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Neuburger PJ, Krishnan S, Patel KM. Achieving Equipoise in Decision-Making for Aortic Valve Replacement in Low-Risk Patients. J Cardiothorac Vasc Anesth 2024; 38:1071-1073. [PMID: 38360424 DOI: 10.1053/j.jvca.2024.01.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Accepted: 01/22/2024] [Indexed: 02/17/2024]
Affiliation(s)
- Peter J Neuburger
- Department of Anesthesiology, Perioperative Care, and Pain Medicine, NYU Grossman School of Medicine, New York, NY.
| | - Sandeep Krishnan
- Department of Anesthesiology, Wayne State University School of Medicine, Pontiac, MI
| | - Kinjal M Patel
- Department of Anesthesiology, Cooper Medical School of Rowan University, One Cooper Plaza, Camden, NJ
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Patel KM, Desai RG, Krishnan S. Conduit Choice in Coronary Artery Bypass Grafting: Insights From an Expert Systematic Review Endorsed by the European Association for Cardio-Thoracic Surgery and the Society of Thoracic Surgeons. J Cardiothorac Vasc Anesth 2024; 38:604-607. [PMID: 38199836 DOI: 10.1053/j.jvca.2023.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 12/09/2023] [Indexed: 01/12/2024]
Affiliation(s)
- Kinjal M Patel
- Adult Cardiothoracic Anesthesiology, Cooper University Healthcare, Cooper Medical School of Rowan University, Camden, NJ.
| | - Ronak G Desai
- Adult Cardiothoracic Anesthesiology, Cooper University Healthcare, Cooper Medical School of Rowan University, Camden, NJ
| | - Sandeep Krishnan
- Adult Cardiothoracic Anesthesiology,Wayne State University School of Medicine,St. Joseph Mercy Oakland Medical Office Building, Pontiac, MI
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Patel KM, Desai RG, Krishnan S. Outcomes for Patients on Peripheral Venoarterial Extracorporeal Membrane Oxygenation After 10-Year Analysis of the Extracorporeal Life Support Organization Registry-What Lessons Can Be Learned? J Cardiothorac Vasc Anesth 2024; 38:12-15. [PMID: 37838508 DOI: 10.1053/j.jvca.2023.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 09/11/2023] [Indexed: 10/16/2023]
Affiliation(s)
- Kinjal M Patel
- Adult Cardiothoracic Anesthesiology, Cooper University Healthcare, Cooper Medical School of Rowan University, Camden, NJ.
| | - Ronak G Desai
- Adult Cardiothoracic Anesthesiology, Cooper University Healthcare, Cooper Medical School of Rowan University, Camden, NJ
| | - Sandeep Krishnan
- Adult Cardiothoracic Anesthesiology, Wayne State University School of Medicine, Pontiac, MI
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Shah K, Ghosh J, Patel S, Chowdhuri MB, Jadeja KA, Shukla G, Macwan T, Kumar A, Dolui S, Singh K, Tanna RL, Patel KM, Dey R, Manchanda R, Ramaiya N, Kumar R, Aich S, Yadava N, Purohit S, Gupta MK, Nagora UC, Pathak SK, Atrey PK, Mayya KBK. Author Correction: Role of pinch in Argon impurity transport in ohmic discharges of Aditya-U Tokamak. Sci Rep 2023; 13:19969. [PMID: 37968383 PMCID: PMC10651834 DOI: 10.1038/s41598-023-47362-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2023] Open
Affiliation(s)
- K Shah
- Department of Physics, Pandit Deendayal Energy University, Raisan, Gandhinagar, 382 007, India.
| | - J Ghosh
- Institute for Plasma Research, Bhat, Gandhinagar, 382 428, India.
- Homi Bhabha National Institute, Training School Complex, Anushaktinagar, Mumbai, 400 094, India.
| | - S Patel
- Department of Physics, Pandit Deendayal Energy University, Raisan, Gandhinagar, 382 007, India
| | - M B Chowdhuri
- Institute for Plasma Research, Bhat, Gandhinagar, 382 428, India
| | - K A Jadeja
- Institute for Plasma Research, Bhat, Gandhinagar, 382 428, India
- Department of Nano Science and Advanced Materials, Saurashtra University, Rajkot, 360 005, India
| | - G Shukla
- ITER-India, Institute for Plasma Research, Koteshwar, Ahmedabad, 380 005, India
| | - T Macwan
- University of California, Los Angeles, CA, 90095, USA
| | - A Kumar
- Institute for Plasma Research, Bhat, Gandhinagar, 382 428, India
- Homi Bhabha National Institute, Training School Complex, Anushaktinagar, Mumbai, 400 094, India
| | - S Dolui
- Institute for Plasma Research, Bhat, Gandhinagar, 382 428, India
- Homi Bhabha National Institute, Training School Complex, Anushaktinagar, Mumbai, 400 094, India
| | - K Singh
- Institute for Plasma Research, Bhat, Gandhinagar, 382 428, India
- Homi Bhabha National Institute, Training School Complex, Anushaktinagar, Mumbai, 400 094, India
| | - R L Tanna
- Institute for Plasma Research, Bhat, Gandhinagar, 382 428, India
- Institute of Science, Nirma University, Ahmedabad, 382 481, India
| | - K M Patel
- Institute for Plasma Research, Bhat, Gandhinagar, 382 428, India
| | - R Dey
- Institute for Plasma Research, Bhat, Gandhinagar, 382 428, India
| | - R Manchanda
- Institute for Plasma Research, Bhat, Gandhinagar, 382 428, India
| | - N Ramaiya
- Institute for Plasma Research, Bhat, Gandhinagar, 382 428, India
| | - R Kumar
- Institute for Plasma Research, Bhat, Gandhinagar, 382 428, India
| | - S Aich
- Institute for Plasma Research, Bhat, Gandhinagar, 382 428, India
| | - N Yadava
- Institute of Science, Nirma University, Ahmedabad, 382 481, India
| | - S Purohit
- Institute for Plasma Research, Bhat, Gandhinagar, 382 428, India
| | - M K Gupta
- Institute for Plasma Research, Bhat, Gandhinagar, 382 428, India
| | - U C Nagora
- Institute for Plasma Research, Bhat, Gandhinagar, 382 428, India
- Homi Bhabha National Institute, Training School Complex, Anushaktinagar, Mumbai, 400 094, India
| | - S K Pathak
- Institute for Plasma Research, Bhat, Gandhinagar, 382 428, India
- Homi Bhabha National Institute, Training School Complex, Anushaktinagar, Mumbai, 400 094, India
| | - P K Atrey
- Institute for Plasma Research, Bhat, Gandhinagar, 382 428, India
| | - K B K Mayya
- Department of Physics, Pandit Deendayal Energy University, Raisan, Gandhinagar, 382 007, India
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Chahal NK, Horak JG, Thalji NK, Augoustides JG, Garner CR, Bradshaw JD, Fernando RJ, Krishnan S, Desai RG, Patel KM. Left Coronary Artery Reimplantation for Repair of Anomalous Origin of the Left Coronary Artery From the Pulmonary Artery in an Adult. J Cardiothorac Vasc Anesth 2023; 37:2098-2108. [PMID: 37516597 DOI: 10.1053/j.jvca.2023.06.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Accepted: 06/26/2023] [Indexed: 07/31/2023]
Affiliation(s)
- Navdeep K Chahal
- Department of Anesthesiology and Critical Care, University of Pennsylvania School of Medicine, Philadelphia, PA
| | - Jiri G Horak
- Cardiothoracic and Critical Care Anesthesiology Sections, Department of Anesthesiology and Critical Care, University of Pennsylvania School of Medicine, Philadelphia, PA
| | - Nabil K Thalji
- Cardiothoracic Anesthesiology Section, Department of Anesthesiology and Critical Care, University of Pennsylvania School of Medicine, Philadelphia, PA
| | - John G Augoustides
- Department of Anesthesiology and Critical Care, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Chandrika R Garner
- Department of Anesthesiology, Cardiothoracic Section, Wake Forest University School of Medicine, Winston Salem, NC
| | - John D Bradshaw
- Department of Anesthesiology, Wake Forest University School of Medicine, Winston Salem, NC
| | - Rohesh J Fernando
- Department of Anesthesiology, Cardiothoracic Section, Wake Forest University School of Medicine, Winston Salem, NC.
| | - Sandeep Krishnan
- Adult Cardiothoracic Anesthesiology, Wayne State University School of Medicine, Pontiac, MI
| | - Ronak G Desai
- Adult Cardiothoracic Anesthesiology, Cooper University Healthcare, Cooper Medical School of Rowan University, Camden, NJ
| | - Kinjal M Patel
- Adult Cardiothoracic Anesthesiology, Cooper University Healthcare, Cooper Medical School of Rowan University, Camden, NJ
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Shah K, Ghosh J, Patel S, Chowdhuri MB, Jadeja KA, Shukla G, Macwan T, Kumar A, Dolui S, Singh K, Tanna RL, Patel KM, Dey R, Manchanda R, Ramaiya N, Kumar R, Aich S, Yadava N, Purohit S, Gupta MK, Nagora UC, Pathak SK, Atrey PK, Mayya KBK. Role of pinch in Argon impurity transport in ohmic discharges of Aditya-U Tokamak. Sci Rep 2023; 13:16087. [PMID: 37752170 PMCID: PMC10522584 DOI: 10.1038/s41598-023-42746-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Accepted: 09/14/2023] [Indexed: 09/28/2023] Open
Abstract
We present experimental results of the trace argon impurity puffing in the ohmic plasmas of Aditya-U tokamak performed to study the argon transport behaviour. Argon line emissions in visible and Vacuum Ultra Violet (VUV) spectral ranges arising from the plasma edge and core respectively are measured simultaneously. During the experiments, space resolved brightness profile of Ar1+ line emissions at 472.69 nm (3p44s 2P3/2-3p44p 2D3/2), 473.59 nm (3p44s 4P5/2-3p44p 4P3/2), 476.49 nm (3p44s 2P1/2-3p44p 2P3/2), 480.60 nm (3p44s 4P5/2-3p44p 4P5/2) are recorded using a high resolution visible spectrometer. Also, a VUV spectrometer has been used to simultaneously observe Ar13+ line emission at 18.79 nm (2s22p 2P3/2-2s2p2 2P3/2) and Ar14+ line emission at 22.11 nm (2s2 1S0-2s2p 1P1). The diffusivity and convective velocity of Ar are obtained by comparing the measured radial emissivity profile of Ar1+ emission and the line intensity ratio of Ar13+ and Ar14+ ions, with those simulated using the impurity transport code, STRAHL. Argon diffusivities ~ 12 m2/s and ~ 0.3 m2/s have been observed in the edge (ρ > 0.85) and core region of the Aditya-U, respectively. The diffusivity values both in the edge and core region are found to be higher than the neo-classical values suggesting that the argon impurity transport is mainly anomalous in the Aditya-U tokamak. Also, an inward pinch of ~ 10 m/s mainly driven by Ware pinch is required to match the measured and simulated data. The measured peaked profile of Ar density suggests impurity accumulation in these discharges.
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Affiliation(s)
- K Shah
- Department of Physics, Pandit Deendayal Energy University, Raisan, Gandhinagar, 382 007, India.
| | - J Ghosh
- Institute for Plasma Research, Bhat, Gandhinagar, 382 428, India.
- Homi Bhabha National Institute, Training School Complex, Anushaktinagar, Mumbai, 400 094, India.
| | - S Patel
- Department of Physics, Pandit Deendayal Energy University, Raisan, Gandhinagar, 382 007, India
| | - M B Chowdhuri
- Institute for Plasma Research, Bhat, Gandhinagar, 382 428, India
| | - K A Jadeja
- Institute for Plasma Research, Bhat, Gandhinagar, 382 428, India
- Department of Nano Science and Advanced Materials, Saurashtra University, Rajkot, 360 005, India
| | - G Shukla
- ITER-India, Institute for Plasma Research, Koteshwar, Ahmedabad, 380 005, India
| | - T Macwan
- University of California, Los Angeles, CA, 90095, USA
| | - A Kumar
- Institute for Plasma Research, Bhat, Gandhinagar, 382 428, India
- Homi Bhabha National Institute, Training School Complex, Anushaktinagar, Mumbai, 400 094, India
| | - S Dolui
- Institute for Plasma Research, Bhat, Gandhinagar, 382 428, India
- Homi Bhabha National Institute, Training School Complex, Anushaktinagar, Mumbai, 400 094, India
| | - K Singh
- Institute for Plasma Research, Bhat, Gandhinagar, 382 428, India
- Homi Bhabha National Institute, Training School Complex, Anushaktinagar, Mumbai, 400 094, India
| | - R L Tanna
- Institute for Plasma Research, Bhat, Gandhinagar, 382 428, India
- Institute of Science, Nirma University, Ahmedabad, 382 481, India
| | - K M Patel
- Institute for Plasma Research, Bhat, Gandhinagar, 382 428, India
| | - R Dey
- Institute for Plasma Research, Bhat, Gandhinagar, 382 428, India
| | - R Manchanda
- Institute for Plasma Research, Bhat, Gandhinagar, 382 428, India
| | - N Ramaiya
- Institute for Plasma Research, Bhat, Gandhinagar, 382 428, India
| | - R Kumar
- Institute for Plasma Research, Bhat, Gandhinagar, 382 428, India
| | - S Aich
- Institute for Plasma Research, Bhat, Gandhinagar, 382 428, India
| | - N Yadava
- Institute of Science, Nirma University, Ahmedabad, 382 481, India
| | - S Purohit
- Institute for Plasma Research, Bhat, Gandhinagar, 382 428, India
| | - M K Gupta
- Institute for Plasma Research, Bhat, Gandhinagar, 382 428, India
| | - U C Nagora
- Institute for Plasma Research, Bhat, Gandhinagar, 382 428, India
- Homi Bhabha National Institute, Training School Complex, Anushaktinagar, Mumbai, 400 094, India
| | - S K Pathak
- Institute for Plasma Research, Bhat, Gandhinagar, 382 428, India
- Homi Bhabha National Institute, Training School Complex, Anushaktinagar, Mumbai, 400 094, India
| | - P K Atrey
- Institute for Plasma Research, Bhat, Gandhinagar, 382 428, India
| | - K B K Mayya
- Department of Physics, Pandit Deendayal Energy University, Raisan, Gandhinagar, 382 007, India
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Frogel J, Navon S, Astbury JC, Augoustides JG, Coleman SR, Fernando RJ, Krishnan S, Desai RG, Patel KM. Echocardiographic Diagnosis and Management of Unexpected Pulmonary Vein Stenosis After Aortic Valve Replacement. J Cardiothorac Vasc Anesth 2023; 37:149-157. [PMID: 36372719 DOI: 10.1053/j.jvca.2022.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 10/06/2022] [Indexed: 11/07/2022]
Affiliation(s)
- Jonathan Frogel
- Department of Anesthesiology, Sheba Medical Center, Ramat Gan, Israel
| | - Shanee Navon
- Sackler School of Medicine at Tel Aviv University, Tel Aviv, Israel
| | - Jeffrey C Astbury
- Department of Anesthesiology, Butler Health System, Lake Erie School of Osteopathic Medicine, Butler, PA
| | - John G Augoustides
- Cardiovascular and Thoracic Division, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Scott R Coleman
- Department of Anesthesiology, Cardiothoracic Section, Wake Forest School of Medicine, Medical Center Boulevard, Winston Salem, NC
| | - Rohesh J Fernando
- Department of Anesthesiology, Cardiothoracic Section, Wake Forest School of Medicine, Medical Center Boulevard, Winston Salem, NC.
| | - Sandeep Krishnan
- Adult Cardiothoracic Anesthesiology, Wayne State University School of Medicine, Pontiac, MI
| | - Ronak G Desai
- Adult Cardiothoracic Anesthesiology, Cooper University Healthcare, Cooper Medical School of Rowan University, Camden, NJ
| | - Kinjal M Patel
- Adult Cardiothoracic Anesthesiology, Cooper University Healthcare, Cooper Medical School of Rowan University, Camden, NJ
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Ramaiya N, Manchanda R, Chowdhuri MB, Yadava N, Dey R, Kumar A, Shah K, Patel S, Jadeja KA, Patel KM, Kumar R, Aich S, Pathak SK, Tanna RL, Ghosh J. Initial results from near-infrared spectroscopy on ADITYA-U tokamak. Rev Sci Instrum 2022; 93:113552. [PMID: 36461425 DOI: 10.1063/5.0101850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 09/12/2022] [Indexed: 06/17/2023]
Abstract
Spectroscopy in vacuum ultraviolet (VUV) and visible ranges plays an important role in the investigation and diagnosis of tokamak plasmas. However, under harsh environmental conditions of fusion grade devices, such as ITER, VUV-visible systems encounter many issues due to the degradation of optical components used in such systems. Here, near-infrared (NIR) spectroscopy has become an effective tool in understanding the edge plasma dynamics. Considering its importance, a NIR spectroscopic diagnostic has been developed and installed on the ADITYA-U tokamak. The system consists of a 0.5 m spectrometer having three gratings with different groove densities, and it is coupled with a linear InGaAs photodiode array. Radiation from the ADITYA-U edge plasma has been collected using a collimating lens and optical fiber combination and transported to the spectrometer. The spectrum in the NIR range from the ADITYA-U plasma has been recorded using this system, in which Paβ and Paγ along with many spectral lines from neutral and singly ionized impurities have been observed. The influxes of H and C have been estimated from measurements. The H influx value is found to be 2.8 × 1016 and 1.9 × 1016 particles cm-2 s-1 from neutral hydrogen lines Hα and Paβ, respectively, and the C influx value is found to be 3.5 × 1015 and 2.9 × 1015 particles cm-2 s-1 from the neutral carbon and singly ionized carbon, respectively. A good agreement is seen between these results and the results obtained by using a routine photomultiplier tube based diagnostic.
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Affiliation(s)
- N Ramaiya
- Institute for Plasma Research, Bhat, Gandhinagar 382 428, India
| | - R Manchanda
- Institute for Plasma Research, Bhat, Gandhinagar 382 428, India
| | - M B Chowdhuri
- Institute for Plasma Research, Bhat, Gandhinagar 382 428, India
| | - N Yadava
- Institute of Science, Nirma University, Ahmedabad 382 481, India
| | - R Dey
- Institute for Plasma Research, Bhat, Gandhinagar 382 428, India
| | - A Kumar
- Institute for Plasma Research, Bhat, Gandhinagar 382 428, India
| | - K Shah
- Department of Physics, Pandit Deendayal Energy University, Raisan, Gandhinagar 382 007, India
| | - S Patel
- Department of Physics, Pandit Deendayal Energy University, Raisan, Gandhinagar 382 007, India
| | - K A Jadeja
- Institute for Plasma Research, Bhat, Gandhinagar 382 428, India
| | - K M Patel
- Institute for Plasma Research, Bhat, Gandhinagar 382 428, India
| | - R Kumar
- Institute for Plasma Research, Bhat, Gandhinagar 382 428, India
| | - S Aich
- Institute for Plasma Research, Bhat, Gandhinagar 382 428, India
| | - S K Pathak
- Institute for Plasma Research, Bhat, Gandhinagar 382 428, India
| | - R L Tanna
- Institute for Plasma Research, Bhat, Gandhinagar 382 428, India
| | - J Ghosh
- Institute for Plasma Research, Bhat, Gandhinagar 382 428, India
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Krishnan S, Park JH, Siddiqui N, Halabi AR, Ahluwalia G, Desai RG, Patel KM. "The Pericardial Effusion is Drained, But the Catheter Is Stuck"-Percutaneous Evacuation of Pericardial Effusion Complicated by Pigtail Catheter Entrapment in Fibrinous Pericarditis. J Cardiothorac Vasc Anesth 2022; 36:3216-3220. [PMID: 35469716 DOI: 10.1053/j.jvca.2022.03.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 03/18/2022] [Accepted: 03/22/2022] [Indexed: 11/11/2022]
Affiliation(s)
- Sandeep Krishnan
- Department of Anesthesiology, Wayne State University School of Medicine, Detroit, MI; Department of Anesthesiology, St. Joseph Mercy Oakland Hospital, Pontiac, MI.
| | - Jee Ha Park
- Department of Anesthesiology, Wayne State University School of Medicine, Detroit, MI
| | - Nazia Siddiqui
- Department of Anesthesiology, Wayne State University School of Medicine, Detroit, MI
| | - Abdul R Halabi
- Department of Cardiology, St. Joseph Mercy Oakland Hospital, Pontiac, MI
| | - Guneet Ahluwalia
- Department of Cardiology, St. Joseph Mercy Oakland Hospital, Pontiac, MI
| | - Ronak G Desai
- Department of Anesthesiology, Cooper University Healthcare, Camden, NJ
| | - Kinjal M Patel
- Department of Anesthesiology, Cooper University Healthcare, Camden, NJ
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Patel KM, de Guzman K, Wise J, van Helmond N, Krishnan S, Mitrev LV, Trivedi KC, Shersher D, Bowen F, Desai RG. Serratus Anterior Plane Block Versus Intercostal Nerve Blocks in Thoracic Surgery: A Retrospective Analysis. J Cardiothorac Vasc Anesth 2022; 36:2841-2842. [PMID: 35365373 DOI: 10.1053/j.jvca.2022.02.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 02/22/2022] [Accepted: 02/27/2022] [Indexed: 11/11/2022]
Affiliation(s)
- Kinjal M Patel
- Department of Anesthesiology, Cooper Medical School of Rowan University, Cooper University Health Care, Camden, NJ.
| | | | - Julie Wise
- Department of Anesthesiology, Robert Wood Johnson Medical Center, New Brunswick, NJ
| | - Noud van Helmond
- Department of Anesthesiology, Cooper Medical School of Rowan University, Cooper University Health Care, Camden, NJ
| | - Sandeep Krishnan
- Adult Cardiothoracic Anesthesiology, Wayne State University School of Medicine, Pontiac, MI
| | - Ludmil V Mitrev
- Department of Anesthesiology, Cooper Medical School of Rowan University, Cooper University Health Care, Camden, NJ
| | - Keyur C Trivedi
- Department of Anesthesiology, Cooper Medical School of Rowan University, Cooper University Health Care, Camden, NJ
| | - David Shersher
- Department of Thoracic Surgery, Cooper Medical School of Rowan University, Cooper University Health Care, Camden, NJ
| | - Frank Bowen
- Department of Thoracic Surgery, Cooper Medical School of Rowan University, Cooper University Health Care, Camden, NJ
| | - Ronak G Desai
- Department of Anesthesiology, Cooper Medical School of Rowan University, Cooper University Health Care, Camden, NJ
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11
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Patel KM, Desai RG, Krishnan S. Increased Endotracheal Tube Cuff Pressures During Transesophageal Echocardiography-A Hidden Risk Factor for Injury or Inconsequential? J Cardiothorac Vasc Anesth 2022; 36:3090-3092. [PMID: 35570083 DOI: 10.1053/j.jvca.2022.04.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 04/10/2022] [Indexed: 11/11/2022]
Affiliation(s)
- Kinjal M Patel
- Adult Cardiothoracic Anesthesiology, Cooper University Healthcare, Cooper Medical School of Rowan University, One Cooper Plaza, Camden, NJ.
| | - Ronak G Desai
- Adult Cardiothoracic Anesthesiology, Cooper University Healthcare, Cooper Medical School of Rowan University, One Cooper Plaza, Camden, NJ.
| | - Sandeep Krishnan
- Adult Cardiothoracic Anesthesiology, Wayne State University School of Medicine, Pontiac, MI.
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12
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Choi JW, Lahori A, Merlo JA, Gill O, Ghoddoussi F, Patel KM, Desai RG, Hakim J, Zatkoff J, Krishnan S. Adductor Canal Blocks With Bupivacaine and Magnesium After Same-day Discharge Total Knee Arthroplasty Improve Postoperative Pain Relief and Decrease Opioid Consumption: A Prospective Randomized Controlled Trial. Clin J Pain 2022; 38:388-395. [PMID: 35440521 DOI: 10.1097/ajp.0000000000001036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 04/10/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Adequate pain management is a critical component of facilitating same-day discharge for total knee arthroplasty (TKA). Adductor canal blocks (ACB) have been shown to be an effective technique for managing pain after TKA. The objective of this study was to investigate the impact of adding magnesium to local anesthetic in ACB on postoperative pain, opioid consumption, nausea, and overall patient satisfaction. MATERIALS AND METHODS A sample of 119 adults undergoing elective unilateral TKA were included. Patients were randomly assigned to receive ACB with magnesium and bupivacaine (n=56) or with bupivacaine only (n=63). Primary outcomes were total opioid consumption in the first 48 hours after surgery and pain scores. Secondary outcomes were the incidence of nausea in the first 48 hours after surgery and total overall satisfaction. RESULTS Opioid consumption decreased significantly in the Mg group compared with the no-Mg group over the first 24 hours (33.2±3.0 vs. 21.3±2.4, P=0.003), the second 24 hours (35.4±2.7 vs. 27.3±2.3, P=0.026), and the first 48 hours total after surgery (68.6±5.1 vs. 48.6±4.3, P=0.004). Pain scores were reduced in the Mg group (24 h: 5.1±2.3 vs. 3.5±2.0, P=0.000; 48 h: 5.1±1.6 vs. 3.9±1.6, P=0.000). Secondary outcomes showed no difference in the incidence of nausea over the first 48 hours and overall satisfaction. CONCLUSION The addition of magnesium to local anesthetic in ACB decreases pain scores and opioid consumption, without increasing nausea, when compared with ACB with local anesthetic alone.
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Affiliation(s)
- Jae W Choi
- Department of Anesthesiology, Wayne State University School of Medicine, Detroit
- Department of Anesthesiology, St. Joseph Mercy Oakland Hospital, Pontiac, MI
| | - Anna Lahori
- Department of Anesthesiology, Wayne State University School of Medicine, Detroit
- Department of Anesthesiology, St. Joseph Mercy Oakland Hospital, Pontiac, MI
| | | | - Opinderjit Gill
- Department of Anesthesiology, Wayne State University School of Medicine, Detroit
- Department of Anesthesiology, St. Joseph Mercy Oakland Hospital, Pontiac, MI
| | - Farhad Ghoddoussi
- Department of Anesthesiology, Wayne State University School of Medicine, Detroit
| | - Kinjal M Patel
- Department of Anesthesiology, Cooper University Healthcare, Camden, NJ
| | - Ronak G Desai
- Department of Anesthesiology, Cooper University Healthcare, Camden, NJ
| | - Joffer Hakim
- Department of Anesthesiology, Wayne State University School of Medicine, Detroit
- Department of Anesthesiology, St. Joseph Mercy Oakland Hospital, Pontiac, MI
| | - Jason Zatkoff
- Department of Anesthesiology, St. Joseph Mercy Oakland Hospital, Pontiac, MI
| | - Sandeep Krishnan
- Department of Anesthesiology, Wayne State University School of Medicine, Detroit
- Department of Anesthesiology, St. Joseph Mercy Oakland Hospital, Pontiac, MI
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13
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Neuburger PJ, Patel KM, Pospishil L. The AVATAR Trial for Severe Asymptomatic Aortic Stenosis: Wait or Operate? J Cardiothorac Vasc Anesth 2022; 36:3715-3718. [DOI: 10.1053/j.jvca.2022.05.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 05/11/2022] [Indexed: 11/11/2022]
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14
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Patel KM, Desai RG, Trivedi K, Neuburger PJ, Krishnan S, Potestio CP. Complications of Transesophageal Echocardiography – A Review of Injuries, Risk Factors and Management. J Cardiothorac Vasc Anesth 2022; 36:3292-3302. [DOI: 10.1053/j.jvca.2022.02.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 02/04/2022] [Accepted: 02/08/2022] [Indexed: 01/09/2023]
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15
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Patel KM, Kumar NS, Desai RG, Mitrev L, Trivedi K, Krishnan S. Blunt Trauma to the Heart: A Review of Pathophysiology and Current Management. J Cardiothorac Vasc Anesth 2021; 36:2707-2718. [PMID: 34840072 DOI: 10.1053/j.jvca.2021.10.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 10/09/2021] [Accepted: 10/13/2021] [Indexed: 11/11/2022]
Abstract
Blunt cardiac injury (BCI), defined as an injury to the heart from blunt force trauma, ranges from minor to life-threatening. The majority of BCIs are due to motor vehicle accidents; however, injuries caused by falls, blasts, and sports-related injuries also can be sources of BCI. A significant proportion of patients with BCI do not survive long enough to receive medical care, succumbing to their injuries at the scene of the accident. Additionally, patients with blunt trauma often have coexisting injuries (brain, spine, orthopedic) that can obscure the clinical picture; therefore, a high degree of suspicion often is required to diagnose BCI. Traditionally, hemodynamically stable injuries suspicious for BCI have been evaluated with electrocardiograms and chest radiographs, whereas hemodynamically unstable BCIs have received operative intervention. More recently, computed tomography and echocardiography increasingly have been utilized to identify injuries more rapidly in hemodynamically unstable patients. Transesophageal echocardiography can play an important role in the diagnosis and management of several BCIs that require operative repair. Close communication with the surgical team and access to blood products for potentially massive transfusion also play key roles in maintaining hemodynamic stability. With proper surgical and anesthetic care, survival in cases involving urgent cardiac repair can reach 66%-to-75%. This narrative review focuses on the types of cardiac injuries that are caused by blunt chest trauma, the modalities and techniques currently used to diagnose BCI, and the perioperative management of injuries that require surgical correction.
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Affiliation(s)
- Kinjal M Patel
- Adult Cardiothoracic Anesthesiology, Cooper University Healthcare, Cooper Medical School of Rowan University, Camden, NJ.
| | - Nakul S Kumar
- Cardiothoracic and Critical Care Anesthesiology, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH
| | - Ronak G Desai
- Adult Cardiothoracic Anesthesiology, Cooper University Healthcare, Cooper Medical School of Rowan University, Camden, NJ
| | - Ludmil Mitrev
- Adult Cardiothoracic Anesthesiology, Cooper University Healthcare, Cooper Medical School of Rowan University, Camden, NJ
| | - Keyur Trivedi
- Adult Cardiothoracic Anesthesiology, Cooper University Healthcare, Cooper Medical School of Rowan University, Camden, NJ
| | - Sandeep Krishnan
- Adult Cardiothoracic Anesthesiology, Wayne State University School of Medicine Pontiac, MI
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16
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Neuburger PJ, Patel KM, Patel PA. The PARTNER 3 Trial at Two Years: What We Have Learned and What Time Will Tell. J Cardiothorac Vasc Anesth 2021; 35:3161-3163. [PMID: 34176679 DOI: 10.1053/j.jvca.2021.05.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 05/21/2021] [Indexed: 11/11/2022]
Affiliation(s)
- Peter J Neuburger
- Department of Anesthesiology, Perioperative Care and Pain Medicine, NYU Grossman School of Medicine, New York, NY
| | - Kinjal M Patel
- Department of Anesthesiology, Cooper Medical School of Rowan University, Camden, NJ
| | - Prakash A Patel
- Department of Anesthesiology, Cardiothoracic Division, Yale University School of Medicine, New Haven, CT
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17
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Patel KM, Krishnan S, Desai RG. Progression of Functional Tricuspid Regurgitation May Be Uncommon After Surgery for Ischemic Mitral Regurgitation: Should the Approach to Concomitant Tricuspid Valve Repair Change? J Cardiothorac Vasc Anesth 2021; 35:3158-3160. [PMID: 34172366 DOI: 10.1053/j.jvca.2021.05.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Accepted: 05/17/2021] [Indexed: 11/11/2022]
Affiliation(s)
- Kinjal M Patel
- Adult Cardiothoracic Anesthesiology, Cooper University Healthcare, Cooper Medical School of Rowan University, Camden, NJ
| | - Sandeep Krishnan
- Adult Cardiothoracic Anesthesiology, Wayne State University School of Medicine, Pontiac, MI
| | - Ronak G Desai
- Adult Cardiothoracic Anesthesiology, Cooper University Healthcare, Cooper Medical School of Rowan University, Camden, NJ
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18
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Patel KM, Kumar NS, Neuburger PJ, Desai RG, Krishnan S. Functional Tricuspid Regurgitation in Patients With Chronic Mitral Regurgitation: An Evidence-Based Narrative Review. J Cardiothorac Vasc Anesth 2021; 36:1730-1740. [PMID: 34175204 DOI: 10.1053/j.jvca.2021.05.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 05/10/2021] [Accepted: 05/13/2021] [Indexed: 11/11/2022]
Abstract
Chronic mitral regurgitation leads to a series of downstream pathologic changes, including pulmonary hypertension, right ventricular dilation, tricuspid leaflet tethering, and tricuspid annular dilation, which can result in functional tricuspid regurgitation (FTR). The five-year survival rate for patients with severe FTR is reported to be as low as 34%. While FTR was often left uncorrected during left-heart valvular surgery, under the assumption that correction of the left-sided lesion would reverse the right-heart changes that cause FTR, recent data largely have supported concomitant tricuspid valve repair at the time of mitral surgery. In this review, the authors discuss the potentially irreversible nature of the changes leading to FTR, the likelihood of progression of FTR after mitral surgery, and the evidence for and against concomitant tricuspid valve repair at the time of mitral valve intervention. Lastly, this narrative review also examines advances in transcatheter therapies for the tricuspid valve and the evidence behind concomitant transcatheter tricuspid repair at the time of transcatheter mitral repair.
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Affiliation(s)
- Kinjal M Patel
- Adult Cardiothoracic Anesthesiology, Cooper University Healthcare, Cooper Medical School of Rowan University, Camden, NJ.
| | - Nakul S Kumar
- Cardiothoracic and Critical Care Anesthesiology, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH
| | - Peter J Neuburger
- Department of Anesthesiology, Perioperative Care & Pain Medicine, NYU Grossman School of Medicine, New York, NY
| | - Ronak G Desai
- Adult Cardiothoracic Anesthesiology, Cooper University Healthcare, Cooper Medical School of Rowan University, Camden, NJ
| | - Sandeep Krishnan
- Adult Cardiothoracic Anesthesiology, Wayne State University School of Medicine, St. Joseph Mercy Oakland Medical Office Building, Pontiac, MI
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19
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Shah K, Ghosh J, Shukla G, Chowdhuri MB, Manchanda R, Yadava N, Ramaiya N, Jadeja KA, Patel KM, Tanna RL, Mayya KBK. Observations of visible argon line emissions and its spatial profile from Aditya-U tokamak plasma. Rev Sci Instrum 2021; 92:053548. [PMID: 34243287 DOI: 10.1063/5.0043877] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 05/07/2021] [Indexed: 06/13/2023]
Abstract
The spectroscopic studies of medium and high Z impurities have been the subject of interest in fusion research due to their role in mitigating plasma disruption and reducing heat load on the plasma facing components. Line emissions from these impurities provide the rotation velocity and ion temperature measurements along with the understanding of the overall impurity behavior in plasma. In the Aditya-U tokamak, the spatially resolved Ar II line emissions have been observed using a high resolution multi-track spectroscopic diagnostic consisting of a 1 m Czerny-Turner spectrometer coupled with a charge coupled device (CCD) detector using seven lines of sight viewing plasma tangentially along the toroidal direction. The spatially resolved Ar II lines at 458.96 nm have been observed. The singly ionized Ar emission peaks at the radial location of ρ = 0.8 of the plasma having a minor radius of 25 cm. Moreover, a 0.5 m UV-visible spectrometer coupled with a CCD detector and having a line of sight passing through the plasma midplane from the radial port was used to record visible Ar survey spectra within the 670-810 nm wavelength range, and all these lines have been identified for further analysis.
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Affiliation(s)
- K Shah
- Department of Physics, Pandit Deendayal Petroleum University, Raisan, Gandhinagar 382421, India
| | - J Ghosh
- Institute for Plasma Research, Bhat, Gandhinagar 382428, India
| | - G Shukla
- Department of Physics, Pandit Deendayal Petroleum University, Raisan, Gandhinagar 382421, India
| | - M B Chowdhuri
- Institute for Plasma Research, Bhat, Gandhinagar 382428, India
| | - R Manchanda
- Institute for Plasma Research, Bhat, Gandhinagar 382428, India
| | - N Yadava
- The National Institute of Engineering, Mysuru 570 008, Karnataka, India
| | - N Ramaiya
- Institute for Plasma Research, Bhat, Gandhinagar 382428, India
| | - K A Jadeja
- Institute for Plasma Research, Bhat, Gandhinagar 382428, India
| | - K M Patel
- Institute for Plasma Research, Bhat, Gandhinagar 382428, India
| | - R L Tanna
- Institute for Plasma Research, Bhat, Gandhinagar 382428, India
| | - K B K Mayya
- Department of Physics, Pandit Deendayal Petroleum University, Raisan, Gandhinagar 382421, India
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20
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Desai RG, de Guzman KD, van Helmond N, Patel KM. Computer-Assisted Instrument Guidance to Improve Adductor Canal Block Performance for Total Knee Arthroplasty: A Pilot Randomized Controlled Trial. Cureus 2021; 13:e14300. [PMID: 33968512 PMCID: PMC8099000 DOI: 10.7759/cureus.14300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background Postoperative pain associated with total knee arthroplasties (TKAs) is routinely managed with ultrasound-guided adductor canal blocks (ACBs). Computer-assisted instrument guidance (CAIG) systems can supplement the existing ultrasound machinery and block needles. CAIG systems allow the operator to navigate the needle in real time while displaying a projected trajectory of its path onto the ultrasound monitor. This study explored how ACBs performed with CAIG compare with conventional ultrasound-only ACBs in terms of block efficiency, success, and potential tissue damage for patients undergoing TKA. Methodology A total of 26 patients undergoing TKA under spinal anesthesia with an ACB were randomized to ACB utilizing conventional real-time ultrasound or to ACB utilizing real-time ultrasound supplemented with CAIG. The primary outcome measure was time to block completion. The secondary outcome measures included number of needle insertions, postoperative pain scores until postoperative day three, postoperative muscle weakness, opioid requirements on postoperative day zero, length of stay, and patient satisfaction with pain management. Results The time required to complete the block as well as the number of needle insertion attempts were similar between the CAIG and conventional ACB groups. Postoperative outcomes such as pain scores up to postoperative day three, postoperative muscle weakness, opioid requirements on postoperative day zero, length of stay, and patient satisfaction with perioperative pain management were comparable between the CAIG and conventional ACB groups. Conclusions CAIG does not reduce ACB performance times or patient outcomes when performed by experienced anesthesiologists.
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Affiliation(s)
- Ronak G Desai
- Anesthesiology, Cooper University Hospital, Camden, USA
| | - Kiana D de Guzman
- Anesthesiology, Cooper Medical School of Rowan University, Camden, USA
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21
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Patel KM, Desai RG, Krishnan S. Mitral Regurgitation in Patients With Coexisting Chronic Aortic Regurgitation: An Evidence-Based Narrative Review. J Cardiothorac Vasc Anesth 2021; 35:3404-3415. [PMID: 33558134 DOI: 10.1053/j.jvca.2021.01.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 01/03/2021] [Accepted: 01/04/2021] [Indexed: 11/11/2022]
Abstract
Chronic aortic regurgitation (AR) frequently leads to significant downstream changes to the left ventricle and pulmonary vasculature; these structural and physiologic changes result in lower- than expected patient survival. Progressive, uncorrected AR can lead to left ventricle dilation and subsequent mitral valve leaflet tethering, as well as mitral annular dilation, resulting in secondary mitral regurgitation (MR) in up to 45% of patients. Surgical aortic valve replacement (AVR) improves secondary MR in most patients, but survival is significantly lower in those patients who do not show improvement in MR after AVR. Thus, there is considerable debate on whether the mitral valve should be intervened upon at the time of the AVR. In this review, the authors address the long-term outlook for patients with chronic AR and concurrent MR. The authors also review the available evidence on concomitant mitral valve surgery in patients undergoing AVR for AR. Lastly, this narrative review examines the recent advances in transcatheter mitral valve repair and replacement, and explores the potential role of transcatheter mitral therapies in patients with secondary MR due to AR.
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Affiliation(s)
- Kinjal M Patel
- Adult Cardiothoracic Anesthesiology, Cooper University Healthcare, Cooper Medical School of Rowan University, Camden, NJ.
| | - Ronak G Desai
- Adult Cardiothoracic Anesthesiology, Cooper University Healthcare, Cooper Medical School of Rowan University, Camden, NJ
| | - Sandeep Krishnan
- Wayne State University School of Medicine, St. Joseph Mercy Oakland Medical Office Building, Pontiac, MI
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22
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Affiliation(s)
- Kinjal M Patel
- Department of Anesthesiology, Cooper Medical School of Rowan University, Cooper University Health Care, Camden, New Jersey,
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23
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Capdeville M, Hargrave J, Patel PA, Patel KM, Desai RG, Trivedi KC, Feinman JW, Garner C, Fernando RJ, Gordon EK, Augoustides JG. Contemporary Challenges for Fellowship Training in Adult Cardiothoracic Anesthesiology: Perspectives From Program Directors Around the United States. J Cardiothorac Vasc Anesth 2020; 34:2047-2059. [DOI: 10.1053/j.jvca.2020.02.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 02/05/2020] [Indexed: 12/11/2022]
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Abstract
Background: Liposomal bupivacaine (LipoB), delivered via intercostal nerve blocks (ICNBs), is
increasingly being used for postoperative pain control in thoracic surgery patients, but there is limited
data on its effectiveness when compared to standard bupivacaine.
Objective: We sought to compare postoperative opioid use, pain control, and length of stay (LOS)
in patients undergoing thoracic surgery with LipoB ICNBs vs patients undergoing thoracic surgery
with ICNBs using standard bupivacaine.
Study Design: A retrospective analysis.
Setting: Research took place in a tertiary academic medical center.
Methods: A transition in the standard of care from standard bupivacaine to LipoB for ICNBs in
March of 2014 allowed us to compare 2 cohorts: patients who received bupivacaine ICNBs from
January 2013 through February of 2014 and patients who received LipoB ICNBs from March 2015
through November 2017. We included patients who underwent thoracic surgery for lung cancer
using robotic-assisted thoracic surgery (RATS), video-assisted thoracic surgery (VATS), or traditional
open thoracotomy, and documentation of ICNB in the operative note. We collected data on pain
scores (Visual Analog Scale [VAS]) and opioid consumption (converted to oral morphine equivalents
[OMEs]) intraoperatively, on postoperative day (POD) 0, POD 1, POD 2, and POD 3. We also analyzed
data on length of stay [LOS]. A primary analysis was performed on the effects of LipoB vs bupivacaine
across all surgery types on opioid consumption, pain scores, and LOS with a secondary analysis on
the same endpoints per individual surgery type.
Results: A total of 129 patients were included from the predefined study periods (n = 62 LipoB and
n = 67 standard bupivacaine). Across all surgery types, LipoB decreased opioid utilization vs standard
bupivacaine (P < .01). Post-hoc testing revealed that this difference existed intraoperatively (55 ± 5 vs
69 ± 4 mg OME, P = .03) and on POD 0 (44 ± 6 vs 68 ± 6 mg OME, P < .01). Surgical subtype analysis
revealed that this difference was mostly driven by lower opioid consumption in patients undergoing
RATS. When compared across all surgery types, LipoB vs bupivacaine did not affect postoperative
pain scores. However, subgroup analysis showed that pain scores were lower in the LipoB vs standard
bupivacaine group undergoing VATS on POD 0, 1, and 2. The LOS across all thoracic surgery types
was lower in the LipoB group when compared to the standard bupivacaine group (median, 4 days
[IQR 2.0-6.0] vs median, 5 days [IQR 3.0-8.0], P < .01). Subgroup analysis showed that the LOS in
patients undergoing VATS with LipoB ICNBs was shorter compared to patients receiving bupivacaine
ICNBs.
Limitations: The retrospective nature of this study makes it prone to several types of bias.
Conclusion: ICNBs with LipoB for thoracic surgery leads to lower opioid consumption and shorter
LOS when compared to ICNBs with standard bupivacaine. The benefit of LipoB over standard
bupivacaine for ICNBs appears especially relevant in VATS or RATS procedures.
Key words: Intercostal nerve block, liposomal bupivacaine, RATS, regional anesthesia, roboticassisted thoracoscopic surgery, thoracotomy, VATS, video-assisted thoracoscopic surgery
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Affiliation(s)
- Kinjal M. Patel
- Department of Anesthesiology, Cooper Medical School of Rowan University, Cooper University Hospital, Camden, New Jersey
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25
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Wise J, van Helmond N, Awad AS, Peters PJ, Trivedi KC, Desai RG, Patel KM. Aorto-Right Atrial Fistula as a Complication of Tricuspid Valve Repair. J Cardiothorac Vasc Anesth 2020; 35:677-679. [PMID: 32620489 DOI: 10.1053/j.jvca.2020.06.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 06/05/2020] [Indexed: 11/11/2022]
Affiliation(s)
- Julie Wise
- Department of Anesthesiology, Cooper Medical School of Rowan University, Cooper University Health Care, Camden, NJ
| | - Noud van Helmond
- Department of Anesthesiology, Cooper Medical School of Rowan University, Cooper University Health Care, Camden, NJ
| | - Ahmed S Awad
- Department of Anesthesiology, Cooper Medical School of Rowan University, Cooper University Health Care, Camden, NJ
| | - Priscilla J Peters
- Department of Cardiology, Cooper Medical School of Rowan University, Cooper University Health Care, Camden, NJ
| | - Keyur C Trivedi
- Department of Anesthesiology, Cooper Medical School of Rowan University, Cooper University Health Care, Camden, NJ
| | - Ronak G Desai
- Department of Anesthesiology, Cooper Medical School of Rowan University, Cooper University Health Care, Camden, NJ
| | - Kinjal M Patel
- Department of Anesthesiology, Cooper Medical School of Rowan University, Cooper University Health Care, Camden, NJ
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26
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Patel KM, van Helmond N, Kilzi GM, Patel A, Bowen FW, Shersher DD, Trivedi K, Desai RG. Liposomal Bupivacaine Versus Bupivacaine for Intercostal Nerve Blocks in Thoracic Surgery: A Retrospective Analysis. Pain Physician 2020; 23:E251-E258. [PMID: 32517400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
BACKGROUND Liposomal bupivacaine (LipoB), delivered via intercostal nerve blocks (ICNBs), is increasingly being used for postoperative pain control in thoracic surgery patients, but there is limited data on its effectiveness when compared to standard bupivacaine. OBJECTIVE We sought to compare postoperative opioid use, pain control, and length of stay (LOS) in patients undergoing thoracic surgery with LipoB ICNBs vs patients undergoing thoracic surgery with ICNBs using standard bupivacaine. STUDY DESIGN A retrospective analysis. SETTING Research took place in a tertiary academic medical center. METHODS A transition in the standard of care from standard bupivacaine to LipoB for ICNBs in March of 2014 allowed us to compare 2 cohorts: patients who received bupivacaine ICNBs from January 2013 through February of 2014 and patients who received LipoB ICNBs from March 2015 through November 2017. We included patients who underwent thoracic surgery for lung cancer using robotic-assisted thoracic surgery (RATS), video-assisted thoracic surgery (VATS), or traditional open thoracotomy, and documentation of ICNB in the operative note. We collected data on pain scores (Visual Analog Scale [VAS]) and opioid consumption (converted to oral morphine equivalents [OMEs]) intraoperatively, on postoperative day (POD) 0, POD 1, POD 2, and POD 3. We also analyzed data on length of stay [LOS]. A primary analysis was performed on the effects of LipoB vs bupivacaine across all surgery types on opioid consumption, pain scores, and LOS with a secondary analysis on the same endpoints per individual surgery type. RESULTS A total of 129 patients were included from the predefined study periods (n = 62 LipoB and n = 67 standard bupivacaine). Across all surgery types, LipoB decreased opioid utilization vs standard bupivacaine (P < .01). Post-hoc testing revealed that this difference existed intraoperatively (55 ± 5 vs 69 ± 4 mg OME, P = .03) and on POD 0 (44 ± 6 vs 68 ± 6 mg OME, P < .01). Surgical subtype analysis revealed that this difference was mostly driven by lower opioid consumption in patients undergoing RATS. When compared across all surgery types, LipoB vs bupivacaine did not affect postoperative pain scores. However, subgroup analysis showed that pain scores were lower in the LipoB vs standard bupivacaine group undergoing VATS on POD 0, 1, and 2. The LOS across all thoracic surgery types was lower in the LipoB group when compared to the standard bupivacaine group (median, 4 days [IQR 2.0-6.0] vs median, 5 days [IQR 3.0-8.0], P < .01). Subgroup analysis showed that the LOS in patients undergoing VATS with LipoB ICNBs was shorter compared to patients receiving bupivacaine ICNBs. LIMITATIONS The retrospective nature of this study makes it prone to several types of bias. CONCLUSION ICNBs with LipoB for thoracic surgery leads to lower opioid consumption and shorter LOS when compared to ICNBs with standard bupivacaine. The benefit of LipoB over standard bupivacaine for ICNBs appears especially relevant in VATS or RATS procedures. KEY WORDS Intercostal nerve block, liposomal bupivacaine, RATS, regional anesthesia, robotic-assisted thoracoscopic surgery, thoracotomy, VATS, video-assisted thoracoscopic surgery.
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Affiliation(s)
- Kinjal M Patel
- Department of Anesthesiology, Cooper University Hospital, Camden, NJ
| | | | - George M Kilzi
- Cooper Medical School of Rowan University, Camden, New Jersey
| | - Akhil Patel
- Department of Anesthesiology, Cooper Medical School of Rowan University, Cooper University Hospital, Camden, New Jersey
| | - Frank W Bowen
- Department of Surgery, Cooper Medical School of Rowan University, Cooper University Hospital, Camden, New Jersey
| | - David D Shersher
- Department of Surgery, Cooper Medical School of Rowan University, Cooper University Hospital, Camden, New Jersey
| | - Keyur Trivedi
- Department of Anesthesiology, Cooper Medical School of Rowan University, Cooper University Hospital, Camden, New Jersey
| | - Ronak G Desai
- Department of Anesthesiology, Cooper University Hospital, Camden, NJ
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27
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Muthukumar K, Patel KM, Mohapatra D, Padh B, Reddy BR. Selective recovery of vanadium as AMV from calcium vanadate sludge by direct AS leaching process: An industrial approach. Waste Manag 2020; 102:815-822. [PMID: 31812833 DOI: 10.1016/j.wasman.2019.11.040] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 11/20/2019] [Accepted: 11/23/2019] [Indexed: 06/10/2023]
Abstract
Generation of calcium vanadate waste sludge their management and treatment.is one of the major problem of metal processing industry. In this paper, we have proposed a simple process for the selective recovery of vanadium as ammonium metavanadate (AMV) from the calcium vanadate sludge using ammonium sulphate (AS) as a leaching agent. Under the optimum leaching condition (pH-7.5, temperature-80 °C, time-1 h, AS reagent-0.5 M) it is possible to leach out 82% of V values from the calcium vanadate sludge. The overall recovery of V is 81% with 98.5% AMV product purity. The AMV product quality from AS leach process has been compared with conventional H2SO4 leach process. The proposed process has major advantages such as, better economic benefits, less chemical consumption, minimum effluent recycling and less waste generation.
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Affiliation(s)
- K Muthukumar
- Technology Centre, R&D Department, Rubamin Ltd., Halol 389350, India
| | - K M Patel
- Technology Centre, R&D Department, Rubamin Ltd., Halol 389350, India
| | - D Mohapatra
- Technology Centre, R&D Department, Rubamin Ltd., Halol 389350, India
| | - Bharat Padh
- Technology Centre, R&D Department, Rubamin Ltd., Halol 389350, India
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Marcotte JH, Patel KM, Gaughan JP, Dy J, Kwiatt ME, McClane SJ, Desai RG. Oral Versus Intravenous Acetaminophen within an Enhanced Recovery after Surgery Protocol in Colorectal Surgery. Pain Physician 2020; 23:57-64. [PMID: 32013279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND Multimodal pain management within enhanced recovery after surgery (ERAS) protocols is designed to decrease opioid use, promote mobilization, and decrease postoperative complications. OBJECTIVES To evaluate the role of intravenous (IV) versus oral (PO) acetaminophen within an established ERAS protocol in colorectal surgery. STUDY DESIGN This was a retrospective observational study. SETTING This research took place within an established perioperative colorectal surgery protocol. METHODS A total of 91 consecutive elective colorectal resections performed according to an ERAS protocol using only IV acetaminophen (IV group) were compared with 84 consecutive resections performed using one dose of IV acetaminophen followed by subsequent administration of oral acetaminophen (PO group). Our multimodal pain management strategy also included transverse abdominis plane blocks, celecoxib, and ketorolac medications for both groups. Opioid requirements, maximum and average daily pain scores by the Visual Analog Scale, and postoperative outcomes were compared between groups. RESULTS There were no differences in maximum or average pain scores on postoperative days 0-3 or at time of discharge between IV and PO groups. Compared with the IV acetaminophen only group, the PO group received significantly more perioperative opioids through 72 hours postoperatively (68.8 oral morphine equivalents [OME] IV group vs. 93.7 OME PO group; P < 0.0001), were more likely to require opioid patient-controlled analgesia (8.9% IV group vs. 46.4% PO group; P < 0.0001), and were more likely to experience postoperative nausea and vomiting (33.0% IV group vs. 48.8% PO group; P = 0.0449). LIMITATIONS Significant limitations include the studies' retrospective nature and that it was performed at a single institution. CONCLUSIONS Restriction of IV acetaminophen within an ERAS protocol in colorectal surgery was associated with increased opioid use, greater need for opioid patient-controlled analgesia, and increased incidence of postoperative nausea and vomiting. IV acetaminophen may be superior to oral acetaminophen in the early postoperative setting. KEY WORDS Perioperative pain management, enhanced recovery after surgery, acetaminophen, multimodal pain control, nonopioid.
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Affiliation(s)
- Joseph H Marcotte
- Department of General Surgery, Cooper University Hospital, Camden, NJ
| | - Kinjal M Patel
- Department of Anesthesiology, Cooper University Hospital, Camden, NJ
| | - John P Gaughan
- Cooper Research Institute, Cooper University Hospital, Camden, NJ
| | - Justin Dy
- Montclair State University, Montclair, NJ
| | - Michael E Kwiatt
- Department of Colorectal Surgery, Cooper University Hospital, Camden, NJ
| | - Steven J McClane
- Department of Colorectal Surgery, Cooper University Hospital, Camden, NJ
| | - Ronak G Desai
- Department of Anesthesiology, Cooper University Hospital, Camden, NJ
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Patel KM, Rosenbloom M, Raza M, Stevens S, Rost J, Awad A, Desai RG. Unexpected Left Atrial Thrombus After Aortic Valve Replacement and Left Atrial Ligation With AtriClip Device: A Case Report. A A Pract 2018; 10:36-38. [PMID: 28937420 DOI: 10.1213/xaa.0000000000000631] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We report the unexpected transesophageal echocardiography (TEE) finding of a left atrial (LA) thrombus near the end of cardiopulmonary bypass and after deployment of an AtriClip (Atricure, Inc, Westchester, OH) in an 84-year-old man with atrial fibrillation and aortic stenosis undergoing aortic valve replacement and LA appendage ligation. TEE examination before cardiopulmonary bypass and deployment of the AtriClip had not shown a thrombus in the LA appendage. The heart was rearrested and thrombus was successfully removed through a left atriotomy. This case emphasizes the importance of careful TEE examination for dislodged thrombi after surgical manipulation of the LA appendage.
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Affiliation(s)
- Kinjal M Patel
- From the Department of Anesthesiology, Department of Surgery, and Cooper Medical School of Rowan University, Camden, New Jersey; and Department of Anesthesia, Cooper University HealthCare, Cooper Medical School of Rowan University, Camden, New Jersey
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Trivedi K, Patel KM. Anesthetic Considerations in the Patient with an Implanted Cardiac Device. Anesthesiology 2018. [DOI: 10.1007/978-3-319-74766-8_8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Patel KM, van der Vos KE, Smith CG, Mouliere F, Tsui D, Morris J, Chandrananda D, Marass F, van den Broek D, Neal DE, Gnanapragasam VJ, Forshew T, van Rhijn BW, Massie CE, Rosenfeld N, van der Heijden MS. Association Of Plasma And Urinary Mutant DNA With Clinical Outcomes In Muscle Invasive Bladder Cancer. Sci Rep 2017; 7:5554. [PMID: 28717136 PMCID: PMC5514073 DOI: 10.1038/s41598-017-05623-3] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Accepted: 05/31/2017] [Indexed: 01/06/2023] Open
Abstract
Muscle Invasive Bladder Cancer (MIBC) has a poor prognosis. Whilst patients can achieve a 6% improvement in overall survival with Neo-Adjuvant Chemotherapy (NAC), many do not respond. Body fluid mutant DNA (mutDNA) may allow non-invasive identification of treatment failure. We collected 248 liquid biopsy samples including plasma, cell pellet (UCP) and supernatant (USN) from spun urine, from 17 patients undergoing NAC. We assessed single nucleotide variants and copy number alterations in mutDNA using Tagged-Amplicon- and shallow Whole Genome- Sequencing. MutDNA was detected in 35.3%, 47.1% and 52.9% of pre-NAC plasma, UCP and USN samples respectively, and urine samples contained higher levels of mutDNA (p = <0.001). Longitudinal mutDNA demonstrated tumour evolution under the selective pressure of NAC e.g. in one case, urine analysis tracked two distinct clones with contrasting treatment sensitivity. Of note, persistence of mutDNA detection during NAC predicted disease recurrence (p = 0.003), emphasising its potential as an early biomarker for chemotherapy response.
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Affiliation(s)
- K M Patel
- Cancer Research UK Cambridge Institute, University of Cambridge, Li Ka Shing Centre, Robinson Way, Cambridge, CB2 0RE, UK
- Cancer Research UK Cambridge Cancer Centre, University of Cambridge, Li Ka Shing Centre, Robinson Way, Cambridge, CB2 0RE, UK
- Academic Urology Group, Department of Surgery & Oncology, University of Cambridge, Box 279 (S4), Cambridge Biomedical Campus, Cambridge, CB2 0QQ, UK
| | - K E van der Vos
- Division of Molecular Carcinogenesis, Netherlands Cancer Institute, Plesmanlaan 121, Amsterdam, 1066 CX, The Netherlands
| | - C G Smith
- Cancer Research UK Cambridge Institute, University of Cambridge, Li Ka Shing Centre, Robinson Way, Cambridge, CB2 0RE, UK
- Cancer Research UK Cambridge Cancer Centre, University of Cambridge, Li Ka Shing Centre, Robinson Way, Cambridge, CB2 0RE, UK
| | - F Mouliere
- Cancer Research UK Cambridge Institute, University of Cambridge, Li Ka Shing Centre, Robinson Way, Cambridge, CB2 0RE, UK
- Cancer Research UK Cambridge Cancer Centre, University of Cambridge, Li Ka Shing Centre, Robinson Way, Cambridge, CB2 0RE, UK
| | - D Tsui
- Cancer Research UK Cambridge Institute, University of Cambridge, Li Ka Shing Centre, Robinson Way, Cambridge, CB2 0RE, UK
- Cancer Research UK Cambridge Cancer Centre, University of Cambridge, Li Ka Shing Centre, Robinson Way, Cambridge, CB2 0RE, UK
| | - J Morris
- Cancer Research UK Cambridge Institute, University of Cambridge, Li Ka Shing Centre, Robinson Way, Cambridge, CB2 0RE, UK
- Cancer Research UK Cambridge Cancer Centre, University of Cambridge, Li Ka Shing Centre, Robinson Way, Cambridge, CB2 0RE, UK
| | - D Chandrananda
- Cancer Research UK Cambridge Institute, University of Cambridge, Li Ka Shing Centre, Robinson Way, Cambridge, CB2 0RE, UK
- Cancer Research UK Cambridge Cancer Centre, University of Cambridge, Li Ka Shing Centre, Robinson Way, Cambridge, CB2 0RE, UK
| | - F Marass
- Cancer Research UK Cambridge Institute, University of Cambridge, Li Ka Shing Centre, Robinson Way, Cambridge, CB2 0RE, UK
- Cancer Research UK Cambridge Cancer Centre, University of Cambridge, Li Ka Shing Centre, Robinson Way, Cambridge, CB2 0RE, UK
| | - D van den Broek
- Department of Clinical Chemistry, Netherlands Cancer Institute, Plesmanlaan 121, Amsterdam, 1066 CX, The Netherlands
| | - D E Neal
- Cancer Research UK Cambridge Institute, University of Cambridge, Li Ka Shing Centre, Robinson Way, Cambridge, CB2 0RE, UK
- Nuffield Department of Surgery, Old Road Campus Research Building, University of Oxford, Oxford, OX3 7DQ, UK
| | - V J Gnanapragasam
- Academic Urology Group, Department of Surgery & Oncology, University of Cambridge, Box 279 (S4), Cambridge Biomedical Campus, Cambridge, CB2 0QQ, UK
| | - T Forshew
- Cancer Research UK Cambridge Institute, University of Cambridge, Li Ka Shing Centre, Robinson Way, Cambridge, CB2 0RE, UK
- Cancer Research UK Cambridge Cancer Centre, University of Cambridge, Li Ka Shing Centre, Robinson Way, Cambridge, CB2 0RE, UK
- UCL cancer Institute, Huntley St, Camden Town, London, WC1E 6DD, UK
| | - B W van Rhijn
- Department of Surgical Oncology (Urology), Netherlands Cancer Institute, Plesmanlaan 121, Amsterdam, 1066 CX, The Netherlands
| | - C E Massie
- Cancer Research UK Cambridge Institute, University of Cambridge, Li Ka Shing Centre, Robinson Way, Cambridge, CB2 0RE, UK
- Cancer Research UK Cambridge Cancer Centre, University of Cambridge, Li Ka Shing Centre, Robinson Way, Cambridge, CB2 0RE, UK
| | - N Rosenfeld
- Cancer Research UK Cambridge Institute, University of Cambridge, Li Ka Shing Centre, Robinson Way, Cambridge, CB2 0RE, UK.
- Cancer Research UK Cambridge Cancer Centre, University of Cambridge, Li Ka Shing Centre, Robinson Way, Cambridge, CB2 0RE, UK.
| | - M S van der Heijden
- Division of Molecular Carcinogenesis, Netherlands Cancer Institute, Plesmanlaan 121, Amsterdam, 1066 CX, The Netherlands.
- Department of Medical Oncology, Netherlands Cancer Institute, Plesmanlaan 121, Amsterdam, 1066 CX, The Netherlands.
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Maka VV, Pancha H, Shukla SN, Talati SS, Shah PM, Patel KM, Anand AS, Shah SA, Patel AA, Parikh S. Clinical Characteristics and prognostic analysis of Triple-negative Breast Cancer: Single institute experience. Gulf J Oncolog 2016; 1:38-44. [PMID: 27050178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/30/2015] [Indexed: 06/05/2023]
Abstract
BACKGROUND Triple-negative breast cancer (TNBC) is a poor prognostic subset of breast cancer that lacks the benefit of specific targeted therapy. MATERIALS AND METHODS A prospective study of the clinical profile of triple negative breast cancer cases at a tertiary referral centre. The duration of the study period was 26 months and the median follow up period was ten months. A total of 111 invasive breast cancer patients were evaluated from 1st August 2009 to 31st October 2011. We examined TNBC patients with respect to clinicopathological parameters, adjuvant chemotherapy regimens and relapse free survival. RESULTS In our study, patients were young (median age at presentation, 47yrs), premenopausal (54%), tumour size was discordant with lymph node positivity, the histology was predominantly intraductal carcinoma (90%), histological grade higher than two (90%). Relapses were early and preferential visceral (32%) and CNS metastasises (11.7%). 91% of patients were eligible for adjuvant therapy but only 80% of the patients could complete full course of adjuvant chemotherapy. Anthracycline-based regimens (43%), sequential anthracycline and taxane-based regimen (24%) and other regimes like CMF (13%) were used as adjuvant chemotherapy in eligible TNBC patients. Median relapse free survival in patients following adjuvant chemotherapy was around 10 months at last follow-up. CONCLUSIONS Patients with TNBC have aggressive clinicopathological characteristics with early and higher rate of disease relapse and therefore derive inadequate benefit from current adjuvant chemotherapy. So, new treatment strategies in adjuvant chemotherapy for TNBC are needed.
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Affiliation(s)
- V V Maka
- Department of Medical Oncology, Gujarat Cancer and Research Institute, Ahmedabad, Gujarat, India
| | - H Pancha
- Department of Medical Oncology, Gujarat Cancer and Research Institute, Ahmedabad, Gujarat, India
| | - S N Shukla
- Department of Medical Oncology, Gujarat Cancer and Research Institute, Ahmedabad, Gujarat, India
| | - S S Talati
- Department of Medical Oncology, Gujarat Cancer and Research Institute, Ahmedabad, Gujarat, India
| | - P M Shah
- Department of Medical Oncology, Gujarat Cancer and Research Institute, Ahmedabad, Gujarat, India
| | - K M Patel
- Department of Medical Oncology, Gujarat Cancer and Research Institute, Ahmedabad, Gujarat, India
| | - A S Anand
- Department of Medical Oncology, Gujarat Cancer and Research Institute, Ahmedabad, Gujarat, India
| | - S A Shah
- Department of Medical Oncology, Gujarat Cancer and Research Institute, Ahmedabad, Gujarat, India
| | - A A Patel
- Department of Medical Oncology, Gujarat Cancer and Research Institute, Ahmedabad, Gujarat, India
| | - S Parikh
- Department of Medical Oncology, Gujarat Cancer and Research Institute, Ahmedabad, Gujarat, India
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Patel KM, Tsui DWY. The translational potential of circulating tumour DNA in oncology. Clin Biochem 2015; 48:957-61. [PMID: 25889059 DOI: 10.1016/j.clinbiochem.2015.04.005] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Revised: 04/02/2015] [Accepted: 04/03/2015] [Indexed: 02/05/2023]
Abstract
The recent understanding of tumour heterogeneity and cancer evolution in response to therapy has raised questions about the value of historical or single site biopsies for guiding treatment decisions. The ability of ctDNA analysis to reveal de novo mutations (i.e., without prior knowledge), allows monitoring of clonal heterogeneity without the need for multiple tumour biopsies. Additionally, ctDNA monitoring of such heterogeneity and novel mutation detection will allow clinicians to detect resistant mechanisms early and tailor treatment therapies accordingly. If ctDNA can be used to detect low volume cancerous states, it will have important applications in treatment stratification post-surgery/radical radiotherapy and may have a role in patient screening. Mutant cfDNA can also be detected in other bodily fluids that are easily accessible and may aid detection of rare mutant alleles in certain cancer types. This article outlines recent advances in these areas.
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Affiliation(s)
- K M Patel
- Cancer Research UK Cambridge Institute, University of Cambridge, Li Ka Shing Centre, Robinson Way, Cambridge CB2 0RE, UK; Department of Academic Urology, University of Cambridge Hospitals, Box 243, Cambridge Biomedical Campus, Hills Road, Cambridge CB2 0QQ, UK
| | - D W Y Tsui
- Cancer Research UK Cambridge Institute, University of Cambridge, Li Ka Shing Centre, Robinson Way, Cambridge CB2 0RE, UK.
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Nade VS, Kawale LA, Patel KM. Protective effect of sitagliptin and rosuvastatin combination on vascular endothelial dysfunction in type-2 diabetes. Indian J Pharm Sci 2015; 77:96-102. [PMID: 25767324 PMCID: PMC4355889 DOI: 10.4103/0250-474x.151604] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2013] [Revised: 10/26/2014] [Accepted: 01/22/2015] [Indexed: 11/10/2022] Open
Abstract
The present investigation aimed to evaluate the protective effects of sitagliptin, glimepiride, rosuvastatin and their combinations on oxidative stress and endothelial dysfunction in the aortic tissues in fructose-fed type-2 diabetic rats. Sitagliptin (20 mg/kg, p.o.), glimepiride (2 mg/kg, p.o.), rosuvastatin (5 mg/kg, p.o.) and their combinations were administered for 6 w after induction of diabetes by fructose (66%, w/v solution, p.o. for 8 w) in wistar rats. The effects were examined on body weight, serum glucose, triglyceride, cholesterol, blood pressure, heart rate, nitric oxide and antioxidant defensive enzymes. After completion of treatment schedule, the blood pressure was determined by invasive method and vascular reactivity was tested with adrenaline, noradrenaline and phenylephrine. Endothelial dysfunction was determined by acetylcholine and sodium nitroprusside-induced vasorelaxation studies on isolated rat aortas. Long term treatments significantly decreased body weight gain, serum glucose, triglyceride and cholesterol levels; normalize the heart rate, and blood pressure in fructose fed rats. The treatments significantly improved vascular reactivity to catecholamines with reduction in elevated blood pressure in type-2 diabetic rats. The significant improvement in the relaxant response to acetylcholine and sodium nitroprusside was obtained on isolated aortas. All the treatments were effective in restoring defensive antioxidant enzymes. Sitagliptin and rosuvastatin were able to reverse endothelial dysfunction in type-2 diabetes, but better ameliorating potential was found when used in combination.
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Affiliation(s)
- Vandana S Nade
- Department of Pharmacology, M. V. P. Samaj's College of Pharmacy, Gangapur Road, Nashik-422 002, India
| | - L A Kawale
- Department of Pharmacology, M. V. P. Samaj's College of Pharmacy, Gangapur Road, Nashik-422 002, India
| | - K M Patel
- Department of Pharmacology, M. V. P. Samaj's College of Pharmacy, Gangapur Road, Nashik-422 002, India
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Murphy GS, Sherwani SS, Szokol JW, Avram MJ, Greenberg SB, Patel KM, Wade LD, Vaughn J, Gray J. Reply to Dr Broderick. J Cardiothorac Vasc Anesth 2013; 27:e3-4. [PMID: 23312778 DOI: 10.1053/j.jvca.2012.08.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2012] [Indexed: 11/11/2022]
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Beniwal SK, Patel KM, Shukla S, Parikh BJ, Shah S, Patel A. Gemcitabine in brief versus prolonged low-dose infusion, both combined with carboplatin for advanced non-small cell lung cancer. Indian J Cancer 2012; 49:202-8. [PMID: 23107971 DOI: 10.4103/0019-509x.102861] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
PURPOSE Gemcitabine in low-dose prolonged infusion is a treatment with documented activity against a variety of tumors. The present study was conducted to evaluate the efficacy and safety of the combination of gemcitabine at a low-dose prolonged infusion in comparison with standard dose gemcitabine with carboplatin in chemonaive patients with advanced non-small cell lung cancer (NSCLC). MATERIALS AND METHODS Sixty chemonaive patients with stage IIIB or IV NSCLC were included. Patients were randomly assigned 1:1 to receive 350 mg/m 2 gemcitabine in a 6-h infusion on days 1 and 8 and carboplatin area under the serum concentration time curve (AUC) 5 on day 1 versus gemcitabine 1,000 mg/m 2 on days 1 and 8 and carboplatin AUC 5 on day 1 (3-week cycle both). A total of 118 chemotherapy cycles, with a median of 4 cycles per patient (range 2-6), and 134 chemotherapy cycles, with a median of 4.47 cycles per patient (range 3-6) were administered in standard and low infusional dose arm, respectively. RESULTS Among patients in the standard arm, 40% had overall response rate (ORR), 33.3% had stable disease and 26.6% had progressive disease, while in low-dose infusional arm, 36.6% had ORR, 36.3% had stable disease and 26.6% had progressive disease (P = 0.992). Median progression-free survival was 5.5 months and 5.4 months, median overall survival was 9.7 months and 10.7 months, and 1-year survival was 33.7% and 36.6% in standard arm and low-dose infusion arm, respectively. Grade 3/4 toxicity was rare. CONCLUSION In NSCLC, gemcitabine low-dose prolonged infusion with carboplatin has low toxicity, especially thrombocytopenia, and has an activity comparable with gemcitabine given in higher dose in standard infusion.
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Affiliation(s)
- S K Beniwal
- Department of Medical Oncology, The Gujarat Cancer and Research Institute, Ahmedabad, Gujarat, India
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Vayakis G, Arshad S, Delhom D, Encheva A, Giacomin T, Jones L, Patel KM, Pérez-Lasala M, Portales M, Prieto D, Sartori F, Simrock S, Snipes JA, Udintsev VS, Watts C, Winter A, Zabeo L. Development of the ITER magnetic diagnostic set and specification. Rev Sci Instrum 2012; 83:10D712. [PMID: 23126886 DOI: 10.1063/1.4732077] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
ITER magnetic diagnostics are now in their detailed design and R&D phase. They have passed their conceptual design reviews and a working diagnostic specification has been prepared aimed at the ITER project requirements. This paper highlights specific design progress, in particular, for the in-vessel coils, steady state sensors, saddle loops and divertor sensors. Key changes in the measurement specifications, and a working concept of software and electronics are also outlined.
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Affiliation(s)
- G Vayakis
- ITER Organization, St Paul lez Durance, France.
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Reichle R, Beaumont B, Boilson D, Bouhamou R, Direz MF, Encheva A, Henderson M, Huxford R, Kazarian F, Lamalle P, Lisgo S, Mitteau R, Patel KM, Pitcher CS, Pitts RA, Prakash A, Raffray R, Schunke B, Snipes J, Diaz AS, Udintsev VS, Walker C, Walsh M. Concept development for the ITER equatorial port visible∕infrared wide angle viewing system. Rev Sci Instrum 2012; 83:10E520. [PMID: 23127027 DOI: 10.1063/1.4734487] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
The ITER equatorial port visible∕infrared wide angle viewing system concept is developed from the measurement requirements. The proposed solution situates 4 viewing systems in the equatorial ports 3, 9, 12, and 17 with 4 views each (looking at the upper target, the inner divertor, and tangentially left and right). This gives sufficient coverage. The spatial resolution of the divertor system is 2 times higher than the other views. For compensation of vacuum-vessel movements, an optical hinge concept is proposed. Compactness and low neutron streaming is achieved by orienting port plug doglegs horizontally. Calibration methods, risks, and R&D topics are outlined.
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Affiliation(s)
- R Reichle
- ITER Organization, Route de Vinon-sur-Verdon, 13115 St Paul-lez-Durance, France.
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Patel KM, Sherwani SS, Baudo AM, Salvacion A, Herborn J, Soong W, Kendall MC. The Use of Transesophageal Echocardiography for Confirmation of Appropriate Impella 5.0 Device Placement. Anesth Analg 2012; 114:82-5. [DOI: 10.1213/ane.0b013e3182367a7d] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Murphy GS, Sherwani SS, Szokol JW, Avram MJ, Greenberg SB, Patel KM, Wade LD, Vaughn J, Gray J. Small-Dose Dexamethasone Improves Quality of Recovery Scores After Elective Cardiac Surgery: A Randomized, Double-Blind, Placebo-Controlled Study. J Cardiothorac Vasc Anesth 2011; 25:950-60. [DOI: 10.1053/j.jvca.2011.03.002] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2011] [Indexed: 11/11/2022]
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Boone JD, Sherwani SS, Herborn JC, Patel KM, De Wolf AM. The Successful Use of Low-Dose Recombinant Tissue Plasminogen Activator for Treatment of Intracardiac/Pulmonary Thrombosis During Liver Transplantation. Anesth Analg 2011; 112:319-21. [DOI: 10.1213/ane.0b013e31820472d4] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Patel SK, Patel NJ, Patel KM, Patel PU, Patel BH. Estimation of Duloxetine Hydrochloride in Pharmaceutical Formulations by RP-HPLC Method. Indian J Pharm Sci 2008; 70:825-7. [PMID: 21369455 PMCID: PMC3040888 DOI: 10.4103/0250-474x.49136] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2007] [Revised: 06/13/2008] [Accepted: 12/20/2008] [Indexed: 11/04/2022] Open
Abstract
Simple, specific, accurate and precise method, namely, reverse phase high performance liquid chromatography was developed for estimation of duloxetine HCl in pharmaceutical formulations. For the high performance liquid chromatography method, Phenomenox C-18, 5 μm column consisting of 250×4.6 mm i.d. in isocratic mode, with mobile phase containing 0.01M 5.5 pH phosphate buffer: acetonitrile (60:40 v/v) and final pH adjust to 5.5±0.02 with phosphoric acid was used. The flow rate was 1.2 ml/min and effluent was monitored at 231 nm. The retention time was 5.61 min. The method was validated in terms of linearity, accuracy and precision. The linearity curve was found to be linear over 0.25-4 μg/ml. The limit of detection and limit of quantification were found to be 0.10 and 0.25 μg/ml respectively. The proposed method was successfully used to determine the drug content of marketed formulations.
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Affiliation(s)
- Sejal K Patel
- S. K. Patel college of Pharmaceutical Education and Research, Ganpat University, Kherava-382 711, India
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Bowyer JF, Pogge AR, Delongchamp RR, O'Callaghan JP, Patel KM, Vrana KE, Freeman WM. A threshold neurotoxic amphetamine exposure inhibits parietal cortex expression of synaptic plasticity-related genes. Neuroscience 2006; 144:66-76. [PMID: 17049170 PMCID: PMC2039899 DOI: 10.1016/j.neuroscience.2006.08.076] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2006] [Revised: 08/23/2006] [Accepted: 08/29/2006] [Indexed: 11/25/2022]
Abstract
Compulsive drug abuse has been conceptualized as a behavioral state where behavioral stimuli override normal decision making. Clinical studies of methamphetamine users have detailed decision making changes and imaging studies have found altered metabolism and activation in the parietal cortex. To examine the molecular effects of amphetamine (AMPH) on the parietal cortex, gene expression responses to amphetamine challenge (7.5 mg/kg) were examined in the parietal cortex of rats pretreated for nine days with either saline, non-neurotoxic amphetamine, or neurotoxic AMPH dosing regimens. The neurotoxic AMPH exposure [three doses of 7.5 mg/kg/day AMPH (6 h between doses), for nine days] produced histological signs of neurotoxicity in the parietal cortex while a non-neurotoxic dosing regimen (2.0 mg/kg/day x 3) did not. Neurotoxic AMPH pretreatment resulted in significantly diminished AMPH challenge-induced mRNA increases of activity-regulated cytoskeletal protein (ARC), nerve growth-factor inducible protein A (NGFI-A), and nerve growth-factor inducible protein B (NGFI-B) in the parietal cortex while neither saline pretreatment nor non-neurotoxic AMPH pretreatment did. This effect was specific to these genes as tissue plasminogen activator (t-PA), neuropeptide Y (NPY) and c-jun expression in response to AMPH challenge was unaltered or enhanced by amphetamine pretreatments. In the striatum, there were no differences between saline, neurotoxic AMPH, and non-neurotoxic AMPH pretreatments on ARC, NGFI-A or NGFI-B expression elicited by the AMPH challenge. These data indicate that the responsiveness of synaptic plasticity-related genes is sensitive to disruption specifically in the parietal cortex by threshold neurotoxic AMPH exposures.
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Affiliation(s)
- J F Bowyer
- Division of Neurotoxicology, National Center for Toxicological Research, HFT-132, Jefferson, AR 72079, USA.
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Abstract
Throughout the world, recent developments in medical curricula have led to marked changes in the teaching of gross anatomy. This change has involved decreasing curricular student contact time and the use of new methods for anatomical teaching. Some "modern" anatomists have welcomed the arrival of these novel methods while other, more "traditional," anatomists have fought to maintain the use of cadaveric dissection. Consequently, controversy over teaching methods has developed to the point that "modernist" and "traditionalist" views within the community of professional anatomists seem to have diverged such that the importance of gross anatomy in the medical curriculum is disputed and that cadaveric dissection by students is no longer the preferred method of teaching. This study tests this hypothesis using Thurstone and Chave attitude analyses to assess attitudes to educational change and the importance of anatomy in medicine and a matrix questionnaire that required professional anatomists to relate course aims to different teaching methods. In total, 112 completed questionnaires were received from anatomists who are employed at higher education institutions that use various teaching methods and who span the academic hierarchy. The results suggest that over 90% of anatomists favor educational change and approximately 98% of professional anatomists believe that gross anatomy has an important role to play in clinical medicine. A clear majority of the anatomists (69%) favored the use of human cadaveric dissection over other teaching methods (this method seeming to achieve a range of different course aims/objectives) (P < 0.001; Kruskal-Wallis). Using Kruskal-Wallis statistical tests, the order-of-preference for teaching methods was found to be as follows: 1. Practical lessons using cadaveric dissection by students. 2. Practical lessons using prosection. 3. Tuition based upon living and radiological anatomy. 4. Electronic tuition using computer aided learning (CAL). 5. Didactic teaching alone (e.g. lectures/class room-based tuition). 6. Use of models. The preference for the use of human cadaveric dissection was evident in all groups of anatomists, whether "traditionalist" or "modernist" (P = 0.002, Chi-squared). These findings are therefore not consistent with our initial hypothesis.
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Affiliation(s)
- K M Patel
- Cardiff School of Biosciences, Cardiff University, Cardiff, UK
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Porcalla AR, Sable CA, Patel KM, Martin GR, Singh N. The epidemiology of Kawasaki disease in an urban hospital: does African American race protect against coronary artery aneurysms? Pediatr Cardiol 2005; 26:775-81. [PMID: 16421770 DOI: 10.1007/s00246-005-0916-5] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The etiology and pathogenesis of Kawasaki disease (KD) is largely unknown. Certain demographic factors and laboratory findings are predictive of the development of coronary artery (CA) aneurysms. The objectives of this study were to determine the epidemiology of KD patients in an urban hospital and determine risk factors associated with their development of CA abnormalities. A longitudinal case series of KD patients admitted to Children's National Medical Center from 1990 to 2002 was examined. Age, sex, ethnic background, duration of fever prior to diagnosis, address, month diagnosed, and CA abnormalities (ectasia or aneurysms) on echocardiography were recorded. Median household income was obtained from the U.S. Census Bureau Web site. The Student t-test, logistic regression analyses, and the Kruskal-Wallis test were used, with significance assumed at p < 0.05. A total of 302 patients were evaluated. CA abnormalties were found in 27 patients (9%), with aneurysms identified in 13 patients (4%). Age was 2.9 +/- 2.4 years (range, 2 months to 14 years). A total of 51 patients (16%) were < or =1 year and 35 patients (12%) were > or =5 years. Ethnic distribution was 54% (164) African American, 24% (72) Caucasian, 9% (29) Asian/Pacific Islander, 8% (23) Hispanic, and 5% (14) Middle Eastern. Only 2/164 (1.2%) African Americans developed CA aneurysms. Neighborhood median income of the cohort was $45,400 +/- $21,200 ($52,200 +/-$25,800 for patients with aneurysms). A total of 28% of cases clustered between December and January. Cases doubled annually in 1999-2001 compared to 1990-1998 (39 vs 19). Multivariate logistic regression found age between 1 and 5 years [p = 0.045; odds ratio, 0.31; 95% confidence interval (CI), 0.10-0.97] and African American race (p = 0.014; odds ratio, 0.15; 95% CI, 0.03-0.68) to be independently protective against CA aneurysms. Duration of fever prior to diagnosis, considered in 210 patients, was different between patients with and without aneurysms (11 +/- 5.3 vs 6.5 +/- 3.8 days, respectively, p = 0.0007). Multivariate logistic regression found fever longer than 5 days to be the only predictive factor associated with the development of aneurysms and any abnormality. African Americans had a shorter duration of fever than the rest of the cohort (6.03 vs 7.31 days), (p = 0.0087). The epidemiology of KD at our hospital is similar to that at other centers except for the predominance of African Americans with a shorter duration of fever prior to diagnosis and a decreased incidence of CA aneurysms compared to other ethnicities. The protective nature of African American ethnicity against the development of CA aneurysms raises speculation about the role of genetics and its interaction with immunity in the pathogenesis of KD.
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Affiliation(s)
- A R Porcalla
- Division of Infectious Disease, Children's National Medical Center/George Washington University, Washington, DC 20010, USA
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Abstract
OBJECTIVES The objective of this study is to investigate the relationship between a physician's subjective mortality prediction and the level of confidence with which that mortality prediction is made. DESIGN AND PARTICIPANTS The study is a prospective cohort of patients less than 18 years of age admitted to a tertiary Paediatric Intensive Care Unit (ICU) at a University Children's Hospital with a minimum length of ICU stay of 10 h. Paediatric ICU attending physicians and fellows provided mortality risk predictions and the level of confidence associated with these predictions on consecutive patients at the time of multidisciplinary rounds within 24 hours of admission to the paediatric ICU. Median confidence levels were compared across different ranges of mortality risk predictions. RESULTS Data were collected on 642 of 713 eligible patients (36 deaths, 5.6%). Mortality predictions greater than 5% and less than 95% were made with significantly less confidence than those predictions <5% and >95%. Experience was associated with greater confidence in prognostication. CONCLUSIONS We conclude that a physician's subjective mortality prediction may be dependent on the level of confidence in the prognosis; that is, a physician less confident in his or her prognosis is more likely to state an intermediate survival prediction. Measuring the level of confidence associated with mortality risk predictions (or any prognostic assessment) may therefore be important because different levels of confidence may translate into differences in a physician's therapeutic plans and their assessment of the patient's future.
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Affiliation(s)
- J P Marcin
- Department of Pediatrics, Section of Critical Care Medicine, University of California-Davis, UC Davis Children's Hospital, 2516 Stockton Boulevard, Sacramento, CA 95817, USA.
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Vyas V, Shah SA, Patel KM, Parekh BB, Nath SV, Hussain BM. Acute lymphocytic leukemia CNS disease presenting as central diabetes insipidus. J Assoc Physicians India 2002; 50:281-2. [PMID: 12038668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Affiliation(s)
- V Vyas
- Department of Medical Oncology, Gujarat Cancer Research Institute, Ahmedabad
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Finkel JC, Cohen IT, Hannallah RS, Patel KM, Kim MS, Hummer KA, Choi SS, Pena M, Schreiber SB, Zalzal G. The effect of intranasal fentanyl on the emergence characteristics after sevoflurane anesthesia in children undergoing surgery for bilateral myringotomy tube placement. Anesth Analg 2001; 92:1164-8. [PMID: 11323340 DOI: 10.1097/00000539-200105000-00016] [Citation(s) in RCA: 102] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
UNLABELLED Children undergoing placement of bilateral myringotomy tubes (BMT) often exhibit pain-related behavior (agitation) in the postanesthesia care unit. We compared the emergence and recovery profiles of pediatric patients who received sevoflurane with or without supplementary intranasal fentanyl for BMT surgery. By using a prospective, double-blinded design, 150 children 6 mo to 5 yr of age, scheduled for routine BMT surgery, were anesthetized with sevoflurane (2%-3%) in a 60% N(2)O/O(2) gas mixture. Patients were randomized to receive equal volumes of intranasal saline (Control), 1 microg/kg fentanyl or 2 microg/kg fentanyl. A blinded observer evaluated each patient using a previously described 4-point agitation scale and the Steward recovery scale. Response to parental presence was observed after a score of six (full recovery) was achieved on the Steward recovery scale. There were no significant differences among the three groups regarding age, weight, surgeon, duration of anesthesia, or ear condition. Recovery times and emergence characteristic scores were not statistically different. Agitation scores were significantly reduced in the 2-microg/kg Fentanyl group as compared with the Control group (P = 0.012). Fentanyl 2 microg/kg is recommended to reduce the incidence of agitation seen in these patients. IMPLICATIONS We examined the use of nasally administered fentanyl for the relief of agitation or discomfort after placement of bilateral myringotomy tubes in 150 children ages 6 mo to 5 yr using a prospective, double-blinded design. Fentanyl 2 microg/kg was found to reduce the incidence of agitation in these patients.
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Affiliation(s)
- J C Finkel
- Department of Anesthesiology, Children's National Medical Center and George Washington University Medical Center, 111 Michigan Ave., Washington, DC 20010, USA
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Abstract
UNLABELLED This study was designed to determine the feasibility and benefits of fast-tracking children after ambulatory surgery. One-hundred-fifty-five healthy children undergoing surgical procedures lasting <90 min were studied in a randomized manner. After surgery, children who met predefined recovery criteria in the operating room were entered into one of the study groups. Seventy-one patients (control) were first admitted to the postanesthesia care unit (PACU) and then to the second-stage recovery unit (SSRU). Eighty-four children bypassed the PACU and were directly admitted to the SSRU (Fast-Track group). The demographic data, airway management, and surgical procedures were similar in both groups of patients. During the recovery phase, 62.0% of the PACU group patients and 40.5% of the Fast-Track patients received analgesics (P = 0.01). The total recovery time was 79.1 +/- 48.3 min in the Fast-Track group and 99.4 +/- 48.6 min in the Control group (P = 0.008). A larger percentage of parents in the Fast-Track group (31% vs 16%) reported that their child was restless on arrival at the SSRU (P = 0.037). There were no clinically significant adverse events. However, adequate pain control must be provided before transfer to SSRU. In conclusion, fast-tracking children after ambulatory surgery is feasible and beneficial when specific selection criteria are used. IMPLICATIONS The results of this study show that the total recovery time is shorter in children who are fast-tracked (bypass the postanesthesia care unit) after ambulatory surgery. A higher percentage of parents of the Fast-Track group felt that their child was restless on arrival at the second-stage recovery unit. Fast-tracking children after ambulatory surgery is feasible and beneficial when specific selection criteria are used.
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Affiliation(s)
- R I Patel
- Department of Anesthesiology and Pediatrics, Children's National Medical Center and George Washington University Medical Center, Washington, DC 20010, USA.
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McRee DE, Williams PA, Sridhar V, Pastuszyn A, Bren KL, Patel KM, Chen Y, Todaro TR, Sanders D, Luna E, Fee JA. Recombinant cytochrome rC557 obtained from Escherichia coli cells expressing a truncated Thermus thermophilus cycA gene. Heme inversion in an improperly matured protein. J Biol Chem 2001; 276:6537-44. [PMID: 11069913 DOI: 10.1074/jbc.m008421200] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Cytochrome rC(557) is an improperly matured, dimeric cytochrome c obtained from expression of the "signal peptide-lacking" Thermus thermophilus cycA gene in the cytoplasm of Escherichia coli. It is characterized by its Q(00) (or alpha-) optical absorption band at 557 nm in the reduced form (Keightley, J. A., Sanders, D., Todaro, T. R., Pastuszyn, A., and Fee, J. A. (1998) J. Biol. Chem. 273, 12006-12016). We report results of a broad ranging, biochemical and spectral characterization of this protein that reveals the presence of a free vinyl group on the porphyrin and a disulfide bond between the protomers and supports His-Met ligation in both valence states of the iron. A 3-A resolution x-ray structure shows that, in comparison with the native protein, the heme moiety is rotated 180 degrees about its alpha,gamma-axis; cysteine 14 has formed a thioether bond with the 2-vinyl of pyrrole ring I instead of the 4-vinyl of pyrrole ring II, as occurs in the native protein; and a cysteine 11 from each protomer has formed an intermolecular disulfide bond. Numerous, minor perturbations exist within the structure of rC(557) in comparison with that of native protein, which result from heme inversion and protein-protein interactions across the dimer interface. The unusual spectral properties of rC(557) are rationalized in terms of this structure.
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Affiliation(s)
- D E McRee
- Department of Molecular Biology, the Scripps Research Institute, La Jolla, California 92037, USA
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