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Chen W, Bai Y, Fang P, Chen J, Wang X, Li Y, Luo X, Xiao Z, Iyer R, Shan F, Yuan T, Wu M, Huang X, Fang D, Yang Q, Zhang Y. Body mass index's effect on CRSwNP extends to pathological endotype and recurrence. Rhinology 2024; 0:3161. [PMID: 38416065 DOI: 10.4193/rhin23.402] [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: 02/29/2024]
Abstract
BACKGROUND Elevated body mass index (BMI) has been recognized as an important contributor to corticosteroid insensitivity in chronic rhinosinusitis with nasal polyps (CRSwNP). We aimed to delineate the effects of elevated BMI on immunological endotype and recurrence in CRSwNP individuals. METHODOLOGY A total of 325 patients with CRSwNP undergoing FESS were recruited and stratified by BMI. H&E staining was employed for histological evaluation. Characteristics of inflammatory patterns were identified by immunohistochemical staining. The predictive factors for recurrence were determined and evaluated by multivariable logistic regression analysis and the receiver operating characteristic (ROC) curves across all subjects and by weight group. RESULTS In all patients with CRSwNP, 26.15% subjects were classified as overweight/obese group across BMI categories and exhibited a higher symptom burden. The upregulated eosinophil/neutrophil-dominant cellular endotype and amplified type 2/ type 3 coexisting inflammation was present in overweight/obese compared to underweight/normal weight controls. Additionally, a higher recurrent proportion was shown in overweight/obese patients than that in underweight/normal weight cohorts. Multivariable logistic regression analysis identified BMI as an independent predictor for recurrence. The predictive capacity of each conventional parameter (tissue eosinophil and CLCs count, and blood eosinophil percentage) alone or in combination was poor in overweight/obese subjects. CONCLUSIONS Overweight/obese CRSwNP stands for a unique phenotype and endotype. Conventional parameters predicting recurrence are compromised in overweight/obese CRSwNP, and there is an urgent need for novel biomarkers that predict recurrence for these patients.
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Affiliation(s)
- W Chen
- Department of Otolaryngology-Head and Neck Surgery, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Y Bai
- Department of Otolaryngology-Head and Neck Surgery, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - P Fang
- Department of Otolaryngology-Head and Neck Surgery, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - J Chen
- Department of Otolaryngology-Head and Neck Surgery, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - X Wang
- Department of Otolaryngology-Head and Neck Surgery, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Y Li
- Department of Otolaryngology-Head and Neck Surgery, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - X Luo
- Department of Otolaryngology-Head and Neck Surgery, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Z Xiao
- Department of Otolaryngology-Head and Neck Surgery, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - R Iyer
- Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - F Shan
- Department of Otolaryngology-Head and Neck Surgery, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - T Yuan
- Department of Otolaryngology-Head and Neck Surgery, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - M Wu
- Department of Otolaryngology-Head and Neck Surgery, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - X Huang
- Department of Otolaryngology-Head and Neck Surgery, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
- Department of Allergy, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - D Fang
- Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Q Yang
- Department of Otolaryngology-Head and Neck Surgery, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
- Department of Allergy, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Y Zhang
- Department of Otolaryngology-Head and Neck Surgery, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
- Department of Allergy, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Diabetology, Guangzhou Key Laboratory of Mechanistic and Translational Obesity Research, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
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Choudhary A, Boudreaux B, Bhullar P, Nelson S, Mangold A, Iyer R. LB889 Risk stratification of squamous cell carcinoma using weakly supervised multitask learning of whole slide images. J Invest Dermatol 2022. [DOI: 10.1016/j.jid.2022.05.905] [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: 11/17/2022]
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Deeken J, Kothiyal P, Wang H, Jo G, Hazrati S, McNair E, Iyer R, Maxwell G. Genetic Ancestry and Variants Correlate with the Risk of HPV Oral Infection in Adult Healthy Men. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2021.12.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Hatoum H, Askegaard G, Iyer R, Prasad Dasi L. Atrial and ventricular flows across a transcatheter mitral valve. Interact Cardiovasc Thorac Surg 2021; 33:1-9. [PMID: 33674829 DOI: 10.1093/icvts/ivab032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 04/24/2020] [Revised: 11/20/2020] [Accepted: 01/10/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES The objective of this study was to evaluate the haemodynamic performance of transcatheter mitral valve replacement (TMVR) Implant with a focus on turbulence and washout adjacent to the ventricular surface of the leaflets. TMVR holds the promise of treating a large spectrum of mitral valve diseases. However, the haemodynamic performance and flow dynamics of such replacements are not fully understood. METHODS A tri-leaflet biopsrosthetic TMVR represented by Caisson implant of size 36A was implanted in the mitral position of a left heart simulator pulse duplicating system under physiological conditions. The 36A implant covers an anterior-posterior range of 26-32 mm and a commissure-to-commissure range of 30-36 mm. Transmitral pressure gradient, effective orifice area and regurgitant fraction were calculated. Particle image velocimetry was performed to evaluate turbulence in 2 perpendicular planes (Reynolds and viscous shear stresses, respectively). Additionally, dye experiments were performed to visualize washout. RESULTS Transmitral pressure gradient was 1.29 ± 0.27 mmHg and effective orifice area was 2.96 ± 0.28 cm2. Regurgitant fraction was 14.13 ± 0.08%. Total washout was 4.27 cardiac cycles. Largest viscous shear stress reaches 3.7 Pa and 2.4 Pa in ventricle and atrium, respectively. Reynolds shear stress in the atrial side was <10 Pa. In the ventricular side, the largest Reynolds shear stress reached ∼35 Pa. CONCLUSIONS TMVR leads to favourable haemodynamics with low degree of turbulence combined with fast washout around the leaflets indicating promising potential for freedom from blood damage potential and thrombosis corroborated by initial clinical studies as part of the valves's Early Feasibility Study.
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Affiliation(s)
- Hoda Hatoum
- Department of Biomedical Engineering, Michigan Technological University, Houghton, MI, USA
| | | | - Ramji Iyer
- R&D Department, LivaNova PLC, Maple Grove, MN, USA
| | - Lakshmi Prasad Dasi
- Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA, USA
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Fountzilas C, Witkiewicz A, Muhitch J, Abrams S, Knudsen E, Mukherjee S, Bajor D, Saltzman J, Wang K, Iyer R, Kalinski P, Boland P. 103P Temporospatial heterogeneity in metastatic colorectal cancer (mCRC). Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.10.592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Juloori A, Liao C, Lemons J, Singh A, Iyer R, Robbins J, George B, Fung J, Pillai A, Arif F, Sharma M, Liauw S. Phase I Study of Stereotactic Body Radiotherapy followed by Ipilimumab with Nivolumab vs. Nivolumab alone in Unresectable Hepatocellular Carcinoma. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.900] [Citation(s) in RCA: 1] [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: 11/26/2022]
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Fountzilas C, Mukherjee S, Saltzman J, Bajor D, Muhitch J, Abrams S, Maguire O, Minderman H, Wang K, Hutson A, Hicks K, Ventola J, Kalinski P, Iyer R, Boland P. P-156 A phase Ib/II study of cetuximab and pembrolizumab in metastatic colorectal cancer. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.04.238] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Elsherif SB, Zheng S, Ganeshan D, Iyer R, Wei W, Bhosale PR. Does dual-energy CT differentiate benign and malignant ovarian tumours? Clin Radiol 2020; 75:606-614. [PMID: 32252992 DOI: 10.1016/j.crad.2020.03.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 03/09/2020] [Indexed: 01/19/2023]
Abstract
AIM To assess the ability of dual-energy computed tomography (DECT) to distinguish benign from malignant ovarian tumours (OTs). MATERIALS AND METHODS Following approval of the institutional review board, the institutional database was mined for treatment-naive patients who underwent primary cytoreduction for OT. Thirty-seven patients were included and divided into those with benign OTs (n = 11) and malignant OTs (n = 26), including high-grade (n = 20) and low-grade (n = 6) malignant OTs. Advanced processing and region of interest delineation on the ovarian mass were performed using the preoperative staging DECT examination using the Advantage Workstation. The pixel-level data of the CT attenuation values at 50, 70, and 120 keV and the effective atomic number (Zeff), water content (WC), and iodine content (IC) in the ovarian mass were recorded. The Wilcoxon rank-sum test was used to compare CT attenuation data at different voltages, Zeff, and WC and IC levels between benign and malignant OTs and between high- and low-grade malignant OTs. Simple logistic regression was used to correlate the imaging characteristics with malignant status and grade. RESULTS Malignant OTs had significantly higher Zeff and IC compared with benign OTs. The threshold values for the diagnosis of malignant OT were IC≥9.74 (100 μg/cm3) with 81% sensitivity and 73% specificity and Zeff ≥8.16 with 85% sensitivity and 73% specificity. High-grade OTs had significantly higher WC compared with low-grade OTs, and a threshold of ≥1,013.92 mg/cm3 differentiated them with 80% sensitivity and 83% specificity. CONCLUSION DECT may be a tool to help distinguish malignant and benign OTs and predict tumour grade.
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Affiliation(s)
- S B Elsherif
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, 1400 Pressler St., Houston, TX 77030, USA.
| | - S Zheng
- Department of Diagnostic and Interventional Imaging, The University of Texas Health Science Center at Houston McGovern Medical School, MSB 2.130B, 6431 Fannin Street, Houston, TX 77030 Houston, Texas, USA
| | - D Ganeshan
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, 1400 Pressler St., Houston, TX 77030, USA
| | - R Iyer
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, 1400 Pressler St., Houston, TX 77030, USA
| | - W Wei
- Taussig Cancer Institute, Cleveland Clinic, 9500 Euclid Ave., Cleveland, OH 44195, USA; Department of Biostatistics, The University of Texas MD Anderson Cancer Center, 1400 Pressler St., Houston, TX 77030, USA
| | - P R Bhosale
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, 1400 Pressler St., Houston, TX 77030, USA
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Gupta V, Raju K, Rao T, Iyer R. Laparoscopic cytoreduction in low disease burden, advanced-stage ovarian cancers: Experience from a tertiary cancer center. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz426.014] [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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10
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Warren J, Nanayakkara S, Andrianopoulos N, Brennan A, Dinh D, Yudi M, Clark D, Ajani AE, Reid CM, Selkrig L, Shaw J, Hiew C, Freeman M, Kaye D, Kingwell BA, Dart AM, Duffy SJ, Reid C, Andrianopoulos N, Brennan A, Dinh D, Reid C, Ajani A, Duffy S, Clark D, Freeman M, Hiew C, Andrianopoulos N, Oqueli E, Brennan A, Duffy S, Shaw J, Walton A, Dart A, Broughton A, Federman J, Keighley C, Hengel C, Peter K, Stub D, Chan W, Warren J, O’Brien J, Selkrig L, Huntington R, Clark D, Farouque O, Horrigan M, Johns J, Oliver L, Brennan J, Chan R, Proimos G, Dortimer T, Chan B, Nadurata V, Huq R, Fernando D, Al-Fiadh A, Yudi M, Sugumar H, Ramchand J, Han H, Picardo S, Brown L, Oqueli E, Hengel C, Sharma A, Zhu B, Ryan N, Harrison T, New G, Roberts L, Freeman M, Rowe M, Proimos G, Cheong Y, Goods C, Fernando D, Teh A, Parfrey S, Ramzy J, Koshy A, Venkataraman P, Flannery D, Hiew C, Sebastian M, Yip T, Mok M, Jaworski C, Hutchinson A, Cimenkaya C, Ngu P, Khialani B, Salehi H, Turner M, Dyson J, McDonald B, Van Den Nouwelant D, Halliburton K, Reid C, Andrianopoulos N, Brennan A, Dinh D, Yan B, Ajani A, Warren R, Eccleston D, Lefkovits J, Iyer R, Gurvitch R, Wilson W, Brooks M, Biswas S, Yeoh J. Impact of Pre-Procedural Blood Pressure on Long-Term Outcomes Following Percutaneous Coronary Intervention. J Am Coll Cardiol 2019; 73:2846-2855. [DOI: 10.1016/j.jacc.2019.03.493] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 03/06/2019] [Accepted: 03/07/2019] [Indexed: 11/28/2022]
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11
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Brown A, Peterson J, Fregoso M, Nayyar M, Cochrane A, Pluhacek J, Lemma M, Aryal S, Shlobin O, King C, Iyer R, Deeken J, Nathan S. The Impact of Pharmacogenomics on Tacrolimus Dosing and Levels among Lung Transplant Recipients. J Heart Lung Transplant 2019. [DOI: 10.1016/j.healun.2019.01.396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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12
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Iyer R, Chalekian A, Lane R, Evans M, Yi S, Morris J. Transcatheter Mitral Valve Replacement: Functional Requirements for Device Design, Bench-Top, and Pre-Clinical Evaluation. Cardiovasc Eng Technol 2018; 9:301-338. [PMID: 29951830 DOI: 10.1007/s13239-018-0364-z] [Citation(s) in RCA: 5] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Accepted: 05/17/2018] [Indexed: 10/28/2022]
Abstract
Transcatheter Mitral Valve Replacement (TMVR) is currently under clinical investigation as a viable treatment option for mitral regurgitation (MR). Therefore, it is important to outline the key functional requirements of a TMVR prosthesis in order to provide an overall approach to assessing mitral valve replacement devices utilizing a combination of in vitro and preclinical methods. This article provides a review of the mitral valve disease as well as general considerations and guidance for developing a TMVR device based on International Industry Standards. Specific details pertaining to the mitral valve apparatus, morphology of mitral valve disease, assessment of specific patient population as well as hazard analysis to evaluate and develop a TMVR device to treat a specific patient population have been included. The details contained within this report are not all inclusive or explicate for every technology being developed but rather thought of as a general guide on how a TMVR technology could be developed in alignment with International Industry Standards. Key learnings from the Transcatheter Aortic Valve Replacement (TAVR) experience has also been considered and taken into account when outlining this general guidance for TMVR. Key learning points from the TAVR development experience included the following: quantification of acceptable levels of paravalvular leak, valve migration potential using various anchoring methods and overall implant frame failure modes when treating the native aortic valve. It should be noted that TAVR is over a decade further along in development and clinical experience compared to TMVR. These key learnings from the early experience with TAVR should be considered with all transcatheter development projects.
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Affiliation(s)
| | | | | | | | - Seung Yi
- Edwards Life Sciences, Irvine, CA, USA
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Hinchcliff E, Hong D, Le H, Chisholm G, Iyer R, Naing A, Jazaeri A. Adverse events and responses in patients with recurrent ovarian cancer undergoing early-phase immune checkpoint inhibitor clinical trials. Gynecol Oncol 2018. [DOI: 10.1016/j.ygyno.2018.04.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Arefin A, Huang JH, Platts D, Hypes VD, Harris JF, Iyer R, Nath P. Fabrication of flexible thin polyurethane membrane for tissue engineering applications. Biomed Microdevices 2017; 19:98. [DOI: 10.1007/s10544-017-0236-6] [Citation(s) in RCA: 8] [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: 12/13/2022]
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Iyer R, Sun K, Erridge S, Ghani L, Davies D, Salooja N. Near-Peer Led Anatomy Teaching Acts as a Useful Supplement to the Medical School Curriculum. Int J Surg 2017. [DOI: 10.1016/j.ijsu.2017.08.383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Battisti N, Beaney T, Redana S, Iyer R, Manickavasagar T, Ring A. Reduced Rates of Severe Complications Following a Change in Anthracycline–Taxane Regimen for Early Breast Cancer: a Single Centre Experience. Clin Oncol (R Coll Radiol) 2017. [DOI: 10.1016/j.clon.2017.01.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Okonji D, Redana S, Iyer R, Mohammed K, Ring A, Johnston S. Fulvestrant Monotherapy in Metastatic Breast Cancer (MBC): a Single Centre Experience. Clin Oncol (R Coll Radiol) 2017. [DOI: 10.1016/j.clon.2017.01.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Iyer R, Mok SF, Savkovic S, Turner L, Fraser G, Desai R, Jayadev V, Conway AJ, Handelsman DJ. Pharmacokinetics of testosterone cream applied to scrotal skin. Andrology 2017; 5:725-731. [DOI: 10.1111/andr.12357] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Revised: 02/06/2017] [Accepted: 02/10/2017] [Indexed: 11/27/2022]
Affiliation(s)
- R. Iyer
- Andrology Department; Concord Hospital and ANZAC Research Institute; University of Sydney; Sydney NSW Australia
| | - S. F. Mok
- Andrology Department; Concord Hospital and ANZAC Research Institute; University of Sydney; Sydney NSW Australia
| | - S. Savkovic
- Andrology Department; Concord Hospital and ANZAC Research Institute; University of Sydney; Sydney NSW Australia
| | - L. Turner
- Andrology Department; Concord Hospital and ANZAC Research Institute; University of Sydney; Sydney NSW Australia
| | - G. Fraser
- Andrology Department; Concord Hospital and ANZAC Research Institute; University of Sydney; Sydney NSW Australia
| | - R. Desai
- Andrology Department; Concord Hospital and ANZAC Research Institute; University of Sydney; Sydney NSW Australia
| | - V. Jayadev
- Andrology Department; Concord Hospital and ANZAC Research Institute; University of Sydney; Sydney NSW Australia
| | - A. J. Conway
- Andrology Department; Concord Hospital and ANZAC Research Institute; University of Sydney; Sydney NSW Australia
| | - D. J. Handelsman
- Andrology Department; Concord Hospital and ANZAC Research Institute; University of Sydney; Sydney NSW Australia
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Battisti NML, Beaney T, Redana S, Iyer R, Manickavasagar T, Fordham I, Mohammed K, Ring A. Reduced Rates of Severe Complications Following a Change in Anthracycline-Taxane Regimen for Early Breast Cancer: a Single Centre Experience. Clin Oncol (R Coll Radiol) 2016; 29:274. [PMID: 28034488 DOI: 10.1016/j.clon.2016.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Accepted: 12/08/2016] [Indexed: 10/20/2022]
Affiliation(s)
- N M L Battisti
- Breast Unit, The Royal Marsden NHS Foundation Trust, London, UK
| | - T Beaney
- Breast Unit, The Royal Marsden NHS Foundation Trust, London, UK
| | - S Redana
- Breast Unit, The Royal Marsden NHS Foundation Trust, London, UK
| | - R Iyer
- Breast Unit, The Royal Marsden NHS Foundation Trust, London, UK
| | | | - I Fordham
- Breast Unit, The Royal Marsden NHS Foundation Trust, London, UK
| | - K Mohammed
- Research and Development Department, The Royal Marsden NHS Foundation Trust, London, UK
| | - A Ring
- Breast Unit, The Royal Marsden NHS Foundation Trust, London, UK
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20
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Rajkumar S, Iyer R, Culora G, Lane G. Fertility sparing management of large cell neuroendocrine tumour of cervix: A case report & review of literature. Gynecol Oncol Rep 2016; 18:15-17. [PMID: 27790635 PMCID: PMC5072145 DOI: 10.1016/j.gore.2016.10.002] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Revised: 10/02/2016] [Accepted: 10/09/2016] [Indexed: 11/15/2022] Open
Abstract
Large cell neuroendocrine cervical carcinoma (LCNEC) is a rare and aggressive cancer that tends to spread and recur early despite intensive multimodal treatment. Conventional treatment strategies for early stage neuroendocrine tumour (NET) include radical hysterectomy followed by adjuvant chemotherapy. There are only 2 reported cases of fertility sparing treatment for NET. We report on the first case of successful conception and delivery at term following radical trachelectomy for early stage LCNEC. First reported case of delivery at term following radical trachelectomy for LCNEC 3 year recurrence free survival following radical trachelectomy in LCNEC Continue data collection on both oncologic and fertility outcomes in LCNEC
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Affiliation(s)
- S Rajkumar
- Department of Gynaecological Oncology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - R Iyer
- Department of Gynaecological Oncology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - G Culora
- Department of Pathology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - G Lane
- Department of Gynaecological Oncology, Guy's and St Thomas' NHS Foundation Trust, London, UK
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Ait-Oudhia S, Mager DE, Pokuri V, Tomaszewski G, Groman A, Zagst P, Fetterly G, Iyer R. Bridging Sunitinib Exposure to Time-to-Tumor Progression in Hepatocellular Carcinoma Patients With Mathematical Modeling of an Angiogenic Biomarker. CPT Pharmacometrics Syst Pharmacol 2016; 5:297-304. [PMID: 27300260 PMCID: PMC5131886 DOI: 10.1002/psp4.12084] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Accepted: 04/18/2016] [Indexed: 12/31/2022]
Abstract
Hepatocellular carcinoma (HCC) is third in cancer-related causes of death worldwide and its treatment is a significant unmet medical need. Sunitinib is a selective tyrosine kinase inhibitor of the angiogenic biomarker: soluble vascular endothelial growth factor receptor-2 (sVEGFR2 ). Sunitinib failed its primary overall survival endpoint in patients with advanced HCC in a phase III trial compared to sorafenib. In the present study, pharmacokinetic-pharmacodynamic modeling was used to link drug-exposure to tumor-growth-inhibition (TGI) and time-to-tumor progression (TTP) through sVEGFR2 dynamics. The results suggest that 1) active drug concentration (i.e., sunitinib and its metabolite) inhibits the release of sVEGFR2 and that such inhibition is associated with TGI, and 2) daily sVEGFR2 exposure is likely a reliable predictor for the TTP in HCC patients. Moreover, the model quantitatively links the dynamics of an angiogenesis biomarker to TTP and accurately predicts observed literature-reported results of placebo treatment.
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Affiliation(s)
- S Ait-Oudhia
- Center for Pharmacometrics and Systems Pharmacology, Department of Pharmaceutics, College of Pharmacy, University of Florida, Orlando, Florida, USA
| | - D E Mager
- Department of Pharmaceutical Sciences, University at Buffalo, State University of New York, Buffalo, New York, USA
| | - V Pokuri
- Department of Medical Oncology, Roswell Park Cancer Institute, Buffalo, New York, USA
| | - G Tomaszewski
- Department of Medical Oncology, Roswell Park Cancer Institute, Buffalo, New York, USA
| | - A Groman
- Department of Medical Oncology, Roswell Park Cancer Institute, Buffalo, New York, USA
| | - P Zagst
- Department of Medical Oncology, Roswell Park Cancer Institute, Buffalo, New York, USA
| | - G Fetterly
- Clinical Pharmacology and Regulatory Affairs, Buffalo, New York, USA
| | - R Iyer
- Department of Medical Oncology, Roswell Park Cancer Institute, Buffalo, New York, USA
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Burnell M, Iyer R, Gentry-Maharaj A, Nordin A, Liston R, Manchanda R, Das N, Gornall R, Beardmore-Gray A, Hillaby K, Leeson S, Linder A, Lopes A, Meechan D, Mould T, Nevin J, Olaitan A, Rufford B, Shanbhag S, Thackeray A, Wood N, Reynolds K, Ryan A, Menon U. Benchmarking of surgical complications in gynaecological oncology: prospective multicentre study. BJOG 2016; 123:2171-2180. [DOI: 10.1111/1471-0528.13994] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/27/2015] [Indexed: 11/26/2022]
Affiliation(s)
- M Burnell
- Department of Women's Cancer; Gynaecological Cancer Research Centre; Institute for Women's Health; University College London; London UK
| | - R Iyer
- Department of Women's Cancer; Gynaecological Cancer Research Centre; Institute for Women's Health; University College London; London UK
| | - A Gentry-Maharaj
- Department of Women's Cancer; Gynaecological Cancer Research Centre; Institute for Women's Health; University College London; London UK
| | - A Nordin
- East Kent Gynaecological Oncology Centre; Queen Elizabeth the Queen Mother Hospital; Margate UK
| | - R Liston
- Department of Women's Cancer; Gynaecological Cancer Research Centre; Institute for Women's Health; University College London; London UK
| | - R Manchanda
- Department of Women's Cancer; Gynaecological Cancer Research Centre; Institute for Women's Health; University College London; London UK
- Department of Gynaecological Cancer; Barts Cancer Centre; Barts and the London NHS Trust; London UK
| | - N Das
- Department of Gynaecological Cancer; Royal Cornwall Hospitals NHS Trust; Truro UK
| | - R Gornall
- Department of Gynaecological Oncology; Cheltenham General Hospital; Cheltenham UK
| | - A Beardmore-Gray
- Department of Women's Cancer; Gynaecological Cancer Research Centre; Institute for Women's Health; University College London; London UK
| | - K Hillaby
- Department of Gynaecological Oncology; Cheltenham General Hospital; Cheltenham UK
| | - S Leeson
- Department of Obstetrics and Gynaecology; BetsiCadwaladr University Health Board; Bangor UK
| | - A Linder
- Department of Gynaecological Oncology; The Ipswich Hospital NHS Trust; Ipswich Suffolk UK
| | - A Lopes
- Department of Gynaecological Cancer; Royal Cornwall Hospitals NHS Trust; Truro UK
| | | | - T Mould
- Department of Gynaecological Oncology; University College London Hospital NHS Foundation Trust; London UK
| | - J Nevin
- Pan Birmingham Gynaecological Cancer Centre; Birmingham City Hospital; Birmingham UK
| | - A Olaitan
- Department of Gynaecological Oncology; University College London Hospital NHS Foundation Trust; London UK
| | - B Rufford
- Department of Gynaecological Oncology; The Ipswich Hospital NHS Trust; Ipswich Suffolk UK
| | - S Shanbhag
- Department of Gynaecological Oncology; Glasgow Royal Infirmary; Glasgow UK
| | | | - N Wood
- Department of Gynaecological Oncology; Lancashire Teaching Hospitals NHS Foundation trust; Royal Preston Hospital; Preston UK
| | - K Reynolds
- Department of Gynaecological Cancer; Barts Cancer Centre; Barts and the London NHS Trust; London UK
| | - A Ryan
- Department of Women's Cancer; Gynaecological Cancer Research Centre; Institute for Women's Health; University College London; London UK
| | - U Menon
- Department of Women's Cancer; Gynaecological Cancer Research Centre; Institute for Women's Health; University College London; London UK
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Gill B, Olsheski M, DAmbrosio D, Clump D, Wegner R, Iyer R, Burton S, Holeva K, Heron D. Hypofractionated Stereotactic Body Radiation Therapy for Low- and Intermediate-Risk Prostate Cancer: A Multi-institutional Phase 2 Analysis. Int J Radiat Oncol Biol Phys 2015. [DOI: 10.1016/j.ijrobp.2015.07.1050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Iyer R, Patel P, Buitrago S, Curtin L, Fetterly G, Maguire O, Minderman H, Toshkov I, Tennant B, Hutson A, Johnson C. 2402 Sorafenib (SOR) dose reduction attenuates its immunosuppressive effects and delays hepatocellular cancer (HCC) development in the woodchuck model of hepatitis B related HCC. Eur J Cancer 2015. [DOI: 10.1016/s0959-8049(16)31318-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Ma W, Fetterly G, LeVea C, Zhao Y, Dy G, Iyer R, Tan W, Brady W, Whitworth A, Adjei A. 2315 A phase Ib study of the FGFR/VEGFR inhibitor dovitinib (D) combined with gemcitabine (G) and Capecitabine (C) in advanced pancreatic cancer patients. Eur J Cancer 2015. [DOI: 10.1016/s0959-8049(16)31231-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Yilmaz C, Ravikumar P, Gyawali D, Iyer R, Unger RH, Hsia CCW. Alveolar-capillary adaptation to chronic hypoxia in the fatty lung. Acta Physiol (Oxf) 2015; 213:933-46. [PMID: 25363080 DOI: 10.1111/apha.12419] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [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: 08/15/2014] [Revised: 09/17/2014] [Accepted: 10/26/2014] [Indexed: 12/18/2022]
Abstract
AIM Obese diabetic (ZDF fa/fa) rats with genetic leptin resistance suffer chronic lipotoxicity associated with age-related lung restriction and abnormal alveolar ultrastructure. We hypothesized that these abnormalities impair adaptation to ambient hypoxia. METHODS Male fa/fa and lean (+/+) ZDF rats (4-months old) were exposed to 21 or 13% O2 for 3 weeks. Lung function was measured under anaesthesia. Lung tissue was assayed for DNA damage and ultrastructure measured by morphometry. RESULTS In normoxia, lung volume, compliance and diffusing capacity were lower, while blood flow was higher in fa/fa than +/+ rats. In hypoxia, fa/fa animals lost more weight, circulating hematocrit rose higher, and lung volume failed to increase compared to +/+. In fa/fa, the hypoxia-induced increase in post-mortem lung volume was attenuated (19%) vs. +/+ (39%). Alveolar ducts were 35% smaller in normoxia but enlarged twofold more in hypoxia compared to +/+. Hypoxia induced broad increases (90-100%) in the volumes and surface areas of alveolar septal components in +/+ lungs; these increases were moderately attenuated in fa/fa lungs (58-75%), especially that of type II epithelium volume (16 vs. 61% in +/+). In fa/fa compared to +/+ lungs, oxidative DNA damage was greater with increased hypoxia induced efflux of alveolar macrophages. Harmonic mean thickness of the diffusion barrier was higher, indicating higher structural resistance to gas transfer. CONCLUSION Chronic lipotoxicity impaired hypoxia-induced lung expansion and compensatory alveolar growth with disproportionate effect on resident alveolar progenitor cells. The moderate structural impairment was offset by physiological adaptation primarily via a higher hematocrit.
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Affiliation(s)
- C. Yilmaz
- Pulmonary and Critical Care Medicine; Department of Internal Medicine; University of Texas Southwestern Medical Center; Dallas TX USA
| | - P. Ravikumar
- Pulmonary and Critical Care Medicine; Department of Internal Medicine; University of Texas Southwestern Medical Center; Dallas TX USA
| | - D. Gyawali
- Pulmonary and Critical Care Medicine; Department of Internal Medicine; University of Texas Southwestern Medical Center; Dallas TX USA
| | - R. Iyer
- Pulmonary and Critical Care Medicine; Department of Internal Medicine; University of Texas Southwestern Medical Center; Dallas TX USA
| | - R. H. Unger
- Touchstone Diabetes Center; Department of Internal Medicine; University of Texas Southwestern Medical Center; Dallas TX USA
| | - C. C. W. Hsia
- Pulmonary and Critical Care Medicine; Department of Internal Medicine; University of Texas Southwestern Medical Center; Dallas TX USA
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Rodda SN, Lubman DI, Iyer R, Gao CX, Dowling NA. Subtyping based on readiness and confidence: the identification of help-seeking profiles for gamblers accessing web-based counselling. Addiction 2015; 110:494-501. [PMID: 25393315 DOI: 10.1111/add.12796] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2014] [Revised: 04/30/2014] [Accepted: 10/29/2014] [Indexed: 12/01/2022]
Abstract
BACKGROUND AND AIMS Problem gamblers are not a homogeneous group and recent data suggest that subtyping can improve treatment outcomes. This study administered three readiness rulers and aimed to identify subtypes of gamblers accessing a national web-based counselling service based on these rulers. METHODS Participants were 1204 gamblers (99.4% problem gamblers) who accessed a single session of web-based counselling in Australia. Measures included three readiness rulers (importance, readiness and confidence to resist an urge to gamble), demographics and the Problem Gambling Severity Index (PGSI). RESULTS Gamblers reported high importance of change [mean = 9.2, standard deviation (SD) = 1.51] and readiness to change (mean = 8.86, SD = 1.84), but lower confidence to resist an urge to gamble (mean = 3.93, SD = 2.44) compared with importance and readiness. The statistical fit indices of a latent class analysis identified a four-class model. Subtype 1 was characterized by a very high readiness to change and very low confidence to resist an urge to gamble (n = 662, 55.0%) and subtype 2 reported high readiness and low confidence (n = 358, 29.7%). Subtype 3 reported moderate ratings on all three rulers (n = 139, 11.6%) and subtype 4 reported high importance of change but low readiness and confidence (n = 45, 3.7%). A multinomial logistic regression indicated that subtypes differed by gender (P < 0.001), age (P = 0.01), gambling activity (P < 0.05), preferred mode of gambling (P < 0.001) and PGSI score (P < 0.001). CONCLUSIONS Problem gamblers in Australia who seek web-based counselling comprise four distinct subgroups based on self-reported levels of readiness to change, confidence to resist the urge to gamble and importance of change.
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Affiliation(s)
- S N Rodda
- Turning Point, Eastern Health, Australia; Eastern Health Clinical School, Monash University, Australia
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Iyer R, Gentry-Maharaj A, Nordin A, Burnell M, Liston R, Manchanda R, Das N, Desai R, Gornall R, Beardmore-Gray A, Nevin J, Hillaby K, Leeson S, Linder A, Lopes A, Meechan D, Mould T, Varkey S, Olaitan A, Rufford B, Ryan A, Shanbhag S, Thackeray A, Wood N, Reynolds K, Menon U. Predictors of complications in gynaecological oncological surgery: a prospective multicentre study (UKGOSOC-UK gynaecological oncology surgical outcomes and complications). Br J Cancer 2015; 112:475-84. [PMID: 25535730 PMCID: PMC4453652 DOI: 10.1038/bjc.2014.630] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Revised: 11/16/2014] [Accepted: 11/30/2014] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND There are limited data on surgical outcomes in gynaecological oncology. We report on predictors of complications in a multicentre prospective study. METHODS Data on surgical procedures and resulting complications were contemporaneously recorded on consented patients in 10 participating UK gynaecological cancer centres. Patients were sent follow-up letters to capture any further complications. Post-operative (Post-op) complications were graded (I-V) in increasing severity using the Clavien-Dindo system. Grade I complications were excluded from the analysis. Univariable and multivariable regression was used to identify predictors of complications using all surgery for intra-operative (Intra-op) and only those with both hospital and patient-reported data for Post-op complications. RESULTS Prospective data were available on 2948 major operations undertaken between April 2010 and February 2012. Median age was 62 years, with 35% obese and 20.4% ASA grade ⩾3. Consultant gynaecological oncologists performed 74.3% of operations. Intra-op complications were reported in 139 of 2948 and Grade II-V Post-op complications in 379 of 1462 surgeries. The predictors of risk were different for Intra-op and Post-op complications. For Intra-op complications, previous abdominal surgery, metabolic/endocrine disorders (excluding diabetes), surgical complexity and final diagnosis were significant in univariable and multivariable regression (P<0.05), with diabetes only in multivariable regression (P=0.006). For Post-op complications, age, comorbidity status, diabetes, surgical approach, duration of surgery, and final diagnosis were significant in both univariable and multivariable regression (P<0.05). CONCLUSIONS This multicentre prospective audit benchmarks the considerable morbidity associated with gynaecological oncology surgery. There are significant patient and surgical factors that influence this risk.
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Affiliation(s)
- R Iyer
- Gynaecological Cancer Research Centre, Department of Women's Cancer, Institute for Women's Health, University College London, 1st Floor Maple House, 149 Tottenham Court Road, London W1T 7DN, UK
| | - A Gentry-Maharaj
- Gynaecological Cancer Research Centre, Department of Women's Cancer, Institute for Women's Health, University College London, 1st Floor Maple House, 149 Tottenham Court Road, London W1T 7DN, UK
| | - A Nordin
- National Cancer Intelligence Network Gynaecology Clinical Reference Group, 5th Floor, Wellington House, 133-155 Waterloo Road, London SE1 8UG, UK
| | - M Burnell
- Gynaecological Cancer Research Centre, Department of Women's Cancer, Institute for Women's Health, University College London, 1st Floor Maple House, 149 Tottenham Court Road, London W1T 7DN, UK
| | - R Liston
- Gynaecological Cancer Research Centre, Department of Women's Cancer, Institute for Women's Health, University College London, 1st Floor Maple House, 149 Tottenham Court Road, London W1T 7DN, UK
| | - R Manchanda
- Gynaecological Cancer Research Centre, Department of Women's Cancer, Institute for Women's Health, University College London, 1st Floor Maple House, 149 Tottenham Court Road, London W1T 7DN, UK
| | - N Das
- Department of Gynaecological Cancer, Royal Cornwall Hospitals NHS Trust, Truro, Cornwall TR1 3LJ, UK
| | - R Desai
- Gynaecological Cancer Research Centre, Department of Women's Cancer, Institute for Women's Health, University College London, 1st Floor Maple House, 149 Tottenham Court Road, London W1T 7DN, UK
| | - R Gornall
- Department of Gynaecological Oncology, Cheltenham General Hospital, Sandford Road, Cheltenham, Gloucestershire GL53 7AN, UK
| | - A Beardmore-Gray
- Gynaecological Cancer Research Centre, Department of Women's Cancer, Institute for Women's Health, University College London, 1st Floor Maple House, 149 Tottenham Court Road, London W1T 7DN, UK
| | - J Nevin
- Pan Birmingham Gynaecological Cancer Centre, Birmingham City Hospital, Dudley Road, Birmingham, West Midlands B18 7QH, UK
| | - K Hillaby
- Department of Gynaecological Oncology, Cheltenham General Hospital, Sandford Road, Cheltenham, Gloucestershire GL53 7AN, UK
| | - S Leeson
- Department of Obstetrics and Gynaecology, Betsi Cadwaladr University Health Board, Penrhosgarnedd, Bangor, Gwynedd, North Wales LL57 2PW, UK
| | - A Linder
- Department of Gynaecological Oncology, The Ipswich Hospital NHS Trust, Heath Road, Ipswich, Suffolk IP4 5PD, UK
| | - A Lopes
- Department of Gynaecological Cancer, Royal Cornwall Hospitals NHS Trust, Truro, Cornwall TR1 3LJ, UK
| | - D Meechan
- Trent Cancer Registry, 5 Old Fulwood Road, Sheffield S10 3TG, UK
| | - T Mould
- Department of Gynaecological Oncology, University College London Hospital NHS Foundation Trust, 2nd Floor North, 250 Euston Road, London NW1 2PG, UK
| | - S Varkey
- Gynaecological Cancer Research Centre, Department of Women's Cancer, Institute for Women's Health, University College London, 1st Floor Maple House, 149 Tottenham Court Road, London W1T 7DN, UK
| | - A Olaitan
- Department of Gynaecological Oncology, University College London Hospital NHS Foundation Trust, 2nd Floor North, 250 Euston Road, London NW1 2PG, UK
| | - B Rufford
- Department of Gynaecological Oncology, The Ipswich Hospital NHS Trust, Heath Road, Ipswich, Suffolk IP4 5PD, UK
| | - A Ryan
- Gynaecological Cancer Research Centre, Department of Women's Cancer, Institute for Women's Health, University College London, 1st Floor Maple House, 149 Tottenham Court Road, London W1T 7DN, UK
| | - S Shanbhag
- Department of Gynaecological Oncology, Glasgow Royal Infirmary, 16 Alexandra Parade, Glasgow G31 2ER, UK
| | - A Thackeray
- Trent Cancer Registry, 5 Old Fulwood Road, Sheffield S10 3TG, UK
| | - N Wood
- Department of Gynaecological Oncology, Lancashire Teaching Hospitals NHS Foundation Trust, Royal Preston Hospital, Sharoe Green Lane, North Fulwood, Preston Lancashire PR2 9HT, UK
| | - K Reynolds
- Department of Gynaecological Cancer, Barts Cancer Centre, Barts and the London NHS Trust, St Bartholomew's Hospital (Barts), West Smithfield, London EC1A 7BE, UK
| | - U Menon
- Gynaecological Cancer Research Centre, Department of Women's Cancer, Institute for Women's Health, University College London, 1st Floor Maple House, 149 Tottenham Court Road, London W1T 7DN, UK
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Suidan R, Ramirez P, Sarasohn D, Teitcher J, Mironov S, Iyer R, Zhou Q, Paul H, Osaka M, Chi D. A prospective trial evaluating the ability of preoperative CT scan and serum CA-125 to predict suboptimal cytoreduction at primary debulking surgery for advanced ovarian, fallopian tube, and peritoneal cancer. Gynecol Oncol 2014. [DOI: 10.1016/j.ygyno.2014.03.079] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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He H, Bhosale P, Wei W, Ramalingam P, Iyer R. MRI is highly specific in determining primary cervical versus endometrial cancer when biopsy results are inconclusive. Clin Radiol 2013; 68:1107-13. [PMID: 23849621 DOI: 10.1016/j.crad.2013.05.095] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2013] [Revised: 05/09/2013] [Accepted: 05/20/2013] [Indexed: 02/03/2023]
Abstract
AIM To evaluate utility of magnetic resonance imaging (MRI) in determining the primary site of endometrial versus cervical tumours when the biopsy results are inconclusive. MATERIAL AND METHODS Forty-eight patients who underwent a total hysterectomy for unknown primary adenocarcinoma of the uterus after endometrial and/or endocervical biopsies were included in the study. The 48 available pelvic MRI images were reviewed by two body radiologists independently and jointly to resolve discordance, blinded to any clinical and pathological information. The clinical information and histopathology were reviewed by a radiology fellow and a pathologist specializing is gynaecological oncology. The final surgical pathology was used as the reference standard to confirm the origin of the primary tumour. RESULTS The radiologists correctly identified the primary sites in 85% of the cases (41/48). There was substantial agreement between the two readers (kappa statistics = 0.79). Both radiologists found that T2 and dynamic T1-weighted images (WI) were most helpful in making the diagnosis, and dynamic T1WI helped resolve problematic cases. The sensitivity and specificity for detecting endometrial and cervical cancer on MRI were 88% and 88% and 75% and 93%, respectively. CONCLUSION MRI has high sensitivity and specificity in determining the origin of the primary endometrial versus cervical tumours when endometrial/endocervical curettage is inconclusive.
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Affiliation(s)
- H He
- Department of Diagnostic and Interventional Imaging, The University of Texas Health Science Center at Houston, Houston, TX, USA
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Saif Ur Rehman S, Ahluwalia MS, Mashtare TL, Spritzer M, Kim FJ, Khushalani N, Iyer R. Cancer of unknown primary presenting with liver metastasis: a cost, time to treatment and outcome analysis. Clin Oncol (R Coll Radiol) 2013; 25:684-5. [PMID: 23845700 DOI: 10.1016/j.clon.2013.06.008] [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] [Received: 05/10/2013] [Revised: 05/16/2013] [Accepted: 06/12/2013] [Indexed: 10/26/2022]
Affiliation(s)
- S Saif Ur Rehman
- State University of New York at Buffalo, Buffalo, NY, USA; Roswell Park Cancer Institute, Buffalo, NY, USA
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Iyer R, Gentry-Maharaj A, Nordin A, Liston R, Burnell M, Das N, Desai R, Gornall R, Beardmore-Gray A, Hillaby K, Leeson S, Linder A, Lopes A, Meechan D, Mould T, Nevin J, Olaitan A, Rufford B, Ryan A, Shanbhag S, Thackeray A, Wood N, Reynolds K, Menon U. Patient-reporting improves estimates of postoperative complication rates: a prospective cohort study in gynaecological oncology. Br J Cancer 2013; 109:623-32. [PMID: 23846170 PMCID: PMC3738134 DOI: 10.1038/bjc.2013.366] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2013] [Revised: 06/16/2013] [Accepted: 06/22/2013] [Indexed: 12/04/2022] Open
Abstract
Background: Most studies use hospital data to calculate postoperative complication rates (PCRs). We report on improving PCR estimates through use of patient-reporting. Methods: A prospective cohort study of major surgery performed at 10 UK gynaecological cancer centres was undertaken. Hospitals entered the data contemporaneously into an online database. Patients were sent follow-up letters to capture postoperative complications. Grade II–V (Clavien–Dindo classification) patient-reported postoperative complications were verified from hospital records. Postoperative complication rate was defined as the proportion of surgeries with a Grade II–V postoperative complication. Results: Patient replies were received for 1462 (68%) of 2152 surgeries undertaken between April 2010 and February 2012. Overall, 452 Grade II–V (402 II, 50 III–V) complications were reported in 379 of the 1462 surgeries. This included 172 surgeries with 200 hospital-reported complications and 231 with 280 patient-reported complications. All (100% concordance) 36 Grade III–V and 158 of 280 (56.4% concordance) Grade II patient-reported complications were verified on hospital case-note review. The PCR using hospital-reported data was 11.8% (172 out of 1462; 95% CI 11–14), patient-reported was 15.8% (231 out of 1462; 95% CI 14–17.8), hospital and verified patient-reported was 19.4% (283 out of 1462; 95% CI 17.4–21.4) and all data were 25.9% (379 out of 1462; 95% CI 24–28). After excluding Grade II complications, the hospital and patient verified Grade III–V PCR was 3.3% (48 out of 1462; 95% CI 2.5–4.3). Conclusion: This is the first prospective study of postoperative complications we are aware of in gynaecological oncology to include the patient-reported data. Patient-reporting is invaluable for obtaining complete information on postoperative complications. Primary care case-note review is likely to improve verification rates of patient-reported Grade II complications.
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Affiliation(s)
- R Iyer
- University College, London, UK
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Savage PM, Sita-Lumsden A, Dickson S, Iyer R, Everard J, Coleman R, Fisher RA, Short D, Casalboni S, Catalano K, Seckl MJ. The relationship of maternal age to molar pregnancy incidence, risks for chemotherapy and subsequent pregnancy outcome. J OBSTET GYNAECOL 2013; 33:406-11. [DOI: 10.3109/01443615.2013.771159] [Citation(s) in RCA: 70] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Shi Y, Iyer R, Soundararajan A, Dobkin D, Vesely I. Collagen-based Tissue Engineering as Applied to Heart Valves. Conf Proc IEEE Eng Med Biol Soc 2012; 2005:4912-5. [PMID: 17281344 DOI: 10.1109/iembs.2005.1615574] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Using the method of directed collagen gel shrinkage, we have been fabricating heart valves and mitral valve chordae [1,2,3]. The principle involves mixing solubilized collagen with the appropriate cells. When the collagen-cell mixture is neutralized, soluble collagen reassembles into fibrils and a gel is created. When the gel is mechanically constrained, the collagen fibrils align in the direction of constraint. The generation of tensile force during contraction is crucial for the formation of highly aligned, compacted collagenous constructs. So far, inappropriate mechanical properties have been one of the main limitations of most collagen-based tissue equivalents. In this study, we focused on providing both biomechanical and biochemical stimuli to increase cellular proliferation, matrix synthesis, and hence improve the mechanical properties of the collagen constructs. We explored a number of holder materials and configurations, with an objective to maximize the lateral compaction of our constructs. We designed a bioreactor that can provide controlled static tension to our collagen constructs. We also developed a nutrition-fortified medium that includes trace elements (Zn2+, Cu2+, Fe2+ and Mn2+), various amino acids, and vitamins (A, B complex, and C). Our ultimate goal was to combine biomechanical and biochemical stimuli, and enhance the mechanical strength of our collagen constructs.
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Affiliation(s)
- Y Shi
- Dept. of Cardiothoracic Surgery, University of Southern California, Childrens Hospital Los Angeles, 4650 Sunset Blvd. Los Angeles, CA 90027
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Kijima N, Hosen N, Kagawa N, Hashimoto N, Chiba Y, Kinoshita M, Sugiyama H, Yoshimine T, Kim YZ, Kim KH, Lee EH, Hu B, Sim H, Mohan N, Agudelo-Garcia P, Nuovo G, Cole S, Viapiano MS, McFarland BC, Hong SW, Rajbhandari R, Twitty GB, Kenneth Gray G, Yu H, Langford CP, Yancey Gillespie G, Benveniste EN, Nozell SE, Nitta R, Mitra S, Bui T, Li G, Munoz JL, Rodriguez-Cruz V, Rameshwar P, Rodriguez-Cruz V, Munoz JL, Rameshwar P, See WL, Mukherjee J, Shannon KM, Pieper RO, Floyd DH, Xiao A, Purow BW, Lavon I, Zrihan D, Refael M, Bier A, Canello T, Siegal T, Zrihan D, Granit A, Siegal T, Lavon I, Xie Q, Wang X, Gong Y, Mao Y, Chen X, Zhou L, Lee SX, Tunkyi A, Wong ET, Swanson KD, Zhang K, Chen L, Zhang J, Shi Z, Han L, Pu P, Kang C, Cho WH, Ogawa D, Godlewski J, Bronisz A, Antonio Chiocca E, Mustafa DAM, Sieuwerts AM, Smid M, de Weerd V, Martens JW, Foekens JA, Kros JM, Zhang J, McCulloch C, Graff J, Sui Y, Dinn S, Huang Y, Li Q, Fiona G, Ogawa D, Nakashima H, Godlewski J, Antonio Chiocca E, Leiss L, Manini I, Enger PO, Yang C, Iyer R, Yu ACH, Li S, Ikejiri BL, Zhuang Z, Lonser R, Massoud TF, Paulmurugan R, Gambhir SS, Merrill MJ, Sun M, Chen M, Edwards NA, Shively SB, Lonser RR, Baia GS, Caballero OL, Orr BA, Lal A, Ho JS, Cowdrey C, Tihan T, Mawrin C, Riggins GJ, Lu D, Leo C, Wheeler H, McDonald K, Schulte A, Zapf S, Stoupiec M, Kolbe K, Riethdorf S, Westphal M, Lamszus K, Timmer M, Rohn G, Koch A, Goldbrunner R, Edwards NA, Lonser RR, Merrill MJ, Ruggieri R, Vanan I, Dong Z, Sarkaria JN, Tran NL, Berens ME, Symons M, Rowther FB, Dawson T, Ashton K, Darling J, Warr T, Okamoto M, Palanichamy K, Gordon N, Patel D, Walston S, Krishanan T, Chakravarti A, Kalinina J, Carroll A, Wang L, Yu Q, Mancheno DE, Wu S, Liu F, Ahn J, He M, Mao H, Van Meir EG, Debinski W, Gonzales O, Beauchamp A, Gibo DM, Seals DF, Speranza MC, Frattini V, Kapetis D, Pisati F, Eoli M, Pellegatta S, Finocchiaro G, Maherally Z, Smith JR, Pilkington GJ, Zhu W, Wang Q, Clark PA, Yang SS, Lin SH, Kahle KT, Kuo JS, Sun D, Hossain MB, Cortes-Santiago N, Gururaj A, Thomas J, Gabrusiewicz K, Gumin J, Xipell E, Lang F, Fueyo J, Yung WKA, Gomez-Manzano C, Cook NJ, Lawrence JE, Rovin RA, Belton RJ, Winn RJ, Ferluga S, Debinski W, Lee SH, Khwaja FW, Zerrouqi A, Devi NS, Van Meir EG, Drucker KL, Lee HK, Bier A, Finniss S, Cazacu S, Poisson L, Xiang C, Rempel SA, Mikkelsen T, Brodie C, Chen M, Shen J, Edwards NA, Lonser RR, Merrill MJ, Kenchappa RS, Valadez JG, Cooper MK, Carter BD, Forsyth PA, Lee JS, Erdreich-Epstein A, Song HR, Lawn S, Kenchappa R, Forsyth P, Lim KJ, Bar EE, Eberhart CG, Blough M, Alnajjar M, Chesnelong C, Weiss S, Chan J, Cairncross G, Wykosky J, Cavenee W, Furnari F, Brown KE, Keir ST, Sampson JH, Bigner DD, Kwatra MM, Kotipatruni RP, Thotala DK, Jaboin J, Taylor TE, Wykosky J, Schinzel AC, Hahn WC, Cavenee WK, Furnari FB, Kapoor GS, Macyszyn L, Bi Y, Fetting H, Poptani H, Ittyerah R, Davuluri RV, O'Rourke D, Pitter KL, Hosni-Ahmed A, Colevas K, Holland EC, Jones TS, Malhotra A, Potts C, Fernandez-Lopez A, Kenney AM, Cheng S, Feng H, Hu B, Jarzynka MJ, Li Y, Keezer S, Johns TG, Hamilton RL, Vuori K, Nishikawa R, Sarkaria JN, Fenton T, Cheng T, Furnari FB, Cavenee WK, Mikheev AM, Mikheeva SA, Silber JR, Horner PJ, Rostomily R, Henson ES, Brown M, Eisenstat DD, Gibson SB, Price RL, Song J, Bingmer K, Oglesbee M, Cook C, Kwon CH, Antonio Chiocca E, Nguyen TT, Nakashima H, Chiocca EA, Lukiw WJ, Culicchia F, Jones BM, Zhao Y, Bhattacharjee S. LAB-CELL BIOLOGY AND SIGNALING. Neuro Oncol 2012. [DOI: 10.1093/neuonc/nos220] [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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Gershenson D, Sun C, Iyer R, Wong K, Kavanagh J, Malpica A, Schmeler K, Bodurka D, Deavers M. Hormonal therapy for recurrent low-grade serous carcinoma of the ovary or peritoneum. Gynecol Oncol 2012. [DOI: 10.1016/j.ygyno.2011.12.080] [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: 11/25/2022]
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Iyer R, Luo M, Li-McLeod J. Switching From Intravenous Immunoglobulin (IGIV) Therapy to IGSC 20%: Estimated Impact on Dosing Requirements and Cost of Therapy. J Allergy Clin Immunol 2012. [DOI: 10.1016/j.jaci.2011.12.539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Luo M, Iyer R, Li-McLeod J. Assessment of Actual Dose Adjustment in Patients Switching From Intravenous Immunoglobulin (IGIV) Therapy to IGSC 20%. J Allergy Clin Immunol 2012. [DOI: 10.1016/j.jaci.2011.12.540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Iyer R, Fetterly G, Groman A, Hutson A, Khushalani N, Mohile S, Ashton E, Litwin A, Grande C, Tomaszewski G. 6517 POSTER Sunitinib and Transarterial Chemoembolization (TACE) for Advanced Hepatocellular Carcinoma (HCC)- Final Results of a Phase 2 Trial. Eur J Cancer 2011. [DOI: 10.1016/s0959-8049(11)71828-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Liveris D, Schwartz I, McKenna D, Nowakowski J, Nadelman RB, DeMarco J, Iyer R, Cox ME, Holmgren D, Wormser GP. Quantitation of cell-associated borrelial DNA in the blood of Lyme disease patients with erythema migrans. Eur J Clin Microbiol Infect Dis 2011; 31:791-5. [PMID: 21842448 DOI: 10.1007/s10096-011-1376-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2011] [Accepted: 07/28/2011] [Indexed: 10/17/2022]
Abstract
Bloodstream invasion is an important event in the pathogenesis of the more serious manifestations of Lyme disease. The number of spirochetes in the blood of infected patients, however, has not been determined, and, therefore, it is unknown whether the number of spirochetes can be correlated with particular clinical or laboratory features. This study was designed to measure the level of Borrelia burgdorferi in the plasma of Lyme disease patients and correlate these levels with selected clinical and laboratory findings. Nested and quantitative polymerase chain reaction (qPCR) was employed to detect cell-associated flaB gene DNA in the plasma of untreated early Lyme disease patients with erythema migrans (EM). Twenty-nine (45.3%) of 64 patients had evidence of B. burgdorferi in their plasma by at least one of the PCR methods. For the 22 qPCR-positive patients, the mean number of flaB gene copies per mL of plasma was 4,660, with a range of 414 to 56,000. The number of flaB gene copies did not significantly correlate with any of the clinical, demographic, or laboratory variables assessed. For reasons discussed, we suggest caution in extrapolating an estimate of the number of viable Borrelia in plasma from the observed number of flaB copies.
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Affiliation(s)
- D Liveris
- Department of Microbiology and Immunology, New York Medical College, Valhalla, NY 10595, USA
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Coleman RL, Duska LR, Ramirez PT, Modesitt SC, Schmeler KM, Iyer R, Garcia M, Sood A. Phase II multi-institutional study of docetaxel plus aflibercept (AVE0005, NSC# 724770) in patients with recurrent ovarian, primary peritoneal, and fallopian tube cancer. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.5017] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Tripathy S, Anand A, Inamdar V, Manoj M, Khillare K, Datye A, Iyer R, Kanoj D, Thakar M, Kale V, Pereira M, Risbud A. Clinical response of newly diagnosed HIV seropositive & seronegative pulmonary tuberculosis patients with the RNTCP Short Course regimen in Pune, India. Indian J Med Res 2011; 133:521-8. [PMID: 21623038 PMCID: PMC3121284] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND & OBJECTIVES In the Revised National Tuberculosis Control Programme (RNTCP) in India prior to 2005, TB patients were offered standard DOTS regimens without knowledge of HIV status. Consequently such patients did not receive anti-retroviral therapy (ART) and the influence of concomitant HIV infection on the outcome of anti-tuberculosis treatment remained undetermined. This study was conducted to determine the results of treatment of HIV seropositive pulmonary tuberculosis patients with the RNTCP (DOTS) regimens under the programme in comparison with HIV negative patients prior to the availability of free ART in India. METHODS Between September 2000 and July 2006, 283 newly diagnosed pulmonary TB patients were enrolled in the study at the TB Outpatient Department at the Talera Hospital in the Pimpri Chinchwad Municipal Corporation area at Pune (Maharashtra): they included 121 HIV seropositive and 162 HIV seronegative patients. They were treated for tuberculosis as per the RNTCP in India. This study was predominantly conducted in the period before the free ART become available in Pune. RESULTS At the end of 6 months of anti-TB treatment, 62 per cent of the HIV seropositive and 92 per cent of the HIV negative smear negative patients completed treatment and were asymptomatic; among smear positive patients, 70 per cent of the HIV-seropositive and 81 per cent of HIV seronegative pulmonary TB patients were cured. Considering the results in the smear positive and smear negative cases together, treatment success rates were substantially lower in HIV positive patients than in HIV negative patients, (66% vs 85%). Further, 29 per cent of HIV seropositive and 1 per cent of the HIV seronegative patients expired during treatment. During the entire period of 30 months, including 6 months of treatment and 24 months of follow up, 61 (51%) of 121 HIV positive patients died; correspondingly there were 6 (4%) deaths among HIV negative patients. INTERPRETATION & CONCLUSIONS The HIV seropositive TB patients responded poorly to the RNTCP regimens as evidenced by lower success rates with chemotherapy and high mortality rates during treatment and follow up. There is a need to streamline the identification and management of HIV associated TB patients in the programme with provision of ART to achieve high cure rates for TB, reducing mortality rates and ensuring a better quality of life.
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Affiliation(s)
- S. Tripathy
- National AIDS Research Institute (ICMR), Pune, India,Reprint requests: Dr S. Tripathy, National AIDS Research Institute, 73 G Block, MIDC, Bhosari, Pune 411 026, India e-mail:
| | - A. Anand
- National AIDS Research Institute (ICMR), Pune, India
| | - V. Inamdar
- National AIDS Research Institute (ICMR), Pune, India
| | | | | | | | - R. Iyer
- Pimpri Chichwad Municipal Corporation, Pune, India
| | | | - M. Thakar
- National AIDS Research Institute (ICMR), Pune, India
| | - V. Kale
- National AIDS Research Institute (ICMR), Pune, India
| | - M. Pereira
- National AIDS Research Institute (ICMR), Pune, India
| | - A.R. Risbud
- National AIDS Research Institute (ICMR), Pune, India
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Chaudhuri BN, Rodrigues C, Balaji V, Iyer R, Sekar U, Wattal C, Chitnis DS, Dhole TN, Joshi S. Incidence of ESBL producers amongst Gram-negative bacilli isolated from intra-abdominal infections across India (based on SMART study, 2007 data). J Assoc Physicians India 2011; 59:287-292. [PMID: 21751604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
OBJECTIVES This study was conducted in 9 centers spread over India from January 1 to December 31, 2007 to monitor in vitro susceptibility of Gram-negative bacilli to Group I carbapenem, ertapenem and other antimicrobials in intra-abdominal infections and to identify early changes in susceptibility pattern of community or hospital acquired organisms, with a focus on ESBL producers. MATERIAL AND METHODS Gram-negative bacilli isolated from intra-abdominal samples of patients with documented intra-abdominal infections were processed for identification by conventional/ automated methods and antimicrobial susceptibility by Micro-Scan (Siemens) MIC panel against 12 antimicrobials (3rd and 4th generation cephalosporins, Groups I and II carbapenems, amikacin, levofloxacin, amoxicillin-clavulanic acid and piperacillin-tazobactam). RESULTS A total of 588 isolates were identified, of which 351 (60%) were E. coli and 114 (19%) were Klebsiella spp. 79% of E. coli and 70% of Klebsiella spp. were ESBL producers in general. 110 of E. coli and 35 of Klebsiella isolates were from community-acquired intra-abdominal infections. 80% of E. coli and 63% of Klebsiella isolates from community-acquired infections were ESBL producers, against 79% of E. coli and 73% of Klebsiella isolates from hospital-acquired infections. Amongst the ESBL-positive isolates of E. coli, 94% were susceptible in vitro to ertapenem, 96% to imipenem and 76% to piperacillin-tazobactam. For ESBL-positive isolates of Klebsiella spp., the corresponding figures were 80%, 94% and 59% respectively. CONCLUSION The study showed a high incidence of ESBL-producers amongst Enterobacteriaceae isolates from intra-abdominal infections in both community-acquired and hospital-acquired settings across India. Ertapenem was comparable with imipenem against ESBL-positive E. coli isolates, while imipenem was more effective than ertapenem against ESBL-positive Klebsiella isolates.
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Wright S, Lekfovits J, Iyer R. Immediate Coronary Angiography will Identify Acute Arterial Occlusion in a Significant Minority of out of Hospital VF Survivors Without ST Elevation. Heart Lung Circ 2011. [DOI: 10.1016/j.hlc.2011.05.318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Majumdar S, Morris A, Gordon C, Kermode JC, Forsythe A, Herrington B, Megason GC, Iyer R. Alarmingly high prevalence of obesity in haemophilia in the state of Mississippi. Haemophilia 2010; 16:455-9. [PMID: 20148981 DOI: 10.1111/j.1365-2516.2009.02187.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The state of Mississippi has consistently been ranked as the state with most number of obese people in the United States with prevalence rates of >30%. Our aims in this study were to estimate the prevalence of overweight and obesity in children and adults diagnosed with haemophilia in Mississippi, and to assess whether race/ethnicity and the severity of haemophilia are important risk factors. A retrospective chart review was performed for all haemophilic patients seen at the Mississippi Hemophilia Treatment Center. Patients were classified into two major age groups: age 2-19.9 years and > or =20 years. Body mass index (BMI) was calculated from the height and weight in kg m(-2) from the last clinic visit. Out of a total of 132 haemophilic patients, 61% were white and 37% were African American. Overall, 51% of the haemophilic patients were either obese or overweight. The prevalence of obesity in the adult (> or =20 years old) haemophilic patients was 36% and an additional 32% were overweight. A significantly greater proportion of patients >20 years old were overweight or obese as compared with the patients in the 2-19.9 year age range (P < 0.002). However, race/ethnicity and severity of haemophilia were not significant risk factors for overweight and obesity. There is a very high prevalence of obesity in the Mississippi haemophilic population, especially in adults. Particular attention at clinic visits should be paid to the BMI in order to identify patients that are overweight or obese to allow for early and appropriate intervention.
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Affiliation(s)
- S Majumdar
- Department of Pediatrics, University of Mississippi Medical Center, Jackson, MS 39216, USA.
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Salerno May K, Fakih M, Khushalani N, Chandrasekhar R, Wilding G, Park L, Flaherty L, Russo R, Iyer R, Yang G. Renal Function following Abdominal Chemoradiotherapy for Gastrointestinal Malignancies in Elderly Patients. Int J Radiat Oncol Biol Phys 2009. [DOI: 10.1016/j.ijrobp.2009.07.617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Iyer R, Khushalani N, Tan W, Litwin A, LeVea C, Hutson A, Tucker C, Ma W, Fakih M, Adjei A. 6603 A phase II study of erlotinib in patients (pts) with advanced pancreatic cancer (APC) who are refractory to gemcitabine (G). EJC Suppl 2009. [DOI: 10.1016/s1359-6349(09)71324-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Coleman RL, Kamat A, Iyer R, Kundra V, Garcia M, Jaffe RB, Sood AK. Phase I and pharmacokinetic study of the novel VEGF-directed fusion protein, aflibercept, in combination with docetaxel in women with recurrent ovarian, fallopian tube, and primary peritoneal cancer. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.5549] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
5549 Background: VEGF blockade has proved to be a promising therapeutic strategy in solid tumors, including ovarian. Aflibercept, a novel fusion protein consisting of the extracellular domains of VEGFR1/2 binds VEGF A, B and PlGF. Aflibercept has been studied as a single agent in heavily pretreated ovarian cancer patients. We hypothesized that the combination of aflibercept and docetaxel could be safely administered to women with recurrent ovarian cancer. Correlative biomarker and imaging studies of anti-angiogenesis targeting, pharmacokinetics (PK) and preliminary efficacy were additional objectives. Methods: Eligible patients had measurable, recurrent disease with no more than 3 prior chemotherapeutic regimens. Study design was a “lead-in” phase I trial; cycle 0, administered aflibercept IV as a single agent in 1 of 3 dose levels (2, 4, or 6 mg/kg) in a 3+3 design. Aflibercept was given in subsequent cycles with docetaxel (75 mg/m2); each cycle was 21 days. Correlative studies in cycle 0 were: PK (single agent), circulating endothelial cells and precursors (CEC, CEP), and imaging FDG-PET, DCE-MRI (baseline, day 2 and day 21). Efficacy evaluation (RECIST) was conducted q2 cycles of combination therapy. Results: Nine patients were recruited, 3 at each dose level. All are evaluable. No DLTs were observed in cycles 0 and 1; The most common hematological toxicities were myelosuppression (1 Grade 4 ANC) and anemia (Grade 2). Non-hematological toxicities (Gr 3) included headache, hypertension, fatigue and ulceration. One patient each with hypertension and ulceration lead to treatment discontinuation after 4 and 13 cycles, respectively. FDG-PET defined SUVmax in target lesions within 25% of baseline in 7 patients; 2 others had >25% increase at 48 hours post treatment. CECs, CEPs, DCE-MRI and PK are being analyzed. Confirmed PR was observed in 2 (22%) with 1 additional near PR. Median number of cycles: 5 (range 3–15). All have now progressed, median time to progression: 15 weeks. Conclusions: Aflibercept can be safely administered at 6 mg/kg with docetaxel repeatedly in this population of recurrent ovarian cancer patients. Preliminary efficacy supports phase II study, which is ongoing. No significant financial relationships to disclose.
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Affiliation(s)
- R. L. Coleman
- UT M. D. Anderson Cancer Center, Houston, TX; University of San Francisco, San Francisco, CA
| | - A. Kamat
- UT M. D. Anderson Cancer Center, Houston, TX; University of San Francisco, San Francisco, CA
| | - R. Iyer
- UT M. D. Anderson Cancer Center, Houston, TX; University of San Francisco, San Francisco, CA
| | - V. Kundra
- UT M. D. Anderson Cancer Center, Houston, TX; University of San Francisco, San Francisco, CA
| | - M. Garcia
- UT M. D. Anderson Cancer Center, Houston, TX; University of San Francisco, San Francisco, CA
| | - R. B. Jaffe
- UT M. D. Anderson Cancer Center, Houston, TX; University of San Francisco, San Francisco, CA
| | - A. K. Sood
- UT M. D. Anderson Cancer Center, Houston, TX; University of San Francisco, San Francisco, CA
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Khushalani NI, Miecznikowski J, Wang D, Nowak N, Nava H, Nava ME, Tan W, Iyer R, Yang G, Pendyala L. Capecitabine (C), oxaliplatin (OXP), and radiation (RT) in resectable esophagus cancer (EC): A phase II trial with gene expression profiling (GEP). J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.e15543] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e15543 Background: Novel chemotherapy regimens in combination with RT aim to improve the pathologic complete response (pCR) in EC. Following our dose-finding phase I study, the present phase II neo-adjuvant (NA) EC trial was designed to examine the pCR rate using C, OXP and RT, with secondary end-points of evaluating toxicity, quality of life, and GEP of tumor tissue for correlation to therapeutic response. Methods: EC patients (PTS) with stages II-IVa, adequate organ function and performance status (ECOG 0–1) were eligible. Treatment consisted of OXP, 85mg/m2 iv on days 1, 15 and 29, C (oral or enteral tube) 625 mg/m2 bid on days of RT, and 50.4 Gy RT (3-D conformal) in 28 fractions, followed by an esophagectomy (E) 4–6 weeks later. 2 cycles of OXP + C were administered post-operatively. GEP using Agilent microarrays was conducted on primary tumor tissue pre-treatment (Rx), day (D) 17 and at E; > 50% viable tumor cells were required. Results: 20 PTS have been enrolled (17 male, 3 female); median age 59.5 yrs; 17 adenocarcinomas & 3 squamous-cell cancers. Clinical stage: II (3), III (13) and IVa (4). 18 PTS have completed NA therapy; Grade 4 toxicity includes anemia (1), lymphopenia (2); grade 3 toxicity includes esophagitis (1), pneumonia (1), wound infection (1), anastomotic leak (2), esophageal fistula (1), bowel obstruction (1), fatigue (1), hyperbilirubinemia (1), elevated ALT, AST (1 & 2, respectively), hypoalbuminemia (3), OXP hypersensitivity (2) & leucopenia (1). One PT died > 60d post- operatively secondary to infection. 15 PTS have undergone an E with 3 pCR (20%). Analysis on pre-Rx GEP on 17 PTS revealed a distinct pattern for pCR PTS with 325 over-expressed and 79 under-expressed genes. Ongoing functional analysis will characterize GEP changes in 1) pCR PTS pre-Rx & at D17, 2) pCR & non-pCR PTS pre-Rx, and 3) by histology. Validation will be performed via RT-PCR. Accrual to the trial continues. Conclusions: C, OXP & RT appears to be a tolerable and efficacious NA regimen for EC. The exploratory GEP analysis may provide insight on predicting response to NA therapy. Acknowledgement: The study was approved and funded by the National Comprehensive Cancer Network (NCCN) from general research support provided by Roche Laboratories, Inc. [Table: see text]
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Affiliation(s)
| | | | - D. Wang
- Roswell Park Cancer Institute, Buffalo, NY
| | - N. Nowak
- Roswell Park Cancer Institute, Buffalo, NY
| | - H. Nava
- Roswell Park Cancer Institute, Buffalo, NY
| | - M. E. Nava
- Roswell Park Cancer Institute, Buffalo, NY
| | - W. Tan
- Roswell Park Cancer Institute, Buffalo, NY
| | - R. Iyer
- Roswell Park Cancer Institute, Buffalo, NY
| | - G. Yang
- Roswell Park Cancer Institute, Buffalo, NY
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Gurvitch R, Wilson W, Watts M, Lefkovits J, Warren R, Iyer R, Brennan A, Andrianopoulos N, Reid C, Ajani A. Zotarolimus Eluting Stent use in small coronary vessels (≤2.5mm) results in similar 12-month clinical outcomes compared to Sirolimus and Paclitaxel eluting stents. Heart Lung Circ 2009. [DOI: 10.1016/j.hlc.2009.05.593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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