Publications by authors named "Akhil Sharma"

46 Publications

Parkin-deficient rats are resistant to neurotoxicity of chronic high-dose methamphetamine.

Exp Neurol 2021 Nov 21;345:113811. Epub 2021 Jul 21.

Department of Pharmaceutical Sciences, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, 259 Mack Ave, Detroit, MI 48201, USA. Electronic address:

Methamphetamine (METH) is a highly addictive and powerful central nervous system psychostimulant with no FDA-approved pharmacotherapy. Parkin is a neuroprotective protein and its loss of function contributes to Parkinson's disease. This study used 3-month-old homozygous parkin knockout (PKO) rats to determine whether loss of parkin protein potentiates neurotoxicity of chronic METH to the nigrostriatal dopamine pathway. PKO rats were chronically treated with 10 mg/kg METH for 10 consecutive days and assessed for neurotoxicity markers in the striatum on the 5th and 10th day of withdrawal from METH. The PKO rats showed higher METH-induced hyperthermia; however, they did not display augmented deficits in dopaminergic and serotonergic neurotoxicity markers, astrocyte activation or decreased mitochondrial enzyme levels as compared to wild-type (WT) rats. Interestingly, saline-treated PKO rats had lower levels of dopamine (DA) as well as mitochondrial complex I and II levels while having increased basal levels of glial fibrillary acidic protein (GFAP), a marker of gliosis. These results indicate PKO display a certain resistance to METH neurotoxicity, possibly mediated by lowered DA levels and downregulated mitochondria.
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http://dx.doi.org/10.1016/j.expneurol.2021.113811DOI Listing
November 2021

Medical Malpractice Trends in Foot and Ankle Surgery.

J Foot Ankle Surg 2021 Jun 22. Epub 2021 Jun 22.

Department of Orthopaedic Surgery, Duke University, Durham, NC.

Medical malpractice lawsuits can place significant economic and psychologic burden on a provider. Orthopedic surgery is one of the most common subspecialties involved in malpractice claims. There is currently no study examining malpractice lawsuits within foot and ankle surgery. Accordingly, the purpose of this work is to examine trends in malpractice claims in foot and ankle surgery. The Westlaw legal database was queried for lawsuits pertaining to foot and ankle surgery from 2008 to 2018. Only cases involving medical malpractice were included for analysis. All available details pertaining to the cases were collected. This included plaintiff demographic and geographic data. Details regarding the cases were also collected such as anatomical location, pathology, complications, and case outcomes. Forty-nine malpractice lawsuits pertaining to foot and ankle were identified. Most plaintiffs in these cases were adult females, and the majority of cases occurred in the northeast (53.1%). The most common anatomical region involved in claims involved the forefoot (29%). The majority of these claims involved surgery (65%). Infection was the most common complication seen in claims (22%). The jury ruled in favor of the defendant surgeon in most cases (73%). This is the first study to examine trends in medical malpractice within foot and ankle surgery. Infection was the most frequent complication seen in claims and forefoot surgery was the most common anatomic location. A large portion of claims resulted after nonoperative treatment. A better understanding of the trends within malpractice claims is crucial to developing strategies for prevention.
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http://dx.doi.org/10.1053/j.jfas.2021.02.016DOI Listing
June 2021

Isolated ST-Elevation Myocardial Infarction Involving Leads I and aVL: Angiographic and Electrocardiographic Correlations from a Tertiary Care Center.

Cardiol Res Pract 2021 21;2021:7638020. Epub 2021 Jun 21.

Department of Cardiology, King George's Medical University, Lucknow 226003, Uttar Pradesh, India.

Background: Determining the infarct-related artery in STEMI during a coronary angiogram can be challenging due to the affliction of multiple vessels. Isolated STEMI involving only EKG leads I and aVL is infrequent. Localization of infarct-related artery based on EKG findings has not been previously done in this subset.

Methods: All consecutive de novo acute coronary syndrome (ACS) patients admitted to coronary care unit with ST elevations involving only leads I and aVL were screened for enrollment. Patients with ST elevation in any additional lead and those who refused a coronary angiogram were excluded. Subsequently, a coronary angiogram was done as part of primary PCI or a pharmacoinvasive approach to identify the infract-related artery (IRA). IRA was defined by characteristics of lesion, flow of blood through stenosis, and presence of intracoronary thrombus. Coronary angiogram was interpreted by two independent observers blinded to the EKG findings. ST changes in inferior and precordial leads were analyzed to find ECG predictors of the culprit artery.

Results: A total of 54 eligible patients of ACS were included in the study. The first major diagonal (D1) was the most frequent IRA in 35.2% followed by left circumflex-obtuse marginal (LCX-OM11) in 29.6%, left anterior descending (LAD) in 20.4%, and ramus intermedius (RI) in 14.8%. Out of total patients with ST depression in lead V2, the LCX-OM11 group was IRA in 50% cases while the RI, D1, and LAD groups accounted for 31.8%, 13.6%, and 4.5%, respectively ( < 0.001). Similarly, LCX-OM1 was the most frequent IRA subjects with ST depressions in leads V1 and V3 (44.4%; = 0.010 and 46.2%; = 0.003, resp.). On the contrary, in patients with ST depression in lead III, LAD and D1 were the most frequent IRA as compared to LCX-OM1 and RI though statistical significance was not attained ( = 0.857 for lead III). ST-segment depression in lead V2 had a positive predictive value of 60% and a negative predictive value of 100% for LCX-OM1 as IRA. Similarly, ST-segment depression in lead V2 had a positive predictive value of 20% and a negative predictive value of 100% for the RI group.

Conclusions: In patients presenting with isolated ST elevation in leads I and aVL, the most frequent IRA on angiogram was first diagonal. ST depressions in EKG leads V1-V3 were the most common predictor of LCX-OM1 while those in inferior leads indicated LAD-D1 as the IRA.
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http://dx.doi.org/10.1155/2021/7638020DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8241503PMC
June 2021

'Routine' versus 'Smart Phone Application Based - Intense' follow up of patients with acute coronary syndrome undergoing percutaneous coronary intervention: Impact on clinical outcomes and patient satisfaction.

Int J Cardiol Heart Vasc 2021 Aug 25;35:100832. Epub 2021 Jun 25.

Department of Cardiology, AIIMS, New Delhi, India.

Background: Acute coronary syndrome (ACS) refers to the spectrum of clinical presentation of coronary artery disease (CAD). As a routine practice at our institute, following PCI, ACS patients are called for the first follow up after two weeks. This period of two weeks can be full of anxieties, concerns and medical issues. In this study, we planned to assess the feasibility/acceptability of smart phone application (app) based system for patient follow-up and its comparison to routine practice among patients with ACS who have undergone a PCI.

Methods: A randomized controlled trial (RCT) was conducted over a period of one year from January to December 2017. After the PCI was deemed successful, patients were recruited and enrolled based on the understanding of basic English language and operation of a smart phone. Those who consented to be part of study were then randomly allocated either the conventional follow up group or the intense follow up (routine + smart phone app based follow up) group. First co- primary outcome was composite of clinical outcomes (mortality, myocardial infarction, stroke, target vessel revascularisation, heart failure admission and emergency visit). Second co- primary outcome was patient satisfaction. The overall patient satisfaction was assessed by the patients using a five-point patient satisfaction survey instrument containing five questions with 5 marks each, in which higher scores meant more satisfaction. Secondary outcome was controlled hypertension in hypertensive patients. It was defined as systolic BP less than 130 and diastolic BP less than 80 mmHg.

Results: A cohort of 228 patients (109 in intense app-based arm; 119 in routine follow up arm) were analyzed. The result showed significant improvement in blood pressure control in hypertensive population in intense app based follow up group (76.2%) when compared to routine follow up group (45%) with p value 0.0062. The satisfaction score was significantly higher in the intense app based follow up (20.7 ± 1.29) as compared to routine follow up (16.5 ± 2.68); p value 0.0001. In the intense app based follow up 72.5% patient felt it was excellent tool (score 21-25) while 27.5% categorized it as good (score 16-20). While the routine follows up was perceived as good by most (91.6%) of the patients. Only 4.2% graded it as excellent and an equal number (4.2%) graded it as a poor way of follow up.

Conclusions: App based system shows higher satisfaction rate and comparable clinical outcome when compared to traditional hospital based follow up protocol alone. It has a high acceptance rate and thus this system should be explored further to optimize long term patient care.
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http://dx.doi.org/10.1016/j.ijcha.2021.100832DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8250165PMC
August 2021

Impact of Subclinical and Clinical Kidney Allograft Rejection Within 1 Year Posttransplantation Among Compatible Transplant With Steroid Withdrawal Protocol.

Transplant Direct 2021 Jul 8;7(7):e706. Epub 2021 Jun 8.

Department of Medicine, Thomas E Starzl Transplantation Institute, Pittsburgh, PA.

Early acute kidney rejection remains an important clinical issue.

Methods: The current study included 552 recipients who had 1-2 surveillance or indication biopsy within the 1 y posttransplant. We evaluated the impact of type of allograft inflammation on allograft outcome. They were divided into 5 groups: no inflammation (NI: 95), subclinical inflammation (SCI: 244), subclinical T cell-mediated rejection (TCMR) (SC-TCMR: 110), clinical TCMR (C-TCMR: 83), and antibody-mediated rejection (AMR: 20). Estimated glomerular filtration rate (eGFR) over time using linear mixed model, cumulative chronic allograft scores/interstitial fibrosis and tubular atrophy (IFTA) ≥2 at 12 mo, and survival estimates were compared between groups.

Results: The common types of rejections were C-TCMR (15%), SC-TCMR (19.9%), and AMR (3.6%) of patients. Eighteen of 20 patients with AMR had mixed rejection with TCMR. Key findings were as follows: (i) posttransplant renal function: eGFR was lower for patients with C-TCMR and AMR ( < 0.0001) compared with NI, SCI, and SC-TCMR groups. There was an increase in delta-creatinine from 3 to 12 mo and cumulative allograft chronicity scores at 12 mo ( < 0.001) according to the type of allograft inflammation. (ii) Allograft histology: the odds of IFTA ≥2 was higher for SC-TCMR (3.7 [1.3-10.4];  = 0.04) but was not significant for C-TCMR (3.1 [1.0-9.4];  = 0.26), and AMR (2.5 [0.5-12.8];  = 0.84) compared with NI group, and (iii) graft loss: C-TCMR accounted for the largest number of graft losses and impending graft losses on long-term follow-up. Graft loss among patient with AMR was numerically higher but was not statistically significant.

Conclusions: The type of kidney allograft inflammation predicted posttransplant eGFR, cumulative chronic allograft score/IFTA ≥2 at 12 mo, and graft loss.
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http://dx.doi.org/10.1097/TXD.0000000000001132DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8191698PMC
July 2021

Severe psoriasis presenting with rapidly progressive (crescentic) IgA-predominant glomerulonephritis.

BMJ Case Rep 2021 May 26;14(5). Epub 2021 May 26.

American University of the Caribbean School of Medicine, Cupecoy, St. Maarten.

IgA nephropathy (IgAN) is commonly associated with psoriasis; however, psoriasis presenting with crescentic IgAN is uncommon. A 49-year-old man with erythrodermic psoriasis with arthritis and stage 2 chronic kidney disease presented to the emergency department with worsening peripheral oedema and difficulty breathing. The patient had been hospitalised previously for a psoriasis flare. He was found to have an acute kidney injury on chronic kidney disease and was diagnosed with crescentic IgA glomerulonephritis on his first hospitalisation. He was treated with corticosteroids and was discharged stable with a plan to start cyclophosphamide in the outpatient setting. On his current hospitalisation, cyclophosphamide was added to his corticosteroids. Crescentic IgAN is rare. Its management has been based largely on observational studies. Our case highlights the importance of starting combined corticosteroids and cyclophosphamide early in crescentic IgAN and that corticosteroid monotherapy is insufficient in controlling disease progression.
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http://dx.doi.org/10.1136/bcr-2021-242627DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8160191PMC
May 2021

Parkin regulates drug-taking behavior in rat model of methamphetamine use disorder.

Transl Psychiatry 2021 05 17;11(1):293. Epub 2021 May 17.

Department of Pharmaceutical Sciences, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, 259 Mack Ave, Detroit, MI, 48201, USA.

There is no FDA-approved medication for methamphetamine (METH) use disorder. New therapeutic approaches are needed, especially for people who use METH heavily and are at high risk for overdose. This study used genetically engineered rats to evaluate PARKIN as a potential target for METH use disorder. PARKIN knockout, PARKIN-overexpressing, and wild-type young adult male Long Evans rats were trained to self-administer high doses of METH using an extended-access METH self-administration paradigm. Reinforcing/rewarding properties of METH were assessed by quantifying drug-taking behavior and time spent in a METH-paired environment. PARKIN knockout rats self-administered more METH and spent more time in the METH-paired environment than wild-type rats. Wild-type rats overexpressing PARKIN self-administered less METH and spent less time in the METH-paired environment. PARKIN knockout rats overexpressing PARKIN self-administered less METH during the first half of drug self-administration days than PARKIN-deficient rats. The results indicate that rats with PARKIN excess or PARKIN deficit are useful models for studying neural substrates underlying "resilience" or vulnerability to METH use disorder and identify PARKIN as a novel potential drug target to treat heavy use of METH.
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http://dx.doi.org/10.1038/s41398-021-01387-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8129108PMC
May 2021

Malpractice trends in shoulder and elbow surgery.

J Shoulder Elbow Surg 2021 Sep 3;30(9):2007-2013. Epub 2021 Feb 3.

Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA.

Background: Medical malpractice is a very common occurrence that many medical providers will have to face; approximately 17,000 medical malpractice cases are filed in the United States each year, and more than 99% of all surgeons are faced with at least 1 instance of malpractice litigation throughout their careers. Malpractice litigation also carries a major economic weight, with medical malpractice spending resulting in an aggregate expenditure of nearly $60 billion annually in the United States. Orthopedic surgery is one of the most common subspecialties involved in malpractice claims. Currently, there are no comprehensive studies examining malpractice lawsuits within shoulder and elbow surgery. Therefore, the purpose of this work is to examine trends in malpractice claims in shoulder and elbow surgery.

Methods: The Westlaw online legal database was queried in order to identify state and federal jury verdicts and settlements pertaining to shoulder and elbow surgery from 2010-2020. Only cases involving medical malpractice in which an orthopedic shoulder and elbow surgeon was a named defendant were included for analysis. All available details pertaining to the cases were collected. This included plaintiff demographic and geographic data. Details regarding the cases were also collected, such as anatomic location, pathology, complications, and case outcomes.

Results: Twenty-five malpractice lawsuits pertaining to orthopedic shoulder and elbow surgery were identified. Most plaintiffs in these cases were adult men, and the majority of cases were filed in the Southwest (28%) and Midwest (28%) regions of the United States. The most common anatomic region involved in claims was the rotator cuff (32%), followed by the glenohumeral joint (20%). The majority of these claims involved surgery (56%). Pain of mechanical nature was the most common complication seen in claims (56%). The jury ruled in favor of the defendant surgeon in most cases (80%).

Discussion: This is the first study that comprehensively examines the full scope of orthopedic shoulder and elbow malpractice claims across the United States. The most common complaint that plaintiffs reported at the time of litigation was residual pain after treatment due to a mechanical etiology, followed by complaints of nerve damage. A large portion of claims resulted after nonoperative treatment. A better understanding of the trends within malpractice claims is crucial to developing strategies for prevention.
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http://dx.doi.org/10.1016/j.jse.2020.12.018DOI Listing
September 2021

Prevalence and trends of occult coronary artery disease in patients with dilated cardiomyopathy.

Am J Cardiovasc Dis 2020 15;10(5):557-563. Epub 2020 Dec 15.

Department of Cardiology, King George's Medical University Lucknow, Uttar Pradesh 226003, India.

Background: Many patients with dilated cardiomyopathy (DCMP), presenting with only dyspnea, have hidden ischemic etiology. In low-income countries, logistic and financial restraints lead to reduced identification of this ischemic burden. We aimed to assess the role of coronary angiography in patients with cardiomyopathy presenting predominantly dyspnea.

Methods: This was a single-center, prospective, observational study conducted at a tertiary-care center in North India over the period of one year. The study population consisted of patients with dyspnea (NYHA II and III) and left ventricular dysfunction [i.e., left ventricular ejection fraction (< 40%)] without a prior documented coronary artery disease (CAD). All patients underwent invasive coronary angiography to detect underlying occult CAD.

Results: A total of 209 patients with global left ventricular hypokinesia (LVEF) were enrolled. Almost half of the study population belonged to the 51-60-year-old group. Diabetes mellitus and smoking were most prevalent risk factors observed in 93 (44.5%) and 92 (44.1%) patients, respectively. Abnormal coronaries were detected in 75 (35.9%) patients; 44 (58.7%) and 29 (38.7%) patients had significant and insignificant CAD, respectively. Single-, double-, and triple-vessel disease was observed in 18 (40.9%), 14 (31.8%), and 12 (27.3%) patients, respectively. The mean age (54.08 ± 6.02 years), LVEF (39.83 ± 3.27%), SYNTAX score (17.14 ± 2.21), and left ventricular internal dimensions (4.93 ± 0.44 cm) were all statistically insignificant.

Conclusion: Patients with DCMP presenting predominantly with dyspnea and having silent underlying significant CAD may benefit from revascularization if CAD is detected by angiography on time.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7811921PMC
December 2020

Incorporating 3D Printing Into Your Practice: Lessons Learned.

Foot Ankle Spec 2020 Dec 20:1938640020980912. Epub 2020 Dec 20.

Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina.

Three-dimensional (3D) printing has greatly benefited medicine, manufacturing vital organs like skin, hearts, kidneys, and livers. Early studies on 3D printing in surgery have consistently reported decreased operative time and improved precision. This technology has gained popularity with orthopaedic surgeons in knee, hip, and shoulder surgeries because 3D printing is associated with enhancing osseointegration. However, this innovation is still not commonly used among foot and ankle surgeons; one reason is that whereas the literature on 3D printing-assisted surgery is populated with studies on operative techniques and clinical outcomes, there exists an ambiguity on how to incorporate this feature into the clinic. Thus, the aim of this technology column is to consolidate and standardize a workflow to guide foot and ankle surgeons on integrating 3D printing into one's practice. We describe a model developed by a single surgeon at one institution who directs a large caseload of 3D-printed foot and ankle surgeries. From the initial patient visit to the interaction between the surgeon and the implant engineering team, to documentation of data adding to the preliminary literature, this work has great implications on streamlining the assimilation of a highly successful technology to improve foot and ankle surgery for both surgeons and patients. Level V.
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http://dx.doi.org/10.1177/1938640020980912DOI Listing
December 2020

The time to reversal of complete atrioventricular block and its predictors in acute ST-segment elevation myocardial infarction.

J Electrocardiol 2020 Nov - Dec;63:129-133. Epub 2020 Oct 31.

Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India.

Objective: The purpose of this study was to determine the time to reversal of complete AV block (CAVB) in ST-segment elevation myocardial infarction (STEMI) with various modalities of treatment and to examine the factors associated with early reversal of CAVB.

Methods: We prospectively assessed the STEMI patients complicated by CAVB. The mean time to reversal of CAVB was analyzed and compared according to the treatment received. Multivariate logistic regression analysis was performed to find the predictors of mortality.

Results: Of 3954 patients with STEMI, CAVB was present in 146(3.7%) patients. Inferior wall myocardial infarction (IWMI) was more commonly associated with CAVB than anterior wall myocardial infarction (AWMI) (74.7% vs 25.3%). The mean time to reversal of CAVB was 25.4 ± 35.5 h. It was significantly lower with the primary percutaneous coronary intervention (PCI) compared to thrombolysis (5.21 ± 10.54 vs 12.98 ± 17.14; p = 0.0001). Predictors of early reversal of CAVB were early presentation to hospital (<6 h) from symptom onset, presence of IWMI, any revascularization done, primary PCI performed in comparison to thrombolysis, and normal serum creatinine levels. The presence of older age, broader QRS complex, cardiogenic shock/heart failure, and elevated creatinine were independent predictors of mortality. The CAVB reverted in all the alive patients except one who required permanent pacemaker implantation.

Conclusion: CAVB is uncommon in STEMI and it recovers in a vast majority of surviving patients. The time to reversal of CAVB in STEMI is lower with primary PCI compared to thrombolysis. Outcomes are poor without revascularization in such patients.
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http://dx.doi.org/10.1016/j.jelectrocard.2020.10.008DOI Listing
June 2021

A comparative assessment of Dorsal radial artery access versus classical radial artery access for percutaneous coronary angiography-a randomized control trial (DORA trial).

Indian Heart J 2020 Sep - Oct;72(5):435-441. Epub 2020 Jun 18.

Department of Cardiology, LPS Institute of Cardiology, Kanpur, UP, 208002, India.

Objectives: This is an open-label randomized control trial with a parallel assignment with single masking comparing patients undergoing coronary angiography via dorsal radial and classical radial access.

Methods: Study done at three tertiary cardiac care centers for two years. A total of 970 patients were finally recruited for the study. Patients were randomly selected for dorsal radial artery access Group A (485 patients) and classical radial artery access Group B (485 patients) without any bias for age & sex.

Results: On comparative assessment both techniques are found to be equal in terms of procedural success rate. While dorsal access was superior in terms of fewer incidences of forearm radial artery occlusion, radial artery spasm, less post-procedure persistence of pain, and hand clumsiness. In comparison to this, the number of puncture attempts and time to achieve post-procedure hemostasis is less in classical radial access.

Conclusion: So both techniques have pros and coins and it is the discretion of interventionists to adopt which technique.
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http://dx.doi.org/10.1016/j.ihj.2020.06.002DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7670258PMC
May 2021

Clinical Outcomes and Complications Following Limited Open Achilles Repair Without an Instrumented Guide.

Foot Ankle Int 2021 Mar 4;42(3):294-304. Epub 2020 Nov 4.

Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA.

Background: We report the clinical outcomes and complications following our limited open incision Achilles tendon repair technique without instrument guides.

Methods: A total of 33 patients were included in this study. We recorded pre- and postoperative scores on the Foot and Ankle Disability Index (FADI), visual analog scale (VAS), and the Foot and Ankle Outcome Score (FAOS). Subgroup analyses were performed for acute (<2 weeks) and subacute (2-6 weeks) Achilles tendon repairs. A value <.05 was considered significant for all statistical analyses.

Results: The median time from injury to surgery was 10.0 days (range, 1-45 days). At a median follow-up of 3.7 years (range, 1.0-9.8 years), the average pre- and postoperative outcome scores improved significantly for the following: FADI index (49.1-98.4, < .001), VAS (4.8-0.2, < .001), FAOS Pain (54.8-99.2, < .001), FAOS Symptoms (84.6-97.0, < .001), FAOS activities of daily living (61.4-97.2, < .001), FAOS Sports and Recreational Activity (39.5-98.5, < .001), and FAOS quality of life (39.7-88.7, < .001). There were no significant differences between pre- and postoperative outcome scores between the acute and subacute Achilles repair groups. There were no wound complication, reruptures, or reoperations in the entire cohort.

Conclusion: Patients showed improvements in postoperative patient-reported outcome scores with minimal complications. There was no significant difference in outcomes for acute vs subacute repairs. Our limited open incision Achilles tendon repair, which required no additional targeting instrumentation, had favorable midterm results.

Level Of Evidence: Level IV, retrospective case series.
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http://dx.doi.org/10.1177/1071100720962493DOI Listing
March 2021

Pathologies of the Peroneals: A Review.

Foot Ankle Spec 2021 Apr 25;14(2):170-177. Epub 2020 Sep 25.

Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina (AS, SGP).

Peroneal tendon disorders remain an often overlooked source of lateral hindfoot pain and tenderness. Medical professionals who specialize in foot and ankle care are still far more likely to diagnose a peroneal tendon disorder as an ankle injury. In fact, acute peroneal dislocations are misdiagnosed in up to 40% of cases. The major subsets of peroneal disorders include peroneal tendonitis and tenosynovitis, painful os peroneum syndrome, subluxation, and tearing of the peroneal tendons. Proper history and physical exam maneuvers must be performed to help identify the source of the injury and differentiate these categories. Detailed imaging through X-ray and magnetic resonance imaging must also be used to diagnose the etiology of the patient's condition in order to direct management. Currently, there is very limited knowledge on peroneal pathologies, and treatment protocol is highly variable and limited to expert opinion. Despite the individual preferences and nuances held by each surgeon when it comes to operating, the overarching principles that guide appropriate management of tendonitis, subluxation, and tendon tear should maintain a higher level of consistency. Therefore, the authors of this review aim to elucidate the most current methods to diagnose these disorders as well as evidence-based practices for optimal management. Level V.
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http://dx.doi.org/10.1177/1938640020916278DOI Listing
April 2021

3D Printed Total Talus Replacement for Avascular Necrosis of the Talus.

Foot Ankle Int 2020 Dec 18;41(12):1529-1536. Epub 2020 Aug 18.

Department of Orthopaedic Surgery, Duke University, Durham, NC, USA.

Background: Talus avascular necrosis (AVN) is a challenging entity to treat. Management options depend on disease severity and functional goals. Total talus replacement (TTR) is a treatment option that maintains joint range of motion. The literature on TTR is limited with variability in implant design and material. The purpose of this study was to evaluate outcomes following TTR with a custom 3D printed metal implant.

Methods: Patients who underwent TTR were retrospectively reviewed over a 3-year period. Basic demographic data and comorbidities were collected. Medical records were reviewed to obtain postoperative and preoperative visual analog scale (VAS) scores, Foot and Ankle Outcome Scores (FAOSs), ankle range of motion, and postoperative complications. Statistical analysis was conducted to compare clinical and patient-reported outcomes pre- and postoperatively. Twenty-seven patients underwent TTR for talar AVN with a mean follow-up of 22.2 months.

Results: Ankle range of motion remained unchanged postoperatively. VAS pain scores improved postoperatively from 7.1 to 3.9 ( < .001). FAOSs improved postoperatively with regard to pain ( < .001), symptoms ( = .001), quality of life ( < .001), and activities of daily living ( < .001). There were 3 complications requiring reoperation in this cohort.

Conclusion: 3D printed TTRs represent a unique surgical option for patients with severe talar AVN. Patients in this cohort demonstrated significant improvements in pain scores and patient-reported outcomes. TTR allows for symptomatic improvement with the preservation of motion in individuals with talar collapse and AVN.

Level Of Evidence: Level IV, retrospective case series.
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http://dx.doi.org/10.1177/1071100720948461DOI Listing
December 2020

The authors reply.

Kidney Int 2020 08;98(2):516

Ringgold Standard Institution, Nephrology Section, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.

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http://dx.doi.org/10.1016/j.kint.2020.04.016DOI Listing
August 2020

Clinical Safety and Efficacy of a Novel Ultrasound-Assisted Bioabsorbable Suture Anchor in Foot and Ankle Surgeries.

Foot Ankle Int 2020 Sep 24;41(9):1073-1078. Epub 2020 Jun 24.

Department of Orthopaedic Surgery, Duke University Medical Center, Chapel Hill, NC, USA.

Background: Suture anchors have been used for soft tissue repair in orthopedic surgery for decades. Recently, bioabsorbable suture anchors have increased in popularity and have spurred the introduction of ultrasound-assisted systems. The purpose of our study was to determine the clinical safety and efficacy of a new ultrasound-assisted suture anchor system for foot and ankle procedures.

Methods: We retrospectively reviewed 50 cases using the ultrasound-assisted suture anchor with at least 24 months of follow-up. We reviewed demographic data including comorbidities, type of procedure, adverse events, and clinical outcomes using the Foot and Ankle Outcome Score (FAOS) and visual analog scale (VAS) score. We divided complications into minor and major, with major complications requiring revision surgery or leading to long-term morbidity. Our primary outcome was complication rates and our secondary outcome was improvement in clinical scores.

Results: The most frequent cases using the anchor included lateral ankle ligament reconstruction ( = 19), insertional Achilles repair ( = 15), lateral ligament reconstruction in conjunction with a total ankle arthroplasty ( = 6), and plantar plate repair ( = 3). There were 5 superficial wound infections that resolved with wound care and/or oral antibiotics. There were 3 major complications (6%): a deep wound infection that required an irrigation and debridement, a deep venous thrombosis, and a recurrence of varus deformity in a patient who underwent a total ankle arthroplasty with lateral ligament reconstruction. Only the varus deformity recurrence case could possibly be directly linked to the suture anchor (2% of all cases). VAS scores improved from 6.0 to 1.2 ( < .001) and FAOS improved from 54.7 to 94.2 ( < .001).

Conclusion: This bioabsorbable anchor was a safe device with low failure rates, and it was used for soft tissue repair cases in the foot and ankle with successful clinical outcomes.

Level Of Evidence: Level IV, retrospective case series.
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http://dx.doi.org/10.1177/1071100720935122DOI Listing
September 2020

Comparison of differential accessibility analysis strategies for ATAC-seq data.

Sci Rep 2020 06 23;10(1):10150. Epub 2020 Jun 23.

Department of Developmental Biology, Center of Regenerative Medicine, Washington University School of Medicine, St. Louis, MO, 63110, USA.

ATAC-seq is widely used to measure chromatin accessibility and identify open chromatin regions (OCRs). OCRs usually indicate active regulatory elements in the genome and are directly associated with the gene regulatory network. The identification of differential accessibility regions (DARs) between different biological conditions is critical in determining the differential activity of regulatory elements. Differential analysis of ATAC-seq shares many similarities with differential expression analysis of RNA-seq data. However, the distribution of ATAC-seq signal intensity is different from that of RNA-seq data, and higher sensitivity is required for DARs identification. Many different tools can be used to perform differential analysis of ATAC-seq data, but a comprehensive comparison and benchmarking of these methods is still lacking. Here, we used simulated datasets to systematically measure the sensitivity and specificity of six different methods. We further discussed the statistical and signal density cut-offs in the differential analysis of ATAC-seq by applying them to real data. Batch effects are very common in high-throughput sequencing experiments. We illustrated that batch-effect correction can dramatically improve sensitivity in the differential analysis of ATAC-seq data. Finally, we developed a user-friendly package, BeCorrect, to perform batch effect correction and visualization of corrected ATAC-seq signals in a genome browser.
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http://dx.doi.org/10.1038/s41598-020-66998-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7311460PMC
June 2020

Three-Dimensional Printed Cage in Patients With Tibiotalocalcaneal Arthrodesis Using a Retrograde Intramedullary Nail: Early Outcomes.

Foot Ankle Spec 2020 May 11:1938640020920947. Epub 2020 May 11.

Division of Sports Medicine, Department of Orthopaedic Surgery, University of Illinois at Chicago, Illinois (LBP).

. Segmental bone loss in the hindfoot hinders the chance of successful outcomes. Tibiotalocalcaneal arthrodesis is a reliable option; nevertheless, the risk of nonunion is high. Three-dimensional (3D) printed titanium implants offer a strong scaffold that can be customized and has demonstrated encouraging healing rates. In this study, we described the clinical outcomes and the radiologic union rate of a case series of patients with hindfoot arthrodesis, using a retrograde intramedullary nail associated to a 3D printed titanium cage. . Seven patients undergoing hindfoot arthrodesis, using a retrograde intramedullary nail associated to a custom 3D printed titanium cage, were included. Demographic data were collected. Functional outcomes were assessed using the American Orthopedic Foot and Ankle Score and the Visual Analogue Scale for pain. Hindfoot alignment and radiographic union were evaluated using weight-bearing radiographs and computed tomography scan, respectively. . A total of 6 (85%) patients had more than 50% bony bridging. Only 1 patient underwent below knee amputation due to recurrence of chronic osteomyelitis. Two additional patients had minor complications. . Tibiotalocalcaneal arthrodesis using customized titanium cages for patients with large bone defects has shown a high rate of union in those at risk of nonunion. However, further research with larger series is needed. Level IV: Case series.
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http://dx.doi.org/10.1177/1938640020920947DOI Listing
May 2020

Large area, patterned growth of 2D MoS and lateral MoS-WS heterostructures for nano- and opto-electronic applications.

Nanotechnology 2020 Apr 12;31(25):255603. Epub 2020 Feb 12.

Department of Applied Physics, Eindhoven University of Technology, PO Box 513, 5600 MB Eindhoven, The Netherlands.

The patterned growth of transition metal dichalcogenides (TMDs) and their lateral heterostructures is paramount for the fabrication of application-oriented electronics and optoelectronics devices. However, the large scale patterned growth of TMDs remains challenging. Here, we demonstrate the synthesis of patterned polycrystalline 2D MoS thin films on device ready SiO/Si substrates, eliminating any etching and transfer steps using a combination of plasma enhanced atomic layer deposition (PEALD) and thermal sulfurization. As an inherent advantage of ALD, precise thickness control ranging from a monolayer to few-layered MoS has been achieved. Furthermore, uniform films with exceptional conformality over 3D structures are obtained. Finally, the approach has been leveraged to obtain in-plane lateral heterostructures of 2D MoS and WS thin films over a large area which opens up an avenue for their direct integration in future nano- and opto-electronic device applications.
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http://dx.doi.org/10.1088/1361-6528/ab7593DOI Listing
April 2020

Octreotide Delaying the Progression of Recurrent IgA Nephropathy After Kidney Transplantation.

Transplant Direct 2020 Jan 24;6(1):e518. Epub 2019 Dec 24.

Department of Medicine and Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA.

IgA Nephropathy (IgAN) is a common cause of end-stage kidney disease worldwide. Unfortunately, the exact pathogenesis of IgAN remains uncertain without any targeted therapy. While kidney transplantation remains the gold standard treatment for those with end-stage kidney disease from IgAN, recurrence occurs frequently and may lead to early kidney transplant loss. Research has suggested that insulin-like growth factor-1 may play a role in mesangial cell proliferation in IgAN and Somatostatin may inhibit insulin-like growth factor-1. In this single case study, we report the use of octreotide, a somatostatin analogue, as a potential novel therapy for early recurrent IgAN post kidney transplant.
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http://dx.doi.org/10.1097/TXD.0000000000000963DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6964927PMC
January 2020

Polarized Raman spectroscopy to elucidate the texture of synthesized MoS.

Nanoscale 2019 Dec 22;11(47):22860-22870. Epub 2019 Nov 22.

Applied Physics, Eindhoven University of Technology, 5600MB Eindhoven, The Netherlands.

Texture has a significant impact on several key properties of transition-metal dichalcogenides (TMDs) films. Films with in-plane oriented grains have been successfully implemented in nano- and opto-electronic devices, whereas, films with out-of-plane oriented material have shown excellent performance in catalytic applications. It will be demonstrated that the texture of nanocrystalline TMD films can be determined with polarized Raman spectroscopy. A model describing the impact of texture on the Raman response of 2D-TMDs will be presented. For the specific case of MoS, the model was used to quantify the impact of texture on the relative strength of the A and E modes in both the unpolarized and polarized Raman configuration. Subsequently, the capability to characterize texture by polarized Raman was demonstrated on various MoS films grown by atomic-layer deposition (ALD) and validated by complementary transmission electron microscopy (TEM) and synchrotron based 2D grazing-incidence X-ray diffraction (GIXD) measurements. This also revealed how the texture evolved during ALD growth of MoS and subsequent annealing of the films. The insights presented in this work allow a deeper understanding of Raman spectra of nanocrystalline TMDs and enable a rapid and non-destructive method to probe texture.
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http://dx.doi.org/10.1039/c9nr08750hDOI Listing
December 2019

Safety and feasibility of same-day discharge after elective percutaneous balloon mitral valvotomy: a prospective, single-center registry in India.

Acta Cardiol 2021 Feb 8;76(1):30-37. Epub 2019 Nov 8.

Deutsches Herzzentrum München, Technische Universität München, Munchen, Germany.

Background: Percutaneous mitral balloon valvotomy PBMV) is an alternative to surgery for patients with severe mitral valve (MV) stenosis. However, the safety and feasibility of same-day discharge (SDD) in patients undergoing elective PBMV for severe MV stenosis is yet to be investigated. This study aimed to assess safety and feasibility of SDD in patients undergoing elective PBMV because of severe MV stenosis in a tertiary-care hospital in India.

Methods: From January 2018 to November 2018, patients with a diagnosis of severe MV stenosis were treated with PBMV at our institution. Among these patients, those suitable for SDD were prospectively included in this registry. Vascular access was achieved in forearm arteries and femoral veins. Clinical, echocardiographic and hemodynamic features were collected before and after PBMV. The primary outcome was 30-day mortality. The secondary outcome was incidence of in-hospital complications. Other outcomes of interest were arterial spasm and forearm haematoma.

Results: A total of 98 patients scheduled for SDD after elective PBMV were included in the registry. Mean MV area increased from 0.8 ± 0.1 to 1.6 ± 0.2 cm ( < .001). Severe MV regurgitation after PBMV occurred in 3 patients, and 1 patient developed pericardial tamponade. Severe arterial spasm occurred in 2 patients. None of the included patients developed a clinically relevant haematoma of forearm. A total of 94 (96%) were discharged on the same day. No patient died up to 30-day follow-up.

Conclusion: PBMV from the venous access site can reduce the hospital stay of patients to less than a day with less local site complications.
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http://dx.doi.org/10.1080/00015385.2019.1686558DOI Listing
February 2021

The Origin of High Activity of Amorphous MoS in the Hydrogen Evolution Reaction.

ChemSusChem 2019 Oct 8;12(19):4383-4389. Epub 2019 Aug 8.

Laboratory for Inorganic Materials and Catalysis, Department of Chemical Engineering and Chemistry, Eindhoven University of Technology, P.O. Box 513, 5600 MB, Eindhoven, The Netherlands.

Molybdenum disulfide (MoS ) and related transition metal chalcogenides can replace expensive precious metal catalysts such as Pt for the hydrogen evolution reaction (HER). The relations between the nanoscale properties and HER activity of well-controlled 2H and Li-promoted 1T phases of MoS , as well as an amorphous MoS phase, have been investigated and a detailed comparison is made on Mo-S and Mo-Mo bond analysis under operando HER conditions, which reveals a similar bond structure in 1T and amorphous MoS phases as a key feature in explaining their increased HER activity. Whereas the distinct bond structure in 1T phase MoS is caused by Li intercalation and disappears under harsh HER conditions, amorphous MoS maintains its intrinsic short Mo-Mo bond feature and, with that, its high HER activity. Quantum-chemical calculations indicate similar electronic structures of small MoS clusters serving as models for amorphous MoS and the 1T phase MoS , showing similar Gibbs free energies for hydrogen adsorption (ΔG ) and metallic character.
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http://dx.doi.org/10.1002/cssc.201901811DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6852468PMC
October 2019

Post-transplant donor specific antibody is associated with poor kidney transplant outcomes only when combined with both T-cell-mediated rejection and non-adherence.

Kidney Int 2019 07 20;96(1):202-213. Epub 2019 Mar 20.

Renal and Electrolyte Division, Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA; Thomas E Starzl Transplantation Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA. Electronic address:

Post-transplant donor specific antibody (DSA) is associated with poor renal allograft outcomes. However, variable timing of DSA assessment and inclusion of patients who undergo desensitization treatments have hindered our understanding of its consequences and limited its predictive value. Here we prospectively studied non-desensitized patients to determine factors associated with poor four-year outcomes in patients who developed post-transplant DSA. Using serial monitoring, 67 of 294 patients were found to develop DSA by one year. Compared to patients who do not develop DSA, those with DSA exhibit an increased incidence of both clinical and subclinical T-cell-mediated rejection (TCMR). The combination of TCMR plus DSA led to an almost three-fold increase in graft loss compared to either DSA or TCMR alone. Moreover, DSA was associated with higher Banff grade TCMR and chronic changes at one year. Antibody-mediated rejection was uncommon and always associated with TCMR. Amongst factors independently associated with DSA plus TCMR; non-adherence is potentially modifiable. Non-adherence, measured as intra-patient variability of calcineurin trough levels during the first post-transplant year, further risk-stratified patients with DSA plus TCMR such that about 75% of these patients had impending graft loss by four years, whereas adherent patients with DSA plus TCMR had outcomes comparable to other patient groups. Thus, early post-transplant DSA, especially in non-adherent patients, is associated with increased incidence of TCMR and represents a high-risk group of patients who might benefit from targeted therapeutic interventions.
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http://dx.doi.org/10.1016/j.kint.2019.01.033DOI Listing
July 2019

High Calcineurin Inhibitor Intrapatient Variability Is Associated With Renal Allograft Inflammation, Chronicity, and Graft Loss.

Transplant Direct 2019 Feb 28;5(2):e424. Epub 2019 Jan 28.

Department of Medicine and Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA.

Background: High calcineurin inhibitor (CNI) intrapatient variability (IPV) has been associated with poor kidney allograft outcomes. However, the relationship between early allograft histological changes, their progression, and CNI-IPV is less well studied. Hence, we evaluated effect of CNI-IPV defined by the degree of fluctuation of CNI levels in all kidney transplant patients over 2 to 12 months posttransplant on early allograft inflammation, subsequent chronicity, and later clinical outcomes.

Methods: Two hundred eighty-six patients transplanted from January 2013 to November 2014 were enrolled with protocol and indication biopsies. The mean CNI-IPV was 28.5% and a quarter of our cohort had IPV of 35% or greater (high CNI IPV). Baseline demographic differences were similar between high and low CNI IPV groups.

Results: High CNI-IPV was associated with a higher incidence of acute rejection (AR) within 1 year (52% vs 31% < 0.001), more persistent/recurrent AR by 1 year (18.2% vs 6.2%, = 0.002), higher-grade AR (≥Banff 1B, 27.5% vs 7.3%, < 0.001), and worse interstitial fibrosis/tubular atrophy ( = 0.005). High CNI-IPV was associated with increased graft loss (GL) and impending graft loss (iGL, defined as eGFR<30 ml/min and >30% decline in eGFR from baseline), regardless of donor-specific antibody, delayed graft function, rejection, or race. In a multivariate Cox Proportional Hazards Model, high CNI-IPV was independently associated with GL + iGL (hazard ratio, 3.1; 95% confidence interval, 1.6-5.9, < 0.001).

Conclusions: High CNI-IPV within 1 year posttransplant is associated with higher incidence of AR, severe AR, allograft chronicity, GL, and iGL. This represents a subset of patients who are at risk for poor kidney transplant outcomes and potentially a modifiable risk factor for late allograft loss.
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http://dx.doi.org/10.1097/TXD.0000000000000862DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6415973PMC
February 2019

Regulatory and Effector B Cells: A New Path Toward Biomarkers and Therapeutic Targets to Improve Transplant Outcomes?

Clin Lab Med 2019 03 18;39(1):15-29. Epub 2018 Dec 18.

Departments of Surgery, Medicine and Immunology, Thomas E. Starzl Transplantation Institute, University of Pittsburgh Medical Center, 200 Lothrop Street, W1545 Biomedical Science Tower, Pittsburgh, PA 15261, USA. Electronic address:

B cells shape the alloimmune response through polarized subsets. These cells inhibit or promote immune responses by expressing suppressive or proinflammatory cytokines. Their summed activity dictates the influence of B cells on the alloimmune response. We review the evidence for regulatory B cells and effector B cells in mice and humans, discuss current limitations in their phenotypic identification, and discuss regulatory B cells as a signature for clinical renal allograft tolerance and predictive markers for allograft outcomes. We discuss the effects of therapeutic agents on regulatory B cells and potential approaches to augment their numbers as a therapeutic tool.
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http://dx.doi.org/10.1016/j.cll.2018.10.011DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8095164PMC
March 2019

To study the usefulness and comparison of myocardial strain imaging by 2D and 3D echocardiography for early detection of cardiotoxicity in patients undergoing cardiotoxic chemotherapy.

Indian Heart J 2019 Nov - Dec;71(6):468-475. Epub 2019 Nov 19.

Department of Cardiology, King George's Medical University, Lucknow, 226003, India.

Background: Chemotherapy-induced cardiotoxicity constitutes subclinical myocardial dysfunction, arrhythmias, pericarditis, coronary vasospasm, and significant symptomatic heart failure. Anthracyclines pose higher risk for long-term cardiac dysfunction, with increased incidences of morbidity and mortality. Hence, early detection of chemotherapy-induced cardiac dysfunction may prompt an earlier treatment modification.

Aim: To evaluate global, longitudinal, radial, and circumferential strain changes in adult patients undergoing anthracycline chemotherapy along with the usefulness of three-dimensional (3D) echocardiography as the new modality over two-dimensional (2D) echocardiography.

Methods: This was a single centre, prospective, observational study that included asymptomatic patients free from any cardiac signs and symptoms attributable to heart failure, who underwent potentially cardiotoxic chemotherapy for malignancy from December 2017 to November 2018 at a tertiary care centre in India. Baseline demographics were recorded, and 2D and 3D echocardiography was performed at baseline and after completion of four cycles of chemotherapy.

Results: All the 55 patients received a cumulative dose of doxorubicin of less than 550 mg/m. Follow-up period from the beginning of doxorubicin therapy was 108 ± 14 days. 9 patients were excluded from the study due to poor 3D images, so data analysis was done only for 46 patients. In 2D echocardiography, only global longitudinal strain (GLS) was observed to be significantly reduced (Δ18.33%; P < 0.001). 2D ejection fraction (EF) did not show significant change (Δ0.67%; P = 0.176), while by 3D echo, EF reduced significantly (Δ3.55%; P < 0.001). 3D global longitudinal (Δ29.19%; P < 0.001), circumferential (Δ30.65%; P < 0.001), area (Δ21.61%; P < 0.001), and radial (Δ29.66%; P < 0.001) strains were observed to be significantly reduced at follow-up.

Conclusion: Myocardial dysfunction induced by cardiotoxic chemotherapy can be detected earlier by using 2D GLS, 3D volumetric analysis, and 3D strain analysis by calculating global, longitudinal, radial, and circumferential strain changes. 3D echocardiographic assessment seems to be more accurate in picking out small changes in left ventricular functions, but at the cost of slightly poor image quality as compared to the 2D echocardiography. These newer techniques could potentially improve the ability for early detection of subclinical abnormalities of LV function in patients undergoing cardiotoxic chemotherapy and thus early initiation of treatment could be possible.
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http://dx.doi.org/10.1016/j.ihj.2019.11.253DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7136339PMC
July 2020

Syndrome 'Z': A Predictor of Angiographic Severity of Coronary Artery Disease in Patients of Acute Coronary Syndrome.

Heart Lung Circ 2019 Aug 23;28(8):1176-1182. Epub 2018 Jun 23.

Department of Cardiology, King George's Medical University, Lucknow, India.

Background: Owing to the growing evidence that the pathophysiology of obstructive sleep apnoea (OSA) and metabolic syndrome (MS) overlap considerably and both adversely impact cardiovascular health, we hypothesised that the presence of OSA with MS additively and adversely affect the severity of coronary artery disease (CAD). Exploration and understanding of this may have direct implications for the development of targeted, preventive strategies for CAD. Thus, this prospective study was aimed to determine the prevalence of 'Syndrome Z' in patients of MS who present with an acute coronary event and to correlate it with the angiographic severity of CAD in these patients.

Methods: The present study was a single centre, cross sectional study conducted in a university teaching hospital. In a span of 6 months, 922 patients with acute coronary syndromes (ACS) were screened for the study. Among these, 861 patients had no evidence of MS. The remaining 61 patients who were diagnosed to have MS were then subjected to an overnight sleep study. Only 58 had good sleep data so were included for further analysis. Angiographic parameters in terms of number of vessels involved and culprit lesions were noted and correlated with presence and absence of OSA and also with its severity based on the Apnoea/Hypopnoea Index (AHI).

Results: The prevalence of OSA positivity in patients with MS who presented with ACS was 34.5% (n=20). Most of the patients in the OSA negative group (78.9%, n=30) had disease limited to only one vessel while in the OSA positive group only a minority (15%, n=3) of patients had their disease limited to a single vessel (p=0.001). The number of lesions in the culprit vessel was also significantly less in the OSA negative group compared to the OSA positive group. While in the OSA negative group 68.4% (n=26) patients had a solitary lesion, followed by two and three lesions in 15.8% (n=6) of the patients each, multiple lesions were more common in OSA positive patients, involving 80% of cases (45.0%, n=9 with two lesions; 35.0%, n=7 with three lesions; only 20%, n=4 had a solitary lesion).

Conclusions: Prevalence of 'Syndrome Z' is high in patients having MS presenting with ACS and it correlates with the angiographic severity of CAD.
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http://dx.doi.org/10.1016/j.hlc.2018.06.1040DOI Listing
August 2019

Low-temperature plasma-enhanced atomic layer deposition of 2-D MoS: large area, thickness control and tuneable morphology.

Nanoscale 2018 May;10(18):8615-8627

Department of Applied Physics, Eindhoven University of Technology, P.O. Box 513, 5600 MB Eindhoven, The Netherlands.

Low-temperature controllable synthesis of monolayer-to-multilayer thick MoS2 with tuneable morphology is demonstrated by using plasma enhanced atomic layer deposition (PEALD). The characteristic self-limiting ALD growth with a growth-per-cycle of 0.1 nm per cycle and digital thickness control down to a monolayer are observed with excellent wafer scale uniformity. The as-deposited films are found to be polycrystalline in nature showing the signature Raman and photoluminescence signals for the mono-to-few layered regime. Furthermore, a transformation in film morphology from in-plane to out-of-plane orientation of the 2-dimensional layers as a function of growth temperature is observed. An extensive study based on high-resolution transmission electron microscopy is presented to unravel the nucleation mechanism of MoS2 on SiO2/Si substrates at 450 °C. In addition, a model elucidating the film morphology transformation (at 450 °C) is hypothesized. Finally, the out-of-plane oriented films are demonstrated to outperform the in-plane oriented films in the hydrogen evolution reaction for water splitting applications.
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http://dx.doi.org/10.1039/c8nr02339eDOI Listing
May 2018
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