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Yoganandan N, Baisden J, Vedantam A, Banerjee A. Complex Neck Loading and Injury Tolerance in Lateral Bending With Head Rotation From Human Cadaver Tests. J Eng Sci Med Diagn Ther 2024; 7:031005. [PMID: 38059268 PMCID: PMC10697077 DOI: 10.1115/1.4063648] [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] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 08/10/2023] [Indexed: 12/08/2023]
Abstract
Advancements in automated vehicles may position the occupant in postures different from the current standard posture. It may affect human tolerance responses. The objective of this study was to determine the lateral bending tolerance of the head-cervical spine with initial head rotation posture using loads at the occipital condyles and lower neck and describe injuries. Using a custom loading device, head-cervical spine complexes from human cadavers were prepared with load cells at the ends. Lateral bending loads were applied to prerotated specimens at 1.5 m/s. At the occipital condyles, peak axial and antero-posterior and medial-lateral shear forces were: 316-954 N, 176-254 N, and 327-508 N, and coronal, sagittal, and axial moments were: 27-38 N·m, 21-38 N·m, and 9.7-19.8 N·m, respectively. At the lower neck, peak axial and shear forces were: 677-1004 N, 115-227 N, and 178-350 N, and coronal, sagittal, and axial moments were: 30-39 N·m, 7.6-21.3 N·m, and 5.7-13.4 N·m, respectively. Ipsilateral atlas lateral mass fractures occurred in four out of five specimens with varying joint diastasis and capsular ligament involvements. Acknowledging that the study used a small sample size, initial tolerances at the occipital condyles and lower neck were estimated using survival analysis. Injury patterns with posture variations are discussed.
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Affiliation(s)
- Narayan Yoganandan
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI 53226
| | - Jamie Baisden
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI 53226
| | - Aditya Vedantam
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI 53226
| | - Anjishnu Banerjee
- Division of Biostatistics, Medical College of Wisconsin, Milwaukee, WI 53226
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Yoganandan N, Choi H, Purushothaman Y, Vedantam A, Harinathan B, Banerjee A. Comparison of Load-Sharing Responses Between Graded Posterior Cervical Foraminotomy and Conventional Fusion Using Finite Element Modeling. J Eng Sci Med Diagn Ther 2024; 7:021006. [PMID: 37860789 PMCID: PMC10583278 DOI: 10.1115/1.4063465] [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] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 08/23/2023] [Indexed: 10/21/2023]
Abstract
Following the diagnosis of unilateral cervical radiculopathy and need for surgical intervention, anterior cervical diskectomy and fusion (conventional fusion) and posterior cervical foraminotomy are common options. Although patient outcomes may be similar between the two procedures, their biomechanical effects have not been fully compared using a head-to-head approach, particularly, in relation to the amount of facet resection and internal load-sharing between spinal segments and components. The objective of this investigation was to compare load-sharing between conventional fusion and graded foraminotomy facet resections under physiological loading. A validated finite element model of the cervical spinal column was used in the study. The intact spine was modified to simulate the two procedures at the C5-C6 spinal segment. Flexion, extension, and lateral bending loads were applied to the intact, graded foraminotomy, and conventional fusion spines. Load-sharing was determined using range of motion data at the C5-C6 and immediate adjacent segments, facet loads at the three segments, and disk pressures at the adjacent segments. Results were normalized with respect to the intact spine to compare surgical options. Conventional fusion leads to increased motion, pressure, and facet loads at adjacent segments. Foraminotomy leads to increased motion and anterior loading at the index level, and motions decrease at adjacent levels. In extension, the left facet load decreases after foraminotomy. Recognizing that foraminotomy is a motion preserving alternative to conventional fusion, this study highlights various intrinsic biomechanical factors and potential instability issues with more than one-half facet resection.
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Affiliation(s)
| | - Hoon Choi
- Cleveland Clinic Florida, Weston, FL 33331
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Banerjee A, Blinston D, Narain MA. Inhibition of liver fibrosis by TET1 may be B cell mediated: Supporting evidence from a case of TNFAIP3 deficiency. J Gastroenterol Hepatol 2024. [PMID: 38660948 DOI: 10.1111/jgh.16595] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Accepted: 04/16/2024] [Indexed: 04/26/2024]
Affiliation(s)
- A Banerjee
- Department of Gastroenterology and Hepatology, Bronglais General Hospital, Aberystwyth, UK
| | - D Blinston
- Department of Gastroenterology and Hepatology, Bronglais General Hospital, Aberystwyth, UK
| | - M A Narain
- Department of Gastroenterology and Hepatology, Bronglais General Hospital, Aberystwyth, UK
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Bobholz SA, Hoefs A, Hamburger J, Lowman AK, Winiarz A, Duenweg SR, Kyereme F, Connelly J, Coss D, Krucoff M, Banerjee A, LaViolette PS. Radio-pathomic maps of glioblastoma identify phenotypes of non-enhancing tumor infiltration associated with bevacizumab treatment response. J Neurooncol 2024; 167:233-241. [PMID: 38372901 PMCID: PMC11024025 DOI: 10.1007/s11060-024-04593-7] [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] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 01/30/2024] [Indexed: 02/20/2024]
Abstract
BACKGROUND Autopsy-based radio-pathomic maps of glioma pathology have shown substantial promise inidentifying areas of non-enhancing tumor presence, which may be able to differentiate subsets of patients that respond favorably to treatments such as bevacizumab that have shown mixed efficacy evidence. We tested the hypthesis that phenotypes of non-enhancing tumor fronts can distinguish between glioblastoma patients that will respond favorably to bevacizumab and will visually capture treatment response. METHODS T1, T1C, FLAIR, and ADC images were used to generate radio-pathomic maps of tumor characteristics for 79 pre-treatment patients with a primary GBM or high-grade IDH1-mutant astrocytoma for this study. Novel phenotyping (hypercellular, hypocellular, hybrid, or well-circumscribed front) of the non-enhancing tumor front was performed on each case. Kaplan Meier analyses were then used to assess differences in survival and bevacizumab efficacy between phenotypes. Phenotype compartment segmentations generated longitudinally for a subset of 26 patients over the course of bevacizumab treatment, where a mixed effect model was used to detect longitudinal changes. RESULTS Well-Circumscribed patients showed significant/trending increases in survival compared to Hypercellular Front (HR = 2.0, p = 0.05), Hypocellular Front (HR = 2.02, p = 0.03), and Hybrid Front tumors (HR = 1.75, p = 0.09). Only patients with hypocellular or hybrid fronts showed significant survival benefits from bevacizumab treatment (HR = 2.35, p = 0.02; and HR = 2.45, p = 0.03, respectively). Hypocellular volumes decreased by an average 50.52 mm3 per day of bevacizumab treatment (p = 0.002). CONCLUSION Patients with a hypocellular tumor front identified by radio-pathomic maps showed improved treatment efficacy when treated with bevacizumab, and reducing hypocellular volumes over the course of treatment may indicate treatment response.
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Affiliation(s)
- Samuel A Bobholz
- Department of Radiology, Medical College of Wisconsin, 8701 Watertown Plank Rd, 53226, Milwaukee, WI, USA
| | - Alisha Hoefs
- Department of Radiology, Medical College of Wisconsin, 8701 Watertown Plank Rd, 53226, Milwaukee, WI, USA
| | - Jordyn Hamburger
- Department of Radiology, Medical College of Wisconsin, 8701 Watertown Plank Rd, 53226, Milwaukee, WI, USA
| | - Allison K Lowman
- Department of Radiology, Medical College of Wisconsin, 8701 Watertown Plank Rd, 53226, Milwaukee, WI, USA
| | - Aleksandra Winiarz
- Department of Biophysics, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Savannah R Duenweg
- Department of Biophysics, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Fitzgerald Kyereme
- Department of Radiology, Medical College of Wisconsin, 8701 Watertown Plank Rd, 53226, Milwaukee, WI, USA
| | - Jennifer Connelly
- Department of Neurology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Dylan Coss
- Department of Pathology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Max Krucoff
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Anjishnu Banerjee
- Department of Biostatistics, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Peter S LaViolette
- Department of Radiology, Medical College of Wisconsin, 8701 Watertown Plank Rd, 53226, Milwaukee, WI, USA.
- Department of Biophysics, Medical College of Wisconsin, Milwaukee, WI, USA.
- Department of Biomedical Engineering, Medical College of Wisconsin, Milwaukee, WI, USA.
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Bobholz SA, Hoefs A, Hamburger J, Lowman AK, Winiarz A, Duenweg SR, Kyereme F, Connelly J, Coss D, Krucoff M, Banerjee A, LaViolette PS. Correction to: Radio-pathomic maps of glioblastoma identify phenotypes of non-enhancing tumor infiltration associated with bevacizumab treatment response. J Neurooncol 2024; 167:243. [PMID: 38498261 PMCID: PMC11023959 DOI: 10.1007/s11060-024-04641-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/20/2024]
Affiliation(s)
- Samuel A Bobholz
- Department of Radiology, Medical College of Wisconsin, 8701 Watertown Plank Rd, 53226, Milwaukee, WI, USA
| | - Alisha Hoefs
- Department of Radiology, Medical College of Wisconsin, 8701 Watertown Plank Rd, 53226, Milwaukee, WI, USA
| | - Jordyn Hamburger
- Department of Radiology, Medical College of Wisconsin, 8701 Watertown Plank Rd, 53226, Milwaukee, WI, USA
| | - Allison K Lowman
- Department of Radiology, Medical College of Wisconsin, 8701 Watertown Plank Rd, 53226, Milwaukee, WI, USA
| | - Aleksandra Winiarz
- Department of Biophysics, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Savannah R Duenweg
- Department of Biophysics, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Fitzgerald Kyereme
- Department of Radiology, Medical College of Wisconsin, 8701 Watertown Plank Rd, 53226, Milwaukee, WI, USA
| | - Jennifer Connelly
- Department of Neurology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Dylan Coss
- Department of Pathology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Max Krucoff
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Anjishnu Banerjee
- Department of Biostatistics, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Peter S LaViolette
- Department of Radiology, Medical College of Wisconsin, 8701 Watertown Plank Rd, 53226, Milwaukee, WI, USA.
- Department of Biophysics, Medical College of Wisconsin, Milwaukee, WI, USA.
- Department of Biomedical Engineering, Medical College of Wisconsin, Milwaukee, WI, USA.
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Haurie L, Grandadam M, Pangburn E, Banerjee A, Burdin S, Pépin C. Bands renormalization and superconductivity in the strongly correlated Hubbard model using composite operators method. J Phys Condens Matter 2024; 36:255601. [PMID: 38215481 DOI: 10.1088/1361-648x/ad1e07] [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] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 01/12/2024] [Indexed: 01/14/2024]
Abstract
We use the composite operator method (COM) to analyze the strongly correlated repulsive Hubbard model, investigating the effect of nearest-neighbor hoppings up to fourth order on a square lattice. We consider two sets of self-consistent equations, one enforcing the Pauli principle and the other imposing charge-charge, spin-spin, and pair-pair correlations using a decoupling scheme developed by Roth (1969Phys. Rev.184451-9). We extract three distinct solutions from these equations: COM1 and COM2 by imposing the Pauli principle and one from Roth decoupling. An overview of the method studying the validity of particle-hole symmetry and the Luttinger theorem for each solution is presented. Additionally, we extend the initial basis to study superconductivity, concluding that it is induced by the Van Hove singularity. Finally, we include higher-order hoppings using realistic estimates for tight binding parameters and compare our results with ARPES measurements on cuprates.
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Affiliation(s)
- L Haurie
- Institut de Physique Théorique, Université Paris Saclay, CEA CNRS, Orme des Merisiers, 91190 Gif-sur-Yvette Cedex, France
| | - M Grandadam
- Department of Physics and Physical Oceanography, Memorial University of Newfoundland, St. John's, Newfoundland & Labrador A1B 3X7, Canada
| | - E Pangburn
- Institut de Physique Théorique, Université Paris Saclay, CEA CNRS, Orme des Merisiers, 91190 Gif-sur-Yvette Cedex, France
| | - A Banerjee
- Department of Physics, Ben-Gurion University of the Negev, Beer-Sheva 84105, Israel
| | - S Burdin
- Université de Bordeaux, CNRS, LOMA, UMR 5798, F-33400 Talence, France
| | - C Pépin
- Institut de Physique Théorique, Université Paris Saclay, CEA CNRS, Orme des Merisiers, 91190 Gif-sur-Yvette Cedex, France
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SenthilKumar G, Schottstaedt AM, Peterson LL, Pedersen LN, Chitambar CR, Vistocky A, Banerjee A, Longo JM, Kelly T, Currey A, Stolley MR, Bergom C. Stay on Track: A Pilot Randomized Control Trial on the Feasibility of a Diet and Exercise Intervention in Patients with Breast Cancer Receiving Radiation Therapy. Cancer Res Commun 2024:742003. [PMID: 38530195 DOI: 10.1158/2767-9764.crc-23-0148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 08/14/2023] [Accepted: 03/18/2024] [Indexed: 03/27/2024]
Abstract
BACKGROUND Among patients with breast cancer undergoing radiation therapy (RT), post-treatment cardiovascular disease and worsened quality of life (QOL) are leading causes of morbidity and mortality. To overcome these negative RT effects, this prospective, randomized clinical trial pilots a 12-week Stay on Track exercise and diet intervention for overweight patients with non-metastatic breast cancer undergoing whole-breast RT. METHODS The intervention group (n=22) participated in three personal exercise and dietary counseling sessions, and received three text reminders/week to adhere to recommendations. The control group (n=22) was administered a diet/exercise information binder. All patients received a Fitbit, and at baseline, 3, and 6 months, measurements of biomarkers, dual-energy X-ray absorptiometry scans, quality of life and physical activity surveys, and food frequency questionnaires were obtained. A satisfaction survey was administered at three months. RESULTS Stay on Track was well received, with high rates of adherence and satisfaction. The intervention group showed an increase in self-reported physical activity and preserved QOL, a decrease in BMI and visceral fat, and higher ACS/AICR dietary adherence. The control participants had reduced QOL, anti-inflammatory markers, and increased metabolic syndrome markers. Both groups had decreased overall body mass. These changes were within group effects. When comparing the intervention and control groups over time, there were notable improvements in dietary adherence in the intervention group. CONCLUSIONS Targeted lifestyle interventions during RT are feasible and could decrease cardiovascular comorbidities in patients with breast cancer. Larger-scale implementation with longer follow-up can better determine interventions that influence cardiometabolic health and QOL.
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Affiliation(s)
| | | | - Lindsay L Peterson
- Washington University in St. Louis School of Medicine, St. Louis, MO, United States
| | | | | | | | | | - John M Longo
- Medical College of Wisconsin, Milwaukee, WI, United States
| | - Tracy Kelly
- Medical College of Wisconsin, Milwaukee, WI, United States
| | - Adam Currey
- Medical College of Wisconsin, Milwaukee, WI, United States
| | - Melinda R Stolley
- Washington University in St. Louis School of Medicine, United States
| | - Carmen Bergom
- Washington University in St. Louis, St. Louis, MO, United States
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Bobholz SA, Lowman AK, Connelly JM, Duenweg SR, Winiarz A, Nath B, Kyereme F, Brehler M, Bukowy J, Coss D, Lupo JM, Phillips JJ, Ellingson BM, Krucoff MO, Mueller WM, Banerjee A, LaViolette PS. Noninvasive Autopsy-Validated Tumor Probability Maps Identify Glioma Invasion Beyond Contrast Enhancement. Neurosurgery 2024:00006123-990000000-01091. [PMID: 38501824 DOI: 10.1227/neu.0000000000002898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 01/09/2024] [Indexed: 03/20/2024] Open
Abstract
BACKGROUND AND OBJECTIVES This study identified a clinically significant subset of patients with glioma with tumor outside of contrast enhancement present at autopsy and subsequently developed a method for detecting nonenhancing tumor using radio-pathomic mapping. We tested the hypothesis that autopsy-based radio-pathomic tumor probability maps would be able to noninvasively identify areas of infiltrative tumor beyond traditional imaging signatures. METHODS A total of 159 tissue samples from 65 subjects were aligned to MRI acquired nearest to death for this retrospective study. Demographic and survival characteristics for patients with and without tumor beyond the contrast-enhancing margin were computed. An ensemble algorithm was used to predict pixelwise tumor presence from pathological annotations using segmented cellularity (Cell), extracellular fluid, and cytoplasm density as input (6 train/3 test subjects). A second level of ensemble algorithms was used to predict voxelwise Cell, extracellular fluid, and cytoplasm on the full data set (43 train/22 test subjects) using 5-by-5 voxel tiles from T1, T1 + C, fluid-attenuated inversion recovery, and apparent diffusion coefficient as input. The models were then combined to generate noninvasive whole brain maps of tumor probability. RESULTS Tumor outside of contrast was identified in 41.5% of patients, who showed worse survival outcomes (hazard ratio = 3.90, P < .001). Tumor probability maps reliably tracked nonenhancing tumor on a range of local and external unseen data, identifying tumor outside of contrast in 69% of presurgical cases that also showed reduced survival outcomes (hazard ratio = 1.67, P = .027). CONCLUSION This study developed a multistage model for mapping gliomas using autopsy tissue samples as ground truth, which was able to identify regions of tumor beyond traditional imaging signatures.
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Affiliation(s)
- Samuel A Bobholz
- Department of Radiology, Medical College of Wisconsin, Milwaukee , Wisconsin , USA
| | - Allison K Lowman
- Department of Radiology, Medical College of Wisconsin, Milwaukee , Wisconsin , USA
| | - Jennifer M Connelly
- Department of Neurology, Medical College of Wisconsin, Milwaukee , Wisconsin , USA
| | - Savannah R Duenweg
- Department of Biophysics, Medical College of Wisconsin, Milwaukee , Wisconsin , USA
| | - Aleksandra Winiarz
- Department of Biophysics, Medical College of Wisconsin, Milwaukee , Wisconsin , USA
| | - Biprojit Nath
- Department of Biophysics, Medical College of Wisconsin, Milwaukee , Wisconsin , USA
| | - Fitzgerald Kyereme
- Department of Radiology, Medical College of Wisconsin, Milwaukee , Wisconsin , USA
| | - Michael Brehler
- Department of Radiology, Medical College of Wisconsin, Milwaukee , Wisconsin , USA
| | - John Bukowy
- Department of Electrical Engineering and Computer Science, Milwaukee School of Engineering, Milwaukee , Wisconsin , USA
| | - Dylan Coss
- Department of Pathology, Medical College of Wisconsin, Milwaukee , Wisconsin , USA
| | - Janine M Lupo
- Department of Radiology and Biomedical Imaging, University of California, San Francisco , California , USA
- UCSF/UC Berkeley Graduate Program in Bioengineering, University of California, San Francisco and Berkeley , California , USA
| | - Joanna J Phillips
- Department of Neurological Surgery, University of California, San Francisco , California , USA
- Department of Pathology, University of California, San Francisco , California , USA
| | - Benjamin M Ellingson
- UCLA Brain Tumor Imaging Laboratory, Department of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles , California , USA
| | - Max O Krucoff
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee , Wisconsin , USA
| | - Wade M Mueller
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee , Wisconsin , USA
| | - Anjishnu Banerjee
- Department of Biostatistics, Medical College of Wisconsin, Milwaukee , Wisconsin , USA
| | - Peter S LaViolette
- Department of Radiology, Medical College of Wisconsin, Milwaukee , Wisconsin , USA
- Department of Biophysics, Medical College of Wisconsin, Milwaukee , Wisconsin , USA
- Department of Biomedical Engineering, Medical College of Wisconsin, Milwaukee , Wisconsin , USA
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Maranto C, Sabharwal L, Udhane V, Pitzen SP, McCluskey B, Qi S, O’Connor C, Devi S, Johnson S, Jacobsohn K, Banerjee A, Iczkowski KA, Wang L, Dehm SM, Nevalainen MT. Stat5 induces androgen receptor ( AR) gene transcription in prostate cancer and offers a druggable pathway to target AR signaling. Sci Adv 2024; 10:eadi2742. [PMID: 38416822 PMCID: PMC10901378 DOI: 10.1126/sciadv.adi2742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 01/24/2024] [Indexed: 03/01/2024]
Abstract
Androgen receptor (AR) drives prostate cancer (PC) growth and progression, and targeting AR signaling is the mainstay of pharmacological therapies for PC. Resistance develops relatively fast as a result of refueled AR activity. A major gap in the field is the lack of understanding of targetable mechanisms that induce persistent AR expression in castrate-resistant PC (CRPC). This study uncovers an unexpected function of active Stat5 signaling, a known promoter of PC growth and clinical progression, as a potent inducer of AR gene transcription. Stat5 suppression inhibited AR gene transcription in preclinical PC models and reduced the levels of wild-type, mutated, and truncated AR proteins. Pharmacological Stat5 inhibition by a specific small-molecule Stat5 inhibitor down-regulated Stat5-inducible genes as well as AR and AR-regulated genes and suppressed PC growth. This work introduces the concept of Stat5 as an inducer of AR gene transcription in PC. Pharmacological Stat5 inhibitors may represent a new strategy for suppressing AR and CRPC growth.
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Affiliation(s)
- Cristina Maranto
- Department of Pathology, Medical College of Wisconsin, Milwaukee, WI 53226, USA
| | - Lavannya Sabharwal
- Department of Pathology, Medical College of Wisconsin, Milwaukee, WI 53226, USA
| | - Vindhya Udhane
- Department of Pathology, Medical College of Wisconsin, Milwaukee, WI 53226, USA
| | - Samuel P. Pitzen
- Masonic Cancer Center, University of Minnesota, Minneapolis, MN 55455, USA
- Graduate Program in Molecular, Cellular, and Developmental Biology and Genetics, University of Minnesota, Minneapolis, MN 55455, USA
| | - Braedan McCluskey
- Minnesota Supercomputing Institute, University of Minnesota, Minneapolis, MN 55455, USA
| | - Songyan Qi
- Masonic Cancer Center, University of Minnesota, Minneapolis, MN 55455, USA
- Graduate Program in Biochemistry, Molecular Biology and Biophysics, University of Minnesota, Minneapolis, MN 55455, USA
| | - Christine O’Connor
- Minnesota Supercomputing Institute, University of Minnesota, Minneapolis, MN 55455, USA
| | - Savita Devi
- Department of Pathology, Medical College of Wisconsin, Milwaukee, WI 53226, USA
| | - Scott Johnson
- Department of Urology, Medical College of Wisconsin, Milwaukee, WI 53226, USA
| | - Kenneth Jacobsohn
- Department of Urology, Medical College of Wisconsin, Milwaukee, WI 53226, USA
| | - Anjishnu Banerjee
- Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, WI 53226, USA
| | | | - Liang Wang
- Department of Tumor Biology, Moffitt Cancer Center, 12902 USF Magnolia Drive, Tampa, FL 33612, USA
| | - Scott M. Dehm
- Masonic Cancer Center, University of Minnesota, Minneapolis, MN 55455, USA
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN 55455, USA
- Department of Urology, University of Minnesota, Minneapolis, MN 55455, USA
| | - Marja T. Nevalainen
- Department of Pathology, Medical College of Wisconsin, Milwaukee, WI 53226, USA
- Department of Pharmacology, Physiology and Cancer Biology, Sidney Kimmel Cancer Center at Jefferson Health, Thomas Jefferson University, Philadelphia, PA 19107, USA
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10
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Calley BJ, Fazio J, Banerjee A, Clark MA. Topical Treatment of Cutaneous Squamous Cell Carcinoma in Situ and the Impact of Clinical Risk Factors and Positive Histologic Margins at the Time of Diagnosis. Dermatol Surg 2024; 50:219-223. [PMID: 38048273 DOI: 10.1097/dss.0000000000004044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/06/2023]
Abstract
BACKGROUND Limited data exist for the efficacy of topical 5-fluorouracil (5-FU) and imiquimod for cutaneous squamous cell carcinoma (cSCC) in situ (cSCCis) with positive histologic margins at the time of diagnosis. OBJECTIVE Identify the efficacy of topical 5-FU and imiquimod in the treatment of cSCCis with positive histologic margins at the time of diagnosis in relation to clinical risk factors. MATERIALS AND METHODS Pathology records were screened at a single institution from 2014 to 2021 for cSCCis with positive histologic margins. Patients were included if they were treated with curative intent with topical 5-FU or imiquimod. Recurrences were evaluated in relation to multiple clinical risk factors. RESULTS Of 215 patients treated with 5-FU or imiquimod after biopsy-proven cSCCis, 19 patients had recurrent cSCCis and 1 patient had upstaging to invasive cSCC. Recurrence was more likely in larger lesions at the time of initial biopsy ( p = .033) and in patients treated with topical imiquimod compared with topical 5-FU ( p < .01). CONCLUSION Topical 5-FU is an appropriate therapy for cSCCis in the correct clinical scenario. Extra consideration should be taken for use of 5-FU in larger diameter cSCCis lesions. Although limited by sample size, our study does not support the use of imiquimod for cSCCis.
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Affiliation(s)
| | - Justin Fazio
- Department of Dermatology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Anjishnu Banerjee
- Department of Biostatistics, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Melanie A Clark
- Medical College of Wisconsin, Milwaukee, Wisconsin
- Department of Dermatology, Medical College of Wisconsin, Milwaukee, Wisconsin
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11
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Manna P, Kanthal S, Das A, Banerjee A, Bandyopadhyay S. Low temperature Raman spectroscopic study of anharmonic and spin-phonon coupled quasi-two dimensional rare earth based francisites. J Phys Condens Matter 2024; 36:215704. [PMID: 38373342 DOI: 10.1088/1361-648x/ad2aad] [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] [Subscribe] [Scholar Register] [Received: 12/25/2023] [Accepted: 02/19/2024] [Indexed: 02/21/2024]
Abstract
Mineral francisites Cu3Bi(SeO3)2O2Cl are unique compounds with interesting quasi two-dimensional structure along with fascinating magnetic properties. The magnetic properties can be fine-tuned when non-magnetic Bi is replaced by a suitable rare earth (RE) metal. It is because of the inclusion of additional magnetic sub-centre RE apart from Cu. Temperature dependent Raman spectroscopy measurements in RE based francisites [Cu3RE(SeO3)2O2Cl, shortly RECufr] were performed in the range of 11 K-295 K. Among the three studied RECufr (LaCufr, NdCufr, and DyCufr) compounds, the properties of phonon vibration vary from moderate (in DyCufr) to weak (in LaCufr) spin phonon coupled and the absence of spin phonon coupling (SPC) (i.e. strictly anharmonic in nature) was observed in NdCufr and the reason for this observation has been provided. More specifically, two Raman-active phonons soften below the antiferromagnetic ordering temperature ofTN≈ 39 K in DyCufr compound, indicating the existence of moderate SPC. This trend of phonon vibration is correlated with magnetic properties, particularly field induced metamagnetic transition (MMT). Strong MMT enabled DyCufr develops SPC, while weak MMT enabled NdCufr is unable to develop SPC.
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Affiliation(s)
- P Manna
- Department of Physics, University of Calcutta, 92 A.P.C. Road, Kolkata 700009, India
| | - S Kanthal
- Department of Physics, University of Calcutta, 92 A.P.C. Road, Kolkata 700009, India
| | - A Das
- Department of Physics, University of Calcutta, 92 A.P.C. Road, Kolkata 700009, India
| | - A Banerjee
- Department of Physics, University of Calcutta, 92 A.P.C. Road, Kolkata 700009, India
| | - S Bandyopadhyay
- Department of Physics, University of Calcutta, 92 A.P.C. Road, Kolkata 700009, India
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12
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Glaeser B, Panariello V, Banerjee A, Olsen CM. Environmental Enrichment during Abstinence Reduces Oxycodone Seeking and c-Fos Expression in a Subpopulation of Medial Prefrontal Cortex Neurons. Drug Alcohol Depend 2024; 255:111077. [PMID: 38228055 PMCID: PMC10869844 DOI: 10.1016/j.drugalcdep.2023.111077] [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: 11/16/2023] [Revised: 12/20/2023] [Accepted: 12/20/2023] [Indexed: 01/18/2024]
Abstract
BACKGROUND Several preclinical studies have demonstrated that environmental enrichment (EE) during abstinence reduces drug seeking for psychostimulant and opioid drugs. Drug seeking is dependent on activity within the dorsomedial prefrontal cortex, and enrichment has been able to reduce drug seeking-associated increases in c-Fos in this region. In this study, we tested the hypothesis that EE during abstinence from oxycodone self-administration would reduce drug seeking and c-Fos immunoreactivity within the prefrontal cortex in a cell-type specific manner. METHODS Male rats self-administered oxycodone in two-hours sessions for three weeks, then underwent an initial drug seeking test under extinction conditions after one week of forced abstinence. Following this test, rats received either EE or remained individually housed in their home cage, then a second drug seeking test, with tissue collection immediately afterward. RESULTS Compared to rats in standard housing, environmentally enriched rats had lower oxycodone seeking. In the prelimbic and infralimbic prefrontal cortices, the number of c-Fos+ cells was reduced, and this reduction was predominantly in inhibitory cells neurons, as evidenced by a reduction in the proportion of c-Fos+ cells in GAD+, but not CamKII+ cells. There was also a robust positive relationship between the number of c-Fos+ cells and persistence of oxycodone seeking in both the PrL and IL. CONCLUSIONS These findings further support the effectiveness of enriched environments to reduce reactivity to drug-associated stimuli and contexts and provide a potential mechanism by which this occurs.
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Affiliation(s)
- Breanna Glaeser
- Department of Pharmacology & Toxicology, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226; Neuroscience Research Center, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226
| | - Valeria Panariello
- Department of Pharmacology & Toxicology, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226; Neuroscience Research Center, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226; Current Address: Department of Science and Medicine, University of Fribourg, Chemin du Musée 14 CH-Fribourg1700 Switzerland
| | - Anjishnu Banerjee
- Division of Biostatistics, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226
| | - Christopher M Olsen
- Department of Pharmacology & Toxicology, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226; Neuroscience Research Center, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226; Department of Neurosurgery, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226.
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13
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Singh SK, Varma RK, Banerjee A, Rathore KK. Study of wave motion on the emergence of veering, locking, and coupling in periodic composite panels. J Acoust Soc Am 2024; 155:826-836. [PMID: 38299940 DOI: 10.1121/10.0024616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 01/11/2024] [Indexed: 02/02/2024]
Abstract
This research proposes the effect of micropolar-Cosserat (MC) parameters (length-scale parameters and Cosserat shear modulus) on the dispersion characteristics of propagating wave modes in periodic composite panels (PCPs). These inbuilt parameters are due to the assumption of the length-scale boundary conditions that allow for capturing the micro-rotational (MR) wave mode along with the flexural ones. A significant contribution of this study is the transformation of the two-dimensional (2-D) periodic composite problem into a series of one-dimensional (1-D) ones using the MC continuum theory. The analysis employs the transfer matrix method in the framework of the state-space approach to investigate periodic systems in the eigenvalue domain. Additionally, Bloch-Floquet's periodic boundary conditions (PBCs) are applied to the unit cell to ensure the periodicity of the system. The main innovation lies in observing veering, locking, and coupling phenomena, which occur due to alterations in lamina orientation and MC parameters. Moreover, the presence of inbuilt parameters renders the dispersion characteristics highly sensitive to even minor coefficient variations, with a mere 1% change significantly impacting eigenmode fluctuations. The sudden bandgap (BG) disappearing nature could be used to identify the accurate value of the coefficient for designing and analyzing PCPs.
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Affiliation(s)
- S K Singh
- Department of Civil Engineering, Indian Institute of Technology Jammu, Jagti, Nagrota NH-44, India
| | - R K Varma
- Department of Civil Engineering, Indian Institute of Technology Jammu, Jagti, Nagrota NH-44, India
| | - A Banerjee
- Department of Civil Engineering, Indian Institute of Technology Delhi, New Delhi, Delhi 110016, India
| | - K K Rathore
- Department of Civil Engineering, Indian Institute of Technology Jammu, Jagti, Nagrota NH-44, India
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14
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Beltrán Ponce S, Jagsi R, Florez N, Thomas CR, Banerjee A, Jasti S, Bailey MM, Lawton CAF, Johnstone C, Clarke CN, Bedi M, Jovanovic M, Saeed H. Can I Leave? Perspectives on Parental Leave and Parenthood in Medical Training Among Program Directors and Trainees in Oncologic Specialties. J Womens Health (Larchmt) 2024; 33:218-227. [PMID: 38011014 DOI: 10.1089/jwh.2023.0200] [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] [Indexed: 11/29/2023] Open
Abstract
Purpose: Peak fertility commonly occurs during medical training, and delaying parenthood can complicate pregnancies. Trainee parental leave policies are varied and lack transparency. Research on the impacts of parenthood on trainee education is limited. Methods: A Qualtrics-based survey was distributed via e-mail/social media to program directors (PDs) within oncologic specialties with a request to forward a parallel survey to trainees. Questions assessed awareness of parental leave policies, supportiveness of parenthood, and impacts on trainee education. Statistical analyses included descriptive frequencies and bivariable comparisons by key groups. Results: A total of 195 PDs and 286 trainees responded. Twelve percent and 29% of PDs were unsure of maternity/paternity leave options, respectively. PDs felt they were more supportive of trainee parenthood than trainees perceived they were. Thirty-nine percent of nonparent trainees (NPTs) would have children already if not in medicine, and >80% of women trainees were concerned about declining fertility. Perceived impacts of parenthood on trainee overall education and academic productivity were more negative for women trainees when rated by PDs and NPTs; however, men/women parents self-reported equal impacts. Leave burden was perceived as higher for women trainees. Conclusions: A significant portion of PDs lack awareness of parental leave policies, highlighting needs for increased transparency. Trainees' perception of PD support for parenthood is less than PD self-reported support. Alongside significant rates of delayed parenthood and fertility concerns, this poses a problem for trainees seeking to start a family, particularly women who are perceived more negatively. Further work is needed to create a supportive culture for trainee parenthood.
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Affiliation(s)
- Sara Beltrán Ponce
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Reshma Jagsi
- Department of Radiation Oncology, Winship Cancer Institute, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Narjust Florez
- Lowe Center for Thoracic Oncology, Dana Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
- The Cancer Care Equity Program, Dana Farber Cancer Institute, Boston, Massachusetts, USA
| | - Charles R Thomas
- Department of Radiation Oncology, Dartmouth Geisel School of Medicine, Hanover, New Hampshire, USA
| | - Anjishnu Banerjee
- Department of Biostatistics, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Shravya Jasti
- Department of Biostatistics, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Morgan M Bailey
- University of Toledo College of Medicine and Life Sciences, Toledo, Ohio, USA
| | - Colleen A F Lawton
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Candice Johnstone
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Callisia N Clarke
- Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Meena Bedi
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | | | - Hina Saeed
- Baptist Health Medical Group, Boca Raton, Florida, USA
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15
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Silber I, Mathimalar S, Mangel I, Nayak AK, Green O, Avraham N, Beidenkopf H, Feldman I, Kanigel A, Klein A, Goldstein M, Banerjee A, Sela E, Dagan Y. Two-component nematic superconductivity in 4Hb-TaS 2. Nat Commun 2024; 15:824. [PMID: 38280890 PMCID: PMC10821864 DOI: 10.1038/s41467-024-45169-3] [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: 09/13/2022] [Accepted: 01/15/2024] [Indexed: 01/29/2024] Open
Abstract
Most superconductors have an isotropic, single component order parameter and are well described by the standard (BCS) theory for superconductivity. Unconventional, multiple-component superconductors are exceptionally rare and are much less understood. Here, we combine scanning tunneling microscopy and angle-resolved macroscopic transport for studying the candidate chiral superconductor, 4Hb-TaS2. We reveal quasi-periodic one-dimensional modulations in the tunneling conductance accompanied by two-fold symmetric superconducting critical field. The strong modulation of the in-plane critical field, Hc2, points to a nematic, unconventional order parameter. However, the imaged vortex core is isotropic at low temperatures. We suggest a model that reconciles this apparent discrepancy and takes into account previously observed spontaneous time-reversal symmetry breaking at low temperatures. The model describes a competition between a dominating chiral superconducting order parameter and a nematic one. The latter emerges close to the normal phase. Our results strongly support the existence of two-component superconductivity in 4Hb-TaS2 and can provide valuable insights into other systems with coexistent charge order and superconductivity.
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Affiliation(s)
- I Silber
- School of Physics and Astronomy, Tel - Aviv University, Tel Aviv, 69978, Israel
| | - S Mathimalar
- Department of Condensed Matter Physics, Weizmann Institute of Science, Rehovot, Israel
| | - I Mangel
- Physics Department, Technion-Israel Institute of Technology, Haifa, 32000, Israel
| | - A K Nayak
- Department of Condensed Matter Physics, Weizmann Institute of Science, Rehovot, Israel
| | - O Green
- School of Physics and Astronomy, Tel - Aviv University, Tel Aviv, 69978, Israel
| | - N Avraham
- Department of Condensed Matter Physics, Weizmann Institute of Science, Rehovot, Israel
| | - H Beidenkopf
- Department of Condensed Matter Physics, Weizmann Institute of Science, Rehovot, Israel
| | - I Feldman
- Physics Department, Technion-Israel Institute of Technology, Haifa, 32000, Israel
| | - A Kanigel
- Physics Department, Technion-Israel Institute of Technology, Haifa, 32000, Israel
| | - A Klein
- Department of Physics, Faculty of Natural Sciences, Ariel University, Ariel, 40700, Israel
- Department of Chemical Physics, The Weizmann Institute of Science, Rehovot, 76100, Israel
| | - M Goldstein
- School of Physics and Astronomy, Tel - Aviv University, Tel Aviv, 69978, Israel
| | - A Banerjee
- Department of Physics, Ben-Gurion University of the Negev, Beer-Sheva, 84105, Israel
| | - E Sela
- School of Physics and Astronomy, Tel - Aviv University, Tel Aviv, 69978, Israel
| | - Y Dagan
- School of Physics and Astronomy, Tel - Aviv University, Tel Aviv, 69978, Israel.
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16
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Bobholz SA, Hoefs A, Hamburger J, Lowman AK, Winiarz A, Duenweg SR, Kyereme F, Connelly J, Coss D, Krucoff M, Banerjee A, LaViolette PS. Radio-pathomic maps of glioblastoma identify phenotypes of non-enhancing tumor infiltration associated with bevacizumab treatment response. Res Sq 2024:rs.3.rs-3832221. [PMID: 38260400 PMCID: PMC10802733 DOI: 10.21203/rs.3.rs-3832221/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2024]
Abstract
Background Autopsy-based radio-pathomic maps of glioma pathology have shown substantial promise inidentifying areas of non-enhancing tumor presence, which may be able to differentiate subsets of patients that respond favorably to treatments such as bevacizumab that have shown mixed efficacy evidence. We tested the hypthesis that phenotypes of non-enhancing tumor fronts can distinguish between glioblastoma patients that will respond favorably to bevacizumab and will visually capture treatment response. Methods T1, T1C, FLAIR, and ADC images were used to generate radio-pathomic maps of tumor characteristics for 79 pre-treatment patients with a primary GBM or high-grade IDH1-mutant astrocytoma for this study. Novel phenotyping (hypercellular, hypocellular, hybrid, or well-circumscribed front) of the non-enhancing tumor front was performed on each case. Kaplan Meier analyses were then used to assess differences in survival and bevacizumab efficacy between phenotypes. Phenotype compartment segmentations generated longitudinally for a subset of 26 patients over the course of bevacizumab treatment, where a mixed effect model was used to detect longitudinal changes. Results Well-Circumscribed patients showed significant/trending increases in survival compared to Hypercellular Front (HR = 2.0, p = 0.05), Hypocellular Front (HR = 2.02, p = 0.03), and Hybrid Front tumors (HR = 1.75, p = 0.09). Only patients with hypocellular or hybrid fronts showed significant survival benefits from bevacizumab treatment (HR = 2.35, p = 0.02; and HR = 2.45, p = 0.03, respectively). Hypocellular volumes decreased by an average 50.52 mm3 per day of bevacizumab treatment (p = 0.002). Conclusion Patients with a hypocellular tumor front identified by radio-pathomic maps showed improved treatment efficacy when treated with bevacizumab, and reducing hypocellular volumes over the course of treatment may indicate treatment response.
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17
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Goeckner BD, Brett BL, Mayer AR, España LY, Banerjee A, Muftuler LT, Meier TB. Associations of prior concussion severity with brain microstructure using mean apparent propagator magnetic resonance imaging. Hum Brain Mapp 2024; 45:e26556. [PMID: 38158641 PMCID: PMC10789198 DOI: 10.1002/hbm.26556] [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] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 10/16/2023] [Accepted: 11/21/2023] [Indexed: 01/03/2024] Open
Abstract
Magnetic resonance imaging (MRI) diffusion studies have shown chronic microstructural tissue abnormalities in athletes with history of concussion, but with inconsistent findings. Concussions with post-traumatic amnesia (PTA) and/or loss of consciousness (LOC) have been connected to greater physiological injury. The novel mean apparent propagator (MAP) MRI is expected to be more sensitive to such tissue injury than the conventional diffusion tensor imaging. This study examined effects of prior concussion severity on microstructure with MAP-MRI. Collegiate-aged athletes (N = 111, 38 females; ≥6 months since most recent concussion, if present) completed semistructured interviews to determine the presence of prior concussion and associated injury characteristics, including PTA and LOC. MAP-MRI metrics (mean non-Gaussian diffusion [NG Mean], return-to-origin probability [RTOP], and mean square displacement [MSD]) were calculated from multi-shell diffusion data, then evaluated for associations with concussion severity through group comparisons in a primary model (athletes with/without prior concussion) and two secondary models (athletes with/without prior concussion with PTA and/or LOC, and athletes with/without prior concussion with LOC only). Bayesian multilevel modeling estimated models in regions of interest (ROI) in white matter and subcortical gray matter, separately. In gray matter, the primary model showed decreased NG Mean and RTOP in the bilateral pallidum and decreased NG Mean in the left putamen with prior concussion. In white matter, lower NG Mean with prior concussion was present in all ROI across all models and was further decreased with LOC. However, only prior concussion with LOC was associated with decreased RTOP and increased MSD across ROI. Exploratory analyses conducted separately in male and female athletes indicate associations in the primary model may differ by sex. Results suggest microstructural measures in gray matter are associated with a general history of concussion, while a severity-dependent association of prior concussion may exist in white matter.
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Affiliation(s)
- Bryna D. Goeckner
- Department of BiophysicsMedical College of WisconsinMilwaukeeWisconsinUSA
| | - Benjamin L. Brett
- Department of NeurosurgeryMedical College of WisconsinMilwaukeeWisconsinUSA
- Department of NeurologyMedical College of WisconsinMilwaukeeWisconsinUSA
| | - Andrew R. Mayer
- The Mind Research Network/Lovelace Biomedical and Environmental Research InstituteAlbuquerqueNew MexicoUSA
- Departments of Neurology and PsychiatryUniversity of New Mexico School of MedicineAlbuquerqueNew MexicoUSA
- Department of PsychologyUniversity of New MexicoAlbuquerqueNew MexicoUSA
| | - Lezlie Y. España
- Department of NeurosurgeryMedical College of WisconsinMilwaukeeWisconsinUSA
| | - Anjishnu Banerjee
- Department of BiostatisticsMedical College of WisconsinMilwaukeeWisconsinUSA
| | - L. Tugan Muftuler
- Department of NeurosurgeryMedical College of WisconsinMilwaukeeWisconsinUSA
| | - Timothy B. Meier
- Department of NeurosurgeryMedical College of WisconsinMilwaukeeWisconsinUSA
- Department of Biomedical EngineeringMedical College of WisconsinMilwaukeeWisconsinUSA
- Department of Cell Biology, Neurobiology and AnatomyMedical College of WisconsinMilwaukeeWisconsinUSA
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18
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de Ortiz de Choudens S, Visotcky A, Banerjee A, Aldakkak M, Tsai S, Evans DB, Christians KK, Clarke CN, George B, Shreenivas A, Kamgar M, Chakrabarti S, Dua KS, Khan AH, Madhavan S, Erickson BA, Hall WA. Characterization of an oligometastatic state in patients with metastatic pancreatic adenocarcinoma undergoing systemic chemotherapy. Cancer Med 2023; 13:e6582. [PMID: 38140796 PMCID: PMC10807686 DOI: 10.1002/cam4.6582] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 06/28/2023] [Accepted: 09/13/2023] [Indexed: 12/24/2023] Open
Abstract
PURPOSE/OBJECTIVES Most patients with pancreatic adenocarcinoma (PDAC) will present with distant metastatic disease at diagnosis. We sought to identify clinical characteristics associated with prolonged overall survival (OS) in patients presenting with metastatic PDAC. MATERIALS/METHODS Patients presenting with metastatic PDAC that received treatment at our institution with FOLFIRINOX or gemcitabine-based chemotherapies between August 1, 2011 and September 1, 2017 were included in the study. Metastatic disease burden was comprehensively characterized radiologically via individual diagnostic imaging segmentation. Landmark analysis was performed at 18 months, and survival curves were estimated using the Kaplan-Meier method and compared between groups via the log-rank test. ECOG and Charlson Comorbidity Index (CCI) were calculated for all patients. RESULTS 121 patients were included with a median age of 62 years (37-86), 40% were female, 25% had ECOG 0 at presentation. Of the 121 patients included, 33% (n = 41) were alive at 12 months and 25% (n = 31) were alive at 18 months. Landmark analysis demonstrated a significant difference between patients surviving <18 months and ≥18 months regarding the presence of lung only metastases (36% vs. 16%, p = 0.04), number of organs with metastases (≥2 vs. 1, p = 0.04), and disease volume (mean of 19.1 cc vs. 1.4 cc, p = 0.04). At Year 1, predictors for improved OS included ECOG status at diagnosis (ECOG 0 vs. ECOG 1, p = 0.04), metastatic disease volume at diagnosis (≤0.1 cc vs. >60 cc, p = 0.004), metastasis only in the liver (p = 0.04), and normalization of CA 19-9 (p < 0.001). At Year 2, the only predictor of improved OS was normalization of the CA 19-9 (p = 0.03). In those patients that normalized their CA 19-9, median overall survival was 16 months. CONCLUSIONS In this exploratory analysis normalization of CA-19-9 or volumetric metastatic disease burden less than 0.2 cc demonstrated a remarkable OS, similar to that of patients with non-metastatic disease. These metrics are useful for counseling patients and identifying cohorts that may be optimal for trials exploring metastatic and/or local tumor-directed interventions.
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Affiliation(s)
| | - Alexis Visotcky
- Division of BiostatisticsMedical College of WisconsinMilwaukeeWisconsinUSA
| | - Anjishnu Banerjee
- Division of BiostatisticsMedical College of WisconsinMilwaukeeWisconsinUSA
| | - Mohammed Aldakkak
- Department of SurgeryMedical College of WisconsinMilwaukeeWisconsinUSA
- LaBahn Pancreatic Cancer ProgramMilwaukeeWisconsinUSA
| | - Susan Tsai
- Department of SurgeryMedical College of WisconsinMilwaukeeWisconsinUSA
- LaBahn Pancreatic Cancer ProgramMilwaukeeWisconsinUSA
| | - Douglas B. Evans
- Department of SurgeryMedical College of WisconsinMilwaukeeWisconsinUSA
- LaBahn Pancreatic Cancer ProgramMilwaukeeWisconsinUSA
| | - Kathleen K. Christians
- Department of SurgeryMedical College of WisconsinMilwaukeeWisconsinUSA
- LaBahn Pancreatic Cancer ProgramMilwaukeeWisconsinUSA
| | - Callisia N. Clarke
- Department of SurgeryMedical College of WisconsinMilwaukeeWisconsinUSA
- LaBahn Pancreatic Cancer ProgramMilwaukeeWisconsinUSA
| | - Ben George
- LaBahn Pancreatic Cancer ProgramMilwaukeeWisconsinUSA
- Division of Medical OncologyMedical College of WisconsinMilwaukeeWisconsinUSA
| | - Aditya Shreenivas
- Division of Medical OncologyMedical College of WisconsinMilwaukeeWisconsinUSA
| | - Mandana Kamgar
- LaBahn Pancreatic Cancer ProgramMilwaukeeWisconsinUSA
- Division of Medical OncologyMedical College of WisconsinMilwaukeeWisconsinUSA
| | - Sakti Chakrabarti
- Division of Medical OncologyMedical College of WisconsinMilwaukeeWisconsinUSA
| | - Kulwinder S. Dua
- Division of Medical OncologyMedical College of WisconsinMilwaukeeWisconsinUSA
- Division of GastroenterologyMedical College of WisconsinMilwaukeeWisconsinUSA
| | - Abdul Haq Khan
- Division of Medical OncologyMedical College of WisconsinMilwaukeeWisconsinUSA
- Division of GastroenterologyMedical College of WisconsinMilwaukeeWisconsinUSA
| | - Srivats Madhavan
- Division of Medical OncologyMedical College of WisconsinMilwaukeeWisconsinUSA
- Division of GastroenterologyMedical College of WisconsinMilwaukeeWisconsinUSA
| | - Beth A. Erickson
- Department of Radiation OncologyMedical College of WisconsinMilwaukeeWisconsinUSA
- LaBahn Pancreatic Cancer ProgramMilwaukeeWisconsinUSA
| | - William A. Hall
- Department of Radiation OncologyMedical College of WisconsinMilwaukeeWisconsinUSA
- LaBahn Pancreatic Cancer ProgramMilwaukeeWisconsinUSA
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Vedantam A, Harinathan B, Purushothaman Y, Scripp S, Banerjee A, Warraich A, Budde MD, Yoganandan N. Determinants of spinal cord stress and strain in degenerative cervical myelopathy: a patient-specific finite element study. Biomech Model Mechanobiol 2023; 22:1789-1799. [PMID: 37306885 DOI: 10.1007/s10237-023-01732-3] [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: 01/21/2023] [Accepted: 05/29/2023] [Indexed: 06/13/2023]
Abstract
Degenerative cervical myelopathy (DCM) is the commonest cause of spinal cord dysfunction in older adults and is characterized by chronic cervical spinal cord compression. Spinal cord stress and strain during neck motion are also known contributors to the pathophysiology of DCM, yet these factors are not routinely assessed for surgical planning. The aim of this study was to measure spinal cord stress/strain in DCM using patient-specific 3D finite element models (FEMs) and determine whether spinal cord compression is the primary determinant of spinal cord stress/strain. Three-dimensional patient-specific FEMs were created for six DCM patients (mild [n = 2], moderate [n = 2] and severe [n = 2]). Flexion and extension of the cervical spine were simulated with a pure moment load of 2 Nm. Segmental spinal cord von Mises stress and maximum principal strain were measured. Measures of spinal cord compression and segmental range of motion (ROM) were included in a regression analysis to determine associations with spinal cord stress and strain. Segmental ROM in flexion-extension and axial rotation was independently associated with spinal cord stress (p < 0.001) and strain (p < 0.001), respectively. This relationship was not seen for lateral bending. Segmental ROM had a stronger association with spinal stress and strain as compared to spinal cord compression. Compared to the severity of spinal cord compression, segmental ROM is a stronger determinant spinal cord stress and strain. Surgical procedures that address segmental ROM in addition to cord compression may best optimize spinal cord biomechanics in DCM.
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Affiliation(s)
- Aditya Vedantam
- Department of Neurosurgery, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, 53226, USA.
| | - Balaji Harinathan
- Department of Neurosurgery, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, 53226, USA
| | - Yuvaraj Purushothaman
- Department of Neurosurgery, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, 53226, USA
| | - Stephen Scripp
- Biomedical Engineering, Milwaukee School of Engineering, Milwaukee, WI, USA
| | - Anjishnu Banerjee
- Department of Biostatistics, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Ali Warraich
- Department of Chemistry, University of Chicago, Chicago, IL, USA
| | - Matthew D Budde
- Department of Neurosurgery, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, 53226, USA
| | - Narayan Yoganandan
- Department of Neurosurgery, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, 53226, USA
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20
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Katsoulis M, Lai AG, Kipourou DK, Gomes M, Banerjee A, Denaxas S, Lumbers RT, Tsilidis K, Kostara M, Belot A, Dale C, Sofat R, Leyrat C, Hemingway H, Diaz-Ordaz K. On the estimation of the effect of weight change on a health outcome using observational data, by utilising the target trial emulation framework. Int J Obes (Lond) 2023; 47:1309-1317. [PMID: 37884665 PMCID: PMC10663146 DOI: 10.1038/s41366-023-01396-0] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 09/17/2023] [Accepted: 10/10/2023] [Indexed: 10/28/2023]
Abstract
BACKGROUND/OBJECTIVES When studying the effect of weight change between two time points on a health outcome using observational data, two main problems arise initially (i) 'when is time zero?' and (ii) 'which confounders should we account for?' From the baseline date or the 1st follow-up (when the weight change can be measured)? Different methods have been previously used in the literature that carry different sources of bias and hence produce different results. METHODS We utilised the target trial emulation framework and considered weight change as a hypothetical intervention. First, we used a simplified example from a hypothetical randomised trial where no modelling is required. Then we simulated data from an observational study where modelling is needed. We demonstrate the problems of each of these methods and suggest a strategy. INTERVENTIONS weight loss/gain vs maintenance. RESULTS The recommended method defines time-zero at enrolment, but adjustment for confounders (or exclusion of individuals based on levels of confounders) should be performed both at enrolment and the 1st follow-up. CONCLUSIONS The implementation of our suggested method [adjusting for (or excluding based on) confounders measured both at baseline and the 1st follow-up] can help researchers attenuate bias by avoiding some common pitfalls. Other methods that have been widely used in the past to estimate the effect of weight change on a health outcome are more biased. However, two issues remain (i) the exposure is not well-defined as there are different ways of changing weight (however we tried to reduce this problem by excluding individuals who develop a chronic disease); and (ii) immortal time bias, which may be small if the time to first follow up is short.
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Affiliation(s)
- M Katsoulis
- MRC Unit for Lifelong Health and Ageing, Institute of Cardiovascular Science, University College London, London, UK.
| | - A G Lai
- Institute of Health Informatics, University College London, London, UK
| | - D K Kipourou
- Inequalities in Cancer Outcomes Network, Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
- AstraZeneca, London, UK
| | - M Gomes
- Department of Applied Health Research, University College London, London, UK
| | - A Banerjee
- Institute of Health Informatics, University College London, London, UK
- University College London Hospitals NHS Trust, London, UK
- Barts Health NHS Trust, The Royal London Hospital, London, UK
| | - S Denaxas
- Institute of Health Informatics, University College London, London, UK
- Alan Turing Institute, London, UK
| | - R T Lumbers
- Institute of Health Informatics, University College London, London, UK
| | - K Tsilidis
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
- Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, Greece
| | - Maria Kostara
- Department of Pediatrics, University Hospital of Ioannina, Ioannina, Greece
| | - A Belot
- Inequalities in Cancer Outcomes Network, Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - C Dale
- Department of Pharmacology and Therapeutics, University of Liverpool, Liverpool, UK
| | - R Sofat
- Department of Pharmacology and Therapeutics, University of Liverpool, Liverpool, UK
| | - C Leyrat
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK
| | - H Hemingway
- Institute of Health Informatics, University College London, London, UK
| | - K Diaz-Ordaz
- Dept of Statistical Science, Faculty of Maths & Physical Sciences, University College London, London, UK
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21
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Yoganandan N, Baisden J, Vedantam A, Varghese V, Banerjee A. Upper cervical spine bone mineral content variations in elderly females. Accid Anal Prev 2023; 193:107329. [PMID: 37783162 DOI: 10.1016/j.aap.2023.107329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 09/13/2023] [Accepted: 09/20/2023] [Indexed: 10/04/2023]
Abstract
The purpose of the study was to determine the bone mineral densities (BMDs) of the C1 and C2 vertebrae and discuss their implications for autonomous vehicle environments and vulnerable road users. Using quantitated computed tomography (QCT), the BMDs were obtained at eight regions for the C1 vertebra and seven regions for the C2 vertebra. The spine surgeon author outlined the boundaries of each region, and nine elderly female human cadaver specimens were used. The regions were based on potential stabilization locations for fracture fixation. In the C1 vertebra, the BMD was greatest at the anterior tubercle, followed by the posterior tubercle, the posterior arch, and the lateral and anterior lateral masses. In the C2 vertebra, the distal odontoid had the greatest BMD, followed by the spinous process, the C2-lateral mass, the odontoid-body interface, and the anterior inferior aspect of the body. Use of these data in female-specific finite element models may lead to a better understanding of load paths, injuries, mechanisms, and tolerance.
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Affiliation(s)
| | | | | | | | - Anjishnu Banerjee
- Division of Biostatistics, Medical College of Wisconsin, Milwaukee, WI, USA
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22
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Yoganandan N, Baisden J, Varghese V, Vedantam A, Stemper B, Banerjee A, Jebaseelan D. Preliminary Data of Neck Muscle Morphology With Head-Supported Mass in Male and Female Volunteers. Mil Med 2023; 188:385-392. [PMID: 37948211 DOI: 10.1093/milmed/usad165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 03/29/2023] [Accepted: 05/02/2023] [Indexed: 11/12/2023] Open
Abstract
INTRODUCTION This study quantified parameters related to muscle morphology using a group of upright seated female and male volunteers with a head-supported mass. MATERIALS AND METHODS Upright magnetic resonance images (MRIs) were obtained from 23 healthy volunteers after approval from the U.S. DoD. They were asymptomatic for neck pain, with no history of injury. The volunteers were scanned using an upright MRI scanner with a head-supported mass (army combat helmet). T1 and T2 sagittal and axial images were obtained. Measurements were performed by an engineer and a neurosurgeon. The cross-sectional areas of the sternocleidomastoid and multifidus muscles were measured at the inferior endplate in the sub-axial column, and the centroid angle and centroid radius were quantified. Differences in the morphology by gender and spinal level were analyzed using a repeated measures analysis of variance model, adjusted for multiple corrections. RESULTS For females and males, the cross-sectional area of the sternocleidomastoid muscle ranged from 2.3 to 3.6 cm2 and from 3.4 to 5.4 cm2, the centroid radius ranged from 4.1 to 5.1 cm and from 4.7 to 5.7 cm, and the centroid angle ranged from 75° to 131° and from 4.8° to 131.2°, respectively. For the multifidus muscle, the area ranged from 1.7 to 3.9 cm2 and from 2.4 to 4.2 cm2, the radius ranged from 3.1 to 3.4 cm and from 3.3 to 3.8 cm, the angle ranged from 15° to 24.4° and 16.2° to 24.4°, respectively. Results from all levels for both muscles and male and female spines are given. CONCLUSIONS The cross-sectional area, angulation, and centroid radii data for flexor and extensor muscles of the cervical spine serve as a dataset that may be used to better define morphologies in computational models and obtain segmental motions and loads under external mechanical forces. These data can be used in computational models for injury prevention, mitigation, and readiness.
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Affiliation(s)
- Narayan Yoganandan
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI 53226, USA
| | - Jamie Baisden
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI 53226, USA
| | - Vicky Varghese
- Department of Orthopedics, NorthShore University Health System, Skokie Hospital, Skokie, IL 60076, USA
| | - Aditya Vedantam
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI 53226, USA
| | - Brian Stemper
- Department of Biomedical Engineering, Medical College of Wisconsin, Milwaukee, WI 53226, USA
| | - Anjishnu Banerjee
- Department of Biostatistics, Medical College of Wisconsin, Milwaukee, WI 53226, USA
| | - Davidson Jebaseelan
- School of Mechanical Engineering, Vellore Institute of Technology, Chennai 600036, India
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23
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Choi H, Purushothaman Y, Gupta B, Banerjee A, Yoganandan N. Subaxial Cervical Spine Motion With Different Sizes of Head-supported Mass Under Accelerative Forces. Mil Med 2023; 188:458-465. [PMID: 37948251 DOI: 10.1093/milmed/usad204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 04/10/2023] [Accepted: 06/01/2023] [Indexed: 11/12/2023] Open
Abstract
INTRODUCTION The evolution of military helmet devices has increased the amount of head-supported mass (HSM) worn by warfighters. HSM has important implications for spine biomechanics, and yet, there is a paucity of studies that investigated the effects of differing HSM and accelerative profiles on spine biomechanics. The aim of this study is to investigate the segmental motions in the subaxial cervical spine with different sizes of HSM under Gx accelerative loading. METHODS A three-dimensional finite element model of the male head-neck spinal column was used. Three different size military helmets were modeled and incorporated into head-neck model. The models were exercised under Gx accelerative loading by inputting low and high pulses to the cervical vertebra used in the experimental studies. Segmental motions were obtained and normalized with respect to the non-HSM case to quantify the effect of HSM. RESULTS Segmental motions increased with an increase in velocity at all segments of the spine. Increasing helmet size resulted in larger motion increases. Angulations ranged from 0.9° to 9.3° at 1.8 m/s and from 1.3° to 10.3° at 2.6 m/s without a helmet. Helmet increased motion between 5% to 74% at 1.8 m/s. At 2.6 m/s, the helmet increased segmental motion anywhere from 10% to 105% in the subaxial cervical spine. The greatest motion was seen at the C5-C6 level, followed by the C6-C7 level. CONCLUSIONS The subaxial cervical spine experiences motion increases at all levels at both velocity profiles with increasing HSM. Larger helmet and greater impact velocity increased motion at all levels, with C5-C6 demonstrating the largest range of motion. HSM should be minimized to reduce the risk of cervical spine injury to the warfighter.
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Affiliation(s)
- Hoon Choi
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee,WI 53226, USA
- Department of Neurosurgery, Neuroscience Institute, Cleveland Clinic Florida, Weston, FL 33331, USA
| | | | - Bhavika Gupta
- Department of Neurosurgery, Neuroscience Institute, Cleveland Clinic Florida, Weston, FL 33331, USA
| | - Anjishnu Banerjee
- Division of Biostatistics, Medical College of Wisconsin, Milwaukee, WI 53226, USA
| | - Narayan Yoganandan
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee,WI 53226, USA
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24
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Sud R, Banerjee A, Viswanath B, Purushottam M, Jain S. Non-synaptic mechanisms of antipsychotics may be key to their actions. Schizophr Res 2023; 261:128-129. [PMID: 37717511 DOI: 10.1016/j.schres.2023.09.006] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 08/09/2023] [Accepted: 09/04/2023] [Indexed: 09/19/2023]
Affiliation(s)
- R Sud
- Molecular Genetics Lab, Department of Psychiatry, NIMHANS, Bangalore, India
| | - A Banerjee
- Molecular Genetics Lab, Department of Psychiatry, NIMHANS, Bangalore, India
| | - B Viswanath
- Molecular Genetics Lab, Department of Psychiatry, NIMHANS, Bangalore, India.
| | - M Purushottam
- Molecular Genetics Lab, Department of Psychiatry, NIMHANS, Bangalore, India
| | - S Jain
- Molecular Genetics Lab, Department of Psychiatry, NIMHANS, Bangalore, India.
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25
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Verhagen NB, SenthilKumar G, Jaraczewski T, Koerber NK, Merrill JR, Flitcroft MA, Szabo A, Banerjee A, Yang X, Taylor BW, Figueroa Castro CE, Yen TW, Clarke CN, Lauer K, Pfeifer KJ, Gould JC, Kothari AN. Severity of Prior Coronavirus Disease 2019 is Associated With Postoperative Outcomes After Major Inpatient Surgery. Ann Surg 2023; 278:e949-e956. [PMID: 37476995 PMCID: PMC10659141 DOI: 10.1097/sla.0000000000006035] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/22/2023]
Abstract
OBJECTIVE To determine how the severity of prior history (Hx) of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection influences postoperative outcomes after major elective inpatient surgery. BACKGROUND Surgical guidelines instituted early in the coronavirus disease 2019 (COVID-19) pandemic recommended a delay in surgery of up to 8 weeks after an acute SARS-CoV-2 infection. This was based on the observation of elevated surgical risk after recovery from COVID-19 early in the pandemic. As the pandemic shifts to an endemic phase, it is unclear whether this association remains, especially for those recovering from asymptomatic or mildly symptomatic COVID-19. METHODS Utilizing the National COVID Cohort Collaborative, we assessed postoperative outcomes for adults with and without a Hx of COVID-19 who underwent major elective inpatient surgery between January 2020 and February 2023. COVID-19 severity and time from infection to surgery were each used as independent variables in multivariable logistic regression models. RESULTS This study included 387,030 patients, of whom 37,354 (9.7%) were diagnosed with preoperative COVID-19. Hx of COVID-19 was found to be an independent risk factor for adverse postoperative outcomes even after a 12-week delay for patients with moderate and severe SARS-CoV-2 infection. Patients with mild COVID-19 did not have an increased risk of adverse postoperative outcomes at any time point. Vaccination decreased the odds of respiratory failure. CONCLUSIONS Impact of COVID-19 on postoperative outcomes is dependent on the severity of illness, with only moderate and severe disease leading to a higher risk of adverse outcomes. Existing perioperative policies should be updated to include consideration of COVID-19 disease severity and vaccination status.
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Affiliation(s)
- Nathaniel B. Verhagen
- Department of Surgery, Division of Surgical Oncology, Medical College of Wisconsin, Milwaukee, WI
| | - Gopika SenthilKumar
- Department of Surgery, Division of Surgical Oncology, Medical College of Wisconsin, Milwaukee, WI
- Department of Physiology and Anesthesiology, Medical College of Wisconsin, Milwaukee, WI
| | - Taylor Jaraczewski
- Department of Surgery, Division of Surgical Oncology, Medical College of Wisconsin, Milwaukee, WI
| | - Nicolas K. Koerber
- Department of Surgery, Division of Surgical Oncology, Medical College of Wisconsin, Milwaukee, WI
| | - Jennifer R. Merrill
- Department of Surgery, Division of Surgical Oncology, Medical College of Wisconsin, Milwaukee, WI
| | - Madelyn A. Flitcroft
- Department of Surgery, Division of Surgical Oncology, Medical College of Wisconsin, Milwaukee, WI
| | - Aniko Szabo
- Department of Biostatistics, Medical College of Wisconsin, Milwaukee, WI
| | - Anjishnu Banerjee
- Department of Biostatistics, Medical College of Wisconsin, Milwaukee, WI
| | - Xin Yang
- Clinical and Translational Science Institute of Southeastern Wisconsin, Medical College of Wisconsin, Milwaukee, WI
| | - Bradley W. Taylor
- Clinical and Translational Science Institute of Southeastern Wisconsin, Medical College of Wisconsin, Milwaukee, WI
| | - Carlos E. Figueroa Castro
- Department of Medicine, Division of Infectious Diseases, Medical College of Wisconsin, Milwaukee, WI
| | - Tina W.F. Yen
- Department of Surgery, Division of Surgical Oncology, Medical College of Wisconsin, Milwaukee, WI
| | - Callisia N. Clarke
- Department of Surgery, Division of Surgical Oncology, Medical College of Wisconsin, Milwaukee, WI
| | - Kathryn Lauer
- Department of Anesthesiology, Medical College of Wisconsin, Milwaukee, WI
| | - Kurt J. Pfeifer
- Department of Medicine, Section of Perioperative & Consultative Medicine, Medical College of Wisconsin, Milwaukee, WI
| | - Jon C. Gould
- Department of Surgery, Division of Minimally Invasive and GI Surgery, Medical College of Wisconsin, Milwaukee, WI
| | - Anai N. Kothari
- Department of Surgery, Division of Surgical Oncology, Medical College of Wisconsin, Milwaukee, WI
- Clinical and Translational Science Institute of Southeastern Wisconsin, Medical College of Wisconsin, Milwaukee, WI
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26
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Raman B, McCracken C, Cassar MP, Moss AJ, Finnigan L, Samat AHA, Ogbole G, Tunnicliffe EM, Alfaro-Almagro F, Menke R, Xie C, Gleeson F, Lukaschuk E, Lamlum H, McGlynn K, Popescu IA, Sanders ZB, Saunders LC, Piechnik SK, Ferreira VM, Nikolaidou C, Rahman NM, Ho LP, Harris VC, Shikotra A, Singapuri A, Pfeffer P, Manisty C, Kon OM, Beggs M, O'Regan DP, Fuld J, Weir-McCall JR, Parekh D, Steeds R, Poinasamy K, Cuthbertson DJ, Kemp GJ, Semple MG, Horsley A, Miller CA, O'Brien C, Shah AM, Chiribiri A, Leavy OC, Richardson M, Elneima O, McAuley HJC, Sereno M, Saunders RM, Houchen-Wolloff L, Greening NJ, Bolton CE, Brown JS, Choudhury G, Diar Bakerly N, Easom N, Echevarria C, Marks M, Hurst JR, Jones MG, Wootton DG, Chalder T, Davies MJ, De Soyza A, Geddes JR, Greenhalf W, Howard LS, Jacob J, Man WDC, Openshaw PJM, Porter JC, Rowland MJ, Scott JT, Singh SJ, Thomas DC, Toshner M, Lewis KE, Heaney LG, Harrison EM, Kerr S, Docherty AB, Lone NI, Quint J, Sheikh A, Zheng B, Jenkins RG, Cox E, Francis S, Halling-Brown M, Chalmers JD, Greenwood JP, Plein S, Hughes PJC, Thompson AAR, Rowland-Jones SL, Wild JM, Kelly M, Treibel TA, Bandula S, Aul R, Miller K, Jezzard P, Smith S, Nichols TE, McCann GP, Evans RA, Wain LV, Brightling CE, Neubauer S, Baillie JK, Shaw A, Hairsine B, Kurasz C, Henson H, Armstrong L, Shenton L, Dobson H, Dell A, Lucey A, Price A, Storrie A, Pennington C, Price C, Mallison G, Willis G, Nassa H, Haworth J, Hoare M, Hawkings N, Fairbairn S, Young S, Walker S, Jarrold I, Sanderson A, David C, Chong-James K, Zongo O, James WY, Martineau A, King B, Armour C, McAulay D, Major E, McGinness J, McGarvey L, Magee N, Stone R, Drain S, Craig T, Bolger A, Haggar A, Lloyd A, Subbe C, Menzies D, Southern D, McIvor E, Roberts K, Manley R, Whitehead V, Saxon W, Bularga A, Mills NL, El-Taweel H, Dawson J, Robinson L, Saralaya D, Regan K, Storton K, Brear L, Amoils S, Bermperi A, Elmer A, Ribeiro C, Cruz I, Taylor J, Worsley J, Dempsey K, Watson L, Jose S, Marciniak S, Parkes M, McQueen A, Oliver C, Williams J, Paradowski K, Broad L, Knibbs L, Haynes M, Sabit R, Milligan L, Sampson C, Hancock A, Evenden C, Lynch C, Hancock K, Roche L, Rees M, Stroud N, Thomas-Woods T, Heller S, Robertson E, Young B, Wassall H, Babores M, Holland M, Keenan N, Shashaa S, Price C, Beranova E, Ramos H, Weston H, Deery J, Austin L, Solly R, Turney S, Cosier T, Hazelton T, Ralser M, Wilson A, Pearce L, Pugmire S, Stoker W, McCormick W, Dewar A, Arbane G, Kaltsakas G, Kerslake H, Rossdale J, Bisnauthsing K, Aguilar Jimenez LA, Martinez LM, Ostermann M, Magtoto MM, Hart N, Marino P, Betts S, Solano TS, Arias AM, Prabhu A, Reed A, Wrey Brown C, Griffin D, Bevan E, Martin J, Owen J, Alvarez Corral M, Williams N, Payne S, Storrar W, Layton A, Lawson C, Mills C, Featherstone J, Stephenson L, Burdett T, Ellis Y, Richards A, Wright C, Sykes DL, Brindle K, Drury K, Holdsworth L, Crooks MG, Atkin P, Flockton R, Thackray-Nocera S, Mohamed A, Taylor A, Perkins E, Ross G, McGuinness H, Tench H, Phipps J, Loosley R, Wolf-Roberts R, Coetzee S, Omar Z, Ross A, Card B, Carr C, King C, Wood C, Copeland D, Calvelo E, Chilvers ER, Russell E, Gordon H, Nunag JL, Schronce J, March K, Samuel K, Burden L, Evison L, McLeavey L, Orriss-Dib L, Tarusan L, Mariveles M, Roy M, Mohamed N, Simpson N, Yasmin N, Cullinan P, Daly P, Haq S, Moriera S, Fayzan T, Munawar U, Nwanguma U, Lingford-Hughes A, Altmann D, Johnston D, Mitchell J, Valabhji J, Price L, Molyneaux PL, Thwaites RS, Walsh S, Frankel A, Lightstone L, Wilkins M, Willicombe M, McAdoo S, Touyz R, Guerdette AM, Warwick K, Hewitt M, Reddy R, White S, McMahon A, Hoare A, Knighton A, Ramos A, Te A, Jolley CJ, Speranza F, Assefa-Kebede H, Peralta I, Breeze J, Shevket K, Powell N, Adeyemi O, Dulawan P, Adrego R, Byrne S, Patale S, Hayday A, Malim M, Pariante C, Sharpe C, Whitney J, Bramham K, Ismail K, Wessely S, Nicholson T, Ashworth A, Humphries A, Tan AL, Whittam B, Coupland C, Favager C, Peckham D, Wade E, Saalmink G, Clarke J, Glossop J, Murira J, Rangeley J, Woods J, Hall L, Dalton M, Window N, Beirne P, Hardy T, Coakley G, Turtle L, Berridge A, Cross A, Key AL, Rowe A, Allt AM, Mears C, Malein F, Madzamba G, Hardwick HE, Earley J, Hawkes J, Pratt J, Wyles J, Tripp KA, Hainey K, Allerton L, Lavelle-Langham L, Melling L, Wajero LO, Poll L, Noonan MJ, French N, Lewis-Burke N, Williams-Howard SA, Cooper S, Kaprowska S, Dobson SL, Marsh S, Highett V, Shaw V, Beadsworth M, Defres S, Watson E, Tiongson GF, Papineni P, Gurram S, Diwanji SN, Quaid S, Briggs A, Hastie C, Rogers N, Stensel D, Bishop L, McIvor K, Rivera-Ortega P, Al-Sheklly B, Avram C, Faluyi D, Blaikely J, Piper Hanley K, Radhakrishnan K, Buch M, Hanley NA, Odell N, Osbourne R, Stockdale S, Felton T, Gorsuch T, Hussell T, Kausar Z, Kabir T, McAllister-Williams H, Paddick S, Burn D, Ayoub A, Greenhalgh A, Sayer A, Young A, Price D, Burns G, MacGowan G, Fisher H, Tedd H, Simpson J, Jiwa K, Witham M, Hogarth P, West S, Wright S, McMahon MJ, Neill P, Dougherty A, Morrow A, Anderson D, Grieve D, Bayes H, Fallon K, Mangion K, Gilmour L, Basu N, Sykes R, Berry C, McInnes IB, Donaldson A, Sage EK, Barrett F, Welsh B, Bell M, Quigley J, Leitch K, Macliver L, Patel M, Hamil R, Deans A, Furniss J, Clohisey S, Elliott A, Solstice AR, Deas C, Tee C, Connell D, Sutherland D, George J, Mohammed S, Bunker J, Holmes K, Dipper A, Morley A, Arnold D, Adamali H, Welch H, Morrison L, Stadon L, Maskell N, Barratt S, Dunn S, Waterson S, Jayaraman B, Light T, Selby N, Hosseini A, Shaw K, Almeida P, Needham R, Thomas AK, Matthews L, Gupta A, Nikolaidis A, Dupont C, Bonnington J, Chrystal M, Greenhaff PL, Linford S, Prosper S, Jang W, Alamoudi A, Bloss A, Megson C, Nicoll D, Fraser E, Pacpaco E, Conneh F, Ogg G, McShane H, Koychev I, Chen J, Pimm J, Ainsworth M, Pavlides M, Sharpe M, Havinden-Williams M, Petousi N, Talbot N, Carter P, Kurupati P, Dong T, Peng Y, Burns A, Kanellakis N, Korszun A, Connolly B, Busby J, Peto T, Patel B, Nolan CM, Cristiano D, Walsh JA, Liyanage K, Gummadi M, Dormand N, Polgar O, George P, Barker RE, Patel S, Price L, Gibbons M, Matila D, Jarvis H, Lim L, Olaosebikan O, Ahmad S, Brill S, Mandal S, Laing C, Michael A, Reddy A, Johnson C, Baxendale H, Parfrey H, Mackie J, Newman J, Pack J, Parmar J, Paques K, Garner L, Harvey A, Summersgill C, Holgate D, Hardy E, Oxton J, Pendlebury J, McMorrow L, Mairs N, Majeed N, Dark P, Ugwuoke R, Knight S, Whittaker S, Strong-Sheldrake S, Matimba-Mupaya W, Chowienczyk P, Pattenadk D, Hurditch E, Chan F, Carborn H, Foot H, Bagshaw J, Hockridge J, Sidebottom J, Lee JH, Birchall K, Turner K, Haslam L, Holt L, Milner L, Begum M, Marshall M, Steele N, Tinker N, Ravencroft P, Butcher R, Misra S, Walker S, Coburn Z, Fairman A, Ford A, Holbourn A, Howell A, Lawrie A, Lye A, Mbuyisa A, Zawia A, Holroyd-Hind B, Thamu B, Clark C, Jarman C, Norman C, Roddis C, Foote D, Lee E, Ilyas F, Stephens G, Newell H, Turton H, Macharia I, Wilson I, Cole J, McNeill J, Meiring J, Rodger J, Watson J, Chapman K, Harrington K, Chetham L, Hesselden L, Nwafor L, Dixon M, Plowright M, Wade P, Gregory R, Lenagh R, Stimpson R, Megson S, Newman T, Cheng Y, Goodwin C, Heeley C, Sissons D, Sowter D, Gregory H, Wynter I, Hutchinson J, Kirk J, Bennett K, Slack K, Allsop L, Holloway L, Flynn M, Gill M, Greatorex M, Holmes M, Buckley P, Shelton S, Turner S, Sewell TA, Whitworth V, Lovegrove W, Tomlinson J, Warburton L, Painter S, Vickers C, Redwood D, Tilley J, Palmer S, Wainwright T, Breen G, Hotopf M, Dunleavy A, Teixeira J, Ali M, Mencias M, Msimanga N, Siddique S, Samakomva T, Tavoukjian V, Forton D, Ahmed R, Cook A, Thaivalappil F, Connor L, Rees T, McNarry M, Williams N, McCormick J, McIntosh J, Vere J, Coulding M, Kilroy S, Turner V, Butt AT, Savill H, Fraile E, Ugoji J, Landers G, Lota H, Portukhay S, Nasseri M, Daniels A, Hormis A, Ingham J, Zeidan L, Osborne L, Chablani M, Banerjee A, David A, Pakzad A, Rangelov B, Williams B, Denneny E, Willoughby J, Xu M, Mehta P, Batterham R, Bell R, Aslani S, Lilaonitkul W, Checkley A, Bang D, Basire D, Lomas D, Wall E, Plant H, Roy K, Heightman M, Lipman M, Merida Morillas M, Ahwireng N, Chambers RC, Jastrub R, Logan S, Hillman T, Botkai A, Casey A, Neal A, Newton-Cox A, Cooper B, Atkin C, McGee C, Welch C, Wilson D, Sapey E, Qureshi H, Hazeldine J, Lord JM, Nyaboko J, Short J, Stockley J, Dasgin J, Draxlbauer K, Isaacs K, Mcgee K, Yip KP, Ratcliffe L, Bates M, Ventura M, Ahmad Haider N, Gautam N, Baggott R, Holden S, Madathil S, Walder S, Yasmin S, Hiwot T, Jackson T, Soulsby T, Kamwa V, Peterkin Z, Suleiman Z, Chaudhuri N, Wheeler H, Djukanovic R, Samuel R, Sass T, Wallis T, Marshall B, Childs C, Marouzet E, Harvey M, Fletcher S, Dickens C, Beckett P, Nanda U, Daynes E, Charalambou A, Yousuf AJ, Lea A, Prickett A, Gooptu B, Hargadon B, Bourne C, Christie C, Edwardson C, Lee D, Baldry E, Stringer E, Woodhead F, Mills G, Arnold H, Aung H, Qureshi IN, Finch J, Skeemer J, Hadley K, Khunti K, Carr L, Ingram L, Aljaroof M, Bakali M, Bakau M, Baldwin M, Bourne M, Pareek M, Soares M, Tobin M, Armstrong N, Brunskill N, Goodman N, Cairns P, Haldar P, McCourt P, Dowling R, Russell R, Diver S, Edwards S, Glover S, Parker S, Siddiqui S, Ward TJC, Mcnally T, Thornton T, Yates T, Ibrahim W, Monteiro W, Thickett D, Wilkinson D, Broome M, McArdle P, Upthegrove R, Wraith D, Langenberg C, Summers C, Bullmore E, Heeney JL, Schwaeble W, Sudlow CL, Adeloye D, Newby DE, Rudan I, Shankar-Hari M, Thorpe M, Pius R, Walmsley S, McGovern A, Ballard C, Allan L, Dennis J, Cavanagh J, Petrie J, O'Donnell K, Spears M, Sattar N, MacDonald S, Guthrie E, Henderson M, Guillen Guio B, Zhao B, Lawson C, Overton C, Taylor C, Tong C, Mukaetova-Ladinska E, Turner E, Pearl JE, Sargant J, Wormleighton J, Bingham M, Sharma M, Steiner M, Samani N, Novotny P, Free R, Allen RJ, Finney S, Terry S, Brugha T, Plekhanova T, McArdle A, Vinson B, Spencer LG, Reynolds W, Ashworth M, Deakin B, Chinoy H, Abel K, Harvie M, Stanel S, Rostron A, Coleman C, Baguley D, Hufton E, Khan F, Hall I, Stewart I, Fabbri L, Wright L, Kitterick P, Morriss R, Johnson S, Bates A, Antoniades C, Clark D, Bhui K, Channon KM, Motohashi K, Sigfrid L, Husain M, Webster M, Fu X, Li X, Kingham L, Klenerman P, Miiler K, Carson G, Simons G, Huneke N, Calder PC, Baldwin D, Bain S, Lasserson D, Daines L, Bright E, Stern M, Crisp P, Dharmagunawardena R, Reddington A, Wight A, Bailey L, Ashish A, Robinson E, Cooper J, Broadley A, Turnbull A, Brookes C, Sarginson C, Ionita D, Redfearn H, Elliott K, Barman L, Griffiths L, Guy Z, Gill R, Nathu R, Harris E, Moss P, Finnigan J, Saunders K, Saunders P, Kon S, Kon SS, O'Brien L, Shah K, Shah P, Richardson E, Brown V, Brown M, Brown J, Brown J, Brown A, Brown A, Brown M, Choudhury N, Jones S, Jones H, Jones L, Jones I, Jones G, Jones H, Jones D, Davies F, Davies E, Davies K, Davies G, Davies GA, Howard K, Porter J, Rowland J, Rowland A, Scott K, Singh S, Singh C, Thomas S, Thomas C, Lewis V, Lewis J, Lewis D, Harrison P, Francis C, Francis R, Hughes RA, Hughes J, Hughes AD, Thompson T, Kelly S, Smith D, Smith N, Smith A, Smith J, Smith L, Smith S, Evans T, Evans RI, Evans D, Evans R, Evans H, Evans J. Multiorgan MRI findings after hospitalisation with COVID-19 in the UK (C-MORE): a prospective, multicentre, observational cohort study. Lancet Respir Med 2023; 11:1003-1019. [PMID: 37748493 PMCID: PMC7615263 DOI: 10.1016/s2213-2600(23)00262-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 06/16/2023] [Accepted: 06/30/2023] [Indexed: 09/27/2023]
Abstract
INTRODUCTION The multiorgan impact of moderate to severe coronavirus infections in the post-acute phase is still poorly understood. We aimed to evaluate the excess burden of multiorgan abnormalities after hospitalisation with COVID-19, evaluate their determinants, and explore associations with patient-related outcome measures. METHODS In a prospective, UK-wide, multicentre MRI follow-up study (C-MORE), adults (aged ≥18 years) discharged from hospital following COVID-19 who were included in Tier 2 of the Post-hospitalisation COVID-19 study (PHOSP-COVID) and contemporary controls with no evidence of previous COVID-19 (SARS-CoV-2 nucleocapsid antibody negative) underwent multiorgan MRI (lungs, heart, brain, liver, and kidneys) with quantitative and qualitative assessment of images and clinical adjudication when relevant. Individuals with end-stage renal failure or contraindications to MRI were excluded. Participants also underwent detailed recording of symptoms, and physiological and biochemical tests. The primary outcome was the excess burden of multiorgan abnormalities (two or more organs) relative to controls, with further adjustments for potential confounders. The C-MORE study is ongoing and is registered with ClinicalTrials.gov, NCT04510025. FINDINGS Of 2710 participants in Tier 2 of PHOSP-COVID, 531 were recruited across 13 UK-wide C-MORE sites. After exclusions, 259 C-MORE patients (mean age 57 years [SD 12]; 158 [61%] male and 101 [39%] female) who were discharged from hospital with PCR-confirmed or clinically diagnosed COVID-19 between March 1, 2020, and Nov 1, 2021, and 52 non-COVID-19 controls from the community (mean age 49 years [SD 14]; 30 [58%] male and 22 [42%] female) were included in the analysis. Patients were assessed at a median of 5·0 months (IQR 4·2-6·3) after hospital discharge. Compared with non-COVID-19 controls, patients were older, living with more obesity, and had more comorbidities. Multiorgan abnormalities on MRI were more frequent in patients than in controls (157 [61%] of 259 vs 14 [27%] of 52; p<0·0001) and independently associated with COVID-19 status (odds ratio [OR] 2·9 [95% CI 1·5-5·8]; padjusted=0·0023) after adjusting for relevant confounders. Compared with controls, patients were more likely to have MRI evidence of lung abnormalities (p=0·0001; parenchymal abnormalities), brain abnormalities (p<0·0001; more white matter hyperintensities and regional brain volume reduction), and kidney abnormalities (p=0·014; lower medullary T1 and loss of corticomedullary differentiation), whereas cardiac and liver MRI abnormalities were similar between patients and controls. Patients with multiorgan abnormalities were older (difference in mean age 7 years [95% CI 4-10]; mean age of 59·8 years [SD 11·7] with multiorgan abnormalities vs mean age of 52·8 years [11·9] without multiorgan abnormalities; p<0·0001), more likely to have three or more comorbidities (OR 2·47 [1·32-4·82]; padjusted=0·0059), and more likely to have a more severe acute infection (acute CRP >5mg/L, OR 3·55 [1·23-11·88]; padjusted=0·025) than those without multiorgan abnormalities. Presence of lung MRI abnormalities was associated with a two-fold higher risk of chest tightness, and multiorgan MRI abnormalities were associated with severe and very severe persistent physical and mental health impairment (PHOSP-COVID symptom clusters) after hospitalisation. INTERPRETATION After hospitalisation for COVID-19, people are at risk of multiorgan abnormalities in the medium term. Our findings emphasise the need for proactive multidisciplinary care pathways, with the potential for imaging to guide surveillance frequency and therapeutic stratification. FUNDING UK Research and Innovation and National Institute for Health Research.
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Yoganandan N, Moore J, Humm JR, Baisden JL, Banerjee A, Pintar FA, Barnes DR, Loftis KL. Human pelvis injury risk curves from underbody blast impact. BMJ Mil Health 2023; 169:436-442. [PMID: 34711674 DOI: 10.1136/bmjmilitary-2021-001863] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 10/07/2021] [Indexed: 11/03/2022]
Abstract
INTRODUCTION Underbody blast loading can result in injuries to the pelvis and the lumbosacral spine. The purpose of this study was to determine human tolerance in this region based on survival analysis. METHODS Twenty-six unembalmed postmortem human surrogate lumbopelvic complexes were procured and pretest medical images were obtained. They were fixed in polymethylmethacrylate at the cranial end and a six-axis load cell was attached. The specimens were aligned in a seated soldier posture. Impacts were applied to the pelvis using a custom vertical accelerator. The experimental design consisted of non-injury and injury tests. Pretest and post-test X-rays and palpation were done following non-injury test, and after injury test medical imaging and gross dissections were done. Injuries were scored using the Abbreviated Injury Scale (AIS). Axial and resultant forces were used to develop human injury probability curves (HIPCs) at AIS 3+ and AIS 4 severities using survival analysis. Then ±95% CI was computed using the delta method, normalised CI size was obtained, and the quality of the injury risk curves was assigned adjectival ratings. RESULTS At the 50% probability level, the resultant and axial forces at the AIS 3+ level were 6.6 kN and 5.9 kN, and at the AIS 4 level these were 8.4 kN and 7.5 kN, respectively. Individual injury risk curves along with ±95% CIs are presented in the paper. Increased injury severity increased the HIPC metrics. Curve qualities were in the good and fair ranges for axial and shear forces at all probability levels and for both injury severities. CONCLUSIONS This is the first study to develop axial and resultant force-based HIPCs defining human tolerance to injuries to the pelvis from vertical impacts using parametric survival analysis. Data can be used to advance military safety under vertical loading to the seated pelvis.
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Affiliation(s)
- Narayan Yoganandan
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - J Moore
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - J R Humm
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - J L Baisden
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - A Banerjee
- Biostatistics, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - F A Pintar
- Joint Department of Biomedical Engineering, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - D R Barnes
- SURVICE Engineering, Belcamp, Maryland, USA
| | - K L Loftis
- DEVCOM, Aberdeen Proving Ground, Maryland, USA
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Patel M, Banerjee A, Erickson BA, Bovi JA. Contouring - How Do We Manage This Pivotal but Time-Consuming Workload? Int J Radiat Oncol Biol Phys 2023; 117:e427. [PMID: 37785397 DOI: 10.1016/j.ijrobp.2023.06.1588] [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) Advanced radiation treatment planning is a complex, multi-step process beginning with image acquisition and using these images to contour radiation targets and organs at risk prior to radiation treatment planning. Contouring is a time-consuming process. Unfortunately, few radiation oncologists have dedicated contouring time allocated in their daily schedule. Also, across radiation practices there is variability amongst dosimetrists, physicists, and physicians in the assignment of contouring responsibilities. The goal of this survey was to explore how the multi-disciplinary task of contouring for treatment planning is managed across radiation oncology practices and its impact on quality of life (QOL) amongst dosimetrists, physicists, and physicians. MATERIALS/METHODS A comprehensive 19-question Qualtrics survey was created evaluating all aspects of contouring and radiation treatment planning and its impact on QOL. The survey was distributed through Twitter, AAMD, a Medical Physics Journal, as well as directly to radiation oncology practices. Survey responses were summarized as proportions and associations tested using Fisher's exact test. RESULTS Physicians spent more time completing job responsibilities after work than dosimetrists and physicists, with an average of 6.22 hours (range 0-20) in comparison to 4.16 (0-30) for dosimetrists and 1.55 (0-12) for physicists (p-value 0.001). Physicians on average spent more time contouring on weekends with 1.81 hours (0-10) in comparison to 0.54 (0-10+) for dosimetrists and 0.31 (0-10) for physicists (p-value <0.001). When considering QOL and time spent after work, more respondents agreed there was a negative impact on QOL with increased responsibilities outside work hours (p-value <0.001). On average, respondents performed anywhere from 0 to 85 weekly radiotherapy simulations. The average time delay between simulation and when the imaging datasets are ready for contours was 1.31 days (1-4). 84 respondents signified there is no repercussion for delayed contour plans as planning is fast-tracked to meet the deadline, while 52 respondents signified postponement of radiotherapy start date. Time spent contouring after work hours (p-value 0.148) and on the weekend (p-value 0.403) were similar for both academic and private centers. Similarly, there was no difference in time of days of completion of 3D Conformal Radiation Therapy (p-value 0.551), Intensity Modulated Radiation Therapy (p-value 0.222), or Stereotactic Body Radiation Therapy (p-value 0.551) from academic versus private centers. CONCLUSION We present new insight into the amount of time spent in radiation oncology practices by dosimetrists, physicists, and physicians, performing the critical task of contouring for radiation treatment planning and its impact on QOL. These results can be used to guide decisions in the clinic for allocation of radiation treatment planning time and manpower.
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Affiliation(s)
- M Patel
- Medical College of Wisconsin, Milwaukee, WI
| | - A Banerjee
- Medical College of Wisconsin, Milwaukee, WI
| | - B A Erickson
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI
| | - J A Bovi
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI
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Chaudhary LN, Jorns JM, Sun Y, Cheng YC, Kamaraju S, Burfeind J, Gonyo MB, Kong AL, Patten C, Yen T, Cortina CS, Carson E, Johnson N, Bergom C, Tsaih SW, Banerjee A, Wang Y, Chervoneva I, Weil E, Chitambar CR, Rui H. Frequent upregulation of HER2 protein in hormone-receptor-positive HER2-negative breast cancer after short-term neoadjuvant endocrine therapy. Breast Cancer Res Treat 2023; 201:387-396. [PMID: 37460683 PMCID: PMC10795510 DOI: 10.1007/s10549-023-07038-3] [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] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 07/05/2023] [Indexed: 07/28/2023]
Abstract
BACKGROUND Endocrine resistant metastatic disease develops in ~ 20-25% of hormone-receptor-positive (HR+) breast cancer (BC) patients despite endocrine therapy (ET) use. Upregulation of HER family receptor tyrosine kinases (RTKs) represent escape mechanisms in response to ET in some HR+ tumors. Short-term neoadjuvant ET (NET) offers the opportunity to identify early endocrine escape mechanisms initiated in individual tumors. METHODS This was a single arm, interventional phase II clinical trial evaluating 4 weeks (± 1 week) of NET in patients with early-stage HR+/HER2-negative (HER2-) BC. The primary objective was to assess NET-induced changes in HER1-4 proteins by immunohistochemistry (IHC) score. Protein upregulation was defined as an increase of ≥ 1 in IHC score following NET. RESULTS Thirty-seven patients with cT1-T3, cN0, HR+/HER2- BC were enrolled. In 35 patients with evaluable tumor HER protein after NET, HER2 was upregulated in 48.6% (17/35; p = 0.025), with HER2-positive status (IHC 3+ or FISH-amplified) detected in three patients at surgery, who were recommended adjuvant trastuzumab-based therapy. Downregulation of HER3 and/or HER4 protein was detected in 54.2% of tumors, whereas HER1 protein remained low and unchanged in all cases. While no significant volumetric reduction was detected radiographically after short-term NET, significant reduction in tumor proliferation rates were observed. No significant associations were identified between any clinicopathologic covariates and changes in HER1-4 protein expression on multivariable analysis. CONCLUSION Short-term NET frequently and preferentially upregulates HER2 over other HER family RTKs in early-stage HR+/HER2- BC and may be a promising strategy to identify tumors that utilize HER2 as an early endocrine escape pathway. CLINICAL TRIAL REGISTRY Trial registration number: NCT03219476.
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Affiliation(s)
- Lubna N Chaudhary
- Division of Hematology and Oncology, Department of Medicine, Froedtert and Medical College of Wisconsin, 9200 W. Wisconsin Ave, Milwaukee, WI, 53226, USA.
| | - Julie M Jorns
- Department of Pathology, Froedtert and Medical College of Wisconsin, 9200 W. Wisconsin Ave, Milwaukee, WI, 53226, USA
| | - Yunguang Sun
- Department of Pathology, Froedtert and Medical College of Wisconsin, 9200 W. Wisconsin Ave, Milwaukee, WI, 53226, USA
| | - Yee Chung Cheng
- Division of Hematology and Oncology, Department of Medicine, Froedtert and Medical College of Wisconsin, 9200 W. Wisconsin Ave, Milwaukee, WI, 53226, USA
| | - Sailaja Kamaraju
- Division of Hematology and Oncology, Department of Medicine, Froedtert and Medical College of Wisconsin, 9200 W. Wisconsin Ave, Milwaukee, WI, 53226, USA
| | - John Burfeind
- Division of Hematology and Oncology, Department of Medicine, Froedtert and Medical College of Wisconsin, 9200 W. Wisconsin Ave, Milwaukee, WI, 53226, USA
| | - Mary Beth Gonyo
- Department of Radiology, Froedtert and Medical College of Wisconsin, 9200 W. Wisconsin Ave, Milwaukee, WI, 53226, USA
| | - Amanda L Kong
- Department of Surgery, Froedtert and Medical College of Wisconsin, 9200 W. Wisconsin Ave, Milwaukee, WI, 53226, USA
| | - Caitlin Patten
- Department of Surgery, Froedtert and Medical College of Wisconsin, 9200 W. Wisconsin Ave, Milwaukee, WI, 53226, USA
| | - Tina Yen
- Department of Surgery, Froedtert and Medical College of Wisconsin, 9200 W. Wisconsin Ave, Milwaukee, WI, 53226, USA
| | - Chandler S Cortina
- Department of Surgery, Froedtert and Medical College of Wisconsin, 9200 W. Wisconsin Ave, Milwaukee, WI, 53226, USA
| | - Ebony Carson
- Clinical Trials Office, Froedtert and Medical College of Wisconsin, 9200 W. Wisconsin Ave, Milwaukee, WI, 53226, USA
| | - Nedra Johnson
- Clinical Trials Office, Froedtert and Medical College of Wisconsin, 9200 W. Wisconsin Ave, Milwaukee, WI, 53226, USA
| | - Carmen Bergom
- Department of Radiation Oncology, Froedtert and Medical College of Wisconsin, 9200 W. Wisconsin Ave, Milwaukee, WI, 53226, USA
| | - Shirng-Wern Tsaih
- Department of Obstetrics and Gynecology, Froedtert and Medical College of Wisconsin, 9200 W. Wisconsin Ave, Milwaukee, WI, 53226, USA
| | - Anjishnu Banerjee
- Division of Biostatistics, Medical College of Wisconsin, Milwaukee, USA
| | - Yu Wang
- Division of Biostatistics, Medical College of Wisconsin, Milwaukee, USA
| | - Inna Chervoneva
- Division of Biostatistics, Department of Pharmacology, Physiology and Cancer Biology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, USA
| | - Elizabeth Weil
- Division of Pharmacy, Froedtert and Medical College of Wisconsin, 9200 W. Wisconsin Ave, Milwaukee, WI, 53226, USA
| | - Christopher R Chitambar
- Division of Hematology and Oncology, Department of Medicine, Froedtert and Medical College of Wisconsin, 9200 W. Wisconsin Ave, Milwaukee, WI, 53226, USA
| | - Hallgeir Rui
- Department of Pathology, Froedtert and Medical College of Wisconsin, 9200 W. Wisconsin Ave, Milwaukee, WI, 53226, USA
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Brant LCC, Pinheiro PC, Passaglia LG, de Souza MFM, Malta DC, Banerjee A, Ribeiro ALP, Nascimento BR. Cardiovascular mortality in Brazil during the COVID-19 pandemic: a comparison between underlying and multiple causes of death. Public Health 2023; 224:131-139. [PMID: 37776607 DOI: 10.1016/j.puhe.2023.08.027] [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: 04/19/2023] [Revised: 07/26/2023] [Accepted: 08/14/2023] [Indexed: 10/02/2023]
Abstract
OBJECTIVES The COVID-19 pandemic has differentially impacted cardiovascular disease (CVD) mortality worldwide. Causes of death misclassification may be one of the reasons. We evaluated the impact of the pandemic on CVD mortality in Brazil, comparing underlying causes (UCs) and multiple causes (MCs) of death. STUDY DESIGN Ecological time-series study. METHODS An ecological, time-series study was conducted analysing age-standardised death rates for CVD, from epidemiological week (EW) 10/2020 to 39/2021, using data from the Mortality Information System, Brazil. CVD was defined using the International Classification of Diseases (ICD-10) coding, if reported as UC or MC of death. Observed and expected data (mean for the same EW, 2017-2019) were compared. Risk ratios (RiRs) were analysed, and 95% confidence intervals (CIs) were calculated. RESULTS Age-standardised mortality rate for CVD as UC of death was 165.8 (95%CI: 165.4-166.3) per 100,000 inhabitants, similar to what was expected (165.6/100,000, 95%CI: 165.2-166.1, RiR = 1.00). There was increased out-of-hospital mortality (RiR = 1.18; 95%CI: 1.17-1.19) and deaths of ill-defined causes (RiR = 1.43; 95%CI: 1.42-1.44). The increase in out-of-hospital deaths was more pronounced in the North (RiR = 1.33; 95%CI 1.30-1.36) region, with a less resilient health system. Conversely, as MCs of death, there was a 10% increase in CVD mortality (observed: 243.2 [95%CI: 242.7-243.7], expected: 221.6 [95%CI: 221.1-222.1] per 100,000). An increase also occurred in the North and Central West regions (RiR = 1.16; 95%CI: 1.15-1.18), among men (RiR = 1.11; 95%CI: 1.11-1.12) and individuals aged ≥60 years (RiR = 1.11; 95%CI: 1.10-1.11). CONCLUSIONS During the pandemic, mortality rates for CVD as MCs of death increased in Brazil, whereas as UC mortality rates did not change. Higher out-of-hospital mortality, misclassification, and competing causes of death may explain this pattern.
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Affiliation(s)
- L C C Brant
- School of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil; Telehealth Center, Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil.
| | - P C Pinheiro
- School of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - L G Passaglia
- School of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - M F M de Souza
- School of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil; Vital Strategies, São Paulo, SP, Brazil
| | - D C Malta
- School of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil; Nursing School, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - A Banerjee
- Institute of Health Informatics, University College London, London, UK
| | - A L P Ribeiro
- School of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil; Telehealth Center, Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - B R Nascimento
- School of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil; Telehealth Center, Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil; Serviço de Hemodinâmica do Hospital Madre Teresa, Belo Horizonte, MG, Brazil
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Das A, Neogi SK, Banerjee A, Tayal A, Bandyopadhyay S. Highly correlated structural, local structural, Raman spectroscopic and magnetic properties of Mn-substituted Cu 2V 2O 7. J Phys Condens Matter 2023; 35. [PMID: 37666248 DOI: 10.1088/1361-648x/acf6a1] [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] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 09/04/2023] [Indexed: 09/06/2023]
Abstract
Low-dimensional quantum spin ½ system Cu2V2O7has been investigated in the framework of Mn-substitution at the Cu site, which is really un-investigated. The studied compounds Cu2 -xMnxV2O7(x= 0, 0.05, 0.1 and 0.15) have been synthesized and characterized structurally, spectroscopically, local structurally and magnetically via x-ray diffraction, Raman, x-ray absorption and temperature, field dependent magnetization measurements respectively. Although Cu2V2O7can be found inα, βandγ-phase, however all of the studied compounds are found in single orthorhombicα-phase which has crucial magneto-electric application potential. Temperature dependent Raman spectra indicated anharmonic phonon-phonon scattering but there is no spin-phonon coupling for VO4vibrational modes. The local structure probed via x-ray absorption near edge structure and extended x-ray absorption fine structure spectroscopy at 15 K, 300 K indicates Cu2+, V5+and mixed valent Mn2+and Mn3+ionic states and justified local structure for the probed ions. Magnetic measurements indicate long-range antiferromagnetic ordering with doping independent Neel temperature (32.5 K). Further observations are strong magnetic hysteresis at 5 K (due to canted spin structure), zero field exchange-bias and their noteworthy enhancement upon Mn-substitution. Interesting correlation between structural parameters and magnetic exchanges has been developed.
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Affiliation(s)
- A Das
- Department of Physics, University of Calcutta, 92 A.P.C. Road, Kolkata 700009, India
| | - S K Neogi
- Department of Physics, Adamas University, Barasat, West Bengal, India
| | - A Banerjee
- Department of Physics, University of Calcutta, 92 A.P.C. Road, Kolkata 700009, India
- CRNN, University of Calcutta, Sector III, Salt Lake, Kolkata 700106, India
| | - A Tayal
- Deutsches Elektronen-Synchrotron DESY, Notkestr. 85, 22607 Hamburg, Germany
| | - S Bandyopadhyay
- Department of Physics, University of Calcutta, 92 A.P.C. Road, Kolkata 700009, India
- CRNN, University of Calcutta, Sector III, Salt Lake, Kolkata 700106, India
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Kerschner A, Jensik K, Berg D, Visotcky A, Banerjee A, Stolley M. Impact of a Cancer Health Education Curriculum Among Milwaukee Public High School Students. J Cancer Educ 2023; 38:1034-1041. [PMID: 36251146 DOI: 10.1007/s13187-022-02228-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/09/2022] [Indexed: 06/02/2023]
Abstract
In Milwaukee and nationwide, cancer incidence, late-stage diagnosis, and mortality are notably higher among some racial/ethnic populations. Cancer education has the potential to impact cancer burden and reduce cancer disparities. In particular, the addition of a service-learning component to academic curriculums has been shown to improve student learning as well as positively impact the surrounding community. This study implemented a cancer health education curriculum (CHEC) at a Milwaukee public high school with the goal of addressing cancer knowledge, fear and fatalism beliefs, and risk behaviors. The curriculum included interactive learning sessions and a service-learning final project. Five-hundred twenty-one students also completed pre- and post-surveys assessing cancer knowledge, fear and fatalism, risk behaviors, cancer-related communication, and a qualitative question asking what they hoped to gain (pre) or did gain (post) from the course. Results indicate (1) a significant improvement in cancer knowledge (p < 0.0001), (2) a decrease in cancer fear and fatalism (p < 0.0001), (3) an increase in fruit consumption (p < 0.0001), (4) a decrease in screen time (p = 0.0004), and (5) an increase in how often students spoke with their family about cancer (p < 0.0001). Qualitative data reflect important gains such as increased interest in sharing their knowledge about cancer with their community. Providing cancer education and leveraging a service-learning requirement led to notable changes in high school students' cancer knowledge, fear and fatalism, and risk behaviors. Students also communicated more with family/friends about cancer. Such efforts could have broader implications for student, family, and community cancer burden.
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Affiliation(s)
- Abigail Kerschner
- Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, 53226, USA.
| | - Kathleen Jensik
- Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, 53226, USA
| | - Dakota Berg
- Milwaukee High School of the Arts, 2300 W Highland Ave, Milwaukee, WI, 53233, USA
| | - Alexis Visotcky
- Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, 53226, USA
| | - Anjishnu Banerjee
- Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, 53226, USA
| | - Melinda Stolley
- Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, 53226, USA
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Baisden JL, Varghese V, Banerjee A, Yoganandan N. Regional variations in C1-C2 bone density on quantitated computed tomography and clinical implications. N Am Spine Soc J 2023; 14:100228. [PMID: 37440985 PMCID: PMC10333715 DOI: 10.1016/j.xnsj.2023.100228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Revised: 04/27/2023] [Accepted: 04/28/2023] [Indexed: 07/15/2023]
Abstract
Background Our elderly population is growing and the number of spine fractures in the elderly is also growing. The elderly population in general may be considered as poor surgical candidates experience a high rate of fractures at C1 and C2 compared with the general population. Nonoperative management of upper cervical fractures is not benign as there is a high nonunion rate for both C1 and C2 fractures in the elderly, and orthosis compliance is often suboptimal, or complicated by skin breakdown. The optimal technique for upper cervical stabilization in the elderly may be different than in younger populations as the bone quality is inferior in the elderly. The objective of this basic science study is to determine whether the bone mineral density (BMD) of C1 and C2 vary by region, and if this is a gender difference in this elderly age group. Methods Twenty cadaveric spines from 45 to 83 years of age were used to obtain BMD using quantitated computed tomography (QCT). BMD was measured using a QCT. For C1, 8 regions were determined: anterior tubercle, bilateral anterior and medial lateral masses, bilateral posterior arches, and posterior tubercle. For C2, 7 regional BMDs were determined: top of odontoid, base of odontoid-body interface, mid body, bilateral lateral masses, anterior inferior body near the discs space, and the C2 spinous process. Results The BMD was greatest at the C1 anterior tubercle (564.4±175.8 mg/cm3) and C1 posterior ring (420.8±110.2 mg/cm3), and least at the anterior and medial lateral masses (262.8±59.5 mg/cm3, 316.9±72.6 mg/cm3). At C2 QCT BMD was greatest at the top of the dens (400.6±107.9 mg/cm3) decreasing down through the odontoid-C2 body junction (267.8±103.5 mg/cm3) and least in the mid C2 body 249.1±68.8 mg/cm3). The posterior arch of C1 and the spinous process of C2 had higher BMD's 420.8±110.2 mg/cm3 and 284.1±93.0 mg/cm3, respectively. A high correlation was observed between the BMD at the interface of the dens-vertebral body with the vertebral body with a Pearson correlation coefficient of 0.86. The BMD of the top of dens was significantly higher (p<.05) than all the regions in C2. Conclusions Regional and segmental BMD variations at C1 and C2 have clinical implications for surgical constructs in the elderly population. Given the higher BMDs of the C1 and C2 spinous process and posterior arches, consideration should be given to incorporate these areas using various C1-C2 wiring techniques. In the elderly, lateral masses particularly at C1 with lower BMD may result in potential screw loosening and nonunion in this age group. Old-school wiring techniques have a track record of efficacy and safety with less blood loss, reduced operative time, reduced X-ray exposure, and should be considered in the elderly as a primary stabilization technique or a belt-over suspenders approach based on regional variations in BMD in the elderly.
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Affiliation(s)
- Jamie L Baisden
- Department of Neurosurgery, Medical College of Wisconsin, 8701 Watertown Plank Rd, Milwaukee, WI 53226, United States
| | - Vicky Varghese
- Department of Orthopedics, Skokie Hospital, NorthShore University Health System, 9600 Gross Point Rd, Skokie, IL 60076, United States
| | - Anjishnu Banerjee
- Department of Biostatistics, Medical College of Wisconsin, Milwaukee, WI 53226, United States
| | - Narayan Yoganandan
- Department of Neurosurgery, Medical College of Wisconsin, 8701 Watertown Plank Rd, Milwaukee, WI 53226, United States
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McAndrew NS, Erickson J, Hetland B, Guttormson J, Patel J, Wallace L, Visotcky A, Banerjee A, Applebaum AJ. A Mixed-Methods Feasibility Study: Eliciting ICU Experiences and Measuring Outcomes of Family Caregivers of Patients Who Have Undergone Hematopoietic Stem Cell Transplantation. J Fam Nurs 2023:10748407231166945. [PMID: 37191306 PMCID: PMC10330518 DOI: 10.1177/10748407231166945] [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] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
The impact of an intensive care unit (ICU) admission on family caregivers of patients who have undergone hematopoietic stem cell transplantation (HSCT) has not been well described. Aims of this study were to determine the feasibility of conducting research with family caregivers of HSCT patients during an ICU admission and generate preliminary data about their experiences and engagement in care. Using a mixed-methods, repeated measures design, we collected data from family caregivers after 48 hr in the ICU (T1) and at 48 hr after transferring out of ICU (T2). Enrolling HSCT caregivers in research while in the ICU was feasible (10/13 consented; 9/10 completed data collection at T1); however, data collection at T2 was not possible for most caregivers. Caregiver distress levels were high, and engagement in care was moderate. The three themes that emerged from interviews (n = 5) highlighted that although HSCT family caregivers faced many challenges and received limited support during their ICU experience, they were able to access their own personal resources and demonstrated resilience.
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Affiliation(s)
- Natalie S McAndrew
- University of Wisconsin-Milwaukee, USA
- Froedtert & the Medical College of Wisconsin, Milwaukee, USA
| | | | - Breanna Hetland
- University of Nebraska Medical Center, Omaha, USA
- Nebraska Medicine, Omaha, USA
| | | | | | | | | | | | - Allison J Applebaum
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Weill Cornell Medicine, New York, NY, USA
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Matoska T, Banerjee A, Shreenivas A, Jurkowski L, Shukla ME, Gore EM, Linsky P, Gasparri M, George B, Johnstone C, Johnstone D, Puckett LL. Definitive Chemoradiation Associated with Improved Survival Outcomes in Patients with Synchronous Oligometastatic Esophageal Cancer. Cancers (Basel) 2023; 15:cancers15092523. [PMID: 37173988 PMCID: PMC10177457 DOI: 10.3390/cancers15092523] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 04/22/2023] [Accepted: 04/24/2023] [Indexed: 05/15/2023] Open
Abstract
BACKGROUND The study of oligometastatic esophageal cancer (EC) is relatively new. Preliminary data suggests that more aggressive treatment regimens in select patients may improve survival rates in oligometastatic EC. However, the consensus recommends palliative treatment. We hypothesized that oligometastatic esophageal cancer patients treated with a definitive approach (chemoradiotherapy [CRT]) would have improved overall survival (OS) compared to those treated with a purely palliative intent and historical controls. METHODS Patients diagnosed with synchronous oligometastatic (any histology, ≤5 metastatic foci) esophageal cancer treated in a single academic hospital were retrospectively analyzed and divided into definitive and palliative treatment groups. Definitive CRT was defined as radiation therapy to the primary site with ≥40 Gy and ≥2 cycles of chemotherapy. RESULTS Of 78 Stage IVB (AJCC 8th ed.) patients, 36 met the pre-specified oligometastatic definition. Of these, 19 received definitive CRT, and 17 received palliative treatment. With a median follow-up of 16.5 months (Range: 2.3-95.0 months), median OS for definitive CRT and palliative groups were 90.2 and 8.1 months (p < 0.01), translating into 5-year OS of 50.5% (95%CI: 32.0-79.8%) vs. 7.5% (95%CI: 1.7-48.9%), respectively. CONCLUSIONS Oligometastatic EC patients treated with definitive CRT benefited from that approach with survival rates (50.5%) that vastly exceeded historical standards of 5% at 5 years for metastatic EC. Oligometastatic EC patients treated with definitive CRT had significantly improved OS compared to those treated with palliative-only intent within our cohort. Notably, definitively treated patients were generally younger and with better performance status versus those palliatively treated. Further prospective evaluation of definitive CRT for oligometastatic EC is warranted.
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Affiliation(s)
- Thomas Matoska
- Department of Radiation Oncology, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226, USA
| | - Anjishnu Banerjee
- Department of Biostatistics, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226, USA
| | - Aditya Shreenivas
- Department of Hematology and Oncology, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226, USA
| | - Lauren Jurkowski
- Department of Hospital Medicine, Washington University School of Medicine in St. Louis, 4523 Clayton Ave, CB 8058-59-01, St. Louis, MO 63110, USA
| | - Monica E Shukla
- Department of Radiation Oncology, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226, USA
| | - Elizabeth M Gore
- Department of Radiation Oncology, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226, USA
| | - Paul Linsky
- Department of Cardiothoracic Surgery, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226, USA
| | - Mario Gasparri
- Department of Cardiothoracic Surgery, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226, USA
| | - Ben George
- Department of Hematology and Oncology, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226, USA
| | - Candice Johnstone
- Department of Radiation Oncology, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226, USA
| | - David Johnstone
- Department of Cardiothoracic Surgery, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226, USA
| | - Lindsay L Puckett
- Department of Radiation Oncology, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226, USA
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Verhagen NB, SenthilKumar G, Jaraczewski T, Koerber NK, Merrill JR, Flitcroft MA, Szabo A, Banerjee A, Yang X, Taylor BW, Castro CEF, Yen TWF, Clarke CN, Lauer K, Pfeifer KJ, Gould JC, Kothari AN. Severity of Prior COVID-19 Infection is Associated with Postoperative Outcomes Following Major Inpatient Surgery. medRxiv 2023:2023.04.12.23288412. [PMID: 37131614 PMCID: PMC10153306 DOI: 10.1101/2023.04.12.23288412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Objective To determine the association between severity of prior history of SARS-CoV-2 infection and postoperative outcomes following major elective inpatient surgery. Summary Background Data Surgical guidelines instituted early in the COVID-19 pandemic recommended delay in surgery up to 8 weeks following an acute SARS-CoV-2 infection. Given that surgical delay can lead to worse medical outcomes, it is unclear if continuation of such stringent policies is necessary and beneficial for all patients, especially those recovering from asymptomatic or mildly symptomatic COVID-19. Methods Utilizing the National Covid Cohort Collaborative (N3C), we assessed postoperative outcomes for adults with and without a history of COVID-19 who underwent major elective inpatient surgery between January 2020 and February 2023. COVID-19 severity and time from SARS-CoV-2 infection to surgery were each used as independent variables in multivariable logistic regression models. Results This study included 387,030 patients, of which 37,354 (9.7%) had a diagnosis of preoperative COVID-19. History of COVID-19 was found to be an independent risk factor for adverse postoperative outcomes even after a 12-week delay for patients with moderate and severe SARS-CoV-2 infection. Patients with mild COVID-19 did not have an increased risk of adverse postoperative outcomes at any time point. Vaccination decreased the odds of mortality and other complications. Conclusions Impact of COVID-19 on postoperative outcomes is dependent on severity of illness, with only moderate and severe disease leading to higher risk of adverse outcomes. Existing wait time policies should be updated to include consideration of COVID-19 disease severity and vaccination status.
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Affiliation(s)
- Nathaniel B Verhagen
- Department of Surgery, Division of Surgical Oncology, Medical College of Wisconsin, Milwaukee, WI
| | - Gopika SenthilKumar
- Department of Surgery, Division of Surgical Oncology, Medical College of Wisconsin, Milwaukee, WI
- Department of Physiology and Anesthesiology, Medical College of Wisconsin, Milwaukee, WI
| | - Taylor Jaraczewski
- Department of Surgery, Division of Surgical Oncology, Medical College of Wisconsin, Milwaukee, WI
| | - Nicolas K Koerber
- Department of Surgery, Division of Surgical Oncology, Medical College of Wisconsin, Milwaukee, WI
| | - Jennifer R Merrill
- Department of Surgery, Division of Surgical Oncology, Medical College of Wisconsin, Milwaukee, WI
| | - Madelyn A Flitcroft
- Department of Surgery, Division of Surgical Oncology, Medical College of Wisconsin, Milwaukee, WI
| | - Aniko Szabo
- Department of Biostatistics, Medical College of Wisconsin, Milwaukee, WI
| | - Anjishnu Banerjee
- Department of Biostatistics, Medical College of Wisconsin, Milwaukee, WI
| | - Xin Yang
- Clinical and Translational Science Institute of Southeastern Wisconsin, Medical College of Wisconsin, Milwaukee, WI
| | - Bradley W Taylor
- Clinical and Translational Science Institute of Southeastern Wisconsin, Medical College of Wisconsin, Milwaukee, WI
| | - Carlos E Figueroa Castro
- Department of Medicine, Division of Infectious Diseases, Medical College of Wisconsin, Milwaukee, WI
| | - Tina W F Yen
- Department of Surgery, Division of Surgical Oncology, Medical College of Wisconsin, Milwaukee, WI
| | - Callisia N Clarke
- Department of Surgery, Division of Surgical Oncology, Medical College of Wisconsin, Milwaukee, WI
| | - Kathryn Lauer
- Department of Anesthesiology, Medical College of Wisconsin, Milwaukee, WI
| | - Kurt J Pfeifer
- Department of Medicine, Section of Perioperative & Consultative Medicine, Medical College of Wisconsin, Milwaukee, WI
| | - Jon C Gould
- Department of Surgery, Division of Minimally Invasive and GI Surgery, Medical College of Wisconsin, Milwaukee, WI
| | - Anai N Kothari
- Department of Surgery, Division of Surgical Oncology, Medical College of Wisconsin, Milwaukee, WI
- Clinical and Translational Science Institute of Southeastern Wisconsin, Medical College of Wisconsin, Milwaukee, WI
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Chaudhary LN, Jorns J, Sun Y, Cheng YC, Kamaraju S, Burfeind J, Gonyo M, Kong A, Patten C, Yen T, Cortina C, Carson E, Johnson N, Bergom C, Tsaih SW, Banerjee A, Wang Y, Chervoneva I, Weil E, Chitambar CR, Rui H. Frequent Upregulation Of HER2 Protein In Hormone Receptor-Positive HER2-Negative Breast Cancer After Short-Term Neoadjuvant Endocrine Therapy. Res Sq 2023:rs.3.rs-2777910. [PMID: 37066270 PMCID: PMC10104267 DOI: 10.21203/rs.3.rs-2777910/v1] [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] [Subscribe] [Scholar Register] [Indexed: 04/18/2023]
Abstract
Background. Endocrine resistant metastatic disease develops in ~20-25% of hormone-receptor positive (HR+) breast cancer (BC) patients despite endocrine therapy (ET) use. Upregulation of HER family receptor tyrosine kinases (RTKs) represent escape mechanisms in response to ET in some HR+ tumors. Short-term neoadjuvant ET (NET) offers the opportunity to identify early endocrine escape mechanisms initiated in individual tumors. Methods. This was a single arm, interventional phase II clinical trial evaluating 4 weeks (+/-1 week) of NET in patients with early-stage HR+/HER2-negative (HER2-) BC. The primary objective was to assess NET-induced changes in HER1-4 proteins by immunohistochemistry (IHC) score. Protein upregulation was defined as an increase of ≥1 in IHC score following NET. Results. Thirty-seven patients with cT1-T3, cN0, HR+/HER2- BC were enrolled. In 35 patients with evaluable tumor HER protein after NET, HER2 was upregulated in 48.6% (17/35; p=0.025), with HER2-positive status (IHC 3+ or FISH-amplified) detected in three patients at surgery, who were recommended adjuvant trastuzumab-based therapy. Downregulation of HER3 and/or HER4 protein was detected in 54.2% of tumors, whereas HER1 protein remained low and unchanged in all cases. While no significant volumetric reduction was detected radiographically after short-term NET, significant reduction in tumor proliferation rates were observed. No significant associations were identified between any clinicopathologic covariates and changes in HER1-4 protein expression on multivariable analysis. Conclusion . Short-term NET frequently and preferentially upregulates HER2 over other HER-family RTKs in early-stage HR+/HER2- BC and may be a promising strategy to identify tumors that utilize HER2 as an early endocrine escape pathway. Trial registration number: NCT03219476 Date of registration for prospectively registered trials: July 17, 2017.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Tina Yen
- MCW: Medical College of Wisconsin
| | | | | | | | | | | | | | - Yu Wang
- MCW: Medical College of Wisconsin
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Polvani LM, Keeble J, Banerjee A, Checa-Garcia R, Chiodo G, Rieder HE, Rosenlof KH. No evidence of worsening Arctic springtime ozone losses over the 21st century. Nat Commun 2023; 14:1608. [PMID: 36964124 PMCID: PMC10039004 DOI: 10.1038/s41467-023-37134-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 03/03/2023] [Indexed: 03/26/2023] Open
Affiliation(s)
- L M Polvani
- Department of Applied Physics and Applied Mathematics, Columbia University, New York, NY, USA.
- Lamont-Doherty Earth Observatory, Columbia University, Palisades, NY, USA.
| | - J Keeble
- Department of Chemistry, University of Cambridge, Cambridge, UK
- National Centre for Atmospheric Science (NCAS), University of Cambridge, Cambridge, UK
| | - A Banerjee
- Cooperative Institute for Research in Environmental Sciences, University of Colorado, Boulder, CO, USA
- Chemical Sciences Laboratory, National Oceanic and Atmospheric Administration, Boulder, CO, USA
| | - R Checa-Garcia
- Institute of Meteorology and Climatology, University of Natural Resources and Life Sciences, Vienna, Austria
| | - G Chiodo
- Department of Environmental Systems Science, Institute for Atmospheric and Climate Science, ETH Zurich, Zurich, Switzerland
| | - H E Rieder
- Institute of Meteorology and Climatology, University of Natural Resources and Life Sciences, Vienna, Austria
| | - K H Rosenlof
- Chemical Sciences Laboratory, National Oceanic and Atmospheric Administration, Boulder, CO, USA
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Banerjee A, Lesser O, Rahman MA, Thomas C, Wang T, Manfra MJ, Berg E, Oreg Y, Stern A, Marcus CM. Local and Nonlocal Transport Spectroscopy in Planar Josephson Junctions. Phys Rev Lett 2023; 130:096202. [PMID: 36930915 DOI: 10.1103/physrevlett.130.096202] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 01/11/2023] [Indexed: 06/18/2023]
Abstract
We report simultaneously acquired local and nonlocal transport spectroscopy in a phase-biased planar Josephson junction based on an epitaxial InAs-Al hybrid two-dimensional heterostructure. Quantum point contacts at the junction ends allow measurement of the 2×2 matrix of local and nonlocal tunneling conductances as a function of magnetic field along the junction, phase difference across the junction, and carrier density. A closing and reopening of a gap was observed in both the local and nonlocal tunneling spectra as a function of magnetic field. For particular tunings of junction density, gap reopenings were accompanied by zero-bias conductance peaks (ZBCPs) in local conductances. End-to-end correlation of gap reopening was strong, while correlation of local ZBCPs was weak. A model of the device, with disorder treated phenomenologically, shows comparable conductance matrix behavior associated with a topological phase transition. Phase dependence helps distinguish possible origins of the ZBCPs.
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Affiliation(s)
- A Banerjee
- Center for Quantum Devices, Niels Bohr Institute, University of Copenhagen, Universitetsparken 5, 2100 Copenhagen, Denmark
| | - O Lesser
- Department of Condensed Matter Physics, Weizmann Institute of Science, Rehovot, Israel 76100
| | - M A Rahman
- Center for Quantum Devices, Niels Bohr Institute, University of Copenhagen, Universitetsparken 5, 2100 Copenhagen, Denmark
| | - C Thomas
- Department of Physics and Astronomy, and Birck Nanotechnology Center, Purdue University, West Lafayette, Indiana 47907 USA
| | - T Wang
- Department of Physics and Astronomy, and Birck Nanotechnology Center, Purdue University, West Lafayette, Indiana 47907 USA
| | - M J Manfra
- Department of Physics and Astronomy, and Birck Nanotechnology Center, Purdue University, West Lafayette, Indiana 47907 USA
- School of Materials Engineering, and School of Electrical and Computer Engineering, Purdue University, West Lafayette, Indiana 47907 USA
| | - E Berg
- Department of Condensed Matter Physics, Weizmann Institute of Science, Rehovot, Israel 76100
| | - Y Oreg
- Department of Condensed Matter Physics, Weizmann Institute of Science, Rehovot, Israel 76100
| | - Ady Stern
- Department of Condensed Matter Physics, Weizmann Institute of Science, Rehovot, Israel 76100
| | - C M Marcus
- Center for Quantum Devices, Niels Bohr Institute, University of Copenhagen, Universitetsparken 5, 2100 Copenhagen, Denmark
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Baruhee D, Ganapathy A, Singh S, Sarwar S, Banerjee A, Bhukya S, Quadri JA, Shariff A. Morphology of human fetal enteric neurons: A comparative study of different segments of the colon. Morphologie 2023; 107:38-46. [PMID: 35764504 DOI: 10.1016/j.morpho.2022.03.001] [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: 12/31/2021] [Revised: 02/23/2022] [Accepted: 03/06/2022] [Indexed: 10/17/2022]
Abstract
OBJECTIVES The Enteric Nervous System (ENS) present in the wall of the gut is currently being explored because of its influence on the gut and beyond. In this context, the morphology of developing ENS has not been completely understood in humans due to lack of adequate literature. The aim of the present study was to observe the morphology of the enteric neurons in the human fetal colon and compare the findings in ascending colon a midgut derivative and descending colon a hindgut derivative at various weeks of gestation (WG). MATERIAL AND METHODS Tissue samples from 15 aborted fetuses (11 WG to 2 months postnatal) were processed for Cresyl violet, H & E staining, and NADPH Diaphorase histochemistry. The morphometric analysis was done by calculating the neuronal number density and neuronal fractional area. The Student t-test; Mann-Whitney test and Wilcoxon signed-rank test were used to analyze the data. RESULTS The muscularis externa with two distinct layers was visible as early as 13 WG and the muscularis mucosae was first observed at 18 WG. The size of the myenteric neurons appeared to be larger with increasing weeks of gestation suggesting a process of neuronal maturation. The neuronal number density and neuronal fractional area seemed to be reduced with advancing fetal age. There was no marked difference between the ascending and sigmoid colon. At 23 and 26 WG, a mature pattern of nitrergic innervation was observed. CONCLUSION This study is done on human fetal tissue samples unlike previous studies on animal samples to comprehend the morphology of developing ENS. It will aid in understanding the effect of ENS on various neurological disorders.
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Affiliation(s)
- D Baruhee
- Department of Obstretics and Gynaecology, ESI, PGIMSR, Basaidarapur, New Delhi, India
| | - A Ganapathy
- Department of Anatomy, All India Institute of Medical Sciences, Bhubaneswar, India
| | - S Singh
- Department of Anatomy, All India Institute of Medical Sciences, New Delhi, India.
| | - S Sarwar
- Department of Anatomy, All India Institute of Medical Sciences, New Delhi, India
| | - A Banerjee
- Department of Anaesthesiology and Critical care, Sanjay Gandhi post graduate institute, Lucknow, India
| | - S Bhukya
- Department of Anatomy, Armed forces medical college, Pune, India
| | - J A Quadri
- Department of Anatomy, All India Institute of Medical Sciences, New Delhi, India
| | - A Shariff
- Department of Anatomy, All India Institute of Medical Sciences, New Delhi, India
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Shafiee S, Jagtap J, Zayats M, Epperlein J, Banerjee A, Geurts A, Flister M, Zhuk S, Joshi A. Dynamic NIR Fluorescence Imaging and Machine Learning Framework for Stratifying High vs. Low Notch-Dll4 Expressing Host Microenvironment in Triple-Negative Breast Cancer. Cancers (Basel) 2023; 15:cancers15051460. [PMID: 36900252 PMCID: PMC10000786 DOI: 10.3390/cancers15051460] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 02/22/2023] [Accepted: 02/23/2023] [Indexed: 03/03/2023] Open
Abstract
Delta like canonical notch ligand 4 (Dll4) expression levels in tumors are known to affect the efficacy of cancer therapies. This study aimed to develop a model to predict Dll4 expression levels in tumors using dynamic enhanced near-infrared (NIR) imaging with indocyanine green (ICG). Two rat-based consomic xenograft (CXM) strains of breast cancer with different Dll4 expression levels and eight congenic xenograft strains were studied. Principal component analysis (PCA) was used to visualize and segment tumors, and modified PCA techniques identified and analyzed tumor and normal regions of interest (ROIs). The average NIR intensity for each ROI was calculated from pixel brightness at each time interval, yielding easily interpretable features including the slope of initial ICG uptake, time to peak perfusion, and rate of ICG intensity change after reaching half-maximum intensity. Machine learning algorithms were applied to select discriminative features for classification, and model performance was evaluated with a confusion matrix, receiver operating characteristic curve, and area under the curve. The selected machine learning methods accurately identified host Dll4 expression alterations with sensitivity and specificity above 90%. This may enable stratification of patients for Dll4 targeted therapies. NIR imaging with ICG can noninvasively assess Dll4 expression levels in tumors and aid in effective decision making for cancer therapy.
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Affiliation(s)
- Shayan Shafiee
- Department of Biomedical Engineering, Marquette University and Medical College of Wisconsin, Milwaukee, WI 53226, USA
| | - Jaidip Jagtap
- Department of Radiology, Mayo Clinic, Rochester, MN 55905, USA
| | | | | | - Anjishnu Banerjee
- Division of Biostatistics, Medical College of Wisconsin, Milwaukee, WI 53226, USA
| | - Aron Geurts
- Department of Physiology, Medical College of Wisconsin, Milwaukee, WI 53226, USA
| | - Michael Flister
- Department of Physiology, Medical College of Wisconsin, Milwaukee, WI 53226, USA
| | - Sergiy Zhuk
- IBM Research Europe, D15 HN66 Dublin, Ireland
| | - Amit Joshi
- Department of Biomedical Engineering, Marquette University and Medical College of Wisconsin, Milwaukee, WI 53226, USA
- Correspondence:
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Wambier DS, Chibinski ACR, Wambier LM, de Lima Navarro MF, Banerjee A. Minimum intervention oral care management of early childhood caries: a 17-year follow-up case report. Eur J Paediatr Dent 2023; 24:20-29. [PMID: 36853218 DOI: 10.23804/ejpd.2023.24.01.04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
BACKGROUND Early childhood caries (ECC) has a profound impact on a child's quality of life, and its management remains a challenge for the paediatric dentist, mainly because it depends on radical changes in the child/carers' daily behaviour and any dental treatment must be provided to very young child. CASE REPORT This case report describes the on-going care of a 2-year-old child presenting with ECC and management until permanent dentition is complete. All patient-focused, teamdelivered care was delivered using the minimum intervention oral care framework, implementing non-invasive and minimally invasive preventive procedures. Throughout the care provided, oral and dental health education was reinforced in all visits. The child's mother was trained to perform effective biofilm control and dietary habits were adjusted, especially baby-bottle removal during sleep. The child was initially anxious and resistant towards any dental examination and clinical procedures. However, with effort from the oral healthcare team members, the patient became compliant, allowing the mother to perform suitable oral hygiene measures, as well as accepting the clinical procedures carried out by the paediatric dentist. The clinical procedures consisted of atraumatic restorations and fluoride varnish applications. During the subsequent years after the baseline treatment, follow-up visits included continued dietary and oral hygiene instruction with positive behavior reinforcement, fluoride topical applications and tooth-restoration complex maintenance with glass-ionomer cement where needed. Currently, the patient is 19 years old and has a stable, healthy permanent dentition. CONCLUSION Understanding of the causes of oral diseases by the patients' caregivers, alongside with pragmatic practical guidance to maintain good oral health, can reduce the risk for acquiring future disease, since caries activity control is the basis for successful caries management.
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Affiliation(s)
- D S Wambier
- Department of Dentistry, Ponta Grossa State University, Ponta Grossa, Paraná, Brazil
| | - A C R Chibinski
- Department of Dentistry, Ponta Grossa State University, Ponta Grossa, Paraná, Brazil
| | - L M Wambier
- Department of Dentistry, Ponta Grossa State University, Ponta Grossa, Paraná, Brazil
| | - M F de Lima Navarro
- Department of Restorative Dentistry, Bauru School of Dentistry, University of São Paulo, Bauru, Brazil
| | - A Banerjee
- Center of Oral Clinical Translational Sciences, Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, London, UK
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Rustamkulov Z, Sing DK, Mukherjee S, May EM, Kirk J, Schlawin E, Line MR, Piaulet C, Carter AL, Batalha NE, Goyal JM, López-Morales M, Lothringer JD, MacDonald RJ, Moran SE, Stevenson KB, Wakeford HR, Espinoza N, Bean JL, Batalha NM, Benneke B, Berta-Thompson ZK, Crossfield IJM, Gao P, Kreidberg L, Powell DK, Cubillos PE, Gibson NP, Leconte J, Molaverdikhani K, Nikolov NK, Parmentier V, Roy P, Taylor J, Turner JD, Wheatley PJ, Aggarwal K, Ahrer E, Alam MK, Alderson L, Allen NH, Banerjee A, Barat S, Barrado D, Barstow JK, Bell TJ, Blecic J, Brande J, Casewell S, Changeat Q, Chubb KL, Crouzet N, Daylan T, Decin L, Désert J, Mikal-Evans T, Feinstein AD, Flagg L, Fortney JJ, Harrington J, Heng K, Hong Y, Hu R, Iro N, Kataria T, Kempton EMR, Krick J, Lendl M, Lillo-Box J, Louca A, Lustig-Yaeger J, Mancini L, Mansfield M, Mayne NJ, Miguel Y, Morello G, Ohno K, Palle E, Petit Dit de la Roche DJM, Rackham BV, Radica M, Ramos-Rosado L, Redfield S, Rogers LK, Shkolnik EL, Southworth J, Teske J, Tremblin P, Tucker GS, Venot O, Waalkes WC, Welbanks L, Zhang X, Zieba S. Early Release Science of the exoplanet WASP-39b with JWST NIRSpec PRISM. Nature 2023; 614:659-663. [PMID: 36623548 PMCID: PMC9946832 DOI: 10.1038/s41586-022-05677-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [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: 09/22/2022] [Accepted: 12/21/2022] [Indexed: 01/11/2023]
Abstract
Transmission spectroscopy1-3 of exoplanets has revealed signatures of water vapour, aerosols and alkali metals in a few dozen exoplanet atmospheres4,5. However, these previous inferences with the Hubble and Spitzer Space Telescopes were hindered by the observations' relatively narrow wavelength range and spectral resolving power, which precluded the unambiguous identification of other chemical species-in particular the primary carbon-bearing molecules6,7. Here we report a broad-wavelength 0.5-5.5 µm atmospheric transmission spectrum of WASP-39b8, a 1,200 K, roughly Saturn-mass, Jupiter-radius exoplanet, measured with the JWST NIRSpec's PRISM mode9 as part of the JWST Transiting Exoplanet Community Early Release Science Team Program10-12. We robustly detect several chemical species at high significance, including Na (19σ), H2O (33σ), CO2 (28σ) and CO (7σ). The non-detection of CH4, combined with a strong CO2 feature, favours atmospheric models with a super-solar atmospheric metallicity. An unanticipated absorption feature at 4 µm is best explained by SO2 (2.7σ), which could be a tracer of atmospheric photochemistry. These observations demonstrate JWST's sensitivity to a rich diversity of exoplanet compositions and chemical processes.
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Affiliation(s)
- Z Rustamkulov
- Department of Earth and Planetary Sciences, Johns Hopkins University, Baltimore, MD, USA.
| | - D K Sing
- Department of Earth and Planetary Sciences, Johns Hopkins University, Baltimore, MD, USA
- Department of Physics and Astronomy, Johns Hopkins University, Baltimore, MD, USA
| | - S Mukherjee
- Department of Astronomy and Astrophysics, University of California, Santa Cruz, Santa Cruz, CA, USA
| | - E M May
- Johns Hopkins APL, Laurel, MD, USA
| | - J Kirk
- Center for Astrophysics, Harvard and Smithsonian, Cambridge, MA, USA
- Department of Physics, Imperial College London, London, UK
| | - E Schlawin
- Steward Observatory, University of Arizona, Tucson, AZ, USA
| | - M R Line
- School of Earth and Space Exploration, Arizona State University, Tempe, AZ, USA
| | - C Piaulet
- Institute of Research on Exoplanets, Department of Physics, University of Montreal, Montreal, Québec, Canada
| | - A L Carter
- Department of Astronomy and Astrophysics, University of California, Santa Cruz, Santa Cruz, CA, USA
| | - N E Batalha
- NASA Ames Research Center, Moffett Field, CA, USA
| | - J M Goyal
- School of Earth and Planetary Sciences, National Institute of Science Education and Research (NISER), HBNI, Jatani, India
| | - M López-Morales
- Center for Astrophysics, Harvard and Smithsonian, Cambridge, MA, USA
| | - J D Lothringer
- Department of Physics, Utah Valley University, Orem, UT, USA
| | - R J MacDonald
- Department of Astronomy, University of Michigan, Ann Arbor, MI, USA
- Department of Astronomy and Carl Sagan Institute, Cornell University, Ithaca, NY, USA
| | - S E Moran
- Lunar and Planetary Laboratory, University of Arizona, Tucson, AZ, USA
| | | | - H R Wakeford
- School of Physics, University of Bristol, HH Wills Physics Laboratory, Bristol, UK
| | - N Espinoza
- Space Telescope Science Institute, Baltimore, MD, USA
| | - J L Bean
- Department of Astronomy and Astrophysics, University of Chicago, Chicago, IL, USA
| | - N M Batalha
- Department of Astronomy and Astrophysics, University of California, Santa Cruz, Santa Cruz, CA, USA
| | - B Benneke
- Institute of Research on Exoplanets, Department of Physics, University of Montreal, Montreal, Québec, Canada
| | - Z K Berta-Thompson
- Department of Astrophysical and Planetary Sciences, University of Colorado, Boulder, CO, USA
| | - I J M Crossfield
- Department of Physics and Astronomy, University of Kansas, Lawrence, KS, USA
| | - P Gao
- Earth and Planets Laboratory, Carnegie Institution of Washington, Washington, DC, USA
| | - L Kreidberg
- Max Planck Institute for Astronomy, Heidelberg, Germany
| | - D K Powell
- Harvard and Smithsonian, Center for Astrophysics, Cambridge, MA, USA
| | - P E Cubillos
- INAF - Astrophysics Observatory at Turin, Turin, Italy
| | - N P Gibson
- School of Physics, Trinity College Dublin, Dublin, Ireland
| | - J Leconte
- Laboratoire d'Astrophysique de Bordeaux, CNRS, Université de Bordeaux, Pessac, France
| | - K Molaverdikhani
- University Observatory Munich, Ludwig Maximilian University, Munich, Germany
- Exzellenzcluster Origins, Garching, Germany
| | - N K Nikolov
- Space Telescope Science Institute, Baltimore, MD, USA
| | - V Parmentier
- Université Côte d'Azur, Observatoire de la Côte d'Azur, CNRS, Laboratoire Lagrange, Nice, France
- Atmospheric, Oceanic and Planetary Physics, Department of Physics, University of Oxford, Oxford, UK
| | - P Roy
- Institute of Research on Exoplanets, Department of Physics, University of Montreal, Montreal, Québec, Canada
| | - J Taylor
- Department of Physics, University of Oxford, Oxford, UK
| | - J D Turner
- Department of Astronomy and Carl Sagan Institute, Cornell University, Ithaca, NY, USA
| | - P J Wheatley
- Centre for Exoplanets and Habitability, University of Warwick, Coventry, UK
- Department of Physics, University of Warwick, Coventry, UK
| | - K Aggarwal
- Indian Institute of Technology, Indore, Indore, India
| | - E Ahrer
- Centre for Exoplanets and Habitability, University of Warwick, Coventry, UK
- Department of Physics, University of Warwick, Coventry, UK
| | - M K Alam
- Earth and Planets Laboratory, Carnegie Institution of Washington, Washington, DC, USA
| | - L Alderson
- School of Physics, University of Bristol, HH Wills Physics Laboratory, Bristol, UK
| | - N H Allen
- Department of Physics and Astronomy, Johns Hopkins University, Baltimore, MD, USA
| | - A Banerjee
- School of Physical Sciences, The Open University, Milton Keynes, UK
| | - S Barat
- Anton Pannekoek Institute for Astronomy, University of Amsterdam, Amsterdam, the Netherlands
| | - D Barrado
- Centre for Astrobiology (CSIC-INTA), European Space Astronomy Centre Campus, University of Maria de Maeztu, Madrid, Spain
| | - J K Barstow
- School of Physical Sciences, The Open University, Milton Keynes, UK
| | - T J Bell
- BAER Institute, NASA Ames Research Center, Moffet Field, Mountain View, CA, USA
| | - J Blecic
- New York University Abu Dhabi, Abu Dhabi, United Arab Emirates
- Center for Astro, Particle and Planetary Physics (CAP3), New York University Abu Dhabi, Abu Dhabi, UAE
| | - J Brande
- Department of Physics and Astronomy, University of Kansas, Lawrence, KS, USA
| | - S Casewell
- School of Physics and Astronomy, University of Leicester, Leicester, UK
| | - Q Changeat
- Space Telescope Science Institute, Baltimore, MD, USA
- European Space Agency (ESA), ESA Baltimore Office, Baltimore, MD, USA
- Department of Physics and Astronomy, University College London, London, UK
| | - K L Chubb
- Centre for Exoplanet Science, University of St Andrews, St Andrews, UK
| | - N Crouzet
- Leiden Observatory, Leiden University, Leiden, the Netherlands
| | - T Daylan
- Department of Astrophysical Sciences, Princeton University, Princeton, NJ, USA
| | - L Decin
- Department of Physics and Astronomy, KU Leuven, Leuven, Belgium
| | - J Désert
- Anton Pannekoek Institute for Astronomy, University of Amsterdam, Amsterdam, the Netherlands
| | - T Mikal-Evans
- Max Planck Institute for Astronomy, Heidelberg, Germany
| | - A D Feinstein
- Department of Astronomy and Astrophysics, University of Chicago, Chicago, IL, USA
- School of Physical Sciences, The Open University, Milton Keynes, UK
| | - L Flagg
- Department of Astronomy and Carl Sagan Institute, Cornell University, Ithaca, NY, USA
| | - J J Fortney
- Department of Astronomy and Astrophysics, University of California, Santa Cruz, Santa Cruz, CA, USA
| | - J Harrington
- Planetary Science Group, Department of Physics and Florida Space Institute, University of Central Florida, Orlando, FL, USA
| | - K Heng
- University Observatory Munich, Ludwig Maximilian University, Munich, Germany
| | - Y Hong
- Department of Astronomy and Carl Sagan Institute, Cornell University, Ithaca, NY, USA
| | - R Hu
- Jet Propulsion Laboratory, California Institute of Technology, Pasadena, CA, USA
- Division of Geological and Planetary Sciences, California Institute of Technology, Pasadena, CA, USA
| | - N Iro
- Institute for Astrophysics, University of Vienna, Vienna, Austria
| | - T Kataria
- Jet Propulsion Laboratory, California Institute of Technology, Pasadena, CA, USA
| | - E M-R Kempton
- Department of Astronomy, University of Maryland, College Park, MD, USA
| | - J Krick
- California Institute of Technology, IPAC, Pasadena, CA, USA
| | - M Lendl
- Department of Astronomy, University of Geneva, Geneva, Switzerland
| | - J Lillo-Box
- Centre for Astrobiology (CSIC-INTA), European Space Astronomy Centre Campus, University of Maria de Maeztu, Madrid, Spain
| | - A Louca
- Leiden Observatory, Leiden University, Leiden, the Netherlands
| | | | - L Mancini
- Max Planck Institute for Astronomy, Heidelberg, Germany
- INAF - Astrophysics Observatory at Turin, Turin, Italy
- Department of Physics, University of Rome 'Tor Vergata', Rome, Italy
| | - M Mansfield
- Steward Observatory, University of Arizona, Tucson, AZ, USA
| | - N J Mayne
- Department of Physics and Astronomy, Faculty of Environment, Science and Economy, University of Exeter, Exeter, UK
| | - Y Miguel
- Leiden Observatory, Leiden University, Leiden, the Netherlands
- SRON Netherlands Institute for Space Research, Leiden, the Netherlands
| | - G Morello
- Institute for Astrophysics of Canarias (IAC), La Laguna, Tenerife, Spain
- Department of Astrophysics, University of La Laguna, La Laguna, Tenerife, Spain
- INAF Äì Palermo Astronomical Observatory, Palermo, Italy
| | - K Ohno
- Department of Astronomy and Astrophysics, University of California, Santa Cruz, Santa Cruz, CA, USA
| | - E Palle
- Institute for Astrophysics of Canarias (IAC), La Laguna, Tenerife, Spain
| | | | - B V Rackham
- Department of Earth, Atmospheric and Planetary Sciences, Massachusetts Institute of Technology, Cambridge, MA, USA
- Kavli Institute for Astrophysics and Space Research, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - M Radica
- Institute of Research on Exoplanets, Department of Physics, University of Montreal, Montreal, Québec, Canada
| | - L Ramos-Rosado
- Department of Physics and Astronomy, Johns Hopkins University, Baltimore, MD, USA
| | - S Redfield
- Astronomy Department and Van Vleck Observatory, Wesleyan University, Middletown, CT, USA
| | - L K Rogers
- Institute of Astronomy, University of Cambridge, Cambridgeshire, UK
| | - E L Shkolnik
- School of Earth and Space Exploration, Arizona State University, Tempe, AZ, USA
| | - J Southworth
- Astrophysics Group, Keele University, Staffordshire, UK
| | - J Teske
- Earth and Planets Laboratory, Carnegie Institution of Washington, Washington, DC, USA
| | - P Tremblin
- UVSQ, CNRS, CEA, Maison de la Simulation, Université Paris-Saclay, Gif-sur-Yvette, France
| | - G S Tucker
- Department of Physics, Brown University, Providence, RI, USA
| | - O Venot
- Université de Paris Cité and Univ Paris Est Creteil, CNRS, LISA, Paris, France
| | - W C Waalkes
- Astrophysics and Planetary Sciences, University of Colorado Boulder, Boulder, CO, USA
| | - L Welbanks
- School of Earth and Space Exploration, Arizona State University, Tempe, AZ, USA
| | - X Zhang
- Department of Earth and Planetary Sciences, University of California Santa Cruz, Santa Cruz, CA, USA
| | - S Zieba
- Max Planck Institute for Astronomy, Heidelberg, Germany
- Leiden Observatory, Leiden University, Leiden, the Netherlands
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Biswas N, Roy D, Karmakar S, Bhowmik R, Mazumdar H, Banerjee A, Roy A, Dey S. Differential expression of TLR4 in patients of coronary artery disease with and without traditional cardiovascular risk factors. Eur Heart J 2023. [DOI: 10.1093/eurheartj/ehac779.137] [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: 01/26/2023] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Atherosclerosis is inherently an inflammatory process, with a complex interplay of inflammatory markers. It is established that these inflammatory markers play an important role in patients of Coronary Artery Disease(CAD) with traditional cardiovascular risk factors. However, the role of inflammation in the atherosclerotic process in patients of CAD without traditional risk factors is still not clearly known.
Purpose
Our purpose was to determine whether in patients of CAD without traditional risk factors, TLR4(Toll like receptor 4) expression as a marker of inflammation is similar to that in patients of CAD with traditional risk factors.
Materials and Methods
This observational cross sectional study was done between July’20 to Dec’21. Equal number of patients of CAD with and without traditional cardiovascular risk factors undergoing Coronary Artery Bypass Grafting (CABG) were enrolled. The risk factors considered were Hypertension, Diabetes, Dyslipidemia, Obesity and Addiction to Tobacco and/or Alcohol. A minimum of two punch biopsy samples of aortic tissue was taken from each subject undergoing CABG. Immunohistochemistry for TLR4, was done in Ventana BenchMark GX System. The primary TLR4 antibody was procured from reputed source.
Results
The presence or absence of TLR4 expression was associated significantly with the Syntax scores (37.40±4.74 vs 29.5±8.71; p value=0.036), total Cholesterol (187±35.06mg/dL vs 130±35.69 mg/dL ;p value 0.010) and LDL cholesterol (118.86±28.12mg/dL vs 64.21±25.61 mg/dL; p value 0.003). TLR4 expression, however, was not significantly associated with the number of coronary vessels involved (p=0.298). TLR4 expression was also not significantly associated with any other individual risk factors. However, when the traditional risk factors were considered in combination, TLR4 expression was associated significantly with the number of risk factors present(p=0.029) the strongest being in those having 4 traditional risk factors. The level of TLR4 expression gradually declined with the decrease in the number of risk factors, having mostly weak or negative expression in patients without any traditional risk factors.
Conclusion
Patients with CAD without any traditional risk factors, had a less severe coronary artery disease as manifested by lower Syntax scores, and had lower degree of TLR4 expression. Patients with CAD with traditional risk factors had more severe coronary artery disease as evidenced by higher Syntax scores, and had higher degree of TLR4 expression proportional to the number of traditional risk factors present. Thus, differential TLR4 expression in CAD patients with and without traditional risk factors indicated a difference in inflammatory state between the two groups and warrants further investigation.
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Affiliation(s)
- N Biswas
- Rabindranath Tagore International Institute of Cardiac Sciences , Kolkata , India
| | - D Roy
- Rabindranath Tagore International Institute of Cardiac Sciences , Kolkata , India
| | - S Karmakar
- Jadavpur University, Centre for Bioequivalence Study, Department of Pharmaceutical Technology , Kolkata , India
| | - R Bhowmik
- Jadavpur University, Centre for Bioequivalence Study, Department of Pharmaceutical Technology , Kolkata , India
| | - H Mazumdar
- Jadavpur University, Centre for Bioequivalence Study, Department of Pharmaceutical Technology , Kolkata , India
| | - A Banerjee
- Rabindranath Tagore International Institute of Cardiac Sciences , Kolkata , India
| | - A Roy
- Rabindranath Tagore International Institute of Cardiac Sciences , Kolkata , India
| | - S Dey
- Rabindranath Tagore International Institute of Cardiac Sciences , Kolkata , India
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Banerjee A, Hendrick P, Blake H. Predictors of self-management in patients with chronic low back pain: a longitudinal study. BMC Musculoskelet Disord 2022; 23:1071. [PMID: 36476492 PMCID: PMC9727914 DOI: 10.1186/s12891-022-05933-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Accepted: 10/28/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Self-management (SM) is a key recommended strategy for managing chronic low back pain (CLBP). However, SM programmes generate small to moderate benefits for reducing pain and disability in patients with CLBP. The benefits of the SM programme can potentially be optimised by identifying specific subgroups of patients who are the best responders. To date, no longitudinal study has examined the predictive relationships between SM and biopsychosocial factors in patients with CLBP. The aim was to determine whether biopsychosocial factors predict SM and its change over time in patients with CLBP. METHODS In this multi-centre longitudinal cohort study, we recruited 270 working-age patients with CLBP (mean age 43.74, 61% female) who consulted outpatient physiotherapy for their CLBP. Participants completed self-reported validated measures of pain intensity, disability, physical activity, kinesiophobia, catastrophising, depression and SM at baseline and six months. SM constructs were measured using eight subscales of the Health Education Impact Questionnaire (heiQ), including Health Directed Activity (HDA), Positive and Active Engagement in Life (PAEL), Emotional Distress (ED), Self-Monitoring and Insight (SMI), Constructive Attitudes and Approaches (CAA), Skill and Technique Acquisition (STA), Social Integration and Support (SIS) and Health Service Navigation (HSN). Data were analysed using General Linear Model (GLM) regression. RESULTS Physical activity and healthcare use (positively) and disability, depression, kinesiophobia, catastrophising (negatively) predicted (p < 0.05, R2 0.07-0.55) SM constructs at baseline in patients with CLBP. Baseline depression (constructs: PAEL, ED, SMI, CAA and STA), kinesiophobia (constructs: CAA and HSN), catastrophising (construct: ED), and physical disability (constructs: PAEL, CAA and SIS) negatively predicted a range of SM constructs. Changes over six months in SM constructs were predicted by changes in depression, kinesiophobia, catastrophising, and physical activity (p < 0.05, R2 0.13-0.32). CONCLUSIONS Self-reported disability, physical activity, depression, catastrophising and kinesiophobia predicted multiple constructs of SM measured using the heiQ subscales in working-age patients with CLBP. Knowledge of biopsychosocial predictors of SM may help triage patients with CLBP into targeted pain management programmes. TRIAL REGISTRATION The study protocol was registered at ClinicalTrials.gov on 22 December 2015 (ID: NCT02636777).
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Affiliation(s)
- A. Banerjee
- grid.9757.c0000 0004 0415 6205Keele University, School of Allied Health Professions, Staffordshire, ST5 5BG UK ,Nottingham CityCare Partnership CIC, Nottingham, UK
| | - P. Hendrick
- grid.4563.40000 0004 1936 8868University of Nottingham, School of Health Sciences, Nottingham, UK
| | - H. Blake
- grid.4563.40000 0004 1936 8868University of Nottingham, School of Health Sciences, Nottingham, UK ,grid.511312.50000 0004 9032 5393NIHR Nottingham Biomedical Research Centre, Nottingham, UK
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Varghese V, Yoganandan N, Baisden J, Choi H, Banerjee A. Morphometry of lumbar muscles in the seated posture with weight-bearing MR scans. J Clin Orthop Trauma 2022; 35:102051. [PMID: 36340960 PMCID: PMC9634358 DOI: 10.1016/j.jcot.2022.102051] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 08/24/2022] [Accepted: 10/18/2022] [Indexed: 11/07/2022] Open
Abstract
Conventional imaging studies of human spine are done in a supine posture in which the axial loading of the spine is not considered. Upright images better reveal the interrelationships between the various internal structures of the spine. The objective of the current study is to determine the cross-sectional areas, radii, and angulations of the psoas, erector spinae, and multifidus muscles of the lumbar spine in the sitting posture. Ten young (mean age 31 ± 4.8 years) asymptomatic female subjects were enrolled. They were seated in an erect posture and weight-bearing T1 and T2 MRIs were obtained. Cross-sectional areas, radii, and angulations of the muscles were measured from L1-L5. Two observers repeated all the measurements for all parameters, and reliability was determined using the inter- and intra-class coefficients. The Pearson product moment correlation was used for association between levels, while level differences were used using a linear regression model. The cross-sectional areas of the psoas and multifidus muscles increased from L1 to L5 (1.9 ± 1.1 to 12.1 ± 2.5 cm2 and 1.8 ± 0.3 to 5.7 ± 1.4 cm2). The cross-sectional area of the erector spinae was greatest at the midlevel (13.9 ± 2.2 cm2) and it decreased in both directions. For the angle, the range for psoas muscles was 75-105°, erector spinae were 39-46° and multifidus was 11-19°. Correlations magnitudes were inconsistent between levels and muscle types. These quantitated data improve our understanding of the geometrical properties in the sitting posture. The weight-bearing MRI-quantified morphometrics of human lumbar spine muscles from this study can be used in biomechanical models for predicting loads on spinal joints under physiological and traumatic situations.
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Affiliation(s)
- Vicky Varghese
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Narayan Yoganandan
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Jamie Baisden
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Hoon Choi
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Anjishnu Banerjee
- Division of Biostatistics, Medical College of Wisconsin, Milwaukee, WI, USA
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Bobholz S, Lowman A, Duenweg S, Winiarz A, Kyereme F, Cochran E, Connelly J, Mueller W, Agarwal M, Banerjee A, LaViolette P. NIMG-56. PHENOTYPIC ANALYSIS OF RADIO-PATHOMIC MAPS IN DE-NOVO GLIOBLASTOMA IDENTIFIES DIFFERENCES IN BEVACIZUMAB TREATMENT RESPONSE. Neuro Oncol 2022. [PMCID: PMC9660921 DOI: 10.1093/neuonc/noac209.674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract
PURPOSE
Bevacizumab (Bev) treatment for recurrent glioblastoma ceases tumor angiogenesis, which changes tumor appearance on Gd enhanced T1-weighted imaging. However, little is known about how non-angiogenic portions of tumor are affected by Bev. Therefore, this study tested the hypothesis that patients with specific tumor appearance phenotypes outside contrast enhancement, as identified using autopsy tissue-based radio-pathomic maps, would show differences in survival benefit from Bev treatment.
METHODS
Previously published methods were used to create machine learning models that generate whole-brain maps of cellularity (Cell), extracellular fluid (ECF) and cytoplasm (Cyt) using glioma autopsy tissue aligned to the patient’s last MRI as ground truth (Bobholz et al. 2022). These maps were then generated for an independent dataset of glioblastoma patients (n=80) using baseline imaging acquired prior to treatment. Patients were then graded for qualitative characteristics of the non-enhancing margin, with phenotypes including Well-Circumscribed (WC) patients with no abnormal tissue surrounding the core, Hypercellular Front (HF) patients with areas of hypercellularity extending from the core, Necrotic Front (NF) patients with areas of necrosis extending from the core, and Hybrid Front (HYF) patients with both hypercellular and necrotic presence beyond the enhancing region. Kaplan Meier analysis was then used to compare survival outcomes between patients who did and did not receive Bev treatment within each phenotype to assess differences in treatment efficacy.
RESULTS
Only patients with NF or HYF showed significant survival increase with bevacizumab treatment (HR=2.35, p=0.02; and HR=2.45, p=0.03, respectively), with no significant or trending difference in survival observed for WC and HF patients.
CONCLUSION
Radio-pathomic phenotypes identify patients who show the greatest survival benefit from Bev treatment, which could be used to direct clinical decision-making.
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Affiliation(s)
| | | | | | | | | | | | | | - Wade Mueller
- Medical College of Wisconsins , Milwaukee, WI , USA
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Bobholz S, Lowman A, Duenweg S, Winiarz A, Kyereme F, Cochran E, Connelly J, Mueller W, Agarwal M, Banerjee A, LaViolette P. NIMG-49. RADIO-PATHOMIC MAPS OF DE-NOVO GLIOBLASTOMA IDENTIFY PHENOTYPES OF TUMOR INVASION ASSOCIATED WITH PROGNOSIS. Neuro Oncol 2022. [DOI: 10.1093/neuonc/noac209.667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract
PURPOSE
Although tumor is known to exist beyond the contrast-enhancing margin, a lack of access to pathological information beyond enhancement has hindered the study of non-angiogenic tumor characteristics and their effects on patient prognosis. This study tested the hypothesis that radio-pathomic maps of tumor characteristics developed using autopsy tissue samples can identify phenotypes relevant to patient survival and treatment outcomes.
METHODS
A dataset of autopsy tissue samples aligned to the MRI as ground truth from 65 glioma patients (training set n=43, test set n=22) was used to train machine learning models that predict and map tumor cellularity (Cell), extracellular fluid (ECF), and cytoplasm (Cyt) density following our previously published methodology (Bobholz et al. 2022). Cell, ECF, and Cyt maps were then generated from the pre-surgical MRI scans from an independent dataset of 80 glioblastoma patients. Each patient was separated into groups based on the appearance of tumor characteristics beyond the contrast-enhancing margin. Group phenotypes included Well-Circumscribed (WC) tumors with no tumor activity beyond contrast enhancement, Necrotic Front (NF) tumors with areas of necrosis extending beyond the tumor margin, Hypercellular Front (HF) tumors with areas of increased cellularity surrounding the tumor, and Hybrid Front (HYF) tumors with characteristics of both HF and NF tumors. A Cox regression was used to assess survival differences between phenotypes, controlling for treatment history.
RESULTS
Across the 80 patients, 22 were classified as WC, 14 were classified as HF, 24 were classified as NF, and 20 were classified as HYF. NF, HF, and HYF tumors each showed significant/trending reductions in survival when compared to WC tumors (HR=2.02, p=0.03; HR=2.0, p=0.06; and HR=1.75, p=0.09, respectively).
CONCLUSION
Radio-pathomic phenotypes identify characteristics beyond the contrast-enhancing margin that affect overall survival outcome in glioblastoma.
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Affiliation(s)
| | | | | | | | | | | | | | - Wade Mueller
- Medical College of Wisconsins , Milwaukee, WI , USA
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Lowman A, Bobholz S, Duenweg S, Kyereme F, Cochran E, Coss D, Connelly J, Mueller W, Agarwal M, Banerjee A, LaViolette P. NCOG-18. OVERALL SURVIVAL VARIATION DUE TO THE TIMING OF POST-SURGICAL RADIATION IN HIGH-GRADE GLIOMAS. Neuro Oncol 2022. [PMCID: PMC9660756 DOI: 10.1093/neuonc/noac209.771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract
PURPOSE
Grade III and IV astrocytomas and glioblastomas are recognized as high-grade gliomas with aggressive heterogenous natures that carry with them a low overall survival (OS). Standard treatment currently involves surgical resection followed by radiation (RT) and concomitant chemotherapy. Despite this standard pathway, there is often disagreement in the optimal timing of radiation initiation post-surgery. In this study, we examined a subset of patients diagnosed with primary high-grade gliomas that underwent radiation following surgery at varying time frames.
METHODS
53 patients from our brain cancer bank with surgical diagnosis of high-grade gliomas were retrospectively analyses for this study. All patients were grouped into three cohorts based on the timing of the initiation of radiation post-surgery. Group 1 RT < 4 weeks, Group 2 RT 4-5 weeks, and Group 3 RT > 5 weeks post-surgery. Overall survival was calculated in days from initial surgical resection to time of death.
RESULTS
Across the three patient cohorts, Group 1 included 9 patients (mean OS 430 days), Group 2 had 18 patients (mean OS 597 days), and Group 3 had 26 patients (mean OS 895 days). Overall survival trended towards a difference between the three radiation timing groups, with Group 3 showing better survival outcomes compared to Group 1 (p=0.07).
CONCLUSIONS
This current study demonstrates a positive outcome with increased time between surgical intervention and initiation of radiation and concomitant chemotherapy. While we did not correct for additional treatment outside of standard clinical care, we would expect to observe similar trends. Despite these promising results for treatment planning, future research in larger cohorts is necessary to investigate possible molecular markers that may also impact treatment response and overall survival.
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Affiliation(s)
| | | | | | | | | | - Dylan Coss
- Medical College of Wisconsin , Milwaukee, WI , USA
| | | | - Wade Mueller
- Medical College of Wisconsins , Milwaukee, WI , USA
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Lowman A, Bobholz S, Brehler M, Duenweg S, Kyereme F, Cochran E, Coss D, Connelly J, Mueller W, Agarwal M, Banerjee A, LaViolette P. NIMG-18. A GROUND TRUTH COMPARISON OF PATHOLOGICALLY CONFIRMED GLIOBLASTOMA MARGINS TO CONTRAST ENHANCEMENT AT AUTOPSY. Neuro Oncol 2022. [DOI: 10.1093/neuonc/noac209.636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract
PURPOSE
Glioblastoma is one of the most common and deadly adult brain tumors. Current standard treatment is surgical resection followed by radiation and concomitant chemotherapy (chemoRT). Glioblastoma progression is monitored using MRI, primarily relying on post-contrast T1-weighted imaging (T1C). Unfortunately, tumor invasion is known to extend beyond traditional contrast enhancement. T1-subtraction (T1S) maps have been introduced as a better tumor volume estimate. In this study we compare T1S map derived tumor annotations to a radiologist for identifying histologically confirmed tumor in patients with differing treatment histories at autopsy.
METHODS
Ten patients with autopsy confirmed glioblastoma and MRI within 1 month of death were recruited for this study. Seven patients received chemoRT combined (chemoRT+) and three patients received no treatment beyond surgery (chemoRT-). Patient’s brains were sliced axially in the same orientation as their final MRI using a patient-specific slicing jig. Large tissue samples were taken, processed, embedded in paraffin, stained for hematoxylin and eosin, and digitized at 40x resolution. Digital images were annotated for infiltrative tumor, pseudopalisading necrosis, and necrosis without palisading cells. T1S and radiologist annotations were created for each patient using their final MRI (mean 18 days prior to death). The annotated histology images were aligned and resampled into MRI space using custom software and the overlap of pathologically confirmed tumor and MRI derived annotations was compared.
RESULTS
T1S maps alone were significantly better at identifying areas of histologically confirmed tumor in chemoRT+ patients compared to chemoRT- patients (p=0.043). T1S derived annotations overlapped with 52% of histologically confirmed tumor in the chemoRT- patients and 78% in the chemoRT+. The radiologist drawn tumor masks were more accurate in chemoRT+ patients, identifying 61% confirmed tumor (trending, p=0.097, chemoRT+=61%).
CONCLUSION
These results demonstrate the difficulty of identifying pathologically confirmed tumor outside contrast enhancement in glioblastoma patients, even in the untreated state.
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Affiliation(s)
| | | | | | | | | | | | - Dylan Coss
- Medical College of Wisconsin , Milwaukee, WI , USA
| | | | - Wade Mueller
- Medical College of Wisconsins , Milwaukee, WI , USA
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