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Jerath A, Satkunasivam R, Kaneshwaran K, Aminoltejari K, Chang A, MacDonell DSY, Kealey A, Ladowski S, Sarmah A, Flexman AM, Lorello GR, Nabecker S, Coburn N, Conn LG, Klaassen Z, Ranganathan S, Riveros C, McCartney CJL, Detsky AS, Wallis CJD. Association Between Anesthesiologist Sex and Patients' Postoperative Outcomes: A Population-based Cohort Study. Ann Surg 2024; 279:569-574. [PMID: 38264927 DOI: 10.1097/sla.0000000000006217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2024]
Abstract
OBJECTIVE To examine the association of anesthesiologist sex on postoperative outcomes. BACKGROUND Differences in patient postoperative outcomes exist, depending on whether the primary surgeon is male or female, with better outcomes seen among patients treated by female surgeons. Whether the intraoperative anesthesiologist's sex is associated with differential postoperative patient outcomes is unknown. METHODS We performed a population-based, retrospective cohort study among adult patients undergoing one of 25 common elective or emergent surgical procedures from 2007 to 2019 in Ontario, Canada. We assessed the association between the sex of the intraoperative anesthesiologist and the primary end point of the adverse postoperative outcome, defined as death, readmission, or complication within 30 days after surgery, using generalized estimating equations. RESULTS Among 1,165,711 patients treated by 3006 surgeons and 1477 anesthesiologists, 311,822 (26.7%) received care from a female anesthesiologist and 853,889 (73.3%) from a male anesthesiologist. Overall, 10.8% of patients experienced one or more adverse postoperative outcomes, of whom 1.1% died. Multivariable adjusted rates of the composite primary end point were higher among patients treated by male anesthesiologists (10.6%) compared with female anesthesiologists (10.4%; adjusted odds ratio 1.02, 95% CI: 1.00-1.05, P =0.048). CONCLUSIONS We demonstrated a significant association between sex of the intraoperative anesthesiologist and patient short-term outcomes after surgery in a large cohort study. This study supports the growing literature of improved patient outcomes among female practitioners. The underlying mechanisms of why outcomes differ between male and female physicians remain elusive and require further in-depth study.
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Affiliation(s)
- Angela Jerath
- Department of Anesthesia and Pain Medicine, Sunnybrook Health Sciences Center, Toronto, ON, Canada
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- ICES, Toronto, ON, Canada
| | - Raj Satkunasivam
- Department of Urology, Houston Methodist Hospital, Houston, TX
- Center for Outcomes Research, Houston Methodist Hospital, Houston, TX
- Department of Health Policy and Management, School of Public Health, Texas A&M University, College Station, TX, USA
| | - Kirusanthy Kaneshwaran
- Department of Anesthesia and Pain Medicine, Sunnybrook Health Sciences Center, Toronto, ON, Canada
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada
| | - Khatereh Aminoltejari
- Department of Surgery, Division of Urology, University of Toronto, Toronto, ON, Canada
| | - Ashton Chang
- Department of Anesthesia and Pain Medicine, Sunnybrook Health Sciences Center, Toronto, ON, Canada
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada
| | - D Su-Yin MacDonell
- Department of Anesthesiology, St. Paul's Hospital/Providence Health Care, Vancouver, BC, Canada
- Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancouver, BC, Canada
| | - Alayne Kealey
- Department of Anesthesia and Pain Medicine, Sunnybrook Health Sciences Center, Toronto, ON, Canada
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada
| | - Stephanie Ladowski
- Department of Anesthesia and Pain Medicine, Sunnybrook Health Sciences Center, Toronto, ON, Canada
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada
| | - Anita Sarmah
- Department of Anesthesia and Pain Medicine, Sunnybrook Health Sciences Center, Toronto, ON, Canada
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada
| | - Alana M Flexman
- Department of Anesthesiology, St. Paul's Hospital/Providence Health Care, Vancouver, BC, Canada
- Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancouver, BC, Canada
| | - Gianni R Lorello
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada
- Department of Anesthesiology and Pain Management, University Health Network - Toronto Western Hospital, Toronto, ON, Canada
- The Wilson Centre, Toronto General Hospital, Toronto, ON, Canada
- Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada
| | - Sabine Nabecker
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada
- Department of Anesthesiology, Mount Sinai Hospital, Toronto, ON, Canada
| | - Natalie Coburn
- Department of Surgery, Sunnybrook Health Sciences Center, Toronto, ON, Canada
| | - Lesley G Conn
- Department of Surgery, Sunnybrook Health Sciences Center, Toronto, ON, Canada
| | - Zachary Klaassen
- Division of Urology, Medical College of Georgia - Augusta University, Augusta, Georgia, USA
| | | | - Carlos Riveros
- Department of Urology, Houston Methodist Hospital, Houston, TX
| | - Colin J L McCartney
- Department of Anesthesia and Pain Medicine, Sunnybrook Health Sciences Center, Toronto, ON, Canada
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada
| | - Allan S Detsky
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Department of Medicine, Mount Sinai Hospital and University Health Network, Toronto, ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Christopher J D Wallis
- Department of Surgery, Division of Urology, University of Toronto, Toronto, ON, Canada
- Department of Surgery, Division of Urology, Mount Sinai Hospital, Toronto, ON, Canada
- Department of Surgical Oncology, University Health Network, Toronto, ON, Canada
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Di Giacomo AM, Schenker M, Medioni J, Mandziuk S, Majem M, Gravis G, Cornfeld M, Ranganathan S, Lou S, Csoszi T. A phase II study of retifanlimab, a humanized anti-PD-1 monoclonal antibody, in patients with solid tumors (POD1UM-203). ESMO Open 2024; 9:102387. [PMID: 38401247 PMCID: PMC10982862 DOI: 10.1016/j.esmoop.2024.102387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 01/25/2024] [Accepted: 01/26/2024] [Indexed: 02/26/2024] Open
Abstract
BACKGROUND POD1UM-203, an open-label, multicenter, phase II study, evaluated retifanlimab, a humanized monoclonal antibody targeting programmed cell death protein-1 (PD-1) in patients with selected solid tumors where immune checkpoint inhibitor therapies have previously shown efficacy. PATIENTS AND METHODS Eligible patients (≥18 years) had measurable disease and included unresectable or metastatic melanoma, treatment-naive metastatic non-small-cell lung cancer (NSCLC) with high programmed death-ligand 1 (PD-L1) expression (tumor proportion score ≥50%), cisplatin-ineligible locally advanced/metastatic urothelial carcinoma (UC) with PD-L1 expression (combined positive score ≥10%), or treatment-naive locally advanced/metastatic clear-cell renal cell carcinoma (RCC). Retifanlimab 500 mg was administered intravenously every 4 weeks as a 30-min infusion. The primary endpoint was investigator-assessed overall response rate. RESULTS Overall, 121 patients (35 melanoma, 23 NSCLC, 29 UC, 34 RCC) were enrolled and treated. The overall response rate [95% confidence interval (CI)] was 40.0% (23.9-57.9) in the melanoma cohort, 34.8% (16.4-57.3) in the NSCLC cohort, 37.9% (20.7-57.7) in the UC cohort, and 23.5% (10.7-41.2) in the RCC cohort. Median duration of response was 11.5 months (95% CI 2.2-not reached) in the UC cohort, and was not reached in the other cohorts. Retifanlimab safety was consistent with previous experience for PD-(L)1 inhibitors. CONCLUSIONS Retifanlimab demonstrated durable antitumor activity in patients with melanoma, NSCLC, UC, or RCC. The efficacy and safety of retifanlimab were as expected for a PD-(L)1 inhibitor. These data support further study of retifanlimab in solid tumors.
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Affiliation(s)
- A M Di Giacomo
- University of Siena, Siena, Italy; Center for Immuno-Oncology, University Hospital of Siena, Siena, Italy
| | - M Schenker
- Centrul de Oncologie Sf. Nectarie, Oncologie Medicala, Craiova, Romania
| | - J Medioni
- Centre of Early Clinical Trials in Cancer, Hôpital Européen Georges-Pompidou, Université Paris Cité, Paris, France
| | - S Mandziuk
- Department of Clinical Oncology and Chemotherapy, Medical University of Lublin, Lublin, Poland
| | - M Majem
- Medical Oncology Department, Hospital de Sant Pau, Barcelona, Spain
| | - G Gravis
- Department of Medical Oncology, Institut Paoli-Calmettes, Aix-Marseille Université, CRCM, Marseille, France
| | | | | | - S Lou
- Incyte Corporation, Wilmington, USA
| | - T Csoszi
- Hetényi Géza Kórház Onkológiai Központ, Szolnok, Hungary.
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Riveros C, Ranganathan S, Haque W, Huang E, Xu J, Kulkarni GS, Geng M, Anis M, Muhammad T, Chan KS, Farach A, Teh BS, Miles BJ, Klaassen Z, Sonpavde GP, Wallis CJ, Satkunasivam R. Comparative real-world survival outcomes of muscle-invasive bladder cancer treated with bladder-only vs. whole-pelvis concurrent chemoradiation. Can Urol Assoc J 2024; 18:17-24. [PMID: 37931278 PMCID: PMC10841558 DOI: 10.5489/cuaj.8386] [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: 11/08/2023]
Abstract
INTRODUCTION Elective pelvic nodal irradiation for patients with muscle-invasive bladder cancer (MIBC) undergoing trimodal therapy (TMT ) is controversial. In patients with node-negative (N0) MIBC, the benefit of elective whole-pelvis concurrent chemoradiation (WP-CCR) compared to bladder-only (BO )-CCR has not been demonstrated. Using real-world data from the National Cancer Database (NCDB ), we sought to compare the overall survival (OS ) between BO-CCR and WP-CCR for MIBC. METHODS Using the 2020 NCDB Participant User File, we identified cases of MIBC diagnosed between 2017 and 2019. We selected patients with clinical T2-T4aN0M0 disease receiving CCR as first-line treatment. CCR was defined as transurethral resection of bladder tumor followed by ≥40 Gy radiation to the bladder with concurrent single- or multiple-agent chemotherapy. Based on elective nodal irradiation status, patients were stratified as having received BO-CCR vs. WP-CCR. OS analysis was performed using summary three-month conditional landmark, inverse probability treatment weighting (IPTW)-adjusted Kaplan-Meier estimates, and Cox regression. RESULTS A total of 604 patients receiving CCR for MIBC were identified: 367 (60.8%) BO-CCR and 237 (39.2%) WP-CCR. Before IPTW, the groups were imbalanced in terms of baseline characteristics. The median followup of the weighted population was 42.3 months (interquartile range 18.1-49.1 months). In IPTW-adjusted Cox proportional hazards regression analysis, WP-CCR was associated with a significant OS benefit compared to BO-CCR (adjusted hazard ratio 0.72, 95% confidence interval 0.54-0.96, p=0.026). CONCLUSIONS In the setting of CCR for N0 MIBC, this retrospective NCDB analysis revealed that WP-CCR was associated with a benefit in OS compared to BO-CCR.
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Affiliation(s)
- Carlos Riveros
- Department of Urology, Houston Methodist Hospital, Houston, TX, United States
| | - Sanjana Ranganathan
- Department of Urology, Houston Methodist Hospital, Houston, TX, United States
| | - Waqar Haque
- Department of Radiation Oncology, Houston Methodist Hospital, Houston, TX, United States
| | - Emily Huang
- Department of Urology, Houston Methodist Hospital, Houston, TX, United States
| | - Jiaqiong Xu
- Center for Health Data Science and Analytics, Houston Methodist Hospital, Houston, TX, United States
| | - Girish S. Kulkarni
- Division of Urology and Surgical Oncology, Department of Surgery, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON, Canada
- Division of Urology, University of Toronto, Toronto, ON, Canada
| | - Michael Geng
- School of Engineering Medicine, Texas A&M University, Houston, TX, United States
| | - Maryam Anis
- Department of Urology, Houston Methodist Hospital, Houston, TX, United States
| | - Taliah Muhammad
- Department of Urology, Houston Methodist Hospital, Houston, TX, United States
| | - Keith Syson Chan
- Department of Urology, Houston Methodist Hospital, Houston, TX, United States
- Center for TME Spatial Profiling in GU Oncology, Houston Methodist Research Institute, Houston, TX, United States
| | - Andrew Farach
- Department of Radiation Oncology, Houston Methodist Hospital, Houston, TX, United States
| | - Bin S. Teh
- Department of Radiation Oncology, Houston Methodist Hospital, Houston, TX, United States
| | - Brian J. Miles
- Department of Urology, Houston Methodist Hospital, Houston, TX, United States
| | - Zachary Klaassen
- Division of Urology, Medical College of Georgia, Augusta University, Augusta, GA, United States
| | - Guru P. Sonpavde
- Genitourinary Oncology Program, AdventHealth Cancer Institute, Orlando, FL, United States
| | - Christopher J.D. Wallis
- Division of Urology and Surgical Oncology, Department of Surgery, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON, Canada
- Division of Urology, University of Toronto, Toronto, ON, Canada
- Division of Urology, Mount Sinai Hospital, Toronto, ON, Canada
| | - Raj Satkunasivam
- Department of Urology, Houston Methodist Hospital, Houston, TX, United States
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Wallis CJD, Jerath A, Aminoltejari K, Kaneshwaran K, Salles A, Buntin MB, Coburn NG, Wright FC, Gotlib Conn L, Heybati K, Luckenbaugh AN, Ranganathan S, Riveros C, McCartney C, Armstrong KA, Bass BL, Detsky AS, Satkunasivam R. Surgeon Sex and Health Care Costs for Patients Undergoing Common Surgical Procedures. JAMA Surg 2024; 159:151-159. [PMID: 38019486 PMCID: PMC10687714 DOI: 10.1001/jamasurg.2023.6031] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 08/27/2023] [Indexed: 11/30/2023]
Abstract
Importance Prior research has shown differences in postoperative outcomes for patients treated by female and male surgeons. It is important to understand, from a health system and payer perspective, whether surgical health care costs differ according to the surgeon's sex. Objective To examine the association between surgeon sex and health care costs among patients undergoing surgery. Design, Setting, and Participants This population-based, retrospective cohort study included adult patients undergoing 1 of 25 common elective or emergent surgical procedures between January 1, 2007, and December 31, 2019, in Ontario, Canada. Analysis was performed from October 2022 to March 2023. Exposure Surgeon sex. Main Outcome and Measure The primary outcome was total health care costs assessed 1 year following surgery. Secondarily, total health care costs at 30 and 90 days, as well as specific cost categories, were assessed. Generalized estimating equations were used with procedure-level clustering to compare costs between patients undergoing equivalent surgeries performed by female and male surgeons, with further adjustment for patient-, surgeon-, anesthesiologist-, hospital-, and procedure-level covariates. Results Among 1 165 711 included patients, 151 054 were treated by a female surgeon and 1 014 657 were treated by a male surgeon. Analyzed at the procedure-specific level and accounting for patient-, surgeon-, anesthesiologist-, and hospital-level covariates, 1-year total health care costs were higher for patients treated by male surgeons ($24 882; 95% CI, $20 780-$29 794) than female surgeons ($18 517; 95% CI, $16 080-$21 324) (adjusted absolute difference, $6365; 95% CI, $3491-9238; adjusted relative risk, 1.10; 95% CI, 1.05-1.14). Similar patterns were observed at 30 days (adjusted absolute difference, $3115; 95% CI, $1682-$4548) and 90 days (adjusted absolute difference, $4228; 95% CI, $2255-$6202). Conclusions and Relevance This analysis found lower 30-day, 90-day, and 1-year health care costs for patients treated by female surgeons compared with those treated by male surgeons. These data further underscore the importance of creating inclusive policies and environments supportive of women surgeons to improve recruitment and retention of a more diverse and representative workforce.
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Affiliation(s)
- Christopher J. D. Wallis
- Division of Urology, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
- Division of Urology, Department of Surgery, Mount Sinai Hospital, Toronto, Ontario, Canada
- Department of Surgical Oncology, University Health Network, Toronto, Ontario, Canada
| | - Angela Jerath
- Department of Anesthesia, Sunnybrook Health Sciences Center, Toronto, Ontario, Canada
| | - Khatereh Aminoltejari
- Division of Urology, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | | | - Arghavan Salles
- Department of Medicine, Stanford University School of Medicine, Palo Alto, California
| | | | - Natalie G. Coburn
- Department of Surgery, Sunnybrook Health Sciences Center, Toronto, Ontario, Canada
| | - Frances C. Wright
- Department of Surgery, Sunnybrook Health Sciences Center, Toronto, Ontario, Canada
| | - Lesley Gotlib Conn
- Department of Surgery, Sunnybrook Health Sciences Center, Toronto, Ontario, Canada
| | - Kiyan Heybati
- Mayo Clinic Alix School of Medicine, Mayo Clinic, Rochester, Minnesota
| | - Amy N. Luckenbaugh
- Department of Urology, Vanderbilt University Medical Center, Nashville, Tennessee
| | | | - Carlos Riveros
- Department of Urology, Houston Methodist Hospital, Houston, Texas
| | - Colin McCartney
- Department of Anesthesia, Sunnybrook Health Sciences Center, Toronto, Ontario, Canada
| | - Kathleen A. Armstrong
- Division of Plastic Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Barbara L. Bass
- School of Medicine and Health Sciences, George Washington University, Washington, DC
| | - Allan S. Detsky
- Department of Medicine, Mount Sinai Hospital and University Health Network, Toronto, Ontario, Canada
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Raj Satkunasivam
- Department of Urology, Houston Methodist Hospital, Houston, Texas
- Center for Outcomes Research, Houston Methodist Hospital, Houston, Texas
- Department of Health Policy and Management, School of Public Health, Texas A&M University, College Station, Texas
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Wallis CJD, Jerath A, Aminoltejari K, Kaneshwaran K, Salles A, Coburn N, Wright FC, Gotlib Conn L, Klaassen Z, Luckenbaugh AN, Ranganathan S, Riveros C, McCartney C, Armstrong K, Bass B, Detsky AS, Satkunasivam R. Surgeon Sex and Long-Term Postoperative Outcomes Among Patients Undergoing Common Surgeries. JAMA Surg 2023; 158:1185-1194. [PMID: 37647075 PMCID: PMC10469289 DOI: 10.1001/jamasurg.2023.3744] [Citation(s) in RCA: 25] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 06/07/2023] [Indexed: 09/01/2023]
Abstract
Importance Sex- and gender-based differences in a surgeon's medical practice and communication may be factors in patients' perioperative outcomes. Patients treated by female surgeons have improved 30-day outcomes. However, whether these outcomes persist over longer follow-up has not been assessed. Objective To examine whether surgeon sex is associated with 90-day and 1-year outcomes among patients undergoing common surgeries. Design, Setting, and Participants A population-based retrospective cohort study was conducted in adults in Ontario, Canada, undergoing 1 of 25 common elective or emergent surgeries between January 1, 2007, and December 31, 2019. Analysis was performed between July 15 and October 20, 2022. Exposure Surgeon sex. Main Outcomes and Measures An adverse postoperative event, defined as the composite of death, readmission, or complication, was assessed at 90 days and 1 year following surgery. Secondarily, each of these outcomes was assessed individually. Outcomes were compared between patients treated by female and male surgeons using generalized estimating equations with clustering at the level of the surgical procedure, accounting for patient-, procedure-, surgeon-, anesthesiologist-, and facility-level covariates. Results Among 1 165 711 included patients, 151 054 were treated by a female and 1 014 657 by a male surgeon. Overall, 14.3% of the patients had 1 or more adverse postoperative outcomes at 90 days and 25.0% had 1 or more adverse postoperative outcomes 1 year following surgery. Among these, 2.0% of patients died within 90 days and 4.3% died within 1 year. Multivariable-adjusted rates of the composite end point were higher among patients treated by male than female surgeons at both 90 days (13.9% vs 12.5%; adjusted odds ratio [AOR], 1.08; 95% CI, 1.03-1.13) and 1 year (25.0% vs 20.7%; AOR, 1.06; 95% CI, 1.01-1.12). Similar patterns were observed for mortality at 90 days (0.8% vs 0.5%; AOR 1.25; 95% CI, 1.12-1.39) and 1 year (2.4% vs 1.6%; AOR, 1.24; 95% CI, 1.13-1.36). Conclusions and Relevance After accounting for patient, procedure, surgeon, anesthesiologist, and hospital characteristics, the findings of this cohort study suggest that patients treated by female surgeons have lower rates of adverse postoperative outcomes including death at 90 days and 1 year after surgery compared with those treated by male surgeons. These findings further support differences in patient outcomes based on physician sex that warrant deeper study regarding underlying causes and potential solutions.
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Affiliation(s)
- Christopher J D Wallis
- Division of Urology, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
- Division of Urology, Department of Surgery, Mount Sinai Hospital, Toronto, Ontario, Canada
- Department of Surgical Oncology, University Health Network, Toronto, Ontario, Canada
| | - Angela Jerath
- Department of Anesthesia, Sunnybrook Health Sciences Center, Toronto, Ontario, Canada
| | - Khatereh Aminoltejari
- Division of Urology, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | | | - Arghavan Salles
- Department of Medicine, Stanford University School of Medicine, Palo Alto, California
| | - Natalie Coburn
- Department of Surgery, Sunnybrook Health Sciences Center, Toronto, Ontario, Canada
| | - Frances C Wright
- Department of Surgery, Sunnybrook Health Sciences Center, Toronto, Ontario, Canada
| | - Lesley Gotlib Conn
- Department of Surgery, Sunnybrook Health Sciences Center, Toronto, Ontario, Canada
| | - Zachary Klaassen
- Division of Urology, Medical College of Georgia-Augusta University, Augusta
| | - Amy N Luckenbaugh
- Department of Urology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Sanjana Ranganathan
- Division of Plastic Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Carlos Riveros
- Division of Plastic Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Colin McCartney
- Department of Anesthesia, Sunnybrook Health Sciences Center, Toronto, Ontario, Canada
| | - Kathleen Armstrong
- Division of Plastic Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Barbara Bass
- George Washington University, School of Medicine and Health Sciences, Washington, DC
| | - Allan S Detsky
- Department of Medicine, Mount Sinai Hospital and University Health Network, Toronto, Ontario, Canada
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Raj Satkunasivam
- Department of Urology, Houston Methodist Hospital, Houston, Texas
- Center for Outcomes Research, Houston Methodist Hospital, Houston, Texas
- Department of Health Policy and Management, School of Public Health, Texas A&M University, College Station
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Riveros C, Ranganathan S, Shah YB, Huang E, Xu J, Geng M, Melchiode Z, Hu S, Miles BJ, Esnaola N, Kaushik D, Jerath A, Wallis CJD, Satkunasivam R. Postoperative Discharge Destination Impacts 30-Day Outcomes: A National Surgical Quality Improvement Program Multi-Specialty Surgical Cohort Analysis. J Clin Med 2023; 12:6784. [PMID: 37959249 PMCID: PMC10650337 DOI: 10.3390/jcm12216784] [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] [Received: 09/11/2023] [Revised: 10/10/2023] [Accepted: 10/24/2023] [Indexed: 11/15/2023] Open
Abstract
Surgical patients can be discharged to a variety of facilities which vary widely in intensity of care. Postoperative readmissions have been found to be more strongly associated with post-discharge events than pre-discharge complications, indicating the importance of discharge destination. We sought to evaluate the association between discharge destination and 30-day outcomes. A retrospective cohort study was conducted using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database. Patients were dichotomized based on discharge destination: home versus non-home. The main outcome of interest was 30-day unplanned readmission. The secondary outcomes included post-discharge pulmonary, infectious, thromboembolic, and bleeding complications, as well as death. In this cohort study of over 1.5 million patients undergoing common surgical procedures across eight surgical specialties, we found non-home discharge to be associated with adverse 30-day post-operative outcomes, namely, unplanned readmissions, post-discharge pulmonary, infectious, thromboembolic, and bleeding complications, as well as death. Non-home discharge is associated with worse 30-day outcomes among patients undergoing common surgical procedures. Patients and caregivers should be counseled regarding discharge destination, as non-home discharge is associated with adverse post-operative outcomes.
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Affiliation(s)
- Carlos Riveros
- Department of Urology, Houston Methodist Hospital, Houston, TX 77030, USA; (C.R.); (S.R.); (E.H.); (Z.M.); (S.H.); (B.J.M.); (D.K.)
| | - Sanjana Ranganathan
- Department of Urology, Houston Methodist Hospital, Houston, TX 77030, USA; (C.R.); (S.R.); (E.H.); (Z.M.); (S.H.); (B.J.M.); (D.K.)
| | - Yash B. Shah
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA 19107, USA;
| | - Emily Huang
- Department of Urology, Houston Methodist Hospital, Houston, TX 77030, USA; (C.R.); (S.R.); (E.H.); (Z.M.); (S.H.); (B.J.M.); (D.K.)
| | - Jiaqiong Xu
- Center for Health Data Science and Analytics, Houston Methodist Research Institute, Houston, TX 77030, USA;
| | - Michael Geng
- School of Engineering Medicine, Texas A&M University, Houston, TX 77030, USA;
| | - Zachary Melchiode
- Department of Urology, Houston Methodist Hospital, Houston, TX 77030, USA; (C.R.); (S.R.); (E.H.); (Z.M.); (S.H.); (B.J.M.); (D.K.)
| | - Siqi Hu
- Department of Urology, Houston Methodist Hospital, Houston, TX 77030, USA; (C.R.); (S.R.); (E.H.); (Z.M.); (S.H.); (B.J.M.); (D.K.)
| | - Brian J. Miles
- Department of Urology, Houston Methodist Hospital, Houston, TX 77030, USA; (C.R.); (S.R.); (E.H.); (Z.M.); (S.H.); (B.J.M.); (D.K.)
| | - Nestor Esnaola
- Department of Surgery, Houston Methodist Hospital, Houston, TX 77030, USA;
| | - Dharam Kaushik
- Department of Urology, Houston Methodist Hospital, Houston, TX 77030, USA; (C.R.); (S.R.); (E.H.); (Z.M.); (S.H.); (B.J.M.); (D.K.)
| | - Angela Jerath
- Department of Anesthesia, Sunnybrook Health Sciences Center, Toronto, ON M4N 3M5, Canada;
| | - Christopher J. D. Wallis
- Division of Urology and Surgical Oncology, Department of Surgery, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON M5R 0A3, Canada;
- Division of Urology, University of Toronto, Toronto, ON M5R 0A3, Canada
- Division of Urology, Mount Sinai Hospital, Toronto, ON M5G 1X5, Canada
| | - Raj Satkunasivam
- Department of Urology, Houston Methodist Hospital, Houston, TX 77030, USA; (C.R.); (S.R.); (E.H.); (Z.M.); (S.H.); (B.J.M.); (D.K.)
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Riveros C, Ranganathan S, Huang E, Ordonez A, Xu J, Geng M, Miles BJ, Esnaola N, Klaassen Z, Jerath A, Kim SJ, Wallis CJD, Satkunasivam R. Glomerular hyperfiltration is an independent predictor of postoperative outcomes: A NSQIP multi-specialty surgical cohort analysis. Nephrology (Carlton) 2023; 28:548-556. [PMID: 37468129 DOI: 10.1111/nep.14221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 07/04/2023] [Accepted: 07/07/2023] [Indexed: 07/21/2023]
Abstract
AIM While high estimated glomerular filtration rate (eGFR) has been associated with increased overall mortality, its effect on postoperative outcomes is relatively understudied. We sought to investigate the association between high eGFR and 30-day postoperative outcomes using a multi-specialty surgical cohort. METHODS Using the National Surgical Quality Improvement Program database, we selected adult for whom eGFR could be calculated using the 2021 Chronic Kidney Disease Epidemiology Collaboration equation. Based on sex-specific distributions of eGFR stratified by age quintiles, we classified patients into low (<5th percentile), normal (5-95th percentile) and high eGFR (>95th percentile). The primary outcome was a composite of any 30-day major adverse outcomes, including: death, reoperation, cardiac arrest, myocardial infarction and stroke. Secondary outcomes included 30-day infectious complications, venous thromboembolism (VTE), bleeding requiring transfusion, prolonged length of stay and unplanned readmission. After matching for demographic differences, comorbidity burden and operative characteristics, logistic regression models were used to evaluate the association between extremes of eGFR and the outcomes of interest. RESULTS Of 1 668 447 patients, 84 115 (5.07%) had a high eGFR. High eGFR was not associated with major adverse outcomes (odds ratio [OR] 1.00 [95% confidence interval (CI): 0.97, 1.03]); however, it was associated with reoperation (OR 1.04 [95% CI: 1.00,1.08]), infectious complications (OR 1.14 [95% CI: 1.11, 1.16]), VTE (OR 1.15 [95% CI: 1.09, 1.22]) and prolonged length of stay (OR 1.19 [95% CI: 1.16, 1.21]). CONCLUSION Our findings support an association between high eGFR and adverse 30-day postoperative outcomes.
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Affiliation(s)
- Carlos Riveros
- Department of Urology, Houston Methodist Hospital, Houston, Texas, USA
| | | | - Emily Huang
- Department of Urology, Houston Methodist Hospital, Houston, Texas, USA
| | - Adriana Ordonez
- Center for Health Data Science and Analytics, Houston Methodist Research Institute, Houston, Texas, USA
| | - Jiaqiong Xu
- Center for Health Data Science and Analytics, Houston Methodist Research Institute, Houston, Texas, USA
| | - Michael Geng
- School of Engineering Medicine, Texas A&M University, Houston, Texas, USA
| | - Brian J Miles
- Department of Urology, Houston Methodist Hospital, Houston, Texas, USA
| | - Nestor Esnaola
- Department of Surgery, Houston Methodist Hospital, Houston, Texas, USA
| | - Zachary Klaassen
- Division of Urology, Medical College of Georgia, Augusta University, Augusta, Georgia, USA
| | - Angela Jerath
- Department of Anesthesia, Sunnybrook Health Sciences Center, Toronto, Canada
| | - S Joseph Kim
- Division of Nephrology and the Kidney Transplant Program, University Health Network, University of Toronto, Toronto, Canada
| | - Christopher J D Wallis
- Division of Urology and Surgical Oncology, Department of Surgery, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Canada
- Division of Urology, University of Toronto, Toronto, Canada
- Division of Urology, Mount Sinai Hospital, Toronto, Canada
| | - Raj Satkunasivam
- Department of Urology, Houston Methodist Hospital, Houston, Texas, USA
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Doyle LW, Ranganathan S, Spittle A, Opie G, Mainzer R, Cheong JL. Expiratory airflow at 7-8 years of age in children born extremely low birthweight from 14 years before to 14 years after the introduction of exogenous surfactant. EClinicalMedicine 2023; 62:102115. [PMID: 37533420 PMCID: PMC10393553 DOI: 10.1016/j.eclinm.2023.102115] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 07/05/2023] [Accepted: 07/06/2023] [Indexed: 08/04/2023] Open
Abstract
Background It is unclear if expiratory airflow in survivors born extremely low birth weight (ELBW; 500-999 g) has improved after the introduction of exogenous surfactant into clinical practice in 1991. The primary aim of this study was to describe the changes in airflow at 7-8 years of age of survivors born ELBW in five discrete cohorts from 14 years before to 14 years after the introduction of exogenous surfactant into clinical practice. Methods The cohorts comprised consecutive survivors born ELBW in 1977-82 and 1985-87 at the Royal Women's Hospital, Melbourne, and in 1991-92, 1997 and 2005 in the state of Victoria, Australia. Survival rates to 2-years of age for infants born ELBW in the state of Victoria rose from approximately 1-in-4 to 3-in-4 over the time of this study. Expiratory airflow measurements at 7-8 years included the forced expired volume in 1 s (FEV1), converted to z-scores for age, height, sex, and race. Findings There were 596 ELBW participants with expiratory flow data, 280 (47%) of whom had bronchopulmonary dysplasia (BPD). Overall, there was little change in zFEV1 over the 28-year period (mean change per year; 0.003, 95% CI -0.010, 0.015, P = 0.67). There was, however, evidence of an interaction between BPD and year; zFEV1 in those who had BPD fell over time (mean change per year -0.019, 95% CI -0.037, -0.009, P = 0.035), whereas zFEV1 improved in those who did not have BPD (mean change per year 0.021, 95% CI 0.006, 0.037, P = 0.007). Interpretation Contrary to recent evidence, expiratory airflow of children born ELBW has not improved with the introduction of surfactant, and may be deteriorating in those who had BPD. Funding National Health and Medical Research Council (Australia); Victorian Government's Operational Infrastructure Support Program.
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Affiliation(s)
- Lex W. Doyle
- Department of Obstetrics and Gynaecology, The Royal Women's Hospital, Melbourne, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Australia
- Newborn Services, The Royal Women's Hospital, Melbourne, Australia
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia
| | - S. Ranganathan
- Department of Paediatrics, University of Melbourne, Melbourne, Australia
- Department of Respiratory Medicine, Royal Children's Hospital, Melbourne, Australia
| | - A.J. Spittle
- Newborn Services, The Royal Women's Hospital, Melbourne, Australia
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia
- Department of Physiotherapy, University of Melbourne, Melbourne, Australia
| | - G. Opie
- Neonatal Services, Mercy Hospital for Women, Melbourne, Australia
| | - R.M. Mainzer
- Department of Paediatrics, University of Melbourne, Melbourne, Australia
- Clinical Epidemiology and Biostatistics, Murdoch Children's Research Institute, Melbourne, Australia
| | - Jeanie L.Y. Cheong
- Department of Obstetrics and Gynaecology, The Royal Women's Hospital, Melbourne, Australia
- Newborn Services, The Royal Women's Hospital, Melbourne, Australia
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia
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Riveros C, Huang E, Ranganathan S, Klaassen Z, Rini B, Wallis CJD, Satkunasivam R. Adjuvant immunotherapy in renal cell carcinoma: a systematic review and meta-analysis. BJU Int 2023; 131:553-561. [PMID: 36709462 DOI: 10.1111/bju.15981] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
OBJECTIVES To synthesise available data regarding the disease-free survival (DFS) benefit of adjuvant immune checkpoint inhibitors (ICIs) for patients with renal cell carcinoma (RCC) and evaluate the overall safety profile of ICIs in this setting. MATERIALS AND METHODS We utilised PubMed, Embase, and relevant conference proceedings to identify phase III randomised controlled trials comparing adjuvant ICIs vs placebo/observation for RCC. The primary outcome of interest was DFS. Variables for subgroup analyses were programmed death-ligand 1 (PD-L1) expression, sarcomatoid features, nephrectomy type, and disease-risk category. Secondary outcomes included Grade ≥3 adverse events (AEs), immune-related AEs, and treatment discontinuation due to AEs. All outcomes were analysed using random-effects models owing to inter-study heterogeneity. RESULTS Among the four included studies, one demonstrated a significant DFS benefit. There was considerable clinical and statistical heterogeneity (I2 = 64%) due to differences in inclusion criteria and interventions. While pooled results across the four studies did not demonstrate a significant benefit in DFS overall (hazard ratio [HR] 0.85, 95% confidence interval [CI] 0.69-1.04) there was significant benefit among patients with positive PD-L1 expression (HR 0.72, 95% CI 0.55-0.94) and sarcomatoid features (HR 0.59, 95% CI 0.38-0.91). CONCLUSION The evidence base to date regarding ICIs as adjuvant therapy in RCC is mixed - conclusions are limited by considerable heterogeneity between studies. However, pooled analyses suggest that patients with positive PD-L1 expression or sarcomatoid features are most likely to benefit from adjuvant immunotherapy.
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Affiliation(s)
- Carlos Riveros
- Department of Urology, Houston Methodist Hospital, Houston, TX, USA
| | - Emily Huang
- Department of Urology, Houston Methodist Hospital, Houston, TX, USA
| | | | - Zachary Klaassen
- Division of Urology, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Brian Rini
- Division of Hematology and Oncology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Christopher J D Wallis
- Division of Urology and Surgical Oncology, Department of Surgery, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON, Canada
- Division of Urology, University of Toronto, Toronto, ON, Canada
- Division of Urology, Mount Sinai Hospital, Toronto, ON, Canada
| | - Raj Satkunasivam
- Department of Urology, Houston Methodist Hospital, Houston, TX, USA
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Lim K, Riveros C, Ranganathan S, Xu J, Patel A, Slawin J, Ordonez A, Aghazadeh M, Morgan M, Miles BJ, Esnaola N, Klaassen Z, Allenson K, Brooks M, Wallis CJD, Satkunasivam R. Morbidity and mortality of multivisceral resection with radical nephrectomy for locally advanced renal cell carcinoma: An analysis of the National Surgical Quality Improvement Program (NSQIP) database. Urol Oncol 2023; 41:209.e1-209.e9. [PMID: 36801191 DOI: 10.1016/j.urolonc.2023.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 12/09/2022] [Accepted: 01/09/2023] [Indexed: 02/21/2023]
Abstract
INTRODUCTION Locally advanced renal cell carcinoma (RCC) can rarely invade into adjacent abdominal viscera without clinical evidence of distant metastases. The role of multivisceral resection (MVR) of involved adjacent organs at the time of radical nephrectomy (RN) remains poorly described and quantified. Using a national database, we aimed to evaluate the association between RN+MVR and 30-day postoperative complications. METHODS AND MATERIALS We conducted a retrospective cohort study of adult patients undergoing RN for RCC with and without MVR between 2005 and 2020 using the ACS-NSQIP database. The primary outcome was a composite of any of the following 30-day major postoperative complications: mortality, reoperation, cardiac event, and neurologic event. Secondary outcomes included individual components of the composite primary outcome, as well as infectious and venous thromboembolic complications, unplanned intubation and ventilation, transfusion, readmission, and prolonged length of stay (LOS). Groups were balanced using propensity score matching. Likelihood of complications was assessed by conditional logistic regression adjusted for unbalanced total operation time. Postoperative complications were compared by Fisher's exact test among subtypes of resection. RESULTS A total of 12,417 patients were identified: 12,193 (98.2%) undergoing RN alone and 224 (1.8%) undergoing RN+MVR. Patients undergoing RN+MVR were more likely to experience major complications (odds ratio [OR] 2.46; 95% confidence interval [CI] 1.28-4.74). However, there was no significant association between RN+MVR and postoperative mortality (OR 2.49; 95% CI 0.89-7.01). RN+MVR was associated with higher rates of reoperation (OR 7.85; 95% CI 2.38-25.8), sepsis (OR 5.45; 95% CI 1.83-16.2), surgical site infection (OR 4.41; 95% CI 2.14-9.07), blood transfusion (OR 2.24; 95% CI 1.55-3.22), readmission (OR 1.78; 95% CI 1.11-2.84), infectious complications (OR 2.62; 95% CI 1.62-4.24), and longer hospital stay (5 days [IQR 3-8] vs. 4 days [IQR 3-7]; OR 2.31 [95% CI 2.13-3.03]). There was no heterogeneity in the association between subtype of MVR and major complication rate. CONCLUSION Undergoing RN+MVR is associated with an increased risk of 30-day postoperative morbidity, including infectious complications, reoperation, blood transfusion, prolonged LOS, and readmission.
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Affiliation(s)
- Kelvin Lim
- Department of Urology, Houston Methodist Hospital, Houston, TX
| | - Carlos Riveros
- Department of Urology, Houston Methodist Hospital, Houston, TX
| | | | - Jiaqiong Xu
- Center for Health Data Science and Analytics, Houston Methodist Research Institute, Houston, TX
| | - Ashmi Patel
- Department of Urology, Houston Methodist Hospital, Houston, TX
| | - Jeremy Slawin
- Department of Urology, Houston Methodist Hospital, Houston, TX
| | - Adriana Ordonez
- Center for Health Data Science and Analytics, Houston Methodist Research Institute, Houston, TX
| | - Monty Aghazadeh
- Department of Urology, Houston Methodist Hospital, Houston, TX
| | - Monica Morgan
- Department of Urology, Houston Methodist Hospital, Houston, TX
| | - Brian J Miles
- Department of Urology, Houston Methodist Hospital, Houston, TX
| | - Nestor Esnaola
- Department of Surgery, Houston Methodist Hospital, Houston, TX
| | - Zachary Klaassen
- Division of Urology, Medical College of Georgia, Augusta University, Augusta, GA
| | - Kelvin Allenson
- Department of Surgery, Houston Methodist Hospital, Houston, TX
| | - Michael Brooks
- Department of Urology, Houston Methodist Hospital, Houston, TX
| | - Christopher J D Wallis
- Division of Urology and Surgical Oncology, Department of Surgery, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada; Division of Urology, University of Toronto, Toronto, Ontario, Canada; Division of Urology, Mount Sinai Hospital, Toronto, Ontario, Canada
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11
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Riveros C, Ranganathan S, Nipper C, Lim K, Brooks M, Dursun F, Miles BJ, Goh AC, Desai M, Klaassen Z, Kulkarni GS, Wallis CJD, Satkunasivam R. Open vs. robot-assisted radical cystectomy with extracorporeal or intracorporeal urinary diversion for bladder cancer A pairwise meta-analysis of outcomes and a network meta-analysis of complications. Can Urol Assoc J 2023; 17:E75-E85. [PMID: 36473475 PMCID: PMC10027355 DOI: 10.5489/cuaj.8096] [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: 11/19/2022]
Abstract
INTRODUCTION There are no meta-analyses of randomized controlled trials (RCTs) comparing open radical cystectomy (OR C) with robot-assisted radical cystectomy (RARC), inclusive of both intracorporeal (iRARC) and extracorporeal (hybrid RARC, hRARC) urinary reconstruction. METHODS MEDL INE, Embase, Scopus, the International Clinical Trials Registry Platform and ClinicalTrials.gov registries were searched in May 2022. Outcomes of interest included recurrence- or progression-free survival (RFS/PFS), margin status and lymph node yield, mean estimated blood loss (EBL) and operating room time (ORT ), hospital length of stay (LOS ), 90-day complications and readmissions, and quality of life (QoL). Pairwise meta-analyses and network meta-analyses were performed using random-effects models and Bayesian hierarchical random-effects models, respectively. RESULTS We found no significant differences between RARC and OR C for oncological and most perioperative outcomes: RFS/PFS (hazard ratio [HR ] 0.91, 95% confidence interval [CI] 0.67-1.23); positive surgical margins (odds ratio [OR ] 1.05, 95% CI 0.60-1.85); lymph node yield (mean difference [MD ] -0.63, 95% CI -2.63-1.37); LOS (MD -0.22, 95% CI -1.10-0.65); overall complications (OR 0.81, 95% CI 0.61-1.07); major complications (OR 0.94, 95% CI 0.69-1.30); readmissions (OR 0.90, 95% CI 0.60-1.35); and QoL (standardized MD -0.02, 95% CI -0.17-0.14). We found significantly lower EBL for RARC compared to OR C (MD -312.61, 95% CI -447 to -178.22) at the expense of significantly prolonged ORT (MD 82.34 minutes, 95% CI 44.82-119.86). Network meta-analysis did not find significant differences in complications between hRARC and iRARC. CONCLUSIONS This meta-analysis confirms the equivalence of RARC and OR C with respect to oncological outcomes.
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Affiliation(s)
- Carlos Riveros
- Department of Urology, Houston Methodist Hospital, Houston, TX, United States
| | - Sanjana Ranganathan
- Department of Urology, Houston Methodist Hospital, Houston, TX, United States
| | - Cole Nipper
- Department of Urology, Houston Methodist Hospital, Houston, TX, United States
| | - Kelvin Lim
- Department of Urology, Houston Methodist Hospital, Houston, TX, United States
| | - Michael Brooks
- Department of Urology, Houston Methodist Hospital, Houston, TX, United States
| | - Furkan Dursun
- Department of Urology, University of Texas Health, San Antonio, TX, United States
| | - Brian J Miles
- Department of Urology, Houston Methodist Hospital, Houston, TX, United States
| | - Alvin C Goh
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York City, NY, United States
| | - Mihir Desai
- USC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Zachary Klaassen
- Division of Urology, Medical College of Georgia, Augusta University, Augusta, GA, United States
| | - Girish S Kulkarni
- Division of Urology and Surgical Oncology, Department of Surgery, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON, Canada
- Division of Urology, University of Toronto, Toronto, ON, Canada
| | - Christopher J D Wallis
- Division of Urology and Surgical Oncology, Department of Surgery, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON, Canada
- Division of Urology, University of Toronto, Toronto, ON, Canada
- Division of Urology, Mount Sinai Hospital, Toronto, ON, Canada
| | - Raj Satkunasivam
- Department of Urology, Houston Methodist Hospital, Houston, TX, United States
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Riveros C, Ranganathan S, Xu J, Chang C, Kaushik D, Morgan M, Miles BJ, Muhammad T, Anis M, Aghazadeh M, Zhang J, Efstathiou E, Klaassen Z, Brooks MA, Rini B, Wallis CJD, Satkunasivam R. Comparative real-world survival outcomes of metastatic papillary and clear cell renal cell carcinoma treated with immunotherapy, targeted therapy, and combination therapy. Urol Oncol 2023; 41:150.e1-150.e9. [PMID: 36610815 DOI: 10.1016/j.urolonc.2022.11.022] [Citation(s) in RCA: 1] [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: 09/14/2022] [Revised: 11/14/2022] [Accepted: 11/27/2022] [Indexed: 01/07/2023]
Abstract
INTRODUCTION While there are a plethora of studies supporting novel treatment approaches in metastatic clear cell renal cell carcinoma (ccRCC), much of the data used to inform care of patients with metastatic papillary RCC (pRCC) is extrapolated from ccRCC. Several recent phase III trials have supported the use of immunotherapy (IO) and targeted therapy (TT)+IO in ccRCC, without corresponding data for pRCC. Using ccRCC as a comparison group, we sought to describe real-world trends in the utilization of systemic therapy and its impact on overall survival (OS) among patients with metastatic pRCC. METHODS Using the National Cancer Database (NCDB), we identified cases of metastatic pRCC and ccRCC between 2015 and 2018. Patients were stratified into groups based on histology and first-line treatments (TT, IO, TT + IO). Differences in baseline characteristics were assessed using the Kruskal-Wallis test for continuous variables, and the Chi-square or Fisher's exact test for categorical variables. Survival analysis was performed using Kaplan-Meier estimates and multivariable Cox regression analyses. RESULTS A total of 6,920 patients with a diagnosis of metastatic RCC were identified: 594 (8.6%) with pRCC and 6,326 (91.4%) with ccRCC. Overall, 4,710 patients received TT (455 pRCC and 4,255 ccRCC), 1,585 received IO (77 pRCC and 1,508 ccRCC), and 625 received TT+IO (62 pRCC and 563 ccRCC). Temporal trend between 2015 and 2018 revealed an increased utilization of IO and TT + IO for pRCC and ccRCC. In patients with metastatic pRCC, neither IO (HR 1.03; 95% CI 0.75-1.42) nor TT+IO (HR 0.90, 95% CI 0.63-1.28) were associated with better OS compared to TT alone. In contrast, both IO and combination TT and IO were associated with significantly better OS than TT for patients with metastatic ccRCC (IO group: hazard ratio [HR] 0.75, 95% confidence interval [CI] 0.68-0.82; TT+IO group: HR 0.82, 95% CI 0.72-0.93). Cytoreductive nephrectomy was associated with better OS in both pRCC (HR 0.59, 95% CI 0.46-0.77) and ccRCC (HR 0.54, 95% CI 0.50-0.58). CONCLUSIONS Although IO and TT + IO were associated with better OS among patients with metastatic ccRCC, this same effect was not observed among patients with pRCC.
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Affiliation(s)
- Carlos Riveros
- Department of Urology, Houston Methodist Hospital, Houston, TX, USA
| | | | - Jiaqiong Xu
- Center for Health Data Science and Analytics, Houston Methodist Hospital, Houston, TX, USA
| | - Courtney Chang
- Department of Urology, Houston Methodist Hospital, Houston, TX, USA
| | - Dharam Kaushik
- Department of Urology, University of Texas Health, San Antonio, TX, USA
| | - Monica Morgan
- Department of Urology, Houston Methodist Hospital, Houston, TX, USA
| | - Brian J Miles
- Department of Urology, Houston Methodist Hospital, Houston, TX, USA
| | - Taliah Muhammad
- Department of Urology, Houston Methodist Hospital, Houston, TX, USA
| | - Maryam Anis
- Department of Urology, Houston Methodist Hospital, Houston, TX, USA
| | - Monty Aghazadeh
- Department of Urology, Houston Methodist Hospital, Houston, TX, USA
| | - Jun Zhang
- Department of Medical Oncology, Houston Methodist Hospital, Houston, TX, USA
| | - Eleni Efstathiou
- Department of Medical Oncology, Houston Methodist Hospital, Houston, TX, USA
| | - Zachary Klaassen
- Division of Urology, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Michael A Brooks
- Department of Urology, Houston Methodist Hospital, Houston, TX, USA
| | - Brian Rini
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Christopher J D Wallis
- Division of Urology and Surgical Oncology, Department of Surgery, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada; Division of Urology, University of Toronto, Toronto, Ontario, Canada; Division of Urology, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Raj Satkunasivam
- Department of Urology, Houston Methodist Hospital, Houston, TX, USA.
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Ranganathan S, Riveros C, Xu J, Geng M, Huang E, Anis M, Muhammad T, Zhang J, Efstathiou E, Wallis CJ, Sonpavde GP, Satkunasivam R. Chemotherapy, immunotherapy, or combination first-line treatment for metastatic urothelial carcinoma of the bladder: A large real-world experience. J Clin Oncol 2023. [DOI: 10.1200/jco.2023.41.6_suppl.477] [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: 03/16/2023] Open
Abstract
477 Background: First-line therapy for metastatic urothelial carcinoma of the bladder (mUC) consists of platinum-based chemotherapy in most patients and PD1/L1 inhibitors in selected patients. Multiple combination chemo-immunotherapy trials failed to show a clear benefit over chemotherapy alone. We sought to use real-world data to evaluate clinical and sociodemographic factors associated with receipt of first-line chemotherapy, immunotherapy or combination chemo-immunotherapy treatment for metastatic bladder cancer and examined differences in overall survival (OS). Methods: We used the National Cancer Database to identify patients with stage IV UCB diagnosed between 2014 and 2018, who were treated with first-line immunotherapy, chemotherapy, or combination treatment. We performed multivariable logistic regression modeling to determine factors associated with treatment receipt. An extension of inverse probability treatment weighting (IPTW) obtained from multinomial logistic regression was used to balance clinical and sociodemographic differences between treatment groups. Adjusted Kaplan-Meier survival analysis and multivariable Cox proportional hazards regression were used to evaluate the association between treatment and OS. Results: A total of 4,169 patients were identified in the cohort; 3,255 (78.1%) were treated with chemotherapy, 601 (14.4%) with immunotherapy, and 313 (7.5%) with combination treatment. Multivariable analysis identified increasing age (RRR: 1.07, 95% CI, 1.06-1.08), comorbidity burden (Charlson-Deyo 2, RRR: 1.65, 95% CI, 1.21-2.24 and Charlson-Deyo 3, RRR: 2.11; 95% CI, 1.51-2.93), and treatment at an academic facility (RRR: 1.26; 95% CI, 1.03-1.53) as independent predictors of receiving immunotherapy. Treatment at an academic facility (RRR: 1.29, 95% CI, 1.01-1.65) was associated with receipt of combination treatment. After IPTW, we found that combination therapy (hazard ratio [HR]: 0.72; 95% CI, 0.62-0.83), but not immunotherapy alone, was associated with improved survival compared to chemotherapy. These data are limited by inability to determine platinum eligibility, and residual confounding. Conclusions: Patients with older age and more comorbidities were more likely to receive immunotherapy than chemotherapy for first-line treatment of metastatic urothelial carcinoma of the bladder. Modest real-world utilization of chemo-immunotherapy was observed to be higher in academic centers and was associated with improved survival compared to chemotherapy. The study is limited by retrospective design; prospective data are necessary to identify patients who may benefit from combination chemo-immunotherapy.
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Affiliation(s)
| | - Carlos Riveros
- Department of Urology, Houston Methodist Hospital, Houston, TX
| | - Jiaqiong Xu
- Center for Health Data Science and Analytics, Houston Methodist Hospital, Houston, TX
| | - Michael Geng
- Texas A&M University, College of Medicine, Houston, TX
| | | | - Maryam Anis
- Department of Urology, Houston Methodist Hospital, Houston, TX
| | - Taliah Muhammad
- Department of Urology, Houston Methodist Hospital, Houston, TX
| | - Jun Zhang
- Houston Methodist Cancer Center, Houston, TX
| | - Eleni Efstathiou
- Department of Medical Oncology, Houston Methodist Hospital, Houston, TX
| | | | | | - Raj Satkunasivam
- Department of Urology and Center for Outcomes Research, Houston Methodist Hospital, Houston, TX
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Huang E, Riveros C, Ranganathan S, Klaassen Z, Rini BI, Wallis CJ, Satkunasivam R. Adjuvant immunotherapy in renal cell carcinoma: A systematic review and meta-analysis of randomized clinical trials. J Clin Oncol 2023. [DOI: 10.1200/jco.2023.41.6_suppl.671] [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: 03/15/2023] Open
Abstract
671 Background: There has been interest in adjuvant immune checkpoint inhibition (ICI) following surgical resection in patients with high-risk renal cell carcinoma (RCC) given high recurrence rates and approvals of ICI in metastatic RCC. The primary objective of this analysis was to synthesize available data regarding the disease-free survival (DFS) benefit of adjuvant ICIs for patients with RCC. Methods: This systematic review was performed according to the PRISMA guidelines. The protocol was registered in PROSPERO (CRD42022361599). We searched PubMed, EMBASE, and relevant conference proceedings to identify phase III randomized controlled trials (RCTs) comparing adjuvant ICI versus placebo/observation. The primary outcome of interest was DFS. Results: Among the four included studies, one demonstrated a significant DFS benefit. There was considerable clinical and statistical heterogeneity (I2=64%) due to differences in inclusion criteria and interventions. While pooled results across the four studies did not demonstrate a significant benefit in DFS overall (HR 0.85, 95% CI 0.69-1.04), there was significant benefit among patients with positive PD-L1 expression (HR 0.72, 95% CI 0.55-0.94) or sarcomatoid features (HR 0.59, 95% CI 0.38-0.91). Conclusions: The evidence base to date regarding ICI as adjuvant therapy in RCC is mixed – conclusions are limited by considerable heterogeneity between studies. However, pooled analyses suggest that patients with positive PDL1 expression or sarcomatoid features are most likely to benefit from adjuvant immunotherapy.
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Affiliation(s)
| | - Carlos Riveros
- Department of Urology, Houston Methodist Hospital, Houston, TX
| | | | - Zachary Klaassen
- Division of Urology, Medical College of Georgia, Augusta University, Augusta, GA
| | - Brian I. Rini
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Christopher J.D. Wallis
- Division of Urology and Surgical Oncology, Department of Surgery, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON, Canada
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Riveros C, Ranganathan S, Haque W, Xu J, Geng M, Anis M, Muhammad T, Farach AM, Teh BS, Wallis CJ, Sonpavde GP, Satkunasivam R. Comparative real-world survival outcomes of muscle-invasive bladder cancer treated with bladder-only vs. whole-pelvis concurrent chemoradiation. J Clin Oncol 2023. [DOI: 10.1200/jco.2023.41.6_suppl.488] [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: 03/16/2023] Open
Abstract
488 Background: Elective nodal irradiation for patients with muscle-invasive bladder cancer (MIBC) undergoing trimodal therapy (TMT) is controversial. In patients with node-negative (N0) MIBC, the benefit of elective whole-pelvis concurrent chemoradiotherapy (WP-CCRT) compared to bladder-only (BO)-CCRT has not been demonstrated. Currently, the National Comprehensive Cancer Network (NCCN) guidelines do not recommend whether to include pelvic nodes in the radiation field. Using real-world data from the National Cancer Database (NCDB), we sought to compare the overall survival (OS) between BO-CCRT and WP-CCRT for MIBC. Methods: Using the 2019 NCDB Participant User File, we identified cases of MIBC diagnosed between 2017 and 2018. We selected patients with clinical T2-T4N0M0 disease receiving TMT as first-line treatment. TMT was defined as transurethral resection of bladder tumor followed by CCRT: 60–65 Gy of RT delivered to the bladder with concurrent single- or multiple-agent chemotherapy. Patients were stratified into BO-CCRT vs. WP-CCRT. Overall survival (OS) analysis was performed using Kaplan-Meier estimates and multivariable Cox proportional hazards regression analysis. The variables included in the multivariable Cox regression model were age, sex, race, comorbidity burden (as per the Charlson-Deyo comorbidity index), facility type, insurance status, median income quartile, rurality, distance from facility, and clinical T stage. Results: A total of 605 patients receiving TMT for MIBC were identified: 162 (26.8%) BO-CCRT and 443 (73.2%) WP-CCRT. The median follow-up time was 25.6 months (interquartile range [IQR]: 4.8-42.6) and 28.7 months (IQR: 3.0-51.6) for BO-CCRT and WP-CCRT, respectively. The median OS was 32.9 months (95% confidence interval [CI] 30.8 – not reached) and 48.3 months (95% CI 39.6 – not reached) for BO-CCRT and WP-CCRT, respectively. However, multivariable Cox regression analysis failed to find an association between WP-CCRT (hazard ratio [HR] 1.08, 95% CI 0.76-1.54) and improved OS, compared to BO-CCRT. Conclusions: Elective nodal-irradiation (WP-CCRT) in the setting of TMT for MIBC was not associated with a benefit in OS compared to BO-CCRT.
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Affiliation(s)
- Carlos Riveros
- Department of Urology, Houston Methodist Hospital, Houston, TX
| | | | - Waqar Haque
- Department of Radiation Oncology, Houston Methodist Hospital, Houston, TX
| | - Jiaqiong Xu
- Center for Health Data Science and Analytics, Houston Methodist Hospital, Houston, TX
| | - Michael Geng
- Texas A&M University, College of Medicine, Houston, TX
| | - Maryam Anis
- Department of Urology, Houston Methodist Hospital, Houston, TX
| | - Taliah Muhammad
- Department of Urology, Houston Methodist Hospital, Houston, TX
| | - Andrew M. Farach
- Department of Radiation Oncology, Houston Methodist Hospital, Houston, TX
| | - Bin S. Teh
- Department of Radiation Oncology, Houston Methodist Hospital, Houston, TX
| | - Christopher J.D. Wallis
- Division of Urology and Surgical Oncology, Department of Surgery, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON, Canada
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Shanthikumar S, Kim S, Giacalone V, Rao P, Ranganathan S, Karpievitch Y, Stick S, Boucher R, Tirouvanziam R, Chandler J, Esther C. 446 Metabolites in early life bronchoalveolar fluid associate with future bronchiectasis risk in children with cystic fibrosis. J Cyst Fibros 2022. [DOI: 10.1016/s1569-1993(22)01136-5] [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: 11/07/2022]
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17
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Ranganathan S, Entezari P, Gabr A, Gordon A, Kulik L, Desai K, Thornburg B, Riaz A, Salem R, Lewandowski R. Abstract No. 309 Evaluating liver function status trends in hepatocellular carcinoma patients with intermediate-stage disease undergoing radioembolization: a longitudinal study. J Vasc Interv Radiol 2022. [DOI: 10.1016/j.jvir.2022.03.390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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18
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Deschamp A, Chen Y, Wang W, Rasic M, Hatch J, Sanders D, Ranganathan S, Ferkol T, Perkins D, Davis S, Finn P. 200: The association of growth and the gut microbiome in infants with cystic fibrosis. J Cyst Fibros 2021. [DOI: 10.1016/s1569-1993(21)01625-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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19
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Esther C, Shanthikumar S, Schultz A, McNally P, Ranganathan S, Stick S, Boucher R. 576: Ivacaftor treatment alters the relationship between mucoinflammation and structural lung disease in preschool-aged children with CF. J Cyst Fibros 2021. [DOI: 10.1016/s1569-1993(21)01999-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Abstract
A new dry-mixing process for producing iodine- and iron-fortified salt on a large scale (20 30 metric tons per shift) was developed in salt factories at Valinokkam and Hyderabad, India. Common salt is mixed with 1% sodium hexametaphosphate, 0.5% ferrous sulphate heptahydrate, and 0.0055% potassium iodide or 0.007% potassium iodate in a ribbon blender. Dry mixing is superior to spray mixing and is associated with no operational problems. The fortified salt produced by this method retains the original colour of the unfortified salt, and the distribution of iodine and iron is uniform. The acceptability of the fortified salt is satisfactory, as various food preparations using the product are indistinguishable in colour, taste, and flavour from those containing unfortified salt
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Abstract
One practical way to control iron-deficiency anaemia is to fortify edible salt with iron. Effective implementation of a programme for producing and distributing iron-fortified salt requires regular monitoring of edible salt for iron, particularly at the retail sales and household levels. A simple, inexpensive (10 rupees) field kit was developed for this purpose. No glassware has to be carried, and reagents are supplied in the form of tablets. It is possible to detect iron fevers as low as 50 parts per million (ppm) and as high as 1,000 ppm. One kit can be used to test 200 salt samples.
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Affiliation(s)
- B. S. Narasinga Rao
- National Institute of Nutrition, Indian Council of Medical Research, Jamai-Osmania, Hyderabad-500007, India
| | - S. Ranganathan
- National Institute of Nutrition, Indian Council of Medical Research, Jamai-Osmania, Hyderabad-500007, India
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23
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Bove KE, Sheridan R, Fei L, Anders R, Chung CT, Cummings OW, Finegold MJ, Finn L, Ranganathan S, Kim G, Lovell M, Magid MS, Melin-Aldana H, Russo P, Shehata B, Wang L, White F, Chen Z, Spino C, Magee JC. Hepatic Hilar Lymph Node Reactivity at Kasai Portoenterostomy for Biliary Atresia: Correlations With Age, Outcome, and Histology of Proximal Biliary Remnant. Pediatr Dev Pathol 2018; 21:29-40. [PMID: 28474973 PMCID: PMC7986481 DOI: 10.1177/1093526617707851] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
We hypothesized that if infection is the proximate cause of congenital biliary atresia, an appropriate response to antigen would occur in lymph nodes contiguous with the biliary remnant. We compared the number of follicular germinal centers (GC) in 79 surgically excised hilar lymph nodes (LN) and 27 incidentally discovered cystic duct LNs in 84 subjects at the time of hepatic portoenterostomy (HPE) for biliary atresia (BA) to autopsy controls from the pancreaticobiliary region of non-septic infants >3 months old at death. All 27 control LN lacked GC, a sign in infants of a primary response to antigenic stimulation. GC were found in 53% of 106 LN in 56 of 84 subjects. Visible surgically excised LN contiguous with the most proximal biliary remnants had 1 or more well-formed reactive GC in only 26/51 subjects. Presence of GC and number of GC/LN was unrelated to age at onset of jaundice or to active fibroplasia in the biliary remnant but was related to older age at HPE. Absent GC in visible and incidentally removed cystic duct LNs predicted survival with the native liver at 2 and 3 years after HPE, P = .03, but significance was lost at longer intervals. The uncommon inflammatory lesions occasionally found in remnants could be secondary either to bile-induced injury or secondary infection established as obstruction evolves. The absence of consistent evidence of antigenic stimulation in LN contiguous with the biliary remnant supports existence of at least 1 major alternative to infection in the etiology of biliary atresia.
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Affiliation(s)
- KE Bove
- Division of Pathology and Laboratory Medicine and Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - R Sheridan
- Division of Pathology and Laboratory Medicine and Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - L Fei
- Division of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - R Anders
- Department of Pathology, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - CT Chung
- Division of Pathology, The Hospital for Sick Children, Toronto, Canada
| | - OW Cummings
- Department of Pathology, Indiana University School of Medicine, Indianapolis, Indiana
| | - MJ Finegold
- Department of Pathology, Texas Children’s Hospital, Houston, Texas
| | - L Finn
- Department of Pathology, Seattle Children’s Hospital, Seattle, Washington
| | - S Ranganathan
- Department of Pathology, Children’s Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania
| | - G Kim
- Department of Anatomic Pathology, University of California, San Francisco, San Francisco, California
| | - M Lovell
- Department of Pathology, Children’s Hospital Colorado, Aurora, Colorado
| | - MS Magid
- Department of Pathology, Kravis Children’s Hospital, Mount Sinai Medical Center, New York, New York
| | - H Melin-Aldana
- Department of Pathology, Ann & Robert H. Lurie Children’s Hospital, Chicago, Illinois
| | - P Russo
- Department of Pathology and Laboratory Medicine, the Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - B Shehata
- Department of Pathology, Children’s Healthcare of Atlanta, Atlanta, Georgia
| | - L Wang
- Department of Pathology, Children’s Hospital Los Angeles, Los Angeles, California
| | - F White
- Department of Pathology and Immunology, Washington University School of Medicine, St Louis, Missouri
| | - Z Chen
- Quest Diagnostics, Health Informatics, Madison New Jersey
| | - C Spino
- Department of Biostatistics, University of Michigan, Ann Arbor, Michigan
| | - JC Magee
- Department of Surgery, University of Michigan, Ann Arbor, Michigan
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24
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McCloskey K, Ponsonby AL, Collier F, Allen K, Tang MLK, Carlin JB, Saffery R, Skilton MR, Cheung M, Ranganathan S, Dwyer T, Burgner D, Vuillermin P. The association between higher maternal pre-pregnancy body mass index and increased birth weight, adiposity and inflammation in the newborn. Pediatr Obes 2018; 13:46-53. [PMID: 27723247 DOI: 10.1111/ijpo.12187] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Accepted: 08/29/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND Excess adiposity and adiposity-related inflammation are known risk factors for cardiovascular disease in adults; however, little is known regarding the determinants of adiposity-related inflammation at birth. OBJECTIVES The aim of this study was to investigate the association between maternal pre-pregnancy BMI and newborn adiposity and inflammation. METHODS Paired maternal (28-week gestation) and infant (umbilical cord) blood samples were collected from a population-derived birth cohort (Barwon Infant Study, n = 1074). Data on maternal comorbidities and infant birth anthropomorphic measures were compiled, and infant aortic intima-media thickness was measured by trans-abdominal ultrasound. In a selected subgroup of term infants (n = 161), matched maternal and cord lipids, high-sensitivity C-reactive protein (hsCRP) and maternal soluble CD14 were measured. Analysis was completed by using pairwise correlation and linear regression. Because of their non-normal distribution, pathology blood measures were log transformed prior to analysis. RESULTS Maternal pre-pregnancy BMI was positively associated with increased birth weight (mean difference 17.8 g per kg m-2 , 95% CI 6.6 to 28.9; p = 0.002), newborn mean skin-fold thickness (mean difference 0.1 mm per kg m-2 , 95% CI 0.0 to 0.1; p < 0.001) and cord blood hsCRP (mean difference of 4.2% increase in hsCRP per kg m-2 increase in pre-pregnancy BMI, 95% CI 0.6 to 7.7%, p = 0.02), but not cord blood soluble CD14. Inclusion of maternal hsCRP as a covariate attenuated the associations between pre-pregnancy BMI and both newborn skin-fold thickness and cord blood hsCRP. CONCLUSION Higher maternal pre-pregnancy BMI is associated with increased newborn adiposity and inflammation. These associations may be partially mediated by maternal inflammation during pregnancy.
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Affiliation(s)
- K McCloskey
- Murdoch Childrens Research Institute, Royal Children's Hospital, Parkville, Australia.,Child Health Research Unit, Barwon Health, Geelong, Australia.,Department of Paediatrics, University of Melbourne, Parkville, Australia
| | - A-L Ponsonby
- Murdoch Childrens Research Institute, Royal Children's Hospital, Parkville, Australia.,Department of Paediatrics, University of Melbourne, Parkville, Australia
| | - F Collier
- Child Health Research Unit, Barwon Health, Geelong, Australia.,Deakin University, Geelong, Australia
| | - K Allen
- Murdoch Childrens Research Institute, Royal Children's Hospital, Parkville, Australia.,Department of Paediatrics, University of Melbourne, Parkville, Australia
| | - M L K Tang
- Murdoch Childrens Research Institute, Royal Children's Hospital, Parkville, Australia.,Department of Paediatrics, University of Melbourne, Parkville, Australia
| | - J B Carlin
- Murdoch Childrens Research Institute, Royal Children's Hospital, Parkville, Australia.,Department of Paediatrics, University of Melbourne, Parkville, Australia
| | - R Saffery
- Murdoch Childrens Research Institute, Royal Children's Hospital, Parkville, Australia.,Department of Paediatrics, University of Melbourne, Parkville, Australia
| | - M R Skilton
- Boden Institute of Obesity, Nutrition, Exercise and Eating Disorders, University of Sydney, Sydney, Australia
| | - M Cheung
- Murdoch Childrens Research Institute, Royal Children's Hospital, Parkville, Australia.,Department of Paediatrics, University of Melbourne, Parkville, Australia
| | - S Ranganathan
- Murdoch Childrens Research Institute, Royal Children's Hospital, Parkville, Australia.,Department of Paediatrics, University of Melbourne, Parkville, Australia
| | - T Dwyer
- Murdoch Childrens Research Institute, Royal Children's Hospital, Parkville, Australia.,Department of Paediatrics, University of Melbourne, Parkville, Australia
| | - D Burgner
- Murdoch Childrens Research Institute, Royal Children's Hospital, Parkville, Australia.,Department of Paediatrics, University of Melbourne, Parkville, Australia.,Department of Paediatrics, Monash University, Clayton, Australia
| | - P Vuillermin
- Murdoch Childrens Research Institute, Royal Children's Hospital, Parkville, Australia.,Child Health Research Unit, Barwon Health, Geelong, Australia.,Deakin University, Geelong, Australia
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25
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Gray L, Leong O, O’Hely M, Collier F, Ranganathan S, Sly P, Tang M, Allen K, Vuillermin P. P43: FOOD ALLERGY BUT NOT SENSITISED TOLERANCE ASSOCIATES WITH SUBSEQUENT ASTHMA. Intern Med J 2017. [DOI: 10.1111/imj.43_13578] [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: 11/27/2022]
Affiliation(s)
- L Gray
- Deakin University; Melbourne Australia
- Barwon Health; Melbourne Australia
| | - O Leong
- Barwon Health; Melbourne Australia
| | - M O’Hely
- Deakin University; Melbourne Australia
- Murdoch Children’s Research Institute; Melbourne Australia
| | - F Collier
- Deakin University; Melbourne Australia
| | - S Ranganathan
- Murdoch Children’s Research Institute; Melbourne Australia
- Royal Children’s Hospital; Melbourne Australia
| | - P Sly
- University of Queensland; Brisbane Australia
| | - M Tang
- Murdoch Children’s Research Institute; Melbourne Australia
- Royal Children’s Hospital; Melbourne Australia
| | - K Allen
- Murdoch Children’s Research Institute; Melbourne Australia
- Royal Children’s Hospital; Melbourne Australia
| | - P Vuillermin
- Deakin University; Melbourne Australia
- Barwon Health; Melbourne Australia
- Murdoch Children’s Research Institute; Melbourne Australia
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26
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Molloy J, Koplin JJ, Allen KJ, Tang MLK, Collier F, Carlin JB, Saffery R, Burgner D, Ranganathan S, Dwyer T, Ward AC, Moreno-Betancur M, Clarke M, Ponsonby AL, Vuillermin P. Vitamin D insufficiency in the first 6 months of infancy and challenge-proven IgE-mediated food allergy at 1 year of age: a case-cohort study. Allergy 2017; 72:1222-1231. [PMID: 28042676 DOI: 10.1111/all.13122] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/31/2016] [Indexed: 12/13/2022]
Abstract
BACKGROUND Ecological evidence suggests vitamin D insufficiency (VDI) due to lower ambient ultraviolet radiation (UVR) exposure may be a risk factor for IgE-mediated food allergy. However, there are no studies relating directly measured VDI during early infancy to subsequent challenge-proven food allergy. OBJECTIVE To prospectively investigate the association between VDI during infancy and challenge-proven food allergy at 1 year. METHODS In a birth cohort (n = 1074), we used a case-cohort design to compare 25-hydroxyvitamin D3 (25(OH)D3 ) levels among infants with food allergy vs a random subcohort (n = 274). The primary exposures were VDI (25(OH)D3 <50 nM) at birth and 6 months of age. Ambient UVR and time in the sun were combined to estimate UVR exposure dose. IgE-mediated food allergy status at 1 year was determined by formal challenge. Binomial regression was used to examine associations between VDI, UVR exposure dose and food allergy and investigate potential confounding. RESULTS Within the random subcohort, VDI was present in 45% (105/233) of newborns and 24% (55/227) of infants at 6 months. Food allergy prevalence at 1 year was 7.7% (61/786), and 6.5% (53/808) were egg-allergic. There was no evidence of an association between VDI at either birth (aRR 1.25, 95% CI 0.70-2.22) or 6 months (aRR 0.93, 95% CI 0.41-2.14) and food allergy at 1 year. CONCLUSIONS There was no evidence that VDI during the first 6 months of infancy is a risk factor for food allergy at 1 year of age. These findings primarily relate to egg allergy, and larger studies are required.
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Affiliation(s)
- J. Molloy
- School of Medicine; Deakin University; Waurn Ponds VIC Australia
- Child Health Research Unit; Barwon Health; Geelong VIC Australia
- Murdoch Childrens Research Institute; Parkville VIC Australia
- Centre for Food and Allergy Research; Parkville VIC Australia
| | - J. J. Koplin
- Murdoch Childrens Research Institute; Parkville VIC Australia
- Centre for Food and Allergy Research; Parkville VIC Australia
- Centre for Epidemiology and Biostatistics; The University of Melbourne; Carlton VIC Australia
| | - K. J. Allen
- Murdoch Childrens Research Institute; Parkville VIC Australia
- Centre for Food and Allergy Research; Parkville VIC Australia
- Department of Paediatrics; University of Melbourne; Parkville VIC Australia
- Department of Allergy and Immunology; Royal Children's Hospital; Parkville VIC Australia
| | - M. L. K. Tang
- Murdoch Childrens Research Institute; Parkville VIC Australia
- Centre for Food and Allergy Research; Parkville VIC Australia
- Department of Paediatrics; University of Melbourne; Parkville VIC Australia
- Department of Allergy and Immunology; Royal Children's Hospital; Parkville VIC Australia
| | - F. Collier
- School of Medicine; Deakin University; Waurn Ponds VIC Australia
- Child Health Research Unit; Barwon Health; Geelong VIC Australia
- Murdoch Childrens Research Institute; Parkville VIC Australia
| | - J. B. Carlin
- Murdoch Childrens Research Institute; Parkville VIC Australia
- Centre for Epidemiology and Biostatistics; The University of Melbourne; Carlton VIC Australia
- Department of Paediatrics; University of Melbourne; Parkville VIC Australia
| | - R. Saffery
- Murdoch Childrens Research Institute; Parkville VIC Australia
| | - D. Burgner
- Murdoch Childrens Research Institute; Parkville VIC Australia
- Department of Paediatrics; University of Melbourne; Parkville VIC Australia
- Department of Paediatrics; Monash University; Clayton VIC Australia
| | - S. Ranganathan
- Murdoch Childrens Research Institute; Parkville VIC Australia
- Department of Paediatrics; University of Melbourne; Parkville VIC Australia
- Department of Respiratory Medicine; Royal Children's Hospital; Parkville VIC Australia
| | - T. Dwyer
- The George Institute for Global Health; University of Oxford; Oxford UK
| | - A. C. Ward
- School of Medicine; Deakin University; Waurn Ponds VIC Australia
| | - M. Moreno-Betancur
- Murdoch Childrens Research Institute; Parkville VIC Australia
- Department of Epidemiology and Preventive Medicine; Monash University; Melbourne VIC Australia
| | - M. Clarke
- Biological and Molecular Mass Spectrometry Facility; Centre for Microscopy, Characterisation and Analysis; University of Western Australia; Perth Western Australia 6009
| | - A. L. Ponsonby
- Murdoch Childrens Research Institute; Parkville VIC Australia
- Centre for Food and Allergy Research; Parkville VIC Australia
| | - P. Vuillermin
- School of Medicine; Deakin University; Waurn Ponds VIC Australia
- Child Health Research Unit; Barwon Health; Geelong VIC Australia
- Murdoch Childrens Research Institute; Parkville VIC Australia
- Centre for Food and Allergy Research; Parkville VIC Australia
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Munro C, Quinlan C, Ranganathan S. 44 Changes in estimated glomerular filtration rate (eGFR) with ivacaftor treatment in the paediatric cystic fibrosis (CF) population. J Cyst Fibros 2017. [DOI: 10.1016/s1569-1993(17)30409-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Haricharan S, Nagabhushana, Srinivasan S, Rajani MB, Ranganathan S. Locating Iron Production Sites in Telangana, India Using Satellite Imagery. CURR SCI INDIA 2016. [DOI: 10.18520/cs/v111/i9/1536-1543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Frayman K, Armstrong D, Carzino R, Ferkol T, Grimwood K, Storch G, Wylie K, Ranganathan S. 80 The microbiome in early cystic fibrosis lung disease: A longitudinal analysis. J Cyst Fibros 2015. [DOI: 10.1016/s1569-1993(15)30257-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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30
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Sayers I, Sharma A, Ranganathan S, Cain T, Skoric B. WS20.5 Cystic fibrosis related structural lung disease on high resolution computed tomography before and after ivacaftor therapy. J Cyst Fibros 2015. [DOI: 10.1016/s1569-1993(15)30120-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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31
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Carzino R, King L, Ranganathan S. 78 Differences in infection, inflammation and structural abnormalities between the right and left lung. J Cyst Fibros 2015. [DOI: 10.1016/s1569-1993(15)30255-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Rizk B, Turki R, Lotfy H, Ranganathan S, Zahed H, Freeman A, Shilbayeh Z, Sassy M, Shalaby M, Malik R. Surgery for endometriosis-associated infertility: do we exaggerate the magnitude of effect? Facts Views Vis Obgyn 2015; 7:109-18. [PMID: 26177374 PMCID: PMC4498168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE Surgery remains the mainstay in the diagnosis and management of endometriosis. The number of surgeries performed for endometriosis worldwide is ever increasing, however do we have evidence for improvement of infertility after the surgery and do we exaggerate the magnitude of effect of surgery when we counsel our patients? The management of patients who failed the surgery could be by repeat surgery or assisted reproduction. What evidence do we have for patients who fail assisted reproduction and what is their best chance for achieving pregnancy? MATERIAL AND METHODS In this study we reviewed the evidence-based practice pertaining to the outcome of surgery assisted infertility associated with endometriosis. Manuscripts published in PubMed and Science Direct as well as the bibliography cited in these articles were reviewed. Patients with peritoneal endometriosis with mild and severe disease were addressed separately. Patients who failed the primary surgery and managed by repeat or assisted reproduction technology were also evaluated. Patients who failed assisted reproduction and managed by surgery were also studied to determine of the best course of action. RESULTS In patients with minimal and mild pelvic endometriosis, excision or ablation of the peritoneal endometriosis increases the pregnancy rate. In women with severe endometriosis, controlled trials suggested an improvement of pregnancy rate. In women with ovarian endometrioma 4 cm or larger ovarian cystectomy increases the pregnancy rate, decreases the recurrence rate, but is associated with decrease in ovarian reserve. In patients who have failed the primary surgery, assisted reproduction appears to be significantly more effective than repeat surgery. In patients who failed assisted reproduction, the management remains to be extremely controversial. Surgery in expert hands might result in significant improvement in pregnancy rate. CONCLUSION In women with minimal and mild endometriosis, surgical excision or ablation of endometriosis is recommended as first line with doubling the pregnancy rate. In patients with moderate and severe endometriosis surgical excision also is recommended as first line. In patients who failed to conceive spontaneously after surgery, assisted reproduction is more effective than repeat surgery. Following surgery, the ovarian reserve may be reduced as determined by Anti Mullerian Hormone. The antral follicle count is not significantly reduced. In women with large endometriomas > 4 cm the ovarian endometrioma should be removed. In women who have failed assisted reproduction, further management remains controversial in the present time.
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Affiliation(s)
- B. Rizk
- Division of reproductive medicine and infertility, Department of Obstetrics and Gynecology, University of South Alabama, Mobile, Alabama, U.S.A.
,
Correspondence at:
| | - R. Turki
- Division of reproductive medicine and infertility, Department of Obstetrics and Gynecology, University of South Alabama, Mobile, Alabama, U.S.A.
,Department of Obstetrics and Gynecology, King Abdulaziz University, Jeddah, Saudi Arabia.
| | - H. Lotfy
- Division of reproductive medicine and infertility, Department of Obstetrics and Gynecology, University of South Alabama, Mobile, Alabama, U.S.A.
,Department of Obstetrics and Gynecology, Tanta University, Egypt.
| | - S. Ranganathan
- Division of reproductive medicine and infertility, Department of Obstetrics and Gynecology, University of South Alabama, Mobile, Alabama, U.S.A.
| | - H. Zahed
- Department of Obstetrics and Gynecology, King Abdulaziz University, Jeddah, Saudi Arabia.
| | - A.R. Freeman
- Division of reproductive medicine and infertility, Department of Obstetrics and Gynecology, University of South Alabama, Mobile, Alabama, U.S.A.
| | - Z. Shilbayeh
- Division of reproductive medicine and infertility, Department of Obstetrics and Gynecology, University of South Alabama, Mobile, Alabama, U.S.A.
| | - M. Sassy
- IVF Michigan, Rochester Hills, Michigan, U.S.A.
| | - M. Shalaby
- LSU School of Medicine, New Orleans, Louisiana.
| | - R. Malik
- Division of reproductive medicine and infertility, Department of Obstetrics and Gynecology, University of South Alabama, Mobile, Alabama, U.S.A.
,Department of Obstetrics and Gynecology, University of Indiana, Indianapolis, Indiana, U.S.A.
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Aarthi V, Krishnamoorthy J, Ranganathan S. PA01.63. Scientific evaluation on Siddha drug G 7 for the management of allergic disorders of the skin. Anc Sci Life 2012. [PMCID: PMC3800867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Purpose: In the ancient siddha literature various herbomineral components individually and in combination are documented to have wide spectrum of activity against allergic disorders of skin like pruritus, urticaria, eczema etc. The aim of the present study was to establish the effect of G7 on IL 8, IL alpha 1 and histamine both in vivo and in vitro studies. Method: The cultured keratinocytes were exposed to uv irradiation and the release of IL 8, IL alpha 1 and histamine were established by ELISA. The effect of G7 on histamine induced wheel and flare reaction were established in human subjects. Capasicin and substance P were used as positive control with intra dermal histamine. Result: G7 had significantly interfered in the release of IL 8, IL alpha 1 and histamine in vitro studies and in vivo studies G7 had significantly reduced wheal and flare reaction in human subjects. Conclusion: The findings of the study have clearly established the anti-allergic effect of G7 and its mechanism of action. Siddha system of medicine was contemporary to ayurvedic system of medicine. Siddha system however was confined to Tamil nadu while the ayurvedic system was prevalent throughout India.
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Affiliation(s)
- V. Aarthi
- Dr.JRK's Siddha Research and Pharmaceuticals Pvt. Ltd, Chennai - 69, India
| | | | - S. Ranganathan
- Dr.JRK's Siddha Research and Pharmaceuticals Pvt. Ltd, Chennai - 69, India
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Alperin N, Ranganathan S, Bagci AM, Adams DJ, Ertl-Wagner B, Saraf-Lavi E, Sklar EM, Lam BL. MRI evidence of impaired CSF homeostasis in obesity-associated idiopathic intracranial hypertension. AJNR Am J Neuroradiol 2012; 34:29-34. [PMID: 22766676 DOI: 10.3174/ajnr.a3171] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Impaired CSF homeostasis and altered venous hemodynamics are proposed mechanisms for elevated pressure in IIH. However, the lack of ventricular expansion steered the focus away from CSF homeostasis in IIH. This study aims to measure intracranial CSF volumes and cerebral venous drainage with MR imaging to determine whether increased CSF volume from impaired CSF homeostasis and venous hemodynamics occur in obesity-related IIH. MATERIALS AND METHODS Two homogeneous cohorts of 11 newly diagnosed pretreatment overweight women with IIH and 11 overweight healthy women were prospectively studied. 3D volumetric MR imaging of the brain was used to quantify CSF and brain tissue volumes, and dynamic phase contrast was used to measure relative cerebral drainage through the internal jugular veins. RESULTS Findings confirm normal ventricular volume in IIH. However, extraventricular CSF volume is significantly increased in IIH (290 ± 52 versus 220 ± 24 mL, P = .001). This is even more significant after normalization with intracranial volume (P = .0007). GM interstitial fluid volume is also increased in IIH (602 ± 57 versus 557 ± 31 mL, P = .037). Total arterial inflow is normal, but relative venous drainage through the IJV is significantly reduced in IIH (65 ± 7% versus 81 ± 10%, P = .001). CONCLUSIONS Increased intracranial CSF volume that accumulates in the extraventricular subarachnoid space provides direct evidence for impaired CSF homeostasis in obesity-associated IIH. The finding of larger GM interstitial fluid volume is consistent with increased overall resistance to cerebral venous drainage, as evident from reduced relative cerebral drainage through the IJV. The present study confirms that both impaired CSF homeostasis and venous hemodynamics coexist in obesity-associated IIH.
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Affiliation(s)
- N Alperin
- Department of Radiology, Bascom Palmer Eye Institute, University of Miami, Miami, Florida 33136, USA.
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Pringle E, Ranganathan S, Harrison J. 258 Does regaining birth weight Z score by 2 years of age impact on clinical outcome in patients with cystic fibrosis? J Cyst Fibros 2012. [DOI: 10.1016/s1569-1993(12)60427-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Doan J, Ranganathan S, Massie J, Harrison J. 124 Eradication of Pseudomonas aeruginosa in children with cystic fibrosis: an Australian experience. J Cyst Fibros 2012. [DOI: 10.1016/s1569-1993(12)60294-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Aarthi V, Krishnamoorthy JR, Ranganathan S. PA01.63. Scientific evaluation on Siddha drug G 7 for the management of allergic disorders of the skin. Anc Sci Life 2012. [DOI: 10.4103/0257-7941.112120] [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: 11/04/2022] Open
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Abstract
Dandruff (pityriasis capitis, seborrheic dermatitis confined to the scalp) is a disease that has been around for centuries despite several treatment options. Almost every day new players are entering the market with various antidandruff products, perhaps due to an increase in the incidence of dandruff all over the world. Interestingly, clinicians, especially dermatologists, gave little attention to this problem. At the end, the dandruff sufferer is puzzled by the array of antidandruff products with varied claims entering the market day by day. Why have we not achieved complete treatment success against dandruff? Is dandruff a disease or disorder? It seems that our understanding about dandruff perfectly fits into the famous saying of Albert Einstein, “as the area of light increases, so does the circumferences of darkness.” Have dermatologists left dandruff unattended, only to be exploited by the personal care industry?
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Affiliation(s)
- Frederick Manuel
- Deparment of Dermatology, Skin Clinic, 22, Paper Mills Road, Perambur, Chennai, Tamil Nadu, India
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Ranganathan S, Babu SM, Bangal PR, Madhavendra S, Voleti SR. The Novel Formation of Ordered and Varied Silica-Imidazole Complexes from Silicic Acid. PHOSPHORUS SULFUR 2011. [DOI: 10.1080/10426507.2010.540727] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- S. Ranganathan
- a Discovery laboratory, Organic Division III , Indian Institute of Chemical Technology , Tarnaka, Hyderabad, Andhra Pradesh, India
| | - S. M. Babu
- a Discovery laboratory, Organic Division III , Indian Institute of Chemical Technology , Tarnaka, Hyderabad, Andhra Pradesh, India
| | - P. R. Bangal
- b Electron Microscopy Center , Indian Institute of Chemical Technology , Hyderabad, Andhra Pradesh, India
| | - S. Madhavendra
- b Electron Microscopy Center , Indian Institute of Chemical Technology , Hyderabad, Andhra Pradesh, India
| | - S. R. Voleti
- c Department of Plant Physiology , Directorate of Rice Research , Hyderabad, Andhra Pradesh, India
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Thangaraj N, Subbanna GN, Ranganathan S, Chattopadhyay K. Electron microscopy and diffraction of icosahedral and decagonal quasicrystals in aluminium-manganese alloys. J Microsc 2011. [DOI: 10.1111/j.1365-2818.1987.tb01351.x] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abstract
The article discuss in detail about the prevalence, pathophysiology, clinical manifestations of dandruff including the etio-pathology. The article also discusses in detail about various treatment methods available for dandruff. The status of dandruff being amphibious – a disease/disorder, and relatively less medical intervention is sought after for the treatment, dandruff is the most commercially exploited skin and scalp disorder/disease by personal care industries.
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Affiliation(s)
- S Ranganathan
- CavinKare Research Centre, No.12 Poonamallee Road, Ekkattuthangal, Chennai - 600 097, India
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Duarte AI, Petit GH, Ranganathan S, Li JY, Oliveira CR, Brundin P, Björkqvist M, Rego AC. IGF-1 protects against diabetic features in an in vivo model of Huntington's disease. Exp Neurol 2011; 231:314-9. [PMID: 21763311 DOI: 10.1016/j.expneurol.2011.06.016] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2011] [Revised: 06/08/2011] [Accepted: 06/26/2011] [Indexed: 01/16/2023]
Abstract
Huntington's disease (HD) is the most prevalent polyglutamine expansion disorder. HD is caused by an expansion of CAG triplet in the huntingtin (HTT) gene, associated with striatal and cortical neuronal loss. Central and peripheral metabolic abnormalities and altered insulin-like growth factor-1 (IGF-1) levels have been described in HD. Thus, we hypothesized that restoration of IGF-1-mediated signaling pathways could rescue R6/2 mice from metabolic stress and behavioral changes induced by polyglutamine expansion. We analyzed the in vivo effect of continuous peripheral IGF-1 administration on diabetic parameters, body weight and motor behavior in the hemizygous R6/2 mouse model of HD. We used 9 week-old and age-matched wild-type mice, subjected to continuously infused recombinant IGF-I or vehicle, for 14 days. IGF-1 treatment prevented the age-related decrease in body weight in R6/2 mice. Although blood glucose levels were higher in R6/2 mice, they did not reach a diabetic state. Even though, IGF-1 ameliorated poor glycemic control in HD mice. This seemed to be associated with a decrease in blood insulin levels in R6/2 mice, which was increased following IGF-1 infusion. Similarly, blood IGF-1 levels decreased during aging in both wild-type and R6/2 mice, being significantly improved upon its continuous infusion. Although no significant differences were found in motor function in R6/2-treated mice, IGF-1 treatment highly improved paw clasping scores. In summary, these results suggest that IGF-1 has a protective role against HD-associated impaired glucose tolerance, by enhancing blood insulin levels.
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Affiliation(s)
- A I Duarte
- Center for Neuroscience and Cell Biology, University of Coimbra, 3004-504 Coimbra, Portugal
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Mascarenhas L, Felgenhauer JL, Bond MC, Femino JD, Laack NN, Ranganathan S, Krailo MD, Marina N. Pilot study of adding vincristine, topotecan, and cyclophosphamide to interval-compressed chemotherapy in newly diagnosed patients with localized Ewing sarcoma family of tumors: A Children's Oncology Group trial. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.9526] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Zhang H, Petit G, Gaughwin PM, Zuo X, Ranganathan S, Smith R, Roybon L, Brundin P, Mobley WC, Li JY. B16 NGF improves the spatial working memory in R6/1 Huntington's disease transgenic mice through the augmentation of cholinergic function and neurogenesis. J Neurol Neurosurg Psychiatry 2010. [DOI: 10.1136/jnnp.2010.222596.16] [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] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Smith C, Winn A, Ranganathan S, Seddon P. A fat lot of good. An 8 year longitudinal investigation of fat intakes in a paediatric CF population. J Cyst Fibros 2010. [DOI: 10.1016/s1569-1993(10)60361-x] [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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Abstract
Abstract
Objectives: The NK-1 receptor antagonist casopitant is a promising agent for the prevention of chemotherapy-related and postoperative nausea and vomiting. However, findings suggestive of cardiac damage were noted in animal studies of long-term administration of casopitant at supratherapeutic doses. Cardiac evaluation of the concomitant use of casopitant with anthracyclines was therefore of particular interest due to myocyte loss associated with anthracycline use.Methods: Chemotherapy-naïve patients receiving anthracyclines as part of a Phase III moderately emetogenic chemotherapy study regimen were randomized to receive ondansetron and dexamethasone plus one of the following casopitant regimens: single-dose 150-mg oral casopitant (ORAL1); 3-day IV/oral casopitant (90 mg IV/50 mg oral/50 mg oral) (IV/ORAL); 3-day oral casopitant (150/50/50 mg) (ORAL3); or placebo. Serial cardiac troponin (cTnI) levels were measured using the Beckman assay. Although this assay is generally considered reliable within the range of 0.04-0.5 ng/mL, levels below the limit of quantitation (LOQ) (<0.04 ng/mL) were also evaluated in an attempt to identify patterns of change below LOQ. Further cardiac assessment consisting of left ventricular ejection fraction (LVEF) monitoring was conducted in patients with cTnI levels ³0.12 ng/mL.Results: In total, 611 patients were evaluated: 155 ORAL1, 145 IV/ORAL, 159 ORAL3, and 152 placebo; no risk factor variation between groups was observed. Adverse events were balanced across treatment groups. Cardiovascular adverse events occurred in 3% of patients in each of the placebo, ORAL1, and ORAL/IV groups and in 2% of the ORAL3 group. Three patients (0.5%) had cTnI >0.12 ng/mL (1 each IV/ORAL, ORAL3, and placebo); all LVEF determinations were normal at follow-up, with the exception of 1 patient with mitral regurgitation but normal ejection fraction. A total of 59 patients (9.7%) had median cTnI 0.04-0.12 ng/mL. Of the remaining patients with cTnI below LOQ, median baseline levels across groups were similar (ORAL1 and IV/ORAL 0.008 ng/mL; ORAL3 0.01 ng/mL; placebo 0.009 ng/mL). After 4 cycles of anthracycline, median cTnI increased to 0.02 ng/mL in all groups, with no difference noted between casopitant and placebo groups.Conclusions: Thorough monitoring of cardiac-related toxicities including cardiac (S)AEs, ECG, and ejection fraction data showed no evidence of increased risk of cardiac damage in the casopitant groups compared with control. Subclinical elevations in cTnI occurred in patients receiving anthracyclines but were not considered to be related to or accentuated by simultaneous administration of casopitant. cTnI elevations were similar across treatment groups and were well below rates reported in the literature for a patient population receiving higher doses of anthracycline. Use of appropriate cardiac biomarkers in ranges below those commonly used to detect infarction may be valuable to detect or exclude subclinical toxicity of potentially cardiotoxic agents used in combination. Additional analysis is ongoing.
Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 1118.
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Affiliation(s)
- M. Ewer
- 1University of Texas M. D. Anderson Cancer Center,, TX,
| | - S. Grunberg
- 2Vermont Cancer Center, University of Vermont, VT,
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Cantacessi C, Zou FC, Hall RS, Zhong W, Jex AR, Campbell BE, Ranganathan S, Sternberg PW, Zhu XQ, Gasser RB. Bioinformatic analysis of abundant, gender-enriched transcripts of adult Ascaris suum (Nematoda) using a semi-automated workflow platform. Mol Cell Probes 2009; 23:205-17. [PMID: 19361552 DOI: 10.1016/j.mcp.2009.03.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2009] [Revised: 03/12/2009] [Accepted: 03/16/2009] [Indexed: 12/17/2022]
Abstract
Expressed sequence tag (EST) data representing transcripts with a high level of differential hybridization in suppressive-subtractive hybridization (SSH)-based microarray analysis between adult female and male Ascaris suum were subjected to detailed bioinformatic analysis. A total of 361 ESTs clustered into 209 sequences, of which 52 and 157 represented transcripts that were enriched in female and male A. suum, respectively. Thirty (57.7%) of the 'female' subset of 52 sequences had orthologues/homologues in other parasitic nematodes and/or Caenorhabditis elegans, 13 (25%) exclusively in other parasitic nematodes and nine (17.3%) had no match in any other organism for which sequence data are currently available; the C. elegans orthologues encoded molecules involved in reproduction as well as embryonic and gamete development, such as vitellogenins and chitin-binding proteins. Of the 'male' subset of 157 sequences, 73 (46.5%) had orthologues/homologues in other parasitic nematodes and/or C. elegans, 57 (37.5%) in other parasitic nematodes only, and 22 (14.5%) had no significant similarity match in any other organism; the C. elegans orthologues encoded predominantly major sperm proteins (MSPs), kinases and phosphatases, actins, myosins and an Ancylostoma secreted protein-like molecule. The findings of the present study should support further genomic investigations of A. suum.
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Affiliation(s)
- C Cantacessi
- Department of Veterinary Science, The University of Melbourne, Victoria, Australia
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Strachan R, Gilbert L, Martin A, Ranganathan S, Selvadurai H, Wainwright C, Jaffe A. Identifying the Bacterial Causes of Childhood Empyema in Australia. Int J Infect Dis 2008. [DOI: 10.1016/j.ijid.2008.05.198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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