1
|
Sharma R, Gupta S, Rathore AS. Novel purification platform based on multimodal preparative scale separation of mAb fragments and aggregates. J Chromatogr A 2024; 1721:464806. [PMID: 38518514 DOI: 10.1016/j.chroma.2024.464806] [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: 12/08/2023] [Revised: 02/21/2024] [Accepted: 03/06/2024] [Indexed: 03/24/2024]
Abstract
Monoclonal antibodies (mAbs) continue to dominate the biopharmaceutical industry. Certain mAbs are prone to fragmentation and clipping and in these cases, adequate removal of these species is critical during manufacturing. Fragments can be generated during fermentation, purification, storage, formulation, and administration. Their addition to the acidic charge-variant of the purified mAb has been reported to decrease stability and potency of the final product. However, contrary to mAb aggregation, manufacturers have not given much attention to removal of fragments and clipped species and as a result most conventional mAb platforms offer at best limited capabilities for their removal. In this study, we propose a novel purification platform that uses multimodal chromatography and achieves complete removal of a range of mAb fragments and clipped products (25-120 kDa). The utility of the platform has been successfully demonstrated for 2 IgG1s and 2 IgG4s. Further, adequate removal of the various host cell impurities such as host cell proteins (<10 ppm) and host cell DNA (<5 ppb) has been achieved. Finally, the platform was able to deliver adequate removal of high molecular weight impurities (<1 %) and a 30 % clearance of the acidic charge variant. The proposed single step has been shown to deliver what the polishing chromatography and intermediate purification chromatography steps deliver in a traditional mAb platform.
Collapse
Affiliation(s)
- Rashmi Sharma
- School of Interdisciplinary Research, Indian Institute of Technology Delhi, India
| | - Surbhi Gupta
- Department of Chemical Engineering, Indian Institute of Technology Delhi, India
| | - Anurag S Rathore
- School of Interdisciplinary Research, Indian Institute of Technology Delhi, India; Department of Chemical Engineering, Indian Institute of Technology Delhi, India.
| |
Collapse
|
2
|
Bimbard C, Takács F, Catarino JA, Fabre JMJ, Gupta S, Lenzi SC, Melin MD, O'Neill N, Orsolic I, Robacha M, Street JS, Teixeira J, Townsend S, van Beest EH, Zhang AM, Churchland AK, Duan CA, Harris KD, Kullmann DM, Lignani G, Mainen ZF, Margrie TW, Rochefort NL, Wikenheiser AM, Carandini M, Coen P. An adaptable, reusable, and light implant for chronic Neuropixels probes. bioRxiv 2024:2023.08.03.551752. [PMID: 37577563 PMCID: PMC10418246 DOI: 10.1101/2023.08.03.551752] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/15/2023]
Abstract
Electrophysiology has proven invaluable to record neural activity, and the development of Neuropixels probes dramatically increased the number of recorded neurons. These probes are often implanted acutely, but acute recordings cannot be performed in freely moving animals and the recorded neurons cannot be tracked across days. To study key behaviors such as navigation, learning, and memory formation, the probes must be implanted chronically. An ideal chronic implant should (1) allow stable recordings of neurons for weeks; (2) allow reuse of the probes after explantation; (3) be light enough for use in mice. Here, we present the "Apollo Implant", an open-source and editable device that meets these criteria and accommodates up to two Neuropixels 1.0 or 2.0 probes. The implant comprises a "payload" module which is attached to the probe and is recoverable, and a "docking" module which is cemented to the skull. The design is adjustable, making it easy to change the distance between probes, the angle of insertion, and the depth of insertion. We tested the implant across eight labs in head-fixed mice, freely moving mice, and freely moving rats. The number of neurons recorded across days was stable, even after repeated implantations of the same probe. The Apollo implant provides an inexpensive, lightweight, and flexible solution for reusable chronic Neuropixels recordings.
Collapse
|
3
|
Gupta S, Schöneich C, Rathore AS. Assessment of change in the basic variants composition of trastuzumab during dilution in saline for administration. Eur J Pharm Biopharm 2024:114295. [PMID: 38636881 DOI: 10.1016/j.ejpb.2024.114295] [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: 12/26/2023] [Revised: 04/01/2024] [Accepted: 04/15/2024] [Indexed: 04/20/2024]
Abstract
Postproduction handling of drug products during preparation or clinical use may affect the structure and efficacy of the drug and perhaps remain unnoticed. Since chemical modifications can impact the product's structure, stability, and biological activity, this study investigates the impact of elevated temperature and subtle shift in pH on the drug product post-dilution in saline. The mAb sample diluted in saline for administration was stressed at elevated temperature and slightly acidic pH condition. Extended stability studies were performed and monitored for size and charge heterogeneity. Size heterogeneity shows no significant changes, whereas charge heterogeneity shows an increase in basic variants and a reduction in main species. Further, basic variants were isolated and characterized to identify the type and site of chemical modification. Intact mass analysis and peptide mapping identify that the basic variants were attributed majorly to the isomerization of HC Asp102 into iso-Asp or its succinimide intermediate. Four basic variants were found to exhibit similar structural properties as the main and control samples. However, basic variants showed reduced binding affinity to HER2 receptor, while there was no significant difference in FcRn binding. The results indicate that modification in the HC Asp102, which is present in the CDR, affects antigen binding and thus can influence the potency of the drug product. Hence, with the conventional stability studies required to license the drug product, including in-use or extended stability studies to mimic the postproduction handling would be desirable.
Collapse
Affiliation(s)
- Surbhi Gupta
- Department of Chemical Engineering, Indian Institute of Technology Delhi,New Delhi 110016, India
| | | | - Anurag S Rathore
- Department of Chemical Engineering, Indian Institute of Technology Delhi,New Delhi 110016, India.
| |
Collapse
|
4
|
Tripathi J, Gupta S, Mishra BB. Synthesis of guar gum maleate under dry conditions: Reaction kinetics and characterization. Int J Biol Macromol 2024; 267:131591. [PMID: 38621574 DOI: 10.1016/j.ijbiomac.2024.131591] [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: 03/13/2024] [Revised: 04/04/2024] [Accepted: 04/12/2024] [Indexed: 04/17/2024]
Abstract
In the present study, a novel environment friendly dry method for preparation of guar gum maleate (GGM) with varying degrees of substitution (DS; 0.02-1.04) was optimized. GGM with a maximum DS of 1.04 was successfully synthesized using guar gum (GG) and maleic anhydride (MA) in proportion of 1: 1 at 80 °C with 4 h of reaction time. The activation energy for the reaction was determined to be 36.91 ± 3.61 kJ mol-1 with pre-exponential factor of 1392 min-1. Esterification of GG was confirmed by FT-IR and 13C NMR. Analysis using size exclusion chromatography (SEC) indicated a decrease in weight average molecular weight (Mw) of the polymer with an increase in polydispersity index (PDI) due to esterification. In comparison with GG, GGM displayed increased hydrophobicity and reduced thermal stability, as analysed by differential scanning calorimetry (DSC). Rheological studies of GGM revealed that initial apparent viscosity decreased with increasing DS. For the first time, the study offered valuable insights on GGM synthesis under dry solvent-less reaction conditions enabling simpler and scalable synthesis process.
Collapse
Affiliation(s)
- J Tripathi
- Food Technology Division, Bhabha Atomic Research Centre, Trombay, Mumbai 400085, India; Homi Bhabha National Institute, Trombay, Mumbai 400094, India.
| | - S Gupta
- Food Technology Division, Bhabha Atomic Research Centre, Trombay, Mumbai 400085, India; Homi Bhabha National Institute, Trombay, Mumbai 400094, India.
| | - B B Mishra
- Food Technology Division, Bhabha Atomic Research Centre, Trombay, Mumbai 400085, India; Homi Bhabha National Institute, Trombay, Mumbai 400094, India.
| |
Collapse
|
5
|
Gupta S, Kashyap M, Bansal Y, Bansal G. In silico insights into design of novel VEGFR-2 inhibitors: SMILES-based QSAR modelling, and docking studies on substituted benzo-fused heteronuclear derivatives. SAR QSAR Environ Res 2024:1-20. [PMID: 38591137 DOI: 10.1080/1062936x.2024.2332203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 03/14/2024] [Indexed: 04/10/2024]
Abstract
Eight QSAR models (M1-M8) were developed from a dataset of 118 benzo-fused heteronuclear derivatives targeting VEGFR-2 by Monte Carlo optimization method of CORALSEA 2023 software. Models were generated with hybrid optimal descriptors using both SMILES and Graphs with zero- and first-order Morgan extended connectivity index from a training set of 103 derivatives. All statistical parameters for model validation were within the prescribed limits, establishing the models to be robust and of excellent quality. Among all models, split-2 of M5 was the best-fit as reflected by r v a lidation 2 , Q v a lidation 2 and MAE . Mechanistic interpretation of this model assisted the identification of structural descriptors as promoters and hinderers for VEGFR-2 inhibition. These descriptors were utilized to design novel VEGFR-2 inhibitors (YS01-YS07) by bringing modifications in compound MS90 in the dataset. Docking of all designed compounds, MS90 and sorafenib with VEGFR-2 binding site revealed favourable binding interactions. Docking score of YS07 was higher than that of MS90 and sorafenib. Molecular dynamics simulation study revealed sustained interactions of YS07 with key amino acids of VEGFR-2 at a run time of 100 ns. This study concludes the development of a best fit QSAR model which can assist the design of new anticancer agents targeting VEGFR-2.
Collapse
Affiliation(s)
- S Gupta
- Department of Pharmaceutical Sciences and Drug Research, Punjabi University, Patiala, India
| | - M Kashyap
- Department of Pharmaceutical Sciences and Drug Research, Punjabi University, Patiala, India
| | - Y Bansal
- Department of Pharmaceutical Sciences and Drug Research, Punjabi University, Patiala, India
| | - G Bansal
- Department of Pharmaceutical Sciences and Drug Research, Punjabi University, Patiala, India
| |
Collapse
|
6
|
Bajjad AA, Ahemad MS, Gupta S, Mehjabeen F, Guin S, Mehra S, Rajesh R. Assessment of clinical validity of KPG index for 3D classification of impacted maxillary canines by cone beam computed tomography in patients. Orthod Craniofac Res 2024. [PMID: 38577813 DOI: 10.1111/ocr.12788] [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] [Accepted: 03/27/2024] [Indexed: 04/06/2024]
Abstract
OBJECTIVES The primary objective of this study was to assess the validity of the KPG index in predicting the difficulty of treatment involving impacted maxillary canines. The secondary objective was to assess the reliability and reproducibility of the index. MATERIALS AND METHODS A retrospective study was conducted on 96 maxillary impacted canines (MIC) in 60 patients aged 13-35 years. Cone-beam computed tomography (CBCT) scans were used to predict the treatment difficulty of MIC using the KPG index. Patient case files were assessed for the actual difficulty encountered in treating MIC. Cohen's kappa correlation coefficient was used for intra-observer reliability and Kendell's W test was used for inter-observer reliability. Spearman's correlation coefficient test was used to assess the correlation between predicted and actual treatment. RESULTS Easy and moderately difficult cases exhibited a moderate correlation between actual and predicted treatment outcomes, whereas difficult cases displayed a weak correlation. The perfect correlation was observed exclusively in extremely difficult cases. The intra-observer reliability for assessing CBCT scans using the KPG guide was found to be 0.88, and the inter-rater reliability was 0.94. CONCLUSION The KPG index displayed 87%, 71%, 50% and 100% validity in easy, moderately difficult, difficult, and extremely difficult cases, respectively. This index showed good reliability and reproducibility. However, it is imperative to consider a multitude of other factors, including the patient's age, presence of associated root resorption in adjacent teeth, and duration of treatment, to make an informed decision between surgical exposure and extraction.
Collapse
Affiliation(s)
- A A Bajjad
- Department of Orthodontics, Kothiwal Dental College and Research Centre, Moradabad, Uttar-Pradesh, India
| | - M S Ahemad
- Department of Orthodontics, Saraswati Dhanwantari Dental College and PG Institute, Parbhani, Maharashtra, India
| | - S Gupta
- Department of Orthodontics, Kothiwal Dental College and Research Centre, Moradabad, Uttar-Pradesh, India
| | - F Mehjabeen
- Department of Orthodontics, Kothiwal Dental College and Research Centre, Moradabad, Uttar-Pradesh, India
| | - S Guin
- Department of Orthodontics, Kothiwal Dental College and Research Centre, Moradabad, Uttar-Pradesh, India
| | - S Mehra
- Department of Orthodontics, Kothiwal Dental College and Research Centre, Moradabad, Uttar-Pradesh, India
| | - R Rajesh
- Department of Orthodontics, Kothiwal Dental College and Research Centre, Moradabad, Uttar-Pradesh, India
| |
Collapse
|
7
|
Loriot Y, Petrylak DP, Rezazadeh Kalebasty A, Fléchon A, Jain RK, Gupta S, Bupathi M, Beuzeboc P, Palmbos P, Balar AV, Kyriakopoulos CE, Pouessel D, Sternberg CN, Tonelli J, Sierecki M, Zhou H, Grivas P, Barthélémy P, Tagawa ST. TROPHY-U-01, a phase II open-label study of sacituzumab govitecan in patients with metastatic urothelial carcinoma progressing after platinum-based chemotherapy and checkpoint inhibitors: updated safety and efficacy outcomes. Ann Oncol 2024; 35:392-401. [PMID: 38244927 DOI: 10.1016/j.annonc.2024.01.002] [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: 09/28/2023] [Revised: 01/02/2024] [Accepted: 01/04/2024] [Indexed: 01/22/2024] Open
Abstract
BACKGROUND Sacituzumab govitecan (SG) is a Trop-2-directed antibody-drug conjugate containing cytotoxic SN-38, the active metabolite of irinotecan. SG received accelerated US Food and Drug Administration approval for locally advanced (LA) or metastatic urothelial carcinoma (mUC) previously treated with platinum-based chemotherapy and a checkpoint inhibitor, based on cohort 1 of the TROPHY-U-01 study. Mutations in the uridine diphosphate glucuronosyltransferase 1A1 (UGT1A1) gene are associated with increased adverse events (AEs) with irinotecan-based therapies. Whether UGT1A1 status could impact SG toxicity and efficacy remains unclear. PATIENTS AND METHODS TROPHY-U-01 (NCT03547973) is a multicohort, open-label, phase II registrational study. Cohort 1 includes patients with LA or mUC who progressed after platinum- and checkpoint inhibitor-based therapies. SG was administered at 10 mg/kg intravenously on days 1 and 8 of 21-day cycles. The primary endpoint was objective response rate (ORR) per central review; secondary endpoints included progression-free survival, overall survival, and safety. Post hoc safety analyses were exploratory with descriptive statistics. Updated analyses include longer follow-up. RESULTS Cohort 1 included 113 patients. At a median follow-up of 10.5 months, ORR was 28% (95% CI 20.2% to 37.6%). Median progression-free survival and overall survival were 5.4 months (95% CI 3.5-6.9 months) and 10.9 months (95% CI 8.9-13.8 months), respectively. Occurrence of grade ≥3 treatment-related AEs and treatment-related discontinuation were consistent with prior reports. UGT1A1 status was wildtype (∗1|∗1) in 40%, heterozygous (∗1|∗28) in 42%, homozygous (∗28|∗28) in 12%, and missing in 6% of patients. In patients with ∗1|∗1, ∗1|∗28, and ∗28|∗28 genotypes, any grade treatment-related AEs occurred in 93%, 94%, and 100% of patients, respectively, and were managed similarly regardless of UGT1A1 status. CONCLUSIONS With longer follow-up, the ORR remains high in patients with heavily pretreated LA or mUC. Safety data were consistent with the known SG toxicity profile. AE incidence varied across UGT1A1 subgroups; however, discontinuation rates remained relatively low for all groups.
Collapse
Affiliation(s)
- Y Loriot
- Medical Oncology Department, Institut de Cancérologie Gustave Roussy, Université Paris-Saclay, Villejuif, France.
| | - D P Petrylak
- Genitourinary Oncology, Yale School of Medicine, New Haven
| | | | - A Fléchon
- Department of Medical Oncology, Centre Léon Bérard, Lyon, France
| | - R K Jain
- Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa
| | - S Gupta
- Division of Oncology, Department of Medicine, Huntsman Cancer Institute, Salt Lake City
| | - M Bupathi
- Medical Oncology, Rocky Mountain Cancer Centers, Littleton, USA
| | - P Beuzeboc
- Oncology and Supportive Care Department, Hôpital Foch, Suresnes, France
| | - P Palmbos
- Urologic Oncology Clinic, Rogel Cancer Center, University of Michigan, Ann Arbor
| | - A V Balar
- Genitourinary Oncology Department, New York University Langone Medical Center, New York
| | - C E Kyriakopoulos
- Division of Hematology, Oncology and Palliative Care, University of Wisconsin-Madison, Madison, USA
| | - D Pouessel
- Department of Medical Oncology and Clinical Research Unit, Institut Claudius Regaud/Institut Universitaire du Cancer de Toulouse (IUCT-Oncopôle), Toulouse, France
| | - C N Sternberg
- Department of Genitourinary Oncology, Weill Cornell Medical College of Cornell University, New York
| | - J Tonelli
- Clinical Development - Oncology, Gilead Sciences, Inc., Parsippany
| | - M Sierecki
- Clinical Development - Oncology, Gilead Sciences, Inc., Parsippany
| | - H Zhou
- Department of Biometrics, Gilead Sciences, Inc., Foster City
| | - P Grivas
- Department of Medicine, University of Washington; Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, USA
| | - P Barthélémy
- Medical Oncology Department, Institut de Cancérologie Strasbourg Europe, Strasbourg, France
| | - S T Tagawa
- Department of Genitourinary Oncology, Weill Cornell Medical College of Cornell University, New York
| |
Collapse
|
8
|
Chetwood JD, Gupta S, Subramaniam K, De Cruz P, Moore G, An YK, Connor SJ, Kermeen M, Paramsothy S, Leong RW. Ustekinumab as induction and maintenance therapy for ulcerative colitis - national extended follow-up and a review of the literature. Expert Opin Drug Saf 2024; 23:449-456. [PMID: 37909484 DOI: 10.1080/14740338.2023.2278686] [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: 05/03/2023] [Accepted: 09/15/2023] [Indexed: 11/03/2023]
Abstract
INTRODUCTION Ustekinumab use in ulcerative colitis had shown low adverse event and high persistence rates to 3 years via the UNIFI long-term extension study. Outcomes beyond 3 years have not been previously described. We describe the safety signals of the entire UNIFI Australian population beyond 3 years. METHODS This retrospective multicenter observational cohort study recruited from all Australian UNIFI centers. The primary outcome was safety via adverse events. Secondary outcomes included the clinical relapse rate on ustekinumab, and the need to switch from ustekinumab to an alternate agent. RESULTS There were 14 patients [11 male, mean age 47 (±14) years], with a median diagnosis of 10.8 (±4.5) years prior to UNIFI enrollment. Median follow-up was 298 weeks (5.7 years) (Interquartile range (IQR): 220-311 weeks). Within the long-term extension, there were three serious adverse events and one minor event. 42.9% (6/14) patients had clinical relapses, of which clinical remission was recaptured in 83.3% (5/6). 85.7% (12/14) persisted on ustekinumab in the long-term, with 7.1% (1/14) electively ceasing ustekinumab and 7.1% (1/14) changed from ustekinumab due to clinical relapse. CONCLUSION For moderate-to-severe UC in Australia, ustekinumab maintained efficacy beyond 3 years with a high persistence rate and no new safety signals. TRIAL REGISTRATION The trial is registered at ANZCTR (identifier: ACTRN12622001332718).
Collapse
Affiliation(s)
- J D Chetwood
- Department of Gastroenterology and Liver Services, Concord Repatriation General Hospital, Sydney, Australia
- Concord Clinical School, University of Sydney, Sydney, Australia
| | - S Gupta
- Gastroenterology and Hepatology Unit, The Canberra Hospital, Canberra, Australian Capital Territory, Australia
| | - K Subramaniam
- Gastroenterology and Hepatology Unit, The Canberra Hospital, Canberra, Australian Capital Territory, Australia
- ANU Medical School, Australian National University, Canberra, Australian Capital Territory, Australia
| | - P De Cruz
- Department of Gastroenterology, Austin Hospital, Melbourne, VIC, Australia
| | - G Moore
- Department of Gastroenterology, Monash Health, Melbourne, VIC, Australia
- School of Clinical Sciences, Monash University, Clayton, VIC, Australia
| | - Y K An
- Department of Gastroenterology, Mater Hospital, Brisbane, QLD, Australia
| | - S J Connor
- Department of Gastroenterology and Hepatology, Liverpool Hospital, Sydney, NSW, Australia
| | - M Kermeen
- Department of Gastroenterology and Liver Services, Concord Repatriation General Hospital, Sydney, Australia
| | - S Paramsothy
- Department of Gastroenterology and Liver Services, Concord Repatriation General Hospital, Sydney, Australia
- Concord Clinical School, University of Sydney, Sydney, Australia
- Department of Gastroenterology, Macquarie University Hospital, Sydney, NSW, Australia
- Faculty of Medicine and Health Sciences, Macquarie University, Sydney, NSW, Australia
| | - R W Leong
- Department of Gastroenterology and Liver Services, Concord Repatriation General Hospital, Sydney, Australia
- Concord Clinical School, University of Sydney, Sydney, Australia
- Department of Gastroenterology, Macquarie University Hospital, Sydney, NSW, Australia
- Faculty of Medicine and Health Sciences, Macquarie University, Sydney, NSW, Australia
| |
Collapse
|
9
|
DelRocco NJ, Loh ML, Borowitz MJ, Gupta S, Rabin KR, Zweidler-McKay P, Maloney KW, Mattano LA, Larsen E, Angiolillo A, Schore RJ, Burke MJ, Salzer WL, Wood BL, Carroll AJ, Heerema NA, Reshmi SC, Gastier-Foster JM, Harvey R, Chen IM, Roberts KG, Mullighan CG, Willman C, Winick N, Carroll WL, Rau RE, Teachey DT, Hunger SP, Raetz EA, Devidas M, Kairalla JA. Enhanced Risk Stratification for Children and Young Adults with B-Cell Acute Lymphoblastic Leukemia: A Children's Oncology Group Report. Leukemia 2024; 38:720-728. [PMID: 38360863 PMCID: PMC10997503 DOI: 10.1038/s41375-024-02166-1] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 01/15/2024] [Accepted: 01/23/2024] [Indexed: 02/17/2024]
Abstract
Current strategies to treat pediatric acute lymphoblastic leukemia rely on risk stratification algorithms using categorical data. We investigated whether using continuous variables assigned different weights would improve risk stratification. We developed and validated a multivariable Cox model for relapse-free survival (RFS) using information from 21199 patients. We constructed risk groups by identifying cutoffs of the COG Prognostic Index (PICOG) that maximized discrimination of the predictive model. Patients with higher PICOG have higher predicted relapse risk. The PICOG reliably discriminates patients with low vs. high relapse risk. For those with moderate relapse risk using current COG risk classification, the PICOG identifies subgroups with varying 5-year RFS. Among current COG standard-risk average patients, PICOG identifies low and intermediate risk groups with 96% and 90% RFS, respectively. Similarly, amongst current COG high-risk patients, PICOG identifies four groups ranging from 96% to 66% RFS, providing additional discrimination for future treatment stratification. When coupled with traditional algorithms, the novel PICOG can more accurately risk stratify patients, identifying groups with better outcomes who may benefit from less intensive therapy, and those who have high relapse risk needing innovative approaches for cure.
Collapse
Affiliation(s)
- N J DelRocco
- Department of Biostatistics, Colleges of Medicine, Public Health and Health Professions, University of Florida, Gainesville, FL, USA.
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, CA, USA.
| | - M L Loh
- Department of Pediatrics and the Ben Towne Center for Childhood Cancer Research, Seattle Children's Hospital, University of Washington, Seattle, WA, USA
| | - M J Borowitz
- Department of Pathology, Johns Hopkins University, Baltimore, MD, USA
| | - S Gupta
- Division of Haematology/Oncology, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - K R Rabin
- Division of Pediatric Hematology/Oncology, Texas Children's Cancer Center, Baylor College of Medicine, Houston, TX, USA
| | | | - K W Maloney
- Department of Pediatrics, University of Colorado and Children's Hospital Colorado, Aurora, CO, USA
| | | | - E Larsen
- Department of Pediatrics, Maine Children's Cancer Program, Scarborough, ME, USA
| | | | - R J Schore
- Division of Pediatric Oncology, Children's National Hospital, Washington, DC and the George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - M J Burke
- Division of Pediatric Hematology-Oncology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - W L Salzer
- Uniformed Services University, F. Edward Hebert School of Medicine, Bethesda, MD, USA
| | - B L Wood
- Children's Hospital Los Angeles, Pathology and Laboratory Medicine, Los Angeles, CA, USA
| | - A J Carroll
- Department of Genetics, University of Alabama at Birmingham, Birmingham, AL, USA
| | - N A Heerema
- Department of Pathology, The Ohio State University Wexner School of Medicine, Columbus, OH, USA
| | - S C Reshmi
- Department of Pathology and Laboratory Medicine, Nationwide Children's Hospital and Departments of Pathology and Pediatrics, Ohio State University College of Medicine, Columbus, OH, USA
| | - J M Gastier-Foster
- Department of Pathology, The Ohio State University Wexner School of Medicine, Columbus, OH, USA
- Department of Pediatrics, Texas Children's Cancer Center, Baylor College of Medicine, Houston, TX, USA
| | - R Harvey
- University of New Mexico Cancer Center, Albuquerque, NM, USA
| | - I M Chen
- University of New Mexico Cancer Center, Albuquerque, NM, USA
| | - K G Roberts
- Department of Pathology, St Jude Children's Research Hospital, Memphis, TN, USA
| | - C G Mullighan
- Department of Pathology, St Jude Children's Research Hospital, Memphis, TN, USA
| | - C Willman
- Mayo Clinic, Cancer Center/Laboratory Medicine and Pathology, Rochester, NY, USA
| | - N Winick
- UTSouthwestern, Simmons Cancer Center, Dallas, TX, USA
| | - W L Carroll
- Perlmutter Cancer Center and Department of Pediatrics, NYU Langone Health, New York, NY, USA
| | - R E Rau
- Department of Pediatrics and the Ben Towne Center for Childhood Cancer Research, Seattle Children's Hospital, University of Washington, Seattle, WA, USA
| | - D T Teachey
- Department of Pediatrics and The Center for Childhood Cancer Research, Children's Hospital of Philadelphia and the Perelman School of Medicine at The University of Pennsylvania, Philadelphia, PA, USA
| | - S P Hunger
- Department of Pediatrics and The Center for Childhood Cancer Research, Children's Hospital of Philadelphia and the Perelman School of Medicine at The University of Pennsylvania, Philadelphia, PA, USA
| | - E A Raetz
- Perlmutter Cancer Center and Department of Pediatrics, NYU Langone Health, New York, NY, USA
| | - M Devidas
- Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - J A Kairalla
- Department of Biostatistics, Colleges of Medicine, Public Health and Health Professions, University of Florida, Gainesville, FL, USA
| |
Collapse
|
10
|
Gupta S, Viotti A, Eichwald T, Roger A, Kaufmann E, Othman R, Ghasemlou N, Rafei M, Foster SL, Talbot S. Navigating the blurred path of mixed neuroimmune signaling. J Allergy Clin Immunol 2024; 153:924-938. [PMID: 38373475 DOI: 10.1016/j.jaci.2024.02.006] [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: 10/11/2023] [Revised: 02/13/2024] [Accepted: 02/14/2024] [Indexed: 02/21/2024]
Abstract
Evolution has created complex mechanisms to sense environmental danger and protect tissues, with the nervous and immune systems playing pivotal roles. These systems work together, coordinating local and systemic reflexes to restore homeostasis in response to tissue injury and infection. By sharing receptors and ligands, they influence the pathogenesis of various diseases. Recently, a less-explored aspect of neuroimmune communication has emerged: the release of neuropeptides from immune cells and cytokines/chemokines from sensory neurons. This article reviews evidence of this unique neuroimmune interplay and its impact on the development of allergy, inflammation, itch, and pain. We highlight the effects of this neuroimmune signaling on vital processes such as host defense, tissue repair, and inflammation resolution, providing avenues for exploration of the underlying mechanisms and therapeutic potential of this signaling.
Collapse
Affiliation(s)
- Surbhi Gupta
- Centre for Neuroscience Studies, Queen's University, Kingston, Ontario, Canada
| | - Alice Viotti
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, Mass
| | - Tuany Eichwald
- Department of Pharmacology and Physiology, Karolinska Institutet, Solna, Sweden; Department of Biomedical and Molecular Sciences, Queen's University, Kingston, Ontario, Canada
| | - Anais Roger
- Department of Biomedical and Molecular Sciences, Queen's University, Kingston, Ontario, Canada; Aix-Marseille University, CNRS, INSERM, Centre d'Immunologie de Marseille-Luminy, Marseille, France
| | - Eva Kaufmann
- Department of Biomedical and Molecular Sciences, Queen's University, Kingston, Ontario, Canada
| | - Rahmeh Othman
- Department of Biomedical and Molecular Sciences, Queen's University, Kingston, Ontario, Canada
| | - Nader Ghasemlou
- Department of Biomedical and Molecular Sciences, Queen's University, Kingston, Ontario, Canada
| | - Moutih Rafei
- Department of Pharmacology and Physiology, University of Montréal, Montréal, Québec, Canada
| | - Simmie L Foster
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, Mass
| | - Sebastien Talbot
- Department of Pharmacology and Physiology, Karolinska Institutet, Solna, Sweden; Department of Biomedical and Molecular Sciences, Queen's University, Kingston, Ontario, Canada.
| |
Collapse
|
11
|
Gupta S, Sangwan N, Sangwan AK, Gupta S, Kumar A, Maan S, Kumar A, Kumar S. Acaricide resistance status of deltamethrin and coumaphos in Hyalomma anatolicum ticks collected from different districts of Haryana. Exp Appl Acarol 2024:10.1007/s10493-023-00894-0. [PMID: 38448756 DOI: 10.1007/s10493-023-00894-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 12/30/2023] [Indexed: 03/08/2024]
Abstract
To study the acaricide resistance status and possible mechanisms of action in conferring resistance to commonly used acaricides (deltamethrin and coumaphos), Hyalomma anatolicum ticks were collected from 6 dairy farms of Hisar and Charkhi Dadri districts of Haryana. By using standard larval packet test, H. anatolicum tick larvae of Charkhi Dadri isolates were found to be susceptible (100% mortality) to both the acaricides. Level-I resistance against coumaphos was recorded from four isolates, whereas, level-II was observed in only one isolate, collected from Hisar. One isolates (Kaimri) from Hisar also showed level-I resistance against deltamethrin. Biochemically, the ticks having higher values of resistance factor (RF) against coumaphos were found to possess increased enzymatic activity of α-esterase, β-esterase, glutathione-S-transferase (GST) and mono-oxygenase enzymes, whereas, the monoamine oxidase did not show any constant trend. However, the RF showed a statistical significant correlation with GST only. Native PAGE analysis of H. anatolicum ticks revealed the presence of nine types of esterases (EST-1 h to EST-9 h) by using napthyl acetate as substrate. In the inhibitory assay, esterases were found to be inhibited by PMSF, indicating the presence of serine residue at catalytic triad. The partial cds of carboxylesterase and domain II of sodium channel genes were sequenced to determine any proposed mutations in resistant isolates of H. anatolicum ticks, however, no mutations were observed in either gene, indicating that increased expression of detoxification enzymes as a possible mechanism for resistance development, in the current study.
Collapse
Affiliation(s)
- Surbhi Gupta
- Department of Veterinary Physiology and Biochemistry, Lala Lajpat Rai University of Veterinary and Animal Sciences, Hisar, Haryana, 125004, India.
| | - Nirmal Sangwan
- Department of Veterinary Physiology and Biochemistry, Lala Lajpat Rai University of Veterinary and Animal Sciences, Hisar, Haryana, 125004, India
| | - Arun Kumar Sangwan
- Department of Veterinary Parasitology, Lala Lajpat Rai University of Veterinary and Animal Sciences, Hisar, Haryana, 125004, India
- Department of Veterinary Parasitology, College of Veterinary Sciences and Animal Husbandry, Central Agricultural University (Imphal), Jalukie, Nagaland, India
| | - Snehil Gupta
- Department of Veterinary Parasitology, Lala Lajpat Rai University of Veterinary and Animal Sciences, Hisar, Haryana, 125004, India
| | - Ankit Kumar
- Haryana Pashu Vigyan Kendra, Lala Lajpat Rai University of Veterinary and Animal Sciences, Uchani, Karnal, Haryana, 132001, India
| | - Sushila Maan
- Department of Animal Biotechnology, Lala Lajpat Rai University of Veterinary and Animal Sciences, Hisar, Haryana, 125004, India
| | - Aman Kumar
- Department of Animal Biotechnology, Lala Lajpat Rai University of Veterinary and Animal Sciences, Hisar, Haryana, 125004, India
| | - Sachin Kumar
- Entomology Laboratory, ICAR-Indian Veterinary Research Institute, Bareilly, Uttar Pradesh, 243122, India
| |
Collapse
|
12
|
Bagaria DK, Gupta S, Pandey S, Choudhary N, Priyadarshini P, Kumar A, Alam J, Mishra B, Sagar S, Kumar S, Gupta A. Abdominal wall reconstruction (AWR) for post-trauma laparotomy ventral hernia and follow-up assessment of functional quality of life (QOL): experience of a level-1 trauma centre in India. Hernia 2024:10.1007/s10029-024-02978-1. [PMID: 38388814 DOI: 10.1007/s10029-024-02978-1] [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: 10/20/2023] [Accepted: 01/25/2024] [Indexed: 02/24/2024]
Abstract
PURPOSE The aim of this study was to examine the postoperative outcomes and follow-up QOL of patients after AWR at a level-1 trauma centre in India. METHODS The study cohort included AWR patients treated between January 2011 and July 2022. The Activities Assessment Scale (AAS) was used to measure QOL, and the Ventral Hernia Recurrence Inventory (VHRI) was used to determine the occurrence of recurrence. In patients suspected of having recurrence, thorough clinical examination and relevant imaging were performed to confirm or rule out recurrence. RESULTS Out of 89 patients, 35 patients whose complete perioperative and follow-up data were available were enrolled. The mean age of the patients was 28 (SD, 9) years. The mean defect size was 14. 9 (SD, 7) cm. The mean time from laparotomy to AWR surgery was 21 months. During the postoperative course, 37% of patients developed complications, such as SSI and seroma. The mean follow-up time was 53 (SD, 43) months. Upon comparing procedures involving the mesh placed in the sublay position with procedures involving the mesh placed in other positions, no statistically significant difference in the recurrence rate (one in each group, p = 0.99), surgical complication rate (33% v/s 66%, p = 0.6), or mean AAS QOL score (94.7 v/s 98, p = 0.4) was observed. The specificity of the VHRI for diagnosing recurrence was 79%. CONCLUSION Overall, the recurrence rate was low in these patients despite the presence of large hernia defects. Long-term QOL was not affected by the specific procedure used. Timely planning and execution are more important than the specific repair approach for post-trauma laparotomy ventral hernia.
Collapse
Affiliation(s)
- D K Bagaria
- Division of Trauma Surgery and Critical Care, Jai Prakash Narayan Apex Trauma Centre, Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India
| | - S Gupta
- Division of Trauma Surgery and Critical Care, Jai Prakash Narayan Apex Trauma Centre, Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India
| | - S Pandey
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | - N Choudhary
- Division of Trauma Surgery and Critical Care, Jai Prakash Narayan Apex Trauma Centre, Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India.
| | - P Priyadarshini
- Division of Trauma Surgery and Critical Care, Jai Prakash Narayan Apex Trauma Centre, Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India
| | - A Kumar
- Division of Trauma Surgery and Critical Care, Jai Prakash Narayan Apex Trauma Centre, Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India
| | - J Alam
- Division of Trauma Surgery and Critical Care, Jai Prakash Narayan Apex Trauma Centre, Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India
| | - B Mishra
- Division of Trauma Surgery and Critical Care, Jai Prakash Narayan Apex Trauma Centre, Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India
| | - S Sagar
- Division of Trauma Surgery and Critical Care, Jai Prakash Narayan Apex Trauma Centre, Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India
| | - S Kumar
- Division of Trauma Surgery and Critical Care, Jai Prakash Narayan Apex Trauma Centre, Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India
| | - A Gupta
- Division of Trauma Surgery and Critical Care, Jai Prakash Narayan Apex Trauma Centre, Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India
| |
Collapse
|
13
|
Necchi A, Pouessel D, Leibowitz R, Gupta S, Fléchon A, García-Donas J, Bilen MA, Debruyne PR, Milowsky MI, Friedlander T, Maio M, Gilmartin A, Li X, Veronese ML, Loriot Y. Pemigatinib for metastatic or surgically unresectable urothelial carcinoma with FGF/FGFR genomic alterations: final results from FIGHT-201. Ann Oncol 2024; 35:200-210. [PMID: 37956738 DOI: 10.1016/j.annonc.2023.10.794] [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: 06/26/2023] [Revised: 10/17/2023] [Accepted: 10/26/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND Fibroblast growth factor receptor 3 (FGFR3) alterations are oncogenic drivers of urothelial carcinoma (UC). Pemigatinib is a selective, oral inhibitor of FGFR1-3 with antitumor activity. We report the efficacy and safety of pemigatinib in the open-label, single-arm, phase II study of previously treated, unresectable or metastatic UC with FGFR3 alterations (FIGHT-201; NCT02872714). PATIENTS AND METHODS Patients ≥18 years old with FGFR3 mutations or fusions/rearrangements (cohort A) and other FGF/FGFR alterations (cohort B) were included. Patients received pemigatinib 13.5 mg once daily continuously (CD) or intermittently (ID) until disease progression or unacceptable toxicity. The primary endpoint was centrally confirmed objective response rate (ORR) as per RECIST v1.1 in cohort A-CD. Secondary endpoints included ORR in cohorts A-ID and B, duration of response (DOR), progression-free survival (PFS), overall survival (OS), and safety. RESULTS Overall, 260 patients were enrolled and treated (A-CD, n = 101; A-ID, n = 103; B, n = 44; unconfirmed FGF/FGFR status, n = 12). All discontinued treatment, most commonly due to progressive disease (68.5%). ORR [95% confidence interval (CI)] in cohorts A-CD and A-ID was 17.8% (10.9% to 26.7%) and 23.3% (15.5% to 32.7%), respectively. Among patients with the most common FGFR3 mutation (S249C; n = 107), ORR was similar between cohorts (A-CD, 23.9%; A-ID, 24.6%). In cohorts A-CD/A-ID, median (95% CI) DOR was 6.2 (4.1-8.3)/6.2 (4.6-8.0) months, PFS was 4.0 (3.5-4.2)/4.3 (3.9-6.1) months, and OS was 6.8 (5.3-9.1)/8.9 (7.5-15.2) months. Pemigatinib had limited clinical activity among patients in cohort B. Of 36 patients with samples available at progression, 6 patients had 8 acquired FGFR3 secondary resistance mutations (V555M/L, n = 3; V553M, n = 1; N540K/S, n = 2; M528I, n = 2). The most common treatment-emergent adverse events overall were diarrhea (44.6%) and alopecia, stomatitis, and hyperphosphatemia (42.7% each). CONCLUSIONS Pemigatinib was generally well tolerated and demonstrated clinical activity in previously treated, unresectable or metastatic UC with FGFR3 mutations or fusions/rearrangements.
Collapse
Affiliation(s)
- A Necchi
- Vita-Salute San Raffaele University, Department of Medical Oncology, IRCCS San Raffaele Hospital, Milan, Italy.
| | - D Pouessel
- Institut Claudius Regaud-IUCT Oncopole, Toulouse, France
| | - R Leibowitz
- Chaim Sheba Medical Center, Ramat Gan; Shamir Medical Center, Zerifin, Israel
| | - S Gupta
- Huntsman Cancer Institute, Salt Lake City, USA
| | | | | | - M A Bilen
- Winship Cancer Institute of Emory University, Atlanta, USA
| | - P R Debruyne
- Kortrijk Cancer Centre, General Hospital Groeninge, Kortrijk, Belgium; Medical Technology Research Centre (MTRC), School of Life Sciences, Anglia Ruskin University, Cambridge; School of Nursing and Midwifery, University of Plymouth, Plymouth, UK
| | - M I Milowsky
- University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill
| | - T Friedlander
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, USA
| | - M Maio
- University of Siena and Center for Immuno-Oncology, Department of Oncology, University Hospital, Siena, Italy
| | | | - X Li
- Incyte Corporation, Wilmington, USA
| | - M L Veronese
- Incyte International Biosciences Sàrl, Morges, Switzerland
| | - Y Loriot
- Gustave Roussy, DITEP, Université Paris-Saclay, INSERM 981, Villejuif, France.
| |
Collapse
|
14
|
Mala R, Malhotra S, Singh N, Gupta S, Upadhyay DA, Kapil A, Sood S. Deciphering Intermediate Nugent scores: Utility of Real-time PCR for Bacterial Vaginosis diagnosis. Diagn Microbiol Infect Dis 2024; 108:116152. [PMID: 38061216 DOI: 10.1016/j.diagmicrobio.2023.116152] [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: 04/23/2023] [Revised: 11/16/2023] [Accepted: 11/26/2023] [Indexed: 01/22/2024]
Abstract
PURPOSE To optimize real-time PCR assays for diagnosis of Bacterial Vaginosis (BV) and determine cut-off loads by ROC analysis for Gardnerella vaginalis, Atopobium vaginae and Lactobacillus spp. as compared to Nugent scoring (Gold standard) in clinical samples. RESULTS Out of 125 women, 34 were positive, 26 intermediate and 65 negative for BV by Nugent scoring. All three real-time PCR assays were found to be highly sensitive & specific and AUC suggested excellent diagnostic accuracy. An optimal cut-off was >9.45 × 103 copies/ ml, >3.34 × 103 copies/ ml & ≤ 18.63 × 103 copies/ ml for G. vaginalis, A. vaginae and Lactobacillus spp. respectively, in BV positives. Gram staining and qPCR were discordant only in patients with intermediate scores (n = 26) where qPCR identified 15 (57.69%) as positive and 11 (42.3%) as negative. CONCLUSION PCR-based molecular BV diagnosis is more accurate and can be used for deciphering intermediate Nugent scores.
Collapse
Affiliation(s)
- R Mala
- Department of Microbiology, AIIMS, New Delhi, India
| | - S Malhotra
- Department of Microbiology, AIIMS, New Delhi, India
| | - N Singh
- Department of Obstetrics & Gynaecology, AIIMS, New Delhi, India
| | - S Gupta
- Department of Dermatology & Venereology, AIIMS, New Delhi, India
| | - D A Upadhyay
- Department of Biostatistics, AIIMS, New Delhi, India
| | - A Kapil
- Department of Microbiology, AIIMS, New Delhi, India
| | - S Sood
- Department of Microbiology, AIIMS, New Delhi, India.
| |
Collapse
|
15
|
Gupta S, Grewal A, Jain K. Obstetric anaesthesiology: manpower and service provision issues in India. Int J Obstet Anesth 2024; 57:103928. [PMID: 37858417 DOI: 10.1016/j.ijoa.2023.103928] [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: 01/03/2023] [Revised: 08/20/2023] [Accepted: 09/07/2023] [Indexed: 10/21/2023]
Abstract
Obstetric anaesthesiologists play a pivotal role as peripartum physicians steering the team of obstetric healthcare providers towards a continuum of medical education, enhanced training and safer patient care. However, in resource-limited countries, deficiency of human resources and hence services available poses challenges to those attempting to reduce maternal mortality rates. Measures to fill the gap include creating a cadre of uniformly well-trained and certified non-physician anaesthesia providers (NPAPs) supervised by a physician obstetric anaesthesiologist and well-equipped rural and urban health care facilities. The Association of Obstetric Anaesthesiologists of India needs to upscale their outreach programs with regular knowledge updates and practical skill training to the NPAPs, medical graduates and postgraduate doctors in these regions. A combination of strong local administrative will, legislation for the provision of essential supplies and a global collaborative effort using checklists and protocols may help to stem gaps in the provision of safe maternal care.
Collapse
Affiliation(s)
- S Gupta
- Department of Anesthesiology, Geetanjali Medical College and Hospital, Udaipur, Rajasthan, India
| | - A Grewal
- Department of Anaesthesiology, All India Institute of Medical Sciences (AIIMS), Bathinda, Punjab, India.
| | - K Jain
- Department of Anaesthesia and Intensive Care, Post-Graduate Institute of Medical Science and Research (PGIMER), Chandigarh, India
| |
Collapse
|
16
|
Loibl S, André F, Bachelot T, Barrios CH, Bergh J, Burstein HJ, Cardoso MJ, Carey LA, Dawood S, Del Mastro L, Denkert C, Fallenberg EM, Francis PA, Gamal-Eldin H, Gelmon K, Geyer CE, Gnant M, Guarneri V, Gupta S, Kim SB, Krug D, Martin M, Meattini I, Morrow M, Janni W, Paluch-Shimon S, Partridge A, Poortmans P, Pusztai L, Regan MM, Sparano J, Spanic T, Swain S, Tjulandin S, Toi M, Trapani D, Tutt A, Xu B, Curigliano G, Harbeck N. Early breast cancer: ESMO Clinical Practice Guideline for diagnosis, treatment and follow-up. Ann Oncol 2024; 35:159-182. [PMID: 38101773 DOI: 10.1016/j.annonc.2023.11.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 11/21/2023] [Accepted: 11/28/2023] [Indexed: 12/17/2023] Open
Affiliation(s)
- S Loibl
- GBG Forschungs GmbH, Neu-Isenburg; Centre for Haematology and Oncology, Bethanien, Frankfurt, Germany
| | - F André
- Breast Cancer Unit, Medical Oncology Department, Gustave Roussy, Cancer Campus, Villejuif
| | - T Bachelot
- Department of Medical Oncology, Centre Léon Bérard, Lyon, France
| | - C H Barrios
- Oncology Department, Latin American Cooperative Oncology Group and Oncoclínicas, Porto Alegre, Brazil
| | - J Bergh
- Department of Oncology-Pathology, Bioclinicum, Karolinska Institutet and Breast Cancer Centre, Karolinska Comprehensive Cancer Centre and University Hospital, Stockholm, Sweden
| | - H J Burstein
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, USA
| | - M J Cardoso
- Breast Unit, Champalimaud Foundation, Champalimaud Cancer Centre, Lisbon; Faculty of Medicine, Lisbon University, Lisbon, Portugal
| | - L A Carey
- Division of Medical Oncology, The University of North Carolina at Chapel Hill, Lineberger Comprehensive Cancer Center, Chapel Hill, USA
| | - S Dawood
- Department of Oncology, Mediclinic City Hospital, Dubai, UAE
| | - L Del Mastro
- Medical Oncology Clinic, IRCCS Ospedale Policlinico San Martino, Genoa; Department of Internal Medicine and Medical Specialities, School of Medicine, University of Genoa, Genoa, Italy
| | - C Denkert
- Institute of Pathology, Philipps-University Marburg and University Hospital Giessen and Marburg, Marburg
| | - E M Fallenberg
- Department of Diagnostic and Interventional Radiology, School of Medicine & Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - P A Francis
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - H Gamal-Eldin
- Department of Surgical Oncology, National Cancer Institute, Cairo University, Cairo, Egypt
| | - K Gelmon
- Department of Medical Oncology, British Columbia Cancer, Vancouver, Canada
| | - C E Geyer
- Department of Internal Medicine, Hillman Cancer Center, University of Pittsburgh, Pittsburgh, USA
| | - M Gnant
- Comprehensive Cancer Centre, Medical University of Vienna, Vienna, Austria
| | - V Guarneri
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova; Oncology 2 Unit, Istituto Oncologico Veneto IOV IRCCS, Padova, Italy
| | - S Gupta
- Department of Medical Oncology, Tata Memorial Centre, Mumbai, India
| | - S B Kim
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - D Krug
- Department of Radiation Oncology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - M Martin
- Hospital General Universitario Gregorio Maranon, Universidad Complutense, GEICAM, Madrid, Spain
| | - I Meattini
- Department of Radiation Oncology, Azienda Ospedaliero-Universitaria Careggi, Florence; Department of Experimental and Clinical Biomedical Sciences 'M. Serio', University of Florence, Florence, Italy
| | - M Morrow
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, USA
| | - W Janni
- Department of Obstetrics and Gynaecology, University of Ulm, Ulm, Germany
| | - S Paluch-Shimon
- Sharett Institute of Oncology Department, Hadassah University Hospital & Faculty of Medicine Hebrew University, Jerusalem, Israel
| | - A Partridge
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, USA
| | - P Poortmans
- Department of Radiation Oncology, Iridium Netwerk, Antwerp; Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - L Pusztai
- Yale Cancer Center, Yale School of Medicine, New Haven
| | - M M Regan
- Division of Biostatistics, Dana-Farber Cancer Institute, Harvard Medical School, Boston
| | - J Sparano
- Department of Medicine, Division of Hematology/Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, USA
| | - T Spanic
- Europa Donna Slovenia, Ljubljana, Slovenia
| | - S Swain
- Medicine Department, Georgetown University Medical Centre and MedStar Health, Washington, USA
| | - S Tjulandin
- N.N. Blokhin National Medical Research Centre of Oncology, Moscow, Russia
| | - M Toi
- Tokyo Metropolitan Cancer and Infectious Disease Center, Komagome Hospital, Bunkyo-ku, Japan
| | - D Trapani
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, USA
| | - A Tutt
- Breast Cancer Research Division, The Institute of Cancer Research, London; Comprehensive Cancer Centre, Division of Cancer Studies, Kings College London, London, UK
| | - B Xu
- Department of Medical Oncology, National Cancer Centre/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - G Curigliano
- Early Drug Development for Innovative Therapies Division, Istituto Europeo di Oncologia, IRCCS, Milan; Department of Oncology and Hemato-Oncology, University of Milano, Milan, Italy
| | - N Harbeck
- Breast Centre, Department of Obstetrics & Gynaecology and Comprehensive Cancer Centre Munich, LMU University Hospital, Munich, Germany
| |
Collapse
|
17
|
Challa A, Maras JS, Nagpal S, Tripathi G, Taneja B, Kachhawa G, Sood S, Dhawan B, Acharya P, Upadhyay AD, Yadav M, Sharma R, Bajpai M, Gupta S. Multi-omics analysis identifies potential microbial and metabolite diagnostic biomarkers of bacterial vaginosis. J Eur Acad Dermatol Venereol 2024. [PMID: 38284174 DOI: 10.1111/jdv.19805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 11/06/2023] [Indexed: 01/30/2024]
Abstract
BACKGROUND Bacterial vaginosis (BV) is a common clinical manifestation of a perturbed vaginal ecology associated with adverse sexual and reproductive health outcomes if left untreated. The existing diagnostic modalities are either cumbersome or require skilled expertise, warranting alternate tests. Application of machine-learning tools to heterogeneous and high-dimensional multi-omics datasets finds promising potential in data integration and may aid biomarker discovery. OBJECTIVES The present study aimed to evaluate the potential of the microbiome and metabolome-derived biomarkers in BV diagnosis. Interpretable machine-learning algorithms were used to evaluate the utility of an integrated-omics-derived classification model. METHODS Vaginal samples obtained from reproductive-age group women with (n = 40) and without BV (n = 40) were subjected to 16S rRNA amplicon sequencing and LC-MS-based metabolomics. The vaginal microbiome and metabolome were characterized, and machine-learning analysis was performed to build a classification model using biomarkers with the highest diagnostic accuracy. RESULTS Microbiome-based diagnostic model exhibited a ROC-AUC (10-fold CV) of 0.84 ± 0.21 and accuracy of 0.79 ± 0.18, and important features were Aerococcus spp., Mycoplasma hominis, Sneathia spp., Lactobacillus spp., Prevotella spp., Gardnerella spp. and Fannyhessea vaginae. The metabolome-derived model displayed superior performance with a ROC-AUC of 0.97 ± 0.07 and an accuracy of 0.92 ± 0.08. Beta-leucine, methylimidazole acetaldehyde, dimethylethanolamine, L-arginine and beta cortol were among key predictive metabolites for BV. A predictive model combining both microbial and metabolite features exhibited a high ROC-AUC of 0.97 ± 0.07 and accuracy of 0.94 ± 0.08 with diagnostic performance only slightly superior to the metabolite-based model. CONCLUSION Application of machine-learning tools to multi-omics datasets aid biomarker discovery with high predictive performance. Metabolome-derived classification models were observed to have superior diagnostic performance in predicting BV than microbiome-based biomarkers.
Collapse
Affiliation(s)
- A Challa
- Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, India
| | - J S Maras
- Department of Molecular and Cellular Medicine, Institute of Liver and Biliary Sciences, New Delhi, India
| | - S Nagpal
- TCS Research, Tata Consultancy Services Ltd, Pune, India
- CSIR-Institute of Genomics and Integrative Biology, New Delhi, India
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, India
| | - G Tripathi
- Department of Molecular and Cellular Medicine, Institute of Liver and Biliary Sciences, New Delhi, India
| | - B Taneja
- CSIR-Institute of Genomics and Integrative Biology, New Delhi, India
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, India
| | - G Kachhawa
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - S Sood
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - B Dhawan
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - P Acharya
- Department of Biochemistry, All India Institute of Medical Sciences, New Delhi, India
| | - A D Upadhyay
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | - M Yadav
- Department of Molecular and Cellular Medicine, Institute of Liver and Biliary Sciences, New Delhi, India
| | - R Sharma
- CSIR-Institute of Genomics and Integrative Biology, New Delhi, India
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, India
| | - M Bajpai
- Department of Transfusion Medicine, Institute of Liver and Biliary Sciences, New Delhi, India
| | - S Gupta
- Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, India
| |
Collapse
|
18
|
Gupta S, Singh P, Sharma B. Montelukast Ameliorates 2K1C-Hypertension Induced Endothelial Dysfunction and Associated Vascular Dementia. Curr Hypertens Rev 2024; 20:CHYR-EPUB-137066. [PMID: 38192137 DOI: 10.2174/0115734021276985231204092425] [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: 08/11/2023] [Revised: 10/31/2023] [Accepted: 11/13/2023] [Indexed: 01/10/2024]
Abstract
BACKGROUND Declined kidney function associated with hypertension is a danger for cognitive deficits, dementia, and brain injury. Cognitive decline and vascular dementia (VaD) are serious public health concerns, which highlights the urgent need for study on the risk factors for cognitive decline. Cysteinyl leukotriene (CysLT1) receptors are concerned with regulating cognition, motivation, inflammatory processes, and neurogenesis. OBJECTIVE This research aims to examine the consequence of montelukast (specific CysLT1 antagonist) in renovascular hypertension 2-kidney-1-clip-2K1C model-triggered VaD in experimental animals. METHODS 2K1C tactics were made to prompt renovascular hypertension in mature male rats. Morris water maze was employed to measure cognition. Mean arterial pressure (MAP), serum nitrite levels, aortic superoxide content, vascular endothelial activity, brain's oxidative stress (diminished glutathione, raised lipid peroxides), inflammatory markers (IL-10, IL-6, TNF-α), cholinergic activity (raised acetylcholinesterase), and cerebral injury (staining of 2, 3, 5- triphenylterazolium chloride) were also examined. RESULTS Montelukast in doses of 5.0 and 10.0 mg kg-1 was used intraperitoneally as the treatment drug. Along with cognitive deficits, 2K1C-operated rats showed elevated MAP, endothelial dysfunction, brain oxidative stress, inflammation, and cerebral damage with diminished serum nitrite/nitrate. Montelukast therapy significantly and dose-dependently mitigated the 2K1Chypertension-provoked impaired behaviors, biochemistry, endothelial functions, and cerebral infarction. CONCLUSION The 2K1C tactic caused renovascular hypertension and associated VaD, which was mitigated via targeted regulation of CysLT1 receptors by montelukast administration. Therefore, montelukast may be taken into consideration for the evaluation of its complete potential in renovascular-hypertension-induced VaD.
Collapse
Affiliation(s)
- Surbhi Gupta
- Department of Pharmacology, School of Pharmacy, Bharat Institute of Technology, Partapur Bypass, Meerut, Uttar Pradesh, India
| | - Prabhat Singh
- Faculty of Pharmacy, Swami Vivekanand Subharti University, Meerut, Uttar Pradesh, India
| | - Bhupesh Sharma
- Department of Pharmacology, Amity Institute of Pharmacy, Amity University Uttar Pradesh, Noida, India
| |
Collapse
|
19
|
Singh A, Gupta S, Gupta V. Pigment migration into the glaucomatous optic cup after blunt trauma. J Fr Ophtalmol 2024; 47:103939. [PMID: 37730498 DOI: 10.1016/j.jfo.2023.05.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 05/18/2023] [Indexed: 09/22/2023]
Affiliation(s)
- A Singh
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences (AIIMS), New Delhi 110029, India.
| | - S Gupta
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences (AIIMS), New Delhi 110029, India
| | - V Gupta
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences (AIIMS), New Delhi 110029, India
| |
Collapse
|
20
|
Singh A, Panigrahi A, Gupta V, Gupta S. Vitiligo iridis in primary congenital glaucoma. J Fr Ophtalmol 2024; 47:103960. [PMID: 37777421 DOI: 10.1016/j.jfo.2023.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 07/28/2023] [Indexed: 10/02/2023]
Affiliation(s)
- A Singh
- Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences (AIIMS), Sri Aurobindo Marg, Ansari Nagar East, New Delhi 110029, India.
| | - A Panigrahi
- Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences (AIIMS), Sri Aurobindo Marg, Ansari Nagar East, New Delhi 110029, India
| | - V Gupta
- Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences (AIIMS), Sri Aurobindo Marg, Ansari Nagar East, New Delhi 110029, India
| | - S Gupta
- Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences (AIIMS), Sri Aurobindo Marg, Ansari Nagar East, New Delhi 110029, India
| |
Collapse
|
21
|
Gupta S, Mandal SP, Bansal YS. Identification using Hand Remnants at the Mass Casualty Site: Forensic Perspective. Mymensingh Med J 2024; 33:279-285. [PMID: 38163804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Abstract
Identification is one of the most important aspects of mass disasters. Stature estimation is an essential parameter for identification and is widely used in forensic anthropology, where DNA facility is limited. A hand is most studied part of the upper limb; however, data are scarce concerning particular geographical populations. This study is an effort to provide tangible data for such forensic investigations. It was a prospective, cross-sectional study on 500 medicolegal death cases brought for post-mortem examination. It aimed to estimate stature in the Northwest population using hand and finger measurements of dead persons by mathematical models. A total of seven parameters in hand were used to generate linear and multiple regression equations, correlation coefficients and finger indexes for stature estimation and sex differentiation. The correlation coefficient between stature and all the hand measurements were significant except for the index and middle finger on both sides in females. Bilateral differences were insignificant for hand length and breath, except for the middle finger length in both sexes and length of thumb in females. Multiple regression equations for stature estimation were better than linear regression equations for stature estimation. SEE ranged from 4.31 to 6.26 in males and 4.11 to 5.25 in females. For identification, hand length is the best individual parameter among other hand measurements. The measurement accuracy and practical aspects can be enhanced if we consider cadaveric participants. The multiple regression model approach can give a fair estimate of the stature of the deceased.
Collapse
Affiliation(s)
- S Gupta
- Dr Shikha Gupta, MD, Assistant Professor, Department of Forensic Medicine and Toxicology, Government Medical College and Hospital, Chandigarh, India: E-mail:
| | | | | |
Collapse
|
22
|
Gupta S, Sikka N, Kamboj M, Hooda A, Devi A, Narwal A. Dental professional's perspective regarding knowledge, awareness, and attitude towards the importance of charting dental anomalies: a cross-sectional study. J Forensic Odontostomatol 2023; 41:52-61. [PMID: 38183972 PMCID: PMC10859071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/08/2024]
Abstract
OBJECTIVES The presence of dental anomalies could play a significant role in the identification of individuals by comparing antemortem and postmortem data. This cross-sectional study aimed to assess the level of knowledge, attitude, and awareness among dental professionals regarding the importance of charting dental anomalies and maintaining dental records. METHODOLOGY A self-structured questionnaire was e-mailed to dental professionals practicing in India. The responses were recorded, data tabulated, and one-way ANOVA and post hoc tests were applied for analysis. The criterion for significance was p < .05. RESULTS A total of 406 dental professionals responded to the survey. A significant difference was observed in the mean attitude score of participants towards the importance of charting dental anomalies and maintaining dental records with regard to place of work (p=.001), gender (p=.044) and educational qualification (p=.039). In addition, a statistically significant difference was observed in the mean awareness score of participants with respect to place of work (p=.033) and gender (p=.001). The major barriers in maintaining dental records were lack of time, adequate knowledge, infrastructure, and financial constraints. CONCLUSION 81.3% and 69.26% study participants had very good awareness and attitude, whereas 71.2% had good knowledge regarding the importance of charting dental anomalies and maintenance of dental records; however, their inaccurate responses in anomaly identification hinted towards the need for proper dental charting and their maintenance to be taught en masse and made part of the BDS curriculum.
Collapse
Affiliation(s)
- S Gupta
- Department of Or Anstomy Fas Graduato institute of Cantal Sciencos Rehtak, Haryana, India
| | - N Sikka
- Department of Dental Materials, Post Graduate Institute of Dental Sciences, Rohtak, Haryana, India
| | - M Kamboj
- Department of Oral Pathology, Post Graduate Institute of Dental Sciences, Rohtak, Haryana, India
| | - A Hooda
- Department of Oral Anatomy, Post Graduate Institute of Dental Sciences, Rohtak, Haryana, India
| | - A Devi
- Department of Oral Pathology, Post Graduate Institute of Dental Sciences, Rohtak, Haryana, India
| | - A Narwal
- Department of Oral Pathology, Post Graduate Institute of Dental Sciences, Rohtak, Haryana, India
| |
Collapse
|
23
|
Grivas P, Grande E, Davis ID, Moon HH, Grimm MO, Gupta S, Barthélémy P, Thibault C, Guenther S, Hanson S, Sternberg CN. Avelumab first-line maintenance treatment for advanced urothelial carcinoma: review of evidence to guide clinical practice. ESMO Open 2023; 8:102050. [PMID: 37976999 PMCID: PMC10685024 DOI: 10.1016/j.esmoop.2023.102050] [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: 06/30/2023] [Revised: 08/03/2023] [Accepted: 09/23/2023] [Indexed: 11/19/2023] Open
Abstract
The JAVELIN Bladder 100 phase III trial led to the incorporation of avelumab first-line (1L) maintenance treatment into international guidelines as a standard of care for patients with advanced urothelial carcinoma (UC) without progression after 1L platinum-based chemotherapy. JAVELIN Bladder 100 showed that avelumab 1L maintenance significantly prolonged overall survival (OS) and progression-free survival in this population compared with a 'watch-and-wait' approach. The aim of this manuscript is to review clinical studies of avelumab 1L maintenance in patients with advanced UC, including long-term efficacy and safety data from JAVELIN Bladder 100, subgroup analyses in clinically relevant subpopulations, and 'real-world' data obtained outside of clinical trials, providing a comprehensive resource to support patient management. Extended follow-up from JAVELIN Bladder 100 has shown that avelumab provides a long-term efficacy benefit, with a median OS of 23.8 months measured from start of maintenance treatment, and 29.7 months measured from start of 1L chemotherapy. Longer OS was observed across subgroups, including patients who received 1L cisplatin + gemcitabine, patients who received four or six cycles of 1L chemotherapy, and patients with complete response, partial response, or stable disease as best response to 1L induction chemotherapy. No new safety signals were seen in patients who received ≥1 year of avelumab treatment, and toxicity was similar in those who had received cisplatin or carboplatin with gemcitabine. Other clinical datasets, including noninterventional studies conducted in Europe, USA, and Asia, have confirmed the efficacy of avelumab 1L maintenance. Potential subsequent treatment options after avelumab maintenance include antibody-drug conjugates (enfortumab vedotin or sacituzumab govitecan), erdafitinib in biomarker-selected patients, platinum rechallenge in suitable patients, nonplatinum chemotherapy, and clinical trial participation; however, evidence to determine optimal treatment sequences is needed. Ongoing trials of avelumab-based combination regimens as maintenance treatment have the potential to evolve the treatment landscape for patients with advanced UC.
Collapse
Affiliation(s)
- P Grivas
- Department of Medicine, Division of Hematology/Oncology, University of Washington School of Medicine, Seattle, USA; Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, USA.
| | - E Grande
- Department of Medical Oncology, MD Anderson Cancer Center Madrid, Madrid, Spain
| | - I D Davis
- Monash University Eastern Health Clinical School, Box Hill, Victoria, Australia
| | - H H Moon
- Department of Hematology/Oncology, Kaiser Permanente Southern California, Riverside Medical Center, Riverside, USA
| | - M-O Grimm
- Department of Urology, Jena University Hospital, Jena, Germany
| | - S Gupta
- Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic Foundation, Cleveland, USA
| | - P Barthélémy
- Medical Oncology Unit, Institut de Cancérologie Strasbourg Europe, Strasbourg
| | - C Thibault
- Department of Medical Oncology, Hôpital Européen Georges Pompidou, Institut du Cancer Paris CARPEM, AP-HP Centre, Paris, France
| | - S Guenther
- Merck Healthcare KGaA, Darmstadt, Germany
| | | | - C N Sternberg
- Englander Institute for Precision Medicine, Weill Cornell Medicine, Hematology/Oncology, Meyer Cancer Center, New York, USA
| |
Collapse
|
24
|
Parodi JB, Burgos LM, Garcia-Zamora S, Liblik K, Pulido L, Gupta S, Saldarriaga C, Puente-Barragan AC, Morejón-Barragán P, Alexanderson-Rosas E, Sosa-Liprandi A, Botto F, Sosa-Liprandi MI, Lopez-Santi R, Vazquez G, Gulati M, Baranchuk A. Gender differences in workplace violence against physicians and nurses in Latin America: a survey from the Interamerican Society of Cardiology. Public Health 2023; 225:127-132. [PMID: 37924636 DOI: 10.1016/j.puhe.2023.09.030] [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: 07/25/2023] [Revised: 09/17/2023] [Accepted: 09/28/2023] [Indexed: 11/06/2023]
Abstract
OBJECTIVES To evaluate gender differences in workplace violence (WPV) against physicians and nurses in Latin America. STUDY DESIGN Cross-sectional study. METHODS A cross-sectional electronic survey was conducted between January 11 and February 28, 2022. A prespecified gender analysis was performed. RESULTS Among the 3056 responses to the electronic survey, 57% were women, 81.6% were physicians, and 18.4% were nurses. At least one act of violence was experienced by 59.2% of respondents, with verbal violence being the most common (97.5%). Women experienced more WPV than men (65.8% vs 50.4%; P < 0.001; odds ratio [OR]: 1.89; 95% confidence interval [CI]: 1.63-2.19). Women were more likely to report at least one episode of WPV per week (19.2% vs 11.9%, P < 0.001), to request for psychological help (14.5% vs 9%, P = 0.001) and to experience more psychosomatic symptoms. In addition, women were more likely to report having considered changing their job after an aggression (57.6% vs 51.3%, P = 0.011) and even leaving their job (33% vs 25.7%, P = 0.001). In a multivariate analysis, being a woman (OR: 1.76), working in emergency departments (OR: 1.99), and with COVID-19 patients (OR: 3.3) were independently associated with more aggressive interactions, while older age (OR: 0.95) and working in a private setting (OR: 0.62) implied lower risk. CONCLUSIONS Women are more likely to experience WPV and to report more psychosomatic symptoms after the event. Preventive measures are urgently needed, with a special focus on high-risk groups such as women.
Collapse
Affiliation(s)
- J B Parodi
- Cardiology Department, Sanatorio Anchorena, Buenos Aires, Argentina
| | - L M Burgos
- Heart Failure Department, Instituto Cardiovascular de Buenos Aires (ICBA), Argentina
| | - S Garcia-Zamora
- Cardiology Department, Delta Clinic, Rosario, Santa Fe, Argentina
| | - K Liblik
- Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - L Pulido
- Pneumology Department, Hospital Italiano, Rosario, Santa Fe, Argentina
| | - S Gupta
- Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | | | | | | | - E Alexanderson-Rosas
- Nuclear Cardiology Department, Instituto Nacional de Cardiologia Ignacio Chávez, Mexico City, Mexico
| | - A Sosa-Liprandi
- Cardiology Department, Sanatorio Güemes, Ciudad Autónoma de Buenos Aires, Argentina
| | - F Botto
- Clinical Research Department, Instituto Cardiovascular de Buenos Aires (ICBA), Argentina
| | - M I Sosa-Liprandi
- Cardiology Department, Sanatorio Güemes, Ciudad Autónoma de Buenos Aires, Argentina
| | - R Lopez-Santi
- Division of Cardiology, Hospital Italiano de La Plata, Buenos Aires, Argentina
| | - G Vazquez
- Department of Psychiatry, Queen's University, Kingston, Ontario, Canada
| | - M Gulati
- Barbra Streisand Women's Heart Center, Cedars-Sinai Smidt Heart Institute, Los Angeles, CA, USA
| | - A Baranchuk
- Division of Cardiology, Queen's University, Kingston, Ontario, Canada.
| |
Collapse
|
25
|
Sharma D, Koul A, Bhushan S, Gupta S, Kaul S, Dhar MK. Insights into microRNA-mediated interaction and regulation of metabolites in tomato. Plant Biol (Stuttg) 2023; 25:1142-1153. [PMID: 37681459 DOI: 10.1111/plb.13572] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 07/23/2023] [Indexed: 09/09/2023]
Abstract
microRNAs direct regulation of various metabolic pathways in plants and animals. miRNAs may be useful in developing novel/elite genotypes, with enhanced metabolites and disease resistance. We examined miRNAs in tomato. In tomato, miRNAs in the carotenoid pathway have not been fully elucidated. We examined the potential role of miRNAs in biosynthesis of carotenoids, transcript profiling of miRNAs and their possible targets (genes and transcription factors) at different development stages of tomato using stem-loop PCR and RT-qPCR. We also identified miRNAs targeting key flavonoid genes, such as chalcone isomerase (CHI), and dihydroflavonol-4-reductase (DFR). Distinct expression profiles of miRNAs and their targets were found in fruits of three tomato accessions, suggesting carotenoid regulation by miRNAs at various stages of fruit development. This was also confirmed using HPLC of the carotenoids. The present study may help in understanding possible regulation of carotenoid biosynthesis. The identified miRNAs can be exploited to enhance biosynthesis of different carotenoids in plants.
Collapse
Affiliation(s)
- D Sharma
- Genome Research Laboratory, School of Biotechnology, University of Jammu, Jammu, India
| | - A Koul
- Department of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton, AB, Canada
| | - S Bhushan
- Department of Botany, Central University of Jammu, Bagla (Rahya Suchani), Samba, Jammu, India
| | - S Gupta
- Genome Research Laboratory, School of Biotechnology, University of Jammu, Jammu, India
| | - S Kaul
- Genome Research Laboratory, School of Biotechnology, University of Jammu, Jammu, India
| | - M K Dhar
- Genome Research Laboratory, School of Biotechnology, University of Jammu, Jammu, India
| |
Collapse
|
26
|
Harrogate S, Barnes J, Thomas K, Isted A, Kunst G, Gupta S, Rudd S, Banerjee T, Hinchliffe R, Mouton R. Peri-operative tobacco cessation interventions: a systematic review and meta-analysis. Anaesthesia 2023; 78:1393-1408. [PMID: 37656151 PMCID: PMC10952322 DOI: 10.1111/anae.16120] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/27/2023] [Indexed: 09/02/2023]
Abstract
Tobacco smoking is associated with a substantially increased risk of postoperative complications. The peri-operative period offers a unique opportunity to support patients to stop tobacco smoking, avoid complications and improve long-term health. This systematic review provides an up-to-date summary of the evidence for tobacco cessation interventions in surgical patients. We conducted a systematic search of randomised controlled trials of tobacco cessation interventions in the peri-operative period. Quantitative synthesis of the abstinence outcomes data was by random-effects meta-analysis. The primary outcome of the meta-analysis was abstinence at the time of surgery, and the secondary outcome was abstinence at 12 months. Thirty-eight studies are included in the review (7310 randomised participants) and 26 studies are included in the meta-analysis (5969 randomised participants). Studies were pooled for subgroup analysis in two ways: by the timing of intervention delivery within the peri-operative period and by the intensity of the intervention protocol. We judged the quality of evidence as moderate, reflecting the degree of heterogeneity and the high risk of bias. Overall, peri-operative tobacco cessation interventions increased successful abstinence both at the time of surgery, risk ratio (95%CI) 1.48 (1.20-1.83), number needed to treat 7; and 12 months after surgery, risk ratio (95%CI) 1.62 (1.29-2.03), number needed to treat 9. More work is needed to inform the design and optimal delivery of interventions that are acceptable to patients and that can be incorporated into contemporary elective and urgent surgical pathways. Future trials should use standardised outcome measures.
Collapse
Affiliation(s)
- S. Harrogate
- Elizabeth Blackwell InstituteUniversity of BristolBristolUK
- Department of Anaesthesia, North Bristol NHS TrustBristolUK
| | - J. Barnes
- Department of Anaesthesia, North Bristol NHS TrustBristolUK
| | - K. Thomas
- Department of Population Health Sciences, Bristol Medical SchoolUniversity of BristolBristolUK
| | - A. Isted
- Department of Anaesthesia, King's College Hospital NHS Foundation TrustLondonUK
| | - G. Kunst
- School of Cardiovascular and Metabolic Medicine and Sciences, King's College LondonLondonUK
- Department of Anaesthesia, King's College Hospital NHS Foundation TrustLondonUK
| | - S. Gupta
- Department of AnaesthesiaUniversity Hospitals Bristol and Weston NHS Foundation TrustBristolUK
| | - S. Rudd
- North Bristol NHS TrustBristolUK
| | | | - R. Hinchliffe
- Department of Translational Health Sciences, Bristol Medical SchoolUniversity of BristolBristolUK
- Department of Vascular Services, North Bristol NHS TrustBristolUK
| | - R. Mouton
- Department of Translational Health Sciences, Bristol Medical SchoolUniversity of BristolBristolUK
- Department of Anaesthesia, North Bristol NHS TrustBristolUK
| |
Collapse
|
27
|
Gupta S, Sangwan N, Sangwan AK, Mann S, Gupta S, Kumar A, Kumar S. Understanding the resistance mechanisms of Rhipicephalus microplus ticks to synthetic pyrethroids and organophosphates in south-west regions of Haryana, North India. Pestic Biochem Physiol 2023; 196:105634. [PMID: 37945265 DOI: 10.1016/j.pestbp.2023.105634] [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] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 09/06/2023] [Accepted: 09/30/2023] [Indexed: 11/12/2023]
Abstract
Chemical control of tick infestation on dairy farms in India strongly relies upon the use of synthetic pyrethroids (deltamethrin) and organophosphate (coumaphos) drugs. Therefore, the present manuscript aims to investigate the resistance status of Rhipicephalus microplus ticks against these acaricides. Fully engorged adult R. microplus ticks were randomly collected from 8 dairy farms in North India and evaluated for acaricide resistance by using the Larval Packet Test (LPT). Of these, ticks collected from one and three farms showed the emergence of Level I acaricide resistance against deltamethrin and coumaphos, respectively. Significant positive correlations were found in the enzymatic activity (α-esterase, β-esterase, glutathione-S-transferase, and mono-oxygenase) of R. microplus tick resistant against coumaphos. Native electrophoretogram analysis showed six different types of esterase activity in R. microplus (EST-1b to EST-6b), and EST-5b activity was more predominantly expressed in resistant ticks. Further, inhibitor studies using various esterase inhibitors suggested that EST-5b is a putative acetylcholine-esterase (AchE), and increased expression of one of the AchE might be responsible for the emergence of acaricide resistance. Further, no mutations were detected in the carboxylesterase (G1120A) and domain II S4-5 linker region (C190A) of the sodium channel genes of resistant R. microplus ticks, indicating that increased expression of detoxification enzymes was the probable mechanism for the development of acaricide resistance in the resistant ticks.
Collapse
Affiliation(s)
- Surbhi Gupta
- Department of Veterinary Physiology and Biochemistry, Lala Lajpat Rai University of Veterinary and Animal Sciences, Hisar, Haryana 125004, India.
| | - Nirmal Sangwan
- Department of Veterinary Physiology and Biochemistry, Lala Lajpat Rai University of Veterinary and Animal Sciences, Hisar, Haryana 125004, India
| | - Arun Kumar Sangwan
- Department of Veterinary Parasitology, College of Veterinary Science and Animal Husbandry, Central Agricultural University (Imphal), Jalukie, Nagaland, India
| | - Sushila Mann
- Department of Animal Biotechnology, Lala Lajpat Rai University of Veterinary and Animal Sciences, Hisar, Haryana 125004, India
| | - Snehil Gupta
- Department of Veterinary Parasitology, Lala Lajpat Rai University of Veterinary and Animal Sciences, Hisar, Haryana 125004, India
| | - Aman Kumar
- Department of Animal Biotechnology, Lala Lajpat Rai University of Veterinary and Animal Sciences, Hisar, Haryana 125004, India
| | - Sachin Kumar
- Entomology Laboratory, ICAR-Indian Veterinary Research Institute, Bareilly, Uttar Pradesh 243122, India
| |
Collapse
|
28
|
Gupta S, Srinivasu V, Sureshkumar D. Metal and catalyst-free strategy to access 1,3-thio-heteroaryl BCP derivatives. Org Biomol Chem 2023; 21:8136-8140. [PMID: 37772462 DOI: 10.1039/d3ob01377d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/30/2023]
Abstract
The widespread presence of bicyclo[1.1.1]pentane (BCP) and sulfur motifs in pharmaceutical compounds underscores the significance of synthesizing suitably functionalized BCP thioethers. In response, we have developed a metal-free and photocatalyst-free strategy that harnesses visible light-induced radical cascades. This approach culminates in the synthesis of essential thio-BCP derivatives, which serve as crucial precursors for the formation of the corresponding sulfoxides, sulfones, and sulfoximines. Importantly, this methodology exhibits potential for large-scale applications, displaying commendable tolerance towards various functional groups while operating under mild reaction conditions.
Collapse
Affiliation(s)
- Surbhi Gupta
- Department of Chemical Sciences, Indian Institute of Science Education and Research Kolkata, Mohanpur, Nadia-741246, West Bengal, India.
| | - Vinjamuri Srinivasu
- Department of Chemical Sciences, Indian Institute of Science Education and Research Kolkata, Mohanpur, Nadia-741246, West Bengal, India.
| | - Devarajulu Sureshkumar
- Department of Chemical Sciences, Indian Institute of Science Education and Research Kolkata, Mohanpur, Nadia-741246, West Bengal, India.
| |
Collapse
|
29
|
Bazyar S, Sutera P, Phillips R, Deek MP, Radwan N, Marshall CH, Mishra MV, Rana ZH, Molitoris JK, Kwok Y, Gupta S, Wenstrup R, DeWeese TL, Song D, Feng FY, Pienta K, Antonarakis E, Kiess AP, Tran PT. Prospective Characterization of Circulating Tumor Cells in Hormone Sensitive Oligometastatic Prostate Cancer Patients on a Metastasis-Directed Therapy Trial. Int J Radiat Oncol Biol Phys 2023; 117:e367-e368. [PMID: 37785256 DOI: 10.1016/j.ijrobp.2023.06.2463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Prospective data have shown that metastasis-directed therapy (MDT) can alter the natural history of oligometastatic disease. In hormone-sensitive prostate cancer (HSPC), the clinical effect of MDT has been validated by STOMP, ORIOLE and SABR-COMET phase II trials. Circulating tumor cells (CTCs) are likely the source for the formation of macroscopic metastases. CTCs may provide an approach for identifying subgroups of patients with oligometastatic HSPC (oligoHSPC) that would benefit most from MDT. Our main goal was to evaluate the feasibility of CTC detection and subtypes in oligoHSPC patients that may benefit from MDT. MATERIALS/METHODS ORIOLE randomized men with recurrent HSPC with 1-3 metastases to observation (Obs) vs. stereotactic ablative radiotherapy (SABR) MDT. Blood samples were prospectively collected at baseline (D0) and 6-mos (D180) and shipped for analysis on Epic Sciences liquid biopsy platform (Epic Sciences, San Diego, CA). Machine learning algorithms identified CTCs and characterized androgen receptor (AR) and PSMA expression. Association with clinical factors and outcomes were examined. Biochemical failure-free survival (BFFS) event was a PSA rise of at least 2 ng/mL and 25% above nadir. Progression-free survival (PFS) was a composite endpoint including BFFS event, radiologic progression (RECIST v1.1); symptomatic progression; initiation of ADT; or death. Comparisons of patient and tumor characteristics performed by two-sample t-tests. Survival curves were generated by the Kaplan-Meier method and evaluated by the log-rank test. Effect of SABR on post-SABR on CTC levels were calculated by McNemar test. RESULTS A total of 82 samples were collected in ORIOLE: 70 SABR (35 D0 and 35 D180) and 12 Obs (7 D0 and 5 D180). 30/42 men had CTCs detected on D0 (71%; AR+ = 7, PSMA+ = 13) and in 26/40 on D180 (65%; AR+ = 9, PSMA+ = 8). Median follow-up was 41.7-mos. There was no association between CTC presence or subtypes (AR+ or PSMA+) with Gleason score or PSA. PFS was significantly lower in the patients with AR+ vs. AR- CTCs on D0 in the SABR arm (p = 0.011, median PFS: AR+ = 9.3- vs. AR+ = 27.1-mos). The median BFFS trended towards a difference for AR+ = 12.9- vs. AR- = 29.2-mos (D180, p = 0.058). SABR had no effect on the presence or subtypes of CTC at D180. CONCLUSION Baseline and dynamic CTC levels and their subtypes in oligoHSPC from the ORIOLE randomized trial of MDT was examined. AR+ CTCs at baseline and 6-mos were correlated with clinical outcomes following SABR. Longer follow-up, further analysis and a greater number of patients are needed for a more comprehensive conclusion.
Collapse
Affiliation(s)
- S Bazyar
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD
| | - P Sutera
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins Medicine, Baltimore, MD
| | - R Phillips
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN
| | - M P Deek
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - N Radwan
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD; Johns Hopkins Medicine, Baltimore, MD
| | | | - M V Mishra
- Maryland Proton Treatment Center, Baltimore, MD
| | - Z H Rana
- University of Maryland, Baltimore, MD
| | - J K Molitoris
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD
| | - Y Kwok
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD
| | - S Gupta
- Epic Sciences, San Diego, CA
| | | | - T L DeWeese
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD; Johns Hopkins University, Baltimore, MD
| | - D Song
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
| | - F Y Feng
- Department of Radiation Oncology, University of California San Francisco, San Francisco, CA
| | - K Pienta
- Department of Medical Oncology, The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD
| | | | - A P Kiess
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
| | - P T Tran
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD
| |
Collapse
|
30
|
Samala SK, Gupta S, Sharma S, Pattanaik J, Pandey S, Sushant S, Raut S, Kunhiparambath H, Pandey R. Hippocampal Avoidance Whole BRAIN Radiotherapy (HA-WBRT) with Simultaneous Integrated BOOST (SIB) vs. HA-WBRT in Multiple Brain Metastases: A Dosimetric Comparison. Int J Radiat Oncol Biol Phys 2023; 117:e147-e148. [PMID: 37784727 DOI: 10.1016/j.ijrobp.2023.06.964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) There has been a paradigm shift in managing multiple brain metastases. Various options include SRS, WBRT, and WBRT with Hippocampal avoidance (HA-WBRT). There is no consensus for the treatment of multiple brain metastases (>3 brain metastases). A new technique that has proven feasible is dose escalation in the form of simultaneous integrated boost. The aim of this study was to compare the dosimetry parameters of HA-WBRT plus simultaneous integrated boost versus HA-WBRT alone in multiple brain metastases. MATERIALS/METHODS In a prospective trial,16 patients with multiple brain metastasis (≥ 3) from various primaries with good performance scores (ECOG PS ≤ 2) are recruited. All patients underwent CT simulation (1.5 mm slice thickness) and RT plans for HA-WBRT with (SIB) and HA-WBRT alone were made. A 5 mm margin was given to the bilateral hippocampus for Hippocampal Avoidance. In the HA-WBRT plan for the PTV i.e., whole brain plus 3 mm margin minus hippocampal avoidance region (H.A.), a dose of 30 Gy in 10 fractions is prescribed over two weeks. In HA-WBRT with SIB, a dose of 30 Gy in 10 fractions over two weeks is prescribed for the PTV, which is the clinical target volume, minus the hippocampal avoidance region (H.A.) minus the PTV Mets (1 mm margin to the GTV). A simultaneous Integrated Boost of 42.5 Gy in 10 # over two weeks is prescribed for PTVmets. Planning was done using a VMAT technique with 6MV F.F.F. beam energy in a treatment planning software. RESULTS The mean B/L hippocampus volume is 3.47 cc. The mean dose of PTV D98% in HA-WBRT plans is 27.45 Gy, whereas in HA-WBRT with S.I.B. is 27.36 Gy (p = 0.90). V30 mean dose in HA-WBRT plans is 93.35%, and the mean dose in HA-WBRT SIB is 91.87% (p = 0.12). PTV D2% mean dose in HA-WBRT Is 36.06 Gy, and in HA-WBRT -S.I.B., it is 40.58 (p< 0.001). The mean bilateral hippocampus Dmax in HA-WBRT is 14.85 Gy, and in HA-WBRT-SIB is 14.25 Gy (p = 0.35). The mean Bilateral hippocampus D100% is 9.14 Gy in HA-WBRT and 9.01 Gy in HA-WBRT-SIB (p = 0.54). The mean brainstem Dmax in HA-WBRT is 36.82 Gy compared to 38.55 Gy in HA-WBRT-SIB (p = 0.02). CONCLUSION In patients planned for a simultaneous boost along with hippocampal sparing whole brain radiotherapy, the mean dose to the hippocampal region did not increase. The Dmax of Brainstem, optic chiasma is significantly higher in HA-WBRT-). Our study, the mean dose to PTVmets is more than 45 Gy and more than 50 Gy to GTV with a BED of more than 65 Gy (α/ß = 10) to the metastases, which is equivalent to some ablative dose regimens. Simultaneous integrated boost along with hippocampal sparing radiotherapy thus helps in sparing the hippocampus and delivering higher doses to the metastases and intermediate doses to the rest of the brain, addressing the microscopic disease.
Collapse
Affiliation(s)
- S K Samala
- All India Institute of Medical Sciences, New Delhi, India
| | - S Gupta
- All India Institute of Medical Sciences, Delhi, India
| | - S Sharma
- All India Institute of Medical Sciences, New Delhi, India
| | - J Pattanaik
- All India Institute of Medical Sciences, New Delhi, India
| | - S Pandey
- All India Institute of Medical Sciences, New Delhi, India
| | - S Sushant
- All India Institute of Medical Sciences, New Delhi, India
| | - S Raut
- All India Institute of Medical Sciences, Delhi, India
| | | | - R Pandey
- All India Institute of Medical Sciences, New Delhi, India
| |
Collapse
|
31
|
Pandey S, Pareek V, Kumar R, Gupta A, Kunhiparambath H, Shalimar, Gamanagatti S, Gupta S, Sharma S, Binjola A, Kumar R, Pattanaik J, Praveen DVS, Sanyal S, Tanwar MS, Yadavalli P, Goel V, Roy S, Das N, Sisodiya R. Role of Stereotactic Body Radiation Therapy in Portal Vein Tumor Thrombosis in Hepatocellular Carcinoma: A Prospective Single Institute Experience. Int J Radiat Oncol Biol Phys 2023; 117:e330-e331. [PMID: 37785168 DOI: 10.1016/j.ijrobp.2023.06.2381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Patients diagnosed with Hepatocellular carcinoma (HCC) complicated with portal vein tumor thrombosis (PVTT) have a limited number of treatment options available and are associated with an overall poor prognosis. With the recent developments in the field of radiation therapy, the role of radiotherapy particularly Stereotactic Body radiotherapy (SBRT) has increased as a loco-regional therapy for HCC. This study was planned to evaluate the role of SBRT in Locally advanced HCC complicated with PVTT and its role as loco-regional therapy. MATERIALS/METHODS We conducted a prospective study that included patients diagnosed with HCC complicated with PVTT Child-Turcotte Pugh (CTP) Class A/B with a maximum score of 7, diagnosed on triple phase Contrast-Enhanced - MRI unsuitable for other ablative procedures. Patients with Bilirubin levels > 4 mg/dl, active Hepatitis, CTP score >7, normal liver volume <700cc or history of prior radiotherapy were excluded from the study. Patients underwent a contrast enhanced 4D-CT simulation with abdominal compression and were planned for SBRT using VMAT technique. Patients were followed-up as per Institute protocol. CECT or MRI for a radiological response was done for response assessment using mRECIST criteria version 1.1. A baseline MRI was done at one-month post-SBRT to understand any RT changes in the liver and to differentiate from tumor progression during the response assessment at three months. RESULTS A total of 22 patients with HCC were recruited and received SBRT to PVTT, with a dosage between 30-42 Gy over 6 fractions treated on alternate days. Patients were assessed post-treatment with triphasic CE-MRI every 3 months as per institute protocol. Five patients had achieved Complete response in form of Portal vein recanalization. Three patients had Partial response to the treatment. Seven patients maintained stable disease status whereas six patients had disease progression during the entire course of treatment. The response rate (CR+PR) to treatment was 36.3% at the time of analysis. The Overall Response rate (CR+PR+SD) was 69%. No grade 3 or 4 toxicities were observed and treatment was tolerated well by patients. Kaplan-Meier method was applied to calculate the survival probability at various follow-up intervals. The median time for overall survival was 25 months ((95% CI: 15-35). Out of the 22 subjects included in the study, 6 patients died. There was a 78% survival probability at 12 months and a 68% survival probability at 18 months of follow-up. CONCLUSION This prospective single-arm study demonstrated the vital role of SBRT in the treatment of Hepatocellular carcinoma with Portal vein tumor thrombosis and its efficacy in terms of achieving excellent local control with relatively lesser toxicities compared with existing treatment modalities. Patients have shown benefit post-treatment in terms of thrombus reduction and restoration of Portal vein flow making them suitable for further treatment like Resection or TACE.
Collapse
Affiliation(s)
- S Pandey
- All India Institute of Medical Sciences, New Delhi, India
| | - V Pareek
- All India Institute of Medical Sciences, New Delhi, India
| | - R Kumar
- All India Institute of Medical Sciences, New Delhi, India
| | - A Gupta
- All India Institute of Medical Sciences, New Delhi, India
| | | | - Shalimar
- All India Institute of Medical Sciences, New Delhi, India
| | - S Gamanagatti
- All India Institute of Medical Sciences, New Delhi, India
| | - S Gupta
- All India Institute of Medical Sciences, New Delhi, India
| | - S Sharma
- All India Institute of Medical Sciences, New Delhi, India
| | - A Binjola
- All India Institute of Medical Sciences, New Delhi, India
| | - R Kumar
- All India Institute of Medical Sciences, Delhi Cancer Registry, New Delhi, India
| | - J Pattanaik
- All India Institute of Medical Sciences, New Delhi, India
| | - D V S Praveen
- All India Institute of Medical Sciences, New Delhi, India
| | - S Sanyal
- All India Institute of Medical Sciences, New Delhi, India
| | - M S Tanwar
- All India Institute of Medical Sciences, New Delhi, India
| | - P Yadavalli
- All India Institute of Medical Sciences, New Delhi, India
| | - V Goel
- All India Institute of Medical Sciences, New Delhi, India
| | - S Roy
- All India Institute of Medical Sciences, New Delhi, India
| | - N Das
- All India Institute of Medical Sciences, New Delhi, India
| | - R Sisodiya
- All India Institute of Medical Sciences, New Delhi, India
| |
Collapse
|
32
|
Sushant S, Sharma DN, Pandey R, Saini SK, Sanyal S, Pattanaik J, Samala SK, Praveen DVS, Tanwar MS, Pandey S, Mandal S, Solanky AP, Sisodiya R, Ghosh A, Dagar A, Shukla BD, Gupta T, Gupta S, Rana P, Mounika G. Multiple Sessions vs. Single Session Image-Based Intracavitary Brachytherapy for Locally Advanced Cervical Cancer: A Randomized Control Trial. Int J Radiat Oncol Biol Phys 2023; 117:S41-S42. [PMID: 37784495 DOI: 10.1016/j.ijrobp.2023.06.314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) The objectives of this study are: 1) To compare the acute toxicity caused in the treatment of locally advanced cervical cancer (LACC) treated with weekly multiple applications vs. a single application for image-guided intracavitary High Dose Rate (HDR) brachytherapy (BT) after External Beam Radiation Therapy (EBRT) 2) To compare the loco-regional control of cancer at six months in the two arms MATERIALS/METHODS: In a prospective study, 40 patients with biopsy-proven LACC with FIGO-2018 stage IIB-IIIC1 disease, underwent EBRT to the pelvis at a dose of 50.4 Gy/ 28 fractions over 5.5 weeks with weekly concurrent cisplatin. After completion of EBRT, they were randomized into two arms with 20 patients each. In the Control arm (Arm-A), BT sessions were given with weekly 3 applications whereas, in the experimental arm (Arm-B), all the sessions were given with a single application at 6-12 hours intervals with aim of the high-risk clinical target volume receiving >80 Gy EQD2 and 2 cm3 of the bladder and rectum/sigmoid receiving <85 Gy and <75 Gy, respectively. The OAR contouring was done on CT RESULTS: All 40 patients were treated as per protocol. The mean duration of treatment including EBRT and BT was 73.15 days [95% CI 68.63-77.66] in Arm A and 55.85 days [95% CI 52.11-59.58] in Arm B which was significant. After 6 months, 37 patients came for follow-up, all 19 patients in Arm A had Grade 1 or Grade 2 rectal toxicity. In Arm B as well all 18 patients had Grade 1 or Grade 2 rectal toxicity. Bladder toxicity was Grade 1 or Grade 2 in 18 patients and Grade 3 severity in 1 patient among Arm A. Among 18 patients of Arm B, bladder toxicity of Grade 1 or Grade 2 was seen in 16 patients, and 2 patients had grade 3 toxicity. 2 patients in Arm A and 3 in Arm B complained of Grade 1 urinary incontinence. Moreover, Abdominal pain at 6 months was of Grade 1 in around 6 patients in Arm A but 14 patients had abdominal pain in Arm B which was of Grade 1 in 8, 4 had grade 2 and 2 patients had grade 3 severity abdominal pain. In the monthly analysis of acute toxicity, none of the patients showed Grade 3 or 4 toxicity at the 1st, 2nd, or 3rd month of completion of treatment. When comparing local control in both arms at 6 months, 2 patients had treatment failure in the Experimental Arm compared to only 1 patient in the Control Arm CONCLUSION: Single Application Multiple Fraction Intracavitary Brachytherapy post concurrent CTRT is a safe option for the treatment of locally advanced cervical cancer. When compared to the weekly application arm, single-application ICRT showed a comparable acute toxicity profile and comparable local control rates as well. Some patients in Single Application Arm showed abdominal pain which needs to be investigated with further trials. The overall treatment time in the single application arm is significantly lower than the standard weekly application arm.
Collapse
Affiliation(s)
- S Sushant
- All India Institute of Medical Sciences, New Delhi, India
| | - D N Sharma
- All India Institute of Medical Sciences, New Delhi, India
| | - R Pandey
- All India Institute of Medical Sciences, New Delhi, India
| | - S K Saini
- All India Institute of Medical Sciences, New Delhi, India
| | - S Sanyal
- All India Institute of Medical Sciences, New Delhi, India
| | - J Pattanaik
- All India Institute of Medical Sciences, New Delhi, India
| | - S K Samala
- All India Institute of Medical Sciences, New Delhi, India
| | - D V S Praveen
- All India Institute of Medical Sciences, New Delhi, India
| | - M S Tanwar
- All India Institute of Medical Sciences, New Delhi, India
| | - S Pandey
- All India Institute of Medical Sciences, New Delhi, India
| | - S Mandal
- All India Institute of Medical Sciences, New Delhi, India
| | - A P Solanky
- All India Institute of Medical Sciences, New Delhi, India
| | - R Sisodiya
- All India Institute of Medical Sciences, New Delhi, India
| | - A Ghosh
- National Cancer Institute, AIIMS, Jhajjar, India
| | - A Dagar
- National Cancer Institute, AIIMS, Jhajjar, India
| | - B D Shukla
- All India Institute of Medical Sciences, New Delhi, India
| | - T Gupta
- All India Institute of Medical Sciences, New Delhi, India
| | - S Gupta
- All India Institute of Medical Sciences, New Delhi, India
| | - P Rana
- All India Institute of Medical Sciences, New Delhi, India
| | - G Mounika
- All India Institute of Medical Sciences, New Delhi, India
| |
Collapse
|
33
|
Pandey S, Pareek V, Kumar R, Gupta A, Kunhiparambath H, Shalimar, Gamanagatti S, Gupta S, Sharma A, Sharma S, Binjola A, Kumar R, Pattanaik J, Sanyal S, Praveen DVS, Tanwar MS, Mandal S, Shyam G, Das N, Goel V. Biological Response Assessment in Hepatocellular Carcinoma Post Stereotactic Body Radiotherapy. Int J Radiat Oncol Biol Phys 2023; 117:e331. [PMID: 37785169 DOI: 10.1016/j.ijrobp.2023.06.2382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Biological Response in Hepatocellular carcinoma (HCC) is measured in terms of serum alpha-fetoprotein (AFP) which is elevated in nearly 60% HCC patients at baseline and is directly related to the severity of the disease. This biological response is defined as the reduction of more than 50% from the baseline levels and is associated with an increased percentage of tumor necrosis and is directly related to increased loco-regional control. Patients diagnosed with HCC have very limited treatment modalities. With the recent advances in the field of radiation therapy and the development of Stereotactic Body radiotherapy (SBRT), the role of radiotherapy has increased as a loco-regional modality for HCC. In this single-arm prospective study, we evaluated the biological response post-SBRT in patients diagnosed with HCC. MATERIALS/METHODS We conducted a prospective study that included patients diagnosed with HCC with baseline elevation of serum AFP, Child-Turcotte Pugh (CTP) Class A/B with a maximum score of 7. Patient's serum AFP levels were recorded at baseline, pre-treatment, and post-treatment. The biological response was measured at 3 months post-treatment and compared with the baseline serum AFP levels using Wilcoxon signed rank test. RESULTS A total of 14 patients with HCC were recruited and received SBRT to the target lesion, with a dose between 30-42 Gy over 6 fractions treated on alternate days. Patients were assessed post-treatment at one month with triphasic CEMRI and serum AFP levels. 12 out of 14 patients (85.71%) had a biological response at 3 months follow-up and levels showed further decline unless a progression was found. The median (IQR) serum AFP level was 1131 ng/ml (359-5668 ng/ml) at baseline. Post-treatment serum AFP levels had a median (IQR) value of 156 ng/ml (15-372 ng/ml) showing a near reduction of 86% from baseline, which was significant. 2/14 pts (14.28%) showed no reduction or even increase in serum AFP levels post-treatment. CONCLUSION This prospective single-arm study demonstrated the vital role of SBRT in the treatment of HCC and its importance in achieving a better disease control. The response was achieved in 86% of patients with marked reduction of nearly 90% in serum AFP levels as compared to the baseline and increased median OS and PFS as compared to patients not receiving radiotherapy. Further prospective studies are warranted to confirm our findings.
Collapse
Affiliation(s)
- S Pandey
- All India Institute of Medical Sciences, New Delhi, India
| | - V Pareek
- All India Institute of Medical Sciences, New Delhi, India
| | - R Kumar
- All India Institute of Medical Sciences, New Delhi, India
| | - A Gupta
- All India Institute of Medical Sciences, New Delhi, India
| | | | - Shalimar
- All India Institute of Medical Sciences, New Delhi, India
| | - S Gamanagatti
- All India Institute of Medical Sciences, New Delhi, India
| | - S Gupta
- All India Institute of Medical Sciences, New Delhi, India
| | - A Sharma
- All India Institute of Medical Sciences, New Delhi, India
| | - S Sharma
- All India Institute of Medical Sciences, New Delhi, India
| | - A Binjola
- All India Institute of Medical Sciences, New Delhi, India
| | - R Kumar
- All India Institute of Medical Sciences, Delhi Cancer Registry, New Delhi, India
| | - J Pattanaik
- All India Institute of Medical Sciences, New Delhi, India
| | - S Sanyal
- All India Institute of Medical Sciences, New Delhi, India
| | - D V S Praveen
- All India Institute of Medical Sciences, New Delhi, India
| | - M S Tanwar
- All India Institute of Medical Sciences, New Delhi, India
| | - S Mandal
- All India Institute of Medical Sciences, New Delhi, India
| | - G Shyam
- All India Institute of Medical Sciences, New Delhi, India
| | - N Das
- All India Institute of Medical Sciences, New Delhi, India
| | - V Goel
- All India Institute of Medical Sciences, New Delhi, India
| |
Collapse
|
34
|
Vuong W, Gupta S, Weight C, Almassi N, Nikolaev A, Tendulkar RD, Scott JG, Chan TA, Mian OY. Trial in Progress: Adaptive RADiation Therapy with Concurrent Sacituzumab Govitecan (SG) for Bladder Preservation in Patients with MIBC (RAD-SG). Int J Radiat Oncol Biol Phys 2023; 117:e447-e448. [PMID: 37785443 DOI: 10.1016/j.ijrobp.2023.06.1630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) A substantial proportion of patients with muscle invasive bladder cancer do not receive curative intent therapy, especially if unfit for or refuse radical cystectomy. Concurrent chemoradiation is an effective alternative to radical cystectomy, however systemic radio-sensitizing chemotherapy may have off target side effects. A Phase I study is accruing which will investigate the concurrent administration of a bladder cancer targeted antibody drug conjugate (Sacituzumab Govitecan) with radiotherapy. MATERIALS/METHODS This trial in progress is a Phase I study of Adaptive RADiation therapy with concurrent Sacituzumab Govitecan (SG) for bladder preservation in patients with muscle invasive bladder cancer (MIBC). Eligible patients will have localized muscle invasive bladder cancer (MIBC) confined to the bladder. The initial cohort is expected to accrue 20 patients. The primary endpoint is to establish the safety, tolerability, and feasibility of bladder preservation therapy treatment with concurrent SG and adaptive image-guided radiation therapy for patients with localized MIBC. The secondary endpoints are to determine the bladder intact event-free survival (BI-EFS) with concurrent SG and radiation therapy for MIBC and compare to historical controls with other concurrent chemoradiation regimens. BI-EFS is defined as the time from treatment to the first documented occurrence of residual/recurrent MIBC, nodal or distant metastases on imaging, radical cystectomy, or death from any cause. Sacituzumab Govitecan targets TROP-2, a surface protein expressed in urothelial cancers of the bladder. SG will be delivered IV, 10 mg/kg, 21-day cycles for 1 loading cycle prior to radiation and two subsequent cycles with concurrent adaptive radiotherapy over a period of 6 weeks (64 Gy). Correlative objectives (Supported by NCI/NIH U54) and will involve 1) elucidation of the genetic and microenvironmental mechanisms that drive efficacy and resistance to combined ADC plus radiation therapy and 2) characterization of tumor clonal dynamics, immune repertoire editing, and imaging changes following treatment with SG plus radiation. RESULTS To be determined. CONCLUSION To be determined.
Collapse
Affiliation(s)
- W Vuong
- Cleveland Clinic Foundation, Cleveland, OH
| | - S Gupta
- Dept of Solid Tumor Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH
| | - C Weight
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH
| | - N Almassi
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH
| | - A Nikolaev
- Cleveland Clinic Florida, Weston, FL, United States
| | - R D Tendulkar
- Dept of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH
| | | | - T A Chan
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH
| | - O Y Mian
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH
| |
Collapse
|
35
|
Gupta S, Singal G, Garg D, Jagannathan S. QC_SANE: Robust Control in DRL Using Quantile Critic With Spiking Actor and Normalized Ensemble. IEEE Trans Neural Netw Learn Syst 2023; 34:6656-6662. [PMID: 34874871 DOI: 10.1109/tnnls.2021.3129525] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Recently introduced deep reinforcement learning (DRL) techniques in discrete-time have resulted in significant advances in online games, robotics, and so on. Inspired from recent developments, we have proposed an approach referred to as Quantile Critic with Spiking Actor and Normalized Ensemble (QC_SANE) for continuous control problems, which uses quantile loss to train critic and a spiking neural network (NN) to train an ensemble of actors. The NN does an internal normalization using a scaled exponential linear unit (SELU) activation function and ensures robustness. The empirical study on multijoint dynamics with contact (MuJoCo)-based environments shows improved training and test results than the state-of-the-art approach: population coded spiking actor network (PopSAN).
Collapse
|
36
|
Gupta S, Devi A, Kamboj M, Hooda A, Narwal AJ. Knowledge, awareness and attitude of dental professionals regarding child maltreatment. J Forensic Odontostomatol 2023; 41:10-20. [PMID: 37634172 PMCID: PMC10473458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 08/29/2023]
Abstract
BACKGROUND Dental professionals could play a significant role in identifying, documenting and reporting child maltreatment to appropriate authorities as children are exposed to various maltreatments that can present in the head and neck region. AIM The aim of this paper is to assess the level of knowledge, awareness and attitude among dental professionals regarding child maltreatment and to identify the barriers that prevent reporting suspected maltreatment. METHODOLOGY The present cross-sectional questionnaire-based study was conducted on dental professionals practising in India by emailing a self-structured questionnaire to assess knowledge, awareness and attitude regarding child maltreatment. RESULTS 422 dental professionals participated in the survey of which 270 were females. A significant difference was observed in mean knowledge (p=.015), awareness (p=.014) score of the participants with regard to place of work and mean knowledge score (p=.024) of the participants with regard to educational qualification. 300 participants reported that lack of adequate knowledge and awareness about the role of dental professionals regarding child maltreatment is one of the major barriers that prevent reporting child maltreatment. CONCLUSION Findings of the study showed that 43.8% of participants had good knowledge and 44.8% were fairly aware regarding child maltreatment. 86.7% of participants showed a very good attitude towards learning more about the role of dental professionals in the management of child maltreatment.
Collapse
Affiliation(s)
- S Gupta
- Dept. of Oral Anatomy, Post Graduate Institute of Dental Sciences, Rohtak, Haryana, India
| | - A Devi
- Dept. of Oral Pathology, Post Graduate Institute of Dental Sciences, Rohtak, Haryana, India
| | - M Kamboj
- Dept. of Oral Pathology, Post Graduate Institute of Dental Sciences, Rohtak, Haryana, India
| | - A Hooda
- Dept. of Oral Anatomy, Post Graduate Institute of Dental Sciences, Rohtak, Haryana, India
| | - A J Narwal
- Dept. of Oral Pathology, Post Graduate Institute of Dental Sciences, Rohtak, Haryana, India
| |
Collapse
|
37
|
Satchell N, Gupta S, Maheshwari M, Shepley PM, Rogers M, Cespedes O, Burnell G. Thin film epitaxial [111] Co[Formula: see text]Pt[Formula: see text]: structure, magnetisation, and spin polarisation. Sci Rep 2023; 13:12468. [PMID: 37528131 PMCID: PMC10394051 DOI: 10.1038/s41598-023-37825-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 06/28/2023] [Indexed: 08/03/2023] Open
Abstract
Ferromagnetic films with perpendicular magnetic anisotropy are of interest in spintronics and superconducting spintronics. Perpendicular magnetic anisotropy can be achieved in thin ferromagnetic multilayer structures, when the anisotropy is driven by carefully engineered interfaces. Devices with multiple interfaces are disadvantageous for our application in superconducting spintronics, where the current perpendicular to plane is affected by the interfaces. Robust intrinsic PMA can be achieved in certain Co[Formula: see text]Pt[Formula: see text] alloys and compounds at any thickness, without increasing the number of interfaces. Here, we grow equiatomic Co[Formula: see text]Pt[Formula: see text] and report a comprehensive study on the structural, magnetic, and spin-polarisation properties in the [Formula: see text] and [Formula: see text] ordered compounds. Primarily, interest in Co[Formula: see text]Pt[Formula: see text] has been in the [Formula: see text] crystal structure, where layers of Pt and Co are stacked alternately in the [100] direction. There has been less work on [Formula: see text] crystal structure, where the stacking is in the [111] direction. For the latter [Formula: see text] crystal structure, we find magnetic anisotropy perpendicular to the film plane. For the former [Formula: see text] crystal structure, the magnetic anisotropy is perpendicular to the [100] plane, which is neither in-plane or out-of-plane in our samples. We obtain a value for the ballistic spin polarisation of the [Formula: see text] and [Formula: see text] Co[Formula: see text]Pt[Formula: see text] to be [Formula: see text].
Collapse
Affiliation(s)
- N. Satchell
- School of Physics and Astronomy, University of Leeds, Leeds, LS2 9JT UK
| | - S. Gupta
- School of Physics and Astronomy, University of Leeds, Leeds, LS2 9JT UK
| | - M. Maheshwari
- School of Physics and Astronomy, University of Leeds, Leeds, LS2 9JT UK
| | - P. M. Shepley
- School of Physics and Astronomy, University of Leeds, Leeds, LS2 9JT UK
| | - M. Rogers
- School of Physics and Astronomy, University of Leeds, Leeds, LS2 9JT UK
| | - O. Cespedes
- School of Physics and Astronomy, University of Leeds, Leeds, LS2 9JT UK
| | - G. Burnell
- School of Physics and Astronomy, University of Leeds, Leeds, LS2 9JT UK
| |
Collapse
|
38
|
Mohd J, Bhat NA, Lone ZA, Bhat TA, Afzal T, Dev B, Butt MF, Gupta S. Outcome of a Simple Novel Technique to Reduce Soft Tissue Complications in Open Tendoachilles Injury: A Series of 20 Patients. Malays Orthop J 2023; 17:49-56. [PMID: 37583530 PMCID: PMC10424994 DOI: 10.5704/moj.2307.008] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Accepted: 12/06/2022] [Indexed: 08/17/2023] Open
Abstract
Introduction Open tendoachilles injuries are rare and associated with significant soft tissues complications. The objective of the present study was to assess the clinical outcome and safety of a simple and minimally invasive technique, with a goal to assess if it may help minimise flap and wound related complications in open tendoachilles injuries. Materials and methods This prospective study of four years duration included 20 patients with open tendoachilles injuries managed with a simple minimally invasive tunnel technique. The primary outcome variable was occurrence of a major soft tissue complication. The secondary outcome variables included functional outcome measured using AOFAS Ankle hind foot score, re-rupture of tendoachilles and need for revision surgery. Results None of the patients in the present series developed a serious soft tissue complication. Based upon the AOFAS hind foot scoring system, good to excellent outcome was achieved in 19 (95%) patients. All the patients were able to perform tip toe walking at six months post-surgery. None of the patients had a re-rupture of the tendoachilles and no patient needed a revision surgery. The complications encountered include thickening of the tendon at the repair site (15%), superficial wound infection (5%), stitch granuloma (5%) and hypertrophic scar (5%). Conclusion This technique seems to be promising in reducing the soft tissue complications associated with the surgical management of open tendoachilles injuries. Most patients had a good final clinical outcome. The technique is safe, simple and reproducible. However, further randomised control studies with a larger sample size assessing the technique are recommended.
Collapse
Affiliation(s)
- J Mohd
- Department of Orthopaedics, Government Medical College Anantnag, Anantnag, India
| | - N A Bhat
- Department of Orthopaedics, Government Medical College Anantnag, Anantnag, India
| | - Z A Lone
- Department of Orthopaedics, Government Medical College Jammu, Jammu, India
| | - T A Bhat
- Department of Orthopaedics, Government Medical College Jammu, Jammu, India
| | - T Afzal
- Department of Orthopaedics, Government Medical College Jammu, Jammu, India
| | - B Dev
- Department of Orthopaedics, Government Medical College Jammu, Jammu, India
| | - M F Butt
- Department of Orthopaedics, Government Medical College Jammu, Jammu, India
| | - S Gupta
- Department of Orthopaedics, Government Medical College Jammu, Jammu, India
| |
Collapse
|
39
|
Patel M G, Nidhi , Gupta K, Gupta M, Gupta S, Krupa S. THE IMPACT OF CLIMATE CHANGE ON INFECTIOUS DISEASES: A COMPREHENSIVE ANALYSIS OF VECTOR-BORNE DISEASES, WATER-BORNE DISEASES, AND PUBLIC HEALTH STRATEGIES. Georgian Med News 2023:136-142. [PMID: 37805887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 10/09/2023]
Abstract
Climate change is long-term modifications to weather patterns and a rise in extreme weather events. It might modify the hazard to human health and exacerbate current problems. The article explores the scientific data in a description of the effects of Infectious diseases in humans and climate change. It identifies scientific advancements and gaps in potential responses from human civilization and how it might prepare for the changes that come with it by adjusting to them. The impact reflects three aspects, such as climate variables, selected infectious diseases, and infectious disease components. This study demonstrates how vulnerable people are to any ill consequences that climate change may have on their health. Humans can actively influence controllable correlated health impacts by taking proactive measures, such as increasing our understanding of the detrimental effects associated with specific diseases and the patterns in climate change. We can also carefully distribute technology and resources, encouraging exercise and public awareness. It is advised to take the following adaption measures: Considering how infectious diseases and climate change are not the only things that science has discovered and create locally efficient early warning systems for those effects to produce more scientific justifications and go beyond scientific reports. Improve prediction of the spatiotemporal processes behind climate change and changes in infectious illnesses connected at different temporal and spatial scales.
Collapse
Affiliation(s)
- G Patel M
- 1Department of Community Medicine, Parul University, PO Limda, Tal.Waghodia, District Vadodara, Gujarat, India
| | - - Nidhi
- 2Department of Nursing, IIMT University, Meerut, Uttar Pradesh, India
| | - K Gupta
- 3Department of Ayurveda, Sanskriti University, Mathura, Uttar Pradesh, India
| | - M Gupta
- 4Department of Pharmacy, Vivekananda Global University, Jaipur, India
| | - S Gupta
- 5Department of Community Medicine, TeerthankerMahaveer University, Moradabad, Uttar Pradesh, India
| | - S Krupa
- 6Department of Chemistry & Biochemistry, School of Sciences, JAIN (Deemed-to-be University), Karnataka, India
| |
Collapse
|
40
|
Rajani AM, Shah UA, Mittal A, Gupta S, Garg R, Rajani AA, Punamiya M, Singhal R. AMR Sign - An Arthroscopic S-shaped Fold Signifying Adequate Medial Meniscus Repair. Malays Orthop J 2023; 17:13-20. [PMID: 37583526 PMCID: PMC10425007 DOI: 10.5704/moj.2307.003] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 09/03/2022] [Indexed: 08/17/2023] Open
Abstract
Introduction The preferred management of medial meniscus tears has notably moved from meniscectomies towards repair. With a higher volume of meniscal repairs being done all across the world with every passing day, the lack of an objective and definitive sign suggesting the adequacy of its repair is daunting. The purpose of our study was to introduce a unique and novel arthroscopic sign formed after adequate repair of the medial meniscus, the AMR (Adequacy of Medial meniscus Repair) sign. We hypothesised that it is not only the objective end point for repair, but can also form the indicator for excellent clinical, functional, and radiological outcome even in the long term. Materials and methods This was a multicentric, prospective study initiated by the corresponding author, and the findings validated subsequently by the other authors. Overall, it included 804 patients of isolated medial meniscus tear operated with arthroscopic all-inside technique between January 2014 and December 2017. Patients were segregated into three groups based on whether an S-shaped curve in the free, inner edge of the medial meniscus sign was formed post-repair, lost after further tightening, or not formed upon subjective completion of repair. All the patients were followed-up and evaluated based of medial joint line tenderness, McMurray's test for medial meniscus, IKDC score, WOMET score, and radiologically using an MRI at the terminal follow-up. Results The mean terminal follow-up was 42.34±4.54 months. There was significant (p<0.01) improvement in all patients at the terminal follow-up post-surgery, irrespective of the group. The group in which AMR sign was formed and maintained showed a significantly better functional outcome on terminal follow-up as well as lower failure rates compared to the other two groups. Conclusion AMR sign is an S-shaped fold at the inner, free edge of medial meniscus, formed after an adequate repair of isolated medial meniscus tear, as viewed on arthroscopy. It is an objective sign denoting regained integrity of the collagen architecture of the medial meniscus following repair. It is also a reliable indicator of excellent long term functional, clinical, and radiological outcome and also lower failure rates in patients after arthroscopic medial meniscus repair.
Collapse
Affiliation(s)
- A M Rajani
- Department of Orthopaedics, Breach Candy Hospital Trust, Mumbai, India
| | - U A Shah
- Department of Orthopaedics, Surgikids Hospital, Ahmedabad, India
| | - Ars Mittal
- Department of Orthopaedics, Orthopaedic Arthroscopy Knee and Shoulder Clinic, Mumbai, India
| | - S Gupta
- Department of Orthopaedics, Galaxy Hospital, Bhopal, India
| | - R Garg
- Department of Orthopaedics, Canadian Specialist Hospital, Dubai, United Arab Emirates
| | - A A Rajani
- Department of Radiology, Orthopaedic Arthroscopy Knee and Shoulder Clinic, Mumbai, India
| | - M Punamiya
- Department of Physiotherapy, Orthopaedic Arthroscopy Knee and Shoulder Clinic, Mumbai, India
| | - R Singhal
- Department of Biostatistics, Orthopaedic Arthroscopy Knee and Shoulder Clinic, Mumbai, India
| |
Collapse
|
41
|
Gupta S, Mishra A, Singh S. Corrigendum to "Cardinal role of eukaryotic initiation factor 2 (eIF2α) in progressive dopaminergic neuronal death & DNA fragmentation : implication of PERK:IRE1α:ATF6 axis in Parkinson's pathology" [Cell Signal (2021) 109922]. Cell Signal 2023:110765. [PMID: 37331864 DOI: 10.1016/j.cellsig.2023.110765] [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: 06/20/2023]
Affiliation(s)
- S Gupta
- Department of Neuroscience and Ageing Biology, Division of Toxicology and Experimental Medicine, CSIR-Central Drug Research Institute, Lucknow 226031, India; Academy of Scientific & Innovative Research (AcSIR), CSIR-Central Drug Research Institute, India
| | - A Mishra
- Cellular and Molecular Neurobiology Unit, Indian Institute of Technology, Jodhpur, Rajasthan 342011, India
| | - S Singh
- Department of Neuroscience and Ageing Biology, Division of Toxicology and Experimental Medicine, CSIR-Central Drug Research Institute, Lucknow 226031, India; Academy of Scientific & Innovative Research (AcSIR), CSIR-Central Drug Research Institute, India.
| |
Collapse
|
42
|
Im SA, Gennari A, Park YH, Kim JH, Jiang ZF, Gupta S, Fadjari TH, Tamura K, Mastura MY, Abesamis-Tiambeng MLT, Lim EH, Lin CH, Sookprasert A, Parinyanitikul N, Tseng LM, Lee SC, Caguioa P, Singh M, Naito Y, Hukom RA, Smruti BK, Wang SS, Kim SB, Lee KH, Ahn HK, Peters S, Kim TW, Yoshino T, Pentheroudakis G, Curigliano G, Harbeck N. Pan-Asian adapted ESMO Clinical Practice Guidelines for the diagnosis, staging and treatment of patients with metastatic breast cancer. ESMO Open 2023; 8:101541. [PMID: 37178669 PMCID: PMC10186487 DOI: 10.1016/j.esmoop.2023.101541] [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: 09/27/2022] [Revised: 03/27/2023] [Accepted: 04/01/2023] [Indexed: 05/15/2023] Open
Abstract
The most recent version of the European Society for Medical Oncology (ESMO) Clinical Practice Guidelines for the diagnosis, staging and treatment of patients with metastatic breast cancer (MBC) was published in 2021. A special, hybrid guidelines meeting was convened by ESMO and the Korean Society of Medical Oncology (KSMO) in collaboration with nine other Asian national oncology societies in May 2022 in order to adapt the ESMO 2021 guidelines to take into account the differences associated with the treatment of MBC in Asia. These guidelines represent the consensus opinions reached by a panel of Asian experts in the treatment of patients with MBC representing the oncological societies of China (CSCO), India (ISMPO), Indonesia (ISHMO), Japan (JSMO), Korea (KSMO), Malaysia (MOS), the Philippines (PSMO), Singapore (SSO), Taiwan (TOS) and Thailand (TSCO). The voting was based on the best available scientific evidence and was independent of drug access or practice restrictions in the different Asian countries. The latter were discussed when appropriate. The aim of these guidelines is to provide guidance for the harmonisation of the management of patients with MBC across the different regions of Asia, drawing from data provided by global and Asian trials whilst at the same time integrating the differences in genetics, demographics and scientific evidence, together with restricted access to certain therapeutic strategies.
Collapse
Affiliation(s)
- S-A Im
- Department of Internal Medicine, Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine, Seoul National University, Seoul, Republic of Korea.
| | - A Gennari
- Department of Translational Medicine, University Piemonte Orientale, Novara, Italy
| | - Y H Park
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - J H Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul National University, Seoul, Republic of Korea
| | - Z-F Jiang
- Department of Oncology, The Fifth Medical Center of PLA General Hospital, Beijing, China
| | - S Gupta
- Tata Memorial Centre and Homi Bhabha National Institute, Mumbai, India
| | - T H Fadjari
- Department of Internal Medicine, Hasan Sadikin General Hospital, Bandung, Indonesia
| | - K Tamura
- Department of Medical Oncology, Shimane University Hospital, Shimane, Japan
| | - M Y Mastura
- Cancer Centre, Pantai Hospital Kuala Lumpur, Kuala Lumpur, Malaysia
| | - M L T Abesamis-Tiambeng
- Section of Medical Oncology, Department of Internal Medicine, Cardinal Santos Cancer Center, San Juan, The Philippines
| | - E H Lim
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore
| | - C-H Lin
- Department of Medical Oncology, National Taiwan University Hospital, Cancer Center Branch, Taipei, Taiwan
| | - A Sookprasert
- Department of Internal Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - N Parinyanitikul
- Medical Oncology Unit, Department of Medicine, Faculty of Medicine, King Chulalongkorn Memorial Hospital and Chulalongkorn University, Bangkok, Thailand
| | - L-M Tseng
- Taipei-Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - S-C Lee
- Department of Haematology-Oncology, National University Cancer Institute, Singapore (NCIS), Singapore, Singapore
| | - P Caguioa
- The Cancer Institute of St Luke's Medical Center, National Capital Region, The Philippines; The Cancer Institute of the University of Santo Tomas Hospital, National Capital Region, The Philippines
| | - M Singh
- Department of Radiotherapy, Pantai Cancer Institute, Pantai Hospital Kuala Lumpur, Kuala Lumpur, Malaysia; Department of Oncology, Pantai Cancer Institute, Pantai Hospital Kuala Lumpur, Kuala Lumpur, Malaysia
| | - Y Naito
- Department of General Internal Medicine, National Cancer Center Hospital East, Kashiwa, Japan
| | - R A Hukom
- Department of Hematology and Medical Oncology, Dharmais Hospital (National Cancer Center), Jakarta, Indonesia
| | - B K Smruti
- Medical Oncology, Lilavati Hospital and Research Centre and Bombay Hospital Institute of Medical Sciences, Mumbai, India
| | - S-S Wang
- Cancer Center, Sun Yat-sen University, Guangzhou, China
| | - S B Kim
- Department of Oncology, Asan Medical Centre, Seoul, Republic of Korea
| | - K-H Lee
- Department of Internal Medicine, Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine, Seoul National University, Seoul, Republic of Korea
| | - H K Ahn
- Division of Medical Oncology, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Republic of Korea
| | - S Peters
- Oncology Department, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - T W Kim
- Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - T Yoshino
- Department of Gastroenterology and Gastrointestinal Oncology, National Cancer Center Hospital East, Kashiwa, Japan
| | | | - G Curigliano
- Istituto Europeo di Oncologia, IRCCS, Milan, Italy; Department of Oncology and Haematology, University of Milano, Milan, Italy
| | - N Harbeck
- Breast Center, Department of Obstetrics and Gynaecology and Comprehensive Cancer Center Munich, LMU University Hospital, Munich, Germany
| |
Collapse
|
43
|
Mohan JR, Mathew AJ, Nishimura K, Feng R, Medwal R, Gupta S, Rawat RS, Fukuma Y. Classification tasks using input driven nonlinear magnetization dynamics in spin Hall oscillator. Sci Rep 2023; 13:7909. [PMID: 37193725 DOI: 10.1038/s41598-023-34849-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 05/09/2023] [Indexed: 05/18/2023] Open
Abstract
The inherent nonlinear magnetization dynamics in spintronic devices make them suitable candidates for neuromorphic hardware. Among spintronic devices, spin torque oscillators such as spin transfer torque oscillators and spin Hall oscillators have shown the capability to perform recognition tasks. In this paper, with the help of micromagnetic simulations, we model and demonstrate that the magnetization dynamics of a single spin Hall oscillator can be nonlinearly transformed by harnessing input pulse streams and can be utilized for classification tasks. The spin Hall oscillator utilizes the microwave spectral characteristics of its magnetization dynamics for processing a binary data input. The spectral change due to the nonlinear magnetization dynamics assists in real-time feature extraction and classification of 4-binary digit input patterns. The performance was tested for the classification of the standard MNIST handwritten digit data set and achieved an accuracy of 83.1% in a simple linear regression model. Our results suggest that modulating time-driven input data can generate diverse magnetization dynamics in the spin Hall oscillator that can be suitable for temporal or sequential information processing.
Collapse
Affiliation(s)
- John Rex Mohan
- Department of Physics and Information Technology, Faculty of Computer Science and Systems Engineering, Kyushu Institute of Technology, Iizuka, 820-8502, Japan
| | - Arun Jacob Mathew
- Department of Physics and Information Technology, Faculty of Computer Science and Systems Engineering, Kyushu Institute of Technology, Iizuka, 820-8502, Japan
| | - Kazuma Nishimura
- Department of Physics and Information Technology, Faculty of Computer Science and Systems Engineering, Kyushu Institute of Technology, Iizuka, 820-8502, Japan
| | - Ruoyan Feng
- Department of Physics and Information Technology, Faculty of Computer Science and Systems Engineering, Kyushu Institute of Technology, Iizuka, 820-8502, Japan
| | - Rohit Medwal
- Natural Sciences and Science Education, National Institute of Education, Nanyang Technological University, Singapore, 637617, Singapore
- Department of Physics, Indian Institute of Technology, Kanpur, 208016, India
| | - Surbhi Gupta
- Natural Sciences and Science Education, National Institute of Education, Nanyang Technological University, Singapore, 637617, Singapore
- Department of Physics, Motilal Nehru National Institute of Technology Allahabad, Prayagraj, 211004, India
| | - Rajdeep Singh Rawat
- Natural Sciences and Science Education, National Institute of Education, Nanyang Technological University, Singapore, 637617, Singapore
| | - Yasuhiro Fukuma
- Department of Physics and Information Technology, Faculty of Computer Science and Systems Engineering, Kyushu Institute of Technology, Iizuka, 820-8502, Japan.
- Research Center for Neuromorphic AI Hardware, Kyushu Institute of Technology, Kitakyushu, 808-0196, Japan.
| |
Collapse
|
44
|
Tubin S, Vozenin M, Prezado Y, Durante M, Prise K, Lara P, Greco C, Massaccesi M, Guha C, Wu X, Mohiuddin M, Vestergaard A, Bassler N, Gupta S, Stock M, Timmerman R. Novel unconventional radiotherapy techniques: Current status and future perspectives - Report from the 2nd international radiation oncology online seminar. Clin Transl Radiat Oncol 2023; 40:100605. [PMID: 36910025 PMCID: PMC9996385 DOI: 10.1016/j.ctro.2023.100605] [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: 12/14/2022] [Revised: 02/16/2023] [Accepted: 02/19/2023] [Indexed: 02/25/2023] Open
Abstract
•Improvement of therapeutic ratio by novel unconventional radiotherapy approaches.•Immunomodulation using high-dose spatially fractionated radiotherapy.•Boosting radiation anti-tumor effects by adding an immune-mediated cell killing.
Collapse
Affiliation(s)
- S. Tubin
- Medaustron Center for Ion Therapy, Marie-Curie Strasse 5, Wiener Neustadt 2700, Austria
- Corresponding author.
| | - M.C. Vozenin
- Radiation Oncology Laboratory, Radiation Oncology Service, Oncology Department, Lausanne University Hospital and University of Lausanne, Switzerland
| | - Y. Prezado
- Institut Curie, Université PSL, CNRS UMR3347, Inserm U1021, Signalisation Radiobiologie et Cancer, Orsay 91400, France
- Université Paris-Saclay, CNRS UMR3347, Inserm U1021, Signalisation Radiobiologie et Cancer, Orsay 91400, France
| | - M. Durante
- Biophysics Department, GSI Helmholtzzentrum für Schwerionenforschung, Planckstraße 1, Darmstadt 64291, Germany
- Technsiche Universität Darmstadt, Institute for Condensed Matter Physics, Darmstadt, Germany
| | - K.M. Prise
- Patrick G Johnston Centre for Cancer Research Queen's University Belfast, 97 Lisburn Road, Belfast BT9 7AE, United Kingdom
| | - P.C. Lara
- Canarian Comprehensive Cancer Center, San Roque University Hospital & Fernando Pessoa Canarias University, C/Dolores de la Rocha 9, Las Palmas GC 35001, Spain
| | - C. Greco
- Department of Radiation Oncology Champalimaud Foundation, Av. Brasilia, Lisbon 1400-038, Portugal
| | - M. Massaccesi
- UOC di Radioterapia Oncologica, Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - C. Guha
- Montefiore Medical Center Radiation Oncology, 111 E 210th St, New York, NY, United States
| | - X. Wu
- Executive Medical Physics Associates, 19470 NE 22nd Road, Miami, FL 33179, United States
| | - M.M. Mohiuddin
- Northwestern Medicine Cancer Center Warrenville and Northwestern Medicine Proton Center, 4455 Weaver Pkwy, Warrenville, IL 60555, United States
| | - A. Vestergaard
- Danish Centre for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark
| | - N. Bassler
- Danish Centre for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark
| | - S. Gupta
- The Loop Immuno-Oncology Laboratory, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC, United States
| | - M. Stock
- Medaustron Center for Ion Therapy, Marie-Curie Strasse 5, Wiener Neustadt 2700, Austria
- Karl Landsteiner University of Health Sciences, Marie-Curie Strasse 5, Wiener Neustadt 2700, Austria
| | - R. Timmerman
- Department of Radiation Oncology, University of Texas, Southwestern Medical Center, Inwood Road Dallas, TX 2280, United States
| |
Collapse
|
45
|
Gupta S, Vohra S, Sethi K, Rani R, Gupta S, Kumar S, Kumar R. In vitro and in vivo evaluation of efficacy of berberine chloride: phyto-alternative approach against Trypanosoma evansi infection. Mol Biochem Parasitol 2023; 254:111562. [PMID: 37084956 DOI: 10.1016/j.molbiopara.2023.111562] [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: 02/22/2023] [Revised: 03/29/2023] [Accepted: 04/19/2023] [Indexed: 04/23/2023]
Abstract
Current chemotherapy against the Surra organism, Trypanosoma evansi has several limitations in terms of efficacy, toxicity, availability and emerging resistance. These reasons make the search of new chemo-preventive and chemo-therapeutic agent with high potency and low toxicity. Alkaloid phyto-molecules, berberine has shown promising anti-kinetoplastid activity against T. cruzi, T. congolense, T. brucei, Leishmania donovani and L. tropica. However, till date, there is no investigation of therapeutic efficacy of berberine chloride (BC) against T. evansi. The IC50 value of BC for growth inhibition of T. evansi at 24h of culture was calculated as 12.15µM. The specific selectivity index (SSI) of BC was calculated as 19.01 and 10.43 against Vero cell line and Equine PBMC's, respectively. Thirteen drug target genes affecting various metabolic pathways were studied to investigate the mode of trypanocidal action of BC. In transcript analysis, the mRNA expression of arginine kinase 1 remained refractory to exposure with BC, which provides metabolic plasticity in adverse environmental conditions. In contrary, rest all the drug target gene were down-regulated, which indicates that drug severely affect DNA replication, cell proliferation, energy homeostasis, redox homeostasis and calcium homeostasis of T. evansi, leading to the death of parasite in low concentrations. It is the first attempt to investigate in vitro anti-trypanosomal activity of BC against T. evansi. These data imply that phytochemicals as alternative strategies can be explored in the future as an alternative treatment for Surra in animal.
Collapse
Affiliation(s)
- Snehil Gupta
- Department of Veterinary Parasitology, Lala Lajpat Rai University of Veterinary and Animal Sciences, Hisar, Haryana, 125004, India; NCVTC, ICAR-National Research Centre on Equines, Hisar, Haryana, 125001, India
| | - Sukhdeep Vohra
- Department of Veterinary Parasitology, Lala Lajpat Rai University of Veterinary and Animal Sciences, Hisar, Haryana, 125004, India; NCVTC, ICAR-National Research Centre on Equines, Hisar, Haryana, 125001, India
| | - Khushboo Sethi
- Parasitology Lab, ICAR-National Research Centre on Equines, Hisar, Haryana, 125001, India; NCVTC, ICAR-National Research Centre on Equines, Hisar, Haryana, 125001, India
| | - Ruma Rani
- Parasitology Lab, ICAR-National Research Centre on Equines, Hisar, Haryana, 125001, India; NCVTC, ICAR-National Research Centre on Equines, Hisar, Haryana, 125001, India
| | - Surbhi Gupta
- Department of Veterinary Physiology and Biochemistry, Lala Lajpat Rai University of Veterinary and Animal Sciences, Hisar, Haryana, 125004, India; NCVTC, ICAR-National Research Centre on Equines, Hisar, Haryana, 125001, India
| | - Sanjay Kumar
- Parasitology Lab, ICAR-National Research Centre on Equines, Hisar, Haryana, 125001, India; NCVTC, ICAR-National Research Centre on Equines, Hisar, Haryana, 125001, India
| | - Rajender Kumar
- Parasitology Lab, ICAR-National Research Centre on Equines, Hisar, Haryana, 125001, India; NCVTC, ICAR-National Research Centre on Equines, Hisar, Haryana, 125001, India.
| |
Collapse
|
46
|
Abstract
Here, we report a facile and efficient method for the difluoroalkylation of vinyl cyclopropanes (VCPs) using visible-light organophotoredox catalysis. This strategy exploits the interplay of α-amino alkyl radical-mediated halogen-atom transfer (XAT) reaction. The broad substrate scope, excellent functional group compatibility, operational simplicity, inexpensive CF2 precursors, and high efficiency make this protocol promising for the cost-efficient synthesis of allylic difluoroalkylated derivatives.
Collapse
Affiliation(s)
- Palasetty Chandu
- Department of Chemical Sciences, Indian Institute of Science Education and Research Kolkata, Mohanpur, 741246 West Bengal, India
| | - Vinjamuri Srinivasu
- Department of Chemical Sciences, Indian Institute of Science Education and Research Kolkata, Mohanpur, 741246 West Bengal, India
| | - Surbhi Gupta
- Department of Chemical Sciences, Indian Institute of Science Education and Research Kolkata, Mohanpur, 741246 West Bengal, India
| | - Devarajulu Sureshkumar
- Department of Chemical Sciences, Indian Institute of Science Education and Research Kolkata, Mohanpur, 741246 West Bengal, India
| |
Collapse
|
47
|
Seth AK, Kansal S, Salve HR, Gupta S, Kumar R, Misra P. The Role of Noncommunicable Disease Clinics in Improving Control of Hypertension and Diabetes Among Adults Residing in Rural Ballabgarh, Haryana. Cureus 2023; 15:e37283. [PMID: 37038380 PMCID: PMC10082560 DOI: 10.7759/cureus.37283] [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] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/08/2023] [Indexed: 04/12/2023] Open
Abstract
Introduction High systolic blood pressure (SBP) and raised plasma glucose are major attributable and preventable causes of death worldwide. The objective of this study was to estimate the control rates and identify determinants of control of hypertension and diabetes among adults. Methods A longitudinal follow-up study was conducted among all the adults registered at the noncommunicable disease (NCD) clinics under the national program at two primary health centers in Faridabad, Haryana. Data were collected every month from the individual booklet generated for registered adults. Two monthly visits in three months and four in six months were considered adequate follow-ups at the NCD clinic. Results In the study, 495 (82.2%) adults had hypertension, and 242 (40.2%) had diabetes. The control rates at the third and sixth months were 37.1% (95% confidence interval (CI): 31.4-42.7) and 53.6% (95% CI: 43.4-59.8) among hypertensives and 28.7% (95% CI: 21.7-35.7) and 35.9% (95% CI: 27.5-44.4) among diabetics. Among hypertensives, six-month control status was associated with adequate follow-up at the NCD clinic (adjusted odds ratio (AOR) 2.3; 95% CI: 1.4-4.0; p-value: 0.002), male sex (AOR 0.5; 95% CI: 0.3-0.9; p-value: 0.02) and high SBP (AOR 0.5; 95% CI: 0.3-0.9; p-value: 0.017). Conclusions Control status was achieved in half of the adults with hypertension and one-third of adults with diabetes after six months of regular follow-up. Adequate follow-up at the NCD clinic, male sex, and raised SBP emerged as determinants of control among hypertensives.
Collapse
Affiliation(s)
- Aswani K Seth
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, IND
| | - Subham Kansal
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, IND
| | - Harshal R Salve
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, IND
| | - Surbhi Gupta
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, IND
| | - Rakesh Kumar
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, IND
| | - Puneet Misra
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, IND
| |
Collapse
|
48
|
Gupta S, Dhillon HS, Gupta N. The Comparative Accuracy of BISAP and PANC3 Scoring System for the Disease Severity and Outcome in Acute Pancreatitis in Tertiary Care Hospital from North India. Kathmandu Univ Med J (KUMJ) 2023; 21:138-143. [PMID: 38628005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2024]
Abstract
Background Acute pancreatitis has local and systemic manifestations, so it's important to assess the severity by various scoring system. Among them bed side index for severity of acute pancreatitis and pancreatitis three score have been considered to be more predictive and easier. Objective To determine the comparative prognostic value of bed side index for severity of acute pancreatitis and pancreatitis 3 score and its correlation with the outcome. Method A prospective observational study was conducted on 50 cases of acute pancreatitis. The patients were assessed clinically, radiologically and biochemically and were categorised into mild, moderate and severe category as per Atlanta Classification. Bed side index for severity of acute pancreatitis and pancreatitis 3 score was calculated at the time of admission and followed till the time of discharge or they had mortality. Result Receiver operating characteristic curve, showed bed side Index for severity of acute pancreatitis score had sensitivity (66.67%), specificity (84.09%), diagnostic accuracy (84%) while pancreatitis 3 score had sensitivity (50%), specificity (81.82%), diagnostic accuracy (80%) for the severity of acute pancreatitis. Bed side index for severity of acute pancreatitis had sensitivity (100%), specificity (66.67%) and Pancreatitis 3 score had sensitivity (66.67%), specificity (80.85%) for predicting the mortality in acute pancreatitis. Conclusion Bed side index for severity of acute pancreatitis and pancreatitis 3 score are both simple, bedside tool for assessing the severity and mortality but bed side index for severity of acute pancreatitis score had better sensitivity, specificity for assessing the severity and mortality as compared to pancreatitis three score.
Collapse
Affiliation(s)
- S Gupta
- Department of General Medicine, Maharishi Markandeshwar Institute of medical sciences and research, Maharishi Markandeshwar Deemed to be University, Mullana, Ambala (Haryana), India
| | - H S Dhillon
- Department of General Medicine, Maharishi Markandeshwar Institute of medical sciences and research, Maharishi Markandeshwar Deemed to be University, Mullana, Ambala (Haryana), India
| | - N Gupta
- Department of General Medicine, Maharishi Markandeshwar Institute of medical sciences and research, Maharishi Markandeshwar Deemed to be University, Mullana, Ambala (Haryana), India
| |
Collapse
|
49
|
Gupta S, Herranz L, Lebel L, Sonnenkalb M, Pellegrini M, Marchetto C, Maruyama Y, Dehbi A, Suckow D, Kärkelä T. Integration of pool scrubbing research to enhance Source-Term calculations (IPRESCA) project – Overview and first results. Nuclear Engineering and Design 2023. [DOI: 10.1016/j.nucengdes.2023.112189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
|
50
|
Angloher G, Banik S, Benato G, Bento A, Bertolini A, Breier R, Bucci C, Burkhart J, Canonica L, D'Addabbo A, Di Lorenzo S, Einfalt L, Erb A, Feilitzsch FV, Ferreiro Iachellini N, Fichtinger S, Fuchs D, Fuss A, Garai A, Ghete VM, Gorla P, Gupta S, Hauff D, Ješkovský M, Jochum J, Kaznacheeva M, Kinast A, Kluck H, Kraus H, Langenkämper A, Mancuso M, Marini L, Mokina V, Nilima A, Olmi M, Ortmann T, Pagliarone C, Pattavina L, Petricca F, Potzel W, Povinec P, Pröbst F, Pucci F, Reindl F, Rothe J, Schäffner K, Schieck J, Schmiedmayer D, Schönert S, Schwertner C, Stahlberg M, Stodolsky L, Strandhagen C, Strauss R, Usherov I, Wagner F, Willers M, Zema V, Ferella F, Laubenstein M, Nisi S. Secular equilibrium assessment in a CaWO 4 target crystal from the dark matter experiment CRESST using Bayesian likelihood normalisation. Appl Radiat Isot 2023; 194:110670. [PMID: 36696751 DOI: 10.1016/j.apradiso.2023.110670] [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: 05/31/2022] [Revised: 11/06/2022] [Accepted: 01/13/2023] [Indexed: 01/22/2023]
Abstract
CRESST is a leading direct detection sub-GeVc-2 dark matter experiment. During its second phase, cryogenic bolometers were used to detect nuclear recoils off the CaWO4 target crystal nuclei. The previously established electromagnetic background model relies on Secular Equilibrium (SE) assumptions. In this work, a validation of SE is attempted by comparing two likelihood-based normalisation results using a recently developed spectral template normalisation method based on Bayesian likelihood. Albeit we find deviations from SE in some cases we conclude that these deviations are artefacts of the fit and that the assumptions of SE is physically meaningful.
Collapse
Affiliation(s)
- G Angloher
- Max-Planck-Institut für Physik, D-80805, München, Germany
| | - S Banik
- Institut für Hochenergiephysik der Österreichischen Akademie der Wissenschaften, A-1050, Wien, Austria; Atominstitut, Technische Universität Wien, A-1020, Wien, Austria
| | - G Benato
- INFN, Laboratori Nazionali del Gran Sasso, I-67100, Assergi, Italy
| | - A Bento
- Max-Planck-Institut für Physik, D-80805, München, Germany; LIBPhys-UC, Departamento de Fisica, Universidade de Coimbra, P3004 516, Coimbra, Portugal
| | - A Bertolini
- Max-Planck-Institut für Physik, D-80805, München, Germany
| | - R Breier
- Comenius University, Faculty of Mathematics, Physics and Informatics, 84248, Bratislava, Slovakia
| | - C Bucci
- INFN, Laboratori Nazionali del Gran Sasso, I-67100, Assergi, Italy
| | - J Burkhart
- Institut für Hochenergiephysik der Österreichischen Akademie der Wissenschaften, A-1050, Wien, Austria; Atominstitut, Technische Universität Wien, A-1020, Wien, Austria.
| | - L Canonica
- Max-Planck-Institut für Physik, D-80805, München, Germany
| | - A D'Addabbo
- INFN, Laboratori Nazionali del Gran Sasso, I-67100, Assergi, Italy
| | - S Di Lorenzo
- INFN, Laboratori Nazionali del Gran Sasso, I-67100, Assergi, Italy
| | - L Einfalt
- Institut für Hochenergiephysik der Österreichischen Akademie der Wissenschaften, A-1050, Wien, Austria; Atominstitut, Technische Universität Wien, A-1020, Wien, Austria
| | - A Erb
- Physik-Department and ORIGINS Excellence Cluster, Technische Universität München, D-85747, Garching, Germany; Walther-Meißner-Institut für Tieftemperaturforschung, D-85748, Garching, Germany
| | - F V Feilitzsch
- Physik-Department and ORIGINS Excellence Cluster, Technische Universität München, D-85747, Garching, Germany
| | - N Ferreiro Iachellini
- Max-Planck-Institut für Physik, D-80805, München, Germany; Excellence Cluster Origins, D-85748, Garching, Germany
| | - S Fichtinger
- Institut für Hochenergiephysik der Österreichischen Akademie der Wissenschaften, A-1050, Wien, Austria
| | - D Fuchs
- Max-Planck-Institut für Physik, D-80805, München, Germany
| | - A Fuss
- Institut für Hochenergiephysik der Österreichischen Akademie der Wissenschaften, A-1050, Wien, Austria; Atominstitut, Technische Universität Wien, A-1020, Wien, Austria
| | - A Garai
- Max-Planck-Institut für Physik, D-80805, München, Germany
| | - V M Ghete
- Institut für Hochenergiephysik der Österreichischen Akademie der Wissenschaften, A-1050, Wien, Austria
| | - P Gorla
- INFN, Laboratori Nazionali del Gran Sasso, I-67100, Assergi, Italy
| | - S Gupta
- Institut für Hochenergiephysik der Österreichischen Akademie der Wissenschaften, A-1050, Wien, Austria
| | - D Hauff
- Max-Planck-Institut für Physik, D-80805, München, Germany
| | - M Ješkovský
- Comenius University, Faculty of Mathematics, Physics and Informatics, 84248, Bratislava, Slovakia
| | - J Jochum
- Eberhard-Karls-Universität Tübingen, D-72076, Tübingen, Germany
| | - M Kaznacheeva
- Physik-Department and ORIGINS Excellence Cluster, Technische Universität München, D-85747, Garching, Germany
| | - A Kinast
- Physik-Department and ORIGINS Excellence Cluster, Technische Universität München, D-85747, Garching, Germany
| | - H Kluck
- Institut für Hochenergiephysik der Österreichischen Akademie der Wissenschaften, A-1050, Wien, Austria
| | - H Kraus
- Department of Physics, University of Oxford, OX1 3RH, Oxford, United Kingdom
| | - A Langenkämper
- Physik-Department and ORIGINS Excellence Cluster, Technische Universität München, D-85747, Garching, Germany
| | - M Mancuso
- Max-Planck-Institut für Physik, D-80805, München, Germany
| | - L Marini
- INFN, Laboratori Nazionali del Gran Sasso, I-67100, Assergi, Italy; GSSI-Gran Sasso Science Institute, I-67100, L'Aquila, Italy
| | - V Mokina
- Institut für Hochenergiephysik der Österreichischen Akademie der Wissenschaften, A-1050, Wien, Austria
| | - A Nilima
- Max-Planck-Institut für Physik, D-80805, München, Germany
| | - M Olmi
- INFN, Laboratori Nazionali del Gran Sasso, I-67100, Assergi, Italy
| | - T Ortmann
- Physik-Department and ORIGINS Excellence Cluster, Technische Universität München, D-85747, Garching, Germany
| | - C Pagliarone
- INFN, Laboratori Nazionali del Gran Sasso, I-67100, Assergi, Italy; Dipartimento di Ingegneria Civile e Meccanica, Universitä degli Studi di Cassino e del Lazio Meridionale, I-03043, Cassino, Italy
| | - L Pattavina
- INFN, Laboratori Nazionali del Gran Sasso, I-67100, Assergi, Italy; Physik-Department and ORIGINS Excellence Cluster, Technische Universität München, D-85747, Garching, Germany
| | - F Petricca
- Max-Planck-Institut für Physik, D-80805, München, Germany
| | - W Potzel
- Physik-Department and ORIGINS Excellence Cluster, Technische Universität München, D-85747, Garching, Germany
| | - P Povinec
- Comenius University, Faculty of Mathematics, Physics and Informatics, 84248, Bratislava, Slovakia
| | - F Pröbst
- Max-Planck-Institut für Physik, D-80805, München, Germany
| | - F Pucci
- Max-Planck-Institut für Physik, D-80805, München, Germany
| | - F Reindl
- Institut für Hochenergiephysik der Österreichischen Akademie der Wissenschaften, A-1050, Wien, Austria; Atominstitut, Technische Universität Wien, A-1020, Wien, Austria
| | - J Rothe
- Physik-Department and ORIGINS Excellence Cluster, Technische Universität München, D-85747, Garching, Germany
| | - K Schäffner
- Max-Planck-Institut für Physik, D-80805, München, Germany
| | - J Schieck
- Institut für Hochenergiephysik der Österreichischen Akademie der Wissenschaften, A-1050, Wien, Austria; Atominstitut, Technische Universität Wien, A-1020, Wien, Austria
| | - D Schmiedmayer
- Institut für Hochenergiephysik der Österreichischen Akademie der Wissenschaften, A-1050, Wien, Austria; Atominstitut, Technische Universität Wien, A-1020, Wien, Austria
| | - S Schönert
- Physik-Department and ORIGINS Excellence Cluster, Technische Universität München, D-85747, Garching, Germany
| | - C Schwertner
- Institut für Hochenergiephysik der Österreichischen Akademie der Wissenschaften, A-1050, Wien, Austria; Atominstitut, Technische Universität Wien, A-1020, Wien, Austria
| | - M Stahlberg
- Max-Planck-Institut für Physik, D-80805, München, Germany
| | - L Stodolsky
- Max-Planck-Institut für Physik, D-80805, München, Germany
| | - C Strandhagen
- Eberhard-Karls-Universität Tübingen, D-72076, Tübingen, Germany
| | - R Strauss
- Physik-Department and ORIGINS Excellence Cluster, Technische Universität München, D-85747, Garching, Germany
| | - I Usherov
- Eberhard-Karls-Universität Tübingen, D-72076, Tübingen, Germany
| | - F Wagner
- Institut für Hochenergiephysik der Österreichischen Akademie der Wissenschaften, A-1050, Wien, Austria
| | - M Willers
- Physik-Department and ORIGINS Excellence Cluster, Technische Universität München, D-85747, Garching, Germany
| | - V Zema
- Max-Planck-Institut für Physik, D-80805, München, Germany
| | | | - F Ferella
- INFN, Laboratori Nazionali del Gran Sasso, I-67100, Assergi, Italy; Department of Physical and Chemical Sciences, University of l'Aquila, via Vetoio (COPPITO 1-2), I-67100, L'Aquila, Italy
| | - M Laubenstein
- INFN, Laboratori Nazionali del Gran Sasso, I-67100, Assergi, Italy
| | - S Nisi
- INFN, Laboratori Nazionali del Gran Sasso, I-67100, Assergi, Italy
| |
Collapse
|