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Dong J, Kwan E, Bergquist JA, Steinberg BA, Dosdall DJ, DiBella EVR, MacLeod RS, Bunch TJ, Ranjan R. Ablation-induced left atrial mechanical dysfunction recovers in weeks after ablation. J Interv Card Electrophysiol 2024:10.1007/s10840-024-01795-x. [PMID: 38587576 DOI: 10.1007/s10840-024-01795-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 03/18/2024] [Indexed: 04/09/2024]
Abstract
BACKGROUND The immediate impact of catheter ablation on left atrial mechanical function and the timeline for its recovery in patients undergoing ablation for atrial fibrillation (AF) remain uncertain. The mechanical function response to catheter ablation in patients with different AF types is poorly understood. METHODS A total of 113 AF patients were included in this retrospective study. Each patient had three magnetic resonance imaging (MRI) studies in sinus rhythm: one pre-ablation, one immediate post-ablation (within 2 days after ablation), and one post-ablation follow-up MRI (≤ 3 months). We used feature tracking in the MRI cine images to determine peak longitudinal atrial strain (PLAS). We evaluated the change in strain from pre-ablation, immediately after ablation to post-ablation follow-up in a short-term study (< 50 days) and a 3-month study (3 months after ablation). RESULTS The PLAS exhibited a notable reduction immediately after ablation, compared to both pre-ablation levels and those observed in follow-up studies conducted at short-term (11.1 ± 9.0 days) and 3-month (69.6 ± 39.6 days) intervals. However, there was no difference between follow-up and pre-ablation PLAS. The PLAS returned to 95% pre-ablation level within 10 days. Paroxysmal AF patients had significantly higher pre-ablation PLAS than persistent AF patients in pre-ablation MRIs. Both type AF patients had significantly lower immediate post-ablation PLAS compared with pre-ablation and post-ablation PLAS. CONCLUSION The present study suggested a significant drop in PLAS immediately after ablation. Left atrial mechanical function recovered within 10 days after ablation. The drop in PLAS did not show a substantial difference between paroxysmal and persistent AF patients.
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Affiliation(s)
- Jiawei Dong
- Department of Biomedical Engineering, University of Utah, Salt Lake City, UT, USA
- Nora Eccles Harrison Cardiovascular Research and Training Institute, University of Utah, Salt Lake City, UT, USA
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Utah, Salt Lake City, UT, USA
| | - Eugene Kwan
- Department of Biomedical Engineering, University of Utah, Salt Lake City, UT, USA
- Nora Eccles Harrison Cardiovascular Research and Training Institute, University of Utah, Salt Lake City, UT, USA
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Utah, Salt Lake City, UT, USA
| | - Jake A Bergquist
- Department of Biomedical Engineering, University of Utah, Salt Lake City, UT, USA
- Nora Eccles Harrison Cardiovascular Research and Training Institute, University of Utah, Salt Lake City, UT, USA
- Scientific Computing and Imaging Institute, University of Utah, Salt Lake City, UT, USA
| | - Benjamin A Steinberg
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Utah, Salt Lake City, UT, USA
| | - Derek J Dosdall
- Department of Biomedical Engineering, University of Utah, Salt Lake City, UT, USA
- Nora Eccles Harrison Cardiovascular Research and Training Institute, University of Utah, Salt Lake City, UT, USA
- Division of Cardiothoracic Surgery, Department of Surgery, University fo Utah, Salt Lake City, UT, USA
| | - Edward V R DiBella
- Department of Biomedical Engineering, University of Utah, Salt Lake City, UT, USA
- Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT, USA
| | - Rob S MacLeod
- Department of Biomedical Engineering, University of Utah, Salt Lake City, UT, USA
- Nora Eccles Harrison Cardiovascular Research and Training Institute, University of Utah, Salt Lake City, UT, USA
- Scientific Computing and Imaging Institute, University of Utah, Salt Lake City, UT, USA
| | - T Jared Bunch
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Utah, Salt Lake City, UT, USA
| | - Ravi Ranjan
- Department of Biomedical Engineering, University of Utah, Salt Lake City, UT, USA.
- Nora Eccles Harrison Cardiovascular Research and Training Institute, University of Utah, Salt Lake City, UT, USA.
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Utah, Salt Lake City, UT, USA.
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Vijayakumar S, Narayan PK, Kumari S, Ranjan R, Kumar V, Kumar A, Alti D. A review of non-invasive samples and tools in kala-azar diagnosis and test of cure. Exp Parasitol 2024; 259:108713. [PMID: 38350522 DOI: 10.1016/j.exppara.2024.108713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 01/24/2024] [Accepted: 02/05/2024] [Indexed: 02/15/2024]
Abstract
The recurrence of visceral leishmaniasis (VL), also called kala-azar (KA), in endemic regions of tropical countries like India, is primarily attributed to asymptomatic VL, post-kala azar dermal leishmaniasis (PKDL), and human immunodeficiency virus (HIV) co-infection. To effectively manage VL cases and elimination targets, an early and rapid diagnosis as well as accurate field surveillance is highly essential. The traditional sampling methods like bone marrow (BM), spleen, and lymph node (LN) tissue aspirations are invasive, painful, tedious, and prone to nosocomial infections, require skilled persons and hospital facilities, and are not feasible in rural areas. Therefore, there is an urgent requirement for the adoption of a patient-friendly, non-invasive, non-hospitalized sampling procedure that ensures an effective VL diagnosis. This review aims to meticulously evaluate the most recent scientific research that focuses on the precision, feasibility, and applicability of non-invasive sampling (NIS) and techniques for the diagnosis and test of cure of VL, particularly in resource-limited settings. Apart from that, the non-invasive techniques (NIT) that have shown promising results while monitoring VL treatment response and relapse are also reviewed. The limitations associated with NIT and possible improvements in this regard are discussed as well to improve the diagnosis and management of VL.
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Affiliation(s)
- Saravanan Vijayakumar
- National Centre for Disease Informatics and Research (ICMR-NCDIR), Bengaluru, 562110, India.
| | | | - Shobha Kumari
- ICMR-Rajendra Memorial Research Institute of Medical Sciences, Patna, India, 800007.
| | - Ravi Ranjan
- ICMR-Rajendra Memorial Research Institute of Medical Sciences, Patna, India, 800007.
| | - Vikash Kumar
- ICMR-Rajendra Memorial Research Institute of Medical Sciences, Patna, India, 800007.
| | - Ashish Kumar
- ICMR-Rajendra Memorial Research Institute of Medical Sciences, Patna, India, 800007.
| | - Dayakar Alti
- ICMR-Rajendra Memorial Research Institute of Medical Sciences, Patna, India, 800007.
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Ranjan R, Koffel T, Klausmeier CA. The three-species problem: Incorporating competitive asymmetry and intransitivity in modern coexistence theory. Ecol Lett 2024; 27:e14426. [PMID: 38603592 DOI: 10.1111/ele.14426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 02/28/2024] [Accepted: 03/08/2024] [Indexed: 04/13/2024]
Abstract
While natural communities can contain hundreds of species, modern coexistence theory focuses primarily on species pairs. Alternatively, the structural stability approach considers the feasibility of equilibria, gaining scalability to larger communities but sacrificing information about dynamic stability. Three-species competitive communities are a bridge to more-diverse communities. They display novel phenomena while remaining amenable to mathematical analysis, but remain incompletely understood. Here, we combine these approaches to identify the key quantities that determine three-species competition outcomes. We show that pairwise niche overlap and fitness differences are insufficient to completely characterize competitive outcomes, which requires a strictly triplet-wise quantity: cyclic asymmetry, which underlies intransitivity. Low pairwise niche overlap stabilizes the triplet, while high fitness differences promote competitive exclusion. The effect of cyclic asymmetry on stability is complex and depends on pairwise niche overlap. In summary, we elucidate how pairwise niche overlap, fitness differences and cyclic asymmetry determine three-species competition outcomes.
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Affiliation(s)
- Ravi Ranjan
- W.K. Kellogg Biological Station, Michigan State University, Hickory Corners, Michigan, USA
- Program in Ecology, Evolution and Behavior, Michigan State University, East Lansing, Michigan, USA
- Department of Plant Biology, Michigan State University, East Lansing, Michigan, USA
- Hanse-Wissenschaftskolleg Institute for Advanced Study, Delmenhorst, Germany
| | - Thomas Koffel
- W.K. Kellogg Biological Station, Michigan State University, Hickory Corners, Michigan, USA
- Program in Ecology, Evolution and Behavior, Michigan State University, East Lansing, Michigan, USA
| | - Christopher A Klausmeier
- W.K. Kellogg Biological Station, Michigan State University, Hickory Corners, Michigan, USA
- Program in Ecology, Evolution and Behavior, Michigan State University, East Lansing, Michigan, USA
- Department of Plant Biology, Michigan State University, East Lansing, Michigan, USA
- Department of Integrative Biology, Michigan State University, East Lansing, Michigan, USA
- Department of Global Ecology, Carnegie Institution for Science, Stanford, California, USA
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4
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Crawford M, Steinberg BA, Ranjan R, Konstantinidis K, Navaravong L, Bunch TJ. Mortality benefit with AF ablation: Impact of normal sinus rhythm seen in CABANA and EAST AFnet. J Cardiovasc Electrophysiol 2024; 35:538-546. [PMID: 38131368 DOI: 10.1111/jce.16160] [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: 09/01/2023] [Revised: 12/08/2023] [Accepted: 12/11/2023] [Indexed: 12/23/2023]
Abstract
Atrial fibrillation (AF) is significantly associated with morbidity and mortality and erodes the quality and quantity of life. It is standard of care to treat patients with AF and an increased risk of stroke with oral anticoagulation therapy, but the more daunting question many clinicians face is whether to pursue a "rate-only" or "rhythm" control strategy. Historical studies over the years have sought to answer this question but have found no significant difference in major clinical outcomes between the two strategies. There are opportunities based on new data to improve the natural history of the disease. The EAST AFnet trial for the first time revealed a significant morbidity and mortality advantage to rhythm control therapy when performed early in the disease process of AF and in the setting of comprehensive medical management that was maintained. The CABANA trial clearly demonstrated that catheter ablation was a more effective long-term treatment of AF in general and significantly lowers risk of AF progression compared to medical therapy. Like multiple prior trials of rhythm management strategies, when rhythm control was effective in these trials, independent of therapy assignment, there was a significantly lower risk of adverse outcomes and death. These contemporary data provide optimism that the pervasive mortality risk in patients with AF observed over the past 50 years may be improved by the timing, use, and efficacy of use of therapeutic interventions.
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Affiliation(s)
- Michael Crawford
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Benjamin A Steinberg
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Ravi Ranjan
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Klitos Konstantinidis
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Leenhapong Navaravong
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Thomas J Bunch
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
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Wiala A, Ranjan R, Schnidar H, Rappersberger K, Posch C. Automated classification of hidradenitis suppurativa disease severity by convolutional neural network analyses using calibrated clinical images. J Eur Acad Dermatol Venereol 2024; 38:576-582. [PMID: 38013510 DOI: 10.1111/jdv.19639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 09/29/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND The assessment of hidradenitis suppurativa (HS) severity requires detailed, and error-prone lesion counts. This proof-of-concept study aimed to automatically classify HS disease severity using machine learning of clinical smartphone images. METHODS 777 ambient-light and size-controlled images were used to build a class-balanced synthetic dataset (n = 7675). Convolutional neural networks (CNN) were used for automated severity classification (scale 0-3), and to assess disease-dynamics. International Hidradenitis Suppurativa Severity Score System (IHS4) served as reference. A U-NET algorithm was implemented for automated localization of diseased skin. RESULTS CNNs were able to distinguish no/mild from moderate/severe disease with an overall prediction accuracy of 78% [receiver operating curve (AUC) 0.85]. Correct IHS4 classification was achieved with an overall accuracy of 72% (AUC 0.84-0.89). In addition, disease dynamics using IHS4 numerical values aligned with CNN outputs (NRMSE 0.262). The UNET algorithm localized lesions with a pixel accuracy of 88.1% and test loss of 0.42. LIMITATIONS Limitations in assessing tattooed and hairy skin. Limited number of patients with dark skin colour and Hurley I. CONCLUSION CNNs were able to distinguish no/mild from moderate/severe disease, classify disease severity over time, and automatically identify diseased skin areas and the skin phototype. This study breaks new grounds for fast, reliable, reproducible and easy-to-use HS severity assessments using clinical images.
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Affiliation(s)
- A Wiala
- Department of Dermatology, Clinic Landstrasse, Vienna, Austria
| | - R Ranjan
- SCARLETRED Holding GmbH, Vienna, Austria
| | - H Schnidar
- SCARLETRED Holding GmbH, Vienna, Austria
| | - K Rappersberger
- Department of Dermatology, Clinic Landstrasse, Vienna, Austria
- School of Medicine, Sigmund Freud University, Vienna, Austria
| | - C Posch
- School of Medicine, Sigmund Freud University, Vienna, Austria
- Department of Dermatology, Clinic Hietzing, Vienna, Austria
- Department of Dermatology and Allergy, School of Medicine, German Cancer Consortium (DKTK), Technical University of Munich, Munich, Germany
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Deopujari CE, Ambekar S, Yetukuri BR, Diyora B, Ghosh A, Krishnan P, Panigrahi M, Ranjan R, Raman C, Tyagi S, Vaishya S, Venkataramana N, Sinha VD, Paniker D, Das S. Expert panel recommendations for topical hemostatic agent use in varied bleeding sites and situations during neuro-spine surgeries. J Clin Neurosci 2024; 120:30-35. [PMID: 38176112 DOI: 10.1016/j.jocn.2023.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 11/22/2023] [Accepted: 12/11/2023] [Indexed: 01/06/2024]
Abstract
Intraoperative bleeding poses a substantial challenge, particularly in neuro-spine surgeries leading to complications such as hematomas, infections, and hemodynamic instability. Despite their proven efficacy, use of topical hemostatic agents (THAs) lacks comprehensive published literature and guidelines particularly in the Indian setting. The present study provides the first-ever Indian expert panel recommendations for effective adjunct THA use in different intraoperative bleeding sites and situations in neuro-spine surgeries. A comprehensive approach, encompassing a literature review, followed by experience sharing in a meeting using a survey helped integrate expert opinions in the form of practical algorithms to guide THA selection. Our survey results revealed a strong inclination towards specific THAs, flowable gelatin + thrombin being choice of THA for difficult to access and problematic bleeding situations during tumor removal/resection, transsphenoidal hypophysectomy and skull-based procedures. Both oxidized regenerated cellulose (ORC)/Fibrillar and flowable gelatin + thrombin were recommended for continuous oozing. ORC/Fibrillar was preferred for arteriovenous and cavernous malformations. This expert-panel guidance on THA use aims to optimize hemostat use practices and improve surgical outcomes in neuro-spine surgery.
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Affiliation(s)
- C E Deopujari
- Department of Neurosurgery, Bombay Hospital Institute of Medical Sciences, Mumbai, India
| | - S Ambekar
- Department of Neurosurgery, Jaslok Hospital, Mumbai, India
| | - B R Yetukuri
- Department of Neurosurgery and Spine Surgery, Yashoda Hospitals, Hyderabad, India
| | - B Diyora
- Department of Neurosurgery, Lokmanya Tilak Municipal General Hospital and Lokmanya Tilak Municipal Medical College, Mumbai, India
| | - A Ghosh
- Department of Neurosurgery, Institute of Neurosciences Kolkata, Kolkata, India
| | - P Krishnan
- Department of Neurosurgery, National Neurosciences Centre Calcutta, Kolkata, India
| | - M Panigrahi
- Department of Neurosurgery, Krishna Institute of Medical Sciences, Hyderabad, India
| | - R Ranjan
- Department of Neurosurgery, Aditya Birla Memorial Hospital, Pune, India
| | - C Raman
- Department of Neurosurgery, Nobel Hospital, Pune, India
| | - S Tyagi
- Department of Neurosurgery, Indraprastha Apollo Hospital, New Delhi, India
| | - S Vaishya
- Department of Neurosurgery, Fortis Memorial Research Institute, Gurugram, India
| | - N Venkataramana
- Department of Neurosurgery, Brains Hospital, Bengaluru, India
| | - V D Sinha
- Department of Neurosurgery, Santokba Durlabhji Memorial Hospital, Jaipur, India
| | - D Paniker
- Department of Neurosurgery, Aster Medcity, Kochi, India
| | - S Das
- Johnson and Johnson Private Limited, Mumbai, India.
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7
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Kumar V, Kumari S, Ranjan R, Kumar A, Alti D. In vitro antileishmanial activity of thioridazine on amphotericin B unresponsive/ sensitive Leishmania donovani promastigotes and intracellular amastigotes. Exp Parasitol 2024; 257:108688. [PMID: 38142765 DOI: 10.1016/j.exppara.2023.108688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 11/20/2023] [Accepted: 12/13/2023] [Indexed: 12/26/2023]
Abstract
The recent increase in the drug (liposomal amphotericin-B) unresponsive cases becomes hostile for the visceral leishmaniasis (VL) elimination target. The quest for new antileishmanial drugs is on the way and may demand more time. Meanwhile, drug repurposing is a quite promising option to explore further. We made such an attempt with thioridazine (TRZ), a first-line antipsychotic drug, which was reported for antimicrobial activity. In this study, we evaluated the drug activity of TRZ against amphotericin-B (Amp-B) sensitive and unresponsive Leishmania donovani promastigotes, as well as intracellular amastigotes (drug sensitive). We observed a potent antileishmanial activity of TRZ with significantly low half maximal inhibitory concentrations (IC50) on both the variants of promastigotes (0.61 ± 0.15 μM). These concentrations are comparable to the previously reported IC50 concentration of the current antileishmanial drug (Amp-B) against L. donovani. Light microscopy reveals the perturbations in promastigote morphology upon TRZ treatment. The in vitro studies on human macrophage cell lines determine the 50% cytotoxicity concentration (CC50) of TRZ on host cells as 20.046 μM and a half maximal effective concentration (EC50) as 0.91 μM during L. donovani infection, in turn selectivity index (SI) was calculated as 22.03 μM. Altogether, the results demonstrate that TRZ has the potential for drug repurposing and further studies on animal models could provide better insights for VL treatment.
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Affiliation(s)
- Vikash Kumar
- Department of Biochemistry, Rajendra Memorial Research Institute of Medical Sciences, Patna, India
| | - Shobha Kumari
- Department of Biochemistry, Rajendra Memorial Research Institute of Medical Sciences, Patna, India
| | - Ravi Ranjan
- Department of Biochemistry, Rajendra Memorial Research Institute of Medical Sciences, Patna, India
| | - Ashish Kumar
- Department of Biochemistry, Rajendra Memorial Research Institute of Medical Sciences, Patna, India
| | - Dayakar Alti
- Department of Immunology, Rajendra Memorial Research Institute of Medical Sciences, Patna, India.
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Pavon N, Diep K, Yang F, Sebastian R, Martinez-Martin B, Ranjan R, Sun Y, Pak C. Patterning ganglionic eminences in developing human brain organoids using a morphogen-gradient-inducing device. Cell Rep Methods 2024; 4:100689. [PMID: 38228151 PMCID: PMC10831957 DOI: 10.1016/j.crmeth.2023.100689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 10/21/2023] [Accepted: 12/18/2023] [Indexed: 01/18/2024]
Abstract
In early neurodevelopment, the central nervous system is established through the coordination of various neural organizers directing tissue patterning and cell differentiation. Better recapitulation of morphogen gradient production and signaling will be crucial for establishing improved developmental models of the brain in vitro. Here, we developed a method by assembling polydimethylsiloxane devices capable of generating a sustained chemical gradient to produce patterned brain organoids, which we termed morphogen-gradient-induced brain organoids (MIBOs). At 3.5 weeks, MIBOs replicated dorsal-ventral patterning observed in the ganglionic eminences (GE). Analysis of mature MIBOs through single-cell RNA sequencing revealed distinct dorsal GE-derived CALB2+ interneurons, medium spiny neurons, and medial GE-derived cell types. Finally, we demonstrate long-term culturing capabilities with MIBOs maintaining stable neural activity in cultures grown up to 5.5 months. MIBOs demonstrate a versatile approach for generating spatially patterned brain organoids for embryonic development and disease modeling.
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Affiliation(s)
- Narciso Pavon
- Graduate Program in Neuroscience and Behavior, UMass Amherst, Amherst, MA 01003, USA; Department of Biochemistry and Molecular Biology, UMass Amherst, Amherst, MA 01003, USA
| | - Karmen Diep
- Department of Biochemistry and Molecular Biology, UMass Amherst, Amherst, MA 01003, USA
| | - Feiyu Yang
- Department of Mechanical and Industrial Engineering, UMass Amherst, Amherst, MA 01003, USA
| | - Rebecca Sebastian
- Graduate Program in Neuroscience and Behavior, UMass Amherst, Amherst, MA 01003, USA; Department of Biochemistry and Molecular Biology, UMass Amherst, Amherst, MA 01003, USA
| | - Beatriz Martinez-Martin
- Department of Biochemistry and Molecular Biology, UMass Amherst, Amherst, MA 01003, USA; Graduate Program in Molecular and Cellular Biology, UMass Amherst, Amherst, MA 01003, USA
| | - Ravi Ranjan
- Genomics Core, Institute of Applied Life Sciences, UMass Amherst, Amherst, MA 01003, USA
| | - Yubing Sun
- Department of Mechanical and Industrial Engineering, UMass Amherst, Amherst, MA 01003, USA.
| | - ChangHui Pak
- Department of Biochemistry and Molecular Biology, UMass Amherst, Amherst, MA 01003, USA.
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Thomas MK, Ranjan R. Designing More Informative Multiple-Driver Experiments. Ann Rev Mar Sci 2024; 16:513-536. [PMID: 37625127 DOI: 10.1146/annurev-marine-041823-095913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/27/2023]
Abstract
For decades, multiple-driver/stressor research has examined interactions among drivers that will undergo large changes in the future: temperature, pH, nutrients, oxygen, pathogens, and more. However, the most commonly used experimental designs-present-versus-future and ANOVA-fail to contribute to general understanding or predictive power. Linking experimental design to process-based mathematical models would help us predict how ecosystems will behave in novel environmental conditions. We review a range of experimental designs and assess the best experimental path toward a predictive ecology. Full factorial response surface, fractional factorial, quadratic response surface, custom, space-filling, and especially optimal and sequential/adaptive designs can help us achieve more valuable scientific goals. Experiments using these designs are challenging to perform with long-lived organisms or at the community and ecosystem levels. But they remain our most promising path toward linking experiments and theory in multiple-driver research and making accurate, useful predictions.
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Affiliation(s)
- Mridul K Thomas
- Department F.-A. Forel for Environmental and Aquatic Sciences and Institute for Environmental Sciences, University of Geneva, Geneva, Switzerland;
| | - Ravi Ranjan
- Helmholtz Institute for Functional Marine Biodiversity at the University of Oldenburg, Oldenburg, Germany;
- Alfred Wegener Institute, Helmholtz Centre for Polar and Marine Research, Bremerhaven, Germany
- Hanse-Wissenschaftskolleg Institute for Advanced Study, Delmenhorst, Germany
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10
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Kennard AS, Velle KB, Ranjan R, Schulz D, Fritz-Laylin LK. An internally controlled system to study microtubule network diversification links tubulin evolution to the use of distinct microtubule regulators. bioRxiv 2024:2024.01.08.573270. [PMID: 38260630 PMCID: PMC10802493 DOI: 10.1101/2024.01.08.573270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2024]
Abstract
Diverse eukaryotic cells assemble microtubule networks that vary in structure and composition. While we understand how cells build microtubule networks with specialized functions, we do not know how microtubule networks diversify across deep evolutionary timescales. This problem has remained unresolved because most organisms use shared pools of tubulins for multiple networks, making it impossible to trace the evolution of any single network. In contrast, the amoeboflagellate Naegleria uses distinct tubulin genes to build distinct microtubule networks: while Naegleria builds flagella from conserved tubulins during differentiation, it uses divergent tubulins to build its mitotic spindle. This genetic separation makes for an internally controlled system to study independent microtubule networks in a single organismal and genomic context. To explore the evolution of these microtubule networks, we identified conserved microtubule binding proteins and used transcriptional profiling of mitosis and differentiation to determine which are upregulated during the assembly of each network. Surprisingly, most microtubule binding proteins are upregulated during only one process, suggesting that Naegleria uses distinct component pools to specialize its microtubule networks. Furthermore, the divergent residues of mitotic tubulins tend to fall within the binding sites of differentiation-specific microtubule regulators, suggesting that interactions between microtubules and their binding proteins constrain tubulin sequence diversification. We therefore propose a model for cytoskeletal evolution in which pools of microtubule network components constrain and guide the diversification of the entire network, so that the evolution of tubulin is inextricably linked to that of its binding partners.
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Affiliation(s)
- Andrew S. Kennard
- Department of Biology, University of Massachusetts, Amherst MA, United States
| | - Katrina B. Velle
- Department of Biology, University of Massachusetts, Amherst MA, United States
| | - Ravi Ranjan
- Genomics Resource Laboratory, Institute of Applied Life Sciences, University of Massachusetts, Amherst MA, United States
| | - Danae Schulz
- Department of Biology, Harvey Mudd College, Claremont CA, United States
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Hirahara AM, Khan MS, Ishidoya Y, Smego D, Roman O, Ranjan R, Krueger L, Hoareau G, Selzman CH, Dosdall DJ. Canine Model of Ischemia-Induced Ventricular Tachycardia. J Surg Res 2024; 293:196-203. [PMID: 37778087 PMCID: PMC10840854 DOI: 10.1016/j.jss.2023.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 08/16/2023] [Accepted: 09/05/2023] [Indexed: 10/03/2023]
Abstract
INTRODUCTION Despite advances in antiarrhythmia therapies, ventricular tachycardia (VT) is a leading cause of sudden cardiac death. Investigation into the characteristics and new treatments for this arrhythmia is required to improve outcomes and a reproducible model of VT would be useful in these endeavors. We therefore created a canine model of ischemia-induced VT. MATERIALS AND METHODS A pacing lead was implanted in the right ventricle in canines (n = 13) and the left anterior descending artery was occluded in two locations for 2 h and subsequently released to create an ischemia-reperfusion injury. In the 10 dogs that survived the first 48 h following the initial study, a terminal study was conducted 4-7 d later and VT was induced using premature stimulation or burst pacing through the right ventricle lead. The arrhythmia was terminated using either antitachycardia pacing or a defibrillatory shock. Multiple inductions into sustained VT were attempted. RESULTS Sustained VT was induced in eight of 10 dogs with an average cycle length of 335 ± 70 bpm. Multiple episodes of VT were induced. Episodes of VT exhibited different electrocardiogram morphologies and cycle lengths in individual animals. CONCLUSIONS This canine model provides a consistent technique for inducing multiple episodes of sustained VT. It may be useful for investigating VT mechanisms and testing novel therapeutics and treatments for patients with VT.
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Affiliation(s)
- Annie M Hirahara
- Department of Biomedical Engineering, University of Utah, Salt Lake City, Utah; Nora Eccles Harrison Cardiovascular Research and Training Institute, University of Utah, Salt Lake City, Utah
| | - Muhammad S Khan
- Nora Eccles Harrison Cardiovascular Research and Training Institute, University of Utah, Salt Lake City, Utah
| | - Yuki Ishidoya
- Nora Eccles Harrison Cardiovascular Research and Training Institute, University of Utah, Salt Lake City, Utah
| | - Douglas Smego
- Division of Cardiothoracic Surgery, Department of Surgery, University of Utah, Salt Lake City, Utah
| | - Orvelin Roman
- Nora Eccles Harrison Cardiovascular Research and Training Institute, University of Utah, Salt Lake City, Utah
| | - Ravi Ranjan
- Department of Biomedical Engineering, University of Utah, Salt Lake City, Utah; Nora Eccles Harrison Cardiovascular Research and Training Institute, University of Utah, Salt Lake City, Utah; Division of Cardiovascular Medicine, Department of Internal Medicine, University of Utah, Salt Lake City, Utah
| | - Lauren Krueger
- Office of Comparative Medicine, University of Utah, Salt Lake City, Utah
| | - Guillaume Hoareau
- Nora Eccles Harrison Cardiovascular Research and Training Institute, University of Utah, Salt Lake City, Utah; Department of Emergency Medicine, University of Utah, Salt Lake City, Utah
| | - Craig H Selzman
- Nora Eccles Harrison Cardiovascular Research and Training Institute, University of Utah, Salt Lake City, Utah; Division of Cardiothoracic Surgery, Department of Surgery, University of Utah, Salt Lake City, Utah
| | - Derek J Dosdall
- Department of Biomedical Engineering, University of Utah, Salt Lake City, Utah; Nora Eccles Harrison Cardiovascular Research and Training Institute, University of Utah, Salt Lake City, Utah; Division of Cardiothoracic Surgery, Department of Surgery, University of Utah, Salt Lake City, Utah; Division of Cardiovascular Medicine, Department of Internal Medicine, University of Utah, Salt Lake City, Utah.
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12
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Pandey H, Singh K, Ranjan R, Dass J, Tyagi S, Seth T, Saxena R, Mahapatra M. Prevalence and Impact of HMOX1 Polymorphism (rs2071746: A > T) in Indian Sickle Cell Disease Patients. J Lab Physicians 2023; 15:583-589. [PMID: 37780888 PMCID: PMC10539052 DOI: 10.1055/s-0043-1770068] [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: 06/27/2022] [Accepted: 04/17/2023] [Indexed: 10/03/2023] Open
Abstract
Introduction Fetal hemoglobin (HbF) levels play significant role in lowering down the morbidity and mortality in sickle cell disease (SCD) patients. Coinheritance of heme oxygenase-1 (HMOX1) rs2071746:A > T polymorphism may contribute to variable HbF levels in Indian SCD patients. Objective This study was aimed to evaluate the role of HMOX1 polymorphism and its impact on HbF level in Indian SCD patients. Materials and Methods One-hundred twenty confirmed cases of SCD and 50 healthy controls were recruited. Their mean age was 11.5 ± 8.6 years (range: 3-23 years). Quantification of Hb, HbA2, HbF, and HbS was done by capillary zone electrophoresis. Allele-specific polymerase chain reaction was used to genotype HMOX1 (rs2071746:A > T) gene polymorphism. Results Out of the 120 cases of SCD, 65 were hemoglobin sickle-shaped (HbSS) and 55 were sickle-beta thalassemia (Sβ). Out of 65 HbSS patients, 29 (44.6%) were heterozygous (AT), 20 (30.76%) were homozygous (TT), and 16 (24.61%) were found wild-type (AA) genotype. Out of 55 Sβ, 22 (40%) were heterozygous, 18 (32%) were homozygous and 15 (28%) were wild-type. Patients carrying HMOX1 (rs2071746:A > T), AT, and TT genotypes had less anemia, painful crisis, splenomegaly, hepatomegaly, jaundice, and blood transfusion. HbF level was found higher in TT genotype (in HbSS the HbF levels was 25.1 ± 4.4; in sickle-beta thalassemia the HbF levels was 36.1 ± 4.7) than wild-type(AA) and was statistically significant ( p -value <0.001). Conclusion The TT genotype of the rs2071746:A > T polymorphism was associated with increased levels of Hb F ( p < 0.001). It can serve as a HbF modifier in Indian sickle cell diseases patients.
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Affiliation(s)
- Hareram Pandey
- Department of Hematology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Kanwaljeet Singh
- Lab Sciences & Molecular Medicine, Army Hospital Research and Referral, Delhi Cantt, Delhi, India
| | - Ravi Ranjan
- Department of Hematology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Jasmita Dass
- Department of Hematology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Seema Tyagi
- Department of Hematology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Tulika Seth
- Department of Hematology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Renu Saxena
- Department of Hematology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Manoranjan Mahapatra
- Department of Hematology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
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Ranjan R, Sharma K, Kumar M, Swain DK, Singh SP, Kharche SD, Singh MK, Chauhan MS. IGF-1 stabilizes goat sperm mitochondrial transmembrane potential and reduces dna fragmentation. Cryo Letters 2023; 44:327-332. [PMID: 38311926] [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] [Subscribe] [Scholar Register] [Indexed: 02/06/2024]
Abstract
BACKGROUND Antioxidant present in sperm cells protects them from oxidative damage. However, sperm are more susceptible to peroxidative damages due to the loss of these enzymes during cryopreservation and their survival and fertility may be compromised. Insulin like growth factor-1 (IGF-1) has an antioxidant effect and could maintain sperm motility. OBJECTIVE To improve seminal parameters, mitochondrial membrane potential (MMP), oxidative status and DNA integrity of buck semen after freeze-thawing by fortification of goat semen diluent with various concentrations of IGF-1. MATERIALS AND METHODS Fifty ejaculates were collected and were extended with tris- citric acid- fructose diluent with 10% egg yolk and 6% glycerol with sperm concentrations of 1×108 mL-1. Post-cryopreserved sperm were assessed for motility and a range of other functional parameters. RESULTS In post-thaw semen sperm motility, live sperm count, acrosome integrity, hypo-osmotic swelling positive spermatozoa, malondialdehyde (MDA), protein carbonyl content (PCC), TUNEL positive sperm differed significantly (P<0.05) with the various concentrations of IGF-1 used. Sperm functional parameters post-thawing were significantly (P<0.05) better in 250 ng/mL IGF-1. IGF-1 protects against lipid peroxidation by lowering MDA and PCC production, thus reducing the harmful effect of reactive oxygen species. The kidding percentage using the artificial insemination technique was significantly higher ( i.e., 40%) in the group supplemented with 250 ng/mL of IGF-1 than in the non-supplemented group (i.e., 30%). CONCLUSION IGF-1 may be used to improve post-thaw semen quality and fertility as measured by actual kidding rate. Doi.org/10.54680/fr23610110312.
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Affiliation(s)
- R Ranjan
- Indian Council of Agricultural Research (ICAR), Central Institute for Research on Goats, Makhdoom, Farah, Mathura, Uttar Pradesh (U.P.), India.
| | - K Sharma
- Indian Council of Agricultural Research (ICAR), Central Institute for Research on Goats, Makhdoom, Farah, Mathura, Uttar Pradesh (U.P.), India
| | - M Kumar
- Indian Council of Agricultural Research (ICAR), Central Institute for Research on Goats, Makhdoom, Farah, Mathura, Uttar Pradesh (U.P.), India
| | - D K Swain
- Deen Dayal Upadhyaya Pashu Chikitsa Vigyan Vishwavidyalaya Evam Go-Anusandhan Sansthan (DUVASU), Mathura, U.P. India
| | - S P Singh
- Indian Council of Agricultural Research (ICAR), Central Institute for Research on Goats, Makhdoom, Farah, Mathura, Uttar Pradesh (U.P.), India
| | - S D Kharche
- Indian Council of Agricultural Research (ICAR), Central Institute for Research on Goats, Makhdoom, Farah, Mathura, Uttar Pradesh (U.P.), India
| | - M K Singh
- Indian Council of Agricultural Research (ICAR), Central Institute for Research on Goats, Makhdoom, Farah, Mathura, Uttar Pradesh (U.P.), India
| | - M S Chauhan
- ICAR-National Dairy Research Institute, Karnal, Haryana, India
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Ranjan R, Nath S, Jha S, Narasimha VL. Single parent adoption in India: Mental health and legal perspectives and the way forward. J Postgrad Med 2023; 69:215-220. [PMID: 37357486 PMCID: PMC10846805 DOI: 10.4103/jpgm.jpgm_718_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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 01/08/2023] [Accepted: 02/01/2023] [Indexed: 06/27/2023] Open
Abstract
Single parent adoption (SPA) is a relatively new construct worldwide and in India. The Ministry of Women and Child Development, Government of India, has laid down criteria for adoption in general and SPA in particular, in conjunction with the Juvenile Justice Act (Care and Protection of Children), 2015. There is scant literature on this topic of SPA, more so in India, that looks into the various psychological nuances of SPA from a mental health professional's (MHP) perspective. This review paper aims to assess SPA from the perspective of a MHP that will focus on its various legal nuances as well as the psychological connotations attached to it. For this, a search strategy was employed that included a thorough literature search from two databases (PubMed and Google Scholar) with relevant keywords related to the topic. The various legal issues pertaining to SPA in the current scenario, the psychological issues and challenges faced by single parents, the behavioral outcomes of adoptees who are adopted by single parents, and ways to deal with the various obstacles of SPA are discussed.
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Affiliation(s)
- R Ranjan
- Department of Psychiatry, All India Institute of Medical Sciences, Patna, Bihar, India
| | - S Nath
- Department of Psychiatry, All India Institute of Medical Sciences, Deoghar, Jharkhand, India
| | - S Jha
- Department of Psychiatry, All India Institute of Medical Sciences, Patna, Bihar, India
| | - VL Narasimha
- Department of Psychiatry, All India Institute of Medical Sciences, Deoghar, Jharkhand, India
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15
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Paccione EN, Lange M, Orkild BA, Bergquist JA, Kwan E, Hunt B, Dosdall D, Macleod RS, Ranjan R. Effects of Biventricular Pacing Locations on Anti-Tachycardia Pacing Success in a Patient-Specific Model. Comput Cardiol (2010) 2023; 2023:10.22489/CinC.2023.369. [PMID: 38435379 PMCID: PMC10906957 DOI: 10.22489/cinc.2023.369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/05/2024]
Abstract
Patients with drug-refractory ventricular tachycardia (VT) often undergo implantation of a cardiac defibrillator (ICD). While life-saving, shock from an ICD can be traumatic. To combat the need for defibrillation, ICDs come equipped with low-energy pacing protocols. These anti-tachycardia pacing (ATP) methods are conventionally delivered from a lead inserted at the apex of the right ventricle (RV) with limited success. Recent studies have shown the promise of biventricular leads placed in the left ventricle (LV) for ATP delivery. This study tested the hypothesis that stimulating ATP from multiple biventricular locations will improve termination rates in a patient-specific computational model. VT was first induced in the model, followed by ATP delivery from 1-4 biventricular stimulus sites. We found that combining stimulation sites does not alter termination success so long as a critical stimulus site is included. Combining the RV stimulus site with any combination of LV sites did not affect ATP success except for one case. Including the RV site may allow biventricular ATP to be a robust approach across different scar distributions without affecting the efficacy of other stimulation sites. Combining sites may increase the likelihood of including a critical stimulus site when such information cannot be ascertained.
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Affiliation(s)
- Eric N Paccione
- University of Utah Department of Biomedical Engineering, Salt Lake City, USA
- Cardiovascular Research and Training Institute, Salt Lake City, USA
- Scientific Computing and Imaging Institute, Salt Lake City, USA
| | - Matthias Lange
- Cardiovascular Research and Training Institute, Salt Lake City, USA
| | - Benjamin A Orkild
- University of Utah Department of Biomedical Engineering, Salt Lake City, USA
- Cardiovascular Research and Training Institute, Salt Lake City, USA
- Scientific Computing and Imaging Institute, Salt Lake City, USA
| | - Jake A Bergquist
- University of Utah Department of Biomedical Engineering, Salt Lake City, USA
- Cardiovascular Research and Training Institute, Salt Lake City, USA
- Scientific Computing and Imaging Institute, Salt Lake City, USA
| | - Eugene Kwan
- University of Utah Department of Biomedical Engineering, Salt Lake City, USA
- Cardiovascular Research and Training Institute, Salt Lake City, USA
| | - Bram Hunt
- University of Utah Department of Biomedical Engineering, Salt Lake City, USA
- Cardiovascular Research and Training Institute, Salt Lake City, USA
| | - Derek Dosdall
- University of Utah Department of Biomedical Engineering, Salt Lake City, USA
- Cardiovascular Research and Training Institute, Salt Lake City, USA
| | - Rob S Macleod
- University of Utah Department of Biomedical Engineering, Salt Lake City, USA
- Cardiovascular Research and Training Institute, Salt Lake City, USA
- Scientific Computing and Imaging Institute, Salt Lake City, USA
| | - Ravi Ranjan
- University of Utah Department of Biomedical Engineering, Salt Lake City, USA
- Cardiovascular Research and Training Institute, Salt Lake City, USA
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16
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Hunt B, Kwan E, Tasdizen T, Bergquist J, Lange M, Orkild B, MacLeod RS, Dosdall DJ, Ranjan R. Transfer Learning for Improved Classification of Drivers in Atrial Fibrillation. Comput Cardiol (2010) 2023; 50:10.22489/cinc.2023.412. [PMID: 38405161 PMCID: PMC10887411 DOI: 10.22489/cinc.2023.412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/27/2024]
Abstract
"Drivers" are theorized mechanisms for persistent atrial fibrillation. Machine learning algorithms have been used to identify drivers, but the small size of current driver datasets limits their performance. We hypothesized that pretraining with unsupervised learning on a large dataset of unlabeled electrograms would improve classifier accuracy on a smaller driver dataset. In this study, we used a SimCLR-based framework to pretrain a residual neural network on a dataset of 113K unlabeled 64-electrode measurements and found weighted testing accuracy to improve over a non-pretrained network (78.6±3.9% vs 71.9±3.3%). This lays ground for development of superior driver detection algorithms and supports use of transfer learning for other datasets of endocardial electrograms.
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Affiliation(s)
- Bram Hunt
- Department of Biomedical Engineering, University of Utah, SLC, UT, USA
- Nora Eccles Cardiovascular Research and Training Institute, University of Utah, SLC, UT, USA
- Division of Cardiovascular Medicine, University of Utah, SLC, UT, USA
| | - Eugene Kwan
- Department of Biomedical Engineering, University of Utah, SLC, UT, USA
- Nora Eccles Cardiovascular Research and Training Institute, University of Utah, SLC, UT, USA
- Division of Cardiovascular Medicine, University of Utah, SLC, UT, USA
| | - Tolga Tasdizen
- Scientific Computing and Imaging Institute, University of Utah, SLC, UT, USA
- Department of Electrical and Computer Engineering, University of Utah, SLC, UT, USA
| | - Jake Bergquist
- Department of Biomedical Engineering, University of Utah, SLC, UT, USA
- Nora Eccles Cardiovascular Research and Training Institute, University of Utah, SLC, UT, USA
- Scientific Computing and Imaging Institute, University of Utah, SLC, UT, USA
| | - Matthias Lange
- Nora Eccles Cardiovascular Research and Training Institute, University of Utah, SLC, UT, USA
- Division of Cardiovascular Medicine, University of Utah, SLC, UT, USA
- Scientific Computing and Imaging Institute, University of Utah, SLC, UT, USA
| | - Benjamin Orkild
- Department of Biomedical Engineering, University of Utah, SLC, UT, USA
- Nora Eccles Cardiovascular Research and Training Institute, University of Utah, SLC, UT, USA
- Division of Cardiovascular Medicine, University of Utah, SLC, UT, USA
| | - Robert S MacLeod
- Department of Biomedical Engineering, University of Utah, SLC, UT, USA
- Nora Eccles Cardiovascular Research and Training Institute, University of Utah, SLC, UT, USA
- Scientific Computing and Imaging Institute, University of Utah, SLC, UT, USA
| | - Derek J Dosdall
- Department of Biomedical Engineering, University of Utah, SLC, UT, USA
- Nora Eccles Cardiovascular Research and Training Institute, University of Utah, SLC, UT, USA
- Division of Cardiovascular Medicine, University of Utah, SLC, UT, USA
- Division of Cardiothoracic Surgery, Department of Surgery, University of Utah, SLC, UT, USA
| | - Ravi Ranjan
- Department of Biomedical Engineering, University of Utah, SLC, UT, USA
- Nora Eccles Cardiovascular Research and Training Institute, University of Utah, SLC, UT, USA
- Division of Cardiovascular Medicine, University of Utah, SLC, UT, USA
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Maharana S, Roy CL, Kishor K, Ranjan R, Ahmad F, Mahapatra M, Saxena R, Kannan M. Depolarized Mitochondrial Membrane Potential and Elevated Calcium in Platelets of Sickle Cell Disease. Indian J Hematol Blood Transfus 2023; 39:565-571. [PMID: 37786815 PMCID: PMC10542052 DOI: 10.1007/s12288-023-01640-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 02/23/2023] [Indexed: 03/06/2023] Open
Abstract
Hemolysis, a crucial feature of Sickle cell disease (SCD), is a key player for cellular activation leading to various complications including thrombosis. In response to hemolysis, platelets get activated and release components that are necessary for further platelet activation and aggregation. Thus, it is believed that platelets contribute to the development of thrombotic complications. Platelets in SCD are expected to be affected due to common cause of hemolysis. To measure the surface markers of platelets including P-Selectin, Phosphatidyl Serine and integrin αIIbβ3 in SCD patients and healthy controls in order to understand the status of the platelets in SCD. To measure the surface markers of activated platelets using flow cytometry. Since mitochondria and calcium play an important role in cellular functions, the mitochondrial membrane potential and calcium content of platelets in SCD were also evaluated using flow cytometry. In the present study, we have observed significant increase of calcium level in SCD platelets. Further, the loss of mitochondrial membrane potential in SCD platelets was found to be significantly higher when compared to platelets of healthy controls. Though the surface markers of activated platelets in SCD remain unchanged, increased level of calcium and mitochondrial membrane potential loss suggest that the platelets in SCD are more prone to become activated. In order to understand the status of the platelets in SCD, apart from the surface markers, it is also important to assess the calcium levels and mitochondrial membrane potential of platelets.
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Affiliation(s)
- Samarjit Maharana
- Division of Blood and Vascular Biology, Department of Life Sciences, School of Life Sciences, Central University of Tamil Nadu, Tiruvarur, 610 101 India
| | - Chitrali Laha Roy
- Division of Blood and Vascular Biology, Department of Life Sciences, School of Life Sciences, Central University of Tamil Nadu, Tiruvarur, 610 101 India
| | - Kamal Kishor
- Department of Hematology, All India Institute of Medical Sciences, New Delhi, India
| | - Ravi Ranjan
- Department of Hematology, All India Institute of Medical Sciences, New Delhi, India
| | - Firdos Ahmad
- Department of Basic Medical Sciences, College of Medicine, University of Sharjah, Sharjah, UAE
| | - Manoranjan Mahapatra
- Department of Hematology, All India Institute of Medical Sciences, New Delhi, India
| | - Renu Saxena
- Department of Hematology, All India Institute of Medical Sciences, New Delhi, India
| | - Meganathan Kannan
- Division of Blood and Vascular Biology, Department of Life Sciences, School of Life Sciences, Central University of Tamil Nadu, Tiruvarur, 610 101 India
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Goyal S, Verma S, Ranjan R, Goyal R. 16 Horner Syndrome: Can it be Familial? Case series in a family and review of literature. BMJ Open Ophthalmol 2023; 8:A6. [PMID: 37797987 DOI: 10.1136/bmjophth-2023-biposa.16] [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: 10/07/2023] Open
Abstract
Ophthalmic literature reveals vague and rare references to Horner syndrome on a hereditary basis. We present a case series of mother and son with Horner syndrome, which was confirmed pharmacologically. They noticed symptoms on the same side at a similar age and no serious pathology was found.Retrospective case review of notes:Case 1: An 11-year-old male presented with 6 week history of anisocoria, mild right ptosis, no heterochromia and no history of trauma or previous surgeries. The anisocoria was more noticeable in the dark, Horner syndrome was confirmed with apraclonidine test.Case 2: Mother of case 1, 50-year-old female diagnosed with right Horner syndrome at the age of 14 in Austria. The presenting features were anisocoria, a lack of sweating on the right side of her face. Diagnosis was reconfirmed pharmacologically.Case 1 was referred to paediatrics for a systemic examination which was normal. He was investigated with urinary catecholamines, MRI head and CT neck and thorax which were all normal. Case 2 was investigated in the past with a normal CT head.Horner syndrome results in the interruption of the oculo-sympathetic pathway and can indicate serious pathology in the head, chest or neck. Our cases demonstrate that familial presentation could indicate an idiopathic aetiology as it is unlikely to have pathological Horner syndrome in two first degree relatives.Our case series highlights the importance of eliciting a family history of Horner syndrome and examining the family members. Positive family history can reassure patients while awaiting results of investigations.
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Affiliation(s)
- S Goyal
- Royal Glamorgan Hospital, UK
| | - S Verma
- Royal Glamorgan Hospital, UK
| | | | - R Goyal
- Royal Glamorgan Hospital, UK
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19
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Akhade SP, Akhade KS, Chavli KH, Ranjan R. Comparison of Burden of Injury at a Tertiary Care Centre of National Importance: Pre-COVID-19 and COVID-19 Era. Indian J Community Med 2023; 48:790-793. [PMID: 37970162 PMCID: PMC10637598 DOI: 10.4103/ijcm.ijcm_826_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: 10/03/2022] [Accepted: 06/27/2023] [Indexed: 11/17/2023] Open
Abstract
During the COVID-19 pandemic, precautionary guidelines to shut down non-essential services had an impact on the pattern of hospital trauma admissions. We compared the trauma cases handled in our hospital from 24th March 2020 to 30th November 2020 during the restricted movement period with statistics from 2019. The objectives of this study is to assess the prevalence of trauma during lockdown and restricted movement phase of COVID-19 pandemic and to analyze the epidemiology factor associated with trauma in pre COVID-19 and COVID-19 era in a tertiary care hospital of National importance in central India. This retrospective record-based study was done to analyze the profile of injured trauma patients presented to trauma and emergency center of tertiary care center of national importance from March 24 to June 30, 2020 (lockdown phase) and 1st July to 30th November (post-lockdown phase) of 2020. Results were compared with data from the year 2019. Total 621 trauma patients were managed during various restricted phases of the COVID-19 pandemic (March 2020 - November 2020). Out of which 128 admissions were in the strict lockdown phase (March-May 2020) while 493 presented after lockdown during the restricted movement phase. Both during and after a strict lockdown, road traffic accidents are significantly reduced. In contrast, assaults and household injuries were significantly higher. During the post-lockdown phase of 2020, self-falls increased significantly in both phases compared to the year 2019. There was a significant decrease in trauma admissions in lockdown phase due to decreased vehicular accident but increase in household injury due increased activities inside home. To determine the readiness to deal with future situations similar to these, we look at the behavioral changes in our patient population during the COVID-19 pandemic.
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Affiliation(s)
- Swapnil P. Akhade
- Department of Forensic Medicine and Toxicology, All Institute of Medical Sciences, Raipur, Chhattisgarh, India
| | - Kiran S. Akhade
- Department of Community Medicine, Raipur Institute of Medical Sciences, Raipur, Chhattisgarh, India
| | - Krishnadutt H. Chavli
- Department of Forensic Medicine and Toxicology, All Institute of Medical Sciences, Raipur, Chhattisgarh, India
| | - Ravi Ranjan
- Medical Record Officer, Medical Record Section, All Institute of Medical Sciences, Raipur, Chhattisgarh, India
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Mhamane NB, Panchal S, Kolekar SK, Ranjan R, Salgaonkar KN, Burange AS, Nalajala N, Datar S, Gopinath CS. Possible handle for broadening the catalysis regime towards low temperatures: proof of concept and mechanistic studies with CO oxidation on surface modified Pd-TiO 2. Phys Chem Chem Phys 2023; 25:22040-22054. [PMID: 37555468 DOI: 10.1039/d3cp01122d] [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: 08/10/2023]
Abstract
The present work demonstrates the effect of temperature-dependent surface modification (SM) treatment and its influence in broadening the catalysis regime with Pd-TiO2 catalysts prepared by various methods. Due to SM induced changes, a shift in the onset of CO oxidation activity as well as broadening of the oxidation catalysis regime by 30 to 65 K to lower temperatures is observed compared to the temperature required for virgin counterparts. SM carried out at 523 K for PdPhoto-TiO2 exhibits the lowest onset (10% CO2 production - T10) and T100 for CO oxidation at 360 and 392 K, respectively, while its virgin counterpart shows T10 and T100 at 393 and 433 K, respectively. The SMd Pd-TiO2 catalysts were investigated using X-ray photoelectron spectroscopy (XPS), ultra-violet photoelectron spectroscopy (UPS) and atomic force microscopy (AFM). It is observed that diffusion of atomic oxygen into Pd-subsurfaces leads to SM and changes the nature of the surface significantly. These changes are demonstrated by work function (ϕ), surface potential, catalytic activity, and correlation among them. UPS results demonstrate the maximum increase in ϕ by 0.5 eV for PdPhoto-TiO2 after SM, compared to all other catalysts. XPS study shows a moderate to severe change in the oxidation states of Pd due to atomic oxygen diffusion into the subsurface layers of Pd. Kelvin probe force microscopy (KPFM) study also reveals corroborating evidence that the surface potential increases linearly with increasing temperature deployed for SM up to 523 K, followed by a marginal decrease at 573 K. The ϕ measured by KPFM and UPS shows a similar trend and correlates well with the changes in catalysis observed. Our results indicate that there is a strong correlation between surface physical and chemical properties, and ϕ changes could be considered as a global marker for chemical reactivity.
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Affiliation(s)
- Nitin B Mhamane
- Catalysis and Inorganic Chemistry Division, CSIR- National Chemical Laboratory, Dr Homi Bhabha Road, Pune 411 008, India.
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad 201 002, India
| | - Suresh Panchal
- Department of Applied Physics, Defence Institute of Advanced Technology (Deemed University), Girinagar, Pune 411025, India
| | - Sadhu K Kolekar
- Catalysis and Inorganic Chemistry Division, CSIR- National Chemical Laboratory, Dr Homi Bhabha Road, Pune 411 008, India.
| | - Ravi Ranjan
- Catalysis and Inorganic Chemistry Division, CSIR- National Chemical Laboratory, Dr Homi Bhabha Road, Pune 411 008, India.
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad 201 002, India
| | - Kranti N Salgaonkar
- Catalysis and Inorganic Chemistry Division, CSIR- National Chemical Laboratory, Dr Homi Bhabha Road, Pune 411 008, India.
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad 201 002, India
| | - Anand S Burange
- Catalysis and Inorganic Chemistry Division, CSIR- National Chemical Laboratory, Dr Homi Bhabha Road, Pune 411 008, India.
- Department of Chemistry, John Wilson Education Society's Wilson College (Autonomous), Chowpatty, Mumbai, 400 007, India
| | - Naresh Nalajala
- Catalysis and Inorganic Chemistry Division, CSIR- National Chemical Laboratory, Dr Homi Bhabha Road, Pune 411 008, India.
| | - Suwarna Datar
- Department of Applied Physics, Defence Institute of Advanced Technology (Deemed University), Girinagar, Pune 411025, India
| | - Chinnakonda S Gopinath
- Catalysis and Inorganic Chemistry Division, CSIR- National Chemical Laboratory, Dr Homi Bhabha Road, Pune 411 008, India.
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad 201 002, India
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21
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Kumar R, Chatterjee M, Ranjan R. Black Grain Mycetoma by a Hyaline Fungus: It is Possible? Indian J Dermatol 2023; 68:464-467. [PMID: 37822405 PMCID: PMC10564221 DOI: 10.4103/ijd.ijd_21_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/13/2023] Open
Affiliation(s)
- Richa Kumar
- From the Department of Dermatology, Command Hospital, Eastern Command, Kolkata, West Bengal, India
| | | | - R Ranjan
- Department of Pathology, Command Hospital, Eastern Command, Kolkata, West Bengal, India
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22
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Singh S, Solay LR, Anand S, Kumar N, Ranjan R, Singh A. Implementation of Gate-All-Around Gate-Engineered Charge Plasma Nanowire FET-Based Common Source Amplifier. Micromachines (Basel) 2023; 14:1357. [PMID: 37512666 PMCID: PMC10384746 DOI: 10.3390/mi14071357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 06/27/2023] [Accepted: 06/29/2023] [Indexed: 07/30/2023]
Abstract
This paper examines the performance of a Gate-Engineered Gate-All-Around Charge Plasma Nanowire Field Effect Transistor (GAA-DMG-GS-CP NW-FET) and the implementation of a common source (CS) amplifier circuit. The proposed GAA-DMG-GS-CP NW-FET incorporates dual-material gate (DMG) and gate stack (GS) as gate engineering techniques and its analog/RF performance parameters are compared to those of the Gate-All-Around Single-Material Gate Charge Plasma Nanowire Field Effect Transistor (GAA-SMG-CP NW-FET) device. Both Gate-All-Around (GAA) devices are designed using the Silvaco TCAD tool. GAA structures have demonstrated good gate control because the gate holds the channel, which is an inherent advantage for both devices discussed herein. The charge plasma dopingless technique is used, in which the source and drain regions are formed using metal contacts and necessary work functions rather than doping. This dopingless technique eliminates the need for doping, reducing fluctuations caused by random dopants and lowering the device's thermal budget. Gate engineering techniques such as DMG and GS significantly improved the current characteristics which played a crucial role in obtaining maximum gain for circuit designs. The lookup table (LUT) approach is used in the implementation of the CS amplifier circuit with the proposed device. The transient response of the circuit is analyzed with both the device structures where the gain achieved for the CS amplifier circuit using the proposed GAA-DMG-GS-CP NW-FET is 15.06 dB. The superior performance showcased by the proposed GAA-DMG-GS-CP NW-FET device with analog, RF and circuit analysis proves its strong candidature for future nanoscale and low-power applications.
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Affiliation(s)
- Sarabdeep Singh
- Model Institute of Engineering and Technology, Jammu 181122, India
| | - Leo Raj Solay
- Department of Electronics and Communication Engineering, Amity University, Noida 201313, India
| | - Sunny Anand
- Department of Electronics and Communication Engineering, Amity University, Noida 201313, India
| | - Naveen Kumar
- Department of Electronics and Nanoscale Engineering, University of Glasgow, Glasgow G12 8QQ, UK
| | - Ravi Ranjan
- Dr. B. R. Ambedkar National Institute of Technology, Jalandhar 144008, India
| | - Amandeep Singh
- National Institute of Technology, Srinagar 190006, India
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23
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Bergquist JA, Zenger B, Brundage J, MacLeod RS, Bunch TJ, Shah R, Ye X, Lyons A, Ranjan R, Tasdizen T, Steinberg BA. Performance of Off-the-Shelf Machine Learning Architectures and Biases in Detection of Low Left Ventricular Ejection Fraction. medRxiv 2023:2023.06.10.23291237. [PMID: 37649910 PMCID: PMC10465010 DOI: 10.1101/2023.06.10.23291237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
Artificial intelligence - machine learning (AI-ML) is a computational technique that has been demonstrated to be able to extract meaningful clinical information from diagnostic data that are not available using either human interpretation or more simple analysis methods. Recent developments have shown that AI-ML approaches applied to ECGs can accurately predict different patient characteristics and pathologies not detectable by expert physician readers. There is an extensive body of literature surrounding the use of AI-ML in other fields, which has given rise to an array of predefined open-source AI-ML architectures which can be translated to new problems in an "off-the-shelf" manner. Applying "off-the-shelf" AI-ML architectures to ECG-based datasets opens the door for rapid development and identification of previously unknown disease biomarkers. Despite the excellent opportunity, the ideal open-source AI-ML architecture for ECG related problems is not known. Furthermore, there has been limited investigation on how and when these AI-ML approaches fail and possible bias or disparities associated with particular network architectures. In this study, we aimed to: (1) determine if open-source, "off-the-shelf" AI-ML architectures could be trained to classify low LVEF from ECGs, (2) assess the accuracy of different AI-ML architectures compared to each other, and (3) to identify which, if any, patient characteristics are associated with poor AI-ML performance.
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24
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Khan MS, Smego D, Ishidoya Y, Hirahara AM, Offei E, Ruiz Castillo MS, Gharbia O, Li H, Palatinus JA, Krueger L, Hong T, Hoareau GL, Ranjan R, Selzman CH, Shaw RM, Dosdall DJ. A canine model of chronic ischemic heart failure. Am J Physiol Heart Circ Physiol 2023; 324:H751-H761. [PMID: 36961487 PMCID: PMC10151054 DOI: 10.1152/ajpheart.00647.2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 03/13/2023] [Accepted: 03/14/2023] [Indexed: 03/25/2023]
Abstract
Preclinical large animal models of chronic heart failure (HF) are crucial to both understanding pathological remodeling and translating fundamental discoveries into novel therapeutics for HF. Canine models of ischemic cardiomyopathy are historically limited by either high early mortality or failure to develop chronic heart failure. Twenty-nine healthy adult dogs (30 ± 4 kg, 15/29 male) underwent thoracotomy followed by one of three types of left anterior descending (LAD) coronary artery ligation procedures: group 1 (n = 4) (simple LAD: proximal and distal LAD ligation); group 2 (n = 14) (simple LAD plus lateral wall including ligation of the distal first diagonal and proximal first obtuse marginal); and group 3 (n = 11) (total LAD devascularization or TLD: simple LAD plus ligation of proximal LAD branches to both the right and left ventricles). Dogs were followed until chronic severe HF developed defined as left ventricular ejection fraction (LVEF) < 40% and NH2-terminal-prohormone B-type natriuretic peptide (NT-proBNP) > 900 pmol/L. Overall early survival (48-h postligation) in 29 dogs was 83% and the survival rate at postligation 5 wk was 69%. Groups 1 and 2 had 100% and 71% early survival, respectively, yet only a 50% success rate of developing chronic HF. Group 3 had excellent survival at postligation 48 h (91%) and a 100% success in the development of chronic ischemic HF. The TLD approach, which limits full LAD and collateral flow to its perfusion bed, provides excellent early survival and reliable development of chronic ischemic HF in canine hearts.NEW & NOTEWORTHY The novel total left anterior descending devascularization (TLD) approach in a canine ischemic heart failure model limits collateral flow in the ischemic zone and provides excellent early survival and repeatable development of chronic ischemic heart failure in the canine heart. This work provides a consistent large animal model for investigating heart failure mechanisms and testing novel therapeutics.
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Affiliation(s)
- Muhammad S Khan
- Nora Eccles Harrison Cardiovascular Research and Training Institute, The University of Utah, Salt Lake City, Utah, United States
| | - Douglas Smego
- Division of Cardiothoracic Surgery, Department of Surgery, The University of Utah, Salt Lake City, Utah, United States
| | - Yuki Ishidoya
- Division of Cardiovascular Medicine, Department of Internal Medicine, The University of Utah, Salt Lake City, Utah, United States
| | - Annie M Hirahara
- Nora Eccles Harrison Cardiovascular Research and Training Institute, The University of Utah, Salt Lake City, Utah, United States
- Department of Biomedical Engineering, The University of Utah, Salt Lake City, Utah, United States
| | - Emmanuel Offei
- Nora Eccles Harrison Cardiovascular Research and Training Institute, The University of Utah, Salt Lake City, Utah, United States
- Department of Biomedical Engineering, The University of Utah, Salt Lake City, Utah, United States
| | - Martha S Ruiz Castillo
- Nora Eccles Harrison Cardiovascular Research and Training Institute, The University of Utah, Salt Lake City, Utah, United States
- Department of Biomedical Engineering, The University of Utah, Salt Lake City, Utah, United States
| | - Omar Gharbia
- Nora Eccles Harrison Cardiovascular Research and Training Institute, The University of Utah, Salt Lake City, Utah, United States
| | - Hui Li
- Division of Cardiothoracic Surgery, Department of Surgery, The University of Utah, Salt Lake City, Utah, United States
| | - Joseph A Palatinus
- Nora Eccles Harrison Cardiovascular Research and Training Institute, The University of Utah, Salt Lake City, Utah, United States
- Division of Cardiovascular Medicine, Department of Internal Medicine, The University of Utah, Salt Lake City, Utah, United States
| | - Lauren Krueger
- Office of Comparative Medicine, The University of Utah, Salt Lake City, Utah, United States
| | - TingTing Hong
- Nora Eccles Harrison Cardiovascular Research and Training Institute, The University of Utah, Salt Lake City, Utah, United States
- Department of Pharmacology and Toxicology, College of Pharmacy, The University of Utah, Salt Lake City, Utah, United States
| | - Guillaume L Hoareau
- Nora Eccles Harrison Cardiovascular Research and Training Institute, The University of Utah, Salt Lake City, Utah, United States
- Department of Emergency Medicine, The University of Utah, Salt Lake City, Utah, United States
| | - Ravi Ranjan
- Nora Eccles Harrison Cardiovascular Research and Training Institute, The University of Utah, Salt Lake City, Utah, United States
- Division of Cardiovascular Medicine, Department of Internal Medicine, The University of Utah, Salt Lake City, Utah, United States
- Department of Biomedical Engineering, The University of Utah, Salt Lake City, Utah, United States
| | - Craig H Selzman
- Division of Cardiothoracic Surgery, Department of Surgery, The University of Utah, Salt Lake City, Utah, United States
| | - Robin M Shaw
- Nora Eccles Harrison Cardiovascular Research and Training Institute, The University of Utah, Salt Lake City, Utah, United States
- Division of Cardiovascular Medicine, Department of Internal Medicine, The University of Utah, Salt Lake City, Utah, United States
- Department of Biomedical Engineering, The University of Utah, Salt Lake City, Utah, United States
| | - Derek J Dosdall
- Nora Eccles Harrison Cardiovascular Research and Training Institute, The University of Utah, Salt Lake City, Utah, United States
- Division of Cardiothoracic Surgery, Department of Surgery, The University of Utah, Salt Lake City, Utah, United States
- Division of Cardiovascular Medicine, Department of Internal Medicine, The University of Utah, Salt Lake City, Utah, United States
- Department of Biomedical Engineering, The University of Utah, Salt Lake City, Utah, United States
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25
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Huang Q, Tian Y, Mendes J, Ranjan R, Adluru G, DiBella E. Quantitative myocardial perfusion with a hybrid 2D simultaneous multi-slice sequence. Magn Reson Imaging 2023; 98:7-16. [PMID: 36563888 PMCID: PMC10474933 DOI: 10.1016/j.mri.2022.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 12/17/2022] [Indexed: 12/24/2022]
Abstract
PURPOSE To evaluate a novel 2D simultaneous multi-slice (SMS) myocardial perfusion acquisition and compare directly to a published quantitative 3D stack-of-stars (SoS) acquisition. METHODS A hybrid saturation recovery radial 2D SMS sequence following a single saturation was created for the quantification of myocardial blood flow (MBF). This sequence acquired three slices simultaneously and generated an arterial input function (AIF) using the first 24 rays. Validation was done in a novel way by alternating heartbeats between the hybrid 2D SMS and the 3D SoS acquisitions. Initial studies were done to study the effects of using only every other beat for the 2D SMS in two subjects, and for the 3D SoS in four subjects. The proposed alternating acquisitions were then performed in ten dog studies at rest, four dog studies at adenosine stress, and two human resting studies. Quantitative MBF analysis was performed for 2D SMS and 3D SoS separately, using a compartment model. RESULTS Acquiring every-other-beat data resulted in 6 ± 5% ("ideal") and 11 ± 8% ("practical") perfusion changes for both 2D SMS and 3D SoS methods. For alternating acquisitions, 2D SMS and 3D SoS quantitative perfusion values were comparable for both the twelve rest studies (2D SMS: 0.69 ± 0.16 vs 3D: 0.69 ± 0.15 ml/g/min, p = 0.55) and the four stress studies (2D SMS: 1.28 ± 0.22 vs 3D: 1.30 ± 0.24 ml/g/min, p = 0.61). CONCLUSION Every-other-beat acquisition changed estimated perfusion values relatively little for both sequences. The quantitative hybrid radial 2D SMS myocardial first-pass perfusion imaging sequence gave results similar to 3D perfusion when compared directly with an alternating beat acquisition.
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Affiliation(s)
- Qi Huang
- Utah Center for Advanced Imaging Research (UCAIR), Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT, USA; Department of Biomedical Engineering, University of Utah, Salt Lake City, UT, USA.
| | - Ye Tian
- Ming Hsieh Department of Electrical and Computer Engineering, University of Southern California, Los Angeles, CA, USA
| | - Jason Mendes
- Utah Center for Advanced Imaging Research (UCAIR), Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT, USA
| | - Ravi Ranjan
- Division of Cardiovascular Medicine, University of Utah, Salt Lake City, UT, USA
| | - Ganesh Adluru
- Utah Center for Advanced Imaging Research (UCAIR), Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT, USA; Department of Biomedical Engineering, University of Utah, Salt Lake City, UT, USA
| | - Edward DiBella
- Utah Center for Advanced Imaging Research (UCAIR), Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT, USA; Department of Biomedical Engineering, University of Utah, Salt Lake City, UT, USA
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26
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Hirahara AM, Khan MS, Gharbia O, Lange M, Ishidoya Y, Smego D, Ranjan R, Stoddard GJ, Selzman C, Dosdall DJ. Antitachycardia pacing at the His bundle is safer than conventional right ventricular antitachycardia pacing in a canine myocardial ischemic injury model. J Cardiovasc Electrophysiol 2023; 34:1249-1256. [PMID: 37125623 PMCID: PMC10259204 DOI: 10.1111/jce.15916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 04/04/2023] [Accepted: 04/18/2023] [Indexed: 05/02/2023]
Abstract
INTRODUCTION Antitachycardia pacing (ATP) is used to terminate ventricular tachycardia (VT) by delivering rapid, low energy pacing to the right ventricle (RV). Unfortunately, ATP is not effective against all VT episodes and can result in adverse outcomes, such as VT acceleration and degeneration into ventricular fibrillation (VF). Improving ATP is therefore desirable. Our objective was to compare the efficacy and safety of ATP delivered at the His bundle to traditional ATP. METHODS Six dogs were anesthetized and pacing leads were implanted in the RV and His bundle. The left anterior descending artery was occluded for 2 h to create an ischemic injury. In a study 4-7 days later, a 128-electrode sock was placed snugly around the ventricles and VT was induced using rapid pacing. ATP was delivered from either the His bundle or RV lead, then attempted at the other location if unsuccessful. Success rates and instances of VT acceleration and degeneration into VF were calculated. RESULTS We induced 83 runs of VT and attempted ATP 128 times. RV ATP was successful in 36% of attempts; His ATP was successful in 38% of attempts. RV ATP resulted in significantly more adverse outcomes. RV and His ATP induced VT acceleration in 9% and 3% of trains, respectively, and induced degeneration into VF in 5% and 1% of trains, respectively. CONCLUSION His bundle ATP is safer, but not significantly more effective, than RV ATP.
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Affiliation(s)
- Annie M Hirahara
- Department of Biomedical Engineering, University of Utah, 36 S Wasatch Drive Salt Lake City, Utah, 84112 USA
- Nora Eccles Harrison Cardiovascular Research and Training Institute, University of Utah, 95 S 2000 E Salt Lake City, Utah, 84112-5000 USA
| | - Muhammad S Khan
- Nora Eccles Harrison Cardiovascular Research and Training Institute, University of Utah, 95 S 2000 E Salt Lake City, Utah, 84112-5000 USA
| | - Omar Gharbia
- Nora Eccles Harrison Cardiovascular Research and Training Institute, University of Utah, 95 S 2000 E Salt Lake City, Utah, 84112-5000 USA
| | - Matthias Lange
- Nora Eccles Harrison Cardiovascular Research and Training Institute, University of Utah, 95 S 2000 E Salt Lake City, Utah, 84112-5000 USA
| | - Yuki Ishidoya
- Nora Eccles Harrison Cardiovascular Research and Training Institute, University of Utah, 95 S 2000 E Salt Lake City, Utah, 84112-5000 USA
| | - Douglas Smego
- Department of Surgery, Division of Cardiothoracic Surgery, 30 N 1900 E Salt Lake City, Utah, 84132 USA
| | - Ravi Ranjan
- Department of Biomedical Engineering, University of Utah, 36 S Wasatch Drive Salt Lake City, Utah, 84112 USA
- Nora Eccles Harrison Cardiovascular Research and Training Institute, University of Utah, 95 S 2000 E Salt Lake City, Utah, 84112-5000 USA
- Department of Internal Medicine, Division of Cardiothoracic Surgery, 30 N 1900 E Salt Lake City, Utah 84132 USA
| | - Gregory J Stoddard
- Clinical and Translational Science Institute, University of Utah, 375 Chipeta Way A, Salt Lake City, Utah, 84108 USA
| | - Craig Selzman
- Nora Eccles Harrison Cardiovascular Research and Training Institute, University of Utah, 95 S 2000 E Salt Lake City, Utah, 84112-5000 USA
- Department of Surgery, Division of Cardiothoracic Surgery, 30 N 1900 E Salt Lake City, Utah, 84132 USA
| | - Derek J Dosdall
- Department of Biomedical Engineering, University of Utah, 36 S Wasatch Drive Salt Lake City, Utah, 84112 USA
- Nora Eccles Harrison Cardiovascular Research and Training Institute, University of Utah, 95 S 2000 E Salt Lake City, Utah, 84112-5000 USA
- Department of Surgery, Division of Cardiothoracic Surgery, 30 N 1900 E Salt Lake City, Utah, 84132 USA
- Department of Internal Medicine, Division of Cardiothoracic Surgery, 30 N 1900 E Salt Lake City, Utah 84132 USA
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27
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Leonard ER, Marques ES, Roy MA, Conlin SM, Ranjan R, Timme-Laragy AR. Dietary exposure to the food preservative tert-Butylhydroquinone (tBHQ) impairs zebrafish (Danio rerio) survival, growth, organ development, and gene expression in Nrf2a-dependent and independent ways. Food Chem Toxicol 2023; 176:113788. [PMID: 37075880 DOI: 10.1016/j.fct.2023.113788] [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: 12/15/2022] [Revised: 04/04/2023] [Accepted: 04/15/2023] [Indexed: 04/21/2023]
Abstract
Tert-Butylhydroquinone (tBHQ), a preservative used to prevent oxidative deterioration of oil, fat, and meat products, has been linked to both chemoprotective and adverse effects. This study investigates the impact of dietary tBHQ consumption on survival, growth parameters, organ development, and gene expression in zebrafish (Danio rerio). As tBHQ activates the transcription factor nuclear factor erythroid 2-related factor 2 (Nrf2a), a zebrafish line with a mutation in the DNA-binding domain of Nrf2a was used to identify Nrf2a-dependent vs independent effects. Homozygous Nrf2a wildtype (wt) and mutant (m) larvae were fed a diet containing 5% tBHQ or a control diet. Survival and growth parameters were assessed at 15 days and at 5 months, and samples were collected for RNA sequencing at 5 months. Dietary exposure to tBHQ throughout the larval and juvenile periods negatively impacted growth and survival. RNA-seq analysis found differentially expressed genes related to growth and development and upregulation of several immune system-related pathways. The findings herein demonstrate that dietary tBHQ exposure may impair growth and survival in both Nrf2a dependent and independent manners.
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Affiliation(s)
- Emily R Leonard
- Department of Environmental Health Sciences, School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst, MA, 01003, USA
| | - Emily S Marques
- Department of Environmental Health Sciences, School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst, MA, 01003, USA
| | - Monika A Roy
- Department of Environmental Health Sciences, School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst, MA, 01003, USA; Biotechnology Training Program, University of Massachusetts Amherst, Amherst, MA, 01003, USA
| | - Sarah M Conlin
- Department of Environmental Health Sciences, School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst, MA, 01003, USA
| | - Ravi Ranjan
- Genomics Resource Laboratory, Institute for Applied Life Sciences, University of Massachusetts Amherst, Amherst, MA, 01003, USA
| | - Alicia R Timme-Laragy
- Department of Environmental Health Sciences, School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst, MA, 01003, USA.
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28
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Zenger B, Li H, Bunch TJ, Crawford C, Fang JC, Groh CA, Hess R, Navaravong L, Ranjan R, Young J, Zhang Y, Steinberg BA. Major drivers of healthcare system costs and cost variability for routine atrial fibrillation ablation. Heart Rhythm O2 2023; 4:251-257. [PMID: 37124552 PMCID: PMC10134392 DOI: 10.1016/j.hroo.2022.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Background Catheter ablation is an effective treatment for atrial fibrillation (AF) but incurs significant financial costs to payers. Reducing variability may improve cost effectiveness. Objectives We aimed to measure (1) the components of direct and indirect costs for routine AF ablation procedures, (2) the variability of those costs, and (3) the main factors driving ablation cost variability. Methods Using data from the University of Utah Health Value Driven Outcomes system, we were able to measure direct, inflation-adjusted costs of uncomplicated, routine AF ablation to the healthcare system. Direct costs were considered costs incurred by pharmacy, disposable supplies, patient labs, implants, and other services categories (primarily anesthesia support) and indirect costs were considered within imaging, facility, and electrophysiology lab management categories. Results A total of 910 patients with 1060 outpatient ablation encounters were included from January 1, 2013, to December 31, 2020. Disposable supplies accounted for the largest component of cost with 44.8 ± 9.7%, followed by other services (primarily anesthesia support) with 30.4 ± 7.7% and facility costs with 16.1 ± 5.6%; pharmacy, imaging, and implant costs each contributed <5%. Direct costs were larger than indirect costs (82.4 ± 5.6% vs 17.6 ± 5.6%). Multivariable regression showed that procedure operator was the primary factor associated with AF ablation overall cost (up to 12% differences depending on operator). Conclusions Direct costs and other services (primarily anesthesia) drive the majority costs associated with AF ablations. There is significant variability in costs for these routine, uncomplicated AF ablation procedures. The procedure operator, and not patient characteristic, is the main driver for cost variability.
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Affiliation(s)
- Brian Zenger
- University of Utah School of Medicine, Salt Lake City, Utah
| | - Haojia Li
- Department of Internal Medicine, Division of Epidemiology, University of Utah, Salt Lake City, Utah
| | - T. Jared Bunch
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Utah, Salt Lake City, Utah
| | - Candice Crawford
- Decision Support, University of Utah Health, Salt Lake City, Utah
| | - James C. Fang
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Utah, Salt Lake City, Utah
| | - Christopher A. Groh
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Utah, Salt Lake City, Utah
| | - Rachel Hess
- Division of General Internal Medicine, Department of Internal Medicine, University of Utah, Salt Lake City, Utah
- Department of Population Health Sciences, University of Utah, Salt Lake City, Utah
| | - Leenhapong Navaravong
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Utah, Salt Lake City, Utah
| | - Ravi Ranjan
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Utah, Salt Lake City, Utah
| | - Jeff Young
- Decision Support, University of Utah Health, Salt Lake City, Utah
| | - Yue Zhang
- Department of Internal Medicine, Division of Epidemiology, University of Utah, Salt Lake City, Utah
| | - Benjamin A. Steinberg
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Utah, Salt Lake City, Utah
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29
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Islam MM, Faruque SM, Das D, Ranjan R, Ahmed SM, Adhikary AB. Diagnostic Dilemma of Frozen Shoulder in Post CABG Patient: A Case Report. Mymensingh Med J 2023; 32:593-598. [PMID: 37002777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2023]
Abstract
Frozen shoulder, also known as adhesive capsulitis, is a condition featured by stiffness and pain in shoulder joint. In this report, we present a case of 58 years old diabetic male patient with the history of coronary artery bypass grafting (CABG) 06 months back. He presented with persistent right shoulder pain for 05 months. Clinical examinations reveal restriction of the right shoulder joint movement in all directions and wasting of the right supraspinatus, infraspinatus and trapezius muscles. Both active and passive range of motions was restricted with painful right shoulder joint. Pain free abduction range was about 40 degrees in right shoulder. Plain X-ray of right shoulder joint and other relevant investigations show normal findings. Considering the clinical and laboratory findings decision was taken to treat the patient with exercise, pain killer and ultrasound therapy which were found to be optimistic.
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Affiliation(s)
- M M Islam
- Dr Md Mahbubul Islam, MD (Physical Medicine) Phase B Student, Department of Physical Medicine & Rehabilitation, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh
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30
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Tokavanich N, Prasitlumkum N, Kewcharoen J, Chokesuwattanaskul R, Phannajit J, Cheungpasitporn W, Akoum N, Ranjan R, Bunch TJ, Navaravong L. Network meta-analysis and systematic review comparing efficacy and safety between very high power short duration, high power short duration, and conventional radiofrequency ablation of atrial fibrillation. J Cardiovasc Electrophysiol 2023; 34:869-879. [PMID: 36691892 DOI: 10.1111/jce.15831] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 12/16/2022] [Revised: 01/11/2023] [Accepted: 01/17/2023] [Indexed: 01/25/2023]
Abstract
BACKGROUND High-power short-duration (HPSD) atrial fibrillation (AF) ablation with a power of 40-50 W was proved to be safe and effective. Very high-power short-duration (vHPSD) AF ablation is a novel method using >50 W to obtain more durable AF ablation. This study aimed to evaluate the efficacy and safety of vHPSD ablation compared with HPSD ablation and conventional power ablation. METHODS A literature search for studies that reported AF ablation outcomes, including short-term freedom from atrial arrhythmia, first-pass isolation (FPI) rate, procedure time, and major complications, was conducted utilizing MEDLINE, EMBASE, and Cochrane databases. All relevant studies were included in this analysis. A random-effects model of network meta-analysis and surface under cumulative ranking curve (SUCRA) were used to rank the treatment for all outcomes. RESULTS A total of 29 studies with 9721 patients were included in the analysis. According to the SUCRA analysis, HPSD ablation had the highest probability of maintaining sinus rhythm. Point estimation showed an odds ratio of 1.5 (95% confidence interval [CI]: 1.2-1.9) between HPSD ablation and conventional power ablation and an odds ratio of 1.3 (95% CI: 0.78-2.2) between vHPSD ablation and conventional power ablation. While the odds ratio of FPI between HPSD ablation and conventional power ablation was 3.6 (95% CI: 1.5-8.9), the odds ratio between vHPSD ablation and conventional power ablation was 2.2 (95% CI: 0.61-8.6). The procedure times of vHPSD and HPSD ablations were comparable and, therefore, shorter than that of conventional power ablation. Major complications were low in all techniques. CONCLUSION vHPSD ablation did not yield higher efficacy than HPSD ablation and conventional power ablation. With the safety concern, vHPSD ablation outcomes were comparable with those of other techniques.
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Affiliation(s)
- Nithi Tokavanich
- Sparrow Hospital, Michigan State University, East Lansing, Michigan, USA
| | - Narut Prasitlumkum
- Department of Cardiology, University of California Riverside, Riverside, California, USA
| | - Jakrin Kewcharoen
- Division of Cardiovascular Medicine, Loma Linda University Health, Loma Linda, California, USA
| | - Ronpichai Chokesuwattanaskul
- Division of Cardiovascular Medicine, Department of Medicine, Cardiac Center, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Jeerath Phannajit
- Division of Clinical Epidemiology and Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | | | - Nazem Akoum
- Cardiology Department, University of Washington Medical Center, Seattle, Washington, USA
| | - Ravi Ranjan
- Division of Cardiovascular Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - T Jared Bunch
- Division of Cardiovascular Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Leenhapong Navaravong
- Division of Cardiovascular Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
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Palatinus JA, Valdez S, Taylor L, Whisenant C, Selzman CH, Drakos SG, Ranjan R, Hong T, Saffitz JE, Shaw RM. GJA1-20k Rescues Cx43 Localization and Arrhythmias in Arrhythmogenic Cardiomyopathy. Circ Res 2023; 132:744-746. [PMID: 36927183 PMCID: PMC10314823 DOI: 10.1161/circresaha.122.322294] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Affiliation(s)
- Joseph A Palatinus
- Nora Eccles Harrison Cardiovascular Research and Training Institute (J.A.P., S.V., L.T., C.W., C.H.S., S.G.D., R.R., T.H., R.M.S.), University of Utah, Salt Lake City
- Department of Medicine, Intermountain Medical Center, Murray, UT (J.A.P.)
- Department of Pathology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA (J.A.P., J.E.S.)
| | - Steven Valdez
- Nora Eccles Harrison Cardiovascular Research and Training Institute (J.A.P., S.V., L.T., C.W., C.H.S., S.G.D., R.R., T.H., R.M.S.), University of Utah, Salt Lake City
| | - Lindsey Taylor
- Nora Eccles Harrison Cardiovascular Research and Training Institute (J.A.P., S.V., L.T., C.W., C.H.S., S.G.D., R.R., T.H., R.M.S.), University of Utah, Salt Lake City
| | - Claire Whisenant
- Nora Eccles Harrison Cardiovascular Research and Training Institute (J.A.P., S.V., L.T., C.W., C.H.S., S.G.D., R.R., T.H., R.M.S.), University of Utah, Salt Lake City
| | - Craig H Selzman
- Nora Eccles Harrison Cardiovascular Research and Training Institute (J.A.P., S.V., L.T., C.W., C.H.S., S.G.D., R.R., T.H., R.M.S.), University of Utah, Salt Lake City
| | - Stavros G Drakos
- Nora Eccles Harrison Cardiovascular Research and Training Institute (J.A.P., S.V., L.T., C.W., C.H.S., S.G.D., R.R., T.H., R.M.S.), University of Utah, Salt Lake City
| | - Ravi Ranjan
- Nora Eccles Harrison Cardiovascular Research and Training Institute (J.A.P., S.V., L.T., C.W., C.H.S., S.G.D., R.R., T.H., R.M.S.), University of Utah, Salt Lake City
| | - TingTing Hong
- Nora Eccles Harrison Cardiovascular Research and Training Institute (J.A.P., S.V., L.T., C.W., C.H.S., S.G.D., R.R., T.H., R.M.S.), University of Utah, Salt Lake City
- Department of Pharmacology and Toxicology, College of Pharmacy (T.H.), University of Utah, Salt Lake City
| | - Jeffrey E Saffitz
- Department of Pathology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA (J.A.P., J.E.S.)
| | - Robin M Shaw
- Nora Eccles Harrison Cardiovascular Research and Training Institute (J.A.P., S.V., L.T., C.W., C.H.S., S.G.D., R.R., T.H., R.M.S.), University of Utah, Salt Lake City
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Sessions AJ, May HT, Crandall BG, Day JD, Cutler MJ, Groh CA, Navaravong L, Ranjan R, Steinberg BA, Jared Bunch T. Response to "Delay in AF ablation costs lives". J Cardiovasc Electrophysiol 2023; 34:1094-1095. [PMID: 36864718 DOI: 10.1111/jce.15878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Accepted: 02/20/2023] [Indexed: 03/04/2023]
Affiliation(s)
| | - Heidi T May
- Department of Cardiology, Intermountain Medical Center, Intermountain Heart Institute, Salt Lake City, Utah, USA
| | - Brian G Crandall
- Department of Cardiology, Intermountain Medical Center, Intermountain Heart Institute, Salt Lake City, Utah, USA
| | - John D Day
- Department of Cardiology, St. Marks Hospital, Utah, Salt Lake City, USA
| | - Michael J Cutler
- Department of Cardiology, Intermountain Medical Center, Intermountain Heart Institute, Salt Lake City, Utah, USA
| | - Christopher A Groh
- Department of Internal Medicine, Division of Cardiology, University Hospital, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Leenapong Navaravong
- Department of Internal Medicine, Division of Cardiology, University Hospital, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Ravi Ranjan
- Department of Internal Medicine, Division of Cardiology, University Hospital, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Benjamin A Steinberg
- Department of Internal Medicine, Division of Cardiology, University Hospital, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - T Jared Bunch
- Department of Internal Medicine, Division of Cardiology, University Hospital, University of Utah School of Medicine, Salt Lake City, Utah, USA
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Feuerborn ML, Dechand J, Vadlamudi RS, Torre M, Freedman RA, Groh C, Navaravong L, Ranjan R, Varela D, Bunch TJ, Steinberg BA. Protocol Development and Initial Experience With Intravenous Sotalol Loading for Atrial Arrhythmias. Crit Pathw Cardiol 2023; 22:1-4. [PMID: 36812336 PMCID: PMC9977272 DOI: 10.1097/hpc.0000000000000308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/16/2023]
Abstract
BACKGROUND Oral sotalol is a class III antiarrhythmic commonly used for the maintenance of sinus rhythm in patients with atrial fibrillation (AF). Recently, the Food and Drug Administration (FDA) approved the use of IV sotalol loading, based primarily on modeling data for the infusion. We aimed to describe a protocol and experience with IV sotalol loading for elective treatment of adult patients with AF and atrial flutter (AFL). METHODS We present our institutional protocol and retrospective review of initial patients treated with IV sotalol for AF/AFL at the University of Utah Hospital between September 2020 and April 2021. RESULTS Eleven patients received IV sotalol for initial loading or dose escalation. All patients were male, aged 56-88 years (median 69). Mean QT interval (QTc) intervals increased from baseline (mean 384 ms) immediately after infusion of IV sotalol (mean change 42ms), but no patient required discontinuation of the medication. Six patients were discharged after 1 night; 4 patients were discharged after 2 nights; and 1 patient was discharged after 4 nights. Nine patients underwent electrical cardioversion prior to discharge (2 prior to load; 7 post-load on the day of discharge). There were no adverse events during the infusion or within 6 months of discharge. Persistence of therapy was 73% (8 of 11) at mean 9.9 weeks to follow up, with no discontinuations for adverse effects. CONCLUSIONS We employed a streamlined protocol that was successfully implemented to facilitate the use of IV sotalol loading for atrial arrhythmias. Our initial experience suggests feasibility, safety, and tolerability while reducing hospitalization duration. Additional data are needed to augment this experience as IV sotalol use is broadened across different patient populations.
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Affiliation(s)
- Melissa L Feuerborn
- Department of Medicine, University of Utah School of Medicine, Salt Lake City, UT
| | - John Dechand
- Department of Pharmacy Services, University of Utah Health, Salt Lake City, UT, USA
| | - Rohith S Vadlamudi
- Department of Medicine, University of Utah School of Medicine, Salt Lake City, UT
| | - Michael Torre
- Department of Population Health, University of Utah School of Medicine, Salt Lake City, UT
| | - Roger A. Freedman
- Division of Cardiovascular Medicine, University of Utah Health Sciences Center, Salt Lake City, UT
| | - Christopher Groh
- Division of Cardiovascular Medicine, University of Utah Health Sciences Center, Salt Lake City, UT
| | - Leenhapong Navaravong
- Division of Cardiovascular Medicine, University of Utah Health Sciences Center, Salt Lake City, UT
| | - Ravi Ranjan
- Division of Cardiovascular Medicine, University of Utah Health Sciences Center, Salt Lake City, UT
| | - Daniel Varela
- Division of Cardiovascular Medicine, University of Utah Health Sciences Center, Salt Lake City, UT
| | - T. Jared Bunch
- Division of Cardiovascular Medicine, University of Utah Health Sciences Center, Salt Lake City, UT
| | - Benjamin A. Steinberg
- Division of Cardiovascular Medicine, University of Utah Health Sciences Center, Salt Lake City, UT
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Sessions AJ, May HT, Crandall BG, Day JD, Cutler MJ, Groh CA, Navaravong L, Ranjan R, Steinberg BA, J Bunch T. Increasing time between first diagnosis of atrial fibrillation and catheter ablation adversely affects long-term outcomes in patients with and without structural heart disease. J Cardiovasc Electrophysiol 2023; 34:507-515. [PMID: 36640433 DOI: 10.1111/jce.15810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 12/05/2022] [Accepted: 12/20/2022] [Indexed: 01/15/2023]
Abstract
INTRODUCTION Atrial Fibrillation (AF) is a common arrhythmia often comorbid with systolic or diastolic heart failure (HF). Catheter ablation is a more effective treatment for AF with concurrent left ventricular dysfunction, however, the optimal timing of use in these patients is unknown. METHODS All patients that received a catheter ablation for AF(n = 9979) with 1 year of follow-up within the Intermountain Healthcare system were included. Patients with were identified by the presence of structural disease by ejection fraction (EF): EF ≤ 35% (n = 1024) and EF > 35% (n = 8955). Recursive partitioning categories were used to separate patients into clinically meaningful strata based upon time from initial AF diagnosis until ablation: 30-180(n = 2689), 2:181-545(n = 1747), 3:546-1825(n = 2941), and 4:>1825(n = 2602) days. RESULTS The mean days from AF diagnosis to first ablation was 3.5 ± 3.8 years (EF > 35%: 3.5 ± 3.8 years, EF ≤ 35%: 3.4 ± 3.8 years, p = .66). In the EF > 35% group, delays in treatment (181-545 vs. 30-180, 546-1825 vs. 30-180, >1825 vs. 30-180 days) increased the risk of death with a hazard ratio (HR) of 2.02(p < .0001), 2.62(p < .0001), and 4.39(p < .0001) respectively with significant risks for HF hospitalization (HR:1.44-3.69), stroke (HR:1.11-2.14), and AF recurrence (HR:1.42-1.81). In patients with an EF ≤ 35%, treatment delays also significantly increased risk of death (HR 2.07-3.77) with similar trends in HF hospitalization (HR:1.63-1.09) and AF recurrence (HR:0.79-1.24). CONCLUSION Delays in catheter ablation for AF resulted in increased all-cause mortality in all patients with differential impact observed on HF hospitalization, stroke, and AF recurrence risks by baseline EF. These data favor earlier use of ablation for AF in patients with and without structural heart disease.
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Affiliation(s)
| | - Heidi T May
- Department of Cardiology, Intermountain Medical Center, Intermountain Heart Institute, Salt Lake City, Utah, USA
| | - Brian G Crandall
- Department of Cardiology, Intermountain Medical Center, Intermountain Heart Institute, Salt Lake City, Utah, USA
| | - John D Day
- St. Marks Hospital, Salt Lake City, Utah, USA
| | - Michael J Cutler
- Department of Cardiology, Intermountain Medical Center, Intermountain Heart Institute, Salt Lake City, Utah, USA
| | - Christopher A Groh
- Department of Internal Medicine, Division of Cardiology, University Hospital, Salt Lake City, Utah, USA
| | - Leenapong Navaravong
- Department of Internal Medicine, Division of Cardiology, University Hospital, Salt Lake City, Utah, USA
| | - Ravi Ranjan
- Department of Internal Medicine, Division of Cardiology, University Hospital, Salt Lake City, Utah, USA
| | - Benjamin A Steinberg
- Department of Internal Medicine, Division of Cardiology, University Hospital, Salt Lake City, Utah, USA
| | - Thomas J Bunch
- Department of Internal Medicine, Division of Cardiology, University Hospital, Salt Lake City, Utah, USA
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Kamali R, Gillete K, Tate J, Abhyankar DA, Dosdall DJ, Plank G, Bunch TJ, Macleod RS, Ranjan R. Treatment Planning for Atrial Fibrillation Using Patient-Specific Models Showing the Importance of Fibrillatory-Areas. Ann Biomed Eng 2023; 51:329-342. [PMID: 35930093 PMCID: PMC10440744 DOI: 10.1007/s10439-022-03029-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 07/18/2022] [Indexed: 01/25/2023]
Abstract
Computational models have made it possible to study the effect of fibrosis and scar on atrial fibrillation (AF) and plan future personalized treatments. Here, we study the effect of area available for fibrillatory waves to sustain AF. Then we use it to plan for AF ablation to improve procedural outcomes. CARPentry was used to create patient-specific models to determine the association between the size of residual contiguous areas available for AF wavefronts to propagate and sustain AF [fibrillatory area (FA)] after ablation with procedural outcomes. The FA was quantified in a novel manner accounting for gaps in ablation lines. We selected 30 persistent AF patients with known ablation outcomes. We divided the atrial surface into five areas based on ablation scar pattern and anatomical landmarks and calculated the FAs. We validated the models based on clinical outcomes and suggested future ablation lines that minimize the FAs and terminate rotor activities in simulations. We also simulated the effects of three common antiarrhythmic drugs. In the patient-specific models, the predicted arrhythmias matched the clinical outcomes in 25 of 30 patients (accuracy 83.33%). The average largest FA (FAmax) in the recurrence group was 8517 ± 1444 vs. 6772 ± 1531 mm2 in the no recurrence group (p < 0.004). The final FAs after adding the suggested ablation lines in the AF recurrence group reduced the average FAmax from 8517 ± 1444 to 6168 ± 1358 mm2 (p < 0.001) and stopped the sustained rotor activity. Simulations also correctly anticipated the effect of antiarrhythmic drugs in 5 out of 6 patients who used drug therapy post unsuccessful ablation (accuracy 83.33%). Sizes of FAs available for AF wavefronts to propagate are important determinants for ablation outcomes. FA size in combination with computational simulations can be used to direct ablation in persistent AF to minimize the critical mass required to sustain recurrent AF.
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Affiliation(s)
- Roya Kamali
- Department of Biomedical Engineering, University of Utah, Salt Lake City, UT, USA
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Utah, Salt Lake City, UT, USA
- Nora Eccles Harrison Cardiovascular Research and Training Institute, University of Utah, Salt Lake City, UT, USA
- Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA, USA
| | - Karli Gillete
- Institute of Biophysics, Medical University of Graz, Graz, Austria
| | - Jess Tate
- Scientific Computing and Imaging Institute, University of Utah, Salt Lake City, UT, USA
| | | | - Derek J Dosdall
- Department of Biomedical Engineering, University of Utah, Salt Lake City, UT, USA
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Utah, Salt Lake City, UT, USA
- Nora Eccles Harrison Cardiovascular Research and Training Institute, University of Utah, Salt Lake City, UT, USA
| | - Gernot Plank
- Institute of Biophysics, Medical University of Graz, Graz, Austria
| | - T Jared Bunch
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Utah, Salt Lake City, UT, USA
| | - Rob S Macleod
- Department of Biomedical Engineering, University of Utah, Salt Lake City, UT, USA
- Nora Eccles Harrison Cardiovascular Research and Training Institute, University of Utah, Salt Lake City, UT, USA
| | - Ravi Ranjan
- Department of Biomedical Engineering, University of Utah, Salt Lake City, UT, USA.
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Utah, Salt Lake City, UT, USA.
- Nora Eccles Harrison Cardiovascular Research and Training Institute, University of Utah, Salt Lake City, UT, USA.
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Kogelschatz B, Zenger B, Steinberg BA, Ranjan R, Jared Bunch T. Atrial fibrillation and the risk of early-onset dementia and cognitive decline: An updated review. Trends Cardiovasc Med 2023:S1050-1738(23)00007-5. [PMID: 36702389 DOI: 10.1016/j.tcm.2023.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 01/02/2023] [Accepted: 01/18/2023] [Indexed: 01/25/2023]
Abstract
The relationship between atrial fibrillation (AF) and dementia has been well described; however, recent data suggest that AF confers a greater risk for the development of early-onset dementia irrespective of clinical stroke. Numerous mechanisms have been hypothesized to explain cognitive decline in the setting of AF, including silent cerebral ischemia, cerebral hypoperfusion, and cerebral microvascular disease. Despite the emergence of data supporting the increased risk of early-onset dementia in patients with AF, the underlying mechanism remains unclear. Furthermore, the mechanism may be influenced by survival bias, genetic susceptibility, or early dysfunction of brain adaptation. Investigation into why this relationship exists could change how prevention and treatment are evaluated.
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Affiliation(s)
- Benjamin Kogelschatz
- Division of Cardiovascular Medicine, University of Utah Health Sciences Center, 30 North 1900 East, Room 4A100, Salt Lake City, UT 84132 USA
| | - Brian Zenger
- Division of Cardiovascular Medicine, University of Utah Health Sciences Center, 30 North 1900 East, Room 4A100, Salt Lake City, UT 84132 USA
| | - Benjamin A Steinberg
- Division of Cardiovascular Medicine, University of Utah Health Sciences Center, 30 North 1900 East, Room 4A100, Salt Lake City, UT 84132 USA
| | - Ravi Ranjan
- Division of Cardiovascular Medicine, University of Utah Health Sciences Center, 30 North 1900 East, Room 4A100, Salt Lake City, UT 84132 USA
| | - T Jared Bunch
- Division of Cardiovascular Medicine, University of Utah Health Sciences Center, 30 North 1900 East, Room 4A100, Salt Lake City, UT 84132 USA.
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Kamali R, Kwan E, Regouski M, Bunch TJ, Dosdall DJ, Hsu E, Macleod RS, Polejaeva I, Ranjan R. Contribution of atrial myofiber architecture to atrial fibrillation. PLoS One 2023; 18:e0279974. [PMID: 36719871 PMCID: PMC9888724 DOI: 10.1371/journal.pone.0279974] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 12/19/2022] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The role of fiber orientation on a global chamber level in sustaining atrial fibrillation (AF) is unknown. The goal of this study was to correlate the fiber direction derived from Diffusion Tensor Imaging (DTI) with AF inducibility. METHODS Transgenic goats with cardiac-specific overexpression of constitutively active TGF-β1 (n = 14) underwent AF inducibility testing by rapid pacing in the left atrium. We chose a minimum of 10 minutes of sustained AF as a cut-off for AF inducibility. Explanted hearts underwent DTI to determine the fiber direction. Using tractography data, we clustered, visualized, and quantified the fiber helix angles in 8 different regions of the left atrial wall using two reference vectors defined based on anatomical landmarks. RESULTS Sustained AF was induced in 7 out of 14 goats. The mean helix fiber angles in 7 out of 8 selected regions were statistically different (P-Value < 0.05) in the AF inducible group. The average fractional anisotropy (FA) and the mean diffusivity (MD) were similar in the two groups with FA of 0.32±0.08 and MD of 8.54±1.72 mm2/s in the non-inducible group and FA of 0.31±0.05 (P-value = 0.90) and MD of 8.68±1.60 mm2/s (P-value = 0.88) in the inducible group. CONCLUSIONS DTI based fiber direction shows significant variability across subjects with a significant difference between animals that are AF inducible versus animals that are not inducible. Fiber direction might be contributing to the initiation and sustaining of AF, and its role needs to be investigated further.
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Affiliation(s)
- Roya Kamali
- Department of Bioengineering, University of Utah, Salt Lake City, Utah, United States of America
- Cardiovascular Medicine, University of Utah, Salt Lake City, Utah, United States of America
- Nora Eccles Harrison Cardiovascular Research and Training Institute, Salt Lake City, Utah, United States of America
| | - Eugene Kwan
- Department of Bioengineering, University of Utah, Salt Lake City, Utah, United States of America
- Cardiovascular Medicine, University of Utah, Salt Lake City, Utah, United States of America
- Nora Eccles Harrison Cardiovascular Research and Training Institute, Salt Lake City, Utah, United States of America
| | - Misha Regouski
- Department of Animal, Dairy and Veterinary Sciences, Utah State University, Logan, Utah, United States of America
| | - T. Jared Bunch
- Cardiovascular Medicine, University of Utah, Salt Lake City, Utah, United States of America
| | - Derek J. Dosdall
- Department of Bioengineering, University of Utah, Salt Lake City, Utah, United States of America
- Cardiovascular Medicine, University of Utah, Salt Lake City, Utah, United States of America
- Nora Eccles Harrison Cardiovascular Research and Training Institute, Salt Lake City, Utah, United States of America
- Department of Surgery, University of Utah, Salt Lake City, Utah, United States of America
| | - Ed Hsu
- Department of Bioengineering, University of Utah, Salt Lake City, Utah, United States of America
| | - Rob S. Macleod
- Department of Bioengineering, University of Utah, Salt Lake City, Utah, United States of America
| | - Irina Polejaeva
- Department of Animal, Dairy and Veterinary Sciences, Utah State University, Logan, Utah, United States of America
| | - Ravi Ranjan
- Department of Bioengineering, University of Utah, Salt Lake City, Utah, United States of America
- Cardiovascular Medicine, University of Utah, Salt Lake City, Utah, United States of America
- Nora Eccles Harrison Cardiovascular Research and Training Institute, Salt Lake City, Utah, United States of America
- * E-mail:
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Ranjan R, Datta PK, Rapaka S, Roy A, Soni KD. HFOV in inhalational injury associated ARDS with broncho-pleural fistula - An old friend to the rescue: Case report. Can J Respir Ther 2023; 59:95-99. [PMID: 37063456 PMCID: PMC10092617 DOI: 10.29390/cjrt-2022-069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 04/18/2023]
Abstract
Introduction Patients with acute respiratory distress syndrome (ARDS) on mechanical ventilation often require high inspiratory pressure and positive end-expiratory pressure (PEEP). However, effective ventilation becomes difficult in cases where a large air leak develops in patients. The management of such a case requires improvisation and the adoption of special ventilation strategies. Case and outcomes We present a case study of a burn patient with airway involvement, developing ARDS and who developed a bronchopleural fistula (BPF) leading to failure of conventional ventilation. He was managed successfully with high-frequency oscillatory ventilation (HFOV) and finally discharged. Conclusion HFOV is a feasible option for ventilating patients with BPF when conventional ventilation fails. At a time when HFOV has largely been relegated to obsolescence, we hope to re-emphasize its relevance under particular circumstances.
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Affiliation(s)
- Ravi Ranjan
- Department of Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Priyankar Kumar Datta
- Department of Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Sriharsha Rapaka
- Department of Critical Care Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Avishek Roy
- Department of Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Kapil Dev Soni
- Department of Anaesthesia and Critical Care, Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India
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Zenger B, Rizzi S, Steinberg BA, Ranjan R, Bunch TJ. This is Your Brain, and This is Your Brain on Atrial Fibrillation: The Roles of Cardiac Malperfusion Events and Vascular Dysfunction in Cognitive Impairment. Arrhythm Electrophysiol Rev 2023; 12:e01. [PMID: 36845168 PMCID: PMC9945461 DOI: 10.15420/aer.2022.29] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 11/14/2022] [Indexed: 02/03/2023] Open
Abstract
AF is an independent and strong predictor of long-term cognitive decline. However, the mechanism for this cognitive decline is difficult to define and likely multifactorial, leading to many different hypotheses. Examples include macro- or microvascular stroke events, biochemical changes to the blood-brain barrier related to anticoagulation, or hypo-hyperperfusion events. This review explores and discusses the hypothesis that AF contributes to cognitive decline and dementia through hypo-hyperperfusion events occurring during cardiac arrhythmias. We briefly explain several brain perfusion imaging techniques and further examine the novel findings associated with changes in brain perfusion in patients with AF. Finally, we discuss the implications and areas requiring more research to further understand and treat patients with cognitive decline related to AF.
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Affiliation(s)
- Brian Zenger
- School of Medicine, University of Utah, Salt Lake City, UT, US
| | - Scott Rizzi
- Department of Internal Medicine, University of Utah Health Sciences, Salt Lake City, UT, US
| | - Benjamin A Steinberg
- School of Medicine, University of Utah, Salt Lake City, UT, US
- Division of Cardiovascular Medicine, University of Utah Health Sciences, Salt Lake City, UT, US
| | - Ravi Ranjan
- Division of Cardiovascular Medicine, University of Utah Health Sciences, Salt Lake City, UT, US
| | - T Jared Bunch
- School of Medicine, University of Utah, Salt Lake City, UT, US
- Division of Cardiovascular Medicine, University of Utah Health Sciences, Salt Lake City, UT, US
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Edwards M, Lam S, Ranjan R, Pereira M, Babbitt C, Lacreuse A. Letrozole treatment alters hippocampal gene expression in common marmosets (Callithrix jacchus). Horm Behav 2023; 147:105281. [PMID: 36434852 PMCID: PMC9839488 DOI: 10.1016/j.yhbeh.2022.105281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 10/28/2022] [Accepted: 11/09/2022] [Indexed: 11/25/2022]
Abstract
Aromatase inhibitors (AIs) are a class of drugs commonly given to patients with estrogen receptor (ER)-dependent breast cancers to reduce estrogenic stimulation. However, AIs like Letrozole are associated with negative side effects such as cognitive deficits, sleep disturbances and hot flashes. We have previously shown that these negative effects can be recapitulated in common marmosets (Callithrix jacchus) treated with Letrozole (20 μg daily) for 4 weeks and that marmosets treated with Letrozole show increased levels of estradiol in the hippocampus (Gervais et al., 2019). In order to better understand the mechanisms through which AIs affect cognitive function and increase steroid levels in the hippocampus, we used bulk, paired-end RNA-sequencing to examine differentially expressed genes among Letrozole-treated (LET; n = 8) and vehicle-treated (VEH; n = 8) male and female animals. Gene ontology results show significant reduction across hundreds of categories, some of the most significant being inflammatory response, stress response, MHC Class II protein complex binding, T-cell activation, carbohydrate binding and signaling receptor binding in LET animals. GSEA results indicate that LET females, but not LET males, show enrichment for hormonal gene sets. Based on the transcriptional changes observed, we conclude that AIs may differentially affect the sexes in part due to processes mediated by the CYP-450 superfamily. Ongoing studies will further investigate the longitudinal effects of AIs on behavior and whether AIs increase the risk of stress-induced neurodegeneration.
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Affiliation(s)
- Mélise Edwards
- University of Massachusetts Amherst, Department of Psychological & Brain Sciences, Amherst, MA 01003, USA; Neuroscience and Behavior Graduate Program, University of Massachusetts, Amherst, MA 01003, USA.
| | - Sam Lam
- University of Massachusetts Amherst, Department of Psychological & Brain Sciences, Amherst, MA 01003, USA
| | - Ravi Ranjan
- University of Massachusetts Amherst, Department of Psychological & Brain Sciences, Amherst, MA 01003, USA; Genomics Resource Laboratory, University of Massachusetts Amherst, Amherst, MA 01003, USA
| | - Mariana Pereira
- University of Massachusetts Amherst, Department of Psychological & Brain Sciences, Amherst, MA 01003, USA; Neuroscience and Behavior Graduate Program, University of Massachusetts, Amherst, MA 01003, USA
| | - Courtney Babbitt
- University of Massachusetts Amherst, Department of Psychological & Brain Sciences, Amherst, MA 01003, USA; University of Massachusetts Amherst, Department of Biology, Amherst, MA 01003, USA
| | - Agnès Lacreuse
- University of Massachusetts Amherst, Department of Psychological & Brain Sciences, Amherst, MA 01003, USA; Neuroscience and Behavior Graduate Program, University of Massachusetts, Amherst, MA 01003, USA
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Wiala A, Ranjan R, Schnidar H, Rappersberger K, Posch C. 091 Automated classification of hidradenitis suppurativa severity by convolutional neural network analyses using clinical images. J Invest Dermatol 2022. [DOI: 10.1016/j.jid.2022.09.101] [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: 11/19/2022]
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Raj R, Mahey R, Bhatla N, Manchanda S, Kumari A, Ranjan R. Laparoscopic Inguinal Gonadectomy in a Case of Partial Androgen Insensitivity Syndrome and Bilateral Gonads in Inguinal Canal. J Minim Invasive Gynecol 2022. [DOI: 10.1016/j.jmig.2022.09.198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Zenger B, Kwan E, Kholmovski E, Peckham ME, Steinberg BA, deHavenon A, Ranjan R, Bunch TJ. Atrial Fibrillation Causes Decreased Cerebrovascular Reserve: A Controlled Experimental Study. JACC Clin Electrophysiol 2022; 8:1451-1453. [PMID: 36089520 DOI: 10.1016/j.jacep.2022.06.008] [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] [Received: 04/28/2022] [Revised: 06/14/2022] [Accepted: 06/19/2022] [Indexed: 12/24/2022]
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Khan MS, Kyriakopoulos CP, Taleb I, Dranow E, Scott M, Ranjan R, Yin M, Tseliou E, Alharethi R, Caine W, Shaw RM, Selzman CH, Drakos SG, Dosdall DJ. Baseline QRS duration associates with cardiac recovery in patients with continuous-flow left ventricular assist device implantation. Am Heart J Plus 2022; 22:100211. [PMID: 38558900 PMCID: PMC10978410 DOI: 10.1016/j.ahjo.2022.100211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 09/14/2022] [Accepted: 09/16/2022] [Indexed: 04/04/2024]
Abstract
Objective In chronic heart failure (HF) patients supported with continuous-flow left ventricular assist device (CF-LVAD), we aimed to assess the clinical association of pre-LVAD QRS duration (QRSd) with post-LVAD cardiac recovery, and its correlation with pre- to post-LVAD change in left ventricular ejection fraction (LVEF) and left ventricular end-diastolic diameter (LVEDD). Methods Chronic HF patients (n = 402) undergoing CF-LVAD implantation were prospectively enrolled, at one of the centers comprising the U.T.A.H. (Utah Transplant Affiliated Hospitals) consortium. After excluding patients with acute HF etiologies, hypertrophic or infiltrative cardiomyopathy, and/or inadequate post-LVAD follow up (<3 months), 315 patients were included in the study. Cardiac recovery was defined as LVEF ≥ 40 % and LVEDD < 6 cm within 12 months post-LVAD implantation. Patients fulfilling this condition were termed as responders (R) and results were compared with non-responders (NR). Results Thirty-five patients (11 %) achieved 'R' criteria, and exhibited a 15 % shorter QRSd compared to 'NR' (123 ± 37 ms vs 145 ± 36 ms; p < 0.001). A univariate analysis identified association of baseline QRSd with post-LVAD cardiac recovery (OR: 0.986, 95 % CI: 0.976-0.996, p < 0.001). In a multivariate logistic regression model, after adjusting for duration of HF (OR: 0.990, 95 % CI: 0.983-0.997, p = 0.006) and gender (OR: 0.388, 95 % CI: 0.160-0.943, p = 0.037), pre-LVAD QRSd exhibited a significant association with post-LVAD cardiac structural and functional improvement (OR: 0.987, 95 % CI: 0.977-0.998, p = 0.027) and the predictive model showed a c-statistic of 0.73 with p < 0.001. The correlations for baseline QRSd with pre- to post-LVAD change in LVEF and LVEDD were also investigated in 'R' and 'NR' groups. Conclusion Chronic advanced HF patients with a shorter baseline QRSd exhibit an increased potential for cardiac recovery after LVAD support.
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Affiliation(s)
- Muhammad S. Khan
- Nora Eccles Harrison Cardiovascular Research and Training Institute, The University of Utah, Salt Lake City, UT, United States of America
| | - Christos P. Kyriakopoulos
- Nora Eccles Harrison Cardiovascular Research and Training Institute, The University of Utah, Salt Lake City, UT, United States of America
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Utah Health & School of Medicine, Salt Lake City, UT, United States of America
| | - Iosif Taleb
- Nora Eccles Harrison Cardiovascular Research and Training Institute, The University of Utah, Salt Lake City, UT, United States of America
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Utah Health & School of Medicine, Salt Lake City, UT, United States of America
| | - Elizabeth Dranow
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Utah Health & School of Medicine, Salt Lake City, UT, United States of America
| | - Monte Scott
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Utah Health & School of Medicine, Salt Lake City, UT, United States of America
| | - Ravi Ranjan
- Nora Eccles Harrison Cardiovascular Research and Training Institute, The University of Utah, Salt Lake City, UT, United States of America
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Utah Health & School of Medicine, Salt Lake City, UT, United States of America
- Department of Biomedical Engineering, The University of Utah, Salt Lake City, UT, United States of America
| | - Michael Yin
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Utah Health & School of Medicine, Salt Lake City, UT, United States of America
| | - Eleni Tseliou
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Utah Health & School of Medicine, Salt Lake City, UT, United States of America
| | - Rami Alharethi
- Cardiovascular Department, Intermountain Medical Center, Salt Lake City, UT, United States of America
| | - William Caine
- Cardiovascular Department, Intermountain Medical Center, Salt Lake City, UT, United States of America
| | - Robin M. Shaw
- Nora Eccles Harrison Cardiovascular Research and Training Institute, The University of Utah, Salt Lake City, UT, United States of America
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Utah Health & School of Medicine, Salt Lake City, UT, United States of America
| | - Craig H. Selzman
- Nora Eccles Harrison Cardiovascular Research and Training Institute, The University of Utah, Salt Lake City, UT, United States of America
- Division of Cardiothoracic Surgery, Department of Surgery, University of Utah Health & School of Medicine, Salt Lake City, UT, United States of America
| | - Stavros G. Drakos
- Nora Eccles Harrison Cardiovascular Research and Training Institute, The University of Utah, Salt Lake City, UT, United States of America
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Utah Health & School of Medicine, Salt Lake City, UT, United States of America
- Department of Biomedical Engineering, The University of Utah, Salt Lake City, UT, United States of America
| | - Derek J. Dosdall
- Nora Eccles Harrison Cardiovascular Research and Training Institute, The University of Utah, Salt Lake City, UT, United States of America
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Utah Health & School of Medicine, Salt Lake City, UT, United States of America
- Department of Biomedical Engineering, The University of Utah, Salt Lake City, UT, United States of America
- Division of Cardiothoracic Surgery, Department of Surgery, University of Utah Health & School of Medicine, Salt Lake City, UT, United States of America
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Wierenga J, Thomas MK, Ranjan R, Ibelings BW. Complex effects of chytrid parasites on the growth of the cyanobacterium Planktothrix rubescens across interacting temperature and light gradients. ISME Commun 2022; 2:93. [PMID: 37938757 PMCID: PMC9723700 DOI: 10.1038/s43705-022-00178-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 08/22/2022] [Accepted: 09/13/2022] [Indexed: 11/09/2023]
Abstract
Chytrids are important drivers of aquatic ecosystems as phytoplankton parasites. The interaction between these parasites and their hosts are shaped by abiotic factors such as temperature and light. Here, we performed a full-factorial experiment to study how temperature and light interact to affect the dynamics of the bloom-forming toxic cyanobacterium Planktothrix rubescens and its chytrid parasite. We used a dynamic host-parasite model to explore how temperature and light affect long term dynamics. At low temperatures, chytrids do not survive. Higher light and temperature levels stimulated both phytoplankton and chytrid growth, with complex effects on their dynamics. Model exploration indicates that increasing temperature and light shifts equilibrium outcomes from P. rubescens persisting alone to stable coexistence and then to limit cycles. This provides an alternative biological explanation for why P. rubescens is mainly found in the relatively cold and dark lake metalimnion - it may enable avoidance of its parasite. Our study emphasizes the importance of investigating how abiotic factors interact with biotic interactions to drive complex outcomes.
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Affiliation(s)
- Joren Wierenga
- Department F.A. Forel for Environmental and Aquatic Sciences and Institute for Environmental Sciences, University of Geneva, Geneva, Switzerland
| | - Mridul K Thomas
- Department F.A. Forel for Environmental and Aquatic Sciences and Institute for Environmental Sciences, University of Geneva, Geneva, Switzerland.
| | - Ravi Ranjan
- Helmholtz Institute of Functional Marine Biodiversity at the University of Oldenburg (HIFMB), Ammerländer Heerstraße 231, D-26129, Oldenburg, Germany
- Alfred-Wegener-Institute, Helmholtz-Centre for Polar and Marine Research (AWI), Am Handelshafen 12, 27570, Bremerhaven, Germany
| | - Bas W Ibelings
- Department F.A. Forel for Environmental and Aquatic Sciences and Institute for Environmental Sciences, University of Geneva, Geneva, Switzerland
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Lange M, Kwan E, Dosdall DJ, MacLeod RS, Bunch TJ, Ranjan R. Case report: Personalized computational model guided ablation for left atrial flutter. Front Cardiovasc Med 2022; 9:893752. [PMID: 36187013 PMCID: PMC9521648 DOI: 10.3389/fcvm.2022.893752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 07/04/2022] [Indexed: 11/21/2022] Open
Abstract
Atypical atrial flutter is seen post-ablation in patients, and it can be challenging to map. These flutters are typically set up around areas of scar in the left atrium. MRI can reliably identify left atrial scar. We propose a personalized computational model using patient specific scar information, to generate a monodomain model. In the model conductivities are adjusted for different tissue regions and flutter was induced with a premature pacing protocol. The model was tested prospectively in patients undergoing atypical flutter ablation. The simulation-predicted flutters were visualized and presented to clinicians. Validation of the computational model was motivated by recording from electroanatomical mapping. These personalized models successfully predicted clinically observed atypical flutter circuits and at times even better than invasive maps leading to flutter termination at isthmus sites predicted by the model.
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Affiliation(s)
- Matthias Lange
- Nora Eccles Harrison Cardiovascular Research and Training Institute, The University of Utah, Salt Lake City, UT, United States
| | - Eugene Kwan
- Nora Eccles Harrison Cardiovascular Research and Training Institute, The University of Utah, Salt Lake City, UT, United States
- Biomedical Engineering, The University of Utah, Salt Lake City, UT, United States
| | - Derek J. Dosdall
- Nora Eccles Harrison Cardiovascular Research and Training Institute, The University of Utah, Salt Lake City, UT, United States
- Biomedical Engineering, The University of Utah, Salt Lake City, UT, United States
- Department of Surgery, Division of Cardiothoracic Surgery, University of Utah School of Medicine, Salt Lake City, UT, United States
| | - Rob S. MacLeod
- Nora Eccles Harrison Cardiovascular Research and Training Institute, The University of Utah, Salt Lake City, UT, United States
- Biomedical Engineering, The University of Utah, Salt Lake City, UT, United States
- Scientific Computing and Imaging Institute, The University of Utah, Salt Lake City, UT, United States
| | - T. Jared Bunch
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of Utah School of Medicine, Salt Lake City, UT, United States
| | - Ravi Ranjan
- Nora Eccles Harrison Cardiovascular Research and Training Institute, The University of Utah, Salt Lake City, UT, United States
- Biomedical Engineering, The University of Utah, Salt Lake City, UT, United States
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of Utah School of Medicine, Salt Lake City, UT, United States
- *Correspondence: Ravi Ranjan,
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Singh S, Chauhan SS, Ranjan R. A cross-sectional study on the incidence of retinal changes and its correlation with variables like blood pressure, liver function tests, kidney function tests, proteinuria, and pedal edema in patients of pregnancy-induced hypertension in a rural setting. Indian J Ophthalmol 2022; 70:3335-3340. [PMID: 36018116 PMCID: PMC9675523 DOI: 10.4103/ijo.ijo_900_21] [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: 02/03/2023] Open
Abstract
Purpose Pregnancy-induced hypertension is a multisystem disorder that occurs after 20 weeks of pregnancy usually in primigravidas and is characterised by proteinuria, pedal edema, hypertension, and abnormal liver and kidney function tests. Since there exists a close relationship between retinal, cerebral, and renal vessels, fundoscopy gives the opportunity of observing the changes in the vascular tree. Methods We conducted a study on 203 pregnant females over a period of 1.5 years in the rural population of North India. We recorded the baseline data from the patient files, including the biochemical investigations, and conducted a fundoscopic examination of all patients included in the study, and correlation of various variables was established. Results Out of 203 patients (403 eyes), 60% were primigravidas of mean age 25.71 ± 4.46 years with the mean duration of pregnancy being 36 weeks. The mean systolic and diastolic blood pressure were160 and 101 mmHg, respectively. There was no significant correlation was seen of proteinuria with eclampsia and the fundus findings. But there was a significant correlation between proteinuria and pedal edema and between the fundus findings and deranged LFT and KFT values. Relationship between the variables was calculated by using Chi-square and Fisher's exact test. A P value < 0.05 was taken as significant. Conclusion Hypertension in pregnancy is the major concern of public health issue worldwide. With proper understanding of the correlating factors such as fundus changes which are directly correlated with whole bo dy vascular changes, which might affect the fetal growth, we can easily predict the outcome and can take appropriate actions as early as possible.
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Affiliation(s)
- Sonali Singh
- Department of Ophthalmology, UPUMS, Saifai, Etawah, Uttar Pradesh, India,Correspondence to: Dr. Sonali Singh, KN 587/3 Asal News Wali Gali, Opposite BDO Office, Alipur, New Delhi, India. E-mail:
| | - Shantanu S Chauhan
- Department of Ophthalmology, Maulana Azad Medical College, New Delhi, India
| | - Ravi Ranjan
- Department of Ophthalmology, UPUMS, Saifai, Etawah, Uttar Pradesh, India
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Bajpai H, Patra KK, Ranjan R, Nalajala N, Reddy KP, Gopinath CS. Correction to "Can Half-a-Monolayer of Pt Simulate Activity Like That of Bulk Pt? Solar Hydrogen Activity Demonstration with Quasi-artificial Leaf Device". ACS Appl Mater Interfaces 2022; 14:32771. [PMID: 35802467 DOI: 10.1021/acsami.2c10019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Affiliation(s)
- Himanshu Bajpai
- Catalysis and Inorganic Chemistry Division, CSIR-National Chemical Laboratory, Dr. Homi Bhabha Road, Pune 411 008, India
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad 201 002, India
| | - Kshirodra Kumar Patra
- Catalysis and Inorganic Chemistry Division, CSIR-National Chemical Laboratory, Dr. Homi Bhabha Road, Pune 411 008, India
| | - Ravi Ranjan
- Catalysis and Inorganic Chemistry Division, CSIR-National Chemical Laboratory, Dr. Homi Bhabha Road, Pune 411 008, India
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad 201 002, India
| | - Naresh Nalajala
- Catalysis and Inorganic Chemistry Division, CSIR-National Chemical Laboratory, Dr. Homi Bhabha Road, Pune 411 008, India
| | - Kasala Prabhakar Reddy
- Catalysis and Inorganic Chemistry Division, CSIR-National Chemical Laboratory, Dr. Homi Bhabha Road, Pune 411 008, India
| | - Chinnakonda S Gopinath
- Catalysis and Inorganic Chemistry Division, CSIR-National Chemical Laboratory, Dr. Homi Bhabha Road, Pune 411 008, India
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad 201 002, India
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Ishidoya Y, Ranjan R. Using MRI to predict ventricular tachycardia recurrence and provide guidance for ablation? Heart Rhythm 2022; 19:1611-1612. [PMID: 35690251 DOI: 10.1016/j.hrthm.2022.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Accepted: 06/06/2022] [Indexed: 11/24/2022]
Affiliation(s)
- Yuki Ishidoya
- Division of Cardiovascular Medicine, University of Utah, Salt Lake City, Utah; Nora Eccles Harrison Cardiovascular Research and Training Institute, University of Utah, Salt Lake City, Utah
| | - Ravi Ranjan
- Division of Cardiovascular Medicine, University of Utah, Salt Lake City, Utah; Nora Eccles Harrison Cardiovascular Research and Training Institute, University of Utah, Salt Lake City, Utah; Department of Biomedical Engineering, University of Utah, Salt Lake City, Utah.
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Wirostko BM, Curtin K, Taylor SC, Paulson C, Pompoco C, Besch BM, Ranjan R, Ritch R. Risk of atrial fibrillation is increased in patients with exfoliation syndrome: the Utah project on exfoliation syndrome (UPEXS). Acta Ophthalmol 2022; 100:e1002-e1009. [PMID: 34549527 DOI: 10.1111/aos.15017] [Citation(s) in RCA: 4] [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: 10/21/2020] [Revised: 08/09/2021] [Accepted: 08/31/2021] [Indexed: 12/21/2022]
Abstract
PURPOSE Exfoliation syndrome, a systemic disorder with ocular manifestations, is associated with lysyl oxidase-like gene variants. Along with transforming growth factor beta-1, lysyl oxidase-like 1 is a key enzyme in stabilizing extracellular matrix and remodelling collagen/elastin. Given the role that transforming growth factor beta-1, lysyl oxidase-like gene variants and fibrosis play in atrial fibrillation, an association with exfoliation syndrome was investigated. METHODS An exfoliation syndrome cohort of 2803 patients and an atrial fibrillation cohort of 43 694 patients aged 60-90 years at disease onset were identified using the Utah Population Database (1996-2015). Conditional logistic regression was used to estimate risk of atrial fibrillation in exfoliation syndrome patients and risk of exfoliation syndrome in atrial fibrillation patients compared with respective 5:1 sex- and age-matched control cohorts. Kaplan-Meier curves were examined to assess survival in atrial fibrillation patients by exfoliation syndrome status. RESULTS Exfoliation syndrome patients had a 21% greater risk (95% CI 1.06-1.37; p < 0.0001) of atrial fibrillation. This was more pronounced in exfoliation syndrome patients with no hypertension history, who exhibited a 52% increased atrial fibrillation risk (95% CI 1.27-1.82; p < 0.0001). Atrial fibrillation patients exhibited a 20% increased risk of exfoliation syndrome (95% CI 1.07-1.35; p = 0.003), while atrial fibrillation patients with no hypertension had a 72% higher exfoliation risk (95% CI 1.45-2.03; p < 0.0001). Atrial fibrillation patients with exfoliation syndrome had a higher estimated probability of survival (alive at study end or at last follow-up) compared with patients with no exfoliation history (p < 0.0001, log-rank test). CONCLUSIONS Exfoliation syndrome patients were at a statistically significant increased risk of atrial fibrillation. Similarly, atrial fibrillation patients were at a statistically significant higher risk of exfoliation, particularly when hypertension history was absent.
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Affiliation(s)
- Barbara M. Wirostko
- Department of Ophthalmology & Visual Science University of Utah School of Medicine and John Moran Eye Center Salt Lake City UT USA
| | - Karen Curtin
- Department of Ophthalmology & Visual Science University of Utah School of Medicine and John Moran Eye Center Salt Lake City UT USA
- Department of Internal Medicine University of Utah School of Medicine Salt Lake City UT USA
| | - Samuel C. Taylor
- Department of Ophthalmology & Visual Science University of Utah School of Medicine and John Moran Eye Center Salt Lake City UT USA
| | - Chase Paulson
- Department of Ophthalmology & Visual Science University of Utah School of Medicine and John Moran Eye Center Salt Lake City UT USA
| | - Christian Pompoco
- Department of Ophthalmology & Visual Science University of Utah School of Medicine and John Moran Eye Center Salt Lake City UT USA
| | - Brian M. Besch
- Department of Ophthalmology & Visual Science University of Utah School of Medicine and John Moran Eye Center Salt Lake City UT USA
- Department of Ophthalmology University of Louisville Louisville Kentucky USA
| | - Ravi Ranjan
- Department of Internal Medicine University of Utah School of Medicine Salt Lake City UT USA
| | - Robert Ritch
- Einhorn Clinical Research Center New York Eye and Ear Infirmary of Mount Sinai New York NY USA
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