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Pankewitz LR, Hustad KG, Govil S, Perry JC, Hegde S, Tang R, Omens JH, Young AA, McCulloch AD, Arevalo HJ. A universal biventricular coordinate system incorporating valve annuli: Validation in congenital heart disease. Med Image Anal 2024; 93:103091. [PMID: 38301348 DOI: 10.1016/j.media.2024.103091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 11/29/2023] [Accepted: 01/12/2024] [Indexed: 02/03/2024]
Abstract
Universal coordinate systems have been proposed to facilitate anatomic registration between three-dimensional images, data and models of the ventricles of the heart. However, current universal ventricular coordinate systems do not account for the outflow tracts and valve annuli where the anatomy is complex. Here we propose an extension to the 'Cobiveco' biventricular coordinate system that also accounts for the intervalvular bridges of the base and provides a tool for anatomically consistent registration between widely varying biventricular shapes. CobivecoX uses a novel algorithm to separate intervalvular bridges and assign new coordinates, including an inflow-outflow coordinate, to describe local positions in these regions uniquely and consistently. Anatomic consistency of registration was validated using curated three-dimensional biventricular shape models derived from cardiac MRI measurements in normal hearts and hearts from patients with congenital heart diseases. This new method allows the advantages of universal cardiac coordinates to be used for three-dimensional ventricular imaging data and models that include the left and right ventricular outflow tracts and valve annuli.
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Affiliation(s)
- Lisa R Pankewitz
- Simula Research Laboratory, Kristian Augusts gate 23, 0164 Oslo, Norway; Department of Informatics, University of Oslo, Gaustadalléen 23B, 0373 Oslo, Norway
| | - Kristian G Hustad
- Simula Research Laboratory, Kristian Augusts gate 23, 0164 Oslo, Norway
| | - Sachin Govil
- Department of Bioengineering, University of California San Diego, 9500 Gilman Drive, La Jolla, CA, 92093-0412, USA
| | - James C Perry
- Department of Bioengineering, University of California San Diego, 9500 Gilman Drive, La Jolla, CA, 92093-0412, USA; Department of Pediatrics, University of California San Diego, La Jolla, CA, USA
| | - Sanjeet Hegde
- Department of Pediatrics, University of California San Diego, La Jolla, CA, USA
| | - Renxiang Tang
- Department of Bioengineering, University of California San Diego, 9500 Gilman Drive, La Jolla, CA, 92093-0412, USA
| | - Jeffrey H Omens
- Department of Bioengineering, University of California San Diego, 9500 Gilman Drive, La Jolla, CA, 92093-0412, USA; Department of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Alistair A Young
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Andrew D McCulloch
- Department of Bioengineering, University of California San Diego, 9500 Gilman Drive, La Jolla, CA, 92093-0412, USA; Department of Medicine, University of California San Diego, La Jolla, CA, USA.
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Marriott AE, Dagley JL, Hegde S, Steven A, Fricks C, DiCosty U, Mansour A, Campbell EJ, Wilson CM, Gusovsky F, Ward SA, Hong WD, O'Neill P, Moorhead A, McCall S, McCall JW, Taylor MJ, Turner JD. Dirofilariasis mouse models for heartworm preclinical research. Front Microbiol 2023; 14:1208301. [PMID: 37426014 PMCID: PMC10324412 DOI: 10.3389/fmicb.2023.1208301] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 05/30/2023] [Indexed: 07/11/2023] Open
Abstract
Introduction Dirofilariasis, including heartworm disease, is a major emergent veterinary parasitic infection and a human zoonosis. Currently, experimental infections of cats and dogs are used in veterinary heartworm preclinical drug research. Methods As a refined alternative in vivo heartworm preventative drug screen, we assessed lymphopenic mouse strains with ablation of the interleukin-2/7 common gamma chain (γc) as susceptible to the larval development phase of Dirofilaria immitis. Results Non-obese diabetic (NOD) severe combined immunodeficiency (SCID)γc-/- (NSG and NXG) and recombination-activating gene (RAG)2-/-γc-/- mouse strains yielded viable D. immitis larvae at 2-4 weeks post-infection, including the use of different batches of D. immitis infectious larvae, different D. immitis isolates, and at different laboratories. Mice did not display any clinical signs associated with infection for up to 4 weeks. Developing larvae were found in subcutaneous and muscle fascia tissues, which is the natural site of this stage of heartworm in dogs. Compared with in vitro-propagated larvae at day 14, in vivo-derived larvae had completed the L4 molt, were significantly larger, and contained expanded Wolbachia endobacteria titres. We established an ex vivo L4 paralytic screening system whereby assays with moxidectin or levamisole highlighted discrepancies in relative drug sensitivities in comparison with in vitro-reared L4 D. immitis. We demonstrated effective depletion of Wolbachia by 70%-90% in D. immitis L4 following 2- to 7-day oral in vivo exposures of NSG- or NXG-infected mice with doxycycline or the rapid-acting investigational drug, AWZ1066S. We validated NSG and NXG D. immitis mouse models as a filaricide screen by in vivo treatments with single injections of moxidectin, which mediated a 60%-88% reduction in L4 larvae at 14-28 days. Discussion Future adoption of these mouse models will benefit end-user laboratories conducting research and development of novel heartworm preventatives via increased access, rapid turnaround, and reduced costs and may simultaneously decrease the need for experimental cat or dog use.
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Affiliation(s)
- A. E. Marriott
- Department of Tropical Disease Biology, Centre for Drugs and Diagnostics, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, United Kingdom
| | - J. L. Dagley
- Department of Tropical Disease Biology, Centre for Drugs and Diagnostics, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, United Kingdom
| | - S. Hegde
- Department of Tropical Disease Biology, Centre for Drugs and Diagnostics, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, United Kingdom
| | - A. Steven
- Department of Tropical Disease Biology, Centre for Drugs and Diagnostics, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, United Kingdom
| | - C. Fricks
- TRS Laboratories Inc, Athens, GA, United States
| | - U. DiCosty
- TRS Laboratories Inc, Athens, GA, United States
| | - A. Mansour
- TRS Laboratories Inc, Athens, GA, United States
| | - E. J. Campbell
- Department of Infectious Diseases, College of Veterinary Medicine, University of Georgia, Athens, GA, United States
| | - C. M. Wilson
- Department of Infectious Diseases, College of Veterinary Medicine, University of Georgia, Athens, GA, United States
| | - F. Gusovsky
- Eisai Global Health, Cambridge, MA, United States
| | - S. A. Ward
- Department of Tropical Disease Biology, Centre for Drugs and Diagnostics, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, United Kingdom
| | - W. D. Hong
- Department of Chemistry, University of Liverpool, Liverpool, United Kingdom
| | - P. O'Neill
- Department of Chemistry, University of Liverpool, Liverpool, United Kingdom
| | - A. Moorhead
- Department of Infectious Diseases, College of Veterinary Medicine, University of Georgia, Athens, GA, United States
| | - S. McCall
- TRS Laboratories Inc, Athens, GA, United States
| | - J. W. McCall
- TRS Laboratories Inc, Athens, GA, United States
- Department of Infectious Diseases, College of Veterinary Medicine, University of Georgia, Athens, GA, United States
| | - M. J. Taylor
- Department of Tropical Disease Biology, Centre for Drugs and Diagnostics, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, United Kingdom
| | - J. D. Turner
- Department of Tropical Disease Biology, Centre for Drugs and Diagnostics, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, United Kingdom
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Govil S, Crabb BT, Deng Y, Dal Toso L, Puyol-Antón E, Pushparajah K, Hegde S, Perry JC, Omens JH, Hsiao A, Young AA, McCulloch AD. A deep learning approach for fully automated cardiac shape modeling in tetralogy of Fallot. J Cardiovasc Magn Reson 2023; 25:15. [PMID: 36849960 PMCID: PMC9969707 DOI: 10.1186/s12968-023-00924-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 01/25/2023] [Indexed: 03/01/2023] Open
Abstract
BACKGROUND Cardiac shape modeling is a useful computational tool that has provided quantitative insights into the mechanisms underlying dysfunction in heart disease. The manual input and time required to make cardiac shape models, however, limits their clinical utility. Here we present an end-to-end pipeline that uses deep learning for automated view classification, slice selection, phase selection, anatomical landmark localization, and myocardial image segmentation for the automated generation of three-dimensional, biventricular shape models. With this approach, we aim to make cardiac shape modeling a more robust and broadly applicable tool that has processing times consistent with clinical workflows. METHODS Cardiovascular magnetic resonance (CMR) images from a cohort of 123 patients with repaired tetralogy of Fallot (rTOF) from two internal sites were used to train and validate each step in the automated pipeline. The complete automated pipeline was tested using CMR images from a cohort of 12 rTOF patients from an internal site and 18 rTOF patients from an external site. Manually and automatically generated shape models from the test set were compared using Euclidean projection distances, global ventricular measurements, and atlas-based shape mode scores. RESULTS The mean absolute error (MAE) between manually and automatically generated shape models in the test set was similar to the voxel resolution of the original CMR images for end-diastolic models (MAE = 1.9 ± 0.5 mm) and end-systolic models (MAE = 2.1 ± 0.7 mm). Global ventricular measurements computed from automated models were in good agreement with those computed from manual models. The average mean absolute difference in shape mode Z-score between manually and automatically generated models was 0.5 standard deviations for the first 20 modes of a reference statistical shape atlas. CONCLUSIONS Using deep learning, accurate three-dimensional, biventricular shape models can be reliably created. This fully automated end-to-end approach dramatically reduces the manual input required to create shape models, thereby enabling the rapid analysis of large-scale datasets and the potential to deploy statistical atlas-based analyses in point-of-care clinical settings. Training data and networks are available from cardiacatlas.org.
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Affiliation(s)
- Sachin Govil
- Department of Bioengineering, University of California San Diego, 9500 Gilman Drive, MC 0412, La Jolla, CA 92093-0412 USA
| | - Brendan T. Crabb
- Department of Bioengineering, University of California San Diego, 9500 Gilman Drive, MC 0412, La Jolla, CA 92093-0412 USA
| | - Yu Deng
- Department of Biomedical Engineering, King’s College London, London, UK
| | - Laura Dal Toso
- Department of Biomedical Engineering, King’s College London, London, UK
| | | | | | - Sanjeet Hegde
- Department of Pediatrics, University of California San Diego, La Jolla, CA USA
- Division of Cardiology, Rady Children’s Hospital San Diego, San Diego, CA USA
| | - James C. Perry
- Department of Pediatrics, University of California San Diego, La Jolla, CA USA
- Division of Cardiology, Rady Children’s Hospital San Diego, San Diego, CA USA
| | - Jeffrey H. Omens
- Department of Bioengineering, University of California San Diego, 9500 Gilman Drive, MC 0412, La Jolla, CA 92093-0412 USA
| | - Albert Hsiao
- Department of Radiology, University of California San Diego, La Jolla, CA USA
| | - Alistair A. Young
- Department of Biomedical Engineering, King’s College London, London, UK
| | - Andrew D. McCulloch
- Department of Bioengineering, University of California San Diego, 9500 Gilman Drive, MC 0412, La Jolla, CA 92093-0412 USA
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Govil S, Mauger C, Hegde S, Occleshaw CJ, Yu X, Perry JC, Young AA, Omens JH, McCulloch AD. Biventricular shape modes discriminate pulmonary valve replacement in tetralogy of Fallot better than imaging indices. Sci Rep 2023; 13:2335. [PMID: 36759522 PMCID: PMC9911768 DOI: 10.1038/s41598-023-28358-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 01/17/2023] [Indexed: 02/11/2023] Open
Abstract
Current indications for pulmonary valve replacement (PVR) in repaired tetralogy of Fallot (rTOF) rely on cardiovascular magnetic resonance (CMR) image-based indices but are inconsistently applied, lead to mixed outcomes, and remain debated. This study aimed to test the hypothesis that specific markers of biventricular shape may discriminate differences between rTOF patients who did and did not require subsequent PVR better than standard imaging indices. In this cross-sectional retrospective study, biventricular shape models were customized to CMR images from 84 rTOF patients. A statistical atlas of end-diastolic shape was constructed using principal component analysis. Multivariate regression was used to quantify shape mode and imaging index associations with subsequent intervention status (PVR, n = 48 vs. No-PVR, n = 36), while accounting for confounders. Clustering analysis was used to test the ability of the most significant shape modes and imaging indices to discriminate PVR status as evaluated by a Matthews correlation coefficient (MCC). Geometric strain analysis was also conducted to assess shape mode associations with systolic function. PVR status correlated significantly with shape modes associated with right ventricular (RV) apical dilation and left ventricular (LV) dilation (p < 0.01), RV basal bulging and LV conicity (p < 0.05), and pulmonary valve dilation (p < 0.01). PVR status also correlated significantly with RV ejection fraction (p < 0.05) and correlated marginally with LV end-systolic volume index (p < 0.07). Shape modes discriminated subsequent PVR better than standard imaging indices (MCC = 0.49 and MCC = 0.28, respectively) and were significantly associated with RV and LV radial systolic strain. Biventricular shape modes discriminated differences between patients who did and did not require subsequent PVR better than standard imaging indices in current use. These regional features of cardiac morphology may provide insight into adaptive vs. maladaptive types of structural remodeling and point toward an improved quantitative, patient-specific assessment tool for clinical use.
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Affiliation(s)
- Sachin Govil
- Department of Bioengineering, University of California San Diego, 9500 Gilman Drive, MC 0412, La Jolla, CA, 92093-0412, USA
| | - Charlène Mauger
- Department of Anatomy and Medical Imaging, University of Auckland, Auckland, New Zealand.,Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - Sanjeet Hegde
- Department of Pediatrics, University of California San Diego, La Jolla, CA, USA.,Division of Cardiology, Rady Children's Hospital San Diego, San Diego, CA, USA
| | | | - Xiaoyang Yu
- Division of Cardiology, Rady Children's Hospital San Diego, San Diego, CA, USA
| | - James C Perry
- Department of Pediatrics, University of California San Diego, La Jolla, CA, USA.,Division of Cardiology, Rady Children's Hospital San Diego, San Diego, CA, USA
| | - Alistair A Young
- Department of Anatomy and Medical Imaging, University of Auckland, Auckland, New Zealand.,Department of Biomedical Engineering, King's College London, London, UK
| | - Jeffrey H Omens
- Department of Bioengineering, University of California San Diego, 9500 Gilman Drive, MC 0412, La Jolla, CA, 92093-0412, USA
| | - Andrew D McCulloch
- Department of Bioengineering, University of California San Diego, 9500 Gilman Drive, MC 0412, La Jolla, CA, 92093-0412, USA.
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Marron T, Maier B, LaMarche N, Hegde S, Belabed M, Mattiuz R, Hennequin C, LeBerichel J, Park M, Hall N, Ogrady D, Fitzgerald B, Gomez J, Doroshow D, Veluswamy R, Rolfo C, Smith C, Rohs N, Yankelevitz D, Chaddha U, Harkin T, Beasley M, Hirsch F, Merad M. P2.12-05 Cancer and Atopy: Parallel Drivers? IL-4 Blockade Synergizes with PD-L1 Blockade to Reverse Type-2Mediated Immunosuppression. J Thorac Oncol 2022. [DOI: 10.1016/j.jtho.2022.07.253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Govil S, Hegde S, Perry JC, Omens JH, McCulloch AD. An Atlas-Based Analysis of Biventricular Mechanics in Tetralogy of Fallot. Stat Atlases Comput Models Heart 2022; 13593:112-122. [PMID: 37251544 PMCID: PMC10226763 DOI: 10.1007/978-3-031-23443-9_11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
The current study proposes an efficient strategy for exploiting the statistical power of cardiac atlases to investigate whether clinically significant variations in ventricular shape are sufficient to explain corresponding differences in ventricular wall motion directly, or if they are indirect markers of altered myocardial mechanical properties. This study was conducted in a cohort of patients with repaired tetralogy of Fallot (rTOF) that face long-term right ventricular (RV) and/or left ventricular (LV) dysfunction as a consequence of adverse remodeling. Features of biventricular end-diastolic (ED) shape associated with RV apical dilation, LV dilation, RV basal bulging, and LV conicity correlated with components of systolic wall motion (SWM) that contribute most to differences in global systolic function. A finite element analysis of systolic biventricular mechanics was employed to assess the effect of perturbations in these ED shape modes on corresponding components of SWM. Perturbations to ED shape modes and myocardial contractility explained observed variation in SWM to varying degrees. In some cases, shape markers were partial determinants of systolic function and, in other cases, they were indirect markers for altered myocardial mechanical properties. Patients with rTOF may benefit from an atlas-based analysis of biventricular mechanics to improve prognosis and gain mechanistic insight into underlying myocardial pathophysiology.
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Affiliation(s)
- Sachin Govil
- Department of Bioengineering, University of California San Diego, San Diego, USA
| | - Sanjeet Hegde
- Division of Cardiology, Rady Children's Hospital San Diego, San Diego, USA
| | - James C Perry
- Division of Cardiology, Rady Children's Hospital San Diego, San Diego, USA
| | - Jeffrey H Omens
- Department of Bioengineering, University of California San Diego, San Diego, USA
| | - Andrew D McCulloch
- Department of Bioengineering, University of California San Diego, San Diego, USA
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El-Sabrout H, Ganta S, Guyon P, Ratnayaka K, Vaughn G, Perry J, Kimball A, Ryan J, Thornburg CD, Tucker S, Mo J, Hegde S, Nigro J, El-Said H. Neonatal Myocardial Infarction: A Proposed Algorithm for Coronary Arterial Thrombus Management. Circ Cardiovasc Interv 2022; 15:e011664. [PMID: 35485231 DOI: 10.1161/circinterventions.121.011664] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Neonatal myocardial infarction is rare and is associated with a high mortality of 40% to 50%. We report our experience with neonatal myocardial infarction, including presentation, management, outcomes, and our current patient management algorithm. METHODS We reviewed all infants admitted with a diagnosis of coronary artery thrombosis, coronary ischemia, or myocardial infarction between January 2015 and May 2021. RESULTS We identified 21 patients (median age, 1 [interquartile range (IQR), 0.25-9.00] day; weight, 3.2 [IQR, 2.9-3.7] kg). Presentation included respiratory distress (16), shock (3), and murmur (2). Regional wall motion abnormalities by echocardiogram were a key criterion for diagnosis and were present in all 21 with varying degrees of depressed left ventricular function (severe [8], moderate [6], mild [2], and low normal [5]). Ejection fraction ranged from 20% to 54% (median, 43% [IQR, 34%-51%]). Mitral regurgitation was present in 19 (90%), left atrial dilation in 15 (71%), and pulmonary hypertension in 18 (86%). ECG was abnormal in 19 (90%). Median troponin I was 0.18 (IQR, 0.12-0.56) ng/mL. Median BNP (B-type natriuretic peptide) was 2100 (IQR, 924-2325) pg/mL. Seventeen had documented coronary thrombosis by cardiac catheterization. Seventeen (81%) were treated with intracoronary tPA (tissue-type plasminogen activator) followed by systemic heparin, AT (antithrombin), and intravenous nitroglycerin, and 4 (19%) were treated with systemic heparin, AT, and intravenous nitroglycerin alone. Nineteen of 21 recovered. One died (also had infradiaphragmatic total anomalous pulmonary venous return). One patient required a ventricular assist device and later underwent heart transplant; this patient was diagnosed late at 5 weeks of age and did not respond to tPA. Nineteen of 21 (90%) regained normal left ventricular function (ejection fraction, 60%-74%; mean, 65% [IQR, 61%-67%]) at latest follow-up (median, 6.8 [IQR, 3.58-14.72] months). Two of 21 (10%) had residual trivial mitral regurgitation. After analysis of these results, we present our current algorithm, which developed and matured over time, to manage neonatal myocardial infarction. CONCLUSIONS We experienced a lower mortality rate for infants with neonatal infarction than that reported in the literature. We propose a post hoc algorithm that may lead to improvement in patient outcomes following coronary artery thrombus.
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Affiliation(s)
- Hannah El-Sabrout
- Division of Pediatric Cardiology (H. El-Sabrout, P.G., K.R., G.V., J.P., S.H., H. El-Said), Rady Children's Hospital/University of California, San Diego
| | - Srujan Ganta
- Division of Pediatric Cardiac Surgery (S.G., J.N.), Rady Children's Hospital/University of California, San Diego
| | - Peter Guyon
- Division of Pediatric Cardiology (H. El-Sabrout, P.G., K.R., G.V., J.P., S.H., H. El-Said), Rady Children's Hospital/University of California, San Diego
| | - Kanishka Ratnayaka
- Division of Pediatric Cardiology (H. El-Sabrout, P.G., K.R., G.V., J.P., S.H., H. El-Said), Rady Children's Hospital/University of California, San Diego
| | - Gabrielle Vaughn
- Division of Pediatric Cardiology (H. El-Sabrout, P.G., K.R., G.V., J.P., S.H., H. El-Said), Rady Children's Hospital/University of California, San Diego
| | - James Perry
- Division of Pediatric Cardiology (H. El-Sabrout, P.G., K.R., G.V., J.P., S.H., H. El-Said), Rady Children's Hospital/University of California, San Diego
| | - Amy Kimball
- Division of Neonatology (A.K.), Rady Children's Hospital/University of California, San Diego
| | - Justin Ryan
- 3D Innovation Lab (J.R.), Rady Children's Hospital/University of California, San Diego
| | - Courtney D Thornburg
- Division of Hematology (C.D.T.), Rady Children's Hospital/University of California, San Diego
| | - Suzanne Tucker
- Division of Pathology (S.T., J.M.), Rady Children's Hospital/University of California, San Diego
| | - Jun Mo
- Division of Pathology (S.T., J.M.), Rady Children's Hospital/University of California, San Diego
| | - Sanjeet Hegde
- Division of Pediatric Cardiology (H. El-Sabrout, P.G., K.R., G.V., J.P., S.H., H. El-Said), Rady Children's Hospital/University of California, San Diego
| | - John Nigro
- Division of Pediatric Cardiac Surgery (S.G., J.N.), Rady Children's Hospital/University of California, San Diego
| | - Howaida El-Said
- Division of Pediatric Cardiology (H. El-Sabrout, P.G., K.R., G.V., J.P., S.H., H. El-Said), Rady Children's Hospital/University of California, San Diego
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Onkaramurthy M, Vishwakarma KK, Singh P, Hegde S, Azeemuddin MM, Rafiq M, Babu UV. Herbal Formulations Ameliorates Chronic Venous Insufficiency, Venotonicity and Elastase Inhibition in the Management of Varicose Veins: A Preclinical Study. Indian J Pharm Sci 2022. [DOI: 10.36468/pharmaceutical-sciences.1000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Bhardwaj P, Thattaruparambil VP, Vellaisamy G, Mahadevaiah S, Hegde S. Gastric teratoma presenting as melena in the newborn: A case report. J Neonatal Perinatal Med 2022; 15:667-669. [PMID: 35694937 DOI: 10.3233/npm-210931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Melena is reported in 1 of 350 to 400 new-borns. Significant upper gastrointestinal bleeding in a neonate with an antenatally diagnosed abdominal mass has not been reported before. This case highlights an unusual presentation of a gastric teratoma and proposes a probable embryological explanation for the site of occurrence.
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Affiliation(s)
- P Bhardwaj
- Department of Pediatric Surgery, St. John's Medical College Hospital, Bengaluru, India
| | - V P Thattaruparambil
- Department of Pediatric Surgery, St. John's Medical College Hospital, Bengaluru, India
| | - G Vellaisamy
- Department of Pathology, St. John's Medical College, Bengaluru, India
| | - S Mahadevaiah
- Department of Pediatric Surgery, St. John's Medical College Hospital, Bengaluru, India
| | - S Hegde
- Department of Pediatric Surgery, St. John's Medical College Hospital, Bengaluru, India
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Mauger CA, Govil S, Chabiniok R, Gilbert K, Hegde S, Hussain T, McCulloch AD, Occleshaw CJ, Omens J, Perry JC, Pushparajah K, Suinesiaputra A, Zhong L, Young AA. Right-left ventricular shape variations in tetralogy of Fallot: associations with pulmonary regurgitation. J Cardiovasc Magn Reson 2021; 23:105. [PMID: 34615541 PMCID: PMC8496085 DOI: 10.1186/s12968-021-00780-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 05/26/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Relationships between right ventricular (RV) and left ventricular (LV) shape and function may be useful in determining optimal timing for pulmonary valve replacement in patients with repaired tetralogy of Fallot (rTOF). However, these are multivariate and difficult to quantify. We aimed to quantify variations in biventricular shape associated with pulmonary regurgitant volume (PRV) in rTOF using a biventricular atlas. METHODS In this cross-sectional retrospective study, a biventricular shape model was customized to cardiovascular magnetic resonance (CMR) images from 88 rTOF patients (median age 16, inter-quartile range 11.8-24.3 years). Morphometric scores quantifying biventricular shape at end-diastole and end-systole were computed using principal component analysis. Multivariate linear regression was used to quantify biventricular shape associations with PRV, corrected for age, sex, height, and weight. Regional associations were confirmed by univariate correlations with distances and angles computed from the models, as well as global systolic strains computed from changes in arc length from end-diastole to end-systole. RESULTS PRV was significantly associated with 5 biventricular morphometric scores, independent of covariates, and accounted for 12.3% of total shape variation (p < 0.05). Increasing PRV was associated with RV dilation and basal bulging, in conjunction with decreased LV septal-lateral dimension (LV flattening) and systolic septal motion towards the RV (all p < 0.05). Increased global RV radial, longitudinal, circumferential and LV radial systolic strains were significantly associated with increased PRV (all p < 0.05). CONCLUSION A biventricular atlas of rTOF patients quantified multivariate relationships between left-right ventricular morphometry and wall motion with pulmonary regurgitation. Regional RV dilation, LV reduction, LV septal-lateral flattening and increased RV strain were all associated with increased pulmonary regurgitant volume. Morphometric scores provide simple metrics linking mechanisms for structural and functional alteration with important clinical indices.
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Affiliation(s)
- Charlène A. Mauger
- Department of Anatomy and Medical Imaging, University of Auckland, Auckland, New Zealand
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - Sachin Govil
- University of California San Diego, La Jolla, CA USA
| | - Radomir Chabiniok
- University of Texas Southwestern Medical Centre, Dallas, TX USA
- Inria, Palaiseau, France
- LMS, École Polytechnique, CNRS, Institut Polytechnique de Paris, Palaiseau, France
- Department of Mathematics, Faculty of Nuclear Sciences and Physical Engineering, Czech Technical University in Prague, Prague, Czech Republic
| | - Kathleen Gilbert
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - Sanjeet Hegde
- University of California San Diego, La Jolla, CA USA
- Division of Cardiology, Rady Children’s Hospital, San Diego, CA USA
| | - Tarique Hussain
- University of Texas Southwestern Medical Centre, Dallas, TX USA
| | | | | | - Jeffrey Omens
- University of California San Diego, La Jolla, CA USA
| | - James C. Perry
- University of California San Diego, La Jolla, CA USA
- Division of Cardiology, Rady Children’s Hospital, San Diego, CA USA
| | | | | | - Liang Zhong
- National Heart Centre, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | - Alistair A. Young
- Department of Anatomy and Medical Imaging, University of Auckland, Auckland, New Zealand
- Department of Biomedical Engineering, King’s College London, London, UK
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11
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Beroukhim RS, Ghelani S, Ashwath R, Balasubramanian S, Biko DM, Buddhe S, Campbell MJ, Cross R, Festa P, Griffin L, Grotenhuis H, Hasbani K, Hashemi S, Hegde S, Hussain T, Jain S, Kiaffas M, Kutty S, Lam CZ, Liberato G, Merlocco A, Misra N, Mowers KL, Muniz JC, Nutting A, Parra DA, Patel JK, Perez-Atayde AR, Prasad D, Rosental CF, Shah A, Samyn MM, Sleeper LA, Slesnick T, Valsangiacomo E, Geva T. Accuracy of Cardiac Magnetic Resonance Imaging Diagnosis of Pediatric Cardiac Masses: A Multicenter Study. JACC Cardiovasc Imaging 2021; 15:1391-1405. [PMID: 34419404 DOI: 10.1016/j.jcmg.2021.07.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 06/21/2021] [Accepted: 07/06/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVES The goals of this study were to: 1) evaluate the cardiac magnetic resonance (CMR) characteristics of pediatric cardiac masses from a large international cohort; 2) test the accuracy of previously developed CMR-based diagnostic criteria; and 3) expand diagnostic criteria using new information. BACKGROUND After diagnosis of a cardiac mass, clinicians must weigh the benefits and risks of ascertaining a tissue diagnosis. Limited data are available on the accuracy of previously developed noninvasive pediatric CMR-based diagnostic criteria. METHODS CMR studies (children 0-18 years of age) with confirmatory histological and/or genetic diagnosis were analyzed by 2 reviewers, without knowledge of prior diagnosis. Diagnostic accuracy was graded as: 1) single correct diagnosis; 2) correct diagnosis among a differential; or 3) incorrect diagnosis. RESULTS Of 213 cases, 174 (82%) had diagnoses that were represented in the previously published diagnostic criteria. In 70% of 174 cases, both reviewers achieved a single correct diagnosis (94% of fibromas, 71% of rhabdomyomas, and 50% of myxomas). When ≤2 differential diagnoses were included, both reviewers reached a correct diagnosis in 86% of cases. Of 29 malignant tumors, both reviewers indicated malignancy as a single diagnosis in 52% of cases. Including ≤2 differential diagnoses, both reviewers indicated malignancy in 83% of cases. Of 6 CMR sequences examined, acquisition of first-pass perfusion and late gadolinium enhancement were independently associated with a higher likelihood of a single correct diagnosis. CONCLUSIONS CMR of cardiac masses in children leads to an accurate diagnosis in most cases. A comprehensive imaging protocol is associated with higher diagnostic accuracy.
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Affiliation(s)
| | - Sunil Ghelani
- Boston Children's Hospital, Boston, Massachusetts, USA
| | - Ravi Ashwath
- University of Iowa Stead Family Children's Hospital, Iowa City, Iowa, USA
| | | | - David M Biko
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | | | | | - Russell Cross
- Children's National Medical Center, Washington, DC, USA
| | - Pierluigi Festa
- Fondazione G. Monasterio C.N.R. Regione Toscana, Pisa, Italy
| | - Lindsay Griffin
- Ann & Robert H Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | | | | | | | - Sanjeet Hegde
- Rady Children's Hospital San Diego, San Diego, California, USA
| | | | - Supriya Jain
- Maria Fareri Children's Hospital at Westchester Medical Center, Valhalla, New York, USA
| | - Maria Kiaffas
- Children's Mercy Hospital, Kansas City, Missouri, USA
| | - Shelby Kutty
- Johns Hopkins Children's Center, Baltimore, Maryland, USA; Children's Hospital and Medical Center, Omaha, Nebraska, USA
| | | | | | | | - Nilanjana Misra
- Cohen Children's Medical Center of New York, Northwell Health, New Hyde Park, New York, USA
| | - Katie L Mowers
- CS Mott Children's Hospital, Ann Arbor, Michigan, USA; St Louis Children's Hospital, St Louis, Missouri, USA
| | | | - Arni Nutting
- Medical University of South Carolina, Charleston, South Carolina, USA
| | - David A Parra
- Vanderbilt Children's Hospital, Nashville, Tennessee, USA
| | - Jyoti K Patel
- Riley Children's Hospital, Indianapolis, Indiana, USA
| | | | | | | | - Amee Shah
- Children's Hospital of New York, New York, New York, USA
| | - Margaret M Samyn
- Medical Collect of Wisconsin/Children's Wisconsin, Milwaukee, Wisconsin, USA
| | | | | | | | - Tal Geva
- Boston Children's Hospital, Boston, Massachusetts, USA
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12
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Forsch N, Govil S, Perry JC, Hegde S, Young AA, Omens JH, McCulloch AD. Computational analysis of cardiac structure and function in congenital heart disease: Translating discoveries to clinical strategies. J Comput Sci 2021; 52:101211. [PMID: 34691293 PMCID: PMC8528218 DOI: 10.1016/j.jocs.2020.101211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Increased availability and access to medical image data has enabled more quantitative approaches to clinical diagnosis, prognosis, and treatment planning for congenital heart disease. Here we present an overview of long-term clinical management of tetralogy of Fallot (TOF) and its intersection with novel computational and data science approaches to discovering biomarkers of functional and prognostic importance. Efforts in translational medicine that seek to address the clinical challenges associated with cardiovascular diseases using personalized and precision-based approaches are then discussed. The considerations and challenges of translational cardiovascular medicine are reviewed, and examples of digital platforms with collaborative, cloud-based, and scalable design are provided.
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Affiliation(s)
- Nickolas Forsch
- Department of Bioengineering, University of California San Diego, La Jolla, CA, USA
| | - Sachin Govil
- Department of Bioengineering, University of California San Diego, La Jolla, CA, USA
| | - James C Perry
- Department of Bioengineering, University of California San Diego, La Jolla, CA, USA
- Department of Pediatrics, University of California San Diego, La Jolla, CA, USA
| | - Sanjeet Hegde
- Department of Pediatrics, University of California San Diego, La Jolla, CA, USA
| | - Alistair A Young
- Department of Biomedical Engineering, King’s College London, London, UK
- Department of Anatomy and Medical Imaging, University of Auckland, Auckland, NZ
| | - Jeffrey H Omens
- Department of Bioengineering, University of California San Diego, La Jolla, CA, USA
- Deparment of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Andrew D McCulloch
- Department of Bioengineering, University of California San Diego, La Jolla, CA, USA
- Deparment of Medicine, University of California San Diego, La Jolla, CA, USA
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13
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Shariff M, Doshi R, Pedreira Vaz I, Adalja D, Krishnan A, Hegde S, Kumar A. Impella versus intra-aortic balloon pump in cardiogenic shock: a meta-analysis assessing 30-days mortality. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1130] [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
Introduction
Cardiogenic shock is linked with eminent morbidity and mortality despite advances in treatment modality. Adjuvant treatment modalities to provide mechanical haemodynamic support in the form of intra-aortic balloon pump (IABP) or Impella are being used among patients with cardiogenic shock. The Impella prunes left ventricular preload, whereas, IABP persuades after load reduction and both contribute to improved cardiac output. A few underpowered randomised control trials (RCTs) and observational studies compared short term mortality benefit of Impella juxtaposed to IABP among patients with cardiogenic shock.
Purpose
A meta-analysis of RCTs and observational studies researching the short-term mortality in cardiogenic shock comparing Impella to IABP was executed.
Methods
The databases PubMed, EMBASE and Cochrane were searched systematically to identify relevant RCTs and observational studies contrasting Impella to IABP and reporting 30-days mortality as outcomes. The search terms used were “Impella”, “IAPB”, “intra-aortic balloon pump” and all word variations were utilised. The search was conducted from the debut of the databases up to January 2020. Two reviewers independently and in tandem performed data screening and extraction from identified articles. Inverse variance method with Paule-Mandel estimator for tau2 and Hartung-Knapp adjustment was used to calculate Risk Ratio with 95% confidence interval. Heterogeneity was assessed using I2 statistics. Furthermore, we calculated the 95% predictive interval for the pooled estimate. All statistical analysis for this meta-analysis was carried out using R statistical software version 3.6.2 using the package meta ( ). Additionally, Grading of Recommendations, Assessment, Development and Evaluations (GRADE) criteria were used to assess the certainty of evidence.
Results
Five studies constituting 728 patients were included in the final analysis. Two were RCTs (ISAR-SHOCK trial and IMPRESS in Severe Shock trial), one study was a propensity score matched observational study and two were unmatched observational studies. There was no difference in the risk of 30-days mortality in patients treated with Impella as compared to IABP [Risk Ratio: 0.97, 95% confidence interval: 0.66–1.41, I2: 32%]. To account for the heterogeneity, we calculated 95% predictive interval: 0.46–2.02. Thus, very low certainty of evidence concluded no difference in the risk of 30-days mortality among cardiogenic shock patients treated with Impella in opposition to IABP.
Conclusion
This meta-analysis comparing Impella juxtaposed with IABP demonstrated no difference in the risk of 30-days mortality among patients with cardiogenic shock.
30-days Mortality
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- M Shariff
- St John's Medical College Hospital, Critical Care Medicine, Bangalore, India
| | - R Doshi
- University of Nevada, Internal Medicine, Reno, United States of America
| | - I Pedreira Vaz
- Jackson Memorial Hospital, Internal Medicine, Miami, United States of America
| | - D Adalja
- Gotri Medical Education and Research Centre, Internal Medicine, Vadodara, India
| | - A Krishnan
- JJM Medical College, Internal Medicine, Davangere, India
| | - S Hegde
- Sri Jayadeva Institute of Cardiovascular Sciences and Research, Cardiology, Mysore, India
| | - A Kumar
- St John's Medical College Hospital, Critical Care Medicine, Bangalore, India
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14
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Narayan HK, Xu R, Forsch N, Govil S, Iukuridze D, Lindenfeld L, Adler E, Hegde S, Tremoulet A, Ky B, Armenian S, Omens J, McCulloch AD. Atlas-based measures of left ventricular shape may improve characterization of adverse remodeling in anthracycline-exposed childhood cancer survivors: a cross-sectional imaging study. Cardiooncology 2020; 6:13. [PMID: 32782827 PMCID: PMC7414730 DOI: 10.1186/s40959-020-00069-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 07/31/2020] [Indexed: 11/28/2022]
Abstract
Background Adverse cardiac remodeling is an important precursor to anthracycline-related cardiac dysfunction, however conventional remodeling indices are limited. We sought to examine the utility of statistical atlas-derived measures of ventricular shape to improve the identification of adverse anthracycline-related remodeling in childhood cancer survivors. Methods We analyzed cardiac magnetic resonance imaging from a cross-sectional cohort of 20 childhood cancer survivors who were treated with low (< 250 mg/m2 [N = 10]) or high (≥250 mg/m2 [N = 10]) dose anthracyclines, matched 1:1 by sex and age between dose groups. We reconstructed 3D computational models of left ventricular end-diastolic shape for each subject and assessed the ability of conventional remodeling indices (volume, mass, and mass to volume ratio) vs. shape modes derived from a statistical shape atlas of an asymptomatic reference population to stratify anthracycline-related remodeling. We compared conventional parameters and five atlas-based shape modes: 1) between survivors and the reference population (N = 1991) using multivariable linear regression, and 2) within survivors by anthracycline dose (low versus high) using two-sided T-tests, multivariable logistic regression, and receiver operating characteristic curves. Results Compared with the reference population, survivors had differences in conventional measures (lower volume and mass) and shape modes (corresponding to lower overall size and lower sphericity; all p < 0.001). Among survivors, differences in a shape mode corresponding to increased basal cavity size and altered mitral annular orientation in the high-dose group were observed (p = 0.039). Collectively, atlas-based shape modes in conjunction with conventional measures discriminated survivors who received low vs. high anthracycline dosage (area under the curve [AUC] 0.930, 95% confidence interval 0.816, 1.00) significantly better than conventional measures alone (AUC 0.710, 95% confidence interval 0.473, 0.947; AUC comparison p = 0.0498). Conclusions Compared with a reference population, heart size is smaller in anthracycline-exposed childhood cancer survivors. Atlas-based measures of left ventricular shape may improve the detection of anthracycline dose-related remodeling differences.
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Affiliation(s)
- Hari K Narayan
- Department of Pediatrics, University of California San Diego, 9500 Gilman Drive #0831, La Jolla, CA 92093-0831 USA
| | - Ronghui Xu
- Department of Family Medicine and Public Health, University of California San Diego, 9500 Gilman Drive #0628, La Jolla, CA 92093-0628 USA.,Department of Mathematics, University of California San Diego, 9500 Gilman Drive #0112, La Jolla, CA 92093-0112 USA
| | - Nickolas Forsch
- Department of Bioengineering, University of California San Diego, 9500 Gilman Drive #0412, La Jolla, CA 92093-0412 USA
| | - Sachin Govil
- Department of Bioengineering, University of California San Diego, 9500 Gilman Drive #0412, La Jolla, CA 92093-0412 USA
| | - David Iukuridze
- Department of Pediatrics, University of California San Diego, 9500 Gilman Drive #0831, La Jolla, CA 92093-0831 USA
| | - Lanie Lindenfeld
- Department of Population Sciences, City of Hope, 1500 E. Duarte Rd, Duarte, CA 91010 USA
| | - Eric Adler
- Department of Medicine, University of California San Diego, 9500 Gilman Drive #8811, La Jolla, CA 92093-8811 USA
| | - Sanjeet Hegde
- Department of Pediatrics, University of California San Diego, 9500 Gilman Drive #0831, La Jolla, CA 92093-0831 USA
| | - Adriana Tremoulet
- Department of Pediatrics, University of California San Diego, 9500 Gilman Drive #0831, La Jolla, CA 92093-0831 USA
| | - Bonnie Ky
- Department of Medicine, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104 USA
| | - Saro Armenian
- Department of Population Sciences, City of Hope, 1500 E. Duarte Rd, Duarte, CA 91010 USA
| | - Jeffrey Omens
- Department of Bioengineering, University of California San Diego, 9500 Gilman Drive #0412, La Jolla, CA 92093-0412 USA.,Department of Medicine, University of California San Diego, 9500 Gilman Drive #8811, La Jolla, CA 92093-8811 USA
| | - Andrew D McCulloch
- Department of Bioengineering, University of California San Diego, 9500 Gilman Drive #0412, La Jolla, CA 92093-0412 USA.,Department of Medicine, University of California San Diego, 9500 Gilman Drive #8811, La Jolla, CA 92093-8811 USA
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15
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Dixon CM, Dyar D, Aurigemma D, Printz BF, Hegde S, Ryan J, Loo JC, Sun HY. Double Choker: Double Aortic Arch with Bilateral Aortic Coarctation Associated with Heterotaxy-Asplenia Syndrome and Complex Atrioventricular Canal Defect. CASE (Phila) 2020; 4:142-145. [PMID: 32577594 PMCID: PMC7303239 DOI: 10.1016/j.case.2020.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
• Double aortic arch (DAA) typically occurs in isolation. • DAA with bilateral coarctation (COA) is very rare with three prior documented cases. • In addition to DAA with bilateral COA our case also has complex intracardiac disease. • Echocardiography served as the primary diagnostic tool with advanced imaging as a useful adjunct.
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Affiliation(s)
- Chandler M Dixon
- Division of Cardiology, Rady Children's Hospital San Diego, San Diego, California
| | - Dan Dyar
- Division of Cardiology, Rady Children's Hospital San Diego, San Diego, California
| | - David Aurigemma
- Division of Cardiology, Rady Children's Hospital San Diego, San Diego, California
- Division of Cardiology, Department of Pediatrics, University of California, San Diego, San Diego, California
| | - Beth F Printz
- Division of Cardiology, Rady Children's Hospital San Diego, San Diego, California
- Division of Cardiology, Department of Pediatrics, University of California, San Diego, San Diego, California
| | - Sanjeet Hegde
- Division of Cardiology, Rady Children's Hospital San Diego, San Diego, California
- Division of Cardiology, Department of Pediatrics, University of California, San Diego, San Diego, California
| | - Justin Ryan
- Division of Cardiology, Rady Children's Hospital San Diego, San Diego, California
| | - John-Charles Loo
- Division of Cardiology, Department of Pediatrics, Kaiser Permanente, Tustin, California
| | - Heather Y Sun
- Division of Cardiology, Rady Children's Hospital San Diego, San Diego, California
- Division of Cardiology, Department of Pediatrics, University of California, San Diego, San Diego, California
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16
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Govil S, Mauger C, Hegde S, Perry J, Suinesiaputra A, Omens J, McCulloch A, Young A. Biventricular Shape Modes Associated with Clinical History and Pulmonary Regurgitation in Repaired Tetralogy of Fallot. FASEB J 2020. [DOI: 10.1096/fasebj.2020.34.s1.04305] [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] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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17
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Contijoch F, Li B, Yang W, Silva-Sepulveda JA, Vodkin I, Printz B, Vavinskaya V, Hegde S, Marsden A, El-Sabrout H, Alshawabkeh L, Moore JW, El-Said H. Exercise MRI highlights heterogeneity in cardiovascular mechanics among patients with Fontan circulation: proposed protocol for routine evaluation. J Thorac Dis 2020; 12:1204-1212. [PMID: 32274201 PMCID: PMC7139092 DOI: 10.21037/jtd.2019.09.59] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Single ventricle physiology and palliation via the Fontan operation lead to a series of cardiovascular changes. In addition, organs such as the kidneys and liver have been shown to experience insults and subsequent injury. This has led to routine surveillance of patients. We present findings from a small cohort of patients that was deeply phenotyped to illustrate the need for comprehensive evaluation. A cohort of four Fontan patients with fairly high cardiovascular function was recruited 5–10 years post-Fontan. Patients underwent a rigorous clinical work-up after which a research MRI scan was performed during which (I) data were obtained during exercise to evaluate changes in stroke volume during supine exercise and (II) magnetic resonance angiograms with phase-contrast images were obtained for computational modeling of flows through the Fontan circulation at rest. Clinical measures were consistent with a fairly homogeneous high function cohort (peak oxygen consumption >20 mL/kg/min, robust response to exercise, peak ventilatory efficiency below levels associated with heart failure, MR-derived ejection fraction >50%). Liver evaluation did not reveal clear signs of cirrhosis or extensive fibrosis. However, we observed considerable variability (27–162%) in the increase in stroke index with exercise [100%±64% increase, 53.9±17.4 mL/beat m2 (rest), 101.1±20.7 mL/beat m2, (exercise)]. Computational flow modeling at rest in two patients also showed marked differences in flow distribution and shear stress. We report marked differences in both changes in stroke index during an exercise MRI protocol as well as computational flow patterns at rest suggesting different compensation strategies may be associated with high functioning Fontan patients. The observed heterogeneity illustrates the need for deep phenotyping to capture patient-specific adaptive mechanisms.
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Affiliation(s)
- Francisco Contijoch
- Department of Bioengineering, UC San Diego, La Jolla CA, USA.,Department of Radiology, UC San Diego, La Jolla CA, USA
| | - Bochao Li
- Department of Bioengineering, UC San Diego, La Jolla CA, USA
| | - Weiguang Yang
- Department of Pediatrics, Stanford University, Palo Alto, CA, USA
| | | | - Irine Vodkin
- Department of Medicine, UC San Diego, La Jolla, CA, USA
| | - Beth Printz
- Department of Pediatric Cardiology, Rady Children's Hospital, San Diego, CA, USA
| | | | - Sanjeet Hegde
- Department of Pediatric Cardiology, Rady Children's Hospital, San Diego, CA, USA
| | - Alison Marsden
- Department of Pediatrics, Stanford University, Palo Alto, CA, USA.,Department of Bioengineering, Stanford University, Palo Alto, CA, USA
| | - Hannah El-Sabrout
- Department of Society and Genetics, UC Los Angeles, Los Angeles, CA, USA
| | | | - John W Moore
- Department of Pediatric Cardiology, Rady Children's Hospital, San Diego, CA, USA
| | - Howaida El-Said
- Department of Pediatric Cardiology, Rady Children's Hospital, San Diego, CA, USA
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18
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Misra U, TcR R, Kumaravelu S, Arjundas D, Wadia R, Nair R, Alurkar A, Pujarai S, Udhar M, Palasdeonkar N, Buddha S, Kumar S, Salvadeeswaran M, Deasai S, Pammidimukkala V, Sharma M, Kumar K, Percival G, Hegde S, Machhavada K. Indian registry in ischemic stroke- tenecteplase (IRIS- TNK)- An interim analysis. J Neurol Sci 2019. [DOI: 10.1016/j.jns.2019.10.690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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19
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N V, Hegde S, Kamble N, Yadav R, Pal PK. Cognitive profile of Parkinson’s disease with and without deficits in motor speed. J Neurol Sci 2019. [DOI: 10.1016/j.jns.2019.10.378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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20
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Hegde S, Patodia A, Shah K, Dixit U. The applicability of the Demirjian, Willems and Chaillet standards to age estimation of 5-15 year old Indian children. J Forensic Odontostomatol 2019; 37:40-50. [PMID: 31187742 PMCID: PMC6875241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
BACKGROUND Demirjian's method of age estimation has been reported to overestimate age and Willems' method to give consistently more accurate results. Not enough, however, is known about the applicability of Chaillet's standards. AIM The present study aimed to compare the accuracy of Demirjian's, Willems' and Chaillet's standards in age estimation of 5 to 15 year-old Indian children. DESIGN In this cross-sectional observational study, three methods were compared for accuracy in estimating the age of 1200 Indian children aged 5-15 years. RESULTS Demirjian's method overestimated age by +0.24 ± 0.80 years, +0.11 ± 0.81years and +0.19 ± 0.80 years in boys, girls and the total sample, respectively. With Willems' method, overestimations of +0.09 ± 0.80 years, +0.08 ± 0.80 years and +0.09 ± 0.80 years were obtained in boys, girls and the total sample, respectively. Chaillet's method underestimated age by -0.12 ± 0.69 years, -0.45 ± 0.88 years and -0.25 ± 0.83 years in boys, girls and the total sample, respectively. Statistically significant differences were observed between dental and chronological ages with all methods (p < 0.001). Significant sex-based differences were observed only with Demirjian's and Chaillet's methods (p < 0.05). CONCLUSION Willems' method was the most accurate in age estimation, followed by Demirjian's and Chaillet's methods. While Demirjian's method was more accurate than Chaillet's in females, Chaillet's method better predicted the age of males.
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Affiliation(s)
- S Hegde
- Department of Pediatric Dentistry, Pacific Dental College and Hospital, Udaipur, Rajasthan, India
| | - A Patodia
- Department of Pediatric Dentistry, Pacific Dental College and Hospital, Udaipur, Rajasthan, India
| | - K Shah
- Department of Pediatric Dentistry, Pacific Dental College and Hospital, Udaipur, Rajasthan, India
| | - U Dixit
- Department of Pediatric and Preventive Dentistry, D. Y. Patil University- School of Dentistry, Navi Mumbai, Maharashtra, India
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Carberry T, Murthy R, Hsiao A, Petko C, Moore J, Lamberti J, Hegde S. Fontan Revision: Presurgical Planning Using Four-Dimensional (4D) Flow and Three-Dimensional (3D) Printing. World J Pediatr Congenit Heart Surg 2019; 10:245-249. [PMID: 30630383 DOI: 10.1177/2150135118799641] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Pulmonary arteriovenous malformations (AVMs) can be a complication of certain postoperative Fontan patients whose hepatic venous blood return is not distributed evenly to both lungs. A ten-year-old female, who had previously undergone staged single ventricle palliation for complex congenital heart disease, underwent a Fontan revision due to significant left-sided pulmonary AVMs and increasing arterial oxygen desaturation. The combination of four-dimensional flow cardiac magnetic resonance imaging and three-dimensional printing enabled presurgical planning for a Fontan takedown and diversion of hepatic venous flow to the azygous vein that resulted in significant clinical improvement.
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Affiliation(s)
- Thomas Carberry
- 1 Division of Cardiology, Rady Children's Hospital/UCSD, San Diego, CA, USA
| | - Raghav Murthy
- 1 Division of Cardiology, Rady Children's Hospital/UCSD, San Diego, CA, USA
| | - Albert Hsiao
- 2 Department of Radiology, UCSD, San Diego, CA, USA
| | - Colin Petko
- 3 Pediatric Cardiology, Kaiser Permanente Moanalua Medical Center, Honolulu, HI, USA
| | - John Moore
- 1 Division of Cardiology, Rady Children's Hospital/UCSD, San Diego, CA, USA
| | - John Lamberti
- 1 Division of Cardiology, Rady Children's Hospital/UCSD, San Diego, CA, USA
| | - Sanjeet Hegde
- 1 Division of Cardiology, Rady Children's Hospital/UCSD, San Diego, CA, USA
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Nayak RC, Hegde S, Althoff MJ, Wellendorf AM, Mohmoud F, Perentesis J, Reina-Campos M, Reynaud D, Zheng Y, Diaz-Meco MT, Moscat J, Cancelas JA. The signaling axis atypical protein kinase C λ/ι-Satb2 mediates leukemic transformation of B-cell progenitors. Nat Commun 2019; 10:46. [PMID: 30610188 PMCID: PMC6320370 DOI: 10.1038/s41467-018-07846-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2017] [Accepted: 11/21/2018] [Indexed: 01/01/2023] Open
Abstract
Epigenetically regulated transcriptional plasticity has been proposed as a mechanism of differentiation arrest and resistance to therapy. BCR-ABL leukemias result from leukemic stem cell/progenitor transformation and represent an opportunity to identify epigenetic progress contributing to lineage leukemogenesis. Primary human and murine BCR-ABL+ leukemic progenitors have increased activation of Cdc42 and the downstream atypical protein kinase C (aPKC). While the isoform aPKCζ behaves as a leukemic suppressor, aPKCλ/ι is critically required for oncogenic progenitor proliferation, survival, and B-cell differentiation arrest, but not for normal B-cell lineage differentiation. In vitro and in vivo B-cell transformation by BCR-ABL requires the downregulation of key genes in the B-cell differentiation program through an aPKC λ/ι-Erk dependent Etv5/Satb2 chromatin repressive signaling complex. Genetic or pharmacological targeting of aPKC impairs human oncogenic addicted leukemias. Therefore, the aPKCλ/ι-SATB2 signaling cascade is required for leukemic BCR-ABL+ B-cell progenitor transformation and is amenable to non-tyrosine kinase inhibition. The upstream pathways regulating leukemic transcriptional plasticity for differentiation arrest and resistance to therapy are unclear. Here the authors show that aPKC λ/ι-controls leukemic B-cell precursor differentiation arrest trough RAC/MEK/ERK/SATB2 epigenetic repression
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Affiliation(s)
- R C Nayak
- Division of Experimental Hematology, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., Cincinnati, OH, 45229, USA
| | - S Hegde
- Division of Experimental Hematology, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., Cincinnati, OH, 45229, USA.,Hoxworth Blood Center, University of Cincinnati, 3130 Highland Ave., Cincinnati, OH, 45267, USA
| | - M J Althoff
- Division of Experimental Hematology, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., Cincinnati, OH, 45229, USA.,Hoxworth Blood Center, University of Cincinnati, 3130 Highland Ave., Cincinnati, OH, 45267, USA.,Graduate Program of Cancer & Cell Biology, University of Cincinnati College of Medicine, Cincinnati, OH, 45267, USA
| | - A M Wellendorf
- Division of Experimental Hematology, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., Cincinnati, OH, 45229, USA
| | - F Mohmoud
- Graduate Program of Cancer & Cell Biology, University of Cincinnati College of Medicine, Cincinnati, OH, 45267, USA
| | - J Perentesis
- Division of Oncology, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., Cincinnati, OH, 45229, USA
| | - M Reina-Campos
- Cancer Metabolism and Signaling Networks Program, Sanford Burnham Prebys Medical Discovery Institute, 10901 North Torrey Pines Road, La Jolla, CA, 92037, USA
| | - D Reynaud
- Division of Experimental Hematology, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., Cincinnati, OH, 45229, USA
| | - Y Zheng
- Division of Experimental Hematology, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., Cincinnati, OH, 45229, USA
| | - M T Diaz-Meco
- Cancer Metabolism and Signaling Networks Program, Sanford Burnham Prebys Medical Discovery Institute, 10901 North Torrey Pines Road, La Jolla, CA, 92037, USA
| | - J Moscat
- Cancer Metabolism and Signaling Networks Program, Sanford Burnham Prebys Medical Discovery Institute, 10901 North Torrey Pines Road, La Jolla, CA, 92037, USA
| | - J A Cancelas
- Division of Experimental Hematology, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., Cincinnati, OH, 45229, USA. .,Hoxworth Blood Center, University of Cincinnati, 3130 Highland Ave., Cincinnati, OH, 45267, USA. .,Graduate Program of Cancer & Cell Biology, University of Cincinnati College of Medicine, Cincinnati, OH, 45267, USA.
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23
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Hegde S, Bawa M, Mahajan JK, Rao KLN. Erb's palsy complicating a case of annular pancreas. J Neonatal Perinatal Med 2018; 11:97-99. [PMID: 29689736 DOI: 10.3233/npm-1816156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We report an unusual presentation of annular pancreas with pneumoperitoneum in a newborn with an associated left sided Erb's palsy. The neurological deficit caused considerable confusion in the diagnosis and unexpected complications after surgery. We highlight the importance of clinical examination and the complications that an Erb's palsy can cause. This unusual triad of Erb's palsy, eventration of diaphragm and annular pancreas has hitherto not been described in literature.
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Affiliation(s)
- S Hegde
- Department of Pediatric Surgery, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - M Bawa
- Department of Pediatric Surgery, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - J K Mahajan
- Department of Pediatric Surgery, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - K L N Rao
- Department of Pediatric Surgery, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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24
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Pathak G, Agostino MJ, Bishara K, Capell WR, Fisher JL, Hegde S, Ibrahim BA, Pilarzyk K, Sabin C, Tuczkewycz T, Wilson S, Kelly MP. PDE11A negatively regulates lithium responsivity. Mol Psychiatry 2017; 22:1714-1724. [PMID: 27646265 PMCID: PMC5359083 DOI: 10.1038/mp.2016.155] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Revised: 07/13/2016] [Accepted: 07/18/2016] [Indexed: 01/15/2023]
Abstract
Lithium responsivity in patients with bipolar disorder has been genetically associated with Phosphodiesterase 11A (PDE11A), and lithium decreases PDE11A mRNA in induced pluripotent stem cell-derived hippocampal neurons originating from lithium-responsive patients. PDE11 is an enzyme uniquely enriched in the hippocampus that breaks down cyclic AMP and cyclic GMP. Here we determined whether decreasing PDE11A expression is sufficient to increase lithium responsivity in mice. In dorsal hippocampus and ventral hippocampus (VHIPP), lithium-responsive C57BL/6J and 129S6/SvEvTac mice show decreased PDE11A4 protein expression relative to lithium-unresponsive BALB/cJ mice. In VHIPP, C57BL/6J mice also show differences in PDE11A4 compartmentalization relative to BALB/cJ mice. In contrast, neither PDE2A nor PDE10A expression differ among the strains. The compartment-specific differences in PDE11A4 protein expression are explained by a coding single-nucleotide polymorphism (SNP) at amino acid 499, which falls within the GAF-B homodimerization domain. Relative to the BALB/cJ 499T, the C57BL/6J 499A decreases PDE11A4 homodimerization, which removes PDE11A4 from the membrane. Consistent with the observation that lower PDE11A4 expression correlates with better lithium responsiveness, we found that Pde11a knockout mice (KO) given 0.4% lithium chow for 3+ weeks exhibit greater lithium responsivity relative to wild-type (WT) littermates in tail suspension, an antidepressant-predictive assay, and amphetamine hyperlocomotion, an anti-manic predictive assay. Reduced PDE11A4 expression may represent a lithium-sensitive pathophysiology, because both C57BL/6J and Pde11a KO mice show increased expression of the pro-inflammatory cytokine interleukin-6 (IL-6) relative to BALB/cJ and PDE11A WT mice, respectively. Our finding that PDE11A4 negatively regulates lithium responsivity in mice suggests that the PDE11A SNPs identified in patients may be functionally relevant.
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Affiliation(s)
- G Pathak
- Department of Pharmacology, Physiology & Neuroscience, University of South Carolina School of Medicine, Columbia, SC, USA
| | | | - K Bishara
- Department of Pharmacology, Physiology & Neuroscience, University of South Carolina School of Medicine, Columbia, SC, USA
| | - W R Capell
- Department of Pharmacology, Physiology & Neuroscience, University of South Carolina School of Medicine, Columbia, SC, USA
| | - J L Fisher
- Department of Pharmacology, Physiology & Neuroscience, University of South Carolina School of Medicine, Columbia, SC, USA
| | - S Hegde
- Department of Pharmacology, Physiology & Neuroscience, University of South Carolina School of Medicine, Columbia, SC, USA
| | - B A Ibrahim
- Department of Pharmacology, Physiology & Neuroscience, University of South Carolina School of Medicine, Columbia, SC, USA
| | - K Pilarzyk
- Department of Pharmacology, Physiology & Neuroscience, University of South Carolina School of Medicine, Columbia, SC, USA
| | - C Sabin
- Department of Pharmacology, Physiology & Neuroscience, University of South Carolina School of Medicine, Columbia, SC, USA
| | | | - S Wilson
- Department of Pharmacology, Physiology & Neuroscience, University of South Carolina School of Medicine, Columbia, SC, USA
| | - M P Kelly
- Department of Pharmacology, Physiology & Neuroscience, University of South Carolina School of Medicine, Columbia, SC, USA
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25
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Roy A, Hegde S, Srinivas M. Sequelae of stroke a prospective study. J Neurol Sci 2017. [DOI: 10.1016/j.jns.2017.08.2778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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26
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Kalz L, Kalz-Füller B, Hegde S, Schwanitz G. Polymorphisms of Q-band Heterochromatin: Qualitative and Quantitative Analyses of Features in 3 Ethnic Groups (Europeans, Indians, and Turks). INT J HUM GENET 2017. [DOI: 10.1080/09723757.2005.11885919] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- L. Kalz
- Institute for Human Genetics, Bonn, Germany
| | | | - S. Hegde
- Manipal Hospital, Bangalore, India
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27
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Ortiz AK, Suinesiaputra A, Young A, Farrar GE, Printz BF, Omens J, McCulloch AD, Perry JC, Hegde S. Left ventricular shape variation in patients with aortic coarctation pre- and post-stent implantation. J Cardiovasc Magn Reson 2016. [PMCID: PMC5032093 DOI: 10.1186/1532-429x-18-s1-p186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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28
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Suinesiaputra A, Farrar GE, Gilbert K, Hegde S, McCulloch AD, Omens J, Perry JC, Young A. Application of Atlas-based global shape and local contraction analysis to single-ventricle congenital heart disease. J Cardiovasc Magn Reson 2016. [PMCID: PMC5032219 DOI: 10.1186/1532-429x-18-s1-p154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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29
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Hegde S, Hsiao A. Improving the Fontan: Pre-surgical planning using four dimensional (4D) flow, bio-mechanical modeling and three dimensional (3D) printing. Progress in Pediatric Cardiology 2016. [DOI: 10.1016/j.ppedcard.2016.07.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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30
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Ebrahim M, Hegde S, Printz B, Abcede M, Proudfoot JA, Davis C. Evaluation of Impedance Cardiography for Measurement of Stroke Volume in Congenital Heart Disease. Pediatr Cardiol 2016; 37:1453-1457. [PMID: 27562130 DOI: 10.1007/s00246-016-1456-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Accepted: 08/16/2016] [Indexed: 11/26/2022]
Abstract
Noninvasive measurement of cardiac output (CO) and particularly stroke volume (SV) remain difficult but potentially valuable. These variables can be particularly challenging to measure in children with congenital heart disease (CHD). Impedance cardiography (IC) is a technique shown to be accurate in measuring SV in adults and in children with structurally normal hearts. The ease of use and rapidity of SV measurement using IC makes it potentially attractive for young patients with CHD. Advances in IC technology have led to more sophisticated signal-morphology IC (SMIC) devices that may further improve accuracy. We tested the accuracy of SMIC to measure SV in 21 subjects with CHD by comparing measurements with those from cardiac magnetic resonance (CMR) imaging. There was good agreement between SMIC and CMR in measurement of SV: mean difference = 1.7 ml (p = 0.47); r = 0.89. The agreement and correlation persisted when controlling for the differences in blood pressure and heart rate during the two testing methods. We conclude that SMIC is accurate at measuring SV and thus CO when compared to CMR in a variety of forms of CHD.
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Affiliation(s)
- Mohammed Ebrahim
- Division of Cardiology, Department of Pediatrics, University of California San Diego, Rady Children's Hospital San Diego, 3020 Children's Way, MC 5004, San Diego, CA, 92123, US
| | - Sanjeet Hegde
- Division of Cardiology, Department of Pediatrics, University of California San Diego, Rady Children's Hospital San Diego, 3020 Children's Way, MC 5004, San Diego, CA, 92123, US
| | - Beth Printz
- Division of Cardiology, Department of Pediatrics, University of California San Diego, Rady Children's Hospital San Diego, 3020 Children's Way, MC 5004, San Diego, CA, 92123, US
| | - Mark Abcede
- Division of Cardiology, Department of Pediatrics, University of California San Diego, Rady Children's Hospital San Diego, 3020 Children's Way, MC 5004, San Diego, CA, 92123, US
| | - James A Proudfoot
- Clinical and Translational Research Institute, University of California San Diego, San Diego, CA, US
| | - Christopher Davis
- Division of Cardiology, Department of Pediatrics, University of California San Diego, Rady Children's Hospital San Diego, 3020 Children's Way, MC 5004, San Diego, CA, 92123, US.
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31
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Farrar G, Suinesiaputra A, Gilbert K, Perry JC, Hegde S, Marsden A, Young AA, Omens JH, McCulloch AD. Atlas-Based Ventricular Shape Analysis for Understanding Congenital Heart Disease. Prog Pediatr Cardiol 2016; 43:61-69. [PMID: 28082823 DOI: 10.1016/j.ppedcard.2016.07.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Congenital heart disease is associated with abnormal ventricular shape that can affect wall mechanics and may be predictive of long-term adverse outcomes. Atlas-based parametric shape analysis was used to analyze ventricular geometries of eight adolescent or adult single-ventricle CHD patients with tricuspid atresia and Fontans. These patients were compared with an "atlas" of non-congenital asymptomatic volunteers, resulting in a set of z-scores which quantify deviations from the control population distribution on a patient-by-patient basis. We examined the potential of these scores to: (1) quantify abnormalities of ventricular geometry in single ventricle physiologies relative to the normal population; (2) comprehensively quantify wall motion in CHD patients; and (3) identify possible relationships between ventricular shape and wall motion that may reflect underlying functional defects or remodeling in CHD patients. CHD ventricular geometries at end-diastole and end-systole were individually compared with statistical shape properties of an asymptomatic population from the Cardiac Atlas Project. Shape analysis-derived model properties, and myocardial wall motions between end-diastole and end-systole, were compared with physician observations of clinical functional parameters. Relationships between altered shape and altered function were evaluated via correlations between atlas-based shape and wall motion scores. Atlas-based shape analysis identified a diverse set of specific quantifiable abnormalities in ventricular geometry or myocardial wall motion in all subjects. Moreover, this initial cohort displayed significant relationships between specific shape abnormalities such as increased ventricular sphericity and functional defects in myocardial deformation, such as decreased long-axis wall motion. These findings suggest that atlas-based ventricular shape analysis may be a useful new tool in the management of patients with CHD who are at risk of impaired ventricular wall mechanics and chamber remodeling.
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Affiliation(s)
- Genevieve Farrar
- Department of Bioengineering, University of California San Diego, La Jolla, CA, USA
| | - Avan Suinesiaputra
- Department of Anatomy and Medical Imaging, University of Auckland, Auckland, NZ
| | - Kathleen Gilbert
- Department of Anatomy and Medical Imaging, University of Auckland, Auckland, NZ
| | - James C Perry
- Division of Cardiology, Rady Children's Hospital, San Diego, CA, USA; Department of Pediatrics, University of California San Diego, La Jolla, CA, USA
| | - Sanjeet Hegde
- Division of Cardiology, Rady Children's Hospital, San Diego, CA, USA; Department of Pediatrics, University of California San Diego, La Jolla, CA, USA
| | - Alison Marsden
- Department of Pediatrics, Stanford University, Stanford, CA, USA
| | - Alistair A Young
- Department of Anatomy and Medical Imaging, University of Auckland, Auckland, NZ
| | - Jeffrey H Omens
- Department of Bioengineering, University of California San Diego, La Jolla, CA, USA; Department of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Andrew D McCulloch
- Department of Bioengineering, University of California San Diego, La Jolla, CA, USA; Department of Medicine, University of California San Diego, La Jolla, CA, USA
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32
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Gilbert K, Farrar G, Cowan B, Suinesiaputra A, Occleshaw C, Pontre B, Perry J, Hegde S, Omens J, McCulloch A, Young A. Improving assessment of congenital heart disease through rapid patient specific modeling. Annu Int Conf IEEE Eng Med Biol Soc 2016; 2016:1228-1231. [PMID: 28268546 DOI: 10.1109/embc.2016.7590927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Congenital heart disease is the most common birth defect, with an incidence of 75 in every 1000 births. As a result of improved interventions, 90% of people with congenital heart disease now survive to adulthood. They must undergo regular imaging to assess their biventricular (left and right ventricular) function. Analysis of the images is problematic due to the large variety of shapes and complex geometry. In this paper we extend a biventricular modeling method to improve the analysis of MR images from congenital heart disease patients. We used a subdivision surface method to create three customizable exemplars, representing common manifestations of anatomy, and incorporated these as priors into an interactive biventricular customization procedure. The CHD-specific priors were tested on 60 cases representing a variety of congenital heart diseases for which the gold standard manual contours were available. The introduction of multiple priors showed a significant decrease in analysis time while maintaining good correlation between the two methods (R2 >.82).
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33
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Openshaw JJ, Hegde S, Sazzad HMS, Khan SU, Hossain MJ, Epstein JH, Daszak P, Gurley ES, Luby SP. Bat Hunting and Bat-Human Interactions in Bangladeshi Villages: Implications for Zoonotic Disease Transmission and Bat Conservation. Transbound Emerg Dis 2016; 64:1287-1293. [PMID: 27125493 PMCID: PMC5086320 DOI: 10.1111/tbed.12505] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [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: 02/11/2016] [Indexed: 01/03/2023]
Abstract
Bats are an important reservoir for emerging zoonotic pathogens. Close human–bat interactions, including the sharing of living spaces and hunting and butchering of bats for food and medicines, may lead to spillover of zoonotic disease into human populations. We used bat exposure and environmental data gathered from 207 Bangladeshi villages to characterize bat exposures and hunting in Bangladesh. Eleven percent of households reported having a bat roost near their homes, 65% reported seeing bats flying over their households at dusk, and 31% reported seeing bats inside their compounds or courtyard areas. Twenty percent of households reported that members had at least daily exposure to bats. Bat hunting occurred in 49% of the villages surveyed and was more likely to occur in households that reported nearby bat roosts (adjusted prevalence ratio [aPR] 2.3, 95% CI 1.1–4.9) and villages located in north‐west (aPR 7.5, 95% CI 2.5–23.0) and south‐west (aPR 6.8, 95% CI 2.1–21.6) regions. Our results suggest high exposure to bats and widespread hunting throughout Bangladesh. This has implications for both zoonotic disease spillover and bat conservation.
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Affiliation(s)
- J J Openshaw
- Infectious Diseases and Geographic Medicine, Stanford University, Stanford, CA, USA
| | - S Hegde
- International Centre for Diarrheal Diseases, Bangladesh, Dhaka, Bangladesh
| | - H M S Sazzad
- International Centre for Diarrheal Diseases, Bangladesh, Dhaka, Bangladesh
| | - S U Khan
- International Centre for Diarrheal Diseases, Bangladesh, Dhaka, Bangladesh
| | - M J Hossain
- International Centre for Diarrheal Diseases, Bangladesh, Dhaka, Bangladesh
| | | | - P Daszak
- EcoHealth Alliance, New York, NY, USA
| | - E S Gurley
- International Centre for Diarrheal Diseases, Bangladesh, Dhaka, Bangladesh
| | - S P Luby
- Infectious Diseases and Geographic Medicine, Stanford University, Stanford, CA, USA.,International Centre for Diarrheal Diseases, Bangladesh, Dhaka, Bangladesh
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Gilbert K, Farrar G, Cowan BR, Suinesiaputra A, Occleshaw C, Pontre B, Perry J, Hegde S, Marsden A, Omens J, McCulloch A, Young AA. Creating shape templates for patient specific biventricular modeling in congenital heart disease. Annu Int Conf IEEE Eng Med Biol Soc 2016; 2015:679-82. [PMID: 26736353 DOI: 10.1109/embc.2015.7318453] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Survival rates for infants with congenital heart disease (CHD) are improving, resulting in a growing population of adults with CHD. However, the analysis of left and right ventricular function is very time-consuming owing to the variety of congenital morphologies. Efficient customization of patient geometry and function depends on high quality shape templates specifically designed for the application. In this paper, we combine a method for creating finite element shape templates with an interactive template customization to patient MRI examinations. This enables different templates to be chosen depending on patient morphology. To demonstrate this pipeline, a new biventricular template with 162 elements was created and tested in place of an existing 82-element template. The method was able to provide fast interactive biventricular analysis with 0.31 sec per edit response time. The new template was customized to 13 CHD patients with similar biventricular topology, showing improved performance over the previous template and good agreement with clinical indices.
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36
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Hegde S, Jain M, Shubha AB. A Rare Bilateral Presentation of Multiple Dens Invaginatus, Shovel-Shaped Incisor and Talon Cusp With Mesiodens. ACTA ACUST UNITED AC 2015; 12:292-5. [DOI: 10.3126/kumj.v12i4.13737] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The aim of this paper is to describe a unique and unusual case of concomitant appearance of morphological dental anomalies in the maxillary anterior region, along with its management in a patient with no systemic abnormality. This case report describes the clinical and radiographic features of talon cusp, dens invaginatus, shovel-shaped incisors and a supernumerary tooth occurring in a single patient, which is a rare presentation. All 4 permanent maxillary incisors had dens invaginatus, the permanent maxillary canines showed the presence of talon cusps, the permanent maxillary central incisors were shovel-shaped and an erupted mesiodens was also observed. Treatment included restorative, surgical and orthodontic approaches.Kathmandu University Medical Journal Vol.12(4) 2014; 292-295
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DiBardino DJ, Gomez-Arostegui J, Kemp A, Raviendran R, Hegde S, Devaney EJ, Lamberti JJ, El-Said H. Intermediate Results of Hybrid Versus Primary Norwood Operation. Ann Thorac Surg 2015; 99:2141-7; discussion 2147-9. [DOI: 10.1016/j.athoracsur.2015.02.025] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2014] [Revised: 01/21/2015] [Accepted: 02/06/2015] [Indexed: 11/25/2022]
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Affiliation(s)
- Daniel J. DiBardino
- Department of Pediatrics, University of California San Diego School of Medicine, Rady Children's Heart Institute, San Diego, CA, USA
- Department of Surgery, University of California San Diego School of Medicine, Cardiovascular Surgery, Rady Children's Heart Institute, San Diego, CA, USA
| | - Sanjeet Hegde
- Department of Pediatrics, University of California San Diego School of Medicine, Rady Children's Heart Institute, San Diego, CA, USA
- Department of Surgery, University of California San Diego School of Medicine, Cardiovascular Surgery, Rady Children's Heart Institute, San Diego, CA, USA
| | - John J. Lamberti
- Department of Pediatrics, University of California San Diego School of Medicine, Rady Children's Heart Institute, San Diego, CA, USA
- Department of Surgery, University of California San Diego School of Medicine, Cardiovascular Surgery, Rady Children's Heart Institute, San Diego, CA, USA
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El-Said H, Hegde S, Foerster S, Hellenbrand W, Kreutzer J, Trucco SM, Holzer R, Burch G, Mirani A, Nicolas R, Porras D, Bergersen L, Moore J. Device therapy for atrial septal defects in a multicenter cohort: acute outcomes and adverse events. Catheter Cardiovasc Interv 2014; 85:227-33. [PMID: 25257700 DOI: 10.1002/ccd.25684] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Revised: 08/26/2014] [Accepted: 09/19/2014] [Indexed: 11/07/2022]
Abstract
BACKGROUND Secundum atrial septal defect (ASD) closure devices were granted approval based on industry-sponsored, prospective, nonrandomized, single device studies, demonstrating acceptable efficacy and safety in selected patients. We sought to report community practice and outcomes. METHODS AND RESULTS Procedure specific data was collected on cases considered for ASD closure in the congenital cardiac catheterization project on outcomes (C3PO) between February 1, 2007 and June 31, 2010. Eight centers contributed data during this time period. All adverse events (AE) were independently reviewed and classified by a five level severity scale. In 40 months (2/07-6/10), 653 of 688 ASDs were occluded with a single device using an AMPLATZER(®) Septal Occluder (ASO) in 566 (87%), GORE(®) HELEX(®) Septal Occluder (HSO) in 33 (5%), and a CardioSEAL(®) or STARFlex™ device (CSD) in 54 (8%). Most patients had an isolated ASD (93%). 85% were >2 years of age. The ASD median diameter was 12 mm [8,16] for ASO, with smaller diameters in HSO 8 mm [7,10] and CSD 8 mm [5,10] (P < 0.001). AE (n = 82) were recorded in 76 cases, 11.5% (95% CI 9.2%, 14.1%) and classified as high severity in 4.7% (95% CI 3.2%, 6.5%), with no mortality. A new conduction abnormality was detected during 15 cases and did not resolve in one. Transcatheter device retrieval was possible in 7 of 10 device embolizations. Device erosion occurred in 3 of 566, 0.5% (95% CI 0.1%, 1.5%), ASO implants. CONCLUSION Although device closure of ASDs is associated with low morbidity and rare mortality, ongoing assessment of device safety profiles are warranted, and registries offer opportunities to facilitate the required surveillance.
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Affiliation(s)
- Howaida El-Said
- Department of Pediatric Cardiology, Rady Children's Hospital, San Diego, California
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Manoor Maiya V, Vaid N, Basu S, Vatyam S, Hegde S, Deshmukh S, Zade B. The Use of Xylitol for the Prevention of Xerostomia in Patients Receiving Intensity Modulated Radiation Therapy for Head and Neck Cancers. Int J Radiat Oncol Biol Phys 2014. [DOI: 10.1016/j.ijrobp.2014.05.1700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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41
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Sullivan JA, Jankowska-Gan E, Shi L, Roenneburg D, Hegde S, Greenspan DS, Wilkes DS, Denlinger LC, Burlingham WJ. Differential requirement for P2X7R function in IL-17 dependent vs. IL-17 independent cellular immune responses. Am J Transplant 2014; 14:1512-22. [PMID: 24866539 PMCID: PMC4295495 DOI: 10.1111/ajt.12741] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2014] [Revised: 02/24/2014] [Accepted: 03/10/2014] [Indexed: 01/25/2023]
Abstract
IL17-dependent autoimmunity to collagen type V (Col V) has been associated with lung transplant obliterative bronchiolitis. Unlike the T helper 1 (Th1)-dependent immune responses to Tetanus Toxoid (TT), the Th17 response to Col V in lung transplant patients and its Th1/17 variant observed in coronary artery disease patients requires IL-1β, tumor necrosis factor α and CD14(+) cells. Given the involvement of the P2X7 receptor (P2X7R) in monocyte IL-1β responses, we investigated its role in Th17-, Th1/17- and Th1-mediated proinflammatory responses. Transfer of antigen-pulsed peripheral blood mononucleated cells (PBMCs) from Col V-reactive patients into SCID mouse footpads along with P2X7R antagonists revealed a selective inhibition of Col V-, but not TT-specific swelling responses. P2X7R inhibitors blocked IL-1β induction from monocytes, including both Col V-α1 peptide-induced (T-dependent), as well as native Col V-induced (T-independent) responses. Significantly higher P2X7R expression was found on CXCR3(neg) CCR4(+)/6(+) CD4(+) [Th17] versus CXCR3(+)CCR4/6(neg) CD4(+) [Th1] subsets in PBMCs, suggesting that the paradigm of selective dependence on P2X7R might extend beyond Col V autoimmunity. Indeed, P2X7R inhibitors suppressed not only anti-Col V, but also Th1/17-mediated alloimmunity, in a heart transplant patient without affecting anti-viral Epstein-Barr virus responses. These results suggest that agents targeting the P2X7R might effectively treat Th17-related transplant pathologies, while maintaining Th1-immunity to infection.
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Affiliation(s)
- JA Sullivan
- Department of Surgery, University of Wisconsin, 600 Highland Avenue, Madison, WI 53792
| | - E Jankowska-Gan
- Department of Surgery, University of Wisconsin, 600 Highland Avenue, Madison, WI 53792
| | - L Shi
- Department of Medicine, University of Wisconsin, 600 Highland Avenue, Madison, WI 53792
| | - D Roenneburg
- Department of Surgery, University of Wisconsin, 600 Highland Avenue, Madison, WI 53792
| | | | - DS Greenspan
- Department of Cell & Regenerative Biology, University of Wisconsin, 600 Highland Avenue, Madison, WI 53792
| | - DS Wilkes
- Department of Medicine, University of Indiana, 340 W 10th St Suite 6200 Indianapolis, IN 46202
| | - LC Denlinger
- Department of Medicine, University of Wisconsin, 600 Highland Avenue, Madison, WI 53792
| | - WJ Burlingham
- Department of Surgery, University of Wisconsin, 600 Highland Avenue, Madison, WI 53792,To whom correspondence should be addressed: 600 Highland Avenue, Room G4/702, Madison, WI 53792. Tel: (608) 263-0119 Fax: (608) 262-6280
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Hegde S, Moore J. Reply. JACC Cardiovasc Interv 2014; 7:338-9. [DOI: 10.1016/j.jcin.2013.11.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2013] [Accepted: 11/21/2013] [Indexed: 11/26/2022]
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Moore J, Hegde S, El-Said H, Beekman R, Benson L, Bergersen L, Holzer R, Jenkins K, Ringel R, Rome J, Vincent R, Martin G. Transcatheter device closure of atrial septal defects: a safety review. JACC Cardiovasc Interv 2014; 6:433-42. [PMID: 23702008 DOI: 10.1016/j.jcin.2013.02.005] [Citation(s) in RCA: 140] [Impact Index Per Article: 14.0] [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] [Received: 01/04/2013] [Accepted: 02/02/2013] [Indexed: 01/11/2023]
Abstract
This review discusses the current safety issues related to U.S. Food and Drug Administration approved atrial septal defect devices and proposes a potential avenue to gather additional safety data including factors, which may be involved in device erosion.
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Affiliation(s)
- John Moore
- Department of Pediatrics, Division of Cardiology, Rady Children's Hospital, University of California, San Diego, San Diego, California 92123, USA.
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Lin CH, Hegde S, Marshall AC, Porras D, Gauvreau K, Balzer DT, Beekman RH, Torres A, Vincent JA, Moore JW, Holzer R, Armsby L, Bergersen L. Incidence and management of life-threatening adverse events during cardiac catheterization for congenital heart disease. Pediatr Cardiol 2014; 35:140-8. [PMID: 23900744 PMCID: PMC3882522 DOI: 10.1007/s00246-013-0752-y] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2013] [Accepted: 06/19/2013] [Indexed: 11/28/2022]
Abstract
Continued advancements in congenital cardiac catheterization and interventions have resulted in increased patient and procedural complexity. Anticipation of life-threatening events and required rescue measures is a critical component to preprocedural preparation. We sought to determine the incidence and nature of life-threatening adverse events in congenital and pediatric cardiac catheterization, risk factors, and resources necessary to anticipate and manage events. Data from 8905 cases performed at the 8 participating institutions of the Congenital Cardiac Catheterization Project on Outcomes were captured between 2007 and 2010 [median 1,095/site (range 133-3,802)]. The incidence of all life-threatening events was 2.1 % [95 % confidence interval (CI) 1.8-2.4 %], whereas mortality was 0.28 % (95 % CI 0.18-0.41 %). Fifty-seven life-threatening events required cardiopulmonary resuscitation, whereas 9 % required extracorporeal membrane oxygenation. Use of a risk adjustment model showed that age <1 year [odd ratio (OR) 1.9, 95 % CI 1.4-2.7, p < 0.001], hemodynamic vulnerability (OR 1.6, 95 % CI 1.1-2.3, p < 0.01), and procedure risk (category 3: OR 2.3, 95 % CI 1.3-4.1; category 4: OR 4.2, 95 % CI 2.4-7.4) were predictors of life-threatening events. Using this model, standardized life-threatening event ratios were calculated, thus showing that one institution had a life-threatening event rate greater than expected. Congenital cardiac catheterization and intervention can be performed safely with a low rate of life-threatening events and mortality; preprocedural evaluation of risk may optimize preparation of emergency rescue and bailout procedures. Risk predictors (age < 1, hemodynamic vulnerability, and procedure risk category) can enhance preprocedural patient risk stratification and planning.
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Affiliation(s)
- C. Huie Lin
- Methodist DeBakey Heart and Vascular Center, Houston, TX USA ,6550 Fannin Street, Suite 1901, Smith Tower, Houston, TX 77030 USA
| | | | | | | | | | | | | | - Alejandro Torres
- Morgan Stanley Children’s Hospital of New York—Presbyterian, New York, NY USA
| | - Julie A. Vincent
- Morgan Stanley Children’s Hospital of New York—Presbyterian, New York, NY USA
| | | | - Ralf Holzer
- Nationwide Children’s Hospital, Columbus, OH USA
| | - Laurie Armsby
- Oregon Health and Science University, Portland, OR USA
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El-Said H, Hegde S, Moore J. First Report of Atretic Coronary Sinus Stenting in a 5-kg Infant Resulting in Dramatic Improvement of Ventricular Function in Functional Single Ventricle. CONGENIT HEART DIS 2013; 9:E175-8. [DOI: 10.1111/chd.12118] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/04/2013] [Indexed: 11/27/2022]
Affiliation(s)
- Howaida El-Said
- Department of Pediatric Cardiology; Rady Children's Hospital; University of California San Diego; San Diego Calif USA
| | - Sanjeet Hegde
- Department of Pediatric Cardiology; Rady Children's Hospital; University of California San Diego; San Diego Calif USA
| | - John Moore
- Department of Pediatric Cardiology; Rady Children's Hospital; University of California San Diego; San Diego Calif USA
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Bennett C, Gangadhar B, Hegde S, Kashyap H, Keshav Kumar J, Mukundan C, Nehra A, Raguram A, Rajakumari K, Rajeswaran J, Rao S, Sadana D, Sadasivan A, Shereena E, Sudhir P, Thomas S. List of contributors. Neuropsychol Rehabil 2013. [DOI: 10.1016/b978-0-12-416046-0.00013-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Sen P, Bhuwanesh K, Ashutosh K, Engineer Z, Hegde S, Sen P, Lal R. Micro-Scale Multi-Effect Distillation System for Low Steam Inputs. ACTA ACUST UNITED AC 2013. [DOI: 10.1016/j.proeng.2013.03.089] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Unnikrishnan B, Jagannath V, Ramapuram JT, Hegde S. Study of depression and its associated factors among women living with HIV AIDS in coastal South India. Retrovirology 2012. [PMCID: PMC3360354 DOI: 10.1186/1742-4690-9-s1-p137] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Tangcharoen T, Bell A, Hegde S, Hussain T, Beerbaum P, Schaeffter T, Razavi R, Botnar RM, Greil GF. Detection of coronary artery anomalies in infants and young children with congenital heart disease by using MR imaging. Radiology 2011; 259:240-7. [PMID: 21325034 DOI: 10.1148/radiol.10100828] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To evaluate the feasibility and accuracy of magnetic resonance (MR) coronary angiography for the detection of coronary artery anomalies in infants and children by using surgical findings as a reference. MATERIALS AND METHODS The data analysis was approved by the institutional review board. One hundred children with congenital heart disease underwent MR coronary angiography while under general anesthesia (mean age ± standard deviation, 3.9 years ± 3; age range, 0.2-11 years). A navigator-gated, T2-prepared, three-dimensional steady-state free precession whole-heart protocol (isotropic voxel size, 1.0-1.3 mm(3); mean imaging time, 4.6 minutes ± 1.2; mean navigator efficiency, 70%; 3-mm gating window) was used after injection of gadopentetate dimeglumine. The cardiac rest period (end systole or middiastole) and acquisition window were prospectively assessed for each patient. Coronary artery image quality (score of 0 [nondiagnostic] to 4 [excellent]), vessel sharpness, and coronary artery anomalies were assessed by two observers. Surgery was performed in 58 patients, and those findings were used to define accuracy. Variables were assessed between age groups by using either analysis of variance or Kruskal-Wallis tests. RESULTS Diagnostic image quality (score, ≥1 for all coronary artery segments) was obtained in 46 of the 58 patients (79%) who underwent surgery. The origin and course of the coronary artery anatomy depicted with MR imaging was confirmed at surgery in all 46 patients-including the four (9%) with substantial coronary artery anomalies. Diagnostic-quality images were obtained in 84 of the 100 patients. The rate of success improved significantly when patients were older than 4 months (88% for patients >4 months vs 17% for patients ≤4 months, P < .001). CONCLUSION Improved whole-heart MR coronary angiography enables accurate detection of abnormal origin and course of the coronary artery system even in very young patients with congenital heart disease.
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Affiliation(s)
- Tarinee Tangcharoen
- Division of Imaging Sciences, Guy's and St Thomas' Hospital, The Rayne Institute, King's College London, 4th Floor, Lambeth Wing, London SE1 7EH, England
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