Publications by authors named "Vikram Bhatia"

145 Publications

Prevalence of Hepatitis Delta Virus Infection among Hepatitis B Virus-Infected and Exposed Patients.

J Glob Infect Dis 2020 Oct-Dec;12(4):197-201. Epub 2020 Nov 30.

Department of Clinical Virology, Institute of Liver and Biliary Sciences, New Delhi, India.

Background: Hepatitis delta virus (HDV) infection is a cause of coinfection and superinfection among hepatitis B virus (HBV)-infected patients. The global prevalence of HDV may vary drastically depending on the geographical location. In India, serological techniques form the basis for the determination of HDV prevalence in majority of the studies with very limited literature based on molecular techniques. In addition, sparse data on HDV infection among HBV-exposed group, i.e., patients with total antibodies to core antigen (anti-hepatitis B core [HBc]) positive and negative hepatitis B surface antigen (HBsAg), are available.

Objective: This study was aimed to determine the prevalence of HDV in both HBV-infected and HBV-exposed groups, utilizing both serological and molecular methods.

Settings And Design: This was a retrospective cross-sectional study conducted from January till June 2018 where samples of 142 patients were retrieved and were categorized into two groups: Group A included patients with both HBsAg and anti-HBc positivity ( = 120/142 [85%]), i.e., confirmed HBV infection, and Group B included patients with anti-HBc positivity and HBsAg negativity ( = 22/142 [15%]), i.e., exposed to HBV.

Materials And Methods: All the specimens were retrieved from -80°C and were tested for anti-HDV immunoglobulin (Ig) M (IgM), anti-HDV IgG, and HDV RNA.

Results: HDV infection was observed in only one patient in Group A and none in Group B, making an overall prevalence of 0.78% (95% confidence interval = 0.02%-3.9%). The infected patient was reactive for both IgM and IgG with a viral load of 2logIU/ml.

Conclusion: The present study provides evidence that HDV infection is very low(0.78%) in this part of India. However further prospective studies with larger sample size are warranted.
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http://dx.doi.org/10.4103/jgid.jgid_137_19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8045544PMC
November 2020

Indian Council of Medical Research consensus document on hepatocellular carcinoma.

Indian J Med Res 2020 Nov;152(5):468-474

Department of Radiation Oncology, Dr. B.R.A Institute-Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India.

This document aims to assist oncologists in making clinical decisions encountered while managing their patients with hepatocellular carcinoma (HCC), specific to Indian practice, based on consensus among experts. Most patients are staged by Barcelona Clinic Liver Cancer (BCLC) staging system which comprises patient performance status, Child-Pugh status, number and size of nodules, portal vein invasion and metastasis. Patients should receive multidisciplinary care. Surgical resection and transplant forms the mainstay of curative treatment. Ablative techniques are used for small tumours (<3 cm) in patients who are not candidates for surgical resection (Child B and C). Patients with advanced (HCC should be assessed on an individual basis to determine whether targeted therapy, interventional radiology procedures or best supportive care should be provided. In advanced HCC, immunotherapy, newer targeted therapies and modern radiation therapy have shown promising results. Patients should be offered regular surveillance after completion of curative resection or treatment of advanced disease.
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http://dx.doi.org/10.4103/ijmr.IJMR_404_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8157895PMC
November 2020

Alcohol associated liver cirrhotics have higher mortality after index hospitalization: Long-term data of 5,138 patients.

Clin Mol Hepatol 2021 01 3;27(1):175-185. Epub 2020 Dec 3.

Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India.

Background/aims: Liver cirrhosis is an important cause of morbidity and mortality globally. Every episode of decompensation and hospitalization reduces survival. We studied the clinical profile and long-term outcomes comparing alcohol-related cirrhosis (ALC) and non-ALC.

Methods: Cirrhosis patients at index hospitalisation (from January 2010 to June 2017), with ≥1 year follow-up were included.

Results: Five thousand and one hundred thirty-eight cirrhosis patients (age, 49.8±14.6 years; male, 79.5%; alcohol, 39.5%; Child-A:B:C, 11.7%:41.6%:46.8%) from their index hospitalization were analysed. The median time from diagnosis of cirrhosis to index hospitalization was 2 years (0.2-10). One thousand and seven hundred seven patients (33.2%) died within a year; 1,248 (24.3%) during index hospitalization. 59.5% (2,316/3,890) of the survivors, required at least one readmission, with additional mortality of 19.8% (459/2,316). ALC compared to non-ALC were more often (P<0.001) male (97.7% vs. 67.7%), younger (40-50 group, 36.2% vs. 20.2%; P<0.001) with higher liver related complications at baseline, (P<0.001 for each), sepsis: 20.3% vs. 14.9%; ascites: 82.2% vs. 65.9%; spontaneous bacterial peritonitis: 21.8% vs. 15.7%; hepatic encephalopathy: 41.0% vs. 25.0%; acute variceal bleeding: 32.0% vs. 23.7%; and acute kidney injury 30.5% vs. 19.6%. ALC patients had higher Child-Pugh (10.6±2.0 vs. 9.0±2.3), model for end-stage liver-disease scores (21.49±8.47 vs. 16.85±7.79), and higher mortality (42.3% vs. 27.3%, P<0.001) compared to non-ALC.

Conclusion: One-third of cirrhosis patients die in index hospitalization. 60% of the survivors require at least one rehospitalization within a year. ALC patients present with higher morbidity and mortality and at a younger age.
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http://dx.doi.org/10.3350/cmh.2020.0068DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7820216PMC
January 2021

Tracing the path of inhaled nitric oxide: Biological consequences of protein nitrosylation.

Pediatr Pulmonol 2021 02 17;56(2):525-538. Epub 2020 Dec 17.

Biology of Breathing Group, Children's Hospital Research Institute of Manitoba, University of Manitoba, Winnipeg, Canada.

Nitric oxide (NO) is a comprehensive regulator of vascular and airway tone. Endogenous NO produced by nitric oxide synthases regulates multiple signaling cascades, including activation of soluble guanylate cyclase to generate cGMP, relaxing smooth muscle cells. Inhaled NO is an established therapy for pulmonary hypertension in neonates, and has been recently proposed for the treatment of hypoxic respiratory failure and acute respiratory distress syndrome due to COVID-19. In this review, we summarize the effects of endogenous and exogenous NO on protein S-nitrosylation, which is the selective and reversible covalent attachment of a nitrogen monoxide group to the thiol side chain of cysteine. This posttranslational modification targets specific cysteines based on the acid/base sequence of surrounding residues, with significant impacts on protein interactions and function. S-nitrosothiol (SNO) formation is tightly compartmentalized and enzymatically controlled, but also propagated by nonenzymatic transnitrosylation of downstream protein targets. Redox-based nitrosylation and denitrosylation pathways dynamically regulate the equilibrium of SNO-proteins. We review the physiological roles of SNO proteins, including nitrosohemoglobin and autoregulation of blood flow through hypoxic vasodilation, and pathological effects of nitrosylation including inhibition of critical vasodilator enzymes; and discuss the intersection of NO source and dose with redox environment, in determining the effects of protein nitrosylation.
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http://dx.doi.org/10.1002/ppul.25201DOI Listing
February 2021

Diagnostic dilemmas in Epstein-Barr virus hepatitis mimicking autoimmune hepatitis: A case report.

J Family Med Prim Care 2020 May 31;9(5):2502-2504. Epub 2020 May 31.

Department of Clinical Virology, Institute of Liver and Biliary Sciences, New Delhi, India.

We report a case of 55-year-old female with chief complaints of fever and deranged liver function tests, diagnosed as autoimmune hepatitis (AIH) and under immunosuppressive therapy for two years. Following the failure in clinical improvement, she was started on anti-tubercular therapy (ATT). While investigating the underlying etiology, virological markers for Hepatitis A to E were found to be negative with plasma Epstein-Barr virus (EBV) viral load of 5 log copies/ml. Additional investigation of the liver biopsy showed Hodgkin's lymphoma (HL). The patient was initiated on chemotherapy but eventually succumbed to the illness. This case report underlines the dilemma in the initial diagnosis of AIH and the importance of considering hepatic involvement of EBV as one of the differential diagnosis among clinically suspected AIH cases not responding to immunosuppressive medications.
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http://dx.doi.org/10.4103/jfmpc.jfmpc_98_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7380741PMC
May 2020

Safety and efficacy of early image-guided percutaneous interventions in acute severe necrotizing pancreatitis: A single-center retrospective study.

Indian J Gastroenterol 2019 12 30;38(6):480-487. Epub 2020 Jan 30.

Department of Hepatology, Institute of Liver and Biliary Sciences, D-1, Vasant Kunj, New Delhi, 110 070, India.

Background: Acute necrotizing pancreatitis is managed conservatively in early phase of the disease. Even minimally invasive procedure is preferred after 21 days of onset and there is a paucity of data on decision and outcomes of early radiological interventions. This study aimed to evaluate efficacy and safety of early image-guided percutaneous interventions in management of acute severe necrotizing pancreatitis.

Methods: A single-center retrospective study was performed after obtaining Institutional review board approval for analyzing hospital records of patients with acute necrotizing pancreatitis from January 2012 to July 2017. Seventy-eight consecutive patients with necrotizing pancreatitis and acute necrotic collections (ANC) were managed with percutaneous catheter drainage (PCD) and catheter-directed necrosectomy, in early phase of the disease (< 21 days). Clinical data and laboratory parameters of the included patients were evaluated until discharge from hospital, or mortality.

Results: Overall survival rate was 73.1%. Forty-two (53.8%) patients survived with PCD alone, while the remaining 15 (19.2%) survivors needed additional necrosectomy. The timing of intervention from the start of the hospitalization to drainage was 14.3 ± 2.4 days. Significant risk factors for mortality were the presence of organ system failure, need for mechanical ventilation, renal replacement therapy, and the acute physiology and chronic health evaluation II (APACHE II) score. An APACHE II score cutoff value of 15 was a significant discriminant for predicting survival with catheter-directed necrosectomy.

Conclusion: An early PCD of ANC in clinically deteriorating patients with acute necrotizing pancreatitis, along with aggressive catheter-directed necrosectomy can avoid surgical interventions, and improve outcome in a significant proportion of patients with acute necrotizing pancreatitis.
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http://dx.doi.org/10.1007/s12664-019-00969-0DOI Listing
December 2019

EUS-guided FNA in Diagnosing Pancreatic Lesions: Strength and Cytological Spectrum.

J Cytol 2019 Oct-Dec;36(4):189-195. Epub 2019 Sep 20.

Department of Pathology, I.L.B.S., New Delhi, India.

Introduction: Early and accurate diagnosis is paramount for improving the therapeutic efficacy of pancreatic cancers. Endoscopic ultrasonography-fine needle aspiration (EUS-FNA) cytology has come up with the advantage of an early and accurate diagnosis of pancreatic cancers. This study was conducted to analyze the spectrum of pancreatic lesions cytology, and appraise the diagnostic accuracy of EUS-FNA cytology for pancreatic solid and cystic lesions.

Materials And Methods: This retrospective study includes 288 EUS-guided pancreatic FNA cases. Clinical data, laboratory tests, cytopathology, histopathology, and imaging reports were retrieved. The final diagnosis was based on EUS-FNA cell block and/or pathology in surgical specimens, with immunohistochemistry support. The results of EUS-guided FNA were compared with the final diagnoses to calculate the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV).

Results: Among 288 EUS-guided pancreatic FNA cases, 175 (62.0%) were malignant. The mean age was 57.8 ± 13.5 years and 50.1 ± 13.7 years, and the mean size of the lesion was 4.1 ± 1.8 cm and 2.2 ± 1.1 cm in malignant and benign groups, respectively. Sensitivity, specificity, PPV, and NPV of EUS-FNA cytology for solid malignant lesions were 98.3%, 95.1%, 98.3%, and 95.1%, and those for cystic lesions were 88%, 92.3%, 100%, and 100%. Diagnostic accuracy of EUS-FNA cytology for solid and cystic pancreatic lesions is 97.4% and 95.0%, respectively. In conclusion of the above; diagnosis of pancreatic solid and cystic malignancy can be assigned from a composite of the EUS-FNA cytology, cell block preparation and immunohistochemistry Diagnosis of pancreatic solid and cystic malignancy can be assigned from a composite of the EUS-FNA cytology, cell block preparation, and immunohistochemistry.
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http://dx.doi.org/10.4103/JOC.JOC_5_18DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6844018PMC
September 2019

Novel Inhibitory Function of the Lipase Propeptide and Three-Dimensional Structures of Its Complexes with the Enzyme.

ACS Omega 2019 Jun 7;4(6):9964-9975. Epub 2019 Jun 7.

York Structural Biology Laboratory, Department of Chemistry, University of York, York YO10 5DD, U.K.

Many proteins are synthesized as precursors, with propeptides playing a variety of roles such as assisting in folding or preventing them from being active within the cell. While the precise role of the propeptide in fungal lipases is not completely understood, it was previously reported that mutations in the propeptide region of the lipase have an influence on the activity of the mature enzyme, stressing the importance of the amino acid composition of this region. We here report two structures of this enzyme in complex with its propeptide, which suggests that the latter plays a role in the correct maturation of the enzyme. Most importantly, we demonstrate that the propeptide shows inhibition of lipase activity in standard lipase assays and propose that an important role of the propeptide is to ensure that the enzyme is not active during its expression pathway in the original host.
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http://dx.doi.org/10.1021/acsomega.9b00612DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6648591PMC
June 2019

Radial-scanning flexible EUS of the anorectum and pelvis.

Endosc Ultrasound 2019 Sep-Oct;8(5):288-297

Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center, Tokyo, Japan.

Standard upper gastrointestinal flexible radial EUS probes are well suited for imaging of anorectum and pelvic pathologies. They offer multiple advantages over conventional rigid rectal probes. The current transducers allow imaging at variable frequencies and are Doppler capable. The flexible shaft of the endoscope and optics allow easy probe insertion to upper sigmoid. Flexible radial EUS probes allow evaluation of anal sphincter complex, rectosigmoid mural pathologies, and paraluminal pelvic disorders. A thorough understanding of pelvic anatomy and image orientation is the key to appropriate image interpretation. In this review, we describe the principles and methodology for anorectal EUS imaging using a flexible radial EUS probe.
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http://dx.doi.org/10.4103/eus.eus_33_19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6791101PMC
June 2019

Long-term outcomes of metachronous neoplasms in the ileal pouch and rectum after surgical treatment in patients with familial adenomatous polyposis.

Endosc Int Open 2019 May 8;7(5):E691-E698. Epub 2019 May 8.

Department of Endoscopy, Aichi Cancer Center Hospital, Nagoya, Japan.

Restorative proctocolectomy has become the most common surgical option for patients with familial adenomatous polyposis (FAP). However, adenomas and even carcinomas may develop in the ileal pouch over time. The aim of this study was to evaluate the long-term incidence and nature of ileal pouch or distal ileal adenomas and carcinomas in patients with FAP. This was a retrospective study of 47 FAP patients with Kock's continent ileostomy (Kock) (n = 8), ileorectal anastomosis (IRA) (n = 13), and ileal pouch-anal anastomosis (IPAA) (n = 26). Patients were followed with a standardized protocol including chromoendoscopy and biopsies of visible polyps in the ileal pouch, distal ileum, and rectum every 6 to 12 months.  Median follow-up was 21.0 years. Overall risk of adenoma development was significantly higher in IRA patients, with incidence rates of 85 % and 100 % at 5 and 10 years' follow-up, respectively, compared to pouch patients (Kock + IPAA) (  < 0.001). However, there was also a high frequency of adenomas in the ileal pouch mucosa, with rates of 12 %, 33 %, and 68 %, at 5, 10, and 20 years of follow-up, respectively. Maximum size of ileal pouch adenomas was significantly related to time since surgery (  = 0.0214). Six cases of advanced adenomas including two cases of adenocarcinomas developed in the ileal pouch mucosa. There is a significant incidence of adenoma(s) in the ileal pouch of FAP patients on long-term follow-up. Regular endoscopic surveillance is recommended, not only in IRA patients, but also in pouch patients after proctocolectomy.
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http://dx.doi.org/10.1055/a-0849-9465DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6506341PMC
May 2019

Sym021, a promising anti-PD1 clinical candidate antibody derived from a new chicken antibody discovery platform.

MAbs 2019 May/Jun;11(4):666-680. Epub 2019 May 3.

a Antibody Discovery, Antibody Discovery , Ballerup , Denmark.

Discovery of therapeutic antibodies is a field of intense development, where immunization of rodents remains a major source of antibody candidates. However, high orthologue protein sequence homology between human and rodent species disfavors generation of antibodies against functionally conserved binding epitopes. Chickens are phylogenetically distant from mammals. Since chickens generate antibodies from a restricted set of germline genes, the possibility of adapting the Symplex antibody discovery platform to chicken immunoglobulin genes and combining it with high-throughput humanization of antibody frameworks by "mass complementarity-determining region grafting" was explored. Hence, wild type chickens were immunized with an immune checkpoint inhibitor programmed cell death 1 (PD1) antigen, and a repertoire of 144 antibodies was generated. The PD1 antibody repertoire was successfully humanized, and we found that most humanized antibodies retained affinity largely similar to that of the parental chicken antibodies. The lead antibody Sym021 blocked PD-L1 and PD-L2 ligand binding, resulting in elevated T-cell cytokine production in vitro. Detailed epitope mapping showed that the epitope recognized by Sym021 was unique compared to the clinically approved PD1 antibodies pembrolizumab and nivolumab. Moreover, Sym021 bound human PD1 with a stronger affinity (30 pM) compared to nivolumab and pembrolizumab, while also cross-reacting with cynomolgus and mouse PD1. This enabled direct testing of Sym021 in the syngeneic mouse in vivo cancer models and evaluation of preclinical toxicology in cynomolgus monkeys. Preclinical in vivo evaluation in various murine and human tumor models demonstrated a pronounced anti-tumor effect of Sym021, supporting its current evaluation in a Phase 1 clinical trial. Abbreviations: ADCC, antibody-dependent cellular cytotoxicity; CD, cluster of differentiation; CDC, complement-dependent cytotoxicity; CDR, complementarity determining region; DC, dendritic cell; ELISA, enzyme-linked immunosorbent assay; FACS, fluorescence activated cell sorting; FR, framework region; GM-CSF, granulocyte-macrophage colony-stimulating factor; HRP, horseradish peroxidase; IgG, immunoglobulin G; IL, interleukin; IFN, interferon; mAb, monoclonal antibody; MLR, mixed lymphocyte reaction; NK, natural killer; PBMC, peripheral blood mono-nuclear cell; PD1, programmed cell death 1; PDL1, programmed cell death ligand 1; RT-PCR, reverse transcription polymerase chain reaction; SEB, Staphylococcus Enterotoxin B; SPR, surface Plasmon Resonance; VL, variable part of light chain; VH, variable part of heavy chain.
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http://dx.doi.org/10.1080/19420862.2019.1596514DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6601539PMC
January 2020

Radial EUS imaging of the liver: A pictorial guide.

Endosc Ultrasound 2019 Mar-Apr;8(2):76-81

Department of Gastroenterology and Endoscopy, S L Raheja Hospital, Mumbai, Maharashtra, India.

Systematic radial EUS imaging can provide a detailed evaluation of most of the liver segments, liver hilum, and hilar and intra-hepatic vascular and ductal anatomy. Innumerable scan planes are possible, and the endosonographers must reference the intra-hepatic vascular structures and ligaments, surface landmarks such as the gallbladder, and adjacent organs such as cardiac chambers and kidneys to define the liver segments. There is no strict demarcation between the adjacent segments, and all estimates are rough approximations. Radial EUS cannot sample detected lesions but can comprehensively evaluate the liver for any pathology. In particular, the superior part of the right anterior sector (S8), S4, and S6 are better seen with the radial than linear EUS probe. Unlike common belief, the liver hilum can also be well evaluated with the radial EUS probe from the mid and upper gastric body, similar to linear probe EUS imaging. Radial EUS imaging of the liver is carried out from three stations: gastroesophageal junction, upper-mid gastric body, and antrum-duodenal bulb. We describe a step-by-step approach to radial EUS description of liver anatomy in this pictorial review.
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http://dx.doi.org/10.4103/eus.eus_17_19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6482600PMC
April 2019

Gastrointestinal Cancers: Molecular Genetics and Biomarkers.

Can J Gastroenterol Hepatol 2018 18;2018:4513860. Epub 2018 Oct 18.

Department of Surgical Gastroenterology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow 226014, India.

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http://dx.doi.org/10.1155/2018/4513860DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6420989PMC
August 2019

Craniofacial skeleton of MEXICAN tetra (Astyanax mexicanus): As a bone disease model.

Dev Dyn 2019 02 18;248(2):153-161. Epub 2018 Dec 18.

Department of Oral Biology, Dr. Gerald Niznick College of Dentistry, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.

A small fresh water fish, the Mexican tetra (Astyanax mexicanus) is a novel animal model in evolutionary developmental biology. The existence of morphologically distinct surface and cave morphs of this species allows simultaneous comparative analysis of phenotypic changes at different life stages. The cavefish harbors many favorable constructive traits (i.e., large jaws with an increased number of teeth, neuromast cells, enlarged olfactory pits and excess storage of adipose tissues) and regressive traits (i.e., reduced eye structures and pigmentation) which are essential for cave adaptation. A wide spectrum of natural craniofacial morphologies can be observed among the different cave populations. Recently, the Mexican tetra has been identified as a human disease model. The fully sequenced genome along with modern genome editing tools has allowed researchers to generate transgenic and targeted gene knockouts with phenotypes that resemble human pathological conditions. This review will discuss the anatomy of the craniofacial skeleton of A. mexicanus with a focus on morphologically variable facial bones, jaws that house continuously replacing teeth and pharyngeal skeleton. Furthermore, the possible applications of this model animal in identifying human congenital and metabolic skeletal disorders is addressed. Developmental Dynamics 248:153-161, 2019. © 2018 Wiley Periodicals, Inc.
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http://dx.doi.org/10.1002/dvdy.4DOI Listing
February 2019

An Amphipathic Helix Directs Cellular Membrane Curvature Sensing and Function of the BAR Domain Protein PICK1.

Cell Rep 2018 05;23(7):2056-2069

Molecular Neuropharmacology and Genetics Laboratory, Lundbeck Foundation Center for Biomembranes in Nanomedicine, Department of Neuroscience, Faculty of Health and Medical Sciences, The Panum Institute - Mærsk Tower, University of Copenhagen, 2200 Copenhagen N, Denmark. Electronic address:

BAR domains are dimeric protein modules that sense, induce, and stabilize lipid membrane curvature. Here, we show that membrane curvature sensing (MCS) directs cellular localization and function of the BAR domain protein PICK1. In PICK1, and the homologous proteins ICA69 and arfaptin2, we identify an amphipathic helix N-terminal to the BAR domain that mediates MCS. Mutational disruption of the helix in PICK1 impaired MCS without affecting membrane binding per se. In insulin-producing INS-1E cells, super-resolution microscopy revealed that disruption of the helix selectively compromised PICK1 density on insulin granules of high curvature during their maturation. This was accompanied by reduced hormone storage in the INS-1E cells. In Drosophila, disruption of the helix compromised growth regulation. By demonstrating size-dependent binding on insulin granules, our finding highlights the function of MCS for BAR domain proteins in a biological context distinct from their function, e.g., at the plasma membrane during endocytosis.
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http://dx.doi.org/10.1016/j.celrep.2018.04.074DOI Listing
May 2018

Comparison of propofol alone and in combination with ketamine or fentanyl for sedation in endoscopic ultrasonography.

Korean J Anesthesiol 2018 Feb 14;71(1):43-47. Epub 2017 Jun 14.

Department of Hepatology, Institute of Liver & Biliary Sciences, New Delhi, India.

Background: We evaluated whether the addition of a small dose of ketamine or fentanyl would lead to a reduction in the total dose of propofol consumed without compromising the safety and recovery of patients having endoscopic ultrasonography (EUS).

Methods: A total of 210 adult patients undergoing elective EUS under sedation were included in the study. Patients were randomized into three groups. Patients were premedicated intravenously with normal saline in group 1, 50 µg fentanyl in group 2, and 0.5 mg/kg ketamine in group 3. All patients received intravenous propofol for sedation. Propofol consumption in mg/kg/h was noted. The incidence of hypotension, bradycardia, desaturation, and coughing was noted. The time to achieve a Post Anesthesia Discharge Score (PADS) of 10 was also noted.

Results: There were 68 patients in group 1, 70 in group 2, and 72 in group 3. The amount of propofol consumed was significantly higher in group 1 (9.25 [7.3-13.2]) than in group 2 (8.8 [6.8-12.2]) and group 3 (7.6 [5.7-9.8]). Patient hemodynamics and oxygenation were well maintained and comparable in all groups. The time to achieve a PADS of 10 was significantly higher in group 3 compared to the other two groups.

Conclusions: The use of 50 µg fentanyl or 0.5 mg/kg ketamine in a single dose during EUS reduces the dose of propofol required for sedation. However, unlike the addition of fentanyl, the addition of ketamine increased the time to recovery. Thus, 50 µg fentanyl is a good additive to propofol infusion for sedation during EUS to reduce the requirement for propofol without affecting the time to recovery.
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http://dx.doi.org/10.4097/kjae.2018.71.1.43DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5809707PMC
February 2018

Diagnostic utility of quantitative cytomegalovirus DNA polymerase chain reaction in intestinal biopsies from patients with inflammatory bowel disease.

J Lab Physicians 2018 Jan-Mar;10(1):38-43

Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India.

Objectives: Diagnostic utility of cytomegalovirus (CMV) DNA quantitative polymerase chain reaction (qPCR) in inflammatory bowel disease (IBD) has not been established. We aimed to compare diagnostic utility of qPCR for CMV in biopsy specimens with blood, serology, and histopathology.

Materials And Methods: A total of 132 patients were included (92 ulcerative colitis [UC], 9 Crohn's disease, and 31 unclassified IBD). Comparison between CMV IgM, CMV DNA qPCR in biopsy, in blood and histopathology was done. Positive result in any of the test was considered as CMV infection. Various risk factors for CMV association with IBD were analyzed.

Results: Confirmed CMV infection was seen in 41 (31.1%) patients. Diagnostic sensitivity of different assays was: DNA in biopsy seen in 37 (90.2%), DNA in blood in 19 (46.3%), CMV IgM in 15 (36.5%), and histopathology in 8 (19.5%). Thirty-two UC cases were further followed up for a median time of 14.0 (: 3-31) months. They were grouped as group I - biopsy and blood DNA both positive (14, 43.7%), Group II - biopsy positive and blood negative (17, 53.1%), and Group III - biopsy negative but blood positive (1, 3.1%). CMV DNA viral load in Group I was significantly higher (mean: 4.2 ± 1.0 log copies/mg) than Group II (mean: 3.2 ± 0.6 copies/mg) and Group III (viral load: 2.69 log copies/ml), < 0.001. Steroid refractoriness was seen more in Group I cases ( = 9) < 0.001. A cutoff of ≥2.5 log copies/mg of DNA in tissue was predictive for steroid refractoriness (AUROC = 0.84).

Conclusions: Quantitation of CMV DNA in intestinal biopsy is a useful diagnostic tool and can predict response to steroid treatment in patients with UC.
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http://dx.doi.org/10.4103/JLP.JLP_94_17DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5784291PMC
February 2018

Ubiquitin C-terminal hydrolase isozyme L1 is associated with shelterin complex at interstitial telomeric sites.

Epigenetics Chromatin 2017 11 10;10(1):54. Epub 2017 Nov 10.

Children's Hospital Research Institute of Manitoba, University of Manitoba, 715 McDermot Avenue, Room 600A, Winnipeg, MB, R3E 3P4, Canada.

Background: Ubiquitin C-terminal hydrolase isozyme L1 (UCHL1) is primarily expressed in neuronal cells and neuroendocrine cells and has been associated with various diseases, including many cancers. It is a multifunctional protein involved in deubiquitination, ubiquitination and ubiquitin homeostasis, but its specific roles are disputed and still generally undetermined.

Results: Herein, we demonstrate that UCHL1 is associated with genomic DNA in certain prostate cancer cell lines, including DU 145 cells derived from a brain metastatic site, and in HEK293T embryonic kidney cells with a neuronal lineage. Chromatin immunoprecipitation and sequencing revealed that UCHL1 localizes to TTAGGG repeats at telomeres and interstitial telomeric sequences, as do TRF1 and TRF2, components of the shelterin complex. A weak or transient interaction between UCHL1 and the shelterin complex was confirmed by immunoprecipitation and proximity ligation assays. UCHL1 and RAP1, also known as TERF2IP and a component of the shelterin complex, were bound to the nuclear scaffold.

Conclusions: We demonstrated a novel feature of UCHL1 in binding telomeres and interstitial telomeric sites.
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http://dx.doi.org/10.1186/s13072-017-0160-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5681776PMC
November 2017

Optimal intake of clear liquids during preparation for afternoon colonoscopy with low-volume polyethylene glycol plus ascorbic acid.

Endosc Int Open 2017 Jun 31;5(6):E416-E423. Epub 2017 May 31.

Department of Endoscopy, Aichi Cancer Center Hospital, Nagoya, Japan.

Background And Study Aims : The standard colonoscopy preparation regimen in Japan for afternoon procedures is sequential intake of 1 L of polyethylene glycol electrolyte lavage solution containing ascorbic acid (PEG-ASC), 0.5 L of clear liquid, 0.5 L of PEG-ASC, and finally 0.25 L of clear fluids (all at a rate of 0.25 L every 15 min). However, this regimen seems poorly tolerated and complicated for many patients compared to previous regimen of polyethylene glycol electrolyte lavage solution. The aim of this study was to evaluate an alternate regimen of 0.5 L of PEG-ASC followed by 0.25 L clear liquids, repeated 3 times.

Patients And Methods : This was a single-blinded, non-inferiority, randomized controlled study. Subjects were randomized to the standard regimen or the alternate regimen using a web-based registry system. All patients were instructed to eat a pre-packaged, low residue diet and to take sodium picosulfate hydrate the day before colonoscopy. The Boston Bowel Preparation Scale was used to evaluate bowel cleansing, and a 3-point scale was used to assess mucosal visibility. The primary endpoint was successful bowel cleansing. The acceptability, tolerability, safety, and endoscopic findings of these two regimens were secondary endpoints.

Results:  A total of 409 patients were randomized to either the standard regimen (n = 204, males 54.0 %, mean age 65.5 years) or the alternate regimen (n = 205, 54.6 %, 65.0 years). The rates of successful bowel cleansing were 71.1 % (64.3 - 77.2 %) with the standard regimen vs. 75.1 % (68.6 - 80.9 %) with the alternate regimen (95 % lower confidence limit, for the difference = - 4.6, non-inferiority  < 0.05). No significant differences were found in tolerability, safety, and endoscopic findings.

Conclusion:  The alternate regimen and standard regimen are clinically equivalent with respect to cleansing efficacy and acceptability, tolerability, safety, and endoscopic findings. These results are good news for patients with difficulty drinking the first liter of PEG-ASC.
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http://dx.doi.org/10.1055/s-0043-106185DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5451275PMC
June 2017

Low dose oral curcumin is not effective in induction of remission in mild to moderate ulcerative colitis: Results from a randomized double blind placebo controlled trial.

World J Gastrointest Pharmacol Ther 2017 May;8(2):147-154

Saurabh Kedia, Sushil Garg, Venigalla Pratap Mouli, Sawan Bopanna, Veena Tiwari, Govind Makharia, Vineet Ahuja, Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi 110029, India.

Aim: To evaluate the role of oral curcumin in inducing clinical remission in patients with mild to moderate ulcerative colitis (UC).

Methods: A prospective randomized double-blind placebo-controlled trial comparing the remission inducing effect of oral curcumin and mesalamine 2.4 g with placebo and mesalamine 2.4 g in patients of ulcerative colitis with mild to moderate severity was conducted from January 2003 to March 2005. The included patients received 1 capsule thrice a day of placebo or curcumin (150 mg) for 8 wk. Patients were evaluated clinically and endoscopically at 0, 4 and 8 wk. The primary outcome was clinical remission at 8 wk and secondary outcomes were clinical response, mucosal healing and treatment failure at 8 wk. The primary analysis was intention to treat worst case scenario (ITT-WCS).

Results: Of 300 patients with UC, 62 patients (curcumin: 29, placebo: 33) fulfilled the inclusion criteria and were randomized at baseline. Of these, 21 patients did not complete the trial, 41 patients (curcumin: 16, placebo: 25) finally completed 8 wk. There was no significant difference in rates of clinical remission (31.3% 27.3%, = 0.75), clinical response (20.7% 36.4%, = 0.18), mucosal healing (34.5% 30.3%, = 0.72), and treatment failure (25% 18.5%, = 0.59) between curcumin and placebo at 8 wk.

Conclusion: Low dose oral curcumin at a dose of 450 mg/d was ineffective in inducing remission in mild to moderate cases of UC.
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http://dx.doi.org/10.4292/wjgpt.v8.i2.147DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5421114PMC
May 2017

Predictors of fifty days in-hospital mortality in patients with culture negative neutrocytic ascites.

BMC Gastroenterol 2017 May 16;17(1):64. Epub 2017 May 16.

Department of Hepatology, Institute of Liver and Biliary Sciences (ILBS), New Delhi, India.

Background: Culture negative neutrocytic ascites is a variant of spontaneous bacterial peritonitis. But there are conflicting reports regarding the mortality associated with culture negativeneutrocytic ascites. Therefore we aim to determine the predictors of mortality associated with culture negativeneutrocytic ascites in a larger sample population.

Methods: We analysed 170 patients consecutively admitted to intensive care unit with diagnosis of culture negative neutrocytic ascites. The clinical, laboratory parameters, etiology of liver cirrhosis was determined along with the scores like model for end stage liver disease, child turcotte pugh were recorded.

Results: The 50 day in-hospital mortality rate in culture negative neutrocytic ascites was 39.41% (n = 67). In univariate analysis, means of parameters like total leucocyte count, urea, bilirubin, alanine transaminase, aspartate transaminase, international normalized ratio, acute kidney injury, septic shock, hepatic encephalopathy and model for end stage liver disease were significantly different among survived and those who died (P value ≤0.05). Cox proportional regression model showed the hazard ratio (HR) of acute kidney injury was 2.212 (95% CI: 1.334-3.667), septic shock (HR = 1.895, 95% CI: 1.081-3.323) and model for end stage liver disease (HR = 1.054, 95% CI: 1.020-1.090). Receiver operating characteristics curve showed aspartate aminotransferase (AST) had highest area under the curve 0.761 (95% CI: 0.625-0.785).

Conclusion: Patients with culture negative neutrocytic ascites have a mortality rate comparable to spontaneous bacterial peritonitis. aspartate aminotransferase, alanine aminotransferase (ALT), acute kidney injury (AKI), model for end stage liver disease (MELD) and septic shock are the independent predictors of 50 days in-hospital mortality in culture negative neutrocytic ascites.
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http://dx.doi.org/10.1186/s12876-017-0621-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5434542PMC
May 2017

The Features of Colorectal Tumors in a Patient with Li-Fraumeni Syndrome.

Intern Med 2017 1;56(3):295-300. Epub 2017 Feb 1.

Department of Gastroenterology, Aichi Cancer Center Hospital, Japan.

A young woman with Li-Fraumeni syndrome (LFS) was referred to our hospital. On examination, multiple flat neoplasms were detected in addition to semi-pedunculated polyps. Restorative proctocolectomy was performed; one submucosal invasive cancer, two mucosal cancers, and several adenomas with high-grade dysplasia were detected. On immunohistochemical staining with p53, every part of all neoplasms, even the small adenomas, showed strong positive staining. Multiple flat neoplasms may be characteristic of patients with LFS and may have a much higher risk of rapid progression to invasive carcinomas than sporadic neoplasms. Thus, careful and frequent colonoscopy surveillance may be needed for patients with LFS.
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http://dx.doi.org/10.2169/internalmedicine.56.7274DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5348453PMC
February 2017

Endoscopic ultrasonography-guided tissue acquisition: How to achieve excellence.

Dig Endosc 2017 May 22;29(4):417-430. Epub 2017 Mar 22.

Center for Interventional Endoscopy, Florida Hospital, Orlando, USA.

Endoscopic ultrasound (EUS)-guided tissue acquisition is a basic forte of an endosonographer. The multiple skills required to accomplish successful results include not only the puncture itself, but also proper lesion identification, correct puncture sequence, collaboration with the pathologist onsite or remotely, proper handling of the specimens, choosing one or more of cytology, cell-block, and/or tissue core preparation and, last, deciding the immunohistochemistry (IHC) panels and ancillary tests which may be needed for the current case. Error in any of these decisions may lead to incomplete or inconclusive information from the procedure, even if the aspirate is 'adequate.' In the present review, we will describe the technical aspects of EUS-guided tissue acquisition, current needles available and how to choose between them, and how to appropriately handle the specimen. We will also discuss the optimal approach to common targets including lymph nodes, pancreatic masses, pancreatic cysts, and subepithelial lesions.
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http://dx.doi.org/10.1111/den.12823DOI Listing
May 2017

Diagnostic performance and factors influencing the accuracy of EUS-FNA of pancreatic neuroendocrine neoplasms.

J Gastroenterol 2017 02 24;52(2):264. Epub 2016 Dec 24.

Department of Gastroenterology, Fortis Escorts Liver and Digestive Institute, New Delhi, India.

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http://dx.doi.org/10.1007/s00535-016-1297-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5281647PMC
February 2017

Controlled lid-opening in Thermomyces lanuginosus lipase- An engineered switch for studying lipase function.

Biochim Biophys Acta Proteins Proteom 2017 Jan 28;1865(1):20-27. Epub 2016 Sep 28.

Department of Chemistry, University of Copenhagen, Universitetsparken 5, DK-2100 Copenhagen Ø, Denmark. Electronic address:

Here, we present a lipase mutant containing a biochemical switch allowing a controlled opening and closing of the lid independent of the environment. The closed form of the TlL mutant shows low binding to hydrophobic surfaces compared to the binding observed after activating the controlled switch inducing lid-opening. We directly show that lipid binding of this mutant is connected to an open lid conformation demonstrating the impact of the exposed amino acid residues and their participation in binding at the water-lipid interface. The switch was created by introducing two cysteine residues into the protein backbone at sites 86 and 255. The crystal structure of the mutant shows the successful formation of a disulfide bond between C86 and C255 which causes strained closure of the lid-domain. Control of enzymatic activity and binding was demonstrated on substrate emulsions and natural lipid layers. The locked form displayed low enzymatic activity (~10%) compared to wild-type. Upon release of the lock, enzymatic activity was fully restored. Only 10% binding to natural lipid substrates was observed for the locked lipase compared to wild-type, but binding was restored upon adding reducing agent. QCM-D measurements revealed a seven-fold increase in binding rate for the unlocked lipase. The TlL_locked mutant shows structural changes across the protein important for understanding the mechanism of lid-opening and closing. Our experimental results reveal sites of interest for future mutagenesis studies aimed at altering the activation mechanism of TlL and create perspectives for generating tunable lipases that activate under controlled conditions.
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http://dx.doi.org/10.1016/j.bbapap.2016.09.016DOI Listing
January 2017

PI3K/Akt/mTOR signaling & its regulator tumour suppressor genes & in human uterine leiomyomas.

Indian J Med Res 2016 May;143(Supplement):S112-S119

Department of Obstetrics & Gynecology, King George's Medical University, Lucknow, India.

Background & Objectives: Despite their high occurrence and associated significant level of morbidity manifesting as spectrum of clinical symptoms, the pathogenesis of uterine leiomyomas (ULs) remains unclear. We investigated expression profile of tumour suppressor genes PTEN (phosphatase and tensin homolog deleted on chromosome ten) and LKB1 (liver kinase B1), and key signaling components of P13K (phosphatidylinositol 3-kinase)/Akt (protein kinase B)/mTOR (mammalian target of rapamycin) pathway in leiomyomas and adjacent normal myometrium in women of reproductive age, to explore the possibility of targeting this pathway for future therapeutic implications.

Methods: Real time PCR (qPCR) was used to quantify relative gene expression levels of PTEN, Akt1, Akt2, mTOR, LKB1 and VEGFA (vascular endothelial growth factor A) in leiomyoma as compared to adjacent normal myometrium. Immunohistochemistry was subsequently performed to analyze expression of PTEN, phospho-Akt, phospho-mTOR, phospho-S6, LKB1 and VEGFA in leiomyoma and adjacent normal myometrium.

Results: Significant upregulation of PTEN (2.52 fold; P=0.03) and LKB1 (3.93 fold; P0.01), and downregulation of VEGFA (2.95 fold; P=0.01) genes were observed in leiomyoma as compared to normal myometrium. Transcript levels of Akt1, Akt2 and mTOR did not vary significantly between leiomyoma and myometrium. An increased immunoexpression of PTEN (P=0.015) and LKB1 (P<0.001) and decreased expression of VEGFA (P=0.01) was observed in leiomyoma as compared to myometrium. Immunostaining for activated (phosphorylated) Akt, mTOR and S6 was absent or low in majority of leiomyoma and myometrium.

Interpretation & Conclusions: Upregulation of PTEN and LKB1 in concert with negative or low levels of activated Akt, mTOR and S6 indicates that PI3K/Akt/mTOR pathway may not play a significant role in pathogenesis of leiomyoma.
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http://dx.doi.org/10.4103/0971-5916.191808DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5080920PMC
May 2016

Residual contamination and bioburden after reprocessing of single-use endoscopic ultrasound needles: An ex vivo study.

Dig Endosc 2017 Mar 13;29(2):175-181. Epub 2016 Nov 13.

Department of Gastroenterology, Fortis Escorts Liver and Digestive Institute, Delhi, India.

Background And Aim: Endoscopic ultrasound (EUS) aspiration needles are single-use devices. However, in many centers, because of cost-constraints, these devices are reused multiple times. We studied microbiological contamination and bioburden on reprocessed needles to evaluate whether these devices can be successfully sterilized.

Methods: We studied 10 EUS needles each of 19 G, 22 G, and 25 G in size, and five 22-G ProCore needles. After initial use, each needle was reprocessed by a standardized protocol. We used standard microbiological cultures, as well as ATP bioluminescence technique to quantify bioburden as relative light units (RLU). We defined significant soil contamination by RLU values >200. We also used extractant fluid to disrupt cell membranes in an attempt to enhance ATP detection.

Results: We found culture positivity in 3/34 (8.8%), and detectable bioburden on the exposed surface of 33/35 (94.3%), and inside lumen of 29 (82.9%) reprocessed FNA needles. Significant bioburden was found in three (8.6%) and two (5.7%) needles on the surface and lumen, respectively. We found that use of extractant fluid enhanced detection of bioburden. Larger (19 G) needles had higher surface contamination (P = 0.016), but there was no relation of luminal contamination with needle diameter (P = 0.138). Sheath design and presence of side bevel did not influence extent of contamination. There was significant correlation between the surface and intraluminal bioburden (P < 0.001).

Conclusions: There is significant bioburden in reprocessed EUS needles; standard microbiological cultures have low sensitivity for detection of needle contamination. We have provided objective evidence for the futility of reprocessing attempts, and practice of EUS needle reuse should be discontinued.
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http://dx.doi.org/10.1111/den.12731DOI Listing
March 2017

Endometrial Expression of Homeobox Genes and Cell Adhesion Molecules in Infertile Women With Intramural Fibroids During Window of Implantation.

Reprod Sci 2017 03 19;24(3):435-444. Epub 2016 Jul 19.

3 Department of Obstetrics and Gynecology, King George's Medical University-UP, Lucknow, Uttar Pradesh, India.

This study was designed to examine the expression and cellular distribution of homeobox ( HOX) genes ( HOXA10 and HOXA11) and cell adhesion molecules (E-cadherin, N-cadherin, and β-catenin) during the window of implantation in infertile women with noncavity-distorting intramural (IM) fibroids (n = 18) and in fertile controls (n = 12). Quantitative real-time polymerase chain reaction and immunohistochemistry were used to evaluate the messenger RNA (mRNA) levels and protein expression, respectively. When compared to fertile controls, reduced HOXA10 and HOXA11 transcript and protein levels were observed in infertile women. However, changes only in the expression of HOXA10 mRNA (-1.72-fold; P = .03) and stromal protein ( P = .001) were statistically significant. Significantly lower E-cadherin mRNA (-10.97-fold; P = .02) and protein levels were seen in infertile patients. E-cadherin immunostaining was significantly reduced both in the luminal ( P = .048) and in the glandular ( P = .014) epithelium of endometrium from infertile patients when compared to controls. No significant change was observed either in the mRNA levels or in the immunoexpression of N-cadherin and β-catenin. However, a trend toward lower N-cadherin expression in the luminal epithelium ( P = .054) and decreased β-catenin expression in the glandular epithelium ( P = .070) was observed in infertile patients. The present findings suggest that altered endometrial HOXA10 and E-cadherin mRNA and protein expression observed in infertile women with IM fibroids during the mid-secretory phase might impair endometrial receptivity leading to infertility in these patients.
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http://dx.doi.org/10.1177/1933719116657196DOI Listing
March 2017

Carvedilol delays the progression of small oesophageal varices in patients with cirrhosis: a randomised placebo-controlled trial.

Gut 2017 10 13;66(10):1838-1843. Epub 2016 Jun 13.

Hepatic Hemodynamic Laboratory, Departments of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, Delhi, India.

Background And Aims: Carvedilol is effective in the primary prophylaxis for large oesophageal varices. We investigated its use in preventing progression of small to large oesophageal varices.

Methods: Consecutive cirrhotics with small oesophageal varices were prospectively randomised to either carvedilol (n=70) or placebo (n=70) and followed up for a minimum of 24 months. Endoscopy was done at baseline and six monthly intervals. Hepatic vein pressure gradient (HVPG) was measured at baseline and at 12 months. The primary endpoint was development of large varices.

Results: Baseline characteristics in two groups were comparable. The predominant aetiology of cirrhosis was non-alcoholic fatty liver disease in both the groups. The mean dose of carvedilol administered was 12±1.67 mg/day and the target heart rate achieved was 58±3 bpm. A higher proportion of patients in carvedilol group had non-progression to large varices than placebo (79.4% vs 61.4%; p=0.04); the mean time of non-progression to large varices was 20.8 months (95% CI 19.4 to 22.4) in carvedilol group and 18.7 months (95% CI 17.1 to 20.4) in placebo group (p=0.04). There was a modest reduction of HVPG at 1 year in carvedilol group (-8.64%) compared with placebo (+0.33%) (p=0.22). None of the patients in either group died of variceal bleeding or liver-related causes. No major adverse events were observed in either group.

Conclusions: Carvedilol is safe and effective in delaying the progression of small to large oesophageal varices in patients with cirrhosis.

Trial Registration Number: NCT01196507; post-results.
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http://dx.doi.org/10.1136/gutjnl-2016-311735DOI Listing
October 2017

Dengue Virus Transmission from Living Donor to Recipient in Liver Transplantation: A Case Report.

J Clin Exp Hepatol 2016 Mar 25;6(1):59-61. Epub 2016 Jan 25.

Gastroenterology and Hepatology, Fortis Escort Liver and Digestive Diseases Institute, Okhla, New Delhi, India.

Many infections are transmitted from a donor to a recipient through organ transplantations. The transmission of dengue virus from a donor to a recipient in liver transplantation is a rare entity, and currently, there is no recommendation for screening this virus prior to transplantation. We report a case of transmission of dengue virus from donor to recipient after liver transplantation. The recipient had a history of multiple admissions for hepatic encephalopathy and ascites. He was admitted in the ICU for 15 days for chronic liver disease, ascites, and acute kidney injury before transplantation. The donor was admitted 1 day before transplantation. The donor spiked fever on postoperative day 2 followed by thrombocytopenia and elevated liver enzymes. The donor blood test was positive for dengue NS1 antigen. The recipient also had a similar clinical picture on postoperative day 5 and his blood test was also positive for dengue NS1 antigen. Hence, the diagnosis for posttransplant donor-derived allograft-related transmission of dengue infection was made. Both recipient and donor were treated with supportive measures and discharged after their full recovery on postoperative days 9 and 18, respectively. The effect of immunosuppression on dengue presentation is still unclear and there is lack of literature available. In our case, the recipient developed dengue fever similar to general population without showing any feature of severe graft dysfunction. We have concluded that dengue virus can also be transmitted from donor to recipient, and immunosuppression did not have any adverse effect on the evolution of dengue fever within the recipient. Delhi being a hyperendemic zone, screening for donors (especially in season time) for dengue virus seems to be the best preventive method to control donor-derived transmission of dengue to recipient.
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http://dx.doi.org/10.1016/j.jceh.2016.01.005DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4862106PMC
March 2016
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