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Bui V, Hsu L, Sun A, Tran L, Shanbhag S, Chang L, Zhou W, Mehta N, Chen M. 401 Deepheartct: A Fully Automatic Hybrid Structure Segmentation Framework Based On Atlas, Reverse Ranking, And Convolutional Neural Network For Computed Tomography Angiography. J Cardiovasc Comput Tomogr 2022. [DOI: 10.1016/j.jcct.2022.06.006] [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: 10/17/2022]
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Reed N, Balega J, Barwick T, Buckley L, Burton K, Eminowicz G, Forrest J, Ganesan R, Harrand R, Holland C, Howe T, Ind T, Iyer R, Kaushik S, Music R, Sadozye A, Shanbhag S, Siddiqui N, Syed S, Percival N, Whitham NL, Nordin A, Fotopoulou C. British Gynaecological Cancer Society (BGCS) cervical cancer guidelines: Recommendations for practice. Eur J Obstet Gynecol Reprod Biol 2020; 256:433-465. [PMID: 33143928 DOI: 10.1016/j.ejogrb.2020.08.020] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 08/05/2020] [Accepted: 08/21/2020] [Indexed: 01/20/2023]
Abstract
Cervix cancer in many countries is declining and screening programmes and immunisation will reduce the incidence in the next few decades. This guideline attempts to cover management of invasive disease reflecting diagnosis and imaging including new imaging and sentinel lymph node biopsies. Smaller volume disease is usually managed surgically whereas advanced disease is treated with (chemo)- radiation. It also includes discussion of fertility sparing procedures. Practices are changing frequently for all aspects of care usually in attempts to reduce complications and improve quality of life. The management of advanced disease is treated by chemotherapy and the use of newer agents is also discussed. Other sections discuss specialist situations such as cancer in pregnancy, rare cervical tumours, late effects and supportive measures and fertility preserving approaches.
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Affiliation(s)
- Nick Reed
- Beatson Oncology Centre, Glasgow, United Kingdom.
| | | | | | - Lynn Buckley
- Clinical Nurse Specialist, Hull University Teaching Hospitals NHS Trust, United Kingdom
| | | | | | | | | | | | | | | | - Thomas Ind
- Royal Marsden Hospital, London, United Kingdom
| | - Rema Iyer
- East Kent Hospitals University Foundation NHS Trust, United Kingdom
| | | | - Robert Music
- Jo's Cervical Cancer Trustt, London, United Kingdom
| | | | - Smruta Shanbhag
- University Hospitals Coventry and Warwickshire NHS Trust, United Kingdom
| | | | - Sheeba Syed
- Queen Elizabeth University Hospital, Glasgow, United Kingdom
| | | | - Natasha Lauren Whitham
- Lancashire Teaching Hospitals (Royal Preston Hospital, Fulwood, Lancashire), United Kingdom
| | - Andy Nordin
- East Kent Gynaecological Oncology Centre, East Kent Hospitals University Foundation Nhs Trust, Queen Elizabeth The Queen Mother Hospital, Margate, United Kingdom
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Shanbhag S, Levine O, Bui V, Bandettini W, Hsu L, Chen M. Association Between Body Mass Index (BMI) And Cardiac Chamber Size As Measured By A Novel Artificial Intelligence (AI) System On Cardiac Computed Tomography Angiography (CCTA) Images. J Cardiovasc Comput Tomogr 2020. [DOI: 10.1016/j.jcct.2020.06.016] [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: 11/26/2022]
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Gimpel D, Shanbhag S, Srivastava T, Macleod M, Conaglen P, Odom N, Kejriwal N, Lin Z, McCormack D, El-Gamel A. Early Discharge From Intensive Care After Cardiac Surgery is Feasible With an Adequate Fast Track, Stepdown Unit: Waikato Experience. Heart Lung Circ 2019. [DOI: 10.1016/j.hlc.2019.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Schoch LK, Asiama A, Zahurak M, Shanbhag S, Hurtt J, Sawyer K, Swinnen LJ, Wagner-Johnston N, Jones RJ, Ambinder RF, Gladstone DE. Pharmacokinetically-targeted dosed everolimus maintenance therapy in lymphoma patients. Cancer Chemother Pharmacol 2017; 81:347-354. [PMID: 29234922 DOI: 10.1007/s00280-017-3499-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Accepted: 12/08/2017] [Indexed: 11/24/2022]
Abstract
BACKGROUND Everolimus, an mTOR inhibitor, is active in refractory lymphomas. However, toxicity with flat dosing limits its usage. Speculatively, pharmacokinetically-targeted dosing could improve tolerability. Therefore, we studied serum-trough dosing with rituximab as maintenance after high-dose cyclophosphamide (HDC) consolidation in lymphoma patients. PATIENTS/METHODS After HDC, everolimus was dosed to serum trough levels (goal 3-15 ng/mL), with quarterly rituximab infusions for 1 year while maintaining < grade II non-hematologic and < grade III hematologic toxicities. Adult patients in first PR/CR with: mantle cell, transformed, double-hit, or high risk chronic lymphocytic leukemia or in second PR for any relapsed B cell lymphoma were eligible. Prophylaxis was given for encapsulated organisms, HSV and PCP. Serum IgG levels were maintained > 500 mg/dL. RESULTS 49 patients, median age: 59.0 years enrolled; MCL (26), CLL (10), transformed lymphoma (7), and other histologies (6). During the life of the study, the most frequent everolimus dosing has been 2.5 mg daily or 2.5 mg every other day; at these doses, serum levels are within the therapeutic range and non-hematologic toxicity is rare. At a median follow-up of 27.1 months, three patients remain on active therapy. Two patients withdrew secondary to potentially-attributable adverse events including a bacterial pneumonia and a viral pneumonia; this low rate of discontinuation compares well to other long-term everolimus trials. While a 58 and 76% EFS at 30 months for the entire cohort and MCL cohort, respectively, compares similarly to previously published HDC/rituximab data, longer follow-up is required. CONCLUSIONS Pharmacokinetically-targeted dosing appears to increase everolimus tolerability. This finding may be applicable to other patient populations.
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Affiliation(s)
- L K Schoch
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, 401 N. Broadway room 1363, Baltimore, MD, 21287, USA
| | - A Asiama
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, 401 N. Broadway room 1363, Baltimore, MD, 21287, USA
| | - M Zahurak
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, 401 N. Broadway room 1363, Baltimore, MD, 21287, USA
| | - S Shanbhag
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, 401 N. Broadway room 1363, Baltimore, MD, 21287, USA
| | - J Hurtt
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, 401 N. Broadway room 1363, Baltimore, MD, 21287, USA
| | - K Sawyer
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, 401 N. Broadway room 1363, Baltimore, MD, 21287, USA
| | - L J Swinnen
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, 401 N. Broadway room 1363, Baltimore, MD, 21287, USA
| | - N Wagner-Johnston
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, 401 N. Broadway room 1363, Baltimore, MD, 21287, USA
| | - R J Jones
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, 401 N. Broadway room 1363, Baltimore, MD, 21287, USA
| | - R F Ambinder
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, 401 N. Broadway room 1363, Baltimore, MD, 21287, USA
| | - Douglas E Gladstone
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, 401 N. Broadway room 1363, Baltimore, MD, 21287, USA.
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Shanbhag S, Bootwala Y, Whitacre JF, Mauter MS. Ion Transport and Competition Effects on NaTi 2(PO 4) 3 and Na 4Mn 9O 18 Selective Insertion Electrode Performance. Langmuir 2017; 33:12580-12591. [PMID: 29028355 DOI: 10.1021/acs.langmuir.7b02861] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
We evaluate the efficiency and capacity of electrochemically reversible insertion electrodes for use in targeted ion removal applications in aqueous solutions. The relative attributes of insertion material chemistry are evaluated by comparing the performance of two different sodium insertion materials, NaTi2(PO4)3 and Na4Mn9O18, in different electrolyte environments. We performed experiments over a range of solution compositions containing both sodium and other non-inserting ions, and we then developed mechanistic insight into the effects of solution concentration and composition on overpotential losses and round trip Coulombic efficiency. In dilute aqueous streams, performance was limited by the rate of ion transport from the bulk electrolyte region to the electrode interface. This leads to slow rates of ion removal, large overpotentials for ion insertion, parasitic charge loss due to water electrolysis, and lower round trip Coulombic efficiencies. This effect is particularly large for insertion electrodes with redox potentials exceeding the water stability window. In solutions with high background concentrations of non-inserting ions, the accumulation of non-inserting ions at the electrode interface limits inserting ion flux and leads to low ion removal capacity and round trip Coulombic efficiency.
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Affiliation(s)
- S Shanbhag
- Department of Civil and Environmental Engineering, ‡Department of Materials Science and Engineering, §Department of Engineering and Public Policy, and ∥The Scott Institute for Energy Innovation, Carnegie Mellon University , 5000 Forbes Ave, Pittsburgh, Pennsylvania 15213, United States
| | - Y Bootwala
- Department of Civil and Environmental Engineering, ‡Department of Materials Science and Engineering, §Department of Engineering and Public Policy, and ∥The Scott Institute for Energy Innovation, Carnegie Mellon University , 5000 Forbes Ave, Pittsburgh, Pennsylvania 15213, United States
| | - J F Whitacre
- Department of Civil and Environmental Engineering, ‡Department of Materials Science and Engineering, §Department of Engineering and Public Policy, and ∥The Scott Institute for Energy Innovation, Carnegie Mellon University , 5000 Forbes Ave, Pittsburgh, Pennsylvania 15213, United States
| | - M S Mauter
- Department of Civil and Environmental Engineering, ‡Department of Materials Science and Engineering, §Department of Engineering and Public Policy, and ∥The Scott Institute for Energy Innovation, Carnegie Mellon University , 5000 Forbes Ave, Pittsburgh, Pennsylvania 15213, United States
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Shanbhag S, Ghosh K, Shetty S. Somatic mosaicism in a severe haemophilia B family detected by allele specific PCR: An alert to the genetic diagnostic laboratories. Thromb Res 2017; 158:138-139. [DOI: 10.1016/j.thromres.2017.09.005] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Revised: 08/24/2017] [Accepted: 09/05/2017] [Indexed: 10/18/2022]
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Prabhudesai A, Shanbhag S, Mirgal D, Kawankar N, Shetty S. A de novo factor VIII mutation in a haemophilia B family leading to combined deficiency of factor VIII and IX. Haemophilia 2017; 23:e477-e479. [PMID: 28750473 DOI: 10.1111/hae.13307] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/12/2017] [Indexed: 11/28/2022]
Affiliation(s)
- A Prabhudesai
- Department of Haemostasis and Thrombosis, National Institute of Immunohaematology (ICMR), Parel, Mumbai, India
| | - S Shanbhag
- Department of Haemostasis and Thrombosis, National Institute of Immunohaematology (ICMR), Parel, Mumbai, India
| | - D Mirgal
- Department of Haemostasis and Thrombosis, National Institute of Immunohaematology (ICMR), Parel, Mumbai, India
| | - N Kawankar
- Department of Haemostasis and Thrombosis, National Institute of Immunohaematology (ICMR), Parel, Mumbai, India
| | - S Shetty
- Department of Haemostasis and Thrombosis, National Institute of Immunohaematology (ICMR), Parel, Mumbai, India
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Affiliation(s)
- S. Shanbhag
- National Institute of Immunohaematology; KEM Hospital; Parel Mumbai India
| | - K. Ghosh
- Surat Raktadan Kendra; Surat Gujarat India
| | - S. Shetty
- National Institute of Immunohaematology; KEM Hospital; Parel Mumbai India
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Burnell M, Iyer R, Gentry-Maharaj A, Nordin A, Liston R, Manchanda R, Das N, Gornall R, Beardmore-Gray A, Hillaby K, Leeson S, Linder A, Lopes A, Meechan D, Mould T, Nevin J, Olaitan A, Rufford B, Shanbhag S, Thackeray A, Wood N, Reynolds K, Ryan A, Menon U. Benchmarking of surgical complications in gynaecological oncology: prospective multicentre study. BJOG 2016; 123:2171-2180. [DOI: 10.1111/1471-0528.13994] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/27/2015] [Indexed: 11/26/2022]
Affiliation(s)
- M Burnell
- Department of Women's Cancer; Gynaecological Cancer Research Centre; Institute for Women's Health; University College London; London UK
| | - R Iyer
- Department of Women's Cancer; Gynaecological Cancer Research Centre; Institute for Women's Health; University College London; London UK
| | - A Gentry-Maharaj
- Department of Women's Cancer; Gynaecological Cancer Research Centre; Institute for Women's Health; University College London; London UK
| | - A Nordin
- East Kent Gynaecological Oncology Centre; Queen Elizabeth the Queen Mother Hospital; Margate UK
| | - R Liston
- Department of Women's Cancer; Gynaecological Cancer Research Centre; Institute for Women's Health; University College London; London UK
| | - R Manchanda
- Department of Women's Cancer; Gynaecological Cancer Research Centre; Institute for Women's Health; University College London; London UK
- Department of Gynaecological Cancer; Barts Cancer Centre; Barts and the London NHS Trust; London UK
| | - N Das
- Department of Gynaecological Cancer; Royal Cornwall Hospitals NHS Trust; Truro UK
| | - R Gornall
- Department of Gynaecological Oncology; Cheltenham General Hospital; Cheltenham UK
| | - A Beardmore-Gray
- Department of Women's Cancer; Gynaecological Cancer Research Centre; Institute for Women's Health; University College London; London UK
| | - K Hillaby
- Department of Gynaecological Oncology; Cheltenham General Hospital; Cheltenham UK
| | - S Leeson
- Department of Obstetrics and Gynaecology; BetsiCadwaladr University Health Board; Bangor UK
| | - A Linder
- Department of Gynaecological Oncology; The Ipswich Hospital NHS Trust; Ipswich Suffolk UK
| | - A Lopes
- Department of Gynaecological Cancer; Royal Cornwall Hospitals NHS Trust; Truro UK
| | | | - T Mould
- Department of Gynaecological Oncology; University College London Hospital NHS Foundation Trust; London UK
| | - J Nevin
- Pan Birmingham Gynaecological Cancer Centre; Birmingham City Hospital; Birmingham UK
| | - A Olaitan
- Department of Gynaecological Oncology; University College London Hospital NHS Foundation Trust; London UK
| | - B Rufford
- Department of Gynaecological Oncology; The Ipswich Hospital NHS Trust; Ipswich Suffolk UK
| | - S Shanbhag
- Department of Gynaecological Oncology; Glasgow Royal Infirmary; Glasgow UK
| | | | - N Wood
- Department of Gynaecological Oncology; Lancashire Teaching Hospitals NHS Foundation trust; Royal Preston Hospital; Preston UK
| | - K Reynolds
- Department of Gynaecological Cancer; Barts Cancer Centre; Barts and the London NHS Trust; London UK
| | - A Ryan
- Department of Women's Cancer; Gynaecological Cancer Research Centre; Institute for Women's Health; University College London; London UK
| | - U Menon
- Department of Women's Cancer; Gynaecological Cancer Research Centre; Institute for Women's Health; University College London; London UK
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Shanbhag S, Lulla C, Ghosh K, Shetty S. Prenatal diagnosis in a haemophilia carrier with triplet pregnancy. Haemophilia 2015; 21:e228-e230. [PMID: 25649477 DOI: 10.1111/hae.12630] [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] [Accepted: 12/18/2014] [Indexed: 11/30/2022]
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Iyer R, Gentry-Maharaj A, Nordin A, Burnell M, Liston R, Manchanda R, Das N, Desai R, Gornall R, Beardmore-Gray A, Nevin J, Hillaby K, Leeson S, Linder A, Lopes A, Meechan D, Mould T, Varkey S, Olaitan A, Rufford B, Ryan A, Shanbhag S, Thackeray A, Wood N, Reynolds K, Menon U. Predictors of complications in gynaecological oncological surgery: a prospective multicentre study (UKGOSOC-UK gynaecological oncology surgical outcomes and complications). Br J Cancer 2014; 112:475-84. [PMID: 25535730 PMCID: PMC4453652 DOI: 10.1038/bjc.2014.630] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Revised: 11/16/2014] [Accepted: 11/30/2014] [Indexed: 12/14/2022] Open
Abstract
Background: There are limited data on surgical outcomes in gynaecological oncology. We report on predictors of complications in a multicentre prospective study. Methods: Data on surgical procedures and resulting complications were contemporaneously recorded on consented patients in 10 participating UK gynaecological cancer centres. Patients were sent follow-up letters to capture any further complications. Post-operative (Post-op) complications were graded (I–V) in increasing severity using the Clavien-Dindo system. Grade I complications were excluded from the analysis. Univariable and multivariable regression was used to identify predictors of complications using all surgery for intra-operative (Intra-op) and only those with both hospital and patient-reported data for Post-op complications. Results: Prospective data were available on 2948 major operations undertaken between April 2010 and February 2012. Median age was 62 years, with 35% obese and 20.4% ASA grade ⩾3. Consultant gynaecological oncologists performed 74.3% of operations. Intra-op complications were reported in 139 of 2948 and Grade II–V Post-op complications in 379 of 1462 surgeries. The predictors of risk were different for Intra-op and Post-op complications. For Intra-op complications, previous abdominal surgery, metabolic/endocrine disorders (excluding diabetes), surgical complexity and final diagnosis were significant in univariable and multivariable regression (P<0.05), with diabetes only in multivariable regression (P=0.006). For Post-op complications, age, comorbidity status, diabetes, surgical approach, duration of surgery, and final diagnosis were significant in both univariable and multivariable regression (P<0.05). Conclusions: This multicentre prospective audit benchmarks the considerable morbidity associated with gynaecological oncology surgery. There are significant patient and surgical factors that influence this risk.
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Affiliation(s)
- R Iyer
- Gynaecological Cancer Research Centre, Department of Women's Cancer, Institute for Women's Health, University College London, 1st Floor Maple House, 149 Tottenham Court Road, London W1T 7DN, UK
| | - A Gentry-Maharaj
- Gynaecological Cancer Research Centre, Department of Women's Cancer, Institute for Women's Health, University College London, 1st Floor Maple House, 149 Tottenham Court Road, London W1T 7DN, UK
| | - A Nordin
- National Cancer Intelligence Network Gynaecology Clinical Reference Group, 5th Floor, Wellington House, 133-155 Waterloo Road, London SE1 8UG, UK
| | - M Burnell
- Gynaecological Cancer Research Centre, Department of Women's Cancer, Institute for Women's Health, University College London, 1st Floor Maple House, 149 Tottenham Court Road, London W1T 7DN, UK
| | - R Liston
- Gynaecological Cancer Research Centre, Department of Women's Cancer, Institute for Women's Health, University College London, 1st Floor Maple House, 149 Tottenham Court Road, London W1T 7DN, UK
| | - R Manchanda
- Gynaecological Cancer Research Centre, Department of Women's Cancer, Institute for Women's Health, University College London, 1st Floor Maple House, 149 Tottenham Court Road, London W1T 7DN, UK
| | - N Das
- Department of Gynaecological Cancer, Royal Cornwall Hospitals NHS Trust, Truro, Cornwall TR1 3LJ, UK
| | - R Desai
- Gynaecological Cancer Research Centre, Department of Women's Cancer, Institute for Women's Health, University College London, 1st Floor Maple House, 149 Tottenham Court Road, London W1T 7DN, UK
| | - R Gornall
- Department of Gynaecological Oncology, Cheltenham General Hospital, Sandford Road, Cheltenham, Gloucestershire GL53 7AN, UK
| | - A Beardmore-Gray
- Gynaecological Cancer Research Centre, Department of Women's Cancer, Institute for Women's Health, University College London, 1st Floor Maple House, 149 Tottenham Court Road, London W1T 7DN, UK
| | - J Nevin
- Pan Birmingham Gynaecological Cancer Centre, Birmingham City Hospital, Dudley Road, Birmingham, West Midlands B18 7QH, UK
| | - K Hillaby
- Department of Gynaecological Oncology, Cheltenham General Hospital, Sandford Road, Cheltenham, Gloucestershire GL53 7AN, UK
| | - S Leeson
- Department of Obstetrics and Gynaecology, Betsi Cadwaladr University Health Board, Penrhosgarnedd, Bangor, Gwynedd, North Wales LL57 2PW, UK
| | - A Linder
- Department of Gynaecological Oncology, The Ipswich Hospital NHS Trust, Heath Road, Ipswich, Suffolk IP4 5PD, UK
| | - A Lopes
- Department of Gynaecological Cancer, Royal Cornwall Hospitals NHS Trust, Truro, Cornwall TR1 3LJ, UK
| | - D Meechan
- Trent Cancer Registry, 5 Old Fulwood Road, Sheffield S10 3TG, UK
| | - T Mould
- Department of Gynaecological Oncology, University College London Hospital NHS Foundation Trust, 2nd Floor North, 250 Euston Road, London NW1 2PG, UK
| | - S Varkey
- Gynaecological Cancer Research Centre, Department of Women's Cancer, Institute for Women's Health, University College London, 1st Floor Maple House, 149 Tottenham Court Road, London W1T 7DN, UK
| | - A Olaitan
- Department of Gynaecological Oncology, University College London Hospital NHS Foundation Trust, 2nd Floor North, 250 Euston Road, London NW1 2PG, UK
| | - B Rufford
- Department of Gynaecological Oncology, The Ipswich Hospital NHS Trust, Heath Road, Ipswich, Suffolk IP4 5PD, UK
| | - A Ryan
- Gynaecological Cancer Research Centre, Department of Women's Cancer, Institute for Women's Health, University College London, 1st Floor Maple House, 149 Tottenham Court Road, London W1T 7DN, UK
| | - S Shanbhag
- Department of Gynaecological Oncology, Glasgow Royal Infirmary, 16 Alexandra Parade, Glasgow G31 2ER, UK
| | - A Thackeray
- Trent Cancer Registry, 5 Old Fulwood Road, Sheffield S10 3TG, UK
| | - N Wood
- Department of Gynaecological Oncology, Lancashire Teaching Hospitals NHS Foundation Trust, Royal Preston Hospital, Sharoe Green Lane, North Fulwood, Preston Lancashire PR2 9HT, UK
| | - K Reynolds
- Department of Gynaecological Cancer, Barts Cancer Centre, Barts and the London NHS Trust, St Bartholomew's Hospital (Barts), West Smithfield, London EC1A 7BE, UK
| | - U Menon
- Gynaecological Cancer Research Centre, Department of Women's Cancer, Institute for Women's Health, University College London, 1st Floor Maple House, 149 Tottenham Court Road, London W1T 7DN, UK
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Munch F, Retel J, Jeuthe S, van Rossum B, Oh-Ici D, Berger F, Kuhne T, Oschkinat H, Messroghli D, Rodriguez Palomares J, Gutierrez Garcia Moreno L, Maldonado G, Garcia G, Otaegui I, Garcia Del Blanco B, Barrabes J, Gonzalez Alujas M, Evangelista A, Garcia Dorado D, Barison A, Del Torto A, Chiappino S, Del Franco A, Pugliese N, Aquaro G, Positano V, Passino C, Emdin M, Masci P, Fischer K, Guensch D, Shie N, Friedrich M, Captur G, Zemrak F, Muthurangu V, Chunming L, Petersen S, Kawel-Boehm N, Bassett P, Elliott P, Lima J, Bluemke D, Moon J, Pontone G, Bertella E, Loguercio M, Baggiano A, Mushtaq S, Aquaro G, Salerni S, Rossi C, Andreini D, Masci P, Ucar E, Baydes R, Ngah N, Kuo Y, Dabir D, Cummins C, Higgins D, Schaeffter T, Gaddum N, Chowienczyk P, Carr-White G, Marber M, Ucar S, Baydes R, Ngah N, Kuo Y, Dabir D, Cummins C, Higgins D, Schaeffter T, Gaddum N, Chowienczyk P, Carr-White G, Marber M, Reinstadler S, Klug G, Feistritzer H, Greber K, Mair J, Schocke M, Franz W, Metzler B, Moschetti K, Petersen S, Pilz G, Wasserfallen J, Lombardi M, Korosoglou G, Van Rossum A, Bruder O, Mahrholdt H, Schwitter J, Rodriguez Palomares J, Garcia Del Blanco B, Ferreira Gonzalez I, Otaegui I, Pineda V, Ruiz Salmeron R, San Roman A, Evangelista A, Fernandez Aviles F, Garcia Dorado D, Winkler S, Allison T, Conn H, Bandettini P, Shanbhag S, Kellman P, Hsu L, Arai A, Klug G, Reinstadler S, Feistritzer H, Pernter B, Mair J, Schocke M, Franz W, Metzler B, Pica S, Sado D, Maestrini V, Fontana M, White S, Treibel T, Anderson S, Piechnik S, Robson M, Lachmann R, Murphy E, Mehta A, Hughes D, Elliott P, Moon J, Ferreira V, Dall'Armellina E, Piechnik S, Karamitsos T, Francis J, Choudhury R, Banning A, Channon K, Kharbanda R, Forfar C, Ormerod O, Prendergast B, Kardos A, Newton J, Friedrich M, Robson M, Neubauer S, Barison A, Del Franco A, Vergaro G, Mirizzi G, Del Torto A, Chiappino S, Masci P, Passino C, Emdin M, Aquaro G, Florian A, Ludwig A, Rosch S, Sechtem U, Yilmaz A, Greulich S, Kitterer D, Latus J, Bentz K, Birkmeier S, Alscher M, Sechtem U, Braun N, Mahrholdt H, Barison A, Pugliese N, Masci P, Del Franco A, Vergaro G, Del Torto A, Passino C, Perfetto F, Emdin M, Aquaro G, Secchi F, Petrini M, Cannao P, Di Leo G, Sardanelli F, Lombardi M, Yoshihara H, Bastiaansen J, Berthonneche C, Comment A, Schwitter J, Gerber B, Noppe G, Marquet N, Buchlin P, Vanoverschelde J, Bertrand L, Horman S, Dorota P, Piotr W, Marek G, Almeida A, Cortez-Dias N, de Sousa J, Carpinteiro L, Magalhaes A, Silva G, Bernardes A, Pinto F, Nunes Diogo A. These abstracts have been selected for presentation in 4 sessions throughout the meeting. Please refer to the PROGRAM for more details. Eur Heart J Cardiovasc Imaging 2014. [DOI: 10.1093/ehjci/jeu083] [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: 11/14/2022] Open
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Gurumurthy M, Bryant A, Shanbhag S. Effectiveness of different treatment modalities for the management of adult-onset granulosa cell tumours of the ovary (primary and recurrent). Cochrane Database Syst Rev 2014; 2014:CD006912. [PMID: 24753008 PMCID: PMC6513416 DOI: 10.1002/14651858.cd006912.pub2] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Granulosa cell tumour is a rare gynaecological tumour of the ovary with recurrences many years after initial diagnosis and treatment. Evidence-based management of granulosa cell tumour of the ovary is limited, and treatment has not been standardised. Surgery, including fertility-sparing procedures for young women, has traditionally been the standard treatment. Adjuvant treatments following surgery have been based on non-randomised trials. A combination of bleomycin, etoposide and cisplatin (BEP) has traditionally been used for treatment of advanced and/or recurrent disease that cannot be optimally managed surgically. OBJECTIVES To evaluate the effectiveness and safety of different treatment modalities offered in current practice for the management of primary, residual and recurrent adult-onset granulosa cell tumours (GCTs) of the ovary. SEARCH METHODS We searched the Cochrane Gynaecological Cancer Group Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE and EMBASE up to December 2013. We also searched registers of clinical trials, abstracts of scientific meetings and reference lists of included studies. SELECTION CRITERIA We searched for randomised controlled trials (RCTs), quasi-RCTs and observational studies that examined women with adult-onset granulosa cell tumours of the ovary (primary and recurrent). For non-randomised studies, we included studies that used multivariate analysis to adjust for baseline characteristics. DATA COLLECTION AND ANALYSIS Two review authors independently abstracted data and assessed risk of bias. Studies were heterogeneous with respect to treatment comparisons, so data were not synthesised in meta-analyses, and methods for assessing heterogeneity were not needed. Risk of bias in included studies was assessed by using the six core items used to assess RCTs and by evaluating four additional criteria specifically addressing risk of bias in non-randomised studies. MAIN RESULTS Five retrospective cohort studies (535 women with a diagnosis of GCT) that used appropriate statistical methods for adjustment were included in the review.Two studies, which carried out multivariate analyses that attempted to identify factors associated with better outcomes (in terms of overall survival), reported no apparent evidence of a difference in overall survival between surgical approaches, whether a participant underwent lymphadenectomy or received adjuvant chemotherapy or radiotherapy. Only percentage of survival for all participants combined was reported in two trials and was not reported at all in one study.One study showed that women who received postoperative radiotherapy had lower risk of disease recurrence compared with those who underwent surgery alone (adjusted hazard ratio (HR) 0.3, 95% confidence interval (CI) 0.1 to 0.6, P value 0.04). Three studies reportedthat there was no evidence of differences in disease recurrence based on execution and type of adjuvant chemotherapy or on type of surgery or surgical approach, other than that surgical staging may be important. One study described no apparent evidence of a difference in disease recurrence between fertility-sparing surgery and conventional surgery. Recurrence-free survival was not reported in one study.Toxicity and adverse event data were incompletely reported in the five studies. None of the five studies reported on quality of life (QoL). All studies were at very high risk of bias. AUTHORS' CONCLUSIONS One study showed a lower recurrence rate with the use of adjuvant radiotherapy, although this study was at high risk of bias and the results should be interpreted with caution. After evaluating the five small retrospective studies, we are unable to reach any firm conclusions as to the effectiveness and safety of different types and approaches of surgery, including conservative surgery, as well as adjuvant chemotherapy or radiotherapy, for management of GCTs of the ovary. The available evidence is very limited, and the review provides only low-quality evidence. Further research is very likely to have an important impact on our confidence in the estimate of effect and may alter our findings.Ideally, multinational RCTs are needed to answer these questions. The disease is relatively rare and generally has a good prognosis. RCTs are challenging to conduct, but three ongoing trials have been identified, demonstrating that they are feasible, although two of these studies are single-arm trials. The study that may be able to provide answers to the question of which chemotherapeutic regimen should be selected for management of sex cord stromal tumours is an ongoing, randomised, phase 2 study, led by the Gynaecological Oncology Group to compare the efficacy of carboplatin and paclitaxel versus standard BEP. These investigators are also looking into the value of inhibin A and inhibin B as predictive biomarkers. Additional trials are required to assess toxicity and QoL associated with different treatment regimens as well as the safety of conservative surgical options.
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Affiliation(s)
- Mahalakshmi Gurumurthy
- University Hospital of LlandoughGynaecological Oncology UnitPenalan RoadPenarthUKCF64 2XX
| | - Andrew Bryant
- Newcastle UniversityInstitute of Health & SocietyMedical School New BuildRichardson RoadNewcastle upon TyneUKNE2 4AX
| | - Smruta Shanbhag
- Glasgow Royal InfirmaryGynaecological OncologyWard 56B, Level 1 QEB16 Alexandra ParadeGlasgowUKG31 2ER
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Jain NA, Chen MY, Shanbhag S, Lu K, Pophali PA, Ito S, Koklanaris E, Hourigan CS, Barrett AJ, Battiwalla M. Contrast enhanced cardiac CT reveals coronary artery disease in 45% of asymptomatic allo-SCT long-term survivors. Bone Marrow Transplant 2013; 49:451-2. [PMID: 24241580 DOI: 10.1038/bmt.2013.182] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- N A Jain
- Hematology Branch, NHLBI, National Institutes of Health, Bethesda, MD, USA
| | - M Y Chen
- Cardiopulmonary Branch, NHLBI, National Institutes of Health, Bethesda, MD, USA
| | - S Shanbhag
- Cardiopulmonary Branch, NHLBI, National Institutes of Health, Bethesda, MD, USA
| | - K Lu
- Hematology Branch, NHLBI, National Institutes of Health, Bethesda, MD, USA
| | - P A Pophali
- Hematology Branch, NHLBI, National Institutes of Health, Bethesda, MD, USA
| | - S Ito
- Hematology Branch, NHLBI, National Institutes of Health, Bethesda, MD, USA
| | - E Koklanaris
- Hematology Branch, NHLBI, National Institutes of Health, Bethesda, MD, USA
| | - C S Hourigan
- Hematology Branch, NHLBI, National Institutes of Health, Bethesda, MD, USA
| | - A J Barrett
- Hematology Branch, NHLBI, National Institutes of Health, Bethesda, MD, USA
| | - M Battiwalla
- Hematology Branch, NHLBI, National Institutes of Health, Bethesda, MD, USA
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Iyer R, Gentry-Maharaj A, Nordin A, Liston R, Burnell M, Das N, Desai R, Gornall R, Beardmore-Gray A, Hillaby K, Leeson S, Linder A, Lopes A, Meechan D, Mould T, Nevin J, Olaitan A, Rufford B, Ryan A, Shanbhag S, Thackeray A, Wood N, Reynolds K, Menon U. Patient-reporting improves estimates of postoperative complication rates: a prospective cohort study in gynaecological oncology. Br J Cancer 2013; 109:623-32. [PMID: 23846170 PMCID: PMC3738134 DOI: 10.1038/bjc.2013.366] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [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: 01/30/2013] [Revised: 06/16/2013] [Accepted: 06/22/2013] [Indexed: 12/04/2022] Open
Abstract
Background: Most studies use hospital data to calculate postoperative complication rates (PCRs). We report on improving PCR estimates through use of patient-reporting. Methods: A prospective cohort study of major surgery performed at 10 UK gynaecological cancer centres was undertaken. Hospitals entered the data contemporaneously into an online database. Patients were sent follow-up letters to capture postoperative complications. Grade II–V (Clavien–Dindo classification) patient-reported postoperative complications were verified from hospital records. Postoperative complication rate was defined as the proportion of surgeries with a Grade II–V postoperative complication. Results: Patient replies were received for 1462 (68%) of 2152 surgeries undertaken between April 2010 and February 2012. Overall, 452 Grade II–V (402 II, 50 III–V) complications were reported in 379 of the 1462 surgeries. This included 172 surgeries with 200 hospital-reported complications and 231 with 280 patient-reported complications. All (100% concordance) 36 Grade III–V and 158 of 280 (56.4% concordance) Grade II patient-reported complications were verified on hospital case-note review. The PCR using hospital-reported data was 11.8% (172 out of 1462; 95% CI 11–14), patient-reported was 15.8% (231 out of 1462; 95% CI 14–17.8), hospital and verified patient-reported was 19.4% (283 out of 1462; 95% CI 17.4–21.4) and all data were 25.9% (379 out of 1462; 95% CI 24–28). After excluding Grade II complications, the hospital and patient verified Grade III–V PCR was 3.3% (48 out of 1462; 95% CI 2.5–4.3). Conclusion: This is the first prospective study of postoperative complications we are aware of in gynaecological oncology to include the patient-reported data. Patient-reporting is invaluable for obtaining complete information on postoperative complications. Primary care case-note review is likely to improve verification rates of patient-reported Grade II complications.
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Affiliation(s)
- R Iyer
- University College, London, UK
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Redmond M, Knapp C, Salim M, Shanbhag S, Jaumdally R. Use of vasopressors in Takotsubo cardiomyopathy: a cautionary tale. Br J Anaesth 2013; 110:487-8. [DOI: 10.1093/bja/aes586] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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18
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Kazakia GJ, Speer D, Shanbhag S, Majumdar S, Conklin BR, Nissenson RA, Hsiao EC. Mineral composition is altered by osteoblast expression of an engineered G(s)-coupled receptor. Calcif Tissue Int 2011; 89:10-20. [PMID: 21526395 PMCID: PMC3110278 DOI: 10.1007/s00223-011-9487-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [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: 12/28/2010] [Accepted: 03/06/2011] [Indexed: 01/22/2023]
Abstract
Activation of the G(s) G protein-coupled receptor Rs1 in osteoblasts increases bone mineral density by 5- to 15-fold in mice and recapitulates histologic aspects of fibrous dysplasia of the bone. However, the effects of constitutive G(s) signaling on bone tissue quality are not known. The goal of this study was to determine bone tissue quality in mice resulting from osteoblast-specific constitutive G(s) activation, by the complementary techniques of FTIR spectroscopy and synchrotron radiation micro-computed tomography (SRμCT). Col1(2.3)-tTA/TetO-Rs1 double transgenic (DT) mice, which showed osteoblast-specific constitutive G(s) signaling activity by the Rs1 receptor, were created. Femora and calvariae of DT and wild-type (WT) mice (6 and 15 weeks old) were analyzed by FTIR spectroscopy. WT and DT femora (3 and 9 weeks old) were imaged by SRμCT. Mineral-to-matrix ratio was 25% lower (P = 0.010), carbonate-to-phosphate ratio was 20% higher (P = 0.025), crystallinity was 4% lower (P = 0.004), and cross-link ratio was 11% lower (P = 0.025) in 6-week DT bone. Differences persisted in 15-week animals. Quantitative SRμCT analysis revealed substantial differences in mean values and heterogeneity of tissue mineral density (TMD). TMD values were 1,156 ± 100 and 711 ± 251 mg/cm(3) (mean ± SD) in WT and DT femoral diaphyses, respectively, at 3 weeks. Similar differences were found in 9-week animals. These results demonstrate that continuous G(s) activation in murine osteoblasts leads to deposition of immature bone tissue with reduced mineralization. Our findings suggest that bone tissue quality may be an important contributor to increased fracture risk in fibrous dysplasia patients.
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Affiliation(s)
- G J Kazakia
- Musculoskeletal Quantitative Imaging Research Group, Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA 94107, USA.
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Shanbhag S, Shetty S, Ghosh K. Mutations in coagulation factor XIII subunit A in severe factor XIII deficiency patients: five novel mutations detected. Haemophilia 2011; 17:e843-5. [PMID: 21658166 DOI: 10.1111/j.1365-2516.2011.02590.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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21
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Shanbhag S, Neil J, Howell C. Anaesthesia for caesarean section in a patient with Gitelman’s syndrome. Int J Obstet Anesth 2010; 19:451-3. [DOI: 10.1016/j.ijoa.2010.05.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2009] [Revised: 09/01/2009] [Accepted: 05/11/2010] [Indexed: 10/19/2022]
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22
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Vadlamudi M, Subramanian G, Shanbhag S, Alamo RG, Varma-Nair M, Fiscus DM, Brown GM, Lu C, Ruff CJ. Molecular Weight and Branching Distribution of a High Performance Metallocene Ethylene 1-Hexene Copolymer Film-Grade Resin. ACTA ACUST UNITED AC 2009. [DOI: 10.1002/masy.200950801] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Abstract
BACKGROUND The development of a mass in association with a previous surgical scar can pose a diagnostic dilemma due to similarities in appearance to hernias, abscesses, hematomas, or desmoid tumors. Scar endometriosis is an uncommon cause of such a lump, but malignant change within this ectopic tissue is exceptionally rare. CASE We present a case of a 55-year-old woman who was found to have an isolated clear cell adenocarcinoma in an area of scar endometriosis more than 30 years after an open tubal sterilization. This mass was initially thought to be an incisional hernia, but was later diagnosed intraoperatively by frozen section and then incompletely excised, highlighting the difficulties in preoperative diagnosis as well as surgical treatment. CONCLUSION Malignant change within scar endometriosis is rare, but increased awareness of this phenomenon is required. Vigilance is paramount and a mass located in or close to a surgical scar should be treated with suspicion.
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Affiliation(s)
- Vanessa N Harry
- Department of Gynaecological Oncology, Aberdeen Royal Infirmary, Aberdeen, Scotland, United Kingdom.
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24
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Shanbhag S, Aucott L, Bhattacharya S, Hamilton MA, McTavish AR. Interventions for 'poor responders' to controlled ovarian hyperstimulation (COH) in in-vitro fertilisation (IVF). Cochrane Database Syst Rev 2007:CD004379. [PMID: 17253503 DOI: 10.1002/14651858.cd004379.pub2] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND The success of in-vitro fertilisation (IVF) treatment depends on adequate follicle recruitment by using controlled ovarian stimulation with gonadotrophins. Failure to recruit adequate follicles is called 'poor response'. Various treatment protocols have been proposed that are targeted at this cohort of women, aiming to increase their ovarian response. OBJECTIVES To compare the effectiveness of different treatment interventions in women who have poor response to controlled ovarian hyperstimulation (are poor responders) in the context of in vitro fertilisation. SEARCH STRATEGY We searched the Cochrane Menstrual Disorders and Subfertility Group Specialised Register of controlled trials (MDSG), the Cochrane Central Register of Controlled trials (CENTRAL) (The Cochrane Library 2003, Issue 1), MEDLINE (1966 to August 2006), EMBASE (1980 to August 2006) and The National Research Register (NRR). The citation lists of relevant publications, review articles, abstracts of scientific meetings and included studies were also searched. The authors were contacted to identify or clarify data that were unclear from the trial reports. SELECTION CRITERIA Only randomised controlled trials (RCTs) comparing one type of intervention versus another for controlled ovarian stimulation of poor responders to a previous IVF treatment, using a standard long protocol were included. DATA COLLECTION AND ANALYSIS Two review authors independently scanned the abstracts, identified relevant papers, assessed inclusion and trial quality and extracted relevant data. Validity was assessed in terms of method of randomisation, completeness of treatment cycle and co-intervention. Where possible, data were pooled for analysis. MAIN RESULTS Nine trials involving six different comparison groups have been included in this review. Only one trial reported live birth rates. Four groups compared the long protocol with another intervention. Only one comparison group (bromocryptine versus long protocol) reported a higher clinical pregnancy rate per cycle, in the bromocryptine arm (OR 5.60, 95% CI 1.40 to 22.47). Two comparison groups showed a lower number of oocytes in the long protocol group (versus stop and gonadotrophin releasing hormone (GnRH) antagonist protocols). However, two comparison groups also showed lower cancellation rates in the long protocol treatment group (versus stop and GnRHa flare-up protocols). None reported any evident difference in the adverse effects. AUTHORS' CONCLUSIONS There is insufficient evidence to support the routine use of any particular intervention either for pituitary downregulation, ovarian stimulation or adjuvant therapy in the management of poor responders to controlled ovarian stimulation in IVF. More robust data from good quality RCTs with relevant outcomes are needed.
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Affiliation(s)
- S Shanbhag
- University of Aberdeen, Assisted Reproduction Unit, Aberdeen Maternity Hospital, Aberdeen, Scotland, UK, AB25 2ZD.
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25
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Pingle S, Shanbhag S. CASH--an innovative approach to sustainable OSH improvement at workplace. Med Lav 2006; 97:358-67. [PMID: 17017372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Occupational health department of a large private enterprise located in India launched Project CASH--Change Agents for Safety and Health, at manufacturing units of the enterprise to bring about a positive change in work environment and improvement in work practices to reduce occupational health risk. Multidisciplinary teams of change agents were constituted and were given intensive training inputs. Reduction in exposure to noise, dust and heat stress were identified as specific objectives after a baseline survey of the work environment. Occupational safety and health knowledge and training was imparted to all field personnel to improve their work practices and attitudes. The focus of the actions was on engineering control measures and process engineering changes necessary for workplace improvement. Noise levels were reduced by an average of more than 9dBA in most of the top ten high noise locations. Out of two locations identified for dust exposure, one was fully eliminated and dust levels at other location were significantly reduced. Heat stress was reduced in all three identified locations with an average reduction of more than 3 degrees C in WBGT levels. Thus, final evaluation of workplace environments revealed significant reduction in exposure to all identified agents, viz noise, dust and heat fulfilling the project objectives. Educating and empowering the team led to reduction of occupational health risks in the work environment. There was positive attitudinal and behavioural change in safety and occupational health awareness & practices among employees. The monetary savings resulting from improvements far outweighed the investments. Success of this pilot project was followed up with further similar projects and their number has grown in geometric proportion for the last three years indicating the sustainability of the project.
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Affiliation(s)
- S Pingle
- Reliance Industries Ltd, Patalganga, India.
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Shanbhag S, Tripathi S. Electrogenic H+ Transport and pH Gradients Generated by a V-H+-ATPase in the Isolated Perfused Larval Drosophila Midgut. J Membr Biol 2005; 206:61-72. [PMID: 16440182 DOI: 10.1007/s00232-005-0774-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2005] [Indexed: 10/25/2022]
Abstract
A method for microperfusion of isolated segments of the midgut epithelium of Drosophila larvae has been developed to characterize cellular transport pathways and membrane transporters. Stereological ultrastructural morphometry shows that this epithelium has unusually long tight junctions, with little or no lateral intercellular volume normally found in most epithelia. Amplification of the apical and basal aspects of the cells, by approximately 17-fold and approximately 7-fold, respectively, predicts an almost exclusively transcellular transport system for solutes. This correlates with the high lumen-negative transepithelial potential (V(t)) of 38 to 45 mV and high resistance (R(t)) of 800 to 1,400 Omega x cm(2) measured by terminated cable analysis, in contrast to other microperfused epithelia like the renal proximal tubule. Several blockers (amiloride 10(-4) M, ouabain 10(-4) M, bumetanide 10(-4) M), K(+) -free solutions, or organic solutes such as D-glucose 10 mM or DL-alanine 0.5 mM failed to affect V(t) or R(t). Bafilomycin-A(1) (3 to 5 microM) decreased V(t) by approximately 40% and short-circuit current (I(sc)) by approximately 50%, and decreased intracellular pH when applied from the basal side only, consistent with an inhibition of an electrogenic V-H(+) -ATPase located in the basal membrane. Gradients of H(+) were detected by pH microelectrodes close to the basal aspect of the cells or within the basal extracellular labyrinth. The apical membrane is more conductive than the basal membrane, facilitating secretion of base (presumably HCO(3)(-)), driven by the basal V-H(+) -ATPase.
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Affiliation(s)
- S Shanbhag
- Tata Institute of Fundamental Research, Mumbai 400 005, India
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Affiliation(s)
- S. Shanbhag
- Department of Chemical Engineering, University of Michigan, Ann Arbor, Michigan 48109-2136
| | - R. G. Larson
- Department of Chemical Engineering, University of Michigan, Ann Arbor, Michigan 48109-2136
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Shanbhag S, Roberts M, Johnson SJ, Wadehra V. Subtyping borderline nuclear changes: is it of value in predicting high-grade cervical intraepithelial neoplasia on histology? Cytopathology 2003; 14:241-8. [PMID: 14510887 DOI: 10.1046/j.1365-2303.2003.00074.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The aim was to determine the association between the subtypes of borderline nuclear changes (BNC) in cervical smears and high-grade cervical intraepithelial neoplasia (HCIN). BNC was reported in 23236 smears received in our laboratory over a 7-year period, 3278 patients were referred for colposcopy. Analysis was restricted to 2007 cases, which fitted the criteria of: (1). consistent subtyping of borderline change and (2). cervical histology result within 12 months of the last abnormal smear. BNC was reported in six categories and correlated with histology. Atypia bordering on dyskaryosis, atypical metaplastic cells and endocervical atypia, were associated with HCIN in 25%, 25.4% and 23.8% of cases, respectively. Dyskeratosis and koilocytotic atypia were associated with HCIN in 19.2% and 13.7% of cases, respectively. Some subtypes of borderline change are more frequently associated with HCIN. The difference is not sufficient to dictate clinical management.
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Affiliation(s)
- S Shanbhag
- Departments of Gynaecology Cellular Pathology (Cytology), Royal Victoria Infirmary, Newcastle-upon-Tyne, UK.
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Affiliation(s)
- Smruta Shanbhag
- The Assisted Reproduction Unit, University of Aberdeen, Aberdeen
| | - Siladitya Bhattacharya
- The Department of Obstetrics and Gynaecology, Aberdeen Maternity Hospital, Aberdeen AB25 2ZD
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Shanbhag S, Bhattacharya S. Current management of ovarian hyperstimulation syndrome. Hosp Med 2002; 63:528-32. [PMID: 12357854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
Abstract
Ovarian hyperstimulation syndrome is an iatrogenic and usually self-limiting condition which can occasionally be life threatening. This article reviews methods of prevention and management of ovarian hyperstimulation syndrome.
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Shanbhag S, Larson RG, Takimoto J, Doi M. Deviations from dynamic dilution in the terminal relaxation of star polymers. Phys Rev Lett 2001; 87:195502. [PMID: 11690420 DOI: 10.1103/physrevlett.87.195502] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2001] [Indexed: 05/23/2023]
Abstract
We present a "slip-link" model for relaxation of entangled star polymers that accounts for chain-end fluctuations and constraint release and that explains deviations from the "dynamic dilution" equation observed in recent dielectric and stress relaxation data. In the terminal regime where tube expansion fails to keep up with chain relaxation, relaxation is controlled by rare events in which newly created entanglements near the branch point draw the chain end towards the last remaining old entanglement, where a shallow fluctuation releases it.
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Affiliation(s)
- S Shanbhag
- Department of Chemical Engineering, University of Michigan, Ann Arbor, Michigan 48109-2136, USA
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Saidi AS, Moodie DS, Garson A, Lipshultz SE, Kaplan S, Lai WW, Colan SD, Starc TJ, Shanbhag S, Easley KA, Bricker JT. Electrocardiography and 24-hour electrocardiographic ambulatory recording (Holter monitor) studies in children infected with human immunodeficiency virus type 1. The Pediatric Pulmonary and Cardiac Complications of Vertically Transmitted HIV-1 Infection Study Group. Pediatr Cardiol 2000; 21:189-96. [PMID: 10818172 DOI: 10.1007/s002460010038] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Limited data are available on the electrocardiogram and ambulatory electrocardiogram recording (Holter) in children infected with the human immunodeficiency virus type 1 (HIV-1). The purpose of this study was to estimate the prevalence and cumulative incidence of rhythm and conduction abnormalities in HIV-1-infected children. Electrocardiograms and Holter monitoring studies were performed annually on 205 HIV-1-infected children enrolled after 28 days of life (group I), 93 HIV-1-infected infants enrolled during pregnancy or during the first 28 days of life (group IIa), and 463 HIV-1-uninfected infants enrolled during pregnancy or during the first 28 days of life (group IIb). The 5-year cumulative incidence in the group I children of second-degree atrioventricular block or supraventricular or ventricular tachycardia was 13.4%, and the 5-year incidence was higher for the older infected group I children (16.8% for children > or =4 years old at first study and 11.4% for children <4 years, p = 0.04). The mean corrected QT interval was also longer for the older infected group I children (p = 0.002) and prolonged in the HIV-1-infected compared to the HIV-1-uninfected group II children (p = 0.02). None of the children had atrial fibrillation or flutter. Arrhythmias are uncommon in children infected with HIV-1 and in children of HIV-1-infected mothers and the arrhythmias identified tend to be benign. Therefore, routine Holter monitoring does not appear to be indicated in asymptomatic children.
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Affiliation(s)
- A S Saidi
- Our Lady's Hospital for Sick Children, Dublin, Ireland
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Venugopala Reddy G, Reiter C, Shanbhag S, Fischbach KF, Rodrigues V. Irregular chiasm-C-roughest, a member of the immunoglobulin superfamily, affects sense organ spacing on the Drosophila antenna by influencing the positioning of founder cells on the disc ectoderm. Dev Genes Evol 1999; 209:581-91. [PMID: 10552299 DOI: 10.1007/s004270050292] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
We describe a role for Irregular chiasmC-roughest (IrreC-rst), an immunoglobulin (Ig) superfamily member, in patterning sense organs on the Drosophila antenna. IrreC-rst protein is initially expressed homogeneously on apical profiles of ectodermal cells in regions of the antennal disc. During specification of founder cells (FCs), the intracellular protein distribution changes and becomes concentrated in regions where specific intercellular contacts presumably occur. Loss of function mutations as well as misexpression of irreC-rst results in an altered arrangement of FCs within the disc compared to wildtype. Sense organ development occurs normally, although spacing is affected. Unlike its role in interommatidial spacing, irreC-rst does not affect apoptosis during antennal development. We propose that IrreC-rst affects the spatial relationship between sensory and ectodermal cells during FC delamination.
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Affiliation(s)
- G Venugopala Reddy
- Department of Biological Sciences, Tata Institute of Fundamental Research, Homi Bhabha Road, Mumbai 400005, India
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Abstract
The sensilla on the proboscis and tarsi of Drosophila contain five neurons, four chemosensory and one mechanosensory. The sugar-sensitive neuron, designated S, carries independent acceptor sites for pyranose, furanose and trehalose. Two others, L1 and L2, respond to salts. The fourth neuron, W, is inhibited by salts and sugars, and is believed to mediate detection of water. We describe here a gene in which mutations alter the neurons in such a way that the S cell is excited by salts. As a result, the mutant flies are strongly attracted by NaCl at concentrations which are repellent to the wild type. To our knowledge, this is the first instance of a mutation which changes the specificity of the chemosensory neurons.
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Affiliation(s)
- K Arora
- Molecular Biology Unit, Tata Institute of Fundamental Research, Bombay, India
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Abstract
A total of nearly 1,000 persons belonging to a number of caste, religious and tribal groupings in Kerala and the Nilgiri Hills of South India have been tested for genetic variation in 4 blood group, 5 serum protein and 17 enzyme systems as well as haemoglobin. The distribution of blood groups, serum protein and enzyme groups is similar to that reported for other South Indian populations. Abnormal haemoglobins were detected in several populations. Abnormal haemoglobins were detected in several populations, HbS being present in more than 20% of the Irula and Kurumba in the Nilgiri Hills. In the Kerala populations there were 4 examples of Hb AD and 1 of Hb AE. Genetic distance estimates using the gene frequency data indicate that the closest groups are the Nayar and Izhava and the Brahmin and Nayar. The tribal populations are approximately twice as far from the Nayar as they are from the Izhava. The Todas of the Nilgiri Hills are somewhat closer to the Brahmin of Kerala than they are to the other tribal populations.
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Joshi SH, Shanbhag S, Bhatia HM. Gm(1) and Gm(2) factors in some of the endogamous caste groups. Indian J Med Res 1975; 63:1314-6. [PMID: 57098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
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