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Rajan S, Franz EM, McAloney CA, Vetter TA, Cam M, Gross AC, Taslim C, Wang M, Cannon MV, Oles A, Roberts RD. Osteosarcoma tumors maintain intra-tumoral transcriptional heterogeneity during bone and lung colonization. BMC Biol 2023; 21:98. [PMID: 37106386 PMCID: PMC10142502 DOI: 10.1186/s12915-023-01593-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 04/11/2023] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND Tumors are complex tissues containing collections of phenotypically diverse malignant and nonmalignant cells. We know little of the mechanisms that govern heterogeneity of tumor cells nor of the role heterogeneity plays in overcoming stresses, such as adaptation to different microenvironments. Osteosarcoma is an ideal model for studying these mechanisms-it exhibits widespread inter- and intra-tumoral heterogeneity, predictable patterns of metastasis, and a lack of clear targetable driver mutations. Understanding the processes that facilitate adaptation to primary and metastatic microenvironments could inform the development of therapeutic targeting strategies. RESULTS We investigated single-cell RNA-sequencing profiles of 47,977 cells obtained from cell line and patient-derived xenograft models as cells adapted to growth within primary bone and metastatic lung environments. Tumor cells maintained phenotypic heterogeneity as they responded to the selective pressures imposed during bone and lung colonization. Heterogenous subsets of cells defined by distinct transcriptional profiles were maintained within bone- and lung-colonizing tumors, despite high-level selection. One prominent heterogenous feature involving glucose metabolism was clearly validated using immunofluorescence staining. Finally, using concurrent lineage tracing and single-cell transcriptomics, we found that lung colonization enriches for multiple clones with distinct transcriptional profiles that are preserved across cellular generations. CONCLUSIONS Response to environmental stressors occurs through complex and dynamic phenotypic adaptations. Heterogeneity is maintained, even in conditions that enforce clonal selection. These findings likely reflect the influences of developmental processes promoting diversification of tumor cell subpopulations, which are retained, even in the face of selective pressures.
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Affiliation(s)
- Sanjana Rajan
- Molecular, Cellular, and Developmental Biology Graduate Program, The Ohio State University, Columbus, OH, USA
- Center for Childhood Cancer, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
| | - Emily M Franz
- Molecular, Cellular, and Developmental Biology Graduate Program, The Ohio State University, Columbus, OH, USA
- Center for Childhood Cancer, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
| | - Camille A McAloney
- Center for Childhood Cancer, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
- Department of Veterinary Biosciences, College of Veterinary Medicine, The Ohio State University, Columbus, OH, USA
| | - Tatyana A Vetter
- Center for Gene Therapy, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
| | - Maren Cam
- Center for Childhood Cancer, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
| | - Amy C Gross
- Center for Childhood Cancer, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
| | - Cenny Taslim
- Center for Childhood Cancer, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
| | - Meng Wang
- Center for Childhood Cancer, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
| | - Matthew V Cannon
- Center for Childhood Cancer, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
| | - Alexander Oles
- Department of Biochemistry & Molecular Biology, Medical University of South Carolina, Charleston, SC, USA
| | - Ryan D Roberts
- Center for Childhood Cancer, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA.
- Division of Pediatric Hematology, Oncology, and BMT, Nationwide Children's Hospital, Columbus, OH, USA.
- The Ohio State University James Comprehensive Cancer Center, Columbus, OH, USA.
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Rajan S, Zaccaria S, Cannon M, Cam M, Gross AC, Raphael BJ, Roberts RD. Structurally complex osteosarcoma genomes exhibit limited heterogeneity within individual tumors and across evolutionary time. Cancer Research Communications 2023; 3:564-575. [PMID: 37066022 PMCID: PMC10093779 DOI: 10.1158/2767-9764.crc-22-0348] [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] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 01/18/2023] [Accepted: 03/06/2023] [Indexed: 03/11/2023]
Abstract
Abstract
Osteosarcoma is an aggressive malignancy characterized by high genomic complexity. Identification of few recurrent mutations in protein coding genes suggests that somatic copy-number aberrations (SCNAs) are the genetic drivers of disease. Models around genomic instability conflict - it is unclear if osteosarcomas result from pervasive ongoing clonal evolution with continuous optimization of the fitness landscape or an early catastrophic event followed by stable maintenance of an abnormal genome. We address this question by investigating SCNAs in >12,000 tumor cells obtained from human osteosarcomas using single cell DNA sequencing, with a degree of precision and accuracy not possible when inferring single cell states using bulk sequencing. Using the CHISEL algorithm, we inferred allele- and haplotype-specific SCNAs from this whole-genome single cell DNA sequencing data. Surprisingly, despite extensive structural complexity, these tumors exhibit a high degree of cell-cell homogeneity with little sub-clonal diversification. Longitudinal analysis of patient samples obtained at distant therapeutic time points (diagnosis, relapse) demonstrated remarkable conservation of SCNA profiles over tumor evolution. Phylogenetic analysis suggests that the majority of SCNAs were acquired early in the oncogenic process, with relatively few structure-altering events arising in response to therapy or during adaptation to growth in metastatic tissues. These data further support the emerging hypothesis that early catastrophic events, rather than sustained genomic instability, give rise to structural complexity, which is then preserved over long periods of tumor developmental time.
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Affiliation(s)
- Sanjana Rajan
- Janssen Immunology R&D, South San Francisco, California, United States
| | | | | | - Maren Cam
- Nationwide Children's Hospital, Columbus, OH, United States
| | - Amy C Gross
- Nationwide Children's Hospital, Columbus, Ohio, United States
| | | | - Ryan D. Roberts
- Nationwide Children's Hospital, Columbus, Ohio, United States
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Maldarelli F, Nguyen T, Adams L, Zipparo M, Gorelick R, Hewitt S, Rajan S, Rubinstein P, Kanakry J. PP 3.16 – 00209 Prolonged persistence of HIV-infected cells in tissues after allogeneic hematopoietic transplant. J Virus Erad 2022. [DOI: 10.1016/j.jve.2022.100196] [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: 12/24/2022] Open
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Adamstein N, Cornel J, Davidson M, Libby P, De Remigis A, Jensen C, Rajan S, Ridker P. The effect of ziltivekimab on the neutrophil-lymphocyte ratio: analysis from RESCUE. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
The neutrophil-lymphocyte ratio (NLR), derived from the complete blood count, independently predicts atherosclerotic events and is a potential biomarker for residual inflammatory risk. A previous study showed that interleukin (IL)-1β inhibition reduces the NLR, but whether inhibition with IL-6, a cytokine downstream of IL-1, also lowers the NLR is unknown.
Purpose
To evaluate whether ziltivekimab, a monoclonal antibody targeting the IL-6 ligand, dose-dependently lowers the NLR compared to placebo.
Methods
The phase II RESCUE trial randomized 264 patients with moderate to severe chronic kidney disease (CKD) and high-sensitivity CRP (hsCRP) >2mg/L in a 1:1:1:1 ratio to placebo or ziltivekimab 7.5 mg, 15 mg, and 30 mg subcutaneously once every four weeks. As previously reported, the trial met its primary endpoint as demonstrated by hsCRP reductions of 4% in the placebo group as compared to 77%, 88%, and 92% at 12 weeks in the ziltivekimab 7.5, 15, and 30 mg groups, respectively. Using RESCUE trial data, we further evaluated the percent change from baseline in the NLR at 12 weeks and sought evidence of correlation between any observed changes in the NLR with changes in other measured biomarkers.
Results
Ziltivekimab dose-dependently reduced the NLR starting at week one and sustained through week 12 (Table). The median change in the NLR at 12 weeks, the primary pre-specified endpoint, was −13.5% in the 7.5 mg group, −14.3% in the 15 mg group, and −22.4% in the 30 mg group compared to 1.56% in the placebo group. The estimated treatment difference was −14.6% (p=0.004), −15.3% (p=0.004), and −23.6% (p<0.0001) in the ziltivekimab 7.5, 15, and 30 mg groups respectively. These changes were driven largely by reductions in the absolute neutrophil count with minimal change in lymphocyte count. The change in NLR with ziltivekimab correlated modestly with the changes in hsCRP (R=0.26, p=0.0006), fibrinogen (R=0.18, p=0.02), and haptoglobin (R=0.17, p=0.03), but not serum amyloid A, ApoA1, ApoB, ApoB/ApoA ratio, or traditional risk markers.
Conclusions
IL-6 inhibition with ziltivekimab lowers the NLR. The ongoing ZEUS cardiovascular (CV) outcomes trial will assess whether ziltivekimab can reduce CV event rates among individuals with stage 3 to 4 CKD, known atherosclerotic disease, and elevated hsCRP. If ziltivekimab reduces CV risk, it would provide further evidence for critical inter-relationships between bone marrow function and atherothrombosis.
Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): Novo Nordisk
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Affiliation(s)
- N Adamstein
- Brigham and Women's Hospital, Harvard Medical School, Center for Cardiovascular Disease Prevention , Boston , United States of America
| | - J Cornel
- Radboud University Medical Center, Department of Cardiology , Nijmegen , The Netherlands
| | - M Davidson
- University of Chicago, Pritzker School of Medicine, Section of Cardiology , Chicago , United States of America
| | - P Libby
- Brigham and Women's Hospital, Harvard Medical School, Division of Cardiovascular Medicine , Boston , United States of America
| | | | - C Jensen
- Novo Nordisk A/S , Søborg , Denmark
| | - S Rajan
- Novo Nordisk A/S , Søborg , Denmark
| | - P Ridker
- Brigham and Women's Hospital, Harvard Medical School, Center for Cardiovascular Disease Prevention , Boston , United States of America
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Jain S, Kumar L, Babu S, Sadhoo A, Ravindran G, Rajan S. Correlation of arterial PaCO 2 to end tidal CO 2 in children undergoing laparoscopic abdominal surgery: An observational study. J Anaesthesiol Clin Pharmacol 2022; 38:640-645. [PMID: 36778836 PMCID: PMC9912885 DOI: 10.4103/joacp.joacp_581_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Revised: 03/23/2021] [Accepted: 04/14/2021] [Indexed: 12/31/2022] Open
Abstract
Background and Aims The reliability of end tidal carbon dioxide (ETCO2) as a measure of arterial carbon dioxide (PaCO2) in pediatric laparoscopy is unclear. We evaluated the correlation of arterial to end tidal P(a-ET) CO2 during pediatric laparoscopy at two hours of pneumoperitoneum as the primary objective. We also compared P(a-ET) CO2 and alveolar to arterial oxygen gradient P(A-a) O2 and haemodynamics at fixed time points during surgery. Material and Methods A cross-sectional study was conducted in 25 children undergoing laparoscopic abdominal surgery. Arterial blood gases were drawn at T0, baseline, T10: ten minutes, T1h: 1 hour, T2h: 2 hours of pnuemoperitoneum and T 10d: 10 mins after deflation. The P(a-ET) CO2, P(A-a) O2, were measured from the blood gas and ETCO2 and FiO2 values on the monitor. The Pearson's correlation coefficient, the Wilcoxon rank test and Chi square test were used for statistical analysis. Results At T2h moderate correlation of P(a-ET) CO2 (r = 0.605, P = 0.001) with 40% children documenting accurate P(a-ET) CO2, -1 to +1 mm Hg was seen. Moderate correlation was also seen at T0, T10, T 10d but poor correlation at T 1h. The P(A-a) O2 increased progressively with surgery and did not correlate with P(a-ET) CO2. Heart rate was stable, but systolic blood pressures at T 10 and diastolic at T10, T 1h, T 2h were higher than baseline. Conclusion Moderate correlation was seen between PaCO2 and ETCO2 at 2 h of pnuemoperitoneum and at T0, T 10, and T 10d. P(A-a) O2 increased with surgery but did not correlate with P(a-ET) CO2.
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Affiliation(s)
- S. Jain
- Department of Anaesthesiology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
| | - L. Kumar
- Department of Anaesthesiology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
| | - S.C. Babu
- Department of Anaesthesiology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
| | - A. Sadhoo
- Department of Anaesthesiology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
| | - G.C. Ravindran
- Department of Biostatistics, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
| | - S. Rajan
- Department of Anaesthesiology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
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Van Zwol W, Rimbert A, Wolters J, Bloks V, Kloosterhuis N, Huijkman N, Smit M, Heeren J, Scheja L, Bournez C, Kuipers J, Rajan S, Hussain M, Zimmerman P, Van De Sluis B, Kuivenhoven J. Hepatic SMLR1 ablation fully protects against diet-induced atherosclerosis but causes hepatosteatosis via reduced VLDL secretion. Atherosclerosis 2022. [DOI: 10.1016/j.atherosclerosis.2022.06.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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Reinecke JB, Hinckley JM, Rajan S, Gross AC, Cam M, Roberts RD. Abstract 2511: Metastatic lung colonization by osteosarcoma requires cooperation between tumor subpopulations with distinct phenotypes. Cancer Res 2022. [DOI: 10.1158/1538-7445.am2022-2511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Four decades of intense effort have not improved outcomes for patients with osteosarcoma. Even though 35-40% of young people so treated still die from the disease, usually from complications related to lung metastasis, our standard of care remains unchanged since 1982. While effective metastasis-targeting interventions could transform clinical care, our incomplete understanding of the mechanisms driving tumor spread have hampered efforts to develop rational, targeted therapeutic interventions. Working to address these gaps, our lab previously showed that concurrent inhibition of IL6 and CXCL8 could prevent metastases in up to 85% of osteosarcoma-bearing mice, though the mechanisms remain unclear. Seeking to understand the mechanism, we generated single-cell RNA-seq datasets from the lungs of osteosarcoma bearing mice collected at multiple time points during lung colonization. We employed niche labeling technology to isolate both tumor and tumor-associated cells and generated single cell transcriptomic datasets from the isolated cells. We used this data to perform inter-cellular signaling analyses and to characterize changes occurring in the composition and phenotype of cells occupying the metastatic niche over developmental time. Immunofluorescent staining of both murine and human metastatic lesions confirmed key findings from the scRNA-seq data. We found that a small subpopulation of osteosarcoma cells triggers an IL1-IL6 paracrine loop upon interaction with lung epithelial cells, driving IL6/CXCL8 production within the early metastatic niche. This subset of tumor cells is hypo-proliferative, hyper-secretory, p21+, and survives the stresses of dissemination to the lung. We call these metastasis initiating cells "anchor" cells and their rapidly proliferative counterparts "growth cells." Very early metastases show near-complete enrichment for anchor-phenotype osteosarcoma cells, while growth cells become dominant as lesions expand. Anchor derived signals can recruit circulating growth cells into a developing niche. However, it remains unclear whether this or state changes in anchor cell progeny are the primary mechanism for the appearance of growth cells within a lesion. Intriguingly, anchor cells appear resistant to chemotherapy, providing a potential mechanism for relapse after treatment. Taken together, the data suggest that the establishment of lung metastases arises through cooperation among tumor cells with distinct phenotypes. Anchor cells survive the initial stresses of the pulmonary environment and modify that environment. Proliferating growth cells are subsequently recruited to anchored niches to produce clinically relevant metastatic lesions. Effective treatment of metastases likely requires combinations of agents that target both osteosarcoma subtypes, which exhibit highly divergent sensitivity to conventional therapies.
Citation Format: James B. Reinecke, John M. Hinckley, Sanjana Rajan, Amy C. Gross, Maren Cam, Ryan D. Roberts. Metastatic lung colonization by osteosarcoma requires cooperation between tumor subpopulations with distinct phenotypes [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 2511.
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Affiliation(s)
- James B. Reinecke
- 1Abigail Wexner Research Institute at Nationwide Children's Hopital, Columbus, OH
| | - John M. Hinckley
- 1Abigail Wexner Research Institute at Nationwide Children's Hopital, Columbus, OH
| | - Sanjana Rajan
- 2The Janssen Pharmaceutical Companies of Johnson & Johnson, Cambridge, MA
| | - Amy C. Gross
- 1Abigail Wexner Research Institute at Nationwide Children's Hopital, Columbus, OH
| | - Maren Cam
- 1Abigail Wexner Research Institute at Nationwide Children's Hopital, Columbus, OH
| | - Ryan D. Roberts
- 1Abigail Wexner Research Institute at Nationwide Children's Hopital, Columbus, OH
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Rajan S, Zaccaria S, Cannon M, Cam M, Gross A, Raphael B, Roberts RD. Abstract 801: Surprisingly conserved copy numbers from cell to cell within structurally complex tumors challenge the unstable genome hypothesis. Cancer Res 2022. [DOI: 10.1158/1538-7445.am2022-801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Osteosarcoma is an aggressive disease that exhibits almost universal p53 inactivation and a high level of genomic complexity. The chaotic genome of most osteosarcomas has led many to assume that this complexity must accumulate under conditions of significant genomic/chromosomal instability. However, such conclusions have been drawn primarily from single-timepoint bulk-tumor analyses. More recent studies have questioned this assumption of chromosomal instability, hypothesizing that genomic complexity could arise from an early catastrophic event followed by faithful propagation of a highly complex, malignancy-promoting genome.
To determine whether osteosarcoma tumors show evidence of instability, we performed single-cell whole-genome sequencing of >14,000 osteosarcoma cells obtained from 15 distinct lesions resected from 8 individual patients. Using the CHISEL algorithm, we inferred allele- and haplotype-specific copy numbers from this sequencing data. To evaluate how the SCNA profiles changed during the evolutionary pressures associated with metastatic dissemination and therapy, we compared the single-cell SCNA profiles of paired samples collected from both primary sites and metastases and from pre-treatment and relapsed specimens. We likewise compared profiles of patient tumors propagated orthotopically in mouse tibias to those grown within the lung to evaluate for tissue-dependent emergence of rare subclones.
Despite extensive structural variations that give rise to highly complex patterns of SCNA, the cells within each tumor showed remarkably little heterogeneity. We found similar evidence of chromosomal stability when we reconstructed phylogenetic trees to identify the evolutionary relationships of cells collected from metastatic lesions or at relapse. Despite being evolutionarily distant, nearly all variants could be assigned to the trunk of the phylogenetic tree, with only modest changes occurring in the branches. This result suggests that nearly all SCNAs were acquired in an early event, followed by selection of advantageous patterns with subsequent preservation of that particular SCNA pattern. Analysis of bulk whole-genome sequencing from serially collected patient samples supports the preservation of SCNA profiles over time.
This work demonstrates the power of combining single-cell DNA sequencing with an allele- and haplotype-specific CNV inference algorithm. Our approach clarifies longstanding questions about the genetics of osteosarcoma initiation and progression, calling into question previous assumptions of genomic instability inferred from single-timepoint bulk sequencing data. These results suggest that an isolated, early catastrophic event, rather than sustained genomic instability, gives rise to the complex genome that characterizes osteosarcoma tumors.
Citation Format: Sanjana Rajan, Simone Zaccaria, Matthew Cannon, Maren Cam, Amy Gross, Benjamin Raphael, Ryan D. Roberts. Surprisingly conserved copy numbers from cell to cell within structurally complex tumors challenge the unstable genome hypothesis [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 801.
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Affiliation(s)
| | | | | | - Maren Cam
- 3Nationwide Children's Hospital, Columbus, OH
| | - Amy Gross
- 3Nationwide Children's Hospital, Columbus, OH
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Verma S, Husain M, Madsen C, Leiter LA, Rajan S, Vilsboll T, Rasmussen S, Libby P. Neutrophil-to-lymphocyte ratio predicts cardiovascular events in patients with type 2 diabetes: post hoc analysis of SUSTAIN 6 and PIONEER 6. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Background
Inflammation plays an important role in atherosclerosis. The neutrophil-to-lymphocyte ratio (NLR) may serve as a clinically useful biomarker of inflammation and cardiovascular (CV) disease, although this relationship has not been studied in people with type 2 diabetes (T2D).
Purpose
This post hoc analysis investigated the relationship between NLRs and CV outcomes in T2D CV outcomes trials for two formulations of semaglutide, a glucagon-like peptide-1 receptor agonist.
Methods
In pooled analyses of the SUSTAIN 6 and PIONEER 6 trials, 6,480 patients with T2D at high CV risk received placebo or semaglutide (once-weekly subcutaneously up to 1.0 mg, or once-daily orally up to 14 mg). NLRs were calculated from complete blood counts at randomisation. Adjudicated outcomes included 3-point major adverse CV events (MACE: composite of CV death, non-fatal myocardial infarction [MI] or non-fatal stroke; primary outcome), expanded MACE, CV death and all-cause death (secondary outcomes). Patient characteristics and CV outcomes were analysed according to baseline NLR tertiles using pooled trial data. Estimation of hazard ratios (HRs) for all outcomes across NLR tertiles used a Cox proportional hazards model. A Cox spline regression with continuous NLR as covariate adjusted for treatment was used to predict the event rate of first MACE at 2 years.
Results
Overall, baseline NLR was recorded in 6,364 patients. Mean baseline NLRs were 1.5, 2.2 and 3.6 in the low, middle and high tertiles, respectively. Patients in the high NLR tertile were older (66.6 years), more likely to be male (70.0%), had longer duration of diabetes (15.3 years), higher body weight (93.3 kg), lower diastolic blood pressure (75.5 mmHg) and estimated glomerular filtration rate (70.4 mL/min/1.73m2) vs those in the lower NLR tertiles (all p<0.0001). Higher NLR was associated with an increased risk of MACE (HR [95% confidence interval (CI)]: 1.37 [1.05; 1.80; p=0.02] and 1.86 [1.45; 2.41; p<0.0001] for the middle and high tertiles, respectively, vs the low tertile). The high NLR tertile was also associated with a 74% increased risk of expanded MACE and twofold risk for CV death and all-cause death vs the low NLR tertile (Figure 1). Spline regression indicated that NLR values >5 increased the risk of first MACE substantially (Figure 2). Further analysis of NLR and MACE by tertiles showed a more pronounced association in patients without prior MI and/or stroke (HR [95% CI]: 1.64 [1.07; 2.56]; p=0.03 and 2.09 [1.38; 3.21]; p=0.0006 in the middle and high tertiles, respectively, vs the low tertile).
Conclusion
Baseline NLR predicts MACE, CV death and all-cause death in patients with T2D and high CV risk. NLR is readily accessible from routinely obtained and inexpensive blood counts; it could offer a convenient, clinically useful inflammatory biomarker for CV risk prediction in this population.
Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): Novo Nordisk A/S Figure 1Figure 2
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Affiliation(s)
- S Verma
- St. Michael's Hospital, Cardiac Surgery, Toronto, Canada
| | - M Husain
- Ted Rogers Centre for Heart Research, University of Toronto, Toronto, Canada
| | - C Madsen
- Novo Nordisk A/S, Søborg, Denmark
| | - L A Leiter
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, Toronto, Canada
| | - S Rajan
- Novo Nordisk A/S, Søborg, Denmark
| | - T Vilsboll
- Steno Diabetes Center Copenhagen, Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
| | | | - P Libby
- Brigham and Women's Hospital, Boston, United States of America
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Chakrabarti D, Qayoom S, Akhtar N, Rajan S, Kumar V, Parveeng S. Snapshot quiz. Br J Surg 2021; 108:339. [PMID: 33793709 DOI: 10.1093/bjs/znaa088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- D Chakrabarti
- Department of Radiation Oncology, King George's Medical University, Lucknow, India
| | - S Qayoom
- Department of Pathology, King George's Medical University, Lucknow, India
| | - N Akhtar
- Department of Surgical Oncology, King George's Medical University, Lucknow, India
| | - S Rajan
- Department of Surgical Oncology, King George's Medical University, Lucknow, India
| | - V Kumar
- Department of Surgical Oncology, King George's Medical University, Lucknow, India
| | - S Parveeng
- Department of Anaesthesiology, Era's Lucknow Medical College & Hospital, Lucknow, India
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Ravindhran B, Rajan S, Mohan LN. P33: PROPOSAL OF A NEW SCORING TOOL FOR PREDICTION OF HYPOCALCEMIA IN PATIENTS UNDERGOING SURGERY FOR PAPILLARY THYROID CANCER. Br J Surg 2021. [DOI: 10.1093/bjs/znab117.118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Introduction
Post-operative hypocalcemia occurs more frequently in certain high-risk patients. The aim of our study is to propose a preliminary scoring system to identify patients who are more likely to develop hypocalcemia following surgery for papillary thyroid cancer.
Method
The study was performed with a retrospective developmental cohort(n=131) and a prospective validation cohort(n=71). Patients underwent either Total Thyroidectomy(TT), TT+Central Neck Dissection(CND) or TT+CND+Modified Radical Neck Dissection(MRND). Significant pre-operative variables and operative findings were converted into categorical variables for analysis. Univariate, multivariate analysis and a logistic regression were used to select significant predictors. The score was constructed by converting into integer, the regression coefficients of independently predictive factors in the logistic regression model. This score was validated prospectively in the validation cohort.
Result
24(18%) out of 131 patients in the developmental cohort and 16(22.5%) out of 71 patients in the validation cohort had symptomatic hypocalcemia. Thyroiditis, positive lymph node metastasis, central and lateral compartment dissection, Neutrophil-to-lymphocyte ratio(NLR)>3.35 and platelet-to-lymphocyte ratio(PLR)>135 were selected as significant predictors. A score with a range of 0-11 was created. The cut-off value for the score was 6 points(sensitivity of 92.0% and specificity of 89.0%). Areas under the ROC curve for the scores were 0.926 and 0.901 in the developmental and validation cohorts, respectively.
Conclusion
This score could be a tool in the prediction of hypocalcemia and could help in identifying patients at a higher risk of post-operative hypocalcemia and guide calcium/Vitamin D treatment, as well as facilitate a safe earlier hospital discharge for low risk patients.
Take-home message
The proposed scoring system could help in identification of patients at a higher risk of post-operative hypocalcemia.
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Affiliation(s)
| | - S Rajan
- St John's Medical College Hospital
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Ravindhran B, Rajan S, Mohan LN. P32: POST-OPERATIVE RELATIVE PARATHORMONE DECLINE (ΔPTH%) AND ABSOLUTE PARATHORMONE DECLINE (ΔPTH) LEVELS ARE BETTER MARKERS OF SYMPTOMATIC HYPOCALCEMIA FOLLOWING TOTAL THYROIDECTOMY THAN POST-OPERATIVE PTH ALONE. Br J Surg 2021. [DOI: 10.1093/bjs/znab117.117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Introduction
Hypocalcemia is a frequent complication following thyroidectomy which can delay discharge and increase overall treatment expenditure. We aimed to assess the predictive value of absolute and relative intact Parathormone(iPTH) decline levels as reliable markers of post-operative hypocalcemia.
Method
This prospective study included 95 consecutive patients at our tertiary care centre. Patients underwent either Total Thyroidectomy(TT), TT+Central Neck Dissection(CND) or TT+CND+Modified Radical Neck Dissection(MRND). iPTH levels were measured four hours after surgery and the following morning after surgery(POD 1). iPTH, absolute iPTH decline(ΔPTH) and relative iPTH decline(ΔPTH%) were calculated and correlated with hypocalcemia. Comparisons between groups were measured by chi-square test, Fischer's exact test and Mann-Whitney U test.
Result
Of the 95 patients, 59 had malignant disease, while 36 patients had benign histopathology. TT was performed in 69 patients, TT+CCLND in 7, and TT+CCLND+MRND in 19. 32.6% of patients(n=31) had biochemical hypocalcemia and 20%(n=19) had symptomatic hypocalcemia. The mean calcium of the cohort on Post-operative day(POD)-1 was 8.3±0.66(range=6.5-9.9) and POD-3 was 8.4±0.69(range=6.3–10.7). Median PTH, measured 4 hours after surgery was 24pg/ml(IQR–23.4;range 2.5–85.5), and measured on POD-1 was 28pg/ml(IQR–27.6;range=2-79). The ΔPTH(U=206;p<0.001) & ΔPTH% (U=127;p<0.001) were significantly higher in patients with symptomatic hypocalcemia. A ΔPTH% of 20%(sensitivity=84%;specificity=91%) and ΔPTH of 3.75 pg/ml(sensitivity = 74%; specificity=87%) were good predictors of symptomatic hypocalcemia.
Conclusion
Post-operative ΔPTH and ΔPTH% are reliable predictors of hypocalcemia following thyroid surgery and have the potential to facilitate a safe early discharge for patients undergoing TT. 20% fall in the PTH level(ΔPTH%) can be useful as a marker of hypocalcemia.
Take-home message
Post-operative ΔPTH and ΔPTH% are better predictors of hypocalcemia following thyroid surgery than a single value of post-operative PTH alone.
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Affiliation(s)
- B Ravindhran
- St John's Medical College Hospital, Bangalore, India
| | - S Rajan
- St John's Medical College Hospital, Bangalore, India
| | - L N Mohan
- St John's Medical College Hospital, Bangalore, India
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Chakrabarti D, Rajan S, Akhtar N, Qayoom S, Gupta S, Verma M, Srivastava K, Kumar V, Bhatt MLB, Gupta R. Short-course radiotherapy with consolidation chemotherapy versus conventionally fractionated long-course chemoradiotherapy for locally advanced rectal cancer: randomized clinical trial. Br J Surg 2021; 108:511-520. [PMID: 33724296 DOI: 10.1093/bjs/znab020] [Citation(s) in RCA: 9] [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: 08/25/2020] [Revised: 10/14/2020] [Accepted: 12/20/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND The trial hypothesis was that, in a resource-constrained situation, short-course radiotherapy would improve treatment compliance compared with conventional chemoradiotherapy for locally advanced rectal cancer, without compromising oncological outcomes. METHODS In this open-label RCT, patients with cT3, cT4 or node-positive non-metastatic rectal cancer were allocated randomly to 5 × 5 Gy radiotherapy and two cycles of XELOX (arm A) or chemoradiotherapy with concurrent capecitabine (arm B), followed by total mesorectal excision in both arms. All patients received a further six cycles of adjuvant chemotherapy with the XELOX regimen. The primary endpoint was treatment compliance, defined as the ability to complete planned treatment, including neoadjuvant radiochemotherapy, surgery, and adjuvant chemotherapy to a dose of six cycles. RESULTS Of 162 allocated patients, 140 were eligible for analysis: 69 in arm A and 71 in arm B. Compliance with planned treatment (primary endpoint) was greater in arm A (63 versus 41 per cent; P = 0.005). The incidence of acute toxicities of neoadjuvant therapy was similar (haematological: 28 versus 32 per cent, P = 0.533; gastrointestinal: 14 versus 21 per cent, P = 0.305; grade III-IV: 2 versus 4 per cent, P = 1.000). Delays in radiotherapy were less common in arm A (9 versus 45 per cent; P < 0.001), and overall times for completion of neoadjuvant treatment were shorter (P < 0.001). The rates of R0 resection (87 versus 90 per cent; P = 0.554), sphincter preservation (32 versus 35 per cent; P = 0.708), pathological complete response (12 versus 10 per cent; P = 0.740), and overall tumour downstaging (75 versus 75 per cent; P = 0.920) were similar. Downstaging of the primary tumour (ypT) was more common in arm A (P = 0.044). There was no difference in postoperative complications between trial arms (P = 0.838). CONCLUSION Reduced treatment delays and a higher rate of compliance were observed with treatment for short-course radiotherapy with consolidation chemotherapy, with no difference in early oncological surgical outcomes. In time- and resource-constrained rectal cancer units in developing countries, short-course radiotherapy should be the standard of care.
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Affiliation(s)
- D Chakrabarti
- Department of Radiation Oncology, King George's Medical University, Lucknow, India
| | - S Rajan
- Department of Surgical Oncology, King George's Medical University, Lucknow, India
| | - N Akhtar
- Department of Surgical Oncology, King George's Medical University, Lucknow, India
| | - S Qayoom
- Department of Pathology, King George's Medical University, Lucknow, India
| | - S Gupta
- Department of Surgical Oncology, King George's Medical University, Lucknow, India
| | - M Verma
- Department of Radiation Oncology, King George's Medical University, Lucknow, India
| | - K Srivastava
- Department of Radiation Oncology, King George's Medical University, Lucknow, India
| | - V Kumar
- Department of Surgical Oncology, King George's Medical University, Lucknow, India
| | - M L B Bhatt
- Department of Radiation Oncology, King George's Medical University, Lucknow, India
| | - R Gupta
- Department of Radiation Oncology, King George's Medical University, Lucknow, India
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Swain P, Rawat R, Mukherjee K, Kumar S, Rai P, Tiwari V, Rajan S, Malhotra S, Ghorui S. MHD effects of partition plates on thermofluid performance of Indian variant LLCB TBM for ITER. Fusion Engineering and Design 2021. [DOI: 10.1016/j.fusengdes.2020.112193] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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15
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Reinecke JB, Hinckley JM, Gross AC, Cam M, Rajan S, Roberts RD. Abstract PO-123: Distinct subpopulations of osteosarcoma cells cooperate to establish lung metastases. Cancer Res 2020. [DOI: 10.1158/1538-7445.tumhet2020-po-123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Four decades of intense multinational efforts to improve outcomes for children and teenagers with osteosarcoma have failed. Today, we still treat patients with a regimen first developed in 1982. The same 35-40% of young people diagnosed with osteosarcoma die from their disease, almost always from complications related to lung metastasis. Believing that therapies targeting lung metastasis could dramatically improve outcomes, we have sought to understand the mechanisms that drive lung colonization in this disease. We previously found that interactions with lung epithelium cause osteosarcoma cells to produce IL6 and CXCL8 and that this activity is necessary for metastasis. Inhibiting IL6 and CXCL8 signaling prevents metastasis entirely in 85% of mice with osteosarcoma. While conducting these studies, we learned that individual tumor cells react differently to signals from lung epithelium. Nearly all the IL6 and CXCL8 produced by osteosarcoma cells come from a small subset of cells. Interactions with pulmonary epithelium cause this discrete subset of tumor cells to produce large quantities of inflammatory cytokines, become strongly p21+, and stop proliferating. Early metastatic lesions consist almost entirely of cells with this phenotype, positioning them to orchestrate the development of the metastatic niche. Thus, we call these hypo-proliferative, cytokine-producing cells that survive early attrition "anchor cells." In the initial stages of metastasis, anchor cells alter the surrounding lung tissue in ways that facilitate subsequent colonization by tumor cells with proliferating phenotypes ("growth cells"). Growth cells then divide to create expanding, clinically-relevant metastasis. Importantly, one can leverage the biology of these anchor cells to develop rational targeting strategies. Anchor cells exhibit profound sensitivity to known senolytic agents. Combining these with conventional therapies (which effectively target growth cells) can eradicate established metastatic lesions and prevent new metastases from forming. These novel findings fundamentally alter our understanding of osteosarcoma and metastasis biology and have direct implications for approaches to treatment.
Citation Format: James B. Reinecke, John M. Hinckley, Amy C. Gross, Maren Cam, Sanjana Rajan, Ryan D. Roberts. Distinct subpopulations of osteosarcoma cells cooperate to establish lung metastases [abstract]. In: Proceedings of the AACR Virtual Special Conference on Tumor Heterogeneity: From Single Cells to Clinical Impact; 2020 Sep 17-18. Philadelphia (PA): AACR; Cancer Res 2020;80(21 Suppl):Abstract nr PO-123.
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Affiliation(s)
| | | | | | - Maren Cam
- Nationwide Children's Hospital, Columbus, OH
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Rajan S, Cam M, Gross A, Reinecke J, Taslim C, Roberts R. Abstract PO-012: Metastatic bottleneck in osteosarcoma selects for certain clonal populations, while metastatic lesions exhibit diverse phenotypes. Cancer Res 2020. [DOI: 10.1158/1538-7445.tumhet2020-po-012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
This study focuses on identifying if the metastatic niche in osteosarcoma (OS) enriches for cells that have a survival advantage either from pre-defined genetic programs or adaptive responses to environmental cues. OS patients who develop metastases experience a dismal survival rate that is lower than twenty percent, a statistic that remains unchanged despite four decades of efforts to improve these outcomes. While therapies that treat metastasis could dramatically improve outcomes, we understand too little about the mechanisms of lung colonization to propose any rational intervention. To simultaneously evaluate changes in clonal diversity and phenotype during the metastatic bottleneck, cell by cell, we combined prospective lineage tracing with single cell transcriptomics in several murine models of metastatic OS. Single cell suspensions of metastatic tumor tissues were processed for single-cell RNA sequencing (scRNA-Seq). For lineage tracing studies, OS cells were virally-transduced to contain a high diversity, heritable and scRNA-Seq compatible lineage tag before inoculating mice. Single-cell libraries were processed bioinformatically to overlay phenotype and lineage information for each cell. Our findings support the following conclusions: First, that the metastatic bottleneck selects for certain clones with increased colonizing capacity, but this selection does not narrow the overall phenotypic diversity of those cells–clones of many different phenotypes can be found within the metastases. Second, the metastatic lung enriches for certain features that are conserved across different cell line and PDX models of metastatic OS. Gene set enrichment analysis of genes enriched within the surviving clones identified novel activated signaling pathways and upstream regulators that appear critical for metastatic progression. This signature includes activated IL6, TGF-β, PDGF signaling, response to a previously unidentified upstream regulator, IL-1β, and the acquisition of enhanced glycolytic activity. Whether each lesion becomes colonized by a phenotypically-distinct clone giving rise to phenotypically-diverse lesions or whether cooperation between phenotypically-distinct clones is required to effect colonization remains a point of active study. In summary, metastatic colonization of the lung by OS involves the selection of phenotypically-diverse tumor cell clones that share characteristics that engender fitness within the lung microenvironment.
Citation Format: Sanjana Rajan, Maren Cam, Amy Gross, James Reinecke, Cenny Taslim, Ryan Roberts. Metastatic bottleneck in osteosarcoma selects for certain clonal populations, while metastatic lesions exhibit diverse phenotypes [abstract]. In: Proceedings of the AACR Virtual Special Conference on Tumor Heterogeneity: From Single Cells to Clinical Impact; 2020 Sep 17-18. Philadelphia (PA): AACR; Cancer Res 2020;80(21 Suppl):Abstract nr PO-012.
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Affiliation(s)
| | - Maren Cam
- 2Center for Childhood Cancers and Blood Diseases, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH,
| | - Amy Gross
- 2Center for Childhood Cancers and Blood Diseases, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH,
| | - James Reinecke
- 2Center for Childhood Cancers and Blood Diseases, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH,
| | - Cenny Taslim
- 2Center for Childhood Cancers and Blood Diseases, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH,
| | - Ryan Roberts
- 3Division of Pediatric Hematology, Oncology, and BMT, Nationwide Children’s Hospital, Columbus, OH
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Karanikolos M, Rajan S, Murphy A, McKee M. No change in life expectancy: the devil is in the detail. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa165.926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
The rate of improvement in life expectancy in high income countries has slowed down over the past few years, and instances where life expectancy is lower than a year before are increasingly common. This paper aims to analyse changes in life expectancy over the last decade to better understand what causes and age groups contribute to the slowdown.
Methods
We use WHO mortality data by age and cause to construct life tables, and we use Arriaga decomposition method to analyse the contribution of specific causes and age groups to changes in life expectancy in Australia, Canada, France, Germany, Netherlands, United Kingdom and the United States of America. We look at the change between 2007-2012 and 2012-2017 (or latest available).
Results
All countries experienced a slowdown in life expectancy in the past 5 years (2012-2017), in comparison to the preceding period. Slowdown in under 65s was particularly pronounced, with younger age groups only contributing minimally (between 0.4 years for males in Germany and -0.4 years for males in the United States) to changes in life expectancy. Among people aged 65 and over, gains ranged between 0.05 years for females in France and 0.6 years for males in the Netherlands. Certain causes of death contributed negatively to change in life expectancy between 2012 and 2017, with notable increases in deaths from accidental poisonings in males (up to -0.09 year in the UK and Canada, and -0.34 in the US) and suicides (up to -0.08 year in Australia and -0.07 in the US).
Conclusions
While recent slowdown in life expectancy gains in high income countries is often attributed to lack of improvement in people of older ages, we show that, beyond this, there are increases in mortality in younger age groups from external causes, that contribute negatively to change in life expectancy in some countries. This pattern is of a particular concern, as deterioration in preventable mortality points to broader worsening of socio-economic climate.
Key messages
Improvements in life expectancy in high income countries slowed down markedly over the past few years, but contributing mortality patterns differ for age groups and causes of death across countries. Persistent increases in preventable mortality from certain external causes in younger age groups in Australia, Canada, US and UK point to broader deterioration of socio-economic climate.
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Affiliation(s)
- M Karanikolos
- European Observatory on Health Systems and Policies, London, UK
- LSHTM, London, UK
| | | | | | - M McKee
- European Observatory on Health Systems and Policies, London, UK
- LSHTM, London, UK
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18
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Chakrabarti D, Rajan S, Akhtar N, Qayoom S, Verma M, Gupta R. P-14 Dose escalated short-course radiotherapy in rectal cancers: Is this the way forward? Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.04.096] [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: 11/30/2022] Open
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Abstract
PURPOSE OF REVIEW Myocardial fibrosis (MF) arises due to myocardial infarction and numerous cardiac diseases. MF may lead to several heart disorders, such as heart failure, arrhythmias, and ischemia. Cardiac magnetic resonance (CMR) imaging techniques, such as late gadolinium enhancement (LGE) CMR, enable non-invasive assessment of MF in the left ventricle (LV). Manual assessment of MF on CMR is a tedious and time-consuming task that is subject to high observer variability. Automated segmentation and quantification of MF is important for risk stratification and treatment planning in patients with heart disorders. This article aims to review the machine learning (ML)-based methodologies developed for MF quantification in the LV using CMR images. RECENT FINDINGS With the availability of relatively large labeled datasets supervised learning methods based on both conventional ML and state-of-the-art deep learning (DL) methods have been successfully applied for automated segmentation of MF. The incorporation of ML algorithms into imaging techniques such as 3D LGE CMR permits fast characterization of MF on CMR imaging and may enhance the diagnosis and prognosis of patients with heart disorders. Concurrently, the studies using cine CMR images have revealed that accurate segmentation of MF on non-contrast CMR imaging might be possible. The application of ML/DL tools in CMR image interpretation is likely to result in accurate and efficient quantification of MF.
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Affiliation(s)
- Fatemeh Zabihollahy
- Department of Systems and Computer Engineering, Carleton University, Ottawa, ON, Canada.
| | - S Rajan
- Department of Systems and Computer Engineering, Carleton University, Ottawa, ON, Canada
| | - E Ukwatta
- School of Engineering, University of Guelph, Guelph, ON, Canada
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20
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Girish P, Jayanthi M, Gitanjali B, Manikandan S, Rajan S. Screening of Weight-Loss Herbal Products for Synthetic Anti-Obesity Adulterants: A Target-Oriented Analysis by Liquid Chromatography-Tandem Mass Spectrometry. J Diet Suppl 2020; 18:92-104. [PMID: 32081055 DOI: 10.1080/19390211.2020.1723774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND The medical and social impact of being overweight, as well as the difficulty in making long-term changes in diet, physical activity, and pitfalls associated with allopathic management, lure obese individuals to over-the-counter weight-loss herbal products (WHPs). However, the safety of herbals is questionable, as reports from all over the world suggest adulteration with synthetic weight loss agents. Objective: The present study was carried out to develop a rapid and sensitive method to screen potential weight loss adulterants in WHPs. Methodology: We procured 33 licensed brands of WHPs that are available in Puducherry (India) and through web stores. Drug-free spiked herbal matrices were used for internal proficiency testing. Spiked herbal matrices and samples were extracted and centrifuged. The supernatant was collected and subjected to liquid chromatography-tandem mass spectrometry analyses. Isocratic elution was carried out by the mobile phase of methanol: 0.1% v/v formic acid (70%:30% v/v) through a C18 column. Analytes were monitored in electrospray ionization positive and negative modes, and an multiple reaction monitoring (MRM) scan was used. Results: Run time was 12 min. Intra- and inter-day precision was < 15% and recoveries were in the range of 99% to 115%. Limit of quantification (LOQ) of the analytes were in the range of 0.1 to 0.3 ng/ml. Conclusion: We developed a sensitive and rapid validated method for the detection of potential adulterants in WHPs. None of the WHPs analyzed were found to contain adulterants. The proposed method will be useful for routine monitoring. WHPs analyzed in this study were not adulterated indicating that WHPs from licensed sources are reliable.
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Affiliation(s)
- P Girish
- Department of Pharmacology, Jawaharlal Institute of Postgraduate Medical Education & Research, Puducherry, India
| | - M Jayanthi
- Department of Pharmacology, Jawaharlal Institute of Postgraduate Medical Education & Research, Puducherry, India
| | - B Gitanjali
- Department of Pharmacology, Jawaharlal Institute of Postgraduate Medical Education & Research, Puducherry, India.,All India Institute of Medical Sciences, Bhubaneswar, India
| | - S Manikandan
- Department of Pharmacology, Jawaharlal Institute of Postgraduate Medical Education & Research, Puducherry, India
| | - S Rajan
- Department of Pharmacology, Jawaharlal Institute of Postgraduate Medical Education & Research, Puducherry, India
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21
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Aronson ID, Cleland CM, Rajan S, Marsch LA, Bania TC. Computer-Based Substance Use Reporting and Acceptance of HIV Testing Among Emergency Department Patients. AIDS Behav 2020; 24:475-483. [PMID: 31049808 DOI: 10.1007/s10461-019-02517-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
More than 10 years after the Centers for Disease Control and Prevention recommended routine HIV testing for patients in emergency departments (ED) and other clinical settings, as many as three out of four patients may not be offered testing, and those who are offered testing frequently decline. The current study examines how participant characteristics, including demographics and reported substance use, influence the efficacy of a video-based intervention designed to increase HIV testing among ED patients who initially declined tests offered by hospital staff. Data from three separate trials in a high volume New York City ED were merged to determine whether patients (N = 560) were more likely to test post-intervention if: (1) they resembled people who appeared onscreen in terms of gender or race; or (2) they reported problem substance use. Chi Square and logistic regression analyses indicated demographic concordance did not significantly increase likelihood of accepting an HIV test. However, participants who reported problem substance use (n = 231) were significantly more likely to test for HIV in comparison to participants who reported either no problem substance use (n = 190) or no substance use at all (n = 125) (x2 = 6.830, p < 0.05). Specifically, 36.4% of patients who reported problem substance use tested for HIV post-intervention compared to 30.5% of patients who did not report problem substance use and 28.8% of participants who did not report substance use at all. This may be an important finding because substance use, including heavy alcohol or cannabis use, can lead to behaviors that increase HIV risk, such as sex with multiple partners or decreased condom use.
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22
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Miglis M, Zitser J, Rajan S, During E, Freeman R, Gibbons C. Cutaneous alpha-synuclein deposition in idiopathic rem sleep behavioral disorder. Sleep Med 2019. [DOI: 10.1016/j.sleep.2019.11.712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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23
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Rajan S, Ljunggren A, Manton DJ, Björkner AE, McCullough M. Post-mitotic odontoblasts in health, disease, and regeneration. Arch Oral Biol 2019; 109:104591. [PMID: 31710968 DOI: 10.1016/j.archoralbio.2019.104591] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 10/09/2019] [Accepted: 10/20/2019] [Indexed: 12/25/2022]
Abstract
OBJECTIVE Description of the odontoblast lifecycle, an overview of the known complex molecular interactions that occur when the health of the dental pulp is challenged and the current and future management strategies on vital and non-vital teeth. METHODS A literature search of the electronic databases included MEDLINE (1966-April 2019), CINAHL (1982-April 2019), EMBASE and EMBASE Classic (1947-April 2019), and hand searches of references retrieved were undertaken using the following MESH terms 'odontoblast*', 'inflammation', 'dental pulp*', 'wound healing' and 'regenerative medicine'. RESULTS Odontoblasts have a sensory and mechano-transduction role so as to detect external stimuli that challenge the dental pulp. On detection, odontoblasts stimulate the innate immunity by activating defence mechanisms key in the healing and repair mechanisms of the tooth. A better understanding of the role of odontoblasts within the dental pulp complex will allow an opportunity for biological management to remove the cause of the insult to the dental pulp, modulate the inflammatory process, and promote the healing and repair capabilities of the tooth. Current strategies include use of conventional dental pulp medicaments while newer methods include bioactive molecules, epigenetic modifications and tissue engineering. CONCLUSION Regenerative medicine methods are in their infancy and experimental stages at best. This review highlights the future direction of dental caries management and consequently research.
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Affiliation(s)
- S Rajan
- The University of Melbourne, Australia.
| | | | - D J Manton
- The University of Melbourne, Australia; Centrum voor Tandheelkunde en Mondzorgkunde, UMCG, University of Groningen, the Netherlands
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24
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Mohr GH, Barcella CA, Kragholm K, Rajan S, Sondergaard KB, Pallisgaard JL, Wissenberg M, Lindhardsen J, Ahlehoff O, Skov L, Lippert FK, Torp-Pedersen C, Gislason G. P4439Increased risk of out-of-hospital cardiac arrest in patients with psoriasis - a nationwide case-control study. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Chronic inflammatory disorders such as psoriasis have been associated with cardiovascular diseases and linked to proarrhythmogenic electrocardiographic changes, including QT-prolongation. However, evidence regarding the risk of out-of-hospital cardiac arrest with a history of psoriasis is lacking.
Purpose
To investigate the association between psoriasis and out-of-hospital cardiac arrest.
Methods
Through the nationwide Danish Cardiac Arrest Registry, we identified adult out-of-hospital cardiac arrest patients of presumed cardiac cause with and without psoriasis between June 2001 and December 2014. The odds of cardiac arrest were estimated using conditional logistic regression in a case-control design where we matched up to nine controls per case on age, sex and ischemic heart disease. The models were adjusted for comorbidities, concomitant pharmacotherapy and socioeconomic position.
Results
A total of 32,447 out-of-hospital cardiac arrest cases were included and matched with 291,999 controls from the general population. The median age was 72 years, 67% were male and 29% had ischemic heart disease. A total of 607 (1.9%) cases and 4662 (1.6%) controls had psoriasis. Compared with cardiac arrest cases without psoriasis, cases with psoriasis had same age (p=0.718) and gender distribution (p=0.794), higher prevalence of comorbidities such as congestive heart failure (25.7% vs 20.2%, p=0.001), chronic kidney disease (8.9% vs 6.2%, p=0.008) and chronic obstructive pulmonary disease (19.0% vs 14.7%, p=0.005) but had same prevalence of cerebral vascular disease (15.8% vs 14.5%, p=0.351) and peripheral vascular disease (13.3% vs 11.1%, p=0.078). In unadjusted and adjusted analyses, psoriasis was significantly associated with increased odds of cardiac arrest (odds ratio (OR) 1.18 [95% confidence interval (CI) 1.08–1.28] and OR 1.13 [95% CI 1.04–1.23], respectively) (Figure 1).
Conclusion
In this nationwide case-control study, psoriasis was significantly associated with increased odds of out-of-hospital cardiac arrest. Focus on risk factors and prevention of cardiovascular disease in patients with psoriasis is warranted.
Acknowledgement/Funding
None
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Affiliation(s)
- G H Mohr
- Gentofte University Hospital, Department of Cardiology, Gentofte, Denmark
| | - C A Barcella
- Gentofte University Hospital, Department of Cardiology, Gentofte, Denmark
| | - K Kragholm
- Aalborg University Hospital, Unit of Epidemiology and Biostatistics,, Aalborg, Denmark
| | - S Rajan
- Gentofte University Hospital, Department of Cardiology, Gentofte, Denmark
| | - K B Sondergaard
- Gentofte University Hospital, Department of Cardiology, Gentofte, Denmark
| | - J L Pallisgaard
- Gentofte University Hospital, Department of Cardiology, Gentofte, Denmark
| | - M Wissenberg
- Gentofte University Hospital, Department of Cardiology, Gentofte, Denmark
| | - J Lindhardsen
- Gentofte University Hospital, Department of Cardiology, Gentofte, Denmark
| | - O Ahlehoff
- Odense University Hospital, Department of Cardiology, Odense, Denmark
| | - L Skov
- Gentofte University Hospital, Department of Dermatology and Allergy, Gentofte, Denmark
| | - F K Lippert
- University of Copenhagen, Emergency Medical Services Copenhagen, Copenhagen, Denmark
| | - C Torp-Pedersen
- Aalborg University Hospital, Unit of Epidemiology and Biostatistics,, Aalborg, Denmark
| | - G Gislason
- Gentofte University Hospital, Department of Cardiology, Gentofte, Denmark
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Christensen DM, Rajan S, Kragholm K, Sondergaard KB, Hansen OM, Gerds TA, Torp-Pedersen C, Gislason GH, Lippert FK, Barcella CA. 5225Bystander cardiopulmonary resuscitation and survival in out-of-hospital cardiac arrest of non-cardiac origin. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Knowledge about the effect of bystander cardiopulmonary resuscitation (CPR) in out-of-hospital cardiac arrest (OHCA) of non-cardiac origin is lacking. We aimed to investigate the association between bystander CPR and survival in OHCA of presumed non-cardiac origin.
Methods
From the Danish Cardiac Arrest Registry and through linkage with national Danish healthcare registries we identified all adult patients with OHCA of presumed non-cardiac origin in Denmark (2001–2014). These were categorized further into OHCA of medical and non-medical cause. We analyzed temporal trends in bystander CPR and 30-day survival during the study period. Multiple logistic regression was used to examine the association between bystander CPR and 30-day survival and reported as standardized 30-day survival chances with versus without bystander CPR standardized to the prehospital OHCA-factors and patient characteristics of all patients in the study population.
Results
We identified 10,761 OHCAs of presumed non-cardiac origin. Bystander CPR was associated with an increased 30-day survival chance of 3.4% (95% confidence interval [CI]: 2.9–3.9) versus 1.8% (95% CI: 1.4–2.2) with no bystander CPR, corresponding to a significant difference of 1.6% (95% CI: 0.9–2.3). During the study period, the overall bystander CPR rates increased from 13.6% (95% CI: 11.2–16.5) to 62.7% (95% CI: 60.2–65.2). 30-day survival increased overall from 1.3% (95% CI: 0.7–2.6) to 4.0% (95% CI: 3.1–5.2). Similar findings were observed in subgroups of medical and non-medical OHCA.
Table 1. Patient and arrest characteristics according to cause of out-of-hospital cardiac arrest Overall Medical OHCA Non-medical OHCA Patient characteristics Total patients 10761 7625 3136 Median age,y 67 70 50 Male, n (%) 6357 (59.1) 4154 (54.5) 2204 (70.4) OHCA factors Witnessed arrest, n (%) 4306 (40.0) 3574 (46.9) 732 (23.3) Public location, n (%) 6979 (64.9) 5494 (72.1) 1485 (47.4) OHCA, out-of-hospital cardiac arrest; CPR, cardiopulmonary resuscitation.
Figure 1. Temporal trends
Conclusion
Bystander CPR was associated with a higher chance of 30-day survival among OHCA of presumed non-cardiac origin regardless of the underlying cause (medical/non-medical). Rates of bystander CPR and 30-day survival improved during the study period.
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Affiliation(s)
- D M Christensen
- Gentofte University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - S Rajan
- Gentofte University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - K Kragholm
- Aalborg University Hospital, Department of Cardiology, Aalborg, Denmark
| | - K B Sondergaard
- Gentofte University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - O M Hansen
- Aalborg University Hospital, Department of Cardiology, Aalborg, Denmark
| | - T A Gerds
- University of Copenhagen, Department of Biostatistics, Copenhagen, Denmark
| | - C Torp-Pedersen
- Aalborg University Hospital, Department of Cardiology, Aalborg, Denmark
| | - G H Gislason
- Gentofte University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - F K Lippert
- Emergency Medical Services, The Capital Region of Denmark, Copenhagen, Denmark
| | - C A Barcella
- Gentofte University Hospital, Department of Cardiology, Copenhagen, Denmark
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Pamidimarri G, Mathaiyan J, Manikandan S, Rajan S, Batmanabane G. Screening of herbal medicines for potential allopathic antidiabetic adulterants: An analytical study. Ayu 2019; 40:262-272. [PMID: 33935445 PMCID: PMC8078608 DOI: 10.4103/ayu.ayu_227_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 07/07/2020] [Accepted: 08/07/2020] [Indexed: 11/15/2022] Open
Abstract
Background: There are several reports worldwide on adulteration of herbal medicines (HMs) with allopathic drugs. In India, only a few studies have reported adulteration of HMs with antidiabetics and there are no systematic studies. Aims: To develop a rapid and validated method for detection of allopathic antidiabetic adulterants and to explore the extent of adulteration in HMs sold in South India. Materials and Methods: Standards and solvents were purchased from Sigma-Aldrich. Different brands of antidiabetic HM samples with manufacturing licenses were procured from dispensaries. Spiked drug free psyllium husk as solid and flask seed oil as liquid herbal matrices were used for method development. The spiked matrices with different concentrations were extracted with methanol and subjected to centrifugation. The supernatant was collected and analyzed by liquid chromatography-tandem mass spectrometry (LC-MS/MS). Isocratic elution was carried on a C18 column with 0.1% (v/v) formic acid:methanol (3:7, v/v) as a mobile phase. All drugs were monitored for two ion products in positive electrospray ionization mode using multiple reaction monitoring scans. Results: The retention time was 9 min. Limit of detection is 10 Pictograms (pg) for all analytes except for metformin, which was 370 pg. Recoveries of analytes range from 96% to 117%. Forty different brands of antidiabetic HMs were analyzed. Adulterant peaks were not observed in the mass chromatograms of HMs. Conclusions: A single-run method was developed by LC-MS/MS for the detection of proposed antidiabetics in HMs from licensed manufacturing units and online sold HMs across herbal dispensaries in Puducherry union territory, India. None of the HMs was found to be adulterated with proposed allopathic antidiabetic adulterants.
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Affiliation(s)
| | | | - S Manikandan
- Department of Pharmacology, JIPMER, Puducherry, India
| | - S Rajan
- Department of Pharmacology, JIPMER, Puducherry, India
| | - Gitanjali Batmanabane
- Department of Pharmacology, JIPMER, Puducherry, India.,Director, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
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Keys T, Burrow MF, Rajan S, Rompre P, Doméjean S, Muller‐Bolla M, Manton DJ. Carious lesion management in children and adolescents by Australian dentists. Aust Dent J 2019; 64:282-292. [DOI: 10.1111/adj.12710] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2019] [Indexed: 11/27/2022]
Affiliation(s)
- T Keys
- Melbourne Dental School The University of Melbourne Parkville Victoria Australia
| | - MF Burrow
- Faculty of Dentistry University of Hong Kong Pokfulam Hong Kong SAR
| | - S Rajan
- Melbourne Dental School The University of Melbourne Parkville Victoria Australia
| | - P Rompre
- Faculty of Dental Medicine Université de Montréal Montréal Quebec Canada
| | - S Doméjean
- UFR d’Odontologie, Centre de Recherche en Odontologie Clinique Univ Clermont Auvergne Clermont‐Ferrand France
- CHU Estaing Clermont‐Ferrand Service d’Odontologie Clermont‐Ferrand France
| | - M Muller‐Bolla
- Centre Hospitalier universitaire de Nice Département Odontologie Pédiatrique, UFR d’Odontologie de Nice‐Sophia Antipolis Université Côte d’Azur Paris Descartes France
| | - DJ Manton
- Melbourne Dental School The University of Melbourne Parkville Victoria Australia
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Chakrabarti D, Rajan S, Akhtar N, Kumar V, Kumar R, Srivastava K, Bhatt M, Gupta R. Long-course chemoradiation in carcinoma rectum; is it really worth it? Perspectives from a developing nation. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz155.015] [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: 11/14/2022] Open
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29
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Christensen DM, Rajan S, Kragholm K, Søndergaard KB, Hansen OM, Gerds TA, Torp-Pedersen C, Gislason GH, Lippert FK, Barcella CA. Bystander cardiopulmonary resuscitation and survival in patients with out-of-hospital cardiac arrest of non-cardiac origin. Resuscitation 2019; 140:98-105. [PMID: 31129226 DOI: 10.1016/j.resuscitation.2019.05.014] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 04/30/2019] [Accepted: 05/16/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Knowledge about the effect of bystander cardiopulmonary resuscitation (CPR) in out-of-hospital cardiac arrest (OHCA) of non-cardiac origin is lacking. We aimed to investigate the association between bystander CPR and survival in OHCA of presumed non-cardiac origin. METHODS From the Danish Cardiac Arrest Registry and through linkage with national Danish healthcare registries we identified all patients with OHCA of presumed non-cardiac origin in Denmark (2001-2014). These were categorized further into OHCA of medical and non-medical cause. We analyzed temporal trends in bystander CPR and 30-day survival during the study period. Multiple logistic regression was used to examine the association between bystander CPR and 30-day survival and reported as standardized 30-day survival chances with versus without bystander CPR standardized to the prehospital OHCA-factors and patient characteristics of all patients in the study population. RESULTS We identified 10,761 OHCAs of presumed non-cardiac origin. Bystander CPR was associated with a significantly higher 30-day survival chance of 3.4% (95% confidence interval [CI]: 2.9-3.9) versus 1.8% (95% CI: 1.4-2.2) without bystander CPR. A similar association was found in subgroups of both medical and non-medical OHCA. During the study period, the overall bystander CPR rates increased from 13.6% (95% CI: 11.2-16.5) to 62.7% (95% CI: 60.2-65.2). 30-day survival increased overall from 1.3% (95% CI: 0.7-2.6) to 4.0% (95% CI: 3.1-5.2). CONCLUSION Bystander CPR was associated with a higher chance of 30-day survival among OHCA of presumed non-cardiac origin regardless of the underlying cause (medical/non-medical). Rates of bystander CPR and 30-day survival improved during the study period.
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Affiliation(s)
- D M Christensen
- Department of Cardiology, Copenhagen University Hospital Herlev and Gentofte, Copenhagen, Denmark.
| | - S Rajan
- Department of Cardiology, Copenhagen University Hospital Herlev and Gentofte, Copenhagen, Denmark
| | - K Kragholm
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark; Unit of Epidemiology and Biostatistics, Aalborg University Hospital, Aalborg, Denmark; Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - K B Søndergaard
- Department of Cardiology, Copenhagen University Hospital Herlev and Gentofte, Copenhagen, Denmark
| | - O M Hansen
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - T A Gerds
- Department of Biostatistics, University of Copenhagen, Copenhagen, Denmark; The Danish Heart Foundation, Copenhagen, Denmark
| | - C Torp-Pedersen
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark; Unit of Epidemiology and Biostatistics, Aalborg University Hospital, Aalborg, Denmark; Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - G H Gislason
- Department of Cardiology, Copenhagen University Hospital Herlev and Gentofte, Copenhagen, Denmark; The Danish Heart Foundation, Copenhagen, Denmark
| | - Freddy K Lippert
- Emergency Medical Services: The Capital Region of Denmark, Copenhagen, Denmark
| | - C A Barcella
- Department of Cardiology, Copenhagen University Hospital Herlev and Gentofte, Copenhagen, Denmark
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Sood R, Paul J, Rajan S, Subramanian S, Balasubramanian D, Iyer S. PO-076 Predictors of postoperative pneumonia in patient undergoing oral cancer resection and its management. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)30242-7] [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: 11/28/2022]
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Rajan S, Kumar V, Gupta S, Akhtar N, Chaturvedi A. Comparison of CA125, HE4 and ROMA to differentiate malignant from benign ovarian masses. Eur J Surg Oncol 2019. [DOI: 10.1016/j.ejso.2018.10.091] [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: 10/27/2022] Open
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Mohr GH, Barcella CA, Kragholm K, Sondergaard KB, Pallisgaard JL, Moller SG, Karlsson L, Wissenberg M, Hansen SM, Lippert FK, Folke F, Torp-Pedersen C, Gislason G, Rajan S. P1752Differences in post-resuscitation care between patients with and without diabetes following out-of-hospital cardiac arrest - a nationwide study. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p1752] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- G H Mohr
- Gentofte University Hospital, Department of Cardiology, Gentofte, Denmark
| | - C A Barcella
- Gentofte University Hospital, Department of Cardiology, Gentofte, Denmark
| | - K Kragholm
- Aalborg University Hospital, Unit of Epidemiology and Biostatistics,, Aalborg, Denmark
| | - K B Sondergaard
- Gentofte University Hospital, Department of Cardiology, Gentofte, Denmark
| | - J L Pallisgaard
- Gentofte University Hospital, Department of Cardiology, Gentofte, Denmark
| | - S G Moller
- Gentofte University Hospital, Department of Cardiology, Gentofte, Denmark
| | - L Karlsson
- Gentofte University Hospital, Department of Cardiology, Gentofte, Denmark
| | - M Wissenberg
- Gentofte University Hospital, Department of Cardiology, Gentofte, Denmark
| | - S M Hansen
- Aalborg University Hospital, Unit of Epidemiology and Biostatistics,, Aalborg, Denmark
| | - F K Lippert
- University of Copenhagen, Emergency Medical Services Copenhagen, Copenhagen, Denmark
| | - F Folke
- Gentofte University Hospital, Department of Cardiology, Gentofte, Denmark
| | - C Torp-Pedersen
- Aalborg University Hospital, Unit of Epidemiology and Biostatistics,, Aalborg, Denmark
| | - G Gislason
- Gentofte University Hospital, Department of Cardiology, Gentofte, Denmark
| | - S Rajan
- Gentofte University Hospital, Department of Cardiology, Gentofte, Denmark
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Ebenezer AJ, Prasad K, Rajan S, Thangam EB. Silencing of H4R inhibits the production of IL-1β through SAPK/JNK signaling in human mast cells. J Recept Signal Transduct Res 2018; 38:204-212. [PMID: 29863427 DOI: 10.1080/10799893.2018.1468783] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
CONTEXT Mast cell (MC) activation through H4R releases various inflammatory mediators which are associated with allergic asthma. OBJECTIVES To investigate the siRNA-mediated gene silencing effect of H4R on human mast cells (HMCs) functions and the activation of stress-activated protein kinases (SAPK)/jun amino-terminal kinases (JNK) signaling pathways for the release of ineterleukin-1β (IL-1β) in HMCs. MATERIALS AND METHODS H4R expression was analyzed by RT-PCR and western blotting in human mast cell line-1 (HMC-1) cells and H4RsiRNA transfected cells. The effect of H4RsiRNA and H4R-antagonist on H4R mediated MC functions such as intracellular Ca2+ release, degranulation, IL-6 and IL-1β release, and the activation SAPK/JNK signaling pathways were studied. HMC-1 cells were stimulated with 10 μM of histamine (His) and 4-methylhistamine (4-MH) and pretreated individually with H4R-antagonist JNJ7777120 (JNJ), histamine H1 receptor (H1R)-antagonist mepyramine, and signaling molecule inhibitors SP600125 (SP) and Bay117082. RESULTS We found that the HMC-1 cells expressed H4R and H4RsiRNA treatment down regulated the H4R expression in HMC-1 cells. Both His and 4-MH induced the intracellular Ca2+ release and degranulation whereas; H4R siRNA and JNJ inhibited the effect. Furthermore, the activation of H4R caused the phosphorylation of SAPK/JNK pathways. H4R gene silencing and pretreatment with SP and JNJ decreased His and 4-MH induced phosphorylation of SAPK/JNK. We found that the activation of H4R caused the release of IL-1β (124.22 pg/ml) and IL-6 (122.50 pg/ml) on HMC-1 cells. Whereas, SAPK/JNK inhibitor (68.36 pg/ml) inhibited the H4R mediated IL-1β release. CONCLUSIONS Taken together, the silencing of H4R inhibited the H4R mediated MC functions and SAPK/JNK phosphorylation. Furthermore, the H4R activation utilized SAPK/JNK signaling pathway for IL-1β release in HMC-1 cells.
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Affiliation(s)
- Angel Jemima Ebenezer
- a Department of Biotechnology, School of Bioengineering , SRM University , Kattankulathur , India
| | - Kavya Prasad
- a Department of Biotechnology, School of Bioengineering , SRM University , Kattankulathur , India
| | - Sanjana Rajan
- a Department of Biotechnology, School of Bioengineering , SRM University , Kattankulathur , India
| | - Elden Berla Thangam
- a Department of Biotechnology, School of Bioengineering , SRM University , Kattankulathur , India
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Adak T, Kumar K, Shukla SK, Singh VK, Rajan S. Micronutrient status in leaf tissue of mango germplasm conserved under subtropical environment of Lucknow, Uttar Pradesh, India. Trop Plant Res 2018. [DOI: 10.22271/tpr.2018.v5.i1.014] [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: 11/08/2022] Open
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35
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Rolls S, Rajan S, Shah A, Bourke J, Chowdhury M, Ghaffar S, Green C, Johnston G, Orton D, Reckling C, Stone N, Wilkinson S, Buckley D. (Meth)acrylate allergy: frequently missed? Br J Dermatol 2018. [DOI: 10.1111/bjd.16402] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
| | | | - A. Shah
- Leicester Royal Infirmary Leicester U.K
| | - J.F. Bourke
- South Infirmary Victoria University Hospital Cork Ireland
| | | | | | | | | | | | | | - N.M. Stone
- Royal Gwent and Nevill Hall Hospitals Newport U.K
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Bajpai A, Khan K, Muthukumar M, Rajan S, Singh NK. Molecular analysis of anthocyanin biosynthesis pathway genes and their differential expression in mango peel. Genome 2018; 61:157-166. [PMID: 29338343 DOI: 10.1139/gen-2017-0205] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Mango fruit is cherished by masses for its taste and nutrition, contributed by color, flavor, and aroma. Among these, peel color is an important trait contributing to fruit quality and market value. We attempted to elucidate the role of key genes of the anthocyanin biosynthesis pathway related to fruit peel color from the leaf transcriptome of mango cultivar Amrapali. A total of 108 mined transcript sequences were assigned to the phenylpropanoid-flavonoid pathway from which 15 contigs representing anthocyanin biosynthesis genes were annotated. Alternate splice variants were identified by mapping against genes of Citrus clementina and Vitis vinifera (closest relatives) and protein subcellular localization was determined. Phylogenetic analysis of these pathway genes clustered them into distinct groups aligning with homologous genes of Magnifera indica, C. clementina, and V. vinifera. Expression profiling revealed higher relative fold expressions in mature fruit peel of red-colored varieties (Arunika, Ambika, and Tommy Atkins) in comparison with the green-peeled Amrapali. MiCHS, MiCHI, and MiF3H alternate splice variants revealed differential gene expression. Functionally divergent variants indicate availability of an allelic pool programmed to play critical roles in peel color. This study provides insight into the molecular genetic basis of peel color and offers scope for development of biomarkers in varietal improvement programs.
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Affiliation(s)
- Anju Bajpai
- a ICAR-Central Institute for Subtropical Horticulture, Lucknow-226101, India
| | - Kasim Khan
- a ICAR-Central Institute for Subtropical Horticulture, Lucknow-226101, India
| | - M Muthukumar
- a ICAR-Central Institute for Subtropical Horticulture, Lucknow-226101, India
| | - S Rajan
- a ICAR-Central Institute for Subtropical Horticulture, Lucknow-226101, India
| | - N K Singh
- b ICAR-National Research Centre on Plant Biotechnology, Pusa Campus, New Delhi-110012, India
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Komatsu R, You J, Rajan S, Kasuya Y, Sessler DI, Turan A. Steroid administration after anaesthetic induction with etomidate does not reduce in-hospital mortality or cardiovascular morbidity after non-cardiac surgery. Br J Anaesth 2017; 120:501-508. [PMID: 29452806 DOI: 10.1016/j.bja.2017.11.079] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Revised: 09/06/2017] [Accepted: 09/11/2017] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND We tested the primary hypothesis that corticosteroid administration after etomidate exposure reduces a composite of in-hospital mortality and cardiovascular morbidity after non-cardiac surgery. METHODS We evaluated ASA physical status III and IV patients who had non-cardiac surgery with general anaesthesia at the Cleveland Clinic. Amongst 4275 patients in whom anaesthesia was induced with etomidate, 804 were also given steroid intraoperatively, mostly dexamethasone at a median dose of 6 mg. We successfully matched 582 steroid patients with 1023 non-steroid patients. The matched groups were compared on composite of in-hospital mortality and cardiovascular morbidity using a generalized-estimating-equation model. Secondly, the matched groups were compared on length of hospital stay using a Cox proportional hazard model, and were descriptively compared on intraoperative blood pressures using a standardized difference. RESULTS There was no significant association between intraoperative steroid administration after anaesthetic induction with etomidate and the composite of in-hospital mortality or cardiovascular morbidity; the estimated common odds ratio across the two components of the composite was 0.86 [95% confidence interval (CI): 0.64, 1.16] for steroid vs non-steroid, P=0.33. The duration of postoperative hospitalisation was significantly shorter amongst steroid patients [median (Q1, Q3): 6 (3, 10) days] than non-steroid patients [7 (4, 11) days], with an estimated hazard ratio of 0.89 (0.80, 0.98) for steroid vs non-steroid, P=0.01. Intraoperative blood pressures were similar in steroid and non-steroid patients. CONCLUSIONS Steroid administration after induction of anaesthesia with etomidate did not reduce mortality or cardiovascular morbidity.
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Affiliation(s)
- R Komatsu
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA 94305695, USA; Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH 44195, USA.
| | - J You
- Departments of Quantitative Health Sciences and Outcomes Research, Cleveland Clinic, Cleveland, OH 44195, USA
| | - S Rajan
- Department of General Anesthesiology, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Y Kasuya
- Department of Anesthesiology, Tokyo Women's Medical University, Shinjuku, Tokyo 162-8666, Japan
| | - D I Sessler
- Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH 44195, USA
| | - A Turan
- Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH 44195, USA
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Pape M, Rajan S, Hansen S, Mortensen R, Riddersholm S, Folke F, Karlsson L, Lippert F, Kober L, Gislason G, Soholm H, Wissenberg M, Torp-Pedersen C, Kragholm K. P2744Low survival after out-of-hospital cardiac arrest in nursing homes despite early initiation of bystander cardiopulmonary resuscitation - a nationwide study. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx502.p2744] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Karlsson L, Sondergaard K, Malta Hansen C, Wissenberg M, Moller Hansen S, Lippert F, Rajan S, Kragholm K, Gislason G, Torp-Pedersen C, Folke F. P2767Straight line versus route distance to nearest automated external defibrillator - implications for cardiac arrest coverage. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx502.p2767] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Sondergaard K, Rajan S, Wissenberg M, Karlsson L, Kragholm K, Pape M, Lippert F, Gislason G, Folke F, Torp-Pedersen C, Hansen S. P2766Bystander cardiopulmonary resuscitation in out-of-hospital cardiac arrest according to location of arrest. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx502.p2766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Mohr G, Sondergaard K, Pallisgaard J, Weeke P, Jensen A, Rajan S, Lippert F, Torp-Pedersen C, Vilsboell T, Gislason G. P2087Use of insulin providers versus insulin sensitizers and risk of out-of-hospital cardiac arrest - a nationwide case-time-control study. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx502.p2087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Dallaston MA, Rajan S, Chekaiban J, Wibowo M, Cross M, Coster MJ, Davis RA, Hofmann A. Dichloro-naphthoquinone as a non-classical inhibitor of the mycobacterial carbonic anhydrase Rv3588c. Medchemcomm 2017; 8:1318-1321. [PMID: 30108843 PMCID: PMC6072524 DOI: 10.1039/c7md00090a] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Accepted: 05/08/2017] [Indexed: 11/21/2022]
Abstract
The soluble mycobacterial carbonic anhydrases Rv3588c and Rv1284 belong to a different class of carbonic anhydrases than those found in humans, making them attractive drug targets by using the inherent differences in the folds of the different classes. By screening a natural product library, we identified naphthoquinone derivatives as a novel non-classical inhibitor scaffold of mycobacterial carbonic anhydrases that lack the sulfonamide/sulfamate group and thus did not affect human carbonic anhydrase II.
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Affiliation(s)
- M A Dallaston
- Griffith Institute for Drug Discovery , Griffith University , Nathan , Queensland 4111 , Australia . ;
| | - S Rajan
- Griffith Institute for Drug Discovery , Griffith University , Nathan , Queensland 4111 , Australia . ;
| | - J Chekaiban
- Griffith Institute for Drug Discovery , Griffith University , Nathan , Queensland 4111 , Australia . ;
| | - M Wibowo
- Griffith Institute for Drug Discovery , Griffith University , Nathan , Queensland 4111 , Australia . ;
| | - M Cross
- Griffith Institute for Drug Discovery , Griffith University , Nathan , Queensland 4111 , Australia . ;
| | - M J Coster
- Griffith Institute for Drug Discovery , Griffith University , Nathan , Queensland 4111 , Australia . ;
| | - R A Davis
- Griffith Institute for Drug Discovery , Griffith University , Nathan , Queensland 4111 , Australia . ;
| | - A Hofmann
- Griffith Institute for Drug Discovery , Griffith University , Nathan , Queensland 4111 , Australia . ;
- Faculty of Veterinary and Agricultural Sciences , The University of Melbourne , Parkville , Victoria 3010 , Australia
- Queensland Tropical Health Alliance , Smithfield , Queensland 4878 , Australia
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Jahnavi S, Saravanan U, Arthi N, Bhuvaneshwar GS, Kumary TV, Rajan S, Verma RS. Biological and mechanical evaluation of a Bio-Hybrid scaffold for autologous valve tissue engineering. Mater Sci Eng C Mater Biol Appl 2016; 73:59-71. [PMID: 28183649 DOI: 10.1016/j.msec.2016.11.116] [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] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Revised: 11/10/2016] [Accepted: 11/23/2016] [Indexed: 10/20/2022]
Abstract
Major challenge in heart valve tissue engineering for paediatric patients is the development of an autologous valve with regenerative capacity. Hybrid tissue engineering approach is recently gaining popularity to design scaffolds with desired biological and mechanical properties that can remodel post implantation. In this study, we fabricated aligned nanofibrous Bio-Hybrid scaffold made of decellularized bovine pericardium: polycaprolactone-chitosan with optimized polymer thickness to yield the desired biological and mechanical properties. CD44+, αSMA+, Vimentin+ and CD105- human valve interstitial cells were isolated and seeded on these Bio-Hybrid scaffolds. Subsequent biological evaluation revealed interstitial cell proliferation with dense extra cellular matrix deposition that indicated the viability for growth and proliferation of seeded cells on the scaffolds. Uniaxial mechanical tests along axial direction showed that the Bio-Hybrid scaffolds has at least 20 times the strength of the native valves and its stiffness is nearly 3 times more than that of native valves. Biaxial and uniaxial mechanical studies on valve interstitial cells cultured Bio-Hybrid scaffolds revealed that the response along the axial and circumferential direction was different, similar to native valves. Overall, our findings suggest that Bio-Hybrid scaffold is a promising material for future development of regenerative heart valve constructs in children.
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Affiliation(s)
- S Jahnavi
- Stem Cell and Molecular Biology Laboratory, Department of Biotechnology, Indian Institute of Technology Madras, Chennai, TN 600036, India; Tissue Culture Laboratory, Biomedical Technology Wing, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Poojappura, Trivandrum, Kerala 695012, India
| | - U Saravanan
- Department of Civil Engineering, Indian Institute of Technology Madras, Chennai, TN 600036, India
| | - N Arthi
- Stem Cell and Molecular Biology Laboratory, Department of Biotechnology, Indian Institute of Technology Madras, Chennai, TN 600036, India
| | - G S Bhuvaneshwar
- Department of Engineering Design, Indian Institute of Technology Madras, Chennai, TN 600036, India
| | - T V Kumary
- Tissue Culture Laboratory, Biomedical Technology Wing, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Poojappura, Trivandrum, Kerala 695012, India
| | - S Rajan
- Madras Medical Mission, Institute of Cardio-Vascular Diseases, Mogappair, Chennai, Tamil Nadu 600037, India
| | - R S Verma
- Stem Cell and Molecular Biology Laboratory, Department of Biotechnology, Indian Institute of Technology Madras, Chennai, TN 600036, India.
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Rajan S, Babazade R, Khanna AK, Turan A. Reply. Br J Anaesth 2016; 117:671. [PMID: 27799187 DOI: 10.1093/bja/aew348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Abstract
The number of people forced to flee their homes and move around the world is increasing rapidly. Such refugee populations are not only more likely to have poor physical, mental and social health outcomes but also to experience difficulties accessing health services in their new country. In particular, children from refugee backgrounds are at increased risk of poor oral health which in time is associated with poor adult oral health and impacts on child health (e.g. growth and development) and well-being. To date, there is little evidence about the nature and extent of their oral health problems nor interventions to improve their oral health status. This article summarises the evidence surrounding the oral health status of children from refugee backgrounds. In addition, a systematic review of the international literature over the past 10 years is presented which identifies interventions to improve the oral health of these vulnerable paediatric populations. Based on this evidence, potential strategies available to dental service providers to optimise provision of responsive dental care are discussed.
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Affiliation(s)
- E Riggs
- Healthy Mothers Healthy Families, Murdoch Childrens Research Institute, The Royal Children's Hospital, Victoria, Australia.,General Practice and Primary Health Care Academic Centre, University of Melbourne, Victoria, Australia
| | - S Rajan
- Melbourne Dental School, The University of Melbourne, Melbourne, Victoria, Australia
| | - S Casey
- Sector Development & Partnerships, Foundation House, The Victorian Foundation for Survivors of Torture Inc, Melbourne, Victoria, Australia
| | - N Kilpatrick
- Cleft Services, Royal Children's Hospital, Melbourne, Victoria, Australia.,Department of Paediatrics, Murdoch Childrens Research Institute, University of Melbourne, Melbourne, Victoria, Australia
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Rajan S, Babazade R, Govindarajan SR, Pal R, You J, Mascha EJ, Khanna A, Yang M, Marcano FD, Singh AK, Kaouk J, Turan A. Perioperative factors associated with acute kidney injury after partial nephrectomy. Br J Anaesth 2016; 116:70-6. [PMID: 26675951 DOI: 10.1093/bja/aev416] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Partial nephrectomy is performed with the aim to preserve renal function. But the occurrence of postoperative acute kidney injury (AKI) can interfere with this goal. Our primary aim was to evaluate associations between pre-specified modifiable factors and estimated glomerular filtration rate after partial nephrectomy. Our secondary aims were to evaluate associations between pre-specified modifiable factors and both serum creatinine concentration and type of nephrectomy. METHODS The records of 1955 patients who underwent partial nephrectomy were collected. Postoperative estimated glomerular filtration rate (eGFR) was used as the primary outcome measure. Twenty modifiable risk factors were studied. A repeated-measures linear model with autoregressive within-subject correlation structure was used. The interaction between all the factors and type of nephrectomy was also studied. RESULTS A total of 1187 (61%) patients had no kidney injury, 647 (33%) had stage I, 80 (4%) had stage II, and 41 (2%) had stage III injury. The mean eGFR increased an estimated 0.83 (99.76% CI 0.79-0.88) ml min(-1) 1.73 m(-2) for a unit increase in baseline eGFR. Mean eGFR was 2.65 (99.76% CI: 0.13, 5.18) ml min(-1) 1.73 m(-2) lower in patients with hypertension. Mean eGFR decreased 0.42 (99.76% CI: 0.22, 0.62) ml min(-1) 1.73 m(-2) for a 10-minute longer in duration of procedure and decreased 2.09 (99.76% CI: 1.39, 2.80) ml min(-1) 1.73 m(-2) for a 10-minute longer in ischemia time. It was 3.53 (99.76% CI: 0.83, 6.23) ml min(-1) 1.73 m(-2) lower for patients who received warm ischemia as compared to cold ischemia. CONCLUSION Potentially modifiable factors associated with AKI in the postoperative period were identified as baseline renal function, preoperative hypertension, longer duration of surgical time and ischaemia time, and warm ischaemia.
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Affiliation(s)
- S Rajan
- Department of General Anesthesia, Cleveland Clinic, Cleveland, OH, USA
| | - R Babazade
- Department of Outcomes Research, Cleveland Clinic, Cleveland, OH, USA
| | - S R Govindarajan
- Department of Outcomes Research, Cleveland Clinic, Cleveland, OH, USA
| | - R Pal
- Cleveland Clinic, Cleveland, OH, USA
| | - J You
- Departments of Qualitative Health Sciences and Outcomes Research, Cleveland Clinic, Cleveland, OH, USA
| | - E J Mascha
- Departments of Qualitative Health Sciences and Outcomes Research, Cleveland Clinic, Cleveland, OH, USA
| | - A Khanna
- Department of Outcomes Research, Cleveland Clinic, Cleveland, OH, USA Surgical ICU, Cleveland Clinic, Cleveland, OH, USA
| | - M Yang
- Cleveland Clinic, Cleveland, OH, USA
| | - F D Marcano
- Department of Outcomes Research, Cleveland Clinic, Cleveland, OH, USA
| | - A K Singh
- Department of Outcomes Research, Cleveland Clinic, Cleveland, OH, USA
| | - J Kaouk
- Center for Laparoscopic and Robotic Surgery, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - A Turan
- Department of Outcomes Research, Cleveland Clinic, 9500 Euclid Avenue, P-77, Cleveland, OH 44195, USA
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Anand T, Rajan S, Aravind L. Describing the interactive model design of avian influenza : Animal infection and human infection. Int J Infect Dis 2016. [DOI: 10.1016/j.ijid.2016.02.552] [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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Bhaskar JT, Tripathy SC, Sabu P, Laluraj CM, Rajan S. Variation of phytoplankton assemblages of Kongsfjorden in early autumn 2012: a microscopic and pigment ratio-based assessment. Environ Monit Assess 2016; 188:224. [PMID: 26969156 DOI: 10.1007/s10661-016-5220-8] [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] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Accepted: 03/03/2016] [Indexed: 06/05/2023]
Abstract
Phytoplankton species distribution and composition were determined by using microscopy and pigment ratios in the Kongsfjorden during early autumn 2012. Variation in sea surface temperature (SST) was minimal and matched well with satellite-derived SST. Nutrients were generally limited. Surface phytoplankton abundance ranged from 0.21 × 10(3) to 10.28 × 10(3) cells L(-1). Phytoplankton abundance decreased with depth and did not show any significant correlation with chlorophyll a (chl a). Column-integrated phytoplankton cell counts (PCC) ranged from 94.3 × 10(6) cells m(-2) (Kf4) to 13.7 × 10(6) cells m(-2) (Kf5), while chl a was lowest at inner part of the fjord (6.3 mg m(-2)) and highest towards the mouth (24.83 mg m(-2)). Biomass from prymnesiophytes and raphidophytes dominated at surface and 10 m, respectively. The contribution of Bacillariophyceae to biomass was low. Generally, heterotrophic dinoflagellates were great in abundance (12.82 %) and ubiquitous in nature and were major contributors to biomass. Various chl pigments (chl b, chl c, phaeopigments (phaeo)) were measured to obtain pigment/chl a ratios to ascertain phytoplankton composition. Phaeo were observed only in inner fjord. Chl b:a ratios and microscopic observations indicated dominance of Chlorophyceae at greater depths than surface. Furthermore, microscopic observations confirmed dominance of chl c containing algae throughout the fjord. The study indicates that pigment ratios can be used as a tool for preliminary identification of major phytoplankton groups. However, under the presence of a large number of heterotrophic dinoflagellates such as Gymnodinium sp. and Gyrodinium sp., pigment signatures need to be supplemented by microscopic observations.
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Affiliation(s)
- Jane T Bhaskar
- ESSO-National Centre for Antarctic and Ocean Research, Ministry of Earth Sciences, Govt. of India, Headland Sada, Vasco da Gama, Goa, 403 804, India.
| | - S C Tripathy
- ESSO-National Centre for Antarctic and Ocean Research, Ministry of Earth Sciences, Govt. of India, Headland Sada, Vasco da Gama, Goa, 403 804, India
| | - P Sabu
- ESSO-National Centre for Antarctic and Ocean Research, Ministry of Earth Sciences, Govt. of India, Headland Sada, Vasco da Gama, Goa, 403 804, India
| | - C M Laluraj
- ESSO-National Centre for Antarctic and Ocean Research, Ministry of Earth Sciences, Govt. of India, Headland Sada, Vasco da Gama, Goa, 403 804, India
| | - S Rajan
- ESSO-National Centre for Antarctic and Ocean Research, Ministry of Earth Sciences, Govt. of India, Headland Sada, Vasco da Gama, Goa, 403 804, India
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Bajpai A, Muthukumar M, Ahmad I, Ravishankar KV, Parthasarthy VA, Sthapit B, Rao R, Verma JP, Rajan S. Molecular and morphological diversity in locally grown non-commercial (heirloom) mango varieties of North India. J Environ Biol 2016; 37:221-228. [PMID: 27097441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Mango (Mangifera indica L.) has been cultivated and conserved in different agro-ecologies including Malihabad region in northern part of India, that is well known for housing diverse types (heirloom and commercial varieties). In the present study, 37 mango types comprising of 27 heirloom varieties from Malihabad region and 10 commercial varieties grown in North and Eastern India were assessed for morphological attributes and molecular diversity. The employed SSR markers amplified 2-13 alleles individually, cumulatively amplifying 124 alleles. These were studied for allelic diversity and genetic dissimilarity ranged from 0.035 to 0.892 arranging the varieties in three major clusters. The results revealed that majority of unique heirloom mangoes from Malihabad were different from the eastern part of the country. It is interesting to note Dashehari, a commercial variety from Malihabad was not aligned with heirloom varieties. Commercial varieties like Gulabkhas and Langra were placed in a separate group including Bombay Green, Himsagar, Dashehari, etc., indicating their dissimilarity with heirloom varieties at molecular level and thus, indicating importance for later from conservation point of view. Furthermore, the hierarchical clustering of varieties based on fruit morphology, assembled these into four groups largely influenced by fruit size. The maximum agreement subtree indicated seemingly good fit as thirteen varieties were arrayed in common grouping pattern. Appreciable dissimilarity among the heirloom varieties demonstrated by molecular analysis, underlines the importance for their on-farm conservation.
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