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Swain M, Budrukkar A, Murthy V, Pai P, Kanoja A, Ghosh-Laskar S, Deshmukh A, Pantvaidya G, Kannan S, Patil VM, Naronha V, Prabhash K, Sinha S, Kumar A, Gupta T, Agarwal J. Contralateral Nodal Relapse in Well-lateralised Oral Cavity Cancers Treated Uniformly with Ipsilateral Surgery and Adjuvant Radiotherapy With or Without Concurrent Chemotherapy: a Retrospective Study. Clin Oncol (R Coll Radiol) 2024; 36:278-286. [PMID: 38365518 DOI: 10.1016/j.clon.2024.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 12/19/2023] [Accepted: 02/07/2024] [Indexed: 02/18/2024]
Abstract
AIMS To evaluate the incidence and pattern of contralateral nodal relapse (CLNR), contralateral nodal relapse-free survival (CLNRFS) and risk factors predicting CLNR in well-lateralised oral cavity cancers (OCC) treated with unilateral surgery and adjuvant ipsilateral radiotherapy with or without concurrent chemotherapy. MATERIALS AND METHODS Consecutive patients of well-lateralised OCC treated between 2012 and 2017 were included. The primary endpoint was incidence of CLNR and CLNRFS. Univariable and multivariable analyses were carried out to identify potential factors predicting CLNR. RESULTS Of the 208 eligible patients, 21 (10%) developed isolated CLNR at a median follow-up of 45 months. The incidence of CLNR was 21.3% in node-positive patients. CLNR was most common at level IB (61.9%) followed by level II. The 5-year CLNRFS and overall survival were 82.5% and 57.7%, respectively. Any positive ipsilateral lymph node (P = 0.001), two or more positive lymph nodes (P < 0.001), involvement of ipsilateral level IB (P = 0.002) or level II lymph node (P < 0.001), presence of extranodal extension (P < 0.001), lymphatic invasion (P = 0.015) and perineural invasion (P = 0.021) were significant factors for CLNR on univariable analysis. The presence of two or more positive lymph nodes (P < 0.001) was an independent prognostic factor for CLNR on multivariable analysis. CLNR increased significantly with each increasing lymph node number beyond two compared with node-negative patients. CONCLUSION The overall incidence of isolated CLNR is low in well-lateralised OCC. Patients with two or more positive lymph nodes have a higher risk of CLNR and may be considered for elective treatment of contralateral neck.
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Affiliation(s)
- M Swain
- Department of Radiation Oncology, Tata Memorial Hospital, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India.
| | - A Budrukkar
- Department of Radiation Oncology, Tata Memorial Hospital, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - V Murthy
- Department of Radiation Oncology, Tata Memorial Hospital, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - P Pai
- Department of Head and Neck Surgical Oncology, Tata Memorial Hospital, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - A Kanoja
- Department of Radiation Oncology, Tata Memorial Hospital, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - S Ghosh-Laskar
- Department of Radiation Oncology, Tata Memorial Hospital, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - A Deshmukh
- Department of Head and Neck Surgical Oncology, Tata Memorial Hospital, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - G Pantvaidya
- Department of Head and Neck Surgical Oncology, Tata Memorial Hospital, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - S Kannan
- Clinical Research Secretariat Advanced Centre for Treatment, Research and Education in Cancer, Tata Memorial Centre, Homi Bhabha National Institute, Kharghar, Navi, Mumbai, India
| | - V M Patil
- Department of Medical Oncology, Tata Memorial Hospital, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - V Naronha
- Department of Medical Oncology, Tata Memorial Hospital, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - K Prabhash
- Department of Medical Oncology, Tata Memorial Hospital, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - S Sinha
- Department of Radiation Oncology, Tata Memorial Hospital, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - A Kumar
- Department of Radiation Oncology, Tata Memorial Hospital, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - T Gupta
- Department of Radiation Oncology, Advanced Centre for Treatment, Research and Education in Cancer, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - J Agarwal
- Department of Radiation Oncology, Tata Memorial Hospital, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
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Gupta T, Kumar M, Kaur UJ, Rao A, Bharti R. Mapping ACE2 and TMPRSS2 co-expression in human brain tissue: implications for SARS-CoV-2 neurological manifestations. J Neurovirol 2024:10.1007/s13365-024-01206-x. [PMID: 38600308 DOI: 10.1007/s13365-024-01206-x] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Revised: 03/31/2024] [Accepted: 04/03/2024] [Indexed: 04/12/2024]
Abstract
The Coronavirus Disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) primarily targets respiratory cells, but emerging evidence shows neurological involvement, with the virus directly affecting neurons and glia. SARS-CoV-2 entry into a target cell requires co-expression of ACE2 (Angiotensin-converting enzyme-2) and TMPRSS2 (Trans membrane serine protease-2). Relevant literature on human neurological tissue is sparse and mostly focused on the olfactory areas. This prompted our study to map brain-wide expression of these entry proteins and assess age-related changes. The normal brain tissue samples were collected from cerebral cortex, hippocampus, basal ganglia, thalamus, hypothalamus, brain stem and cerebellum; and were divided into two groups - up to 40 years (n = 10) and above 40 years (n = 10). ACE2 and TMPRSS2 gene expression analysis was done using qRT-PCR and protein co-expression was seen by immunofluorescence. The ACE2 and TMPRSS2 gene expression was observed to be highest in hypothalamus and thalamus regions, respectively. Immunoreactivity for both ACE-2 and TMPRSS2 was observed in all examined brain regions, confirming the presence of these viral entry receptors. Co-localisation was maximum in hypothalamus. Our study did not find any trend related to different age groups. The expression of both these viral entry receptors suggests that normal human brain is susceptibility to SARS-CoV-2, perhaps which could be related to the cognitive and neurological impairment that occur in patients.
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Affiliation(s)
- Tulika Gupta
- Department of Anatomy, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
| | - Munish Kumar
- Division of Neuro-anesthesia, Department of Anesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ujjwal Jit Kaur
- Department of Anatomy, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Asha Rao
- Department of Anatomy, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ranjana Bharti
- Department of Anatomy, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Gupta T, Eckstrand KL, Lenniger CJ, Haas GL, Silk JS, Ryan ND, Phillips ML, Flores LE, Pizzagalli DA, Forbes EE. Anhedonia in adolescents at transdiagnostic familial risk for severe mental illness: Clustering by symptoms and mechanisms of association with behavior. J Affect Disord 2024; 347:249-261. [PMID: 37995926 PMCID: PMC10843785 DOI: 10.1016/j.jad.2023.11.062] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 11/07/2023] [Accepted: 11/17/2023] [Indexed: 11/25/2023]
Abstract
BACKGROUND Anhedonia is a transdiagnostic symptom of severe mental illness (SMI) and emerges during adolescence. Possible subphenotypes and neural mechanisms of anhedonia in adolescents at risk for SMI are understudied. METHODS Adolescents at familial risk for SMI (N = 81) completed anhedonia (e.g., consummatory, anticipatory, social), demographic, and clinical measures and one year prior, a subsample (N = 46) completed fMRI scanning during a monetary reward task. Profiles were identified using k-means clustering of anhedonia type and differences in demographics, suicidal ideation, impulsivity, and emotional processes were examined. Moderation analyses were conducted to investigate whether levels of brain activation of reward regions moderated the relationships between anhedonia type and behaviors. RESULTS Two-clusters emerged: a high anhedonia profile (high-anhedonia), characterized by high levels of all types of anhedonia, (N = 32) and a low anhedonia profile (low-anhedonia), characterized by low levels of anhedonia types (N = 49). Adolescents in the high-anhedonia profile reported more suicidal ideation and negative affect, and less positive affect and desire for emotional closeness than low-anhedonia profile. Furthermore, more suicidal ideation, less positive affect, and less desire for emotional closeness differentiated the familial high-risk, high-anhedonia profile adolescents from the familial high-risk, low-anhedonia profile adolescents. Across anhedonia profiles, moderation analyses revealed that adolescents with high dmPFC neural activation in response to reward had positive relationships between social, anticipatory, and consummatory anhedonia and suicidal ideation. LIMITATIONS Small subsample with fMRI data. CONCLUSION Profiles of anhedonia emerge transdiagnostically and vary on clinical features. Anhedonia severity and activation in frontostriatal reward areas have value for clinically important outcomes such as suicidal ideation.
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Affiliation(s)
- T Gupta
- University of Pittsburgh, Department of Psychiatry, Pittsburgh, PA, USA.
| | - K L Eckstrand
- University of Pittsburgh, Department of Psychiatry, Pittsburgh, PA, USA
| | - C J Lenniger
- University of Pittsburgh, Department of Psychology, Pittsburgh, PA, USA
| | - G L Haas
- University of Pittsburgh, Department of Psychiatry, Pittsburgh, PA, USA; University of Pittsburgh, Department of Psychology, Pittsburgh, PA, USA; VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
| | - J S Silk
- University of Pittsburgh, Department of Psychiatry, Pittsburgh, PA, USA; University of Pittsburgh, Department of Psychology, Pittsburgh, PA, USA
| | - N D Ryan
- University of Pittsburgh, Department of Psychiatry, Pittsburgh, PA, USA
| | - M L Phillips
- University of Pittsburgh, Department of Psychiatry, Pittsburgh, PA, USA
| | - L E Flores
- Queens University, Department of Psychology, Kingston, Ontario, CA, USA
| | - D A Pizzagalli
- Harvard Medical School and McLean Hospital, Department of Psychiatry, Boston, MA, USA
| | - E E Forbes
- University of Pittsburgh, Department of Psychiatry, Pittsburgh, PA, USA; University of Pittsburgh, Department of Psychology, Pittsburgh, PA, USA; University of Pittsburgh, Department of Pediatrics, Pittsburgh, PA, USA; University of Pittsburgh, Department of Clinical and Translational Science, Pittsburgh, PA, USA
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Narayan V, Kumar M, Mahajan S, Ganesh V, Luthra A, Gupta T, Rawat A, Singh A, Vyas S, Narayanan V, Depuru A, Kaur K, Panda N, Bhagat H. The Role of Serum Matrix Metalloproteinase-9 as a Predictor of Delayed Cerebral Ischemia in Patients with Aneurysmal Subarachnoid Hemorrhage. J Mol Neurosci 2024; 74:18. [PMID: 38315311 DOI: 10.1007/s12031-024-02194-7] [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: 11/08/2023] [Accepted: 01/26/2024] [Indexed: 02/07/2024]
Abstract
Delayed cerebral ischemia (DCI) is one of the major causes of a poor neurological outcome following aneurysmal subarachnoid hemorrhage (aSAH). Several biomarkers, including matrix metalloproteinase-9 (MMP-9), have been evaluated to predict the development of DCI for timely management. This prospective cohort study was done on 98 patients with aSAH presenting within 72 h of the ictus. Serum samples were collected preoperatively, 7 days after ictus, 10 days after ictus, or when the patient developed DCI, whichever was earlier. The primary objective was to correlate the serum MMP-9 levels with the development of DCI. The secondary objectives were to correlate the serum MMP-9 levels with sonographic vasospasm and the neurological outcome. There was no correlation between the serum MMP-9 levels and the development of DCI (p = 0.37). Similarly, there was no correlation between the serum MMP-9 levels and the sonographic vasospasm (0.05) nor with the modified Rankin Scale (mRS) at discharge (p = 0.27), mRS at 3 months (p = 0.22), and Glasgow Outcome Scale Extended (GOSE) at 3 months (p = 0.15). Serum MMP-9 levels do not predict the development of DCI following aSAH.
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Affiliation(s)
- Vinitha Narayan
- Department of Anesthesia and Intensive Care 4th Floor, Nehru Hospital PGIMER, Sector 12, Chandigarh, 160012, India
| | - Munish Kumar
- Department of Anesthesia and Intensive Care 4th Floor, Nehru Hospital PGIMER, Sector 12, Chandigarh, 160012, India
| | - Shalvi Mahajan
- Department of Anesthesia and Intensive Care 4th Floor, Nehru Hospital PGIMER, Sector 12, Chandigarh, 160012, India
| | - Venkata Ganesh
- Department of Anesthesia and Intensive Care 4th Floor, Nehru Hospital PGIMER, Sector 12, Chandigarh, 160012, India
| | - Ankur Luthra
- Department of Anesthesia and Intensive Care 4th Floor, Nehru Hospital PGIMER, Sector 12, Chandigarh, 160012, India
| | - Tulika Gupta
- Department of Anatomy, PGIMER, Chandigarh, India
| | - Amit Rawat
- Department of Pediatric Immunology, PGIMER, Chandigarh, India
| | | | - Sameer Vyas
- Department of Radiodiagnosis, PGIMER, Chandigarh, India
| | - Vidhya Narayanan
- Department of Anesthesia, Sree Balaji Medical College and Hospital, Chennai, Tamil Nadu, India
| | | | - Kirandeep Kaur
- Department of Anesthesia and Intensive Care 4th Floor, Nehru Hospital PGIMER, Sector 12, Chandigarh, 160012, India
| | - Nidhi Panda
- Department of Anesthesia and Intensive Care 4th Floor, Nehru Hospital PGIMER, Sector 12, Chandigarh, 160012, India
| | - Hemant Bhagat
- Department of Anesthesia and Intensive Care 4th Floor, Nehru Hospital PGIMER, Sector 12, Chandigarh, 160012, India.
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Gupta T, Bowles P, Bhutta MF. Effectiveness, perceptions and environmental benefits of remote consultation for adults referred with recurrent tonsillitis. Ann R Coll Surg Engl 2024; 106:173-177. [PMID: 36779457 PMCID: PMC10830344 DOI: 10.1308/rcsann.2022.0098] [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] [Accepted: 06/27/2022] [Indexed: 02/14/2023] Open
Abstract
INTRODUCTION We evaluate remote consultation for adult patients referred with recurrent sore throat, measuring the effectiveness of the consultation, satisfaction and environmental impact. METHODS Eligible patients were invited to telephone clinics, undertaking a satisfaction survey after consultation, focusing on perceived convenience, satisfaction, cost and travel arrangements (used to calculate potential environmental benefit). Provider opinion was also captured. RESULTS Forty-eight of 60 patients attended, with 38 (63%) eligible for inclusion. Thirty-six of these 38 patients (95%) had a definitive outcome of tonsillectomy (27/38) or discharge (9/38). Thirty-three of the 38 patients (87%) responded to the survey and reported high satisfaction in all arms of questioning (mean Likert ranking = 4.7/5). A mean of 3.76 hours of missed work and 5.17kg carbon dioxide emission equivalents were saved per patient. Provider responses were positive towards ongoing remote consultation use. CONCLUSIONS Telephone consultation for adult patients considered for tonsillectomy is convenient to patients in terms of cost and time, reduces environmental harm and is associated with high patient and provider satisfaction.
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Affiliation(s)
- T Gupta
- University Hospitals Sussex NHS Foundation Trust, UK
| | - P Bowles
- University Hospitals Sussex NHS Foundation Trust, UK
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Shekhawat D, Gupta T, Singh P, Sahni D, Tubbs RS, Gupta SK. Surgical anatomy of the cerebellar tonsils: A cadaveric study. Clin Anat 2024; 37:25-32. [PMID: 37248820 DOI: 10.1002/ca.24075] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 05/18/2023] [Indexed: 05/31/2023]
Abstract
BACKGROUND Knowledge of the normal anatomy of the cerebellar tonsils is a prerequisite in various surgeries of the posterior cranial fossa Clinical conditions, as the Chiari I malformations (CIM) alter the normal position of the cerebellar tonsils. OBJECTIVE Therefore, we aim to better elucidate the surgical anatomy of and around the cerebellar tonsils in regard to the CIM. METHODS Fifty formalin-fixed adult cadavers injected with colored latex through vertebral arteries underwent craniotomy and durotomy to expose the cerebellar tonsils and related structures. The tonsils and their surrounding anatomy were then studied. RESULTS Forty cerebellar tonsils were at or above the foramen magnum. Five specimens presented with CIM with the tonsils below (3-5 mm) the FM with a mean tonsillar decent of 7.9 ± 2.3 mm. Of the cadavers without CIM, in forty-two cases, the thickness of the dura mater was within ±3SD ranges. In three cases, the dura mater was thinner at the CVJ and one case; the dura adhered tightly to the inner aspect of the occipital squama. In five CIM cadavers, the dura mater was markedly thicker at the CVJ. The PICA caudal loop was 5.9 ± 1.6 mm long. In CIM cases, the PICA loop was longer, nearer the dura, 1 mm below the superior border of the C1 posterior arch. The distances from the PICA loop were markedly reduced by 3 mm from the spinal accessory nerve and 2 mm from the first spinal nerve. The DN was significantly closer to the tonsillar peduncle in CIM cases. CONCLUSION These data are important for better understanding the intrinsic and extrinsic anatomy of the cerebellar tonsils in patients with and without CIM. Importantly, tonsillectomy/tonsillar coagulation must consider the close relationship of the dentate nucleus to the base of the cerebellar tonsil to avoid iatrogenic injury.
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Affiliation(s)
- Devendra Shekhawat
- Department of Anatomy, Post graduate Institute of Medical Education & Research, Chandigarh, India
- Department of Neurosurgery, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Tulika Gupta
- Department of Anatomy, Post graduate Institute of Medical Education & Research, Chandigarh, India
| | - Paramajeet Singh
- Department of Radiodiagnosis, Post graduate Institute of Medical Education & Research, Chandigarh, India
| | - Daisy Sahni
- Department of Anatomy, Post graduate Institute of Medical Education & Research, Chandigarh, India
| | - R Shane Tubbs
- Department of Neurosurgery, Tulane University School of Medicine, New Orleans, Louisiana, USA
- Department of Neurology, Tulane University School of Medicine, New Orleans, Louisiana, USA
- Department of Structural & Cellular Biology, Tulane University School of Medicine, New Orleans, Louisiana, USA
- Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana, USA
- Department of Anatomical Sciences, St. George's University, St. George's, Grenada
- Department of Neurosurgery and Ochsner Neuroscience Institute, Ochsner Health System, New Orleans, Louisiana, USA
- Brisbane Clinical Neuroscience Centre, University of Queensland, Brisbane, Australia
| | - S K Gupta
- Department of Neurosurgery, Post graduate Institute of Medical Education & Research, Chandigarh, India
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Gulati S, Tripathy S, Gupta T, Gaba S. Facial nerve communication with ansa cervicalis - An unusual anatomical variation. J Postgrad Med 2024; 70:60-63. [PMID: 38037772 PMCID: PMC10947731 DOI: 10.4103/jpgm.jpgm_454_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Revised: 08/03/2023] [Accepted: 08/14/2023] [Indexed: 12/02/2023] Open
Abstract
Neural connections of the seventh cranial nerve with its neighboring nerves are common and well documented; however, communication with ansa cervicalis is as yet unknown. We present a case with such a connection found during cadaveric dissection, with hitherto unknown consequences. In this specimen, after giving the marginal mandibular and cervical branches, the cervicofacial division continued distally to communicate with the distal loop of ansa cervicalis. Presence of such connection may result in facial muscle paralysis on injury to the ansa or strap muscle paralysis on injury to the facial nerve, depending on the direction of nerve fibers. Such unusual connections bring to light the need for extreme care during surgeries in the neck to safeguard any such connections and when using the ansa as donor.
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Affiliation(s)
- S Gulati
- Department of Plastic Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - S Tripathy
- Department of Plastic Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - T Gupta
- Department of Anatomy, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - S Gaba
- Department of Plastic Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Gupta T, Kaur M, Gupta M, Singla N, Kharbanda PS, Bansal YS, Radotra BD, Gupta SK. Analysis of distribution and localization of proteins of the reelin signalling pathway in mesial temporal lobe epilepsy. Int J Neurosci 2023:1-15. [PMID: 38060511 DOI: 10.1080/00207454.2023.2292957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 12/02/2023] [Indexed: 12/17/2023]
Abstract
INTRODUCTION Granule cell dispersion (GCD) is pathognomonic of hippocampal sclerosis seen in the mesial temporal lobe epilepsy (MTLE). Current animal studies indicate deficiency of Reelin is associated with abnormal granule cell migration leading to GCD. The present study aimed to evaluate complete Reelin signalling pathway to assess whether Reelin deficiency is related to MTLE. MATERIALS AND METHODS Hippocampal sclerosis was confirmed by H and E stain. To explore the amount and cellular location of the Reelin cascade molecules, the hippocampal tissues from MTLE surgery and controls (n = 15 each) were studied using Immuno-histochemistry (IHC). Additionally, confocal imaging was used to validate the IHC findings by co-localization of different proteins. Quantification of IHC images was performed using histo-score and confocal images by Image J software. RESULTS Immune expression of active Reelin was significantly reduced in patients. Reelin receptors were deranged, apolipoprotein E receptor 2 was increased while very low-density lipoprotein receptor was reduced. Disabled-1, a downstream molecule was significantly reduced in MTLE. Its ultimate target, cofilin was thus disinhibited and expressed more in MTLE. Reelin cleaving protease, matrix metalloprotease-9 (MMP-9) and MMP-9 inhibitor, tissue inhibitor of matrix protease-1, showed reduced expression in extracellular matrix. Semi-quantification of immunohistochemistry was done using Histo (H) score. H score of Reelin in diseased patients was 15 against 125 for control patients. These results were validated by confocal fluorescence microscopy. CONCLUSIONS Reelin signalling cascade was deranged in chronic MTLE. Pharmacological manipulation of Reelin cascade can be done at various levels and it may provide novel treatment options for MTLE.
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Affiliation(s)
- Tulika Gupta
- Department of Anatomy, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Mandeep Kaur
- Department of Anatomy, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Mili Gupta
- Department of Biochemistry, Dr. Harvansh Singh Judge Institute of Dental Sciences and Hospital, Panjab University, Chandigarh, India
| | - Navneet Singla
- Department of Neurosurgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Parampreet S Kharbanda
- Department of Neurology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Yogender S Bansal
- Department of Forensic Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - B D Radotra
- Department of Histopathology Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - S K Gupta
- Department of Neurosurgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Gupta T, Ali Y, Sudan S, Bowles PFD. Injection medialisation laryngoplasty: an alternative approach for challenging cases. J Laryngol Otol 2023; 137:1406-1408. [PMID: 36683388 DOI: 10.1017/s0022215123000038] [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] [Indexed: 01/24/2023]
Abstract
OBJECTIVE Conventional injection medialisation laryngoplasty techniques may be compromised by patient-specific factors such as marked kyphosis, an anteriorly positioned larynx or intolerance to nasendoscopy. This paper describes a technique for successful injection medialisation laryngoplasty where conventional methods are precluded, in an 88-year-old man with presbyphonia on a background of Parkinson's disease. METHODS After induction of general anaesthesia, a transoral introducing needle, shaped by tactile manipulation to match the curvature of a 'C-MAC' intubating video-laryngoscope 'D-blade' attachment, was introduced until visible above the glottis. The implant material was then injected into the paraglottic space as normal until satisfactory medialisation of the vocal fold was achieved. RESULTS When reviewed in the out-patient clinic four weeks later, the patient's post-operative Voice Handicap Index score fell to 6, from a pre-operative score of 21. CONCLUSION By utilising commonly available equipment and anaesthetic support to recreate the views and access conventional nasendoscopy and laryngoscopy facilitate, this novel procedure provides a viable and proven alternative in uncommon but challenging cases.
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Affiliation(s)
- T Gupta
- ENT, Royal Sussex County Hospital, Brighton, UK
| | - Y Ali
- Anaesthetics, Royal Sussex County Hospital, Brighton, UK
| | - S Sudan
- Anaesthetics, Royal Sussex County Hospital, Brighton, UK
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Baviskar Y, Likonda B, Pant S, Mokal S, Pawar A, Dasgupta A, Chatterjee A, Gupta T. Short-course Palliative Hypofractionated Radiotherapy in Patients with Poor-prognosis High-grade Glioma: Survival and Quality of Life Outcomes from a Prospective Phase II Study. Clin Oncol (R Coll Radiol) 2023; 35:e573-e581. [PMID: 37455146 DOI: 10.1016/j.clon.2023.07.001] [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] [Received: 02/17/2023] [Revised: 04/11/2023] [Accepted: 07/07/2023] [Indexed: 07/18/2023]
Abstract
AIMS To report longitudinal quality of life (QoL) outcomes and survival in patients with poor-prognosis high-grade glioma (HGG) treated with palliative hypofractionated radiotherapy. MATERIALS AND METHODS Patients with poor-prognosis HGG were accrued on a prospective study of short-course palliative hypofractionated radiotherapy (35 Gy/10 fractions/2 weeks). The European Organization for Research and Treatment of Cancer QoL core questionnaire (QLQ-C30) and brain cancer module (BN20) were used in English or validated Indian vernacular languages (Hindi and Marathi) for QoL assessment at baseline (before radiotherapy), the conclusion of radiotherapy, 1 month post-radiotherapy and subsequently at 3-monthly intervals until disease progression/death. Baseline QoL scores were compared with corresponding scores from a historical HGG cohort. Summary QoL scores were compared longitudinally over time by related samples Friedman's two-way test. Progression-free survival and overall survival were calculated using the Kaplan-Meier method and reported as 1-year estimates with 95% confidence intervals. RESULTS Forty-nine (89%) of 55 patients completed the planned course of hypofractionated radiotherapy. Longitudinal QoL data were available in 42 (86%) of 49 patients completing radiotherapy, comprising the present cohort. The median age of included patients, comprised mainly of glioblastoma patients (81%), was 57 years, with an interquartile range (IQR) of 50-66 years and a median baseline Karnofsky score of 60 (IQR = 50-60). Baseline QoL scores were significantly worse for several domains compared with a historical institutional cohort of HGG patients treated previously with conventionally fractionated radiotherapy, indicating negative selection bias. QoL scores remained stable for most domains after palliative hypofractionated radiotherapy, with statistically significant improvements in fatigue (P = 0.032), dyspnoea (P = 0.042) and motor dysfunction (P = 0.036) over time. At a median follow-up of 8 months, Kaplan-Meier estimates of 1-year progression-free survival and overall survival were 33.3% (95% confidence interval 21.7-51.1%) and 38.1% (95% confidence interval 25.9-56%), respectively. CONCLUSION Short-course palliative hypofractionated radiotherapy in patients with poor-prognosis HGG is associated with stable and/or improved QoL scores in several domains, making it a viable resource-sparing regimen.
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Affiliation(s)
- Y Baviskar
- Department of Radiation Oncology, Tata Memorial Hospital (TMH)/Advanced Centre for Treatment Research and Education in Cancer (ACTREC), Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - B Likonda
- Department of Radiation Oncology, Tata Memorial Hospital (TMH)/Advanced Centre for Treatment Research and Education in Cancer (ACTREC), Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - S Pant
- Department of Radiation Oncology, Tata Memorial Hospital (TMH)/Advanced Centre for Treatment Research and Education in Cancer (ACTREC), Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - S Mokal
- Department of Clinical Research Secretariat, Tata Memorial Hospital (TMH)/Advanced Centre for Treatment Research and Education in Cancer (ACTREC), Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - A Pawar
- Department of Clinical Research Secretariat, Tata Memorial Hospital (TMH)/Advanced Centre for Treatment Research and Education in Cancer (ACTREC), Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - A Dasgupta
- Department of Radiation Oncology, Tata Memorial Hospital (TMH)/Advanced Centre for Treatment Research and Education in Cancer (ACTREC), Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - A Chatterjee
- Department of Radiation Oncology, Tata Memorial Hospital (TMH)/Advanced Centre for Treatment Research and Education in Cancer (ACTREC), Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - T Gupta
- Department of Radiation Oncology, Tata Memorial Hospital (TMH)/Advanced Centre for Treatment Research and Education in Cancer (ACTREC), Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India.
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Gupta T, Munawara R, Kaur M, Ram K, Rao A, Gupta S, Gupta SK. Central myelin-peripheral myelin junction in trigeminal, facial, and vestibulocochlear nerve: A histo-morphometric study. Ann Anat 2023; 250:152128. [PMID: 37399929 DOI: 10.1016/j.aanat.2023.152128] [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: 04/26/2023] [Accepted: 06/14/2023] [Indexed: 07/05/2023]
Abstract
BACKGROUND The study aimed to locate the central myelin and peripheral myelin junction (CNS PNS Junction, CPJ) in trigeminal, facial and vestibulocochlear nerves. METHODS The cisternal segments of the nerves were cut from the brainstem to the proximal margin of trigeminal ganglia (trigeminal nerve) and internal acoustic meatus (facial and vestibulocochlear nerve) from cadavers. Horizontal sections of H&E stained slides were analysed and histo morphometry was performed. The CPJ was confirmed by immunohistochemistry using monoclonal myelin basic protein antibody. RESULTS The mean length of the trigeminal, facial and vestibulocochlear nerves were 13.6 ± 3.1 mm, 12.4 ± 1.9 mm and 11.5 ± 2.0 mm respectively; mean length of the centrally myelinated segment at the point of maximum convexity was 4.1 ± 1.5 mm, 3.7 ± 1.6 mm, 3.6 ± 1.4 mm respectively. Six different patterns were observed fortheCPJ.Utilizing the derived values, the CPJwas located at a distance of 18 - 48% and 17 - 61% of the total length of the nerve in all the cases in trigeminal and facial nerve respectively. In vestibulocochlear nerve, it was located at a distance of about 13 - 54% of the total length of the nerve. CONCLUSIONS The location of the CPJ in the vestibulocochlear nerve was midway between the brainstem and internal acoustic meatus which is a novel observation.For all the nerves, the CPJ was located either at or before the half way along the length of the nerve in huge majority (97%); never crossing the 60% of the nerve length.
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Affiliation(s)
- Tulika Gupta
- Department of Anatomy, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India.
| | - Rafika Munawara
- Department of Anatomy, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Mandeep Kaur
- Department of Anatomy, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Kalu Ram
- Department of Anatomy, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Asha Rao
- Department of Anatomy, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Shivani Gupta
- Department of Anatomy, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Sunil Kumar Gupta
- Department of Neurosurgery, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
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Sushant S, Sharma DN, Pandey R, Saini SK, Sanyal S, Pattanaik J, Samala SK, Praveen DVS, Tanwar MS, Pandey S, Mandal S, Solanky AP, Sisodiya R, Ghosh A, Dagar A, Shukla BD, Gupta T, Gupta S, Rana P, Mounika G. Multiple Sessions vs. Single Session Image-Based Intracavitary Brachytherapy for Locally Advanced Cervical Cancer: A Randomized Control Trial. Int J Radiat Oncol Biol Phys 2023; 117:S41-S42. [PMID: 37784495 DOI: 10.1016/j.ijrobp.2023.06.314] [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 objectives of this study are: 1) To compare the acute toxicity caused in the treatment of locally advanced cervical cancer (LACC) treated with weekly multiple applications vs. a single application for image-guided intracavitary High Dose Rate (HDR) brachytherapy (BT) after External Beam Radiation Therapy (EBRT) 2) To compare the loco-regional control of cancer at six months in the two arms MATERIALS/METHODS: In a prospective study, 40 patients with biopsy-proven LACC with FIGO-2018 stage IIB-IIIC1 disease, underwent EBRT to the pelvis at a dose of 50.4 Gy/ 28 fractions over 5.5 weeks with weekly concurrent cisplatin. After completion of EBRT, they were randomized into two arms with 20 patients each. In the Control arm (Arm-A), BT sessions were given with weekly 3 applications whereas, in the experimental arm (Arm-B), all the sessions were given with a single application at 6-12 hours intervals with aim of the high-risk clinical target volume receiving >80 Gy EQD2 and 2 cm3 of the bladder and rectum/sigmoid receiving <85 Gy and <75 Gy, respectively. The OAR contouring was done on CT RESULTS: All 40 patients were treated as per protocol. The mean duration of treatment including EBRT and BT was 73.15 days [95% CI 68.63-77.66] in Arm A and 55.85 days [95% CI 52.11-59.58] in Arm B which was significant. After 6 months, 37 patients came for follow-up, all 19 patients in Arm A had Grade 1 or Grade 2 rectal toxicity. In Arm B as well all 18 patients had Grade 1 or Grade 2 rectal toxicity. Bladder toxicity was Grade 1 or Grade 2 in 18 patients and Grade 3 severity in 1 patient among Arm A. Among 18 patients of Arm B, bladder toxicity of Grade 1 or Grade 2 was seen in 16 patients, and 2 patients had grade 3 toxicity. 2 patients in Arm A and 3 in Arm B complained of Grade 1 urinary incontinence. Moreover, Abdominal pain at 6 months was of Grade 1 in around 6 patients in Arm A but 14 patients had abdominal pain in Arm B which was of Grade 1 in 8, 4 had grade 2 and 2 patients had grade 3 severity abdominal pain. In the monthly analysis of acute toxicity, none of the patients showed Grade 3 or 4 toxicity at the 1st, 2nd, or 3rd month of completion of treatment. When comparing local control in both arms at 6 months, 2 patients had treatment failure in the Experimental Arm compared to only 1 patient in the Control Arm CONCLUSION: Single Application Multiple Fraction Intracavitary Brachytherapy post concurrent CTRT is a safe option for the treatment of locally advanced cervical cancer. When compared to the weekly application arm, single-application ICRT showed a comparable acute toxicity profile and comparable local control rates as well. Some patients in Single Application Arm showed abdominal pain which needs to be investigated with further trials. The overall treatment time in the single application arm is significantly lower than the standard weekly application arm.
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Affiliation(s)
- S Sushant
- All India Institute of Medical Sciences, New Delhi, India
| | - D N Sharma
- All India Institute of Medical Sciences, New Delhi, India
| | - R Pandey
- All India Institute of Medical Sciences, New Delhi, India
| | - S K Saini
- All India Institute of Medical Sciences, New Delhi, India
| | - S Sanyal
- All India Institute of Medical Sciences, New Delhi, India
| | - J Pattanaik
- All India Institute of Medical Sciences, New Delhi, India
| | - S K Samala
- All India Institute of Medical Sciences, New Delhi, India
| | - D V S Praveen
- All India Institute of Medical Sciences, New Delhi, India
| | - M S Tanwar
- All India Institute of Medical Sciences, New Delhi, India
| | - S Pandey
- All India Institute of Medical Sciences, New Delhi, India
| | - S Mandal
- All India Institute of Medical Sciences, New Delhi, India
| | - A P Solanky
- All India Institute of Medical Sciences, New Delhi, India
| | - R Sisodiya
- All India Institute of Medical Sciences, New Delhi, India
| | - A Ghosh
- National Cancer Institute, AIIMS, Jhajjar, India
| | - A Dagar
- National Cancer Institute, AIIMS, Jhajjar, India
| | - B D Shukla
- All India Institute of Medical Sciences, New Delhi, India
| | - T Gupta
- All India Institute of Medical Sciences, New Delhi, India
| | - S Gupta
- All India Institute of Medical Sciences, New Delhi, India
| | - P Rana
- All India Institute of Medical Sciences, New Delhi, India
| | - G Mounika
- All India Institute of Medical Sciences, New Delhi, India
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Kaur M, Gupta T, Gupta M, Singla N, Kharbanda PS, Bansal YS, Sahni D, Radotra BD, Gupta SK. Expressional Study of Permeability Glycoprotein and Multidrug Resistance Protein 1 in Drug-resistant Mesial Temporal Lobe Epilepsy. Basic Clin Neurosci 2023; 14:615-630. [PMID: 38628830 PMCID: PMC11016880 DOI: 10.32598/bcn.2021.2554.3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 08/09/2021] [Accepted: 07/27/2023] [Indexed: 04/19/2024] Open
Abstract
Introduction About 30% of patients with epilepsy do not respond to anti-epileptic drugs, leading to refractory seizures. The pathogenesis of drug-resistance in mesial temporal lobe epilepsy (MTLE) is not completely understood. Increased activity of drug-efflux transporters might be involved, resulting in subclinical concentrations of the drug at the target site. The major drug-efflux transporters are permeability glycoprotein (P-gp) and multidrug-resistance associated protein-1 (MRP-1). The major drawback so far is the expressional analysis of transporters in equal numbers of drug-resistant epileptic tissue and age-matched non-epileptic tissue. Methods We have studied P-gp and MRP-1 drug-efflux transporters in the sclerotic hippocampal tissues resected from the epilepsy surgery patients (n=15) and compared their expression profile with the tissues resected from non-epileptic autopsy cases (n=15). Results Statistically significant over expression of both P-gp (P<0.0001) and MRP-1 (P=0.01) at gene and protein levels were found in the MTLE cases. The fold change of P-gp was more pronounced than MRP-1. Immunohistochemistry of the patient group showed increased immunoreactivity of P-gp at blood-brain barrier and increased reactivity of MRP-1 in the parenchyma. The results were confirmed by confocal immunofluorescence microscopy. Conclusion Our results suggested that P-gp in association with MRP-1 might be responsible for the multi-drug resistance in epilepsy. P-gp and MRP-1 could be important determinants of bio availability and tissue distribution of anti-epileptic drugs in the brain which can pharmacologically inhibited to achieve optimal drug penetration to target site.
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Affiliation(s)
- Mandeep Kaur
- Department of Anatomy, Institute of Medical Education and Research, Chandigarh, India
| | - Tulika Gupta
- Department of Anatomy, Institute of Medical Education and Research, Chandigarh, India
| | - Mili Gupta
- Department of Biochemistry, Singh Judge Institute of Dental Sciences and Hospital, Panjab University, Chandigarh, India
| | - Navneet Singla
- Department of Neurosurgery, Institute of Medical Education and Research, Chandigarh, India
| | | | - Yogender Singh Bansal
- Department of Forensic Medicine, Institute of Medical Education and Research, Chandigarh, India
| | - Daisy Sahni
- Department of Anatomy, Institute of Medical Education and Research, Chandigarh, India
| | - Bishan Das Radotra
- Department of Histopathology, Institute of Medical Education and Research, Chandigarh, India
| | - Sunil Kumar Gupta
- Department of Neurosurgery, Institute of Medical Education and Research, Chandigarh, India
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Kumar M, Patel K, Chinnapparaj S, Sharma T, Aggarwal A, Singla N, Karthigeyan M, Singh A, Sahoo SK, Tripathi M, Takkar A, Gupta T, Pal A, Attri SV, Bansal YS, Ratho RK, Gupta SK, Khullar M, Vashishta RK, Mukherjee KK, Grover VK, Prasad R, Chatterjee A, Gowda H, Bhagat H. Dysregulated Genes and Signaling Pathways in the Formation and Rupture of Intracranial Aneurysm. Transl Stroke Res 2023:10.1007/s12975-023-01178-w. [PMID: 37644376 DOI: 10.1007/s12975-023-01178-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 03/21/2023] [Accepted: 07/10/2023] [Indexed: 08/31/2023]
Abstract
Intracranial aneurysm (IA) has the potential to rupture. Despite scientific advances, we are still not in a position to screen patients for IA and identify those at risk of rupture. It is critical to comprehend the molecular basis of disease to facilitate the development of novel diagnostic strategies. We used transcriptomics to identify the dysregulated genes and understand their role in the disease biology. In particular, RNA-Seq was performed in tissue samples of controls, unruptured IA, and ruptured IA. Dysregulated genes (DGs) were identified and analyzed to understand the functional aspects of molecules. Subsequently, candidate genes were validated at both transcript and protein level. There were 314 DGs in patients with unruptured IA when compared to control samples. Out of these, SPARC and OSM were validated as candidate molecules in unruptured IA. PI3K-AKT signaling pathway was found to be an important pathway for the formation of IA. Similarly, 301 DGs were identified in the samples of ruptured IA when compared with unruptured IAs. CTSL was found to be a key candidate molecule which along with Hippo signaling pathway may be involved in the rupture of IA. We conclude that activation of PI3K-AKT signaling pathway by OSM along with up-regulation of SPARC is important for the formation of IA. Further, regulation of Hippo pathway through PI3K-AKT signaling results in the down-regulation of YAP1 gene. This along with up-regulation of CTSL leads to further weakening of aneurysm wall and its subsequent rupture.
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Affiliation(s)
- Munish Kumar
- Division of Neuro-anesthesia, Department of Anesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Krishna Patel
- Institute of Bioinformatics, International Tech Park, Bangalore, India
| | - Shobia Chinnapparaj
- Division of Neuro-anesthesia, Department of Anesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Tanavi Sharma
- Division of Neuro-anesthesia, Department of Anesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ashish Aggarwal
- Department of Neurosurgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Navneet Singla
- Department of Neurosurgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Madhivanan Karthigeyan
- Department of Neurosurgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Apinderpreet Singh
- Department of Neurosurgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sushanta Kumar Sahoo
- Department of Neurosurgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Manjul Tripathi
- Department of Neurosurgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Aastha Takkar
- Department of Neurology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Tulika Gupta
- Department of Anatomy, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Arnab Pal
- Department of Biochemistry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Savita Verma Attri
- Pediatric Biochemistry, Department of Pediatrics, Advanced Pediatrics Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Yogender Singh Bansal
- Department of Forensic Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Radha Kanta Ratho
- Department of Virology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sunil K Gupta
- Department of Neurosurgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Madhu Khullar
- Department of Experimental Medicine and Biotechnology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Rakesh Kumar Vashishta
- Department of Histopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Kanchan Kumar Mukherjee
- Department of Neurosurgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Vinod Kumar Grover
- Division of Neuro-anesthesia, Department of Anesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Rajendra Prasad
- Department of Biochemistry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Aditi Chatterjee
- Institute of Bioinformatics, International Tech Park, Bangalore, India
| | - Harsha Gowda
- Institute of Bioinformatics, International Tech Park, Bangalore, India
| | - Hemant Bhagat
- Division of Neuro-anesthesia, Department of Anesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
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Labrada L, Mazurek J, Haeffele C, Weingarten A, Gupta T, Menachem J. Shone's Complex: Not So ‘Simple’ after All. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.482] [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: 04/05/2023] Open
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Gupta T, Kharodi C, Cheema N. Morphometry and anatomical variations of the inferior oblique muscle as relevant to the strabismus surgeries. Strabismus 2023; 31:17-25. [PMID: 36755440 DOI: 10.1080/09273972.2023.2168706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
Effective outcome of inferior oblique (IO) corrective surgeries demands a detailed knowledge of morphometry and variations of IO. Our aim was to study and morphometrically define the surgical anatomy of the IO muscle and its variations. Also to provide easily identifiable surgical coordinates to locate, the IO origin and the oculomotor nerve entry point into the IO. Dissection was performed on 16 cadaveric orbits. IO anatomy, variations, morphometry and relevant surgical distances were measured using digital caliper. IO with multiple bellies was found in five specimens. The IO mean length was 33.1 ± 3.3 mm, width at origin was 3.1 ± 0.6 mm, and width at insertion was 8.8 ± 1.5 mm. For easy localization of origin, its distance from the palpable landmarks, Zygomatico-maxillary suture and fronto-maxillary suture was measured. The mean distance between IO and the optic nerve was 10 mm. Distance of the nerve to inferior oblique entry point to the origin and insertion of the inferior oblique was measured. The nerve to IO was 28 mm long. The mean distance of the nerve entry point to IO origin was 15.5 ± 2.3 mm and distance to IO insertion was 15.2 ± 2.8 mm. A muscular bridge between the Inferior rectus (IR) & IO was found in one case, affecting ~¼ of the IO length; the distal end of the bridge was 5 mm from the IO insertion. Origin of the IO can be localized on the orbital surface of maxilla, 1-2 cm from the point where zygomatico-maxillary suture cuts the inferior orbital margin and 1-2 cm from the fronto-maxillary suture. In 19% of the orbits, the IO length was less than 30 mm, which may cause traction injury in muscle transposition procedures. The width at insertion is useful as most corrective surgeries are performed at the insertion site. The nerve to IO consistently entered at the center of medial border. The nerve entry point is important surgically as myectomy is performed between it and the insertion point. The safe distance available from the optic nerve was 7 mm. Detailed morphometry of IO may aid surgeons in better surgical planning and execution.
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Affiliation(s)
- Tulika Gupta
- Department of Anatomy, Post Graduate Institute of Medical Education and Research, Chandigarh
| | - Chetan Kharodi
- Department of Anatomy, Post Graduate Institute of Medical Education and Research, Chandigarh
| | - Neelkamal Cheema
- Department of Anatomy, Post Graduate Institute of Medical Education and Research, Chandigarh
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Gupta T, Bhutta MF. Outcomes of remote versus face-to-face ear, nose and throat outpatient consultation on patient pathways. Ann R Coll Surg Engl 2023:rcsann20220144. [PMID: 36688846 DOI: 10.1308/rcsann.2022.0144] [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: 01/24/2023] Open
Abstract
INTRODUCTION Remote consultation has potential benefits in increasing patient pathway efficiency and has been found to reduce costs and carbon emissions. Previous studies of remote consultation in ear, nose and throat (ENT) practice have reported mixed results and used relatively small sample sizes. The aim of this article is to study the impact of remote telephone consultation on ENT clinic outcomes and pathway efficiency, compared with in-person review, within new and follow-up patient cohorts and subspeciality, where previous studies demonstrate mixed and inconclusive results. METHODS This was a comparison of remote clinic appointment outcomes over a 2-month period from a single ENT referral centre (426) with an equivalent data set of face-to-face clinic appointments over a similar time frame (1,533). Statistical analysis included chi-squared test for clinic outcomes and two-sample t-squared test for mean hand-off between both cohorts (p < 0.05). RESULTS For new referrals, remote consultation was associated with statistically significantly greater rates of follow-up (p < 0.00001), investigation (p = 0.00251) and hand-off (p < 0.00013) than patients seen face-to-face - particularly where presenting with head and neck symptoms. For follow-up patients, remote consultation had similar rates of investigation (p = 0.11071) or further follow-up (p = 0.08) and mean hand-off (p < 0.11764) to those seen face-to-face. CONCLUSIONS Remote consultation in ENT could become the norm for follow-up patients, but should be used with caution in the initial consultation of new patients.
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Affiliation(s)
- T Gupta
- Brighton and Sussex University Hospital NHS Foundation Trust, UK
| | - M F Bhutta
- Brighton and Sussex University Hospital NHS Foundation Trust, UK.,Brighton and Sussex Medical School, UK
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Gupta T, Kaur M, Singla N, Radotra BD, Sahni D, Kharbanda PS, Gupta SK. Reelin Signaling Pathway and Mesial Temporal Lobe Epilepsy: A Causative Link. Basic Clin Neurosci 2023; 14:57-72. [PMID: 37346868 PMCID: PMC10279991 DOI: 10.32598/bcn.2021.2554.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 09/22/2020] [Accepted: 10/10/2020] [Indexed: 06/23/2023] Open
Abstract
Introduction Mesial temporal lobe epilepsy (MTLE) is the most frequent form of partial epilepsy. Granule cell dispersion, resulting from aberrant neuronal migration in the hippocampus, is pathognomonic of MTLE. Reelin, a secreted neurodevelopmental glycoprotein has a crucial role in controlling the radial migration of neurons. Several animal studies have implicated Reelin in the MTLE pathogenesis Mesial temporal lobe epilepsy (MTLE) is the most frequent form of partial epilepsy. Granule cell dispersion, resulting from aberrant neuronal migration in the hippocampus, is pathognomonic of MTLE. Reelin, a secreted neurodevelopmental glycoprotein has a crucial role in controlling the radial migration of neurons. Several animal studies have implicated Reelin in the MTLE pathogenesis. Methods The aim of this study was to investigate the Reelin signalling pathway in the MTLE patients. Therefore, we studied each step in the Reelin signalling pathway for the gene and protein expressions, in the hippocampal tissue obtained from patients undergoing surgery for MTLE and compared it with age matched normal autopsy cases. Results We found statistically significant decrease (P<0.001) in the Reelin mRNA expression in MTLE patients. Among the two reelin receptors, apolipoprotein E receptor 2 (ApoER2) was significantly increased whereas very low density lipoprotein receptor (VLDLR) was decreased among the patients. Disabled 1 (Dab1), the downstream target of reelin, was found to be decreased. Dab1 in turn inhibits Cofilin, which is responsible for cytoskeletal reorganization, thus limiting aberrant neuronal migration. Statistically significant over expression of Cofilin protein was found in the patient group. Matrix metalloproteinase 9 (MMP-9) and tissue inhibitor of metalloproteases-1 (TIMP-1), both of which are involved in processing of Reelin, were down regulated in 70-85% of cases. Conclusion The whole pathway was found to be deranged in MTLE. These results indicate that Reelin signalling pathway is disturbed at various points in the MTLE patients and might be involved in the pathogenesis & progression of MTLE. Our results extend the existing information regarding the components of the Reelin pathway and further, establish a link between pathway disturbance and MTLE.
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Affiliation(s)
- Tulika Gupta
- Department of Anatomy, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Mandeep Kaur
- Department of Anatomy, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Navneet Singla
- Department of Neurosurgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Bishan Dass Radotra
- Department of Histopathology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Daisy Sahni
- Department of Anatomy, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | | | - Sunil K Gupta
- Department of Neurosurgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Berberian S, Patock-Peckham JA, Guarino K, Gupta T, Sanabria F, Infurna F. Does loneliness before the age of twelve indirectly affect impaired control over drinking, alcohol use, and problems through perceived stress? Addict Behav Rep 2022; 16:100448. [PMID: 35875348 PMCID: PMC9301507 DOI: 10.1016/j.abrep.2022.100448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 06/21/2022] [Accepted: 07/10/2022] [Indexed: 11/03/2022] Open
Abstract
Loneliness is the pain of feeling socially isolated from others (Russell et al., 1980). The Stress-Dampening Hypothesis (Marlatt, 1987; Sayette, 1993; Sher, 1987) posits that individuals drink to alleviate negative affect. To date, it has not been determined whether loneliness experienced as a child can indirectly influence at-risk patterns of alcohol use through the mediating mechanism of stress and impaired control. Impaired control over alcohol use (IC) is the difficulty adhering to one's own self-proscribed limits on drinking behaviors (Heather et al., 1993). Impaired control is an at-risk pattern of use that is particularly relevant to emerging adults. Methods: We examined the direct and indirect relationships between childhood loneliness, stress, IC, and alcohol-related problems with a structural equation model. In a college student sample, we utilized a (k = 20,000) bootstrap technique and a model indirect command in Mplus to examine potential mediational pathways. Cisgender sex was included as a covariate. Results: Loneliness was directly linked to stress as well as to alcohol-related problems. Higher levels of loneliness were indirectly linked to both more alcohol use and alcohol-related problems through more stress and in turn, more impaired control over drinking. Conclusions: The current study is consistent with the Stress Dampening Hypothesis (Marlatt, 1987; Sayette, 1993; Sher, 1987). Our findings suggest that therapeutic interventions combating loneliness in childhood may disrupt the stress-dampening pathway to dysregulated alcohol use in emerging adulthood.
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Affiliation(s)
- S Berberian
- Arizona State University, Department of Psychology, Tempe, AZ 85287-1104, USA
| | - J A Patock-Peckham
- Arizona State University, Department of Psychology, Tempe, AZ 85287-1104, USA
| | - K Guarino
- Arizona State University, Department of Psychology, Tempe, AZ 85287-1104, USA
| | - T Gupta
- Arizona State University, Department of Psychology, Tempe, AZ 85287-1104, USA
| | - F Sanabria
- Arizona State University, Department of Psychology, Tempe, AZ 85287-1104, USA
| | - F Infurna
- Arizona State University, Department of Psychology, Tempe, AZ 85287-1104, USA
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Bagal B, Goda Shastri J, Nayak L, Chatterjee A, Dasgupta A, Jain H, Thorat J, Sahay A, Epari S, Khanna N, Laskar S, Gupta T, Sengar M. 216P Lenalidomide maintenance after whole brain radiotherapy in relapsed/refractory primary CNS lymphoma. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.10.251] [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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21
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Singh M, Sharma M, Nair AG, Mehta A, Kaur M, Gupta R, Gupta T, Sahni D. Cadaver dissection for oculoplastic procedures: A beginner's guide. Indian J Ophthalmol 2022; 70:3239-3244. [PMID: 36018092 DOI: 10.4103/ijo.ijo_3037_21] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
The purpose of this article is to form a basic guide for beginning the cadaver dissection training programs focused on oculoplastic surgical procedures. Ours was a collaborative study between the departments of Ophthalmology and Anatomy in a tertiary care teaching institute. We formed a step-wise approach to begin the cadaver dissection focused on the oculoplastic surgical procedures. The basics of cadaver procurement, processing, and preparation for dissections were described. The operative requirements of trainees, surgical handling of cadavers, and basic oculoplastic surgical steps were discussed. The types of embalming (cadaver preservation process) and steps have been described in detail. We have emphasized the preoperative discussion about the proposed dissections using standard teachings and skull models for easier understanding. Additional helping tools like soft embalming and injectable substances for better intra-dissection understanding (intra-arterial, intravenous and orbital injections) have been described. Post-dissection cadaver handing and soft-tissue disposal protocols have also been described. Overall, the cadaver dissections provide holistic surgical learning for the residents, specialty trainees, and practitioners. This article may act as a basic step-wise guide for starting the cadaver-based oculoplastics lab dissection in various institutes and workshops.
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Affiliation(s)
- Manpreet Singh
- Department of Ophthalmology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Manjula Sharma
- Department of Ophthalmology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Akshay G Nair
- Ophthalmic Plastic Surgery and Ocular Oncology Services, Aditya Jyot Eye Hospital, Mumbai; Ophthalmic Plastic Surgery and Ocular Oncology Services, Advanced Eye Hospital and Institute, A Unit of Dr. Agarwal's Eye Hospitals, Navi Mumbai; Lokmanya Tilak Municipal Medical College and General Hospital, Dr. Babasaheb Ambedkar Road, Sion, Mumbai, Maharashtra, India
| | - Aditi Mehta
- Department of Ophthalmology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Manpreet Kaur
- Department of Ophthalmology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Richa Gupta
- Department of Anatomy, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Tulika Gupta
- Department of Anatomy, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Daisy Sahni
- Department of Anatomy, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Filipov N, Mote R, Sakamoto K, Gupta T, Wallon O, Carpenter J. P16-02 Mycobacterium tuberculosis challenge enhances dopaminergic toxicity and neuroinflammation caused by intrapallidal manganese administration. Toxicol Lett 2022. [DOI: 10.1016/j.toxlet.2022.07.592] [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: 10/14/2022]
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23
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Dale J, Mclean E, Gupta T, Healy C. 788 Caecal Duplication Cyst: An Unexpected Cause of Bowel Obstruction in a 12-Year-Old. Br J Surg 2022. [DOI: 10.1093/bjs/znac269.296] [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: 11/05/2022]
Abstract
Abstract
We report the case of a rare cause of bowel obstruction in a 12-year-old girl who presented with a short history of abdominal distension and vomiting after a month of unexplained urinary frequency and weight loss. Abdominal radiographs demonstrated small bowel obstruction with an unknown pelvic mass. A raised CA125 suggested a possible ovarian lesion and a magnetic resonance scan was interpreted as supportive of this pathology. Intra-operatively a 120x90x70mm cystic mass was found attached to the caecal serosa, immediately adjacent to the ileocaecal valve. There was an associated 180-degree twist of the terminal ileum and ascending colon. A limited right hemicolectomy was performed, and histopathology confirmed the diagnosis of a caecal intestinal duplication cyst. Post-operatively she has recovered well, with resolution of her obstructive and urinary symptoms. Given the unusual age of presentation, uncommon location of the cyst and the diagnostic challenges incurred, the authors wish to share their experience of managing an atypical duplication cyst.
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Affiliation(s)
- J Dale
- Royal Alexandra Children's Hospital , Brighton , United Kingdom
| | - E Mclean
- Royal Alexandra Children's Hospital , Brighton , United Kingdom
| | - T Gupta
- Royal Alexandra Children's Hospital , Brighton , United Kingdom
| | - C Healy
- Royal Alexandra Children's Hospital , Brighton , United Kingdom
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24
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Gauthier DT, Doss JH, LaGatta M, Gupta T, Karls RK, Quinn FD. Genomic Degeneration and Reduction in the Fish Pathogen Mycobacterium shottsii. Microbiol Spectr 2022; 10:e0115821. [PMID: 35579461 PMCID: PMC9241763 DOI: 10.1128/spectrum.01158-21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 08/09/2021] [Accepted: 04/26/2022] [Indexed: 01/17/2023] Open
Abstract
Mycobacterium shottsii is a dysgonic, nonpigmented mycobacterium originally isolated from diseased striped bass (Morone saxatilis) in the Chesapeake Bay, USA. Genomic analysis reveals that M. shottsii is a Mycobacterium ulcerans/Mycobacterium marinum clade (MuMC) member, but unlike the superficially similar M. pseudoshottsii, also isolated from striped bass, it is not an M. ulcerans ecovar, instead belonging to a transitional group of strains basal to proposed "Aronson" and "M" lineages. Although phylogenetically distinct from the human pathogen M. ulcerans, the M. shottsii genome shows parallel but nonhomologous genomic degeneration, including massive accumulation of pseudogenes accompanied by proliferation of unique insertion sequences (ISMysh01, ISMysh03), large-scale deletions, and genomic reorganization relative to typical M. marinum strains. Coupled with its observed ecological characteristics and loss of chromogenicity, the genomic structure of M. shottsii is suggestive of evolution toward a state of obligate pathogenicity, as observed for other Mycobacterium spp., including M. ulcerans, M. tuberculosis, and M. leprae. IMPORTANCE Morone saxatilis (striped bass) is an ecologically and economically important finfish species on the United States east coast. Mycobacterium shottsii and Mycobacterium pseudoshottsii were originally described in the early 2000s as novel species from outbreaks of visceral and dermal mycobacteriosis in this species. Biochemical and genetic characterization place these species within the Mycobacterium ulcerans/M. marinum clade (MuMC), and M. pseudoshottsii has been proposed as an ecovar of M. ulcerans. Here, we describe the complete genome of M. shottsii, demonstrating that it is clearly not an M. ulcerans ecovar; however, it has undergone parallel genomic modification suggestive of a transition to obligate pathogenicity. As in M. ulcerans, the M. shottsii genome demonstrates widespread pseudogene formation driven by proliferation of insertion sequences, as well as genomic reorganization. This work clarifies the phylogenetic position of M. shottsii relative to other MuMC members and provides insight into processes shaping its genomic structure.
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Affiliation(s)
- D. T. Gauthier
- Department of Biological Sciences, Old Dominion University, Norfolk, Virginia, USA
| | - J. H. Doss
- Department of Biological Sciences, Old Dominion University, Norfolk, Virginia, USA
| | - M. LaGatta
- Department of Infectious Diseases, University of Georgia, Athens, Georgia, USA
- Pathens Incorporated, Athens, Georgia, USA
| | - T. Gupta
- Department of Infectious Diseases, University of Georgia, Athens, Georgia, USA
| | - R. K. Karls
- Department of Infectious Diseases, University of Georgia, Athens, Georgia, USA
- Pathens Incorporated, Athens, Georgia, USA
| | - F. D. Quinn
- Department of Infectious Diseases, University of Georgia, Athens, Georgia, USA
- Pathens Incorporated, Athens, Georgia, USA
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Dasgupta A, Thomas Alex A, Sahu A, Agarwal U, Chatterjee A, Goswami S, Gaikwad U, Bano N, Singh V, Shetty P, Moiyadi A, Sahay A, Sridhar E, Choudhari A, Bhattacharya K, Kinhikar R, Jalali R, Gupta T, Goda J. OC-0927 Impact of radiation doses to parahippocampal gyrus and amygdala on memory in pituitary adenomas. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)02707-4] [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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26
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Budrukkar A, Murthy V, Kashid S, Swain M, Rangarajan V, Ghosh Laskar S, Kannan S, Kale S, Upereti R, Gawli S, Pai P, Pantvaidya G, Gupta T, Agarwal J. OC-0100 IMRT vs IMRT and brachytherapy for early oropharyngeal cancers (Brachytrial) : A randomized trial. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)02476-8] [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: 10/18/2022]
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27
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Agarwal J, Sinha S, Lewis Salins S, Pandey S, Deodhar J, Salins N, Ghosh Laskar S, Budrukkar A, Gupta T, Murthy V, Swain M, Nair S, Chaturvedi P. OC-0592 Impact of palliative care referral on distress in patients undergoing RT for HNSCC: Randomized Trial. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)02614-7] [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: 10/18/2022]
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28
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Gupta R, Gupta T, Kumari C, Aggarwal A, Sahni D. Revisiting the surgical anatomy of the triangle of doom and the triangle of pain. Clin Anat 2022; 35:899-905. [DOI: 10.1002/ca.23886] [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] [Received: 09/15/2021] [Revised: 04/13/2022] [Accepted: 04/13/2022] [Indexed: 11/06/2022]
Affiliation(s)
- Richa Gupta
- Department of Anatomy PGIMER Chandigarh India
| | | | | | | | - Daisy Sahni
- Department of Anatomy PGIMER Chandigarh India
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Glennon SE, Ram K, Gupta T, Iwanaga J, Dumont AS, Small JE, Sahni D, Tubbs RS. Basilar Artery Bands: Anatomic and Histologic Study with Application to Coiling and Stenting Procedures. World Neurosurg 2022; 160:e227-e233. [PMID: 34995828 DOI: 10.1016/j.wneu.2021.12.114] [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: 11/25/2021] [Accepted: 12/30/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Internal bands of the basilar artery (BA) have been rarely studied. Because bands could have obvious consequences in patient diagnosis and care, the present multiinstitutional cadaveric study was performed. METHODS The intraluminal bands of BAs were studied in 80 cadaveric specimens derived from India (Group 1) and the United States (Group 2). Their orientation within the vessel was recorded. Measurements included the length of the BA, diameter of the BA, intraluminal band length and thickness, and distance of the band to the vertebrobasilar junction. Selected bands were submitted for histologic analysis. RESULTS In Group 1, an intraluminal band (all vertically oriented) was identified in 16.6%. The mean length and thickness of the bands were 2.04 mm and 1.33 mm, respectively. These bands were located at a mean distance of 1.74 mm superior to the vertebrobasilar junction. In Group 2, an intraluminal band was identified in 6%. One band was vertically positioned, and 2 were horizontally positioned. The mean length and thickness of the bands were 2.5 mm and 0.9 mm, respectively. These latter bands were located at a mean distance of 2.23 mm superior to the vertebrobasilar junction. Histologically, the bands were essentially extensions of the tunica media and interna of the artery. CONCLUSIONS To our knowledge, this study is the first multiethnic study of the prevalence and morphometry of the BA bands. A better understanding of these bands may help reveal their relationship to thrombus and aneurysmal formation and their impact on endovascular procedures.
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Affiliation(s)
| | - Kalu Ram
- Department of Anatomy, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Tulika Gupta
- Department of Anatomy, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Joe Iwanaga
- Department of Neurology, Tulane University School of Medicine, New Orleans, Louisiana, USA; Department of Neurosurgery, Tulane University School of Medicine, New Orleans, Louisiana, USA.
| | - Aaron S Dumont
- Department of Neurosurgery, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Juan E Small
- Department of Neuroradiology, Lahey Hospital and Medical Center, Burlington, Massachusetts, USA
| | - Daisy Sahni
- Department of Anatomy, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - R Shane Tubbs
- Department of Neurology, Tulane University School of Medicine, New Orleans, Louisiana, USA; Department of Neurosurgery, Tulane University School of Medicine, New Orleans, Louisiana, USA; Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana, USA; Department of Structural & Cellular Biology, Tulane University School of Medicine, New Orleans, Louisiana, USA; Department of Neurosurgery and Ochsner Neuroscience Institute, Ochsner Health System, New Orleans, Louisiana, USA; Department of Anatomical Sciences, St. George's University, St. George's, Grenada
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Singal A, Gupta T, Aggarwal A, Sahni D. Osseous deficiencies, pockets, superfluous lateral border thickening in scapula: a rare occurrence. Surg Radiol Anat 2022; 44:621-625. [PMID: 35266029 DOI: 10.1007/s00276-022-02920-z] [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: 12/22/2021] [Accepted: 02/27/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Beyond the nutrient and suprascapular foramen, the other foramina, holes or osseous deficiencies, pockets has rarely been reported in scapula. If present, the bony holes or deficiencies may lead to radiolucent areas and may be mistaken for sites of osteolytic destruction related to skeletal metastases, multiple myeloma or others. CASE REPORT In the present case of left scapula, unusual osseous deficiencies of different size and shape along with pockets were observed in the body of scapula. The maximum height and width of largest bony deficiency was 35.8 mm and 12.6 mm. There was abnormal osseous thickening beside the lateral border of scapula along with the presence of some spines. Five nutrient foramina, three on the costal and two on the dorsal surface were noticed. CONCLUSIONS The present case reports the osseous deficiencies, pockets and extra osseous growth along the lateral border, multiple nutrient foramina altogether in one specimen. Thorough anatomical knowledge of these unusual osseous variations can provide the clinicians, radiologists and forensic experts with better clinical judgement and may add insight to the surgical planning by orthopaedic surgeons.
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Affiliation(s)
- Anjali Singal
- Department of Anatomy, All India Institute of Medical Sciences, Bathinda, Punjab, 151001, India.
| | - Tulika Gupta
- Department of Anatomy, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Anjali Aggarwal
- Department of Anatomy, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Daisy Sahni
- Department of Anatomy, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Sahoo SK, Gupta SK, Salunke P, Dhandapani S, Aggarwal A, Singla N, Karthigeyan M, Singh A, Tripathi M, Gendle C, Singla R, Chhabra R, Mohindra S, Tewari MK, Rekhapalli RS, Kokkula P, Gupta T. Setting up a Neurosurgical Skills Laboratory and Designing Simulation Courses to Augment Resident Training Program. Neurol India 2022; 70:612-617. [PMID: 35532628 DOI: 10.4103/0028-3886.344633] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND The surgical skill practice in neurosurgery is being compromised in the recent past owing to the duty time constraint, patient safety concerns, and medico-legal issues. Surgical practice outside the operating room is essential to enhance a resident's operative skills and to gain confidence. OBJECTIVE To discuss the experience of establishing an 'in-house neurosurgery skills laboratory' and various training sessions conducted with cadaveric and non-cadaveric simulation modules. METHODS A skills laboratory was set up in the existing resident teaching hall with nine workstations. Each station has been equipped with an operating table, surgeon's chair, basic microscope, endoscope, high-speed drill system, and a suction machine. Vascular anastomosis, high-speed drilling, and basic neuroendoscopy were planned on low-cost non-cadaveric modules. Craniotomy and various surgical approaches were designed on cadaveric modules obtained from the anatomy department. RESULT A total of 18 residents in divided groups during their initial three semesters had participated in the non-cadaveric simulation courses. Twenty-six residents had participated and 12 sessions were conducted on the cadaveric modules. Three workshops were conducted and 20 residents and faculty members from five other institutions had participated in the cadaveric hands-on training session. CONCLUSION A well-equipped skills laboratory provides an opportunity for the residents to acquire operative expertise in a similar atmosphere to that of the operating theater. A structured program comprising various operative practice sessions should be incorporated into the resident training program.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Raghav Singla
- Department of Neurosurgery, PGIMER, Chandigarh, India
| | | | | | | | | | | | - Tulika Gupta
- Department of Anatomy, PGIMER, Chandigarh, India
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Garg S, Gupta T, Sahni D. Digastric musculus sternalis. Surg Radiol Anat 2022; 44:443-446. [PMID: 35113184 DOI: 10.1007/s00276-022-02888-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 01/13/2022] [Indexed: 10/19/2022]
Abstract
PURPOSE To report a rare variant muscle. METHODS Aberrant muscle was observed in the anterior chest wall musculature during routine cadaver prosection. RESULTS Musculus sternalis consisting of two muscular bellies united at an angle by an intermediate tendon was observed anterior to the pectoral major of the left side. The muscle did not have any bony attachment. CONCLUSIONS The present case represents a hybrid muscle with superior belly derived from the prepectoral mass and inferior belly from ventral longitudinal muscle column. Clinically, the musculus sternalis may be misinterpreted as a pathological mass or lesion thus its accurate knowledge is significant to radiologists, angiologists and surgeons for better interpretation of mammographic images, safer interventions and for reconstructive surgeries.
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Affiliation(s)
- Shallu Garg
- Department of Anatomy, St. John's Medical College, Bengaluru, India
| | - Tulika Gupta
- Department of Anatomy, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India.
| | - Daisy Sahni
- Department of Anatomy, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
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Gupta T, Kaur M, Sahni D. Identification of novel pulmonary vein nodes as generators of ectopic arrhythmic foci for atrial fibrillation: an immunohistochemical proof. Surg Radiol Anat 2022; 44:129-136. [PMID: 34994828 DOI: 10.1007/s00276-021-02864-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 11/22/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE The atrial muscle sleeve (AMS) of the pulmonary vein is the most common source of the arrhythmogenic triggers in atrial fibrillation (AF). Anatomical substrate generating these ectopic currents is still elusive. The present study was designed to study the AMS of pulmonary veins with an emphasis on the structural basis which might govern AF initiation and perpetuation. METHODS The study was conducted on a longitudinal tissue section of pulmonary vein, taken from 15 human cadaveric nondiseased hearts. Tissue was studied histologically using H&E and Gömöri trichrome stain. The pacemaker channels were identified by immunohistochemistry using monoclonal HCN4 and HCN1 antibodies. RESULTS The AMS was identified in each pulmonary vein, located between the tunica adventitia and tunica media. A node-like arrangement of myocytes was seen within the AMS in 30% of veins. It had a compact zone limited by a fibrous capsule and contained much smaller, paler and interconnected myocytes. Outside the capsule, there was a zone of dispersed, singly placed myocytes separating the compact zone from the working myocytes of the AMS. HCN4 and HCN1 antibodies were expressed on the cell membrane of nodal myocytes, while the working myocytes demonstrated none to minimal staining. CONCLUSION Pulmonary veins nodes are similar to the specialized cardiac conductive tissue in the histological arrangement of compact and transitional zones, cellular characteristics and the presence of pacemaker channels. They might be the anatomical basis of ectopic arrhythmogenic foci. To our knowledge, these nodes are being described for the first time in human.
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Affiliation(s)
- Tulika Gupta
- Department of Anatomy, Postgraduate Institute of Medical Education and Research, Sector-12, Chandigarh, 160012, India.
| | - Mandeep Kaur
- Department of Anatomy, Postgraduate Institute of Medical Education and Research, Sector-12, Chandigarh, 160012, India
| | - Daisy Sahni
- Department of Anatomy, Postgraduate Institute of Medical Education and Research, Sector-12, Chandigarh, 160012, India
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Roy S, Shukla P, Ahmed N, Du MH, Tarannum I, Kong XJ, Gupta T, Singh SKK, Das S. Interplay between anisotropy and magnetic exchange to modulate magnetic relaxation behaviors of phenoxo bridged Dy2 dimers with axial β-diketonate co-ligands. Dalton Trans 2022; 51:18187-18202. [DOI: 10.1039/d2dt03117e] [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: 11/11/2022]
Abstract
A series of Schiff base LH ((E)-2-((pyridin-2-ylmethylene)amino)phenol) supported phenoxo bridged symmetric [Dy2(L)2(hfac)4] (1), [Dy2(L)2(tfac)4] (2) and asymmetric [Dy2(L)2(thd)3(NO3)]·1.5H2O (3) binuclear complexes were isolated using diffrently substituted β-diketonate co-ligands (Hhfac =...
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35
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Laskar SG, Sinha S, Singh M, Mummudi N, Mittal R, Gavarraju A, Budrukkar A, Swain M, Agarwal JP, Gupta T, Murthy V, Mokal S, Patil V, Noronha V, Joshi A, Menon N, Prabhash K. Post-cricoid and Upper Oesophagus Cancers Treated with Organ Preservation Using Intensity-modulated Image-guided Radiotherapy: a Phase II Prospective Study of Outcomes, Toxicity and Quality of Life. Clin Oncol (R Coll Radiol) 2021; 34:220-229. [PMID: 34872822 DOI: 10.1016/j.clon.2021.11.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 10/12/2021] [Accepted: 11/15/2021] [Indexed: 11/26/2022]
Abstract
AIMS To prospectively examine the outcomes, toxicity and quality of life (QoL) of patients with post-cricoid and upper oesophagus (PCUE) cancers treated with an organ-preservation approach of (chemo)-radiotherapy using intensity-modulated image-guided radiotherapy (IM-IGRT). MATERIALS AND METHODS This phase II prospective study was conducted at a tertiary cancer centre from February 2017 to January 2020. Forty patients with squamous cell carcinoma of PCUE of stage T1-3, N0-2, M0 were accrued. Gross exolaryngeal extension/dysfunctional larynx were major exclusion criteria. Patients received 63-66 Gy in once-daily fractions using volumetric modulated arc therapy with daily IGRT. Outcome measures included disease-related outcomes, patterns of failure, Radiation Therapy Oncology Group toxicities, feeding tube dependency and QoL. RESULTS The median follow-up was 22 months. Twenty-six (87.5%) patients had locoregionally advanced disease and 34 (85%) patients received (chemo)-radiotherapy. A complete response was observed in 26 (65%) patients. The 2-year locoregional control, event-free survival and cause-specific survival were 59.6%, 40.2% and 44.8%, respectively. The volume of primary tumour (GTVPvol) exceeding 28 cm3 had inferior overall survival (P = 0.005) on univariate analysis. Multivariable analysis showed GTVPvol and positron emission tomography-computed tomography maximum standardised uptake value to be independently predictive for event-free and overall survival. A feeding tube requirement at presentation was seen in 11 (27.5%) patients, whereas long-term feeding tube dependency at 6 months was seen in 10 (37%) patients. For QoL, a statistical improvement in pain, appetite loss and swallowing was observed over time. CONCLUSION Although the outcomes of PCUE cancers remain dismal, the use of state of the art diagnostic modalities, careful case selection and modern radiotherapy techniques improved outcomes as compared with before in this exclusive analysis of PCUE cancers.
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Affiliation(s)
- S G Laskar
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India.
| | - S Sinha
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - M Singh
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - N Mummudi
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - R Mittal
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - A Gavarraju
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - A Budrukkar
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - M Swain
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - J P Agarwal
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - T Gupta
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - V Murthy
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - S Mokal
- Clinical Research Secretariat, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - V Patil
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - V Noronha
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - A Joshi
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - N Menon
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - K Prabhash
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
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Gupta T, Pant S, Likonda B, Dasgupta A, Chatterjee A, Kannan S, Sastri G, Trivedi S, Dutta D, Jalali R. Comparison of Two Palliative Hypofractionated Radiotherapy Regimens in Poor-Prognosis High-Grade Glioma: A Propensity-Matched Analysis. Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.1580] [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: 11/17/2022]
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Gupta T, Kaur M, Shekhawat D, Aggarwal R, Nanda N, Sahni D. Glucagon Like Peptide-1 and Its Receptor in Human Brain: Distribution of Expression, Functional Implications, Age Related Changes & Species Specific Characteristics. Basic Clin Neurosci 2021. [DOI: 10.32598/bcn.2021.2554.2] [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: 11/20/2022] Open
Abstract
Emerging evidence has shown that the Glucagon like peptide-1 (GLP-1) agonist can be used for treating Alzheimer’s disease, but knowledge of its neural targets is limited. To understand the neural substrates of GLP-1, we have done whole brain mapping for GLP-1 and its receptor (GLP-1R), in 30 human brains. GLP-1 expression was studied by immuno-histochemistry and confirmed by western blot method. GLP-1R gene expression was studied by RT-PCR. GLP-1 expression was seen in most of the cortical areas (maximum in frontal, prefrontal & parietal cortex), diencephalon and brainstem, but not in cerebellum. Protein expression studies validated these results. Highest expression of GLP-1R was found in the frontal cortex. The orbito-frontal cortex and cerebellum had negligible expression. Hippocampus demonstrated significant presence of GLP-1R but patchy immunoreactivity to GLP-1. GLP-1R presence in most of the human cortical regions and absence in cerebellum is the major deviation from the animal brain. Sites which might be of interest in Alzheimer’s have been identified. GLP-1 demonstrated age related decline in most of the areas after 5thdecade. At 60yrs GLP-1 was not found in any of the cortical areas except in the prefrontal cortex but it was present in the sub-cortical areas. Age related profiling of GLP-1 in various brain areas has been analysed, which can have important bearing on understanding the Alzheimer’s. This study provides detailed description of GLP-1 and GLP-1R locations by complete human brain mapping for the first time and may lead to novel treatment options targeting the GLP-1 receptors.
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Gupta T, Kaur H, Kapila S, Kapila R. Lactobacillus fermentum (MTCC-5898) alleviates Escherichia coli-induced inflammatory responses in intestinal epithelial cells by modulating immune genes and NF-κB signalling. J Appl Microbiol 2021; 131:3008-3017. [PMID: 33999475 DOI: 10.1111/jam.15153] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 05/07/2021] [Accepted: 05/11/2021] [Indexed: 02/06/2023]
Abstract
AIM Dietary intervention using probiotic bacteria has emerged as a promising preventive strategy in addressing foodborne infections or gastrointestinal disorders. This study investigated the immunomodulatory effects of Lactobacillus fermentum (MTCC-5898) on Escherichia coli-induced inflammatory responses in intestinal epithelial cells. METHODS AND RESULTS The immune response of intestinal cells (Caco-2) in the presence of probiotic Lact. fermentum was determined during exclusion, competition and displacement of E. coli as the inflammatory agent. To achieve this objective, transcriptional modulation of key immune-related genes (cytokines, pattern recognition receptors and NF-κB), release of cytokines and nuclear translocation of the NF-κB subunit p-65 were studied. Expression of pro-inflammatory cytokines IL-8, TNF-α, IFN-ϒ and IL-23 was high in E. coli-exposed intestinal cells. However, overexpression of these E. coli-induced pro-inflammatory cytokines was prevented by Lact. fermentum during exclusion and competition assays. It also modulated the transcriptional expression of regulatory cytokines (IL-10 and TGF-β), pattern recognition receptors (TLR-2 and TLR-4) and genes associated with master inflammatory regulators (NF-κB and SIGIRR) to reduce E. coli-induced inflammation. The protective effect of Lact. fermentum was further confirmed by suppression of nuclear translocation of cytoplasmic NF-κB subunit (p-65). CONCLUSION Lactobacillus fermentum alleviated E. coli-induced inflammatory responses by modulating the NF-κB signalling besides pro-inflammatory and regulatory cytokines expression. SIGNIFICANCE AND IMPACT OF THE STUDY Lactobacillus fermentum holds significant promise as a potent nutraceutical that prevents and manages inflammatory gut-associated dysfunctions.
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Affiliation(s)
- T Gupta
- Animal Biochemistry Division, ICAR-National Dairy Research Institute, Karnal, India
| | - H Kaur
- Animal Biochemistry Division, ICAR-National Dairy Research Institute, Karnal, India
| | - S Kapila
- Animal Biochemistry Division, ICAR-National Dairy Research Institute, Karnal, India
| | - R Kapila
- Animal Biochemistry Division, ICAR-National Dairy Research Institute, Karnal, India
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Kumari C, Gupta T, Gupta R, Kumar V, Sahni D, Aggarwal A, Neelkamal. Cadaveric anatomy of the lumbar triangular safe zone of Kambin's in North West Indian population. Anat Cell Biol 2021; 54:35-41. [PMID: 33619238 PMCID: PMC8017462 DOI: 10.5115/acb.20.243] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 12/01/2020] [Accepted: 12/07/2020] [Indexed: 11/27/2022] Open
Abstract
A three dimensional triangular space ‘the Kambin’s triangle (KT)’ present on the dorsolateral aspect of the intervertebral disc, is considered to be a safe area for transforaminal approaches. It allows access to the exiting and traversing nerve roots, the thecal sac and to the intervertebral disc spaces. Our aim was to calculate the area of the triangle by measuring the height and base at all the intervertebral spaces bilaterally in the lumbar region in North West Indian cadavers and to assess the diameter of circle inscribed within this triangle which will correspond to the size of cannula inserted for the minimally invasive transforaminal approaches in this population. Five randomly chosen adult cadavers were used for this study. After clearing the area, the exiting nerve was identified. The height and base of the bony KTs (n=40) were measured with the help of digital Vernier’s calliper (accuracy 0.02 mm) to calculate the area of the KT. There is a steady increase in the area of the bony KT reaching maximum at the level of L4-5 intervertebral space. Statistically there were no differences in the calculated areas between right and left side. The mean diameter of inscribed circle within the triangle also showed gradual increase from 5.82 mm at L1-2 level, reaching maximum value of 7.26 mm at L4-5 level on the right side while on the left side the values were 5.66 mm and 8.16 mm respectively. Careful anatomical consideration is of utmost importance in transforaminal approaches during surgical or interventional procedures in this region. Cannula having external diameter ranging 6–8 mm is recommended for any interventional approach through Kambin’s space.
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Affiliation(s)
- Chiman Kumari
- Department of Anatomy, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Tulika Gupta
- Department of Anatomy, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Richa Gupta
- Department of Anatomy, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Vishal Kumar
- Department of Orthopaedics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Daisy Sahni
- Department of Anatomy, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Anjali Aggarwal
- Department of Anatomy, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Neelkamal
- Department of Anatomy, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Dutta U, Sachan A, Premkumar M, Gupta T, Sahoo S, Grover S, Sharma S, Lakshmi PVM, Talati S, Biswal M, Suri V, Singh MP, Ghai B, Chhabra R, Bharti B, Samanta J, Arora P, Mohindra R, Malhotra S, Singh G, Guru RR, Pandey N, Koushal V, Kumar A, Bhogal RS, Aggarwal AK, Goel K, Malhotra P, Yaddanapudi N, Mahajan P, Thakur JS, Sehgal R, Ghosh A, Sehgal IS, Agarwal R, Jayashree M, Bhalla A, Jain S, Kochhar R, Chakrabarti A, Puri GD, Ram J. Multidimensional dynamic healthcare personnel (HCP)-centric model from a low-income and middle-income country to support and protect COVID-19 warriors: a large prospective cohort study. BMJ Open 2021; 11:e043837. [PMID: 33619195 PMCID: PMC7902325 DOI: 10.1136/bmjopen-2020-043837] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVES Healthcare personnel (HCP) are at an increased risk of acquiring COVID-19 infection especially in resource-restricted healthcare settings, and return to homes unfit for self-isolation, making them apprehensive about COVID-19 duty and transmission risk to their families. We aimed at implementing a novel multidimensional HCP-centric evidence-based, dynamic policy with the objectives to reduce risk of HCP infection, ensure welfare and safety of the HCP and to improve willingness to accept and return to duty. SETTING Our tertiary care university hospital, with 12 600 HCP, was divided into high-risk, medium-risk and low-risk zones. In the high-risk and medium-risk zones, we organised training, logistic support, postduty HCP welfare and collected feedback, and sent them home after they tested negative for COVID-19. We supervised use of appropriate personal protective equipment (PPE) and kept communication paperless. PARTICIPANTS We recruited willing low-risk HCP, aged <50 years, with no comorbidities to work in COVID-19 zones. Social distancing, hand hygiene and universal masking were advocated in the low-risk zone. RESULTS Between 31 March and 20 July 2020, we clinically screened 5553 outpatients, of whom 3012 (54.2%) were COVID-19 suspects managed in the medium-risk zone. Among them, 346 (11.4%) tested COVID-19 positive (57.2% male) and were managed in the high-risk zone with 19 (5.4%) deaths. One (0.08%) of the 1224 HCP in high-risk zone, 6 (0.62%) of 960 HCP in medium-risk zone and 23 (0.18%) of the 12 600 HCP in the low-risk zone tested positive at the end of shift. All the 30 COVID-19-positive HCP have since recovered. This HCP-centric policy resulted in low transmission rates (<1%), ensured satisfaction with training (92%), PPE (90.8%), medical and psychosocial support (79%) and improved acceptance of COVID-19 duty with 54.7% volunteering for re-deployment. CONCLUSION A multidimensional HCP-centric policy was effective in ensuring safety, satisfaction and welfare of HCP in a resource-poor setting and resulted in a willing workforce to fight the pandemic.
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Affiliation(s)
- Usha Dutta
- Department of Gastroenterology, PGIMER, Chandigarh, India
| | - Anurag Sachan
- Department of Gastroenterology, PGIMER, Chandigarh, India
| | - Madhumita Premkumar
- Department of Gastroenterology, PGIMER, Chandigarh, India
- Department of Hepatology, PGIMER, Chandigarh, India
| | - Tulika Gupta
- Department of Anatomy, PGIMER, Chandigarh, India
| | | | | | - Sugandhi Sharma
- Department of Community Medicine and School of Public Health, PGIMER, Chandigarh, India
| | - P V M Lakshmi
- Department of Community Medicine and School of Public Health, PGIMER, Chandigarh, India
| | - Shweta Talati
- Department of Hospital Administration, PGIMER, Chandigarh, India
| | | | - Vikas Suri
- Department of Internal Medicine, PGIMER, Chandigarh, India
| | - Mini P Singh
- Department of Virology, PGIMER, Chandigarh, India
| | - Babita Ghai
- Department of Anesthesia, PGIMER, Chandigarh, India
| | | | | | | | - Pankaj Arora
- Department of Hospital Administration, PGIMER, Chandigarh, India
- Department of Internal Medicine, PGIMER, Chandigarh, India
| | - Ritin Mohindra
- Department of Internal Medicine, PGIMER, Chandigarh, India
| | | | - Gurmeet Singh
- Department of Community Medicine and School of Public Health, PGIMER, Chandigarh, India
| | | | - Navin Pandey
- Department of Hospital Administration, PGIMER, Chandigarh, India
| | - Vipin Koushal
- Department of Hospital Administration, PGIMER, Chandigarh, India
| | - Ashok Kumar
- Department of Hospital Administration, PGIMER, Chandigarh, India
| | | | - Arun K Aggarwal
- Department of Community Medicine and School of Public Health, PGIMER, Chandigarh, India
| | - Kapil Goel
- Department of Community Medicine and School of Public Health, PGIMER, Chandigarh, India
| | | | | | - Pranay Mahajan
- Department of Hospital Administration, PGIMER, Chandigarh, India
| | - J S Thakur
- Department of Community Medicine and School of Public Health, PGIMER, Chandigarh, India
| | - Rakesh Sehgal
- Department of Parasitology, PGIMER, Chandigarh, India
| | - Arnab Ghosh
- Department of Virology, PGIMER, Chandigarh, India
| | | | | | | | - Ashish Bhalla
- Department of Internal Medicine, PGIMER, Chandigarh, India
| | - Sanjay Jain
- Department of Internal Medicine, PGIMER, Chandigarh, India
| | - Rakesh Kochhar
- Department of Gastroenterology, PGIMER, Chandigarh, India
| | | | | | - Jagat Ram
- Department of Ophthalmology, PGIMER, Chandigarh, India
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Gupta T, Maitre M, Maitre P, Goda JS, Krishnatry R, Chatterjee A, Moiyadi A, Shetty P, Epari S, Sahay A, Patil V, Jalali R. High-dose salvage re-irradiation for recurrent/progressive adult diffuse glioma: healing or hurting? Clin Transl Oncol 2021; 23:1358-1367. [PMID: 33528810 DOI: 10.1007/s12094-020-02526-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Accepted: 11/13/2020] [Indexed: 12/21/2022]
Abstract
PURPOSE To report survival outcomes and identify prognostic factors of salvage re-irradiation (re-RT) in recurrent/progressive glioma. METHODS Medical records of patients treated with high-dose re-RT as part of multi-modality salvage therapy for recurrence/progression of adult diffuse glioma from 2010 to 2019 were analyzed retrospectively. RESULTS A total of 111 patients developing recurrent/progressive high-grade glioma after adequate upfront treatment at initial diagnosis were included. The first course of radiotherapy (RT) had been delivered to a median dose of 59.4 Gy with an inter-quartile range (IQR) of 54-60 Gy. Median time to recurrence/progression was 4.3 years (IQR = 2.3-7.4 years) while the median time to re-RT was 4.8 years (IQR = 3.6-7.9 years). Re-RT was delivered with intensity-modulated radiation therapy (IMRT) using 1.8 Gy/fraction to a median dose of 54 Gy (IQR = 50.4-55.8 Gy) for a cumulative median equivalent dose in 2-Gy fractions (EQD2) of 104.3 Gy (IQR = 102.6-109.4 Gy). At a median follow-up of 14 months after re-RT, the 1-year Kaplan-Meier estimates of post-re-RT progression-free survival (PFS) and overall survival (OS) were 42.8 and 61.8%, respectively. Univariate analysis identified histological grade at recurrence/progression; histological subtype; disease-free interval (DFI) and time interval between both courses of RT; performance status at re-RT; dose at re-RT and cumulative EQD2; isocitrate dehydrogenase (IDH) mutation; and O6-methyl-guanine DNA methyl transferase (MGMT) gene promoter methylation as significant prognostic factors. Preserved performance status, longer DFI, prolonged time interval between both courses of RT, and presence of IDH mutation were associated with significantly improved PFS on multi-variate analysis. However, only performance status retained independent prognostic significance for OS on multi-variate analysis. Post-treatment changes were seen in 33 (30%) patients on follow-up imaging, with higher cumulative dose (EQD2 ≥ 104.3 Gy) being associated with increased risk of post-re-RT pseudo-progression. CONCLUSION This clinical audit reports encouraging survival outcomes and identifies key prognostic factors associated with high-dose salvage re-RT in recurrent/progressive glioma.
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Affiliation(s)
- T Gupta
- Department of Radiation Oncology, Advanced Centre for Treatment Research and Education in Cancer (ACTREC)/Tata Memorial Hospital (TMH), Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Kharghar, Navi Mumbai, 410210, India.
| | - M Maitre
- Department of Radiation Oncology, Advanced Centre for Treatment Research and Education in Cancer (ACTREC)/Tata Memorial Hospital (TMH), Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Kharghar, Navi Mumbai, 410210, India
| | - P Maitre
- Department of Radiation Oncology, Advanced Centre for Treatment Research and Education in Cancer (ACTREC)/Tata Memorial Hospital (TMH), Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Kharghar, Navi Mumbai, 410210, India
| | - J S Goda
- Department of Radiation Oncology, Advanced Centre for Treatment Research and Education in Cancer (ACTREC)/Tata Memorial Hospital (TMH), Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Kharghar, Navi Mumbai, 410210, India
| | - R Krishnatry
- Department of Radiation Oncology, Advanced Centre for Treatment Research and Education in Cancer (ACTREC)/Tata Memorial Hospital (TMH), Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Kharghar, Navi Mumbai, 410210, India
| | - A Chatterjee
- Department of Radiation Oncology, Advanced Centre for Treatment Research and Education in Cancer (ACTREC)/Tata Memorial Hospital (TMH), Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Kharghar, Navi Mumbai, 410210, India
| | - A Moiyadi
- Department of Neuro-Surgical Oncology, Advanced Centre for Treatment Research and Education in Cancer (ACTREC)/Tata Memorial Hospital (TMH), Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Kharghar, Navi Mumbai, 410210, India
| | - P Shetty
- Department of Neuro-Surgical Oncology, Advanced Centre for Treatment Research and Education in Cancer (ACTREC)/Tata Memorial Hospital (TMH), Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Kharghar, Navi Mumbai, 410210, India
| | - S Epari
- Department of Pathology, Advanced Centre for Treatment Research and Education in Cancer (ACTREC)/Tata Memorial Hospital (TMH), Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Kharghar, Navi Mumbai, 410210, India
| | - A Sahay
- Department of Pathology, Advanced Centre for Treatment Research and Education in Cancer (ACTREC)/Tata Memorial Hospital (TMH), Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Kharghar, Navi Mumbai, 410210, India
| | - V Patil
- Department of Medical Oncology, Advanced Centre for Treatment Research and Education in Cancer (ACTREC)/Tata Memorial Hospital (TMH), Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Kharghar, Navi Mumbai, 410210, India
| | - R Jalali
- Department of Radiation Oncology, Advanced Centre for Treatment Research and Education in Cancer (ACTREC)/Tata Memorial Hospital (TMH), Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Kharghar, Navi Mumbai, 410210, India
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Sardana K, Mathachan SR, Gupta T. Antibiotic resistance in acne an emergent need to recognize resistance to azithromycin and restrict its unapproved use in acne vulgaris. J Eur Acad Dermatol Venereol 2021; 35:e347-e348. [PMID: 33351973 DOI: 10.1111/jdv.17099] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 11/26/2020] [Accepted: 12/16/2020] [Indexed: 12/26/2022]
Affiliation(s)
- K Sardana
- Department of Dermatology, Venereology and Leprosy, ABVIMS & Dr. Ram Manohar Lohia Hospital, New Delhi, India
| | - S R Mathachan
- Department of Dermatology, Venereology and Leprosy, ABVIMS & Dr. Ram Manohar Lohia Hospital, New Delhi, India
| | - T Gupta
- Department of Dermatology, Venereology and Leprosy, Maulana Azad Medical College, New Delhi, India
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Singal A, Sahni D, Gupta T, Aggarwal A, Gupta AK. Surgical anatomy of basal turn in relation to middle cranial fossa and round window as pertaining to middle fossa cochlear implant technique. Surg Radiol Anat 2021; 43:1195-1201. [PMID: 33399918 DOI: 10.1007/s00276-020-02647-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Accepted: 12/04/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE The purpose of this investigation was to evaluate the relation of the basal turn of cochlea with middle cranial fossa and round window as pertaining to middle cranial fossa cochlear implant technique. METHODS Fifty-four formalin preserved temporal bones were micro-dissected to expose the basal turn. The point (f) was marked on the basal turn of cochlea where there was minimum distance of basal turn of cochlea from the floor of middle cranial fossa (f1). The f-f1 distance, the angle (∠smf) and distance of point "f" from the round window (s-f) was measured. RESULTS The mean minimum distance between basal turn of cochlea and floor of middle cranial fossa (f-f1) was 2.0 ± 0.7 mm.The point f was at mean distance (s-f) and angle (∠smf) of 14.7 ± 1.6 mm and 217° ± 13.7° from round window, respectively. CONCLUSIONS The information may be helpful for designing appropriate electrode array for middle fossa technique especially for deciding the length of electrode array towards round window, as otherwise electrode may extend into vestibule of inner ear. In the cases where bone thickness between superior part of basal turn of cochlea and middle cranial fossa is < 1.5 mm, surgeon should be extra cautious.
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Affiliation(s)
- Anjali Singal
- Department of Anatomy, All India Institute of Medical Sciences, Bathinda, Punjab, 151001, India.
| | - Daisy Sahni
- Department of Anatomy, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Tulika Gupta
- Department of Anatomy, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Anjali Aggarwal
- Department of Anatomy, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ashok Kumar Gupta
- Department of Otorhinolaryngology and Head-Neck Surgery, Fortis Hospital, Mohali, Punjab, India
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Singal A, Gupta T, Sahni D. Diffuse Idiopathic Skeletal Hyperostosis: An Anatomical Case Report. J Clin Diagn Res 2021. [DOI: 10.7860/jcdr/2021/46200.14579] [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: 11/24/2022]
Abstract
Diffuse Idiopathic Skeletal Hyperostosis (DISH) is a noninflammatory disease of unknown cause characterised by osteophytic calcification or ossification of ligaments and enthesis; especially spinal. Authors hereby present a case report of a 65-year-old male cadaver, in whom the fusion of contiguous nine vertebrae from fifth thoracic to first lumbar vertebrae, because of ossification of the Anterior Longitudinal Ligament (ALL) was noticed. The tenth and eleventh thoracic vertebrae seemed to be affected worse, as maximum osseous anterior outgrowth (12 mm) of ossified ALL, ossification of Ligamentum Flavum (LF) and supraspinous ligament was also observed at this level. The Ossification of Anterior Longitudinal Ligament (OALL) along with the involvement of LF has not been classically reported. Ossification of spinal ligaments may cause local thoracic pain, stiffness and slowly progressive myelopathy. Ossified LF at the level of joint between tenth and eleventh thoracic vertebrae may result in compression of spinal cord at this level.
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Dwivedi SK, Ali R, Singh M, Gupta T, Kar AK, Prakash V, Sadasivam A, Patnaik S, Misra A. A simple naphthalimide based PET probe for Fe3+ and selective detection of pyrophosphate through displacement approach: Cell imaging studies and logic interpretation. J Photochem Photobiol A Chem 2020. [DOI: 10.1016/j.jphotochem.2020.112854] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Sasson SC, Zaunders JJ, Nahar K, Munier CML, Fairfax BP, Olsson-Brown A, Jolly C, Read SA, Ahlenstiel G, Palendira U, Scolyer RA, Carlino MS, Payne MJ, Cheung VTF, Gupta T, Klenerman P, Long GV, Brain O, Menzies AM, Kelleher AD. Mucosal-associated invariant T (MAIT) cells are activated in the gastrointestinal tissue of patients with combination ipilimumab and nivolumab therapy-related colitis in a pathology distinct from ulcerative colitis. Clin Exp Immunol 2020; 202:335-352. [PMID: 32734627 PMCID: PMC7670140 DOI: 10.1111/cei.13502] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [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: 03/16/2020] [Revised: 06/09/2020] [Accepted: 07/07/2020] [Indexed: 12/15/2022] Open
Abstract
The aim of this study was to investigate the pathogenesis of combination ipilimumab and nivolumab-associated colitis (IN-COL) by measuring gut-derived and peripheral blood mononuclear cell (GMNC; PBMC) profiles. We studied GMNC and PBMC from patients with IN-COL, IN-treated with no adverse-events (IN-NAE), ulcerative colitis (UC) and healthy volunteers using flow cytometry. In the gastrointestinal-derived cells we found high levels of activated CD8+ T cells and mucosal-associated invariant T (MAIT) cells in IN-COL, changes that were not evident in IN-NAE or UC. UC, but not IN-C, was associated with a high proportion of regulatory T cells (Treg ). We sought to determine if local tissue responses could be measured in peripheral blood. Peripherally, checkpoint inhibition instigated a rise in activated memory CD4+ and CD8+ T cells, regardless of colitis. Low circulating MAIT cells at baseline was associated with IN-COL patients compared with IN-NAE in one of two cohorts. UC, but not IN-COL, was associated with high levels of circulating plasmablasts. In summary, the alterations in T cell subsets measured in IN-COL-affected tissue, characterized by high levels of activated CD8+ T cells and MAIT cells and a low proportion of Treg , reflected a pathology distinct from UC. These tissue changes differed from the periphery, where T cell activation was a widespread on-treatment effect, and circulating MAIT cell count was low but not reliably predictive of colitis.
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Affiliation(s)
- S C Sasson
- Translational Gastroenterology Unit and Oxford Biomedical Research Centre, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - J J Zaunders
- Centre for Applied Medical Research, St Vincent's Hospital, Sydney, Australia
| | - K Nahar
- Melanoma Institute Australia and The University of Sydney, Sydney, Australia
| | - C M L Munier
- The Kirby Institute, University of New South Wales, Sydney, Australia
| | - B P Fairfax
- Department of Oncology, Churchill Hospital, Oxford, UK.,Department of Oncology, University of Oxford, Oxford, UK.,MRC Weatherall Institute of Molecular Medicine, University of Oxford, Oxford, UK
| | - A Olsson-Brown
- The Clatterbridge Cancer Centre NHS Foundation Trust and Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - C Jolly
- The Clatterbridge Cancer Centre NHS Foundation Trust and Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - S A Read
- Westmead Institute of Medical Research, Sydney, Australia.,Western Sydney University, Sydney, Australia
| | - G Ahlenstiel
- Westmead Institute of Medical Research, Sydney, Australia.,Department of Gastroenterology, Blacktown Hospital, Sydney, Australia
| | - U Palendira
- Discipline of Infectious Diseases and Immunology, The University of Sydney, Sydney, Australia
| | - R A Scolyer
- Melanoma Institute Australia and The University of Sydney, Sydney, Australia.,Department of Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, Sydney, Australia
| | - M S Carlino
- Melanoma Institute Australia and The University of Sydney, Sydney, Australia.,Department of Medical Oncology, Westmead and Blacktown Hospitals, Sydney, Australia
| | - M J Payne
- Department of Oncology, Churchill Hospital, Oxford, UK
| | - V T F Cheung
- Translational Gastroenterology Unit and Oxford Biomedical Research Centre, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - T Gupta
- Translational Gastroenterology Unit and Oxford Biomedical Research Centre, Nuffield Department of Medicine, University of Oxford, Oxford, UK.,MRC Weatherall Institute of Molecular Medicine, University of Oxford, Oxford, UK
| | - P Klenerman
- Translational Gastroenterology Unit and Oxford Biomedical Research Centre, Nuffield Department of Medicine, University of Oxford, Oxford, UK.,Peter Medawar Building of Pathogen Research, University of Oxford, Oxford, UK
| | - G V Long
- Melanoma Institute Australia and The University of Sydney, Sydney, Australia.,Department of Medical Oncology, Royal North Shore Hospital and Mater Hospitals, Sydney, Australia
| | - O Brain
- Translational Gastroenterology Unit and Oxford Biomedical Research Centre, Nuffield Department of Medicine, University of Oxford, Oxford, UK.,Department of Gastroenterology, John Radcliffe Hospital, Oxford, UK
| | - A M Menzies
- Melanoma Institute Australia and The University of Sydney, Sydney, Australia.,Department of Medical Oncology, Royal North Shore Hospital and Mater Hospitals, Sydney, Australia
| | - A D Kelleher
- Centre for Applied Medical Research, St Vincent's Hospital, Sydney, Australia.,The Kirby Institute, University of New South Wales, Sydney, Australia
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Niggas A, Schwestka J, Creutzburg S, Gupta T, Eder D, Bayer BC, Aumayr F, Wilhelm RA. The role of contaminations in ion beam spectroscopy with freestanding 2D materials: A study on thermal treatment. J Chem Phys 2020; 153:014702. [PMID: 32640815 DOI: 10.1063/5.0011255] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
As surface-only materials, freestanding 2D materials are known to have a high level of contamination-mostly in the form of hydrocarbons, water, and residuals from production and exfoliation. For well-designed experiments, it is of particular importance to develop effective cleaning procedures, especially since standard surface science techniques are typically not applicable. We perform ion spectroscopy with highly charged ions transmitted through freestanding atomically thin materials and present two techniques to achieve clean samples, both based on thermal treatment. Ion charge exchange and energy loss are used to analyze the degree of sample contamination. We find that even after cleaning, heavily contaminated spots remain on single layer graphene. The contamination coverage, however, clusters in strand-like structures leaving large clean areas. We present a way to discriminate clean from contaminated areas with our ion beam spectroscopy if the heterogeneity of the surface is increased sufficiently enough. We expect a similar discrimination to be necessary in most other experimental techniques.
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Affiliation(s)
- A Niggas
- Institute of Applied Physics, TU Wien, 1040 Vienna, Austria
| | - J Schwestka
- Institute of Applied Physics, TU Wien, 1040 Vienna, Austria
| | - S Creutzburg
- Institute of Ion Beams and Materials Research, Helmholtz-Zentrum Dresden-Rossendorf, 01328 Dresden, Germany
| | - T Gupta
- Institute of Materials Chemistry, TU Wien, 1060 Vienna, Austria
| | - D Eder
- Institute of Materials Chemistry, TU Wien, 1060 Vienna, Austria
| | - B C Bayer
- Institute of Materials Chemistry, TU Wien, 1060 Vienna, Austria
| | - F Aumayr
- Institute of Applied Physics, TU Wien, 1040 Vienna, Austria
| | - R A Wilhelm
- Institute of Applied Physics, TU Wien, 1040 Vienna, Austria
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Basak D, Leusen JV, Gupta T, Kögerler P, Bertolasi V, Ray D. Unusually Distorted Pseudo-Octahedral Coordination Environment Around CoII from Thioether Schiff Base Ligands in Dinuclear [CoLn] (Ln = La, Gd, Tb, Dy, Ho) Complexes: Synthesis, Structure, and Understanding of Magnetic Behavior. Inorg Chem 2020; 59:2387-2405. [DOI: 10.1021/acs.inorgchem.9b03259] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Dipmalya Basak
- Department of Chemistry, Indian Institute of Technology, Kharagpur 721 302, India
| | - Jan van Leusen
- Institute of Inorganic Chemistry, RWTH Aachen University, D-52074 Aachen, Germany
| | - Tulika Gupta
- Department of Chemistry, Institute of Science, Banaras Hindu University, Varanasi 221005, India
| | - Paul Kögerler
- Institute of Inorganic Chemistry, RWTH Aachen University, D-52074 Aachen, Germany
| | - Valerio Bertolasi
- Dipartimento di ScienzeChimiche e Farmaceutiche, University of Ferrara, 44121 Ferrara, Italy
| | - Debashis Ray
- Department of Chemistry, Indian Institute of Technology, Kharagpur 721 302, India
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Singal A, Gupta T, Sahni D, Aggarwal A. Anatomy of scalenovertebral triangle: A vade mecum for clinicians. Morphologie 2020; 104:174-181. [PMID: 31982324 DOI: 10.1016/j.morpho.2019.12.004] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 12/27/2019] [Accepted: 12/31/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVE OF THE STUDY The thorough anatomical knowledge of scalenovertebral triangle or Triangle of the vertebral artery and its contents is crucial in various neurosurgical procedures such as scalenotomy, stellate ganglion block, direct isolation of proximal vertebral artery and proximal brachial plexus repair. MATERIAL AND METHOD Thirty scalenovertebral triangles of known age and sex were dissected. The morphometry of the triangle and stellate ganglion was done. Various relevant distances were measured for topographical location of neurovascular structures especially stellate ganglion and vertebral artery within the triangle. RESULTS The mean height and width of the scalenovertebral triangle was 21.7+5.1mm and 19.4+4.4mm respectively. Vertebral artery originated from subclavian artery within the triangle except in one case (left side) where it originated from aortic arch. The mean minimum distance of stellate ganglion from phrenic nerve, scalenus anterior and vertebral origin was 12.6+4.5mm, 12.26+4mm and 2.3+1.3mm respectively. CONCLUSIONS The origin and proximal part of vertebral artery may not be present within the scalenovertebral triangle, thus topographic anatomy of the stellate ganglion is also affected and may cause complications during stellate ganglion block. Stellate ganglion is never located in the lateral or upper third of triangle. Occasionally, the phrenic nerve may cross the triangle, making it unsafe during stellate ganglion block.
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Affiliation(s)
- A Singal
- Department of Anatomy, All India institute of Medical Sciences, 151001 Bathinda (Punjab), India
| | - T Gupta
- Department of Anatomy, Postgraduate Institute of Medical Education & Research (PGIMER), 160012 Chandigarh, India.
| | - D Sahni
- Department of Anatomy, Postgraduate Institute of Medical Education & Research (PGIMER), 160012 Chandigarh, India
| | - A Aggarwal
- Department of Anatomy, Postgraduate Institute of Medical Education & Research (PGIMER), 160012 Chandigarh, India
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Basak D, van Leusen J, Gupta T, Kögerler P, Ray D. Synthetic diversity and change in nuclearity in [Co-Dy] coordination aggregates: bridge removal, solvent induced structural reorganization and AC susceptibility measurements. Dalton Trans 2020; 49:7576-7591. [PMID: 32458935 DOI: 10.1039/d0dt01728k] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Three new cobalt(ii/iii)-dysprosium(iii) complexes, [DyIII3CoII2CoIII2(L1)2(O2CCMe3)8(OH)4(OMe)2(H2O)4]·Dy(η1-O2CCMe3)2(η2-O2CCMe3)2(MeOH)2·4H2O (1), [DyIII3CoII2CoIII2(L2)2(O2CCMe3)8(OH)4(OMe)2(MeOH)2(H2O)2]·Dy(η1-O2CCMe3)2(η2-O2CCMe3)2(MeOH)2·4MeOH (2) and DyIII2CoII2CoIII2(L2)2(O2CCMe3)10(OH)2 (3) have been reported. In the heptanuclear 3d-4f monocationic aggregates in 1 and 2 the three dysprosium and four cobalt sites are arranged into a vertex shared dicubane structure, induced by two structure-directing ligands. Interestingly, a unique and previously unknown dysprosium(iii)-pivalate based counter anion, Dy(η1-O2CCMe3)2(η2-O2CCMe3)2(MeOH)2-, was trapped by the monocationic cores during crystallization. MeCN induced structural rearrangement of 2 through loss of OMe- bridges and dysprosium(iii) ions at the shared vertex resulted in the hexanuclear 3d-4f neutral aggregate 3, in which two dysprosium and four cobalt sites exhibit a near planar disposition. HRMS(+ve) of solutions of 1 and 2 revealed the pathway for aggregation processes and solvent induced structural transformation along with the importance of bridging OMe- in directing the formation of these compounds. Magnetic studies show a non-zero out-of-phase component in the AC susceptibility measurements of 1 but not in 2 and 3, although 1 and 2 have a very similar {CoIII2CoII2DyIII3} core and another DyIII center. Ab initio single-ion calculations point to the different single-ion anisotropic behavior for DyIII centers (energy in cm-1 and g-tensors) as well as negative and positive D values for CoII sites in 1 and 2 respectively reaffirming the experimental result. However, calculations envision that, zero-field out-of-phase signal and no out-of-phase signal in 1 and 2 respectively do not solely generate from the single-ion Dy/Co anisotropies and the overall relaxation mechanism can be understood by considering the exchange interactions between DyIII-DyIII and DyIII-CoII centres.
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Affiliation(s)
- Dipmalya Basak
- Department of Chemistry, Indian Institute of Technology, Kharagpur 721 302, India.
| | - Jan van Leusen
- Institute of Inorganic Chemistry, RWTH Aachen University, D-52074 Aachen, Germany
| | - Tulika Gupta
- Department of Chemistry, Institute of Science, Banaras Hindu University, Varanasi 221005, India
| | - Paul Kögerler
- Institute of Inorganic Chemistry, RWTH Aachen University, D-52074 Aachen, Germany
| | - Debashis Ray
- Department of Chemistry, Indian Institute of Technology, Kharagpur 721 302, India.
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