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Ellsworth SG, Ross A, Shiue K, Murthy P, Patel RB, Zellars RC, Miller AC, Russ KA, Lotze M. Influence of Radiation Fractionation on Immune Repertoire Diversity in Solid Tumor Patients. Int J Radiat Oncol Biol Phys 2023; 117:S157. [PMID: 37784394 DOI: 10.1016/j.ijrobp.2023.06.582] [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) Radiation (RT)-induced lymphopenia (RIL) occurs in up to 75% of patients undergoing RT and is associated with worse tumor control and survival across a spectrum of solid tumors. Patients undergoing hypofractionated RT are at lower risk of RIL compared with patients treated with more prolonged RT courses. However, it is unknown whether immune repertoire diversity is similarly affected by fractionation scheme in patients undergoing RT. This prospective study analyzed RT-induced changes in immune repertoire diversity in patients treated with conventionally (CFRT) vs hypofractionated RT (HFRT). MATERIALS/METHODS RNA-based T and B cell receptor sequencing was performed on peripheral lymphocytes collected prospectively before RT and within 4 weeks of the last RT fraction from 23 patients (18 men, 5 women, median age 67 y) with primary solid tumors undergoing CFRT (≤3 Gy/day x ≥10 days, n = 13) or HFRT (≥5 Gy/day x ≤5 days, n = 10). Absolute lymphocyte counts (ALC; cells/μL) were obtained from clinical laboratory data. The number of unique CDR3 receptors (uCDR3) and Shannon entropy were used to monitor changes in T (TCR Vβ) and B (BCR IgH) receptor diversity. RESULTS ALC decreased after RT in 90% (20/22) of patients (mean pre-RT ALC 1830 vs 1040 post-RT, p <0.001). Mean % ALC loss was greater in CFRT vs HFRT patients (44.3 vs. 35.2%). After RT, entropy in IgH and Vβ decreased in 18/23 (78%) and 17/23 (74%) patients, respectively; uCDR3 in IgH and Vβ decreased in 14/23 (61%) and 15/23 (65%). Among patients with concordant decreases in ALC and uCDR3, a moderate correlation between magnitude of ALC loss and uCDR3 levels in the T-cell receptor Vβ was observed (r = 0.64, p = 0.02). For both receptor species studied (IgH and Vβ), HFRT patients were more likely to have an increase in either entropy or uCDR3 in the face of decreased ALC (36 vs 15%, X2 p = 0.03). Furthermore, while decreases in entropy were observed among the CFRT patients for both IgH (median entropy 10.4 vs 9.4, p = 0.06) and Vβ (9.7 vs 8.1, p = 0.02), entropy did not significantly change following RT in the HFRT patients (IgH 10.6 vs 10.4, p = 0.74 and Vβ 10.9 vs 10.8, p = 0.24). CONCLUSION RT-induced changes in immune repertoire diversity are variably reflected in the peripheral ALC. Both HFRT and CFRT depleted circulating lymphocytes, but patients undergoing HFRT were more likely to experience increases in T and B cell diversity metrics despite lymphopenia. It is therefore possible that relative sparing of repertoire diversity among patients undergoing HFRT could increase the likelihood of tumor antigen recognition by peripheral blood lymphocytes. As immune repertoire diversity is associated with the likelihood of response to immunotherapy, these findings also have implications for RT-immunotherapy combinations. Further study is required to understand the relationship between RT exposure to circulating lymphocyte populations and immune repertoire diversity.
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Affiliation(s)
- S G Ellsworth
- Department of Radiation Oncology, UPMC Hillman Cancer Center, Pittsburgh, PA
| | - A Ross
- University of Pittsburgh, Pittsburgh, PA
| | - K Shiue
- Department of Radiation Oncology, Indiana University School of Medicine, Indianapolis, IN
| | - P Murthy
- University of Pittsburgh Hillman Cancer Center, Pittsburgh, PA
| | - R B Patel
- UPMC Hillman Cancer Center, Pittsburgh, PA
| | - R C Zellars
- Indiana University Department of Radiation Oncology, Indianapolis, IN
| | | | - K A Russ
- Indiana University School of Medicine, Indianapolis, IN
| | - M Lotze
- University of Pittsburgh Hillman Cancer Center, Pittsburgh, PA
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Koerner SA, Rajkumar H, Edinger R, Lalonde RJ, Patel RB. Combination Immunotherapy with Partial Versus Whole Tumor Radiotherapy in a Preclinical Melanoma Tumor Model. Int J Radiat Oncol Biol Phys 2023; 117:e241. [PMID: 37784952 DOI: 10.1016/j.ijrobp.2023.06.1169] [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) Partial tumor radiotherapy (PTRT) with immune checkpoint inhibition (ICI) is currently the subject of clinical trials and may be used clinically for large volume tumors when the full gross tumor volume (GTV) cannot be safely treated with full dose. PTRT delivers RT to a portion of the GTV, underdosing or not treating the remainder of the GTV, hypothesizing that ICI-mediated tumor infiltrating lymphocyte (TIL) infiltration will produce adequate disease control in un- or under-irradiated GTV. Standard treatment is whole tumor radiotherapy (WTRT), and potential differences in disease control between PTRT and WTRT with ICI have not been robustly assessed. We hypothesized that PTRT with ICI and WTRT with ICI will demonstrate similar tumor regression, and both RT regimens will demonstrate superior tumor regression as compared to ICI alone. MATERIALS/METHODS B78 melanoma flank tumors were generated in C57B/L6 mice, with randomization at tumor size of 1 cm to experimental cohorts of PTRT + ICI and WTRT + ICI and control groups of no RT ± ICI. Custom lead shields were fabricated to deliver 16 Gy single fraction PTRT (50% tumor treatment) and WTRT, with dosimetry confirmation via radiochromic film. ICI was delivered through I.P. injection of murine anti-CTLA4 and anti-PD-L1 at days 0, 3, and 6 post-RT. Tumor regression was assessed via differences in tumor volume at ten days post completion of ICI, and mean cohort tumor volumes were compared with ANOVA (α <0.05). Variances between individual cohorts were assessed via t-test (α <0.05). RESULTS Treatment cohorts demonstrated significant variance in tumor volume at ten days following treatment completion (p = 0.007, Table 1). WTRT + ICI demonstrated superior tumor regression when compared to PTRT + ICI (p = 0.006), ICI alone (p = 0.002), and control cohorts (p = 0.013). There was no difference in tumor regression between PTRT + ICI and ICI alone (p = 0.709), and PTRT + ICI did not achieve significant regression when compared to control (p = 0.083). Tumor regression did not differ between cohorts receiving no RT ± ICI (p = 0.103). CONCLUSION Our results in this ICI resistant melanoma model demonstrated superior tumor regression with WTRT + ICI as compared to PTRT + ICI and ICI alone, suggesting that even with concurrent ICI, PTRT may not be sufficient treatment for melanoma. PTRT + ICI tumor regression was similar to ICI alone, suggesting that PTRT may not overcome immune resistance in the unirradiated tumor volume. Further investigation of optimal RT regimens to potentiate ICI response is warranted and correlative studies examining spatial immunomodulation in unirradiated and irradiated portions of the same tumor are underway.
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Affiliation(s)
- S A Koerner
- Department of Radiation Oncology, UPMC Hillman Cancer Center, Pittsburgh, PA
| | - H Rajkumar
- University of Pittsburgh, Pittsburgh, PA
| | - R Edinger
- University of Pittsburgh, Pittsburgh, PA
| | | | - R B Patel
- UPMC Hillman Cancer Center, Pittsburgh, PA
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Qin K, Honjo K, Sherrill-Mix S, Liu W, Stoltz RM, Oman AK, Hall LA, Li R, Sterrett S, Frederick ER, Lancaster JR, Narkhede M, Mehta A, Ogunsile FJ, Patel RB, Ketas TJ, Cruz Portillo VM, Cupo A, Larimer BM, Bansal A, Goepfert PA, Hahn BH, Davis RS. Exposure of progressive immune dysfunction by SARS-CoV-2 mRNA vaccination in patients with chronic lymphocytic leukemia: A prospective cohort study. PLoS Med 2023; 20:e1004157. [PMID: 37384638 PMCID: PMC10309642 DOI: 10.1371/journal.pmed.1004157] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 05/31/2023] [Indexed: 07/01/2023] Open
Abstract
BACKGROUND Patients with chronic lymphocytic leukemia (CLL) have reduced seroconversion rates and lower binding antibody (Ab) and neutralizing antibody (NAb) titers than healthy individuals following Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) mRNA vaccination. Here, we dissected vaccine-mediated humoral and cellular responses to understand the mechanisms underlying CLL-induced immune dysfunction. METHODS AND FINDINGS We performed a prospective observational study in SARS-CoV-2 infection-naïve CLL patients (n = 95) and healthy controls (n = 30) who were vaccinated between December 2020 and June 2021. Sixty-one CLL patients and 27 healthy controls received 2 doses of the Pfizer-BioNTech BNT162b2 vaccine, while 34 CLL patients and 3 healthy controls received 2 doses of the Moderna mRNA-1273 vaccine. The median time to analysis was 38 days (IQR, 27 to 83) for CLL patients and 36 days (IQR, 28 to 57) for healthy controls. Testing plasma samples for SARS-CoV-2 anti-spike and receptor-binding domain Abs by enzyme-linked immunosorbent assay (ELISA), we found that all healthy controls seroconverted to both antigens, while CLL patients had lower response rates (68% and 54%) as well as lower median titers (23-fold and 30-fold; both p < 0.001). Similarly, NAb responses against the then prevalent D614G and Delta SARS-CoV-2 variants were detected in 97% and 93% of controls, respectively, but in only 42% and 38% of CLL patients, who also exhibited >23-fold and >17-fold lower median NAb titers (both p < 0.001). Interestingly, 26% of CLL patients failed to develop NAbs but had high-titer binding Abs that preferentially reacted with the S2 subunit of the SARS-CoV-2 spike. Since these patients were also seropositive for endemic human coronaviruses (HCoVs), these responses likely reflect cross-reactive HCoV Abs rather than vaccine-induced de novo responses. CLL disease status, advanced Rai stage (III-IV), elevated serum beta-2 microglobulin levels (β2m >2.4 mg/L), prior therapy, anti-CD20 immunotherapy (<12 months), and intravenous immunoglobulin (IVIg) prophylaxis were all predictive of an inability to mount SARS-CoV-2 NAbs (all p ≤ 0.03). T cell response rates determined for a subset of participants were 2.8-fold lower for CLL patients compared to healthy controls (0.05, 95% CI 0.01 to 0.27, p < 0.001), with reduced intracellular IFNγ staining (p = 0.03) and effector polyfunctionality (p < 0.001) observed in CD4+ but not in CD8+ T cells. Surprisingly, in treatment-naïve CLL patients, BNT162b2 vaccination was identified as an independent negative risk factor for NAb generation (5.8, 95% CI 1.6 to 27, p = 0.006). CLL patients who received mRNA-1273 had 12-fold higher (p < 0.001) NAb titers and 1.7-fold higher (6.5, 95% CI 1.3 to 32, p = 0.02) response rates than BNT162b2 vaccinees despite similar disease characteristics. The absence of detectable NAbs in CLL patients was associated with reduced naïve CD4+ T cells (p = 0.03) and increased CD8+ effector memory T cells (p = 0.006). Limitations of the study were that not all participants were subjected to the same immune analyses and that pre-vaccination samples were not available. CONCLUSIONS CLL pathogenesis is characterized by a progressive loss of adaptive immune functions, including in most treatment-naïve patients, with preexisting memory being preserved longer than the capacity to mount responses to new antigens. In addition, higher NAb titers and response rates identify mRNA-1273 as a superior vaccine for CLL patients.
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Affiliation(s)
- Kai Qin
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Kazuhito Honjo
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Scott Sherrill-Mix
- Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Weimin Liu
- Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Regina M. Stoltz
- Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Allisa K. Oman
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Lucinda A. Hall
- Department of Radiology, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Ran Li
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Sarah Sterrett
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Ellen R. Frederick
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Jeffrey R. Lancaster
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Mayur Narkhede
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
- O’Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Amitkumar Mehta
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
- O’Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Foluso J. Ogunsile
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Rima B. Patel
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Thomas J. Ketas
- Department of Microbiology and Immunology, Weill Medical College of Cornell University, New York, New York, United States of America
| | - Victor M. Cruz Portillo
- Department of Microbiology and Immunology, Weill Medical College of Cornell University, New York, New York, United States of America
| | - Albert Cupo
- Department of Microbiology and Immunology, Weill Medical College of Cornell University, New York, New York, United States of America
| | - Benjamin M. Larimer
- Department of Radiology, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
- O’Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Anju Bansal
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
- O’Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Paul A. Goepfert
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
- O’Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
- Department of Microbiology, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Beatrice H. Hahn
- Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
- Department of Microbiology, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Randall S. Davis
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
- O’Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
- Department of Microbiology, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
- Department of Biochemistry and Molecular Genetics, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
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Mitchell JP, Carter I, Christopher JD, Copley M, Doub WH, Goodey A, Gruenloh CJ, Larson BB, Lyapustina S, Patel RB, Stein SW, Suman JD. Good Practices for the Laboratory Performance Testing of Aqueous Oral Inhaled Products (OIPs): an Assessment from the International Pharmaceutical Aerosol Consortium on Regulation and Science (IPAC-RS). AAPS PharmSciTech 2023; 24:73. [PMID: 36869256 DOI: 10.1208/s12249-023-02528-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 02/06/2023] [Indexed: 03/05/2023] Open
Abstract
Multiple sources must be consulted to determine the most appropriate procedures for the laboratory-based performance evaluation of aqueous oral inhaled products (OIPs) for the primary measures, dose uniformity/delivery, and aerodynamic particle (droplet) size distribution (APSD). These sources have been developed at different times, mainly in Europe and North America, during the past 25 years by diverse organizations, including pharmacopeial chapter/monograph development committees, regulatory agencies, and national and international standards bodies. As a result, there is a lack of consistency across all the recommendations, with the potential to cause confusion to those developing performance test methods. We have reviewed key methodological aspects of source guidance documents identified by a survey of the pertinent literature and evaluated the underlying evidence supporting their recommendations for the evaluation of these performance measures. We have also subsequently developed a consistent series of solutions to guide those faced with the various associated challenges when developing OIP performance testing methods for oral aqueous inhaled products.
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Affiliation(s)
- Jolyon P Mitchell
- Jolyon Mitchell Inhaler Consulting Services Inc., 1154 St. Anthony Road, London, Ontario, N6H2R1, Canada.
| | - I Carter
- PPD Inc., Part of Thermo Fisher Scientific, Athlone, Ireland
| | | | - M Copley
- Copley Scientific Ltd., Nottingham, UK
| | - W H Doub
- OINDP In Vitro Analysis, Kirkwood, Missouri, 63122, USA
| | - A Goodey
- Merck & Co. Inc., Kenilworth, New Jersey, 07033, USA
| | - C J Gruenloh
- PPD Inc., Part of Thermo Fisher Scientific, Middleton, Wisconsin, 53562-466, USA
| | - B B Larson
- PPD Inc., Part of Thermo Fisher Scientific, Middleton, Wisconsin, 53562-466, USA
| | - S Lyapustina
- Faegre Drinker Biddle & Reath LLP, Washington, District of Columbia, 20005, USA
| | - R B Patel
- Intellectual Designs LLC, Brookfield, Connecticut, 06804, USA
| | - S W Stein
- Kindeva Drug Delivery, Woodbury, Minnesota, 55129, USA
| | - J D Suman
- Next Breath LLC, a Division of Aptar Group, Halethorpe, Maryland, 21227, USA
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5
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Qin K, Honjo K, Sherrill-Mix S, Liu W, Stoltz R, Oman AK, Hall LA, Li R, Sterrett S, Frederick ER, Lancaster JR, Narkhede M, Mehta A, Ogunsile FJ, Patel RB, Ketas TJ, Cruz Portillo VM, Cupo A, Larimer BM, Bansal A, Goepfert PA, Hahn BH, Davis RS. SARS-CoV-2 mRNA vaccination exposes progressive adaptive immune dysfunction in patients with chronic lymphocytic leukemia. medRxiv 2022:2022.12.19.22283645. [PMID: 36597532 PMCID: PMC9810225 DOI: 10.1101/2022.12.19.22283645] [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] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Chronic lymphocytic leukemia (CLL) patients have lower seroconversion rates and antibody titers following SARS-CoV-2 vaccination, but the reasons for this diminished response are poorly understood. Here, we studied humoral and cellular responses in 95 CLL patients and 30 healthy controls after two BNT162b2 or mRNA-2173 mRNA immunizations. We found that 42% of CLL vaccinees developed SARS-CoV-2-specific binding and neutralizing antibodies (NAbs), while 32% had no response. Interestingly, 26% were seropositive, but had no detectable NAbs, suggesting the maintenance of pre-existing endemic human coronavirus-specific antibodies that cross-react with the S2 domain of the SARS-CoV-2 spike. These individuals had more advanced disease. In treatment-naïve CLL patients, mRNA-2173 induced 12-fold higher NAb titers and 1.7-fold higher response rates than BNT162b2. These data reveal a graded loss of immune function, with pre-existing memory being preserved longer than the capacity to respond to new antigens, and identify mRNA-2173 as a superior vaccine for CLL patients.
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Affiliation(s)
- Kai Qin
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL 35294, USA,These authors contributed equally
| | - Kazuhito Honjo
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL 35294, USA,These authors contributed equally
| | - Scott Sherrill-Mix
- Department of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA,These authors contributed equally
| | - Weimin Liu
- Department of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA,These authors contributed equally
| | - Regina Stoltz
- Department of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA,These authors contributed equally
| | - Allisa K. Oman
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Lucinda A. Hall
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Ran Li
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Sarah Sterrett
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Ellen R. Frederick
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Jeffrey R. Lancaster
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Mayur Narkhede
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL 35294, USA,O’Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Amitkumar Mehta
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL 35294, USA,O’Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Foluso J. Ogunsile
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Rima B. Patel
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Thomas J. Ketas
- Department of Microbiology and Immunology, Weill Medical College of Cornell University, New York, NY 10065, USA
| | - Victor M Cruz Portillo
- Department of Microbiology and Immunology, Weill Medical College of Cornell University, New York, NY 10065, USA
| | - Albert Cupo
- Department of Microbiology and Immunology, Weill Medical College of Cornell University, New York, NY 10065, USA
| | - Benjamin M. Larimer
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL 35294, USA,O’Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Anju Bansal
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL 35294, USA,O’Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Paul A. Goepfert
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL 35294, USA,O’Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL 35294, USA,Department of Microbiology, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Beatrice H. Hahn
- Department of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA,Department of Microbiology, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Randall S. Davis
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL 35294, USA,O’Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL 35294, USA,Department of Microbiology, University of Alabama at Birmingham, Birmingham, AL 35294, USA,Department of Biochemistry & Molecular Genetics, University of Alabama at Birmingham, Birmingham, AL 35294, USA,Lead Contact,Correspondence: (R.S.D.)
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Casasanta NA, Shah N, Troy K, Edwards C, Patel RB. Presentation of concurrent thrombotic thrombocytopenic purpura and Graves' disease. Blood Coagul Fibrinolysis 2022; 33:422-424. [PMID: 35867945 DOI: 10.1097/mbc.0000000000001154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Thrombotic thrombocytopenic purpura (TTP) is a type of thrombotic microangiopathy caused by deficient activity of ADAMTS13 that most commonly occurs secondary to an acquired autoantibody. There are limited data on the association between TTP and autoimmune thyroid disease. We present a case of acquired TTP in the setting of thyrotoxicosis from Graves' disease. Our patient improved with standard treatment of both TTP and thyrotoxicosis. A retrospective review of patients with TTP at our institution demonstrated that 32% had another autoimmune disorder, highlighting the concept of polyautoimmunity. These findings suggest an association between TTP and uncontrolled autoimmune disease. In patients with newly diagnosed TTP, physicians should evaluate for other autoimmune diseases and check thyroid function tests.
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Affiliation(s)
| | - Nirali Shah
- Division of Endocrinology, Diabetes, and Bone Disease
| | - Kevin Troy
- Division of Hematology and Oncology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Colleen Edwards
- Division of Hematology and Oncology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Rima B Patel
- Division of Hematology and Oncology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Sempere-Llagostera S, Thekkadath GS, Patel RB, Kolthammer WS, Walmsley IA. Reducing g (2)(0) of a parametric down-conversion source via photon-number resolution with superconducting nanowire detectors. Opt Express 2022; 30:3138-3147. [PMID: 35209439 DOI: 10.1364/oe.450172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 01/06/2022] [Indexed: 06/14/2023]
Abstract
Multiphoton contributions pose a significant challenge for the realisation of heralded single-photon sources (HSPS) based on nonlinear processes. In this work, we improve the quality of single photons generated in this way by harnessing the photon-number resolving (PNR) capabilities of commercial superconducting nanowire single-photon detectors (SNSPDs). We report a 13 ± 0.4% reduction of g(2)(τ = 0), even with a collection efficiency in the photon source of only 29.6%. Our work demonstrates the first application of the PNR capabilities of SNSPDs and shows improvement in the quality of an HSPS with widely available technology.
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8
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Thekkadath GS, Bell BA, Patel RB, Kim MS, Walmsley IA. Measuring the Joint Spectral Mode of Photon Pairs Using Intensity Interferometry. Phys Rev Lett 2022; 128:023601. [PMID: 35089759 DOI: 10.1103/physrevlett.128.023601] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 10/12/2021] [Accepted: 12/22/2021] [Indexed: 05/14/2023]
Abstract
The ability to manipulate and measure the time-frequency structure of quantum light is useful for information processing and metrology. Measuring this structure is also important when developing quantum light sources with high modal purity that can interfere with other independent sources. Here, we present and experimentally demonstrate a scheme based on intensity interferometry to measure the joint spectral mode of photon pairs produced by spontaneous parametric down-conversion. We observe correlations in the spectral phase of the photons due to chirp in the pump. We show that our scheme can be combined with stimulated emission tomography to quickly measure their mode using bright classical light. Our scheme does not require phase stability, nonlinearities, or spectral shaping and thus is an experimentally simple way of measuring the modal structure of quantum light.
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Affiliation(s)
- G S Thekkadath
- Department of Physics, Imperial College London, Prince Consort Road, London SW7 2AZ, United Kingdom
- National Research Council of Canada, 100 Sussex Drive, Ottawa, K1A 0R6, Canada
| | - B A Bell
- Department of Physics, Imperial College London, Prince Consort Road, London SW7 2AZ, United Kingdom
| | - R B Patel
- Department of Physics, Imperial College London, Prince Consort Road, London SW7 2AZ, United Kingdom
- Clarendon Laboratory, University of Oxford, Parks Road, Oxford, OX1 3PU, United Kingdom
| | - M S Kim
- Department of Physics, Imperial College London, Prince Consort Road, London SW7 2AZ, United Kingdom
| | - I A Walmsley
- Department of Physics, Imperial College London, Prince Consort Road, London SW7 2AZ, United Kingdom
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9
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Thekkadath GS, Sempere-Llagostera S, Bell BA, Patel RB, Kim MS, Walmsley IA. Single-shot discrimination of coherent states beyond the standard quantum limit. Opt Lett 2021; 46:2565-2568. [PMID: 34061057 DOI: 10.1364/ol.421646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 04/13/2021] [Indexed: 06/12/2023]
Abstract
The discrimination of coherent states is a key task in optical communication and quantum key distribution protocols. In this work, we use a photon-number-resolving detector, the transition-edge sensor, to discriminate binary-phase-shifted coherent states at a telecom wavelength. Owing to its dynamic range and high efficiency, we achieve a bit error probability that unconditionally exceeds the standard quantum limit (SQL) by up to 7.7 dB. The improvement to the SQL persists for signals containing up to approximately seven photons on average and is achieved in a single shot (i.e., without measurement feedback), thus making our approach compatible with larger bandwidths.
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10
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Thekkadath GS, Mycroft ME, Bell BA, Wade CG, Eckstein A, Phillips DS, Patel RB, Buraczewski A, Lita AE, Gerrits T, Nam SW, Stobińska M, Lvovsky AI, Walmsley IA. Quantum-enhanced interferometry with large heralded photon-number states. npj Quantum Inf 2020; 6:10.1038/s41534-020-00320-y. [PMID: 34131511 PMCID: PMC8201641 DOI: 10.1038/s41534-020-00320-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Accepted: 09/04/2020] [Indexed: 05/14/2023]
Abstract
Quantum phenomena such as entanglement can improve fundamental limits on the sensitivity of a measurement probe. In optical interferometry, a probe consisting of N entangled photons provides up to aN enhancement in phase sensitivity compared to a classical probe of the same energy. Here, we employ high-gain parametric down-conversion sources and photon-number-resolving detectors to perform interferometry with heralded quantum probes of sizes up to N = 8 (i.e. measuring up to 16-photon coincidences). Our probes are created by injecting heralded photon-number states into an interferometer, and in principle provide quantum-enhanced phase sensitivity even in the presence of significant optical loss. Our work paves the way towards quantum-enhanced interferometry using large entangled photonic states.
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Affiliation(s)
- G S Thekkadath
- Clarendon Laboratory, University of Oxford, Parks Road, Oxford OX1 3PU, UK
| | - M E Mycroft
- Faculty of Physics, University of Warsaw, ul. Pasteura 5, 02-093 Warsaw, Poland
| | - B A Bell
- Clarendon Laboratory, University of Oxford, Parks Road, Oxford OX1 3PU, UK
| | - C G Wade
- Clarendon Laboratory, University of Oxford, Parks Road, Oxford OX1 3PU, UK
| | - A Eckstein
- Clarendon Laboratory, University of Oxford, Parks Road, Oxford OX1 3PU, UK
| | - D S Phillips
- Clarendon Laboratory, University of Oxford, Parks Road, Oxford OX1 3PU, UK
| | - R B Patel
- Clarendon Laboratory, University of Oxford, Parks Road, Oxford OX1 3PU, UK
| | - A Buraczewski
- Faculty of Physics, University of Warsaw, ul. Pasteura 5, 02-093 Warsaw, Poland
| | - A E Lita
- National Institute of Standards and Technology, 325 Broadway, Boulder, Colorado 80305, USA
| | - T Gerrits
- National Institute of Standards and Technology, 325 Broadway, Boulder, Colorado 80305, USA
- National Institute of Standards and Technology, 100 Bureau Drive, Gaithersburg, Maryland 20899, USA
| | - S W Nam
- National Institute of Standards and Technology, 325 Broadway, Boulder, Colorado 80305, USA
| | - M Stobińska
- Faculty of Physics, University of Warsaw, ul. Pasteura 5, 02-093 Warsaw, Poland
| | - A I Lvovsky
- Clarendon Laboratory, University of Oxford, Parks Road, Oxford OX1 3PU, UK
| | - I A Walmsley
- Clarendon Laboratory, University of Oxford, Parks Road, Oxford OX1 3PU, UK
- Department of Physics, Imperial College London, Prince Consort Rd, London SW7 2AZ, UK
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11
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Adam RD, Dahlstrom EW, Martens CA, Bruno DP, Barbian KD, Ricklefs SM, Hernandez MM, Narla NP, Patel RB, Porcella SF, Nash TE. Genome sequencing of Giardia lamblia genotypes A2 and B isolates (DH and GS) and comparative analysis with the genomes of genotypes A1 and E (WB and Pig). Genome Biol Evol 2014; 5:2498-511. [PMID: 24307482 PMCID: PMC3879983 DOI: 10.1093/gbe/evt197] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Giardia lamblia (syn G. intestinalis, G. duodenalis) is the most common pathogenic intestinal parasite of humans worldwide and is a frequent cause of endemic and epidemic diarrhea. G. lamblia is divided into eight genotypes (A-H) which infect a wide range of mammals and humans, but human infections are caused by Genotypes A and B. To unambiguously determine the relationship among genotypes, we sequenced GS and DH (Genotypes B and A2) to high depth coverage and compared the assemblies with the nearly completed WB genome and draft sequencing surveys of Genotypes E (P15; pig isolate) and B (GS; human isolate). Our results identified DH as the smallest Giardia genome sequenced to date, while GS is the largest. Our open reading frame analyses and phylogenetic analyses showed that GS was more distant from the other three genomes than any of the other three were from each other. Whole-genome comparisons of DH_A2 and GS_B with the optically mapped WB_A1 demonstrated substantial synteny across all five chromosomes but also included a number of rearrangements, inversions, and chromosomal translocations that were more common toward the chromosome ends. However, the WB_A1/GS_B alignment demonstrated only about 70% sequence identity across the syntenic regions. Our findings add to information presented in previous reports suggesting that GS is a different species of Giardia as supported by the degree of genomic diversity, coding capacity, heterozygosity, phylogenetic distance, and known biological differences from WB_A1 and other G. lamblia genotypes.
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Affiliation(s)
- Rodney D. Adam
- Departments of Medicine and Immunobiology, University of Arizona College of Medicine
- *Corresponding author: E-mail:
| | - Eric W. Dahlstrom
- Research Technologies Section, Genomics Unit, Rocky Mountain Laboratories, National Institute of Allergy and Infectious Diseases, National Institutes of Health, US Department of Health and Human Services, Hamilton, MT
| | - Craig A. Martens
- Research Technologies Section, Genomics Unit, Rocky Mountain Laboratories, National Institute of Allergy and Infectious Diseases, National Institutes of Health, US Department of Health and Human Services, Hamilton, MT
| | - Daniel P. Bruno
- Research Technologies Section, Genomics Unit, Rocky Mountain Laboratories, National Institute of Allergy and Infectious Diseases, National Institutes of Health, US Department of Health and Human Services, Hamilton, MT
| | - Kent D. Barbian
- Research Technologies Section, Genomics Unit, Rocky Mountain Laboratories, National Institute of Allergy and Infectious Diseases, National Institutes of Health, US Department of Health and Human Services, Hamilton, MT
| | - Stacy M. Ricklefs
- Research Technologies Section, Genomics Unit, Rocky Mountain Laboratories, National Institute of Allergy and Infectious Diseases, National Institutes of Health, US Department of Health and Human Services, Hamilton, MT
| | - Matthew M. Hernandez
- Research Technologies Section, Genomics Unit, Rocky Mountain Laboratories, National Institute of Allergy and Infectious Diseases, National Institutes of Health, US Department of Health and Human Services, Hamilton, MT
| | - Nirmala P. Narla
- Departments of Medicine and Immunobiology, University of Arizona College of Medicine
| | - Rima B. Patel
- Departments of Medicine and Immunobiology, University of Arizona College of Medicine
| | - Stephen F. Porcella
- Research Technologies Section, Genomics Unit, Rocky Mountain Laboratories, National Institute of Allergy and Infectious Diseases, National Institutes of Health, US Department of Health and Human Services, Hamilton, MT
| | - Theodore E. Nash
- Laboratory of Parasitic Diseases, National Institutes of Allergy and Infectious Diseases, NIH, Bethesda, MD
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12
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Joseph JK, Patel RB, Damle AA, Nair N, Badwe RA, Basu S. Functional Radionuclide Imaging, In-Vitro Radioiodine Uptake Estimation and RT-PCR in the Evaluation of Sodium Iodide Symporter (NIS) Expression and Functionality in Breast Cancer: A Pilot Study. Indian J Surg Oncol 2013; 4:80-91. [PMID: 24426705 DOI: 10.1007/s13193-012-0205-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2012] [Accepted: 12/11/2012] [Indexed: 10/27/2022] Open
Abstract
Breast cancer is a common malignancy in females, which is considered as a systemic disease, whose treatment involves combined modality including systemic as well as local treatment. Recent studies have shown that breast cancer also expresses Sodium Iodide Symporter (NIS) gene, like in the thyroid, which is the factor responsible for the uptake of iodide by the thyroid, enabling radioiodine therapy of thyroid disorders. This study aimed to evaluate various radionuclide imaging characteristics, in vitro radioiodine uptake (RAIU) and evaluation of NIS expression by using Reverse Transcriptase-Polymerase Chain Reaction (RT-PCR) to explore sodium iodide symporter (NIS) expression and iodine uptake in breast cancer and to explor e whether radioiodine can be used for the diagnosis and treatment of breast cancer. Ways of differential regulation of NIS expression in breast cancer has also been explored. Female patients with palpable breast lump and histologically proven infiltrating duct carcinoma were taken up for the study, which included 50 females of mean age 49 years. (range: 23-73 years). The patients were categorized into different groups, depending on the type of the study performed. The uptake patterns in various imaging modalities were analyzed and compared with invitro and RT-PCR studies. 68 % of breast cancer cases showed (99m)Tc-pertechnetate uptake at the initial images. This finding could partly be due to tumor vascularity, which is usually higher compared to the normal tissues. The uptake in the delayed imaging could be related to that due to NIS in the breast. Use of perchlorate or stable iodine did not alter the pertechnetate uptake pattern in breast tumor. Good correlation between (99m)Tc-pertechnetate and (99m)Tc-tetrofosmin uptake in breast cancer was demonstrated. In vitro radioactive iodine uptake in the breast tumor was significantly higher than that in the normal breast tissue. Only 42 % of breast tumor samples studied using RT-PCR showed NIS expression. Correlation between (99m)Tc-pertechnetate uptake and NIS expression could not be well established. Further studies with higher dose of radioiodine and/or mechanisms of differentially blocking the thyroid are required to assess the feasibility of radioiodine therapy for breast cancer.
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Affiliation(s)
- J K Joseph
- Radiation Medicine Centre, Bhabha Atomic Research Centre, TATA Memorial Hospital Annexe, Jerbai Wadia Road, Parel, Mumbai, 400 012 India ; Department of Radiotherapy and Oncology, Govt. Medical College, Kottayam, Kerala 686 008 India
| | - R B Patel
- Radiation Medicine Centre, Bhabha Atomic Research Centre, TATA Memorial Hospital Annexe, Jerbai Wadia Road, Parel, Mumbai, 400 012 India
| | - A A Damle
- Radiation Medicine Centre, Bhabha Atomic Research Centre, TATA Memorial Hospital Annexe, Jerbai Wadia Road, Parel, Mumbai, 400 012 India
| | - N Nair
- Radiation Medicine Centre, Bhabha Atomic Research Centre, TATA Memorial Hospital Annexe, Jerbai Wadia Road, Parel, Mumbai, 400 012 India
| | - R A Badwe
- Department of Surgery, Tata Memorial Hospital, Jerbai Wadia Road, Parel, Mumbai, 400 012 India
| | - S Basu
- Radiation Medicine Centre, Bhabha Atomic Research Centre, TATA Memorial Hospital Annexe, Jerbai Wadia Road, Parel, Mumbai, 400 012 India
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Patel RB, Vasava N, Hukkeri S. Non-obstructed femoral hernia containing ascending colon, caecum, appendix and small bowel with concurrent bilateral recurrent inguinal hernia. Hernia 2010; 16:211-3. [PMID: 20835740 DOI: 10.1007/s10029-010-0726-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2010] [Accepted: 08/26/2010] [Indexed: 11/30/2022]
Abstract
Femoral hernias, which are less common than inguinal hernias and more often found in females, occasionally contain more than just small intestine and omentum. Uncommon contents reported in femoral hernia sacs include caecum, appendix, Meckel's diverticulum (Littre hernia), testis, ovary, transverse colon and even stomach or kidney. Strangulation of femoral hernias containing appendix, small intestine and caecum, and Meckel's diverticulum are well reported in the literature. Here, we report a case of a male patient having bilateral femoral hernia with bilateral recurrent inguinal hernia. A huge, right-sided femoral hernia contained terminal ileum, appendix, caecum and ascending colon, which were irreducible but neither obstructed nor strangulated. The patient was operated on with a Pfannenstiel incision together with an infrainguinal incision. For reduction of content, an inguinal ligament was also incised. Bilateral preperitoneal, polypropylene mesh hernioplasty was performed along with rolled plug placement in the right femoral canal. The patient had an uneventful post operative recovery and no recurrence in 6 months of follow up.
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Affiliation(s)
- R B Patel
- Department of Surgery, NHL Municipal Medical College, Ahmadabad, India.
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14
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Patel RB, Bennett AJ, Cooper K, Atkinson P, Nicoll CA, Ritchie DA, Shields AJ. Postselective two-photon interference from a continuous nonclassical stream of photons emitted by a quantum dot. Phys Rev Lett 2008; 100:207405. [PMID: 18518580 DOI: 10.1103/physrevlett.100.207405] [Citation(s) in RCA: 3] [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: 01/03/2008] [Indexed: 05/26/2023]
Abstract
We report an electrically driven semiconductor single-photon source capable of emitting photons with a coherence time of up to 400 ps under fixed bias. It is shown that increasing the injection current causes the coherence time to reduce, and this effect is well explained by the fast modulation of a fluctuating environment. Hong-Ou-Mandel-type two-photon interference using a Mach-Zehnder interferometer is demonstrated using this source to test the indistinguishability of individual photons by postselecting events where two photons collide at a beam splitter. Finally, we consider how improvements in our detection system can be used to achieve a higher interference visibility.
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Affiliation(s)
- R B Patel
- Toshiba Research Europe Limited, Cambridge Research Laboratory, 208 Cambridge Science Park, Milton Road, Cambridge, CB4 0GZ, United Kingdom.
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15
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Birring SS, Patel RB, Parker D, McKenna S, Hargadon B, Monteiro WR, Falconer Smith JF, Pavord ID. Airway function and markers of airway inflammation in patients with treated hypothyroidism. Thorax 2005; 60:249-53. [PMID: 15741445 PMCID: PMC1747336 DOI: 10.1136/thx.2004.034900] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND There is increasing evidence of an association between organ specific autoimmune diseases, particularly autoimmune thyroid disease and respiratory morbidity. A study was undertaken to determine whether patients with autoimmune thyroid disease have objective evidence of airway inflammation and dysfunction. METHODS Twenty six non-smoking women with treated hypothyroidism and 19 non-smoking controls completed a symptom questionnaire and underwent full lung function tests, capsaicin cough reflex sensitivity measurement, methacholine challenge test, and sputum induction over two visits. RESULTS Symptoms of cough (p = 0.01), dyspnoea (p = 0.01), sputum production (p = 0.004), and wheeze (p = 0.04) were reported more commonly in patients than controls. Patients with hypothyroidism had heightened cough reflex sensitivity compared with controls (geometric mean concentration of capsaicin causing five coughs: 40 v 108 mmol/l; mean difference 1.4 doubling doses; 95% confidence interval of difference 0.4 to 2.5; p = 0.008) and a significantly higher proportion of patients had airway hyperresponsiveness (methacholine provocative concentration (PC(20)) <8 mg/ml: 38% v 0%; p = 0.016). Patients with hypothyroidism also had a significantly higher induced sputum total neutrophil cell count (p = 0.01), total lymphocyte count (p = 0.02), and sputum supernatant interleukin-8 concentrations (p = 0.048). CONCLUSION Patients with treated hypothyroidism report more respiratory symptoms and have objective evidence of airway dysfunction and inflammation.
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Affiliation(s)
- S S Birring
- Institute for Lung Health, Department of Respiratory Medicine, Glenfield Hospital, Leicester LE3 9QP, UK.
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16
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Birring SS, Passant C, Patel RB, Prudon B, Murty GE, Pavord ID. Chronic tonsillar enlargement and cough: preliminary evidence of a novel and treatable cause of chronic cough. Eur Respir J 2004; 23:199-201. [PMID: 14979491 DOI: 10.1183/09031936.03.00066403] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Tonsillar enlargement is sometimes seen in patients with otherwise unexplained chronic cough although its significance is unclear. In this study, the authors set out to test the hypothesis that cough symptoms and cough reflex sensitivity will improve after tonsillectomy in patients with otherwise unexplained chronic cough and enlarged tonsils. Eight consecutive patients with unexplained chronic cough and enlarged tonsils were recruited from 236 patients seen in a cough clinic between 2000 and 2001. Six patients with enlarged tonsils and no cough who were undergoing tonsillectomy for other reasons were recruited as a control group. All patients rated cough severity on a cough visual analogue score (0-100 mm) and had capsaicin cough reflex sensitivity measurement twice before and again 3 months after tonsillectomy. Patients with a chronic cough had heightened cough reflex sensitivity compared with the control group at baseline. There was a significant improvement in mean cough visual analogue score 3 months after tonsillectomy in patients with chronic cough (mean difference 30 mm; 95% confidence interval of difference 8-51 mm). The geometric mean concentration of capsaicin required to cause five coughs increased from 4 to 207 micromol L(-1) after tonsillectomy in patients with chronic cough (mean difference from baseline 5.6 doubling concentrations; 95% confidence interval of difference 3.1-8.2). There was no change in cough reflex sensitivity in control patients after tonsillectomy. These preliminary findings suggest for the first time a possible role for tonsillectomy in patients with enlarged tonsils in whom other causes of cough have been ruled out.
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Affiliation(s)
- S S Birring
- Institute for Lung Health, Dept of Respiratory Medicine, Glenfield Hospital, Leicester, UK.
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17
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Patel RB, Kwartler JA, Hodosh RM, Baredes S. Spontaneous cerebrospinal fluid leakage and middle ear encephalocele in seven patients. Ear Nose Throat J 2000; 79:372-3, 376-8. [PMID: 10832203] [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: 02/16/2023] Open
Abstract
Isolated cases of spontaneous cerebrospinal fluid (CSF) leakage with and without middle ear encephalocele have been reported. These leaks are usually accompanied by episodes of recurrent meningitis, hearing loss, or chronic headache. In this article, we report seven new cases of spontaneous CSF leakage. Six of these patients had conductive hearing loss and serous otitis media, and three had recurrent meningitis. Prior to a definitive diagnosis, six patients had received myringotomy tubes, which produced profuse clear otorrhea. Three patients had positive beta-2 transferrin assays. Computed tomography and magnetic resonance imaging confirmed a defect in the temporal bone tegmen. A combined transmastoid and middle fossa surgical approach with a three-layer closure was used to repair the tegmen defect. All patients had a lumbar drain placed prior to surgery. In addition to describing the seven new cases, we review the history of CSF leakage and discuss diagnostic methods, surgical findings, and our recommendations for management.
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Affiliation(s)
- R B Patel
- Section of Otolaryngology, New Jersey Medical School, University of Medicine and Dentistry of New Jersey, Newark, USA
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18
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Affiliation(s)
- R B Patel
- Section of Otolaryngology, University of Medicine and Dentistry of New Jersey Medical School, Newark, USA
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19
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Tiwari BP, Ramanathan P, Patel RB, Raste AS, Gadre SG, Soman CS, Deodhar KK. Animal model for liver dysfunction using lomustine in Wistar rats. Indian J Gastroenterol 2000; 19:9-11. [PMID: 10659479] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
AIM To induce intrahepatic cholestasis in rats using lomustine 1(2-chloroethyl)-3-cyclohexyl-l-nitrosourea (CCNU). METHODS Doses of 10 mg, 20 mg and 30 mg/Kg body weight of CCNU were injected intraperitoneally in separate groups of animals. RESULTS With 10 mg/Kg body weight of CCNU, serum bilirubin levels increased for up to 72 hours and then slowly returned to normal. With a dose of 20 mg/Kg body weight of CCNU, serum bilirubin, AST, ALT and alkaline phosphatase levels increased for 72 hours and then returned to normal over 4-5 weeks. With a dose of 30 mg/Kg body weight peak levels of serum bilirubin were reached on day 17. Pathological studies were carried out after injection of 30 mg/Kg body weight of CCNU. After 72 hours hepatocytes were normal, with minimal nonspecific inflammation and bile duct proliferation. After 16 days, triaditis was observed with deposition of collagen. Focal fibrosis was also noticed. There was no significant abnormality of hepatocytes. After 75 days, hepatocytes showed focal ballooning. Bile duct proliferation was seen invading the parenchyma. Nodules of hepatocytes separated by irregular fibrous bands indicated cirrhosis. CONCLUSIONS An animal model of intrahepatic cholestasis has been developed using CCNU; this model may be used to assess the utility of hepatobiliary radiopharmaceuticals.
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Affiliation(s)
- B P Tiwari
- Radiation Medicine Center (BARC), Tata Memorial Center (TMC), Annexe.
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20
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Lanjewar DN, Maheshwari MB, Lakhani SN, Patel RB, Holla VV. Childhood sarcoid myopathy manifesting as joint contractures. Indian Pediatr 1996; 33:128-30. [PMID: 8772933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- D N Lanjewar
- Department of Pathology, Grant Medical College, Bombay
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Abstract
BACKGROUND Progestin or estrogen-progestin combination therapy has not proven useful in the treatment of endometriosis of the abdominal scar after cesarean delivery. We report our experience in managing this condition with a gonadotropin agonist. CASE A 22-year-old black woman with a history of two previous cesareans developed endometriosis of the abdominal scar. The extent of the lesion was estimated by computed tomographic (CT) scan, and a 6-month preoperative course of leuprolide acetate was administered. The patient exhibited prompt symptomatic response to the gonadotropin agonist, but the physical examination and CT scan findings were unchanged. Pathologic examination after surgical removal of the lesion confirmed the clinical diagnosis. CONCLUSION Leuprolide acetate administered to a patient with cesarean scar endometriosis was associated with an improvement in symptoms, but there was no change in lesion size.
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Affiliation(s)
- M E Rivlin
- Department of Obstetrics and Gynecology, University of Mississippi Medical Center, Jackson, USA
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22
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Rivlin ME, Patel RB, Hess LW, Hess DB, Meeks GR. Leuprolide acetate depot for the treatment of uterine leiomyomas. Changes in bone density, uterine volume and uterine vascular resistive index. J Reprod Med 1994; 39:663-6. [PMID: 7807474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
This study measured the changes in uterine volume, uterine vascular resistive index and lumbar vertebral bone density before and after a six-month course of leuprolide acetate depot in women with uterine leiomyomas. All nine patients studied were black. The high baseline bone density of black women may provide a greater scope for the use of gonadotropin agonists as compared to women in the general population. A significant reduction in uterine volume was achieved in the patients with leuprolide therapy. Uterine vascular resistive indices were not altered consistently following leuprolide therapy in women with leiomyomas.
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Affiliation(s)
- M E Rivlin
- Department of Obstetrics and Gynecology, University of Mississippi Medical Center, Jackson
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23
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Gandhi TP, Patel RB, Sheikh MA, Jhala A, Santani DD. Pharmacokinetics of gentamicin in rabbits pretreated with nonsteroidal anti-inflammatory drugs: an interaction study. J Pharm Sci 1994; 83:542-4. [PMID: 8046610 DOI: 10.1002/jps.2600830419] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Interaction between nonsteroidal anti-inflammatory drugs (NSAIDs) and other drugs occurs relatively frequently because of the wide use of NSAIDs. Such interactions with drugs of narrow therapeutic index used in serious disease states may lead to toxicity. Gentamicin toxicity is based on its concentration in serum, and any alteration in pharmacokinetic parameters may lead to gentamicin accumulation in the body and subsequently to severe nephrotoxicity and ototoxicity. To test this hypothesis, the effect of pretreatment with NSAIDs on gentamicin pharmacokinetics was examined in rabbit. Gentamicin sulfate (5 mg/kg) was administered to rabbits pretreated with aspirin (300 mg/kg), ketorolac tromethamine (3 mg/kg), ibuprofen (20 mg/kg), and piroxicam (2 mg/kg) twice a day for 1 week. The pretreatment with NSAIDs had significant effects on the body clearance and maximum concentration. Aspirin, piroxicam and ketorolac tromethamine pretreatment had significant effects on the area under the curve of gentamicin versus time. Aspirin and ketorolac tromethamine pretreatment had significant effects on the half-life of gentamicin. Aspirin had a significant effect on the volume of distribution of gentamicin. These results suggest that pretreatment with NSAIDs alters the pharmacokinetics of gentamicin and leads to accumulation inside the body, which could result in toxicity.
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Abstract
Magnetic resonance (MR) imaging is commonly used in the followup of patients who have undergone surgical removal of tumors from the cranial base to assess the possibility of tumor recurrence, persistence, or surgical complications. Interpretations of this study must be cautious because postoperative enhanced signals are encountered frequently. Although technological improvements continue to enhance the usefulness of MR images for followup, problems remain in differentiating between fibrotic, reconstructive changes, and tumor recurrence. In this study, the hospital records and MR findings of 215 patients who had undergone skull base surgery were reviewed. The study was prompted by negative operative exploration in three patients in whom postoperative MR images strongly suggested tumor recurrence. One-year follow-up images were available in 174 patients. Of these, 94% showed signal enhancement on the 1-year follow-up study. Progressive changes were observed in 14% of patients. The correlation of preoperative MR findings and surgery, with regard to dural involvement, vascular involvement, cranial nerve infiltration, and extent of intracranial infiltration, was analyzed in 28 patients. Methods to facilitate the detection of tumor recurrence using MR images are reviewed.
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Affiliation(s)
- V K Anand
- Division of Otolaryngology, University of Mississippi Medical Center, Jackson 39216-4505
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25
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Rivlin ME, McGehee RP, Patel RB, Meeks GR. Acute urinary retention due to a free-standing broad ligament leiomyoma. J Miss State Med Assoc 1992; 33:355-7. [PMID: 1460663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
A 38-year-old woman who had used oral contraceptives continuously since age 22 presented with acute urinary retention. Physical examination revealed a bladder outlet obstruction due to a large paravaginal/broad ligament mass. Magnetic resonance imaging (MRI) demonstrated that the mass was separate from the uterus which was confirmed at surgery when an isolated free-standing leiomyoma was removed.
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Affiliation(s)
- M E Rivlin
- Department of Obstetrics and Gynecology, University Medical Center, Jackson
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26
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Mangalan S, Patel RB, Gandhi TP, Chakravarthy BK. Detection and determination of free and plasma protein-bound astemizole by thin-layer chromatography: a useful technique for bioavailability studies. J Chromatogr 1991; 567:498-503. [PMID: 1939483 DOI: 10.1016/0378-4347(91)80158-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
A thin-layer chromatographic (TLC) procedure has been developed for the determination of astemizole in plasma as the free and as protein-bound substance. The detection and quantification were performed without using internal standards. In earlier described methods for the estimation of astemizole by high-performance liquid chromatography and radioimmunoassay, only free levels in plasma were quantified, at 3.3% of the total astemizole, with the remaining 96.7% bound to plasma protein and tissue. Our method employs proteolysis of plasma proteins by incubating plasma for 2 h in pepsin. After proteolysis the astemizole is extracted, and a known amount of the extract is spotted on precoated silica gel F 254 plates. Astemizole was quantified using a Shimadzu CS-930 dual-wavelength TLC scanner. The method provides a direct estimate of total astemizole present in the plasma.
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Affiliation(s)
- S Mangalan
- R & D Centre, Cadila Laboratories Ltd., Ahmedabad, India
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27
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Kamath SA, Phadke V, Anand AJ, Patel RB, Deshpande DV. Epilepsy and craniofacial abnormalities. J Assoc Physicians India 1991; 39:227. [PMID: 1909317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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28
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Patel AG, Patel RB, Patel MR. Liquid chromatographic determination of clobetasone-17-butyrate in ointments. J Assoc Off Anal Chem 1990; 73:893-5. [PMID: 2289922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
A liquid chromatographic (LC) method has been developed for determination of clobetasone-17-butyrate in ointment using clobetasone propionate as an internal standard. Separation was carried out on a C18 reverse-phase column using water-methanol as a mobile phase. Methylparaben and propylparaben (both sodium salt) used as preservatives did not interfere with separation. Compounds are detected photometrically at 235 nm. Mean assay results for 0.05% commercial ointments were 100.36% (n = 5). Mean recovery of clobetasone-17-butyrate added to commercial ointment was 99.89%.
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Affiliation(s)
- A G Patel
- Cadila Laboratories Ltd, Analytical Research Laboratory, Gujarat, India
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29
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Ramanathan P, Patel RB, Subrahmanyam N, Nayak UN, Sachdev SS, Ramamoorthy N. Visualization of suppressed thyroid tissue by technetium-99m-tertiary butyl isonitrile: an alternative to post-TSH stimulation scanning. J Nucl Med 1990; 31:1163-5. [PMID: 2362195] [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: 12/31/2022] Open
Abstract
The autonomously functioning thyroid nodule (AFTN) is a discrete, nodular structure which operates independently of pituitary control and without relation to the remaining thyroid tissue. Presently, for the visualization of a suppressed thyroid lobe, a patient has to undergo the thyrotropin (TSH) stimulation test, which has several disadvantages. In this study we have used tertiary butyl isonitrile (99mTc-TBI), well known as a myocardial imaging agent, for visualization of the suppressed lobe. Thirteen of fourteen patients studied demonstrated a contralateral lobe on a 99mTc-TBI scan which was not visualized with a 99mTc0(4) or 131I scan. Although it is not possible to demonstrate the autonomous nature of the hyperfunctioning thyroid nodule using 99mTc-TBI, we conclude that it is feasible to use this agent to visualize the lobe without the TSH test.
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Affiliation(s)
- P Ramanathan
- Radiation Medicine Centre, (B.A.R.C.), Tata Memorial Centre Annexe, Parel, Bombay, India
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30
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Shishoo CJ, Devani MB, Bhadti VS, Jain KS, Rathod IS, Goyal RK, Gandhi TP, Patel RB, Naik SR. Synthesis and pharmacological study of antihyperlipaemic activity of 2-substituted thieno(2,3-d)pyrimidin-4(3H)-ones. Arzneimittelforschung 1990; 40:567-72. [PMID: 2383297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
A series of 2-substituted thieno(2,3-d)pyrimidin-4-(3H) ones (1-15) was prepared by the reaction of thiophene ortho-aminoester (IV) with a variety of nitriles (V) under acidic conditions, and screened for antihyperlipaemic activity in various animal models. While most of these compounds were found active, 2-chloromethyl-5,6,7,8-tetrahydrobenzo(b)thieno(2,3-d) pyrimidin-4(3H)-one (5) was found to be the most active of all. The serum triglyceride lowering activity exhibited by 5 was found comparable to that of clofibrate and riboflavin tetrabutyrate. Compound 5 was also found to be safe as indicated by acute and chronic toxicity studies in mice and rats.
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Affiliation(s)
- C J Shishoo
- Department of Pharmaceutical Chemistry, Lallubhai Motilal College of Pharmacy, Ahmedabad, India
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31
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Rivlin ME, Miller JD, Krueger RP, Patel RB, Bower JD. Leuprolide acetate in the management of ureteral obstruction caused by endometriosis. Obstet Gynecol 1990; 75:532-6. [PMID: 2106110] [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: 12/30/2022]
Abstract
Endometriotic ureteral obstruction is a serious event commonly diagnosed late and therefore associated with a major risk of hydronephrotic renal atrophy. The standard therapy is surgical. However, medical treatment has been reported using danazol, progestins, and estrogen-progestin combinations, although solid documentation of the effect of hormonal therapy against ureteral endometriosis is lacking. Gonadotropin-releasing hormone (GnRH) agonist treatment of endometriosis has yielded good results but has not been adequately reported in patients with ureteric involvement. We report three patients treated with a GnRH agonist, leuprolide acetate, for 6-9 months as a preoperative course. One patient had bilateral and two had unilateral obstruction. The preoperative course relieved the obstruction in the patient with bilateral disease and in one with unilateral changes. The failure occurred in a patient with intrinsic ureteric endometriosis. This early experience suggests a place for GnRH agonist therapy for patients with ureteric obstruction due to endometriosis, probably, but not necessarily, in conjunction with a planned surgical procedure. If medical therapy is attempted, close surveillance of renal function is mandatory.
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Affiliation(s)
- M E Rivlin
- Department of Obstetrics and Gynecology, University of Mississippi Medical Center, Jackson
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32
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Sachdev SS, Ramamoorthy N, Nayak UN, Patel RB, Ramanathan P, Srivastava S, Lal R, Raghavan SV, Shah KB, Desai CN. Preparation and evaluation of 99mTc-t-butylisonitrile (99mTc-TBI) for myocardial imaging: a kit for hospital radiopharmacy. Int J Rad Appl Instrum B 1990; 17:543-52. [PMID: 2254092 DOI: 10.1016/0883-2897(90)90130-s] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
A previous method was modified to obtain [99mTc(TBI)6]+ by reacting Zn(TBI)2Br2 directly with 99mTcO4- in the presence of Sn2+ ions. [Cu(TBI)4]Cl was next used as a source of TBI. On reaction with 99mTcO4- and Sn2+ ions for 3 min at 100 degrees C, [99mTc(TBI)6]+ product of radiochemical purity greater than 90% and yield greater than 70% was obtained. Data of biodistribution in rats (2-2.5% in heart) and biokinetics in rabbits were satisfactory. The kit formulation was found to be stable and also safe for administration.
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Affiliation(s)
- S S Sachdev
- Isopharm, Radiopharmaceuticals Operations, Board of Radiation and Isotope Technology, BARC Vashi Complex, New Bombay, India
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Abstract
We studied 289 newborn infants from birth till one year of age. Low birth weight babies (less than 2.5 kg) were 52.9%. Boys suffered 9.7 episodes of sickness, and girls 8.6 episodes of sickness. The mean episodes of various sicknesses, and their impact on weight gain, feeding pattern and growth pattern are discussed. Six deaths were observed, of which 4 were among the low birth weight babies. Mortality in babies born less than 2 kg was 44.4% and above 2 kg was less than 1%.
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Abstract
Pulmonary function tests (PFT) were performed on 84 children studying in a Municipal School, near a plant manufacturing chemicals in Chembur, a suburb of Bombay, from where large amounts of chlorine gas leaked out on 30th August, 1985. It was found that only 23.8% had normal PFT's. 66.7% showed an obstructive pattern and 9.5% showed a restrictive pattern of PFT's. This is a preliminary report to establish the prevalence of lower PFT values in children staying in an area of air pollution in Bombay.
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35
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Patel RB, Ramani S, Parmar B. Klebsiella pneumoniae osteomyelitis in sickle cell anemia. Indian J Pediatr 1989; 56:145-9. [PMID: 2684851 DOI: 10.1007/bf02749731] [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] [Indexed: 01/02/2023]
Abstract
A case of Klebsiella pneumoniae osteomyelitis in a patient with sickle cell anemia is reported. The literature is briefly reviewed. The case is presented because of the rarity of Klebsiella pneumonia osteomyelitis in sickle cell disease.
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36
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Patel RB, Shah GF, Jain SM. The effect of rifampicin on piroxicam kinetics. Indian J Physiol Pharmacol 1988; 32:226-8. [PMID: 3198245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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37
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Patel MC, Patel RB, Ramanathan P, Ramamoorthy N, Krishna BA, Sharma SM. Clinical evaluation of 99mTc(V)-dimercapto succinic acid (DMSA) for imaging medullary carcinoma of thyroid and its metastasis. Eur J Nucl Med 1988; 13:507-10. [PMID: 2836203 DOI: 10.1007/bf00256625] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
99mTc(V)-DMSA kits developed by the Radiopharmaceutical Division, Bhabha Atomic Research Centre, have been evaluated for potential use in scanning medullary carcinoma of the thyroid and its metastases. There were 15 patients with proved medullary carcinoma and 6 patients with other differentiated thyroid carcinoma. Amongst the 15 patients with medullary carcinoma, 12 (80%) showed positive localisation either in the primary or one or more metastatic sites. None of the six patients with carcinoma other than medullary showed increased concentration of 99mTc(V)-DMSA. Of the 37 known metastatic sites in 15 patients with medullary carcinoma, 24 showed concentration of 99mTc(V)-DMSA (64.9%). In addition, 99mTc(V)-DMSA concentration was seen in 14 sites where no evidence of metastasis was revealed. The incidence of 99mTc(V)-DMSA concentration in soft tissue and bone metastasis was similar.
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Affiliation(s)
- M C Patel
- Radiation Medicine Centre, Bhabha Atomic Research Centre, Tata Memorial Centre Annexe, Bombay, India
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38
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Patel RB, Shah GF, Raval JD, Gandhi TP, Patel MR, Gilbert RN. Effect of tinidazole and metronidazole on serum lipid profile in healthy human volunteers. J Assoc Physicians India 1987; 35:708-10. [PMID: 3446681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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39
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Patel RB, Shah GF, Raval JD, Patel MR. Influence of antidiabetic drugs on the activity of nonsteroidal anti-inflammatory drugs in carrageenan paw edema test in the rat. Indian J Physiol Pharmacol 1987; 31:289-92. [PMID: 3450636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Affiliation(s)
- R B Patel
- Department of Pharmacology, Research and Development, Cadila Laboratories Pvt. Ltd, Maninagar, Ahmedabad
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40
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Chakravarthy BK, Patel RB, Gandhi TP, Patel A, Gilbert RN. Variation of drug responses in diabetic rats under environmental stress. Indian J Exp Biol 1987; 25:623-6. [PMID: 3449451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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41
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42
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Patel RB, Shah GF, Raval JD, Gandhi TP, Gilbert RN. Calcium antagonists and blood glucose in normal rabbits. Arzneimittelforschung 1987; 37:410-2. [PMID: 3300662] [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: 01/05/2023]
Abstract
The effects of the calcium antagonists verapamil and nifedipine on blood glucose levels, glucose tolerance, insulin secretion during glucose tolerance and hypoglycaemic effect of tolbutamide were studied in normal nondiabetic rabbits. Daily dosage of 40 mg/kg verapamil and 5 mg/kg nifedipine given orally up to 7 days did not affect blood glucose level, glucose tolerance, insulin secretion during glucose tolerance and hypoglycaemic activity of tolbutamide 250 mg/kg p.o.
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McNamara PJ, Foster TS, Digenis GA, Patel RB, Craig WA, Welling PG, Rapaka RS, Prasad VK, Shah VP. Influence of tablet dissolution on furosemide bioavailability: a bioequivalence study. Pharm Res 1987; 4:150-3. [PMID: 3509139 DOI: 10.1023/a:1016427321532] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
In order to evaluate the in vitro dissolution and in vivo bioavailability relationship for furosemide, a bioequivalence study was carried out. Furosemide (40 mg) was administered orally to 12 normal volunteers in a 6 x 6 crossover design using six products (five tablets and one solution) obtained from three pharmaceutical companies. Plasma and urine concentrations of furosemide were quantitated by high-performance liquid chromatography (HPLC). Plasma furosemide profiles were analyzed by non-compartmental methods. Compared to the oral solution, all of the formulations exhibited lower peak furosemide concentrations, longer mean residence times, and, in some cases, diminished bioavailability (range, 66-96%). Similar results were obtained when the reference product (a rapidly dissolving tablet) was used as the standard. All of the products failed the 75/75 rule when compared to either reference standard, apparently because of large intersubject variability. The total amount of furosemide excreted in urine could be associated with the percentage drug dissolved (in vitro) at 30 min. The pH 5.6 dissolution medium (compared to pH 4.6) appears to be an appropriate test medium for assuring batch uniformity and bioequivalence of furosemide products.
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Affiliation(s)
- P J McNamara
- College of Pharmacy, University of Kentucky, Lexington 40506
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Ramamoorthy N, Shetye SV, Pandey PM, Mani RS, Patel MC, Patel RB, Ramanathan P, Krishna BA, Sharma SM. Preparation and evaluation of 99mTc(V)-DMSA complex: studies in medullary carcinoma of thyroid. Eur J Nucl Med 1987; 12:623-8. [PMID: 3034614 DOI: 10.1007/bf00284540] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Consequent to the promising results reported with 99mTc(V)-DMSA for imaging certain types of soft tissue tumors, we have developed methods to prepare this radiopharmaceutical in three ways: from freshly prepared reagents, through the use of a two component kit and use of the standard renal DMSA kit by a modified recipe. The 99mTc(V)-DMSA complex has been subjected to paper electrophoretic and chromatographic procedures and also biodistribution studies. The distinctly different behaviour of this new product compared to that of the well known renal DMSA complex has been clearly established. Scintiimaging in a preliminary clinical trial in patients with medullary carcinoma of the thyroid has been encouraging.
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45
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Patel RB, Patel MR, Patel AA, Shah AK, Patel AG. Separation and determination of food colours in pharmaceutical preparations by column chromatography. Analyst 1986; 111:577-8. [PMID: 3740429 DOI: 10.1039/an9861100577] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Lewin JR, Das SK, Blumenthal BI, D'Cruz C, Patel RB, Howell GE. Osseous pseudotumor. The sole manifestation of sinus histiocytosis with massive lymphadenopathy. Am J Clin Pathol 1985; 84:547-50. [PMID: 4036885 DOI: 10.1093/ajcp/84.4.547] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Sinus histiocytosis with massive lymphadenopathy may involve extra-nodal tissue sites. Skeletal involvement is uncommon and has always been associated with disease in other nonosseous locations. The present case is the first to document sinus histiocytosis with massive lymphadenopathy arising primarily within bone and unaccompanied by disease elsewhere.
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Patel RB. Evaluation of complex carpal trauma: thin-section direct longitudinal computed tomography scanning through a plaster cast. J Comput Tomogr 1985; 9:107-9. [PMID: 3987329 DOI: 10.1016/0149-936x(85)90003-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Direct longitudinal computed tomography of the wrist, with a plaster cast on the forearm, is described. In a case of complex carpal injuries, the advantages of this method are compared with those of conventional radiographic studies.
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49
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Abstract
A patient with the development of a post-surgical mass in the thigh, at the site of surgery, is described. Lymphoscintigraphy was important in solving the clinical dilemma.
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50
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Abstract
The relative bioavailability of hydrocortisone was determined from four different 20-mg tablet formulations and one suspension in 15 healthy male volunteers; results were compared with in vitro dissolution rates. Plasma levels of hydrocortisone were determined by a liquid chromatography method developed in this laboratory. Dissolution of the tablet formulations, using the official USP test, varied from 7.8 to 93.8% in 30 min. Similar plasma profiles were obtained from all tablet products, and there were no differences among tablets in the cumulative percentage of drug absorbed. There were no clear trends in any pharmacokinetic parameter values among the tablet dosages, and the four products were considered bioequivalent. The suspension dosage yielded significantly higher plasma levels compared with some of the tablet formulations during the initial 30-min postdose, significantly higher cumulative absorption at 0.5 and 1.0 h compared with one tablet formulation, and significantly higher ka and Cmax, and shorter tmax values, compared with some of the tablets.
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