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Rahman H, Vikram P, Hu Y, Asthana S, Tanaji A, Suryanarayanan P, Quadros C, Mehta L, Shahid M, Gkanogiannis A, Thushar S, Balazadeh S, Mueller-Roeber B, Becerra Lopez-Lavalle LA, Wei T, Singh RK. Mining genomic regions associated with agronomic and biochemical traits in quinoa through GWAS. Sci Rep 2024; 14:9205. [PMID: 38649738 PMCID: PMC11035704 DOI: 10.1038/s41598-024-59565-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 04/12/2024] [Indexed: 04/25/2024] Open
Abstract
Quinoa (Chenopodium quinoa Willd.), an Andean crop, is a facultative halophyte food crop recognized globally for its high nutritional value and plasticity to adapt to harsh conditions. We conducted a genome-wide association study on a diverse set of quinoa germplasm accessions. These accessions were evaluated for the following agronomic and biochemical traits: days to 50% flowering (DTF), plant height (PH), panicle length (PL), stem diameter (SD), seed yield (SY), grain diameter (GD), and thousand-grain weight (TGW). These accessions underwent genotyping-by-sequencing using the DNBSeq-G400R platform. Among all evaluated traits, TGW represented maximum broad-sense heritability. Our study revealed average SNP density of ≈ 3.11 SNPs/10 kb for the whole genome, with the lowest and highest on chromosomes Cq1B and Cq9A, respectively. Principal component analysis clustered the quinoa population in three main clusters, one clearly representing lowland Chilean accessions, whereas the other two groups corresponded to germplasm from the highlands of Peru and Bolivia. In our germplasm set, we estimated linkage disequilibrium decay to be ≈ 118.5 kb. Marker-trait analyses revealed major and consistent effect associations for DTF on chromosomes 3A, 4B, 5B, 6A, 7A, 7B and 8B, with phenotypic variance explained (PVE) as high as 19.15%. Nine associations across eight chromosomes were also found for saponin content with 20% PVE by qSPN5A.1. More QTLs were identified for PL and TGW on multiple chromosomal locations. We identified putative candidate genes in the genomic regions associated with DTF and saponin content. The consistent and major-effect genomic associations can be used in fast-tracking quinoa breeding for wider adaptation across marginal environments.
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Affiliation(s)
- Hifzur Rahman
- International Center for Biosaline Agriculture, Dubai, UAE.
| | - Prashant Vikram
- International Center for Biosaline Agriculture, Dubai, UAE
- SGT University, Gurugram, Haryana, India
| | - Yulan Hu
- BGI-Research, 518083, Shenzhen, China
- BGI Research, 430074, Wuhan, China
| | | | - Abhinav Tanaji
- Birla Institute of Technology and Science Pilani, Dubai Campus, Dubai, UAE
| | | | - Chris Quadros
- Birla Institute of Technology and Science Pilani, Dubai Campus, Dubai, UAE
| | - Lovely Mehta
- International Center for Biosaline Agriculture, Dubai, UAE
| | | | | | | | - Salma Balazadeh
- Institute of Biology Leiden, Sylvius Laboratory, Leiden University, Sylviusweg 72, 2333 BE, Leiden, The Netherlands
| | - Bernd Mueller-Roeber
- Department of Molecular Biology, University of Potsdam, Karl-Liebknecht-Straße 24-25, Haus 20, 14476, Potsdam, Germany
| | | | - Tong Wei
- International Center for Biosaline Agriculture, Dubai, UAE.
- BGI-Research, 518083, Shenzhen, China.
- BGI Research, 430074, Wuhan, China.
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Rowley PA, Paukner MJ, Eisenmenger LB, Field AS, Davidson RJ, Johnson SC, Asthana S, Chin NA, Prabhakaran V, Bendlin BB, Postle BR, Goldsmith HH, Carlsson CM, Brooks MA, Kalin NH, Williams LE, Rowley HA. Incidental Findings from 16,400 Brain MRI Examinations of Research Volunteers. AJNR Am J Neuroradiol 2023; 44:417-423. [PMID: 36927761 PMCID: PMC10084899 DOI: 10.3174/ajnr.a7821] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 02/20/2023] [Indexed: 03/18/2023]
Abstract
BACKGROUND AND PURPOSE Incidental findings are discovered in neuroimaging research, ranging from trivial to life-threatening. We describe the prevalence and characteristics of incidental findings from 16,400 research brain MRIs, comparing spontaneous detection by nonradiology scanning staff versus formal neuroradiologist interpretation. MATERIALS AND METHODS We prospectively collected 16,400 brain MRIs (7782 males, 8618 females; younger than 1 to 94 years of age; median age, 38 years) under an institutional review board directive intended to identify clinically relevant incidental findings. The study population included 13,150 presumed healthy volunteers and 3250 individuals with known neurologic diagnoses. Scanning staff were asked to flag concerning imaging findings seen during the scan session, and neuroradiologists produced structured reports after reviewing every scan. RESULTS Neuroradiologists reported 13,593/16,400 (83%) scans as having normal findings, 2193/16,400 (13.3%) with abnormal findings without follow-up recommended, and 614/16,400 (3.7%) with "abnormal findings with follow-up recommended." The most common abnormalities prompting follow-up were vascular (263/614, 43%), neoplastic (130/614, 21%), and congenital (92/614, 15%). Volunteers older than 65 years of age were significantly more likely to have scans with abnormal findings (P < .001); however, among all volunteers with incidental findings, those younger than 65 years of age were more likely to be recommended for follow-up. Nonradiologists flagged <1% of MRIs containing at least 1 abnormality reported by the neuroradiologists to be concerning enough to warrant further evaluation. CONCLUSIONS Four percent of individuals who undergo research brain MRIs have an incidental, potentially clinically significant finding. Routine neuroradiologist review of all scans yields a much higher rate of significant lesion detection than selective referral from nonradiologists who perform the examinations. Workflow and scan review processes need to be carefully considered when designing research protocols.
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Affiliation(s)
- P A Rowley
- From the University of Wisconsin School of Medicine and Public Health (P.A.R., L.B.E., A.S.F., R.J.D., S.C.J., S.A., V.P., B.B.B., B.R.P., H.H.G., C.M.C., M.A.B., N.H.K., L.E.W., H.A.R.)
- Departments of Radiology (P.A.R., LB.E., A.S.F., V.P., H.A.R.)
| | | | - L B Eisenmenger
- From the University of Wisconsin School of Medicine and Public Health (P.A.R., L.B.E., A.S.F., R.J.D., S.C.J., S.A., V.P., B.B.B., B.R.P., H.H.G., C.M.C., M.A.B., N.H.K., L.E.W., H.A.R.)
- Departments of Radiology (P.A.R., LB.E., A.S.F., V.P., H.A.R.)
| | - A S Field
- From the University of Wisconsin School of Medicine and Public Health (P.A.R., L.B.E., A.S.F., R.J.D., S.C.J., S.A., V.P., B.B.B., B.R.P., H.H.G., C.M.C., M.A.B., N.H.K., L.E.W., H.A.R.)
- Departments of Radiology (P.A.R., LB.E., A.S.F., V.P., H.A.R.)
| | - R J Davidson
- From the University of Wisconsin School of Medicine and Public Health (P.A.R., L.B.E., A.S.F., R.J.D., S.C.J., S.A., V.P., B.B.B., B.R.P., H.H.G., C.M.C., M.A.B., N.H.K., L.E.W., H.A.R.)
- Psychology (R.J.D., B.R.P., H.H.G.)
| | - S C Johnson
- From the University of Wisconsin School of Medicine and Public Health (P.A.R., L.B.E., A.S.F., R.J.D., S.C.J., S.A., V.P., B.B.B., B.R.P., H.H.G., C.M.C., M.A.B., N.H.K., L.E.W., H.A.R.)
- Wisconsin Alzheimer's Disease Research Center (S.C.J., S.A., B.B.B., C.M.C.)
- Departments of Medicine (S.C.J., S.A., N.A.C., B.B.B., C.M.C.)
| | - S Asthana
- From the University of Wisconsin School of Medicine and Public Health (P.A.R., L.B.E., A.S.F., R.J.D., S.C.J., S.A., V.P., B.B.B., B.R.P., H.H.G., C.M.C., M.A.B., N.H.K., L.E.W., H.A.R.)
- Wisconsin Alzheimer's Disease Research Center (S.C.J., S.A., B.B.B., C.M.C.)
- Departments of Medicine (S.C.J., S.A., N.A.C., B.B.B., C.M.C.)
| | - N A Chin
- Departments of Medicine (S.C.J., S.A., N.A.C., B.B.B., C.M.C.)
| | - V Prabhakaran
- From the University of Wisconsin School of Medicine and Public Health (P.A.R., L.B.E., A.S.F., R.J.D., S.C.J., S.A., V.P., B.B.B., B.R.P., H.H.G., C.M.C., M.A.B., N.H.K., L.E.W., H.A.R.)
- Departments of Radiology (P.A.R., LB.E., A.S.F., V.P., H.A.R.)
| | - B B Bendlin
- From the University of Wisconsin School of Medicine and Public Health (P.A.R., L.B.E., A.S.F., R.J.D., S.C.J., S.A., V.P., B.B.B., B.R.P., H.H.G., C.M.C., M.A.B., N.H.K., L.E.W., H.A.R.)
- Wisconsin Alzheimer's Disease Research Center (S.C.J., S.A., B.B.B., C.M.C.)
- Departments of Medicine (S.C.J., S.A., N.A.C., B.B.B., C.M.C.)
| | - B R Postle
- From the University of Wisconsin School of Medicine and Public Health (P.A.R., L.B.E., A.S.F., R.J.D., S.C.J., S.A., V.P., B.B.B., B.R.P., H.H.G., C.M.C., M.A.B., N.H.K., L.E.W., H.A.R.)
- Psychology (R.J.D., B.R.P., H.H.G.)
| | - H H Goldsmith
- From the University of Wisconsin School of Medicine and Public Health (P.A.R., L.B.E., A.S.F., R.J.D., S.C.J., S.A., V.P., B.B.B., B.R.P., H.H.G., C.M.C., M.A.B., N.H.K., L.E.W., H.A.R.)
- Psychology (R.J.D., B.R.P., H.H.G.)
| | - C M Carlsson
- From the University of Wisconsin School of Medicine and Public Health (P.A.R., L.B.E., A.S.F., R.J.D., S.C.J., S.A., V.P., B.B.B., B.R.P., H.H.G., C.M.C., M.A.B., N.H.K., L.E.W., H.A.R.)
- Wisconsin Alzheimer's Disease Research Center (S.C.J., S.A., B.B.B., C.M.C.)
- Departments of Medicine (S.C.J., S.A., N.A.C., B.B.B., C.M.C.)
| | - M A Brooks
- From the University of Wisconsin School of Medicine and Public Health (P.A.R., L.B.E., A.S.F., R.J.D., S.C.J., S.A., V.P., B.B.B., B.R.P., H.H.G., C.M.C., M.A.B., N.H.K., L.E.W., H.A.R.)
- Orthopedics (M.A.B.)
| | - N H Kalin
- From the University of Wisconsin School of Medicine and Public Health (P.A.R., L.B.E., A.S.F., R.J.D., S.C.J., S.A., V.P., B.B.B., B.R.P., H.H.G., C.M.C., M.A.B., N.H.K., L.E.W., H.A.R.)
- Psychiatry (N.H.K., L.E.W.), University of Wisconsin-Madison, Madison, Wisconsin
| | - L E Williams
- From the University of Wisconsin School of Medicine and Public Health (P.A.R., L.B.E., A.S.F., R.J.D., S.C.J., S.A., V.P., B.B.B., B.R.P., H.H.G., C.M.C., M.A.B., N.H.K., L.E.W., H.A.R.)
- Psychiatry (N.H.K., L.E.W.), University of Wisconsin-Madison, Madison, Wisconsin
| | - H A Rowley
- From the University of Wisconsin School of Medicine and Public Health (P.A.R., L.B.E., A.S.F., R.J.D., S.C.J., S.A., V.P., B.B.B., B.R.P., H.H.G., C.M.C., M.A.B., N.H.K., L.E.W., H.A.R.)
- Departments of Radiology (P.A.R., LB.E., A.S.F., V.P., H.A.R.)
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Indrayan A, Vishwakarma G, Malhotra RK, Gupta P, Sachdev HPS, Karande S, Asthana S, Labani S. The development of QERM scoring system for comprehensive assessment of the Quality of Empirical Research in Medicine - Part 1. J Postgrad Med 2022; 68:221-230. [PMID: 36348606 PMCID: PMC9841535 DOI: 10.4103/jpgm.jpgm_460_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Purpose Whereas a large number of features are mentioned to connote the quality of medical research, no tool is available to comprehensively measure it objectively across different types of studies. Also, all the available tools are for reporting, and none includes quality of the inputs and the process of research. The present paper is aimed to initiate a discussion on the need to develop such a comprehensive scoring system (in the first place), to show that it is feasible, and to describe the process of developing a credible system. Method An expert group comprising researchers, reviewers, and editors of medical journals extensively reviewed the literature on the quality of medical research and held detailed discussions to parse quality at all stages of medical research into specific domains and items that can be assigned scores on the pattern of quality-of-life score. Results Besides identifying the domains of the quality of medical research, a comprehensive tool for scoring emerged that can be possibly used to objectively measure the quality of empirical research comprising surveys, trials, and observational studies. Thus, this can be used as a tool to assess Quality of Empirical Research in Medicine (QERM). The expert group confirmed its face and content validity. The tool can be used by the researchers for self-assessment and improvement before submission of a paper for publication, and the reviewers and editors can use this for assessing the submissions. Published papers can also be rated such as those included in a meta-analysis. Conclusion It is feasible to devise a comprehensive scoring system comprising domains and items for assessing the quality of medical research end-to-end from choosing a problem to publication. The proposed scoring system needs to be reviewed by the researchers and needs to be validated.
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Affiliation(s)
| | - A Indrayan
- Clinical Research, Max Healthcare, New Delhi, India,Address for correspondence: Dr. Indrayan A, E-mail:
| | - G Vishwakarma
- Biostatistics, Indian Spinal Injuries Centre, New Delhi, India
| | - RK Malhotra
- Surgical Oncology, Dr. B. R. Ambedkar Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - P Gupta
- Pediatrics, University College of Medical Sciences, Delhi, India
| | - HPS Sachdev
- Pediatrics and Clinical Epidemiology, Sitaram Bhartia Institute of Sciences and Research, New Delhi, India
| | - S Karande
- Pediatrics, Seth G. S. Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - S Asthana
- Epidemiology and Biostatistics, National Institute of Cancer Prevention and Research (Indian Council of Medical Research), Noida, Uttar Pradesh, India
| | - S Labani
- Epidemiology and Biostatistics, National Institute of Cancer Prevention and Research (Indian Council of Medical Research), Noida, Uttar Pradesh, India
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O'Hara J, Norton D, Koscik R, Lambrou N, Wyman M, Adrienne J, Bouges S, Zuelsdorff M, Flowers-Benton S, Jonaitis ECarlsson C, Johnson S, Asthana S, Gleason C. C-13 Sex Differences in Cognitive and Neurobiological Markers of Alzheimer's Disease. Arch Clin Neuropsychol 2019. [DOI: 10.1093/arclin/acz034.175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Objective
Previous work has demonstrated that intra-individual cognitive variability (IICV) has predictive power similar to traditional Alzheimer’s disease (AD) biomarkers, such as CSF or hippocampal volume (HV) loss. Genetic factors, such as sex, have been identified as predictors of cognitive decline. Analysis of sex differences in IICV and other biomarkers may elucidate additional dimensions of this metric.
Method
Baseline neurocognitive test and neuroimaging data from 335 participants with ≥2 visits enrolled in the Wisconsin Alzheimer’s Disease Research Center Clinical Core were included. Z-scores were calculated comparing individual performance to group performance by test (Rey Auditory Verbal Learning Test (Learning and Delayed Recall), Trail Making Test (A and B), and either Boston Naming Test (BNT) or Multilingual Naming Test (MINT)). MINT scores were converted to BNT scores using the NACC Crosswalk Study. The standard deviation of z-scores across tests was calculated to determine IICV. Characteristics by sex were compared using Mann-Whitney and Fisher’s Exact tests. Spearman’s Rho was calculated to compare IICV and HV (relative to intercranial volume).
Results
At baseline (Table 1): (1) Males had more education than females; (2) females had both higher relative HV and IICV; and (3) in females, relative HV demonstrated a weak positive correlation with baseline IICV (Figure 1).
Conclusions
IICV has previously demonstrated potential as a cost-effective non-invasive marker of preclinical AD. In females, larger relative HV and its correlation with IICV may be due to differences in metabolic brain age or concurrent progression of HV and IICV through the AD process. Analyses of other biopsychosocial factors are needed.
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O'Hara J, Norton D, Koscik R, Lambrou N, Wyman M, Johnson A, Bouges S, Zuelsdorff M, Flowers-Benton S, Jonaitis ECarlsson C, Johnson S, Asthana S, Gleason C. C-12 Race and Sex Differences in Cognitive and Neurobiological Markers of Alzheimer's Disease. Arch Clin Neuropsychol 2019. [DOI: 10.1093/arclin/acz034.174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Objective
Intra-Individual Cognitive Variability (IICV) previously demonstrated predictive power similar to AD biomarkers (i.e., CSF and hippocampal volume (HV) loss). Previous work suggested sex differences in relative HV and IICV. Additionally, IICV differs in whites and underrepresented racial groups (URG). Our objective was to analyze these sex differences in white and URG participants.
Method
Baseline neurocognitive test and neuroimaging data from 335 cognitively healthy participants with ≥2 visits enrolled in the Wisconsin ADRC Clinical Core were included. Z-scores were calculated comparing individual performance to group performance by test (Rey Auditory Verbal Learning Test (Learning and Delayed Recall), Trail Making Test (A and B), and either Boston Naming Test (BNT) or Multilingual Naming Test (MINT)). MINT scores were converted to BNT scores using the NACC Crosswalk Study. The standard deviation of z-scores across tests was calculated to determine IICV. Characteristics by race and sex were compared using Mann-Whitney, Fisher’s Exact, and Kruskal-Wallis tests. Spearman’s Rho was calculated to compare baseline IICV and relative HV.
Results
At baseline (Table 1), differences across racial groups in age, years of education, relative HV, and IICV were identified. Sex and racial group differences were identified (Table 2). A weak positive correlation between HV and IICV was seen in white females (Figure 1).
Conclusions
IICV has potential to become a cost-effective, non-invasive marker of preclinical AD. Again, correlation between HV and IICV was seen, but only in white females. Analyses suggest group differences between white and URG males and females. However, more data is needed to further explore these differences.
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Sprecher K, Derynda B, Riedner B, Zetterberg H, Blennow K, Carlsson C, Okonkwo O, Asthana S, Johnson S, Benca R, Bendlin B. 0282 WHITE MATTER DAMAGE AND AXONAL DEGENERATION ARE RELATED TO HYPOXIA IN UNTREATED OBSTRUCTIVE SLEEP APNEA. Sleep 2017. [DOI: 10.1093/sleepj/zsx050.281] [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: 11/12/2022] Open
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Dasari BV, Asthana S, Ahmad N. How to Avoid Injury to the Renal Artery due to Inclusion of Superior Mesenteric Artery Patch during Organ Procurement. Int J Organ Transplant Med 2017; 8:171-172. [PMID: 28924467 PMCID: PMC5592106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
| | | | - N. Ahmad
- Correspondence: Niaz Ahmad MD, FRCS, Consultant Surgeon, Division of Surgery, Department of Transplantation, St James’s University Hospital, Beckett Street, Leeds LS9 7TF, United Kingdom, Tel: +44-113-206-5175, Fax: +44-113-244-8182, E-mail:
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Raz L, Hunter LV, Dowling NM, Wharton W, Gleason CE, Jayachandran M, Anderson L, Asthana S, Miller VM. Differential effects of hormone therapy on serotonin, vascular function and mood in the KEEPS. Climacteric 2015; 19:49-59. [PMID: 26652904 DOI: 10.3109/13697137.2015.1116504] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND Serotonin (5-hydroxytryptamine, 5-HT) is modulated by sex steroid hormones and affects vascular function and mood. In the Kronos Early Estrogen Prevention Cognitive and Affective Ancillary Study (KEEPS-Cog), women randomized to oral conjugated equine estrogens (oCEE) showed greater benefit on affective mood states than women randomized to transdermal 17β-estradiol (tE2) or placebo (PL). This study examined the effect of these treatments on the platelet content of 5-HT as a surrogate measure of 5-HT synthesis and uptake in the brain. METHODS The following were measured in a subset (n = 79) of women enrolled in KEEPS-Cog: 5-HT by ELISA, carotid intima-medial thickness (CIMT) by ultrasound, endothelial function by reactive hyperemic index (RHI), and self-reported symptoms of affective mood states by the Profile of Mood States (POMS) questionnaire. RESULTS Mean platelet content of 5-HT increased by 107.0%, 84.5% and 39.8%, in tE2, oCEE and PL groups, respectively. Platelet 5-HT positively correlated with estrone in the oCEE group and with 17β- estradiol in the tE2 group. Platelet 5-HT showed a positive association with RHI, but not CIMT, in the PL and oCEE groups. Reduction in mood scores for depression-dejection and anger-hostility was associated with elevations in platelet 5-HT only in the oCEE group (r = -0.5, p = 0.02). CONCLUSIONS Effects of oCEE compared to tE2 on RHI and mood may be related to mechanisms involving platelet, and perhaps neuronal, uptake and release of 5-HT and reflect conversion of estrone to bioavailable 17β-estradiol in platelets and the brain.
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Affiliation(s)
- L Raz
- a Department of Physiology and Biomedical Engineering , Mayo Clinic , Rochester , Minnesota , USA
| | - L V Hunter
- a Department of Physiology and Biomedical Engineering , Mayo Clinic , Rochester , Minnesota , USA
| | - N M Dowling
- b Department of Biostatistics and Medical Informatics , University of Wisconsin , Madison , WI , USA ;,c Department of Medicine , University of Wisconsin and Geriatric Research, Education and Clinical Center, Madison VA Hospital , Madison , WI , USA
| | - W Wharton
- d Department of Neurology , Emory University , Atlanta , GA , USA
| | - C E Gleason
- c Department of Medicine , University of Wisconsin and Geriatric Research, Education and Clinical Center, Madison VA Hospital , Madison , WI , USA
| | - M Jayachandran
- a Department of Physiology and Biomedical Engineering , Mayo Clinic , Rochester , Minnesota , USA
| | - L Anderson
- a Department of Physiology and Biomedical Engineering , Mayo Clinic , Rochester , Minnesota , USA
| | - S Asthana
- c Department of Medicine , University of Wisconsin and Geriatric Research, Education and Clinical Center, Madison VA Hospital , Madison , WI , USA
| | - V M Miller
- a Department of Physiology and Biomedical Engineering , Mayo Clinic , Rochester , Minnesota , USA ;,e Department of Surgery , Mayo Clinic , Rochester , Minnesota , USA
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Huang G, Wharton W, Travison TG, Ho MH, Gleason C, Asthana S, Bhasin S, Basaria S. Effects of testosterone administration on cognitive function in hysterectomized women with low testosterone levels: a dose-response randomized trial. J Endocrinol Invest 2015; 38:455-61. [PMID: 25430996 PMCID: PMC4716804 DOI: 10.1007/s40618-014-0213-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Accepted: 11/12/2014] [Indexed: 12/27/2022]
Abstract
PURPOSE To determine the dose-dependent effects of testosterone administration on cognition in women with low testosterone levels. METHODS 71 hysterectomized women with or without oophorectomy with total testosterone <31 ng/dl and/or free testosterone <3.5 pg/ml received a standardized transdermal estradiol regimen during the 12-week run-in period and were then randomized to receive weekly intramuscular injections of placebo, 3, 6.25, 12.5, or 25 mg testosterone enanthate for 24 weeks. Total testosterone was measured in serum by LC-MS/MS, and free testosterone levels were measured by equilibrium dialysis. Cognitive function was evaluated using a comprehensive battery of standardized neuropsychological tests at baseline and 24 weeks. RESULTS 46 women who had baseline and end-of-treatment cognitive function data constituted the analytic sample. The five groups were similar at baseline. Mean on-treatment nadir total testosterone concentrations were 15, 89, 98, 134, and 234 ng/dl in the placebo, 3, 6.25, 12.5, and 25 mg groups, respectively. No significant changes in spatial ability, verbal fluency, verbal memory, or executive function were observed in any treatment arm compared to placebo even after adjustment for baseline cognitive function, age, and education. Multiple regression analysis did not show any significant relation between changes in testosterone concentrations and change in cognitive function scores. CONCLUSION Short-term testosterone administration over a wide range of doses for 24 weeks in women with low testosterone levels was neither associated with improvements nor worsening of cognitive function.
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Affiliation(s)
- G Huang
- Section of Men's Health: Aging and Metabolism, Harvard Medical School, Brigham and Women's Hospital, BLI-5, 221 Longwood Avenue, Boston, MA, 02115, USA.
| | - W Wharton
- Department of Neurology, Emory University, WWHC 1841 Clifton Rd., NE, Atlanta, GA, 30329, USA
| | - T G Travison
- Section of Men's Health: Aging and Metabolism, Harvard Medical School, Brigham and Women's Hospital, BLI-5, 221 Longwood Avenue, Boston, MA, 02115, USA
| | - M H Ho
- Division of Endocrinology, Metabolism and Molecular Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, CA, 90059, USA
| | - C Gleason
- School of Medicine and Public Health, University of Wisconsin, Madison, WI, 53792, USA
- Geriatric Research, Education and Clinical Center, William S. Middleton Memorial Veterans Hospital, Madison, WI, 53705, USA
- Wisconsin Alzheimer's Disease Research Center, Madison, WI, 53792, USA
| | - S Asthana
- School of Medicine and Public Health, University of Wisconsin, Madison, WI, 53792, USA
- Geriatric Research, Education and Clinical Center, William S. Middleton Memorial Veterans Hospital, Madison, WI, 53705, USA
- Wisconsin Alzheimer's Disease Research Center, Madison, WI, 53792, USA
| | - S Bhasin
- Section of Men's Health: Aging and Metabolism, Harvard Medical School, Brigham and Women's Hospital, BLI-5, 221 Longwood Avenue, Boston, MA, 02115, USA
| | - S Basaria
- Section of Men's Health: Aging and Metabolism, Harvard Medical School, Brigham and Women's Hospital, BLI-5, 221 Longwood Avenue, Boston, MA, 02115, USA
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Ray SS, Asthana S, Agarwal T, Singothu S, Samal A, Banerjee I, Pal K, Pramanik K. Molecular docking and interactions of pueraria tuberosa with vascular endothelial growth factor receptors. Indian J Pharm Sci 2015; 77:439-45. [PMID: 26664060 PMCID: PMC4649782 DOI: 10.4103/0250-474x.164780] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Pueraria tuberosa is known for its therapeutic potentials in cardiovascular disorders, but its effect in angiogenesis has not been studied so far. In this study, a computational approach has been applied to elucidate the role of the phytochemicals in inhibition of angiogenesis through modulation of vascular endothelial growth factor receptors: Vascular endothelial growth factor receptor-1 and vascular endothelial growth factor receptor-2, major factors responsible for angiogenesis. Metabolite structures retrieved from PubChem and KNApSAcK – 3D databases, were docked using AutoDock4.2 tool. Hydrogen bond and molecular docking, absorption, distribution, metabolism and excretion and toxicity predictions were carried out using UCSF Chimera, LigPlot+ and PreADMET server, respectively. From the docking analysis, it was observed that puerarone and tuberostan had significant binding affinity for the intracellular kinase domain of vascular endothelial growth factor receptors-1 and vascular endothelial growth factor receptor-2 respectively. It is important to mention that both the phytochemicals shared similar interaction profile as that of standard inhibitors of vascular endothelial growth factor receptors. Also, both puerarone and tuberostan interacted with Lys861/Lys868 (adenosine 5’-triphosphate binding site of vascular endothelial growth factor receptors-1/vascular endothelial growth factor receptors-2), thus providing a clue that they may enforce their inhibitory effect by blocking the adenosine 5’-triphosphate binding domain of vascular endothelial growth factor receptors. Moreover, these molecules exhibited good drug-likeness, absorption, distribution, metabolism and excretion properties without any carcinogenic and toxic effects. The interaction pattern of the puerarone and tuberostan may provide a hint for a novel drug design for vascular endothelial growth factor tyrosine kinase receptors with better specificity to treat angiogenic disorders.
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Labani S, Asthana S. Human papillomavirus viral load on careHPV testing of self-collected vaginal samples vs. clinician-collected cervical samples. Eur J Obstet Gynecol Reprod Biol 2014; 181:233-9. [DOI: 10.1016/j.ejogrb.2014.08.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2014] [Revised: 07/03/2014] [Accepted: 08/04/2014] [Indexed: 10/24/2022]
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Asthana S, Bhambani S, Sodhani P, Gupta S, Satyanarayana L. A comparative study of cervical cancer screening methods in a rural community setting of North India. Indian J Cancer 2014; 51:124-8. [DOI: 10.4103/0019-509x.138172] [Citation(s) in RCA: 15] [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: 11/04/2022]
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13
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Gupta A, Asthana S, Konwar R, Chourasia MK. An Insight Into Potential of Nanoparticles-Assisted Chemotherapy of Cancer Using Gemcitabine and Its Fatty Acid Prodrug: A Comparative Study. J Biomed Nanotechnol 2013; 9:915-25. [DOI: 10.1166/jbn.2013.1591] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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14
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Okonkwo OC, Xu G, Dowling NM, Bendlin BB, Larue A, Hermann BP, Koscik R, Jonaitis E, Rowley HA, Carlsson CM, Asthana S, Sager MA, Johnson SC. Family history of Alzheimer disease predicts hippocampal atrophy in healthy middle-aged adults. Neurology 2012; 78:1769-76. [PMID: 22592366 DOI: 10.1212/wnl.0b013e3182583047] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To evaluate the longitudinal influence of family history (FH) of Alzheimer disease (AD) and apolipoprotein E ε4 allele (APOE4) on brain atrophy and cognitive decline over 4 years among asymptomatic middle-aged individuals. METHODS Participants were cognitively healthy adults with (FH+) (n = 60) and without (FH-) (n = 48) a FH of AD (mean age at baseline 54 years) enrolled in the Wisconsin Registry for Alzheimer's Prevention. They underwent APOE genotyping, cognitive testing, and an MRI scan at baseline and 4 years later. A covariate-adjusted voxel-based analysis interrogated gray matter (GM) modulated probability maps at the 4-year follow-up visit as a function of FH and APOE4. We also examined the influence of parent of origin on GM atrophy. Parallel analyses investigated the effects of FH and APOE4 on cognitive decline. RESULTS Neither FH nor APOE4 had an effect on regional GM or cognition at baseline. Longitudinally, a FH × APOE4 interaction was found in the right posterior hippocampus, which was driven by a significant difference between the FH+ and FH- subjects who were APOE4-. In addition, a significant FH main effect was observed in the left posterior hippocampus. No significant APOE4 main effects were detected. Persons with a maternal history of AD were just as likely as those with a paternal history of AD to experience posterior hippocampal atrophy. There was no longitudinal decline in cognition within the cohort. CONCLUSION Over a 4-year interval, asymptomatic middle-aged adults with FH of AD exhibit significant atrophy in the posterior hippocampi in the absence of measurable cognitive changes. This result provides further evidence that detectable disease-related neuroanatomic changes do occur early in the AD pathologic cascade.
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Affiliation(s)
- O C Okonkwo
- Geriatric Research Education and Clinical Center, William S. Middleton Memorial Veterans Hospital, Madison, WI, USA
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Abstract
Background: The uterine cervix is the second most common site of cancer among Indian women.Though the human papillomavirus has been demonstrated to be a causative agent for this cancer, a variety of other risk factors are in play, such as sexual and reproductive patterns, socioeconomic, hygienic practices, and diet. The accumulated evidence suggests that cervical cancer is preventable and is highly suitable for primary prevention. The dietary intake of antioxidants and vitamins like vitamin A, carotenoids, vitamin C, folacin and tocopherol is found to have protective effects against cancer of the cervix. Dietary data regarding cervical cancer are still scanty. Objective: The present study was therefore undertaken to study the dietary pattern among uterine cervical cancer patients and normal controls. Materials and Methods: A total of 60 consecutive patients and 60 controls were enrolled from a referral hospital during the year 2004. A schedule inclusive of the food frequency pattern and 24-h dietary recall along with the general information was administered to all the enrolled subjects to describe findings on the food consumption pattern along with other important factors. Results: The mean intake of energy, protein, vitamins, etc., between the cases and controls was not significantly different except for the vitamin C level. Serum vitamin E was found to have lower average in patients as compared to controls. The nutrient intake of cervical cancer patients and controls was grossly deficient in the socioeconomic group studied. With regard to the macronutrient intake, calorie and protein intakes showed a deficit of around 50% when compared to RDA. Conclusion: The food consumption profile was not significantly different between cervical cancer patients and normal controls.
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Affiliation(s)
- Lakshmi Labani
- Department of Endocrinology, Nizam Institute of Medical Sciences, Hyderabad, AP, India
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Abstract
Splenic artery aneurysms (SAAs) are the third most common forms of intra-abdominal aneurysm, and the most commonly encountered visceral aneurysms in the general population. SAAs occur more commonly in patients with portal hypertension and liver failure and, as such, are often encountered in patients undergoing high-resolution abdominal imaging as part of a work-up for liver transplantation. While rupture rates of between 2% and 10% have been reported in the literature, little is known about the natural history and behavior of these lesions in patients with liver disease. Interventional management options pose a challenge given the high anesthetic and surgical risk of such patients. This study was conducted to study the management of all SAAs diagnosed among patients presenting for a liver transplant assessment at a single center over a three-yr period. We discuss the presentation and management options, with elective and emergent presentation of SAA in patients with end-stage liver disease.
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Affiliation(s)
- S Asthana
- Hepatobiliary and Transplant Unit, University of Alberta Hospital, Edmonton, AB, Canada
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Wagh P, Ingale S, Rav A, Kaushik T, Gupta S, Asthana S, Wasnik R, Sohoni R, Adya M. Detonating Cord for Flux Compression Generation using Electrical Detonator No. 33. DEFENCE SCI J 2011. [DOI: 10.14429/dsj.61.30] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Goldsmith PJ, Asthana S, Fitzpatrick M, Finlay E, Attia MS, Menon KV, Pollard SG, Ridgway DM, Ahmad N. Transplantation of adult-sized kidneys in low-weight pediatric recipients achieves short-term outcomes comparable to size-matched grafts. Pediatr Transplant 2010; 14:919-24. [PMID: 20840437 DOI: 10.1111/j.1399-3046.2010.01375.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Low-weight pediatric recipients are disadvantaged by scarcity of size-matched donors. ASK have been successfully used for pediatric recipients. We report the results of renal transplantation using ASK in low-weight pediatric recipients and compare outcomes in weight-matched and unmatched donor-recipient pairs. The outcomes of renal transplants using ASK grafts in low-weight (<20 kg) recipients from a single center over a 10-yr period were reviewed. Two groups, comprising recipients of grafts from weight-matched and mismatched donors, were compared. Primary outcome was one-yr graft survival. Secondary outcomes were one- and two-yr calculated eGFR, changes in recipient body weight, perioperative cardiovascular stability, rates of AR and DGF. Twenty-three low-weight recipients were transplanted. Eleven received ASK grafts from high-weight donors and 12 grafts from low-weight donors. One patient in each group had early graft loss. No significant difference was observed in rates of DGF, AR, one-yr graft or patient survival and perioperative cardiovascular parameters. ASK with considerable donor:recipient weight discrepancies can be safely transplanted into small pediatric recipients with comparable outcomes to grafts with less weight discrepancy.
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Affiliation(s)
- P J Goldsmith
- Division of Surgery, Department of Transplant Surgery, St James's University Hospital, Leeds, UK
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Fischer B, Yui Chan J, Hunter C, Yvslaker M, Uptegraw J, Carlsson C, Kind A, Hunt GG, Asthana S, Gleason C. 077 BEYOND AGS CRITERIA: IDENTIFYING SENIORS AT-RISK FOR FALLS. Parkinsonism Relat Disord 2010. [DOI: 10.1016/s1353-8020(10)70078-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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21
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Bendlin BB, Carlsson CM, Gleason CE, Johnson SC, Sodhi A, Gallagher CL, Puglielli L, Engelman CD, Ries ML, Xu G, Wharton W, Asthana S. Midlife predictors of Alzheimer's disease. Maturitas 2010; 65:131-7. [PMID: 20044221 PMCID: PMC2895971 DOI: 10.1016/j.maturitas.2009.12.014] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2009] [Revised: 12/10/2009] [Accepted: 12/11/2009] [Indexed: 12/20/2022]
Abstract
Factors contributing to increased risk for Alzheimer's disease (AD) include age, sex, genes, and family history of AD. Several risk factors for AD are endogenous; however, accumulating evidence implicates modifiable risk factors in the pathogenesis of AD. Although the continued task of identifying new genes will be critical to learning more about the disease, several research findings suggest that potentially alterable environmental factors influence genetic contributions, providing targets for disease prevention and treatment. Here, we review midlife risk factors for AD, and address the potential for therapeutic intervention in midlife.
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Affiliation(s)
- B B Bendlin
- William S. Middleton Memorial Veterans Hospital, Geriatric Research Educational and Clinical Center, Madison, WI, USA.
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Abstract
INTRODUCTION The aim of this study is to determine whether there are any clinical or biochemical predictors of common bile duct (CBD) stones in patients undergoing laparoscopic cholecystectomy. METHODS A prospective database of nearly 1000 laparoscopic cholecystectomies performed under the care of a single surgeon with a standardised technique between 1999 and 2006, was analysed. Clinical presentation, ultrasound and immediate preoperative biochemical results as well as the operative cholangiogram findings were reviewed. Routine cholangiography was attempted in most patients and the primary outcome variable was the detection of bile duct stones. The data was analysed using chi-squared test for categorical variables. The significant variables on univariate analysis were further characterised to identify the independent predictors of bile duct stones using a logistic regression model (significance p < 0.05). RESULTS A total of 757 of 988 patients (77%) underwent cholangiography. Male-to-female ratio was 1 : 3 with a median age of 54 years (range: 17-93). Ten per cent of patients had bile duct stones identified on cholangiography. On univariate analysis, jaundice (p = 0.019), cholangitis (p < 0.001), alanine transaminase > 100 (p = 0.024), alkaline phosphatase (ALP) > 350 (p < 0.001) and CBD > 10 mm (p = 0.01) were significant markers for predicting bile duct stones. Bilirubin > 30 (x2 normal) was found not to be significant (p = 0.145). On a logistic regression model, ALP > 350 and/or cholangitis were found to be independent predictive factors of CBD stones (odds ratio 6.1). CONCLUSIONS If a policy of routine intra-operative cholangiography is not adopted, a history of cholangitis or a raised ALP immediately preoperatively should lead to a high suspicion of CBD stones.
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Affiliation(s)
- A J Sheen
- Department of Hepatobiliary Surgery, St James University Hospital, Leeds, UK
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Hidalgo E, Asthana S, Nishio H, Wyatt J, Toogood GJ, Prasad KR, Lodge JPA. Surgery for hilar cholangiocarcinoma: the Leeds experience. Eur J Surg Oncol 2007. [PMID: 18036765 DOI: 10.1016/j.ejso.2007.10.005/p] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
AIM To review the experience with hilar cholangiocarcinoma and to determine the results of a radical surgical approach in a UK centre. METHODS A 10-year review of all patients treated surgically for proximal bile duct carcinoma at a single surgical unit was conducted. Patient demographics, disease details and histopathology reports were reviewed. From January 1993 through December 2003, 106 patients were admitted with the diagnosis of hilar cholangiocarcinoma and 61 patients received surgical exploration. RESULTS Tumours were staged as follows (UICC 6th edition): stage IB, n=10 IIA, n=9; IIB, n=20; III, n=8; IV, n=14. Out of 61 patients, 44 had a resection (3 bile duct resection alone, 41 liver resection with bile duct resection), 5 were considered unresectable and 12 underwent liver transplantation (LT). The caudate lobe was excised in 34 of the patients and regional lymphadenectomy was systematically carried out. Para-aortic lymphadenectomy was performed in 17 cases. Portal vein resection was needed in 17 and hepatic artery resection was performed in 4 cases. Negative histologic margins (R0) were achieved in 20 patients and microscopic margin involvement (R1) was seen in 16. In the remaining 8 resected patients, localised metastasis were found (peritoneal deposits in 2, liver metastasis in 4 and positive para-aortic lymph nodes in 2); nevertheless the resection was performed and it was considered R2. Overall survival at 3 and 5 years for patients who underwent a resection was 43% and 28% including postoperative deaths. The 1-, 3- and 5-year actuarial survival rates for patients who underwent R0 resection were 78%, 64% and 45% respectively, including the postoperative deaths (n=3). The median survival time was 41.1 months. The 1-, 3- and 5-year actuarial survival rates for R1 resection and R2 were 60%, 26%, 26% and 25% and 0% respectively, while the median survival time for these groups was 15.4 and 6.8 months respectively. The actuarial survival rate at 1, 3 and 5 years for well-differentiated tumours (G1) was 73%, 54% and 40% (median 39.7 months). The figures for G2 were 60%, 48% and 0%. The figures for G3 (poorly differentiated) were 16% and 0% at three years (p=0.03).The overall survival at 3 and 5 years for those patients who had a liver transplant was 41% and 20% including early postoperative mortality. The tumour grading (presence of poorly differentiated tumour) was found to be the only independent factor affecting the survival time producing a hazard ratio of 4.3 (p=0.0034, 95% confidence interval 0.1007-6.342). CONCLUSIONS Radical surgical resection is the best treatment for hilar cholangiocarcinoma. R0 resection provides acceptable 5-year survival, but R1 resection may also provide acceptable palliation. In our experience TNM stage and tumour grade were the main determinants of long-term survival.
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Affiliation(s)
- E Hidalgo
- Hepatobiliary and Transplant Unit, St James's University Hospital, Leeds LS9 7TF, UK
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25
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Hidalgo E, Asthana S, Nishio H, Wyatt J, Toogood GJ, Prasad KR, Lodge JPA. Surgery for hilar cholangiocarcinoma: the Leeds experience. Eur J Surg Oncol 2007; 34:787-94. [PMID: 18036765 DOI: 10.1016/j.ejso.2007.10.005] [Citation(s) in RCA: 84] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2007] [Accepted: 10/12/2007] [Indexed: 01/06/2023] Open
Abstract
AIM To review the experience with hilar cholangiocarcinoma and to determine the results of a radical surgical approach in a UK centre. METHODS A 10-year review of all patients treated surgically for proximal bile duct carcinoma at a single surgical unit was conducted. Patient demographics, disease details and histopathology reports were reviewed. From January 1993 through December 2003, 106 patients were admitted with the diagnosis of hilar cholangiocarcinoma and 61 patients received surgical exploration. RESULTS Tumours were staged as follows (UICC 6th edition): stage IB, n=10 IIA, n=9; IIB, n=20; III, n=8; IV, n=14. Out of 61 patients, 44 had a resection (3 bile duct resection alone, 41 liver resection with bile duct resection), 5 were considered unresectable and 12 underwent liver transplantation (LT). The caudate lobe was excised in 34 of the patients and regional lymphadenectomy was systematically carried out. Para-aortic lymphadenectomy was performed in 17 cases. Portal vein resection was needed in 17 and hepatic artery resection was performed in 4 cases. Negative histologic margins (R0) were achieved in 20 patients and microscopic margin involvement (R1) was seen in 16. In the remaining 8 resected patients, localised metastasis were found (peritoneal deposits in 2, liver metastasis in 4 and positive para-aortic lymph nodes in 2); nevertheless the resection was performed and it was considered R2. Overall survival at 3 and 5 years for patients who underwent a resection was 43% and 28% including postoperative deaths. The 1-, 3- and 5-year actuarial survival rates for patients who underwent R0 resection were 78%, 64% and 45% respectively, including the postoperative deaths (n=3). The median survival time was 41.1 months. The 1-, 3- and 5-year actuarial survival rates for R1 resection and R2 were 60%, 26%, 26% and 25% and 0% respectively, while the median survival time for these groups was 15.4 and 6.8 months respectively. The actuarial survival rate at 1, 3 and 5 years for well-differentiated tumours (G1) was 73%, 54% and 40% (median 39.7 months). The figures for G2 were 60%, 48% and 0%. The figures for G3 (poorly differentiated) were 16% and 0% at three years (p=0.03).The overall survival at 3 and 5 years for those patients who had a liver transplant was 41% and 20% including early postoperative mortality. The tumour grading (presence of poorly differentiated tumour) was found to be the only independent factor affecting the survival time producing a hazard ratio of 4.3 (p=0.0034, 95% confidence interval 0.1007-6.342). CONCLUSIONS Radical surgical resection is the best treatment for hilar cholangiocarcinoma. R0 resection provides acceptable 5-year survival, but R1 resection may also provide acceptable palliation. In our experience TNM stage and tumour grade were the main determinants of long-term survival.
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Affiliation(s)
- E Hidalgo
- Hepatobiliary and Transplant Unit, St James's University Hospital, Leeds LS9 7TF, UK
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Ertekin-Taner N, Younkin LH, Yager DM, Parfitt F, Baker MC, Asthana S, Hutton ML, Younkin SG, Graff-Radford NR. Plasma amyloid beta protein is elevated in late-onset Alzheimer disease families. Neurology 2007; 70:596-606. [PMID: 17914065 DOI: 10.1212/01.wnl.0000278386.00035.21] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE Plasma A beta levels are elevated in early-onset Alzheimer disease (AD) caused by autosomal dominant mutations. Our objective was to determine whether similar genetic elevations exist in late-onset AD (LOAD). METHODS We measured plasma A beta in first-degree relatives of patients with LOAD in a cross-sectional series and in extended LOAD families. We screened these subjects for pathogenic mutations in early-onset AD genes and determined their ApoE genotypes. RESULTS Plasma A beta is significantly elevated in the LOAD first-degree relatives in comparison to unrelated controls and married-in spouses. These elevations are not due to ApoE epsilon 4 or pathogenic coding mutations in the known early-onset AD genes. CONCLUSIONS The findings provide strong evidence for the existence of novel, as yet unknown genetic factors that affect late-onset Alzheimer disease by increasing A beta.
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Affiliation(s)
- N Ertekin-Taner
- Department of Neuroscience, Mayo Clinic, 4500 San Pablo Road South, Jacksonville, FL 32224, USA
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Krishnamachary MK, Swain-Eng RJ, Barnet J, Maloney J, Stewart JA, Asthana S. Wisconsin Comorbidity Assessment Scale (WCAS): A novel, comprehensive, performance-based assessment scale of geriatric syndromes and medical comorbidities in older cancer patients. J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.19619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
19619 Background: Elderly patients with cancer have potential for multiple geriatric syndromes that influence treatment and outcomes. No single clinical assessment tool has targeted all the major geriatric syndromes and their interaction on cancer management and outcomes. We developed WCAS to evaluate cognitive and physical function, risk of falls and gait disorders, polypharmacy, and medical comorbidities. Methods: Eighteen newly diagnosed patients with breast cancer (age 55–82), were enrolled prior to cancer treatment. Cognitive function was evaluated with a comprehensive battery of neuropsychological tests targeting the domains of memory, executive function, attention, language, and praxis. Physical function skills were assessed with novel performance-based tasks (e.g., bed-making) and computerized assessments of balance, gait and risk of falls. Cancer treatment included surgery in all patients with variable use of adjuvant radiation and medical therapy. WCAS was administered at baseline and at month 6. Results: Ten subjects have completed both baseline and month 6 visits. Surgical treatment occurred at a mean of ten days after baseline assessment (SD 6.7). The mean (SD) of the age, years of education and baseline Mini Mental Status Exam (MMSE) was 66 years (7.3), 15.2 years (3.7) and 29.3 (1.1). From baseline to month six assessment performance on the WAIS Digit Symbol test, a measure of working memory and processing speed, declined (mean change −11.7, p<0.01). Likewise, the performance on the WAIS letter number sequence test (mean change −1.3, p=0.09) and the MMSE (mean change −1.1, p=0.12) declined. Interestingly, four subjects with pre-existing hypothyroidism on replacement treatment showed a greater decline (p<0.01) in memory than those without this common condition. Conclusions: Findings indicate that breast cancer diagnosis and therapy can be associated with significant decline in aspects of cognition in older adults with cancer. These changes can last at least 6 months and are more pronounced in those with hypothyroidism. Larger, longer term prospective studies utilizing WCAS are necessary to confirm our preliminary findings. No significant financial relationships to disclose.
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Affiliation(s)
| | | | - J. Barnet
- University of Wisconsin, VAMC Madison, GRECC, Madison, WI
| | - J. Maloney
- University of Wisconsin, VAMC Madison, GRECC, Madison, WI
| | - J. A. Stewart
- University of Wisconsin, VAMC Madison, GRECC, Madison, WI
| | - S. Asthana
- University of Wisconsin, VAMC Madison, GRECC, Madison, WI
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Sarveswaran J, Ikponmwosa A, Asthana S, Spark JI. Should Cardiac Troponins be Used as a Risk Stratification Tool for Patients with Chronic Critical Limb Ischaemia? Eur J Vasc Endovasc Surg 2007; 33:703-7. [PMID: 17275360 DOI: 10.1016/j.ejvs.2006.11.041] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2006] [Accepted: 11/30/2006] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Cardiovascular mortality in patients with chronic critical lower limb ischaemia (CCLI) is high and early risk stratification in these patients may aid clinical management improving outcomes. Cardiac troponin I (cTnI) has prognostic significance in patients with unstable angina. The aim of this study was to evaluate the prognostic significance of cardiac troponins in CCLI patients who had no clinical evidence of unstable coronary heart disease. METHODS Patients (n=152) admitted with CCLI to a single vascular unit over a two-year period were included prospectively in this study. Patients with clinical evidence of unstable coronary disease were excluded from the study. Patient demographics, clinical history, co-morbidity and risk factors for peripheral vascular disease were documented. Admission cTnI levels were recorded using a threshold, 0.1 ng/ml. The primary endpoint was mortality. RESULTS Fifty-two patients (34.2%) had an elevated cTnI, whilst 100 (65.8%) had cTnI <0.1 ng/ml. Sixty-two patients died during the follow-up period, 38 with an elevated admission cTnI. Death rate in patients with cTnI >0.1 ng/nl was 73% compared with 24% in those with levels below the threshold (p<0.0001). Patients with elevated cTnI were significantly older than those with normal level (median age 76 years vs 71 years, p<0.001). An elevated cTnI was found to independently predict disease-specific mortality on Cox regression analysis (Hazard Ratio 4.2; 95% Confidence Interval 1.3-12.7). CONCLUSION In this series of patients with CCLI the measurement of cTnI on admission was a significant independent predictor of survival. cTnI has potential as a prognostic test to stratify patients with a high cardiovascular risk and may enable further optimisation of these high-risk patients.
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Affiliation(s)
- J Sarveswaran
- Leeds Vascular Institute, Leeds General Infirmary, Leeds, LS1 3EX, UK
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Halazun K, Bofkin K, Asthana S, Evans C, Henderson M, Spark J. Hyperhomocysteinaemia is Associated with the Rate of Abdominal Aortic Aneurysm Expansion. J Vasc Surg 2007. [DOI: 10.1016/j.jvs.2007.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Gandy R, Asthana S, Menon KV, Ahmad N, Lodge JPA. The use of polyglactin 910 mesh to obtain haemostasis and prevent further splitting in a fractured transplant kidney. Ann R Coll Surg Engl 2007; 88:590-1. [PMID: 17380611 PMCID: PMC1963772 DOI: 10.1308/rcsann.2006.88.6.590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- R Gandy
- Department of Transplant Surgery, St. James's University Hospital, Leeds, UK
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Baker D, Yasui N, Lane NJ, Ohrt TL, Asthana S, Gleason CE. 3 RATE OF UNDIAGNOSED COGNITIVE IMPAIRMENT IN COMMUNITY SETTINGS: IS THERE A NEED FOR SCREENING? J Investig Med 2007. [DOI: 10.1136/jim-55-02-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Baker D, Yasui N, Lane N, Ohrt T, Asthana S, Gleason CE. Rate of Undiagnosed Cognitive Impairment in Community Settings: Is There a Need for Screening? J Investig Med 2007. [DOI: 10.1177/108155890705500203] [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: 01/08/2023]
Affiliation(s)
- D. Baker
- University of Wisconsin, Madison, WI
| | - N. Yasui
- University of Wisconsin, Madison, WI
| | - N.J. Lane
- University of Wisconsin, Madison, WI
| | - T.L. Ohrt
- University of Wisconsin, Madison, WI
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Gleason CE, Schmitz TW, Hess T, Koscik RL, Trivedi MA, Ries ML, Carlsson CM, Sager MA, Asthana S, Johnson SC. Hormone effects on fMRI and cognitive measures of encoding: importance of hormone preparation. Neurology 2007; 67:2039-41. [PMID: 17159116 PMCID: PMC2650493 DOI: 10.1212/01.wnl.0000247277.81400.43] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
We compared fMRI and cognitive data from nine hormone therapy (HT)-naive women with data from women exposed to either opposed conjugated equine estrogens (CEE) (n = 10) or opposed estradiol (n = 4). Exposure to either form of HT was associated with healthier fMRI response; however, CEE-exposed women exhibited poorer memory performance than either HT-naive or estradiol-exposed subjects. These preliminary findings emphasize the need to characterize differential neural effects of various HTs.
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Affiliation(s)
- C E Gleason
- Section of Geriatrics and Gerontology, Department of Medicine, University of Wisconsin, 2870 University Ave., Suite 106, Madison, WI 53705, USA.
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Halazun KJ, Bofkin KA, Asthana S, Evans C, Henderson M, Spark JI. Hyperhomocysteinaemia is associated with the rate of abdominal aortic aneurysm expansion. Eur J Vasc Endovasc Surg 2006; 33:391-4; discussion 395-6. [PMID: 17164089 DOI: 10.1016/j.ejvs.2006.10.022] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2006] [Accepted: 10/08/2006] [Indexed: 11/21/2022]
Abstract
OBJECTIVES Previous literature has suggested an association between AAA and the presence of elevated plasma homocysteine levels (HCY). Homocysteine can stimulate elastolysis in the arterial media via activation of elastase and matrix metalloproteinases. No evidence in the literature exists correlating aneurysm expansion and HCY. The study objective is to identify whether the rate of AAA expansion is related to HCY. METHODS 108 patients undergoing surveillance for AAA were identified at our vascular surgical unit. AAA size and growth rate were assessed by serial ultrasonographic measurements. Fasting total HCY levels were measured using fluorescence polarisation immunoassays. Demographic details and atherosclerotic risk factors were noted all AAA patients. A multivariate analysis was performed for growth rate vs. HCY, hypertension and hypercholesterolaemia. The correlation between AAA growth rate, AAA size and HCY levels were calculated. RESULTS 60% of patients with AAA had some degree of hyperhomocysteinaemia (> 15 micromol/l). Multivariate analysis showed HCY to be the only significant factor affecting AAA growth rate. A positive correlation was demonstrated between HCY levels and AAA growth rate using a linear regression model (R=0.28, p=0.003). Median growth rate among patients with hyperHCY was double that of patients with normal HCY (0.5 mm/month vs. 0.25 mm/month, p=0.003). A growth rate of > 10 mm/year was seen in 25% of hyper HCY patients and in only 2% of patients with normal HCY. In addition patients with hyper HCY and larger AAAs (> 4 cm) had a growth rate twice as fast as patients with hyper HCY and AAAs < 4 cm. CONCLUSIONS A correlation between HCY and growth rate exists, although this is weak due to the multifactorial aetiology of AAAs. HyperHCY patients have faster expansion rates than patients with normal HCY, with significant numbers demonstrating rapid expansion (> 10 mm/year) and therefore an increased risk of rupture.
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Affiliation(s)
- K J Halazun
- Leeds Vascular Institute, Leeds General Infirmary, Leeds, West Yorkshire, UK.
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35
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Kulstad JJ, Green PS, Cook DG, Watson GS, Reger MA, Baker LD, Plymate SR, Asthana S, Rhoads K, Mehta PD, Craft S. Differential modulation of plasma -amyloid by insulin in patients with Alzheimer disease. Neurology 2006; 66:1506-10. [PMID: 16717209 DOI: 10.1212/01.wnl.0000216274.58185.09] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Hyperinsulinemia and insulin resistance are risk factors for memory impairment and Alzheimer disease (AD). Insulin regulates levels of the amyloid beta-peptide (Abeta) in vitro in neuronal cultures and in vivo in the CSF of normal older adults. OBJECTIVE To determine whether insulin affected plasma Abeta levels and whether such effects differed for patients with AD compared with normal older adults. METHODS Fifty-nine patients with AD and 50 healthy older adults each received infusions of saline and of insulin (1.0 mU.kg(-1).min(-1)) with accompanying dextrose to maintain euglycemia. A subset of participants (19 AD, 12 normal) received two additional conditions, in which insulin was infused at a lower (0.33 mU.kg(-1).min(-1)) and higher (1.67 mU.kg(-1).min(-1)) rate. Plasma insulin and Abeta were measured after 120 minutes of infusion. RESULTS Adults with AD had higher plasma insulin vs normal adults at the two higher infusion rates, despite receiving comparable amounts of insulin. For normal adults, insulin reduced plasma Abeta levels at the middle (1.0 mU.kg(-1).min(-1)) dose, with attenuated effects at lower and higher doses. In contrast, for patients with AD, insulin raised plasma Abeta levels at the two higher doses (1.0 and 1.67 mU.kg(-1).min(-1)). CONCLUSIONS These results suggest that patients with Alzheimer disease (AD) have reduced insulin clearance and insulin-provoked plasma amyloid beta-peptide (Abeta) elevation. Abnormal regulation of peripheral Abeta by insulin may contribute to AD risk.
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Affiliation(s)
- J J Kulstad
- Geriatric Research, Education, and Clinical Center, VA Puget Sound Health Care System, Seattle, WA 98108, USA
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Dasgupta D, Sharpe J, Prasad KR, Asthana S, Toogood GJ, Pollard SG, Lodge JPA. Triangular and self-triangulating cavocavostomy for orthotopic liver transplantation without posterior suture lines: a modified surgical technique. Transpl Int 2006; 19:117-21. [PMID: 16441360 DOI: 10.1111/j.1432-2277.2005.00246.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
A modified caval preservation technique with the potential for decreased incidence of venous outflow obstruction and haemorrhage.
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Affiliation(s)
- D Dasgupta
- The HPB and Transplant Unit, St James's University Hospital, Leeds LS9 7TF, UK
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Cherrier MM, Matsumoto AM, Amory JK, Asthana S, Bremner W, Peskind ER, Raskind MA, Craft S. Testosterone improves spatial memory in men with Alzheimer disease and mild cognitive impairment. Neurology 2006; 64:2063-8. [PMID: 15985573 DOI: 10.1212/01.wnl.0000165995.98986.f1] [Citation(s) in RCA: 184] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To determine the efficacy of testosterone (T) supplementation on cognition in a sample of men with Alzheimer disease (AD) or mild cognitive impairment (MCI). METHODS Fifteen patients with AD and 17 patients with MCI aged 63 to 85 years completed a randomized, double-blind, placebo-controlled study. Nineteen participants received weekly intramuscular (IM) injections of 100 mg T enanthate and 13 participants received weekly injections of placebo (saline) for 6 weeks. Cognitive evaluations using a battery of neuropsychological tests were conducted at baseline, week 3, and week 6 of treatment and again after 6 weeks of washout. RESULTS Peak serum total T levels were raised from baseline an average of 295% in the active treatment group. Improvements in spatial memory (p < 0.05) and constructional abilities (p < 0.05) and verbal memory were evident in the T group. No changes were noted for selective and divided attention or language. Prostate specific antigen did not significantly change during this brief treatment. CONCLUSION Testosterone supplementation may benefit selective cognitive functions in men with Alzheimer disease and mild cognitive impairment.
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Affiliation(s)
- M M Cherrier
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA.
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Johnson SC, Schmitz TW, Moritz CH, Meyerand ME, Rowley HA, Alexander AL, Hansen KW, Gleason CE, Carlsson CM, Ries ML, Asthana S, Chen K, Reiman EM, Alexander GE. Activation of brain regions vulnerable to Alzheimer's disease: the effect of mild cognitive impairment. Neurobiol Aging 2005; 27:1604-12. [PMID: 16226349 PMCID: PMC2627778 DOI: 10.1016/j.neurobiolaging.2005.09.017] [Citation(s) in RCA: 168] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2005] [Revised: 07/29/2005] [Accepted: 09/08/2005] [Indexed: 11/25/2022]
Abstract
This study examined the functionality of the medial temporal lobe (MTL) and posterior cingulate (PC) in mild cognitive impairment amnestic type (MCI), a syndrome that puts patients at greater risk for developing Alzheimer disease (AD). Functional MRI (fMRI) was used to identify regions normally active during encoding of novel items and recognition of previously learned items in a reference group of 77 healthy young and middle-aged adults. The pattern of activation in this group guided further comparisons between 14 MCI subjects and 14 age-matched controls. The MCI patients exhibited less activity in the PC during recognition of previously learned items, and in the right hippocampus during encoding of novel items, despite comparable task performance to the controls. Reduced fMRI signal change in the MTL supports prior studies implicating the hippocampus for encoding new information. Reduced signal change in the PC converges with recent research on its role in recognition in normal adults as well as metabolic decline in people with genetic or cognitive risk for AD. Our results suggest that a change in function in the PC may account, in part, for memory recollection failure in AD.
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Affiliation(s)
- S C Johnson
- Geriatric Research Education and Clinical Center, Wm. S. Middleton VA Hospital, 2500 Overlook Terrace (11G), GRECC, Madison, WI 53705, USA.
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Lane NJ, Ohrt TL, Meade SA, Slattery AM, Gleason CE, Asthana S. 10 AN ANALYSIS OF PATIENTS' INTEREST IN RESEARCH FROM A MEMORY SPECIALTY CLINIC. J Investig Med 2005. [DOI: 10.2310/6650.2005.00206.9] [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: 11/18/2022]
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Abstract
Recent findings from the Women's Health Initiative (WHI) have raised considerable concern over prolonged use of opposed and unopposed oral conjugated equine estrogen (CEE), given the increased risk of serious adverse effects, including stroke and venous thromboembolic complications. Furthermore, results from the WHI Memory Study (WHIMS) indicated that over 5 years of therapy with Prempro impaired performance on global cognitive tests and nearly doubled the risk of dementia. These surprising findings were contradictory to cumulative evidence from basic science, epidemiological and some intervention studies suggesting hormone therapy was cardioprotective and could potentially reduce the risk of dementia. This review paper focuses on the neurobiology of estrogen, summarizing the clinical evidence for neuroprotective and cognition-enhancing efficacy of estrogen. Further, the paper briefly discusses variables that may account for the unexpected findings of WHIMS, and offers suggestions for future research.
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Affiliation(s)
- C E Gleason
- Wm. S. Middleton Memorial Veterans Hospital, Madison, Wisconsin 53705, USA.
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Asthana S, Gibson A, Moon G, Brigham P, Dicker J. The demographic and social class basis of inequality in self reported morbidity: an exploration using the Health Survey for England. J Epidemiol Community Health 2004; 58:303-7. [PMID: 15026443 PMCID: PMC1732732 DOI: 10.1136/jech.2002.003475] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
STUDY OBJECTIVES To assess the relative contribution of age and social class to variations in the prevalence of a selection of self reported health problems. To examine the implications of observed variations for research on health inequalities. DESIGN Secondary analysis of the Health Survey for England (1991-1997) using morbidities that are particularly prone to class effects. A statistical measure of the "relative class effect" is introduced to compare the effects of adjusting for social class and age. MAIN RESULTS There is substantial variation in the relative importance of the age and class distributions of different diseases. Age effects often overshadow those of class even for conditions where an apparently strong social gradient exists. Only for self reported mental health among women does the social gradient exceed the age gradient. Within the context of a dominating age gradient, social gradients are relatively high for mental health and general health for both sexes. Variation in the relative strengths of the social gradients between the sexes are observed for angina symptoms. CONCLUSIONS Given variations in the "relative class effect", analysis recognising the distinct contributions of age, sex, and social class to specific morbidities is advocated as a transparent and robust approach to the assessment of morbidity based inequality.
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Affiliation(s)
- S Asthana
- Department of Social Policy and Social Work, University of Plymouth, Plymouth, UK
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Gleason CE, Slattery A, Ohrt T, Lane N, Meade S, Agate J, Carlsson CM, Asthana S. 16 POTENTIAL COGNITIVE BENEFITS OF SOY ISOFLAVONES. J Investig Med 2004. [DOI: 10.1136/jim-52-suppl2-16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Deo SVS, Ray S, Rath GK, Shukla NK, Kar M, Asthana S, Raina V. Prevalence and risk factors for development of lymphedema following breast cancer treatment. Indian J Cancer 2004; 41:8-12. [PMID: 15105573] [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: 04/29/2023]
Abstract
BACKGROUND Early detection and multimodality therapy has resulted in an overall improvement of survival among breast cancer patients. Despite a significant shift in the treatment approach from radical mastectomy to breast conservation a significant number of patients develop lymphedema. This study was conducted to evaluate the prevalence and risk factors for development of lymphedema. SETTINGS AND DESIGN Retrospective analysis for prevalence of lymphedema in a tertiary care regional cancer centre. MATERIAL AND METHODS Three hundred treated breast cancer patients with a minimum follow up of one year were evaluated for the prevalence and risk factors for lymphedema. Lymphedema was assessed using a serial circumferential measurement method. More than 3 cm difference in circumference is considered as clinical significant lymphedema. Univariate and multivariate analysis were performed for evaluating the risk factors by using the Chi square test and Cox logistic regression analysis. RESULTS The prevalence of clinically significant lymphedema was 33.5 % and 17.2 % had severe lymphedema. The prevalence of lymphedema was 13.4 % in patients treated with surgery only where as the prevalence was 42.4% in patients treated with surgery and radiotherapy. Stage of the disease, body surface area > 1. 5 m2, presence of co-morbid conditions, post operative radiotherapy and anthracycline based chemotherapy were significant risk factors in univariate analysis where as axillary irradiation and presence of co-morbid conditions have emerged as independent risk factors in multivariate analysis (P < 0.001). CONCLUSION Post treatment lymphedema continues to be a significant problem following breast cancer therapy. Presence of co-morbid conditions and axillary radiation significantly increases the risk of lymphedema. A combination of axillary dissection and axillary radiation should be avoided whenever feasible to avoid lymphedema.
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Affiliation(s)
- S V S Deo
- Department of Surgical Oncology, Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi-110 029, India.
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Deo SVS, Ray S, Rath GK, Shukla NK, Kar M, Asthana S, Raina V. Prevalence and risk factors for development of lymphedema following breast cancer treatment. Indian J Cancer 2004. [DOI: 10.4103/0019-509x.12338] [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: 03/08/2023]
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Cherrier MM, Plymate S, Mohan S, Asthana S, Matsumoto AM, Bremner W, Peskind E, Raskind M, Latendresse S, Haley AP, Craft S. Relationship between testosterone supplementation and insulin-like growth factor-I levels and cognition in healthy older men. Psychoneuroendocrinology 2004; 29:65-82. [PMID: 14575730 DOI: 10.1016/s0306-4530(02)00136-1] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Our laboratory has previously reported that testosterone (T) administration to older men significantly improves cognitive function. This study examined potential changes in insulin-like growth factor (IGF) IGF-I, IGF-II and IGF-related binding proteins in response to T administration in older men and their relationship to cognitive functioning. METHODS Twenty-five healthy community dwelling volunteers, ranging in age from 50-80 years were randomized to receive weekly intra-muscular (i.m.) injections of either 100 mg T enanthate or placebo (saline) for 6 weeks. Serum hormone levels and cognitive functioning was assessed at baseline and twice during treatment. RESULTS Significant positive associations between IGF-I and IGF-II and spatial memory, spatial reasoning, and verbal fluency were observed after 6 weeks of T administration. Increased serum T levels from treatment were positively associated with improvement in spatial reasoning performance, whereas estradiol was associated with a decline in divided attention performance. Serum IGF-I, IGF-II and IGFBPs did not change in response to T treatment. CONCLUSIONS Our results suggest that T, estradiol and IGF-I may have independent and selective effects on cognitive functioning. Positive associations between T levels and cognition are consistent with an effect of androgen treatment, whereas positive associations between IGF-I levels and cognition are reflective of a relationship between endogenous IGF-I levels and cognition.
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Affiliation(s)
- M M Cherrier
- Department of Psychiatry and Behavioral Sciences, University of Washington Medical School, 1959 NE Pacific, Box 356560, Seattle, WA 98195, USA.
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Watson GS, Peskind ER, Asthana S, Purganan K, Wait C, Chapman D, Schwartz MW, Plymate S, Craft S. Insulin increases CSF Abeta42 levels in normal older adults. Neurology 2003; 60:1899-903. [PMID: 12821730 DOI: 10.1212/01.wnl.0000065916.25128.25] [Citation(s) in RCA: 168] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Abnormal insulin metabolism may contribute to the clinical symptoms and pathophysiology of AD. In vitro studies show that insulin enhances the release of beta-amyloid protein (Abeta) or inhibits its degradation, either of which might increase amyloid burden. METHODS On separate mornings, 16 healthy older adults (10 women, 6 men; mean age 68.7 years, SD 8.6 years) each underwent two infusions consisting of either saline (placebo) or insulin (1.0 mU x kg(-1) x min(-1)) plus dextrose to maintain euglycemia. After 120 minutes of infusion, blood, CSF, and cognitive measures were acquired. RESULTS As expected, insulin infusion produced an increase in CSF insulin concentration. Insulin infusion also led to an increase in CSF Abeta42 levels, most notably in older subjects. As has been observed previously, insulin infusion facilitated declarative memory, but such facilitation was attenuated in the subjects with the greatest increase in CSF Abeta42 levels. CONCLUSIONS These findings are consistent with recent in vitro studies of insulin effects on Abeta and support the notion that insulin may modulate Abeta42 levels acutely in humans.
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Affiliation(s)
- G S Watson
- Geriatric Research, Education, and Clinical Center, Veterans Affairs Puget Sound Health Care System, Seattle 98108, USA
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Asthana S, Kennedy JP. Novel polyisobutylene stars. XXIII. Thermal, mechanical, and processing characteristics of poly(phenylene ether)/polydivinylbenzene(polyisobutylene-b-polystyrene)37 blends. J Appl Polym Sci 2002. [DOI: 10.1002/app.11294] [Citation(s) in RCA: 6] [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: 11/07/2022]
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Deo SVS, Shukla NK, Asthana S, Niranjan B, Srinivas G. A comparative study of modified radical mastectomy using harmonic scalpel and electrocautery. Singapore Med J 2002; 43:226-8. [PMID: 12188072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
Abstract
AIM The harmonic scalpel is recently emerging as an alternative surgical tool for dissection and haemostasis and has been extensively used in the field of minimally invasive surgery. We studied the utility and advantages of this instrument over electrocautery for performing modified radical mastectomy. METHODS The operative and morbidity details of twenty-three breast cancer patients who underwent modified radical mastectomy using the harmonic scalpel were compared with 23 matched controls operated with electrocautery by the same surgical team. RESULTS There was no significant difference in the operating time between the harmonic scalpel and electrocautery group (104 and 100 mins, p > 0.05). The blood loss (60 +/- 35 ml and 294 +/- 155, p < 0.001) and drainage volume (590 +/- 430 ml and 1,085 +/- 690 ml, p < 0.001) were significantly lower in the harmonic scalpel group. There was a significant reduction of drain days in harmonic scalpel group (mean five and nine days, p < 0.05). There was no significant difference in the seroma rate between two groups (16% and 22%). CONCLUSION Modified radical mastectomy using harmonic scalpel is feasible and learning curve is short. Harmonic scalpel significantly reduces the blood loss and duration of drainage as compared to electrocautery.
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Affiliation(s)
- S V S Deo
- Department of Surgical Oncology, Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi
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49
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Shukla NK, Deo SVS, Asthana S, Raina V, Dronamaraju SS. Neoadjuvant chemotherapy in advanced gastric cancer--results of a pilot study. Trop Gastroenterol 2002; 23:94-6. [PMID: 12632980] [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] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
INTRODUCTION Adenocarcinoma of the stomach is usually advanced at presentation, and local or distant spread may preclude the option of primary curative resection. Neoadjuvant chemotherapy (NAC) has shown promise in downstaging initially unresectable disease. This pilot study was planned to assess the utility of NAC using Cisplatin and 5-Fluoro uracil in the management of initially unresectable gastric cancer. PATIENTS AND METHODS Ten patients with unresectable gastric adnocarcinoma were included. They received two cycles of cisplatin, 30 mg/m2 intravenously in combination with 5-Fluoro Uracil, 1000 mg/m2. They were restaged using Endoscopy and CT scan and taken up for exploratory laparotomy. RESULTS Eight of 10 patients (80%) had an objective response to chemotherapy. Six patients (60%) with initially unresectable disease could be offered curative surgery. The median survival was 10 months (range 1-60 months). There were two long term survivors (48 and 60 months respectively). CONCLUSION Neoadjuvant chemotherapy (NAC) is an effective option in downstaging initially unresectable gastric carcinoma. Complete response to chemotherapy also predicts long term survival.
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Affiliation(s)
- N K Shukla
- Institute Rotary Cancer Hospital (IRCH), All India Institute of Medical Sciences (AIIMS), New Delhi-110 029, India.
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Gibson A, Asthana S, Brigham P, Moon G, Dicker J. Geographies of need and the new NHS: methodological issues in the definition and measurement of the health needs of local populations. Health Place 2002; 8:47-60. [PMID: 11852263 DOI: 10.1016/s1353-8292(01)00035-1] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
For a variety of purposes it is increasingly necessary to establish the health needs of local populations. Following a critique of existing proxies of need, this paper presents and evaluates an alternative which draws upon epidemiological evidence concerning the age, sex and social class distribution of morbidity in order to estimate the prevalence of specific conditions in designated populations. By way of demonstrating the insights to be gained through the use of these indicative prevalence rates, the paper considers the treatment of ischaemic heart disease in a sample of 539 practices and presents evidence regarding the significance of deprivation and rurality in determining health service use relative to needs.
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Affiliation(s)
- A Gibson
- Department of Geography, University of Exeter, Amory Building, Rennes Drive, Exeter EX4 4PN, UK.
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