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( Rajesh Gupta ),( Aditya Atul Kulkarni ),( Rahul Gupta ),( Sunil Shenvi ),( Tanvi Jain ),( Raghavendra Babu ),( Mandeep Kang ),( Surinder Rana ) 대한간학회 2020 춘·추계 학술대회 (KASL) Vol.2020 No.1
Aims: Step-up approach is becoming a standard of care for management of acute necrotizing pancreatitis. We aimed to investigate the learning curve effect and increasing experience on management and outcomes of surgical step-up approach at our high-volume tertiary referral center. Methods: In a retrospective analysis of database of patients with acute necrotizing pancreatitis referred to our unit, we divided patients into three distinct time periods: Group-1 (2008-2012), Group-2 (2013-2016) and Group-3 (2017-2019). Outcomes between different time periods were compared. Results: Total of 335 patients were included, with 92 patients in Group-1, 117 in Group-2 and 126 in Group-3. Patients treated on surgical side in later time period had higher incidence of multiorgan failure (26.1% vs. 49.6% vs. 45.2%, P<0.001), APACHE II scores at presentation (8 vs. 10 vs. 9, P=0.006) and at first intervention (9 vs. 11 vs. 10, P=0.037), as well higher mCTSI score (8 vs. 10 vs. 10, P<0.001). Over time, median percutaneous drain size (10Fr vs. 12Fr vs. 14 Fr, P<0.001) as well as sepsis reversal after drainage (40.2% vs. 59% vs. 49.2%, P=0.026) increased, whereas median number of drains (P=0.001) and interventions (4 vs. 3 vs. 3, P=0.005) decreased significantly. Necrosectomy requirement, length of stay and mortality remained similar over time despite more severe cases referred to surgical side. Conclusions: With increasing experience of step-up approach, sicker patients with higher severity of pancreatitis could be managed successfully with fewer drains and procedures leading to significantly higher sepsis reversal with drainage, with no increase in surgery requirement or mortality.
Rajesh Malhotra,Saurabh Gupta,Vivek Gupta,Vikrant Manhas 대한정형외과학회 2022 Clinics in Orthopedic Surgery Vol.14 No.1
Background: Young age in osteonecrosis of the femoral head (ONFH) demands bone-preserving, short-stem arthroplasty. Several designs including neck-preserving stems and neck-resecting, shortened, standard stems are classified as short stems. There is a paucity of literature investigating risk factors and outcomes of intraoperative complications of neck preserving, short-stem arthroplasty in ONFH. Methods: A total of 107 hips operated with METHA short-stem arthroplasty for ONFH were retrospectively evaluated. The mean age of patients was 43.7 years (range, 27–60 years). Nine patients had an intraoperative fracture. Seven hips received prophylactic cerclage wiring for poor bone quality. Patients were invited for clinical and radiological evaluation at the latest follow-up. Results: The mean follow-up of patients was 47.2 months. Significant association with intraoperative fractures and the need for prophylactic cerclage wiring were found in steroids-, alcohol-, and chronic renal failure-induced ONFH. However, patient sex, body mass index, traumatic/idiopathic ONFH, previous implant in situ , prosthesis size, and single-sitting bilateral total hip replacement (THA) were not the risk factors. All hips showed signs of osteointegration at final follow-up. No revision was done during the study period for any cause. Conclusions: METHA short-stem THA offers excellent functional and radiological outcomes in ONFH. However, precaution must be exercised in patients with steroids-, alcohol-, and renal disorders-induced ONFN due to poor bone quality and higher chances of intraoperative fractures. Also, additional measures such as the use of a high-speed burr and prophylactic cerclage wiring in ONFH may allow predictable and safe use of short stems.
Navigated Unicompartmental Knee Arthroplasty: A Different Perspective
Rajesh Malhotra,Saurabh Gupta,Vivek Gupta,Vikrant Manhas 대한정형외과학회 2021 Clinics in Orthopedic Surgery Vol.13 No.4
Background: Anteromedial osteoarthritis is a recognized indication for unicompartmental knee arthroplasty (UKA). Favorable postoperative outcomes largely depend on proper patient selection, correct implant positioning, and limb alignment. Computer navigation has a proven value over conventional systems in reducing mechanical errors in total knee arthroplasty (TKA). However, the lack of strong evidence impedes the universal use of computer navigation technology in UKA. Therefore, this study was proposed to investigate the accuracy of component positioning and limb alignment in computer navigated UKA and to observe the role of navigation in proper patient selection. Methods: A total of 50 knees (38 patients) underwent computer navigated UKA between 2016 and 2018. All operations were performed by the senior surgeon using the same navigation system and implant type. The navigation system was used as a tool to aid patient selection: knees with preoperative residual varus > 5° on valgus stress and hyperextension > 10° were switched to navigated TKA. We measured the accuracy of component placement in sagittal and coronal planes on postoperative radiographs. Functional outcomes were also evaluated at the final follow-up (a minimum of 16 months). Results: Nine patients had tibia vara and 14 patients had preoperative hyperextension deformity. We observed coronal outliers for the tibial component in 12% knees and for the femoral component in 10% knees. We also observed sagittal outliers for the tibial component in 14% knees and for the femoral component in 6% knees. There was a significant improvement in the functional score at the final follow-up. On multiple linear regression, no difference was found in functional scores of knees with or without tibia vara (p = 0.16) and with or without hyperextension (p = 0.25). Conclusions: Our study further validates the role of computer navigation in desirable implant positioning and limb alignment. We encourage use of computer-assisted navigation as a tool for patient selection, as it allows intraoperative dynamic goniometry and provides real-time kinematic behavior of the knee to obviate pitfalls such as significant residual varus angulation and hyperextension that predispose early failure of UKA.
Manoj Gupta,Rachit Ahuja,Sweety Gupta,Deepa Joseph,Rajesh Pasricha,Swati Verma,Laxman Pandey 대한방사선종양학회 2020 Radiation Oncology Journal Vol.38 No.2
Purpose: Due to COVID 19 pandemic, the treatment of cancer patients has become a dilemma for every oncologist. Cancer patients are at an increased risk of immunosuppression and have a higher risk to acquire any infection. There are individual experiences from some centers regarding the management of cancer patients during such a crisis. So we have developed our institutional strategy to balance between COVID and cancer management. Materials and Methods: Radiation Oncology departmental meeting was held to prepare a consensus document on Radiotherapy schedules and department functioning during this pandemic. Results: Strategies were taken in form of following areas were steps need to be taken to decrease risk of infection, categorise treatment on the basis of priority, radiotherapy schedules modification, academic meetings and management of COVID positive patient/personnel in Radiation Oncology department. Conclusion: We hope to strike the balance in overcoming both the battles and emerge as winners. Stringent long term follow up will be done for assessing the response or any unforeseen treatment related sequelae.
Exploring the Potential of Natural Products as FoxO1 Inhibitors: an In Silico Approach
Gupta Anugya,Haldhar Rajesh,Agarwal Vipul,Rajput Dharmendra Singh,Chun Kyung-Soo,Han Sang Beom,Raj Vinit,Lee Sangkil 한국응용약물학회 2024 Biomolecules & Therapeutics(구 응용약물학회지) Vol.32 No.3
FoxO1, a member of the Forkhead transcription factor family subgroup O (FoxO), is expressed in a range of cell types and is crucial for various pathophysiological processes, such as apoptosis and inflammation. While FoxO1’s roles in multiple diseases have been recognized, the target has remained largely unexplored due to the absence of cost-effective and efficient inhibitors. Therefore, there is a need for natural FoxO1 inhibitors with minimal adverse effects. In this study, docking, MMGBSA, and ADMET analyses were performed to identify natural compounds that exhibit strong binding affinity to FoxO1. The top candidates were then subjected to molecular dynamics (MD) simulations. A natural product library was screened for interaction with FoxO1 (PDB ID- 3CO6) using the Glide module of the Schrödinger suite. In silico ADMET profiling was conducted using SwissADME and pkCSM web servers. Binding free energies of the selected compounds were assessed with the Prime-MMGBSA module, while the dynamics of the top hits were analyzed using the Desmond module of the Schrödinger suite. Several natural products demonstrated high docking scores with FoxO1, indicating their potential as FoxO1 inhibitors. Specifically, the docking scores of neochlorogenic acid and fraxin were both below -6.0. These compounds also exhibit favorable drug-like properties, and a 25 ns MD study revealed a stable interaction between fraxin and FoxO1. Our findings highlight the potential of various natural products, particularly fraxin, as effective FoxO1 inhibitors with strong binding affinity, dynamic stability, and suitable ADMET profiles.
( Gupta Anil Kumar ),( Rajiv Pathak ),( Bharat Singh ),( Hemlata Gautam ),( Ram Kumar ),( Raj Kumar ),( Rajesh Arora ),( Hemant K. Gautam ) 한국미생물 · 생명공학회 2011 Journal of microbiology and biotechnology Vol.21 No.6
A Gram-positive bacterium was isolated from the saline soils of Jangpura (U.P.), India, and showed high-level of radiation-resistant property and survived upto 12.5 kGy dose of gamma radiation. The 16S rDNA sequence of this strain was examined, identified as Bacillus sp. strain HKG 112, and was submitted to the NCBI GenBank (Accession No. GQ925432). The mechanism of radiation resistance and gene level expression were examined by proteomic analysis of whole-cell extract. Two proteins, 38 kDa and 86.5 kDa excised from SDS-PAGE, which showed more significant changes after radiation exposure, were identified by MALDI-TOF as being flagellin and S-layer protein, respectively. Twenty selected 2-DE protein spots from the crude extracts of Bacillus sp. HKG 112, excised from 2- DE, were identified by liquid chromatography mass spectrometry (LC-MS) out of which 16 spots showed significant changes after radiation exposure and might be responsible for the radiation resistance property. Our results suggest that the different responses of some genes under radiation for the expression of radiation-dependent proteins could contribute to a physiological advantage and would be a significant initial step towards a fullsystem understanding of the radiation stress protection mechanisms of bacteria in different environments.