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Niazi T, Nabid A, Malagon T, Bettahar R, Vincent L, Martin AG, Jolicoeur M, Yassa M, Barkati M, Igidbashian L, Bahoric B, Archambault R, Villeneuve H, Tsui JMG, Mohiuddin M. Hypofractionated, Dose Escalation Radiation Therapy for High-Risk Prostate Cancer: The Safety Analysis of the Prostate Cancer Study-5, a Groupe de Radio-Oncologie Génito-Urinaire de Quebec Led Phase 3 Trial. Int J Radiat Oncol Biol Phys 2024; 118:52-62. [PMID: 37224928 DOI: 10.1016/j.ijrobp.2023.05.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 04/27/2023] [Accepted: 05/08/2023] [Indexed: 05/26/2023]
Abstract
PURPOSE The low α\β ratio of 1.2 to 2 for prostate cancer (PCa) suggests high radiation-fraction sensitivity and predicts a therapeutic advantage of hypofractionated (HF) radiation therapy (RT). To date, no phase 3 randomized clinical trial has compared moderately HF RT with standard fractionation (SF) exclusively in high-risk PCa patients. We are reporting the safety of moderate HF RT in high-risk PCa in an initially noninferiority-designed phase 3 clinical trial. METHODS AND MATERIALS From February 2012 to March 2015, 329 high-risk PCa patients were randomized to receive either SF or HF RT. All patients received neoadjuvant, concurrent, and long-term adjuvant androgen deprivation therapy. Standard fractionation RT consisted of 76 Gy in 2 Gy per fraction to the prostate, where 46 Gy was delivered to the pelvic lymph nodes. Hypofractionated RT included concomitant dose escalation of 68 Gy in 2.72 Gy per fraction to the prostate and 45 Gy in 1.8 Gy per fraction to the pelvic lymph nodes. The coprimary endpoints were acute and delayed toxicity at 6 and 24 months, respectively. The trial was originally designed as a noninferiority with a 5% absolute margin. Given the lower-than-expected toxicities in both arms, the noninferiority analysis was completely dropped. RESULTS Of the 329 patients, 164 were randomized to the HF and 165 to the SF arms. In total, there were more grade 1 or worse acute gastrointestinal (GI) events in the HF arm, 102 versus 83 events in the HF and SF arm, respectively (P = .016). This did not remain significant at 8 weeks of follow-up. There were no differences in grade 1 or worse acute GU events in the 2 arms, 105 versus 99 events in the HF and SF arm, respectively (P = .3). At 24 months, 12 patients in the SF arm and 15 patients in the HF arm had grade 2 or worse delayed GI-related adverse events (hazard ratio, 1.32; 95% CI, 0.62-2.83; P = .482). There were 11 patients in the SF arm and 3 patients in the HF arm with grade 2 or higher delayed genitourinary (GU) toxicities (hazard ratio, 0.26; 95% CI, 0.07-0.94; P = .037). There were 3 grade 3 GI and one grade 3 GU delayed toxicities in the HF arm and 3 grade 3 GU and no grade 3 GI toxicities in the SF arm. No grade 4-toxicities were reported. CONCLUSIONS This is the first study of moderate HF dose-escalated RT in exclusively high-risk patients with prostate cancer treated with long-term androgen deprivation therapy and pelvic RT. Although our data were not analyzed as a noninferiority, our results demonstrate that moderately HF RT is well-tolerated, similar to SF RT at 2 years, and could be considered an alternative to SF RT.
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Affiliation(s)
- Tamim Niazi
- Department of Oncology, Division of Radiation Onclogy, Hôpital Maisonneuve-Rosemont, Montreal, Quebec, Canada.
| | - Abdenour Nabid
- Department of Oncology, Division of Radiation Onclogy, Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Talia Malagon
- Department of Oncology, McGill University, Montreal, Quebec, Canada
| | - Redouane Bettahar
- Division of Radiation Onclogy, Centre Hospitalier Régional de Rimouski-Centre de Cancer, Rimouski, Quebec, Canada
| | - Linda Vincent
- Division of Radiation Onclogy, Pavillon Ste-Marie Centre Hospitalier Régional de Trois-Rivières, Trois-Rivières, Quebec, Canada
| | - Andre-Guy Martin
- Department of Oncology, Division of Radiation Onclogy, Centre Hospitalier Universitaire de Québec-L'Hôtel-Dieu de Québec, Quebec City, Quebec, Canada
| | - Marjory Jolicoeur
- Department of Oncology, Division of Radiation Onclogy, Hôpital Charles LeMoyne, Greenfield Park, Quebec, Canada
| | - Michael Yassa
- Department of Oncology, Division of Radiation Onclogy, Hôpital Maisonneuve-Rosemont, Montreal, Quebec, Canada
| | - Maroie Barkati
- Department of Oncology, Division of Radiation Onclogy, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | - Levon Igidbashian
- Division of Radiation Onclogy, Hôpital Cité-de-la-Santé, Laval, Quebec, Canada
| | - Boris Bahoric
- Department of Oncology, Division of Radiation Onclogy, Jewish General Hospital, McGill University, Quebec, Canada
| | - Robert Archambault
- Department of Oncology, Division of Radiation Onclogy, Hôpital Gatineau, Gatineau, Quebec, Canada
| | - Hugo Villeneuve
- Department of Oncology, Division of Radiation Onclogy, Hôpital de Chicoutimi, Chicoutimi, Quebec, Canada
| | - James Man Git Tsui
- Department of Oncology, Division of Radiation Onclogy, McGill University Health Centre, Montreal, Quebec, Canada
| | - Mohammed Mohiuddin
- Department of Oncology, Division of Radiation Onclogy, Saint John Regional Hospital (MM), Saint John, New Brunswick, Canada
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Martinez C, Karim M, El-Misri R, Kaldany E, Nabid A, Bettahar R, Vincent LS, Martin AG, Jolicoeur M, Yassa M, Barkati M, Bahoric B, Archambault R, Villeneuve H, Mohiuddin M, Niazi TM. Conventional vs. Hypo-Fractionated, Radiotherapy for High-Risk Prostate Cancer (PCS5), Randomized, Non-Inferiority, Phase 3 Trial: Posthoc Analysis of IMRT vs. 3D-CRT Radiation Therapy Associated Toxicities. Int J Radiat Oncol Biol Phys 2023; 117:S25-S26. [PMID: 37784461 DOI: 10.1016/j.ijrobp.2023.06.283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) The Prostate Cancer Study number 5 (PCS5), is a multi-centric non-inferiority, phase 3, randomized controlled trial of high-risk prostate cancer patients of treated with either conventionally fractionated radiotherapy (CFRT) or hypofractionated radiotherapy (HFRT). The 7 years' pre-planned analysis showed that HFRT (68 Gy in 25 fractions) was as effective and well tolerated as CFRT (76 Gy in 38 fractions). In this posthoc analysis we aim to report the genitourinary (GU) and gastrointestinal (GI) toxicities associated with radiation therapy techniques: intensity-modulated radiotherapy (IMRT) and 3D-conformal radiotherapy (3D-CRT). MATERIALS/METHODS PCS5 randomized patients in a 1:1 ratio to receive either CFRT or HFRT. All patients received long term neoadjuvant, concurrent and adjuvant androgen suppression, with a median duration of 24 months. The toxicities were reported as per the Common Terminology Criteria for Adverse Events version 4. Acute toxicities were defined as presenting ≤ 180 days post-RT start and delayed > 180 days. The cumulative acute and delayed GI and GU toxicities were classified in grade groups: grade 1 or higher (G1+), G2+, and G3+. For each grade group, acute and delayed, we performed multivariable logistic regression analyses, adjusting for age, CTV volume, diabetes, fractionation (CRFT or HFRT), hypertension, and stage < T3b or ≥ T3b. For efficacy analyses cox-regression was utilized. A p-value < 0.05 was considered significant. RESULTS Three hundred twenty of the 329 patients enrolled in the trial were included in this posthoc analyses. The mean age was 71.4 ± 6.1 years, and the mean CTV volume (n = 219) was 47.25 ± 19.9 cc. IMRT was used in 195 (60.6%) patients and 3D-CRT in 125 (39.1%) patients. Multivariable logistic regression showed a significant difference in favor of IMRT for GI G2+ acute toxicity (OR = 0.285 [0.14-0.59]; CI: 95%; p<0.001) and GI G2+ delayed toxicity (OR = 0.202 [0.60-0.69]; CI: 95%; p = 0.01). There were no differences in G3+ GI or GU toxicities and there were no grade 4 toxicities. There were no differences in efficacy at 7 years between the two treatment technics. Outcomes for IMRT vs. 3D-CRT respectively, overall survival (81.5% vs 79.2%; HR: 0.92 [0.55-1.53]; CI: 95%; p-value: 0.74), distant metastasis free survival (90,7% vs 92.8%; HR: 1.4 [0.63-3.1]; CI: 95%; p-value: 0.42), prostate cancer mortality (95.8% vs. 92.2%; HR: 0.93 [0.32-2.67]; CI: 95%; p-value: 0.89), and biochemical failure (85.1% vs 88%; HR: 1.35 [0.72-2.52]; CI: 95%; p-value: 0.35). CONCLUSION This is the first phase 3 randomized controlled trial assessing the use of HFRT vs. CFRT, exclusively in high-risk prostate cancer patients. Given that our efficacy data at 7 years follow-up establishes moderate HFRT as a new standard of care and no difference between IMRT and 3D-CRT, we strongly recommend that patients who are treated with EBRT should receive IMRT, given the reduced acute and delayed grade 2 or higher GI toxicities.
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Affiliation(s)
- C Martinez
- McGill University Health Centre, Montreal, QC, Canada; Jewish General Hospital, Montreal, QC, Canada
| | - M Karim
- Jewish General Hospital, Montreal, QC, Canada
| | - R El-Misri
- Jewish General Hospital, Montreal, QC, Canada
| | - E Kaldany
- Department of Radiation Oncology, Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - A Nabid
- Centre hospitalier universitaire de Sherbrooke, Sherbrooke, QC, Canada
| | - R Bettahar
- CSSS Rimouski-Neigette, Rimouski, QC, Canada
| | - L S Vincent
- Pavillon Ste-Marie Centre hospitalier régional de Trois-Rivières (CHRTR), Trois-Rivieres, QC, Canada
| | - A G Martin
- Department of Radiation Oncology CHU de Québec-Université Laval, Québec, QC, Canada
| | - M Jolicoeur
- Charles LeMoyne Hospital, Longueuil, QC, Canada
| | - M Yassa
- CIUSSS de L'Est-de-I'lle-de Montreal Hopital Maisonneuve-Rosemont, Montreal, QC, Canada
| | - M Barkati
- Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, QC, Canada
| | - B Bahoric
- Jewish General Hospital, Montreal, QC, Canada
| | | | | | - M Mohiuddin
- Saint John Regional Hospital and Dalhousie University, Saint John, NB, Canada
| | - T M Niazi
- McGill University, Montreal, QC, Canada
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Karmakar PK, Ahmed F, Momen A, Monwar M, Das PR, Ameen MH, Jannat S, Roy A, Uddin MJ, Karmoker KK, Dutta B, Rahman MS, Mandal SC, Mohiuddin M. Transcatheter Aortic Valve Replacement in Bicuspid Aortic Valve: A Case Report. Mymensingh Med J 2023; 32:888-892. [PMID: 37391991] [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: 07/02/2023]
Abstract
Among other valvular heart disease Aortic stenosis (AS) is the most common in the developed world. Transcatheter Aortic Valve Replacement (TAVR) is most acceptable treatment option for patient with severely calcified aortic stenosis with high and intermediate risk group. Among several challenges, one of the main challenges is to deal with bicuspid aortic valve (BAV). Non-circular annulus, bulky leaflets leading to perivalvular leaks and risk for rupture and often very severe calcification may contribute to periprocedural strokes leading to poor clinical outcome. This case, a 68-year-old woman with a history of type 2 diabetes mellitus (DM), hypothyroidism, bicuspid aortic valve and severe aortic stenosis, bronchial asthma, who had repeatedly refused any suggestion for open heart surgery, was our volunteer candidate for TAVR. After successful TAVR the peak pressure gradient decreased from 100mmHg to 17mmHg. So, TAVR could be a viable option for highly selected patients with severe aortic stenosis and bicuspid aortic valve who have favourable anatomy.
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Affiliation(s)
- P K Karmakar
- Dr Pradip Kumar Karmakar, Associate Professor, Cardiology, National Institute of Cardiovascular Diseases (NICVD), Dhaka, Bangladesh; E-mail:
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Kuddus MA, Rahman A, Alam F, Mohiuddin M. Analysis of the different interventions scenario for programmatic measles control in Bangladesh: A modelling study. PLoS One 2023; 18:e0283082. [PMID: 37384663 PMCID: PMC10310053 DOI: 10.1371/journal.pone.0283082] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 03/02/2023] [Indexed: 07/01/2023] Open
Abstract
In recent years measles has been one of the most critical public health problem in Bangladesh. Although the Ministry of Health in Bangladesh employs a broad extension of measles control policies, logistical challenges exist, and there is significant doubt regarding the disease burden. Mathematical modelling of measles is considered one of the most effective ways to understand infection transmission and estimate parameters in different countries, such as Bangladesh. In this study, a mathematical modelling framework is presented to explore the dynamics of measles in Bangladesh. We calibrated the model using cumulative measles incidence data from 2000 to 2019. Also, we performed a sensitivity analysis of the model parameters and found that the contact rate had the most significant influence on the basic reproduction number R0. Four hypothetical intervention scenarios were developed and simulated for the period from 2020 to 2035. The results show that the scenario which combines enhanced treatment for exposed and infected population, first and second doses of vaccine is the most effective at rapidly reducing the total number of measles incidence and mortality in Bangladesh. Our findings also suggest that strategies that focus on a single interventions do not dramatically affect the decline in measles incidence cases; instead, those that combine two or more interventions simultaneously are the most effective in decreasing the burden of measles incidence and mortality. In addition, we also evaluated the cost-effectiveness of varying combinations of three basic control strategies including distancing, vaccination and treatment, all within the optimal control framework. Our finding suggested that combines distancing, vaccination and treatment control strategy is the most cost-effective for reducing the burden of measles in Bangladesh. Other strategies can be comprised to measles depending on the availability of funds and policymakers' choices.
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Affiliation(s)
- Md Abdul Kuddus
- Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, QLD, Australia
- Department of Mathematics, University of Rajshahi, Rajshahi, Bangladesh
| | - Azizur Rahman
- School of Computing and Mathematics, Charles Sturt University, Wagga Wagga, NSW, Australia
| | - Farzana Alam
- Department of Electrical and Electronic Engineering, Rajshahi University of Engineering & Technology, Rajshahi, Bangladesh
| | - M. Mohiuddin
- Department of Mathematics, Comilla University, Cumilla, Bangladesh
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Park R, Mohiuddin M, Arellano R, Pogatzki-Zahn E, Klar G, Gilron I. Prevalence of postoperative pain after hospital discharge: systematic review and meta-analysis. Pain Rep 2023; 8:e1075. [PMID: 37181639 PMCID: PMC10168527 DOI: 10.1097/pr9.0000000000001075] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 02/24/2023] [Accepted: 02/26/2023] [Indexed: 05/16/2023] Open
Abstract
Assessment and management of postoperative pain after hospital discharge is very challenging. We conducted a systematic review to synthesize available evidence on the prevalence of moderate-to-severe postoperative pain within the first 1 to 14 days after hospital discharge. The previously published protocol for this review was registered in PROSPERO. MEDLINE and EMBASE databases were searched until November 2020. We included observational postsurgical pain studies in the posthospital discharge setting. The primary outcome for the review was the proportion of study participants with moderate-to-severe postoperative pain (eg, pain score of 4 or more on a 10-point Numerical Rating Scale) within the first 1 to 14 days after hospital discharge. This review included 27 eligible studies involving a total of 22,108 participants having undergone a wide variety of surgical procedures. The 27 studies included ambulatory surgeries (n = 19), inpatient surgeries (n = 1), both ambulatory and inpatient surgeries (n = 4), or was not specified (n = 3). Meta-analyses of combinable studies provided estimates of pooled prevalence rates of moderate-to-severe postoperative pain ranging from 31% 1 day after discharge to 58% 1 to 2 weeks after discharge. These findings suggest that moderate-to-severe postoperative pain is a common occurrence after hospital discharge and highlight the importance of future efforts to more effectively evaluate, prevent, and treat postsurgical pain in patients discharged from the hospital.
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Affiliation(s)
- Rex Park
- Department of Anesthesiology and Perioperative Medicine, Queen's University, Kingston, Canada
| | - Mohammed Mohiuddin
- Department of Anesthesiology and Perioperative Medicine, Queen's University, Kingston, Canada
| | - Ramiro Arellano
- Department of Anesthesiology and Perioperative Medicine, Queen's University, Kingston, Canada
| | - Esther Pogatzki-Zahn
- Department of Anesthesiology, Critical Care Medicine and Pain Therapy, University Hospital Muenster, Muenster, Germany
| | - Gregory Klar
- Department of Anesthesiology and Perioperative Medicine, Queen's University, Kingston, Canada
| | - Ian Gilron
- Department of Anesthesiology and Perioperative Medicine, Queen's University, Kingston, Canada
- Department of Biomedical and Molecular Sciences, Queen's University, Kingston, Canada
- Centre for Neuroscience Studies, Queen's University, Kingston, Canada
- School of Policy Studies, Queen's University, Kingston, Canada
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Niazi T, Nabid A, Malagon T, Bettahar R, Vincent L, Martin A, Jolicoeur M, Yassa M, Barkati M, Igidbashian L, Bahoric B, Archambault R, Villeneuve H, Mohiuddin M. Conventional vs. Hypofractionated, Radiotherapy for High-Risk Prostate Cancer: 7-Year Outcomes of the Randomized, Non-Inferiority, Phase 3 PCS5 Trial. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.2323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Kim M, Baumlin N, Mohiuddin M, Yoshida M, Dennis J, Bengtson C, Salathe M. 426 Metformin improves high mobility group box protein 1–induced mucociliary dysfunction in cystic fibrosis airway epithelial cells. J Cyst Fibros 2022. [DOI: 10.1016/s1569-1993(22)01116-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Mohiuddin M, Tona A, Elliot J. Process Development and Manufacturing: CHARACTERIZING PROTOTYPE FIXED CELL-BASED REFERENCE MATERIALS FOR GENOMIC AND FLOW CYTOMETRY MEASUREMENTS. Cytotherapy 2022. [DOI: 10.1016/s1465-3249(22)00440-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Bazarbashi S, Elshenawy MA, Badran A, Aljubran A, Alzahrani A, Almanea H, Alsuhaibani A, Alashwah A, Neimatallah M, Abduljabbar A, Ashari L, Alhomoud S, Ghebeh H, Elhassan T, Alsanea N, Mohiuddin M. Neoadjuvant concurrent chemoradiotherapy using infusional gemcitabine in locally advanced rectal cancer: A phase II trial. Cancer Med 2022; 11:2056-2066. [PMID: 35146939 PMCID: PMC9119355 DOI: 10.1002/cam4.4590] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 12/17/2021] [Accepted: 12/25/2021] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION Gemcitabine is a well-known radiosensitizer. Herein, we tested the efficacy and toxicity of preoperative concurrent infusional gemcitabine and radiotherapy in locally advanced rectal cancer. PATIENTS AND METHODS This was a phase II, single-arm trial. Eligible patients had a diagnosis of rectal adenocarcinoma with clinical stage T3-T4 and/or nodal involvement, age ≥18 years, and no prior chemotherapy or radiotherapy. Patients received preoperative radiation at a dose of 50.4-54 Gy over 28 days with concurrent infusional gemcitabine administered at a dose of 100 mg/m2 over the course of 24 h weekly for 6 weeks. The primary endpoint was pathological complete response (pCR). RESULTS Forty patients were recruited. Only one patient did not complete therapy due to death. Eight patients did not undergo surgery, one died, two progressed to nonresectable disease, and five withdrew consent. Five patients progressed prior to surgery, with two having unresectable metastases and three having resectable liver metastases. One was found to have peritoneal metastasis during surgery. Out of the 32 patients who underwent surgery, seven achieved pCR at a rate of 20%. With a median follow-up of 30 months, four additional patients had a distant relapse (one had a subsequent local relapse). The 3-year event-free and overall survival rates were 70% and 85%, respectively. The commonest preoperative grade 3-4 toxicity included lymphopenia (50%), neutropenia (41%), anemia (15%), diarrhea (12%), abdominal pain (12%), and proctitis (8%). CONCLUSION Concurrent preoperative chemoradiotherapy using infusional gemcitabine for locally advanced rectal cancer achieved an encouraging degree of local control with manageable toxicity.
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Affiliation(s)
- Shouki Bazarbashi
- Section of Medical Oncology, Oncology CenterKing Faisal Specialist Hospital and Research CenterRiyadhSaudi Arabia
| | - Mahmoud A. Elshenawy
- Section of Medical Oncology, Oncology CenterKing Faisal Specialist Hospital and Research CenterRiyadhSaudi Arabia
- Clinical Oncology Department, Faculty of MedicineMenoufia UniversityShebin ElkomEgypt
| | - Ahmed Badran
- Section of Medical Oncology, Oncology CenterKing Faisal Specialist Hospital and Research CenterRiyadhSaudi Arabia
- Clinical Oncology Department, Faculty of MedicineAin Shams UniversityCairoEgypt
| | - Ali Aljubran
- Section of Medical Oncology, Oncology CenterKing Faisal Specialist Hospital and Research CenterRiyadhSaudi Arabia
| | - Ahmed Alzahrani
- Section of Medical Oncology, Oncology CenterKing Faisal Specialist Hospital and Research CenterRiyadhSaudi Arabia
| | - Hadeel Almanea
- Department of Pathology and Laboratory MedicineKing Faisal Specialist Hospital and Research CenterRiyadhSaudi Arabia
| | - Abdullah Alsuhaibani
- Section of Radiation Oncology, Oncology CenterKing Faisal Specialist Hospital and Research CenterRiyadhSaudi Arabia
- Oncology CenterKing Khaled University HospitalRiyadhSaudi Arabia
| | - Ahmed Alashwah
- Section of Radiation Oncology, Oncology CenterKing Faisal Specialist Hospital and Research CenterRiyadhSaudi Arabia
- Kasr El‐Aini Center for Clinical Oncology and Nuclear Medicine (NEMROCK), Faculty of MedicineCairo UniversityCairoEgypt
| | - Mohamed Neimatallah
- Department of RadiologyKing Faisal Specialist Hospital and Research CenterRiyadhSaudi Arabia
| | - Alaa Abduljabbar
- Department of SurgeryKing Faisal Specialist Hospital and Research CenterRiyadhSaudi Arabia
| | - Luai Ashari
- Department of SurgeryKing Faisal Specialist Hospital and Research CenterRiyadhSaudi Arabia
| | - Samar Alhomoud
- Department of SurgeryKing Faisal Specialist Hospital and Research CenterRiyadhSaudi Arabia
| | - Hazem Ghebeh
- Research CenterKing Faisal Specialist Hospital and Research CenterRiyadhSaudi Arabia
| | - Tusneem Elhassan
- Research CenterKing Faisal Specialist Hospital and Research CenterRiyadhSaudi Arabia
| | - Nasser Alsanea
- Department of SurgeryKing Faisal Specialist Hospital and Research CenterRiyadhSaudi Arabia
| | - Mohammed Mohiuddin
- Section of Radiation Oncology, Oncology CenterKing Faisal Specialist Hospital and Research CenterRiyadhSaudi Arabia
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Mohiuddin M. SP-0695 Spatially-fractionated radiotherapy: A new hope in locally advanced soft tissue sarcomas? Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)04017-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Mayr NA, Snider JW, Regine WF, Mohiuddin M, Hippe DS, Peñagarícano J, Mohiuddin M, Kudrimoti MR, Zhang H, Limoli CL, Le QT, Simone CB. An International Consensus on the Design of Prospective Clinical–Translational Trials in Spatially Fractionated Radiation Therapy. Adv Radiat Oncol 2022; 7:100866. [PMID: 35198833 PMCID: PMC8843999 DOI: 10.1016/j.adro.2021.100866] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 11/12/2021] [Indexed: 12/17/2022] Open
Abstract
Purpose Spatially fractionated radiation therapy (SFRT), which delivers highly nonuniform dose distributions instead of conventionally practiced homogeneous tumor dose, has shown high rates of clinical response with minimal toxicities in large-volume primary or metastatic malignancies. However, prospective multi-institutional clinical trials in SFRT are lacking, and SFRT techniques and dose parameters remain variable. Agreement on dose prescription, technical administration, and clinical and translational design parameters for SFRT trials is essential to enable broad participation and successful accrual to rigorously test the SFRT approach. We aimed to develop a consensus for the design of multi-institutional clinical trials in SFRT, tailored to specific primary tumor sites, to help facilitate development and enhance the feasibility of such trials. Methods and Materials Primary tumor sites with sufficient pilot experience in SFRT were identified, and fundamental trial design questions were determined. For each tumor site, a comprehensive consensus effort was established through disease-specific expert panels. Clinical trial design criteria included eligibility, SFRT technology and technique, dose and fractionation, target- and normal-tissue dose parameters, systemic therapies, clinical trial endpoints, and translational science considerations. Iterative appropriateness rank voting, expert panel consensus reviews and discussions, and public comment posting were used for consensus development. Results Clinical trial criteria were developed for head and neck cancer and soft-tissue sarcoma. Final consensus among the 22 trial design categories each (a total of 163 criteria) was high to moderate overall. Uniform patient cohorts of advanced bulky disease, standardization of SFRT technologies and dosimetry and physics parameters, and collection of translational correlates were considered essential to trial design. Final guideline recommendations and the degree of agreement are presented and discussed. Conclusions This consensus provides design guidelines for the development of prospective multi-institutional clinical trials testing SFRT in advanced head and neck cancer and soft-tissue sarcoma through in-advance harmonization of the fundamental clinical trial design among SFRT experts, potential investigators, and the SFRT community.
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Affiliation(s)
- Nina A. Mayr
- Department of Radiation Oncology, University of Washington School of Medicine, Seattle, Washington
- Tumor Heterogeneity Imaging and Radiomics Laboratory, University of Washington School of Medicine, Seattle, Washington
- Corresponding author: Nina A. Mayr, MD
| | - James W. Snider
- Department of Radiation Oncology, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama
| | - William F. Regine
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, Maryland
| | - Majid Mohiuddin
- Radiation Oncology Consultants and Northwestern Proton Center, Warrenville, Illinois
| | - Daniel S. Hippe
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | | | | | - Mahesh R. Kudrimoti
- Department of Radiation Medicine, University of Kentucky College of Medicine, Lexington, Kentucky
| | - Hualin Zhang
- Department of Radiation Oncology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Charles L. Limoli
- Department of Radiation Oncology, University of California School of Medicine, Irvine, Irvine, California
| | - Quynh-Thu Le
- Department of Radiation Oncology, Stanford University, Stanford, California
| | - Charles B. Simone
- Department of Radiation Oncology, New York Proton Center, New York, New York
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Bazarbashi S, Gad AM, Badran AA, Elshenawy M, Aljubran AH, Al Zahrani A, Al Manae H, Alsuhaibani A, Elashwah A, Neimatallah M, Abdul Jabbar A, Ashari L, Al Homoud S, Ghebeh H, Alsanea N, Mohiuddin M. Outcome of preoperative concurrent radiation and infusional gemcitabine in locally advanced rectal cancer, a phase 2 trial. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.4_suppl.094] [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
94 Background: The achievement of a pathological complete response with preoperative concurrent chemoradiotherapy in locally advanced rectal cancer has been found to correlate with a reduced incidence of local and distant recurrences. With the radiosensetizing properties of gemcitabine, we tested the efficacy and toxicity of preoperative concurrent infusional gemcitabine and radiotherapy in locally advanced rectal cancer. Methods: This was a phase II, single-arm, single-institution trial. Eligibility included a diagnosis of rectal adenocarcinoma with stage T2–4 and/or nodal involvement by MRI and endoscopic rectal ultrasound, age ≥ 18 years and no prior chemotherapy or radiotherapy. Patients received preoperative radiation at a dose of 50.4–54 Gy over 28 days with concurrent infusional gemcitabine administered at a dose of 100 mg/m2 over the course of 24 hours weekly for 6 weeks. The primary endpoint was a pathological complete response (pCR). The trial was registered at clinicaltrials.gov (NCT02919878). Results: Forty patients were enrolled in the study. All of the patients completed the planned therapy, except for one patient who died at the end of his concurrent chemoradiation. Eight patients did not undergo surgery, with 1 patient dying (mentioned above), 2 patients progressing to nonresectable disease and 5 patients withdrawing consent. Six patients progressed prior to or had metastases identified at surgery, with 2 patients having unresectable metastases, 3 patients having resectable liver metastases and 1 patient having a peritoneal metastasis (not resected). Serious adverse events were reported in 8 patients (20%). The most common grade 3–4 toxicities in the preoperative period included lymphopenia (50%), neutropenia (41%), anemia (15%), diarrhea (12%), abdominal pain (12%) and proctitis (8%). Out of the 32 patients who underwent surgery, 7 patients achieved pCR at a rate of 20%. With a median follow-up of 30 months, 4 additional patients relapsed (all of these patients had distant metastases, with one subsequently having a local recurrence). The 3-year event-free and overall survival rates were 70% and 85%, respectively. Conclusions: Concurrent preoperative chemoradiotherapy using infusional gemcitabine for locally advanced rectal cancer achieved an encouraging local control. Distant metastasis remains not decreased. Further investigations of a preoperative regimen containing gemcitabine is warranted. Clinical trial information: NCT02919878.
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Affiliation(s)
- Shouki Bazarbashi
- King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Ahmed Mostafa Gad
- Ain Shams University, Faculty of Medicine, Clinical Oncology Department, Cairo, Egypt
| | - Ahmed Ali Badran
- Ain Shams University, Faculty of Medicine, Clinical Oncology Department, Cairo, Egypt
| | | | - Ali H Aljubran
- King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Ahmad Al Zahrani
- King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Hadeel Al Manae
- King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | | | - Ahmed Elashwah
- Kasr El-Aini Centre of Clinical Oncology and Nuclear Medicine (NEMROCK), Faculty of Medicine, Cairo University, Cairo, Egypt
| | | | - Alaa Abdul Jabbar
- King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Luai Ashari
- King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Samar Al Homoud
- King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Hazem Ghebeh
- King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Nasser Alsanea
- King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Mohammed Mohiuddin
- King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
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VanderWalde N, Moughan J, Lichtman SM, Jagsi R, Ballo M, VanderWalde A, Mohiuddin M, Meropol NJ, Kachnic L, Berger A, Ajani J, Anne R, Hopkins JL, Arora A, Meyer J, Ellsworth SG, Lee RJ, Green N, Crane CH. The association of age with acute toxicities in NRG oncology combined modality lower GI cancer trials. J Geriatr Oncol 2021; 13:294-301. [PMID: 34756496 DOI: 10.1016/j.jgo.2021.10.008] [Citation(s) in RCA: 4] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 09/03/2021] [Accepted: 10/18/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE Expected toxicity from chemoradiation (CRT) is an important factor in treatment decisions but is poorly understood in older adults with lower gastrointestinal (GI) malignancies. Our objective was to compare acute adverse events (AAEs) of older and younger adults with lower GI malignancies treated on NRG studies. METHODS Data from 6 NRG trials, testing combined modality therapy in patients with anal or rectal cancer, were used to test the hypothesis that older age was associated with increased AAEs. AAEs and compliance with protocol-directed therapy were compared between patients aged ≥70 and < 70. Categorical variables were compared across age groups using the chi-square test. The association of age on AAEs was evaluated using a covariate-adjusted logistic regression model, with odds ratio (OR) reported. To adjust for multiple comparisons, a p-value <0.01 was considered statistically significant. RESULTS There were 2525 patients, including 380 patients ≥70 years old (15%) evaluable. Older patients were more likely to have worse baseline performance status (PS 1 or 2) (23% vs. 16%, p = 0.001), but otherwise baseline characteristics were similar. Older patients were less likely to complete their chemotherapy (78% vs. 87%, p < 0.001), but had similar RT duration. On univariate analysis, older patients were more likely to experience grade ≥ 3 GI AAEs (36% vs. 23%, p < 0.001), and less likely to experience grade ≥ 3 skin AAEs (8% vs. 14%, p = 0.002). On multivariable analysis, older age was associated with grade ≥ 3 GI AAE (OR 1.93, 95% CI: 1.52, 2.47, p < 0.001) after adjusting for sex, race, PS, and disease site. CONCLUSIONS Older patients with lower GI cancers who underwent CRT were less likely to complete chemotherapy and had higher rates of grade 3+ GI AAEs. These results can be used to counsel older adults prior to treatment and manage expected toxicities throughout pelvic CRT.
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Affiliation(s)
- Noam VanderWalde
- University of Tennessee Health Science Center/The West Clinic - Wolf River, USA.
| | | | | | | | - Matthew Ballo
- University of Tennessee Health Science Center/The West Clinic - Wolf River, USA
| | - Ari VanderWalde
- University of Tennessee Health Science Center/The West Clinic - Wolf River, USA
| | | | - Neal J Meropol
- Flatiron Health/Case Comprehensive Cancer Center, Case Western Reserve University, USA
| | - Lisa Kachnic
- Columbia University, Herbert Irving Comprehensive Cancer Center, USA
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Mohiuddin M, Kasahara K. P34.06 Antiproliferative Effects of Paclitaxel on PC9-MET Cells During the Coronavirus Disease 2019 Pandemic. J Thorac Oncol 2021. [PMCID: PMC8523165 DOI: 10.1016/j.jtho.2021.08.423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Kuddus MA, Mohiuddin M, Rahman A. Mathematical analysis of a measles transmission dynamics model in Bangladesh with double dose vaccination. Sci Rep 2021; 11:16571. [PMID: 34400667 PMCID: PMC8368032 DOI: 10.1038/s41598-021-95913-8] [Citation(s) in RCA: 6] [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: 04/24/2021] [Accepted: 07/31/2021] [Indexed: 11/25/2022] Open
Abstract
Although the availability of the measles vaccine, it is still epidemic in many countries globally, including Bangladesh. Eradication of measles needs to keep the basic reproduction number less than one \documentclass[12pt]{minimal}
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\begin{document}$$(\mathrm{i}.\mathrm{e}. \, \, {\mathrm{R}}_{0}<1)$$\end{document}(i.e.R0<1). This paper investigates a modified (SVEIR) measles compartmental model with double dose vaccination in Bangladesh to simulate the measles prevalence. We perform a dynamical analysis of the resulting system and find that the model contains two equilibrium points: a disease-free equilibrium and an endemic equilibrium. The disease will be died out if the basic reproduction number is less than one \documentclass[12pt]{minimal}
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\begin{document}$$(\mathrm{i}.\mathrm{e}. \, \, {\mathrm{ R}}_{0}<1)$$\end{document}(i.e.R0<1), and if greater than one \documentclass[12pt]{minimal}
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\begin{document}$$(\mathrm{i}.\mathrm{e}. \, \, {\mathrm{R}}_{0}>1)$$\end{document}(i.e.R0>1) epidemic occurs. While using the Routh-Hurwitz criteria, the equilibria are found to be locally asymptotically stable under the former condition on \documentclass[12pt]{minimal}
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\begin{document}$${\mathrm{R}}_{0}$$\end{document}R0. The partial rank correlation coefficients (PRCCs), a global sensitivity analysis method is used to compute \documentclass[12pt]{minimal}
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\begin{document}$${\mathrm{R}}_{0}$$\end{document}R0 and measles prevalence \documentclass[12pt]{minimal}
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\begin{document}$$\left({\mathrm{I}}^{*}\right)$$\end{document}I∗ with respect to the estimated and fitted model parameters. We found that the transmission rate \documentclass[12pt]{minimal}
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\begin{document}$$(\upbeta )$$\end{document}(β) had the most significant influence on measles prevalence. Numerical simulations were carried out to commissions our analytical outcomes. These findings show that how progression rate, transmission rate and double dose vaccination rate affect the dynamics of measles prevalence. The information that we generate from this study may help government and public health professionals in making strategies to deal with the omissions of a measles outbreak and thus control and prevent an epidemic in Bangladesh.
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Affiliation(s)
- Md Abdul Kuddus
- Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, QLD, Australia. .,Department of Mathematics, University of Rajshahi, Rajshahi, 6205, Bangladesh.
| | - M Mohiuddin
- Department of Mathematics, Comilla University, Cumilla, 3506, Bangladesh
| | - Azizur Rahman
- School of Computing and Mathematics, Charles Sturt University, Wagga Wagga, NSW, 2678, Australia
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Mohiuddin M, Blyth FM, Degenhardt L, Di Forti M, Eccleston C, Haroutounian S, Moore A, Rice ASC, Wallace M, Park R, Gilron I. General risks of harm with cannabinoids, cannabis, and cannabis-based medicine possibly relevant to patients receiving these for pain management: an overview of systematic reviews. Pain 2021; 162:S80-S96. [PMID: 32941319 DOI: 10.1097/j.pain.0000000000002000] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 07/07/2020] [Indexed: 12/11/2022]
Abstract
ABSTRACT The growing demand for improved pain treatments together with expanding legalization of, and access to, cannabinoids, cannabis, and cannabis-based medicines has intensified the focus on risk-benefit considerations in pain management. Given limited harms data from analgesic clinical trials, we conducted an overview of systematic reviews focused on all harms possibly relevant to patients receiving cannabinoids for pain management. This PROSPERO-registered, PRISMA-compliant systematic overview identified 79 reviews, encompassing over 2200 individual reports about psychiatric and psychosocial harms, cognitive/behavioral effects, motor vehicle accidents, cardiovascular, respiratory, cancer-related, maternal/fetal, and general harms. Reviews, and their included studies, were of variable quality. Available evidence suggests variable associations between cannabis exposure (ranging from monthly to daily use based largely on self-report) and psychosis, motor vehicle accidents, respiratory problems, and other harms. Most evidence comes from settings other than that of pain management (eg, nonmedicinal and experimental) but does signal a need for caution and more robust harms evaluation in future studies. Given partial overlap between patients receiving cannabinoids for pain management and individuals using cannabinoids for other reasons, lessons from the crisis of oversupply and overuse of opioids in some parts of the world emphasize the need to broadly consider harms evidence from real-world settings. The advancement of research on cannabinoid harms will serve to guide optimal approaches to the use of cannabinoids for pain management. In the meantime, this evidence should be carefully examined when making risk-benefit considerations about the use of cannabinoids, cannabis, and cannabis-based medicine for chronic pain.
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Affiliation(s)
- Mohammed Mohiuddin
- Department of Anesthesiology and Perioperative Medicine, Kingston General Hospital, Queen's University, Kingston, ON, Canada
| | - Fiona M Blyth
- University of Sydney Centre for Education and Research on Ageing, Concord Repatriation General Hospital, Concord, NSW, Australia
| | - Louisa Degenhardt
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, NSW, Australia
| | - Marta Di Forti
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
- National Institute for Health Research (NIHR), Mental Health Biomedical Research Centre at South London, Maudsley NHS Foundation Trust, King's College, London, United Kingdom
- South London and Maudsley NHS Mental Health Foundation Trust, London, United Kingdom
| | | | - Simon Haroutounian
- Division of Clinical and Translational Research, Department of Anesthesiology, Washington University Pain Center, Washington University School of Medicine, St Louis, MO, United States
| | | | - Andrew S C Rice
- Department Surgery and Cancer, Pain Research Group, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Mark Wallace
- Department of Anesthesiology, University of California San Diego, San Diego, CA, United States
| | - Rex Park
- Department of Anesthesiology and Perioperative Medicine, Kingston General Hospital, Queen's University, Kingston, ON, Canada
| | - Ian Gilron
- Department of Anesthesiology and Perioperative Medicine, Kingston General Hospital, Queen's University, Kingston, ON, Canada
- Centre for Neuroscience Studies, Queen's University, Kingston, ON, Canada
- School of Policy Studies, Queen's University, Kingston, ON, Canada
- Department of Biomedical and Molecular Sciences, Queen's University, Kingston, ON, Canada
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17
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Haroutounian S, Arendt-Nielsen L, Belton J, Blyth FM, Degenhardt L, Forti MD, Eccleston C, Finn DP, Finnerup NB, Fisher E, Fogarty AE, Gilron I, Hohmann AG, Kalso E, Krane E, Mohiuddin M, Moore RA, Rowbotham M, Soliman N, Wallace M, Zinboonyahgoon N, Rice ASC. International Association for the Study of Pain Presidential Task Force on Cannabis and Cannabinoid Analgesia: research agenda on the use of cannabinoids, cannabis, and cannabis-based medicines for pain management. Pain 2021; 162:S117-S124. [PMID: 34138827 PMCID: PMC8855877 DOI: 10.1097/j.pain.0000000000002266] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 03/10/2021] [Indexed: 01/08/2023]
Abstract
ABSTRACT The President of the International Association for the Study of Pain established a task force on cannabis and cannabinoid analgesia to systematically examine the evidence on (1) analgesic pharmacology of cannabinoids and preclinical evidence on their efficacy in animal models of injury-related or pathological persistent pain; (2) the clinical efficacy of cannabis, cannabinoids, and cannabis-based medicines for pain; (3) harms related to long-term use of cannabinoids; as well as (4) societal issues and policy implications related to the use of these compounds for pain management. Here, we summarize key knowledge gaps identified in the task force outputs and propose a research agenda for generating high-quality evidence on the topic. The systematic assessment of preclinical and clinical literature identified gaps in rigor of study design and reporting across the translational spectrum. We provide recommendations to improve the quality, rigor, transparency, and reproducibility of preclinical and clinical research on cannabis and cannabinoids for pain, as well as for the conduct of systematic reviews on the topic. Gaps related to comprehensive understanding of the endocannabinoid system and cannabinoid pharmacology, including pharmacokinetics and drug formulation aspects, are discussed. We outline key areas where high-quality clinical trials with cannabinoids are needed. Remaining important questions about long-term and short-term safety of cannabis and cannabinoids are emphasized. Finally, regulatory, societal, and policy challenges associated with medicinal and nonmedicinal use of cannabis are highlighted, with recommendations for improving patient safety and reducing societal harms in the context of pain management.
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Affiliation(s)
- Simon Haroutounian
- Division of Clinical and Translational Research and Washington University Pain Center. Department of Anesthesiology, Washington University School of Medicine. St Louis, MO, USA
| | - Lars Arendt-Nielsen
- Center for Neuroplasticity and Pain (CNAP) and Center for Sensory-Motor Interaction (SMI), Department of Health Science and Technology, School of Medicine, Aalborg University, Aalborg, Denmark
| | - Joletta Belton
- Endless Possibilities Initiative, Fraser, CO, USA; Global Alliance of Pain Patient Advocates (GAPPA) Presidential Task Force
| | - Fiona M. Blyth
- Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW 2006, Australia
| | - Louisa Degenhardt
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW 2052, Australia
| | - Marta Di Forti
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London SE5 8AF, UK. National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King’s College London, UK. South London and Maudsley NHS Mental Health Foundation Trust, London, UK
| | - Christopher Eccleston
- Centre for Pain Research. The University of Bath, Bath, UK, & Department of Clinical and Health Psychology, The University of Ghent, Belgium
| | - David P. Finn
- Pharmacology and Therapeutics, School of Medicine, Galway Neuroscience Centre and Centre for Pain Research, Human Biology Building, National University of Ireland Galway, University Road, Galway, Ireland
| | - Nanna B Finnerup
- Danish Pain Research Center, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Emma Fisher
- Centre for Pain Research. The University of Bath, Bath, UK
| | - Alexandra E. Fogarty
- Department of Neurology, Division of Physical Medicine & Rehabilitation, Washington University School of Medicine. St Louis, MO, USA
| | - Ian Gilron
- Departments of Anesthesiology & Perioperative Medicine and Biomedical & Molecular Sciences, Kingston Health Sciences Centre and Queen’s University; Centre for Neuroscience Studies, Queen’s University; School of Policy Studies, Queen’s University, Kingston, Canada
| | - Andrea G. Hohmann
- Department of Psychological and Brain Sciences, Program in Neuroscience, Gill Center for Biomolecular Science, Indiana University, Bloomington, IN, USA
| | - Eija Kalso
- Department of Pharmacology and SleepWell Research Programme, University of Helsinki; Department of Anaesthesiology, Intensive Care and Pain Medicine, Helsinki University Hospital
| | - Elliot Krane
- Departments of Anesthesiology, Perioperative, and Pain Medicine, & Pediatrics, Stanford University School of Medicine, Stanford, California, USA
| | - Mohammed Mohiuddin
- Department of Anesthesiology & Perioperative Medicine and, Queen’s University, Kingston, Canada
| | | | - Michael Rowbotham
- Department of Anesthesia, University of California, San Francisco, California, USA
| | - Nadia Soliman
- Pain Research, Department of Surgery & Cancer, Faculty of Medicine, Imperial College London, UK
| | - Mark Wallace
- Division of Pain Medicine, Department of Anesthesiology, University of California San Diego
| | | | - Andrew SC Rice
- Pain Research, Department of Surgery & Cancer, Faculty of Medicine, Imperial College London, UK
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Mohiuddin M, Park R, Wesselmann U, Pukall C, Jarvi K, Nickel C, Doiron C, Gilron I. Efficacy and Safety of Drug Combinations for Chronic Pelvic Pain: Protocol for a Systematic Review. JMIR Res Protoc 2021; 10:e21909. [PMID: 33999006 PMCID: PMC8167620 DOI: 10.2196/21909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Revised: 02/24/2021] [Accepted: 04/16/2021] [Indexed: 11/13/2022] Open
Abstract
Background Chronic pelvic pain with various etiologies and mechanisms affects men and women and is a major challenge. Monotherapy is often unsuccessful for chronic pelvic pain, and combinations of different classes of medications are frequently prescribed, with the expectation of improved outcomes. Although a number of combination trials for chronic pelvic pain have been reported, we are not aware of any systematic reviews of the available evidence on combination drug therapy for chronic pelvic pain. Objective We have developed a protocol for a systematic review to evaluate available evidence of the efficacy and safety of drug combinations for chronic pelvic pain. Methods This systematic review will involve a detailed search of randomized controlled trials investigating drug combinations to treat chronic pelvic pain in adults. The databases searched will include the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, and EMBASE from their inception until the date the searches are run to identify relevant studies. The primary outcome will be pain relief measured using validated scoring tools. Secondary outcomes, where reported, will include the following: adverse events, serious adverse events, sexual function, quality of life, and depression and anxiety. Methodological quality of each included study will be assessed using the Cochrane Risk of Bias Tool. Results The systematic review defined by this protocol is expected to synthesize available good quality evidence on combination drug therapy in chronic pelvic pain, which may help guide future research and treatment choices for patients and their health care providers. Conclusions This review will provide a clearer understanding of the efficacy and safety of combination pharmacological therapy for chronic pelvic pain. Trial Registration PROSPERO International Prospective Register of Systematic Reviews CRD42020192231; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=192231 International Registered Report Identifier (IRRID) PRR1-10.2196/21909
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Affiliation(s)
- Mohammed Mohiuddin
- Department of Anesthesiology & Perioperative Medicine, Kingston General Hospital, Queen's University, Kingston, ON, Canada
| | - Rex Park
- Department of Anesthesiology & Perioperative Medicine, Kingston General Hospital, Queen's University, Kingston, ON, Canada
| | - Ursula Wesselmann
- Departments of Anesthesiology and Perioperative Medicine, Division of Pain Medicine, Neurology and Psychology, The University of Alabama at Birmingham, Birmingham, AL, United States
| | - Caroline Pukall
- Department of Psychology, Centre for Neuroscience Studies, School of Rehabilitation Therapy, Queen's University, Kingston, ON, Canada
| | - Keith Jarvi
- Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Curtis Nickel
- Department of Urology, Queen's University, Kingston, ON, Canada
| | | | - Ian Gilron
- Department of Anesthesiology & Perioperative Medicine, Kingston General Hospital, Queen's University, Kingston, ON, Canada
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Baul TK, Chakraborty A, Nandi R, Mohiuddin M, Kilpeläinen A, Sultana T. Effects of tree species diversity and stand structure on carbon stocks of homestead forests in Maheshkhali Island, Southern Bangladesh. Carbon Balance Manag 2021; 16:11. [PMID: 33909182 PMCID: PMC8080351 DOI: 10.1186/s13021-021-00175-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 09/14/2020] [Accepted: 04/16/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND The homestead forests of Bangladesh occupy 0.27 million hectares (10% of the total forested area) and have potential to store carbon (C) and conserve biodiversity. Small scale forestry practices, however, are lacking reliable estimation of C stocks and tree species diversity. This may hinder successful implementation of REDD + and similar mechanisms as they concentrate on large-scale forests. This study aimed to estimate the above- and below-ground carbon stocks in homestead forests of Maheshkhali Island in Bangladesh and how tree species diversity and stand structural variation affect these C stocks. We randomly surveyed a total of 239 homestead forests in the hillside, beachside, and inland in 2019. RESULTS Tree biomass C stocks were 48-67% greater in the inland and hillside forests than in the beachside due to significantly greater stand density, basal area, tree diameter. In total we found 52 tree species, but most abundant species in the inland and hillside forests, Mangifera indica, Samanea saman, and Artocarpus heterophyllus stored the most C in tree biomass. Greater tree species richness and diversity index in the inland and hillside forests indicated greater above- and below-ground tree biomass C stocks. An increase in tree species richness and diversity index by one unit was found to increase the tree biomass C stock by 22 and 30 Mg C ha-1, respectively. The total soil C stock was also affected by tree species diversity, stand density, and their interaction with soil properties. Total soil C stocks were greatest (51 Mg ha-1) in the inland forests, having also the greatest stand density and tree species richness. C stock in soil surface was greatest in the hillside forests due to the greatest litterfall, but the average share of litterfall from the total biomass C was only 0.1%. CONCLUSIONS Homestead forest ecosystems could store 96 Mg C ha-1 in total, which can contribute to climate change mitigation by generating C credits for small-scale homestead forests owners. Above- and below-ground tree biomass C stocks were found to correlate with tree species diversity, which may also contribute to biodiversity conservation in the REDD + in Bangladesh and countries alike.
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Affiliation(s)
- Tarit Kumar Baul
- Institute of Forestry and Environmental Sciences, University of Chittagong, Chittagong, 4331 Bangladesh
| | - Avinanda Chakraborty
- Institute of Forestry and Environmental Sciences, University of Chittagong, Chittagong, 4331 Bangladesh
| | - Rajasree Nandi
- Institute of Forestry and Environmental Sciences, University of Chittagong, Chittagong, 4331 Bangladesh
| | - Mohammed Mohiuddin
- Institute of Forestry and Environmental Sciences, University of Chittagong, Chittagong, 4331 Bangladesh
| | - Antti Kilpeläinen
- Faculty of Science and Forestry, School of Forest Sciences, University of Eastern Finland (UEF), P.O. Box 111, 80101 Joensuu, Finland
| | - Taslima Sultana
- Institute of Forestry and Environmental Sciences, University of Chittagong, Chittagong, 4331 Bangladesh
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Mohiuddin M, Pivetta B, Gilron I, Khan JS. Efficacy and Safety of N-acetylcysteine for the Management of Chronic Pain in Adults: A Systematic Review & Meta-analysis. Pain Med 2021; 22:2896-2907. [PMID: 33560443 DOI: 10.1093/pm/pnab042] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To assess the efficacy and safety of N-acetylcysteine in the treatment of chronic pain. METHODS A systematic search was carried out until April 2020 for clinical studies of N-acetylcysteine in the management of any persistent or recurrent chronic pain condition for adults ≥ 18 years old. Risk of Bias was assessed using the validated risk of bias tools. When appropriate, a meta-analysis using a random-effects model was performed, with a fixed-effect model for sensitivity analysis. RESULTS Nine studies (n = 863) were included (5 randomized controlled trials [RCTs], 2 open-label non-comparative studies and 2 comparative studies), that evaluated patients with sickle cell disease (3), complex regional pain syndrome (1), pelvic pain/endometriosis (2), rheumatoid arthritis (1), diabetic neuropathy (1), and chronic neuropathic pain (1). In the pooled analysis of 3 RCTs, N-acetylcysteine did not reduce pain intensities (SMD -0.21, 95% CI -0.33 to 0.75, random-effects), improve functional outcomes (SMD 0.21, 95% CI -0.33 to 0.75) or quality of life (SMD 0.60, 95% CI -4.44 to 5.64); however, sensitivity analysis with a fixed effect model demonstrated an effect for pain intensities and function. Due to adverse events being inconsistently reported, no conclusion could be made regarding safety of N-acetylcysteine in chronic pain. CONCLUSIONS While there is some evidence to indicate N-acetylcysteine may provide analgesic efficacy for certain pain conditions, there is insufficient evidence to provide definitive evidence on NAC in chronic pain management. Larger-size RCTs spanning a variety of chronic pain conditions are needed to determine N-acetylcysteine's role, if any, in pain medicine.
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Affiliation(s)
| | - Bianca Pivetta
- Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Ian Gilron
- Department of Anesthesiology and Perioperative Medicine, Kingston General Hospital, Queen's University Kingston, Canada
| | - James S Khan
- Mount Sinai Hospital, Department of Anesthesia and Pain Medicine, University of Toronto, Toronto, Canada
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Park R, Mohiuddin M, Arellano R, Pogatzki-Zahn E, Klar G, Gilron I. Prevalence of Postoperative Pain Following Hospital Discharge: Protocol for a Systematic Review. JMIR Res Protoc 2020; 9:e22437. [PMID: 33275105 PMCID: PMC7748962 DOI: 10.2196/22437] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Revised: 09/21/2020] [Accepted: 11/10/2020] [Indexed: 01/22/2023] Open
Abstract
Background Pain is one of the most common, feared, and unpleasant symptoms associated with surgery. However, there is a clear gap in patient care after surgical patients are discharged from hospital, resulting in poorly controlled postoperative pain. Inadequate pain management after discharge can have detrimental effects on quality of life and lead to the development of chronic postsurgical pain. The severity of postoperative pain before discharge is well described, but less emphasis has been placed on assessing pain at home after hospital discharge. Objective The objective of this review is to summarize the prevalence of moderate-to-severe postoperative pain within the first 1 to 14 days after hospital discharge. Methods A detailed search of epidemiological studies investigating postoperative pain will be conducted on MEDLINE and EMBASE from their inception until the date the searches are run. The primary outcome will be the proportion of patients reporting moderate-to-severe postoperative pain at rest and with movement within the first 1 to 14 days after hospital discharge. The secondary outcomes will include a comparison of postoperative pain after discharge between patients who underwent ambulatory and inpatient surgery, and adverse outcomes attributable to poor pain control after hospital discharge (eg, readmission to hospital, emergency room or other unplanned medical visits, or a decrease in quality of life). Results The protocol has been registered in PROSPERO (registration number CRD42020194346). The search strategies for MEDLINE and EMBASE have been completed. The final results are expected to be published in May 2021. Conclusions This systematic review is expected to synthesize evidence describing the prevalence of postoperative pain after hospital discharge. Available epidemiological evidence may help inform the magnitude of the problem of postoperative pain at home after hospital discharge. Trial Registration PROSPERO International Prospective Register of Systematic Reviews CRD42020194346; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=194346 International Registered Report Identifier (IRRID) PRR1-10.2196/22437
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Affiliation(s)
- Rex Park
- Department of Anesthesiology and Perioperative Medicine, Kingston General Hospital, Queen's University, Kingston, ON, Canada
| | - Mohammed Mohiuddin
- Department of Anesthesiology and Perioperative Medicine, Kingston General Hospital, Queen's University, Kingston, ON, Canada
| | - Ramiro Arellano
- Department of Anesthesiology and Perioperative Medicine, Kingston General Hospital, Queen's University, Kingston, ON, Canada
| | - Esther Pogatzki-Zahn
- Department of Anesthesiology, Critical Care Medicine and Pain Therapy, University Hospital Muenster, Muenster, Germany
| | - Gregory Klar
- Department of Anesthesiology and Perioperative Medicine, Kingston General Hospital, Queen's University, Kingston, ON, Canada
| | - Ian Gilron
- Department of Anesthesiology and Perioperative Medicine, Kingston General Hospital, Queen's University, Kingston, ON, Canada
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22
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Park R, Ho AMH, Pickering G, Arendt-Nielsen L, Mohiuddin M, Gilron I. Efficacy and Safety of Magnesium for the Management of Chronic Pain in Adults: A Systematic Review. Anesth Analg 2020; 131:764-775. [PMID: 32049671 DOI: 10.1213/ane.0000000000004673] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Chronic pain is a highly prevalent and complex health problem that is associated with a heavy symptom burden, substantial economic and social impact, and also, very few highly effective treatments. This review examines evidence for the efficacy and safety of magnesium in chronic pain. The previously published protocol for this review was registered in International Prospective Register of Systematic Reviews (PROSPERO), MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials (CENTRAL) databases were searched until September 2018. We included randomized controlled trials (RCTs) comparing magnesium (at any dose, frequency, or route of administration) with placebo using participant-reported pain measures. A total of 9 RCTs containing 418 participants were included. Three studies examined neuropathic pain (62 participants), 3 examined migraines (190 participants), 2 examined complex regional pain syndrome (86 participants), and 1 examined low back pain with a neuropathic component (80 participants). Heterogeneity of included studies precluded any meta-analyses. No judgment could be made about safety because adverse events were inconsistently reported in the included studies. Evidence of analgesic efficacy from included studies was equivocal. However, reported efficacy signals in some of the included trials provide a rationale for more definitive studies. Future, larger-sized trials with good assay sensitivity and better safety assessment and reporting, as well as careful attention to formulations with optimal bioavailability, will serve to better define the role of magnesium in the management of chronic pain.
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Affiliation(s)
- Rex Park
- From the Department of Anesthesiology and Perioperative Medicine, Queen's University, Kingston, Ontario, Canada
| | - Anthony M-H Ho
- From the Department of Anesthesiology and Perioperative Medicine, Queen's University, Kingston, Ontario, Canada
| | - Gisele Pickering
- Department of Clinical Pharmacology, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Lars Arendt-Nielsen
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Mohammed Mohiuddin
- From the Department of Anesthesiology and Perioperative Medicine, Queen's University, Kingston, Ontario, Canada
| | - Ian Gilron
- From the Department of Anesthesiology and Perioperative Medicine, Queen's University, Kingston, Ontario, Canada.,Department of Biomedical and Molecular Sciences, Queen's University, Kingston, Ontario, Canada.,Centre for Neuroscience Studies, Queen's University, Kingston, Ontario, Canada
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Griffin RJ, Ahmed MM, Amendola B, Belyakov O, Bentzen SM, Butterworth KT, Chang S, Coleman CN, Djonov V, Formenti SC, Glatstein E, Guha C, Kalnicki S, Le QT, Loo BW, Mahadevan A, Massaccesi M, Maxim PG, Mohiuddin M, Mohiuddin M, Mayr NA, Obcemea C, Petersson K, Regine W, Roach M, Romanelli P, Simone CB, Snider JW, Spitz DR, Vikram B, Vozenin MC, Abdel-Wahab M, Welsh J, Wu X, Limoli CL. Understanding High-Dose, Ultra-High Dose Rate, and Spatially Fractionated Radiation Therapy. Int J Radiat Oncol Biol Phys 2020; 107:766-778. [PMID: 32298811 DOI: 10.1016/j.ijrobp.2020.03.028] [Citation(s) in RCA: 63] [Impact Index Per Article: 15.8] [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: 12/20/2019] [Revised: 03/13/2020] [Accepted: 03/16/2020] [Indexed: 12/12/2022]
Abstract
The National Cancer Institute's Radiation Research Program, in collaboration with the Radiosurgery Society, hosted a workshop called Understanding High-Dose, Ultra-High Dose Rate and Spatially Fractionated Radiotherapy on August 20 and 21, 2018 to bring together experts in experimental and clinical experience in these and related fields. Critically, the overall aims were to understand the biological underpinning of these emerging techniques and the technical/physical parameters that must be further defined to drive clinical practice through innovative biologically based clinical trials.
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Affiliation(s)
- Robert J Griffin
- Department of Radiation Oncology, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Mansoor M Ahmed
- Division of Cancer Treatment and Diagnosis, Rockville, Maryland
| | | | - Oleg Belyakov
- International Atomic Energy Agency, Vienna International Centre, Vienna, Austria
| | - Søren M Bentzen
- Division of Biostatistics and Bioinformatics, University of Maryland, Baltimore, Maryland
| | - Karl T Butterworth
- Centre for Cancer Research and Cell Biology, Queens University Belfast, Belfast, United Kingdom
| | - Sha Chang
- Department of Radiation Oncology, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | | | - Valentin Djonov
- Bern Institute of Anatomy, University of Bern, Bern, Switzerland
| | - Sylvia C Formenti
- Department of Radiation Oncology, Weill Cornell Medicine, New York, New York
| | - Eli Glatstein
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Chandan Guha
- Department of Radiation Oncology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York
| | - Shalom Kalnicki
- Department of Radiation Oncology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York
| | - Quynh-Thu Le
- Department of Radiation Oncology, Stanford University Medical Center, Stanford, California
| | - Billy W Loo
- Department of Radiation Oncology, Stanford University Medical Center, Stanford, California
| | - Anand Mahadevan
- Department of Radiation Oncology, Geisinger Health Systems, Danville, Pennsylvania
| | - Mariangela Massaccesi
- Department of Radiation Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Peter G Maxim
- Department of Radiation Oncology, Indiana University School of Medicine, Indianapolis, Indiana
| | | | | | - Nina A Mayr
- Department of Radiation Oncology, University of Washington Medical Center, Seattle, Washington
| | | | - Kristoffer Petersson
- Oxford Institute for Radiation Oncology, University of Oxford, Oxford, United Kingdom
| | - William Regine
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, Maryland
| | - Mack Roach
- Department of Radiation Oncology & Urology, University of California, San Francisco, San Francisco, California
| | | | - Charles B Simone
- Department of Radiation Oncology, New York Proton Center, New York, New York
| | - James W Snider
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, Maryland
| | - Douglas R Spitz
- Free Radical & Radiation Biology Program, University of Iowa, Iowa City, Iowa
| | | | - Marie-Catherine Vozenin
- Laboratory of Radiation Oncology/DO/Radio-Oncology/CHUV, Lausanne University Hospital, Switzerland
| | - May Abdel-Wahab
- International Atomic Energy Agency Headquarters, Vienna International Centre, Vienna, Austria
| | - James Welsh
- Edward Hines VA Medical Center and Loyola University Stritch School of Medicine, Chicago, Illinois
| | - Xiaodong Wu
- Executive Medical Physics Associates, Miami, Florida; Shanghai Proton and Heavy Ion Center, Shanghai, China
| | - Charles L Limoli
- Department of Radiation Oncology, University of California-Irvine, Irvine, California.
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Goerlich C, Kaczorowski D, Singh A, Abdullah M, Lewis B, Zhang T, Tatarov I, Sentz F, Hershfeld A, Odonkor P, Williams B, Strauss E, Ayares D, Griffith B, Mohiuddin M. Human Thrombomodulin Transgene Expression Prevents Intracardiac Thrombus in Life Supporting Pig-to-Baboon Cardiac Xenotransplantation. J Heart Lung Transplant 2020. [DOI: 10.1016/j.healun.2020.01.1069] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Mohiuddin M, Chowdhury MN, Chowdhury MS, Islam S, Hasan R, Zakir H, Saeed A, Masum AS. Association of Estimated GFR (By MDRD) with the Carotid Intima Media Thickness (CIMT) in Different Stages of CKD among Patients with Type 2 Diabetes Mellitus. Mymensingh Med J 2020; 29:209-214. [PMID: 31915360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Most of the mortalities among Diabetic Nephropathy patients are cardiovascular, if we identify the risk factor, measures can be taken to prevent it. Hence an objective was set to evaluate the association between carotid artery intima media thickness (CIMT) with eGFR in patients of CKD stage III, IV and V among patients with type 2 diabetes mellitus; also, correlation with age, BMI, lipid profile. This cross-sectional, observational study was performed in 70 patients in different stages of CKD in Diabetic Patients selected by Inclusion Criteria (Diabetic nephropathy patients with stages III, IV, V and exclusion Criteria (Acute kidney injury, History of carotid surgery, Patients of MI and stroke). This study was performed in Department of Nephrology, Dhaka Medical College in collaboration with the Department of Radiology and Imaging, laboratory of Department of Biochemistry and Department of Microbiology at Dhaka Medical College Hospital (By standard method in laboratory) from 1st January 2016 to 31st December 2016. eGFR was measured by MDRD formula and the CIMT was measured using an ultrasonographic examination. The mean CIMT was 0.9±0.21mm, and 62.9% of the subjects showed IMT thickening (≥1mm). The carotid IMT elevated significantly with the stage progression of CKD (Overall eGFR mean 28.8±14.5mL/min/1.73m² in CIMT<1mm with range from 6 to 54 and 9.1±9.0mL/min/1.73m² in CIMT ≥1mm with range from 3 to 32 (p=0.001). The eGFR was significantly lower in the patients with CIMT thickening than those without CIMT thickening. eGFR was also significantly associated with CKD stages (p=0.001), serum creatinine (p=0.001), BMI (r = -0.330, p=0.005), and negatively associated with age group, duration of hypertension, smoking. However, the CIMT was not significantly different among the patients at different stages of diabetic nephropathy (r = -0.172, p=156) and age group. It has been concluded that the mean CIMT was markedly high in patients with CKD compared to normal expected value. This study showed a relationship between the CIMT and the renal parameters as eGFR and the stages of diabetic nephropathy with a confirm association between the CIMT and diabetic macroangiopathy.
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Affiliation(s)
- M Mohiuddin
- Dr Md Mohiuddin, Assistant Professor, Department of Nephrology, Anwer Khan Modern Medical College (AKMMC), Dhaka, Bangladesh
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Khriguian J, Tsui J, Kucharczyk M, Nabid A, Bettahar R, Vincent L, Martin A, Jolicoeur M, Yassa M, Barkati M, Igidbashian L, Bahoric B, Archambault R, Villeneuve H, Mohiuddin M, Niazi T. Rectal Wall vs. Whole Rectum Dose: Which Volume Better Predicts Gastrointestinal Toxicity from Prostate External Beam Radiotherapy? Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.1822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Tsui J, Khriguian J, Kucharczyk M, Nabid A, Bettahar R, Vincent L, Martin A, Jolicoeur M, Yassa M, Barkati M, Igidbashian L, Bahoric B, Archambault R, Villeneuve H, Mohiuddin M, Niazi T. Optimal Hypofractionated Rectal Dose-Volume Constraint From The Prostate Cancer Patients of The PCS V Trial. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.1777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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28
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Vaughan R, Tsui J, Kucharczyk M, Nabid A, Bettahar R, Vincent L, Martin A, Jolicoeur M, Yassa M, Barkati M, Igidbashian L, Bahoric B, Archambault R, Villeneuve H, Mohiuddin M, Niazi T. The Clinical Significance of Bone Mineral Density Changes Following Long Term Androgen Deprivation Therapy in Prostate Cancer Patients Enrolled in the PCS V Trial. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.1780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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VanderWalde NA, Moughan J, Lichtman SM, Jagsi R, Ballo MT, Vanderwalde AM, Mohiuddin M, Meropol NJ, Kachnic LA, Garofalo MC, Ajani JA, Beart RW, Anne R, Evans LS, Arora A, Meyer JE, Lee JJ, Keech JA, Soori GS, Crane CH. The association of age with acute toxicities in NRG oncology combined modality lower GI cancer trials. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.4_suppl.649] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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
649 Background: This study sought to compare adverse events (AEs) of older and younger adults with lower gastrointestinal (GI) malignancies treated on NRG studies. Methods: Data from six NRG trials (RTOG 9811/0012/0247/0529/0822 & NSABP R-04), testing combined modality therapy (radiation and chemotherapy) in patients with anal or rectal cancer, were collected to test the hypothesis that older age was associated with increase in acute ( ≤ 90 days from treatment start) AEs. AEs were defined as GI, Genitourinary (GU), hematologic, or skin. AEs and compliance with protocol-directed therapy were compared between patients aged ≥ 70 years and < 70 years. Categorical variables were compared across age groups using the chi-square test. The association of age on AEs was evaluated using a covariate-adjusted logistic regression model, with odds ratio (OR) reported. To adjust for multiple comparisons, a p-value < 0.01 was considered statistically significant. Results: Data from 2525 patients were collected (43% female, 72% rectal cancer). There were 380 patients ≥ 70 years old (15%). Older patients were more likely to have worse baseline performance status (PS 1 or 2) (23% vs. 16%, p <0.01), but otherwise baseline characteristics were similar. Older patients were less likely to have completed their chemotherapy (78% vs. 87%, p < 0.01), but had similar median RT duration. On univariate analysis, patients ≥ 70 were more likely to experience grade ≥ 3 GI AEs (36% vs. 23%, OR 1.82, p < 0.001), and less likely to experience ≥ 3 skin AEs (8% vs. 14%, OR 0.56, p = 0.002). There was no difference between GU or hematologic AEs. On multivariable analysis, age ≥ 70 was associated with grade ≥ 3 GI AE (OR 1.80, 95% CI: 1.40, 2.31; p < 0.001) after adjusting for gender, PS, T stage, disease site, RT duration, and chemotherapy completion. Conclusions: Older patients with curable lower GI cancers who underwent combined-modality therapy were less likely to complete chemotherapy and were more likely to experience serious GI toxicity, whereas younger patients had higher rates of serious skin AEs.
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Affiliation(s)
- Noam Avraham VanderWalde
- Department of Radiation Oncology, University of Tennessee Health Science Center/West Cancer Center, Memphis, TN
| | - Jennifer Moughan
- NRG Oncology Statistics and Data Management Center - ACR, Philadelphia, PA
| | | | - Reshma Jagsi
- University of Michigan Health System, Ann Arbor, MI
| | - Matthew T. Ballo
- Department of Radiation Oncology, University of Tennessee Health Science Center/West Cancer Center, Memphis, TN
| | - Ari M. Vanderwalde
- Division of Hematology/Oncology, The University of Tennessee Health Science Center, West Cancer Center, Germantown, TN
| | | | - Neal J. Meropol
- Flatiron Health, New York, NY and Case Comprehensive Cancer Center, Cleveland, OH
| | | | | | | | | | - Rani Anne
- Thomas Jefferson University, Philadelphia, PA
| | | | | | | | - James J. Lee
- University of Pittsburgh Cancer Institute, Pittsburgh, PA
| | | | - Gamini S. Soori
- NRG Oncology/NSABP, and Nebraska Cancer Specialists, Omaha, NE
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Park R, Ho AMH, Pickering G, Arendt-Nielsen L, Mohiuddin M, Gilron I. Magnesium for the Management of Chronic Noncancer Pain in Adults: Protocol for a Systematic Review. JMIR Res Protoc 2019; 8:e11654. [PMID: 30635260 PMCID: PMC6330196 DOI: 10.2196/11654] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2018] [Revised: 10/19/2018] [Accepted: 10/22/2018] [Indexed: 12/16/2022] Open
Abstract
Background Chronic pain is a highly prevalent and complex health problem that is associated with a severe symptom burden, as well as substantial economic and social impact. Many patients with chronic pain still suffer from unrelieved or undertreated pain due to the incomplete efficacy and dose-limiting adverse effects of current therapies. Long-term and high-dose opioid use has considerably increased in the past 20 years despite limited evidence supporting its effectiveness in several chronic pain conditions, and serious concerns have emerged regarding adverse effects and potential misuse. Until recently, the steady increase in opioid prescribing rates has been associated with rising opioid-related mortality and other serious problems, emphasizing the need for better nonopioid therapies. Emerging evidence supports the safe use of magnesium in controlling chronic pain, but its overall efficacy and safety is still unclear. Objective This paper aims to assess the efficacy and safety of magnesium compared with a placebo for the treatment of chronic noncancer pain. Methods We will conduct a detailed search on Cochrane Central Register of Controlled Trials, MEDLINE, and EMBASE from their inception until the date the searches are run to identify relevant randomized controlled trials. The reference lists of retrieved studies as well as Web-based trial registries will also be searched. We will include randomized double-blind trials comparing magnesium (at any dose, frequency, or route of administration) with placebo using participant-reported pain assessment. Two reviewers will independently evaluate studies for eligibility, extract data, and assess trial quality and potential bias. Risk of bias will be assessed using criteria outlined in the Cochrane Handbook for Systematic Review of Interventions. Primary outcomes for this review will include any validated measure of pain intensity or pain relief. Dichotomous data will be used to calculate the risk ratio and number needed to treat or harm. The quality of evidence will be assessed using the Grading of Recommendations Assessment, Development and Evaluation approach. Results This protocol is grant-funded and has undergone a peer-review process through the Queen’s University Department of Anesthesiology and Perioperative Medicine Vandewater Endowed Studentship. This project is also supported, in part, by the Chronic Pain Network of the Canadian Institutes of Health Research Strategy for Patient-Oriented Research. The electronic database search strategies are currently being developed and modified. The entire review is expected to be completed by January 1, 2019. Conclusions The completion of this review is expected to identify available high-quality evidence describing the efficacy and safety of magnesium for the treatment of chronic noncancer pain. International Registered Report Identifier (IRRID) PRR1-10.2196/11654
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Affiliation(s)
- Rex Park
- School of Medicine, Queen's University, Kingston, ON, Canada
| | - Anthony M-H Ho
- Department of Anesthesiology and Perioperative Medicine, Queen's University, Kingston, ON, Canada
| | | | | | | | - Ian Gilron
- Department of Anesthesiology and Perioperative Medicine, Queen's University, Kingston, ON, Canada.,Department of Biomedical and Molecular Sciences, Queen's University, Kingston, ON, Canada.,Centre for Neuroscience Studies, Queen's University, Kingston, ON, Canada
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DiChiacchio L, Singh A, Chan J, Corcoran P, Lewis B, Thomas M, Ayares D, Horvath K, Horvath K, Mohiuddin M. Human Thrombomodulin Expression Confers Prolonged Graft Survival over Costimulation Blockade Alone in a Pig-to-Baboon Heterotopic Cardiac Xenotransplant Model. J Heart Lung Transplant 2018. [DOI: 10.1016/j.healun.2018.01.034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Nelli SR, Chakravarthy RD, Mohiuddin M, Lin HC. The role of amino acids on supramolecular co-assembly of naphthalenediimide–pyrene based hydrogelators. RSC Adv 2018; 8:14753-14759. [PMID: 35541324 PMCID: PMC9079960 DOI: 10.1039/c8ra00929e] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 04/11/2018] [Indexed: 11/21/2022] Open
Abstract
This report describes the two component self-assembly of π-capped amino acid hydrogelators (serine (S), aspartic acid (D), glutamic acid (E) or lysine (K)) prepared from pyrene (Py) based donor and naphthalenediimide (NDI) based acceptor molecules. The co-assembly can be triggered to form hydrogels by varying the pH conditions and the major driving forces behind the hydrogelation were found to be the formation of a strong charge-transfer (CT) complex and hydrogen bonding interactions at suitable pH conditions. The NDI–Py blends with matched donor/acceptor amino acid pairs undergo self-assembly under acidic pH conditions, whereas the blend (NDI–S + Py–K) with a mismatched amino acid pair forms a stable hydrogel under physiological pH conditions. UV-Vis, FTIR and rheological studies clearly indicate the formation and the stability of these CT-induced hydrogels. These hydrogels are of nanofibrous morphology with an average diameter of about 6–9 nm as evidenced by TEM analysis. In addition, this novel NDI–Py mixed component system exhibited good biocompatibility towards PC3 cells. Overall, since hydrogels based on CT-mediated two-component assemblies are very rare, our newly discovered NDI–Py hydrogels provide chemical insights into the design of a CT-induced hydrogelator and might facilitate various applications in biomedical engineering. The importance of side chains of amino acids for NDI–Py co-assembled hydrogelation is described.![]()
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Affiliation(s)
- Srinivasa Rao Nelli
- Department of Materials Science and Engineering
- National Chiao Tung University
- Hsinchu
- Republic of China
| | - Rajan Deepan Chakravarthy
- Department of Materials Science and Engineering
- National Chiao Tung University
- Hsinchu
- Republic of China
| | - Mohammed Mohiuddin
- Department of Materials Science and Engineering
- National Chiao Tung University
- Hsinchu
- Republic of China
| | - Hsin-Chieh Lin
- Department of Materials Science and Engineering
- National Chiao Tung University
- Hsinchu
- Republic of China
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Niazi T, Nabid A, Bettahar R, Vincent L, Martin A, Jolicoeur M, Yassa M, Barkati M, Igidbashian L, Bahoric B, Archambault R, Villeneuve H, Mohiuddin M, Azoulay L. Phase 3 Study of Hypofractionated, Dose Escalation Radiation Therapy for High-Risk Adenocarcinoma of the Prostate. Int J Radiat Oncol Biol Phys 2017. [DOI: 10.1016/j.ijrobp.2017.06.305] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Tamanna S, Rahman F, Tang TH, Ahmed SA, Ang KC, Zannat KE, Jilani MSA, Mohiuddin M, Haq JA. Seroprevalence of Leptospira infection in selected rural and urban areas of Bangladesh by rLipL32 based ELISA. IMC J Med Sci 2017. [DOI: 10.3329/imcjms.v11i2.33095] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background and objectives: Leptospirosis is a zoonotic infection with worldwide distribution caused by the Leptospira species and predominant in the tropical and subtropical regions. Information on leptospirosis in Bangladesh is limited. The present study was designed to detect anti-leptospiral antibodies in human serum samples in Bangladeshi population by developing an in-house ELISA using recombinant LipL32 (rLipL32) antigen. The study was conducted from April 2014 to December 2014.Method: Healthy individuals from two rural areas and fever cases from one urban healthcare center were enrolled in the study. Rural health centers were located at Sonargoan and Bajitpur sub-district (Upozilla) of Narayaganj and Kishorganj districts. Sonargoan health center is located 26 km south-east and Bajitpur is located 71 km north-east of Dhaka city. About 1-2 ml of blood was collected with aseptic measure and serum was separated and stored at -200C until used. Anti-leptospiral IgG antibody was determined by recombinant LipL32 (rLipL32) antigen based indirect enzyme linked immunosorbent assay (ELISA). Seropositive cases were further confirmed by commercial Leptospira IgG ELISA.Results: The study included 250 febrile cases and 376 healthy individuals from urban and rural areas, respectively. Out of total 626 study population, anti-LipL32 specific IgG antibody was detected in 70 individuals (11.2%). The rate of positivity of anti-LipL32 antibody among the healthy individuals from rural area was 10.6% while the rate was 12.0% in urban febrile population. The rate of positivity in rural and urban population was not significantly (p>0.05) different. Among the urban population, the rate of seropositivity was 9.1% and 16.4% in 21- 40 yrs and above 40 years age group respectively while the rate was 7.2% and 14.0% in rural population respectively. Out of 70 seropositive cases detected by LipL32 ELISA, 65 (92.9%) were positive by commercial ELISA.Conclusion: The present study has revealed that leptospirosis is prevalent in Bangladesh and should be looked for in febrile and clinically suspected cases. The study has also demonstrated that rLipL32 protein may be used as a candidate antigen for the serodiagnosis of leptospirosis.IMC J Med Sci 2017; 11(2): 50-55
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Brenner P, Mayr T, Reichart B, Guethoff S, Buchholz S, Dashkevich A, Michel S, Lutzmann I, Werner F, Bauer A, Klymiuk N, Wolf E, Reimann K, Mohiuddin M, Hermanns W, Ayares D, McGregor C, Steen S, Abicht J. New Standards in Orthotopic Cardiac Xenotransplantation of Multitransgenic Pig Hearts Preserved with “Steens” Cold Blood Cardioplegia Perfusion in a Pig-to-Baboon Model with CD40mAb or CD40L Costimulation Blockade. Thorac Cardiovasc Surg 2017. [DOI: 10.1055/s-0037-1598771] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- P. Brenner
- Ludwig-Maximilians-University (LMU), Department of Cardiac Surgery, Munich, Germany
| | - T. Mayr
- Walter-Brendel-Centre, LMU, Munich, Germany
| | | | | | - S. Buchholz
- Ludwig-Maximilians-University (LMU), Department of Cardiac Surgery, Munich, Germany
| | - A. Dashkevich
- Ludwig-Maximilians-University (LMU), Department of Cardiac Surgery, Munich, Germany
| | - S. Michel
- Ludwig-Maximilians-University (LMU), Department of Cardiac Surgery, Munich, Germany
| | | | - F. Werner
- Walter-Brendel-Centre, LMU, Munich, Germany
| | - A. Bauer
- Ludwig-Maximilians-University (LMU), Department of Anaesthesiology, Munich, Germany
| | - N. Klymiuk
- Ludwig-Maximilians-University (LMU), Department of Molecular Animal Breeding and Biotechnology, Munich, Germany
| | - E. Wolf
- Ludwig-Maximilians-University (LMU), Department of Molecular Animal Breeding and Biotechnology, Munich, Germany
| | - K. Reimann
- University of Massachusetts Medical School, MassBiologics, Boston, United States
| | - M. Mohiuddin
- NHLBI, NIH, Cardiothoracic Surgery Research Laboratory, Bethesda, United States
| | - W. Hermanns
- Ludwig-Maximilians-University (LMU), Department of Veterinary Pathology, Munich, Germany
| | - D. Ayares
- Revivicor Inc, Blackburg, United States
| | - C. McGregor
- University College, Department of Cardiothoracic Surgery, London, United Kingdom
| | - S. Steen
- University of Lund, Department of Cardiothoracic Surgery, Lund, Sweden
| | - J.M. Abicht
- Ludwig-Maximilians-University (LMU), Department of Anaesthesiology, Munich, Germany
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Mohiuddin M, Arbain D, Islam AKMS, Ahmad MS, Ahmad MN. Alpha-Glucosidase Enzyme Biosensor for the Electrochemical Measurement of Antidiabetic Potential of Medicinal Plants. Nanoscale Res Lett 2016; 11:95. [PMID: 26887579 PMCID: PMC4759339 DOI: 10.1186/s11671-016-1292-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [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: 09/04/2015] [Accepted: 02/01/2016] [Indexed: 06/05/2023]
Abstract
A biosensor for measuring the antidiabetic potential of medicinal plants was developed by covalent immobilization of α-glucosidase (AG) enzyme onto amine-functionalized multi-walled carbon nanotubes (MWCNTs-NH2). The immobilized enzyme was entrapped in freeze-thawed polyvinyl alcohol (PVA) together with p-nitrophenyl-α-D-glucopyranoside (PNPG) on the screen-printed carbon electrode at low pH to prevent the premature reaction between PNPG and AG enzyme. The enzymatic reaction within the biosensor is inhibited by bioactive compounds in the medicinal plant extracts. The capability of medicinal plants to inhibit the AG enzyme on the electrode correlates to the potential of the medicinal plants to inhibit the production of glucose from the carbohydrate in the human body. Thus, the inhibition indicates the antidiabetic potential of the medicinal plants. The performance of the biosensor was evaluated to measure the antidiabetic potential of three medicinal plants such as Tebengau (Ehretis laevis), Cemumar (Micromelum pubescens), and Kedondong (Spondias dulcis) and acarbose (commercial antidiabetic drug) via cyclic voltammetry, amperometry, and spectrophotometry. The cyclic voltammetry (CV) response for the inhibition of the AG enzyme activity by Tebengau plant extracts showed a linear relation in the range from 0.423-8.29 μA, and the inhibition detection limit was 0.253 μA. The biosensor exhibited good sensitivity (0.422 μA/mg Tebengau plant extracts) and rapid response (22 s). The biosensor retains approximately 82.16 % of its initial activity even after 30 days of storage at 4 °C.
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Affiliation(s)
- M Mohiuddin
- Production Department, Palash Urea Fertilizer Factory Ltd., Bangladesh Chemical Industries Corporation, Dhaka, Bangladesh.
| | - D Arbain
- School of Bioprocess Engineering, Universiti Malaysia Perlis, 01000, Kangar, Perlis, Malaysia
| | - A K M Shafiqul Islam
- School of Bioprocess Engineering, Universiti Malaysia Perlis, 01000, Kangar, Perlis, Malaysia
- Centre of Excellence for Advanced Sensor Technology, Universiti Malaysia Perlis, 01000, Kangar, Perlis, Malaysia
| | - M S Ahmad
- School of Bioprocess Engineering, Universiti Malaysia Perlis, 01000, Kangar, Perlis, Malaysia
| | - M N Ahmad
- Centre of Excellence for Advanced Sensor Technology, Universiti Malaysia Perlis, 01000, Kangar, Perlis, Malaysia
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Huhn JL, Regine WF, Valentino JP, Meigooni AS, Kudrimoti M, Mohiuddin M. Spatially Fractionated GRID Radiation Treatment of Advanced Neck Disease Associated with Head and Neck Cancer. Technol Cancer Res Treat 2016; 5:607-12. [PMID: 17121437 DOI: 10.1177/153303460600500608] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Advanced nodal disease associated with head and neck cancer warrants aggressive, often multi-modality therapy to maximize local-regional control. The expansion of a novel treatment paradigm developed by our institution includes the addition of a single-fraction of high dose spatially-fractionated radiation (GRID) to a conventional course of treatment. Between 1995 and 2002 a series of 27 patients (median age 65) with bulky N2-3 disease were treated. Median nodal tumor size was 7 cm. Two groups of patients were evaluated. Group 1 (N=14) patients received a median neck dose 69 Gy (range 54–79 Gy) plus GRID treatment. Group 2 (N=13) patients received a median neck dose of 59 Gy (range 54–72 Gy) plus GRID treatment followed by planned neck dissection. Patients were evaluated for local-regional control, pathological response, survival, and morbidity. Median time to follow-up for Group 1 was 10 months (range 3–44 months). Neck control was 93%. Disease specific survival was 50%. Morbidity was limited to soft-tissue related damage and was mild. Median time to follow-up for Group 2 was 38 months (range 5–116 months). Pathologic complete response rate was 85%. Overall neck control rate was 92%. Disease specific survival was 85%. Surgical morbidity was limited to three wound healing complications. GRID treatment may be safely added to conventional treatment management of locally advanced neck disease related to cancer with acceptable morbidity. It may improve pathologic complete response rates in those patients who undergo planned neck dissection, possibly leading to improved survival. In patients with inoperable bulky disease, addition of GRID enhances local-regional control.
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Affiliation(s)
- Jeniffer L Huhn
- University of Kentucky, 800 Rose St. N15, Lexington, KY 40536, USA.
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Coleman C, Formenti S, Chao N, Grover S, Rodin D, Petereit D, Vikram B, Pistenmaa D, Mohiuddin M, Williams T. The International Cancer Expert Corps (ICEC): Implementing a global force to address the catastrophic rise in cancer in the developing world. Radiother Oncol 2016. [DOI: 10.1016/s0167-8140(16)30055-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Brenner P, Mayr T, Guethoff S, Buchholz S, Pöttinger T, Lutzmann I, Werner F, Bauer A, Klymiuk N, Wolf E, Reimann K, Mohiuddin M, Hermanns W, Ayares D, McGregor C, Lambris J, Hagl C, Reichart B, Abicht JM. Costimulation Blockade with CD40mAb in (Life-Supporting) Heterotopic and Orthotopic Cardiac Xenotransplantation of GalT-KO/hCD46/hTM Transgenic Pig Hearts in a Pig-to-Baboon Model. Thorac Cardiovasc Surg 2016. [DOI: 10.1055/s-0036-1571687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Edwards J, Shah P, Huhn J, St. Clair W, Regine W, Mohiuddin M, Kudrimoti M. Definitive GRID and Fractionated Radiation in Bulky Head and Neck Cancer Associated With Low Rates of Distant Metastasis. Int J Radiat Oncol Biol Phys 2015. [DOI: 10.1016/j.ijrobp.2015.07.1399] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Park H, Mohiuddin M, Yaldo D, Tom B, Worlikar N. SU-C-BRB-03: Novel Technique to Implement GRID Therapy in a Commercial Treatment Planning System. Med Phys 2015. [DOI: 10.1118/1.4923806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Liang L, Bekerat H, Tomic N, DeBlois F, Vuong T, Devic S, Nobah A, Mohiuddin M, Moftah B. PO-0774: Optimal beam quality for Linac-based Spatially Fractionated Grid Radiation Therapy (SFGRT). Radiother Oncol 2015. [DOI: 10.1016/s0167-8140(15)40766-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Mohiuddin M, Arbain D, Shafiqul Islam AKM, Rahman M, Ahmad MS, Ahmad MN. Electrochemical measurement of the antidiabetic potential of medicinal plants using multi-walled carbon nanotubes paste electrode. RUSS J ELECTROCHEM+ 2015. [DOI: 10.1134/s1023193514120027] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Nobah A, Mohiuddin M, Devic S, Moftah B. Effective spatially fractionated GRID radiation treatment planning for a passive grid block. Br J Radiol 2015; 88:20140363. [PMID: 25382164 PMCID: PMC4277376 DOI: 10.1259/bjr.20140363] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Revised: 10/29/2014] [Accepted: 11/06/2014] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To commission a grid block for spatially fractionated grid radiation therapy (SFGRT) treatments and describe its clinical implementation and verification through the record and verify (R&V) system. METHODS SFGRT was developed as a treatment modality for bulky tumours that cannot be easily controlled with conventionally fractionated radiation. Treatment is delivered in the form of open-closed areas. Currently, SFGRT is performed by either using a commercially available grid block or a multileaf collimator (MLC) of a linear accelerator. In this work, 6-MV photon beam was used to study dosimetric characteristics of the grid block. We inserted the grid block into a commercially available treatment planning system (TPS), and the feasibility of delivering such treatment plans on a linear accelerator using a R&V system was verified. Dose measurements were performed using a miniature PinPoint(TM) ion chamber (PTW, Freiburg, Germany) in a water phantom and radiochromic film within solid water slabs. PinPoint ion chamber was used to measure the output factors, percentage depth dose (PDD) curves and beam profiles at two depths, depth of maximum dose (zmax) and 10 cm. Film sheets were used to measure dose profiles at zmax and 10-cm depth. RESULTS The largest observed percentage difference between output factors for the grid block technique calculated by the TPS and measured with the PinPoint ion chamber was 3.6% for the 5 × 5-cm(2) field size. Relatively significant discrepancies between measured and calculated PDD values appear only in the build-up region, which was found to amount to <4%, while a good agreement (differences <2%) at depths beyond zmax was observed. Dose verification comparisons performed between calculated and measured dose distributions were in clinically acceptable agreements. When comparing the MLC-based with the grid block technique, the advantage of treating large tumours with a single field reduces treatment time by at least 3-5 times, having significant impact on patient throughput. CONCLUSION The proposed method supports and helps to standardize the clinical implementation of the grid block in a safer and more accurate way. ADVANCES IN KNOWLEDGE This work describes the method to implement treatment planning for the grid block technique in radiotherapy departments.
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Affiliation(s)
- A Nobah
- 1 Biomedical Physics Department, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
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Spring PM, Arnold SM, Shajahan S, Brown B, Dey S, Lele SM, Valentino J, Jones R, Mohiuddin M, Ahmed MM. Low Dose Fractionated Radiation Potentiates the Effects of Taxotere in Nude Mice Xenografts of Squamous Cell Carcinoma of Head and Neck. Cell Cycle 2014. [DOI: 10.4161/cc.3.4.786] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Singh A, Corcoran P, Thomas M, Lewis B, Ayares D, Reimann K, Horvath K, Mohiuddin M. Costimulation Blockade With Anti CD40 Antibody Maintains CD4+ and Treg Cell Numbers in Pig To Baboon Cardiac Transplantation Model. Transplantation 2014. [DOI: 10.1097/00007890-201407151-00096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Wu GA, Prochnik S, Jenkins J, Salse J, Hellsten U, Murat F, Perrier X, Ruiz M, Scalabrin S, Terol J, Takita MA, Labadie K, Poulain J, Couloux A, Jabbari K, Cattonaro F, Del Fabbro C, Pinosio S, Zuccolo A, Chapman J, Grimwood J, Tadeo FR, Estornell LH, Muñoz-Sanz JV, Ibanez V, Herrero-Ortega A, Aleza P, Pérez-Pérez J, Ramón D, Brunel D, Luro F, Chen C, Farmerie WG, Desany B, Kodira C, Mohiuddin M, Harkins T, Fredrikson K, Burns P, Lomsadze A, Borodovsky M, Reforgiato G, Freitas-Astúa J, Quetier F, Navarro L, Roose M, Wincker P, Schmutz J, Morgante M, Machado MA, Talon M, Jaillon O, Ollitrault P, Gmitter F, Rokhsar D. Sequencing of diverse mandarin, pummelo and orange genomes reveals complex history of admixture during citrus domestication. Nat Biotechnol 2014; 32:656-62. [PMID: 24908277 PMCID: PMC4113729 DOI: 10.1038/nbt.2906] [Citation(s) in RCA: 320] [Impact Index Per Article: 32.0] [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] [Subscribe] [Scholar Register] [Received: 10/09/2013] [Accepted: 04/14/2014] [Indexed: 01/21/2023]
Abstract
Cultivated citrus are selections from, or hybrids of, wild progenitor species whose identities and contributions to citrus domestication remain controversial. Here we sequence and compare citrus genomes--a high-quality reference haploid clementine genome and mandarin, pummelo, sweet-orange and sour-orange genomes--and show that cultivated types derive from two progenitor species. Although cultivated pummelos represent selections from one progenitor species, Citrus maxima, cultivated mandarins are introgressions of C. maxima into the ancestral mandarin species Citrus reticulata. The most widely cultivated citrus, sweet orange, is the offspring of previously admixed individuals, but sour orange is an F1 hybrid of pure C. maxima and C. reticulata parents, thus implying that wild mandarins were part of the early breeding germplasm. A Chinese wild 'mandarin' diverges substantially from C. reticulata, thus suggesting the possibility of other unrecognized wild citrus species. Understanding citrus phylogeny through genome analysis clarifies taxonomic relationships and facilitates sequence-directed genetic improvement.
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Affiliation(s)
- G. Albert Wu
- US-Department of Energy Joint Genome Institute, Walnut Creek, CA, USA
| | - Simon Prochnik
- US-Department of Energy Joint Genome Institute, Walnut Creek, CA, USA
| | - Jerry Jenkins
- HudsonAlpha Biotechnology Institute, Huntsville, AL, USA
| | - Jerome Salse
- INRA/UBP UMR 1095 GDEC, Clermont Ferrand, France
| | - Uffe Hellsten
- US-Department of Energy Joint Genome Institute, Walnut Creek, CA, USA
| | | | | | | | | | - Javier Terol
- Centro de Genomica, Instituto Valenciano de Investigaciones Agrarias (IVIA), Valencia, Spain
| | | | - Karine Labadie
- Commissariat à l'Energie Atomique (CEA), Institut de Génomique (IG), Genoscope, Evry, France
| | - Julie Poulain
- Commissariat à l'Energie Atomique (CEA), Institut de Génomique (IG), Genoscope, Evry, France
| | - Arnaud Couloux
- Commissariat à l'Energie Atomique (CEA), Institut de Génomique (IG), Genoscope, Evry, France
| | - Kamel Jabbari
- Commissariat à l'Energie Atomique (CEA), Institut de Génomique (IG), Genoscope, Evry, France
| | | | | | | | - Andrea Zuccolo
- Istituto di Genomica Applicata, Udine, Italy
- Institute of Life Sciences, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Jarrod Chapman
- US-Department of Energy Joint Genome Institute, Walnut Creek, CA, USA
| | - Jane Grimwood
- HudsonAlpha Biotechnology Institute, Huntsville, AL, USA
| | - Francisco R. Tadeo
- Centro de Genomica, Instituto Valenciano de Investigaciones Agrarias (IVIA), Valencia, Spain
| | - Leandro H. Estornell
- Centro de Genomica, Instituto Valenciano de Investigaciones Agrarias (IVIA), Valencia, Spain
| | - Juan V. Muñoz-Sanz
- Centro de Genomica, Instituto Valenciano de Investigaciones Agrarias (IVIA), Valencia, Spain
| | - Victoria Ibanez
- Centro de Genomica, Instituto Valenciano de Investigaciones Agrarias (IVIA), Valencia, Spain
| | - Amparo Herrero-Ortega
- Centro de Genomica, Instituto Valenciano de Investigaciones Agrarias (IVIA), Valencia, Spain
| | - Pablo Aleza
- Centro de Protección Vegetal y Biotecnología-IVIA, Moncada, Valencia, Spain
| | | | | | - Dominique Brunel
- Commissariat à l'Energie Atomique (CEA), Institut de Génomique (IG), Genoscope, Evry, France
- INRA, US EPGV_1279, Evry, France
| | | | - Chunxian Chen
- Citrus Research and Education Center (CREC), Institute of Food and Agricultural Sciences (IFAS), University of Florida, Lake Alfred, FL, USA
| | - William G. Farmerie
- Interdisciplinary Center for Biotechnology Research, University of Florida, Gainesville, FL, USA
| | - Brian Desany
- 454 Life Sciences, A Roche Company, 15 Commercial Street, Branford CT, USA
| | - Chinnappa Kodira
- 454 Life Sciences, A Roche Company, 15 Commercial Street, Branford CT, USA
| | - Mohammed Mohiuddin
- 454 Life Sciences, A Roche Company, 15 Commercial Street, Branford CT, USA
| | - Tim Harkins
- 454 Life Sciences, A Roche Company, 15 Commercial Street, Branford CT, USA
| | - Karin Fredrikson
- 454 Life Sciences, A Roche Company, 15 Commercial Street, Branford CT, USA
| | - Paul Burns
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA, USA
- School of Computational Science & Engineering, Georgia Institute of Technology, Atlanta, GA, USA
| | - Alexandre Lomsadze
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA, USA
- School of Computational Science & Engineering, Georgia Institute of Technology, Atlanta, GA, USA
| | - Mark Borodovsky
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA, USA
- School of Computational Science & Engineering, Georgia Institute of Technology, Atlanta, GA, USA
- Department of Biological and Medical Physics, Moscow Institute of Physics and Technology, Dolgoprudny, Moscow Region, Russia
| | - Giuseppe Reforgiato
- Consiglio per la Ricerca e la Sperimentazione in Agricoltura (CRA-ACM), Acireale, Italy
| | - Juliana Freitas-Astúa
- Centro de Citricultura Sylvio Moreira, IAC, Cordeirópolis, SP, Brazil
- Embrapa Cassava and Fruits, Cruz das Almas, BA, Brazil
| | - Francis Quetier
- Commissariat à l'Energie Atomique (CEA), Institut de Génomique (IG), Genoscope, Evry, France
- Département de Biologie, Université d’Evry, Evry, France
| | - Luis Navarro
- Centro de Protección Vegetal y Biotecnología-IVIA, Moncada, Valencia, Spain
| | - Mikeal Roose
- Department of Botany and Plant Sciences, University of California, Riverside, CA, USA
| | - Patrick Wincker
- Commissariat à l'Energie Atomique (CEA), Institut de Génomique (IG), Genoscope, Evry, France
- Département de Biologie, Université d’Evry, Evry, France
- Centre National de Recherche Scientifique (CNRS), Evry, France
| | - Jeremy Schmutz
- HudsonAlpha Biotechnology Institute, Huntsville, AL, USA
| | - Michele Morgante
- Istituto di Genomica Applicata, Udine, Italy
- Department of Agriculture and Environmental Sciences, University of Udine, Udine, Italy
| | | | - Manuel Talon
- Centro de Genomica, Instituto Valenciano de Investigaciones Agrarias (IVIA), Valencia, Spain
| | - Olivier Jaillon
- Commissariat à l'Energie Atomique (CEA), Institut de Génomique (IG), Genoscope, Evry, France
- Département de Biologie, Université d’Evry, Evry, France
- Centre National de Recherche Scientifique (CNRS), Evry, France
| | | | - Frederick Gmitter
- Citrus Research and Education Center (CREC), Institute of Food and Agricultural Sciences (IFAS), University of Florida, Lake Alfred, FL, USA
| | - Daniel Rokhsar
- US-Department of Energy Joint Genome Institute, Walnut Creek, CA, USA
- Division of Genetics, Genomics, and Development, University of California, Berkeley, CA, USA
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Prasanna A, Ahmed MM, Mohiuddin M, Coleman CN. Exploiting sensitization windows of opportunity in hyper and hypo-fractionated radiation therapy. J Thorac Dis 2014; 6:287-302. [PMID: 24688774 DOI: 10.3978/j.issn.2072-1439.2014.01.14] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2013] [Accepted: 01/12/2014] [Indexed: 12/13/2022]
Abstract
In contrast to the conventional radiotherapy/chemoradiotherapy paradigms used in the treatment of majority of cancer types, this review will describe two areas of radiobiology, hyperfractionated and hypofractionated radiation therapy, for cancer treatment focusing on application of novel concepts underlying these treatment modalities. The initial part of the review discusses the phenomenon of hyper-radiation sensitivity (HRS) at lower doses (0.1 to 0.6 Gy), describing the underlying mechanisms and how this could enhance the effects of chemotherapy, particularly, in hyperfractionated settings. The second part examines the radiobiological/physiological mechanisms underlying the effects of high-dose hypofractionated radiation therapy that can be exploited for tumor cure. These include abscopal/bystander effects, activation of immune system, endothelial cell death and effect of hypoxia with re-oxygenation. These biological properties along with targeted dose delivery and distribution to reduce normal tissue toxicity may make high-dose hypofractionation more effective than conventional radiation therapy for treatment of advanced cancers. The novel radiation physics based methods that take into consideration the tumor volume to be irradiated and normal tissue avoidance/tolerance can further improve treatment outcome and post-treatment quality of life. In conclusion, there is enough evidence to further explore novel avenues to exploit biological mechanisms from hyper-fractionation by enhancing the efficacy of chemotherapy and hypo-fractionated radiation therapy that could enhance tumor control and use imaging and technological advances to reduce toxicity.
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Affiliation(s)
- Anish Prasanna
- 1 Radiation Research Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, National Institutes of Health, Rockville, MD, USA ; 2 Oncology Centre, King Faisal Specialist Hospital and Research Centre, Riyadh, Kingdom of Saudi Arabia
| | - Mansoor M Ahmed
- 1 Radiation Research Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, National Institutes of Health, Rockville, MD, USA ; 2 Oncology Centre, King Faisal Specialist Hospital and Research Centre, Riyadh, Kingdom of Saudi Arabia
| | - Mohammed Mohiuddin
- 1 Radiation Research Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, National Institutes of Health, Rockville, MD, USA ; 2 Oncology Centre, King Faisal Specialist Hospital and Research Centre, Riyadh, Kingdom of Saudi Arabia
| | - C Norman Coleman
- 1 Radiation Research Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, National Institutes of Health, Rockville, MD, USA ; 2 Oncology Centre, King Faisal Specialist Hospital and Research Centre, Riyadh, Kingdom of Saudi Arabia
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Parfrey LW, Walters WA, Lauber CL, Clemente JC, Berg-Lyons D, Teiling C, Kodira C, Mohiuddin M, Brunelle J, Driscoll M, Fierer N, Gilbert JA, Knight R. Communities of microbial eukaryotes in the mammalian gut within the context of environmental eukaryotic diversity. Front Microbiol 2014; 5:298. [PMID: 24995004 PMCID: PMC4063188 DOI: 10.3389/fmicb.2014.00298] [Citation(s) in RCA: 100] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Accepted: 05/30/2014] [Indexed: 12/21/2022] Open
Abstract
Eukaryotic microbes (protists) residing in the vertebrate gut influence host health and disease, but their diversity and distribution in healthy hosts is poorly understood. Protists found in the gut are typically considered parasites, but many are commensal and some are beneficial. Further, the hygiene hypothesis predicts that association with our co-evolved microbial symbionts may be important to overall health. It is therefore imperative that we understand the normal diversity of our eukaryotic gut microbiota to test for such effects and avoid eliminating commensal organisms. We assembled a dataset of healthy individuals from two populations, one with traditional, agrarian lifestyles and a second with modern, westernized lifestyles, and characterized the human eukaryotic microbiota via high-throughput sequencing. To place the human gut microbiota within a broader context our dataset also includes gut samples from diverse mammals and samples from other aquatic and terrestrial environments. We curated the SILVA ribosomal database to reflect current knowledge of eukaryotic taxonomy and employ it as a phylogenetic framework to compare eukaryotic diversity across environment. We show that adults from the non-western population harbor a diverse community of protists, and diversity in the human gut is comparable to that in other mammals. However, the eukaryotic microbiota of the western population appears depauperate. The distribution of symbionts found in mammals reflects both host phylogeny and diet. Eukaryotic microbiota in the gut are less diverse and more patchily distributed than bacteria. More broadly, we show that eukaryotic communities in the gut are less diverse than in aquatic and terrestrial habitats, and few taxa are shared across habitat types, and diversity patterns of eukaryotes are correlated with those observed for bacteria. These results outline the distribution and diversity of microbial eukaryotic communities in the mammalian gut and across environments.
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Affiliation(s)
| | - William A Walters
- Department of Molecular, Cellular, and Developmental Biology, University of Colorado Boulder, CO, USA
| | - Christian L Lauber
- Cooperative Institute for Research in Environmental Sciences, University of Colorado Boulder, CO, USA
| | - Jose C Clemente
- Biofrontiers Institute, University of Colorado Boulder, CO, USA
| | | | | | | | | | | | | | - Noah Fierer
- Cooperative Institute for Research in Environmental Sciences, University of Colorado Boulder, CO, USA ; Department of Ecology and Evolutionary Biology, University of Colorado Boulder, CO, USA
| | - Jack A Gilbert
- Department of Ecology and Evolution, University of Chicago Chicago, IL, USA ; Institute of Genomic and Systems Biology, Argonne National Laboratory Argonne, IL, USA
| | - Rob Knight
- Biofrontiers Institute, University of Colorado Boulder, CO, USA ; Howard Hughes Medical Institute, University of Colorado Boulder, CO, USA
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50
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Mohiuddin M, Memon M, Nobah A, Elsebaie M, AL Suhaibani A, Pant R, Shaheen M, Alyamani M, Al Dayal F. Locally advanced high-grade extremity soft tissue sarcoma: Response with novel approach to neoadjuvant chemoradiation using induction spatially fractionated GRID radiotherapy (SFGRT). J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.10575] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Mohammed Mohiuddin
- King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Muhammad Memon
- King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Ahmed Nobah
- King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
| | - Medhat Elsebaie
- King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
| | | | | | | | - Majid Alyamani
- King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
| | - Fouad Al Dayal
- King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
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