018. [DOI: 10.5958/0974-4150.2018.00119.0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
|
38
|
Pandiarajan J, Krishnan M. Comparative bacterial survey in the gut of lepidopteran insects with different bionetwork. Microbiology (Reading) 2018. [DOI: 10.1134/s0026261718010137] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
|
39
|
Ravi M, Paul SF, Krishnan M, Vijayalakshmi K, Selvi VV, Jayanth VR. Glycophorin-A Mutations as a Window to Study Carcinogenesis. INT J HUM GENET 2017. [DOI: 10.1080/09723757.2004.11885868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Maddaly Ravi
- Sri Ramachandra Medical College and Research Institute (Deemed University), 1, Ramachandra Nagar, Porur, Chennai 600 116, Tamilnadu, India
| | - Solomon F.D Paul
- Sri Ramachandra Medical College and Research Institute (Deemed University), 1, Ramachandra Nagar, Porur, Chennai 600 116, Tamilnadu, India
| | - M. Krishnan
- Sri Ramachandra Medical College and Research Institute (Deemed University), 1, Ramachandra Nagar, Porur, Chennai 600 116, Tamilnadu, India
| | - K. Vijayalakshmi
- Sri Ramachandra Medical College and Research Institute (Deemed University), 1, Ramachandra Nagar, Porur, Chennai 600 116, Tamilnadu, India
| | - V. Vettri Selvi
- Sri Ramachandra Medical College and Research Institute (Deemed University), 1, Ramachandra Nagar, Porur, Chennai 600 116, Tamilnadu, India
| | - Vikram R Jayanth
- Sri Ramachandra Medical College and Research Institute (Deemed University), 1, Ramachandra Nagar, Porur, Chennai 600 116, Tamilnadu, India
| |
Collapse
|
40
|
Krishnan M, Ahmed A, Walters RW, Silberstein PT. Factors Affecting Adjuvant Therapy in Stage III Pancreatic Cancer-Analysis of the National Cancer Database. Clin Med Insights Oncol 2017; 11:1179554917728040. [PMID: 28894395 PMCID: PMC5582659 DOI: 10.1177/1179554917728040] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/23/2017] [Accepted: 07/02/2017] [Indexed: 12/25/2022]
Abstract
BACKGROUND Adjuvant therapy after curative resection is associated with survival benefit in stage III pancreatic cancer. We analyzed the factors affecting the outcome of adjuvant therapy in stage III pancreatic cancer and compared overall survival with different modalities of adjuvant treatment. METHODS This is a retrospective study of patients with stage III pancreatic cancer listed in the National Cancer Database (NCDB) who were diagnosed between 2004 and 2012. Patients were stratified based on adjuvant therapy they received. Unadjusted Kaplan-Meier and multivariable Cox regression analysis were performed. RESULTS We analyzed a cohort included 1731 patients who were recipients of adjuvant therapy for stage III pancreatic cancer within the limits of our database. Patients who received adjuvant chemoradiation had the longest postdiagnosis survival time, followed by patients who received adjuvant chemotherapy, and finally patients who received no adjuvant therapy. On multivariate analysis, advancing age and patients with Medicaid had worse survival, whereas Spanish origin and lower Charlson comorbidity score had better survival. CONCLUSIONS Our study is the largest trial using the NCDB addressing the effects of adjuvant therapy specifically in stage III pancreatic cancer. Within the limits of our study, survival benefit with adjuvant therapy was more apparent with longer duration from date of diagnosis.
Collapse
Affiliation(s)
- Mridula Krishnan
- Department of Medicine, School of Medicine, Creighton University, Omaha, NE, USA
| | - Aabra Ahmed
- Department of Medicine, School of Medicine, Creighton University, Omaha, NE, USA
| | - Ryan W Walters
- Department of Medicine, School of Medicine, Creighton University, Omaha, NE, USA
| | - Peter T Silberstein
- Division of Hematology/Oncology, School of Medicine, Creighton University, Omaha, NE, USA
| |
Collapse
|
41
|
Krishnan M. Erratum: “A simple model for electrical charge in globular macromolecules and linear polyelectrolytes in solution” [J. Chem. Phys. 146, 205101 (2017)]. J Chem Phys 2017; 147:079901. [DOI: 10.1063/1.4999597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
|
42
|
Gapp J, Krishnan M, Ratnaraj F, Schroell RP, Moore D. Cardiac Arrhythmias Resulting from a Peripherally Inserted Central Catheter: Two Cases and a Review of the Literature. Cureus 2017; 9:e1308. [PMID: 28690942 PMCID: PMC5497924 DOI: 10.7759/cureus.1308] [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] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
We present two cases of patients being treated for diabetic ketoacidosis in the intensive care unit who experienced cardiac arrhythmia secondary to peripherally inserted central catheters (PICCs). In one instance, the patient became bradycardic and experienced related loss of consciousness, ultimately requiring cardiopulmonary resuscitation. In the second case, the patient experienced an episode of nonsustained ventricular tachycardia. We explore the various types of arrhythmias that have been reported secondary to central venous catheters, as well as factors that place patients at an increased risk for arrhythmia while undergoing PICC insertion. Furthermore, we look at the literature for methods to improve the insertion of PICC lines by decreasing the risk of catheter over-insertion as well as the effects of training for PICC placement.
Collapse
Affiliation(s)
- Jonathan Gapp
- Internal Medicine, Creighton University Medical Center
| | | | | | | | - Douglas Moore
- Pulmonary, Critical Care and Sleep Medicine, Creighton University Medical Center
| |
Collapse
|
43
|
Abstract
Streptococcus gordonii (S. gordonii) is a pioneer oral bacteria that is recognized as an agent of bacterial endocarditis. However, an extensive review of the literature revealed no reported case of S. gordonii causing empyema. We present a case of a 65-year-old male who presented with respiratory distress. Physical examination revealed several dental caries with decreased breath sounds in the bibasilar regions. A computed tomography (CT) scan of the chest and abdomen demonstrated left-sided pleural effusion and a 4.3 cm x 2.8 cm splenic abscess. He received intravenous (IV) antibiotics, and his blood cultures remained negative. Drainage of the splenic abscess grew S. gordonii. A CT-guided thoracentesis yielded 450 ml of exudative fluid. Pleural fluid cultures grew S. gordonii. A CT scan of the head and neck ruled out an intra-oral abscess. He received six weeks of IV penicillin with a follow-up CT scan showing resolution of both the splenic abscess and the left parapneumonic effusion.
Collapse
Affiliation(s)
| | | | | | | | | | - Pamela A Foral
- Internal Medicine, Creighton University School of Pharmacy and Health Professions
| | | |
Collapse
|
44
|
Rameshkumar N, Dhanapaul S, Krishnan M, Kayalvizhi N. Bacillus tequilensis A Novel Thermotolerant Strain for Effective Bioremediation of Melanoidin Pigment in Its Natural Environment. ACTA ACUST UNITED AC 2017. [DOI: 10.1007/978-3-319-48439-6_25] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/15/2023]
|
45
|
Ahmed A, Krishnan M, Siu M, Walters RW, Silberstein PT. Immunotherapy and survival in stage IV melanoma: A National Cancer Database (NCDB) analysis. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.7_suppl.160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
160 Background: Interleukin-2 (IL-2) has been the predominant immunotherapy used for stage IV melanoma for the past decades, with newer immunotherapy drugs approved within the past five years. By using the National Cancer Database (NCDB), our study aims to be the largest to determine the impact of immunotherapy on patients with stage IV melanoma. To examine only IL-2 and interferon-alpha, only patients diagnosed prior to 2011 were used. Methods: 10,771 patients diagnosed with stage IV melanoma between 2004-2010 were identified with sufficient data. 1,009 of these patients were given immunotherapy. Chi-square analysis was used to determine demographic differences between those with and without immunotherapy. Between-therapy survival differences were estimated by the Kaplan-Meier method and associated log-rank tests; Tukey-Kramer adjusted p < .05 indicated statistical significance. Results: Patients with immunotherapy had a median survival of 17.4 months, while those without immunotherapy had a median survival of 7.1 months. 27% of patients given immunotherapy were alive three years post diagnosis, compared to only 14% of patients who were not given immunotherapy. Immunotherapy patients had a greater percentage of those with private insurance (65.3% vs. 37.7%, p<0.001), an income greater than $63,000 (40.5% vs. 31.9%, p<0.001), and no comorbidities (87.3% vs. 77.5%, p<0.001) compared to patients not given immunotherapy. Conclusions: Patients with immunotherapy had nearly a 2.5-fold increase in median survival compared to patients not provided immunotherapy. Compared to those without immunotherapy, immunotherapy patients lived in more wealthy and educated zip codes, and had more private insurance. [Table: see text]
Collapse
Affiliation(s)
| | | | - Margaret Siu
- Creighton University School of Medicine, Omaha, NE
| | | | | |
Collapse
|
46
|
Krishnan M, Ahmed A, Khanal N, Silberstein PT. An analysis of the National Cancer Database (NCDB): Immunotherapy and survival in stage III melanoma. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.7_suppl.159] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
159 Background: High dose Interferon (IFN) was the standard adjuvant treatment used for stage III melanoma between 2004-2010. To our knowledge, this is the largest study using the NCDB to determine the impact of immunotherapy used prior to 2011 in stage III melanoma. Methods: We identified 19,864 patients with stage III melanoma between 2004-2010. Among these, 5,406 of them received immunotherapy. Chi-square analysis was used to determine demographic differences between those with versus without immunotherapy. Between-therapy survival differences were estimated by the Kaplan-Meier method and associated log-rank tests; Tukey-Kramer adjusted p < 0.05 indicated statistical significance. Results: Patients who received immunotherapy had a mean survival of 89.8 months while those who did not had a mean survival of 71 months. The percentage of patients alive at 5 and 10 years was 62% and 52% (among those who received immunotherapy) compared to 46% and 32% (among those who did not receive immunotherapy) respectively. A much higher percentage of these patients were privately insured (73% vs. 47.1%, p<0.001). Those who received immunotherapy were more likely to be younger, have a higher income (36.2% vs. 34.8%, p<0.001), and a greater percentage of females received immunotherapy compared to males. (See Table 1.) Conclusions: Previously, Kirkwood et al. demonstrated a modest improvement in overall survival with IFN by 12 months (2.8 to 3.8 years). In our study, patients who received immunotherapy had a significant improvement in mean survival by 19 months. It was observed that patients who received immunotherapy were substantially younger, had private insurance and fewer comorbidities. [Table: see text]
Collapse
Affiliation(s)
| | | | - Nabin Khanal
- Creighton University School of Medicine, Omaha, NE
| | | |
Collapse
|
47
|
Abstract
We present measurements of the net electrical surface charge of silicon dioxide (SiO2) in contact with solvents of dielectric constants between 5 and 80. Our experimental approach relies on observing the thermal motion of single silica particles confined in an electrostatic fluidic trap created by SiO2 surfaces. We compare the experimentally measured functional form of the trapping potential with that from free energy calculations and thereby determine the net surface charge in the system. Our findings clearly demonstrate that contrary to popular perception, even in the absence of surfactants, the net electrical charge of ionizable surfaces in contact with apolar solvents can be large enough to lead to significant repulsive forces. A charge regulation model for SiO2 surfaces with a single tunable parameter explains our measurements. This model may find general applicability in estimating the net charge of ionizable surfaces, given system parameters such as the dissociation or association constants of the ionizable groups and the pH, ionic strength, and dielectric constant of the solvent phase.
Collapse
Affiliation(s)
- G Kokot
- Department of Chemistry, University of Zurich, Winterthurerstrasse 190, CH 8057 Zurich, Switzerland
| | - M I Bespalova
- Department of Chemistry, University of Zurich, Winterthurerstrasse 190, CH 8057 Zurich, Switzerland
| | - M Krishnan
- Department of Chemistry, University of Zurich, Winterthurerstrasse 190, CH 8057 Zurich, Switzerland
| |
Collapse
|
48
|
Ahmed A, Walters RW, Malouff TD, Krishnan M, Jabbari J, Silberstein PT. Adjuvant therapy in stage II pancreatic cancer: A National Cancer Database analysis. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.4_suppl.283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
283 Background: Oldfield et al (2015) showed the conflicting evidence regarding the effect of adjuvant chemotherapy vs. chemoradiation in pancreatic cancer. Using patients identified by the National Cancer Database (NCDB), we are the largest study to compare survival in stage II pancreatic cancer patients who received adjuvant chemotherapy, chemoradiation, radiation, or no adjuvant therapy. Methods: We identified 65,091 patients with stage II pancreatic cancer who received surgery only or surgery in combination with chemotherapy, radiation, or chemoradiation. Between-therapy survival differences were estimated by the Kaplan-Meier method and associated log-rank tests; Tukey-Kramer adjusted p < .05 indicated statistical significance. Results: Patient characteristics were similar between groups; although, patients receiving chemoradiation were younger, had fewer comorbidities, and were more likely to have private insurance compared to all other therapy groups. Statistically significant survival differences were indicated between all therapy groups (all adjusted p< 0.05), as patients receiving chemoradiation had the longest survival followed by patients receiving chemotherapy, patients receiving radiation therapy, and patients receiving no adjuvant therapy (median survival = 22.5, 19.6, 16.9, 14.8 months, respectively). When examining other variables, patients living in an area with a median income < $43,000 were 14% more likely to die compared to patients in an area with a median income ≥ $63,000 (p < 0.001) and those with no comorbidities were 19% less likely to die than patients with two or more comorbidities (p < 0.001). Conclusions: Our data suggests that adjuvant therapy improves median and 3-year survival compared to no adjuvant therapy. Of all adjuvant therapies examined, adjuvant chemoradiation was associated with the greatest increase in survival, followed by adjuvant chemotherapy. Table 1: Median survival and survival rates of stage II pancreatic cancer [Table: see text]
Collapse
|
49
|
Krishnan M, Gharzai L, Qurie A, Diab O, Narayanan MA, Vivekanandan R, Walters RW. Incidence of colorectal carcinoma following liver transplantation: A retrospective analysis using the United Network for Organ Sharing (UNOS) database. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.4_suppl.542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
542 Background: Since 1988, approximately 145,000 liver transplants (LT) have been performed in the United States, with 7,127 in 2015 alone. Several malignancies occur more frequently in solid organ transplant recipients. Studies have shown increased risk of Colorectal cancer (CRC) post LT in adults with primary sclerosing cholangitis, whether the risk of de novo CRC is increased or not remains controversial. Methods: A retrospective analysis was conducted using the UNOS database. Between-group differences in CRC rates were compared using Fisher’s exact test whereas, the differences in observed years between liver transplant and CRC were compared using negative binomial regression models. Results: We retrospectively analyzed 12,337 recipients of LT within the UNOS database. The overall incidence of CRC post LT was estimated to be at 3.8 percent. Interestingly, the incidence was higher in women and non-obese recipients. All immunosuppressive agents within the limits of the database were analysed for maintenance and anti-rejection. The two agents with some increase in incidence were cyclosporine and cellcept but this was statistically insignificant.(Table 1) Women and elderly ( > 65 years) were likely to develop CRC approximately 25 percent earlier than men and younger patients (p = 0.003 and p = 0.001, respectively). Conclusions: Studies have shown a trend toward increased incidence of CRC post LT. These studies were limited by the sample size and were single-center trials. To date there are no elaborate guidelines on surveillance of CRC in LT recipients. In our study there was a shorter interval to development of CRC in older patients and women, suggesting that this population may benefit from early initiation of screening. [Table: see text]
Collapse
|
50
|
Earnshaw C, Edwin C, Bhat J, Krishnan M, Mamais C, Somashekar S, Sunil A, Williams S, Leong S. An analysis of the fate of 917 manuscripts rejected from Clinical Otolaryngology. Clin Otolaryngol 2017; 42:709-714. [DOI: 10.1111/coa.12820] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/24/2016] [Indexed: 01/14/2023]
Affiliation(s)
- C.H. Earnshaw
- Mersey ENT Research Collaborative; Merseyside UK
- Institute of Translational Medicine; University of Liverpool; Liverpool UK
| | - C. Edwin
- Mersey ENT Research Collaborative; Merseyside UK
| | - J. Bhat
- Mersey ENT Research Collaborative; Merseyside UK
| | - M. Krishnan
- Mersey ENT Research Collaborative; Merseyside UK
| | - C. Mamais
- Mersey ENT Research Collaborative; Merseyside UK
| | | | - A. Sunil
- Mersey ENT Research Collaborative; Merseyside UK
| | | | - S.C. Leong
- Mersey ENT Research Collaborative; Merseyside UK
- Institute of Translational Medicine; University of Liverpool; Liverpool UK
| |
Collapse
|