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Krishnamoorthy A, Upadhyay R, Sevanan M. Chrysin for Neurotrophic and Neurotransmitter Balance in Parkinson's Disease. Methods Mol Biol 2024; 2761:477-490. [PMID: 38427256 DOI: 10.1007/978-1-0716-3662-6_32] [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] [Indexed: 03/02/2024]
Abstract
1-Methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP) has a direct impact on the dopaminergic neurons in the substantia nigra pars compacta (SNpc), dopamine in the striatum (ST), homovanillic acid (HVA), neurotrophic factors of the SNpc, and ST regions leading to Parkinson's disease (PD). Dopaminergic neuron atrophy in the SNpc and dopamine degradation in the ST have an explicit link to disrupted homeostasis of the neurotrophic factor brain-derived neurotrophic factor (BDNF) of the SNpc and ST regions. Chrysin is a flavonoid with a pharmacological potential that directly influences neurotrophic levels as well as neurotransmitters. As a result, analysis of the altering levels of neurotransmitters such as dopamine and its metabolites, 3,4-dihydroxyphenylacetic acid (DOPAC) and homovanillic acid (HVA), are observed via high-performance liquid chromatography (HPLC) and the confirmation of the influential role of BDNF and glial-derived neurotrophic factor (GDNF) in the homeostasis of dopamine, DOPAC, and HAV via examination of gene expression. The observation confirmed that chrysin balances the altering levels of neurotransmitters as well as neurotrophic factors. The protocols for reverse transcription-polymerase chain reaction (RT-PCR) and HPLC analysis for neurotransmitter levels from the SNpc and ST regions of acute PD mice brain-induced MPTP are described in this chapter.
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Affiliation(s)
| | - Riddhi Upadhyay
- Division of Biotechnology, Karunya Institute of Technology and Sciences (Deemed to be University), Coimbatore, India
| | - Murugan Sevanan
- Division of Biotechnology, Karunya Institute of Technology and Sciences (Deemed to be University), Coimbatore, India
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Upadhyay R, Elguindy AN, Sengupta S, Wang K, Beyer S, Thomas EM, Raval R, Palmer JD. Initial Report of Boswellia Serrata for Management of Cerebral Radiation Necrosis after Stereotactic Radiosurgery for Brain Metastases. Int J Radiat Oncol Biol Phys 2023; 117:S172-S173. [PMID: 37784429 DOI: 10.1016/j.ijrobp.2023.06.639] [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: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Radiation necrosis (RN) is a concerning late toxicity after radiation therapy (RT) for brain metastases. Oral corticosteroids are the mainstay of management; however, they are not optimal for long-term use given multiple side effects and drug interactions, particularly with the emergence of immunotherapy for several cancers. Boswellia serrata (BS) is an over-the-counter supplement used for its anti-inflammatory properties and has been recently shown to reduce cerebral edema after brain RT. We evaluated the response rates with BS in a series of patients with brain metastases treated with stereotactic radiosurgery (SRS) who developed RN. MATERIALS/METHODS We included patients who developed RN after SRS for brain metastases at our institution from 2020-2022 and were treated with BS. Patients were prescribed over the counter BS 4.2-4.5g daily in divided doses. Follow-up MRI imaging was obtained every 2-3 months after starting BS. Response was assessed using Response Assessment in Neuro-Oncology (RANO) criteria. Primary endpoint was ≥25% decrease in edema volume on T2-FLAIR MRI from baseline. Patients were censored if they had tumor progression or repeat RT to necrotic area, or death. Kaplan-Meier curves were used for survival estimates. RESULTS A total of 50 patients received BS for Grade 1-3 CTCAE v5.0 RN (G1 = 11, G2 = 36, and G3 = 3). Median age was 62.8 years (range 36.9 - 50) and median RT dose was 24 Gy in 3 fractions. Median time to RN after SRS was 10 months(m). Median follow-up after starting BS was 6m and 40 patients had at least 1 follow up MRI available to evaluate response. The best response was complete response (CR) in 15% patients and partial response (PR) in 40% while 35% had stable disease (SD) and 10% had progressive disease. Median time to CR was 9m (6-12m) and PR was 6m (3-12m). Percentage of patients who had any response (CR or PR) at 3, 6, 9 and 12 months was 25%, 60%, 43% and 50%, respectively. 56% patients had symptomatic RN, of which 35.7% had improvement in symptoms with BS alone, while 64% required steroid use. Overall, median duration of response in patients with CR, PR or SD was 7.5m(range 2-31m). Salvage treatment for RN was steroids (33), surgery (4), Bevacizumab (5) or hyperbaric oxygen therapy (1). No patients had any CTCAE grade 3 or higher toxicities. 3 patients (6%) had any side-effects all of whom had Grade 1-2 gastrointestinal intolerance or diarrhea. 2 patients stopped treatment due to enrolment on an immunotherapy clinical trial. Overall, 39 patients remained on BS at last follow-up or death. CONCLUSION We observed >50% response rates with use of BS in our cohort of patients with Grade 1-3 RN after SRS. More than 1/3rd patients with symptomatic RN were able to avoid long-term steroid use. BS is an easily available over-the-counter drug that appears to be a safe and promising treatment option for RN, and can potentially decrease steroid dependence in these patients, reducing the risk of several side-effects. Further prospective studies to compare Boswellia with placebo is warranted.
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Affiliation(s)
| | - A N Elguindy
- The James Cancer Center, Ohio State University Wexner Medical Center, Columbus, OH
| | - S Sengupta
- Department of Neurology, University of Cincinnati, Cincinnati, OH
| | - K Wang
- Department of Radiation Oncology, University of Cincinnati, Cincinnati, OH
| | - S Beyer
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - E M Thomas
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - R Raval
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - J D Palmer
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, OH
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Upadhyay R, Dhakal A, Karivedu V, Wheeler C, Hoyd R, Bhateja P, Bonomi M, Valentin S, Gamez ME, Konieczkowski DJ, Baliga S, Grecula JC, Blakaj DM, Gogineni E, Mitchell DL, Denko N, Jhawar SR, Spakowicz D. Comparative Analysis of Tumor Microbiome, Molecular Profile and Immune Cell Abundance by HPV Status in Head and Neck Cancers and Their Impact on Survival. Int J Radiat Oncol Biol Phys 2023; 117:e264. [PMID: 37785006 DOI: 10.1016/j.ijrobp.2023.06.1221] [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: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Traditional clinical and molecular prognostic factors offer valuable insight into the heterogeneous natural history and treatment response of head and neck squamous cell carcinoma (HNSCC) yet fail to explain the full spectrum of observed variability. The tumor microenvironment (TME), comprising microbiome and immune cells can impact treatment response and prognosis. We analyzed The Cancer Genome Atlas (TCGA) to evaluate the association of specific microbes and genes in TME with survival and their differential expression in HPV positive (+) and HPV negative (-) HNSCC. MATERIALS/METHODS HNSCC RNA sequencing (RNAseq) samples from TCGA were processed through the Exogenous sequencing in Tumors and Immune Cells (ExoTIC) pipeline to identify gene expression and microbial presence. HPV status was assessed by detection of papillomaviridae family of microbes. Clinical data from TCGA was extracted to compare overall survival (OS) and control for competing variables using Cox proportional hazards regression. Difference in immune cell abundance was evaluated by Kruskal-Wallis test. All statistical analysis was performed using R. RESULTS A total of 498 RNAseq samples from TCGA were analyzed. Oral cavity, oropharynx, hypopharynx, and larynx tumors comprised 21.6%, 15%, 1.8%, and 22.2% of specimens, respectively. HPV was detected in 111 patients (22%), most commonly Alpha papillomavirus 9 (90.1%). Of the 5838 enriched microbes, 330 were significantly associated with OS after controlling for tumor stage, smoking, and age. Specifically, the presence of Alpha papillomavirus 9 was associated with significantly improved OS [adjusted HR = 0.60 (95% CI 0.40 - 0.89, p = 0.01)]. Microbial species found in more abundance in HPV- tumors included Citrobacter farmeri, Thermoanaerobacter kivui and Yersinia pestis which are gram negative anaerobes. Genes related to cellular transport and DNA repair were enriched while genes related to proliferation (e.g., SAGE1) were depleted in HPV+ samples. HPV- tumors had a significantly higher number of M0 (p < 0.001) and M2 macrophages (p = 0.035) while HPV+ tumors had more T regulatory cells (p < 0.001) and CD8+ T-cells (p < 0.001). CONCLUSION Tumor microenvironment was significantly associated with survival for HNSCC patients, with particular microbes such as Alpha papillomavirus 9 correlating with improved OS. Greater abundance of certain anaerobic microbes was seen in HPV- tumors. These findings suggest TME can be used to predict patient outcomes and potentially guide personalized treatment approaches. We found an abundance of M0 and M2 macrophages in HPV- tumors, which are considered pro-tumorigenic, while anti-tumor M1 macrophages were similar in the two groups. This may help identify mechanism of resistance to immunotherapies and tailor novel immunotherapy combinations in specific patient subgroups. With further prospective research and external validation these findings have the potential to significantly impact the way we treat HNSCC in the future.
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Affiliation(s)
| | - A Dhakal
- The Ohio State University College of Medicine, Columbus, OH
| | - V Karivedu
- The Ohio State University Wexner Medical Center, Columbus, OH
| | - C Wheeler
- The Ohio State University Wexner Medical Center, Columbus, OH
| | - R Hoyd
- The Ohio State University Wexner Medical Center, Columbus, OH
| | - P Bhateja
- The Ohio State University Wexner Medical Center, Columbus, OH
| | - M Bonomi
- Department of Medical Oncology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - S Valentin
- The Ohio State University Wexner Medical Center, Columbus, OH
| | - M E Gamez
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN
| | | | - S Baliga
- Ohio State University, Columbus, OH
| | - J C Grecula
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - D M Blakaj
- James Cancer Hospital and Solove Research Institute, The Ohio State University, Columbus, OH
| | - E Gogineni
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - D L Mitchell
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - N Denko
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - S R Jhawar
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - D Spakowicz
- The Ohio State University Wexner Medical Center, Columbus, OH
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Dohm AE, Upadhyay R, Tang JD, Oliver DE, Perez BA, Rosenberg SA, Yu HHM, Palmer JD, Beyer S, Owen D, Ahmed KA. Upfront Osimertinib Alone vs. Osimertinib and Radiotherapy for the Treatment of EGFR-Positive NSCLC Brain Metastases: A Multi-Institutional Series. Int J Radiat Oncol Biol Phys 2023; 117:e100-e101. [PMID: 37784626 DOI: 10.1016/j.ijrobp.2023.06.869] [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: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Given the increased brain penetrance of osimertinib, the role of upfront radiotherapy (RT) has been questioned for the management of patients with EGFR+ NSCLC brain metastases (BM). We conducted a multi-institutional review of patients with EGFR+ NSCLC treated with upfront osimertinib or osimertinib in combination with RT for new or progressing BM. MATERIALS/METHODS Our multi-institutional analysis included 128 patients with 714 BM treated between 2013 and 2022. Two BM treatment groups were evaluated: (1) upfront osimertinib alone (n = 66) and (2) osimertinib + RT [whole brain radiation therapy or stereotactic/fractionated radiosurgery (SRS/FSRT)] prior or concurrently with osimertinib (n = 62)]; both groups began treatment within 2 months of BM diagnosis. Time-to-event analysis was conducted with the Kaplan-Meier (KM) method, and outcomes included intracranial control (IC) [both local and distant], intracranial progression free survival (IPFS), and overall survival (OS). A Cox proportional hazards model was utilized for multivariate analysis (MVA). RESULTS Median follow-up from BM diagnosis was 33.9 months (0.13-76.2 months). No differences in age (p = 0.46), sex (p = 0.72), DS-GPA (p = 0.08), KPS (p = 0.57), number of BM (p = 0.19) or volume of BM (p = 0.45), RT dose (p = 0.45), number of systemic metastases (p = 0.88), and patients symptomatic at presentation (p = 1.0) were noted. Prior treatment of BM was more common in the osimertinib + RT group (50% osimertinib + RT and 27% osimertinib; p = 0.01). The 12-month KM rates for osimertinib vs osimertinib + RT groups for IC were 72% vs 73% (p = 0.33); IPFS 53% vs 66% (p = 0.007); and OS 65% vs 80% (p = 0.025). On MVA, higher KPS (p = 0.002) was associated with increased OS and no extracranial metastasis with increased OS (p = 0.01) and IPFS (p = 0.001). MVA showed no association between osimertinib vs osimertinib + RT for IC, IPFS, or OS. Of the 66 patients treated with upfront osimertinib, 18 patients (27%) with 31 lesions eventually required RT for intracranial progression with the majority 72% being treated with SRS/FSRT at median of 13.5 months (1-22 months) following the start of osimertinib. CONCLUSION This study suggests that upfront osimertinib alone may provide sufficient intracranial control to allow RT to be deferred until further intracranial progression in select patients. Prospective trials are warranted to further guide treatment.
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Affiliation(s)
- A E Dohm
- H. Lee Moffitt Cancer Center and Research Institute, Department of Radiation Oncology, Tampa, FL
| | - R Upadhyay
- The Ohio State University Wexner Medical Center, Columbus, OH
| | - J D Tang
- H. Lee Moffitt Cancer Center and Research Institute, Department of Radiation Oncology, Tampa, FL
| | - D E Oliver
- H. Lee Moffitt Cancer Center and Research Institute, Department of Radiation Oncology, Tampa, FL
| | - B A Perez
- H. Lee Moffitt Cancer Center and Research Institute, Department of Radiation Oncology, Tampa, FL
| | - S A Rosenberg
- H. Lee Moffitt Cancer Center and Research Institute, Department of Radiation Oncology, Tampa, FL
| | - H H M Yu
- H. Lee Moffitt Cancer Center and Research Institute, Department of Radiation Oncology, Tampa, FL
| | - J D Palmer
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - S Beyer
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - D Owen
- The Ohio State University, Columbus, OH
| | - K A Ahmed
- H. Lee Moffitt Cancer Center and Research Institute, Department of Radiation Oncology, Tampa, FL
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McCalla A, Upadhyay R, Perlow HK, Raval R, Beyer S, Blakaj DM, Grecula JC, Palmer JD, Thomas EM. WBRT is Associated with Higher Rates of Hematologic Toxicity than Stereotactic Radiosurgery in Brain Metastasis Patients. Int J Radiat Oncol Biol Phys 2023; 117:e137-e138. [PMID: 37784705 DOI: 10.1016/j.ijrobp.2023.06.944] [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: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Whole brain radiotherapy (WBRT) has historically been a standard of care in patients with multiple brain metastases. Studies show that WBRT may be associated with a transient detriment in hematological parameters because of exposure to a larger proportion of circulating lymphocytes, platelets and hematopoietic cells within the bone marrow of the cranium. In this study, we tested the hypothesis that stereotactic radiotherapy (SRS) may cause reduced hematologic toxicity in patients compared to WBRT. MATERIALS/METHODS We retrospectively identified 100 patients treated for brain metastasis, with either SRS or WBRT from 2016 to 2019, and queried their pre- and post-treatment hematological parameters including hemoglobin, total white blood cell (WBC), absolute neutrophil count (ANC), absolute lymphocyte count, and platelet count. CTCAE v5.0 was used for grading hematologic toxicities. Serial values were compared by treatment type and controlled for age, gender, and systemic therapy. Student t-test was used for intergroup comparison and p-value <0.05 was considered significant. RESULTS Of 100 patients, median brain metastases was 3 (range 1-22), 51 received SRS and 49 received WBRT. We observed that patients treated with WBRT had a significantly higher post-treatment reduction in platelet count (-51.2 vs 9.8; p = 0.001) and higher incidence of any grade thrombocytopenia (31.2% vs 10%; p = 0.019) compared to patients treated with SRS. We also noted that compared with SRS, WBRT was associated with a higher post-treatment reduction in circulating lymphocytes (-0.80 vs 0.14; p = 0.071) and higher incidence of G3+ lymphopenia (43.2% vs 22.2%; p = 0.07). Numerical incidence of any G3+ hematological toxicity was also higher in the WBRT group but the difference was not statistically significant (40% vs 28%, p = 0.162). Hemoglobin count, WBC, and ANC were not meaningfully different pre- and post-treatment for either group. CONCLUSION WBRT results in an increased amount and duration of radiation exposure to circulating intracranial blood volume. In our study, patients treated with WBRT experienced higher rates of clinically significant lymphopenia & thrombocytopenia compared to patients treated with SRS. In addition to the cognitive benefits of SRS compared to WBRT, there may be significant hematologic benefits as well. Further studies are warranted to clarify and validate these findings.
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Affiliation(s)
- A McCalla
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, OH
| | | | - H K Perlow
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - R Raval
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - S Beyer
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - D M Blakaj
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - J C Grecula
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - J D Palmer
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - E M Thomas
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, OH
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Upadhyay R, Palmer JD, Perlow HK, Schoenhals J, Ghose J, Rajappa P, Blakaj DM, Beyer S, Grecula JC, Sim AJ, Hardesty D, Elder JB, Chakravarti A, Thomas EM, Raval R. Patient-Reported Cognitive Outcomes and Survival after Stereotactic Radiosurgery for 15 or More Brain Metastases. Int J Radiat Oncol Biol Phys 2023; 117:e153-e154. [PMID: 37784741 DOI: 10.1016/j.ijrobp.2023.06.977] [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: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Overall survival (OS) in metastatic cancer patients has been improving with continued advancements, necessitating greater attention to treatment related toxicities. Patients with ≥ 15 brain metastases (BM) continue to be treated with whole brain radiation therapy (WBRT), despite poor neurocognitive outcomes. We analyzed our institutional experience of treating these patients with stereotactic radiosurgery (SRS), with the aim of evaluating safety, cognitive outcomes, and survival metrics. MATERIALS/METHODS Patients who received SRS for ≥ 15 BMs in 1-5 fractions from 2014-2022 using the previously described single isocenter multi-target technique were included. Cognitive outcomes were objectively evaluated using serial Patient-Reported Outcome Measurement Information System (PROMIS) scores. Kaplan-Meier method was used for survival analysis and log-rank test was used for intergroup comparisons. RESULTS A total of 118 patients underwent 124 courses of LINAC-based SRS. The mean and median number of lesions treated per patient was 24.8 and 20, respectively (range 15 - 94). Most common primary histologies were lung (47.6%), melanoma (21.0%), and breast (14.5%). The median SRS dose was 24 Gy (range 18 - 30 Gy) with 87.9% receiving 3 fraction SRS. At the time of SRS, 19.4% patients had received prior WBRT and 24.2% had received at least one prior SRS course. The rate of any grade radiation necrosis (RN) and ≥ grade 3 RN were 15.3% and 3.2% respectively. New onset seizures were seen in 2.4%, alopecia in 2.4%, and subjective cognitive decline in 4% of patients. Median follow-up by reverse Kaplan-Meier method was 17.8 months (m). Cognitive data was available for 38 patients. Mean PROMIS scores at baseline, 3m, 6m and 9m after SRS were 32.0, 31.6, 30.4 and 28.7 out of 40, respectively. When longitudinal trends were available, 25 of 31 patients had a stable or improved PROMIS score. The 12m local control was 97.6%. Cumulative incidence of distant intracranial failure was 79.2%. One year freedom from neurological death, leptomeningeal disease, and salvage WBRT were 85.6%, 87.6% and 71.7% respectively. Median OS from brain metastases diagnosis was 11.3m (95% CI 7.2m - 15.3m) overall, while it was 9.2m (6.5 - 11.8m) after excluding patients who had prior WBRT or SRS (n = 79). One-year survival was 40% from diagnosis and 38.7% from SRS. On Cox regression analysis, prior WBRT (p = 0.002), higher KPS (p = 0.050), systemic therapy after SRS (p<0.001), and controlled extracranial disease (p = 0.007) predicted for improved OS. CONCLUSION We present here the largest study evaluating SRS for patients with ≥ 15 BMs. We found that SRS was safe, had favorable cognitive outcomes, and comparable survival outcomes to contemporary studies evaluating WBRT in this patient population. Treatment-naïve patients had a median survival of > 6 months, long enough to benefit from cognitive sparing with SRS. Our study supports further randomized studies comparing SRS and memory avoidance WBRT approaches for patients with ≥ 15 BMs.
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Affiliation(s)
- R Upadhyay
- The Ohio State University Wexner Medical Center, Columbus, OH
| | - J D Palmer
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - H K Perlow
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - J Schoenhals
- The Ohio State University Wexner Medical Center, Columbus, OH
| | - J Ghose
- The Ohio State University, Columbus, OH
| | - P Rajappa
- Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, OH
| | - D M Blakaj
- James Cancer Hospital and Solove Research Institute, The Ohio State University, Columbus, OH
| | - S Beyer
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - J C Grecula
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - A J Sim
- H. Lee Moffitt Cancer Center and Research Institute, Department of Radiation Oncology, Tampa, FL
| | - D Hardesty
- Department of Neurosurgery, The Ohio State University Wexner Medical Center, Columbus, OH
| | - J B Elder
- The James Cancer Hospital, Columbus, OH
| | - A Chakravarti
- The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - E M Thomas
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - R Raval
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, OH
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Tadesse F, De B, Vauthey JN, Javle M, Upadhyay R, Kumala T, Shi C, Dodoo G, Corrigan KL, Manzar GS, Marqueen KE, Pagan VB, Lee S, Jaoude JA, Ludmir EB, Koay EJ. Enhancement Patterns of Metastatic Intrahepatic Cholangiocarcinoma and Outcomes after Chemotherapy and Radiation. Int J Radiat Oncol Biol Phys 2023; 117:e341. [PMID: 37785192 DOI: 10.1016/j.ijrobp.2023.06.2403] [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: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Patients with metastatic intrahepatic cholangiocarcinoma (M1-iCCA) have a poor prognosis with a 5-year survival rate of less than 20%. Definitive doses of radiation therapy (RT) after upfront chemotherapy (chemo/RT) in this patient population have shown to prolong survival by reducing the risk of tumor-related liver failure compared to chemotherapy alone. Our group has also identified a baseline radiographic feature, the arterial enhancement pattern, which has pathological and prognostic associations for iCCA. We tested the hypothesis that baseline arterial enhancement is independently associated with survival outcomes for patients who receive chemo/RT or chemo alone. MATERIALS/METHODS Patients with M1-iCCA from 2010 to 2021 were included in this retrospective study. Patients were grouped into those who underwent chemo alone and those who underwent chemo/RT. The inclusion criteria included confirmed diagnosis of M1-iCCA, availability of baseline multi-phasic computed tomography (CT), and follow-up for at least six months or until death. Tumor arterial enhancement patterns were categorized as previously described into hypovascular or hypervascular, where the tumors that were hypervascular had either peripheral enhancement or central enhancement. Mean tumor density in Hounsfield units was recorded for each patient. Survival was estimated using the Kaplan Meier method, and Cox proportional models were used to adjust for prognostic variables. RESULTS A total of 281 patients with iCCA were identified and 229 had evaluable CT scans. Demographic and baseline characteristics of patient groups are shown in the Table. On univariate analysis, patient age, ECOG performance status (PS) at diagnosis, treatment type, and arterial enhancement patterns associated with overall survival (OS). On multivariable analysis, the arterial enhancement pattern independently associated with OS after accounting for covariates. Patients with hypervascular tumors had prolonged OS compared to those with hypovascular tumors (HR = 0.72, [0.54 - 0.96], p = 0.02). Prolonged OS was also observed in the chemo/RT group compared to the chemo alone group (HR = 0.37, [0.25-0.54], p< 0.0001). CONCLUSION Baseline enhancement patterns of M1-iCCA were prognostic in the contexts of chemo alone and chemo/RT. This imaging-based biomarker may improve the ability to stratify patients for therapeutic management.
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Affiliation(s)
- F Tadesse
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - B De
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - J N Vauthey
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - M Javle
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - T Kumala
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - C Shi
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - G Dodoo
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - K L Corrigan
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - G S Manzar
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - K E Marqueen
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - V Bernard Pagan
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - S Lee
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - J Abi Jaoude
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - E B Ludmir
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - E J Koay
- The University of Texas MD Anderson Cancer Center, Houston, TX
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Muacevic A, Adler JR, Watts A, Aedma S, Jose JA, Jyotheeswara Pillai K, Rizkalla A, Sharma S, Upadhyay R, Dhobale S, Bin Farooq T, Khanam R, Patel KV, Martin R. Independent Predictors of Mortality in COVID-19 Myocardial Injury: The Role of Troponin Levels, GRACE Score, SOFA Score, and TIMI Score. Cureus 2022; 14:e32082. [PMID: 36600831 PMCID: PMC9803800 DOI: 10.7759/cureus.32082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/30/2022] [Indexed: 12/03/2022] Open
Abstract
Background Coronavirus disease 2019 (COVID-19) infection is associated with troponin elevation, which is associated with increased mortality. However, it is not clear if troponin elevation is independently linked to increased mortality in COVID-19 patients. Although there is considerable literature on risk factors for mortality in COVID-19-associated myocardial injury, the Global Registry of Acute Coronary Events (GRACE), Thrombolysis in Myocardial Infarction (TIMI), and Sequential Organ Failure Assessment (SOFA) scores have not been studied in COVID-19-related myocardial injury. This data is important in risk-stratifying COVID-19 myocardial injury patients. Methodology Of the 1,500 COVID-19 patients admitted to our hospitals, 217 patients who had troponin levels measured were included. Key variables were collected manually, and univariate and multivariate cox regression analysis was done to determine the predictors of mortality in COVID-19-associated myocardial injury. The differences in clinical profiles and outcomes of COVID-19 patients with and without troponin elevation were compared. Results Mortality was 26.5% in the normal troponin group and 54.6% in the elevated troponin group. Patients with elevated troponins had increased frequency of hypotension (p = 0.01), oxygen support (p < 0.01), low absolute lymphocyte (p < 0.01), elevated blood urea nitrogen (p < 0.01), higher C-reactive protein (p < 0.01), higher D-dimer (p < 0.01), higher lactic acid (p < 0.01), and higher Quick SOFA (qSOFA), SOFA, TIMI, and GRACE (all scores p < 0.01). On univariate cox regression, troponin elevation (hazard ratio (HR) = 1.85, 95% confidence interval (CI) = 1.18-2.88, p < 0.01), TIMI score >3 (HRv = 1.79, 95% CI = 1.11-2.75, p = 0.01), and GRACE score >140 (HR = 2.27, 95% CI = 1.45-3.55, p < 0.01) were highly associated with mortality, whereas cardiovascular disease (HR = 1.40, 95% CI = 0.89-2.21, p = 0.129) and cardiovascular risk factors (HR = 1.15, 95% CI = 0.73-1.81, p = 0.52) were not. After adjusting for age, use of a non-rebreather or high-flow nasal cannula, hemoglobin <8.5 g/dL, suspected or confirmed source of infection, and qSOFA and SOFA scores (HR = 1.18, 95% CI = 1.07-1.29, p < 0.01) were independently associated with mortality, whereas troponin (HR = 1.08, 95% CI = 0.63-1.85, p = 0.76), TIMI score (HR = 1.02, 95% CI = 0.99-1.06, p = 0.12) and GRACE scores (HR = 1.01, 95% CI = 0.99-1.02, p = 0.10) were not associated with mortality. Conclusions Our study shows that troponin, GRACE score, and TIMI score are not independent predictors of mortality in COVID-19 myocardial injury. This may be because troponin elevation in COVID-19 patients may be related to demand ischemia rather than acute coronary syndrome-related. This was shown by the association of troponin with a higher degree of systemic inflammation and end-organ dysfunction. Therefore, we recommend SOFA scores in risk-stratifying COVID-19 patients with myocardial injury.
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Upadhyay R, Yadav D, Venkatesulu B, Singh R, Baliga S, Raval R, Lazow M, Salloum R, Fouladi M, Mardis E, Zaorsky N, Trifiletti D, Paulino A, Palmer J. Risk of Secondary Malignant Neoplasms in Children Following Proton Therapy vs. Photon Therapy for Primary CNS Tumors. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.1757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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10
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Valluri A, Singh R, Lehrer E, Cao Y, Upadhyay R, Trifiletti D, Lo S, Redmond K, Sahgal A, Palmer J. Clinical Outcomes Following Stereotactic Body Radiation Therapy (SBRT) for Non-Spinal Bone Metastases: A Systematic Review and Meta-Analysis. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.1651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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11
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Yadullahi Mir WA, Siddiqui AH, Valecha G, Patel S, Ayub F, Upadhyay R, Alhajri SA, Gaire S, Shrestha DB. A Narrative Review of Existing Options for COVID-19-Specific Treatments. Adv Virol 2021; 2021:8554192. [PMID: 34804163 PMCID: PMC8604608 DOI: 10.1155/2021/8554192] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 10/16/2021] [Indexed: 12/15/2022] Open
Abstract
The new coronavirus disease 2019 (COVID-19) was declared a global pandemic in early 2020. The ongoing COVID-19 pandemic has affected morbidity and mortality tremendously. Even though multiple drugs are being used throughout the world since the advent of COVID-19, only limited treatment options are available for COVID-19. Therefore, drugs targeting various pathologic aspects of the disease are being explored. Multiple studies have been published to demonstrate their clinical efficacy until now. Based on the current evidence to date, we summarized the mechanism, roles, and side effects of all existing treatment options to target this potentially fatal virus.
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Affiliation(s)
| | | | - Gautam Valecha
- Department of Oncology, Presbyterian Healthcare Services, Albuquerque, NM, USA
| | - Shawn Patel
- Department of Internal Medicine, The Carle Illinois College of Medicine, Champaign, IL, USA
| | - Fatima Ayub
- Department of Internal Medicine, The Carle Illinois College of Medicine, Champaign, IL, USA
| | - Riddhi Upadhyay
- Department of Internal Medicine, The Carle Illinois College of Medicine, Champaign, IL, USA
| | - Sana Ahmed Alhajri
- Department of Pediatrics, University of Illinois Chicago, Chicago, IL, USA
| | - Suman Gaire
- Department of Emergency Medicine, Palpa Hospital, Palpa, Nepal
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12
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Upadhyay R, Grosshans D, McGovern S, McAleer M, Woodhouse K, Zaky W, Chintagumpala M, Mahajan A, Paulino A. Quantifying the Risk and Dosimetric Variables of Symptomatic Brainstem Injury After Proton Beam Radiation in Pediatric Brain Tumors. Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.198] [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: 12/01/2022]
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13
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Upadhyay R, Jaiswal V, Bhattacherjee A, Patra AK. Role of whole-body vibration exposure and posture of dumper operators in musculoskeletal disorders: a case study in metalliferous mines. Int J Occup Saf Ergon 2021; 28:1711-1721. [PMID: 34042562 DOI: 10.1080/10803548.2021.1932111] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Objectives. The combined role of whole-body vibration (WBV) exposure and awkward posture on musculoskeletal disorders (MSDs) experienced by dumper operators in two metalliferous mines in India was evaluated through a cross-sectional study. Methods. Frequency-weighted root mean square (rms) acceleration was used for WBV exposure assessment. Anthropometry and rapid upper limb assessment (RULA) were used for static and dynamic posture assessment, respectively. Prevalence of MSDs was assessed using the Nordic musculoskeletal questionnaire (NMQ). Logistic regression was used to assess the factors contributing to MSD problems. Results. The rms values revealed that the operators exceeded the lower limit of Standard No. ISO 2631-1:1997. The dynamic posture study revealed that the majority of dumper operators were taking awkward postures and 58-74% of them were subjected to high and medium levels of MSD risk. The adjusted odds ratio (7.96, 95% confidence interval [1.24, 41.35]) for the most awkward postures revealed WBV exposure as the significant risk factor for MSD problems among the operators. Conclusion. WBV exposure and posture of operators should be regularly monitored and corrective actions implemented to reduce their MSD problems. Ergonomic seat design based on the anthropometry of the operators should be assessed at the time of procuring new equipment.
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Affiliation(s)
- R Upadhyay
- Department of Mining Engineering, Indian Institute of Technology Kharagpur, India
| | - V Jaiswal
- Department of Mining Engineering, Indian Institute of Technology Kharagpur, India
| | - A Bhattacherjee
- Department of Mining Engineering, Indian Institute of Technology Kharagpur, India
| | - A K Patra
- Department of Mining Engineering, Indian Institute of Technology Kharagpur, India
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Taneja I, Damhorst GL, Lopez-Espina C, Zhao SD, Zhu R, Khan S, White K, Kumar J, Vincent A, Yeh L, Majdizadeh S, Weir W, Isbell S, Skinner J, Devanand M, Azharuddin S, Meenakshisundaram R, Upadhyay R, Syed A, Bauman T, Devito J, Heinzmann C, Podolej G, Shen L, Timilsina SS, Quinlan L, Manafirasi S, Valera E, Reddy B, Bashir R. Diagnostic and prognostic capabilities of a biomarker and EMR-based machine learning algorithm for sepsis. Clin Transl Sci 2021; 14:1578-1589. [PMID: 33786999 PMCID: PMC8301583 DOI: 10.1111/cts.13030] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [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: 09/24/2020] [Revised: 02/09/2021] [Accepted: 02/10/2021] [Indexed: 01/08/2023] Open
Abstract
Sepsis is a major cause of mortality among hospitalized patients worldwide. Shorter time to administration of broad‐spectrum antibiotics is associated with improved outcomes, but early recognition of sepsis remains a major challenge. In a two‐center cohort study with prospective sample collection from 1400 adult patients in emergency departments suspected of sepsis, we sought to determine the diagnostic and prognostic capabilities of a machine‐learning algorithm based on clinical data and a set of uncommonly measured biomarkers. Specifically, we demonstrate that a machine‐learning model developed using this dataset outputs a score with not only diagnostic capability but also prognostic power with respect to hospital length of stay (LOS), 30‐day mortality, and 3‐day inpatient re‐admission both in our entire testing cohort and various subpopulations. The area under the receiver operating curve (AUROC) for diagnosis of sepsis was 0.83. Predicted risk scores for patients with septic shock were higher compared with patients with sepsis but without shock (p < 0.0001). Scores for patients with infection and organ dysfunction were higher compared with those without either condition (p < 0.0001). Stratification based on predicted scores of the patients into low, medium, and high‐risk groups showed significant differences in LOS (p < 0.0001), 30‐day mortality (p < 0.0001), and 30‐day inpatient readmission (p < 0.0001). In conclusion, a machine‐learning algorithm based on electronic medical record (EMR) data and three nonroutinely measured biomarkers demonstrated good diagnostic and prognostic capability at the time of initial blood culture.
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Affiliation(s)
| | - Gregory L Damhorst
- Prenosis Inc., Chicago, Illinois, USA.,Department of Medicine, Emory University, Atlanta, Georgia, USA
| | | | - Sihai Dave Zhao
- Department of Statistics, University of Illinois at Urbana-Champaign, Champaign, Illinois, USA
| | - Ruoqing Zhu
- Department of Statistics, University of Illinois at Urbana-Champaign, Champaign, Illinois, USA
| | - Shah Khan
- Prenosis Inc., Chicago, Illinois, USA
| | - Karen White
- Biomedical Research Center, Carle Foundation Hospital, Urbana, Illinois, USA
| | - James Kumar
- Biomedical Research Center, Carle Foundation Hospital, Urbana, Illinois, USA
| | | | - Leon Yeh
- OSF Saint Francis Medical Center, Peoria, Illinois, USA
| | - Shirin Majdizadeh
- Biomedical Research Center, Carle Foundation Hospital, Urbana, Illinois, USA
| | - William Weir
- Biomedical Research Center, Carle Foundation Hospital, Urbana, Illinois, USA
| | - Scott Isbell
- Department of Pathology, Saint Louis University School of Medicine, St. Louis, Missouri, USA
| | - James Skinner
- Biomedical Research Center, Carle Foundation Hospital, Urbana, Illinois, USA
| | - Manubolo Devanand
- Biomedical Research Center, Carle Foundation Hospital, Urbana, Illinois, USA
| | - Syed Azharuddin
- Biomedical Research Center, Carle Foundation Hospital, Urbana, Illinois, USA
| | | | - Riddhi Upadhyay
- Biomedical Research Center, Carle Foundation Hospital, Urbana, Illinois, USA
| | | | - Thomas Bauman
- OSF Saint Francis Medical Center, Peoria, Illinois, USA
| | - Joseph Devito
- OSF Saint Francis Medical Center, Peoria, Illinois, USA
| | | | | | | | | | | | | | - Enrique Valera
- Department of Bioengineering, University of Illinois at Urbana-Champaign, Champaign, Illinois, USA
| | - Bobby Reddy
- Prenosis Inc., Chicago, Illinois, USA.,Department of Bioengineering, University of Illinois at Urbana-Champaign, Champaign, Illinois, USA
| | - Rashid Bashir
- Department of Bioengineering, University of Illinois at Urbana-Champaign, Champaign, Illinois, USA
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Upadhyay R, Shankar A, Kumar R, Bharti S, Saini D. Physician-reported Factors Affecting HPV Vaccination and Cervical Cancer Prevention in a Middle-Income Country: Overcoming Cultural Challenges. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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16
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Patel K, Sambataro J, Singh V, Jones P, Zorrilla CA, Upadhyay R. ATYPICAL TERRITORY FOR LUNG ADENOCARCINOMA. Chest 2020. [DOI: 10.1016/j.chest.2020.08.1373] [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] Open
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17
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Mahajan P, Upadhyay R, Aedma S, Talha Khan M, Thameem D. A RARE CASE OF RAPIDLY PROGRESSIVE INTERSTITIAL LUNG DISEASE IN A PATIENT WITH CLINICALLY AMYOPATHIC DERMATOMYOSITIS WITH ANTI-MELANOMA DIFFERENTIATION-ASSOCIATED GENE 5 ANTIBODIES. Chest 2020. [DOI: 10.1016/j.chest.2020.08.1062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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18
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Jindal K, Upadhyay R, Singh H. Application of hybrid GLCT-PICA de-noising method in automated EEG artifact removal. Biomed Signal Process Control 2020. [DOI: 10.1016/j.bspc.2020.101977] [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: 10/24/2022]
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19
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Dube A, Gupta J, Jindal K, Sharma A, Gupta K, Vijay M, Upadhyay R. Application of variational mode decomposition in automated migraine disease diagnosis. IJHTM 2020. [DOI: 10.1504/ijhtm.2020.10039893] [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: 11/21/2022]
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20
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Jindal K, Upadhyay R, Vijay M, Sharma A, Gupta K, Gupta J, Dube A. Application of variational mode decomposition in automated migraine disease diagnosis. IJHTM 2020. [DOI: 10.1504/ijhtm.2020.116763] [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: 11/21/2022]
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21
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Upadhyay R, Sharma D, Julka P, Rath G. A phase II randomised study of Adjuvant hypo-fractionated radiotherapy with concurrent vs sequential letrozole in post-menopausal women with hormone receptor positive breast cancer: Report of pulmonary toxicity and cosmetic outcome. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx362.032] [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: 11/14/2022] Open
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22
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Upadhyay R, Julka P, Rath G. Role of radiotherapy and its impact on survival of male breast cancer: Experience from a tertiary cancer center. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx364.005] [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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23
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Bhat A, Sabharwal K, Bhat M, Singla M, Kumar V, Upadhyay R. Correction of penile torsion and chordee by mobilization of urethra with spongiosum in chordee without hypospadias. J Pediatr Urol 2014; 10:1238-43. [PMID: 25130900 DOI: 10.1016/j.jpurol.2014.06.016] [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] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2014] [Accepted: 06/20/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To investigate the feasibility of correcting coexistent penile torsion and chordee without hypospadias by mobilization of the urethra and spongiosum. MATERIALS AND METHODS A retrospective study of nine patients with simultaneous penile torsion and chordee without hypospadias was undertaken between January 2006 and December 2012. During this period, a total of 364 cases of hypospadias and 38 of chordee without hypospadias were operated on, making a total of 402 patients with hypospadias-related complexes. The same steps were used for correction of both torque and chordee. After a circumcoronal incision, the penis was fully degloved and the spongiosum with urethra was lifted up off the cavernosa. Next, mobilization of the hypoplastic urethra with spongiosum was extended into the glans. If chordee or torque persisted, urethral mobilization was performed proximally up to the bulbar urethra, as required. Spongioplasty and glansplasty were done and a per-urethral stent was kept in for three to five days. RESULTS The age of the patients ranged from 5 to 16 years (median 6 years). Penile torsion ranged from 30° to 120°, with a median of 75°. Ventral chordee ranged from 45° to 100°, with a median of 50°. A ratio of 1:9.6 was found for chordee without hypospadias compared to the total hypospadias cases, with an incidence of 9.5%. The ratio of chordee without hypospadias with torsion compared to the total hypospadias cases was 1:29. There was an incidence of chordee without hypospadias with penile torsion of 3.5% in all patients with hypospadias. The ratio of chordee without hypospadias with torsion to only chordee without hypospadias was 1:1.71, with an incidence of 37.0%. Every step contributed to the correction of curvature and torsion. Chordee was corrected in two patients by penile degloving and lifting of the spongiosa off the urethral plate; three patients required additional mobilization of the urethra into the glans. Another two patients needed proximal urethral mobilization and one required a dorsal plication. In five patients, torque was corrected by penile degloving, lifting of the spongiosa and mobilization of the urethra into the glans; four patients required further proximal urethral mobilization. All patients had excellent functional and cosmetic results. No residual chordee or torque was observed in any patient on follow-up at 12-24 months. CONCLUSION The technique of distally mobilizing a hypoplastic urethra with spongiosum from the corpora into the glans, and proximally up to the bulbar region corrects moderate to severe chordee and torsion with excellent cosmetic results. The incidence of torsion with chordee without hypospadias was 3.5% of all cases of hypospadias.
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Affiliation(s)
- A Bhat
- Department of Urology, S.P. Medical College, Bikaner, Rajasthan, 334003, India.
| | - K Sabharwal
- Department of Urology, S.P. Medical College, Bikaner, Rajasthan, 334003, India.
| | - M Bhat
- Department of Preventive and Social Medicine, S.P. Medical College, Bikaner, Rajasthan, 334003, India.
| | - M Singla
- Department of Urology, S.P. Medical College, Bikaner, Rajasthan, 334003, India.
| | - V Kumar
- Department of Urology, S.P. Medical College, Bikaner, Rajasthan, 334003, India.
| | - R Upadhyay
- Department of Urology, S.P. Medical College, Bikaner, Rajasthan, 334003, India.
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Prakash G, Umar M, Ajay S, Bali D, Upadhyay R, Gupta KK, Dixit J, Mittal B. COX-2 gene polymorphisms and risk of chronic periodontitis: a case-control study and meta-analysis. Oral Dis 2013; 21:38-45. [PMID: 24267395 DOI: 10.1111/odi.12203] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2013] [Revised: 10/03/2013] [Accepted: 10/21/2013] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Cyclooxygenase-2 (COX-2) enzyme is a major mediator of inflammation in periodontitis, leading to loss of gingival tissues and alveolar bone supporting the teeth. Previous studies have explored the role of COX-2 polymorphisms with the risk of periodontitis in different ethnic groups; however, findings are inconsistent. So, we aimed to investigate the association of COX-2 polymorphisms (rs20417, rs689466, and rs5275) in susceptibility to chronic periodontitis (CP) in northern Indian population. Meta-analysis was also carried out to precisely estimate the effect of COX-2 polymorphisms in CP. MATERIALS AND METHODS Genotyping of COX-2 polymorphisms was carried out through PCR-RFLP in 200 CP cases and 200 controls. For risk estimation, binary logistic regression was applied using SPSS, version 15.0, while meta-analysis was carried using MIX 2.0 software. RESULTS None of the COX-2 polymorphisms independently were associated with the risk of CP. Meta-analysis suggested a significant reduced risk of CP with rs5275+8473 C allele and rs20417 in Chinese population. CONCLUSIONS No association was observed in any of the studied COX-2 polymorphisms with CP in North India. But, the study should be replicated in larger sample size to arrive at a definitive conclusion. Meta-analysis suggested a role of rs5275 COX-2 polymorphisms in susceptibility to overall CP, and on ethnic basis, rs20417 showed reduced risk of CP in Chinese population.
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Affiliation(s)
- G Prakash
- Department of Medical Genetics, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
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Ghoshal UC, Abraham P, Bhatt C, Choudhuri G, Bhatia SJ, Shenoy KT, Banka NH, Bose K, Bohidar NP, Chakravartty K, Shekhar NC, Desai N, Dutta U, Das G, Dutta S, Dixit VK, Goswami BD, Jain RK, Jain S, Jayanthi V, Kochhar R, Kumar A, Makharia G, Mukewar SV, Mohan Prasad VG, Mohanty A, Mohan AT, Sathyaprakash BS, Prabhakar B, Philip M, Veerraju EP, Ray G, Rai RR, Seth AK, Sachdeva A, Singh SP, Sood A, Thomas V, Tiwari S, Tandan M, Upadhyay R, Vij JC. Epidemiological and clinical profile of irritable bowel syndrome in India: report of the Indian Society of Gastroenterology Task Force. Indian J Gastroenterol 2008; 27:22-8. [PMID: 18541934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
AIMS To study the profile of irritable bowel syndrome (IBS), and the frequency of such symptoms among the general population, in India. METHODS In this prospective, multi-center study, data were obtained from 2785 patients with chronic lower gastrointestinal symptoms (complainants) with no alarm feature and negative investigations for organic causes visiting physicians at 30 centers, and from 4500 community subjects (non-complainants), using separate questionnaires. RESULTS Most complainants were middle-aged (mean age 39.4 years) and male (1891; 68%). The common symptoms were: abdominal pain or discomfort (1958; 70%), abdominal fullness (1951; 70%); subjective feeling of constipation (1404 of 2656; 53%), or diarrhea (1252 of 2656, 47%), incomplete evacuation (2134; 77%), mucus with stools (1506; 54%), straining at stools (1271; 46%), epigastric pain (1364; 49%) and milk intolerance (906; 32%). Median stool frequency was similar in patients who felt they had constipation or those who felt they had diarrhea. Information to subtype symptoms using standard criteria was available in 1301 patients; of these, 507 (39%) had constipation-predominant IBS ( 3 <or= stools/week), 50 (4%) had diarrhea-predominant IBS (>3 stools/day) and 744 (57%) had indeterminate symptoms. Among non-complainants, most subjects reported daily defecation frequency of one (2520 [56%]) or two (1535 [34%]). Among non-complainants, 567 (12.6%) reported abdominal pain, 503 (11%) irregular bowel, 1030 (23%) incomplete evacuation, 167 (4%) mucus and 846 (18%) straining at stools; a combination of abdominal pain or discomfort relieved by defecation, and incomplete evacuation was present in 189/4500 (4.2%) community subjects. CONCLUSIONS Most patients with IBS in India are middle-aged men, and have a sense of incomplete evacuation and mucus with stools. Abdominal pain or discomfort is frequent but not universal. Importantly, stool frequency was similar irrespective of whether the patients felt having constipation or diarrhea. Most (90%) non-complainant subjects had 1 or 2 stools per day; symptoms complex suggestive of IBS was present in 4.2% of community subjects.
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Cerny J, Galili N, Liu Q, Devuni D, Hassan K, Upadhyay R, Mumtaz M, Mehdi M, Raza A. Complete blood count may provide risk stratification for survival and AML transformation in CMML. J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.17502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
17502 We performed a retrospective analysis of 120 patients with CMML (98 de novo CMML and 22 evolving from MDS) to examine clinical features that may influence survival and AML transformation. Univariate analysis showed low hemoglobin level; WBC > 13,000, platelet count < 50,000 and abnormal cytogenetics as poor prognostic features. Univariate analysis also determined that BM blasts >5% and Int2/High IPSS were associated with higher rates of AML but IPSS could not be used for survival assessment. Multivariate analysis showed hemoglobin < 12 g/dL, older age, abnormal cytogenetics as risk factors for shorter survival; older age, male sex, low platelet count, BM blasts > 5%, lymphocyte and monocyte counts were independent risk factors for AML transformation. Previous attempts to devise prognostic scoring systems for CMML have incorporated both peripheral blood and bone marrow features. We have used hemoglobin, lymphocyte count and platelet count to generate 3 prognostic scoring systems, which differed by severity of thrombocytopenia. Score 1 (>100, 50–100, <50) identified 3 different risk groups (low, intermediate, and high) with median OS: not reached (n/a), 18, and 9 months for all CMML patients (p<0.0001) as well as for the de novo CMML patients (p<0.0001). Score 2 (>50, <50) divided patients into 3 risk groups (low, intermediate, and high) with median OS: n/a, 19 and 10 months for all CMML (p=0.0002) versus n/a, 28 and 11 months for de novo CMML patients (p=0.0011). Score 3 (<100, >100) separated all CMML (p=0.0073) and de novo CMML patients (p=0.0054) into 2 risk groups (high, low) with median time to AML 53 months and n/a. In conclusion we suggest three new scoring systems for CMML patients that can be easily calculated after an initial CBC. Scores 1 and 2 help to assess survival while score 3 indicates risk for AML transformation. *Acknowledgements: This work has been partially supported by the AMA Foundation Seed Grant Research Program 2006. No significant financial relationships to disclose.
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Affiliation(s)
- J. Cerny
- University of Massachusetts, Worcester, MA
| | - N. Galili
- University of Massachusetts, Worcester, MA
| | - Q. Liu
- University of Massachusetts, Worcester, MA
| | - D. Devuni
- University of Massachusetts, Worcester, MA
| | - K. Hassan
- University of Massachusetts, Worcester, MA
| | | | - M. Mumtaz
- University of Massachusetts, Worcester, MA
| | - M. Mehdi
- University of Massachusetts, Worcester, MA
| | - A. Raza
- University of Massachusetts, Worcester, MA
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Upadhyay R, Shukla A, Gaur K. Assessment of peroxidase isozyme marker-based model for cross identifications in hybrids (F(1)) of urdbean [ Vigna mungo (L.) Hepper]. Theor Appl Genet 2002; 105:1215-1219. [PMID: 12582901 DOI: 10.1007/s00122-002-0978-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/08/2001] [Accepted: 04/08/2002] [Indexed: 05/24/2023]
Abstract
Four hybrids (4 F(1)s) were chosen out of crosses in the urdbean [ Vigna mungo (L.) Hepper, 2n = 22] having contrasting morphological characters. Zymograms for isozyme peroxidase were drawn from the patterns obtained from parents and their respective F(1) hybrids on the basis of relative similarities to parental bands. The selfed or crossed nature of hybrid pods was determined from the zymograms and their analysis. The number of bands and their intensities gave an idea about the extent of crossing in F(1) populations. Genetic identity (I) values were indicative of their selfed nature. Dendrograms were constructed on the basis of genetic identity values to display the relative similarities between the populations. Analysis was based on individual pods to confirm their hybrid or selfed nature. Possible use of this technique for identification of F(1) pods and elimination of selfed pods might be implemented to shorten the breeding operations during crossing.
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Affiliation(s)
- R. Upadhyay
- Department of Genetics and Plant Breeding, G.B. Pant University of Agriculture and Technology, Pantnagar-263145, India,
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28
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Upadhyay R, Gupta S, Kanungo MS. Trans-acting factors that interact with the proximal promoter sequences of ovalbumin gene are tissue-specific and age-related. Mol Cell Biochem 1999; 201:65-72. [PMID: 10630624 DOI: 10.1023/a:1007000215524] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Aging or deterioration of functions of various organs occurs after adulthood due to alterations in the expression of genes that maintain adulthood functions. Molecular changes that occur in regulation of genes in higher organisms after adulthood can be understood by using genes whose timing and rate of expression run parallel with specific functions during the life span. One such function is egg formation in birds which is dependent on the expression of egg protein genes, ovalbumin, lysozyme, vitellogenin, etc. Trans-acting factors are known to play a pivotal role in the regulation of transcription of genes. We show here a decrease in the level/binding of nuclear trans-acting factors with specific cis-acting elements of the promoter of the ovalbumin gene of oviduct of old Japanese quail. This parallels the decrease in the expression of the ovalbumin gene in the oviduct after adulthood. These factors are tissue-specific and bind in a cooperative and sequential manner to the ovalbumin gene promoter.
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Affiliation(s)
- R Upadhyay
- Department of Zoology, Banaras Hindu University, Varanasi, India
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Abstract
Alterations in the basal transcription rates of eukaryotic genes are believed to involve the binding of trans-acting factor(s) with specific DNA sequences in the promoter. We show here two interrelated events for the VTGII gene of the old, non-egg laying Japanese quail: alterations in the structure of the chromatin encompassing the gene, and binding of trans-acting factors to the promoter of the gene. Estradiol/progesterone alone or together cause alterations in the conformation of the chromatin of the promoter region of the gene. This may allow free access of nuclear protein(s) to the cis-acting elements, ERE, PRE and NF1, in the promoter of the gene and cause activation of transcription.
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Affiliation(s)
- S Gupta
- Department of Zoology, Banaras Hindu University, Varanasi, India
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31
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Kanungo MS, Gupta S, Upadhyay R. Molecular biology of ageing. Indian J Med Res 1997; 106:413-22. [PMID: 9361476] [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: 02/05/2023] Open
Abstract
The process of deterioration or ageing of functions that occurs in all organisms after the attainment of reproductive ability is the sum total of the decline in activity of various organs. The functions of different organs begin to deteriorate at different times of the life span and at different rates. It is believed that different genes are involved in the ageing of different organs. Studies on isoenzyme patterns of enzymes show that the genes responsible for coding of different subunits of the enzymes are sequentially expressed during the life span. Also, the decrease in the levels of enzymes seen after adulthood is reversible and can be raised to adult level by inducing their genes by steroid hormones. Another factor that contributes to the decrease in the levels of enzymes is increasing compaction of the chromatin that houses the genes as seen from digestion of chromatin by DNase I and MNase. This decreases the rate of transcription of genes. The expression of many genes declines after adulthood which is due to the decrease in trans-acting nuclear proteins that bind to specific cis-acting sequences in the promoter regions of genes. These proteins are inducible by steroid hormones. Hence the deterioration of functions that occurs after adulthood can be delayed, and the adulthood period can by prolonged by manipulation of the expression of genes.
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Affiliation(s)
- M S Kanungo
- Department of Zoology, Banaras Hindu University, Varanasi
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32
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Abstract
Northern hybridization studies showed that the level of ovalbumin mRNA decreases in the oviduct of the Japanese quail after adulthood. In order to find out if this is due to changes in the conformation of the chromatin containing the promoter region of the gene, nuclei of the oviduct of young, adult and old birds were digested by DNaseI and micrococcal nuclease (MNase). Southern hybridization with the labelled promoter showed that this region is less sensitive to the two enzymes in the old birds. Both the endonucleases recognized the same hypersensitive sites. The results indicate that the chromatin containing the promoter is present in an open conformation in adult birds. Gel mobility shift assay using a 20-mer dsDNA containing the CAAT-box and nuclear extract of oviduct shows the presence of trans-acting factors that bind to this region. The levels of these factors are lower in old birds. This may be the reason for the lower expression of the gene in old birds.
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Affiliation(s)
- R Upadhyay
- Department of Zoology, Banaras Hindu University, Varanasi, India
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33
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Stierle AA, Upadhyay R, Hershenhorn J, Strobel GA, Molina G. The phytotoxins ofMycosphaerella fijiensis, the causative agent of Black Sigatoka disease of bananas and plantains. ACTA ACUST UNITED AC 1991. [DOI: 10.1007/bf01922472] [Citation(s) in RCA: 31] [Impact Index Per Article: 0.9] [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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Rainsford KD, Dieppe PA, Pritchard MH, Rhodes J, Leach H, Russell RI, Walker FS, Upadhyay R, Hort JF. Protection from gastrointestinal side-effects by azapropazone by its incorporation into a glucose-sodium acid citrate formulation. Aliment Pharmacol Ther 1991; 5:419-33. [PMID: 1777551 DOI: 10.1111/j.1365-2036.1991.tb00046.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Addition of glucose and sodium citrate to azapropazone, in proportions of 1:1:1 by weight reduced gastric mucosal damage in rats and there was a trend towards reduction in radiolabelled faecal red cell loss in human volunteers compared with that with azapropazone alone. The glucose and citrate did not affect the pharmacokinetics of azapropazone, or its therapeutic efficacy. While no difference was observed in endoscopic injury and in symptomatic gastrointestinal complaints in a multicentre comparison in rheumatic patients, a striking reduction in symptoms was observed in those patients with a history of severe gastrointestinal intolerance to non-steroidal anti-inflammatory drugs.
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Affiliation(s)
- K D Rainsford
- Department of Biomedical Sciences, McMaster University, Faculty of Health Sciences, Hamilton, Ontario, Canada
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Abstract
We have encountered five cases of chronic iron deficiency anaemia due to bleeding from gastric antral vascular ectasia (watermelon stomach). Two cases were associated with a lymphoma and in three cases there was evidence of portal hypertension. Two patients were treated conservatively by blood transfusions. The other patients required either surgery or tranexamic acid or endoscopic laser therapy to control the chronic haemorrhage.
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Affiliation(s)
- R H Park
- Gastroenterology Unit, Royal Infirmary, Glasgow, UK
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Abstract
In summary, therefore, there are interesting associations between H pylori, duodenal ulcer, and non-ulcer dyspepsia. In type B gastritis there may be enough evidence to suggest a causal role. The relation between gastritis and upper gastrointestinal symptomatology, however, remains contentious. The relation between H pylori and acid secretion may be more intimate than was previously thought. 'Pylorites' must temper their enthusiasm and provide hard data; 'Schwartzians' must broaden their horizons.
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Upadhyay R, Torley HI, McKinlay AW, Sturrock RD, Russell RI. Iron deficiency anaemia in patients with rheumatic disease receiving non-steroidal anti-inflammatory drugs: the role of upper gastrointestinal lesions. Ann Rheum Dis 1990; 49:359-62. [PMID: 2383058 PMCID: PMC1004100 DOI: 10.1136/ard.49.6.359] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Upper gastrointestinal lesions associated with non-steroidal anti-inflammatory drug (NSAID) treatment are commonly implicated as the cause for iron deficiency anaemia in patients with rheumatic diseases. Such patients, however, may also have other causes for iron deficiency, including blood loss from the intestine. One hundred and four patients (mean age 58 years; male 21, female 83; smokers 14) with rheumatic disease (rheumatoid 91, others 13) and absent bone marrow iron stores (mean haemoglobin 83 g/l) were examined. At endoscopy 47 of 104 (45%) had upper gastrointestinal lesions (oesophageal ulcer 4, gastric ulcer 25, gastric erosion 13, duodenal ulcer 4, gastric ulcer and duodenal ulcer 1). Endoscopic healing was assessed in 23 patients with upper gastrointestinal lesions. Eighteen of 23 (78%) lesions healed with treatment. An improvement of anaemia occurred in 10 of 18 (56%) patients with healed lesions. Twenty three of 104 (22%) patients had dyspeptic symptoms. Ten of 23 (43%) patients with dyspepsia had an upper gastrointestinal lesion as compared with 30 of 81 (37%) patients without dyspepsia. A faecal occult blood test result was available in 53 patients. Of these, 13 were positive while 40 were negative. An upper gastrointestinal lesion was present in seven of 13 (54%) patients positive for the faecal occult blood test as compared with 14 of 40 (35%) negative for the test. Thus upper gastrointestinal lesions have previously been overestimated as the cause of iron deficiency anaemia in patients receiving NSAIDs. A positive faecal occult blood test or the presence of dyspepsia is not associated with upper gastrointestinal lesions in such patients.
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Affiliation(s)
- R Upadhyay
- Gastroenterology Unit, Royal Infirmary, Glasgow
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Taha AS, Boothman P, Holland P, McKinlay A, Upadhyay R, Kelly RW, Lee F, Russell RI. Gastric mucosal prostaglandin synthesis in the presence of Campylobacter pylori in patients with gastric ulcers and non-ulcer dyspepsia. Am J Gastroenterol 1990; 85:47-50. [PMID: 2296963] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
It is unclear how Campylobacter pylori (CP) interacts with gastric mucosal prostaglandins (PG). In a double-blind study we measured gastric PG synthesis in 22 patients with benign gastric antral ulcers (GU) and 26 with non-ulcer dyspepsis (NUD). CP status was determined by histology and bacteriology: 26 (16 GU plus 10 NUD) were CP positive, and 22 (6 GU plus 16 NUD) were CP negative. Patients with severe gastritis regardless of CP status) had significantly higher PGE2 and PGI2 values than those with mild gastritis. Severe gastritis was found in 36% of CP-negative subjects and 77% of the CP-positive patients (chi 2 = 8.64, p less than 0.01), but no significant differences in PG values were found between CP-positive or -negative patients.
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Affiliation(s)
- A S Taha
- Department of Gastroenterology, Glasgow Royal Infirmary
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McKinlay AW, Upadhyay R, Russell RI. Campylobacter pylori and gastroduodenal disease. Is there a relationship? Postgrad Med 1989; 86:31-3, 37-8, 41. [PMID: 2813224 DOI: 10.1080/00325481.1989.11700769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Much has been discovered about Campylobacter pylori in the past 6 years. Yet, many questions remain: Is the organism commensal or is it a pathogen? What is its environmental source? How is it transmitted? What is its role in gastroduodenal disease? The authors of this article discuss these and other issues relating to this common organism.
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Affiliation(s)
- A W McKinlay
- Gastroenterology Unit, Glasgow Royal Infirmary, Scotland, United Kingdom
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Upadhyay R, McKinlay AW, Danesh BJ, Russell RI. An unusual case of ileocecal carcinoma presenting with steatorrhea. Am J Gastroenterol 1989; 84:1467-8. [PMID: 2816887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Upadhyay R, McKinlay AW, Russell RI. Use of endoscopy in patients with dyspepsia. BMJ 1989; 299:621-2. [PMID: 2508832 PMCID: PMC1837452 DOI: 10.1136/bmj.299.6699.621-d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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Upadhyay R, Taha AS, Sturrock RD, Russell RI. Misoprostol and ulcer prophylaxis. Lancet 1989; 1:212-3. [PMID: 2563111 DOI: 10.1016/s0140-6736(89)91220-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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Upadhyay R, McKinlay A, Russell RI. Gastrointestinal damage induced by anti-inflammatory drugs. BMJ 1988; 297:1474. [PMID: 3147035 PMCID: PMC1835126 DOI: 10.1136/bmj.297.6661.1474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Upadhyay R, Howatson A, McKinlay A, Danesh BJ, Sturrock RD, Russell RI. Campylobacter pylori associated gastritis in patients with rheumatoid arthritis taking nonsteroidal anti-inflammatory drugs. Br J Rheumatol 1988; 27:113-6. [PMID: 3365529 DOI: 10.1093/rheumatology/27.2.113] [Citation(s) in RCA: 49] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Fifty-two patients with rheumatoid arthritis taking nonsteroidal anti-inflammatory drugs were studied in order to assess the carriage rate of Campylobacter pylori (C. pylori) with reference to dyspeptic symptoms, endoscopic appearance and antral histology. All patients were interviewed using a standard gastrointestinal symptom scoring questionnaire and underwent endoscopy at which two antral biopsies were obtained. Sections were examined for the presence and severity of gastritis and of C. pylori. Forty-four of 52 patients (85%) had histological evidence of gastritis. Twenty-six of 44 (59%) patients with gastritis were positive for C. pylori. Twenty-six of 28 patients with 'active' (polymorph infiltration) chronic gastritis were positive for C. pylori (p less than 0.002). Sixteen of 26 bacteria-positive patients had gastrointestinal symptoms compared with eight of 26 bacteria-negative patients (p less than 0.05) and this may have therapeutic implications. There was no correlation between the presence of organisms and the appearances at endoscopy.
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Affiliation(s)
- R Upadhyay
- Gastroenterology Unit, Royal Infirmary, Glasgow, UK
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46
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Affiliation(s)
- R Upadhyay
- Gastroenterology Unit, Royal Infirmary, Glasgow
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47
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Archer GJ, Hamilton AA, Upadhyay R, Finlay M, Grace PM. Results of simple aspiration of pneumothoraces. Br J Dis Chest 1985; 79:177-82. [PMID: 3986122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The results of simple aspiration in 30 cases of pneumothorax are presented. The procedure was successful in 33% of cases with known pre-existing lung disease, and in 83% of those without. Aspiration was also more successful in those patients under 50 years of age and if the estimated degree of lung collapse was less than 50%.
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49
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Bhandari B, Upadhyay R, Shrimali LN, Agarwal SS. Jonit in the treatment of hymenolepiasis: a new drug by cyclic regimen. Indian Pediatr 1973; 10:675-7. [PMID: 4793393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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50
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Bhandari B, Upadhyay R. Standard and single dosage regimens of "Flagyl" (metronidazole) in giardiasis in children. Indian Pediatr 1972; 9:800-4. [PMID: 4661554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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