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Arora VK, Chopra KK. Pathways to end TB- challenges. Indian J Tuberc 2024; 71:1-2. [PMID: 38296381 DOI: 10.1016/j.ijtb.2024.01.008] [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: 01/08/2024] [Accepted: 01/09/2024] [Indexed: 02/08/2024]
Affiliation(s)
- V K Arora
- TB Association of India, 3 Red Cross Rd, Gokul Nagar, Sansad Marg Area, New Delhi, Delhi 110001, India.
| | - Kamal Kishore Chopra
- New Delhi Tuberculosis Centre, Jawaharlal Nehru Marg, Delhi Gate, New Delhi 110002, India.
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Arora VK, Kishore Chopra K. Pediatric tuberculosis - A diagnostic Dilemma. Indian J Tuberc 2023; 70 Suppl 1:S6-S7. [PMID: 38110262 DOI: 10.1016/j.ijtb.2023.11.003] [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: 11/04/2023] [Accepted: 11/09/2023] [Indexed: 12/20/2023]
Affiliation(s)
- V K Arora
- TB Association of India, 3, Red Cross Rd, Gokul Nagar, Sansad Marg Area, New Delhi, Delhi, 110001, India.
| | - Kamal Kishore Chopra
- New Delhi Tuberculosis Centre, Jawaharlal Nehru Marg, Delhi Gate, New Delhi, 110002, India.
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Freshour SL, Chen THP, Fisk B, Shen H, Mosior M, Skidmore ZL, Fronick C, Bolzenius JK, Griffith OL, Arora VK, Griffith M. Endothelial cells are a key target of IFN-g during response to combined PD-1/CTLA-4 ICB treatment in a mouse model of bladder cancer. iScience 2023; 26:107937. [PMID: 37810214 PMCID: PMC10558731 DOI: 10.1016/j.isci.2023.107937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 08/08/2023] [Accepted: 09/13/2023] [Indexed: 10/10/2023] Open
Abstract
To explore mechanisms of response to combined PD-1/CTLA-4 immune checkpoint blockade (ICB) treatment in individual cell types, we generated scRNA-seq using a mouse model of invasive urothelial carcinoma with three conditions: untreated tumor, treated tumor, and tumor treated after CD4+ T cell depletion. After classifying tumor cells based on detection of somatic variants and assigning non-tumor cell types using SingleR, we performed differential expression analysis, overrepresentation analysis, and gene set enrichment analysis (GSEA) within each cell type. GSEA revealed that endothelial cells were enriched for upregulated IFN-g response genes when comparing treated cells to both untreated cells and cells treated after CD4+ T cell depletion. Functional analysis showed that knocking out IFNgR1 in endothelial cells inhibited treatment response. Together, these results indicated that IFN-g signaling in endothelial cells is a key mediator of ICB induced anti-tumor activity.
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Affiliation(s)
- Sharon L. Freshour
- Department of Medicine, Washington University in St. Louis School of Medicine, St. Louis, MO 63110, USA
| | - Timothy H.-P. Chen
- Department of Medicine, Washington University in St. Louis School of Medicine, St. Louis, MO 63110, USA
| | - Bryan Fisk
- Department of Medicine, Washington University in St. Louis School of Medicine, St. Louis, MO 63110, USA
- McDonnell Genome Institute, Washington University in St. Louis School of Medicine, St. Louis, MO 63110, USA
| | - Haolin Shen
- Department of Medicine, Washington University in St. Louis School of Medicine, St. Louis, MO 63110, USA
| | - Matthew Mosior
- Department of Medicine, Washington University in St. Louis School of Medicine, St. Louis, MO 63110, USA
- McDonnell Genome Institute, Washington University in St. Louis School of Medicine, St. Louis, MO 63110, USA
| | - Zachary L. Skidmore
- Department of Medicine, Washington University in St. Louis School of Medicine, St. Louis, MO 63110, USA
- McDonnell Genome Institute, Washington University in St. Louis School of Medicine, St. Louis, MO 63110, USA
| | - Catrina Fronick
- McDonnell Genome Institute, Washington University in St. Louis School of Medicine, St. Louis, MO 63110, USA
| | - Jennifer K. Bolzenius
- Department of Medicine, Washington University in St. Louis School of Medicine, St. Louis, MO 63110, USA
- Siteman Cancer Center, Washington University in St. Louis School of Medicine, St. Louis, MO 63110, USA
| | - Obi L. Griffith
- Department of Medicine, Washington University in St. Louis School of Medicine, St. Louis, MO 63110, USA
- McDonnell Genome Institute, Washington University in St. Louis School of Medicine, St. Louis, MO 63110, USA
- Siteman Cancer Center, Washington University in St. Louis School of Medicine, St. Louis, MO 63110, USA
- Department of Genetics, Washington University in St. Louis School of Medicine, St. Louis, MO 63110, USA
| | - Vivek K. Arora
- Department of Medicine, Washington University in St. Louis School of Medicine, St. Louis, MO 63110, USA
- Siteman Cancer Center, Washington University in St. Louis School of Medicine, St. Louis, MO 63110, USA
| | - Malachi Griffith
- Department of Medicine, Washington University in St. Louis School of Medicine, St. Louis, MO 63110, USA
- McDonnell Genome Institute, Washington University in St. Louis School of Medicine, St. Louis, MO 63110, USA
- Siteman Cancer Center, Washington University in St. Louis School of Medicine, St. Louis, MO 63110, USA
- Department of Genetics, Washington University in St. Louis School of Medicine, St. Louis, MO 63110, USA
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Arora VK, Jindal SK, Katiyar SK, Behra D, Talwar D, Sarin R, Dhar R, Mehta P, Bhargava S, Singhal P, Joshi S, Tiwaskar M, Nikam C, Chatterjee A, Vora A. Genomic revolution: Transforming tuberculosis diagnosis and treatment with the use of Whole Genome Sequencing - A consensus statement. Indian J Tuberc 2023; 70:383-389. [PMID: 37968042 DOI: 10.1016/j.ijtb.2023.10.002] [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: 10/10/2023] [Accepted: 10/10/2023] [Indexed: 11/17/2023]
Abstract
Tuberculosis (TB) is a preventable, treatable, and curable disease. However, in 2020, 9∙9 million people were estimated to have developed tuberculosis, and 1.5 million people were estimated to have died from it. Whereas in India, 2.6 million were diagnosed with TB and 436,000 succumbed to TB in 2019. India (26%) is the major contributor to the global drop in TB cases. The COVID-19 pandemic has substantially reduced access to services for the diagnosis and treatment of TB, resulting in an increase in deaths and a reversal in global progress. [1] Presently, TB incidence is falling at a rate of 2% per year, obstructed mainly by the rearing pandemic of drug-resistant tuberculosis (DRTB). Particularly concerning is multi-drug resistant TB (MDRTB), defined as resistance towards isoniazid (INH) and rifampicin (RIF). [2] The World Health Organization (WHO) targeted to reduce worldwide TB incidence by 90% until 2035. (1) Early initiation of effective treatment based on susceptibility patterns of the Mycobacterium tuberculosis complex (MTBC) is considered key to successful TB control in countries with high DRTB incidence. Worldwide MDRTB treatment outcomes are poor, with cure rates less than 60% (2) due to the lack of comprehensive Drug Susceptibility Testing (DST) in most high MDRTB burden countries. This is leading to the inadequate anti-TB activity of the provided regimens (3-5), unlike regimens advised for DST assure optimal results. (6) In addition to resistances to the established regimens, the resistance to the newer DRTB drugs is increasing. On World TB Day 2022, Academy of Advanced Medical Education, Thyrocare Technologies Limited and HyastackAnalytics - IITB along with expert pulmonologist and renowned physicians from India convened for an advisory board meeting in Delhi on 20th March 2022 to discuss the role of Whole Genome Sequencing (WGS) in the diagnosis and management of TB. Objectives and specific topics relating to WGS in MDRTB were discussed, each expert shared their views, which led to a group discussion with a commitment to putting the patient first, and increasing their collective efforts, the organizations recognized that it is possible to make this goal a reality. The organizations involved in the discussion have declared their commitment to engaging in collaborative efforts to tackle DRTB detection efficiently. They advocate for strengthening access to WGS TB services, controlling and preventing TB, improving surveillance and drug resistance management, and investing in research and development. This Round Table serves as a framework to build on and ensure that the goal of ending TB is achievable with WGS services wherever needed. Post discussion, a uniform consensus was said to be arrived if more than 80% board members agreed to the statement. The present paper is the outcome of aspects presented and discussed in the advisory board meeting.
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Affiliation(s)
- V K Arora
- Pulmonologist and Tuberculous and Chest Diseases Specialist, Delhi, India
| | - S K Jindal
- Director, Jindal Clinics, Chandigarh, India
| | - S K Katiyar
- Pulmonologist, TB & Chest Diseases Specialist, Kanpur, India
| | - Digambar Behra
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Deepak Talwar
- Senior Consultant & Chairman - Metro Respiratory Center Pulmonology & Sleep Medicine, Noida, India
| | - Rohit Sarin
- Principal Consultant and Former Director, National Institute of Tuberculosis and Respiratory Diseases, Delhi, India
| | - Raja Dhar
- Department of Pulmonology C K Birla Group of Hospitals Kolkata, India
| | | | - Salil Bhargava
- Professor of Chest and TB at M G M Medical College, Indore, India
| | | | | | | | - Chaitali Nikam
- HaystackAnalytics, IITB, Mumbai, India; Thyrocare Technologies Limited, Mumbai, India
| | | | - Agam Vora
- Brahma Kumari's Global Hospital & Research Centre, Mumbai, India.
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Vora A, Mehta P, Arora VK, Behera D, Kar A, Katiyar SK, Samaria JK, Koul P, Jaychandra A, Singh BP, Kandi S, Nazir Shah N, Jain NK, Najeeb R, Ahmad S, Najib R, Faisal M, Dewan B. Aviptadil: A promising treatment option for acute respiratory distress syndrome. Indian J Tuberc 2023; 70:510-511. [PMID: 37968060 DOI: 10.1016/j.ijtb.2023.03.013] [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: 11/02/2022] [Accepted: 03/28/2023] [Indexed: 11/17/2023]
Affiliation(s)
- Agam Vora
- Vora Clinic, Borivali West, Mumbai, Maharashtra, India
| | - Parthiv Mehta
- Mehta Hospital, Drive-in Road, Thaltej, Ahmedabad, Gujarat, India
| | - V K Arora
- Arora Clinic, C151, Sector 51, Kendriya Vihar, Noida, Uttar Pradesh, India
| | - D Behera
- Department of Pulmonology, Fortis Hospital, Mohali, Punjab, India
| | - Arindam Kar
- Department of Critical Care Medicine, HN Reliance Foundation Hospital and Research Centre, Girgaon, Mumbai, Maharashtra, India
| | - S K Katiyar
- Chest Care Centre, Swaroop Nagar, Kanpur, Uttar Pradesh, India
| | - J K Samaria
- Samaria Multi-Speciality & Chest Centre, Kabir Nagar Colony, Varanasi, Uttar Pradesh, India
| | - Parvaiz Koul
- Sher-i-Kashmir Institute of Medical Sciences, Soura, Srinagar, Jammu & Kashmir, India
| | - A Jaychandra
- Department of Pulmonology, Care Hospitals, Banjara Hills, Hyderabad, Telangana, India
| | - B P Singh
- Department of Respiratory & Critical Care, Midland Healthcare & Research Center, Lucknow, Uttar Pradesh, India
| | | | - Naveed Nazir Shah
- Chest Disease Hospital, Buchwara, Srinagar, Jammu and Kashmir, India
| | - N K Jain
- 57/58, Shastri Nagar, Jaipur, Rajasthan, India
| | - Rukhsana Najeeb
- SMHS Hospital, Karan Nagar, Srinagar, Jammu and Kashmir, India
| | - Sadiq Ahmad
- SMHS Hospital, Karan Nagar, Srinagar, Jammu and Kashmir, India
| | - Rayees Najib
- SMHS Hospital, Karan Nagar, Srinagar, Jammu and Kashmir, India
| | - Mir Faisal
- Magarmal Bagh, Near Shifa Hospital, Srinagar, Jammu and Kashmir, India
| | - Bhupesh Dewan
- Department of Medical Services, Zuventus Healthcare Limited, Zuventus House, Plot Y2, CTS No.: 358/A2, Near Nahur Railway Station, Nahur West, Mumbai 400078, Maharashtra, India.
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Ahmad P, Arora VK. Prevalance of tuberculosis amongst healthcare workers, working in DOTS/sputum microscopy centre in two different districts of state of Uttarakhand & Uttar Pradesh of India. Indian J Tuberc 2023; 70:405-408. [PMID: 37968045 DOI: 10.1016/j.ijtb.2023.03.011] [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: 10/11/2022] [Revised: 02/04/2023] [Accepted: 03/22/2023] [Indexed: 11/17/2023]
Abstract
BACKGROUND & OBJECTIVE The Healthcare workers (HCWs) who work in DOTS/Sputum microscopy centre are exposed to higher risk of contacting tuberculosis (TB) comparatively to other health workers who are serving the other health sectors. The HCWs in DOTS are more exposed due to direct contact with patients suffering from TB or through sharing the infected air space with the infectious patients. The aim of the study is to know the prevalance of TB disease amongst the HCWs who are working in DOTS cum Sputum Microscopy Centre's under RNTCP in two different districts of state of Uttar Pradesh (UP) and Uttarakhand (UK) of india. METHODS The prospective cross-sectional study is conducted in two districts of different states having high burden of TB disease in UP and low burden of TB disease in UK state. All 100% (130) staff i.e. Medical officers, Sputum microscopy technicians, DOTS providers of DOTS cum Sputum Microscopy centre's of both selected Ghaziabad (UP) and Dehradun (UK) districts are covered in the study. RESULTS The 4.6% (6) healthcare workers of both the districts were taking ATT at the time of interview and 13.8% (18) HCWs had taken the ATT in past. The 62.5% (15) HCWs i.e 55.5% (5) from Dehradun district and 66.6% (10) from Ghaziabad district preferred to have a ATT from the private medical store inspite of taking DOTS with assumption of low efficacy of drugs and high toxicity. The 58.33% (14) HCWs ie 55.5% (5) staff members of DOTS/sputum microscopy centre in Dehradun & 60.0% (9) staff members of DOTS/sputum microscopy centre in Ghaziabad district had not notified about the status of their disease to the health care authority due the assumption that they may be asked to leave the job or to go on a long unpaid leave. CONCLUSION The 18.4% (24) HCWs of both the district got TB disease during their working in DOTS/Sputum microscopy centre and 4.6% (6) HCWs of both the districts were taking the ATT at the time of interview.
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Affiliation(s)
- Parvez Ahmad
- Department of Chest & TB, Santosh Medical College & University, Ghaziabad, UP, India.
| | - V K Arora
- Santosh University, Ghaziabad, UP, India
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Agrawal S, Singal A, Grover C, Das S, Arora VK, Madhu SV. Prevalence of onychomycosis in patients with diabetes mellitus: A cross-sectional study from a tertiary care hospital in North India. Indian J Dermatol Venereol Leprol 2023; 89:710-717. [PMID: 37067104 DOI: 10.25259/ijdvl_360_2022] [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: 04/07/2022] [Accepted: 12/11/2022] [Indexed: 04/05/2023]
Abstract
Background Though diabetes mellitus (DM) is a well-recognised risk factor for onychomycosis (OM), the epidemiology of OM in diabetic patients remains largely unexplored, especially from the Indian subcontinent. Aims and objectives To estimate the prevalence of OM in diabetic patients, to identify and analyse risk factors, and correlate the severity of nail changes with glycemic control (HBA1c). Methods This cross-sectional, analytical study involved 300 diabetic patients. Patients with the clinical diagnosis of OM, supplanted by at least two of the four tests (KOH, culture, onychoscopy and nail histopathology) were considered cases of OM. Demographic and haematological profile was analysed using chi-square test/ Fischer's exact test. Logistic regression was applied to assess the independent risk factors. Results The prevalence of OM in DM patients was 34% (102/300) and significant risk factors included; age >60 years, male gender, closed shoes, disease duration >5 years, high BMI (>25) and lack of awareness about nail changes. Distal and lateral subungual OM (78%) was the commonest presentation followed by proximal subungual OM, superficial OM and total dystrophic OM. Correlation between HbA1c and the number of nails involved was found to be significant. Limitation As cases were recruited from a hospital setting, there could be chances of Berksonian bias. Conclusion The prevalence of OM in diabetic patients is high and the severity of nail changes correlates with HbA1C levels. It is important to diagnose OM early in order to treat and prevent complications.
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Affiliation(s)
- Sonia Agrawal
- Department of Dermatology & STD, University College of Medical Sciences and GTB Hospital, Delhi, India
| | - Archana Singal
- Department of Dermatology & STD, University College of Medical Sciences and GTB Hospital, Delhi, India
| | - Chander Grover
- Department of Dermatology & STD, University College of Medical Sciences and GTB Hospital, Delhi, India
| | - Shukla Das
- Department of Microbiology, University College of Medical Sciences and GTB Hospital, Delhi, India
| | - V K Arora
- Department of Pathology, University College of Medical Sciences and GTB Hospital, Delhi, India
| | - S V Madhu
- Department of Endocrinology, University College of Medical Sciences and GTB Hospital, Delhi, India
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Metz EM, Vardag SN, Basu S, Jung M, Ahrens B, El-Madany T, Sitch S, Arora VK, Briggs PR, Friedlingstein P, Goll DS, Jain AK, Kato E, Lombardozzi D, Nabel JEMS, Poulter B, Séférian R, Tian H, Wiltshire A, Yuan W, Yue X, Zaehle S, Deutscher NM, Griffith DWT, Butz A. Soil respiration-driven CO 2 pulses dominate Australia's flux variability. Science 2023; 379:1332-1335. [PMID: 36996200 DOI: 10.1126/science.add7833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/01/2023]
Abstract
The Australian continent contributes substantially to the year-to-year variability of the global terrestrial carbon dioxide (CO2) sink. However, the scarcity of in situ observations in remote areas prevents the deciphering of processes that force the CO2 flux variability. In this study, by examining atmospheric CO2 measurements from satellites in the period 2009-2018, we find recurrent end-of-dry-season CO2 pulses over the Australian continent. These pulses largely control the year-to-year variability of Australia's CO2 balance. They cause two to three times larger seasonal variations compared with previous top-down inversions and bottom-up estimates. The pulses occur shortly after the onset of rainfall and are driven by enhanced soil respiration preceding photosynthetic uptake in Australia's semiarid regions. The suggested continental-scale relevance of soil-rewetting processes has substantial implications for our understanding and modeling of global climate-carbon cycle feedbacks.
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Affiliation(s)
- Eva-Marie Metz
- Institute of Environmental Physics, Heidelberg University, 69120 Heidelberg, Germany
| | - Sanam N Vardag
- Institute of Environmental Physics, Heidelberg University, 69120 Heidelberg, Germany
- Heidelberg Center for the Environment (HCE), Heidelberg University, 69120 Heidelberg, Germany
| | - Sourish Basu
- Goddard Space Flight Center, NASA, Greenbelt, MD 20771, USA
- Earth System Science Interdisciplinary Center, University of Maryland, College Park, MD 20740, USA
| | - Martin Jung
- Max Planck Institute for Biogeochemistry, 07745 Jena, Germany
| | - Bernhard Ahrens
- Max Planck Institute for Biogeochemistry, 07745 Jena, Germany
| | - Tarek El-Madany
- Max Planck Institute for Biogeochemistry, 07745 Jena, Germany
| | - Stephen Sitch
- College of Life and Environmental Sciences, University of Exeter, Exeter EX4 4RJ, Devon, UK
| | - Vivek K Arora
- Canadian Centre for Climate Modelling and Analysis, Environment and Climate Change Canada, Victoria, BC V8N 1V9, Canada
| | - Peter R Briggs
- Climate Science Centre, CSIRO Oceans and Atmosphere, Canberra, ACT 2601, Australia
| | - Pierre Friedlingstein
- College of Engineering, Mathematics and Physical Sciences, University of Exeter, Exeter EX4 4QF, UK
- Laboratoire de Météorologie Dynamique, Institut Pierre-Simon Laplace, CNRS-ENS-UPMC-X, Département de Géosciences, Ecole Normale Supérieure, 75005 Paris, France
| | - Daniel S Goll
- Université Paris Saclay, CEA-CNRS-UVSQ, LSCE/IPSL, 91191 Gif sur Yvette, France
| | - Atul K Jain
- Department of Atmospheric Sciences, University of Illinois Urbana-Champaign, Urbana, IL 61801, USA
| | - Etsushi Kato
- Institute of Applied Energy, Tokyo 105-0003, Japan
| | - Danica Lombardozzi
- Climate and Global Dynamics Laboratory, National Center for Atmospheric Research, Boulder, CO 80305, USA
| | - Julia E M S Nabel
- Max Planck Institute for Biogeochemistry, 07745 Jena, Germany
- Max Planck Institute for Meteorology, 20146 Hamburg, Germany
| | - Benjamin Poulter
- Biospheric Sciences Laboratory, Goddard Space Flight Center, NASA, Greenbelt, MD 20771, USA
| | - Roland Séférian
- CNRM, Université de Toulouse, Météo-France, CNRS, 31057 Toulouse, France
| | - Hanqin Tian
- Schiller Institute for Integrated Science and Society, Department of Earth and Environmental Sciences, Boston College, Chestnut Hill, MA 02467, USA
| | - Andrew Wiltshire
- Met Office Hadley Centre for Climate Science and Services, Exeter EX1 3PB, UK
| | - Wenping Yuan
- School of Atmospheric Sciences, Southern Marine Science and Engineering Guangdong Laboratory (Zhuhai), Sun Yat-sen University, Zhuhai 519082, China
| | - Xu Yue
- Jiangsu Key Laboratory of Atmospheric Environment Monitoring and Pollution Control, Jiangsu Collaborative Innovation Center of Atmospheric Environment and Equipment Technology, School of Environmental Science and Engineering, Nanjing University of Information Science and Technology (NUIST), Nanjing 210044, China
| | - Sönke Zaehle
- Max Planck Institute for Biogeochemistry, 07745 Jena, Germany
| | - Nicholas M Deutscher
- Centre for Atmospheric Chemistry, School of Earth, Atmospheric and Life Sciences, University of Wollongong, Wollongong, NSW 2522, Australia
| | - David W T Griffith
- Centre for Atmospheric Chemistry, School of Earth, Atmospheric and Life Sciences, University of Wollongong, Wollongong, NSW 2522, Australia
| | - André Butz
- Institute of Environmental Physics, Heidelberg University, 69120 Heidelberg, Germany
- Heidelberg Center for the Environment (HCE), Heidelberg University, 69120 Heidelberg, Germany
- Interdisciplinary Center for Scientific Computing (IWR), Heidelberg University, 69120 Heidelberg, Germany
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Freshour SL, Chen THP, Fisk B, Shen H, Mosior M, Skidmore ZL, Fronick C, Bolzenius JK, Griffith OL, Arora VK, Griffith M. Endothelial cells are a key target of IFN-g during response to combined PD-1/CTLA-4 ICB treatment in a mouse model of bladder cancer. bioRxiv 2023:2023.03.28.534561. [PMID: 37034778 PMCID: PMC10081275 DOI: 10.1101/2023.03.28.534561] [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] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
To explore mechanisms of response to combined PD-1/CTLA-4 immune checkpoint blockade (ICB) treatment in individual cell types, we generated scRNA-seq using a mouse model of invasive urothelial carcinoma with three conditions: untreated tumor, treated tumor, and tumor treated after CD4+ T cell depletion. After classifying tumor cells based on detection of somatic variants and assigning non-tumor cell types using SingleR, we performed differential expression analysis, overrepresentation analysis, and gene set enrichment analysis (GSEA) within each cell type. GSEA revealed that endothelial cells were enriched for upregulated IFN-g response genes when comparing treated cells to both untreated cells and cells treated after CD4+ T cell depletion. Functional analysis showed that knocking out IFNgR1 in endothelial cells inhibited treatment response. Together, these results indicated that IFN-g signaling in endothelial cells is a key mediator of ICB induced anti-tumor activity.
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Affiliation(s)
- Sharon L. Freshour
- Department of Medicine, Washington University in St. Louis School of Medicine, St. Louis, MO 63110, USA
| | - Timothy H.-P. Chen
- Department of Medicine, Washington University in St. Louis School of Medicine, St. Louis, MO 63110, USA
| | - Bryan Fisk
- Department of Medicine, Washington University in St. Louis School of Medicine, St. Louis, MO 63110, USA
- McDonnell Genome Institute, Washington University in St. Louis School of Medicine, St. Louis, MO 63110, USA
| | - Haolin Shen
- Department of Medicine, Washington University in St. Louis School of Medicine, St. Louis, MO 63110, USA
| | - Matthew Mosior
- Department of Medicine, Washington University in St. Louis School of Medicine, St. Louis, MO 63110, USA
- McDonnell Genome Institute, Washington University in St. Louis School of Medicine, St. Louis, MO 63110, USA
| | - Zachary L. Skidmore
- Department of Medicine, Washington University in St. Louis School of Medicine, St. Louis, MO 63110, USA
- McDonnell Genome Institute, Washington University in St. Louis School of Medicine, St. Louis, MO 63110, USA
| | - Catrina Fronick
- McDonnell Genome Institute, Washington University in St. Louis School of Medicine, St. Louis, MO 63110, USA
| | - Jennifer K. Bolzenius
- Department of Medicine, Washington University in St. Louis School of Medicine, St. Louis, MO 63110, USA
- Siteman Cancer Center, Washington University in St. Louis School of Medicine, St. Louis, MO 63110, USA
| | - Obi L. Griffith
- Department of Medicine, Washington University in St. Louis School of Medicine, St. Louis, MO 63110, USA
- McDonnell Genome Institute, Washington University in St. Louis School of Medicine, St. Louis, MO 63110, USA
- Siteman Cancer Center, Washington University in St. Louis School of Medicine, St. Louis, MO 63110, USA
- Department of Genetics, Washington University in St. Louis School of Medicine, St. Louis, MO 63110, USA
| | - Vivek K. Arora
- Department of Medicine, Washington University in St. Louis School of Medicine, St. Louis, MO 63110, USA
- Siteman Cancer Center, Washington University in St. Louis School of Medicine, St. Louis, MO 63110, USA
| | - Malachi Griffith
- Department of Medicine, Washington University in St. Louis School of Medicine, St. Louis, MO 63110, USA
- McDonnell Genome Institute, Washington University in St. Louis School of Medicine, St. Louis, MO 63110, USA
- Siteman Cancer Center, Washington University in St. Louis School of Medicine, St. Louis, MO 63110, USA
- Department of Genetics, Washington University in St. Louis School of Medicine, St. Louis, MO 63110, USA
- Lead Contact
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Fernández-Martínez M, Peñuelas J, Chevallier F, Ciais P, Obersteiner M, Rödenbeck C, Sardans J, Vicca S, Yang H, Sitch S, Friedlingstein P, Arora VK, Goll DS, Jain AK, Lombardozzi DL, McGuire PC, Janssens IA. Diagnosing destabilization risk in global land carbon sinks. Nature 2023; 615:848-853. [PMID: 36813960 DOI: 10.1038/s41586-023-05725-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 01/11/2023] [Indexed: 02/24/2023]
Abstract
Global net land carbon uptake or net biome production (NBP) has increased during recent decades1. Whether its temporal variability and autocorrelation have changed during this period, however, remains elusive, even though an increase in both could indicate an increased potential for a destabilized carbon sink2,3. Here, we investigate the trends and controls of net terrestrial carbon uptake and its temporal variability and autocorrelation from 1981 to 2018 using two atmospheric-inversion models, the amplitude of the seasonal cycle of atmospheric CO2 concentration derived from nine monitoring stations distributed across the Pacific Ocean and dynamic global vegetation models. We find that annual NBP and its interdecadal variability increased globally whereas temporal autocorrelation decreased. We observe a separation of regions characterized by increasingly variable NBP, associated with warm regions and increasingly variable temperatures, lower and weaker positive trends in NBP and regions where NBP became stronger and less variable. Plant species richness presented a concave-down parabolic spatial relationship with NBP and its variability at the global scale whereas nitrogen deposition generally increased NBP. Increasing temperature and its increasing variability appear as the most important drivers of declining and increasingly variable NBP. Our results show increasing variability of NBP regionally that can be mostly attributed to climate change and that may point to destabilization of the coupled carbon-climate system.
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Affiliation(s)
- Marcos Fernández-Martínez
- PLECO (Plants and Ecosystems), Department of Biology, University of Antwerp, Wilrijk, Belgium.
- CREAF, Campus de Bellaterra (UAB), Cerdanyola del Vallès, Spain.
- BEECA-UB, Department of Evolutionary Biology, Ecology and Environmental Sciences, University of Barcelona, Barcelona, Spain.
| | - Josep Peñuelas
- CREAF, Campus de Bellaterra (UAB), Cerdanyola del Vallès, Spain
- CSIC, Global Ecology Unit, CREAF-CSIC-UAB, Bellaterra, Barcelona, Spain
| | - Frederic Chevallier
- Laboratoire des Sciences du Climat et de l'Environnement, LSCE/IPSL, CEA-CNRS-UVSQ, Université Paris-Saclay, Gif-sur-Yvette, France
| | - Philippe Ciais
- Laboratoire des Sciences du Climat et de l'Environnement, LSCE/IPSL, CEA-CNRS-UVSQ, Université Paris-Saclay, Gif-sur-Yvette, France
| | - Michael Obersteiner
- International Institute for Applied Systems Analysis (IIASA), Laxenburg, Austria
- School of Geography and the Environment, University of Oxford, Oxford, UK
| | - Christian Rödenbeck
- Department of Biogeochmical Systems, Max Planck Institute for Biogeochemistry, Jena, Germany
| | - Jordi Sardans
- CREAF, Campus de Bellaterra (UAB), Cerdanyola del Vallès, Spain
- CSIC, Global Ecology Unit, CREAF-CSIC-UAB, Bellaterra, Barcelona, Spain
| | - Sara Vicca
- PLECO (Plants and Ecosystems), Department of Biology, University of Antwerp, Wilrijk, Belgium
| | - Hui Yang
- Laboratoire des Sciences du Climat et de l'Environnement, LSCE/IPSL, CEA-CNRS-UVSQ, Université Paris-Saclay, Gif-sur-Yvette, France
| | - Stephen Sitch
- College of Life and Environmental Sciences, University of Exeter, Exeter, UK
| | - Pierre Friedlingstein
- College of Engineering, Mathematics, and Physical Sciences, University of Exeter, Exeter, UK
| | - Vivek K Arora
- Canadian Centre for Climate Modelling and Analysis, Climate Research Division, Environment and Climate Change Canada, Victoria, BC, Canada
| | - Daniel S Goll
- Laboratoire des Sciences du Climat et de l'Environnement, LSCE/IPSL, CEA-CNRS-UVSQ, Université Paris-Saclay, Gif-sur-Yvette, France
| | - Atul K Jain
- Department of Atmospheric Sciences, University of Illinois, Urbana, IL, USA
| | - Danica L Lombardozzi
- Climate and Global Dynamics Laboratory, National Center for Atmospheric Research, Boulder, CO, USA
| | - Patrick C McGuire
- Department of Meteorology, Department of Geography & Environmental Science, National Centre for Atmospheric Science, University of Reading, Reading, UK
| | - Ivan A Janssens
- PLECO (Plants and Ecosystems), Department of Biology, University of Antwerp, Wilrijk, Belgium
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11
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Chopra KK, Matta S, Arora VK. Drug resistant tuberculosis among elderly: Challenges. Indian J Tuberc 2022; 69 Suppl 2:S202-S204. [PMID: 36400509 DOI: 10.1016/j.ijtb.2022.10.022] [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: 10/13/2022] [Accepted: 10/25/2022] [Indexed: 06/16/2023]
Abstract
The article deals with challenges faced by the geriatric populations while on MDR treatment. Risk factors like tobacco use, low socio-economic status, previous disease, longer delays in seeking treatment and reduced mobility are some of the challenges while initiating MDR treatment. Other issues like drug-related adverse events and increased co-morbidity pose a major challenge while treating patients. Susceptibility among the geriatric age group includes various anatomical and physiological changes including nutritional deficiencies and co morbidities.
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Affiliation(s)
- K K Chopra
- Director New Delhi Tuberculosis Centre, India
| | - S Matta
- Epidemiologist New Delhi Tuberculosis centre, India.
| | - V K Arora
- Vice Chairman (P & R) and Hony, Technical advisor, Tuberculosis Association of India, India
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12
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O'Sullivan M, Friedlingstein P, Sitch S, Anthoni P, Arneth A, Arora VK, Bastrikov V, Delire C, Goll DS, Jain A, Kato E, Kennedy D, Knauer J, Lienert S, Lombardozzi D, McGuire PC, Melton JR, Nabel JEMS, Pongratz J, Poulter B, Séférian R, Tian H, Vuichard N, Walker AP, Yuan W, Yue X, Zaehle S. Process-oriented analysis of dominant sources of uncertainty in the land carbon sink. Nat Commun 2022; 13:4781. [PMID: 35970991 PMCID: PMC9378641 DOI: 10.1038/s41467-022-32416-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 07/28/2022] [Indexed: 11/12/2022] Open
Abstract
The observed global net land carbon sink is captured by current land models. All models agree that atmospheric CO2 and nitrogen deposition driven gains in carbon stocks are partially offset by climate and land-use and land-cover change (LULCC) losses. However, there is a lack of consensus in the partitioning of the sink between vegetation and soil, where models do not even agree on the direction of change in carbon stocks over the past 60 years. This uncertainty is driven by plant productivity, allocation, and turnover response to atmospheric CO2 (and to a smaller extent to LULCC), and the response of soil to LULCC (and to a lesser extent climate). Overall, differences in turnover explain ~70% of model spread in both vegetation and soil carbon changes. Further analysis of internal plant and soil (individual pools) cycling is needed to reduce uncertainty in the controlling processes behind the global land carbon sink. The global net land sink is relatively well constrained. However, the responsible drivers and above/below-ground partitioning are highly uncertain. Model issues regarding turnover of individual plant and soil components are responsible.
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Affiliation(s)
- Michael O'Sullivan
- College of Engineering, Mathematics and Physical Sciences, University of Exeter, Exeter, EX4 4QF, UK.
| | - Pierre Friedlingstein
- College of Engineering, Mathematics and Physical Sciences, University of Exeter, Exeter, EX4 4QF, UK.,Laboratoire de Météorologie Dynamique, Institut Pierre-Simon Laplace, CNRS-ENS-UPMC-X, Paris, France
| | - Stephen Sitch
- College of Life and Environmental Sciences, University of Exeter, Exeter, EX4 4RJ, UK
| | - Peter Anthoni
- Karlsruhe Institute of Technology, Institute of Meteorology and Climate Research/Atmospheric Environmental Research, 82467, Garmisch-Partenkirchen, Germany
| | - Almut Arneth
- Karlsruhe Institute of Technology, Institute of Meteorology and Climate Research/Atmospheric Environmental Research, 82467, Garmisch-Partenkirchen, Germany
| | - Vivek K Arora
- Canadian Centre for Climate Modelling and Analysis, Climate Research Division, Environment and Climate Change Canada, Victoria, BC, Canada
| | - Vladislav Bastrikov
- Laboratoire des Sciences du Climat et de l'Environnement, LSCE/IPSL, CEA-CNRS-UVSQ, Université Paris-Saclay, F-91198, Gif-sur-Yvette, France
| | - Christine Delire
- CNRM, Université de Toulouse, Météo-France, CNRS, Toulouse, France
| | - Daniel S Goll
- Laboratoire des Sciences du Climat et de l'Environnement, LSCE/IPSL, CEA-CNRS-UVSQ, Université Paris-Saclay, F-91198, Gif-sur-Yvette, France
| | - Atul Jain
- Department of Atmospheric Sciences, University of Illinois, Urbana, IL, 61821, USA
| | - Etsushi Kato
- Institute of Applied Energy (IAE), Minato-ku, Tokyo, 105-0003, Japan
| | - Daniel Kennedy
- National Center for Atmospheric Research, Climate and Global Dynamics, Terrestrial Sciences Section, Boulder, CO, 80305, USA
| | - Jürgen Knauer
- Hawkesbury Institute for the Environment, Western Sydney University, Penrith, NSW, Australia.,CSIRO Oceans and Atmosphere, Canberra, ACT, 2101, Australia
| | - Sebastian Lienert
- Climate and Environmental Physics, Physics Institute and Oeschger Centre for Climate Change Research, University of Bern, Bern, Switzerland
| | - Danica Lombardozzi
- National Center for Atmospheric Research, Climate and Global Dynamics, Terrestrial Sciences Section, Boulder, CO, 80305, USA
| | | | - Joe R Melton
- Canadian Centre for Climate Modelling and Analysis, Climate Research Division, Environment and Climate Change Canada, Victoria, BC, Canada
| | - Julia E M S Nabel
- Max Planck Institute for Meteorology, Bundesstr. 53, 20146, Hamburg, Germany.,Max Planck Institute for Biogeochemistry, Jena, Germany
| | - Julia Pongratz
- Max Planck Institute for Meteorology, Bundesstr. 53, 20146, Hamburg, Germany.,Ludwig-Maximilians-Universität München, Luisenstr. 37, 80333, München, Germany
| | - Benjamin Poulter
- NASA Goddard Space Flight Center, Biospheric Sciences Laboratory, Greenbelt, MD, 20771, USA
| | - Roland Séférian
- CNRM, Université de Toulouse, Météo-France, CNRS, Toulouse, France
| | - Hanqin Tian
- Schiller Institute for Integrated Science and Society, Department of Earth and Environmental Sciences, Boston College, Chestnut Hill, MA, 02467, USA
| | - Nicolas Vuichard
- Laboratoire des Sciences du Climat et de l'Environnement, LSCE/IPSL, CEA-CNRS-UVSQ, Université Paris-Saclay, F-91198, Gif-sur-Yvette, France
| | - Anthony P Walker
- Climate Change Science Institute & Environmental Sciences Division, Oak Ridge National Lab, Oak Ridge, TN, 37831, USA
| | - Wenping Yuan
- School of Atmospheric Sciences, Sun Yat-sen University, Zhuhai, Guangdong, 510245, China
| | - Xu Yue
- School of Environmental Science and Engineering, Nanjing University of Information Science and Technology (NUIST), Nanjing, China
| | - Sönke Zaehle
- Max Planck Institute for Biogeochemistry, Jena, Germany
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13
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Katiyar SK, Gaur SN, Solanki RN, Sarangdhar N, Suri JC, Kumar R, Khilnani GC, Chaudhary D, Singla R, Koul PA, Mahashur AA, Ghoshal AG, Behera D, Christopher DJ, Talwar D, Ganguly D, Paramesh H, Gupta KB, Kumar T M, Motiani PD, Shankar PS, Chawla R, Guleria R, Jindal SK, Luhadia SK, Arora VK, Vijayan VK, Faye A, Jindal A, Murar AK, Jaiswal A, M A, Janmeja AK, Prajapat B, Ravindran C, Bhattacharyya D, D'Souza G, Sehgal IS, Samaria JK, Sarma J, Singh L, Sen MK, Bainara MK, Gupta M, Awad NT, Mishra N, Shah NN, Jain N, Mohapatra PR, Mrigpuri P, Tiwari P, Narasimhan R, Kumar RV, Prasad R, Swarnakar R, Chawla RK, Kumar R, Chakrabarti S, Katiyar S, Mittal S, Spalgais S, Saha S, Kant S, Singh VK, Hadda V, Kumar V, Singh V, Chopra V, B V. Indian Guidelines on Nebulization Therapy. Indian J Tuberc 2022; 69 Suppl 1:S1-S191. [PMID: 36372542 DOI: 10.1016/j.ijtb.2022.06.004] [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: 05/07/2022] [Revised: 06/03/2022] [Accepted: 06/09/2022] [Indexed: 06/16/2023]
Abstract
Inhalational therapy, today, happens to be the mainstay of treatment in obstructive airway diseases (OADs), such as asthma, chronic obstructive pulmonary disease (COPD), and is also in the present, used in a variety of other pulmonary and even non-pulmonary disorders. Hand-held inhalation devices may often be difficult to use, particularly for children, elderly, debilitated or distressed patients. Nebulization therapy emerges as a good option in these cases besides being useful in the home care, emergency room and critical care settings. With so many advancements taking place in nebulizer technology; availability of a plethora of drug formulations for its use, and the widening scope of this therapy; medical practitioners, respiratory therapists, and other health care personnel face the challenge of choosing appropriate inhalation devices and drug formulations, besides their rational application and use in different clinical situations. Adequate maintenance of nebulizer equipment including their disinfection and storage are the other relevant issues requiring guidance. Injudicious and improper use of nebulizers and their poor maintenance can sometimes lead to serious health hazards, nosocomial infections, transmission of infection, and other adverse outcomes. Thus, it is imperative to have a proper national guideline on nebulization practices to bridge the knowledge gaps amongst various health care personnel involved in this practice. It will also serve as an educational and scientific resource for healthcare professionals, as well as promote future research by identifying neglected and ignored areas in this field. Such comprehensive guidelines on this subject have not been available in the country and the only available proper international guidelines were released in 1997 which have not been updated for a noticeably long period of over two decades, though many changes and advancements have taken place in this technology in the recent past. Much of nebulization practices in the present may not be evidence-based and even some of these, the way they are currently used, may be ineffective or even harmful. Recognizing the knowledge deficit and paucity of guidelines on the usage of nebulizers in various settings such as inpatient, out-patient, emergency room, critical care, and domiciliary use in India in a wide variety of indications to standardize nebulization practices and to address many other related issues; National College of Chest Physicians (India), commissioned a National task force consisting of eminent experts in the field of Pulmonary Medicine from different backgrounds and different parts of the country to review the available evidence from the medical literature on the scientific principles and clinical practices of nebulization therapy and to formulate evidence-based guidelines on it. The guideline is based on all possible literature that could be explored with the best available evidence and incorporating expert opinions. To support the guideline with high-quality evidence, a systematic search of the electronic databases was performed to identify the relevant studies, position papers, consensus reports, and recommendations published. Rating of the level of the quality of evidence and the strength of recommendation was done using the GRADE system. Six topics were identified, each given to one group of experts comprising of advisors, chairpersons, convenor and members, and such six groups (A-F) were formed and the consensus recommendations of each group was included as a section in the guidelines (Sections I to VI). The topics included were: A. Introduction, basic principles and technical aspects of nebulization, types of equipment, their choice, use, and maintenance B. Nebulization therapy in obstructive airway diseases C. Nebulization therapy in the intensive care unit D. Use of various drugs (other than bronchodilators and inhaled corticosteroids) by nebulized route and miscellaneous uses of nebulization therapy E. Domiciliary/Home/Maintenance nebulization therapy; public & health care workers education, and F. Nebulization therapy in COVID-19 pandemic and in patients of other contagious viral respiratory infections (included later considering the crisis created due to COVID-19 pandemic). Various issues in different sections have been discussed in the form of questions, followed by point-wise evidence statements based on the existing knowledge, and recommendations have been formulated.
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Affiliation(s)
- S K Katiyar
- Department of Tuberculosis & Respiratory Diseases, G.S.V.M. Medical College & C.S.J.M. University, Kanpur, Uttar Pradesh, India.
| | - S N Gaur
- Vallabhbhai Patel Chest Institute, University of Delhi, Respiratory Medicine, School of Medical Sciences and Research, Sharda University, Greater NOIDA, Uttar Pradesh, India
| | - R N Solanki
- Department of Tuberculosis & Chest Diseases, B. J. Medical College, Ahmedabad, Gujarat, India
| | - Nikhil Sarangdhar
- Department of Pulmonary Medicine, D. Y. Patil School of Medicine, Navi Mumbai, Maharashtra, India
| | - J C Suri
- Department of Pulmonary, Critical Care & Sleep Medicine, Vardhman Mahavir Medical College & Safdarjung Hospital, New Delhi, India
| | - Raj Kumar
- Vallabhbhai Patel Chest Institute, Department of Pulmonary Medicine, National Centre of Allergy, Asthma & Immunology; University of Delhi, Delhi, India
| | - G C Khilnani
- PSRI Institute of Pulmonary, Critical Care, & Sleep Medicine, PSRI Hospital, Department of Pulmonary Medicine & Sleep Disorders, All India Institute of Medical Sciences, New Delhi, India
| | - Dhruva Chaudhary
- Department of Pulmonary & Critical Care Medicine, Pt. Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India
| | - Rupak Singla
- Department of Tuberculosis & Respiratory Diseases, National Institute of Tuberculosis & Respiratory Diseases (formerly L.R.S. Institute), Delhi, India
| | - Parvaiz A Koul
- Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Jammu & Kashmir, India
| | - Ashok A Mahashur
- Department of Respiratory Medicine, P. D. Hinduja Hospital, Mumbai, Maharashtra, India
| | - A G Ghoshal
- National Allergy Asthma Bronchitis Institute, Kolkata, West Bengal, India
| | - D Behera
- Department of Pulmonary Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - D J Christopher
- Department of Pulmonary Medicine, Christian Medical College, Vellore, Tamil Nadu, India
| | - Deepak Talwar
- Metro Centre for Respiratory Diseases, Noida, Uttar Pradesh, India
| | | | - H Paramesh
- Paediatric Pulmonologist & Environmentalist, Lakeside Hospital & Education Trust, Bengaluru, Karnataka, India
| | - K B Gupta
- Department of Tuberculosis & Respiratory Medicine, Pt. Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences Rohtak, Haryana, India
| | - Mohan Kumar T
- Department of Pulmonary, Critical Care & Sleep Medicine, One Care Medical Centre, Coimbatore, Tamil Nadu, India
| | - P D Motiani
- Department of Pulmonary Diseases, Dr. S. N. Medical College, Jodhpur, Rajasthan, India
| | - P S Shankar
- SCEO, KBN Hospital, Kalaburagi, Karnataka, India
| | - Rajesh Chawla
- Respiratory and Critical Care Medicine, Indraprastha Apollo Hospitals, New Delhi, India
| | - Randeep Guleria
- All India Institute of Medical Sciences, Department of Pulmonary Medicine & Sleep Disorders, AIIMS, New Delhi, India
| | - S K Jindal
- Department of Pulmonary Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - S K Luhadia
- Department of Tuberculosis and Respiratory Medicine, Geetanjali Medical College and Hospital, Udaipur, Rajasthan, India
| | - V K Arora
- Indian Journal of Tuberculosis, Santosh University, NCR Delhi, National Institute of TB & Respiratory Diseases Delhi, India; JIPMER, Puducherry, India
| | - V K Vijayan
- Vallabhbhai Patel Chest Institute, Department of Pulmonary Medicine, University of Delhi, Delhi, India
| | - Abhishek Faye
- Centre for Lung and Sleep Disorders, Nagpur, Maharashtra, India
| | | | - Amit K Murar
- Respiratory Medicine, Cronus Multi-Specialty Hospital, New Delhi, India
| | - Anand Jaiswal
- Respiratory & Sleep Medicine, Medanta Medicity, Gurugram, Haryana, India
| | - Arunachalam M
- All India Institute of Medical Sciences, New Delhi, India
| | - A K Janmeja
- Department of Respiratory Medicine, Government Medical College, Chandigarh, India
| | - Brijesh Prajapat
- Pulmonary and Critical Care Medicine, Yashoda Hospital and Research Centre, Ghaziabad, Uttar Pradesh, India
| | - C Ravindran
- Department of TB & Chest, Government Medical College, Kozhikode, Kerala, India
| | - Debajyoti Bhattacharyya
- Department of Pulmonary Medicine, Institute of Liver and Biliary Sciences, Army Hospital (Research & Referral), New Delhi, India
| | | | - Inderpaul Singh Sehgal
- Department of Pulmonary Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - J K Samaria
- Centre for Research and Treatment of Allergy, Asthma & Bronchitis, Department of Chest Diseases, IMS, BHU, Varanasi, Uttar Pradesh, India
| | - Jogesh Sarma
- Department of Pulmonary Medicine, Gauhati Medical College and Hospital, Guwahati, Assam, India
| | - Lalit Singh
- Department of Respiratory Medicine, SRMS Institute of Medical Sciences, Bareilly, Uttar Pradesh, India
| | - M K Sen
- Department of Respiratory Medicine, ESIC Medical College, NIT Faridabad, Haryana, India; Department of Pulmonary, Critical Care & Sleep Medicine, Vardhman Mahavir Medical College & Safdarjung Hospital, New Delhi, India
| | - Mahendra K Bainara
- Department of Pulmonary Medicine, R.N.T. Medical College, Udaipur, Rajasthan, India
| | - Mansi Gupta
- Department of Pulmonary Medicine, Sanjay Gandhi PostGraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Nilkanth T Awad
- Department of Pulmonary Medicine, Lokmanya Tilak Municipal Medical College, Mumbai, Maharashtra, India
| | - Narayan Mishra
- Department of Pulmonary Medicine, M.K.C.G. Medical College, Berhampur, Orissa, India
| | - Naveed N Shah
- Department of Pulmonary Medicine, Chest Diseases Hospital, Government Medical College, Srinagar, Jammu & Kashmir, India
| | - Neetu Jain
- Department of Pulmonary, Critical Care & Sleep Medicine, PSRI, New Delhi, India
| | - Prasanta R Mohapatra
- Department of Pulmonary Medicine & Critical Care, All India Institute of Medical Sciences, Bhubaneswar, Orissa, India
| | - Parul Mrigpuri
- Department of Pulmonary Medicine, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi, India
| | - Pawan Tiwari
- School of Excellence in Pulmonary Medicine, NSCB Medical College, Jabalpur, Madhya Pradesh, India
| | - R Narasimhan
- Department of EBUS and Bronchial Thermoplasty Services at Apollo Hospitals, Chennai, Tamil Nadu, India
| | - R Vijai Kumar
- Department of Pulmonary Medicine, MediCiti Medical College, Hyderabad, Telangana, India
| | - Rajendra Prasad
- Vallabhbhai Patel Chest Institute, University of Delhi and U.P. Rural Institute of Medical Sciences & Research, Safai, Uttar Pradesh, India
| | - Rajesh Swarnakar
- Department of Respiratory, Critical Care, Sleep Medicine and Interventional Pulmonology, Getwell Hospital & Research Institute, Nagpur, Maharashtra, India
| | - Rakesh K Chawla
- Department of, Respiratory Medicine, Critical Care, Sleep & Interventional Pulmonology, Saroj Super Speciality Hospital, Jaipur Golden Hospital, Rajiv Gandhi Cancer Hospital, Delhi, India
| | - Rohit Kumar
- Department of Pulmonary, Critical Care & Sleep Medicine, Vardhman Mahavir Medical College & Safdarjung Hospital, New Delhi, India
| | - S Chakrabarti
- Department of Pulmonary, Critical Care & Sleep Medicine, Vardhman Mahavir Medical College & Safdarjung Hospital, New Delhi, India
| | | | - Saurabh Mittal
- Department of Pulmonary, Critical Care & Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Sonam Spalgais
- Department of Pulmonary Medicine, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi, India
| | | | - Surya Kant
- Department of Respiratory (Pulmonary) Medicine, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - V K Singh
- Centre for Visceral Mechanisms, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi, India
| | - Vijay Hadda
- Department of Pulmonary Medicine & Sleep Disorders, All India Institute of Medical Sciences, New Delhi, India
| | - Vikas Kumar
- All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
| | - Virendra Singh
- Mahavir Jaipuria Rajasthan Hospital, Jaipur, Rajasthan, India
| | - Vishal Chopra
- Department of Chest & Tuberculosis, Government Medical College, Patiala, Punjab, India
| | - Visweswaran B
- Interventional Pulmonology, Yashoda Hospitals, Hyderabad, Telangana, India
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14
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Chauhan PS, Shiang A, Chen K, Babbra R, Feng W, Szymanski JJ, Harris PK, Hatcher C, Roussin J, Basarabescu F, Brunt L, Mayer LR, Borkowski A, Maguire L, Baumann BC, Reimers MA, Kim EH, Arora VK, Smith ZL, Chaudhuri AA. Integrative analysis of urine cell-free DNA for the detection of residual disease in localized bladder cancer patients. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.6_suppl.559] [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: 11/20/2022] Open
Abstract
559 Background: We previously developed a liquid biopsy assay to measure urine tumor DNA (utDNA) levels based on detection of single nucleotide variants (SNVs) in urine cell-free DNA (cfDNA). Nonsilent SNV detection in urine from muscle-invasive bladder cancer (MIBC) patients prior to radical cystectomy (RC) was associated with pathologic residual disease and worse progression-free survival (Chauhan et al., PLOS Medicine, 2021). Given the multiple types of genomic alterations present in bladder cancer (BC), here we developed a multi-omics approach for estimating utDNA levels without restricting our approach to SNVs. We performed ultra-low pass whole genome sequencing (ULP-WGS) based copy number analysis and urine Cancer Personalized Profiling by deep Sequencing (uCAPP-Seq) of urine cell-free DNA to predict pathologic complete response (pCR) in localized BC patients. Methods: We acquired urine preoperatively from 65 BC patients (69% muscle-invasive) on the day of standard-of-care RC, and after neoadjuvant chemotherapy in 48% of patients. We performed ULP-WGS of urine cfDNA from all 65 BC patients and 11 healthy adults. utDNA levels based on genome-wide copy number alterations (CNAs) in urine cfDNA was estimated using ichorCNA. In order to derive a SNV-based utDNA level as well, uCAPP-Seq was applied to urine cfDNA samples derived from 42 patients using a 145 kb panel of 49 consensus driver genes commonly mutated in MIBC. Results: In our cohort of 65 BC patients, 55% of patients achieved pCR ( n = 36) while 45% had residual disease detected in their surgical sample (no pCR; n = 29). Comparing ULP-WGS-derived utDNA levels between the groups, patients with no pCR had significantly higher CNA-derived tumor fractions in urine compared to patients with pCR (median 8.9% vs 1.8%, p = 0.01) and healthy adults ( n = 11) (median 8.9% vs 0%, p = 0.006). Further analysis with uCAPP-Seq in 42 patients revealed that nonsilent SNV-based utDNA detection correlated significantly with the absence of pCR ( p < 0.001) with a sensitivity of 81% and specificity of 81%. Moreover, utDNA-positive patients exhibited significantly worse progression-free survival compared to utDNA-negative patients (HR = 7.4; 95% CI: 1.4–38.9; p = 0.02). Conclusions: Bladder cancer patients who did not attain a pCR at the time of RC had greater genome-wide copy number alterations and nonsilent single nucleotide variants in their urine cfDNA compared to patients with pCR. These results suggest that integrative multi-omics of urine derived from MIBC patients has potential real-world clinical impact for bladder-sparing approaches in select patients.
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Affiliation(s)
- Pradeep S. Chauhan
- Division of Cancer Biology, Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO
| | - Alexander Shiang
- Division of Cancer Biology, Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO
| | - Kevin Chen
- Division of Cancer Biology, Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO
| | - Ramandeep Babbra
- Wilmot Institute Cancer Center, University of Rochester medical Center, Rochester, NY
| | - Wenjia Feng
- Division of Cancer Biology, Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO
| | - Jeffrey J. Szymanski
- Division of Cancer Biology, Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO
| | - Peter K. Harris
- Division of Cancer Biology, Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO
| | - Casey Hatcher
- Division of Cancer Biology, Department of Radiation Oncology, Washington University School of Medicine, St Louis, MO
| | - Jessica Roussin
- Department of Radiation Oncology, Washington University School of Medicine, St Louis, MO
| | - Franco Basarabescu
- Department of Radiation Oncology, Washington University School of Medicine, St Louis, MO
| | - Lindsey Brunt
- Department of Radiation Oncology, Washington University School of Medicine, St Louis, MO
| | - Lindsey R. Mayer
- Department of Radiation Oncology, Washington University School of Medicine, St Louis, MO
| | - Ariel Borkowski
- Division of Oncology, Department of Medicine, Washington University School of Medicine, St Louis, MO
| | - Lenon Maguire
- Division of Medical Oncology, Department of Medicine, Washington University School of Medicine, St. Louis, MO
| | - Brian C. Baumann
- Division of Cancer Biology, Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO
| | | | - Eric H Kim
- Division of Urology, Department of Surgery, Washington University School of Medicine, St. Louis, MO
| | - Vivek K Arora
- Division of Medical Oncology, Department of Medicine, Washington University School of Medicine, St. Louis, MO
| | - Zachary L Smith
- Division of Urology, Department of Surgery, Washington University School of Medicine, St. Louis, MO
| | - Aadel A Chaudhuri
- Division of Cancer Biology, Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO
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Gupta S, Arora VK, Gupta AK, Bandhu Gupta M. Utilization of health care services by elderly for respiratory diseases including TB - Challenges. Indian J Tuberc 2022; 69 Suppl 2:S246-S252. [PMID: 36400518 DOI: 10.1016/j.ijtb.2022.10.013] [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: 08/22/2022] [Revised: 08/27/2022] [Accepted: 10/21/2022] [Indexed: 11/11/2022]
Abstract
Progressive functional decline of all body organ systems in association with decreased immunity makes elderly vulnerable to all types of diseases including respiratory diseases. Advances in medical fields have resulted in increasing proportion of elderly globally. Healthcare demands of elderly population are complex. Provision of healthcare services for this continuously increasing population subgroup & ensuring their adequate utilization is full of challenges. These are demographic, socioeconomic, financial, physical accessibility, quality of healthcare services, attitudinal & transportation related. Large size of this subgroup with special healthcare needs in context of limited available resources of middle income country like India is the biggest challenge. Poor educational status & socioeconomic condition of Indian elderly, dependence on family, absence of formal social security & healthcare security complicates situation further. Condition of elderly females is particularly worse. In view of poor physical ability with often associated physical disability makes accessibility of healthcare services also significant factor. Overcoming negative attitudinal factors prevalent in Indian elderly & make them utilize available healthcare services is another huge challenge. Quality of healthcare services in form of availability of required expertise & equipments, attitude of healthcare providers towards elderly patients & convenience in utilization of these services also play an important role. Special provisions in TB control program for elderly in view of their complex needs, high prevalence, morbidity & mortality are also required.
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Affiliation(s)
- Sonisha Gupta
- Department of Respiratory Medicine, SMSR, Sharda University, Greater Noida, India.
| | - V K Arora
- Respiratory Diseases, Senior Consultant, Ex-Vice Chancellor, Santosh University, NCR, Delhi
| | | | - Mohan Bandhu Gupta
- Department of Respiratory Medicine, SMSR, Sharda University, Greater Noida, India
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Chauhan PS, Chen K, Babbra RK, Feng W, Pejovic N, Nallicheri A, Harris PK, Dienstbach K, Atkocius A, Maguire L, Qaium F, Szymanski JJ, Baumann BC, Ding L, Cao D, Reimers MA, Kim EH, Smith ZL, Arora VK, Chaudhuri AA. Correction: Urine tumor DNA detection of minimal residual disease in muscle-invasive bladder cancer treated with curative-intent radical cystectomy: A cohort study. PLoS Med 2021; 18:e1003876. [PMID: 34905549 PMCID: PMC8670709 DOI: 10.1371/journal.pmed.1003876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
[This corrects the article DOI: 10.1371/journal.pmed.1003732.].
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Padmapriyadarsini C, Banurekha V, Arora VK. Challenges in TB control and the anticipated COVID-19 third wave: Way forward. Indian J Tuberc 2021; 68:425-427. [PMID: 34752307 PMCID: PMC8316627 DOI: 10.1016/j.ijtb.2021.07.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 07/22/2021] [Indexed: 11/25/2022]
Affiliation(s)
- C Padmapriyadarsini
- ICMR-National Institute for Research in Tuberculosis, Chetput, Chennai, India.
| | - V Banurekha
- ICMR-National Institute for Research in Tuberculosis, Chetput, Chennai, India
| | - V K Arora
- Tuberculosis Association of India, India
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18
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Chopra KK, Matta S, Arora VK. Impact of COVID-19 and tobacco on TB control. Indian J Tuberc 2021; 68S:S4-S6. [PMID: 34538390 PMCID: PMC8384480 DOI: 10.1016/j.ijtb.2021.08.012] [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: 08/06/2021] [Accepted: 08/10/2021] [Indexed: 06/13/2023]
Affiliation(s)
- K K Chopra
- New Delhi Tuberculosis Centre, New Delhi, India; Indian Journal of Tuberculosis, India.
| | - S Matta
- New Delhi Tuberculosis Centre, New Delhi, India
| | - V K Arora
- TB Association of India, India; Indian Journal of Tuberculosis, India
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19
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Chauhan PS, Chen K, Babbra RK, Feng W, Pejovic N, Nallicheri A, Harris PK, Dienstbach K, Atkocius A, Maguire L, Qaium F, Szymanski JJ, Baumann BC, Ding L, Cao D, Reimers MA, Kim EH, Smith ZL, Arora VK, Chaudhuri AA. Urine tumor DNA detection of minimal residual disease in muscle-invasive bladder cancer treated with curative-intent radical cystectomy: A cohort study. PLoS Med 2021; 18:e1003732. [PMID: 34464379 PMCID: PMC8407541 DOI: 10.1371/journal.pmed.1003732] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 07/12/2021] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND The standard of care treatment for muscle-invasive bladder cancer (MIBC) is radical cystectomy, which is typically preceded by neoadjuvant chemotherapy. However, the inability to assess minimal residual disease (MRD) noninvasively limits our ability to offer bladder-sparing treatment. Here, we sought to develop a liquid biopsy solution via urine tumor DNA (utDNA) analysis. METHODS AND FINDINGS We applied urine Cancer Personalized Profiling by Deep Sequencing (uCAPP-Seq), a targeted next-generation sequencing (NGS) method for detecting utDNA, to urine cell-free DNA (cfDNA) samples acquired between April 2019 and November 2020 on the day of curative-intent radical cystectomy from 42 patients with localized bladder cancer. The average age of patients was 69 years (range: 50 to 86), of whom 76% (32/42) were male, 64% (27/42) were smokers, and 76% (32/42) had a confirmed diagnosis of MIBC. Among MIBC patients, 59% (19/32) received neoadjuvant chemotherapy. utDNA variant calling was performed noninvasively without prior sequencing of tumor tissue. The overall utDNA level for each patient was represented by the non-silent mutation with the highest variant allele fraction after removing germline variants. Urine was similarly analyzed from 15 healthy adults. utDNA analysis revealed a median utDNA level of 0% in healthy adults and 2.4% in bladder cancer patients. When patients were classified as those who had residual disease detected in their surgical sample (n = 16) compared to those who achieved a pathologic complete response (pCR; n = 26), median utDNA levels were 4.3% vs. 0%, respectively (p = 0.002). Using an optimal utDNA threshold to define MRD detection, positive utDNA MRD detection was highly correlated with the absence of pCR (p < 0.001) with a sensitivity of 81% and specificity of 81%. Leave-one-out cross-validation applied to the prediction of pathologic response based on utDNA MRD detection in our cohort yielded a highly significant accuracy of 81% (p = 0.007). Moreover, utDNA MRD-positive patients exhibited significantly worse progression-free survival (PFS; HR = 7.4; 95% CI: 1.4-38.9; p = 0.02) compared to utDNA MRD-negative patients. Concordance between urine- and tumor-derived mutations, determined in 5 MIBC patients, was 85%. Tumor mutational burden (TMB) in utDNA MRD-positive patients was inferred from the number of non-silent mutations detected in urine cfDNA by applying a linear relationship derived from The Cancer Genome Atlas (TCGA) whole exome sequencing of 409 MIBC tumors. We suggest that about 58% of these patients with high inferred TMB might have been candidates for treatment with early immune checkpoint blockade. Study limitations included an analysis restricted only to single-nucleotide variants (SNVs), survival differences diminished by surgery, and a low number of DNA damage response (DRR) mutations detected after neoadjuvant chemotherapy at the MRD time point. CONCLUSIONS utDNA MRD detection prior to curative-intent radical cystectomy for bladder cancer correlated significantly with pathologic response, which may help select patients for bladder-sparing treatment. utDNA MRD detection also correlated significantly with PFS. Furthermore, utDNA can be used to noninvasively infer TMB, which could facilitate personalized immunotherapy for bladder cancer in the future.
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Affiliation(s)
- Pradeep S. Chauhan
- Division of Cancer Biology, Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri, United States of America
| | - Kevin Chen
- Division of Cancer Biology, Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri, United States of America
| | - Ramandeep K. Babbra
- Division of Cancer Biology, Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri, United States of America
| | - Wenjia Feng
- Division of Cancer Biology, Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri, United States of America
| | - Nadja Pejovic
- Division of Cancer Biology, Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri, United States of America
| | - Armaan Nallicheri
- Division of Cancer Biology, Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri, United States of America
| | - Peter K. Harris
- Division of Cancer Biology, Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri, United States of America
| | - Katherine Dienstbach
- Division of Medical Oncology, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, United States of America
- Siteman Cancer Center, Barnes Jewish Hospital and Washington University School of Medicine, St. Louis, Missouri, United States of America
| | - Andrew Atkocius
- Division of Medical Oncology, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, United States of America
- Siteman Cancer Center, Barnes Jewish Hospital and Washington University School of Medicine, St. Louis, Missouri, United States of America
| | - Lenon Maguire
- Division of Medical Oncology, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, United States of America
- Siteman Cancer Center, Barnes Jewish Hospital and Washington University School of Medicine, St. Louis, Missouri, United States of America
| | - Faridi Qaium
- Division of Cancer Biology, Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri, United States of America
| | - Jeffrey J. Szymanski
- Division of Cancer Biology, Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri, United States of America
| | - Brian C. Baumann
- Division of Cancer Biology, Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri, United States of America
- Siteman Cancer Center, Barnes Jewish Hospital and Washington University School of Medicine, St. Louis, Missouri, United States of America
| | - Li Ding
- Division of Medical Oncology, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, United States of America
- Siteman Cancer Center, Barnes Jewish Hospital and Washington University School of Medicine, St. Louis, Missouri, United States of America
- Department of Genetics, Washington University School of Medicine, St. Louis, Missouri, United States of America
- McDonnell Genome Institute, Washington University School of Medicine, St. Louis, Missouri, United States of America
- Division of Biology and Biomedical Sciences, Washington University School of Medicine, St. Louis, Missouri, United States of America
| | - Dengfeng Cao
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, Missouri, United States of America
| | - Melissa A. Reimers
- Division of Medical Oncology, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, United States of America
- Siteman Cancer Center, Barnes Jewish Hospital and Washington University School of Medicine, St. Louis, Missouri, United States of America
| | - Eric H. Kim
- Siteman Cancer Center, Barnes Jewish Hospital and Washington University School of Medicine, St. Louis, Missouri, United States of America
- Division of Urology, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, United States of America
| | - Zachary L. Smith
- Siteman Cancer Center, Barnes Jewish Hospital and Washington University School of Medicine, St. Louis, Missouri, United States of America
- Division of Urology, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, United States of America
| | - Vivek K. Arora
- Division of Medical Oncology, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, United States of America
- Siteman Cancer Center, Barnes Jewish Hospital and Washington University School of Medicine, St. Louis, Missouri, United States of America
| | - Aadel A. Chaudhuri
- Division of Cancer Biology, Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri, United States of America
- Siteman Cancer Center, Barnes Jewish Hospital and Washington University School of Medicine, St. Louis, Missouri, United States of America
- Department of Genetics, Washington University School of Medicine, St. Louis, Missouri, United States of America
- Division of Biology and Biomedical Sciences, Washington University School of Medicine, St. Louis, Missouri, United States of America
- Department of Biomedical Engineering, Washington University School of Medicine, St. Louis, Missouri, United States of America
- Department of Computer Science and Engineering, Washington University in St. Louis, St. Louis, Missouri, United States of America
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20
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Chen K, Chauhan PS, Babbra RK, Feng W, Harris PK, Dienstbach K, Atkocius A, Maguire L, Qaium F, Nallicheri A, Baumann BC, Reimers MA, Kim EH, Smith ZL, Arora VK, Chaudhuri AA. Abstract 547: Urine tumor DNA MRD detection and correlation with pathologic complete response in muscle-invasive bladder cancer treated with curative-intent radical cystectomy. Cancer Res 2021. [DOI: 10.1158/1538-7445.am2021-547] [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: 11/16/2022]
Abstract
Abstract
Objective: Standard-of-care for muscle-invasive bladder cancer (MIBC) is neoadjuvant chemotherapy followed by radical cystectomy. The inability to assess molecular residual disease (MRD) noninvasively limits our ability to offer bladder-sparing treatment. We seek to develop a liquid biopsy solution via urine tumor DNA (utDNA) analysis.
Methods: We applied uCAPP-Seq, a targeted next-generation sequencing method for detecting utDNA, to urine cell-free DNA samples acquired on the day of curative-intent radical cystectomy from 42 patients with non-metastatic bladder cancer, 30 of whom had a confirmed diagnosis of MIBC and 19 of whom received neoadjuvant chemotherapy. utDNA mutational calling was performed noninvasively without tumor tissue sequencing knowledge. The overall utDNA level for each patient was represented by the non-silent mutation with the highest duplex-supported variant allele fraction after removing germline variants. Urine was similarly analyzed from 15 healthy donors. The concordance between urine cell-free DNA and tumor tissue was determined for a subset of patients. Tumor mutational burden (TMB) in utDNA MRD-positive patients was inferred from the number of mutations detected in urine cell-free DNA by applying a linear relationship derived from TCGA whole-exome sequencing of 409 MIBC tumors.
Results: utDNA analysis revealed a median utDNA level of 0% in healthy donors and 2.4% in non-metastatic bladder cancer patients. Concordance between urine- and tumor-derived mutations, determined in 5 MIBC patients, was 87%. When patients were classified as those who had residual disease detected in their surgical sample (n = 16) compared to those who achieved a pathologic complete response (n = 26), median utDNA levels were 4.3% vs. 0%, respectively (P = 0.002). The lack of utDNA MRD detection was highly correlated with pathologic complete response by Fisher's exact test (P = 0.0001) with Youden's index-determined sensitivity of 81% and specificity of 81%. Moreover, utDNA MRD-positive patients exhibited significantly worse progression-free survival compared to utDNA MRD-negative patients (HR = 7.2; P = 0.03) with a median follow-up time of 200 days. Leveraging data from TCGA, the median inferred TMB in utDNA MRD-positive patients was 198 mutations per exome. We suggest that 58% of these patients with inferred TMB ≥ this level might have been candidates for early immune checkpoint blockade.
Conclusion: The lack of utDNA MRD detection prior to curative-intent radical cystectomy for muscle-invasive bladder cancer correlated significantly with pathologic complete response. utDNA MRD detection status also correlated significantly with progression-free survival. Furthermore, utDNA results can be used to noninvasively infer TMB, which may facilitate the targeted use of adjuvant immunotherapy.
Citation Format: Kevin Chen, Pradeep S. Chauhan, Ramandeep K. Babbra, Wenjia Feng, Peter K. Harris, Katherine Dienstbach, Andrew Atkocius, Lenon Maguire, Faridi Qaium, Armaan Nallicheri, Brian C. Baumann, Melissa A. Reimers, Eric H. Kim, Zachary L. Smith, Vivek K. Arora, Aadel A. Chaudhuri. Urine tumor DNA MRD detection and correlation with pathologic complete response in muscle-invasive bladder cancer treated with curative-intent radical cystectomy [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2021; 2021 Apr 10-15 and May 17-21. Philadelphia (PA): AACR; Cancer Res 2021;81(13_Suppl):Abstract nr 547.
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Affiliation(s)
- Kevin Chen
- Washington University School of Medicine, St. Louis, MO
| | | | | | - Wenjia Feng
- Washington University School of Medicine, St. Louis, MO
| | | | | | | | - Lenon Maguire
- Washington University School of Medicine, St. Louis, MO
| | - Faridi Qaium
- Washington University School of Medicine, St. Louis, MO
| | | | | | | | - Eric H. Kim
- Washington University School of Medicine, St. Louis, MO
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21
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Affiliation(s)
- K K Chopra
- New Delhi Tuberculosis Centre, New Delhi, India; Indian Journal of Tuberculosis, India.
| | - S Matta
- New Delhi Tuberculosis Centre, New Delhi, India
| | - V K Arora
- TB Association of India, India; Indian Journal of Tuberculosis, India
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22
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Chen K, Chauhan PS, Babbra RK, Feng W, Pejovic N, Nallicheri A, Harris PK, Dienstbach K, Atkocius A, Maguire L, Qaium F, Szymanski JJ, Baumann BC, Ding L, Cao D, Reimers MA, Kim EH, Smith ZL, Arora VK, Chaudhuri AA. Tracking minimal residual disease with urine tumor DNA in muscle-invasive bladder cancer after neoadjuvant chemotherapy. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.e16514] [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: 11/20/2022] Open
Abstract
e16514 Background: Standard-of-care for muscle-invasive bladder cancer (MIBC) consists of neoadjuvant chemotherapy (NAC) followed by radical cystectomy. The inability to noninvasively assess minimal residual disease (MRD) after NAC limits our ability to offer bladder-sparing treatment. We perform urine tumor DNA (utDNA) analysis to identify pathologic complete response (pCR) at the time of cystectomy in patients receiving NAC. Methods: We applied CAPP-Seq to urine cell-free DNA samples acquired on the day of radical cystectomy from 19 MIBC patients treated with NAC. utDNA variant-calling was performed without prior tumor mutational knowledge using a panel of 49 consensus driver genes mutated in MIBC. The utDNA level for each patient was represented by the duplex-supported non-silent driver mutation with the highest variant allele fraction (vAF) after removing germline variants. We also serially tracked utDNA variants in two patients before, during, and after NAC. Results: Comparing patients with residual disease detected in their cystectomy specimen ( n = 10) to those who achieved a pCR ( n = 9), median utDNA levels were 2.4% vs. 0%, respectively ( P = 0.006). Using an optimal utDNA threshold to define MRD detection, positive utDNA MRD was highly correlated with the absence of pCR ( P = 0.003). Analysis of two patients’ serial urine samples revealed utDNA dynamics that were consistent with treatment responses in real-time. In one patient who ultimately achieved a pCR, four non-silent driver mutations were detectable pre-NAC, including ERCC2 N238S (7.8% vAF) associated with increased chemosensitivity. One week after starting NAC, ERCC2 N238S increased by 1.6-fold in urine, as did PIK3CA E726K which increased by 8.4-fold. Four weeks post-NAC, however, all mutations previously detected in this patient’s urine became undetectable, consistent with the patient’s pCR and long-term disease-free survival. Conversely, another patient harbored two non-silent driver mutations in PLEKHS1 (1.9% vAF) and KMT2D (4.9% vAF) pre-NAC. One week after starting NAC, both mutations decreased dramatically by 8.0- and 4.3-fold, respectively. By three weeks post-NAC, however, these mutations progressively increased by 5.2-fold on average, which correlated with a lack of pCR as well as post-treatment disease progression. Two newly detected non-silent driver mutations in ARID1A and ERBB2 also emerged on NAC and persisted following completion of chemotherapy , likely reflecting the development of treatment resistance. Conclusions: utDNA MRD after NAC but before radical cystectomy for MIBC correlated significantly with pathologic response, which could help personalize patient selection for bladder-sparing treatments in the future. Serial monitoring of utDNA variants during NAC can reveal dynamic mutational changes that reflect real-time treatment responses as well as ultimate disease-free survival.
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Affiliation(s)
- Kevin Chen
- Division of Cancer Biology, Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO
| | - Pradeep S Chauhan
- Division of Cancer Biology, Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO
| | - Ramandeep K Babbra
- Division of Cancer Biology, Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO
| | - Wenjia Feng
- Division of Cancer Biology, Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO
| | - Nadja Pejovic
- Division of Cancer Biology, Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO
| | - Armaan Nallicheri
- Division of Cancer Biology, Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO
| | - Peter K Harris
- Division of Cancer Biology, Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO
| | - Katherine Dienstbach
- Division of Medical Oncology, Department of Medicine, Washington University School of Medicine, St. Louis, MO
| | - Andrew Atkocius
- Division of Medical Oncology, Department of Medicine, Washington University School of Medicine, St. Louis, MO
| | - Lenon Maguire
- Division of Medical Oncology, Department of Medicine, Washington University School of Medicine, St. Louis, MO
| | - Faridi Qaium
- Division of Cancer Biology, Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO
| | - Jeffrey J Szymanski
- Division of Cancer Biology, Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO
| | - Brian C Baumann
- Division of Cancer Biology, Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO
| | - Li Ding
- McDonnell Genome Institute, Washington University School of Medicine, St. Louis, MO
| | - Dengfeng Cao
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO
| | - Melissa Andrea Reimers
- Division of Medical Oncology, Department of Medicine, Washington University School of Medicine, St. Louis, MO
| | - Eric H Kim
- Division of Urology, Department of Surgery, Washington University School of Medicine, St. Louis, MO
| | - Zachary L Smith
- Division of Urology, Department of Surgery, Washington University School of Medicine, St. Louis, MO
| | - Vivek K Arora
- Division of Medical Oncology, Department of Medicine, Washington University School of Medicine, St. Louis, MO
| | - Aadel A Chaudhuri
- Division of Cancer Biology, Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO
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Palmbos PL, Daignault-Newton S, Tomlins SA, Agarwal N, Twardowski P, Morgans AK, Kelly WK, Arora VK, Antonarakis ES, Siddiqui J, Jacobson JA, Davenport MS, Robinson DR, Chinnaiyan AM, Knudsen KE, Hussain M. A Randomized Phase II Study of Androgen Deprivation Therapy with or without Palbociclib in RB-positive Metastatic Hormone-Sensitive Prostate Cancer. Clin Cancer Res 2021; 27:3017-3027. [PMID: 33727260 DOI: 10.1158/1078-0432.ccr-21-0024] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 02/16/2021] [Accepted: 03/12/2021] [Indexed: 12/12/2022]
Abstract
PURPOSE Palbociclib, a cyclin-dependent kinase (CDK) 4/6 inhibitor, blocks proliferation in a RB and cyclin D-dependent manner in preclinical prostate cancer models. We hypothesized that cotargeting androgen receptor and cell cycle with palbociclib would improve outcomes in patients with metastatic hormone-sensitive prostate cancer (mHSPC). PATIENTS AND METHODS A total of 60 patients with RB-intact mHSPC were randomized (1:2) to Arm 1: androgen deprivation (AD) or Arm 2: AD + palbociclib. Primary endpoint was PSA response rate (RR) after 28 weeks of therapy. Secondary endpoints included safety, PSA, and clinical progression-free survival (PFS), as well as PSA and radiographic RR. Tumors underwent exome sequencing when available. Circulating tumor cells (CTC) were enumerated at various timepoints. RESULTS A total of 72 patients with mHSPC underwent metastatic disease biopsy and 64 had adequate tissue for RB assessment. A total of 62 of 64 (97%) retained RB expression. A total of 60 patients initiated therapy (Arm 1: 20; Arm 2: 40). Neutropenia was the most common grade 3/4 adverse event in Arm 2. Eighty percent of patients (Arm 1: 16/20, Arm 2: 32/40; P = 0.87) met primary PSA endpoint ≤4 ng/mL at 28 weeks. PSA undetectable rate at 28 weeks was 50% and 43% in Arms 1 and 2, respectively (P = 0.5). Radiographic RR was 89% in both arms. Twelve-month biochemical PFS was 69% and 74% in Arms 1 and 2, respectively (P = 0.72). TP53 and PIK3 pathway mutations, 8q gains, and pretreatment CTCs were associated with reduced PSA PFS. CONCLUSIONS Palbociclib did not impact outcome in RB-intact mHSPC. Pretreatment CTC, TP53 and PIK3 pathway mutations, and 8q gain were associated with poor outcome.
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Affiliation(s)
| | | | | | - Neeraj Agarwal
- Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
| | | | - Alicia K Morgans
- Northwestern University/Robert H. Lurie Comprehensive Cancer Center, Chicago, Illinois
| | - Wm Kevin Kelly
- Sidney Kimmel Cancer Center at Jefferson Health and Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Vivek K Arora
- Washington University in St. Louis, St. Louis, Missouri
| | | | - Javed Siddiqui
- Michigan Medicine Rogel Cancer Center, Ann Arbor, Michigan
| | - Jon A Jacobson
- Michigan Medicine Rogel Cancer Center, Ann Arbor, Michigan
| | | | - Dan R Robinson
- Michigan Medicine Rogel Cancer Center, Ann Arbor, Michigan
| | | | - Karen E Knudsen
- Sidney Kimmel Cancer Center at Jefferson Health and Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Maha Hussain
- Northwestern University/Robert H. Lurie Comprehensive Cancer Center, Chicago, Illinois.
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Bhargava S, Chopra KK, Arora VK. NATCON virtual 2020 - Challenges and way ahead. Indian J Tuberc 2021; 68:1-2. [PMID: 33641828 DOI: 10.1016/j.ijtb.2021.02.002] [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: 10/22/2022]
Affiliation(s)
- Salil Bhargava
- Pulmonary Medicine, M G M Medical College, Indore, India
| | - K K Chopra
- New Delhi Tuberculosis Centre, New Delhi, India; Indian Journal of Tuberculosis, India.
| | - V K Arora
- TB Association of India, India; Indian Journal of Tuberculosis, India
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25
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Matta S, Arora VK, Chopra KK. Lessons to be learnt from 100 year old 1918 influenza pandemic viz a viz 2019 corona pandemic with an eye on NTEP. Indian J Tuberc 2020; 67:S132-S138. [PMID: 33308659 PMCID: PMC7543972 DOI: 10.1016/j.ijtb.2020.09.032] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 09/28/2020] [Indexed: 12/28/2022]
Abstract
The article is about the 1918 H1N1 flu pandemic also called the “Spanish flu“ which killed 50 million plus people worldwide, and the coronavirus pandemic (Covid-19) which has spread in the world at an alarming pace. As of now there are 11,327,790 cases and 532,340 deaths globally. Aim of this article is to draw conclusions and share knowledge from both the pandemics and apply these lessons in other health programmes.
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Affiliation(s)
| | - V K Arora
- Honorary Treasurer & Trustee TAI, TB Association of India
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26
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O'Sullivan M, Smith WK, Sitch S, Friedlingstein P, Arora VK, Haverd V, Jain AK, Kato E, Kautz M, Lombardozzi D, Nabel JEMS, Tian H, Vuichard N, Wiltshire A, Zhu D, Buermann W. Climate-Driven Variability and Trends in Plant Productivity Over Recent Decades Based on Three Global Products. Global Biogeochem Cycles 2020; 34:e2020GB006613. [PMID: 33380772 PMCID: PMC7757257 DOI: 10.1029/2020gb006613] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Revised: 11/17/2020] [Accepted: 11/22/2020] [Indexed: 06/12/2023]
Abstract
Variability in climate exerts a strong influence on vegetation productivity (gross primary productivity; GPP), and therefore has a large impact on the land carbon sink. However, no direct observations of global GPP exist, and estimates rely on models that are constrained by observations at various spatial and temporal scales. Here, we assess the consistency in GPP from global products which extend for more than three decades; two observation-based approaches, the upscaling of FLUXNET site observations (FLUXCOM) and a remote sensing derived light use efficiency model (RS-LUE), and from a suite of terrestrial biosphere models (TRENDYv6). At local scales, we find high correlations in annual GPP among the products, with exceptions in tropical and high northern latitudes. On longer time scales, the products agree on the direction of trends over 58% of the land, with large increases across northern latitudes driven by warming trends. Further, tropical regions exhibit the largest interannual variability in GPP, with both rainforests and savannas contributing substantially. Variability in savanna GPP is likely predominantly driven by water availability, although temperature could play a role via soil moisture-atmosphere feedbacks. There is, however, no consensus on the magnitude and driver of variability of tropical forests, which suggest uncertainties in process representations and underlying observations remain. These results emphasize the need for more direct long-term observations of GPP along with an extension of in situ networks in underrepresented regions (e.g., tropical forests). Such capabilities would support efforts to better validate relevant processes in models, to more accurately estimate GPP.
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Affiliation(s)
- Michael O'Sullivan
- College of Engineering, Mathematics and Physical SciencesUniversity of ExeterExeterUK
| | - William K. Smith
- School of Natural Resources and the EnvironmentUniversity of ArizonaTucsonAZUSA
| | - Stephen Sitch
- College of Life and Environmental SciencesUniversity of ExeterExeterUK
| | - Pierre Friedlingstein
- College of Engineering, Mathematics and Physical SciencesUniversity of ExeterExeterUK
- LMD/IPSL, ENS, PSL Université, École Polytechnique, Institut Polytechnique de Paris, Sorbonne Université, CNRSParisFrance
| | - Vivek K. Arora
- Canadian Centre for Climate Modelling and Analysis, Environment and Climate Change CanadaUniversity of VictoriaVictoriaBritish ColumbiaCanada
| | | | - Atul K. Jain
- Department of Atmospheric SciencesUniversity of IllinoisUrbanaILUSA
| | | | - Markus Kautz
- Institute of Meteorology and Climate Research – Atmospheric Environmental Research (IMK‐IFU)Karlsruhe Institute of Technology (KIT)Garmisch‐PartenkirchenGermany
- Forest Research Institute Baden‐WürttembergFreiburgGermany
| | - Danica Lombardozzi
- Climate and Global Dynamics DivisionNational Center for Atmospheric ResearchBoulderCOUSA
| | | | - Hanqin Tian
- International Center for Climate and Global Change Research, School of Forestry and Wildlife SciencesAuburn UniversityAuburnALUSA
| | - Nicolas Vuichard
- Laboratoire des Sciences du Climat et de l'Environnement, UMR8212 CEA‐CNRS‐UVSQ, Université Paris‐Saclay, IPSLGif‐sur‐YvetteFrance
| | | | - Dan Zhu
- Laboratoire des Sciences du Climat et de l'Environnement, UMR8212 CEA‐CNRS‐UVSQ, Université Paris‐Saclay, IPSLGif‐sur‐YvetteFrance
| | - Wolfgang Buermann
- Institute of GeographyAugsburg UniversityAugsburgGermany
- Institute of the Environment and SustainabilityUniversity of California, Los AngelesLos AngelesCAUSA
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Abstract
The present article highlights morbidity and mortality trends of Covid 19 in the last 3 months in top 10 countries of the world. In spite of efforts being undertaken, all countries are showing an increasing trend in terms of morbidity and mortality. The order of countries in terms of mortality and morbidity has changed in the last 3 months. Various efforts are being undertaken by WHO and other agencies world over including the vaccine development initiative.
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Affiliation(s)
| | - K K Chopra
- STDC, Delhi New Delhi TB Centre, New Delhi, India
| | - V K Arora
- Honorary Treasurer & Trustee TAI TB Association of India, India
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28
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Rajpal S, Arora VK. Latent TB (LTBI) treatment: Challenges in India with an eye on 2025: "To Treat LTBI or not to treat, that is the question". Indian J Tuberc 2020; 67:S43-S47. [PMID: 33308671 DOI: 10.1016/j.ijtb.2020.09.028] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 09/24/2020] [Indexed: 10/23/2022]
Abstract
Latent tuberculosis infection (LTBI) is defined as a consistent immune response to Mycobacterium tuberculosis antigens without evidence of clinically evident active tuberculosis (TB). Diagnosis and treatment for LTBI are important for TB, especially in high-risk populations especially in high prevalent country like India. Tuberculin skin test (TST) and interferon-gamma release assays (IGRAs) are used to diagnose LTBI. Therefore an unequivocal policy /of diagnosis and treatment of LTBI will serve to ameliorate the standards of the Indian health scenario and bring the TB infection to the propinquity of its ultimate elimination.
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Affiliation(s)
| | - V K Arora
- Vice Chairman Publication & Research, Honorary Treasurer, Honorary Technical Advisor, TB Association of India, India
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29
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Wang K, Wang Y, Wang X, He Y, Li X, Keeling RF, Ciais P, Heimann M, Peng S, Chevallier F, Friedlingstein P, Sitch S, Buermann W, Arora VK, Haverd V, Jain AK, Kato E, Lienert S, Lombardozzi D, Nabel JEMS, Poulter B, Vuichard N, Wiltshire A, Zeng N, Zhu D, Piao S. Causes of slowing-down seasonal CO 2 amplitude at Mauna Loa. Glob Chang Biol 2020; 26:4462-4477. [PMID: 32415896 DOI: 10.1111/gcb.15162] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 03/23/2020] [Accepted: 05/06/2020] [Indexed: 05/27/2023]
Abstract
Changing amplitude of the seasonal cycle of atmospheric CO2 (SCA) in the northern hemisphere is an emerging carbon cycle property. Mauna Loa (MLO) station (20°N, 156°W), which has the longest continuous northern hemisphere CO2 record, shows an increasing SCA before the 1980s (p < .01), followed by no significant change thereafter. We analyzed the potential driving factors of SCA slowing-down, with an ensemble of dynamic global vegetation models (DGVMs) coupled with an atmospheric transport model. We found that slowing-down of SCA at MLO is primarily explained by response of net biome productivity (NBP) to climate change, and by changes in atmospheric circulations. Through NBP, climate change increases SCA at MLO before the 1980s and decreases it afterwards. The effect of climate change on the slowing-down of SCA at MLO is mainly exerted by intensified drought stress acting to offset the acceleration driven by CO2 fertilization. This challenges the view that CO2 fertilization is the dominant cause of emergent SCA trends at northern sites south of 40°N. The contribution of agricultural intensification on the deceleration of SCA at MLO was elusive according to land-atmosphere CO2 flux estimated by DGVMs and atmospheric inversions. Our results also show the necessity to adequately account for changing circulation patterns in understanding carbon cycle dynamics observed from atmospheric observations and in using these observations to benchmark DGVMs.
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Affiliation(s)
- Kai Wang
- Sino-French Institute for Earth System Science, College of Urban and Environmental Sciences, Peking University, Beijing, China
| | - Yilong Wang
- Key Laboratory of Land Surface Pattern and Simulation, Institute of Geographical Sciences and Natural Resources Research, Chinese Academy of Sciences, Beijing, China
- Laboratoire des Sciences du Climat et de l'Environnement, CEA CNRS UVSQ, Gif-sur-Yvette, France
| | - Xuhui Wang
- Sino-French Institute for Earth System Science, College of Urban and Environmental Sciences, Peking University, Beijing, China
| | - Yue He
- Sino-French Institute for Earth System Science, College of Urban and Environmental Sciences, Peking University, Beijing, China
| | - Xiangyi Li
- Sino-French Institute for Earth System Science, College of Urban and Environmental Sciences, Peking University, Beijing, China
| | - Ralph F Keeling
- Scripps Institution of Oceanography, University of California, San Diego, La Jolla, CA, USA
| | - Philippe Ciais
- Sino-French Institute for Earth System Science, College of Urban and Environmental Sciences, Peking University, Beijing, China
- Laboratoire des Sciences du Climat et de l'Environnement, CEA CNRS UVSQ, Gif-sur-Yvette, France
| | - Martin Heimann
- Max Planck Institute for Biogeochemistry, Jena, Germany
- Institute for Atmospheric and Earth System Research (INAR), Faculty of Science, University of Helsinki, Helsinki, Finland
| | - Shushi Peng
- Sino-French Institute for Earth System Science, College of Urban and Environmental Sciences, Peking University, Beijing, China
| | - Frédéric Chevallier
- Laboratoire des Sciences du Climat et de l'Environnement, CEA CNRS UVSQ, Gif-sur-Yvette, France
| | - Pierre Friedlingstein
- College of Engineering, Mathematics and Physical Sciences, University of Exeter, Exeter, UK
| | - Stephen Sitch
- College of Life and Environmental Sciences, University of Exeter, Exeter, UK
| | - Wolfgang Buermann
- Institute of Geography, Augsburg University, Augsburg, Germany
- Institute of the Environment and Sustainability, University of California, Los Angeles, Los Angeles, CA, USA
| | - Vivek K Arora
- Canadian Centre for Climate Modelling and Analysis, Environment Canada, University of Victoria, Victoria, BC, Canada
| | | | - Atul K Jain
- Department of Atmospheric Sciences, University of Illinois, Urbana, IL, USA
| | | | - Sebastian Lienert
- Climate and Environmental Physics, Physics Institute and Oeschger Centre for Climate Change Research, University of Bern, Bern, Switzerland
| | - Danica Lombardozzi
- National Center for Atmospheric Research, Climate and Global Dynamics, Terrestrial Sciences Section, Boulder, CO, USA
| | | | - Benjamin Poulter
- NASA Goddard Space Flight Center, Biospheric Sciences Laboratory, Greenbelt, MD, USA
| | - Nicolas Vuichard
- Laboratoire des Sciences du Climat et de l'Environnement, CEA CNRS UVSQ, Gif-sur-Yvette, France
| | | | - Ning Zeng
- Department of Atmospheric and Oceanic Science, University of Maryland, College Park, MD, USA
| | - Dan Zhu
- Laboratoire des Sciences du Climat et de l'Environnement, CEA CNRS UVSQ, Gif-sur-Yvette, France
| | - Shilong Piao
- Sino-French Institute for Earth System Science, College of Urban and Environmental Sciences, Peking University, Beijing, China
- Key Laboratory of Alpine Ecology and Biodiversity, Institute of Tibetan Plateau Research, Chinese Academy of Sciences, Beijing, China
- Center for Excellence in Tibetan Earth Science, Chinese Academy of Sciences, Beijing, China
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30
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Chaudhuri AA, Pellini B, Pejovic N, Chauhan PS, Harris PK, Szymanski JJ, Smith ZL, Arora VK. Emerging Roles of Urine-Based Tumor DNA Analysis in Bladder Cancer Management. JCO Precis Oncol 2020; 4:2000060. [PMID: 32923907 DOI: 10.1200/po.20.00060] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/11/2020] [Indexed: 12/26/2022] Open
Affiliation(s)
- Aadel A Chaudhuri
- Division of Cancer Biology, Department of Radiation Oncology, Washington University School of Medicine, St Louis, MO.,Department of Genetics, Washington University School of Medicine, St Louis, MO.,Department of Computer Science and Engineering, Washington University in St Louis, St Louis, MO.,Department of Biomedical Engineering, Washington University in St Louis, St Louis, MO.,Siteman Cancer Center, Barnes Jewish Hospital and Washington University School of Medicine, St Louis, MO
| | - Bruna Pellini
- Siteman Cancer Center, Barnes Jewish Hospital and Washington University School of Medicine, St Louis, MO.,Division of Oncology, Department of Medicine, Washington University School of Medicine, St Louis, MO
| | - Nadja Pejovic
- Division of Cancer Biology, Department of Radiation Oncology, Washington University School of Medicine, St Louis, MO
| | - Pradeep S Chauhan
- Division of Cancer Biology, Department of Radiation Oncology, Washington University School of Medicine, St Louis, MO
| | - Peter K Harris
- Division of Cancer Biology, Department of Radiation Oncology, Washington University School of Medicine, St Louis, MO
| | - Jeffrey J Szymanski
- Division of Cancer Biology, Department of Radiation Oncology, Washington University School of Medicine, St Louis, MO.,Siteman Cancer Center, Barnes Jewish Hospital and Washington University School of Medicine, St Louis, MO
| | - Zachary L Smith
- Siteman Cancer Center, Barnes Jewish Hospital and Washington University School of Medicine, St Louis, MO.,Division of Urologic Surgery, Department of Surgery, Washington University School of Medicine, St Louis, MO
| | - Vivek K Arora
- Siteman Cancer Center, Barnes Jewish Hospital and Washington University School of Medicine, St Louis, MO.,Division of Oncology, Department of Medicine, Washington University School of Medicine, St Louis, MO
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31
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Yang H, Ciais P, Santoro M, Huang Y, Li W, Wang Y, Bastos A, Goll D, Arneth A, Anthoni P, Arora VK, Friedlingstein P, Harverd V, Joetzjer E, Kautz M, Lienert S, Nabel JEMS, O'Sullivan M, Sitch S, Vuichard N, Wiltshire A, Zhu D. Comparison of forest above-ground biomass from dynamic global vegetation models with spatially explicit remotely sensed observation-based estimates. Glob Chang Biol 2020; 26:3997-4012. [PMID: 32427397 DOI: 10.1111/gcb.15117] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 12/21/2019] [Accepted: 03/19/2020] [Indexed: 06/11/2023]
Abstract
Gaps in our current understanding and quantification of biomass carbon stocks, particularly in tropics, lead to large uncertainty in future projections of the terrestrial carbon balance. We use the recently published GlobBiomass data set of forest above-ground biomass (AGB) density for the year 2010, obtained from multiple remote sensing and in situ observations at 100 m spatial resolution to evaluate AGB estimated by nine dynamic global vegetation models (DGVMs). The global total forest AGB of the nine DGVMs is 365 ± 66 Pg C, the spread corresponding to the standard deviation between models, compared to 275 Pg C with an uncertainty of ~13.5% from GlobBiomass. Model-data discrepancy in total forest AGB can be attributed to their discrepancies in the AGB density and/or forest area. While DGVMs represent the global spatial gradients of AGB density reasonably well, they only have modest ability to reproduce the regional spatial gradients of AGB density at scales below 1000 km. The 95th percentile of AGB density (AGB95 ) in tropics can be considered as the potential maximum of AGB density which can be reached for a given annual precipitation. GlobBiomass data show local deficits of AGB density compared to the AGB95 , particularly in transitional and/or wet regions in tropics. We hypothesize that local human disturbances cause more AGB density deficits from GlobBiomass than from DGVMs, which rarely represent human disturbances. We then analyse empirical relationships between AGB density deficits and forest cover changes, population density, burned areas and livestock density. Regression analysis indicated that more than 40% of the spatial variance of AGB density deficits in South America and Africa can be explained; in Southeast Asia, these factors explain only ~25%. This result suggests TRENDY v6 DGVMs tend to underestimate biomass loss from diverse and widespread anthropogenic disturbances, and as a result overestimate turnover time in AGB.
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Affiliation(s)
- Hui Yang
- Laboratoire des Sciences du Climat et de l'Environnement, LSCE/IPSL, CEA-CNRS-UVSQ, Université Paris-Saclay, Gif-sur-Yvette, France
| | - Philippe Ciais
- Laboratoire des Sciences du Climat et de l'Environnement, LSCE/IPSL, CEA-CNRS-UVSQ, Université Paris-Saclay, Gif-sur-Yvette, France
| | | | - Yuanyuan Huang
- Laboratoire des Sciences du Climat et de l'Environnement, LSCE/IPSL, CEA-CNRS-UVSQ, Université Paris-Saclay, Gif-sur-Yvette, France
- CSIRO Oceans and Atmosphere, Aspendale, Vic., Australia
| | - Wei Li
- Department of Earth System Science, Ministry of Education Key Laboratory for Earth System Modeling, Tsinghua University, Beijing, China
| | - Yilong Wang
- Laboratoire des Sciences du Climat et de l'Environnement, LSCE/IPSL, CEA-CNRS-UVSQ, Université Paris-Saclay, Gif-sur-Yvette, France
| | - Ana Bastos
- Department für Geographie, Ludwig-Maximilians-Universität München, Munchen, Germany
| | - Daniel Goll
- Department of Geography, University of Augsburg, Augsburg, Germany
| | - Almut Arneth
- Institute of Meteorology and Climate Research/Atmospheric Environmental Research, Karlsruhe Institute of Technology, Garmisch-Partenkirchen, Germany
| | - Peter Anthoni
- Institute of Meteorology and Climate Research/Atmospheric Environmental Research, Karlsruhe Institute of Technology, Garmisch-Partenkirchen, Germany
| | - Vivek K Arora
- Canadian Centre for Climate Modelling and Analysis, Climate Research Division, Environment and Climate Change Canada, Victoria, BC, Canada
| | - Pierre Friedlingstein
- College of Engineering, Mathematics and Physical Sciences, University of Exeter, Exeter, UK
- LMD/IPSL, ENS, PSL Université, École Polytechnique, Institut Polytechnique de Paris, Sorbonne Université, CNRS, Paris, France
| | | | - Emilie Joetzjer
- CNRM, Université de Toulouse, Météo-France, CNRS, Toulouse, France
| | - Markus Kautz
- Department of Forest Health, Forest Research Institute Baden-Württemberg, Freiburg, Germany
| | - Sebastian Lienert
- Climate and Environmental Physics, Physics Institute, University of Bern, Bern, Switzerland
- Oeschger Centre for Climate Change Research, University of Bern, Bern, Switzerland
| | | | - Michael O'Sullivan
- College of Engineering, Mathematics and Physical Sciences, University of Exeter, Exeter, UK
| | - Stephen Sitch
- College of Life and Environmental Sciences, University of Exeter, Exeter, UK
| | - Nicolas Vuichard
- Laboratoire des Sciences du Climat et de l'Environnement, LSCE/IPSL, CEA-CNRS-UVSQ, Université Paris-Saclay, Gif-sur-Yvette, France
| | | | - Dan Zhu
- Laboratoire des Sciences du Climat et de l'Environnement, LSCE/IPSL, CEA-CNRS-UVSQ, Université Paris-Saclay, Gif-sur-Yvette, France
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Abstract
A group of senior doctors with vast clinical experience met on 19th July'20 under the aegis of Academy of Advanced Medical Education. The panel looked at Ivermectin, one of the old molecule and evaluated it's use in COVID 19 (Novel Coronavirus Disease 2019) management. After critical panel discussion, all the attending doctors came to a conclusion that Ivermectin can be a potential molecule for prophylaxis and treatment of people infected with Coronavirus, owing to its anti-viral properties coupled with effective cost, availability and good tolerability and safety.
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Affiliation(s)
- Agam Vora
- Academy of Advanced Medical Education, Vora Clinic, 302, Soni Shopping Center, L T Road, Borivali West, Mumbai, 400092, Maharashtra, India.
| | - V K Arora
- Academy of Advanced Medical Education, Vora Clinic, 302, Soni Shopping Center, L T Road, Borivali West, Mumbai, 400092, Maharashtra, India
| | - D Behera
- Academy of Advanced Medical Education, Vora Clinic, 302, Soni Shopping Center, L T Road, Borivali West, Mumbai, 400092, Maharashtra, India
| | - Surya Kant Tripathy
- Department of Respiratory Medicine, King George's Medical University, Lucknow, U.P, India
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33
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Fischer-Valuck BW, Michalski JM, Harton JG, Birtle A, Christodouleas JP, Efstathiou JA, Arora VK, Kim EH, Knoche EM, Pachynski RK, Picus J, Rao YJ, Reimers M, Roth BJ, Sargos P, Smith ZL, Zaghloul MS, Gay HA, Patel SA, Baumann BC. Management of Muscle-Invasive Bladder Cancer During a Pandemic: Impact of Treatment Delay on Survival Outcomes for Patients Treated With Definitive Concurrent Chemoradiotherapy. Clin Genitourin Cancer 2020; 19:41-46.e1. [PMID: 33187904 PMCID: PMC7306737 DOI: 10.1016/j.clgc.2020.06.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 06/15/2020] [Accepted: 06/15/2020] [Indexed: 01/10/2023]
Abstract
Introduction During the coronavirus disease 2019 (COVID-19) pandemic, providers and patients must engage in shared decision making to ensure that the benefit of early intervention for muscle-invasive bladder cancer exceeds the risk of contracting COVID-19 in the clinical setting. It is unknown whether treatment delays for patients eligible for curative chemoradiation (CRT) compromise long-term outcomes. Patients and Methods We used the National Cancer Data Base to investigate whether there is an association between a ≥ 90-day delay from transurethral resection of bladder tumor (TURBT) in initiating CRT and overall survival. We included patients with cT2-4N0M0 muscle-invasive bladder cancer from 2004 to 2015 who underwent TURBT and curative-intent concurrent CRT. Patients were grouped on the basis of timing of CRT: ≤ 89 days after TURBT (earlier) vs. ≥ 90 and < 180 days after TURBT (delayed). Results A total of 1387 (87.5%) received earlier CRT (median, 45 days after TURBT; interquartile range, 34-59 days), and 197 (12.5%) received delayed CRT (median, 111 days after TURBT; interquartile range, 98-130 days). Median overall survival was 29.0 months (95% CI, 26.0-32.0) versus 27.0 months (95% CI, 19.75-34.24) for earlier and delayed CRT (P = .94). On multivariable analysis, delayed CRT was not associated with an overall survival difference (hazard ratio, 1.05; 95% CI, 0.87-1.27; P = .60). Conclusion Although these results are limited and require validation, short, strategic treatment delays during a pandemic can be considered on the basis of clinician judgment.
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Affiliation(s)
| | - Jeff M Michalski
- Department of Radiation Oncology, Washington University School of Medicine in St Louis, St Louis, MO
| | - Joanna G Harton
- Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Alison Birtle
- Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK; University of Manchester, Manchester, UK
| | - John P Christodouleas
- Department of Radiation Oncology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Jason A Efstathiou
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA
| | - Vivek K Arora
- Division of Oncology, Washington University School of Medicine in St Louis, St Louis, MO
| | - Eric H Kim
- Division of Urology, Washington University School of Medicine in St Louis, St Louis, MO
| | - Eric M Knoche
- Division of Oncology, Washington University School of Medicine in St Louis, St Louis, MO
| | - Russell K Pachynski
- Division of Oncology, Washington University School of Medicine in St Louis, St Louis, MO
| | - Joel Picus
- Division of Oncology, Washington University School of Medicine in St Louis, St Louis, MO
| | - Yuan James Rao
- Department of Radiation Oncology, George Washington University, Washington D.C
| | - Melissa Reimers
- Division of Oncology, Washington University School of Medicine in St Louis, St Louis, MO
| | - Bruce J Roth
- Division of Oncology, Washington University School of Medicine in St Louis, St Louis, MO
| | - Paul Sargos
- Department of Radiation Oncology, Jewish General Hospital, Montreal, QC, Canada; Department of Radiotherapy, Institut Bergonié, Bordeaux, France
| | - Zachary L Smith
- Division of Urology, Washington University School of Medicine in St Louis, St Louis, MO
| | - Mohamed S Zaghloul
- Radiation Oncology Department, Children's Cancer Hospital, Cairo, Egypt; Radiation Oncology Department, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Hiram A Gay
- Department of Radiation Oncology, Washington University School of Medicine in St Louis, St Louis, MO
| | - Sagar A Patel
- Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, GA
| | - Brian C Baumann
- Department of Radiation Oncology, Washington University School of Medicine in St Louis, St Louis, MO; Department of Radiation Oncology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.
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Sharma A, Bisht D, Das S, Rai G, Dutt S, Arora VK. Molecular Detection of Aspergillus in Sputum of Patients with Lower Respiratory Tract Infections. Int J Appl Basic Med Res 2020; 10:86-90. [PMID: 32566523 PMCID: PMC7289198 DOI: 10.4103/ijabmr.ijabmr_364_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Revised: 03/30/2019] [Accepted: 02/13/2020] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Raised incidences of respiratory tract infections due to fungal agents in immunocompetent individuals are a cause of concern due to the unavailability of rapid diagnostic methods. MATERIALS AND METHODS Sputum and serum samples were collected from patients having lower respiratory tract infections (LRTIs), serum samples were screened for the presence of anti Aspergillus antibodies and sputum samples were homogenized and processed for identification of Aspergillus by conventional methods and further subjected to polymerase chain reaction (PCR) using genus-specific ITS 4-5 primers. RESULTS PCR identified Aspergillus in 28% sputum samples, which was high as compared to conventional methods. CONCLUSION Simple conventional PCR technique proves to be useful screening in for early identification of Aspergillus colonization in patients with LRTI, which can prevent irreversible damage in their lungs by fungal invasion.
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Affiliation(s)
- Alosha Sharma
- Department of Microbiology, Santosh Medical College, Ghaziabad, Uttar Pradesh, India
| | - Dakshina Bisht
- Department of Microbiology, Santosh Medical College, Ghaziabad, Uttar Pradesh, India
| | - Shukla Das
- Department of Microbiology, UCMS, GTBH, New Delhi, India
| | - Gargi Rai
- Department of Microbiology, UCMS, GTBH, New Delhi, India
| | - Shyama Dutt
- Department of Microbiology, UCMS, GTBH, New Delhi, India
| | - V K Arora
- Department of TB and Chest, Santosh Medical College, Ghaziabad, Uttar Pradesh, India
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Affiliation(s)
- K K Chopra
- Director, New Delhi Tuberculosis Centre, New Delhi, India; Associate Executive Editor, Indian Journal of Tuberculosis, India
| | - V K Arora
- Vice Chairman (P&R), TB Association of India, India; Executive Editor, Indian Journal of Tuberculosis, India.
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Affiliation(s)
- V K Arora
- TB Association of India, Indian Journal of Tuberculosis, NITRD, Delhi, India.
| | - K K Chopra
- New Delhi Tuberculosis Centre, Indian Journal of Tuberculosis, New Delhi, India
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Chopra KK, Arora VK. Changing climate and respiratory diseases. Indian J Tuberc 2019; 66:431-432. [PMID: 31813427 DOI: 10.1016/j.ijtb.2019.11.010] [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] [Indexed: 06/10/2023]
Affiliation(s)
- K K Chopra
- New Delhi Tuberculosis Centre, Indian Journal of Tuberculosis, New Delhi, India.
| | - V K Arora
- TB Association of India, Indian Journal of Tuberculosis, India
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Sharma A, Ahuja S, Diwaker P, Wadhwa N, Arora VK. Acinic cell carcinoma of the parotid gland: A diagnostic dilemma on cytology. Malays J Pathol 2019; 41:191-194. [PMID: 31427555] [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: 06/10/2023]
Abstract
INTRODUCTION Acinic cell carcinoma (ACC) represents 1-6% of parotid gland neoplasms. CASE REPORT We report cytomorphological features of two uncommon variants of acinic cell carcinoma. The first case was an eleven-year-old female with a nodular mass in parotid and the FNA smears demonstrated a lymphoepithelial lesion composed of epithelial tumour cells with features of acinar cells in a lymphoid background. The second case was a 62-year-old male with a large parotid mass. The FNA smears revealed presence of extracellular, acellular amyloid-like material with tumour cells arranged in follicles. DISCUSSION Awareness of cytomorphological features of these unusual variants of acinic cell carcinoma may help to avoid diagnostic pitfall.
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Affiliation(s)
- A Sharma
- University College of Medical Sciences, Department of Pathology, Delhi, India.
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Chopra KK, Arora VK. Geriatric TB: Needs focussed attention under RNTCP. Indian J Tuberc 2019; 66:323-324. [PMID: 31439174 DOI: 10.1016/j.ijtb.2019.07.002] [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] [Indexed: 06/10/2023]
Affiliation(s)
- K K Chopra
- New Delhi Tuberculosis Centre, New Delhi, India; Indian Journal of Tuberculosis, India.
| | - V K Arora
- TB Association of India, India; Indian Journal of Tuberculosis, India
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40
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Affiliation(s)
- K K Chopra
- New Delhi Tuberculosis Centre, New Delhi, India; Indian Journal of Tuberculosis, India.
| | - V K Arora
- TB Association of India, India; Indian Journal of Tuberculosis, India
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Arora VK, Chandra K, Chandra M. Occupational tuberculosis in sewage workers: A neglected domain. Indian J Tuberc 2019; 66:3-5. [PMID: 30797278 DOI: 10.1016/j.ijtb.2018.09.001] [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: 07/16/2018] [Accepted: 09/14/2018] [Indexed: 06/09/2023]
Affiliation(s)
- V K Arora
- Santosh University, Ghaziabad, Uttar Pradesh, India
| | | | - Mina Chandra
- Department of Psychiatry, PGIMER and Dr RML Hospital, New Delhi, India
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Fischer-Valuck BW, Michalski JM, Contreras JA, Brenneman R, Christodouleas JP, Abraham CD, Kim EH, Arora VK, Bullock AD, Carmona R, Figenshau RS, Grubb R, Knoche EM, Pachynski RK, Picus J, Roth BJ, Sargos P, Andriole GL, Gay HA, Baumann BC. A propensity analysis comparing definitive chemo-radiotherapy for muscle-invasive squamous cell carcinoma of the bladder vs. urothelial carcinoma of the bladder using the National Cancer Database. Clin Transl Radiat Oncol 2018; 15:38-41. [PMID: 30656221 PMCID: PMC6304339 DOI: 10.1016/j.ctro.2018.12.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2018] [Revised: 12/01/2018] [Accepted: 12/04/2018] [Indexed: 11/30/2022] Open
Abstract
Limited information is known about treatment outcomes for squamous cell carcinoma of the bladder (SqCC). Treatment for SqCC is extrapolated from urothelial carcinoma. Outcomes of chemoRT for SqCC are very limited. Following chemoRT, patients with SqCC do worse than counterparts with urothelial carcinoma.
Introduction Squamous cell carcinoma (SqCC) is the second most common histology of primary bladder cancer, but still very limited information is known about its treatment outcomes. Most bladder cancer trials have excluded SqCC, and the current treatment paradigm for localized SqCC is extrapolated from results in urothelial carcinoma (UC). In particular, there is limited data on the efficacy of definitive chemo-radiotherapy (CRT). In this study, we compare overall survival outcomes between SqCC and UC patients treated with definitive CRT. Materials/methods We queried the National Cancer Database (NCDB) for muscle-invasive (cT2-T4 N0 M0) bladder cancer patients diagnosed from 2004 to 2013 who underwent concurrent CRT. Propensity matching was performed to match patients with SqCC to those with UC. OS was analyzed using the Kaplan-Meier survival method, and the log-rank test and Cox regression were used for analyses. Results 3332 patients met inclusion criteria of which 79 (2.3%) had SqCC. 73.4% of SqCC patients had clinical T2 disease compared to 82.5% of UC patients. Unadjusted median OS for SqCC patients was 15.6 months (95% CI, 11.7–19.6) versus 29.1 months (95% CI, 27.5–30.7) for those with UC (P < 0.0001). On multivariable analysis, factors associated with worse OS included: SqCC histology [HR: 1.53 (95% CI, 1.19–1.97); P = 0.001], increasing age [HR: 1.02 (95% CI, 1.02–1.03); P < 0.0001], increasing clinical T-stage [HR: 1.21 (95% CI, 1.13–1.29); P < 0.0001], and Charlson-Deyo comorbidity index [HR: 1.26 (95% CI, 1.18–1.33); P < 0.0001]. Seventy-seven SqCC patients were included in the propensity-matched analysis (154 total patients) with a median OS for SqCC patients of 15.1 months (95% CI, 11.1–18.9) vs. 30.4 months (95% CI, 19.4–41.4) for patients with UC (P = 0.013). Conclusions This is the largest study to-date assessing survival outcomes for SqCC of the bladder treated with CRT. In this study, SqCC had worse overall survival compared to UC patients. Histology had a greater impact on survival than increasing T-stage, suggesting that histology should be an important factor when determining a patient’s treatment strategy and that treatment intensification in this subgroup may be warranted.
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Affiliation(s)
- Benjamin W. Fischer-Valuck
- Washington University in St. Louis, Department of Radiation Oncology, St. Louis, MO, United States
- Emory University, Winship Cancer Institute, Department of Radiation Oncology, Atlanta, GA, United States
| | - Jeff M. Michalski
- Washington University in St. Louis, Department of Radiation Oncology, St. Louis, MO, United States
| | - Jessika A. Contreras
- Washington University in St. Louis, Department of Radiation Oncology, St. Louis, MO, United States
| | - Randall Brenneman
- Washington University in St. Louis, Department of Radiation Oncology, St. Louis, MO, United States
| | - John P. Christodouleas
- University of Pennsylvania, Department of Radiation Oncology, Philadelphia, PA, United States
| | - Christopher D. Abraham
- Washington University in St. Louis, Department of Radiation Oncology, St. Louis, MO, United States
| | - Eric H. Kim
- Washington University in St. Louis, Division of Urology, St. Louis, MO, United States
| | - Vivek K. Arora
- Washington University in St. Louis, Division of Medical Oncology, St. Louis, MO, United States
| | - Arnold D. Bullock
- Washington University in St. Louis, Division of Urology, St. Louis, MO, United States
| | - Ruben Carmona
- University of Pennsylvania, Department of Radiation Oncology, Philadelphia, PA, United States
| | - Robert S. Figenshau
- Washington University in St. Louis, Division of Urology, St. Louis, MO, United States
| | - Robert Grubb
- Washington University in St. Louis, Division of Urology, St. Louis, MO, United States
| | - Eric M. Knoche
- Washington University in St. Louis, Division of Medical Oncology, St. Louis, MO, United States
| | - Russell K. Pachynski
- Washington University in St. Louis, Division of Medical Oncology, St. Louis, MO, United States
| | - Joel Picus
- Washington University in St. Louis, Division of Medical Oncology, St. Louis, MO, United States
| | - Bruce J. Roth
- Washington University in St. Louis, Division of Medical Oncology, St. Louis, MO, United States
| | - Paul Sargos
- Département de radiothérapie, Institut Bergonié, Bordeaux, France
| | - Gerald L. Andriole
- Washington University in St. Louis, Division of Urology, St. Louis, MO, United States
| | - Hiram A. Gay
- Washington University in St. Louis, Department of Radiation Oncology, St. Louis, MO, United States
| | - Brian C. Baumann
- Washington University in St. Louis, Department of Radiation Oncology, St. Louis, MO, United States
- Corresponding author at: Department of Radiation Oncology, Washington University, 4921 Parkview Place, St. Louis, MO 63110, United States.
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Sato Y, Bolzenius JK, Eteleeb AM, Su X, Maher CA, Sehn JK, Arora VK. CD4+ T cells induce rejection of urothelial tumors after immune checkpoint blockade. JCI Insight 2018; 3:121062. [PMID: 30518683 PMCID: PMC6328023 DOI: 10.1172/jci.insight.121062] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [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: 03/13/2018] [Accepted: 10/31/2018] [Indexed: 12/30/2022] Open
Abstract
Immune checkpoint blockade (ICB) provides clinical benefit to a minority of patients with urothelial carcinoma (UC). The role of CD4+ T cells in ICB-induced antitumor activity is not well defined; however, CD4+ T cells are speculated to play a supportive role in the development of CD8+ T cells that kill tumor cells after recognition of tumor antigens presented by MHC class I. To investigate the mechanisms of ICB-induced activity against UC, we developed mouse organoid-based transplantable models that have histologic and genetic similarity to human bladder cancer. We found that ICB can induce tumor rejection and protective immunity with these systems in a manner dependent on CD4+ T cells but not reliant on CD8+ T cells. Evaluation of tumor infiltrates and draining lymph nodes after ICB revealed expansion of IFN-γ-producing CD4+ T cells. Tumor cells in this system express MHC class I, MHC class II, and the IFN-γ receptor (Ifngr1), but none were necessary for ICB-induced tumor rejection. IFN-γ neutralization blocked ICB activity, and, in mice depleted of CD4+ T cells, IFN-γ ectopically expressed in the tumor microenvironment was sufficient to inhibit growth of tumors in which the epithelial compartment lacked Ifngr1. Our findings suggest unappreciated CD4+ T cell-dependent mechanisms of ICB activity, principally mediated through IFN-γ effects on the microenvironment.
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Affiliation(s)
- Yuji Sato
- Department of Internal Medicine, Division of Oncology
| | | | | | - Xinming Su
- Department of Internal Medicine, Division of Oncology
| | - Christopher A. Maher
- Department of Internal Medicine, Division of Oncology
- McDonnell Genome Institute, and
| | - Jennifer K. Sehn
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, Missouri, USA
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Bastos A, Friedlingstein P, Sitch S, Chen C, Mialon A, Wigneron JP, Arora VK, Briggs PR, Canadell JG, Ciais P, Chevallier F, Cheng L, Delire C, Haverd V, Jain AK, Joos F, Kato E, Lienert S, Lombardozzi D, Melton JR, Myneni R, Nabel JEMS, Pongratz J, Poulter B, Rödenbeck C, Séférian R, Tian H, van Eck C, Viovy N, Vuichard N, Walker AP, Wiltshire A, Yang J, Zaehle S, Zeng N, Zhu D. Impact of the 2015/2016 El Niño on the terrestrial carbon cycle constrained by bottom-up and top-down approaches. Philos Trans R Soc Lond B Biol Sci 2018; 373:rstb.2017.0304. [PMID: 30297465 PMCID: PMC6178442 DOI: 10.1098/rstb.2017.0304] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/22/2018] [Indexed: 11/12/2022] Open
Abstract
Evaluating the response of the land carbon sink to the anomalies in temperature and drought imposed by El Niño events provides insights into the present-day carbon cycle and its climate-driven variability. It is also a necessary step to build confidence in terrestrial ecosystems models' response to the warming and drying stresses expected in the future over many continents, and particularly in the tropics. Here we present an in-depth analysis of the response of the terrestrial carbon cycle to the 2015/2016 El Niño that imposed extreme warming and dry conditions in the tropics and other sensitive regions. First, we provide a synthesis of the spatio-temporal evolution of anomalies in net land–atmosphere CO2 fluxes estimated by two in situ measurements based on atmospheric inversions and 16 land-surface models (LSMs) from TRENDYv6. Simulated changes in ecosystem productivity, decomposition rates and fire emissions are also investigated. Inversions and LSMs generally agree on the decrease and subsequent recovery of the land sink in response to the onset, peak and demise of El Niño conditions and point to the decreased strength of the land carbon sink: by 0.4–0.7 PgC yr−1 (inversions) and by 1.0 PgC yr−1 (LSMs) during 2015/2016. LSM simulations indicate that a decrease in productivity, rather than increase in respiration, dominated the net biome productivity anomalies in response to ENSO throughout the tropics, mainly associated with prolonged drought conditions. This article is part of a discussion meeting issue ‘The impact of the 2015/2016 El Niño on the terrestrial tropical carbon cycle: patterns, mechanisms and implications’.
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Affiliation(s)
- Ana Bastos
- Department of Geography, Ludwig Maximilians University Munich, Luisenstr. 37, Munich D-80333, Germany .,Laboratoire des Sciences du Climat et de l'Environnement (LSCE), CEA-CNRS-UVSQ, UMR8212, Gif-sur-Yvette 91191, France
| | - Pierre Friedlingstein
- College of Engineering, Mathematics and Physical Sciences, University of Exeter, Exeter EX4 4QF, UK
| | - Stephen Sitch
- College of Life and Environmental Sciences, University of Exeter, Exeter EX4 4RJ, UK
| | - Chi Chen
- Department of Earth and Environment, Boston University, Boston, MA 02215, USA
| | - Arnaud Mialon
- CESBIO, Université de Toulouse, CNES/CNRS/IRD/UPS, 31400 Toulouse, France
| | | | - Vivek K Arora
- Canadian Centre for Climate Modelling and Analysis, Environment and Climate Change Canada, University of Victoria, Victoria, British Columbia, Canada V8W2Y2
| | - Peter R Briggs
- CSIRO Oceans and Atmosphere, Canberra, ACT 2601, Australia
| | - Josep G Canadell
- Global Carbon Project, CSIRO Oceans and Atmosphere, Canberra, ACT 2601, Australia
| | - Philippe Ciais
- Laboratoire des Sciences du Climat et de l'Environnement (LSCE), CEA-CNRS-UVSQ, UMR8212, Gif-sur-Yvette 91191, France
| | - Frédéric Chevallier
- Laboratoire des Sciences du Climat et de l'Environnement (LSCE), CEA-CNRS-UVSQ, UMR8212, Gif-sur-Yvette 91191, France
| | - Lei Cheng
- State Key Laboratory of Water Resources and Hydropower Engineering Science, Wuhan University, Wuhan 430072, People's Republic of China
| | - Christine Delire
- Centre National de Recherches Météorologiques, CNRM, Unité 3589 CNRS/Meteo-France/Université Fédérale de Toulouse, Av G Coriolis, Toulouse 31057, France
| | - Vanessa Haverd
- CSIRO Oceans and Atmosphere, Canberra, ACT 2601, Australia
| | - Atul K Jain
- Department of Atmospheric Sciences, University of Illinois, Urbana, IL 61801, USA
| | - Fortunat Joos
- Climate and Environmental Physics, Physics Institute and Oeschger Centre for Climate Change Research, University of Bern, Bern CH-3012, Switzerland
| | - Etsushi Kato
- Institute of Applied Energy (IAE), Minato, Tokyo 105-0003, Japan
| | - Sebastian Lienert
- Climate and Environmental Physics, Physics Institute and Oeschger Centre for Climate Change Research, University of Bern, Bern CH-3012, Switzerland
| | - Danica Lombardozzi
- Climate and Global Dynamics Division, National Center for Atmospheric Research, Boulder, CO 80302, USA
| | - Joe R Melton
- Climate Processes Section, Environment and Climate Change Canada, Downsview, Ontario, Canada V8W2Y2
| | - Ranga Myneni
- Department of Earth and Environment, Boston University, Boston, MA 02215, USA
| | | | - Julia Pongratz
- Department of Geography, Ludwig Maximilians University Munich, Luisenstr. 37, Munich D-80333, Germany.,Max Planck Institute for Meteorology, Hamburg 20146, Germany
| | - Benjamin Poulter
- NASA Goddard Space Flight Center, Biospheric Sciences Lab, Greenbelt, MD 20816, USA
| | | | - Roland Séférian
- Centre National de Recherches Météorologiques, CNRM, Unité 3589 CNRS/Meteo-France/Université Fédérale de Toulouse, Av G Coriolis, Toulouse 31057, France
| | - Hanqin Tian
- International Center for Climate and Global Change Research, School of Forestry and Wildlife Sciences, Auburn University, 602 Duncan Drive, Auburn, AL 36849, USA
| | - Christel van Eck
- Department of Geoscience, Environment and Society, CP 160/02, Université Libre de Bruxelles, Brussels 1050, Belgium
| | - Nicolas Viovy
- Laboratoire des Sciences du Climat et de l'Environnement (LSCE), CEA-CNRS-UVSQ, UMR8212, Gif-sur-Yvette 91191, France
| | - Nicolas Vuichard
- Laboratoire des Sciences du Climat et de l'Environnement (LSCE), CEA-CNRS-UVSQ, UMR8212, Gif-sur-Yvette 91191, France
| | - Anthony P Walker
- Environmental Sciences Division and Climate Change Science Institute, Oak Ridge National Laboratory, Oak Ridge, TN 37831, USA
| | | | - Jia Yang
- International Center for Climate and Global Change Research, School of Forestry and Wildlife Sciences, Auburn University, 602 Duncan Drive, Auburn, AL 36849, USA
| | - Sönke Zaehle
- Max Planck Institute for Biogeochemistry, 07745 Jena, Germany
| | - Ning Zeng
- Department of Atmospheric and Oceanic Science and Earth System Science Interdisciplinary Center, University of Maryland, College Park, MD 100029, USA.,State Key Laboratory of Numerical Modelling for Atmospheric Sciences and Geophysical Fluid Dynamics, Institute of Atmospheric Physics, Beijing 20740, People's Republic of China
| | - Dan Zhu
- Laboratoire des Sciences du Climat et de l'Environnement (LSCE), CEA-CNRS-UVSQ, UMR8212, Gif-sur-Yvette 91191, France
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Chopra KK, Hanif K M M, Arora VK, Vashistha H. Can sputum microscopy be replaced? Indian J Tuberc 2018; 65:275-276. [PMID: 30522611 DOI: 10.1016/j.ijtb.2018.08.005] [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: 08/30/2018] [Accepted: 08/30/2018] [Indexed: 06/09/2023]
Affiliation(s)
- K K Chopra
- New Delhi Tuberculosis Centre, New Delhi, India; Indian Journal of Tuberculosis, India.
| | - M Hanif K M
- New Delhi Tuberculosis Centre, New Delhi, India
| | - V K Arora
- TB Association of India, India; Indian Journal of Tuberculosis, India
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Arora VK, Melton JR. Reduction in global area burned and wildfire emissions since 1930s enhances carbon uptake by land. Nat Commun 2018; 9:1326. [PMID: 29666366 PMCID: PMC5904128 DOI: 10.1038/s41467-018-03838-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Accepted: 03/16/2018] [Indexed: 11/11/2022] Open
Abstract
The terrestrial biosphere currently absorbs about 30% of anthropogenic CO2 emissions. This carbon uptake over land results primarily from vegetation’s response to increasing atmospheric CO2 but other factors also play a role. Here we show that since the 1930s increasing population densities and cropland area have decreased global area burned, consistent with the charcoal record and recent satellite-based observations. The associated reduced wildfire emissions from increase in cropland area do not enhance carbon uptake since natural vegetation that is spared burning was deforested anyway. However, reduction in fire CO2 emissions due to fire suppression and landscape fragmentation associated with increases in population density is calculated to enhance land carbon uptake by 0.13 Pg C yr−1, or ~19% of the global land carbon uptake (0.7 ± 0.6 Pg C yr−1), for the 1960–2009 period. These results identify reduction in global wildfire CO2 emissions as yet another mechanism that is currently enhancing carbon uptake over land. Anthropogenic influences alter natural fire regimes in multiple ways but the resulting effect on the land carbon budget has not been quantified. Here the authors show that the reduction in global area burned and wildfire emissions due to anthropogenic influences is currently enhancing carbon uptake over land.
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Affiliation(s)
- Vivek K Arora
- Canadian Centre for Climate Modelling and Analysis, Climate Research Division, Environment and Climate Change Canada, Victoria, BC, V8W 2Y2, Canada.
| | - Joe R Melton
- Climate Research Division, Environment and Climate Change Canada, Victoria, BC, V8W 2Y2, Canada
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Affiliation(s)
- V K Arora
- Vice Chairman (P&R), TB Association of India, India; Executive Editor, Indian Journal of Tuberculosis, India
| | - K K Chopra
- Director, New Delhi Tuberculosis Centre, New Delhi, India; Associate Executive Editor, Indian Journal of Tuberculosis, India.
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48
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Halstead AM, Kapadia CD, Bolzenius J, Chu CE, Schriefer A, Wartman LD, Bowman GR, Arora VK. Bladder-cancer-associated mutations in RXRA activate peroxisome proliferator-activated receptors to drive urothelial proliferation. eLife 2017; 6:e30862. [PMID: 29143738 PMCID: PMC5720590 DOI: 10.7554/elife.30862] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Accepted: 11/10/2017] [Indexed: 12/14/2022] Open
Abstract
RXRA regulates transcription as part of a heterodimer with 14 other nuclear receptors, including the peroxisome proliferator-activated receptors (PPARs). Analysis from TCGA raised the possibility that hyperactive PPAR signaling, either due to PPAR gamma gene amplification or RXRA hot-spot mutation (S427F/Y) drives 20-25% of human bladder cancers. Here, we characterize mutant RXRA, demonstrating it induces enhancer/promoter activity in the context of RXRA/PPAR heterodimers in human bladder cancer cells. Structure-function studies indicate that the RXRA substitution allosterically regulates the PPAR AF2 domain via an aromatic interaction with the terminal tyrosine found in PPARs. In mouse urothelial organoids, PPAR agonism is sufficient to drive growth-factor-independent growth in the context of concurrent tumor suppressor loss. Similarly, mutant RXRA stimulates growth-factor-independent growth of Trp53/Kdm6a null bladder organoids. Mutant RXRA-driven growth of urothelium is reversible by PPAR inhibition, supporting PPARs as targetable drivers of bladder cancer.
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Affiliation(s)
- Angela M Halstead
- Department of Internal Medicine, Division of OncologyWashington University School of MedicineSt LouisUnited States
| | - Chiraag D Kapadia
- Department of Internal Medicine, Division of OncologyWashington University School of MedicineSt LouisUnited States
| | - Jennifer Bolzenius
- Department of Internal Medicine, Division of OncologyWashington University School of MedicineSt LouisUnited States
| | - Clarence E Chu
- Department of Internal Medicine, Division of OncologyWashington University School of MedicineSt LouisUnited States
| | - Andrew Schriefer
- Genome Technology Access CenterWashington University School of MedicineSt LouisUnited States
| | - Lukas D Wartman
- Department of Internal Medicine, Division of OncologyWashington University School of MedicineSt LouisUnited States
| | - Gregory R Bowman
- Department of Biochemistry and Molecular BiophysicsWashington University School of MedicineSt LouisUnited States
| | - Vivek K Arora
- Department of Internal Medicine, Division of OncologyWashington University School of MedicineSt LouisUnited States
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49
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Wadhwa N, Diwaker P, Lotha N, Arora VK, Singh N. Cytokeratin 20 immunocytochemistry on urine sediments: A potential low-cost adjunct to cytology in the diagnosis of low-grade urothelial carcinoma. Cytopathology 2017; 28:531-535. [PMID: 28940433 DOI: 10.1111/cyt.12463] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [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: 07/19/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND Urine cytology is the corner-stone for the diagnosis of urothelial neoplasia; however, a substantial proportion of low-grade carcinomas are reported as inconclusive owing to scant cellularity and subtle cytological features. Biomarkers applied on urine sediment smears of such patients are likely to be clinically relevant. Access to Food and Drug Administration approved urinary biomarkers in resource limited setting is poor. Detection of cytokeratin 20 (CK20) in urine sediments, although still a research tool, is a promising marker as immunocytochemistry is performed regularly in several Indian laboratories. OBJECTIVE We tested the clinical utility of CK20 immunocytochemistry as a potential low-cost adjunct to urine cytology in diagnosis of low-grade urothelial carcinoma. One hundred and fifty fresh, voided urine specimens from 42 cases of biopsy proven urothelial neoplasia (14 high grade, 28 combined low-grade [n=26]) and low malignant potential [n=2]), and 20 non-neoplastic lesions were included in the study sample. RESULTS Confident diagnosis of malignancy was possible in five (17.8%) low-grade malignancies. Thirteen of 16 (81.3%) low-grade malignancies with inconclusive cytology showed positive CK20 expression. This reduced the proportion of low-grade cases with inconclusive cytology from 57.1% to 10.7% (P=.021). In addition, we could correctly classify one case of bladder lithiasis with false positive urine cytology. Discrepant CK20 staining (positive) was seen in one patient with acute cystitis. CONCLUSIONS CK20 expression in non-umbrella cells is a robust marker of urinary bladder carcinoma. It has potential clinical utility for identification of low-grade urothelial malignancy with inconclusive cytological diagnosis.
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Affiliation(s)
- N Wadhwa
- Department of Pathology, University College of Medical Sciences, University of Delhi, Shahdra, Delhi, India
| | - P Diwaker
- Department of Pathology, University College of Medical Sciences, University of Delhi, Shahdra, Delhi, India
| | - N Lotha
- Department of Pathology, University College of Medical Sciences, University of Delhi, Shahdra, Delhi, India
| | - V K Arora
- Department of Pathology, University College of Medical Sciences, University of Delhi, Shahdra, Delhi, India
| | - N Singh
- Department of Pathology, University College of Medical Sciences, University of Delhi, Shahdra, Delhi, India
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Shah N, Wang P, Wongvipat J, Karthaus WR, Abida W, Armenia J, Rockowitz S, Drier Y, Bernstein BE, Long HW, Freedman ML, Arora VK, Zheng D, Sawyers CL. Regulation of the glucocorticoid receptor via a BET-dependent enhancer drives antiandrogen resistance in prostate cancer. eLife 2017; 6. [PMID: 28891793 PMCID: PMC5593504 DOI: 10.7554/elife.27861] [Citation(s) in RCA: 128] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Accepted: 08/24/2017] [Indexed: 12/18/2022] Open
Abstract
In prostate cancer, resistance to the antiandrogen enzalutamide (Enz) can occur through bypass of androgen receptor (AR) blockade by the glucocorticoid receptor (GR). In contrast to fixed genomic alterations, here we show that GR-mediated antiandrogen resistance is adaptive and reversible due to regulation of GR expression by a tissue-specific enhancer. GR expression is silenced in prostate cancer by a combination of AR binding and EZH2-mediated repression at the GR locus, but is restored in advanced prostate cancers upon reversion of both repressive signals. Remarkably, BET bromodomain inhibition resensitizes drug-resistant tumors to Enz by selectively impairing the GR signaling axis via this enhancer. In addition to revealing an underlying molecular mechanism of GR-driven drug resistance, these data suggest that inhibitors of broadly active chromatin-readers could have utility in nuanced clinical contexts of acquired drug resistance with a more favorable therapeutic index.
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Affiliation(s)
- Neel Shah
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, United States.,The Louis V. Gerstner Graduate School of Biomedical Sciences, Sloan Kettering Institute, Memorial Sloan Kettering Cancer Center, New York, United States
| | - Ping Wang
- Department of Neurology, Genetics and Neuroscience, Albert Einstein College of Medicine, Bronx, United States
| | - John Wongvipat
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, United States
| | - Wouter R Karthaus
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, United States
| | - Wassim Abida
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, United States
| | - Joshua Armenia
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, United States
| | - Shira Rockowitz
- Department of Neurology, Genetics and Neuroscience, Albert Einstein College of Medicine, Bronx, United States
| | - Yotam Drier
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, United States
| | - Bradley E Bernstein
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, United States
| | - Henry W Long
- Department of Medical Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, United States
| | - Matthew L Freedman
- Department of Medical Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, United States
| | - Vivek K Arora
- Division of Medical Oncology, Washington University School of Medicine, St Louis, United States
| | - Deyou Zheng
- Department of Neurology, Genetics and Neuroscience, Albert Einstein College of Medicine, Bronx, United States
| | - Charles L Sawyers
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, United States.,Howard Hughes Medical Institute, Memorial Sloan Kettering Cancer Center, New York, United States
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