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Khanna V, Sohn G, Khanna S, Ashraf M, Mittal MM, Mounsamy V, Sambandam S. Lower Intraoperative and Immediate Postoperative Complications in Robotic Versus Conventional Primary Total Hip Arthroplasty: A Retrospective Cohort Analysis of Over 360,000 Patients. Cureus 2024; 16:e57726. [PMID: 38711699 PMCID: PMC11073758 DOI: 10.7759/cureus.57726] [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] [Accepted: 04/06/2024] [Indexed: 05/08/2024] Open
Abstract
PURPOSE Although a trend of an improved alignment with robotic total hip arthroplasty (THA) over conventional methods has surfaced from recent series, it is unknown whether these results translate into meaningful enhancements in postoperative outcomes. To address this lack in the literature, we compared the perioperative morbidity and mortality with robotic and conventional THA in a large national cohort of 367,894 patients. We hypothesized that no significant differences would exist in the outcomes between the two groups. METHODS Records were extracted from 2016-2019 from the National Inpatient Sample (NIS) database Healthcare Cost and Utilization Project which is the largest in-patient database in the United States. From 367,894 THAs, robotics were employed for 7,863 patients. The remaining 360,031 conventional THAs served as controls. The two groups were compared for demographics, admission, and hospital stay details including costs, and mortality and morbidity data including medical and surgical complications. Descriptive statistics were used for demographic data while analytical statistics including t-tests, chi-squared tests, Fischer exact test, and Pearson chi-squared tests were used for perioperative outcomes. Statistical significance was set at p<0.005. RESULTS Demographic distributions between robotic and conventional THA groups displayed similar age and sex characteristics. Shorter mean lengths of stay (1.87 days) were seen in robotic THA versus conventional THA (2.33 days) while higher costs were noted for the former (mean $68,686.71 vs $66,840.39) (p<0.005). Low overall mortality (0.03% robotic, 0.09% conventional) was seen in both groups (p>0.005). Higher comparative incidences of anemia, acute renal failure, and pneumonia were seen in conventional THA (p<0.005) while no significant differences were noted for other complications including myocardial infarction, pulmonary embolism, deep vein thrombosis, and cardiac arrest (p>0.005). Among others, lower dislocation rates, mechanical complications, periprosthetic joint infection, and periprosthetic fractures were seen with robotic THA (p<0.005). Wound complications and superficial infection rates did not differ between the two groups (p>0.005). CONCLUSIONS Evidence has emerged from our results to support more routine adaptation of the robotic option of performing a THA. These can be based on lower local, systemic, and mechanical complications as demonstrated by the present study. Further evaluation of these results in follow-up would help establish the foothold of robotic surgery in total hip replacement in the modern context.
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Affiliation(s)
| | - Garrett Sohn
- Orthopedics, UT Southwestern Medical Center, Dallas, USA
| | - Surya Khanna
- Orthopaedics, Jawaharlal Nehru Medical College, Belagavi, IND
| | - Munis Ashraf
- Orthopedics, Saveetha Medical College and Hospital, Chennai, IND
| | - Mehul M Mittal
- Orthopedics, UT Southwestern Medical Center, Dallas, USA
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Gaut D, Oliai C, Boiarsky J, Zhang S, Salhotra A, Azenkot T, Kennedy VE, Khanna V, Olmedo Gutierrez K, Shukla N, Moskoff B, Park G, Afkhami M, Patel A, Jeyakumar D, Mannis G, Logan AC, Jonas BA, Schiller G. Measurable residual disease conversion rate with consolidation chemotherapy in acute myeloid leukemia. Leuk Lymphoma 2024; 65:69-77. [PMID: 37801340 DOI: 10.1080/10428194.2023.2264426] [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] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 09/20/2023] [Indexed: 10/07/2023]
Abstract
The rate of MRD clearance in AML with standard consolidation chemotherapy is not well defined. A multi-institution retrospective analysis was performed on 107 consecutively treated AML patients in morphologic complete remission with detectable MRD post-induction therapy who received standard chemotherapy consolidation. In response to standard intermediate/high-dose cytarabine consolidation therapy, 26 of 60 patients (43.3%) with MRD threshold of detection of at least 0.1% converted to MRD-negative status (undetectable with assay used), and 6 of 47 patients (12.8%) with MRD threshold of detection > 0.1% converted to MRD-negative status. Multivariable logistic regression for patients with MRD threshold of detection of at least 0.1% showed that, when controlling for age, ELN risk category, dose of cytarabine, and use of a combination agent, treatment with 1 cycle of consolidation cytarabine versus ≥2 cycles decreased the odds of conversion of AML to MRD-negative (OR = 0.24, 95% CI 0.07-0.85, p = 0.03).
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Affiliation(s)
- Daria Gaut
- Division of Hematology/Oncology, Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Caspian Oliai
- Division of Hematology/Oncology, Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Jonathan Boiarsky
- Division of Hematology/Oncology, Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Shiliang Zhang
- Division of Hematology/Oncology, Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Amandeep Salhotra
- Department of Hematology and Hematopoietic Cell Transplant, City of Hope, Duarte, California, USA
| | - Tali Azenkot
- Division of Hematology/Oncology, Department of Medicine, University of California Davis School of Medicine, Sacramento, California, USA
| | - Vanessa E Kennedy
- Division of Hematology/Oncology, Department of Medicine, University of California San Francisco School of Medicine, San Francisco, California, USA
| | - Vishesh Khanna
- Division of Hematology, Department of Medicine, Stanford Cancer Institute, Stanford, California, USA
| | - Karla Olmedo Gutierrez
- Division of Hematology/Oncology, Department of Medicine, University of California Irvine School of Medicine, Orange, California, USA
| | - Navika Shukla
- Divison of Hematology/Oncology, Department of Medicine, University of Chicago, Chicago, Illinois, USA
| | - Benjamin Moskoff
- Division of Hematology/Oncology, Department of Medicine, University of California Davis School of Medicine, Sacramento, California, USA
| | - Gabriel Park
- Department of Hematology and Hematopoietic Cell Transplant, City of Hope, Duarte, California, USA
| | - Michelle Afkhami
- Department of Hematology and Hematopoietic Cell Transplant, City of Hope, Duarte, California, USA
| | - Anand Patel
- Divison of Hematology/Oncology, Department of Medicine, University of Chicago, Chicago, Illinois, USA
| | - Deepa Jeyakumar
- Division of Hematology/Oncology, Department of Medicine, University of California Irvine School of Medicine, Orange, California, USA
| | - Gabriel Mannis
- Division of Hematology, Department of Medicine, Stanford Cancer Institute, Stanford, California, USA
| | - Aaron C Logan
- Division of Hematology/Oncology, Department of Medicine, University of California San Francisco School of Medicine, San Francisco, California, USA
| | - Brian A Jonas
- Division of Hematology/Oncology, Department of Medicine, University of California Davis School of Medicine, Sacramento, California, USA
| | - Gary Schiller
- Division of Hematology/Oncology, Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
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Khanna V, Lu R, Kumar J, Molina A, Stehr H, Spiteri E, Spinner M, Silva O, Fernandez-Pol S, Tan B, Greenberg PL. The clinical, molecular, and prognostic features of the 2022 WHO and ICC classification systems for myelodysplastic neoplasms. Leuk Res 2024; 136:107433. [PMID: 38154193 DOI: 10.1016/j.leukres.2023.107433] [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] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 12/09/2023] [Accepted: 12/14/2023] [Indexed: 12/30/2023]
Abstract
Myelodysplastic neoplasms (MDS) are clonal disorders of bone marrow failure exhibiting a variable risk of progression to acute myeloid leukemia. MDS exhibit certain prognostic genetic or cytogenetic abnormalities, an observation that has led to both the pathologic reclassification of MDS in the 2022 World Health Organization (WHO) and International Consensus Classification (ICC) systems, as well as to an updated prognostic schema, the Molecular International Prognostic Scoring System (IPSS-M). This single-institution study characterized the molecular patterns and clinical outcomes associated with the 2022 WHO and ICC classification schemas to assess their clinical utility. Strikingly, with the exception of one individual, all 210 patients in our cohort were classified into analogous categories by the two pathologic/diagnostic schemas. Most patients (70%) were classified morphologically while the remaining 30% had genetically classified disease by both criteria. Prognostic risk, as assessed by the IPSS-M score was highest in patients with MDS with biallelic/multi-hit TP53 mutations and lowest in pts with MDS-SF3B1. Median leukemia-free survival (LFS) was shortest for those with MDS with biallelic/multi-hit TP53 (0.7 years) and longest for those with MDS with low blasts (LFS not reached). These data demonstrate the clear ability of the 2022 WHO and ICC classifications to organize MDS patients into distinct prognostic risk groups and further show that both classification systems share more similarities than differences. Incorporation of the IPSS-M and IPSS-R features provide additive prognostic and survival components to both the WHO and ICC classifications, which together enhance their utility for evaluating and treating MDS patients.
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Affiliation(s)
- Vishesh Khanna
- Department of Medicine, Division of Hematology, Stanford University School of Medicine, Stanford, CA, United States
| | - Rong Lu
- Department of Medicine, Quantitative Sciences Unit, Stanford University School of Medicine, Stanford, CA, United States
| | - Jyoti Kumar
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, United States
| | - Alfonso Molina
- Department of Medicine, Division of Hematology, Stanford University School of Medicine, Stanford, CA, United States
| | - Henning Stehr
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, United States
| | - Elizabeth Spiteri
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, United States
| | - Michael Spinner
- Department of Medicine, Division of Hematology, Stanford University School of Medicine, Stanford, CA, United States
| | - Oscar Silva
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, United States
| | - Sebastian Fernandez-Pol
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, United States
| | - Brent Tan
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, United States
| | - Peter L Greenberg
- Department of Medicine, Division of Hematology, Stanford University School of Medicine, Stanford, CA, United States.
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Khanna V, Azenkot T, Liu SQ, Gilbert J, Cheung E, Lau K, Pollyea DA, Traer E, Jonas BA, Zhang TY, Mannis GN. Outcomes with molecularly targeted agents as salvage therapy following frontline venetoclax + hypomethylating agent in adults with acute myeloid leukemia: A multicenter retrospective analysis. Leuk Res 2023; 131:107331. [PMID: 37263072 DOI: 10.1016/j.leukres.2023.107331] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 04/24/2023] [Accepted: 05/26/2023] [Indexed: 06/03/2023]
Affiliation(s)
- Vishesh Khanna
- Department of Medicine, Division of Hematology, Stanford University School of Medicine, Stanford, CA, USA
| | - Tali Azenkot
- Department of Medicine, University of California Davis School of Medicine, Sacramento, CA, USA
| | - Selina Qiuying Liu
- Knight Cancer Institute, Division of Hematology & Medical Oncology, Oregon Health & Science University, Portland, OR, USA
| | - Jason Gilbert
- Division of Hematology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Edna Cheung
- Department of Pharmacy, Stanford Healthcare, Stanford, CA, USA
| | - Kimberly Lau
- Department of Pharmacy, Stanford Healthcare, Stanford, CA, USA
| | - Daniel A Pollyea
- Division of Hematology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Elie Traer
- Knight Cancer Institute, Division of Hematology & Medical Oncology, Oregon Health & Science University, Portland, OR, USA
| | - Brian A Jonas
- Department of Medicine, Division of Malignant Hematology, Cellular Therapy and Transplantation, University of California Davis School of Medicine, Sacramento, CA, USA
| | - Tian Y Zhang
- Department of Medicine, Division of Hematology, Stanford University School of Medicine, Stanford, CA, USA
| | - Gabriel N Mannis
- Department of Medicine, Division of Hematology, Stanford University School of Medicine, Stanford, CA, USA.
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Gupta PK, Acharya A, Khanna V, Mourya A. Intra-femoral tunnel graft lengths less than 20 mm do not predispose to early graft failure, inferior outcomes or poor function. A prospective clinico-radiological comparative study. Musculoskelet Surg 2023; 107:179-186. [PMID: 35288845 DOI: 10.1007/s12306-022-00740-3] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 02/21/2022] [Indexed: 05/18/2023]
Abstract
PURPOSE Increasing demands on skills with mounting pressures from expectations from arthroscopic anterior cruciate ligament (ACL) reconstructions requires precise knowledge of technical details by surgeons. One such element is the minimum length of graft in femoral tunnel to allow for adequate tendon-to-bone healing and early return to activities and sports. This has, however, remained an unanswered question. PURPOSE To study and compare clinico-radiological outcomes of ACL reconstructions in patients with < 20 mm of intra-femoral tunnel graft length with those measuring ≥ 20 mm. METHODS All eligible patients undergoing arthroscopic ACL reconstruction were sequentially divided into two groups based on the intra-femoral tunnel graft lengths (A: < 20 mm, n = 27; and B: ≥ 20 mm, n = 25). Exclusions were made for those > 45 years of age, with chondral and/or multi-ligamentous injuries and with systemic pathologies. All patients were postoperatively evaluated in clinics by physical examination and functional scoring (Lysholm and modified Cincinnati scores) at 3, 6 and 12-month intervals. Graft vascularity was assessed by signal-to-noise quotient ratio (SNQR) using magnetic resonance imaging (MRI) at 3 and 12 months. RESULTS No significant differences were noted in mean Lysholm and modified Cincinnati scores between the two groups at the end of 1 year. There were also no significant differences in graft maturation over time and SNQR at 3 and 12 months in the region of interest (ROI). CONCLUSIONS Intra-femoral tunnel graft length of less than 20 mm does not compromise early clinical and functional outcomes of ACL reconstructions.
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Affiliation(s)
- P K Gupta
- Department of Sports Medicine, Sir Ganga Ram Hospital, New Delhi, India.
| | - A Acharya
- Department of Sports Medicine, Sir Ganga Ram Hospital, New Delhi, India
| | - V Khanna
- University Hospital Dorset, Dorset, UK
| | - A Mourya
- Department of Orthopaedics, Sir Ganga Ram Hospital, New Delhi, India
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Desai A, Anavim A, Perez I, Yun J, Desai S, Li S, Khanna V. Abstract No. 592 Incidence of Caval Extension of Iliofemoral DVT in Patients Undergoing Thrombectomy. J Vasc Interv Radiol 2023. [DOI: 10.1016/j.jvir.2022.12.450] [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: 02/27/2023] Open
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Khanna V, Sakthivelnathan V, Senthil T, Varatharaj S, Mounasamy V, Sambandam S. Dialysis Patients Undergoing Total Hip Arthroplasty have Higher Rates of Morbidity and Mortality and Incur Greater Healthcare Costs: A National Database Study from 367,894 Patients. Indian J Orthop 2023; 57:336-343. [PMID: 36777113 PMCID: PMC9880083 DOI: 10.1007/s43465-022-00799-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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Accepted: 12/08/2022] [Indexed: 12/24/2022]
Abstract
Purpose The incidence of a total hip arthroplasty (THA) is sevenfold higher in dialysed patients. Only a few have specifically studied the impact of chronic dialysis on outcomes of THA whilst comparing them with non-dialysed/controls. The present study questioned whether significant differences existed in morbidity and mortality rates after THA in dialysed and non-dialysed patients. Methods The National Inpatient Sample (NIS) database Healthcare Cost and Utilization Project using records for THAs performed during 2016-2019 was employed. This largest, nationwide, in-patient database in the US acquires data from > 7 million hospital stays annually from > 20% hospitals. Among 367,894 THAs performed during 2016-2019, 383 were regularly dialysed. The two groups (dialysis and controls) were compared for in-hospital mortality, demographic data, perioperative details and medical/surgical complications. Results Dialysed patients were younger (p < 0.001), had greater mortality (0.5% vs 0.09%, p = 0.005), lengths of stay (4.4 vs 2.3 days, p < 0.001), costs ($96,824 vs $66,848, p < 0.001) and male preponderance (p < 0.001). Postoperative dislocations (3.1% vs 1.4%, p = 0.013), mechanical complications (p = 0.032) and blood loss (p = 0.031) were greater in dialysed patients. Medical postoperative complications (myocardial infarction, pneumonia, thromboembolism, acute renal failure), periprosthetic fractures, wound dehiscence, superficial and deep surgical-site infection and periprosthetic joint infections were comparable between the 2 groups. Dialysed patients had elective THAs more often (25% vs 8.6%). Controls had higher (twofold) home discharges while ~ 50% of dialysed THAs needed discharge to another facility. Conclusions This large national data highlighted greater morbidity and mortality among dialysis patients following THA, something to consider preoperatively along with individual circumstances whilst making risk-benefit assessments for arthroplasty. Improvements in healthcare could bridge gaps between outcomes and expectations in dialysed patients.
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Affiliation(s)
- Vishesh Khanna
- Trauma and Orthopaedics, Morriston Hospital, Swansea Bay University Health Board, Swansea, UK
| | | | | | | | - Varatharaj Mounasamy
- Department of Orthopedics, University of Texas Southwestern, Dallas, USA
- Orthopedics, Dallas VAMC, Dallas, TX USA
| | - Senthil Sambandam
- Department of Orthopedics, University of Texas Southwestern, Dallas, USA
- Orthopedics, Dallas VAMC, Dallas, TX USA
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Annapareddy A, Daultani D, Mulpur P, Khanna V, Sankineani SR, Eachempati KK, Reddy AVG. High Prevalence of Isolated Antero-medial Osteoarthritis (AMOA) in Indian Patients Undergoing Primary Total Knee Arthroplasty. Indian J Orthop 2022; 56:1774-1781. [PMID: 36187578 PMCID: PMC9485309 DOI: 10.1007/s43465-022-00710-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 07/21/2022] [Indexed: 02/04/2023]
Abstract
Background Isolated antero-medial osteoarthritis (AMOA) of the knee is a distinct pattern of arthritis. Medial arthritis of the knee in select patients can be managed with uni-compartmental arthroplasty (UKA), with studies showing shorter hospital stay, faster rehabilitation and reduced medical complications in the post-operative period compared to TKA. However, the prevalence of AMOA in Indian patients with osteoarthritis of the knee is unknown. The aim of this study was to evaluate the prevalence of AMOA in patients undergoing primary TKA for OA. Methods This was a prospective evaluation of 2518 knees in 1936 patients who were selected for primary TKA. Pre-operative radiographs were screened based on the Oxford UKA Radiological decision aid and diagnosis of AMOA was established. All 2518 knees underwent primary total knee arthroplasty and cases of AMOA were confirmed intra-operatively based on ACL integrity, lateral compartment wear and medial compartment wear pattern. Cases with AMOA arthritic wear pattern were considered amenable for UKA if radiographs showed intact lateral joint space, intra-operatively those with intact and functional ACL, acceptable patellofemoral wear (Outerbridge I-II). Results We report a prevalence of 46.94% of AMOA, who were amenable for UKA. Obese patients were more likely to have a damaged or non-functional ACL and more likely to have a high degree of wear, not amenable for UKA (p < 0.05). Non-functional ACL was associated with higher prevalence of posterior extension of arthritic wear. Conclusion This study demonstrated a high prevalence (46.94%) of antero-medial osteoarthritis (AMOA), amenable for UKA. Patient selection is important for improving outcomes after TKA or UKA. Future studies are warranted to compare outcomes of both UKA and TKA in patients with isolated AMOA of the knee.
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Affiliation(s)
- Adarsh Annapareddy
- Sunshine Bone and Joint Institute, Sunshine Hospitals, PG Road, Ramgopalpet, Secunderabad, Hyderabad, Telangana 500003 India
| | - Deepesh Daultani
- Sunshine Bone and Joint Institute, Sunshine Hospitals, PG Road, Ramgopalpet, Secunderabad, Hyderabad, Telangana 500003 India
| | - Praharsha Mulpur
- Sunshine Bone and Joint Institute, Sunshine Hospitals, PG Road, Ramgopalpet, Secunderabad, Hyderabad, Telangana 500003 India
| | - Vishesh Khanna
- Sunshine Bone and Joint Institute, Sunshine Hospitals, PG Road, Ramgopalpet, Secunderabad, Hyderabad, Telangana 500003 India
| | | | | | - A. V. Gurava Reddy
- Sunshine Bone and Joint Institute, Sunshine Hospitals, PG Road, Ramgopalpet, Secunderabad, Hyderabad, Telangana 500003 India
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Desai S, Desai A, Anavim A, Taghipour M, Khanna V, Natarajan B, Brady P. Abstract No. 230 Endovascular management approaches for hepatic artery stenosis following adult liver transplantation. J Vasc Interv Radiol 2022. [DOI: 10.1016/j.jvir.2022.03.311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Khanna V, Miles C, Sundaram V, Sheth S, Steffen M, Biedermann S, Jun D, Winters E, Khan SA. Abemaciclib in metastatic or locally advanced anaplastic thyroid cancer. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.tps6112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
TPS6112 Background: Anaplastic thyroid cancer (ATC) is a rare and lethal tumor of thyroid epithelium, with disease-specific mortality approaching 100%. ATC accounts for > 50% of the 1200 annual deaths attributable to thyroid cancer. In the pre-molecular era, treatment options were largely ineffective, reflected in a median overall survival of 3-4 months following diagnosis. Outcomes have improved in BRAF V600E-mutated ATC with the FDA approval of dabrafenib and trametinib (Subbiah et al. JCO, 2018). However, a significant need exists for patients with BRAF wild-type tumors and patients with BRAF-mutated tumors who progress following treatment with BRAF-directed therapies. Abemaciclib is a CDK4/6 inhibitor currently FDA-approved in combination with endocrine therapy for hormone-positive breast cancer. Genomic analyses of ATC have indicated the presence of an intact Rb (Retinoblastoma) expression as well as the existence of CDKN2A (the gene encoding human p16) mutations in up to 32% of patients with ATC (Khan et al., Head Neck, 2019). Moreover, Lee et al. in 2008 reported undetectable p16 levels in 24 out of 27 (89%) patients with ATC. Low p16 levels would be expected to result in accelerated S phase entry, leading to uncontrolled ATC growth. Finally, studies in mouse xenograft models have demonstrated that ribociclib (a CDK4/6 inhibitor) slows proliferation and induces apoptosis of ATC cells (Lee et al., Cancer Letters, 2018). These molecular alterations and pre-clinical data provide a mechanistic rationale by which to evaluate CDK4/6 inhibitors in ATC and, to date, no CDK4/6 inhibitors have been evaluated in thyroid cancer. Methods: This multicenter, single-arm Phase 2 study will evaluate the safety and efficacy of treatment with abemaciclib in patients with histologically confirmed unresectable or metastatic ATC, using an optimal Simon two-stage design. Patients with BRAF V600E+ ATC must have progressed on or have an intolerance to dabrafenib and trametinib. The study intervention is abemaciclib 200 mg orally twice daily. The primary endpoint is overall response rate at eight weeks from the start of treatment. Secondary endpoints include progression-free survival and overall survival. Currently, 6 patients have been enrolled. Planned genomic analysis will be conducted to identify potential predictive biomarkers. Clinical trial information: NCT04552769.
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Khanna V, S APRIYA. An Intelligent Fuzzy and IoT aware Air Quality Prediction and Monitoring System using CRF and Bi-LSTM. IJIEI 2022. [DOI: 10.1504/ijiei.2022.10053546] [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: 01/19/2023]
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Akhtar M, Shafi A, Khanna V, Mukhopadhyay S, Patel K, Ozkor M, Baumbach A, Mathur A, Kennon S, Awad W, Mullen MM. The management of severe aortic stenosis during the COVID-19 pandemic: an observational study comparing TAVI and SAVR. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
Outcomes and characteristics of patients with severe aortic stenosis (AS) treated during the COVID-19 pandemic is unknown.
Methods
This was a single-centre observational study of patients undergoing AS treatment with transcatheter (TAVI) or surgical (SAVR) therapy during the first-wave of the UK COVID-19 pandemic compared to a control cohort undergoing treatment in 2019.
Demographics, baseline echocardiogram, CT, procedural characteristics and outcome data were collated. The primary outcome was 30-day all-cause mortality. The secondary endpoint was duration of post-procedural hospitalisation.
Results
319 patients were recruited - 122 underwent intervention during the pandemic [73 TAVI; 49 SAVR] and 197 in 2019 [127 TAVI; 70 SAVR].
In 2020, TAVI patients had a higher Euroscore II (p<0.001) but there were no differences in procedural complications or mortality [p=0.16] compared to TAVI 2019 cases. Duration from TAVI to discharge was shorter in 2020 (p<0.001).
SAVR 2020 patients had similar baseline profile [p=0.48], surgical characteristics, mortality (p=0.68) and duration from SAVR to discharge compared to those in 2019.
During the pandemic, TAVI patients were older (p<0.001) and had a higher Euroscore II (p<0.001) than SAVR counterparts. TAVI patients had reduced 30-day mortality [0 (0%) vs 3 (6%); p=0.06] and were discharged more rapidly post-intervention than SAVR patients [median 1 [1] vs 7 [4] days; p<0.001) translating into shorter hospitalization (p<0.001).
Conclusions
TAVI and SAVR can be safely delivered with predictable resource utilisation during a pandemic. Despite the TAVI cohort incorporating higher risk, older patients, outcomes were at least as good as SAVR with a shorter length of post-procedural hospitalisation.
Funding Acknowledgement
Type of funding sources: None. Procedural Complications TAVI/SAVRDuration to discharge post TAVI/SAVR
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Affiliation(s)
- M Akhtar
- Barts Heart Centre, London, United Kingdom
| | - A Shafi
- Barts Heart Centre, London, United Kingdom
| | - V Khanna
- Barts Heart Centre, London, United Kingdom
| | | | - K Patel
- Barts Heart Centre, London, United Kingdom
| | - M Ozkor
- Barts Heart Centre, London, United Kingdom
| | - A Baumbach
- Barts Heart Centre, London, United Kingdom
| | - A Mathur
- Barts Heart Centre, London, United Kingdom
| | - S Kennon
- Barts Heart Centre, London, United Kingdom
| | - W Awad
- Barts Heart Centre, London, United Kingdom
| | - M M Mullen
- Barts Heart Centre, London, United Kingdom
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Diwekar U, Amekudzi-Kennedy A, Bakshi B, Baumgartner R, Boumans R, Burger P, Cabezas H, Egler M, Farley J, Fath B, Gleason T, Huang Y, Karunanithi A, Khanna V, Mangan A, Mayer AL, Mukherjee R, Mullally G, Rico-Ramirez V, Shonnard D, Svanström M, Theis T. A perspective on the role of uncertainty in sustainability science and engineering. Resour Conserv Recycl 2021; 164:105140. [PMID: 32921915 PMCID: PMC7480224 DOI: 10.1016/j.resconrec.2020.105140] [Citation(s) in RCA: 3] [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] [Figures] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 08/25/2020] [Accepted: 08/26/2020] [Indexed: 06/11/2023]
Abstract
The Trans-Atlantic Research and Development Interchange on Sustainability Workshop (TARDIS) is a meeting on scientific topics related to sustainability. The 2019 workshop theme was "On the Role of Uncertainty in Managing the Earth for Global Sustainability." This paper presents the perspectives on this topic derived from talks and discussions at the 2019 TARDIS workshop. There are four kinds of uncertainties encountered in sustainability ranging from clear enough futures to true surprises. The current state-of-the-art in assessing and mitigating these uncertainties is discussed.
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Affiliation(s)
- U Diwekar
- Vishwamitra Research Institute, Crystal Lake, IL 60012, United States
| | | | - B Bakshi
- The Ohio State University, Columbus, OH 43210, United States
| | - R Baumgartner
- University of Graz, Merangasse 18/I, 8010, Graz, Austria
| | - R Boumans
- AFORDable Futures LLC, Charlotte, VT, United States
| | - P Burger
- University of Basel, Basel, Switzerland
| | - H Cabezas
- University of Miskolc, Miskolc, Hungary
| | - M Egler
- University of Vermont, Burlington, VT, United States
| | - J Farley
- University of Vermont, Burlington, VT, United States
| | - B Fath
- Towson University, Towson, MD, United States
- Advanced Systems Analysis Program, International Institute for Applied Systems Analysis, Laxenburg, Austria
| | - T Gleason
- USA Environmental Protection Agency, Narragansett, Rhode Island 02882, United States
| | - Y Huang
- Wayne State University, Detroit, Michigan 48202, United States
| | - A Karunanithi
- University of Colorado Denver, Denver, CO, 80217, United States
| | - V Khanna
- University of Pittsburgh, Pittsburgh, Pennsylvania, United States
| | - A Mangan
- United States Business Council for Sustainable Development, Austin, Texas, United States
| | - A L Mayer
- Michigan Technological University, Houghton, MI, United States
| | - R Mukherjee
- Vishwamitra Research Institute, Crystal Lake, IL 60012, United States
- The University of Texas Permian Basin, Odessa, TX, 79762, United States
| | | | - V Rico-Ramirez
- Instituto Tecnologico de Celaya, Celaya, Guanajuato 38010, Mexico
| | - D Shonnard
- Michigan Technological University, Houghton, MI, United States
| | - M Svanström
- Chalmers University of Technology, Gothenburg, Sweden
| | - T Theis
- The University of Illinois at Chicago, Chicago, IL, 60612, United States
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14
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Achey RL, Vo S, Cioffi G, Gittleman H, Schroer J, Khanna V, Buerki R, Kruchko C, Barnholtz-Sloan JS. Ependymoma, NOS and anaplastic ependymoma incidence and survival in the United States varies widely by patient and clinical characteristics, 2000-2016. Neurooncol Pract 2020; 7:549-558. [PMID: 33014396 DOI: 10.1093/nop/npaa023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Ependymoma is a rare CNS tumor arising from the ependymal lining of the ventricular system. General differences in incidence and survival have been noted but not examined on a comprehensive scale for all ages and by histology. Despite the rarity of ependymomas, morbidity/mortality associated with an ependymoma diagnosis justifies closer examination. METHODS Incidence data were obtained from the Central Brain Tumor Registry of the United States in collaboration with the Centers for Disease Control and Prevention and the National Cancer Institute, and survival data from Surveillance Epidemiology and End Results, from 2000 to 2016 for anaplastic ependymoma and ependymoma, not otherwise specified (NOS). Age-adjusted incidence rates (IRs) per 100 000 person-years were analyzed by age, sex, race, and location. Survival analysis was performed with Kaplan-Meier curves and multivariable Cox proportional hazards models. RESULTS Incidence of anaplastic ependymoma was highest in ages 0 to 4 years. African American populations had lower incidence but had a 78% increased risk of death compared to white populations (hazard ratio [HR]: 1.78 [95% CI, 1.30-2.44]). Incidence was highest for anaplastic ependymoma in the supratentorial region. Adults (age 40+ years) had almost twice the risk of death compared to children (ages 0-14 years) (HR: 1.97 [95% CI, 1.45-2.66]). For ependymoma, NOS, subtotal resection had a risk of mortality 1.86 times greater than gross total resection ([HR: 1.86 [95% CI, 1.32-2.63]). CONCLUSIONS African American populations experienced higher mortality rates despite lower incidence compared to white populations. Extent of resection is an important prognostic factor for survival. This highlights need for further evaluation of treatment patterns and racial disparities in the care of patients with ependymoma subtypes.
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Affiliation(s)
- Rebecca L Achey
- Department of Neurosurgery, Neurological Institute, Cleveland Clinic, Cleveland, Ohio
| | - Sierra Vo
- Department of Mathematics, Applied Mathematics, and Statistics, Case Western Reserve, Cleveland, Ohio
| | - Gino Cioffi
- Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Haley Gittleman
- Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Julia Schroer
- Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Vishesh Khanna
- Department of Internal Medicine, Stanford University, Stanford, California
| | - Robin Buerki
- Department of Neurology, University Hospitals of Cleveland, Cleveland, Ohio
| | - Carol Kruchko
- Central Brain Tumor Registry of the United States, Hinsdale, Illinois
| | - Jill S Barnholtz-Sloan
- Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, Ohio.,Central Brain Tumor Registry of the United States, Hinsdale, Illinois
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15
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Zhang H, Wilmot B, Bottomly D, Dao KHT, Stevens E, Eide CA, Khanna V, Rofelty A, Savage S, Reister Schultz A, Long N, White L, Carlos A, Henson R, Lin C, Searles R, Collins RH, DeAngelo DJ, Deininger MW, Dunn T, Hein T, Luskin MR, Medeiros BC, Oh ST, Pollyea DA, Steensma DP, Stone RM, Druker BJ, McWeeney SK, Maxson JE, Gotlib JR, Tyner JW. Genomic landscape of neutrophilic leukemias of ambiguous diagnosis. Blood 2019; 134:867-879. [PMID: 31366621 PMCID: PMC6742922 DOI: 10.1182/blood.2019000611] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Accepted: 06/27/2019] [Indexed: 12/12/2022] Open
Abstract
Chronic neutrophilic leukemia (CNL), atypical chronic myeloid leukemia (aCML), and myelodysplastic/myeloproliferative neoplasms, unclassifiable (MDS/MPN-U) are a group of rare and heterogeneous myeloid disorders. There is strong morphologic resemblance among these distinct diagnostic entities as well as a lack of specific molecular markers and limited understanding of disease pathogenesis, which has made diagnosis challenging in certain cases. The treatment has remained empirical, resulting in dismal outcomes. We, therefore, performed whole-exome and RNA sequencing of these rare hematologic malignancies and present the most complete survey of the genomic landscape of these diseases to date. We observed a diversity of combinatorial mutational patterns that generally do not cluster within any one diagnosis. Gene expression analysis reveals enrichment, but not cosegregation, of clinical and genetic disease features with transcriptional clusters. In conclusion, these groups of diseases represent a continuum of related diseases rather than discrete diagnostic entities.
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Affiliation(s)
- Haijiao Zhang
- Department of Cell, Developmental and Cancer Biology
- Division of Hematology and Medical Oncology, and
| | - Beth Wilmot
- Division of Bioinformatics and Computational Biology, Department of Medical Informatics and Clinical Epidemiology, Knight Cancer Institute, Oregon Health & Science University, Portland, OR
| | - Daniel Bottomly
- Division of Bioinformatics and Computational Biology, Department of Medical Informatics and Clinical Epidemiology, Knight Cancer Institute, Oregon Health & Science University, Portland, OR
| | | | - Emily Stevens
- Fred Hutchinson Cancer Research Institute, Washington University School of Medicine, Seattle, WA
| | - Christopher A Eide
- Division of Hematology and Medical Oncology, and
- Howard Hughes Medical Institute, Chevy Chase, MD
| | - Vishesh Khanna
- Division of Hematology and Medical Oncology, and
- Howard Hughes Medical Institute, Chevy Chase, MD
| | - Angela Rofelty
- Department of Cell, Developmental and Cancer Biology
- Division of Hematology and Medical Oncology, and
| | - Samantha Savage
- Department of Cell, Developmental and Cancer Biology
- Division of Hematology and Medical Oncology, and
| | - Anna Reister Schultz
- Department of Cell, Developmental and Cancer Biology
- Division of Hematology and Medical Oncology, and
| | - Nicola Long
- Department of Cell, Developmental and Cancer Biology
- Division of Hematology and Medical Oncology, and
| | - Libbey White
- Division of Bioinformatics and Computational Biology, Department of Medical Informatics and Clinical Epidemiology, Knight Cancer Institute, Oregon Health & Science University, Portland, OR
| | - Amy Carlos
- Integrated Genomics Laboratories, Oregon Health & Science University, Portland, OR
| | - Rachel Henson
- Integrated Genomics Laboratories, Oregon Health & Science University, Portland, OR
| | - Chenwei Lin
- Integrated Genomics Laboratories, Oregon Health & Science University, Portland, OR
| | - Robert Searles
- Integrated Genomics Laboratories, Oregon Health & Science University, Portland, OR
| | - Robert H Collins
- Hematology/Oncology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX
| | - Daniel J DeAngelo
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | | | - Tamara Dunn
- Stanford Cancer Institute, Stanford University School of Medicine, Stanford, CA
| | - Than Hein
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | - Marlise R Luskin
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - Bruno C Medeiros
- Stanford Cancer Institute, Stanford University School of Medicine, Stanford, CA
| | - Stephen T Oh
- Hematology Division, Department of Medicine, Washington University School of Medicine, Washington University in St. Louis, St. Louis, MO; and
| | - Daniel A Pollyea
- Division of Hematology, Oncology, and Bone Marrow Transplantation, University of Colorado School of Medicine, Aurora, CO
| | - David P Steensma
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - Richard M Stone
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - Brian J Druker
- Division of Hematology and Medical Oncology, and
- Howard Hughes Medical Institute, Chevy Chase, MD
| | - Shannon K McWeeney
- Division of Bioinformatics and Computational Biology, Department of Medical Informatics and Clinical Epidemiology, Knight Cancer Institute, Oregon Health & Science University, Portland, OR
| | | | - Jason R Gotlib
- Stanford Cancer Institute, Stanford University School of Medicine, Stanford, CA
| | - Jeffrey W Tyner
- Department of Cell, Developmental and Cancer Biology
- Division of Hematology and Medical Oncology, and
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16
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Gupta PK, Acharya A, Khanna V, Roy S, Khillan K, Sambandam SN. PRP versus steroids in a deadlock for efficacy: long-term stability versus short-term intensity-results from a randomised trial. Musculoskelet Surg 2019; 104:285-294. [PMID: 31448392 DOI: 10.1007/s12306-019-00619-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2018] [Accepted: 08/06/2019] [Indexed: 01/28/2023]
Abstract
PURPOSE A popular choice for lateral epicondylitis (LE), corticosteroid injections have been associated with prominent side effects, which has led to the conception of modalities like platelet-rich plasma (PRP). This randomised trial aimed to evaluate and compare the 6-week, 3-month and 1-year outcomes with PRP and corticosteroid injections in LE. We hypothesised that PRP would prove more effective in relieving pain and improving function. METHODS At the sports medicine unit of our tertiary care teaching centre, 80 patients with LE were randomised into either receiving PRP (group A) or corticosteroids (group B) injections. Pre-injection visual analogue scale (VAS), disabilities of the arm, shoulder and hand (DASH) score, Mayo elbow performance score (MEPS) and grip strength score (GSS) were recorded. Common extensor origins were identified and infiltrated with 3 ml of either PRP or corticosteroid (triamcinolone in 2% xylocaine) using a peppering technique. Follow-up scores and extent of pain relief were recorded and compared. RESULTS At 6 weeks, there were greater improvements in group B versus A in mean VAS (13.8 vs. 44.5; p < 0.001), DASH (64.2 vs. 53.3; p < 0.001), MEPS (88.0 vs. 74.5; p = 0.004) and GSS (89.3 vs. 73.4; p = 0.039). These scores showed a reversed pattern at 3 months when group A outcomes superseded group B (VAS p = 0.002; DASH p < 0.001; MEPS p = 0.002; GSS p = 0.045). At 1-year follow-up, group A continued to enjoy better pain relief and function (VAS p = 0.024; DASH p < 0.001; MEPS p = 0.009; GSS p = 0.028). CONCLUSIONS Albeit corticosteroid injections show good short-term results at 6 weeks, patients receiving PRP injections fare better at 3 and 12 months.
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Affiliation(s)
- P Kumar Gupta
- Department of Sports Medicine, Sir Ganga Ram Hospital, New Delhi, India.
| | - A Acharya
- Department of Sports Medicine, Sir Ganga Ram Hospital, New Delhi, India
| | - V Khanna
- Department of Orthopaedics, Sir Ganga Ram Hospital, New Delhi, India
| | - S Roy
- Department of Sports Medicine, Sir Ganga Ram Hospital, New Delhi, India
| | - K Khillan
- Department of Blood Transfusion Medicine, Sir Ganga Ram Hospital, New Delhi, India
| | - S Nathan Sambandam
- Department of Orthopedics, Louis A Johnson VA Medical Center, Clarksburg, WV, USA
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17
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Khanna V, Gurava Reddy AV, Daultani D, Sankineani SR, Khanna J, Annapareddy A, Eachampati KK. When can I go home after my knee replacement? Factors affecting the duration of in-hospital stay after knee replacement. Eur J Orthop Surg Traumatol 2019; 29:1719-1728. [PMID: 31273493 DOI: 10.1007/s00590-019-02485-5] [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] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 06/26/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Despite a sevenfold decline in the number of postoperative nights (21-3) after a total knee arthroplasty (TKA) over the last four decades, predictors of length of stay (LOS) are not fully understood. We attempted to ascertain these factors by analyzing a large cohort of patients. METHODS Prospectively collected data between January 2016 and March 2017 were retrospectively analyzed at our institute. Charts of 1663 consecutive, simple primary unilateral and bilateral TKAs were reviewed for the LOS excluding staggered bilateral, complex primary and revision knees. STATISTICAL ANALYSIS Preoperative variables [demographics, cash/credit status, historical, clinical, laboratory findings, Knee Society Function Scores and Oxford Knee Scores (OKSs)] were scrutinized by multivariate regression to identify significant factors affecting LOS and formulate model equations for patients and health caregivers. Results were incorporated into an iOS application, which was tested for accuracy. RESULTS Among 1524 unilateral and 139 bilateral TKAs, mean LOS was 4.4 and 5.2 days, respectively. Five factors, namely insurance, flexion/hyperextension deformity, preoperative OKS and a rheumatoid etiology, were significantly associated with prolonged LOS in unilateral knees. The impact of these independent variables on LOS could be calculated by: [Formula: see text]For bilateral cases, the only significant variable extending LOS was a low preoperative OKS and the equation is given as follows: [Formula: see text]The iOS-app-predicted LOS and actual LOS were similar (p > 0.05) for 115 prospectively operated knees. CONCLUSION Poor preoperative OKS, rheumatoid etiology, flexion and hyperextension deformity and delays in insurance affected unilateral TKR LOS, while poor preoperative OKS alone affected LOS in bilateral cases.
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Affiliation(s)
- Vishesh Khanna
- Sunshine Hospitals, Penderghast Road, Opposite Parsi Dharamsala, Paradise, Secunderabad, Telangana, 500003, India. .,, New Delhi, India.
| | - A V Gurava Reddy
- Sunshine Hospitals, Penderghast Road, Opposite Parsi Dharamsala, Paradise, Secunderabad, Telangana, 500003, India
| | - Deepesh Daultani
- Sunshine Hospitals, Penderghast Road, Opposite Parsi Dharamsala, Paradise, Secunderabad, Telangana, 500003, India
| | - Sukesh Rao Sankineani
- Sunshine Hospitals, Penderghast Road, Opposite Parsi Dharamsala, Paradise, Secunderabad, Telangana, 500003, India
| | | | - Adarsh Annapareddy
- Sunshine Hospitals, Penderghast Road, Opposite Parsi Dharamsala, Paradise, Secunderabad, Telangana, 500003, India
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18
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Achey RL, Gittleman H, Schroer J, Khanna V, Kruchko C, Barnholtz-Sloan JS. Nonmalignant and malignant meningioma incidence and survival in the elderly, 2005-2015, using the Central Brain Tumor Registry of the United States. Neuro Oncol 2019; 21:380-391. [PMID: 30295804 PMCID: PMC6380426 DOI: 10.1093/neuonc/noy162] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [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: 11/13/2022] Open
Abstract
BACKGROUND Meningioma incidence increases significantly with age. In the expanding elderly population, we lack complete understanding of population-based trends in meningioma incidence/survival. We provide an updated, comprehensive analysis of meningioma incidence and survival for individuals aged over 65. METHODS Data were obtained from the Central Brain Tumor Registry of the United States (CBTRUS) from 2005-2015 for nonmalignant and malignant meningioma. Age-adjusted incidence rates per 100000 person-years were analyzed by age, sex, race, ethnicity, location, and treatment modalities. Survival was analyzed using Kaplan-Meier and multivariable Cox proportional hazards models for a subset of CBTRUS data. RESULTS Nonmalignant meningioma incidence doubled from adults age 65-69 years to adults over age 85 years and was significantly greater in females than males for all ages. Malignant meningioma incidence did not differ by sex for any age grouping. Nonmalignant and malignant meningioma incidence was significantly greater in black populations versus others. Nonmalignant meningioma survival was worse with age, in black populations, and in males, including when analyzed by 5-year age groups. Surgical resection and radiation did not improve survival compared with resection alone in nonmalignant meningioma. CONCLUSIONS This study reports increasing nonmalignant meningioma incidence in the elderly, increased incidence in black populations, and in females. In contrast, malignant meningioma incidence did not differ between sexes. Risk of death was higher for black individuals and males. Additionally, radiation did not confer a survival advantage when combined with resection for nonmalignant meningioma. Thus, we identify clinically relevant discrepancies in meningioma incidence/survival that require further study.
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Affiliation(s)
- Rebecca L Achey
- Department of Neurosurgery, Neurological Institute, Cleveland Clinic, Cleveland, Ohio
| | - Haley Gittleman
- Case Comprehensive Cancer Center, Case Western Reserve University School of Medicine, Cleveland, Ohio
- Central Brain Tumor Registry of the United States, Hinsdale, Illinois
| | - Julia Schroer
- Case Comprehensive Cancer Center, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Vishesh Khanna
- Department of Internal Medicine, Stanford University, Stanford, California
| | - Carol Kruchko
- Department of Neurosurgery, Neurological Institute, Cleveland Clinic, Cleveland, Ohio
- Central Brain Tumor Registry of the United States, Hinsdale, Illinois
| | - Jill S Barnholtz-Sloan
- Case Comprehensive Cancer Center, Case Western Reserve University School of Medicine, Cleveland, Ohio
- Central Brain Tumor Registry of the United States, Hinsdale, Illinois
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19
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Gurava Reddy AV, Thayi C, Natarajan N, Sankineani SR, Daultani D, Khanna V, Eachempati KK. Validating the Role of Steroid in Analgesic Cocktail Preparation for Local Infiltration in Total Knee Arthroplasty: A Comparative Study. Anesth Essays Res 2019; 12:903-906. [PMID: 30662128 PMCID: PMC6319064 DOI: 10.4103/aer.aer_138_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background: Pain control after total knee arthroplasty (TKA) through local analgesic cocktail preparation has gained widespread popularity in recent times. Local steroids have potent anti-inflammatory effect leading to reduced postoperative swelling and pain which might increase the efficacy and duration of local infiltration analgesia. Aim: The aim is to evaluate whether the addition of local steroid to an injectable analgesic cocktail for periarticular infiltration leads to better pain control and knee range of motion (ROM) in the immediate postoperative period compared to patients who do not receive steroid in their cocktail. Settings and Designs: A prospective study was conducted in a group of 140 patients undergoing unilateral TKA between June 2017 and December 2017. Materials and Methods: All the patients in the study group received either periarticular infiltration with an analgesic cocktail (Group I, n = 70) or analgesic cocktail with 100 mg methylprednisolone (Group II, n = 70) for postoperative pain with ultrasound-guided adductor canal block (ACB). Patients were evaluated with visual analog scale (VAS) for pain at 8, 24, and 48 h postoperatively and ROM at 48 h after surgery. Statistical Analysis: The SPSS 19.0 software (SPSS Inc., Chicago, IL, USA) was used for the statistical analysis. Student t-test has been used to find the pairwise significance. Results: Group II had a statistically significant decrease in VAS scores at 8 h (P = 0.096), first postoperative day (P = 0.0001) and second postoperative day (P = 0.0001) as compared to Group I. However, there was no statistically significant difference seen with early ROM in both the groups at 48 h (P < 0.361). Conclusion: Patients who received steroid cocktail infiltration plus ACB had an improved and better postoperative analgesia in an early postoperative period of 24–48 h; however, there was no significant difference in clinical ROM and functional outcome when compared to the study group.
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Affiliation(s)
- A V Gurava Reddy
- Department of Orthopaedics, Sunshine Hospital, Secunderabad, Telangana, India
| | - Chiranjeevi Thayi
- Department of Orthopaedics, Sunshine Hospital, Secunderabad, Telangana, India
| | - Nandkumar Natarajan
- Department of Orthopaedics, Sunshine Hospital, Secunderabad, Telangana, India
| | | | - Deepesh Daultani
- Department of Orthopaedics, Sunshine Hospital, Secunderabad, Telangana, India
| | - Vishesh Khanna
- Department of Orthopaedics, Sunshine Hospital, Secunderabad, Telangana, India
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20
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Gurava Reddy AV, Shafeekh M, Sankineani SR, Jhakotia K, Sagi M, Daultani D, Khanna V, Eachempati KK. Comparison between Multisite Infiltration Analgesia versus Adductor Canal Block for Pain Management in Total Knee Arthroplasty: A Prospective Study. Anesth Essays Res 2019; 12:774-777. [PMID: 30662106 PMCID: PMC6319077 DOI: 10.4103/aer.aer_124_18] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Background: Severe acute postoperative pain after total knee arthroplasty (TKA) may cause significant morbidity to patients. Recent techniques such as peripheral nerve blocks have shown promising hope in providing appropriate pain control without systemic side effects. Adductor canal block (ACB) and multisite infiltration analgesia (MIA) are two techniques that are proven to be effective individually. Aim: This study aims to compare the efficacy of ACB versus MIA in postoperative analgesia and functional recovery after unilateral knee arthroplasty. Settings and Design: A prospective study was conducted between July 2016 and December 2016 involving 200 patients undergoing unilateral TKA. Materials and Methods: Patients were either administered MIA (Group I, n = 100 patients) or ACB (Group II, n = 100 patients). All the patients were assessed for severity of pain by visual analog scale (VAS) at 8, 24, and 48 h postoperatively and knee range of motion (ROM) at 48 h after surgery. Statistical Analysis: The Statistical Package for the Social Sciences (SPSS 19.0, SPSS Inc., Chicago, IL, USA) was used for descriptive and inferential analysis. Results: Patients who received MIA showed significantly better VAS scores 8, 24, and 48 h after surgery. Furthermore, this subset of patients showed a marginally better ROM postoperatively. However, there was no difference number of patients requiring rescue analgesia for breakthrough pain or technique-related problems between both groups. Conclusion: This study demonstrates that MIA is a safe technique that provides effective analgesia at 8, 24, and 48 h postoperatively. This leads to faster rehabilitation compared to ACB in patients undergoing TKA.
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Affiliation(s)
- A V Gurava Reddy
- Department of Orthopaedics, Sunshine Hospital, Secunderabad, Telangana, India
| | - Mohammed Shafeekh
- Department of Orthopaedics, Sunshine Hospital, Secunderabad, Telangana, India
| | | | - Khubchand Jhakotia
- Department of Anaesthesia, Sunshine Hospital, Secunderabad, Telangana, India
| | - Muralidhar Sagi
- Department of Orthopaedics, Sunshine Hospital, Secunderabad, Telangana, India
| | - Deepesh Daultani
- Department of Orthopaedics, Sunshine Hospital, Secunderabad, Telangana, India
| | - Vishesh Khanna
- Department of Orthopaedics, Sunshine Hospital, Secunderabad, Telangana, India
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Khanna V, Ashraf M, Sambandam SN. Spontaneous Retroperitoneal Hematoma Presenting as Femoral Neuropathy in a Patient on Low Molecular Weight Heparin Therapy. J Orthop Case Rep 2018; 8:55-57. [PMID: 30584517 PMCID: PMC6298708 DOI: 10.13107/jocr.2250-0685.1106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Introduction Retroperitoneal hemorrhage has been sparsely reported with warfarin therapy. In this paper, we describe a case of spontaneous retroperitoneal hematoma causing femoral neuropathy following treatment with low molecular weight heparin. Case Report A 65-year-old gentleman had presented with acute onset left-sided thigh pain, paraesthesia, and weakness along with lower backache. On deeper introspection, our patient had, in the recent past, been thrombolyzed for pulmonary embolism. The clinical examination led us to suspect an acute lumbar pathology, and he was investigated on those lines. Imaging studies, however, revealed a massive retroperitoneal hemorrhage which was the cause of femoral neuropathy. In this case report, the presentation of this rare association has been discussed with special emphasis on clinical premonition in the background of anticoagulant therapy. Watchful and medical treatment yielded successful recovery at follow-up. Conclusion Cautious clinical assessment is needed in patients taking anticoagulant therapy. The presentation of a femoral neuropathy is often intriguing. Management options include careful observation and emergency decompression in cases of worsening neurological status.
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Affiliation(s)
- Vishesh Khanna
- Department of Orthopaedics, Arthroplasty Fellow, Sunshine Hospital, Secunderabad, Telangana, India
| | - Munis Ashraf
- Department of Orthopaedics, K.G Hospital and Postgraduate Medical Institute, Coimbatore, Tamil Nadu, India
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22
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Khanna V, Sambandam SN, Ashraf M, Mounasamy V. Extra-articular deformities in arthritic knees-a grueling challenge for arthroplasty surgeons: An evidence-based update. Orthop Rev (Pavia) 2018; 9:7374. [PMID: 29564077 PMCID: PMC5850062 DOI: 10.4081/or.2017.7374] [Citation(s) in RCA: 4] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Revised: 12/09/2017] [Accepted: 12/10/2017] [Indexed: 12/21/2022] Open
Abstract
Critical to the success of a total knee arthroplasty (TKA) is the anatomical alignment. This may appear as a challenge in an extra-articular deformity (EAD) that may be inherent in certain people or result from fracture malunion, congenital disorders, nutritional, metabolic and infective causes. This appraisal aimed at providing the reader with an up-todate overview of the research carried out on, and existent evidence of EAD correction while planning a TKA. We reviewed the current English literature on TKA in extra-articular knee deformities. Among the published data, a common initial approach of mandatory clinical and radiological assessment emerges as an obligatory step while handling cases with EAD. While several methods of managing the deformity and arthritis have been described, a broad division into intra-articular and extra-articular means can be deciphered. The relatively old-school, yet reliable thought process of extra-articular correction allows an all-inclusive restoration of alignment with the inherent complications related to the necessary osteotomy. A cohort of younger and more venturesome surgeons seem inclined towards performing navigated, intra-articular correction for mild to moderate and sometimes, severe deformities. The crux of the matter lies is obtaining a well-balanced knee without violating the all-important cruciates. Restoring the patient’s ambulatory status seems sooner with the intra-articular methods which are also more precise in determining the axes and while removing minimum bone. Greatest satisfaction is accomplished in those with less grotesque, rotationallyaligned knees while meticulously balancing soft-tissues and encouraging earlier weightbearing.
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Affiliation(s)
| | | | - Munis Ashraf
- K.G. Hospital and Post Graduate Medical Institute, Arts College Road, Coimbatore, Tamil Nadu, India
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Khanna V, Achey R, Ostrom Q, Block-Beach H, Kruchko C, Barnholtz-Sloan J, de Blank P. EPID-12. INCIDENCE AND SURVIVAL TRENDS FOR MEDULLOBLASTOMAS IN THE UNITED STATES FROM 2001 TO 2013. Neuro Oncol 2017. [DOI: 10.1093/neuonc/nox168.290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Sambandam SN, Khanna V, Rohinikumar G, Mounasamy V. Pre-discharge postoperative radiographs after primary total knee replacement : tradition or science? Acta Orthop Belg 2017; 83:132-139. [PMID: 29322905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Consistent evidence exists on the inutility of immediate postoperative radiographs after a total knee replacement (TKR). We hypothesized that eliminating the pre-discharge film would not have any effect on the postoperative patient outcomes. Retrospective analysis of prospectively collected data was performed on 220 knees. Patients undergoing a simple primary TKR operated by 2 surgeons (Surgeon A and B) from January 2013 to July 2015 were divided into 2 groups (Groups 1 and 2 having 112 and 108 knees respectively). While Surgeon A routinely asked for the second postoperative day pre-discharge radiograph, Surgeon B directly performed weight bearing radiographs 6 weeks postoperatively. Greater knee pain was seen in Group 1 (p = 0.01). No changes in rehabilitation protocols based on pre-discharge radiographs, complications, medico-legal issues or revision surgery could be identified in any patient. The quality of the pre-discharge radiographs was adequate in 65 of the 112 knees (58%). A cost reduction of approximately $220 per patient was observed with the exclusion of the pre-discharge film. Eliminating routine inpatient pre-discharge radio-graphs after simple primary TKR does not alter the rehabilitation protocol, identify any of the standard complication or have any medico-legal implications. On the contrary, these films seem to increase postoperative pain and costs.
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Kochar G, Chakranarayan A, Kohli S, Kohli V, Khanna V, Jayan B, Chopra S, Verma M. Effect of surgical mandibular advancement on pharyngeal airway dimensions: a three-dimensional computed tomography study. Int J Oral Maxillofac Surg 2016; 45:553-9. [DOI: 10.1016/j.ijom.2015.10.006] [Citation(s) in RCA: 16] [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] [Received: 05/18/2015] [Revised: 07/31/2015] [Accepted: 10/07/2015] [Indexed: 12/01/2022]
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Sambandam SN, Khanna V, Gul A, Mounasamy V. Rotator cuff tears: An evidence based approach. World J Orthop 2015; 6:902-918. [PMID: 26716086 PMCID: PMC4686437 DOI: 10.5312/wjo.v6.i11.902] [Citation(s) in RCA: 91] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2015] [Revised: 08/04/2015] [Accepted: 10/19/2015] [Indexed: 02/06/2023] Open
Abstract
Lesions of the rotator cuff (RC) are a common occurrence affecting millions of people across all parts of the globe. RC tears are also rampantly prevalent with an age-dependent increase in numbers. Other associated factors include a history of trauma, limb dominance, contralateral shoulder, smoking-status, hypercholesterolemia, posture and occupational dispositions. The challenge lies in early diagnosis since a high proportion of patients are asymptomatic. Pain and decreasing shoulder power and function should alert the heedful practitioner in recognizing promptly the onset or aggravation of existing RC tears. Partial-thickness tears (PTT) can be bursal-sided or articular-sided tears. Over the course of time, PTT enlarge and propagate into full-thickness tears (FTT) and develop distinct chronic pathological changes due to muscle retraction, fatty infiltration and muscle atrophy. These lead to a reduction in tendon elasticity and viability. Eventually, the glenohumeral joint experiences a series of degenerative alterations - cuff tear arthropathy. To avert this, a vigilant clinician must utilize and corroborate clinical skill and radiological findings to identify tear progression. Modern radio-diagnostic means of ultrasonography and magnetic resonance imaging provide excellent visualization of structural details and are crucial in determining further course of action for these patients. Physical therapy along with activity modifications, anti-inflammatory and analgesic medications form the pillars of nonoperative treatment. Elderly patients with minimal functional demands can be managed conservatively and reassessed at frequent intervals. Regular monitoring helps in isolating patients who require surgical interventions. Early surgery should be considered in younger, active and symptomatic, healthy patients. In addition to being cost-effective, this helps in providing a functional shoulder with a stable cuff. An easily reproducible technique of maximal strength and sturdiness should by chosen among the armamentarium of the shoulder surgeon. Grade 1 PTTs do well with debridement while more severe lesions mandate repair either by trans-tendon technique or repair following conversion into FTT. Early repair of repairable FTT can avoid appearance and progression of disability and weakness. The choice of surgery varies from surgeon-to-surgeon with arthroscopy taking the lead in the current scenario. The double-row repairs have an edge over the single-row technique in some patients especially those with massive tears. Stronger, cost-effective and improved functional scores can be obtained by the former. Both early and delayed postoperative rehabilitation programmes have led to comparable outcomes. Guarded results may be anticipated in patients in extremes of age, presence of comorbidities and severe tear patters. Overall, satisfactory results are obtained with timely diagnosis and execution of the appropriate treatment modality.
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Khanna V, Pierce ST, Dao KHT, Tognon CE, Hunt DE, Junio B, Tyner JW, Druker BJ. Durable Disease Control with MEK Inhibition in a Patient with NRAS-mutated Atypical Chronic Myeloid Leukemia. Cureus 2015; 7:e414. [PMID: 26870618 PMCID: PMC4725740 DOI: 10.7759/cureus.414] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Atypical chronic myeloid leukemia (aCML) and chronic neutrophilic leukemia (CNL) are rare hematologic neoplasms characterized by leukocytosis and a hypercellular bone marrow. Although recurrent mutations in the colony-stimulating factor 3 receptor (CSF3R) are frequently observed in patients with (CNL), the mutational landscape in (aCML) is less well-defined. In this report, we describe an 81-year-old male who was diagnosed with aCML. He presented with leukocytosis and anemia but no significant clinical symptoms. Standard laboratory studies revealed the absence of the Philadelphia chromosome. Massively parallel sequencing demonstrated no mutations in CSF3R, but the presence of a heterozygous NRAS-G12D variant (47% allele frequency). The patient was started on treatment with trametinib, an MEK1/2 inhibitor with Food and Drug Administration approval for malignant melanoma. Therapy with trametinib resulted in exceptional improvements in his blood counts and continued disease control with 14 months of follow-up. This case highlights the need for clinical trials evaluating the safety and efficacy of MEK1/2 as a therapeutic target for the treatment of patients with NRAS-mutated aCML/CNL.
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Affiliation(s)
- Vishesh Khanna
- Knight Cancer Institute, Oregon Health & Science University ; Howard Hughes Medical Institute Medical Research Fellows Program, Howard Hughes Medical Institute ; Cleveland Clinic Lerner College of Medicine, Case Western Reserve University
| | - Scott T Pierce
- Department of Hematology/Oncology, Saint Joseph Hospital
| | - Kim-Hien T Dao
- Knight Cancer Institute, Oregon Health & Science University
| | | | - David E Hunt
- Saint Joseph Hospital Laboratory, Saint Joseph Hospital
| | - Brian Junio
- Knight Cancer Institute, Oregon Health & Science University
| | | | - Brian J Druker
- Knight Cancer Institute, Oregon Health & Science University ; Howard Hughes Medical Institute Investigator Program, Howard Hughes Medical Institute ; Division of Hematology & Medical Oncology, Oregon Health & Science University ; Department of Cell, Developmental & Cancer Biology, Oregon Health & Science University
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Mounasamy V, Mallu S, Khanna V, Sambandam S. Subtrochanteric fractures after retrograde femoral nailing. World J Orthop 2015; 6:738-743. [PMID: 26495251 PMCID: PMC4610916 DOI: 10.5312/wjo.v6.i9.738] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Revised: 06/21/2015] [Accepted: 07/23/2015] [Indexed: 02/06/2023] Open
Abstract
Secondary fractures around femoral nails placed for the management of hip fractures are well known. We report, two cases of a fracture of the femur at the interlocking screw site in the subtrochanteric area after retrograde femoral nailing of a femoral shaft fracture. Only a few reports in the existing literature have described these fractures. Two young men after sustaining a fall presented to us with pain, swelling and deformity in the upper thigh region. On enquiring, examining and radiographing them, peri-implant fractures of subtrochanteric nature through the distal interlocking screws were revealed in both patients who also had histories of previous falls for which retrograde intramedullary nailing was performed for their respective femora. Both patients were managed with similar surgical routines including removal of the existing hardware, open reduction and ace cephallomedullary antegrade nailing. The second case did show evidence of delayed healing and was additionally stabilized with cerclage wires. Both patients had uneventful postoperative outcomes and union was evident at the end of 6 mo postoperatively with a good range of motion at the hip and knee. Our report suggests that though seldom reported, peri-implant fractures around the subtrochanteric region can occur and pose a challenge to the treating orthopaedic surgeon. We suggest these be managed, after initial stabilization and resuscitation, by implant removal, open reduction and interlocking intramedullary antegrade nailing. Good results and progression to union can be expected in these patients by adhering to basic principles of osteosynthesis.
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Abstract
Bariatric surgery has emerged as an effective treatment for type 2 diabetes in the setting of obesity, with recent clinical trials demonstrating biochemical remission (i.e., euglycemia) in up to 40 % of subjects at 3 years post-surgery. Conversely, these trials also highlight that a significant proportion of individuals undergoing bariatric surgery experience residual diabetes (i.e., they do not achieve remission or experience diabetes recurrence). The management of residual diabetes following surgery requires personalized attention, yet limited evidence exists on which to base clinical decisions. Hence, we aim to review the evidence that does exist and propose clinical management strategies in patients with persistent hyperglycemia following bariatric surgery.
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Affiliation(s)
- Vishesh Khanna
- Department of Endocrinology, Diabetes, and Metabolism, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH, 44195, USA,
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Först M, Caviglia AD, Scherwitzl R, Mankowsky R, Zubko P, Khanna V, Bromberger H, Wilkins SB, Chuang YD, Lee WS, Schlotter WF, Turner JJ, Dakovski GL, Minitti MP, Robinson J, Clark SR, Jaksch D, Triscone JM, Hill JP, Dhesi SS, Cavalleri A. Spatially resolved ultrafast magnetic dynamics initiated at a complex oxide heterointerface. Nat Mater 2015; 14:883-8. [PMID: 26147844 DOI: 10.1038/nmat4341] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Accepted: 06/01/2015] [Indexed: 05/19/2023]
Abstract
Static strain in complex oxide heterostructures has been extensively used to engineer electronic and magnetic properties at equilibrium. In the same spirit, deformations of the crystal lattice with light may be used to achieve functional control across heterointerfaces dynamically. Here, by exciting large-amplitude infrared-active vibrations in a LaAlO3 substrate we induce magnetic order melting in a NdNiO3 film across a heterointerface. Femtosecond resonant soft X-ray diffraction is used to determine the spatiotemporal evolution of the magnetic disordering. We observe a magnetic melt front that propagates from the substrate interface into the film, at a speed that suggests electronically driven motion. Light control and ultrafast phase front propagation at heterointerfaces may lead to new opportunities in optomagnetism, for example by driving domain wall motion to transport information across suitably designed devices.
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Affiliation(s)
- M Först
- Max Planck Institute for the Structure and Dynamics of Matter, 22761 Hamburg, Germany
- Center for Free Electron Laser Science, 22761 Hamburg, Germany
| | - A D Caviglia
- Kavli Institute of Nanoscience, Delft University of Technology, 2628 CJ Delft, The Netherlands
| | - R Scherwitzl
- Department of Quantum Matter Physics, Université de Genève, 1211 Genève, Switzerland
| | - R Mankowsky
- Max Planck Institute for the Structure and Dynamics of Matter, 22761 Hamburg, Germany
- Center for Free Electron Laser Science, 22761 Hamburg, Germany
| | - P Zubko
- Department of Quantum Matter Physics, Université de Genève, 1211 Genève, Switzerland
| | - V Khanna
- Max Planck Institute for the Structure and Dynamics of Matter, 22761 Hamburg, Germany
- Department of Physics, Clarendon Laboratory, University of Oxford, Oxford OX1 3PU, UK
- Diamond Light Source, Didcot OX11 0DE, UK
| | - H Bromberger
- Max Planck Institute for the Structure and Dynamics of Matter, 22761 Hamburg, Germany
- Center for Free Electron Laser Science, 22761 Hamburg, Germany
| | - S B Wilkins
- Condensed Matter Physics and Materials Science Department, Brookhaven National Laboratory, Upton, New York 11973, USA
| | - Y-D Chuang
- Advanced Light Source, Lawrence Berkeley Laboratory, Berkeley, California 94720, USA
| | - W S Lee
- The Stanford Institute for Materials and Energy Sciences (SIMES), Stanford Linear Accelerator Center (SLAC) National Accelerator Laboratory and Stanford University, Menlo Park, California 94025, USA
| | - W F Schlotter
- Linac Coherent Light Source, Stanford Linear Accelerator Center (SLAC) National Accelerator Laboratory, Menlo Park, California 94025, USA
| | - J J Turner
- Linac Coherent Light Source, Stanford Linear Accelerator Center (SLAC) National Accelerator Laboratory, Menlo Park, California 94025, USA
| | - G L Dakovski
- Linac Coherent Light Source, Stanford Linear Accelerator Center (SLAC) National Accelerator Laboratory, Menlo Park, California 94025, USA
| | - M P Minitti
- Linac Coherent Light Source, Stanford Linear Accelerator Center (SLAC) National Accelerator Laboratory, Menlo Park, California 94025, USA
| | - J Robinson
- Linac Coherent Light Source, Stanford Linear Accelerator Center (SLAC) National Accelerator Laboratory, Menlo Park, California 94025, USA
| | - S R Clark
- Department of Physics, Clarendon Laboratory, University of Oxford, Oxford OX1 3PU, UK
- Centre for Quantum Technologies, National University of Singapore, Singapore 117543, Singapore
| | - D Jaksch
- Department of Physics, Clarendon Laboratory, University of Oxford, Oxford OX1 3PU, UK
- Centre for Quantum Technologies, National University of Singapore, Singapore 117543, Singapore
| | - J-M Triscone
- Department of Quantum Matter Physics, Université de Genève, 1211 Genève, Switzerland
| | - J P Hill
- Condensed Matter Physics and Materials Science Department, Brookhaven National Laboratory, Upton, New York 11973, USA
| | - S S Dhesi
- Diamond Light Source, Didcot OX11 0DE, UK
| | - A Cavalleri
- Max Planck Institute for the Structure and Dynamics of Matter, 22761 Hamburg, Germany
- Center for Free Electron Laser Science, 22761 Hamburg, Germany
- Department of Physics, Clarendon Laboratory, University of Oxford, Oxford OX1 3PU, UK
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Khanna V, Mikael R, Thayalasamy K, Sambu N, Dimitrov BD, Englyst N, Calver AL, Corbett S, Gray H, Simpson IA, Wilkinson JR, Curzen N. Does the response to aspirin and clopidogrel vary over 6 months in patients with ischemic heart disease? J Thromb Haemost 2015; 13:920-30. [PMID: 25809653 DOI: 10.1111/jth.12909] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [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: 11/05/2014] [Accepted: 03/16/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND Dual-antiplatelet therapy (DAPT) with aspirin and a P2Y12 inhibitor, mostly clopidogrel, is the default therapy in both acute coronary syndrome (ACS) and after intracoronary stents. It is well established that responses to antiplatelet therapy (APT), particularly clopidogrel, are subject to considerable interindividual variability. OBJECTIVES We investigated whether responses to APT in individuals vary significantly over time. METHODS Simultaneous assay with VerifyNow(™) and short thrombelastography (s-TEG) was performed before and at four time points over 6 months after hospital discharge in 40 patients receiving DAPT. Serum thromboxane B2 levels were also measured. RESULTS While aspirin response units (ARU) by VerifyNow(™) and serum thromboxane B2 levels remained stable over time, arachidonic acid (AA)-mediated platelet aggregation with s-TEG (i.e. area under the curve at 15 min in AA channel, AUC15AA ) increased at 1 week compared with predischarge (P < 0.008). In addition, platelet reactivity units (PRU) by VerifyNow(™) (P = 0.046) and adenosine diphosphate (ADP)-mediated platelet aggregation with s-TEG (i.e. AUC15ADP ) also increased at 1 week compared with predischarge (P = 0.026). There were no significant changes in either platelet reactivity or rates of high on-treatment platelet reactivity while receiving clopidogrel beyond 1 week. CONCLUSIONS This study demonstrates important variability in responses to APT within individuals between predischarge and 1 week but not thereafter. The use of a single early (predischarge) platelet function assay as an indicator of future response may therefore be flawed. The design of future strategies to assess individual responses for tailored therapy needs to take this into account.
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Affiliation(s)
- V Khanna
- Wessex Cardiothoracic Unit, University Hospital Southampton NHS Foundation Trust, Southampton, UK
- Faculty of Medicine, University of Southampton, Southampton, UK
| | - R Mikael
- Faculty of Medicine, University of Southampton, Southampton, UK
| | - K Thayalasamy
- Faculty of Medicine, University of Southampton, Southampton, UK
| | - N Sambu
- Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | - B D Dimitrov
- Faculty of Medicine, University of Southampton, Southampton, UK
| | - N Englyst
- Faculty of Medicine, University of Southampton, Southampton, UK
| | - A L Calver
- Wessex Cardiothoracic Unit, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - S Corbett
- Wessex Cardiothoracic Unit, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - H Gray
- Wessex Cardiothoracic Unit, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - I A Simpson
- Wessex Cardiothoracic Unit, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - J R Wilkinson
- Wessex Cardiothoracic Unit, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - N Curzen
- Wessex Cardiothoracic Unit, University Hospital Southampton NHS Foundation Trust, Southampton, UK
- Faculty of Medicine, University of Southampton, Southampton, UK
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Khanna V, Malin SK, Bena J, Abood B, Pothier CE, Bhatt DL, Nissen S, Watanabe R, Brethauer SA, Schauer PR, Kirwan JP, Kashyap SR. Adults with long-duration type 2 diabetes have blunted glycemic and β-cell function improvements after bariatric surgery. Obesity (Silver Spring) 2015; 23:523-6. [PMID: 25651277 PMCID: PMC4340772 DOI: 10.1002/oby.21021] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Accepted: 12/09/2014] [Indexed: 02/06/2023]
Abstract
OBJECTIVE This study investigated the effect of type 2 diabetes duration on glucose regulation 24 months post-bariatric surgery. METHODS Twenty-seven adults with short- (<5 years) and long-duration (≥10 years) type 2 diabetes received a mixed-meal tolerance test at baseline and 24 months postsurgery. Body weight, insulin sensitivity, first- and second-phase meal-stimulated insulin secretion, disposition index (i.e., DI or pancreatic β-cell function), and incretin responses were examined. RESULTS Adults with short-duration type 2 diabetes had better HbA(1c), greater insulin secretory capacity, and greater DI compared with adults with long-duration type 2 diabetes, despite similar weight loss and incretin responses. Diabetes duration correlated with smaller improvements in HbA(1c) and DI but not weight loss. CONCLUSIONS Enhanced β-cell function characterizes the effect of bariatric surgery in adults with diabetes for <5 years, independent of weight loss or incretins. Additional therapy postsurgery may be required to improve glycemia for people with long-standing type 2 diabetes.
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Affiliation(s)
- Vishesh Khanna
- Dept of Endocrinology, Diabetes, and Metabolism, Cleveland Clinic, Cleveland, OH, USA
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA
| | - Steven K. Malin
- Dept of Kinesiology, University of Virginia, Charlottesville, VA USA
| | - James Bena
- Dept of Quantitative Health Sciences, Cleveland Clinic, Cleveland OH, USA
| | - Beth Abood
- Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland OH, USA
| | - Claire E. Pothier
- Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland OH, USA
| | - Deepak L Bhatt
- Heart and Vascular Center, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Steven Nissen
- Heart and Vascular Institute, Cleveland Clinic, Cleveland OH, USA
| | - Richard Watanabe
- Dept of Physiology and Biophysics, University of Southern California, Los Angeles, California, USA
| | - Stacy A. Brethauer
- Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland OH, USA
- Metabolic Translational Research Center, Endocrine and Metabolism Institute, Cleveland Clinic, Cleveland OH, USA
| | - Philip R. Schauer
- Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland OH, USA
- Metabolic Translational Research Center, Endocrine and Metabolism Institute, Cleveland Clinic, Cleveland OH, USA
| | - John P. Kirwan
- Metabolic Translational Research Center, Endocrine and Metabolism Institute, Cleveland Clinic, Cleveland OH, USA
- Dept of Pathobiology, Lerner Research Institute, Cleveland Clinic, Cleveland OH, USA
| | - Sangeeta R. Kashyap
- Dept of Endocrinology, Diabetes, and Metabolism, Cleveland Clinic, Cleveland, OH, USA
- Metabolic Translational Research Center, Endocrine and Metabolism Institute, Cleveland Clinic, Cleveland OH, USA
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Khanna V, Sambandam SN, Gul A, Mounasamy V. "WhatsApp"ening in orthopedic care: a concise report from a 300-bedded tertiary care teaching center. Eur J Orthop Surg Traumatol 2015; 25:821-6. [PMID: 25633127 DOI: 10.1007/s00590-015-1600-y] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2014] [Accepted: 12/15/2014] [Indexed: 11/27/2022]
Abstract
Smartphones have emerged as essential tools providing assistance in patient care, monitoring, rehabilitation, communication, diagnosis, teaching, research and reference. Among innumerable communication apps, WhatsApp has been widely popular and cost effective. The aim of our study was to report the impact of introduction of a smartphone app "WhatsApp" as an intradepartmental communication tool on (1) awareness of patient-related information, (2) efficiency of the handover process and (3) duration of traditional morning handovers among orthopedic residents in a 300-bedded tertiary care teaching center. Written handovers and paging used for communication at our center led to occasional inefficiencies among residents. Widespread use, low cost, availability and double password protection (phone lock and WhatsApp lock) made WhatsApp's group conversation feature an ideal tool for intradepartmental patient-related communication. Twenty-five consecutive admissions before and after WhatsApp (BW, AW) were included in the study. Eight orthopedic residents attempted fifty randomly arranged questions based on the twenty-five patients in each study period. A null hypothesis that introduction of WhatsApp group would neither increase the awareness of patient-related information nor improve the efficiency of the handovers among residents was assumed. A significant improvement observed in scores obtained by residents in the AW group led to rejection of the null hypothesis. The residents also reported swifter and efficient handovers after the introduction of WhatsApp. Our results indicate that the introduction of a smartphone app "WhatsApp" as an intradepartmental communication tool can bring about an improvement in patient-related awareness, communication and handovers among orthopedic residents.
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Affiliation(s)
- Vishesh Khanna
- K.G. Hospital and Post Graduate Medical Institute, Arts College Road, Coimbatore, 641018, Tamil Nadu, India,
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Abstract
Cartilage defects of the hip cause significant pain and may lead to arthritic changes that necessitate hip replacement. We propose the use of fresh osteochondral allografts as an option for the treatment of such defects in young patients. Here we present the results of fresh osteochondral allografts for cartilage defects in 17 patients in a prospective study. The underlying diagnoses for the cartilage defects were osteochondritis dissecans in eight and avascular necrosis in six. Two had Legg-Calve-Perthes and one a femoral head fracture. Pre-operatively, an MRI was used to determine the size of the cartilage defect and the femoral head diameter. All patients underwent surgical hip dislocation with a trochanteric slide osteotomy for placement of the allograft. The mean age at surgery was 25.9 years (17 to 44) and mean follow-up was 41.6 months (3 to 74). The mean Harris hip score was significantly better after surgery (p < 0.01) and 13 patients had fair to good outcomes. One patient required a repeat allograft, one patient underwent hip replacement and two patients are awaiting hip replacement. Fresh osteochondral allograft is a reasonable treatment option for hip cartilage defects in young patients. Cite this article: Bone Joint J 2014;96-B(11 Supple A):11–16.
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Affiliation(s)
- V. Khanna
- Mount Sinai Hospital, University of Toronto, 600
University Avenue, Room 476A, Toronto, Ontario, M5G
1X5, Canada
| | - D. M. Tushinski
- Mount Sinai Hospital, University of Toronto, 600
University Avenue, Room 476A, Toronto, Ontario, M5G
1X5, Canada
| | - M. Drexler
- Mount Sinai Hospital, University of Toronto, 600
University Avenue, Room 476A, Toronto, Ontario, M5G
1X5, Canada
| | - D. B. Backstein
- Mount Sinai Hospital, University of Toronto, 600
University Avenue, Room 476A, Toronto, Ontario, M5G
1X5, Canada
| | - A. E. Gross
- Mount Sinai Hospital, University of Toronto, 600
University Avenue, Room 476A, Toronto, Ontario, M5G
1X5, Canada
| | - O. A. Safir
- Mount Sinai Hospital, University of Toronto, 600
University Avenue, Room 476A, Toronto, Ontario, M5G
1X5, Canada
| | - P. R. Kuzyk
- Mount Sinai Hospital, University of Toronto, 600
University Avenue, Room 476A, Toronto, Ontario, M5G
1X5, Canada
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35
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Affiliation(s)
- V Khanna
- Department of Prosthodontics, Shree Bankey Bihari Dental College and Research Centre, Ghaziabad, Uttar Pradesh, India
| | - G Khanna
- Department of Pedodontics, Shree Bankey Bihari Dental College and Research Centre, Ghaziabad, Uttar Pradesh, India
| | - A Bansal
- Department of Prosthodontics, Shree Bankey Bihari Dental College and Research Centre, Ghaziabad, Uttar Pradesh, India
| | - R Malik
- Department of Conservative Dentistry, Shree Bankey Bihari Dental College and Research Centre, Ghaziabad, Uttar Pradesh, India. E-mail:
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36
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Först M, Tobey RI, Bromberger H, Wilkins SB, Khanna V, Caviglia AD, Chuang YD, Lee WS, Schlotter WF, Turner JJ, Minitti MP, Krupin O, Xu ZJ, Wen JS, Gu GD, Dhesi SS, Cavalleri A, Hill JP. Melting of charge stripes in vibrationally driven La(1.875)Ba(0.125)CuO4: assessing the respective roles of electronic and lattice order in frustrated superconductors. Phys Rev Lett 2014; 112:157002. [PMID: 24785066 DOI: 10.1103/physrevlett.112.157002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2013] [Indexed: 05/19/2023]
Abstract
We report femtosecond resonant soft x-ray diffraction measurements of the dynamics of the charge order and of the crystal lattice in nonsuperconducting, stripe-ordered La1.875Ba0.125CuO4. Excitation of the in-plane Cu-O stretching phonon with a midinfrared pulse has been previously shown to induce a transient superconducting state in the closely related compound La1.675Eu0.2Sr0.125CuO4. In La1.875Ba0.125CuO4, we find that the charge stripe order melts promptly on a subpicosecond time scale. Surprisingly, the low temperature tetragonal (LTT) distortion is only weakly reduced, reacting on significantly longer time scales that do not correlate with light-induced superconductivity. This experiment suggests that charge modulations alone, and not the LTT distortion, prevent superconductivity in equilibrium.
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Affiliation(s)
- M Först
- Max-Planck Institute for the Structure and Dynamics of Matter, 22761 Hamburg, Germany
| | - R I Tobey
- Zernike Institute for Advanced Materials, University of Groningen, 9747AG Groningen, Netherlands
| | - H Bromberger
- Max-Planck Institute for the Structure and Dynamics of Matter, 22761 Hamburg, Germany
| | - S B Wilkins
- Condensed Matter Physics and Materials Science Department, Brookhaven National Laboratory, Upton, New York 11973, USA
| | - V Khanna
- Department of Physics, Clarendon Laboratory, University of Oxford, Oxford OX1 3PU, United Kingdom and Diamond Light Source, Chilton, Didcot, Oxfordshire OX11 0QX, United Kingdom
| | - A D Caviglia
- Max-Planck Institute for the Structure and Dynamics of Matter, 22761 Hamburg, Germany
| | - Y-D Chuang
- Advanced Light Source, Lawrence Berkeley Laboratory, Berkeley 94720, California, USA
| | - W S Lee
- SIMES, SLAC National Accelerator Laboratory and Stanford University, Menlo Park 94025, California, USA
| | - W F Schlotter
- Linac Coherent Light Source, SLAC National Accelerator Laboratory, Menlo Park 94025, California, USA
| | - J J Turner
- Linac Coherent Light Source, SLAC National Accelerator Laboratory, Menlo Park 94025, California, USA
| | - M P Minitti
- Linac Coherent Light Source, SLAC National Accelerator Laboratory, Menlo Park 94025, California, USA
| | - O Krupin
- European XFEL GmbH, 22761 Hamburg, Germany
| | - Z J Xu
- Condensed Matter Physics and Materials Science Department, Brookhaven National Laboratory, Upton, New York 11973, USA
| | - J S Wen
- Condensed Matter Physics and Materials Science Department, Brookhaven National Laboratory, Upton, New York 11973, USA
| | - G D Gu
- Condensed Matter Physics and Materials Science Department, Brookhaven National Laboratory, Upton, New York 11973, USA
| | - S S Dhesi
- Diamond Light Source, Chilton, Didcot, Oxfordshire OX11 0QX, United Kingdom
| | - A Cavalleri
- Max-Planck Institute for the Structure and Dynamics of Matter, 22761 Hamburg, Germany and Department of Physics, Clarendon Laboratory, University of Oxford, Oxford OX1 3PU, United Kingdom and Center for Free Electron Laser Science and University of Hamburg, 22761 Hamburg, Germany
| | - J P Hill
- Condensed Matter Physics and Materials Science Department, Brookhaven National Laboratory, Upton, New York 11973, USA
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37
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Dienst A, Casandruc E, Fausti D, Zhang L, Eckstein M, Hoffmann M, Khanna V, Dean N, Gensch M, Winnerl S, Seidel W, Pyon S, Takayama T, Takagi H, Cavalleri A. Optical excitation of Josephson plasma solitons in a cuprate superconductor. Nat Mater 2013; 12:535-541. [PMID: 23524373 DOI: 10.1038/nmat3580] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2011] [Accepted: 01/28/2013] [Indexed: 06/02/2023]
Abstract
Josephson plasma waves are linear electromagnetic modes that propagate along the planes of cuprate superconductors, sustained by interlayer tunnelling supercurrents. For strong electromagnetic fields, as the supercurrents approach the critical value, the electrodynamics become highly nonlinear. Josephson plasma solitons (JPSs) are breather excitations predicted in this regime, bound vortex-antivortex pairs that propagate coherently without dispersion. We experimentally demonstrate the excitation of a JPS in La1.84Sr0.16CuO4, using intense narrowband radiation from an infrared free-electron laser tuned to the 2-THz Josephson plasma resonance. The JPS becomes observable as it causes a transparency window in the opaque spectral region immediately below the plasma resonance. Optical control of magnetic-flux-carrying solitons may lead to new applications in terahertz-frequency plasmonics, in information storage and transport and in the manipulation of high-Tc superconductivity.
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Affiliation(s)
- A Dienst
- Department of Physics, Clarendon Laboratory, University of Oxford, Oxford, UK
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38
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Tobey R, Wall S, Först M, Bromberger H, Khanna V, Turner J, Schlotter W, Trigo M, Krupin O, Lee WS, Chuang YD, Moore R, Cavalieri A, Wilkins SB, Zeng H, Mitchell JF, Dhesi S, Cavalleri A, Hill JP. Measuring 3D magnetic correlations during the photo-induced melting of electronic order in La 0.5Sr 1.5MnO 4. EPJ Web of Conferences 2013. [DOI: 10.1051/epjconf/20134103003] [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: 11/14/2022] Open
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39
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Agrawal A, Sahoo S, Singh D, Khanna V. Oral health in pregnancy: Old problem, new findings yet more predicaments. Ann Med Health Sci Res 2013; 3:467. [PMID: 24116338 PMCID: PMC3793464 DOI: 10.4103/2141-9248.117939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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40
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DeLaurier A, Nakamura Y, Braasch I, Khanna V, Kato H, Wakitani S, Postlethwait JH, Kimmel CB. Histone deacetylase-4 is required during early cranial neural crest development for generation of the zebrafish palatal skeleton. BMC Dev Biol 2012; 12:16. [PMID: 22676467 PMCID: PMC3426487 DOI: 10.1186/1471-213x-12-16] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/05/2012] [Accepted: 04/30/2012] [Indexed: 12/21/2022]
Abstract
Background Histone deacetylase-4 (Hdac4) is a class II histone deacetylase that inhibits the activity of transcription factors. In humans, HDAC4 deficiency is associated with non-syndromic oral clefts and brachydactyly mental retardation syndrome (BDMR) with craniofacial abnormalities. Results We identify hdac4 in zebrafish and characterize its function in craniofacial morphogenesis. The gene is present as a single copy, and the deduced Hdac4 protein sequence shares all known functional domains with human HDAC4. The zebrafish hdac4 transcript is widely present in migratory cranial neural crest (CNC) cells of the embryo, including populations migrating around the eye, which previously have been shown to contribute to the formation of the palatal skeleton of the early larva. Embryos injected with hdac4 morpholinos (MO) have reduced or absent CNC populations that normally migrate medial to the eye. CNC-derived palatal precursor cells do not recover at the post-migratory stage, and subsequently we found that defects in the developing cartilaginous palatal skeleton correlate with reduction or absence of early CNC cells. Palatal skeletal defects prominently include a shortened, clefted, or missing ethmoid plate, and are associated with a shortening of the face of young larvae. Conclusions Our results demonstrate that Hdac4 is a regulator of CNC-derived palatal skeletal precursors during early embryogenesis. Cleft palate resulting from HDAC4 mutations in human patients may result from defects in a homologous CNC progenitor cell population.
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Affiliation(s)
- April DeLaurier
- Institute of Neuroscience, 1254 University of Oregon, Eugene, OR 97403, USA.
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41
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Abstract
OBJECTIVE A study was carried out to investigate the rationale that use of a thyroid collar (TC) in cephalometric radiography hampers the diagnostic and descriptive quality of lateral cephalogram. METHODS A randomized observer blinded study was designed. The study consisted of two groups. The first group data were retrieved from the oral radiology archival system having lateral cephalogram without a TC. The second group was selected from the oral radiology department of patients where lateral cephalogram was taken using a TC. Lateral cephalogram was taken on direct digital system, the Kodak 9000 unit (Eastman Kodak, Rochester, NY). 2 observers blinded about the aim of the study were appointed to identify 15 sets of landmarks on the lateral cephalogram. Interobserver variance was also analysed for the study. RESULTS 50 lateral cephalograms in each group were studied. Out of 15 sets of landmarks, 12 were identified consistent with the TC group. Three landmarks, namely the hyoid bone, second cervical vertebra and third cervical vertebra could not be identified on the TC group. There was no significant difference in the interobserver markings on lateral cephalogram. CONCLUSIONS TCs do mask a few landmarks on the lateral cephalogram. These landmarks are mainly used for analysis of skeletal maturity index (SMI). Lead TCs are probably the most convenient and easily available means to protect the thyroid from unwanted radiation while taking lateral cephalogram. It is therefore encouraged to use a TC during routine cephalometric radiography where SMI information is not needed.
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Affiliation(s)
- K P Sansare
- Dr Kaustubh Sansare, Oral Medicine and Radiology, Nair Hospital Dental College, Mumbai, India.
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42
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Abstract
The earliest documented history of cleft lip is based on a combination of religion, superstition, invention and charlatanism. While Greeks ignored their existence, Spartans and Romans would kill these children as they were considered to harbour evil spirits. When saner senses prevailed Fabricius ab Aquapendente (1537–1619) was the first to suggest the embryological basis of these clefts. The knowledge of cleft lip and the surgical correction received a big boost during the period between the Renaissance and the 19th century with the publication of Pierre Franco's Petit Traité and Traité des Hernies in which he described the condition as “lievré fendu de nativité” (cleft lip present from birth). The first documented Cleft lip surgery is from China in 390 BC in an 18 year old would be soldier, Wey Young-Chi. Albucasis of Arabia and his fellow surgeons used the cautery instead of the scalpel and Yperman in 1854 recommended scarifying the margins with a scalpel before suturing them with a triangular needle dipped in wax. The repair was reinforced by passing a long needle through the two sides of the lip and fixing the shaft of the needle with a figure-of-eight thread over the lip. Germanicus Mirault can be credited to be the originator of the triangular flap which was later modified by C.W. Tennison in 1952 and Peter Randall in 1959. In the late 50s, Ralph Millard gave us his legendary ‘cut as you go’ technique. The protruding premaxilla of a bilateral cleft lip too has seen many changes throughout the ages – from being discarded totally to being pushed back by wedge resection of vomer to finally being left to the orthodontists.
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Affiliation(s)
- S Bhattacharya
- Department of Plastic Reconstructive and Aesthetic Surgery, Sahara India Medical Institute, Lucknow, India
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43
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Abstract
Oral tuberculosis and its radiographic findings are not commonly encountered in an oral and maxillofacial radiology practice. Literature has occasional mention of the radiographic findings of oral tuberculosis, which are still ambiguous. When affected, it is manifested majorly in the oral mucosa and rarely in the jaw bones. Here, we report certain unusual radiographic findings of oral tuberculosis which have been rarely mentioned in the literature. Four illustrative cases describe bony resorption, condylar resorption, resorption of the inferior border of the mandible and rarefaction of the alveolar bone as radiographic findings of oral tuberculosis. Follow up of the first case demonstrated regeneration of the condylar head after anti-Kochs therapy was completed, a hitherto unreported phenomenon. The importance of including tuberculosis in the differential diagnosis of some of the unusual radiographic manifestations is emphasized.
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Affiliation(s)
- K Sansare
- Department of Oral Medicine and Radiology, Nair Hospital Dental College, Mumbai, India.
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44
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Rutzen-Lopez H, Khanna V, Reynolds MR. Atrial fibrillation: epidemiology, prognosis and therapy. Minerva Med 2011; 102:187-207. [PMID: 21593721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Atrial fibrillation is the most common cardiac tachyarrhythmia encountered in clinical practice affecting 1% of the population. It is characterized by uncoordinated atrial activation that can lead to embolic complications and reduction in cardiac output resulting in significant morbidity, mortality and a reduction in quality of life. The three major goals in the management of atrial fibrillation are rate control, prevention of thromboembolism and correction of rhythm disturbance. This article will review up-to-date thinking about strategies for achieving each of these fundamental goals of AF care, with an emphasis on new drugs such as dabigatran and dronedarone and emerging non-pharmacologic therapies such as catheter ablation and left atrial appendage exclusion. After many years with relatively few new treatments, the past few years have seen a number of exciting developments which will hopefully improve clinician's ability to improve the outcomes of patients with this chronic and troublesome condition.
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Affiliation(s)
- H Rutzen-Lopez
- Beth Israel Deaconess Medical Center, VA Boston Healthcare System, Boston, MA, USA
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45
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Ehrke H, Tobey RI, Wall S, Cavill SA, Först M, Khanna V, Garl T, Stojanovic N, Prabhakaran D, Boothroyd AT, Gensch M, Mirone A, Reutler P, Revcolevschi A, Dhesi SS, Cavalleri A. Photoinduced melting of antiferromagnetic order in La(0.5)Sr(1.5)MnO4 measured using ultrafast resonant soft x-ray diffraction. Phys Rev Lett 2011; 106:217401. [PMID: 21699341 DOI: 10.1103/physrevlett.106.217401] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2011] [Indexed: 05/15/2023]
Abstract
We used ultrafast resonant soft x-ray diffraction to probe the picosecond dynamics of spin and orbital order in La(0.5)Sr(1.5)MnO(4) after photoexcitation with a femtosecond pulse of 1.5 eV radiation. Complete melting of antiferromagnetic spin order is evidenced by the disappearance of a (1/4,1/4,1/2) diffraction peak. On the other hand, the (1/4,1/4,0) diffraction peak, reflecting orbital order, is only partially reduced. We interpret the results as evidence of destabilization in the short-range exchange pattern with no significant relaxation of the long-range Jahn-Teller distortions. Cluster calculations are used to analyze different possible magnetically ordered states in the long-lived metastable phase. Nonthermal coupling between light and magnetism emerges as a primary aspect of photoinduced phase transitions in manganites.
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Affiliation(s)
- H Ehrke
- Department of Physics, Clarendon Laboratory, University of Oxford, Oxford, United Kingdom
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46
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Sansare K, Khanna V, Karjodkar F. Early victims of X-rays: a tribute and current perception. Dentomaxillofac Radiol 2011; 40:123-5. [PMID: 21239576 PMCID: PMC3520298 DOI: 10.1259/dmfr/73488299] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [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: 10/27/2009] [Revised: 11/27/2009] [Accepted: 02/09/2010] [Indexed: 11/05/2022] Open
Abstract
X-rays were discovered in 1895 and since then much has been written about Wilhelm Roentgen and the events surrounding the discovery. However, there have been only scattered references in the literature about the early workers who dedicated their life, and death, to X-rays. Radiology has come of age since then. Large exposure times have been reduced to milliseconds and there has been a change from analogue to digital. The advent of new and rapidly developing modalities and the ubiquitous presence of cone beam CT (CBCT) highlight the need to remember the early victims of X-rays, especially with the lack of universal guidelines for taking a CBCT scan. The aim of this article is to alert the oral radiologist to exposing patients irrespective of need, and to pay respect to the victims on the 116(th) anniversary of the discovery of X-rays.
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Affiliation(s)
- K Sansare
- Department of Oral Medicine and Radiology, Nair Hospital Dental College, Mumbai, India.
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47
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Sansare K, Khanna V, Karjodkar F. The role of maxillofacial radiologists in gunshot injuries: a hypothesized missile trajectory in two case reports. Dentomaxillofac Radiol 2010; 40:53-9. [PMID: 21159916 DOI: 10.1259/dmfr/72527764] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Gunshot injuries are an emerging form of trauma that oral radiologists increasingly have to deal with. There are two main types of gunshot injuries: high-velocity and low-velocity bullet injuries. The outcome of high-velocity gunshot injury is usually fatal; however, a non-fatal low-velocity injury to the maxillofacial region is more likely to be encountered by the oral and maxillofacial radiologist. It is therefore important to up-to-date knowledge of ballistic science and its implications in the field of maxillofacial radiology. The ability of oral and maxillofacial radiologists to predict the missile trajectory will aid the assessment and localization of the damage caused by the bullet and its splinters. Predicting the missile trajectory may also be of help to law enforcement agencies and forensic scientists in determining the type of firearm used and direction of fire. This article, which examines two cases, attempts to highlight to the oral radiologist this emerging form of trauma and its implications.
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Affiliation(s)
- K Sansare
- Oral Medicine and Radiology, Nair Hospital Dental College, Mumbai, India.
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48
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Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is a pulmonary inflammatory disease characterised by airflow limitation. The role of various inflammatory mediators such as interleukin-1beta (IL-beta) and Immunoglobulin E (IgE) have been implicated in COPD. In present study we aimed to establish if there is an association between the serum levels of IL-1beta and IgE and the severity of airway obstruction. MATERIALS AND METHODS The study group comprised of 30 non atopic smokers, suffering from COPD and 30 non smoker, healthy controls. Serum levels of IgE and IL-1beta were assayed by ELISA in all subjects along with their pulmonary function tests. RESULTS Serum IgE and IL-1beta levels were significantly raised in COPD patients as compared to healthy controls. IL-1beta was negatively correlated with FEV1 (r = -0.624, p = 0.003) and IgE showed a negative correlation with FVC (r = -0.477, p = 0.034). CONCLUSION Our study suggests that in COPD IL-1beta and IgE serum levels correlate with clinical aspects of disease severity. We suggest that the production of IgE and IL-1beta in the airways of patients with COPD may be related to smoking which affects airway obstruction.
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Affiliation(s)
- B Singh
- Department of Biochemistry, GB Pant Hospital, New Delhi, India.
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49
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Rajagopalan MS, Khanna V, Stott M, Leiter Y, Showalter TN, Dicker A, Lawrence YR. Accuracy of cancer information on the Internet: A comparison of a Wiki with a professionally maintained database. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.6058] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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50
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Bhattacharya S, Khanna V, Kohli R. Cleft lip: The historical perspective. Indian J Plast Surg 2009. [DOI: 10.1055/s-0039-1699370] [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: 10/25/2022] Open
Abstract
ABSTRACTThe earliest documented history of cleft lip is based on a combination of religion, superstition, invention and charlatanism. While Greeks ignored their existence, Spartans and Romans would kill these children as they were considered to harbour evil spirits. When saner senses prevailed Fabricius ab Aquapendente (1537–1619) was the first to suggest the embryological basis of these clefts. The knowledge of cleft lip and the surgical correction received a big boost during the period between the Renaissance and the 19th century with the publication of Pierre Franco's Petit Traité and Traité des Hernies in which he described the condition as “lièvre fendu de nativitè” (cleft lip present from birth). The first documented Cleft lip surgery is from China in 390 BC in an 18 year old would be soldier, Wey Young-Chi. Albucasis of Arabia and his fellow surgeons used the cautery instead of the scalpel and Yperman in 1854 recommended scarifying the margins with a scalpel before suturing them with a triangular needle dipped in wax. The repair was reinforced by passing a long needle through the two sides of the lip and fixing the shaft of the needle with a figure-of-eight thread over the lip. Germanicus Mirault can be credited to be the originator of the triangular flap which was later modified by C.W. Tennison in 1952 and Peter Randall in 1959. In the late 50s, Ralph Millard gave us his legendary ‘cut as you go’ technique. The protruding premaxilla of a bilateral cleft lip too has seen many changes throughout the ages OE from being discarded totally to being pushed back by wedge resection of vomer to finally being left to the orthodontists.
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Affiliation(s)
- S. Bhattacharya
- Department of Plastic Reconstructive and Aesthetic Surgery, Sahara India Medical Institute, Lucknow, India
| | - V. Khanna
- Department of Plastic Reconstructive and Aesthetic Surgery, Sahara India Medical Institute, Lucknow, India
| | - R. Kohli
- Department of Plastic Reconstructive and Aesthetic Surgery, Sahara India Medical Institute, Lucknow, India
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