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Madan R, Kumar N, Singh T, Yadav J, Kumar R, Sachdeva N, Jain R, Goyal S, Khosla D, Jayapalan S, Sahoo S, M K, Tripathi M. Early Bone Mineral Density Changes and Endocrinal Dysfunction in Childhood Brain Tumor Patients: A Prospective Study. Int J Radiat Oncol Biol Phys 2023; 117:e134. [PMID: 37784699 DOI: 10.1016/j.ijrobp.2023.06.937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Reduced bone mineral density (BMD) and hormonal dysfunction are considered as a late effect of cranial radiation (RT). Only few studies have reported the occurrence of these problems soon after the diagnosis of brain tumor or RT initiation, emphasizing that these are not necessarily the late effects of RT. Thus, we conducted the study to analyze the incidence of low BMD and hormonal dysfunction prior to or within 6 months of RT (early change) in children with brain tumors. MATERIALS/METHODS The study was conducted as a part of intramural funding program at a tertiary care center in India. Childhood and adolescent brain tumor patients were advised for dual energy X-ray absorptiometry scan (DXA) and hormonal evaluation prior to RT. In some patients, first DXA was done within 6 months of RT due to logistics. To see the effect of radiation, we have planned to repeat hormonal evaluation after 6 and 12 months and DXA after 12 months of RT. RESULTS Twenty-five patients were analyzed. Median age at diagnosis was 11 years with a male to female ratio of 5.2:1. Medulloblastoma was the commonest diagnosis (n = 12), followed by glioma (n = 8), pineal tumors (n = 3) and ependymoma (n = 2). Nineteen and six patients underwent DXA before RT and within 6 months of RT respectively. For BMD assessment, Z score was calculated at hip and lumbar spine. BMD was defined as low (Z score = -1 to-1.99), very low (Z score = -2 to -2.5) and secondary osteoporosis (Z score ≤ -2.5). Median Z score at femur neck and spine was -2 and -1.9 respectively. Overall; 6, 3 and 9 patients had normal, low and very low BMD respectively. Seven patients had secondary osteoporosis (Table 1). Two patients with secondary osteoporosis had low vitamin D levels. None of the patient had compression fracture. On statistical analysis, no correlation was found between BMD changes and age, sex and site of the tumor. Pre RT endocrinal assessment (N = 25) was done by tanner staging and serum hormonal levels (GH, T3/T4/TSH, ACTH, cortisol and prolactin). Gonadal hormonal assessment was done in children with early or delayed puberty. Three patients were found to have endocrinal abnormality before RT (precautious puberty, central hypothyroidism and low sex hormones in 1 patient each). Follow up DXA and hormonal evaluation are awaited to see the effect of RT. CONCLUSION The index study is one of the very few studies evaluating the early changes in BMD and hormonal dysfunction soon after brain tumor diagnosis or within 6 months of RT. We observed that a significant proportion of children had reduced BMD and hormonal dysfunction before RT, highlighting the importance of early assessment and referral to the specialist for better quality of life. Table 1: BMD and endocrinal dysfunction before or within 6 months of RT.
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Affiliation(s)
| | | | | | | | | | | | - R Jain
- PGIMER, Chandigarh, India
| | - S Goyal
- PGIMER, Chandigarh, India; Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | | | | | | | - K M
- PGIMER, Chandigarh, India
| | - M Tripathi
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Dhere VR, Schuster DM, Goyal S, Schreibmann E, Hershatter B, Patel SA, Shelton JW, Hanasoge S, Patel PR, Sebastian N, Lawal IO, Jani A. Biochemical Relapse-Free Survival in Post-Prostatectomy Patients Receiving 18F-Fluciclovine-Guided Prostate Bed Only Radiation: Post-Hoc Analysis of a Prospective Randomized Trial. Int J Radiat Oncol Biol Phys 2023; 117:e376. [PMID: 37785277 DOI: 10.1016/j.ijrobp.2023.06.2482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Whole pelvis (WP) radiation therapy (XRT) significantly improved biochemical relapse free survival (bRFS) compared to prostate-bed (PB)-only XRT in RTOG 0534, yet increased toxicity and was performed in an era prior to PET staging (Pollack et al, Lancet, 2022). Separately, 18F-fluciclovine PET/CT (PET)-guided post-prostatectomy XRT demonstrated improved bRFS compared to XRT guided by conventional imaging alone. We hypothesized that patients whose decisions were changed from whole pelvic XRT to PB-only XRT after PET imaging would have bRFS that was (a) not significantly different than patients initially planned for PB-only XRT, and (b) significantly improved over patients planned for WP XRT without PET guidance. MATERIALS/METHODS We conducted a post-hoc analysis of a prospective, randomized, single-institution trial comparing conventional (Arm A) v. PET-guided (Arm B) post-prostatectomy XRT. For patients randomized to Arm B, pre-PET treatment field decisions were recorded, and post-fluciclovine fields were rigidly defined per protocol: pN0 patients with no pelvic or extrapelvic PET uptake received PB-only XRT. Three- and four-year bRFS were compared in patients initially planned for WP with change to PB-only XRT [Arm B (WP→PB)] v Arm B patients initially planned for PB-only with final XRT to PB-only [Arm B(PB→PB)] & Arm A patients treated with whole pelvic XRT [Arm A(WP)] using Z test and log-rank test. Demographics were compared using Chi-square test, Fisher's exact test, or ANOVA as appropriate. RESULTS We identified 10 Arm B (WP→PB), 31 Arm B (PB→PB), and 25 Arm A (WP) patients. Androgen deprivation was used in 50.0% of Arm B (WP→PB) and 3.2% of Arm B (PB→PB) patients, p<0.01. Mean pre-XRT PSA was significantly higher (1.56 v 0.32 ng/mL, respectively, p<0.01) in Arm B (WP→PB) v Arm B (PB→PB) patients, however, there was no significant difference in extracapsular extension (p = 1.00), seminal vesical invasion (p = 1.00), Gleason score ≥8 (p = 0.58) or margin positivity (p = 0.73) between cohorts. Three- and four-year bRFS was 80% in Arm B (WP→PB) & 87.4% in Arm B (PB→PB), p = 0.47, respectively. Arm A (WP) patients had significantly worse three- (35.2%) and four-year (13.2%) bRFS compared to Arm B (WP→PB), p<0.01. CONCLUSION Patients initially planned for WP XRT whose treatment field decisions were changed to PB-only XRT after PET guidance had, in this post-hoc analysis, (a) relapse rates not significantly different than patients initially planned for PB-only XRT and (b) improved relapse rates over patients treated with WP XRT without PET guidance. PET-guided volume de-escalation in selected patients may be one approach to mitigating excess toxicity seen with WP XRT without compromising outcomes and warrants further exploration.
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Affiliation(s)
- V R Dhere
- Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, GA
| | - D M Schuster
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, GA
| | - S Goyal
- Department of Biostatistics and Bioinformatics Shared Resource, Winship Cancer Institute, Atlanta, GA
| | - E Schreibmann
- Winship Cancer Institute of Emory University, Department of Radiation Oncology, Atlanta, GA
| | - B Hershatter
- Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, GA
| | - S A Patel
- Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, GA
| | - J W Shelton
- Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, GA
| | - S Hanasoge
- Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, GA
| | - P R Patel
- Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, GA
| | - N Sebastian
- Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, OH
| | | | - A Jani
- Department of Radiation Oncology, Emory University, Atlanta, GA
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Sebastian N, Goyal S, Liu Y, Patel PR, Hanasoge S, Dhere VR, Shelton JW, Godette KD, Jani A, Hershatter B, Fischer-Valuck B, Patel SA. Association of Radiation Facility Volume with Overall Survival in Patients with Very High-Risk Prostate Cancer Treated with Radiation and Androgen Deprivation Therapy. Int J Radiat Oncol Biol Phys 2023; 117:e434-e435. [PMID: 37785414 DOI: 10.1016/j.ijrobp.2023.06.1604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Studies suggest an association of treatment at high volume facilities with improved survival in cancer patients receiving surgery or radiation therapy. This association has not been studied in patients with very high-risk prostate cancer, who are treated using a multimodality approach that often requires specialized care with advanced diagnostic imaging, complex radiotherapeutic planning, and multidrug antiandrogen regimens. We used the National Cancer Database (NCDB) to study the association of radiation treatment facility volume (FV) with overall survival (OS). MATERIALS/METHODS We selected for patients with very high risk, localized prostate cancer by NCCN criteria (cT3b-T4, primary Gleason pattern 5, >4 cores with grade group 4-5, and/or 2-3 high risk features). We included patients who received hormone therapy with either external beam radiation to a dose of ≥60 Gy or external beam radiation to a dose of ≥45 Gy combined with brachytherapy. Association of FV with OS was evaluated through a bias-adjusted log-rank test to identify the optimal cut point of FV for dichotomization. Kaplan-Meier curves were used to study the association of binary FV with overall survival (OS) with and without IPTW (inverse probability treatment weighting) balancing the following confounders: age, race, median income, education, insurance, academic treatment facility, Charlson comorbidity score, T stage, PSA, Gleason score, total radiation dose, year of diagnosis, and patient distance from treatment facility. Cox proportional hazards model was built using backward variable selection strategy (α of 0.05 for removal). RESULTS We identified 25,219 very high-risk prostate cancer patients by NCCN criteria (median follow up 57.36 months; 95% CI 56.67 - 58.09) diagnosed between 2004 and 2015. High FV (n = 6,438) was associated with better OS on univariable analysis (hazard ratio [HR] = 0.81; 95% confidence interval [CI] 0.77 - 0.86; p < 0.001) and multivariable analysis (HR = 0.89; 95% CI 0.84 - 0.95; p < 0.001). Other factors associated with improved OS on multivariable analysis included younger age, non-white/black race, higher income, private insurance, academic/research treatment facility, lower comorbidity, lower T-stage, lower PSA, and lower Gleason score. After IPTW adjustment, high FV remained associated with better OS (HR = 0.90; 95% CI 0.85 - 0.95; p < 0.001). CONCLUSION Patients with NCCN very high-risk prostate cancer treated at a radiation facility with high case volume had better OS than patients treated at a facility with low volume, after adjustment for confounders. This may suggest that for very high-risk patients, outcomes may be improved by the expertise and optimal multidisciplinary care that typically accompany high facility treatment volume.
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Affiliation(s)
- N Sebastian
- Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, OH
| | - S Goyal
- Department of Biostatistics and Bioinformatics Shared Resource, Winship Cancer Institute, Atlanta, GA
| | - Y Liu
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA
| | - P R Patel
- Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, GA
| | - S Hanasoge
- Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, GA
| | - V R Dhere
- Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, GA
| | - J W Shelton
- Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, GA
| | - K D Godette
- Winship Cancer Institute, Department of Radiation Oncology, Emory University, Atlanta, GA
| | - A Jani
- Department of Radiation Oncology, Emory University, Atlanta, GA
| | - B Hershatter
- Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, GA
| | | | - S A Patel
- Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, GA
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Krastein J, Goyal S, Bauman J, Rao YJ. Utility of the "All of Us" Database for Radiation Oncology Research. Int J Radiat Oncol Biol Phys 2023; 117:e472-e473. [PMID: 37785501 DOI: 10.1016/j.ijrobp.2023.06.1682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) We provide an overview the All of Us Research Program, a National Institutes of Health funded research database, and report on the utility of this database for Radiation Oncology research. MATERIALS/METHODS The All of Us Research Program aims to create a large and diverse health database with participants from across the US. Patients consent to join the database and agree to share electronic health records, complete surveys, provide physical measurements, and donate at least one biospecimen. In this observational study, we used the public data browser feature of the All of Us Dataset to evaluate utility for future radiation oncology research. Within the database, we report on the number of cases of common cancers in the US, using ICD10 codes, and also the number of patients treated with common radiotherapy procedures, using CPT4 codes. We then qualitatively report on additional data of interest. Of note, public patient counts in All of Us is rounded to the nearest interval of 20. Additional tiers of data access exist, including individual level data, which were not used in this survey of public data. RESULTS The database includes 372,380 participants, of which 46,380 patients have a diagnosis of cancer. Within the identified top 10 cancers according to ACS, there were a total of 26,540 primary malignant cancers. The most common type of cancers were breast cancer (ICD10 - c50 [n = 6,960]), Prostate (ICD10 - c61 [n = 4,500]), Non-Hodgkin lymphoma (ICD10 - c85 [n = 2860]), Lung & bronchus (ICD10 - c34 [n = 2000]), Colon (ICD10 - c18 [n = 1940]), Melanoma of the skin (ICD10 - c43 [n = 1740]), Thyroid(ICD10 - c73 [n = 1720]), Kidney (ICD10 - c64 [n = 1300]), Urinary bladder (ICD10 - c67 [n = 1140]). The most common radiation therapy procedures were Computerized Tomography simulation (CPT - 77290 [n = 4,040]), Intensity Modulated Radiation Therapy (CPT - 77386 [n = 780]), 3D conformal radiation therapy (CPT - 77412 [n = 1,720]), Stereotactic Body Radiation Therapy (CPT - 77373 [n = 400]), Brachytherapy (CPT - 77770- 77772 [n = 240]), and Proton Therapy (CPT - 77520-77525 [n = 140]). Qualitatively, other data within All of Us include labs values, drug exposures, comorbidities, other procedures, physical measurements, and wearable biometrics (Fitbit) data. Genomic data typically includes germline testing using whole genome sequencing or genotyping array. Patient surveys include data on personal medical history, family health history, lifestyle, social determinants of health, COVID19 experience, and overall health. Potential outcome variables of interest to oncology research in the database include survival, cause of death, additional procedures or diagnoses after cancer treatment, and quality of life metrics derived from the survey instruments. CONCLUSION The All Of Us Research Database includes a large number of cancer cases, of which a substantial number received radiotherapy. Future work will focus on focused hypothesis-driven research questions.
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Affiliation(s)
- J Krastein
- Division of Radiation Oncology, Department of Radiology, George Washington University School of Medicine and Health Sciences, Washington, DC
| | - S Goyal
- Radiation Oncology, George Washington University School of Medicine and Health Sciences, Washington, DC
| | - J Bauman
- Medical Oncology, George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Y J Rao
- Radiation Oncology, George Washington University School of Medicine and Health Sciences, Washington, DC
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Hands JM, Whalen M, Haji-Momenian S, Frazier H, Andrawis R, Jarrett T, Provenzano D, Bauman JE, Estephan F, Aghdam H, Chen D, Goyal S, Ojong-Ntui M, Rao YJ. Focal Boosted IMRT Treatment of Prostate Cancer to 84 Gy in 28 Fractions: Preliminary Clinical Outcomes and Dosimetry. Int J Radiat Oncol Biol Phys 2023; 117:e390. [PMID: 37785313 DOI: 10.1016/j.ijrobp.2023.06.2513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) The FLAME trial reported that focal boosting of prostate tumor to 95 Gy in 35 fractions improves biochemical control. However, this treatment is not commonly used in the United States. We investigated a focally boosted treatment of 84 Gy in 28 fractions (EQD2 108 Gy, BED 252 Gy). MATERIALS/METHODS Between 2019-2022, men with unfavorable intermediate risk (uIR) and high risk (HR) prostate cancer were enrolled on a prospective registry and received a novel IMRT regimen. The dose levels were 84 Gy to the gross tumor volume (GTV) as defined on mpMRI (T2W and ADC) with no added margin, 70 Gy to the prostate and proximal seminal vesicles, and optional 50.4 Gy to elective pelvic lymph nodes (all 28 fractions). Patients received fiducial markers and hydrogel spacer. The treatment planning goal was to cover 95% of the GTV at 84 Gy, and also meet the target and normal tissue dosimetry criteria of the hypofractionated treatment arm of NRG-GU005. VMAT was used for treatment delivery. ADT was given at the discretion of the treating physician. RESULTS A total of 20 men were included in the study, 2 (10%) uIR and 18 (90%) HR. 9 (45%) tumors were GS 7, 7 (35%) were GS 8, and 4 (20%) were GS 9. There were 13 (65%) stage cT1, 4 (20%) cT2 and 3 (15%) cT3. One (5%) patient received short term ADT, 18 (95%) long term ADT, and 1 (5%) refused ADT. 18 (90%) men received elective nodal radiation. The mean baseline PSA was 25.1 (range 4.2-73.4). The median baseline IPSS score was 11.1 (IQR 4.5-12), and 4 patients had severe baseline urinary symptoms (IPSS ≥20). The mean baseline prostate volume was 57.4 cc (range 26.8-198.3). The mean volume of the 84 Gy boost target was 7.1 cc (range 2.3-15.0) and the mean proportion of the prostate boosted was 14.8% (range 2% - 47%). There were 10 (50%) men with 1 boost target, 6 (30%) with two, 3 (15%) with three, and 1 (5%) had 4 boost targets. Targets were located in peripheral zone (85%), transition zone (30%), and central zone (5%). Patients met all per-protocol normal tissue criteria of NRG-GU005, except for bladder D0.03cc. The mean±SD (Gy) rectum D15%, D25%, and D30% were 51±5, 45±5, 42±4. The mean±SD (Gy) bladder D0.03cc, D30%, D50% were 79±4, 50±8, 38±10. At a median follow up time of 21.3 months (range 7.1-38.2), no patients have developed biochemical progression, local recurrence, distant progression, or death from prostate cancer. One patient died at 18 months from metastatic colorectal cancer, unrelated to prostate cancer treatment. Acute grade 1-2 GU toxicity occurred in 13 (65%) patients, and acute grade 1-2 GI toxicity occurred in 4 (20%) patients. No patients developed grade 3+ acute or late GU or GI toxicity. Two patients required temporary foley catheter for obstruction during RT, and both had IPSS >20 at baseline. The patient who refused ADT had a PSA bounce of magnitude 2.2 ng/mL at 14 months, PSA values declined without additional treatment. CONCLUSION A novel 28-fraction focal boosted IMRT treatment is feasible and has an acceptable early toxicity profile. Oncologic results are promising but require longer follow up.
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Affiliation(s)
- J M Hands
- The George Washington University School of Medicine and Health Sciences, Manhattan Beach, CA
| | - M Whalen
- Department of Urology, George Washington University School of Medicine and Health Sciences, Washington, DC
| | - S Haji-Momenian
- Radiology, George Washington University School of Medicine and Health Sciences, Washington, DC
| | | | | | | | - D Provenzano
- Biomedical Engineering, George Washington University School of Engineering and Applied Science, Washington, DC
| | - J E Bauman
- University of Arizona Division of Hematology-Oncology, Tucson, AZ
| | | | - H Aghdam
- Division of Radiation Oncology, Department of Radiology, George Washington University School of Medicine and Health Sciences, Washington, DC
| | - D Chen
- Division of Radiation Oncology, Department of Radiology, George Washington University School of Medicine and Health Sciences, Washington, DC
| | - S Goyal
- Radiation Oncology, George Washington University School of Medicine and Health Sciences, Washington, DC
| | - M Ojong-Ntui
- The George Washington University, Washington, DC
| | - Y J Rao
- Radiation Oncology, George Washington University School of Medicine and Health Sciences, Washington, DC
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Provenzano D, Wang JY, Haji-Momenian S, Shin B, Riess J, Khati N, Bauman J, Goyal S, Loew M, Chappell N, Rao YJ. Prediction of Progression After Cervix Cancer Radiotherapy Using a Machine-Learning Model on Pre-Treatment MRI. Int J Radiat Oncol Biol Phys 2023; 117:S132. [PMID: 37784341 DOI: 10.1016/j.ijrobp.2023.06.482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) MRI may be useful to identify women with cervical cancer at high risk of disease progression to test strategies of treatment intensification. The purpose of this study was to determine the value of a machine-learning model built on pre-treatment MRI for prediction of risk of progression after radiation therapy. MATERIALS/METHODS MagneticResonance Imaging (MRI) data for women with cervical cancer was collected from The Cancer Genome Atlas Cervical Squamous Cell Carcinoma and Endocervical Adenocarcinoma Collection (TCGA-CESC) on the Cancer Imaging Archive (TCIA), which reported clinical, treatment, and imaging data from a single institution. 27 patients who had received radiation for cervical cancer were selected for input into a custom 3-D Residual Neural Network (ResNet) model with added custom layers specific to DICOM data in tensorflow python package. One T2 MRI per patient was used to predict recurrence free survival after radiation treatment, where patients were predicted to be "high risk" or "low risk" for disease recurrence as the output of the model. All slices of the T2 MRI were used. The model was validated using five-fold cross validation; 80% of the data was used to train each fold and 20% was used for testing. Final model statistical significance was confirmed through shuffle test at the p < 0.01 level. The clinical outcomes of patients and the model's "low-risk" and "high-risk" prediction were compared. RESULTS There were 27 patients in the study with mean age of 51 years (range 29-79). 20 patients had squamous cell carcinoma and 7 patients had adenocarcinoma. The stage breakdown consisted of 9 women IB, 2 IIA, 9 IIB, 2 IIIA, 2 IIIB, and 3 stage IV. 10 women were treated with radiation alone and 17 with chemo-radiation. 5 women received surgery in addition to radiation or chemoradiation. 21 patients received brachytherapy. Median follow-up of patients was 29 months (range 3-64). The model predicted 7 patients as "high risk" for recurrence; all 7 developed a recurrence during follow up. None of the 20 patients predicted to be "low risk" developed disease recurrence. Among all patients in the study, the two-year progression free survival (PFS) was 82.0%. Patients identified as "low risk" and "high risk" by model had two-year PFS of 100% and 43%, respectively. Among patients with recurrence, 3 developed local recurrence and 4 developed distant metastases. The ResNet model achieved cross-validated accuracy of 92% for prediction of progression-free survival (p<0.01). CONCLUSION A 3-D ResNet machine-learning model using pretreatment MRI image data can accurately predict clinical outcomes for cervical cancer following radiation therapy. Future work to confirm generalizability should focus on validation with a larger clinical dataset.
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Affiliation(s)
- D Provenzano
- Biomedical Engineering, George Washington University School of Engineering and Applied Science, Washington, DC
| | - J Y Wang
- Radiation Oncology, George Washington University School of Medicine and Health Sciences, Washington, DC
| | - S Haji-Momenian
- Radiology, George Washington University School of Medicine and Health Sciences, Washington, DC
| | - B Shin
- Radiology, George Washington University School of Medicine and Health Sciences, Washington, DC
| | - J Riess
- Radiology, George Washington University School of Medicine and Health Sciences, Washington, DC
| | - N Khati
- Radiology, George Washington University School of Medicine and Health Sciences, Washington, DC
| | - J Bauman
- Medical Oncology, George Washington University School of Medicine and Health Sciences, Washington, DC
| | - S Goyal
- Radiation Oncology, George Washington University School of Medicine and Health Sciences, Washington, DC
| | - M Loew
- Medical Oncology, George Washington University School of Medicine and Health Sciences, Washington, DC
| | - N Chappell
- Gynecological Oncology, George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Y J Rao
- Radiation Oncology, George Washington University School of Medicine and Health Sciences, Washington, DC
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Goyal S, Verma S, Ranjan R, Goyal R. 16 Horner Syndrome: Can it be Familial? Case series in a family and review of literature. BMJ Open Ophthalmol 2023; 8:A6. [PMID: 37797987 DOI: 10.1136/bmjophth-2023-biposa.16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/07/2023] Open
Abstract
Ophthalmic literature reveals vague and rare references to Horner syndrome on a hereditary basis. We present a case series of mother and son with Horner syndrome, which was confirmed pharmacologically. They noticed symptoms on the same side at a similar age and no serious pathology was found.Retrospective case review of notes:Case 1: An 11-year-old male presented with 6 week history of anisocoria, mild right ptosis, no heterochromia and no history of trauma or previous surgeries. The anisocoria was more noticeable in the dark, Horner syndrome was confirmed with apraclonidine test.Case 2: Mother of case 1, 50-year-old female diagnosed with right Horner syndrome at the age of 14 in Austria. The presenting features were anisocoria, a lack of sweating on the right side of her face. Diagnosis was reconfirmed pharmacologically.Case 1 was referred to paediatrics for a systemic examination which was normal. He was investigated with urinary catecholamines, MRI head and CT neck and thorax which were all normal. Case 2 was investigated in the past with a normal CT head.Horner syndrome results in the interruption of the oculo-sympathetic pathway and can indicate serious pathology in the head, chest or neck. Our cases demonstrate that familial presentation could indicate an idiopathic aetiology as it is unlikely to have pathological Horner syndrome in two first degree relatives.Our case series highlights the importance of eliciting a family history of Horner syndrome and examining the family members. Positive family history can reassure patients while awaiting results of investigations.
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Affiliation(s)
- S Goyal
- Royal Glamorgan Hospital, UK
| | - S Verma
- Royal Glamorgan Hospital, UK
| | | | - R Goyal
- Royal Glamorgan Hospital, UK
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Khaladkar SM, Goyal S, Vinay Kumar Parripati SS, Gupta V, Goyal S. Tracheo-oesophageal fistula in a case of organophosphate poisoning. Afr J Thorac Crit Care Med 2023; 29:10.7196/AJTCCM.2023.v29i1.267. [PMID: 37476659 PMCID: PMC10354871 DOI: 10.7196/ajtccm.2023.v29i1.267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Indexed: 07/22/2023] Open
Affiliation(s)
- S M Khaladkar
- Department of Radiodiagnosis, Dr D Y Patil Medical College, Hospital
and Research Centre, Dr DY Patil Vidyapeeth, Pune, Maharashtra, India
| | - S Goyal
- Department of Radiodiagnosis, Dr D Y Patil Medical College, Hospital
and Research Centre, Dr DY Patil Vidyapeeth, Pune, Maharashtra, India
| | - S S Vinay Kumar Parripati
- Department of Radiodiagnosis, Dr D Y Patil Medical College, Hospital
and Research Centre, Dr DY Patil Vidyapeeth, Pune, Maharashtra, India
| | - V Gupta
- Department of Radiodiagnosis, Dr D Y Patil Medical College, Hospital
and Research Centre, Dr DY Patil Vidyapeeth, Pune, Maharashtra, India
| | - S Goyal
- Government Medical College, Amritsar, Punjab, India
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Goyal S, Gray-Owen S, Girardin S. A23 INTESTINAL STEM CELL REGULATION BY THE BACTERIAL METABOLITE ADP-HEPTOSE VIA ACTIVATION OF THE ALPK1-TIFA SIGNALLING PATHWAY. J Can Assoc Gastroenterol 2023. [PMCID: PMC9991211 DOI: 10.1093/jcag/gwac036.023] [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: 03/09/2023] Open
Abstract
NOT PUBLISHED AT AUTHOR’S REQUEST
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Affiliation(s)
| | - S Gray-Owen
- MolGen, University of Toronto, Toronto, Canada
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Schweizer MT, True L, Gulati R, Zhao Y, Ellis W, Schade G, Montgomery B, Goyal S, Nega K, Hakansson AK, Liu Y, Davicioni E, Pienta K, Nelson PS, Lin D, Wright J. Reply by Authors. J Urol 2023; 209:362-363. [PMID: 36621992 DOI: 10.1097/ju.0000000000003038.02] [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: 01/10/2023]
Affiliation(s)
- Michael T Schweizer
- Department of Medicine, University of Washington, Seattle, Washington.,Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Lawrence True
- Department of Pathology, University of Washington, Seattle, Washington
| | - Roman Gulati
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Yibai Zhao
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - William Ellis
- Department of Urology, University of Washington, Seattle, Washington
| | - George Schade
- Department of Urology, University of Washington, Seattle, Washington
| | - Bruce Montgomery
- Department of Medicine, University of Washington, Seattle, Washington.,Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington.,VA Puget Sound Health Care System and Prostate Cancer Foundation POPCAP Network, Seattle, Washington
| | - Sonia Goyal
- Department of Medicine, University of Washington, Seattle, Washington
| | - Katie Nega
- Department of Medicine, University of Washington, Seattle, Washington
| | | | - Yang Liu
- Veracyte, Inc., San Francisco, California
| | | | - Kenneth Pienta
- The James Buchanan Brady Urological Institute, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Peter S Nelson
- Department of Medicine, University of Washington, Seattle, Washington.,Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington.,Division of Human Biology, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Daniel Lin
- Department of Urology, University of Washington, Seattle, Washington
| | - Jonathan Wright
- Department of Urology, University of Washington, Seattle, Washington
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Schweizer MT, True L, Gulati R, Zhao Y, Ellis W, Schade G, Montgomery B, Goyal S, Nega K, Hakansson AK, Liu Y, Davicioni E, Pienta K, Nelson PS, Lin D, Wright J. Pathological Effects of Apalutamide in Lower-risk Prostate Cancer: Results From a Phase II Clinical Trial. J Urol 2023; 209:354-363. [PMID: 36621991 PMCID: PMC9833838 DOI: 10.1097/ju.0000000000003038] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
PURPOSE Active surveillance is a safe and effective strategy for men with lower-risk prostate cancer who want to avoid local therapy; however, many patients on active surveillance progress to active treatment (eg, prostatectomy or radiation). We hypothesized that apalutamide would decrease active surveillance attrition rates through downstaging low-grade tumors. MATERIALS AND METHODS This was an open-label, single-arm, phase II study testing 90 days of oral apalutamide 240 mg daily in men with low- to intermediate-risk prostate cancer on active surveillance. The primary objective was to determine the percentage of patients with a negative biopsy immediately following treatment. Secondary objectives were to assess long-term clinical outcomes, quality of life, safety, and biomarkers of response/resistance. RESULTS Twenty-three patients enrolled and 22 completed 90 days of apalutamide with post-treatment biopsy. Fifteen (65%) had Grade Group 1 disease, and all others had Grade Group 2 disease. Seven (30%) had favorable- to intermediate-risk disease. Of 22 evaluable patients, 13 (59%) had no residual cancer on post-treatment biopsy. The median time to first positive biopsy was 364 days (95% CI: 91-742 days). The impact of apalutamide on quality of life was minimal and transient. Decipher risk classifier revealed a greater number of negative post-treatment biopsies in those with higher baseline genomic risk score (P = .01). CONCLUSIONS The negative repeat biopsy rate following 90 days of apalutamide was high in men with prostate cancer followed on active surveillance. Apalutamide was safe, well tolerated, and had minimal impact on quality of life. Randomized studies evaluating the effects of apalutamide in men enrolled on active surveillance are warranted.
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Affiliation(s)
- Michael T Schweizer
- Department of Medicine, University of Washington, Seattle, Washington
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Lawrence True
- Department of Pathology, University of Washington, Seattle, Washington
| | - Roman Gulati
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Yibai Zhao
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - William Ellis
- Department of Urology, University of Washington, Seattle, Washington
| | - George Schade
- Department of Urology, University of Washington, Seattle, Washington
| | - Bruce Montgomery
- Department of Medicine, University of Washington, Seattle, Washington
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
- VA Puget Sound Health Care System and Prostate Cancer Foundation POPCAP Network, Seattle, Washington
| | - Sonia Goyal
- Department of Medicine, University of Washington, Seattle, Washington
| | - Katie Nega
- Department of Medicine, University of Washington, Seattle, Washington
| | | | - Yang Liu
- Veracyte, Inc., San Francisco, California
| | | | - Kenneth Pienta
- The James Buchanan Brady Urological Institute, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Peter S Nelson
- Department of Medicine, University of Washington, Seattle, Washington
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
- Division of Human Biology, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Daniel Lin
- Department of Urology, University of Washington, Seattle, Washington
| | - Jonathan Wright
- Department of Urology, University of Washington, Seattle, Washington
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Priya TK, Singla D, Talawar P, Sharma RS, Goyal S, Purohit G. Comparative efficacy of quadratus lumborum type-II and erector spinae plane block in patients undergoing caesarean section under spinal anaesthesia: a randomised controlled trial. Int J Obstet Anesth 2023; 53:103614. [PMID: 36535864 DOI: 10.1016/j.ijoa.2022.103614] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 08/03/2022] [Accepted: 11/29/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Quadratus lumborum and erector spinae plane blocks have been used to provide analgesia in patients undergoing thoracic or abdominal surgeries. Our study compared the analgesic efficacy of the quadratus lumborum type-II block (QLB-II) and the erector spinae plane block (ESPB) in parturients who underwent caesarean section under spinal anaesthesia. METHODS Fifty-two patients with comparable demographic profiles were randomised into two groups, QLB-II (n = 26) and ESPB (n = 26). After the surgery, patients received either ultrasound-guided QLB-II or ESPB using 0.25% bupivacaine 0.3 mL/kg. Comparison of analgesic efficacy was in terms of fentanyl consumption (primary outcome), pain scores, incidence of complications in the 24-h postoperative period, and quality of recovery (QoR-15) on postoperative days one and two, and day of discharge. RESULTS There was no significant difference in cumulative number of fentanyl doses (W = 349.000, P = 0.840), numerical rating score at rest (P = 0.648) or with movement (P = 0.520), QoR-15 scores on postoperative day one (P = 0.549), day two (P = 0.927) or day of discharge (P = 0.676). CONCLUSION We concluded that patients who underwent QLB-II or ESPB reported similar analgesic efficacy, complications, and quality of recovery in the postoperative period.
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Affiliation(s)
- T K Priya
- Department of Anaesthesiology, AIIMS, Rishikesh, Uttarakhand, India
| | - D Singla
- Department of Anaesthesiology, AIIMS, Rishikesh, Uttarakhand, India.
| | - P Talawar
- Department of Anaesthesiology, AIIMS, Rishikesh, Uttarakhand, India
| | - R S Sharma
- Department of Anaesthesiology, AIIMS, Rishikesh, Uttarakhand, India
| | - S Goyal
- Department of Anaesthesiology, AIIMS, Rishikesh, Uttarakhand, India
| | - G Purohit
- Department of Anaesthesiology, AIIMS, Rishikesh, Uttarakhand, India
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Dhere V, Schuster D, Goyal S, Schreibmann E, Hershatter B, Patel S, Shelton J, Hanasoge S, Patel P, Sebastian N, Adediran O, Lawal I, Jani A. Randomized Trial of 18F-fluciclovine vs. 68Ga-PSMA PET/CT Guided Post-Prostatectomy Radiotherapy: Interim Volumetric and Toxicity Analyses. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.1162] [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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Mitra S, Simson D, Singh S, Goyal S, Khurana H, Dewan A, Barik S, Dobriyal K, Krishnan A, Pansuriya M, Mishra M. Survival Outcomes and Patterns of Failure in Patients with Carcinoma Stomach Who Underwent D2 Lymphadenectomy Followed by Either Adjuvant Chemoradiation or Chemotherapy Alone: A Retrospective Review from a Tertiary Care Cancer Research Institute. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.1053] [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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Amrith B, Goel V, Joga S, Koyyala V, Goyal S, Batra U, Doval D, Talwar V. 122P Efficacy and safety of mFOLFOX-6 in advanced gastric cancer: A prospective observational study. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.10.158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2022] Open
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Abbott R, Abe H, Acernese F, Ackley K, Adhikari N, Adhikari R, Adkins V, Adya V, Affeldt C, Agarwal D, Agathos M, Agatsuma K, Aggarwal N, Aguiar O, Aiello L, Ain A, Ajith P, Akutsu T, Albanesi S, Alfaidi R, Allocca A, Altin P, Amato A, Anand C, Anand S, Ananyeva A, Anderson S, Anderson W, Ando M, Andrade T, Andres N, Andrés-Carcasona M, Andrić T, Angelova S, Ansoldi S, Antelis J, Antier S, Apostolatos T, Appavuravther E, Appert S, Apple S, Arai K, Araya A, Araya M, Areeda J, Arène M, Aritomi N, Arnaud N, Arogeti M, Aronson S, Arun K, Asada H, Asali Y, Ashton G, Aso Y, Assiduo M, Melo SADS, Aston S, Astone P, Aubin F, AultONeal K, Austin C, Babak S, Badaracco F, Bader M, Badger C, Bae S, Bae Y, Baer A, Bagnasco S, Bai Y, Baird J, Bajpai R, Baka T, Ball M, Ballardin G, Ballmer S, Balsamo A, Baltus G, Banagiri S, Banerjee B, Bankar D, Barayoga J, Barbieri C, Barish B, Barker D, Barneo P, Barone F, Barr B, Barsotti L, Barsuglia M, Barta D, Bartlett J, Barton M, Bartos I, Basak S, Bassiri R, Basti A, Bawaj M, Bayley J, Mills J, Milotti E, Minenkov Y, Mio N, Mir L, Miravet-Tenés M, Mishkin A, Mishra C, Mishra T, Mistry T, Bazzan M, Mitra S, Mitrofanov V, Mitselmakher G, Mittleman R, Miyakawa O, Miyo K, Miyoki S, Mo G, Modafferi L, Moguel E, Becher B, Mogushi K, Mohapatra S, Mohite S, Molina I, Molina-Ruiz M, Mondin M, Montani M, Moore C, Moragues J, Moraru D, Bécsy B, Morawski F, More A, Moreno C, Moreno G, Mori Y, Morisaki S, Morisue N, Moriwaki Y, Mours B, Mow-Lowry C, Bedakihale V, Mozzon S, Muciaccia F, Mukherjee A, Mukherjee D, Mukherjee S, Mukherjee S, Mukherjee S, Mukund N, Mullavey A, Munch J, Beirnaert F, Muñiz E, Murray P, Musenich R, Muusse S, Nadji S, Nagano K, Nagar A, Nakamura K, Nakano H, Nakano M, Bejger M, Nakayama Y, Napolano V, Nardecchia I, Narikawa T, Narola H, Naticchioni L, Nayak B, Nayak R, Neil B, Neilson J, Belahcene I, Nelson A, Nelson T, Nery M, Neubauer P, Neunzert A, Ng K, Ng S, Nguyen C, Nguyen P, Nguyen T, Benedetto V, Quynh LN, Ni J, Ni WT, Nichols S, Nishimoto T, Nishizawa A, Nissanke S, Nitoglia E, Nocera F, Norman M, Beniwal D, North C, Nozaki S, Nurbek G, Nuttall L, Obayashi Y, Oberling J, O’Brien B, O’Dell J, Oelker E, Ogaki W, Benjamin M, Oganesyan G, Oh J, Oh K, Oh S, Ohashi M, Ohashi T, Ohkawa M, Ohme F, Ohta H, Okada M, Bennett T, Okutani Y, Olivetto C, Oohara K, Oram R, O’Reilly B, Ormiston R, Ormsby N, O’Shaughnessy R, O’Shea E, Oshino S, Bentley J, Ossokine S, Osthelder C, Otabe S, Ottaway D, Overmier H, Pace A, Pagano G, Pagano R, Page M, Pagliaroli G, BenYaala M, Pai A, Pai S, Pal S, Palamos J, Palashov O, Palomba C, Pan H, Pan KC, Panda P, Pang P, Bera S, Pankow C, Pannarale F, Pant B, Panther F, Paoletti F, Paoli A, Paolone A, Pappas G, Parisi A, Park H, Berbel M, Park J, Parker W, Pascucci D, Pasqualetti A, Passaquieti R, Passuello D, Patel M, Pathak M, Patricelli B, Patron A, Bergamin F, Paul S, Payne E, Pedraza M, Pedurand R, Pegoraro M, Pele A, Arellano FP, Penano S, Penn S, Perego A, Berger B, Pereira A, Pereira T, Perez C, Périgois C, Perkins C, Perreca A, Perriès S, Pesios D, Petermann J, Petterson D, Bernuzzi S, Pfeiffer H, Pham H, Pham K, Phukon K, Phurailatpam H, Piccinni O, Pichot M, Piendibene M, Piergiovanni F, Pierini L, Bersanetti D, Pierro V, Pillant G, Pillas M, Pilo F, Pinard L, Pineda-Bosque C, Pinto I, Pinto M, Piotrzkowski B, Piotrzkowski K, Bertolini A, Pirello M, Pitkin M, Placidi A, Placidi E, Planas M, Plastino W, Pluchar C, Poggiani R, Polini E, Pong D, Betzwieser J, Ponrathnam S, Porter E, Poulton R, Poverman A, Powell J, Pracchia M, Pradier T, Prajapati A, Prasai K, Prasanna R, Beveridge D, Pratten G, Principe M, Prodi G, Prokhorov L, Prosposito P, Prudenzi L, Puecher A, Punturo M, Puosi F, Puppo P, Bhandare R, Pürrer M, Qi H, Quartey N, Quetschke V, Quinonez P, Quitzow-James R, Raab F, Raaijmakers G, Radkins H, Radulesco N, Bhandari A, Raffai P, Rail S, Raja S, Rajan C, Ramirez K, Ramirez T, Ramos-Buades A, Rana J, Rapagnani P, Ray A, Bhardwaj U, Raymond V, Raza N, Razzano M, Read J, Rees L, Regimbau T, Rei L, Reid S, Reid S, Reitze D, Bhatt R, Relton P, Renzini A, Rettegno P, Revenu B, Reza A, Rezac M, Ricci F, Richards D, Richardson J, Richardson L, Bhattacharjee D, Riemenschneider G, Riles K, Rinaldi S, Rink K, Robertson N, Robie R, Robinet F, Rocchi A, Rodriguez S, Rolland L, Bhaumik S, Rollins J, Romanelli M, Romano R, Romel C, Romero A, Romero-Shaw I, Romie J, Ronchini S, Rosa L, Rose C, Bianchi A, Rosińska D, Ross M, Rowan S, Rowlinson S, Roy S, Roy S, Rozza D, Ruggi P, Ruiz-Rocha K, Ryan K, Bilenko I, Sachdev S, Sadecki T, Sadiq J, Saha S, Saito Y, Sakai K, Sakellariadou M, Sakon S, Salafia O, Salces-Carcoba F, Billingsley G, Salconi L, Saleem M, Salemi F, Samajdar A, Sanchez E, Sanchez J, Sanchez L, Sanchis-Gual N, Sanders J, Sanuy A, Bini S, Saravanan T, Sarin N, Sassolas B, Satari H, Sauter O, Savage R, Savant V, Sawada T, Sawant H, Sayah S, Birney R, Schaetzl D, Scheel M, Scheuer J, Schiworski M, Schmidt P, Schmidt S, Schnabel R, Schneewind M, Schofield R, Schönbeck A, Birnholtz O, Schulte B, Schutz B, Schwartz E, Scott J, Scott S, Seglar-Arroyo M, Sekiguchi Y, Sellers D, Sengupta A, Sentenac D, Biscans S, Seo E, Sequino V, Sergeev A, Setyawati Y, Shaffer T, Shahriar M, Shaikh M, Shams B, Shao L, Sharma A, Bischi M, Sharma P, Shawhan P, Shcheblanov N, Sheela A, Shikano Y, Shikauchi M, Shimizu H, Shimode K, Shinkai H, Shishido T, Biscoveanu S, Shoda A, Shoemaker D, Shoemaker D, ShyamSundar S, Sieniawska M, Sigg D, Silenzi L, Singer L, Singh D, Singh M, Bisht A, Singh N, Singha A, Sintes A, Sipala V, Skliris V, Slagmolen B, Slaven-Blair T, Smetana J, Smith J, Smith L, Biswas B, Smith R, Soldateschi J, Somala S, Somiya K, Song I, Soni K, Soni S, Sordini V, Sorrentino F, Sorrentino N, Bitossi M, Soulard R, Souradeep T, Sowell E, Spagnuolo V, Spencer A, Spera M, Spinicelli P, Srivastava A, Srivastava V, Staats K, Bizouard MA, Stachie C, Stachurski F, Steer D, Steinlechner J, Steinlechner S, Stergioulas N, Stops D, Stover M, Strain K, Strang L, Blackburn J, Stratta G, Strong M, Strunk A, Sturani R, Stuver A, Suchenek M, Sudhagar S, Sudhir V, Sugimoto R, Suh H, Blair C, Sullivan A, Summerscales T, Sun L, Sunil S, Sur A, Suresh J, Sutton P, Suzuki T, Suzuki T, Suzuki T, Blair D, Swinkels B, Szczepańczyk M, Szewczyk P, Tacca M, Tagoshi H, Tait S, Takahashi H, Takahashi R, Takano S, Takeda H, Blair R, Takeda M, Talbot C, Talbot C, Tanaka K, Tanaka T, Tanaka T, Tanasijczuk A, Tanioka S, Tanner D, Tao D, Bobba F, Tao L, Tapia R, Martín ETS, Taranto C, Taruya A, Tasson J, Tenorio R, Terhune J, Terkowski L, Thirugnanasambandam M, Bode N, Thomas M, Thomas P, Thompson E, Thompson J, Thondapu S, Thorne K, Thrane E, Tiwari S, Tiwari S, Tiwari V, Boër M, Toivonen A, Tolley A, Tomaru T, Tomura T, Tonelli M, Tornasi Z, Torres-Forné A, Torrie C, e Melo IT, Töyrä D, Bogaert G, Trapananti A, Travasso F, Traylor G, Trevor M, Tringali M, Tripathee A, Troiano L, Trovato A, Trozzo L, Trudeau R, Boldrini M, Tsai D, Tsang K, Tsang T, Tsao JS, Tse M, Tso R, Tsuchida S, Tsukada L, Tsuna D, Tsutsui T, Bolingbroke G, Turbang K, Turconi M, Tuyenbayev D, Ubhi A, Uchikata N, Uchiyama T, Udall R, Ueda A, Uehara T, Ueno K, Bonavena L, Ueshima G, Unnikrishnan C, Urban A, Ushiba T, Utina A, Vajente G, Vajpeyi A, Valdes G, Valentini M, Valsan V, Bondu F, van Bakel N, van Beuzekom M, van Dael M, van den Brand J, Van Den Broeck C, Vander-Hyde D, van Haevermaet H, van Heijningen J, van Putten M, van Remortel N, Bonilla E, Vardaro M, Vargas A, Varma V, Vasúth M, Vecchio A, Vedovato G, Veitch J, Veitch P, Venneberg J, Venugopalan G, Bonnand R, Verkindt D, Verma P, Verma Y, Vermeulen S, Veske D, Vetrano F, Viceré A, Vidyant S, Viets A, Vijaykumar A, Booker P, Villa-Ortega V, Vinet JY, Virtuoso A, Vitale S, Vocca H, von Reis E, von Wrangel J, Vorvick C, Vyatchanin S, Wade L, Boom B, Wade M, Wagner K, Walet R, Walker M, Wallace G, Wallace L, Wang J, Wang J, Wang W, Ward R, Bork R, Warner J, Was M, Washimi T, Washington N, Watchi J, Weaver B, Weaving C, Webster S, Weinert M, Weinstein A, Boschi V, Weiss R, Weller C, Weller R, Wellmann F, Wen L, Weßels P, Wette K, Whelan J, White D, Whiting B, Bose N, Whittle C, Wilken D, Williams D, Williams M, Williamson A, Willis J, Willke B, Wilson D, Wipf C, Wlodarczyk T, Bose S, Woan G, Woehler J, Wofford J, Wong D, Wong I, Wright M, Wu C, Wu D, Wu H, Wysocki D, Bossilkov V, Xiao L, Yamada T, Yamamoto H, Yamamoto K, Yamamoto T, Yamashita K, Yamazaki R, Yang F, Yang K, Yang L, Boudart V, Yang YC, Yang Y, Yang Y, Yap M, Yeeles D, Yeh SW, Yelikar A, Ying M, Yokoyama J, Yokozawa T, Bouffanais Y, Yoo J, Yoshioka T, Yu H, Yu H, Yuzurihara H, Zadrożny A, Zanolin M, Zeidler S, Zelenova T, Zendri JP, Bozzi A, Zevin M, Zhan M, Zhang H, Zhang J, Zhang L, Zhang R, Zhang T, Zhang Y, Zhao C, Zhao G, Bradaschia C, Zhao Y, Zhao Y, Zhou R, Zhou Z, Zhu X, Zhu ZH, Zucker M, Zweizig J, Brady P, Bramley A, Branch A, Branchesi M, Brau J, Breschi M, Briant T, Briggs J, Brillet A, Brinkmann M, Brockill P, Brooks A, Brooks J, Brown D, Brunett S, Bruno G, Bruntz R, Bryant J, Bucci F, Bulik T, Bulten H, Buonanno A, Burtnyk K, Buscicchio R, Buskulic D, Buy C, Byer R, Davies GC, Cabras G, Cabrita R, Cadonati L, Caesar M, Cagnoli G, Cahillane C, Bustillo JC, Callaghan J, Callister T, Calloni E, Cameron J, Camp J, Canepa M, Canevarolo S, Cannavacciuolo M, Cannon K, Cao H, Cao Z, Capocasa E, Capote E, Carapella G, Carbognani F, Carlassara M, Carlin J, Carney M, Carpinelli M, Carrillo G, Carullo G, Carver T, Diaz JC, Casentini C, Castaldi G, Caudill S, Cavaglià M, Cavalier F, Cavalieri R, Cella G, Cerdá-Durán P, Cesarini E, Chaibi W, Subrahmanya SC, Champion E, Chan CH, Chan C, Chan C, Chan K, Chan M, Chandra K, Chang I, Chanial P, Chao S, Chapman-Bird C, Charlton P, Chase E, Chassande-Mottin E, Chatterjee C, Chatterjee D, Chatterjee D, Chaturvedi M, Chaty S, Chen C, Chen D, Chen H, Chen J, Chen K, Chen X, Chen YB, Chen YR, Chen Z, Cheng H, Cheong C, Cheung H, Chia H, Chiadini F, Chiang CY, Chiarini G, Chierici R, Chincarini A, Chiofalo M, Chiummo A, Choudhary R, Choudhary S, Christensen N, Chu Q, Chu YK, Chua S, Chung K, Ciani G, Ciecielag P, Cieślar M, Cifaldi M, Ciobanu A, Ciolfi R, Cipriano F, Clara F, Clark J, Clearwater P, Clesse S, Cleva F, Coccia E, Codazzo E, Cohadon PF, Cohen D, Colleoni M, Collette C, Colombo A, Colpi M, Compton C, Constancio M, Conti L, Cooper S, Corban P, Corbitt T, Cordero-Carrión I, Corezzi S, Corley K, Cornish N, Corre D, Corsi A, Cortese S, Costa C, Cotesta R, Cottingham R, Coughlin M, Coulon JP, Countryman S, Cousins B, Couvares P, Coward D, Cowart M, Coyne D, Coyne R, Creighton J, Creighton T, Criswell A, Croquette M, Crowder S, Cudell J, Cullen T, Cumming A, Cummings R, Cunningham L, Cuoco E, Curyło M, Dabadie P, Canton TD, Dall’Osso S, Dálya G, Dana A, D’Angelo B, Danilishin S, D’Antonio S, Danzmann K, Darsow-Fromm C, Dasgupta A, Datrier L, Datta S, Datta S, Dattilo V, Dave I, Davier M, Davis 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I, Martin R, Martinez M, Martinez V, Martinez V, Martinovic K, Martynov D, Marx E, Masalehdan H, Mason K, Massera E, Masserot A, Masso-Reid M, Mastrogiovanni S, Matas A, Mateu-Lucena M, Matichard F, Matiushechkina M, Mavalvala N, McCann J, McCarthy R, McClelland D, McClincy P, McCormick S, McCuller L, McGhee G, McGuire S, McIsaac C, McIver J, McRae T, McWilliams S, Meacher D, Mehmet M, Mehta A, Meijer Q, Melatos A, Melchor D, Mendell G, Menendez-Vazquez A, Menoni C, Mercer R, Mereni L, Merfeld K, Merilh E, Merritt J, Merzougui M, Meshkov S, Messenger C, Messick C, Meyers P, Meylahn F, Mhaske A, Miani A, Miao H, Michaloliakos I, Michel C, Michimura Y, Middleton H, Mihaylov D, Milano L, Miller A, Miller A, Miller B, Millhouse M. Search for continuous gravitational wave emission from the Milky Way center in O3 LIGO-Virgo data. Int J Clin Exp Med 2022. [DOI: 10.1103/physrevd.106.042003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Goyal S, Chua C, Chen YS, Murphy D, O 'Neill GK. Utility of 3D printed models as adjunct in acetabular fracture teaching for Orthopaedic trainees. BMC Med Educ 2022; 22:595. [PMID: 35918716 PMCID: PMC9344721 DOI: 10.1186/s12909-022-03621-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Accepted: 06/27/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE To evaluate the use of 3-D printed models as compared to didactic lectures in the teaching of acetabular fractures for Orthopaedic trainees. METHODS This was a randomised prospective study conducted in a tertiary hospital setting which consisted of 16 Orthopaedic residents. Ten different cases of acetabular fracture patterns were identified and printed as 3-D models. The baseline knowledge of orthopaedic residents regarding acetabular fracture classification and surgical approach was determined by an x-ray based pre-test. Trainees were then randomly assigned into two groups. Group I received only lectures. Group II were additionally provided with 3-D printed models during the lecture. Participants were then assessed for comprehension and retention of teaching. RESULTS Sixteen trainees participated in the trial. Both Group 1 and 2 improved post teaching with a mean score of 2.5 and 1.9 to 4.4 and 6 out of 10 respectively. The post test score for fracture classification and surgical approach were significantly higher for 3-D model group (p < 0.05). Trainees felt that the physical characteristics of the 3-D models were a good representation of acetabular fracture configuration, and should be used routinely for teaching and surgical planning. CONCLUSION 3-D printed model of real clinical cases have significant educational impact compared to lecture-based learning towards improving young trainees' understanding of complex acetabular fractures.
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Affiliation(s)
- S Goyal
- Department of Orthopaedics, University Orthopaedics and Hand & Reconstructive Microsurgery Centre, National University Health System, Level 11, Tower Block, 1E Kent Ridge Road, Singapore, 119228, Singapore.
| | - Cxk Chua
- Department of Orthopaedics, University Orthopaedics and Hand & Reconstructive Microsurgery Centre, National University Health System, Level 11, Tower Block, 1E Kent Ridge Road, Singapore, 119228, Singapore
| | - Y S Chen
- Department of Orthopaedic Surgery, Ng Teng Fong General Hospital, 1 Jurong East Street 21, Singapore, 609606, Singapore
| | - D Murphy
- Department of Orthopaedics, University Orthopaedics and Hand & Reconstructive Microsurgery Centre, National University Health System, Level 11, Tower Block, 1E Kent Ridge Road, Singapore, 119228, Singapore
| | - G K O 'Neill
- Department of Orthopaedics, University Orthopaedics and Hand & Reconstructive Microsurgery Centre, National University Health System, Level 11, Tower Block, 1E Kent Ridge Road, Singapore, 119228, Singapore
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M, D'Afflitto M, Deshpande A, Duque Golding J, Frisira E, Germani Batacchi M, Gomaa A, Hay D, Hutchison R, Iakovou A, Iakovou D, Ismail E, Jefferson S, Jones L, Khouli Y, Knowles C, Mason J, McCaughan R, Moffatt J, Morawala A, Nadir H, Neyroud F, Nikookam Y, Parmar A, Pinto L, Ramamoorthy R, Richards E, Thomson S, Trainer C, Valetopoulou A, Vassiliou A, Wantman A, Wilde S, Dickinson M, Rockall T, Senn D, Wcislo K, Zalmay P, Adelekan K, Allen K, Bajaj M, Gatumbu P, Hang S, Hashmi Y, Kaur T, Kawesha A, Kisiel A, Woodmass M, Adelowo T, Ahari D, Alhwaishel K, Atherton R, Clayton B, Cockroft A, Curtis Lopez C, Hilton M, Ismail N, Kouadria M, Lee L, MacConnachie A, Monks F, Mungroo S, Nikoletopoulou C, Pearce L, Sara X, Shahid A, Suresh G, Wilcha R, Atiyah A, Davies E, Dermanis A, Gibbons H, Hyde A, Lawson A, Lee C, Leung-Tack M, Li Saw Hee J, Mostafa O, Nair D, Pattani N, Plumbley-Jones J, Pufal K, Ramesh P, Sanghera J, Saram S, Scadding S, See S, Stringer H, Torrance A, Vardon H, 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Nightingale K, O'Neill K, Onyemuchara I, Senior R, Shanahan A, Sherlock J, Spyridoulias A, Stavrou C, Stokes D, Tamang R, Taylor E, Trafford C, Uden C, Waddington C, Yassin D, Zaman M, Bangi S, Cheng T, Chew D, Hussain N, Imani-Masouleh S, Mahasivam G, McKnight G, Ng HL, Ota HC, Pasha T, Ravindran W, Shah K, Vishnu K S, Zaman S, Carr W, Cope S, Eagles EJ, Howarth-Maddison M, Li CY, Reed J, Ridge A, Stubbs T, Teasdaled D, Umar R, Worthington J, Dhebri A, Kalenderov R, Alattas A, Arain Z, Bhudia R, Chia D, Daniel S, Dar T, Garland H, Girish M, Hampson A, Kyriacou H, Lehovsky K, Mullins W, Omorphos N, Vasdev N, Venkatesh A, Waldock W, Bhandari A, Brown G, Choa G, Eichenauer CE, Ezennia K, Kidwai Z, Lloyd-Thomas A, Macaskill Stewart A, Massardi C, Sinclair E, Skajaa N, Smith M, Tan I, Afsheen N, Anuar A, Azam Z, Bhatia P, Davies-kelly N, Dickinson S, Elkawafi M, Ganapathy M, Gupta S, Khoury EG, Licudi D, Mehta V, Neequaye S, Nita G, Tay VL, Zhao S, Botsa E, Cuthbert H, Elliott J, Furlepa M, Lehmann J, Mangtani A, Narayan A, Nazarian S, Parmar C, Shah D, Shaw C, Zhao Z, Beck C, Caldwell S, Clements JM, French B, Kenny R, Kirk S, Lindsay J, McClung A, McLaughlin N, Watson S, Whiteside E, Alyacoubi S, Arumugam V, Beg R, Dawas K, Garg S, Lloyd ER, Mahfouz Y, Manobharath N, Moonesinghe R, Morka N, Patel K, Prashar J, Yip S, Adeeko ES, Ajekigbe F, Bhat A, Evans C, Farrugia A, Gurung C, Long T, Malik B, Manirajan S, Newport D, Rayer J, Ridha A, Ross E, Saran T, Sinker A, Waruingi D, Allen R, Al Sadek Y, Alves do Canto Brum H, Asharaf H, Ashman M, Balakumar V, Barrington J, Baskaran R, Berry A, Bhachoo H, Bilal A, Boaden L, Chia WL, Covell G, Crook D, Dadnam F, Davis L, De Berker H, Doyle C, Fox C, Gruffydd-Davies M, Hafouda Y, Hill A, Hubbard E, Hunter A, Inpadhas V, Jamshaid M, Jandu G, Jeyanthi M, Jones T, Kantor C, Kwak SY, Malik N, Matt R, McNulty P, Miles C, Mohomed A, Myat P, Niharika J, Nixon A, O'Reilly D, Parmar K, Pengelly S, Price L, Ramsden M, Turnor R, Wales E, Waring H, Wu M, Yang T, Ye TTS, Zander A, Zeicu C, Bellam S, Francombe J, Kawamoto N, Rahman MR, Sathyanarayana A, Tang HT, Cheung J, Hollingshead J, Page V, Sugarman J, Wong E, Chiong J, Fung E, Kan SY, Kiang J, Kok J, Krahelski O, Liew MY, Lyell B, Sharif Z, Speake D, Alim L, Amakye NY, Chandrasekaran J, Chandratreya N, Drake J, Owoso T, Thu YM, Abou El Ela Bourquin B, Alberts J, Chapman D, Rehnnuma N, Ainsworth K, Carpenter H, Emmanuel T, Fisher T, Gabrel M, Guan Z, Hollows S, Hotouras A, Ip Fung Chun N, Jaffer S, Kallikas G, Kennedy N, Lewinsohn B, Liu FY, Mohammed S, Rutherfurd A, Situ T, Stammer A, Taylor F, Thin N, Urgesi E, Zhang N, Ahmad MA, Bishop A, Bowes A, Dixit A, Glasson R, Hatta S, Hatt K, Larcombe S, Preece J, Riordan E, Fegredo D, Haq MZ, Li C, McCann G, Stewart D, Baraza W, Bhullar D, Burt G, Coyle J, Deans J, Devine A, Hird R, Ikotun O, Manchip G, Ross C, Storey L, Tan WWL, Tse C, Warner C, Whitehead M, Wu F, Court EL, Crisp E, Huttman M, Mayes F, Robertson H, Rosen H, Sandberg C, Smith H, Al Bakry M, Ashwell W, Bajaj S, Bandyopadhyay D, Browlee O, Burway S, Chand CP, Elsayeh K, Elsharkawi A, Evans E, Ferrin S, Fort-Schaale A, Iacob M, I K, Impelliziere Licastro G, Mankoo AS, Olaniyan T, Otun J, Pereira R, Reddy R, Saeed D, Simmonds O, Singhal G, Tron K, Wickstone C, Williams R, Bradshaw E, De Kock Jewell V, Houlden C, Knight C, Metezai H, Mirza-Davies A, Seymour Z, Spink D, Wischhusen S. Evaluation of prognostic risk models for postoperative pulmonary complications in adult patients undergoing major abdominal surgery: a systematic review and international external validation cohort study. Lancet Digit Health 2022; 4:e520-e531. [PMID: 35750401 DOI: 10.1016/s2589-7500(22)00069-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 01/07/2022] [Accepted: 04/06/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Stratifying risk of postoperative pulmonary complications after major abdominal surgery allows clinicians to modify risk through targeted interventions and enhanced monitoring. In this study, we aimed to identify and validate prognostic models against a new consensus definition of postoperative pulmonary complications. METHODS We did a systematic review and international external validation cohort study. The systematic review was done in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We searched MEDLINE and Embase on March 1, 2020, for articles published in English that reported on risk prediction models for postoperative pulmonary complications following abdominal surgery. External validation of existing models was done within a prospective international cohort study of adult patients (≥18 years) undergoing major abdominal surgery. Data were collected between Jan 1, 2019, and April 30, 2019, in the UK, Ireland, and Australia. Discriminative ability and prognostic accuracy summary statistics were compared between models for the 30-day postoperative pulmonary complication rate as defined by the Standardised Endpoints in Perioperative Medicine Core Outcome Measures in Perioperative and Anaesthetic Care (StEP-COMPAC). Model performance was compared using the area under the receiver operating characteristic curve (AUROCC). FINDINGS In total, we identified 2903 records from our literature search; of which, 2514 (86·6%) unique records were screened, 121 (4·8%) of 2514 full texts were assessed for eligibility, and 29 unique prognostic models were identified. Nine (31·0%) of 29 models had score development reported only, 19 (65·5%) had undergone internal validation, and only four (13·8%) had been externally validated. Data to validate six eligible models were collected in the international external validation cohort study. Data from 11 591 patients were available, with an overall postoperative pulmonary complication rate of 7·8% (n=903). None of the six models showed good discrimination (defined as AUROCC ≥0·70) for identifying postoperative pulmonary complications, with the Assess Respiratory Risk in Surgical Patients in Catalonia score showing the best discrimination (AUROCC 0·700 [95% CI 0·683-0·717]). INTERPRETATION In the pre-COVID-19 pandemic data, variability in the risk of pulmonary complications (StEP-COMPAC definition) following major abdominal surgery was poorly described by existing prognostication tools. To improve surgical safety during the COVID-19 pandemic recovery and beyond, novel risk stratification tools are required. FUNDING British Journal of Surgery Society.
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Joga S, Goyal S, Mehta A, Sharma M, Koyyala V, Doval D, Goyal P, Aggarwal C, M. swamy, Patel A, Nathani S, Suryavanshi M, Narayan S, Soni S, Jain A, Redhu P. P-21 Molecular subtypes (profile) of colorectal cancer and their correlation with clinical and pathological profile in a tertiary care centre in India. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.04.112] [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: 11/01/2022] Open
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Madan R, Dhayalan S, Oinam A, Tomar P, Kumar N, Goyal S, Khosla D, Periasamy K, Sahoo S, Ahuja C, Chatterjee D. PO-1166 Impact of radiation techniques on hematological toxicity during craniospinal irradiation. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)03130-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Singla A, Madan R, Kumar N, Goyal S, Tripathi M, Gupta K, Gupta D, Kapoor R. PO-1149 Clinico-pathological and prognostic factors of Medulloblastoma - Tertiary care centre in India. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)03113-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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22
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Arora G, Taneja J, Bhardwaj P, Goyal S, Naidu K, Yadav SK, Saluja D, Jetly S. Adverse events and Breakthrough infections associated with COVID-19 vaccination in the Indian population. J Med Virol 2022; 94:3147-3154. [PMID: 35261064 PMCID: PMC9088477 DOI: 10.1002/jmv.27708] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 02/20/2022] [Accepted: 03/05/2022] [Indexed: 11/21/2022]
Abstract
Vaccines against COVID‐19 provide immunity to deter severe morbidities associated with the infection. However, it does not prevent infection altogether in all exposed individuals. Furthermore, emerging variants of SARS‐CoV‐2 impose a threat concerning the competency of the vaccines in combating the infection. This study aims to determine the variability in adverse events and the extent of breakthrough infections in the Indian population. A retrospective study was conducted using a pre‐validated questionnaire encompassing social, demographic, general health, the status of SARS‐CoV‐2 infection, vaccination, associated adverse events, and breakthrough infections in the Indian population. Informed consent and ethical approval were obtained as per Indian Council of Medical Research (ICMR) guidelines. Participants, who provided the complete information, were Indian citizens, above 18 years, and if vaccinated, administered with either Covishield or Covaxin, were considered for the study. Data have been compiled in Microsoft Excel and analyzed for statistical differences using STATA 11. The responses from 2051 individuals fulfilling the inclusion criteria were analyzed. Among 2051, 1119 respondents were vaccinated and 932 respondents were non‐vaccinated. Among 1119 vaccinated respondents, 7 were excluded because of missing data. Therefore, out of 1112 vaccinated, 413 experienced adverse events with a major fraction of younger individuals, age 18–40 years, getting affected (74.82%; 309/413). Furthermore, considerably more females than males encountered adverse consequences to vaccination (p < 0.05). Among vaccinated participants, breakthrough infections were observed in 7.91% (88/1112; 57.96% males and 42.04% females) with the older age group, 61 years and above (odds ratio, 3.25 [1.32–8.03]; p = 0.011), and males were found to be at higher risk. Further research is needed to find the age and sex‐related factors in determining vaccine effectiveness and adverse events. Significant higher adverse events following COVID‐19 vaccination in females in comparison to males. Breakthrough infections among Indian population was found to be 7.91%. Older people and males were found to be at high risk for getting breakthrough infections.
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Affiliation(s)
- G Arora
- Delhi School of Public Health, IoE & Dr. B.R. Ambedkar Center for Biomedical Research, University of Delhi-110007
| | - J Taneja
- Zoology Department, Daulat Ram College, University of Delhi-110007
| | - P Bhardwaj
- Department of Zoology, University of Delhi-110007
| | - S Goyal
- Manav Rachna International School, Sector 14, Faridabad, Haryana, 121007
| | - K Naidu
- IPCA Laboratories Ltd., Mumbai, 400067
| | - S K Yadav
- Zoology Department, Daulat Ram College, University of Delhi-110007
| | - D Saluja
- Delhi School of Public Health, IoE & Dr. B.R. Ambedkar Center for Biomedical Research, University of Delhi-110007
| | - S Jetly
- Department of Biomedical Sciences, Acharya Narendra Dev College, University of Delhi-110019
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Chalif E, El Shatanofy M, Mozaffari K, Goyal S, Sherman J. Rapidly recurrent recalcitrant Rathke Cleft Cyst: Case report and review of the literature. Neurochirurgie 2022; 68:535-539. [DOI: 10.1016/j.neuchi.2022.01.002] [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: 08/26/2021] [Revised: 01/07/2022] [Accepted: 01/11/2022] [Indexed: 11/17/2022]
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Mohar SS, Goyal S, Kaur R. Localization of sensor nodes in wireless sensor networks using bat optimization algorithm with enhanced exploration and exploitation characteristics. J Supercomput 2022; 78:11975-12023. [PMID: 35221523 PMCID: PMC8861493 DOI: 10.1007/s11227-022-04320-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 01/16/2022] [Indexed: 06/14/2023]
Abstract
Wireless sensor networks (WSNs) contain sensor nodes in enormous amount to accumulate the information about the nearby surroundings, and this information is insignificant until the exact position from where data have been collected is revealed. Localization of sensor nodes in WSNs plays a significant role in several applications such as detecting the enemy movement in military applications. The major aim of localization problem is to find the coordinates of all target nodes with the help of anchor nodes. In this paper, two variants of bat optimization algorithm (BOA) are proposed to localize the sensor nodes in a more efficient way and to overcome the drawbacks of original BOA, i.e. being trapped in local optimum solution. The exploration and exploitation features of original BOA are modified in the proposed BOA variants 1 and 2 using improved global and local search strategies. To validate the efficiency of the proposed BOA variants 1 and 2, several simulations have been performed for various numbers of target nodes and anchor nodes, and the results are compared with original BOA and other existing optimization algorithms applied to node localization problem. The proposed BOA variants 1 and 2 outperform the other algorithms in terms of mean localization error, number of localized nodes and computing time. Further, the proposed BOA variants 1 and 2 and original BOA are also compared in terms of various errors and localization efficiency for several values of target and anchor nodes. The simulations results signify that the proposed BOA variant 2 is superior to the proposed BOA variant 1 and existing BOA in terms of several errors. The node localization based on the proposed BOA variant 2 is more effective as it takes less time to perform computations and has less mean localization error than the proposed BOA variant 1, BOA and other existing optimization algorithms.
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Affiliation(s)
- Satinder Singh Mohar
- Department of Electronics and Communication Engineering, Punjabi University Patiala, Punjab, India
| | - Sonia Goyal
- Department of Electronics and Communication Engineering, Punjabi University Patiala, Punjab, India
| | - Ranjit Kaur
- Department of Electronics and Communication Engineering, Punjabi University Patiala, Punjab, India
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Schlafstein A, Goyal S, Amini A, Karam S, Saba N, Kaka A, Aiken A, Beitler J, Stokes W. Does Operability Status Influence Outcomes in Patients With T4 Larynx Cancer Undergoing Larynx Preservation? Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.1085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Dhere V, Fischer-Valuck B, Goyal S, Liu Y, Morgan T, Ghavidel B, Moghanaki D, Hershatter B, Patel P, Jani A, Godette K, Rossi P, Patel S. Toxicity Outcomes After Low-Dose-Rate vs. High-Dose-Rate Brachytherapy Boost in Combination With External Beam Radiation for Intermediate and High-Risk Prostate Cancer. Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Dhere V, Schuster D, Goyal S, Schreibmann E, Hershatter B, Rossi P, Shelton J, Patel P, Jani A. Randomized Trial of Conventional vs Conventional Plus Fluciclovine (18F) PET/CT-Guided Post-Prostatectomy Radiotherapy for Prostate Cancer: Volumetric and Patient-Reported Toxicity Analyses. Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Singla A, Khosla D, Kapoor R, Kumar D, Madan R, Periasamy K, Goyal S, Gupta R, Gupta V. 1486P Clinicopathological characteristics and prognostic factors of ampullary cancer: A tertiary care centre experience over 10 years. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Singla V, Goyal S, Periasamy K, Madan R, Vias P. PO-1400 Seminal vesicle adenocarcinoma: A systematic review of published literature. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)07851-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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31
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Goyal S, Tanigawa Y, Zhang W, Jin-Fang C, Almeida M, Sim X, Lerner M, Chainakul J, Ramiu J, Seraphin C, Apple B, Vaughan A, Muniu J, Peralta J, Lehman D, Ralhan S, Wander G, Singh J, Mehra N, Sidorov E, Peyton M, Blackett P, Curran J, Tai E, Van Dam R, Cheng CY, Duggirala R, Blangero J, Chambers J, Sabanayagam C, Kooner J, Rivas M, Sanghera D. Association of ApoCIII common variants with risk of coronary artery disease: A Mendelian randomization study. Atherosclerosis 2021. [DOI: 10.1016/j.atherosclerosis.2021.06.036] [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: 10/20/2022]
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32
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Madan R, Dey T, Goyal S, Bansal D, Trehan A, Peters N, Chatterjee D, Ballari N, Khosla D. PO-1436 Burden of pediatric oncology in radiotherapy department:A tertiary care center experience from India. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)07887-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Grivas P, Khaki AR, Wise-Draper TM, French B, Hennessy C, Hsu CY, Shyr Y, Li X, Choueiri TK, Painter CA, Peters S, Rini BI, Thompson MA, Mishra S, Rivera DR, Acoba JD, Abidi MZ, Bakouny Z, Bashir B, Bekaii-Saab T, Berg S, Bernicker EH, Bilen MA, Bindal P, Bishnoi R, Bouganim N, Bowles DW, Cabal A, Caimi PF, Chism DD, Crowell J, Curran C, Desai A, Dixon B, Doroshow DB, Durbin EB, Elkrief A, Farmakiotis D, Fazio A, Fecher LA, Flora DB, Friese CR, Fu J, Gadgeel SM, Galsky MD, Gill DM, Glover MJ, Goyal S, Grover P, Gulati S, Gupta S, Halabi S, Halfdanarson TR, Halmos B, Hausrath DJ, Hawley JE, Hsu E, Huynh-Le M, Hwang C, Jani C, Jayaraj A, Johnson DB, Kasi A, Khan H, Koshkin VS, Kuderer NM, Kwon DH, Lammers PE, Li A, Loaiza-Bonilla A, Low CA, Lustberg MB, Lyman GH, McKay RR, McNair C, Menon H, Mesa RA, Mico V, Mundt D, Nagaraj G, Nakasone ES, Nakayama J, Nizam A, Nock NL, Park C, Patel JM, Patel KG, Peddi P, Pennell NA, Piper-Vallillo AJ, Puc M, Ravindranathan D, Reeves ME, Reuben DY, Rosenstein L, Rosovsky RP, Rubinstein SM, Salazar M, Schmidt AL, Schwartz GK, Shah MR, Shah SA, Shah C, Shaya JA, Singh SRK, Smits M, Stockerl-Goldstein KE, Stover DG, Streckfuss M, Subbiah S, Tachiki L, Tadesse E, Thakkar A, Tucker MD, Verma AK, Vinh DC, Weiss M, Wu JT, Wulff-Burchfield E, Xie Z, Yu PP, Zhang T, Zhou AY, Zhu H, Zubiri L, Shah DP, Warner JL, Lopes G. Association of clinical factors and recent anticancer therapy with COVID-19 severity among patients with cancer: a report from the COVID-19 and Cancer Consortium. Ann Oncol 2021; 32:787-800. [PMID: 33746047 PMCID: PMC7972830 DOI: 10.1016/j.annonc.2021.02.024] [Citation(s) in RCA: 202] [Impact Index Per Article: 67.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 02/18/2021] [Accepted: 02/28/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Patients with cancer may be at high risk of adverse outcomes from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. We analyzed a cohort of patients with cancer and coronavirus 2019 (COVID-19) reported to the COVID-19 and Cancer Consortium (CCC19) to identify prognostic clinical factors, including laboratory measurements and anticancer therapies. PATIENTS AND METHODS Patients with active or historical cancer and a laboratory-confirmed SARS-CoV-2 diagnosis recorded between 17 March and 18 November 2020 were included. The primary outcome was COVID-19 severity measured on an ordinal scale (uncomplicated, hospitalized, admitted to intensive care unit, mechanically ventilated, died within 30 days). Multivariable regression models included demographics, cancer status, anticancer therapy and timing, COVID-19-directed therapies, and laboratory measurements (among hospitalized patients). RESULTS A total of 4966 patients were included (median age 66 years, 51% female, 50% non-Hispanic white); 2872 (58%) were hospitalized and 695 (14%) died; 61% had cancer that was present, diagnosed, or treated within the year prior to COVID-19 diagnosis. Older age, male sex, obesity, cardiovascular and pulmonary comorbidities, renal disease, diabetes mellitus, non-Hispanic black race, Hispanic ethnicity, worse Eastern Cooperative Oncology Group performance status, recent cytotoxic chemotherapy, and hematologic malignancy were associated with higher COVID-19 severity. Among hospitalized patients, low or high absolute lymphocyte count; high absolute neutrophil count; low platelet count; abnormal creatinine; troponin; lactate dehydrogenase; and C-reactive protein were associated with higher COVID-19 severity. Patients diagnosed early in the COVID-19 pandemic (January-April 2020) had worse outcomes than those diagnosed later. Specific anticancer therapies (e.g. R-CHOP, platinum combined with etoposide, and DNA methyltransferase inhibitors) were associated with high 30-day all-cause mortality. CONCLUSIONS Clinical factors (e.g. older age, hematological malignancy, recent chemotherapy) and laboratory measurements were associated with poor outcomes among patients with cancer and COVID-19. Although further studies are needed, caution may be required in utilizing particular anticancer therapies. CLINICAL TRIAL IDENTIFIER NCT04354701.
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Affiliation(s)
- P Grivas
- University of Washington/Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance, Seattle, USA.
| | - A R Khaki
- University of Washington/Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance, Seattle, USA; Stanford University, Stanford, USA
| | | | - B French
- Vanderbilt University Medical Center, Nashville, USA
| | - C Hennessy
- Vanderbilt University Medical Center, Nashville, USA
| | - C-Y Hsu
- Vanderbilt University Medical Center, Nashville, USA
| | - Y Shyr
- Vanderbilt University Medical Center, Nashville, USA
| | - X Li
- Vanderbilt University School of Medicine, Nashville, USA
| | | | - C A Painter
- Broad Institute, Cancer Program, Cambridge, USA
| | - S Peters
- Lausanne University, Lausanne, Switzerland
| | - B I Rini
- Vanderbilt University Medical Center, Nashville, USA
| | | | - S Mishra
- Vanderbilt University Medical Center, Nashville, USA
| | - D R Rivera
- Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, USA
| | - J D Acoba
- University of Hawaii Cancer Center, Honolulu, USA
| | - M Z Abidi
- University of Colorado School of Medicine, Aurora, USA
| | - Z Bakouny
- Dana-Farber Cancer Institute, Boston, USA
| | - B Bashir
- Sidney Kimmel Cancer Center at Thomas Jefferson University, Philadelphia, USA
| | | | - S Berg
- Cardinal Bernardin Cancer Center, Loyola University Medical Center, Maywood, USA
| | | | - M A Bilen
- Winship Cancer Institute of Emory University, Atlanta, USA
| | - P Bindal
- Beth Israel Deaconess Medical Center, Boston, USA
| | - R Bishnoi
- University of Florida, Gainesville, USA
| | - N Bouganim
- McGill University Health Centre, Montréal, Canada
| | - D W Bowles
- University of Colorado School of Medicine, Aurora, USA
| | - A Cabal
- University of California San Diego, Moores Cancer Center, La Jolla, USA
| | - P F Caimi
- University Hospitals Seidman Cancer Center, Cleveland, USA; Case Western Reserve University, Cleveland, USA
| | - D D Chism
- Thompson Cancer Survival Center, Knoxville, USA
| | - J Crowell
- St. Elizabeth Healthcare, Edgewood, USA
| | - C Curran
- Dana-Farber Cancer Institute, Boston, USA
| | - A Desai
- Mayo Clinic Cancer Center, Rochester, USA
| | - B Dixon
- St. Elizabeth Healthcare, Edgewood, USA
| | - D B Doroshow
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, USA
| | - E B Durbin
- Markey Cancer Center, University of Kentucky, Lexington, USA
| | - A Elkrief
- McGill University Health Centre, Montréal, Canada
| | - D Farmakiotis
- The Warren Alpert Medical School of Brown University, Providence, USA
| | - A Fazio
- Tufts Medical Center Cancer Center, Boston and Stoneham, USA
| | - L A Fecher
- University of Michigan Rogel Cancer Center, Ann Arbor, USA
| | - D B Flora
- St. Elizabeth Healthcare, Edgewood, USA
| | - C R Friese
- University of Michigan Rogel Cancer Center, Ann Arbor, USA
| | - J Fu
- Tufts Medical Center Cancer Center, Boston and Stoneham, USA
| | - S M Gadgeel
- Henry Ford Cancer Institute/Henry Ford Health System, Detroit, USA
| | - M D Galsky
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, USA
| | - D M Gill
- Intermountain Healthcare, Salt Lake City, USA
| | | | - S Goyal
- George Washington University, Washington DC, USA
| | - P Grover
- University of Cincinnati Cancer Center, Cincinnati, USA
| | - S Gulati
- University of Cincinnati Cancer Center, Cincinnati, USA
| | - S Gupta
- Cleveland Clinic Taussig Cancer Institute, Cleveland, USA
| | | | | | - B Halmos
- Albert Einstein Cancer Center/Montefiore Medical Center, Bronx, USA
| | - D J Hausrath
- Vanderbilt University School of Medicine, Nashville, USA
| | - J E Hawley
- Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, USA
| | - E Hsu
- Hartford HealthCare, Hartford, USA; University of Connecticut, Farmington, USA
| | - M Huynh-Le
- George Washington University, Washington DC, USA
| | - C Hwang
- Henry Ford Cancer Institute/Henry Ford Health System, Detroit, USA
| | - C Jani
- Mount Auburn Hospital, Cambridge, USA
| | | | - D B Johnson
- Vanderbilt University Medical Center, Nashville, USA
| | - A Kasi
- University of Kansas Medical Center, Kansas City, USA
| | - H Khan
- The Warren Alpert Medical School of Brown University, Providence, USA
| | - V S Koshkin
- University of California, San Francisco, San Francisco, USA
| | - N M Kuderer
- Advanced Cancer Research Group, LLC, Kirkland, USA
| | - D H Kwon
- University of California, San Francisco, San Francisco, USA
| | | | - A Li
- Baylor College of Medicine, Houston, USA
| | | | - C A Low
- Intermountain Healthcare, Salt Lake City, USA
| | | | - G H Lyman
- University of Washington/Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance, Seattle, USA
| | - R R McKay
- University of California San Diego, Moores Cancer Center, La Jolla, USA
| | - C McNair
- Sidney Kimmel Cancer Center at Thomas Jefferson University, Philadelphia, USA
| | - H Menon
- Penn State Health/Penn State Cancer Institute/St. Joseph Cancer Center, Hershey, USA
| | - R A Mesa
- Mays Cancer Center at UT Health San Antonio MD Anderson, San Antonio, USA
| | - V Mico
- Sidney Kimmel Cancer Center at Thomas Jefferson University, Philadelphia, USA
| | - D Mundt
- Advocate Aurora Health, Milwaukee, USA
| | - G Nagaraj
- Loma Linda University Cancer Center, Loma Linda, USA
| | - E S Nakasone
- University of Washington/Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance, Seattle, USA
| | - J Nakayama
- Case Western Reserve University, Cleveland, USA; University Hospitals Cleveland Medical Center, Cleveland, USA
| | - A Nizam
- Cleveland Clinic Taussig Cancer Institute, Cleveland, USA
| | - N L Nock
- University Hospitals Seidman Cancer Center, Cleveland, USA; Case Western Reserve University, Cleveland, USA
| | - C Park
- University of Cincinnati Cancer Center, Cincinnati, USA
| | - J M Patel
- Beth Israel Deaconess Medical Center, Boston, USA
| | - K G Patel
- University of California Davis Comprehensive Cancer Center, Sacramento, USA
| | - P Peddi
- Willis-Knighton Cancer Center, Shreveport, USA
| | - N A Pennell
- Cleveland Clinic Taussig Cancer Institute, Cleveland, USA
| | | | - M Puc
- Virtua Health, Marlton, USA
| | | | - M E Reeves
- Loma Linda University Cancer Center, Loma Linda, USA
| | - D Y Reuben
- Medical University of South Carolina, Charleston, USA
| | | | - R P Rosovsky
- Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | | | - M Salazar
- Mays Cancer Center at UT Health San Antonio MD Anderson, San Antonio, USA
| | | | - G K Schwartz
- Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, USA
| | - M R Shah
- Rutgers Cancer Institute of New Jersey, New Brunswick, USA
| | - S A Shah
- Stanford University, Stanford, USA
| | - C Shah
- University of Florida, Gainesville, USA
| | - J A Shaya
- University of California San Diego, Moores Cancer Center, La Jolla, USA
| | - S R K Singh
- Henry Ford Cancer Institute/Henry Ford Health System, Detroit, USA
| | - M Smits
- ThedaCare Regional Cancer Center, Appleton, USA
| | | | - D G Stover
- The Ohio State University, Columbus, USA
| | | | - S Subbiah
- Stanley S. Scott Cancer Center, LSU Health Sciences Center, New Orleans, USA
| | - L Tachiki
- University of Washington/Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance, Seattle, USA
| | - E Tadesse
- Advocate Aurora Health, Milwaukee, USA
| | - A Thakkar
- Albert Einstein Cancer Center/Montefiore Medical Center, Bronx, USA
| | - M D Tucker
- Vanderbilt University Medical Center, Nashville, USA
| | - A K Verma
- Albert Einstein Cancer Center/Montefiore Medical Center, Bronx, USA
| | - D C Vinh
- McGill University Health Centre, Montréal, Canada
| | - M Weiss
- ThedaCare Regional Cancer Center, Appleton, USA
| | - J T Wu
- Stanford University, Stanford, USA
| | | | - Z Xie
- Mayo Clinic Cancer Center, Rochester, USA
| | - P P Yu
- Hartford HealthCare, Hartford, USA
| | - T Zhang
- Duke University, Durham, USA
| | - A Y Zhou
- Siteman Cancer Center, Washington University School of Medicine, St. Louis, USA
| | - H Zhu
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, USA
| | - L Zubiri
- Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | - D P Shah
- Mays Cancer Center at UT Health San Antonio MD Anderson, San Antonio, USA
| | - J L Warner
- Vanderbilt University Medical Center, Nashville, USA
| | - GdL Lopes
- University of Miami/Sylvester Comprehensive Cancer Center, Miami, USA
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Xue E, Xie H, Leisenring WM, Kimball LE, Goyal S, Chung L, Blazevic R, Maltez B, Edwards A, Dahlberg AE, Salit RB, Delaney C, Pergam SA, Boeckh M, Milano F, Hill JA. High Incidence of Herpes Zoster After Cord Blood Hematopoietic Cell Transplant Despite Longer Duration of Antiviral Prophylaxis. Clin Infect Dis 2021; 72:1350-1357. [PMID: 32150265 DOI: 10.1093/cid/ciaa222] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 10/03/2019] [Accepted: 03/03/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Cord blood transplant (CBT) recipients have a high incidence of herpes zoster (HZ) in the context of short-term peritransplant antiviral prophylaxis. In 2009, international guidelines recommended HZ prophylaxis for at least 1 year after hematopoietic cell transplant. The impact of longer-term antiviral prophylaxis on HZ incidence after CBT is unknown. METHODS We retrospectively analyzed varicella zoster virus (VZV)-seropositive CBT recipients who were transplanted between 2006 and 2016. We abstracted HZ events and other variables for up to 5 years post-CBT. We calculated the cumulative incidence of HZ and used Cox proportional hazards regression to identify variables associated with HZ. RESULTS The study cohort consisted of 227 patients. Among 1-year survivors, 91% were still receiving prophylaxis, for a median duration of 20.6 months. HZ occurred in 44 patients (19%) at a median of 23.6 months. The cumulative incidence of HZ by 1 year after CBT was 1.8% (95% confidence interval [CI], .1%-4%), but increased to 26% (95% CI, 19%-33%) by 5 years. In a multivariable analysis, acute graft-vs-host disease was associated with increased risk, whereas antiviral prophylaxis was associated with reduced risk for HZ (adjusted hazard ratio, 0.19 [95% CI, .09-.4]). There was no association between CD4+ T-cell counts at 1 year post-CBT and subsequent risk for HZ. CONCLUSIONS We found a high incidence of HZ after CBT despite antiviral prophylaxis for > 1 year. Based on these findings, we suggest longer duration of prophylaxis for HZ after CBT. Compliance with antiviral prophylaxis, VZV-specific immune monitoring, and vaccination to mitigate HZ after CBT also require further study.
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Affiliation(s)
- Elisabetta Xue
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA.,Hematology and Bone Marrow Transplant Unit, San Raffaele Scientific Institute, Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy
| | - Hu Xie
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Wendy M Leisenring
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Louise E Kimball
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Sonia Goyal
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Lisa Chung
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Rachel Blazevic
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Byron Maltez
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Anna Edwards
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Ann E Dahlberg
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Rachel B Salit
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Colleen Delaney
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA.,Nohla Therapeutics, Seattle, Washington, USA
| | - Steven A Pergam
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA.,Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Michael Boeckh
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA.,Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Filippo Milano
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Joshua A Hill
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA.,Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
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35
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Goyal S, Negrelli J, Lyons J, Liebo M. Association of Infection Rate in Heart Transplant Recipients with Combined Tacrolimus and Sirolimus at High versus Low Concentration. J Heart Lung Transplant 2021. [DOI: 10.1016/j.healun.2021.01.420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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36
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Affiliation(s)
- A Kumar
- Department of Ophthalmology, Army College of Medical Sciences and Base Hospital, Delhi Cantt 110010, India
| | - S K Mishra
- Department of Ophthalmology, Army College of Medical Sciences and Base Hospital, Delhi Cantt 110010, India
| | - S Goyal
- Department of Ophthalmology, Army College of Medical Sciences and Base Hospital, Delhi Cantt 110010, India
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37
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Kumar N, Madan R, Gupta K, Chatterjee D, Uppal DK, Goyal S, Ballari N, Khosla D, Sahoo SK, Ahuja CK. Embryonal tumors with multilayered rosettes: A tertiary care centre experience. Clin Neurol Neurosurg 2021; 202:106508. [PMID: 33556852 DOI: 10.1016/j.clineuro.2021.106508] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 01/15/2021] [Accepted: 01/16/2021] [Indexed: 11/15/2022]
Abstract
BACKGROUND Embryonal tumors with multilayered rosettes (ETMR) is an extremely rare and highly aggressive tumor. It includes three distinct entities i.e, embryonal tumor with abundant neuropil and true rosettes (ETANTR), ependymoblastoma (EBL) and medulloepithelioma (MEPL). Here, we present our institutional experience of seven ETMR cases treated over a period of five years. MATERIALS AND METHODS Patients' records from 2015 to 2019 were reviewed manually and electronically to retrieve the data. Clinicopathological and outcome details of ETMR cases were entered in a predesigned proforma. RESULTS A total of seven cases of ETMR were registered from 2015 to 2019 with a median age at presentation of four years (range 3-7 years). All patients underwent surgery. However, only three patients completed the planned adjuvant treatment, comprising of focal radiotherapy (RT) alone, craniospinal irradiation (CSI) alone and CSI followed by six cycles of chemotherapy in one patient each respectively. Two patients commenced CSI but deteriorated during RT and thereafter needed best supportive care. Two patients could not be started on any adjuvant treatment. Unfortunately, six patients succumbed to their disease within one year of their diagnosis. Only one patient who received both CSI and adjuvant chemotherapy is alive at 15 months of diagnosis. CONCLUSION ETMR is a rare and aggressive entity. Majority of the patients die within one year of the diagnosis despite multimodality treatment.
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MESH Headings
- Brain Neoplasms/diagnostic imaging
- Brain Neoplasms/mortality
- Brain Neoplasms/pathology
- Brain Neoplasms/therapy
- Chemoradiotherapy, Adjuvant
- Child
- Child, Preschool
- Female
- Humans
- Male
- Neoplasms, Germ Cell and Embryonal/diagnostic imaging
- Neoplasms, Germ Cell and Embryonal/mortality
- Neoplasms, Germ Cell and Embryonal/pathology
- Neoplasms, Germ Cell and Embryonal/therapy
- Neuroectodermal Tumors, Primitive/diagnostic imaging
- Neuroectodermal Tumors, Primitive/mortality
- Neuroectodermal Tumors, Primitive/pathology
- Neuroectodermal Tumors, Primitive/therapy
- Neurosurgical Procedures
- Radiotherapy, Adjuvant
- Tertiary Care Centers
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Affiliation(s)
- N Kumar
- Department of Radiotherapy and Oncology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - R Madan
- Department of Radiotherapy and Oncology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
| | - K Gupta
- Department of Histopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - D Chatterjee
- Department of Histopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - D K Uppal
- Department of Radiotherapy and Oncology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - S Goyal
- Department of Radiotherapy and Oncology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - N Ballari
- Department of Radiotherapy and Oncology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - D Khosla
- Department of Radiotherapy and Oncology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - S K Sahoo
- Department of Neurosurgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - C K Ahuja
- Department of Radiodiagnosis, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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38
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Bhati AP, Goyal S, Yadav R, N S. Pattern formation in Passiflora incarnata: An activator-inhibitor model. J Biosci 2021; 46:84. [PMID: 34423786] [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: 06/13/2023]
Abstract
Based on a careful examination of the onset of violet colored dots along the filaments in the developing floral bud stage and the formation of alternating bands of violet and white color in the matured flowers of Passiflora incarnata (Passion flower), it is concluded that the pattern arises from a competition between the production of violet colored anthocyanin and the colorless flavonols along the filaments. The activator-inhibitor model of Gierer and Meinhardt along with the reaction diffusion theory of Turing is used to explain the formation of concentric rings in the flower.
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Affiliation(s)
- Agastya P Bhati
- Department of Chemistry, Centre for Computational Science, University College London, London, UK
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39
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Yehia ZA, Poppe M, Baker C, Toppmeyer D, Goyal S, Kirstein L, Khan A, Haffty B. Reconstruction Outcomes in a Multi-Institution Prospective Phase II Hypofractionated Post-Mastectomy Radiation Therapy Trial. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.2087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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40
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Provenzano D, Rao K, Cifter G, Sarfaraz M, Aghdam H, Ojong-Ntui M, Loew M, Goyal S, Rao Y. Adverse Events of After-loading High Dose Rate Brachytherapy Reported to the United States Food and Drug Administration (FDA). Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.1445] [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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41
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Koyyala V, Jajodia A, Beer L, Doval D, Talwar V, Goel V, Batra U, Goyal S, Gupta A, Chaturvedi A, Prosch H, Joga S, Domadia K, Medisetty P, Amrith B, La Mantia M, Pasricha S, Russo A, Mehta A. 215P Analysis of spatial heterogeneity of responses in metastatic sites with nivolumab in renal cell carcinoma. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.10.226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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42
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Khosla D, Kapoor R, Rana S, Tomar P, Periasamy K, Madan R, Goyal S, Kumar N. Dosimetric Comparison of Three-Dimensional Conformal Radiotherapy (3DCRT) and Volumetric Modulated Arc Therapy (VMAT) Plans for Hypofractionated Whole Breast and Regional Nodes Irradiation in Breast Cancer Patients Following Breast Conservative Surgery. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.767] [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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43
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Oaks Z, Goyal S, Liu Y, Reeder Hayes K, Gupta G, Patel S, Royce T. Sentinel Lymph Node Biopsy (SLNB) Versus Axillary Lymph Node Dissection in US Women with Breast Cancer and Persistently Positive Lymph Nodes Following Neoadjuvant Chemotherapy. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.1043] [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: 11/24/2022]
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44
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Schlafstein A, Liu Y, Goyal S, Kahn S, Godette K, Lin J, Torres M, Royce T, Patel S. Regional Nodal Irradiation in Initial Node Positive Breast Cancer Patients Who Become Pathologically Node Negative Following Neoadjuvant Chemotherapy and Sentinel Lymph Node Biopsy Alone Without Full Axillary Dissection. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.1075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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45
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Messing I, Goyal S, Sherman J, Thakkar P, Siegel R, Joshi A, Goodman J, Ojong-Ntui M, Rao Y. Incidence And Prognosis Of Brain Metastases In Head And Neck Cancer Patients At Diagnosis: A Population Based Study. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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46
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Forner S, Vasiliadou I, Little J, Fenton M, Goyal S, Burcombe R, Brulinski P, Sevitt T. PO-0882: Single centre review of the survival benefit and toxicity of PCI in Small Cell Lung Cancer. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)00899-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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47
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BettolI P, Liu Z, Jara N, Fong C, Wong W, Terlizzi M, Sargos P, Zillie T, Thariat J, Ploussard G, Goyal S, Chung P, Berlin A, Sole C. PO-1219: Primary Bladder Sarcoma: a multiinstitutional experience from the Rare Cancer Network. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)01237-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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48
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Agrawal C, Doval D, Agarwal A, Goyal P, Baghmar S, Talwar V, Batra U, Goyal S, Sinha R, Archana S, Jain P. Real world evidence of palbociclib use in metastatic hormone positive HER negative metastatic breast cancer in Indian population. Eur J Cancer 2020. [DOI: 10.1016/s0959-8049(20)30812-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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49
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Gaba F, Blyuss O, Chandrasekaran D, Osman M, Goyal S, Gan C, Izatt L, Tripathi V, Esteban I, McNicol L, Ragupathy K, Crawford R, Evans DG, Legood R, Menon U, Manchanda R. Attitudes towards risk-reducing early salpingectomy with delayed oophorectomy for ovarian cancer prevention: a cohort study. BJOG 2020; 128:714-726. [PMID: 32803845 DOI: 10.1111/1471-0528.16424] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/13/2020] [Indexed: 01/16/2023]
Abstract
OBJECTIVE To determine risk-reducing early salpingectomy and delayed oophorectomy (RRESDO) acceptability and effect of surgical prevention on menopausal sequelae/satisfaction/regret in women at increased ovarian cancer (OC) risk. DESIGN Multicentre, cohort, questionnaire study (IRSCTN:12310993). SETTING United Kingdom (UK). POPULATION UK women without OC ≥18 years, at increased OC risk, with/without previous RRSO, ascertained through specialist familial cancer/genetic clinics and BRCA support groups. METHODS Participants completed a 39-item questionnaire. Baseline characteristics were described using descriptive statistics. Logistic/linear regression models analysed the impact of variables on RRESDO acceptability and health outcomes. MAIN OUTCOMES RRESDO acceptability, menopausal sequelae, satisfaction/regret. RESULTS In all, 346 of 683 participants underwent risk-reducing salpingo-oophorectomy (RRSO). Of premenopausal women who had not undergone RRSO, 69.1% (181/262) found it acceptable to participate in a research study offering RRESDO. Premenopausal women concerned about sexual dysfunction were more likely to find RRESDO acceptable (odds ratio [OR] = 2.9, 95% CI 1.2-7.7, P = 0.025). Women experiencing sexual dysfunction after premenopausal RRSO were more likely to find RRESDO acceptable in retrospect (OR = 5.3, 95% CI 1.2-27.5, P < 0.031). In all, 88.8% (143/161) premenopausal and 95.2% (80/84) postmenopausal women who underwent RRSO, respectively, were satisfied with their decision, whereas 9.4% (15/160) premenopausal and 1.2% (1/81) postmenopausal women who underwent RRSO regretted their decision. HRT uptake in premenopausal individuals without breast cancer (BC) was 74.1% (80/108). HRT use did not significantly affect satisfaction/regret levels but did reduce symptoms of vaginal dryness (OR = 0.4, 95% CI 0.2-0.9, P = 0.025). CONCLUSION Data show high RRESDO acceptability, particularly in women concerned about sexual dysfunction. Although RRSO satisfaction remains high, regret rates are much higher for premenopausal women than for postmenopausal women. HRT use following premenopausal RRSO does not increase satisfaction but does reduce vaginal dryness. TWEETABLE ABSTRACT RRESDO has high acceptability among premenopausal women at increased ovarian cancer risk, particularly those concerned about sexual dysfunction.
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Affiliation(s)
- F Gaba
- Wolfson Institute of Preventive Medicine, Cancer Research UK, Barts Centre, Queen Mary University of London, Charterhouse Square, London, UK.,Department of Gynaecological Oncology, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
| | - O Blyuss
- School of Physics, Astronomy and Mathematics, University of Hertfordshire, Hatfield, UK.,Department of Paediatrics and Paediatric Infectious Diseases, Sechenov First Moscow State Medical University, Moscow, Russia.,Department of Applied Mathematics, Lobachevsky State University of Nizhny Novgorod, Nizhny Novgorod, Russia
| | - D Chandrasekaran
- Wolfson Institute of Preventive Medicine, Cancer Research UK, Barts Centre, Queen Mary University of London, Charterhouse Square, London, UK.,Department of Gynaecological Oncology, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
| | - M Osman
- Wolfson Institute of Preventive Medicine, Cancer Research UK, Barts Centre, Queen Mary University of London, Charterhouse Square, London, UK
| | - S Goyal
- Wolfson Institute of Preventive Medicine, Cancer Research UK, Barts Centre, Queen Mary University of London, Charterhouse Square, London, UK
| | - C Gan
- Department of Gynaecological Oncology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - L Izatt
- Department of Clinical Genetics, Guy's Hospital, London, UK
| | - V Tripathi
- Department of Clinical Genetics, Guy's Hospital, London, UK
| | - I Esteban
- Ninewells Hospital, NHS Tayside, Dundee, UK
| | - L McNicol
- Ninewells Hospital, NHS Tayside, Dundee, UK
| | | | - R Crawford
- Department of Gynaecological Oncology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - D G Evans
- Manchester Centre for Genomic Medicine, MAHSC, Division of Evolution and Genomic Sciences, University of Manchester, Manchester, UK
| | - R Legood
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - U Menon
- MRC Clinical Trials Unit, University College London, London, UK
| | - R Manchanda
- Wolfson Institute of Preventive Medicine, Cancer Research UK, Barts Centre, Queen Mary University of London, Charterhouse Square, London, UK.,Department of Gynaecological Oncology, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK.,MRC Clinical Trials Unit, University College London, London, UK
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50
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Koyyala V, Jajodia A, Gupta A, BP A, Chaturvedhi A, Rao A, Mehta A, Gupta N, Pasricha S, Joga S, Medisetty P, Mantia ML, Goyal S, Singh S. P-309 Correlation between baseline CEA levels and TNM stage at presentation in colorectal cancers in an Indian population. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.04.391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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