357 results on '"Abhinav Goyal"'
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2. Improved circuitry and post-processing for interleaved fast-scan cyclic voltammetry and electrophysiology measurements
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Ashwin K. Avula, Abhinav Goyal, Aaron E. Rusheen, Jason Yuen, Warren O. Dennis, Diane R. Eaker, Joshua B. Boesche, Charles D. Blaha, Kevin E. Bennet, Kendall H. Lee, Hojin Shin, and Yoonbae Oh
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fast-scan cyclic voltammetry ,electrophysiological recording ,post signal processing ,dopamine ,electrochemistry ,Electrical engineering. Electronics. Nuclear engineering ,TK1-9971 - Abstract
The combination of electrophysiology and electrochemistry acquisition methods using a single carbon fiber microelectrode (CFM) in the brain has enabled more extensive analysis of neurochemical release, neural activity, and animal behavior. Predominantly, analog CMOS (Complementary Metal Oxide Semiconductor) switches are used for these interleaved applications to alternate the CFM output between electrophysiology and electrochemistry acquisition circuitry. However, one underlying issue with analog CMOS switches is the introduction of transient voltage artifacts in recorded electrophysiology signals resulting from CMOS charge injection. These injected artifacts attenuate electrophysiology data and delay reliable signal observation after every switch actuation from electrochemistry acquisition. Previously published attempts at interleaved electrophysiology and electrochemistry were able to recover reliable electrophysiology data within approximately 10–50 ms after switch actuation by employing various high-pass filtering methods to mitigate the observed voltage artifacts. However, high-pass filtering of this nature also attenuates valuable portions of the local-field potential (LFP) frequency range, thus limiting the extent of network-level insights that can be derived from in vivo measurements. This paper proposes a solution to overcome the limitation of charge injection artifacts that affect electrophysiological data while preserving important lower-frequency LFP bands. A voltage follower operational amplifier was integrated before the CMOS switch to increase current flow to the switch and dissipate any injected charge. This hardware addition resulted in a 16.98% decrease in electrophysiology acquisition delay compared to circuitry without a voltage follower. Additionally, single-term exponential modeling was implemented in post-processing to characterize and subtract remaining transient voltage artifacts in recorded electrophysiology data. As a result, electrophysiology data was reliably recovered 3.26 ± 0.22 ms after the beginning of the acquisition period (a 60% decrease from previous studies), while also minimizing LFP attenuation. Through these advancements, coupled electrophysiology and electrochemistry measurements can be conducted at higher scan rates while retaining data integrity for a more comprehensive analysis of neural activity and neurochemical release.
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- 2023
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3. Oxycodone-induced dopaminergic and respiratory effects are modulated by deep brain stimulation
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Jason Yuen, Abhinav Goyal, Aaron E. Rusheen, Abbas Z. Kouzani, Michael Berk, Jee Hyun Kim, Susannah J. Tye, Osama A. Abulseoud, Tyler S. Oesterle, Charles D. Blaha, Kevin E. Bennet, Kendall H. Lee, Yoonbae Oh, and Hojin Shin
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substance use disorder ,deep brain stimulation ,nucleus accumbens ,ventral tegmental area ,oxycodone ,dopamine ,Therapeutics. Pharmacology ,RM1-950 - Abstract
Introduction: Opioids are the leading cause of overdose death in the United States, accounting for almost 70,000 deaths in 2020. Deep brain stimulation (DBS) is a promising new treatment for substance use disorders. Here, we hypothesized that VTA DBS would modulate both the dopaminergic and respiratory effect of oxycodone.Methods: Multiple-cyclic square wave voltammetry (M-CSWV) was used to investigate how deep brain stimulation (130 Hz, 0.2 ms, and 0.2 mA) of the rodent ventral segmental area (VTA), which contains abundant dopaminergic neurons, modulates the acute effects of oxycodone administration (2.5 mg/kg, i.v.) on nucleus accumbens core (NAcc) tonic extracellular dopamine levels and respiratory rate in urethane-anesthetized rats (1.5 g/kg, i.p.).Results: I.V. administration of oxycodone resulted in an increase in NAcc tonic dopamine levels (296.9 ± 37.0 nM) compared to baseline (150.7 ± 15.5 nM) and saline administration (152.0 ± 16.1 nM) (296.9 ± 37.0 vs. 150.7 ± 15.5 vs. 152.0 ± 16.1, respectively, p = 0.022, n = 5). This robust oxycodone-induced increase in NAcc dopamine concentration was associated with a sharp reduction in respiratory rate (111.7 ± 2.6 min−1 vs. 67.9 ± 8.3 min−1; pre- vs. post-oxycodone; p < 0.001). Continuous DBS targeted at the VTA (n = 5) reduced baseline dopamine levels, attenuated the oxycodone-induced increase in dopamine levels to (+39.0% vs. +95%), and respiratory depression (121.5 ± 6.7 min−1 vs. 105.2 ± 4.1 min−1; pre- vs. post-oxycodone; p = 0.072).Discussion: Here we demonstrated VTA DBS alleviates oxycodone-induced increases in NAcc dopamine levels and reverses respiratory suppression. These results support the possibility of using neuromodulation technology for treatment of drug addiction.
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- 2023
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4. High frequency deep brain stimulation can mitigate the acute effects of cocaine administration on tonic dopamine levels in the rat nucleus accumbens
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Jason Yuen, Abhinav Goyal, Aaron E. Rusheen, Abbas Z. Kouzani, Michael Berk, Jee Hyun Kim, Susannah J. Tye, Charles D. Blaha, Kevin E. Bennet, Kendall H. Lee, Hojin Shin, and Yoonbae Oh
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substance use disorder ,deep brain stimulation ,nucleus accumbens ,ventral tegmental area ,cocaine ,tonic dopamine ,Neurosciences. Biological psychiatry. Neuropsychiatry ,RC321-571 - Abstract
Cocaine’s addictive properties stem from its capacity to increase tonic extracellular dopamine levels in the nucleus accumbens (NAc). The ventral tegmental area (VTA) is a principal source of NAc dopamine. To investigate how high frequency stimulation (HFS) of the rodent VTA or nucleus accumbens core (NAcc) modulates the acute effects of cocaine administration on NAcc tonic dopamine levels multiple-cyclic square wave voltammetry (M-CSWV) was used. VTA HFS alone decreased NAcc tonic dopamine levels by 42%. NAcc HFS alone resulted in an initial decrease in tonic dopamine levels followed by a return to baseline. VTA or NAcc HFS following cocaine administration prevented the cocaine-induced increase in NAcc tonic dopamine. The present results suggest a possible underlying mechanism of NAc deep brain stimulation (DBS) in the treatment of substance use disorders (SUDs) and the possibility of treating SUD by abolishing dopamine release elicited by cocaine and other drugs of abuse by DBS in VTA, although further studies with chronic addiction models are required to confirm that. Furthermore, we demonstrated the use of M-CSWV can reliably measure tonic dopamine levels in vivo with both drug administration and DBS with minimal artifacts.
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- 2023
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5. Enhanced Dopamine Sensitivity Using Steered Fast-Scan Cyclic Voltammetry
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Yumin Kang, Abhinav Goyal, Sangmun Hwang, Cheonho Park, Hyun U. Cho, Hojin Shin, Jinsick Park, Kevin E. Bennet, Kendall H. Lee, Yoonbae Oh, and Dong Pyo Jang
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Chemistry ,QD1-999 - Published
- 2021
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6. Emergency Interhospital Transfer of Patients With ST‐Segment–Elevation Myocardial Infarction: Call 9‐1‐1—The American Heart Association Mission: Lifeline Program
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William J. French, Mic Gunderson, David Travis, Mark Bieniarz, Jessica Zegre‐Hemsey, Abhinav Goyal, and Alice K. Jacobs
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acute myocardial infarction ,Call 9‐1‐1 ,STAT TRANSFER ,STEMI ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
ABSTRACT: The American Heart Association Mission: Lifeline program objectives are to improve the quality of care and outcomes for patients with ST‐segment–elevation myocardial infarction. Every minute of delay in treatment adversely affects 1‐year mortality. Transfer of patients safely and timely to hospitals with primary percutaneous coronary intervention capability is needed to improve outcomes. But treatment times continue to show delays, especially during interhospital transfers. A simple 3‐step process of an interhospital “Call 9‐1‐1” protocol may expedite this process. This STAT TRANSFER process uses a systems approach that considers diverse ways in which patients access care, how EMS responds and determines destinations, how referring hospital transfers are performed, urban and rural differences, and how receiving hospitals prepare for an incoming patient with ST‐segment–elevation myocardial infarction. This initiative suggests a strategy to reduce variability in interhospital transfer times using a STAT TRANSFER and a Call 9‐1‐1 process in a system of care that involves all stakeholders.
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- 2022
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7. Software for near-real-time voltammetric tracking of tonic neurotransmitter levels in vivo
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Abhinav Goyal, Sangmun Hwang, Aaron E. Rusheen, Charles D. Blaha, Kevin E. Bennet, Kendall H. Lee, Dong Pyo Jang, Yoonbae Oh, and Hojin Shin
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cyclic voltammetry ,tonic neurotransmitters ,electrochemistry software ,computational neuroscience ,signal processing ,Neurosciences. Biological psychiatry. Neuropsychiatry ,RC321-571 - Abstract
Tonic extracellular neurotransmitter concentrations are important modulators of central network homeostasis. Disruptions in these tonic levels are thought to play a role in neurologic and psychiatric disease. Therefore, ways to improve their quantification are actively being investigated. Previously published voltammetric software packages have implemented FSCV, which is not capable of measuring tonic concentrations of neurotransmitters in vivo. In this paper, custom software was developed for near-real-time tracking (scans every 10 s) of neurotransmitters’ tonic concentrations with high sensitivity and spatiotemporal resolution both in vitro and in vivo using cyclic voltammetry combined with dynamic background subtraction (M-CSWV and FSCAV). This software was designed with flexibility, speed, and user-friendliness in mind. This software enables near-real-time measurement by reducing data analysis time through an optimized modeling algorithm, and efficient memory handling makes long-term measurement possible. The software permits customization of the cyclic voltammetric waveform shape, enabling experiments to detect a specific analyte of interest. Finally, flexibility considerations allow the user to alter the fitting parameters, filtering characteristics, and size and shape of the analyte kernel, based on data obtained live during the experiment to obtain accurate measurements as experimental conditions change. Herein, the design and advantages of this near-real-time voltammetric software are described, and its use is demonstrated in in vivo experiments.
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- 2022
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8. Automatic and Reliable Quantification of Tonic Dopamine Concentrations In Vivo Using a Novel Probabilistic Inference Method
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Jaekyung Kim, Abhijeet S. Barath, Aaron E. Rusheen, Juan M. Rojas Cabrera, J. Blair Price, Hojin Shin, Abhinav Goyal, Jason W. Yuen, Danielle E. Jondal, Charles D. Blaha, Kendall H. Lee, Dong Pyo Jang, and Yoonbae Oh
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Chemistry ,QD1-999 - Published
- 2021
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9. Heart failure documentation in outpatients with diabetes and volume overload: an observational cohort study from the Diabetes Collaborative Registry
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Suzanne V. Arnold, Philip G. Jones, Michael Beasley, Jeanine Cordova, Abhinav Goyal, Gregg C. Fonarow, and Leo Seman
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Heart failure ,Diabetes ,Quality of care ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Abstract Background Heart failure is a common and devastating complication of type 2 diabetes (T2D). Prompt recognition of heart failure may avert hospitalization, facilitate use of guideline-directed therapies, and impact choice of T2D medications. We sought to determine the rate and factors associated with heart failure documentation in T2D patients with evidence of volume overload requiring loop diuretics. Methods DCR is an on-going, prospective US registry of outpatient T2D patients from > 5000 cardiology, endocrinology, and primary care clinicians (current analysis used data from 2013–2019). Among T2D patients receiving loop diuretics, we examined the rate of chart documentation of heart failure. We used a 3-level hierarchical logistic regression model (patients nested within physician within practice) to examine factors associated with heart failure diagnosis. Results Among 1,322,640 adults with T2D, 225,125 (17.0%) were receiving a loop diuretic, of whom 91,969 (40.9%) had documentation of heart failure. Male sex, lower body mass index, atrial fibrillation, chronic kidney disease, and coronary artery disease were associated with greater odds of heart failure diagnosis. After accounting for patient factors, patients seen by cardiologists were the most likely to have HF documented followed by PCPs and then endocrinologists. Conclusions Among US outpatients with T2D, 17% of patients had evidence of volume overload—defined by loop diuretic prescription—of whom fewer than half had a clinical diagnosis of heart failure. While there may be non-heart failure indications for loop diuretics, our data suggest that a substantial proportion of T2D patients may have unrecognized heart failure and therefore could be missing opportunities for targeted therapies that could alter the clinical course of heart failure.
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- 2020
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10. Functionally distinct high and low theta oscillations in the human hippocampus
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Abhinav Goyal, Jonathan Miller, Salman E. Qasim, Andrew J. Watrous, Honghui Zhang, Joel M. Stein, Cory S. Inman, Robert E. Gross, Jon T. Willie, Bradley Lega, Jui-Jui Lin, Ashwini Sharan, Chengyuan Wu, Michael R. Sperling, Sameer A. Sheth, Guy M. McKhann, Elliot H. Smith, Catherine Schevon, and Joshua Jacobs
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Science - Abstract
We show that the human hippocampus exhibits two distinct theta oscillations during spatial navigation with the faster oscillation in posterior regions showing movement modulation. This result suggests a distinct feature of the human hippocampus compared to rodents, which generally show a single 8 Hz rhythm.
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- 2020
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11. Invariant patterns of clonal succession determine specific clinical features of myelodysplastic syndromes
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Yasunobu Nagata, Hideki Makishima, Cassandra M. Kerr, Bartlomiej P. Przychodzen, Mai Aly, Abhinav Goyal, Hassan Awada, Mohammad Fahad Asad, Teodora Kuzmanovic, Hiromichi Suzuki, Tetsuichi Yoshizato, Kenichi Yoshida, Kenichi Chiba, Hiroko Tanaka, Yuichi Shiraishi, Satoru Miyano, Sudipto Mukherjee, Thomas LaFramboise, Aziz Nazha, Mikkael A. Sekeres, Tomas Radivoyevitch, Torsten Haferlach, Seishi Ogawa, and Jaroslaw P. Maciejewski
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Science - Abstract
Stepwise acquisition of mutations gives rise to myelodysplastic syndrome (MDS) in older adults. Here, the authors infer the clonal hierarchy of 1809 MDS patients, revealing insights into the evolution of dominant/secondary mutations and how these impact clinical phenotypes like leukemic progression and therapy response.
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- 2019
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12. Polypharmacy and mortality association by chronic kidney disease status: The REasons for Geographic And Racial Differences in Stroke Study
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Winn Cashion, William McClellan, Suzanne Judd, Abhinav Goyal, David Kleinbaum, Michael Goodman, Valerie Prince, Paul Muntner, and George Howard
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chronic kidney disease ,epidemiology ,mortality ,polypharmacy ,REGARDS cohort study ,Therapeutics. Pharmacology ,RM1-950 - Abstract
Abstract Many Americans take multiple medications simultaneously (polypharmacy). Polypharmacy's effects on mortality are uncertain. We endeavored to assess the association between polypharmacy and mortality in a large U.S. cohort and examine potential effect modification by chronic kidney disease (CKD) status. The REasons for Geographic And Racial Differences in Stroke cohort data (n = 29 627, comprised of U.S. black and white adults) were used. During a baseline home visit, pill bottle inspections ascertained medications used in the previous 2 weeks. Polypharmacy status (major [≥8 ingredients], minor [6–7 ingredients], and none [0–5 ingredients]) was determined by counting the total number of generic ingredients. Cox models (time‐on‐study and age‐time‐scale methods) assessed the association between polypharmacy and mortality. Alternative models examined confounding by indication and possible effect modification by CKD. Over 4.9 years median follow‐up, 2538 deaths were observed. Major polypharmacy was associated with increased mortality in all models, with hazard ratios and 95% confidence intervals ranging from 1.22 (1.07–1.40) to 2.35 (2.15–2.56), with weaker associations in more adjusted models. Minor polypharmacy was associated with mortality in some, but not all, models. The polypharmacy–mortality association did not differ by CKD status. While residual confounding by indication cannot be excluded, in this large American cohort, major polypharmacy was consistently associated with mortality.
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- 2021
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13. Cocaine-Induced Changes in Tonic Dopamine Concentrations Measured Using Multiple-Cyclic Square Wave Voltammetry in vivo
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Jason Yuen, Abhinav Goyal, Aaron E. Rusheen, Abbas Z. Kouzani, Michael Berk, Jee Hyun Kim, Susannah J. Tye, Charles D. Blaha, Kevin E. Bennet, Dong-Pyo Jang, Kendall H. Lee, Hojin Shin, and Yoonbae Oh
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cocaine ,tonic dopamine ,addiction ,voltammetry ,nucleus accumbens ,neuroscience ,Therapeutics. Pharmacology ,RM1-950 - Abstract
For over 40 years, in vivo microdialysis techniques have been at the forefront in measuring the effects of illicit substances on brain tonic extracellular levels of dopamine that underlie many aspects of drug addiction. However, the size of microdialysis probes and sampling rate may limit this technique’s ability to provide an accurate assessment of drug effects in microneural environments. A novel electrochemical method known as multiple-cyclic square wave voltammetry (M-CSWV), was recently developed to measure second-to-second changes in tonic dopamine levels at microelectrodes, providing spatiotemporal resolution superior to microdialysis. Here, we utilized M-CSWV and fast-scan cyclic voltammetry (FSCV) to measure changes in tonic or phasic dopamine release in the nucleus accumbens core (NAcc) after acute cocaine administration. Carbon-fiber microelectrodes (CFM) and stimulating electrodes were implanted into the NAcc and medial forebrain bundle (MFB) of urethane anesthetized (1.5 g/kg i.p.) Sprague-Dawley rats, respectively. Using FSCV, depths of each electrode were optimized by determining maximal MFB electrical stimulation-evoked phasic dopamine release. Changes in phasic responses were measured after a single dose of intravenous saline or cocaine hydrochloride (3 mg/kg; n = 4). In a separate group, changes in tonic dopamine levels were measured using M-CSWV after intravenous saline and after cocaine hydrochloride (3 mg/kg; n = 5). Both the phasic and tonic dopamine responses in the NAcc were augmented by the injection of cocaine compared to saline control. The phasic and tonic levels changed by approximately x2.4 and x1.9, respectively. These increases were largely consistent with previous studies using FSCV and microdialysis. However, the minimal disruption/disturbance of neuronal tissue by the CFM may explain why the baseline tonic dopamine values (134 ± 32 nM) measured by M-CSWV were found to be 10-fold higher when compared to conventional microdialysis. In this study, we demonstrated phasic dopamine dynamics in the NAcc with acute cocaine administration. M-CSWV was able to record rapid changes in tonic levels of dopamine, which cannot be achieved with other current voltammetric techniques. Taken together, M-CSWV has the potential to provide an unprecedented level of physiologic insight into dopamine signaling, both in vitro and in vivo, which will significantly enhance our understanding of neurochemical mechanisms underlying psychiatric conditions.
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- 2021
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14. Temporal trends in the association of social vulnerability and race/ethnicity with county-level COVID-19 incidence and outcomes in the USA: an ecological analysis
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Anurag Mehta, Shivani A Patel, Abhinav Goyal, Arshed A Quyyumi, Shabatun J Islam, Aditi Nayak, Yingtian Hu, Katherine Dieppa, Zakaria Almuwaqqat, Samaah Sullivan, Tené T Lewis, and Alanna A Morris
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Medicine - Abstract
Background The COVID-19 pandemic adversely affected the socially vulnerable and minority communities in the USA initially, but the temporal trends during the year-long pandemic remain unknown.Objective We examined the temporal association of county-level Social Vulnerability Index (SVI), a percentile-based measure of social vulnerability to disasters, its subcomponents and race/ethnic composition with COVID-19 incidence and mortality in the USA in the year starting in March 2020.Methods Counties (n=3091) with ≥50 COVID-19 cases by 6 March 2021 were included in the study. Associations between SVI (and its subcomponents) and county-level racial composition with incidence and death per capita were assessed by fitting a negative-binomial mixed-effects model. This model was also used to examine potential time-varying associations between weekly number of cases/deaths and SVI or racial composition. Data were adjusted for percentage of population aged ≥65 years, state-level testing rate, comorbidities using the average Hierarchical Condition Category score, and environmental factors including average fine particulate matter of diameter ≥2.5 μm, temperature and precipitation.Results Higher SVI, indicative of greater social vulnerability, was independently associated with higher COVID-19 incidence (adjusted incidence rate ratio per 10 percentile increase: 1.02, 95% CI 1.02 to 1.03, p
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- 2021
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15. DeepNavNet: Automated Landmark Localization for Neuronavigation
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Christine A. Edwards, Abhinav Goyal, Aaron E. Rusheen, Abbas Z. Kouzani, and Kendall H. Lee
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deep brain stimulation ,deep learning ,human-machine teaming ,landmark localization ,neuroimaging ,neuronavigation ,Neurosciences. Biological psychiatry. Neuropsychiatry ,RC321-571 - Abstract
Functional neurosurgery requires neuroimaging technologies that enable precise navigation to targeted structures. Insufficient image resolution of deep brain structures necessitates alignment to a brain atlas to indirectly locate targets within preoperative magnetic resonance imaging (MRI) scans. Indirect targeting through atlas-image registration is innately imprecise, increases preoperative planning time, and requires manual identification of anterior and posterior commissure (AC and PC) reference landmarks which is subject to human error. As such, we created a deep learning-based pipeline that consistently and automatically locates, with submillimeter accuracy, the AC and PC anatomical landmarks within MRI volumes without the need for an atlas. Our novel deep learning pipeline (DeepNavNet) regresses from MRI scans to heatmap volumes centered on AC and PC anatomical landmarks to extract their three-dimensional coordinates with submillimeter accuracy. We collated and manually labeled the location of AC and PC points in 1128 publicly available MRI volumes used for training, validation, and inference experiments. Instantiations of our DeepNavNet architecture, as well as a baseline model for reference, were evaluated based on the average 3D localization errors for the AC and PC points across 311 MRI volumes. Our DeepNavNet model significantly outperformed a baseline and achieved a mean 3D localization error of 0.79 ± 0.33 mm and 0.78 ± 0.33 mm between the ground truth and the detected AC and PC points, respectively. In conclusion, the DeepNavNet model pipeline provides submillimeter accuracy for localizing AC and PC anatomical landmarks in MRI volumes, enabling improved surgical efficiency and accuracy.
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- 2021
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16. Case Report: Heparin-induced thrombocytopenia in a patient with COVID-19 [version 2; peer review: 2 approved]
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Ragia Aly, Sachin Gupta, Sorab Gupta, Balraj Singh, Abhinav Goyal, and Sheila Kalathil
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Medicine ,Science - Abstract
With the spread of the novel coronavirus disease of 2019 (COVID-19) worldwide and associated high incidence of thromboembolic complications, the use of heparin is on the rise. It therefore is crucial to identify patients with contraindications for heparin. Heparin-induced thrombocytopenia (HIT) is a life-threatening complication of exposure to heparin. We report a 66-year-old woman, who was admitted to the hospital with COVID-19 infection. Her course was complicated by pulmonary embolism and dialysis catheter thrombosis. Our patient had a known history of HIT. Treatment of this patient with heparin would have been catastrophic. The COVID-19 pandemic has overwhelmed healthcare systems and is causing a global health crisis. Nevertheless, this case serves as a reminder of the importance of making every effort to obtain thorough history and review of records of every patient.
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- 2021
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17. Use of non‐LDL‐C lipid‐lowering medications in patients with type 2 diabetes
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Suzanne V. Arnold, Kensey Gosch, Nathan D. Wong, Vittal Hejjaji, Abhinav Goyal, Lawrence A. Leiter, and Mikhail Kosiborod
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diabetes mellitus ,lipids ,quality of care ,triglycerides ,Diseases of the endocrine glands. Clinical endocrinology ,RC648-665 - Abstract
Abstract Background A number of non‐low‐density lipoprotein cholesterol lipid abnormalities are associated with type 2 diabetes and insulin resistance, which may lead practitioners to use medications targeting these abnormal lipid fractions despite a lack of evidence or guideline recommendations. Methods and Results Among 382 921 US patients with type 2 diabetes (69% with cardiovascular disease, 76% on a statin), 95 995 (26%) were on some nonstatin lipid‐lowering medication—19 265 (5%) on niacin, 32 919 (9%) on a fibrate and 69 513 (18%) on fish oil. Use of all three medications was stable over time and higher in patients with cardiovascular disease and with higher triglyceride levels, although even among patients with triglyceride levels
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- 2020
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18. Long-term survival of implantable cardioverter defibrillator recipients with end-stage renal disease
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Mikhael F. El-Chami, MD, FACC, FHRS, Lea Matar, Paige Smith, RN, Mary Casey, RN, Maher A. Addish, Kimberly Kelly, Research Coordinator, Carolyn Wood, RN, CCDS, John Merlino, MD, Abhinav Goyal, MD MHS, Angel R. Leon, MD, and Faisal M. Merchant, MD
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ESRD ,Sudden cardiac death ,ICD ,Survival ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Background: The efficacy of implantable cardioverter-defibrillators (ICD) for primary prevention of sudden cardiac death (SCD) has not been studied in patients with end-stage renal disease (ESRD) and left ventricular dysfunction. We sought to identify predictors of long-term survival among ICD recipients with and without ESRD. Methods: Patients implanted with an ICD at our institution from January 2006 to March 2014 were retrospectively identified. Clinical and demographic characteristics were collected. Patients were stratified by the presence of ESRD at the time of ICD implant. Mortality data were collected from the Social Security Death Index (SSDI). Results: A total of 3453 patients received an ICD at our institution in the pre-specified time period, 184 (5.3%) of whom had ESRD. In general, ESRD patients were sicker and had more comorbidities. Kaplan Meier survival curve showed that ESRD patients had worse survival as compared with non-dialysis patients (p
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- 2017
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19. Health-Care Utilization and Complications of Endoscopic Esophageal Dilation in a National Population
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Abhinav Goyal, Kshitij Chatterjee, Sujani Yadlapati, and Shailender Singh
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Esophageal stenosis ,Endoscopic dilation ,Inpatients ,Percutaneous endoscopic gastrostomy ,Malignant stricture ,Internal medicine ,RC31-1245 ,Diseases of the digestive system. Gastroenterology ,RC799-869 - Abstract
Background/Aims Esophageal stricture is usually managed with outpatient endoscopic dilation. However, patients with food impaction or failure to thrive undergo inpatient dilation. Esophageal perforation is the most feared complication, and its risk in inpatient setting is unknown. Methods We used National Inpatient Sample (NIS) database for 2007–2013. International Classification of Diseases, 9th revision, Clinical Modification (ICD-9-CM) codes were used to identify patients with esophageal strictures. Logistic regression was used to assess association between hospital/patient characteristics and utilization of esophageal dilation. Results There were 591,187 hospitalizations involving esophageal stricture; 4.2% were malignant. Endoscopic dilation was performed in 28.7% cases. Dilation was more frequently utilized (odds ratio [OR], 1.36; p
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- 2017
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20. Predicting Colonoscopy Time: A Quality Improvement Initiative
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Deepanshu Jain, Abhinav Goyal, and Stacey Zavala
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Colonoscopy ,Total procedure time ,Timing of colonoscopy ,Indication of colonoscopy ,Internal medicine ,RC31-1245 ,Diseases of the digestive system. Gastroenterology ,RC799-869 - Abstract
Background/Aims There is lack of consensus on the optimal time allotted for colonoscopy, which increases patient wait times. Our aim was to identify and quantify the individual pre-procedural factors that determine the total procedure time (TPT) of colonoscopy. Methods This retrospective study involved 4,494 subjects, undergoing outpatient colonoscopy. Effects of age, sex, body mass index, abdominal surgery history, procedure indication (screening, surveillance, or diagnostic), procedure session (morning or afternoon), and endoscopist’s experience (fellow or attending) on TPT were evaluated using multiple regression analysis. A p0.05) as did afternoon session colonoscopies (p=0.004). Less experienced endoscopists had longer TPTs (p>0.05). Screening (p=0.01) and surveillance (p=0.008) colonoscopies had a longer TPT than diagnostic procedures. Overall, the F-value of the regression model was 0.0009. Conclusions The indication for colonoscopy and the time of day have statistically significant associations with TPT. These results will help in streamlining workflow, reduce wait time, and improve patient satisfaction.
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- 2016
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21. Association of Cognitive Impairment With Treatment and Outcomes in Older Myocardial Infarction Patients: A Report From the NCDR Chest Pain–MI Registry
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Akshay Bagai, Anita Y. Chen, Jacob A. Udell, John A. Dodson, David D. McManus, Mathew S. Maurer, Jonathan R. Enriquez, Judith Hochman, Abhinav Goyal, Timothy D. Henry, Martha Gulati, Kirk N. Garratt, Matthew T. Roe, and Karen P. Alexander
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cognitive impairment ,myocardial infarction ,percutaneous coronary intervention ,health services research ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Background Little is known regarding use of cardiac therapies and clinical outcomes among older myocardial infarction (MI) patients with cognitive impairment. Methods and Results Patients ≥65 years old with MI in the NCDR (National Cardiovascular Data Registry) Chest Pain–MI Registry between January 2015 and December 2016 were categorized by presence and degree of chart‐documented cognitive impairment. We evaluated whether cognitive impairment was associated with all‐cause in‐hospital mortality after adjusting for known prognosticators. Among 43 812 ST‐segment–elevation myocardial infarction (STEMI) patients, 3.9% had mild and 2.0% had moderate/severe cognitive impairment; among 90 904 non–ST‐segment–elevation myocardial infarction (NSTEMI patients, 5.7% had mild and 2.6% had moderate/severe cognitive impairment. A statistically significant but numerically small difference in the use of primary percutaneous coronary intervention was observed between patients with STEMI with and without cognitive impairment (none, 92.1% versus mild, 92.8% versus moderate/severe, 90.4%; P=0.03); use of fibrinolysis was lower among patients with cognitive impairment (none, 40.9% versus mild, 27.4% versus moderate/severe, 24.2%; P
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- 2019
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22. Temporal Trends in Utilization of Cardiac Therapies and Outcomes for Myocardial Infarction by Degree of Chronic Kidney Disease: A Report From the NCDR Chest Pain–MI Registry
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Akshay Bagai, Di Lu, Joseph Lucas, Abhinav Goyal, Charles A. Herzog, Tracy Y. Wang, Shaun G. Goodman, and Matthew T. Roe
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chronic kidney disease ,myocardial infarction ,outcomes research ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Background We sought to determine temporal trends in use of evidence‐based therapies and clinical outcomes among myocardial infarction (MI) patients with chronic kidney disease (CKD). Methods and Results MI patients from the NCDR (National Cardiovascular Data Registry) Chest Pain–MI Registry between January 2007 and December 2015 were categorized into 3 groups by degree of CKD (end‐stage renal disease on dialysis, CKD [glomerular filtration rate
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- 2018
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23. Obesity and Cecal Intubation Time
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Deepanshu Jain, Abhinav Goyal, and Jorge Uribe
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Obesity, Body mass index ,Cecal intubation time ,Gender identity ,Internal medicine ,RC31-1245 ,Diseases of the digestive system. Gastroenterology ,RC799-869 - Abstract
Background/Aims: Obesity is a much-debated factor with conflicting evidence regarding its association with cecum intubation rates during colonoscopy. We aimed to identify the association between cecal intubation (CI) time and obesity by eliminating confounding factors. Methods: A retrospective chart review of subjects undergoing outpatient colonoscopy was conducted. The population was categorized by sex and obesity (body mass index [BMI, kg/m2]: I,
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- 2016
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24. Advanced Practice Provider Versus Physician‐Only Outpatient Follow‐Up After Acute Myocardial Infarction
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Jennifer A. Rymer, Anita Y. Chen, Laine Thomas, Judith Stafford, Jonathan R. Enriquez, Abhinav Goyal, Eric D. Peterson, and Tracy Y. Wang
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adherence ,advanced practice providers ,myocardial infarction ,nursing ,readmission ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Background Physician shortages and reimbursement changes have led to greater use of advanced practice providers (APPs). Prevalence of and outcomes associated with APP care following myocardial infarction are unknown. Methods and Results We examined outpatient cardiology or primary care visits within 90 days post‐myocardial infarction among 29 477 Medicare‐insured patients aged ≥65 years from 364 hospitals in Acute Coronary Treatment Intervention Outcomes Network Registry. We compared medication adherence, all‐cause readmission risk, mortality, and major adverse cardiovascular events between patients seen by APPs versus physicians only. Overall, 11% of myocardial infarction patients were treated by an APP. Patients seen by APPs were more likely to have diabetes mellitus (37% versus 33%) and heart failure (20% versus 16%), be discharged to a nursing facility (21% versus 13%) and had more outpatient visits within 90 days post‐discharge (median 6 versus 5, P
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- 2018
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25. Errors in Electronic Health Record–Based Data Query of Statin Prescriptions in Patients With Coronary Artery Disease in a Large, Academic, Multispecialty Clinic Practice
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Eric Y. Shin, Patricia Ochuko, Kunal Bhatt, Brian Howard, Gerard McGorisk, Linda Delaney, Kristan Langdon, Marjan Khosravanipour, Andiran A. Nambi, Allison Grahovec, Douglas C. Morris, Penny Z. Castellano, Leslee J. Shaw, Laurence S. Sperling, and Abhinav Goyal
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coronary artery disease ,electronic health records ,guideline ,performance measure ,statin ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
BackgroundWith the recent implementation of the Medicare Quality Payment Program, providers face increasing accountability for delivering high‐quality care. Such pay‐for‐performance programs aim to leverage systematic data captured by electronic health record (EHR) systems to measure performance; however, the fidelity of EHR query for assessing performance has not been validated compared with manual chart review. We sought to determine whether our institution's methodology of EHR query could accurately identify cases in which providers failed to prescribe statins for eligible patients with coronary artery disease. Methods and ResultsA total of 9459 patients with coronary artery disease were seen at least twice at the Emory Clinic between July 2014 and June 2015, of whom 1338 (14.1%, 95% confidence interval 13.5–14.9%) had no statin prescription or exemption per EHR query. A total of 120 patient cases were randomly selected and reviewed by 2 physicians for further adjudication. Of the 120 cases initially classified as statin prescription failures, only 21 (17.5%; 95% confidence interval, 11.7–25.3%) represented true failure following physician review. ConclusionsSole reliance on EHR data query to measure quality metrics may lead to significant errors in assessing provider performance. Institutions should be cognizant of these potential sources of error, provide support to medical providers, and form collaborative data management teams to promote and improve meaningful use of EHRs. We propose actionable steps to improve the accuracy of EHR data query that require hypothesis testing and prospective validation in future studies.
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- 2018
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26. Quality of Care of the Initial Patient Cohort of the Diabetes Collaborative Registry®
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Suzanne V. Arnold, Abhinav Goyal, Silvio E. Inzucchi, Darren K. McGuire, Fengming Tang, Sanjeev N. Mehta, Laurence S. Sperling, Thomas M. Maddox, Daniel Einhorn, Nathan D. Wong, Niklas Hammar, Peter Fenici, Kamlesh Khunti, Carolyn S. P. Lam, and Mikhail Kosiborod
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diabetes mellitus ,quality of care ,registry ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
BackgroundAlthough guidelines and performance measures exist for patients with diabetes mellitus, achievement of these metrics is not well known. The Diabetes Collaborative Registry® (DCR) was formed to understand the quality of diabetes mellitus care across the primary and specialty care continuum in the United States. Methods and ResultsWe assessed the frequency of achievement of 7 diabetes mellitus–related quality metrics and variability across the Diabetes Collaborative Registry® sites. Among 574 972 patients with diabetes mellitus from 259 US practices, median (interquartile range) achievement of the quality metrics across the practices was the following: (1) glycemic control: 19% (5–47); (2) blood pressure control: 80% (67–88); (3) angiotensin‐converting enzyme inhibitors/angiotensin II receptor blockers in patients with coronary artery disease: 62% (51–69); (4) nephropathy screening: 62% (53–71); (5) eye examination: 0.7% (0.0–79); (6) foot examination: 0.0% (0.0–2.3); and (7) tobacco screening/cessation counseling: 86% (80–94). In hierarchical, modified Poisson regression models, there was substantial variability in meeting these metrics across sites, particularly with documentation of glycemic control and eye and foot examinations. There was also notable variation across specialties, with endocrinology practices performing better on glycemic control and diabetes mellitus foot examinations and cardiology practices succeeding more in blood pressure control and use of angiotensin‐converting enzyme inhibitors/angiotensin II receptor blockers. ConclusionsThe Diabetes Collaborative Registry® was established to document and improve the quality of outpatient diabetes mellitus care. While target achievement of some metrics of cardiovascular risk modification was high, achievement of others was suboptimal and highly variable. This may be attributable to fragmentation of care, lack of ownership among various specialists concerning certain domains of care, incomplete documentation, true gaps in care, or a combination of these factors.
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- 2017
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27. Chronic pain induces generalized enhancement of aversion
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Qiaosheng Zhang, Toby Manders, Ai Phuong Tong, Runtao Yang, Arpan Garg, Erik Martinez, Haocheng Zhou, Jahrane Dale, Abhinav Goyal, Louise Urien, Guang Yang, Zhe Chen, and Jing Wang
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pain ,aversion ,anterior cingulate cortex ,nocicpetive ,coding ,rat ,Medicine ,Science ,Biology (General) ,QH301-705.5 - Abstract
A hallmark feature of chronic pain is its ability to impact other sensory and affective experiences. It is notably associated with hypersensitivity at the site of tissue injury. It is less clear, however, if chronic pain can also induce a generalized site-nonspecific enhancement in the aversive response to nociceptive inputs. Here, we showed that chronic pain in one limb in rats increased the aversive response to acute pain stimuli in the opposite limb, as assessed by conditioned place aversion. Interestingly, neural activities in the anterior cingulate cortex (ACC) correlated with noxious intensities, and optogenetic modulation of ACC neurons showed bidirectional control of the aversive response to acute pain. Chronic pain, however, altered acute pain intensity representation in the ACC to increase the aversive response to noxious stimuli at anatomically unrelated sites. Thus, chronic pain can disrupt cortical circuitry to enhance the aversive experience in a generalized anatomically nonspecific manner.
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- 2017
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28. A Unique Case of Mycophenolate Induced Colitis after 10 Years of Use
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Abhinav Goyal, Moiz Salahuddin, and Yogesh Govil
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Diseases of the digestive system. Gastroenterology ,RC799-869 - Abstract
A 31-year-old female with a history of lupus nephritis on Hydroxychloroquine, Prednisone, and Mycophenolate Mofetil (MMF) for 10 years presented to the hospital for ankle swelling. On day four, she started to have severe, nonbloody, watery diarrhea with abdominal distension and tenderness. Stool PCR was negative for C. difficile. CT abdomen/pelvis showed gaseous distension of the colon without any obstruction. Flexible sigmoidoscopy revealed a normal looking mucosa. Histopathology showed crypt atrophy and increased crypt apoptosis, consistent with MMF colitis. The diarrhea resolved three days after stopping MMF. Although generally well tolerated, diarrhea is a common side effect of MMF. Most cases occur in the first six months of starting MMF. This case is unique because it describes MMF colitis in lupus after more than 10 years. Thus, MMF colitis should be considered as a differential in patients taking it, regardless of the duration of use.
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- 2016
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29. Use of Aldosterone Antagonist to Treat Diarrhea and Hypokalemia of Ogilvie’s Syndrome
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Pradhum Ram, Abhinav Goyal, Marvin Lu, Joshua Sloan, and William McElhaugh
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Diseases of the digestive system. Gastroenterology ,RC799-869 - Abstract
Ogilvie’s syndrome (OS) is a functional obstruction of the bowel due to an autonomic imbalance. It often presents with diarrhea and is associated with hypokalemia. We present a case of a 70-year-old male who developed severe abdominal distension, watery diarrhea, and persistent hypokalemia status after left hip arthroplasty after suffering from a femoral neck fracture due to a fall and was diagnosed with OS. The persistent hypokalemia was slow to improve despite aggressive repletion because of the high potassium losses in the stool. This is most likely mediated through the increased expression of BK channels in the colonic mucosa. Aldosterone is theorized to have a role in the regulation of BK channels. Spironolactone was subsequently given and resulted in marked improvement of the diarrhea and hypokalemia. Thus, this case suggests a novel therapeutic approach for the treatment of Ogilvie’s syndrome-associated diarrhea and hypokalemia.
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- 2016
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30. A Unique Case of Pancreatic Mass due to Pancreatic Elastofibromatosis
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Abhinav Goyal, Deepanshu Jain, Ishfaq Bhat, and Shailender Singh
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Diseases of the digestive system. Gastroenterology ,RC799-869 - Abstract
Elastofibroma is a benign tumor of the musculoskeletal system characterized by the abnormal accumulation of elastinophilic fibers. It has been classically described for subscapular region but has been reported in several musculoskeletal sites over the years and rarely even in the GI tract but never in pancreas. We therefore present the case of a 45-year-old female who presented with intermittent abdominal pain. CT of abdomen revealed 1.4 cm pancreatic neck lesion without peripancreatic lymphadenopathy. Endoscopic ultrasound (EUS) guided FNA was nondiagnostic. Surgical resection was performed with central pancreatectomy. Histopathology revealed well demarcated nodules of hypocellular collagen with abundant elastic fibers, characteristic of pancreatic elastofibroma. Treatment is not needed unless symptomatic and surgical resection is the preferred therapeutic option when indicated. This case adds another entity to the differential diagnosis of pancreatic mass lesions.
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- 2016
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31. Impact of end stage kidney disease on costs and outcomes of Clostridium difficile infection
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Abhinav Goyal, Kshitij Chatterjee, Sujani Yadlapati, and Janani Rangaswami
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Clostridium difficile ,End-stage renal disease ,End-stage kidney disease ,Cost ,Outcomes ,Infectious and parasitic diseases ,RC109-216 - Abstract
Objectives: To assess the impact of end stage kidney disease (ESKD) on the outcomes of Clostridium difficile infection (CDI), including complications of infection, length of hospital stay, overall mortality, and healthcare burden. Methods: The National Inpatient Sample (NIS) database created by the Agency of Healthcare Research and Quality (AHRQ) was used, covering the years 2009 through 2013. Manufacturer-provided sampling weights were used to produce national estimates. Results: All-cause unadjusted in-hospital mortality was significantly higher for patients with CDI and ESKD than for patients without ESKD (11.6% vs. 7.7%, p
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- 2017
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32. The Emerging Epidemic of Obesity, Diabetes, and the Metabolic Syndrome in China
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Jia Shen, Abhinav Goyal, and Laurence Sperling
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Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Published
- 2012
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33. Use of Remote Monitoring to Improve Outcomes in Patients with Heart Failure: A Pilot Trial
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Ambar Kulshreshtha, Joseph C. Kvedar, Abhinav Goyal, Elkan F. Halpern, and Alice J. Watson
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Medicine - Abstract
Remote monitoring (RM) of homebound heart failure (HF) patients has previously been shown to reduce hospital admissions. We conducted a pilot trial of ambulatory, non-homebound patients recently hospitalized for HF to determine whether RM could be successfully implemented in the ambulatory setting. Eligible patients from Massachusetts General Hospital (𝑛=150) were randomized to a control group (𝑛=68) or to a group that was offered RM (𝑛=82). The participants transmitted vital signs data to a nurse who coordinated care with the physician over the course of the 6-month study. Participants in the RM program had a lower all-cause per person readmission rate (mean=0.64, SD±0.87) compared to the usual care group (mean=0.73, SD±1.51; 𝑃-value=.75) although the difference was not statistically significant. HF-related readmission rate was similarly reduced in participants. This pilot study demonstrates that RM can be successfully implemented in non-homebound HF patients and may reduce readmission rates.
- Published
- 2010
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34. Building Accurate Low Latency ASR for Streaming Voice Search in E-commerce.
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Abhinav Goyal 0003 and Nikesh Garera
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- 2023
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35. End-to-End Speech to Intent Prediction to improve E-commerce Customer Support Voicebot in Hindi and English.
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Abhinav Goyal 0003, Anupam Singh, and Nikesh Garera
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- 2022
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36. Building Accurate Low Latency ASR for Streaming Voice Search.
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Abhinav Goyal 0003 and Nikesh Garera
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- 2023
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37. Comparison of the impact of skull density ratio with alternative skull metrics on magnetic resonance–guided focused ultrasound thalamotomy for tremor
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Jason, Yuen, Abhinav, Goyal, Timothy J, Kaufmann, Lauren M, Jackson, Kai J, Miller, Bryan T, Klassen, Neha, Dhawan, Kendall H, Lee, and Vance T, Lehman
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General Medicine - Abstract
OBJECTIVE One of the key metrics that is used to predict the likelihood of success of MR-guided focused ultrasound (MRgFUS) thalamotomy is the overall calvarial skull density ratio (SDR). However, this measure does not fully predict the sonication parameters that would be required or the technical success rates. The authors aimed to assess other skull characteristics that may also contribute to technical success. METHODS The authors retrospectively studied consecutive patients with essential tremor who were treated by MRgFUS at their center between 2017 and 2021. They evaluated the correlation between the different treatment parameters, particularly maximum power and energy delivered, with a range of patients’ skull metrics and demographics. Machine learning algorithms were applied to investigate whether sonication parameters could be predicted from skull density metrics alone and whether including combined local transducer SDRs with overall calvarial SDR would increase model accuracy. RESULTS A total of 62 patients were included in the study. The mean age was 77.1 (SD 9.2) years, and 78% of treatments (49/63) were performed in males. The mean SDR was 0.51 (SD 0.10). Among the evaluated metrics, SDR had the highest correlation with the maximum power used in treatment (ρ = −0.626, p < 0.001; proportion of local SDR values ≤ 0.8 group also had ρ = +0.626, p < 0.001) and maximum energy delivered (ρ = −0.680, p < 0.001). Machine learning algorithms achieved a moderate ability to predict maximum power and energy required from the local and overall SDRs (accuracy of approximately 80% for maximum power and approximately 55% for maximum energy), and high ability to predict average maximum temperature reached from the local and overall SDRs (approximately 95% accuracy). CONCLUSIONS The authors compared a number of skull metrics against SDR and showed that SDR was one of the best indicators of treatment parameters when used alone. In addition, a number of other machine learning algorithms are proposed that may be explored to improve its accuracy when additional data are obtained. Additional metrics related to eventual sonication parameters should also be identified and explored.
- Published
- 2023
38. Case Report: Heparin-induced thrombocytopenia in a patient with COVID-19 [version 1; peer review: 1 approved, 1 approved with reservations]
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Ragia Aly, Sachin Gupta, Sorab Gupta, Balraj Singh, Abhinav Goyal, and Sheila Kalathil
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Case Report ,Articles ,Heparin-induced thrombocytopenia ,COVID- 19 - Abstract
With the spread of the novel corona virus disease of 20 19 (COVID-19) worldwide and associated high incidence of thromboembolic complications, the use of heparin is on the rise. It therefore is crucial to identify patients with contraindications for heparin. Heparin-induced thrombocytopenia (HIT) is a life-threatening complication of exposure to heparin. We report a 66-year-old woman, who was admitted to the hospital with COVID-19 infection. Her course was complicated by pulmonary embolism and dialysis catheter thrombosis. Our patient had a known history of HIT. Treatment of this patient with heparin would have been catastrophic. The COVID-19 pandemic has overwhelmed healthcare systems and is causing a global health crisis. Nevertheless, this case serves as a reminder of the importance of making every effort to obtain thorough history and review of records of every patient.
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- 2020
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39. A COMPARISON OF EFFECTS OF DEXMEDETOMIDINE VERSUS MIDAZOLAM-FENTANYL ON POST-OPERATIVE RECOVERY, SEDATION, ANALGESIA AND HEMODYNAMIC PARAMETERS IN PATIENTS UNDERGOING MIDDLE EAR SURGERY UNDER LOCAL ANESTHESIA
- Author
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Abhinav Goyal, Garima Bhutani, Meena Singh, Naveen Sharma, Seema Rani, Rahul Saini, and Mohd Fazal Ahmed Makki
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Pharmacology ,Pharmaceutical Science ,Pharmacology (medical) - Abstract
Objective: The objective of the study was to compare the effects of dexmedetomidine versus midazolam-fentanyl on post-operative recovery, sedation, analgesia, and hemodynamic parameters in patients undergoing middle ear surgery under local anesthesia. Methods: Seventy-two patients were randomly divided into two equal groups - Group D (dexmedetomidine) and Group MF (midazolam and fentanyl). Intra operative heart rate, mean blood pressure, respiratory rate (RR), and SPO2 were recorded every 15 min for the 1st 30 min and then at every 30 min interval till the end of the surgery. In post-operative period, hemodynamic parameters, Aldrete score and pain were assessed at every 30 min till the patient was discharged from post anesthesia care unit (PACU). Post-operative sedation of the patient was checked at 1 h, 2 h, 4 h, and 8 h. Observations: Midazolam and fentanyl combination caused more fall in Aldrete scores as compared to dexmedetomidine initially, but readiness to discharge from PACU was similar in both the groups. Patients of MF group had significantly higher sedation scores at post op 2 h, but overall duration of sedation was similar in both the groups. Post-op pain was significantly more in MF group patients, as compared to dexmedetomidine patients at 1.5 h. More number of patients of MF group demanded rescue analgesia in PACU. Both group of drugs caused similar changes in hemodynamic parameters during surgery but in post-operative period, dexmedetomidine produced less decline in RR and oxygen saturation as compared to midazolam and fentanyl combination. Conclusion: The present study concluded that dexmedetomidine seems to be a better alternative to the combination of midazolam plus fentanyl sedation for patients undergoing middle ear surgeries done under local anesthesia due to better analgesia and lesser derangement of hemodynamic parameters in post-operative period.
- Published
- 2022
40. SAFETY MONITORING OF COVID-19 VACCINE: IN A TERTIARY CARE HOSPITAL IN HARYANA
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ARVIND NARWAT, MITALI DUA, and ABHINAV GOYAL
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Pharmacology ,Pharmaceutical Science - Abstract
Objective: The present study aimed to ensure the safety and related potential adverse effects following ChAdOx1 nCoV-19 vaccination (AZD1222) in a scenario when numerous vaccines have been approved on an emergency basis by the WHO and other regulatory agencies to prevent the widespread of COVID-19 infection and to decrease the associated mortality and morbidity. Methods: This study was an open, non-comparative, non-interventional, observational study conducted on healthcare workers of BPS Govt. medical college for women and elderly people who received the first dose of COVID-19 vaccinationChAdOx1 nCoV-19 vaccine (AZD1222) by conducting their interviews and recording the data Results: Between January and March 2021, a total of 1907 participants were enrolled in this study. Out of 1907 recipients, 70 recipients reports adverse drug events following vaccination. Myalgia (0.629%), headache (1.31%), fever (≥ 37.5 °C, 0.839%) and fever with chills (≥ 37.5 °C, 1.048) were the most common adverse events after the first dose of vaccination of ChAdOx1 nCoV-19 vaccine (AZD1222. Throat irritation (0.209 %) and Generalised itching (0.262) were the least common adverse events. Conclusion: ChAdOx1 nCoV-19 (Astrazeneca) has an acceptable safety profile as observed in this study. To our knowledge, very few studies are done that review the safety of COVID-19 vaccines. Further safety data from a larger sample size and of longer duration are warranted to establish safety
- Published
- 2023
41. Use of primary bariatric surgery among patients with obesity and diabetes. Insights from the Diabetes Collaborative Registry
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Priya Jain, Vittal Hejjaji, Merrill B. Thomas, Raul Angel Garcia, Kevin F. Kennedy, Abhinav Goyal, Laurence Sperling, Sandeep R. Das, Samar Hafida, Jonathan R. Enriquez, and Suzanne V. Arnold
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Nutrition and Dietetics ,Endocrinology, Diabetes and Metabolism ,Medicine (miscellaneous) - Published
- 2022
42. Preexisting frailty and outcomes in older patients with acute myocardial infarction
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Jacob A. Udell, Di Lu, Akshay Bagai, John A. Dodson, Nihar R. Desai, Gregg C. Fonarow, Abhinav Goyal, Kirk N. Garratt, Joseph Lucas, William S. Weintraub, Daniel E. Forman, Matthew T. Roe, and Karen P. Alexander
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Canada ,Frailty ,Frail Elderly ,Myocardial Infarction ,Humans ,Female ,Hospital Mortality ,Registries ,Cardiology and Cardiovascular Medicine ,Aged - Abstract
Little is known about the prevalence and prognostic impact of preexisting frailty on acute care and in-hospital outcomes in older adults in the setting of acute myocardial infarction (AMI).Preexisting frailty was assessed at baseline in consecutive AMI patients ≥65 years of age treated at 778 hospitals participating in the NCDR ACTION Registry between January 1, 2015 to December 31, 2016. Three domains of preexisting frailty (cognition, ambulation, and functional independence) were abstracted from chart review and summed in 2 ways: an ACTION Frailty Scale based on responses to 6 groups adapted from the Canadian Study of Health and Aging Clinical Frailty Scale and an ACTION Frailty Score derived by summing a rank score of 0-2 assigned for each grade (total ranged between 0 to 6). Multivariable logistic regression examined the association between assigned frailty by score or scale and in-hospital mortality.Among 143,722 older AMI patients, 108,059 (75.2%) were fit and/or well and 6,484 (4.5%) were vulnerable to frailty, while 7,527 (5.2%) had mild, 3,913 (2.7%) had moderate, 2,715 had (1.9%) severe, and 632 (0.4%) had very severe frailty according to the ACTION Frailty Scale, while 14,392 (10.0%) could not be categorized due to incomplete ascertainment. Frail patients were older, more frequently female, of non-white race and/or ethnicity, and less likely to be treated with guideline-recommended therapies. Increasing severity of frailty by this scale was associated with a step-wise higher risk for in-hospital mortality (P-trend.001). Patient categories of the ACTION Frailty Score provided similar results. After adjustment, each 1-unit increase in Frailty Score was associated with a 12% higher mortality risk (OR 1.12, 95% CI 1.10-1.15).Among older patients with acute myocardial infarction, frailty is common and independently associated with in-hospital mortality. These findings show the importance of pragmatic evaluation of frailty in hospital-level quality scores, guideline recommendations, and incorporation into other registry data collection efforts.
- Published
- 2022
43. Democracy and the pricing of initial public offerings around the world
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Huu Nhan Duong, Abhinav Goyal, Madhu Veeraraghavan, and Vasileios Kallinterakis
- Subjects
Economics and Econometrics ,Corporate governance ,Information asymmetry ,Strategy and Management ,media_common.quotation_subject ,Audit ,Monetary economics ,Venture capital ,Democracy ,Shareholder ,Accounting ,Agency (sociology) ,IPO underpricing ,Business ,Initial public offering ,Finance ,media_common - Abstract
We find a negative relation between democracy and initial public offering (IPO) underpricing for a sample of 23,050 IPOs across 45 countries. The effect of democracy on underpricing is weaker for IPOs audited by Big 4 auditing firms, backed by venture capital firms, and with better disclosure specificity of use of proceeds. Democracy exerts a larger influence on underpricing for firms with higher agency problems, in countries with weaker institutional quality or shareholder protection, and during periods of high investor sentiment or economic policy uncertainty. Overall, our results highlight the importance of democracy in reducing IPO underpricing around the world.
- Published
- 2022
44. Risk Factors Associated With New-Onset Myocardial Perfusion Abnormalities in Kidney Transplant Candidates
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Lehman, Godwin, Ziduo, Zheng, Suprateek, Kundu, Ryan, Cousins, Billy Joe, Mullinax, Yi-An, Ko, Kendra, Little, Andrew, Smith, Arshed, Quyyumi, Abhinav, Goyal, Thomas, Pearson, Valeria, Moncayo, and Adam J, Mitchell
- Subjects
Male ,Perfusion ,Tomography, Emission-Computed, Single-Photon ,Peripheral Arterial Disease ,Risk Factors ,Myocardial Infarction ,Myocardial Ischemia ,Myocardial Perfusion Imaging ,Humans ,Female ,Coronary Artery Disease ,Cardiology and Cardiovascular Medicine ,Kidney Transplantation - Abstract
The optimal coronary artery disease surveillance strategy for end-stage renal disease patients being evaluated for kidney transplantation is unknown. It is unclear what risk factors are associated with the development of new-onset perfusion abnormalities on serial myocardial perfusion imaging. Potential kidney transplant recipients who underwent 2 myocardial perfusion imaging studies at Emory University Hospital between January 2010 and December 2019 were identified. We assessed the frequency of development of any new perfusion defect and development of moderate to severe ischemia (reversible perfusion defect10%) on serial imaging. Finally, we identified the clinical and imaging factors associated with new perfusion defects and explored the association between new perfusion defects and all-cause mortality. History of myocardial infarction (MI) and peripheral artery disease was associated with an increased risk of developing a new perfusion defect. History of MI was also associated with the risk of developing moderate-severe ischemia. Female patients were less likely to develop new perfusion defects or moderate-severe ischemia. There was no association between either outcome and all-cause mortality. In conclusion, a history of MI, peripheral artery disease, and male gender are risk factors for developing new perfusion defects, although only the history of MI and male gender predict moderate to severe ischemia. Interval development of any abnormal perfusion is not associated with increased mortality.
- Published
- 2022
45. Micromagnetic Stimulation (μMS) Controls Dopamine Release: An in vivo Study Using WINCS Harmoni
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Renata Saha, Abhinav Goyal, Jason Yuen, Yoonbae Oh, Robert P. Bloom, Onri J. Benally, Kai Wu, Theoden I. Netoff, Walter C. Low, Kevin E. Bennet, Kendall H. Lee, Hojin Shin, and Jian-Ping Wang
- Subjects
Article - Abstract
ObjectiveResearch into the role of neurotransmitters in regulating normal and pathologic brain functions has made significant progress. Yet, clinical trials that aim to improve therapeutic interventions do not take advantage of thein vivochanges in the neurochemistry that occur in real time during disease progression, drug interactions or response to pharmacological, cognitive, behavioral, and neuromodulation therapies. In this work, we used the WINCSHarmonitool to study the real timein vivochanges in dopamine release in rodent brains for the micromagnetic neuromodulation therapy.ApproachAlthough still in its infancy, micromagnetic stimulation (μMS) using micro-meter sized coils or microcoils (μcoils) has shown incredible promise in spatially selective, galvanic contact free and highly focal neuromodulation. These μcoils are powered by a time-varying current which generates a magnetic field. As per Faraday’s Laws of Electromagnetic Induction, this magnetic field induces an electric field in a conducting medium (here, the brain tissues). We used a solenoidal-shaped μcoil to stimulate the medial forebrain bundle (MFB) of the rodent brainin vivo. The evokedin vivodopamine releases in the striatum were tracked in real time by carbon fiber microelectrodes (CFM) using fast scan cyclic voltammetry (FSCV).ResultsOur experiments report that μcoils can successfully activate the MFB in rodent brains, triggering dopamine releasein vivo. We further show that the successful release of dopamine upon micromagnetic stimulation is dependent on the orientation of the μcoil. Furthermore, varied intensities of μMS can control the concentration of dopamine releases in the striatum.SignificanceThis work helps us better understand the brain and its conditions arising from a new therapeutic intervention, like μMS, at the level of neurotransmitter release. Despite its early stage, this study potentially paves the path for μMS to enter the clinical world as a precisely controlled and optimized neuromodulation therapy.
- Published
- 2023
46. Deep brain stimulation alleviates tics in Tourette syndrome via striatal dopamine transmission
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Aaron E Rusheen, Juan Rojas-Cabrera, Abhinav Goyal, Hojin Shin, Jason Yuen, Dong-Pyo Jang, Keven E Bennet, Charles D Blaha, Kendall H Lee, and Yoonbae Oh
- Subjects
Neurology (clinical) - Abstract
Tourette syndrome is a childhood-onset neuropsychiatric disorder characterized by intrusive motor and vocal tics that can lead to self-injury and deleterious mental health complications. While dysfunction in striatal dopamine neurotransmission has been proposed to underlie tic behavior, evidence is scarce and inconclusive. Deep brain stimulation (DBS) of the thalamic centromedian parafascicular complex (CMPf), an approved surgical interventive treatment for medical refractory Tourette syndrome, may reduce tics by affecting striatal dopamine release. Here, we use electrophysiology, electrochemistry, optogenetics, pharmacological treatments, and behavioral measurements to mechanistically examine how thalamic DBS modulates synaptic and tonic dopamine activity in the dorsomedial striatum. Previous studies demonstrated focal disruption of GABAergic transmission in the dorsolateral striatum of rats led to repetitive motor tics recapitulating the major symptom of Tourette Syndrome. We employed this model under light anesthesia and found CMPf DBS evoked synaptic dopamine release and elevated tonic dopamine levels via striatal cholinergic interneurons while concomitantly reducing motor tic behavior. The improvement in tic behavior was found to be mediated by D2 receptor activation as blocking this receptor prevented the therapeutic response. Our results demonstrate that release of striatal dopamine mediates the therapeutic effects of CMPf DBS, and points to striatal dopamine dysfunction as a driver for motor tics in the pathoneurophysiology of Tourette syndrome.
- Published
- 2023
47. Signet Ring Cell Carcinoma Presenting as a Necrotic Duodenocolic Fistulizing Mass
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Shiva F Naidoo, Hamzah Shariff, Dhruv Lowe, Abhinav Goyal, and Divey Manocha
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General Engineering - Published
- 2023
48. Abstract WP80: The Heart-brain Connection: Implementing Strategies To Reduce The Rate Of Perioperative Stroke For Patients Undergoing Coronary Artery Bypass Graft Surgery
- Author
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Deborah Westover, Wendy Wright, Iman Aziz, Abhinav Goyal, W B Keeling, Kendra J Grubb, Gaetano Paone, Julie Shoffstall, Antasia Giebler, Robert Groff, Dee Lacey, Karima Benameur, Sylvia Yaw, and Fadi B Nahab
- Subjects
Advanced and Specialized Nursing ,Neurology (clinical) ,Cardiology and Cardiovascular Medicine - Abstract
Background: Stroke is a known complication of cardiac surgery. The objective of this study was to implement a systemwide strategy to reduce perioperative stroke after isolated coronary artery bypass graft (CABG) surgery utilizing best practices from cardiothoracic surgery and neurology expertise. Methods: A prospective, quality improvement study of all isolated CABG patients at three hospitals within a multicenter academic healthcare system, in a large metropolitan area, was completed from January 1, 2021 to June 30, 2022. Utilizing Lean methodology, a multidisciplinary team of cardiothoracic surgeons, neurologists, anesthesiologists, certified stroke nurses, and process improvement specialists conducted a gap analysis to identify interventions to decrease the observed to expected (O/E) ratio of risk-adjusted perioperative strokes. The team developed a pre-operative evaluation process for patients with a history of stroke, formalized the utilization of intra-operative epiaortic ultrasound, and deployed education on BE-FAST symptoms and the purpose of stroke alerts to providers, nurses, and ancillary staff caring for the patient population. Results: During the study period, 1175 patients underwent isolated CABG. Risk adjusted perioperative stroke rates in the first 6 months of 2021 compared to 2022 declined from an O/E ratio of 1.32 to 0.78. Among patients with new post-operative stroke symptoms, the time frame from last known well to symptom recognition decreased from 704 to 486 minutes. Following the implementation of the protocol, one site saw the utilization of inpatient stroke alerts after CABG increase from 81.3% to 100% for patients with new BE-FAST symptoms. Conclusion: Multidisciplinary implementation of best practices was associated with lower risk adjusted perioperative stroke rates, reductions in time to new symptom recognition, and increased utilization of inpatient stroke alert processes. Further study is needed to monitor the effects of the pre-operative evaluation process and the standardization of epiaortic ultrasound. Future goals are to standardize the methods and assess the benefit to other types of cardiac surgery.
- Published
- 2023
49. Lead from the Front: Does Shareholder Interlock Board of Directors Create Value?
- Author
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Chen Wang, Wenxuan Hou, Abhinav Goyal, and Qing Ye
- Published
- 2023
50. Parallelization of industrial process control program based on the technique of differential evolution using multi-threading.
- Author
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Rajeev Agrawal, Abhinav Goyal 0001, Debjani Sambasivam, and Arya K. Bhattacharya
- Published
- 2014
- Full Text
- View/download PDF
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