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Lahiri D, Krishna KVM, Verma AK, Modak P, Vishwanadh B, Chattopadhyay S, Shibata T, Sharma SK, Sarkar SK, Clifton PH, Biswas A, Garg N, K Dey G. Comprehensive characterization of the structure of Zr-based metallic glasses. Sci Rep 2024; 14:4911. [PMID: 38418473 PMCID: PMC10902397 DOI: 10.1038/s41598-024-53509-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 02/01/2024] [Indexed: 03/01/2024] Open
Abstract
Structure of metallic glasses fascinates as the generic amorphous structural template for ubiquitous systems. Its specification necessitates determination of the complete hierarchical structure, starting from short-range-order (SRO) → medium-range-order (MRO) → bulk structure and free volume (FV) distribution. This link has largely remained elusive since previous investigations adopted one-technique-at-a-time approach, focusing on limited aspects of any one domain. Reconstruction of structure from experimental data inversion is non-unique for many of these techniques. As a result, complete and precise structural understanding of glass has not emerged yet. In this work, we demonstrate the first experimental pathway for reconstruction of the integrated structure, forZr 67 Ni 33 andZr 52 Ti 6 Al 10 Cu 18 Ni 14 glasses. Our strategy engages diverse (× 7) multi-scale techniques [XAFS, 3D-APT, ABED/NBED, FEM, XRD, PAS, FHREM] on the same glass. This strategy complemented mutual limitations of techniques and corroborated common parameters to generate complete, self-consistent and precise parameters. Further, MRO domain size and inter-void separation were correlated to identify the presence of FV at MRO boundaries. This enabled the first experimental reconstruction of hierarchical subset: SRO → MRO → FV → bulk structure. The first ever image of intermediate region between MRO domains emerged from this link. We clarify that determination of all subsets is not our objective; the essence and novelty of this work lies in directing the pathway towards finite solution, in the most logical and unambiguous way.
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Affiliation(s)
- Debdutta Lahiri
- High Pressure and Synchrotron Radiation Physics Division, Bhabha Atomic Research Centre, Mumbai, 400085, India.
| | - K V Mani Krishna
- Materials Science Division, Bhabha Atomic Research Centre, Mumbai, 400085, India
| | - Ashok K Verma
- High Pressure and Synchrotron Radiation Physics Division, Bhabha Atomic Research Centre, Mumbai, 400085, India.
| | - P Modak
- High Pressure and Synchrotron Radiation Physics Division, Bhabha Atomic Research Centre, Mumbai, 400085, India
| | - B Vishwanadh
- Materials Science Division, Bhabha Atomic Research Centre, Mumbai, 400085, India
| | - Soma Chattopadhyay
- Physical Sciences Department, Elgin Community College, 1700 Spartan Drive, Elgin, IL, 60123, USA
| | - Tomohiro Shibata
- Materials Science, Kennametal Inc., 1600 Technology Way, Latrobe, PA, 15650, USA
| | - S K Sharma
- Radiochemistry Division, Bhabha Atomic Research Centre, Mumbai, 400085, India
| | - Sudip Kumar Sarkar
- Materials Science Division, Bhabha Atomic Research Centre, Mumbai, 400085, India
| | | | - A Biswas
- Materials Science Division, Bhabha Atomic Research Centre, Mumbai, 400085, India
| | - Nandini Garg
- High Pressure and Synchrotron Radiation Physics Division, Bhabha Atomic Research Centre, Mumbai, 400085, India
| | - G K Dey
- Materials Group, Bhabha Atomic Research Centre, Mumbai, 400085, India
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Ivaškevičius V, Biswas A, Singh S, Stulpinaitė U, Reda S, Rühl H, Pezeshkpoor B, Pavlova A, Oldenburg J. Fibrinogen Bonn (p. Arg510Cys) in the Aα-Chain Is Associated with High Risk of Venous Thrombosis. Hamostaseologie 2023; 43:440-446. [PMID: 37442158 DOI: 10.1055/a-2094-7191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/15/2023] Open
Abstract
INTRODUCTION Inherited dysfibrinogenemia is a qualitative defect of fibrinogen caused by various mutations among three fibrinogen genes. Dysfibrinogenemia can be associated with an increased risk of thrombosis, bleeding, or both. Here, we report a 36-year-old female with dysfibrinogenemia who experienced two successful pregnancies under thromboprophylaxis after cerebral venous sinus thrombosis (CVST). PATIENTS AND METHODS In addition to plasmatic coagulation tests, fibrinogen genes FGA, FGB, and FGG were screened using direct genomic DNA sequencing. The structural-functional implications of the detected mutation were analyzed in silico. RESULTS Inherited dysfibrinogenemia was diagnosed in an index patient after CVST in a risk situation. Anticoagulation with warfarin was stopped after 12 months when the first pregnancy was planned. Pregnancy and spontaneous delivery (2020) was uncomplicated. A second pregnancy was interrupted because of acute cytomegalovirus infection and the third pregnancy was successful in 2022. Pregnancies were accompanied by thromboprophylaxis with enoxaparin 40 mg once daily until 6 weeks postpartum. Substitution of fibrinogen has not become necessary in the index patient so far. Genetic analysis revealed a novel missense mutation (p. Arg510Cys) in the FGA gene ("fibrinogen Bonn") in the index patient, as well as an asymptomatic sister, and their father who experienced recurrent pulmonary embolism. Surface exposure of wild-type Arg510 suggested the mutated Cys510 to form nonnative disulfide bonds with surface-exposed reactive cysteines from other plasma proteins like albumin leading to formation of aggregates and impaired fibrinolysis. CONCLUSIONS Fibrinogen Bonn might be associated with an increased risk of thrombosis, possibly due to impaired polymerization.
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Affiliation(s)
- V Ivaškevičius
- Institute for Experimental Hematology and Transfusion Medicine, University Hospital Bonn, Bonn, Germany
| | - A Biswas
- Institute for Experimental Hematology and Transfusion Medicine, University Hospital Bonn, Bonn, Germany
| | - S Singh
- Institute for Experimental Hematology and Transfusion Medicine, University Hospital Bonn, Bonn, Germany
| | - U Stulpinaitė
- Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - S Reda
- Institute for Experimental Hematology and Transfusion Medicine, University Hospital Bonn, Bonn, Germany
| | - H Rühl
- Institute for Experimental Hematology and Transfusion Medicine, University Hospital Bonn, Bonn, Germany
| | - B Pezeshkpoor
- Institute for Experimental Hematology and Transfusion Medicine, University Hospital Bonn, Bonn, Germany
| | - A Pavlova
- Institute for Experimental Hematology and Transfusion Medicine, University Hospital Bonn, Bonn, Germany
| | - J Oldenburg
- Institute for Experimental Hematology and Transfusion Medicine, University Hospital Bonn, Bonn, Germany
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Biswas A, Roy S, Ghosh V, Kumar L, Sharma A, Gupta R, Mallick S. Clinical Outcome and Patterns of Failure in Patients with Solitary Plasmacytoma Treated with Radical Radiotherapy. Int J Radiat Oncol Biol Phys 2023; 117:S109. [PMID: 37784287 DOI: 10.1016/j.ijrobp.2023.06.073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) We intended to assess the patterns of care and failure in patients with solitary plasmacytoma (SP), treated at our institute from 2011-21. MATERIALS/METHODS Data pertaining to the management of patients with SP was abstracted by retrospective chart review. Progression free survival (PFS) and overall survival (OS) were defined as the time intervals from the date of diagnosis to the date of progression (local, systemic or both) and death or last follow up, respectively. PFS and OS were analyzed by Kaplan Meier method. RESULTS Atotal of 72 patients were diagnosed with SP (61-bone plasmacytoma; 11-extramedullary plasmacytoma) in between 2011 and 2021. The median age at diagnosis was 52 years. The male: female ratio was 2.27. The ECOG PS were 0, 1, 2, 3, and 4 in 1, 46, 11, 10, and 3 patients, respectively. The median diameter of the lesion was 6.7 cm (range 2.3-18.4 cm). The median M protein was 0.375 g/dl (range 0.63-5.3 g/dl). On bone marrow examination, 8 and 64 patients had no and minimal marrow involvement, respectively (median bone marrow plasma cells 4%). Radical radiotherapy (RT) was administered in 71 patients, the techniques being 2D-conventional in 35, 3D-conformal in 14, IMRT in 8 and VMAT in 5 patients (details not available in 9). The median RT dose was 45 Gy in 25 fractions over 5 weeks (range 45-50 Gy). In addition, 5(7%) patients underwent surgery prior to RT and 6(8.5%) patients received systemic chemotherapy. After RT, the median quantum of symptom relief was 75% (range 0-100%). The best response to RT was CR, PR, SD and PD in 41(57.7%),18(25.4%),3(4.2%) and 4(5.6%) patients, respectively (response assessment could not be done in 5). Local control with primary RT was achieved in 58(81.7%) patients. No RT related grade 3/4 acute or late toxicity was reported. The median follow up was 48.3 months (range 1.3-141.6 months). A total of 28(39.4%) patients experienced disease progression (systemic in 15, local in 7 and both in 6), out of which 13 could be successfully salvaged with further systemic chemotherapy (mostly bortezomib, lenalidomide/pomalidomide and dexamethasone based) with or without local treatment. On progression to multiple myeloma, 9 patients underwent high dose chemotherapy(melphalan) followed by autologous stem cell transplant. Nine (12.7%) patients died, the causes being COVID-19 infection in 1, surgical complications in 1, PD in 2, second malignancies in 3 and unknown in 2. The actuarial rates of PFS & OS were 58.4% & 92.5% at 3 years and 50.3% & 89.4% at 5 years, respectively. Metachronous second malignancies were noted in 4 patients (B-ALL-1, lung cancer-1, metastatic carcinoma cervix-1, metastatic carcinoma gall bladder-1). CONCLUSION In patients with SP, radical RT with a modest dose (45-50 Gy) leads to satisfactory symptom relief, response and local control. Close to 40% patients eventually progress to multiple myeloma, out of which 50% can be successfully salvaged with further systemic chemotherapy. The 5-year OS approaches 90% in this cohort.
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Affiliation(s)
- A Biswas
- All India Institute of Medical Sciences, New Delhi, India
| | - S Roy
- All India Institute of Medical Sciences, New Delhi, India
| | - V Ghosh
- All India Institute of Medical Sciences, New Delhi, India
| | - L Kumar
- All India Institute of Medical Sciences, New Delhi, India
| | - A Sharma
- All India Institute of Medical Sciences, New Delhi, India
| | - R Gupta
- All India Institute of Medical Sciences, New Delhi, India
| | - S Mallick
- All India Institute of Medical Sciences, New Delhi, India
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Pattanaik J, Bhasker S, Biswas A, R AV, Sharma A, Pramanik R, Kumar R, Sanyal S, Samala SK, Ghosh V, Sushant S, Pandey S, Tanwar MS, Praveen DVS, Mandal S. Patient-Reported Outcomes Evaluating the Impact of Hypo-Fractionated Palliative Quadshot Radiotherapy and Concurrent CDDP Treatment on Health-Related Quality of Life in Patients with Locally Advanced Squamous Cell Carcinoma of the Head and Neck. Int J Radiat Oncol Biol Phys 2023; 117:S122. [PMID: 37784316 DOI: 10.1016/j.ijrobp.2023.06.461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) In locally advanced squamous cell carcinoma of the head and neck (LAHNSCC), the main goal of treatment remains survival while improving quality of life (QOL). In recent decades, there has been a paradigm shift in the measurement of clinical outcomes in patients diagnosed with cancer, focusing on the patient perspective by incorporating patient-reported outcomes (PROs). The primary objective of this study was to evaluate the improvement in quality of life with the use of cyclic hypo-fractionated palliative QUAD SHOT radiotherapy (RT) with concurrent cisplatin (CDDP) in previously untreated patients with incurable LAHNSCC. MATERIALS/METHODS In this prospective interventional phase- II study, 60 patients with locally advanced squamous cell carcinoma of the head and neck, majority stage IVB, ECOG PS ≤ 3, were treated with QUAD SHOT RT (14 Gy/4 fractions/2 days - BD with 6-hour interval and concurrent CDDP at 6 mg/m2. This treatment was repeated at 4-week intervals for 2 additional cycles if tumor progression did not occur. Serial changes in HR -QoL were assessed using EORTC QLQ C-30 and H&N-35) at 4 different time points. Statistical methods such as the Wilcoxon signed-rank test and Friedman test were used to compare QoL values at different time points with Bonferroni correction for multiple comparisons to control for type I errors. RESULTS The median global health score (GHS) at baseline was 41.667, with an initial increase in score at 4 weeks (50.00) and at 8 weeks (54.167) that did not continue at 12 weeks (41.667). Symptoms related to toxicities (speech, social contact, sticky saliva, dry mouth, senses in H&N 35) were lower after 4 weeks. Application of the Friedman test for four time points revealed significant improvement in role function at 4 weeks, which remained constant at 8 weeks but was not sustained at 12 weeks. Comparison of HN-35 symptom scores between the four time points showed improvement in symptoms such as pain, swallowing, and mouth opening at 4 and 8 weeks. The mean QLQ C30 summary score for these patients improved at four weeks but did not remain constant at 8 and 12 weeks. CONCLUSION Our study showed significant improvement in quality-of-life parameters and reduction in symptom burden at 4 and 8 weeks due to disease control and symptom palliation by QUADSHOT CTRT, while quality-of-life scores worsened and symptom scores were not maintained at 12 weeks due to disease progression and occurrence of acute toxicities. This phase II study may serve as the basis for designing a phase III randomized control trial to compare quality of life changes with QUADSHOT CTRT and other palliative CTRT regimens.
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Affiliation(s)
- J Pattanaik
- All India Institute of Medical Sciences, New Delhi, India
| | - S Bhasker
- All India Institute of Medical Sciences, New Delhi, India
| | - A Biswas
- All India Institute of Medical Sciences, New Delhi, India
| | - A V R
- All India Institute of Medical Sciences, New Delhi, India
| | - A Sharma
- All India Institute of Medical Sciences, New Delhi, India
| | - R Pramanik
- DM Medical Oncology, AIIMS New Delhi, Delhi, India
| | - R Kumar
- All India Institute of Medical Sciences, Delhi Cancer Registry, New Delhi, India
| | - S Sanyal
- All India Institute of Medical Sciences, New Delhi, India
| | - S K Samala
- All India Institute of Medical Sciences, New Delhi, India
| | - V Ghosh
- All India Institute of Medical Sciences, New Delhi, India
| | - S Sushant
- All India Institute of Medical Sciences, New Delhi, India
| | - S Pandey
- All India Institute of Medical Sciences, New Delhi, India
| | - M S Tanwar
- All India Institute of Medical Sciences, New Delhi, India
| | - D V S Praveen
- All India Institute of Medical Sciences, New Delhi, India
| | - S Mandal
- All India Institute of Medical Sciences, New Delhi, India
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Singh UB, Ray Y, Kanswal S, Sharma HP, Aayilliath AK, Wig N, Ahuja V, Biswas A, Velpandian T. Low rifampicin levels in plasma associated with a poor clinical response in patients with abdominal TB. Int J Tuberc Lung Dis 2023; 27:787-789. [PMID: 37749829 PMCID: PMC10519389 DOI: 10.5588/ijtld.23.0149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 06/15/2023] [Indexed: 09/27/2023] Open
Affiliation(s)
- U B Singh
- Department of Microbiology, All India Institute of Medical Sciences (AIIMS), New Delhi
| | - Y Ray
- Department of Microbiology, All India Institute of Medical Sciences (AIIMS), New Delhi, Department of Medicine, AIIMS, New Delhi
| | - S Kanswal
- Centralized Core Research Facility, AIIMS, New Delhi
| | - H P Sharma
- Centralized Core Research Facility, AIIMS, New Delhi
| | - A K Aayilliath
- Department of Microbiology, All India Institute of Medical Sciences (AIIMS), New Delhi, Department of Medicine, AIIMS, New Delhi
| | - N Wig
- Department of Medicine, AIIMS, New Delhi
| | - V Ahuja
- Department of Gastroenterology, AIIMS, New Delhi
| | - A Biswas
- Department of Medicine, AIIMS, New Delhi
| | - T Velpandian
- Department of Ocular Pharmacology & Pharmacy, AIIMS, New Delhi, India
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Bhasker S, Pattanaik J, Biswas A, R AV, Sharma A, Pramanik R, Sanyal S, Praveen DVS, Kumar R, Sushant S, Ghosh V, Mandal S, Samala SK, Tanwar MS, Pandey S. Hypo-Fractionated Palliative QUADSHOT Radiotherapy and Concurrent CDDP in Patients with LAHNSCC: Toxicities and Clinical Outcomes. Int J Radiat Oncol Biol Phys 2023; 117:e567. [PMID: 37785734 DOI: 10.1016/j.ijrobp.2023.06.1893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Shorter palliative hypo-fractionated radiotherapy regimens given concurrently with chemotherapy, preferably cisplatin (radiosensitizer), increase response rates with acceptable toxicity, leading to better compliance of patients with locally advanced squamous cell carcinoma of the head and neck (LAHNSCC) in whom late toxicities due to chemoradiotherapy are less relevant. This single institution prospective interventional phase II study was conducted with the goal of achieving high rates of locoregional control with acceptable treatment-related toxicity. MATERIALS/METHODS In this prospective interventional phase- II study, 60 patients with LAHNSCC (treatment naive), the majority in stage IVB and ECOG PS ≤ 3, were treated with QUAD SHOT RT using the conventional 2D technique (14Gy in 4 fractions on 2 consecutive days twice daily with a 6-hour interval between the two fractions) and concurrent cisplatin (CDDP) at a dose of 6 mg/m2. This treatment was repeated at 4-week intervals for 2 additional cycles if tumor progression did not occur. The Kaplan-Meier method was used to determine survival probability for progression-free survival (PFS) and overall survival (OS). Descriptive statistics with number and percentage were used for each toxicity and tumor response at different time points. A P value of less than 0.05 was considered significant. RESULTS In our study, all patients received at least one cycle of QUADSHOT chemoradiotherapy (CTRT), while 35 and 18 patients received the 2nd and 3rd QUADSHOT CTRT, respectively. Of the patients who completed the first cycle of QUADSHOT CTRT, 27 (45%) patients had a partial response (PR) and 22 (36.7%) had stable disease (SD). Of the patients who completed the second cycle QUADSHOT CTRT, 77.2% had SD, while 11.4% had PR and 11.4% had PD. After the 3rd QUADSHOT CTRT, 72.2% had SD, while 11.1% had PR and 16.7% had PD. The overall response rate (SD +PR) in our study was 81%, 88.6%, and 83% after the 1st, 2nd, and 3rd QUADSHOT CTRT, respectively. After the 3rd QUADSHOT CTRT, no patient showed grade 4 toxicity. Most patients had grade I/ II toxicities e.g., skin (grade I -83%), mucositis (grade II -50%), salivary gland toxicity (grade II -50%), grade I laryngitis (83.3%). Grade- III oral mucositis and pharyngitis were seen in 27% and 6.7% of patients, respectively. Median OS and PFS were 7.9 months and 6.2 months, respectively. CONCLUSION Concurrent chemotherapy acts as a radiosensitizer and provides a synergistic effect when coupled with hypo-fractionated radiation, resulting in more effective control of locoregional disease in locally advanced head and neck tumors with acceptable toxicities. This study is hypothesis-generating and may serve as a basis for developing optimal CTRT regimens for patients with LAHNSCC who are not suitable for curative treatment.
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Affiliation(s)
- S Bhasker
- All India Institute of Medical Sciences, New Delhi, India
| | - J Pattanaik
- All India Institute of Medical Sciences, New Delhi, India
| | - A Biswas
- All India Institute of Medical Sciences, New Delhi, India
| | - A V R
- All India Institute of Medical Sciences, New Delhi, India
| | - A Sharma
- All India Institute of Medical Sciences, New Delhi, India
| | - R Pramanik
- DM Medical Oncology, AIIMS New Delhi, Delhi, India
| | - S Sanyal
- All India Institute of Medical Sciences, New Delhi, India
| | - D V S Praveen
- All India Institute of Medical Sciences, New Delhi, India
| | - R Kumar
- All India Institute of Medical Sciences, Delhi Cancer Registry, New Delhi, India
| | - S Sushant
- All India Institute of Medical Sciences, New Delhi, India
| | - V Ghosh
- All India Institute of Medical Sciences, New Delhi, India
| | - S Mandal
- All India Institute of Medical Sciences, New Delhi, India
| | - S K Samala
- All India Institute of Medical Sciences, New Delhi, India
| | - M S Tanwar
- All India Institute of Medical Sciences, New Delhi, India
| | - S Pandey
- All India Institute of Medical Sciences, New Delhi, India
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Abstract
Zika virus (ZIKV) is an arthropod-borne flavivirus that presents with acute febrile illness associated with rash, arthralgia and conjunctivitis. After years of sporadic reports in Africa, the three major outbreaks of this disease occurred in Yap Islands (2007), French Polynesia (2013-14) and South Americas (2015-16). Although, serological surveys suggested the presence of ZIKV in India in 1950s, cross-reactivity could not be ruled out. The first four proven cases of ZIKV from India were reported in 2017. This was followed by major outbreaks in the states of Rajasthan and Madhya Pradesh in 2018. Fortunately, the outbreaks in India were not associated with neurological complications. These outbreaks in India highlighted the spread of this disease beyond geographical barriers owing to the growing globalization, increased travel and ubiquitous presence of its vector, the Aedes mosquito. In this review, we discuss the epidemiology, clinical features and management of ZIKV in India.
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Affiliation(s)
- N Gupta
- From the Department of Medicine, All India Institute of Medical Sciences, 3rd Floor, Teaching Block, New Delhi 110029
| | - P Kodan
- From the Department of Medicine, All India Institute of Medical Sciences, 3rd Floor, Teaching Block, New Delhi 110029
| | - K Baruah
- National Vector Borne Disease Control Programme, Ministry of Health and Family Welfare, Government of India, 22 Shyam Nath Marg, New Delhi 110054, India
| | - M Soneja
- From the Department of Medicine, All India Institute of Medical Sciences, 3rd Floor, Teaching Block, New Delhi 110029
| | - A Biswas
- From the Department of Medicine, All India Institute of Medical Sciences, 3rd Floor, Teaching Block, New Delhi 110029
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Biswas A, McNamara C, Gowda VK, Gala F, Sudhakar S, Sidpra J, Vari MS, Striano P, Blaser S, Severino M, Batzios S, Mankad K. Neuroimaging Features of Biotinidase Deficiency. AJNR Am J Neuroradiol 2023; 44:328-333. [PMID: 36759144 PMCID: PMC10187823 DOI: 10.3174/ajnr.a7781] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 01/04/2023] [Indexed: 02/11/2023]
Abstract
Biotinidase deficiency is an autosomal recessive condition caused by pathogenic variants in the BTD gene. Resultant deficiency of free biotin leads to impaired activity of the enzyme carboxylase and related neurologic, dermatologic, and ocular symptoms. Many of these are reversible on treatment, but early recognition and commencement of biotin supplementation are critical. This practice is especially important in countries where routine neonatal screening for biotinidase deficiency is not performed. In this report comprising 14 patients from multiple centers, we demonstrate the MR imaging patterns of this disorder at various age groups. Knowledge of these patterns in the appropriate clinical context will help guide early diagnosis of this treatable metabolic disorder.
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Affiliation(s)
- A Biswas
- From the Department of Diagnostic Imaging (A.B., S. Blaser), The Hospital for Sick Children, Toronto, Ontario, Canada
- Departments of Neuroradiology (A.B., C.M., S.S., J.S., K.M.)
| | - C McNamara
- Departments of Neuroradiology (A.B., C.M., S.S., J.S., K.M.)
| | - V K Gowda
- Department of Pediatric Neurology (V.K.G.), Indira Gandhi Institute of Child Health, Bengaluru, Karnataka, India
| | - F Gala
- Department of Radiodiagnosis (F.G.), Bai Jerbai Wadia Hospital, Mumbai, Maharashtra, India
| | - S Sudhakar
- Departments of Neuroradiology (A.B., C.M., S.S., J.S., K.M.)
| | - J Sidpra
- Departments of Neuroradiology (A.B., C.M., S.S., J.S., K.M.)
- Developmental Biology and Cancer Section (J.S.), University College London Great Ormond Street Institute of Child Health, London, UK
| | - M S Vari
- Pediatric Neurology and Muscular Diseases Unit (M.S.V., P.S.)
| | - P Striano
- Pediatric Neurology and Muscular Diseases Unit (M.S.V., P.S.)
| | - S Blaser
- From the Department of Diagnostic Imaging (A.B., S. Blaser), The Hospital for Sick Children, Toronto, Ontario, Canada
| | - M Severino
- Neuroradiology Unit (M.S.), Istituto di Ricovero e Cura a Carattere Scientifico Istituto Giannina Gaslini, Genoa, Italy
| | - S Batzios
- Paediatric Metabolic Medicine (S. Batzios), Great Ormond Street Hospital for Children, National Health Service Foundation Trust, London, UK
| | - K Mankad
- Departments of Neuroradiology (A.B., C.M., S.S., J.S., K.M.)
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White K, Connor K, Meylan M, Bougoüin A, Salvucci M, Bielle F, O'Farrell AC, Sweeney K, Weng L, Bergers G, Dicker P, Ashley DM, Lipp ES, Low JT, Zhao J, Wen P, Prins R, Verreault M, Idbaih A, Biswas A, Prehn JHM, Lambrechts D, Arijs I, Lodi F, Dilcan G, Lamfers M, Leenstra S, Fabro F, Ntafoulis I, Kros JM, Cryan J, Brett F, Quissac E, Beausang A, MacNally S, O'Halloran P, Clerkin J, Bacon O, Kremer A, Chi Yen RT, Varn FS, Verhaak RGW, Sautès-Fridman C, Fridman WH, Byrne AT. Identification, validation and biological characterisation of novel glioblastoma tumour microenvironment subtypes: implications for precision immunotherapy. Ann Oncol 2023; 34:300-314. [PMID: 36494005 DOI: 10.1016/j.annonc.2022.11.008] [Citation(s) in RCA: 24] [Impact Index Per Article: 24.0] [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: 05/05/2022] [Revised: 11/14/2022] [Accepted: 11/15/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND New precision medicine therapies are urgently required for glioblastoma (GBM). However, to date, efforts to subtype patients based on molecular profiles have failed to direct treatment strategies. We hypothesised that interrogation of the GBM tumour microenvironment (TME) and identification of novel TME-specific subtypes could inform new precision immunotherapy treatment strategies. MATERIALS AND METHODS A refined and validated microenvironment cell population (MCP) counter method was applied to >800 GBM patient tumours (GBM-MCP-counter). Specifically, partition around medoids (PAM) clustering of GBM-MCP-counter scores in the GLIOTRAIN discovery cohort identified three novel patient clusters, uniquely characterised by TME composition, functional orientation markers and immune checkpoint proteins. Validation was carried out in three independent GBM-RNA-seq datasets. Neoantigen, mutational and gene ontology analysis identified mutations and uniquely altered pathways across subtypes. The longitudinal Glioma Longitudinal AnalySiS (GLASS) cohort and three immunotherapy clinical trial cohorts [treatment with neoadjuvant/adjuvant anti-programmed cell death protein 1 (PD-1) or PSVRIPO] were further interrogated to assess subtype alterations between primary and recurrent tumours and to assess the utility of TME classifiers as immunotherapy biomarkers. RESULTS TMEHigh tumours (30%) displayed elevated lymphocyte, myeloid cell immune checkpoint, programmed cell death protein 1 (PD-1) and cytotoxic T-lymphocyte-associated protein 4 transcripts. TMEHigh/mesenchymal+ patients featured tertiary lymphoid structures. TMEMed (46%) tumours were enriched for endothelial cell gene expression profiles and displayed heterogeneous immune populations. TMELow (24%) tumours were manifest as an 'immune-desert' group. TME subtype transitions upon recurrence were identified in the longitudinal GLASS cohort. Assessment of GBM immunotherapy trial datasets revealed that TMEHigh patients receiving neoadjuvant anti-PD-1 had significantly increased overall survival (P = 0.04). Moreover, TMEHigh patients treated with adjuvant anti-PD-1 or oncolytic virus (PVSRIPO) showed a trend towards improved survival. CONCLUSIONS We have established a novel TME-based classification system for application in intracranial malignancies. TME subtypes represent canonical 'termini a quo' (starting points) to support an improved precision immunotherapy treatment approach.
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Affiliation(s)
- K White
- Department of Physiology and Medical Physics, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - K Connor
- Department of Physiology and Medical Physics, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - M Meylan
- Centre de Recherche des Cordeliers, INSERM, Sorbonne Université, USPC, Université de Paris, Paris, France
| | - A Bougoüin
- Centre de Recherche des Cordeliers, INSERM, Sorbonne Université, USPC, Université de Paris, Paris, France
| | - M Salvucci
- Department of Physiology and Medical Physics, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - F Bielle
- Paris Brain Institute (ICM), CNRS UMR 7225, Inserm U 1127, UPMC-P6 UMR S 1127, Hôpital de la Pitié-Salpêtrière, Paris, France
| | - A C O'Farrell
- Department of Physiology and Medical Physics, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - K Sweeney
- National Centre of Neurosurgery, Beaumont Hospital, Dublin, Ireland
| | - L Weng
- VIB-KU Leuven Center for Cancer Biology, Department of Oncology, Leuven, Belgium
| | - G Bergers
- VIB-KU Leuven Center for Cancer Biology, Department of Oncology, Leuven, Belgium
| | - P Dicker
- Epidemiology & Public Health, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - D M Ashley
- Duke Cancer Institute, Duke University, Durham, USA
| | - E S Lipp
- Duke Cancer Institute, Duke University, Durham, USA
| | - J T Low
- Duke Cancer Institute, Duke University, Durham, USA
| | - J Zhao
- Department of Systems Biology at Columbia University, New York, USA
| | - P Wen
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, Boston, USA
| | - R Prins
- Department of Medical and Molecular Pharmacology, David Geffen School of Medicine, University of California, Los Angeles, USA
| | - M Verreault
- Paris Brain Institute (ICM), CNRS UMR 7225, Inserm U 1127, UPMC-P6 UMR S 1127, Hôpital de la Pitié-Salpêtrière, Paris, France
| | - A Idbaih
- Sorbonne Université, Inserm, CNRS, UMR S 1127, Paris Brain Institute (ICM), AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière-Charles Foix, Paris, France
| | - A Biswas
- Department of Physiology and Medical Physics, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - J H M Prehn
- Department of Physiology and Medical Physics, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - D Lambrechts
- Laboratory for Translational Genetics, Department of Human Genetics, Leuven, Belgium; VIB Center for Cancer Biology, Leuven, Belgium
| | - I Arijs
- Laboratory for Translational Genetics, Department of Human Genetics, Leuven, Belgium; VIB Center for Cancer Biology, Leuven, Belgium
| | - F Lodi
- Laboratory for Translational Genetics, Department of Human Genetics, Leuven, Belgium; VIB Center for Cancer Biology, Leuven, Belgium
| | - G Dilcan
- Laboratory for Translational Genetics, Department of Human Genetics, Leuven, Belgium; VIB Center for Cancer Biology, Leuven, Belgium
| | - M Lamfers
- Department of Neurosurgery, Brain Tumor Center, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - S Leenstra
- Department of Neurosurgery, Brain Tumor Center, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - F Fabro
- Department of Neurosurgery, Brain Tumor Center, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - I Ntafoulis
- Department of Neurosurgery, Brain Tumor Center, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - J M Kros
- Department of Pathology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - J Cryan
- Department of Neuropathology, Beaumont Hospital, Dublin, Ireland
| | - F Brett
- Department of Neuropathology, Beaumont Hospital, Dublin, Ireland
| | - E Quissac
- Paris Brain Institute (ICM), CNRS UMR 7225, Inserm U 1127, UPMC-P6 UMR S 1127, Hôpital de la Pitié-Salpêtrière, Paris, France
| | - A Beausang
- Department of Neuropathology, Beaumont Hospital, Dublin, Ireland
| | - S MacNally
- National Centre of Neurosurgery, Beaumont Hospital, Dublin, Ireland
| | - P O'Halloran
- National Centre of Neurosurgery, Beaumont Hospital, Dublin, Ireland
| | - J Clerkin
- National Centre of Neurosurgery, Beaumont Hospital, Dublin, Ireland
| | - O Bacon
- Department of Neuropathology, Beaumont Hospital, Dublin, Ireland
| | - A Kremer
- Information Technology for Translational Medicine (ITTM), Luxembourg, Luxembourg
| | - R T Chi Yen
- Information Technology for Translational Medicine (ITTM), Luxembourg, Luxembourg
| | - F S Varn
- The Jackson Laboratory for Genomic Medicine, Farmington, USA
| | - R G W Verhaak
- The Jackson Laboratory for Genomic Medicine, Farmington, USA; Department of Neurosurgery, Cancer Center Amsterdam, Amsterdam University Medical Centers, VU University Medical Center, Amsterdam, the Netherlands
| | - C Sautès-Fridman
- Centre de Recherche des Cordeliers, INSERM, Sorbonne Université, USPC, Université de Paris, Paris, France
| | - W H Fridman
- Centre de Recherche des Cordeliers, INSERM, Sorbonne Université, USPC, Université de Paris, Paris, France
| | - A T Byrne
- Department of Physiology and Medical Physics, Royal College of Surgeons in Ireland, Dublin, Ireland.
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Della Rosa M, Duranovich F, Pacheco D, Sandoval E, Khan A, Biswas A, Jonker A. Forage type affects the temporal methane emission profiles in dairy cows fed fresh forages. Anim Feed Sci Technol 2023. [DOI: 10.1016/j.anifeedsci.2023.115604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
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11
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Phillips S, Biswas A, Watson T. An assessment of learners’ child passenger safety knowledge. Am J Med Sci 2023. [DOI: 10.1016/s0002-9629(23)00198-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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12
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Sarkar P, Biswas A, Kumar R, Rai S, Jha SN, Bhattacharyya D. Role of C and B 4C barrier layers in controlling diffusion propagation across the interface of Cr/Sc multilayers. Phys Chem Chem Phys 2023; 25:3072-3082. [PMID: 36620902 DOI: 10.1039/d2cp03785h] [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: 01/10/2023]
Abstract
The optical performance of low-bilayer-thickness metallic multilayers (ML) can be improved significantly by limiting the intermixing of consecutive layers at the interfaces. Barrier layers are supposed to exhibit a decisive role in controlling diffusion across the interfaces. The element-specific grazing incidence extended X-ray absorption fine structure technique using synchrotron radiation has been used in conjunction with grazing incidence X-ray reflectivity and diffuse X-ray scattering measurements to study the impact of the two most common barrier layers, viz., C and B4C, at the interfaces of Cr/Sc MLs. The diffusion propagation is reduced by both the barrier layers; however, it is found that the improvement is more significant with the B4C barrier layer. It is seen that C forms an intermixed layer with Sc and leads to carbide formation at the interface, which then acts as shielding and prevents further interdiffusion, while B4C hardly penetrates into Sc and stops the overlap between Sc and Cr directly by wetting the corresponding interface. Thus, the above measurements reveal crucial and precise information regarding the elemental diffusion kinetics at the interfaces of Cr/Sc MLs in a non-destructive way, which is very important for technological applications of these MLs as X-ray optical devices.
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Affiliation(s)
- P Sarkar
- Atomic & Molecular Physics Division, Bhabha Atomic Research Centre, Mumbai 400 085, India.
| | - A Biswas
- Atomic & Molecular Physics Division, Bhabha Atomic Research Centre, Mumbai 400 085, India.
| | - Ravi Kumar
- Atomic & Molecular Physics Division, Bhabha Atomic Research Centre, Mumbai 400 085, India.
| | - S Rai
- Synchrotron Utilisation Section, Raja Ramnna Centre for Advanced Technology, Indore 752013, India
| | - S N Jha
- Beamline Development & Applications Section Bhabha Atomic Research Centre, Mumbai 400 085, India
| | - D Bhattacharyya
- Atomic & Molecular Physics Division, Bhabha Atomic Research Centre, Mumbai 400 085, India.
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Biswas A, Vega-Guzman J, Bansal A, Kara AH, Aphane M, Yildirim Y, Alshehri HM. Solitary waves, shock waves and conservation laws with the surface tension effect in the Boussinesq equation. PEAS 2023. [DOI: 10.3176/proc.2023.1.03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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14
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D'Arco F, Biswas A, Clement E, Rajput K, Juliano AF. Subtle Malformation of the Cochlear Apex and Genetic Abnormalities: Beyond the "Thorny" Cochlea. AJNR Am J Neuroradiol 2023; 44:79-81. [PMID: 36549853 PMCID: PMC9835904 DOI: 10.3174/ajnr.a7746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 11/15/2022] [Indexed: 12/24/2022]
Abstract
With the routine use of high-resolution heavily T2-weighted sequences to evaluate patients with hearing deficits, new, subtle phenotypes of cochlear malformations are being discovered and an increasing number of genotype-phenotype correlations are being found through a reverse phenotype approach, which can help guide geneticists. In this brief report, we present subtle malformations of the apical turn of the cochlea related to 3 genetic mutations, emphasizing the importance of a careful assessment of the cochlear apex.
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Affiliation(s)
- F D'Arco
- From the Department of Radiology (F.D., A.B.)
| | - A Biswas
- From the Department of Radiology (F.D., A.B.)
| | | | - K Rajput
- Audiological Medicine (K.R.), Great Ormond Street Hospital for Children, National Health Service Foundation Trust, London, UK
| | - A F Juliano
- Department of Radiology (A.F.J.), Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts
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Kanodia R, Kumar R, Biswas A, Bhasker S. 251P Is QUAD SHOT palliative cyclical hypo-fractionated radiotherapy in advanced head and neck cancer the way to go? An alternative regimen in low resource countries. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.10.064] [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: 12/05/2022] Open
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16
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Ahmad T, Desai NR, Yamamoto Y, Biswas A, Ghazi L, Martin M, Simonov M, Dhar R, Hsiao A, Kashyap N, Allen L, Velazquez EJ, Wilson FP. Alerting Clinicians to 1-Year Mortality Risk in Patients Hospitalized With Heart Failure: The REVEAL-HF Randomized Clinical Trial. JAMA Cardiol 2022; 7:905-912. [PMID: 35947362 PMCID: PMC9366654 DOI: 10.1001/jamacardio.2022.2496] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 06/21/2022] [Indexed: 01/18/2023]
Abstract
Importance Heart failure is a major cause of morbidity and mortality worldwide. The use of risk scores has the potential to improve targeted use of interventions by clinicians that improve patient outcomes, but this hypothesis has not been tested in a randomized trial. Objective To evaluate whether prognostic information in heart failure translates into improved decisions about initiation and intensity of treatment, more appropriate end-of-life care, and a subsequent reduction in rates of hospitalization or death. Design, Setting, and Participants This was a pragmatic, multicenter, electronic health record-based, randomized clinical trial across the Yale New Haven Health System, comprising small community hospitals and large tertiary care centers. Patients hospitalized for heart failure who had N-terminal pro-brain natriuretic peptide (NT-proBNP) levels of greater than 500 pg/mL and received intravenous diuretics within 24 hours of admission were automatically randomly assigned to the alert (intervention) or usual-care groups. Interventions The alert group had their risk of 1-year mortality calculated using an algorithm that was derived and validated using similar historic patients in the electronic health record. This estimate, including a categorical risk assessment, was presented to clinicians while they were interacting with a patient's electronic health record. Main Outcomes and Measures The primary outcome was a composite of 30-day hospital readmissions and all-cause mortality at 1 year. Results Between November 27, 2019, through March 7, 2021, 3124 patients were randomly assigned to the alert (1590 [50.9%]) or usual-care (1534 [49.1%]) group. The alert group had a median (IQR) age of 76.5 (65-86) years, and 796 were female patients (50.1%). Patients from the following race and ethnicity groups were included: 13 Asian (0.8%), 324 Black (20.4%), 136 Hispanic (8.6%), 1448 non-Hispanic (91.1%), 1126 White (70.8%), 6 other ethnicity (0.4%), and 127 other race (8.0%). The usual-care group had a median (IQR) age of 77 (65-86) years, and 788 were female patients (51.4%). Patients from the following race and ethnicity groups were included: 11 Asian (1.4%), 298 Black (19.4%), 162 Hispanic (10.6%), 1359 non-Hispanic (88.6%), 1077 White (70.2%), 13 other ethnicity (0.9%), and 137 other race (8.9%). Median (IQR) NT-proBNP levels were 3826 (1692-8241) pg/mL in the alert group and 3867 (1663-8917) pg/mL in the usual-care group. A total of 284 patients (17.9%) and 270 patients (17.6%) were admitted to the intensive care unit in the alert and usual-care groups, respectively. A total of 367 patients (23.1%) and 359 patients (23.4%) had a left ventricular ejection fraction of 40% or less in the alert and usual-care groups, respectively. The model achieved an area under the curve of 0.74 in the trial population. The primary outcome occurred in 619 patients (38.9%) in the alert group and 603 patients (39.3%) in the usual-care group (P = .89). There were no significant differences between study groups in the prescription of heart failure medications at discharge, the placement of an implantable cardioverter-defibrillator, or referral to palliative care. Conclusions and Relevance Provision of 1-year mortality estimates during heart failure hospitalization did not affect hospitalization or mortality, nor did it affect clinical decision-making. Trial Registration ClinicalTrials.gov Identifier NCT03845660.
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Affiliation(s)
- Tariq Ahmad
- Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, Connecticut
- Clinical and Translational Research Accelerator, Yale University School of Medicine, New Haven, Connecticut
| | - Nihar R. Desai
- Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, Connecticut
- Clinical and Translational Research Accelerator, Yale University School of Medicine, New Haven, Connecticut
| | - Yu Yamamoto
- Clinical and Translational Research Accelerator, Yale University School of Medicine, New Haven, Connecticut
| | - Aditya Biswas
- Clinical and Translational Research Accelerator, Yale University School of Medicine, New Haven, Connecticut
| | - Lama Ghazi
- Clinical and Translational Research Accelerator, Yale University School of Medicine, New Haven, Connecticut
| | - Melissa Martin
- Clinical and Translational Research Accelerator, Yale University School of Medicine, New Haven, Connecticut
| | - Michael Simonov
- Joint Data Analytics Team, Yale University School of Medicine, New Haven, Connecticut
| | - Ravi Dhar
- Department of Psychology, Yale University, New Haven, Connecticut
- Department of Management and Marketing, Yale School of Management, New Haven, Connecticut
| | - Allen Hsiao
- Joint Data Analytics Team, Yale University School of Medicine, New Haven, Connecticut
| | - Nitu Kashyap
- Joint Data Analytics Team, Yale University School of Medicine, New Haven, Connecticut
| | - Larry Allen
- Division of Cardiology, University of Colorado School of Medicine, Aurora
| | - Eric J. Velazquez
- Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - F. Perry Wilson
- Clinical and Translational Research Accelerator, Yale University School of Medicine, New Haven, Connecticut
- Section of Nephrology, Yale University School of Medicine, New Haven, Connecticut
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Ghazi L, Li F, Chen X, Simonov M, Yamamoto Y, Biswas A, Hanna J, Shah T, Peixoto AJ, Wilson FP. Blood pressure response to commonly administered antihypertensives for severe inpatient hypertension. PLoS One 2022; 17:e0265497. [PMID: 35385506 PMCID: PMC8985959 DOI: 10.1371/journal.pone.0265497] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 03/02/2022] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Blood pressure (BP) elevations are commonly treated in hospitalized patients; however, treatment is not guideline directed. Our objective was to assess BP response to commonly prescribed antihypertensives after the development of severe inpatient hypertension (HTN). METHODS This is a cohort study of adults, excluding intensive care unit patients, within a single healthcare system admitted for reasons other than HTN who developed severe HTN (systolic BP>180 or diastolic BP >110 mmHg at least 1 hour after admission). We identified the most commonly administered antihypertensives given within 6 hours of severe HTN (given to >10% of treated patients). We studied the association of treatment with each antihypertensive vs. no treatment on BP change in the 6 hours following severe HTN development using mixed-effects model after adjusting for demographics and clinical characteristics. RESULTS Among 23,147 patients who developed severe HTN, 9,166 received antihypertensive treatment. The most common antihypertensives given were oral metoprolol (n = 1991), oral amlodipine (n = 1812), oral carvedilol (n = 1116), IV hydralazine (n = 1069) and oral hydralazine (n = 953). In the fully adjusted model, treatment with IV hydralazine led to 13 [-15.9, -10.1], 18 [-22.2, -14] and 11 [-14.1, -8.3] mmHg lower MAP, SBP, and DBP in the 6 hours following severe HTN development compared to no treatment. Treatment with oral hydralazine and oral carvedilol also resulted in significantly lower BPs in the 6 hours following severe HTN development (6 [-9.1, -2.1 and -7 [-9.1, -4.2] lower MAP, respectively) compared to no treatment. Receiving metoprolol and amlodipine did not result in a drop in BP compared to no treatment. CONCLUSION Among commonly used antihypertensives, IV hydralazine resulted in the most significant drop in BP following severe HTN, while metoprolol and amlodipine did not lower BP. Further research to assess the effect of treatment on clinical outcomes and if needed which antihypertensives to administer are necessary.
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Affiliation(s)
- Lama Ghazi
- Department of Internal Medicine, Clinical and Translational Research Accelerator, Yale University, New Haven, CT, United States of America
- * E-mail:
| | - Fan Li
- Department of Biostatistics, Yale School of Public Health, New Haven, CT, United States of America
| | - Xinyuan Chen
- Department of Mathematics and Statistics, Mississippi State University, Mississippi State, MS, United States of America
| | - Michael Simonov
- Department of Internal Medicine, Clinical and Translational Research Accelerator, Yale University, New Haven, CT, United States of America
| | - Yu Yamamoto
- Department of Internal Medicine, Clinical and Translational Research Accelerator, Yale University, New Haven, CT, United States of America
| | - Aditya Biswas
- Department of Internal Medicine, Clinical and Translational Research Accelerator, Yale University, New Haven, CT, United States of America
| | - Jonathan Hanna
- Department of Internal Medicine, Yale School of Medicine, Yale University, New Haven, CT, United States of America
| | - Tayyab Shah
- Department of Internal Medicine, Yale School of Medicine, Yale University, New Haven, CT, United States of America
| | - Aldo J. Peixoto
- Department of Internal Medicine, Section of Nephrology, Yale School of Medicine, and the Hypertension Program, Yale New Haven Hospital Heart and Vascular Center, New Haven, CT, United States of America
| | - F. Perry Wilson
- Department of Internal Medicine, Clinical and Translational Research Accelerator, Yale University, New Haven, CT, United States of America
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Ghazi L, Li F, Chen X, Simonov M, Yamamoto Y, Biswas A, Hanna J, Shah T, Townsend R, Peixoto A, Wilson FP. Severe inpatient hypertension prevalence and blood pressure response to antihypertensive treatment. J Clin Hypertens (Greenwich) 2022; 24:339-349. [PMID: 35174627 PMCID: PMC8925013 DOI: 10.1111/jch.14431] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 12/20/2021] [Accepted: 12/27/2021] [Indexed: 12/15/2022]
Abstract
Severe hypertension (HTN) that develops during hospitalization is more common than admission for HTN; however, it is poorly studied, and treatment guidelines are lacking. Our goal is to characterize hospitalized patients who develop severe HTN and assess blood pressure (BP) response to treatment. This is a multi-hospital retrospective cohort study of adults admitted for reasons other than HTN who developed severe HTN. The authors defined severe inpatient HTN as the first documented BP elevation (systolic BP > 180 or diastolic BP > 110) at least 1 hour after admission. Treatment was defined as receiving antihypertensives (intravenous [IV] or oral) within 6h of BP elevation. As a measure of possible overtreatment, the authors studied the association between treatment and time to mean arterial pressure (MAP) drop ≥ 30% using the Cox proportional hazards model. Among 224 265 hospitalized adults, 10% developed severe HTN of which 40% were treated. Compared to patients who did not develop severe HTN, those who did were older, more commonly women and black, and had more comorbidities. Incident MAP drop ≥ 30% among treated and untreated patients with severe HTN was 2.2 versus 5.7/1000 person-hours. After adjustment, treated versus. untreated patients had lower rates of MAP drop ≥ 30% (hazard rate [HR]: 0.9 [0.8, 0.99]). However, those receiving only IV treatment versus untreated had greater rates of MAP drop ≥ 30% (1.4 [1.2, 1.7]). Overall, the authors found that clinically significant MAP drop is observed among inpatients with severe HTN irrespective of treatment, with greater rates observed among patients treated only with IV antihypertensives. Further research is needed to phenotype inpatients with severe HTN.
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Affiliation(s)
- Lama Ghazi
- Department of Internal Medicine, Clinical and Translational Research Accelerator, Yale University, New Haven, Connecticut, USA
| | - Fan Li
- Department of Biostatistics, Yale School of Public Health, New Haven, Connecticut, USA
| | - Xinyuan Chen
- Department of Mathematics and Statistics, Mississippi State University, Mississippi State, Mississippi, USA
| | - Michael Simonov
- Department of Internal Medicine, Clinical and Translational Research Accelerator, Yale University, New Haven, Connecticut, USA
| | - Yu Yamamoto
- Department of Internal Medicine, Clinical and Translational Research Accelerator, Yale University, New Haven, Connecticut, USA
| | - Aditya Biswas
- Department of Internal Medicine, Clinical and Translational Research Accelerator, Yale University, New Haven, Connecticut, USA
| | - Jonathan Hanna
- Department of Internal Medicine, Yale School of Medicine, Yale University, New Haven, Connecticut, USA
| | - Tayyab Shah
- Department of Internal Medicine, Yale School of Medicine, Yale University, New Haven, Connecticut, USA
| | - Raymond Townsend
- Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Aldo Peixoto
- Department of Internal Medicine, Section of Nephrology, Yale School of Medicine, and the Hypertension Program, Yale New Haven Hospital Heart and Vascular Center, New Haven, Connecticut, USA
| | - F Perry Wilson
- Department of Internal Medicine, Clinical and Translational Research Accelerator, Yale University, New Haven, Connecticut, USA
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Biswas A, Amirabadi A, Wagner M, Ertl-Wagner B. Features of Visually AcceSAble Rembrandt Images: Interrater Reliability in Pediatric Brain Tumors. AJNR Am J Neuroradiol 2022; 43:304-308. [PMID: 35058297 PMCID: PMC8985665 DOI: 10.3174/ajnr.a7399] [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] [Received: 08/16/2021] [Accepted: 10/20/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND AND PURPOSE At present, no evidence-based lexicon exists for pediatric intracranial tumors. The Visually AcceSAble Rembrandt Images terminology describes reproducible MR imaging features of adult gliomas for prediction of tumor grade, molecular markers, and survival. Our aim was to assess the interrater reliability of the pre-resection features of Visually AcceSAble Rembrandt Images in pediatric brain tumors. MATERIALS AND METHODS Fifty consecutive pre-resection brain MR imaging examinations of pediatric intracranial neoplasms were independently reviewed by 3 neuroradiologists. The intraclass correlation coefficient for continuous variables and the Krippendorf alpha were used to evaluate the interrater agreement. Subgroup analysis was performed for 30 gliomas. RESULTS Parameters with almost perfect agreement (α > .8) included tumor location (F1) and proportion of enhancing tumor (F5). Parameters with substantial agreement (α = .61-.80) were side of tumor epicenter (F2), involvement of eloquent brain (F3), enhancement quality (F4), proportion of non-contrast-enhancing tumor (F6), and deep white matter invasion (F21). The other parameters showed either moderate (α = .41-.60; n = 11), fair (α = .21-.40; n = 5), or slight agreement (α = 0-.20; n = 1). Subgroup analysis of 30 gliomas showed almost perfect agreement for tumor location (F1), involvement of eloquent brain (F3), and proportion of enhancing tumor (F5); and substantial agreement for side of tumor epicenter (F2), enhancement quality (F4), proportion of noncontrast enhancing tumor (F6), cysts (F8), thickness of enhancing margin (F11), and deep white matter invasion (F21). The intraclass correlation coefficient for measurements in the axial plane was excellent in both the main group (0.984 [F29] and 0.982 [F30]) and the glioma subgroup (0.973 [F29] and 0.973 [F30]). CONCLUSIONS Nine features of Visually AcceSAble Rembrandt Images have an acceptable interrater agreement in pediatric brain tumors. For the subgroup of pediatric gliomas, 11 features of Visually AcceSAble Rembrandt Images have an acceptable interrater agreement. The low degree of reproducibility of the remainder of the features necessitates the use of features tailored to the pediatric age group and is likely related to the more heterogeneous imaging morphology of pediatric brain tumors.
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Affiliation(s)
- A. Biswas
- From the Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, Ontario, Canada,Department of Medical Imaging, University of Toronto, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - A. Amirabadi
- From the Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, Ontario, Canada,Department of Medical Imaging, University of Toronto, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - M.W. Wagner
- From the Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, Ontario, Canada,Department of Medical Imaging, University of Toronto, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - B.B. Ertl-Wagner
- From the Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, Ontario, Canada,Department of Medical Imaging, University of Toronto, The Hospital for Sick Children, Toronto, Ontario, Canada
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Alshehri HM, Biswas A, González-Gaxiola O, Yildirim Y. Bright optical solitons with polynomial law of nonlinear refractive index by Adomian decomposition scheme. PEAS 2022. [DOI: 10.3176/proc.2022.3.02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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21
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Alngar ME, Alzahrani AK, Belic MR, Biswas A, Ekici M, Khan S, Zayed EM. Optical solitons in fiber Bragg gratings with quadratic-cubic law of nonlinear refractive index and cubic-quartic dispersive reflectivity. PEAS 2022. [DOI: 10.3176/proc.2022.2.05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Subramanian S, Biswas A, Alves C, Sudhakar S, Shekdar K, Krishnan P, Shroff M, Taranath A, Arrigoni F, Aldinger K, Leventer R, Dobyns W, Mankad K. ACTA2-Related Dysgyria: An Under-Recognized Malformation of Cortical Development. AJNR Am J Neuroradiol 2022; 43:146-150. [PMID: 34857515 PMCID: PMC8757559 DOI: 10.3174/ajnr.a7364] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 09/27/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND AND PURPOSE Pathogenic variants in the ACTA2 gene cause a distinctive arterial phenotype that has recently been described to be associated with brain malformation. Our objective was to further characterize gyral abnormalities in patients with ACTA2 pathogenic variants as per the 2020 consensus recommendations for the definition and classification of malformations of cortical development. MATERIALS AND METHODS We performed a retrospective, multicentric review of patients with proved ACTA2 pathogenic variants, searching for the presence of malformations of cortical development. A consensus read was performed for all patients, and the type and location of cortical malformation were noted in each. The presence of the typical ACTA2 arterial phenotype as well as demographic and relevant clinical data was obtained. RESULTS We included 13 patients with ACTA2 pathogenic variants (Arg179His mutation, n = 11, and Arg179Cys mutation, n = 2). Ninety-two percent (12/13) of patients had peri-Sylvian dysgyria, 77% (10/13) had frontal dysgyria, and 15% (2/13) had generalized dysgyria. The peri-Sylvian location was involved in all patients with dysgyria (12/12). All patients with dysgyria had a characteristic arterial phenotype described in ACTA2 pathogenic variants. One patient did not have dysgyria or the characteristic arterial phenotype. CONCLUSIONS Dysgyria is common in patients with ACTA2 pathogenic variants, with a peri-Sylvian and frontal predominance, and was seen in all our patients who also had the typical ACTA2 arterial phenotype.
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Affiliation(s)
- S. Subramanian
- From the Division of Pediatric Radiology (S.S.), Department of Radiology, UPMC Children’s Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - A. Biswas
- Department of Diagnostic Imaging (A.B., P.K., M.S.), The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | | | - S.V. Sudhakar
- Department of Radiology (S.V.S., K.M.), Great Ormond Street Hospital, NHS Foundation Trust, London, UK
| | - K.V. Shekdar
- Department of Radiology, and Department of Radiology (K.V.S.), Perelman School of Medicine at the University of Pennsylvania, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - P. Krishnan
- Department of Diagnostic Imaging (A.B., P.K., M.S.), The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - M. Shroff
- Department of Diagnostic Imaging (A.B., P.K., M.S.), The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - A. Taranath
- Department of Medical Imaging (A.T.), Women’s and Children’s Hospital, Adelaide, South Australia, Australia
| | - F. Arrigoni
- Neuroimaging Lab (F.A.), Scientific Institute, Istituto di Ricovero e Cura a Carattere Scientifico Eugenio Medea, Bosisio Parini, Italy
| | - K.A. Aldinger
- Department of Pediatrics (K.A.A.), University of Washington School of Medicine, Seattle, Washington,Center for Integrative Brain Research (K.A.A., W.B.D.), Seattle Children’s Research Institute, Seattle, Washington
| | - R.J. Leventer
- Department of Neurology (R.J.L.), Royal Children’s Hospital and Murdoch Children’s Research Institute, Parkville, Victoria, Australia,Department of Pediatrics (R.J.L.), University of Melbourne, Melbourne, Victoria, Australia
| | - W.B. Dobyns
- Center for Integrative Brain Research (K.A.A., W.B.D.), Seattle Children’s Research Institute, Seattle, Washington,Division of Genetics and Metabolism (W.B.D.), Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota
| | - K. Mankad
- Department of Radiology (S.V.S., K.M.), Great Ormond Street Hospital, NHS Foundation Trust, London, UK
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23
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Kinney MV, Day LT, Palestra F, Biswas A, Jackson D, Roos N, de Jonge A, Doherty P, Manu AA, Moran AC, George AS. Overcoming blame culture: key strategies to catalyse maternal and perinatal death surveillance and response. BJOG 2021; 129:839-844. [PMID: 34709701 PMCID: PMC9298870 DOI: 10.1111/1471-0528.16989] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/17/2021] [Indexed: 11/29/2022]
Affiliation(s)
- M V Kinney
- School of Public Health, University of the Western Cape, Bellville, South Africa
| | - L T Day
- Maternal Newborn Health Group, Maternal Adolescent, Reproductive and Child Health (MARCH) Centre, London School of Hygiene and Tropical Medicine, London, UK.,Maternal Newborn Health Group, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - F Palestra
- World Health Organization, Geneva, Switzerland
| | | | - D Jackson
- School of Public Health, University of the Western Cape, Bellville, South Africa.,Maternal, Adolescent, Reproductive and Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, UK
| | - N Roos
- Department of Medicine, Solna, Clinical Epidemiology Division, Karolinska Institutet, Stockholm, Sweden.,Karolinska University Hospital, Stockholm, Sweden
| | - A de Jonge
- Midwifery Science, AVAG (Academy Midwifery Amsterdam and Groningen), Amsterdam Public Health Research Institute, Amsterdam University Medical Centre, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,University Medical Center Groningen, Groningen, The Netherlands
| | - P Doherty
- Options Consultancy Services Ltd, St Magnus House, London, UK
| | - A A Manu
- Epidemiology and Disease Control, School of Public Health, University of Ghana, Legon, Accra, Ghana
| | - A C Moran
- Department of Maternal, Newborn, Child, Adolescent Health & Ageing, World Health Organization, Geneva, Switzerland
| | - A S George
- School of Public Health, University of the Western Cape, Bellville, South Africa
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24
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Ghazi L, Li F, Chen E, SIMONOV MICHAEL, Yamamoto Y, Biswas A, Hanna J, Shah T, Peixoto AJ, Wilson FP. Abstract P110: Intravenous Hydralazine Effect On Blood Pressure Following Severe Inpatient Hypertension Development. Hypertension 2021. [DOI: 10.1161/hyp.78.suppl_1.p110] [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
Background:
BP elevations in the hospital are commonly treated with intravenous medications, specifically hydralazine. However, treatment guidelines are lacking. Our goal is to assess the effect of intravenous hydralazine on BP following severe inpatient HTN development.
Methods:
This is a cohort study of adults admitted for reasons other than HTN and developed severe HTN within a single healthcare system. We defined severe inpatient HTN as the first documentation of BP elevation (>180 systolic or >110 diastolic) at least 1 hour after admission. Pregnant women were excluded. Mixed-effects models with nonlinear time trend were used to assess and visualize the time-dependent effect of intravenous hydralazine on BP within 6 hours of BP elevation.
Results:
Of the 23,147 inpatients who developed severe HTN, 13,753 were untreated and 9,166 were treated of which 12% received intravenous hydralazine. Of the treated and untreated patients, 57 and 46% had a severe MAP reduction (drop ≥30%) (p-value<0.01). Risk factors for severe MAP drop include older age, history of drug and alcohol abuse, and higher BP on admission. Compared to inpatients with severe HTN who did not receive antihypertensives, those treated with intravenous hydralazine had a -12 [-14, -10], -19 [-22, -17], -8[-10, -7] mmHg greater reduction in MAP, SBP, and DBP after adjustment for demographic and clinical characteristics. Moreover, intravenous hydralazine resulted in acute BP reduction (
Figure 1
).
Conclusion:
Severe MAP reduction is observed in both treated and untreated inpatients with severe HTN, however adjusted absolute decrease in MAP is greater in inpatients treated with intravenous hydralazine.
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25
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Ghazi L, Li F, Chen E, Simonov M, Yamamoto Y, Biswas A, Hanna J, Shah T, Peixoto AJ, Wilson FP. Abstract 57: Risk Factors For Severe Reductions In Blood Pressure After Treatment Of Severe Inpatient Hypertension. Hypertension 2021. [DOI: 10.1161/hyp.78.suppl_1.57] [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
Background:
Incident severe HTN during hospitalization is far more common than admission for HTN, however treatment guidelines are lacking. Severe inpatient HTN is poorly studied, therefore our goal is to characterize inpatients who develop severe HTN and assess BP response to antihypertensive treatment.
Methods:
This is a cohort study of adults admitted for reasons other than HTN and developed severe HTN within a single healthcare system. We defined severe inpatient HTN as the first documentation of BP elevation (>180 systolic or >110 diastolic) at least 1 hour after hospital admission. Treatment was defined as receiving antihypertensive medications within 6 hours of BP elevation. We studied the association between treatment and BP drop ≥30%.
Results:
Among 224,265 hospitalized adults, 23,147 developed severe HTN of which 40% were treated. Compared to inpatients who did not develop severe HTN, those who did were older, more commonly women and Black, and had more comorbidities. Of the treated and untreated patients, 45.5 and 46.4% had a MAP drop ≥30% (p-value= 0.2). Risk factors for severe MAP drop include older age, Black race, HTN, and diabetes. Additionally, treatment vs. no treatment and treatment with intravenous vs. oral medications were associated with greater odds of MAP drop ≥30% (
Table 1
).
Conclusion:
While there was no difference in the proportion of treated and untreated patients with severe MAP reduction, after adjustment for factors independently associated with HTN we found that treatment was associated with severe BP drop. Further research is needed to phenotype inpatients with severe HTN to help establish treatment guidelines.
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26
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Vázquez-González Y, Prieto C, Filizoglu M, Ragazzo-Sánchez J, Calderón-Santoyo M, Furtado R, Cheng H, Biswas A, Lagaron J. Electrosprayed cashew gum microparticles for the encapsulation of highly sensitive bioactive materials. Carbohydr Polym 2021; 264:118060. [DOI: 10.1016/j.carbpol.2021.118060] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Revised: 03/15/2021] [Accepted: 04/06/2021] [Indexed: 12/22/2022]
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27
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Ahmad T, Yamamoto Y, Biswas A, Ghazi L, Martin M, Simonov M, Hsiao A, Kashyap N, Velazquez EJ, Desai NR, Wilson FP. REVeAL-HF: Design and Rationale of a Pragmatic Randomized Controlled Trial Embedded Within Routine Clinical Practice. JACC Heart Fail 2021; 9:409-419. [PMID: 33992566 DOI: 10.1016/j.jchf.2021.03.006] [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] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 02/26/2021] [Accepted: 03/02/2021] [Indexed: 01/30/2023]
Abstract
Heart failure (HF) is one of the most common causes of hospitalization in the United States and carries a significant risk of morbidity and mortality. Use of evidence-based interventions may improve outcomes, but their use is encumbered in part by limitations in accurate prognostication. The REVeAL-HF (Risk EValuation And its Impact on ClinicAL Decision Making and Outcomes in Heart Failure) trial is the first to definitively evaluate the impact of knowledge about prognosis on clinical decision making and patient outcomes. The REVeAL-HF trial is a pragmatic, completely electronic, randomized controlled trial that has completed enrollment of 3,124 adults hospitalized for HF, defined as having an N-terminal pro-B-type natriuretic peptide level of >500 pg/ml and receiving intravenous diuretic agents within 24 h of admission. Patients randomized to the intervention had their risk of 1-year mortality generated with information in the electronic health record and presented to their providers, who had the option to give feedback on their impression of this risk assessment. The authors are examining the impact of this information on clinical decision-making (use of HF pharmacotherapies, referral to electrophysiology, palliative care referral, and referral for advanced therapies like heart transplantation or mechanical circulatory support) and patient outcomes (length of stay, post-discharge 30-day rehospitalizations, and 1-year mortality). The REVeAL-HF trial will definitively examine whether knowledge about prognosis in HF has an impact on clinical decision making and patient outcomes. It will also examine the relationship between calculated, perceived, and real risk of mortality in this patient population. (Risk EValuation And Its Impact on ClinicAL Decision Making and Outcomes in Heart Failure [REVeAL-HF]; NCT03845660).
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Affiliation(s)
- Tariq Ahmad
- Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, Connecticut, USA; Clinical and Translational Research Accelerator, Yale University School of Medicine, New Haven, Connecticut, USA.
| | - Yu Yamamoto
- Clinical and Translational Research Accelerator, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Aditya Biswas
- Clinical and Translational Research Accelerator, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Lama Ghazi
- Clinical and Translational Research Accelerator, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Melissa Martin
- Clinical and Translational Research Accelerator, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Michael Simonov
- Joint Data Analytics Team, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Allen Hsiao
- Joint Data Analytics Team, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Nitu Kashyap
- Joint Data Analytics Team, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Eric J Velazquez
- Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Nihar R Desai
- Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, Connecticut, USA; Clinical and Translational Research Accelerator, Yale University School of Medicine, New Haven, Connecticut, USA
| | - F Perry Wilson
- Clinical and Translational Research Accelerator, Yale University School of Medicine, New Haven, Connecticut, USA; Section of Nephrology, Yale University School of Medicine, New Haven, Connecticut, USA
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28
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Ghazi L, Simonov M, Mansour SG, Moledina DG, Greenberg JH, Yamamoto Y, Biswas A, Wilson FP. Predicting patients with false negative SARS-CoV-2 testing at hospital admission: A retrospective multi-center study. PLoS One 2021; 16:e0251376. [PMID: 33979353 PMCID: PMC8115794 DOI: 10.1371/journal.pone.0251376] [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] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 04/26/2021] [Indexed: 01/22/2023] Open
Abstract
Importance False negative SARS-CoV-2 tests can lead to spread of infection in the inpatient setting to other patients and healthcare workers. However, the population of patients with COVID who are admitted with false negative testing is unstudied. Objective To characterize and develop a model to predict true SARS-CoV-2 infection among patients who initially test negative for COVID by PCR. Design Retrospective cohort study. Setting Five hospitals within the Yale New Haven Health System between 3/10/2020 and 9/1/2020. Participants Adult patients who received diagnostic testing for SARS-CoV-2 virus within the first 96 hours of hospitalization. Exposure We developed a logistic regression model from readily available electronic health record data to predict SARS-CoV-2 positivity in patients who were positive for COVID and those who were negative and never retested. Main outcomes and measures This model was applied to patients testing negative for SARS-CoV-2 who were retested within the first 96 hours of hospitalization. We evaluated the ability of the model to discriminate between patients who would subsequently retest negative and those who would subsequently retest positive. Results We included 31,459 hospitalized adult patients; 2,666 of these patients tested positive for COVID and 3,511 initially tested negative for COVID and were retested. Of the patients who were retested, 61 (1.7%) had a subsequent positive COVID test. The model showed that higher age, vital sign abnormalities, and lower white blood cell count served as strong predictors for COVID positivity in these patients. The model had moderate performance to predict which patients would retest positive with a test set area under the receiver-operator characteristic (ROC) of 0.76 (95% CI 0.70–0.83). Using a cutpoint for our risk prediction model at the 90th percentile for probability, we were able to capture 35/61 (57%) of the patients who would retest positive. This cutpoint amounts to a number-needed-to-retest range between 15 and 77 patients. Conclusion and relevance We show that a pragmatic model can predict which patients should be retested for COVID. Further research is required to determine if this risk model can be applied prospectively in hospitalized patients to prevent the spread of SARS-CoV-2 infections.
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Affiliation(s)
- Lama Ghazi
- Clinical and Translational Research Accelerator, Yale University, New Haven, Connecticut, United States of America
| | - Michael Simonov
- Clinical and Translational Research Accelerator, Yale University, New Haven, Connecticut, United States of America
| | - Sherry G. Mansour
- Clinical and Translational Research Accelerator, Yale University, New Haven, Connecticut, United States of America
| | - Dennis G. Moledina
- Clinical and Translational Research Accelerator, Yale University, New Haven, Connecticut, United States of America
| | - Jason H. Greenberg
- Clinical and Translational Research Accelerator, Yale University, New Haven, Connecticut, United States of America
| | - Yu Yamamoto
- Clinical and Translational Research Accelerator, Yale University, New Haven, Connecticut, United States of America
| | - Aditya Biswas
- Clinical and Translational Research Accelerator, Yale University, New Haven, Connecticut, United States of America
| | - F. Perry Wilson
- Clinical and Translational Research Accelerator, Yale University, New Haven, Connecticut, United States of America
- * E-mail:
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29
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Ahlawat S, Srinivasu K, Biswas A, Choudhury N. Distortion energy-electronic energy compensation determines the nature of solute interactions with irradiation induced vacancies in ferritic steel. Phys Chem Chem Phys 2021; 23:8689-8704. [PMID: 33876029 DOI: 10.1039/d1cp00100k] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Fundamental knowledge of vacancy-solute atom (in particular, Cu and Ni) interactions at the electronic level is of utmost importance to understand experimentally observed Cu-precipitation in reactor pressure vessel (RPV) steel. In the present investigation, using first-principles electronic structure calculations within the framework of density functional theory (DFT), we unravel the nature of such interactions between a vacancy (V) or di-vacancy and solute atoms (mainly Cu and Ni) in the bcc-Fe lattice. One of the very novel features of the present investigation is that we demonstrate the importance of distortion energy-electronic energy compensation in stabilizing the formation of vacancy-Cu and vacancy-Ni clusters in ferritic steel. Further decomposition of the electronic energy contribution into different bonding contributions in conjugation with differential charge density analyses clearly reveals the origin of stability as a consequence of mutual compensation of different energy modes. For both Cu-Cu and Ni-Ni interactions, the presence of a vacancy leads to a more attractive interaction, implying that such vacancies generated due to irradiation make solute aggregation easier compared with the case of model steel with no defects. We have also demonstrated that the formation of CumNin clusters (m, n = 1, 5) is energetically favorable in addition to demonstrating that the stability increases with an increasing number of Cu or Ni atoms. The rate of increase of stability with the addition of solute atoms is higher in the case of the addition of Cu atoms into a Ni cluster than it is for adding Ni atoms into a Cu cluster. The present investigation thus provides a deeper electronic level understanding of solute-point defect interaction and cluster formation probability for Cu and Ni atoms in the ferritic steel.
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Affiliation(s)
- Sarita Ahlawat
- Material Science Division, Bhabha Atomic Research Centre, Mumbai 400 085, India.
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30
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Moledina DG, Simonov M, Yamamoto Y, Alausa J, Arora T, Biswas A, Cantley LG, Ghazi L, Greenberg JH, Hinchcliff M, Huang C, Mansour SG, Martin M, Peixoto A, Schulz W, Subair L, Testani JM, Ugwuowo U, Young P, Wilson FP. The Association of COVID-19 With Acute Kidney Injury Independent of Severity of Illness: A Multicenter Cohort Study. Am J Kidney Dis 2021; 77:490-499.e1. [PMID: 33422598 PMCID: PMC7791318 DOI: 10.1053/j.ajkd.2020.12.007] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 12/23/2020] [Indexed: 02/07/2023]
Abstract
RATIONALE & OBJECTIVE Although coronavirus disease 2019 (COVID-19) has been associated with acute kidney injury (AKI), it is unclear whether this association is independent of traditional risk factors such as hypotension, nephrotoxin exposure, and inflammation. We tested the independent association of COVID-19 with AKI. STUDY DESIGN Multicenter, observational, cohort study. SETTING & PARTICIPANTS Patients admitted to 1 of 6 hospitals within the Yale New Haven Health System between March 10, 2020, and August 31, 2020, with results for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) testing via polymerase chain reaction of a nasopharyngeal sample. EXPOSURE Positive test for SARS-CoV-2. OUTCOME AKI by KDIGO (Kidney Disease: Improving Global Outcomes) criteria. ANALYTICAL APPROACH Evaluated the association of COVID-19 with AKI after controlling for time-invariant factors at admission (eg, demographic characteristics, comorbidities) and time-varying factors updated continuously during hospitalization (eg, vital signs, medications, laboratory results, respiratory failure) using time-updated Cox proportional hazard models. RESULTS Of the 22,122 patients hospitalized, 2,600 tested positive and 19,522 tested negative for SARS-CoV-2. Compared with patients who tested negative, patients with COVID-19 had more AKI (30.6% vs 18.2%; absolute risk difference, 12.5% [95% CI, 10.6%-14.3%]) and dialysis-requiring AKI (8.5% vs 3.6%) and lower rates of recovery from AKI (58% vs 69.8%). Compared with patients without COVID-19, patients with COVID-19 had higher inflammatory marker levels (C-reactive protein, ferritin) and greater use of vasopressors and diuretic agents. Compared with patients without COVID-19, patients with COVID-19 had a higher rate of AKI in univariable analysis (hazard ratio, 1.84 [95% CI, 1.73-1.95]). In a fully adjusted model controlling for demographic variables, comorbidities, vital signs, medications, and laboratory results, COVID-19 remained associated with a high rate of AKI (adjusted hazard ratio, 1.40 [95% CI, 1.29-1.53]). LIMITATIONS Possibility of residual confounding. CONCLUSIONS COVID-19 is associated with high rates of AKI not fully explained by adjustment for known risk factors. This suggests the presence of mechanisms of AKI not accounted for in this analysis, which may include a direct effect of COVID-19 on the kidney or other unmeasured mediators. Future studies should evaluate the possible unique pathways by which COVID-19 may cause AKI.
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Affiliation(s)
- Dennis G Moledina
- Section of Nephrology, Department of Internal Medicine, Yale School of Medicine, New Haven, CT; Clinical and Translational Research Accelerator, Department of Internal Medicine, Yale School of Medicine, New Haven, CT
| | - Michael Simonov
- Clinical and Translational Research Accelerator, Department of Internal Medicine, Yale School of Medicine, New Haven, CT; Section of General Internal Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT
| | - Yu Yamamoto
- Clinical and Translational Research Accelerator, Department of Internal Medicine, Yale School of Medicine, New Haven, CT
| | - Jameel Alausa
- Clinical and Translational Research Accelerator, Department of Internal Medicine, Yale School of Medicine, New Haven, CT
| | - Tanima Arora
- Clinical and Translational Research Accelerator, Department of Internal Medicine, Yale School of Medicine, New Haven, CT
| | - Aditya Biswas
- Clinical and Translational Research Accelerator, Department of Internal Medicine, Yale School of Medicine, New Haven, CT
| | - Lloyd G Cantley
- Section of Nephrology, Department of Internal Medicine, Yale School of Medicine, New Haven, CT
| | - Lama Ghazi
- Section of General Internal Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT
| | - Jason H Greenberg
- Section of General Internal Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT; Section of Pediatric Nephrology, Department of Pediatrics, Yale School of Medicine, New Haven, CT
| | - Monique Hinchcliff
- Clinical and Translational Research Accelerator, Department of Internal Medicine, Yale School of Medicine, New Haven, CT; Section of Rheumatology, Department of Internal Medicine, Yale School of Medicine, New Haven, CT
| | - Chenxi Huang
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, CT
| | - Sherry G Mansour
- Section of Nephrology, Department of Internal Medicine, Yale School of Medicine, New Haven, CT; Clinical and Translational Research Accelerator, Department of Internal Medicine, Yale School of Medicine, New Haven, CT
| | - Melissa Martin
- Clinical and Translational Research Accelerator, Department of Internal Medicine, Yale School of Medicine, New Haven, CT
| | - Aldo Peixoto
- Section of Nephrology, Department of Internal Medicine, Yale School of Medicine, New Haven, CT
| | - Wade Schulz
- Department of Laboratory Medicine, Yale School of Medicine, New Haven, CT; Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, CT
| | - Labeebah Subair
- Clinical and Translational Research Accelerator, Department of Internal Medicine, Yale School of Medicine, New Haven, CT
| | - Jeffrey M Testani
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT
| | - Ugochukwu Ugwuowo
- Clinical and Translational Research Accelerator, Department of Internal Medicine, Yale School of Medicine, New Haven, CT
| | - Patrick Young
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, CT
| | - F Perry Wilson
- Section of Nephrology, Department of Internal Medicine, Yale School of Medicine, New Haven, CT; Clinical and Translational Research Accelerator, Department of Internal Medicine, Yale School of Medicine, New Haven, CT.
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31
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Gupta K, Lalit M, Biswas A, Sanada CD, Greene C, Hukari K, Maulik U, Bandyopadhyay S, Ramalingam N, Ahuja G, Ghosh A, Sengupta D. Modeling expression ranks for noise-tolerant differential expression analysis of scRNA-seq data. Genome Res 2021; 31:689-697. [PMID: 33674351 PMCID: PMC8015842 DOI: 10.1101/gr.267070.120] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 02/22/2021] [Indexed: 12/13/2022]
Abstract
Systematic delineation of complex biological systems is an ever-challenging and resource-intensive process. Single-cell transcriptomics allows us to study cell-to-cell variability in complex tissues at an unprecedented resolution. Accurate modeling of gene expression plays a critical role in the statistical determination of tissue-specific gene expression patterns. In the past few years, considerable efforts have been made to identify appropriate parametric models for single-cell expression data. The zero-inflated version of Poisson/negative binomial and log-normal distributions have emerged as the most popular alternatives owing to their ability to accommodate high dropout rates, as commonly observed in single-cell data. Although the majority of the parametric approaches directly model expression estimates, we explore the potential of modeling expression ranks, as robust surrogates for transcript abundance. Here we examined the performance of the discrete generalized beta distribution (DGBD) on real data and devised a Wald-type test for comparing gene expression across two phenotypically divergent groups of single cells. We performed a comprehensive assessment of the proposed method to understand its advantages compared with some of the existing best-practice approaches. We concluded that besides striking a reasonable balance between Type I and Type II errors, ROSeq, the proposed differential expression test, is exceptionally robust to expression noise and scales rapidly with increasing sample size. For wider dissemination and adoption of the method, we created an R package called ROSeq and made it available on the Bioconductor platform.
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Affiliation(s)
- Krishan Gupta
- Department of Computer Science and Engineering, Indraprastha Institute of Information Technology, Delhi 110020, India
| | - Manan Lalit
- Max Planck Institute of Molecular Cell Biology and Genetics, Dresden 01307, Germany
| | - Aditya Biswas
- Microsoft India Private Limited, Hyderabad, Telangana 500032, India
| | - Chad D Sanada
- Fluidigm Corporation, South San Francisco, California 94080, USA
| | - Cassandra Greene
- Fluidigm Corporation, South San Francisco, California 94080, USA
| | - Kyle Hukari
- Fluidigm Corporation, South San Francisco, California 94080, USA
| | - Ujjwal Maulik
- Department of Computer Science, Jadavpur University, Kolkata, West Bengal 700032, India
| | | | | | - Gaurav Ahuja
- Department of Computational Biology, Indraprastha Institute of Information Technology, Delhi 110020, India
| | - Abhik Ghosh
- Interdisciplinary Statistical Research Unit, Indian Statistical Institute, Kolkata 700108, India
| | - Debarka Sengupta
- Department of Computer Science and Engineering, Indraprastha Institute of Information Technology, Delhi 110020, India.,Department of Computational Biology, Indraprastha Institute of Information Technology, Delhi 110020, India.,Centre for Artificial Intelligence, Indraprastha Institute of Information Technology, Delhi 110020, India.,Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, QLD 4000, Australia
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Biswas A, Saran I, Wilson FP. Introduction to Supervised Machine Learning. Kidney360 2021; 2:878-880. [PMID: 35373058 PMCID: PMC8791341 DOI: 10.34067/kid.0000182021] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 03/02/2021] [Indexed: 02/04/2023]
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Nugent J, Aklilu A, Yamamoto Y, Simonov M, Li F, Biswas A, Ghazi L, Greenberg J, Mansour S, Moledina D, Wilson FP. Assessment of Acute Kidney Injury and Longitudinal Kidney Function After Hospital Discharge Among Patients With and Without COVID-19. JAMA Netw Open 2021; 4:e211095. [PMID: 33688965 PMCID: PMC7948062 DOI: 10.1001/jamanetworkopen.2021.1095] [Citation(s) in RCA: 93] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 01/18/2021] [Indexed: 12/13/2022] Open
Abstract
Importance Acute kidney injury (AKI) occurs in up to half of patients hospitalized with coronavirus disease 2019 (COVID-19). The longitudinal effects of COVID-19-associated AKI on kidney function remain unknown. Objective To compare the rate of change in estimated glomerular filtration rate (eGFR) after hospital discharge between patients with and without COVID-19 who experienced in-hospital AKI. Design, Setting, and Participants A retrospective cohort study was conducted at 5 hospitals in Connecticut and Rhode Island from March 10 to August 31, 2020. Patients who were tested for COVID-19 and developed AKI were screened, and those who survived past discharge, did not require dialysis within 3 days of discharge, and had at least 1 outpatient creatinine level measurement following discharge were included. Exposures Diagnosis of COVID-19. Main Outcomes and Measures Mixed-effects models were used to assess the association between COVID-19-associated AKI and eGFR slope after discharge. The secondary outcome was the time to AKI recovery for the subgroup of patients whose kidney function had not returned to the baseline level by discharge. Results A total of 182 patients with COVID-19-associated AKI and 1430 patients with AKI not associated with COVID-19 were included. The population included 813 women (50.4%); median age was 69.7 years (interquartile range, 58.9-78.9 years). Patients with COVID-19-associated AKI were more likely to be Black (73 [40.1%] vs 225 [15.7%]) or Hispanic (40 [22%] vs 126 [8.8%]) and had fewer comorbidities than those without COVID-19 but similar rates of preexisting chronic kidney disease and hypertension. Patients with COVID-19-associated AKI had a greater decrease in eGFR in the unadjusted model (-11.3; 95% CI, -22.1 to -0.4 mL/min/1.73 m2/y; P = .04) and after adjusting for baseline comorbidities (-12.4; 95% CI, -23.7 to -1.2 mL/min/1.73 m2/y; P = .03). In the fully adjusted model controlling for comorbidities, peak creatinine level, and in-hospital dialysis requirement, the eGFR slope difference persisted (-14.0; 95% CI, -25.1 to -2.9 mL/min/1.73 m2/y; P = .01). In the subgroup of patients who had not achieved AKI recovery by discharge (n = 319), COVID-19-associated AKI was associated with decreased kidney recovery during outpatient follow-up (adjusted hazard ratio, 0.57; 95% CI, 0.35-0.92). Conclusions and Relevance In this cohort study of US patients who experienced in-hospital AKI, COVID-19-associated AKI was associated with a greater rate of eGFR decrease after discharge compared with AKI in patients without COVID-19, independent of underlying comorbidities or AKI severity. This eGFR trajectory may reinforce the importance of monitoring kidney function after AKI and studying interventions to limit kidney disease after COVID-19-associated AKI.
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Affiliation(s)
- James Nugent
- Section of Nephrology, Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut
| | - Abinet Aklilu
- Clinical and Translational Research Accelerator, Department of Medicine, Yale University School of Medicine, New Haven, Connecticut
- Section of Nephrology, Department of Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Yu Yamamoto
- Clinical and Translational Research Accelerator, Department of Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Michael Simonov
- Clinical and Translational Research Accelerator, Department of Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Fan Li
- Department of Biostatistics, Yale University School of Public Health, New Haven, Connecticut
| | - Aditya Biswas
- Clinical and Translational Research Accelerator, Department of Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Lama Ghazi
- Clinical and Translational Research Accelerator, Department of Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Jason Greenberg
- Section of Nephrology, Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut
- Clinical and Translational Research Accelerator, Department of Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Sherry Mansour
- Clinical and Translational Research Accelerator, Department of Medicine, Yale University School of Medicine, New Haven, Connecticut
- Section of Nephrology, Department of Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Dennis Moledina
- Clinical and Translational Research Accelerator, Department of Medicine, Yale University School of Medicine, New Haven, Connecticut
- Section of Nephrology, Department of Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - F. Perry Wilson
- Clinical and Translational Research Accelerator, Department of Medicine, Yale University School of Medicine, New Haven, Connecticut
- Section of Nephrology, Department of Medicine, Yale University School of Medicine, New Haven, Connecticut
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Wilson FP, Martin M, Yamamoto Y, Partridge C, Moreira E, Arora T, Biswas A, Feldman H, Garg AX, Greenberg JH, Hinchcliff M, Latham S, Li F, Lin H, Mansour SG, Moledina DG, Palevsky PM, Parikh CR, Simonov M, Testani J, Ugwuowo U. Electronic health record alerts for acute kidney injury: multicenter, randomized clinical trial. BMJ 2021; 372:m4786. [PMID: 33461986 PMCID: PMC8034420 DOI: 10.1136/bmj.m4786] [Citation(s) in RCA: 83] [Impact Index Per Article: 27.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVE To determine whether electronic health record alerts for acute kidney injury would improve patient outcomes of mortality, dialysis, and progression of acute kidney injury. DESIGN Double blinded, multicenter, parallel, randomized controlled trial. SETTING Six hospitals (four teaching and two non-teaching) in the Yale New Haven Health System in Connecticut and Rhode Island, US, ranging from small community hospitals to large tertiary care centers. PARTICIPANTS 6030 adult inpatients with acute kidney injury, as defined by the Kidney Disease: Improving Global Outcomes (KDIGO) creatinine criteria. INTERVENTIONS An electronic health record based "pop-up" alert for acute kidney injury with an associated acute kidney injury order set upon provider opening of the patient's medical record. MAIN OUTCOME MEASURES A composite of progression of acute kidney injury, receipt of dialysis, or death within 14 days of randomization. Prespecified secondary outcomes included outcomes at each hospital and frequency of various care practices for acute kidney injury. RESULTS 6030 patients were randomized over 22 months. The primary outcome occurred in 653 (21.3%) of 3059 patients with an alert and in 622 (20.9%) of 2971 patients receiving usual care (relative risk 1.02, 95% confidence interval 0.93 to 1.13, P=0.67). Analysis by each hospital showed worse outcomes in the two non-teaching hospitals (n=765, 13%), where alerts were associated with a higher risk of the primary outcome (relative risk 1.49, 95% confidence interval 1.12 to 1.98, P=0.006). More deaths occurred at these centers (15.6% in the alert group v 8.6% in the usual care group, P=0.003). Certain acute kidney injury care practices were increased in the alert group but did not appear to mediate these outcomes. CONCLUSIONS Alerts did not reduce the risk of our primary outcome among patients in hospital with acute kidney injury. The heterogeneity of effect across clinical centers should lead to a re-evaluation of existing alerting systems for acute kidney injury. TRIAL REGISTRATION ClinicalTrials.gov NCT02753751.
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Affiliation(s)
- F Perry Wilson
- Department of Medicine, Section of Nephrology, Yale University School of Medicine, New Haven, CT, USA
- Clinical and Translational Research Accelerator, Department of Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Melissa Martin
- Department of Medicine, Section of Nephrology, Yale University School of Medicine, New Haven, CT, USA
- Clinical and Translational Research Accelerator, Department of Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Yu Yamamoto
- Department of Medicine, Section of Nephrology, Yale University School of Medicine, New Haven, CT, USA
- Clinical and Translational Research Accelerator, Department of Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Caitlin Partridge
- Joint Data Analytics Team, Yale School of Medicine, New Haven, CT, USA
| | - Erica Moreira
- Joint Data Analytics Team, Yale School of Medicine, New Haven, CT, USA
| | - Tanima Arora
- Department of Medicine, Section of Nephrology, Yale University School of Medicine, New Haven, CT, USA
- Clinical and Translational Research Accelerator, Department of Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Aditya Biswas
- Department of Medicine, Section of Nephrology, Yale University School of Medicine, New Haven, CT, USA
- Clinical and Translational Research Accelerator, Department of Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Harold Feldman
- Department of Epidemiology and Biostatistics and the Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Amit X Garg
- Department of Epidemiology and Biostatistics and Department of Medicine, Division of Nephrology, Schulich School of Medicine & Dentistry, Western University, ON, Canada
| | - Jason H Greenberg
- Clinical and Translational Research Accelerator, Department of Medicine, Yale University School of Medicine, New Haven, CT, USA
- Department of Pediatrics, Yale University School of Medicine, New Haven, CT, USA
| | - Monique Hinchcliff
- Department of Medicine, Section of Rheumatology, Allergy and Immunology, Yale University School of Medicine, New Haven, CT, USA
| | - Stephen Latham
- Yale Interdisciplinary Center for Bioethics, Yale Law School, New Haven, CT, USA
| | - Fan Li
- Department of Biostatistics, Yale School of Public Health, New Haven, CT, USA
| | - Haiqun Lin
- Rutgers University Biomedical and Health Sciences, Newark, NJ, USA
| | - Sherry G Mansour
- Department of Medicine, Section of Nephrology, Yale University School of Medicine, New Haven, CT, USA
- Clinical and Translational Research Accelerator, Department of Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Dennis G Moledina
- Department of Medicine, Section of Nephrology, Yale University School of Medicine, New Haven, CT, USA
- Clinical and Translational Research Accelerator, Department of Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Paul M Palevsky
- Medicine and Clinical & Translational Science, University of Pittsburgh School of Medicine and Renal Section, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
| | - Chirag R Parikh
- Department of Medicine, Division of Nephrology, John Hopkins Medicine, Baltimore, MD, USA
| | - Michael Simonov
- Clinical and Translational Research Accelerator, Department of Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Jeffrey Testani
- Department of Internal Medicine, Section of Cardiology, Yale University School of Medicine, New Haven, CT, USA
| | - Ugochukwu Ugwuowo
- Department of Medicine, Section of Nephrology, Yale University School of Medicine, New Haven, CT, USA
- Clinical and Translational Research Accelerator, Department of Medicine, Yale University School of Medicine, New Haven, CT, USA
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Sarkar P, Biswas A, Abharana N, Rai S, Modi MH, Bhattacharyya D. Interface modification of Cr/Ti multilayers with C barrier layer for enhanced reflectivity in the water window regime. J Synchrotron Radiat 2021; 28:224-230. [PMID: 33399572 DOI: 10.1107/s1600577520013429] [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] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 10/07/2020] [Indexed: 06/12/2023]
Abstract
The influence of a carbon barrier layer to improve the reflectivity of Cr/Ti multilayers, intended to be used in the water window wavelength regime, is investigated. Specular grazing-incidence X-ray reflectivity results of Cr/Ti multilayers with 10 bilayers show that interface widths are reduced to ∼0.24 nm upon introduction of a ∼0.3 nm C barrier layer at each Cr-on-Ti interface. As the number of bilayers increases to 75, a multilayer with C barrier layers maintains almost the same interface widths with no cumulative increase in interface imperfections. Using such interface-engineered Cr/C/Ti multilayers, a remarkably high soft X-ray reflectivity of ∼31.6% is achieved at a wavelength of 2.77 nm and at a grazing angle of incidence of 16.2°, which is the highest reflectivity reported so far in the literature in this wavelength regime. Further investigation of the multilayers by diffused grazing-incidence X-ray reflectivity and grazing-incidence extended X-ray absorption fine-structure measurements using synchrotron radiation suggests that the improvement in interface microstructure can be attributed to significant suppression of inter-diffusion at Cr/Ti interfaces by the introduction of C barrier layers and also due to the smoothing effect of the C layer promoting two-dimensional growth of the multilayer.
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Affiliation(s)
- P Sarkar
- Atomic and Molecular Physics Division, Bhabha Atomic Research Centre, Mumbai 400085, India
| | - A Biswas
- Atomic and Molecular Physics Division, Bhabha Atomic Research Centre, Mumbai 400085, India
| | - N Abharana
- Atomic and Molecular Physics Division, Bhabha Atomic Research Centre, Mumbai 400085, India
| | - S Rai
- Synchrotron Utilisation Section, Raja Ramnna Centre for Advanced Technology, Indore 752013, India
| | - M H Modi
- Synchrotron Utilisation Section, Raja Ramnna Centre for Advanced Technology, Indore 752013, India
| | - D Bhattacharyya
- Atomic and Molecular Physics Division, Bhabha Atomic Research Centre, Mumbai 400085, India
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Ghazi L, Simonov M, Mansour S, Moledina D, Greenberg J, Yamamoto Y, Biswas A, Wilson FP. Predicting patients with false negative SARS-CoV-2 testing at hospital admission: A retrospective multi-center study. medRxiv 2020:2020.11.30.20241414. [PMID: 33300016 PMCID: PMC7724687 DOI: 10.1101/2020.11.30.20241414] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Importance False negative SARS-CoV-2 tests can lead to spread of infection in the inpatient setting to other patients and healthcare workers. However, the population of patients with COVID who are admitted with false negative testing is unstudied. Objective To characterize and develop a model to predict true SARS-CoV-2 infection among patients who initially test negative for COVID by PCR. Design Retrospective cohort study. Setting Five hospitals within the Yale New Haven Health System between 3/10/2020 and 9/1/2020. Participants Adult patients who received diagnostic testing for SARS-CoV-2 virus within the first 96 hours of hospitalization. Exposure We developed a logistic regression model from readily available electronic health record data to predict SARS-CoV-2 positivity in patients who were positive for COVID and those who were negative and never retested. Main Outcomes and Measures This model was applied to patients testing negative for SARS-CoV-2 who were retested within the first 96 hours of hospitalization. We evaluated the ability of the model to discriminate between patients who would subsequently retest negative and those who would subsequently retest positive. Results We included 31,459 hospitalized adult patients; 2,666 of these patients tested positive for COVID and 3,511 initially tested negative for COVID and were retested. Of the patients who were retested, 61 (1.7%) had a subsequent positive COVID test. The model showed that higher age, vital sign abnormalities, and lower white blood cell count served as strong predictors for COVID positivity in these patients. The model had moderate performance to predict which patients would retest positive with a test set area under the receiver-operator characteristic (ROC) of 0.76 (95% CI 0.70 - 0.83). Using a cutpoint for our risk prediction model at the 90th percentile for probability, we were able to capture 35/61 (57%) of the patients who would retest positive. This cutpoint amounts to a number-needed-to-retest range between 15 and 77 patients. Conclusion and Relevance We show that a pragmatic model can predict which patients should be retested for COVID. Further research is required to determine if this risk model can be applied prospectively in hospitalized patients to prevent the spread of SARS-CoV-2 infections.
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Affiliation(s)
- Lama Ghazi
- Clinical and Translational Research Accelerator, Yale University, New Haven, Connecticut
| | - Michael Simonov
- Clinical and Translational Research Accelerator, Yale University, New Haven, Connecticut
| | - Sherry Mansour
- Clinical and Translational Research Accelerator, Yale University, New Haven, Connecticut
| | - Dennis Moledina
- Clinical and Translational Research Accelerator, Yale University, New Haven, Connecticut
| | - Jason Greenberg
- Clinical and Translational Research Accelerator, Yale University, New Haven, Connecticut
| | - Yu Yamamoto
- Clinical and Translational Research Accelerator, Yale University, New Haven, Connecticut
| | - Aditya Biswas
- Clinical and Translational Research Accelerator, Yale University, New Haven, Connecticut
| | - F. Perry Wilson
- Clinical and Translational Research Accelerator, Yale University, New Haven, Connecticut
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Earp E, Mitchell A, Biswas A. A herpetiform eruption with unexpected immunofluorescence findings. Clin Exp Dermatol 2020; 46:207-209. [PMID: 33038038 DOI: 10.1111/ced.14461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 08/26/2020] [Accepted: 09/08/2020] [Indexed: 11/27/2022]
Affiliation(s)
- E Earp
- Department of Dermatology, Lauriston Building, Lauriston Place, Edinburgh, UK
| | - A Mitchell
- Department of Dermatology, Lauriston Building, Lauriston Place, Edinburgh, UK
| | - A Biswas
- Department of Pathology, Western General Hospital and The University of Edinburgh, Edinburgh, UK
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Affiliation(s)
- B Somu
- Department of Medicine, All India Institute of Medical Sciences, 3rd Floor Teaching Block, New Delhi 110029, India
| | - S Halkur Shankar
- Department of Medicine, All India Institute of Medical Sciences, 3rd Floor Teaching Block, New Delhi 110029, India
| | - U Baitha
- Department of Medicine, All India Institute of Medical Sciences, 3rd Floor Teaching Block, New Delhi 110029, India
| | - A Biswas
- Department of Medicine, All India Institute of Medical Sciences, 3rd Floor Teaching Block, New Delhi 110029, India
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Sharma A, Mohanti B, Thakar A, Bhasker S, Sikka K, Singh A, Pramanik R, Kumar R, Biswas A, Deo S, Thulkar S, Bahadur S. 959P Analysis of concurrent chemo-radiation using weekly cisplatin in locally advanced SCCHN: Identification of prognostic factors. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.1074] [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: 10/23/2022] Open
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Biswas A, Krishnan P, Amirabadi A, Blaser S, Mercimek-Andrews S, Shroff M. Expanding the Neuroimaging Phenotype of Neuronal Ceroid Lipofuscinoses. AJNR Am J Neuroradiol 2020; 41:1930-1936. [PMID: 32855186 DOI: 10.3174/ajnr.a6726] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Accepted: 06/16/2020] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Neuronal ceroid lipofuscinoses are a group of neurodegenerative disorders characterized by the accumulation of autofluorescent lipopigments in neuronal cells. As a result of storage material in the brain and retina, clinical manifestations include speech delay, cognitive dysfunction, motor regression, epilepsy, vision loss, and early death. At present, 14 different ceroid lipofuscinosis (CLN) genes are known. Recently, the FDA approved the use of recombinant human proenzyme of tripeptidyl-peptidase 1 for CLN2 disease, while phase I/IIa clinical trials for gene therapy in CLN3 and CLN6 are ongoing. Early diagnosis is, therefore, key to initiating treatment and arresting disease progression. Neuroimaging features of CLN1, CLN2, CLN3, and CLN5 diseases are well-described, with sparse literature on other subtypes. We aimed to investigate and expand the MR imaging features of genetically proved neuronal ceroid lipofuscinoses subtypes at our institution and also to report the time interval between the age of disease onset and the diagnosis of neuronal ceroid lipofuscinoses. MATERIALS AND METHODS We investigated and analyzed the age of disease onset and neuroimaging findings (signal intensity in periventricular, deep, and subcortical white matter, thalami, basal ganglia, posterior limb of the internal capsule, insular/subinsular regions, and ventral pons; and the presence or absence of supratentorial and/or infratentorial atrophy) of patients with genetically proved neuronal ceroid lipofuscinoses at our institution. This group consisted of 24 patients who underwent 40 brain MR imaging investigations between 1993 and 2019, with a male preponderance (male/female ratio = 15:9). RESULTS The mean ages of disease onset, first brain MR imaging, and diagnosis of neuronal ceroid lipofuscinoses were 4.70 ± 3.48 years, 6.76 ± 4.49 years, and 7.27 ± 4.78 years, respectively. Findings on initial brain MR imaging included T2/FLAIR hypointensity in the thalami (n = 22); T2/FLAIR hyperintensity in the periventricular and deep white matter (n = 22), posterior limb of the internal capsule (n = 22), ventral pons (n = 19), and insular/subinsular region (n = 18); supratentorial (n = 21) and infratentorial atrophy (n = 20). Eight of 9 patients who had follow-up neuroimaging showed progressive changes. CONCLUSIONS We identified reported classic neuroimaging features in all except 1 patient with neuronal ceroid lipofuscinoses in our study. CLN2, CLN5, and CLN7 diseases showed predominant cerebellar-over-cerebral atrophy. We demonstrate that abnormal signal intensity in the deep white matter, posterior limb of the internal capsule, and ventral pons is more common than previously reported in the literature. We report abnormal signal intensity in the insular/subinsular region for the first time. The difference in the median time from disease onset and diagnosis was 1.5 years.
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Affiliation(s)
- A Biswas
- From the Department of Diagnostic Imaging (A.B., P.K., A.A., S.B., M.S.), The Hospital for Sick Children, Toronto, Canada asthik.biswas@sickkids
| | - P Krishnan
- From the Department of Diagnostic Imaging (A.B., P.K., A.A., S.B., M.S.), The Hospital for Sick Children, Toronto, Canada
| | - A Amirabadi
- From the Department of Diagnostic Imaging (A.B., P.K., A.A., S.B., M.S.), The Hospital for Sick Children, Toronto, Canada
| | - S Blaser
- From the Department of Diagnostic Imaging (A.B., P.K., A.A., S.B., M.S.), The Hospital for Sick Children, Toronto, Canada
| | - S Mercimek-Andrews
- Division of Clinical and Metabolic Genetics (S.M.-A.), Department of Pediatrics, University of Toronto, The Hospital for Sick Children, Toronto, Canada
| | - M Shroff
- From the Department of Diagnostic Imaging (A.B., P.K., A.A., S.B., M.S.), The Hospital for Sick Children, Toronto, Canada
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Olabi B, Biswas A, Tidman MJ. Interdigital lesions: it's a dog's life. Clin Exp Dermatol 2020; 45:1077-1079. [PMID: 32844479 DOI: 10.1111/ced.14372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 06/17/2020] [Indexed: 11/29/2022]
Affiliation(s)
- B Olabi
- Department of Dermatology, Lauriston Building, Edinburgh, UK
| | - A Biswas
- Department of Pathology, Western General Hospital and the University of Edinburgh, Edinburgh, UK
| | - M J Tidman
- Department of Dermatology, Lauriston Building, Edinburgh, UK
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Biswas A, Iakutkina O, Wang Q, Lei HC, Dressel M, Uykur E. Spin-Reorientation-Induced Band Gap in Fe_{3}Sn_{2}: Optical Signatures of Weyl Nodes. Phys Rev Lett 2020; 125:076403. [PMID: 32857538 DOI: 10.1103/physrevlett.125.076403] [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] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 07/21/2020] [Indexed: 06/11/2023]
Abstract
Temperature- and frequency-dependent infrared spectroscopy identifies two contributions to the electronic properties of the magnetic kagome metal Fe_{3}Sn_{2}: two-dimensional Dirac fermions and strongly correlated flat bands. The interband transitions within the linearly dispersing Dirac bands appear as a two-step feature along with a very narrow Drude component due to intraband contribution. Low-lying absorption features indicate flat bands with multiple van Hove singularities. Localized charge carriers are seen as a Drude peak shifted to finite frequencies. The spectral weight is redistributed when the spins are reoriented at low temperatures; a sharp mode appears suggesting the opening of a gap due to the spin reorientation as the sign of additional Weyl nodes in the system.
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Affiliation(s)
- A Biswas
- 1. Physikalisches Institut, Universität Stuttgart, 70569 Stuttgart, Germany
| | - O Iakutkina
- 1. Physikalisches Institut, Universität Stuttgart, 70569 Stuttgart, Germany
| | - Q Wang
- Department of Physics and Beijing Key Laboratory of Opto-electronic Functional Materials & Micro-nano Devices, Renmin University of China, Beijing 100872, China
| | - H C Lei
- Department of Physics and Beijing Key Laboratory of Opto-electronic Functional Materials & Micro-nano Devices, Renmin University of China, Beijing 100872, China
| | - M Dressel
- 1. Physikalisches Institut, Universität Stuttgart, 70569 Stuttgart, Germany
| | - E Uykur
- 1. Physikalisches Institut, Universität Stuttgart, 70569 Stuttgart, Germany
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Awasthi S, Biswas A, Metya SK, Majumder A. Optical configuration of modified Fredkin gate using lithium-niobate-based Mach-Zehnder interferometer. Appl Opt 2020; 59:7083-7091. [PMID: 32788803 DOI: 10.1364/ao.397451] [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] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 07/06/2020] [Indexed: 06/11/2023]
Abstract
The continuous quest for reversible computation that could be extensively used in applications such as digital signal processing, quantum computing, quantum-dot cellular automata, and nanotechnology has recently discovered its optical implementation as light tenders high-speed computing with the slightest information loss. The electro-optic effect of a lithium-niobate-based Mach-Zehnder interferometer is explored to configure a 4×4 modified Fredkin gate, capable of furnishing as many as 16 logical combinations, and thus showing potential of curbing the area overhead. The optical design is carried out using the beam propagation method. We have also performed the mathematical modeling and analyzed the results in MATLAB.
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Ugwuowo U, Yamamoto Y, Arora T, Saran I, Partridge C, Biswas A, Martin M, Moledina DG, Greenberg JH, Simonov M, Mansour SG, Vela R, Testani JM, Rao V, Rentfro K, Obeid W, Parikh CR, Wilson FP. Real-Time Prediction of Acute Kidney Injury in Hospitalized Adults: Implementation and Proof of Concept. Am J Kidney Dis 2020; 76:806-814.e1. [PMID: 32505812 DOI: 10.1053/j.ajkd.2020.05.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 05/05/2020] [Indexed: 11/11/2022]
Abstract
RATIONALE & OBJECTIVE Acute kidney injury (AKI) is diagnosed based on changes in serum creatinine concentration, a late marker of this syndrome. Algorithms that predict elevated risk for AKI are of great interest, but no studies have incorporated such an algorithm into the electronic health record to assist with clinical care. We describe the experience of implementing such an algorithm. STUDY DESIGN Prospective observational cohort study. SETTING & PARTICIPANTS 2,856 hospitalized adults in a single urban tertiary-care hospital with an algorithm-predicted risk for AKI in the next 24 hours>15%. Alerts were also used to target a convenience sample of 100 patients for measurement of 16 urine and 6 blood biomarkers. EXPOSURE Clinical characteristics at the time of pre-AKI alert. OUTCOME AKI within 24 hours of pre-AKI alert (AKI24). ANALYTICAL APPROACH Descriptive statistics and univariable associations. RESULTS At enrollment, mean predicted probability of AKI24 was 19.1%; 18.9% of patients went on to develop AKI24. Outcomes were generally poor among this population, with 29% inpatient mortality among those who developed AKI24 and 14% among those who did not (P<0.001). Systolic blood pressure<100mm Hg (28% of patients with AKI24 vs 18% without), heart rate>100 beats/min (32% of patients with AKI24 vs 24% without), and oxygen saturation<92% (15% of patients with AKI24 vs 6% without) were all more common among those who developed AKI24. Of all biomarkers measured, only hyaline casts on urine microscopy (72% of patients with AKI24 vs 25% without) and fractional excretion of urea nitrogen (20% [IQR, 12%-36%] among patients with AKI24 vs 34% [IQR, 25%-44%] without) differed between those who did and did not develop AKI24. LIMITATIONS Single-center study, reliance on serum creatinine level for AKI diagnosis, small number of patients undergoing biomarker evaluation. CONCLUSIONS A real-time AKI risk model was successfully integrated into the EHR.
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Affiliation(s)
- Ugochukwu Ugwuowo
- Section of Nephrology, Department of Medicine, Yale University School of Medicine, New Haven, CT; Clinical and Translational Research Accelerator, Yale University School of Medicine, New Haven, CT; Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Yu Yamamoto
- Section of Nephrology, Department of Medicine, Yale University School of Medicine, New Haven, CT; Clinical and Translational Research Accelerator, Yale University School of Medicine, New Haven, CT
| | - Tanima Arora
- Section of Nephrology, Department of Medicine, Yale University School of Medicine, New Haven, CT; Clinical and Translational Research Accelerator, Yale University School of Medicine, New Haven, CT
| | - Ishan Saran
- Department of Physics, Emory University, Atlanta, GA
| | - Caitlin Partridge
- Joint Data Analytics Team, Yale University School of Medicine, New Haven, CT
| | - Aditya Biswas
- Section of Nephrology, Department of Medicine, Yale University School of Medicine, New Haven, CT; Clinical and Translational Research Accelerator, Yale University School of Medicine, New Haven, CT
| | - Melissa Martin
- Section of Nephrology, Department of Medicine, Yale University School of Medicine, New Haven, CT; Clinical and Translational Research Accelerator, Yale University School of Medicine, New Haven, CT
| | - Dennis G Moledina
- Clinical and Translational Research Accelerator, Yale University School of Medicine, New Haven, CT
| | - Jason H Greenberg
- Clinical and Translational Research Accelerator, Yale University School of Medicine, New Haven, CT; Department of Pediatrics, Yale University School of Medicine, New Haven, CT
| | - Michael Simonov
- Clinical and Translational Research Accelerator, Yale University School of Medicine, New Haven, CT
| | - Sherry G Mansour
- Section of Nephrology, Department of Medicine, Yale University School of Medicine, New Haven, CT; Clinical and Translational Research Accelerator, Yale University School of Medicine, New Haven, CT
| | - Ricardo Vela
- Department of Mechanical Engineering, University of Texas at El Paso. El Paso, TX
| | - Jeffrey M Testani
- Section of Cardiology, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT
| | - Veena Rao
- Section of Cardiology, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT
| | - Keith Rentfro
- Section of Nephrology, Department of Medicine, Yale University School of Medicine, New Haven, CT
| | - Wassim Obeid
- Johns Hopkins University School of Medicine, Baltimore, MD; Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Chirag R Parikh
- Johns Hopkins University School of Medicine, Baltimore, MD; Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - F Perry Wilson
- Section of Nephrology, Department of Medicine, Yale University School of Medicine, New Haven, CT; Clinical and Translational Research Accelerator, Yale University School of Medicine, New Haven, CT.
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Sandokji I, Yamamoto Y, Biswas A, Arora T, Ugwuowo U, Simonov M, Saran I, Martin M, Testani JM, Mansour S, Moledina DG, Greenberg JH, Wilson FP. A Time-Updated, Parsimonious Model to Predict AKI in Hospitalized Children. J Am Soc Nephrol 2020; 31:1348-1357. [PMID: 32381598 DOI: 10.1681/asn.2019070745] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [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: 07/26/2019] [Accepted: 03/13/2020] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Timely prediction of AKI in children can allow for targeted interventions, but the wealth of data in the electronic health record poses unique modeling challenges. METHODS We retrospectively reviewed the electronic medical records of all children younger than 18 years old who had at least two creatinine values measured during a hospital admission from January 2014 through January 2018. We divided the study population into derivation, and internal and external validation cohorts, and used five feature selection techniques to select 10 of 720 potentially predictive variables from the electronic health records. Model performance was assessed by the area under the receiver operating characteristic curve in the validation cohorts. The primary outcome was development of AKI (per the Kidney Disease Improving Global Outcomes creatinine definition) within a moving 48-hour window. Secondary outcomes included severe AKI (stage 2 or 3), inpatient mortality, and length of stay. RESULTS Among 8473 encounters studied, AKI occurred in 516 (10.2%), 207 (9%), and 27 (2.5%) encounters in the derivation, and internal and external validation cohorts, respectively. The highest-performing model used a machine learning-based genetic algorithm, with an overall receiver operating characteristic curve in the internal validation cohort of 0.76 [95% confidence interval (CI), 0.72 to 0.79] for AKI, 0.79 (95% CI, 0.74 to 0.83) for severe AKI, and 0.81 (95% CI, 0.77 to 0.86) for neonatal AKI. To translate this prediction model into a clinical risk-stratification tool, we identified high- and low-risk threshold points. CONCLUSIONS Using various machine learning algorithms, we identified and validated a time-updated prediction model of ten readily available electronic health record variables to accurately predict imminent AKI in hospitalized children.
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Affiliation(s)
- Ibrahim Sandokji
- Department of Pediatrics, Section of Nephrology, Yale University School of Medicine, New Haven, Connecticut.,Clinical and Translational Research Accelerator, Department of Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Yu Yamamoto
- Clinical and Translational Research Accelerator, Department of Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Aditya Biswas
- Clinical and Translational Research Accelerator, Department of Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Tanima Arora
- Clinical and Translational Research Accelerator, Department of Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Ugochukwu Ugwuowo
- Clinical and Translational Research Accelerator, Department of Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Michael Simonov
- Clinical and Translational Research Accelerator, Department of Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Ishan Saran
- Clinical and Translational Research Accelerator, Department of Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Melissa Martin
- Clinical and Translational Research Accelerator, Department of Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Jeffrey M Testani
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Sherry Mansour
- Clinical and Translational Research Accelerator, Department of Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Dennis G Moledina
- Clinical and Translational Research Accelerator, Department of Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Jason H Greenberg
- Department of Pediatrics, Section of Nephrology, Yale University School of Medicine, New Haven, Connecticut.,Clinical and Translational Research Accelerator, Department of Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - F Perry Wilson
- Clinical and Translational Research Accelerator, Department of Medicine, Yale University School of Medicine, New Haven, Connecticut
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Dubey R, Yadav A, Pawar A, Biswas A. Comparing the outcome of progenitor (CD34+) Cell dose calculated using ideal body weight to actual body weight on engraftment of neutrophils and platelets after PBSC transplant. Cytotherapy 2020. [DOI: 10.1016/j.jcyt.2020.03.082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Affiliation(s)
- V Kumar
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - P Jorwal
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - A Biswas
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - V Deorari
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
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Sharma A, Chaudhary M, Thakar A, Bhaskar S, Sikka K, Pramanik R, Biswas A, Singh C, Sahoo R, Deo S, Kumar R, Thulkar S, Kakkar A, Seth S, Sreenivas V. Concurrent chemotherapy and external radiation therapy: An open label non-inferiority phase III randomized controlled trial of weekly versus three weekly cisplatin and radical radiotherapy in locally advanced head and neck squamous cell carcinoma: CONCERT trial. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz252.064] [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: 11/14/2022] Open
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Biswas A, Saini D, Roy A, Mukherjee A, Gangopadhyay G. Can behavioral symptoms differentiate cortical from subcortical dementia - A comparative study of behavioral profile of Parkinson’s disease dementia and behavioral variant of frontotemporal dementia. J Neurol Sci 2019. [DOI: 10.1016/j.jns.2019.10.246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Devnani B, Gupta S, Haresh K, Biswas A, Pareek V, Batra M, Singh M, Tandon V, Julka P, Rath G. Impact of Adjuvant Therapy on Survival in Treatment of Central Nervous System Hemangiopericytoma. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.2224] [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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