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Reddy JP, Liu S, Bathala T, Smith BD, Ramirez D, Shaitelman SF, Chun SG, Brewster AM, Barcenas CH, Ghia AJ, Ludmir EB, Patel AB, Shah SJ, Woodward WA, Gomez DR, Tang C. Addition of Metastasis-Directed Therapy to Standard of Care Systemic Therapy for Oligometastatic Breast Cancer (EXTEND): A Multicenter, Randomized Phase II Trial. Int J Radiat Oncol Biol Phys 2023; 117:S136-S137. [PMID: 37784348 DOI: 10.1016/j.ijrobp.2023.06.541] [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) Prior retrospective and prospective evidence have suggested a potential survival benefit of adding metastasis-directed therapy (MDT) to standard of care systemic therapy for oligometastatic breast cancer. This has led to the increased utilization of MDT in this setting despite the lack of randomized evidence to support this approach. Furthermore, the recent presentation of NRG-BR002 has questioned the value of MDT. Thus, we evaluated whether the addition of MDT to systemic therapy improves PFS in oligometastatic breast cancer. MATERIALS/METHODS EXTEND (NCT03599765) is a phase II randomized basket trial for multiple solid tumors testing whether the addition of MDT improves PFS. The primary endpoint was pre-specified to be independently assessed and reported for the breast basket when a minimum of 6 months of follow-up had been reached. Patients with ≤5 metastases were randomized to standard of care systemic therapy with or without MDT. The choice of systemic therapy was at the discretion of the treating medical oncologist. Number of metastatic lesions and prior lines of systemic therapy for metastatic disease were used as stratification variables pre-randomization. The primary endpoint was progression-free survival (PFS) defined as time to randomization to date of clinical or radiographic progression or death. The study was designed to have 80% power to detect an improvement in median PFS from 18 to 36 months, with a type I error of 0.1. RESULTS Between September 2018 to July 2022, 43 patients were randomized. 22 patients were assigned to the MDT arm, and 21 patients to the no MDT arm. Three patients were not evaluable. The MDT arm patients were older vs the no-MDT arm patients (median 61.5 years vs 48 years, p = 0.01). Otherwise, the arms were well-balanced. Overall, 8 patients had triple negative disease (18.6%), and 12 patients (30%) had de novo metastatic disease. Of those patients with de novo presentation randomized to MDT, all except one had the primary tumor treated with surgery and radiation. At a median follow-up of 19.4 months, 20 events were observed. Among the 40 evaluable patients, there were 5 deaths (3 in the MDT arm and 2 in the no MDT arm). There was no difference in PFS between the MDT and no MDT arms (median 15.6 v 24.9 months, p = 0.66). Similarly, there was no difference in the secondary endpoint of time to new metastatic lesion appearance between the MDT and no MDT arms (median 15.6 months vs not reached, p = 0.09). Two grade 3 toxicities were observed in the MDT arm, and 1 in the no MDT arm. Further analysis of correlative translational biomarkers, including immune markers and ctDNA, are ongoing. CONCLUSION The addition of MDT to standard of care systemic therapy did not improve PFS or time to new metastatic lesion in patients with oligometastatic breast cancer. This data coupled with the recently presented NRG-BR002 results, suggests there is no benefit to MDT in an otherwise unselected oligometastatic breast cancer population.
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Affiliation(s)
- J P Reddy
- University of Texas MD Anderson Cancer Center, Houston, TX
| | - S Liu
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - T Bathala
- Department of Abdominal Imaging, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - B D Smith
- Department of Breast Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - D Ramirez
- University of Texas MD Anderson Cancer Center, Houston, TX
| | - S F Shaitelman
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - S G Chun
- Department of Radiation Oncology, Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - A M Brewster
- University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - A J Ghia
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - E B Ludmir
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - A B Patel
- Winship Cancer Institute at Emory University, Atlanta, GA
| | - S J Shah
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - W A Woodward
- Department of Breast Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - D R Gomez
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - C Tang
- Department of Genitourinary Radiation Oncology, Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
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Garg AK, Hernandez M, Schlembach PJ, McAleer MF, Brown PD, Gopal RS, Wiederhold L, Swanson TA, Shah SJ, Li J, Ferguson S, Philip N, De Gracia B, Bloom E, Chun SG. Frameless Fractionated Linear Accelerator-Based Stereotactic Radiotherapy for Brain Metastases: Results of a Single-Arm Phase II Multi-Institutional Clinical Trial. Int J Radiat Oncol Biol Phys 2023; 117:e94-e95. [PMID: 37786219 DOI: 10.1016/j.ijrobp.2023.06.857] [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) Stereotactic radiotherapy (SRT) yields high rates of local control for brain metastases while minimizing neurocognitive side effects. While advanced SRT platforms are widely available in urban centers, rural/suburban patients face geographic and socioeconomic barriers to access SRS. For this reason, we conducted a multi-institutional Phase 2 clinical trial to test the safety and efficacy of 3-5 fraction frameless fractionated stereotactic radiotherapy (FFSRT) for brain metastases in an integrated academic satellite network MATERIALS/METHODS: This IRB-approved Phase 2 trial was conducted for patients ≥18-years-old with 1-4 brain metastases. Brain metastases involving the optic pathway or brainstem were excluded. Gross tumor volume (GTV) was delineated with a volumetric brain MRI and planning target volume (PTV) was GTV + 2 mm margin. Radiation dose was based on GTV size: < 3.0 cm, 27 Gy in 3 fractions, and 3.0-3.9 cm, 30 Gy in 5 fractions. Toxicity was evaluated using the Common Terminology Criteria for Adverse Events (CTCAE) version 4. RESULTS Of 76 evaluable patients, the median age was 67 years, 56.6% were female, 82.9% were white/Caucasian and 89.6% had an Eastern Cooperative Oncology Group performance status ≤ 2. Most brain metastases were from lung cancer (51.3%) and breast cancer (15.7%). With median follow-up of 10 months, local control was 93%, median survival was 1.8 years (95% confidence interval (CI): 1.5-2.4 years), 1-year OS was 73.8% (95% CI: 0.59-0.84), and 2-year OS was 31% (95% CI: 0.12-0.52). There were no CTCAE Grade ≥ 3 protocol-related adverse events. CONCLUSION Outcomes of this trial compare favorably with contemporary SRT trials for brain metastases. FFSRT may provide opportunities to expand SRS access for underserved populations across the MDACC enterprise and in future clinical trials for brain metastases.
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Affiliation(s)
- A K Garg
- Presbyterian Healthcare Services, Albuquerque, NM
| | - M Hernandez
- MD Anderson, Houston, TX; Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - P J Schlembach
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - M F McAleer
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - P D Brown
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN
| | - R S Gopal
- Radiation Care at Meridian Park, Tualitin, OR
| | | | - T A Swanson
- University of Texas Medical Branch, Galveston, TX
| | - S J Shah
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Sugar Land, TX
| | - J Li
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - S Ferguson
- Department of Neurosurgery, University of Texas MD Anderson Cancer Center, Houston, TX
| | - N Philip
- MD Anderson Cancer Center, HOUSTON, TX
| | - B De Gracia
- MD Anderson Cancer Center, Houston, TX, United States
| | - E Bloom
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - S G Chun
- University of Texas Southwestern Medical Center, Dallas, TX
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Defilippi C, Shah SJ, Alemayehu W, Lam CSP, Butler J, Reimann S, O'Connor CM, Shah P, Westerhout CM, Armstrong PW. Targeted discovery proteomics to identify clinical phenotypes in heart failure with preserved ejection fraction: a proteomics substudy of VITALITY-HFpEF. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Heart failure with preserved ejection fraction (HFpEF) is a heterogenous syndrome that may emerge from overlapping systemic processes associated with several medical co-morbidities, often within an inflammatory milieu. Identification of unique proteins associated with distinct phenotypes may yield insight into novel therapeutics.
Purpose
Determine if unique clusters of circulating proteins are associated with specific clinical characteristics in patients with HFpEF.
Methods
A targeted discovery proteomics approach with 358 unique proteins associated with cardiovascular disease and inflammation (Olink) was used at baseline in VITALITY-HFpEF among 789 participants with documented left ventricular EF ≥45% and recent decompensation (<6 mos). Proteins were clustered applying the weighted correlation network analysis (WCNA). The associations of the clinical characteristics and frailty and clusters were estimated with linear regression adjusted for age and eGFR. Frailty was characterized as normal, pre-frail, and frail using the Fried criteria. KCCQ was the primary and 6-minute walk distance (6MWD) the secondary endpoint of VITALITY-HFpEF.
Results
Four unique clusters were identified containing 24, 66, 197, and 81 proteins, respectively. Figure 1 shows the adjusted association of the 4 protein clusters, shown with their hub proteins, with the clinical characteristics. The color (red: positive, green: negative relationship) and intensity indicate the magnitude of the standardized difference (relative to the variation [i.e., T-value]); p-value shown in boxes. Cluster 3, with tumor necrosis factor receptor 1 as a hub protein that mediates apoptosis and inflammation, was associated with greater frailty and physical limitation along with shorter 6MWD. In contrast, cluster 4, with protein C as a hub protein that regulates anticoagulation and exerts a protective function on endothelial cells, is associated with less frailty and younger age, and more frequently male sex. Cluster 2 was associated with only younger age and cluster 1 with no clinical characteristics.
Conclusions
Proteomics appear to identify specific clinical phenotypes associated with HFpEF. Further exploration of this approach may provide insight into the diverse pathophysiology characterizing this disorder and a more targeted approach to therapy.
Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): VITALITY-HFpEF was funded by Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., Kenilworth, NJ, USA and Bayer AG, Wuppertal, Germany.
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Affiliation(s)
- C Defilippi
- Inova Heart and Vascular Institute , Falls Church , United States of America
| | - S J Shah
- Northwestern University , Chicago , United States of America
| | - W Alemayehu
- University of Alberta, Canadian VIGOUR Centre , Edmonton , Canada
| | - C S P Lam
- National University Heart Centre, Duke-NUS , Singapore , Singapore
| | - J Butler
- Baylor University Medical Center , Dallas , United States of America
| | | | - C M O'Connor
- Inova Heart and Vascular Institute , Falls Church , United States of America
| | - P Shah
- Inova Heart and Vascular Institute , Falls Church , United States of America
| | - C M Westerhout
- University of Alberta, Canadian VIGOUR Centre , Edmonton , Canada
| | - P W Armstrong
- University of Alberta, Canadian VIGOUR Centre , Edmonton , Canada
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Wachter R, Pieske B, Baldridge A, Ibram G, Zhao Z, Shah SJ. Reduction in heart failure hospitalizations by sacubitril/valsartan; a post-hoc analysis of the PARALLAX trial. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
The PARALLAX trial recently showed a significant reduction in plasma N-terminal pro-B-type natriuretic peptide (NT-proBNP) concentrations by angiotensin receptor neprilysin inhibition with sacubitril/valsartan (S/V) compared to standard medical therapy (SMT) in patients with heart failure and ejection fraction ≥40%. As NT-proBNP reductions have been associated with a reduction in future heart failure hospitalizations (HHF), we aimed to investigate the impact of S/V on this endpoint in comparison to standard medical therapy.
Methods
The PARALLAX study was a 24-week, randomized, active-controlled, parallel group study to evaluate S/V compared to SMT for comorbidities. Eligible patients were stratified into three strata according to their individual RASi treatment (ACEi, ARB, ACEi/ARB-naïve) and randomized within each stratum 1:1 to S/V (N=1281; target dose (td), 97/103 mg b.i.d.) or individual comparator (N=1285; enalapril (td 10 mg b.i.d), valsartan (160 mg b.i.d.), or placebo). Hospitalizations for cardiac failure reported as serious adverse events by investigators were analysed in this post-oc secondary analysis.
Results
2566 patients with heart failure and LVEF ≥40%, were randomized to receive either S/V or SMT according to RASi stratum (n=1,016 ACE inhibitor stratum, n=1,174 ARB stratum, n=326 no RAS stratum). After 12 weeks, adjusted geometric mean ratio of NT-proBNP showed a 16.4% greater reduction sith S/V vs. SMT (p<0.0001). S/V reduced the risk for cardiac failure events leading to hospitalization by 51% (hazard ratio (HR) 0.49; 95% CI 0.30, 0.81; p=0.005). Similar results were obtained in all three strata: HR 0.55 (0.25–1.19) in ACE inhibitor stratum, HR 0.50 (024–1.02) in ARB stratum and HR 0.37 (0.10–1.38) in no RAS stratum.
Conclusion
The significant reduction of NT-proBNP plasma levels by S/V in comparison to SMT in PARALLAX was associated with a significant reduction in heart failure hospitalisations. These results, together with evidence from the PARAGON trial, support the use of S/V in HFpEF for avoiding heart failure hospitalizations.
Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): Novartis
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Affiliation(s)
- R Wachter
- Leipzig University Hospital , Leipzig , Germany
| | - B Pieske
- Charite - Campus Virchow-Klinikum (CVK), Cardiology , Berlin , Germany
| | - A Baldridge
- Northwestern University, Stistics, Bluhm Cardiovascular Institute , Chicago , United States of America
| | - G Ibram
- Novartis , East Hanover , United States of America
| | - Z Zhao
- Novartis , Shanghai , China
| | - S J Shah
- Northwestern University, Bluhm Cardiovascular Institute , Chicago , United States of America
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5
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Fontana M, Buchholtz K, Engelmann MDM, Grogan M, Hovingh GK, Kristen AV, Poulsen P, Shah SJ, Maurer MS. NNC6019–0001, a humanized monoclonal antibody, in patients with transthyretin amyloid cardiomyopathy (ATTR-CM): rationale and study design of a phase 2, randomized, placebo-controlled trial. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction
Transthyretin amyloid cardiomyopathy (ATTR-CM) is a chronic condition associated with progressive heart failure, resulting from extracellular deposition of misfolded transthyretin (TTR) protein as amyloid fibrils in the myocardium. Currently, there are few disease-modifying treatments. NNC6019–0001 is a humanized monoclonal antibody designed to deplete amyloid via antibody-mediated phagocytosis by targeting a unique epitope that is exposed only on misfolded monomeric and aggregated forms of TTR. In a phase 1, open-label, 3-month dose escalation trial, NNC6019–0001 was well tolerated at all doses tested (up to and including 30 mg/kg).1 The maximum tolerated dose was not reached. Exploratory cardiac endpoints were stable or indicated a possible benefit.
Purpose
To evaluate the effect of NNC6019–0001 30 mg/kg and 100 mg/kg on cardiac functional endpoints and predictive biomarkers in patients with ATTR-CM, and to assess pharmacokinetics, safety and tolerability, to establish the optimal dose for a phase 3 trial.
Methods
This is a randomized, double-blind, placebo-controlled trial recruiting 99 patients with hereditary or wild-type ATTR-CM (Figure). Inclusion criteria are New York Heart Association (NYHA) class II or III heart failure, left ventricle wall thickening (LVWT) ≥12 mm, N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels ≥650 pg/mL in sinus rhythm and >1000 pg/mL in atrial fibrillation, and a 6-minute walk test (6MWT) distance of 150–450 m. Patients will be randomly assigned to receive intravenous NNC6019–0001 30 mg/kg or 100 mg/kg or placebo, each in addition to standard of care, every 4 weeks for 52 weeks, followed by a 12-week follow-up. In a sentinel dosing phase, three patients per arm will receive the study drug or placebo, in combination with 24-hour inpatient cardiac monitoring and 7 days of continuous cardiac (tele-) monitoring. The primary endpoints are change from baseline to week 52 in 6MWT and in NT-proBNP levels. Secondary endpoints include cardiac measures: extracellular volume on cardiac magnetic resonance imaging, global longitudinal strain, troponin T levels, hospitalization due to cardiovascular events, and urgent visits due to heart failure. Quality of life will be assessed using the Kansas City Cardiomyopathy Questionnaire (KCCQ). All-cause mortality, pharmacokinetics and treatment-emergent adverse events will also be assessed.
Results
The trial will start mid-2022 with global recruitment.
Conclusion
Disease-modifying treatments are needed for patients with ATTR-CM, where treatment is often limited to managing symptoms and best supportive care; the first disease-modifying therapies recently became available. This phase 2 trial will be used to determine the appropriate dose for the phase 3 trial of NNC6019–0001, a novel antibody therapy designed to deplete amyloid in patients with ATTR-CM.
Funding Acknowledgement
Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): This trial was funded by Novo Nordisk A/S. Medical writing support was provided by Johanna Scheinost PhD, PharmaGenesis Oxford Central, Oxford, UK, with funding from Novo Nordisk A/S.
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Affiliation(s)
- M Fontana
- National Amyloidosis Centre, University College London, Royal Free Campus , London , United Kingdom
| | | | | | - M Grogan
- Mayo Clinic , Rochester , United States of America
| | | | - A V Kristen
- Department of Cardiology, Amyloidosis Center, Heidelberg University , Heidelberg , Germany
| | | | - S J Shah
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine , Chicago , United States of America
| | - M S Maurer
- Cardiac Amyloidosis Program, Department of Medicine, Columbia University Irving Medical Center , New York , United States of America
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6
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Deis T, Wolsk E, Mujkanovic J, Komtebedde J, Burkhoff D, Kaye D, Hasenfuß G, Hayward C, Van der Heyden J, Petrie MC, Shah SJ, Borlaug BA, Kahwash R, Litwin S, Hoendermis E, Hummel S, Gustafsson F. Resting and exercise haemodynamic characteristics of patients with advanced heart failure and preserved ejection fraction. ESC Heart Fail 2021; 9:186-195. [PMID: 34877822 PMCID: PMC8788022 DOI: 10.1002/ehf2.13697] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Revised: 09/07/2021] [Accepted: 10/29/2021] [Indexed: 01/03/2023] Open
Abstract
Aims This study aimed to describe haemodynamic features of patients with advanced heart failure with preserved ejection fraction (HFpEF) as defined by the Heart Failure Association (HFA) of the European Society of Cardiology (ESC). Methods and results We used pooled data from two dedicated HFpEF studies with invasive exercise haemodynamic protocols, the REDUCE LAP‐HF (Reduce Elevated Left Atrial Pressure in Patients with Heart Failure) trial and the REDUCE LAP‐HF I trial, and categorized patients according to advanced heart failure (AdHF) criteria. The well‐characterized HFpEF patients were considered advanced if they had persistent New York Heart Association classification of III–IV and heart failure (HF) hospitalization < 12 months and a 6 min walk test distance < 300 m. Twenty‐four (22%) out of 108 patients met the AdHF criteria. On evaluation, clinical characteristics and resting haemodynamics were not different in the two groups. Patients with AdHF had lower work capacity compared with non‐advanced patients (35 ± 16 vs. 45 ± 18 W, P = 0.021). Workload‐corrected pulmonary capillary wedge pressure normalized to body weight (PCWL) was higher in AdHF patients compared with non‐advanced (112 ± 55 vs. 86 ± 49 mmHg/W/kg, P = 0.04). Further, AdHF patients had a smaller increase in cardiac index during exercise (1.1 ± 0.7 vs. 1.6 ± 0.9 L/min/m2, P = 0.028). Conclusions A significantly higher PCWL and lower cardiac index reserve during exercise were observed in AdHF patients compared with non‐advanced. These differences were not apparent at rest. Therapies targeting the haemodynamic compromise associated with advanced HFpEF are needed.
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Affiliation(s)
- T Deis
- Department of Cardiology, Rigshospitalet, University of Copenhagen, 9 Blegdamsvej, Copenhagen, 2100, Denmark
| | - E Wolsk
- Department of Cardiology, Rigshospitalet, University of Copenhagen, 9 Blegdamsvej, Copenhagen, 2100, Denmark.,Department of Cardiology, Herlev-Gentofte Hospital, Hellerup, Denmark
| | - J Mujkanovic
- Department of Cardiology, Rigshospitalet, University of Copenhagen, 9 Blegdamsvej, Copenhagen, 2100, Denmark
| | | | - D Burkhoff
- Cardiovascular Research Foundation, New York, NY, USA
| | - D Kaye
- Department of Cardiology, Alfred Hospital, Melbourne, Victoria, Australia
| | - G Hasenfuß
- Georg-August Universität, Heart Centre, Gottingen, Germany
| | - C Hayward
- Department of Cardiology, St-Jan Hospital, Bruges, Belgium
| | | | - M C Petrie
- Institute of Cardiovascular and Medical Sciences, British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | - S J Shah
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - B A Borlaug
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - R Kahwash
- The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - S Litwin
- Medical University of South Carolina, Charleston, SC, USA
| | - E Hoendermis
- University Medical Center, Groningen, The Netherlands
| | - S Hummel
- University of Michigan Frankel Cardiovascular Center, Ann Arbor, MI, USA.,Ann Arbor Veterans Affairs Health System, Ann Arbor, MI, USA
| | - F Gustafsson
- Department of Cardiology, Rigshospitalet, University of Copenhagen, 9 Blegdamsvej, Copenhagen, 2100, Denmark
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7
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Saba S, Al Sergani A, Vriz O, Kholaif N, Ramzan K, Jawad Shah S, Ahmad O, Albayyat R, Di Michele S, Pergola V, Di Giannuario G, Elmahi I, Ibrahim S, Galzerano D, Di Salvo G. Echocardiographic features and behavior of cardiac structural abnormalities in mucopolysaccharidosis. Eur Heart J Cardiovasc Imaging 2021. [DOI: 10.1093/ehjci/jeaa356.086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Mucopolysaccharidosis (MPS) is a rare genetic lysosomal storage disorder with a wide variability of phenotype. A systematic descriptive study dealing with the echocardiographic (E) features of valvular involvement and their evolution over the time in adolescent and adult patients, whose number is growing up in adult echocardiographic laboratory, is lacking in the medical literature.
Purpose
To detect the E features of valvular involvement and their evolution in adolescent and adult patients.
Method
Study design: observational descriptive retrospective. Study group: 142 E studies in 17 adolescent and adult patients with diagnosis of MPS from 2001 until 2020. Mitral (M), aortic (A), tricuspid (T) valves (V) E features (thickness, mobility, calcification, and function), their evolution over the time and the behaviour with Enzyme replacement therapy (ERT) or bone marrow transplant (BMT) were assessed.
Result
52% male, mean age 21 yrs ranges 16 to 48 yrs. 5% of the patient had MPS type I, 11% MPS type II, 29% MPS type IV, and 52% MPS type VI. 70% received ERT and 11% BMT.
In the severe case all the valves were involved (panel A, B, C; white arrows point to valve leaflets; yellow arrows MV apparatus) the whole MV apparatus was involved since the earlier stage and in the latest stage the calcification was massive (panel C). The predominant valvular dysfunction was the regurgitation followed by mixed disorder while the most frequent severe lesion was the stenosis; the echocardiographic pattern differs from the classical hockey stick appearance of the early phase of rheumatic MV and the thickening is different from the myxomatous MV for the reduced mobility and the presence of calcification. The reduced mobility of the TV (panel C) also differs from the Loeffler syndrome because of the restriction of the leaflets and the association with thickening and calcification. Under treatment, the MV thickening was found to have a slow progression of less than 1 mm yearly in 61% cases.
Conclusion
Our results showed that all the valves are affected mainly the MV; the echocardiographic pattern of MPS, different from other valvular diseases of adolescent and adult age, can help in avoiding misdiagnose. Our observations also suggest that the cardiac involvement show slow rate of progression after the initiation of the therapy. Further studies are required to confirm our results.
Type of valve % of valve thickness % of reduced mobility % calcification diffuse % valve lesion Mitral valve 88% 65% 47% 75% Aortic valve 76% 23% 41% 57% Tricuspid valve 82% 47% 17% 52% Abstract Figure. Echocardiographic features
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Affiliation(s)
- S Saba
- King Faisal Specialist Hospital & Research Centre, Heart Centre, Riyadh, Saudi Arabia
| | - A Al Sergani
- King Saud University, College of Medicine, Riyadh, Saudi Arabia
| | - O Vriz
- King Faisal Specialist Hospital & Research Centre, Heart Centre, College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - N Kholaif
- King Faisal Specialist Hospital & Research Centre, Heart Centre, College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - K Ramzan
- King Faisal Specialist Hospital & Research Centre, Department of Genetics, and Research Centre, Riyadh, Saudi Arabia
| | - S Jawad Shah
- King Faisal Specialist Hospital & Research Centre, Oncology and General surgery, Riyadh, Saudi Arabia
| | - O Ahmad
- King Faisal Specialist Hospital & Research Centre, Heart Centre, Riyadh, Saudi Arabia
| | - R Albayyat
- King Faisal Specialist Hospital & Research Centre, Heart Centre, Riyadh, Saudi Arabia
| | - S Di Michele
- San Filippo Neri Hospital, Cardiology Division , Rome, Italy
| | - V Pergola
- University of Padua, Department of Cardio-Thoraco-Vascular Sciences and Public Health, Padua, Italy
| | - G Di Giannuario
- Infermi Hospital of Rimini, Cardiology Division, Rimini, Italy
| | - I Elmahi
- Alfaisal University, College of Medicine, Riyadh, Saudi Arabia
| | - S Ibrahim
- King Faisal Specialist Hospital & Research Centre, Heart Centre, Riyadh, Saudi Arabia
| | - D Galzerano
- King Faisal Specialist Hospital & Research Centre, Heart Centre, College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - G Di Salvo
- University of Padua, Paediatric Cardiology and Congenital Heart Disease Department, padua, Italy
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8
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Chen C, Nishtala A, Groenendyk JW, Schultz W, Li E, Shah SJ, Burt RK, Freed BH. Improvement in left atrial reservoir strain following hematopoietic stem cell transplant in patients with systemic sclerosis. Eur Heart J Cardiovasc Imaging 2021. [DOI: 10.1093/ehjci/jeaa356.161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Introduction
Systemic sclerosis (SSc) can cause cardiac complications as a result of multi-organ fibrosis. The study of left atrial (LA) mechanics can offer insights into the pathophysiology of cardiac involvement in SSc. LA strain measured by speckle-tracking echocardiography (STE) has been shown to be a sensitive marker of LA function. The impact of a disease modifying treatment like hematopoietic stem cell transplant (HSCT) on LA mechanics is not known.
Aim
To study the effect of HSCT on LA mechanics using both conventional echocardiography and STE.
Methods
Patients with SSc who underwent comprehensive 2D echo evaluation pre- and post-HSCT were identified. Patients with pulmonary hypertension on right heart catheterization (RHC) were excluded. The modified Rodnan skin score (mRSS) was evaluated for each patient pre- and post-HSCT. Speckle tracking software was utilized to measure myocardial strain (TomTec, Unterschleissheim, Germany). LA reservoir strain was measured from the apical 2-, and 4-chamber views. The ratio of E/e’ to LA reservoir strain was used to non-invasively estimate LA stiffness. Paired student’s t-test and Pearson"s correlation were used in data analysis.
Results
Among 89 patients with SSc (average age 46 ± 11 years, 75% female) who underwent HSCT, the mRSS significantly improved after HSCT. The mean pulmonary capillary wedge pressure (PCWP) measured by RHC prior to HSCT was 9.6 ± 4.1 mmHg. LA reservoir strain was abnormal at baseline and significantly improved following HSCT. Although LA volume index and E/e’ remained unchanged, LA stiffness index decreased significantly post-HSCT. There was no correlation between LA reservoir strain and PCWP at baseline or between change in LA reservoir strain and change in LA volume index or E/e’.
Conclusions
Patients undergoing HSCT for SSc show significant improvement in LA reservoir strain and LA stiffness despite no significant change in LA volumes or estimates of LV filling pressures. This improvement in LA mechanics following HSCT thus appears to be independent of loading conditions and could represent an improvement in intrinsic LA performance.
Key clinical and echo characteristics Pre-HSCT Post-HSCT P value Median mRSS (25th - 75th percentile) 20 (13-34) 9 (4-20) <0.01 LA volume index (ml/m2) 24.6 ± 8.3 24.1 ± 7.1 0.66 E/e’ 8.0 ± 2.4 8.3 ± 2.6 0.30 LA stiffness index 0.24 ± 0.12 0.18 ± 0.08 <0.01 LA reservoir strain (%)* 35.8 ± 8.6 47.7 ± 11.2 <0.01 All values are presented as mean ± SD unless indicated otherwise. *Normal LA reservoir strain is defined in this study as being greater than 39%.
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Affiliation(s)
- C Chen
- Northwestern University, Chicago, United States of America
| | - A Nishtala
- Northwestern University, Chicago, United States of America
| | - JW Groenendyk
- Northwestern University, Chicago, United States of America
| | - W Schultz
- Northwestern University, Chicago, United States of America
| | - E Li
- Mount Sinai Hospital, New York, United States of America
| | - SJ Shah
- Northwestern University, Chicago, United States of America
| | - RK Burt
- Northwestern University, Chicago, United States of America
| | - BH Freed
- Northwestern University, Chicago, United States of America
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9
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Chen C, Nishtala A, Groenendyk JW, Schultz WM, Li E, Shah SJ, Burt RK, Freed BH. Heterogeneous pattern of improvement in right ventricular mechanics following hematopoietic stem cell transplant in patients with systemic sclerosis. Eur Heart J Cardiovasc Imaging 2021. [DOI: 10.1093/ehjci/jeaa356.160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Introduction
Systemic sclerosis (SSc) is an autoimmune disorder that causes fibrosis in the skin and internal organs, including the heart. Patients with SSc can have right ventricular (RV) systolic dysfunction in the absence of pulmonary hypertension. Studies have shown a predilection for impairment of the mid and apical segments of the RV free wall compared to controls. The effect of hematopoietic stem cell transplant (HSCT) – a disease modifying treatment for SSc – on RV mechanics is not known.
Aim
To study the effect of HSCT on RV mechanics using speckle-tracking echocardiography.
Methods
Patients with SSc who underwent comprehensive 2D echocardiographic evaluation pre- and post-HSCT were identified. The modified Rodnan skin score (mRSS) was evaluated for each patient pre- and post-HSCT. Speckle tracking software was utilized to measure myocardial strain (TomTec, Unterschleissheim, Germany). RV strain was measured from the RV focused apical 4-chamber view. Paired student’s t-test and linear regression analysis were used in data analysis.
Results
Among 89 patients with SSc (average age 46 ± 11 years, 75% female) who underwent HSCT, the mRSS significantly improved after HSCT. The mean pulmonary arterial pressure measured by right heart catheterization prior to HSCT was 18.5 ± 4.5 mmHg. There was a significant improvement in RV global longitudinal strain (GLS) and free wall strain (FWS) following HSCT. The improvement in strain was significant in the mid and apical segments of the RV free wall, but not so in the basal segment. The change in RV strain was linearly related to pre-HSCT strain. The lower the RV GLS and FWS, the greater the improvement in strain after HSCT.
Conclusions
There was a significant improvement in RV strain in patients undergoing HSCT, specifically within the mid and apical segments of the RV free wall. The improvement in strain after HSCT was directly related to the baseline strain. This suggests that HSCT may directly improve RV mechanics with the preferential enhancement of the less robust mid and apical RV free wall segments.
Key clinical and echo characteristics Pre-HSCT Post-HSCT P value Median mRSS (25th - 75th percentile) 20 (13-34) 9 (4-20) <0.01 RV GLS (%) -18.13 ± 3.88 -20.06 ± 4.51 <0.01 RV FWS (%) -20.79 ± 5.30 -23.21 ± 5.61 <0.01 RV basal free wall (%) -27.97 ± 9.33 -27.84 ± 7.94 0.93 RV mid free wall (%) -20.68 ± 9.61 -23.75 ± 7.91 0.05 RV apical free wall (%) -15.26 ± 8.57 -20.84 ± 8.92 <0.01 All values are presented as mean ± SD unless indicated otherwise. Abstract Figure. Pre-HSCT RV strain vs change in strain
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Affiliation(s)
- C Chen
- Northwestern University, Chicago, United States of America
| | - A Nishtala
- Northwestern University, Chicago, United States of America
| | - JW Groenendyk
- Northwestern University, Chicago, United States of America
| | - WM Schultz
- Northwestern University, Chicago, United States of America
| | - E Li
- Mount Sinai Hospital, New York, United States of America
| | - SJ Shah
- Northwestern University, Chicago, United States of America
| | - RK Burt
- Northwestern University, Chicago, United States of America
| | - BH Freed
- Northwestern University, Chicago, United States of America
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Elliott P, Drachman BM, Gottlieb SS, Hoffman JE, Hummel SL, Lenihan DJ, Ebede B, Gundapaneni B, Schwartz JH, Sultan MB, Shah SJ. 1169Interim analysis of data from a long-term, extension trial of tafamidis meglumine in patients with transthyretin amyloid cardiomyopathy. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Transthyretin amyloid cardiomyopathy (ATTR-CM), is an underdiagnosed, fatal disease caused by the deposition of transthyretin amyloid fibrils in the heart leading to heart failure. The Transthyretin Cardiomyopathy Clinical Trial (ATTR-ACT), an international, multi-center, double-blind, placebo-controlled, randomized study, demonstrated the efficacy and safety of tafamidis treatment for patients with ATTR-CM due to variant (ATTRm) or wild-type (ATTRwt) TTR.
Purpose
This is a pooled analysis of data from ATTR-ACT and interim data from the ongoing, long-term, extension study to evaluate longer term data on the efficacy of tafamidis in patients with ATTR-CM.
Methods
Patients who completed ATTR-ACT (which had a duration of 30 months) were eligible to be enrolled in a long-term, extension study in which patients either continued to receive tafamidis meglumine at the same dose (the tafamidis/tafamidis [T/T] group) or, for patients previously treated with placebo, were randomised (in a 1:2 ratio) to tafamidis meglumine 20 mg or 80 mg (the placebo/tafamidis [P/T] group) for up to 60 months. The primary efficacy outcome was all-cause mortality. This analysis combined data from the completed ATTR-ACT with interim data from the extension study (cut-off date: 15 Feb, 2018), and included patients treated with tafamidis meglumine across the two studies with a median follow up of 36 months.
Results
All-cause mortality was significantly lower in the T/T group (n=264; 88 events, 33.3%) compared with the P/T group (n=177; 88 events, 50.3%); hazard ratio (95% CI), 0.64 (0.47, 0.85); P=0.001. In the subgroup of ATTRwt patients, all-cause mortality was significantly reduced in the T/T group (55/201; 27.4%) compared with the P/T group (60/134; 44.8%); 0.64 (0.44, 0.92); P=0.002. In the 106 (24.0%) ATTRm patients, there was a trend towards a reduction in all-cause mortality in the T/T group (33/63; 52.4%) compared with the P/T group (29/43; 67.4%); 0.66 (0.39, 1.09); P=0.17. In patients who were NYHA Class I or II at baseline, all-cause mortality was significantly reduced in the T/T group (38/186; 20.4%) compared with the P/T group (45/114; 39.5%); 0.49 (0.32, 0.75); P=0.001. In those patients with more severe symptoms at baseline (NYHA Class III), there were fewer deaths in the T/T group (50/78; 64.1%) compared with the P/T group (44/63; 69.8%); 0.80 (0.53, 1.21), but this difference was not statistically significant (P=0.50).
Conclusions
In ATTR-ACT, tafamidis was shown to significantly improve survival, functional capacity, and quality of life in patients with ATTR-CM. This pooled analysis with data from the ongoing extension study further supports the efficacy of tafamidis in patients over a longer period of time and the importance of early diagnosis and treatment.
Acknowledgement/Funding
This study was sponsored by Pfizer.
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Affiliation(s)
- P Elliott
- University College London, London, United Kingdom
| | - B M Drachman
- Penn Presbyterian Medical Center, University of Pennsylvania Health System, Philadelphia, United States of America
| | - S S Gottlieb
- University of Maryland, School of Medicine, Baltimore, United States of America
| | - J E Hoffman
- University of Miami, Miami, United States of America
| | - S L Hummel
- University of Michigan, Ann Arbor, United States of America
| | - D J Lenihan
- Washington University School of Medicine, St. Louis, United States of America
| | - B Ebede
- Pfizer Inc, Collegeville, United States of America
| | | | | | - M B Sultan
- Pfizer Inc, New York, United States of America
| | - S J Shah
- Northwestern University Feinberg School of Medicine, Division of Cardiology, Department of Medicine, Chicago, United States of America
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11
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Beldhuis IE, Myhre PL, Claggett B, Damman K, Fang JC, Lewis EF, O'Meara E, Pitt B, Shah SJ, Voors AA, Pfeffer MA, Solomon SD, Desai AS. P6508Balance of risk and benefit of spironolactone according to renal function in heart failure patients with preserved ejection fraction. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p6508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- I E Beldhuis
- Brigham and Women's Hospital, Cardiovascular Division, Boston, United States of America
| | - P L Myhre
- Brigham and Women's Hospital, Cardiovascular Division, Boston, United States of America
| | - B Claggett
- Brigham and Women's Hospital, Cardiovascular Division, Boston, United States of America
| | - K Damman
- University Medical Center Groningen, Department of Cardiology, Groningen, Netherlands
| | - J C Fang
- University of Utah School of Medicine, Salt Lake City, United States of America
| | - E F Lewis
- Brigham and Women's Hospital, Cardiovascular Division, Boston, United States of America
| | - E O'Meara
- Montreal Heart Institute, Montreal, Canada
| | - B Pitt
- University of Michigan School of Medicine, Ann Arbor, United States of America
| | - S J Shah
- Northwestern University Medical Center, Division of Cardiology, Chicago, United States of America
| | - A A Voors
- University Medical Center Groningen, Department of Cardiology, Groningen, Netherlands
| | - M A Pfeffer
- Brigham and Women's Hospital, Cardiovascular Division, Boston, United States of America
| | - S D Solomon
- Brigham and Women's Hospital, Cardiovascular Division, Boston, United States of America
| | - A S Desai
- Brigham and Women's Hospital, Cardiovascular Division, Boston, United States of America
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Stecklein SR, Babiera GV, Bedrosian I, Shaitelman SF, Ballo MT, Tereffe W, Arzu IY, Perkins GH, Strom EA, Reed VK, Dvorak T, Smith BD, Woodward WA, Hoffman KE, Schlembach PJ, Chronowski GM, Shah SJ, Kirsner SM, Nelson CL, Guerra W, Dibaj SS, Bloom ES. Abstract P2-11-12: Prospective comparison of late toxicity and cosmetic outcome after accelerated partial breast irradiation with conformal external beam radiotherapy or single-entry multi-lumen intracavitary brachytherapy. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p2-11-12] [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
Purpose/Objective(s):
To prospectively compare late toxicity after accelerated partial breast irradiation (APBI) with 3D-conformal external beam radiotherapy (3D-CRT) or single-entry multi-lumen intracavitary brachytherapy.
Patients/Methods:
Two hundred eighty-one patients with pTis or pT2N0 (≤3.0 cm) breast cancer treated with segmental mastectomy were prospectively enrolled on a multi-institution observational protocol from 12/2008 – 8/2014. Patients were enrolled and treated at primary, satellite, and affiliated academic institutions. APBI was delivered using 3D-CRT or with a Contura®, MammoSite®, or SAVI® brachytherapy catheter. 3D-CRT patients were treated to 34.0 Gy (7%) or 38.5 Gy (93%) at 3.4-3.85 Gy/fx BID and brachytherapy patients were treated to 34.0 Gy at 3.4 Gy/fx BID. Per protocol, patients were clinically evaluated at 2, 6, 12, 18, and 24 months and then annually. At each clinical evaluation the radiation oncologist scored cosmetic outcome (excellent/good/fair/poor according to the Harvard Cosmesis Scale), toxicity (seroma/infection/fat necrosis/pain/telangiectasia/radiation dermatitis/hyperpigmentation/hypopigmentation/fibrosis/induration/edema/other according to CTCAE v3.0) and recurrence status.
Results:
The median age was 61 years. Of 281 patients, 211 (75%) had invasive breast cancer and 70 (25%) had in situ disease. Among patients with invasive disease, 90% were HR+/HER2-, and among patients with in situ disease, 83% were HR+. APBI was delivered with 3D-CRT in 29 (10%) patients and with single-entry multi-lumen intracavitary brachytherapy in 252 (90%) patients. Among the brachytherapy patients, APBI was delivered with the SAVI®, Contura®, and MammoSite® devices in 176 (70%), 56 (22%), and 20 (8%) patients, respectively. With a median follow-up of 49 months, rates of Grade 1 (G1) and Grade 2-3 (G2-3) toxicity are:
3D-CRTBrachytherapy G1G2-3G1G2-3G1G2-3 N (%)N (%)N (%)N (%) Fibrosis13 (46%)1 (4%)176 (72%)6 (2%)p=0.008p=0.54Fat Necrosis0 (0%)0 (0%)0 (0%)4 (2%)p=1.00p=1.00Telangiectasia6 (21%)1 (4%)44 (18%)5 (2%)p=0.61p=0.48Seroma2 (7%)1 (4%)135 (55%)12 (5%)p<0.0001p=1.00
Mean skin dose of the maximally-irradiated 0.1 cc (D0.1cc) of skin was significantly higher in patients who developed telangiectasia (103.4% ± 16.1% compared to 96.5% ± 18.6% of prescription dose, p=0.007) and fibrosis (100.1% ± 15.5% compared to 92.8% ± 23.0% of prescription dose, p=0.02). Crude rates of fair or poor cosmetic outcome at 2-4 and 4-6 years were 6.9% and 14.8%, respectively, for 3D-CRT and 14.8% and 21.3%, respectively, for brachytherapy (p>0.05 at both timepoints). Five-year recurrence-free survival was 96.3% with 3D-CRT and 96.1% for brachytherapy (p>0.05).
Conclusion:
APBI with single-entry multi-lumen intracavitary brachytherapy is associated with increased rates of grade 1 fibrosis and seroma than APBI with 3D-CRT. Higher mean skin D0.1cc is associated with increased risk of telangiectasia and fibrosis. Despite increased low-grade fibrosis, there is no significant difference in radiation oncologist-reported fair or poor cosmetic outcome out to six years, or rate of five-year ipsilateral breast recurrence.
Citation Format: Stecklein SR, Babiera GV, Bedrosian I, Shaitelman SF, Ballo MT, Tereffe W, Arzu IY, Perkins GH, Strom EA, Reed VK, Dvorak T, Smith BD, Woodward WA, Hoffman KE, Schlembach PJ, Chronowski GM, Shah SJ, Kirsner SM, Nelson CL, Guerra W, Dibaj SS, Bloom ES. Prospective comparison of late toxicity and cosmetic outcome after accelerated partial breast irradiation with conformal external beam radiotherapy or single-entry multi-lumen intracavitary brachytherapy [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 P2-11-12.
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Affiliation(s)
- SR Stecklein
- The University of Texas MD Anderson Cancer Center, Houston, TX; The University of Tennessee Health Science Center, Memphis, TN; UFHealth Cancer Center / Orlando Health, Orlando, FL
| | - GV Babiera
- The University of Texas MD Anderson Cancer Center, Houston, TX; The University of Tennessee Health Science Center, Memphis, TN; UFHealth Cancer Center / Orlando Health, Orlando, FL
| | - I Bedrosian
- The University of Texas MD Anderson Cancer Center, Houston, TX; The University of Tennessee Health Science Center, Memphis, TN; UFHealth Cancer Center / Orlando Health, Orlando, FL
| | - SF Shaitelman
- The University of Texas MD Anderson Cancer Center, Houston, TX; The University of Tennessee Health Science Center, Memphis, TN; UFHealth Cancer Center / Orlando Health, Orlando, FL
| | - MT Ballo
- The University of Texas MD Anderson Cancer Center, Houston, TX; The University of Tennessee Health Science Center, Memphis, TN; UFHealth Cancer Center / Orlando Health, Orlando, FL
| | - W Tereffe
- The University of Texas MD Anderson Cancer Center, Houston, TX; The University of Tennessee Health Science Center, Memphis, TN; UFHealth Cancer Center / Orlando Health, Orlando, FL
| | - IY Arzu
- The University of Texas MD Anderson Cancer Center, Houston, TX; The University of Tennessee Health Science Center, Memphis, TN; UFHealth Cancer Center / Orlando Health, Orlando, FL
| | - GH Perkins
- The University of Texas MD Anderson Cancer Center, Houston, TX; The University of Tennessee Health Science Center, Memphis, TN; UFHealth Cancer Center / Orlando Health, Orlando, FL
| | - EA Strom
- The University of Texas MD Anderson Cancer Center, Houston, TX; The University of Tennessee Health Science Center, Memphis, TN; UFHealth Cancer Center / Orlando Health, Orlando, FL
| | - VK Reed
- The University of Texas MD Anderson Cancer Center, Houston, TX; The University of Tennessee Health Science Center, Memphis, TN; UFHealth Cancer Center / Orlando Health, Orlando, FL
| | - T Dvorak
- The University of Texas MD Anderson Cancer Center, Houston, TX; The University of Tennessee Health Science Center, Memphis, TN; UFHealth Cancer Center / Orlando Health, Orlando, FL
| | - BD Smith
- The University of Texas MD Anderson Cancer Center, Houston, TX; The University of Tennessee Health Science Center, Memphis, TN; UFHealth Cancer Center / Orlando Health, Orlando, FL
| | - WA Woodward
- The University of Texas MD Anderson Cancer Center, Houston, TX; The University of Tennessee Health Science Center, Memphis, TN; UFHealth Cancer Center / Orlando Health, Orlando, FL
| | - KE Hoffman
- The University of Texas MD Anderson Cancer Center, Houston, TX; The University of Tennessee Health Science Center, Memphis, TN; UFHealth Cancer Center / Orlando Health, Orlando, FL
| | - PJ Schlembach
- The University of Texas MD Anderson Cancer Center, Houston, TX; The University of Tennessee Health Science Center, Memphis, TN; UFHealth Cancer Center / Orlando Health, Orlando, FL
| | - GM Chronowski
- The University of Texas MD Anderson Cancer Center, Houston, TX; The University of Tennessee Health Science Center, Memphis, TN; UFHealth Cancer Center / Orlando Health, Orlando, FL
| | - SJ Shah
- The University of Texas MD Anderson Cancer Center, Houston, TX; The University of Tennessee Health Science Center, Memphis, TN; UFHealth Cancer Center / Orlando Health, Orlando, FL
| | - SM Kirsner
- The University of Texas MD Anderson Cancer Center, Houston, TX; The University of Tennessee Health Science Center, Memphis, TN; UFHealth Cancer Center / Orlando Health, Orlando, FL
| | - CL Nelson
- The University of Texas MD Anderson Cancer Center, Houston, TX; The University of Tennessee Health Science Center, Memphis, TN; UFHealth Cancer Center / Orlando Health, Orlando, FL
| | - W Guerra
- The University of Texas MD Anderson Cancer Center, Houston, TX; The University of Tennessee Health Science Center, Memphis, TN; UFHealth Cancer Center / Orlando Health, Orlando, FL
| | - SS Dibaj
- The University of Texas MD Anderson Cancer Center, Houston, TX; The University of Tennessee Health Science Center, Memphis, TN; UFHealth Cancer Center / Orlando Health, Orlando, FL
| | - ES Bloom
- The University of Texas MD Anderson Cancer Center, Houston, TX; The University of Tennessee Health Science Center, Memphis, TN; UFHealth Cancer Center / Orlando Health, Orlando, FL
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Farge D, Burt RK, Oliveira MC, Mousseaux E, Rovira M, Marjanovic Z, de Vries-Bouwstra J, Del Papa N, Saccardi R, Shah SJ, Lee DC, Denton C, Alexander T, Kiely DG, Snowden JA. Cardiopulmonary assessment of patients with systemic sclerosis for hematopoietic stem cell transplantation: recommendations from the European Society for Blood and Marrow Transplantation Autoimmune Diseases Working Party and collaborating partners. Bone Marrow Transplant 2017; 52:1495-1503. [PMID: 28530671 PMCID: PMC5671927 DOI: 10.1038/bmt.2017.56] [Citation(s) in RCA: 78] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Accepted: 01/29/2017] [Indexed: 02/07/2023]
Abstract
Systemic sclerosis (SSc) is a rare disabling autoimmune disease with a similar mortality to many cancers. Two randomized controlled trials of autologous hematopoietic stem cell transplantation (AHSCT) for SSc have shown significant improvement in organ function, quality of life and long-term survival compared to standard therapy. However, transplant-related mortality (TRM) ranged from 3–10% in patients undergoing HSCT. In SSc, the main cause of non-transplant and TRM is cardiac related. We therefore updated the previously published guidelines for cardiac evaluation, which should be performed in dedicated centers with expertize in HSCT for SSc. The current recommendations are based on pre-transplant cardiopulmonary evaluations combining pulmonary function tests, echocardiography, cardiac magnetic resonance imaging and invasive hemodynamic testing, initiated at Northwestern University (Chicago) and subsequently discussed and endorsed within the EBMT ADWP in 2016.
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Affiliation(s)
- D Farge
- Department of Internal Medicine, Unité Clinique de Médecine Interne, Maladies Auto-immunes et Pathologie Vasculaire, UF 04, Hôpital Saint-Louis, AP-HP Assistance Publique des Hôpitaux de Paris, INSERM UMRS 1160, Paris Denis Diderot University, Paris, France
| | - R K Burt
- Department of Medicine, Division of Immunotherapy, Northwestern University, Chicago, IL, USA
| | - M-C Oliveira
- Departamento de Clínica Médica, Center for Cell-based Therapy, Regional Blood Center of Ribeirão Preto, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - E Mousseaux
- Hôpital Européen Georges Pompidou, AP-HP Assistance Publique des Hôpitaux de Paris, INSERM UMR 970, Université Paris Descartes, Paris, France
| | - M Rovira
- Department of Hematology, HSCT Unit, Hospital Clinic, Barcelona, Spain
| | - Z Marjanovic
- Department of Hematology, Saint-Antoine Hospital Paris, Assistance Publique des Hôpitaux de Paris, APHP, Paris, France
| | | | - N Del Papa
- Department of Rheumatology, Scleroderma Clinic, Osp. G. Pini, Milan, Italy
| | - R Saccardi
- Department of Hematology, Cord Blood Bank, Careggi University Hospital, Florence, Italy
| | - S J Shah
- Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - D C Lee
- Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - C Denton
- UCL Division of Medicine Royal Free Campus, London, UK
| | - T Alexander
- Department of Rheumatology and Clinical Immunology, Charité University Medicine Berlin, Berlin, Germany
| | - D G Kiely
- Sheffield Pulmonary Vascular Disease Unit, M-floor, Royal Hallamshire Hospital, Sheffield, UK
| | - J A Snowden
- Department of Haematology, Sheffield Teaching Hospitals NHS Foundation Trust, University of Sheffield, Sheffield, UK
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Kia L, Shah SJ, Wang E, Sharma D, Selvaraj S, Medina C, Cahan J, Mahon H, Levitsky J. Role of pretransplant echocardiographic evaluation in predicting outcomes following liver transplantation. Am J Transplant 2013; 13:2395-401. [PMID: 23915391 DOI: 10.1111/ajt.12385] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2012] [Revised: 05/27/2013] [Accepted: 06/02/2013] [Indexed: 01/25/2023]
Abstract
Maintenance of cardiac function is critical to the survival of patients with end-stage liver disease after liver transplantation (LT). We sought to determine whether pre-LT echocardiographic indices of right heart structure and function were independently predictive of morbidity and mortality post-LT. We retrospectively studied 216 consecutive patients who underwent pre-LT 2-dimensional/Doppler echocardiography with subsequent LT from 2007 to 2010. A blinded reader analyzed multiple echocardiographic parameters, including right ventricular structure and function, pulmonary artery systolic pressure (PASP) and the presence and severity of tricuspid regurgitation (TR). On univariate analysis, Model of End-Stage Liver Disease (MELD) score, PASP, presence of ≥mild TR, post-operative renal replacement therapy (RRT) and spontaneous bacterial peritonitis were found to be significant predictors of adverse outcomes. On multivariate analysis, only ≥mild TR was found to predict both patient mortality (p = 0.0024, HR = 3.91, 95% CI: 1.62-9.44) and graft failure (p = 0.0010, HR = 3.70, 95% CI: 1.70-8.06). PASP and MELD correlated with post-LT intensive care unit length of stay (LOS) and, along with hemodialysis, were associated with hospital LOS and time on ventilator. In conclusion, pre-LT echocardiographic assessments of the right heart may be useful in predicting post-LT morbidity and mortality and guiding the selection of appropriate LT candidates.
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Affiliation(s)
- L Kia
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
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Abstract
The aim of this study was to define the epidemiology of World Health Organization (WHO) Group I pulmonary arterial hypertension (PAH) in a large referral centre in the USA. The Pulmonary Hypertension Connection registry, initiated in 2004, evaluated all patients in a single USA practice from 1982-2006. For comparison, the authors divided the group by incident versus prevalent cohorts, aetiology and by treatment era. In total, 578 patients (77% female) aged 48+/-14 yrs were entered. Of these, 80% had class III or IV symptoms. Over time, connective tissue disease-associated PAH increased, while referrals for HIV remained low. One-third of patients were referred on calcium channel blocker therapy even though only 4.6% had an acute response to vasodilator challenge. When compared by treatment era, there were no differences in the severity of PAH. However, survival had improved over time, with a 1-yr survival of 85% in the incident cohort. In the USA, pulmonary arterial hypertension patients are still referred to tertiary centres too late. Referral of connective tissue disease is increasing, while referral of HIV remains low. Inappropriate calcium channel blocker treatment is common. Survival rates have increased but remain low suggesting that prognosis is improving but PAH is still a progressive, fatal disease.
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Affiliation(s)
- T Thenappan
- Department of Medicine, University of Chicago, IL, USA
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17
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Abstract
Electromagnetic ultra-wideband pulses (UWB) or nanopulses, are generated by a wide range of electronic devices used in communications and radar technology. However, the specific effects of nanopulse exposure on cell growth and function have not been extensively investigated. Here, studies have been conducted to determine the effects of prolonged exposure to non-ionizing, low to moderate intensity nanopulses on the growth of pre-neoplastic CL-S1 mammary epithelial cells in vitro. Cells were grown in culture and maintained in serum-free defined medium containing 10 ng/ml EGF and 10 microg/ml insulin as comitogens. Studies showed that 0.25-3.0 h exposure to nanopulses of 18 kV/m field intensity, 1 kHz repetition rate and 10 ns pulse width had no effect on CL-S1 cell growth or viability during the subsequent 72-h culture period. However, exposure to similar nanopulses for prolonged periods of time (4-6 h) resulted in a significant increase in cell proliferation, as compared to untreated controls. Additional studies showed that nanopulse exposure enhanced CL-S1 cell growth when cells were maintained in media containing only EGF, but had no effect on cells maintained in defined media that were mitogen-free or containing only insulin. Studies also showed that the growth-promoting effects of nanopulse exposure were associated with a relatively large increase in intracellular levels of phospho-MEK1 (active) and phospho-ERK1/2 (active) in these cells. These findings demonstrate that prolonged exposure to moderate levels of UWB enhanced EGF-dependent mitogenesis, and that this growth-promoting effect appears to be mediated by enhanced activation of the mitogen-activated protein kinase (MAPK) signalling pathway in pre-neoplastic CL-S1 mammary epithelial cells.
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Affiliation(s)
- P W Sylvester
- School of Pharmacy, University of Louisiana at Monroe, Monroe, LA 71209-0470, USA.
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18
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Vaidya RA, Vaidya ADB, Talwalkar SC, Mehtalia SD, Shringi MS, Pandey SN, Shah SJ, Godse C, Joshi JV, Sheth J, Kamdar VV. Clinical, endocrine and metabolic studies in the kindred of familial partial lipodystrophy--a syndrome of insulin resistance. J Assoc Physicians India 2002; 50:773-6. [PMID: 12240840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
Abstract
OBJECTIVE To study clinical, endocrine and metabolic profiles in the kindred of subjects with familial partial lipodystrophy (FPLD, Dunnigan type). MATERIAL AND METHODS Twenty two relatives (10 males, 12 females), from an extended family with FPLD, were assessed for the phenotypic features, impaired glucose tolerance (IGT)/diabetes mellitus (DM), dyslipidemia and the presence of insulin resistance. Plasma glucose and serum lipids were measured using glucose oxidase and standard colorimetric methods. Serum insulin was estimated by radioimmunoassay. RESULTS The age was 12 to 67 years, two being adolescents. Two of the 20 adults were overweight and eight were underweight; BMI (adults) was 15.5 to 28.5. Features of FPLD were evident among eight out of 12 women. This typical phenotype was not obvious in all 10 male members. Varying degree of Hirsuitism was observed in four of 12 women, acanthosis nigricans in 11 out of 22 members and skin tags were present in only eight of 22; hypertension in six members and diabetes in four. Eleven members had either impaired glucose tolerance (IGT) (n=7), or DM (n=4). Ten of 20 members showed hyperinsulinemic response on oral glucose tolerance test (OGTT). Dyslipidemia was present in 13 family members. CONCLUSION The majority (2/3rd) of female members showed typical phenotypic features of FPLD, with a clustering of cardiovascular risk factors and insulin resistance syndrome. More than half the men without phenotypic features of FPLD had either IGT/DM, dyslipidemia, hypertension or cardiovascular disease.
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19
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Shah SJ, Taub JW, Witt TL, Pollock BH, Ding BC, Moore DS, Amylon M, Pullen J, Ravindranath Y, Matherly LH. Relationship of p15 and p16 gene alterations to elevated dihydrofolate reductase in childhood acute lymphoblastic leukaemia. Br J Haematol 2001; 113:746-56. [PMID: 11380466 DOI: 10.1046/j.1365-2141.2001.02775.x] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The downstream effects of p15 and p16 gene deletions and loss of transcripts on dihydrofolate reductase (DHFR) were examined in 63 B-precursor (BP) acute lymphoblastic leukaemia (ALL) samples. p15 and/or p16 gene deletions were seen in 6% and 8%, respectively, of BP-ALL samples; however, losses of p15 and/or p16 transcripts were seen in 26 out of 63 (41%) samples. Loss of p15 transcripts (36.5%) exceeded that for p16 (17.5%). For the 26 BP-ALLs that lacked p15 and/or p16 transcripts, only six (23%) exhibited low levels of DHFR by flow cytometry assay with Pt430, a fluorescent anti-folate. Conversely, 18 out of 37 (49%) BP-ALL samples with intact p15 and/or p16 genes and transcripts showed low levels of DHFR (P = 0.04). In p15- and p16-null K562 cells transfected with a tetracycline-inducible p15 cDNA construct, induction of p15 transcripts and protein was accompanied by decreased growth rates, decreased S-phase fraction, decreased retinoblastoma protein phosphorylation, and markedly reduced levels of DHFR transcripts and protein. Collectively, our results suggest that losses of p15 and/or p16 gene expression result in elevated levels of DHFR in BP-ALL in children. However, additional downstream factors undoubtedly also contribute to elevated levels of this enzyme target.
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Affiliation(s)
- S J Shah
- Experimental and Clinical Therapeutics Program, Barbara Ann Karmanos Cancer Institute, Detroit, Michigan, USA
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20
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Abstract
OBJECTIVES To assess trauma patients' frequency of sleep problems, to evaluate their injuries in the context of their sleep habits, and to determine how often ED health care workers (HCWs) inquire about sleep complaints. METHODS This was a prospective observational study of patients evaluated in the ED for unintentional trauma. Patients answered a "sleep survey" that was reviewed for the amount and timing of sleep in the preinjury period and for indications of a sleep problem. Preinjury sleep characteristics were compared with the individual's usual habits, and the group's sleep features were compared with "normal" sleep and the prevalence of sleep problems in historical controls. RESULTS Seventy patients were surveyed. Mechanisms and types of injury included motor vehicle collisions (MVCs), falls, lacerations, bruises, sprains, and fractures. The mean total sleep time in the preinjury period (6.9 hours) was significantly shorter than that obtained during usual weekday and weekend sleep. Twenty-four patients (34.3%) were at high risk for a sleep problem. Few patients thought a sleep problem contributed to the injury. No other ED HCW asked about the patient's sleep habits. CONCLUSIONS Acute sleep deprivation in the preinjury period, and chronic sleep deprivation with a variety of other sleep problems are found in this patient population. Despite the association of sleep problems and certain types of injury (e.g., MVC), ED HCWs do not inquire about sleep in their initial ED evaluations. This important issue may be overlooked in trauma risk assessment and prevention.
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Affiliation(s)
- R Goldberg
- Department of Internal Medicine, MCP-Hahnemann University, Philadelphia, PA 19129, USA.
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21
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Feinglass J, Brown JL, LoSasso A, Sohn MW, Manheim LM, Shah SJ, Pearce WH. Rates of lower-extremity amputation and arterial reconstruction in the United States, 1979 to 1996. Am J Public Health 1999; 89:1222-7. [PMID: 10432910 PMCID: PMC1508694 DOI: 10.2105/ajph.89.8.1222] [Citation(s) in RCA: 93] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES This report describes trends in the rates of lower-extremity amputation and revascularization procedures and vascular disease risk factors. METHODS We analyzed trends in National Hospital Discharge Survey data for 1979 through 1996 and in National Health Interview Study data for 1983 through 1994. RESULTS Despite a decline between 1983/84 and 1991/92, by 1995/96 the rate of major amputation had increased 10.6% since 1979/80. The earlier 12-year decline was positively correlated with reductions in the prevalence of smoking (r = 0.88, P < .0001), hypertension (r = 0.65, P = .02), and heart disease (r = 0.73, P = .007), but not diabetes (r = -0.33, P = .29). During the 1980s, amputation and angioplasty rates were inversely correlated (r = -0.75, P = .001), but the decline in amputation rates occurred before the increase in angioplasty. The major amputation rate, which has increased since 1993, was 24.95 per 100,000 people in 1996. CONCLUSIONS Major amputation rates fell in the years following the diffusion of distal bypass surgery but before the widespread use of peripheral angioplasty. Because disease prevalence and primary amputation rates are unknown, it is difficult to estimate the contribution of recent improvements in vascular surgery to limb preservation.
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Affiliation(s)
- J Feinglass
- Division of General Internal Medicine, Northwestern University Medical School, Chicago, Ill., USA.
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22
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Argekar AP, Shah SJ. Simultaneous determination of cinnarizine and domepiridone maleate from tablet dosage form by reverse phase ion pair high performance liquid chromatography. J Pharm Biomed Anal 1999; 19:813-7. [PMID: 10698546 DOI: 10.1016/s0731-7085(98)00103-4] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.1] [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: 11/20/2022]
Abstract
A new simple, precise, rapid and selective reverse phase ion pair high performance liquid chromatography (HPLC-RP) method has been developed for the simultaneous determination of cinnarizine (CINN) and domepiridone maleate (DOME) from tablets using acetonitrile-methanol-water-0.1 N sulfuric acid (37:10:48:5 v/v/v/v) containing sodium lauryl sulfate (0.01 M), as a mobile phase and a Machery Nagel nitrile column (10 microns, 25 cm x 4.0 mm i.d.) as the stationary phase. The flow of mobile phase through the column was kept at 1.0 ml min(-1) through out the analysis. Detection was carried out using a UV detector at 225 nm. The retention times for CINN and DOME were 4.73 and 9.41 min, respectively. The linearity range and percentage recoveries for CINN and DOME were 4 1000 and 60-750 microg ml(-1) and 99.90 and 99.60%, respectively.
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Affiliation(s)
- A P Argekar
- Department of Chemistry, The Institute of Science, Mumbai, India
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23
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Abstract
1. The main objective of this study was to determine whether eccentric contraction-induced muscle injury causes impaired plasmalemmal action potential conduction, which could explain the injury-induced excitation-contraction coupling failure. Mice were chronically implanted with stimulating electrodes on the left common peroneal nerve and with electromyographic (EMG) electrodes on the left tibialis anterior (TA) muscle. The left anterior crural muscles of anaesthetized mice were stimulated to perform 150 eccentric (ECC) (n = 12 mice) or 150 concentric (CON) (n = 11 mice) contractions. Isometric torque, EMG root mean square (RMS) and M-wave mean and median frequencies were measured before, immediately after, and at 1, 3, 5 and 14 days after the protocols. In parallel experiments, nicotinic acetylcholine receptor (AChR) concentration was measured in TA muscles to determine whether the excitation failure elicited a denervation-like response. 2. Immediately after the ECC protocol, torque was reduced by 47-89 %, while RMS was reduced by 9-21 %; the RMS decrement was not different from that observed for the CON protocol, which did not elicit large torque deficits. One day later, both ECC and CON RMS had returned to baseline values and did not change over the next 2 weeks. However, torque production by the ECC group showed a slow recovery over that time and was still depressed by 12-30 % after 2 weeks. M-wave mean and median frequencies were not affected by performance of either protocol. 3. AChR concentration was elevated by 79 and 368 % at 3 and 5 days, respectively, after the ECC protocol; AChR concentration had returned to control levels 2 weeks after the protocol. At the time of peak AChR concentration in the ECC protocol muscles (i.e. 5 days), AChR concentration in CON protocol muscles was not different from the control level. 4. In conclusion, these data demonstrate no major role for impaired plasmalemmal action potential conduction in the excitation-contraction coupling failure induced by eccentric contractions. Additionally, a muscle injured by eccentric contractions shows a response in AChR concentration similar to a transiently denervated muscle.
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Affiliation(s)
- G L Warren
- Muscle Biology Laboratory, Texas A&M University, College Station, TX 77843, USA.
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24
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Argekar AP, Shah SJ, Raj SV. Simultaneous determination of pseudoephidrine HCl (PSE) and terfanidine (TER) from formulations by reversed-phase ion pair high-performance liquid chromatography (RP-HPLC). Drug Dev Ind Pharm 1998; 24:219-23. [PMID: 9876578 DOI: 10.3109/03639049809085613] [Citation(s) in RCA: 8] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
A new simple, precise, rapid, and selective reversed-phase ion pair high-performance liquid chromatography (RP-HPLC) method has been developed for the simultaneous determination of pseudoephidrine (PSE) and terfanidine (TER) from tablets using 60:15:25 acetontrile:methanol:water (v/v) containing 2.9 g sodium lauryl sulfate/liter, pH adjusted to 3.1 using phosphoric acid as a mobile phase and C18 Spherisorb ODS 2 (3 microns, 5 cm x 4.6 mm i.d.) as stationary phase. Detection was carried out using a UV detector at 254 nm. A constant flow of 1.0 ml/min was maintained throughout the analysis. Retention times for PSE and TER were 1.90 and 7.35 min, respectively. Linearity range and percentage recoveries for PSE and TER were 24-1200 and 12-600 micrograms/ml, and 100.01 and 100.4%, respectively.
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Affiliation(s)
- A P Argekar
- Department of Chemistry, Institute of Science, Mumbai, India
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25
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Abstract
Malignant fibrous histiocytoma (MFH), an aggressive high-grade soft tissue sarcoma, usually occurs in the elderly during the fifth to seventh decade of life. It commonly arises in the retroperitoneum, extremities, and head and neck region. Primary pulmonary MFH is extremely rare and is frequently fatal. We present the youngest known case, a 9-year-old boy with a primary left lung grade II inflammatory MFH, stage II. He underwent a left upper lobectomy for tumor resection. After completing radiation therapy, he was started on vincristine, actinomycin D, and cyclophosphamide alternating with vincristine, doxorubicin, and cyclophosphamide every 3 weeks. After five such cycles, he had a histologically proven local recurrence. He then received chemotherapy consisting of ifosfamide (2 g/m2) and etoposide (VP-16) (100 mg/m2) given daily for 3 days every 3 weeks. The patient attained complete remission (CR) after five such cycles and completed treatment without any major complications. He received a total of 16 courses and is continuing in CR 36 months off treatment. Ifosfamide and etoposide (VP-16), known for their usefulness in treatment of adult soft tissue sarcomas, can be used as salvage chemotherapy for patients with MFH who fail the front-line conventional chemotherapy.
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Affiliation(s)
- S J Shah
- Louisiana State University Medical Center, New Orleans, USA
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26
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Abstract
PURPOSE We discuss an unusual clinical presentation of Hodgkin disease with immune thrombocytopenia and autoimmune hemolytic anemia. PATIENTS AND METHODS A 4-year-old boy presented to us with a large anterior mediastinal mass, thrombocytopenia, and Coombs' positive hemolytic anemia refractory to transfusion therapy. Biopsy of the anterior mediastinal mass was possible only after administration of intravenous immunoglobulin to raise the platelet count. The immune manifestations decreased with initiation of appropriate chemotherapy. RESULT The child was able to successfully complete chemotherapy and radiation therapy and has no clinical or laboratory evidence of persistent autoimmune phenomena. CONCLUSION Immune thrombocytopenia with autoimmune hemolytic anaemia is a rare presenting manifestation of Hodgkin disease and can present difficulty in diagnosis and management.
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Affiliation(s)
- S J Shah
- Louisiana State University Medical Center and Children's Hospital, New Orleans, USA
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27
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Bhatt AD, Dalal DG, Shah SJ, Joshi BA, Gajjar MN, Vaidya RA, Vaidya AB, Antarkar DS. Conceptual and methodologic challenges of assessing the short-term efficacy of Guggulu in obesity: data emergent from a naturalistic clinical trial. J Postgrad Med 1995; 41:5-7. [PMID: 10740691] [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
An open comparative trial was conducted in 58 adult obese patients (Body Mass Index > or = 25 kg/square metre). Group I (n = 27), non-drug, was advised diet (1200-1600 cals) and a brisk walk for 30 minutes. Group II, in addition, received Guggulu (Medohar) 1.5-3 gms/day for 30 days. Mean difference in weight loss between Guggulu and non-drug group was 0.32 kg (ns) on day 15 and 0.58 kg on day 30 (ns). The mean weight reduction in patients (> 90 kgs) was 1.92 kg (ns) and 2.25 kg (ns) higher in Guggulu group. All patients weighing > 90 kg lost weight in Guggulu group whilst 3 in non-drug group did not lose weight. Guggulu was tolerated well. The data from this pilot study suggest a synergistic diet-Guggulu interaction over 30 days in patients weighing > 90 kgs which needs to be confirmed in a large placebo controlled study.
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Affiliation(s)
- A D Bhatt
- Swami Prakashananda Ayurveda Research Centre, Juhu, Bombay
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28
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Shah SN, Shah SJ. Autonomic nervous system--not forgotten. J Assoc Physicians India 1994; 42:7-8. [PMID: 7836256] [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: 01/27/2023]
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29
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Rais N, Gandhi L, Gotur J, Rajani G, Shah SJ, Kudva BT. The internal myxoedema syndrome of Eskamilla, Lisser and Shepherdson (a case report). J Postgrad Med 1992; 38:32-3. [PMID: 1512723] [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: 12/27/2022] Open
Affiliation(s)
- N Rais
- Endocrine and Metabolic Section, c.m.c., III, Bombay
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30
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Bhatt AD, Nandkarni AM, Shah LP, Bakshi R, Doshi KJ, Shah SJ, Gupta KC, Bhatia SC, Vaidya AB. Pharmacokinetics of nitroxazepine in depressed patients. Indian J Psychiatry 1991; 33:108-12. [PMID: 21897465 PMCID: PMC2988296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
A pharmacokinetic study was done on 10 depressed patients (DSM-III-R 296.3). The patients were treated with Sintamil (R) (nitroxazepine HCl) with titrated dose from 75 mg to 225 mg for 6 weeks. Plasma levels of nitroxazepine (Sintamil (R)) and its metabolites desmethyl (D), N-oxide (N-O) and carboxylic acid (c) were estimated. Anti-depressant efficacy was judged by reduction in Hamilton Rating Depression Scale (HDRS) scores, and tolerability was monitored by reports of unwanted effects.The overall reduction in HDRS score was about 50% by 6 weeks. The plasma levels of nitroxazepin (ng/ral) showed a rise from a mean ( +SEM) level. 47.0 4-7.3 on day 1 (dose 75 mg) to 129.84-24.6 on day 7 (dose 150 mg) (p< 0.01) and remained steady till day 21. There were large interindividual variations. The metabolites followed a similar pattern. The HDRS score showed a steady reduction between day 14 and 42 when the levels of nitroxizepine and des-methyl metabolites were maintained between 176.5 ng/ml to 251 ng/ml.
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Affiliation(s)
- A D Bhatt
- Medical Department, Hindustan CIBA-Geigy Limited, Bombay
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31
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Mukherjee M, Shah SJ. Haemorheology on the horizon. J Assoc Physicians India 1990; 38:791-2. [PMID: 2084087] [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: 12/30/2022]
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32
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Abstract
Computer vision techniques implemented on an IBM PC/AT have been applied to the study of microvascular permeability and interstitial diffusion in dorsal skin flap chamber preparations of hamsters. Experimental data was obtained for the leakage of fluorescent labelled dextran (70,000 daltons) after a precisely controlled mild degree of localized thermal trauma and compared with control data acquired prior to burn injury. Computer vision analysis techniques were applied to convert the fluorescent images into two-dimensional concentration maps. Interstitial diffusion coefficient values were computed from measured extravascular concentration profiles around a vessel of interest, assuming cylindrical or rectangular geometry, and optimally fitting a diffusion model to the data. An increase in the apparent diffusivity after mild thermal trauma was observed. Novel techniques were applied to solve hardware problems related to data acquisition and analysis, and a new library of software was developed to handle specific image processing requirements.
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Affiliation(s)
- S J Aggarwal
- Department of Mechanical Engineering, University of Texas, Austin 78712-1084
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33
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Thatte UM, Shah SJ, Dalvi SS, Suraokar S, Temulkar P, Anklesaria P, Kshirsagar NA. Acute drug interaction between indomethacin and nifedipine in hypertensive patients. J Assoc Physicians India 1988; 36:695-8. [PMID: 3235427] [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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34
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Ghosh SS, Bhatt AD, Bhatia SC, Shah SJ, Banavalikar MM, Shah NN, Revankar SN, Bharucha ED, Desai ND, Gupta KC. Effect of food on the absorption and pharmacokinetics of sulphadiazine and trimethoprim after administration of Aubril to healthy human volunteers. J Assoc Physicians India 1988; 36:607-10. [PMID: 3220810] [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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35
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Dasgupta D, D'Souza M, Shah SJ, Gupta KC, Satoskar RS. Clinical evaluation of chandonium iodide as muscle relaxant. Indian J Med Res 1988; 87:298-302. [PMID: 3397166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
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36
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Shah SJ, Panthaki MH, Banker DD. HLA-A,-B,-C matching in renal transplantation. Indian J Med Res 1988; 87:59-61. [PMID: 3283034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
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37
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38
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Abstract
A case is reported in which a previously patent artery became temporarily occluded during angiography. The authors believe it happened because of incompatibility of the contrast agent ioxaglate (Hexabrix) and papaverine. Extreme caution is recommended whenever a new low-osmolality contrast agent is used in conjunction with a pharmacoangiographic agent.
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39
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Satoskar RR, Shah SJ, Shenoy SG. Evaluation of anti-inflammatory property of curcumin (diferuloyl methane) in patients with postoperative inflammation. Int J Clin Pharmacol Ther Toxicol 1986; 24:651-4. [PMID: 3546166] [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: 01/06/2023]
Abstract
A new model for evaluating nonsteroidal anti-inflammatory drugs (NSAIDs) is described. In this model of postoperative inflammation, the anti-inflammatory activity of curcumin (diferuloyl methane) was investigated in comparison with phenylbutazone and placebo. Phenylbutazone and curcumin produced a better anti-inflammatory response than placebo.
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40
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Shah SJ, Bhandarkar SD, Satoskar RS. Drug interaction between chlorpropamide and non-steroidal anti-inflammatory drugs, ibuprofen and phenylbutazone. Int J Clin Pharmacol Ther Toxicol 1984; 22:470-2. [PMID: 6500764] [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: 01/20/2023]
Abstract
Diabetics well controlled on chlorpropamide received, in randomized manner either 1200 mg of ibuprofen or 300 mg of phenylbutazone per day for rheumatic pains, for a period of 4 weeks. Fasting and postlunch, whole blood, true sugars (FBS and PLBS) were estimated at weekly intervals. Subjects taking phenylbutazone showed reduction in FBS values throughout the treatment; the reduction became statistically significant at the 3rd and 4th week. Clinical hypoglycemia, however, was not observed. The FBS values returned to pretreatment levels after stopping phenylbutazone. No significant reduction was seen in FBS in subjects taking ibuprofen. There was no significant change in PLBS values in either group.
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41
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Shah SJ, Karnadikar NG, Vaidya SV, Pathak L. Cardiac rehabilitation after myocardial infarction. J Assoc Physicians India 1984; 32:517-9. [PMID: 6511731] [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: 01/20/2023]
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42
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Shah SJ, Fonseca V, Rais N, Sayeed A, Bhandarkar SD. Effect of propranolol on the electrocardiogram in hypothyroidism. J Postgrad Med 1983; 29:160-1. [PMID: 6655603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
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43
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Shah SJ, Trivedi NM, Khamar BM. Cystoid macular oedema in aphakic patients. Indian J Ophthalmol 1983; 31:137-9. [PMID: 6676199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
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44
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Shah SJ, Vyas UH, Khamar BM. Management of aphakic retinal detachment with small, immobile pupil. Indian J Ophthalmol 1983; 31:202-3. [PMID: 6676218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
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45
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Abstract
Radiography revealed aphthous ulcers, plaquelike erosions, and deep collar button ulcerations in a patient with herpes involving the rectum and the sigmoid colon. It is concluded that herpes simplex virus should be added to the list of disease entities that produce aphthous and collar button ulcerations.
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46
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Pathak L, Shah SJ. Two dimensional echocardiography. Indian Heart J 1981; 33:1-4. [PMID: 7251000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
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47
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Pathak L, Shah SJ. Echocardiography in I.H.S.S. Indian Heart J 1979; 31:286-90. [PMID: 574854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
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48
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Pathak L, Shah SN, Shah SJ. Significance of stress testing. Indian Heart J 1979; 31:129-31. [PMID: 500099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
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49
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Shah SJ, Shah SN. Controversy of the decade. Coronary artery bypass graft (CABG) surgery. Indian Heart J 1978; 30:134-7. [PMID: 308925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
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50
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Pathak L, Iyengar M, Shah SJ. Verapamil in supraventricular tachycardia. Indian Heart J 1978; 30:163-7. [PMID: 700747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
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