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Effects of empagliflozin on progression of chronic kidney disease: a prespecified secondary analysis from the empa-kidney trial. Lancet Diabetes Endocrinol 2024; 12:39-50. [PMID: 38061371 PMCID: PMC7615591 DOI: 10.1016/s2213-8587(23)00321-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 10/24/2023] [Accepted: 10/25/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Sodium-glucose co-transporter-2 (SGLT2) inhibitors reduce progression of chronic kidney disease and the risk of cardiovascular morbidity and mortality in a wide range of patients. However, their effects on kidney disease progression in some patients with chronic kidney disease are unclear because few clinical kidney outcomes occurred among such patients in the completed trials. In particular, some guidelines stratify their level of recommendation about who should be treated with SGLT2 inhibitors based on diabetes status and albuminuria. We aimed to assess the effects of empagliflozin on progression of chronic kidney disease both overall and among specific types of participants in the EMPA-KIDNEY trial. METHODS EMPA-KIDNEY, a randomised, controlled, phase 3 trial, was conducted at 241 centres in eight countries (Canada, China, Germany, Italy, Japan, Malaysia, the UK, and the USA), and included individuals aged 18 years or older with an estimated glomerular filtration rate (eGFR) of 20 to less than 45 mL/min per 1·73 m2, or with an eGFR of 45 to less than 90 mL/min per 1·73 m2 with a urinary albumin-to-creatinine ratio (uACR) of 200 mg/g or higher. We explored the effects of 10 mg oral empagliflozin once daily versus placebo on the annualised rate of change in estimated glomerular filtration rate (eGFR slope), a tertiary outcome. We studied the acute slope (from randomisation to 2 months) and chronic slope (from 2 months onwards) separately, using shared parameter models to estimate the latter. Analyses were done in all randomly assigned participants by intention to treat. EMPA-KIDNEY is registered at ClinicalTrials.gov, NCT03594110. FINDINGS Between May 15, 2019, and April 16, 2021, 6609 participants were randomly assigned and then followed up for a median of 2·0 years (IQR 1·5-2·4). Prespecified subgroups of eGFR included 2282 (34·5%) participants with an eGFR of less than 30 mL/min per 1·73 m2, 2928 (44·3%) with an eGFR of 30 to less than 45 mL/min per 1·73 m2, and 1399 (21·2%) with an eGFR 45 mL/min per 1·73 m2 or higher. Prespecified subgroups of uACR included 1328 (20·1%) with a uACR of less than 30 mg/g, 1864 (28·2%) with a uACR of 30 to 300 mg/g, and 3417 (51·7%) with a uACR of more than 300 mg/g. Overall, allocation to empagliflozin caused an acute 2·12 mL/min per 1·73 m2 (95% CI 1·83-2·41) reduction in eGFR, equivalent to a 6% (5-6) dip in the first 2 months. After this, it halved the chronic slope from -2·75 to -1·37 mL/min per 1·73 m2 per year (relative difference 50%, 95% CI 42-58). The absolute and relative benefits of empagliflozin on the magnitude of the chronic slope varied significantly depending on diabetes status and baseline levels of eGFR and uACR. In particular, the absolute difference in chronic slopes was lower in patients with lower baseline uACR, but because this group progressed more slowly than those with higher uACR, this translated to a larger relative difference in chronic slopes in this group (86% [36-136] reduction in the chronic slope among those with baseline uACR <30 mg/g compared with a 29% [19-38] reduction for those with baseline uACR ≥2000 mg/g; ptrend<0·0001). INTERPRETATION Empagliflozin slowed the rate of progression of chronic kidney disease among all types of participant in the EMPA-KIDNEY trial, including those with little albuminuria. Albuminuria alone should not be used to determine whether to treat with an SGLT2 inhibitor. FUNDING Boehringer Ingelheim and Eli Lilly.
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T, Tamori Y, Tamura R, Tamura Y, Tan CHH, Tan EZZ, Tanabe A, Tanabe K, Tanaka A, Tanaka A, Tanaka N, Tang S, Tang Z, Tanigaki K, Tarlac M, Tatsuzawa A, Tay JF, Tay LL, Taylor J, Taylor K, Taylor K, Te A, Tenbusch L, Teng KS, Terakawa A, Terry J, Tham ZD, Tholl S, Thomas G, Thong KM, Tietjen D, Timadjer A, Tindall H, Tipper S, Tobin K, Toda N, Tokuyama A, Tolibas M, Tomita A, Tomita T, Tomlinson J, Tonks L, Topf J, Topping S, Torp A, Torres A, Totaro F, Toth P, Toyonaga Y, Tripodi F, Trivedi K, Tropman E, Tschope D, Tse J, Tsuji K, Tsunekawa S, Tsunoda R, Tucky B, Tufail S, Tuffaha A, Turan E, Turner H, Turner J, Turner M, Tuttle KR, Tye YL, Tyler A, Tyler J, Uchi H, Uchida H, Uchida T, Uchida T, Udagawa T, Ueda S, Ueda Y, Ueki K, Ugni S, Ugwu E, Umeno R, Unekawa C, Uozumi K, Urquia K, Valleteau A, Valletta C, van Erp R, Vanhoy C, Varad V, Varma R, Varughese A, Vasquez P, Vasseur A, Veelken R, Velagapudi C, Verdel K, Vettoretti S, Vezzoli G, Vielhauer V, Viera R, Vilar E, Villaruel S, Vinall L, Vinathan J, Visnjic M, Voigt E, von-Eynatten M, Vourvou M, Wada J, Wada J, Wada T, Wada Y, Wakayama K, Wakita Y, Wallendszus K, Walters T, Wan Mohamad WH, Wang L, Wang W, Wang X, Wang X, Wang Y, Wanner C, Wanninayake S, Watada H, Watanabe K, Watanabe K, Watanabe M, Waterfall H, Watkins D, Watson S, Weaving L, Weber B, Webley Y, Webster A, Webster M, Weetman M, Wei W, Weihprecht H, Weiland L, Weinmann-Menke J, Weinreich T, Wendt R, Weng Y, Whalen M, Whalley G, Wheatley R, Wheeler A, Wheeler J, Whelton P, White K, Whitmore B, Whittaker S, Wiebel J, Wiley J, Wilkinson L, Willett M, Williams A, Williams E, Williams K, Williams T, Wilson A, Wilson P, Wincott L, Wines E, Winkelmann B, Winkler M, Winter-Goodwin B, Witczak J, Wittes J, Wittmann M, Wolf G, Wolf L, Wolfling R, Wong C, Wong E, Wong HS, Wong LW, Wong YH, Wonnacott A, Wood A, Wood L, Woodhouse H, Wooding N, Woodman A, Wren K, Wu J, Wu P, Xia S, Xiao H, Xiao X, Xie Y, Xu C, Xu Y, Xue H, Yahaya H, Yalamanchili H, Yamada A, Yamada N, Yamagata K, Yamaguchi M, Yamaji Y, Yamamoto A, Yamamoto S, Yamamoto S, Yamamoto T, Yamanaka A, Yamano T, Yamanouchi Y, Yamasaki N, Yamasaki Y, Yamasaki Y, Yamashita C, Yamauchi T, Yan Q, Yanagisawa E, Yang F, Yang L, Yano S, Yao S, Yao Y, Yarlagadda S, Yasuda Y, Yiu V, Yokoyama T, Yoshida S, Yoshidome E, Yoshikawa H, Young A, Young T, Yousif V, Yu H, Yu Y, Yuasa K, Yusof N, Zalunardo N, Zander B, Zani R, Zappulo F, Zayed M, Zemann B, Zettergren P, Zhang H, Zhang L, Zhang L, Zhang N, Zhang X, Zhao J, Zhao L, Zhao S, Zhao Z, Zhong H, Zhou N, Zhou S, Zhu D, Zhu L, Zhu S, Zietz M, Zippo M, Zirino F, Zulkipli FH. Impact of primary kidney disease on the effects of empagliflozin in patients with chronic kidney disease: secondary analyses of the EMPA-KIDNEY trial. Lancet Diabetes Endocrinol 2024; 12:51-60. [PMID: 38061372 DOI: 10.1016/s2213-8587(23)00322-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 10/24/2023] [Accepted: 10/25/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND The EMPA-KIDNEY trial showed that empagliflozin reduced the risk of the primary composite outcome of kidney disease progression or cardiovascular death in patients with chronic kidney disease mainly through slowing progression. We aimed to assess how effects of empagliflozin might differ by primary kidney disease across its broad population. METHODS EMPA-KIDNEY, a randomised, controlled, phase 3 trial, was conducted at 241 centres in eight countries (Canada, China, Germany, Italy, Japan, Malaysia, the UK, and the USA). Patients were eligible if their estimated glomerular filtration rate (eGFR) was 20 to less than 45 mL/min per 1·73 m2, or 45 to less than 90 mL/min per 1·73 m2 with a urinary albumin-to-creatinine ratio (uACR) of 200 mg/g or higher at screening. They were randomly assigned (1:1) to 10 mg oral empagliflozin once daily or matching placebo. Effects on kidney disease progression (defined as a sustained ≥40% eGFR decline from randomisation, end-stage kidney disease, a sustained eGFR below 10 mL/min per 1·73 m2, or death from kidney failure) were assessed using prespecified Cox models, and eGFR slope analyses used shared parameter models. Subgroup comparisons were performed by including relevant interaction terms in models. EMPA-KIDNEY is registered with ClinicalTrials.gov, NCT03594110. FINDINGS Between May 15, 2019, and April 16, 2021, 6609 participants were randomly assigned and followed up for a median of 2·0 years (IQR 1·5-2·4). Prespecified subgroupings by primary kidney disease included 2057 (31·1%) participants with diabetic kidney disease, 1669 (25·3%) with glomerular disease, 1445 (21·9%) with hypertensive or renovascular disease, and 1438 (21·8%) with other or unknown causes. Kidney disease progression occurred in 384 (11·6%) of 3304 patients in the empagliflozin group and 504 (15·2%) of 3305 patients in the placebo group (hazard ratio 0·71 [95% CI 0·62-0·81]), with no evidence that the relative effect size varied significantly by primary kidney disease (pheterogeneity=0·62). The between-group difference in chronic eGFR slopes (ie, from 2 months to final follow-up) was 1·37 mL/min per 1·73 m2 per year (95% CI 1·16-1·59), representing a 50% (42-58) reduction in the rate of chronic eGFR decline. This relative effect of empagliflozin on chronic eGFR slope was similar in analyses by different primary kidney diseases, including in explorations by type of glomerular disease and diabetes (p values for heterogeneity all >0·1). INTERPRETATION In a broad range of patients with chronic kidney disease at risk of progression, including a wide range of non-diabetic causes of chronic kidney disease, empagliflozin reduced risk of kidney disease progression. Relative effect sizes were broadly similar irrespective of the cause of primary kidney disease, suggesting that SGLT2 inhibitors should be part of a standard of care to minimise risk of kidney failure in chronic kidney disease. FUNDING Boehringer Ingelheim, Eli Lilly, and UK Medical Research Council.
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Paul R, Goldberg SI, Chan AW. Demystifying the Role of Radiation Dose Bath in Brain Injury Using Machine Learning. Int J Radiat Oncol Biol Phys 2023; 117:e460. [PMID: 37785474 DOI: 10.1016/j.ijrobp.2023.06.1656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) It is well known that high-dose radiation results in brain injury, the long-term effects of low-dose radiation, however, is uncertain. The purpose of this study was to investigate the role of low-dose bath on MRI changes, on both clinical and micro-architectural levels, using machine learning and computational methods. MATERIALS/METHODS Six hundreds and fifty-six temporal lobe and 45 whole brain DVHs from patients treated for nasopharyngeal cancer (NPC) with IMRT or proton were included in this study. Temporal lobe injury (TLI) was defined as development of new T1 enhancement on MRI with or without surrounding T2 edema. Patients were divided randomly into train (50%) and test (50%) sets. Accuracy and AUC were used to evaluate the model performance. Minimum redundancy maximum relevance (MRMR) or SHAP algorithms was employed for feature selection. Support vector machine or random forest was used for classification. Automated cortical region segmentation using FreeSurfer v6 was performed in 33 patients with a minimum follow-up of 4 years. Architectural and biological MRI changes were determined in 34 different brain regions for each individual patient. RESULTS The top-ranked temporal lobe features predicting TLI were V66/V38 for IMRT patients and V10 for proton patients with an AUC of 0.95 and 0.74, respectively. For whole brain, the top features were V16 and V13 with an AUC of 0.70. The rates of TLI at 5 years for V10-20(whole brain) ≥ 180cc and V10-20(whole brain) < 180 were 39.5% and 6.2%, respectively (HR = 5.5, 95% CI 1.4-22.0, p = 0.02). There were global changes in gray matter thickness, with most pronounced changes occurred in parietal lobe (-4.79%, p = 0.007) and occipital lobe (-5.68%, p = 0.03). Similarly, there were diffuse changes in white matter and subcortical volume. After radiation, the frontal lobe increased by 17.5% (p = 0.04), lateral ventricle 41% (p = 0.03), and choroid plexus 34.3% (p = 0.03). CONCLUSION Low-dose radiation bath is associated with increased risk of temporal lobe injury and global disruption in brain architecture in NPC survivors.
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Affiliation(s)
- R Paul
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | | | - A W Chan
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
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Martínez DA, Cai J, Lin G, Goodman KE, Paul R, Lessler J, Levin SR, Toerper M, Simner PJ, Milstone AM, Klein EY. Modelling interventions and contact networks to reduce the spread of carbapenem-resistant organisms between individuals in the ICU. J Hosp Infect 2023; 136:1-7. [PMID: 36907332 PMCID: PMC10315994 DOI: 10.1016/j.jhin.2023.02.016] [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: 08/22/2022] [Revised: 01/25/2023] [Accepted: 02/03/2023] [Indexed: 03/13/2023]
Abstract
BACKGROUND Contact precautions are widely used to prevent the transmission of carbapenem-resistant organisms (CROs) in hospital wards. However, evidence for their effectiveness in natural hospital environments is limited. OBJECTIVE To determine which contact precautions, healthcare worker (HCW)-patient interactions, and patient and ward characteristics are associated with greater risk of CRO infection or colonization. DESIGN, SETTING AND PARTICIPANTS CRO clinical and surveillance cultures from two high-acuity wards were assessed through probabilistic modelling to characterize a susceptible patient's risk of CRO infection or colonization during a ward stay. User- and time-stamped electronic health records were used to build HCW-mediated contact networks between patients. Probabilistic models were adjusted for patient (e.g. antibiotic administration) and ward (e.g. hand hygiene compliance, environmental cleaning) characteristics. The effects of risk factors were assessed by adjusted odds ratio (aOR) and 95% Bayesian credible intervals (CrI). EXPOSURES The degree of interaction with CRO-positive patients, stratified by whether CRO-positive patients were on contact precautions. MAIN OUTCOMES AND MEASURES The prevalence of CROs and number of new carriers (i.e. incident CRO aquisition). RESULTS Among 2193 ward visits, 126 (5.8%) patients became colonized or infected with CROs. Susceptible patients had 4.8 daily interactions with CRO-positive individuals on contact precautions (vs 1.9 interactions with those not on contact precautions). The use of contact precautions for CRO-positive patients was associated with a reduced rate (7.4 vs 93.5 per 1000 patient-days at risk) and odds (aOR 0.03, 95% CrI 0.01-0.17) of CRO acquisition among susceptible patients, resulting in an estimated absolute risk reduction of 9.0% (95% CrI 7.6-9.2%). Also, carbapenem administration to susceptible patients was associated with increased odds of CRO acquisition (aOR 2.38, 95% CrI 1.70-3.29). CONCLUSIONS AND RELEVANCE In this population-based cohort study, the use of contact precautions for patients colonized or infected with CROs was associated with lower risk of CRO acquisition among susceptible patients, even after adjusting for antibiotic exposure. Further studies that include organism genotyping are needed to confirm these findings.
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Affiliation(s)
- D A Martínez
- School of Industrial Engineering, Pontificia Universidad Católica de Valparaíso, Valparaíso, Chile; Department of Emergency Medicine, Johns Hopkins University, Baltimore, MD, USA; Department of Medicine, Johns Hopkins University, Baltimore, MD, USA.
| | - J Cai
- Department of Applied Mathematics and Statistics, Johns Hopkins University, Baltimore, MD, USA
| | - G Lin
- Center for Disease Dynamics, Economics and Policy, Washington, DC, USA
| | - K E Goodman
- Department of Epidemiology and Public Health, University of Maryland, Baltimore, MD, USA
| | - R Paul
- Department of Public Health Sciences, University of North Carolina at Charlotte, Charlotte, NC, USA
| | - J Lessler
- Department of Epidemiology, Johns Hopkins University, Baltimore, MD, USA; Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - S R Levin
- Department of Emergency Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - M Toerper
- Department of Emergency Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - P J Simner
- Division of Medical Microbiology, Department of Pathology, Johns Hopkins University, Baltimore, MD, USA
| | - A M Milstone
- Department of Epidemiology, Johns Hopkins University, Baltimore, MD, USA; Department of Pediatrics, Johns Hopkins University, Baltimore, MD, USA
| | - E Y Klein
- Department of Emergency Medicine, Johns Hopkins University, Baltimore, MD, USA; Center for Disease Dynamics, Economics and Policy, Washington, DC, USA; Department of Epidemiology, Johns Hopkins University, Baltimore, MD, USA
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Paul R, Roy J, Roy K. Prediction of soil ecotoxicity against Folsomia candida using acute and chronic endpoints. SAR QSAR Environ Res 2023; 34:321-340. [PMID: 37218661 DOI: 10.1080/1062936x.2023.2211350] [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] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Soil invertebrates serve as great biological indicators of soil quality. However, there are very few in silico models developed so far on the soil toxicity of chemicals against soil invertebrates due to paucity of data. In this study, three available soil ecotoxicity data (pLC50, pLOEL and pNOEL) against the soil invertebrate Folsomia candida were collected from the ECOTOX database (cfpub.epa.gov/ecotox) and subjected to quantitative structure-activity relationship (QSAR) analysis using 2D descriptors. The collected data for each endpoint were initially curated and used to develop a partial least squares (PLS) regression model based on the features selected through a genetic algorithm followed by the best subset selection. Both internal and external validation metrics of the models' predictions are well-balanced and within the acceptable range as per the Organization for the Economic Cooperation and Development (OECD) criteria. From the developed models, it has been found that molecular weight and presence of phosphate group, electron donor groups, and polyhalogen substitution have a significant impact on the soil ecotoxicity. The soil ecotoxicological risk assessment of organic chemicals can therefore be prioritized by these features. With the availability of additional data in the future, the models may be further refined for more precise predictions.
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Affiliation(s)
- R Paul
- Drug Theoretics and Cheminformatics Laboratory, Department of Pharmaceutical Technology, Jadavpur University, Kolkata, India
| | - J Roy
- Drug Theoretics and Cheminformatics Laboratory, Department of Pharmaceutical Technology, Jadavpur University, Kolkata, India
| | - K Roy
- Drug Theoretics and Cheminformatics Laboratory, Department of Pharmaceutical Technology, Jadavpur University, Kolkata, India
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Gong X, Polsin DN, Paul R, Henderson BJ, Eggert JH, Coppari F, Smith RF, Rygg JR, Collins GW. X-Ray Diffraction of Ramp-Compressed Silicon to 390 GPa. Phys Rev Lett 2023; 130:076101. [PMID: 36867795 DOI: 10.1103/physrevlett.130.076101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 11/15/2022] [Accepted: 01/19/2023] [Indexed: 06/18/2023]
Abstract
Silicon (Si) exhibits a rich collection of phase transitions under ambient-temperature isothermal and shock compression. This report describes in situ diffraction measurements of ramp-compressed Si between 40 and 389 GPa. Angle-dispersive x-ray scattering reveals that Si assumes an hexagonal close-packed (hcp) structure between 40 and 93 GPa and, at higher pressure, a face-centered cubic structure that persists to at least 389 GPa, the highest pressure for which the crystal structure of Si has been investigated. The range of hcp stability extends to higher pressures and temperatures than predicted by theory.
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Affiliation(s)
- X Gong
- University of Rochester Laboratory for Laser Energetics, Rochester, New York 14623-1299, USA
- Department of Mechanical Engineering, University of Rochester, Rochester, New York 14627-0132, USA
| | - D N Polsin
- University of Rochester Laboratory for Laser Energetics, Rochester, New York 14623-1299, USA
- Department of Mechanical Engineering, University of Rochester, Rochester, New York 14627-0132, USA
| | - R Paul
- University of Rochester Laboratory for Laser Energetics, Rochester, New York 14623-1299, USA
- Department of Mechanical Engineering, University of Rochester, Rochester, New York 14627-0132, USA
| | - B J Henderson
- University of Rochester Laboratory for Laser Energetics, Rochester, New York 14623-1299, USA
- Department of Physics and Astronomy, University of Rochester, Rochester, New York 14627-0171, USA
| | - J H Eggert
- Lawrence Livermore National Laboratory, Livermore, California 94550-9234, USA
| | - F Coppari
- Lawrence Livermore National Laboratory, Livermore, California 94550-9234, USA
| | - R F Smith
- Lawrence Livermore National Laboratory, Livermore, California 94550-9234, USA
| | - J R Rygg
- University of Rochester Laboratory for Laser Energetics, Rochester, New York 14623-1299, USA
- Department of Mechanical Engineering, University of Rochester, Rochester, New York 14627-0132, USA
- Department of Physics and Astronomy, University of Rochester, Rochester, New York 14627-0171, USA
| | - G W Collins
- University of Rochester Laboratory for Laser Energetics, Rochester, New York 14623-1299, USA
- Department of Mechanical Engineering, University of Rochester, Rochester, New York 14627-0132, USA
- Department of Physics and Astronomy, University of Rochester, Rochester, New York 14627-0171, USA
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Paul R, Juliano A, Faquin W, Chan A. An Artificial Intelligence Ultrasound Platform for Screening and Staging Thyroid C. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.1404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Paul R, Zhang Y, Goldberg S, Weyman E, Chan A. Decoding Brain Fog in Head and Neck Cancer Survivors Using Artificial Intelligence. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.883] [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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Paul R, Chan A. Brain Global Structural and Network Topological Alterations in Long-term Nasopharyngeal Cancer Survivors. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2021.12.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Paul R, Juliano A, Faquin W, Chan A. An Artificial Intelligence Ultrasound Platform for Screening and Staging of Thyroid Cancer. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2021.12.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Miller TA, Wurdeman S, Paul R, Forthofer M. The Value of Health Economics and Outcomes Research in Prosthetics and Orthotics. Can Prosthet Orthot J 2021; 4:35959. [PMID: 37615002 PMCID: PMC10443510 DOI: 10.33137/cpoj.v4i2.35959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The demand has increased for evidence regarding the effectiveness and value of prosthetic and orthotic rehabilitation interventions. Clinicians and managers are under pressure to provide treatment recommendations and demonstrate effectiveness through outcomes. It is often assumed that rehabilitation interventions, including the provision of custom-made and custom-fit orthotic and prosthetic devices, are beneficial to patients. Assessing the value of orthotic and prosthetic services has become more critical to continue to ensure equitable access to needed services. Health economics and outcomes research methods serve as tools to gauge the value of prosthetic and orthotic rehabilitation interventions. The purpose of this article is to provide an overview of the current need of health economics and outcomes research in orthotics and prosthetics, to introduce common economic methods that assist to generate real-world evidence, and to discusses the potential value of economic methods for clinicians and clinical practice.
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Affiliation(s)
- TA Miller
- Department of Clinical and Scientific Affairs, Hanger Clinic, Austin, Texas, USA
- College of Health and Human Services, University of North Carolina at Charlotte, Charlotte, North Carolina, USA
| | - S Wurdeman
- Department of Clinical and Scientific Affairs, Hanger Clinic, Austin, Texas, USA
- Department of Biomechanics, The University of Nebraska at Omaha, Omaha, Nebraska, USA
| | - R Paul
- Department of Clinical and Scientific Affairs, Hanger Clinic, Austin, Texas, USA
| | - M Forthofer
- Department of Clinical and Scientific Affairs, Hanger Clinic, Austin, Texas, USA
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Zeeshan Hameed B, Somani B, T P R, Raza S, Paul R, Naik N, Singh H, Shah M, Reddy S. Application of Artificial Intelligence-based classifiers to predict the outcome measures and stone-free status following percutaneous nephrolithotomy for staghorn calculi: Cross-validation of data and estimation of accuracy. Eur Urol 2021. [DOI: 10.1016/s0302-2838(21)01348-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Chan P, Colby DJ, Kroon E, Sacdalan C, Pinyakorn S, Paul R, Robb M, Valcour V, Ananworanich J, Marra C, Spudich S. Clinical and laboratory impact of concomitant syphilis infection during acute HIV. HIV Med 2021; 22:502-511. [PMID: 33728759 DOI: 10.1111/hiv.13079] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/24/2020] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Cognitive impairment has been reported in people living with HIV-1 (PLWH) with prior syphilis, while PLWH who present with incident syphilis have reduced blood CD4 T-lymphocyte and elevated HIV-1 RNA levels. However, the clinical, virological and neurocognitive effects of syphilis during acute HIV-1 (AHI) remain unknown. METHODS Pre-antiretroviral therapy laboratory outcomes and neurocognitive performance in a four-test battery in the SEARCH10/RV254 AHI cohort were compared according to syphilis status, determined by serum Treponema pallidum haemagglutination (TPHA), Venereal Disease Research Laboratory (VDRL) and syphilis treatment history. Impaired cognitive performance was defined as having z-scores ≤ -1 in at least two tests or ≤ -2 in at least one test. RESULTS Out of 595 AHI participants (97% male, median age of 26 years and estimated duration of HIV-1 infection of 19 days), 119 (20%) had history of syphilis (TPHA-positive), of whom 51 (9%) had untreated syphilis (TPHA-positive/VDRL-positive/without prior treatment). Compared with those without syphilis (TPHA-negative), individuals with untreated syphilis had higher CD8 T-lymphocyte levels but not higher plasma HIV-1 RNA or lower CD4 T-lymphocyte levels. Taking into account estimated duration of HIV-1 infection (P < 0.001), and later Fiebig stages (III-V) (P < 0.001), those with untreated syphilis had higher CD8 T-lymphocyte levels (P = 0.049). Individuals with any syphilis (TPHA-positive), but not untreated syphilis, had higher odds of impaired cognitive performance than those without (P = 0.002). CONCLUSIONS During AHI, individuals with any history of syphilis (TPHA-positive) had poorer cognitive performance than those without syphilis. However, syphilis was not associated with worsened HIV disease measures as described in chronic infection.
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Affiliation(s)
- P Chan
- SEARCH, Thai Red Cross AIDS Research Centre, Bangkok, Thailand
| | - D J Colby
- SEARCH, Thai Red Cross AIDS Research Centre, Bangkok, Thailand
| | - E Kroon
- SEARCH, Thai Red Cross AIDS Research Centre, Bangkok, Thailand
| | - C Sacdalan
- SEARCH, Thai Red Cross AIDS Research Centre, Bangkok, Thailand
| | - S Pinyakorn
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA.,U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | - R Paul
- Missouri Institute of Mental Health, University of Missouri-St Louis, St Louis, MO, USA
| | - M Robb
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA.,U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | - V Valcour
- Memory and Aging Center, Department of Neurology, University of California San Francisco, San Francisco, CA, USA
| | - J Ananworanich
- SEARCH, Thai Red Cross AIDS Research Centre, Bangkok, Thailand.,Department of Global Health, University of Amsterdam, Amsterdam, The Netherlands
| | - C Marra
- Department of Neurology, University of Washington, Seattle, WA, USA
| | - S Spudich
- Department of Neurology, Yale University School of Medicine, New Haven, CT, USA
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Kanguya T, Vinkoor M, Sharma A, van Wyk S, Paul R, Mayeya J, Murray LK, Sikazwe I, Kane JC. Mental Health Comorbidity In HIV-positive Zambian Adults Who Consume Alcohol. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa165.688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Alcohol abuse is common in Zambia and a growing threat to achieving the 90 90 90 treatment target to ending the HIV epidemic. Brief counselling is offered but has limited effectiveness possibly because it does not address the mental health issues that underpin drinking behavior. We assessed the frequency and nature of comorbid mental health issues in HIV-positive drinkers in Zambia.
Methods
As part of an ongoing randomized control trial (NCT03966885), we recruited HIV positive adults on ART who reported at least 1 alcoholic drink in the previous 3 months from two clinics in Lusaka, Zambia. Using audio computer assisted self-interviewers, we captured demographic information and screened for unhealthy alcohol use (AUDIT), depression (CES-D), trauma (HTQ) and other substance abuse (ASSIST). These instruments have previously been validated in Zambia. Established cut-offs were used to define unhealthy alcohol use (AU), depression (DEP), post-traumatic stress disorder (PTSD) and substance abuse (SU).
Results
Among 300 individuals reporting any alcohol use, 165 agreed to screening. 155 participants were recruited, including 93 men and 62 women. Nearly all screened 146 (94.2%) had unhealthy alcohol use and 9 (5.8%) had low to moderate alcohol scores. Comorbid mental health issues were present in 72 % of unhealthy drinkers, most commonly depression 46 (31.5 %) and trauma 35 (24 %). Non-alcohol substance use (7.6 %) comorbidities where less prevalent than mental health comorbidities among those with unhealthy alcohol use.
Conclusions
Among urban Zambian adults living with HIV who reported alcohol consumption at their ART clinic, unhealthy use was the norm; moderate alcohol use was rare. Comorbid mental health issues (particularly depression and trauma) are highly prevalent among unhealthy drinkers with HIV. These data suggest that all unhealthy drinkers should be screened for mental health issues.
Key messages
Alcohol Abuse In HIV Patients Is Common In Zambia. HIV Patients Abusing Alcohol Suffer From Depression and Trauma.
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Affiliation(s)
- T Kanguya
- Centre For Infectious Disease Research In Zambia, Lusaka, Zambia
| | - M Vinkoor
- Centre For Infectious Disease Research In Zambia, Lusaka, Zambia
- John Hopkins University, USA
- University of Alabama at Birmingham, USA
| | - A Sharma
- Centre For Infectious Disease Research In Zambia, Lusaka, Zambia
| | | | - R Paul
- University of Zambia, Zambia, Zambia
| | - J Mayeya
- Zambian Ministry of Health, Zambia, Zambia
| | | | - I Sikazwe
- Centre For Infectious Disease Research In Zambia, Lusaka, Zambia
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Larosa M, Morel N, Belhocine M, Ruffatti A, Silva NM, Paul R, Mouthon L, Dreyfus M, Piette JC, Souchaud-Debouverie O, Deneux-Tharaux C, Tsatsaris V, Pannier E, Guettrot Imbert G, Le Guern V, Doria A, Costedoat-Chalumeau N. THU0275 SEVERE PREECLAMPSIA RELATED TO ANTIPHOSPHOLIPID SYNDROME: AN EUROPEAN STUDY OF 40 WOMEN. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.5901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:One of the 3 features of obstetrical antiphospholipid syndrome (APS) is severe preeclampsia (PE). Its time of occurrence, the associated risk of thromboses and systemic lupus erythematosus (SLE) have not been reported yet.Objectives:We analyzed severe PE in a series of women with APS.Methods:We retrospectively collected data of female patients from 5 French internal medicine and 1 Italian rheumatology units. Inclusion criteria were: a severe PE/eclampsia(1), that occurred before 34 weeks of gestation (WG) in patients who met the APS classification criteria(2).Results:40 patients were enrolled (Table 1). Because of known APS/positive aPL/previous obstetrical complications, 23(57.5%) patients were treated during the index PE: 4 with low dose aspirin (LDA), 4 with low molecular weight heparin (LMWH), and 15 with a combination of both. 7 patients were also treated with hydroxychloroquine, 8 with corticosteroids and 3 with immunosuppressants. 17(42.5%) patients received no treatment. 24(60%) live births were observed. During a follow-up period of 3 years, 26(65%) patients had at least 1 new pregnancy, with a total of 38 pregnancies which resulted in 33(86.8%) live births. 57.5% pregnancies who resulted in live births occurred without any maternal or fetal complications. All 26 patients who had at least 1 pregnancy after index PE were treated with LDA; LMWH was given at prophylactic and therapeutic dosage in 13(50%) patients, respectively. No patient experienced 3 consecutive miscarriages.Table 1.40 APS patients with severe PEOverall features (n, %)Patients40 (100)Age at PE, (median, IQR)30.5 (27-33)PE term, WG (median, IQR)25.5 (23-29) Live births24 (60) Birth term, WG (median, IQR)25.5 (23.7-30.3) Associated SLE12 (30)Maternal complications (n, %)25 (62.5) HELLP18 (45) E6 (15) CAPS3 (7.5) Placental abruptions3 (7.5)Fetal complications (n, %)31 (77.5) IUGR18 (45) IUFD11 (2.5) Preterm delivery22 (55)Obstetrical history (n, %) Primiparous21 (52.5) Index PE before APS12 (30)Thrombosis (n, %) Thrombosis before PE index14 (35.0) Thrombosis after PE index2 (5.0)Abs at APS diagnosis (n, %) aPL triple positivity21 (52.5) IgG/IgM anti-cardiolipin34 (85.0) IgG/IgM anti-β2GPI25 (62.5) LAC33 (82.5)Legend to Table 1:PE: preeclampsia; APS: antiphospholipid syndrome; IQR: interquartile range; WG: weeks of gestation; SLE: systemic lupus erythematosus; HELLP: Hemolysis, elevated liver enzymes, low platelet; E: eclampsia; CAPS: catastrophic APS; IUGR: intrauterine growth restriction; IUFD: intrauterine fetal death; CHB: congenital atrioventricular block; aPL: antiphospholipid antibodies; LAC: lupus anticoagulant.Conclusion:Among the APS criteria, “3 consecutive miscarriages criterion” was not found. The majority of patients also experienced thrombosis and SLE before the index PE.References:[1]Diagnosis and Management of preeclampsia and eclampsia. International Journal of Gynecology &Obestetrics 2002;77:67-75.[2]Miyakis S, et al. International consensus statement on an update of the classification criteria for definite antiphospholipid syndrome (APS). J Thromb Haemost 2006;4:295e 306.Disclosure of Interests:Maddalena Larosa: None declared, Nathalie Morel: None declared, Meriem BELHOCINE: None declared, Amelia Ruffatti: None declared, Nicolas Martin Silva: None declared, Romain Paul: None declared, Luc Mouthon: None declared, Michel DREYFUS: None declared, Jean-Charles PIETTE: None declared, Odile Souchaud-Debouverie: None declared, Catherine Deneux-Tharaux: None declared, Vassilis Tsatsaris: None declared, Emmanuelle Pannier: None declared, Gaêlle Guettrot Imbert: None declared, Véronique LE GUERN Grant/research support from: UCB for GR2 study (to our institution), Andrea Doria Consultant of: GSK, Pfizer, Abbvie, Novartis, Ely Lilly, Speakers bureau: UCB pharma, GSK, Pfizer, Janssen, Abbvie, Novartis, Ely Lilly, BMS, Nathalie Costedoat-Chalumeau Grant/research support from: UCB to my institution
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Burnside M, Lewis D, Crocket H, Wilson R, Williman J, Jefferies C, Paul R, Wheeler BJ, de Bock M. CREATE (Community deRivEd AutomaTEd insulin delivery) trial. Randomised parallel arm open label clinical trial comparing automated insulin delivery using a mobile controller (AnyDANA-loop) with an open-source algorithm with sensor augmented pump therapy in type 1 diabetes. J Diabetes Metab Disord 2020; 19:1615-1629. [PMID: 32837953 PMCID: PMC7261211 DOI: 10.1007/s40200-020-00547-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 05/16/2020] [Indexed: 01/22/2023]
Abstract
Background Commercialised automated insulin delivery (AID) systems have demonstrated improved outcomes in type 1 diabetes (T1D), however, they have limited capacity for algorithm individualisation, and can be prohibitively expensive if an individual is without access to health insurance or health funding subsidy. Freely available open-source algorithms, which have the ability to individualise algorithm parameters paired with commercial insulin pumps, and continuous glucose monitoring make up the so-called "do it yourself" (DIY) approach to AID. Limited data on the open-source approach have shown promising results, but data from a large randomised control trial are lacking. Methods The CREATE (Community deRivEd AutomaTEd insulin delivery) trial is an open-labelled, randomised, parallel 24-week, multi-site trial comparing sensor augmented pump therapy (SAPT) to our AnyDANA-loop. The three components of AnyDANA-loop are: 1) OpenAPS algorithm implemented in a smartphone (a version of AndroidAPS), 2) DANA-i™ insulin pump and, 3) Dexcom G6R continuous glucose monitor (CGM). The primary outcome measure is the percentage of time in target sensor glucose range (3.9 -10mmol/L). Secondary outcomes include psycho-social factors and platform performance. Analysis of online collective learning, characteristic of the open-source approach, is planned. 100 participants with T1D aged 7 - 70 years (age stratified into children/adolescents 7-15 years and adults 16-70 years), will be recruited from four sites in New Zealand. A 24-week continuation phase follows, to assess long-term safety.
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Affiliation(s)
- M Burnside
- Department of Paediatrics, University of Otago, 2 Riccarton Avenue, Christchurch, 8011 New Zealand.,Paediatric Department, Canterbury District Health Board, Christchurch, New Zealand.,Endocrinology Department, Canterbury District Health Board, Christchurch, New Zealand
| | | | - H Crocket
- Te Huataki Waiora School of Health, Sport & Human Performance, University of Waikato, Hamilton, New Zealand
| | - R Wilson
- Department of Paediatrics, University of Otago, 2 Riccarton Avenue, Christchurch, 8011 New Zealand
| | - J Williman
- Department of Population Health, University of Otago, Christchurch, New Zealand
| | - C Jefferies
- Department of Paediatric Endocrinology, Starship Children's Hospital, Auckland District Health Board, Auckland, New Zealand.,Liggins Institute, University of Auckland, Auckland, New Zealand
| | - R Paul
- Waikato Regional Diabetes Service, Waikato District Health Board, Hamilton, New Zealand.,Waikato Medical Research Centre, University of Waikato, Hamilton, New Zealand
| | - B J Wheeler
- Department of Women's and Children's Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand.,Paediatric Department, Southern District Health Board, Dunedin, New Zealand
| | - Martin de Bock
- Department of Paediatrics, University of Otago, 2 Riccarton Avenue, Christchurch, 8011 New Zealand.,Paediatric Department, Canterbury District Health Board, Christchurch, New Zealand.,Endocrinology Department, Canterbury District Health Board, Christchurch, New Zealand
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Iyengar A, Paul R, Vasudevan A. SUN-084 Assessment of malnutrition and protein energy wasting (PEW) in Indian children with chronic kidney disease(CKD). Kidney Int Rep 2020. [DOI: 10.1016/j.ekir.2020.02.610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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18
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Harbtn DN, Amleh A, Bernes A, Bodzian F, Boyer K, Conaway J, Dias H, Dommarco R, Duverney-Pret P, Earnest S, Ely D, Fornarelli L, Förster R, Gentry G, Görlitz G, Gomez F, Guess P, Hähnchen K, Hamilton D, Halley M, Hathaway M, Hickes H, Isono K, Kulinna H, Lucas P, Manger P, Manso L, Moffett S, Müller T, Orii T, Paul R, Reubke K, Rivera L, Rubbiani M, Schetter J, Schulz D, Shaocong L, Smead F, Tam K, Tengler H, Torma L, del Valle M, Verweij A, Walls G, Weiping G. Quantitation of Tebuconazole in Liquid and Solid Formulations by Capillary GC: Collaborative Study. J AOAC Int 2020. [DOI: 10.1093/jaoac/80.4.703] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
A capillary gas chromatographic method has been developed for quantitation of tebuconazole (Folicur, Elite, Raxil, Lynx) in liquid and solid formulations. Tebuconazole is a broad-spectrum, systemic foliar fungicide used to control diseases of wheat, barley, peanut, and grasses grown for seed. Samples are dissolved in acetone and analyzed by capillary gas chromatography (GC) with dicyclohexyl phthalate as internal standard. Twenty-two laboratories from 11 countries participated in a collaborative study of the method. Each collaborator was provided reference standard, internal standard, and blind duplicate samples from 6 formulations: aqueous flowable (F), aqueous emulsifiable concentrate (EW), emulsifiable concentrate for seed treatment (ES), flowable for seed treatment (FS), wettable powder (WP), and dry flowable (DF). Collaborators were instructed to use peak area measurements for quantitation. The seed treatment flowable formulation required confirmation of accurate integration values by the collaborator. Relative standard deviation values for reproducibility (RSDR) for analysis of the formulations were as follows: 3.6 lb/gal F, 1.22; 250 g/L EW, 1.13; 15 g/L ES, 2.40; 25 g/L FS, 2.65; 25% WP, 0.96; 25% DF, 0.72; 45% DF, 0.72. The capillary GC method for quantitation of tebuconazole in fungicide formulations has been adopted first action by AOAC INTERNATIONAL.
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Affiliation(s)
- Donald N Harbtn
- Bayer Corporation, Agriculture Division, PO Box 4913, 8400 Hawthorne Rd, Kansas City, MO 64120-0013
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19
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Mitchell B, Laws E, Paul R, Vasan S, Kroon E, Valcour V, Spudich S, Shikuma C, Ananworanich J, Ndhlovu L. A modified TZM-bl assay (MoCo-TZA) documents replication-competent HIV in circulating monocytes despite 2 years of antiretroviral therapy initiated early during acute infection. J Virus Erad 2019. [DOI: 10.1016/s2055-6640(20)30167-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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20
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Nongrum S, Singh VA, Paul R, Karnik S, Mehta S, Bera SS. A Study about Co-Infection of Fungal Pathogens in Active Tuberculosis Patients. Mymensingh Med J 2019; 28:920-924. [PMID: 31599261] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The diagnosis of mycotic lung infection in pulmonary TB patients remains misdiagnosed because of its non-specific clinical manifestations which mimics the symptoms of TB. Physicians have to rely on the investigation but as radiology and pathology cannot probe the appropriate diagnosis, conventional microbiology or PCR testing continue as an essential mode for the diagnosis. In developing country like India PCR is not cost effective. Thus, Direct microscopy by KOH (10%), Gram's staining & Culture remains only option for identification. A three-year cross-sectional study was carried out in the Department of Microbiology, Maharishi Markandeshwar Institute of Medical Science & Research, Mullana, India from August 2015 to August 2018. On 300 LED positive sputum samples collected from previously treated cases of pulmonary TB. Early morning sputum was collected and subjected to KOH 10%, Gram's staining afterwards cultured on Sabouraud Dextrose Agar and species identification was done by LPCB preparation. In 300 LED smear positive samples, the dominant pathogens were C. albicans (43.3%), followed by C. non-albicans (26.7%), A. fumigatus (21.7%) etc. ATT administration for 5-8 months' duration of illness showed highest fungal infection (45%) and maximum growth of fungus was seen in the Autumn season (45%). The co-occurrence of fungi with tubercle bacteria adds fatal consequences thus routine screening is recommended for proper diagnosis and early treatment of mycotic infection in the patients of Pulmonary TB on ATT.
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Affiliation(s)
- S Nongrum
- Sumi Nongrum, Tutor/ Demonstrator, Department of Microbiology, Maharishi Markandeshwar Institute of Medical Science & Research (MMIMSR), Maharishi Markandeshwar Deemed to be University (MMDU), Mullana, Ambala, Haryana, India
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Sreedharan SE, Sayed JV, Vipina V, Mohan M, Paul R, Sylaja P. Post stroke dysphagia and disability in minor strokes. J Neurol Sci 2019. [DOI: 10.1016/j.jns.2019.10.442] [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: 11/29/2022]
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22
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Paul R, Prasanna MV, Gantayat RR, Singh MK. Groundwater quality assessment in Jirania Block, west district of Tripura, India, using hydrogeochemical fingerprints. SN Appl Sci 2019. [DOI: 10.1007/s42452-019-1092-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
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23
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Paul R, Hu SX, Karasiev VV. Anharmonic and Anomalous Trends in the High-Pressure Phase Diagram of Silicon. Phys Rev Lett 2019; 122:125701. [PMID: 30978067 DOI: 10.1103/physrevlett.122.125701] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Indexed: 06/09/2023]
Abstract
A multifaceted first-principles approach utilizing density functional theory, evolutionary algorithms, and lattice dynamics was used to construct the phase diagram of silicon up to 4 TPa and 26 000 K. These calculations predicted that (i) an anomalous sequence of face-centered cubic to body-centered cubic to simple cubic crystalline phase transitions occur at pressures of 2.87 and 3.89 TPa, respectively, along the cold curve, (ii) the orthorhombic phases of Imma and Cmce-16 appear on the phase diagram only when the anharmonic contribution to the Gibbs free energy is taken into account, and (iii) a substantial change in the slope of the principal Hugoniot is observed if the anharmonic free energy of the cubic diamond phase is considered.
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Affiliation(s)
- R Paul
- Laboratory for Laser Energetics, University of Rochester, Rochester, New York 14623, USA
| | - S X Hu
- Laboratory for Laser Energetics, University of Rochester, Rochester, New York 14623, USA
| | - V V Karasiev
- Laboratory for Laser Energetics, University of Rochester, Rochester, New York 14623, USA
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Kumar R, Daga G, Paul R. Evaluation of specimen mammogram and frozen section in intraoperative margin assessment of breast conservation surgery. Breast 2019. [DOI: 10.1016/s0960-9776(19)30391-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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25
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Paul R, Tsanaclis L, Murray C, Boroujerdi R, Facer L, Corbin A. Ethyl Glucuronide as a Long-term Alcohol Biomarker in Fingernail and Hair. Matrix Comparison and Evaluation of Gender Bias. Alcohol Alcohol 2019; 54:402-407. [DOI: 10.1093/alcalc/agz015] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 02/04/2019] [Indexed: 11/15/2022] Open
Abstract
Abstract
Aims
This work aimed to assess the performance of hair and fingernail ethyl glucuronide (EtG) measurement for use as a biomarker of alcohol consumption in persons with known drinking history across a range of drinking behaviours.
Methods
EtG concentrations were assessed from the hair and fingernails of 50 study participants. Alcohol consumption of the previous 90 days was assessed by participant interview using the alcohol timeline follow-back method. EtG concentration was determined using LC–MS-MS using a method which was validated and accredited to ISO/IEC 17025 standards.
Results
There was significant correlation between alcohol consumption and EtG concentrations found in hair and fingernail samples across the study group (n = 50). From participants testing positive for EtG (male n = 14, female n = 13) no significant difference was found between male and female EtG levels in either hair or fingernails. Across all participants there was no significant difference in hair or fingernail EtG concentration between male (n = 23) and females (n = 27).
Conclusions
Our results support the use of EtG to indicate alcohol consumption over the previous 90 days, or ~3 months as is the normal practice in hair analysis. The results confirm that fingernails can be a useful alternative matrix where hair samples are not available.
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Affiliation(s)
- R Paul
- Bournemouth University, Faculty of Science and Technology, Talbot Campus, Fern Barrow, Poole, UK
| | - L Tsanaclis
- Cansford Laboratories, Pentwyn Business Centre, 1A Wharfedale Road, Cardiff, UK
| | - C Murray
- Bournemouth University, Faculty of Science and Technology, Talbot Campus, Fern Barrow, Poole, UK
| | - R Boroujerdi
- Bournemouth University, Faculty of Science and Technology, Talbot Campus, Fern Barrow, Poole, UK
| | - L Facer
- Bournemouth University, Faculty of Science and Technology, Talbot Campus, Fern Barrow, Poole, UK
| | - A Corbin
- Bournemouth University, Faculty of Science and Technology, Talbot Campus, Fern Barrow, Poole, UK
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Paul R, Solzak JP, Radovich M. Abstract P3-06-05: Whole genome sequence analysis of 77 breast cancer patients reveal increased somatic transposable element insertions responsible for early onset of cancer. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p3-06-05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
More than 50% of the human genome consists of transposable elements (TE). However only certain classes of retrotransposons (ALU, SVA, ERV and L1) are believed to be active. They transpose using an RNA intermediate causing target-site duplications along with a poly-A tail. They can also insert into intronic regions and disrupt normal transcription of protein-coding genes. However, most TEs are repressed using various epigenetic mechanisms such as DNA methylation, histone modifications and RNA silencing. The piRNA pathway also plays an important role in retrotransposon silencing by establishing a repressive chromatin state. In this study, somatic and germline TE insertions in 77 TCGA breast cancer cases were characterized. These studies have revealed that somatic TEs can insert into intronic regions of tumor suppressor genes such as LRP1B, RAD51B and WNK2. Characterization of germline TE insertions, reveal insertions in intronic regions of predisposition genes such as CDH1 and BRCA2. Analysis of germline SNPs in high somatic TE patients reveals the presence of deleterious variants in genes such as NRDE2, RAD51C and DDX3X which are known to regulate TEs using RNA silencing via the piRNA pathway and other DNA-damage response mechanisms. Patients having high somatic TE insertions were found to have lower age of diagnosis suggesting a role in the early onset of cancer (median age of patients with high TE=43.37yrs; low TE=59.77yrs, Wilcoxan p=0.023). Further comparison of somatic TE insertion burden against somatic point-mutation burden revealed an inverse correlation suggesting analysis of TE insertions is indispensable to get the complete mutation profile of breast cancer genomes.
Citation Format: Paul R, Solzak JP, Radovich M. Whole genome sequence analysis of 77 breast cancer patients reveal increased somatic transposable element insertions responsible for early onset of cancer [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P3-06-05.
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Affiliation(s)
- R Paul
- Indiana University Purdue University Indianapolis, Indianapolis, IN
| | - JP Solzak
- Indiana University Purdue University Indianapolis, Indianapolis, IN
| | - M Radovich
- Indiana University Purdue University Indianapolis, Indianapolis, IN
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Motalab M, Paul R, Saha S, Mojumder S, Ahmed T, Suhling JC. Atomistic analysis of the thermomechanical properties of Sn-Ag-Cu solder materials at the nanoscale with the MEAM potential. J Mol Model 2019; 25:59. [PMID: 30741336 DOI: 10.1007/s00894-019-3939-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Accepted: 01/24/2019] [Indexed: 10/27/2022]
Abstract
Sn-Ag-Cu, commonly known as SAC, is considered to be among the most promising of all lead-free solder alloys. Research aimed at making electronic components smaller has pointed to the possible use of nanosized solder joints in the future. In this study, for the first time, molecular dynamics simulations were used to analyze the thermomechanical properties of SAC solder materials at the nanoscale. The modified embedded-atom method (MEAM) potential was utilized in the simulations of the SAC solder materials. The dimensions of the structures considered were 55 × 55 × 59 Å. Four different SAC solders were studied, with Ag percentages ranging from 1% to 4% (SAC105, SAC205, SAC305, and SAC405). Thus, the effects of the Ag percentage on the thermomechanical properties of the solder at the nanoscale were identified. The impacts of the temperature on the uniaxial tensile properties and coefficient of thermal expansion (CTE) values of the SAC solder materials were investigated by performing simulations of the materials at different temperatures. Results suggest that as the Ag percentage increases, the uniaxial tensile strength and CTE of the solder increase whereas the failure strain and thermal conductivity decrease. The results presented should prove useful in the electronic packaging industry.
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Affiliation(s)
- M Motalab
- Department of Mechanical Engineering, Bangladesh University of Engineering and Technology, Dhaka, 1000, Bangladesh
| | - R Paul
- Department of Mechanical Engineering, Bangladesh University of Engineering and Technology, Dhaka, 1000, Bangladesh
| | - S Saha
- Department of Mechanical Engineering, Bangladesh University of Engineering and Technology, Dhaka, 1000, Bangladesh.
| | - S Mojumder
- Department of Mechanical Engineering, Bangladesh University of Engineering and Technology, Dhaka, 1000, Bangladesh
| | - T Ahmed
- Department of Mechanical Engineering, Bangladesh University of Engineering and Technology, Dhaka, 1000, Bangladesh
| | - J C Suhling
- Department of Mechanical Engineering, Auburn University, Auburn, AL, 36849, USA
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Chaudhury N, Paul R, Misra R, Chaudhuri SS, Mirza S, Sen S. Evaluating the Trends of Bloodstream Infections by Nonfermenting Gram Negative Bacilli among the Patients in a Tertiary Care Hospital of Western Part of India and its Antibiogram. ACTA ACUST UNITED AC 2019. [DOI: 10.20546/ijcmas.2019.801.121] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Zeal C, Paul R, Maddipati R, Madden T. Associations between women’s self-reported influences on contraceptive decision and race. Contraception 2018. [DOI: 10.1016/j.contraception.2018.07.064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Zeal C, Paul R, Maddipati R, Madden T. Self-reported influences on contraceptive decision making differ by desired contraceptive method. Contraception 2018. [DOI: 10.1016/j.contraception.2018.07.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Basu S, Sutradhar S, Paul R. Substrate stiffness and mechanical stress due to intercellular cooperativity guides tissue structure. J Theor Biol 2018; 457:124-136. [PMID: 30144408 DOI: 10.1016/j.jtbi.2018.08.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Revised: 07/30/2018] [Accepted: 08/01/2018] [Indexed: 12/31/2022]
Abstract
A key challenge in cell and tissue morphogenesis is to understand how a crucial balance between cell proliferation and apoptosis maintains an evolving tissue structure. These processes are mutually non-exclusive and require stiffness monitoring of the host substrate. Adhered cells actively mechanosense the tension in the extracellular matrix (ECM). They collectively alter self-organization and generate a host of tissue patterns. Using an in silico elastic fiber-network in two dimensions, we simulate cell-ECM composite structures and characterize features of the emerging tissue patterns during successive cell proliferation and apoptosis. Our data reveals that, in general, cell viability is a function of the cell-induced effective ECM stiffness supported by intercellular cooperativity. Translating this into a remodeling tissue, we find that average cell cycle duration in concert with the locally stressed regions of the ECM promote heterogeneous proliferation and apoptosis inducing finger-like protrusions along the tissue periphery - a feature normally observed during tumorigenesis. Further, we find that recovery of a scratch wound is delayed for cells harbored on a compliant or (and) in a highly collagen depleted ECM.
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Affiliation(s)
- S Basu
- Department of Solid State Physics, Indian Association for the Cultivation of Science, 2A & 2B Raja S. C. Mullick Road, Kolkata, West Bengal 700032, India.
| | - S Sutradhar
- Department of Solid State Physics, Indian Association for the Cultivation of Science, 2A & 2B Raja S. C. Mullick Road, Kolkata, West Bengal 700032, India; Department of Molecular Biophysics and Biochemistry, Yale University, New Haven, CT 06511, USA.
| | - R Paul
- Department of Solid State Physics, Indian Association for the Cultivation of Science, 2A & 2B Raja S. C. Mullick Road, Kolkata, West Bengal 700032, India.
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Abstract
Aims The Walch Type C dysplastic glenoid is characterized by excessive retroversion. This anatomical study describes its morphology. Patients and Methods A total of 29 shoulders with a dysplastic glenoid were analyzed. CT was used to measure retroversion, inclination, height, width, radius-of-curvature, surface area, depth, subluxation of the humeral head and the Goutallier classification of fatty infiltration. The severity of dysplasia and deficiency of the posterior rim of the glenoid were recorded. Results A type C glenoid occurred in 1.8% of shoulders referred to our tertiary centres. The mean retroversion, inclination, height, width, radius-of-curvature, surface area, and depth of the glenoid were 37°, 3°, 46 mm, 30 mm, 37°, 1284 mm3, and 16 mm, respectively. The mean posterior subluxation was 90%. The Goutallier class was < 2 in 25 shoulders (86%). Glenoid dysplasia was mild in four, moderate in 14, and severe in 11 shoulders. The typical appearance of the posterior glenoid rim had a rounded or ‘lazy J’ morphology. The glenoid neck was deficient in 18 shoulders (62%). Conclusion A dysplastic Type C glenoid characteristically has a uniconcave retroverted morphology, a deficient posteroinferior rim and scapular neck, and a reduced depth. These findings help to define the unique anatomical variations and may aid the planning of surgery and the development of components for these patients. Cite this article: Bone Joint J 2018;100-B:1074–9.
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Affiliation(s)
- R. Paul
- The Roth McFarlane Hand and Upper Limb
Center, University of Western Ontario, London, Ontario, Canada
| | - N. Knowles
- Department of Mechanical and Materials
Engineering, University of Western Ontario
| | - J. Chaoui
- IMT Atlantique, and VP Software Strategy,Wright
Medical, Plouzane, France
| | - M-O. Gauci
- Institut Universitaire Locomoteur et du
Sport, Nice, France
| | - L. Ferreira
- Department of Mechanical and Materials
Engineering, University of Western Ontario
| | - G. Walch
- Ramsay Générale de Santé, Hôpital Privé
Jean Mermoz, Centre Orthopédique Santy, Lyon, France
| | - G. S. Athwal
- St Joseph’s Health Care London, London, Ontario, Canada
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Chaudhury N, Paul R, Misra RN, Mirza S, Chaudhuri SS, Sen S. Emerging importance of acinetobacter and its antibiogram in the recent era. APJHS 2018; 5:25-32. [DOI: 10.21276/apjhs.2018.5.2.7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/19/2023]
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Abstract
Thromboembolic complications remain as one of the main problems for blood contacting artificial organs such as heart valves, bloodpumps and others. In vitro evaluation of thrombogenesis in prototypes has not previously been part of the standard evaluation of these devices. In comparison to hemolysis testing, evaluation of the thrombogenic potential is more difficult to perform because of the complexity of the blood coagulation system. We present an in vitro testing procedure that allows the accelerated examination of the thrombogenic potential of different types of blood pumps. Additionally, first results are presented that indicate the reliability of the accelerated clotting test for mechanical heart valves. Results for the centrifugal pump BioMedicus and two microaxial pumps have shown typical thrombus formation at locations such as bearings. The results indicate that the accelerated clotting test is an excellent addition to the much more expensive animal testing of artificial organs or assist devices. In vitro testing permits studies of thrombus formation to be performed at an early stage and at low costs and also facilitates a more precise investigation of device areas known to be potential hot spots for thrombus formation.
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Affiliation(s)
- R. Paul
- Helmholtz-Institute for Biomedical Engineering, Aachen - Germany
| | - O. Marseille
- Helmholtz-Institute for Biomedical Engineering, Aachen - Germany
| | - E. Hintze
- Helmholtz-Institute for Biomedical Engineering, Aachen - Germany
| | - L. Huber
- Second Department of Surgery, LBI of Cardiac Surgery, Vienna - Austria
| | - H. Schima
- Second Department of Surgery, LBI of Cardiac Surgery, Vienna - Austria
| | - H. Reul
- Helmholtz-Institute for Biomedical Engineering, Aachen - Germany
| | - G. Rau
- Helmholtz-Institute for Biomedical Engineering, Aachen - Germany
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Zimmer R, Steegers A, Paul R, Affeld K, Reul H. Velocities, Shear Stresses and Blood Damage Potential of the Leakage Jets of the Medtronic Parallel™ Bileaflet Valve. Int J Artif Organs 2018. [DOI: 10.1177/039139880002300107] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- R. Zimmer
- Charité - Humboldt University, Biofluidmechanics Laboratory, Berlin
| | - A. Steegers
- Helmholtz-Institute for Biomedical Engineering, Aachen - Germany
| | - R. Paul
- Helmholtz-Institute for Biomedical Engineering, Aachen - Germany
| | - K. Affeld
- Charité - Humboldt University, Biofluidmechanics Laboratory, Berlin
| | - H. Reul
- Helmholtz-Institute for Biomedical Engineering, Aachen - Germany
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Paul R, Solzak JP, Chen YH, Hancock BA, Radovich M. Abstract P3-04-10: Analysis of somatic transposable element insertions in a breast cancer genome. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p3-04-10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Introduction: More than 50% of the human genome consists of transposable elements (TE). However most TEs are inactive and remain relatively stable among different human populations. However, some classes of retrotransposons consisting of Alu, SVA, ERV and L1s are active and believe to be involved in cancer. Commonly used bioinformatics pipelines of whole genome sequencing (WGS) data do not currently analyze for somatic TE insertions, and maybe missing an important class of somatic mutations. As a proof-of-concept, we analyzed the HCC1143 triple-negative breast cancer cell line along with a matched normal control to analyze for the presence of somatic TEs.
Methods: WGS data of the HCC1143 cell line along with the matched lymphoblastoid control cell line, HCC1143BL, were downloaded from the NCI GDC Commons. We used discordant read-pair (only one paired-end read matches to the reference genome) and split-read (part of a read matches to the reference) analysis to detect novel somatic TE insertion sites in genes known to play important roles in cancer proliferation.
Results: Most TE insertions are heterogenous in nature such that they insert only in a small subset of the cells. Therefore by comparing the number of split reads and discordant reads to the total number of reads the heterogenity of the insertion can be inserted. The discordant and split read analysis revealed about 30 high confidence hits. A subset of the high confidence hits were validated experimentally using PCR amplification and gel electrophoresis. About 85% of the hits were successfully validated. A subset of the validated hits known to be relevant to breast cancer have been shown in Table 1.
Table 1 - Validated somatic TE insertion locations in HCC1143 cell lineGeneFunctionChromosome numberStart positionStop position% heterogeneity in tumor line = (split_reads + discordant_reads)*2 / total_reads% heterogeneity in blood line = (split_reads + discordant_reads)*2 / total_readsPBRM1Chromatin remodeling352662648526635501001.1GLIS3Overexpressed in TNBC/involved in Wnt pathway942369794237291402.5XPR1Receptor of murine leukemia viruses1180857399180857714253.2CSMD1Tumor suppressor gene84452610445304323.520TMEM181Involved in tamoxifen response61590532671590538254.710
Discussion: Using the approach described above, we were able to detect somatic TEs within several genes known to be involved in cancer. PBRM1, a gene involved in chromatin remodeling, was found to have several exons replaced with a TE insert. Other genes such as CSMD1 is a known tumor suppressor gene, and TMEM181 which is involved in tamoxifen response. These results suggest that TE insertions may be involved in cancer biology. Therefore, TE insert prediction can serve as useful biomarkers for early detection and have precision medicine implications in the treatment of breast cancer. Analyses in additional breast cancer patient genomes is currently underway.
Citation Format: Paul R, Solzak JP, Chen Y-H, Hancock BA, Radovich M. Analysis of somatic transposable element insertions in a breast cancer genome [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P3-04-10.
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Affiliation(s)
- R Paul
- Indiana University, Indianapolis, IN
| | - JP Solzak
- Indiana University, Indianapolis, IN
| | - Y-H Chen
- Indiana University, Indianapolis, IN
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Solzak J, Hancock B, Paul R, Radovich M. Abstract P1-10-03: Precision therapeutic combinations are synergistic against triple negative breast cancer using compensatory pathways. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p1-10-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Introduction: Triple negative breast cancer (TNBC) accounts for 15% of all breast cancer cases in the United States, and despite its lower incidence, contributes to a disproportionately higher rate of morbidity and mortality compared to other breast cancer subtypes. In an effort to treat TNBC, a cancer that has no targeted therapies, many have chosen to experiment with combinations of drugs that are chosen for their genomic expression or “hard targets”. It has been previously noted however, that single agent therapeutics can change the genomic landscape of both mice and human cells and may be responsible for resistance. Here we show that targeting a compensatory pathway after treatment with a single therapy, results in synergistic combinations and can outperform the choice of hard target therapies.
Methods: Eight TNBC cell lines were chosen based on their abundance of clinically actionable targets. The primary hard target combinations were chosen using data from TCGA and a board consisting of oncologists and researchers at Indiana University School of Medicine. Compensatory therapies were found using RNA sequencing data from untreated versus single therapeutic treated TNBC cell lines. The merged transcript RPKMs were transformed and analyzed for differential expression. Statistically significant genes were imported into Ingenuity Pathway Analysis (IPA) to identify either therapeutics or genomic targets using the Causal network analysis and Upstream regulator functions. All drug combinations were tested in their respective cell lines and cell viability was assessed via Celltiter-Fluor. Synergy of the combinations was calculated using the Chou-Talalay method.
Results: Using genomically chosen hard targets for drug combinations, all eight cell lines displayed additive or antagonistic results except low nanomolar doses for the MDA-MB-231 cell line. Dosing of MDA-MB-231s with Debrafinib and Pazopanib however, turned highly antagonistic as dosing increased. Using next-generation RNA sequencing data of TNBCs, IPA analysis identified several compensatory targets for each cell line when treated with one of the primary genomically driven drug at its IC50. Using dose escalation of the new drugs with a single hard target drug, we found that each compensatory combination displayed a striking increase in synergy across all TNBC cell lines treated when compared to their original hard target combination.
Conclusion: RNA sequencing of TNBC cells lines treated with single therapies chosen by actionable genomic landscape has revealed compensatory pathways, indicating further druggable targets. These compensatory pathways have been observed to more efficacious in treating TNBC cell lines. Using therapeutics that are either FDA approved or in clinical trials we have found that each compensatory combination shows a higher level of synergy across all cell lines. These data show that choosing a secondary therapy based on compensatory pathways may outperform hard target combinations in the clinic.
Citation Format: Solzak J, Hancock B, Paul R, Radovich M. Precision therapeutic combinations are synergistic against triple negative breast cancer using compensatory pathways [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P1-10-03.
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Affiliation(s)
- J Solzak
- Indiana University School of Medicine, Indianapolis, IN
| | - B Hancock
- Indiana University School of Medicine, Indianapolis, IN
| | - R Paul
- Indiana University School of Medicine, Indianapolis, IN
| | - M Radovich
- Indiana University School of Medicine, Indianapolis, IN
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Dumitrascu C, Paul R, Kingston R, Williams R. Influence of alcohol containing and alcohol free cosmetics on FAEE concentrations in hair. A performance evaluation of ethyl palmitate as sole marker, versus the sum of four FAEEs. Forensic Sci Int 2018; 283:29-34. [DOI: 10.1016/j.forsciint.2017.12.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Revised: 11/30/2017] [Accepted: 12/02/2017] [Indexed: 10/18/2022]
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Abstract
We present a comprehensive Monte Carlo study of domain growth in the random-bond XY model with nonconserved kinetics. The presence of quenched disorder slows down domain growth in d=2,3. In d=2, we observe power-law growth with a disorder-dependent exponent on the time scales of our simulation. In d=3, we see the signature of an asymptotically logarithmic growth regime. The scaling functions for the real-space correlation function are seen to be independent of the disorder. However, the same does not apply for the two-time autocorrelation function, demonstrating the breakdown of superuniversality.
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Affiliation(s)
- M Kumar
- School of Physical Sciences, Jawaharlal Nehru University, New Delhi-110067, India
| | - S Chatterjee
- Indian Association for the Cultivation of Science, Kolkata-700032, India
| | - R Paul
- Indian Association for the Cultivation of Science, Kolkata-700032, India
| | - S Puri
- School of Physical Sciences, Jawaharlal Nehru University, New Delhi-110067, India
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Chaurasia R, Thresiamma KC, Eapen CK, Zachariah BJ, Paul R, Sritharan M. Pathogen-specific leptospiral proteins in urine of patients with febrile illness aids in differential diagnosis of leptospirosis from dengue. Eur J Clin Microbiol Infect Dis 2018; 37:423-433. [PMID: 29332210 DOI: 10.1007/s10096-018-3187-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [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: 11/21/2017] [Accepted: 01/05/2018] [Indexed: 01/19/2023]
Abstract
Leptospirosis and dengue are two commonly seen infectious diseases of the tropics. Differential diagnosis of leptospirosis from dengue fever is often difficult due to overlapping clinical symptoms and lack of economically viable and easy-to-perform laboratory tests. The gold standard for diagnosis is the microscopic agglutination test (MAT). In this study, the diagnostic potential of screening for pathogen-specific leptospiral antigens in urine samples is presented as a non-invasive method of disease diagnosis. In a study group of 40 patients, the serum was tested for anti-leptospiral antibodies by MAT and enzyme-linked immunosorbent assay (ELISA). Urine of these patients was screened for leptospiral antigens by ELISA using specific antibodies against LipL32, LipL41, Fla1, HbpA and sphingomyelinase. Group I patients (n = 23) were classified as leptospirosis-positive based on MAT and high titres of circulating IgM-specific anti-leptospiral antibodies. All of these patients excreted all five leptospiral antigens in the urine. The 17 MAT-negative cases included six patients with pyrexia of unknown origin (PUO; Group II) and 11 confirmed dengue patients (Group III). The latter tested negative for both serum anti-leptospiral antibodies and urinary leptospiral antigens. A salient outcome of this study was highlighting the usefulness of screening for urinary leptospiral antigens in disease diagnosis, as their presence confirmed leptospiral aetiology in two PUO patients. Immunoblots of urinary antigens identified well-defined bands corresponding to LipL32, HbpA and sphingomyelinase; the significance of the 42- and 58-kDa sphingomyelinase bands is discussed.
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Affiliation(s)
- R Chaurasia
- Department of Animal Biology, School of Life Sciences, University of Hyderabad, Prof. CR Rao Road, Gachibowli, Hyderabad, 500 046, India
| | - K C Thresiamma
- Departments of Biochemistry and Medicine, MOSC Medical College, Kerala, India
| | - C K Eapen
- Departments of Biochemistry and Medicine, MOSC Medical College, Kerala, India
| | - B J Zachariah
- Departments of Biochemistry and Medicine, MOSC Medical College, Kerala, India
| | - R Paul
- Departments of Biochemistry and Medicine, MOSC Medical College, Kerala, India
| | - M Sritharan
- Department of Animal Biology, School of Life Sciences, University of Hyderabad, Prof. CR Rao Road, Gachibowli, Hyderabad, 500 046, India.
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Samba T, Bhat P, Owiti P, Samuels L, Kanneh PJ, Paul R, Kargbo B, Harries AD. Non-communicable diseases in the Western Area District, Sierra Leone, before and during the Ebola outbreak. Public Health Action 2017; 7:S16-S21. [PMID: 28744434 PMCID: PMC5515558 DOI: 10.5588/pha.16.0086] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Accepted: 11/26/2016] [Indexed: 12/22/2022] Open
Abstract
Setting: Twenty-seven peripheral health units, five secondary hospitals and one tertiary hospital, Western Area District, Sierra Leone. Objectives: To describe reporting systems, monthly attendances and facility-based patterns of six non-communicable diseases (NCDs) in the pre-Ebola and Ebola virus disease outbreak periods. Design: A cross-sectional study using programme data. Results: Reporting was 89% complete on the six selected NCDs pre-Ebola and 86% during the Ebola outbreak (P < 0.01). Overall, marked declining trends in NCDs were reported during the Ebola period, with a monthly mean of 342 cases pre-Ebola and 164 during the Ebola outbreak. The monthly mean number of cases per disease in the pre-Ebola and Ebola outbreak periods was respectively 228 vs. 85 for hypertension, 43 vs. 27 for cardiovascular diseases, 36 vs. 18 for diabetes and 25 vs. 29 for peptic ulcer disease; this last condition increased during the outbreak. There were higher proportions of NCDs among females during the Ebola outbreak compared with the pre-Ebola period. Except for peptic ulcer disease, the number of patients with NCDs declined by 25% in peripheral health units, 91% in the secondary hospitals and 70% in the tertiary hospital between the pre-Ebola and the Ebola outbreak periods. Conclusion: Comprehensive reporting of NCDs was suboptimal, and declined during the Ebola epidemic. There were decreases in reported attendances for NCDs between the pre-Ebola and the Ebola outbreak periods, which were even more marked in the hospitals. This study has important policy implications.
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Affiliation(s)
- T Samba
- Western Area District Health Management Team, Ministry of Health and Sanitation (MoHS), Freetown, Sierra Leone
| | - P Bhat
- Ministry of Health, Government of Karnataka, Bengaluru, India
| | - P Owiti
- Academic Model Providing Access to Health Care (AMPATH), Eldoret, Kenya
- International Union Against Tuberculosis and Lung Disease, Paris, France
| | - L Samuels
- Western Area District Health Management Team, Ministry of Health and Sanitation (MoHS), Freetown, Sierra Leone
| | - P J Kanneh
- Western Area District Health Management Team, Ministry of Health and Sanitation (MoHS), Freetown, Sierra Leone
| | - R Paul
- Western Area District Health Management Team, Ministry of Health and Sanitation (MoHS), Freetown, Sierra Leone
| | | | - A D Harries
- International Union Against Tuberculosis and Lung Disease, Paris, France
- London School of Hygiene & Tropical Medicine, London, UK
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Gupta N, Giblin E, Leagre C, Longmire-Cook S, Tigges T, Compton J, Dugan T, liebross R, Givens S, Schmidt K, Paul R, Trivedi R, Smith B, Reeves D, Hanson J, Schmidt T. Abstract P5-16-12: Pertuzumab and trastuzumab in combination with weekly paclitaxel delivers high pCR rates with favourable toxicity profile in neo-adjuvant treatment of Her-2 positive breast cancer. Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-p5-16-12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
This abstract was not presented at the symposium.
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Affiliation(s)
- N Gupta
- St. Vincent Cancer Care, St Vincent Hospital, Indianapolis, IN
| | - E Giblin
- St. Vincent Cancer Care, St Vincent Hospital, Indianapolis, IN
| | - C Leagre
- St. Vincent Cancer Care, St Vincent Hospital, Indianapolis, IN
| | - S Longmire-Cook
- St. Vincent Cancer Care, St Vincent Hospital, Indianapolis, IN
| | - T Tigges
- St. Vincent Cancer Care, St Vincent Hospital, Indianapolis, IN
| | - J Compton
- St. Vincent Cancer Care, St Vincent Hospital, Indianapolis, IN
| | - T Dugan
- St. Vincent Cancer Care, St Vincent Hospital, Indianapolis, IN
| | - R liebross
- St. Vincent Cancer Care, St Vincent Hospital, Indianapolis, IN
| | - S Givens
- St. Vincent Cancer Care, St Vincent Hospital, Indianapolis, IN
| | - K Schmidt
- St. Vincent Cancer Care, St Vincent Hospital, Indianapolis, IN
| | - R Paul
- St. Vincent Cancer Care, St Vincent Hospital, Indianapolis, IN
| | - R Trivedi
- St. Vincent Cancer Care, St Vincent Hospital, Indianapolis, IN
| | - B Smith
- St. Vincent Cancer Care, St Vincent Hospital, Indianapolis, IN
| | - D Reeves
- St. Vincent Cancer Care, St Vincent Hospital, Indianapolis, IN
| | - J Hanson
- St. Vincent Cancer Care, St Vincent Hospital, Indianapolis, IN
| | - T Schmidt
- St. Vincent Cancer Care, St Vincent Hospital, Indianapolis, IN
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Rössel T, Paul R, Richter T, Ludwig S, Hofmockel T, Heller AR, Koch T. [Management of anesthesia in endovascular interventions]. Anaesthesist 2016; 65:891-910. [PMID: 27900415 DOI: 10.1007/s00101-016-0241-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Cardiovascular diseases are one of the leading causes of morbidity and mortality in Germany. In these patients, the high-risk profile necessitates an interdisciplinary and multimodal approach to treatment. Endovascular interventions and vascular surgery have become established as an important element of this strategy in the past; however, the different anatomical localizations of pathological vascular alterations make it necessary to use a wide spectrum of procedural options and methods; therefore, the requirements for management of anesthesia are variable and necessitate a differentiated approach. Endovascular procedures can be carried out with the patient under general or regional anesthesia (RA); however, in the currently available literature there is no evidence for an advantage of RA over general anesthesia regarding morbidity and mortality, although a reduction in pulmonary complications could be found for some endovascular interventions. Epidural and spinal RA procedures should be carefully considered with respect to the risk-benefit ratio and consideration of the recent guidelines on anesthesia against the background of the current study situation and the regular use of therapy with anticoagulants. The following article elucidates the specific characteristics of anesthesia management as exemplified by some selected endovascular interventions.
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Affiliation(s)
- T Rössel
- Klinik für Anästhesiologie und Intensivmedizin, TU Dresden, Fetscherstr. 74, 01307, Dresden, Deutschland.
| | - R Paul
- Klinik für Anästhesiologie und Intensivmedizin, TU Dresden, Fetscherstr. 74, 01307, Dresden, Deutschland
| | - T Richter
- Klinik für Anästhesiologie und Intensivmedizin, TU Dresden, Fetscherstr. 74, 01307, Dresden, Deutschland
| | - S Ludwig
- Klinik für Viszeral-, Thorax- und Gefäßchirurgie, TU Dresden, Dresden, Deutschland
| | - T Hofmockel
- Institut und Poliklinik für Radiologische Diagnostik, TU Dresden, Dresden, Deutschland
| | - A R Heller
- Klinik für Anästhesiologie und Intensivmedizin, TU Dresden, Fetscherstr. 74, 01307, Dresden, Deutschland
| | - T Koch
- Klinik für Anästhesiologie und Intensivmedizin, TU Dresden, Fetscherstr. 74, 01307, Dresden, Deutschland
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MacQuillan EL, Curtis AB, Baker KM, Paul R, Back YO. Using GIS Mapping to Target Public Health Interventions: Examining Birth Outcomes Across GIS Techniques. J Community Health 2016; 42:633-638. [DOI: 10.1007/s10900-016-0298-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Mullen M, Paul R, Frisse A, Wan L, Camaryn CR. Who matters most in postpartum birth control counseling? Evaluating the credible sources. Contraception 2016. [DOI: 10.1016/j.contraception.2016.07.118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Paul R, Hamshaw E, Gray H, Koch P, Contento I, Fullilove R. #eatingoodtonight: Capitalizing on Retrievable Data from Social Media Platforms for Nutrition Researchers and Practitioners. J Acad Nutr Diet 2016. [DOI: 10.1016/j.jand.2016.06.237] [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: 11/28/2022]
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Monteserin J, Paul R, Lopez B, Cnockaert M, Tortoli E, Menéndez C, García MJ, Palomino JC, Vandamme P, Ritacco V, Martin A. Combined approach to the identification of clinically infrequent non-tuberculous mycobacteria in Argentina. Int J Tuberc Lung Dis 2016; 20:1257-62. [DOI: 10.5588/ijtld.16.0122] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Katebi L, Paul R, Gray H, Contento I, Koch P. College Students’ Motivators and Barriers of Participating in Local Food Systems. J Acad Nutr Diet 2016. [DOI: 10.1016/j.jand.2016.06.149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Datta AK, Mandal A, Das D, Gupta S, Saha A, Paul R, Sengupta S. B CHROMOSOMES IN ANGIOSPERM--A REVIEW. Tsitol Genet 2016; 50:68-79. [PMID: 27266187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
A review article on B chromosomes (Bs) in angiosperms is documented considering occurrence, morphology, polymorphic B forms, divisional phase heterogeneity, chromatin organization and gene content, sequence composition, origin, evolutionary aspects and significant role on host with an objective to foresee the evolutionary perspectives as it still remains an enigma. Irrespective of the origin of Bs, it seems that they have attained the following modifications, namely, insertion of centromeric and telomeric sequences, structural reorganization and procuring mitotic and meiotic drives but shows genetic inertness and present in the host as selfish DNA. In the context, few questions are raised. Further, scientific quest may unravel the unexplored information about Bs to ascertain its evolutionary perspectives, if any.
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