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Patel V, Patel J, Gan J, Rahiminejad M, Preston R, Mak SM, Benedetti G. Reporting of coronary artery calcification on chest CT studies in patients with interstitial lung disease. Clin Radiol 2024; 79:e532-e538. [PMID: 38242805 DOI: 10.1016/j.crad.2023.11.028] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 11/03/2023] [Accepted: 11/29/2023] [Indexed: 01/21/2024]
Abstract
AIM To evaluate the prevalence of coronary artery calcification (CAC) on non-contrast computed tomography (CT) of the thorax in patients with interstitial lung disease (ILD), assess consistency of CAC reporting and assess incidence of subsequent cardiac events. MATERIALS AND METHODS Patients with known interstitial lung disease who underwent a CT thorax over a 2-year period were retrospectively reviewed. Presence of CAC was assessed using a visual scale for CAC reporting and graded as mild, moderate, or severe by two cardiothoracic radiologists. CT reports were reviewed to determine if presence of CAC had been described. Electronic medical records were reviewed for any subsequent cardiothoracic events from the date of the CT thorax to present. RESULTS 254 patients were included in the analysis (54.7% men; mean age 59.9 yo). 43.7% had CAC on their CT thorax; however, in 87.3% of those, reports did not comment on its presence. 8 patients had cardiac events; 7 of them had CAC on CT although only in 1 case this was reported. Global CAC and LAD CAC Patients with cardiac events had a significantly higher global CAC (p=0.016) and LAD CAC (p=0.048) when compared to patients without. CONCLUSION We demonstrated a high prevalence of CAC in ILD patients and its significant association with adverse cardiac events. Unfortunately, CAC on CT thorax is still largely unreported. As per recent BSCI/BSCCT and BSTI guidelines, reporting of CAC should become part of routine practice, as may prompt prevention and impact on patients outcome.
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Affiliation(s)
- V Patel
- The Royal Marsden, Fulham Road, London, SW3 6JJ, UK
| | - J Patel
- Guy's and St Thomas' NHS Foundation Trust, Westminster Bridge Road, London, SE1 7EH, UK
| | - J Gan
- Guy's and St Thomas' NHS Foundation Trust, Westminster Bridge Road, London, SE1 7EH, UK
| | - M Rahiminejad
- National Hospital for Neurology and Neurosurgery, Queen Square, London, WC1N 3BG, UK
| | - R Preston
- Guy's and St Thomas' NHS Foundation Trust, Westminster Bridge Road, London, SE1 7EH, UK
| | - S M Mak
- Guy's and St Thomas' NHS Foundation Trust, Westminster Bridge Road, London, SE1 7EH, UK
| | - G Benedetti
- Guy's and St Thomas' NHS Foundation Trust, Westminster Bridge Road, London, SE1 7EH, UK.
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Ratneswaren T, Chan N, Aeron-Thomas J, Sait S, Adesalu O, Alhawamdeh M, Benger M, Garnham J, Dixon L, Tona F, McNamara C, Taylor E, Lobotesis K, Lim E, Goldberg O, Asmar N, Evbuomwan O, Banerjee S, Holm-Mercer L, Senor J, Tsitsiou Y, Tantrige P, Taha A, Ballal K, Mattar A, Daadipour A, Elfergani K, Barker R, Chakravartty R, Murchison AG, Kemp BJ, Simister R, Davagnanam I, Wong OY, Werring D, Banaras A, Anjari M, Rodrigues JCL, Thompson CAS, Haines IR, Burnett TA, Zaher REY, Reay VL, Banerjee M, Sew Hee CSL, Oo AP, Lo A, Rogers P, Hughes T, Marin A, Mukherjee S, Jaber H, Sanders E, Owen S, Bhandari M, Sundayi S, Bhagat A, Elsakka M, Hashmi OH, Lymbouris M, Gurung-Koney Y, Arshad M, Hasan I, Singh N, Patel V, Rahiminejad M, Booth TC. COVID-19 Stroke Apical Lung Examination Study 2: a national prospective CTA biomarker study of the lung apices, in patients presenting with suspected acute stroke (COVID SALES 2). Neuroimage Clin 2024; 42:103590. [PMID: 38513535 DOI: 10.1016/j.nicl.2024.103590] [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] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Revised: 03/10/2024] [Accepted: 03/13/2024] [Indexed: 03/23/2024]
Abstract
BACKGROUND Apical ground-glass opacification (GGO) identified on CT angiography (CTA) performed for suspected acute stroke was developed in 2020 as a coronavirus-disease-2019 (COVID-19) diagnostic and prognostic biomarker in a retrospective study during the first wave of COVID-19. OBJECTIVE To prospectively validate whether GGO on CTA performed for suspected acute stroke is a reliable COVID-19 diagnostic and prognostic biomarker and whether it is reliable for COVID-19 vaccinated patients. METHODS In this prospective, pragmatic, national, multi-center validation study performed at 13 sites, we captured study data consecutively in patients undergoing CTA for suspected acute stroke from January-March 2021. Demographic and clinical features associated with stroke and COVID-19 were incorporated. The primary outcome was the likelihood of reverse-transcriptase-polymerase-chain-reaction swab-test-confirmed COVID-19 using the GGO biomarker. Secondary outcomes investigated were functional status at discharge and survival analyses at 30 and 90 days. Univariate and multivariable statistical analyses were employed. RESULTS CTAs from 1,111 patients were analyzed, with apical GGO identified in 8.5 % during a period of high COVID-19 prevalence. GGO showed good inter-rater reliability (Fleiss κ = 0.77); and high COVID-19 specificity (93.7 %, 91.8-95.2) and negative predictive value (NPV; 97.8 %, 96.5-98.6). In subgroup analysis of vaccinated patients, GGO remained a good diagnostic biomarker (specificity 93.1 %, 89.8-95.5; NPV 99.7 %, 98.3-100.0). Patients with COVID-19 were more likely to have higher stroke score (NIHSS (mean +/- SD) 6.9 +/- 6.9, COVID-19 negative, 9.7 +/- 9.0, COVID-19 positive; p = 0.01), carotid occlusions (6.2 % negative, 14.9 % positive; p = 0.02), and larger infarcts on presentation CT (ASPECTS 9.4 +/- 1.5, COVID-19 negative, 8.6 +/- 2.4, COVID-19 positive; p = 0.00). After multivariable logistic regression, GGO (odds ratio 15.7, 6.2-40.1), myalgia (8.9, 2.1-38.2) and higher core body temperature (1.9, 1.1-3.2) were independent COVID-19 predictors. GGO was associated with worse functional outcome on discharge and worse survival after univariate analysis. However, after adjustment for factors including stroke severity, GGO was not independently predictive of functional outcome or mortality. CONCLUSION Apical GGO on CTA performed for patients with suspected acute stroke is a reliable diagnostic biomarker for COVID-19, which in combination with clinical features may be useful in COVID-19 triage.
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Affiliation(s)
- T Ratneswaren
- Charing Cross Hospital, London, UK; Addenbrooke's Hospital, Cambridge, UK
| | - N Chan
- Royal London Hospital, London, UK
| | | | - S Sait
- King's College Hospital, London, UK
| | | | | | - M Benger
- King's College Hospital, London, UK
| | | | - L Dixon
- Charing Cross Hospital, London, UK
| | - F Tona
- Charing Cross Hospital, London, UK
| | | | - E Taylor
- Charing Cross Hospital, London, UK
| | | | - E Lim
- Charing Cross Hospital, London, UK
| | | | - N Asmar
- Charing Cross Hospital, London, UK
| | | | | | | | - J Senor
- Charing Cross Hospital, London, UK
| | | | - P Tantrige
- Princess Royal University Hospital, Orpington, UK
| | - A Taha
- Princess Royal University Hospital, Orpington, UK
| | - K Ballal
- Princess Royal University Hospital, Orpington, UK
| | - A Mattar
- Princess Royal University Hospital, Orpington, UK
| | - A Daadipour
- Princess Royal University Hospital, Orpington, UK
| | - K Elfergani
- Princess Royal University Hospital, Orpington, UK
| | - R Barker
- Frimley Park Hospital, Surrey, UK
| | | | | | - B J Kemp
- John Radcliffe Hospital, Oxford, UK
| | | | | | - O Y Wong
- University College Hospital, London, UK
| | - D Werring
- Comprehensive Stroke Service, National Hospital for Neurology and Neurosurgery, University College Hospitals NHS Foundation Trust, London, UK; Stroke Research Centre, UCL Queen Square Institute of Neurology, London, UK
| | - A Banaras
- University College Hospital, London, UK
| | - M Anjari
- Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, UK
| | | | | | | | | | - R E Y Zaher
- Southampton General Hospital, Southampton, UK
| | - V L Reay
- Southampton General Hospital, Southampton, UK
| | - M Banerjee
- Southampton General Hospital, Southampton, UK
| | | | - A P Oo
- Southampton General Hospital, Southampton, UK
| | - A Lo
- Addenbrooke's Hospital, Cambridge, UK
| | - P Rogers
- Addenbrooke's Hospital, Cambridge, UK
| | - T Hughes
- Cardiff and Vale University Health Board, Cardiff, UK
| | - A Marin
- Cardiff and Vale University Health Board, Cardiff, UK
| | - S Mukherjee
- Cardiff and Vale University Health Board, Cardiff, UK
| | - H Jaber
- Cardiff and Vale University Health Board, Cardiff, UK
| | - E Sanders
- Cardiff and Vale University Health Board, Cardiff, UK
| | - S Owen
- Cardiff and Vale University Health Board, Cardiff, UK
| | | | - S Sundayi
- Watford General Hospital, Watford, UK
| | - A Bhagat
- Watford General Hospital, Watford, UK
| | - M Elsakka
- Watford General Hospital, Watford, UK
| | - O H Hashmi
- Norfolk and Norwich University Hospital, Norwich, UK
| | - M Lymbouris
- Norfolk and Norwich University Hospital, Norwich, UK
| | | | - M Arshad
- Norfolk and Norwich University Hospital, Norwich, UK
| | - I Hasan
- Norfolk and Norwich University Hospital, Norwich, UK
| | - N Singh
- Norfolk and Norwich University Hospital, Norwich, UK
| | - V Patel
- St Thomas' Hospital, London, UK
| | | | - T C Booth
- King's College Hospital, London, UK; School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK.
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Patel V, Mill J, Okonkwo OC, Salamat S, Li L, Raife T. Global Energy Metabolism Deficit in Alzheimer Disease Brain. J Prev Alzheimers Dis 2024; 11:171-178. [PMID: 38230730 DOI: 10.14283/jpad.2023.91] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2024]
Abstract
BACKGROUND The understanding of Alzheimer's disease (AD) has been dominated by the amyloid hypothesis. However, therapies targeting beta-amyloid have largely failed, generating interest in other potential pathogenic factors including energy metabolism. OBJECTIVES To interrogate canonical energy metabolism pathways from human prefrontal cortical tissue samples obtained from necropsy comparing AD and control. DESIGN, SETTING, AND PARTICIPANTS Postmortem pre-frontal cortical tissue from 10 subjects histologically diagnosed with AD and 10 control (CTRL) subjects was subjected to untargeted metabolomics to interrogate energy metabolism pathways. The samples were matched by age, sex, and post-mortem interval. Metabolite Measurements: Untargeted metabolomics analyses were via Metabolon®. RESULTS Glucose-derived energy metabolites in the glycolytic and pentose phosphate pathway and the ketone body β-hydroxybutyrate were uniformly decreased in AD brain vs. CTRL brain. CONCLUSION This pilot study aimed to identify energy metabolism abnormalities using untargeted brain metabolomics in two independent subject cohorts. Our study revealed a pattern of global energy deficit in AD brain, supporting a growing body of evidence of deficient energy metabolism in AD.
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Affiliation(s)
- V Patel
- Viharkumar Patel, University of California Davis Department of Pathology, 4400 V Street Suite 1114, Sacramento, CA 95817, USA, E-mail:
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Boyd AM, Sue C, Khandoobhai A, Vinson B, Shaikh H, Sorenson S, Patel V, Snyder B, Bondarenka C, Koukounas Y, Earl M, Jenkins M. Evaluation of oncology infusion pharmacy practices: A nationwide survey. J Oncol Pharm Pract 2024; 30:127-141. [PMID: 37122190 DOI: 10.1177/10781552231170358] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
PURPOSE Oncology care continues to evolve at a rapid pace including provision of infusion-based care. There is currently a lack of robust metrics around oncology infusion centers and pharmacy practice. The workgroup completed a nationwide survey to learn about oncology-based infusion pharmacy services offered. The objective was to highlight consistent, measureable oncology-based infusion pharmacy metrics that will provide a foundation to describe overall productivity including emphasis on high patient-safety standards. METHODS A nationwide survey was developed via a workgroup within the Vizient Pharmacy Cancer Care Group beginning in April 2019 and conducted electronically via the Vizient Pharmacy Network from September to November 2020. The survey was designed to capture a number of key metrics related to oncology-based infusion pharmacy services. RESULTS Forty-one sites responded to the survey. Responses highlighted hours of operation (median = 11.5), number of infusion chairs (median = 45). Staffing metrics included 7.1 pharmacist full-time equivalent (FTE) and 7.6 technician FTE per week. 80.5% of sites had cleanrooms and 95.1% reported both hazardous and nonhazardous compounding hoods. 68.3% of sites reported using intravenous (IV) technology, 50.0% measured turnaround time, and 31.4% prepared treatment medications in advance. CONCLUSION There was variability among oncology infusion pharmacy practices in regard to survey responses among sites. The survey results highlight the need for standardization of established productivity metrics across oncology infusion pharmacies in order to improve efficiency and contain costs in the changing oncology landscape. The survey provides insight into oncology infusion pharmacy practices nationwide and provides information for pharmacy leaders to help guide their practices.
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Affiliation(s)
- A M Boyd
- Department of Pharmacy, Cleveland Clinic, Cleveland, OH, USA
| | - C Sue
- Department of Pharmacy, UC Health, Cincinnati, OH, USA
| | - A Khandoobhai
- Department of Pharmacy, The Johns Hopkins Hospital, Baltimore, MD, USA
| | - B Vinson
- Department of Pharmacy, Cedars-Sinai, Los Angeles, CA, USA
| | - H Shaikh
- Department of Pharmacy, University Health, Kansas City, MO, USA
| | - S Sorenson
- Department of Pharmacy, University of Iowa Health Care, Iowa City, IA, USA
| | - V Patel
- Department of Pharmacy, Cedars-Sinai, Los Angeles, CA, USA
| | - B Snyder
- Department of Pharmacy, Atrium Health Wake Forest Baptist, Winston-Salem, NC, USA
- Bristol-Meyers Squibb Company, New York, NY, USA
| | - C Bondarenka
- Department of Pharmacy, Medical University of South Carolina, Charleston, SC, USA
| | - Y Koukounas
- Department of Pharmacy, Cleveland Clinic, Cleveland, OH, USA
- Novartis, Basel, Switzerland
| | - M Earl
- Department of Pharmacy, Cleveland Clinic, Cleveland, OH, USA
- Seagen, Bothell, WA, USA
| | - M Jenkins
- Department of Pharmacy Services, UVA Health, Charlottesville, VA, USA
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Takahashi K, Cheung CMG, Iida T, Lai TYY, Ohji M, Yanagi Y, Kawano M, Ohsawa S, Suzuki T, Kotecha A, Lin H, Patel V, Swaminathan B, Lee WK. Efficacy, durability, and safety of faricimab in patients from Asian countries with neovascular age-related macular degeneration: 1-Year subgroup analysis of the TENAYA and LUCERNE trials. Graefes Arch Clin Exp Ophthalmol 2023; 261:3125-3137. [PMID: 37294433 PMCID: PMC10251323 DOI: 10.1007/s00417-023-06071-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 01/11/2023] [Revised: 03/30/2023] [Accepted: 04/11/2023] [Indexed: 06/10/2023] Open
Abstract
PURPOSE To evaluate 1-year efficacy, durability, and safety of faricimab among patients from Asian countries in the TENAYA/LUCERNE trials of neovascular age-related macular degeneration (nAMD). METHODS Treatment-naïve patients with nAMD were randomly assigned (1:1) to faricimab 6.0 mg up to every 16 weeks (Q16W), based on disease activity at weeks 20 and 24, or aflibercept 2.0 mg Q8W. The primary endpoint was change in best-corrected visual acuity (BCVA) from baseline averaged over weeks 40, 44, and 48. RESULTS In the pooled TENAYA/LUCERNE trials, there were 120 (9.0%) and 1209 (91.0%) patients in the Asian (faricimab n = 61; aflibercept n = 59) and non-Asian country (faricimab n = 604; aflibercept n = 605) subgroups, respectively. In the Asian country subgroup, mean BCVA change from baseline at the primary endpoint visits was 7.1 (95% CI, 4.3-9.8) letters with faricimab and 7.2 (4.4-10.0) letters with aflibercept. In non-Asian country patients, mean vision gains were 6.1 (5.2-7.1) and 5.7 (4.8-6.7) letters with faricimab and aflibercept, respectively. At week 48, 59.6% of Asian country patients in the faricimab group achieved Q16W dosing (vs. 43.9% non-Asian) and 91.2% achieved ≥ Q12W dosing (vs. 77.5% non-Asian). Central subfield thickness reductions were similar between the subgroups, with meaningful and similar reductions from baseline observed at the primary endpoint visits and over time. Faricimab was well tolerated in both subgroups, with an acceptable safety profile. CONCLUSION Consistent with the global TENAYA/LUCERNE findings, faricimab up to Q16W showed sustained visual and anatomical benefits in patients with nAMD from Asian and non-Asian countries. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT03823287 (TENAYA); NCT03823300 (LUCERNE). Date of registration: January 30, 2019.
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Affiliation(s)
- Kanji Takahashi
- Department of Ophthalmology, Kansai Medical University, School of Medicine, 2-5-1 Shinmachi, Hirakata City, Osaka, 573-1191, Japan.
| | - Chui Ming Gemmy Cheung
- Singapore Eye Research Institute, Singapore National Eye Centre, Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
| | | | - Timothy Y Y Lai
- Department of Ophthalmology and Visual Science, The Chinese University of Hong Kong, Hong Kong, New Territories, China
| | - Masahito Ohji
- Department of Ophthalmology, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Yasuo Yanagi
- Department of Ophthalmology and Microtechnology, Yokohama City University, Yokohama, Japan
| | - Mika Kawano
- Chugai Pharmaceutical Co., Ltd., Tokyo, Japan
| | | | | | | | - Hugh Lin
- Genentech, Inc., South San Francisco, CA, USA
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Patel V, Aggarwal P, Sarvaiya J, Maity P, Ravichandiran V, Kaity S. Exploring novel and fast stability or sameness evaluation tool for different categories of injectable formulations. Eur J Pharm Sci 2023; 190:106551. [PMID: 37562551 DOI: 10.1016/j.ejps.2023.106551] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 06/19/2023] [Accepted: 07/30/2023] [Indexed: 08/12/2023]
Abstract
The establishment of drug product stability and sameness is the heart of generic formulation development. For regulatory filing, various instrumental methods are used on a case basis to establish the generic and innovator product sameness in multiple aspects. Here in the present study, we explored the applicability of the Time-correlated single photon counting (TCS-PC) technique as a fast, reliable, and nondestructive method for establishing the sameness of three different categories of injectable formulations, namely, Amphotericin B liposome for injection, enoxaparin injection, and iron sucrose injection. All three category formulations were evaluated in their native and artificially induced post degradation state to identify the discrimination power of the used instrumental techniques. The degradation of materials were confirmed by high performance liquid chromatography (HPLC). Based on the product category, pre and post-degradation samples were evaluated by selective instrumental methods like differential scanning calorimetry (DSC), nuclear magnetic resonance (NMR), fluorescence spectroscopy, particle size analysis by dynamic light scattering (DLS), small angle X-ray scattering (SAXS), Raman spectroscopy, inductively coupled plasma optical-emission spectrometry (ICP-OES) and circular dichroism study. All pre and post-degradation samples were further analyzed by TCS-PC. We observed that, TCS-PC can identify the differences between the initial and post degradation samples in very less time with promising discrimination power across the different injectable formulation types. Thus TCS-PC can be used as a fast and promising stability or sameness evaluation tool for different injectable drug products.
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Affiliation(s)
- Vaibhavi Patel
- School of Engineering and Technology, National Forensic Sciences University, Gandhinagar, Gujarat, India
| | - Punita Aggarwal
- School of Engineering and Technology, National Forensic Sciences University, Gandhinagar, Gujarat, India; National Institute of Pharmaceutical Education and Research (NIPER), Kolkata, West Bengal, India
| | - Jayrajsinh Sarvaiya
- Center of Excellence FTF, National Forensic Sciences University, Gandhinagar, Gujarat, India
| | - Prasenjit Maity
- School of Engineering and Technology, National Forensic Sciences University, Gandhinagar, Gujarat, India
| | - Velayutham Ravichandiran
- National Institute of Pharmaceutical Education and Research (NIPER), Kolkata, West Bengal, India
| | - Santanu Kaity
- National Institute of Pharmaceutical Education and Research (NIPER), Kolkata, West Bengal, India.
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Humbert-Vidan L, Patel V, King AP, Guerrero Urbano T. Interpretability of a Deep Learning-Based Prediction Model for Mandibular Osteoradionecrosis. Int J Radiat Oncol Biol Phys 2023; 117:e468-e469. [PMID: 37785491 DOI: 10.1016/j.ijrobp.2023.06.1673] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) The development of radiation-induced toxicities is a multifactorial process. Existing DVH-based prediction models use traditional multivariate analysis to combine all the potential risk factors. Recently, deep learning (DL) has been proposed for predicting mandibular osteoradionecrosis (ORN) directly from 3D dose distribution maps [1]. However, with this approach, incorporating non-imaging data such as potential risk factors presents challenges. We investigate the use of DL-based multimodality fusion for the purpose of radiation-induced ORN toxicity prediction. MATERIALS/METHODS This study explores early and late fusion strategies for combining 3D radiation dose distribution maps and clinical and demographic variables in the prediction of mandibular ORN incidence in head and neck cancer patients treated with radiotherapy. The results are compared to single-modality predictions with a random forest (RF) trained only on clinical variables and a 3D DenseNet40 trained on dose maps alone. We investigate two different fusion approaches. In the first, the image features extracted from the radiation dose maps using a 3D DenseNet40 were concatenated with the clinical variables into one single vector using a type II early fusion strategy. The combined feature vector was input into a fully connected layer for classification of ORN vs. controls. A final softmax activation layer was added to obtain the class predicted probabilities. The second approach used a late fusion strategy, in which the outputs from the 3D DenseNet40 and the RF model were combined by averaging the predicted classification probabilities for each of the two classes (ORN and no ORN) to obtain the final class decision on a case-by-case basis. RESULTS The AUROC values obtained for the late and early fusion models and the single-modality 3D DenseNet40 and RF models were 0.70, 0.68, 0.69 and 0.60, respectively. The highest AUC ROC was observed with the late fusion approach, which was statistically significantly different to that of the RF single-modality model with a significance level of 0.05. However, after Bonferroni correction (Altman 1999) for multiple comparisons was applied, resulting in a corrected significance level of 0.05/6 = 0.008 for each comparison, no statistically significant difference was observed between any of the models' AUROC values. This is most likely due to the lack of discriminative contribution observed from clinical variables, which on their own resulted in a poorly predictive RF model. CONCLUSION To our knowledge, no previous work has been published on the use of multimodal fusion DL methods to combine dose distribution maps and clinical variables in the prediction of mandibular ORN. Although non-conclusive results were obtained, this study demonstrates the potential of DL in the prediction of the multifactorial side effects resulting from radiotherapy treatments. [1] Humbert-Vidan L et al. Prediction of Mandibular ORN Incidence from 3D Radiation Dose Distribution Maps Using DL (2022).
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Affiliation(s)
- L Humbert-Vidan
- Department of Medical Physics, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; School of Cancer and Pharmaceutical Sciences, King's College London, London, United Kingdom
| | - V Patel
- Department of Oral Surgery, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - A P King
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - T Guerrero Urbano
- King's College London, London, United Kingdom; Department of Oncology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
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de Pinho IS, Barroso T, Trabulo C, Campoa E, Patel V, Gonçalves L, Araújo J, Monteiro C, Ferreira A, Machado B, Dâmaso S, Luz P, de Sousa RT, Costa L. P159 Neutrophil-to-lymphocyte Ratio and Platelet-to-lymphocyte Ratio are not predictive of Pathologic Complete Response to Neoadjuvant Chemotherapy in Triple-negative Breast Cancer. Breast 2023. [DOI: 10.1016/s0960-9776(23)00276-x] [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: 03/16/2023] Open
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Patel V, Rodrigues D. A282 RISK FACTORS ASSOCIATED WITH UNSUCCESSFUL HIGH-RESOLUTION MANOMETRY: FAILURE IS COMMON BUT WHAT CAN WE CHANGE. J Can Assoc Gastroenterol 2023. [PMCID: PMC9991398 DOI: 10.1093/jcag/gwac036.282] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/09/2023] Open
Abstract
Background High-resolution manometry (HRM) is a diagnostic tool used to evaluate esophageal motor function and diagnose motility disorders. A standardized protocol is used to make an accurate diagnosis based on the Chicago Classification. Some existing literature suggests that incomplete or imperfect manometry tests are common, however; there remains a paucity of data to evaluate risk factors for failure to help clinicians determine when a study may be difficult to perform. Purpose Our goal was to quantify how often failed tests occurred and determine specific factors that may be associated with failed HRM. Method We retrospectively evaluated records for HRM tests performed over 1 year at our academic centre. Based on clinical experience, we identified several factors that may be associated with the success of HRM testing including the following: indications and symptoms leading to testing, patient’s age and biological sex, previous esophageal manometry history, previous esophageal/gastric surgery, previous septal repair/deviated septum, history of significant nausea/vomiting, history of anxiety/depression, history of irritable bowel syndrome, and medication use (opioids, proton pump inhibitors, calcium channel blockers, nitrates). We then compared patients with successful HRM vs. unsuccessful HRM with regard to our pre-specified risk factors. Result(s) 29 HRM tests were unsuccessful from a total of 152 that were performed (19% failure rate). Reasons for failure included the inability to pass the probe through LES (55%) and the inability to tolerate the manometry probe for a minimum of 10 saline swallows (45%). After separating the failed cases from successful tests, both groups had a similar distribution of age and sex. Specific symptoms and indications did not have a significant association with unsuccessful tests. A previous history of failed manometry was associated with unsuccessful HRM (OR: 15, 95% CI 1.88 to 183.8, p=0.0156). Conversely, PPI usage was associated with fewer failed HRM tests (OR: 0.37, 95% CI 0.16 to 0.90, p=0.0343). Other medical history or medication use was not found to be associated with testing failure in our study. Conclusion(s) HRM is useful for diagnosing esophageal motility disorders, but incomplete tests are common. Although this study did not identify any factors in a patient’s medical history that could be used to predict failure in patients who have never had testing, further investigations may identify if PPI therapy can make HRM testing more tolerable. Additionally, the association between previous failed HRM and repeat failures suggests that endoscopic probe placement techniques should be considered instead of retrying conventional probe placement. Please acknowledge all funding agencies by checking the applicable boxes below None Disclosure of Interest None Declared
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Affiliation(s)
- V Patel
- Queen's University, Kingston, Canada
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10
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Tao S, Zhou X, Greco E, Gupta V, Freund BE, Westerhold EM, Feyissa AM, Tatum WO, Grewal S, Patel V, Middlebrooks EH. Edge-Enhancing Gradient-Echo MP2RAGE for Clinical Epilepsy Imaging at 7T. AJNR Am J Neuroradiol 2023; 44:268-270. [PMID: 36732031 PMCID: PMC10187818 DOI: 10.3174/ajnr.a7782] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 08/15/2022] [Accepted: 01/03/2023] [Indexed: 02/04/2023]
Abstract
The 3D edge-enhancing gradient-echo (EDGE) MR imaging sequence offers superior contrast-to-noise ratio in the detection of focal cortical dysplasia. EDGE could benefit from 7T MR imaging but also faces challenges such as image inhomogeneity and low acquisition efficiency. We propose an EDGE-MP2RAGE sequence that can provide both EDGE and T1-weighted contrast, simultaneously, improving data-acquisition efficiency. We demonstrate that with sequence optimization, EDGE images with sufficient uniformity and T1-weighted images with high gray-to-white matter contrast can be achieved.
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Affiliation(s)
- S Tao
- From the Departments of Radiology (S.T., X.Z., E.G., V.G., E.M.W., V.P., E.H.M.)
| | - X Zhou
- From the Departments of Radiology (S.T., X.Z., E.G., V.G., E.M.W., V.P., E.H.M.)
| | - E Greco
- From the Departments of Radiology (S.T., X.Z., E.G., V.G., E.M.W., V.P., E.H.M.)
| | - V Gupta
- From the Departments of Radiology (S.T., X.Z., E.G., V.G., E.M.W., V.P., E.H.M.)
| | | | - E M Westerhold
- From the Departments of Radiology (S.T., X.Z., E.G., V.G., E.M.W., V.P., E.H.M.)
| | | | | | - S Grewal
- Neurosurgery (S.G., E.H.M.), Mayo Clinic, Jacksonville, Florida
| | - V Patel
- From the Departments of Radiology (S.T., X.Z., E.G., V.G., E.M.W., V.P., E.H.M.)
| | - E H Middlebrooks
- From the Departments of Radiology (S.T., X.Z., E.G., V.G., E.M.W., V.P., E.H.M.)
- Neurosurgery (S.G., E.H.M.), Mayo Clinic, Jacksonville, Florida
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du Pisanie J, Ramakrishnan V, Patel V, Commander C, Yu H. Abstract No. 50 Skeletal Muscle Enhancement on Contrast-Enhanced MRI: A Potential Imaging Biomarker for Severity of Systemic Inflammation and Liver Dysfunction in Cirrhotic Patients. J Vasc Interv Radiol 2023. [DOI: 10.1016/j.jvir.2022.12.093] [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: 02/27/2023] Open
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12
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Govorov A, Kolontarev K, Diyakov V, Arutyunyan P, Moschovas M, Jaber A, Patel V, Pushkar D. Treatment of Zinner syndrome with robot-assisted surgery. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)00624-3] [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: 02/12/2023]
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13
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Bravi C, Dall’Oglio P, Mazzone E, De Groote R, Falagario U, Schiavina R, Piazza P, Borghesi M, Scarcella S, Moschovas M, Turri F, Andras I, Di Maida F, Carrieri G, Terrone C, Autorino R, Patel V, Porpiglia F, Bocciardi A, Minervini A, Montorsi F, Rha K, Mottrie A. The surgical learning curve for positive surgical margins after robot-assisted radical prostatectomy: Results from a multi-institutional collaboration. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)01145-4] [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: 02/12/2023]
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14
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Goncalves L, Gonçalves D, Esteban Casanelles T, Soares de Pinho I, Barroso T, Patel V, Esperanca-Martins M, Brás R, Lobo-Martins S, Semedo P, Moreira C, Teixeira Sousa A, Mansinho A, Marques Da Costa L. 100P Immunotherapy around the clock: Impact on stage IV melanoma. Immuno-Oncology and Technology 2022. [DOI: 10.1016/j.iotech.2022.100204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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15
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Patel V, Petersen JM, Jhala D. Highly Effective, Easy, & Simple Model for the Day-to-Day Monitoring of Blood Bank Inventory Leading to Successful Operations to Provide Blood Products in the Times of Blood Product Shortage Nationally Due to COVID-19 Pandemic. Am J Clin Pathol 2022. [DOI: 10.1093/ajcp/aqac126.337] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Abstract
Introduction/Objective
Providing blood products in a timely manner is very important and is an integral part of the health care system to provide best patient care. Transfusion medicine services should be well prepared to respond to blood product demands in a timely manner. Due to the COVID-19 pandemic, all the transfusion medicine services nationally have been facing blood product shortages. A model was created in Pathology & Laboratory services (P&LMS) at the Corporal Michael J. Crescenz Veteran Affairs Medical Center (CMC VAMC) to communicate effectively to the patient care team to keep up with ongoing clinical care demands despite the national blood shortage.
Methods/Case Report
Transfusion medicine team at CMC VAMC communicated to patient care team about the national shortage of blood products. All blood requests were evaluated for appropriate usage of blood. Also, PACS (Peri Operative cells Savers) services was considered for Operating room for patient with major blood loss. Daily blood inventory was evaluated, closely monitored, and communicated to patient care team to meet the demands from Jan 16th, 2022, to April 11th, 2022. Importantly, P&LMS created a simple model where each blood product in reduction was recorded every morning and evening. This simple method of 24/7 real time monitoring of the supply of blood products helped tremendously in decision making for procedure prioritization based on clinical indications and contributed to the continued successful clinical operation.
Results (if a Case Study enter NA)
Procedures were successfully prioritized according to the blood supply. Simultaneously, there was no delay in issuing blood products as clinically needed. A significant amount of reduced inventory noted from Jan 16th, 2022, to April 11th, 2022; the average reduction was O+ 53% reduced and A+ 44% reduced.
Conclusion
By monitoring the day-to-day blood bank inventory effectively, P&LMS at CMC VAMC was able to support all the critical clinical needs by providing blood products in a timely manner. P&LMS services was able to reduce the wastage and was able to provide all the critical blood product without any significant delays by monitoring in Realtime. The value of collaborating and communicating to the patient care team cannot be understated as it is both simple and highly cost effective.
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Affiliation(s)
- V Patel
- Pathology and Laboratory Services, Corporal Michael J. Crescenz VA Medical Center Philadelphia , Philadelphia, Pennsylvania , United States
| | - J M Petersen
- Pathology and Laboratory Medicine, Corporal Michael J. Crescenz Veteran Affairs Medical Center and University of Pennsylvania , Philadelphia, Pennsylvania , United States
| | - D Jhala
- Pathology and Laboratory Medicine, Corporal Michael J. Crescenz Veteran Affairs Medical Center and University of Pennsylvania , Philadelphia, Pennsylvania , United States
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16
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Patel S, Patel V, Petersen JM, Jhala D. A Holistic Approach for an Efficient Day to Day Operation for Blood Bank Market Withdrawals and Recalls Using Departmental Electronic Occurrence System: A CMCVAMC Experience. Am J Clin Pathol 2022. [DOI: 10.1093/ajcp/aqac126.336] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Abstract
Introduction/Objective
Donor centers and reagent manufacturers may issue recalls or market withdrawals. Donor center withdrawals of blood components involve units that have a reason that may present a risk to the patient, that subsequently require discarding the product if not transfused or appropriate clinical notification and follow-up if already transfused prior to the notification. Reagent recalls involve problems with reagents that require appropriate corrective action as per the circumstances. Patient safety event reporting systems are universal in hospitals and are a backbone of efforts to detect patient safety events and quality problems. Pathology and Laboratory Medicine (P&LMS) at the Corporal Michael J. Crescenz Veteran Affairs Medical Center (CMC VAMC) has established an electronic occurrence reporting (EOR) program to track and respond to these in the blood bank. The authors explored the usefulness of the holistic approach of this initiative.
Methods/Case Report
EOR is available to all the employees of Blood Bank in P&LMS, who regularly report all received recalls and market withdrawals into the system. These are reviewed by the supervisor and blood bank medical director and co-director to ensure appropriate steps are taken. Information on all market recalls and withdrawals affecting blood bank were compiled from January 1st, 2021, to June 1st, 2022, for quality assurance review.
Results (if a Case Study enter NA)
The EOR plays a significant role in organizing the data from all the recalls and market withdrawals to guide improvement in patient care. There were seven market withdrawals during the study period, all from the donor center for blood product component withdrawals. All seven cases were recorded efficiently with review by the blood bank supervisor and blood bank medical director and co-director. Appropriate follow-up action was performed and recorded for all seven cases in the EOR.
Conclusion
The EOR for withdrawals recalls in Blood Bank is highly effective, successful program in terms of electronic organized monitoring. This monitoring is part of ensuring quality care in real time, and plays an important role as part of Veteran Affairs position as a High reliability Organization (HRO).
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Affiliation(s)
- S Patel
- Pathology and Laboratory Medicine , CMC VAMC , Philadelphia , Pennsylvania , United States
| | - V Patel
- Pathology and Laboratory Medicine , CMC VAMC , Philadelphia , Pennsylvania , United States
| | - J M Petersen
- Pathology and Laboratory Medicine , CMC VAMC , Philadelphia , Pennsylvania , United States
| | - D Jhala
- Pathology and Laboratory Medicine , CMC VAMC , Philadelphia , Pennsylvania , United States
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Petersen JM, Jhala D, Patel V. Continuing Profound Impact of Continued Education Sessions on Blood Bank Specimen Labeling Years Later at the Veteran Affairs Medical Center. Am J Clin Pathol 2022. [DOI: 10.1093/ajcp/aqac126.334] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Abstract
Introduction/Objective
Proper patient identification is a critical safety element for transfusion medicine, particularly for the prevention of acute hemolytic transfusion reactions (AHTR). Mislabeled specimens have been documented to carry an increased risk of patient misidentification. Therefore, the submission of a mislabeled specimen to the blood bank generally results in a specimen rejection with a redraw. At the Philadelphia Veteran Affairs Medical Center, an identification bracelet with alphanumeric code is used to help improve transfusion safety but also has additional patient labeling requirements. The redrawing of blood bank specimens poses risks in phlebotomy, and a quality improvement initiative was previously undertaken to educate staff on proper blood specimen and band labeling and usage to prevent labeling errors, improve safety in patient care, and reduce intended redraws.
Methods/Case Report
Colorful laminated posters delineating the labeling requirements and process for blood bank specimens collected using the blood bank system were made and distributed at the time of in-service training by the blood bank in 2017 to the areas of the hospital whereby errors had been noted to occur in the past. The dedicated in-service training was repeated prior to the change in the identification blood band from the Hollister Ident-ATM Blood Recipient Band (Precision Diagnostics Corporation, Valencia CA) to the Typenex Blood Bands (Typenex Medical, Chicago IL) on 11/12/2019. As part of the quality metrics of the blood bank, blood bank specimen labeling errors was tracked from 2017 to track the persistence of the effect of the initial training.
Results (if a Case Study enter NA)
The percentage of properly labeled specimens as a percentage of total specimens increased after the in-service training; specifically, an increase from a low of 97% (December 2017) to a high of 99% (August 2018). The percentage of properly labeled specimens remains at the increased level of 99% and above even at the 4.5-year mark in mid-2022.
Conclusion
The continued availability of laminated educational posters on blood specimen labeling for the clinical service areas combined with initial in-service education can have lasting effects to improve the quality of care even years after the initial in-service education sessions.
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Affiliation(s)
- J M Petersen
- Pathology and Laboratory Medicine, CMCVAMC and University of Pennsylvania , Philadelphia, Pennsylvania , United States
| | - D Jhala
- Pathology and Laboratory Medicine, CMCVAMC and University of Pennsylvania , Philadelphia, Pennsylvania , United States
| | - V Patel
- Department of Pathology and Laboratory Medicine, Corporal Michael J. Crescenz VA Medical Center , Philadelphia, Pennsylvania , United States
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Soares De Pinho I, Simão D, Roldán Galanares M, Lopes-Brás R, Patel V, Esperança-Martins M, Gonçalves L, Alves L, Fernandes I, Gamez Casado S, Artacho Criado S, Baena Cañada J, Costa J, Fernandes A, Teixeira de Sousa R, Costa L, Luz P. Anthracycline versus no anthracycline neoadjuvant therapy for HER2 breast cancer: real world evidence. Eur J Cancer 2022. [DOI: 10.1016/s0959-8049(22)01516-7] [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: 11/19/2022]
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19
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McCarthy C, Finan P, Garrett M, Campbell E, Walker E, Beaumont E, Cade I, Mooney L, Kendrew J, Schwarz D, Schuster V, Domingo A, Holliday N, Patel V, Garcia Raposo F, Gorman T, Aillard B, Hewison S, Ehlert J, Lauterwasser J. Discovery and functional characterization of potent, balanced AXL/ MER inhibitors using a novel MER X-Ray crystal structure. Eur J Cancer 2022. [DOI: 10.1016/s0959-8049(22)00854-1] [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: 11/03/2022]
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20
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Meechem M, Jadli A, Gomes K, Mackay C, Chen Y, Ballasy N, Patel V. VASCULAR SMOOTH MUSCLE CELL PHENOTYPIC DIFFERENTIATION AND METABOLIC DYSFUNCTION IN THORACIC AORTA ATHEROSCLEROSIS. Can J Cardiol 2022. [DOI: 10.1016/j.cjca.2022.08.206] [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: 11/16/2022] Open
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21
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Covas Moschovas M, Jaber A, Perera R, Sandri M, Rogers T, Morales K, Ortiz C, Patel V. Simultaneous hernia repair in robotic-assisted radical prostatectomy is safe with low rates of mesh complications. EUR UROL SUPPL 2022. [DOI: 10.1016/s2666-1683(22)02258-3] [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: 11/05/2022] Open
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22
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Jadli A, Gomes K, Ballasy N, Belke D, Wijesuriya M, Fedak P, Patel V. ENDOTHELIAL COLONY-FORMING CELL-DERIVED EXTRACELLULAR VESICLES AND CARDIAC REPAIR AFTER MYOCARDIAL INFARCTION. Can J Cardiol 2022. [DOI: 10.1016/j.cjca.2022.08.023] [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: 11/17/2022] Open
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23
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Bravi C, Mazzone E, Dell’Oglio P, Moschovas MC, Martini A, Rosiello G, Piazza P, Mottaran A, Paciotti M, Sarchi L, Puliatti S, Knipper S, De Groote R, Schiavina R, Rocco B, Galfano A, Briganti A, Montorsi F, Patel V, Mottrie A. A nomogram to predict pathologic T2 stage in candidates to robot-assisted radical prostatectomy with iT3 prostate cancer on preoperative multiparametric mri: results from a multi-institutional collaboration. EUR UROL SUPPL 2022. [DOI: 10.1016/s2666-1683(22)01169-7] [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: 11/07/2022] Open
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24
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Govorov A, Kolontarev K, Diyakov V, Moschovas M, Jaber A, Patel V, Pushkar D. Treatment of Zinner syndrome with robot-assisted surgery. EUR UROL SUPPL 2022. [DOI: 10.1016/s2666-1683(22)02139-5] [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: 11/07/2022] Open
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25
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Abou Zeinab M, Ferguson E, Kaviani A, Tuna Beksac A, Covas Moschovas M, Morgantini L, Hemal S, Josehp J, Kim M, Crivellaro S, Patel V, Nix J, Kaouk J. Single-port extraperitoneal vs. transperitoneal robotic-assisted radical prostatectomy: A multi-institutional matched-pair comparison of perioperative outcomes. EUR UROL SUPPL 2022. [DOI: 10.1016/s2666-1683(22)02142-5] [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: 11/07/2022] Open
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26
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Jadli A, Ballasy N, Gomes K, Mackay C, Meechem M, Wijesuriya M, Belke D, Fedak P, Patel V. ANGIOTENSIN 1-7 EXERTS PROTECTIVE EFFECTS IN THORACIC AORTIC ANEURYSM BY ATTENUATING SMOOTH MUSCLE CELL PHENOTYPIC SWITCHING. Can J Cardiol 2022. [DOI: 10.1016/j.cjca.2022.08.201] [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: 11/26/2022] Open
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27
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Rios-Diaz AJ, Morris MP, Christopher AN, Patel V, Broach RB, Heniford BT, Hsu JY, Fischer JP. National epidemiologic trends (2008-2018) in the United States for the incidence and expenditures associated with incisional hernia in relation to abdominal surgery. Hernia 2022; 26:1355-1368. [PMID: 36006563 DOI: 10.1007/s10029-022-02644-4] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 06/04/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE It is unknown whether the trend of rising incisional hernia (IH) repair (IHR) incidence and costs until 2011 currently persists. We aimed to evaluate how the IHR procedure incidence, cost and patient risk-profile have changed over the last decade relative to all abdominal surgeries (AS). METHODS Repeated cross-sectional analysis of 38,512,737 patients undergoing inpatient 4AS including IHR within the 2008-2018 National Inpatient Sample. Yearly incidence (procedures/1,000,000 people [PMP]), hospital costs, surgical and patient characteristics were compared between IHR and AS using generalized linear and multinomial regression. RESULTS Between 2008-2018, 3.1% of AS were IHR (1,200,568/38,512,737). There was a steeper decrease in the incidence of AS (356.5 PMP/year) compared to IHR procedures (12.0 PMP/year) which resulted in the IHR burden relative to AS (2008-2018: 12,576.3 to 9,113.4 PMP; trend difference P < 0.01). National costs averaged $47.9 and 1.7 billion/year for AS and IHR, respectively. From 2008-2018, procedure costs increased significantly for AS (68.2%) and IHR (74.6%; trends P < 0.01). Open IHR downtrended (42.2%), whereas laparoscopic (511.1%) and robotic (19,301%) uptrended significantly (trends P < 0.01). For both AS and IHR, the proportion of older (65-85y), Black and Hispanic, publicly-insured, and low-income patients, with higher comorbidity burden, undergoing elective procedures at small- and medium-sized hospitals uptrended significantly (all P < 0.01). CONCLUSION IH persists as a healthcare burden as demonstrated by the increased proportion of IHR relative to all AS, disproportionate presence of high-risk patients that undergo these procedures, and increased costs. Targeted efforts for IH prevention have the potential of decreasing $17 M/year in costs for every 1% reduction.
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Affiliation(s)
- A J Rios-Diaz
- Division of Plastic Surgery, Department of Surgery, University of Pennsylvania Health System, 51 North 39th Street, Wright Saunders Building, Philadelphia, PA, 19104, USA
- Department of Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - M P Morris
- Division of Plastic Surgery, Department of Surgery, University of Pennsylvania Health System, 51 North 39th Street, Wright Saunders Building, Philadelphia, PA, 19104, USA
| | - A N Christopher
- Division of Plastic Surgery, Department of Surgery, University of Pennsylvania Health System, 51 North 39th Street, Wright Saunders Building, Philadelphia, PA, 19104, USA
- Department of Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - V Patel
- Division of Plastic Surgery, Department of Surgery, University of Pennsylvania Health System, 51 North 39th Street, Wright Saunders Building, Philadelphia, PA, 19104, USA
| | - R B Broach
- Division of Plastic Surgery, Department of Surgery, University of Pennsylvania Health System, 51 North 39th Street, Wright Saunders Building, Philadelphia, PA, 19104, USA
| | - B T Heniford
- Division of Gastrointestinal and Minimally Invasive Surgery, Carolinas Medical Center, Charlotte, NC, USA
| | - J Y Hsu
- Center for Clinical Epidemiology and Biostatistics (CCEB), University of Pennsylvania, Philadelphia, PA, USA
| | - J P Fischer
- Division of Plastic Surgery, Department of Surgery, University of Pennsylvania Health System, 51 North 39th Street, Wright Saunders Building, Philadelphia, PA, 19104, USA.
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Onyekaba G, Mauch JT, Patel V, Broach RB, Thrippleton S, Fischer JP. The Abdominal Hernia-Q: a critical analysis of the components that impact quality-of-life. Hernia 2022; 26:839-846. [PMID: 34338937 DOI: 10.1007/s10029-021-02475-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Accepted: 07/16/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE Ventral hernias (VH) are a common surgical problem associated with significant morbidity. While assessment tools have examined quality-of-life (QoL), the relative change in specific domains of hernia-related QoL measures from pre- to post-operative period has yet to be comprehensively examined. Using the Abdominal Hernia-Q (AHQ), this study aims to assess the impact of ventral hernia repair (VHR) on key components of QoL. METHODS A retrospective chart review was conducted of patients undergoing VHR between September 2017 and September 2019 who had completed at least one pre- and post-operative AHQ. Post-operative intervals were created to capture AHQ responses around standard follow-up visits (< 1.5 months, 1.5-4.5 months, 4.5-11 months, and 11 + months) and scores were statistically analyzed. RESULTS A total of 136 patients were included, with an average age of 54.8 years at the time of VHR. Compared to the pre-operative period, the appearance score increased significantly (p < 0.05). The physical domain score increased from < 1.5 month to the 1.5-4.5 month period (p = 0.03) and remained significantly higher in later time period. The appearance score decreased from the 1.5-4.5 month to 4.5-11 month period (p = 0.05). CONCLUSIONS VHR leads to a sustained multi-dimensional increase in hernia-specific QoL measures during the post-operative course driven by early positive changes in appearance and sustained physical functioning. The initial increase in QoL is mainly driven by an improvement in appearance, while the sustained increase may be due to restored physical function.
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Affiliation(s)
- G Onyekaba
- Divison of Plastic Surgery, Department of Surgery, University of Pennsylvania, 51 North 39th Street, Wright Saunders Building, Philadelphia, PA, 19104, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - J T Mauch
- Divison of Plastic Surgery, Department of Surgery, University of Pennsylvania, 51 North 39th Street, Wright Saunders Building, Philadelphia, PA, 19104, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - V Patel
- Divison of Plastic Surgery, Department of Surgery, University of Pennsylvania, 51 North 39th Street, Wright Saunders Building, Philadelphia, PA, 19104, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - R B Broach
- Divison of Plastic Surgery, Department of Surgery, University of Pennsylvania, 51 North 39th Street, Wright Saunders Building, Philadelphia, PA, 19104, USA
| | - S Thrippleton
- Divison of Plastic Surgery, Department of Surgery, University of Pennsylvania, 51 North 39th Street, Wright Saunders Building, Philadelphia, PA, 19104, USA
| | - J P Fischer
- Divison of Plastic Surgery, Department of Surgery, University of Pennsylvania, 51 North 39th Street, Wright Saunders Building, Philadelphia, PA, 19104, USA.
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29
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Wang CA, Wong R, Kou TD, Zheng H, Wittstock K, Khaychuk V, Patel V. POS0343 TREATMENT PERSISTENCE AND ADHERENCE AMONG PATIENTS WITH JUVENILE IDIOPATHIC ARTHRITIS RECEIVING ABATACEPT OR TNF INHIBITORS USING US CLAIMS DATA. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.1289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundJuvenile idiopathic arthritis (JIA) is the most common rheumatic condition among children and teens1 and contributes to a diminished quality of life.2 Previous data underscore the potential for abatacept to improve health-related outcomes in patients with JIA after demonstrating poor responses to other DMARDs.3 Patients with RA show greater persistence on abatacept vs TNF inhibitors (TNFi), and this should also be confirmed in patients with JIA.4ObjectivesTo evaluate treatment persistence and adherence at 12- and 18-month follow-up in patients with JIA newly initiating either abatacept or a TNFi.MethodsThis analysis used data from the IQVIA PharMetrics Plus claims database from Jan 2008–Apr 2021. We identified patients with ≥ 1 claim of JIA diagnosis after Jan 2008, who were < 18 years old at initial diagnosis, had ≥ 1 claim of abatacept or TNFi treatment (adalimumab, etanercept, golimumab) following diagnosis, had continuous enrollment in medical and pharmacy benefits for ≥ 12 months before index date (first prescription of abatacept or TNFi), and had 12 or 18 months’ continuous medical and pharmacy enrollment after index date. Patients receiving abatacept or TNFi treatment ≤ 12 months prior to index date and patients initiating combined abatacept + TNFi treatment on the index date were excluded. Specific outcomes included: discontinuation (absence of a new prescription for index treatment within the gap of 5× treatment half-life), persistence rate (proportion of patients continuing index medication without any gaps exceeding 5× treatment half-life), and treatment adherence (defined as medication possession ratio [MPR, proportion of follow-up period where medication supply is available] and proportion of days covered [PDC, proportion of follow-up period where a patient is covered by a given drug]). All outcomes were reported at 12 and 18 months. All statistical analyses are descriptive with the intent for hypothesis generation.ResultsThere were 2847 patients (abatacept, n = 111; TNFi, n = 2736) at 12-month follow-up; fewer completed the 18-month follow-up (2403 patients: abatacept, n = 94; TNFi, n = 2309). At index date, treatment groups were similar for sex, geographic location, and comorbidities (Table 1). Numerically higher persistence was observed in patients prescribed abatacept compared with TNFi overall at both time points. Abatacept persistence was higher than etanercept but similar to adalimumab (Figure 1). At 12 months, the percent of patients with PDC ≥ 0.8 was 57% for abatacept, 51% for adalimumab, and 38% for etanercept, while MPR ≥ 0.8 was 63% for abatacept, 55% for adalimumab, and 42% for etanercept. Patients prescribed abatacept had numerically greater proportions of PDC ≥ 0.8 (abatacept, 48%; adalimumab, 40%; etanercept, 29%) and MPR ≥ 0.8 (abatacept, 53%; adalimumab, 44%; etanercept, 33%) at 18 months.Table 1.Baseline characteristics of patients with 12-month follow-up dataCharacteristicAbatacept (n = 111)TNFi (n = 2736)Age, years, mean (SD)14.4 (3.8)12.6 (4.6)Female sex89 (80.2)1930 (70.5)Geographic region South43 (38.7)865 (31.6) Midwest40 (36.0)818 (29.9) West9 (8.1)408 (14.9) East19 (17.1)540 (19.7) Unknown0 (0)105 (3.8)Comorbidities Asthma9 (8.1)275 (10.1) COPD11 (9.9)323 (11.8) Cardiovascular disease14 (12.6)222 (8.1) Uveitis14 (12.6)321 (11.7) Iridocyclitisa12 (10.8)216 (7.9)CCI score, mean (SD)0.58 (0.73)0.46 (0.68)Data are shown as n (%) unless otherwise specified.aSubgroup disease under uveitis.CCI, Charlson Comorbidity Index; COPD, chronic obstructive pulmonary disease.ConclusionThe present findings suggest that patients with JIA initiating abatacept treatment display numerically higher persistence and adherence compared with patients treated with TNFis at both 12- and 18-months’ follow-up.References[1]Prakken B, et al. Lancet 2011;377:2138–49.[2]Lovell DJ, et al. Arthritis Rheumatol 2015;67:2759–70.[3]Ruperto N, et al. Lancet 2008;372:383–91.[4]Han X, et al. J Health Econ Outcomes Res 2021;8:71–8.AcknowledgementsThis study was sponsored by Bristol Myers Squibb. Medical writing and editorial assistance were provided by Ryan Miller, of Caudex, and were funded by Bristol Myers Squibb. Project analysis was provided by Akshay Vinod (Mu Sigma).Disclosure of InterestsChing-An Wang Consultant of: Novartis (used to work there as an external contractor from Jan 2016 to Apr 2021), Employee of: Bristol Myers Squibb, Robert Wong Shareholder of: Bristol Myers Squibb, Employee of: Bristol Myers Squibb, Tzuyung Douglas Kou Shareholder of: Bristol Myers Squibb, Employee of: Bristol Myers Squibb, Hanke Zheng Employee of: Bristol Myers Squibb, Keith Wittstock Shareholder of: Bristol Myers Squibb, Employee of: Bristol Myers Squibb, Vadim Khaychuk Shareholder of: Bristol Myers Squibb, Employee of: Bristol Myers Squibb, Vardhaman PATEL Shareholder of: Bristol Myers Squibb, Employee of: Bristol Myers Squibb
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Patel S, Wehry S, Bass J, Plowman K, Lindner D, Patel V, Cubeddu R, Velamakanni S, Abuawad M. Abstract No. 327 Vacuum-assisted aspiration of right heart thrombi, masses and vegetations using the AngioVac System: a single-center experience. J Vasc Interv Radiol 2022. [DOI: 10.1016/j.jvir.2022.03.408] [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: 11/15/2022] Open
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Humbert-Vidan L, Patel V, Andlauer R, King A, Guerrero Urbano T. PO-1770 Prediction of mandibular ORN with DL-based classification of 3D radiation dose distribution maps. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)03734-3] [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: 10/18/2022]
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Patel V, Dholaria B, Jayani R, Sengsayadeth S, Wigger M, Horst S, Lindenfeld J, Schlendorf K, Ooi H, Brinkley M, Zalawadiya S, Pedrotty D, Hoffman J, Hung R, Goodman S, Savani B, Kassim A, Harrell S, Punnoose L. Long Term Hematologic and Graft Outcomes After Cardiac Transplant in Al Amyloidosis. J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.1649] [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: 11/28/2022] Open
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Pasrija C, Shah A, Holmes S, Bittle G, Reed R, Patel V, Lau C, Krupnick A. Safety of Single Lung Transplantation Post Donation Service Area-Specific Organ Distribution. J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.1226] [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: 10/18/2022] Open
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Heier JS, Khanani AM, Quezada Ruiz C, Basu K, Ferrone PJ, Brittain C, Figueroa MS, Lin H, Holz FG, Patel V, Lai TYY, Silverman D, Regillo C, Swaminathan B, Viola F, Cheung CMG, Wong TY. Efficacy, durability, and safety of intravitreal faricimab up to every 16 weeks for neovascular age-related macular degeneration (TENAYA and LUCERNE): two randomised, double-masked, phase 3, non-inferiority trials. Lancet 2022; 399:729-740. [PMID: 35085502 DOI: 10.1016/s0140-6736(22)00010-1] [Citation(s) in RCA: 169] [Impact Index Per Article: 84.5] [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] [Received: 08/31/2021] [Revised: 10/29/2021] [Accepted: 11/25/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND Faricimab is a bispecific antibody that acts through dual inhibition of both angiopoietin-2 and vascular endothelial growth factor A. We report primary results of two phase 3 trials evaluating intravitreal faricimab with extension up to every 16 weeks for neovascular age-related macular degeneration (nAMD). METHODS TENAYA and LUCERNE were randomised, double-masked, non-inferiority trials across 271 sites worldwide. Treatment-naive patients with nAMD aged 50 years or older were randomly assigned (1:1) to intravitreal faricimab 6·0 mg up to every 16 weeks, based on protocol-defined disease activity assessments at weeks 20 and 24, or aflibercept 2·0 mg every 8 weeks. Randomisation was performed through an interactive voice or web-based response system using a stratified permuted block randomisation method. Patients, investigators, those assessing outcomes, and the funder were masked to group assignments. The primary endpoint was mean change in best-corrected visual acuity (BCVA) from baseline averaged over weeks 40, 44, and 48 (prespecified non-inferiority margin of four letters), in the intention-to-treat population. Safety analyses included patients who received at least one dose of study treatment. These trials are registered with ClinicalTrials.gov (TENAYA NCT03823287 and LUCERNE NCT03823300). FINDINGS Across the two trials, 1329 patients were randomly assigned between Feb 19 and Nov 19, 2019 (TENAYA n=334 faricimab and n=337 aflibercept), and between March 11 and Nov 1, 2019 (LUCERNE n=331 faricimab and n=327 aflibercept). BCVA change from baseline with faricimab was non-inferior to aflibercept in both TENAYA (adjusted mean change 5·8 letters [95% CI 4·6 to 7·1] and 5·1 letters [3·9 to 6·4]; treatment difference 0·7 letters [-1·1 to 2·5]) and LUCERNE (6·6 letters [5·3 to 7·8] and 6·6 letters [5·3 to 7·8]; treatment difference 0·0 letters [-1·7 to 1·8]). Rates of ocular adverse events were comparable between faricimab and aflibercept (TENAYA n=121 [36·3%] vs n=128 [38·1%], and LUCERNE n=133 [40·2%] vs n=118 [36·2%]). INTERPRETATION Visual benefits with faricimab given at up to 16-week intervals demonstrates its potential to meaningfully extend the time between treatments with sustained efficacy, thereby reducing treatment burden in patients with nAMD. FUNDING F Hoffmann-La Roche.
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Affiliation(s)
| | - Arshad M Khanani
- Sierra Eye Associates, Reno, NV, USA; The University of Nevada, Reno School of Medicine, Reno, NV, USA
| | - Carlos Quezada Ruiz
- Clinica de Ojos Garza Viejo, San Pedro Garza Garcia, Nuevo Leon, Mexico; Genentech, South San Francisco, CA, USA
| | - Karen Basu
- Roche Products (Ireland), Dublin, Ireland
| | | | | | - Marta S Figueroa
- Clinica Baviera, Ramon y Cajal University Hospital, Madrid, Spain
| | - Hugh Lin
- Genentech, South San Francisco, CA, USA
| | - Frank G Holz
- Department of Ophthalmology and GRADE Reading Center, University of Bonn, Bonn, Germany
| | | | - Timothy Y Y Lai
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | | | - Carl Regillo
- Mid Atlantic Retina, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA, USA
| | | | - Francesco Viola
- Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Chui Ming Gemmy Cheung
- Singapore National Eye Centre, Duke-NUS Medical School, National University of Singapore, Singapore
| | - Tien Y Wong
- Singapore National Eye Centre, Duke-NUS Medical School, National University of Singapore, Singapore
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Covas Moschovas M, Rogers T, Noel J, Abdel J, Bhat S, Patel V. Anatomical robotic-assisted radical prostatectomy: Step-by-step nerve-sparing technique for different grades of preservation. Eur Urol 2022. [DOI: 10.1016/s0302-2838(22)01293-3] [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: 11/24/2022]
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Covas Moschovas M, Noel J, Jaber A, Rogers T, Mottrie A, Patel V. SP approach to radical prostatectomy: Step-by-step technique comparing the Xi and SP consoles. Eur Urol 2022. [DOI: 10.1016/s0302-2838(22)01294-5] [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: 11/04/2022]
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Sighinolfi M, Dourado A, Assumma S, Cassani A, Annino F, Patel V, Annino F, Patel V, Moschovas M, Cacciamani G, Bozzini G, Gregori A, Morini E, Simoes J, Eissa A, Puliatti S, Sarchi L, Micali S, Rocco B. The role of 3-D imaging reconstruction in real-life urologic practice: Results from a global survey. Eur Urol 2022. [DOI: 10.1016/s0302-2838(22)00099-9] [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: 11/04/2022]
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Bhat K, Nathan A, Covas Moschovas M, Nathan S, Patel V. Outcomes of salvage robotic-assisted radical prostatectomy comparing patients with primary focal therapy versus whole gland ablation: A multicentric collaborative data. Eur Urol 2022. [DOI: 10.1016/s0302-2838(22)01039-9] [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: 11/04/2022]
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Vergis N, Patel V, Bogdanowicz K, Czyzewska-Khan J, Fiorentino F, Day E, Cross M, Foster N, Lord E, Goldin R, Forrest E, Thursz M. IL-1 Signal Inhibition In Alcoholic Hepatitis (ISAIAH): a study protocol for a multicentre, randomised, placebo-controlled trial to explore the potential benefits of canakinumab in the treatment of alcoholic hepatitis. Trials 2021; 22:792. [PMID: 34763711 PMCID: PMC8581959 DOI: 10.1186/s13063-021-05719-2] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 10/12/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Alcohol consumption causes a spectrum of liver abnormalities and leads to over 3 million deaths per year. Alcoholic hepatitis (AH) is a florid presentation of alcoholic liver disease characterized by liver failure in the context of recent and heavy alcohol consumption. The aim of this study is to explore the potential benefits of the IL-1β antibody, canakinumab, in the treatment of AH. METHODS This is a multicentre, double-blind, randomised placebo-controlled trial. Participants will be diagnosed with AH using clinical criteria. Liver biopsy will then confirm that all histological features of AH are present. Up to 58 participants will be recruited into two groups from 15 centres in the UK. Patients will receive an infusion of Canakinumab or matched placebo by random 1:1 allocation. The primary outcome is the difference between groups in the proportion of patients demonstrating histological improvement and will compare histological appearances at baseline with appearances at 28 days to assign a category of "improved" or "not improved". Patients with evidence of ongoing disease activity will receive a second infusion of canakinumab or placebo. Participants will be followed up for 90 days. Secondary outcomes include mortality and change in MELD score at 90 days. DISCUSSION This phase II study will explore the benefits of the IL-1β antibody, canakinumab, in the treatment of AH to provide proof of concept that inhibition of IL-1β signalling may improve histology and survival for patients with AH. TRIAL REGISTRATION EudraCT 2017-003724-79 . Prospectively registered on 13 April 2018.
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Affiliation(s)
- N Vergis
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK.
| | - V Patel
- Institute of Liver Studies, King's College Hospital NHS Foundation Trust, London, UK.,Institute of Hepatology London, Foundation for Liver Research, London, UK.,School of Immunology and Microbial Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - K Bogdanowicz
- Imperial Clinical Trials Unit, Department of Surgery and Cancer, Imperial College, London, UK
| | - J Czyzewska-Khan
- Imperial Clinical Trials Unit, Department of Surgery and Cancer, Imperial College, London, UK
| | - F Fiorentino
- Imperial Clinical Trials Unit, Department of Surgery and Cancer, Imperial College, London, UK
| | - E Day
- Imperial Clinical Trials Unit, Department of Surgery and Cancer, Imperial College, London, UK
| | - M Cross
- Imperial Clinical Trials Unit, Department of Surgery and Cancer, Imperial College, London, UK
| | - N Foster
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| | - E Lord
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| | - R Goldin
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| | - E Forrest
- Glasgow Royal Infirmary and University of Glasgow, Glasgow, UK
| | - M Thursz
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
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Patel V, Brull R, Abdallah F. Serratus plane blocks in breast cancer surgery: a reply. Anaesthesia 2021; 77:228. [PMID: 34747009 DOI: 10.1111/anae.15618] [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] [Accepted: 10/14/2021] [Indexed: 11/29/2022]
Affiliation(s)
- V Patel
- Toronto Western Hospital, Toronto, ON, Canada
| | - R Brull
- Toronto Western Hospital, Toronto, ON, Canada
| | - F Abdallah
- University of Ottawa, Ottawa, ON, Canada.,University of Toronto, Toronto, ON, Canada
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Bhat S, Covas Moschovas M, Sandri M, Noel J, Rogers T, Pereira R, Reddy S, Roof S, Patel V. Outcomes of Salvage Robot-Assisted Radical Prostatectomy (S-RARP) post focal ablation for prostate cancer in comparison with primary Robot-assisted Radical Prostatectomy (RARP); A matched analysis. EUR UROL SUPPL 2021. [DOI: 10.1016/s2666-1683(21)02218-7] [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: 10/19/2022] Open
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Noël J, Mascarenhas A, Nwaiwu C, Liu Y, Buharin V, Oberlin J, Dechert A, Kim P, Patel V. ActivSight laser speckle contrast imaging compared to indocyanine green in renal perfusion of an animal model. EUR UROL SUPPL 2021. [DOI: 10.1016/s2666-1683(21)02307-7] [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: 10/19/2022] Open
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Covas Moschovas M, Noel J, Bhat S, Rogers T, Mottrie A, Patel V. SP approach to radical prostatectomy: Step-by-step technique comparing the Xi and SP consoles. EUR UROL SUPPL 2021. [DOI: 10.1016/s2666-1683(21)02281-3] [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: 11/28/2022] Open
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Chu B, Patel V, Bryer J, Hamilton K, Fadugba O, Micheletti R. P171 IMPLEMENTATION OF A PENICILLIN SKIN TESTING SERVICE IN INPATIENTS WITH HEMATOLOGIC MALIGNANCIES. Ann Allergy Asthma Immunol 2021. [DOI: 10.1016/j.anai.2021.08.149] [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: 11/16/2022]
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Covas Moschovas M, Noel J, Bhat S, Sandri M, Kind S, Rogers T, Mottrie A, Patel V. Perioperative outcomes and long-term continence rates comparing the da Vinci SP and Xi consoles approaching radical prostatectomy: A propensity score matching analysis. EUR UROL SUPPL 2021. [DOI: 10.1016/s2666-1683(21)02236-9] [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: 10/19/2022] Open
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Covas Moschovas M, Rogers T, Noel J, Abdel J, Sandri M, Patel V. Hernia repair with mesh placement during robotic-assisted radical prostatectomy does not increase mesh complications. EUR UROL SUPPL 2021. [DOI: 10.1016/s2666-1683(21)02223-0] [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: 11/15/2022] Open
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Moorthy A, Kulkarni P, Patel V, Kumar P. P34 The value of combined ophthalmology and rheumatology review- an unmet need. Rheumatol Adv Pract 2021. [PMCID: PMC8832451 DOI: 10.1093/rap/rkab068.033] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Case report - Introduction Rheumatic diseases manifest in different specialties including ophthalmology. Presentation with eye symptoms may be a sight-threatening emergency such as GCA. Other inflammatory symptoms such as uveitis present to the Eye Casualty frequently, which need prompt rheumatologist input for a holistic management. Case report - Case description We present an interesting case with multiple learning points for both rheumatologists as well as ophthalmologists. We present a case of a 73-year-old Caucasian lady who initially presented to the Eye Department. She was diagnosed as having bilateral uveitis by the ophthalmologist with an interest in uveitis. She had various investigations which showed positive HLA-B27 status, ENA, ANA, serum ACE level were normal; however, she was found to have raised immunoglobulins and plasma viscosity. She was treated with steroid eye drops and intravitreal dexamethasone implant in both eyes. She is a steroid responder and unfortunately developed glaucoma which needed two surgical procedures. She developed chronic cystoid macular oedema in Left eye. She did not have any symptoms of psoriasis or gut symptoms suggestive of inflammatory bowel disease. She did report symptoms of inflammatory bowel disease. She had an MRI of axial spine as per AS protocol, which confirmed inflammatory spondyloarthropathy. She was diagnosed to have non-radiographic spondyloarthropathy which is managed by simple anti-inflammatories. Her BASDAI is less than 3 and does not qualify for biologic treatment for her axial spondyloarthropathy. Her main symptoms were ocular, which is very active and she is not able to escalate to biologic therapy. Case report - Discussion This is a patient presenting with late-onset inflammatory back pain without any articular or extra-articular activity. Her main manifestation is spectrum of spondyloarthropathy with uveitis; however, we could not escalate her to biologics. She has been on topical, intraocular and oral steroids which has led on to complications. The combined clinic between rheumatologists and ophthalmologists is key in managing such patients. Case report - Key learning points
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Affiliation(s)
- Arumugam Moorthy
- Rheumatology Department, Leicester Royal Infirmary, Leicester, United Kingdom
| | - Priti Kulkarni
- Ophthalmology Department, Leicester Royal Infirmary, Leicester, United Kingdom
| | - V Patel
- Rheumatology Department, Leicester Royal Infirmary, Leicester, United Kingdom
| | - Periyasamy Kumar
- Ophthalmology Department, Leicester Royal Infirmary, Leicester, United Kingdom
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Abstract
Abstract
Background
Myocardial fibrosis is a common feature of hypertrophic cardiomyopathy (HCM) but its pathophysiology has yet to be elucidated.
Purpose
In this study, we used a multiplex approach to examine the genetic regulation of pathways associated with fibrosis in patients undergoing septal myectomy.
Methods
Myocardial tissue was collected at time of surgical intervention. Control biopsy samples were obtained from the left ventricular free wall from structurally normal hearts during autopsy following non-cardiac related death. Tissue was either snap frozen in liquid nitrogen and subsequently stored at −80 degrees or collected in RNA laterTM and frozen 24 hours later at −80 degrees. Total RNA was extracted from HCM tissue samples using the Qiagen RNeasy fibrous tissues mini kit and from control samples using mirVana isolation kit (Ambion), according to the manufacturer's protocol. Quantitative PCR (qPCR) was performed on the extracted RNA using a RT. Profiler™ Human finrosis PCR Array.
Results
The study cohort comprised 22 HCM samples and 5 controls. The relative regulation of genes involved in myocardial fibrosis in patients with HCM compared to controls is shown in figure 1.
In patients with HCM, there was increased expression of genes involved in collagen synthesis. A significant two-fold upregulation in type III procollagen mRNA was observed relative to controls (p=0.013) with a similar trend identified for type I procollagen (1.5 fold up-regulation, p=0.081). The gene expression of MMP3 (−1.5 fold, p=0.029) and MMP8 (−1.8, p=0.002) which are involved in collaged degradation were downregulated in the HCM group.
The gene expression of pro-fibrotic mediators TGF-β2 (4.8 fold, p=0.008) and CCN2 (2.9 fold, p=0.021) was also significantly elevated. Within the HCM group, there was a correlation between the fold regulation of TGF-β1 (r=0.570, p=0.006; r=0.528, p=0.012), TGF-β2 (r=0.569, p=0.006; r=0.514, p=0.014) and TGF-β3 (r=0.738, p<0.001; r=0.496, p=0.019) to gene regulation of type I and III procollagens respectively.
The expression of BMP-7 which has been shown to reduce myocardial fibrosis by antagonising TGF- β mediated endothelial – mesothelial transformation of fibroblasts was also down-regulated in HCM (−3.8, p=0.015).
Conclusions
Genetic expression of procollagen is significantly upregulated in patients with HCM relative to controls. TGF-β and CCN2 mediated signalling appear to be key mediators in promoting collagen expression.
Funding Acknowledgement
Type of funding sources: Other. Main funding source(s): Heart Hospital Charitable Grant, UK Figure 1. Gene expression in HCM
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Affiliation(s)
- V Patel
- University College of London, London, United Kingdom
| | - P Syrris
- University College of London, Centre for Heart Muscle Disease, Institute of Cardiovascular Science, London, United Kingdom
| | - C Coats
- University College of London, London, United Kingdom
| | - J Lucena
- Institute of Legal Medicine and Forensic Sciences of Seville, Seville, Spain
| | - E Lara-Pezzi
- University Hospital Puerta de Hierro Majadahonda, Madrid, Spain
| | - P Garcia-Pavia
- University Hospital Puerta de Hierro Majadahonda, Madrid, Spain
| | - P M Elliott
- University College of London, London, United Kingdom
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Morris R, Elbadri Z, Patel V, Azam A. 217 Covid-19 And Femoral Neck Fracture: A Retrospective Review. Br J Surg 2021. [PMCID: PMC8524487 DOI: 10.1093/bjs/znab259.446] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Aim
Covid-19 has dominated healthcare over the past year. It most severely affects the elderly, a population whom also commonly present following falls, sustaining femoral neck fractures. Our aim was to retrospectively evaluate the effects of concomitant covid-19 infection in patients presenting acutely with femoral neck fractures.
Method
We conducted a retrospective review of all patients with femoral neck fractures during the ‘first wave’ of the coronavirus pandemic in Ysbyty Gwynedd (Bangor, UK), between April 2020 to June 2020. We noted each patient’s covid-19 status within 14 days of presentation with their acute femoral neck fracture and compared length of stay, discharge destination and mortality rate between covid and non-covid groups.
Results
There was a total of 75 femoral neck fractures in the 3-month period studied. 4 patients had incomplete data and were excluded from analysis. Of the remaining 71 patients, 15 (21%) were covid-positive within 14 days of admission, 47 patients (66%) were confirmed covid-negative and 9 patients (13%) received no coronavirus testing. The average age of patients was 88 in the covid-positive group and 84 in the covid-negative group. Those who developed covid-19 infection had an increased length of hospital stay (33 days covid-positive versus 14 days covid-negative; p = 0.25) and significantly increased in-hospital mortality rate (47% covid-positive versus 6% covid-negative; p = 0.001).
Conclusions
These results show that concomitant infection with covid-19 shortly after femoral neck fracture is associated with a significant increase in hospital mortality. They highlight the importance of trying to prevent covid-19 infection in this patient group.
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Affiliation(s)
- R Morris
- Ysbyty Gwynedd, Bangor, United Kingdom
| | - Z Elbadri
- Ysbyty Gwynedd, Bangor, United Kingdom
| | - V Patel
- Ysbyty Gwynedd, Bangor, United Kingdom
| | - A Azam
- Ysbyty Gwynedd, Bangor, United Kingdom
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Abstract
Abstract
Introduction
Primary intraosseous carcinoma (PIOC) of the jaw is an incredibly rare lesion with approximately 200 cases reported in the literature. PIOC are mostly asymptomatic incidental radiographic findings and present as poorly-defined, non-corticated radiolucencies often with root resorption and cortical perforation. Prognosis is considered poor and best predicted by histological grade.
Case report
A gentleman in his 50s presented to his dentist with a draining sinus from his LR6 tooth. A radiograph revealed a non-corticated radiolucency localised to the distal root of the LR6. 7 months later, he returned with pain and mobility of the LR7. Another radiograph revealed a non-corticated radiolucency from around the distal root of the LR6 extending to the LR8. Urgent biopsy of the mandibular bone was arranged by the oral and maxillofacial surgery team. Histopathology revealed the lesion was likely a benign squamous odontogenic tumour. However, it was not possible to exclude a well-differentiated squamous cell carcinoma. Correlation of clinical findings, imaging and multidisciplinary team discussion was recommended. Following the MDT meeting, excision of the bony lesion was undertaken. Histopathology this time returned as primary intraosseous carcinoma NOS T4N0M0, thought to have arisen from a radicular cyst associated with the LR6/7. The treatment was right segmental mandibulectomy, fibular free flap, selective neck dissection (I-III) and adjuvant radiotherapy.
Conclusions
This case highlights how subtle radiographic features can represent malignancy in lesions appearing cystic at first. Although rare, clinicians should be aware of PIOC as a differential diagnosis when presented with radiographic features which could represent malignancy.
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Affiliation(s)
- V Patel
- Leeds Dental Institute, Leeds, United Kingdom
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