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Chidambaram S, Anthony D, Jansen T, Vigo V, Fernandez Miranda JC. Intraoperative augmented reality fiber tractography complements cortical and subcortical mapping. World Neurosurg X 2023; 20:100226. [PMID: 37456694 PMCID: PMC10344792 DOI: 10.1016/j.wnsx.2023.100226] [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: 11/11/2022] [Accepted: 06/12/2023] [Indexed: 07/18/2023] Open
Abstract
Augmented reality (AR) has been found to be advantageous in enhancing visualization of complex neuroanatomy intraoperatively and in neurosurgical education. Another key tool that allows neurosurgeons to have enhanced visualization, namely of white matter tracts, is diffusion tensor imaging (DTI) that is processed with high-definition fiber tractography (HDFT). There remains an enduring challenge in the structural-functional correlation of white matter tracts that centers on the difficulty in clearly assigning function to any given fiber tract when evaluating them through separated as opposed to integrated modalities. Combining the technologies of AR with fiber tractography shows promise in helping to fill in this gap between structural-functional correlation of white matter tracts. This novel study demonstrates through a series of three cases of awake craniotomies for glioma resections a technique that allows the first and most direct evidence of fiber tract stimulation and assignment of function or deficit in vivo through the intraoperative, real-time fusion of electrical cortical stimulation, AR, and HDFT. This novel technique has qualitatively shown to be helpful in guiding intraoperative decision making on extent of resection of gliomas. Future studies could focus on larger, prospective cohorts of glioma patients who undergo this methodology and further correlate the post-operative imaging results to patient functional outcomes.
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Affiliation(s)
| | | | | | | | - Juan C. Fernandez Miranda
- Corresponding author. Department of Neurological Surgery, Stanford University, 213 Quarry Rd, Rm 2851MC 5957, Palo Alto, CA, 94304, USA.
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2
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Wallace W, Chan C, Chidambaram S, Hanna L, Iqbal F, Acharya A, Normahani P, Ashrafian H, Markar S, Sounderajah V, Darzi A. 471 Assessing the Accuracy and Bias of Digital Symptom Checkers with Myocardial Infarction Patients. Br J Surg 2022. [DOI: 10.1093/bjs/znac269.105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Abstract
Aim
The accuracy and safety of symptom checkers in diagnosing and triaging patients is of concern; especially those with life-threatening conditions. The study's aims were to: 1. assess the accuracy of symptom checkers in diagnosing and triaging myocardial infarctions (MI) and, 2. determine whether differences in gender or presentation type exist.
Method
This prospective diagnostic accuracy study assessed 8 symptom checkers using 100 MI patients of various presentations: typical or atypical. The ability of a symptom checker in providing MI as the first diagnosis (D1) and the first 3 (D3) diagnoses were diagnostic accuracy measures. Triage advice was deemed correct if the symptom checker recommended seeking emergency treatment.
Results
Symptom checkers correctly diagnosed 48.0±31.4% of cases with MI first. D3 accuracy was 72.6±20.2%. Mean triage accuracy was 82.6±12.6%.
24.0±16.2% of atypical cases had a correct primary diagnosis. D3 accuracy for atypical MI was 43.8±20.6%, significantly lower than that of typical MI (p<0.01). Atypical case triage accuracy was 52.7±20.0%, significantly lower than typical cases (84.2±14.7%, p<0.01).
10.0% of the atypical female cases were diagnosed correctly with MI as the first diagnosis. Female atypical cases had significantly lower accuracy than typical female cases for all accuracy measures (p<0.01).
Conclusions
Symptom checkers generally provide low accuracy for diagnosing MI. Approximately 20% of cases were under-triaged. Results varied between symptom checkers: patients who presented with atypical symptoms tended to be under-diagnosed and under-triaged, especially those who were female. This demonstrated potential gender bias and therefore raises questions regarding symptom checker regulation and safety.
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Affiliation(s)
- W Wallace
- Imperial College London , London , United Kingdom
| | - C Chan
- Imperial College London , London , United Kingdom
| | | | - L Hanna
- Imperial College London , London , United Kingdom
| | - F Iqbal
- Imperial College London , London , United Kingdom
| | - A Acharya
- Imperial College London , London , United Kingdom
| | - P Normahani
- Imperial College London , London , United Kingdom
| | - H Ashrafian
- Imperial College London , London , United Kingdom
| | - S Markar
- Karolinska Institutet , Stockholm , Sweden
- University of Oxford , Oxford , United Kingdom
| | | | - A Darzi
- Imperial College London , London , United Kingdom
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3
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Chidambaram S, Hong S, Simpson M, Osazuwa-Peters N, Ward G, Massa S. Temporal Trends in Oropharyngeal Cancer Incidence, Survival, and Cancer-Directed Surgery Among Elderly Americans. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2021.12.067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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4
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Mazul A, Chidambaram S, Massa S. Head and Neck Cancer Incidence and Trends Differ by Site, Race, and Sex. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2021.12.066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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5
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Van Den Heede K, Paspala A, Chander N, Chidambaram S, Wernig F, Todd JF, DiMarco AN, Palazzo FF. To block, or not to block … is it still the question? Effectiveness of alpha- and beta-blockade in phaeochromocytoma surgery: an institutional analysis. Ann R Coll Surg Engl 2022; 104:138-143. [PMID: 35100845 DOI: 10.1308/rcsann.2021.1077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023] Open
Abstract
INTRODUCTION Phaeochromocytomas/paraganglioma (PPGL) surgery was historically associated with significant risks of perioperative complications. The decreased mortality (<3.0%) had been attributed in part to optimal preoperative alpha-blockade. The value of alpha-blockade in decreasing morbidity is being challenged. The aim of our study is to present an institutional experience of preoperative alpha-blocking of PPGL and its effect on cardiovascular stability and postoperative morbidity. METHODS A retrospective study using data from our institutional database was conducted. All patients undergoing adrenalectomy for PPGL from October 2011 to September 2020 were included. All patients were routinely alpha-blocked. Intraoperative cardiovascular instability (ICI) was assessed through number of systolic blood pressure (SBP) episodes >160mmHg, SBP <90mmHg, the need for vasoactive drugs and volume of intraoperative crystalloids administered. Morbidity was also evaluated. RESULTS A total of 100 consecutive patients undergoing surgery were identified of whom 53 patients had complete anaesthetic records available for analysis. Thirty-two patients (60%) had at least one episode with an SBP >160mmHg. Nine (17%) cases had no intraoperative hypotensive episodes, while 3 (6%) patients had >10 intraoperative episodes of an SBP <90mmHg. Twenty-one (40%) patients received vasoactive drugs during surgery. The median volume of intraoperative crystalloids was 2 litres (1-4). Postoperatively, no patient experienced cardiovascular complications, including arrhythmia or myocardial ischaemia. Only two were admitted to an intensive care unit (ICU) and one 30-day readmission occurred. CONCLUSIONS Cardiac instability remained significant in PPGL surgery despite optimal alpha- and beta-blockade. While omitting blockade would appear empirically questionable, a randomised controlled trial (RCT) of surgery with and without alpha-blockade will provide an answer.
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Affiliation(s)
| | - A Paspala
- Attikon University Hospital National and Kapodistrian University of Athens, Greece
| | | | | | | | | | - A N DiMarco
- Hammersmith Hospital London, UK
- Imperial College London, UK
| | - F F Palazzo
- Hammersmith Hospital London, UK
- Imperial College London, UK
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6
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Panda B, Chidambaram S, Snow D, Malakar A, Singh DK, Ramanathan AL. Source apportionment and health risk assessment of nitrate in foothill aquifers of Western Ghats, South India. Ecotoxicol Environ Saf 2022; 229:113075. [PMID: 34923327 DOI: 10.1016/j.ecoenv.2021.113075] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Revised: 12/06/2021] [Accepted: 12/09/2021] [Indexed: 06/14/2023]
Abstract
The present research reports the level of nitrate (NO3-), associated health risks and possible sources of contamination in groundwater from south India. Many samples (32%) are above or approaching the recommended level of NO3- for safe drinking water. The correlation analysis indicates different sources of NO3- contamination in different regions rather than a common origin. The isotopic measurements provide information about potential nitrogen sources contributing NO3- to the groundwater. Based on isotope analysis, the sources of NO3- in the groundwater of this region are likely to be from (a) septic sewage (b) organic nitrogen (animal and livestock excreta) (c) sewage (domestic & chemical fertilizers). Among the sample analyzed sewage, manure and septic sewage contribute 46%, 23% and 31% NO3- to groundwater. The HQ > 1 indicates non-carcinogenic health risk due to consumption of high NO3- in drinking water. Among the studied age groups, infants are exposed to higher risk than children and adults. Results indicate that groundwater of this region is polluted with NO3- due to anthropogenic activities. Continuous consumption of such water may pose serious health risk to the residents.
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Affiliation(s)
| | | | - Daniel Snow
- University of Nebraska-Lincoln, United States
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7
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Guadix SW, Tao AJ, An A, Demetres M, Tosi U, Chidambaram S, Knisely JPS, Ramakrishna R, Pannullo SC. Assessing the long-term safety and efficacy of gamma knife and linear accelerator radiosurgery for vestibular schwannoma: A systematic review and meta-analysis. Neurooncol Pract 2021; 8:639-651. [PMID: 34777833 DOI: 10.1093/nop/npab052] [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: 11/15/2022] Open
Abstract
Background Differences in long-term outcomes of single-fraction stereotactic radiosurgery (SRS) between gamma knife (GK) and linear accelerator (LINAC) systems for vestibular schwannoma (VS) management remain unclear. To investigate differences in safety and efficacy between modalities, we conducted a meta-analysis of studies over the past decade. Methods MEDLINE, EMBASE, and Cochrane databases were queried for studies with the following inclusion criteria: English language, published between January 2010 and April 2020, cohort size ≥30, and mean/median follow-up ≥5 years. Odds ratios (OR) compared rates of tumor control, hearing preservation, and cranial nerve toxicities before and after SRS. Results Thirty-nine studies were included (29 GK, 10 LINAC) with 6516 total patients. Tumor control rates were 93% (95% CI 91-94%) and 94% (95% CI 91-97%) for GK and LINAC, respectively. Both GK (OR 0.06, 95% CI 0.02-0.13) and LINAC (OR 0.47, 95% CI 0.29-0.76) reduced odds of serviceable hearing. Neither GK (OR 0.71, 95% CI 0.41-1.22) nor LINAC (OR 1.13, 95% CI 0.64-2.00) impacted facial nerve function. GK decreased odds of trigeminal nerve (TN) impairment (OR 0.55, 95% CI 0.32-0.94) while LINAC did not impact TN function (OR 1.45, 95% CI 0.81-2.61). Lastly, LINAC offered decreased odds of tinnitus (OR 0.15, 95% CI 0.03-0.87) not observed with GK (OR 0.70, 95% CI 0.48-1.01). Conclusions VS tumor control and hearing preservation rates are comparable between GK and LINAC SRS. GK may better preserve TN function, while LINAC decreases tinnitus rates. Future studies are warranted to investigate the efficacy of GK and LINAC SRS more directly.
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Affiliation(s)
| | - Alice J Tao
- Weill Cornell Medical College, New York, New York, USA
| | - Anjile An
- Division of Biostatistics, Department of Population Health Sciences, Weill Cornell Medicine, New York, New York, USA
| | - Michelle Demetres
- Samuel J. Wood Library & C.V. Starr Biomedical Information Center, Weill Cornell Medicine, New York, New York, USA
| | - Umberto Tosi
- Department of Neurological Surgery, Weill Cornell Medicine, New York, New York, USA
| | - Swathi Chidambaram
- Department of Neurological Surgery, Weill Cornell Medicine, New York, New York, USA
| | - Jonathan P S Knisely
- Department of Radiation Oncology, Weill Cornell Medicine, New York, New York, USA
| | - Rohan Ramakrishna
- Department of Neurological Surgery, Weill Cornell Medicine, New York, New York, USA
| | - Susan C Pannullo
- Department of Neurological Surgery, Weill Cornell Medicine, New York, New York, USA
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8
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Van Den Heede K, Paspala A, Chander N, Chidambaram S, Wernig F, Todd JF, DiMarco AN, Palazzo FF. To block, or not to block … is it still the question? Effectiveness of alpha- and beta-blockade in phaeochromocytoma surgery: an institutional analysis. Ann R Coll Surg Engl 2021; 104:138-143. [PMID: 34582296 DOI: 10.1308/rcsann.2021.0133] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Phaeochromocytomas/paraganglioma (PPGL) surgery was historically associated with significant risks of perioperative complications. The decreased mortality (<3.0%) had been attributed in part to optimal preoperative alpha-blockade. The value of alpha-blockade in decreasing morbidity is being challenged. The aim of our study is to present an institutional experience of preoperative alpha-blocking of PPGL and its effect on cardiovascular stability and postoperative morbidity. METHODS A retrospective study using data from our institutional database was conducted. All patients undergoing adrenalectomy for PPGL from October 2011 to September 2020 were included. All patients were routinely alpha-blocked. Intraoperative cardiovascular instability (ICI) was assessed through number of systolic blood pressure (SBP) episodes >160mmHg, SBP <90mmHg, the need for vasoactive drugs and volume of intraoperative crystalloids administered. Morbidity was also evaluated. RESULTS A total of 100 consecutive patients undergoing surgery were identified of whom 53 patients had complete anaesthetic records available for analysis. Thirty-two patients (60%) had at least one episode with an SBP >160mmHg. Nine (17%) cases had no intraoperative hypotensive episodes, while 3 (6%) patients had >10 intraoperative episodes of an SBP <90mmHg. Twenty-one (40%) patients received vasoactive drugs during surgery. The median volume of intraoperative crystalloids was 2 litres (1-4). Postoperatively, no patient experienced cardiovascular complications, including arrhythmia or myocardial ischaemia. Only two were admitted to an intensive care unit (ICU) and one 30-day readmission occurred. CONCLUSIONS Cardiac instability remained significant in PPGL surgery despite optimal alpha- and beta-blockade. While omitting blockade would appear empirically questionable, a randomised controlled trial (RCT) of surgery with and without alpha-blockade will provide an answer.
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Affiliation(s)
| | - A Paspala
- Attikon University Hospital National and Kapodistrian University of Athens, Greece
| | | | | | | | | | - A N DiMarco
- Hammersmith Hospital London, UK.,Imperial College London, UK
| | - F F Palazzo
- Hammersmith Hospital London, UK.,Imperial College London, UK
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9
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Stifano V, Palumbo MC, Chidambaram S, Sturiale CL, Albanese A, Marchese E, Redaelli A, Pannullo SC, Olivi A. The use of Mixed Reality for the treatment planning of unruptured intracranial aneurysms. J Neurosurg Sci 2021:S0390-5616.21.05356-X. [PMID: 34342192 DOI: 10.23736/s0390-5616.21.05356-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND A thorough comprehension of topographic neuroanatomy is paramount in neurosurgery. In recent years, great attention has been raised towards extended reality, which comprises virtual, augmented, and mixed reality (MR) as an aid for surgery. In this paper, we describe our preliminary experience with the use of a new MR platform, aiming to assess its reliability and usefulness in the planning of surgical treatment of unruptured intracranial aneurysms. METHODS We prospectively enrolled 5 patients, harboring a total of 8 intracranial unruptured aneurysms, undergoing elective surgical clipping. A wearable mixed-reality device (HoloLens) was used to display and interact with a holographic model during surgical planning. Afterward, a total of 10 among surgeons and residents filled in a 5-point Likert-scale evaluation questionnaire. RESULTS According to the participants' feedback, the main MR platform advantages were considered the educational value, its utility during patients positioning and craniotomy planning, as well as the anatomical and imaging interpretation during surgery. The graphic performance was also deemed very satisfactory. On the other hand, the device was evaluated as not easy to use and pretty uncomfortable when worn for a long time. CONCLUSIONS We demonstrated that MR could play important role in planning the surgical treatment of intracranial aneurysms by enhancing the visualization and understanding of the patient-specific anatomy.
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Affiliation(s)
- Vito Stifano
- Institute of Neurosurgery, Catholic University of the Sacred Heart, Rome, Italy
| | - Maria C Palumbo
- Department of Electronics, Information and Bioengineering, Politecnico of Milan, Milan, Italy
| | - Swathi Chidambaram
- Department of Neurological Surgery, Weill Cornell Medical College, Cornell University, New York, NY, USA
| | - Carmelo L Sturiale
- Institute of Neurosurgery, Fondazione Policlinico A. Gemelli IRCCS, Rome, Italy -
| | - Alessio Albanese
- Institute of Neurosurgery, Catholic University of the Sacred Heart, Rome, Italy.,Institute of Neurosurgery, Fondazione Policlinico A. Gemelli IRCCS, Rome, Italy
| | - Enrico Marchese
- Institute of Neurosurgery, Catholic University of the Sacred Heart, Rome, Italy.,Institute of Neurosurgery, Fondazione Policlinico A. Gemelli IRCCS, Rome, Italy
| | - Alberto Redaelli
- Department of Electronics, Information and Bioengineering, Politecnico of Milan, Milan, Italy
| | - Susan C Pannullo
- Department of Neurological Surgery, Weill Cornell Medical College, Cornell University, New York, NY, USA.,Biomedical Engineering, College of Engineering, Cornell University, New York, NY, USA
| | - Alessandro Olivi
- Institute of Neurosurgery, Catholic University of the Sacred Heart, Rome, Italy.,Institute of Neurosurgery, Fondazione Policlinico A. Gemelli IRCCS, Rome, Italy
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10
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Chidambaram S, Stifano V, Demetres M, Teyssandier M, Palumbo MC, Redaelli A, Olivi A, Apuzzo MLJ, Pannullo SC. Applications of augmented reality in the neurosurgical operating room: A systematic review of the literature. J Clin Neurosci 2021; 91:43-61. [PMID: 34373059 DOI: 10.1016/j.jocn.2021.06.032] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [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: 12/14/2020] [Revised: 06/17/2021] [Accepted: 06/18/2021] [Indexed: 12/15/2022]
Abstract
Advancements in imaging techniques are key forces of progress in neurosurgery. The importance of accurate visualization of intraoperative anatomy cannot be overemphasized and is commonly delivered through traditional neuronavigation. Augmented Reality (AR) technology has been tested and applied widely in various neurosurgical subspecialties in intraoperative, clinical use and shows promise for the future. This systematic review of the literature explores the ways in which AR technology has been successfully brought into the operating room (OR) and incorporated into clinical practice. A comprehensive literature search was performed in the following databases from inception-April 2020: Ovid MEDLINE, Ovid EMBASE, and The Cochrane Library. Studies retrieved were then screened for eligibility against predefined inclusion/exclusion criteria. A total of 54 articles were included in this systematic review. The studies were sub- grouped into brain and spine subspecialties and analyzed for their incorporation of AR in the neurosurgical clinical setting. AR technology has the potential to greatly enhance intraoperative visualization and guidance in neurosurgery beyond the traditional neuronavigation systems. However, there are several key challenges to scaling the use of this technology and bringing it into standard operative practice including accurate and efficient brain segmentation of magnetic resonance imaging (MRI) scans, accounting for brain shift, reducing coregistration errors, and improving the AR device hardware. There is also an exciting potential for future work combining AR with multimodal imaging techniques and artificial intelligence to further enhance its impact in neurosurgery.
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Affiliation(s)
| | - Vito Stifano
- Department of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Institute of Neurosurgery, Catholic University, Rome, Italy
| | - Michelle Demetres
- Samuel J. Wood & C.V. Starr Biomedical Information Center, Weill Cornell Medical, College/New York Presbyterian Hospital, New York, NY, USA
| | | | - Maria Chiara Palumbo
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy
| | - Alberto Redaelli
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy
| | - Alessandro Olivi
- Department of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Institute of Neurosurgery, Catholic University, Rome, Italy
| | | | - Susan C Pannullo
- Department of Neurosurgery, Weill Cornell Medical College, NY, USA.
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11
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Van Den Heede K, Chidambaram S, Winter Beatty J, Chander N, Markar S, Tolley NS, Palazzo FF, Kinross JK, Di Marco AN. Correction to: The PanSurg-PREDICT Study: Endocrine Surgery During the COVID-19 Pandemic. World J Surg 2021; 45:2325. [PMID: 34036414 PMCID: PMC8147592 DOI: 10.1007/s00268-021-06171-8] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Affiliation(s)
- K Van Den Heede
- Department of Endocrine Surgery, Hammersmith Hospital, 72 Du Cane Rd, London, W12 0HS, UK.
| | - S Chidambaram
- Department of Surgery and Cancer, Imperial College, London, UK
| | - J Winter Beatty
- Department of Surgery and Cancer, Imperial College, London, UK
| | - N Chander
- Department of Endocrine Surgery, Hammersmith Hospital, 72 Du Cane Rd, London, W12 0HS, UK
| | - S Markar
- Department of Surgery and Cancer, Imperial College, London, UK
| | - N S Tolley
- Department of Endocrine Surgery, Hammersmith Hospital, 72 Du Cane Rd, London, W12 0HS, UK
- Department of Surgery and Cancer, Imperial College, London, UK
| | - F F Palazzo
- Department of Endocrine Surgery, Hammersmith Hospital, 72 Du Cane Rd, London, W12 0HS, UK
- Department of Surgery and Cancer, Imperial College, London, UK
| | - J K Kinross
- Department of Surgery and Cancer, Imperial College, London, UK
| | - A N Di Marco
- Department of Endocrine Surgery, Hammersmith Hospital, 72 Du Cane Rd, London, W12 0HS, UK
- Department of Surgery and Cancer, Imperial College, London, UK
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12
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Van Den Heede K, Chidambaram S, Winter Beatty J, Chander N, Markar S, Tolley NS, Palazzo FF, Kinross JK, Di Marco AN. The PanSurg-PREDICT Study: Endocrine Surgery During the COVID-19 Pandemic. World J Surg 2021; 45:2315-2324. [PMID: 33877392 PMCID: PMC8057006 DOI: 10.1007/s00268-021-06099-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/21/2021] [Indexed: 01/19/2023]
Abstract
Background In the midst of the COVID-19 pandemic, patients have continued to present with endocrine (surgical) pathology in an environment depleted of resources. This study investigated how the pandemic affected endocrine surgery practice. Methods PanSurg-PREDICT is an international, multicentre, prospective, observational cohort study of emergency and elective surgical patients in secondary/tertiary care during the pandemic. PREDICT-Endocrine collected endocrine-specific data alongside demographics, COVID-19 and outcome data from 11–3-2020 to 13–9-2020. Results A total of 380 endocrine surgery patients (19 centres, 12 countries) were analysed (224 thyroidectomies, 116 parathyroidectomies, 40 adrenalectomies). Ninety-seven percent were elective, and 63% needed surgery within 4 weeks. Eight percent were initially deferred but had surgery during the pandemic; less than 1% percent was deferred for more than 6 months. Decision-making was affected by capacity, COVID-19 status or the pandemic in 17%, 5% and 7% of cases. Indication was cancer/worrying lesion in 61% of thyroidectomies and 73% of adrenalectomies and calcium 2.80 mmol/l or greater in 50% of parathyroidectomies. COVID-19 status was unknown at presentation in 92% and remained unknown before surgery in 30%. Two-thirds were asked to self-isolate before surgery. There was one COVID-19-related ICU admission and no mortalities. Consultant-delivered care occurred in a majority (anaesthetist 96%, primary surgeon 76%). Post-operative vocal cord check was reported in only 14% of neck endocrine operations. Both of these observations are likely to reflect modification of practice due to the pandemic. Conclusion The COVID-19 pandemic has affected endocrine surgical decision-making, case mix and personnel delivering care. Significant variation was seen in COVID-19 risk mitigation measures. COVID-19-related complications were uncommon. This analysis demonstrates the safety of endocrine surgery during this pandemic. Supplementary Information The online version contains supplementary material available at 10.1007/s00268-021-06099-z.
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Affiliation(s)
- K Van Den Heede
- Department of Endocrine Surgery, Hammersmith Hospital, 72 Du Cane Rd, London, W12 0HS, UK.
| | - S Chidambaram
- Department of Surgery and Cancer, Imperial College, London, UK
| | - J Winter Beatty
- Department of Surgery and Cancer, Imperial College, London, UK
| | - N Chander
- Department of Endocrine Surgery, Hammersmith Hospital, 72 Du Cane Rd, London, W12 0HS, UK
| | - S Markar
- Department of Surgery and Cancer, Imperial College, London, UK
| | - N S Tolley
- Department of Endocrine Surgery, Hammersmith Hospital, 72 Du Cane Rd, London, W12 0HS, UK.,Department of Surgery and Cancer, Imperial College, London, UK
| | - F F Palazzo
- Department of Endocrine Surgery, Hammersmith Hospital, 72 Du Cane Rd, London, W12 0HS, UK.,Department of Surgery and Cancer, Imperial College, London, UK
| | - J K Kinross
- Department of Surgery and Cancer, Imperial College, London, UK
| | - A N Di Marco
- Department of Endocrine Surgery, Hammersmith Hospital, 72 Du Cane Rd, London, W12 0HS, UK.,Department of Surgery and Cancer, Imperial College, London, UK
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13
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Tosi U, Chidambaram S, Schwarz J, Diaz SM, Singh S, Norman S, Radwanski R, Murthy S, Apuzzo M, Schwartz TH, Pannullo SC. The World of Neurosurgery Reimagined Post COVID-19: Crisis ↔ Opportunities. World Neurosurg 2021; 148:251-255. [PMID: 33770847 DOI: 10.1016/j.wneu.2020.11.167] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 11/10/2020] [Indexed: 10/21/2022]
Abstract
The COVID-19 pandemic has impacted neurosurgery in unforeseeable ways. Neurosurgical patient care, research, and education have undergone extraordinary modifications as medicine and mankind have adapted to overcome the challenges posed by this pandemic. Some changes will disappear as the situation slowly recovers to a prepandemic status quo. Others will remain: This pandemic has sparked some long-overdue systemic transformations across all levels of medicine, including in neurosurgery, that will be beneficial in the future. In this paper, we present some of the challenges faced across different levels of neurosurgical clinical care, research, and education, the changes that followed, and how some of these modifications have transformed into opportunities for improvement and growth in the future.
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Affiliation(s)
- Umberto Tosi
- Department of Neurological Surgery, Weill Cornell Medicine, New York, New York, USA
| | - Swathi Chidambaram
- Department of Neurological Surgery, Weill Cornell Medicine, New York, New York, USA
| | - Justin Schwarz
- Department of Neurological Surgery, Weill Cornell Medicine, New York, New York, USA
| | | | - Sunidhi Singh
- Weill Cornell Medical College, New York, New York, USA
| | - Sofya Norman
- Weill Cornell Medical College, New York, New York, USA
| | - Ryan Radwanski
- Department of Neurological Surgery, Weill Cornell Medicine, New York, New York, USA; Weill Cornell Medical College, New York, New York, USA
| | - Santosh Murthy
- Department of Neurology, Weill Cornell Medicine, New York, New York, USA
| | - Michael Apuzzo
- Department of Neurological Surgery, Weill Cornell Medicine, New York, New York, USA
| | - Theodore H Schwartz
- Department of Neurological Surgery, Weill Cornell Medicine, New York, New York, USA
| | - Susan C Pannullo
- Department of Neurological Surgery, Weill Cornell Medicine, New York, New York, USA.
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Schmidt FA, Mullally M, Lohmann M, Hiepe P, Kirnaz S, Chidambaram S, Wipplinger C, Härtl R. Elastic Image Fusion Software to Coregister Preoperatively Planned Pedicle Screws With Intraoperative Computed Tomography Data for Image-Guided Spinal Surgery. Int J Spine Surg 2021; 15:295-301. [PMID: 33900987 DOI: 10.14444/8039] [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] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND For complex spinal cases, especially when robotic guidance is used, preoperative planning of pedicle screws can be helpful. Transfer of these preoperatively planned pedicle screws to intraoperative 3-dimensional imaging is challenging because of changes in anatomic alignment between preoperative supine and intraoperative prone imaging, especially when multiple levels are involved. In the spine, where each individual vertebra is subject to independent movement from adjacent level, rigid image fusion is confined to a single vertebra and can display fusion inaccuracies on adjacent levels. A novel elastic fusion algorithm is introduced to overcome these disadvantages. This study aimed to investigate image registration accuracy of preoperatively planned pedicle screws with an elastic fusion algorithm vs. rigid fusion for intraoperative placement with image-guided surgery. METHODS A total of 12 patients, were selected depending on the availability of a preoperative spinal computed tomography (CT) and an intraoperative AIRO CT scan (BrainLAB AG, Munich, Germany) of the same spinal region. To verify accuracy differences between rigid fusion and elastic fusion 76 bilateral screw trajectories were virtually defined in the preoperative CT image, and they were transferred via either rigid fusion or elastic fusion to the intraoperative CT scan. Accuracy of the transferred screws in the rigid and elastic fusion group was determined by measuring pedicle breaches on the intraoperative CT. RESULTS In the rigid fusion group 1.3% of screws showed a breach of less than 2 mm, 9.2% showed breaches between 2 and 4 mm, and 18.4% of the screws showed an error above 4 mm. The elastic fusion group showed no breaches and provided high accuracy between preoperative and intraoperative screw placement. CONCLUSION Elastic fusion provides high registration accuracy and represents a considerable step towards efficiency and safety in CT-based image-guided surgery. LEVEL OF EVIDENCE 3.
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Affiliation(s)
- Franziska A Schmidt
- Weill Cornell Brain and Spine Center, Department of Neurological Surgery, Weill Cornell Medical College, New York Presbyterian Hospital, New York, New York
| | | | | | | | - Sertac Kirnaz
- Weill Cornell Brain and Spine Center, Department of Neurological Surgery, Weill Cornell Medical College, New York Presbyterian Hospital, New York, New York
| | - Swathi Chidambaram
- Weill Cornell Brain and Spine Center, Department of Neurological Surgery, Weill Cornell Medical College, New York Presbyterian Hospital, New York, New York
| | - Christoph Wipplinger
- Weill Cornell Brain and Spine Center, Department of Neurological Surgery, Weill Cornell Medical College, New York Presbyterian Hospital, New York, New York
| | - Roger Härtl
- Weill Cornell Brain and Spine Center, Department of Neurological Surgery, Weill Cornell Medical College, New York Presbyterian Hospital, New York, New York
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15
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Chidambaram S, Vasudevan MC, Pande A, Chidambaram S, Pannullo SC. Dr. Thanjavur Santhanakrishna Kanaka-A Pioneer and Neurosurgical Innovator. World Neurosurg 2021; 150:84-88. [PMID: 33757884 DOI: 10.1016/j.wneu.2021.03.079] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 03/13/2021] [Accepted: 03/15/2021] [Indexed: 11/15/2022]
Abstract
BACKGROUND Thanjavur Santhanakrishna Kanaka, M.B.B.S., M.S. (General Surgery), M.S. (Neurosurgery), Ph.D., and former Captain, Indian Army Medical Corps, was born on March 31, 1932. She became the first woman neurosurgeon in India and all of Asia. METHODS This manuscript was compiled through a combination of interviews and references to other articles and some of the published manuscripts of Dr. Kanaka and her colleagues. RESULTS Dr. Kanaka was a trailblazer for women in neurosurgery and a pioneer in functional and stereotactic neurosurgery. During her long and productive career, she authored dozens of articles reported in prestigious neurosurgical journals worldwide and helped inspire and train the next generations of neurosurgeons in India and abroad. Even after retirement, Dr. Kanaka continued to focus on serving the medical community through her Sri Santhanakrishna Padmavathi Health Care and Research Foundation in Chennai with the mission of serving underprivileged and senior citizens in the local community. In addition to her accomplishments as a practicing neurosurgeon, Dr. Kanaka's career was notable for her successful collaborations with biomedical engineers on medical device development using locally sourced materials and talent in India. CONCLUSIONS Through her innovative thinking, compassion for her patients, and unwavering resilience, Dr. Kanaka has continued to serve as an inspiration to all pursuing a career in academic medicine and neurosurgery.
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Affiliation(s)
- Swathi Chidambaram
- Graduate School of Business, Stanford University, Stanford, California, USA
| | - Madabushi C Vasudevan
- Postgraduate Institute of Neurological Surgery, Dr. A. Lakshmipathi Neurosurgical Centre, Voluntary Health Services Hospital, Chennai, India
| | - Anil Pande
- Postgraduate Institute of Neurological Surgery, Dr. A. Lakshmipathi Neurosurgical Centre, Voluntary Health Services Hospital, Chennai, India
| | | | - Susan C Pannullo
- Department of Neurological Surgery, Weill Cornell Medicine, New York, New York, USA; Department of Biomedical Engineering, College of Engineering, Cornell University, Ithaca, New York, USA.
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16
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Chidambaram S, Guadix SW, Kwon J, Tang J, Rivera A, Berkowitz A, Kalnicki S, Pannullo SC. Evidence-based practice of stereotactic radiosurgery: Outcomes from an educational course for neurosurgery and radiation oncology residents. Surg Neurol Int 2021; 12:77. [PMID: 33767881 PMCID: PMC7982098 DOI: 10.25259/sni_539_2020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Accepted: 02/13/2021] [Indexed: 11/25/2022] Open
Abstract
Background: As the field of brain and spine stereotactic radiosurgery (SRS) continues to grow, so will the need for a comprehensive evidence base. However, it is unclear to what degree trainees feel properly equipped to use SRS. We assess the perceptions and comfort level reported by neurosurgery and radiation oncology residents concerning the evidence-based practice of SRS. Methods: A continuing medical education (CME) course provided peer-reviewed updates regarding treatment with intracranial and spinal SRS. Presentations were given by neurosurgery and radiation oncology residents with mentorship by senior faculty. To gauge perceptions regarding SRS, attendees were surveyed. Responses before and after the course were analyzed using the Fisher’s exact test in R statistical software. Results: Participants reported the greatest knowledge improvements concerning data registries (P < 0.001) and clinical trials (P = 0.026). About 82% of all (n = 17) radiation oncology and neurosurgery residents either agreed or strongly agreed that a brain and spine SRS rotation would be beneficial in their training. However, only 47% agreed or strongly agreed that one was currently part of their training. In addition, knowledge gains in SRS indications (P = 0.084) and ability to seek collaboration with colleagues (P = 0.084) showed notable trends. Conclusion: There are clear knowledge gaps shared by potential future practitioners of SRS. Specifically, knowledge regarding SRS data registries, indications, and clinical trials offer potential areas for increased educational focus. Furthermore, the gap between enthusiasm for increased SRS training and the current availability of such training at medical institutions must be addressed.
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Affiliation(s)
- Swathi Chidambaram
- Department of Neurological Surgery, Weill Cornell Medicine, Bronx, New York, United States
| | - Sergio W Guadix
- Weill Cornell Medical College, Bronx, New York, United States
| | - John Kwon
- Weill Cornell Medical College, Bronx, New York, United States
| | - Justin Tang
- Department of Radiation Oncology, Albert Einstein College of Medicine, Bronx, New York, United States
| | - Amanda Rivera
- Department of Radiation Oncology, Albert Einstein College of Medicine, Bronx, New York, United States
| | - Aviva Berkowitz
- Department of Radiation Oncology, Albert Einstein College of Medicine, Bronx, New York, United States
| | - Shalom Kalnicki
- Department of Radiation Oncology, Albert Einstein College of Medicine, Bronx, New York, United States
| | - Susan C Pannullo
- Department of Neurological Surgery, Weill Cornell Medicine, Bronx, New York, United States
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17
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Vasudevan U, Gantayat RR, Chidambaram S, Prasanna MV, Venkatramanan S, Devaraj N, Nepolian M, Ganesh N. Microbial contamination and its associations with major ions in shallow groundwater along coastal Tamil Nadu. Environ Geochem Health 2021; 43:1069-1088. [PMID: 32940833 DOI: 10.1007/s10653-020-00712-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 08/31/2020] [Indexed: 06/11/2023]
Abstract
Microbes in groundwater play a key role in determining the drinking water quality of the water. The study aims to interpret the sources of microbes in groundwater and its relationship to geochemistry. The study was carried out by collecting groundwater samples and analyzed to obtain various cations and anions, where HCO3-, Cl- and NO3- found to be higher than permissible limits in few samples. Microbial analysis, like total coliform (TC), total viable counts (TVC), fecal coliforms (FC), Vibrio cholera (V. cholerae) and total Streptococci (T. streptococci) were analyzed, and the observations reveal that most of the samples were found to be above the permissible limits adopted by EU, BIS, WHO and USEPA standards. Correlation analysis shows good correlation between Mg2+-HCO3-, K+-NO3-, TVC- V. cholerae and T. streptococci-FC. Major ions like Mg+, K+, NO3, Ca2+ and PO4 along with TS and FC were identified to control the geochemical and microbial activities in the region. The magnesium hardness in the groundwater is inferred to influence the TVC and V. cholerae. The mixing of effluents from different sources reflected the association of Cl with TC. Population of microbes T. streptococci and FC was mainly associated with Ca and Cl content in groundwater, depicting the role of electron acceptors and donors. The sources of the microbial population were observed with respect to the land use pattern and the spatial distribution of hydrogeochemical factors in the region. The study inferred that highest microbial activity in the observed in the residential areas, cultivated regions and around the landfill sites due to the leaching of sewage water and fertilizers runoff into groundwater. The concentrations of ions and microbes were found to be above the permissible limits of drinking water quality standards. This may lead to the deterioration in the health of particular coastal region.
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Affiliation(s)
- U Vasudevan
- Department of Earth Sciences, Annamalai University, Annamalai Nagar, 608002, India
| | - Rakesh Roshan Gantayat
- Department of Applied Geology, Faculty of Engineering and Science, Curtin University Malaysia, CDT 250, 98009, Miri, Sarawak, Malaysia
| | - S Chidambaram
- Department of Earth Sciences, Annamalai University, Annamalai Nagar, 608002, India
- Water Research Centre, Kuwait Institute for Scientific Research, Safat, Kuwait
| | - M V Prasanna
- Department of Applied Geology, Faculty of Engineering and Science, Curtin University Malaysia, CDT 250, 98009, Miri, Sarawak, Malaysia
| | - S Venkatramanan
- Department for Management of Science and Technology Development, Ton Duc Thang University, Ho Chi Minh City, Vietnam.
- Faculty of Applied Sciences, Ton Duc Thang University, Ho Chi Minh City, Vietnam.
| | - N Devaraj
- Department of Earth Sciences, Annamalai University, Annamalai Nagar, 608002, India
| | - M Nepolian
- Department of Earth Sciences, Annamalai University, Annamalai Nagar, 608002, India
| | - N Ganesh
- Department of Earth Sciences, Annamalai University, Annamalai Nagar, 608002, India
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18
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Tay K, Chidambaram S, Sim LB, Lee KC. Burden of cardiovascular risk factors in stable HIV patients aged 50 years old and above. Int J Infect Dis 2020. [DOI: 10.1016/j.ijid.2020.09.742] [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: 10/22/2022] Open
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19
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Gani YM, Chidambaram S, Lee C, Leong C. Rhodococcus infection in HIV infected patients: Clinical presentation and diagnoses. Int J Infect Dis 2020. [DOI: 10.1016/j.ijid.2020.09.451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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20
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Chidambaram S, Macaluso D, Pannullo SC. Alopecia following cranial stereotactic radiosurgery: A comprehensive review of the literature. J Clin Neurosci 2020; 80:203-206. [PMID: 33099346 DOI: 10.1016/j.jocn.2020.08.020] [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: 07/25/2020] [Accepted: 08/16/2020] [Indexed: 11/17/2022]
Abstract
Alopecia is often an undesirable side effect for patients undergoing radiation treatment. Although prophylaxis has been studied for alopecia following radiotherapy and chemotherapy, little research has been done in preventing radiosurgery induced alopecia. Past studies have found that increasing the dose of radiation delivered increases the degree of alopecia by generating a late regenerative response by the hair follicles (HFs). Various studies showed that using hair sparing techniques such as IMRT, VMAT, and HS-WBRT decreases the amount of dose to the scalp, thereby reducing hair loss. It has also been found that the location of the scalp with the highest degree of alopecia is that which is closest to area of greatest dose overlap. Accordingly, preventing dose overlap with arcs or cerrobend blocks has been shown to decrease alopecia. It has also been reported that hair loss is found in the area closer to the contour arcs where the dose is highest. We have reviewed the existing data on the prevention and treatment of radiation-induced alopecia and have presented here a comprehensive review of the reported data and relevant clinical considerations relating to dose, location, and scalp surface area (SSA).
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Affiliation(s)
- Swathi Chidambaram
- Department of Neurological Surgery, Weill Cornell Medical College, New York, NY
| | | | - Susan C Pannullo
- Department of Neurological Surgery, Weill Cornell Medical College, New York, NY.
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21
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Senthilkumar S, Akila M, Chidambaram S, Manimekalai R. Optical, thermal and mechanical properties of a novel bio-organic chlorophyll-b of Ficus religiosa added nickel sulphate hexahydrate crystal for NLO applications. Chem Phys Lett 2020. [DOI: 10.1016/j.cplett.2020.137607] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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22
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Abstract
The COVID-19 pandemic is affecting all aspects of the healthcare ecosystem, including administration of stereotactic radiosurgery (SRS). The clinical and logistical challenges created by the COVID-19 public health crisis are clear, but the solutions to these issues are less readily apparent. The goal of this work is to use our experience at a large, academic medical center as a lens for interpreting the many looming issues specific to radiosurgery and its role in the treatment of brain and spine disorders. While the full impact of the pandemic remains to be seen, the aim of this paper is to provide a structural framework to optimize delivery of neurosurgically oriented radiosurgery with proposed clinical workflow strategies. Innovative solutions to the current pandemic crisis affecting the healthcare ecosystem will be driven by increased interdisciplinary and global dialogue.
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Affiliation(s)
- Susan C Pannullo
- Neurosurgery, NewYork-Presbyterian/Weill Cornell Medical Center, New York, USA
| | | | - Andrew Brandmaier
- Radiation Oncology, NewYork Presbyterian/Weill Cornell Medical Center, New York, USA
| | - Jonathan Knisely
- Radiation Oncology, NewYork Presbyterian/Weill Cornell Medical Center, New York, USA
| | - John R Adler
- Radiation Oncology, Stanford University Medical Center, Stanford, USA.,Department of Neurosurgery, Stanford University School of Medicine, Stanford, USA
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23
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Pannullo SC, Julie DAR, Chidambaram S, Balogun OD, Formenti SC, Apuzzo MLJ, Knisely JPS. Worldwide Access to Stereotactic Radiosurgery. World Neurosurg 2020; 130:608-614. [PMID: 31581410 DOI: 10.1016/j.wneu.2019.04.031] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 03/18/2019] [Accepted: 03/28/2019] [Indexed: 12/31/2022]
Abstract
Stereotactic radiosurgery is a safe and effective technology that can address a variety of neurosurgical conditions, but in many parts of the world, access remains an issue. Although the technology is increasingly available in the United States, Canada, Europe, and parts of Asia, poor access to central nervous system (CNS) imaging and inadequate treatment equipment in other parts of the world limit the availability of radiosurgery as a treatment option. In addition, epidemiologic data about cancer and CNS metastases in low-income countries are sparse and much less complete than in more developed countries, and the need for radiosurgery may be underestimated as a result. Current radiosurgical platforms can be expensive to install and require a substantial amount of personnel training for safe operation. Socioeconomic and political forces are relevant to limitations to and opportunities for improving access to care. Here we examine the current barriers to access and propose areas for future efforts to improve global availability of radiosurgery for neurosurgical conditions.
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Affiliation(s)
- Susan C Pannullo
- Department of Neurological Surgery, Weill Cornell Medicine, New York, New York, USA.
| | - Diana A R Julie
- Department of Radiation Oncology, Weill Cornell Medicine, New York, New York, USA
| | - Swathi Chidambaram
- Department of Neurological Surgery, Weill Cornell Medicine, New York, New York, USA
| | - Onyinye D Balogun
- Department of Radiation Oncology, Weill Cornell Medicine, New York, New York, USA
| | | | - Michael L J Apuzzo
- Department of Neurological Surgery, Weill Cornell Medicine, New York, New York, USA
| | - Jonathan P S Knisely
- Department of Radiation Oncology, Weill Cornell Medicine, New York, New York, USA
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24
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Chidambaram S, Swong K, Ander M, Nockels RP. Pseudohypoxic Brain Swelling After Uncomplicated Lumbar Decompression and Fusion for Spondylolisthesis. World Neurosurg 2019; 133:155-158. [PMID: 31493605 DOI: 10.1016/j.wneu.2019.07.228] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 07/30/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Pseudohypoxic brain swelling (PHBS), also known as postoperative intracranial hypotension-associated venous congestion, is a rare complication after neurosurgery characterized by rapid and often severe postoperative deterioration in consciousness and distinct imaging findings on brain magnetic resonance imaging. Imaging findings associated with PHBS include computed tomography and magnetic resonance imaging findings that resemble hypoxic changes and intracranial hypotensive changes in basal ganglia and thalamus, telencephalic, and infratentorial regions without notable changes in intracranial vasculature. CASE DESCRIPTION This report describes the case of an L4-5 microdiskectomy with posterior decompression and fusion complicated by clinical and radiographic findings resembling PHBS without a known intraoperative durotomy. CONCLUSIONS Spine surgeons should be alerted to the possibility that PHBS may occur in patients even after an operation without known durotomy or cerebrospinal fluid leakage and with spontaneous clinical resolution unrelated to suction drainage changes or epidural blood patches.
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Affiliation(s)
- Swathi Chidambaram
- Department of Neurological Surgery, Loyola University Medical Center, Maywood, Illinois, USA
| | - Kevin Swong
- Department of Neurological Surgery, Loyola University Medical Center, Maywood, Illinois, USA
| | - Michael Ander
- Department of Neurological Surgery, Loyola University Medical Center, Maywood, Illinois, USA
| | - Russel P Nockels
- Department of Neurological Surgery, Loyola University Medical Center, Maywood, Illinois, USA.
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25
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Chidambaram S, Pannullo SC, Roytman M, Pisapia DJ, Liechty B, Magge RS, Ramakrishna R, Stieg PE, Schwartz TH, Ivanidze J. Dynamic contrast-enhanced magnetic resonance imaging perfusion characteristics in meningiomas treated with resection and adjuvant radiosurgery. Neurosurg Focus 2019; 46:E10. [DOI: 10.3171/2019.3.focus1954] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 03/25/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVEThere is a need for advanced imaging biomarkers to improve radiation treatment planning and response assessment. T1-weighted dynamic contrast-enhanced perfusion MRI (DCE MRI) allows quantitative assessment of tissue perfusion and blood-brain barrier dysfunction and has entered clinical practice in the management of primary and secondary brain neoplasms. The authors sought to retrospectively investigate DCE MRI parameters in meningiomas treated with resection and adjuvant radiation therapy using volumetric segmentation.METHODSA retrospective review of more than 300 patients with meningiomas resected between January 2015 and December 2018 identified 14 eligible patients with 18 meningiomas who underwent resection and adjuvant radiotherapy. Patients were excluded if they did not undergo adjuvant radiation therapy or DCE MRI. Demographic and clinical characteristics were obtained and compared to DCE perfusion metrics, including mean plasma volume (vp), extracellular volume (ve), volume transfer constant (Ktrans), rate constant (kep), and wash-in rate of contrast into the tissue, which were derived from volumetric analysis of the enhancing volumes of interest.RESULTSThe mean patient age was 64 years (range 49–86 years), and 50% of patients (7/14) were female. The average tumor volume was 8.07 cm3 (range 0.21–27.89 cm3). The median Ki-67 in the cohort was 15%. When stratified by median Ki-67, patients with Ki-67 greater than 15% had lower median vp (0.02 vs 0.10, p = 0.002), and lower median wash-in rate (1.27 vs 4.08 sec−1, p = 0.04) than patients with Ki-67 of 15% or below. Logistic regression analysis demonstrated a statistically significant, moderate positive correlation between ve and time to progression (r = 0.49, p < 0.05). Furthermore, there was a moderate positive correlation between Ktrans and time to progression, which approached, but did not reach, statistical significance (r = 0.48, p = 0.05).CONCLUSIONSThis study demonstrates a potential role for DCE MRI in the preoperative characterization and stratification of meningiomas, laying the foundation for future prospective studies incorporating DCE as a biomarker in meningioma diagnosis and treatment planning.
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Affiliation(s)
| | | | - Michelle Roytman
- 2Radiology, Division of Neuroradiology, Division of Molecular Imaging and Therapeutics; and
| | | | | | - Rajiv S. Magge
- 4Weill Cornell Medicine, Cornell University, New York, New York
| | | | | | | | - Jana Ivanidze
- 2Radiology, Division of Neuroradiology, Division of Molecular Imaging and Therapeutics; and
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McCoy S, Tundo F, Chidambaram S, Baaj A. Clinical considerations for spinal surgery in the osteoporotic patient: A comprehensive review. Clin Neurol Neurosurg 2019; 180:40-47. [DOI: 10.1016/j.clineuro.2019.03.010] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 03/04/2019] [Accepted: 03/10/2019] [Indexed: 11/30/2022]
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27
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Chidambaram S, Pannullo SC, Schwartz TH, Wernicke AG. Reirradiation of Recurrent Brain Metastases: Where Do We Stand? World Neurosurg 2019; 125:156-163. [PMID: 30738931 DOI: 10.1016/j.wneu.2019.01.182] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Revised: 01/17/2019] [Accepted: 01/19/2019] [Indexed: 10/27/2022]
Abstract
Brain metastases occur in a large portion of patients with cancer. Although advances in radiotherapy have helped to improve survival, they have also raised questions regarding the best modality for retreatment in the context of recurrent disease. The spectrum of treatment options for recurrent intracranial metastatic disease after previous radiotherapy includes salvage stereotactic radiosurgery, whole brain radiotherapy, and brachytherapy. We have comprehensively reviewed the existing data on the efficacy and toxicity of the various reirradiation treatment modalities. We examined the key clinical considerations that guide patient selection, such as dose, tumor size, interval to retreatment, and local control and survival rates.
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Affiliation(s)
- Swathi Chidambaram
- Department of Neurosurgery, Weill Medical College of Cornell University, New York, New York, USA
| | - Susan C Pannullo
- Department of Neurosurgery, Weill Medical College of Cornell University, New York, New York, USA
| | - Theodore H Schwartz
- Department of Neurosurgery, Weill Medical College of Cornell University, New York, New York, USA
| | - A Gabriella Wernicke
- Department of Neurosurgery, Weill Medical College of Cornell University, New York, New York, USA; Department of Radiation Oncology, Weill Medical College of Cornell University, New York, New York, USA.
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Goh E, Chidambaram S, Erridge S, Ma S. Laparoscopic vs Open Hepatectomy for Hepatocellular Carcinoma in Patients with Cirrhosis: A Meta-Analysis of the Long-Term Survival Outcomes. Int J Surg 2018. [DOI: 10.1016/j.ijsu.2018.05.707] [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: 10/28/2022]
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29
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Prakash R, Srinivasamoorthy K, Gopinath S, Saravanan K, Vinnarasi F, Ponnumani G, Chidambaram S, Anandhan P. Radon isotope assessment of submarine groundwater discharge (SGD) in Coleroon River Estuary, Tamil Nadu, India. J Radioanal Nucl Chem 2018. [DOI: 10.1007/s10967-018-5877-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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30
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Kannan S, Chandran GJ, Balaram P, Chidambaram S, Nair MK. Potential Biological Markers for the Staging of Tumor Progression in Oral Mucosa: A Multivariate Analysis. Int J Biol Markers 2018; 11:67-76. [PMID: 8776606 DOI: 10.1177/172460089601100202] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A recent trend in cancer control programmes is the development of early detection strategies and chemoprevention of premalignant lesions. The present study evaluates the potential of selected markers in the biological staging of tumor progression in oral mucosa for better management of the disease. The expression patterns of various cytokeratin protein types such as 10/11, 13 & 16, 19, 18, 14 and pancytokeratin, involucrin, ras p21, epidermal growth factor (EGF) and its receptor (EGFR) were assessed immunohistochemically in various stages of tumor progression in oral mucosa. Statistical analyses such as the Kruskal-Wallis one-way ANOVA, Spearman's rank correlation and multiple regression analysis were carried out to see which proteins have a significant association with tumor progression in oral mucosa. Statistical analysis showed that the expression patterns of cytokeratin types 10/11, 14 and 19, involucrin and epidermal growth factor were significantly correlated with tumor progression in oral mucosa in both univariate and multivariate analysis. Thus the biological stage of a lesion can be calculated from the multiple regression equation derived for these proteins, which could be more useful in assessing the stage of tumor progression in oral mucosa than histopathological grading.
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Affiliation(s)
- S Kannan
- Division of Cancer Research, Regional Cancer Centre, Kerala, India
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Chidambaram S, Nepolian M, Ramanathan A, Sarathidasan J, Thilagavathi R, Thivya C, Prasanna M, Srinivasamoorthy K, Jacob N, Mohokar H. An attempt to identify and estimate the subsurface groundwater discharge in the south east coast of India. ACTA ACUST UNITED AC 2017. [DOI: 10.1016/j.ijsbe.2017.07.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Chidambaram S, Vasudevan MC, Nair MN, Joyce C, Germanwala AV. Impact of Operating Room Environment on Postoperative Central Nervous System Infection in a Resource-Limited Neurosurgical Center in South Asia. World Neurosurg 2017; 110:e239-e244. [PMID: 29104154 DOI: 10.1016/j.wneu.2017.10.142] [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] [Received: 06/28/2017] [Revised: 10/24/2017] [Accepted: 10/25/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND Postoperative central nervous system infections (PCNSIs) are serious complications following neurosurgical intervention. We previously investigated the incidence and causative pathogens of PCNSIs at a resource-limited, neurosurgical center in south Asia. This follow-up study was conducted to analyze differences in PCNSIs at the same institution following only one apparent change: the operating room air filtration system. METHODS This was a retrospective study of all neurosurgical cases performed between December 1, 2013, and March 31, 2016 at our center. Providers, patient demographic data, case types, perioperative care, rate of PCNSI, and rates of other complications were reviewed. These results were then compared with the findings of our previous study of neurosurgical cases between June 1, 2012, and June 30, 2013. RESULTS All 623 neurosurgical operative cases over the study period were reviewed. Four patients (0.6%) had a PCNSI, and no patients had a positive cerebrospinal fluid (CSF) culture. In the previous study, among 363 cases, 71 patients (19.6%) had a PCNSI and 7 (1.9%) had a positive CSF culture (all Gram-negative organisms). The differences in both parameters are statistically significant (P < 0.001). Between the 2 studies, there was no change in treatment providers, case types, case durations, antibiotic administration practices, and patient demographics. CONCLUSIONS The rates of PCNSI and positive CSF culture were significantly lower in our present cohort compared with the cohort in our previous study. The sole apparent change involves the air filtration system inside the neurosurgical operating rooms; this environmental change occurred during the 5 months between the 2 studies. This study demonstrates the impact of environmental factors in reducing infections.
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Affiliation(s)
- Swathi Chidambaram
- Department of Neurosurgery, Loyola University Medical Center, Maywood, Illinois, USA.
| | - Madabushi Chakravarthy Vasudevan
- Postgraduate Institute of Neurological Surgery, Dr. A. Lakshmipathi Neurosurgical Centre, Voluntary Health Services Hospital, Chennai, India
| | - Mani Nathan Nair
- Department of Neurosurgery, Georgetown University School of Medicine, Washington DC, USA
| | - Cara Joyce
- Department of Biostatistics, Loyola University Medical Center, Maywood, Illinois, USA
| | - Anand V Germanwala
- Department of Neurosurgery, Loyola University Medical Center, Maywood, Illinois, USA
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Thivya C, Chidambaram S, Thilagavathi R, Tirumalesh K, Nepolian M, Prasanna MV. Spatial and temporal variations of radon concentrations in groundwater of hard rock aquifers in Madurai district, India. J Radioanal Nucl Chem 2017. [DOI: 10.1007/s10967-017-5300-4] [Citation(s) in RCA: 7] [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: 11/28/2022]
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Panda B, Chidambaram S, Ganesh N. An attempt to understand the subsurface variation along the mountain front and riparian region through geophysics technique in South India. ACTA ACUST UNITED AC 2017. [DOI: 10.1007/s40808-017-0334-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [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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Chidambaram S, DeShields T, Potter P, Olsen S, Chen L. Patient and provider concordance on symptoms during the oncology outpatient clinic visit. J Community Support Oncol 2016; 12:370-7. [PMID: 25853259 DOI: 10.12788/jcso.0080] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/07/2014] [Indexed: 11/20/2022]
Abstract
BACKGROUND Cancer patients experience multiple symptoms, with specific symptoms varying by cancer type. Problems in communication between patients and health care providers (HCPs) can interfere with effective symptom assessment and management. OBJECTIVE To address gaps in previous research by prospectively examining concordance between HCPs and patients on identifying patients' symptoms by using an identical tool for patients and HCPs at the time of the oncology clinic visit. METHODS 94 patients completed measures of symptom experience and medical comorbidities before seeing their oncology medical team. HCPs were informed of a patient's participation in the study before seeing the patient in clinic. Immediately after the clinic visit, HCPs completed a symptom survey in which they noted the patient's symptoms. RESULTS Patients reported more symptoms than the HCPs endorsed. The highest level of concordance for any symptom fell in the moderate agreement range. Kappa values reflecting concordance between patients and HCPs were not significantly different between the various patient-HCP pairs. No demographic or clinical variables for patients were found to be statistically related to the level of agreement on patients' symptoms. LIMITATIONS The use of a small convenience sample size drawn from 3 specialty oncology outpatient clinics may limit the generalizability of the results to other types of cancer. The distribution of cancer stage was weighted toward stages III and IV, likely contributing to the number of symptoms. CONCLUSIONS The level of agreement between HCPs and oncology patients on patient symptoms is weak. Concordance levels were similar, regardless of the type of HCP.
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Affiliation(s)
| | - Teresa DeShields
- Siteman Cancer Center, Barnes-Jewish Hospital, and Washington University School of Medicine, St. Louis, Missouri, USA.
| | | | - Sarah Olsen
- Barnes-Jewish Hospital, St. Louis, Missouri, USA
| | - Ling Chen
- Washington University School of Medicine, St. Louis, Missouri, USA
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Jagadeeshan S, Subramanian A, Tentu S, Beesetti S, Singhal M, Raghavan S, Surabhi RP, Mavuluri J, Bhoopalan H, Biswal J, Pitani RS, Chidambaram S, Sundaram S, Malathi R, Jeyaraman J, Nair AS, Venkatraman G, Rayala SK. P21-activated kinase 1 (Pak1) signaling influences therapeutic outcome in pancreatic cancer. Ann Oncol 2016; 27:1546-56. [PMID: 27117533 DOI: 10.1093/annonc/mdw184] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [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: 11/26/2015] [Accepted: 04/21/2016] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Therapeutic resistance to gemcitabine in pancreatic ductal adenocarcinoma (PDAC) is attributed to various cellular mechanisms and signaling molecules that influence as a single factor or in combination. DESIGN In this study, utilizing in vitro p21-activated kinase 1 (Pak1) overexpression and knockdown cell line models along with in vivo athymic mouse tumor xenograft models and clinical samples, we demonstrate that Pak1 is a crucial signaling kinase in gemcitabine resistance. RESULTS Pak1 kindles resistance via modulation of epithelial-mesenchymal transition and activation of pancreatic stellate cells. Our results from gemcitabine-resistant and -sensitive cell line models showed that elevated Pak1 kinase activity is required to confer gemcitabine resistance. This was substantiated by elevated levels of phosphorylated Pak1 and ribonucleotide reductase M1 levels in the majority of human PDAC tumors when compared with normal. Delineation of the signaling pathway revealed that Pak1 confers resistance to gemcitabine by preventing DNA damage, inhibiting apoptosis and regulating survival signals via NF-κB. Furthermore, we found that Pak1 is an upstream interacting substrate of transforming growth factor β-activated kinase 1-a molecule implicated in gemcitabine resistance. Molecular mechanistic studies revealed that gemcitabine docks with the active site of Pak1; furthermore, gemcitabine treatment induces Pak1 kinase activity both in vivo and in cell-free system. Finally, results from athymic mouse tumor models illustrated that Pak1 inhibition by IPA-3 enhances the cytotoxicity of gemcitabine and brings about pancreatic tumor regression. CONCLUSION To our knowledge, this is the first study illustrating the mechanistic role of Pak1 in causing gemcitabine resistance via multiple signaling crosstalks, and hence Pak1-specific inhibitors will prove to be a better adjuvant with existing chemotherapy modality for PDAC.
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Affiliation(s)
- S Jagadeeshan
- Department of Biotechnology, Indian Institute of Technology Madras (IITM), Chennai Department of Genetics, University of Madras, Chennai
| | - A Subramanian
- Department of Biotechnology, Indian Institute of Technology Madras (IITM), Chennai
| | - S Tentu
- Department of Biotechnology, Indian Institute of Technology Madras (IITM), Chennai
| | - S Beesetti
- Department of Biotechnology, Indian Institute of Technology Madras (IITM), Chennai
| | - M Singhal
- Department of Biotechnology, Indian Institute of Technology Madras (IITM), Chennai
| | - S Raghavan
- Department of Biotechnology, Indian Institute of Technology Madras (IITM), Chennai
| | | | - J Mavuluri
- Department of Biotechnology, Indian Institute of Technology Madras (IITM), Chennai
| | | | - J Biswal
- Department of Bioinformatics, Alagappa University, Karaikudi
| | | | | | - S Sundaram
- Department of Pathology, Sri Ramachandra University, Porur, Chennai
| | - R Malathi
- Department of Genetics, University of Madras, Chennai
| | - J Jeyaraman
- Department of Bioinformatics, Alagappa University, Karaikudi
| | - A S Nair
- Rajiv Gandhi Centre for Biotechnology (RGCB), Thiruvananthapuram, Kerala, India
| | | | - S K Rayala
- Department of Biotechnology, Indian Institute of Technology Madras (IITM), Chennai
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Adithya VS, Chidambaram S, Tirumalesh K, Thivya C, Thilagavathi R, Prasanna MV. Assessment of sources for higher Uranium concentration in ground waters of the Central Tamilnadu, India. ACTA ACUST UNITED AC 2016. [DOI: 10.1088/1757-899x/121/1/012009] [Citation(s) in RCA: 8] [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: 11/11/2022]
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Pradeep K, Nepolian M, Anandhan P, Chandran, Kaviyarasan R, Prasanna MV, Chidambaram S. A study on variation in dissolved silica concentration in groundwater of hard rock aquifers in Southeast coast of India. ACTA ACUST UNITED AC 2016. [DOI: 10.1088/1757-899x/121/1/012008] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Thivya C, Chidambaram S, Keesari T, Prasanna MV, Thilagavathi R, Adithya VS, Singaraja C. Lithological and hydrochemical controls on distribution and speciation of uranium in groundwaters of hard-rock granitic aquifers of Madurai District, Tamil Nadu (India). Environ Geochem Health 2016; 38:497-509. [PMID: 26104429 DOI: 10.1007/s10653-015-9735-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Accepted: 06/16/2015] [Indexed: 06/04/2023]
Abstract
Uranium is a radioactive element normally present in hexavalent form as U(VI) in solution and elevated levels in drinking water cause health hazards. Representative groundwater samples were collected from different litho-units in this region and were analyzed for total U and major and minor ions. Results indicate that the highest U concentration (113 µg l(-1)) was found in granitic terrains of this region and about 10 % of the samples exceed the permissible limit for drinking water. Among different species of U in aqueous media, carbonate complexes [UO2(CO3)(2)(2-)] are found to be dominant. Groundwater with higher U has higher pCO2 values, indicating weathering by bicarbonate ions resulting in preferential mobilization of U in groundwater. The major minerals uraninite and coffinite were found to be supersaturated and are likely to control the distribution of U in the study area. Nature of U in groundwater, the effects of lithology on hydrochemistry and factors controlling its distribution in hard rock aquifers of Madurai district are highlighted in this paper.
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Affiliation(s)
- C Thivya
- Department of Earth Sciences, Annamalai University, Annamalai Nagar, 608002, India
| | - S Chidambaram
- Department of Earth Sciences, Annamalai University, Annamalai Nagar, 608002, India
| | - Tirumalesh Keesari
- Isotope Production and Applications Division, Bhabha Atomic Research Centre, Mumbai, India
| | - M V Prasanna
- Department of Applied Geology, Faculty of Engineering and Science, Curtin University, CDT 250, 98009, Miri, Sarawak, Malaysia.
| | - R Thilagavathi
- Department of Earth Sciences, Annamalai University, Annamalai Nagar, 608002, India
| | - V S Adithya
- Department of Earth Sciences, Annamalai University, Annamalai Nagar, 608002, India
| | - C Singaraja
- Department of Earth Sciences, Annamalai University, Annamalai Nagar, 608002, India
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Fiandaca MS, Zhong X, Cheema AK, Orquiza MH, Chidambaram S, Tan MT, Gresenz CR, FitzGerald KT, Nalls MA, Singleton AB, Mapstone M, Federoff HJ. Plasma 24-metabolite Panel Predicts Preclinical Transition to Clinical Stages of Alzheimer's Disease. Front Neurol 2015; 6:237. [PMID: 26617567 PMCID: PMC4642213 DOI: 10.3389/fneur.2015.00237] [Citation(s) in RCA: 81] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Accepted: 10/26/2015] [Indexed: 11/13/2022] Open
Abstract
We recently documented plasma lipid dysregulation in preclinical late-onset Alzheimer's disease (LOAD). A 10 plasma lipid panel, predicted phenoconversion and provided 90% sensitivity and 85% specificity in differentiating an at-risk group from those that would remain cognitively intact. Despite these encouraging results, low positive predictive values limit the clinical usefulness of this panel as a screening tool in subjects aged 70-80 years or younger. In this report, we re-examine our metabolomic data, analyzing baseline plasma specimens from our group of phenoconverters (n = 28) and a matched set of cognitively normal subjects (n = 73), and discover and internally validate a panel of 24 plasma metabolites. The new panel provides a classifier with receiver operating characteristic area under the curve for the discovery and internal validation cohort of 1.0 and 0.995 (95% confidence intervals of 1.0-1.0, and 0.981-1.0), respectively. Twenty-two of the 24 metabolites were significantly dysregulated lipids. While positive and negative predictive values were improved compared to our 10-lipid panel, low positive predictive values provide a reality check on the utility of such biomarkers in this age group (or younger). Through inclusion of additional significantly dysregulated analyte species, our new biomarker panel provides greater accuracy in our cohort but remains limited by predictive power. Unfortunately, the novel metabolite panel alone may not provide improvement in counseling and management of at-risk individuals but may further improve selection of subjects for LOAD secondary prevention trials. We expect that external validation will remain challenging due to our stringent study design, especially compared with more diverse subject cohorts. We do anticipate, however, external validation of reduced plasma lipid species as a predictor of phenoconversion to either prodromal or manifest LOAD.
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Affiliation(s)
- Massimo S Fiandaca
- Department of Neurology, University of California Irvine , Irvine, CA , USA ; Department of Neurological Surgery, University of California Irvine , Irvine, CA , USA
| | - Xiaogang Zhong
- Department of Bioinformatics, Biostatistics and Biomathematics, Georgetown University Medical Center , Washington, DC , USA
| | - Amrita K Cheema
- Departments of Oncology and Biochemistry, Georgetown University Medical Center , Washington, DC , USA
| | - Michael H Orquiza
- Department of Neuroscience, Georgetown University Medical Center , Washington, DC , USA
| | - Swathi Chidambaram
- School of Medicine, Georgetown University Medical Center , Washington, DC , USA
| | - Ming T Tan
- Department of Bioinformatics, Biostatistics and Biomathematics, Georgetown University Medical Center , Washington, DC , USA
| | - Carole Roan Gresenz
- Department of Economics, Sociology and Statistics, RAND Corporation , Arlington, VA , USA
| | - Kevin T FitzGerald
- Pellegrino Center for Clinical Bioethics, Georgetown University Medical Center , Washington, DC , USA
| | - Mike A Nalls
- Laboratory of Neurogenetics, National Institute on Aging, National Institutes of Health , Bethesda, MD , USA
| | - Andrew B Singleton
- Laboratory of Neurogenetics, National Institute on Aging, National Institutes of Health , Bethesda, MD , USA
| | - Mark Mapstone
- Department of Neurology, University of California Irvine , Irvine, CA , USA
| | - Howard J Federoff
- Department of Neurology, University of California Irvine , Irvine, CA , USA
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Thivya C, Chidambaram S, Thilagavathi R, Prasanna MV, Singaraja C, Adithya VS, Nepolian M. A multivariate statistical approach to identify the spatio-temporal variation of geochemical process in a hard rock aquifer. Environ Monit Assess 2015; 187:552. [PMID: 26239570 DOI: 10.1007/s10661-015-4738-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/02/2014] [Accepted: 07/14/2015] [Indexed: 05/08/2023]
Abstract
A study has been carried out in crystalline hard rock aquifers of Madurai district, Tamil Nadu, to identify the spatial and temporal variations and to understand sources responsible for hydrogeochemical processes in the region. Totally, 216 samples were collected for four seasons [premonsoon (PRM), southwest monsoon (SWM), northeast monsoon (NWM), and postmonsoon (POM)]. The Na and K ions are attributed from weathering of feldspars in charnockite and fissile hornblende gneiss. The results also indicate that monsoon leaches the U ions in the groundwater and later it is reflected in the (222)Rn levels also. The statistical relationship on the temporal data reflects the fact that Ca, Mg, Na, Cl, HCO3, and SO4 form the spinal species, which are the chief ions playing the significant role in the geochemistry of the region. The factor loadings of the temporal data reveal the fact that the predominant factor is anthropogenic process and followed by natural weathering and U dissolution. The spatial analysis of the temporal data reveals that weathering is prominent in the NW part and that of distribution of U and (222)Rn along the NE part of the study area. This is also reflected in the cluster analysis, and it is understood that lithology, land use pattern, lineaments, and groundwater flow direction determine the spatial variation of these ions with respect to season.
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Affiliation(s)
- C Thivya
- Department of Earth Sciences, Annamalai University, Annamalai Nagar, 608002, India
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Ali SAM, Manoharan PS, Shekhawat KS, Deb S, Chidambaram S, Konchada J, Venugopal N, Vadivel H. Influence of Full Veneer Restoration on Fracture Resistance of Three Different Core Materials: An Invitro Study. J Clin Diagn Res 2015; 9:ZC12-5. [PMID: 26501004 DOI: 10.7860/jcdr/2015/12891.6440] [Citation(s) in RCA: 3] [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: 01/07/2015] [Accepted: 07/14/2015] [Indexed: 11/24/2022]
Abstract
AIMS AND OBJECTIVES One of the factor which affects the strength of the tooth restored with core material is the property of the material. In clinical situation all such restored teeth are protected by crowns. This study evaluated the strength of different core materials on a compromised tooth structure after restoration with a crown. MATERIALS AND METHODS Seventy extracted intact human premolars were collected and mounted within a mould using auto-polymerizing resin. The teeth were divided in-to four groups - A, B, C and D. Each group contained 20 teeth except group A with 10 teeth. All the teeth were prepared for full veneer cast crown. Except for the teeth in group: A) extensive class-I cavities were prepared in the teeth of all the groups and restored with; B) composite resin, 3M EPSE Filtek P60; C) Silver reinforced glass ionomer, SHOFU Hi Dense XP and; (D) Resin reinforced glass ionomer, GC Gold Label light cure GIC. All the teeth were restored with cast-metal alloy and exposed to 1.2 million cycles of cyclic loading in a chewing simulator. Subsequently, the teeth that survived were loaded till fracture in the universal testing machine. Fracture loads and type of fractures were recorded. RESULTS All the specimens survived cyclic loading. The mean fracture strength of the silver reinforced glass ionomer was greater with and without crown (p<0.001). Statistical analysis for the mean fracture load of each specimen showed significant difference between the groups. CONCLUSION Under the condition of this study, core materials when restored with artificial crown had a significant increase in fracture resistance.
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Affiliation(s)
- S A Mohamed Ali
- Assistant Professor, Department of Prosthodontics, Indira Gandhi institute of Dental Sciences , Pondicherry, India
| | - P S Manoharan
- Head and Professor, Department of Prosthodontics, Indira Gandhi institute of Dental Sciences , Pondicherry, India
| | - Kuldeep Singh Shekhawat
- Assistant Professor, Department of Community Dentistry, Indira Gandhi Institute of Dental Sciences , Pondicherry, India
| | - Saikat Deb
- Assistant Professor, Department of Prosthodontics, Mithila Minority Dental College and Hospital , Darbhanga, Bihar, India
| | - S Chidambaram
- Head and Professor, Department of Orthodontics, Ultra Dental College Tamil Nadu, India
| | - Jagadish Konchada
- Assistant Professor, Department of Prosthodontics, Sree Sai Dental College and Research Institue , Srikakulam, India
| | | | - Harish Vadivel
- Assistant Professor, Department of Dentistry, Menakshi ammal Medical College , Chennai, India
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Singaraja C, Chidambaram S, Jacob N, Selvam S, Johnsonbabu G, Anandhan P. Radon levels in groundwater in the Tuticorin district of Tamil Nadu, South India. J Radioanal Nucl Chem 2015. [DOI: 10.1007/s10967-015-4312-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [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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Felbaum D, Chidambaram S, Mason RB, Armonda RA, Liu AH. Vertebral-venous fistula: an unusual cause for ocular symptoms mimicking a carotid cavernous fistula. BMJ Case Rep 2015; 2015:bcr-2015-011796. [PMID: 26150625 DOI: 10.1136/bcr-2015-011796] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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: 11/04/2022] Open
Abstract
Vertebral-venous fistulas (VVF), or vertebral-vertebral arteriovenous fistulas, are an uncommon clinical entity. Typically, they present as a result of a direct vascular connection between an extracranial branch of the vertebral artery or its radicular components and the epidural venous plexus. These may manifest with signs and symptoms referable to cervical myelopathy secondary to compression or steal phenomenon. To our knowledge, this is the first case to identify a patient who presented with classic ocular symptoms attributable to a carotid cavernous fistula but secondary to a VVF. We present its treatment and clinical outcome. In addition, we present a brief literature review surrounding this uncommon disease.
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Affiliation(s)
- Daniel Felbaum
- Department of Neurosurgery, Medstar Georgetown University Hospital, Washington DC, USA
| | - Swathi Chidambaram
- Department of Neurosurgery, Medstar Georgetown University Hospital, Washington DC, USA
| | - Robert Bryan Mason
- Department of Neurosurgery, Medstar Washington Hospital Center, Washington DC, USA
| | - Rocco A Armonda
- Department of Neurosurgery, Medstar Washington Hospital Center, Washington DC, USA
| | - Ai Hsi Liu
- Department of Radiology, Medstar Washington Hospital Center, Washington DC, USA
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Chidambaram S, Prasad MBK, Prasanna MV, Manivannan R, Anandhan P. Evaluation of Metal Pollution in Groundwater in the Industrialized Environs in and Around Dindigul, Tamilnadu, India. ACTA ACUST UNITED AC 2014. [DOI: 10.1007/s12403-014-0150-6] [Citation(s) in RCA: 10] [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: 10/24/2022]
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Venkataramana V, Chidambaram S, Reddy BV, Goud EVSS, Arafath M, Krishnan6 S. Impact of Bisphosphonate on Orthodontic tooth movement and osteoclastic count: An Animal Study. J Int Oral Health 2014; 6:1-8. [PMID: 24876695 PMCID: PMC4037805] [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: 09/10/2013] [Accepted: 12/15/2013] [Indexed: 06/03/2023] Open
Abstract
Background : The aim of the current study is to examine the effect of systemically administered BP-Pamidronate, on Orthodontic Tooth Movement (OTM) along with osteoclastic quantification in New Zealand white rabbits. Materials & Methods : Twenty rabbits used in the study, were equally divided into 2 groups ; Group-1 as Control & Group-2 as Experimental. A sentalloy NITI closed coil spring (GAC International, USA) of 100 gram force, ligated between the lower first molar and the anterior most incisors of the rabbit has served as orthodontic force element. The BP- Pamidronate was administered at the dosage of 1.5 mg/kg body intra-peritonially, on the 1st, 7th and 14th day of the experiment. On the 21st day both group of animals were sacrificed, mandibles were dissected. The formed diastema between the 1st and 2nd molar was measured on the dissected mandibles using standard metric scale, which is considered as the OTM in the mesial direction. Next, the alveolar bone regions along with intact mesial surfaces were processed for histological investigation (osteoclastic count). Results : The student 't' test has been done to compare the mean values of molar tooth movement and osteoclastic count. Parameter :1 molar tooth movement has shown a significant difference between the control (3.750 ± 0.548 mm) and the experimental group (3.050 ± 0.556 mm) with calculated 'p' value (p-value <0.05) is significant at 0.0110 level. Parameter : 2 osteoclastic count has shown a significant difference between the control (13.335000 ± 0.735856 per square mm.) and the experimental group (11.426900 ± 1.49369 per square mm) calculated 'p' value (p-value <0.05) is significant at 0.003 level. Conclusion : The molar tooth movement and the osteoclastic count were significantly reduced in BP - Pamidronate administered animals than non-drug recipients. How to cite the article: Venkataramana V, Chidambaram S, Reddy BV, Goud EV, Arafath M, Krishnan S. Impact of Bisphosphonate on Orthodontic tooth movement and olsteoclastic count: An Animal Study. J Int Oral Health 2014;6(2):1-8.
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Affiliation(s)
- V Venkataramana
- Department of Orthodontics & Dento-facial Orthopaedics, Panineeya Mahavidhyalaya Institute of Dental Sciences, Kamalanagar, Dilshuknagar, Hyderabad, Andhra Pradesh, India
| | - S Chidambaram
- Department of Orthodontics & Dento-facial Orthopaedics, Rajah Muthiah College of Dental Sciences, Annamalai University, Chidambaram, Tamil Nadu, India
| | - B Vishnuvardhan Reddy
- Department of Orthodontics, G Pulla Reddy Dental College & Hospital, G Pulla Reddy Nagar, Kurnool, Andhra Pradesh, India
| | - E V Soma Shekara Goud
- Department of Oral & Maxillofacial Pathology, Chandra Dental College, Uttar Pradesh, India
| | - Mohammed Arafath
- Department of Orthodontics & Dentofacial Orthopedics, Rajah Muthiah College of Dental Sciences, Annamalai University, Chidambaram, Tamil Nadu, India
| | - Santhana Krishnan6
- Division of Orthodontics & Dento-facial Orthopedics, Rajah Muthiah College of Dental Sciences, Annamalai University, Chidambaram, Tamil Nadu, India
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Garcia Martin A, Fernandez Golfin C, Salido Tahoces L, Fernandez Santos S, Jimenez Nacher J, Moya Mur J, Velasco Valdazo E, Hernandez Antolin R, Zamorano Gomez J, Veronesi F, Corsi C, Caiani E, Lamberti C, Tsang W, Holmgren C, Guo X, Bateman M, Iaizzo P, Vannier M, Lang R, Patel A, Adamayn K, Tumasyan LR, Chilingaryan A, Nasr G, Eleraki A, Farouk N, Axelsson A, Langhoff L, Jensen M, Vejlstrup N, Iversen K, Bundgaard H, Watanabe T, Iwai-Takano M, Attenhofer Jost CH, Pfyffer M, Seifert B, Scharf C, Candinas R, Medeiros-Domingo A, Chin JY, Yoon H, Vollbon W, Singbal Y, Rhodes K, Wahi S, Katova TM, Simova II, Hristova K, Kostova V, Pauncheva B, Bircan A, Sade L, Eroglu S, Pirat B, Okyay K, Bal U, Muderrisoglu H, Heggemann F, Buggisch H, Welzel G, Doesch C, Hansmann J, Schoenberg S, Borggrefe M, Wenz F, Papavassiliu T, Lohr F, Roussin I, Drakopoulou M, Rosen S, Sharma R, Prasad S, Lyon A, Carpenter J, Senior R, Breithardt OA, Razavi H, Arya A, Nabutovsky Y, Ryu K, Gaspar T, Kosiuk J, Eitel C, Hindricks G, Piorkowski C, Pires S, Nunes A, Cortez-Dias N, Belo A, Zimbarra Cabrita I, Sousa C, Pinto F, Baron T, Johansson K, Flachskampf F, Christersson C, Pires S, Cortez-Dias N, Nunes A, Belo A, Zimbarra Cabrita I, Sousa C, Pinto F, Santoro A, Federico Alvino F, Giovanni Antonelli G, Raffaella De Vito R, Roberta Molle R, Sergio Mondillo S, Gustafsson M, Alehagen U, Johansson P, Tsukishiro Y, Onishi T, Chimura M, Yamada S, Taniguchi Y, Yasaka Y, Kawai H, Souza JRM, Zacharias LGT, Pithon KR, Ozahata TM, Cliquet AJ, Blotta MH, Nadruz WJ, Fabiani I, Conte L, Cuono C, Liga R, Giannini C, Barletta V, Nardi C, Delle Donne M, Palagi C, Di Bello V, Glaveckaite S, Valeviciene N, Palionis D, Laucevicius A, Hristova K, Bogdanova V, Ferferieva V, Shiue I, Castellon X, Boles U, Rakhit R, Shiu MF, Gilbert T, Papachristidis A, Henein MY, Westholm C, Johnson J, Jernberg T, Winter R, Ghosh Dastidar A, Augustine D, Cengarle M, Mcalindon E, Bucciarelli-Ducci C, Nightingale A, Onishi T, Watanabe T, Fujita M, Mizukami Y, Sakata Y, Nakatani S, Nanto S, Uematsu M, Saraste A, Luotolahti M, Varis A, Vasankari T, Tunturi S, Taittonen M, Rautakorpi P, Airaksinen J, Ukkonen H, Knuuti J, Boshchenko A, Vrublevsky A, Karpov R, Yoshikawa H, Suzuki M, Hashimoto G, Kusunose Y, Otsuka T, Nakamura M, Sugi K, Rosner S, Orban M, Lesevic H, Karl M, Hadamitzky M, Sonne C, Panaro A, Martinez F, Huguet M, Moral S, Palet J, Oller G, Cuso I, Jornet A, Rodriguez Palomares J, Evangelista A, Stoebe S, Tarr A, Pfeiffer D, Hagendorff A, Gilmanov D, Baroni M, Cerone E, Galli E, Berti S, Glauber M, Soesanto A, Yuniadi Y, Mansyur M, Kusmana D, Venkateshvaran A, Dash PK, Sola S, Govind SC, Shahgaldi K, Winter R, Brodin LA, Manouras A, Dokainish H, Sadreddini M, Nieuwlaat R, Lonn E, Healey J, Nguyen V, Cimadevilla C, Dreyfus J, Codogno I, Vahanian A, Messika-Zeitoun D, Lim YJ, Kawamura A, Kawano S, Polte C, Gao S, Lagerstrand K, Cederbom U, Bech-Hanssen O, Baum J, Beeres F, Van Hall S, Boering Y, Zeus T, Kehmeier E, Kelm M, Balzer J, Della Mattia A, Pinamonti B, Abate E, Nicolosi G, Proclemer A, Bassetti M, Luzzati R, Sinagra G, Hlubocka Z, Jiratova K, Dostalova G, Hlubocky J, Dohnalova A, Linhart A, Palecek T, Sonne C, Lesevic H, Karl M, Rosner S, Hadamitzky M, Ott I, Malev E, Reeva S, Zemtsovsky E, Igual Munoz B, Alonso Fernandez Pau P, Miro Palau Vicente V, Maceira Gonzalez Alicia A, Estornell Erill J, Andres La Huerta A, Donate Bertolin L, Valera Martinez F, Salvador Sanz Antonio A, Montero Argudo Anastasio A, Nemes A, Kalapos A, Domsik P, Chadaide S, Sepp R, Forster T, Onaindia J, Arana X, Cacicedo A, Velasco S, Rodriguez I, Capelastegui A, Sadaba M, Gonzalez J, Salcedo A, Laraudogoitia E, Archontakis S, Gatzoulis K, Vlasseros I, Arsenos P, Tsiachris D, Vouliotis A, Sideris S, Karistinos G, Kalikazaros I, Stefanadis C, Ancona R, Comenale Pinto S, Caso P, Coppola M, Arenga F, Cavallaro C, Vecchione F, D'onofrio A, Calabro R, Correia CE, Moreira D, Cabral C, Santos J, Cardoso J, Igual Munoz B, Maceira Gonzalez A, Estornell Erill Jordi J, Jimenez Carreno R, Arnau Vives M, Monmeneu Menadas J, Domingo-Valero D, Sanchez Fernandez E, Montero Argudo Anastasio A, Zorio Grima E, Cincin A, Tigen K, Karaahmet T, Dundar C, Sunbul M, Guler A, Bulut M, Basaran Y, Mordi I, Carrick D, Berry C, Tzemos N, Cruz I, Ferreira A, Rocha Lopes L, Joao I, Almeida A, Fazendas P, Cotrim C, Pereira H, Ochoa JP, Fernandez A, Filipuzzi J, Casabe J, Salmo J, Vaisbuj F, Ganum G, Di Nunzio H, Veron L, Guevara E, Salemi V, Nerbass F, Portilho N, Ferreira Filho J, Pedrosa R, Arteaga-Fernandez E, Mady C, Drager L, Lorenzi-Filho G, Marques J, Almeida AMG, Menezes M, Silva G, Placido R, Amaro C, Brito D, Diogo A, Lourenco MR, Azevedo O, Moutinho J, Nogueira I, Machado I, Portugues J, Quelhas I, Lourenco A, Calore C, Muraru D, Melacini P, Badano L, Mihaila S, Puma L, Peluso D, Casablanca S, Ortile A, Iliceto S, Kang MK, Yu S, Park J, Kim S, Park T, Mun HS, C S, Cho SR, Han S, Lee N, Khalifa EA, Hamodraka E, Kallistratos M, Zacharopoulou I, Kouremenos N, Mavropoulos D, Tsoukas A, Kontogiannis N, Papanikolaou N, Tsoukanas K, Manolis A, Villagraz Tecedor L, Jimenez Lopez Guarch C, Alonso Chaterina S, Blazquez Arrollo L, Lopez Melgar B, Veitia Sarmiento A, Mayordomo Gomez S, Escribano Subias M, Lichodziejewska B, Kurnicka K, Goliszek S, Dzikowska Diduch O, Kostrubiec M, Krupa M, Grudzka K, Ciurzynski M, Palczewski P, Pruszczyk P, Sakata K, Ishiguro M, Kimura G, Uesugo Y, Takemoto K, Minamishima T, Futuya M, Matsue S, Satoh T, Yoshino H, Signorello M, Gianturco L, Colombo C, Stella D, Atzeni F, Boccassini L, Sarzi-Puttini P, Turiel M, Kinova E, Deliiska B, Krivoshiev S, Goudev A, De Stefano F, Santoro C, Buonauro A, Schiano-Lomoriello V, Muscariello R, De Palma D, Galderisi M, Ranganadha Babu B, Chidambaram S, Sangareddi V, Dhandapani V, Ravi M, Meenakshi K, Muthukumar D, Swaminathan N, Ravishankar G, Bruno RM, Giardini G, Catizzo B, Brustia R, Malacrida S, Armenia S, Cauchy E, Pratali L, Cesana F, Alloni M, Vallerio P, De Chiara B, Musca F, Belli O, Ricotta R, Siena S, Moreo A, Giannattasio C, Magnino C, Omede' P, Avenatti E, Presutti D, Sabia L, Moretti C, Bucca C, Gaita F, Veglio F, Milan A, Eichhorn J, Springer W, Helling A, Alarajab A, Loukanov T, Ikeda M, Kijima Y, Akagi T, Toh N, Oe H, Nakagawa K, Tanabe Y, Watanabe N, Ito H, Hascoet S, Hadeed K, Marchal P, Bennadji A, Peyre M, Dulac Y, Heitz F, Alacoque X, Chausseray G, Acar P, Kong W, Ling L, Yip J, Poh K, Vassiliou V, Rekhraj S, Hoole S, Watkinson O, Kydd A, Boyd J, Mcnab D, Densem C, Shapiro L, Rana B, Potpara T, Djikic D, Polovina M, Marcetic Z, Peric V, Lip G, Gaudron P, Niemann M, Herrmann S, Hu K, Strotmann J, Beer M, Bijnens B, Liu D, Ertl G, Weidemann F, Peric V, Jovanovic A, Djikic D, Otasevic P, Kochanowski J, Piatkowski R, Scislo P, Grabowski M, Marchel M, Opolski G, Bandera F, Guazzi M, Arena R, Corra U, Ghio S, Forfia P, Rossi A, Dini F, Cahalin L, Temporelli L, Rallidis L, Tsangaris I, Makavos G, Anthi A, Pappas A, Orfanos S, Lekakis J, Anastasiou-Nana M, Kuznetsov VA, Krinochkin DV, Yaroslavskaya EI, Zaharova EH, Pushkarev GS, Mizia-Stec K, Wita K, Mizia M, Loboz-Grudzien K, Szwed H, Kowalik I, Kukulski T, Gosciniak P, Kasprzak J, Plonska-Gosciniak E, Cimino S, Pedrizzetti G, Tonti G, Cicogna F, Petronilli V, De Luca L, Iacoboni C, Agati L, Hoffmann R, Barletta G, Von Bardeleben S, Kasprzak J, Greis C, Vanoverschelde J, Becher H, Galrinho A, Moura Branco L, Fiarresga A, Cacela D, Ramos R, Cruz Ferreira R, Van Den Oord S, Akkus Z, Bosch J, Renaud G, Sijbrands E, Verhagen H, Van Der Lugt A, Van Der Steen A, Schinkel A, Mordi I, Tzemos N, Stanton T, Delgado D, Yu E, Drakopoulou M, Gonzalez-Gonzalez A, Karonis T, Roussin I, Babu-Narayan S, Swan L, Senior R, Li W, Parisi V, Pagano G, Pellegrino T, Femminella G, De Lucia C, Formisano R, Cuocolo A, Perrone Filardi P, Leosco D, Rengo G, Unlu S, Farsalinos K, Amelot K, Daraban A, Ciarka A, Delcroix M, Voigt J, Miskovic A, Poerner T, Goebel B, Stiller C, Moritz A, Sakata K, Uesugo Y, Kimura G, Ishiguro M, Takemoto K, Minamishima T, Futuya M, Satoh T, Yoshino H, Miyoshi T, Tanaka H, Kaneko A, Matsumoto K, Imanishi J, Motoji Y, Mochizuki Y, Minami H, Kawai H, Hirata K, Wutthimanop A, See O, Vathesathokit P, Yamwong S, Sritara P, Rosner A, Kildal A, Stenberg T, Myrmel T, How O, Capriolo M, Frea S, Giustetto C, Scrocco C, Benedetto S, Grosso Marra W, Morello M, Gaita F, Garcia-Gonzalez P, Cozar-Santiago P, Chacon-Hernandez N, Ferrando-Beltran M, Fabregat-Andres O, De La Espriella-Juan R, Fontane-Martinez C, Jurado-Sanchez R, Morell-Cabedo S, Ridocci-Soriano F, Mihaila S, Piasentini E, Muraru D, Peluso D, Casablanca S, Puma L, Naso P, Iliceto S, Vinereanu D, Badano L, Tarzia P, Villano A, Figliozzi S, Russo G, Parrinello R, Lamendola P, Sestito A, Lanza G, Crea F, Sulemane S, Panoulas V, Bratsas A, Frankel A, Nihoyannopoulos P, Dores H, Andrade M, Almeida M, Goncalves P, Branco P, Gaspar A, Gomes A, Horta E, Carvalho M, Mendes M, Yue W, Li X, Chen Y, Luo Y, Gu P, Yiu K, Siu C, Tse H, Cho E, Lee S, Hwang B, Kim D, Jang S, Jeon H, Youn H, Kim J. Poster session Thursday 12 December - PM: 12/12/2013, 14:00-18:00 * Location: Poster area. Eur Heart J Cardiovasc Imaging 2013. [DOI: 10.1093/ehjci/jet204] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Kumar KS, Rao CH, Reddy KB, Chidambaram S, Girish H, Murgod S. Flowable composite an alternative orthodontic bonding adhesive: an in vitro study. J Contemp Dent Pract 2013; 14:883-6. [PMID: 24685792 DOI: 10.5005/jp-journals-10024-1420] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To determine the clinical applicability of Ormocer based fowable adhesive (Admira fow) in comparison with BisGMA based adhesive (Transbond XT) and Ormocer based packable adhesive (Admira). MATERIALS AND METHODS Sixty human premolars, divided into group I (n = 20) Transbond XT, group II (n = 20) Admira and group III (n = 20) Admira fow were bonded with metal brackets using adhesives. Brackets were debonded in shear on an Instron universal testing machine with a crosshead speed of 1 mm per minute. The mode of bond failure was determined by modifed ARI index. RESULTS The results obtained from SBS evaluation and modifed ARI showed highest shear bond strength for Transbond XT (SD 11.64) 3.68 followed by Admira fow (SD 11.0) 2.87 and least for Admira (SD 9.42) 2.21. However, the difference was not statistically signifcant, but an intergroup comparison done using Independent student 't' test, showed statically signifcant difference between Transbond XT and Admira. Kaplan-Meier survival analysis showed least survival median value for Admira, but the survival median value is not statistically signifcant among the three groups. All groups had modifed ARI score of three (60-70%), suggestive of cohesive type of failure. CONCLUSION The in vitro study showed that fowable Ormocer can be an good alternative to commonly used BisGMA based adhesive but the its effcacy needs clinical assessment through a survival analysis. CLINICAL SIGNIFCANCE: Admire fow can defnitely be considered as an alternative bonding system due to their comparable bond strength and debonding characters and reported properties of biocompatibility.
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Affiliation(s)
- K Supradeep Kumar
- Assistant Professor, Department of Orthodontics and Dentofacial Orthopaedics, St. Joseph Dental College, Eluru, Andhra Pradesh India e-mail:
| | - C Hanumantha Rao
- Assistant Professor, Department of Orthodontics, Vishnu Dental College, Bhimavaram, Andhra Pradesh, India
| | - Kv Baburam Reddy
- Professor, Department of Orthodontics, Vishnu Dental College Bhimavaram, Andhra Pradesh, India
| | - S Chidambaram
- Professor, Department of Orthodontics, Rajah Muthiah Dental College and Hospital, Chidambaram, Tamil Nadu, India
| | - Hc Girish
- Professor and Head, Department of Oral Pathology, Rajarajeshwari Dental College and Hospital, Bengaluru, Karnataka, India
| | - Sanjay Murgod
- Professor, Department of Oral Pathology, Rajarajeshwari Dental College and Hospital, Bengaluru, Karnataka, India
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Varma DPK, Chidambaram S, Reddy KB, Vijay M, Ravindranath D, Prasad MR. Comparison of galvanic corrosion potential of metal injection molded brackets to that of conventional metal brackets with nickel-titanium and copper nickel-titanium archwire combinations. J Contemp Dent Pract 2013; 14:488-495. [PMID: 24171995 DOI: 10.5005/jp-journals-10024-1350] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
AIM The aim of the study is to investigate the galvanic corrosion potential of metal injection molding (MIM) brackets to that of conventional brackets under similar in vitro conditions with nickel-titanium and copper nickel-titanium archwires. MATERIALS AND METHODS Twenty-five maxillary premolar MIM stainless steel brackets and 25 conventional stainless steel brackets and archwires, 0.16 inch, each 10 mm length, 25 nickeltitanium wires, 25 copper nickel-titanium wires were used. They were divided into four groups which had five samples each. Combination of MIM bracket with copper nickel-titanium wire, MIM bracket with nickel-titanium wire and conventional stainless steel brackets with copper nickel-titanium wire and conventional stainless steel brackets with nickel-titanium wires which later were suspended in 350 ml of 1 M lactic acid solution media. Galvanic corrosion potential of four groups were analyzed under similar in vitro conditions. Precorrosion and postcorrosion elemental composition of MIM and conventional stainless steel bracket by scanning electron microscope (SEM) with energy dispersive spectroscope (EDS) was done. RESULTS MIM bracket showed decreased corrosion susceptibility than conventional bracket with copper nickeltitanium wire. Both MIM and conventional bracket showed similar corrosion resistance potential in association with nickel-titanium archwires. It seems that both brackets are more compatible with copper nickel-titanium archwires regarding the decrease in the consequences of galvanic reaction. The EDS analysis showed that the MIM brackets with copper nickel-titanium wires released less metal ions than conventional bracket with copper nickeltitanium wires. CONCLUSION MIM brackets showed decreased corrosion susceptibility, copper nickel-titanium archwires are compatible with both the brackets than nickel-titanium archwires. CLINICAL SIGNIFICANCE Clinically MIM and conventional brackets behaved more or less similarly in terms of corrosion resistance. In order to decrease the corrosion potential of MIM brackets, more precise manufacturing technique should be improved to get a more smoother surface finish.
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Affiliation(s)
- D Praveen Kumar Varma
- Professor, Department of Orthodontics, Vishnu Dental College Bhimavaram-534202, Andhra Pradesh, India, e-mail:
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Cikes M, Tong L, Jasaityte R, Hamilton J, Sutherland G, D'hooge J, Yurdakul S, Oner F, Avci BK, Sahin S, Direskeneli H, Aytekin S, Fang F, Chan A, Zhang Q, Sanderson J, Kwong J, Yu C, Zaidi A, Raju H, Ghani S, Gati S, Cox A, Sheikh N, Sharma R, Sharma S, Kutty S, Kottam A, Padiyath A, Gao S, Drvol L, Lof J, Li L, Rangamani S, Danford D, Kuehne T, Rosner A, Avenarius D, Malm S, Iqbal A, Baltabaeva A, Schirmer H, Bijnens B, Myrmel T, Magalhaes A, Silva Marques J, Martins S, Carrilho Ferreira P, Jorge C, Silva D, Placido R, Goncalves S, Almeida A, Nunes Diogo A, Poulidakis E, Aggeli C, Sideris S, Dilaveris P, Gatzoulis K, Felekos I, Koutagiar I, Sfendouraki E, Roussakis G, Stefanadis C, Zhang Q, Sun J, Gao R, Feng Y, Liu X, Sheng W, Liu F, Yu C, Hallioglu O, Citirik D, Buyukakilli B, Ozeren M, Gurgul S, Tasdelen B, Rodriguez Lopez A, Rodriguez Lopez A, Garcia Cuenllas L, Garcia Cuenllas L, Medrano C, Medrano C, Granja S, Granja S, Marin C, Marin C, Maroto E, Maroto E, Alvarez T, Alvarez T, Ballesteros F, Ballesteros F, Camino M, Camino M, Centeno M, Centeno M, Alraies M, Aljaroudi W, Halley C, Rodriguez L, Grimm R, Thomas J, Jaber W, Knight D, Coghlan J, Muthurangu V, Grasso A, Toumpanakis C, Caplin M, Taylor A, Davar J, Mohlkert LA, Halvorsen C, Hallberg J, Sjoberg G, Norman M, Cameli M, Losito M, Lisi M, Natali B, Massoni A, Maccherini M, Chiavarelli M, Massetti M, Mondillo S, Sljivic A, Stojcevski B, Celic V, Pencic B, Majstorovic A, Cosic Z, Backovic S, Ilic-Djordjevic I, Muraru D, Gripari P, Esposito R, Tamborini G, Galderisi M, Ermacora D, Maffessanti F, Santoro C, Pepi M, Badano L, Bombardini T, Cini D, Picano E, Shahgaldi K, Gunyeli E, Sahlen A, Manouras A, Winter R, Banovic M, Vukcevic V, Ostojic M, Markovic Z, Mladenovic A, Trifunovic D, Stojkovic S, Bacic D, Dedovic D, Seferovic P, Huttin O, Coulibaly S, Mercy M, Schwartz J, Zinzius P, Sellal J, Popovic B, Marie P, Juilliere Y, Selton-Suty C, Gurzun MM, Ionescu A, Bahlay B, Jones G, Rimbas R, Enescu O, Mihaila S, Ciobanu A, Vinereanu D, Vlasseros I, Koumoulidis A, Tousoulis D, Veioglanis S, Avgeropoulou A, Katsi V, Stefanadis C, Kallikazaros I, Kiviniemi T, Ylitalo A, Airaksinen K, Lehtinen T, Saraste A, Pietila M, Karjalainen P, Trifunovic D, Ostojic M, Stankovic S, Vujisic-Tesic B, Petrovic M, Banovic M, Boricic M, Draganic G, Petrovic M, Stepanovic J, Kuznetsov V, Yaroslavskaya E, Pushkarev G, Krinochkin D, Zyrianov I, Dekleva M, Stevanovic A, Kleut M, Suzic Lazic J, Markovic Nikolic N, Akhunova S, Saifullina G, Sadykov A, Loudon M, D'arcy J, Arnold L, Reynolds R, Mabbet C, Prendergast B, Dahl J, Videbaek L, Poulsen M, Rudbaek T, Pellikka P, Rasmussen L, Moller J, Lowery C, Frenneaux M, Dawson D, Dwivedi G, Singh S, Rudd A, Mahadevan D, Srinivasan J, Jiminez D, Sahinarslan A, Vecchio F, Maccarthy P, Wendler O, Monaghan M, Harimura Y, Seo Y, Ishizu T, Noguchi Y, Aonuma K, Urdaniz MM, Palomares JFR, Rius JB, Surribas IB, Tura GT, Garcia-Moreno LG, Alujas TG, Masip AE, Mas PT, Dorado 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Poster Session Wednesday 5 December all day Display * Determinants of left ventricular performance. Eur Heart J Cardiovasc Imaging 2012. [DOI: 10.1093/ehjci/jes248] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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