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Krishnan V, Abraham MK, Abraham A, Nair IR, Mathews B. An Unusual Antenatal Presentation of a Mature Pericardial Teratoma Masquerading as Congenital Pulmonary Airway Malformation. J Med Ultrasound 2023; 31:232-234. [PMID: 38024999 PMCID: PMC10668913 DOI: 10.4103/jmu.jmu_220_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 01/30/2022] [Accepted: 04/07/2022] [Indexed: 12/01/2023] Open
Abstract
We report an antenatal presentation of a huge pericardial mature teratoma that was referred as congenital pulmonary airway malformation (CPAM) in the late third trimester of pregnancy. Initial ultrasound evaluation revealed a huge predominantly cystic lesion with mixed echogenicity in the left hemithorax. A provisional diagnosis of pleural tumor was considered in view of previous scans at 20‒28 weeks being normal and associated pleural effusion. Magnetic resonance imaging of the fetus reported the lesion to be CPAM which was supported by postnatal computed tomographic imaging done on day 2 of life. However, intraoperatively, the lesion was found to be of pericardial origin which on subsequent histopathological examination was confirmed to be mature teratoma. We recommend considering potential differential diagnosis other than CPAM, especially when the lesion is found for the first time in the late third trimester.
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Affiliation(s)
- Vivek Krishnan
- Division of Fetal Medicine and Perinatology, Amrita Institute of Medical Sciences, Kochi, Kerala, India
| | - Mohan K Abraham
- Department of Pediatric Surgery, Amrita Institute of Medical Sciences, Kochi, Kerala, India
| | - Ajay Abraham
- Department of Pediatric Surgery, Amrita Institute of Medical Sciences, Kochi, Kerala, India
| | | | - Basil Mathews
- Division of Fetal Medicine and Perinatology, Amrita Institute of Medical Sciences, Kochi, Kerala, India
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Henry C, Kapoor S, Krishnan V, Levi J, Fargen K, D'Agostino R, Hendrix S, Foster D, Brown P, Tegeler CA, Sarwal A. Evaluation of the transverse venous sinus with transcranial color-coded duplex. J Neuroimaging 2023. [PMID: 37088867 DOI: 10.1111/jon.13108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 04/03/2023] [Accepted: 04/11/2023] [Indexed: 04/25/2023] Open
Abstract
BACKGROUND AND PURPOSE Ultrasound-derived diagnosis of transverse venous sinus stenosis (TVSS) may have a promise given recent exploration of its role in pathophysiology of intracranial hypertension and availability of interventions like venous stenting. We investigated transverse venous sinus (TVS) insonation using transcranial color-coded duplex (TCCD) to establish normative values, inform on inherent physiological variability, and other measures to allow future studies on testing the construct validity of TCCD venous in diagnosing TVSS. METHODS An institutional review board-approved prospective observational study evaluated 20 healthy volunteers to define TCCD-based measures for the TVS. Comparatively, the basal vein of Rosenthal, deep middle cerebral veins, and internal jugular veins were insonated. We report on physiological variability including the intrasubject, intersubject, and side-to-side variability; gradient of TVS velocities on each side from medial to lateral insonation; and the relationship between TVS and other insonated venous structures. RESULTS Fifteen out of 20 subjects had the TVS insonated bilaterally, and five had unilaterally (four right, one left). TVS velocities had comparable intrasubject variability to other intracranial veins insonated and lower velocity-based variability than the pulsatility index. There was significant side-side variability in TVS-derived measures without discernible patterns. Insonating TVS from medial to lateral revealed a gradient with a bimodal peak in ultrasound-derived velocities. We did not find discernible relationships between TVS and other veins for TCCD-derived measures. CONCLUSIONS These results can inform future studies validating the normative values in a larger sample and help explore the role of TCCD venous in the diagnosis of venous sinus stenosis.
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Affiliation(s)
- Christine Henry
- Wake Forest School of Medicine, Wake Forest University, Winston-Salem, North Carolina, USA
| | - Sahil Kapoor
- Department of Neurology, Atrium Health Wake Forest Baptist Medical Center, Winston-Salem, North Carolina, USA
| | - Vivek Krishnan
- Wake Forest School of Medicine, Wake Forest University, Winston-Salem, North Carolina, USA
| | - John Levi
- Department of Anesthesiology, University of Illinois, Illinois, Chicago, USA
| | - Kyle Fargen
- Department of Neurosurgery, Atrium Health Wake Forest Baptist Medical Center, Winston-Salem, North Carolina, USA
| | - Ralph D'Agostino
- Department of Biostatistics and Data Science, Atrium Health Wake Forest Baptist Medical Center, Winston-Salem, North Carolina, USA
| | - Sheryl Hendrix
- Department of Neurology, Atrium Health Wake Forest Baptist Medical Center, Winston-Salem, North Carolina, USA
| | - Dana Foster
- Department of Neurology, Atrium Health Wake Forest Baptist Medical Center, Winston-Salem, North Carolina, USA
| | - Patrick Brown
- Departments of Radiology and Neurosurgery, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Charles A Tegeler
- Department of Neurology, Atrium Health Wake Forest Baptist Medical Center, Winston-Salem, North Carolina, USA
| | - Aarti Sarwal
- Department of Neurology, Atrium Health Wake Forest Baptist Medical Center, Winston-Salem, North Carolina, USA
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Seth I, Aiyappan RK, Singh S, Seth A, Sharma D, K JM, Krishnan V, Seth A, Yadav CM, Jain H. Mid-Trimester Fetal Anterior Abdominal Wall Subcutaneous Tissue Thickness: An Early Ultrasonographic Predictor of Gestational Diabetes Mellitus. Cureus 2023; 15:e34610. [PMID: 36891019 PMCID: PMC9985981 DOI: 10.7759/cureus.34610] [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: 01/31/2023] [Indexed: 02/05/2023] Open
Abstract
Background This study aimed to determine whether mid-trimester fetal anterior abdominal wall subcutaneous tissue thickness (FASTT) is an early sonographic predictor of gestational diabetes mellitus (GDM), as well as to study its correlation with maternal glycemic values on GDM screening at 24-28 weeks. Methodology We conducted a prospective, case-control study. FASTT was assessed at anomaly scan in 896 uncomplicated singleton pregnancies. The 75-gram oral glucose tolerance test (OGTT) was done for all included patients at 24-28 weeks. Women diagnosed with GDM were taken as cases and appropriately matched in equal numbers as controls. Statistical analysis was done using SPSS version 20 (IBM Corp., Armonk, NY, USA). Independent-samples t-test, chi-square test, receiver operating characteristic curve, and Pearson's correlation coefficient (r) were performed wherever applicable. Results A total of 93 cases and 94 controls were included. Fetuses of women with GDM had significantly higher mean FASTT at 20 weeks (1.605 ± 0.328 mm vs. 1.222 ± 0.121 mm; p < 0.001). The FASTT cut-off obtained was 1.35 mm (sensitivity = 79.6%, specificity = 87.2%, positive predictive value = 86%, negative predictive value = 81.2%). There was a moderate positive correlation between fasting blood sugar (FBS) and two-hour OGTT values and FASTT (r = 0.332, p < 0.001 and r = 0.399, p < 0.001, respectively). FASTT >1.35 mm had an independent predictive value for GDM and was associated with a 19.608-fold increased risk of GDM. Conclusions FASTT values greater than 1.35 mm at 20 weeks are associated with a significantly increased risk of GDM. In addition, FASTT correlates with FBS and two-hour OGTT at 24-28 weeks and is a simple predictor of GDM at 18-20 weeks.
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Affiliation(s)
- Isha Seth
- Obstetrics and Gynaecology, Amrita Hospital, Faridabad, IND
| | | | - Sunayana Singh
- Obstetrics and Gynaecology, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, IND
| | - Aditya Seth
- Orthopaedics, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, IND
| | - Deepti Sharma
- Obstetrics and Gynaecology, Amrita Hospital, Faridabad, IND
| | - Janu M K
- Obstetrics and Gynaecology, Amrita Institute of Medical Sciences, Kochi, IND
| | - Vivek Krishnan
- Perinatology and Foetal Medicine, Amrita Institute of Medical Sciences, Kochi, IND
| | - Arushi Seth
- Medicine, Jawaharlal Nehru Medical College, Belgaum, IND
| | - Chander Mohan Yadav
- Orthopaedics and Rehabilitation, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, IND
| | - Harsh Jain
- Orthopaedics and Rehabilitation, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, IND
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Sullivan MN, Thakore P, Krishnan V, Alphonsa S, Li W, Feng Earley Y, Earley S. Endothelial cell TRPA1 activity exacerbates cerebral hemorrhage during severe hypertension. Front Mol Biosci 2023; 10:1129435. [PMID: 36793787 PMCID: PMC9922848 DOI: 10.3389/fmolb.2023.1129435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 01/17/2023] [Indexed: 01/31/2023] Open
Abstract
Introduction: Hypoxia-induced dilation of cerebral arteries orchestrated by Ca2+-permeable transient receptor potential ankyrin 1 (TRPA1) cation channels on endothelial cells is neuroprotective during ischemic stroke, but it is unknown if the channel has a similar impact during hemorrhagic stroke. TRPA1 channels are endogenously activated by lipid peroxide metabolites generated by reactive oxygen species (ROS). Uncontrolled hypertension, a primary risk factor for the development of hemorrhagic stroke, is associated with increased ROS production and oxidative stress. Therefore, we hypothesized that TRPA1 channel activity is increased during hemorrhagic stroke. Methods: Severe, chronic hypertension was induced in control (Trpa1 fl/fl) and endothelial cell-specific TRPA1 knockout (Trpa1-ecKO) mice using a combination of chronic angiotensin II administration, a high-salt diet, and the addition of a nitric oxide synthase inhibitor to drinking water. Blood pressure was measured in awake, freely-moving mice using surgically placed radiotelemetry transmitters. TRPA1-dependent cerebral artery dilation was evaluated with pressure myography, and expression of TRPA1 and NADPH oxidase (NOX) isoforms in arteries from both groups was determined using PCR and Western blotting techniques. In addition, ROS generation capacity was evaluated using a lucigenin assay. Histology was performed to examine intracerebral hemorrhage lesion size and location. Results: All animals became hypertensive, and a majority developed intracerebral hemorrhages or died of unknown causes. Baseline blood pressure and responses to the hypertensive stimulus did not differ between groups. Expression of TRPA1 in cerebral arteries from control mice was not altered after 28 days of treatment, but expression of three NOX isoforms and the capacity for ROS generation was increased in hypertensive animals. NOX-dependent activation of TRPA1 channels dilated cerebral arteries from hypertensive animals to a greater extent compared with controls. The number of intracerebral hemorrhage lesions in hypertensive animals did not differ between control and Trpa1-ecKO animals but were significantly smaller in Trpa1-ecKO mice. Morbidity and mortality did not differ between groups. Discussion: We conclude that endothelial cell TRPA1 channel activity increases cerebral blood flow during hypertension resulting in increased extravasation of blood during intracerebral hemorrhage events; however, this effect does not impact overall survival. Our data suggest that blocking TRPA1 channels may not be helpful for treating hypertension-associated hemorrhagic stroke in a clinical setting.
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Affiliation(s)
- Michelle N. Sullivan
- Oregon National Primate Research Center, Oregon Health and Science University, Beaverton, OR, United States
| | - Pratish Thakore
- Department of Pharmacology, Center for Molecular and Cellular Signaling in the Cardiovascular System, Reno School of Medicine, University of Nevada, Reno, NV, United States
| | - Vivek Krishnan
- Department of Pharmacology, Center for Molecular and Cellular Signaling in the Cardiovascular System, Reno School of Medicine, University of Nevada, Reno, NV, United States
| | - Sushma Alphonsa
- Department of Pharmacology, Center for Molecular and Cellular Signaling in the Cardiovascular System, Reno School of Medicine, University of Nevada, Reno, NV, United States
| | - Wencheng Li
- Department of Pathology, Wake Forest University School of Medicine, Winston-Salem, NC, United States
| | - Yumei Feng Earley
- Department of Pharmacology, Center for Molecular and Cellular Signaling in the Cardiovascular System, Reno School of Medicine, University of Nevada, Reno, NV, United States
- Department of Physiology and Cell Biology, Center for Molecular and Cellular Signaling in the Cardiovascular System, Reno School of Medicine, University of Nevada, Reno, NV, United States
| | - Scott Earley
- Department of Pharmacology, Center for Molecular and Cellular Signaling in the Cardiovascular System, Reno School of Medicine, University of Nevada, Reno, NV, United States
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Karmegaraj B, Srimurugan B, Krishnan V, Vaidyanathan B. Clinical presentation, conventional/4D spatio-temporal image correlation imaging findings, pregnancy and early postnatal outcomes in fetuses having anomalies of systemic venous return in the absence of significant intracardiac defects: A retrospective study from two centres in Southern India. Echocardiography 2023; 40:15-29. [PMID: 36468658 DOI: 10.1111/echo.15458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 08/29/2022] [Accepted: 09/09/2022] [Indexed: 12/09/2022] Open
Abstract
BACKGROUND Recent advances in fetal ultrasound imaging, especially four-dimensional (4D) spatio-temporal image correlation techniques permit detailed evaluation of the fetal venous system and its abnormalities. In this report, we present the clinical presentation, conventional/4D spatio-temporal image correlation imaging findings, pregnancy, and early postnatal outcomes in fetuses having anomalies of systemic venous return in the absence of significant intracardiac defects from two centres in southern India. OBJECTIVES To report the clinical presentation, conventional/4D spatio-temporal image correlation imaging findings, pregnancy, and early postnatal outcomes in fetuses having anomalies of systemic venous return in the absence of significant intracardiac defects from two centres in Southern India. METHODS Retrospective study (October 2017 to March 2022). All fetuses referred with abnormal cardiac imaging findings who were diagnosed to have anomalies of systemic venous return in the absence of significant intracardiac defects were included. Imaging techniques like 2D with color and 4D spatio-temporal image correlation fetal imaging were used to evaluate systemic venous anomalies. Systemic venous anomalies were grouped into cardinal venous anomalies and umbilico-portosystemic venous anomalies. RESULTS Thirty-nine fetuses were included; this represented 4.4% of all cardiac anomalies diagnosed during the study period. Cardinal venous anomalies were seen in 29 fetuses (74%); the mean gestation age at diagnosis was 25.5 ± 3.4 weeks. Absent dilated coronary sinus was associated with anomalous drainage of superior caval vein through completely unroofed coronary sinus into the left atrium (n = 3) which resulted in cyanosis after birth in all infants. Among the three cases, one underwent surgery at 6 months of age due to a progressive increase in cyanosis (Spo2 78%) and others are awaiting surgery. A prenatal genetic evaluation was performed in 17 (58.6%). Cardinal venous anomalies were not associated with genetic abnormalities. Live births occurred in all fetuses with cardinal venous anomalies. Umbilico-portosystemic venous anomalies were seen in 10 (26%). The mean gestation age at diagnosis was 26.5 ± 4.5 weeks. Except in a fetus with the extrahepatic portosystemic shunt (umbilical vein to iliac vein), the genetic evaluation was normal in our cohort. Extracardiac anomalies (n = 3/10; 30%) were seen in both intra (n = 1) and extrahepatic portosystemic shunts (n = 2). CONCLUSION Anomalies of systemic venous return in the absence of significant intracardiac, extracardiac, and genetic abnormalities carried an overall favorable prognosis in our cohort. Precise characterization of anatomic details using advanced imaging techniques helps in the understanding of this complex three-dimensional anatomy and in the prognostication of these anomalies.
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Affiliation(s)
- Balaganesh Karmegaraj
- Fetal Cardiology Division, Department, of Pediatric Cardiology, Amrita Institute of Medical Sciences, and Research Centre, Kochi, Kerala, India.,Sowmi Fetal and Pediatric Heart Centre, Tirunelveli, Tamil Nadu, India
| | - Balaji Srimurugan
- Department of Pediatric Cardiovascular Thoracic Surgery, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India
| | - Vivek Krishnan
- Division of Fetal Medicine, Amrita Institute of Medical Sciences, Cochin, Kerala, India
| | - Balu Vaidyanathan
- Fetal Cardiology Division, Department, of Pediatric Cardiology, Amrita Institute of Medical Sciences, and Research Centre, Kochi, Kerala, India
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Aliabadi S, Akin E, Krishnan V, Earley S, Feng Earley Y. Abstract 030: Aldosterone Promotes Nanoscale Colocalization Of Epithelial Sodium Channel Subunit Alpha And Sodium Calcium Exchanger In Neuro2a Cells. Hypertension 2022. [DOI: 10.1161/hyp.79.suppl_1.030] [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: 11/16/2022]
Abstract
We previously reported that hypertensive patients have a higher concentration of sodium ([Na
+
]) in their cerebrospinal fluid (CSF) compared with normotensive subjects but no difference in plasma [Na
+
] was observed, suggesting the potential importance of CSF [Na
+
] in hypertension. Epithelial sodium channels (ENaC) in the brain have been shown to be up regulated in salt-induced hypertension (SH). However, the molecular mechanisms of how brain ENaC contributes to SH development are not yet understood. We hypothesize that ENaC forms a nanoscale colocalization with the sodium-calcium exchanger (NCX) that mediates downstream signaling pathways leading to SH. To test our hypothesis, using self-labeling proteins we generated SNAP-ENaC-α and Halo-NCX1 constructs, enabling high-resolution imaging of surface expressed proteins. Expression of ENaC-α-SNAP and NCX1.5-Halo was confirmed by western blot showing an increase in expression (fold change) of ENaC-α (7.6 ± 1.7 vs. 1 ± 0.3, p<0.02) and NCX1.5 (10.1 ± 0.8 vs. 1 ± 0.4, p<0.0006) in transfected Neuro2A cells compared with controls. Transfected cells were treated with vehicle or aldosterone (100 nM) for 2 hours (n=15 cells from 3 repeat experiments/group) and imaged using ground-state depletion super-resolution microscopy. Data were analyzed using object-based analysis (OBA). Aldosterone treatment increased the density of individual ENaC-α clusters on the cell surface (12.4 ± 1.3 vs. 6.9 ± 1.08 clusters/μm
2
, p<0.002), supporting the functional role of aldosterone on increasing ENaC-α surface abundance. Importantly, the frequency (3.1 ± 0.34% vs 1.7 ± 0.22% colocalized /total clusters, p<0.001) and the density (0.5 ± 0.1 vs 0.2 ± 0.04 clusters/μm
2
of cell surface, p<0.009) of colocalized (< 40nm) ENaC-α and NCX 1.5 clusters were significantly increased in aldosterone treated cells. In sum, these data show aldosterone increases the number of ENaC-α channels on the cell surface and promotes its nanoscale colocalization with NCX, providing evidence for a functional role of ENaC-α and NCX1 coupling. Nanoscale colocalization of ENaC and NCX is potentially significant in SH, and future studies will focus on elucidating the functional importance and mechanisms.
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Krishnan V, Elayedatt R, Hausman-Kedem M, Krajden Haratz K. Prenatal diagnosis of multiple intracranial arteriovenous malformations. Ultrasound Obstet Gynecol 2022; 59:836-839. [PMID: 35107191 DOI: 10.1002/uog.24871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 01/05/2022] [Accepted: 01/14/2022] [Indexed: 06/14/2023]
Affiliation(s)
- V Krishnan
- Division of Fetal Medicine & Perinatology, Amrita Centre of Excellence in Fetal Care, Amrita Institute of Medical Sciences, Kochi, India
| | - R Elayedatt
- Division of Fetal Medicine & Perinatology, Amrita Centre of Excellence in Fetal Care, Amrita Institute of Medical Sciences, Kochi, India
| | - M Hausman-Kedem
- Pediatric Neurology Institute, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - K Krajden Haratz
- Ultrasound in ObGyn Unit, Lis Maternity Hospital, Tel Aviv Medical Center, Tel Aviv, Israel
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Krishnan V, Ali S, Gonzales A, Thakore P, Griffin C, Yamasaki E, Alvarado MG, Johnson MT, Trebak M, Earley S. Peripheral Coupling Sites Formed by STIM1 Govern the Contractility of Vascular Smooth Muscle Cells. FASEB J 2022. [DOI: 10.1096/fasebj.2022.36.s1.r5019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | - Sher Ali
- PharmacologyUniversity of NevadaRenoNV
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Krishnan V, Ali S, Gonzales AL, Thakore P, Griffin CS, Yamasaki E, Alvarado MG, Johnson MT, Trebak M, Earley S. STIM1-dependent peripheral coupling governs the contractility of vascular smooth muscle cells. eLife 2022; 11:70278. [PMID: 35147077 PMCID: PMC8947769 DOI: 10.7554/elife.70278] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 02/10/2022] [Indexed: 11/28/2022] Open
Abstract
Peripheral coupling between the sarcoplasmic reticulum (SR) and plasma membrane (PM) forms signaling complexes that regulate the membrane potential and contractility of vascular smooth muscle cells (VSMCs). The mechanisms responsible for these membrane interactions are poorly understood. In many cells, STIM1 (stromal interaction molecule 1), a single-transmembrane-domain protein that resides in the endoplasmic reticulum (ER), transiently moves to ER-PM junctions in response to depletion of ER Ca2+ stores and initiates store-operated Ca2+ entry (SOCE). Fully differentiated VSMCs express STIM1 but exhibit only marginal SOCE activity. We hypothesized that STIM1 is constitutively active in contractile VSMCs and maintains peripheral coupling. In support of this concept, we found that the number and size of SR-PM interacting sites were decreased, and SR-dependent Ca2+-signaling processes were disrupted in freshly isolated cerebral artery SMCs from tamoxifen-inducible, SMC-specific STIM1-knockout (Stim1-smKO) mice. VSMCs from Stim1-smKO mice also exhibited a reduction in nanoscale colocalization between Ca2+-release sites on the SR and Ca2+-activated ion channels on the PM, accompanied by diminished channel activity. Stim1-smKO mice were hypotensive, and resistance arteries isolated from them displayed blunted contractility. These data suggest that STIM1 – independent of SR Ca2+ store depletion – is critically important for stable peripheral coupling in contractile VSMCs.
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Affiliation(s)
- Vivek Krishnan
- Department of Pharmacology, University of Nevada Reno, Reno, United States
| | - Sher Ali
- Department of Pharmacology, University of Nevada Reno, Reno, United States
| | - Albert L Gonzales
- Department of Physiology and Cell Biology, University of Nevada Reno, Reno, United States
| | - Pratish Thakore
- Department of Pharmacology, University of Nevada, Reno, Reno, United States
| | - Caoimhin S Griffin
- Department of Pharmacology, University of Nevada Reno, Reno, United States
| | - Evan Yamasaki
- Department of Pharmacology, University of Nevada Reno, Reno, United States
| | - Michael G Alvarado
- Department of Pharmacology, University of Nevada Reno, Reno, United States
| | - Martin T Johnson
- Department of Cellular and Molecular Physiology, Penn State University, Hershey, United States
| | - Mohamed Trebak
- Department of Pharmacology and Chemical Biology, University of Pittsburgh, Pittsburgh, United States
| | - Scott Earley
- Department of Pharmacology, University of Nevada Reno, Reno, United States
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Krishnan V, Prakash M, Kumar S, Malhotra R, Kapoor PM. Transesophageal Echocardiography in Bentall Surgery: Hope or Hype? Journal of Cardiac Critical Care TSS 2022. [DOI: 10.1055/s-0042-1742715] [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: 10/19/2022] Open
Abstract
AbstractA 57-year-old male patient who is a known case of hypertension well controlled on ramipril presented with a history of shortness of breath and palpitation of 3 months duration. The symptoms were insidious in onset; however, it progressed rapidly over the period of 3 months, wherein at present the patient feels breathless in performing normal daily activities of living making him New York Heart Association class III patient. Palpitations are regular in nature and present throughout the time and are exacerbated on performing even light activities within his house. There was associated swelling of bilateral lower limbs that usually improved after a night's rest; however, it was not completely resolved. The individual did not give any history of chest pain, presyncope, syncope, or any other symptoms that pointed toward a cardiac condition.
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Affiliation(s)
- V. Krishnan
- Department of Cardiac Anaesthesia and Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Mohit Prakash
- Department of Cardiac Anaesthesia and Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Sanjeev Kumar
- Department of Cardiac Anaesthesia and Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Rohit Malhotra
- Department of Cardiac Anaesthesia and Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Poonam Malhotra Kapoor
- Department of Cardiac Anaesthesia and Critical Care, All India Institute of Medical Sciences, New Delhi, India
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Krishnan V, Thomas M, Sharma M, Elayedatt RA. Prenatal 3D-Ultrasound Diagnosis of “Tessier 3” Lateral Facial Cleft. J Fetal Med 2021. [DOI: 10.1007/s40556-021-00326-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Krishnan V, Sharma A, Ramamurthy R, Elayedatt R, Ramamurthy BS. Prenatal Ventriculomegaly - Diagnosis, Prognostication and Management. Neurol India 2021; 69:S305-S312. [PMID: 35102981 DOI: 10.4103/0028-3886.332280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Fetal ventriculomegaly (VM) refers to the abnormal enlargement of one or more ventricles of the brain in-utero. The enlargement may or may not be related to ventricular obstruction and increased intracranial pressure; therefore, the term "hydrocephalus" is not used. VM is diagnosed usually in the mid-trimester when the atrial diameter (AD) of the lateral ventricle is more than 10 mm on one or both sides. A thorough workup is then required to identify the cause as the etiology is diverse. Fetal magnetic resonance imaging (MRI) may yield additional information. Serial ultrasound follow-up would be required to assess its progression with advancing gestation. The prognosis and long-term outcomes greatly depend upon the etiology, the severity at diagnosis, progression, and associations. This article reviews the definitions, diagnosis, and workup of fetal VM, discusses follow-up protocols and prognosis, and examines the role of fetal therapy, including fetoscopic surgery in its prenatal management.
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Affiliation(s)
- Vivek Krishnan
- Fetal Medicine and Perinatology, Amrita Centre of Excellence in Fetal Care, AMRITA Institute of Medical Sciences, Kochi, Kerala, India
| | - Akshatha Sharma
- Apollo Centre for Fetal Medicine, Indraprastha Apollo Hospitals, New Delhi, India
| | | | - Rinshi Elayedatt
- Fetal Medicine and Perinatology, Amrita Centre of Excellence in Fetal Care, AMRITA Institute of Medical Sciences, Kochi, Kerala, India
| | - B S Ramamurthy
- Srinivasa Ultrasound Scanning Centre, Bangalore, Karnataka, India
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Ali S, Solano AS, Gonzales AL, Thakore P, Krishnan V, Yamasaki E, Earley S. Nitric Oxide Signals Through IRAG to Inhibit TRPM4 Channels and Dilate Cerebral Arteries. Function (Oxf) 2021; 2:zqab051. [PMID: 34734188 PMCID: PMC8557268 DOI: 10.1093/function/zqab051] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 09/30/2021] [Accepted: 10/05/2021] [Indexed: 01/12/2023]
Abstract
Nitric oxide (NO) relaxes vascular smooth muscle cells (SMCs) and dilates blood vessels by increasing intracellular levels of cyclic guanosine monophosphate (cGMP), which stimulates the activity of cGMP-dependent protein kinase (PKG). However, the vasodilator mechanisms downstream of PKG remain incompletely understood. Here, we found that transient receptor potential melastatin 4 (TRPM4) cation channels, which are activated by Ca2+ released from the sarcoplasmic reticulum (SR) through inositol triphosphate receptors (IP3Rs) under native conditions, are essential for SMC membrane depolarization and vasoconstriction. We hypothesized that signaling via the NO/cGMP/PKG pathway causes vasodilation by inhibiting TRPM4. We found that TRPM4 currents activated by stretching the plasma membrane or directly activating IP3Rs were suppressed by exogenous NO or a membrane-permeable cGMP analog, the latter of which also impaired IP3R-mediated release of Ca2+ from the SR. The effects of NO on TRPM4 activity were blocked by inhibition of soluble guanylyl cyclase or PKG. Notably, upon phosphorylation by PKG, IRAG (IP3R-associated PKG substrate) inhibited IP3R-mediated Ca2+ release, and knockdown of IRAG expression diminished NO-mediated inhibition of TRPM4 activity and vasodilation. Using superresolution microscopy, we found that IRAG, PKG, and IP3Rs form a nanoscale signaling complex on the SR of SMCs. We conclude that NO/cGMP/PKG signaling through IRAG inhibits IP3R-dependent activation of TRPM4 channels in SMCs to dilate arteries. SIGNIFICANCE STATEMENT Nitric oxide is a gaseous vasodilator produced by endothelial cells that is essential for cardiovascular function. Although NO-mediated signaling pathways have been intensively studied, the mechanisms by which they relax SMCs to dilate blood vessels remain incompletely understood. In this study, we show that NO causes vasodilation by inhibiting the activity of Ca2+-dependent TRPM4 cation channels. Probing further, we found that NO does not act directly on TRPM4 but instead initiates a signaling cascade that inhibits its activation by blocking the release of Ca2+ from the SR. Thus, our findings reveal the essential molecular pathways of NO-induced vasodilation-a fundamental unresolved concept in cardiovascular physiology.
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Affiliation(s)
| | | | - Albert L Gonzales
- Department of Physiology and Cell Biology, Center for Molecular and Cellular Signaling in the Cardiovascular System, University of Nevada, Reno School of Medicine, University of Nevada, Reno, NV 89557-0318, USA
| | - Pratish Thakore
- Department of Pharmacology, Center for Molecular and Cellular Signaling in the Cardiovascular System, Reno School of Medicine, University of Nevada, Reno, NV 89557-0318, USA
| | - Vivek Krishnan
- Department of Pharmacology, Center for Molecular and Cellular Signaling in the Cardiovascular System, Reno School of Medicine, University of Nevada, Reno, NV 89557-0318, USA
| | - Evan Yamasaki
- Department of Pharmacology, Center for Molecular and Cellular Signaling in the Cardiovascular System, Reno School of Medicine, University of Nevada, Reno, NV 89557-0318, USA
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Mathews B, Karmegaraj B, Vidya C, Krishnan V. Atypical Antenatal Presentation of an Unusual Nonmucinous Papillary Variant of Giant Congenital Pulmonary Airway Malformation Masquerading as Congenital Diaphragmatic Hernia with Volvulus. J Med Ultrasound 2021; 29:284-287. [PMID: 35127410 PMCID: PMC8772466 DOI: 10.4103/jmu.jmu_139_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 11/19/2020] [Accepted: 12/08/2020] [Indexed: 11/24/2022] Open
Abstract
We report a case of a huge congenital pulmonary airway malformation (CPAM) that was referred as congenital diaphragmatic hernia (CDH). Initial ultrasound evaluation revealed a huge cystic lesion with septations, in the thorax, causing mediastinal shift and compression effects, suggesting the possibility of a thoracic lymphangioma, or bowel herniation with obstruction. A fetal magnetic resonance imaging reported possible bowel herniation through a posterior defect in the diaphragm, with volvulus, reinforcing the diagnosis of CDH. It was only on autopsy and subsequent histopathology examination that the diagnosis of a rare variant of CPAM-nonmucinous papillary type, could be made. To the best of our knowledge, a CPAM this huge has not been reported prenatally at this gestation. We recommend considering the potential diagnosis of CPAM in any thoracic cystic irrespective of its size or appearance.
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Affiliation(s)
- Basil Mathews
- Department of Fetal Medicine and Perinatology, Amrita Institute of Medical Sciences, Kochi, Kerala, India
| | - Balaganesh Karmegaraj
- Department of Fetal and Pediatric Cardiology, Amrita Institute of Medical Sciences, Kochi, Kerala, India
| | - C Vidya
- Department of Fetal Pathology, Amrita Institute of Medical Sciences, AIMS, Kochi, Kerala, India
| | - Vivek Krishnan
- Department of Fetal Medicine and Perinatology, Amrita Institute of Medical Sciences, Kochi, Kerala, India
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De Vlam K, Gallo G, Mease PJ, Rahman P, Krishnan V, Sandoval D, Lin CY, Bolce R, Conaghan PG. POS0901 IXEKIZUMAB SHOWS A DISTINCT PATTERN OF PAIN IMPROVEMENT BEYOND INFLAMMATION IN RADIOGRAPHIC AXIAL SPONDYLOARTHRITIS. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:The efficacy of ixekizumab (IXE) in biologic-naïve patients with radiographic axial spondyloarthritis (r-axSpA) has been previously presented using traditional axSpA outcome measures, such as BASDAI and ASAS.Objectives:In patients with active r-axSpA, to assess the analgesic efficacy of IXE as it relates to patient-reported and objective measures of inflammation.Methods:The Phase III COAST-V (NCT02696785) multi-center, randomized, double-blind, placebo (PBO)-controlled and active reference arm with adalimumab (ADA) trial investigated the efficacy of IXE in 341 patients (pts) with active r-axSpA for 52 weeks (W). Pts were initially randomized to IXEQ4W, IXEQ2W, PBO, and ADAQ2W. At W16, pts assigned to PBO and ADA were re-randomized to IXEQ2W or Q4W. Changes in spinal pain at night (SP-N) and spinal pain were measured at each study visit and analysed while controlling for CRP levels or mean of BASDAI questions 5 & 6 (Q5: Duration and Q6: Intensity of morning stiffness). Observed data analyses are presented for each group stratified by treatment arm and compared to PBO. In the initial analysis, pts were categorized into 2 sub-groups defined as “Sustained” and “Fluctuating” depending on: CRP <5 mg/L W4-16 vs. CRP ≥5 mg/L at any point beyond W4 between weeks 4-16 respectively. In a second analysis, pts were categorized based on BASDAI Q5/6 improvement: “Sustained” if ≥2-pt improvement W12-16 vs. “Fluctuating” if <2-pt improvement at any point beyond W12 between W12-16.Results:Between W0 and W16, pts treated (tx) with IXEQ4W experienced greater reduction in SP-N than pts tx with ADA, in both CRP sustained and fluctuating groups (Fig 1a). Pts in the IXEQ4W and ADA arms showed different trajectories of pain improvement in the CRP fluctuating groups. For the pts with a fluctuating CRP ≥5 mg/L, pts in IXEQ4W arm demonstrated a greater reduction in SP-N compared to pts in PBO arm (p < .001) at W16, whereas pts in ADA arm did not experience a reduction in SP-N compared to PBO (p = .416). For the pts with a sustained CRP <5mg/L, IXEQ4W and ADA treatments both significantly demonstrated reduction in SP-N compared to PBO at W16 (IXEQ4W: p = .002; ADA: p = .02), with IXEQ4W treatment showing a greater level of reduction (Fig 1a). The pts randomized to ADA and re-randomized to IXEQ2W or Q4W (ADA/IXE) experienced further improvement in SP-N. This effect was sustained over the 52-wk period (Fig 1b). The same pattern of improvement in SP-N was observed when controlling for the BASDAI Q5/6; the SP-N improvement was greater in pts with a sustained BASDAI Q5/6 compared to pts with a fluctuating BASDAI Q5/6, regardless of treatment (Table 1). In the fluctuating BASDAI Q5/6, for pts in ADA/IXE arm, further reduction of both spinal pain and SP-N were observed (Table 1).Table 1.Change in Pain Outcome at baseline, week 16 and week 52 by Inflammation Status as assessed by BASDAI or CRP levels for patients receiving placebo (PBO), adalimumab (ADA), and ixekizumab every 4 weeks (IXE Q4W)Change from baselinePBOADAIXEQ4WbaselineWeek 16(as observed)Week 52PBO/IXE(as observed)baselineWeek 16(as observed)Week 52ADA/IXE(as observed)baselineWeek 16(as observed)Week 52(as observed)Spinal painBASDAI Q5/6 sustained7.54-3.33-4.657.21-4.07-4.57.4-4.52-4.94BASDAI Q5/6 fluctuating7.37-1.32-2.826.76-1.2-2.246.97-1.3-2.52CRP sustained7-1.53-1.936.83-2.9-3.67.23-3.57-4.21CRP fluctuating7.51-1.96-3.637.28-2-2.897.24-2.91-3.93Spinal pain at nightBASDAI Q5/6 sustained7.12-3.21-4.617.26-4.63-4.927.12-4.73-4.91BASDAI Q5/6 fluctuating7.05-1.15-2.886.6-1.2-2.497.03-2.17-2.92CRP sustained7.2-1.87-2.276.76-3.2-3.856.89-3.8-4.12CRP fluctuating7.04-1.69-3.67.24-2.21-3.397.35-3.68-4.38Conclusion:IXE reduced SP-N and spinal pain irrespective of CRP or morning stiffness. Additionally, pts treated with ADA re-randomized to IXE experienced a further reduction in SP-N and spinal pain. Collectively, these results support the additive benefits of IXE in reducing pain above measurable effects on inflammation.Acknowledgements:The authors would like to thank Eglantine Julle-Daniere for writing and editorial contributionsDisclosure of Interests:Kurt de Vlam Speakers bureau: Eli Lilly, Novartis, Pfizer, Paid instructor for: Celgene, Amgen, Consultant of: Elil Lillyn Novartis, UCB, Galapagos, Sandoz, Pfizer, Grant/research support from: Celgene, Gaia Gallo Shareholder of: Eli Lilly, Employee of: Eli Lilly, Philip J Mease Speakers bureau: AbbVie, Amgen, Eli Lilly, Janssen, Novartis, Pfizer, UCB, Consultant of: AbbVie, Amgen, Boehringer Ingelheim, Bristol Myers Squibb, Eli Lilly, Galapagos, Gilead, GlaxoSmithKline, Janssen, Novartis, Pfizer, Sun, UCB, Grant/research support from: AbbVie, Amgen, Bristol Myers Squibb, Eli Lilly, Galapagos, Janssen, Novartis, Pfizer, Sun, UCB, Proton Rahman Speakers bureau: AbbVie, Amgen, BMS, Celgene, Eli Lilly, Janssen, Merck, Novartis, Pfizer, UCB, Consultant of: AbbVie, Amgen, BMS, Celgene, Eli Lilly, Janssen, Merck, Novartis, Pfizer, UCB, Grant/research support from: Janssen, Novartis, Venkatesh Krishnan Shareholder of: Eli Lilly, Employee of: Eli Lilly, David Sandoval Shareholder of: Eli Lilly, Employee of: Eli Lilly, Chen-Yen Lin Shareholder of: Eli Lilly, Employee of: Eli Lilly, Rebecca Bolce Shareholder of: Eli Lilly, Employee of: Eli Lilly, Philip G Conaghan Consultant of: personal fees from: AbbVie, AstraZeneca, BMS, Eli Lilly, EMD Serono, Flexion Therapeutics, Galapagos, Gilead, Novartis, Pfizer
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Elayedatt RA, Krishnan V. Rare Association of Fetal Chondrodysplasia Punctata in Maternal SLE: A Case Report. J Fetal Med 2021. [DOI: 10.1007/s40556-021-00296-5] [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: 11/24/2022]
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Vishalkumar P, Jayaprakash NS, Desai PK, Krishnan V, Vijayalakshmi MA. Evaluation of anti-histidine-rich protein 2 monoclonal antibodies, developed by using poly (N-isopropylacrylamide) as an adjuvant for malarial diagnostic application. Trop Biomed 2020; 37:1050-1061. [PMID: 33612757 DOI: 10.47665/tb.37.4.1050] [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: 11/21/2022]
Abstract
OBJECTIVE To evaluate the sensitivity and the stability of the monoclonal antibodies (Aa3c10, b10c1), against truncated Histidine-rich protein 2 (PfHRP2), developed using smart polymer, poly N-isopropylacrylamide, as adjuvant for malarial diagnostic applications in comparison with the available commercial antibodies. METHODS Two hybridoma clones (Aa3c10, b10c1) were used for the production of ascites in BALB/c mice. Purification of monoclonal antibodies from the ascites was carried out using affinity columns. The thermal stability study of monoclonal antibodies was done by storing it at 37°C and 45°C for thirty days. The stored antibodies were analyzed using SDS-PAGE and flow-through device where the antigenantibody interaction was visualized by Protein A colloidal gold solution. Sensitivity was determined by endpoint dilution ELISA and the dissociation constant by competitive ELISA. Sensitive pair optimization was done by sandwich ELISA using biotinylated antibodies. Prototype preparation for lateral flow assay had a colloidal gold-based detection system. RESULTS Thermal stability experiments showed that both mAbs (Aa3c10; b10c1) are stable up to thirty days at 45°C while the commercially available mAbs were stable up to fifteen days only. Compared to commercial antibodies, the mAb Aa3c10, showed the highest sensitivity in end-point titre. In sensitive pair optimization, it was observed that the mAb, b10c1, as a detector and the mAb, Aa3c10, as a capture antibody showed the highest absorbance to detect 50pg/ml PfHRP2 antigen. The prototype formulation of lateral flow assay using the mAbs (Aa3c10; b10c1) showed good reactivity with WHO panel and no false-positive results were observed with twenty clinically negative samples and five P. vivax positive samples. CONCLUSIONS The novel monoclonal antibodies (Aa3c10, b10c1) against truncated PfHRP2, could be a strong potential candidates that can be included in making RDTs with better sensitivity and stability.
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Affiliation(s)
- P Vishalkumar
- Arkray Healthcare Pvt Ltd, Plot No. 336, 338, 340, Rd Number 30, Sachin 394230, Surat, India
| | - N S Jayaprakash
- Centre for Bioseparation Technology (CBST), Vellore Institute of Technology (VIT), Vellore 632014, Tamil Nadu, India
| | - P K Desai
- Arkray Healthcare Pvt Ltd, Plot No. 336, 338, 340, Rd Number 30, Sachin 394230, Surat, India
| | - V Krishnan
- Centre for Bioseparation Technology (CBST), Vellore Institute of Technology (VIT), Vellore 632014, Tamil Nadu, India
| | - M A Vijayalakshmi
- Centre for Bioseparation Technology (CBST), Vellore Institute of Technology (VIT), Vellore 632014, Tamil Nadu, India
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Yesodharan D, Krishnan V, Nair IR, Ganapathy A, Mannan AU, Nampoothiri S. Lethal Cenani Lenz syndrome in two consecutive pregnancies: Further extension of phenotype from Maldives. Am J Med Genet A 2020; 185:620-624. [PMID: 33179409 DOI: 10.1002/ajmg.a.61971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 10/16/2020] [Accepted: 10/17/2020] [Indexed: 11/07/2022]
Abstract
Cenani Lenz syndrome is a rare autosomal recessive disorder associated with variable degree of limb malformations, dysmorphism, and renal agenesis. It is caused due to pathogenic variants in the LRP4 gene, which plays an important role in limb and renal development. Mutations in the APC gene have also been occasionally associated with CLS. The phenotypic spectrum ranges from mild to very severe perinatal lethal type depending on the type of variant. We report a pathogenic variant, c.2710 del T (p.Trp904GlyfsTer5) in theLRP4 gene, in a fetus with lethal Cenani Lenz syndrome with antenatal presentation of tetraphocomelia and symmetrical involvement of hands and feet.
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Affiliation(s)
- Dhanya Yesodharan
- Department of Pediatric Genetics, Amrita Institute of Medical Sciences and Research Center, Cochin, India
| | - Vivek Krishnan
- Department of Perinatology, Amrita Institute of Medical Sciences and Research Center, Cochin, India
| | - Indu R Nair
- Department of Pathology, Amrita Institute of Medical Sciences and Research Center, Cochin, India
| | | | | | - Sheela Nampoothiri
- Department of Pediatric Genetics, Amrita Institute of Medical Sciences and Research Center, Cochin, India
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Koh TL, Canet E, Amjad S, Bellomo R, Taylor D, Gan HK, Marhoon N, Lim A, Ong WL, Krishnan V, Khor R. Prognostic performance of qSOFA in oncology patients admitted to the emergency department with suspected infection. Asia Pac J Clin Oncol 2020; 17:94-100. [PMID: 33078888 DOI: 10.1111/ajco.13422] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 06/16/2020] [Indexed: 12/22/2022]
Abstract
AIM We aimed to test the performance of the quick Sequential Organ Failure Assessment score (qSOFA) in predicting the outcomes of oncology patients admitted to the emergency department (ED) with suspected infection. METHODS Retrospective cohort analysis of all oncology patients presenting to the ED of a tertiary hospital with suspected infection from 1 December 2014 to 1 June 2017. Patients were identified by cross-linkage of ED and Oncology electronic health records. The primary outcome was in-hospital mortality and/or ICU stay ≥ 3 days. RESULTS A total of 1655 patients were included in this study--1267 (76.6%) with solid tumor and 388 (23.4%) with hematological malignancies. At presentation, 495 patients had chemotherapy, and 140 had radiotherapy within the preceding 6 months. Four hundred patients received chemotherapy and/or radiotherapy in the previous 4 weeks. Overall, 371 (22.4%) patients had qSOFA ≥ 2. Such patients had a higher likelihood of respiratory infections compared to patients with a qSOFA < 2 (43.9% vs 29%) and were more likely to be admitted to ICU or require mechanical ventilation. In-hospital mortality or in-hospital mortality and/or ICU stay ≥ 3 days were 17.3% and 21%, for qSOFA ≥ 2 patients versus 4.7% and 6.9% for qSOFA < 2 patients (P < .001). qSOFA ≥ 2 had a negative predictive value of 95% for in-hospital mortality and 93% for in-hospital mortality or ICU stay ≥ 3 days. CONCLUSION Among oncology patients presenting to the ED with suspected infection, a qSOFA ≥ 2 is associated with a threefold risk of hospital mortality/prolonged ICU stay. Its absence helps identify low-risk patients.
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Affiliation(s)
- Tze Lui Koh
- Department of Radiation Oncology, Olivia Newton-John Cancer Wellness and Research Centre, Austin Health, Heidelberg, Victoria, Australia
| | - Emmanuel Canet
- Medical ICU, Hôtel-Dieu, University Hospital, Nantes, Loire-Atlantique, France
| | - Sobia Amjad
- University of Melbourne, Parkville, Victoria, Australia
| | | | - David Taylor
- University of Melbourne, Parkville, Victoria, Australia.,Emergency Department, Austin Health, Heidelberg, Victoria, Australia
| | - Hui K Gan
- Medical Oncology, Olivia Newton-John Cancer Wellness and Research Centre, Austin Health, Heidelberg, Victoria, Australia.,La Trobe University School of Cancer Medicine, Heidelberg, Victoria, Australia.,Department of Medicine, University of Melbourne, Heidelberg, Victoria, Australia
| | - Nada Marhoon
- Medical Oncology, Olivia Newton-John Cancer Wellness and Research Centre, Austin Health, Heidelberg, Victoria, Australia
| | - Andrew Lim
- Medical Oncology, Olivia Newton-John Cancer Wellness and Research Centre, Austin Health, Heidelberg, Victoria, Australia
| | - Wee Loon Ong
- Department of Radiation Oncology, Olivia Newton-John Cancer Wellness and Research Centre, Austin Health, Heidelberg, Victoria, Australia.,Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,Health and Biomedical Informatics Centre, University of Melbourne, Melbourne, Victoria, Australia.,School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | | | - Richard Khor
- Department of Radiation Oncology, Olivia Newton-John Cancer Wellness and Research Centre, Austin Health, Heidelberg, Victoria, Australia
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Krishnan V, Thanigaiarasu L, Overzier M, Aartsma-Rus A, Bogdanik L, Lutz C, Larcher T, Guiner CL, Grounds M. DMD – BIOMARKERS & OUTCOME MEASURES. Neuromuscul Disord 2020. [DOI: 10.1016/j.nmd.2020.08.125] [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: 11/27/2022]
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21
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Mohandass A, Krishnan V, Gribkova ED, Asuthkar S, Baskaran P, Nersesyan Y, Hussain Z, Wise LM, George RE, Stokes N, Alexander BM, Cohen AM, Pavlov EV, Llano DA, Zhu MX, Thyagarajan B, Zakharian E. TRPM8 as the rapid testosterone signaling receptor: Implications in the regulation of dimorphic sexual and social behaviors. FASEB J 2020; 34:10887-10906. [PMID: 32609392 PMCID: PMC7496617 DOI: 10.1096/fj.202000794r] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Revised: 05/20/2020] [Accepted: 06/08/2020] [Indexed: 01/19/2023]
Abstract
Testosterone regulates dimorphic sexual behaviors in all vertebrates. However, the molecular mechanism underlying these behaviors remains unclear. Here, we report that a newly identified rapid testosterone signaling receptor, Transient Receptor Potential Melastatin 8 (TRPM8), regulates dimorphic sexual and social behaviors in mice. We found that, along with higher steroid levels in the circulation, TRPM8-/- male mice exhibit increased mounting frequency indiscriminate of sex, delayed sexual satiety, and increased aggression compared to wild-type controls, while TRPM8-/- females display an increased olfaction-exploratory behavior. Furthermore, neuronal responses to acute testosterone application onto the amygdala were attenuated in TRPM8-/- males but remained unchanged in females. Moreover, activation of dopaminergic neurons in the ventral tegmental area following mating was impaired in TRPM8-/- males. Together, these results demonstrate that TRPM8 regulates dimorphic sexual and social behaviors, and potentially constitutes a signalosome for mediation of sex-reward mechanism in males. Thus, deficiency of TRPM8 might lead to a delayed sexual satiety phenomenon.
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Affiliation(s)
- Adithya Mohandass
- College of Health Sciences, School of Pharmacy, University of Wyoming, Laramie, WY, USA
| | - Vivek Krishnan
- College of Health Sciences, School of Pharmacy, University of Wyoming, Laramie, WY, USA
| | - Ekaterina D Gribkova
- Department of Molecular and Integrative Physiology, Neuroscience Program and Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana Champaign, Urbana, IL, USA
| | - Swapna Asuthkar
- Department of Cancer Biology and Pharmacology, University of Illinois College of Medicine, Peoria, IL, USA
| | - Padmamalini Baskaran
- College of Health Sciences, School of Pharmacy, University of Wyoming, Laramie, WY, USA
| | - Yelena Nersesyan
- Department of Cancer Biology and Pharmacology, University of Illinois College of Medicine, Peoria, IL, USA
| | - Zahir Hussain
- Department of Cancer Biology and Pharmacology, University of Illinois College of Medicine, Peoria, IL, USA.,Department of Physiology, Faculty of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Leslie M Wise
- Department of Cancer Biology and Pharmacology, University of Illinois College of Medicine, Peoria, IL, USA
| | - Robert E George
- Department of Cancer Biology and Pharmacology, University of Illinois College of Medicine, Peoria, IL, USA
| | - Nadarra Stokes
- Department of Cancer Biology and Pharmacology, University of Illinois College of Medicine, Peoria, IL, USA
| | | | - Alejandro M Cohen
- Biological Mass Spectrometry Core Facility, Life Sciences Research Institute, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Evgeny V Pavlov
- Department of Molecular Pathobiology, New York University College of Dentistry, New York, NY, USA
| | - Daniel A Llano
- Department of Molecular and Integrative Physiology, Neuroscience Program and Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana Champaign, Urbana, IL, USA
| | - Michael X Zhu
- Department of Integrative Biology and Pharmacology, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Baskaran Thyagarajan
- College of Health Sciences, School of Pharmacy, University of Wyoming, Laramie, WY, USA
| | - Eleonora Zakharian
- Department of Cancer Biology and Pharmacology, University of Illinois College of Medicine, Peoria, IL, USA
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Karmegaraj B, Vaidyanathan B, Krishnan V. Intra- and extraabdominal course of umbilical veins in a 4 vessel umbilical cord of a fetus with dextrotransposition of great vessels. Am J Obstet Gynecol 2020; 222:619-622. [PMID: 31765642 DOI: 10.1016/j.ajog.2019.11.1261] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 11/04/2019] [Indexed: 11/25/2022]
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Karmegaraj B, Deol SK, Krishnan V, Vaidyanathan B. Prenatal diagnosis of asplenia syndrome with sliding hiatus hernia in a fetus. Ann Pediatr Cardiol 2020; 13:167-170. [PMID: 32641894 PMCID: PMC7331833 DOI: 10.4103/apc.apc_34_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 06/05/2019] [Accepted: 12/05/2019] [Indexed: 11/04/2022] Open
Abstract
We report a case of right isomerism with a complex congenital heart disease associated with hiatus hernia in a 19-week-old fetus with relevant review of literature. This report highlights the importance of having a proper checklist for prenatal identification of extracardiac manifestations of isomerism syndromes. This will enable us to provide an effective family-centered counseling for perinatal management of these complex lesions. To our knowledge, prenatal sonographic detection of a sliding hiatal hernia in a fetus with right isomerism has not been reported previously.
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Affiliation(s)
- Balaganesh Karmegaraj
- Departmentof Fetal Cardiology, Amrita School of Medicine, Amrita Institute of Medical Sciences, Kochi, Kerala, India
| | - Satjeet Kaur Deol
- Department of Fetal Medicine, Amrita School of Medicine, Amrita Institute of Medical Sciences, Kochi, Kerala, India
| | - Vivek Krishnan
- Department of Fetal Medicine, Amrita School of Medicine, Amrita Institute of Medical Sciences, Kochi, Kerala, India
| | - Balu Vaidyanathan
- Departmentof Fetal Cardiology, Amrita School of Medicine, Amrita Institute of Medical Sciences, Kochi, Kerala, India
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Pratap S, Megta AK, Krishnan V. Sortases from a Probiotic Lactobacillus rhamnosus GG: Cloning, Expression, Purification, Crystallization and Preliminary X-Ray Diffraction Study. CRYSTALLOGR REP+ 2020. [DOI: 10.1134/s1063774519070162] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Krishnan V, Ali S, Thakore P, Johnson M, Yamasaki E, Trebak M, Earley S. STIM1 Maintains Stable Peripheral Coupling in Fully Differentiated Contractile Vascular Smooth Muscle Cells Independently of Ca2+ Store Depletion. Biophys J 2020. [DOI: 10.1016/j.bpj.2019.11.1842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Yamasaki E, Thakore P, Krishnan V, Earley S. Differential expression of angiotensin II type 1 receptor subtypes within the cerebral microvasculature. Am J Physiol Heart Circ Physiol 2020; 318:H461-H469. [PMID: 31886721 PMCID: PMC7052625 DOI: 10.1152/ajpheart.00582.2019] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 12/10/2019] [Accepted: 12/24/2019] [Indexed: 01/12/2023]
Abstract
Arteries and arterioles constrict in response to intraluminal pressure to generate myogenic tone, but the molecular nature of the vascular force-sensing mechanism is not fully characterized. Here, we investigated the role of angiotensin II type 1 receptors (AT1Rs) on vascular smooth muscle cells in the development of myogenic tone in cerebral parenchymal arterioles from mice. We found that pretreatment with the AT1R blocker losartan inhibited the development of myogenic tone in these vessels but did not alter the luminal diameter of arterioles with preestablished tone. Rodents express two AT1R isotypes: AT1Ra and AT1Rb. We previously demonstrated that AT1Rb is expressed at much higher levels compared with AT1Ra in cerebral pial arteries and is required for myogenic contractility in these vessels, whereas AT1Ra is unnecessary for this function. Here, we found that AT1Ra and AT1Rb are expressed at similar levels in parenchymal arterioles and that genetic knockout of AT1Ra blunted the ability of these vessels to generate myogenic tone. We also found that AT1Rb and total AT1R expression levels are much lower in parenchymal arterioles compared with pial arteries and that parenchymal arterioles are less sensitive to the vasoconstrictive effects of the endogenous AT1R ligand angiotensin II (ANG II). We conclude that 1) AT1Rs are critical for the initiation, but not the maintenance, of myogenic tone in parenchymal arterioles, and 2) lower levels of AT1Rb and total AT1R in parenchymal arterioles compared with pial arteries result in differences in myogenic and ANG II-induced vasoconstriction between these vascular segments.NEW & NOTEWORTHY Myogenic tone is critical for appropriate regulation of cerebral blood flow, but the mechanisms used by vascular smooth muscle cells to detect changes in intraluminal pressure are not fully characterized. Here, we demonstrate angiotensin II receptor type 1 (AT1R) is indispensable to initiation, but not maintenance, of myogenic tone in cerebral parenchymal arterioles. Furthermore, we demonstrate differences in AT1R expression levels lead to critical differences in contractile regulation between parenchymal arterioles and cerebral pial arteries.
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Affiliation(s)
- Evan Yamasaki
- Department of Pharmacology, Center for Molecular and Cellular Signaling in the Cardiovascular System, University of Nevada, Reno School of Medicine, Reno, Nevada
| | - Pratish Thakore
- Department of Pharmacology, Center for Molecular and Cellular Signaling in the Cardiovascular System, University of Nevada, Reno School of Medicine, Reno, Nevada
| | - Vivek Krishnan
- Department of Pharmacology, Center for Molecular and Cellular Signaling in the Cardiovascular System, University of Nevada, Reno School of Medicine, Reno, Nevada
| | - Scott Earley
- Department of Pharmacology, Center for Molecular and Cellular Signaling in the Cardiovascular System, University of Nevada, Reno School of Medicine, Reno, Nevada
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Krishnan V, Shenoy V, Sunny S, Thambiran R, Keezhattoor D, Namdeo S, K R. Defining critical antibody titre in column agglutination method to guide fetal surveillance. Transfus Apher Sci 2020; 59:102732. [PMID: 32147382 DOI: 10.1016/j.transci.2020.102732] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 12/24/2019] [Accepted: 01/17/2020] [Indexed: 11/27/2022]
Abstract
INTRODUCTION A critical anti D antibody titre, defined for the conventional tube method of Indirect Coomb's test (ICT), when employed in the more sensitive column method could result in unnecessary referrals and frequent obstetric doppler scans. This study aimed to compare anti D titres by tube and column method in antenatal mothers, to assess their correlation with fetal anemia and to determine a critical titre for the column method. METHODS Forty six antenatal mothers with anti D antibody were included in the study. Antibody titration was performed by serial twofold dilution of serum by both column and tube method and were correlated with middle cerebral artery peak systolic velocity (MCA PSV) measurement by Doppler ultrasonography. Receiver operating curve (ROC) was used to determine the cut-offs for critical titre by tube and column method in predicting fetal anemia. RESULTS Column method had a median titre 3 fold higher than tube method. There was a significant association between fetal anemia by USG with median critical titres determined for both column (p = 0.031) and tube method (p = 0.016). ROC analysis showed the cut off for critical titres in column method as 64 with 90 % sensitivity, 72.7 % specificity and 75.38 % accuracy. CONCLUSIONS The use of critical titre for anti D antibody, defined for the tube method, when applied to the column agglutination method would lead to increased referrals to specialized fetal medicine centres. Rather, an Anti D titre of 64 by column method can predict the likelihood of fetal anemia and should be considered as the critical titre to guide patient referrals.
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Affiliation(s)
- Vivek Krishnan
- Perinatology, Amrita Institute of Medical Sciences and Research Centre, Amrita Vishwa Vidyapeetham University, Cochin, Kerala, India
| | - Veena Shenoy
- Transfusion Medicine, Amrita Institute of Medical Sciences and Research Centre, Amrita Vishwa Vidyapeetham University, Cochin, Kerala, India.
| | - Shilna Sunny
- Transfusion Medicine, Amrita Institute of Medical Sciences and Research Centre, Amrita Vishwa Vidyapeetham University, Cochin, Kerala, India
| | - Ramanathan Thambiran
- Transfusion Medicine, Amrita Institute of Medical Sciences and Research Centre, Amrita Vishwa Vidyapeetham University, Cochin, Kerala, India
| | - Dhanya Keezhattoor
- Perinatology, Amrita Institute of Medical Sciences and Research Centre, Amrita Vishwa Vidyapeetham University, Cochin, Kerala, India
| | - Sushmita Namdeo
- Perinatology, Amrita Institute of Medical Sciences and Research Centre, Amrita Vishwa Vidyapeetham University, Cochin, Kerala, India
| | - Radhamany K
- Obstetrics &Gynecology, Amrita Institute of Medical Sciences and Research Centre, Amrita Vishwa Vidyapeetham University, Cochin, Kerala, India
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Da Silva-Candal A, Brown T, Krishnan V, Lopez-Loureiro I, Ávila-Gómez P, Pusuluri A, Pérez-Díaz A, Correa-Paz C, Hervella P, Castillo J, Mitragotri S, Campos F. Shape effect in active targeting of nanoparticles to inflamed cerebral endothelium under static and flow conditions. J Control Release 2019; 309:94-105. [DOI: 10.1016/j.jconrel.2019.07.026] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 07/16/2019] [Accepted: 07/18/2019] [Indexed: 12/21/2022]
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Mathews B, Namdeo S, Krishnan V. Prenatal Diagnosis of Aorta-Portal Vein-Umbilical Vein Anastomosis. J Med Ultrasound 2019; 27:165. [PMID: 31867186 PMCID: PMC6905268 DOI: 10.4103/jmu.jmu_105_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 02/11/2019] [Indexed: 12/03/2022] Open
Affiliation(s)
- Basil Mathews
- Department of Fetal Medicine and Perinatology, Amrita Institute of Medical Sciences, Ernakulam, Kerala, India
| | - Sushmita Namdeo
- Department of Fetal Medicine and Perinatology, Amrita Institute of Medical Sciences, Ernakulam, Kerala, India
| | - Vivek Krishnan
- Department of Fetal Medicine and Perinatology, Amrita Institute of Medical Sciences, Ernakulam, Kerala, India
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Mathews B, Namdeo S, Krishnan V. Prenatal Diagnosis of Aorta-Portal Vein-Umbilical Vein Anastomosis. J Med Ultrasound 2019; 27:215-216. [PMID: 31867200 PMCID: PMC6905248 DOI: 10.4103/jmu.jmu_8_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 02/11/2019] [Indexed: 11/05/2022] Open
Affiliation(s)
- Basil Mathews
- Department of Fetal Medicine and Perinatology, Amrita Institute of Medical Sciences, Ernakulam, Kerala, India
| | - Sushmita Namdeo
- Department of Fetal Medicine and Perinatology, Amrita Institute of Medical Sciences, Ernakulam, Kerala, India
| | - Vivek Krishnan
- Department of Fetal Medicine and Perinatology, Amrita Institute of Medical Sciences, Ernakulam, Kerala, India
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Ayad T, Stephenson K, A L Smit D, Ben-Ari O, Késmárszky R, Lechien JR, Sobol S, Meller C, Sargi Z, Maunsell R, De Siati RD, Jia H, Krishnan V, North H, Eter EG, Metwaly O, Peer S, Teissier N, Sowerby L, Hong P, Fakhry N. Young Otolaryngologists of International Federation of Oto-rhino-laryngological Societies (YO-IFOS) committees. Eur Ann Otorhinolaryngol Head Neck Dis 2018; 135:S61-S65. [PMID: 30174261 DOI: 10.1016/j.anorl.2018.08.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Revised: 08/07/2018] [Accepted: 08/08/2018] [Indexed: 11/30/2022]
Affiliation(s)
- T Ayad
- Centre Hospitalier de l'Université de Montréal, Montreal, Canada.
| | - K Stephenson
- Birmingham Children's Hospital, Birmingham, United Kingdom
| | - D A L Smit
- University Medical Centre Utrecht, Utrecht, The Netherlands
| | - O Ben-Ari
- Tel Aviv Sourasky Medical Center, affiliated to Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - J R Lechien
- Centre Hospitalier Universitaire de Bruxelles, Site Saint-Pierre, Bruxelles, Belgium
| | - S Sobol
- University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA
| | - C Meller
- Prince of Wales and Sydney Hospitals, Sydney, Australia
| | - Z Sargi
- Sylvester Comprehensive Cancer Center, University of Miami, Miami, Fl, USA
| | - R Maunsell
- Setor de Otorrinolaringologia Pediátrica, FCM-UNICAMP, Campinas, Brazil
| | - R D De Siati
- Université Catholique de Louvain, Cliniques Universitaires Saint Luc, Brussels, Belgium
| | - H Jia
- Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - V Krishnan
- Madras ENT Research Foundation, Raja Annamalaipuram, Chennai, India
| | - H North
- Westmead Hospital, Sydney, Australia
| | - E G Eter
- Saint joseph University, School of Medecine, Beirut, Lebanon
| | - O Metwaly
- Kasr Alainy School of Medicine, Cairo University, Cairo, Egypt
| | - S Peer
- Red Cross War Memorial Children's Hospital, Cape Town, South Africa
| | | | - L Sowerby
- St. Joseph's Healthcare, Western University, London, Canada
| | - P Hong
- IWK Health Centre, Division of Otolaryngology-Head and Neck Surgery, Dalhousie University, Halifax, Nova Scotia
| | - N Fakhry
- Hôpital de la Conception, Marseille, France
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Canet E, Taylor DM, Khor R, Krishnan V, Bellomo R. qSOFA as predictor of mortality and prolonged ICU admission in Emergency Department patients with suspected infection. J Crit Care 2018; 48:118-123. [PMID: 30176527 DOI: 10.1016/j.jcrc.2018.08.022] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [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: 05/28/2018] [Revised: 07/03/2018] [Accepted: 08/18/2018] [Indexed: 12/21/2022]
Abstract
PURPOSE We assessed the quick Sequential Organ Failure Assessment (qSOFA) score as a predictor of in-hospital mortality or prolonged ICU stay in Emergency Department (ED) patients with suspected infection. PATIENTS AND METHODS We measured qSOFA in a cohort of 11,205 ED patients with suspected infection. The primary outcome was in-hospital mortality and/or ICU stay ≥3 days. RESULTS The qSOFA score was positive in 2429 (21.7%) patients. In-hospital mortality, and in-hospital mortality or ICU stay ≥3 days were 12.8% and 17.2% respectively for qSOFA positive patients vs 2.2% and 4.2% for qSOFA negative patients (p < .0001). For the prediction of in-hospital mortality, a positive qSOFA had a positive predictive value (PPV) of 13% (95% CI, 11-14) and a negative predictive value (NPV) of 98% (95% CI, 97-98). For the prediction of in-hospital mortality or ICU stay ≥3 days, the PPV and NPV of a positive qSOFA were 17% (95% CI, 16-19) and 96 (95% CI, 95-96), respectively. CONCLUSION Among ED patients with suspected infection, a positive qSOFA identified those at much greater risk of mortality and longer ICU stay.
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Affiliation(s)
- Emmanuel Canet
- Department of Intensive Care, Austin Hospital, Heidelberg, Melbourne, Victoria, Australia; Data Analytics Research and Evaluation (DARE) Center, Melbourne University and Austin Hospital, Melbourne, Australia
| | - David McD Taylor
- Emergency Department, Austin Health, Heidelberg, Melbourne, Victoria, Australia; School of Medicine, The University of Melbourne, Parkville, Melbourne, Victoria, Australia
| | - Richard Khor
- Olivia Newton John Cancer Wellness and Research Centre, Austin Health, Department of Radiation Oncology, Melbourne, Victoria, Australia; Sir Peter MacCallum Department of Oncology, Melbourne University, Victoria, Australia
| | | | - Rinaldo Bellomo
- Department of Intensive Care, Austin Hospital, Heidelberg, Melbourne, Victoria, Australia; Data Analytics Research and Evaluation (DARE) Center, Melbourne University and Austin Hospital, Melbourne, Australia; School of Medicine, The University of Melbourne, Parkville, Melbourne, Victoria, Australia; Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
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Mageshwaran V, Sharma V, Chinnkar M, Parvez N, Krishnan V. Biodegradation of Gossypol by Mixed Fungal Cultures in Minimal Medium. APPL BIOCHEM MICRO+ 2018. [DOI: 10.1134/s0003683818030092] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Priya L, Vignesh V, Krishnan V, Ajeesh RP. Design and development of a smart knee pain relief pad based on vibration and alternate heating and cooling treatments. Technol Health Care 2018; 26:543-551. [PMID: 29630572 DOI: 10.3233/thc-181213] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Knee pain is one of the main health issues faced by different people in different parts of the world. Over one fourth of the people above the age of fifty suffer from knee pain. Though there are several physiotherapy treatments for treating knee pain they are not self-applicable and those which are self-applicable by the patient are not highly efficient. This paper deals with an approach towards the use of combining two effective physiotherapy treatments which include vibrations at acupressure points on knee and alternate heating and cooling treatments. These treatments are controlled by a smart phone in which the user can choose their setting depending on intensity and places of pain. The knee pad controlled using the smart phone serves as a self-applicable and effective knee pain treatment especially for the elderly. Heating and cooling combination therapy will be a suitable alternative for treatment of musculoskeletal diseases, decreases muscle spasms, muscular pain/tension and also increases the speed of nerve conduction, thus improving range of motion. This methodology also helps to relieve the sinusitis pain, chronic low back pain and muscular sprain in athletes.
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Krishnan V, Patel NJ, Mackrell JG, Sweetana SA, Bullock H, Ma YL, Waterhouse TH, Yaden BC, Henck J, Zeng QQ, Gavardinas K, Jadhav P, Saeed A, Garcia-Losada P, Robins DA, Benson CT. Development of a selective androgen receptor modulator for transdermal use in hypogonadal patients. Andrology 2018. [PMID: 29527831 DOI: 10.1111/andr.12479] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [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: 12/22/2022]
Abstract
We have identified a non-steroidal selective androgen receptor modulator (SARM), termed LY305, that is bioavailable through a transdermal route of administration while highly cleared via hepatic metabolism to limit parent compound exposure in the liver. Selection of this compound and its transdermal formulation was based on the optimization of skin absorption properties using both in vitro and in vivo skin models that supported PBPK modeling for human PK predictions. This molecule is an agonist in perineal muscle while being a weak partial agonist in the androgenic tissues such as prostate. When LY305 was tested in animal models of skeletal atrophy it restored the skeletal muscle mass through accelerated repair. In a bone fracture model, LY305 remained osteoprotective in the regenerating tissue and void of deleterious effects. Finally, in a small cohort of healthy volunteers, we assessed the safety and tolerability of LY305 when administered transdermally. LY305 showed a dose-dependent increase in serum exposure and was well tolerated with minimal adverse effects. Notably, there were no statistically significant changes to hematocrit or HDL after 4-week treatment period. Collectively, LY305 represents a first of its kind de novo development of a non-steroidal transdermal SARM with unique properties which could find clinical utility in hypogonadal men.
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Affiliation(s)
- V Krishnan
- Lilly Research Laboratories, Lilly Corporate Center, Indianapolis, IN, USA
| | - N J Patel
- Lilly Research Laboratories, Lilly Corporate Center, Indianapolis, IN, USA
| | - J G Mackrell
- Lilly Research Laboratories, Lilly Corporate Center, Indianapolis, IN, USA
| | - S A Sweetana
- Lilly Research Laboratories, Lilly Corporate Center, Indianapolis, IN, USA
| | - H Bullock
- Lilly Research Laboratories, Lilly Corporate Center, Indianapolis, IN, USA
| | - Y L Ma
- Lilly Research Laboratories, Lilly Corporate Center, Indianapolis, IN, USA
| | - T H Waterhouse
- Lilly Research Laboratories, Lilly Corporate Center, Indianapolis, IN, USA
| | - B C Yaden
- Lilly Research Laboratories, Lilly Corporate Center, Indianapolis, IN, USA
| | - J Henck
- Lilly Research Laboratories, Lilly Corporate Center, Indianapolis, IN, USA
| | - Q Q Zeng
- Lilly Research Laboratories, Lilly Corporate Center, Indianapolis, IN, USA
| | - K Gavardinas
- Lilly Research Laboratories, Lilly Corporate Center, Indianapolis, IN, USA
| | - P Jadhav
- Lilly Research Laboratories, Lilly Corporate Center, Indianapolis, IN, USA
| | - A Saeed
- Lilly Research Laboratories, Lilly Corporate Center, Indianapolis, IN, USA
| | - P Garcia-Losada
- Lilly Research Laboratories, Lilly Corporate Center, Indianapolis, IN, USA
| | - D A Robins
- Lilly Research Laboratories, Lilly Corporate Center, Indianapolis, IN, USA
| | - C T Benson
- Lilly Research Laboratories, Lilly Corporate Center, Indianapolis, IN, USA
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Demirkhanyan L, Krishnan V, Asuthkar S, Alexander B, Hussain Z, Baskaran P, Nersesyan Y, Cohen A, Pavlov E, Thyagarajan B, Zakharian E. TRPM8 Regulates Sexual Desire and Satiety. Biophys J 2018. [DOI: 10.1016/j.bpj.2017.11.3469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Karmegeraj B, Namdeo S, Sudhakar A, Krishnan V, Kunjukutty R, Vaidyanathan B. Clinical presentation, management, and postnatal outcomes of fetal tachyarrhythmias: A 10-year single-center experience. Ann Pediatr Cardiol 2018; 11:34-39. [PMID: 29440828 PMCID: PMC5803975 DOI: 10.4103/apc.apc_102_17] [Citation(s) in RCA: 5] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background Limited information is available regarding the prevalence and outcomes of fetal tachyarrhythmias from the developing countries. Aims This study aims to report referral patterns, management protocols, and pregnancy outcomes of fetuses with tachyarrhythmias reporting to a single center in South India. Methods All fetuses with documented sustained fetal tachyarrhythmia during the study period (2008-2017) were included. Arrhythmia characterization and hemodynamic evaluation were done using fetal echocardiography. Patients were grouped into supraventricular tachycardia (SVT) and atrial flutter (AF) groups. Patient characteristics, transplacental therapy (TPT), pregnancy, and postnatal outcomes were analyzed. Results Total of 19 fetuses included; 11 had SVT and 8 AF. Mean gestational age at referral was higher for AF (32.5 ± 3.2 vs. 29.6 ± 3.3 weeks; P = 0.05). Hydrops fetalis was present 8 (42%) fetuses; 4 in each group. TPT was instituted in 18 fetuses; 12 (66.7%) received combination therapy; 4 (21%) received direct fetal therapy. Eighteen fetuses (91%) were born alive with one intrauterine death in a fetus with SVT and severe hydrops. Seven (87.5%) fetuses with hydrops survived. Twelve patients (66.7%) were delivered in sinus rhythm. Six babies (33.3%) had tachycardia at birth requiring anti-arrhythmic therapy. All patients survived the neonatal period. Duration of trans-placental therapy (3.8 + 3.3 vs. 7.3 + 3.4 weeks) was shorter in the AF group. Conclusions Aggressive TPT using combination of drugs achieves excellent pregnancy and postnatal outcomes in fetuses with tachyarrhythmia. Early diagnosis and prompt referral before hemodynamic decompensation is critical for ensuring optimal outcomes.
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Affiliation(s)
- Balaganesh Karmegeraj
- Department of Pediatric Cardiology, Amrita School of Medicine, Amrita Institute of Medical Sciences, Kochi, Kerala, India
| | - Sushmita Namdeo
- Department of Fetal Medicine, Amrita School of Medicine, Amrita Institute of Medical Sciences, Kochi, Kerala, India
| | - Abish Sudhakar
- Department of Pediatric Cardiology, Amrita School of Medicine, Amrita Institute of Medical Sciences, Kochi, Kerala, India
| | - Vivek Krishnan
- Department of Fetal Medicine, Amrita School of Medicine, Amrita Institute of Medical Sciences, Kochi, Kerala, India
| | - Radhamany Kunjukutty
- Department of Obstetrics, Amrita School of Medicine, Amrita Institute of Medical Sciences, Kochi, Kerala, India
| | - Balu Vaidyanathan
- Department of Pediatric Cardiology, Amrita School of Medicine, Amrita Institute of Medical Sciences, Kochi, Kerala, India
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Bhasin S, Travison TG, O'Brien L, MacKrell J, Krishnan V, Ouyang H, Pencina K, Basaria S. Contributors to the substantial variation in on-treatment testosterone levels in men receiving transdermal testosterone gels in randomized trials. Andrology 2017; 6:151-157. [DOI: 10.1111/andr.12428] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Revised: 08/18/2017] [Accepted: 08/21/2017] [Indexed: 11/27/2022]
Affiliation(s)
- S. Bhasin
- Research Program in Men's Health: Aging and Metabolism; Boston Claude D. Pepper Older Americans Independence Center; Brigham and Women's Hospital; Harvard Medical School; Boston MA USA
| | - T. G. Travison
- Research Program in Men's Health: Aging and Metabolism; Boston Claude D. Pepper Older Americans Independence Center; Brigham and Women's Hospital; Harvard Medical School; Boston MA USA
| | - L. O'Brien
- Eli Lilly and Company; Indianapolis IN USA
| | | | | | - H. Ouyang
- Eli Lilly and Company; Indianapolis IN USA
| | - K. Pencina
- Research Program in Men's Health: Aging and Metabolism; Boston Claude D. Pepper Older Americans Independence Center; Brigham and Women's Hospital; Harvard Medical School; Boston MA USA
| | - S. Basaria
- Research Program in Men's Health: Aging and Metabolism; Boston Claude D. Pepper Older Americans Independence Center; Brigham and Women's Hospital; Harvard Medical School; Boston MA USA
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Mitra V, Hu M, Majumdar D, Krishnan V, Chaudhury B, Hancock J, Dwarakanath D. Safety and efficacy of self-expandable metal stents for obstructive proximal and distal large bowel cancer. J R Coll Physicians Edinb 2017; 47:30-34. [PMID: 28569279 DOI: 10.4997/jrcpe.2017.107] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Self-expandable metal stents are often used to treat obstructive large bowel cancers. This study assessed the safety and efficacy of colonic stent insertion carried out in a district general hospital. Methods A retrospective review was carried out between 1 January 2007 and 28 February 2014 to identify patients who underwent stent insertion for malignant colorectal obstruction. Results Seventy-five patients (median age 75.2 years, 70.6% male) with primary colorectal cancer underwent stent insertion - 53 underwent semi-elective self-expanded metal stent insertion (for subacute bowel obstruction) and 22 had emergency stent inserted (for acute bowel obstruction). The majority (88%) had self-expanded metal stents inserted for palliation. Technical and clinical success rates were 98.7% and 91.2%, respectively. One patient had stent-related perforation; there was no procedure-related mortality. Conclusion This study shows that self-expanded metal stent insertion in malignant colorectal obstruction is safe and effective and can be successfully delivered in a district general hospital with high technical and clinical success rates.
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Affiliation(s)
- V Mitra
- V Mitra, James Cook University Hospital, Marton Rd, Middlesbrough TS4 3BW, UK.
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Reddy NL, Kumar S, Krishnan V, Sathish M, Shankar M. Multifunctional Cu/Ag quantum dots on TiO 2 nanotubes as highly efficient photocatalysts for enhanced solar hydrogen evolution. J Catal 2017. [DOI: 10.1016/j.jcat.2017.02.032] [Citation(s) in RCA: 86] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Affiliation(s)
- V Krishnan
- Department of Orthodontics; Sri Sankara Dental College; Varkala Trivandrum Kerala India
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Thyagarajan B, Baskaran P, Krishnan V. Analysis of Role of TRPV1 in Exercise, Energy Intake and Obesity. Biophys J 2017. [DOI: 10.1016/j.bpj.2016.11.2211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Palacio L, Krishnan V, Le NLO, Sharpless NE, Beauséjour CM. Sustained p16 INK4a expression is required to prevent IR-induced tumorigenesis in mice. Oncogene 2016; 36:1309-1314. [PMID: 27568978 PMCID: PMC5336385 DOI: 10.1038/onc.2016.298] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Revised: 06/29/2016] [Accepted: 07/17/2016] [Indexed: 12/17/2022]
Abstract
Exposure of murine and human tissues to ionizing radiation (IR) induces the expression of p16INK4a, a tumor suppressor gene and senescence/aging biomarker. Increased p16INK4a expression is often delayed several weeks post exposure to IR. In this context, it remains unclear if it occurs to suppress aberrant cellular growth of potentially transformed cells or is simply a result of IR-induced loss of tissue homeostasis. To address this question, we used a conditional p16INK4a null mouse model and determined the impact of p16INK4a inactivation long-term post exposure to IR. We found that, in vitro, bone marrow stromal cells exposed to IR enter DNA replication following p16INK4a inactivation. However, these cells did not resume growth; instead, they mostly underwent cell cycle arrest in G2. Similarly, delayed inactivation of p16INK4a in mice several weeks post exposure to IR resulted in increased BrdU incorporation and cancer incidence. In fact, we found that the onset of tumorigenesis was similar whether p16INK4a was inactivated before or after exposure to IR. Overall, our results suggest that IR-induced p16INK4a dependent growth arrest is reversible in mice and that sustained p16INK4a expression is necessary to protect against tumorigenesis.
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Affiliation(s)
- L Palacio
- Centre de Recherche du Centre Hospitalier Universitaire Ste-Justine, Montréal, Canada.,Département de Pharmacologie, Université de Montréal, Montréal, Canada
| | - V Krishnan
- Centre de Recherche du Centre Hospitalier Universitaire Ste-Justine, Montréal, Canada.,Département de Pharmacologie, Université de Montréal, Montréal, Canada
| | - N L O Le
- Centre de Recherche du Centre Hospitalier Universitaire Ste-Justine, Montréal, Canada
| | - N E Sharpless
- Departments of Medicine and Genetics, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - C M Beauséjour
- Centre de Recherche du Centre Hospitalier Universitaire Ste-Justine, Montréal, Canada.,Département de Pharmacologie, Université de Montréal, Montréal, Canada
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Baskaran P, Krishnan V, Ren J, Thyagarajan B. Capsaicin induces browning of white adipose tissue and counters obesity by activating TRPV1 channel-dependent mechanisms. Br J Pharmacol 2016; 173:2369-89. [PMID: 27174467 DOI: 10.1111/bph.13514] [Citation(s) in RCA: 205] [Impact Index Per Article: 25.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Revised: 04/27/2016] [Accepted: 04/30/2016] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND AND PURPOSE The growing epidemic of obesity and metabolic diseases necessitates the development of novel strategies to prevent and treat such diseases. Current research suggests that browning of white adipose tissue (WAT) promotes energy expenditure to counter obesity. Recent research suggests that activation of the TRPV1 channels counters obesity. However, the mechanism by which activation of TRPV1 channels counters obesity still remains unclear. EXPERIMENTAL APPROACH We evaluated the effect of dietary capsaicin to induce a browning program in WAT by activating TRPV1 channels to prevent diet-induced obesity using wild-type and TRPV1(-/-) mouse models. We performed experiments using preadipocytes and fat pads from these mice. KEY RESULTS Capsaicin stimulated the expression of brown fat-specific thermogenic uncoupling protein-1 and bone morphogenetic protein-8b in WAT. Capsaicin triggered browning of WAT by promoting sirtuin-1 expression and activity via TRPV1 channel-dependent elevation of intracellular Ca(2) (+) and phosphorylation of Ca(2) (+) /calmodulin-activated protein kinase II and AMP-activated kinase. Capsaicin increased the expression of PPARγ 1 coactivator α and enhanced metabolic and ambulatory activity. Further, capsaicin stimulated sirtuin-1-dependent deacetylation of PPARγ and the transcription factor PRDM-16 and facilitated PPARγ-PRDM-16 interaction to induce browning of WAT. Dietary capsaicin did not protect TRPV1(-/-) mice from obesity. CONCLUSIONS AND INTERPRETATIONS Our results show for the first time that activation of TRPV1 channels by dietary capsaicin triggers browning of WAT to counteract obesity. Our results suggest that activation of TRPV1 channels is a promising strategy to counter obesity.
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Affiliation(s)
| | - Vivek Krishnan
- School of Pharmacy, University of Wyoming, Laramie, WY, USA
| | - Jun Ren
- School of Pharmacy, University of Wyoming, Laramie, WY, USA
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Krishnan V, Rinker-Schaeffer C, Dorigo O. Omental macrophages: Drivers of ovarian cancer metastatic colonization. Gynecol Oncol 2016. [DOI: 10.1016/j.ygyno.2016.04.197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Krishnan V, Thirunavukkarasu J. Assessment of Knowledge of Self Blood Glucose Monitoring and Extent of Self Titration of Anti-Diabetic Drugs among Diabetes Mellitus Patients - A Cross Sectional, Community Based Study. J Clin Diagn Res 2016; 10:FC09-11. [PMID: 27134888 DOI: 10.7860/jcdr/2016/18387.7396] [Citation(s) in RCA: 3] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Accepted: 01/27/2016] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Self blood glucose monitoring is an important context of self care in the management of diabetes mellitus. All the guidelines must be followed while performing self blood glucose monitoring and tracking of values is essential to facilitate the physician while titrating the drugs and /or doses of anti diabetes medication. Self titration by patients following self monitoring must be discouraged. AIM To assess the knowledge and practice of self blood glucose monitoring among diabetes patients and extent of self titration of anti diabetes medicines among diabetes patients based on self blood glucose monitoring. MATERIALS AND METHODS This pilot, cross-sectional, observational study was conducted using a validated questionnaire among adult male and female diabetes patients performing self blood glucose monitoring at home. Diabetes patients with complications and juvenile diabetes patients were excluded. RESULTS Out of 153 patients surveyed, only 37 (24.1%) (20 males, 17 females) patients were aware and have been following self blood glucose monitoring appropriately. About 116 (75.8%) (64 males, 52 females) of patients were devoid of adequate knowledge and did not practice self blood glucose monitoring in a proper way. Ninety eight (64.05%) accepted that they self titrate their anti diabetic medicines based on self monitoring. CONCLUSION Self monitoring of blood glucose should be encouraged and patients should be taught importance of following correct steps and tracking of self monitoring by physician or diabetes educator.
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Affiliation(s)
- V Krishnan
- Assistant Professor, Department of Pharmacology, Saveetha Medical College , Chennai, India
| | - J Thirunavukkarasu
- Professor, Department of Pharmacology, Saveetha Medical College , Chennai, India
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Reddy KL, Rai M, Prabhakar N, Arppe R, Rai SB, Singh SK, Rosenholm JM, Krishnan V. Controlled synthesis, bioimaging and toxicity assessments in strong red emitting Mn2+ doped NaYF4:Yb3+/Ho3+ nanophosphors. RSC Adv 2016. [DOI: 10.1039/c6ra07106f] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Rare earth, Yb3+/Ho3+ doped NaYF4 nanophosphors co-doped with Mn2+ showed enhanced red emission under NIR irradiation and were successfully used for cancer cell imaging.
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Affiliation(s)
- K. L. Reddy
- School of Basic Sciences and Advanced Materials Research Center
- Indian Institute of Technology Mandi
- Mandi
- India
| | - M. Rai
- Department of Physics
- Banaras Hindu University
- Varanasi
- India
| | - N. Prabhakar
- Pharmaceutical Sciences Laboratory
- Faculty of Sciences and Engineering
- Åbo Akademi University
- Turku
- Finland
| | - R. Arppe
- Department of Biotechnology
- University of Turku
- Turku
- Finland
| | - S. B. Rai
- Department of Physics
- Banaras Hindu University
- Varanasi
- India
| | - S. K. Singh
- Department of Physics
- Indian Institute of Technology (Banaras Hindu University)
- Varanasi
- India
| | - J. M. Rosenholm
- Pharmaceutical Sciences Laboratory
- Faculty of Sciences and Engineering
- Åbo Akademi University
- Turku
- Finland
| | - V. Krishnan
- School of Basic Sciences and Advanced Materials Research Center
- Indian Institute of Technology Mandi
- Mandi
- India
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Luke R, Khan SN, Iqbal PS, Soman RR, Chakkarayan J, Krishnan V. Estimation of Specific Salivary Enzymatic Biomarkers in Individuals with Gingivitis and Chronic Periodontitis: A Clinical and Biochemical Study. J Int Oral Health 2015; 7:54-7. [PMID: 26435618 PMCID: PMC4589720] [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: 11/09/2022] Open
Abstract
BACKGROUND Host response to periodontal disease includes the release of different enzymes from stromal, epithelial or inflammatory cells. The enzymes which are produced from these cells are associated with cell injury and cell death like: Aspartate aminotransferase (AST), Alanine aminotransferase (ALT), Alkaline phosphatase (ALP) and Blood urea nitrogen (BUN). Normal enzymatic activity of these enzymes is necessary for healthy functioning of gingiva and periodontium. The aim of the study is to estimate the levels of enzymes AST, ALT, ALP and BUN and to correlate the level of estimated enzymes with that of clinical parameters in the saliva of Healthy subjects, Gingivitis patients and patients with chronic periodontitis. METHODS The study included a total of 40 male subjects within the age group of 21 to 50 years, and examined the activity of enzymes AST, ALT, ALP and BUN in saliva spectrophotometrically and compared their values between healthy subjects, gingivitis and chronic periodontitis patients. Clinical parameters like OHI - S (Oral hygiene index - Simplified, SBI (Sulcus Bleeding Index), PPD (Probing Pocket Depth), CAL (Clinical Attachment Level), and PI (Periodontal Index) were recorded. RESULTS Obtained results showed statistically significant increases of activity of AST, ALT, ALP, and BUN in saliva from patients with periodontal disease (p<0.001) in relation to gingivitis and control groups. There was also an increase in periodontal parameters with an increase in salivary enzymes. CONCLUSION The present study shows that the salivary enzyme activity can be used as biomarkers to determine periodontal tissue damage, which may be useful in diagnosis, prognosis and evaluation of post therapy effects in periodontal disease.
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Affiliation(s)
- Roji Luke
- Assistant Professor, Department of Periodontics, Educare Institute of Dental Sciences, Kerala, India,Correspondence: Dr. Luke R. Mallel Bunglow, Kurumpakara P.O, Pathanamthitta- 691 523, Kerala, India. Phone: +91-9946199658.
| | - S Nubesh Khan
- Assistant Professor, Department of Periodontics, Sri Sankara Dental College, Varkala, Kerala, India
| | - P Safar Iqbal
- Assistant Professor, Department of Periodontics, Malabar Dental College, Edappal, Kerala, India
| | - Rino Roopak Soman
- Associate Professor, Department of Periodontics, Pushpagiri College of Dental Sciences, Thiruvalla, Kerala, India
| | - Jithesh Chakkarayan
- Assistant Professor, Department of Orthodontics, Kannur Dental College, Anjarakandy, Kannur, Kerala, India
| | - V Krishnan
- Professor, Department of Periodontics, Rajah Muthiah Dental College & Hospital, Chidambaram, Tamil Nadu, India
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Gilkey MJ, Krishnan V, Scheetz L, Jia X, Rajasekaran AK, Dhurjati PS. Physiologically Based Pharmacokinetic Modeling of Fluorescently Labeled Block Copolymer Nanoparticles for Controlled Drug Delivery in Leukemia Therapy. CPT Pharmacometrics Syst Pharmacol 2015. [PMID: 26225236 PMCID: PMC4394613 DOI: 10.1002/psp4.13] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
A physiologically based pharmacokinetic (PBPK) model was developed that describes the concentration and biodistribution of fluorescently labeled nanoparticles in mice used for the controlled delivery of dexamethasone in acute lymphoblastic leukemia (ALL) therapy. The simulated data showed initial spikes in nanoparticle concentration in the liver, spleen, and kidneys, whereas concentration in plasma decreased rapidly. These simulation results were consistent with previously published in vivo data. At shorter time scales, the simulated data predicted decrease of nanoparticles from plasma with concomitant increase in the liver, spleen, and kidneys before decaying at longer timepoints. Interestingly, the simulated data predicted an unaccounted accumulation of about 50% of the injected dose of nanoparticles. Incorporation of an additional compartment into the model justified the presence of unaccounted nanoparticles in this compartment. Our results suggest that the proposed PBPK model can be an excellent tool for prediction of optimal dose of nanoparticle-encapsulated drugs for cancer treatment.
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Affiliation(s)
- M J Gilkey
- Department of Chemical and Biomolecular Engineering, University of Delaware Newark, Delaware, USA
| | - V Krishnan
- Department of Materials Science and Engineering, University of Delaware Newark, Delaware, USA ; Nemours Biomedical Research, A I DuPont Hospital for Children Wilmington, Delaware, USA
| | - L Scheetz
- Department of Biomedical Engineering, University of Delaware Newark, Delaware, USA
| | - X Jia
- Department of Materials Science and Engineering, University of Delaware Newark, Delaware, USA ; Department of Biomedical Engineering, University of Delaware Newark, Delaware, USA ; Department of Biological Sciences, Center for Translational Cancer Research, University of Delaware Newark, Delaware, USA
| | - A K Rajasekaran
- Department of Materials Science and Engineering, University of Delaware Newark, Delaware, USA ; Department of Biological Sciences, Center for Translational Cancer Research, University of Delaware Newark, Delaware, USA ; Lankenau Institute for Medical Research Wynnewood, Pennsylvania, USA
| | - P S Dhurjati
- Department of Chemical and Biomolecular Engineering, University of Delaware Newark, Delaware, USA
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