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Gopal R.,Madurai Kamaraj University | Rani U.,Apollo Speciality Hospitals | Murugesan R.,Chettinad Academy of Research and Education | Kumar K.,Mission Research | And 2 more authors.
Clinical Lymphoma, Myeloma and Leukemia | Year: 2016

Purpose: The biological response of electron beam radiation (EBR) in tumors remains underexplored. This study describes the molecular biological and genomic impact of EBR on tumor cells. Methods: A mouse model bearing Dalton's lymphoma ascites cells was exposed to an 8-MeV pulsed electron beam, at a dose rate of 2 Gy/min using a microtron, a linear accelerator. The radiation-induced changes were assessed by histopathology, fluorescence-activated cell sorting, signaling pathway-focused reporter assays, and gene expression by microarray analysis. Results: EBR was found to increase apoptosis and G2-M cell cycle arrest with concomitant tumor regression in vivo. The microarray data revealed that EBR induced tumor regression, apoptosis, and cell cycle arrest mediated by p53, PPAR, and SMAD2/3/4 signaling pathways. Activation of interferon regulatory factor and NFkB signaling were also found upon EBR. Chemo-genomics exploration revealed the possibility of drugs that can be effectively used in combination with EBR. Conclusion: For the first time, an 8-MeV pulse EBR induced genomic changes, and their consequence in molecular and biological processes were identified in lymphoma cells. The comprehensive investigation of radiation-mediated responses in cancer cells also revealed the potential therapeutic features of EBR. © 2016 Elsevier Inc. Source

Seshadri R.A.,Cancer Institute WIA | Srinivasan A.,Apollo Speciality Hospitals | Tapkire R.,Cancer Institute WIA | Swaminathan R.,Cancer Institute WIA
Surgical Endoscopy and Other Interventional Techniques | Year: 2012

Background Neoadjuvant chemoradiation (nCRT) currently is commonly incorporated into the multimodal treatment of locally advanced rectal cancers. This study aimed to compare the short-term outcomes and oncologic adequacy of laparoscopic and conventional open surgery for rectal cancer after nCRT. Methods A series of 72 patients who underwent laparoscopic surgery (Lap group) for rectal cancer after nCRT were matched for type of surgery, gender, and American Society of Anesthesiologists (ASA) class with 72 patients who underwent conventional surgery during the same time period (Open group). The short-term outcomes were compared between the two groups of patients. Results No significant difference was found between the two groups in terms of age, distance of tumor from the anal verge, body mass index, or posttreatment pathologic stage of the disease. There were significant differences between the Lap and Open groups in terms of blood loss (median: 200 vs 400 ml; P<0.001), duration of surgery (median: 270 vs 240 min; P<0.001), time to passing of first flatus (median: 2 vs 3 days; P<0.001), time to start of normal diet (median: 5 vs 6 days; P<0.001), and hospital stay (median: 12 vs 15 days; P<0.001). A significant difference in the number of lymph nodes harvested was not identified between the two groups, although more patients in the Open group had a positive circumferential resection margin than in the Lap group (10 vs 1%; P = 0.03). The short-term benefits of laparoscopic surgery also were observed when the 64 patients who underwent abdominoperineal resection (APR) in each of the two groups were compared separately. Conclusion Laparoscopic surgery for rectal cancer, especially laparoscopic APR, after nCRT is safe and associated with earlier recovery of bowel function, a shorter hospital stay, and an oncologically adequate specimen compared with conventional open surgery. © Springer Science+Business Media, LLC 2011. Source

Meenakshi-Sundaram S.,Apollo Speciality Hospitals
Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia | Year: 2013

A 23-year-old woman, who underwent a percutaneous transluminal mitral commissurotomy for a tight mitral stenosis, developed an acute ischemic stroke involving the proximal right middle cerebral artery territory. She had a dense left hemiplegia with a National Institutes of Health Stroke Scale score of 12. She was emergently treated within 1 hour with intra-arterial tenecteplase and made a dramatic recovery. Intra-arterial tenecteplase is an attractive option for treating acute ischemic stroke with proximal or major vessel occlusion. Copyright © 2013 Elsevier Ltd. All rights reserved. Source

Jerome J.T.J.,Hand and Reconstructive Microsurgery | Rajmohan B.,Apollo Speciality Hospitals
Microsurgery | Year: 2012

Combined neurotization of both axillary and suprascapular nerves in shoulder reanimation has been widely accepted in brachial plexus injuries, and the functional outcome is much superior to single nerve transfer. This study describes the surgical anatomy for axillary nerve relative to the available donor nerves and emphasize the salient technical aspects of anterior deltopectoral approach in brachial plexus injuries. Fifteen patients with brachial plexus injury who had axillary nerve neurotizations were evaluated. Five patients had complete avulsion, 9 patients had C5, six patients had brachial plexus injury pattern, and one patient had combined axillary and suprascapular nerve injury. The long head of triceps branch was the donor in C5,6 injuries; nerve to brachialis in combined nerve injury and intercostals for C5-T1 avulsion injuries. All these donors were identified through the anterior approach, and the nerve transfer was done. The recovery of deltoid was found excellent (M5) in C5,6 brachial plexus injuries with an average of 134.4° abduction at follow up of average 34.6 months. The shoulder recovery was good with 130° abduction in a case of combined axillary and suprascapular nerve injury. The deltoid recovery was good (M3) in C5-T1 avulsion injuries patients with an average of 64° shoulder abduction at follow up of 35 months. We believe that anterior approach is simple and easy for all axillary nerve transfers in brachial plexus injuries. © 2012 Wiley Periodicals, Inc. Microsurgery, 2012. Copyright © 2012 Wiley Periodicals, Inc. Source

Jerome J.T.J.,Apollo Speciality Hospitals
Plastic and Reconstructive Surgery | Year: 2011

Shoulder abduction is a very complex movement and quite important for upper limb function, as more distal functions depend on a stable shoulder, especially in C5, C6 brachial plexus injuries. Various studies in the literature have emphasized the importance of improved functional outcome and shoulder reanimation with concomitant neurotization of suprascapular nerve and axillary nerve in C5, C6 brachial plexus injuries. A number of approaches to axillary nerve transfer in brachial plexus injuries have been reported. The author describes an innovative anterior deltopectoral approach for axillary nerve transfers in five patients with C5, C6 brachial plexus injuries. The spinal accessory nerve was neurotized with the suprascapular nerve through a transverse supraclavicular incision. The axillary nerve and the long head of the triceps branch were identified through the anterior deltopectoral approach and neurotized at the posterior cord level. This approach gives easy access to other donors such as the medial pectoral, thoracodorsal, and median and ulnar nerves. Oberlins transfer was also performed for elbow flexion by extending the deltopectoral incision. The regained shoulder active abduction (M5) averaged 120 degrees and active external rotation averaged 65 degrees at the final follow-up of 26 months (average). This anterior deltopectoral approach is an excellent alternative for axillary nerve transfer in brachial plexus injuries and produces results comparable with those of other approaches. All brachial plexus surgeons must understand the anatomy and the relationship of the axillary nerve to the surrounding structures. © 2011 by the American Society of Plastic Surgeons. Source

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