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Jahani B, Vaidya R, Jin JM, Aboytes DA, Broz KS, Krothapalli S, Pujari B, Baig WM, Tang SY. Assessment of bovine cortical bone fracture behavior using impact microindentation as a surrogate of fracture toughness. JBMR Plus 2024; 8:ziad012. [PMID: 38505533 PMCID: PMC10945719 DOI: 10.1093/jbmrpl/ziad012] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 11/14/2023] [Accepted: 12/05/2023] [Indexed: 03/21/2024] Open
Abstract
The fracture behavior of bone is critically important for evaluating its mechanical competence and ability to resist fractures. Fracture toughness is an intrinsic material property that quantifies a material's ability to withstand crack propagation under controlled conditions. However, properly conducting fracture toughness testing requires the access to calibrated mechanical load frames and the destructive testing of bone samples, and therefore fracture toughness tests are clinically impractical. Impact microindentation mimicks certain aspects of fracture toughness measurements, but its relationship with fracture toughness remains unknown. In this study, we aimed to compare measurements of notched fracture toughness and impact microindentation in fresh and boiled bovine bone. Skeletally mature bovine bone specimens (n = 48) were prepared, and half of them were boiled to denature the organic matrix, while the other half remained preserved in frozen conditions. All samples underwent a notched fracture toughness test to determine their resistance to crack initiation (KIC) and an impact microindentation test using the OsteoProbe to obtain the Bone Material Strength index (BMSi). Boiling the bone samples increased the denatured collagen content, while mineral density and porosity remained unaffected. The boiled bones also showed significant reduction in both KIC (P < .0001) and the average BMSi (P < .0001), leading to impaired resistance of bone to crack propagation. Remarkably, the average BMSi exhibited a high correlation with KIC (r = 0.86; P < .001). A ranked order difference analysis confirmed the excellent agreement between the 2 measures. This study provides the first evidence that impact microindentation could serve as a surrogate measure for bone fracture behavior. The potential of impact microindentation to assess bone fracture resistance with minimal sample disruption could offer valuable insights into bone health without the need for cumbersome testing equipment and sample destruction.
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Affiliation(s)
- Babak Jahani
- Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, MO 63110, United States
| | - Rachana Vaidya
- Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, MO 63110, United States
| | - James M Jin
- Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, MO 63110, United States
| | - Donald A Aboytes
- Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, MO 63110, United States
| | - Kaitlyn S Broz
- Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, MO 63110, United States
- Department of Mechanical Engineering and Materials Science, Washington University in St. Louis, St. Louis, MO 63110, United States
| | - Siva Krothapalli
- School of Medicine, St Louis University, MO 63104, United States
| | - Bhanuteja Pujari
- School of Medicine, St Louis University, MO 63104, United States
| | - Walee M Baig
- Department of Biology and Environmental Health, Missouri Southern State University, Joplin, MO 64801, United States
| | - Simon Y Tang
- Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, MO 63110, United States
- Department of Mechanical Engineering and Materials Science, Washington University in St. Louis, St. Louis, MO 63110, United States
- Department of Biomedical Engineering, Washington University in St. Louis, St. Louis, MO 63130, United States
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Li C, Krothapalli S, Chen YM. Targeting Endoplasmic Reticulum for Novel Therapeutics and Monitoring in Acute Kidney Injury. Nephron Clin Pract 2022; 147:21-24. [PMID: 36116429 PMCID: PMC9928598 DOI: 10.1159/000526050] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Accepted: 07/13/2022] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Endoplasmic reticulum (ER) stress response is a conservative mechanism involving a complex network of different molecular branches to determine cell fate through specific transcription factors and downstream executors. Emerging evidence shows that ER stress is implicated in the occurrence and progression of acute kidney injury (AKI) in different animal models and human patients. However, there is still a lack of therapeutics targeting the ER in AKI. SUMMARY Several therapeutic chemicals, including a compound that induces activating transcription factor 6 (ATF6) and chemical chaperones, have been developed to target the ER in the treatment of AKI. Meanwhile, ER stress-inducible secreted proteins, mesencephalic astrocyte-derived neurotrophic factor (MANF), and cysteine-rich with EGF-like domains 2 (CRELD2) could serve as potential ER stress biomarkers in the early diagnosis and treatment response monitoring of human patients with AKI. KEY MESSAGES Experimental and clinical evidence suggests the critical role of ER in the pathogenesis and progression of AKI, and ER is a novel target in AKI therapy.
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Affiliation(s)
- Chuang Li
- Division of Nephrology, Department of Medicine, Washington University School of Medicine, St. Louis MO, USA
| | - Siva Krothapalli
- Division of Nephrology, Department of Medicine, Washington University School of Medicine, St. Louis MO, USA
- Saint Louis University, St. Louis MO, USA
| | - Ying Maggie Chen
- Division of Nephrology, Department of Medicine, Washington University School of Medicine, St. Louis MO, USA
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Derenbecker R, Colon C, Barrios J, Arora P, Parcha V, Krothapalli S, Shah R, Plumb VJ, Doppalapudi H, McElderry HT, Maddox WR. RISK FACTORS ASSOCIATED WITH 60-DAY MORTALITY FOLLOWING CARDIAC LEAD EXTRACTION. J Am Coll Cardiol 2022. [DOI: 10.1016/s0735-1097(22)01160-3] [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] [Indexed: 11/17/2022]
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Krothapalli S, Bhave PD. A Comparison Between NOACs and Warfarin on Time to Elective Cardioversion. J Atr Fibrillation 2016; 9:1451. [PMID: 27909537 PMCID: PMC5129690 DOI: 10.4022/jafib.1451] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Revised: 07/04/2016] [Accepted: 07/06/2016] [Indexed: 06/06/2023]
Abstract
Cardioversion of atrial fibrillation is a procedure that has been commonly performed for over half a century. There is known to be an elevated risk of thromboembolism around the time of cardioversion, which has been shown to be drastically reduced with oral anticoagulation. The consistency of therapeutic anticoagulation in the weeks leading up to elective cardioversion is an important factor in the safety of the procedure. Until recently, the only option for oral anti-coagulation was Warfarin. The challenges of dosing Warfarin to achieve a therapeutic INR are well documented. In recent years, novel oral anticoagulant medications have been developed, which are thought to provide a consistent intensity of anticoagulation and do not require routine monitoring or dose adjustment. The purpose of this review is to examine the literature pertaining to a comparison of Warfarin versus novel oral anti-coagulants with respect to time of elective cardioversion.
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Shantha GPS, Doshi H, Kumar A, Krothapalli S, Dandamudi G, Bhave P, Mazur A, Hodgson-Zingman D, Giudici M. 137-02: Temporal Trends in Hospitalization Rates for Acute Ischemic Stroke among Nonagenarians with Atrial Fibrillation in the United States: A 15 Year Experience. Europace 2016. [DOI: 10.1093/europace/18.suppl_1.i177] [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: 11/13/2022] Open
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Alqasrawi M, Joseph L, Eshcol J, Doshi H, Iqbal O, Mesubi O, Worden N, Krothapalli S, Bhave P, Giudici M. Abstract 128: Catheter-based Ablation May Improve Survival in Patients with Acute Decompensated Heart Failure with Reduced Ejection Fraction and Atrial Fibrillation or Flutter with Rapid Ventricular Response. Circ Cardiovasc Qual Outcomes 2015. [DOI: 10.1161/circoutcomes.8.suppl_2.128] [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: 11/16/2022]
Abstract
Background:
There is no current evidence regarding safety and efficacy of various rhythm control strategies such as Amiodarone, electrical cardioversion (DCCV), catheter based ablation and other anti-arrhythmic drugs (AAD) for acute control of rapid ventricular response (RVR) in hospitalized patients with atrial fibrillation or flutter (AF/AFL) and acute decompensated heart failure with reduced ejection fraction (ADHFrEF).
Methods:
Single center retrospective study from our registry of hospitalized patients with ADHFrEF and rapid AF/AFL over a 5-year period
Results:
We included 52 patients with ADHFrEF and rapid AF/AFL (mean age, 64.3±13.9 years; 39 (75%) males; mean left ventricular EF [%], 29.4±8.1; median follow up duration [months], 13 [interquartile range, 5.3-19]): 30 (57.7%) received amiodarone, 19 (36.5%) received DCCV, 10 (19.2%) received catheter ablation and 1 (1.9%) received other AAD. Patients who were treated with catheter ablation had significantly higher rates of survival to median follow up and to hospital discharge compared to those who were not treated with ablation. There were no significant differences in symptoms control, major bleeding event, systemic embolism, worsening HF, procedure related complications, and length of hospital stay between patients treated with and without amiodarone, DCCV and catheter ablation (Table 1). New onset AF/AFL, new HF, left ventricular EF, NYHA functional class, and loading with AAD did not predict response to DCCV (P = 0.22-0.87) (Table 2).
Conclusion:
Acute control of rapid AF/AFL in hospitalized patients with ADHFrEF using catheter ablation significantly improved survival. Catheter-based ablation may be a safe and efficacious treatment option for these patients.
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Krothapalli S, Joseph L, Iqbal O, Mesubi O, Doshi H, Worden N, Eshcol J, Alqasrawi M, Bhave P, Giudici M. EFFICACY AND SAFETY OUTCOMES OF VARIOUS RATE CONTROL STRATEGIES FOR PATIENTS WITH ACUTE DECOMPENSATED HEART FAILURE WITH REDUCED EJECTION FRACTION AND ATRIAL FIBRILLATION OR FLUTTER WITH RAPID VENTRICULAR RESPONSE. J Am Coll Cardiol 2015. [DOI: 10.1016/s0735-1097(15)60474-0] [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] [Indexed: 10/23/2022]
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Dahhan A, Maddox WR, Krothapalli S, Farmer M, Shah A, Ford B, Rhodes M, Matthews L, Barnes VA, Sharma GK. Education of Physicians and Implementation of a Formal Referral System Can Improve Cardiac Rehabilitation Referral and Participation Rates after Percutaneous Coronary Intervention. Heart Lung Circ 2015; 24:806-16. [PMID: 25797328 DOI: 10.1016/j.hlc.2015.02.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Accepted: 02/06/2015] [Indexed: 10/24/2022]
Abstract
BACKGROUND Cardiac rehabilitation (CR) is an effective preventive measure that remains underutilised in the United States. The study aimed to determine the CR referral rate (RR) after percutaneous coronary intervention (PCI) at an academic tertiary care centre, identify barriers to referral, and evaluate awareness of CR benefits and indications (CRBI) among cardiologists. Subsequently, it aimed to evaluate if an intervention consisting of physicians' education about CRBI and implementation of a formal CR referral system could improve RR and consequently participation rate (PR). METHODS Data were retrospectively collected for all consecutive patients who underwent PCI over 12 months. Referral rate was determined and variables were compared for differences between referred and non-referred patients. A questionnaire was distributed among the physicians in the Division of Cardiology to assess awareness of CRBI and referral practice patterns. After implementation of the intervention, data were collected retrospectively for consecutive patients who underwent PCI in the following six months. Referral rate and changes in PRs were determined. RESULTS Prior to the intervention, RR was 17.6%. Different barriers were identified, but the questionnaire revealed lack of physicians' awareness of CRBI and inconsistent referral patterns. After the intervention, RR increased to 88.96% (Odds Ratio 37.73, 95% CI 21.34-66.70, p<0.0001) and PR increased by 32.8% to reach 26%. Personal endorsement of CRBI by cardiologists known to patients increased CR program graduation rate by 35%. CONCLUSIONS Cardiologists' awareness of CRBI increases CR RR and their personal endorsement improves PR and compliance. Education of providers and implementation of a formal referral system can improve RR and PR.
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Affiliation(s)
| | | | | | | | - Amit Shah
- Georgia Regents University, Augusta, GA, USA
| | | | - Marc Rhodes
- Georgia Regents University, Augusta, GA, USA
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Krothapalli S, Bhave PD. My Patient Taking A Novel Oral Anticoagulant Needs Surgery, Device Implantation, Or Ablation. J Atr Fibrillation 2014; 7:1145. [PMID: 27957125 DOI: 10.4022/jafib.1145] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2014] [Revised: 10/03/2014] [Accepted: 10/14/2014] [Indexed: 11/10/2022]
Abstract
Atrial fibrillation (AF) is a highly prevalent chronic condition and a growing number of patients are on chronic anticoagulation therapy with novel oral anticoagulant (NOAC) agents: dabigatran, rivaroxaban, and apixaban. Many of these patients are expected to require invasive procedures. There is no clear consensus regarding the peri-procedural management of patients using NOACs, as to how to minimize both bleeding risk and thromboembolism risk. This review of the current available literature is designed to help formulate peri-procedural anticoagulation strategies for patients with AF taking NOACs who are being considered for catheter ablation, device implant, or other surgery. To help frame the discussion, we offer 3 case vignettes that we will revisit to at the end of the review of the existing literature. Case 1: A 62 year-old female with hypertension, diabetes, and symptomatic paroxysmal AF who is prescribed dabigatran for thromboembolism prevention. She has failed attempts at maintaining sinus rhythm with antiarrhythmic drugs. She is now being considered for catheter ablation of AF. Case 2: A 76 year-old male with hypertension, diabetes, prior stroke, and ischemic cardiomyopathy who has persistent drug-refractory AF. He is maintained on chronic anticoagulation with dabigatran for thromboembolism prevention. He has an implantable cardioverter-defibrillator (ICD) which requires a generator change. Case 3: A 58 year-old male with hypertension and paroxysmal AF who takes rivaroxaban for thromboembolic prophylaxis and is being considered for a knee replacement surgery.
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Murphy M, Krothapalli S, Cuellar J, Kanjanauthai S, Heeke B, Gomadam PS, Guha A, Barnes VA, Litwin SE, Sharma GK. Prognostic value of normal stress echocardiography in obese patients. J Obes 2014; 2014:419724. [PMID: 25258682 PMCID: PMC4167457 DOI: 10.1155/2014/419724] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2014] [Revised: 07/15/2014] [Accepted: 08/02/2014] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Chest pain is a common problem in obese patients. Because of the body habitus, the results of noninvasive evaluation for CAD may be limited in this group. METHODS We reviewed the records of 1446 consecutive patients who had undergone clinically indicated stress echocardiography (SE). We compared major adverse cardiac events (MACE; myocardial infarction, cardiac intervention, cardiac death, subsequent hospitalization for cardiac events, and emergency department visits) at 1 year in normal weight, overweight, and obese subjects with normal SE. RESULTS Excluding patients with an abnormal and indeterminate SE and those who were lost to follow-up, a retrospective analysis of 704 patients was performed. There were 366 obese patients (BMI ≥ 30), 196 overweight patients (BMI 25-29.9), and 142 patients with normal BMI (18.5-24.9). There was no MACE in the groups at 1-year follow-up after a normal SE. CONCLUSIONS In obese patients including those with multiple risk factors and symptoms concerning for cardiac ischemia, stress echocardiography is an effective and reliable noninvasive tool for identifying those with a low 1-year risk of cardiac events.
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Affiliation(s)
- Michele Murphy
- Division of Cardiology, Medical College of Georgia, Georgia Regents University, 1120 15th Street, BBR 6518, Augusta, GA 30912-3105, USA
| | - Siva Krothapalli
- Division of Cardiology, Medical College of Georgia, Georgia Regents University, 1120 15th Street, BBR 6518, Augusta, GA 30912-3105, USA
| | - Jose Cuellar
- Division of Cardiology, Medical College of Georgia, Georgia Regents University, 1120 15th Street, BBR 6518, Augusta, GA 30912-3105, USA
| | - Somsupha Kanjanauthai
- Division of Cardiology, Medical College of Georgia, Georgia Regents University, 1120 15th Street, BBR 6518, Augusta, GA 30912-3105, USA
| | - Brian Heeke
- Division of Cardiology, Medical College of Georgia, Georgia Regents University, 1120 15th Street, BBR 6518, Augusta, GA 30912-3105, USA
| | - Pallavi S. Gomadam
- Division of Cardiology, Medical College of Georgia, Georgia Regents University, 1120 15th Street, BBR 6518, Augusta, GA 30912-3105, USA
| | - Avirup Guha
- Division of Cardiology, Medical College of Georgia, Georgia Regents University, 1120 15th Street, BBR 6518, Augusta, GA 30912-3105, USA
| | - Vernon A. Barnes
- Division of Cardiology, Medical College of Georgia, Georgia Regents University, 1120 15th Street, BBR 6518, Augusta, GA 30912-3105, USA
| | - Sheldon E. Litwin
- Division of Cardiology, Medical College of Georgia, Georgia Regents University, 1120 15th Street, BBR 6518, Augusta, GA 30912-3105, USA
| | - Gyanendra K. Sharma
- Division of Cardiology, Medical College of Georgia, Georgia Regents University, 1120 15th Street, BBR 6518, Augusta, GA 30912-3105, USA
- *Gyanendra K. Sharma:
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Kanjanauthai S, Dahhan A, Napier R, Krothapalli S, Zang LF, Lan L, Sharma G. APPROPRIATE UTILIZATION OF TRANSESOPHAGEAL ECHOCARDIOGRAPHY IN AN ACADEMIC SETTING. J Am Coll Cardiol 2011. [DOI: 10.1016/s0735-1097(11)60760-2] [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] [Indexed: 10/18/2022]
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