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Rastogi R, Vargas PA, Oberholzer J, Pelletier S, Goldaracena N. Simultaneous split liver/kidney transplantation: A national and single center experience report. Clin Transplant 2024; 38:e15208. [PMID: 38041492 DOI: 10.1111/ctr.15208] [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: 05/08/2023] [Revised: 09/26/2023] [Accepted: 11/19/2023] [Indexed: 12/03/2023]
Abstract
BACKGROUND End-stage liver disease (ESLD) and end-stage renal disease (ESRD) are prevalent diseases for which the definitive treatment is transplantation. With limited organ supply, strategies to maximize organ availability has led to increasing rates of split liver transplantations for ESLD patients. Therefore, simultaneous split liver and kidney transplantations (SSLK) for patients with ESLD and ESRD could represent a treatment option for comorbid patients. However, current practice and outcomes after SSLK are unknown. METHODS We aim to report national trends and our experience with patients undergoing SSLK. We performed a retrospective review of the United Network for Organ Sharing (UNOS) Standard Transplant Analysis and Research file from January 2011-April 2022. Descriptive analysis of preoperative characteristics, postoperative outcomes and actuarial graft and patient survivals are reported. RESULTS National review of the UNOS transplant registry from 2011-2021 of adult patients undergoing initial transplantation via SSLK demonstrates that this procedure remains uncommon, with only 76 such cases captured in that time. Nevertheless, survival rates at 1, 3, and 5 years remains robust, at 94%, 92%, and 90% for patients overall, 90%, 88%, 88%, for the liver graft, and 93%, 91%, 88% for the kidney graft, respectively. Review of a single center experience with three such patients from 2019-2021 has shown a safe, enduring transplant option with no graft complications seen. CONCLUSIONS SSLK is both safe and a feasible option to optimize organ supply while allowing recipients to receive quality liver and kidney grafts and should be considered more often by transplant centers going forward.
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Affiliation(s)
- Radhika Rastogi
- Department of Surgery, Division of Transplantation, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Paola A Vargas
- Department of Surgery, Division of Transplantation, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Jose Oberholzer
- Department of Surgery, Division of Transplantation, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Shawn Pelletier
- Department of Surgery, Division of Transplantation, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Nicolas Goldaracena
- Department of Surgery, Division of Transplantation, University of Virginia Health System, Charlottesville, Virginia, USA
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Singh P, Rastogi R. P-574 Ovarian Revitalisation using Platelet Rich Plasma. Hum Reprod 2022. [DOI: 10.1093/humrep/deac107.530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Study question
Can we rejuvinate ovaries (with low ovarian reserve) by injecting fresh platelet rich plasma ?
Summary answer
With ovarian PRP injections, Ovarian reserve will increase and number of follicles increases in treated ovaries .
What is known already
Till date no definitive treatment is available to restore function of ovaries. Few drugs e.g. granulocyte colony stimulating factor etc tried for the same but no satisfactory result was achieved. Oral ovulogens and gonadotropins cannot produce satisfactory number of ova in these patients. So they were forced to go for donar ova. By using ovarian PRP injections couple can have a chance of their own biological child.
Study design, size, duration
we conducted the pilot study involving injection of autologous fresh platelet rich plasma injection into the ovaries of subfertile females by comparison of their fertility parameters viz. hormonal profile involving measurements of blood levels of follicular stimulating hormone (FSH), luteinizing hormone (LH), anti-Mullerian hormone (AMH), prostaglandin E2 levels (PGE2); antral follicular count (AFC); number of mature follicles (NMF) and number of retrieved oocytes (NRO) in both pre-PRP and post-PRP states.
Participants/materials, setting, methods
Forty-five subfertile females of more than 20 years were included in our study . All the patients underwent fresh autologous PRP injection under transvaginal ultrasonographic guidance. Besides the demographic data, each patient’s hormonal profile (including blood levels of AMH, FSH, LH, PGE2), AFC, NMF and NRO in both pre-PRP and post-PRP state were recorded in a predesigned proforma. Statistical evaluation of the recorded data was done using appropriate methods and tools.
Main results and the role of chance
Mean age, weight, height, body mass index and years of subfertility of the patients in our study was 31.27yrs, 58.38kg, 154.84cm, 24.37kg/m2 and 8.44years respectively. The mean blood levels of AMH increased significantly in post-PRP state (1.6 vs 2.4pg/ml) in contrast to significant decrease in blood level of FSH (21.4 vs 12.5mIU/ml), LH (15.1 vs 5.9mIU/ml) & PGE2 (162.7 vs 66pg/ml). The AFC, NMF & NRO also increased in post-PRP state relative to pre-PRP state. The differences in above levels and numbers were statistically significant.
Limitations, reasons for caution
Autologous PRP injection into ovaries improves hormonal profile, AFC and number of mature follicles as well as retrieved oocytes. Furthur followup is needed to know weather our patients concieve spontaneously or they will need some kind of assisted tecniques to concieve a pregnency.
Wider implications of the findings
Autologous PRP injection into ovaries improves hormonal profile, AFC and number of mature follicles as well as retrieved oocytes, it can be utilized as a revitalisation tool to boost fertility. Our study results reinforce the above concept. However, outcome-based studies are needed to further validate the results of our study.
Trial registration number
TMU/IEC/19-20/0113
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Affiliation(s)
- P Singh
- SPARSH IVF, Obs & Gynae - TMMC &RC , MORADABAD, India
| | - R Rastogi
- TMMC&RC, Radiology, -moradabad , India
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Zhang A, Rastogi R, Marsh KM, Yang B, Wu D, Kron IL, Yang Z. Topical Neck Cooling Without Systemic Hypothermia Attenuates Myocardial Ischemic Injury and Post-ischemic Reperfusion Injury. Front Cardiovasc Med 2022; 9:893837. [PMID: 35837603 PMCID: PMC9274088 DOI: 10.3389/fcvm.2022.893837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 05/31/2022] [Indexed: 11/13/2022] Open
Abstract
Background Following acute myocardial infarction (MI), irreversible damage to the myocardium can only be reduced by shortening the duration between symptom onset and revascularization. While systemic hypothermia has shown promising results in slowing pre-revascularization myocardial damage, it is resource intensive and not conducive to prehospital initiation. We hypothesized that topical neck cooling (NC), an easily implemented therapy for en route transfer to definitive therapy, could similarly attenuate myocardial ischemia-reperfusion injury (IRI). Methods Using an in vivo mouse model of myocardial IRI, moderate systemic hypothermia or NC was applied following left coronary artery (LCA) occlusion and subsequent reperfusion, at early, late, and post-reperfusion intervals. Vagotomy was performed after late NC in an additional group. Hearts were harvested to measure infarct size. Results Both hypothermia treatments equally attenuated myocardial infarct size by 60% compared to control. The infarct-sparing effect of NC was temperature-dependent and timing-dependent. Vagotomy at the gastroesophageal junction abolished the infarct-sparing effect of late NC. Cardiac perfusate isolated following ischemia had significantly reduced cardiac troponin T, HMGB1, cell-free DNA, and interferon α and β levels after NC. Conclusions Topical neck cooling attenuates myocardial IRI in a vagus nerve-dependent manner, with an effect comparable to that of systemic hypothermia. NC attenuated infarct size when applied during ischemia, with earlier initiation resulting in superior infarct sparing. This novel therapy exerts a cardioprotective effect without requiring significant change in core temperature and may be a promising practical strategy to attenuate myocardial damage while patients await definitive revascularization.
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Rastogi R, Lattimore CM, Mehaffey JH, Turrentine FE, Maitland HS, Zaydfudim VM. Electronic Health Record Risk-Stratification Tool Reduces Venous Thromboembolism Events in Surgical Patients. Surg Open Sci 2022; 9:34-40. [PMID: 35620709 PMCID: PMC9127397 DOI: 10.1016/j.sopen.2022.04.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Accepted: 04/13/2022] [Indexed: 11/28/2022] Open
Abstract
Background Venous thromboembolism is a preventable cause of morbidity and mortality after surgery. To ensure that patients receive appropriate venous thromboembolism chemoprophylaxis, a nonmandatory risk-stratification tool based on patient clinical condition was implemented through the electronic health record to stratify patient risk and recommend chemoprophylaxis. We hypothesized that implementing this tool would reduce postoperative venous thromboembolism events in general surgery as well as across all surgical services. Methods All adult patients undergoing inpatient surgical operations (January 2012–December 2019) at a single quaternary care center and Level 1 trauma center were abstracted from institutional electronic health record database and stratified into patients admitted before and after venous thromboembolism risk-stratification tool implementation. Bivariable analyses compared venous thromboembolism chemoprophylaxis prescription and venous thromboembolism events with implementation and screening among all surgical patients as well as in general surgery patient subset. Results A total of 64,377 adults underwent operations: 27,819 preimplementation and 36,558 postimplementation. A significant reduction in venous thromboembolism events occurred from pre- to post-tool implementation for all cases (0.77% vs 0.47%, P < .001). General surgery patients (n = 15,723) had a significant increase in chemoprophylaxis prescription (81.9% vs 86.0%, P < .001) and a significant reduction in venous thromboembolism events (1.41% vs 0.59%, P < .001). After tool implementation, use of extended postdischarge chemoprophylaxis was greater among general surgery patient subset than the entire patient cohort (46.7% vs 29.6%, P < .001). Conclusion The integration of a nonmandatory electronic health record risk-stratification tool was associated with a significant reduction in venous thromboembolism events. Extended chemoprophylaxis was prescribed in nearly half of general surgery patients at very high risk for postdischarge events. Implementing an electronic VTE risk-stratification tool reduced surgical VTE events. Even as a nonmandatory tool, risk stratification led to overall fewer VTE events. Postoperative VTE events were reduced by 39% after the tool was integrated in EHR. With the tool, general surgery had 58% less VTE events and improved prophylaxis use.
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Affiliation(s)
- Radhika Rastogi
- Department of Surgery, University of Virginia, Charlottesville, VA 22908
| | - Courtney M. Lattimore
- Department of Surgery, University of Virginia, Charlottesville, VA 22908
- Surgical Outcomes Research Center, University of Virginia, Charlottesville, VA 22908
| | - J. Hunter Mehaffey
- Department of Surgery, University of Virginia, Charlottesville, VA 22908
| | - Florence E. Turrentine
- Department of Surgery, University of Virginia, Charlottesville, VA 22908
- Surgical Outcomes Research Center, University of Virginia, Charlottesville, VA 22908
| | - Hillary S. Maitland
- Department of Medicine, Hematology/Oncology, University of Virginia, Charlottesville, VA 22908
| | - Victor M. Zaydfudim
- Department of Surgery, University of Virginia, Charlottesville, VA 22908
- Surgical Outcomes Research Center, University of Virginia, Charlottesville, VA 22908
- Corresponding author at: Division of Surgical Oncology, Department of Surgery, PO Box 800709, Charlottesville, VA, 22908-0709. Tel.: + 1-434-924-2839; fax: + 1 434-982-4778. @vz_surgery
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Le P, Navaneethan SD, Yu PC, Pallotta AM, Rastogi R, Patel P, Brateanu A, Imrey PB, Rothberg MB. Association of antibiotic use and acute kidney injury in patients hospitalized with community-acquired pneumonia. Curr Med Res Opin 2022; 38:443-450. [PMID: 34714213 DOI: 10.1080/03007995.2021.2000716] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Acute kidney injury (AKI) is common among hospitalized patients with community-acquired pneumonia (CAP). We aimed to estimate and compare the risk of AKI for various antibiotic combinations in adults hospitalized for CAP. METHODS We conducted a retrospective cohort study of the Premier Healthcare Database containing all admissions for 660 US hospitals from 2010 to 2015. We included adults aged ≥18 years hospitalized with CAP and considered 6 different antibiotic combinations based on continuous use in the first 3 hospital days. The primary outcome was incident AKI, defined by ICD-9 codes 584.5-584-9. We evaluated associations of AKI with in-hospital mortality and length-of-stay. We excluded patients who were admitted directly to the intensive care unit, had AKI codes present on admission or had dialysis in the first 2 days. We used generalized linear mixed models with the hospital as a random effect and covariate adjustment for patient demographics, comorbidities, other treatments on day 0/1, and hospital characteristics. RESULTS The total sample included 449,535 patients, 3.15% of whom developed AKI. All other regimens but fluoroquinolones exhibited higher AKI odds than 3rd generation cephalosporin with or without macrolide. The combination of piperacillin/tazobactam and vancomycin with or without other antibiotics was associated with the highest AKI odds (OR = 1.89; 95% CI: 1.73-2.06). Patients with incident AKI had an increased odds of hospital mortality (OR = 6.37; 95% CI: 6.07-6.69) and longer length-of-stay (mean multiplier = 1.84; 95% CI: 1.82, 1.86). CONCLUSION Compared to 3rd generation cephalosporin with or without macrolide, piperacillin/tazobactam, vancomycin, and their combination were associated with higher odds of developing AKI, which in turn were associated with worse clinical outcomes.
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Affiliation(s)
- Phuc Le
- Center for Value-based Care Research, Cleveland Clinic, Cleveland, OH, USA
| | - Sankar Dass Navaneethan
- Section of Nephrology, Michael E. DeBakey VA Medical Center, Section of Nephrology, Baylor College of Medicine, Houston, TX, USA
| | - Pei-Chun Yu
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA
| | | | - Radhika Rastogi
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA
| | - Preethi Patel
- Department of Hospital Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Andrei Brateanu
- Department of Hospital Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Peter B Imrey
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA
| | - Michael B Rothberg
- Center for Value-based Care Research, Cleveland Clinic, Cleveland, OH, USA
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Rastogi R, Yu PC, Deshpande A, Hashmi AZ, Herzig SJ, Rothberg MB. Treatment and outcomes among patients ≥85 years hospitalized with community-acquired pneumonia. J Investig Med 2022; 70:376-382. [PMID: 34702774 PMCID: PMC9203123 DOI: 10.1136/jim-2021-002078] [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] [Accepted: 09/15/2021] [Indexed: 02/03/2023]
Abstract
Our objective was to describe community-acquired pneumonia (CAP) among patients ≥85 years and compare them to patients aged 65-74. This was a retrospective cohort study. The study setting included 638 hospitals in the USA participating in the Premier database from 2010 to 2015. The study participants were 488,382 adults aged ≥65 years hospitalized with CAP. Patients ≥85 years were more likely to be white (79.8% vs 76.2%), female (58.1% vs 48.3%), and admitted with aspiration pneumonia (17.1% vs 7.0%) as compared with those aged 65-75 years. They had higher rates of dementia (30.4% vs 7.8%), but lower rates of diabetes (11.2% vs 17.6%) and chronic obstructive pulmonary disease (25.5% vs 54.7%). While Staphylococcus aureus (33.4%) was the most common pathogen across all age groups, patients aged ≥85 were more likely to have Escherichia coli pneumonia (16.1% vs 10.7%) compared with those aged 65-74. In adjusted models, patients aged ≥85 had greater in-hospital mortality (OR 1.14, 95% CI 1.11 to 1.18), but were less likely to be admitted to the intensive care unit (OR 0.54, 95% CI 0.53 to 0.55) and receive mechanical ventilation (OR 0.47, 95% CI 0.46 to 0.48). They also had lower rates of acute kidney injury (OR 0.95, 95% CI 0.91 to 1.00) and Clostridium difficile infection (OR 0.91, 95% CI 0.85 to 0.99), shorter lengths of stay (mean multiplier 0.93, 95% CI 0.92 to 0.93) and lower cost (mean multiplier 0.81, 95% CI 0.80 to 0.81), and were more likely to be discharged to a skilled nursing facility (OR 2.19, 95% CI 2.15 to 2.24) or hospice (OR 2.19, 95% CI 2.11 to 2.27). In conclusion, patients aged ≥85 have different comorbidities and etiologies of CAP, receive less intense treatment, and have greater mortality than patients between 65 and 75 years.
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Affiliation(s)
- Radhika Rastogi
- The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Pei-Chun Yu
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio, USA
| | - Abhishek Deshpande
- Center for Value-Based Care Research, Cleveland Clinic, Cleveland, Ohio, USA
| | - Ardeshir Z Hashmi
- Department of Internal Medicine and Geriatrics, Cleveland Clinic, Cleveland, Ohio, USA
| | - Shoshana J Herzig
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Michael B Rothberg
- Center for Value-Based Care Research, Cleveland Clinic, Cleveland, Ohio, USA
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Rastogi R, Morgan BJ, Badr MS, Chowdhuri S. Hypercapnia-induced vasodilation in the cerebral circulation is reduced in older adults with sleep-disordered breathing. J Appl Physiol (1985) 2022; 132:14-23. [PMID: 34709067 PMCID: PMC8721948 DOI: 10.1152/japplphysiol.00347.2021] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
The prevalence of sleep-disordered breathing (SDB) is higher in older adults compared with younger individuals. The increased propensity for ventilatory control instability in older adults may contribute to the increased prevalence of central apneas. Reductions in the cerebral vascular response to CO2 may exacerbate ventilatory overshoots and undershoots during sleep. Thus, we hypothesized that hypercapnia-induced cerebral vasodilation (HCVD) will be reduced in older compared with younger adults. In 11 older and 10 younger adults with SDB, blood flow velocity in the middle cerebral artery (MCAV) was measured using Doppler transcranial ultrasonography during multiple steady-state hyperoxic hypercapnic breathing trials while awake, interspersed with room air breathing. Changes in ventilation, MCAV, and mean arterial pressure (MAP) via finger plethysmography during the trials were compared with baseline eupneic values. For each hyperoxic hypercapnic trial, the change (Δ) in MCAV for a corresponding change in end-tidal CO2 and the HCVD or the change in cerebral vascular conductance (MCAV divided by MAP) for a corresponding change in end-tidal CO2 was determined. The hypercapnic ventilatory response was similar between the age groups, as was ΔMCAV/Δ[Formula: see text]. However, compared with young, older adults had a significantly smaller HCVD (1.3 ± 0.7 vs. 2.1 ± 0.6 units/mmHg, P = 0.004). Multivariable analyses demonstrated that age and nadir oxygen saturation during nocturnal polysomnography were significant predictors of HCVD. Thus, our data indicate that older age and SDB-related hypoxia are associated with diminished HCVD. We hypothesize that this impairment in vascular function may contribute to breathing instability during sleep in these individuals.NEW & NOTEWORTHY This study demonstrates, for the first time, in individuals with sleep-disordered breathing (SDB) that aging is associated with decreased hypercapnia-induced cerebral vasodilation (HCVD). In addition to advanced age, the magnitude of nocturnal oxygen desaturation due to SDB is an equal independent predictor of HCVD.
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Affiliation(s)
- R. Rastogi
- 1Medical Service, Sleep Medicine Section, John D. Dingell Veterans Affairs Medical Center, Detroit, Michigan,2Division of Pulmonary/Critical Care and Sleep Medicine, Department of Medicine, Wayne State University School of Medicine, Detroit, Michigan
| | - B. J. Morgan
- 3Department of Orthopedics and Rehabilitation, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - M. S. Badr
- 1Medical Service, Sleep Medicine Section, John D. Dingell Veterans Affairs Medical Center, Detroit, Michigan,2Division of Pulmonary/Critical Care and Sleep Medicine, Department of Medicine, Wayne State University School of Medicine, Detroit, Michigan
| | - S. Chowdhuri
- 1Medical Service, Sleep Medicine Section, John D. Dingell Veterans Affairs Medical Center, Detroit, Michigan,2Division of Pulmonary/Critical Care and Sleep Medicine, Department of Medicine, Wayne State University School of Medicine, Detroit, Michigan
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Marsh KM, Rastogi R, Zhang A, Wu D, Kron IL, Yang Z. Hydroxychloroquine Attenuates Myocardial Ischemic and Post-Ischemic Reperfusion Injury by Inhibiting the Toll-Like Receptor 9 – Type I Interferon Pathway. Cardiol Cardiovasc Med 2022; 6:416-423. [PMID: 36081846 PMCID: PMC9450995 DOI: 10.26502/fccm.92920278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Background: We hypothesized that hydroxychloroquine (HCQ) attenuates myocardial ischemia/reperfusion injury (IRI) via TLR9 – type I interferon (IFN-I) pathway inhibition. Methods: The left coronary artery of wild-type (WT) C57BL/6 and congenic TLR9−/− mice was occluded for 40 minutes, with or without 60 minutes of reperfusion (40’/0’ or 40’/60’). Either ODN-2088 or HCQ (TLR9 inhibitors), or ODN-1826 (TLR9 agonist) was administered to determine effect on infarct size (IS). After 40’/0’, cardiac perfusate (CP) was collected from harvested hearts and administered to either intact WT mice after 20 minutes of ischemia or isolated splenocytes. Type-I interferon (IFNα and IFNβ) levels were measured in plasma and splenocyte culture supernatant, and levels of damage associated molecular patterns HMGB1 and cell-free DNA (cfDNA) were measured in CP. Results: After 40’/60’, WT mice treated with HCQ or ODN-2088 had significantly reduced IS. TLR9−/− mice and HCQ-treated WT mice undergoing 40’/0’ and 40’/60’ similarly attenuated IS, with significantly lower IFN-Is in CP after 40’/0’ and in plasma after 40’/60’. IS was significantly increased in 40’/0’ CP-treated and ODN-1826-treated 20’/60’ WT mice. CP-treated WT splenocytes produced significantly higher IFN-I in culture supernatant, which was significantly reduced with HCQ. Conclusions: The TLR9–IFN-I-mediated inflammatory response contributes significantly to both ischemic and post-ischemic myocardial ischemia-reperfusion injury. HMGB1 and cfDNA released from ischemic myocardium activated the intra-myocardial TLR9 – IFN-I inflammatory pathway during ischemia and the extra-myocardial TLR9 – IFN-I inflammatory pathway during reperfusion. Hydroxychloroquine reduces production of IFN-I and attenuates myocardial IRI, likely by inhibiting the TLR9–IFN-I pathway.
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Affiliation(s)
- Katherine M Marsh
- Department of Surgery, University of Virginia, Charlottesville, VA, USA
| | - Radhika Rastogi
- Department of Surgery, University of Virginia, Charlottesville, VA, USA
| | - Aimee Zhang
- Department of Surgery, University of Virginia, Charlottesville, VA, USA
| | - Di Wu
- Department of Surgery, University of Virginia, Charlottesville, VA, USA
| | - Irving L Kron
- Department of Surgery, University of Virginia, Charlottesville, VA, USA
| | - Zequan Yang
- Department of Surgery, University of Virginia, Charlottesville, VA, USA
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Rastogi R, Rome ES. Adolescent Gynecology in the Office Setting. Pediatr Rev 2021; 42:427-438. [PMID: 34341084 DOI: 10.1542/pir.2019-0122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Ensuring open communication, partnership with patient and parent, and clarification of confidentiality during an adolescent gynecologic visit helps establish an environment in which a history and physical examination can be performed safely and with a focus on prevention, recognition of disease, and treatment as necessary. The history should include the menstrual status and gynecologic review of systems. The examination should document Tanner staging (sexual maturity rating) and be otherwise symptom guided. Similarly, testing in the office is largely risk and symptom related. Contraceptive counseling is an important component of the office visit, as well. Long and short curricula for teaching pediatric and adolescent gynecology have been developed by the North American Society for Pediatric and Adolescent Gynecology and are readily available for use. (1)(2) Although state-based variation in consent and confidentiality exists, pediatric practices should aim to protect patient confidentiality and transition to more independent health-care decision making.
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Affiliation(s)
- Radhika Rastogi
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH
| | - Ellen S Rome
- Center for Adolescent Medicine, Cleveland Clinic Children's Hospital, Department of Pediatric Endocrinology, Cleveland Clinic Lerner College of Medicine at Case Western Reserve University, Cleveland, OH
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Speaker SL, Rastogi R, Sussman TA, Hu B, Misra-Hebert AD, Rothberg MB. Treatment of Patients with Prediabetes in a Primary Care Setting 2011-2018: an Observational Study. J Gen Intern Med 2021; 36:923-929. [PMID: 33449282 PMCID: PMC8041989 DOI: 10.1007/s11606-020-06354-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 11/18/2020] [Indexed: 01/21/2023]
Abstract
BACKGROUND Over one third of American adults are at high risk for developing diabetes, which can be delayed or prevented using interventions such as medical nutrition therapy (MNT) or metformin. Physicians' self-reported rates of prediabetes treatment are improving, but patterns of actual referral, prescription, and MNT visits are unknown. OBJECTIVE To characterize treatment of prediabetes in primary care. DESIGN We conducted a retrospective cohort study using electronic health record data. We described patterns of treatment and used multivariable logistic regression to evaluate the association of patient factors and PCP-specific treatment rate with patient treatment. PATIENTS We included overweight or obese outpatients who had a first prediabetes-range hemoglobin A1c (HbA1c) during 2011-2018 and had primary care provider (PCP) follow-up within a year. MAIN MEASURES We collected patient characteristics and the following treatments: metformin prescription; referral to MNT, diabetes education, endocrinology, or bariatric medicine; and MNT visit. We did not capture within-visit physician counseling. KEY RESULTS Of 16,713 outpatients with prediabetes, 20.4% received treatment, including metformin prescriptions (7.8%) and MNT referrals (11.3%), but only 7.4% of referred patients completed a MNT visit. The strongest predictor of treatment was the patient's PCP's treatment rate. Some PCPs never treated prediabetes, but two treated more than half of their patients; 62% had no patients complete a MNT visit. Being younger or female and having higher body mass index or HbA1c were also positively associated with treatment. Compared to white patients, black patients were more likely to receive MNT referral and less likely to receive metformin. CONCLUSIONS Almost 80% of patients with new prediabetes never received treatment, and those who did receive referrals had very poor visit completion. Treatment rates appear to reflect provider rather than patient preferences.
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Affiliation(s)
- Sidra L Speaker
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Radhika Rastogi
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | | | - Bo Hu
- Quantitative Health Services, Cleveland Clinic, Cleveland, OH, USA
| | - Anita D Misra-Hebert
- Quantitative Health Services, Cleveland Clinic, Cleveland, OH, USA
- Center for Value-Based Care Research, Cleveland Clinic, Cleveland, OH, USA
| | - Michael B Rothberg
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, OH, USA.
- Center for Value-Based Care Research, Cleveland Clinic, Cleveland, OH, USA.
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Tzeng A, Bruno B, Cooperrider J, Dinardo PB, Baird R, Swetlik C, Goldstein BN, Rastogi R, Roth AJ, Gilligan TD, Rish JM. A Structured Peer Assessment Method with Regular Reinforcement Promotes Longitudinal Self-Perceived Development of Medical Students' Feedback Skills. Med Sci Educ 2021; 31:655-663. [PMID: 34457918 PMCID: PMC8368272 DOI: 10.1007/s40670-021-01242-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/05/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Given that training is integral to providing constructive peer feedback, we examined the impact of a regularly reinforced, structured peer assessment method on student-reported feedback abilities throughout a two-year preclinical Communication Skills course. METHODS Three consecutive 32-student medical school classes were introduced to the Observation-Reaction-Feedback method for providing verbal assessment during Year 1 Communication Skills orientation. In biweekly small-group sessions, students received worksheets reiterating the method and practiced giving verbal feedback to peers. Periodic questionnaires evaluated student perceptions of feedback delivery and the Observation-Reaction-Feedback method. RESULTS Biweekly reinforcement of the Observation-Reaction-Feedback method encouraged its uptake, which correlated with reports of more constructive, specific feedback. Compared to non-users, students who used the method noted greater improvement in comfort with assessing peers in Year 1 and continued growth of feedback abilities in Year 2. Comfort with providing modifying feedback and verbal feedback increased over the two-year course, while comfort with providing reinforcing feedback and written feedback remained similarly high. Concurrently, student preference for feedback anonymity decreased. CONCLUSIONS Regular reinforcement of a peer assessment framework can increase student usage of the method, which promotes the expansion of self-reported peer feedback skills over time. These findings support investigation of analogous strategies in other medical education settings. SUPPLEMENTARY INFORMATION The online version contains supplementary material available at 10.1007/s40670-021-01242-w.
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Affiliation(s)
- Alice Tzeng
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH USA
| | - Bethany Bruno
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH USA
| | - Jessica Cooperrider
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH USA
| | - Perry B. Dinardo
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH USA
| | - Rachael Baird
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH USA
- Women’s Health Institute, Cleveland Clinic, Cleveland, OH USA
| | - Carol Swetlik
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH USA
- Neurological Institute, Cleveland Clinic, Cleveland, OH USA
| | - Brittany N. Goldstein
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH USA
- Department of Psychiatry & Behavioral Sciences, McGaw Medical Center of Northwestern University, Chicago, Chicago, IL USA
| | - Radhika Rastogi
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH USA
- Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, PA USA
| | - Alicia J. Roth
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH USA
- Sleep Disorders Center, Cleveland Clinic, Cleveland, OH USA
| | - Timothy D. Gilligan
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH USA
- Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH USA
| | - Julie M. Rish
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH USA
- Center for Behavioral Health, Cleveland Clinic, Cleveland, OH USA
- Office of Patient Experience, Cleveland Clinic, Cleveland, OH USA
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12
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Abstract
IMPORTANCE Despite high prevalence of elevated blood pressure (BP) among medical inpatients, BP management guidelines are lacking for this population. The outcomes associated with intensifying BP treatment in the hospital are poorly studied. OBJECTIVES To characterize clinician response to BP in the hospital and at discharge and to compare short- and long-term outcomes associated with antihypertensive treatment intensification. DESIGN, SETTING, AND PARTICIPANTS This cohort study took place from January 1 to December 31, 2017, with 1 year of follow-up at 10 hospitals within the Cleveland Clinic Hospitals health care system. All adults admitted to a medicine service in 2017 were evaluated for inclusion. Patients with cardiovascular diagnoses were excluded. Demographic and BP characteristics were used for propensity matching. EXPOSURES Acute hypertension treatment, defined as administration of an intravenous antihypertensive medication or a new class of an oral antihypertensive treatment. MAIN OUTCOMES AND MEASURES The association between acute hypertension treatment and subsequent inpatient acute kidney injury, myocardial injury, and stroke was measured. Postdischarge outcomes included stroke and myocardial infarction within 30 days and BP control up to 1 year. RESULTS Among 22 834 adults hospitalized for noncardiovascular diagnoses (mean [SD] age, 65.6 [17.9] years; 12 993 women [56.9%]; 15 963 White patients [69.9%]), 17 821 (78%) had at least 1 hypertensive BP recorded during their admission. Of these patients, 5904 (33.1%) were treated. A total of 8692 of 106 097 cases (8.2%) of hypertensive systolic BPs were treated; of these, 5747 (66%) were treated with oral medications. In a propensity-matched sample controlling for patient and BP characteristics, treated patients had higher rates of subsequent acute kidney injury (466 of 4520 [10.3%] vs 357 of 4520 [7.9%]; P < .001) and myocardial injury (53 of 4520 [1.2%] vs 26 of 4520 [0.6%]; P = .003). There was no BP interval in which treated patients had better outcomes than untreated patients. A total of 1645 of 17 821 patients (9%) with hypertension were discharged with an intensified antihypertensive regimen. Medication intensification at discharge was not associated with better BP control in the following year. CONCLUSIONS AND RELEVANCE In this cohort study, hypertension was common among medical inpatients, but antihypertensive treatment intensification was not. Intensification of therapy without signs of end-organ damage was associated with worse outcomes.
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Affiliation(s)
- Radhika Rastogi
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Megan M Sheehan
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio
| | - Bo Hu
- Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio
| | - Victoria Shaker
- Center for Value-Based Care Research, Cleveland Clinic, Cleveland, Ohio
| | - Lisa Kojima
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio
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13
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Abstract
Eating disorders are common in adolescents and young adults, including those with a history of overweight or obesity, and are associated with numerous systemic sequelae. Understanding the differences in presentation between these patients and those who have a more classic anorexia nervosa phenotype is critical to ensuring timely recognition and treatment.
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Affiliation(s)
- Radhika Rastogi
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH
| | - Ellen S Rome Md
- Head, Center for Adolescent Medicine, Department of General Pediatrics, Cleveland Clinic; Professor, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH
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14
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Rastogi R, Mehaffey JH, Turrentine BE, Maitland HS, Zaydfudim VM. Implementation of an Electronic Medical Record Risk Stratification Tool to Reduce Venous Thromboembolism Events. J Am Coll Surg 2020. [DOI: 10.1016/j.jamcollsurg.2020.07.273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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15
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Martinez KA, Keenan K, Rastogi R, Roufael J, Fletcher A, Rood MN, Rothberg MB. The Association Between Physician Race/Ethnicity and Patient Satisfaction: an Exploration in Direct to Consumer Telemedicine. J Gen Intern Med 2020; 35:2600-2606. [PMID: 32632788 PMCID: PMC7459065 DOI: 10.1007/s11606-020-06005-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 06/19/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Patient satisfaction measures have important implications for physicians. Patient bias against non-White physicians may impact physician satisfaction ratings, but this has not been widely studied. OBJECTIVE To assess differences in patient satisfaction by physician race/ethnicity. DESIGN A cross-sectional observational study. PARTICIPANTS Patients seeking care on a large nationwide direct to consumer telemedicine platform between July 2016 and July 2018 and their physicians. MAIN MEASURES Patient satisfaction was ascertained immediately following the encounter on scales of 1 to 5 stars and scored two ways: (1) top-box satisfaction (5 stars versus fewer) and (2) dissatisfaction (2 or fewer stars versus 3 or more). To approximate the information patients would use to make assumptions about physician race/ethnicity, four reviewers classified physicians into categories based on physician name and photo. These included White American, Black American, South Asian, Middle Eastern, Hispanic, and East Asian. Mixed effects logistic regression was used to assess differences in patient top-box satisfaction and patient dissatisfaction by physician race/ethnicity, controlling for patient characteristics, prescription receipt, physician specialty, and whether the physician trained in the USA versus internationally. KEY RESULTS The sample included 119,016 encounters with 390 physicians. Sixty percent were White American, 14% South Asian, 7% Black American, 7% Hispanic, 6% Middle Eastern, and 6% East Asian. Encounters with South Asian physicians (aOR 0.70; 95% CI 0.54-0.91) and East Asian physicians (aOR 0.72; 95% CI 0.53-0.99) were significantly less likely than those with White American physicians to result in top-box satisfaction. Compared to encounters with White American physicians, those with Black American physicians (aOR 1.72; 95% CI 1.12-2.64), South Asian physicians (aOR 1.77; 95% CI 1.23-2.56), and East Asian physicians (aOR 2.10; 95% CI 1.38-3.20) were more likely to result in patient dissatisfaction. CONCLUSIONS In our study, patients reported lower satisfaction with some groups of non-White American physicians, which may have implications for their compensation, professional reputation, and job satisfaction.
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Affiliation(s)
- Kathryn A Martinez
- Center for Value-Based Care Research, Cleveland Clinic, 9500 Euclid Ave, G10, Cleveland, OH, 44195, USA.
| | - Kaitlin Keenan
- Cleveland Clinic Lerner College of Medicine, Cleveland, OH, USA
| | - Radhika Rastogi
- Cleveland Clinic Lerner College of Medicine, Cleveland, OH, USA
| | - Joud Roufael
- Kent State University College of Public Health, Kent, OH, USA
| | - Adrianne Fletcher
- Jack, Joseph and Morton Mandel School of Applied Social Sciences, Case Western Reserve University, Cleveland, OH, USA
| | - Mark N Rood
- Department of Family Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Michael B Rothberg
- Center for Value-Based Care Research, Cleveland Clinic, 9500 Euclid Ave, G10, Cleveland, OH, 44195, USA
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16
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Abstract
Early diagnosis of diarrhea is critical to prevent disease progression. Diarrhea in newborns can be congenital or acquired; acquired diarrheas are the major cause in infants. Congenital diarrheal diseases are rare and include defects in digestion, absorption, and transport of nutrients, and electrolytes; disorders of enterocyte differentiation and polarization; defects of enteroendocrine cell differentiation; dysregulation of the intestinal immune response; and dysfunction of the immune system. This review discusses the clinical approach that may help in early identification and management of different congenital diarrheal diseases.
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Affiliation(s)
- Mira Younis
- Department of Neonatology, Cleveland Clinic Children's, 9500 Euclid Avenue, M31-37, Cleveland, OH 44195, USA; Cleveland Clinic Lerner's College of Medicine, EC-10 Cleveland Clinic, 9501 Euclid Ave, Cleveland, OH 44195, USA
| | - Radhika Rastogi
- Cleveland Clinic Lerner's College of Medicine, EC-10 Cleveland Clinic, 9501 Euclid Ave, Cleveland, OH 44195, USA
| | - Ankur Chugh
- Pediatric Gastroenterology, Medical College of Wisconsin, 9000 W. Wisconsin Av, 6(th) Floor Clinics, Suite 610, Milwaukee, WI 53226, USA
| | - Shantanu Rastogi
- Newborn Services, George Washington University Hospital, Children's National Medical Center, 900 23rd Street, NW G2092, Washington, DC 20037, USA
| | - Hany Aly
- Department of Neonatology, Cleveland Clinic Children's, 9500 Euclid Avenue, M31-37, Cleveland, OH 44195, USA; Cleveland Clinic Lerner's College of Medicine, EC-10 Cleveland Clinic, 9501 Euclid Ave, Cleveland, OH 44195, USA.
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17
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Rastogi R, Sieke EH, Nahra A, Sabik J, Rome ES. Return of Menses in Previously Overweight Patients with Eating Disorders. J Pediatr Adolesc Gynecol 2020; 33:133-138. [PMID: 31715368 DOI: 10.1016/j.jpag.2019.11.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 06/24/2019] [Revised: 10/02/2019] [Accepted: 11/04/2019] [Indexed: 10/25/2022]
Abstract
STUDY OBJECTIVE Adolescents with eating disorders and a history of overweight present with higher weights, longer duration of disease, but equally severe symptomatology compared with previously normal weight patients. To better delineate treatment goals for this understudied population, we compared weight at menses resumption with premorbid maximum weight among previously overweight and normal weight patients. DESIGN Retrospective cohort study. SETTING Outpatient adolescent medicine clinic at an eating disorder referral center. PARTICIPANTS Postmenarchal patients meeting criteria for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition eating disorders. History of overweight was defined as a body mass index (BMI) greater than or equal to the 85th percentile or 25 or more. INTERVENTIONS AND MAIN OUTCOME MEASURES Weight characteristics at presentation and menses resumption (BMI, BMI z-score, change from maximum weight to presentation weight) RESULTS: Previously overweight patients presented with greater mean weight, longer duration of disease, and higher BMI than previously normal weight patients. No difference was found in rates of amenorrhea at presentation or menses resumption. Previously overweight patients resumed menses at a younger age and higher BMI z-scores. The difference between weight at menses resumption and premorbid maximum weight was greater for previously overweight patients. CONCLUSION Previously overweight patients with eating disorders present differently than their normal-weight peers, so reliance on weight status as a screening criterion might result in underdiagnosis. Although BMI z-scores associated with menses resumption are higher for previously overweight patients, there is no difference in weight gain between presentation and menses resumption and time to menses resumption compared with previously normal-weight patients. Moreover, menses resumption occurred at weights significantly lower than premorbid maximum weight for previously overweight patients, so restoration to highest premorbid weight is not necessary.
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Affiliation(s)
- Radhika Rastogi
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio.
| | - Erin H Sieke
- The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Alexa Nahra
- Department of General Pediatrics and Adolescent Medicine, Cleveland Clinic Children's Hospital, Cleveland, Ohio
| | - Julia Sabik
- Department of General Pediatrics and Adolescent Medicine, Cleveland Clinic Children's Hospital, Cleveland, Ohio
| | - Ellen S Rome
- Department of General Pediatrics and Adolescent Medicine, Cleveland Clinic Children's Hospital, Cleveland, Ohio
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18
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Martinez KA, Rastogi R, Lipold L, Rothberg MB. Response to requests for contraception in one direct-to-consumer telemedicine service. Contraception 2020; 101:350-352. [PMID: 32059840 DOI: 10.1016/j.contraception.2020.01.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 01/29/2020] [Accepted: 01/29/2020] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To describe real-world care seeking and contraception provision in one direct to consumer telemedicine platform. STUDY DESIGN We described encounters with reproductive age female patients between July 2016 and July 2018 seeking contraception on the American Well telemedicine platform. RESULTS Of 126,712 total encounters with reproductive age women, 682 were with women seeking contraception, and 83% received it. The mean encounter length was 4.4 min versus 5.0 min for non-contraceptive visits. Insurance information was provided for 78% of contraceptive encounters versus 85% of non-contraceptive encounters, p < 0.001. Of the 27 encounters in which the patient requested emergency contraception, three did not result in such a prescription. CONCLUSION Direct to consumer telemedicine may increase access to contraceptives, yet overall use was uncommon. Most women seeking contraception via direct to consumer telemedicine on this platform received it. Three women who requested emergency contraception did not receive it, yet reasons for this are unknown.
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Affiliation(s)
- Kathryn A Martinez
- Cleveland Clinic Center for Value-Based Care Research, 9500 Euclid, Ave, G10, Cleveland, OH 44195, United States.
| | - Radhika Rastogi
- Cleveland Clinic Lerner College of Medicine, 9501 Euclid Ave, Cleveland, OH 44195, United States.
| | - Laura Lipold
- Department of Family Medicine, Cleveland Clinic, 26900 Cedar Rd, Beachwood, OH 44122, United States.
| | - Michael B Rothberg
- Cleveland Clinic Center for Value-Based Care Research, 9500 Euclid, Ave, G10, Cleveland, OH 44195, United States.
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19
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Rastogi R, Deshpande A, Le P, Yu PC, Imrey P, Hashmi A, Rothberg M. 2206. Patterns of Care and Outcomes in Elderly Patients Hospitalized with Community-acquired Pneumonia in the United States. Open Forum Infect Dis 2019. [PMCID: PMC6810574 DOI: 10.1093/ofid/ofz360.2513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background Community-acquired pneumonia (CAP) is a common cause of morbidity and mortality in the elderly. Few studies compare the elderly (>65) and very elderly (≥85 years). We aimed to describe characteristics and patterns of care for very elderly patients hospitalized with CAP. Methods We conducted a retrospective cohort study using administrative data from 2010 to 2015 of about 660 US hospitals in the Premier database. Adults aged ≥65 years hospitalized with CAP, identified by either a principal ICD-9 code of pneumonia or a principal diagnosis of sepsis or respiratory failure coupled with a secondary code for pneumonia, were included. We compared demographics, insurance status, comorbidities, presentation characteristics and treatments among three age groups: 65–74, 75–84, and ≥ 85 years. Results The final sample included 488,382 patients aged ≥65 years, a third of whom were ≥85 years. Geriatricians cared for <1% of patients during hospitalization, regardless of patient age. Compared with those aged 65–74 years, the patients ≥85 were more likely to be female, of white race, have Medicare insurance, and a principal diagnosis of aspiration pneumonia (17.1% vs. 7%) (Table 1). The oldest group had higher rates of cardiac comorbidities, chronic kidney disease and dementia, but lower rates of diabetes, obesity, pulmonary disease, and smoking. On presentation, more of the very elderly had concomitant urinary tract infections. They were less likely to receive opiates and benzodiazepines, but more likely to receive foley catheters and antipsychotic medications. Antibiotics given in the first 2 days were similar across the groups. Fewer very elderly patients were admitted to the ICU or got ventilation compared with younger groups. More of the very elderly were discharged to hospice and fewer were discharged home. Compared with younger ages, the very elderly had similar lengths of stay but lower costs, and higher in-hospital mortality and 30-day readmission. Conclusion The very elderly represent a unique population with distinct clinical characteristics and outcomes from younger elderly patients. They have different co-morbidities and appear to receive less aggressive treatment with lower costs and higher mortality despite similar lengths of stay. ![]()
Disclosures All authors: No reported disclosures.
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Affiliation(s)
- Radhika Rastogi
- Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio
| | | | - Phuc Le
- Cleveland Clinic, Cleveland, Ohio
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20
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Abstract
RATIONALE Paragangliomas are rare neuroendocrine tumors that originate in specialized cells derived from the neural crest with metastasis to the thoracic spine being among the rarest forms. Here, we are presenting a detailed analysis of a case of malignant paraganglioma in the thoracic spinal region in a 14-year-old boy. Our focus is to emphasize the importance of considering malignant paraganglioma as a diagnosis and guiding the perioperative management upon surgical treatment. The management of these unique cases has yet to be well-documented. PATIENT CONCERNS A 14-year-old boy presented with a 5-month history of continuous and progressive elevated blood pressure and back pain. The patient, who had been diagnosed of malignant paraganglioma in the left posterior mediastinum for 3 months, received surgical resection of paraganglioma in the left posterior mediastinum, which had involved the left intervertebral foramen of T4. However, the tumor was not completely resected during the first operation. DIAGNOSES Magnetic resonance imaging of spine and positron emission tomography-computed tomography showed spinal cord compression secondary to the epidural component of the T4 mass, with increased marrow infiltration of the left T4 intervertebral foramen, which was difficult to be removed. Postoperative pathology confirmed the diagnosis of spinal involvement of malignant paraganglioma. INTERVENTIONS The patient underwent biopsy and percutaneous vertebroplasty of T4 and paravertebral lesions, and needle-track cement augmentation via a posterior approach. OUTCOMES The patient's neurological deficits improved significantly after the surgery, and the postoperative period was uneventful at the 10-month follow-up visit. There were no other complications associated with the operation during the follow-up period. LESSONS Combined efforts of specialists from orthopedics, neurosurgery, thoracic surgery, and medical oncology led to the successful diagnosis and management of this patient. Malignant paraganglioma of thoracic spine, although rare, should be part of the differential diagnosis when the patient has a history of paraganglioma and presents with back pain and radiculopathy. We recommend the posterior approach for spinal decompression of the malignant paraganglioma when the tumor has caused neurological deficits. Osteoplasty by cement augmentation is also a good choice for surgical treatment. However, we need to take the potential risk of complications in bone cement applications into full consideration.
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Affiliation(s)
| | - Xi Zhou
- Department of Orthopaedic Surgery
| | - An Song
- Department of Endocrinology, Key Laboratory of Endocrinology, National Health and Family Planning Commission
| | - Zhen Huo
- Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - William A. Li
- Department of Neurosurgery, School of Medicine, Wayne State University, Detroit, MI
| | - Radhika Rastogi
- Department of Neurosurgery, School of Medicine, Wayne State University, Detroit, MI
| | | | - Yong Liu
- Department of Orthopaedic Surgery
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21
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Abstract
Nicotinamide adenine dinucleotide phosphate oxidase (NOX) is a multisubunit enzyme complex that utilizes nicotinamide adenine dinucleotide phosphate to produce superoxide anions and other reactive oxygen species. Under normal circumstances, reactive oxygen species mediate a number of important cellular functions, including the facilitation of adaptive immunity. In pathogenic circumstances, however, excess reactive oxygen species generated by NOX promotes apoptotic cell death. In ischemic stroke, in particular, it has been shown that both NOX activation and derangements in glucose metabolism result in increased apoptosis. Moreover, recent studies have established that glucose, as a NOX substrate, plays a vital role in the pathogenesis of reperfusion injury. Thus, NOX inhibition has the potential to mitigate the deleterious impact of hyperglycemia on stroke. In this paper, we provide an overview of this research, coupled with a discussion of its implications for the development of NOX inhibition as a strategy for the treatment of ischemic stroke. Both inhibition using apocynin, as well as the prospect of developing more specific inhibitors based on what is now understood of the biology of NOX assembly and activation, will be highlighted in the course of our discussion.
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Affiliation(s)
- Jiamei Shen
- China-America Institute of Neuroscience, Beijing Luhe Hospital, Capital Medical University, Beijing, China; Department of Neurosurgery, Wayne State University School of Medicine, Detroit, MI, USA
| | - Radhika Rastogi
- Department of Neurosurgery, Wayne State University School of Medicine, Detroit, MI, USA
| | - Xiaokun Geng
- China-America Institute of Neuroscience, Beijing Luhe Hospital, Capital Medical University, Beijing, China; Department of Neurosurgery, Wayne State University School of Medicine, Detroit, MI, USA; Department of Neurology, Beijing Luhe Hospital, Capital Medical University, Beijing, China
| | - Yuchuan Ding
- Department of Neurosurgery, Wayne State University School of Medicine, Detroit, MI, USA
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22
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Abstract
RATIONALE Metastatic thymic carcinoma in the spine is a rare disease with no standard curative managements yet. The objective of this study is to report a very rare case of spinal metastases of thymic carcinoma successfully operated by combination of instrumentation and cement augmentation together with adjuvant treatment. The management of these unique cases has yet to be well-documented. PATIENT CONCERNS A 57-year-old man presented with a 6-month history of continuous and progressive back pain. The patient, who had been diagnosed of thymic carcinoma (stage IV B) for 3 years, received surgical treatment of median sternotomy thymectomy, followed by 3 cycles of chemotherapy and 12 cycles of radiotherapy. DIAGNOSIS Magnetic resonance imaging (MRI) of spine showed spinal cord compression secondary to the epidural component of the T4 mass, with increased metastatic marrow infiltration of the left T4 vetebral body, which presented as a solid tumor. Post-operative pathology confirmed the diagnosis of spinal metastases of thymic carcinoma. INTERVENTIONS The patient underwent exploratory surgery, circumferential spinal cord decompression, cement augmentation and a stabilization procedure via a posterior approach. OUTCOMES The patient's neurological deficits improved significantly after the surgery, and the postoperative period was uneventful at the 3-month follow-up visit. There were no other complications associated with the operation during the follow-up period. LESSONS Taken together, the lesion's clinical features, imaging results, and pathological characteristics are unique. Combined efforts of specialists from orthopedics, neurosurgery, thoracic surgery, and medical oncology led to the successful diagnosis and management of this patient. Metastatic thymic carcinoma of the spine, although rare, should be part of the differential diagnosis when the patient has a history of thymic carcinoma and presents with back pain and radiculopathy. We recommend the posterior approach for spinal decompression of the metastatic thymic carcinoma when the tumor has caused neurological deficits. Osteoplasty by cement augmentation is also a good choice for surgical treatment.
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Affiliation(s)
- Shuzhong Liu
- Department of Orthopaedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences
| | - Xi Zhou
- Department of Orthopaedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences
| | - An Song
- Department of Endocrinology, Key Laboratory of Endocrinology, National Health and Family Planning Commission
| | - Zhen Huo
- Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, China
| | - William A. Li
- Department of Neurosurgery, Wayne State University School of Medicine, Detroit, MI
| | - Radhika Rastogi
- Department of Neurosurgery, Wayne State University School of Medicine, Detroit, MI
| | - Yipeng Wang
- Department of Orthopaedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences
| | - Yong Liu
- Department of Orthopaedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences
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23
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Abstract
RATIONALE Malignant thymoma in the spine is a rare disease without standard curative managements so far. The objective of this article is to report a very rare case of recurrent malignant thymoma with sacrum metastases causing severe lumbosacral pain, which was presented with acute radiculopathy and treated with 2 operations combined with stabilization and cement augmentation. The management of these unique cases is not well-documented. PATIENT CONCERNS A 75-year-old man presented with lumbosacral pain, radiating pain and numbness of the left extremity. The patient underwent thymectomy in 2008, and posterior spinal cord decompression, tumor resection and a stabilization procedure in 2011. Pathologic results confirmed malignant thymomas of the spine. Imaging studies revealed the density of soft tissues, obvious bony destruction in the sacrum, and significant spinal cord obstruction. DIAGNOSES We believe this is a less-documented case of metastatic thymoma of the sacral spine presenting with back pain and radiculopathy, and presenting as a giant solid tumor. INTERVENTIONS The patient underwent osteoplasty via a posterior approach. Pathologic results confirmed malignant thymomas of the sacral spine. OUTCOMES The patient's neurological deficits improved significantly after the surgery, and the postoperative period was uneventful at the 6-month and 1-year follow-up visit. There were no other complications associated with the operation during the follow-up period. LESSONS This article emphasizes metastatic thymoma of the spine, although rare, should be part of the differential when the patient presents with back pain and radiculopathy. We recommend the posterior approach for spinal decompression of the metastatic thymoma when the tumor has caused neurological deficits. Osteoplasty by cement augmentation is also a good choice for surgical treatment.
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Affiliation(s)
- Shuzhong Liu
- Department of Orthopaedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences
| | - Xi Zhou
- Department of Orthopaedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences
| | - An Song
- Department of Endocrinology, Key Laboratory of Endocrinology, National Health and Family Planning Commission, Peking Union Medical College Hospital
| | - Zhen Huo
- Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, China
| | - William A. Li
- Department of Neurosurgery, Wayne State University School of Medicine, Detroit, MI
| | - Radhika Rastogi
- Department of Neurosurgery, Wayne State University School of Medicine, Detroit, MI
| | - Yipeng Wang
- Department of Orthopaedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences
| | - Yong Liu
- Department of Orthopaedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences
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Ghosh B, Yadav S, Budhiraja V, Dass P, Rastogi R, Chowdhury S. Anatomical variation of the ulnar artery: clinical and developmental significance. ACTA ACUST UNITED AC 2018. [DOI: 10.4322/jms.331116] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Abstract
Introduction: Variation of the ulnar artery in the upper limb is uncommon. The existence of such a variant is of particular clinical significance, as these arteries are more susceptible to trauma, and can be easily confused with superficial veins during medical and surgical procedures, potentially leading to iatrogenic distal limb ischemia. Case report: During routine dissection we observed a unilateral case of superficial ulnar artery in a 60-year-old male cadaver. It originated from the left brachial artery in the middle of the arm, near to insertion of coracobrachialis muscle. From its origin, it passed downwards in the medial part of arm behind the median nerve and forearm in a supericial plane compared to normal ulnar artery. In the hand, the supericial ulnar artery anastomosed with the palmar branch of the radial artery, creating the supericial palmar arch. Brachial artery divided into the radial and common interosseous arteries in the cubital fossa. The normal ulnar artery was absent. The existence of superficial ulnar artery is undeniably of interest to the clinicians as well as to the anatomists.
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Affiliation(s)
- B. Ghosh
- Department of Anatomy, Dr. Rajendra Prasad Government Medical College, Tanda, Kangra, Himachal Pradesh, India
| | - S. Yadav
- Department of Anatomy, Dr. Rajendra Prasad Government Medical College, Tanda, Kangra, Himachal Pradesh, India
| | - V. Budhiraja
- Department of Anatomy, L.N. Medical College, Bhopal, M.P, India
| | - P. Dass
- Department of Anatomy, Dr. Rajendra Prasad Government Medical College, Tanda, Kangra, Himachal Pradesh, India
| | - R. Rastogi
- Department of Anatomy, L.N. Medical College, Bhopal, M.P, India
| | - S. Chowdhury
- PGT Biology, Kendriya Vidyalaya, Dharmashala Cantt, Himachal Pradesh, India
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Abstract
RATIONALE Malignant pheochromocytoma in the spine is a rare disease without standard curative managements so far. The objective of this article is to report a very rare case of malignant pheochromocytoma with sacrum metastases causing severe lumbosacral pain, which was presented with acute radiculopathy and treated with three operations combined with cement augmentation and stabilization. The management of these unique cases has yet to be well-documented. PATIENT CONCERNS A 58-year-old man presented with lumbosacral pain, radiating pain and numbness of the right extremity. The patient underwent excision of right adrenal pheochromocytoma in 2010. Imaging studies revealed the density of soft tissues, obvious bony destruction in the sacrum, and significant spinal cord obstruction. DIAGNOSES We believe this is the first report of malignant pheochromocytoma with sacrum metastases. INTERVENTIONS The patient underwent tissue biopsy and osteoplasty after embolization of the internal iliac artery in January 2015, and exploratory surgery, circumferential spinal cord decompression, and a stabilization procedure via a posterior approach in June 2015 due to spinal canal stenosis caused by cement. Since the position of pedicle screw was not good enough, a revision surgery was performed the next day following the procedures in June 2015. OUTCOMES The patient's neurological deficits improved significantly after the third surgery, and the postoperative period was uneventful at the three-year follow-up visit. LESSONS We recommend the posterior approach for spinal decompression of the metastatic pheochromocytoma when the tumor has caused neurological deficits. Osteoplasty by cement augmentation is also a good choice for surgical treatment. However, the potential risk of complications in bone cement applications need to be fully recognized.
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Affiliation(s)
- Shuzhong Liu
- Department of Orthopaedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences
| | - Xi Zhou
- Department of Orthopaedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences
| | - An Song
- Department of Endocrinology, Key Laboratory of Endocrinology, National Health and Family Planning Commission, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, People's Republic of China
| | - William A. Li
- Department of Neurosurgery, Wayne State University School of Medicine, Detroit, Michigan
| | - Radhika Rastogi
- Department of Neurosurgery, Wayne State University School of Medicine, Detroit, Michigan
| | - Yipeng Wang
- Department of Orthopaedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences
| | - Yong Liu
- Department of Orthopaedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences
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Zhang LJ, Liu MY, Rastogi R, Ding JN. Psychocardiological disorder and brain serotonin after comorbid myocardial infarction and depression: an experimental study. Neurol Res 2018; 40:516-523. [PMID: 29577822 DOI: 10.1080/01616412.2018.1455460] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Objectives We investigated whether trimetazidine pretreatment can regulate central and peripheral serotonin (5-HT) in rats of myocardial infarction (MI) combined with depression. Methods Forty rats were randomly assigned to a sham operation group (n = 10) and a disease model group (n = 30). The sham operation group was pretreated with normal saline for 4 weeks. The disease model group was randomly assigned further into a negative control subgroup, a positive control subgroup, and a treatment subgroup - the groups received saline, sertraline, and trimetazidine pretreatment, respectively, for 4 weeks, then the rats were subjected to MI combined with depression. 5-HT concentrations in the serum, platelet lysate, and cerebral cortex lysate were analyzed with ELISA. Results The levels of serum 5-HT and platelet 5-HT were significantly lower in negative control subgroup than the sham operation group (P < 0.05), but there was no significant difference in brain 5-HT (P > 0.05). Compared with the negative control subgroup, the levels of serum 5-HT and platelet 5-HT in the positive control subgroup and treatment subgroup were significantly higher (P < 0.05). The levels of 5-HT in brain of the positive control subgroup and treatment subgroup were significantly lower than those in the negative control subgroup (P < 0.05). Conclusions Trimetazidine pretreatment can increase serum and platelet 5-HT levels in rats with MI and depression and decrease 5-HT levels in brain tissue. This regulatory effect on central and peripheral 5-HT suggests a role for trimetazidine in the treatment of psychocardiological diseases.
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Affiliation(s)
- Li-Jun Zhang
- a Department of Cardiology , Beijing Anzhen Hospital Affiliated to Capital Medical University , Beijing , China
| | - Mei-Yan Liu
- a Department of Cardiology , Beijing Anzhen Hospital Affiliated to Capital Medical University , Beijing , China
| | - Radhika Rastogi
- b Department of Neurosurgery , Wayne State University School of Medicine , Detroit , MI , USA
| | - Jessie N Ding
- b Department of Neurosurgery , Wayne State University School of Medicine , Detroit , MI , USA
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Shen J, Rastogi R, Guan L, Li F, Du H, Geng X, Ding Y. Omega-3 fatty acid supplement reduces activation of NADPH oxidase in intracranial atherosclerosis stenosis. Neurol Res 2018; 40:499-507. [PMID: 29576013 DOI: 10.1080/01616412.2018.1451290] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Jiamei Shen
- China-America Institute of Neuroscience, Beijing Luhe Hospital, Capital Medical University, Beijing, China
- Department of Neurosurgery, Wayne State University School of Medicine, Detroit, MI, USA
| | - Radhika Rastogi
- Department of Neurosurgery, Wayne State University School of Medicine, Detroit, MI, USA
| | - Longfei Guan
- China-America Institute of Neuroscience, Beijing Luhe Hospital, Capital Medical University, Beijing, China
- Department of Neurosurgery, Wayne State University School of Medicine, Detroit, MI, USA
| | - Fengwu Li
- China-America Institute of Neuroscience, Beijing Luhe Hospital, Capital Medical University, Beijing, China
| | - Huishan Du
- China-America Institute of Neuroscience, Beijing Luhe Hospital, Capital Medical University, Beijing, China
- Department of Neurology, Beijing Luhe Hospital, Capital Medical University, Beijing, China
| | - Xiaokun Geng
- China-America Institute of Neuroscience, Beijing Luhe Hospital, Capital Medical University, Beijing, China
- Department of Neurosurgery, Wayne State University School of Medicine, Detroit, MI, USA
- Department of Neurology, Beijing Luhe Hospital, Capital Medical University, Beijing, China
| | - Yuchuan Ding
- China-America Institute of Neuroscience, Beijing Luhe Hospital, Capital Medical University, Beijing, China
- Department of Neurosurgery, Wayne State University School of Medicine, Detroit, MI, USA
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Abstract
Ramucirumab is a recombinant human monoclonal antibody and is used in the treatment of advanced malignancies. Its mechanism of action is by inhibiting angiogenesis in tumor cells by targeting the vascular endothelial growth factor receptor 2. United States Food and Drug Administration (FDA) approved it initially in 2014 for the treatment of advanced gastric or gastro-esophageal junction adenocarcinoma and metastatic non-small cell lung carcinoma. It was approved by FDA in 2015 for the treatment of advanced colorectal cancer. This manuscript consolidates pre-clinical trials to phase I, II, and III trial data indicating the effects of ramucirumab on different cancer types, which led to its approval. By comparing these clinical trials alongside each other, we can more easily examine the studies that have already been completed, along with currently ongoing studies and potential further areas of interest for this newly approved treatment. This approach makes it convenient to compare dosages, overall survival, adverse events, as well as possible routes for combination therapy with ramucirumab. By compiling results for various oncological malignancies, we can differentiate between treatments that are effective and have the highest incidence of stable disease, and those that do not seem promising. Ramucirumab has been effective in the treatment of various carcinomas and this article outlines other tumors in which this treatment option may be successful.
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Affiliation(s)
- A Vennepureddy
- 1 Department of Internal Medicine, Staten Island University Hospital, NY, USA
| | - P Singh
- 1 Department of Internal Medicine, Staten Island University Hospital, NY, USA
| | - R Rastogi
- 1 Department of Internal Medicine, Staten Island University Hospital, NY, USA
| | - J P Atallah
- 2 Division of Hematology and Oncology, Staten Island University Hospital, NY, USA
| | - T Terjanian
- 2 Division of Hematology and Oncology, Staten Island University Hospital, NY, USA
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Bakkila K, Axelrod B, Kushida C, Rastogi R, Vogel D, Chowdhuri S. 0619 IMPACT OF OSA AND OSA-COPD OVERLAP SYNDROME ON NEUROCOGNITIVE OUTCOMES. Sleep 2017. [DOI: 10.1093/sleepj/zsx050.618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Bhasin V, Srivastava A, Rastogi R, Lele HG, Vaze KK, Ghosh AK, Kushwaha HS. Best-Estimate Evaluation of Large-Break Loss-of-Coolant Accident for Advanced Natural Circulation Nuclear Reactor. NUCL SCI ENG 2017. [DOI: 10.13182/nse160-318] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Vivek Bhasin
- Bhabha Atomic Research Centre, Health Safety and Environmental Group Trombay, Mumbai – 400 085, India
| | - A. Srivastava
- Bhabha Atomic Research Centre, Health Safety and Environmental Group Trombay, Mumbai – 400 085, India
| | - R. Rastogi
- Bhabha Atomic Research Centre, Health Safety and Environmental Group Trombay, Mumbai – 400 085, India
| | - H. G. Lele
- Bhabha Atomic Research Centre, Health Safety and Environmental Group Trombay, Mumbai – 400 085, India
| | - K. K. Vaze
- Bhabha Atomic Research Centre, Health Safety and Environmental Group Trombay, Mumbai – 400 085, India
| | - A. K. Ghosh
- Bhabha Atomic Research Centre, Health Safety and Environmental Group Trombay, Mumbai – 400 085, India
| | - H. S. Kushwaha
- Bhabha Atomic Research Centre, Health Safety and Environmental Group Trombay, Mumbai – 400 085, India
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Rastogi R, Geng X, Ding Y. Abstract TP120: A Novel Potential Therapy in Severe Stroke: Neuroprotective Chlorpromazine/Promethazine Combination in Transient and Permanent Ischemia. Stroke 2017. [DOI: 10.1161/str.48.suppl_1.tp120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose:
Previous studies have demonstrated depressive or hibernation-like roles of phenothiazine neuroleptics [combined chlorpromazine and promethazine (C+P)] in brain activity. This ischemic stroke study aimed to establish neuroprotection by reducing oxidative stress and improving brain metabolism through post-ischemic C+P administration.
Methods:
Sprague-Dawley rats (n=272) were subjected to transient (2 or 4 h) middle cerebral artery occlusion (MCAO) followed by 6 or 24 h reperfusion, or permanent (28 h) MCAO without reperfusion. At 2 h after ischemic onset, rats received either an intraperitoneal (IP) injection of saline or two doses of C+P. Body temperatures, brain infarct volumes, and neurological deficits were examined. Oxidative metabolism and stress were determined by levels of ATP, NADH, and reactive oxygen species (ROS). Protein kinase C-δ (PKC-δ) and Akt expression were determined by Western blotting.
Results:
In both transient and permanent ischemia models, C+P administration significantly induced a dose-dependent reduction in body temperature and neuroprotection within as early as 5 min and lasting up to 12 h. Body temperature reduction either only slightly or did not enhance C+P-induced neuroprotection, as determined by infarct volumes and neurological deficits post-stroke. C+P therapy improved brain metabolism as determined by increased ATP levels and NADH activity, as well as diminished ROS production. These therapeutic effects were associated with alterations in PKC-δ and Akt protein expression.
Conclusions:
C+P treatments conferred neuroprotection in severe stroke models by suppressing the damaging cascade of metabolic events, most likely independent of drug-induced hypothermia. These findings may direct us towards the development of an efficacious, practical, and accessible neuroprotective therapy in stroke patients.
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Garg B, Rastogi R, Gupta S, Rastogi H, Garg H, Chowdhury V. Evaluation of biliary complications on magnetic resonance cholangiopancreatography and comparison with direct cholangiography after living-donor liver transplantation. Clin Radiol 2017; 72:518.e9-518.e15. [PMID: 28118992 DOI: 10.1016/j.crad.2016.12.019] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Revised: 12/13/2016] [Accepted: 12/23/2016] [Indexed: 02/08/2023]
Abstract
AIM To evaluate the imaging characteristics of biliary complications following liver transplantation on magnetic resonance cholangiopancreatography (MRCP) and its diagnostic accuracy in comparison with direct cholangiography. MATERIAL AND METHODS In this prospective study, 34 patients being evaluated for possible biliary complications after living-donor liver transplantation (LDLT) with abnormal MRCP findings were followed up for information regarding direct cholangiography either endoscopic retrograde cholangiopancreatography (ERCP) or percutaneous transhepatic cholangiography (PTC) within 7 days of MRCP. Twenty-nine patients underwent ERCP and five patients underwent PTC. RESULTS Compared to findings at direct cholangiography, MRCP presented 96.9% sensitivity, 96.9% positive predictive value, and 94.1% accuracy for the detection of biliary complications. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy for detection of anastomotic strictures, biliary leak, and biliary stone or sludge on MRCP was found to be 100%, 84.6%, 91.3%, 100% and 94.1%; 72.7%, 95.7%, 88.9%, 88% and 88.2%; 80%, 100%, 100%, 96.7% and 97.1%, respectively. CONCLUSION MRCP is a reliable non-invasive technique to evaluate the biliary complications following LDLT. MRCP should be the imaging method of choice for diagnosis in this setting and direct cholangiography should be reserved for cases that need therapeutic interventions.
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Affiliation(s)
- B Garg
- Department of Radiology, Indraprastha Apollo Hospital, Sarita Vihar, New Delhi 110027, India
| | - R Rastogi
- Department of Radiology, Indraprastha Apollo Hospital, Sarita Vihar, New Delhi 110027, India.
| | - S Gupta
- Department of Liver Transplant Surgery, Centre for Liver and Biliary Sciences, Indraprastha Apollo Hospital, New Delhi, India
| | - H Rastogi
- Department of Radiology, Indraprastha Apollo Hospital, Sarita Vihar, New Delhi 110027, India
| | - H Garg
- Department of Hepatology and Gastroenterology, Centre for Liver & Biliary Sciences, Indraprastha Apollo Hospital, Sarita Vihar, New Delhi 110027, India
| | - V Chowdhury
- Department of Radiology, Indraprastha Apollo Hospital, Sarita Vihar, New Delhi 110027, India
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Rastogi R, Geng X, Li F, Ding Y. NOX Activation by Subunit Interaction and Underlying Mechanisms in Disease. Front Cell Neurosci 2017; 10:301. [PMID: 28119569 PMCID: PMC5222855 DOI: 10.3389/fncel.2016.00301] [Citation(s) in RCA: 137] [Impact Index Per Article: 19.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2016] [Accepted: 12/20/2016] [Indexed: 12/19/2022] Open
Abstract
Nicotinamide adenine dinucleotide phosphate (NAPDH) oxidase (NOX) is an enzyme complex with the sole function of producing superoxide anion and reactive oxygen species (ROS) at the expense of NADPH. Vital to the immune system as well as cellular signaling, NOX is also involved in the pathologies of a wide variety of disease states. Particularly, it is an integral player in many neurological diseases, including stroke, TBI, and neurodegenerative diseases. Pathologically, NOX produces an excessive amount of ROS that exceed the body’s antioxidant ability to neutralize them, leading to oxidative stress and aberrant signaling. This prevalence makes it an attractive therapeutic target and as such, NOX inhibitors have been studied and developed to counter NOX’s deleterious effects. However, recent studies of NOX have created a better understanding of the NOX complex. Comprised of independent cytosolic subunits, p47-phox, p67-phox, p40-phox and Rac, and membrane subunits, gp91-phox and p22-phox, the NOX complex requires a unique activation process through subunit interaction. Of these subunits, p47-phox plays the most important role in activation, binding and translocating the cytosolic subunits to the membrane and anchoring to p22-phox to organize the complex for NOX activation and function. Moreover, these interactions, particularly that between p47-phox and p22-phox, are dependent on phosphorylation initiated by upstream processes involving protein kinase C (PKC). This review will look at these interactions between subunits and with PKC. It will focus on the interaction involving p47-phox with p22-phox, key in bringing the cytosolic subunits to the membrane. Furthermore, the implication of these interactions as a target for NOX inhibitors such as apocynin will be discussed as a potential avenue for further investigation, in order to develop more specific NOX inhibitors based on the inhibition of NOX assembly and activation.
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Affiliation(s)
- Radhika Rastogi
- Department of Neurosurgery, Wayne State University School of Medicine Detroit, MI, USA
| | - Xiaokun Geng
- Department of Neurosurgery, Wayne State University School of MedicineDetroit, MI, USA; China-America Institute of Neuroscience, Beijing Luhe Hospital, Capital Medical UniversityBeijing, China; Department of Neurology, Beijing Luhe Hospital, Capital Medical UniversityBeijing, China
| | - Fengwu Li
- China-America Institute of Neuroscience, Beijing Luhe Hospital, Capital Medical University Beijing, China
| | - Yuchuan Ding
- Department of Neurosurgery, Wayne State University School of MedicineDetroit, MI, USA; China-America Institute of Neuroscience, Beijing Luhe Hospital, Capital Medical UniversityBeijing, China
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Parmar S, Moore-Langston S, Fredrickson V, Kim JM, Rastogi R, Elmadoun O, Ding Y. Neuroprotective mechanisms of oxygen and ethanol: a potential combination therapy in stroke. Curr Med Chem 2016; 22:1194-204. [PMID: 25620099 DOI: 10.2174/0929867322666150114152945] [Citation(s) in RCA: 8] [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] [Subscribe] [Scholar Register] [Received: 09/01/2014] [Revised: 01/05/2015] [Accepted: 01/08/2015] [Indexed: 11/22/2022]
Abstract
Currently, stroke researchers are racing to develop neuroprotective strategies that shield the brain from ischemia-induced injury. To date, neuroprotective agents that have shown promise in animal studies have failed in clinical trials. Since the pathophysiology of ischemic stroke exploits numerous pathways leading to cellular injury, a combination of neuroprotective agents may offer substantially better results than a single agent alone - by intervening in multiple mechanisms. In this paper, we consider an approach using combination therapy with normobaric oxygen (NBO) and ethanol. Studies indicate that NBO therapy improves tissue oxygenation, thereby reducing the extent of hypoxic injury and decelerating the development of tissue necrosis when administered early after stroke onset. Studies have also demonstrated that low to moderate levels of ethanol not only decrease the risk of stroke, but also reduce post-ischemic sequelae. This article reviews the history of NBO and ethanol therapies, their mechanisms of action, the results of key clinical trials, and the rationale for their use as a combination therapy in the context of stroke treatment.
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Affiliation(s)
| | | | | | | | | | | | - Yuchuan Ding
- Department of Neurological Surgery, Wayne State University School of Medicine, 550 E Canfield, Detroit, MI 48201, USA.
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Rastogi R, Rastogi D, Silver EJ. Quality of life among urban children with obesity and asthma. J Health Care Poor Underserved 2016; 25:683-93. [PMID: 24858878 DOI: 10.1353/hpu.2014.0081] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To investigate quality of life (QoL) among obese asthmatic children and elucidate its association with lung function. METHODS Preadolescent inner-city children with obesity, asthma, both, or neither completed the Pediatric Quality of Life 4.0 (PedsQL) and Asthma Quality of Life Questionnaires and spirometry testing. Spirometric indices, composite and individual QoL scores were compared between groups using analysis of variance while proportion of children reporting item-specific impairment were compared by chi-squaretest. RESULTS The composite QoL scores did not differ between obese asthmatics and the other study groups. FEV1/FVC was the lowest among obese asthmatics but did not correlate with QoL measures. DISCUSSION Overall QoL in obese asthmatic preadolescents is well preserved. Since QoL measures did not correlate with spirometric indics, asthma severity may not serve as a surrogate marker of QoL. QoL evaluation should be incorporated in asthma management and early identification of changes may prevent further deterioration.
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Cai L, Thibodeau A, Peng C, Ji X, Rastogi R, Xin R, Singh S, Geng X, Rafols JA, Ding Y. Combination therapy of normobaric oxygen with hypothermia or ethanol modulates pyruvate dehydrogenase complex in thromboembolic cerebral ischemia. J Neurosci Res 2016; 94:749-58. [PMID: 27027410 DOI: 10.1002/jnr.23740] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Revised: 02/09/2016] [Accepted: 03/10/2016] [Indexed: 02/04/2023]
Affiliation(s)
- Lipeng Cai
- China-America Institute of Neuroscience, Xuanwu Hospital; Capital Medical University; Beijing China
- Department of Neurological Surgery; Wayne State University School of Medicine; Detroit Michigan
- Department of Neurology, Luhe Hospital; Capital Medical University; Beijing China
| | - Alexa Thibodeau
- Department of Neurological Surgery; Wayne State University School of Medicine; Detroit Michigan
| | - Changya Peng
- Department of Neurological Surgery; Wayne State University School of Medicine; Detroit Michigan
| | - Xunming Ji
- China-America Institute of Neuroscience, Xuanwu Hospital; Capital Medical University; Beijing China
| | - Radhika Rastogi
- Department of Neurological Surgery; Wayne State University School of Medicine; Detroit Michigan
| | - Ruiqiang Xin
- Department of Neurological Surgery; Wayne State University School of Medicine; Detroit Michigan
- Department of Radiology, Luhe Hospital; Capital Medical University; Beijing China
| | - Sunpreet Singh
- Department of Neurological Surgery; Wayne State University School of Medicine; Detroit Michigan
| | - Xiaokun Geng
- China-America Institute of Neuroscience, Xuanwu Hospital; Capital Medical University; Beijing China
- Department of Neurological Surgery; Wayne State University School of Medicine; Detroit Michigan
- Department of Neurology, Luhe Hospital; Capital Medical University; Beijing China
| | - Jose A. Rafols
- Department of Anatomy and Cell Biology; Wayne State University School of Medicine; Detroit Michigan
| | - Yuchuan Ding
- China-America Institute of Neuroscience, Xuanwu Hospital; Capital Medical University; Beijing China
- Department of Neurological Surgery; Wayne State University School of Medicine; Detroit Michigan
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Cai L, Stevenson J, Peng C, Xin R, Rastogi R, Liu K, Geng X, Gao Z, Ji X, Rafols JA, Ji Z, Ding Y. Adjuvant therapies using normobaric oxygen with hypothermia or ethanol for reducing hyperglycolysis in thromboembolic cerebral ischemia. Neuroscience 2016; 318:45-57. [PMID: 26794589 DOI: 10.1016/j.neuroscience.2016.01.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Revised: 11/25/2015] [Accepted: 01/06/2016] [Indexed: 01/08/2023]
Abstract
BACKGROUND AND PURPOSE Normobaric oxygen (NBO), ethanol (EtOH), and therapeutic hypothermia (TH) delivered alone or in combination have neuroprotective properties after acute stroke. We used an autologous thromboembolic rat stroke model to assess the additive effects of these treatments for reducing the deleterious effects of hyperglycolysis post-stroke in which reperfusion is induced with recombinant tissue plasminogen activator (rt-PA). METHODS Sprague-Dawley rats were subjected to middle cerebral artery (MCA) occlusion with an autologous embolus. One hour after occlusion, rt-PA was administered alone or with NBO (60%), EtOH (1.0 g/kg), TH (33 °C), either singly or in combination. Infarct volume and neurological deficit were assessed at 24h after rt-PA-induced reperfusion with or without other treatments. The extent of hyperglycolysis, as determined by cerebral glucose and lactate levels was evaluated at 3 and 24h after rt-PA administration. At the same time points, expressions of glucose transporter 1 (Glut1), glucose transporter 3 (Glut3), phosphofructokinase1 (PFK-1), and lactate dehydrogenase were (LDH) measured by Western blotting. RESULTS Following rt-PA in rats with thromboembolic stroke, NBO combined with TH or EtOH most effectively decreased infarct volume and neurological deficit. As compared to rt-PA alone, EtOH or TH but not NBO monotherapies significantly reduced post-stroke hyperglycolysis. The increased utilization of glucose and production of lactate post-stroke was prevented most effectively when NBO was combined with either EtOH or TH after reperfusion with rt-PA, as shown by the significantly decreased Glut1, Glut3, PFK-1, and LDH levels. CONCLUSIONS In a rat thromboembolic stroke model, both EtOH and TH used individually offer neuroprotection after the administration of rt-PA. While NBO monotherapy does not appear to be effective, it significantly potentiates the efficacy of EtOH and TH. The similar neuroprotection and underlying mechanisms pertaining to the attenuation of hyperglycolysis provided by EtOH or TH in combination with NBO suggest a possibility of substituting EtOH for TH. Thus a combination of NBO and EtOH, which are widely available and easily used, could become a novel and effective neuroprotective strategy in the clinical setting.
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Affiliation(s)
- L Cai
- China-America Institute of Neuroscience, Department of Neurology, Luhe Hospital, Capital Medical University, Beijing, China; Department of Neurological Surgery, Wayne State University School of Medicine, Detroit, MI, USA
| | - J Stevenson
- Department of Neurological Surgery, Wayne State University School of Medicine, Detroit, MI, USA
| | - C Peng
- Department of Neurological Surgery, Wayne State University School of Medicine, Detroit, MI, USA
| | - R Xin
- Department of Neurological Surgery, Wayne State University School of Medicine, Detroit, MI, USA; Department of Radiology, Luhe Hospital, Capital Medical University, Beijing, China
| | - R Rastogi
- Department of Neurological Surgery, Wayne State University School of Medicine, Detroit, MI, USA
| | - K Liu
- Department of Neurological Surgery, Wayne State University School of Medicine, Detroit, MI, USA
| | - X Geng
- China-America Institute of Neuroscience, Department of Neurology, Luhe Hospital, Capital Medical University, Beijing, China; Department of Neurological Surgery, Wayne State University School of Medicine, Detroit, MI, USA
| | - Z Gao
- Cerebral Vascular Diseases Research Institute, Capital Medical University, Beijing, China
| | - X Ji
- Cerebral Vascular Diseases Research Institute, Capital Medical University, Beijing, China
| | - J A Rafols
- Department of Anatomy and Cell Biology, Wayne State University School of Medicine, Detroit, MI, USA
| | - Z Ji
- China-America Institute of Neuroscience, Department of Neurology, Luhe Hospital, Capital Medical University, Beijing, China.
| | - Y Ding
- China-America Institute of Neuroscience, Department of Neurology, Luhe Hospital, Capital Medical University, Beijing, China; Department of Neurological Surgery, Wayne State University School of Medicine, Detroit, MI, USA.
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Ji Z, Liu K, Cai L, Peng C, Xin R, Gao Z, Zhao E, Rastogi R, Han W, Rafols JA, Geng X, Ding Y. Therapeutic effect of tPA in ischemic stroke is enhanced by its combination with normobaric oxygen and hypothermia or ethanol. Brain Res 2015; 1627:31-40. [PMID: 26319679 DOI: 10.1016/j.brainres.2015.08.019] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [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: 06/04/2015] [Revised: 08/17/2015] [Accepted: 08/18/2015] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND PURPOSE Our lab has previously elucidated the neuroprotective effects of normobaric oxygen (NBO) and ethanol (EtOH) in ischemic stroke. The present study further evaluated the effect of EtOH or hypothermia (Hypo) in the presence of low concentration of NBO and determined whether EtOH can substitute hypothermia in a more clinically relevant autologous embolus rat stroke model in which reperfusion was established by tissue-type plasminogen activator (t-PA). METHODS At 1h of middle cerebral artery occlusion (MCAO) by an autologous embolus, rats received t-PA. In addition, at the same time, ischemic animals were treated with either EtOH (1.0 g/kg) or hypothermia (33°C for 3h) in combination with NBO (60% for 3h). Extent of neuroprotection was assessed by apoptotic cell death measured by ELISA and Western immunoblotting analysis for pro- (AIF, activated Caspase-3, Bax) and anti-apoptotic (Bcl-2) protein expression at 3 and 24h of reperfusion induced by t-PA administration. RESULTS Compared to ischemic rats treated only with t-PA, animals with NBO, hypothermia or EtOH had significantly reduced apoptotic cell death by 32.5%, 43.1% and 36.0% respectively. Furthermore, combination therapy that included NBO+EtOH or NBO+Hypo with t-PA exhibited a much larger decline (p<0.01) in the cell death by 71.1% and 73.6%, respectively. Similarly, NBO+EtOH or NBO+Hypo treatment in addition to t-PA enhanced beneficial effects on both pro- and anti-apoptotic protein expressions as compared to other options. CONCLUSIONS Neuroprotection after stroke can be enhanced by combination treatment with either EtOH or hypothermia in the presence of t-PA and 60% NBO. Because the effects produced by EtOH and hypothermia are comparable, their mechanism of action may be not only similar but also could be interchangeable in future clinical trials.
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Affiliation(s)
- Zhili Ji
- Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Kayin Liu
- Department of Neurological Surgery, Wayne State University School of Medicine, Detroit, MI, USA
| | - Lipeng Cai
- Department of Neurological Surgery, Wayne State University School of Medicine, Detroit, MI, USA; China-America Institute of Neuroscience, Department of Neurology, Luhe Hospital, Capital Medical University, Beijing, China
| | - Changya Peng
- Department of Neurological Surgery, Wayne State University School of Medicine, Detroit, MI, USA
| | - Ruiqiang Xin
- Department of Neurological Surgery, Wayne State University School of Medicine, Detroit, MI, USA; China-America Institute of Neuroscience, Department of Neurology, Luhe Hospital, Capital Medical University, Beijing, China; Department of Radiology, Luhe Hospital, Capital Medical University, Beijing, China
| | - Zhi Gao
- Cerebral Vascular Diseases Research Institute, Capital Medical University, Beijing, China
| | - Ethan Zhao
- Department of Neurological Surgery, Wayne State University School of Medicine, Detroit, MI, USA
| | - Radhika Rastogi
- Department of Neurological Surgery, Wayne State University School of Medicine, Detroit, MI, USA
| | - Wei Han
- Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China.
| | - Jose A Rafols
- Department of Anatomy and Cell Biology, Wayne State University School of Medicine, Detroit, MI USA
| | - Xiaokun Geng
- Department of Neurological Surgery, Wayne State University School of Medicine, Detroit, MI, USA; China-America Institute of Neuroscience, Department of Neurology, Luhe Hospital, Capital Medical University, Beijing, China
| | - Yuchuan Ding
- Department of Neurological Surgery, Wayne State University School of Medicine, Detroit, MI, USA; China-America Institute of Neuroscience, Department of Neurology, Luhe Hospital, Capital Medical University, Beijing, China.
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Xu B, Qiao Q, Chen M, Rastogi R, Luo D, Bi Q. Relationship between neurological complications, cerebrovascular and cerebral perfusion following off-pump coronary artery bypass grafting. Neurol Res 2015; 37:421-6. [DOI: 10.1179/1743132815y.0000000030] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Geng X, Sy CA, Kwiecien TD, Ji X, Peng C, Rastogi R, Cai L, Du H, Brogan D, Singh S, Rafols JA, Ding Y. Reduced cerebral monocarboxylate transporters and lactate levels by ethanol and normobaric oxygen therapy in severe transient and permanent ischemic stroke. Brain Res 2015; 1603:65-75. [PMID: 25641040 DOI: 10.1016/j.brainres.2015.01.040] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2014] [Revised: 01/16/2015] [Accepted: 01/20/2015] [Indexed: 01/04/2023]
Abstract
OBJECTIVES Neuroprotective benefits of ethanol (EtOH) and normobaric oxygenation (NBO) were previously demonstrated in transient and permanent ischemic stroke. Here we sought to identify whether the enhanced lactic acidosis and increased expression of monocarboxylate transporters (MCTs) observed after stroke might be attenuated by single and/or combined EtOH and NBO therapies. METHODS Sprague-Dawley rats (n=96) were subjected to right middle cerebral artery occlusion (MCAO) for 2 or 4h (transient ischemia), or 28 h (permanent ischemia) followed by 3, 24h, or no reperfusion. Rats received: (1) either an intraperitoneal injection of saline (sham treatment), one dose of EtOH (1.5 g/kg), two doses of EtOH (1.5 g/kg at 2h of MCAO, followed by 1.0 g/kg 2h after 1st dose), or (2) EtOH+95% NBO (at 2h of MCAO for 6h in permanent ischemia). Lactate levels were detected at 3 and 24h of reperfusion. Gene and protein expressions of MCT-1, -2, -4 were assessed by real-time PCR and western blotting. RESULTS A dose-dependent EtOH neuroprotection was found in transient ischemia. Following transient ischemia, a single dose of EtOH (in 2h-MCAO) or a double dose (in 4h-MCAO), significantly attenuated lactate levels, as well as the mRNAs and protein expressions of MCT-1, MCT-2, and MCT-4. However, while two doses of EtOH alone was ineffective in permanent stroke, the combined therapy (EtOH+95% NBO) resulted in a more significant attenuation in all the above levels and expressions. CONCLUSIONS Our study demonstrates that acute EtOH administration attenuated lactic acidosis in transient or permanent ischemic stroke. This EtOH-induced beneficial effect was potentiated by NBO therapy in permanent ischemia. Because both EtOH and NBO are readily available, inexpensive and easy to administer, their combination could be implemented in the clinics shortly after stroke.
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Affiliation(s)
- Xiaokun Geng
- China-America Institute of Neuroscience, Luhe Hospital, Capital Medical University, Beijing, China; Department of Neurological Surgery, Wayne State University School of Medicine, 550 E Canfield, Detroit, MI 48201, USA
| | - Christopher A Sy
- Department of Neurological Surgery, Wayne State University School of Medicine, 550 E Canfield, Detroit, MI 48201, USA
| | - Timothy D Kwiecien
- Department of Neurological Surgery, Wayne State University School of Medicine, 550 E Canfield, Detroit, MI 48201, USA
| | - Xunming Ji
- China-America Institute of Neuroscience, Luhe Hospital, Capital Medical University, Beijing, China; Department of Neurosurgery, Xuanwu Hospital, China-America Institute of Neuroscience, Luhe Hospital Capital Medical University, Beijing 100053, China.
| | - Changya Peng
- Department of Neurological Surgery, Wayne State University School of Medicine, 550 E Canfield, Detroit, MI 48201, USA
| | - Radhika Rastogi
- Department of Neurological Surgery, Wayne State University School of Medicine, 550 E Canfield, Detroit, MI 48201, USA
| | - Lipeng Cai
- China-America Institute of Neuroscience, Luhe Hospital, Capital Medical University, Beijing, China; Department of Neurological Surgery, Wayne State University School of Medicine, 550 E Canfield, Detroit, MI 48201, USA
| | - Huishan Du
- China-America Institute of Neuroscience, Luhe Hospital, Capital Medical University, Beijing, China
| | - David Brogan
- Department of Neurological Surgery, Wayne State University School of Medicine, 550 E Canfield, Detroit, MI 48201, USA
| | - Sunpreet Singh
- Department of Neurological Surgery, Wayne State University School of Medicine, 550 E Canfield, Detroit, MI 48201, USA
| | - Jose A Rafols
- Department of Anatomy and Cell Biology, Wayne State University School of Medicine, Detroit, MI, USA
| | - Yuchuan Ding
- China-America Institute of Neuroscience, Luhe Hospital, Capital Medical University, Beijing, China; Department of Neurological Surgery, Wayne State University School of Medicine, 550 E Canfield, Detroit, MI 48201, USA.
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Ding Y, Choi H, Fan Z, Haacke E, Rastogi R, Xia S, Wang M, Luo Y, Li M, Kwiecien T. Recent advances in magnetic resonance imaging for stroke diagnosis. Brain Circ 2015. [DOI: 10.4103/2394-8108.164996] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Robbins SM, Rastogi R, Howard J, Rosedale R. Comparison of measurement properties of the P4 pain scale and disease specific pain measures in patients with knee osteoarthritis. Osteoarthritis Cartilage 2014; 22:805-12. [PMID: 24721460 DOI: 10.1016/j.joca.2014.03.018] [Citation(s) in RCA: 6] [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: 11/11/2013] [Revised: 03/19/2014] [Accepted: 03/31/2014] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To compare measurement properties of the P4 pain scale, Western Ontario and McMaster Universities Arthritis Index pain subscale (WOMAC-pain), and Intermittent and Constant Osteoarthritis Pain (ICOAP) measure in patients with knee osteoarthritis (OA). DESIGN A secondary analysis from a randomized controlled trial included participants (n = 156) with knee OA that were consulting with a surgeon regarding knee arthroplasty. They completed pain measures (P4, WOMAC-pain, ICOAP) and WOMAC-function subscale (WOMAC-function) at baseline and 2 weeks. Measurement properties assessed in various subgroups included floor/ceiling effects, test-retest reliability using intraclass correlation coefficients (ICC2,1), internal consistency using Cronbach's ɑ, factorial structure of each pain measure combined with WOMAC-function using principal component analysis, and responsiveness using standardized response mean (SRM). RESULTS P4 had low floor and ceiling effects (<1%). P4 test-retest reliability (ICC2,1 = 0.72), internal consistency (Chronbach's ɑ = 0.91), and responsiveness (SRM = 0.56) were similar to the values for WOMAC-pain and ICOAP. Factorial structure of P4 and ICOAP were separate from WOMAC-function items. WOMAC-pain and WOMAC-function items loaded on similar factors. ICOAP-constant subscale had a large floor effect (33%). CONCLUSIONS P4 should be used to measure pain in patients with knee OA. It had acceptable measurement properties which is comparable to more widely used pain measures. WOMAC-pain shared a factorial structure with WOMAC-function indicating these measures might be capturing the same construct, questioning its validity to measure pain separately from function. ICOAP had acceptable properties. More work should compare pain measures in less severely affected OA populations.
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Affiliation(s)
- S M Robbins
- Centre for Interdisciplinary Research in Rehabilitation, Constance Lethbridge Rehabilitation Centre, and School of Physical and Occupational Therapy, McGill University, Montreal, Canada.
| | - R Rastogi
- Department of Physiotherapy, London Health Sciences Centre, London, Canada.
| | - J Howard
- Division of Orthopedic Surgery, Western University and London Health Sciences Centre, London, Canada.
| | - R Rosedale
- Occupational Health and Safety Services, London Health Sciences Centre, London, Canada.
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Zhao S, Fu J, Liu F, Rastogi R, Zhang J, Zhao Y. Small interfering RNA directed against CTMP reduces acute traumatic brain injury in a mouse model by activating Akt. Neurol Res 2014; 36:483-90. [PMID: 24670215 DOI: 10.1179/1743132814y.0000000353] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OBJECTIVE Protein kinase B (PKB/Akt), which is phosphorylated and activated by upstream activators, exerts critical neuroprotective effects by phosphorylating downstream targets after traumatic brain injury (TBI). Studies on the regulation of Akt will be crucial for our understanding of neuronal survival. The goal of this study is to investigate the effects of carboxyl-terminal modulator protein (CTMP) on phosphorylation of Akt and neurological function in a mouse model of TBI. METHODS Traumatic brain injury in mice was performed by a controlled cortical impact device. The expression of Akt, phospho-Akt, and CTMP was examined in the injured cortices by immunohistochemistry and Western blot analysis. To determine the effects of CTMP, small interfering RNAs (siRNAs) directed against CTMP were injected in mice with TBI, and the expression of phosphorylated Akt and neurological function were evaluated. RESULTS Phospho-Akt significantly increased at 4 hours post-TBI in the nucleus (P < 0.01) and remained at high levels until 72 hours after TBI, as shown by Western blot analysis. In the cytosol, the expression of phospho-Akt reached its peak at 4 hours post-TBI, but decreased markedly at 24 hours and maintained below pre-TBI levels until 72 hours post-TBI. Interestingly, the expression of CTMP significantly increased 4 hours after TBI (P < 0.01) and sustained those levels until 72 hours without dramatic changes. Treatment with CTMP siRNA effectively augmented the phosphorylation of Akt and significantly improved the neurological functional recovery up to 28 days post-TBI. CONCLUSION We conclude that Akt is phosphorylated and translocated to nucleus after TBI to exert neuroprotective effects. However, CTMP is simultaneously triggered to inhibit the phosphorylation of Akt. Inhibition of CTMP by siRNA improves the recovery of neurological functions after TBI.
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Felix AS, Cook LS, Gaudet MM, Rohan TE, Schouten LJ, Setiawan VW, Wise LA, Anderson KE, Bernstein L, De Vivo I, Friedenreich CM, Gapstur SM, Goldbohm RA, Henderson B, Horn-Ross PL, Kolonel L, Lacey JV, Liang X, Lissowska J, Magliocco A, McCullough ML, Miller AB, Olson SH, Palmer JR, Park Y, Patel AV, Prescott J, Rastogi R, Robien K, Rosenberg L, Schairer C, Ou Shu X, van den Brandt PA, Virkus RA, Wentzensen N, Xiang YB, Xu WH, Yang HP, Brinton LA. The etiology of uterine sarcomas: a pooled analysis of the epidemiology of endometrial cancer consortium. Br J Cancer 2013; 108:727-34. [PMID: 23348519 PMCID: PMC3593566 DOI: 10.1038/bjc.2013.2] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Uterine sarcomas are characterised by early age at diagnosis, poor prognosis, and higher incidence among Black compared with White women, but their aetiology is poorly understood. Therefore, we performed a pooled analysis of data collected in the Epidemiology of Endometrial Cancer Consortium. We also examined risk factor associations for malignant mixed mullerian tumours (MMMTs) and endometrioid endometrial carcinomas (EECs) for comparison purposes. METHODS We pooled data on 229 uterine sarcomas, 244 MMMTs, 7623 EEC cases, and 28,829 controls. Odds ratios (ORs) and 95% confidence intervals (CIs) for risk factors associated with uterine sarcoma, MMMT, and EEC were estimated with polytomous logistic regression. We also examined associations between epidemiological factors and histological subtypes of uterine sarcoma. RESULTS Significant risk factors for uterine sarcoma included obesity (body mass index (BMI)≥30 vs BMI<25 kg m(-2) (OR: 1.73, 95% CI: 1.22-2.46), P-trend=0.008) and history of diabetes (OR: 2.33, 95% CI: 1.41-3.83). Older age at menarche was inversely associated with uterine sarcoma risk (≥15 years vs <11 years (OR: 0.70, 95% CI: 0.34-1.44), P-trend: 0.04). BMI was significantly, but less strongly related to uterine sarcomas compared with EECs (OR: 3.03, 95% CI: 2.82-3.26) or MMMTs (OR: 2.25, 95% CI: 1.60-3.15, P-heterogeneity=0.01). CONCLUSION In the largest aetiological study of uterine sarcomas, associations between menstrual, hormonal, and anthropometric risk factors and uterine sarcoma were similar to those identified for EEC. Further exploration of factors that might explain patterns of age- and race-specific incidence rates for uterine sarcoma are needed.
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Affiliation(s)
- A S Felix
- Cancer Prevention Fellowship Program, Division of Cancer Prevention, National Cancer Institute, National Institutes of Health, Rockville, MD, USA.
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Naik RM, Prasad S, Yadav SBS, Rastogi R, Tiwari RK. The formation of an antitubercular complex [Fe(CN)5
(INH)]3−
through mercury(II)-catalyzed ligand substitution reaction: A kinetic and mechanistic study. INT J CHEM KINET 2012. [DOI: 10.1002/kin.20581] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Budhiraja V, Rastogi R, Asthana AK. Variations in the formation of the median nerve and its clinical correlation. Folia Morphol (Warsz) 2012; 71:28-30. [PMID: 22532182] [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: 05/31/2023]
Abstract
Variations in the formation of the median nerve are of interest to anatomists, radiologists, and surgeons. These variations may be vulnerable to damage in surgical operations, but their knowledge also helps in the interpretation of a nervous compression having unexplained clinical symptoms. We studied the variation in the formation of the median nerve in 87 cadavers, i.e. 174 upper limbs of formalin preserved cadavers at the department of Anatomy, Subharti medical college. We observed an additional root taking part in the formation of the median nerve in 26.4% of upper limbs, unusual low formation of the median nerve in the arm in front of the brachial artery in 18.4% of upper limbs, and median nerve formation medial to the axillary artery in 10.3% of upper limbs. Knowledge of such anatomical variations is of interest to the anatomist and clinician alike. Surgeons who perform procedures involving neoplasm or trauma repair need to be aware of these variations.
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Affiliation(s)
- V Budhiraja
- Department of Anatomy, Subharti Medical College, Meerut (U.P.), India.
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Prasad MH, Gera B, Thangamani I, Rastogi R, Gopika V, Verma V, Mukhopadhyay D, Bhasin V, Chatterjee B, Sanyasi Rao V, Lele H, Ghosh A. Level-1, -2 and -3 PSA for AHWR. Nuclear Engineering and Design 2011. [DOI: 10.1016/j.nucengdes.2011.05.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Affiliation(s)
- R Rastogi
- Consultant Radiologist, Yash Hospital & Research Center, Muradabad (U.P.) - 244001
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Rastogi R, Gl M, Rastogi N, Rastogi V. Interstitial ectopic pregnancy: A rare and difficult clinicosonographic diagnosis. J Hum Reprod Sci 2011; 1:81-2. [PMID: 19562051 PMCID: PMC2700669 DOI: 10.4103/0974-1208.44116] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2008] [Revised: 09/17/2008] [Accepted: 09/18/2008] [Indexed: 11/15/2022] Open
Abstract
Ectopic pregnancy in the interstitial part of the fallopian tube is a rare event. This condition presents a challenge for clinical as well as radiological diagnosis. Although routine two-dimensional ultrasound can be suggestive, three-dimensional ultrasound is highly accurate in diagnosis. Hence, the authors report a rare case of interstitial ectopic pregnancy diagnosed preoperatively by three-dimensional ultrasound and managed laparoscopically.
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Affiliation(s)
- R Rastogi
- Yash Diagnostic Center, Yash Hospital and Research Center, Civil Lines, Kanth Road, Moradabad, Uttar Pradesh-244 001, India
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Budhiraja V, Rastogi R, Asthana AK. Variant origin of superior polar artery and unusual hilar branching pattern of renal artery with clinical correlation. Folia Morphol (Warsz) 2011; 70:24-28. [PMID: 21604249] [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: 05/30/2023]
Abstract
Classically, a single renal artery arising from the abdominal aorta supplies the respective kidney on each side. Near the hilum of the kidney each renal artery divides into anterior and posterior branchs, which in turn divide into segmental arteries supplying the different renal segments. A total of 84 formalin fixed cadavers (73 male and 11 female, 168 kidneys in total) constituted the material for the study. During routine abdominal dissection conducted for medical undergraduates, the kidneys and their arteries were explored and variations in morphological patterns of renal arteries were noted. We observed superior polar renal artery in 22.6% cases. Superior polar renal arteries had different sources of origin. In 10.7% of cases it came directly from the abdominal aorta as an accessory renal artery; in 5.4% of cases as a direct branch from the main renal artery; in 3.6% of cases from the superior hilar renal artery (from one of the duplicated renal arteries); and in 3.0% of cases from a segmental branch of the renal artery. We also observed unusual hilar branching patterns of renal arteries, which included a fork pattern in 11.3% of cases, ladder pattern in 7.7% of cases, net pattern in 5.9% of cases, and triplicate in 3.0% of cases. Understanding the anatomy of vascular variations of the kidney is essential for the clinician to be able to perform procedures such as renal transplantation, interventional radiological procedures, and renal vascular operations more safely and efficiently.
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Affiliation(s)
- V Budhiraja
- Department of Anatomy, Subharti Medical College, India.
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