1
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Verma P, Malhotra G, Rao RD, Sonavane S, Agrawal R. Rare Presentations of Differentiated Thyroid Cancer Exposing Dr Jekyll and Mr Hyde Nature of an Otherwise Indolent Disease: Case Series. Clin Nucl Med 2024; 49:e193-e196. [PMID: 38409755 DOI: 10.1097/rlu.0000000000005138] [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: 02/28/2024]
Abstract
ABSTRACT Differentiated thyroid carcinoma (DTC) usually manifests as an indolent cancer with good prognosis. However, rarely uncommon sites of metastatic involvement can worsen the prognosis and require aggressive therapeutic approach. Here in, we describe 5 patients (3 women and 2 men) harboring rare sites of metastatic involvement from DTC including the adrenals, colon, kidneys, urinary bladder, brachial plexus, and superior vena cava with contiguous right atrial involvement. The awareness of such rare sites of involvement from DTC is imperative for treating clinicians to plan individualistic approach in management including multiprong therapies for better patient care.
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Affiliation(s)
| | | | | | | | - Ritesh Agrawal
- Department of Endocrine Surgery, Bombay Hospital and Medical Research Centre, Mumbai, India
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2
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Bao X, Kumar SS, Shah NJ, Penning D, Weinstein M, Malhotra G, Rose S, Drover D, Pennington MW, Domino K, Meng L, Treggiari M, Clavijo C, Wagener G, Chitilian H, Maheshwari K. AcumenTM hypotension prediction index guidance for prevention and treatment of hypotension in noncardiac surgery: a prospective, single-arm, multicenter trial. Perioper Med (Lond) 2024; 13:13. [PMID: 38439069 PMCID: PMC10913612 DOI: 10.1186/s13741-024-00369-9] [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: 08/06/2023] [Accepted: 02/25/2024] [Indexed: 03/06/2024] Open
Abstract
BACKGROUND Intraoperative hypotension is common during noncardiac surgery and is associated with postoperative myocardial infarction, acute kidney injury, stroke, and severe infection. The Hypotension Prediction Index software is an algorithm based on arterial waveform analysis that alerts clinicians of the patient's likelihood of experiencing a future hypotensive event, defined as mean arterial pressure < 65 mmHg for at least 1 min. METHODS Two analyses included (1) a prospective, single-arm trial, with continuous blood pressure measurements from study monitors, compared to a historical comparison cohort. (2) A post hoc analysis of a subset of trial participants versus a propensity score-weighted contemporaneous comparison group, using external data from the Multicenter Perioperative Outcomes Group (MPOG). The trial included 485 subjects in 11 sites; 406 were in the final effectiveness analysis. The post hoc analysis included 457 trial participants and 15,796 comparison patients. Patients were eligible if aged 18 years or older, American Society of Anesthesiologists (ASA) physical status 3 or 4, and scheduled for moderate- to high-risk noncardiac surgery expected to last at least 3 h. MEASUREMENTS minutes of mean arterial pressure (MAP) below 65 mmHg and area under MAP < 65 mmHg. RESULTS Analysis 1: Trial subjects (n = 406) experienced a mean of 9 ± 13 min of MAP below 65 mmHg, compared with the MPOG historical control mean of 25 ± 41 min, a 65% reduction (p < 0.001). Subjects with at least one episode of hypotension (n = 293) had a mean of 12 ± 14 min of MAP below 65 mmHg compared with the MPOG historical control mean of 28 ± 43 min, a 58% reduction (p< 0.001). Analysis 2: In the post hoc inverse probability treatment weighting model, patients in the trial demonstrated a 35% reduction in minutes of hypotension compared to a contemporaneous comparison group [exponentiated coefficient: - 0.35 (95%CI - 0.43, - 0.27); p < 0.001]. CONCLUSIONS The use of prediction software for blood pressure management was associated with a clinically meaningful reduction in the duration of intraoperative hypotension. Further studies must investigate whether predictive algorithms to prevent hypotension can reduce adverse outcomes. TRIAL REGISTRATION Clinical trial number: NCT03805217. Registry URL: https://clinicaltrials.gov/ct2/show/NCT03805217 . Principal investigator: Xiaodong Bao, MD, PhD. Date of registration: January 15, 2019.
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Affiliation(s)
- Xiaodong Bao
- Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA.
| | - Sathish S Kumar
- Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Nirav J Shah
- Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Donald Penning
- Department of Anesthesiology, Henry Ford Health System, Detroit, MI, USA
| | - Mitchell Weinstein
- Department of Anesthesiology and Critical Care, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Gaurav Malhotra
- Department of Anesthesiology and Critical Care, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Sydney Rose
- Department of Anesthesiology and Perioperative Medicine, Oregon Health & Science University, Portland, OR, USA
| | - David Drover
- Department of Anesthesia, Stanford University, Stanford, CA, USA
| | - Matthew W Pennington
- Department of Anesthesiology and Pain Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | - Karen Domino
- Department of Anesthesiology and Pain Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | - Lingzhong Meng
- Department of Anesthesiology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Mariam Treggiari
- Department of Anesthesiology, Duke University School of Medicine, Durham, NC, USA
| | - Claudia Clavijo
- Department of Anesthesiology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Gebhard Wagener
- Department of Anesthesiology, College of Physicians & Surgeons of Columbia University, New York, NY, USA
| | - Hovig Chitilian
- Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Kamal Maheshwari
- Department of General Anesthesiology, Cleveland Clinic, Cleveland, OH, USA
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3
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Swan AL, Broadbent A, Singh Gaur P, Mishra A, Gurwitz K, Mithani A, Morgan SL, Malhotra G, Brooksbank C. Making bioinformatics training FAIR: the EMBL-EBI training portal. Front Bioinform 2024; 4:1347168. [PMID: 38357576 PMCID: PMC10866141 DOI: 10.3389/fbinf.2024.1347168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 01/17/2024] [Indexed: 02/16/2024] Open
Abstract
EMBL-EBI provides a broad range of training in data-driven life sciences. To improve awareness and access to training course listings and to make digital learning materials findable and simple to use, the EMBL-EBI Training website, www.ebi.ac.uk/training, was redesigned and restructured. To provide a framework for the redesign of the website, the FAIR (findable, accessible, interoperable, reusable) principles were applied to both the listings of live training courses and the presentation of on-demand training content. Each of the FAIR principles guided decisions on the choice of technology used to develop the website, including the details provided about training and the way in which training was presented. Since its release the openly accessible website has been accessed by an average of 58,492 users a month. There have also been over 12,000 unique users creating accounts since the functionality was added in March 2022, allowing these users to track their learning and record completion of training. Development of the website was completed using the Agile Scrum project management methodology and a focus on user experience. This framework continues to be used now that the website is live for the maintenance and improvement of the website, as feedback continues to be collected and further ways to make training FAIR are identified. Here, we describe the process of making EMBL-EBI's training FAIR through the development of a new website and our experience of implementing Agile Scrum.
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Affiliation(s)
- A. L. Swan
- EMBL’s European Bioinformatics Institute (EMBL-EBI), Wellcome Genome Campus, Cambridge, United Kingdom
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4
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Bowers JS, Malhotra G, Dujmović M, Montero ML, Tsvetkov C, Biscione V, Puebla G, Adolfi F, Hummel JE, Heaton RF, Evans BD, Mitchell J, Blything R. Clarifying status of DNNs as models of human vision. Behav Brain Sci 2023; 46:e415. [PMID: 38054298 DOI: 10.1017/s0140525x23002777] [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: 12/07/2023]
Abstract
On several key issues we agree with the commentators. Perhaps most importantly, everyone seems to agree that psychology has an important role to play in building better models of human vision, and (most) everyone agrees (including us) that deep neural networks (DNNs) will play an important role in modelling human vision going forward. But there are also disagreements about what models are for, how DNN-human correspondences should be evaluated, the value of alternative modelling approaches, and impact of marketing hype in the literature. In our view, these latter issues are contributing to many unjustified claims regarding DNN-human correspondences in vision and other domains of cognition. We explore all these issues in this response.
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Affiliation(s)
- Jeffrey S Bowers
- School of Psychological Science, University of Bristol, Bristol, UK ; https://jeffbowers.blogs.bristol.ac.uk/
| | - Gaurav Malhotra
- School of Psychological Science, University of Bristol, Bristol, UK ; https://jeffbowers.blogs.bristol.ac.uk/
| | - Marin Dujmović
- School of Psychological Science, University of Bristol, Bristol, UK ; https://jeffbowers.blogs.bristol.ac.uk/
| | - Milton L Montero
- School of Psychological Science, University of Bristol, Bristol, UK ; https://jeffbowers.blogs.bristol.ac.uk/
| | - Christian Tsvetkov
- School of Psychological Science, University of Bristol, Bristol, UK ; https://jeffbowers.blogs.bristol.ac.uk/
| | - Valerio Biscione
- School of Psychological Science, University of Bristol, Bristol, UK ; https://jeffbowers.blogs.bristol.ac.uk/
| | | | - Federico Adolfi
- Ernst Strüngmann Institute (ESI) for Neuroscience in Cooperation with Max Planck Society, Frankfurt am Main, Germany
| | - John E Hummel
- Psychology Department, University of Illinois Urbana-Champaign, Champaign, IL, USA
| | - Rachel F Heaton
- Psychology Department, University of Illinois Urbana-Champaign, Champaign, IL, USA
| | - Benjamin D Evans
- Department of Informatics, School of Engineering and Informatics, University of Sussex, Brighton, UK
| | - Jeffrey Mitchell
- Department of Informatics, School of Engineering and Informatics, University of Sussex, Brighton, UK
| | - Ryan Blything
- School of Psychology, Aston University, Birmingham, UK
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5
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Malhotra G, Dujmović M, Hummel J, Bowers JS. Human shape representations are not an emergent property of learning to classify objects. J Exp Psychol Gen 2023; 152:3380-3402. [PMID: 37695326 DOI: 10.1037/xge0001440] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/12/2023]
Abstract
Humans are particularly sensitive to relationships between parts of objects. It remains unclear why this is. One hypothesis is that relational features are highly diagnostic of object categories and emerge as a result of learning to classify objects. We tested this by analyzing the internal representations of supervised convolutional neural networks (CNNs) trained to classify large sets of objects. We found that CNNs do not show the same sensitivity to relational changes as previously observed for human participants. Furthermore, when we precisely controlled the deformations to objects, human behavior was best predicted by the number of relational changes while CNNs were equally sensitive to all changes. Even changing the statistics of the learning environment by making relations uniquely diagnostic did not make networks more sensitive to relations in general. Our results show that learning to classify objects is not sufficient for the emergence of human shape representations. Instead, these results suggest that humans are selectively sensitive to relational changes because they build representations of distal objects from their retinal images and interpret relational changes as changes to these distal objects. This inferential process makes human shape representations qualitatively different from those of artificial neural networks optimized to perform image classification. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
| | | | - John Hummel
- Department of Psychology, University of Illinois Urbana-Champaign
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6
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Yami Channaiah C, Karlekar M, Sarathi V, Lila AR, Ravindra S, Badhe PV, Malhotra G, Memon SS, Patil VA, Pramesh CS, Bandgar T. Paediatric and adolescent ectopic Cushing's syndrome: systematic review. Eur J Endocrinol 2023; 189:S75-S87. [PMID: 37801647 DOI: 10.1093/ejendo/lvad133] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 08/06/2023] [Accepted: 10/04/2023] [Indexed: 10/08/2023]
Abstract
OBJECTIVE The data on clinical, biochemical, radiological characteristics, and outcomes in paediatric ectopic adrenocorticotropic hormone syndrome (EAS) are limited owing to rarity of the condition. We report three new cases and perform a systematic review of paediatric EAS. DESIGN AND METHOD Case records of paediatric and adolescent EAS patient's ≤20 years presenting at our centre between 1997 and 2021 were retrospectively reviewed, and a systematic review of the literature published between January 1970 and December 2022 was performed. RESULTS A total of 161 patients including 3 new patients from our centre were identified. Bronchial neuroendocrine tumours (NET) (28.5%), thymic NET (22.9%), primitive cell-derived tumours (18.6%), and gastro-entero-pancreatic-NET (13.7%) were the common causes. Primitive cell-derived tumours were the most common in the first decade (24/45, 53.4%) and were the largest (82 [60-100] mm), whereas bronchial NETs predominated during the second decade (42/116, 36.2%) and were the smallest (15 [10-25] mm). Computed tomography localized 92.9% (118/127) of paediatric EAS patients. Immediate postoperative remission was attained in 77.9% (88/113) patients, whereas 30.4% (24/79) relapsed over a median (IQR) period of 13 (8-36) months. Over a median (IQR) follow-up of 2 (0.6-4.6) years, 31.4% of patients died. The median survival was higher in bronchial NET than in other tumour groups. Distant metastasis and tumour size were independent negative predictors of survival. CONCLUSIONS Aetiological profile of paediatric and adolescent EAS is distinct from that of adults. Bronchial NETs have the best long-term survival, whereas distant metastasis and tumour size predict poor survival.
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Affiliation(s)
- Chethan Yami Channaiah
- Department of Endocrinology, Seth GS Medical College and KEM Hospital, Mumbai 400012, India
| | - Manjiri Karlekar
- Department of Endocrinology, Seth GS Medical College and KEM Hospital, Mumbai 400012, India
| | - Vijaya Sarathi
- Department of Endocrinology, Vydehi Institute of Medical Sciences and Research Centre, Bengaluru 560066, India
| | - Anurag Ranjan Lila
- Department of Endocrinology, Seth GS Medical College and KEM Hospital, Mumbai 400012, India
| | - Shruthi Ravindra
- Department of Endocrinology, Diabetes and Metabolism, Narayana Medical College, Nellore 524001, India
| | - Padma Vikram Badhe
- Department of Radiology, Seth GS Medical College and KEM Hospital, Mumbai 400012, India
| | - Gaurav Malhotra
- Radiation Medical Centre, Bhabha Atomic Research Centre, Mumbai 400012, India
| | - Saba Samad Memon
- Department of Endocrinology, Seth GS Medical College and KEM Hospital, Mumbai 400012, India
| | | | - C S Pramesh
- Department of Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai 400012, India
| | - Tushar Bandgar
- Department of Endocrinology, Seth GS Medical College and KEM Hospital, Mumbai 400012, India
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7
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Tsvetkov C, Malhotra G, Evans BD, Bowers JS. The role of capacity constraints in Convolutional Neural Networks for learning random versus natural data. Neural Netw 2023; 161:515-524. [PMID: 36805266 DOI: 10.1016/j.neunet.2023.01.011] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 11/17/2022] [Accepted: 01/11/2023] [Indexed: 02/05/2023]
Abstract
Convolutional neural networks (CNNs) are often described as promising models of human vision, yet they show many differences from human abilities. We focus on a superhuman capacity of top-performing CNNs, namely, their ability to learn very large datasets of random patterns. We verify that human learning on such tasks is extremely limited, even with few stimuli. We argue that the performance difference is due to CNNs' overcapacity and introduce biologically inspired mechanisms to constrain it, while retaining the good test set generalisation to structured images as characteristic of CNNs. We investigate the efficacy of adding noise to hidden units' activations, restricting early convolutional layers with a bottleneck, and using a bounded activation function. Internal noise was the most potent intervention and the only one which, by itself, could reduce random data performance in the tested models to chance levels. We also investigated whether networks with biologically inspired capacity constraints show improved generalisation to out-of-distribution stimuli, however little benefit was observed. Our results suggest that constraining networks with biologically motivated mechanisms paves the way for closer correspondence between network and human performance, but the few manipulations we have tested are only a small step towards that goal.
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Affiliation(s)
- Christian Tsvetkov
- School of Psychological Science, University of Bristol, 12a Priory Road, Bristol BS8 1TU, UK.
| | - Gaurav Malhotra
- School of Psychological Science, University of Bristol, 12a Priory Road, Bristol BS8 1TU, UK.
| | - Benjamin D Evans
- School of Psychological Science, University of Bristol, 12a Priory Road, Bristol BS8 1TU, UK; Department of Informatics, School of Engineering and Informatics, University of Sussex, Falmer, Brighton, BN1 9RH, UK.
| | - Jeffrey S Bowers
- School of Psychological Science, University of Bristol, 12a Priory Road, Bristol BS8 1TU, UK.
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8
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Verma P, Chandak A, Shetye SS, Nazar AK, Bagul SD, Malhotra G. Angiogenesis Imaging of Adrenocortical Carcinoma with Ga-68-NODAGA-RGD Positron Emission Tomography: Opening New Horizons in Multimodality Imaging from Theranostic Perspective. Indian J Nucl Med 2023; 38:183-184. [PMID: 37456196 PMCID: PMC10348488 DOI: 10.4103/ijnm.ijnm_186_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 12/24/2022] [Indexed: 07/18/2023] Open
Abstract
A 53-year-old female, with a known case of adrenocortical carcinoma (ACC), underwent F-18 fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) for initial staging, which revealed FDG avid large left suprarenal mass contiguous with hypermetabolic tumor thrombus in the inferior vena cava (IVC) through the left renal vein. Thereafter, she underwent angiogenesis imaging using Ga-68-NODAGA-RGD PET/CT, which showed similar avid tracer uptake in both primary and IVC thrombus. Demonstration of RGD avidity in ACC in this case opens a new horizon for targeted radionuclide therapy (e.g., Lu-177 RGD) in selected patients, who may have limited therapeutic options.
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Affiliation(s)
- Priyanka Verma
- Radiation Medicine Centre, Bhabha Atomic Research Centre, Mumbai, Maharashtra, India
- Clinical Nuclear Medicine, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Ashok Chandak
- Radiation Medicine Centre, Bhabha Atomic Research Centre, Mumbai, Maharashtra, India
| | - Suyog Sharad Shetye
- Department of Surgery, Seth G S Medical College and King Edward Memorial Hospital, Mumbai, Maharashtra, India
| | - Aamir K. Nazar
- Radiation Medicine Centre, Bhabha Atomic Research Centre, Mumbai, Maharashtra, India
| | - Swati Dinesh Bagul
- Radiation Medicine Centre, Bhabha Atomic Research Centre, Mumbai, Maharashtra, India
| | - Gaurav Malhotra
- Radiation Medicine Centre, Bhabha Atomic Research Centre, Mumbai, Maharashtra, India
- Clinical Nuclear Medicine, Homi Bhabha National Institute, Mumbai, Maharashtra, India
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9
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Bowers JS, Malhotra G, Dujmović M, Llera Montero M, Tsvetkov C, Biscione V, Puebla G, Adolfi F, Hummel JE, Heaton RF, Evans BD, Mitchell J, Blything R. Deep problems with neural network models of human vision. Behav Brain Sci 2022; 46:e385. [PMID: 36453586 DOI: 10.1017/s0140525x22002813] [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: 12/03/2022]
Abstract
Deep neural networks (DNNs) have had extraordinary successes in classifying photographic images of objects and are often described as the best models of biological vision. This conclusion is largely based on three sets of findings: (1) DNNs are more accurate than any other model in classifying images taken from various datasets, (2) DNNs do the best job in predicting the pattern of human errors in classifying objects taken from various behavioral datasets, and (3) DNNs do the best job in predicting brain signals in response to images taken from various brain datasets (e.g., single cell responses or fMRI data). However, these behavioral and brain datasets do not test hypotheses regarding what features are contributing to good predictions and we show that the predictions may be mediated by DNNs that share little overlap with biological vision. More problematically, we show that DNNs account for almost no results from psychological research. This contradicts the common claim that DNNs are good, let alone the best, models of human object recognition. We argue that theorists interested in developing biologically plausible models of human vision need to direct their attention to explaining psychological findings. More generally, theorists need to build models that explain the results of experiments that manipulate independent variables designed to test hypotheses rather than compete on making the best predictions. We conclude by briefly summarizing various promising modeling approaches that focus on psychological data.
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Affiliation(s)
- Jeffrey S Bowers
- School of Psychological Science, University of Bristol, Bristol, UK ; https://jeffbowers.blogs.bristol.ac.uk/
| | - Gaurav Malhotra
- School of Psychological Science, University of Bristol, Bristol, UK ; https://jeffbowers.blogs.bristol.ac.uk/
| | - Marin Dujmović
- School of Psychological Science, University of Bristol, Bristol, UK ; https://jeffbowers.blogs.bristol.ac.uk/
| | - Milton Llera Montero
- School of Psychological Science, University of Bristol, Bristol, UK ; https://jeffbowers.blogs.bristol.ac.uk/
| | - Christian Tsvetkov
- School of Psychological Science, University of Bristol, Bristol, UK ; https://jeffbowers.blogs.bristol.ac.uk/
| | - Valerio Biscione
- School of Psychological Science, University of Bristol, Bristol, UK ; https://jeffbowers.blogs.bristol.ac.uk/
| | - Guillermo Puebla
- School of Psychological Science, University of Bristol, Bristol, UK ; https://jeffbowers.blogs.bristol.ac.uk/
| | - Federico Adolfi
- School of Psychological Science, University of Bristol, Bristol, UK ; https://jeffbowers.blogs.bristol.ac.uk/
- Ernst Strüngmann Institute (ESI) for Neuroscience in Cooperation with Max Planck Society, Frankfurt am Main, Germany
| | - John E Hummel
- Department of Psychology, University of Illinois Urbana-Champaign, Champaign, IL, USA
| | - Rachel F Heaton
- Department of Psychology, University of Illinois Urbana-Champaign, Champaign, IL, USA
| | - Benjamin D Evans
- Department of Informatics, School of Engineering and Informatics, University of Sussex, Brighton, UK
| | - Jeffrey Mitchell
- Department of Informatics, School of Engineering and Informatics, University of Sussex, Brighton, UK
| | - Ryan Blything
- School of Psychology, Aston University, Birmingham, UK
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10
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Dodamani MH, Jaiswal SK, Sarathi V, Marfatia H, D'Cruz A, Malhotra G, Hira P, Patil VA, Lila AR, Shah NS, Bandgar TR. Comparison of the Sensitivity of 68Ga-DOTATATE PET/CT with Other Imaging Modalities in Detecting Head and Neck Paraganglioma: Experience from Western India. World J Nucl Med 2022; 21:184-191. [PMID: 36060084 PMCID: PMC9436509 DOI: 10.1055/s-0042-1751030] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background
This study aimed to compare the sensitivity of
68
Ga-DOTATATE positron emission tomography/computed tomography (PET/CT) with other imaging modalities in the detection of head and neck paraganglioma (HNPGL).
Methods
The data of consecutive HNPGL patients (
n
= 34) who had undergone at least
68
Ga-DOTATATE PET/CT and anatomical imaging (contrast-enhanced computed tomography/magnetic resonance imaging [CECT/MRI]) were retrospectively reviewed. The diagnosis of HNPGL (the primary tumor) was confirmed either by histopathology (
n
= 10) or was based on clinical follow-up and correlation of anatomical with functional imaging in whom histopathology was not available (
n
= 24). The sensitivities of
68
Ga DOTATATE PET/CT, 18F-fluorodeoxyglucose positron emission tomography/computed tomography (
18
F-FDG-PET/CT),
131
I-metaiodobenzylguanidine (
131
I-MIBG) scintigraphy, and CECT/MRI for primary HNPGL, associated primary pheochromocytoma + sympathetic paraganglioma (PCC + sPGL), and metastatic lesions were analyzed.
Results
Thirty-four patients (males: 15) [isolated HNPGL: 26, HNPGL + PCC: 04, HNPGL+ sPGL: 03, HNPGL + PCC + sPGL: 01] harboring 50 primary lesions were included. For total lesions,
68
Ga-DOTATATE PET/CT (99.3%) had significantly higher lesion-wise sensitivity than
18
F-FDG PET/CT (81.6%,
p
= 0.0164),
131
I-MIBG (15.2%,
p
≤0.0001), CECT (46.3%,
p
≤ 0.0001) but similar sensitivity as MRI neck (97%,
p
= 0.79). On head-to-head comparison (21 primary HNPGL and 39 metastatic lesions),
68
Ga DOTATATE PET/CT had significantly higher lesion-wise sensitivities for the detection of metastatic (100 vs. 71.9%,
p
= 0.04) and total lesions (100 vs. 77.2%,
p
≤ 0.0001).
Conclusion
68
Ga-DOTATATE PET/CT was the most sensitive imaging modality for the detection of HNPGL and related lesions with significantly higher lesion-wise sensitivities than those of
18
F-FDG PET/CT,
131
I-MIBG, and CECT.
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Affiliation(s)
| | - Sanjeet Kumar Jaiswal
- Department of Endocrinology, Seth G.S. Medical College & KEM Hospital, Mumbai, Maharashtra, India
| | - Vijaya Sarathi
- Department of Endocrinology, Vydehi Institute of Medical Sciences and Research Centre, Bangalore, Karnataka, India
| | - Hetal Marfatia
- Department of ENT, Seth G.S. Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - Anil D'Cruz
- Department of Head and Neck Oncosurgery, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Gaurav Malhotra
- Department of Nuclear Medicine, Bhabha Atomic Research Centre, Mumbai, Maharashtra, India
| | - Priya Hira
- Department of Radiodiagnosis, Seth G.S. Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - Virendra A. Patil
- Department of Endocrinology, Seth G.S. Medical College & KEM Hospital, Mumbai, Maharashtra, India
| | - Anurag R. Lila
- Department of Endocrinology, Seth G.S. Medical College & KEM Hospital, Mumbai, Maharashtra, India
| | - Nalini S. Shah
- Department of Endocrinology, Seth G.S. Medical College & KEM Hospital, Mumbai, Maharashtra, India
| | - Tushar R. Bandgar
- Department of Endocrinology, Seth G.S. Medical College & KEM Hospital, Mumbai, Maharashtra, India
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Malhotra G. A comprehensive approach to predict auction prices and economic value creation of cricketers in the Indian Premier League (IPL). JSA 2022. [DOI: 10.3233/jsa-200580] [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: 11/15/2022]
Abstract
The Indian Premier League (IPL), the most successful cricket tournament in India, has immensely grown in popularity. Unlike similar tournaments like Major League Baseball and the UEFA Champions League, their models cannot be replicated due to the dynamic pricing nature of player auctions. The research intends to generate a predictive model that predicts the auction price of a player using key quantitative variables. The players were categorised by batsmen, bowlers, and all-rounders. Due to the holistic hedonic nature of the model, equations were formed to predict a player’s future performance, in terms of measurable points, and to extrapolate economic value creation given a budget constraint. This study provides insights on the player’s economic value by comparing the auction price paid vs. the player’s actual performance. This new approach to modelling in cricket games not only aims to produce more accurate results using the hedonic pricing method, but also enlightens an introduction to a more holistic modelling process to intricately understand the profiting avenues for team owners to reverse-engineer value additions of players at each level and position. Finally, this model, which considers the factors an IPL franchise would, is being designed to be utilised in future IPL auctions.
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Malhotra G, Dujmović M, Bowers JS. Feature blindness: A challenge for understanding and modelling visual object recognition. PLoS Comput Biol 2022; 18:e1009572. [PMID: 35560155 PMCID: PMC9132323 DOI: 10.1371/journal.pcbi.1009572] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 05/25/2022] [Accepted: 03/19/2022] [Indexed: 12/02/2022] Open
Abstract
Humans rely heavily on the shape of objects to recognise them. Recently, it has been argued that Convolutional Neural Networks (CNNs) can also show a shape-bias, provided their learning environment contains this bias. This has led to the proposal that CNNs provide good mechanistic models of shape-bias and, more generally, human visual processing. However, it is also possible that humans and CNNs show a shape-bias for very different reasons, namely, shape-bias in humans may be a consequence of architectural and cognitive constraints whereas CNNs show a shape-bias as a consequence of learning the statistics of the environment. We investigated this question by exploring shape-bias in humans and CNNs when they learn in a novel environment. We observed that, in this new environment, humans (i) focused on shape and overlooked many non-shape features, even when non-shape features were more diagnostic, (ii) learned based on only one out of multiple predictive features, and (iii) failed to learn when global features, such as shape, were absent. This behaviour contrasted with the predictions of a statistical inference model with no priors, showing the strong role that shape-bias plays in human feature selection. It also contrasted with CNNs that (i) preferred to categorise objects based on non-shape features, and (ii) increased reliance on these non-shape features as they became more predictive. This was the case even when the CNN was pre-trained to have a shape-bias and the convolutional backbone was frozen. These results suggest that shape-bias has a different source in humans and CNNs: while learning in CNNs is driven by the statistical properties of the environment, humans are highly constrained by their previous biases, which suggests that cognitive constraints play a key role in how humans learn to recognise novel objects. Any object consists of hundreds of visual features that can be used to recognise it. How do humans select which feature to use? Do we always choose features that are best at predicting the object? In a series of experiments using carefully designed stimuli, we find that humans frequently ignore many features that are clearly visible and highly predictive. This behaviour is statistically inefficient and we show that it contrasts with statistical inference models such as state-of-the-art neural networks. Unlike humans, these models learn to rely on the most predictive feature when trained on the same data. We argue that the reason underlying human behaviour may be a bias to look for features that are less hungry for cognitive resources and generalise better to novel instances. Models that incorporate cognitive constraints may not only allow us to better understand human vision but also help us develop machine learning models that are more robust to changes in incidental features of objects.
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Affiliation(s)
- Gaurav Malhotra
- School of Psychological Sciences, University of Bristol, Bristol, United Kingdom
- * E-mail:
| | - Marin Dujmović
- School of Psychological Sciences, University of Bristol, Bristol, United Kingdom
| | - Jeffrey S. Bowers
- School of Psychological Sciences, University of Bristol, Bristol, United Kingdom
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Shah R, Sehemby M, Garg R, Purandare N, Hira P, Mahajan A, Lele V, Malhotra G, Verma P, Rojekar A, Dalvi A, Uchino S, Rastogi S, Lila A, Patil V, Shah N, Bandgar T. 68 Ga-DOTATATE PET/CT imaging in endogenous hyperinsulinemic hypoglycemia: A tertiary endocrine centre experience. Clin Endocrinol (Oxf) 2022; 96:190-199. [PMID: 34498757 DOI: 10.1111/cen.14586] [Citation(s) in RCA: 2] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Revised: 08/08/2021] [Accepted: 08/10/2021] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Literature regarding utility of 68 Ga-DOTATATE PET/CT in insulinoma localization across various subgroups [benign/malignant/multiple endocrine neoplasia-1 (MEN-1) syndrome associated] remains scarce. In this study, the performance of 68 Ga-DOTATATE PET/CT was compared with contrast-enhanced computed tomography (CECT) and 68 Ga-NODAGA-Exendin-4 PET/CT (whenever available) in an endogenous hyperinsulinemic hypoglycemia (EHH) cohort. DESIGN Retrospective audit. PATIENTS EHH patients [N = 36, lesions (n) = 49, final diagnosis: benign sporadic insulinoma (BSI) (N = 20), malignant insulinoma (N = 4, n = 14), MEN-1 syndrome associated insulinoma (N = 9, n = 15), Munchausen syndrome (N = 2) and drug-induced hypoglycemia (N = 1)] having both preoperative imaging modalities (CECT and 68 Ga-DOTATATE PET/CT). MEASUREMENTS Per-lesion sensitivity (Sn) and positive predictive value (PPV) for histopathological diagnosis of insulinoma. RESULTS Sn and PPV of 68 Ga-DOTATATE PET/CT were 67.3% and 89.2%; 55% and 100%; 85.7% and 100%; and 66.7% and 77% for overall EHH, BSI, malignant, and MEN-1 syndrome associated insulinoma cohorts respectively. Despite having comparatively lower sensitivity in BSI cohort, 68 Ga-DOTATATE PET/CT localized a pancreatic tail lesion missed by other modalities. 68 Ga-DOTATATE PET/CT had comparatively higher sensitivity in malignant insulinoma than BSI cohort. 68 Ga-DOTATATE PET/CT also paved the way for successful response to 177 Lu-based peptide receptor radionuclide therapy (PRRT). In MEN-1 cases, lower PPV as compared with BSI was due to uptake in non-insulinoma pancreatic neuroendocrine tumours (Pan-NET). CONCLUSIONS 68 Ga-DOTATATE PET/CT has supplemental role in selected cases of BSI with negative and/or discordant results with CECT and 68 Ga-NODAGA-Exendin-4 PET/CT. In malignant insulinoma, 68 Ga-DOTATATE-PET/CT has an additional theranostic potential. Interference due to uptake in non-insulinoma Pan-NET in MEN-1 syndrome may hinder insulinoma localization with 68 Ga-DOTATATE-PET/CT.
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Affiliation(s)
- Ravikumar Shah
- Department of Endocrinology, Seth GS Medical College & KEM Hospital, Mumbai, India
| | - Manjeetkaur Sehemby
- Department of Endocrinology, Seth GS Medical College & KEM Hospital, Mumbai, India
| | - Robin Garg
- Department of Endocrinology, Seth GS Medical College & KEM Hospital, Mumbai, India
| | - Nilendu Purandare
- Department of Radiodiagnosis and Imaging, Tata Memorial Center, Mumbai, India
| | - Priya Hira
- Department of Radiodiagnosis, Seth GS Medical College & KEM Hospital, Mumbai, India
| | - Abhishek Mahajan
- Department of Radiodiagnosis and Imaging, Tata Memorial Center, Mumbai, India
| | - Vikram Lele
- Department of Nuclear Medicine & PET/CT, Jaslok Hospital & Research Center, Mumbai, India
| | - Gaurav Malhotra
- Radiation Medicine Centre, Bhabha Atomic Research Centre, Tata Memorial Centre, Mumbai, India
| | - Priyanka Verma
- Radiation Medicine Centre, Bhabha Atomic Research Centre, Tata Memorial Centre, Mumbai, India
| | - Amey Rojekar
- Department of Pathology, Seth GS Medical College & KEM Hospital, Mumbai, India
| | - Abhay Dalvi
- Department of General Surgery, Seth GS Medical College & KEM Hospital, Mumbai, India
| | - Shinya Uchino
- Endocrine Surgical Department, Noguchi Thyroid Clinic and Hospital Foundation, Oita, Japan
| | - Shivam Rastogi
- Department of Radiodiagnosis and Imaging, Tata Memorial Center, Mumbai, India
| | - Anurag Lila
- Department of Endocrinology, Seth GS Medical College & KEM Hospital, Mumbai, India
| | - Virendra Patil
- Department of Endocrinology, Seth GS Medical College & KEM Hospital, Mumbai, India
| | - Nalini Shah
- Department of Endocrinology, Seth GS Medical College & KEM Hospital, Mumbai, India
| | - Tushar Bandgar
- Department of Endocrinology, Seth GS Medical College & KEM Hospital, Mumbai, India
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14
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Gosavi V, Lila A, Memon SS, Sarathi V, Thakkar K, Dalvi A, Malhotra G, Prakash G, Patil V, Shah NS, Bandgar T. Clinical Spectrum of Adrenal Cushing's Syndrome and the Caution for Interpretation of Adrenocorticotrophic Hormone: A Single-Center Experience. Horm Metab Res 2022; 54:57-66. [PMID: 35130566 DOI: 10.1055/a-1735-3232] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
UNLABELLED To describe the differences in presentation, biochemistry, and radiological evaluation of various etiologies of adrenal Cushing's syndrome (CS) from a single center. To emphasize caution for interpretation of plasma adrenocorticotropic hormone (ACTH), as a spuriously unsuppressed ACTH level by immunometric assay may lead to therapeutic misadventures in adrenal CS. DESIGN Retrospective, single-center, observational study. METHODS Fifty-eight adrenal CS patients [Adrenocortical carcinoma (ACC), n=30; Adenoma (ACA), n=15; Primary pigmented nodular adrenocortical disease (PPNAD), n=10; ACTH independent macronodular adrenal hyperplasia (AIMAH), n=3) evaluated at a tertiary care center in western India between January 2006 to March 2020 were included. Data on demography, clinical evaluation, biochemistry, imaging, management, histopathology, and outcome were recorded in a standard format and analyzed. RESULTS Cortisol secreting ACC presented at 38(1-50) years with abdominal mass in 26/30 (86.7%) and 16/30 (53.3%) had metastases at presentation. ACA with autonomous cortisol excess presented at 25(4.9-40) years with discriminating features of CS in 14/15 (93.3%), sex steroid production in 2/15, unenhanced HU <10 in only one, and relative washout >40% in 8/11 (72.7%). One ACA and eight ACC patients had plasma ACTH (by Siemens Immulite assay) > 20 pg/ml, despite hypercortisolemic state. CONCLUSIONS Cortisol-secreting ACC and ACA most often present with mass effects and florid CS, respectively. Baseline HU has low sensitivity to differentiate cortisol-secreting ACA from ACC. Plasma ACTH measured by Seimens Immulite is often unsuppressed, especially in ACC patients, which can be addressed by measuring ACTH by more accurate assays.
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Affiliation(s)
- Vikrant Gosavi
- Department of Endocrinology, Seth G. S. Medical College and KEM Hospital, Mumbai, India
| | - Anurag Lila
- Department of Endocrinology, Seth G. S. Medical College and KEM Hospital, Mumbai, India
| | - Saba Samad Memon
- Department of Endocrinology, Seth G. S. Medical College and KEM Hospital, Mumbai, India
| | - Vijaya Sarathi
- Department of Endocrinology, Vydehi Institute of Medical Sciences and Research Centre, Bangalore, India
| | - Kunal Thakkar
- Sterling Ramkrishna Speciality Hospital, Gandhidham, India
| | - Abhay Dalvi
- Department of Surgery, Seth G. S. Medical College and KEM Hospital, Mumbai, India
| | - Gaurav Malhotra
- Department of Nuclear Medicine, Bhabha Atomic Research Centre, Mumbai, India
| | - Gagan Prakash
- Department of Uro-oncology, Tata Memorial Hospital, Mumbai, India
| | - Virendra Patil
- Department of Endocrinology, Seth G. S. Medical College and KEM Hospital, Mumbai, India
| | - Nalini S Shah
- Department of Endocrinology, Seth G. S. Medical College and KEM Hospital, Mumbai, India
| | - Tushar Bandgar
- Department of Endocrinology, Seth G. S. Medical College and KEM Hospital, Mumbai, India
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Malhotra G, Stewart P. Outcomes of Rotational Atherectomy in Three Large Queensland Centres Without Onsite Cardiac Surgical Backup in a Contemporary Patient Cohort – A 9-Year Experience. Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.06.609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Verma P, Malhotra G, Dodamani MH, Lila AR, Asopa RV, Bandgar TR. Complete Resolution of Disease After Peptide Receptor Radionuclide Therapy in a Patient of Metastatic Insulinoma. Clin Nucl Med 2022; 47:e77-e78. [PMID: 34284474 DOI: 10.1097/rlu.0000000000003831] [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: 11/25/2022]
Abstract
ABSTRACT A 48-year-old man, a case of metastatic insulinoma, who failed transarterial chemoembolization of liver metastases underwent multiple cycles of peptide receptor radionuclide therapy with 177Lu-DOTATATE, following which a complete morphologic and metabolic response was demonstrated on 68Ga-DOTATATE PET/CT. Patient had a remarkable improvement in his quality of life as intractable hypoglycemic episodes resolved after treatment. Peptide receptor radionuclide therapy is a promising targeted radionuclide therapy in patients of metastatic insulinomas that can result in reduced tumor burden and improved quality of life, particularly those who fail the conventional treatment modalities as seen in the present case.
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Affiliation(s)
- Priyanka Verma
- From the Radiation Medicine Centre, Bhabha Atomic Research Centre
| | - Gaurav Malhotra
- From the Radiation Medicine Centre, Bhabha Atomic Research Centre
| | - Manjunath H Dodamani
- Department of Endocrinology, King Edward Memorial Hospital and Seth Gordhandas Sunderdas Medical College, Mumbai, India
| | - Anurag R Lila
- Department of Endocrinology, King Edward Memorial Hospital and Seth Gordhandas Sunderdas Medical College, Mumbai, India
| | - Ramesh V Asopa
- From the Radiation Medicine Centre, Bhabha Atomic Research Centre
| | - Tushar R Bandgar
- Department of Endocrinology, King Edward Memorial Hospital and Seth Gordhandas Sunderdas Medical College, Mumbai, India
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Malhotra G, Phadke MS, Rakshit S, Bagul SD, Verma P, Asopa RV. Unilateral Breast Uptake of 99mTc-MIBI in a Lactating Woman During Myocardial Perfusion Imaging. Clin Nucl Med 2022; 47:e6-e8. [PMID: 34132682 DOI: 10.1097/rlu.0000000000003765] [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: 11/25/2022]
Abstract
ABSTRACT A 34-year-old woman, who was 11 months postpartum, underwent 99mTc-MIBI myocardial perfusion SPECT imaging for atypical symptomatology with normal baseline electrocardiogram and 2-dimensional echocardiography. She was lactating on and off, preferentially from the right breast. Analysis of the raw images revealed unilateral intense tracer uptake in the right breast region that persisted in the delayed spot views (24-hour postinjection). Although bilateral breast uptake of 99mTc-MIBI may be seen in postpartum scenario, unilateral breast uptake can also occur in patients with preferential lactation from 1 breast as seen in this case and should not be mistaken for pathology.
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Affiliation(s)
- Gaurav Malhotra
- From the Radiation Medicine Centre, Bhabha Atomic Research Centre
| | - Milind S Phadke
- Department of Cardiology, Lokmanya Tilak Municipal General Hospital and Lokmanya Tilak Municipal Medical College, Sion, Mumbai, India
| | - Sutapa Rakshit
- From the Radiation Medicine Centre, Bhabha Atomic Research Centre
| | - Swati D Bagul
- From the Radiation Medicine Centre, Bhabha Atomic Research Centre
| | - Priyanka Verma
- From the Radiation Medicine Centre, Bhabha Atomic Research Centre
| | - Ramesh V Asopa
- From the Radiation Medicine Centre, Bhabha Atomic Research Centre
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Kumar S, Lila AR, Memon SS, Sarathi V, Patil VA, Menon S, Mittal N, Prakash G, Malhotra G, Shah NS, Bandgar TR. Metastatic cluster 2-related pheochromocytoma/paraganglioma: a single-center experience and systematic review. Endocr Connect 2021; 10:1463-1476. [PMID: 34662294 PMCID: PMC8630763 DOI: 10.1530/ec-21-0455] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 10/18/2021] [Indexed: 11/24/2022]
Abstract
Risk of metastatic disease in the cluster 2-related pheochromocytoma/paraganglioma (PPGL) is low. In MEN2 patients, identification of origin of metastases from pheochromocytoma (PCC) or medullary thyroid carcinoma (MTC) is challenging as both are of neuroendocrine origin. We aim to describe our experience and perform a systematic review to assess prevalence, demographics, biochemistry, diagnostic evaluation, management, and predictors of cluster 2-related metastatic PPGL. Retrospective analysis of 3 cases from our cohort and 43 cases from world literature was done. For calculation of prevalence, all reported patients (n = 3063) of cluster 2 were included. We found that the risk of metastasis in cluster 2-related PPGL was 2.6% (2% in RET, 5% in NF1, 4.8% in TMEM127 and 16.7% in MAX variation). In metastatic PCC in MEN2, median age was 39 years, bilateral tumors were present in 71% and median tumor size was 9.7 cm (range 4-19) with 43.5% mortality. All patients had a primary tumor size ≥4 cm. Origin of primary tumor was diagnosed by histopathology of metastatic lesion in 11 (57.9%), 131I-MIBG scan in 6 (31.6%), and selective venous sampling and CT in 1 (5.3%) patient each. In subgroup of neurofibromatosis 1 (NF1), median age was 46 years (range 14-59) with median tumor size 6 cm and 57% mortality. To conclude, the risk of metastatic disease in cluster 2-related PPGL is low, being especially high in tumors with size ≥4 cm and associated with high mortality. One-third patients of NF1 with metastatic PPGL had presented in second decade of life. Long-term studies are needed to formulate management recommendations.
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Affiliation(s)
- Sandeep Kumar
- Department of Endocrinology, Seth G S Medical College & KEM Hospital, Mumbai, India
| | - Anurag Ranjan Lila
- Department of Endocrinology, Seth G S Medical College & KEM Hospital, Mumbai, India
| | - Saba Samad Memon
- Department of Endocrinology, Seth G S Medical College & KEM Hospital, Mumbai, India
| | - Vijaya Sarathi
- Department of Endocrinology, Vydehi Institute of Medical Sciences and Research Centre, Bangalore, India
| | - Virendra A Patil
- Department of Endocrinology, Seth G S Medical College & KEM Hospital, Mumbai, India
| | - Santosh Menon
- Department of Pathology, Tata Memorial Hospital, Mumbai, India
| | - Neha Mittal
- Department of Pathology, Tata Memorial Hospital, Mumbai, India
| | - Gagan Prakash
- Department of Uro-oncology, Tata Memorial Hospital, Mumbai, India
| | - Gaurav Malhotra
- Department of Nuclear Medicine, Bhabha Atomic Research Centre, Mumbai, India
| | - Nalini S Shah
- Department of Endocrinology, Seth G S Medical College & KEM Hospital, Mumbai, India
| | - Tushar R Bandgar
- Department of Endocrinology, Seth G S Medical College & KEM Hospital, Mumbai, India
- Correspondence should be addressed to T R Bandgar:
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Shah R, Garg R, Majmundar M, Purandare N, Malhotra G, Patil V, Ramteke-Jadhav S, Lila A, Shah N, Bandgar T. Exendin-4-based imaging in insulinoma localization: Systematic review and meta-analysis. Clin Endocrinol (Oxf) 2021; 95:354-364. [PMID: 33386617 DOI: 10.1111/cen.14406] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 12/07/2020] [Accepted: 12/29/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND CONTEXT Glucagon-like peptide-1 receptor (GLP-1 R) based imaging has shown higher sensitivity for insulinoma localization as compared to other anatomic/functional imaging. METHODOLOGY We reviewed the published English literature for GLP-1 R targeted imaging in insulinoma in PubMed until August 2020 in accordance with PRISMA guidelines using the MeSH terms "((Exendin-4 PET/CT) OR (Exendin-4 SPECT/CT) OR (GLP-1 R imaging)) AND (Insulinoma)". An individual patient data-metanalysis (IPD-MA) was performed, and performance parameters were calculated for the histopathological diagnosis of insulinoma. MAIN OUTCOME MEASURES True-positive (TP), false-positive (FP), false-negative (FN), true-negative (TN), sensitivity (Sn), specificity (Sp), positive predictive value (PPV) and negative predictive value (NPV) for insulinoma localization. RESULTS A total of 179 cases (316 lesions) from 16 publications were included for IPD-MA. For insulinoma localization, exendin-4-PET/CT (Sn & PPV: 94%) performed better than exendin-4-SPECT/CT (Sn: 63%, PPV: 94%). The Sn was lower in malignant insulinoma cases whereas the Sp was higher in cases with MEN-1 syndrome. With exendin-4-based imaging, FP uptakes in Brunner's gland, normal pancreas, and other β-cell pathologies and FN results in pancreatic tail lesions and malignancy were seen in a few patients. TN results suggested the correct diagnosis of other endogenous hyperinsulinemic hypoglycaemia (EHH) subtypes. CONCLUSION For insulinoma localization, exendin-4 PET/CT should be preferred over exendin-4 SPECT/CT because of higher sensitivity and specificity. FP uptakes in Brunner's gland, normal pancreas, and other β-cell pathologies and FN results in tail lesions, and malignant insulinomas are limitations. Higher specificity for insulinoma localization is particularly useful in patients with MEN-1 syndrome.
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Affiliation(s)
- Ravikumar Shah
- Department of Endocrinology, Seth GS Medical College & KEM Hospital, Parel, Mumbai, India
| | - Robin Garg
- Department of Endocrinology, Seth GS Medical College & KEM Hospital, Parel, Mumbai, India
| | - Monil Majmundar
- Department of Internal Medicine, New York Medical College, Metropolitan Hospital Center, New York, NY, USA
| | - Nilendu Purandare
- Department of Radiodiagnosis and Imaging, Tata Memorial Center, Mumbai, India
| | - Gaurav Malhotra
- Radiation Medicine Centre, Bhabha Atomic Research Centre, Tata Memorial Centre, Annexe, Parel, Mumbai, India
| | - Virendra Patil
- Department of Endocrinology, Seth GS Medical College & KEM Hospital, Parel, Mumbai, India
| | - Swati Ramteke-Jadhav
- Department of Endocrinology, Seth GS Medical College & KEM Hospital, Parel, Mumbai, India
| | - Anurag Lila
- Department of Endocrinology, Seth GS Medical College & KEM Hospital, Parel, Mumbai, India
| | - Nalini Shah
- Department of Endocrinology, Seth GS Medical College & KEM Hospital, Parel, Mumbai, India
| | - Tushar Bandgar
- Department of Endocrinology, Seth GS Medical College & KEM Hospital, Parel, Mumbai, India
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Verma P, Malhotra G, Meshram V, Chandak A, Sonavane S, Lila AR, Bandgar TR, Asopa RV. Prostate-Specific Membrane Antigen Expression in Patients With Differentiated Thyroid Cancer With Thyroglobulin Elevation and Negative Iodine Scintigraphy Using 68Ga-PSMA-HBED-CC PET/CT. Clin Nucl Med 2021; 46:e406-e409. [PMID: 33883490 DOI: 10.1097/rlu.0000000000003655] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF THE REPORT Prostate-specific membrane antigen (PSMA) is a member of superfamily of zinc-dependent exopeptidases that is robustly expressed in prostate cancer cells and nonprostatic solid tumor neovasculature including microvessels of thyroid tumors. Its expression in differentiated thyroid cancer (DTC) has been confirmed in many recent studies, but systematic studies exploring PSMA expression in patients with DTC with thyroglobulin elevation and negative iodine scintigraphy (TENIS) are lacking. The aim of the present study was to evaluate the role of PSMA scan in TENIS patients with DTC. METHODS Nine consecutive patients with DTC with proven TENIS syndrome (6 men and 3 women with age range 29-68 years and mean age of 48 years) underwent 18F-FDG PET/CT as per the institution protocol. Thereafter, they were subjected to 68Ga-PSMA-HBED-CC PET/CT as per the institution protocol within a week of FDG PET imaging. Prostate-specific membrane antigen expression (SUVmax) in the lesions was compared with 18F-FDG PET and CT scan findings. RESULTS In 5 of 9 patients with TENIS, the metastatic lesions showed PSMA expression. A total of 14 lesions were seen on the CT scan. Prostate-specific membrane antigen PET detected 9 of 14 lesions (64.28%) (SUVmax ranging from 10.1 to 45.67; median SUVmax of 16.31), whereas FDG PET was positive in 11 of 14 lesions (78.57%). The lesions that showed PSMA uptake was localized to bones (5 of 9) and lungs (4 of 9). Two lesions that were localized to iliac crest and acetabulum were missed on FDG PET but were seen on CT and PSMA PET scan. CONCLUSIONS The results of this pilot study indicate that 68Ga-HBED-CC-PSMA PET/CT demonstrates PSMA expression in TENIS patients with lesions being localized to the bones and lungs. 68Ga-PSMA PET/CT could be useful for the identification of TENIS patients who might benefit from PSMA-targeted radionuclide therapy.
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Affiliation(s)
- Priyanka Verma
- From the Radiation Medicine Centre, Bhabha Atomic Research Centre
| | - Gaurav Malhotra
- From the Radiation Medicine Centre, Bhabha Atomic Research Centre
| | - Vilas Meshram
- From the Radiation Medicine Centre, Bhabha Atomic Research Centre
| | - Ashok Chandak
- From the Radiation Medicine Centre, Bhabha Atomic Research Centre
| | - Sunita Sonavane
- From the Radiation Medicine Centre, Bhabha Atomic Research Centre
| | - Anurag R Lila
- Department of Endocrinology, Seth G. S. Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - Tushar R Bandgar
- Department of Endocrinology, Seth G. S. Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - Ramesh V Asopa
- From the Radiation Medicine Centre, Bhabha Atomic Research Centre
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21
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Malhotra G, Aute PP, Awasare S, Asopa RV. 68Ga-PSMA-HBED-CC PET/CT Findings in a Patient of Polyostotic Fibrous Dysplasia. Clin Nucl Med 2021; 46:e349-e352. [PMID: 33417342 DOI: 10.1097/rlu.0000000000003492] [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: 11/26/2022]
Abstract
ABSTRACT A 43-year-old man diagnosed with fibrous dysplasia with McCune-Albright syndrome was subjected to 18F-fluoride bone scan and 68Ga-PSMA-HBED-CC PET/CT as per the institution protocol. 18F-bone scan revealed extensive involvement of axial and appendicular skeleton confirming polyostotic fibrous dysplasia. 68Ga-PSMA PET/CT showed increased tracer uptake in corresponding lesions of fibrous dysplasia. PSMA uptake in fibrous dysplasia lesions has been rarely described with literature evidence being limited to anecdotal case reports. Nevertheless, due to increasing use of PSMA PET/CT, one should be aware of this false-positive finding to avoid misinterpretation of the scans.
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Affiliation(s)
- Gaurav Malhotra
- From the Radiation Medicine Centre, Bhabha Atomic Research Centre, Mumbai
| | | | - Sushama Awasare
- From the Radiation Medicine Centre, Bhabha Atomic Research Centre, Mumbai
| | - Ramesh V Asopa
- From the Radiation Medicine Centre, Bhabha Atomic Research Centre, Mumbai
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Abstract
ABSTRACT Poland syndrome is a rare congenital anomaly characterized by unilateral aplasia of the sternoclavicular head of pectoralis major muscle with varying degree of same side upper limb anomalies. A 44-year-old man, with a case of adenocarcinoma of stomach, whose CECT chest revealed complete absence of pectoralis major and minor muscles on the left side, was diagnosed with Poland syndrome without presence of typical ipsilateral limb anomalies. Follow-up PET/CT revealed metabolically active recurrent disease with typical findings of Poland syndrome. It is important to be aware of oncologic association in a patient of Poland syndrome as highlighted in the present case.
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Affiliation(s)
- Sarvesh Loharkar
- From the Radiation Medicine Centre, Bhabha Atomic Research Centre, Mumbai, India
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Barnabas R, Jaiswal SK, Memon SS, Sarathi V, Malhotra G, Verma P, Patil VA, Lila AR, Shah NS, Bandgar TR. Low-Dose, Low-Specific Activity 131I-metaiodobenzyl Guanidine Therapy in Metastatic Pheochromocytoma/Sympathetic Paraganglioma: Single-Center Experience from Western India. Indian J Endocrinol Metab 2021; 25:148-159. [PMID: 34660244 PMCID: PMC8477742 DOI: 10.4103/ijem.ijem_52_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 06/22/2021] [Accepted: 07/08/2021] [Indexed: 01/23/2023] Open
Abstract
INTRODUCTION Radionuclide therapy is a promising treatment modality in metastatic pheochromocytoma/paraganglioma (PPGL). There is scarce data on 131I-metaiodobenzyl guanidine (131I-MIBG) therapy from the Indian subcontinent. Hence, we aim to study the safety and effectiveness of low-dose, low-specific activity (LSA) 131I-MIBG therapy in patients with symptomatic, metastatic PPGL. METHODS Clinical, hormonal, and radiological response parameters and side effects of LSA 131I-MIBG therapy in patients with symptomatic, metastatic PPGL were retrospectively reviewed. World health organizations' (WHO) symptomatic, hormonal, and tumor response, and response evaluation criteria in solid tumors (RECIST1.1) criteria were used to assess the response. RESULTS Seventeen (PCC: 11, sympathetic PGL: 06) patients (15 with disease progression) received low-dose LSA 131I-MIBG therapy. Complete remission (CR), partial remission (PR), stable disease (SD), and progressive disease (PD) were 18% (3/17), 24% (4/17), 18% (3/17), and 41% (7/17), respectively, for WHO symptomatic response; 20% (2/10), 10% (1/10), 30% (3/10), and 40% (4/10), respectively, for WHO hormonal response; and 19% (3/16), 6% (1/16), 31% (5/16), and 44% (7/16), respectively for tumor response based on RECIST1.1. All patients with symptomatic PD and 50% (2/4) with hormonal PD had progression as per RECIST1.1 criteria. Side effects included thrombocytopenia, acute myeloid leukemia, mucoepidermoid carcinoma, and azoospermia in 6% (1/17) each. CONCLUSIONS Our study reaffirms the modest efficacy and safety of low-dose, LSA 131I-MIBG therapy in patients with symptomatic, metastatic PPGL. Symptomatic, but not hormonal, progression after 131I-MIBG therapy correlates well with tumor progression and should be further evaluated with imaging. In resource-limited settings, anatomic imaging alone may be used to assess tumor response to 131I-MIBG therapy.
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Affiliation(s)
- Rohit Barnabas
- Department of Endocrinology, Seth G.S Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - Sanjeet Kumar Jaiswal
- Department of Endocrinology, Seth G.S Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - Saba Samad Memon
- Department of Endocrinology, Seth G.S Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - Vijaya Sarathi
- Department of Endocrinology, Vydehi Institute of Medical Sciences and Research Center, Bengaluru, Karnataka, India
| | - Gaurav Malhotra
- Department of Nuclear Medicine, Bhabha Atomic Research Centre, Mumbai, Maharashtra, India
| | - Priyanka Verma
- Department of Nuclear Medicine, Bhabha Atomic Research Centre, Mumbai, Maharashtra, India
| | - Virendra A. Patil
- Department of Endocrinology, Seth G.S Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - Anurag R. Lila
- Department of Endocrinology, Seth G.S Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - Nalini S. Shah
- Department of Endocrinology, Seth G.S Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - Tushar R. Bandgar
- Department of Endocrinology, Seth G.S Medical College and KEM Hospital, Mumbai, Maharashtra, India
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Jaiswal SK, Sarathi V, Malhotra G, Hira P, Shah R, Patil VA, Dalvi A, Prakash G, Lila AR, Shah NS, Bandgar T. The utility of 68Ga-DOTATATE PET/CT in localizing primary/metastatic pheochromocytoma and paraganglioma in children and adolescents - a single-center experience. J Pediatr Endocrinol Metab 2021; 34:109-119. [PMID: 33180042 DOI: 10.1515/jpem-2020-0354] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 10/15/2020] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Pediatric pheochromocytoma and paraganglioma (PPGL) are rare tumors with limited data on the diagnostic performance of 68Ga-DOTA(0)-Tyr(3)-octreotate positron emission tomography-computed tomography (68Ga-DOTATATE PET/CT). We have described our experience of 68Ga-DOTATATE PET/CT in overall and von Hippel Lindau (VHL)-associated pediatric PPGL and compared its sensitivity with that of 131I-meta-iodobenzyl-guanidine (131I-MIBG), 18F-fluorodeoxyglucose PET/CT (18F-FDG PET/CT), and contrast-enhanced CT (CECT). METHODS Retrospective evaluation of consecutive PPGL patients (age: ≤20 years), who had undergone at least one functional imaging [131I-MIBG, 18F-FDG PET/CT, and/or 68Ga-DOTATATE PET/CT], was done. Composite of anatomical and all the performed functional imaging scans, image comparator (IC), was considered as the gold standard for sensitivity analysis. RESULTS In a cohort of 32 patients (16 males, age at diagnosis: 16.4 ± 2.68 years), lesion-wise sensitivity of 68Ga-DOTATATE PET/CT (95%) was higher than that of both 18F-FDG-PET/CT (80%, p=0.027) and 131I-MIBG (65%, p=0.0004) for overall lesions, than that of 18F-FDG-PET/CT (100 vs. 67%, p=0.017) for primary PPG, and than that of 131I-MIBG (93 vs. 42%, p=0.0001) for metastases. In the VHL (n=14), subgroup, 68Ga-DOTATATE PET/CT had higher lesion-wise sensitivity (100%) compared to 18F-FDG PET/CT (74%, p=0.045) and 131I-MIBG (64%, p=0.0145). CONCLUSIONS In our pediatric PPGL cohort, overall lesion-wise sensitivity of 68Ga-DOTATATE PET/CT was higher than that of 18F-FDG PET/CT and 131I-MIBG scintigraphy. Hence, we recommend 68Ga-DOTATATE PET/CT as the preferred modality in pediatric PPGL. 68Ga-DOTATATE PET/CT may evolve as a preferred imaging modality for disease surveillance in VHL.
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Affiliation(s)
- Sanjeet Kumar Jaiswal
- Department of Endocrinology, Seth G.S. Medical College & KEM Hospital, Mumbai, Maharashtra, India
| | - Vijaya Sarathi
- Department of Endocrinology, Vydehi Institute of Medical Sciences and Research Center, Bengaluru, Karnataka, India
| | - Gaurav Malhotra
- Department of Nuclear Medicine, Bhabha Atomic Research Centre, Mumbai, Maharashtra, India
| | - Priya Hira
- Department of Radiology, Seth G.S. Medical College & KEM Hospital, Mumbai, Maharashtra, India
| | - Ravikumar Shah
- Department of Endocrinology, Seth G.S. Medical College & KEM Hospital, Mumbai, Maharashtra, India
| | - Virendra A Patil
- Department of Endocrinology, Seth G.S. Medical College & KEM Hospital, Mumbai, Maharashtra, India
| | - Abhay Dalvi
- Department of General Surgery, Seth G.S. Medical College & KEM Hospital, Mumbai, India
| | - Gagan Prakash
- Department of Uro-Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Anurag R Lila
- Department of Endocrinology, Seth G.S. Medical College & KEM Hospital, Mumbai, Maharashtra, India
| | - Nalini S Shah
- Department of Endocrinology, Seth G.S. Medical College & KEM Hospital, Mumbai, Maharashtra, India
| | - Tushar Bandgar
- Department of Endocrinology, Seth G.S. Medical College & KEM Hospital, Mumbai, Maharashtra, India
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Bandgar T, Jaiswal S, Sarathi V, Malhotra G, Verma P, Hira P, Badhe P, Memon S, Barnabas R, Patil V, Anurag, Lila R, Shah N. The utility of 68ga-dotatate pet/ct in localizing primary/metastatic pheochromocytoma and paraganglioma: Asian Indian experience. Indian J Endocrinol Metab 2021; 25:410-417. [PMID: 35300451 PMCID: PMC8923324 DOI: 10.4103/ijem.ijem_307_21] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 09/17/2021] [Accepted: 11/26/2021] [Indexed: 11/16/2022] Open
Abstract
Purpose: Pheochromocytoma and paraganglioma (PGL), together called PPGL, are rare tumors with a limited number of studies on the diagnostic performance of 68Ga-DOTA (0)-Tyr (3)-octreotate positron emission tomography-computed tomography (68Ga-DOTATATE PET/CT) from the Asian-Indian subcontinent. Materials and Methods: In this retrospective study, PPGL suspects (n = 87) who had undergone at least contrast-enhanced computed tomography (CECT) and 68Ga-DOTATATE PET/CT, were included. Lesion-wise, patient-wise, and region-wise sensitivities of 68Ga-DOTATATE PET/CT, 18F fluorodeoxyglucose positron emission tomography CT (18F-FDG PET/CT, n = 53), 131I-metaiodobenzylguanidine (131I-MIBG, n = 37), and CECT were compared, and diagnostic performance of 68Ga-DOTATATE PET/CT in the detection of PPGL was calculated. Results: 68Ga-DOTATATE PET/CT had significantly higher lesion-wise sensitivity than 131I-MIBG for both primary (94% vs 75%, P = 0.004) and metastatic disease (85% vs 59%, P = 0.001) and higher sensitivity than CECT for metastatic lesions (83% vs 43%, P = 0.0001). The lesion-wise sensitivity of 68Ga-DOTATATE PET/CT was similar to 18F-FDG PET/CT for both primary tumors (94% vs 85%, P = 0.08) and metastatic lesions (82% vs 84%, P = 0.76) in the whole cohort but tended to be inferior in the head to head comparison. Conclusion: 68Ga-DOTATATE PET/CT had higher sensitivity for detection of PPGL than 131I-MIBG (primary and metastatic) and CECT (metastatic) but similar to 18F-FDG PET/CT (primary and metastatic).
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Garg R, Shah R, Tiwari A, Purandare N, Lele VR, Malhotra G, Verma P, Gosavi V, Dalvi A, Kumar Jaiswal S, Patil V, Ramteke-Jadhav S, Lila A, Shah N, Bandgar T. Exendin-4-based imaging in endogenous hyperinsulinemic hypoglycaemia cohort: A tertiary Endocrine centre experience. Clin Endocrinol (Oxf) 2020; 93:678-686. [PMID: 32716527 DOI: 10.1111/cen.14299] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 07/08/2020] [Accepted: 07/12/2020] [Indexed: 12/11/2022]
Abstract
CONTEXT Insulinoma needs accurate preoperative localization for minimally invasive surgery. Exendin-4-based imaging has shown promising results. OBJECTIVE To evaluate performance parameters of exendin-4-based imaging in insulinoma localization and compare with other imaging modalities. DESIGN Retrospective cross-sectional study. PATIENTS We report 14 patients with endogenous hyperinsulinemic hypoglycaemia (EHH) managed at our centre; in whom, the final diagnosis was insulinoma (n = 11), Munchausen syndrome (MS) (n = 2) and inconclusive (n = 1). Retrospective reporting of CECT, 68 Ga-DOTATATE PET/CT and 68 Ga-NODAGA-exendin-4-PET/CT was done. With per-lesion analysis, performance parameters were calculated for the histopathological diagnosis of insulinoma. MAIN OUTCOME MEASURES True positive (TP), false positive (FP), false negative (FN), true negative (TN), sensitivity (Sn), specificity (Sp), positive predictive value (PPV), negative predictive value (NPV) for insulinoma localization. RESULTS In our cohort, 12 histopathologically proven insulinoma lesions [(TP): 11 primary lesions, 1 metastasis] were detected in 11 patients, whereas two patients had MS (TN). Sn and PPV were 75% and 100%, 33.3% and 80% and 83.3% and 71.4% for CECT, 68 Ga-DOTATATE PET/CT and 68 Ga-NODAGA-exendin-4-PET/CT, respectively. With exendin-4-based imaging, FP uptake in normal pancreatic tissue and FN results in the pancreatic tail lesion was seen. In one patient, TN result suggested the correct diagnosis of MS. CONCLUSION 68 Ga-NODAGA-exendin-4-PET/CT has higher sensitivity than 68 Ga-DOTATATE PET/CT and CECT for insulinoma localization. FP uptake in normal pancreas and FN result in tail lesions are limitations of currently utilized exendin-4-based imaging.
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Affiliation(s)
- Robin Garg
- Department of Endocrinology, Seth GS Medical College & KEM Hospital, Parel, India
| | - Ravikumar Shah
- Department of Endocrinology, Seth GS Medical College & KEM Hospital, Parel, India
| | - Ankita Tiwari
- Department of Endocrinology, Seth GS Medical College & KEM Hospital, Parel, India
| | - Nilendu Purandare
- Department of Radiodiagnosis and Imaging, Tata Memorial Center, Mumbai, India
| | - Vikram R Lele
- Department of Nuclear Medicine & PET/CT, Jaslok Hospital & Research Center, Mumbai, India
| | - Gaurav Malhotra
- Radiation Medicine Centre, Bhabha Atomic Research Centre, Tata Memorial Centre, Annexe, India
| | - Priyanka Verma
- Radiation Medicine Centre, Bhabha Atomic Research Centre, Tata Memorial Centre, Annexe, India
| | - Vikrant Gosavi
- Department of Endocrinology, Seth GS Medical College & KEM Hospital, Parel, India
| | - Abhay Dalvi
- Department of General Surgery, Seth GS Medical College & KEM Hospital, Parel, India
| | | | - Virendra Patil
- Department of Endocrinology, Seth GS Medical College & KEM Hospital, Parel, India
| | - Swati Ramteke-Jadhav
- Department of Endocrinology, Seth GS Medical College & KEM Hospital, Parel, India
| | - Anurag Lila
- Department of Endocrinology, Seth GS Medical College & KEM Hospital, Parel, India
| | - Nalini Shah
- Department of Endocrinology, Seth GS Medical College & KEM Hospital, Parel, India
| | - Tushar Bandgar
- Department of Endocrinology, Seth GS Medical College & KEM Hospital, Parel, India
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Kumar Jaiswal S, Sarathi V, Samad Memon S, Garg R, Malhotra G, Verma P, Shah R, Kaur Sehemby M, A Patil V, Jadhav S, Ranjan Lila A, S Shah N, R Bandgar T. 177Lu-DOTATATE therapy in metastatic/inoperable pheochromocytoma-paraganglioma. Endocr Connect 2020; 9:864-873. [PMID: 32784267 PMCID: PMC7487189 DOI: 10.1530/ec-20-0292] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 08/12/2020] [Indexed: 12/18/2022]
Abstract
INTRODUCTION 177Lu-DOTATATE-based peptide receptor radionuclide therapy (PRRT) is a promising therapy for metastatic and/or inoperable pheochromocytoma and paraganglioma (PPGL). We aim to evaluate the efficacy and safety of and identify predictors of response to 177Lu-DOTATATE therapy in metastatic and/or inoperable PPGL. METHODS This retrospective study involved 15 patients of metastatic or unresectable PPGL, who received 177Lu-DOTATATE PRRT therapy. Clinical, biochemical (plasma-free normetanephrine), and radiological (anatomical and functional) responses were compared before and after the last therapy. RESULTS A total of 15 patients (4 PCC, 4 sPGL, 5 HNPGL, 1 PCC + sPGL, 1 HNPGL + sPGL) were included. The median duration of follow up was 27 (range: 11-62) months from the start of PRRT. Based on the RECIST (1.1) criteria, progressive disease was seen in three (20%), stable disease in eight (53%), partial response in one (7%), and minor response in three (20%) and controlled disease in 12 (80%). On linear regression analysis the presence of PGL (P= 0.044) and baseline SUVmax >21 (P < 0.0001) were significant positive predictors of early response to PRRT. Encouraging safety profiles were noted with no long term nephrotoxicity and hematotoxicity. CONCLUSION 177Lu-DOTATATE therapy is an effective and safe modality of treatment for patients with metastatic/inoperable PPGL. Although it is not prudent to withhold PRRT in metastatic PPGL with baseline SUVmax < 21, baseline SUVmax >21 can be used to predict early response to PRRT.
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Affiliation(s)
- Sanjeet Kumar Jaiswal
- Department of Endocrinology, Seth G.S Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - Vijaya Sarathi
- Department of Endocrinology, Vydehi Institute of Medical Sciences and Research Center, Bengaluru, Karnataka, India
| | - Saba Samad Memon
- Department of Endocrinology, Seth G.S Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - Robin Garg
- Department of Endocrinology, Seth G.S Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - Gaurav Malhotra
- Department of Nuclear Medicine, Bhabha Atomic Research Centre, Mumbai, Maharashtra, India
| | - Priyanka Verma
- Department of Nuclear Medicine, Bhabha Atomic Research Centre, Mumbai, Maharashtra, India
| | - Ravikumar Shah
- Department of Endocrinology, Seth G.S Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - Manjeet Kaur Sehemby
- Department of Endocrinology, Seth G.S Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - Virendra A Patil
- Department of Endocrinology, Seth G.S Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - Swati Jadhav
- Department of Endocrinology, Seth G.S Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - Anurag Ranjan Lila
- Department of Endocrinology, Seth G.S Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - Nalini S Shah
- Department of Endocrinology, Seth G.S Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - Tushar R Bandgar
- Department of Endocrinology, Seth G.S Medical College and KEM Hospital, Mumbai, Maharashtra, India
- Correspondence should be addressed to T R Bandgar:
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Patil VA, Goroshi MR, Shah H, Malhotra G, Hira P, Sarathi V, Lele VR, Jadhav S, Lila A, Bandgar TR, Shah NS. Comparison of 68Ga-DOTA-NaI 3-Octreotide/tyr 3-octreotate positron emission tomography/computed tomography and contrast-enhanced computed tomography in localization of tumors in multiple endocrine neoplasia 1 syndrome. World J Nucl Med 2020; 19:99-105. [PMID: 32939195 PMCID: PMC7478292 DOI: 10.4103/wjnm.wjnm_24_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 06/18/2019] [Indexed: 11/22/2022] Open
Abstract
The optimum imaging modality for the screening of multiple endocrine neoplasia type 1 (MEN1)-associated tumors is not well established. Here, we compare the performance of contrast-enhanced CT (CECT) versus 68Ga DOTA-NOC/TATE PET/CT in MEN1 patients. The retrospective case record study is conducted at a tertiary health-care center. Thirty-four patients, who have undergone both CECT and 68Ga DOTA-NOC/ TATE PET, were included in the analysis. CECT had higher per-lesion sensitivity than 68Ga DOTA-NOC/TATE PET/CT for the detection of parathyroid lesions, (82.6% vs. 24.6%, P < 0.001). 68Ga DOTA-NOC/TATE PET/CT had higher per-lesion sensitivity than CECT for the detection of metastases (85% vs. 47.5%, P < 0.001) and gastrinomas (90% vs. 10%, P = 0.003). When combined use of the two imaging modalities is compared to CECT alone (63.7% vs. 93.1%, P = 0.00012) and 68Ga-DOTA-NOC/TATE PET/CT alone (74.1% vs. 93.1%, P = 0.0057), it provided significantly higher per-lesion sensitivity for the detection of gastroenteropancreatic neuroendocrine tumors (GEP-NETs). 68Ga-DOTA-NOC/ TATE PET was more sensitive for the detection of gastrinomas and metastases than CECT, whereas it was less sensitive for the detection of parathyroid lesions than CECT. The combined use of both the imaging modalities significantly increases the sensitivity for detection of GEP-NETs.
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Affiliation(s)
- Virendra A Patil
- Department of Endocrinology, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - Manjunath R Goroshi
- Department of Endocrinology, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - Hina Shah
- Department of Nuclear Medicine and Positron Emission Tomography/Computed Tomography, Jaslok Hospital and Research Centre, Mumbai, Maharashtra, India
| | - Gaurav Malhotra
- Radiation Medicine Centre, Bhabha Atomic Research Centre, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Priya Hira
- Department of Radiology, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - Vijaya Sarathi
- Department of Endocrinology, Narayana Medical College, Nellore, Andhra Pradesh, India
| | - Vikram R Lele
- Department of Nuclear Medicine and Positron Emission Tomography/Computed Tomography, Jaslok Hospital and Research Centre, Mumbai, Maharashtra, India
| | - Swati Jadhav
- Department of Endocrinology, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - Anurag Lila
- Department of Endocrinology, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - Tushar R Bandgar
- Department of Endocrinology, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - Nalini S Shah
- Department of Endocrinology, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
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Abstract
Deep convolutional neural networks (DCNNs) are frequently described as the best current models of human and primate vision. An obvious challenge to this claim is the existence of adversarial images that fool DCNNs but are uninterpretable to humans. However, recent research has suggested that there may be similarities in how humans and DCNNs interpret these seemingly nonsense images. We reanalysed data from a high-profile paper and conducted five experiments controlling for different ways in which these images can be generated and selected. We show human-DCNN agreement is much weaker and more variable than previously reported, and that the weak agreement is contingent on the choice of adversarial images and the design of the experiment. Indeed, we find there are well-known methods of generating images for which humans show no agreement with DCNNs. We conclude that adversarial images still pose a challenge to theorists using DCNNs as models of human vision.
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Affiliation(s)
- Marin Dujmović
- School of Psychological Science, University of BristolBristolUnited Kingdom
| | - Gaurav Malhotra
- School of Psychological Science, University of BristolBristolUnited Kingdom
| | - Jeffrey S Bowers
- School of Psychological Science, University of BristolBristolUnited Kingdom
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Malhotra G, Evans BD, Bowers JS. Hiding a plane with a pixel: examining shape-bias in CNNs and the benefit of building in biological constraints. Vision Res 2020; 174:57-68. [PMID: 32599343 DOI: 10.1016/j.visres.2020.04.013] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 03/06/2020] [Accepted: 04/07/2020] [Indexed: 11/30/2022]
Abstract
When deep convolutional neural networks (CNNs) are trained "end-to-end" on raw data, some of the feature detectors they develop in their early layers resemble the representations found in early visual cortex. This result has been used to draw parallels between deep learning systems and human visual perception. In this study, we show that when CNNs are trained end-to-end they learn to classify images based on whatever feature is predictive of a category within the dataset. This can lead to bizarre results where CNNs learn idiosyncratic features such as high-frequency noise-like masks. In the extreme case, our results demonstrate image categorisation on the basis of a single pixel. Such features are extremely unlikely to play any role in human object recognition, where experiments have repeatedly shown a strong preference for shape. Through a series of empirical studies with standard high-performance CNNs, we show that these networks do not develop a shape-bias merely through regularisation methods or more ecologically plausible training regimes. These results raise doubts over the assumption that simply learning end-to-end in standard CNNs leads to the emergence of similar representations to the human visual system. In the second part of the paper, we show that CNNs are less reliant on these idiosyncratic features when we forgo end-to-end learning and introduce hard-wired Gabor filters designed to mimic early visual processing in V1.
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Affiliation(s)
- Gaurav Malhotra
- School of Psychological, Science University of Bristol, Bristol BS8 1TU, UK.
| | - Benjamin D Evans
- School of Psychological, Science University of Bristol, Bristol BS8 1TU, UK
| | - Jeffrey S Bowers
- School of Psychological, Science University of Bristol, Bristol BS8 1TU, UK
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Vyas AN, Malhotra G, Nagaraj NC, Landry M. Gender attitudes in adolescence: evaluating the Girl Rising gender-sensitization program in India. International Journal of Adolescence and Youth 2019. [DOI: 10.1080/02673843.2019.1598450] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Affiliation(s)
- Amita N. Vyas
- Department of Prevention and Community Health, George Washington University Milken Institute School of Public Health , Washington, DC, USA
| | - G. Malhotra
- Department of Prevention and Community Health, George Washington University Milken Institute School of Public Health , Washington, DC, USA
| | - N. C. Nagaraj
- Department of Prevention and Community Health, George Washington University Milken Institute School of Public Health , Washington, DC, USA
| | - M. Landry
- Department of Prevention and Community Health, George Washington University Milken Institute School of Public Health , Washington, DC, USA
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Ez-Zizi A, McNamara JM, Malhotra G, Houston AI. Optimal gut size of small birds and its dependence on environmental and physiological parameters. J Theor Biol 2018; 454:357-366. [PMID: 29782931 DOI: 10.1016/j.jtbi.2018.05.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Revised: 04/21/2018] [Accepted: 05/08/2018] [Indexed: 10/16/2022]
Abstract
Most optimal foraging models assume that the foraging behaviour of small birds depends on a single state variable, their energy reserves in the form of stored fat. Here, we include a second state variable-the contents of the bird's gut-to investigate how a bird should optimise its gut size to minimise its long-term mortality, depending on the availability of food, the size of meal and the bird's digestive constraints. Our results show that (1) the current level of fat is never less important than gut contents in determining the bird's survival; (2) there exists a unique optimal gut size, which is determined by a trade-off between the energetic gains and costs of maintaining a large digestive system; (3) the optimal gut size increases as the bird's digestive cycle becomes slower, allowing the bird to store undigested food; (4) the critical environmental factor for determining the optimal gut size is the mass of food found in a successful foraging effort ("meal size"). We find that when the environment is harsh, it is optimal for the bird to maintain a gut that is larger than the size of a meal. However, the optimal size of the gut in rich environments exactly matches the meal size (i.e. the mass of food that the optimal gut can carry is exactly the mass of food that can be obtained in a successful foraging attempt).
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Affiliation(s)
- Adnane Ez-Zizi
- School of Mathematics, University of Bristol, University Walk, Bristol, BS8 1TW, UK.
| | - John M McNamara
- School of Mathematics, University of Bristol, University Walk, Bristol, BS8 1TW, UK
| | - Gaurav Malhotra
- School of Experimental Psychology, University of Bristol, Priory Road, Bristol, BS8 1TU, UK
| | - Alasdair I Houston
- School of Biological Sciences, University of Bristol, Tyndall Avenue, Bristol, BS8 1TQ, UK
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Ruane L, Malhotra G, Greenslade J, Parsonage W, Cullen L. Sex Differences in Coronary Artery Anatomy in Chest Pain Patients Investigated With Coronary Angiography. Heart Lung Circ 2018. [DOI: 10.1016/j.hlc.2018.06.680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Are C, Yanala U, Malhotra G, Hall B, Smith L, Wyld L, Cummings C, Lecoq C, Audisio RA, Berman RS. Global Curriculum in Research Literacy for the Surgical Oncologist. Ann Surg Oncol 2017; 25:604-616. [DOI: 10.1245/s10434-017-6277-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Indexed: 11/18/2022]
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Malhotra G, Palan JM, Alraheem AA, Fahey A, Stephenson K, Abott A, Simon G. Primary hyperparathyroidism - A retrospective review. EJEA 2017. [DOI: 10.1530/endoabs.50.p065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
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Tiwari A, Shah N, Sarathi V, Malhotra G, Bakshi G, Prakash G, Khadilkar K, Pandit R, Lila A, Bandgar T. Genetic status determines 18
F-FDG uptake in pheochromocytoma/paraganglioma. J Med Imaging Radiat Oncol 2017; 61:745-752. [DOI: 10.1111/1754-9485.12620] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Accepted: 03/27/2017] [Indexed: 12/01/2022]
Affiliation(s)
- Ankita Tiwari
- Department of Endocrinology; Seth G S Medical College and KEM Hospital; Mumbai India
| | - Nalini Shah
- Department of Endocrinology; Seth G S Medical College and KEM Hospital; Mumbai India
| | - Vijaya Sarathi
- Department of Endocrinology; Vydehi Institute of Medical Sciences and Research Centre; Bangalore Karnataka India
| | - Gaurav Malhotra
- Radiation Medicine Centre; Bhabha Atomic Research Centre; Mumbai Maharashtra India
| | - Ganesh Bakshi
- Department of Uro-oncology; Tata Memorial Hospital; Mumbai Maharashtra India
| | - Gagan Prakash
- Department of Uro-oncology; Tata Memorial Hospital; Mumbai Maharashtra India
| | - Kranti Khadilkar
- Department of Endocrinology; Seth G S Medical College and KEM Hospital; Mumbai India
| | - Reshma Pandit
- Department of Endocrinology; Seth G S Medical College and KEM Hospital; Mumbai India
| | - Anurag Lila
- Department of Endocrinology; Seth G S Medical College and KEM Hospital; Mumbai India
| | - Tushar Bandgar
- Department of Endocrinology; Seth G S Medical College and KEM Hospital; Mumbai India
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Malhotra G, Leslie DS, Ludwig CJH, Bogacz R. Overcoming indecision by changing the decision boundary. J Exp Psychol Gen 2017; 146:776-805. [PMID: 28406682 PMCID: PMC5459222 DOI: 10.1037/xge0000286] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Revised: 01/10/2017] [Accepted: 01/16/2017] [Indexed: 12/29/2022]
Abstract
The dominant theoretical framework for decision making asserts that people make decisions by integrating noisy evidence to a threshold. It has recently been shown that in many ecologically realistic situations, decreasing the decision boundary maximizes the reward available from decisions. However, empirical support for decreasing boundaries in humans is scant. To investigate this problem, we used an ideal observer model to identify the conditions under which participants should change their decision boundaries with time to maximize reward rate. We conducted 6 expanded-judgment experiments that precisely matched the assumptions of this theoretical model. In this paradigm, participants could sample noisy, binary evidence presented sequentially. Blocks of trials were fixed in duration, and each trial was an independent reward opportunity. Participants therefore had to trade off speed (getting as many rewards as possible) against accuracy (sampling more evidence). Having access to the actual evidence samples experienced by participants enabled us to infer the slope of the decision boundary. We found that participants indeed modulated the slope of the decision boundary in the direction predicted by the ideal observer model, although we also observed systematic deviations from optimality. Participants using suboptimal boundaries do so in a robust manner, so that any error in their boundary setting is relatively inexpensive. The use of a normative model provides insight into what variable(s) human decision makers are trying to optimize. Furthermore, this normative model allowed us to choose diagnostic experiments and in doing so we present clear evidence for time-varying boundaries. (PsycINFO Database Record
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Affiliation(s)
| | - David S Leslie
- Department of Mathematics and Statistics, Lancaster University
| | | | - Rafal Bogacz
- MRC Brain Network Dynamics Unit, University of Oxford
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Verma P, Malhotra G, Kothari S, Jagtap R, Asopa RV. Increased F-FDG Uptake in Bilateral Gynecomastia Secondary to Feminizing Adrenal Tumor: A Rare Case Report and Review of Literature. Indian J Nucl Med 2017; 32:145-147. [PMID: 28533648 PMCID: PMC5439191 DOI: 10.4103/0972-3919.202246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
A 21 year old male who presented with painful enlargement of both the breasts and a hyperestrogenic state, was found to harbor a heterogeneous mass arising from the right adrenal on contrast enhanced Computed Tomography abdomen. The mass was hypermetabolic with no regional, nodal or distant metastases on Fluorine-18 Fluorodeoxyglucose Positron Emission Tomography /Computed Tomography examination. Notably, substantial tracer uptake was seen in bilateral gynecomastia. The patient underwent a right adrenalectomy with the histopathology report confirming adrenocortical carcinoma. This case demonstrates utility of FDG PET/CT in adrenocortical carcinoma. However, when interpreting FDG PET/CT as a staging tool in oncological male patients, one should consider gynecomastia as a possible cause for increased FDG uptake in the breast as it may lead to a false positive interpretation.
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Affiliation(s)
- Priyanka Verma
- Radiation Medicine Centre, Bhabha Atomic Research Centre, TMC Annexe, Jerbai Wadia Road, Parel, Mumbai, India
| | - Gaurav Malhotra
- Radiation Medicine Centre, Bhabha Atomic Research Centre, TMC Annexe, Jerbai Wadia Road, Parel, Mumbai, India
| | | | - Rajlaxmi Jagtap
- Radiation Medicine Centre, Bhabha Atomic Research Centre, TMC Annexe, Jerbai Wadia Road, Parel, Mumbai, India
| | - Ramesh V Asopa
- Radiation Medicine Centre, Bhabha Atomic Research Centre, TMC Annexe, Jerbai Wadia Road, Parel, Mumbai, India
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Pandit R, Khadilkar K, Sarathi V, Kasaliwal R, Goroshi M, Khare S, Nair S, Raghavan V, Dalvi A, Hira P, Fernandes G, Sathe P, Rojekar A, Malhotra G, Bakshi G, Prakash G, Bhansali A, Walia R, Kamalanathan S, Sahoo J, Desai A, Bhagwat N, Mappa P, Rajput R, Chandrashekhar SR, Shivane V, Menon P, Lila A, Bandgar T, Shah N. Germline mutations and genotype-phenotype correlation in Asian Indian patients with pheochromocytoma and paraganglioma. Eur J Endocrinol 2016; 175:X3. [PMID: 27811160 DOI: 10.1530/eje-16-0126e] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Reshma Pandit
- Department of EndocrinologySeth G S Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - Kranti Khadilkar
- Department of EndocrinologySeth G S Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - Vijaya Sarathi
- 2Department of EndocrinologyVydehi Institute of Medical Sciences and Research Centre, Bangalore, Karnataka, India
| | - Rajeev Kasaliwal
- 3Department of EndocrinologyMahatma Gandhi Hospital and Medical College, Jaipur, Rajasthan, India
| | - Manjunath Goroshi
- Department of EndocrinologySeth G S Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - Shruti Khare
- Department of EndocrinologySeth G S Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - Sandhya Nair
- Department of EndocrinologySeth G S Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - Vijaya Raghavan
- Department of EndocrinologySeth G S Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | | | | | - Gwendolyn Fernandes
- PathologySeth G S Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - Pragati Sathe
- PathologySeth G S Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - Amey Rojekar
- PathologySeth G S Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - Gaurav Malhotra
- Radiation Medicine CentreBhabha Atomic Research Centre, Mumbai, Maharashtra, India
| | - Ganesh Bakshi
- Department of Uro-oncologyTata Memorial Hospital, Mumbai, Maharashtra, India
| | - Gagan Prakash
- Department of Uro-oncologyTata Memorial Hospital, Mumbai, Maharashtra, India
| | - Anil Bhansali
- Department of EndocrinologyPostgraduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| | - Rama Walia
- Department of EndocrinologyPostgraduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| | - Sadishkumar Kamalanathan
- Department of EndocrinologyJawaharlal Institute of Postgraduate Medical Education & Research (JIPMER), Pondicherry, India
| | - Jayaprakash Sahoo
- Department of EndocrinologyJawaharlal Institute of Postgraduate Medical Education & Research (JIPMER), Pondicherry, India
| | - Ankush Desai
- Endocrine UnitDepartment of Medicine, Goa Medical College, Bambolim, Goa, India
| | - Nikhil Bhagwat
- Department of EndocrinologyTopiwala National Medical College & BYL Nair Charitable Hospital, Mumbai, Maharashtra, India
| | - Prashanth Mappa
- Department of MedicineKannur Medical College and Hospital, Kannur, Kerala, India
| | - Rajesh Rajput
- Department of EndocrinologyPt. B.D. Sharma PGIMS, Rohtak, Haryana, India
| | - Sudha Rao Chandrashekhar
- Division of Pediatric EndocrinologyBai Jerbai Wadia Hospital for Children, Mumbai, Maharashtra, India
| | - Vyankatesh Shivane
- Department of EndocrinologySeth G S Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - Padma Menon
- Department of EndocrinologySeth G S Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - Anurag Lila
- Department of EndocrinologySeth G S Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - Tushar Bandgar
- Department of EndocrinologySeth G S Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - Nalin Shah
- Department of EndocrinologySeth G S Medical College and KEM Hospital, Mumbai, Maharashtra, India
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Khadilkar K, Sarathi V, Kasaliwal R, Pandit R, Goroshi M, Malhotra G, Dalvi A, Bakshi G, Bhansali A, Rajput R, Shivane V, Lila A, Bandgar T, Shah NS. Predictors of malignancy in patients with pheochromocytomas/paragangliomas: Asian Indian experience. Endocr Connect 2016; 5:89-97. [PMID: 27852633 PMCID: PMC5314950 DOI: 10.1530/ec-16-0086] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Accepted: 11/16/2016] [Indexed: 01/04/2023]
Abstract
BACKGROUND AND AIMS Malignant transformation of pheochromocytomas/paragangliomas (PCC/PGL) is a rare occurrence, and predictive factors for the same are not well understood. This study aims to identify the predictors of malignancy in patients with PCC/PGL. MATERIALS AND METHODS We performed a retrospective analysis of 142 patients with either PCC or PGL registered at our institute between 2000 and 2015. Records were evaluated for clinical parameters like age, gender, familial/syndromic presentation, symptomatic presentation, biochemistry, size, number and location of tumours and presence of metastases and mode of its diagnosis. RESULTS Twenty patients were found to have metastases; 13 had metastases at diagnosis and seven during follow-up. Metastases were detected by radiology (CT-neck to pelvis) in 11/20 patients (5/13 synchronous and 6/7 metachronous), 131I-metaiodobenzylguanidine in five (2/12 synchronous and 3/6 metachronous) patients and 18F-flurodeoxyglucose PET/CT in 15 (12/12 synchronous and 3/3 metachronous) patients. Malignant tumours were significantly larger than benign tumours (8.3 ± 4.1 cm, range: 3-22 cm vs 5.7 ± 2.3 cm, range: 2-14 cm, P = 0.0001) and less frequently metanephrine secreting. On linear regression analysis, tumour size and lack of metanephrine secretion were the independent predictors of malignancy. CONCLUSIONS Patients with primary tumour size >5.7 cm and lack of metanephrine secretory status should be evaluated for possible malignancy not only at diagnosis but also in the postoperative period. As compared to CT and 131I-MIBG scan, 18F-flurodeoxyglucose PET/CT analyses are better (sensitivity: 100%) for the diagnosis of metastases in our study.
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Affiliation(s)
- Kranti Khadilkar
- Department of EndocrinologySeth G S Medical College and KEM Hospital, Mumbai, India
| | - Vijaya Sarathi
- Department of EndocrinologyVydehi Institute of Medical Sciences and Research Center, Bangalore, India
| | - Rajeev Kasaliwal
- Department of EndocrinologyMahatma Gandhi Hospital and Medical College, Jaipur, India
| | - Reshma Pandit
- Department of EndocrinologySeth G S Medical College and KEM Hospital, Mumbai, India
| | - Manjunath Goroshi
- Department of EndocrinologySeth G S Medical College and KEM Hospital, Mumbai, India
| | - Gaurav Malhotra
- Radiation Medicine CentreBhabha Atomic Research Centre, Mumbai, India
| | - Abhay Dalvi
- Department of General SurgerySeth G S Medical College and KEM Hospital, Mumbai, India
| | - Ganesh Bakshi
- Department of Uro-oncologyTata Memorial Hospital, Mumbai, India
| | - Anil Bhansali
- Department of EndocrinologyPostgraduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| | - Rajesh Rajput
- Department of EndocrinologyPt. B.D. Sharma PGIMS, Rohtak, India
| | - Vyankatesh Shivane
- Department of EndocrinologySeth G S Medical College and KEM Hospital, Mumbai, India
| | - Anurag Lila
- Department of EndocrinologySeth G S Medical College and KEM Hospital, Mumbai, India
| | - Tushar Bandgar
- Department of EndocrinologySeth G S Medical College and KEM Hospital, Mumbai, India
| | - Nalini S Shah
- Department of EndocrinologySeth G S Medical College and KEM Hospital, Mumbai, India
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Pandit R, Khadilkar K, Sarathi V, Kasaliwal R, Goroshi M, Khare S, Nair S, Raghavan V, Dalvi A, Hira P, Fernandes G, Sathe P, Rojekar A, Malhotra G, Bakshi G, Prakash G, Bhansali A, Walia R, Kamalanathan S, Sahoo J, Desai A, Bhagwat N, Mappa P, Rajput R, Chandrashekhar SR, Shivane V, Menon P, Lila A, Bandgar T, Shah N. Germline mutations and genotype-phenotype correlation in Asian Indian patients with pheochromocytoma and paraganglioma. Eur J Endocrinol 2016; 175:311-23. [PMID: 27539324 DOI: 10.1530/eje-16-0126] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Accepted: 07/15/2016] [Indexed: 12/20/2022]
Abstract
BACKGROUND Genetic aetiology of pheochromocytoma (PCC) and paraganglioma (PGL) is increasingly being studied; however, Asian Indian data on this aspect are scarce. OBJECTIVE To study the prevalence of germline mutations and genotype-phenotype correlation in Asian Indian PCC/PGL patients. DESIGN In this study, 150 index patients (M:F, 73:77) with PCC/PGL were evaluated. Phenotypic data were collected. Germline mutations in five susceptibility genes (RET, VHL, SDHB, SDHD and SDHC) were tested by sequencing and NF1 was diagnosed according to phenotype. RESULT Of the total population, 49 (32.7%) PCC/PGL patients had germline mutations (VHL: 23 (15.3%), RET: 13 (8.7%), SDHB: 9 (6%), SDHD: 2 (1.3%) and NF1: 2 (1.3%)). Amongst the 30 patients with familial and/or syndromic presentation, all had germline mutations (VHL: 14 (46.7%), RET: 13 (43.3%), SDHB: 1 (3.3%) and NF1: 2 (6.7%)). Out of 120 patients with apparently sporadic presentation, 19 (15.8%) had a germline mutation (VHL: 9 (7.5%), SDHB: 8 (6.7%) and SDHD: 2 (1.7%)). Mutation carriers were younger (29.9 ± 14.5 years vs 36.8 ± 14.9; P = 0.01) and had a higher prevalence of bilateral PCC (26.5% vs 2.9%, P < 0.001) and multifocal tumours (12.2% vs 0.96%, P = 0.06). Based on syndromic features, metastasis, location and number of tumours, around 96% mutations in our cohort could be detected by appropriately selected single gene testing. CONCLUSION Asian Indians with PCC/PGL differ from Western cohorts in having preponderance of VHL mutations in multifocal tumours and apparently sporadic unilateral PCC. Syndromic presentation, metastasis, location and number of PCC/PGL can be effectively used for guiding genetic prioritisation.
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Affiliation(s)
- Reshma Pandit
- Department of EndocrinologySeth G S Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - Kranti Khadilkar
- Department of EndocrinologySeth G S Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - Vijaya Sarathi
- Department of EndocrinologyVydehi Institute of Medical Sciences and Research Centre, Bangalore, Karnataka, India
| | - Rajeev Kasaliwal
- Department of EndocrinologyMahatma Gandhi Hospital and Medical College, Jaipur, Rajasthan, India
| | - Manjunath Goroshi
- Department of EndocrinologySeth G S Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - Shruti Khare
- Department of EndocrinologySeth G S Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - Sandhya Nair
- Department of EndocrinologySeth G S Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - Vijaya Raghavan
- Department of EndocrinologySeth G S Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | | | | | - Gwendolyn Fernandes
- PathologySeth G S Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - Pragati Sathe
- PathologySeth G S Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - Amey Rojekar
- PathologySeth G S Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - Gaurav Malhotra
- Radiation Medicine CentreBhabha Atomic Research Centre, Mumbai, Maharashtra, India
| | - Ganesh Bakshi
- Department of Uro-oncologyTata Memorial Hospital, Mumbai, Maharashtra, India
| | - Gagan Prakash
- Department of Uro-oncologyTata Memorial Hospital, Mumbai, Maharashtra, India
| | - Anil Bhansali
- Department of EndocrinologyPostgraduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| | - Rama Walia
- Department of EndocrinologyPostgraduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| | - Sadishkumar Kamalanathan
- Department of EndocrinologyJawaharlal Institute of Postgraduate Medical Education & Research (JIPMER), Pondicherry, India
| | - Jayaprakash Sahoo
- Department of EndocrinologyJawaharlal Institute of Postgraduate Medical Education & Research (JIPMER), Pondicherry, India
| | - Ankush Desai
- Endocrine UnitDepartment of Medicine, Goa Medical College, Bambolim, Goa, India
| | - Nikhil Bhagwat
- Department of EndocrinologyTopiwala National Medical College & BYL Nair Charitable Hospital, Mumbai, Maharashtra, India
| | - Prashanth Mappa
- Department of MedicineKannur Medical College and Hospital, Kannur, Kerala, India
| | - Rajesh Rajput
- Department of EndocrinologyPt. B.D. Sharma PGIMS, Rohtak, Haryana, India
| | - Sudha Rao Chandrashekhar
- Division of Pediatric EndocrinologyBai Jerbai Wadia Hospital for Children, Mumbai, Maharashtra, India
| | - Vyankatesh Shivane
- Department of EndocrinologySeth G S Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - Padma Menon
- Department of EndocrinologySeth G S Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - Anurag Lila
- Department of EndocrinologySeth G S Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - Tushar Bandgar
- Department of EndocrinologySeth G S Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - Nalini Shah
- Department of EndocrinologySeth G S Medical College and KEM Hospital, Mumbai, Maharashtra, India
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Bourdeaux CP, Thomas MJC, Gould TH, Malhotra G, Jarvstad A, Jones T, Gilchrist ID. Increasing compliance with low tidal volume ventilation in the ICU with two nudge-based interventions: evaluation through intervention time-series analyses. BMJ Open 2016; 6:e010129. [PMID: 27230998 PMCID: PMC4885280 DOI: 10.1136/bmjopen-2015-010129] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVES Low tidal volume (TVe) ventilation improves outcomes for ventilated patients, and the majority of clinicians state they implement it. Unfortunately, most patients never receive low TVes. 'Nudges' influence decision-making with subtle cognitive mechanisms and are effective in many contexts. There have been few studies examining their impact on clinical decision-making. We investigated the impact of 2 interventions designed using principles from behavioural science on the deployment of low TVe ventilation in the intensive care unit (ICU). SETTING University Hospitals Bristol, a tertiary, mixed medical and surgical ICU with 20 beds, admitting over 1300 patients per year. PARTICIPANTS Data were collected from 2144 consecutive patients receiving controlled mechanical ventilation for more than 1 hour between October 2010 and September 2014. Patients on controlled mechanical ventilation for more than 20 hours were included in the final analysis. INTERVENTIONS (1) Default ventilator settings were adjusted to comply with low TVe targets from the initiation of ventilation unless actively changed by a clinician. (2) A large dashboard was deployed displaying TVes in the format mL/kg ideal body weight (IBW) with alerts when TVes were excessive. PRIMARY OUTCOME MEASURE TVe in mL/kg IBW. FINDINGS TVe was significantly lower in the defaults group. In the dashboard intervention, TVe fell more quickly and by a greater amount after a TVe of 8 mL/kg IBW was breached when compared with controls. This effect improved in each subsequent year for 3 years. CONCLUSIONS This study has demonstrated that adjustment of default ventilator settings and a dashboard with alerts for excessive TVe can significantly influence clinical decision-making. This offers a promising strategy to improve compliance with low TVe ventilation, and suggests that using insights from behavioural science has potential to improve the translation of evidence into practice.
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Affiliation(s)
| | | | - Timothy H Gould
- Intensive Care Unit, University Hospitals Bristol, Bristol, UK
| | - Gaurav Malhotra
- School of Experimental Psychology, University of Bristol, Bristol, UK
| | - Andreas Jarvstad
- School of Experimental Psychology, University of Bristol, Bristol, UK
| | | | - Iain D Gilchrist
- School of Experimental Psychology, University of Bristol, Bristol, UK
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Goroshi MR, Jadhav SS, Lila AR, Kasaliwal R, Khare S, Yerawar CG, Hira P, Phadke U, Shah H, Lele VR, Malhotra G, Bandgar T, Shah NS. Comparison of 68Ga-DOTANOC PET/CT and contrast-enhanced CT in localisation of tumours in ectopic ACTH syndrome. Endocr Connect 2016; 5:83-91. [PMID: 27006371 PMCID: PMC5002954 DOI: 10.1530/ec-16-0010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Accepted: 03/22/2016] [Indexed: 11/25/2022]
Abstract
BACKGROUND Localising ectopic adrenocorticotrophic hormone (ACTH) syndrome (EAS) tumour source is challenging. Somatostatin receptor-based PET imaging has shown promising results, but the data is limited to case reports and small case series. We reviewed here the performance of (68)Ga-DOTANOC positron emission tomography (PET)/computed tomography (CT) and contrast-enhanced CT (CECT) in our cohort of 12 consecutive EAS patients. MATERIALS AND METHODS Retrospective data analysis of 12 consecutive patients of EAS presenting to a single tertiary care centre in a period between January 2013 and December 2014 was done. CECT and (68)Ga-DOTANOC PET/CT were reported (blinded) by an experienced radiologist and a nuclear medicine physician, respectively. The performance of CECT and (68)Ga-DOTANOC PET/CT was compared. RESULTS Tumours could be localised in 11 out of 12 patients at initial presentation (overt cases), whereas in one patient, tumour remained occult. Thirteen lesions were identified in 11 patients as EAS source (true positives). CECT localised 12 out of these 13 lesions (sensitivity 92.3%) and identified five false-positive lesions (positive predictive value (PPV) 70.5%). Compared with false-positive lesions, true-positive lesions had greater mean contrast enhancement at 60s (33.2 vs 5.6 Hounsfield units (HU)). (68)Ga-DOTANOC PET/CT was able to identify 9 out of 13 lesions (sensitivity 69.2%) and reported no false-positive lesions (PPV 100%). CONCLUSION CECT remains the first-line investigation in localisation of EAS. The contrast enhancement pattern on CECT can further aid in characterisation of the lesions. (68)Ga-DOTANOC PET/CT can be added to CECT, to enhance positive prediction of the suggestive lesions.
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Affiliation(s)
- Majunath R Goroshi
- Department of EndocrinologySeth G S Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - Swati S Jadhav
- Department of EndocrinologySeth G S Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - Anurag R Lila
- Department of EndocrinologySeth G S Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - Rajeev Kasaliwal
- Department of EndocrinologySeth G S Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - Shruti Khare
- Department of EndocrinologySeth G S Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - Chaitanya G Yerawar
- Department of EndocrinologySeth G S Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - Priya Hira
- Department of RadiologySeth G S Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | | | - Hina Shah
- Department of Nuclear Medicine and Positron Emission Tomography/Computed TomographyJaslok Hospital and Research Centre, Mumbai, Maharashtra, India
| | - Vikram R Lele
- Department of Nuclear Medicine and Positron Emission Tomography/Computed TomographyJaslok Hospital and Research Centre, Mumbai, Maharashtra, India
| | - Gaurav Malhotra
- Radiation Medicine CentreBhabha Atomic Research Centre, Tata Memorial Centre, Annexe, Parel, Mumbai, Maharashtra, India
| | - Tushar Bandgar
- Department of EndocrinologySeth G S Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - Nalini S Shah
- Department of EndocrinologySeth G S Medical College and KEM Hospital, Mumbai, Maharashtra, India
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Sonavane SN, Malhotra G, Asopa R, Upadhye T. Role of fluorine-18 fluorodeoxyglucose positron emission tomography in a case of renal cell carcinoma to differentiate tumor thrombus from bland thrombus. Indian J Nucl Med 2015; 30:355-7. [PMID: 26430326 PMCID: PMC4579627 DOI: 10.4103/0972-3919.164016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Tumor thrombus is a rare complication of many solid tumors. We present a case of renal cell carcinoma whose baseline contrast-enhanced computerized tomography (CT) revealed an heterogeneously enhancing mass in the upper half of right kidney with tumor thrombus in the right renal vein extending to suprarenal inferior vena cava (IVC), crossing the cavoatrial junction and reaching up to the right atrium (Grade IV). Fluorine-18 fluorodeoxyglucose (18F-FDG) positron emission tomography (PET)/CT imaging revealed large irregular right renal mass, hypermetabolic tumor thrombus extending from the right renal vein to suprarenal IVC reaching up to the right atrium. There was no FDG uptake noted in the infrarenal IVC and bilateral iliofemoral venous thrombi. Thus, 18F-FDG PET/CT was not only helpful in the staging, but was also helpful in differentiating tumor thrombus from bland thrombus in our patient.
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Affiliation(s)
- Sunita Nitin Sonavane
- Department of Nuclear Medicine and PET/CT, Radiation Medicine Center, Parel, Mumbai, Maharashtra, India
| | - Gaurav Malhotra
- Department of Nuclear Medicine and PET/CT, Radiation Medicine Center, Parel, Mumbai, Maharashtra, India
| | - Ramesh Asopa
- Department of Nuclear Medicine, Radiation Medicine Center, Parel, Mumbai, Maharashtra, India
| | - Trupti Upadhye
- Department of Nuclear Medicine, Radiation Medicine Center, Parel, Mumbai, Maharashtra, India
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Kasaliwal R, Goroshi M, Khadilkar K, Bakshi G, Rangarajan V, Malhotra G, Lila A, Bandgar T, Shah NS. PRIMARY ADRENAL LYMPHOMA: A SINGLE-CENTER EXPERIENCE. Endocr Pract 2015; 21:719-24. [PMID: 25716633 DOI: 10.4158/ep14471.or] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To describe the clinical presentation, biochemistry, imaging features, and treatment outcome of patients with primary adrenal lymphoma (PAL) presenting to a single tertiary care center. METHODS We performed a retrospective analysis of case records of 7 patients diagnosed with PAL between January 2011 and May 2014 at our institution in Mumbai, India. RESULTS Median age of presentation in our series was 48 years (range, 41 to 60 years), with a male to female ratio of 6:1. Bilateral adrenal involvement was seen in 4 of 7 patients (58%). Adrenal insufficiency (AI) was seen in 3 of the 4 patients with bilateral involvement (75%). Computed tomography showed slight to moderate contrast enhancement of adrenal masses in 4 of 5 patients (80%). Diffuse, large, B-cell lymphoma (DLBCL) was the most common immunophenotype (85%). One patient died due to rapid disease progression even before starting chemotherapy. Six patients were treated with chemotherapy and/or external beam radiotherapy. After 1 year, 2 more patients had died, whereas 4 patients were in remission. CONCLUSION PAL should always be considered in differential diagnosis of bilateral adrenal mass with AI. DLBCL is the most common histologic subtype of PAL. Despite treatment, long-term prognosis of PAL remains poor.
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Malhotra G, Kataria P, Shukla P, Gupta S, Sargaiyan V, Mahendra A, Subudhi SK. A novel approach for retreatment of multirooted tooth by partial radisection. Ann Afr Med 2015; 14:69-72. [PMID: 25567700 DOI: 10.4103/1596-3519.148751] [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: 11/04/2022] Open
Abstract
Modern advances in all phases of dentistry have provided the opportunity for patients to maintain a functional dentition for lifetime. Therapeutic measures performed to ensure retention of teeth vary in complexity. The treatment may involve combining restorative dentistry, endodontics, and periodontics so that the teeth are retained in whole or in part. Thus, tooth resection procedures are used to preserve as much tooth structure as possible rather than sacrificing the whole tooth. This treatment can produce predictable results as long as proper diagnostic, endodontic, surgical, prosthetic, and maintenance procedures are performed. The keys to long-term success appear to be thorough diagnosis, selection of patients with good oral hygiene and careful surgical and restorative management.
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Affiliation(s)
| | | | | | - Shivangi Gupta
- Departments of Periodontics and Implantology, D.J. College of Dental Sciences and Research, Modinagar, Uttar Pradesh, India
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Jadhav S, Kasaliwal R, Lele V, Rangarajan V, Chandra P, Shah H, Malhotra G, Jagtap VS, Budyal S, Lila AR, Bandgar T, Shah NS. Functional imaging in primary tumour-induced osteomalacia: relative performance of FDG PET/CT vs somatostatin receptor-based functional scans: a series of nine patients. Clin Endocrinol (Oxf) 2014; 81:31-7. [PMID: 24528172 DOI: 10.1111/cen.12426] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2013] [Revised: 12/07/2013] [Accepted: 01/27/2014] [Indexed: 02/04/2023]
Abstract
CONTEXT Localization of phosphatonin-producing mesenchymal tumours in patients with primary tumour-induced osteomalacia (pTIO) is challenging. Functional imaging plays an important role in the localization of these tumours. OBJECTIVE We studied the relative performance of different functional imaging modalities ((18) F-FDG PET/CT, (99) Tc-HYNIC-TOC SPECT/CT and (68) Ga-DOTATATE PET/CT) in tumour localization in cases of pTIO. DESIGN AND METHODS Retrospective chart evaluation of 16 patients with confirmed TIO treated from 2006 to 2013 was conducted in a tertiary care referral centre. RESULTS Of 16, nine patients had pTIO. In these nine, the positivity rates of different functional imaging modalities were 50% for (18) F-FDG PET/CT (four of eight patients), 100% for (99) Tc-HYNIC-TOC SPECT/CT (six of six patients) and 100% for (68) Ga-DOTATATE PET/CT (seven of seven patients). Of nine patients, six were subjected to both the (99) Tc-HYNIC-TOC SPECT/CT and (68) Ga-DOTATATE PET/CT and all of them showed coregistration on the two scans. CONCLUSIONS In patients with pTIO, the somatostatin receptor-based functional scans performed better than (18) F-FDG PET/CT in tumour localization. Amongst the somatostatin receptor-based scans, (99) Tc-HYNIC-TOC SPECT/CT and (68) Ga-DOTATATE PET/CT performed equally well for localization of tumours.
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Affiliation(s)
- Swati Jadhav
- Department of Endocrinology, KEM Hospital, Mumbai, India
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Malhotra G, Swami A, Shah P, Mittal N, Gandhi SJ, Tiwari B, Jatale PV, Asopa RV. F-18 fluorodeoxyglucose positron emission tomography "super scan" in a patient of metastatic primitive neuroectodermal tumor of the kidney. Indian J Nucl Med 2013; 27:115-8. [PMID: 23723585 PMCID: PMC3665138 DOI: 10.4103/0972-3919.110709] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
We report F-18 fluorodeoxyglucose (FDG) “positron emission tomography (PET) super scan” akin to “super scan” of conventional skeletal scintigraphy, in a rare case of primitive neuroectodermal tumor (PNET) of the kidney. A twelve year old male patient of metastatic PNET of the kidney was subjected to a “true” whole body F-18 FDG PET scan including lower limbs and skull region as per the institution protocol. The images revealed extensive hypermetabolic areas corresponding to the computed tomography described renal, hepatic, and pancreatic lesions along with intense and non-uniform uptake in the marrows of axial and appendicular skeletal system. Interestingly, low background tracer concentration was observed along with very low F-18 FDG uptake in the brain, skeletal muscles of limb, mediastinum, and bowel. In view of these findings, the scan can be interpreted as “PET super scan” due to its resemblance with the super scan of skeletal scintigraphy. A repeat F-18 FDG PET scan after chemotherapy revealed marked treatment response with disappearance of “super scan”-like pattern, reduction in number, size, metabolic activity of the lesions, and stimulated marrow sans the previously diseased portion. Though uncommon, the reporting physician should be aware of “PET super scan” and its implications as described in this case.
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Affiliation(s)
- Gaurav Malhotra
- Radiation Medicine Centre, Bhabha Atomic Research Centre, Tata Memorial Centre Annexe, Mumbai, Maharashtra, India
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Chalakkal P, de Noronha de Ataide I, Akkara F, Malhotra G. Modified serial extraction in a case with missing mandibular second premolars and a brief review of related treatment modalities. J Indian Soc Pedod Prev Dent 2013; 31:126-31. [PMID: 23886726 DOI: 10.4103/0970-4388.115719] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
This article discusses a case of an 8-year-old female child who presented with severe lower anterior crowding and congenitally missing lower second premolars. A conventional serial extraction procedure could not be performed due to the congenital absence of teeth. Instead, planned extraction of a few primary teeth was done to relieve the lower anterior crowding, the results of which were near satisfactory.
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Affiliation(s)
- P Chalakkal
- Department of Pedodontics and Preventive Dentistry, Goa Dental College and Hospital, Bambolim, Goa, India
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Malhotra G, Elkassabany NM, Frogel J, Patel AR, Steinberg G, Shaefi S, Mahmood F. CASE 8--2012 intraoperative embolization of renal cell tumor thrombus during radical nephrectomy. J Cardiothorac Vasc Anesth 2012; 26:1124-30. [PMID: 22883446 DOI: 10.1053/j.jvca.2012.06.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [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: 11/09/2011] [Indexed: 11/11/2022]
Affiliation(s)
- Gaurav Malhotra
- Department of Anesthesiology and Critical Care, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
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