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Mazza DF, Boonsri PS, Arora A, Bayne CO, Szabo RM, Chaudhari AJ, Boutin RD. Relationships between diagnostic imaging of first carpometacarpal osteoarthritis and pain, functional status, and disease progression: A systematic review. Osteoarthritis Cartilage 2024; 32:476-492. [PMID: 38141842 DOI: 10.1016/j.joca.2023.11.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 10/20/2023] [Accepted: 11/29/2023] [Indexed: 12/25/2023]
Abstract
OBJECTIVE To systematically review the association of pain, function, and progression in first carpometacarpal (CMC) osteoarthritis (OA) with imaging biomarkers and radiography-based staging. DESIGN Database searches in PubMed, Embase, and the Cochrane Library, along with citation searching were conducted in accordance with published guidance. Data on the association of imaging with pain, functional status, and disease progression were extracted and synthesized, along with key information on study methodology such as sample sizes, use of control subjects, study design, number of image raters, and blinding. Methodological quality was assessed using National Heart, Lung, and Blood Institute tools. RESULTS After duplicate removal, a total of 1969 records were screened. Forty-six articles are included in this review, covering a total of 28,202 study participants, 7263 with first CMC OA. Osteophytes were found to be one of the strongest biomarkers for pain across imaging modalities. Radiographic findings alone showed conflicting relationships with pain. However, Kellgren-Lawrence staging showed consistent associations with pain in various studies. Radiographic, sonographic, and MRI findings and staging showed little association to tools evaluating functional status across imaging modalities. The same imaging methods showed limited ability to predict progression of first CMC OA. A major limitation was the heterogeneity in the study base, limiting synthesis of results. CONCLUSION Imaging findings and radiography-based staging systems generally showed strong associations with pain, but not with functional status or disease progression. More research and improved imaging techniques are needed to help physicians better manage patients with first CMC OA.
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Affiliation(s)
- Dario F Mazza
- Department of Radiology, University of California, Davis, CA, USA.
| | | | - Aman Arora
- Department of Radiology, University of California, Davis, CA, USA.
| | - Christopher O Bayne
- Department of Orthopaedic Surgery, University of California, Davis, CA, USA.
| | - Robert M Szabo
- Department of Orthopaedic Surgery, University of California, Davis, CA, USA.
| | | | - Robert D Boutin
- Department of Radiology, Stanford University School of Medicine, Stanford, CA, USA.
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Sabharwal N, Arora A, Upadhyaya V, Sehgal MM, Nayak K, Katyal S, Dahiya M, Pratap C, Sharma R. Impression Disinfection and Its Effect on Dimensional Accuracy and Surface Detail in the Times of COVID-19: An In Vitro Study. Cureus 2024; 16:e55931. [PMID: 38623104 PMCID: PMC11017823 DOI: 10.7759/cureus.55931] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/10/2024] [Indexed: 04/17/2024] Open
Abstract
Introduction The disinfection of impressions is crucial to eliminate the viral and other microbial loads to prevent the cross contamination of diseases. The aim of this study was to compare the effect of different virucidal disinfecting methods on the dimensional accuracy and surface detail reproduction (SDR) of impression materials. Methods A total of 160 samples were fabricated with different impression materials using zinc oxide eugenol (Group 1), alginate (Group 2), polyether (Group 3), and addition silicone (Group 4) impression materials, each containing 40 samples (n=40). These groups were further divided into Subgroups A, B, C, and D (n=10) based on the disinfecting method used. Disinfection was carried out using 0.2% peracetic acid (A), a natural polymer of glucosamine (B), ultraviolet (UV) radiation (C), and ozonated water (D). The disinfected impressions were poured in type IV gypsum, and the obtained casts were checked for dimensional accuracy and surface detail reproduction (SDR). For dimensional accuracy, a one-way analysis of variance (ANOVA) test and, for surface detail reproduction, the chi-square test were used to compare the different subgroups of each impression material separately. Results Zinc oxide eugenol samples showed the lowest mean dimensional change when disinfected with 0.2% peracetic acid (1A=154.1 µm), and alginate showed the lowest mean dimensional change when disinfected using ozonated water (2D=134.9 µm). On the other hand, the lowest mean dimensional change observed in polyether and addition silicone samples was those which were disinfected using UV radiation (3C=100.9 µm and 4C=113.5 µm). Surface detail was reproduced adequately in most of the samples. Conclusion A 0.2% peracetic acid could be used to disinfect zinc oxide eugenol impressions, ozonated water for alginate impressions, and UV radiation for polyether and addition silicone impressions.
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Affiliation(s)
- Niharika Sabharwal
- Prosthodontics, Institute of Technology and Science (ITS) Dental College, Ghaziabad, IND
| | - Aman Arora
- Prosthodontics, JN Kapoor Dayanand Anglo Vedic (DAV) Dental College, Yamunanagar, IND
| | - Viram Upadhyaya
- Prosthodontics, JN Kapoor Dayanand Anglo Vedic (DAV) Dental College, Yamunanagar, IND
| | - Monika M Sehgal
- Prosthodontics, JN Kapoor Dayanand Anglo Vedic (DAV) Dental College, Yamunanagar, IND
| | - Karvika Nayak
- Prosthodontics, Institute of Technology and Science (ITS) Dental College, Ghaziabad, IND
| | - Setu Katyal
- Endodontics, Institute of Technology and Science (ITS) Dental College, Ghaziabad, IND
| | - Manisha Dahiya
- Prosthodontics, JN Kapoor Dayanand Anglo Vedic (DAV) Dental College, Yamunanagar, IND
| | - Chandrama Pratap
- Prosthodontics, JN Kapoor Dayanand Anglo Vedic (DAV) Dental College, Yamunanagar, IND
| | - Radhika Sharma
- Prosthodontics, JN Kapoor Dayanand Anglo Vedic (DAV) Dental College, Yamunanagar, IND
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Haffner MR, Saiz AM, Darrow MA, Judge SJ, Laun T, Arora A, Taylor SL, Randall RL, Alvarez EM, Thorpe SW. Effect of ALDH1A1 and CD44 on Survival and Disease Recurrence in Patients With Osteosarcoma. Cureus 2024; 16:e52404. [PMID: 38371078 PMCID: PMC10869251 DOI: 10.7759/cureus.52404] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/15/2024] [Indexed: 02/20/2024] Open
Abstract
PURPOSE Emerging evidence suggests that osteosarcoma stem cells (OSCs) may be responsible for tumor initiation propagation, recurrence, and resistance to therapy. We set out to evaluate the relationship between the abundance of ALDH1A1 and CD44-positive cells in biopsy and resection samples on disease recurrence and overall survival. METHODS A retrospective review of 20 patients, including biopsy and resection samples, was performed at a comprehensive cancer center. Additionally, we queried the publicly available TARGET dataset of osteosarcoma patients. RESULTS Neither the percentages of ALDH1A1-positive cells nor CD44-positive cells were significantly associated with overall mortality or disease recurrence in either biopsy or resection samples. Unlike our institutional data, overall survival was significantly correlated to higher ALDH1A1 expression in the TARGET dataset both in univariate and age-adjusted analyses. CONCLUSIONS ADLH1 and CD44, potential markers of OSCs, were not found to be reliable clinical immunohistochemical prognostic markers for osteosarcoma patient survival, specifically disease-free survival. Osteosarcoma patients with high ALDH1A1 RNA expression showed improved overall survival in examining a national genomic database of osteosarcoma patients but again no association with disease-free survival. The potential of CD44 and ALDH1A1 as cellular-specific prognostic markers of survival, and as possible molecular targets, may be limited in osteosarcoma.
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Affiliation(s)
- Max R Haffner
- Orthopedic Surgery, UC (University of California) Davis Health, Sacramento, USA
| | - Augustine M Saiz
- Orthopedic Surgery, UC (University of California) Davis Health, Sacramento, USA
| | - Morgan A Darrow
- Pathology and Laboratory Medicine, UC (University of California) Davis Health, Sacramento, USA
| | - Sean J Judge
- Surgery, UC (University of California) Davis Health, Sacramento, USA
| | - Tammy Laun
- Medicine, Oakland University William Beaumont School of Medicine, Auburn Hills, USA
| | - Aman Arora
- Urology, UC (University of California) Davis School of Medicine, Sacramento, USA
| | - Sandra L Taylor
- Division of Biostatistics, Public Health Sciences, Sacramento, USA
| | - R Lor Randall
- Orthopedic Surgery, UC (University of California) Davis Health, Sacramento, USA
| | - Elysia M Alvarez
- Pediatric Hematology and Oncology, UC (University of California) Davis Health, Sacramento, USA
| | - Steven W Thorpe
- Orthopedic Surgery, UC (University of California) Davis Health, Sacramento, USA
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Murthy V, Kashid SR, Vadassery A, Pal M, Maitre P, Arora A, Singh P, Menon S, Bakshi G, Joshi A, Prakash G. Prospective Comparative Study of Quality of Life in Bladder Cancer Patients Undergoing Cystectomy or Bladder Preservation. Int J Radiat Oncol Biol Phys 2023; 117:S112. [PMID: 37784294 DOI: 10.1016/j.ijrobp.2023.06.440] [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) Health-related Quality of life (HRQOL) may be decisive when different treatments yield comparable survival outcomes. We compared QOL in patients undergoing radical cystectomy with ileal conduit (RCIC) or bladder preservation (BP) with (chemo)radiotherapy for bladder cancer. MATERIALS/METHODS Patients with histological diagnosis of bladder cancer, stage T1-T4, N0-N1, M0 with a minimum follow-up of 6 months from the last treatment intervention (RCIC or BP) and alive without disease at the time of QOL assessment were eligible for inclusion. After ethics committee approval, two HRQOL instruments were translated, validated and administered: Bladder cancer index (BCI) for bladder cancer-specific HRQOL, which includes 36 items under three domains - bladder, bowel and sexual function and the EORTC QLQ C30 which includes 30 items under three domains - functional, symptom and global health. The mean QOL scores across various domains and specific questions were compared between the two treatment groups using the independent t-test. RESULTS Of the 104 patients enrolled, 56 had RCIC, and 48 received BP, and included 95 (91.3%) males. The median time from treatment completion to QOL assessment was 22 months (IQR 10-56). The median age for the entire cohort was 62 years (IQR 55-68), 65.5 years (IQR 55-71) in BP and 59.5 years (IQR 55-66) in RCIC. Overall, mean BCI urinary scores and bowel scores were high in both groups, with no significant difference in function or bother subdomains between the two groups (Table 1). Overall, BCI sexual scores were low in both the groups but significantly better after BP (BPmean 56.9, RCICmean 41.5, p = 0.01). Mean scores for sexual function BPmean 38.4 and RCIC mean 25 p (0.07) and sexual bother BPmean 81 RCICmean 62 (p 0.02) subdomains. There was no significant difference in EORTC QOL outcomes in functional (BPmean 91.4, RCICmean 88.7 p 0.23), symptom (BPmean 89.8, RCICmean 89, p = 0.68) and global health scale (BPmean 76.8, RCICmean 78.5, p = 0.69) in both groups. On question-wise assessment, the ability to perform an exercise (BPmean 94.2, RCICmean 85, p = 0.06) and urinary leakage at night time (BPmean 91.7, RCICmean 77.6, p = 0.01) were better in the BP group, while scores for blood in the urine (BPmean 89.1, RCICmean 97, p = 0.05) were better in the RCIC group compared to BP. CONCLUSION Overall, QOL was good in both groups in the urinary and bowel domains while it was low in the sexual domain. However, bladder preservation performed significantly better in the sexual domain than RCIC.
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Affiliation(s)
- V Murthy
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - S R Kashid
- Department of Radiation Oncology, Tata Memorial Hospital, HBNI, Mumbai, India
| | - A Vadassery
- Department of Radiation Oncology, Tata Memorial Hospital, HBNI, Mumbai, India
| | - M Pal
- Department of Surgical Oncology, Tata Memorial Hospital, HBNI, Mumbai, India
| | - P Maitre
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - A Arora
- Department of Surgical Oncology, Tata Memorial Hospital, HBNI, Mumbai, India
| | - P Singh
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - S Menon
- Department of Pathology, Tata Memorial Hospital, HBNI, Mumbai, India
| | - G Bakshi
- Department of Surgical Oncology, Tata Memorial Hospital, HBNI, Mumbai, India
| | - A Joshi
- Department of Medical Oncology, Tata Memorial Hospital, HBNI, Mumbai, India
| | - G Prakash
- Department of Surgical Oncology, Tata Memorial Hospital, HBNI, Mumbai, India
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Murthy V, Maitre P, Singh M, Pal M, Arora A, Pujari L, Kapoor A, Pandey H, Sharma R, Gudipudi D, Joshi A, Prabhash K, Noronha V, Menon S, Mehta P, Bakshi G, Prakash G. Study Protocol of the Bladder Adjuvant RadioTherapy (BART) Trial: A Randomised Phase III Trial of Adjuvant Radiotherapy Following Cystectomy in Bladder Cancer. Clin Oncol (R Coll Radiol) 2023; 35:e506-e515. [PMID: 37208232 DOI: 10.1016/j.clon.2023.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 04/10/2023] [Accepted: 04/28/2023] [Indexed: 05/21/2023]
Abstract
AIMS To assess the efficacy and safety of adjuvant radiotherapy in patients with high-risk muscle-invasive bladder cancer (MIBC) following radical cystectomy (RC) and chemotherapy. MATERIALS AND METHODS The BART (Bladder Adjuvant RadioTherapy) trial is an ongoing multicentric, randomised, phase III trial comparing the efficacy and safety of adjuvant radiotherapy versus observation in patients with high-risk MIBC. The key eligibility criteria include ≥pT3, node-positive (pN+), positive margins and/or nodal yield <10, or, neoadjuvant chemotherapy for cT3/T4/N+ disease. In total, 153 patients will be accrued and randomised, in a 1:1 ratio, to either observation (standard arm) or adjuvant radiotherapy (test arm) following surgery and chemotherapy. Stratification parameters include nodal status (N+ versus N0) and chemotherapy (neoadjuvant chemotherapy versus adjuvant chemotherapy versus no chemotherapy). For patients in the test arm, adjuvant radiotherapy to cystectomy bed and pelvic nodes is planned with intensity-modulated radiotherapy to a dose of 50.4 Gy in 28 fractions using daily image guidance. All patients will follow-up with 3-monthly clinical review and urine cytology for 2 years and subsequently 6 monthly until 5 years, with contrast-enhanced computed tomography abdomen pelvis 6 monthly for 2 years and annually until 5 years. Physician-scored toxicity using Common Terminology Criteria for Adverse Events version 5.0 and patient-reported quality of life using the Functional Assessment of Cancer Therapy - Colorectal questionnaire is recorded pre-treatment and at follow-up. ENDPOINTS AND STATISTICS The primary endpoint is 2-year locoregional recurrence-free survival. The sample size calculation was based on the estimated improvement in 2-year locoregional recurrence-free survival from 70% in the standard arm to 85% in the test arm (hazard ratio 0.45) using 80% statistical power and a two-sided alpha error of 0.05. Secondary endpoints include disease-free survival, overall survival, acute and late toxicity, patterns of failure and quality of life. CONCLUSION The BART trial aims to evaluate whether contemporary radiotherapy after standard-of-care surgery and chemotherapy reduces pelvic recurrences safely and also potentially affects survival in high-risk MIBC.
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Affiliation(s)
- V Murthy
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India.
| | - P Maitre
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - M Singh
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - M Pal
- Department of Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - A Arora
- Department of Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - L Pujari
- Department of Radiation Oncology, HBCH & MPMMMC, Varanasi, India
| | - A Kapoor
- Department of Medical Oncology, HBCH & MPMMMC, Varanasi, India
| | - H Pandey
- Department of Surgical Oncology, HBCH & MPMMMC, Varanasi, India
| | - R Sharma
- Department of Uro-Oncology, Basavatarakam Indo-American Cancer Hospital and Research Institute, Hyderabad, India
| | - D Gudipudi
- Department of Uro-Oncology, Basavatarakam Indo-American Cancer Hospital and Research Institute, Hyderabad, India
| | - A Joshi
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - K Prabhash
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - V Noronha
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - S Menon
- Department of Pathology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - P Mehta
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - G Bakshi
- Department of Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - G Prakash
- Department of Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
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Hamm SE, Yuan C, McQueen LF, Wallace MA, Zhang H, Arora A, Garafalo AM, McMillan RP, Lawlor MW, Prom MJ, Ott EM, Yan J, Addington AK, Morris CA, Gonzalez JP, Grange RW. Prolonged voluntary wheel running reveals unique adaptations in mdx mice treated with microdystrophin constructs ± the nNOS-binding site. Front Physiol 2023; 14:1166206. [PMID: 37435312 PMCID: PMC10330712 DOI: 10.3389/fphys.2023.1166206] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 05/10/2023] [Indexed: 07/13/2023] Open
Abstract
We tested the effects of prolonged voluntary wheel running on the muscle function of mdx mice treated with one of two different microdystrophin constructs. At 7 weeks of age mdx mice were injected with a single dose of AAV9-CK8-microdystrophin with (gene therapy 1, GT1) or without (gene therapy 2, GT2) the nNOS-binding domain and were assigned to one of four gene therapy treated groups: mdxRGT1 (run, GT1), mdxGT1 (no run, GT1), or mdxRGT2 (run,GT2), mdxGT2 (no run, GT2). There were two mdx untreated groups injected with excipient: mdxR (run, no gene therapy) and mdx (no run, no gene therapy). A third no treatment group, Wildtype (WT) received no injection and did not run. mdxRGT1, mdxRGT2 and mdxR performed voluntary wheel running for 52 weeks; WT and remaining mdx groups were cage active. Robust expression of microdystrophin occurred in diaphragm, quadriceps, and heart muscles of all treated mice. Dystrophic muscle pathology was high in diaphragms of non-treated mdx and mdxR mice and improved in all treated groups. Endurance capacity was rescued by both voluntary wheel running and gene therapy alone, but their combination was most beneficial. All treated groups increased in vivo plantarflexor torque over both mdx and mdxR mice. mdx and mdxR mice displayed ∼3-fold lower diaphragm force and power compared to WT values. Treated groups demonstrated partial improvements in diaphragm force and power, with mdxRGT2 mice experiencing the greatest improvement at ∼60% of WT values. Evaluation of oxidative red quadriceps fibers revealed the greatest improvements in mitochondrial respiration in mdxRGT1 mice, reaching WT levels. Interestingly, mdxGT2 mice displayed diaphragm mitochondrial respiration values similar to WT but mdxRGT2 animals showed relative decreases compared to the no run group. Collectively, these data demonstrate that either microdystrophin construct combined with voluntary wheel running increased in vivo maximal muscle strength, power, and endurance. However, these data also highlighted important differences between the two microdystrophin constructs. GT1, with the nNOS-binding site, improved more markers of exercise-driven adaptations in metabolic enzyme activity of limb muscles, while GT2, without the nNOS-binding site, demonstrated greater protection of diaphragm strength after chronic voluntary endurance exercise but decreased mitochondrial respiration in the context of running.
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Affiliation(s)
- S. E. Hamm
- Department of Human Nutrition, Foods and Exercise and Metabolism Core, Virginia Tech, Blacksburg, VA, United States
| | - C. Yuan
- Department of Human Nutrition, Foods and Exercise and Metabolism Core, Virginia Tech, Blacksburg, VA, United States
| | - L. F. McQueen
- Department of Human Nutrition, Foods and Exercise and Metabolism Core, Virginia Tech, Blacksburg, VA, United States
| | - M. A. Wallace
- Department of Human Nutrition, Foods and Exercise and Metabolism Core, Virginia Tech, Blacksburg, VA, United States
| | - H. Zhang
- Department of Human Nutrition, Foods and Exercise and Metabolism Core, Virginia Tech, Blacksburg, VA, United States
| | - A. Arora
- Department of Human Nutrition, Foods and Exercise and Metabolism Core, Virginia Tech, Blacksburg, VA, United States
| | - A. M. Garafalo
- Department of Human Nutrition, Foods and Exercise and Metabolism Core, Virginia Tech, Blacksburg, VA, United States
| | - R. P. McMillan
- Department of Human Nutrition, Foods and Exercise and Metabolism Core, Virginia Tech, Blacksburg, VA, United States
| | - M. W. Lawlor
- Department of Pathology and Neuroscience Research Center, Medical College of Wisconsin and Diverge Translational Science Laboratory, Milwaukee, WI, United States
| | - M. J. Prom
- Department of Pathology and Neuroscience Research Center, Medical College of Wisconsin and Diverge Translational Science Laboratory, Milwaukee, WI, United States
| | - E. M. Ott
- Department of Pathology and Neuroscience Research Center, Medical College of Wisconsin and Diverge Translational Science Laboratory, Milwaukee, WI, United States
| | - J. Yan
- Department of Human Nutrition, Foods and Exercise and Metabolism Core, Virginia Tech, Blacksburg, VA, United States
| | - A. K. Addington
- Department of Human Nutrition, Foods and Exercise and Metabolism Core, Virginia Tech, Blacksburg, VA, United States
| | - C. A. Morris
- Solid Biosciences, Inc., Cambridge, MA, United States
| | | | - R. W. Grange
- Department of Human Nutrition, Foods and Exercise and Metabolism Core, Virginia Tech, Blacksburg, VA, United States
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Gurumurthy S, Arora A, Krishna H, Chinnusamy V, Hazra KK. Genotypic capacity of post-anthesis stem reserve mobilization in wheat for yield sustainability under drought and heat stress in the subtropical region. Front Genet 2023; 14:1180941. [PMID: 37408776 PMCID: PMC10318140 DOI: 10.3389/fgene.2023.1180941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 05/23/2023] [Indexed: 07/07/2023] Open
Abstract
Wheat productivity is severely affected by drought and heat stress conditions worldwide. Currently, stem reserve mobilization (SRM) is receiving increased attention as a trait that can sustain wheat yields under adverse environments. However, the significance of SRM in sustaining wheat yields under drought and heat stress conditions remains uncertain in the tropical climate of Indo-Gangetic Plain region. Therefore, this study aimed to investigate genotypic variations in SRM in wheat and their influence on yield sustainability under drought and heat stress environments. The experiment was designed in an alpha-lattice layout, accommodating 43 genotypes under four simulated environments [timely sown and well irrigated (non-stress); timely sown and water-deficit/drought stress; late-sown and well-irrigated crop facing terminally high temperature; and late-sown and water-deficit stress (both water-deficit and heat stress)]. The water-deficit stress significantly increased SRM (16%-68%, p < 0.01) compared to the non-stress environment, while the heat stress conditions reduced SRM (12%-18%). Both SRM and stem reserve mobilization efficiency exhibited positive correlations with grain weight (grain weight spike-1) under all three different stress treatments (p < 0.05). Strong positive correlations between stem weight (at 12 days after anthesis) and grain weight were observed across the environments (p < 0.001); however, a significant positive correlation between stem weight and SRM was observed only with stress treatments. Results revealed that the SRM trait could effectively alleviate the impacts of water-deficit stress on yields. However, the SRM-mediated yield protection was uncertain under heat stress and combined water-deficit and heat stress treatments, possibly due to sink inefficiencies caused by high temperature during the reproductive period. Defoliated plants exhibited higher SRM than non-defoliated plants, with the highest increment observed in the non-stress treatment compared to all the stress treatments. Results revealed that wider genetic variability exists for the SRM trait, which could be used to improve wheat yield under drought stress conditions.
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Affiliation(s)
- S. Gurumurthy
- Division of Plant Physiology, ICAR–Indian Agricultural Research Institute, New Delhi, India
- School of Water Stress Management, ICAR–National Institute of Abiotic Stress Management, Baramati, Maharashtra, India
| | - A. Arora
- Division of Plant Physiology, ICAR–Indian Agricultural Research Institute, New Delhi, India
| | - Hari Krishna
- Division of Genetics, ICAR–Indian Agricultural Research Institute, New Delhi, India
| | - V. Chinnusamy
- Division of Plant Physiology, ICAR–Indian Agricultural Research Institute, New Delhi, India
| | - K. K. Hazra
- Crop Production Division, ICAR–Indian Institute of Pulses Research, Kanpur, Uttar Pradesh, India
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8
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Swann JR, Diaz Heijtz R, Mayneris-Perxachs J, Arora A, Isaksson J, Bölte S, Tammimies K. Characterizing the metabolomic signature of attention-deficit hyperactivity disorder in twins. Neuropharmacology 2023; 234:109562. [PMID: 37100381 DOI: 10.1016/j.neuropharm.2023.109562] [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: 12/17/2022] [Revised: 03/05/2023] [Accepted: 04/21/2023] [Indexed: 04/28/2023]
Abstract
Emerging evidence implicate the gut microbiota as a potential susceptibility factor in attention-deficit hyperactivity disorder (ADHD), a common multifactorial neurodevelopmental condition. However, little is known about the biochemical signature of ADHD, including the metabolic contribution of the microbiota via the gut-brain axis, and the relative contribution of genetics and environmental factors. Here, we perform unbiased metabolomic profiling of urine and fecal samples collected from a well-characterized Swedish twin cohort enriched for ADHD (33 ADHD, 79 non-ADHD), using 1H nuclear magnetic resonance spectroscopy and liquid chromatography-mass spectrometry. Our results highlight sex-specific patterns in the metabolic phenotype of individuals with ADHD. Specifically, the urine profile of males, but not females, with ADHD was characterized by greater excretion of hippurate, a product of microbial-host co-metabolism that can cross the blood-brain-barrier with bioactivity of potential relevance to ADHD. This trans-genomic metabolite was also negatively correlated with IQ in males and was significantly correlated with fecal metabolites associated with gut microbial metabolism. The fecal profile of ADHD individuals was characterized by increased excretion of stearoyl-linoleoyl-glycerol, 3,7-dimethylurate, and FAD and lower amounts of glycerol 3-phosphate, thymine, 2(1H)-quinolinone, aspartate, xanthine, hypoxanthine, and orotate. These changes were independent of ADHD medication, age, and BMI. Furthermore, our specific twins' models revealed that many of these gut metabolites had a stronger genetic influence than environmental. These findings suggest that metabolic disturbances in ADHD, involving combined gut microbial and host metabolic processes, may largely derive from gene variants previously linked to behavioral symptoms in this disorder.
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Affiliation(s)
- J R Swann
- School of Human Development and Health, Faculty of Medicine, University of Southampton, UK; Department of Metabolism, Digestion, and Reproduction, Faculty of Medicine, Imperial College London, UK.
| | - R Diaz Heijtz
- Department of Neuroscience, Karolinska Institutet Region Stockholm, Stockholm, Sweden
| | - J Mayneris-Perxachs
- Department of Diabetes, Endocrinology and Nutrition, Girona Biomedical Research Institute, Girona, Spain; CIBER Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III, Madrid, Spain
| | - A Arora
- Center of Neurodevelopmental Disorders (KIND), Centre for Psychiatry Research, Department of Women's and Children's Health, Karolinska Institutet Region Stockholm, Stockholm, Sweden; Astrid Lindgren Children's Hospital, Karolinska University Hospital, Region Stockholm, Stockholm, Sweden
| | - J Isaksson
- Center of Neurodevelopmental Disorders (KIND), Centre for Psychiatry Research, Department of Women's and Children's Health, Karolinska Institutet Region Stockholm, Stockholm, Sweden; Department of Medical Sciences, Child and Adolescent Psychiatry Unit, Uppsala University, Uppsala, Sweden
| | - S Bölte
- Center of Neurodevelopmental Disorders (KIND), Centre for Psychiatry Research, Department of Women's and Children's Health, Karolinska Institutet Region Stockholm, Stockholm, Sweden; Curtin Autism Research Group, Curtin School of Allied Health, Curtin University, Perth, Western Australia, Australia; Child and Adolescent Psychiatry, Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden.
| | - K Tammimies
- Center of Neurodevelopmental Disorders (KIND), Centre for Psychiatry Research, Department of Women's and Children's Health, Karolinska Institutet Region Stockholm, Stockholm, Sweden; Astrid Lindgren Children's Hospital, Karolinska University Hospital, Region Stockholm, Stockholm, Sweden
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Hussain RN, Chiu A, Pittam B, Taktak A, Damato BE, Kacperek A, Errington D, Cauchi P, Chadha V, Connolly J, Salvi S, Rundle P, Cohen V, Arora A, Sagoo M, Bekir O, Kopsidas K, Heimann H. Proton beam radiotherapy for choroidal and ciliary body melanoma in the UK-national audit of referral patterns of 1084 cases. Eye (Lond) 2023; 37:1033-1036. [PMID: 35840716 PMCID: PMC10050435 DOI: 10.1038/s41433-022-02178-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 07/03/2022] [Accepted: 07/07/2022] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION Proton beam therapy has been utilised for the treatment of uveal melanoma in the UK for over 30 years, undertaken under a single centre. In the UK, all ocular tumours are treated at one of four centres. We aimed to understand the variation in referral patterns to the UK proton service, capturing all uveal melanoma patients treated with this modality. METHODS Retrospective analysis of data regarding all patients treated at the Clatterbridge Proton service between January 2004 and December 2014. RESULTS A total of 1084 patients with uveal melanoma were treated. The mean age was 57 years (range 9-90 years), basal diameter of 11.5 mm (range 2.0-23.4 mm) and tumour thickness of 3.9 mm (range 0.1-15.4 mm). The majority were TNM stage I (39%) or II (36%). The distance to the optic nerve varied from 0 to 24.5 mm with 148 (14%) of patients having ciliary body involvement. There were variations in the phenotypic characteristic of the tumours treated with protons from different centres, with London referring predominantly small tumours at the posterior pole, Glasgow referring large tumours often at the ciliary body and Liverpool sending a mix of these groups. DISCUSSION In the UK, common indications for the use of proton treatment in uveal melanoma include small tumours in the posterior pole poorly accessible for plaque treatment (adjacent to the disc), tumours at the posterior pole affecting the fovea and large anterior tumours traditionally too large for brachytherapy. This is the first UK-wide audit enabling the capture of all patients treated at the single proton centre.
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Affiliation(s)
- R N Hussain
- Liverpool Ocular Oncology Centre, Royal Liverpool Hospital, Liverpool, L7 8XP, UK.
| | - A Chiu
- Liverpool Ocular Oncology Centre, Royal Liverpool Hospital, Liverpool, L7 8XP, UK
| | - B Pittam
- Liverpool Ocular Oncology Centre, Royal Liverpool Hospital, Liverpool, L7 8XP, UK
| | - A Taktak
- Department of Eye and Vision Science and Department of Biostatistics, University of Liverpool, Liverpool, L69 3GL, UK
| | - B E Damato
- Ocular Oncology Service, Moorfields Eye Hospital, London, EC1V 2PD, UK
- NIHR Biomedical Research Centre for Ophthalmology at Moorfields Eye Hospital and UCL Institute of Ophthalmology, London, EC1V 2PD, UK
| | - A Kacperek
- University College London, London, WC1E 6BT, UK
| | - D Errington
- Clatterbridge Cancer Centre, Clatterbridge Road, Bebington, Wirral, CH63 4JY, UK
| | - P Cauchi
- Tennent Institute of Ophthalmology, Gartnavel General Hospital, 1053 Great Western Road, Glasgow, G12 0YN, UK
| | - V Chadha
- Tennent Institute of Ophthalmology, Gartnavel General Hospital, 1053 Great Western Road, Glasgow, G12 0YN, UK
| | - J Connolly
- Tennent Institute of Ophthalmology, Gartnavel General Hospital, 1053 Great Western Road, Glasgow, G12 0YN, UK
| | - S Salvi
- The National Sheffield Ocular Oncology Service, Royal Hallamshire Hospital, S10 2JF, Sheffield, UK
| | - P Rundle
- The National Sheffield Ocular Oncology Service, Royal Hallamshire Hospital, S10 2JF, Sheffield, UK
| | - V Cohen
- Ocular Oncology Service, Moorfields Eye Hospital, London, EC1V 2PD, UK
- NIHR Biomedical Research Centre for Ophthalmology at Moorfields Eye Hospital and UCL Institute of Ophthalmology, London, EC1V 2PD, UK
| | - A Arora
- Ocular Oncology Service, Moorfields Eye Hospital, London, EC1V 2PD, UK
- NIHR Biomedical Research Centre for Ophthalmology at Moorfields Eye Hospital and UCL Institute of Ophthalmology, London, EC1V 2PD, UK
| | - M Sagoo
- Ocular Oncology Service, Moorfields Eye Hospital, London, EC1V 2PD, UK
- NIHR Biomedical Research Centre for Ophthalmology at Moorfields Eye Hospital and UCL Institute of Ophthalmology, London, EC1V 2PD, UK
| | - O Bekir
- Tennent Institute of Ophthalmology, Gartnavel General Hospital, 1053 Great Western Road, Glasgow, G12 0YN, UK
| | - K Kopsidas
- The National Sheffield Ocular Oncology Service, Royal Hallamshire Hospital, S10 2JF, Sheffield, UK
| | - H Heimann
- Liverpool Ocular Oncology Centre, Royal Liverpool Hospital, Liverpool, L7 8XP, UK
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Prakash G, Chandankhede U, Nadkarni S, Pal M, Arora A, Gujela A, Bakshi G. The Belly-Up technique for pericaval nodal dissection in RPLND - Saving caval resections and reconstructions. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)01409-4] [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: 02/12/2023]
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11
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Arora PC, Arora A, Arora S. White Oral Lesions of Morsicatio Linguarum. Indian J Dermatol 2022; 67:756-759. [PMID: 36998842 PMCID: PMC10043684 DOI: 10.4103/ijd.ijd_483_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/01/2023] Open
Affiliation(s)
- Preeti C Arora
- Department of Oral Medicine, Diagnosis and Radiology, SGRD Institute of Dental Sciences and Research, Amritsar, Punjab, India
| | - Aman Arora
- Department of Prosthodontics, SGRD Institute of Dental Sciences and Research, Amritsar, Punjab, India
| | - Saurabh Arora
- Department of Pathology, GMC Amritsar, Punjab, India E-mail:
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Menon S, Shah A, Sali A, Prakash G, Bakshi G, Pal M, Joshi A, Murthy V, Maitre P, Arora A, Desai S. Concordance of histological grade between pre-operative biopsy and resection specimen in penile squamous cell carcinoma. EUR UROL SUPPL 2022. [DOI: 10.1016/s2666-1683(22)02457-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Kumar M, Arora A, Kumar M. P-138 PREDICTORS OF COMPLICATIONS IN COMPLEX VENTRAL HERNIA REPAIR USING POSTERIOR COMPONENT SEPARATION TECHNIQUE WITH RETRO RECTUS MESH PLACEMENT – AN OBSERVATIONAL STUDY. Br J Surg 2022. [DOI: 10.1093/bjs/znac308.235] [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: 11/13/2022]
Abstract
Abstract
Introduction
Incisional Hernia has an incidence ranging from 2–20%. Large and complex incisional hernias are difficult to treat with standard procedures. PCS-TAR is a relatively novel procedure. There persists a gap in knowledge regarding its outcomes, especially in the Indian population.
Aims & Objective
To identify the pre-operative clinical and radiological factors that predict the risk of re-herniation and wound and mesh-related complications after CVH (Complex Ventral Hernia)
Methodology
In a prospective observational study, patients undergoing open PCS-TAR with retro rectus mesh for Complex Ventral Hernia repair included in the study. The patient demographics, hernia characteristics, radiological details, operative data, post- operative outcomes, and follow-up data were entered in a pre-designed proforma. Data were analyzed with SPSS softwere.
Results
35 patients with CVH were included, of which 30 (85%) women and 5 men. The mean age was 51.8 years and the mean BMI was 29.7 kg/m2. The mean size of defect was 12 cm. 83% hernia were midline primary and 255 were recurrent hernias. We observed zero recurrences at six months of follow-up, but a high wound morbidity rate of up to 49%, of which most common was seroma formation. 23% of patients developed SSI.
Conclusion
In conclusion, PCS-TAR is a promising novel procedure for complex ventral hernias not amenable to primary closure using the traditional retro rectus approach, with excellent short term outcomes. Wound morbidity is a significant concern with this procedure, which can be prevented or reduced by thorough pre-operative optimization on a case-to-case basis.
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Affiliation(s)
- M Kumar
- General Surgery, AIIMS Patna , Patna , India
| | - A Arora
- General Surgery, AIIMS Patna , Patna , India
| | - M Kumar
- General Surgery, AIIMS Patna , Patna , India
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Lamarca A, Palmer D, Wasan H, Ross P, Ma Y, Arora A, Falk S, Gillmore R, Wadsley J, Patel K, Anthoney A, Maravellas A, Waters J, Hoobs C, Macdonald T, Ryder D, Ramage J, Davies L, Bridgewater J, Valle J. 54MO Quality of life (QoL) and value of health (V-He) in advanced biliary cancers (ABC) treated with second-line active-symptom-control (ASC) alone or ASC with oxaliplatin/5-FU chemotherapy (ASC+FOLFOX) in the randomised phase III, multi-centre, open-label ABC-06 trial. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.082] [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: 11/01/2022] Open
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Arora A, Kivelä A, Taskinen J, Raiborg C, Olkkonen V. Role of Protrudin in endothelial cell function. Atherosclerosis 2022. [DOI: 10.1016/j.atherosclerosis.2022.06.056] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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16
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Arora A, Storr SJ, Reddy H, Lobo DN, Madhusudan S, Zaitoun AM. O085 CD10 expression in carcinomas of the pancreas, bile duct and ampulla. Br J Surg 2022. [DOI: 10.1093/bjs/znac242.085] [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: 11/06/2022]
Abstract
Abstract
Introduction
Pancreatic cancer and cholangiocarcinoma including, cancer of ampulla of Vater, are very aggressive and have a dismal prognosis; hence improved methods of patient stratification are required.
Methods
We assessed the expression of CD10 in stromal and epithelial cells of two patient cohorts using immunohistochemistry on tissue microarrays. The first cohort was composed of 68 pancreatic adenocarcinomas and the second cohort was composed of 120 cancers of the bile duct and ampulla.
Results
In bile duct and ampullary carcinomas an association was observed between CD10 stromal expression and patient age (p =0.009). The CD10 stromal expression was associated with poor disease specific survival (DSS) (p =0.05). In multivariate Cox model for DSS, stromal CD10 expression (p = 0.037) was independently associated with poor outcome. In multivariate Cox model for disease free survival (DFS), CD10 stromal expression (p = 0.012), and nodal status (p = 0.025) were independently associated with poor outcome. In pancreatic cancer, no statistically significant association was observed between CD 10 stromal expression and clinicopathological variables such as tumour size (p = 0.099), T stage (p = 0.393), N stage (p = 0.860), Vascular invasion (p = 0.904), perineural invasion (p = 0.532) and grade (0.168). In multivariate Cox model for DSS, T stage (p = 0.042) was independently associated with poor outcome.
Conclusion
The results suggest that CD10 stromal expression may have prognostic significance in cholangiocarcinoma. The findings of this study warrant a larger follow-up study.
Take-home message
The results suggest that CD10 stromal expression may have prognostic significance in cholangiocarcinoma. The findings of this study warrant a larger follow-up study.
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Affiliation(s)
- A Arora
- Nottingham University Hospitals NHS Foundation Trust
| | - SJ Storr
- Nottingham University Hospitals NHS Foundation Trust
| | - H Reddy
- Nottingham University Hospitals NHS Foundation Trust
| | - DN Lobo
- Nottingham University Hospitals NHS Foundation Trust
| | - S Madhusudan
- Nottingham University Hospitals NHS Foundation Trust
| | - AM Zaitoun
- Nottingham University Hospitals NHS Foundation Trust
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Lamarca A, Palmer D, Wasan H, Ross P, Ting Ma Y, Arora A, Falk S, Gillmore R, Wadsley J, Patel K, Anthoney A, Maraveyas A, Waters J, Hoobs C, Macdonald T, Ryder D, Ramage J, Davies L, Bridgewater J, Valle J. P-88 Clinical role of tumour markers in advanced biliary cancers (ABC) treated with second-line active-symptom-control (ASC) alone or ASC with oxaliplatin/5-FU chemotherapy (ASC+mFOLFOX) in the randomised phase III, multi-centre, open-label ABC-06 trial. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.04.178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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18
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Ha DH, Arora A, Harford J, Luzzi L, Chrisopoulos S, Do LG. Population Impact of Sugar-Sweetened Beverages on Dental Caries and Overweight/Obesity in Australian Children. JDR Clin Trans Res 2022:23800844221091701. [PMID: 35466760 DOI: 10.1177/23800844221091701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
KNOWLEDGE TRANSFER STATEMENT The reported findings greatly consolidated evidence of detrimental effects of sugars intake on child oral health and overweight and obesity, some of the most prevalent chronic conditions in children. Evidence on population impact of sugars intake is directly informative to policy makers and the public about the potential impact of population-based programs targeting sugars intake to prevent dental caries and overweight and obesity.
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Affiliation(s)
- D H Ha
- School of Dentistry, Faculty of Health and Behavioural Sciences, University of Queensland, Brisbane, Australia.,Australian Research Centre for Population Oral Health, University of Adelaide, Adelaide, Australia
| | - A Arora
- School of Health Sciences, Western Sydney University, Penrith, NSW, Australia.,Health Equity Laboratory, Campbelltown, NSW, Australia.,Translational Health Research Institute, Western Sydney University, Penrith, NSW, Australia.,Oral Health Services, Sydney Local Health District and Sydney Dental Hospital, Surry Hills, NSW, Australia.,Discipline of Child and Adolescent Health, Sydney Medical School, The University of Sydney, Westmead, NSW, Australia
| | - J Harford
- College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - L Luzzi
- Australian Research Centre for Population Oral Health, University of Adelaide, Adelaide, Australia
| | - S Chrisopoulos
- Australian Research Centre for Population Oral Health, University of Adelaide, Adelaide, Australia
| | - L G Do
- School of Dentistry, Faculty of Health and Behavioural Sciences, University of Queensland, Brisbane, Australia.,Australian Research Centre for Population Oral Health, University of Adelaide, Adelaide, Australia
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Affiliation(s)
- A Arora
- School of Clinical Medicine, University of Cambridge, Addenbrooke's Hospital, Hills Road, Cambridge, CB2 0SP, UK
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Alkindi KM, Mukherjee K, Pandey M, Arora A, Janizadeh S, Pham QB, Anh DT, Ahmadi K. Prediction of groundwater nitrate concentration in a semiarid region using hybrid Bayesian artificial intelligence approaches. Environ Sci Pollut Res Int 2022; 29:20421-20436. [PMID: 34735705 DOI: 10.1007/s11356-021-17224-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 10/21/2021] [Indexed: 06/13/2023]
Abstract
Nitrate is a major pollutant in groundwater whose main source is municipal wastewater and agricultural activities. In the present study, Bayesian approaches such as Bayesian generalized linear model (BGLM), Bayesian regularized neural network (BRNN), Bayesian additive regression tree (BART), and Bayesian ridge regression (BRR) were used to model groundwater nitrate contamination in a semiarid region Marvdasht watershed, Fars province, Iran. Eleven groundwater (GW) nitrate conditioning factors have been taken as input parameters for predictive modeling. The results showed that the Bayesian models used in this study were all competent to model groundwater nitrate and the BART model with R2 = 0.83 was more efficient than the other models. The result of variable importance showed that potassium (K) has the highest importance in the models followed by rainfall, altitude, groundwater depth, and distance from the residential area. The results of the study can support the decision-making process to control and reduce the sources of nitrate pollution.
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Affiliation(s)
- Khalifa M Alkindi
- UNESCO Chair on Aflaj Studies, Archaeohydrology, University of Nizwa, Nizwa, Oman
| | - Kaustuv Mukherjee
- Department of Geography, Chandidas Mahavidyalaya, Birbhum, WB, 731215, India
| | - Manish Pandey
- University Center for Research & Development (UCRD), Chandigarh University, Mohali, 140413, Punjab, India
- Department of Civil Engineering, University Institute of Engineering, Chandigarh University, Mohali, 140413, Punjab, India
| | - Aman Arora
- Department of Geography, Faculty of Natural Sciences, Jamia Millia Islamia, New Delhi, 10025, Delhi, India
| | - Saeid Janizadeh
- Department of Watershed Management Engineering and Sciences, Faculty in Natural Resources and Marine Science, Tarbiat Modares University, 14115-111, Tehran, Iran
| | - Quoc Bao Pham
- Institute of Applied Technology, Thu Dau Mot University, Binh Duong Province, Vietnam
| | - Duong Tran Anh
- Ho Chi Minh City University of Technology (HUTECH) 475A, Dien Bien Phu, Ward 25, Binh Thanh District, Ho Chi Minh City, Vietnam.
| | - Kourosh Ahmadi
- Department of Forestry, Faculty in Natural Resources and Marine Science, Tarbiat Modares University, 14115-111, Tehran, Iran
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Arora A, Arkle T, Sreedharan L, Kumar B. 60 Neoadjuvant Imatinib Mesylate – an Ace of Spaces for Surgical Management of an Oesophago-Gastric Junction Gastro-Intestinal Stromal Tumour. Br J Surg 2022. [DOI: 10.1093/bjs/znac039.031] [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: 11/13/2022]
Abstract
Abstract
Introduction
Oesophageal gastro-intestinal stromal tumours (GISTs) are rare, accounting for less than five percent of all GIST, with the majority of these occurring at the oesophago-gastric junction (OGJ). Due to the anatomical location and size of these tumours at presentation, surgical resection is often a major undertaking.
Neoadjuvant treatment with tyrosine kinase inhibitors, such as Imatinib mesylate, have the potential to downstage such tumours, thereby limiting the extent of subsequent surgical resection. This may therefore reduce any potentially associated morbidity and mortality.
Case Description
We report the case of a 75-year-old gentleman who presented with a large OGJ GIST, which presented with dysphagia. The tumour was deemed too large for local excision due to the risk of compromising the lumen at the OGJ in attempting to obtain a clear resection margin. Given the patient’s co-morbidity, oesophagectomy or total gastrectomy was deemed too major an undertaking. Therefore, endoscopic biopsies were obtained with a view to possible neoadjuvant therapy. These confirmed DOG-1 and Exon-11 mutations, suggesting sensitivity to Imatinib mesylate. A standard dose regime of 400mg daily for a planned 36-month course was commenced. Subsequent imaging showed a substantial decrease in tumour bulk and the decision was made to perform a local excision. A local enucleation procedure was performed, and the patient made a sound recovery.
Post-operative histology of resected tumour showed almost complete tumour regression.
Discussion
This significant response to neoadjuvant Imatinib mesylate therapy demonstrates clear potential for its use in similar cases, where radical resection would cause significant morbidity and risk mortality.
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Affiliation(s)
- A. Arora
- Norfolk and Norwich University Hopsital, Norwich, United Kingdom
| | - T. Arkle
- Norfolk and Norwich University Hopsital, Norwich, United Kingdom
| | - L. Sreedharan
- Norfolk and Norwich University Hopsital, Norwich, United Kingdom
| | - B. Kumar
- Norfolk and Norwich University Hopsital, Norwich, United Kingdom
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Chandankhede U, Arora A, Prakash G, Pal M, Tummala M, Mohan A, Bakshi G. Outcomes of penile cancer stratified by nodal staging: Importance of pelvic nodal involvement. Eur Urol 2022. [DOI: 10.1016/s0302-2838(22)00772-2] [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: 11/27/2022]
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Aguirre A, Sharma K, Arora A, Humphries MD. Early ABI Testing May Decrease Risk of Amputation for Patients With Lower Extremity Ulcers. Ann Vasc Surg 2022; 79:65-71. [PMID: 34656726 PMCID: PMC9889134 DOI: 10.1016/j.avsg.2021.08.015] [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: 05/06/2021] [Revised: 07/22/2021] [Accepted: 08/01/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Patients with lower extremity wounds from diabetes mellitus or peripheral artery disease (PAD) have a risk of amputation as high as 25%. In patients with arterial disease, revascularization decreases the risk of amputation. We aimed to determine if the early assessment of arterial perfusion correlates with the risk of amputation. METHODS We retrospectively reviewed patients referred to the vascular clinic over 18 months with Rutherford Grade 5 and 6 chronic limb-threatening ischemia to determine if patients had a pulse exam done at the time the wound was identified and when ankle brachial index (ABI) testing to evaluate perfusion was performed. Kaplan Meier analysis was used to determine if the timing of ABI testing affected the time to revascularization, wound healing, and risk of amputation. RESULTS Ninety-three patients with lower extremity wounds were identified. Of these, 59 patients (63%) did not have a pulse exam performed by their primary care provider when the wound was identified. Patients were classified by when they underwent ankle brachial index testing to assess arterial perfusion. Twenty-four had early ABI (<30 days) testing, with the remaining 69 patients having late ABI testing. Patients in the early ABI group were more likely to have a pulse exam done by their PCP than those in the late group, 12 (50%) vs. 22 (32%), P = 0.03. Early ABI patients had a quicker time to vascular referral (13 days vs. 91 days, P < 0.001). Early ABI patients also had quicker times to wound healing than those in the late group (117 days vs. 287 days, P < 0.001). Finally, patients that underwent early ABI were less likely to require amputation (Fig. 1), although this did not reach statistical significance (P = 0.07). CONCLUSIONS Early ABI testing expedites specialty referral and time to revascularization. It can decrease the time to wound healing. Larger cohort studies are needed to determine the overall effect of early ABI testing to decrease amputation rates.
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Affiliation(s)
- Angela Aguirre
- Division of Vascular and Endovascular Surgery, University of California Davis Health, Sacramento, CA
| | - Kritika Sharma
- Division of Vascular and Endovascular Surgery, University of California Davis Health, Sacramento, CA
| | - Aman Arora
- Division of Vascular and Endovascular Surgery, University of California Davis Health, Sacramento, CA
| | - Misty D Humphries
- Division of Vascular and Endovascular Surgery, University of California Davis Health, Sacramento, CA.
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Arora A, Prakash G, Pal M, Chandankhede U, Tummala M, Mohan A, Bakshi G, Chandankhede U, Chandankhede U. Patterns of recurrence in penile cancer: Implications for surveillance strategies. Eur Urol 2022. [DOI: 10.1016/s0302-2838(22)00774-6] [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: 11/04/2022]
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Chawla S, Fotedar S, Garg A, Arora A. Study of lipid profile in young patients (age 40 years or below) with acute coronary syndrome. J Family Med Prim Care 2022; 11:3034-3039. [PMID: 36119344 PMCID: PMC9480743 DOI: 10.4103/jfmpc.jfmpc_2229_21] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Revised: 02/04/2022] [Accepted: 02/07/2022] [Indexed: 11/04/2022] Open
Abstract
Background: Aims and Objectives: Material and Methods: Results: Conclusion:
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Baldodia A, kumar Sharma R, Tewari S, Arora A. Association among hsCRP Levels, Bone Mineral Density, and Periodontal Parameters in Postmenopausal Women. J Dent Indones 2021. [DOI: 10.14693/jdi.v28i3.1266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Association of Osteoporosis and periodontitis is well documented. Osteopenia being the initial state of bone loss prior to osteoporosis; finding its correlation with clinical attachment loss holds significance in the process of establishing early reduction in BMD as a risk factor for periodontitis. Objectives: The present cross sectional study aimed to explore the association of osteopenia with serum high sensitivity C-reactive protein (hsCRP) levels, and periodontal parameters in narrow age range postmenopausal (PM) women. Methods: 112 participants in this single centred cross sectional study were bifurcated into test group: osteopenic PM women [n=62], and control group: normal bone mineral density [BMD] PM women [n=50]. BMD, serum levels of hsCRP, and periodontal parameters were recorded. Results: Clinical attachment loss [CAL] and hsCRP were found to be significantly higher in the osteopenic PM group. Conclusion: An association of osteopenia with increased CAL in PM women was found, implicating postmenopausal osteopenia associated with increased risk of periodontitis. The present study hints towards the comprehensive management of Periodontitis and osteopenia in postmenopausal women by maintaining a good coordination between the physicians and dentists.
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Kalra M, Bakhshi S, Singh M, Seth R, Verma N, Jain S, Radhakrishnan V, Mandal P, Mahajan A, Arora R, Dinand V, Kapoor G, Sajid M, Thulkar S, Arora A, Taluja A, Chandra J. PET-CT vs CECT for response assessment in childhood Hodgkin Lymphoma - Subset analysis of InPOG HL-15-01 study. Pediatric Hematology Oncology Journal 2021. [DOI: 10.1016/j.phoj.2022.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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28
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Eapen V, Woolfenden S, Schmied V, Jalaludin B, Lawson K, Liaw ST, Lingam R, Page A, Cibralic S, Winata T, Mendoza Diaz A, Lam-Cassettari C, Burley J, Boydell K, Lin P, Masi A, Katz I, Dadich A, Preddy J, Bruce J, Raman S, Kohlhoff J, Descallar J, Karlov L, Kaplun C, Arora A, Di Mento B, Smead M, Doyle K, Grace R, McClean T, Blight V, Wood A, Raine KH. "Watch Me Grow- Electronic (WMG-E)" surveillance approach to identify and address child development, parental mental health, and psychosocial needs: study protocol. BMC Health Serv Res 2021; 21:1240. [PMID: 34789234 PMCID: PMC8596348 DOI: 10.1186/s12913-021-07243-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 10/29/2021] [Indexed: 11/11/2022] Open
Abstract
Background The COVID-19 pandemic and the associated economic recession has increased parental psychosocial stress and mental health challenges. This has adversely impacted child development and wellbeing, particularly for children from priority populations (culturally and linguistically diverse (CALD) and rural/regional communities) who are at an already increased risk of health inequality. The increased mental health and psychosocial needs were compounded by the closure of in-person preventive and health promotion programs resulting in health organisations embracing technology and online services. Watch Me Grow- Electronic (WMG-E) – developmental surveillance platform- exemplifies one such service. WMG-E was developed to monitor child development and guide parents towards more detailed assessments when risk is identified. This Randomised Controlled Trial (RCT) aims to expand WMG-E as a digital navigation tool by also incorporating parents’ mental health and psychosocial needs. Children and families needing additional assessments and supports will be electronically directed to relevant resources in the ‘care-as-usual’ group. In contrast, the intervention group will receive continuity of care, with additional in-person assessment and ‘warm hand over’ by a ‘service navigator’ to ensure their needs are met. Methods Using an RCT we will determine: (1) parental engagement with developmental surveillance; (2) access to services for those with mental health and social care needs; and (3) uptake of service recommendations. Three hundred parents/carers of children aged 6 months to 3 years (recruited from a culturally diverse, or rural/regional site) will be randomly allocated to the ‘care-as-usual’ or ‘intervention’ group. A mixed methods implementation evaluation will be completed, with semi-structured interviews to ascertain the acceptability, feasibility and impact of the WMG-E platform and service navigator. Conclusions Using WMG-E is expected to: normalise and de-stigmatise mental health and psychosocial screening; increase parental engagement and service use; and result in the early identification and management of child developmental needs, parental mental health, and family psychosocial needs. If effective, digital solutions such as WMG-E to engage and empower parents alongside a service navigator for vulnerable families needing additional support, will have significant practice and policy implications in the pandemic/post pandemic period. Trial registration The trial (Protocol No. 1.0, Version 3.1) was registered with ANZCTR (registration number: ACTRN12621000766819) on July 21st, 2021 and reporting of the trial results will be according to recommendations in the CONSORT Statement.
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Affiliation(s)
- V Eapen
- School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, Australia. .,South Western Sydney Local Health District, Liverpool, Australia.
| | - S Woolfenden
- Sydney Children's Hospital Randwick, Randwick, Australia
| | - V Schmied
- School of Nursing and Midwifery, Western Sydney University, Sydney, Australia
| | - B Jalaludin
- South Western Sydney Local Health District, Liverpool, Australia.,Ingham Institute for Applied Medical Research, Liverpool, Australia
| | - K Lawson
- School of Business, Western Sydney University, Sydney, Australia
| | - S T Liaw
- Population Child Health Research Group, School of Women's and Children's Health, Faculty of Medicine, University of New South Wales, Sydney, Australia.,WHO Collaborating Centre for eHealth, University of New South Wales, Sydney, Australia
| | - R Lingam
- Population Child Health Research Group, School of Women's and Children's Health, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - A Page
- School of Medicine, Western Sydney University, Campbelltown, Australia
| | - S Cibralic
- Ingham Institute for Applied Medical Research, Liverpool, Australia
| | - T Winata
- South Western Sydney Local Health District, Liverpool, Australia
| | - A Mendoza Diaz
- School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - C Lam-Cassettari
- School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - J Burley
- Population Child Health Research Group, School of Women's and Children's Health, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - K Boydell
- Black Dog Institute, Sydney, Australia
| | - P Lin
- School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, Australia.,South Western Sydney Local Health District, Liverpool, Australia
| | - A Masi
- School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - I Katz
- Social Policy Research Centre, Faculty of Arts, Design, & Architecture, University of New South Wales, Sydney, Australia
| | - A Dadich
- School of Business, Western Sydney University, Sydney, Australia
| | - J Preddy
- Murrumbidgee Local Health District, Wagga Wagga, Australia
| | - J Bruce
- Murrumbidgee Local Health District, Wagga Wagga, Australia
| | - S Raman
- South Western Sydney Local Health District, Liverpool, Australia
| | - J Kohlhoff
- School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, Australia.,Karitane, Carramar, Australia
| | - J Descallar
- Ingham Institute for Applied Medical Research, Liverpool, Australia
| | - L Karlov
- South Western Sydney Local Health District, Liverpool, Australia
| | - C Kaplun
- Ingham Institute for Applied Medical Research, Liverpool, Australia.,TeEACH -Transforming early Education and Child Health Research Centre, Western Sydney University, Sydney, Australia
| | - A Arora
- School of Health Sciences, Western Sydney University, Sydney, Australia.,Sydney Local Health District, Camperdown, Australia
| | - B Di Mento
- School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - M Smead
- Murrumbidgee Local Health District, Wagga Wagga, Australia
| | - K Doyle
- School of Medicine, Western Sydney University, Campbelltown, Australia
| | - R Grace
- TeEACH -Transforming early Education and Child Health Research Centre, Western Sydney University, Sydney, Australia
| | | | - V Blight
- South Western Sydney Local Health District, Liverpool, Australia
| | - A Wood
- Karitane, Carramar, Australia
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Kumar S, Ashok V, Jain D, Arora A, Singh A, Sikka P. Validation of an obstetric quality of recovery scoring tool (ObsQoR-11) after elective caesarean delivery in a developing country: a prospective observational study. Int J Obstet Anesth 2021; 49:103235. [PMID: 34810053 DOI: 10.1016/j.ijoa.2021.103235] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 09/12/2021] [Accepted: 10/24/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND The obstetric quality of recovery scoring tool (ObsQoR-11) was developed and validated in the United Kingdom for use after elective and emergency caesarean delivery. Quality of recovery scoring tools validated in one country may not be valid in other countries with significant cultural, socio-economic and linguistic variations. The aim of the current study was to validate a Hindi version of the ObsQoR-11. METHODS In this prospective observational study, 100 parturients who underwent elective caesarean delivery in a tertiary care obstetric referral university hospital in North India were asked to complete a Hindi version of the ObsQoR-11 scoring tool 24 h after surgery. The performance of the Hindi version of ObsQoR-11 was assessed using measures of validity, reliability, and feasibility. RESULTS The Hindi version of ObsQoR-11 correlated moderately with the global health visual analogue scale (r=0.45, 95% CI 0.27 to 0.59; P <0.0001) and discriminated well between good and poor recovery (mean (SD) score 84.6 (9.4) vs 75.0 (11.2); P <0.0001). The reliability and internal consistency were moderate (Cronbach's alpha=0.66; Spearman-Brown Prophesy Reliability estimate=0.57) with good repeatability (intraclass correlation coefficient 0.85, 95% CI 0.69 to 0.93; P <0.0001) and no floor or ceiling effects. All parturients completed the questionnaire (median (IQR) time of completion of 3 (1.5 - 5.5) min). CONCLUSION The Hindi version of the ObsQoR-11 questionnaire is a promising scoring tool to evaluate quality of recovery after elective caesarean delivery. Further research is needed to evaluate the Hindi tool in other institutions in India, as well as in other languages.
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Affiliation(s)
- S Kumar
- Department of Anaesthesia and Intensive Care, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh India
| | - V Ashok
- Department of Anaesthesia and Intensive Care, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh India.
| | - D Jain
- Department of Anaesthesia and Intensive Care, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh India
| | - A Arora
- Department of Obstetrics and Gynaecology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh India
| | - A Singh
- Department of Obstetrics and Gynaecology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh India
| | - P Sikka
- Department of Obstetrics and Gynaecology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh India
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30
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Arshad Z, Maughan HD, Pettit MH, Kumar KHS, Arora A, Khanduja V. 1300 Version Abnormalities of the Femur and Acetabulum in Patients with Femoroacetabular Impingement: A Systematic Review. Br J Surg 2021. [DOI: 10.1093/bjs/znab259.1044] [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: 11/14/2022]
Abstract
Abstract
Aim
This systematic review aims to understand the relationship between version abnormalities of the femur and acetabulum in patients with primary and secondary femoroacetabular impingement (FAI).
Method
A systematic review was conducted according to PRISMA guidelines. A computer-based search was performed using the EMBASE, MEDLINE, PubMed and Cochrane databases for articles relating to version and torsional abnormalities in FAI, Legg-Calve-Perthes disease (LCPD) and slipped capital femoral epiphysis (SCFE). The study was registered in the Open Science Framework. Two authors independently performed title/abstract and full text screening according to predetermined inclusion criteria.
Results
A total of 1206 articles were identified 55 articles, involving 10, 091 hips, met the inclusion criteria. All studies evaluating femoral/acetabular version in FAI reported ‘normal’ mean version values (10o to 25o). However, distribution analysis revealed that an estimated 31.4% and 51.3% of patients with FAI displayed abnormal acetabular and femoral version, respectively. Abnormal femoral version was reported in an estimated 74.5% of hips with LCPD, and abnormal acetabular version in an estimated 20%. Acetabular version was significantly lower in hips with SCFE compared to controls (Z=-3.26, P < 0.01).
Conclusions
Patients presenting with hip pain attributed to FAI are likely to display an abnormality in femoral or acetabular version. This highlights the importance of evaluating these parameters during assessment of these patients, in order to guide clinical decision making.
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Affiliation(s)
- Z Arshad
- University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom
| | - H D Maughan
- University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom
| | - M H Pettit
- University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom
| | - K H S Kumar
- Department of Trauma and Orthopaedic Surgery, Addenbrooke's hospital, Cambridge university Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - A Arora
- Department of Trauma and Orthopaedic Surgery, Addenbrooke's hospital, Cambridge university Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - V Khanduja
- Department of Trauma and Orthopaedic Surgery, Addenbrooke's hospital, Cambridge university Hospitals NHS Foundation Trust, Cambridge, United Kingdom
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Nathan A, Fricker M, De Groote R, Arora A, Phuah Y, Flora K, Patel S, Kasivisvanathan V, Sridhar A, Shaw G, Kelly J, Briggs T, Rajan P, Sooriakumaran P, Nathan S. 283 Salvage Versus Primary Robot-Assisted Radical Prostatectomy: A Propensity-Matched Comparative Effectiveness Study from A High-Volume Tertiary Centre. Br J Surg 2021. [DOI: 10.1093/bjs/znab259.1075] [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: 11/12/2022]
Abstract
Abstract
Aim
Salvage Robot-Assisted Radical Prostatectomy (sRARP) is a potential treatment option for locally recurrent Prostate Cancer after non-surgical primary treatment. There are minimal data comparing outcomes between propensity-matched salvage and primary Robot-Assisted Radical Prostatectomy (RARP). We compare perioperative, oncological, and functional outcomes of sRARP with primary RARP and between sRARP post-whole and focal gland therapy.
Method
1:1 propensity-matched comparison of 146 sRARP with primary RARP from a cohort of 3,852 consecutive patients from a high-volume tertiary centre.
Results
There were no significant differences in patient characteristics between the salvage and primary RARP groups. Grade III-V Clavien-Dindo complication rates were 1.3% and 0% in the salvage and primary groups, respectively (p = 0.310). Median (IQR) follow-up was 16 (10,30) and 21 (13,33) months in the salvage and primary groups, respectively. BCR rates were 30.8% and 13.7% in the salvage and primary groups, respectively (p < 0.001). Pad-free continence rates were 79.1% and 85.4% at two years in the salvage and primary groups, respectively (p = 0.160). ED rates were 95.2% and 77.4% in the salvage and primary groups, respectively (p < 0.001). Comparing the whole gland and focal gland groups, BCR rates were 33.3% and 29.1%, respectively (p = 0.687), pad-free continence rates were 66% and 89.3%, respectively (p = 0.001), and ED rates were 98.3% and 93%, respectively (p = 0.145).
Conclusions
SRARP has similar perioperative but inferior oncological outcomes to primary RARP. Continence rates are similar to primary RARP, but potency is worse. Perioperative and oncological outcomes of sRARP after focal gland therapy are similar but continence outcomes are superior compared to sRARP after whole gland therapy.
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Affiliation(s)
- A Nathan
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
- University College London, London, United Kingdom
| | - M Fricker
- University of Newcastle, Newcastle, United Kingdom
| | - R De Groote
- Department of Urology, Onze Lieve Vrouw Hospital Aalst, Aalst, Belgium
| | - A Arora
- Department of Urology, Tata Memorial Hospital, Mumbai, India
| | - Y Phuah
- University College London, London, United Kingdom
| | - K Flora
- University College London, London, United Kingdom
| | - S Patel
- University College London, London, United Kingdom
| | - V Kasivisvanathan
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
- University College London, London, United Kingdom
| | - A Sridhar
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - G Shaw
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - J Kelly
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - T Briggs
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - P Rajan
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
- Barts Cancer Institute, CR-UK Barts Centre, Queen Mary University of London, London, United Kingdom
| | - P Sooriakumaran
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, United Kingdom
| | - S Nathan
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
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Arora A, Raffaele A, Agarwala S, Parigi GB, Manzoni F, Klersy C, Bhatnagar V. 1124 Is Delayed Presentation A Prognostic Factor for The Survival of Patients with Esophageal Atresia More Than Associated Anomalies? Comparison Between Different Social Realities. Br J Surg 2021. [DOI: 10.1093/bjs/znab259.684] [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: 11/14/2022]
Abstract
Abstract
Background
The aim is to evaluate if different social reality could represent a prognostic factor as associated anomalies affecting survival of neonates with esophageal atresia (EA).
Method
Retrospective analysis of records of neonates with EA with or without Tracheoesophageal Fistula (TEF) from January 2011 to September 2018 at Policlinico San Matteo Pavia, Italy(SMAT) and the All India Institute of Medical Sciences New Delhi, India (AIIMS).Survival was correlated with the presence of anomalies, different types and the number of organ systems involved.Age at presentation and birth weight were considered to find an association with mortality.
Results
Out of 180 patients,162 were from AIIMS and 18 from SMAT.The overall mortality was 28.85%, which occurred at AIIMS, being 0% at SMAT.83.33% at SMAT and 72.84% at AIIMS had associated anomalies.The mortality was 25% for neonates without an anomaly, being 26.15% for those with one (p > 0.05).No statistically significant correlation between outcome and associated anomalies was found.Instead, survival declines gradually as the age at presentation increases.
Conclusions
The presence of associated anomalies paradoxically does not affect the outcome because incidence of delayed presentation has a stronger effect than the presence of associated anomalies. Sensibilization is necessary to improve survival in EA neonates in developing countries, such as India.
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Affiliation(s)
- A Arora
- Università Degli Studi di Pavia, Pavia, Italy
| | - A Raffaele
- Università Degli Studi di Pavia, Pavia, Italy
| | - S Agarwala
- All India Institute of Medical Sciences, New Delhi, India
| | - G B Parigi
- Università Degli Studi di Pavia, Pavia, Italy
| | - F Manzoni
- Università Degli Studi di Pavia, Pavia, Italy
| | - C Klersy
- Università Degli Studi di Pavia, Pavia, Italy
| | - V Bhatnagar
- All India Institute of Medical Sciences, New Delhi, India
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Kathiravelupillai A, Arora A, Jeannon JP, Brunet-Garcia A, Faulkner J, Sandison A. 1079 Analysis of Human Papilloma Virus (HPV) Status in Metastatic Oropharyngeal Squamous Cell Carcinoma (OPSCC). Br J Surg 2021. [DOI: 10.1093/bjs/znab259.792] [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: 11/14/2022]
Abstract
Abstract
Introduction
OPSCC often (80%) presents with ipsilateral neck metastasis. Presentation may be as carcinoma of unknown primary (CUP). Sampling via ultrasound guided Fine Needle Aspiration Cytology (FNAC) and/or Core Biopsy (CB) from nodal metastases is required for diagnosis, comparison with primary tumour and to assess human papilloma virus (HPV) status. HPV positive biopsy from CUP may indicate oropharynx primary. HPV positive OPSCC has better prognosis. HPV association is ascertained by p16 immunocytochemistry (p16- IHC) and HPV DNA in situ hybridization (HPV-ISH). In a cohort of OPSCC patients from a single referral centre 68% had metastatic disease. Core biopsy was optimal for HPV testing.
Method
Retrospective review of records from Transoral Robotic Surgery (TORS) patients treated for OPSCC between December 2017-2019 was conducted. Cohort included patients undergoing TORS for diagnostic purposes and with curative intent.
Results
Data was available from 23 patients who had TORS for OPSCC. 47.8% (n = 11) presented with lymphadenopathy. 82.6% (n = 19) underwent FNAC. 68.4% (n = 13) were diagnosed with metastatic OPSCC and 56.5% (n = 13) underwent neck dissections. 52.2% (n = 12) had confirmed HPV positive metastases, 75% (n = 9) had 1 node positive, 25% (n = 3) had >1 node positive. FNAC yielded enough tissue for p16 IHC and HPV-ISH in 10.5% (n = 2). CB yielded sufficient tissue for analysis in all cases 39.1% (n = 9).
Conclusions
The study confirms high incidence of neck metastases in HPV associated OPSCC patients. Needle core biopsy appears superior to FNAC for tissue sampling to assess HPV status in tumours metastatic to neck.
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Affiliation(s)
| | - A Arora
- Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - J P Jeannon
- Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - A Brunet-Garcia
- Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - J Faulkner
- Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - A Sandison
- Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
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Gao C, Al-Lami A, Al-Zuhir N, Simo R, Arora A, Jeannon JP. 1692 No Longer Unknown: A Systematic Review & Meta-Analysis of The Effectiveness of Trans-Oral Surgical Techniques in Identifying Head and Neck Primary Cancer in Carcinoma Unknown Primary. Br J Surg 2021. [DOI: 10.1093/bjs/znab258.034] [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: 11/12/2022]
Abstract
Abstract
Aim
The use of transoral robotic surgery (TORS), transoral laser microsurgery (TLM) and more recently reported transoral endoscopic electrocautery (TOEC) in the identification of the primary cancer in CUP patients has gained popularity. This systematic review aims to assess the effectiveness of TORS, TLM and TOEC.
Method
A systematic review and meta-analysis using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting methodology was carried out to assess the effectiveness of the three trans-oral surgical techniques. EMBASE, MEDLINE and CINAHL databases were searched from inception to September 2020. Primary outcome measure was detection rates of primary cancer of the different techniques. Secondary outcome measures were complications and length of hospital stay.
Results
289 studies were identified of which 30 met the inclusion criteria (28 case series and 2 case reports). The overall combined primary identification rate was 72.3% (567 /777 patients). The primary identification rates were 49.7% and 34.2% in lingual (n = 273) and palatine tonsillectomy (n = 118) respectively. The primary cancer identification rates by surgical techniques are: TORS was 60% (CI 0.49, 0.70), TLM was 80% (CI 0.58, 1.01), TOEC was 41% (CI 0.05, 0.76). The commonest complication was haemorrhage (5.3%).
Conclusions
This is the largest systematic review in the subject and incorporates the more recently published surgical technique of TOEC. Lingual tonsillectomy is an effective procedure in CUP work up. Further larger, multi-centre, prospective studies of PET CT negative CUP patients is needed to draw conclusive results
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Affiliation(s)
- C Gao
- William Harvey Hospital, Ashford, United Kingdom
| | - A Al-Lami
- William Harvey Hospital, Ashford, United Kingdom
| | - N Al-Zuhir
- Guys' and St. Thomas's NHS Foundation Trust, London, United Kingdom
| | - R Simo
- Guys' and St. Thomas's NHS Foundation Trust, London, United Kingdom
| | - A Arora
- Guys' and St. Thomas's NHS Foundation Trust, London, United Kingdom
| | - J P Jeannon
- Guys' and St. Thomas's NHS Foundation Trust, London, United Kingdom
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Gonzalez G, Arora A, Choi E, Bresee C, Perley J, Anger JT. Outcomes of the Supris® Sling in an Urban Latina Population. Urology 2021; 163:3-7. [PMID: 34637838 DOI: 10.1016/j.urology.2021.07.054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 06/20/2021] [Accepted: 07/23/2021] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To analyze patient reported outcomes, safety, and efficacy of the Supris® mid-urethral sling in a diverse population. METHODS A retrospective chart review of 101 women who underwent a mid-urethral Supris® sling procedure was conducted. Baseline characteristics and peri-operative parameters were collected. Post-operative results and patient reported outcomes were collected at an average follow-up time of 19 months using the Urogenital Distress Inventory-6 (UDI-6) and Patient Global Impression of Improvement (PGI-I) validated questionnaires. Subjective cure rates were compared using the nonparametric Wilcoxon Rank Sum Test. RESULTS The median age of women was 57 years old, and 86.1% identified as Latina. 28% and 72% of women had a SUI and MUI diagnosis, respectively. Women, on average, used two pads pre-operatively and none post-operatively. There was a 3% surgical revision rate. 80 women completed the questionnaires. 82% of the MUI group reported being very much improved or much better. The SUI group reported being 94% very much improved or much better. The UDI-6 questions related to urgency and leakage of small amounts of urine were significantly different between the MUI and SUI groups (p = 0.002 and p = 0.044). CONCLUSIONS In our primarily Latina patient population, the majority of whom had MUI, the Supris® retropubic sling greatly improved symptoms. Although reported outcomes were excellent in both groups, those with pre-operative urge incontinence were more likely to experience urge symptoms post-operatively. Despite persistent urge symptoms, patients reported improvement of their overall symptoms.
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Affiliation(s)
- Gabriela Gonzalez
- Department of Urology, University of California, Davis School of Medicine, Sacramento, CA
| | - Aman Arora
- University of California, Davis School of Medicine, Sacramento, CA
| | - Eunice Choi
- Department of Surgery, Division of Urology, Cedars-Sinai Medical Center, Beverly Hills, CA
| | - Catherine Bresee
- Department of Statistics, Cedars Sinai Medical Center, Los Angeles, CA
| | | | - Jennifer T Anger
- Department of Surgery, Division of Urology, Cedars-Sinai Medical Center, Beverly Hills, CA.
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Kumar M, Kumar M, Kumar Jha A, Arora A. Snapshots Quiz. Br J Surg 2021; 108:1104. [PMID: 34160031 DOI: 10.1093/bjs/znab227] [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: 05/13/2021] [Accepted: 05/23/2021] [Indexed: 11/13/2022]
Abstract
A 55-year-old male presented with a 6 month history of multiple swellings on the right buttock and sacral region with yellowish discharge. The patient frequently walked bare foot, but denied any history trauma. Fine needle aspirate cytology showed acute dense inflammation, nuclear debris and numerous filamentous bacilli, which on staining revealed gram positive bacilli. What is the diagnosis?
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Affiliation(s)
- M Kumar
- Department of General Surgery, All India Institute of Medical Sciences, Patna, India
| | - M Kumar
- Department of General Surgery, All India Institute of Medical Sciences, Patna, India
| | - A Kumar Jha
- Department of General Surgery, All India Institute of Medical Sciences, Patna, India
| | - A Arora
- Department of General Surgery, All India Institute of Medical Sciences, Patna, India
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Gonzalez G, Dallas K, Arora A, Kobashi KC, Anger JT. Underrepresentation of Racial and Ethnic Diversity in Research Informing the American Urological Association/Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction Stress Urinary Incontinence Guideline. Urology 2021; 163:16-21. [PMID: 34536408 DOI: 10.1016/j.urology.2021.08.038] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 08/16/2021] [Accepted: 08/27/2021] [Indexed: 01/09/2023]
Abstract
OBJECTIVE To characterize the racial/ethnic representation in the studies used in the American Urological Association/Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction stress urinary incontinence guideline. METHODS Cited studies were reviewed using inclusion and exclusion criteria. The inclusion criteria focused on United States literature to allow for demographic comparison with census data. To compare the racial representation in a study to the diversity in the surrounding city, we calculated the differences between county census data and the study race reported data and performed regression analyses. RESULTS Eighty-seven cited studies were reviewed, of which 33 were excluded and 52 studies were further evaluated. Seventeen studies were US studies, nine of which reported race. Eighty percent of the women included in the 9 studies were non-Hispanic white women. A diverse geographic region did not correlate with increased study enrollment of non-White patients. CONCLUSION The majority of cited studies used to develop the stress urinary incontinence management guidelines did not report the race/ethnicity of participants. Among those studies that did, Asian, Black, and Hispanic women were included at lower rates than non-Hispanic white women, identifying an area of opportunity to improve research recruitment and promote health equity. Non-Hispanic women were consistently overrepresented while other women were either under-represented or completely excluded.
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Affiliation(s)
- Gabriela Gonzalez
- Department of Urology, University of California, Davis School of Medicine, Sacramento, CA
| | - Kai Dallas
- Division of Urology, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Aman Arora
- University of California, Davis School of Medicine, Sacramento, CA
| | | | - Jennifer T Anger
- Department of Urology, University of California, San Diego School of Medicine, La Jolla, CA.
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Rai A, Arora A, Jain A, Panneerselvam E. Modified vertical osteotomy cut in bilateral sagittal split osteotomy. Br J Oral Maxillofac Surg 2021; 59:965-967. [PMID: 34456077 DOI: 10.1016/j.bjoms.2020.10.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 10/23/2020] [Indexed: 11/15/2022]
Abstract
Bilateral sagittal split osteotomy (BSSO) is the most common orthognathic surgical procedure for the correction of facial deformities. Like any other surgical procedure, it is also associated with a risk of complications. One of these is described in the literature as notching at the lower inferior border of the mandible. Such discontinuity in the contour of the lower border is often a concern for patients. To overcome this complication, we recommend a modified vertical osteotomy cut while performing BSSO.
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Affiliation(s)
- A Rai
- Department of Dentistry, AIIMS, Saket Nagar, Bhopal, MP, India.
| | - A Arora
- Department of Oral and Maxillofacial Surgery, Shree Bankey Bihari Dental College & Research Centre, Ghaziabad, UP, India.
| | | | - E Panneerselvam
- Department of Oral and Maxillofacial Surgery, SRM Dental College & Hospital, Chennai, India.
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Raniga S, Parikh N, Arora A, Vaghani M, Vora PA, Vaidya V. Is HRCT reliable in determining disease activity in pulmonary tuberculosis? Indian J Radiol Imaging 2021. [DOI: 10.4103/0971-3026.29096] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Abstract
Aims and Objectives
The purpose of our study is to [1] determine the activity of disease based on the HRCT findings (2) to define indications for the use of HRCT in evaluation of Pulmonary TB and (3) to determine whether additional information provided by HRCT alters clinical management of the disease.
Materials and Methods
The present study was carried out at Shree Sayajirao General Hospital (SSGH), Baroda, Gujarat, India from January 2002 to December 2002. Twenty five patients with sputum positive post-primary pulmonary TB were studied prospectively with chest radiographs and HRCT. The diagnosis of active TB was based on detection of acid-fast bacilli in sputum. None of the patients in our study population was HIV positive. All patients underwent x-ray chest and HRCT chest (Philips Tomoscan, Best, Netherlands). The pattern, extent and severity of HRCT findings were recorded and compared with the plain x-ray findings. The gathered information and investigations were subjected to statistical analysis.
Results
Our study population consisted of sputum positive (AFB positive) 25 patients, 22 of them were newly diagnosed/suspected post-primary tuberculosis (GROUP 1) and 3 of them had taken six months of AKT (GROUP 2). Our study included 22 males and 3 females with average age of 38 years (range, 14-65 years.) In total chest radiographic signs of active tuberculosis were seen in twelve (48%) patients. HRCT showed evidences of active tuberculosis in all 22 patients of newly diagnosed tuberculosis; and in 2 out of 3 patients with prior history of AKT. Thus, total of 24 (96%) patients had evidence of active pulmonary TB on HRCT. One patient with prior history of AKT showed evidence of pulmonary Koch′s sequel.
Conclusion
Although chest radiography remains the foremost imaging technique in the evaluation of pulmonary TB, HRCT can be useful in certain circumstances and can provide important information in the diagnosis and management of the disease. HRCT is helpful in the distinction of active form inactive TB. HRCT is better than plain chest radiograph in identification of extent of pulmonary TB, especially subtle areas of consolidation, cavitation, bronchogenic and miliary spread. HRCT is recommended when the radiographic findings are normal or inconclusive and tuberculosis is suspected clinically for the confirmation of diagnosis and determination of activity.
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Affiliation(s)
- S Raniga
- Department of Radiology, S.S.G. Hospital and Medical College, Vadodara, India
| | - N Parikh
- Department of Radiology, S.S.G. Hospital and Medical College, Vadodara, India
| | - A Arora
- Department of Radiology, S.S.G. Hospital and Medical College, Vadodara, India
| | - M Vaghani
- Department of Radiology, S.S.G. Hospital and Medical College, Vadodara, India
| | - P A Vora
- Department of Radiology, S.S.G. Hospital and Medical College, Vadodara, India
| | - V Vaidya
- Department of Radiology, S.S.G. Hospital and Medical College, Vadodara, India
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Ramskold L, Lemaître S, Arora A. Iris metastasis from renal cell carcinoma. J Fr Ophtalmol 2021; 44:1278-1280. [PMID: 34353666 DOI: 10.1016/j.jfo.2021.02.008] [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: 01/13/2021] [Accepted: 02/05/2021] [Indexed: 10/20/2022]
Affiliation(s)
- L Ramskold
- Ocular Oncology Service, Moorfields Eye Hospital NHS Foundation Trust, 162, City Road, London, EC1V 2PD, United Kingdom.
| | - S Lemaître
- Ocular Oncology Service, Moorfields Eye Hospital NHS Foundation Trust, 162, City Road, London, EC1V 2PD, United Kingdom
| | - A Arora
- Ocular Oncology Service, Moorfields Eye Hospital NHS Foundation Trust, 162, City Road, London, EC1V 2PD, United Kingdom
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Mohta A, Jain SK, Mehta RD, Arora A. Development of eruptive pseudoangiomatosis following COVID-19 immunization - Apropos of 5 cases. J Eur Acad Dermatol Venereol 2021; 35:e722-e725. [PMID: 34236736 PMCID: PMC8447312 DOI: 10.1111/jdv.17499] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 06/02/2021] [Accepted: 07/02/2021] [Indexed: 12/01/2022]
Affiliation(s)
- A Mohta
- Department of Dermatology, Venereology and Leprosy, Sardar Patel Medical College, Bikaner, Rajasthan, India
| | - S K Jain
- Department of Dermatology, Venereology and Leprosy, Government Medical College, Kota, Rajasthan, India
| | - R D Mehta
- Department of Dermatology, Venereology and Leprosy, Sardar Patel Medical College, Bikaner, Rajasthan, India
| | - A Arora
- Department of Dermatology, Venereology and Leprosy, Sardar Patel Medical College, Bikaner, Rajasthan, India
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Nathan A, Fricker M, De Groote R, Arora A, Phuah Y, Flora K, Pavan N, Kasivisvanathan V, Collins J, Kelkar A, Sridhar A, Shaw G, Rajan P, Kelly J, Briggs T, Sooriakumaran P, Nathan S. Salvage versus primary robot-assisted radical prostatectomy: A propensity-matched comparative effectiveness study from a high-volume tertiary center. Eur Urol 2021. [DOI: 10.1016/s0302-2838(21)01569-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Arora A, McDonald C, Iansavitchene A, Brahmania M, Sey M. A65 ENDOSCOPIST-TARGETED INTERVENTIONS TO OPTIMIZE ADENOMA DETECTION RATE - A SYSTEMATIC REVIEW AND META-ANALYSIS. J Can Assoc Gastroenterol 2021. [DOI: 10.1093/jcag/gwab002.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Adenoma detection rate (ADR) has emerged as the strongest quality assurance metric that has consistently been shown to be inversely associated with the development of colorectal cancer after colonoscopy. Unfortunately, marked variability in ADR exists among endoscopists. A multitude of interventions targeted at endoscopists to optimize their ADR have been reported, including but not limited to withdrawal time, in room observers, physician report cards, and quality improvement and training programs. However, it is unclear which of them are truly effective.
Aims
We performed a systematic review and meta-analysis of the literature to evaluate the effectiveness of endoscopist-targeted interventions to improve adenoma detection rate (ADR) or polyp detection rate (PDR).
Methods
Systematic searches of major databases were conducted through to March 2018 to identify potentially relevant studies. Both randomized controlled trials and observational studies were included. Data for ADR and PDR were analyzed on the log-odds scale using a random-effects meta-analysis model using restricted maximum likelihood (with Mantel-Haenszel fixed-effect meta-analysis used for fewer than 4 studies). Statistical effect-size heterogeneity was assessed using a Chi2 test and quantifying the relative proportion of variation using the I2 statistic. Publication bias was assessed by the Harbord regression test.
Results
From 4299 initial studies, 24 were included in the systematic review and 13 were included in the meta-analysis representing a total of 55,090 colonoscopies. Physician report card interventions (7 studies) and withdrawal time focused interventions (6 studies) were meta-analyzed. The pooled odds ratio for ADR for report card interventions was 1.31 (95% CI: 1.15, 1.50; p<0.0001), favoring report cards to detect more adenomas. Statistical heterogeneity was detected with substantial relative effect-size variability (Chi2, p<0.0001; I2=80.1%). No statistical evidence of publication bias was found. 6 studies reported data for PDR using withdrawal time focused interventions, with 3 of these reporting data on ADR. The pooled odds ratio for ADR was 1.02 (95% CI: 0.86, 1.22; p=0.81) and for PDR was 1.07 (95% CI: 0.88, 1.31; p=0.51) which were not statistically significant. Statistical heterogeneity was detected in both groups (Chi2, p<0.001; I2=82.2% for ADR and I2=89.4% for PDR) and there was statistical evidence of publication bias. Figures 1 and 2 represent Forest plots for the effect of pre-and post-report card and withdrawal time focused interventions on ADR.
Conclusions
Our study provides evidence that the distribution of colonoscopy quality report cards to physicians significantly improves overall ADR and should strongly be considered as part of quality improvement programs aimed at optimizing colonoscopy performance.
Funding Agencies
None
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Affiliation(s)
- A Arora
- Gastroenterology, Western University, London, ON, Canada
| | - C McDonald
- Gastroenterology, Western University, London, ON, Canada
| | | | - M Brahmania
- Gastroenterology, Western University, London, ON, Canada
| | - M Sey
- Western University, London, ON, Canada
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Arora A, Patel A, Yadav BS, Goyal A, Thakur OP, Garg AK, Raman R. Study on Evolution of Micropipes from Hexagonal Voids in 4H-SiC Crystals by Cathodoluminescence Imaging. Microsc Microanal 2021; 27:215-226. [PMID: 33509316 DOI: 10.1017/s1431927621000039] [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] [Indexed: 06/12/2023]
Abstract
This paper presents an investigation on micropipe evolution from hexagonal voids in physical vapor transport-grown 4H-SiC single crystals using the cathodoluminescence (CL) imaging technique. Complementary techniques optical microscopy, scanning electron microscopy, and energy-dispersive spectroscopy (EDS) are also used to understand the formation mechanism of hexagonal voids along with the origin of pipes from these voids. The ability of CL to image variations along the depth of the sample provides new insights on how micropipes are attached to hexagonal voids that lie deep within the bulk single crystals. CL imaging confirms that multiple micropipes can originate from a single hexagonal void. EDS mapping shows that the inside of the micropipe walls exhibits higher levels of carbon. Investigation of the seed region by optical imaging shows that improper fixing of the seed to the crucible lid is the root cause for the formation of hexagonal voids that subsequently lead to micropipe formation.
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Affiliation(s)
- Aman Arora
- Solid State Physics Laboratory, Timarpur, Lucknow Road, Delhi110054, India
| | - Ankit Patel
- Solid State Physics Laboratory, Timarpur, Lucknow Road, Delhi110054, India
| | - Brajesh S Yadav
- Solid State Physics Laboratory, Timarpur, Lucknow Road, Delhi110054, India
| | - Anshu Goyal
- Solid State Physics Laboratory, Timarpur, Lucknow Road, Delhi110054, India
| | - Om P Thakur
- Solid State Physics Laboratory, Timarpur, Lucknow Road, Delhi110054, India
| | - Arun K Garg
- Solid State Physics Laboratory, Timarpur, Lucknow Road, Delhi110054, India
| | - Ramachandran Raman
- Solid State Physics Laboratory, Timarpur, Lucknow Road, Delhi110054, India
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Singh S, Bansal P, Arora A, Goel A. Esophageal adenocarcinoma with metastatic skin nodules and Budd-Chiari syndrome. J Postgrad Med 2021; 67:122-123. [PMID: 33818522 PMCID: PMC8253335 DOI: 10.4103/jpgm.jpgm_1319_20] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- S Singh
- Department of Medicine, Lady Hardinge Medical College and Dr. Ram Manohar Lohia Hospital, New Delhi, India
| | - P Bansal
- Department of Medicine, Lady Hardinge Medical College and Dr. Ram Manohar Lohia Hospital, New Delhi, India
| | - A Arora
- Department of Medicine, Lady Hardinge Medical College and Dr. Ram Manohar Lohia Hospital, New Delhi, India
| | - A Goel
- Department of Medicine, Lady Hardinge Medical College and Dr. Ram Manohar Lohia Hospital, New Delhi, India
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Arora A, Arabameri A, Pandey M, Siddiqui MA, Shukla UK, Bui DT, Mishra VN, Bhardwaj A. Optimization of state-of-the-art fuzzy-metaheuristic ANFIS-based machine learning models for flood susceptibility prediction mapping in the Middle Ganga Plain, India. Sci Total Environ 2021; 750:141565. [PMID: 32882492 DOI: 10.1016/j.scitotenv.2020.141565] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 07/31/2020] [Accepted: 08/06/2020] [Indexed: 05/22/2023]
Abstract
This study is an attempt to quantitatively test and compare novel advanced-machine learning algorithms in terms of their performance in achieving the goal of predicting flood susceptible areas in a low altitudinal range, sub-tropical floodplain environmental setting, like that prevailing in the Middle Ganga Plain (MGP), India. This part of the Ganga floodplain region, which under the influence of undergoing active tectonic regime related subsidence, is the hotbed of annual flood disaster. This makes the region one of the best natural laboratories to test the flood susceptibility models for establishing a universalization of such models in low relief highly flood prone areas. Based on highly sophisticated flood inventory archived for this region, and 12 flood conditioning factors viz. annual rainfall, soil type, stream density, distance from stream, distance from road, Topographic Wetness Index (TWI), altitude, slope aspect, slope, curvature, land use/land cover, and geomorphology, an advanced novel hybrid model Adaptive Neuro Fuzzy Inference System (ANFIS), and three metaheuristic models-based ensembles with ANFIS namely ANFIS-GA (Genetic Algorithm), ANFIS-DE (Differential Evolution), and ANFIS-PSO (Particle Swarm Optimization), have been applied for zonation of the flood susceptible areas. The flood inventory dataset, prepared by collected flood samples, were apportioned into 70:30 classes to prepare training and validation datasets. One independent validation method, the Area-Under Receiver Operating Characteristic (AUROC) Curve, and other 11 cut-off-dependent model evaluation metrices have helped to conclude that the ANIFS-GA has outperformed other three models with highest success rate AUC = 0.922 and prediction rate AUC = 0.924. The accuracy was also found to be highest for ANFIS-GA during training (0.886) & validation (0.883). Better performance of ANIFS-GA than the individual models as well as some ensemble models suggests and warrants further study in this topoclimatic environment using other classes of susceptibility models. This will further help establishing a benchmark model with capability of highest accuracy and sensitivity performance in the similar topographic and climatic setting taking assumption of the quality of input parameters as constant.
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Affiliation(s)
- Aman Arora
- Department of Geography, Faculty of Natural Sciences, Jamia Millia Islamia, New Delhi 110025, India.
| | - Alireza Arabameri
- Department of Geomorphology, Tarbiat Modares University, Jalal Ale Ahmad Highway, Tehran 9821, Iran
| | - Manish Pandey
- University Center for Research & Development (UCRD), Chandigarh University, Mohali 140413, Punjab, India; Department of Civil Engineering, Chandigarh University, Mohali 140413, Punjab, India.
| | - Masood A Siddiqui
- Department of Geography, Faculty of Natural Sciences, Jamia Millia Islamia, New Delhi 110025, India
| | - U K Shukla
- Center for Advanced Study in Geology, Institute of Science, Banaras Hindu University, Varanasi 221005, India
| | - Dieu Tien Bui
- Institute of Research and Development, Duy Tan University, Da Nang 550000, Viet Nam
| | - Varun Narayan Mishra
- Centre for Climate Change and Water Research, Suresh Gyan Vihar University, Jaipur 302017, Rajasthan, India
| | - Anshuman Bhardwaj
- School of Geosciences, University of Aberdeen, Meston Building, King's College, Aberdeen AB24 3UE, UK; Division of Space Technology, Department of Computer Science, Electrical and Space Engineering, Luleå University of Technology, 97187 Luleå, Sweden
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Takhar A, Tornari C, Amin N, Wyncoll D, Tricklebank S, Arora A, Ahmad I, Simo R, Surda P. Safety and outcomes of percutaneous tracheostomy in coronavirus disease 2019 pneumonitis patients requiring prolonged mechanical ventilation. J Laryngol Otol 2020; 134:1-10. [PMID: 33143760 PMCID: PMC7729174 DOI: 10.1017/s0022215120002303] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/14/2020] [Indexed: 12/23/2022]
Abstract
OBJECTIVES Tracheostomy for coronavirus disease 2019 pneumonitis patients requiring prolonged invasive mechanical ventilation remains a matter of debate. This study analysed the timing and outcomes of percutaneous tracheostomy, and reports our experience of a dedicated ENT-anaesthetics department led tracheostomy team. METHOD A prospective single-centre observational study was conducted of patients undergoing tracheostomy, who had been diagnosed with coronavirus disease 2019 pneumonitis, between 21st March and 20th May 2020. RESULTS Eighty-one patients underwent tracheostomy after a median (interquartile range) of 16 (13-20) days of invasive mechanical ventilation. Median follow-up duration was 32 (23-40) days. Of patients, 86.7 per cent were successfully liberated from invasive mechanical ventilation in a median (interquartile range) of 12 (7-16) days. Moreover, 68.7 per cent were subsequently discharged from hospital. On univariate analysis, there was no difference in outcomes between early (before day 14) and late (day 14 or later) tracheostomy. The mortality rate was 8.6 per cent and no deaths were tracheostomy related. CONCLUSION Outcomes appear favourable when patients are carefully selected. Percutaneous tracheostomy performed via a multidisciplinary approach, with appropriate training, was safe and optimised healthcare resource utilisation.
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Affiliation(s)
- A Takhar
- Department of Otolaryngology and Head and Neck Surgery, Guy's and St Thomas’ NHS Foundation Trust, King's College London, London, UK
| | - C Tornari
- Department of Otolaryngology and Head and Neck Surgery, Guy's and St Thomas’ NHS Foundation Trust, King's College London, London, UK
| | - N Amin
- Department of Otolaryngology and Head and Neck Surgery, Guy's and St Thomas’ NHS Foundation Trust, King's College London, London, UK
| | - D Wyncoll
- Department of Critical Care, Guy's and St Thomas’ NHS Foundation Trust, King's College London, London, UK
| | - S Tricklebank
- Department of Critical Care, Guy's and St Thomas’ NHS Foundation Trust, King's College London, London, UK
| | - A Arora
- Department of Otolaryngology and Head and Neck Surgery, Guy's and St Thomas’ NHS Foundation Trust, King's College London, London, UK
| | - I Ahmad
- Department of Anaesthesia, Guy's and St Thomas’ NHS Foundation Trust, King's College London, London, UK
| | - R Simo
- Department of Otolaryngology and Head and Neck Surgery, Guy's and St Thomas’ NHS Foundation Trust, King's College London, London, UK
| | - P Surda
- Department of Otolaryngology and Head and Neck Surgery, Guy's and St Thomas’ NHS Foundation Trust, King's College London, London, UK
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Pandey A, Dhaka A, Kumari C, Kaushik J, Arora A, Dutta S, Dixit A, Raman R. RF Sputtered MoO3 Thin Film on Si (100) for Gas Sensing Applications. DEFENCE SCI J 2020. [DOI: 10.14429/dsj.70.16342] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Molybdenum Trioxide (MoO3) films are grown on Si(100) substrates by reactive RF magnetron sputtering in plasma containing a mixture of Argon and Oxygen, using a pure Molybdenum target. In this paper, we report the deposition of (MoO3) films on Si(100) substrates under varying gas flow (O2 + Ar gas) (20 sccm to 30 sccm with the duration of deposition~ 1hr) by RF reactive magnetron sputtering at room temperature. To get crystalline MoO3 films annealing in O2 environment at 500 °C for 4 h is done. Phase formation and orientation of the film is characterized by Glancing incidence X-ray diffraction (GIXRD). The identification of the orthorhombic MoO3 phase is investigated by XRD and Raman spectroscopy. Raman lines at 819 cm-1 and 995 cm-1 are due to the (A1g, B1g) symmetric stretching (Mo-O–Mo) bond and asymmetric stretching band (Mo=O) respectively. Surface morphology and cross-sectional image of the deposited thin films were investigated by FE-SEM image. UV-Visible reflectance and cross-sectional FE-SEM image confirm the thickness of the MoO3 films with oxygen-rich and oxygen deficient phase formation occur. Reverse leakage current density of 20 sccm 1hr sample is low (1×10-6 mA/cm2) as compared to 30 sccm 1hr sample (1×10-3 mA/cm2). The higher leakage is due to crack formation during the ex-situ annealing of MoO3 films. This MoO3 films can be used in Gas sensing and switching devices.
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Arora A, Dhillan R. Diabetic Foot Limb Salvage in Low-Resource Settings: Challenges and Solutions. J Am Coll Surg 2020. [DOI: 10.1016/j.jamcollsurg.2020.07.235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Touska P, Oikonomou G, Ngu R, Chandra A, Malhotra A, Fry A, Oakley R, Arora A, Jeannon JP, Simo R. The role of transoral fine needle aspiration in expediting diagnosis and reducing risk in head and neck cancer patients in the coronavirus disease 2019 (COVID-19) era: a single-institution experience. J Laryngol Otol 2020; 134:1-8. [PMID: 32873344 PMCID: PMC7533497 DOI: 10.1017/s0022215120001929] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/15/2020] [Indexed: 12/12/2022]
Abstract
OBJECTIVE The global coronavirus disease 2019 (COVID-19) pandemic has necessitated rapid alterations to diagnostic pathways for head and neck cancer patients that aim to reduce risk to patients (exposure to the hospital environment) and staff (aerosol-generating procedures). Transoral fine needle aspiration cytology offers a low-risk means of rapidly diagnosing patients with oral cavity or oropharyngeal lesions. The technique was utilised in selected patients at our institution during the pandemic. The outcomes are considered in this study. METHOD Diagnostic outcomes were retrospectively evaluated for a series of patients undergoing transoral fine needle aspiration cytology of oral cavity and oropharyngeal lesions during the COVID-19 pandemic. RESULTS Five patients underwent transoral fine needle aspiration cytology, yielding lesional material in 100 per cent, with cell blocks providing additional information. In one case, excision biopsy of a lymphoproliferative lesion was required for final diagnosis. CONCLUSION Transoral fine needle aspiration cytology can provide rapid diagnosis in patients with oral cavity and oropharyngeal lesions. Whilst limitations exist (including tolerability and lesion location), the technique offers significant advantages pertinent to the COVID-19 era, and could be employed in the future to obviate diagnostic surgery in selected patients.
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Affiliation(s)
- P Touska
- Department of Radiology, Guy's and St Thomas’ Hospitals NHS Foundation Trust, London, UK
| | - G Oikonomou
- Department of ENT Surgery, Guy's and St Thomas’ Hospitals NHS Foundation Trust, London, UK
| | - R Ngu
- Department of Dental Maxillofacial Imaging, Guy's and St Thomas’ Hospitals NHS Foundation Trust, London, UK
| | - A Chandra
- Department of Cellular Pathology, Guy's and St Thomas’ Hospitals NHS Foundation Trust, London, UK
| | - A Malhotra
- Department of Cellular Pathology, Guy's and St Thomas’ Hospitals NHS Foundation Trust, London, UK
| | - A Fry
- Department of ENT Surgery, Guy's and St Thomas’ Hospitals NHS Foundation Trust, London, UK
| | - R Oakley
- Department of ENT Surgery, Guy's and St Thomas’ Hospitals NHS Foundation Trust, London, UK
| | - A Arora
- Department of ENT Surgery, Guy's and St Thomas’ Hospitals NHS Foundation Trust, London, UK
| | - J-P Jeannon
- Department of ENT Surgery, Guy's and St Thomas’ Hospitals NHS Foundation Trust, London, UK
| | - R Simo
- Department of ENT Surgery, Guy's and St Thomas’ Hospitals NHS Foundation Trust, London, UK
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