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Articles by A Gupta
Total Records ( 8 ) for A Gupta
  Z Gil , A Gupta , B Kummer , P. G Cordeiro , D. H Kraus , J. P Shah and S. G. Patel
 

Objective  To assess the utility of the pectoralis major muscle flap (PMMF) in patients undergoing salvage total laryngectomy.

Design  Retrospective cohort analysis.

Setting  Tertiary care cancer center.

Patients  The study included 461 patients who underwent laryngectomy. Eighty of them underwent salvage surgery with primary pharyngeal closure.

Interventions  Of the 80 patients, 69 (86%) underwent primary pharyngeal closure alone and 11 (14%) underwent a PMMF, which was used to buttress the pharyngeal suture line.

Main Outcome Measure  Two hundred thirty-six variables were recorded for each patient. Complications related to pharyngeal closure were measured.

Results  Sixty-four percent of the patients who underwent PMMF also underwent chemoradiation therapy as the initial definitive treatment compared with 25% in the non-PMMF group (P = .03). On multivariate analysis, chemoradiation therapy was the only independent predictor of pharyngocutaneous fistula formation (relative risk, 1.82; P = .02). Nevertheless, the pharyngocutaneous fistula rate was similar in the PMMF (27%) and the non-PMMF (24%) groups. Furthermore, similar durations of tube feeding, days to oral feeding, and hospitalization period were recorded in both groups.

Conclusion  The PMMF should be used judiciously as a surgical adjunct in high-risk patients, with the goal of minimizing the risk for the development of a pharyngocutaneous fistula.

  W. C Spanos , P Nowicki , D. W Lee , A Hoover , B Hostager , A Gupta , M. E Anderson and J. H. Lee
 

Background  Human papillomavirus (HPV) is the most identifiable cause of head and neck squamous cell cancer (HNSCC). Compared with HPV-negative HNSCC, HPV-positive HNSCC presents at an advanced stage but with significantly better survival. We created a syngeneic mouse model of HPV-positive and HPV-negative HNSCC by transforming mouse primary tonsil epithelial cells with either HPV oncogenes or a nonantigenic RNA interference strategy that affects similar oncogenic pathways.

Objectives  To examine the effect of radiation therapy on HPV-positive and HPV-negative tumors in immune-competent and immune-incompetent mice and to examine responses in human cancer cell lines.

Design  Prospective in vivo murine model.

Main Outcome Measures  Survival and tumor growth.

Results  For human and murine transformed cell lines, HPV-positive cells were more resistant to radiation and cisplatin therapy compared with HPV-negative cells. In vivo, HPV-positive tumors were more sensitive to radiation, with complete clearance at 20 Gy, compared with their HPV-negative counterparts, which showed persistent growth. Cisplatin in vivo cleared HPV-positive tumors but not HPV-negative tumors. However, neither radiation or cisplatin therapy cured immune-incompetent mice. Adoptive transfer of wild-type immune cells into immune-incompetent mice restored HPV-positive tumor clearance with cisplatin therapy.

Conclusions  The HPV-positive tumors are not more curable based on increased epithelial sensitivity to cisplatin or radiation therapy. Instead, radiation and cisplatin induce an immune response to this antigenic cancer. The implications of these results may lead to novel therapies that enhance tumor eradication for HPV-positive cancers.

  A Oscarsson , A Gupta , M Fredrikson , J Jarhult , M Nystrom , E Pettersson , B Darvish , H Krook , E Swahn and C. Eintrei
  Background

Major adverse cardiac events (MACEs) are a common cause of death after non-cardiac surgery. Despite evidence for the benefit of aspirin for secondary prevention, it is often discontinued in the perioperative period due to the risk of bleeding.

Methods

We conducted a randomized, double-blind, placebo-controlled trial in order to compare the effect of low-dose aspirin with that of placebo on myocardial damage, cardiovascular, and bleeding complications in high-risk patients undergoing non-cardiac surgery. Aspirin (75 mg) or placebo was given 7 days before surgery and continued until the third postoperative day. Patients were followed up for 30 days after surgery.

Results

A total of 220 patients were enrolled, 109 patients received aspirin and 111 received placebo. Four patients (3.7%) in the aspirin group and 10 patients (9.0%) in the placebo group had elevated troponin T levels in the postoperative period (P=0.10). Twelve patients (5.4%) had an MACE during the first 30 postoperative days. Two of these patients (1.8%) were in the aspirin group and 10 patients (9.0%) were in the placebo group (P=0.02). Treatment with aspirin resulted in a 7.2% absolute risk reduction [95% confidence interval (CI), 1.3–13%] for postoperative MACE. The relative risk reduction was 80% (95% CI, 9.2–95%). Numbers needed to treat were 14 (95% CI, 7.6–78). No significant differences in bleeding complications were seen between the two groups.

Conclusions

In high-risk patients undergoing non-cardiac surgery, perioperative aspirin reduced the risk of MACE without increasing bleeding complications. However, the study was not powered to evaluate bleeding complications.

  S. P Thotan , V Kumar , A Gupta , A Mallya and S. Rao
 

Subcutaneous phycomycosis is a rare fungal infection of the deeper layers of skin. We describe a representative case. A 10-year-old boy presented with a large swelling on the back of 3 months duration. Biopsy of the lesion confirmed the diagnosis of subcutaneous phycomycosis. There was complete resolution of the lesion after treatment with oral potassium iodide for 3 months.

  A Gupta , S Jothy , P Somerville and J. S. Zaltzman
 

We report a rare cause of rapidly progressive renal failure associated with low complement, positive ANA but negative anti DS-DNA. A renal biopsy demonstrated tubulointerstitial nephritis with positive immunoglobulin staining involving the interstitium and tubular basement membrane but glomerular sparing. A review of the literature and differential diagnosis are discussed.

  N Prasad , M Jain , A Gupta , R. K Sharma and V. Agarwal
 

Cytomegalovirus (CMV) infection involving the skin is rare. We present a case of a renal transplant recipient who developed fever and axillary, scrotal and penile skin ulcers after renal transplantation. The skin ulcers did not heal with antibiotics. The skin biopsy revealed CMV inclusion bodies, CMV antigen on immunohistochemistry and high CMV DNA copies. The patient was diagnosed with CMV cutaneous ulcers. The skin ulcers healed after treatment with intravenous ganciclovir and oral valganciclovir. The diagnosis of CMV disease should be considered in the febrile immunosuppressed patient with skin ulcers. The biopsy of the cutaneous lesions may provide the diagnostic clue in such patients.

  Z. A Cooper , A Ghosh , A Gupta , T Maity , I. J Benjamin , S. N Vogel , J. D Hasday and I. S. Singh
 

We previously showed that exposure to febrile-range temperatures (FRT, 39.5–40°C) reduces LPS-induced TNF- expression, in part through the direct interaction of heat shock factor-1 (HSF1) with the TNF- gene promoter. However, it is not known whether exposure to FRT also modifies more proximal LPS-induced signaling events. Using HSF1-null mice, we confirmed that HSF1 is required for FRT-induced repression of TNF- in vitro by LPS-stimulated bone marrow-derived macrophages and in vivo in mice challenged intratracheally with LPS. Exposing LPS-stimulated RAW 264.7 mouse macrophages to FRT reduced TNF- expression while increasing IL-1β expression despite the two genes sharing a common myeloid differentiation protein-88 (MyD88)-dependent pathway. Global activation of the three LPS-induced signaling intermediates that lead to cytokine gene expression, ERK and p38 MAPKs and NF-B, was not affected by exposing RAW 264.7 cells to FRT as assessed by ERK and p38 phosphorylation and NF-B in vitro DNA-binding activity and activation of a NF-B-dependent synthetic promoter. However, chromatin immunoprecipitation (ChIP) analysis demonstrated that exposure to FRT reduced LPS-induced recruitment of NF-B p65 to the TNF- promoter while simultaneously increasing its recruitment to the IL-1β promoter. These data suggest that FRT exerts its effects on cytokine gene expression in a gene-specific manner through distal effects on promoter activation rather than proximal receptor activation and signal transduction.

  D. K Park , H. A Fogel , S Bhatia , B. R Bach , A Gupta , E. F Shewman , V Wang , N Verma and M. T. Provencher
  Background

In sum, 1-, 2-, and 4-stranded allografts are used for soft tissue anterior cruciate ligament reconstruction; however, the fixation properties of fixation devices are not well assessed.

Hypothesis

There are no differences in the biomechanical characteristics of 1 (Achilles)-, 2 (posterior tibialis)-, and 4 (semitendinosus)-stranded allograft tibial fixation.

Study Design

Controlled laboratory study.

Methods

Sixty-three fresh-frozen porcine tibiae were used to evaluate the fixation of 1-, 2-, and 4-stranded human tendon allografts (Achilles, posterior tibialis, and semitendinosus) with 3 fixation devices (Delta, Intrafix, and Calaxo screws). With use of a materials testing system, each graft was subjected to 500 cycles of loading (50–250 N, 0.75 mm/sec) to determine displacement and cyclic stiffness, followed by a monotonic failure test (20 mm/min) to determine maximum load and pullout stiffness.

Results

For each graft type, there were no significant biomechanical differences between fixation devices. However, the 1-stranded graft (Achilles) construct demonstrated significantly higher mean displacement (3.17 ± 1.62 mm), lower cyclical stiffness (156 ± 25 N/mm), lower load to failure (479 ± 87 N), and lower pullout stiffness (140 ± 28 N/mm). In comparison with the 2-stranded graft (posterior tibialis), the 4-stranded graft (semitendinosus) exhibited lower displacement (0.86 ± 0.44 to 1.12 ± 0.51 mm) and higher ultimate failure load (832 ± 255 to 656 ± 168 N). Numerous differences in fixation properties were noted when comparing a device to each of the 3 grafts.

Conclusion

The 1-stranded allograft demonstrated inferior biomechanical tibial fixation properties when compared with 2 (posterior tibialis)- and 4 (semitendinosus)-stranded allograft constructs for all fixation devices tested.

Clinical Relevance

This study demonstrated that not all tibial fixation devices are designed to adequately accommodate different types of anterior cruciate ligament allografts. Biomechanical evidence suggests that caution is warranted when using an Achilles allograft fixated solely with an interference device.

 
 
 
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