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Paudel PK, Bhandari P, Kc N, Devkota B. Morbidity and Mortality Profile of Neonates Admitted in Neonatal Intensive Care Unit. J Nepal Health Res Counc 2024; 21:373-379. [PMID: 38615206 DOI: 10.33314/jnhrc.v21i3.4168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 03/22/2024] [Indexed: 04/15/2024]
Abstract
BACKGROUND The neonatal period faces the greatest risk of death as they are vulnerable to sepsis, birth asphyxia, hypoxic injuries etc. A substantial disparity exists in NMR between Nepal and other developed countries and among different provinces of Nepal as well. This study was conducted to describe the pattern of neonatal admission, and immediate hospital outcomes from NICU located in a remote part of Nepal. METHODS This prospective study was conducted in The Province Hospital, Karnali, Nepal over a period of six months (June 2021 to Dec 2021 AD). The variables used were neonatal age, sex, gestation, birth weight, maternal age, mode and place of delivery. Neonatal morbidities and final outcomes at discharge were recorded in a predesigned proforma. RESULTS A total of 396 neonates included, the majority were inborn 283(71%), male 241(61%), term 301(76%) and had normal birth weight 279 (70.4%). Neonatal sepsis 188(37.2%), prematurity 95(24%), and birth asphyxia 55(15.2%) were main indications for hospitalization. The majority 337(85%) improved after treatment, while 33(8.3%) died, 12 (3%) left against medical advice and 14(3.5%) cases were referred. Preterm neonates had thrice the risk of mortality than term neonates (OR =3.27). Low birth weight (< 2500 grams) had higher odds of poor outcomes (OR =3.5). Low maternal age (<20 years), prematurity, LBW, mechanical ventilation and inotrope use were predictors of poor outcomes. CONCLUSIONS Neonatal sepsis, prematurity and perinatal asphyxia were the most common causes of NICU admissions. Mechanical ventilation, inotropes use, extreme prematurity, low birth weight and younger age of the mother were predictors of poor outcome.
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Affiliation(s)
| | | | - Nawaraj Kc
- Department of Pediatrics, Province Hospital, Karnali
| | - Bibek Devkota
- Department of Anesthesia, Province Hospital, Karnali
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Yadav D, Bhattarai A, Bhandari P, Danai A, Singh UK. Klippel-Feil Syndrome Associated with Renal and Cardiac Anomalies in an Infant: A Case Report. JNMA J Nepal Med Assoc 2023; 61:819-821. [PMID: 38289771 PMCID: PMC10579768 DOI: 10.31729/jnma.8303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Indexed: 02/01/2024] Open
Abstract
Klippel-Feil syndrome is a rare congenital bone disorder characterised by a triad of short neck, low posterior hairline and limited lateral bending of the neck with an annual incidence of 1 in 40,000 live births. It has remained an obscure term in the medical literature because of its variability in presentation and wide spectrum of anomalies involving multiple organ systems. It is unusual to find a case that has all three classical triad features. Here, we present a case of a 9-month-old infant who manifests not only all three classical triad features associated with Klippel-Feil syndrome but also demonstrates the presence of congenital heart disease, scoliosis, and renal ectopia. An early comprehensive evaluation of a suspected case is essential for diagnosis and counselling which impacts its prognosis, helps minimize social stigma and affords parents the opportunity to consider cosmetic surgery as an option, should they choose to pursue it. Keywords case reports; congenital; heart diseases; Klippel-Feil syndrome; scoliosis.
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Affiliation(s)
- Dipa Yadav
- Department of Paediatric Intensive Care, International Friendship Children's Hospital, Maharajgunj, Kathmandu, Nepal
| | - Anish Bhattarai
- Department of Paediatric Intensive Care, International Friendship Children's Hospital, Maharajgunj, Kathmandu, Nepal
| | - Prakreeti Bhandari
- Department of Paediatric Intensive Care, International Friendship Children's Hospital, Maharajgunj, Kathmandu, Nepal
| | - Anu Danai
- Department of Paediatric Intensive Care, International Friendship Children's Hospital, Maharajgunj, Kathmandu, Nepal
| | - Umesh Kumar Singh
- Department of Paediatrics, Nepalese Army Institute of Health Sciences, Sanobharyang, Kathmandu, Nepal
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3
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Allphin AJ, Clark DP, Thuering T, Bhandari P, Ghaghada KB, Badea CT. Micro-CT imaging of multiple K-edge elements using GaAs and CdTe photon counting detectors. Phys Med Biol 2023; 68:10.1088/1361-6560/acc77e. [PMID: 36963115 PMCID: PMC10179208 DOI: 10.1088/1361-6560/acc77e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 03/24/2023] [Indexed: 03/26/2023]
Abstract
Objective.To evaluate the performance of two photon-counting (PC) detectors based on different detector materials, gallium arsenide (GaAs) and cadmium telluride (CdTe), for PC micro-CT imaging of phantoms with multiple contrast materials. Another objective is to determine if combining these two detectors in the same micro-CT system can offer higher spectral performance and significant artifact reduction compared to a single detector system.Approach. We have constructed a dual-detector, micro-CT system equipped with two PCDs based on different detector materials: gallium arsenide (GaAs) and cadmium telluride (CdTe). We demonstrate the performance of these detectors for PC micro-CT imaging of phantoms with up to 5 contrast materials with K-edges spread across the x-ray spectrum ranging from iodine with a K-edge at 33.2 keV to bismuth with a K-edge at 90.5 keV. We also demonstrate the use of our system to image a mouse prepared with both iodine and bismuth contrast agents to target different biological systems.Main results.When using the same dose and scan parameters, GaAs shows increased low energy (<50 keV) spectral sensitivity and specificity compared to CdTe. However, GaAs performance at high energies suffers from spectral artifacts and has comparatively low photon counts indicating wasted radiation dose. We demonstrate that combining a GaAs-based and a CdTe-based PC detector in the same micro-CT system offers higher spectral performance and significant artifact reduction compared to a single detector system.Significance.More accurate PC micro-CT using a GaAs PCD alone or in combination with a CdTe PCD could serve for developing new contrast agents such as nanoparticles that show promise in the developing field of theranostics (therapy and diagnostics).
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Affiliation(s)
- A. J. Allphin
- Quantitative Imaging and Analysis Lab, Department of Radiology, Duke University Medical Center, Durham, NC 27710, USA
| | - D. P. Clark
- Quantitative Imaging and Analysis Lab, Department of Radiology, Duke University Medical Center, Durham, NC 27710, USA
| | | | - P. Bhandari
- E. B. Singleton Department of Radiology, Texas Children’s Hospital/Baylor College of Medicine, Houston, TX 77030, USA
| | - K. B. Ghaghada
- E. B. Singleton Department of Radiology, Texas Children’s Hospital/Baylor College of Medicine, Houston, TX 77030, USA
| | - C. T. Badea
- Quantitative Imaging and Analysis Lab, Department of Radiology, Duke University Medical Center, Durham, NC 27710, USA
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4
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Maharjan N, Bajracharya D, Ojha B, Bhandari P, Koju S. A Recurrent Case of Ameloblastic Fibroma in 37-year Old Male. Kathmandu Univ Med J (KUMJ) 2023; 21:230-234. [PMID: 38628020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2024]
Abstract
Ameloblastic fibroma (AF) is a benign mixed epithelial and mesenchymal odontogenic tumor. This was previously grouped in odontogenic tumor showing odontogenic epithelium with odontogenic ectomesenchyme, with or without hard tissue formation. This report describes a case of ameloblastic fibroma in a 37-yearold male who came with the complain of swelling in the left side of lower jaw since one year. Enucleation of the mass followed by reconstruction was done six years back. However, after two years of initial treatment; radiographic findings suggested recurrence. Histopathological examination confirmed the diagnosis of ameloblastic fibroma. Patient had no clinical and radiographic evidence of recurrence in three and six months' follow-up. Because of the higher proliferative capacity and malignant degree of the mesenchymal component in the recurrent neoplasm, sarcomatous transformation may occur. Hence, a long term clinical and radiographical follow-up is essential due to its transformation into ameloblastic fibrosarcoma.
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Affiliation(s)
- N Maharjan
- Department of Oral and Maxillofacial Pathology, Kantipur Dental College Teaching Hospital, Dhapasi, Kathmandu, Nepal
| | - D Bajracharya
- Department of Oral and Maxillofacial Pathology, Kantipur Dental College Teaching Hospital, Dhapasi, Kathmandu, Nepal
| | - B Ojha
- Department of Oral and Maxillofacial Pathology, Kantipur Dental College Teaching Hospital, Dhapasi, Kathmandu, Nepal
| | - P Bhandari
- Department of Oral and Maxillofacial Pathology, Kantipur Dental College Teaching Hospital, Dhapasi, Kathmandu, Nepal
| | - S Koju
- Department of Oral and Maxillofacial Pathology, Kantipur Dental College Teaching Hospital, Dhapasi, Kathmandu, Nepal
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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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6
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Shrestha R, Bhandari P, Shrestha P. Diversity in human major histocompatibility genes among ethnic groups of Nepal. Clin Chim Acta 2019. [DOI: 10.1016/j.cca.2019.03.1206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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7
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Rutter MD, Dolwani S, East J, Beckett C, Bhandari P, McKaig B, Phull P, Ragunath K, Saunders B, O'Toole P. Defining, recognizing and describing significant polyp and early colorectal cancer lesions. Colorectal Dis 2019; 21 Suppl 1:11-13. [PMID: 30809904 DOI: 10.1111/codi.14491] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Accepted: 09/23/2018] [Indexed: 02/08/2023]
Affiliation(s)
- M D Rutter
- Department of Gastroenterology, University Hospital of North Tees, Stockton-on-Tees, UK.,Northern Institute for Cancer Research, Newcastle University, Newcastle-upon-Tyne, UK
| | - S Dolwani
- Department of Gastroenterology, University Hospital of Wales, Cardiff, UK
| | - J East
- Translational Gastroenterology Unit, John Radcliffe Hospital, Oxford, UK
| | - C Beckett
- Gastroenterology, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - P Bhandari
- Gastroenterology, Portsmouth Hospital, Portsmouth, UK
| | - B McKaig
- Gastroenterology, Royal Wolverhampton NHS Trust, Wolverhampton, UK
| | - P Phull
- Gastrointestinal and Liver Service, Aberdeen Royal Infirmary, Aberdeeen, UK
| | - K Ragunath
- Faculty of Medicine and Health Sciences, University of Nottingham School of Medicine, Nottingham, UK
| | - B Saunders
- Wolfson Unit for Endoscopy, St Mark's Hospital and Imperial College London, Harrow, UK
| | - P O'Toole
- Gastroenterology, Royal Liverpool 45 3 and Broadgreen University Hospitals NHS Trust, Liverpool, UK
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8
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East JE, Bhandari P, Dolwani S, MacCarthy F, Rutter MD, Saunders BP. Endoscopic excision of significant polyp and early colorectal cancer lesions. Colorectal Dis 2019; 21 Suppl 1:37-40. [PMID: 30809912 DOI: 10.1111/codi.14493] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Accepted: 10/17/2018] [Indexed: 12/06/2022]
Affiliation(s)
- J E East
- Translational Gastroenterology Unit, Nuffield Department of Medicine, Oxford NIHR Biomedical Research Centre, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - P Bhandari
- Solent Centre for Digestive Diseases, Portsmouth, UK
| | - S Dolwani
- School of Medicine, Cardiff University, Cardiff, UK
| | - F MacCarthy
- Department of Gastroenterology, St James's Hospital, Dublin, Ireland
| | - M D Rutter
- Department of Gastroenterology, University Hospital of North Tees, Stockton-on-Tees, UK.,Northern Institute for Cancer Research, Newcastle University, Newcastle, UK
| | - B P Saunders
- St Mark's Hospital and Academic Institute, London, UK
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9
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Lognonné P, Banerdt WB, Giardini D, Pike WT, Christensen U, Laudet P, de Raucourt S, Zweifel P, Calcutt S, Bierwirth M, Hurst KJ, Ijpelaan F, Umland JW, Llorca-Cejudo R, Larson SA, Garcia RF, Kedar S, Knapmeyer-Endrun B, Mimoun D, Mocquet A, Panning MP, Weber RC, Sylvestre-Baron A, Pont G, Verdier N, Kerjean L, Facto LJ, Gharakanian V, Feldman JE, Hoffman TL, Klein DB, Klein K, Onufer NP, Paredes-Garcia J, Petkov MP, Willis JR, Smrekar SE, Drilleau M, Gabsi T, Nebut T, Robert O, Tillier S, Moreau C, Parise M, Aveni G, Ben Charef S, Bennour Y, Camus T, Dandonneau PA, Desfoux C, Lecomte B, Pot O, Revuz P, Mance D, tenPierick J, Bowles NE, Charalambous C, Delahunty AK, Hurley J, Irshad R, Liu H, Mukherjee AG, Standley IM, Stott AE, Temple J, Warren T, Eberhardt M, Kramer A, Kühne W, Miettinen EP, Monecke M, Aicardi C, André M, Baroukh J, Borrien A, Bouisset A, Boutte P, Brethomé K, Brysbaert C, Carlier T, Deleuze M, Desmarres JM, Dilhan D, Doucet C, Faye D, Faye-Refalo N, Gonzalez R, Imbert C, Larigauderie C, Locatelli E, Luno L, Meyer JR, Mialhe F, Mouret JM, Nonon M, Pahn Y, Paillet A, Pasquier P, Perez G, Perez R, Perrin L, Pouilloux B, Rosak A, Savin de Larclause I, Sicre J, Sodki M, Toulemont N, Vella B, Yana C, Alibay F, Avalos OM, Balzer MA, Bhandari P, Blanco E, Bone BD, Bousman JC, Bruneau P, Calef FJ, Calvet RJ, D’Agostino SA, de los Santos G, Deen RG, Denise RW, Ervin J, Ferraro NW, Gengl HE, Grinblat F, Hernandez D, Hetzel M, Johnson ME, Khachikyan L, Lin JY, Madzunkov SM, Marshall SL, Mikellides IG, Miller EA, Raff W, Singer JE, Sunday CM, Villalvazo JF, Wallace MC, Banfield D, Rodriguez-Manfredi JA, Russell CT, Trebi-Ollennu A, Maki JN, Beucler E, Böse M, Bonjour C, Berenguer JL, Ceylan S, Clinton J, Conejero V, Daubar I, Dehant V, Delage P, Euchner F, Estève I, Fayon L, Ferraioli L, Johnson CL, Gagnepain-Beyneix J, Golombek M, Khan A, Kawamura T, Kenda B, Labrot P, Murdoch N, Pardo C, Perrin C, Pou L, Sauron A, Savoie D, Stähler S, Stutzmann E, Teanby NA, Tromp J, van Driel M, Wieczorek M, Widmer-Schnidrig R, Wookey J. SEIS: Insight's Seismic Experiment for Internal Structure of Mars. Space Sci Rev 2019; 215:12. [PMID: 30880848 PMCID: PMC6394762 DOI: 10.1007/s11214-018-0574-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Accepted: 12/29/2018] [Indexed: 05/23/2023]
Abstract
UNLABELLED By the end of 2018, 42 years after the landing of the two Viking seismometers on Mars, InSight will deploy onto Mars' surface the SEIS (Seismic Experiment for Internal Structure) instrument; a six-axes seismometer equipped with both a long-period three-axes Very Broad Band (VBB) instrument and a three-axes short-period (SP) instrument. These six sensors will cover a broad range of the seismic bandwidth, from 0.01 Hz to 50 Hz, with possible extension to longer periods. Data will be transmitted in the form of three continuous VBB components at 2 sample per second (sps), an estimation of the short period energy content from the SP at 1 sps and a continuous compound VBB/SP vertical axis at 10 sps. The continuous streams will be augmented by requested event data with sample rates from 20 to 100 sps. SEIS will improve upon the existing resolution of Viking's Mars seismic monitoring by a factor of ∼ 2500 at 1 Hz and ∼ 200 000 at 0.1 Hz. An additional major improvement is that, contrary to Viking, the seismometers will be deployed via a robotic arm directly onto Mars' surface and will be protected against temperature and wind by highly efficient thermal and wind shielding. Based on existing knowledge of Mars, it is reasonable to infer a moment magnitude detection threshold of M w ∼ 3 at 40 ∘ epicentral distance and a potential to detect several tens of quakes and about five impacts per year. In this paper, we first describe the science goals of the experiment and the rationale used to define its requirements. We then provide a detailed description of the hardware, from the sensors to the deployment system and associated performance, including transfer functions of the seismic sensors and temperature sensors. We conclude by describing the experiment ground segment, including data processing services, outreach and education networks and provide a description of the format to be used for future data distribution. ELECTRONIC SUPPLEMENTARY MATERIAL The online version of this article (10.1007/s11214-018-0574-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- P. Lognonné
- Institut de Physique du Globe de Paris-Sorbonne Paris Cité, Université Paris Diderot (UMR 7154 CNRS), Planetology et Space Science Team, 35 Rue Hélène Brion, Paris, 75013 France
| | - W. B. Banerdt
- Jet Propulsion Laboratory, California Institute of Technology, Pasadena, CA 91109 USA
| | - D. Giardini
- Institut of Geophysics, ETHZ, Sonneggstrasse 5, 8092 Zurich, Switzerland
| | - W. T. Pike
- Department of Electrical and Electronic Engineering, Faculty of Engineering, Imperial College London, London, UK
| | - U. Christensen
- Department of Planets and Comets, Max Planck Institute for Solar System Research, Göttingen, Germany
| | - P. Laudet
- Centre National d’Etudes Spatiales, 18 av. Edouard Belin, 31401 Toulouse Cedex 9, France
| | - S. de Raucourt
- Institut de Physique du Globe de Paris-Sorbonne Paris Cité, Université Paris Diderot (UMR 7154 CNRS), Planetology et Space Science Team, 35 Rue Hélène Brion, Paris, 75013 France
| | - P. Zweifel
- Institut of Geophysics, ETHZ, Sonneggstrasse 5, 8092 Zurich, Switzerland
| | - S. Calcutt
- Atmospheric, Oceanic, & Planetary Physics, University of Oxford, Parks Road, Oxford, OX1 3PU UK
- Clarendon Laboratory, University of Oxford, Parks Road, Oxford, OX1 3PU UK
| | - M. Bierwirth
- Department of Planets and Comets, Max Planck Institute for Solar System Research, Göttingen, Germany
| | - K. J. Hurst
- Jet Propulsion Laboratory, California Institute of Technology, Pasadena, CA 91109 USA
| | - F. Ijpelaan
- Centre National d’Etudes Spatiales, 18 av. Edouard Belin, 31401 Toulouse Cedex 9, France
| | - J. W. Umland
- Jet Propulsion Laboratory, California Institute of Technology, Pasadena, CA 91109 USA
| | - R. Llorca-Cejudo
- Centre National d’Etudes Spatiales, 18 av. Edouard Belin, 31401 Toulouse Cedex 9, France
| | - S. A. Larson
- Jet Propulsion Laboratory, California Institute of Technology, Pasadena, CA 91109 USA
| | - R. F. Garcia
- ISAE-SUPAERO, Toulouse University, 10 Avenue E. Belin, 31400 Toulouse, France
| | - S. Kedar
- Jet Propulsion Laboratory, California Institute of Technology, Pasadena, CA 91109 USA
| | - B. Knapmeyer-Endrun
- Department of Planets and Comets, Max Planck Institute for Solar System Research, Göttingen, Germany
| | - D. Mimoun
- ISAE-SUPAERO, Toulouse University, 10 Avenue E. Belin, 31400 Toulouse, France
| | - A. Mocquet
- LPG Nantes, UMR6112, CNRS-Université de Nantes, 2 rue de la Houssinière, BP 92208, 44322 Nantes cedex 3, France
| | - M. P. Panning
- Jet Propulsion Laboratory, California Institute of Technology, Pasadena, CA 91109 USA
| | - R. C. Weber
- NASA Marshall Space Flight Center, 320 Sparkman Drive, Huntsville, AL 35805 USA
| | - A. Sylvestre-Baron
- Centre National d’Etudes Spatiales, 18 av. Edouard Belin, 31401 Toulouse Cedex 9, France
| | - G. Pont
- Centre National d’Etudes Spatiales, 18 av. Edouard Belin, 31401 Toulouse Cedex 9, France
| | - N. Verdier
- Centre National d’Etudes Spatiales, 18 av. Edouard Belin, 31401 Toulouse Cedex 9, France
| | - L. Kerjean
- Centre National d’Etudes Spatiales, 18 av. Edouard Belin, 31401 Toulouse Cedex 9, France
| | - L. J. Facto
- Jet Propulsion Laboratory, California Institute of Technology, Pasadena, CA 91109 USA
| | - V. Gharakanian
- Jet Propulsion Laboratory, California Institute of Technology, Pasadena, CA 91109 USA
| | - J. E. Feldman
- Jet Propulsion Laboratory, California Institute of Technology, Pasadena, CA 91109 USA
| | - T. L. Hoffman
- Jet Propulsion Laboratory, California Institute of Technology, Pasadena, CA 91109 USA
| | - D. B. Klein
- Jet Propulsion Laboratory, California Institute of Technology, Pasadena, CA 91109 USA
| | - K. Klein
- Jet Propulsion Laboratory, California Institute of Technology, Pasadena, CA 91109 USA
| | - N. P. Onufer
- Jet Propulsion Laboratory, California Institute of Technology, Pasadena, CA 91109 USA
| | - J. Paredes-Garcia
- Jet Propulsion Laboratory, California Institute of Technology, Pasadena, CA 91109 USA
| | - M. P. Petkov
- Jet Propulsion Laboratory, California Institute of Technology, Pasadena, CA 91109 USA
| | - J. R. Willis
- Jet Propulsion Laboratory, California Institute of Technology, Pasadena, CA 91109 USA
| | - S. E. Smrekar
- Jet Propulsion Laboratory, California Institute of Technology, Pasadena, CA 91109 USA
| | - M. Drilleau
- Institut de Physique du Globe de Paris-Sorbonne Paris Cité, Université Paris Diderot (UMR 7154 CNRS), Planetology et Space Science Team, 35 Rue Hélène Brion, Paris, 75013 France
| | - T. Gabsi
- Institut de Physique du Globe de Paris-Sorbonne Paris Cité, Université Paris Diderot (UMR 7154 CNRS), Planetology et Space Science Team, 35 Rue Hélène Brion, Paris, 75013 France
| | - T. Nebut
- Institut de Physique du Globe de Paris-Sorbonne Paris Cité, Université Paris Diderot (UMR 7154 CNRS), Planetology et Space Science Team, 35 Rue Hélène Brion, Paris, 75013 France
| | - O. Robert
- Institut de Physique du Globe de Paris-Sorbonne Paris Cité, Université Paris Diderot (UMR 7154 CNRS), Planetology et Space Science Team, 35 Rue Hélène Brion, Paris, 75013 France
| | - S. Tillier
- Institut de Physique du Globe de Paris-Sorbonne Paris Cité, Université Paris Diderot (UMR 7154 CNRS), Planetology et Space Science Team, 35 Rue Hélène Brion, Paris, 75013 France
| | - C. Moreau
- Institut de Physique du Globe de Paris-Sorbonne Paris Cité, Université Paris Diderot (UMR 7154 CNRS), Planetology et Space Science Team, 35 Rue Hélène Brion, Paris, 75013 France
| | - M. Parise
- Institut de Physique du Globe de Paris-Sorbonne Paris Cité, Université Paris Diderot (UMR 7154 CNRS), Planetology et Space Science Team, 35 Rue Hélène Brion, Paris, 75013 France
| | - G. Aveni
- Institut de Physique du Globe de Paris-Sorbonne Paris Cité, Université Paris Diderot (UMR 7154 CNRS), Planetology et Space Science Team, 35 Rue Hélène Brion, Paris, 75013 France
| | - S. Ben Charef
- Institut de Physique du Globe de Paris-Sorbonne Paris Cité, Université Paris Diderot (UMR 7154 CNRS), Planetology et Space Science Team, 35 Rue Hélène Brion, Paris, 75013 France
| | - Y. Bennour
- Institut de Physique du Globe de Paris-Sorbonne Paris Cité, Université Paris Diderot (UMR 7154 CNRS), Planetology et Space Science Team, 35 Rue Hélène Brion, Paris, 75013 France
| | - T. Camus
- Institut de Recherche en Astrophysique et Planétologie, UMR5277 CNRS - Université Toulouse III Paul Sabatier, 14, avenue Edouard Belin, 31400 Toulouse, France
| | - P. A. Dandonneau
- Institut de Physique du Globe de Paris-Sorbonne Paris Cité, Université Paris Diderot (UMR 7154 CNRS), Planetology et Space Science Team, 35 Rue Hélène Brion, Paris, 75013 France
| | - C. Desfoux
- Institut de Physique du Globe de Paris-Sorbonne Paris Cité, Université Paris Diderot (UMR 7154 CNRS), Planetology et Space Science Team, 35 Rue Hélène Brion, Paris, 75013 France
| | - B. Lecomte
- Institut de Physique du Globe de Paris-Sorbonne Paris Cité, Université Paris Diderot (UMR 7154 CNRS), Planetology et Space Science Team, 35 Rue Hélène Brion, Paris, 75013 France
- Present Address: Institut d’Astrophysique Spatiale, Université Paris-Sud, Bâtiment 121, 91405 Orsay Cedex, France
| | - O. Pot
- Institut de Physique du Globe de Paris-Sorbonne Paris Cité, Université Paris Diderot (UMR 7154 CNRS), Planetology et Space Science Team, 35 Rue Hélène Brion, Paris, 75013 France
- Present Address: Laboratoire de Mécanique et d’Acoustique, LMA - UMR 7031 AMU - CNRS - Centrale Marseille, 4 impasse Nikola Tesla, CS 40006, 13453 Marseille Cedex 13, France
| | - P. Revuz
- Institut de Physique du Globe de Paris-Sorbonne Paris Cité, Université Paris Diderot (UMR 7154 CNRS), Planetology et Space Science Team, 35 Rue Hélène Brion, Paris, 75013 France
| | - D. Mance
- Institut of Geophysics, ETHZ, Sonneggstrasse 5, 8092 Zurich, Switzerland
| | - J. tenPierick
- Institut of Geophysics, ETHZ, Sonneggstrasse 5, 8092 Zurich, Switzerland
| | - N. E. Bowles
- Atmospheric, Oceanic, & Planetary Physics, University of Oxford, Parks Road, Oxford, OX1 3PU UK
- Clarendon Laboratory, University of Oxford, Parks Road, Oxford, OX1 3PU UK
| | - C. Charalambous
- Department of Electrical and Electronic Engineering, Faculty of Engineering, Imperial College London, London, UK
| | - A. K. Delahunty
- Department of Electrical and Electronic Engineering, Faculty of Engineering, Imperial College London, London, UK
- Present Address: Advanced Technology and Research, Arup, 13 Fitzroy Street, London, W1T 4BQ UK
| | - J. Hurley
- Atmospheric, Oceanic, & Planetary Physics, University of Oxford, Parks Road, Oxford, OX1 3PU UK
- Clarendon Laboratory, University of Oxford, Parks Road, Oxford, OX1 3PU UK
- RAL Space, STFC Rutherford Appleton Laboratory, Harwell Science and Innovation Campus, Didcot, OX11 0QX UK
| | - R. Irshad
- RAL Space, STFC Rutherford Appleton Laboratory, Harwell Science and Innovation Campus, Didcot, OX11 0QX UK
| | - Huafeng Liu
- Department of Electrical and Electronic Engineering, Faculty of Engineering, Imperial College London, London, UK
- Present Address: Center for Gravitational Experiments, Huazhong University of Science and Technology, 1037 Luoyu Rd, Wuhan, 430074 P.R. China
| | - A. G. Mukherjee
- Department of Electrical and Electronic Engineering, Faculty of Engineering, Imperial College London, London, UK
| | | | - A. E. Stott
- Department of Electrical and Electronic Engineering, Faculty of Engineering, Imperial College London, London, UK
| | - J. Temple
- Atmospheric, Oceanic, & Planetary Physics, University of Oxford, Parks Road, Oxford, OX1 3PU UK
- Clarendon Laboratory, University of Oxford, Parks Road, Oxford, OX1 3PU UK
| | - T. Warren
- Atmospheric, Oceanic, & Planetary Physics, University of Oxford, Parks Road, Oxford, OX1 3PU UK
- Clarendon Laboratory, University of Oxford, Parks Road, Oxford, OX1 3PU UK
| | - M. Eberhardt
- Department of Planets and Comets, Max Planck Institute for Solar System Research, Göttingen, Germany
| | - A. Kramer
- Department of Planets and Comets, Max Planck Institute for Solar System Research, Göttingen, Germany
| | - W. Kühne
- Department of Planets and Comets, Max Planck Institute for Solar System Research, Göttingen, Germany
| | - E.-P. Miettinen
- Department of Planets and Comets, Max Planck Institute for Solar System Research, Göttingen, Germany
| | - M. Monecke
- Department of Planets and Comets, Max Planck Institute for Solar System Research, Göttingen, Germany
| | - C. Aicardi
- Centre National d’Etudes Spatiales, 18 av. Edouard Belin, 31401 Toulouse Cedex 9, France
| | - M. André
- Centre National d’Etudes Spatiales, 18 av. Edouard Belin, 31401 Toulouse Cedex 9, France
| | - J. Baroukh
- Centre National d’Etudes Spatiales, 18 av. Edouard Belin, 31401 Toulouse Cedex 9, France
| | - A. Borrien
- Centre National d’Etudes Spatiales, 18 av. Edouard Belin, 31401 Toulouse Cedex 9, France
| | - A. Bouisset
- Centre National d’Etudes Spatiales, 18 av. Edouard Belin, 31401 Toulouse Cedex 9, France
| | - P. Boutte
- Centre National d’Etudes Spatiales, 18 av. Edouard Belin, 31401 Toulouse Cedex 9, France
| | - K. Brethomé
- Centre National d’Etudes Spatiales, 18 av. Edouard Belin, 31401 Toulouse Cedex 9, France
| | - C. Brysbaert
- Centre National d’Etudes Spatiales, 18 av. Edouard Belin, 31401 Toulouse Cedex 9, France
| | - T. Carlier
- Centre National d’Etudes Spatiales, 18 av. Edouard Belin, 31401 Toulouse Cedex 9, France
| | - M. Deleuze
- Centre National d’Etudes Spatiales, 18 av. Edouard Belin, 31401 Toulouse Cedex 9, France
| | - J. M. Desmarres
- Centre National d’Etudes Spatiales, 18 av. Edouard Belin, 31401 Toulouse Cedex 9, France
| | - D. Dilhan
- Centre National d’Etudes Spatiales, 18 av. Edouard Belin, 31401 Toulouse Cedex 9, France
| | - C. Doucet
- Centre National d’Etudes Spatiales, 18 av. Edouard Belin, 31401 Toulouse Cedex 9, France
| | - D. Faye
- Centre National d’Etudes Spatiales, 18 av. Edouard Belin, 31401 Toulouse Cedex 9, France
| | - N. Faye-Refalo
- Centre National d’Etudes Spatiales, 18 av. Edouard Belin, 31401 Toulouse Cedex 9, France
| | - R. Gonzalez
- Centre National d’Etudes Spatiales, 18 av. Edouard Belin, 31401 Toulouse Cedex 9, France
| | - C. Imbert
- Centre National d’Etudes Spatiales, 18 av. Edouard Belin, 31401 Toulouse Cedex 9, France
| | - C. Larigauderie
- Centre National d’Etudes Spatiales, 18 av. Edouard Belin, 31401 Toulouse Cedex 9, France
| | - E. Locatelli
- Centre National d’Etudes Spatiales, 18 av. Edouard Belin, 31401 Toulouse Cedex 9, France
| | - L. Luno
- Centre National d’Etudes Spatiales, 18 av. Edouard Belin, 31401 Toulouse Cedex 9, France
| | - J.-R. Meyer
- Centre National d’Etudes Spatiales, 18 av. Edouard Belin, 31401 Toulouse Cedex 9, France
| | - F. Mialhe
- Centre National d’Etudes Spatiales, 18 av. Edouard Belin, 31401 Toulouse Cedex 9, France
| | - J. M. Mouret
- Centre National d’Etudes Spatiales, 18 av. Edouard Belin, 31401 Toulouse Cedex 9, France
| | - M. Nonon
- Centre National d’Etudes Spatiales, 18 av. Edouard Belin, 31401 Toulouse Cedex 9, France
| | - Y. Pahn
- Centre National d’Etudes Spatiales, 18 av. Edouard Belin, 31401 Toulouse Cedex 9, France
| | - A. Paillet
- Centre National d’Etudes Spatiales, 18 av. Edouard Belin, 31401 Toulouse Cedex 9, France
| | - P. Pasquier
- Centre National d’Etudes Spatiales, 18 av. Edouard Belin, 31401 Toulouse Cedex 9, France
| | - G. Perez
- Centre National d’Etudes Spatiales, 18 av. Edouard Belin, 31401 Toulouse Cedex 9, France
| | - R. Perez
- Centre National d’Etudes Spatiales, 18 av. Edouard Belin, 31401 Toulouse Cedex 9, France
| | - L. Perrin
- Centre National d’Etudes Spatiales, 18 av. Edouard Belin, 31401 Toulouse Cedex 9, France
| | - B. Pouilloux
- Centre National d’Etudes Spatiales, 18 av. Edouard Belin, 31401 Toulouse Cedex 9, France
| | - A. Rosak
- Centre National d’Etudes Spatiales, 18 av. Edouard Belin, 31401 Toulouse Cedex 9, France
| | - I. Savin de Larclause
- Centre National d’Etudes Spatiales, 18 av. Edouard Belin, 31401 Toulouse Cedex 9, France
| | - J. Sicre
- Centre National d’Etudes Spatiales, 18 av. Edouard Belin, 31401 Toulouse Cedex 9, France
| | - M. Sodki
- Centre National d’Etudes Spatiales, 18 av. Edouard Belin, 31401 Toulouse Cedex 9, France
| | - N. Toulemont
- Centre National d’Etudes Spatiales, 18 av. Edouard Belin, 31401 Toulouse Cedex 9, France
| | - B. Vella
- Centre National d’Etudes Spatiales, 18 av. Edouard Belin, 31401 Toulouse Cedex 9, France
| | - C. Yana
- Centre National d’Etudes Spatiales, 18 av. Edouard Belin, 31401 Toulouse Cedex 9, France
| | - F. Alibay
- Jet Propulsion Laboratory, California Institute of Technology, Pasadena, CA 91109 USA
| | - O. M. Avalos
- Jet Propulsion Laboratory, California Institute of Technology, Pasadena, CA 91109 USA
| | - M. A. Balzer
- Jet Propulsion Laboratory, California Institute of Technology, Pasadena, CA 91109 USA
| | - P. Bhandari
- Jet Propulsion Laboratory, California Institute of Technology, Pasadena, CA 91109 USA
| | - E. Blanco
- Jet Propulsion Laboratory, California Institute of Technology, Pasadena, CA 91109 USA
| | - B. D. Bone
- Jet Propulsion Laboratory, California Institute of Technology, Pasadena, CA 91109 USA
| | - J. C. Bousman
- Jet Propulsion Laboratory, California Institute of Technology, Pasadena, CA 91109 USA
| | - P. Bruneau
- Jet Propulsion Laboratory, California Institute of Technology, Pasadena, CA 91109 USA
| | - F. J. Calef
- Jet Propulsion Laboratory, California Institute of Technology, Pasadena, CA 91109 USA
| | - R. J. Calvet
- Jet Propulsion Laboratory, California Institute of Technology, Pasadena, CA 91109 USA
| | - S. A. D’Agostino
- Jet Propulsion Laboratory, California Institute of Technology, Pasadena, CA 91109 USA
| | - G. de los Santos
- Jet Propulsion Laboratory, California Institute of Technology, Pasadena, CA 91109 USA
| | - R. G. Deen
- Jet Propulsion Laboratory, California Institute of Technology, Pasadena, CA 91109 USA
| | - R. W. Denise
- Jet Propulsion Laboratory, California Institute of Technology, Pasadena, CA 91109 USA
| | - J. Ervin
- Jet Propulsion Laboratory, California Institute of Technology, Pasadena, CA 91109 USA
| | - N. W. Ferraro
- Jet Propulsion Laboratory, California Institute of Technology, Pasadena, CA 91109 USA
| | - H. E. Gengl
- Jet Propulsion Laboratory, California Institute of Technology, Pasadena, CA 91109 USA
| | - F. Grinblat
- Jet Propulsion Laboratory, California Institute of Technology, Pasadena, CA 91109 USA
| | - D. Hernandez
- Jet Propulsion Laboratory, California Institute of Technology, Pasadena, CA 91109 USA
| | - M. Hetzel
- Jet Propulsion Laboratory, California Institute of Technology, Pasadena, CA 91109 USA
| | - M. E. Johnson
- Jet Propulsion Laboratory, California Institute of Technology, Pasadena, CA 91109 USA
| | - L. Khachikyan
- Jet Propulsion Laboratory, California Institute of Technology, Pasadena, CA 91109 USA
| | - J. Y. Lin
- Jet Propulsion Laboratory, California Institute of Technology, Pasadena, CA 91109 USA
| | - S. M. Madzunkov
- Jet Propulsion Laboratory, California Institute of Technology, Pasadena, CA 91109 USA
| | - S. L. Marshall
- Jet Propulsion Laboratory, California Institute of Technology, Pasadena, CA 91109 USA
| | - I. G. Mikellides
- Jet Propulsion Laboratory, California Institute of Technology, Pasadena, CA 91109 USA
| | - E. A. Miller
- Jet Propulsion Laboratory, California Institute of Technology, Pasadena, CA 91109 USA
| | - W. Raff
- Jet Propulsion Laboratory, California Institute of Technology, Pasadena, CA 91109 USA
| | - J. E. Singer
- Jet Propulsion Laboratory, California Institute of Technology, Pasadena, CA 91109 USA
| | - C. M. Sunday
- Jet Propulsion Laboratory, California Institute of Technology, Pasadena, CA 91109 USA
| | - J. F. Villalvazo
- Jet Propulsion Laboratory, California Institute of Technology, Pasadena, CA 91109 USA
| | - M. C. Wallace
- Jet Propulsion Laboratory, California Institute of Technology, Pasadena, CA 91109 USA
| | - D. Banfield
- Cornell Center for Astrophysics and Planetary Science, Cornell University, Ithaca, NY USA
| | | | - C. T. Russell
- Earth, Planetary and Space Sciences, University of California, Los Angeles, Los Angeles, USA
| | - A. Trebi-Ollennu
- Jet Propulsion Laboratory, California Institute of Technology, Pasadena, CA 91109 USA
| | - J. N. Maki
- Jet Propulsion Laboratory, California Institute of Technology, Pasadena, CA 91109 USA
| | - E. Beucler
- LPG Nantes, UMR6112, CNRS-Université de Nantes, 2 rue de la Houssinière, BP 92208, 44322 Nantes cedex 3, France
| | - M. Böse
- Swiss Seismological Service, ETHZ, Sonneggstrasse 5, 8092 Zurich, Switzerland
| | - C. Bonjour
- Institut of Geophysics, ETHZ, Sonneggstrasse 5, 8092 Zurich, Switzerland
| | - J. L. Berenguer
- Geoazur, University Cote d’Azur, 250 rue Einstein, 06560 Valbonne, France
| | - S. Ceylan
- Institut of Geophysics, ETHZ, Sonneggstrasse 5, 8092 Zurich, Switzerland
| | - J. Clinton
- Swiss Seismological Service, ETHZ, Sonneggstrasse 5, 8092 Zurich, Switzerland
| | - V. Conejero
- Département de Sismologie, Institut de Physique du Globe de Paris-Sorbonne Paris Cité, UMR 7154 CNRS - Université Paris Diderot, 1 Rue Jussieu, Paris Cedex, 75238 France
| | - I. Daubar
- Jet Propulsion Laboratory, California Institute of Technology, Pasadena, CA 91109 USA
| | - V. Dehant
- Royal Observatory of Belgium, 3 avenue Circulaire, 1180 Brussels, Belgium
| | - P. Delage
- Laboratoire Navier (CERMES), Ecole des Ponts ParisTech, Marne la Vallée, France
| | - F. Euchner
- Institut of Geophysics, ETHZ, Sonneggstrasse 5, 8092 Zurich, Switzerland
| | - I. Estève
- Institut de Minéralogie et de Physique des Matériaux et de Cosmochimie, Case courrier 115, 4 Place Jussieu, 75252 Paris Cedex 05, France
| | - L. Fayon
- Institut de Physique du Globe de Paris-Sorbonne Paris Cité, Université Paris Diderot (UMR 7154 CNRS), Planetology et Space Science Team, 35 Rue Hélène Brion, Paris, 75013 France
| | - L. Ferraioli
- Institut of Geophysics, ETHZ, Sonneggstrasse 5, 8092 Zurich, Switzerland
| | - C. L. Johnson
- University of British Columbia, Vancouver, BC Canada
- Planetary Science Institute, Tucson, AZ USA
| | - J. Gagnepain-Beyneix
- Institut de Physique du Globe de Paris-Sorbonne Paris Cité, Université Paris Diderot (UMR 7154 CNRS), Planetology et Space Science Team, 35 Rue Hélène Brion, Paris, 75013 France
| | - M. Golombek
- Jet Propulsion Laboratory, California Institute of Technology, Pasadena, CA 91109 USA
| | - A. Khan
- Institut of Geophysics, ETHZ, Sonneggstrasse 5, 8092 Zurich, Switzerland
| | - T. Kawamura
- Institut de Physique du Globe de Paris-Sorbonne Paris Cité, Université Paris Diderot (UMR 7154 CNRS), Planetology et Space Science Team, 35 Rue Hélène Brion, Paris, 75013 France
| | - B. Kenda
- Institut de Physique du Globe de Paris-Sorbonne Paris Cité, Université Paris Diderot (UMR 7154 CNRS), Planetology et Space Science Team, 35 Rue Hélène Brion, Paris, 75013 France
| | - P. Labrot
- Institut de Physique du Globe de Paris-Sorbonne Paris Cité, Université Paris Diderot (UMR 7154 CNRS), Planetology et Space Science Team, 35 Rue Hélène Brion, Paris, 75013 France
| | - N. Murdoch
- ISAE-SUPAERO, Toulouse University, 10 Avenue E. Belin, 31400 Toulouse, France
| | - C. Pardo
- Département de Sismologie, Institut de Physique du Globe de Paris-Sorbonne Paris Cité, UMR 7154 CNRS - Université Paris Diderot, 1 Rue Jussieu, Paris Cedex, 75238 France
| | - C. Perrin
- Institut de Physique du Globe de Paris-Sorbonne Paris Cité, Université Paris Diderot (UMR 7154 CNRS), Planetology et Space Science Team, 35 Rue Hélène Brion, Paris, 75013 France
| | - L. Pou
- ISAE-SUPAERO, Toulouse University, 10 Avenue E. Belin, 31400 Toulouse, France
| | - A. Sauron
- Institut of Geophysics, ETHZ, Sonneggstrasse 5, 8092 Zurich, Switzerland
| | - D. Savoie
- SYRTE, Observatoire de Paris, Université PSL, CNRS, Sorbonne Université, LNE, 61 avenue de l’Observatoire, 75014 Paris, France
| | - S. Stähler
- Institut of Geophysics, ETHZ, Sonneggstrasse 5, 8092 Zurich, Switzerland
| | - E. Stutzmann
- Département de Sismologie, Institut de Physique du Globe de Paris-Sorbonne Paris Cité, UMR 7154 CNRS - Université Paris Diderot, 1 Rue Jussieu, Paris Cedex, 75238 France
| | - N. A. Teanby
- School of Earth Sciences, University of Bristol, Wills Memorial Building, Queens Road, Bristol, BS8 1RJ UK
| | - J. Tromp
- Department of Geosciences, Princeton University, Guyot Hall, Princeton, NJ 08544 USA
| | - M. van Driel
- Institut of Geophysics, ETHZ, Sonneggstrasse 5, 8092 Zurich, Switzerland
| | - M. Wieczorek
- Observatoire de la Côte d’Azur, Boulevard de l’Observatoire, CS 34229, 06304 Nice Cedex 4, France
| | - R. Widmer-Schnidrig
- Black Forest Observatory, Karlsruhe Institute of Technology and Stuttgart University, Heubach 206, 77709 Wolfach, Germany
| | - J. Wookey
- School of Earth Sciences, University of Bristol, Wills Memorial Building, Queens Road, Bristol, BS8 1RJ UK
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Colwell E, Bhandari P, Benson J, He H, Lui N, Berry M, Shrager J, Backhus L. P2.15-06 Examination of Optimal Timing of Post-Surgical Surveillance for Early Stage Lung Cancer Patients and Association with Outcomes. J Thorac Oncol 2018. [DOI: 10.1016/j.jtho.2018.08.1447] [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: 10/28/2022]
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Pompili C, Edwards M, Hasegawa S, Yoshino I, Chida M, Novoa N, Brunelli A, Bhandari P, Naunheim K, Backhus L. P2.15-21 Post Resection Lung Cancer Surveillance: Comparisons of Practice Between STS, ESTS and JACS Members. J Thorac Oncol 2018. [DOI: 10.1016/j.jtho.2018.08.1463] [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: 11/30/2022]
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Sharma KR, Bhandari P, Adhikari N, Tripathi P, Khanal S, Tiwari BR. Extended Spectrum β-lactamase (ESBL) Producing Multi Drug Resistant (MDR) Urinary Pathogens in a Children Hospital from Nepal. Kathmandu Univ Med J (KUMJ) 2018; 16:151-155. [PMID: 30636756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Background Multidrug resistant in clinical bacterial isolates has increasingly been reported through out the world and is associated with high morbidity, mortality and increased health care costs. It is important to determine the status of multidrug resistance pattern to understand the current resistance trend so that appropriate antibiotics can be used in practice. Objective To determine the antibiotic resistant profile and prevalence of extended spectrum β-lactamase producing multidrug resistant strains in pediatric patients of Kanti Children's Hospital, Kathmandu, Nepal. Method Urine sample was cultured by standard microbiological techniques and bacterial isolates were identified using different biochemical tests. Antibiotic susceptibility testing was performed by Kirby Bauer disc diffusion method and extended spectrum β-lactamase detection was carried out using combined disc method as recommended by Clinical Laboratory Standard Institute guidelines. Result All together 65 different bacteria were isolated and subsequently identified. E. coli was the most common isolate with 46 (71%) isolates 63% of these isolates were multidrug resistant. Gram negative isolates were most resistant to nalidixic acid (81.97%) followed by ampicillin (69.35%) and co-trimoxazole (69.35%). The extended spectrum β-lactamase producing isolates were 43% among total isolates. Conclusion Higher rate of Extended Spectrum β-lactamase production among multidrug resistant isolates suggested routine extended spectrum β-lactamase testing in clinical isolates.
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Affiliation(s)
- K R Sharma
- Department of Microbiology, Kantipur College of Medical Sciences, Kathmandu, Nepal
| | - P Bhandari
- Department of Microbiology, National College (NIST), Kathmandu, Nepal
| | - N Adhikari
- Department of Microbiology, Kantipur College of Medical Sciences, Kathmandu, Nepal
| | - P Tripathi
- Department of Pathology Laboratory, Kanti Children's Hospital, Kathmandu, Nepal
| | - S Khanal
- Department of Microbiology, National College (NIST), Kathmandu, Nepal
| | - B R Tiwari
- School of Health and Allied Sciences, Pokhara University, Pokhara, Nepal
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Subramaniam S, Kandiah K, Chedgy F, Meredith P, Longcroft-Wheaton G, Bhandari P. The safety and efficacy of radiofrequency ablation following endoscopic submucosal dissection for Barrett's neoplasia. Dis Esophagus 2018; 31:4683665. [PMID: 29211875 DOI: 10.1093/dote/dox133] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Indexed: 12/11/2022]
Abstract
The current standard of treating early Barrett's neoplasia is resection of visible lesions using endoscopic mucosal resection (EMR) followed by ablative therapy to the Barrett's segment. There is increasing evidence to support the use of endoscopic submucosal dissection (ESD) where en-bloc resection and lower recurrence rates may be achieved. However, ESD is associated with deep submucosal dissection when compared to EMR. This may increase the risk of complications including stricture formation with subsequent radiofrequency ablation (RFA) therapy. The aim of this study is to compare the safety and efficacy of RFA following EMR and ESD as well as when RFA was used without prior endoscopic resection. The primary outcome measure was complication rates. Clearance of dysplasia (CRD) and clearance of intestinal metaplasia (CRIM) were secondary outcomes. A retrospective analysis of a cohort of 91 patients referred for RFA from a single academic tertiary center was performed. The choice of endoscopic resection method was tailored according to the lesion type and morphology. Focal and circumferential ablation was performed after initial follow up endoscopy postresection. Patients proceeded straight to RFA in the absence of any visible lesions. In this study, the ESD group had a higher proportion of cancers compared to the EMR cohort (74.1% vs. 30.2%, P < 0.01) prior to RFA. All complications post RFA occurred in the groups with previous endoscopic resection. There was no significant difference in the total complication rate (7.4% vs. 9.3%, P = 0.78) and stricture formation rate (3.7% vs. 9.3%, P = 0.38) between the ESD and EMR groups. CRD was achieved in 96.3% in the ESD group, 88.4% in the EMR group, and all patients in the RFA alone group. CRIM rates were similar in the EMR and ESD groups (81.4% vs. 85.2%) but higher in the RFA alone group (90.5%). In conclusion, RFA following ESD is very effective and not associated with an increased risk of complications compared to EMR. This supports the application of RFA in the treatment algorithm of patients undergoing ESD for Barrett's neoplasia.
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Affiliation(s)
| | | | | | - P Meredith
- Research & Innovation, Queen Alexandra Hospital, Portsmouth, United Kingdom
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Backhus L, Bhandari P, Pompili C, Brunelli A, Novoa N, Naunheim K, Edwards M. OA 04.06 Surgeon Practices for Post Resection Lung Cancer Surveillance: Comparisons of STS and ESTS Members. J Thorac Oncol 2017. [DOI: 10.1016/j.jtho.2017.09.344] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Maurya R, Chaudhary A, Kumar A, Bhandari P. Study of neck shaft angle and femoral length in dry femora of Uttarakhand Region. J ANAT SOC INDIA 2017. [DOI: 10.1016/j.jasi.2017.08.349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Bhandari P, Chaudhary A, Kumar A, Maurya R. Anatomical variations of sacral hiatus of Uttarakhand region. J ANAT SOC INDIA 2017. [DOI: 10.1016/j.jasi.2017.08.344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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17
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Basford P, Longcroft-Wheaton G, Higashi R, Uraoka T, Bhandari P. Colonic lesion characterisation skills among UK endoscopists and the impact of a brief training intervention. Frontline Gastroenterol 2017; 8:2-7. [PMID: 28839877 PMCID: PMC5369455 DOI: 10.1136/flgastro-2016-100689] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Revised: 04/17/2016] [Accepted: 05/10/2016] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVE To assess UK gastroenterology registrars' and consultants' competence in in vivo characterisation of polyps, plus the impact of a dedicated colonic lesion characterisation training intervention. DESIGN Prospective evaluation of a computer-based colonic lesion training module. SETTING Three UK general hospitals. PATIENTS High-quality endoscopic images obtained during colonoscopy in a previous study. INTERVENTIONS 30 min computer-based training module covering in vivo characterisation of colonic lesions viewed under white light, chromoendoscopy and magnification chromoendoscopy. MAIN OUTCOME MEASURES Accuracy of characterisation of colonic lesions (hyperplastic vs adenoma vs cancer) before and after training and differences between groups (bowel cancer screening (BCS) nurses vs gastroenterology trainees vs consultant gastroenterologists). RESULTS Mean accuracy pretraining was 61.1%, 67.6% and 60.0% for the trainee, consultant and nurse groups respectively with no significant difference between the groups. Mean accuracy post-training improved significantly to 71.2%, 72.6% and 67.2% for the trainee, consultant and nurse groups (p<0.001 vs pretraining) with no significant difference between the three groups. Mean sensitivity and specificity improved significantly for the 15 participants overall. CONCLUSIONS The baseline level of colonic lesion characterisation skills is limited for gastroenterology consultants and trainees and does not differ from that of non-endoscopist BCS nurses. Accuracy of lesion characterisation can be modestly improved with a brief computer-based training intervention. Lesion characterisation should become a standard part of training in colonoscopy, and should be learnt alongside technical skills for endoscope handing and therapeutic procedures.
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Affiliation(s)
- P Basford
- Department of Gastroenterology, Queen Alexandra Hospital, Hampshire, UK
| | | | - Reiji Higashi
- Department of Internal Medicine, Hiroshima City Hospital, Hiroshima, Japan
| | - Toshio Uraoka
- Department of Gastroenterology, National Hospital Organization, Tokyo Medical Center, Tokyo, Japan
| | - P Bhandari
- Department of Gastroenterology, Queen Alexandra Hospital, Hampshire, UK
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Bhandari P, Meenakshi, Rajesh, Rai M. management of black scurf disease of potato (solanum tuberosum l.) with effective fungicide thifluzamide 24%sc. ACTA ACUST UNITED AC 2017. [DOI: 10.5958/0976-4623.2016.00042.6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Chattree A, Barbour JA, Thomas-Gibson S, Bhandari P, Saunders BP, Veitch AM, Anderson J, Rembacken BJ, Loughrey MB, Pullan R, Garrett WV, Lewis G, Dolwani S, Rutter MD. Report of the Association of Coloproctology of Great Britain and Ireland/British Society of Gastroenterology Colorectal Polyp Working Group: the development of a complex colorectal polyp minimum dataset. Colorectal Dis 2017; 19:67-75. [PMID: 27610599 DOI: 10.1111/codi.13504] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Accepted: 07/04/2016] [Indexed: 02/08/2023]
Abstract
AIM The management of large non-pedunculated colorectal polyps (LNPCPs) is complex, with widespread variation in management and outcome, even amongst experienced clinicians. Variations in the assessment and decision-making processes are likely to be a major factor in this variability. The creation of a standardized minimum dataset to aid decision-making may therefore result in improved clinical management. METHOD An official working group of 13 multidisciplinary specialists was appointed by the Association of Coloproctology of Great Britain and Ireland (ACPGBI) and the British Society of Gastroenterology (BSG) to develop a minimum dataset on LNPCPs. The literature review used to structure the ACPGBI/BSG guidelines for the management of LNPCPs was used by a steering subcommittee to identify various parameters pertaining to the decision-making processes in the assessment and management of LNPCPs. A modified Delphi consensus process was then used for voting on proposed parameters over multiple voting rounds with at least 80% agreement defined as consensus. The minimum dataset was used in a pilot process to ensure rigidity and usability. RESULTS A 23-parameter minimum dataset with parameters relating to patient and lesion factors, including six parameters relating to image retrieval, was formulated over four rounds of voting with two pilot processes to test rigidity and usability. CONCLUSION This paper describes the development of the first reported evidence-based and expert consensus minimum dataset for the management of LNPCPs. It is anticipated that this dataset will allow comprehensive and standardized lesion assessment to improve decision-making in the assessment and management of LNPCPs.
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Affiliation(s)
- A Chattree
- Department of Gastroenterology, University Hospital of North Tees, Stockton on Tees, UK.,University School of Medicine, Pharmacy and Health, Durham University, Stockton on Tees, UK
| | - J A Barbour
- Department of Gastroenterology, Queen Elizabeth Hospital, Gateshead, UK
| | | | - P Bhandari
- Department of Gastroenterology, Queen Alexandra Hospital, Portsmouth, UK
| | - B P Saunders
- Wolfson Unit for Endoscopy, St Mark's Hospital, London, UK
| | - A M Veitch
- Department of Gastroenterology, New Cross Hospital, Wolverhampton, UK
| | - J Anderson
- Department of Gastroenterology, Cheltenham General Hospital, Cheltenham, UK
| | - B J Rembacken
- Department of Gastroenterology, Leeds General Infirmary, Leeds, UK
| | - M B Loughrey
- Department of Histopathology, Royal Victoria Hospital, Belfast, UK
| | - R Pullan
- Department of Colorectal Surgery, Torbay Hospital, Torquay, UK
| | - W V Garrett
- Department of Colorectal Surgery, Medway Maritime Hospital, Gillingham, UK
| | - G Lewis
- Department of Gastroenterology, University Hospital Llandough, Cardiff, UK
| | - S Dolwani
- Department of Gastroenterology, University Hospital Llandough, Cardiff, UK
| | - M D Rutter
- Department of Gastroenterology, University Hospital of North Tees, Stockton on Tees, UK.,University School of Medicine, Pharmacy and Health, Durham University, Stockton on Tees, UK
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20
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Hassan C, Repici A, Sharma P, Correale L, Zullo A, Bretthauer M, Senore C, Spada C, Bellisario C, Bhandari P, Rex DK. Efficacy and safety of endoscopic resection of large colorectal polyps: a systematic review and meta-analysis. Gut 2016; 65:806-20. [PMID: 25681402 DOI: 10.1136/gutjnl-2014-308481] [Citation(s) in RCA: 252] [Impact Index Per Article: 31.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Accepted: 01/20/2015] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To assess the efficacy and safety of endoscopic resection of large colorectal polyps. DESIGN Relevant publications were identified in MEDLINE/EMBASE/Cochrane Central Register for the period 1966-2014. Studies in which ≥20 mm colorectal neoplastic lesions were treated with endoscopic resection were included. Rates of postendoscopic resection surgery due to non-curative resection or adverse events, as well as the rates of complete endoscopic removal, invasive cancer, adverse events, recurrence and mortality, were extracted. Study quality was ascertained according to Newcastle-Ottawa Scale. Forest plot was produced based on random effect models. I2 statistic was used to describe the variation across studies due to heterogeneity. Meta-regression analysis was also performed. RESULTS 50 studies including 6442 patients and 6779 large polyps were included in the analyses. Overall, 503 out of 6442 patients (pooled rate: 8%, 95% CI 7% to 10%, I2=78.6%) underwent surgery due to non-curative endoscopic resection, and 31/6442 (pooled rate: 1%, 95% CI 0.7% to 1.4%, I2=0%) to adverse events. Invasive cancer at histology, non-curative endoscopic resection, synchronous lesions and recurrence accounted for 58%, 28%, 2.2% and 5.9% of all the surgeries, respectively. Endoscopic perforation occurred in 96/6595 (1.5%, 95% CI 1.2% to 1.7%) polyps, while bleeding in 423/6474 (6.5%, 95% CI 5.9% to 7.1%). Overall, 5334 patients entered in surveillance, 502/5836 (8.6%, 95% CI 7.9% to 9.3%) being lost at follow-up. Endoscopic recurrence was detected in 735/5334 patients (13.8%, 95% CI 12.9% to 14.7%), being an invasive cancer in 14/5334 (0.3%, 95% CI 0.1% to 0.4%). Endoscopic treatment was successful in 664/735 cases (90.3%, 95% CI 88.2% to 92.5%). Mortality related with management of large polyps was reported in 5/6278 cases (0.08%, 95% CI 0.01% to 0.15%). CONCLUSIONS Endoscopic resection of large polyps appeared to be an extremely effective and safe intervention. However, an adequate endoscopic surveillance is necessary for its long-term efficacy.
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Affiliation(s)
- C Hassan
- Endoscopy Unit, 'Nuovo Regina Margherita Hospital', Rome, Italy
| | - A Repici
- Digestive Endoscopy Unit, Istituto Clinico Humanitas, Milan, Italy
| | - P Sharma
- Division of Gastroenterology and Hepatology, Veterans Affairs Medical Center and University of Kansas School of Medicine, Kansas City, Kansas, USA
| | | | - A Zullo
- Endoscopy Unit, 'Nuovo Regina Margherita Hospital', Rome, Italy
| | - M Bretthauer
- Department of Health Economy and Health Management, University of Oslo, Oslo, Norway Gastroenterology Unit, Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway
| | - C Senore
- AOU S Giovanni Battista-CPO Piemonte, SCDO Epidemiologia dei Tumori 2, Turin, Italy
| | - C Spada
- Digestive Endoscopy Unit, Catholic University, Rome, Italy
| | | | - P Bhandari
- Division of Gastroenterology/Hepatology, Indiana University Medical Center, Indianapolis, Indiana, USA
| | - D K Rex
- Division of Gastroenterology/Hepatology, Indiana University Medical Center, Indianapolis, Indiana, USA
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21
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Bhandari P, Hamal R, Shrestha A. Sideroblastic anemia. J Pathol Nep 2016. [DOI: 10.3126/jpn.v6i11.15695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Sideroblastic anemias are a heterogenous group of disorders that have as a common feature with the presence of ringed sideroblasts in the marrow. We present a case of young female, nursing student who presented with increasing palpitation, fatigue and exertional shortness of breath for the last one year. She had a low hemoglobin and high serum iron. Anemia with iron overload prompted us to do bone marrow study and there were 19% ringed sideroblasts and iron overload fulfilling the diagnosis of sideroblastic anemia. We searched for secondary causes of ringed sideroblast but could not find any culprit. Her cytogenetics report was normal and genetic analysis was not done due to financial reason. Since the diagnosis 3 months back, patient is on pyridoxine, folic acid, deferasirox and still needs regular blood transfusion suggesting that she may be pyridoxine refractory and may develop iron overload.
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22
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Basford P, Longcroft-Wheaton G, Bhandari P. ASGE Technology Committee reviews on real-time endoscopic assessment of the histology of diminutive colorectal polyps, and high-definition and high-magnification endoscopes. Gastrointest Endosc 2015; 82:1139-40. [PMID: 26614165 DOI: 10.1016/j.gie.2015.05.039] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Accepted: 05/23/2015] [Indexed: 01/23/2023]
Affiliation(s)
- Peter Basford
- Department of Gastroenterology, Queen Alexandra Hospital, Portsmouth, UK
| | | | - P Bhandari
- Departments of Gastroenterology and Endoscopy, Queen Alexandra Hospital, Portsmouth, UK
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23
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Haidry RJ, Butt MA, Dunn JM, Gupta A, Lipman G, Smart HL, Bhandari P, Smith L, Willert R, Fullarton G, Di Pietro M, Gordon C, Penman I, Barr H, Patel P, Kapoor N, Hoare J, Narayanasamy R, Ang Y, Veitch A, Ragunath K, Novelli M, Lovat LB. Improvement over time in outcomes for patients undergoing endoscopic therapy for Barrett's oesophagus-related neoplasia: 6-year experience from the first 500 patients treated in the UK patient registry. Gut 2015; 64:1192-9. [PMID: 25539672 PMCID: PMC4515987 DOI: 10.1136/gutjnl-2014-308501] [Citation(s) in RCA: 77] [Impact Index Per Article: 8.6] [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: 09/23/2014] [Accepted: 11/29/2014] [Indexed: 02/06/2023]
Abstract
BACKGROUND Barrett's oesophagus (BE) is a pre-malignant condition leading to oesophageal adenocarcinoma (OAC). Treatment of neoplasia at an early stage is desirable. Combined endoscopic mucosal resection (EMR) followed by radiofrequency ablation (RFA) is an alternative to surgery for patients with BE-related neoplasia. METHODS We examined prospective data from the UK registry of patients undergoing RFA/EMR for BE-related neoplasia from 2008 to 2013. Before RFA, visible lesions were removed by EMR. Thereafter, patients had RFA 3-monthly until all BE was ablated or cancer developed (endpoints). End of treatment biopsies were recommended at around 12 months from first RFA treatment or when endpoints were reached. Outcomes for clearance of dysplasia (CR-D) and BE (CR-IM) at end of treatment were assessed over two time periods (2008-2010 and 2011-2013). Durability of successful treatment and progression to OAC were also evaluated. RESULTS 508 patients have completed treatment. CR-D and CR-IM improved significantly between the former and later time periods, from 77% and 56% to 92% and 83%, respectively (p<0.0001). EMR for visible lesions prior to RFA increased from 48% to 60% (p=0.013). Rescue EMR after RFA decreased from 13% to 2% (p<0.0001). Progression to OAC at 12 months is not significantly different (3.6% vs 2.1%, p=0.51). CONCLUSIONS Clinical outcomes for BE neoplasia have improved significantly over the past 6 years with improved lesion recognition and aggressive resection of visible lesions before RFA. Despite advances in technique, the rate of cancer progression remains 2-4% at 1 year in these high-risk patients. TRIAL REGISTRATION NUMBER ISRCTN93069556.
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Affiliation(s)
- R J Haidry
- Research Department of Tissue and Energy, Division of Surgery and Interventional Science, University College London, London, UK,Department of Gastroenterology, University College Hospital NHS Foundation Trust, London, UK
| | - M A Butt
- Research Department of Tissue and Energy, Division of Surgery and Interventional Science, University College London, London, UK
| | - J M Dunn
- Guy's and St Thomas’ NHS foundation Trust, London, UK,Institute for Cancer Genetics and Informatics, Oslo University, Oslo, Norway
| | - A Gupta
- Department of Gastroenterology, University College Hospital NHS Foundation Trust, London, UK
| | - G Lipman
- Research Department of Tissue and Energy, Division of Surgery and Interventional Science, University College London, London, UK
| | - H L Smart
- Department of Gastroenterology and Hepatology, Royal Liverpool University Hospital, Liverpool, UK
| | - P Bhandari
- Princess Alexandra Hospital, Portsmouth, UK
| | - L Smith
- Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - R Willert
- Central Manchester University Hospitals NHS Foundation Trust, Manchester,UK
| | | | | | - C Gordon
- Royal Bournemouth Hospital, Bournemouth, UK
| | - I Penman
- Royal Infirmary Edinburgh, Edinburgh, UK
| | - H Barr
- Oesophagogastric Surgery, Gloucestershire Hospital NHS Trust, Birmingham, UK
| | - P Patel
- Department of Gastroenterology, Southampton University Hospital, Southampton, UK
| | - N Kapoor
- Digestive Diseases Centre, Aintree University Hospital, Liverpool, UK
| | - J Hoare
- St Mary's Hospital NHS Trust, London, UK
| | | | - Y Ang
- Centre of Gastrointestinal Sciences, University of Manchester, Salford Royal Foundation NHS Trust, Salford, UK
| | - A Veitch
- Department of Gastroenterology, Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, UK
| | - K Ragunath
- Department of Gastroenterology, Nottingham University Hospital NHS Trust, Nottingham, UK
| | - M Novelli
- Department of Gastroenterology, University College Hospital NHS Foundation Trust, London, UK
| | - L B Lovat
- Research Department of Tissue and Energy, Division of Surgery and Interventional Science, University College London, London, UK,Department of Gastroenterology, University College Hospital NHS Foundation Trust, London, UK
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24
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Bhandari P. Functional Outcomes of Nerve Reconstruction in Severe Obstetric Brachial Plexus Palsy. IJNT 2015. [DOI: 10.1055/s-0035-1555661] [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: 10/23/2022]
Affiliation(s)
- P. Bhandari
- Department of Plastic and Reconstructive Surgery, Army Hospital (Research and Referral), Udhampur, Jammu and Kashmir, India
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25
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Gupta S, Miskovic D, Bhandari P, Dolwani S, McKaig B, Pullan R, Rembacken B, Riley S, Rutter MD, Suzuki N, Tsiamoulos Z, Valori R, Vance ME, Faiz OD, Saunders BP, Thomas-Gibson S. A novel method for determining the difficulty of colonoscopic polypectomy. Frontline Gastroenterol 2013; 4:244-248. [PMID: 28839733 PMCID: PMC5369843 DOI: 10.1136/flgastro-2013-100331] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2013] [Revised: 05/09/2013] [Accepted: 05/11/2013] [Indexed: 02/04/2023] Open
Abstract
INTRODUCTION Endoscopists are now expected to perform polypectomy routinely. Colonic polypectomy varies in difficulty, depending on polyp morphology, size, location and access. The measurement of the degree of difficulty of polypectomy, based on polyp characteristics, has not previously been described. OBJECTIVE To define the level of difficulty of polypectomy. METHODS Consensus by nine endoscopists regarding parameters that determine the complexity of a polyp was achieved through the Delphi method. The endoscopists then assigned a polyp complexity level to each possible combination of parameters. A scoring system to measure the difficulty level of a polyp was developed and validated by two different expert endoscopists. RESULTS Through two Delphi rounds, four factors for determining the complexity of a polypectomy were identified: size (S), morphology (M), site (S) and access (A). A scoring system was established, based on size (1-9 points), morphology (1-3 points), site (1-2 points) and access (1-3 points). Four polyp levels (with increasing level of complexity) were identified based on the range of scores obtained: level I (4-5), level II (6-9), level III (10-12) and level IV (>12). There was a high degree of interrater reliability for the polyp scores (interclass correlation coefficient of 0.93) and levels (κ=0.888). CONCLUSIONS The scoring system is feasible and reliable. Defining polyp complexity levels may be useful for planning training, competency assessment and certification in colonoscopic polypectomy. This may allow for more efficient service delivery and referral pathways.
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Affiliation(s)
- S Gupta
- Wolfson Unit for Endoscopy, St Mark's Hospital and Imperial College London, Harrow, UK
| | - D Miskovic
- Department of Surgery and Cancer, Imperial College London, St Mary's Hospital, London, UK
| | - P Bhandari
- Department of Gastroenterology, Queen Alexandra Hospital, Cosham, Portsmouth, UK
| | - S Dolwani
- Department of Gastroenterology, University Hospital of Wales, Cardiff, UK
| | - B McKaig
- Department of Gastroenterology, New Cross Hospital, Wolverhampton, UK
| | - R Pullan
- Department of Colorectal Surgery, Torbay Hospital, Torquay, UK
| | - B Rembacken
- Department of Gastroenterology, Leeds General Infirmary, Leeds, UK
| | - S Riley
- Department of Gastroenterology, Northern General Hospital, Sheffield, UK
| | - M D Rutter
- Department of Gastroenterology, University Hospital North Tees, Stockton-on-Tees, UK
| | - N Suzuki
- Wolfson Unit for Endoscopy, St Mark's Hospital and Imperial College London, Harrow, UK
| | - Z Tsiamoulos
- Wolfson Unit for Endoscopy, St Mark's Hospital and Imperial College London, Harrow, UK
| | - R Valori
- Department of Gastroenterology, Gloucestershire Royal Hospital, Gloucester, UK
| | - M E Vance
- Wolfson Unit for Endoscopy, St Mark's Hospital and Imperial College London, Harrow, UK
| | - O D Faiz
- Department of Surgery and Cancer, Imperial College London, St Mary's Hospital, London, UK
| | - B P Saunders
- Wolfson Unit for Endoscopy, St Mark's Hospital and Imperial College London, Harrow, UK
| | - S Thomas-Gibson
- Wolfson Unit for Endoscopy, St Mark's Hospital and Imperial College London, Harrow, UK
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Longcroft-Wheaton G, Bhandari P. Endobarrier: a viable alternative to gastric bypass surgery? Practical Diabetes 2013. [DOI: 10.1002/pdi.1804] [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: 11/08/2022]
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Tuladhar A, Shrestha S, Raut PP, Bhandari P, Shrestha P. HLA antigen distribution in renal transplant recipients and donors. J Nepal Health Res Counc 2013; 11:289-292. [PMID: 24908533] [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: 06/03/2023]
Abstract
BACKGROUND HLA typing analysis is important in renal transplant patient. This study is the first report from Nepal to find out distribution of HLA A, B, DR antigen in live related renal transplant recipients and donors from Nepal. The aim of this study was to investigate the distribution of HLA in the live related renal transplant recipients and donors of Nepal. METHODS In a retrospective study, HLA patterns were defined in 100 live related renal transplant recipients and donors. One year study is done from June 2011 to May 2012. The study was done by using sequence specific oligonucleotides primers and polymerase chain reaction and assay. Allele frequencies were obtained by direct counting. RESULTS A total of 12 HLA-A, 15 HLA-B and 13 HLA-DRB1 alleles were identified at the four-digit level in the live related renal transplant recipients and donors of Nepal. High frequency alleles were HLA-A*11 (34.5%), A*24 (17%), A*33 (13%); HLA-B*15(27%), B*35(19%), B*40 (10%); HLA-DRB1*15 (33.5%), DRB1*12 (21.4%) and DRB1*04 (7.32%). CONCLUSIONS These results showed considerable heterogeneity in both HLA class I and class II antigens. To reduce the risk of allograft rejection, transplantation from HLA matched donors is recommended.
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Affiliation(s)
- A Tuladhar
- Department of Pathology, Aarogya Foundation, Pulchowk, Lalitapur, Nepal
| | - S Shrestha
- Department of Pathology, Aarogya Foundation, Pulchowk, Lalitapur, Nepal
| | - P P Raut
- Department of Pathology, Aarogya Foundation, Pulchowk, Lalitapur, Nepal
| | - P Bhandari
- Department of Pathology, Aarogya Foundation, Pulchowk, Lalitapur, Nepal
| | - P Shrestha
- Department of Nephrology, National Academy of Medical Sciences, Kathmandu, Nepal
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Longcroft-Wheaton G, Brown J, Basford P, Cowlishaw D, Higgins B, Bhandari P. Duration of acetowhitening as a novel objective tool for diagnosing high risk neoplasia in Barrett's esophagus: a prospective cohort trial. Endoscopy 2013; 45:426-32. [PMID: 23733726 DOI: 10.1055/s-0032-1326630] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND STUDY AIMS Acetic acid reacts with Barrett's mucosa to produce acetowhitening which disappears with time. The clinical significance of this is unknown. We aimed to quantify the acetowhitening time, developing an objective tool for diagnosis of neoplasia in Barrett's esophagus. PATIENTS AND METHODS Prospective cohort study in a tertiary referral center, enrolling patients undergoing surveillance of Barrett's metaplasia or referred with suspected neoplasia. Acetic acid 2.5 % was applied to the mucosa via a spray catheter. Acetowhitening was observed and time to disappearance recorded. Targeted biopsies of any neoplasia and quadrantic 2-cm biopsies of residual Barrett's area were then taken. Histological findings were investigated in relation to duration of acetowhitening. RESULTS 132 patients were examined. A receiver operating characteristic (ROC) curve was produced for identifying high risk neoplasia according to acetowhitening duration. The area under the curve (AUC) was 0.93 (0.89 - 0.97). Using a threshold of 142 seconds yielded a sensitivity for neoplasia of 98 % (95 % confidence interval [95 %CI] 89 % - 100 %) and specificity of 84 % (74 % - 91 %). The ROC curve for mucosal neoplasia (high grade dysplasia or intramucosal carcinoma) versus deep invasive cancer showed an AUC of 0.786 (0.61 - 0.96); a cutoff of 20 seconds yielded a sensitivity and specificity for invasive cancer of 67 % (35 % - 90 %) and 85 % (69 % - 95 %), respectively. CONCLUSION The time to disappearance of acetowhitening can serve as a simple but very sensitive tool for the diagnosis of high risk neoplasia in Barrett's esophagus. It can be used to distinguish mucosal neoplasia from deep invasive cancer.
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Affiliation(s)
- G Longcroft-Wheaton
- Department of Gastroenterology, Queen Alexandra Hospital, Portsmouth Hospitals NHS Trust, Portsmouth, United Kingdom
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Longcroft-Wheaton G, Brown J, Cowlishaw D, Higgins B, Bhandari P. High-definition vs. standard-definition colonoscopy in the characterization of small colonic polyps: results from a randomized trial. Endoscopy 2012; 44:905-10. [PMID: 22893132 DOI: 10.1055/s-0032-1310004] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [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: 12/10/2022]
Abstract
BACKGROUND AND STUDY AIMS The resolution of endoscopes has increased in recent years. Modern Fujinon colonoscopes have a charge-coupled device (CCD) pixel density of 650,000 pixels compared with the 410,000 pixel CCD in standard-definition scopes. Acquiring high-definition scopes represents a significant capital investment and their clinical value remains uncertain. The aim of the current study was to investigate the impact of high-definition endoscopes on the in vivo histology prediction of colonic polyps. PATIENTS AND METHODS Colonoscopy procedures were performed using Fujinon colonoscopes and EPX-4400 processor. Procedures were randomized to be performed using either a standard-definition EC-530 colonoscope or high-definition EC-530 and EC-590 colonoscopes. Polyps of <10 mm were assessed using both white light imaging (WLI) and flexible spectral imaging color enhancement (FICE), and the predicted diagnosis was recorded. Polyps were removed and sent for histological analysis by a pathologist who was blinded to the endoscopic diagnosis. The predicted diagnosis was compared with the histology to calculate the accuracy, sensitivity, and specificity of in vivo assessment using either standard or high-definition scopes. RESULTS A total of 293 polyps of <10 mm were examined–150 polyps using the standard-definition colonoscope and 143 polyps using high-definition colonoscopes. There was no difference in sensitivity, specificity or accuracy between the two scopes when WLI was used (standard vs. high: accuracy 70% [95% CI 62–77] vs. 73% [95% CI 65–80]; P=0.61). When FICE was used, high-definition colonoscopes showed a sensitivity of 93% compared with 83% for standard-definition colonoscopes (P=0.048); specificity was 81% and 82%, respectively. CONCLUSIONS There was no difference between high- and standard-definition colonoscopes when white light was used, but FICE significantly improved the in vivo diagnosis of small polyps when high-definition scopes were used compared with standard definition.
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Bhandari P, Kandaswamy P, Cowlishaw D, Longcroft-Wheaton G. Acetic acid-enhanced chromoendoscopy is more cost-effective than protocol-guided biopsies in a high-risk Barrett's population. Dis Esophagus 2012; 25:386-92. [PMID: 21981061 DOI: 10.1111/j.1442-2050.2011.01267.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
To examine the efficacy and potential cost implications of acetic acid (AA) chromoendoscopy in the assessment of Barrett's neoplasia. Our prospective database of patients referred between 2005 and 2010 with suspected early neoplasia was reviewed. High-resolution Fujinon gastroscopes and EPX-4400 processor were used. Inspection of Barrett's neoplasia was carried out using white light followed by AA. Neoplastic areas were noted, and targeted biopsy was carried out. This was followed by quadrantic biopsies of the remaining Barrett's neoplasia. The cost of protocol-guided biopsies was compared with AA-guided biopsy protocols. Two hundred sixty-three procedures on 197 patients were examined. High-risk neoplasia was found during 143 procedures. In 96% of cases it was identified with AA. The cost of histological evaluation by Cleveland protocol would be £139,416.30. The cost by AA-targeted biopsy followed by random biopsies in one pot would be £25,032.50. For AA-targeted biopsies alone the cost would be £9,541.8 but results in a 4% miss rate. AA localizes neoplastic lesions in the majority of patients and could potentially represent a significant cost saving in patients with suspected neoplasia.
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Affiliation(s)
- P Bhandari
- Research Registrar Gastroenterology, Portsmouth, Hampshire, UK.
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Bhandari P, Hill JS, Farris SP, Costin B, Martin I, Chan CL, Alaimo JT, Bettinger JC, Davies AG, Miles MF, Grotewiel M. Chloride intracellular channels modulate acute ethanol behaviors in Drosophila, Caenorhabditis elegans and mice. Genes Brain Behav 2012; 11:387-97. [PMID: 22239914 DOI: 10.1111/j.1601-183x.2012.00765.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Identifying genes that influence behavioral responses to alcohol is critical for understanding the molecular basis of alcoholism and ultimately developing therapeutic interventions for the disease. Using an integrated approach that combined the power of the Drosophila, Caenorhabditis elegans and mouse model systems with bioinformatics analyses, we established a novel, conserved role for chloride intracellular channels (CLICs) in alcohol-related behavior. CLIC proteins might have several biochemical functions including intracellular chloride channel activity, modulation of transforming growth factor (TGF)-β signaling, and regulation of ryanodine receptors and A-kinase anchoring proteins. We initially identified vertebrate Clic4 as a candidate ethanol-responsive gene via bioinformatic analysis of data from published microarray studies of mouse and human ethanol-related genes. We confirmed that Clic4 expression was increased by ethanol treatment in mouse prefrontal cortex and also uncovered a correlation between basal expression of Clic4 in prefrontal cortex and the locomotor activating and sedating properties of ethanol across the BXD mouse genetic reference panel. Furthermore, we found that disruption of the sole Clic Drosophila orthologue significantly blunted sensitivity to alcohol in flies, that mutations in two C. elegans Clic orthologues, exc-4 and exl-1, altered behavioral responses to acute ethanol in worms and that viral-mediated overexpression of Clic4 in mouse brain decreased the sedating properties of ethanol. Together, our studies demonstrate key roles for Clic genes in behavioral responses to acute alcohol in Drosophila, C. elegans and mice.
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Affiliation(s)
- P Bhandari
- Department of Human and Molecular Genetics, Department of Pharmacology and Toxicology, Virginia Commonwealth University Alcohol Research Center, Richmond, VA, USA
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Abstract
Background: Early diagnosis represents the best opportunity for cure of colorectal cancer. Current screening programmes use faecal occult blood testing for screening, which has limited sensitivity and poor specificity. Methods: In this study we looked at a series of previously described diagnostic markers utilising circulating free DNA (cfDNA), with a preparation method allowing small DNA fragments to be isolated. The Circulating free DNA was isolated from samples obtained from 85 patients, including 35 patients without endoscopic abnormality, a group of 26 patients with benign colorectal adenomas, and 24 patients with colorectal carcinomas. In each case, polymerase chain reaction (PCR) was performed for Line1 79 bp, Line1 300 bp, Alu 115 bp, Alu 247 bp, and mitochondrial primers. In addition, carcinoembryonic antigen (CEA) was measured by ELISA. Each marker was analysed between normal, polyp, and cancer populations, and the best performing analysed in combination by logistic regression. Results: The best model was able to discriminate normal from populations with adenoma or carcinoma using three DNA markers and CEA, showing an area under the receiver operator characteristic (ROC) curve of 0.855 with a positive predictive value of 81.1% for polyps and cancer diagnosis. Conclusion: These circulating markers in combination with other markers offer the prospect of a simple blood test as a possible secondary screen for colorectal cancers and polyps in patients with positive faecal occult blood tests.
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Affiliation(s)
- R Mead
- Department of Gastroenterology and Translational Oncology Research Centre, Queen Alexandra Hospital, Portsmouth PO6 3LY, UK
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Affiliation(s)
- P Bhandari
- Department of Pharmacognosy, School of Pharmacy, Trinity College Dublin, 18 Shresybury Rd., Dublin, Ireland
| | - A I Gray
- Department of Pharmacognosy, School of Pharmacy, Trinity College Dublin, 18 Shresybury Rd., Dublin, Ireland
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Bhandari P, Green S, Hamanaka H, Nakajima T, Matsuda T, Saito Y, Oda I, Gotoda T. Use of Gascon and Pronase either as a pre-endoscopic drink or as targeted endoscopic flushes to improve visibility during gastroscopy: a prospective, randomized, controlled, blinded trial. Scand J Gastroenterol 2010; 45:357-61. [PMID: 20148732 DOI: 10.3109/00365520903483643] [Citation(s) in RCA: 28] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To assess whether endoscopic flushes of the bubble-bursting agent Gascon and the mucolytic agent Pronase are as effective in terms of improving endoscopic mucosal visibility as a pre-endoscopic drink of the same agents. MATERIAL AND METHODS A total of 112 patients attending a Japanese tertiary referral centre for upper gastrointestinal endoscopy were randomized to receive either the standard Japanese procedure of a pre-endoscopic drink of water containing Gascon and Pronase with endoscopic flushes of 20-ml aliquots of water, or no pre-endoscopic therapy but endoscopic flushes of 20-ml aliquots of water containing Gascon, with or without Pronase as necessary. RESULTS Visibility scores were significantly better in the pre-endoscopic drink group than in either of the endoscopic flush groups. The group receiving a pre-endoscopic drink required fewer flushes during the procedure and there was no difference in the endoscopic time between the three groups. CONCLUSIONS Our results suggest that endoscopic spraying of these bubble-bursting and mucolytic agents is not able to offer equivalent improvements in endoscopic mucosal visibility when compared with the standard Japanese therapy of a pre-endoscopic drink of these agents. The addition of Pronase to the spray solution had no measurable benefit over Gascon alone. We therefore cannot recommend endoscopic spraying of mucous clearing agents over their use as a pre-endoscopic drink.
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Affiliation(s)
- P Bhandari
- Portsmouth Hospitals Trust, Portsmouth, UK
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Epstein M, Bardack A, Bhandari P, Doggett J, Gagliolo N, Graff S, Li E, Petro E, Sailey M, Salaets N, Tousley B, Turner J, McCombe-Waller S, Whitall J, Abshire P. 285 EMG FEEDBACK VIA VIDEOGAME FOR REHABILITATION OF HEMIPARETIC GAIT. Parkinsonism Relat Disord 2010. [DOI: 10.1016/s1353-8020(10)70286-8] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Kumar P, Domjan J, Bhandari P, Ellis R, Higginson A. Is there an association between intestinal perfusion and Crohn's disease activity? A feasibility study using contrast-enhanced ultrasound. Br J Radiol 2008; 82:112-7. [PMID: 18955414 DOI: 10.1259/bjr/43430629] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
A recent study used contrast-enhanced ultrasound to assess splanchnic haemodynamics. This study investigates whether an association exists between disease activity and splanchnic transit time in patients with suspected Crohn's disease. The study protocol had the approval of the local ethics committee, and written informed consent was obtained. 18 patients (11 women; mean age, 40 years; age range, 23-69 years) with suspected or confirmed Crohn's disease were recruited prospectively. A bolus injection of an ultrasound contrast agent was given via a peripheral vein and time-intensity curves of the superior mesenteric artery and vein were analysed. Splanchnic transit time was calculated as the time interval between the rise in signal intensity to >10% above baseline value. Baseline parameters measured included the time-averaged maximum velocity and cross-sectional area of the superior mesenteric artery (SMA). Pearson correlations were used to test associations between different numeric measurements; the independent samples t-test was used to test associations between different numeric measurements; and the independent samples t-test was used to compare mean values between patients with active and inactive disease. There was a weak negative association between splanchnic transit time and the Crohn's Disease Activity Index (CDAI) (r = -0.42), which did not reach statistical significance (p = 0.13), although the mean splanchnic transit time was reduced in the active group (4.0 s vs 6.9 s). The SMA flow rate was significantly greater in active disease (37 ml s(-1) vs 22 ml s(-1); Mann-Whitney U, p = 0.02). This study demonstrates the feasibility of using contrast-enhanced ultrasound as an assessment tool for Crohn's disease.
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Affiliation(s)
- P Kumar
- Queen Alexandra Hospital, Southwick Hill Road, Cosham, Portsmouth, UK.
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Leedham SJ, Preston SL, McDonald SAC, Elia G, Bhandari P, Poller D, Harrison R, Novelli MR, Jankowski JA, Wright NA. Individual crypt genetic heterogeneity and the origin of metaplastic glandular epithelium in human Barrett's oesophagus. Gut 2008; 57:1041-8. [PMID: 18305067 PMCID: PMC2564832 DOI: 10.1136/gut.2007.143339] [Citation(s) in RCA: 168] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVES Current models of clonal expansion in human Barrett's oesophagus are based upon heterogenous, flow-purified biopsy analysis taken at multiple segment levels. Detection of identical mutation fingerprints from these biopsy samples led to the proposal that a mutated clone with a selective advantage can clonally expand to fill an entire Barrett's segment at the expense of competing clones (selective sweep to fixation model). We aimed to assess clonality at a much higher resolution by microdissecting and genetically analysing individual crypts. The histogenesis of Barrett's metaplasia and neo-squamous islands has never been demonstrated. We investigated the oesophageal gland squamous ducts as the source of both epithelial sub-types. METHODS Individual crypts across Barrett's biopsy and oesophagectomy blocks were dissected. Determination of tumour suppressor gene loss of heterozygosity patterns, p16 and p53 point mutations were carried out on a crypt-by-crypt basis. Cases of contiguous neo-squamous islands and columnar metaplasia with oesophageal squamous ducts were identified. Tissues were isolated by laser capture microdissection and genetically analysed. RESULTS Individual crypt dissection revealed mutation patterns that were masked in whole biopsy analysis. Dissection across oesophagectomy specimens demonstrated marked clonal heterogeneity, with multiple independent clones present. We identified a p16 point mutation arising in the squamous epithelium of the oesophageal gland duct, which was also present in a contiguous metaplastic crypt, whereas neo-squamous islands arising from squamous ducts were wild-type with respect to surrounding Barrett's dysplasia. CONCLUSIONS By studying clonality at the crypt level we demonstrate that Barrett's heterogeneity arises from multiple independent clones, in contrast to the selective sweep to fixation model of clonal expansion previously described. We suggest that the squamous gland ducts situated throughout the oesophagus are the source of a progenitor cell that may be susceptible to gene mutation resulting in conversion to Barrett's metaplastic epithelium. Additionally, these data suggest that wild-type ducts may be the source of neo-squamous islands.
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Affiliation(s)
- S J Leedham
- Histopathology Unit, Cancer Research UK, London, UK.
| | - S L Preston
- Histopathology Unit, Cancer Research UK, London, UK,Institute of Cell and Molecular Sciences, St Bartholomew’s and Royal London School of Medicine and Dentistry, Queen Mary University, London, UK
| | - S A C McDonald
- Histopathology Unit, Cancer Research UK, London, UK,Department of Clinical Pharmacology, University of Oxford, Oxford, UK
| | - G Elia
- Histopathology Unit, Cancer Research UK, London, UK
| | - P Bhandari
- Department of Gastroenterology Queen Alexandra Hospital, Portsmouth, UK
| | - D Poller
- Pathology Department, Queen Alexandra Hospital, Portsmouth, UK
| | - R Harrison
- Pathology Department, Leicester General Hospital, Leicester, UK
| | - M R Novelli
- Histopathology Department, University College Hospital, London, UK
| | - J A Jankowski
- Histopathology Unit, Cancer Research UK, London, UK,Department of Clinical Pharmacology, University of Oxford, Oxford, UK,Digestive Disease Centre, Leicester Royal Infirmary, Leicester, UK
| | - N A Wright
- Histopathology Unit, Cancer Research UK, London, UK,Institute of Cell and Molecular Sciences, St Bartholomew’s and Royal London School of Medicine and Dentistry, Queen Mary University, London, UK
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Bhandari P, Kumar N, Gupta AP, Singh B, Kaul VK. Micro-LC Determination of Swertiamarin in Swertia species and Bacoside-A in Bacopa monnieri. Chromatographia 2006. [DOI: 10.1365/s10337-006-0065-x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Abstract
AIMS To test the hypothesis that both COX-1 and COX-2 expression in human gastric mucosa is up-regulated in the presence of inflammation as seen in patients with gastritis and gastric ulcers. METHODS AND RESULTS We performed immunohistochemistry using COX-1 and COX-2 monoclonal antibodies on gastric biopsies from 59 patients with normal mucosa, gastritis and gastric ulcers. Expression of COX-1 and COX-2 was quantified using an intensity proportion scoring system. Expression of COX-1 was primarily seen in the lamina propria mononuclear cells with some expression in deep gastric glands in the ulcer group. Expression of COX-2 was primarily seen in the deep gastric glands with focal expression in the lamina propria mononuclear cells. We found a stepwise increase in the expression of both COX-1 and COX-2 as mucosal damage progressed from normal to gastritis to gastric ulcer. CONCLUSIONS We conclude that both COX-1 and COX-2 expression in the gastric mucosa are increased in the setting of gastritis and gastric ulceration. Although this increased expression may be due, at least in part, to an increase in inflammatory cell numbers, this study raises the possibility that both COX-1 and COX-2 are inducible, contrary to the traditionally held view of only COX-2 being inducible.
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Affiliation(s)
- P Bhandari
- Department of Gastroenterology, Southampton University Hospitals, Southampton, UK
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Roderick P, Davies R, Raftery J, Crabbe D, Pearce R, Patel P, Bhandari P. Cost-effectiveness of population screening for Helicobacter pylori in preventing gastric cancer and peptic ulcer disease, using simulation. J Med Screen 2004. [PMID: 14561268 DOI: 10.1258/096914103769011067] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVES To evaluate the cost-effectiveness of population screening for Helicobacter pylori in preventing gastric cancer and peptic ulcer disease in England and Wales. METHODS A discrete event simulation model used parameter estimates, derived from peer-reviewed literature, routine data and statistical modelling. Population screening was compared with no screening but with opportunistic eradication in patients presenting with dyspepsia. Costs included screening, eradication and costs averted to provide costs per life years saved (cost/LYS) for preventing gastric cancer and peptic ulcer disease. Sensitivity analyses were undertaken. RESULTS The cost/LYS from screening at age 40 years was Uk pounds 5860 at discount rates of 6%. The outcomes were sensitive to H. pylori prevalence, the degree of opportunistic eradication, the discount rate, the efficacy of eradication on gastric cancer risk, the risk of complicated peptic ulcer disease and gastric cancer associated with H. pylori infection, and the duration of follow-up. In sensitivity analyses, the cost/LYS rarely exceeded UK pounds 20000 over an 80-year follow-up, but did for shorter periods. CONCLUSIONS H. pylori screening may be cost-effective in the long term. However, before screening can be recommended further evidence is needed to resolve some of the uncertainties, particularly over the efficacy of eradication on risk of gastric cancer, the risk associated with complicated peptic ulcers, and the effect of more widespread opportunistic testing of patients with dyspepsia.
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Affiliation(s)
- P Roderick
- Health Care Research Unit, University of Southampton, Southampton.
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Roderick P, Davies R, Raftery J, Crabbe D, Pearce R, Patel P, Bhandari P. Cost-effectiveness of population screening for Helicobacter pylori in preventing gastric cancer and peptic ulcer disease, using simulation. J Med Screen 2004; 10:148-56. [PMID: 14561268 DOI: 10.1177/096914130301000310] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To evaluate the cost-effectiveness of population screening for Helicobacter pylori in preventing gastric cancer and peptic ulcer disease in England and Wales. METHODS A discrete event simulation model used parameter estimates, derived from peer-reviewed literature, routine data and statistical modelling. Population screening was compared with no screening but with opportunistic eradication in patients presenting with dyspepsia. Costs included screening, eradication and costs averted to provide costs per life years saved (cost/LYS) for preventing gastric cancer and peptic ulcer disease. Sensitivity analyses were undertaken. RESULTS The cost/LYS from screening at age 40 years was Uk pounds 5860 at discount rates of 6%. The outcomes were sensitive to H. pylori prevalence, the degree of opportunistic eradication, the discount rate, the efficacy of eradication on gastric cancer risk, the risk of complicated peptic ulcer disease and gastric cancer associated with H. pylori infection, and the duration of follow-up. In sensitivity analyses, the cost/LYS rarely exceeded UK pounds 20000 over an 80-year follow-up, but did for shorter periods. CONCLUSIONS H. pylori screening may be cost-effective in the long term. However, before screening can be recommended further evidence is needed to resolve some of the uncertainties, particularly over the efficacy of eradication on risk of gastric cancer, the risk associated with complicated peptic ulcers, and the effect of more widespread opportunistic testing of patients with dyspepsia.
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Affiliation(s)
- P Roderick
- Health Care Research Unit, University of Southampton, Southampton.
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Roderick P, Davies R, Raftery J, Crabbe D, Pearce R, Bhandari P, Patel P. The cost-effectiveness of screening for Helicobacter pylori to reduce mortality and morbidity from gastric cancer and peptic ulcer disease: a discrete-event simulation model. Health Technol Assess 2003; 7:1-86. [PMID: 12709294 DOI: 10.3310/hta7060] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- P Roderick
- Health Care Research Unit, University of Southampton, Southampton SO16 7PX, UK
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Bhandari P, Shashidhara LS. Studies on human colon cancer gene APC by targeted expression in Drosophila. Oncogene 2001; 20:6871-80. [PMID: 11687966 DOI: 10.1038/sj.onc.1204849] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2001] [Revised: 07/09/2001] [Accepted: 07/17/2001] [Indexed: 12/16/2022]
Abstract
Mutations in human Adenomatous Polyposis Coli (APC) gene are associated with both familial and sporadic colorectal tumors. APC is known to down regulate beta-catenin levels, a transducer of Wnt signaling. The aim of this study is to provide transgenic Drosophila expressing either full-length or truncated forms of human APC (hAPC) protein and methods for using them in functional genomics and drug screening. Consistent with its biochemical properties, targeted expression of either full-length hAPC or its beta-catenin binding domain alone negatively regulated the function of the beta-catenin homologue, Armadillo (Arm) and thereby, inhibited Wnt/Wg signaling during fly development. hAPC inhibited Arm function even in the absence of GSK-3beta activity, although the latter was required to mediate the degradation of Arm. Consistent with this, hAPC suppressed the phenotypes induced by the over-expression of degradation-resistant forms of Arm. Subsequently, using hAPC-induced eye phenotypes as the assay in a suppressor-enhancer screen, we have identified two new loci in Drosophila, which modulate Wnt/Wg signaling. In addition, an anti-colon cancer drug, indomethacin, specifically enhanced hAPC-induced phenotypes.
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Affiliation(s)
- P Bhandari
- Centre for Cellular and Molecular Biology, Uppal Road, Hyderabad, India 500 007
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Shickle D, Carlisle J, Fryers P, Wallace S, Suckling R, Cork M, Bowns I, Beyleveld D, McDonagh A, Sandvik L, Mowinckel P, Abdelnoor M, Erikssen G, Erikssen J, White R, Altmann DR, Nanchahal K, Oliver S, Donovan JL, Peters TJ, Frankel S, Hamdy FC, Neal DE, Whincup PH, Gilg J, Papacosta O, Miller GJ, Alberti KGMM, Cook D, Lawlor DA, Ebrahim S, Smith GD, Lampe F, Morris R, Whincup P, Walker M, Ebrahim S, Shaper A, Brunner E, Shipley M, Hemingway H, Juneja M, Page M, Stansfeld S, Kumari M, Walker B, Andrew R, Seckl J, Papadopoulos A, Checkley S, Marmot M, Wood D, Sheehan J, Reilly M, Twomey H, Collins M, Daly A, Loningsigh S, Dolan E, Smith GD, Ben-Shlomo Y, Perry I, Moher M, Yudkkin P, Wright L, Turner R, Fuller A, Schofield T, Mant D, Feder G, Lilford RJ, Dobbie F, Warren R, Braunholtz D, Boaden R, Nolte E, Scholz R, Shkolnikov V, McKee M, Neilson S, Gilthorpe MS, Wilson RC, Jenkinson C, Coulter A, Bruster S, Richards N, Chandola T, Cromwell DA, Griffiths DA, Campbell MJ, Mollison J, McIntosh E, Grimshaw J, Thomas R, Rovers MM, Straatman H, Zielhuis GA, Hemminki E, Hove SL, Veerus P, Hakama M, Tuimala R, Rahu M, Ukoumunne OC, Gulliford MC, Shepstone L, Spencer N, Araya R, Rojas G, Fritsch RE, Acuna J, Lewis G, Ajdacic-Gross V, Bopp M, Eich D, Rossler W, Gutzwiller F, Corcoran P, Brennan A, Reilly M, Perry IJ, Middleton N, Whitley E, Frankel S, Dorling D, Gunnell D, Stanistreet D, Paine K, Scherf C, Morison L, Walraven G, O'Cathain A, Sampson F, Nicholl J, Munro J, Chapple A, Ziebland S, McPherson A, Herxheimer A, Shepperd S, Miller R, Brindle L, Donovan JL, Peters TJ, Quine S, O'Reilly M, Cahill M, Perry IJ, Maconochie N, Doyle P, Prior S, Ego A, Subtil D, Cosson M, Legoueff F, Houfflin-Debarge V, Querleu D, Rasmussen F, Smith GD, Sterne JAC, Tynelius P, Leon DA, Doyle P, Roman E, Maconochie N, Smith P, Beral V, Macfarlane A, Shoham-Vardi I, Winer N, Weitzman D, Levcovich A, Lahelma E, Kivela K, Roos E, Tuominen T, Dahl E, Diderichsen F, Elstad J, Lissau I, Lundberg O, Rahkonen O, Rasmussen NK, Yngwe MA, Gilmore AB, McKee M, Rose R, Salmond C, Crampton P, Tobias M, Li L, Manor O, Power C, Bruster S, Coulter A, Jenkinson C, Osler M, Prescott E, Gronbak M, Andersen AN, Due P, Engholm G, Drury N, Bruce J, Poobalan AS, Smith WCS, Jeffrey RR, Chambers WA, Mueller JE, Doring A, Stieber J, Thorand B, Lowel H, Chen R, Tunstall-Pedoe H, Redpath A, Macintyre K, Stewart S, Chalmers JWT, Boyd AJ, Finlayson A, Pell JP, McMurray JJV, Capewell S, Chalmers JWT, Macintyre K, Stewart S, Boyd AJ, Finlayson A, Pell JP, Redpath, McMurray JJV, Capewell S, Critchley J, Capewell S, Stefoski-Mikeljevic J, Johnston C, Cartman M, Sainsbury R, Forman D, Haward R, Morris E, Haward R, Forman D, Cartman M, Johnston C, Moebus S, Lehmann N, Goodacre S, Calvert N, Montgomery AA, Fahey T, Ben-Shlomo Y, Harding J, Anderson W, Florin D, Gillam S, Ely M, Nath U, Ben-Shlomo Y, Thomson RG, Morris HR, Wood NW, Lees AJ, Burn DJ, West RR, Fielder HM, Palmer SR, Dunstan F, Fone D, Higgs G, Senior M, Moss N, Campbell R, Pound P, Pope C, Britten N, Pill R, Morgan M, Donovan J, Rottingen JA, Garnett GP, Jagger C, Robine JM, Clarke M, Tobiasz-Adamczyk B, Szafraniec K, Lall R, Campbell MJ, Walter SJ, McGrother C, Donaldson M, Dallosso H, Dineen BP, Bourne RR, Ali SM, Huq DMN, Johnson GJ, Stang A, Jockel KH, Karvonen S, Vikat A, Rimpela M, Borras JM, Schiaffino A, Fernandez E, Borrell C, Garcia M, Salto E, Jefferis B, Power C, Graham H, Manor O, Yudkin P, Hey K, Roberts S, Welch S, Johnstone E, Murphy M, Griffiths S, Jones L, Walton R, Rasul F, Stansfeld SA, Hart CL, Gillis C, Smith GD, Marks D, Lambert H, Thorogood M, Neil H, Humphries S, Wonderling D, Surman G, Newdick H, Johnson A, Pharoah P, Glinianaia SV, Wright C, Rankin J, Basso O, Christensen K, Olsen J, Love A, Cheung WY, Williams J, Jackson S, Maddocks A, Hutchings H, Gissler M, Pakkanen M, Olausson PO, Owen CG, Whincup PH, Odoki K, Gilg JA, Cook DG, Aveyard P, Markham WA, Sherratt E, Bullock A, Macarthur C, Cheng KK, Daniels H, Murphy S, Egger M, Grimsley M, Green G, Read C, Redgrave P, Suokas A, McCulloch A, Zagozdzon P, Zaborski L, Cardano M, Costa G, Demaria M, Gnavi R, Spadea T, Vannoni F, Batty D, Leon DA, Rahi J, Morton S, Leon D, Stavola BDE, Gunnell D, Fouskakis D, Rasmussen F, Tynelius P, Harrison G, Spadea T, Faggiano F, Armaroli P, Maina L, Costa G, Ellison GTH, Travis R, Phillips M, Dedman D, Upton M, McCarthy A, Elwood P, Davies D, Shlomo YB, Smith GD, Berrington A, Cramer DW, Kuper H, Harlow BL, Titus-Ernstoff L, McLeod A, Stockton D, Brown H, Leyland AH, Liratsopulos G, West CR, Williams EMI, Abrams K, Sharp L, Little J, Brockton N, Cotton SC, Haites NE, Cassidy J, Kamali A, Kinsman J, Kintu P, Quigley M, Carpenter L, Kengeya-Kayondo J, Whitworth. JAG, Porter K, Noah N, Rawson H, Crampin A, Smith WCS, Group CMSOBOTMS, Jahn A, Kudzala A, Kitundu H, Lyamuya E, Razum O, Thomas SL, Wheeler JG, Hall AJ, Moore L, Dennehy A, Shemilt I, Belderson P, Brandon M, Harvey I, Moffatt P, Mugford M, Norris N, O'Brien M, Reading R, Robinson J, Schofield G, Shepstone L, Thoburn J, Cliffe S, Leiva A, Tookey P, Hamers F, Nicoll A, Critchley J, Capewell S, Ness AR, Hughes J, Elwood PC, Whitley E, Smith GD, Burr ML, Chase D, Roderick P, Cooper K, Davies R, Raftery J, Martikainen P, Kauppinen TM, Valkonen T, Somerville M, Barton A, Foy C, Basham M, Thomson H, Petticrew M, Morrison D, Chandola T, Biddulph J, McCarthy M, Gallivan S, Utley M, Kinra S, Black ME, Murphy M, Hey K, Jones L, Brzezinski ZJ, Mazur J, Mierzejewska E, Evans JG, Clarke R, Sherliker P, Birks J, Wrieden WL, Connaghan JP, Tunstall-Pedoe H, Silva IDS, Mangtani P, McCormack V, Bhakta D, Sevak L, McMichael AJ, Sauvaget C, Nagano J, Ogilvie D, Raffle AE, Alden B, Brett M, Babb PJ, Quinn M, Banks E, Beral V, Bull D, Reeves G, Leung GM, Lam TH, Thach TQ, Hedley AJ, Roderick P, Davies R, Crabbe D, Patel P, Raftery J, Bhandari P, Pearce R, Thomas MC, Walker M, Lennon LT, Thomson AG, Lampe FC, Shaper AG, Whincup PH, Fallon UB, Ben-Shlomo Y, Laurence KM, Lancashire RJ, Pharoah POD, Nevin NC, Smith GD, Fear NT, Roman E, Ansell P, Bull D, Nilsen TIL, Vatten LJ, Lane JA, Harvey RF, Murray LJ, Harvey IM, Donovan JL, Egger M, Wright CM, Parker L, Lamont D, Craft AW, Hallqvist J, Lundberg M, Diderichsen F, Boniface DR, McNeilly E, Bromen K, Pohlabeln H, Ahrens W, Jahn I, Jockel KH, Darby S, Doll R, Whitley E, Key T, Silcocks P, Linos D, Markaki I, Ntalles K, Riza E, Linos A, Memon A, Darif M, AL-Saleh K, Suresh A, de Vries CS, Bromley SE, Williams TJ, Farmer RDT, Ruiz M, Nieto A, Boshuizen HC, Nagelkerke NJD, Schellekens JFP, Peeters MF, Den Boer JW, Van Vliet JA, Neppelenbroek SE, Spaendonck MAECV, Mazloomzadeh S, Woodman CBJ, Collins S, Winter H, Bailey A, Young LS, Rosenbauer J, Herzig P, Giani G, Olowokure B, Spencer NJ, Hawker JI, Blair I, Smith R, Olowokure B, White J, Rush M, Hawker JI, Ramsay M, Watkins J, Mayor S, Matthews I, Crilly M, Bundred P, Prosser H, Walley T, Walker ZAK, Oakley L, Townsend JL, Donovan C, Smith H, Bell J, Hurst Z, Marshall S, Wild S, Whyman C, Barter M, Wishart K, Macleod C, Marinko K, Malmstrom M, Johansson SE, Sundquist J, Crampton P, Salmond C, Tobias M, Lumley J, Small R, Brown S, Watson L, Gunn J, Hawe P, Shiell A, Langer M, Steiner G, Tiefenthaler M, Adamek S, Ronsmans C, Khlat M, Waterstone M, Bewley S, Wolfe C, Hooper R, Moore L, Campbell R, Whelan A, Winter H, Macarthur C, Bick D, Lancashire R, Knowles H, Henderson C, Belfield C, Gee H, Biggerstaff D, Lilford R, Olsen J, the EuroMap Group, Spencer EA, Davey GK, Appleby PN, Key TJ., Breeze E, Leon D, Clarke R, Fletcher A, Boniface DR, McNeilly E, Lam TH, Ho SY, Hedley AJ, Mak KH, Canoy D, Khaw KT, Thorogood M, Appleby PN, Mann JI, Key TJ, Bobak M, Pikhart H, Martikainen P, Rose R, Marmot M, Rooney CIF, Cook L, Uren Z, Watson MC, Bond CM, Grimshaw JM, Mollison J, Ludbrook A, Poobalan AS, Bruce J, King PM, Krukowksi ZH, Smith WCS, Chambers WA, Seagroatt V, Goldacre M, Purcell B, Majeed A, Mayor S, Watkins J, Matthews I, Morris RW, Whincup PH, Emberson J, Lampe FC, Walker M, Wannamethee G, Shaper AG, Ebrahim S, May M, McCarron P, Frankel S, Smith GD, Yarnell J, Ebrahim S, May M, McCarron P, Shlomo YB, Stansfeld S, Gallacher J, Smith GD, Taylor FC, Rees K, Ebrahim S, Angelini GD, Ascione R, Muller-Nordhorn J, Binting S, Kulig M, Voller H, Willich SN, Group FTPS, Whincup PH, Emberson J, Papacosta O, Walker M, Lennon L, Thomson A, Sturdy PM, Anderson HR, Butland BK, Bland JM, Victor CR, Wilman C, Gupta R, Anderson HR, Mindell J, Joffe M, Nikiforov B, Pattenden S, Armstrong B, Hedley AJ, Wong CM, Thach TQ, Chau P, Lam TH, Anderson HR, Whitley E, Darby S, Deo H, Doll R, Raleigh VS, Logie J, Macrae K, Lawrenson R, Villegas R, Nielson S, O'Halloran DJ, Perry IJ, Gallacher JEJ, Elwood PC, Yarnell JWG, Shlomo YB, Pickering J, Evans JMM, Morris AD, Sedgwick JEC, Pearce AJ, Gulliford MC, Walker M, Thomson A, Whincup P, Lyons RA, Jones S, Richmond P, McCarthy J, Fone D, Lester N, Johansen A, Saunders J, Palmer SR, Barnes I, Banks E, Beral V, Jones GT, Watson KD, Taylor S, Papageorgiou AC, Silman AJ, Symmons DPM, Macfarlane GJ, Pope D, Hunt I, Birrell F, Silman A, Macfarlane G, Thorpe L, Thomas K, Fitter M, Brazier J, Macpherson H, Campbell M, Nicholl J, Morgan A, Roman M, Allison T, Symmons D, Urwin M, Brammah T, Roxby M, Williams G, Primatesta P, Falaschetti E, Poulter NR, Knibb R, Armstrong SJ, Chilvers CED, Logan RFA, Woods KL, Bhavnani V, Clarke A, Dowie J, Kennedy A, Pell I, Goldacre MJ, Kurina L, Seagroatt V, Yeates D, Watson E, Clements A, Yudkin P, Rose P, Bukach C, Mackay J, Lucassen A, Austoker J, Guillemin M, Brown W, Tell GS, Nurk E, Vollset SE, Nygard O, Refsum H, Ueland PM, Villegas R, Nielson S, Creagh D, Hinchion R, Perry IJ, Allen NE, Key TJ, Vatten LJ, Odegard RA, Nilsen ST, Austgulen R, Harding AH, Khaw KT, Wareham NJ, Riza E, Silva IDS, De Stavola B, Bradlow HL, Sepkovic DW, Linos D, Linos A. Society for Social Medicine and the International Epidemiological Association European Group. Abstracts of oral presentations. Br J Soc Med 2001. [DOI: 10.1136/jech.55.suppl_1.a1] [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: 11/03/2022]
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Bhandari P. Bioequivalence of two brands of sustained release theophylline brands. J Assoc Physicians India 1999; 47:461. [PMID: 10778546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
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Abstract
Salt-induced overexpression of genes cloned downstream of the phage T7 phi10 promoter was demonstrated in an Escherichia coli strain (GJ1158) which carries a single chromosomally integrated copy of the gene for phage T7 RNA polymerase under transcriptional control of the cis-regulatory elements of the osmoresponsive proU operon. Plasmids that have been constructed to obtain overproduction of individual target gene products in strain BL21(DE3) (by addition of isopropyl-beta-D-thiogalactopyranoside as an inducer) can directly be transformed into GJ1158. The NaCl induction regimen was also shown to be associated with a decreased propensity for sequestration of overexpressed target proteins within insoluble inclusion bodies.
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Affiliation(s)
- P Bhandari
- Centre for Cellular and Molecular Biology, Hyderabad, India
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Shah PK, Lakhotia M, Purohit A, Jain SK, Gupta SK, Bhandari P. Modification in sucrose tolerance test with acarbose, guargum and their combination in patients with non-insulin dependent diabetes. J Assoc Physicians India 1993; 41:703-5. [PMID: 8005921] [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: 01/28/2023]
Abstract
The study was undertaken to assess the efficacy guargum, Acarbose and their combination in modifying the sucrose absorption in patients of non Insulin dependent diabetes mellitus (NIDDM). Fifty patients of NIDDM were randomly distributed in three groups. Group A had 20 patients who received 20 grams of guargum, Group B had 10 patients who received 100 mg of Acrabose, Group C had 20 patients who received 10 grams of guargum and 50 grams of Acrabose. All the patients underwent 50 grams sucrose tolerance test with and without the trial drugs. Blood glucose levels were determined at 0, 30, 60, 90 and 120 minutes after sucrose loading. With the drugs, there was a significant decrease in the blood glucose levels at all time intervals (p < 001) in all the three groups. In all the three groups the blood glucose levels with the trial drugs was significantly lower (p < 001) than without the drug. It was seen that acarbose alone and guargum alone did not differ significantly in reducing the blood sugar level whereas combination of two produced significantly greater reduction in blood glucose levels than either of the drug used alone. Thus both guargum and acarbose are equally effective in modifying the absorption of sucrose. When combined in half the dosage they have synergistic effect and the reduction in blood glucose level is greater than either of the drug used alone.
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Affiliation(s)
- P K Shah
- Department of Medicine, Dr. SN Medical College, Jodhpur, Rajasthan, India
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Abstract
Resinferatoxin (100 micrograms/kg, s.c.), the ultrapotent analogue of capsaicin, when given acutely blocked radiation-(200 rads) and copper sulphate (40 mg% 30 ml, p.o.)-induced emesis in ferrets and substantially decreased loperamide (0.5 mg/kg, s.c.)-induced vomiting, without significantly affecting the von Bezold-Jarisch reflex or gag reflex. It also produced a decrease in core temperature as has been reported for capsaicin. The observation that resinferatoxin reduced or blocked emesis induced by both centrally (loperamide) and peripherally (CuSO4, radiation) acting stimuli suggests a novel anti-emetic action that may provide an insight into clinically useful innovative anti-emetics. The mechanism by which resinferatoxin has its anti-emetic effect is at present unknown, although the combination of results from the present study suggest a central site of action involving modulation of release of neurotransmitter, possibly in the nucleus tractus solitarius.
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Affiliation(s)
- P L Andrews
- Department of Physiology, St George's Hospital Medical School, Tooting, London, U.K
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Affiliation(s)
- P L Andrews
- Department of Physiology, St. George's Hospital Medical School, Tooting, London, U.K
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