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Journal of Innovative Optical Health Sciences 2011年第2期4卷 173-182页

作者： rammohan v.maikala YAGESH N.BHAMBHANIy Liberty Mutual Research Institute for Safety 71 Frankland Road HopkintonMA 01748USA Faculty of Rehabilitation Medicine University of Alberta Edmonton Alberta T6G 2G4Canada

Understanding muscle hemodynamics using near-infrared spectroscopy is increasingly evident in the recent spinal disorders-related ***,none of these human studies addressed the issue of physiological limits for the lumbar muscle within the same participants during various exercise *** purpose of this study is to evaluate physiological limits for the lumbar muscle during dynamic and static endurance *** three separate days,22 healthy men and women performed three endurance protocols(static prone trunk extension,arm cranking,and pushingpulling)until volitional *** each protocol,minimum and maximum oxygenation and blood volume responses from the right lumbar erector spinae were obtained using a continuous dual wavelength near-infrared spectroscopy(Micro-Runman,NIM Inc.,PA,USA).Statistical analysis showed that greatest reduction in oxygenation(minimum)were obtained during dynamic exercises:pushingpulling(2.1 times)and arm cranking(2.03 times)versus static test (Pvery and minimum at the point of volitional exhaustion)during static test was lower[(66-75%for oxygenation)and(34-46%for blood volume)]than dynamic exercises (Pvolitional exhaustion might be a good alternative in establishing near-infrared spectroscopy-derived physiological limits to the lumbar *** research is essential to identify an optimal calibration procedure for establishing true hypoxic values for the human lumbar muscle.

关键词： Arm cranking back muscle endurance gender differences oxygenation and blood volume pushingpulling Sorensen test

Post-transplant immunosuppression and COvID-19:From a double whammy to a mixed blessing

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World Journal of Transplantation 2020年第9期10卷 267-276页

作者： Ashwin rammohan The Institute of Liver Disease and Transplantation Dr.Rela Institute and Medical CentreChennai 600044India

The coronavirus pandemic(COvID-19)has had an unprecedented effect on various disease processes and their ***-19 is likely to have a complex pathophysiological interplay with the post-transplant patients;one affecting the clinical course and outcome of the *** the absence of validated data from trials,there is strong dependence on experience based on previous similar epidemics(SARS/MERS),and from consensus based on expert *** the fact that our knowledge is rapidly evolving with time,there still is relatively limited objective data on the effect of COvID-19 on the human *** questions remain unanswered,one of which involves the management of immunosuppression in the post-transplant recipient during this *** core tenet of which continues to be that of establishing an equipoise between infection and *** review summarises the current knowledge on immune interactions of the virus,the immunomodulatory effects that may be at play,and its relation to the art of immunosuppression.

关键词： COvID-19 Post-transplant immunosuppression Immunity Review

Robotic donor hepatectomy:Are we there yet?

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World Journal of Gastrointestinal Surgery 2021年第7期13卷 668-677页

作者： Ashwin rammohan Mohamed Rela Institute of Liver Disease&Transplantation Dr.Rela Institute&Medical CentreBharath Institute of Higher Education&ResearchChennai 600044India

In living donor liver transplantation(LDLT)the safety of the live donor(LD)is of paramount *** all efforts,the morbidity rates approach 25%-40%with conventional open donor hepatectomy(DH)***,most of these complications are related to the operative wound and despite increased selfesteem and satisfaction in various quality of life analyses on LD,the most common grievance is that of the *** safe and precise DH through a conventional laparoscopic approach is a formidable task with a precipitous learning curve for the whole *** to the ramifications the donor operation carries for the donor,the recipient,the transplant team and for the LDLT program in general,the development and acceptance of minimally invasive DH(MIDH)has been *** robotic surgical system overcomes the reduced visualization,restricted range of motion and physiological tremor associated with laparoscopic surgery and allows for a comparatively easier transition from technical feasibility to ***,many questions especially with regards to standardization of surgical technique,comparison of outcomes,understanding of the learning curve,*** *** aim of this review is to provide insights into the evolution of MIDH and highlight the current status of robotic DH,appreciating the existing challenges and its future role.

关键词： Liver transplantation Donor hepatectomy Minimal invasive surgery Robotic surgery Outcomes

Long-term liver allograft fibrosis:A review with emphasis on idiopathic post-transplant hepatitis and chronic antibody mediated rejection

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World Journal of Hepatology 2022年第8期14卷 1541-1549页

作者： Mukul vij Ashwin rammohan Mohamed Rela Department of Pathology Dr.Rela Institute and Medical CenterChennai 600044Tamil NaduIndia Institute of Liver disease and Transplantation Dr.Rela Institute and Medical CenterChennai 600044Tamil NaduIndia

Liver transplantation(LT)is a life-saving surgical procedure and the current standard of care for most patients with end stage liver *** improvements in organ preservation techniques,perioperative care,and immunosuppression,there is better patient and graft survival following LT,and assessment of the liver allograft in long-term survivors is becoming increasingly *** or de novo viral or autoimmune injury remains the most common causes of chronic hepatitis and fibrosis following liver transplantation in ***,no obvious cause can be identified in many adults with controlled recurrent disease and the majority of pediatric LT recipients,as they have been transplanted for non-recurrent liver *** surveillance liver biopsies post LT have been evaluated in several adult and pediatric centers to identify long-term pathological *** findings are frequently present in liver biopsies obtained after a year post *** significance of these findings is uncertain as many of these are seen in protocol liver biopsies from patients with clinically good allograft function and normal liver chemistry *** narrative review summaries the factors predisposing to long-term liver allograft fibrosis,highlighting the putative role of idiopathic post-LT hepatitis and chronic antibody mediated rejection in its pathogenesis.

关键词： Liver allograft fibrosis Long term Idiopathic hepatitis Chronic antibody mediated rejection

Current perspectives on the role of liver transplantation for Langerhans cell histiocytosis:A narrative review

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World Journal of Gastroenterology 2022年第30期28卷 4044-4052页

作者： Jagadeesh Menon Ashwin rammohan Mukul vij Naresh Shanmugam Mohamed Rela Institute of Liver Disease&Transplantation Dr.Rela Institute&Medical CentreBharath Institute of Higher Education&ResearchChennai 600044India

Langerhans cell histiocytosis(LCH)is a malignant disease of the histiocytes involving various organ *** spectrum of liver involvement in LCH ranges from mild transaminitis to end-stage liver *** hallmark of hepatic LCH is secondary sclerosing cholangitis,which manifests due to a progressive destruction of the biliary tree by malignant *** remains the mainstay of treatment for active *** recognition,diagnosis and a systematic approach to the management of LCH can ameliorate the disease ***,the liver involvement in these patients may progress despite the LCH being in *** transplantation(LT)remains central in the management of such *** facets of the management of LCH,especially those with liver involvement remain ***,aspects of LT in LCH with regards to the indication,timing and post-LT management,including immunosuppression and adjuvant therapy,remain *** review summarises the current evidence and discusses the practical aspects of the role of LT in the management of LCH.

关键词： Langerhans cell histiocytosis Liver transplantation Outcomes Management Chemotherapy Ethics

Incidental gall bladder cancers:Are they truly incidental?

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World Journal of Gastrointestinal Oncology 2014年第12期6卷 441-443页

作者： Ashwin rammohan Sathya D Cherukuri Jeswanth Sathyanesan Ravichandran Palaniappan Manoharan Govindan The Institute of Surgical Gastroenterology and Liver Transplantation Centre for GI Bleed Division of HPB diseases Stanley Medical College Hospital Stanley Medical College Hospital

AIM: To seek and analyze features suggestive of gallbladder cancer(GBC) on preoperative imaging and intraoperative findings in patients diagnosed as having incidental GBC(IGBC). METHODS: The study was conducted on 79 patients of IGBC managed in our department over a 10-year period(2003-2012). Review of preoperative imaging and operative notes was done to ascertain any suspicion of ***: Of the 79 patients, Ultrasound abdomen showed diffuse thickening, not suspicious of malignancy in 5 patients, and diffuse suspicious thickening was seen in 4 patients. Focal thickening suspicious of malignancy was present in 24 patients. Preoperative computed tomography/magnetic resonance imaging was done in 9 patients for suspicion of malignancy. In 5 patients, dif-ficult Cholecystectomy was encountered due to dense/inflammatory adhesions. Intraoperative findings showed focal thickening of the gallbladder and a gallbladder mass in 9 and 17 patients respectively. On overall analysis, 37 patients had preoperative imaging or intraoperative findings suggestive of malignancy, which was either a missed GBC or an unsuspected/unexpected GBC. In 42(53.2%) patients, there was no evidence suggestive of malignancy and was an unanticipated ***: Our study highlights a potential and not-so-rare pitfall of Laparoscopic Cholecystectomy. A greater awareness of this clinical entity along with a high index of suspicion and a low threshold for conversion to open procedure, especially in endemic areas may avert avoidable patient morbidity and mortality.

关键词： Incidental gallbladder cancer Preoperative detection Imaging

Combined hepatocellular cholangiocarcinoma: A clinicopathological update

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World Journal of Hepatology 2024年第5期16卷 766-775页

作者： Mukul vij Fadl H veerankutty Ashwin rammohan Mohamed Rela Department of Pathology Institute of Liver Disease and TransplantationChennai 600044India Comprehensive Liver Care Institute VPS LakeshoreCochin 682040India Institute of Liver Disease and Transplantation Dr.Rela Institute and Medical CentreChennai 600044India

Combined hepatocellular-cholangiocarcinoma(cHCC-CCA)is a rare primary liver cancer associated with an appalling *** diagnosis and manage-ment of this entity have been challenging to physicians,radiologists,surgeons,pathologists,and oncologists *** diagnostic and prognostic value of biomarkers such as the immunohistochemical expression of nestin,a progenitor cell marker,have been explored *** a better understanding of biology and the clinical course of cHCC-CCA,newer treatment modalities like immune checkpoint inhibitors are being tried to improve the survival of patients with this rare *** this review,we give an account of the recent developments in the pathology,diagnostic approach,and management of cHCC-CCA.

关键词： Combined hepatocellular-cholangiocarcinoma Immunotherapy Nestin Hepatocellular carcinoma Cholangiocarcinoma Liver cancer Biomarker Immune checkpoint inhibitors Pathology Genomic landscape

Assessment on facile Diels-Alder approach of α-pyrone and terpenoquinone for the expedient synthesis of various natural scaffolds

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Natural Products and Bioprospecting 2022年第1期12卷 137-157页

作者： Aluru rammohan Albert F.Khasanov Dmitry S.Kopchuk Duvvuru Gunasekar Grigory v.Zyryanov Oleg N.Chupakhin Ural Federal University 19 Mira St.Ekaterinburg 620002Russian Federation Natural Products Division Department of ChemistrySri Venkateswara UniversityTirupati 517502India Ural Division of the Russian Academy of Sciences I.Ya.Postovsky Institute of Organic Synthesis22 S.Kovalevskoy St.Ekaterinburg 620219Russian Federation

The development of highly facile synthetic procedures for the expedient synthesis of complex natural molecules is always in *** this aspect,the Diels-Alder reaction(DAR)has a versatile approach to the synthesis of complex natural compounds and highly regio-/stereoselcetive heterocyclic ***,α-pyrone and terpeno-quinone are two versatile key intermediates that are prevalent in various bioactive natural compounds for instance,(±)-crinine,(±)-joubertinamine,(±)-pancratistatin,(−)-cyclozonarone,and 8-ephipuupehedione,***,the current review summarizes the Diels-Alder reaction application ofα-pyrone and terpenoquinone to the construc-tive synthesis of various natural products over the past two decades(2001-2021).Equally,it serves as a stencil for the invention and development of new synthetic strategies for high-complex molecular structured natural and heterocy-clic molecules.

关键词： α-Pyrone Diels-Alder reaction(DAR) Marine natural compounds Terpenoquinone Total synthesis

Pathological,molecular,and clinical characteristics of cholangiocarcinoma:A comprehensive review

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World Journal of Gastrointestinal Oncology 2022年第3期14卷 607-627页

作者： Mukul vij Yogesh Puri Ashwin rammohan Gowripriya G Rajesh Rajalingam Ilankumaran Kaliamoorthy Mohamed Rela Department of Pathology Dr Rela Institute and Medical centerChennai 600044Tamil NaduIndia Institute of Liver Disease and Transplantation Dr Rela Institute and Medical CenterChennai 600044Tamil NaduIndia

Cholangiocarcinomas are a heterogeneous group of highly aggressive cancers that may arise anywhere within the biliary *** is a wide geographical variation with regards to its incidence,and risk-factor associations which may include liver fluke infection,primary sclerosing cholangitis,and hepatolithiasis amongst *** tumours are classified into intrahepatic,perihilar and distal based on their anatomical ***,intrahepatic cholangiocarcinomas are further sub-classified into small and large duct *** and distal cholangiocarcinomas are usually mucin-producing tubular *** develop through a multistep carcinogenesis and are preceded by dysplastic and in situ *** clinical characteristics and management of these tumours have been extensively elucidated in literature,their ultra-structure and tumour biology remain relatively *** review focuses on the current knowledge of pathological characteristics,molecular alterations of cholangiocarcinoma,and its precursor lesions(including biliary intraepithelial neoplasia,intraductal papillary neoplasms of the bile duct,intraductal tubulopapillary neoplasms and mucinous cystic neoplasm).

关键词： Cholangiocarcinoma Classification Pathology Molecular features Precursors lesions Treatment

Non-invasive real-time assessment of hepatic macrovesicular steatosis in liver donors:Hypothesis,design and proof-of-concept study

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World Journal of Hepatology 2021年第10期13卷 1208-1214页

作者： Allwyn S Rajamani Ashwin rammohan vv Raghavendra Sai Mohamed Rela Department of Applied Mechanics Indian Institute of Technology MadrasChennai 600036India Institute of Liver Disease and Transplantation Dr.Rela Institute and Medical CentreBharath Institute of Higher Education and ResearchChennai 600044India

Macrovesicular Steatosis(MS)is an independent risk factor for adverse post-liver transplant(LT)*** degree of MS is intimately related to the viability of the liver graft,which in turn is crucial to the success of the *** ideal liver graft should have no MS and most centres would find it unacceptable to use a donor liver with severe MS for *** a formal liver biopsy is the goldstandard diagnostic test for MS,given the logistical and time constraints it is not universally *** tests like a frozen section biopsy are plagued by issues of fallibility with reporting and sampling bias making them inferior to a liver ***,the development of an accurate,non-invasive,easy-to-use,handheld,real-time device for quantification of MS would fill this lacuna in the deceased donor selection *** present the hypothesis,design and proof-ofconcept of a study,which aims to standardise and determine the feasibility and accuracy of a novel handheld device applying the principle of diffuse reflectance spectroscopy for real-time quantification of MS.

关键词： Macrovesicular steatosis Deceased donors Liver transplantation Real-time devices Diffuse reflectance spectroscopy