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Ran KR, Das O, Johnston DT, Vutakuri N, Ranganathan S, Broachwala M, Chopra H, Azad CL, Azad TD, Robinson S, Belzberg AJ, Tuffaha SH, Lubelski D. Nerve-targeted surgical treatments for spasticity: a narrative review. World Neurosurg 2024:S1878-8750(24)00657-0. [PMID: 38649021 DOI: 10.1016/j.wneu.2024.04.084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Revised: 04/12/2024] [Accepted: 04/15/2024] [Indexed: 04/25/2024]
Abstract
Spasticity is a potentially debilitating symptom of various acquired and congenital neurologic pathologies that, without adequate treatment, may lead to long-term disability, compromise functional independence, and negatively impact mental health. Several conservative as well as non-nerve targeted surgical strategies have been developed for the treatment of spasticity, but these may be associated with significant drawbacks, such as adverse side effects to medication, device dependence on intrathecal baclofen pumps, and inadequate relief with tendon-based procedures. In these circumstances, patients may benefit from nerve-targeted surgical interventions such as (i) selective dorsal rhizotomy, (ii) hyperselective neurectomy, and (iii) nerve transfer. When selecting the appropriate surgical approach, preoperative patient characteristics, as well as the risks and benefits of nerve-targeted surgical intervention, must be carefully evaluated. Here, we review the current evidence on the efficacy of these nerve-targeted surgical approaches for treating spasticity across various congenital and acquired neurologic pathologies.
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Affiliation(s)
- Kathleen R Ran
- Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, MD, USA.
| | - Oishika Das
- Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, MD, USA
| | - David T Johnston
- McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Neha Vutakuri
- Department of Psychology & Neuroscience, Duke University, Durham, NC, USA
| | | | - Mustafa Broachwala
- Department of Physical Medicine and Rehabilitation, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Harman Chopra
- Department of Physical Medicine and Rehabilitation, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Chao Long Azad
- Department of Plastic and Reconstructive Surgery, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Tej D Azad
- Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, MD, USA
| | | | - Allan J Belzberg
- Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Sami H Tuffaha
- Department of Plastic and Reconstructive Surgery, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Daniel Lubelski
- Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, MD, USA
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Ranganathan S, Dee EC, Debnath N, Patel TA, Jain B, Murthy V. Access and barriers to genomic classifiers for breast cancer and prostate cancer in India. Int J Cancer 2024; 154:1335-1339. [PMID: 37962056 DOI: 10.1002/ijc.34784] [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: 05/16/2023] [Revised: 09/25/2023] [Accepted: 10/10/2023] [Indexed: 11/15/2023]
Abstract
The incidence of cancer in general, including breast and prostate cancer specifically, is increasing in India. Breast and prostate cancers have genomic classifiers developed to guide therapy decisions. However, these genomic classifiers are often inaccessible in India due to high cost. These classifiers may also be less suitable to the Indian population, as data primarily from patients in wealthy Western countries were used in developing these genomic classifiers. In addition to the limitations in using these existing genomic classifiers, developing and validating new genomic classifiers for breast and prostate cancer in India is challenging due to the heterogeneity in the Indian population. However, there are steps that can be taken to address the various barriers that currently exist for accurate, accessible genomic classifiers for cancer in India.
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Affiliation(s)
| | - Edward Christopher Dee
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Neha Debnath
- Department of Medicine, Icahn School of Medicine at Mount Sinai (Morningside/West), New York, New York, USA
| | - Tej A Patel
- Department of Healthcare Management & Policy, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Bhav Jain
- Department of Health Policy, Stanford University School of Medicine, Stanford, California, USA
| | - Vedang Murthy
- Department of Radiation Oncology, ACTREC, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
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Chakravarti S, Kuo CC, Oak A, Ranganathan S, Jimenez AE, Kazemi F, Saint-Germain MA, Gallia G, Rincon-Torroella J, Jackson C, Bettegowda C, Mukherjee D. The Socioeconomic Distressed Communities Index Predicts 90-day Mortality among Intracranial Tumor Patients. World Neurosurg 2024:S1878-8750(24)00559-X. [PMID: 38599377 DOI: 10.1016/j.wneu.2024.03.173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Accepted: 03/31/2024] [Indexed: 04/12/2024]
Abstract
BACKGROUND Socioeconomic status (SES) is a major determinant of quality of life and outcomes. However, SES remains difficult to measure comprehensively. Distress communities index (DCI), a composite of seven socioeconomic factors, has been increasingly recognized for its correlation with poor outcomes. OBJECTIVE To determine the predictive value of DCI on outcomes following intracranial tumor surgery. METHODS A single institution, retrospective review was conducted to identify adult intracranial tumor patients undergoing resection (2016-2021). Patient ZIP codes were matched to DCI and stratified by DCI quartiles (low:0-24.9, low-intermediate:25-49.9, intermediate-high:50-74.9, high:75-100). Univariate followed by multivariate regressions assessed the effects of DCI on postoperative outcomes. Receiver operating curves (ROC) were generated for significant outcomes. RESULTS A total of 2,389 patients were included: 1,015 patients (42.5%) resided in low distress communities, 689 (28.8%) in low-intermediate distress communities, 445 (18.6%) in intermediate-high distress communities, and 240 (10.0%) in high distress communities. On multivariate analysis, risk of fracture (adjusted odds ratio [aOR]=1.60, 95% confidence interval [CI] 1.26-2.05, p<0.001) and 90-day mortality (aOR=1.58, 95%CI 1.21-2.06, p<0.001) increased with increasing DCI quartile. Good predictive accuracy was observed for both models, with ROC of 0.746 (95%CI 0.720-0.766) for fracture and 0.743 (95%CI 0.714-0.772) for 90-day mortality. CONCLUSION Intracranial tumor patients from distressed communities are at increased risk for adverse events and death in the postoperative period. DCI may be a useful, holistic measure of SES that can help risk stratifying patients and should be considered when building healthcare pathways.
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Affiliation(s)
- Sachiv Chakravarti
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Cathleen C Kuo
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, Buffalo, NY
| | - Atharv Oak
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Sruthi Ranganathan
- School of Clinical Medicine, University of Cambridge, Cambridge, England
| | - Adrian E Jimenez
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, Buffalo, NY
| | - Foad Kazemi
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, Buffalo, NY
| | - Max A Saint-Germain
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Gary Gallia
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | | | - Christopher Jackson
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Chetan Bettegowda
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Debraj Mukherjee
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, Buffalo, NY.
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Scalia G, Priola SM, Ranganathan S, Venkataram T, Orestano V, Marrone S, Chaurasia B, Maugeri R, Iacopino DG, Strigari L, Salvati M, Umana GE. Assessing the impact of mixed reality-assisted informed consent: A study protocol. Surg Neurol Int 2024; 15:88. [PMID: 38628537 PMCID: PMC11021117 DOI: 10.25259/sni_1021_2023] [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] [Received: 12/26/2023] [Accepted: 02/20/2024] [Indexed: 04/19/2024] Open
Abstract
Background Informed consent is a crucial aspect of modern medicine, but it can be challenging due to the complexity of the information involved. Mixed reality (MR) has emerged as a promising technology to improve communication. However, there is a lack of comprehensive research on the impact of MR on medical informed consent. The proposed research protocol provides a solid foundation for conducting future investigations and developing MR-based protocols that can enhance patients' understanding and engagement in the decision-making process. Methods This study will employ a randomized controlled trial design. Two arms will be defined: MR-assisted informed consent (MRaIC) as the experimental arm and conventional informed consent (CIC) as the control arm consent, with 52 patients in each group. The protocol includes the use of questionnaires to analyze the anxiety levels and the awareness of the procedure that the patient is going to perform to study the impact of MRaIC versus CIC before medical procedures. Results The study will evaluate the impact of MR on patients' information comprehension, engagement during the process of obtaining informed consent, emotional reactions, and consent decisions. Ethical concerns will be addressed. Conclusion This study protocol provides a comprehensive approach to investigate the impact of MR on medical informed consent. The findings may contribute to a better understanding of the effects of MR on information comprehension, engagement during the process of obtaining informed consent, psychological experience, consent decisions, and ethical considerations. The integration of MR technology has the potential to enhance surgical communication practices and improve the informed consent process.
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Affiliation(s)
- Gianluca Scalia
- Neurosurgery Unit, Department of Head and Neck Sugery, Garibaldi Hospital, Catania, Italy
| | - Stefano Maria Priola
- Department of Neurosurgery, Health Sciences North, Northern Ontario School of Medicine, Sudbury, Ontario, Canada
| | - Sruthi Ranganathan
- Department of Medicine, University of Cambridge, Cambridge CB2 OQQ, United Kingdom
| | - Tejas Venkataram
- Department of Neurosurgery, Trauma Center, Gamma Knife Center, Cannizzaro Hospital, Catania, Italy
| | - Valeria Orestano
- Psychology Center Orestano-Pittera, “l’Intreccio” Association, San Giovanni la Punta (CT), Italy
| | - Salvatore Marrone
- Neurosurgical Clinic, AOUP “Paolo Giaccone”, Post Graduate Residency Program in Neurologic Surgery, Department of Biomedicine Neurosciences and Advanced Diagnostics, School of Medicine, University of Palermo, Palermo, Italy
| | - Bipin Chaurasia
- Department of Neurosurgery, Neurosurgery Clinic, Birgunj, Nepal
| | - Rosario Maugeri
- Neurosurgical Clinic, AOUP “Paolo Giaccone”, Post Graduate Residency Program in Neurologic Surgery, Department of Biomedicine Neurosciences and Advanced Diagnostics, School of Medicine, University of Palermo, Palermo, Italy
| | - Domenico Gerardo Iacopino
- Neurosurgical Clinic, AOUP “Paolo Giaccone”, Post Graduate Residency Program in Neurologic Surgery, Department of Biomedicine Neurosciences and Advanced Diagnostics, School of Medicine, University of Palermo, Palermo, Italy
| | - Lidia Strigari
- Department of Medical Physics, University Hospital of Bologna, Bologna, Italy
| | - Maurizio Salvati
- Department of Neurosurgery, Policlinico “Tor Vergata”, University of Rome “Tor Vergata”, Rome, Italy
| | - Giuseppe Emmanuele Umana
- Department of Neurosurgery, Trauma Center, Gamma Knife Center, Cannizzaro Hospital, Catania, Italy
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Ranganathan S, Haslam A, Tuia J, Prasad V. Characteristics and outcomes of new molecular oncology drug approvals, in combination or monotherapy. J Cancer Policy 2024; 39:100462. [PMID: 38061492 DOI: 10.1016/j.jcpo.2023.100462] [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: 10/31/2023] [Accepted: 12/03/2023] [Indexed: 12/17/2023]
Abstract
IMPORTANCE Understanding the factors that are associated with new molecular entity (NME) cancer drug approvals as a single agent and in combination, and European Society for Medical Oncology (ESMO) scores, can aid in identifying suitable factors to consider in trial designs for future drugs. In addition, the association between the various outcomes can aid in determining benefit when surrogate outcomes are used in approval consideration. OBJECTIVE This study aims to (1) use the measures used in evaluating clinical trials by ESMO scores to determine the differences in the characteristics of 2013-2022 Food and Drug Administration (FDA) oncology NME drug approvals for those approved for use in combination or as a monotherapy, and (2) analyze the association between survival outcomes and the response rate for monotherapy NME drugs and/or drugs approved in combination. DESIGN Cross-sectional analysis. SETTING US FDA Oncology Drug Approvals (2013-2022) PARTICIPANTS: US FDA Oncology Drug Approvals (2013-2022) EXPOSURES: Trial-level characteristics (tumor types, basis of approval, randomized or not, phase) and associations between overall survival (OS), progression-free survival (PFS), or overall response rate (ORR) and whether NME drugs were approved as monotherapy or in combination . RESULTS Drugs approved for use as a monotherapy are less likely to be approved using a randomized study (p < 0.001) and more likely to be approved via the accelerated pathway (p = 0.012) and be open-label (p < 0.001). Drugs approved for use as a combination or monotherapy significantly differed on their approval basis (p = 0.002), phase of trial at the time of approval (p = 0.02), and ESMO scores (p = 0.02). There was low correlation between response rate and either PFS or OS metrics. However, nearly all of the drugs with large improvements in OS (> 5months) were drugs with robust ORR. CONCLUSIONS AND RELEVANCE Drugs approved as monotherapy with a low response rate are likely to have marginal benefit in OS and PFS.
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Affiliation(s)
| | - Alyson Haslam
- University of California San Francisco, 550 16th St, 2nd Fl, San Francisco, CA 94158, United States
| | - Jordan Tuia
- University of California San Francisco, 550 16th St, 2nd Fl, San Francisco, CA 94158, United States
| | - Vinay Prasad
- University of California San Francisco, 550 16th St, 2nd Fl, San Francisco, CA 94158, United States.
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Di Giacomo AM, Schenker M, Medioni J, Mandziuk S, Majem M, Gravis G, Cornfeld M, Ranganathan S, Lou S, Csoszi T. A phase II study of retifanlimab, a humanized anti-PD-1 monoclonal antibody, in patients with solid tumors (POD1UM-203). ESMO Open 2024; 9:102387. [PMID: 38401247 PMCID: PMC10982862 DOI: 10.1016/j.esmoop.2024.102387] [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: 06/09/2023] [Revised: 01/25/2024] [Accepted: 01/26/2024] [Indexed: 02/26/2024] Open
Abstract
BACKGROUND POD1UM-203, an open-label, multicenter, phase II study, evaluated retifanlimab, a humanized monoclonal antibody targeting programmed cell death protein-1 (PD-1) in patients with selected solid tumors where immune checkpoint inhibitor therapies have previously shown efficacy. PATIENTS AND METHODS Eligible patients (≥18 years) had measurable disease and included unresectable or metastatic melanoma, treatment-naive metastatic non-small-cell lung cancer (NSCLC) with high programmed death-ligand 1 (PD-L1) expression (tumor proportion score ≥50%), cisplatin-ineligible locally advanced/metastatic urothelial carcinoma (UC) with PD-L1 expression (combined positive score ≥10%), or treatment-naive locally advanced/metastatic clear-cell renal cell carcinoma (RCC). Retifanlimab 500 mg was administered intravenously every 4 weeks as a 30-min infusion. The primary endpoint was investigator-assessed overall response rate. RESULTS Overall, 121 patients (35 melanoma, 23 NSCLC, 29 UC, 34 RCC) were enrolled and treated. The overall response rate [95% confidence interval (CI)] was 40.0% (23.9-57.9) in the melanoma cohort, 34.8% (16.4-57.3) in the NSCLC cohort, 37.9% (20.7-57.7) in the UC cohort, and 23.5% (10.7-41.2) in the RCC cohort. Median duration of response was 11.5 months (95% CI 2.2-not reached) in the UC cohort, and was not reached in the other cohorts. Retifanlimab safety was consistent with previous experience for PD-(L)1 inhibitors. CONCLUSIONS Retifanlimab demonstrated durable antitumor activity in patients with melanoma, NSCLC, UC, or RCC. The efficacy and safety of retifanlimab were as expected for a PD-(L)1 inhibitor. These data support further study of retifanlimab in solid tumors.
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Affiliation(s)
- A M Di Giacomo
- University of Siena, Siena, Italy; Center for Immuno-Oncology, University Hospital of Siena, Siena, Italy
| | - M Schenker
- Centrul de Oncologie Sf. Nectarie, Oncologie Medicala, Craiova, Romania
| | - J Medioni
- Centre of Early Clinical Trials in Cancer, Hôpital Européen Georges-Pompidou, Université Paris Cité, Paris, France
| | - S Mandziuk
- Department of Clinical Oncology and Chemotherapy, Medical University of Lublin, Lublin, Poland
| | - M Majem
- Medical Oncology Department, Hospital de Sant Pau, Barcelona, Spain
| | - G Gravis
- Department of Medical Oncology, Institut Paoli-Calmettes, Aix-Marseille Université, CRCM, Marseille, France
| | | | | | - S Lou
- Incyte Corporation, Wilmington, USA
| | - T Csoszi
- Hetényi Géza Kórház Onkológiai Központ, Szolnok, Hungary.
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7
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Raut R, Shams S, Scalia G, Umana GE, Ranganathan S, Rasheed M, Vats A, Chaurasia B. Comparison of ventriculoperitoneal shunt versus endoscopic third ventriculostomy in managing hydrocephalus due to tuberculous meningitis: a randomized controlled trial with a 30-day follow-up. Ann Med Surg (Lond) 2024; 86:881-885. [PMID: 38333284 PMCID: PMC10849454 DOI: 10.1097/ms9.0000000000001701] [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] [Received: 11/05/2023] [Accepted: 12/29/2023] [Indexed: 02/10/2024] Open
Abstract
Background Hydrocephalus is a significant complication arising from tuberculous meningitis (TBM). While ventriculoperitoneal shunt (VPS) remains the primary surgical approach for TBM-related hydrocephalus, there is a rising trend in the use of endoscopic third ventriculostomy (ETV). Materials and methods This randomized controlled trial, conducted from February 2018 to July 2019, enroled 60 patients aged 20-50 with TBM-related hydrocephalus. Patients underwent either VPS or ETV. Both groups were followed up for a minimum of 30 days, evaluating clinical outcomes and modifications in the modified Vellore grading system. Glasgow Coma Scale (GCS) assessments were conducted at 7-days and 30-day post-surgery for both groups. Results The mean GCS scores were comparable between the two groups on the 7th and 30th postoperative days. The association between modified Vellore Grade and treatment modality did not show statistically significant differences (P=1.0 and P=0.3) on the seventh and thirtieth postoperative days respectively. Conclusions Both VPS and ETV demonstrate efficacy in managing hydrocephalus secondary to TBM in adult patients. Our 30-day outcomes did not reveal discernible differences between the two procedures. Therefore, considering technical expertise and experience with ETV, it may be considered as the primary choice for cerebrospinal fluid (CSF) diversion in TBM-associated hydrocephalus, owing to its avoidance of several lifelong complications linked with VPS.
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Affiliation(s)
- Rupesh Raut
- Department of Neurosurgery, Patan Hospital, Patan Academy of Health Sciences, Lalitpur
| | - Shahzad Shams
- Department of Neurosurgery, King Edward Medical University, Mayo Hospital, Lahore, Pakistan
| | - Gianluca Scalia
- Neurosurgery Unit, Department of Head and Neck Surgery, Garibaldi Hospital
| | | | | | - Muddassar Rasheed
- Department of Neurosurgery, King Edward Medical University, Mayo Hospital, Lahore, Pakistan
| | - Atul Vats
- James Cook University Hospital, Middlesbrough, UK
| | - Bipin Chaurasia
- Department of Neurosurgery, Neurosurgery Clinic, Birgunj, Nepal
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Ranganathan S, Abramov D, Chew NWS, Mallen C, Marshall M, Kobo O, Mamas MA. Trends in Cardiovascular Mortality Among Patients With Alzheimer's Disease in the United States from 1999 to 2020. Am J Cardiol 2024; 211:326-333. [PMID: 37993040 DOI: 10.1016/j.amjcard.2023.11.044] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 10/24/2023] [Accepted: 11/14/2023] [Indexed: 11/24/2023]
Abstract
This study aimed to compare the trends in cardiovascular diseases (CVDs)-related mortality in patients with Alzheimer's disease (AD) and in the general population aged ≥65 years. Data from the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research Multiple Cause of Death dataset were used to determine national trends in age-adjusted CVD mortality rates (AAMR) and average annual percent change (AAPC) values in patients with AD and the overall population aged ≥65 years from 1999 to 2020. Data for AAMR and AAPCs were also stratified by age, gender, ethnicity/race, geographical region, urbanization status, and subgroups of CVD. Trends in the overall AAMR stratified by gender, age, ethnicity/race, geographical region, urbanization status, and CVD subgroups were statistically different between patients with AD and the overall population (overall AAPC for CVD mortality rate in patients with AD = -3.5% [confidence interval -4.1% to -2.9%] vs -2.6% [confidence interval -2.3% to -2.9%] in overall population, p = 0.01). Differences in the decrease in the mortality rates between patients with AD and the overall population were found to be statistically different across all stratifications except for the change in the mortality rates for hypertensive diseases (p = 0.05), females (p = 0.2), and Asian or Pacific Islanders (p = 0.09). In conclusion, CVD-related mortality in patients with AD decreased over the last 2 decades, and decreases were more prominent than seen in the general population aged ≥65 years. These results may help focus public health efforts to optimize CVD health in patients with AD.
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Affiliation(s)
| | - Dmitry Abramov
- Division of Cardiology, Department of Medicine, Loma Linda University Medical Center, Loma Linda, California
| | - Nicholas W S Chew
- Department of Cardiology, National University Heart Centre, National University Health System, Singapore, Singapore
| | - Christian Mallen
- School of Medicine, Keele University, Staffordshire, United Kingdom
| | - Michelle Marshall
- Department of Cardiology, Hillel Yaffe Medical Center, Hadera, Israel
| | - Ofer Kobo
- School of Medicine, Keele University, Staffordshire, United Kingdom; Department of Cardiology, Hillel Yaffe Medical Center, Hadera, Israel
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, Keele University, Keele, United Kingdom.
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Marrone S, Scalia G, Strigari L, Ranganathan S, Travali M, Maugeri R, Costanzo R, Brunasso L, Bonosi L, Cicero S, Iacopino DG, Salvati M, Umana GE. Improving mixed-reality neuronavigation with blue-green light: a comparative multimodal laboratory study. Neurosurg Focus 2024; 56:E7. [PMID: 38163345 DOI: 10.3171/2023.10.focus23598] [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: 08/30/2023] [Accepted: 10/30/2023] [Indexed: 01/03/2024]
Abstract
OBJECTIVE This study aimed to rigorously assess the accuracy of mixed-reality neuronavigation (MRN) in comparison with magnetic neuronavigation (MN) through a comprehensive phantom-based experiment. It introduces a novel dimension by examining the influence of blue-green light (BGL) on MRN accuracy, a previously unexplored avenue in this domain. METHODS Twenty-nine phantoms, each meticulously marked with 5-6 fiducials, underwent CT scans as part of the navigation protocol. A 3D model was then superimposed onto a 3D-printed plaster skull using a semiautomatic registration process. The study meticulously evaluated the accuracy of both navigation techniques by pinpointing specific markers on the plaster surface. Precise measurements were then taken using digital calipers, with navigation conducted under three distinct lighting conditions: indirect white light (referred to as no light [NL]), direct white light (WL), and BGL. The research enlisted two operators with distinct levels of experience, one senior and one junior, to ensure a comprehensive analysis. The study was structured into two distinct experiments (experiment 1 [MN] and experiment 2 [MRN]) conducted by the two operators. Data analysis focused on calculating average and median values within subgroups, considering variables such as the type of lighting, precision, and recording time. RESULTS In experiment 1, no statistically significant differences emerged between the two operators. However, in experiment 2, notable disparities became apparent, with the senior operator recording longer times but achieving higher precision. Most significantly, BGL consistently demonstrated a capacity to enhance accuracy in MRN across both experiments. CONCLUSIONS This study demonstrated the substantial positive influence of BGL on MRN accuracy, providing profound implications for the design and implementation of mixed-reality systems. It also emphasized that integrating BGL into mixed-reality environments could profoundly improve user experience and performance. Further research is essential to validate these findings in real-world settings and explore the broader potential of BGL in a variety of mixed-reality applications.
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Affiliation(s)
- Salvatore Marrone
- 1Department of Biomedicine, Neurosciences and Advanced Diagnostics, Neurosurgery Unit, School of Medicine, University of Palermo
| | - Gianluca Scalia
- 2Department of Head and Neck Surgery, Neurosurgery Unit, Garibaldi Hospital, Catania
| | - Lidia Strigari
- 3Department of Medical Physics, IRCCS Azienda University Hospital of Bologna, Italy
| | | | - Mario Travali
- 5Department of Diagnostic Imaging, Neuroradiology Unit, Cannizzaro Hospital, Catania
| | - Rosario Maugeri
- 1Department of Biomedicine, Neurosciences and Advanced Diagnostics, Neurosurgery Unit, School of Medicine, University of Palermo
| | - Roberta Costanzo
- 1Department of Biomedicine, Neurosciences and Advanced Diagnostics, Neurosurgery Unit, School of Medicine, University of Palermo
| | - Lara Brunasso
- 1Department of Biomedicine, Neurosciences and Advanced Diagnostics, Neurosurgery Unit, School of Medicine, University of Palermo
| | - Lapo Bonosi
- 1Department of Biomedicine, Neurosciences and Advanced Diagnostics, Neurosurgery Unit, School of Medicine, University of Palermo
| | - Salvatore Cicero
- 6Department of Neurosurgery, Trauma Center, Gamma Knife Center, Cannizzaro Hospital, Catania; and
| | - Domenico Gerardo Iacopino
- 1Department of Biomedicine, Neurosciences and Advanced Diagnostics, Neurosurgery Unit, School of Medicine, University of Palermo
| | - Maurizio Salvati
- 7Department of Neurosurgery, Policlinico Tor Vergata, Rome, Italy
| | - Giuseppe Emanuele Umana
- 6Department of Neurosurgery, Trauma Center, Gamma Knife Center, Cannizzaro Hospital, Catania; and
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Dalmage M, LoPresti MA, Sarkar P, Ranganathan S, Abdelmageed S, Pagadala M, Shlobin NA, Lam S, DeCuypere M. Survival and neurological outcomes after stereotactic biopsy of diffuse intrinsic pontine glioma: a systematic review. J Neurosurg Pediatr 2023; 32:665-672. [PMID: 37724839 DOI: 10.3171/2023.7.peds22462] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 07/18/2023] [Indexed: 09/21/2023]
Abstract
OBJECTIVE Diffuse intrinsic pontine gliomas (DIPGs) are aggressive and malignant tumors of the brainstem. Stereotactic biopsy can obtain molecular and genetic information for diagnostic and potentially therapeutic purposes. However, there is no consensus on the safety of biopsy or effect on survival. The authors aimed to characterize neurological risk associated with and the effect of stereotactic biopsy on survival among patients with DIPGs. METHODS A systematic review was performed in accordance with PRISMA guidelines to identify all studies examining pediatric patients with DIPG who underwent stereotactic biopsy. The search strategy was deployed in PubMed, Embase, and Scopus. The quality of studies was assessed using the Grading of Recommendations, Assessment, Development and Evaluation system, and risk of bias was evaluated with the Cochrane Risk of Bias in Nonrandomized Studies-of Interventions tool. Bibliographic, demographic, clinical, and outcome data were extracted from studies meeting inclusion criteria. RESULTS Of 2634 resultant articles, 13 were included, representing 192 patients undergoing biopsy. The weighted mean age at diagnosis was 7.5 years (range 0.5-17 years). There was an overall neurosurgical complication rate of 13.02% (25/192). The most common neurosurgical complication was cranial nerve palsy (4.2%, 8/192), of which cranial nerve VII was the most common (37.5%, 3/8). The second most common complication was perioperative hemorrhage (3.6%, 7/192), followed by hemiparesis (2.1%, 4/192), speech disorders (1.6%, 3/192) such as dysarthria and dysphasia, and movement disorders (1.0%, 2/192). Hydrocephalus was less commonly reported (0.5%, 1/192), and there were no complications relating to wound infection/dehiscence (0%, 0/192) or CSF leak (0%, 0/192). No mortality was specifically attributed to biopsy. Diagnostic yield of biopsy revealed a weighted mean of 97.4% (range 91%-100%). Of the studies reporting survival data, 37.6% (32/85) of patients died within the study follow-up period (range 2 weeks-48 months). The mean overall survival in patients undergoing biopsy was 9.73 months (SD 0.68, median 10 months, range 6-13 months). CONCLUSIONS Children with DIPGs undergoing biopsy have mild to moderate rates of neurosurgical complications and no excessive morbidity. With reasonably acceptable surgical risk and high diagnostic yield, stereotactic biopsy of DIPGs can allow for characterization of patient-specific molecular and genetic features that may influence prognosis and the development of future therapeutic strategies.
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Affiliation(s)
- Mahalia Dalmage
- 1Division of Biological Sciences, Pritzker School of Medicine, University of Chicago, Illinois
| | - Melissa A LoPresti
- 2Division of Pediatric Neurosurgery, Ann and Robert H. Lurie Children's Hospital of Chicago, Illinois
| | - Prottusha Sarkar
- 2Division of Pediatric Neurosurgery, Ann and Robert H. Lurie Children's Hospital of Chicago, Illinois
| | | | - Sunny Abdelmageed
- 2Division of Pediatric Neurosurgery, Ann and Robert H. Lurie Children's Hospital of Chicago, Illinois
| | - Manasa Pagadala
- 2Division of Pediatric Neurosurgery, Ann and Robert H. Lurie Children's Hospital of Chicago, Illinois
| | - Nathan A Shlobin
- 2Division of Pediatric Neurosurgery, Ann and Robert H. Lurie Children's Hospital of Chicago, Illinois
| | - Sandi Lam
- 2Division of Pediatric Neurosurgery, Ann and Robert H. Lurie Children's Hospital of Chicago, Illinois
- 4Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois; and
- 5Malnati Brain Tumor Institute of the Lurie Comprehensive Cancer Center, Northwestern University, Chicago, Illinois
| | - Michael DeCuypere
- 2Division of Pediatric Neurosurgery, Ann and Robert H. Lurie Children's Hospital of Chicago, Illinois
- 4Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois; and
- 5Malnati Brain Tumor Institute of the Lurie Comprehensive Cancer Center, Northwestern University, Chicago, Illinois
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11
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Doyle LW, Ranganathan S, Spittle A, Opie G, Mainzer R, Cheong JL. Expiratory airflow at 7-8 years of age in children born extremely low birthweight from 14 years before to 14 years after the introduction of exogenous surfactant. EClinicalMedicine 2023; 62:102115. [PMID: 37533420 PMCID: PMC10393553 DOI: 10.1016/j.eclinm.2023.102115] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 07/05/2023] [Accepted: 07/06/2023] [Indexed: 08/04/2023] Open
Abstract
Background It is unclear if expiratory airflow in survivors born extremely low birth weight (ELBW; 500-999 g) has improved after the introduction of exogenous surfactant into clinical practice in 1991. The primary aim of this study was to describe the changes in airflow at 7-8 years of age of survivors born ELBW in five discrete cohorts from 14 years before to 14 years after the introduction of exogenous surfactant into clinical practice. Methods The cohorts comprised consecutive survivors born ELBW in 1977-82 and 1985-87 at the Royal Women's Hospital, Melbourne, and in 1991-92, 1997 and 2005 in the state of Victoria, Australia. Survival rates to 2-years of age for infants born ELBW in the state of Victoria rose from approximately 1-in-4 to 3-in-4 over the time of this study. Expiratory airflow measurements at 7-8 years included the forced expired volume in 1 s (FEV1), converted to z-scores for age, height, sex, and race. Findings There were 596 ELBW participants with expiratory flow data, 280 (47%) of whom had bronchopulmonary dysplasia (BPD). Overall, there was little change in zFEV1 over the 28-year period (mean change per year; 0.003, 95% CI -0.010, 0.015, P = 0.67). There was, however, evidence of an interaction between BPD and year; zFEV1 in those who had BPD fell over time (mean change per year -0.019, 95% CI -0.037, -0.009, P = 0.035), whereas zFEV1 improved in those who did not have BPD (mean change per year 0.021, 95% CI 0.006, 0.037, P = 0.007). Interpretation Contrary to recent evidence, expiratory airflow of children born ELBW has not improved with the introduction of surfactant, and may be deteriorating in those who had BPD. Funding National Health and Medical Research Council (Australia); Victorian Government's Operational Infrastructure Support Program.
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Affiliation(s)
- Lex W. Doyle
- Department of Obstetrics and Gynaecology, The Royal Women's Hospital, Melbourne, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Australia
- Newborn Services, The Royal Women's Hospital, Melbourne, Australia
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia
| | - S. Ranganathan
- Department of Paediatrics, University of Melbourne, Melbourne, Australia
- Department of Respiratory Medicine, Royal Children's Hospital, Melbourne, Australia
| | - A.J. Spittle
- Newborn Services, The Royal Women's Hospital, Melbourne, Australia
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia
- Department of Physiotherapy, University of Melbourne, Melbourne, Australia
| | - G. Opie
- Neonatal Services, Mercy Hospital for Women, Melbourne, Australia
| | - R.M. Mainzer
- Department of Paediatrics, University of Melbourne, Melbourne, Australia
- Clinical Epidemiology and Biostatistics, Murdoch Children's Research Institute, Melbourne, Australia
| | - Jeanie L.Y. Cheong
- Department of Obstetrics and Gynaecology, The Royal Women's Hospital, Melbourne, Australia
- Newborn Services, The Royal Women's Hospital, Melbourne, Australia
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia
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12
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Ranganathan S, Tomar V, Chino F, Jain B, Patel TA, Dee EC, Mathew A. A burden shared: the financial, psychological, and health-related consequences borne by family members and caregivers of people with cancer in India. Support Care Cancer 2023; 31:420. [PMID: 37354234 DOI: 10.1007/s00520-023-07886-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Accepted: 06/13/2023] [Indexed: 06/26/2023]
Abstract
In India, approximately 1.4 million new cases of cancer are recorded annually, with 26.7 million people living with cancer in 2021. Providing care for family members with cancer impacts caregivers' health and financial resources. Effects on caregivers' health and financial resources, understood as family and caregiver "financial toxicity" of cancer, are important to explore in the Indian context, where family members often serve as caregivers, in light of cultural attitudes towards family. This is reinforced by other structural issues such as grave disparities in socioeconomic status, barriers in access to care, and limited access to supportive care services for many patients. Effects on family caregivers' financial resources are particularly prevalent in India given the increased dependency on out-of-pocket financing for healthcare, disparate access to insurance coverage, and limitations in public expenditure on healthcare. In this paper, we explore family and caregiver financial toxicity of cancer in the Indian context, highlighting the multiple psychosocial aspects through which these factors may play out. We suggest steps forward, including future directions in (1) health services research, (2) community-level interventions, and (3) policy changes. We underscore that multidisciplinary and multi-sectoral efforts are needed to study and address family and caregiver financial toxicity in India.
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Affiliation(s)
| | | | - Fumiko Chino
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Radiation Oncology and Affordability Working Group, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Bhav Jain
- Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Tej A Patel
- University of Pennsylvania, Philadelphia, PA, USA
| | - Edward Christopher Dee
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
| | - Aju Mathew
- Department of Oncology, MOSC Medical College, Ernakulam, Kerala, 682311, India
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13
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Ranganathan S, Vervoort D. Residency Research Fever Across the World. JAMA Surg 2023:2802867. [PMID: 36947067 DOI: 10.1001/jamasurg.2023.0029] [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: 03/23/2023]
Affiliation(s)
| | - Dominique Vervoort
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
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14
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Joseph J, Baby HM, Zhao S, Li X, Cheung K, Swain K, Agus E, Ranganathan S, Gao J, Luo JN, Joshi N. Role of bioaerosol in virus transmission and material-based countermeasures. Exploration (Beijing) 2022; 2:20210038. [PMID: 37324804 PMCID: PMC10190935 DOI: 10.1002/exp.20210038] [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] [Figures] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 04/15/2022] [Indexed: 06/17/2023]
Abstract
Respiratory pathogens transmit primarily through particles such as droplets and aerosols. Although often overlooked, the resuspension of settled droplets is also a key facilitator of disease transmission. In this review, we discuss the three main mechanisms of aerosol generation: direct generation such as coughing and sneezing, indirect generation such as medical procedures, and resuspension of settled droplets and aerosols. The size of particles and environmental factors influence their airborne lifetime and ability to cause infection. Specifically, humidity and temperature are key factors controlling the evaporation of suspended droplets, consequently affecting the duration in which particles remain airborne. We also suggest material-based approaches for effective prevention of disease transmission. These approaches include electrostatically charged virucidal agents and surface coatings, which have been shown to be highly effective in deactivating and reducing resuspension of pathogen-laden aerosols.
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Affiliation(s)
- John Joseph
- Center for Nanomedicine, Department of AnesthesiologyPerioperative and Pain Medicine, Brigham and Women's HospitalBostonMassachusettsUSA
- Harvard Medical SchoolBostonMassachusettsUSA
| | - Helna Mary Baby
- Center for Nanomedicine, Department of AnesthesiologyPerioperative and Pain Medicine, Brigham and Women's HospitalBostonMassachusettsUSA
| | - Spencer Zhao
- Center for Nanomedicine, Department of AnesthesiologyPerioperative and Pain Medicine, Brigham and Women's HospitalBostonMassachusettsUSA
| | - Xiang‐Ling Li
- Center for Nanomedicine, Department of AnesthesiologyPerioperative and Pain Medicine, Brigham and Women's HospitalBostonMassachusettsUSA
| | - Krisco‐Cheuk Cheung
- Center for Nanomedicine, Department of AnesthesiologyPerioperative and Pain Medicine, Brigham and Women's HospitalBostonMassachusettsUSA
| | - Kabir Swain
- Center for Nanomedicine, Department of AnesthesiologyPerioperative and Pain Medicine, Brigham and Women's HospitalBostonMassachusettsUSA
| | - Eli Agus
- Center for Nanomedicine, Department of AnesthesiologyPerioperative and Pain Medicine, Brigham and Women's HospitalBostonMassachusettsUSA
| | - Sruthi Ranganathan
- Center for Nanomedicine, Department of AnesthesiologyPerioperative and Pain Medicine, Brigham and Women's HospitalBostonMassachusettsUSA
| | - Jingjing Gao
- Center for Nanomedicine, Department of AnesthesiologyPerioperative and Pain Medicine, Brigham and Women's HospitalBostonMassachusettsUSA
- Harvard Medical SchoolBostonMassachusettsUSA
| | - James N Luo
- Harvard Medical SchoolBostonMassachusettsUSA
- Department of SurgeryBrigham and Women's HospitalBostonMassachusettsUSA
| | - Nitin Joshi
- Center for Nanomedicine, Department of AnesthesiologyPerioperative and Pain Medicine, Brigham and Women's HospitalBostonMassachusettsUSA
- Harvard Medical SchoolBostonMassachusettsUSA
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15
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Shanthikumar S, Kim S, Giacalone V, Rao P, Ranganathan S, Karpievitch Y, Stick S, Boucher R, Tirouvanziam R, Chandler J, Esther C. 446 Metabolites in early life bronchoalveolar fluid associate with future bronchiectasis risk in children with cystic fibrosis. J Cyst Fibros 2022. [DOI: 10.1016/s1569-1993(22)01136-5] [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: 11/07/2022]
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16
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Ranganathan S, Entezari P, Gabr A, Gordon A, Kulik L, Desai K, Thornburg B, Riaz A, Salem R, Lewandowski R. Abstract No. 309 Evaluating liver function status trends in hepatocellular carcinoma patients with intermediate-stage disease undergoing radioembolization: a longitudinal study. J Vasc Interv Radiol 2022. [DOI: 10.1016/j.jvir.2022.03.390] [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: 10/18/2022] Open
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17
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Deschamp A, Chen Y, Wang W, Rasic M, Hatch J, Sanders D, Ranganathan S, Ferkol T, Perkins D, Davis S, Finn P. 200: The association of growth and the gut microbiome in infants with cystic fibrosis. J Cyst Fibros 2021. [DOI: 10.1016/s1569-1993(21)01625-8] [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: 10/20/2022]
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18
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Esther C, Shanthikumar S, Schultz A, McNally P, Ranganathan S, Stick S, Boucher R. 576: Ivacaftor treatment alters the relationship between mucoinflammation and structural lung disease in preschool-aged children with CF. J Cyst Fibros 2021. [DOI: 10.1016/s1569-1993(21)01999-8] [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: 10/20/2022]
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19
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Lee KS, Ranganathan S, Choong AMTL, Ng JJ. A scoping review on the changes in vascular surgical practice during the early phases of the COVID-19 pandemic. Semin Vasc Surg 2021; 34:63-73. [PMID: 34642038 PMCID: PMC8349480 DOI: 10.1053/j.semvascsurg.2021.07.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 07/28/2021] [Accepted: 07/28/2021] [Indexed: 01/18/2023]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has had a profound effect on the delivery of vascular surgery to patients around the world. In order to conserve resources and reduce the risk of COVID-19 infection, many institutions have postponed or cancelled surgical procedures. In this scoping review, we aim to review current literature and recapitulate the significant changes in elective and emergency vascular surgery during the COVID-19 pandemic. We conducted this scoping review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews. We included all articles that had reported the effects of the COVID-19 pandemic on elective or emergency vascular surgery. A total of 28 articles were included in this scoping review. We identified eight distinct themes that were relevant to our study topic. We report global, regional, and local data on vascular surgical cases. We also discuss the adoption of vascular surgery triage systems, emergence of global collaborative vascular surgery research groups, increased use of endovascular techniques and locoregional anesthesia, delayed presentation of vascular surgery conditions, and poorer outcomes of patients with chronic limb threatening ischemia. This scoping review provides a snapshot of the impact of the COVID-19 pandemic on elective and emergency vascular surgery.
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Affiliation(s)
- Keng Siang Lee
- SingVaSC, Singapore Vascular Surgical Collaborative, Singapore; Bristol Medical School, University of Bristol, Bristol, UK; Cardiovascular Research Institute, National University of Singapore, Singapore
| | - Sruthi Ranganathan
- SingVaSC, Singapore Vascular Surgical Collaborative, Singapore; Department of Medicine, University of Cambridge, Cambridge CB2 OQQ, UK; Cardiovascular Research Institute, National University of Singapore, Singapore
| | - Andrew M T L Choong
- SingVaSC, Singapore Vascular Surgical Collaborative, Singapore; Department of Medicine, University of Cambridge, Cambridge CB2 OQQ, UK; Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Division of Vascular and Endovascular Surgery, National University Heart Centre, Singapore; Cardiovascular Research Institute, National University of Singapore, Singapore
| | - Jun Jie Ng
- SingVaSC, Singapore Vascular Surgical Collaborative, Singapore; Department of Medicine, University of Cambridge, Cambridge CB2 OQQ, UK; Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Cardiovascular Research Institute, National University of Singapore, Singapore.
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20
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Ranganathan S, Balagangadharan K, Selvamurugan N. Chitosan and gelatin-based electrospun fibers for bone tissue engineering. Int J Biol Macromol 2019; 133:354-364. [DOI: 10.1016/j.ijbiomac.2019.04.115] [Citation(s) in RCA: 96] [Impact Index Per Article: 19.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Revised: 04/06/2019] [Accepted: 04/16/2019] [Indexed: 12/29/2022]
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21
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Abstract
A new dry-mixing process for producing iodine- and iron-fortified salt on a large scale (20 30 metric tons per shift) was developed in salt factories at Valinokkam and Hyderabad, India. Common salt is mixed with 1% sodium hexametaphosphate, 0.5% ferrous sulphate heptahydrate, and 0.0055% potassium iodide or 0.007% potassium iodate in a ribbon blender. Dry mixing is superior to spray mixing and is associated with no operational problems. The fortified salt produced by this method retains the original colour of the unfortified salt, and the distribution of iodine and iron is uniform. The acceptability of the fortified salt is satisfactory, as various food preparations using the product are indistinguishable in colour, taste, and flavour from those containing unfortified salt
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22
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Abstract
One practical way to control iron-deficiency anaemia is to fortify edible salt with iron. Effective implementation of a programme for producing and distributing iron-fortified salt requires regular monitoring of edible salt for iron, particularly at the retail sales and household levels. A simple, inexpensive (10 rupees) field kit was developed for this purpose. No glassware has to be carried, and reagents are supplied in the form of tablets. It is possible to detect iron fevers as low as 50 parts per million (ppm) and as high as 1,000 ppm. One kit can be used to test 200 salt samples.
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23
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Affiliation(s)
- B. S. Narasinga Rao
- National Institute of Nutrition, Indian Council of Medical Research, Jamai-Osmania, Hyderabad-500007, India
| | - S. Ranganathan
- National Institute of Nutrition, Indian Council of Medical Research, Jamai-Osmania, Hyderabad-500007, India
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24
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Bove KE, Sheridan R, Fei L, Anders R, Chung CT, Cummings OW, Finegold MJ, Finn L, Ranganathan S, Kim G, Lovell M, Magid MS, Melin-Aldana H, Russo P, Shehata B, Wang L, White F, Chen Z, Spino C, Magee JC. Hepatic Hilar Lymph Node Reactivity at Kasai Portoenterostomy for Biliary Atresia: Correlations With Age, Outcome, and Histology of Proximal Biliary Remnant. Pediatr Dev Pathol 2018; 21:29-40. [PMID: 28474973 PMCID: PMC7986481 DOI: 10.1177/1093526617707851] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [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: 12/18/2022]
Abstract
We hypothesized that if infection is the proximate cause of congenital biliary atresia, an appropriate response to antigen would occur in lymph nodes contiguous with the biliary remnant. We compared the number of follicular germinal centers (GC) in 79 surgically excised hilar lymph nodes (LN) and 27 incidentally discovered cystic duct LNs in 84 subjects at the time of hepatic portoenterostomy (HPE) for biliary atresia (BA) to autopsy controls from the pancreaticobiliary region of non-septic infants >3 months old at death. All 27 control LN lacked GC, a sign in infants of a primary response to antigenic stimulation. GC were found in 53% of 106 LN in 56 of 84 subjects. Visible surgically excised LN contiguous with the most proximal biliary remnants had 1 or more well-formed reactive GC in only 26/51 subjects. Presence of GC and number of GC/LN was unrelated to age at onset of jaundice or to active fibroplasia in the biliary remnant but was related to older age at HPE. Absent GC in visible and incidentally removed cystic duct LNs predicted survival with the native liver at 2 and 3 years after HPE, P = .03, but significance was lost at longer intervals. The uncommon inflammatory lesions occasionally found in remnants could be secondary either to bile-induced injury or secondary infection established as obstruction evolves. The absence of consistent evidence of antigenic stimulation in LN contiguous with the biliary remnant supports existence of at least 1 major alternative to infection in the etiology of biliary atresia.
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Affiliation(s)
- KE Bove
- Division of Pathology and Laboratory Medicine and Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - R Sheridan
- Division of Pathology and Laboratory Medicine and Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - L Fei
- Division of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - R Anders
- Department of Pathology, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - CT Chung
- Division of Pathology, The Hospital for Sick Children, Toronto, Canada
| | - OW Cummings
- Department of Pathology, Indiana University School of Medicine, Indianapolis, Indiana
| | - MJ Finegold
- Department of Pathology, Texas Children’s Hospital, Houston, Texas
| | - L Finn
- Department of Pathology, Seattle Children’s Hospital, Seattle, Washington
| | - S Ranganathan
- Department of Pathology, Children’s Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania
| | - G Kim
- Department of Anatomic Pathology, University of California, San Francisco, San Francisco, California
| | - M Lovell
- Department of Pathology, Children’s Hospital Colorado, Aurora, Colorado
| | - MS Magid
- Department of Pathology, Kravis Children’s Hospital, Mount Sinai Medical Center, New York, New York
| | - H Melin-Aldana
- Department of Pathology, Ann & Robert H. Lurie Children’s Hospital, Chicago, Illinois
| | - P Russo
- Department of Pathology and Laboratory Medicine, the Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - B Shehata
- Department of Pathology, Children’s Healthcare of Atlanta, Atlanta, Georgia
| | - L Wang
- Department of Pathology, Children’s Hospital Los Angeles, Los Angeles, California
| | - F White
- Department of Pathology and Immunology, Washington University School of Medicine, St Louis, Missouri
| | - Z Chen
- Quest Diagnostics, Health Informatics, Madison New Jersey
| | - C Spino
- Department of Biostatistics, University of Michigan, Ann Arbor, Michigan
| | - JC Magee
- Department of Surgery, University of Michigan, Ann Arbor, Michigan
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25
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McCloskey K, Ponsonby AL, Collier F, Allen K, Tang MLK, Carlin JB, Saffery R, Skilton MR, Cheung M, Ranganathan S, Dwyer T, Burgner D, Vuillermin P. The association between higher maternal pre-pregnancy body mass index and increased birth weight, adiposity and inflammation in the newborn. Pediatr Obes 2018; 13:46-53. [PMID: 27723247 DOI: 10.1111/ijpo.12187] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [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: 03/31/2016] [Accepted: 08/29/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND Excess adiposity and adiposity-related inflammation are known risk factors for cardiovascular disease in adults; however, little is known regarding the determinants of adiposity-related inflammation at birth. OBJECTIVES The aim of this study was to investigate the association between maternal pre-pregnancy BMI and newborn adiposity and inflammation. METHODS Paired maternal (28-week gestation) and infant (umbilical cord) blood samples were collected from a population-derived birth cohort (Barwon Infant Study, n = 1074). Data on maternal comorbidities and infant birth anthropomorphic measures were compiled, and infant aortic intima-media thickness was measured by trans-abdominal ultrasound. In a selected subgroup of term infants (n = 161), matched maternal and cord lipids, high-sensitivity C-reactive protein (hsCRP) and maternal soluble CD14 were measured. Analysis was completed by using pairwise correlation and linear regression. Because of their non-normal distribution, pathology blood measures were log transformed prior to analysis. RESULTS Maternal pre-pregnancy BMI was positively associated with increased birth weight (mean difference 17.8 g per kg m-2 , 95% CI 6.6 to 28.9; p = 0.002), newborn mean skin-fold thickness (mean difference 0.1 mm per kg m-2 , 95% CI 0.0 to 0.1; p < 0.001) and cord blood hsCRP (mean difference of 4.2% increase in hsCRP per kg m-2 increase in pre-pregnancy BMI, 95% CI 0.6 to 7.7%, p = 0.02), but not cord blood soluble CD14. Inclusion of maternal hsCRP as a covariate attenuated the associations between pre-pregnancy BMI and both newborn skin-fold thickness and cord blood hsCRP. CONCLUSION Higher maternal pre-pregnancy BMI is associated with increased newborn adiposity and inflammation. These associations may be partially mediated by maternal inflammation during pregnancy.
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Affiliation(s)
- K McCloskey
- Murdoch Childrens Research Institute, Royal Children's Hospital, Parkville, Australia.,Child Health Research Unit, Barwon Health, Geelong, Australia.,Department of Paediatrics, University of Melbourne, Parkville, Australia
| | - A-L Ponsonby
- Murdoch Childrens Research Institute, Royal Children's Hospital, Parkville, Australia.,Department of Paediatrics, University of Melbourne, Parkville, Australia
| | - F Collier
- Child Health Research Unit, Barwon Health, Geelong, Australia.,Deakin University, Geelong, Australia
| | - K Allen
- Murdoch Childrens Research Institute, Royal Children's Hospital, Parkville, Australia.,Department of Paediatrics, University of Melbourne, Parkville, Australia
| | - M L K Tang
- Murdoch Childrens Research Institute, Royal Children's Hospital, Parkville, Australia.,Department of Paediatrics, University of Melbourne, Parkville, Australia
| | - J B Carlin
- Murdoch Childrens Research Institute, Royal Children's Hospital, Parkville, Australia.,Department of Paediatrics, University of Melbourne, Parkville, Australia
| | - R Saffery
- Murdoch Childrens Research Institute, Royal Children's Hospital, Parkville, Australia.,Department of Paediatrics, University of Melbourne, Parkville, Australia
| | - M R Skilton
- Boden Institute of Obesity, Nutrition, Exercise and Eating Disorders, University of Sydney, Sydney, Australia
| | - M Cheung
- Murdoch Childrens Research Institute, Royal Children's Hospital, Parkville, Australia.,Department of Paediatrics, University of Melbourne, Parkville, Australia
| | - S Ranganathan
- Murdoch Childrens Research Institute, Royal Children's Hospital, Parkville, Australia.,Department of Paediatrics, University of Melbourne, Parkville, Australia
| | - T Dwyer
- Murdoch Childrens Research Institute, Royal Children's Hospital, Parkville, Australia.,Department of Paediatrics, University of Melbourne, Parkville, Australia
| | - D Burgner
- Murdoch Childrens Research Institute, Royal Children's Hospital, Parkville, Australia.,Department of Paediatrics, University of Melbourne, Parkville, Australia.,Department of Paediatrics, Monash University, Clayton, Australia
| | - P Vuillermin
- Murdoch Childrens Research Institute, Royal Children's Hospital, Parkville, Australia.,Child Health Research Unit, Barwon Health, Geelong, Australia.,Deakin University, Geelong, Australia
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Gray L, Leong O, O’Hely M, Collier F, Ranganathan S, Sly P, Tang M, Allen K, Vuillermin P. P43: FOOD ALLERGY BUT NOT SENSITISED TOLERANCE ASSOCIATES WITH SUBSEQUENT ASTHMA. Intern Med J 2017. [DOI: 10.1111/imj.43_13578] [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: 11/27/2022]
Affiliation(s)
- L Gray
- Deakin University; Melbourne Australia
- Barwon Health; Melbourne Australia
| | - O Leong
- Barwon Health; Melbourne Australia
| | - M O’Hely
- Deakin University; Melbourne Australia
- Murdoch Children’s Research Institute; Melbourne Australia
| | - F Collier
- Deakin University; Melbourne Australia
| | - S Ranganathan
- Murdoch Children’s Research Institute; Melbourne Australia
- Royal Children’s Hospital; Melbourne Australia
| | - P Sly
- University of Queensland; Brisbane Australia
| | - M Tang
- Murdoch Children’s Research Institute; Melbourne Australia
- Royal Children’s Hospital; Melbourne Australia
| | - K Allen
- Murdoch Children’s Research Institute; Melbourne Australia
- Royal Children’s Hospital; Melbourne Australia
| | - P Vuillermin
- Deakin University; Melbourne Australia
- Barwon Health; Melbourne Australia
- Murdoch Children’s Research Institute; Melbourne Australia
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Molloy J, Koplin JJ, Allen KJ, Tang MLK, Collier F, Carlin JB, Saffery R, Burgner D, Ranganathan S, Dwyer T, Ward AC, Moreno-Betancur M, Clarke M, Ponsonby AL, Vuillermin P. Vitamin D insufficiency in the first 6 months of infancy and challenge-proven IgE-mediated food allergy at 1 year of age: a case-cohort study. Allergy 2017; 72:1222-1231. [PMID: 28042676 DOI: 10.1111/all.13122] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/31/2016] [Indexed: 12/13/2022]
Abstract
BACKGROUND Ecological evidence suggests vitamin D insufficiency (VDI) due to lower ambient ultraviolet radiation (UVR) exposure may be a risk factor for IgE-mediated food allergy. However, there are no studies relating directly measured VDI during early infancy to subsequent challenge-proven food allergy. OBJECTIVE To prospectively investigate the association between VDI during infancy and challenge-proven food allergy at 1 year. METHODS In a birth cohort (n = 1074), we used a case-cohort design to compare 25-hydroxyvitamin D3 (25(OH)D3 ) levels among infants with food allergy vs a random subcohort (n = 274). The primary exposures were VDI (25(OH)D3 <50 nM) at birth and 6 months of age. Ambient UVR and time in the sun were combined to estimate UVR exposure dose. IgE-mediated food allergy status at 1 year was determined by formal challenge. Binomial regression was used to examine associations between VDI, UVR exposure dose and food allergy and investigate potential confounding. RESULTS Within the random subcohort, VDI was present in 45% (105/233) of newborns and 24% (55/227) of infants at 6 months. Food allergy prevalence at 1 year was 7.7% (61/786), and 6.5% (53/808) were egg-allergic. There was no evidence of an association between VDI at either birth (aRR 1.25, 95% CI 0.70-2.22) or 6 months (aRR 0.93, 95% CI 0.41-2.14) and food allergy at 1 year. CONCLUSIONS There was no evidence that VDI during the first 6 months of infancy is a risk factor for food allergy at 1 year of age. These findings primarily relate to egg allergy, and larger studies are required.
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Affiliation(s)
- J. Molloy
- School of Medicine; Deakin University; Waurn Ponds VIC Australia
- Child Health Research Unit; Barwon Health; Geelong VIC Australia
- Murdoch Childrens Research Institute; Parkville VIC Australia
- Centre for Food and Allergy Research; Parkville VIC Australia
| | - J. J. Koplin
- Murdoch Childrens Research Institute; Parkville VIC Australia
- Centre for Food and Allergy Research; Parkville VIC Australia
- Centre for Epidemiology and Biostatistics; The University of Melbourne; Carlton VIC Australia
| | - K. J. Allen
- Murdoch Childrens Research Institute; Parkville VIC Australia
- Centre for Food and Allergy Research; Parkville VIC Australia
- Department of Paediatrics; University of Melbourne; Parkville VIC Australia
- Department of Allergy and Immunology; Royal Children's Hospital; Parkville VIC Australia
| | - M. L. K. Tang
- Murdoch Childrens Research Institute; Parkville VIC Australia
- Centre for Food and Allergy Research; Parkville VIC Australia
- Department of Paediatrics; University of Melbourne; Parkville VIC Australia
- Department of Allergy and Immunology; Royal Children's Hospital; Parkville VIC Australia
| | - F. Collier
- School of Medicine; Deakin University; Waurn Ponds VIC Australia
- Child Health Research Unit; Barwon Health; Geelong VIC Australia
- Murdoch Childrens Research Institute; Parkville VIC Australia
| | - J. B. Carlin
- Murdoch Childrens Research Institute; Parkville VIC Australia
- Centre for Epidemiology and Biostatistics; The University of Melbourne; Carlton VIC Australia
- Department of Paediatrics; University of Melbourne; Parkville VIC Australia
| | - R. Saffery
- Murdoch Childrens Research Institute; Parkville VIC Australia
| | - D. Burgner
- Murdoch Childrens Research Institute; Parkville VIC Australia
- Department of Paediatrics; University of Melbourne; Parkville VIC Australia
- Department of Paediatrics; Monash University; Clayton VIC Australia
| | - S. Ranganathan
- Murdoch Childrens Research Institute; Parkville VIC Australia
- Department of Paediatrics; University of Melbourne; Parkville VIC Australia
- Department of Respiratory Medicine; Royal Children's Hospital; Parkville VIC Australia
| | - T. Dwyer
- The George Institute for Global Health; University of Oxford; Oxford UK
| | - A. C. Ward
- School of Medicine; Deakin University; Waurn Ponds VIC Australia
| | - M. Moreno-Betancur
- Murdoch Childrens Research Institute; Parkville VIC Australia
- Department of Epidemiology and Preventive Medicine; Monash University; Melbourne VIC Australia
| | - M. Clarke
- Biological and Molecular Mass Spectrometry Facility; Centre for Microscopy, Characterisation and Analysis; University of Western Australia; Perth Western Australia 6009
| | - A. L. Ponsonby
- Murdoch Childrens Research Institute; Parkville VIC Australia
- Centre for Food and Allergy Research; Parkville VIC Australia
| | - P. Vuillermin
- School of Medicine; Deakin University; Waurn Ponds VIC Australia
- Child Health Research Unit; Barwon Health; Geelong VIC Australia
- Murdoch Childrens Research Institute; Parkville VIC Australia
- Centre for Food and Allergy Research; Parkville VIC Australia
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Munro C, Quinlan C, Ranganathan S. 44 Changes in estimated glomerular filtration rate (eGFR) with ivacaftor treatment in the paediatric cystic fibrosis (CF) population. J Cyst Fibros 2017. [DOI: 10.1016/s1569-1993(17)30409-5] [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: 11/26/2022]
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Haricharan S, Nagabhushana, Srinivasan S, Rajani MB, Ranganathan S. Locating Iron Production Sites in Telangana, India Using Satellite Imagery. CURR SCI INDIA 2016. [DOI: 10.18520/cs/v111/i9/1536-1543] [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: 11/15/2022]
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Frayman K, Armstrong D, Carzino R, Ferkol T, Grimwood K, Storch G, Wylie K, Ranganathan S. 80 The microbiome in early cystic fibrosis lung disease: A longitudinal analysis. J Cyst Fibros 2015. [DOI: 10.1016/s1569-1993(15)30257-5] [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: 10/23/2022]
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31
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Sayers I, Sharma A, Ranganathan S, Cain T, Skoric B. WS20.5 Cystic fibrosis related structural lung disease on high resolution computed tomography before and after ivacaftor therapy. J Cyst Fibros 2015. [DOI: 10.1016/s1569-1993(15)30120-x] [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: 10/23/2022]
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Carzino R, King L, Ranganathan S. 78 Differences in infection, inflammation and structural abnormalities between the right and left lung. J Cyst Fibros 2015. [DOI: 10.1016/s1569-1993(15)30255-1] [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: 11/26/2022]
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Rizk B, Turki R, Lotfy H, Ranganathan S, Zahed H, Freeman A, Shilbayeh Z, Sassy M, Shalaby M, Malik R. Surgery for endometriosis-associated infertility: do we exaggerate the magnitude of effect? Facts Views Vis Obgyn 2015; 7:109-18. [PMID: 26177374 PMCID: PMC4498168] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE Surgery remains the mainstay in the diagnosis and management of endometriosis. The number of surgeries performed for endometriosis worldwide is ever increasing, however do we have evidence for improvement of infertility after the surgery and do we exaggerate the magnitude of effect of surgery when we counsel our patients? The management of patients who failed the surgery could be by repeat surgery or assisted reproduction. What evidence do we have for patients who fail assisted reproduction and what is their best chance for achieving pregnancy? MATERIAL AND METHODS In this study we reviewed the evidence-based practice pertaining to the outcome of surgery assisted infertility associated with endometriosis. Manuscripts published in PubMed and Science Direct as well as the bibliography cited in these articles were reviewed. Patients with peritoneal endometriosis with mild and severe disease were addressed separately. Patients who failed the primary surgery and managed by repeat or assisted reproduction technology were also evaluated. Patients who failed assisted reproduction and managed by surgery were also studied to determine of the best course of action. RESULTS In patients with minimal and mild pelvic endometriosis, excision or ablation of the peritoneal endometriosis increases the pregnancy rate. In women with severe endometriosis, controlled trials suggested an improvement of pregnancy rate. In women with ovarian endometrioma 4 cm or larger ovarian cystectomy increases the pregnancy rate, decreases the recurrence rate, but is associated with decrease in ovarian reserve. In patients who have failed the primary surgery, assisted reproduction appears to be significantly more effective than repeat surgery. In patients who failed assisted reproduction, the management remains to be extremely controversial. Surgery in expert hands might result in significant improvement in pregnancy rate. CONCLUSION In women with minimal and mild endometriosis, surgical excision or ablation of endometriosis is recommended as first line with doubling the pregnancy rate. In patients with moderate and severe endometriosis surgical excision also is recommended as first line. In patients who failed to conceive spontaneously after surgery, assisted reproduction is more effective than repeat surgery. Following surgery, the ovarian reserve may be reduced as determined by Anti Mullerian Hormone. The antral follicle count is not significantly reduced. In women with large endometriomas > 4 cm the ovarian endometrioma should be removed. In women who have failed assisted reproduction, further management remains controversial in the present time.
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Affiliation(s)
- B. Rizk
- Division of reproductive medicine and infertility, Department of Obstetrics and Gynecology, University of South Alabama, Mobile, Alabama, U.S.A.
,
Correspondence at:
| | - R. Turki
- Division of reproductive medicine and infertility, Department of Obstetrics and Gynecology, University of South Alabama, Mobile, Alabama, U.S.A.
,Department of Obstetrics and Gynecology, King Abdulaziz University, Jeddah, Saudi Arabia.
| | - H. Lotfy
- Division of reproductive medicine and infertility, Department of Obstetrics and Gynecology, University of South Alabama, Mobile, Alabama, U.S.A.
,Department of Obstetrics and Gynecology, Tanta University, Egypt.
| | - S. Ranganathan
- Division of reproductive medicine and infertility, Department of Obstetrics and Gynecology, University of South Alabama, Mobile, Alabama, U.S.A.
| | - H. Zahed
- Department of Obstetrics and Gynecology, King Abdulaziz University, Jeddah, Saudi Arabia.
| | - A.R. Freeman
- Division of reproductive medicine and infertility, Department of Obstetrics and Gynecology, University of South Alabama, Mobile, Alabama, U.S.A.
| | - Z. Shilbayeh
- Division of reproductive medicine and infertility, Department of Obstetrics and Gynecology, University of South Alabama, Mobile, Alabama, U.S.A.
| | - M. Sassy
- IVF Michigan, Rochester Hills, Michigan, U.S.A.
| | - M. Shalaby
- LSU School of Medicine, New Orleans, Louisiana.
| | - R. Malik
- Division of reproductive medicine and infertility, Department of Obstetrics and Gynecology, University of South Alabama, Mobile, Alabama, U.S.A.
,Department of Obstetrics and Gynecology, University of Indiana, Indianapolis, Indiana, U.S.A.
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Aarthi V, Krishnamoorthy J, Ranganathan S. PA01.63. Scientific evaluation on Siddha drug G 7 for the management of allergic disorders of the skin. Anc Sci Life 2012. [PMCID: PMC3800867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Purpose: In the ancient siddha literature various herbomineral components individually and in combination are documented to have wide spectrum of activity against allergic disorders of skin like pruritus, urticaria, eczema etc. The aim of the present study was to establish the effect of G7 on IL 8, IL alpha 1 and histamine both in vivo and in vitro studies. Method: The cultured keratinocytes were exposed to uv irradiation and the release of IL 8, IL alpha 1 and histamine were established by ELISA. The effect of G7 on histamine induced wheel and flare reaction were established in human subjects. Capasicin and substance P were used as positive control with intra dermal histamine. Result: G7 had significantly interfered in the release of IL 8, IL alpha 1 and histamine in vitro studies and in vivo studies G7 had significantly reduced wheal and flare reaction in human subjects. Conclusion: The findings of the study have clearly established the anti-allergic effect of G7 and its mechanism of action. Siddha system of medicine was contemporary to ayurvedic system of medicine. Siddha system however was confined to Tamil nadu while the ayurvedic system was prevalent throughout India.
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Affiliation(s)
- V. Aarthi
- Dr.JRK's Siddha Research and Pharmaceuticals Pvt. Ltd, Chennai - 69, India
| | | | - S. Ranganathan
- Dr.JRK's Siddha Research and Pharmaceuticals Pvt. Ltd, Chennai - 69, India
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Alperin N, Ranganathan S, Bagci AM, Adams DJ, Ertl-Wagner B, Saraf-Lavi E, Sklar EM, Lam BL. MRI evidence of impaired CSF homeostasis in obesity-associated idiopathic intracranial hypertension. AJNR Am J Neuroradiol 2012; 34:29-34. [PMID: 22766676 DOI: 10.3174/ajnr.a3171] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Impaired CSF homeostasis and altered venous hemodynamics are proposed mechanisms for elevated pressure in IIH. However, the lack of ventricular expansion steered the focus away from CSF homeostasis in IIH. This study aims to measure intracranial CSF volumes and cerebral venous drainage with MR imaging to determine whether increased CSF volume from impaired CSF homeostasis and venous hemodynamics occur in obesity-related IIH. MATERIALS AND METHODS Two homogeneous cohorts of 11 newly diagnosed pretreatment overweight women with IIH and 11 overweight healthy women were prospectively studied. 3D volumetric MR imaging of the brain was used to quantify CSF and brain tissue volumes, and dynamic phase contrast was used to measure relative cerebral drainage through the internal jugular veins. RESULTS Findings confirm normal ventricular volume in IIH. However, extraventricular CSF volume is significantly increased in IIH (290 ± 52 versus 220 ± 24 mL, P = .001). This is even more significant after normalization with intracranial volume (P = .0007). GM interstitial fluid volume is also increased in IIH (602 ± 57 versus 557 ± 31 mL, P = .037). Total arterial inflow is normal, but relative venous drainage through the IJV is significantly reduced in IIH (65 ± 7% versus 81 ± 10%, P = .001). CONCLUSIONS Increased intracranial CSF volume that accumulates in the extraventricular subarachnoid space provides direct evidence for impaired CSF homeostasis in obesity-associated IIH. The finding of larger GM interstitial fluid volume is consistent with increased overall resistance to cerebral venous drainage, as evident from reduced relative cerebral drainage through the IJV. The present study confirms that both impaired CSF homeostasis and venous hemodynamics coexist in obesity-associated IIH.
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Affiliation(s)
- N Alperin
- Department of Radiology, Bascom Palmer Eye Institute, University of Miami, Miami, Florida 33136, USA.
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Pringle E, Ranganathan S, Harrison J. 258 Does regaining birth weight Z score by 2 years of age impact on clinical outcome in patients with cystic fibrosis? J Cyst Fibros 2012. [DOI: 10.1016/s1569-1993(12)60427-5] [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: 10/28/2022]
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Doan J, Ranganathan S, Massie J, Harrison J. 124 Eradication of Pseudomonas aeruginosa in children with cystic fibrosis: an Australian experience. J Cyst Fibros 2012. [DOI: 10.1016/s1569-1993(12)60294-x] [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: 10/28/2022]
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38
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Aarthi V, Krishnamoorthy JR, Ranganathan S. PA01.63. Scientific evaluation on Siddha drug G 7 for the management of allergic disorders of the skin. Anc Sci Life 2012. [DOI: 10.4103/0257-7941.112120] [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: 11/04/2022] Open
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Abstract
Dandruff (pityriasis capitis, seborrheic dermatitis confined to the scalp) is a disease that has been around for centuries despite several treatment options. Almost every day new players are entering the market with various antidandruff products, perhaps due to an increase in the incidence of dandruff all over the world. Interestingly, clinicians, especially dermatologists, gave little attention to this problem. At the end, the dandruff sufferer is puzzled by the array of antidandruff products with varied claims entering the market day by day. Why have we not achieved complete treatment success against dandruff? Is dandruff a disease or disorder? It seems that our understanding about dandruff perfectly fits into the famous saying of Albert Einstein, “as the area of light increases, so does the circumferences of darkness.” Have dermatologists left dandruff unattended, only to be exploited by the personal care industry?
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Affiliation(s)
- Frederick Manuel
- Deparment of Dermatology, Skin Clinic, 22, Paper Mills Road, Perambur, Chennai, Tamil Nadu, India
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Ranganathan S, Babu SM, Bangal PR, Madhavendra S, Voleti SR. The Novel Formation of Ordered and Varied Silica-Imidazole Complexes from Silicic Acid. PHOSPHORUS SULFUR 2011. [DOI: 10.1080/10426507.2010.540727] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- S. Ranganathan
- a Discovery laboratory, Organic Division III , Indian Institute of Chemical Technology , Tarnaka, Hyderabad, Andhra Pradesh, India
| | - S. M. Babu
- a Discovery laboratory, Organic Division III , Indian Institute of Chemical Technology , Tarnaka, Hyderabad, Andhra Pradesh, India
| | - P. R. Bangal
- b Electron Microscopy Center , Indian Institute of Chemical Technology , Hyderabad, Andhra Pradesh, India
| | - S. Madhavendra
- b Electron Microscopy Center , Indian Institute of Chemical Technology , Hyderabad, Andhra Pradesh, India
| | - S. R. Voleti
- c Department of Plant Physiology , Directorate of Rice Research , Hyderabad, Andhra Pradesh, India
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Thangaraj N, Subbanna GN, Ranganathan S, Chattopadhyay K. Electron microscopy and diffraction of icosahedral and decagonal quasicrystals in aluminium-manganese alloys. J Microsc 2011. [DOI: 10.1111/j.1365-2818.1987.tb01351.x] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.2] [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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Abstract
The article discuss in detail about the prevalence, pathophysiology, clinical manifestations of dandruff including the etio-pathology. The article also discusses in detail about various treatment methods available for dandruff. The status of dandruff being amphibious – a disease/disorder, and relatively less medical intervention is sought after for the treatment, dandruff is the most commercially exploited skin and scalp disorder/disease by personal care industries.
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Affiliation(s)
- S Ranganathan
- CavinKare Research Centre, No.12 Poonamallee Road, Ekkattuthangal, Chennai - 600 097, India
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Duarte AI, Petit GH, Ranganathan S, Li JY, Oliveira CR, Brundin P, Björkqvist M, Rego AC. IGF-1 protects against diabetic features in an in vivo model of Huntington's disease. Exp Neurol 2011; 231:314-9. [PMID: 21763311 DOI: 10.1016/j.expneurol.2011.06.016] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2011] [Revised: 06/08/2011] [Accepted: 06/26/2011] [Indexed: 01/16/2023]
Abstract
Huntington's disease (HD) is the most prevalent polyglutamine expansion disorder. HD is caused by an expansion of CAG triplet in the huntingtin (HTT) gene, associated with striatal and cortical neuronal loss. Central and peripheral metabolic abnormalities and altered insulin-like growth factor-1 (IGF-1) levels have been described in HD. Thus, we hypothesized that restoration of IGF-1-mediated signaling pathways could rescue R6/2 mice from metabolic stress and behavioral changes induced by polyglutamine expansion. We analyzed the in vivo effect of continuous peripheral IGF-1 administration on diabetic parameters, body weight and motor behavior in the hemizygous R6/2 mouse model of HD. We used 9 week-old and age-matched wild-type mice, subjected to continuously infused recombinant IGF-I or vehicle, for 14 days. IGF-1 treatment prevented the age-related decrease in body weight in R6/2 mice. Although blood glucose levels were higher in R6/2 mice, they did not reach a diabetic state. Even though, IGF-1 ameliorated poor glycemic control in HD mice. This seemed to be associated with a decrease in blood insulin levels in R6/2 mice, which was increased following IGF-1 infusion. Similarly, blood IGF-1 levels decreased during aging in both wild-type and R6/2 mice, being significantly improved upon its continuous infusion. Although no significant differences were found in motor function in R6/2-treated mice, IGF-1 treatment highly improved paw clasping scores. In summary, these results suggest that IGF-1 has a protective role against HD-associated impaired glucose tolerance, by enhancing blood insulin levels.
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Affiliation(s)
- A I Duarte
- Center for Neuroscience and Cell Biology, University of Coimbra, 3004-504 Coimbra, Portugal
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Mascarenhas L, Felgenhauer JL, Bond MC, Femino JD, Laack NN, Ranganathan S, Krailo MD, Marina N. Pilot study of adding vincristine, topotecan, and cyclophosphamide to interval-compressed chemotherapy in newly diagnosed patients with localized Ewing sarcoma family of tumors: A Children's Oncology Group trial. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.9526] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Zhang H, Petit G, Gaughwin PM, Zuo X, Ranganathan S, Smith R, Roybon L, Brundin P, Mobley WC, Li JY. B16 NGF improves the spatial working memory in R6/1 Huntington's disease transgenic mice through the augmentation of cholinergic function and neurogenesis. J Neurol Neurosurg Psychiatry 2010. [DOI: 10.1136/jnnp.2010.222596.16] [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] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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48
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Smith C, Winn A, Ranganathan S, Seddon P. A fat lot of good. An 8 year longitudinal investigation of fat intakes in a paediatric CF population. J Cyst Fibros 2010. [DOI: 10.1016/s1569-1993(10)60361-x] [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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Abstract
Abstract
Objectives: The NK-1 receptor antagonist casopitant is a promising agent for the prevention of chemotherapy-related and postoperative nausea and vomiting. However, findings suggestive of cardiac damage were noted in animal studies of long-term administration of casopitant at supratherapeutic doses. Cardiac evaluation of the concomitant use of casopitant with anthracyclines was therefore of particular interest due to myocyte loss associated with anthracycline use.Methods: Chemotherapy-naïve patients receiving anthracyclines as part of a Phase III moderately emetogenic chemotherapy study regimen were randomized to receive ondansetron and dexamethasone plus one of the following casopitant regimens: single-dose 150-mg oral casopitant (ORAL1); 3-day IV/oral casopitant (90 mg IV/50 mg oral/50 mg oral) (IV/ORAL); 3-day oral casopitant (150/50/50 mg) (ORAL3); or placebo. Serial cardiac troponin (cTnI) levels were measured using the Beckman assay. Although this assay is generally considered reliable within the range of 0.04-0.5 ng/mL, levels below the limit of quantitation (LOQ) (<0.04 ng/mL) were also evaluated in an attempt to identify patterns of change below LOQ. Further cardiac assessment consisting of left ventricular ejection fraction (LVEF) monitoring was conducted in patients with cTnI levels ³0.12 ng/mL.Results: In total, 611 patients were evaluated: 155 ORAL1, 145 IV/ORAL, 159 ORAL3, and 152 placebo; no risk factor variation between groups was observed. Adverse events were balanced across treatment groups. Cardiovascular adverse events occurred in 3% of patients in each of the placebo, ORAL1, and ORAL/IV groups and in 2% of the ORAL3 group. Three patients (0.5%) had cTnI >0.12 ng/mL (1 each IV/ORAL, ORAL3, and placebo); all LVEF determinations were normal at follow-up, with the exception of 1 patient with mitral regurgitation but normal ejection fraction. A total of 59 patients (9.7%) had median cTnI 0.04-0.12 ng/mL. Of the remaining patients with cTnI below LOQ, median baseline levels across groups were similar (ORAL1 and IV/ORAL 0.008 ng/mL; ORAL3 0.01 ng/mL; placebo 0.009 ng/mL). After 4 cycles of anthracycline, median cTnI increased to 0.02 ng/mL in all groups, with no difference noted between casopitant and placebo groups.Conclusions: Thorough monitoring of cardiac-related toxicities including cardiac (S)AEs, ECG, and ejection fraction data showed no evidence of increased risk of cardiac damage in the casopitant groups compared with control. Subclinical elevations in cTnI occurred in patients receiving anthracyclines but were not considered to be related to or accentuated by simultaneous administration of casopitant. cTnI elevations were similar across treatment groups and were well below rates reported in the literature for a patient population receiving higher doses of anthracycline. Use of appropriate cardiac biomarkers in ranges below those commonly used to detect infarction may be valuable to detect or exclude subclinical toxicity of potentially cardiotoxic agents used in combination. Additional analysis is ongoing.
Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 1118.
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Affiliation(s)
- M. Ewer
- 1University of Texas M. D. Anderson Cancer Center,, TX,
| | - S. Grunberg
- 2Vermont Cancer Center, University of Vermont, VT,
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Cantacessi C, Zou FC, Hall RS, Zhong W, Jex AR, Campbell BE, Ranganathan S, Sternberg PW, Zhu XQ, Gasser RB. Bioinformatic analysis of abundant, gender-enriched transcripts of adult Ascaris suum (Nematoda) using a semi-automated workflow platform. Mol Cell Probes 2009; 23:205-17. [PMID: 19361552 DOI: 10.1016/j.mcp.2009.03.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2009] [Revised: 03/12/2009] [Accepted: 03/16/2009] [Indexed: 12/17/2022]
Abstract
Expressed sequence tag (EST) data representing transcripts with a high level of differential hybridization in suppressive-subtractive hybridization (SSH)-based microarray analysis between adult female and male Ascaris suum were subjected to detailed bioinformatic analysis. A total of 361 ESTs clustered into 209 sequences, of which 52 and 157 represented transcripts that were enriched in female and male A. suum, respectively. Thirty (57.7%) of the 'female' subset of 52 sequences had orthologues/homologues in other parasitic nematodes and/or Caenorhabditis elegans, 13 (25%) exclusively in other parasitic nematodes and nine (17.3%) had no match in any other organism for which sequence data are currently available; the C. elegans orthologues encoded molecules involved in reproduction as well as embryonic and gamete development, such as vitellogenins and chitin-binding proteins. Of the 'male' subset of 157 sequences, 73 (46.5%) had orthologues/homologues in other parasitic nematodes and/or C. elegans, 57 (37.5%) in other parasitic nematodes only, and 22 (14.5%) had no significant similarity match in any other organism; the C. elegans orthologues encoded predominantly major sperm proteins (MSPs), kinases and phosphatases, actins, myosins and an Ancylostoma secreted protein-like molecule. The findings of the present study should support further genomic investigations of A. suum.
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Affiliation(s)
- C Cantacessi
- Department of Veterinary Science, The University of Melbourne, Victoria, Australia
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