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Ellis KS, Robinson CE, Foster R, Fatayer H, Gandhi A. Efficient management of new patient referrals to a breast service: the safe introduction of an advanced nurse practitioner-led telephone breast pain service. Ann R Coll Surg Engl 2024; 106:359-363. [PMID: 37642083 PMCID: PMC10981980 DOI: 10.1308/rcsann.2023.0056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/30/2023] [Indexed: 08/31/2023] Open
Abstract
INTRODUCTION There has been an almost 100% increase in referrals to breast cancer diagnostic clinics in the past decade. Breaching of the two-week cancer referral target is now commonplace, potentially delaying diagnoses of breast malignancy in many women. Almost one in five of these referrals are women with mastalgia, not a symptom linked to breast cancer. The objective of the study was the safe introduction of an advanced nurse practitioner-led telephone service for women with mastalgia to improve the service for women and create capacity for those with "red flag" breast symptoms. METHODS Referrals to clinic were triaged, women with mastalgia only were directed to a telephone-based assessment clinic and symptoms evaluated using a multidisciplinary created proforma. RESULTS Within 23 months, 1,427 women were assessed in the breast pain telephone assessment clinic: 863 (61%) were aged over 40 and 564 (39%) aged under 40. A total of 1,238 underwent telephone assessment. Reassurance and discharge only was needed for 365 (26%). The aetiology of pain was identified as musculoskeletal in 1,104/1,238 (89%) of patients, with only 39/1,238 (3.2%) identified as having true breast pain. Additional symptoms were mentioned by 264 women (18%) during the consultation; all immediately redirected back to a diagnostic clinic. Mammography was undertaken in 609 women (43%). Seven women (0.6%) were diagnosed with a breast malignancy. Patient survey indicated that 93% of patients were satisfied with the care received and 97% said they would recommend the service to a family member or friend. CONCLUSIONS Although face-to-face assessments for breast pain remain the standard practice in many breast units, data indicating the safety of a telephone assessment clinic, along with high levels of patient satisfaction, question whether services can be delivered differently.
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Affiliation(s)
- KS Ellis
- Manchester University NHS Foundation Trust, UK
| | - CE Robinson
- Manchester University NHS Foundation Trust, UK
| | - R Foster
- Manchester University NHS Foundation Trust, UK
| | - H Fatayer
- Manchester University NHS Foundation Trust, UK
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Ingesson LC, Doblas A, Gandhi A, Jahanbakhsh S, Meister H. Generic approach to assess the measuring performance of total-radiated power quantities by multi-channel resistive bolometer diagnostics on fusion experiments. Rev Sci Instrum 2024; 95:013505. [PMID: 38214589 DOI: 10.1063/5.0177114] [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] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 12/20/2023] [Indexed: 01/13/2024]
Abstract
On present-day magnetic-confinement fusion experiments, the performance of multi-channel bolometer diagnostics has typically evolved over time through experience with earlier versions of the diagnostic and experimental results obtained. For future large-scale fusion experiments and reactors, it is necessary to be able to predict the performance as a function of design decisions and constraints. A methodology has been developed to predict the accuracy with which the volume-integrated total radiated power can be estimated from the measurements by a resistive bolometer diagnostic, considering, in particular, its line-of-sight geometry, étendues of individual lines of sight, bolometer-sensor characteristics, and the expected noise level that can be obtained with its electronics and signal chain. The methodology depends on a number of assumptions in order to arrive at analytical expressions but does not restrict the final implementation of data-processing of the diagnostic measurements. The methodology allows us to predict the performance in terms of accuracy, total-radiated power level, and frequency or time resolution and to optimize bolometer-sensor characteristics for a set of performance requirements. This is illustrated for the bolometer diagnostic that is being designed for the ITER experiment. The reasonableness, consequences, and limitations of the assumptions are discussed in detail.
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Affiliation(s)
- L C Ingesson
- Fusion for Energy, C/ Josep Pla 2, Torres Diagonal Litoral B3, 08019 Barcelona, Spain
| | - A Doblas
- ATG, Plaça d'Ernest Lluch i Martin 5, 08019 Barcelona, Spain
| | - A Gandhi
- ADF Group, La Bastide Blanche-Bât G, 13127 Vitrolles, France
| | - S Jahanbakhsh
- Max Planck Institute for Plasma Physics (IPP), Boltzmannstr. 2, 85748 Garching, Germany
| | - H Meister
- Max Planck Institute for Plasma Physics (IPP), Boltzmannstr. 2, 85748 Garching, Germany
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Lawrence E, Johri G, Dave R, Li R, Gandhi A. A contemporary analysis of the pre- and intraoperative recognition of multigland parathyroid disease. Langenbecks Arch Surg 2023; 408:389. [PMID: 37806985 PMCID: PMC10560634 DOI: 10.1007/s00423-023-03087-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 08/28/2023] [Indexed: 10/10/2023]
Abstract
BACKGROUND Despite advances in biochemical and radiological identification of parathyroid gland enlargement, primary hyperparathyroidism (PHPT) due to sporadic multigland parathyroid disease (MGPD) remains a perioperative diagnostic dilemma. Failure to recognise MGPD pre- or intraoperatively may negatively impact surgical cure rates and result in persistent PHPT and ongoing patient morbidity. METHODS We have conducted a comprehensive review of published literature in attempt to determine factors that could aid in reliably diagnosing sporadic MGPD pre- or intraoperatively. We discuss preoperative clinical features and examine pre- and intraoperative biochemical and imaging findings concentrating on those areas that give practicing surgeons and the wider multi-disciplinary endocrine team indications that a patient has MGDP. This could alter surgical strategy. CONCLUSION Biochemistry can provide diagnosis of PHPT but cannot reliably discriminate parathyroid pathology. Histopathology can aid diagnosis between MGPD and adenoma, but histological appearance can overlap. Multiple negative imaging modalities indicate that MGPD may be more likely than a single parathyroid adenoma, but the gold standard for diagnosis is still intraoperative identification during BNE. MGPD remains a difficult disease to both diagnose and treat.
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Affiliation(s)
- E Lawrence
- Wythenshawe Hospital and Nightingale Breast Cancer Centre, Manchester University Foundation Trust, Southmoor Road, Manchester, M23 9LT, UK
| | - G Johri
- Wythenshawe Hospital and Nightingale Breast Cancer Centre, Manchester University Foundation Trust, Southmoor Road, Manchester, M23 9LT, UK
| | - R Dave
- Wythenshawe Hospital and Nightingale Breast Cancer Centre, Manchester University Foundation Trust, Southmoor Road, Manchester, M23 9LT, UK
| | - R Li
- Wythenshawe Hospital and Nightingale Breast Cancer Centre, Manchester University Foundation Trust, Southmoor Road, Manchester, M23 9LT, UK
| | - A Gandhi
- Wythenshawe Hospital and Nightingale Breast Cancer Centre, Manchester University Foundation Trust, Southmoor Road, Manchester, M23 9LT, UK.
- Division of Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Oglesby Cancer Research Building, M20 4GJ, Manchester, UK.
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Anderson KR, Li W, Thomas E, Gandhi A, Conley A, Ottosen M. Parent factors associated with Neonatal Intensive Care Unit (NICU) discharge readiness in high-risk infants. Am J Med Sci 2023. [DOI: 10.1016/s0002-9629(23)00433-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Staal RGW, Gandhi A, Zhou H, Cajina M, Jacobsen AM, Hestehave S, Hopper A, Poda S, Chandresana G, Zorn SH, Campbell B, Segerdahl M, Mӧller T, Munro G. Inhibition of P2X7 receptors by Lu AF27139 diminishes colonic hypersensitivity and CNS prostanoid levels in a rat model of visceral pain. Purinergic Signal 2022; 18:499-514. [PMID: 36001278 PMCID: PMC9832206 DOI: 10.1007/s11302-022-09892-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 07/27/2022] [Indexed: 01/14/2023] Open
Abstract
Visceral pain is a prominent feature of various gastrointestinal diseases. The P2X7 receptor is expressed by multiple cell types including dorsal root ganglion satellite glial cells, macrophages, and spinal microglia, all of which have been implicated in nociceptive sensitization. We have used the selective and CNS penetrant P2X7 receptor antagonist Lu AF27139 to explore this receptor's role in distinct rat models of inflammatory and visceral hypersensitivity. Rats injected with CFA in the hindpaw displayed a marked reduction in hindpaw mechanical threshold, which was dose-dependently reversed by Lu AF27139 (3-30 mg/kg, p.o.). In rats injected with TNBS in the proximal colon, the colorectal distension threshold measured distally was significantly lower than sham treated rats at 7 days post-injection (P < 0.001), indicative of a marked central sensitization. Colonic hypersensitivity was also reversed by Lu AF27139 (10-100 mg/kg) and by the κ-opioid receptor agonist U-50,488H (3 mg/kg, s.c.). Moreover, both Lu AF27139 and U-50,488H prevented a TNBS-induced increase in spinal and brain levels of PGE2 and LTB4, as well as an increase in brain levels of PGF2α and TXB2. Lu AF27139 was well tolerated as revealed by a lack of significant effect on rotarod motor function and coordination at all doses tested up to 300 mg/kg. Thus, P2X7 receptor antagonism is efficacious in a rat model of visceral pain, via a mechanism which potentially involves attenuation of microglial function within spinal and/or supraspinal pain circuits, albeit a peripheral site of action cannot be excluded.
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Affiliation(s)
- Roland G W Staal
- Neuroinflammation Disease Biology Unit Lundbeck Research USA, Paramus, NJ, USA
| | - Adarsh Gandhi
- Neuroinflammation Disease Biology Unit Lundbeck Research USA, Paramus, NJ, USA
| | - Hua Zhou
- Neuroinflammation Disease Biology Unit Lundbeck Research USA, Paramus, NJ, USA
| | - Manuel Cajina
- Neuroinflammation Disease Biology Unit Lundbeck Research USA, Paramus, NJ, USA
| | | | - Sara Hestehave
- Neurodegeneration In Vivo Lundbeck Research, Valby, Denmark
| | - Allen Hopper
- Neuroinflammation Disease Biology Unit Lundbeck Research USA, Paramus, NJ, USA
| | - Suresh Poda
- Neuroinflammation Disease Biology Unit Lundbeck Research USA, Paramus, NJ, USA
| | - Gamini Chandresana
- Neuroinflammation Disease Biology Unit Lundbeck Research USA, Paramus, NJ, USA
| | - Stevin H Zorn
- Neuroinflammation Disease Biology Unit Lundbeck Research USA, Paramus, NJ, USA
| | - Brian Campbell
- Neuroinflammation Disease Biology Unit Lundbeck Research USA, Paramus, NJ, USA
| | - Marta Segerdahl
- Clinical Research Neurology Lundbeck Research, Valby, Denmark
| | - Thomas Mӧller
- Neuroinflammation Disease Biology Unit Lundbeck Research USA, Paramus, NJ, USA
| | - Gordon Munro
- Neurodegeneration In Vivo Lundbeck Research, Valby, Denmark.
- Hoba Therapeutics, Ole Maaløes Vej 3, 2200, Copenhagen N, Denmark.
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Gandhi A, Taylor J, Morici M, Reid A, Meniawy T, Khattak M, Millward M, Gray E, Zaenker P. 130P Autoantibodies as potential biomarkers of high grade immune-related adverse events (irAEs) in metastatic melanoma patients treated with check point inhibitors (ICIs). Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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7
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Torr B, Choi S, Jones C, Allen S, Kavanaugh G, Hamill M, Monson K, Machmahon S, Valgon Petrizan M, Fallowfield L, Jenkins V, George A, Evans D, Gandhi A, Kemp Z, Hubank M, Turnbull C. 156TiP BRCA-DIRECT: A randomised UK study evaluating a digital pathway for germline genetic testing and non-inferiority of digitally-delivered information in women with breast cancer. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.03.173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Staal R, Khayrullina T, Christensen R, Hestehave S, Zhou H, Cajina M, Nattini ME, Gandhi A, Fallon SM, Schmidt M, Zorn SH, Brodbeck RM, Chandrasena G, Segerdahl Storck M, Breysse N, Hopper AT, Möller T, Munro G. P2X7 receptor mediated release of microglial prostanoids and miRNAs correlates with reversal of neuropathic hypersensitivity in rats. Eur J Pain 2022; 26:1304-1321. [PMID: 35388574 DOI: 10.1002/ejp.1951] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 03/29/2022] [Accepted: 04/03/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND P2X7 receptor antagonists have potential for treating various CNS diseases, including neuropathic pain, although none have been approved for clinical use. Reasons may include insufficient understanding of P2X7 receptor signaling in pain and the lack of a corresponding preclinical mechanistic biomarker. METHODS Lu AF27139 is a highly selective and potent small molecule antagonist at rat, mouse, and human forms of the P2X7 receptor, with excellent pharmacokinetic and CNS permeability properties. In the current experiments, we probed the utility of previously characterized and novel signaling cascades exposed to Lu AF27139 using cultured microglia combined with release assays. Subsequently, we assessed the biomarker potential of identified candidate molecules in the rat chronic constriction injury (CCI) model of neuropathic pain; study design limitations precluded their assessment in spared nerve injury (SNI) rats. RESULTS Lu AF27139 blocked several pain-relevant pathways downstream of P2X7 receptors in-vitro. At brain and spinal cord receptor occupancy levels capable of functionally blocking P2X7 receptors, it diminished neuropathic hypersensitivity in SNI rats, and less potently in CCI rats. Although tissue levels of numerous molecules previously linked to neuropathic pain and P2X7 receptor function (e.g. IL-6, IL-1β, cathepsin-S, 2-AG) were unaffected by CCI, Lu AF27139-mediated regulation of spinal PGE2 and miRNA (e.g. rno-miR-93-5p) levels increased by CCI aligned with its ability to diminish neuropathic hypersensitivity. CONCLUSIONS We have identified a pain-relevant P2X7 receptor-regulated mechanism in neuropathic rats that could hold promise as a translatable biomarker and by association enhance the clinical progression of P2X7 receptor antagonists in neuropathic pain.
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Affiliation(s)
- Roland Staal
- Neuroinflammation Disease Biology Unit Lundbeck Research USA, 215 College Road, Paramus, NJ, 07652, USA
| | - Tanzilya Khayrullina
- Neuroinflammation Disease Biology Unit Lundbeck Research USA, 215 College Road, Paramus, NJ, 07652, USA
| | - Rie Christensen
- Neurodegeneration In Vivo Lundbeck A/S, Ottiliavej 9, 2500, Valby, Denmark
| | - Sara Hestehave
- Neurodegeneration In Vivo Lundbeck A/S, Ottiliavej 9, 2500, Valby, Denmark
| | - Hua Zhou
- Neuroinflammation Disease Biology Unit Lundbeck Research USA, 215 College Road, Paramus, NJ, 07652, USA
| | - Manuel Cajina
- Neuroinflammation Disease Biology Unit Lundbeck Research USA, 215 College Road, Paramus, NJ, 07652, USA
| | - Megan E Nattini
- Neuroinflammation Disease Biology Unit Lundbeck Research USA, 215 College Road, Paramus, NJ, 07652, USA
| | - Adarsh Gandhi
- Neuroinflammation Disease Biology Unit Lundbeck Research USA, 215 College Road, Paramus, NJ, 07652, USA
| | - Shaun M Fallon
- Neuroinflammation Disease Biology Unit Lundbeck Research USA, 215 College Road, Paramus, NJ, 07652, USA
| | - Megan Schmidt
- Neuroinflammation Disease Biology Unit Lundbeck Research USA, 215 College Road, Paramus, NJ, 07652, USA
| | - Stevin H Zorn
- Neuroinflammation Disease Biology Unit Lundbeck Research USA, 215 College Road, Paramus, NJ, 07652, USA
| | - Robbin M Brodbeck
- Neuroinflammation Disease Biology Unit Lundbeck Research USA, 215 College Road, Paramus, NJ, 07652, USA
| | - Gamini Chandrasena
- Neuroinflammation Disease Biology Unit Lundbeck Research USA, 215 College Road, Paramus, NJ, 07652, USA
| | | | - Nathalie Breysse
- Neuroinflammation Disease Biology Unit Lundbeck Research USA, 215 College Road, Paramus, NJ, 07652, USA
| | - Allen T Hopper
- Neuroinflammation Disease Biology Unit Lundbeck Research USA, 215 College Road, Paramus, NJ, 07652, USA
| | - Thomas Möller
- Neuroinflammation Disease Biology Unit Lundbeck Research USA, 215 College Road, Paramus, NJ, 07652, USA
| | - Gordon Munro
- Neurodegeneration In Vivo Lundbeck A/S, Ottiliavej 9, 2500, Valby, Denmark
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9
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Bromley HL, Preston M, Walter L, Dave R, Lord N, Wright P, Rowland M, Gandhi A. Assessing the impact of a gynaecomastia assessment and treatment infographic in primary care in Greater Manchester. Ann R Coll Surg Engl 2022; 104:174-180. [PMID: 34822303 PMCID: PMC9773909 DOI: 10.1308/rcsann.2021.0149] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Men with gynaecomastia are routinely referred to breast clinics, yet most do not require breast surgical intervention. The aim of this study was to assess the impact of a novel point-of-care gynaecomastia decision infographic in primary care on the assessment, management and referral practices to tertiary breast surgical services. METHODS A study was carried out of male patient referrals from primary care in Greater Manchester to a tertiary breast centre between January and March in 2018-2020. Referral patterns were compared before and after the infographic went live in general practices in Greater Manchester in January 2020. Data were collected for gynaecomastia referrals, including aetiology, investigation and management. RESULTS In total, 394 men were referred to a tertiary breast centre from 163 general practices, of which 271 (68.8%) had a diagnosis of gynaecomastia. Use of the decision infographic by primary healthcare providers was associated with a decrease in male breast referrals with gynaecomastia (79.6% to 62.0%). Fewer gynaecomastia patients were referred with a benign physiological or drug-related cause after implementation of the infographic (52.2% vs 41.8%). Only 10 (3.7%) patients with gynaecomastia underwent breast surgery during the study period. CONCLUSION Implementation of a gynaecomastia infographic in primary care in Manchester was associated with a reduction in gynaecomastia referrals to secondary care. We hypothesise that implementation of the infographic into primary care nationally may potentially translate to hundreds of patients receiving more specialty-appropriate referrals, improving overall management of gynaecomastia. Further study is warranted to test this hypothesis.
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Affiliation(s)
- HL Bromley
- Manchester University Hospitals NHS Foundation Trust, UK
| | - M Preston
- Manchester University Hospitals NHS Foundation Trust, UK
| | - L Walter
- Manchester University Hospitals NHS Foundation Trust, UK
| | - R Dave
- Manchester University Hospitals NHS Foundation Trust, UK
| | - N Lord
- St Johns Medical Centre, UK
| | | | - M Rowland
- Liverpool University Hospitals NHS Foundation Trust, UK
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Zheng Y, Gandhi A, Sewell K, Tumin D, Bear K. Point-of-care ultrasound educational interventions in the neonatal intensive care unit: A systematic review. J Neonatal Perinatal Med 2022; 15:511-520. [PMID: 35491808 DOI: 10.3233/npm-210925] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
OBJECTIVE The benefits of point-of-care ultrasound (POCUS) in the neonatal intensive care unit (NICU) have been widely recognized, but education on this area of practice remains variable. We reviewed published educational interventions regarding POCUS use in the NICU and whether they have led to sustainable increases in POCUS use. METHODS A systematic search of 6 databases was performed for publications from January 2000 to March 2021. Studies with quantitative data related to POCUS educational interventions in the NICU were included. Data on number of participants and roles, educational intervention, curriculum description, and project outcome measures (including sustainability) was extracted. RESULTS The search resulted in 686 articles, of which nine studies met the inclusion criteria. Educational interventions included didactic sessions, simulation practice, animal practice, and practice in real patients. The most common assessment was based on the quality and accuracy of the images. At the participant level, the average time to reach proficiency ranged from eight hours and thirty-six minutes to five months, and none of the studies evaluated sustainability of POCUS use after the intervention. CONCLUSION There is a lack of standardized training modules and assessments for POCUS use in the NICU. Given that none of the studies addressed sustainability or standardized training, we recommend that a standardized training protocol and assessment tool is developed and studied longitudinally; and that barriers to sustainable POCUS use in the NICU (such as billing issues and a lack of POCUS machines and instructors) be systematically addressed as part of this work.
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Affiliation(s)
- Y Zheng
- Department of Pediatrics, East Carolina University and Vidant Medical Center, Greenville, NC, USA
| | - A Gandhi
- Department of Pediatrics, Brody School of Medicine at East Carolina University, Greenville, NC, USA
| | - K Sewell
- Department of Pediatrics, Brody School of Medicine at East Carolina University, Greenville, NC, USA
| | - D Tumin
- Department of Pediatrics, Brody School of Medicine at East Carolina University, Greenville, NC, USA
| | - K Bear
- Department of Neonatology, Vidant Medical Center, Greenville, NC, USA
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Rubenis I, Ling J, Maouris T, Walker D, Gandhi A, Ng A. Characteristics of Patients Presenting With Heart Failure, Subsequent Management, and Outcomes in a Regional New South Wales Hospital: A 12-Month Retrospective Cohort Study. Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.06.073] [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: 10/16/2022]
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Gandhi A, Masand V, Zaki MEA, Al-Hussain SA, Ghorbal AB, Chapolikar A. QSAR analysis of sodium glucose co-transporter 2 (SGLT2) inhibitors for anti-hyperglycaemic lead development. SAR QSAR Environ Res 2021; 32:731-744. [PMID: 34494464 DOI: 10.1080/1062936x.2021.1971295] [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] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 08/18/2021] [Indexed: 06/13/2023]
Abstract
QSAR (Quantitative Structure Activity Relationship) modelling was performed on a dataset of 90 sodium-dependent glucose cotransporter 2 (SGLT2) inhibitors. The quantitative and explicative evaluations revealed some of the subtle and distinguished structural features that are responsible for the inhibitory potency of these compounds against SGLT2, such as less possible number of ring carbons at 8 Å from the lipophilic atoms in the molecule (fringClipo8A) and more possible value for the sum of the partial charges of the lipophilic atoms present within seven bonds from the donor atoms (lipo_don_7Bc). Multivariate GA-MLR (genetic algorithm-multi linear regression) and thorough validation methodology out-turned a statistically robust QSAR model with a very high predictability shown from various statistical parameters. A QSAR model with r2 = 0.83, F = 51.54, Q2LOO = 0.79, Q2LMO = 0.79, CCCcv = 0.88, Q2Fn = 0.76-0.81, r2ext = 0.77, CCCext = 0.85, and with RMSEtr < RMSEcv was proposed. This QSAR model will assist synthetic chemists in the development of the SGLT2 inhibitors as the antidiabetic leads.
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Affiliation(s)
- A Gandhi
- Department of Chemistry, Government College of Arts and Science, Aurangabad, Maharashtra, India
| | - V Masand
- Department of Chemistry, Vidya Bharati Mahavidyalaya, Amravati, Maharashtra, India
| | - M E A Zaki
- Department of Chemistry, College of Science, Al-Imam Mohammad Ibn Saud Islamic University, Riyadh, Saudi Arabia
| | - S A Al-Hussain
- Department of Chemistry, College of Science, Al-Imam Mohammad Ibn Saud Islamic University, Riyadh, Saudi Arabia
| | - A Ben Ghorbal
- Department of Mathematics and Statistics, College of Sciences, Al-Imam Mohammad Ibn Saud Islamic University, Riyadh, Saudi Arabia
| | - A Chapolikar
- Department of Chemistry, Government College of Arts and Science, Aurangabad, Maharashtra, India
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Murphy J, Gandhi A. Does Mastectomy Reduce Overall Survival in Early Stage Breast Cancer? Clin Oncol (R Coll Radiol) 2021; 33:440-447. [DOI: 10.1016/j.clon.2021.03.005] [Citation(s) in RCA: 3] [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] [Received: 09/08/2020] [Revised: 12/22/2020] [Accepted: 03/05/2021] [Indexed: 01/12/2023]
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Gandhi A, Duxbury P, Murphy J, Foden P, Lalloo F, Clancy T, Wisely J, Kirwan CC, Howell A, Evans DG. Patient reported outcome measures in a cohort of patients at high risk of breast cancer treated by bilateral risk reducing mastectomy and breast reconstruction. J Plast Reconstr Aesthet Surg 2021; 75:69-76. [PMID: 34219040 DOI: 10.1016/j.bjps.2021.06.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 02/12/2021] [Accepted: 06/02/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Many women with increased lifetime risk of developing breast cancer, due to pathogenic gene variants or family history, choose to undergo bilateral risk reducing mastectomies (BRRM). Patient reported outcome measures (PROMS) are an increasingly important part of informed consent but are little studied in women undergoing BRRM. METHODS We used a validated PROMS tool for breast reconstruction (BREAST-Q) in 297 women who had BRRM and breast reconstruction, 81% of whom had no malignancy (Benign Group, BG) and 19% in whom a perioperative breast cancer was diagnosed (Cancer Group, CG). 128 women also completed a Hospital Anxiety & Depression Score (HADS) questionnaire to test if preoperative HADS score could predict PROMS outcomes. RESULTS Women in the CG had lower PROMS scores for satisfaction with their breasts, nipple reconstruction and sexual wellbeing. Both groups reported equal satisfaction with BRRM outcome and psychosocial well-being. Physical well-being PROMS of the abdomen and chest were high in women in both groups as were scores for satisfaction with the care they received. The CG group reported suboptimal quality of patient information. A higher presurgical HADS anxiety score predicted less favourable postoperative psychosocial well-being despite similar levels of satisfaction with aesthetic outcome. CONCLUSION We show a high degree of patient reported satisfaction by woman undergoing BRRM and reconstruction. There was a negative association with a cancer diagnosis on quality of life PROMS and higher preoperative anxiety levels negatively affected postoperative psychosocial well-being. These important findings should be part of the informed consent process during preoperative counselling.
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Affiliation(s)
- A Gandhi
- Prevent Breast Cancer Centre, Wythenshawe Hospital, Manchester University Hospital NHS Foundation Trust, Manchester, UK; Division of Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK.
| | - P Duxbury
- Prevent Breast Cancer Centre, Wythenshawe Hospital, Manchester University Hospital NHS Foundation Trust, Manchester, UK
| | - J Murphy
- Prevent Breast Cancer Centre, Wythenshawe Hospital, Manchester University Hospital NHS Foundation Trust, Manchester, UK
| | - P Foden
- Department of Medical Statistics, Wythenshawe Hospital, Manchester University Hospital NHS Foundation Trust, Manchester, UK
| | - F Lalloo
- Department of Clinical Genetics, Manchester Centre for Genomic Medicine, St Marys Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - T Clancy
- Department of Clinical Genetics, Manchester Centre for Genomic Medicine, St Marys Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - J Wisely
- Department of Clinical Psychology, Laureate House, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - C C Kirwan
- Prevent Breast Cancer Centre, Wythenshawe Hospital, Manchester University Hospital NHS Foundation Trust, Manchester, UK; Division of Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - A Howell
- Prevent Breast Cancer Centre, Wythenshawe Hospital, Manchester University Hospital NHS Foundation Trust, Manchester, UK; Division of Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - D G Evans
- Prevent Breast Cancer Centre, Wythenshawe Hospital, Manchester University Hospital NHS Foundation Trust, Manchester, UK; Division of Evolution and Genomic Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
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15
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Yadav B, Sandeep K, Gandhi A, Saraswat A, Sharma D, Chaudhuri P. Design updates for helium cooling system of Indian LLCB blanket. Fusion Engineering and Design 2021. [DOI: 10.1016/j.fusengdes.2021.112342] [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] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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16
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Fairhead R, Vickers P, Kuek DK, Lee E, Mermekli A, Gandhi A, Hughes R, McKean D. Contrast Dispersal Patterns in CT-Guided Indirect Posterolateral Cervical Nerve Root Injections. Semin Musculoskelet Radiol 2021. [DOI: 10.1055/s-0041-1731554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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17
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Mermekli A, Hare N, Fairhead R, Kuek DK, Gandhi A, Dalili D, Hughes R, Papanikitas J, McKean D. Radiofrequency Ablation Combined with Augmentation for Local Tumor Control of Skeletal Metastases. Semin Musculoskelet Radiol 2021. [DOI: 10.1055/s-0041-1731526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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18
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Gilmour A, Cutress R, Gandhi A, Harcourt D, Little K, Mansell J, Murphy J, Pennery E, Tillett R, Vidya R, Martin L. Oncoplastic breast surgery: A guide to good practice. Eur J Surg Oncol 2021; 47:2272-2285. [PMID: 34001384 DOI: 10.1016/j.ejso.2021.05.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [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: 04/08/2021] [Revised: 04/18/2021] [Accepted: 05/05/2021] [Indexed: 02/08/2023] Open
Abstract
Oncoplastic Breast Surgery has become standard of care in the management of Breast Cancer patients. These guidelines written by an Expert Advisory Group; convened by the Association of Breast Surgery (ABS) and the British Association of Plastic, Reconstructive and Aesthetic Surgeons (BAPRAS), are designed to provide all members of the breast cancer multidisciplinary team (MDT) with guidance on the best breast surgical oncoplastic and reconstructive practice at each stage of a patient's journey, based on current evidence. It is hoped they will also be of benefit to the wide range of professionals and service commissioners who are involved in this area of clinical practice.
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Affiliation(s)
- A Gilmour
- Canniesburn Plastic Surgery Unit, Glasgow Royal Infirmary, United Kingdom
| | - R Cutress
- University of Southampton and University Hospital Southampton, United Kingdom
| | - A Gandhi
- Manchester Academic Health Sciences Centre & Manchester University Hospitals NHS Trust, Manchester, United Kingdom
| | - D Harcourt
- Centre for Appearance Research, University of the West of England, Bristol, United Kingdom
| | - K Little
- Liverpool Breast Unit, Liverpool University Foundation Trust, United Kingdom
| | - J Mansell
- Gartnavel General Hospital, Glasgow, United Kingdom
| | - J Murphy
- Manchester University Hospitals NHS Trust, United Kingdom
| | | | - R Tillett
- Royal Devon and Exeter NHS Trust, Exeter, United Kingdom
| | - R Vidya
- The Royal Wolverhampton NHS Trust, Wolverhampton, United Kingdom
| | - L Martin
- Liverpool Breast Unit, Liverpool University Foundation Trust, United Kingdom.
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19
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Hopper AT, Juhl M, Hornberg J, Badolo L, Kilburn JP, Thougaard A, Smagin G, Song D, Calice L, Menon V, Dale E, Zhang H, Cajina M, Nattini ME, Gandhi A, Grenon M, Jones K, Khayrullina T, Chandrasena G, Thomsen C, Zorn SH, Brodbeck R, Poda SB, Staal R, Möller T. Synthesis and Characterization of the Novel Rodent-Active and CNS-Penetrant P2X7 Receptor Antagonist Lu AF27139. J Med Chem 2021; 64:4891-4902. [PMID: 33822617 DOI: 10.1021/acs.jmedchem.0c02249] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
There remains an insufficient number of P2X7 receptor antagonists with adequate rodent potency, CNS permeability, and pharmacokinetic properties from which to evaluate CNS disease hypotheses preclinically. Herein, we describe the molecular pharmacology, safety, pharmacokinetics, and functional CNS target engagement of Lu AF27139, a novel rodent-active and CNS-penetrant P2X7 receptor antagonist. Lu AF27139 is highly selective and potent against rat, mouse, and human forms of the receptors. The rat pharmacokinetic profile is favorable with high oral bioavailability, modest clearance (0.79 L/(h kg)), and good CNS permeability. In vivo mouse CNS microdialysis studies of lipopolysaccharide (LPS)-primed and 2'(3')-O-(benzoylbenzoyl)adenosine-5'-triphosphate (BzATP)-induced IL-1β release demonstrate functional CNS target engagement. Importantly, Lu AF27139 was without effect in standard in vitro and in vivo toxicity studies. Based on these properties, we believe Lu AF27139 will be a valuable tool for probing the role of the P2X7 receptor in rodent models of CNS diseases.
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Affiliation(s)
- Allen T Hopper
- Neuroinflammation Disease Biology Unit Lundbeck Research USA, 215 College Road, Paramus, New Jersey 07652, United States
| | - Martin Juhl
- Process Research Lundbeck A/S, Ottiliavej 9, 2500 Valby, Denmark
| | - Jorrit Hornberg
- Toxicology Research Lundbeck A/S, Ottiliavej 9, 2500 Valby, Denmark
| | - Lassina Badolo
- Chemistry and DMPK Lundbeck A/S, Ottiliavej 9, 2500 Valby, Denmark
| | | | | | - Gennady Smagin
- Neuroinflammation Disease Biology Unit Lundbeck Research USA, 215 College Road, Paramus, New Jersey 07652, United States
| | - Dekun Song
- Neuroinflammation Disease Biology Unit Lundbeck Research USA, 215 College Road, Paramus, New Jersey 07652, United States
| | - Londye Calice
- Neuroinflammation Disease Biology Unit Lundbeck Research USA, 215 College Road, Paramus, New Jersey 07652, United States
| | - Veena Menon
- Neuroinflammation Disease Biology Unit Lundbeck Research USA, 215 College Road, Paramus, New Jersey 07652, United States
| | - Elena Dale
- Neuroinflammation Disease Biology Unit Lundbeck Research USA, 215 College Road, Paramus, New Jersey 07652, United States
| | - Hong Zhang
- Neuroinflammation Disease Biology Unit Lundbeck Research USA, 215 College Road, Paramus, New Jersey 07652, United States
| | - Manuel Cajina
- Neuroinflammation Disease Biology Unit Lundbeck Research USA, 215 College Road, Paramus, New Jersey 07652, United States
| | - Megan E Nattini
- Neuroinflammation Disease Biology Unit Lundbeck Research USA, 215 College Road, Paramus, New Jersey 07652, United States
| | - Adarsh Gandhi
- Neuroinflammation Disease Biology Unit Lundbeck Research USA, 215 College Road, Paramus, New Jersey 07652, United States
| | - Michel Grenon
- Neuroinflammation Disease Biology Unit Lundbeck Research USA, 215 College Road, Paramus, New Jersey 07652, United States
| | - Ken Jones
- Neuroinflammation Disease Biology Unit Lundbeck Research USA, 215 College Road, Paramus, New Jersey 07652, United States
| | - Tanzilya Khayrullina
- Neuroinflammation Disease Biology Unit Lundbeck Research USA, 215 College Road, Paramus, New Jersey 07652, United States
| | - Gamini Chandrasena
- Neuroinflammation Disease Biology Unit Lundbeck Research USA, 215 College Road, Paramus, New Jersey 07652, United States
| | - Christian Thomsen
- Neuroinflammation Disease Biology Unit Lundbeck Research USA, 215 College Road, Paramus, New Jersey 07652, United States
| | - Stevin H Zorn
- Neuroinflammation Disease Biology Unit Lundbeck Research USA, 215 College Road, Paramus, New Jersey 07652, United States
| | - Robb Brodbeck
- Neuroinflammation Disease Biology Unit Lundbeck Research USA, 215 College Road, Paramus, New Jersey 07652, United States
| | - Suresh Babu Poda
- Neuroinflammation Disease Biology Unit Lundbeck Research USA, 215 College Road, Paramus, New Jersey 07652, United States
| | - Roland Staal
- Neuroinflammation Disease Biology Unit Lundbeck Research USA, 215 College Road, Paramus, New Jersey 07652, United States
| | - Thomas Möller
- Neuroinflammation Disease Biology Unit Lundbeck Research USA, 215 College Road, Paramus, New Jersey 07652, United States
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20
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Mehta M, Singh NL, Singh RK, Parashari S, Subhash PV, Naik H, Chauhan RD, Makwana R, Suryanarayana SV, Mukherjee S, Gandhi A, Varmuza J, Katovsky K. Measurement of 90Zr(n,2n)89Zr and 90Zr(n,p)90mY reaction cross-sections in the neutron energy range of 10.95 to 20.02 MeV. J Radioanal Nucl Chem 2021. [DOI: 10.1007/s10967-021-07625-y] [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: 11/25/2022]
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21
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Satyanath RK, Sorout J, Jayachandra S, Gandhi A, Kacker S. Physiological and clinical aspects in COVID-19. Vestn Ross univ družby nar , Ser Med 2020. [DOI: 10.22363/2313-0245-2020-24-3-201-206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
There is a new public health crises threatening globally with the emergence and spread of 2019 novel corona virus (COVID-19) or the severe acute respiratory syndrome corona virus 2 (SARS-CoV-2). In very recent decade we have seen endemic outbreaks in the form of Middle East respiratory syndrome coronavirus (MERS CoV) and severe acute respiratory syndrome related coronavirus (SARS-CoV). Now we again see the emergence of another serious outbreak due to a new strain called the SARS-CoV-2 virus. This SARS-CoV-2 initially presented as pneumonia of unknown etiology with group of symptoms including fever, dry cough and shortness of breath in a cluster of patients in December 2019 Wuhan, China. COVID-19 now has quickly became a health emergency now across worldwide. SARS-CoV-2 is a newly emerging human infectious corona virus that causes COVID-19, now this has been recognized as a pandemic by the World Health Organization (WHO) on 11th March, 2020. Because of the pathogenesis and proliferation pathways of COVID-19 are still unknown the development of vaccine was not developed yet and definitive treatment was not implemented. Therefore, in this article, new potential COVID-19 therapies are briefly reviewed. The world is in emergent need for searching of possible medications for COVID-19.
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22
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Dave RV, Cheung S, Sibbering M, Kearins O, Jenkins J, Gandhi A. Residual lymph node tumour burden following removal of a single axillary sentinel lymph with macrometastatic disease in women with screen-detected invasive breast cancer. BJS Open 2020; 5:6024956. [PMID: 33688940 PMCID: PMC7944503 DOI: 10.1093/bjsopen/zraa022] [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] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 09/11/2020] [Indexed: 01/28/2023] Open
Abstract
Background Women with screen-detected invasive breast cancer who have macrometastatic disease on axillary sentinel lymph node biopsy (SLNB) are usually offered either surgical axillary node clearance (ANC) or axillary radiotherapy. These treatments can lead to significant complications for patients. The aim of this study was to identify a group of patients who may not require completion ANC. Methods Data from the NHS Breast Screening Programme between 1 April 2012 and 31 March 2017 were interrogated to identify women with invasive breast carcinoma and a single sentinel lymph node (SLN) with macrometastatic disease who subsequently proceeded to completion ANC. Univariable and multivariable analyses were performed to identify patients with a single positive SLN who had no further lymph node metastasis on ANC. Results Of the 2401 women included in the cohort, the presence of non-sentinel node disease was significantly affected by: the number of nodes obtained at SLNB (odds ratio (OR) 0.49 for retrieval of more than 1 node), invasive size of tumour (OR 1.63 for size greater than 20 mm), surgical treatment (OR 1.34 for mastectomy), human epidermal growth factor receptor (HER) 2 status (OR 0.71 for HER2 positivity), and patient age (OR 1.10 for age less than 50 years; OR 1.46 for age greater than 70 years). Patients aged less than 70 years, with tumour size smaller than 2 cm, more than one node retrieved on SLNB, and who had breast-conserving surgery had a lower chance of positive non-sentinel nodes on completion ANC compared with other patients. Conclusion This study, of a purely screen-detected breast cancer cohort, identified a subset of patients who may be spared completion ANC in the event of a single axillary SLN with macrometastasis.
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Affiliation(s)
- R V Dave
- The Nightingale Centre, Wythenshawe Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - S Cheung
- National Health Service Breast Screening Programme, Public Health England, Birmingham, UK
| | - M Sibbering
- University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
| | - O Kearins
- National Health Service Breast Screening Programme, Public Health England, Birmingham, UK
| | - J Jenkins
- National Health Service Breast Screening Programme, Public Health England, Birmingham, UK
| | - A Gandhi
- The Nightingale Centre, Wythenshawe Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester, UK.,Manchester Academic Health Sciences Centre, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
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23
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Hile E, Valente A, Gandhi A, Xu C, Neuhold R, Moore K. Gait speed change during first chemotherapy cycle may predict later dose-reduction in ovarian cancer patients over 70: An exploratory analysis. Gynecol Oncol 2020. [DOI: 10.1016/j.ygyno.2020.05.582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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24
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Hile E, Valente A, Gandhi A, Neuhold R, Xu C, Moore K. Mobility-related basic and instrumental activities of daily living fluctuate over 2-3 cycles of chemotherapy for ovarian cancer in women over 70: An exploratory analysis. Gynecol Oncol 2020. [DOI: 10.1016/j.ygyno.2020.06.123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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25
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Masand VH, Rastija V, Patil MK, Gandhi A, Chapolikar A. Extending the identification of structural features responsible for anti-SARS-CoV activity of peptide-type compounds using QSAR modelling. SAR QSAR Environ Res 2020; 31:643-654. [PMID: 32847369 DOI: 10.1080/1062936x.2020.1784271] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 06/15/2020] [Indexed: 06/11/2023]
Abstract
A quantitative structure-activity relationship (QSAR) model was built from a dataset of 54 peptide-type compounds as SARS-CoV inhibitors. The analysis was executed to identify prominent and hidden structural features that govern anti-SARS-CoV activity. The QSAR model was derived from the genetic algorithm-multi-linear regression (GA-MLR) methodology. This resulted in the generation of a statistically robust and highly predictive model. In addition, it satisfied the OECD principles for QSAR validation. The model was validated thoroughly and fulfilled the threshold values of a battery of statistical parameters (e.g. r 2 = 0.87, Q 2 loo = 0.82). The derived model is successful in identifying many atom-pairs as important structural features that govern the anti-SARS-CoV activity of peptide-type compounds. The newly developed model has a good balance of descriptive and statistical approaches. Consequently, the present work is useful for future modifications of peptide-type compounds for SARS-CoV and SARS-CoV-2 activity.
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Affiliation(s)
- V H Masand
- Department of Chemistry, Vidya Bharati Mahavidyalaya , Amravati, India
| | - V Rastija
- Department of Chemistry, Faculty of Agrobiotechnical Sciences, Josip Juraj Strossmayer University of Osijek , Osijek, Croatia
| | - M K Patil
- Department of Chemistry, Dr. Babasaheb Ambedkar Marathwada University , Aurangabad, India
| | - A Gandhi
- Department of Chemistry, Government College of Arts and Science , Aurangabad, India
| | - A Chapolikar
- Department of Chemistry, Government College of Arts and Science , Aurangabad, India
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26
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Kamali A, Sullivan KC, Rahmani F, Gandhi A, Aein A, Arevalo O, Rabiei P, Choi SJ, Zhang X, Gabr RE, Riascos RF. Indentation and Transverse Diameter of the Meckel Cave: Imaging Markers to Diagnose Idiopathic Intracranial Hypertension. AJNR Am J Neuroradiol 2020; 41:1487-1494. [PMID: 32763895 DOI: 10.3174/ajnr.a6682] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 10/14/2019] [Accepted: 05/19/2020] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Clinical and imaging manifestations of idiopathic intracranial hypertension should prompt early diagnosis and treatment to avoid complications. Multiple diagnostic imaging criteria are reported to suggest the diagnosis of idiopathic intracranial hypertension with questionable sensitivity and/or specificity. Increased intracranial pressure results in dilation of the perineural cisternal spaces such as the optic nerve sheaths and the Meckel cave. It may also cause protrusion of cisternal structures of the Meckel cave through the skull base foramina, which could result in indentation or a bilobed appearance of the Meckel cave. We investigated the changes in the Meckel cave in patients with proved idiopathic intracranial hypertension versus healthy controls. MATERIALS AND METHODS We studied 75 patients with a diagnosis of idiopathic intracranial hypertension and 75 age-and sex-matched healthy controls. The transverse diameter of Meckel cave was measured in the axial and coronal planes of T2-weighted MR imaging sequences, and comparison was made between the 2 groups. RESULTS The mean diameters of the Meckel cave on the coronal T2 plane in patients with idiopathic intracranial hypertension were 5.21 ± 1.22 mm on the right side and 5.16 ± 0.90 mm on the left side, while in the control group, they measured 3.89 ± 0.62 mm and 4.09 ± 0.68 mm, respectively (P value < .001). Of 75 patients with an approved diagnosis of idiopathic intracranial hypertension, 57 (76%) showed an indented Meckel cave as opposed to 21 (28%) in the control group. CONCLUSIONS Our results confirm for the first time that the shape and size of the Meckel cave can be used as sensitive and specific diagnostic imaging markers for the diagnosis of idiopathic intracranial hypertension.
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Affiliation(s)
- A Kamali
- From the Department of Diagnostic Radiology (A.K., A.A., O.A., P.R., X.Z., R.E.G., R.F.R.), University of Texas at Houston, Houston, Texas
| | - K C Sullivan
- University of Texas Medical School Health Science Center Houston (K.C.S., S.J.C.), Houston, Texas
| | - F Rahmani
- Neuroimaging Laboratory at Mallinckrodt Institute of Radiology (F.R.), Washington University School of Medicine, St. Louis, Missouri
| | - A Gandhi
- Rice University (A.G.), Houston, Texas
| | - A Aein
- From the Department of Diagnostic Radiology (A.K., A.A., O.A., P.R., X.Z., R.E.G., R.F.R.), University of Texas at Houston, Houston, Texas
| | - O Arevalo
- From the Department of Diagnostic Radiology (A.K., A.A., O.A., P.R., X.Z., R.E.G., R.F.R.), University of Texas at Houston, Houston, Texas
| | - P Rabiei
- From the Department of Diagnostic Radiology (A.K., A.A., O.A., P.R., X.Z., R.E.G., R.F.R.), University of Texas at Houston, Houston, Texas
| | - S J Choi
- University of Texas Medical School Health Science Center Houston (K.C.S., S.J.C.), Houston, Texas
| | - X Zhang
- From the Department of Diagnostic Radiology (A.K., A.A., O.A., P.R., X.Z., R.E.G., R.F.R.), University of Texas at Houston, Houston, Texas
| | - R E Gabr
- From the Department of Diagnostic Radiology (A.K., A.A., O.A., P.R., X.Z., R.E.G., R.F.R.), University of Texas at Houston, Houston, Texas
| | - R F Riascos
- From the Department of Diagnostic Radiology (A.K., A.A., O.A., P.R., X.Z., R.E.G., R.F.R.), University of Texas at Houston, Houston, Texas
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27
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Garimella N, Zere T, Hartman N, Gandhi A, Bekele A, Li X, Stone H, Sacks L, Weaver JL. Effect of drug combinations on the kinetics of antibiotic resistance emergence in Escherichia coli CFT073 using an in vitro hollow-fibre infection model. Int J Antimicrob Agents 2019; 55:105861. [PMID: 31838036 DOI: 10.1016/j.ijantimicag.2019.105861] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 09/18/2019] [Revised: 11/04/2019] [Accepted: 12/08/2019] [Indexed: 11/30/2022]
Abstract
Antibiotic resistance is one of the major threats to public health today. To address this problem requires an urgent comprehensive approach. Strategic and multitargeted combination therapy has been increasingly used clinically to treat bacterial infections. The hollow-fibre infection model (HFIM) is a well-controlled in vitro bioreactor system that is increasingly being used in the assessment of resistance emergence with monotherapies and combination antibiotic therapies. In this study, the HFIM was evaluated as a reliable in vitro method to quantitatively and reproducibly analyse the emergence of antibiotic resistance using ampicillin, fosfomycin and ciprofloxacin and their simultaneous combinations against Escherichia coli CFT073, a clinical uropathogenic strain. Bacteria were exposed to clinically relevant pharmacokinetic (PK) concentrations of the drugs for 10 days. Drug and bacterial samples were collected at different time points for PK analysis and to enumerate total and resistant bacterial populations, respectively. The results demonstrated that double or triple combinations significantly delayed the emergence of resistant E. coli CFT073 subpopulations. These findings suggest that strategic combinations of antimicrobials may play a role in controlling the emergence of resistance during treatment. Further animal and human trials will be needed to confirm this and to ensure that there is no adverse impact on the host microbiome or unexpected toxicity. The HFIM system could potentially be used to identify clinically relevant combination dosing regimens for use in a clinical trial evaluating the appearance of resistance to antibacterial drugs.
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Affiliation(s)
- Narayana Garimella
- Division of Applied Regulatory Science, Office of Clinical Pharmacology, Center for Drug Evaluation and Research, US Food and Drug Administration, USA
| | - Tesfalem Zere
- Division of Applied Regulatory Science, Office of Clinical Pharmacology, Center for Drug Evaluation and Research, US Food and Drug Administration, USA
| | - Neil Hartman
- Division of Applied Regulatory Science, Office of Clinical Pharmacology, Center for Drug Evaluation and Research, US Food and Drug Administration, USA
| | - Adarsh Gandhi
- Division of Applied Regulatory Science, Office of Clinical Pharmacology, Center for Drug Evaluation and Research, US Food and Drug Administration, USA
| | - Aschalew Bekele
- Division of Microbiology Assessment, Office of Product Quality, Center for Drug Evaluation and Research, US Food and Drug Administration, USA
| | - Xianbin Li
- Division of Biometrics IV, Office of Biostatistics, Center for Drug Evaluation and Research, US Food and Drug Administration, USA
| | - Heather Stone
- Office of Medical Policy, Center for Drug Evaluation and Research, US Food and Drug Administration, USA
| | - Leonard Sacks
- Office of Medical Policy, Center for Drug Evaluation and Research, US Food and Drug Administration, USA
| | - James L Weaver
- Division of Applied Regulatory Science, Office of Clinical Pharmacology, Center for Drug Evaluation and Research, US Food and Drug Administration, USA.
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28
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Gandhi A, Doughty J. Comment on: Management of the axilla following neoadjuvant chemotherapy for breast cancer. Br J Surg 2019; 106:1705. [PMID: 31639210 DOI: 10.1002/bjs.11415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 10/02/2019] [Indexed: 11/08/2022]
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29
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Vandenbroucke T, Verheecke M, van Gerwen M, Van Calsteren K, Halaska M, Fumagalli M, Fruscio R, Veening M, Lagae L, Ottevanger P, Voigt JU, de Haan J, Gziri M, Gandhi A, Maggen C, Mertens L, Naulaers G, Claes L, Amant F. Child development at 6 years after maternal cancer diagnosis and treatment during pregnancy. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz265.075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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30
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Mallen A, Townsend M, Boac B, Todd S, Gandhi A, Kuznicki M, Magliocco A, Fridley B, Tworoger S, Vadaparampil S, Wenham R. Predictive factors of genetic referral for advanced, epithelial ovarian cancer patients at a Single-Institution Cancer Center. Gynecol Oncol 2019. [DOI: 10.1016/j.ygyno.2019.03.191] [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: 10/26/2022]
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31
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Zavras PD, Wang Y, Gandhi A, Lontos K, Delgoffe GM. Evaluating tisagenlecleucel and its potential in the treatment of relapsed or refractory diffuse large B cell lymphoma: evidence to date. Onco Targets Ther 2019; 12:4543-4554. [PMID: 31354288 PMCID: PMC6572744 DOI: 10.2147/ott.s177844] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Accepted: 04/29/2019] [Indexed: 12/19/2022] Open
Abstract
Chimeric antigen receptor (CAR) T cells have changed the treatment landscape of relapsed or refractory diffuse large B cell lymphoma. This review focuses on the biology of tisagenlecleucel and the clinical data that support its use in this setting. In addition, we discuss how it compares to other CAR T products, the financial implications for payers, and ongoing trials.
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Affiliation(s)
- P D Zavras
- Infectious Disease Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Y Wang
- Tumor Microenvironment Center, UPMC Hillman Cancer Center, University of Pittsburgh, Pittsburgh, PA, USA.,School of Medicine, Tsinghua University, Beijing, People's Republic of China
| | - A Gandhi
- Blood and Marrow Transplant Program, Department of Medicine, Stanford University, Stanford, CA, USA
| | - K Lontos
- Tumor Microenvironment Center, UPMC Hillman Cancer Center, University of Pittsburgh, Pittsburgh, PA, USA.,Division of Hematology/Oncology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - G M Delgoffe
- Tumor Microenvironment Center, UPMC Hillman Cancer Center, University of Pittsburgh, Pittsburgh, PA, USA.,Department of Immunology, University of Pittsburgh, Pittsburgh, PA, USA
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Gandhi A, Terrin M, Costa N, Young R, Wijesinha M, Vesselinov R, Young C, Kaczorowski D, Madathil R, Griffith B, Thomas B, Iacono A, Timofte I. Sirolimus Based Immunosuppression Regimen after Lung Transplantation Can Decrease CNI Related Nephrotoxicity. J Heart Lung Transplant 2019. [DOI: 10.1016/j.healun.2019.01.1046] [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: 10/27/2022] Open
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Timofte I, Terrin M, Gandhi A, Yang R, Wijesinha M, Vesselinov R, McLaughlin P, Costa N, Kaczorowski D, Madathil R, Griffith B, Iacono A. Inhaled Cyclosporine-Based Immunosuppression Regimen for Lung Transplant Associated Malignancy. J Heart Lung Transplant 2019. [DOI: 10.1016/j.healun.2019.01.548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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34
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Shah R, Gandhi A, Mistry Y. Experience of sentinel lymph node biopsy (SLNB) with Tc99 & gamma probe in early breast cancer – its cost, accuracy, complications in Kailash Cancer Hospital & Research Centre in rural India. Breast 2019. [DOI: 10.1016/s0960-9776(19)30382-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Verma A, Yadav B, Gandhi A, Kumar E, Thorve S, Soni R. Pipe stress analysis of first wall helium cooling system for conceptual design development of IN LLCB TBM. Fusion Engineering and Design 2018. [DOI: 10.1016/j.fusengdes.2018.09.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Pinder S, Shaaban A, Deb R, Desai A, Gandhi A, Lee A, Pain S, Wilkinson L, Sharma N. NHS Breast Screening multidisciplinary working group guidelines for the diagnosis and management of breast lesions of uncertain malignant potential on core biopsy (B3 lesions). Clin Radiol 2018; 73:682-692. [DOI: 10.1016/j.crad.2018.04.004] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Accepted: 04/11/2018] [Indexed: 10/28/2022]
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Shah P, Rohly M, Brown A, Timofte I, Nayyar M, Gandhi A, Kim N, Joshi A, Iacono A, Nathan S, Avery R, Orens J, Agbor-Enoh S, Valantine H. Donor Derived Cell Free DNA is Elevated With Pathogens That are Risk Factors For Chronic Lung Allograft Dysfunction. J Heart Lung Transplant 2018. [DOI: 10.1016/j.healun.2018.01.267] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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38
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Gandhi A, Matta M, Garimella N, Zere T, Weaver J. Development and validation of a LC-MS/MS method for quantitation of fosfomycin - Application to in vitro antimicrobial resistance study using hollow-fiber infection model. Biomed Chromatogr 2018; 32:e4214. [PMID: 29461629 DOI: 10.1002/bmc.4214] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Revised: 01/31/2018] [Accepted: 02/09/2018] [Indexed: 11/05/2022]
Abstract
Extensive use and misuse of antibiotics over the past 50 years has contributed to the emergence and spread of antibiotic-resistant bacterial strains, rendering them as a global health concern. To address this issue, a dynamic in vitro hollow-fiber system, which mimics the in vivo environment more closely than the static model, was used to study the emergence of bacterial resistance of Escherichia coli against fosfomycin (FOS). To aid in this endeavor we developed and validated a liquid chromatography-tandem mass spectrometry (LC-MS/MS) assay for quantitative analysis of FOS in lysogeny broth. FOS was resolved on a Kinetex HILIC (2.1 × 50 mm, 2.6 μm) column with 2 mm ammonium acetate (pH 4.76) and acetonitrile as mobile phase within 3 min. Multiple reaction monitoring was used to acquire data on a triple quadrupole mass spectrometer. The assay was linear from 1 to 1000 μg/mL. Inter- and intra-assay precision and accuracy were <15% and between ±85 and 115% respectively. No significant matrix effect was observed when corrected with the internal standard. FOS was stable for up to 24 h at room temperature, up to three freeze-thaw cycles and up to 24 h when stored at 4°C in the autosampler. In vitro experimental data were similar to the simulated plasma pharmacokinetic data, further confirming the appropriateness of the experimental design to quantitate antibiotics and study occurrence of antimicrobial resistance in real time. The validated LC-MS/MS assays for quantitative determination of FOS in lysogeny broth will help antimicrobial drug resistance studies.
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Affiliation(s)
- Adarsh Gandhi
- Division of Applied Regulatory Science, Office of Clinical Pharmacology, Food and Drug Administration, Silver Spring, Maryland, USA
| | - Murali Matta
- Division of Applied Regulatory Science, Office of Clinical Pharmacology, Food and Drug Administration, Silver Spring, Maryland, USA
| | - Narayana Garimella
- Division of Applied Regulatory Science, Office of Clinical Pharmacology, Food and Drug Administration, Silver Spring, Maryland, USA
| | - Tesfalem Zere
- Division of Applied Regulatory Science, Office of Clinical Pharmacology, Food and Drug Administration, Silver Spring, Maryland, USA
| | - James Weaver
- Division of Applied Regulatory Science, Office of Clinical Pharmacology, Food and Drug Administration, Silver Spring, Maryland, USA
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Fedorov N, Grozdanov D, Bystritskiy V, Kopach Y, Ruskov I, Skoy V, Tretyakova T, Zamyatin N, Wang D, Aliev F, Hramco C, Gandhi A, Kumar A, Dabylova S, Bogolubov E, Barmakov Y. Measurements of the gamma-quanta angular distributions emitted from neutron inelastic scattering on 28Si. EPJ Web Conf 2018. [DOI: 10.1051/epjconf/201817702002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
The characteristic gamma radiation from the interaction of 14.1 MeV neutrons with a natural silicon sample is investigated with Tagged Neutron Method (TNM). The anisotropy of gamma-ray emission of 1.779 MeV was measured at 11 azimuth angles with a step of ∠15°. The present results are in good agreement with some recent experimental data.
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Yadav B, Gandhi A, Verma A, Sandeep K, Chaudhari V, Kumar ER. Helium cooling systems for Indian LLCB TBM testing in ITER. Fusion Engineering and Design 2017. [DOI: 10.1016/j.fusengdes.2017.05.097] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Abstract
Paroxysmal nocturnal hemoglobinuria (PNH) is a rare, acquired, potentially life-threatening disease of blood, characterized by complement-induced intravascular hemolytic anemia and thrombosis. PNH can sometimes present directly with renal manifestations, without showing any hematological manifestation. It, therefore, becomes essential for clinicians and pathologists to be aware of the spectrum of renal changes in PNH. The aim of this study was to document the morphologic changes observed in renal biopsies in patients with PNH. This is an observational study. We report three cases that presented with acute or chronic renal insufficiency and were suspected as PNH on viewing their renal biopsy in light of their clinical and laboratory details. All the three cases were confirmed as PNH on the basis of flow cytometric analysis of CD55 and CD59. Renal biopsy in these patients showed a variety of morphologic changes, however the most consistent finding was moderate-to-heavy siderosis in their kidneys. PNH per se may be difficult to diagnose clinically and sometimes present directly with renal manifestations. It is, therefore, prudent for nephrologists and nephropathologists to be aware of the spectrum of renal changes in PNH.
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Affiliation(s)
- V Puri
- Department of Pathology, University College of Medical Sciences, New Delhi, India
| | - A Gandhi
- Department of Pathology, University College of Medical Sciences, New Delhi, India
| | - S Sharma
- Department of Pathology, University College of Medical Sciences, New Delhi, India
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Kaur A, Verma R, Gandhi A, Riaz S, Vega-Sanchez M, Jaffe F, Yu D, Chatila W, D’alonzo G, Weaver S, Shariff T, Krachman S. 0631 EFFECT OF DISEASE SEVERITY ON DETERMINING BODY POSITION DURING SLEEP IN PATIENTS WITH POSITIONAL OBSTRUCTIVE SLEEP APNEA. Sleep 2017. [DOI: 10.1093/sleepj/zsx050.630] [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] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Gandhi A, Riaz S, Kaur A, Verma R, Vega-Sanchez M, Jaffe F, Yu D, Chatila W, D’alonzo G, Weaver S, Shariff T, Krachman S. 0570 INFLUENCE OF GENDER ON THE EFFECTIVENESS OF POSITIONAL THERAPY IN THE TREATMENT OF PATIENTS WITH POSITIONAL OBSTRUCTIVE SLEEP APNEA. Sleep 2017. [DOI: 10.1093/sleepj/zsx050.569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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44
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Muralidharan G, Gandhi A. Data on assessment of Acinetobacter sp. on growth and yield parameters of rice under field condition. Data Brief 2017; 11:403-407. [PMID: 28275674 PMCID: PMC5331148 DOI: 10.1016/j.dib.2017.02.039] [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: 01/06/2017] [Revised: 02/14/2017] [Accepted: 02/15/2017] [Indexed: 11/26/2022] Open
Abstract
In this paper, we presented the information on growth and yield parameters of rice genotype (BPT5204 and IR64) in field condition. Investigated strains are related to the research article “Assessment of zinc solubilizing potentiality of Acinetobacter sp. isolated from rice rhizosphere” [1]. The article describes the inoculation effect of Acinetobacter sp. on rice genotypes. The statistical analysis of the experimental data was carried out using social science SPSS software (ver. 16.0 for windows).
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Affiliation(s)
- G Muralidharan
- Department of Botany, Annamalai University, Annamalai Nagar 608002, Tamilnadu, India; H.H. The Rajah׳s College, Pudukkottai 622001, Tamilnadu, India
| | - A Gandhi
- Department of Botany, Annamalai University, Annamalai Nagar 608002, Tamilnadu, India
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Holt RE, Topps A, Lim YY, Gandhi A. Abstract P4-02-12: Tomosynthesis as an alternative to magnetic resonance imaging (MRI) in assessing invasive lobular carcinoma (ILC) multifocality. Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-p4-02-12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Introduction
Invasive lobular carcinoma is associated with a higher rate of multifocality than other types of breast cancer. Breast MRI is commonly performed in patients diagnosed with ILC to assess for additional disease prior to formulating a management plan. MRI may be both time consuming and costly and can delay treatment.
Recently tomosynthesis has become an adjunct in the assessment and diagnosis of breast cancer. It is readily available at the time of mammography therefore providing information at the one stop clinic. We proposed that it may be possible to use tomosynthesis to assess for multifocality in ILC in place of MRI.
Method
A retrospective review of all cases of ILC diagnosed at a single regional screening unit over a 3-year period was performed. Patients having surgery as primary treatment were included. Ninety-eight patients were identified, 29 having both MRI and tomosynthesis in addition to mammography and ultrasound scan as part of their assessment. Histological data was used to compare the two imaging modalities. Bland and Altman limits of agreement analysis was performed to assess the difference between MRI and tomosynthsis in these patients. An acceptable difference (the difference in values that is unlikely to influence management) was set at 5mm.
Results
The Bland and Altman limits of agreement analysis produced three graphs to demonstrate the difference between MRI and Tomosynthesis, MRI and histology size and Tomosynthesis and histology size. It shows that the average difference between MRI and Tomosynthesis = 3.8mm (95% limits of agreement: –19.2 to 26.8mm). The percentage of 'acceptable' differences (defined as ≤ 5mm) was 72% for MRI and tomosynthesis suggesting that there is good concordance between the two. Tumours measuring >30mm on MRI are perceived as smaller under Tomosynthesis.
The analysis demonstrated the average difference between MRI and histology values is -1.3 mm (95% limits of agreement = – 33.2 to 30.6)compared with an average difference between Tomosynthesis and histology of -5.1 mm (95% limits of agreement = – 27.7 to 17.5). The percentage of 'acceptable' differences (defined as ≤ 5 mm) was 48% for both MRI vs histology and Tomosynthesis vs histology, suggesting that neither is superior when compared to final histology results.
In three patients there were multifocal cancers identified on histology that had not been detected by any imaging modality. In one patient there were MRI images that suggested a second tumour which was not present on histological examination. The same is true for a patient diagnosed with a second cancer identified by tomosynthesis but not found in the specimen. A third patient was diagnosed with a second tumour by both image modalities but again not present on histology. In one case tomosysnthesis detected a true second cancer that was not identified on MRI.
Conclusion
We believe this preliminary study suggests that tomosynthesis is equivocal to MRI for assessing multifocality in ILC. If confirmed the implications would be a shorter investigative pathway with reduced delays and costs. A larger mutli-centre trial to assess the use of tomosynthesis to replace MRI in patients with ILC is warranted.
Citation Format: Holt RE, Topps A, Lim YY, Gandhi A. Tomosynthesis as an alternative to magnetic resonance imaging (MRI) in assessing invasive lobular carcinoma (ILC) multifocality [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P4-02-12.
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Affiliation(s)
- RE Holt
- University Hospital of South Manchester NHS Trust, Manchester, United Kingdom; Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - A Topps
- University Hospital of South Manchester NHS Trust, Manchester, United Kingdom; Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - YY Lim
- University Hospital of South Manchester NHS Trust, Manchester, United Kingdom; Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - A Gandhi
- University Hospital of South Manchester NHS Trust, Manchester, United Kingdom; Manchester Academic Health Science Centre, Manchester, United Kingdom
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Agarwal P, Sharma D, Gandhi A, Binjola A, Subramani V, Chander S. SU-F-P-46: Comparative Study Between Two Normalization Prescriptions for Accelerated Partial Breast Irradiation: A Dosimetric Study. Med Phys 2016. [DOI: 10.1118/1.4955753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Chilukuri S, Adulkar D, Subramaniam S, Mohammed N, Gandhi A, Kathirvel M, Swamy T, Kiran Kumar K, Yadala N. PO-0881: Patient selection for DIBH technique for left sided breast cancers: Impact of chest wall shape. Radiother Oncol 2016. [DOI: 10.1016/s0167-8140(16)32131-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Mallick P, Shah P, Gandhi A, Ghose R. Impact of obesity on accumulation of the toxic irinotecan metabolite, SN-38, in mice. Life Sci 2015; 139:132-8. [PMID: 26334566 DOI: 10.1016/j.lfs.2015.08.017] [Citation(s) in RCA: 9] [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: 04/27/2015] [Revised: 08/19/2015] [Accepted: 08/22/2015] [Indexed: 01/21/2023]
Abstract
AIM Our aim is to investigate the impact of high fat diet-induced obesity on plasma concentrations of the toxic irinotecan metabolite, SN-38, in mice. MAIN METHODS Diet-induced obese (DIO, 60% kcal fed) and lean mice (10% kcal fed) were treated orally with a single dose of 10mg/kg irinotecan to determine pharmacokinetic (PK) parameters. Feces and livers were collected for quantification of irinotecan and its metabolites (SN-38 & SN-38G). SN-38G formation by Ugt1a1 enzyme was analyzed in liver S9 fractions. Expression of the pro-inflammatory cytokine, TNF-α was determined in liver and plasma. Hepatic β-glucuronidase and carboxylesterase enzymes (CES) were also determined. KEY FINDINGS AUC0-8 and Cmax of SN-38 increased by 2-fold in DIO mice compared to their lean controls. This was accompanied by a~2-fold reduction in AUC0-8 and Cmax of SN-38G in DIO mice. There were no differences in the PK parameters of irinotecan in DIO or lean mice. Conversion of SN-38 to SN-38G by Ugt1a1 enzyme was reduced by ~2-fold in liver S9 fractions in DIO mice. Furthermore, in DIO mice, β-glucuronidase activity increased by 2-fold, whereas there was no change in CES activity. TNF-α mRNA expression was 3 fold higher in DIO mice. SIGNIFICANCE Our study demonstrates that reduced hepatic Ugt1a activity during obesity likely contributes to reduced glucuronidation, and results in higher levels of the toxic metabolite, SN-38. Thus, irinotecan dosage should be closely monitored for effective and safe chemotherapy in obese cancer patients who are at a higher risk of developing liver toxicity.
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Affiliation(s)
- Pankajini Mallick
- Department of Pharmacological and Pharmaceutical Sciences, University of Houston, Houston, TX, USA
| | - Pranav Shah
- Division of Pre-Clinical Innovation, National Center for Advancing Translational Sciences, Rockville, MD, USA
| | - Adarsh Gandhi
- Department of Bioanalysis and Physiology, Lundbeck Research Inc. USA, Paramus, NJ, USA
| | - Romi Ghose
- Department of Pharmacological and Pharmaceutical Sciences, University of Houston, Houston, TX, USA.
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Gandhi A, Ranganathan B, Thiryayi S, Rowland M, Yap B. Variations in single/two stage thyroidectomies for cancer may be due to differences in thyroid fine needle cytology provision. European Journal of Surgical Oncology (EJSO) 2015; 41:1033-8. [DOI: 10.1016/j.ejso.2015.04.010] [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] [Subscribe] [Scholar Register] [Received: 11/21/2014] [Revised: 04/06/2015] [Accepted: 04/18/2015] [Indexed: 10/23/2022]
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Abstract
Abstract
In this article, a new technology is described to manufacture open cell thermoplastic foamed sheets with the aid of surface-quenching phenomenon during an extrusion process. As the gas laden polymer extrudate exits the slit die, its surface is rapidly quenched which results in freezing of cells on the surface, while the cells at the core continue to grow and leads to development of open-cellular microstructure at the core. Influence of chill roll temperature was found to be extremely significant in developing porous morphological attributes. Subsequently, synergistic effect of physical blowing agent (N2) content and chill roll temperature was examined for their expansion ratio and foam thickness. Fascinatingly, with reduced chill roll temperatures open-cell microstructure and high expansion ratio was obtained although its thickness was observed to decrease. Further, influence of chill roll rotating speed on foam microstructure and expansion ratio was studied. Lower chill roll rotational speed resulted in development of open-cellular microstructure; while at higher speeds, closed cell morphology was obtained. The results coherently demonstrate that by controlling the chill roll temperatures; open-cellular microstructure can be developed in sheet extrusion foaming process.
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Affiliation(s)
- A. Gandhi
- Mechanical Engineering Department , Indian Institute of Technology, New Delhi , India
| | - N. Bhatnagar
- Mechanical Engineering Department , Indian Institute of Technology, New Delhi , India
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