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Parker CC, Petersen PM, Cook AD, Clarke NW, Catton C, Cross WR, Kynaston H, Parulekar WR, Persad RA, Saad F, Bower L, Durkan GC, Logue J, Maniatis C, Noor D, Payne H, Anderson J, Bahl AK, Bashir F, Bottomley DM, Brasso K, Capaldi L, Cooke PW, Chung C, Donohue J, Eddy B, Heath CM, Henderson A, Henry A, Jaganathan R, Jakobsen H, James ND, Joseph J, Lees K, Lester J, Lindberg H, Makar A, Morris SL, Oommen N, Ostler P, Owen L, Patel P, Pope A, Popert R, Raman R, Ramani V, Røder A, Sayers I, Simms M, Srinivasan V, Sundaram S, Tarver KL, Tran A, Wells P, Wilson J, Zarkar AM, Parmar MKM, Sydes MR. Timing of Radiotherapy (RT) After Radical Prostatectomy (RP): Long-term outcomes in the RADICALS-RT trial [NCT00541047]. Ann Oncol 2024:S0923-7534(24)00105-4. [PMID: 38583574 DOI: 10.1016/j.annonc.2024.03.010] [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: 10/20/2023] [Revised: 03/25/2024] [Accepted: 03/27/2024] [Indexed: 04/09/2024] Open
Abstract
BACKGROUND The optimal timing of radiotherapy (RT) after radical prostatectomy for prostate cancer has been uncertain. RADICALS-RT compared efficacy and safety of adjuvant RT versus an observation policy with salvage RT for PSA failure. METHODS RADICALS-RT was a randomised controlled trial enrolling patients with ≥1 risk factor (pT3/4, Gleason 7-10, positive margins, pre-op PSA≥10ng/ml) for recurrence after radical prostatectomy. Patients were randomised 1:1 to adjuvant RT ("Adjuvant-RT") or an observation policy with salvage RT for PSA failure ("Salvage-RT") defined as PSA≥0.1ng/ml or 3 consecutive rises. Stratification factors were Gleason score, margin status, planned RT schedule (52.5Gy/20 fractions or 66Gy/33 fractions) and treatment centre. The primary outcome measure was freedom-from-distant metastasis, designed with 80% power to detect an improvement from 90% with Salvage-RT (control) to 95% at 10yr with Adjuvant-RT. Secondary outcome measures were bPFS, freedom-from-non-protocol hormone therapy, safety and patient-reported outcomes. Standard survival analysis methods were used; HR<1 favours Adjuvant-RT. FINDINGS Between Oct-2007 and Dec-2016, 1396 participants from UK, Denmark, Canada and Ireland were randomised: 699 Salvage-RT, 697 Adjuvant-RT. Allocated groups were balanced with median age 65yr. 93% (649/697) Adjuvant-RT reported RT within 6m after randomisation; 39% (270/699) Salvage-RT reported RT during follow-up. Median follow-up was 7.8 years. With 80 distant metastasis events, 10yr FFDM was 93% for Adjuvant-RT and 90% for Salvage-RT: HR=0.68 (95%CI 0·43-1·07, p=0·095). Of 109 deaths, 17 were due to prostate cancer. Overall survival was not improved (HR=0.980, 95%CI 0.667-1.440, p=0.917). Adjuvant-RT reported worse urinary and faecal incontinence one year after randomisation (p=0.001); faecal incontinence remained significant after ten years (p=0.017). INTERPRETATION Long-term results from RADICALS-RT confirm adjuvant RT after radical prostatectomy increases the risk of urinary and bowel morbidity, but does not meaningfully improve disease control. An observation policy with salvage RT for PSA failure should be the current standard after radical prostatectomy.
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Affiliation(s)
- C C Parker
- Institute of Cancer Research, Royal Marsden NHS Foundation Trust, Sutton, UK
| | - P M Petersen
- Dept of Oncology, Copenhagen Prostate Cancer Center, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - A D Cook
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, UCL, London, UK
| | - N W Clarke
- Dept of Urology, The Christie and Salford Royal Hospitals, Manchester, UK; The University of Manchester, Manchester, UK
| | - C Catton
- Dept of Radiation Oncology, Princess Margaret Hospital, University Health Network, Toronto, ON, Canada
| | - W R Cross
- Dept of Urology, St James's University Hospital, Leeds, UK
| | - H Kynaston
- Division of Cancer and Genetics, Cardiff University, Cardiff, UK
| | - W R Parulekar
- Canadian Cancer Trials Group, Queen's University, Kingston, ON, Canada
| | - R A Persad
- Dept of Urology, Bristol Urological Institute, Bristol, UK
| | - F Saad
- Dept of Urology, Centre Hospitalier de l'Université de Montréal, Montreal, Canada
| | - L Bower
- Guy's and St Thomas' NHS Foundation Trust, London, UK; Institute of Cancer Research, Royal Marsden NHS Foundation Trust, London, UK
| | - G C Durkan
- Dept of Urology, University Hospital Galway, Galway, Ireland
| | - J Logue
- Dept of Oncology, The Christie Hospital NHS FT, Wilmslow Road, Manchester, UK
| | - C Maniatis
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, UCL, London, UK
| | - D Noor
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, UCL, London, UK
| | - H Payne
- The Prostate Centre, London, UK
| | - J Anderson
- St James's Institute of Oncology, Leeds, UK
| | - A K Bahl
- Bristol Haematology and Oncology Centre, University Hospitals Bristol & Weston NHS Trust, Bristol, UK
| | - F Bashir
- Queen's Centre for Oncology, Castle Hill Hospital, Hull University Teaching Hospitals NHS Trust, Cottingham, UK
| | | | - K Brasso
- Dept of Urology, Copenhagen Prostate Cancer Center, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark; Dept of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - L Capaldi
- Worcester Oncology Centre, Worcestershire Acute NHS Hospitals Trust, Worcester, UK
| | - P W Cooke
- Dept of Urology, The Royal Wolverhampton NHS Trust, Wolverhampton, UK
| | - C Chung
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, UCL, London, UK
| | - J Donohue
- Dept of Urology, Maidstone and Tunbridge Wells NHS Trust, Maidstone, UK
| | - B Eddy
- East Kent University Hospitals Foundation Trust, Kent, UK
| | - C M Heath
- Dept of Clinical Oncology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - A Henderson
- Dept of Urology, Maidstone and Tunbridge Wells NHS Trust, Maidstone, UK
| | - A Henry
- Leeds Institute of Medical Research, University of Leeds, Leeds, UK
| | - R Jaganathan
- Dept of Urology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - H Jakobsen
- Dept of Urology, Herlev University Hospital, Herlev, Denmark
| | - N D James
- Institute of Cancer Research, Royal Marsden NHS Foundation Trust, London, UK
| | - J Joseph
- Leeds Teaching Hospitals, UK; York and Scarborough Teaching Hospitals, UK
| | - K Lees
- Dept of Oncology, Maidstone and Tunbridge Wells NHS Trust, Maidstone, UK
| | - J Lester
- South West Wales Cancer Centre, Singleton Hospital, Swansea, UK
| | - H Lindberg
- Dept of Oncology, Herlev University Hospital, Herlev, Denmark
| | - A Makar
- Dept of Urology, Worcestershire Acute Hospitals Trust, Worcester, UK
| | - S L Morris
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - N Oommen
- Wrexham Maelor Hospital, Wrexham, UK
| | - P Ostler
- Mount Vernon Cancer Centre, Northwood, UK
| | - L Owen
- Bradford Royal Infirmary, Bradford, UK; Leeds Cancer Centre, Leeds, UK
| | - P Patel
- Dept of Urology, University College London Hospitals, London, UK
| | - A Pope
- Mount Vernon Cancer Centre, Northwood, UK
| | - R Popert
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - R Raman
- Kent Oncology Centre, Kent & Canterbury Hospital, Canterbury, UK
| | - V Ramani
- Dept of Urology, The Christie and Salford Royal Hospitals, Manchester, UK
| | - A Røder
- Dept of Urology, Copenhagen Prostate Cancer Center, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - I Sayers
- Deanesly Centre, New Cross Hospital, Wolverhampton, UK
| | - M Simms
- Dept of Urology, Hull University Hospitals NHS Trust, UK
| | - V Srinivasan
- Glan Clwyd Hospital, Betsi Cadwaladr University Health Board, Rhyl, UK
| | - S Sundaram
- Dept of Urology, Mid Yorkshire Teaching Hospital, Pontefract, UK
| | - K L Tarver
- Dept of Oncology, Queen's Hospital, Romford, UK
| | - A Tran
- Dept of Oncology, The Christie Hospital NHS FT, Wilmslow Road, Manchester, UK
| | - P Wells
- St Bartholomews Hospital, London UK
| | - J Wilson
- Royal Gwent Hospital, Newport, UK
| | - A M Zarkar
- Dept of Oncology, University Hospitals Birmingham, Birmingham, UK
| | - M K M Parmar
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, UCL, London, UK
| | - M R Sydes
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, UCL, London, UK.
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Adiyat KT, Pooleri GK, Cherian DT, Santhamma SGN, Ravichandran K, Sundaram S. Negative predictive value of PSMA PET scan for lymph node staging in patients undergoing robotic radical prostatectomy and pelvic lymph node dissection. Int Urol Nephrol 2023; 55:1453-1457. [PMID: 37086333 DOI: 10.1007/s11255-023-03595-0] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 04/09/2023] [Indexed: 04/23/2023]
Abstract
PURPOSE To assess the negative predictive value of PSMA PET scan for lymph node staging in patients undergoing robotic radical prostatectomy and pelvic lymph node dissection. MATERIALS AND METHODS A retrospective analysis of patients who underwent robotic-assisted radical prostatectomy with pelvic lymph node dissection and had a preoperative negative PSMA PET scan for metastasis was performed. The documented pre-operative variables studied included age, BMI, PSA at diagnosis, Gleason score, and biopsy ISUP grades. Patients were categorised as low, intermediate and high risk according to the D Amico classification. The post-op variables included were number of lymph nodes harvested, number of positive nodes, positivity rate, size of the node metastasis, T staging and ISUP grading. RESULTS The overall negative predictive value of PSMA PET scan was 71.6%. Further sub-classification according to risk stratification demonstrated a NPV of 58.02%, 92.7% and 90% for high, intermediate and low risk, respectively. CONCLUSION Pelvic lymph node dissection cannot be excluded based on a negative preop PSMA PET/CT scan.
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Affiliation(s)
- Kishore Thekke Adiyat
- Aster Medcity, Kochi, India.
- Department of Urology, Aster Medcity, Kuttisahib Road, Cheranelloor, Ernakulam, Kerala, 682027, India.
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Jose P, Kumar SS, Chandru BA, Sundaram S, Vijayanand SM, Kutty VR, Varma RP. Local governments and community-based rehabilitation for developmental disabilities: leaving no one behind. Public Health Action 2023; 13:37-43. [PMID: 36949741 PMCID: PMC9983811 DOI: 10.5588/pha.22.0027] [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: 05/02/2022] [Accepted: 09/21/2022] [Indexed: 03/06/2023] Open
Abstract
SETTING The BUDS (not an acronym) institutions comprise a community-based rehabilitation initiative for children and families affected by developmental disabilities in Kerala, India. OBJECTIVE To explore the role of local governments in the establishment and functioning of BUDS institutions. DESIGN We used qualitative approaches comprising document review and in-depth interviews with trainers, parents of children with developmental disabilities and elected representatives. RESULTS BUDS was created by Kudumbasree, a decentralised women empowerment and poverty alleviation initiative. Our findings illustrate the role of local governments in facilitating expansion through the establishment of infrastructure, therapy equipment, transportation and financial allocation for these, as well as through the development of human resources, assistance with enrolment for financial assistance and insurance programmes, and coordination with education and health sectors. Programme implementation varied considerably regarding available infrastructure, staffing and services among the institutions studied. The institutions were physically closed during the COVID-19 pandemic but continued to function in alternative ways. CONCLUSION Despite variable implementation, local governments have supported the expansion of BUDS institutions, thereby creating more spaces for inclusive and integrated education and rehabilitation of persons with disabilities in Kerala. The expansion over the past two decades and measures during the COVID-19 pandemic suggest resilience and sustainability of the model.
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Affiliation(s)
- P Jose
- Health Action by People, Thiruvananthapuram, India
| | - S S Kumar
- Prajaahita Foundation, Kozhikode, India
| | - B A Chandru
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology (SCTIMST), Thiruvananthapuram, India
| | - S Sundaram
- Comprehensive Care Centre for Neurodevelopmental Disorders, Department of Neurology, SCTIMST, Thiruvananthapuram, India
| | | | - V R Kutty
- Health Action by People, Thiruvananthapuram, India
| | - R P Varma
- Health Action by People, Thiruvananthapuram, India
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology (SCTIMST), Thiruvananthapuram, India
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Giri S, Sundaram S. Does the wire diameter really determine the outcomes in cold snare polypectomy? J Gastroenterol Hepatol 2023; 38:665. [PMID: 36866450 DOI: 10.1111/jgh.16160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Accepted: 02/27/2023] [Indexed: 03/04/2023]
Affiliation(s)
- S Giri
- Department of Gastroenterology, Nizam's Institute of Medical Sciences, Hyderabad, India
| | - S Sundaram
- Department of Digestive Diseases and Clinical Nutrition, Tata Memorial Hospital, Mumbai, India
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Heritage S, Sundaram S, Kirkby NF, Kirkby KJ, Mee T, Jena R. An Update to the Malthus Model for Radiotherapy Utilisation in England. Clin Oncol (R Coll Radiol) 2023; 35:e1-e9. [PMID: 35835634 DOI: 10.1016/j.clon.2022.06.006] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 05/17/2022] [Accepted: 06/16/2022] [Indexed: 01/05/2023]
Abstract
AIMS The Malthus Programme predicts national and local radiotherapy demand by combining cancer incidence data with decision trees detailing the indications, and appropriate dose fractionation, for radiotherapy. Since the last model update in 2017, technological advancements and the COVID-19 pandemic have led to increasing hypofractionation of radiotherapy schedules. Indications for radiotherapy have also evolved, particularly in the context of oligometastatic disease. Here we present a brief update on the model for 2021. We have updated the decision trees for breast, prostate, lung and head and neck cancers, and incorporated recent cancer incidence data into our model, generating a current estimate of fraction demand for these four cancer sites across England. MATERIALS AND METHODS The decision tree update was based on evidence from practice-changing randomised controlled trials, published guidelines, audit data and expert opinion. Site- and stage-specific incidence data were taken from the National Disease Registration Service. We used the updated model to estimate the proportion of patients who would receive radiotherapy (appropriate rate of radiotherapy) and the fraction demand per million population at a national and Clinical Commissioning Group level in 2021. RESULTS The total predicted fraction demand has decreased by 11.4% across all four cancer sites in our new model, compared with the 2017 version. This reduction can be explained primarily by greater use of hypofractionated treatments (including stereotactic ablative radiotherapy) and a shift towards earlier stage presentation. The only large change in appropriate rate of radiotherapy was an absolute decrease of 3% for lung cancer. CONCLUSIONS Compared with our previous model, the current version predicts a reduction in fraction demand across England. This is driven principally by hypofractionation of radiotherapy regimens, using technology that requires increasingly complex planning. Treatment complexity and local service factors need to be taken into account when translating fraction burden into linear accelerator demand or throughput.
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Affiliation(s)
- S Heritage
- School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - S Sundaram
- School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - N F Kirkby
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK; The Christie NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - K J Kirkby
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK; The Christie NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - T Mee
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK; The Christie NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - R Jena
- Department of Oncology, University of Cambridge, Cambridge, UK.
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Mathiyalagan P, Rajangam T, Bhargavi K, Gnanaraj R, Sundaram S. Clinical Profile, Immediate- and Short-term Outcome of Patients with Intermediate-risk Acute Pulmonary Thromboembolism. Indian J Crit Care Med 2022; 26:1192-1197. [PMID: 36873599 PMCID: PMC9983647 DOI: 10.5005/jp-journals-10071-24351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 10/12/2022] [Indexed: 11/07/2022] Open
Abstract
Background Long-term outcomes of acute pulmonary thromboembolism (PTE) have been reported. However, the immediate- and short-term outcomes have not been reported adequately. Objectives Primary objective was to determine the patient characteristics, and immediate- and short-term outcomes of intermediate-risk PTE, and the secondary objective was to evaluate the benefit of thrombolysis in normotensive PTE patients. Material and methods This study included patients diagnosed with acute intermediate PTE. Patient's electrocardiography (ECG) parameters along with echocardiography (echo), etc., conducted at the time of admission, during their stay in hospital, at the time of discharge, and during follow-up were recorded. The patients were treated using thrombolysis or anticoagulants depending on hemodynamic decompensation. During follow-up, they were reassessed for echo parameters-right ventricular (RV) function and pulmonary arterial hypertension (PAH). Results Among 55 patients, 29 (52.73%) were diagnosed with intermediate high-risk PTE and 26 (47.27%) with intermediate low-risk PTE. They were normotensive and most of them had a simplified pulmonary embolism severity index (sPESI) score <2. Typical ECG pattern S1Q3T3 along with echo patterns and elevated cardiac troponin levels were observed in most of the patients. Patients treated with thrombolytic agents showed a reduction in hemodynamic decompensation as opposed to patients treated with anticoagulants who had clinical signs of right heart failure (RHF) on follow-up after 3 months. Conclusion This study contributes to the existing literature on outcomes of intermediate-risk PTE and the effect of thrombolysis on patients with hemodynamic stability. Thrombolysis reduced the incidence and progression of RHF in patients with hemodynamic instability. How to cite this article Mathiyalagan P, Rajangam T, Bhargavi K, Gnanaraj R, Sundaram S. Clinical Profile, Immediate- and Short-term Outcome of Patients with Intermediate-risk Acute Pulmonary Thromboembolism. Indian J Crit Care Med 2022;26(11):1192-1197.
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Affiliation(s)
- Praveen Mathiyalagan
- Department of Medicine, PSG Institute of Medical Sciences & Research, Coimbatore, Tamil Nadu, India
| | - Tolstoy Rajangam
- Department of Medicine, PSG Institute of Medical Sciences & Research, Coimbatore, Tamil Nadu, India
| | - Kumar Bhargavi
- Department of Medicine, PSG Institute of Medical Sciences & Research, Coimbatore, Tamil Nadu, India
| | - Ramya Gnanaraj
- Department of Ophthalmology, Sankara Nethralaya Foundation, Coimbatore, Tamil Nadu, India
| | - Shanmuga Sundaram
- Department of Cardiology, PSG Institute of Medical Sciences & Research, Coimbatore, Tamil Nadu, India
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Sundaram S, Vijayakumar V, Balasubramanian V. Electronic and structure conformational analysis (HOMO-LUMO, MEP, NBO, ELF, LOL, AIM) of hydrogen bond binary liquid crystal mixture: DFT/TD-DFT approach. COMPUT THEOR CHEM 2022. [DOI: 10.1016/j.comptc.2022.113920] [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: 11/30/2022]
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Nair D, Martinek MR, Colley J, Sundaram S, Hariharan R, Morales G, Sommer P, Healy S, Siddiqui U, Williams C, Sarver A, Lo M. Paroxysmal atrial fibrillation ablation with a novel flexible tip radiofrequency catheter incorporating contact force sensing: acute results of the TactiFlex AF IDE trial. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Catheter ablation is an established therapy for paroxysmal atrial fibrillation (PAF). The TactiFlex™ Ablation Catheter, Sensor-Enabled™ (TactiFlex SE) is a next-generation radiofrequency ablation catheter incorporating highly accurate fiber optics-based contact force sensing technology with a flexible, laser-cut tip.
Purpose
To demonstrate that ablation with TactiFlex SE is safe and effective for the treatment of drug refractory, symptomatic PAF.
Methods
The TactiFlex AF IDE is a prospective, non-randomized, multi-center clinical study which enrolled 355 subjects worldwide. Enrollment in the main study began on June 26, 2020 and completed on June 18, 2021. Subjects underwent de novo Pulmonary Vein Isolation (PVI) and, if indicated, a Cavotricuspid Isthmus ablation (CTI line) for CTI-dependent atrial flutter.
Results
Subjects were divided into two as treated subgroups: High Standard Power (HSP, n=189), defined as subjects with 100% of left atrial lesions ablated at ≥40 W, and Low Standard Power (LSP, n=119), defined as subjects with at least one left atrial lesion ablated at <40W. First pass success, defined as isolation of all pulmonary veins (PVs) confirmed after a minimum 20 min waiting period was achieved in 93.5% (175/186) and 84.5% (98/116) of HSP and LSP subjects, respectively (p=0.0104). Significant decreases in the HSP versus LSP procedures were also seen in total procedure time (112.0 min [89.0, 139.5] and 149.0 [115.0, 182.0], respectively [p<0.001]), total RF time for PV ablation (14.0 min [11.0, 19.0] and 29.0 [19.0, 41.0], respectively [p<0.0001]), total fluoroscopy time (4.0 min [0.0, 11.0] and 8.0 [3.0, 17.0], respectively [p<0.0001]) and irrigation fluid volume (378.0 mL [310.0, 466.0] and 636.0 [476.0, 829.0], respectively [p<0.0001]) (values given as Median [Q1, Q3]), see Figure 1. Both HSP and LSP subjects had a low rate of repeat procedures (1.6% [3/182] and 4.3% [5/115], respectively [p=0.2684]) and primary safety endpoint events (4.8% [9/189] and 4.2% [5/119], respectively [p=0.8182]) through 90 days post-index procedure.
Conclusion
The acute data on the TactiFlex SE catheter demonstrates safe and effective treatment of PAF using either a HSP or LSP ablation strategy. Ablation procedures performed using a HSP strategy were shorter and required less irrigation fluid and fluoroscopy. It is anticipated these results will be reflected in the 12-month safety and effectiveness primary endpoints.
Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): Abbott
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Affiliation(s)
- D Nair
- St. Bernards Medical Center , Jonesboro , United States of America
| | - M R Martinek
- A. o. Krankenhaus her Elisabethinen Linz , Linz , Austria
| | - J Colley
- Jackson Heart Clinic , Jackson , United States of America
| | - S Sundaram
- South Denver Cardiology Associates PC , Littleton , United States of America
| | - R Hariharan
- Memorial Hermann Hospital , Houston , United States of America
| | - G Morales
- Affinity Cardiovascular Specialists, LLC , Birmingham , United States of America
| | - P Sommer
- Heart and Diabetes Center NRW , Bad Oeynhausen , Germany
| | - S Healy
- Monash Medical Centre , Melbourne , Australia
| | - U Siddiqui
- Advent Health Orlando , Orlando , United States of America
| | - C Williams
- Abbott , Saint Paul , United States of America
| | - A Sarver
- Abbott , Saint Paul , United States of America
| | - M Lo
- Arkansas Heart Hospital , Little Rock , United States of America
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Chan TH, Taylor NT, Sundaram S, Hepplestone SP. Phase Stability and Electronic Properties of Hybrid Organic-Inorganic Perovskite Solid Solution (CH(NH 2) 2) x (CH 3NH 3) 1-x Pb(Br y I 1-y ) 3 as a Function of Composition. J Phys Chem C Nanomater Interfaces 2022; 126:13640-13648. [PMID: 36017360 PMCID: PMC9393887 DOI: 10.1021/acs.jpcc.2c03555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 07/10/2022] [Indexed: 06/15/2023]
Abstract
Compositional mixing provides the means to maintain the structural stability of a hybrid organic-inorganic perovskite for efficient and robust photovoltaic applications. Here we present a theoretical, first-principles study of the electronic and energetic properties of the solid solution (CH(NH2)2) x (CH3NH3)1-x PbBr y I1-y , the mixing of two organic molecules with various orientations, formamidinium and methylammonium, and two halides, bromide and iodide. Our results show the variation in the band gap as a function of composition (x and y) provides several candidates that exceed the 27.5% Schockley-Queisser efficiency. The variation in the composition of hybrid perovskite shows specific regions where either the hexagonal or cubic phase dominates. We discuss the balance between the band gap and phase stability and indicate regions where the phase transition temperature between cubic and hexagonal phases is far from room temperature, indicating that these compositions are more robust at room temperature against phase transitions.
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Affiliation(s)
- T. H. Chan
- Department
of Physics and Astronomy, College of Engineering, Mathematics and
Physical Sciences, Streatham Campus, University
of Exeter, Exeter EX4 4QL, U.K.
| | - N. T. Taylor
- Department
of Physics and Astronomy, College of Engineering, Mathematics and
Physical Sciences, Streatham Campus, University
of Exeter, Exeter EX4 4QL, U.K.
| | - S. Sundaram
- The
School of Engineering and the Built Environment, Merchiston Campus, Edinburgh Napier University, Edinburgh EH10 5DT, U.K.
| | - S. P. Hepplestone
- Department
of Physics and Astronomy, College of Engineering, Mathematics and
Physical Sciences, Streatham Campus, University
of Exeter, Exeter EX4 4QL, U.K.
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Nair D, Martinek M, Colley J, Sundaram S, Sharma S, Morales G, Sommer P, Healy S, Siddiqui U, Williams C, Sarver A, Lo M. Acute results of a novel flexible tip radiofrequency catheter incorporating contact force sensing. Europace 2022. [DOI: 10.1093/europace/euac053.077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Private company. Main funding source(s): Abbott
Background
Catheter ablation is an established therapy for paroxysmal atrial fibrillation (PAF). The TactiFlex Ablation Catheter, Sensor-Enabled (TactiFlex SE) is a next-generation radiofrequency ablation catheter incorporating highly accurate fiber optics-based contact force sensing technology with a flexible, laser-cut tip. This is the first report of results from the TactiFlex IDE clinical study.
Purpose
To demonstrate that ablation with TactiFlex SE is safe and effective for the treatment of drug refractory, symptomatic PAF.
Methods
The TactiFlex IDE (NCT04356040) is a prospective, non-randomized, multi-center clinical study which enrolled 305 subjects worldwide in the main study. Enrollment in the main study began on June 26, 2020 and completed on June 8, 2021. Subjects underwent de novo Pulmonary Vein Isolation (PVI) and, if indicated, a Cavotricuspid Isthmus ablation (CTI line) for CTI-dependent atrial flutter.
Results
Acute procedural success was achieved in 98.6% (274/278) of the main study cohort who underwent an ablation procedure using the TactiFlex SE. First pass success, defined as isolation of all pulmonary veins (PVs) confirmed after a minimum 20 min waiting period was achieved in 89.6% (249/278) of subjects. This was a significant improvement versus the TactiSense IDE trial (TactiCath Ablation Catheter, Sensor-Enabled). Significant decreases were also seen in total procedure time (123 min [101.0, 163.5]), total PV ablation time (55.5 min [35.0, 81.0]), total fluoroscopy time (6.0 min [0.0, 13.0]) and irrigation fluid volume (450.0 mL [346.0, 636.0]) (values given as Median [Q1, Q3]), see FIGURE. All subjects have completed at least 90 days of follow-up. Only 2.6% (7/271) of subjects required a repeat procedure during the 90-day blanking period. The primary safety and effectiveness endpoints will be evaluated at 12-months. At 90 days, 4.3% (12/281) subjects had experienced a primary safety endpoint event.
Conclusions
The acute data from the TactiFlex IDE clinical study demonstrate safety and effectiveness of the TactiFlex SE catheter in the treatment of PAF. Ablation procedures performed using the next-generation TactiFlex SE catheter were shorter and had improved acute clinical effectiveness outcomes versus the TactiSense IDE. It is anticipated these results will also be reflected in the 12-month safety and effectiveness endpoints.
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Affiliation(s)
- D Nair
- St. Bernards Medical Center, Jonesboro, United States of America
| | - M Martinek
- A. o. Krankenhaus her Elisabethinen Linz, Linz, Austria
| | - J Colley
- Jackson Heart Clinic, Jackson, United States of America
| | - S Sundaram
- South Denver Cardiology Associates PC, Denver, United States of America
| | - S Sharma
- Memorial Hermann Hospital, Houston, United States of America
| | - G Morales
- Affinity Cardiovascular Specialists, LLC, Birmingham, United States of America
| | - P Sommer
- Heart and Diabetes Center NRW, Bad Oeynhausen, Germany
| | - S Healy
- Monash Medical Center, Clayton, Australia
| | - U Siddiqui
- Advent Health Orlando, Orlando, United States of America
| | - C Williams
- Abbott, Saint Paul, United States of America
| | - A Sarver
- Abbott, Saint Paul, United States of America
| | - M Lo
- Arkansas Heart Hospital, Little Rock, United States of America
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Sundaram S, Chaudhry S, Dinesh S, Baid R. P.46 The effect of standardisation of trans-layer infiltration technique on patient satisfaction and pain scores following caesarean section. Int J Obstet Anesth 2022. [DOI: 10.1016/j.ijoa.2022.103342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Singh Bajwa S, Malde A, Prabhu SS, Sundaram S. Paediatric anaesthesia practice: Has it really changed over the times? Indian J Anaesth 2022; 66:621-624. [DOI: 10.4103/ija.ija_776_22] [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] [Received: 09/08/2022] [Revised: 09/08/2022] [Accepted: 09/08/2022] [Indexed: 11/04/2022] Open
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Lenin S, Sujatha R, Sundaram S. Nutritional Composition, Mineral analysis and Sensory Evaluation of Cake and Chocolate with Moringa oleifera Leaf Powder. JPRI 2021. [DOI: 10.9734/jpri/2021/v33i60b34886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Moringa oleifera is a plant native to India that thrives in tropical and subtropical climates around the world. Moringa is commonly farmed around the world because it can resist both severe drought and moderate winter. The nutritional composition of dry M. oleifera leaf powder was investigated in this study. The leaf extract was examined for its proximate, mineral, vitamin, and sensory properties. The analysis were carried out in supplemented M. oleifera in cake and chocolate prepared with varying proportions such as C, 10%, 15% and 20% respectively. The results in Chocolate sample were carried out for nutritional analysis represented in moisture (1.36, 1.56, 1.73 and 1.96 g/100g), ash (3.44, 3.75, 3.96 and 4.03 g/100g), Protein (8.25, 9.25, 9.87 and 10.01 g/100g) and Fat (36.38, 30.47, 28.29 and 27.22 g/100g). Mineral analysis for Calcium (43.13, 47.73, 48.75 and 49.22 mg), Potassium (558.55, 587.90, 589.20 and 599.73 mg), Phosphorus (76.64, 89.44, 90.24 and 91.74 mg) and Iron (8.43, 9.44, 9.78 and 9.94 mg). Vitamin analysis for β – Carotene (0.02, 0.06, 0.06 and 0.08 mg) and Vitamin – C (0.23, 0.47, 0.53 and 0.61 mg). The sensory analysis was carried out for Concentration of Leaf Powder, Colour and Appearance, Smell, Taste, Mouth Feel and over all Acceptability. Whereas in Cake sample the nutritional analysis represented in moisture (04.32, 05.23, 5.44 and 5.93 g/100g), in ash (05.73, 06.43, 6.76 and 7.06 g/100g), Protein (08.16, 08.75, 8.95 and 8.54 g/100g) and Fat (04.74, 04.23, 04.15 and 04.08 g/100g). Mineral analysis for Calcium (26.71, 27.21, 27.43 and 26.43 mg), Potassium (32.44, 35.26, 35.64 and 35.21 mg), Phosphorus (53.76, 53.99, 57.25 and 55.16 mg) and Iron (01.25, 1.86, 2.05 and 2.16 mg). Vitamin analysis for β – Carotene (00.04, 0.05, 0.05 and 0.06 mg) and Vitamin – C (00.08, 0.12, 0.13 and 0.08 mg). With the addition of Moringa leaf powder, the sensory qualities were found to be within acceptable limits. Moringa leaves are a good source of proteins, minerals, and vitamins, and they can be used as a supplement to improve the nutritional profile of chocolate and cake in the baking industry.
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Punj J, Sundaram S. Ultrasound-guided glossopharyngeal nerve block: Description of a new technique. J Anaesthesiol Clin Pharmacol 2021; 37:483-485. [PMID: 34759567 PMCID: PMC8562455 DOI: 10.4103/joacp.joacp_138_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 04/09/2021] [Accepted: 04/10/2021] [Indexed: 11/06/2022] Open
Affiliation(s)
- Jyotsna Punj
- Department of Anesthesiology, Pain Medicine and Critical Care-AIIMS, New Delhi, India
| | - Shanmuga Sundaram
- Department of Anesthesiology, Pain Medicine and Critical Care-AIIMS, New Delhi, India
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Murthy SK, Ramkumar MSD, Raghavn NM, Pooja B, Sundaram S. Role of Anthropometric Data in Assessing Hamstring Graft Size in Anterior Cruciate Ligament Reconstruction. JPRI 2021. [DOI: 10.9734/jpri/2021/v33i48a33200] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Background and Objective: Preoperative information of hamstring graft size for anterior cruciate ligament reconstruction (ACL) is critical for making optimal graft selections. The aim of the present study was to view whether anthropometric parameters including height, weight, BMI and thigh circumference have any bearing on the size of hamstring tendon grafts used in anterior cruciate ligament replacement.
Methods: Pre-operative anthropometric measurements were taken on 72 patients undergoing primary ACL reconstruction, including age, gender, height, weight, BMI, and thigh circumference. The Person correlation coefficient was used to assess the correlation of these anthropometric variables and simple logistic regression was used to evaluate the correlation of these anthropometric variables on the size of the graft that was acquired.
Results: Gracilis tendon [GT] length correlates with height (r 1/4 0,432), and semitendinosus [ST] length correlates with thigh circumference (r 1/4 0,255). Women's graft diameter (7.16 ± 0.82 mm) smaller than that of men (7.39 ± 0.63 mm) (p > 0.05), although not statistically significant. The diameter of the autograft was shown to be strongly linked with parameters.
Conclusion: As a consequence, our findings suggest that anthropometric measures can be used in the preoperative planning and prediction of hamstring graft length and diameter in anterior cruciate ligament reconstruction.
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Sharma GK, Natarajan CK, Hementhakumar V, Sundaram S, Sharma SS. Prognostic Value of Amplitude-Integrated Electroencephalography in Term Neonates With Encephalopathy. Indian Pediatr 2021; 58:928-931. [PMID: 33864450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To evaluate the prognostic value of amplitude-integrated EEG in term neonates with encephalopathy. METHODS In this prospective observational study we enrolled 58 term neonates with encephalopathy from March, 2019 to March, 2020. Level of alertness was ascertained as per Volpe's classification and tone as per Amiel-Tison scale of tone assessment. Abnormal aEEG was defined as background activity other than continuous normal voltage, or immature or absent sleep-wake cycle, or presence of electrical seizure. Primary outcome was abnormal neurological examination at discharge and/or death prior to discharge. RESULTS Out of 58 neonates, aEEG was abnormal for 50 (86.2%). There was a statistically significant association between abnormal aEEG findings and primary outcome (P=0.04). The aEEG score cut-off of >2 had satisfactory sensitivity (88.8%) and specificity (79.5%) to predict primary outcome. CONCLUSIONS Abnormal aEEG had good sensitivity but low specificity to predict the primary outcome in term neonates with encephalopathy.
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Affiliation(s)
- Giriraj Kumar Sharma
- Department of Neonatology, Kanchi Kamakoti CHILDS Trust Hospital, Chennai, Tamil Nadu
| | - Chandra Kumar Natarajan
- Department of Neonatology, Kanchi Kamakoti CHILDS Trust Hospital, Chennai, Tamil Nadu. Correspondence to: Dr Chandra Kumar Natarajan, Head of the Department, Department of Neonatology, Kanchi Kamakoti CHILDS Trust Hospital, Nageshwara road, Nungambakkam, Chennai, Tamil Nadu.
| | | | - Shanmuga Sundaram
- Department of Neonatology, Kanchi Kamakoti CHILDS Trust Hospital, Chennai, Tamil Nadu
| | - Shyam Sundar Sharma
- Department of Neonatology, Kanchi Kamakoti CHILDS Trust Hospital, Chennai, Tamil Nadu
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Sharma GK, Natarajan CK, Hementhakumar V, Sundaram S, Sharma SS. Prognostic Value of Amplitude-Integrated Electroencephalography in Term Neonates With Encephalopathy. Indian Pediatr 2021. [DOI: 10.1007/s13312-021-2323-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Torka P, Groman A, Wong J, Baysal B, Nichols J, Kader A, Mavis C, Jani Sait S, Block A, Przespolewski E, Mohr A, Lund I, McWhite K, Kostrewa J, DeMarco J, Johnson M, Darrall A, Thomas R, Sundaram S, Ghione P, Hutson A, Hernandez‐Ilizaliturri F. A PHASE 1 STUDY OF CARFILZOMIB WITH RITUXIMAB, IFOSFAMIDE, CARBOPLATIN AND ETOPOSIDE (C‐RICE) IN TRANSPLANT‐ELIGIBLE RELAPSED/REFRACTORY DIFFUSE LARGE B‐CELL LYMPHOMA. Hematol Oncol 2021. [DOI: 10.1002/hon.83_2881] [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: 11/07/2022]
Affiliation(s)
- P. Torka
- Roswell Park Comprehensive Cancer Center Medicine Buffalo USA
| | - A. Groman
- Roswell Park Comprehensive Cancer Center Biostatistics Buffalo USA
| | - J. Wong
- Roswell Park Comprehensive Cancer Center Pathology Buffalo USA
| | - B. Baysal
- Roswell Park Comprehensive Cancer Center Pathology Buffalo USA
| | - J. Nichols
- Roswell Park Comprehensive Cancer Center Clinical Research Services Buffalo USA
| | - A. Kader
- Roswell Park Comprehensive Cancer Center Clinical Research Services Buffalo USA
| | - C. Mavis
- Roswell Park Comprehensive Cancer Center Immunology Buffalo USA
| | - S. Jani Sait
- Roswell Park Comprehensive Cancer Center Cytogenetics Buffalo USA
| | - A. Block
- Roswell Park Comprehensive Cancer Center Cytogenetics Buffalo USA
| | | | - A. Mohr
- Roswell Park Comprehensive Cancer Center Medicine Buffalo USA
| | - I. Lund
- Roswell Park Comprehensive Cancer Center Medicine Buffalo USA
| | - K. McWhite
- Roswell Park Comprehensive Cancer Center Medicine Buffalo USA
| | - J. Kostrewa
- Roswell Park Comprehensive Cancer Center Medicine Buffalo USA
| | - J. DeMarco
- Roswell Park Comprehensive Cancer Center Medicine Buffalo USA
| | - M. Johnson
- Roswell Park Comprehensive Cancer Center Medicine Buffalo USA
| | - A. Darrall
- Roswell Park Comprehensive Cancer Center Medicine Buffalo USA
| | - R.‐N. Thomas
- Roswell Park Comprehensive Cancer Center Medicine Buffalo USA
| | - S. Sundaram
- Roswell Park Comprehensive Cancer Center Medicine Buffalo USA
| | - P. Ghione
- Roswell Park Comprehensive Cancer Center Medicine Buffalo USA
| | - A. Hutson
- Roswell Park Comprehensive Cancer Center Biostatistics Buffalo USA
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David KA, Sundaram S, Kim S, Vaca R, Lin Y, Singer S, Malecek M, Carter J, Zayac A, Kim MS, Reddy N, Ney D, Habib A, Strouse C, Graber J, Bachanova V, Salman S, Vendiola JA, Hossain N, Tsang M, Major A, Bond DB, Agrawal P, Mier‐Hicks A, Torka P, Rajakumar P, Venugopal P, Berg S, Glantz M, Goldlust S, Kumar P, Ollila T, Cai J, Spurgeon S, Sieg A, Cleveland J, Epperla N, Karmali R, Naik S, Martin P, Smith SM, Rubenstein J, Kahl B, Evens AM. OLDER PATIENTS WITH PRIMARY CENTRAL NERVOUS SYSTEM LYMPHOMA (PCNSL): REAL WORLD (RW) OUTCOMES OF POST‐INDUCTION THERAPY IN THE MODERN ERA. Hematol Oncol 2021. [DOI: 10.1002/hon.69_2880] [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: 11/10/2022]
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Ghione P, Cortes Gomez E, Torka P, Sundaram S, Mavis C, Tabbo' F, Gu J, Cacciapuoti MT, Yoffe L, Wang J, Hernandez‐Ilizaliturri F, Inghirami G. RNA SEQUENCING REVEALS DIFFERENT GENE EXPRESSION IN MALE VERSUS FEMALE DIFFUSE LARGE B‐CELL LYMPHOMA. Hematol Oncol 2021. [DOI: 10.1002/hon.14_2880] [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: 11/08/2022]
Affiliation(s)
- P Ghione
- Roswell Park Comprehensive Cancer Center Lymphoma Buffalo NY USA
| | - E Cortes Gomez
- Roswell Park Comprehensive Cancer Center Biostatistics Buffalo New York USA
| | - P Torka
- Roswell Park Comprehensive Cancer Center Lymphoma Buffalo NY USA
| | - S Sundaram
- Roswell Park Comprehensive Cancer Center Lymphoma Buffalo NY USA
| | - C Mavis
- Roswell Park Comprehensive Cancer Center Lymphoma Buffalo NY USA
| | - F Tabbo'
- Universita' degli Studi di Torino Oncology Torino Italy
| | - J Gu
- Roswell Park Comprehensive Cancer Center Lymphoma Buffalo NY USA
| | | | - L Yoffe
- Weill Cornell Medicine Biostatistics New York New York USA
| | - J Wang
- Roswell Park Comprehensive Cancer Center Biostatistics Buffalo New York USA
| | | | - G Inghirami
- Weill Cornell Medicine Hematopathology New York USA
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Giuggia M, Volpicelli M, Mantica M, Notarangelo MF, Sundaram S, Gora P, Bottoni N. Incidence and location of residual gaps identified by a high-density grid-style catheter after PVI is confirmed by pacing the ablation lines. Europace 2021. [DOI: 10.1093/europace/euab116.190] [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: 11/12/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
The continual pursuit of more durable pulmonary vein isolation (PVI) has led ablationists to evaluate many different techniques for confirming isolation. One such technique involves using the ablation catheter to pace along the ablation lines, ensuring loss of pace capture. Initial observations from a small cohort of patients suggested that a high-density, grid style mapping catheter (HD Grid) enabling simultaneous recording of adjacent bipolar EGMs in two directions (HD Wave) may identify residual gaps that are missed when using the technique of pacing the ablation line in isolation. The true incidence of these residual gaps as identified in a large patient population has not been previously reported.
Purpose
To quantify in a large cohort of AF ablation patients, the presence of residual gaps identified by HD Grid which are missed by a technique of pacing along the ablation lines with the ablation catheter.
Methods
Self-reported data was prospectively collected in AF radiofrequency ablation procedures in which PVI was first confirmed by pacing along the ablation line followed by assessment using the HD Grid. Procedural characteristics and acute outcomes, including the incidence and location of gaps post-ablation, were analyzed.
Results
Data was collected in 111 AF ablation procedures performed in 18 centers across the United States and Europe. Paroxysmal (PAF), persistent (PersAF), and longstanding persistent AF (LsPersAF) accounted for 60.4%, 33.3%, and 6.3% of cases, respectively. Overall, 64.0% of ablations were de novo procedures. Following ablation, PVI was confirmed in all cases by pacing the ablation line with an average output of 9.1 ± 2.6mA and pulse width of 2.1 ± 0.5ms. Adenosine was administered in 3.6% of cases, isoproterenol in 3.6%, and a combination in 0.9%. PVI was then reassessed with HD Grid using a variety of techniques including exit block (91.0%), voltage mapping (82.0%), loss of pace capture along the ablation lines (47.7%), and entrance block (27.0%); note: total exceeds 100% as more than one technique may be used in a single case. A second dose of adenosine was administered in 2.7% of cases; isoproterenol in 2.7%. The HD Wave configuration was used in 96.4% of cases. HD Grid identified a total of 130 gaps in 65 (58.6%) patients, which were missed by pacing the ablation line (Figure 1).
Conclusions
In over half of the patients evaluated, the HD Grid identified residual PVI gaps that were missed when isolation was confirmed by using the ablation catheter to pace the ablation lines. These results suggest that the pacing technique, used in isolation, is not sufficient for complete gap detection. One limitation of this analysis was the use of a workflow which consistently assessed PVI with the HD Grid following confirmation of isolation by pacing the ablation lines. Despite this limitation, the rate at which residual gaps were identified is noteworthy and likely warrants additional study. Abstract Figure.
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Affiliation(s)
| | | | - M Mantica
- Instituto Clinico Sant"Ambrogio, Arrhytmia and Clinical Electrophysiology Unit, Milan, Italy
| | - MF Notarangelo
- Azienda Ospedaliero-Universitaria of Parma, Parma, Italy
| | - S Sundaram
- South Denver Cardiology Associates, Littleton, CO, United States of America
| | - P Gora
- Abbott, Minneapolis, United States of America
| | - N Bottoni
- Santa Maria Nuova Hospital, Interventional Arrhythmology Unit, Reggio Emilia, Italy
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Sekar H, Krishnamoorthy S, Kumaresan N, Chandrasekaran D, Ramaswamy P, Sundaram S, Raj N. Clinicopathological comparison of VHL expression as a prognostic tumor marker in renal cell carcinoma: A single center experience. Niger J Clin Pract 2021; 24:614-620. [PMID: 33851686 DOI: 10.4103/njcp.njcp_57_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
AIM To assess the VHL gene expression as a prognostic marker in Renal Cell Carcinoma (RCC) and compare it with clinicopathologic features. MATERIALS AND METHODS This retrospective observational study was conducted in the department of Urology and Renal Transplantation in Sri Ramachandra Institute of Higher Education and Research, Chennai from August 2016 to August 2018. Thirty patients who have undergone a radical/partial nephrectomy with biopsy proven histological diagnosis of RCC during the study period were included in the study. Data was analyzed using Statistical package for Social Sciences version 17. RESULTS A complete loss and retained VHL expression were noted in 60% and 40% of the RCC specimens. Association between smoking and VHL expression was found to be statistically significant. There was no statistical significance found between age group, sex, chief complaints, BMI. ECOG score, hypertension, family history, location of tumor, calcification, venous system or lymphnode involvement. However, rT staging, nature of lesion and cut surface, HPE type, pT staging, HPE grade, necrosis and lympho-vascular invasion were also found to be statistically significant. CONCLUSION Complete loss of VHL expression was noted in majority of the specimens that leads to the development of RCC. Smoking has been found to be statistically significant in tumors that retain VHL expression which may contributes to more aggressive form of tumor. Association between rT staging, nature of lesion and cut surface, HPE type, pT staging, HPE grade, necrosis and lympho-vascular invasion were also found to be statistically significant.
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Affiliation(s)
- H Sekar
- Department of Urology, Physiology, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
| | - S Krishnamoorthy
- Department of Urology, Physiology, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
| | - N Kumaresan
- Department of Urology, Physiology, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
| | - D Chandrasekaran
- Department of Pathology, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
| | - P Ramaswamy
- Department of Pathology, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
| | - S Sundaram
- Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
| | - N Raj
- Consultant Urologist, R.G Stone Clinic, Chennai, Tamil Nadu, India
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Sundaram S, Punj J. Randomized Controlled Trial Comparing Landmark and Ultrasound-Guided Glossopharyngeal Nerve in Eagle Syndrome. Pain Med 2020; 21:1208-1215. [PMID: 32167550 DOI: 10.1093/pm/pnz370] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
INTRODUCTION The glossopharyngeal nerve lies posterior to the internal carotid artery at the submandibular region. The primary objective of this study was to compare ultrasound-guided glossopharyngeal nerve block (UGPNB) and landmark glossopharyngeal nerve block (GPNB). MATERIALS & METHODS Inclusion criteria were patients with unilateral Eagle syndrome and ear pain. Group UGPNB (N = 25) received three UGPNBs at weekly intervals with 1.5 mL of 0.5% ropivacaine and 20 mg of methylprednisolone. Group GPNB (N = 26) received landmark GPNB. Pain intensity was evaluated with the numerical rating scale (NRS) before every block, 30 minutes after every block, and at one, three, and five weeks after the third block. Quality of life, assessed using the Brief Pain Inventory (BPI), and satisfaction scores were noted. RESULTS NRS scores before the second and third blocks and a week after were significantly lower in group UGPNB and comparable at weeks 3 and 5. NRS scores 30 minutes after every block were significantly decreased from the preblock values but were comparable between groups. In 68% of patients, a curvilinear probe delineated the internal carotid artery (ICA). Out-of-plane needle trajectory was required in 64% of patients. BPI and satisfaction scores were significantly better in the UGPNB group in the "block" weeks. CONCLUSIONS UGPNB with 1.5 mL of 0.5% ropivacaine and 20 mg of methylprednisolone injected posterior to the ICA in the submandibular region provides better pain relief for at least a week compared with an extraoral landmark technique when three weekly consecutive blocks are given. In most patients, a curvilinear probe and out-of-plane needle trajectory are most suitable for ultrasound block.
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Affiliation(s)
- Shanmuga Sundaram
- Department of Anesthesiology, All India Institute of Medical Sciences, New Delhi, India
| | - Jyotsna Punj
- Department of Anesthesiology, All India Institute of Medical Sciences, New Delhi, India
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Elisofon SA, Magee JC, Ng VL, Horslen SP, Fioravanti V, Economides J, Erinjeri J, Anand R, Mazariegos GV, Martin A, Mannino D, Flynn L, Mohammad S, Alonso E, Superina R, Brandt K, Riordan M, Lokar J, Ito J, Elisofon S, Zapata L, Jain A, Foristal E, Gupta N, Whitlow C, Naik K, Espinosa H, Miethke A, Hawkins A, Hardy J, Engels E, Schreibeis A, Ovchinsky N, Kogan‐Liberman D, Cunningham R, Malik P, Sundaram S, Feldman A, Garcia B, Yanni G, Kohli R, Emamaullee J, Secules C, Magee J, Lopez J, Bilhartz J, Hollenbeck J, Shaw B, Bartow C, Forest S, Rand E, Byrne A, Linguiti I, Wann L, Seidman C, Mazariegos G, Soltys K, Squires J, Kepler A, Vitola B, Telega G, Lerret S, Desai D, Moghe J, Cutright L, Daniel J, Andrews W, Fioravanti V, Slowik V, Cisneros R, Faseler M, Hufferd M, Kelly B, Sudan D, Mavis A, Moats L, Swan‐Nesbit S, Yazigi N, Buranych A, Hobby A, Rao G, Maccaby B, Gopalareddy V, Boulware M, Ibrahim S, El Youssef M, Furuya K, Schatz A, Weckwerth J, Lovejoy C, Kasi N, Nadig S, Law M, Arnon R, Chu J, Bucuvalas J, Czurda M, Secheli B, Almy C, Haydel B, Lobritto S, Emand J, Biney‐Amissah E, Gamino D, Gomez A, Himes R, Seal J, Stewart S, Bergeron J, Truxillo A, Lebel S, Davidson H, Book L, Ramstack D, Riley A, Jennings C, Horslen S, Hsu E, Wallace K, Turmelle Y, Nadler M, Postma S, Miloh T, Economides J, Timmons K, Ng V, Subramonian A, Dharmaraj B, McDiarmid S, Feist S, Rhee S, Perito E, Gallagher L, Smith K, Ebel N, Zerofsky M, Nogueira J, Greer R, Gilmour S, Robert C, Cars C, Azzam R, Boone P, Garbarino N, Lalonde M, Kerkar N, Dokus K, Helbig K, Grizzanti M, Tomiyama K, Cocking J, Alexopoulos S, Bhave C, Schillo R, Bailey A, Dulek D, Ramsey L, Ekong U, Valentino P, Hettiarachchi D, Tomlin R. Society of pediatric liver transplantation: Current registry status 2011-2018. Pediatr Transplant 2020; 24:e13605. [PMID: 31680409 DOI: 10.1111/petr.13605] [Citation(s) in RCA: 62] [Impact Index Per Article: 15.5] [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: 05/31/2019] [Revised: 08/08/2019] [Accepted: 09/27/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND SPLIT was founded in 1995 in order to collect comprehensive prospective data on pediatric liver transplantation, including waiting list data, transplant, and early and late outcomes. Since 2011, data collection of the current registry has been refined to focus on prospective data and outcomes only after transplant to serve as a foundation for the future development of targeted clinical studies. OBJECTIVE To report the outcomes of the SPLIT registry from 2011 to 2018. METHODS This is a multicenter, cross-sectional analysis characterizing patients transplanted and enrolled in the SPLIT registry between 2011 and 2018. All patients, <18 years of age, received a first liver-only, a combined liver-kidney, or a combined liver-pancreas transplant during this study period. RESULTS A total of 1911 recipients from 39 participating centers in North America were registered. Indications included biliary atresia (38.5%), metabolic disease (19.1%), tumors (11.7%), and fulminant liver failure (11.5%). Greater than 50% of recipients were transplanted as either Status 1A/1B or with a MELD/PELD exception score. Incompatible transplants were performed in 4.1%. Kaplan-Meier estimates of 1-year patient and graft survival were 97.3% and 96.6%. First 30 days of surgical complications included reoperation (31.7%), hepatic artery thrombosis (6.3%), and portal vein thrombosis (3.2%). In the first 90 days, biliary tract complications were reported in 13.6%. Acute cellular rejection during first year was 34.7%. At 1 and 2 years of follow-up, 39.2% and 50.6% had normal liver tests on monotherapy (tacrolimus or sirolimus). Further surgical, survival, allograft function, and complications are detailed.
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Affiliation(s)
- Scott A Elisofon
- Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, Boston, Massachusetts
| | - John C Magee
- Division of Surgery, University of Michigan Transplant Center, Ann Arbor, Michigan
| | - Vicky L Ng
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Transplant and Regenerative Medicine Center, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Simon P Horslen
- Department of Pediatrics, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, Washington
| | - Vicki Fioravanti
- Section of Hepatology and Liver Transplantation, Children's Mercy Hospital, Kansas City, Missouri
| | | | | | | | - George V Mazariegos
- Division of Pediatric Transplant Surgery, Hillman Center for Pediatric Transplantation, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
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Palaniappan B, Arthur S, Sundaram VL, Butts M, Sundaram S, Mani K, Singh S, Nepal N, Sundaram U. Inhibition of intestinal villus cell Na/K-ATPase mediates altered glucose and NaCl absorption in obesity-associated diabetes and hypertension. FASEB J 2019; 33:9323-9333. [PMID: 31107610 PMCID: PMC6662973 DOI: 10.1096/fj.201802673r] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2018] [Accepted: 04/23/2019] [Indexed: 01/07/2023]
Abstract
During obesity, diabetes and hypertension inevitably coexist and cause innumerable health disparities. In the obesity, diabetes, and hypertension triad (ODHT), deregulation of glucose and NaCl homeostasis, respectively, causes diabetes and hypertension. In the mammalian intestine, glucose is primarily absorbed by Na-glucose cotransport 1 (SGLT1) and coupled NaCl by the dual operation of Na-H exchange 3 (NHE3) and Cl-HCO3 [down-regulated in adenoma (DRA) or putative anion transporter 1 (PAT1)] exchange in the brush border membrane (BBM) of villus cells. The basolateral membrane (BLM) Na/K-ATPase provides the favorable transcellular Na gradient for BBM SGLT1 and NHE3. How these multiple, distinct transport processes may be affected in ODHT is unclear. Here, we show the novel and broad regulation by Na/K-ATPase of glucose and NaCl absorption in ODHT in multiple species (mice, rats, and humans). In vivo, during obesity inhibition of villus-cell BLM, Na/K-ATPase led to compensatory stimulation of BBM SGLT1 and DRA or PAT1, whereas NHE3 was unaffected. Supporting this new cellular adaptive mechanism, direct silencing of BLM Na/K-ATPase in intestinal epithelial cells resulted in selective stimulation of BBM SGLT1 and DRA or PAT1 but not NHE3. These changes will lead to an increase in glucose absorption, maintenance of traditional coupled NaCl absorption, and a de novo increase in NaCl absorption from the novel coupling of stimulated SGLT1 with DRA or PAT1. Thus, these novel observations provide the pathophysiologic basis for the deregulation of glucose and NaCl homeostasis of diabetes and hypertension, respectively, during obesity. These observations may lead to more efficacious treatment for obesity-associated diabetes and hypertension.-Palaniappan, B., Arthur, S., Sundaram, V. L., Butts, M., Sundaram, S., Mani, K., Singh, S., Nepal, N., Sundaram, U. Inhibition of intestinal villus cell Na/K-ATPase mediates altered glucose and NaCl absorption in obesity-associated diabetes and hypertension.
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Affiliation(s)
- Balasubramanian Palaniappan
- Department of Clinical and Translational Sciences, Joan C. Edwards School of Medicine, Marshall University, Huntington, West Virginia, USA
| | - Subha Arthur
- Department of Clinical and Translational Sciences, Joan C. Edwards School of Medicine, Marshall University, Huntington, West Virginia, USA
| | - Vijaya Lakshmi Sundaram
- Department of Clinical and Translational Sciences, Joan C. Edwards School of Medicine, Marshall University, Huntington, West Virginia, USA
| | - Molly Butts
- Department of Clinical and Translational Sciences, Joan C. Edwards School of Medicine, Marshall University, Huntington, West Virginia, USA
| | - Shanmuga Sundaram
- Department of Clinical and Translational Sciences, Joan C. Edwards School of Medicine, Marshall University, Huntington, West Virginia, USA
| | - Kathiresh Mani
- Department of Clinical and Translational Sciences, Joan C. Edwards School of Medicine, Marshall University, Huntington, West Virginia, USA
| | - Soudamani Singh
- Department of Clinical and Translational Sciences, Joan C. Edwards School of Medicine, Marshall University, Huntington, West Virginia, USA
| | - Niraj Nepal
- Department of Clinical and Translational Sciences, Joan C. Edwards School of Medicine, Marshall University, Huntington, West Virginia, USA
| | - Uma Sundaram
- Department of Clinical and Translational Sciences, Joan C. Edwards School of Medicine, Marshall University, Huntington, West Virginia, USA
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Babu R, Vittalraj P, Sundaram S, Shalini S. Pathological changes in ureterovesical and ureteropelvic junction obstruction explained by fetal ureter histology. J Pediatr Urol 2019; 15:240.e1-240.e7. [PMID: 30850354 DOI: 10.1016/j.jpurol.2019.02.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 02/03/2019] [Indexed: 12/14/2022]
Abstract
UNLABELLED The etiology of ureterovesical junction obstruction (UVJO) and ureteropelvic junction obstruction (UPJO) is obscure with an adynamic narrow segment causing the obstruction. In this study, the authors compared interstitial cells of Cajal (ICC) and collagen-to-muscle ratio (CM ratio) between UVJO, UPJO, and fetal ureters to investigate whether a maturational arrest of the fetal ureter could explain both clinical pathologies. METHODS Group 1 (control) involved specimens of the normal ureter (nephrectomy for trauma/tumor; n = 20), while group 2, specimens of UVJO (n = 14); group 2 was further divided into group 2a, the dilated megaureter above UVJO, and group 2b, UVJO narrow segment; group 3, UPJO narrow segment excised during pyeloplasty (n = 31); and group 4, normal fetal ureters (n = 12). The specimens were analyzed for ICC using immunohistochemistry and CM ratio on Masson's trichrome (stains collagen in blue and muscle in red). RESULTS The median ICC/10 high-power field was 16.1 (8.3) in the normal and 17.3 (7.9) in the dilated segment of the megaureter, with no significant difference, but was significantly less in the narrow segment of UVJO at 4.5 (2.0), narrow segment of UPJO at 5.1 (2.3), and fetal ureter at 5.0 (2.3). The median CM ratio was 0.75 (0.29) in the normal and 0.65 (0.2) in the dilated segment of the megaureter, with no significant difference between them (figure), but was significantly higher in the narrow segment of UVJO at 3.0 (0.8), narrow segment of UPJO at 2.5 (0.71), and fetal ureter at 3.1 (0.61). Overall UVJO, UPJO, and fetal ureter segment had significantly less ICC density and more collagen compared with the normal ureter (P < 0.001 by Mann-Whitney U test). DISCUSSION There are conflicting reports on the etiopathogenesis of UVJO and UPJO, with several authors showing decreased ICC and increased collagen in the narrow segment. In this study, the authors found that the pathological changes at UVJ and UPJ segments resemble fetal ureter morphology. We also found that in fetal ureters, as the gestation progressed, there was an increase in the ICC density/smooth muscle, whereas the collagen content decreased. While the entire ureter has uniform embryological origin, it essentially remains an epithelial tube until the late gestation. The maturational process involves differentiation of smooth muscles cells/ICC to establish the peristaltic machinery required to functionally connect the ureter at both ends. This process, probably, starts at the mid ureter during fetal life and extends toward the UPJ and UVJ, and its failure, probably, results in UPJO or UVJO. The study's limitations are small numbers, and further larger studies are required to validate this hypothesis.
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Affiliation(s)
- R Babu
- Department of Pediatric Urology, Sri Ramachandra Institute of Higher Education and Reseach, Porur, Chennai 600116, India.
| | - P Vittalraj
- Department of Pathology, Sri Ramachandra Institute of Higher Education and Reseach, Porur, Chennai 600116, India
| | - S Sundaram
- Department of Pathology, Sri Ramachandra Institute of Higher Education and Reseach, Porur, Chennai 600116, India
| | - S Shalini
- Department of Pathology, Sri Ramachandra Institute of Higher Education and Reseach, Porur, Chennai 600116, India
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Manoharan P, Sundaram S, Singh S, Sundaram U. Inducible Nitric Oxide Regulates Brush Border Membrane Na-Glucose Co-transport, but Not Na:H Exchange via p38 MAP Kinase in Intestinal Epithelial Cells. Cells 2018; 7:cells7080111. [PMID: 30126234 PMCID: PMC6115905 DOI: 10.3390/cells7080111] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 08/14/2018] [Accepted: 08/16/2018] [Indexed: 12/12/2022] Open
Abstract
During chronic intestinal inflammation in rabbit intestinal villus cells brush border membrane (BBM) Na-glucose co-transport (SGLT1), but not Na/H exchange (NHE3) is inhibited. The mechanism of inhibition is secondary to a decrease in the number of BBM co-transporters. In the chronic enteritis mucosa, inducible nitric oxide (iNO) and superoxide production are known to be increased and together they produce abundant peroxynitrite (OONO), a potent oxidant. However, whether OONO mediates the SGLT1 and NHE3 changes in intestinal epithelial cells during chronic intestinal inflammation is unknown. Thus, we determined the effect of OONO on SGLT1 and NHE3 in small intestinal epithelial cell (IEC-18) monolayers grown on trans well plates. In cells treated with 100 μM SIN-1 (OONO donor) for 24 h, SGLT1 was inhibited while NHE3 activity was unaltered. SIN-1 treated cells produced 40 times more OONO fluorescence compared to control cells. Uric acid (1mM) a natural scavenger of OONO prevented the OONO mediated SGLT1 inhibition. Na+/K+-ATPase which maintains the favorable trans-cellular Na gradient for Na-dependent absorptive processes was decreased by OONO. Kinetics studies demonstrated that the mechanism of inhibition of SGLT1 by OONO was secondary to reduction in the number of co-transporters (Vmax) without an alteration in the affinity. Western blot analysis showed a significant decrease in SGLT1 protein expression. Further, p38 mitogen-activated protein (MAP) kinase pathway appeared to mediate the OONO inhibition of SGLT1. Finally, at the level of the co-transporter, 3-Nitrotyrosine formation appears to be the mechanism of inhibition of SGLT1. In conclusion, peroxynitrite inhibited BBM SGLT1, but not NHE3 in intestinal epithelial cells. These changes and the mechanism of SGLT1 inhibition by OONO in IEC-18 cells is identical to that seen in villus cells during chronic enteritis. Thus, these data indicate that peroxynitrite, known to be elevated in the mucosa, may mediate the inhibition of villus cell BBM SGLT1 in vivo in the chronically inflamed intestine.
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Affiliation(s)
- Palanikumar Manoharan
- Department of Molecular Genetics, Biochemistry & Microbiology, University of Cincinnati, Cincinnati, OH 45221, USA.
| | - Shanmuga Sundaram
- Department of Clinical and Translational Sciences and Appalachian Clinical and Translational Science Institute, Joan C. Edwards School of Medicine, Marshall University, Huntington, WV 25701, USA.
| | - Soudamani Singh
- Department of Clinical and Translational Sciences and Appalachian Clinical and Translational Science Institute, Joan C. Edwards School of Medicine, Marshall University, Huntington, WV 25701, USA.
| | - Uma Sundaram
- Department of Clinical and Translational Sciences and Appalachian Clinical and Translational Science Institute, Joan C. Edwards School of Medicine, Marshall University, Huntington, WV 25701, USA.
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Sundaram S, Yan L. Time-restricted feeding mitigates high-fat diet-enhanced mammary tumorigenesis in MMTV-PyMT mice. Nutr Res 2018; 59:72-79. [PMID: 30442235 DOI: 10.1016/j.nutres.2018.07.014] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2018] [Revised: 07/02/2018] [Accepted: 07/29/2018] [Indexed: 12/13/2022]
Abstract
Erratic eating behavior disrupts the daily feeding and fasting pattern and leads to metabolic dysfunction and chronic diseases including cancer. In the present study, we tested the hypothesis that time-restricted feeding of a high-fat diet (HFD) to the dark phase does not enhance mammary tumorigenesis in MMTV-PyMT mice. Female mice were assigned to 3 groups and fed the standard AIN93G diet or an HFD with or without dark phase restricted feeding (12 hours). The duration of restricted feeding was 8 weeks. The HFD group had 24% more body fat mass than the AIN93G group; the body fat mass of the restricted group remained similar to that of the AIN93G group. Energy intake of the restricted group was similar to that of the HFD and AIN93G groups. The median mammary tumor latency was 5.8, 7.0, and 6.4 weeks for the AIN93G, HFD, and restricted groups, respectively. Mammary tumor progression was 241% higher in the HFD group than that in the AIN93G group; there was no significant difference in tumor progression between the restricted and AIN93G groups. Plasma concentrations of leptin, monocyte chemoattractant protein-1, plasminogen activator inhibitor-1, angiopoietin-2, vascular endothelial growth factor, and hepatocyte growth factor were significantly higher in the HFD group than those in the control group; these measurements were similar between the restricted and control groups. In conclusion, feeding restricted to the dark phase mitigates the HFD-enhanced mammary tumorigenesis; this may be related to the lower body adiposity and associated inflammatory and angiogenic signals.
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Affiliation(s)
- S Sundaram
- US Department of Agriculture, Agricultural Research Service, Grand Forks Human Nutrition Research Center, Grand Forks, ND 58202, USA.
| | - L Yan
- US Department of Agriculture, Agricultural Research Service, Grand Forks Human Nutrition Research Center, Grand Forks, ND 58202, USA.
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Sampathkumar G, Nair V, Menon UV, Smitha NV, Sundaram S, Kumar H, Pavithran PV, Bhavani N, Menon AS, Abraham N, Pullikkal A. A Comparison of Clinicopathological Characteristics and Short-Term Outcome of Papillary Thyroid Carcinoma with Tall Cell Histology and Classic Papillary Thyroid Carcinoma: A Single-Institution Experience. Indian J Endocrinol Metab 2018; 22:405-409. [PMID: 30090735 PMCID: PMC6063188 DOI: 10.4103/ijem.ijem_65_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
CONTEXT Papillary thyroid carcinoma with tall cell histology (PTC-TCH) is an aggressive subtype in terms of clinicopathological features and outcome. Even 10% of tall cells can show aggressive features. AIMS The aim of this study is to investigate the behavior of PTC-TCH, to compare with classic PTC (cPTC), and evaluate the short-term outcome. SETTINGS AND DESIGN This is a retrospective analysis of patients with cPTC and those with TCH (PTC-TCH) seen from January 2010 to May 2017 seen in our Thyroid Cancer Clinic. MATERIALS AND METHODS A total of 40 patients with TCH were compared with 352 cPTC and evaluated for age, gender, tumor size, presence of multifocality, capsular, vascular invasion, extrathyroid extension, and appearance of metastases. Short-term response to therapy was assessed using the 2015 American Thyroid Association guidelines. STATISTICAL ANALYSIS P < 0.05 was considered statistically significant. All analyses were performed with SPSS software (Version 21.0, Chicago, IL, USA). RESULTS PTC with TCH presented at a younger age, had larger tumors, and more extrathyroid extension. Seven out of 40 cases developed lung metastases, (17.5% vs. 4.5% in cPTC), within a year of diagnosis. CONCLUSION PTC-TCH irrespective of percentage of tall cells showed aggressive features and early metastases. They should be recognized early as an aggressive subtype and treated intensively. Close follow-up must be instituted to look for metastases, especially to the lungs.
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Affiliation(s)
- Geethalakshmi Sampathkumar
- Department of Endocrinology, Amrita Institute of Medical Sciences and Research Centre, Cochin, Kerala, India
| | - Vasantha Nair
- Department of Endocrinology, Amrita Institute of Medical Sciences and Research Centre, Cochin, Kerala, India
| | - Usha V. Menon
- Department of Endocrinology, Amrita Institute of Medical Sciences and Research Centre, Cochin, Kerala, India
| | - N. V. Smitha
- Department of Pathology, Amrita Institute of Medical Sciences and Research Centre, Cochin, Kerala, India
| | - Shanmuga Sundaram
- Department of Nuclear Medicine, Amrita Institute of Medical Sciences and Research Centre, Cochin, Kerala, India
| | - Harish Kumar
- Department of Endocrinology, Amrita Institute of Medical Sciences and Research Centre, Cochin, Kerala, India
| | - Praveen V. Pavithran
- Department of Endocrinology, Amrita Institute of Medical Sciences and Research Centre, Cochin, Kerala, India
| | - Nisha Bhavani
- Department of Endocrinology, Amrita Institute of Medical Sciences and Research Centre, Cochin, Kerala, India
| | - Arun S. Menon
- Department of Endocrinology, Amrita Institute of Medical Sciences and Research Centre, Cochin, Kerala, India
| | - Nithya Abraham
- Department of Endocrinology, Amrita Institute of Medical Sciences and Research Centre, Cochin, Kerala, India
| | - Annie Pullikkal
- Department of Endocrinology, Amrita Institute of Medical Sciences and Research Centre, Cochin, Kerala, India
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Parasuram B, Sundaram S, Sathiskumar C, Karthikeyan S. Synthesis of multi-walled carbon nanotubes using tire pyrolysis oil as a carbon precursor by spray pyrolysis method. INORG NANO-MET CHEM 2018. [DOI: 10.1080/24701556.2017.1357578] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- B. Parasuram
- Department of Mechanical Engineering, The Salem Polytechnic College, Salem, Tamil Nadu, India
| | - S. Sundaram
- Department of Mechanical Engineering, Vidyaa Vikas Engineering College, Tiruchengode, Tamil Nadu, India
| | - C. Sathiskumar
- Research and Development Centre, Bharathiar University, Coimbatore, Tamil Nadu, India
| | - S. Karthikeyan
- Department of Chemistry, Chikkanna Government Arts College, Tirupur, Tamil Nadu, India
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Jaber B, Sundaram S, Neto MC, King A, Pereira B. Polymyxin-B Stimulates Tumor Necrosis Factor-α Production by Human Peripheral Blood Mononuclear Cells. Int J Artif Organs 2018. [DOI: 10.1177/039139889802100505] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Gram-negative bacterial lipopolysaccharide (LPS) is a well known stimulus for cytokine production, particularly interleukin-1 (IL-1) and tumor necrosis tactor alpha (TNFα). Polymyxin B (PMX-B) is a cationic polypeptide that binds to LPS, neutralizing its biological effects. PMX-B also disrupts gram-negative bacterial cell membrane phospholipids but is highly toxic to mammalian cells, therefore is of limited use. PMX-B is used as additive to media, as a way to handle LPS contamination. To derive benefit from the ability of PMX-B to neutralize lipid A in vivo while avoiding its systemic toxicity, PMX-B was covalently bound to polystyrene-derivative fibers, creating a hemoperfusion column (PMX-F) for the selective removal of circulating ET In vitro PMX-F hemoperfusion studies have demonstrated effective ET removal, using either the Limulus amebocyte lysate assay or TNFα production by peripheral blood mononuclear cells (PBMC) as an index of ET removal. However, the question whether PMX-B itself could stimulate human PBMC to produce cytokines has not been adequately addressed. We examined the effect of increasing concentrations of PMX-B on cytokine production by PBMC in vitro. PBMC harvested from healthy volunteers were incubated for 24 hours at 37°C with control (tissue culture media RPMI), or 5 µg/ml, 10 µg/ml, 20 µg/ml or 100 µg/ml PMX-B. At the end of 24 hours, PBMC were subjected to three freeze-thaw cycles, and total TNFα production (pg/2.5x106 PBMC) was measured by radioimmunoassay. Total TNFα production by PBMC was 163 ± 3 pg, 171 ± 9 pg, 164 ± 4 pg, 323 ± 63 pg and 331 ± 58 pg, in the control, PMX-B 5 µg/ml, 10 µg/ml, 20 µg/ml and 100 µg/ml conditions, respectively. Compared to controls (RPMI), the percentage increase in TNFα production by PBMC was 5 ± 6% (P=0.23), 1 ± 3% (P=0.45), 99 ± 40% (P=0.03) and 103 ± 36% (P=0.02) in the presence of 5 µg/ml, 10 µg/ml, 20 µg/ml and 100 µg/ml of PMX-B, respectively. Furthermore, total TNFα production correlated significantly with increasing concentrations of PMX-B (R=0.53, P=0.007). We conclude that the use of PMX-B in in vitro studies as an LPS-neutralizing agent, or in the experimental treatment of endotoxic or septic shock can lead to erroneous interpretations of cytokine production by PBMC, and should be used cautiously in in vitro systems at high concentrations.
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Affiliation(s)
- B.L. Jaber
- Division of Nephrology, Department of Medicine, New England Medical Center Hospitals, Boston, Massachusetts - USA
| | - S. Sundaram
- Division of Nephrology, Department of Medicine, New England Medical Center Hospitals, Boston, Massachusetts - USA
| | - M. Cendoroglo Neto
- Division of Nephrology, Department of Medicine, New England Medical Center Hospitals, Boston, Massachusetts - USA
| | - A.J. King
- Division of Nephrology, Department of Medicine, New England Medical Center Hospitals, Boston, Massachusetts - USA
| | - B.J.G. Pereira
- Division of Nephrology, Department of Medicine, New England Medical Center Hospitals, Boston, Massachusetts - USA
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Abstract
Monitoring of cardiopulmonary bypass (CPB) in terms of alterations to the concentrations of selected blood constituents leads to contrasting patterns of response. This has been verified by determining the influence of CPB on the activation of fibrinolysis, complement, leucocytes and the contact phase of coagulation. Fibrinolytic activity was determined by fibrin degradation products (X-FDP's), complement activation by C3a and C5a, leucocyte activation by granulocyte elastase and contact activation by factor XII-like activity (FXIIA). Five patients undergoing elective coronary artery surgery using a bubble oxygenator and pulsatile perfusion were studied. X-FDP's rose gradually during CPB and remained elevated. Similar patterns were observed for elastase and FXIIA. In contrast, C3a rose sharply with peak values at 1½-2h of bypass while C5a did not show significant changes during bypass. The data obtained have enabled the establishment of response patterns for parameters in CPB which will provide information relevant to the clinical application of biomaterials.
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Affiliation(s)
- S. Sundaram
- Department of Bioengineering Unit, University of Strathclyde, Glasgow - UK
| | - L. Irvine
- Department of Bioengineering Unit, University of Strathclyde, Glasgow - UK
| | - J.M. Courtney
- Department of Bioengineering Unit, University of Strathclyde, Glasgow - UK
| | - D.P. Taggart
- Department of Cardiac Surgery, Royal Infirmary, University of Glasgow, Glasgow - UK
| | - D.J. Wheatley
- Department of Cardiac Surgery, Royal Infirmary, University of Glasgow, Glasgow - UK
| | - G.D.O. Lowe
- Department of Medicine, Royal Infirmary, University of Glasgow, Glasgow - UK
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Sundaram S, Barrett T, Butt N, Porat R, King A, Pereira B. Cytokine Production by Human Peripheral Blood Mononuclear Cells Stimulated by a Pseudomonas Aeruginosa Culture Filtrate: Role of Plasma and Polymyxin B. Int J Artif Organs 2018. [DOI: 10.1177/039139889601900504] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The lack of consensus regarding the significance of transmembrane passage of bacterial products across hemodialysis membranes can be related to several methodological differences in the various studies, including the choice of circulating fluid in the blood compartment of the model, nature and concentration of the bacterial products employed to challenge the dialysate compartment and whether cytokine production by PMBC or the limulus amebocyte lysate (LAL) assay was used as the index of transfer and the cytokine used as the read-out. In this study, we examined the production of interleukin-1 alpha (IL-1α), interieukin-1 receptor antagonist (IL-1Ra) and interleukin-8 (IL-8) by peripheral blood mononuclear cells (PBMC) incubated with a Pseudomonas aeruginosa culture filtrate. Further, the effects of 10% autologous human plasma and Polymyxin B sulfate (PmB) on cytokine production by PBMC were also characterized. The results of our study indicate that the Ps. aeruginosa culture filtrate had both PmB suppressible and PmB non-suppressible components and that the addition of 10% human plasma significantly enhanced cytokine production by both PmB suppressible and PmB non-suppressible components. The enhancing effect of plasma was most evident at low concentrations of the filtrate. The inhibitory effect of PmB was most evident in samples cultured in the presence of 10% plasma. There was a direct correlation between the production of IL-1α and IL-1Ra suggesting that both pro-inflammatory cytokines and cytokine-specific inhibitory proteins are concurrently produced. There results have direct relevance to selection of study conditions for in vitro models used to study the transmembrane passage of bacterial products across hemodialysis membranes
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Affiliation(s)
- S. Sundaram
- Divisions of Nephrology and Geographical Medicine, Department of Medicine, New England Medical Center Hospitals, Boston, Massachusetts - USA
| | - T.W. Barrett
- Divisions of Nephrology and Geographical Medicine, Department of Medicine, New England Medical Center Hospitals, Boston, Massachusetts - USA
| | - N.K. Butt
- Divisions of Nephrology and Geographical Medicine, Department of Medicine, New England Medical Center Hospitals, Boston, Massachusetts - USA
| | - R. Porat
- Infectious Diseases and Geographical Medicine, Department of Medicine, New England Medical Center Hospitals, Boston, Massachusetts - USA
| | - A.J. King
- Divisions of Nephrology and Geographical Medicine, Department of Medicine, New England Medical Center Hospitals, Boston, Massachusetts - USA
| | - B.J.G. Pereira
- Divisions of Nephrology and Geographical Medicine, Department of Medicine, New England Medical Center Hospitals, Boston, Massachusetts - USA
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Sundaram S, Courtney J, Taggart D, Tweddel A, Martin W, McQuiston A, Wheatley D, Lowe G. Biocompatibility of Cardiopulmonary Bypass: Influence on Blood Compatibility of Device Type, Mode of Blood Flow and Duration of Application. Int J Artif Organs 2018. [DOI: 10.1177/039139889401700210] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The biocompatibility of artificial organs is recognised as an area presenting difficulties in terms of the complexity of the situation. The nature of the blood response involving interactions of systems, pattern and extent of change, patient status and the influence of the whole device contribute to the complexity. Recognising these, the profile of the blood response to cardiopulmonary bypass (CPB), with respect to type of device, mode of blood flow, duration of the procedure and patient status, has been evaluated by monitoring contact phase activation [Factor XII-like activity (FXIIA)], fibrinolytic activity [Fibrin degradation products (X-FDP's)], complement activation (C3a, C5a), leucocyte activation [Granulocyte elastase (GE)] and platelet and white cell imaging. FXIIA, X-FDP's, and GE rose gradually during CPB, with levels remaining elevated post-operatively for up to 48 h. In contrast, C3a levels rose sharply with no significant elevation in the post-operative period, while C5a did not show significant changes during bypass. The use of pulsatile perfusion resulted in lesser activation of the parameters, although these were significantly less only for GE. The alterations in FXIIA, X-FDP's, C3a and GE correlated positively with the duration of CPB, with this effect pronounced in the post-operative period for FXIIA, X-FDP's and GE. However, these changes had no apparent influence on clinical outcome and the majority of patients had uncomplicated post-operative recoveries. With respect to the use of bubble/membrane oxygenators, platelet and white cell deposition and the patterns of change for FXIIA and C3a were similar in the two groups. The investigation has enabled a broad perspective of biocompatibility in CPB relevant to the clinical application of biomaterials.
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Affiliation(s)
- S. Sundaram
- Bioengineering Unit, University of Strathclyde, Glasgow
| | - J.M. Courtney
- Bioengineering Unit, University of Strathclyde, Glasgow
| | - D.P. Taggart
- Department of Cardiac Surgery, Royal Infirmary, University of Glasgow, Glasgow
| | - A.C. Tweddel
- Department of Cardiac Surgery, Royal Infirmary, University of Glasgow, Glasgow
| | - W. Martin
- Department of Cardiac Surgery, Royal Infirmary, University of Glasgow, Glasgow
| | - A.M. McQuiston
- Department of Cardiac Surgery, Royal Infirmary, University of Glasgow, Glasgow
| | - D.J. Wheatley
- Department of Cardiac Surgery, Royal Infirmary, University of Glasgow, Glasgow
| | - G.D.O. Lowe
- Department of Medicine, Royal Infirmary, University of Glasgow, Glasgow - U.K
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Venkataraman S, Sundaram S, Selvarajan R, Savithri HS. Structural studies on banana bunchy top virus. Acta Crystallogr A Found Adv 2017. [DOI: 10.1107/s2053273317083863] [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: 11/10/2022] Open
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Sundaram S, Patil P, Mehta S. Patterns of care and adherence to evidence based guidelines in patients with hepatocellular cancer. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx660.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Sundaram S, Jayaprakasam R, Dhandapani M, Senthil T, Vijayakumar V. Theoretical (DFT) and experimental studies on multiple hydrogen bonded liquid crystals comprising between aliphatic and aromatic acids. J Mol Liq 2017. [DOI: 10.1016/j.molliq.2017.08.010] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Sinha S, Sundaram S. Modulation of sodium potassium ATPase activity of rat brain synaptosome by norepinepherine and serotonin. J Neurol Sci 2017. [DOI: 10.1016/j.jns.2017.08.848] [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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Venkateswarlu K, Sundaram S. Détermination des constantes de force d’après les données de l’effet raman : molécules du type xyz2, planes et pyramidales. ACTA ACUST UNITED AC 2017. [DOI: 10.1051/jcp/1957540202] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Sundaram S, Subhasri P, Vasanthi T, Senthil TS, Jayaprakasam R, Vijayakumar VN. Experimental investigation on the effect of mesogenic ratio in hydrogen-bonded liquid crystal complexes. J DISPER SCI TECHNOL 2017. [DOI: 10.1080/01932691.2017.1283514] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- S. Sundaram
- Bannari Amman Institute of Technology, Physics, Alathukombai, BIT, Sathyamangalam, Erode (Dt), Erode, India
| | - P. Subhasri
- Bannari Amman Institute of Technology, Physics, Alathukombai, BIT, Sathyamangalam, Erode (Dt), Erode, India
| | - T. Vasanthi
- Bannari Amman Institute of Technology, Physics, Alathukombai, BIT, Sathyamangalam, Erode (Dt), Erode, India
| | - T. S. Senthil
- Erode Sengunthar Engineering College, Physics, Thudupathi, Erode, India
| | - R. Jayaprakasam
- Bannari Amman Institute of Technology, Physics, Alathukombai, BIT, Sathyamangalam, Erode (Dt), Erode, India
| | - V. N. Vijayakumar
- Bannari Amman Institute of Technology, Physics, Alathukombai, BIT, Sathyamangalam, Erode (Dt), Erode, India
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Sundaram S, Kaliappan T, Gopalan R, Palanimuthu R, Anandhan P, Joseph RM. Mechanism and Immediate Outcome of Significant Mitral Regurgitation Following Balloon Mitral Valvuloplasty with JOMIVA Balloon. J Clin Diagn Res 2017; 11:OC01-OC04. [PMID: 28511424 DOI: 10.7860/jcdr/2017/24202.9333] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Accepted: 11/09/2016] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Balloon Mitral Valvuloplasty (BMV) with inoue balloon is the most common technique being followed worldwide. Over the wire BMV is a modified technique with Joseph Mitral Valvuloplasty (JOMIVA) balloon and is being followed in certain centres. We hypothesized that, the incidence and mechanism of Mitral Regurgitation (MR) is likely to be different from that of inoue balloon. AIM To assess the mechanism and immediate clinical outcome of significant MR following BMV with JOMIVA balloon retrospectively. MATERIALS AND METHODS We retrospectively analyzed the outcome of 48 patients who developed moderate to severe MR out of 249 patients who underwent BMV in our institute. We analyzed the echocardiographic and clinical parameters of these patients. RESULTS Nineteen (7.6%) patients developed severe MR and 29 (11.2%) patients developed moderate MR. Commisural separation resulting in MR was the most common cause which was contributing to 73.6 % and 85.7% of patients with moderate and severe MR respectively. Leaflet tear was the second most common cause which contributed to 15.7% and 14.2% of patients with severe and moderate MR respectively. Chordal rupture contributed to 10.5% of patients with severe MR. Six (31.6%) patients with severe MR developed worsening breathlessness among them one had to be referred for mitral valve replacement during index hospitalization and the rest could be managed medically. Patients with moderate MR remained asymptomatic and stable. CONCLUSION Severe MR following JOMIVA BMV results most commonly due to wide separation of commisures. JOMIVA balloon is less likely to cause damage to subvalvular structures than inoue balloon. Most patients who develop severe MR will not require emergency mitral valve replacement. Moderate MR is well tolerated clinically.
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Affiliation(s)
- Shanmuga Sundaram
- Associate Professor, Department of Cardiology, PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India
| | - Tamilarasu Kaliappan
- Associate Professor, Department of Cardiology, PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India
| | - Rajendiran Gopalan
- Professor, Department of Cardiology, PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India
| | - Ramasamy Palanimuthu
- Associate Professor, Department of Cardiology, PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India
| | - Premkrishna Anandhan
- Assistant Professor, Department of Cardiology, PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India
| | - Rinku Mary Joseph
- Clinical Pharmacist, Department of Cardiology, PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India
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Satish C, Sunny G, Vijaykumar D, Sundaram S. Axillary Reverse Mapping (ARM) to Identify the Sentinel Node of the Upper Limb in Breast Cancer Surgery. Clin Oncol (R Coll Radiol) 2017. [DOI: 10.1016/j.clon.2016.10.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Bruno-Mascarenhas M, Ramesh V, Venkatraman S, Mahendran J, Sundaram S. Microsurgical anatomy of the superior sagittal sinus and draining veins. Neurol India 2017; 65:794-800. [DOI: 10.4103/neuroindia.ni_644_16] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Malik S, White V, Sundaram S, Humphreys K, Patel R, Samraj S. 'Don't forget the children' - test before it is too late. Int J STD AIDS 2016; 28:192-195. [PMID: 27784828 DOI: 10.1177/0956462416676623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
In 2009, 'Don't forget the children' guideline recommended that all new HIV-positive patients attending adult HIV services should have any existing children identified and tested for HIV alongside a coherent documentation process. A retrospective case note review was performed on 173 HIV-positive women registered at the Royal South Hants adult HIV service until 31 January 2014. Data were assessed as a whole (n = 173) and, in addition, two comparator groups were formulated: (a) pre-guidelines (n = 108) and (b) post-guidelines (n = 65). Out of 80 children eligible for HIV testing, only 43 (54%) had clear documentation of a test result, and in the remaining 37 (46%), it was either not considered or not followed through. Documentation of need for testing increased significantly from 67% in pre-guideline group to 100% in the post-guideline group (p < 0.001). The median time from recognition of need to test to actual testing remained 24 months in both groups. Although this audit demonstrated improvement in identification of at-risk children and their testing, there is still need for improvement.
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Affiliation(s)
- S Malik
- 1 Department of Sexual Health, Royal Bournemouth Hospital, Bournemouth, UK
| | - V White
- 2 Department of Genitourinary Medicine, Royal South Hants Hospital, Southampton, UK
| | - S Sundaram
- 2 Department of Genitourinary Medicine, Royal South Hants Hospital, Southampton, UK
| | - K Humphreys
- 2 Department of Genitourinary Medicine, Royal South Hants Hospital, Southampton, UK
| | - R Patel
- 2 Department of Genitourinary Medicine, Royal South Hants Hospital, Southampton, UK
| | - S Samraj
- 2 Department of Genitourinary Medicine, Royal South Hants Hospital, Southampton, UK
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Sundaram S, Kannoth S, Thomas B, Sarma PS, Sylaja PN. Collateral Assessment by CT Angiography as a Predictor of Outcome in Symptomatic Cervical Internal Carotid Artery Occlusion. AJNR Am J Neuroradiol 2016; 38:52-57. [PMID: 27765736 DOI: 10.3174/ajnr.a4957] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2016] [Accepted: 08/14/2016] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Cervical internal carotid artery occlusion can present with varied clinical manifestations such as transient ischemic attack, stroke, and chronic ocular ischemia, or can be asymptomatic. The outcome in these patients is considerably influenced by cerebral hemodynamic compensatory adaptation of the intracranial collateral pathways. Our aim was to study whether collateral circulation as assessed by CT angiography can predict 3-month outcome and initial stroke severity in patients with symptomatic cervical ICA occlusion. MATERIALS AND METHODS This was a retrospective study of 65 patients with symptomatic cervical ICA occlusion from January 2011 to December 2013. The collateral vessels (anterior and posterior communicating arteries, ophthalmic artery, and leptomeningeal arteries) were assessed by CTA. The outcome at 3 months was defined as poor if the modified Rankin Scale score was ≥3. RESULTS The mean age of subjects was 57 ± 11.6 years (range, 32-80 years), and 92% were men. Thirty-three (50.8%) patients had poor outcome. Absence of the ipsilateral ophthalmic artery, poor leptomeningeal collaterals, and <2 collaterals were predictors of stroke severity at onset and poor 3-month outcome in univariate analysis. In the multiple logistic regression analysis, inadequate flow through the secondary collaterals (ipsilateral ophthalmic artery or leptomeningeal collaterals; OR, 4.5; 95% CI, 1.4-14.9; P = .01) and higher NIHSS score at stroke onset (OR, 19.2; 95% CI, 2.2-166.2; P = .007) independently predicted poor outcome at 3 months. CONCLUSIONS Assessment of collateral circulation with CTA can be a useful predictor of 3-month outcome in patients with symptomatic cervical ICA occlusion.
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Affiliation(s)
- S Sundaram
- From the Department of Neurology (S.S., P.N.S.), Comprehensive Stroke Care Program
| | - S Kannoth
- Department of Imaging Sciences and Interventional Radiology (S.K., B.T.)
| | - B Thomas
- Department of Imaging Sciences and Interventional Radiology (S.K., B.T.)
| | - P S Sarma
- Achutha Menon Centre for Health Science Studies (P.S.S.), Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
| | - P N Sylaja
- From the Department of Neurology (S.S., P.N.S.), Comprehensive Stroke Care Program
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Heine D, Sundaram S, Beudert M, Martin K, Hertweck C. A widespread bacterial phenazine forms S-conjugates with biogenic thiols and crosslinks proteins. Chem Sci 2016; 7:4848-4855. [PMID: 30155132 PMCID: PMC6016718 DOI: 10.1039/c6sc00503a] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Accepted: 04/13/2016] [Indexed: 01/13/2023] Open
Abstract
Phenazines are redox-active compounds produced by a range of bacteria, including many pathogens. Endowed with various biological activities, these ubiquitous N-heterocycles are well known for their ability to generate reactive oxygen species by redox cycling. Phenazines may lead to an irreversible depletion of glutathione, but a detailed mechanism has remained elusive. Furthermore, it is not understood why phenazines have so many protein targets and cause protein misfolding as well as their aggregation. Here we report the discovery of unprecedented conjugates (panphenazines A, B) of panthetheine and phenazine-1-carboxylic (PCA) acid from a Kitasatospora sp., which prompted us to investigate their biogenesis. We found that PCA reacts with diverse biogenic thiols under radical-forming conditions, which provides a plausible model for irreversible glutathione depletion. To evaluate the scope of the reaction in cells we designed biotin and rhodamine conjugates for protein labelling and examined their covalent fusion with model proteins (ketosynthase, carbonic anhydrase III, albumin). Our results reveal important, yet overlooked biological roles of phenazines and show for the first time their function in protein conjugation and crosslinking.
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Affiliation(s)
- D Heine
- Leibniz Institute for Natural Product Research and Infection Biology , Hans Knoell Institute , Beutenbergstrasse 11a , 07745 Jena , Germany .
| | - S Sundaram
- Leibniz Institute for Natural Product Research and Infection Biology , Hans Knoell Institute , Beutenbergstrasse 11a , 07745 Jena , Germany .
| | - Matthias Beudert
- Leibniz Institute for Natural Product Research and Infection Biology , Hans Knoell Institute , Beutenbergstrasse 11a , 07745 Jena , Germany .
| | - K Martin
- Leibniz Institute for Natural Product Research and Infection Biology , Hans Knoell Institute , Beutenbergstrasse 11a , 07745 Jena , Germany .
| | - C Hertweck
- Leibniz Institute for Natural Product Research and Infection Biology , Hans Knoell Institute , Beutenbergstrasse 11a , 07745 Jena , Germany .
- Friedrich Schiller University , 07737 Jena , Germany
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Aseervatham GSB, Suryakala U, Doulethunisha, Sundaram S, Bose PC, Sivasudha T. Expression pattern of NMDA receptors reveals antiepileptic potential of apigenin 8-C-glucoside and chlorogenic acid in pilocarpine induced epileptic mice. Biomed Pharmacother 2016; 82:54-64. [PMID: 27470339 DOI: 10.1016/j.biopha.2016.04.066] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [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: 03/18/2016] [Revised: 04/29/2016] [Accepted: 04/29/2016] [Indexed: 01/09/2023] Open
Abstract
The present study was aimed to evaluate the effect of apigenin 8-C-glucoside (Vitexin) and chlorogenic acid on epileptic mice induced by pilocarpine and explored its possible mechanisms. Intraperitonial administration of pilocarpine (85mg/kg) induced seizure in mice was assessed by behavior observations, which is significantly (p>0.05) reduced by apigenin 8-C-glucoside (AP8CG) (10mg/kg) and chlorogenic acid (CA) (5mg/kg), similar to diazepam. Seizure was accompanied by an imbalance in the levels of Gamma-aminobutyric acid (GABA) and glutamate in the pilocarpine administered group. Moreover, convulsion along with reduced acetylcholinesterase, increased monoamine oxidase and oxidative stress was observed in epileptic mice brain. AP8CG and CA significantly restored back to normal levels even at lower doses. Further, increased lipid peroxidation and nitrite content was also significantly attenuated by AP8CG and CA. However, CA was found to be more effective when compared to AP8CG. In addition, the mRNA expression of N-methyl-d-aspartate receptor (NMDAR), mGluR1 and mGlu5 was significantly (P≤0.05) inhibited by AP8CG and CA in a lower dose. The mRNA expression of GRIK1 did not differ significantly in any of the group and showed a similar pattern of expression. Our result shows that AP8CG and CA selectively inhibit NMDAR, mGluR1 and mGlu5 expression. Modification in the provoked NMDAR calcium response coupled with neuronal death. Hence, these findings underline that the polyphenolics, AP8CG and CA have exerted antiepileptic and neuroprotective activity by suppressing glutamate receptors.
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Affiliation(s)
- G Smilin Bell Aseervatham
- Department of Environmental Biotechnology, Bharathidasan University, Tiruchirappalli 620 024, Tamilnadu, India
| | - U Suryakala
- Department of Environmental Biotechnology, Bharathidasan University, Tiruchirappalli 620 024, Tamilnadu, India
| | - Doulethunisha
- Central Inter-Disciplinary Research Facility, Mahatma Gandhi Medical College and Research Institute Campus, Pillayarkuppam, Puducherry 607 402, India
| | - S Sundaram
- Department of Environmental Biotechnology, Bharathidasan University, Tiruchirappalli 620 024, Tamilnadu, India
| | - P Chandra Bose
- Department of Biotechnology, Anna University, Tiruchirappalli 620 024, Tamilnadu, India
| | - T Sivasudha
- Department of Environmental Biotechnology, Bharathidasan University, Tiruchirappalli 620 024, Tamilnadu, India.
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Jagadeeshan S, Subramanian A, Tentu S, Beesetti S, Singhal M, Raghavan S, Surabhi RP, Mavuluri J, Bhoopalan H, Biswal J, Pitani RS, Chidambaram S, Sundaram S, Malathi R, Jeyaraman J, Nair AS, Venkatraman G, Rayala SK. P21-activated kinase 1 (Pak1) signaling influences therapeutic outcome in pancreatic cancer. Ann Oncol 2016; 27:1546-56. [PMID: 27117533 DOI: 10.1093/annonc/mdw184] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Accepted: 04/21/2016] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Therapeutic resistance to gemcitabine in pancreatic ductal adenocarcinoma (PDAC) is attributed to various cellular mechanisms and signaling molecules that influence as a single factor or in combination. DESIGN In this study, utilizing in vitro p21-activated kinase 1 (Pak1) overexpression and knockdown cell line models along with in vivo athymic mouse tumor xenograft models and clinical samples, we demonstrate that Pak1 is a crucial signaling kinase in gemcitabine resistance. RESULTS Pak1 kindles resistance via modulation of epithelial-mesenchymal transition and activation of pancreatic stellate cells. Our results from gemcitabine-resistant and -sensitive cell line models showed that elevated Pak1 kinase activity is required to confer gemcitabine resistance. This was substantiated by elevated levels of phosphorylated Pak1 and ribonucleotide reductase M1 levels in the majority of human PDAC tumors when compared with normal. Delineation of the signaling pathway revealed that Pak1 confers resistance to gemcitabine by preventing DNA damage, inhibiting apoptosis and regulating survival signals via NF-κB. Furthermore, we found that Pak1 is an upstream interacting substrate of transforming growth factor β-activated kinase 1-a molecule implicated in gemcitabine resistance. Molecular mechanistic studies revealed that gemcitabine docks with the active site of Pak1; furthermore, gemcitabine treatment induces Pak1 kinase activity both in vivo and in cell-free system. Finally, results from athymic mouse tumor models illustrated that Pak1 inhibition by IPA-3 enhances the cytotoxicity of gemcitabine and brings about pancreatic tumor regression. CONCLUSION To our knowledge, this is the first study illustrating the mechanistic role of Pak1 in causing gemcitabine resistance via multiple signaling crosstalks, and hence Pak1-specific inhibitors will prove to be a better adjuvant with existing chemotherapy modality for PDAC.
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Affiliation(s)
- S Jagadeeshan
- Department of Biotechnology, Indian Institute of Technology Madras (IITM), Chennai Department of Genetics, University of Madras, Chennai
| | - A Subramanian
- Department of Biotechnology, Indian Institute of Technology Madras (IITM), Chennai
| | - S Tentu
- Department of Biotechnology, Indian Institute of Technology Madras (IITM), Chennai
| | - S Beesetti
- Department of Biotechnology, Indian Institute of Technology Madras (IITM), Chennai
| | - M Singhal
- Department of Biotechnology, Indian Institute of Technology Madras (IITM), Chennai
| | - S Raghavan
- Department of Biotechnology, Indian Institute of Technology Madras (IITM), Chennai
| | | | - J Mavuluri
- Department of Biotechnology, Indian Institute of Technology Madras (IITM), Chennai
| | | | - J Biswal
- Department of Bioinformatics, Alagappa University, Karaikudi
| | | | | | - S Sundaram
- Department of Pathology, Sri Ramachandra University, Porur, Chennai
| | - R Malathi
- Department of Genetics, University of Madras, Chennai
| | - J Jeyaraman
- Department of Bioinformatics, Alagappa University, Karaikudi
| | - A S Nair
- Rajiv Gandhi Centre for Biotechnology (RGCB), Thiruvananthapuram, Kerala, India
| | | | - S K Rayala
- Department of Biotechnology, Indian Institute of Technology Madras (IITM), Chennai
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Sundaram S, Li X, El Gmili Y, Bonanno PL, Puybaret R, Pradalier C, Pantzas K, Patriarche G, Voss PL, Salvestrini JP, Ougazzaden A. Single-crystal nanopyramidal BGaN by nanoselective area growth on AlN/Si(111) and GaN templates. Nanotechnology 2016; 27:115602. [PMID: 26878255 DOI: 10.1088/0957-4484/27/11/115602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
We report nano-selective area growth (NSAG) of BGaN by MOCVD on AlN/Si(111) and GaN templates resulting in 150 nm single crystalline nanopyramids. This is in contrast to unmasked or micro-selective area growth, which results in a multi-crystalline structure on both substrates. Various characterization techniques were used to evaluate NSAG as a viable technique to improve BGaN material quality on AlN/Si(111) using results of GaN NSAG and unmasked BGaN growth for comparison. Evaluation of BGaN nanopyramid quality, shape and size uniformity revealed that the growth mechanism is the same on both the templates. Further STEM analysis of BGaN nanopyramids on AlN/Si (111) templates confirmed that these are single-crystalline structures without any dislocations, likely due to single nucleation occurring in the 80 nm mask opening. CL results correspond to boron content between 1.7% and 2.0% in the nanopyramids. We conclude that NSAG is promising for growth of high-quality BGaN nanostructures and complex nano-heterostructures, especially for low-cost silicon substrates.
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Affiliation(s)
- S Sundaram
- CNRS, UMI 2958 Georgia Tech-CNRS, F-57070 Metz, France
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