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Johnson WV, Phung QH, Patel VR, Tsai AK, Arora N, Klein MA, Westanmo AD, Blaes AH, Gupta A. Trajectory of Healthcare Contact Days for Veterans With Advanced Gastrointestinal Malignancy. Oncologist 2024; 29:e290-e293. [PMID: 38016182 PMCID: PMC10836304 DOI: 10.1093/oncolo/oyad313] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 11/03/2023] [Indexed: 11/30/2023] Open
Abstract
How and where patients with advanced cancer facing limited survival spend their time is critical. Healthcare contact days (days with healthcare contact outside the home) offer a patient-centered and practical measure of how much of a person's life is consumed by healthcare. We retrospectively analyzed contact days among decedent veterans with stage IV gastrointestinal cancer at the Minneapolis Veterans Affairs Healthcare System from 2010 to 2021. Among 468 decedents, the median overall survival was 4 months. Patients spent 1 in 3 days with healthcare contact. Over the course of illness, the percentage of contact days followed a "U-shaped" pattern, with an initial post-diagnosis peak, a lower middle trough, and an eventual rise as patients neared the end-of-life. Contact days varied by clinical factors and by sociodemographics. These data have important implications for improving care delivery, such as through care coordination and communicating expected burdens to and supporting patients and care partners.
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Affiliation(s)
- Whitney V Johnson
- Division of Hematology, Oncology, and Transplantation, Department of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Quan H Phung
- Division of Hematology, Oncology, and Transplantation, Department of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Vishal R Patel
- Dell Medical School, The University of Texas at Austin, Austin, TX, USA
| | - Alexander K Tsai
- Division of Hematology, Oncology, and Transplantation, Department of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Nivedita Arora
- Hematology/Oncology Section, Minneapolis Veterans Affairs Healthcare System, Minneapolis, MN, US
| | - Mark A Klein
- Hematology/Oncology Section, Minneapolis Veterans Affairs Healthcare System, Minneapolis, MN, US
| | - Anders D Westanmo
- Department of Pharmacy, Minneapolis VA Healthcare System, Minneapolis, MN, USA
| | - Anne H Blaes
- Division of Hematology, Oncology, and Transplantation, Department of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Arjun Gupta
- Division of Hematology, Oncology, and Transplantation, Department of Medicine, University of Minnesota, Minneapolis, MN, USA
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Patel VR, Liu M, Byrne JP, Haynes AB, Ibrahim AM. Surgeon Supply by County-Level Rurality and Social Vulnerability From 2010 to 2020. JAMA Surg 2024; 159:223-225. [PMID: 38019482 PMCID: PMC10687707 DOI: 10.1001/jamasurg.2023.5632] [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: 05/19/2023] [Accepted: 08/24/2023] [Indexed: 11/30/2023]
Abstract
This cross-sectional study examines the surgical workforce in all counties across the US from 2010 to 2020.
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Affiliation(s)
| | - Michael Liu
- Harvard Medical School, Boston, Massachusetts
| | - James P. Byrne
- Division of Acute Care Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | | | - Andrew M. Ibrahim
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor
- Taubman College of Architecture and Urban Planning, University of Michigan, Ann Arbor
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Liu M, Patel VR, Salas RN, Rice MB, Kazi DS, Zheng Z, Wadhera RK. Neighborhood Environmental Burden and Cardiovascular Health in the US. JAMA Cardiol 2024; 9:153-163. [PMID: 37955891 PMCID: PMC10644252 DOI: 10.1001/jamacardio.2023.4680] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 10/18/2023] [Indexed: 11/14/2023]
Abstract
Importance Cardiovascular disease is the leading cause of death in the US. However, little is known about the association between cumulative environmental burden and cardiovascular health across US neighborhoods. Objective To evaluate the association of neighborhood-level environmental burden with prevalence of cardiovascular risk factors and diseases, overall and by levels of social vulnerability. Design, Settings, and Participants This was a national cross-sectional study of 71 659 US Census tracts. Environmental burden (EBI) and social vulnerability indices from the US Centers for Disease Control and Prevention (CDC) and Agency for Toxic Substances and Disease Registry were linked to the 2020 CDC PLACES data set. Data were analyzed from March to October 2023. Exposures The EBI, a measure of cumulative environmental burden encompassing 5 domains (air pollution, hazardous or toxic sites, built environment, transportation infrastructure, and water pollution). Main Outcomes and Measures Neighborhood-level prevalence of cardiovascular risk factors (hypertension, diabetes, and obesity) and cardiovascular diseases (coronary heart disease and stroke). Results Across the US, neighborhoods with the highest environmental burden (top EBI quartile) were more likely than those with the lowest environmental burden (bottom EBI quartile) to be urban (16 626 [92.7%] vs 13 414 [75.4%]), in the Midwest (5191 [28.9%] vs 2782 [15.6%]), have greater median (IQR) social vulnerability scores (0.64 [0.36-0.85] vs 0.42 [0.20-0.65]), and have higher proportions of adults in racial or ethnic minority groups (median [IQR], 34% [12-73] vs 12% [5-30]). After adjustment, neighborhoods with the highest environmental burden had significantly higher rates of cardiovascular risk factors than those with the lowest burden, including hypertension (mean [SD], 32.83% [7.99] vs 32.14% [6.99]; adjusted difference, 0.84%; 95% CI, 0.71-0.98), diabetes (mean [SD], 12.19% [4.33] vs 10.68% [3.27]; adjusted difference, 0.62%; 95% CI, 0.53-0.70), and obesity (mean [SD], 33.57% [7.62] vs 30.86% [6.15]; adjusted difference, 0.77%; 95% CI, 0.60-0.94). Similarly, neighborhoods with the highest environmental burden had significantly higher rates of coronary heart disease (mean [SD], 6.66% [2.15] vs 6.82% [2.41]; adjusted difference, 0.28%; 95% CI, 0.22-0.33) and stroke (mean [SD], 3.65% [1.47] vs 3.31% [1.12]; adjusted difference, 0.19%; 95% CI, 0.15-0.22). Results were consistent after matching highest and lowest environmentally burdened neighborhoods geospatially and based on other covariates. The associations between environmental burden quartiles and cardiovascular risk factors and diseases were most pronounced among socially vulnerable neighborhoods. Conclusions and Relevance In this cross-sectional study of US neighborhoods, cumulative environmental burden was associated with higher rates of cardiovascular risk factors and diseases, although absolute differences were small. The strongest associations were observed in socially vulnerable neighborhoods. Whether initiatives that address poor environmental conditions will improve cardiovascular health requires additional prospective investigations.
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Affiliation(s)
- Michael Liu
- Section of Health Policy and Equity, Richard A. and Susan F. Smith Center for Outcomes Research, Beth Israel Deaconess Medical Center, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | | | - Renee N. Salas
- Harvard Medical School, Boston, Massachusetts
- Center for Social Justice and Health Equity, Department of Emergency Medicine, Massachusetts General Hospital, Boston
- C-CHANGE, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
- Harvard Global Health Institute, Boston, Massachusetts
| | - Mary B. Rice
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Dhruv S. Kazi
- Section of Health Policy and Equity, Richard A. and Susan F. Smith Center for Outcomes Research, Beth Israel Deaconess Medical Center, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - ZhaoNian Zheng
- Section of Health Policy and Equity, Richard A. and Susan F. Smith Center for Outcomes Research, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Rishi K. Wadhera
- Section of Health Policy and Equity, Richard A. and Susan F. Smith Center for Outcomes Research, Beth Israel Deaconess Medical Center, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
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Patel VR, Rozycki G, Jopling J, Subramanian M, Kent A, Manukyan M, Sakran JV, Haut E, Levy M, Nathens AB, Brown C, Byrne JP. Association Between Geospatial Access to Trauma Center Care and Motor Vehicle Crash Mortality in the United States. J Trauma Acute Care Surg 2023:01586154-990000000-00580. [PMID: 38053239 DOI: 10.1097/ta.0000000000004221] [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: 12/07/2023]
Abstract
BACKGROUND Motor vehicle crashes (MVCs) are a leading cause of preventable trauma death in the United States (US). Access to trauma center care is highly variable nationwide. The objective of this study was to measure the association between geospatial access to trauma center care and MVC mortality. METHODS This was a population-based study of MVC-related deaths that occurred in 3,141 US counties (2017-2020). ACS and state-verified level I-III trauma centers were mapped. Geospatial network analysis estimated the ground transport time to the nearest trauma center from the population-weighted centroid for each county. In this way, the exposure was the predicted access time to trauma center care for each county population. Hierarchical negative binomial regression measured the risk-adjusted association between predicted access time and MVC mortality, adjusting for population demographics, rurality, access to trauma resources, and state traffic safety laws. RESULTS We identified 92,398 crash fatalities over the four-year study period. Trauma centers mapped included 217 level I, 343 level II, and 495 level III trauma centers. The median county predicted access time was 47 min (IQR 26-71 min). Median county MVC mortality was 12.5 deaths/100,000 person-years (IQR 7.4-20.3 deaths/100,000 person-years). After risk-adjustment, longer predicted access times were significantly associated with higher rates of MVC mortality (>60 min vs. <15 min; MRR 1.36; 95%CI 1.31-1.40). This relationship was significantly more pronounced in urban/suburban vs. rural/wilderness counties (p for interaction, <0.001). County access to trauma center care explained 16% of observed state-level variation in MVC mortality. CONCLUSIONS Geospatial access to trauma center care is significantly associated with MVC mortality and contributes meaningfully to between-state differences in road traffic deaths. Efforts to improve trauma system organization should prioritize access to trauma center care to minimize crash fatalities. LEVEL OF EVIDENCE Level III, Epidemiological.
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Affiliation(s)
- Vishal R Patel
- Dell Medical School, The University of Texas at Austin, Austin, TX
| | - Grace Rozycki
- Division of Acute Care Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Jeffrey Jopling
- Division of Acute Care Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Madhu Subramanian
- Division of Acute Care Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Alistair Kent
- Division of Acute Care Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Mariuxi Manukyan
- Division of Acute Care Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | | | | | | | - Avery B Nathens
- Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON
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Patel VR, Ramesh V, Tsai AK, Sedhom R, Westanmo AD, Blaes AH, Vogel RI, Parsons HM, Hanna TP, Ganguli I, Dusetzina SB, Rocque GB, Booth CM, Gupta A. Health Care Contact Days Experienced by Decedents With Advanced GI Cancer. JCO Oncol Pract 2023; 19:1031-1038. [PMID: 37738532 PMCID: PMC10667015 DOI: 10.1200/op.23.00232] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 07/05/2023] [Accepted: 08/14/2023] [Indexed: 09/24/2023] Open
Abstract
PURPOSE Frequent visits to health care facilities can be time intensive and all-consuming for people with cancer. We measured health care contact days (days with healthcare contact outside the home) among decedents with advanced GI cancer and examined sources of contact days, their associations with demographic and clinical factors, and their temporal patterns over the course of illness. METHODS We conducted a retrospective cohort study using a tumor registry and electronic medical record data for decedents with stage IV GI cancer between 2011 and 2019 in a large health care network in MN. We determined contact days from diagnosis to death using chart review. Using multivariable beta regression adjusted for sociodemographic and clinical characteristics offset by survival, we calculated adjusted estimates of contact days and determined patient-level factors associated with percentage of contact days. RESULTS We identified 809 patients eligible for analysis (median [IQR] age at diagnosis, 65 [56-73] years). The median (IQR) overall survival was 175 (56-459) days. Patients spent a median (IQR) of 25.8% (17.4%-39.1%) of these as contact days. Of these days, 83.6% were spent on outpatient visits. In the multivariable analysis, older age, Black race, and never receiving systemic cancer-directed treatment were associated with a higher percentage of contact days. The percentage of contact days was highest in the first month after diagnosis (39.6%) and before death (32.2%), with a more moderate middle phase (U-shaped curve). CONCLUSION Decedents with advanced GI cancer spend 1 in 4 days alive with health care contact, despite a median survival of under 6 months. This is even higher immediately postdiagnosis and near death. These findings highlight the need to understand sources of variation, benchmark appropriate care, and deliver more efficient care for this vulnerable population with limited time.
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Affiliation(s)
- Vishal R Patel
- Dell Medical School, The University of Texas at Austin, Austin, TX
| | | | | | - Ramy Sedhom
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Anders D Westanmo
- Department of Pharmacy, Minneapolis VA Health Care System, Minneapolis, MN
| | | | | | | | - Timothy P Hanna
- Division of Cancer Care and Epidemiology, Queen's University, Kingston, ON, Canada
| | - Ishani Ganguli
- Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, MA
| | - Stacie B Dusetzina
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, TN
- Vanderbilt-Ingram Cancer Center, Nashville, TN
| | - Gabrielle B Rocque
- Division of Hematology and Oncology, University of Alabama at Birmingham, Birmingham, AL
| | | | - Arjun Gupta
- University of Minnesota, Minneapolis, MN
- Costs of Care, Cambridge, MA
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Patel VR, Gereta S, Jafri F, Mackert M, Haynes AB. Examining Public Communication About Surgical Cancer Care on Twitter. J Surg Res 2023; 291:433-441. [PMID: 37517351 DOI: 10.1016/j.jss.2023.06.048] [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: 11/12/2022] [Revised: 04/12/2023] [Accepted: 06/13/2023] [Indexed: 08/01/2023]
Abstract
INTRODUCTION Social media platforms like Twitter are highly utilized for communicating about cancer care. Although surgery is the primary curative treatment for solid malignancies, little is known about online communication behaviors regarding this treatment modality. This study tracked online discussions and characterized participants to better characterize the content of public communication about surgical cancer care. METHODS Tweets referencing cancer surgery were collected from 2018 to 2021 using Twitter's Application Programming Interface. Metadata (e.g., profile biography, follower count) was used to predict user demographic information. Natural language processing was performed using Latent Dirichlet Allocation to identify common themes of conversation and mentioned cancer sites. RESULTS There were 442,840 tweets about cancer surgery by 262,168 users, including individuals (65%), influencers (1.5%), surgeons (1%), and oncologists (0.5%). Following the onset of the COVID-19 pandemic, tweets mentioning delays in care increased by 21.7% (1971-57,846 tweets). Individuals commonly mentioned surgical costs (20.3%) and postoperative recovery (21.6%). Surgeons and oncologists frequently mentioned research (52.7%), but infrequently mentioned community support (7.8%) or survivorship (9.3%). Relative to their prevalence, neurologic cancers were most discussed (231 tweets per 1000 operations) while thoracic (29 tweets per 1000 operations) and urologic cancers were least discussed (12 tweets per 1000 operations). CONCLUSIONS Twitter was utilized by patients to discuss real-time issues such as COVID-19-related surgical delays and the financial burden of cancer surgery. Further efforts to improve community outreach may be optimized by targeting greater discussion of undermentioned cancer types and encouraging clinicians to participate in discussions about community-centered themes.
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Affiliation(s)
- Vishal R Patel
- Dell Medical School, The University of Texas at Austin, Austin, Texas.
| | - Sofia Gereta
- Dell Medical School, The University of Texas at Austin, Austin, Texas
| | - Faraz Jafri
- Dell Medical School, The University of Texas at Austin, Austin, Texas
| | - Michael Mackert
- Center for Health Communication, Moody College of Communication, The University of Texas at Austin, Austin, Texas
| | - Alex B Haynes
- Dell Medical School, The University of Texas at Austin, Austin, Texas
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Patel VR, Jella T, Gupta A, Nassel A, Ibrahim A, Hussaini SQ. Association of Neighborhood-Level Environmental Injustice With Health Status in the US. JAMA Intern Med 2023; 183:1162-1163. [PMID: 37578753 PMCID: PMC10425860 DOI: 10.1001/jamainternmed.2023.2835] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 05/13/2023] [Indexed: 08/15/2023]
Abstract
This cross-sectional study uses the Environmental Justice Index to assess the association between environmental injustice and health status at the neighborhood level.
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Affiliation(s)
- Vishal R. Patel
- Dell Medical School, The University of Texas at Austin, Austin
| | - Tarun Jella
- Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Arjun Gupta
- Masonic Cancer Center, University of Minnesota, Minneapolis
| | - Ariann Nassel
- Lister Hill Center for Health Policy, University of Alabama, Birmingham
| | - Andrew Ibrahim
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor
- Taubman College of Architecture & Urban Planning, University of Michigan, Ann Arbor
| | - S.M. Qasim Hussaini
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins Medicine, Baltimore, Maryland
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Jella TK, Patel VR, Cwalina TB, Schmidt JE, Lawler EA, Vallier HA. What Factors Are Associated With Early Career Attrition Among Orthopaedic Surgeons in the United States? Clin Orthop Relat Res 2023; 481:1895-1903. [PMID: 36881550 PMCID: PMC10499099 DOI: 10.1097/corr.0000000000002625] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 01/15/2023] [Accepted: 02/15/2023] [Indexed: 03/08/2023]
Abstract
BACKGROUND The attrition of medical personnel in the United States healthcare system has been an ongoing concern among physicians and policymakers alike. Prior studies have shown that reasons for leaving clinical practice vary widely and may range from professional dissatisfaction or disability to the pursuit of alternative career opportunities. Whereas attrition among older personnel has often been understood as a natural phenomenon, attrition among early-career surgeons may pose a host of additional challenges from an individual and societal perspective. QUESTIONS/PURPOSES (1) What percentage of orthopaedic surgeons experience early-career attrition, defined as leaving active clinical practice within the first 10 years after completion of training? (2) What are the surgeon and practice characteristics associated with early-career attrition? METHODS In this retrospective analysis drawn from a large database, we used the 2014 Physician Compare National Downloadable File (PC-NDF), a registry of all healthcare professionals in the United States participating in Medicare. A total of 18,107 orthopaedic surgeons were identified, 4853 of whom were within the first 10 years of training completion. The PC-NDF registry was chosen because it has a high degree of granularity, national representativeness, independent validation through the Medicare claims adjudication and enrollment process, and the ability to longitudinally monitor the entry and exit of surgeons from active clinical practice. The primary outcome of early-career attrition was defined by three conditions, all of which had to be simultaneously satisfied ("condition one" AND "condition two" AND "condition three"). The first condition was presence in the Q1 2014 PC-NDF dataset and absence from the same dataset the following year (Q1 2015 PC-NDF). The second condition was consistent absence from the PC-NDF dataset for the following 6 years (Q1 2016, Q1 2017, Q1 2018, Q1 2019, Q1 2020, and Q1 2021), and the third condition was absence from the Centers for Medicare and Medicaid Services Opt-Out registry, which tracks clinicians who have formally discontinued enrollment in the Medicare program. Of the 18,107 orthopaedic surgeons identified in the dataset, 5% (938) were women, 33% (6045) were subspecialty-trained, 77% (13,949) practiced in groups of 10 or more, 24% (4405) practiced in the Midwest, 87% (15,816) practiced in urban areas, and 22% (3887) practiced at academic centers. Surgeons not enrolled in the Medicare program are not represented in this study cohort. A multivariable logistic regression model with adjusted odds ratios and 95% confidence intervals was constructed to investigate characteristics associated with early-career attrition. RESULTS Among the 4853 early-career orthopaedic surgeons identified in the dataset, 2% (78) were determined to experience attrition between the first quarter 2014 and the same point in 2015. After controlling for potential confounding variables such as years since training completion, practice size, and geographic region, we found that women were more likely than men to experience early-career attrition (adjusted OR 2.8 [95% CI 1.5 to 5.0]; p = 0.006]), as were academic orthopaedic surgeons compared with private practitioners (adjusted OR 1.7 [95% CI 1.02 to 3.0]; p = 0.04), while general orthopaedic surgeons were less likely to experience attrition than subspecialists (adjusted OR 0.5 [95% CI 0.3 to 0.8]; p = 0.01). CONCLUSION A small but important proportion of orthopaedic surgeons leave the specialty during the first 10 years of practice. Factors most-strongly associated with this attrition were academic affiliation, being a woman, and clinical subspecialization. CLINICAL RELEVANCE Based on these findings, academic orthopaedic practices might consider expanding the role of routine exit interviews to identify instances in which early-career surgeons face illness, disability, burnout, or any other forms of severe personal hardships. If attrition occurs because of such factors, these individuals could benefit from connection to well-vetted coaching or counseling services. Professional societies might be well positioned to conduct detailed surveys to assess the precise reasons for early attrition and characterize any inequities in workforce retention across a diverse range of demographic subgroups. Future studies should also determine whether orthopaedics is an outlier, or whether 2% attrition is similar to the proportion in the overall medical profession.
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Affiliation(s)
- Tarun K. Jella
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Vishal R. Patel
- Dell Medical School, the University of Texas at Austin, Austin, TX, USA
| | - Thomas B. Cwalina
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | | | - Ericka A. Lawler
- Department of Orthopedics and Rehabilitation, University of Iowa Hospital and Clinics, Iowa City, IA, USA
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Patel VR, Haynes AB. Technology Cannot Fix Dysfunctional Teams: Safety Culture Is Essential to Surgical Safety Checklist Effectiveness. Jt Comm J Qual Patient Saf 2023; 49:505-506. [PMID: 37507333 DOI: 10.1016/j.jcjq.2023.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/30/2023]
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Jafri FI, Patel VR, Xu J, Polsky D, Gupta A, Hussaini SMQ. Association of Medicare Program Type with Health Care Access, Utilization, and Affordability among Cancer Survivors. Cancers (Basel) 2023; 15:3964. [PMID: 37568779 PMCID: PMC10417052 DOI: 10.3390/cancers15153964] [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: 06/19/2023] [Revised: 07/17/2023] [Accepted: 08/01/2023] [Indexed: 08/13/2023] Open
Abstract
BACKGROUND The Medicare Advantage program provides care to nearly half of Medicare beneficiaries, including a rapidly growing population of cancer survivors. Despite its increased adoption, it is still unknown whether or not the program improves healthcare access, outcomes, and affordability for cancer survivors. METHODS We performed a cross-sectional study of Medicare beneficiaries aged ≥ 65 years with a self-reported history of cancer from the 2019 National Health Interview Survey. We used multivariable logistic regression to evaluate the association between Medicare program type (Medicare Advantage vs. traditional Medicare) and measures of healthcare access, acute care utilization, and affordability. RESULTS We identified 4451 beneficiaries with a history of cancer, corresponding to 26.6 million weighted cancer survivors in 2019. Of the beneficiaries, 35.8% were enrolled in Medicare Advantage, whereas 64.2% were enrolled in traditional Medicare. The age, sex, racial and ethnic composition, household income, primary site of cancer, and comorbidity burden of Medicare Advantage and traditional Medicare beneficiaries were similar. In the adjusted analysis, there were no differences in healthcare access or acute care utilization between traditional Medicare and Medicare Advantage beneficiaries. However, cancer survivors enrolled in Medicare Advantage were more likely to worry about (34.3% vs. 29.4%; aOR, 1.3 (95% CI, 1.1-1.5)) or have problems paying (13.6% vs. 11.1%; aOR, 1.4 (95% CI, 1.1-1.8)) medical bills. CONCLUSIONS We found no evidence that Medicare Advantage beneficiaries with cancer had better healthcare access, affordability, or acute care utilization than traditional Medicare beneficiaries did. Furthermore, Medicare Advantage beneficiaries were more likely to report financial strain and have difficulty paying for their medical bills than were those with traditional Medicare. Despite the generous benefits and attractive incentives, Medicare Advantage plans may not be more cost-effective than traditional Medicare is for cancer survivors. Our study informs ongoing congressional deliberations to re-evaluate the role of Medicare Advantage in promoting equity among beneficiaries with cancer.
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Affiliation(s)
- Faraz I. Jafri
- Dell Medical School, The University of Texas at Austin, Austin, TX 78712, USA;
| | - Vishal R. Patel
- Dell Medical School, The University of Texas at Austin, Austin, TX 78712, USA;
| | - Jianhui Xu
- Department of Health Policy & Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA; (J.X.); (D.P.)
| | - Daniel Polsky
- Department of Health Policy & Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA; (J.X.); (D.P.)
- Division of General Internal Medicine, Johns Hopkins Medicine, Baltimore, MD 21224, USA
- Carey Business School, Johns Hopkins University, Baltimore, MD 21218, USA
| | - Arjun Gupta
- Masonic Cancer Center, University of Minnesota, Minneapolis, MN 55455, USA;
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Abstract
Importance The incidence of melanoma in situ (MIS) is increasing more rapidly than any invasive or in situ cancer in the US. Although more than half of melanomas diagnosed are MIS, information about long-term prognosis following a diagnosis of MIS remains unknown. Objective To evaluate mortality and factors associated with mortality after a diagnosis of MIS. Design, Setting, and Participants This population-based cohort study of adults with a diagnosis of first primary MIS from 2000 to 2018 included data from the US Surveillance, Epidemiology, and End Results Program, which were analyzed from July to September 2022. Main Outcomes and Measures Mortality after a diagnosis of MIS was evaluated using 15-year melanoma-specific survival, 15-year relative survival (ie, compared with similar individuals without MIS), and standardized mortality ratios (SMRs). Cox regression was used to estimate hazard ratios (HRs) for death by demographic and clinical characteristics. Results Among 137 872 patients with a first-and-only MIS, the mean (SD) age at diagnosis was 61.9 (16.5) years (64 027 women [46.4%]; 239 [0.2%] American Indian or Alaska Native, 606 [0.4%] Asian, 344 [0.2%] Black, 3348 [2.4%] Hispanic, and 133 335 [96.7%] White individuals). Mean (range) follow-up was 6.6 (0-18.9) years. The 15-year melanoma-specific survival was 98.4% (95% CI, 98.3%-98.5%), whereas the 15-year relative survival was 112.4% (95% CI, 112.0%-112.8%). The melanoma-specific SMR was 1.89 (95% CI, 1.77-2.02); however, the all-cause SMR was 0.68 (95% CI, 0.67-0.7). Risk of melanoma-specific mortality was higher for older patients (7.4% for those 80 years or older vs 1.4% for those aged 60-69 years; adjusted HR, 8.2; 95% CI, 6.7-10.0) and patients with acral lentiginous histology results (3.3% for acral lentiginous vs 0.9% for superficial spreading; HR, 5.3; 95% CI, 2.3-12.3). Of patients with primary MIS, 6751 (4.3%) experienced a second primary invasive melanoma and 11 628 (7.4%) experienced a second primary MIS. Compared with patients without a subsequent melanoma, the risk of melanoma-specific mortality was increased for those with a second primary invasive melanoma (adjusted HR, 4.1; 95% CI, 3.6-4.6) and was decreased for those with a second primary MIS (adjusted HR, 0.7; 95% CI, 0.6-0.9). Conclusions and relevance The results of this cohort study suggest that patients with a diagnosis of MIS have an increased but low risk of melanoma-specific mortality and live longer than people in the general population, suggesting that there is significant detection of low-risk disease among health-seeking individuals. Factors associated with death following MIS include older age (≥80 years) and subsequent primary invasive melanoma.
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Affiliation(s)
- Vishal R Patel
- Dell Medical School, The University of Texas at Austin, Austin
| | - Mya L Roberson
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill
- Associate Editor, JAMA Dermatology
| | - Michael P Pignone
- Department of Internal Medicine, Dell Medical School, The University of Texas at Austin, Austin
| | - Adewole S Adamson
- Associate Editor, JAMA Dermatology
- Web Editor, JAMA Dermatology
- Division of Dermatology, Dell Medical School, The University of Texas at Austin, Austin
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12
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Patel VR, Tsai AK, Blaes A, Parikh RB, Adamson AS, Gupta A. Association Between Price and Appropriateness of Cancer-Related Medical Information Generated by Chat-Based Artificial Intelligence Models. JCO Clin Cancer Inform 2023; 7:e2300041. [PMID: 37327463 DOI: 10.1200/cci.23.00041] [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] [Received: 03/09/2023] [Revised: 03/20/2023] [Accepted: 04/06/2023] [Indexed: 06/18/2023] Open
Affiliation(s)
- Vishal R Patel
- Dell Medical School, The University of Texas at Austin, Austin, TX
| | | | - Anne Blaes
- Masonic Cancer Center, University of Minnesota, Minneapolis, MN
| | - Ravi B Parikh
- Perelman School of Medicine, University of Pennsylvania, PA
| | | | - Arjun Gupta
- Masonic Cancer Center, University of Minnesota, Minneapolis, MN
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13
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Patel VR, Hussaini SMQ, Blaes AH, Morgans AK, Haynes AB, Adamson AS, Gupta A. Trends in the Prevalence of Functional Limitations Among US Cancer Survivors, 1999-2018. JAMA Oncol 2023:2804895. [PMID: 37166810 PMCID: PMC10176176 DOI: 10.1001/jamaoncol.2023.1180] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Affiliation(s)
| | - S M Qasim Hussaini
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins Medicine, Baltimore, Maryland
| | - Anne H Blaes
- Masonic Cancer Center, University of Minnesota, Minneapolis
| | | | - Alex B Haynes
- Dell Medical School, The University of Texas at Austin
| | | | - Arjun Gupta
- Masonic Cancer Center, University of Minnesota, Minneapolis
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14
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Patel VR, Gupta A, Blaes AH, Winkfield KM, Haynes AB, Hussaini SMQ. Prevalence of Delayed or Forgone Care Due to Patient-Clinician Identity Discordance Among US Cancer Survivors. JAMA Oncol 2023; 9:719-722. [PMID: 36995727 PMCID: PMC10064278 DOI: 10.1001/jamaoncol.2023.0242] [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: 09/27/2022] [Accepted: 01/17/2023] [Indexed: 03/31/2023]
Abstract
This case-control study assesses the prevalence of patient-reported delayed or forgone care due to patient-clinician identity discordance among cancer survivors and factors associated with this barrier to care.
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Affiliation(s)
| | - Arjun Gupta
- Masonic Cancer Center, University of Minnesota, Minneapolis
| | - Anne H. Blaes
- Masonic Cancer Center, University of Minnesota, Minneapolis
| | - Karen M. Winkfield
- Meharry–Vanderbilt Alliance, Vanderbilt University Medical Center, Nashville, Tennessee
| | | | - S. M. Qasim Hussaini
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins Medicine, Baltimore, Maryland
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15
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Patel VR, Cwalina TB, Nortjé N, Mullangi S, Parikh RB, Shih YCT, Gupta A, Hussaini SMQ. Incorporating Cost Measures Into the Merit-Based Incentive Payment System: Implications for Oncologists. JCO Oncol Pract 2023:OP2200858. [PMID: 37094233 DOI: 10.1200/op.22.00858] [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: 04/26/2023] Open
Abstract
PURPOSE The Merit-Based Incentive Payment System (MIPS) is currently the only federally mandated value-based payment model for oncologists. The weight of cost measures in MIPS has increased from 0% in 2017 to 30% in 2022. Given that cost measures are specialty-agnostic, specialties with greater costs of care such as oncology may be unfairly affected. We investigated the implications of incorporating cost measures into MIPS on physician reimbursements for oncologists and other physicians. METHODS We evaluated physicians scored on cost and quality in the 2018 MIPS using the Doctors and Clinicians database. We used multivariable Tobit regression to identify physician-level factors associated with cost and quality scores. We simulated composite MIPS scores and payment adjustments by applying the 2022 cost-quality weights to the 2018 category scores and compared changes across specialties. RESULTS Of 168,098 identified MIPS-participating physicians, 5,942 (3.5%) were oncologists. Oncologists had the lowest cost scores compared with other specialties (adjusted mean score, 58.4 for oncologists v 71.0 for nononcologists; difference, -12.66 [95% CI, -13.34 to -11.99]), while quality scores were similar (82.9 v 84.2; difference, -1.31 [95% CI, -2.65 to 0.03]). After the 2022 cost-quality reweighting, oncologists would receive a 4.3-point (95% CI, 4.58 to 4.04) reduction in composite MIPS scores, corresponding to a four-fold increase in magnitude of physician penalties ($4,233.41 US dollars [USD] in 2018 v $18,531.06 USD in 2022) and greater reduction in exceptional payment bonuses compared with physicians in other specialties (-42.8% [95% CI, -44.1 to -41.5] for oncologists v -23.6% [95% CI, -23.8 to -23.4] for others). CONCLUSION Oncologists will likely be disproportionally penalized after the incorporation of cost measures into MIPS. Specialty-specific recalibration of cost measures is needed to ensure that policy efforts to promote value-based care do not compromise health care quality and outcomes.
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Affiliation(s)
- Vishal R Patel
- Dell Medical School, The University of Texas at Austin, Austin, TX
| | - Thomas B Cwalina
- Case Western Reserve University School of Medicine, Cleveland, OH
| | - Nico Nortjé
- Section of Clinical Ethics, Department of Critical Care Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Samyukta Mullangi
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Ravi B Parikh
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Ya-Chen Tina Shih
- Section of Cancer Economics and Policy, Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Arjun Gupta
- Masonic Cancer Center, University of Minnesota, Minneapolis, MN
| | - S M Qasim Hussaini
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins Medicine, Baltimore, MD
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16
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Patel VR, Cwalina TB, Gupta A, Nortjé N, Mullangi S, Parikh RB, Shih YCT, Hussaini SMQ. Oncologist Participation and Performance in the Merit-Based Incentive Payment System. Oncologist 2023; 28:e228-e232. [PMID: 36847139 PMCID: PMC10078897 DOI: 10.1093/oncolo/oyad033] [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: 08/21/2022] [Accepted: 01/23/2023] [Indexed: 03/01/2023] Open
Abstract
The merit-based incentive payment system (MIPS) is a value-based payment model created by the Centers for Medicare & Medicaid Services (CMS) to promote high-value care through performance-based adjustments of Medicare reimbursements. In this cross-sectional study, we examined the participation and performance of oncologists in the 2019 MIPS. Oncologist participation was low (86%) compared to all-specialty participation (97%). After adjusting for practice characteristics, higher MIPS scores were observed among oncologists with alternative payment models (APMs) as their filing source (mean score, 91 for APMs vs. 77.6 for individuals; difference, 13.41 [95% CI, 12.21, 14.6]), indicating the importance of greater organizational resources for participants. Lower scores were associated with greater patient complexity (mean score, 83.4 for highest quintile vs. 84.9 for lowest quintile, difference, -1.43 [95% CI, -2.48, -0.37]), suggesting the need for better risk-adjustment by CMS. Our findings may guide future efforts to improve oncologist engagement in MIPS.
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Affiliation(s)
- Vishal R Patel
- Dell Medical School, The University of Texas at Austin, Austin, TX, USA
| | - Thomas B Cwalina
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Arjun Gupta
- Division of Hematology, Oncology and Transplantation, Department of Medicine, Masonic Cancer Center, University of Minnesota, MN, USA
| | - Nico Nortjé
- Section of Clinical Ethics, Department of Critical Care Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Samyukta Mullangi
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Ravi B Parikh
- Penn Center for Cancer Care Innovation, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA.,Department of Medicine, Perelman School of Medicine, University of Pennsylvania, PA, USA
| | - Ya-Chen Tina Shih
- Section of Cancer Economics and Policy, Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - S M Qasim Hussaini
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins Medicine, Baltimore, MD, USA
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17
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Patel VR, Gupta A, Hussaini SMQ. Impact of proposed 2022 changes to the Merit-Based Incentive Payment System (MIPS) on oncologist performance and reimbursement. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.28_suppl.006] [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: 11/20/2022] Open
Abstract
6 Background: In 2017, the Centers for Medicare & Medicaid Services (CMS) executed a landmark bipartisan legislation aimed at gradually shifting American healthcare from a fee-for-service model to a value-based system. The resulting payment model, MIPS, uses cost and quality metrics to assign clinicians an overall MIPS score, where higher scores correspond to greater payments for practices. In 2018, cost metrics contributed only 10% of this composite score, while quality metrics contributed 50%. Beginning with 2022, the cost and quality categories will be equally weighted (30% each) to encourage clinicians to reduce healthcare costs. As the cost of cancer care is disproportionately high, we investigated the implications of the updated scoring on reimbursements for oncologists and other providers participating in MIPS. Methods: We included physicians participating in the 2018 MIPS Performance Year files. We categorized hematological-, medical, radiation, gynecological, and surgical oncologists as oncologists and delineated those with National Cancer Institute-designated Cancer Center (NCICC)-affiliation. We excluded individuals who were exempt from reporting cost scores due to their MIPS-filing method. We calculated the projected 2022 MIPS composite scores (range, 0-100) by multiplying the 2022 weights by the 2018 component scores. We compared the change in composite MIPS score and the corresponding negative payment adjustments due to reweighing across specialties. Clopper–Pearson 95% confidence intervals were reported. Results: The cohort included 168,659 physicians, of which 163,150 (97%) were non-oncologists and 5,509 (3%) were oncologists. Of oncologists, 1,757 (32%) were at a NCICC. Cost scores (higher is better) for each group were as follows: non-oncologists, 75.2; all oncologists, 65.5; NCICC oncologists, 57.1. Reweighing the 2018 MIPS composite scores with the updated 2022 cost/quality weights resulted in a mean 1.7-point decrease (88.7 to 87) for non-oncologists, a 3.8-point decrease (89.7 to 85.9) for all oncologists, and a 5.2-point decrease (89.2 to 84) for NCICC oncologists. Following the reweighing, the proportion of non-oncologists incurring penalties will increase by 12.8% (95% CI, 12.7%–12.9%); all oncologists by 14.3% (95% CI, 13.2%–15.4%); and NCICC oncologists by 20% (95% CI, 18.1%–21.9%). Conclusions: Beginning with 2022 performance year, federally mandated reweighing of MIPS cost metrics will result in a disproportionate increase in oncologists receiving negative payment adjustments. With a majority Medicare population with new cancer diagnoses, higher patient complexity, and declining operating margins at many oncologic practices, we highlight striking upcoming changes that may inform further optimization of MIPS cost metrics by CMS to ensure oncologists providing high quality care are not penalized.
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Affiliation(s)
- Vishal R. Patel
- Department of Medical Education, Dell Medical School, The University of Texas at Austin, Austin, TX
| | - Arjun Gupta
- University of Minnesota Masonic Cancer Center, Minneapolis, MN
| | - S. M. Qasim Hussaini
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins Hospital, Baltimore, MD
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18
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Gereta S, Patel VR, Mackert M, Haynes AB. #SurgOnc: Global discussions about surgical cancer care on Twitter during COVID-19. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.11045] [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: 11/20/2022] Open
Abstract
11045 Background: Social media platforms such as Twitter are highly utilized to communicate about cancer care. Although surgery is the primary treatment for solid malignancies, little is known about public perceptions or communication behaviors regarding this treatment modality. Further, prolonged lockdowns and widespread delays of planned operations during the COVID-19 pandemic have magnified the importance of virtual communication about surgical cancer care. Methods: Tweets referencing cancer surgery were collected from January 2018 to January 2022 using Twitter’s Application Programming Interface. Account metadata was used to predict user demographic information and to compare tweeting metrics across users. Natural language processing models were applied to tweet content to resolve common topics of conversation and to classify tweets by cancer type. Results: There were 442,840 original tweets about cancer surgery by 262,168 users. Individuals accounted for most users (65%) while influencers accounted for the least (1.4%). Influencers made the most median impressions (19,139). Of 240,713 tweets discussing surgery for specific cancers, breast (20%) and neurologic (17%) cancers were most mentioned. When adjusting for national rates of procedures performed, tweets about surgery for neurologic cancers were the most common (231 tweets per 1000 procedures) whereas those for urologic cancers were the least common (15 tweets per 1000 procedures). Discussions about cancer surgery research made up 31% of tweets before the pandemic but only 11% of tweets during the pandemic. During the pandemic, concern regarding COVID-19 related delays was the most tweeted topic (23%). Cancer surgery research was most cited by oncologists, as well as in tweets about hepatopancreatobiliary and colorectal cancers. The cost of surgery was commonly mentioned in tweets about breast and gynecologic cancers and contained the most negative sentiment score (-0.7). Conclusions: Twitter was highly utilized to discuss surgical cancer care during the COVID-19 pandemic. During the pandemic, conversations shifted focus from research to survivorship and reflected real-time events such as COVID-19-related surgical delays. We identified the financial burden of cancer care as a commonly held concern among patients discussing cancer surgery on social media. Future public health outreach about cancer surgery may be optimized by coordinating with influencers and by targeting topics of concern like cost of surgery and undermentioned content like urologic cancers. Twitter’s role as a platform for research dissemination was disrupted by the COVID-19 pandemic, and further tracking is needed regarding online research discussions after the pandemic.
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Affiliation(s)
- Sofia Gereta
- Department of Medical Education, Dell Medical School, The University of Texas at Austin, Austin, TX
| | - Vishal R. Patel
- Department of Medical Education, Dell Medical School, The University of Texas at Austin, Austin, TX
| | - Michael Mackert
- Center for Health Communication, Moody College of Communication, The University of Texas at Austin, Austin, TX
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19
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Patel VR, Gereta S, Blanton CJ, Chu AL, Patel AP, Mackert M, Zientek D, Nortjé N, Khurshid A, Moriates C, Wallingford G. Perceptions of Life Support and Advance Care Planning During the COVID-19 Pandemic. Chest 2022; 161:1609-1619. [PMID: 35077706 PMCID: PMC8783527 DOI: 10.1016/j.chest.2022.01.023] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Revised: 12/14/2021] [Accepted: 01/13/2022] [Indexed: 11/02/2022] Open
Abstract
Background Research Question Study Design and Methods Results Interpretation
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20
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Patel VR, Gombos DS, Admirand J, Ghafoori SD. Partial spontaneous regression of choroidal melanoma: A case image with histopathology and gene expression profiling. Am J Ophthalmol Case Rep 2022; 26:101517. [PMID: 35496766 PMCID: PMC9048143 DOI: 10.1016/j.ajoc.2022.101517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 03/08/2022] [Accepted: 04/03/2022] [Indexed: 11/25/2022] Open
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21
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Chu AL, Patel VR, Blanton CJ, Gereta S, Mackert M, Nortje N, Pignone M. Colorectal cancer conversations on Twitter: A content analysis of global perceptions and outreach efforts. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.4_suppl.035] [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: 11/20/2022] Open
Abstract
35 Background: Screening is highly effective at reducing colorectal cancer (CRC) mortality. Social media is extensively used to communicate about cancer care, yet little is known about the role of these online platforms in promoting CRC screening and early diagnosis. This study tracked Twitter discussions about CRC and characterized participating users to better understand public communication and perceptions of CRC on social media. Methods: Tweets containing references to CRC were collected from January 2020 to April 2021 using Twitter’s Application Programming Interface. Account metadata was used to predict user demographic information and classify users as either organizations, individuals, or influencers. Influencers represent high-impact users, defined by sizeable follower counts or verified Twitter status. Latent Dirichlet Allocation, a natural language processing model, was used to identify observed topics of discussion in the collected tweets. Results: There were 72,229 unique CRC-related tweets by 31,170 users. Tweets reached a daily maximum after Chadwick Boseman, a well-known American actor, died from CRC. Individuals accounted for the majority of users (62.8%); organizations (35.2%); influencers (2%). Influencers made the most median impressions (35,853 impressions). Tweets contained the following topics: bereavement (27.9%), appeals for early detection (19.4%), research (14.0%), National Colorectal Cancer Awareness Month (NCCAM) (13.7%), screening access (12.5%), and risk factors (12.4%). Tweets referencing bereavement had the most user engagement. Links to clinical trial enrollment information were the least shared type of embedded content (0.3%). Conclusions: Discussions about CRC largely focused on bereavement and early detection. Online coverage of NCCAM, personal experiences, and celebrity deaths related to CRC effectively stimulated goal-oriented tweets about early detection. Our findings suggest that Twitter may be a suitable platform for promoting and communicating future public health recommendations about CRC.
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Affiliation(s)
- Alexander L. Chu
- Department of Medical Education, Dell Medical School, The University of Texas at Austin, Austin, TX
| | - Vishal R. Patel
- Department of Medical Education, Dell Medical School, The University of Texas at Austin, Austin, TX
| | - Christopher J. Blanton
- Department of Medical Education, Dell Medical School, The University of Texas at Austin, Austin, TX
| | - Sofia Gereta
- Department of Medical Education, Dell Medical School, The University of Texas at Austin, Austin, TX
| | - Michael Mackert
- Center for Health Communication, Moody College of Communication, The University of Texas at Austin, Austin, TX
| | - Nico Nortje
- Department of Critical Care Medicine, Division of Anesthesiology and Critical Care, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Michael Pignone
- Department of Internal Medicine, Dell Medical School, The University of Texas at Austin, Austin, TX
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22
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Patel VR, Salinas AM, Qi D, Gupta S, Sidote DJ, Goldschen-Ohm MP. Single-molecule binding dynamics and cooperativity of the first two cyclic nucleotides at the TAX-4 CNG channel. Biophys J 2022. [DOI: 10.1016/j.bpj.2021.11.850] [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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23
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Patel VR, Gereta S, Blanton CJ, Chu AL, Reddy NK, Mackert M, Nortjé N, Pignone MP. #ColonCancer: Social Media Discussions About Colorectal Cancer During the COVID-19 Pandemic. JCO Clin Cancer Inform 2022; 6:e2100180. [PMID: 35025670 DOI: 10.1200/cci.21.00180] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
PURPOSE Colorectal cancer (CRC) is the second leading cause of cancer-related mortality worldwide. Social media platforms such as Twitter are extensively used to communicate about cancer care, yet little is known about the role of these online platforms in promoting early detection or sharing the lived experiences of patients with CRC. This study tracked Twitter discussions about CRC and characterized participating users to better understand public communication and perceptions of CRC during the COVID-19 pandemic. METHODS Tweets containing references to CRC were collected from January 2020 to April 2021 using Twitter's Application Programming Interface. Account metadata was used to predict user demographic information and classify users as either organizations, individuals, clinicians, or influencers. We compared the number of impressions across users and analyzed the content of tweets using natural language processing models to identify prominent topics of discussion. RESULTS There were 72,229 unique CRC-related tweets by 31,170 users. Most users were male (66%) and older than 40 years (57%). Individuals accounted for most users (44%); organizations (35%); clinicians (19%); and influencers (2%). Influencers made the most median impressions (35,853). Organizations made the most overall impressions (1,067,189,613). Tweets contained the following topics: bereavement (20%), appeals for early detection (20%), research (17%), National Colorectal Cancer Awareness Month (15%), screening access (14%), and risk factors (14%). CONCLUSION Discussions about CRC largely focused on bereavement and early detection. Online coverage of National Colorectal Cancer Awareness Month and personal experiences with CRC effectively stimulated goal-oriented tweets about early detection. Our findings suggest that although Twitter is commonly used for communicating about CRC, partnering with influencers may be an effective strategy for improving communication of future public health recommendations related to CRC.
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Affiliation(s)
- Vishal R Patel
- Dell Medical School, The University of Texas at Austin, Austin, TX
| | - Sofia Gereta
- Dell Medical School, The University of Texas at Austin, Austin, TX
| | | | - Alexander L Chu
- Dell Medical School, The University of Texas at Austin, Austin, TX
| | - Neha K Reddy
- Dell Medical School, The University of Texas at Austin, Austin, TX
| | - Michael Mackert
- Center for Health Communication, Moody College of Communication, The University of Texas at Austin, Austin, TX
| | - Nico Nortjé
- Division of Anesthesiology and Critical Care, Department of Critical Care Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
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24
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Tijerina AN, Srivastava AV, Patel VR, Osterberg EC. Current use of testosterone therapy in LGBTQ populations. Int J Impot Res 2021; 34:642-648. [PMID: 34815551 DOI: 10.1038/s41443-021-00490-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 10/14/2021] [Accepted: 10/25/2021] [Indexed: 01/23/2023]
Abstract
Testosterone therapy (TT) is a type of gender-affirming hormone therapy (GAHT) in lesbian, gay, bisexual, transgender, and genderqueer (LGBTQ) populations for gender dysphoria (GD), body uneasiness, and sexual dysfunction. The physical and physiological effects of TT vary widely depending on the dosing regimen and duration of treatment. An individualized approach prioritizing patient-specific desired effects in the context of pre-existing characteristics and health history is strongly recommended. Although TT is an effective treatment for many patients, there has been an increase in the illegitimate acquisition of TT in recent years. Non-judicious prescribing and lack of physician surveillance increases the risk of unintended side effects and potential serious health consequences.
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Affiliation(s)
- A N Tijerina
- University of Texas Dell Medical School, Austin, TX, 78712, USA.
| | - A V Srivastava
- University of Texas Dell Medical School, Austin, TX, 78712, USA
| | - V R Patel
- University of Texas Dell Medical School, Austin, TX, 78712, USA
| | - E C Osterberg
- University of Texas Dell Medical School, Austin, TX, 78712, USA.,Dell Medical School Department of Surgery and Perioperative Care and Ascension Seton Hospital Network, Austin, TX, 78712, USA
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25
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Patel VR, Salinas AM, Qi D, Gupta S, Sidote DJ, Goldschen-Ohm MP. Single-molecule imaging with cell-derived nanovesicles reveals early binding dynamics at a cyclic nucleotide-gated ion channel. Nat Commun 2021; 12:6459. [PMID: 34753946 PMCID: PMC8578382 DOI: 10.1038/s41467-021-26816-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 10/21/2021] [Indexed: 12/05/2022] Open
Abstract
Ligand binding to membrane proteins is critical for many biological signaling processes. However, individual binding events are rarely directly observed, and their asynchronous dynamics are occluded in ensemble-averaged measures. For membrane proteins, single-molecule approaches that resolve these dynamics are challenged by dysfunction in non-native lipid environments, lack of access to intracellular sites, and costly sample preparation. Here, we introduce an approach combining cell-derived nanovesicles, microfluidics, and single-molecule fluorescence colocalization microscopy to track individual binding events at a cyclic nucleotide-gated TAX-4 ion channel critical for sensory transduction. Our observations reveal dynamics of both nucleotide binding and a subsequent conformational change likely preceding pore opening. Kinetic modeling suggests that binding of the second ligand is either independent of the first ligand or exhibits up to ~10-fold positive binding cooperativity. This approach is broadly applicable to studies of binding dynamics for proteins with extracellular or intracellular domains in native cell membrane.
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Affiliation(s)
- Vishal R Patel
- Department of Neuroscience, The University of Texas at Austin, Austin, TX, USA
- Dell Medical School, The University of Texas at Austin, Austin, TX, USA
| | - Arturo M Salinas
- Department of Physics, The University of Texas at Austin, Austin, TX, USA
| | - Darong Qi
- Department of Neuroscience, The University of Texas at Austin, Austin, TX, USA
| | - Shipra Gupta
- Department of Neuroscience, The University of Texas at Austin, Austin, TX, USA
| | - David J Sidote
- Department of Neuroscience, The University of Texas at Austin, Austin, TX, USA
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Kay HE, Srikanth P, Srivastava AV, Tijerina AN, Patel VR, Hauser N, Laviana AA, Wolf JS, Osterberg EC. Preoperative and Intraoperative Factors Predictive of Complications and Stricture Recurrence after Multiple Urethroplasty Techniques. J Am Coll Surg 2021. [DOI: 10.1016/j.jamcollsurg.2021.07.641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Patel VR, Soni HK, Trivedi VB, Patel JB, Jain S. Development and Validation of Analytical Method for Simultaneous Estimation of Active Constituents in a Polyherbal Ointment by Gas Chromatography. J AOAC Int 2019; 102:1027-1032. [PMID: 30563584 DOI: 10.5740/jaoacint.18-0383] [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] [Indexed: 11/17/2022]
Abstract
Background: The simultaneous, quantitative determination of all active ingredients present in the analgesic formulation (Dazzle ointment) requires an ideal and novel method by which these phytoconstituents can be separated with the highest resolution without any interference from one another. Objective: The present work was conducted to develop and validate a quantitative method for the simultaneous estimation of all five phytoconstituents present in a polyherbal analgesic ointment by GC. Methods: α-Pinene, 1,8-cineole, camphor, menthol, and methyl salicylate present in the ingredients of the ointment were analyzed and quantified by GC using a crosslinked 5% phenyl polydimethylsiloxane capillary column, nitrogen as a carrier gas, and a flame-ionization detector. Aniline was used as the internal standard. Method validation was also performed in order to demonstrate its selectivity, linearity, accuracy, precision, LOD, LOQ, and robustness. Results: The calibration curves of all five marker compounds showed good linear correlation coefficients (r² >0.998) within the tested ranges. The precision of the method was tested by carrying out intra- and interday analyses of the same sample. RSD values were observed to be <1.00%. The accuracy of the method, determined by performing recovery studies, was found to be between 99.25 and 101.39%. The developed method was also demonstrated to be robust (RSD <1.29%) by making small but deliberate variations in method parameters. Conclusions: The developed GC method is simple, precise, and accurate, it and can be used for the rapid quality control testing of the polyherbal formulation. Highlights: The developed GC method will assist in the standardization of polyherbal analgesic formulation consists of α-pinene, 1,8-cineole, camphor, menthol, and methyl salicylate as active constituents.
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Affiliation(s)
- Vishal R Patel
- Vasu Research Centre, Plot No. A2/624-625/2, GIDC, Vadodara, India 390010
| | - Hardik K Soni
- Vasu Research Centre, Plot No. A2/624-625/2, GIDC, Vadodara, India 390010
| | - Vikram B Trivedi
- Vasu Research Centre, Plot No. A2/624-625/2, GIDC, Vadodara, India 390010
| | - Jigna B Patel
- Babaria Institute of Pharmacy, Vadodara-Mumbai National Highway 8, Vadodara, India 391240
| | - Suresh Jain
- Babaria Institute of Pharmacy, Vadodara-Mumbai National Highway 8, Vadodara, India 391240
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Mistretta FA, Grasso AA, Buffi N, Cozzi G, De Lorenzis E, Fiori C, Patel VR, Porpiglia F, Scarpa R, Srinivas S, Rocco B. Robot-assisted radical prostatectomy: recent advances. MINERVA UROL NEFROL 2015; 67:281-292. [PMID: 26086533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Robot assisted radical prostatectomy (RARP) represents the leading application of robotic surgery in the urologic field and it has become the main treatment option for localized prostate cancer (PCa) in the USA In the present review we summarized and critically analyzed the literature of the past five years about this widely used robotic procedure. RARP has continuously evolved in terms of technical modifications and procedural steps. Long-term data are now available, suggesting comparable oncological outcomes to those of open and laparoscopic radical prostatectomy. Good functional outcomes have also been demonstrated. Technological innovations and the introduction of more advanced robotic platforms featuring novel arm-integrated equipment, together with a mature clinical experience with the robotic approach, are likely to lead towards optimal outcomes. Despite the expanding clinical implementation of RARP in the management of prostate cancer, some issues related to this procedure remain matter of debate, such as costs, comparative outcomes versus other approaches, and its role in high risk disease.
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Affiliation(s)
- F A Mistretta
- Department of Urology, University of Milan, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Milan, Italy -
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Patel VR, Ceglia N, Zeller M, Eckel-Mahan K, Sassone-Corsi P, Baldi P. The pervasiveness and plasticity of circadian oscillations: the coupled circadian-oscillators framework. Bioinformatics 2015; 31:3181-8. [PMID: 26049162 DOI: 10.1093/bioinformatics/btv353] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2014] [Accepted: 06/02/2015] [Indexed: 01/20/2023] Open
Abstract
MOTIVATION Circadian oscillations have been observed in animals, plants, fungi and cyanobacteria and play a fundamental role in coordinating the homeostasis and behavior of biological systems. Genetically encoded molecular clocks found in nearly every cell, based on negative transcription/translation feedback loops and involving only a dozen genes, play a central role in maintaining these oscillations. However, high-throughput gene expression experiments reveal that in a typical tissue, a much larger fraction ([Formula: see text]) of all transcripts oscillate with the day-night cycle and the oscillating species vary with tissue type suggesting that perhaps a much larger fraction of all transcripts, and perhaps also other molecular species, may bear the potential for circadian oscillations. RESULTS To better quantify the pervasiveness and plasticity of circadian oscillations, we conduct the first large-scale analysis aggregating the results of 18 circadian transcriptomic studies and 10 circadian metabolomic studies conducted in mice using different tissues and under different conditions. We find that over half of protein coding genes in the cell can produce transcripts that are circadian in at least one set of conditions and similarly for measured metabolites. Genetic or environmental perturbations can disrupt existing oscillations by changing their amplitudes and phases, suppressing them or giving rise to novel circadian oscillations. The oscillating species and their oscillations provide a characteristic signature of the physiological state of the corresponding cell/tissue. Molecular networks comprise many oscillator loops that have been sculpted by evolution over two trillion day-night cycles to have intrinsic circadian frequency. These oscillating loops are coupled by shared nodes in a large network of coupled circadian oscillators where the clock genes form a major hub. Cells can program and re-program their circadian repertoire through epigenetic and other mechanisms. AVAILABILITY AND IMPLEMENTATION High-resolution and tissue/condition specific circadian data and networks available at http://circadiomics.igb.uci.edu. CONTACT pfbaldi@ics.uci.edu SUPPLEMENTARY INFORMATION Supplementary data are available at Bioinformatics online.
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Affiliation(s)
- Vishal R Patel
- Department of Computer Science, Institute for Genomics and Bioinformatics
| | - Nicholas Ceglia
- Department of Computer Science, Institute for Genomics and Bioinformatics
| | - Michael Zeller
- Department of Computer Science, Institute for Genomics and Bioinformatics
| | - Kristin Eckel-Mahan
- Department of Biological Chemistry and Center for Epigenetics and Metabolism, University of California, Irvine (UCI), Irvine, CA - 92697, USA
| | - Paolo Sassone-Corsi
- Institute for Genomics and Bioinformatics, Department of Biological Chemistry and Center for Epigenetics and Metabolism, University of California, Irvine (UCI), Irvine, CA - 92697, USA
| | - Pierre Baldi
- Department of Computer Science, Institute for Genomics and Bioinformatics, Department of Biological Chemistry and Center for Epigenetics and Metabolism, University of California, Irvine (UCI), Irvine, CA - 92697, USA
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Dyar KA, Ciciliot S, Wright LE, Biensø RS, Malagoli Tagliazucchi G, Patel VR, Forcato M, Peña-Paz MI, Gudiksen A, Solagna F, Albiero M, Moretti I, Eckel-Mahan KL, Baldi P, Sassone-Corsi P, Rizzuto R, Bicciato S, Pilegaard H, Blaauw B, Schiaffino S. Erratum to "Muscle insulin sensitivity and glucose metabolism are controlled by the intrinsic muscle clock" [Mol Metab 3 (2014) 29-41]. Mol Metab 2014; 3:857. [PMID: 25503566 DOI: 10.1016/j.molmet.2014.09.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [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: 10/24/2022] Open
Abstract
[This corrects the article DOI: 10.1016/j.molmet.2013.10.005.].
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Affiliation(s)
- Kenneth A Dyar
- Venetian Institute of Molecular Medicine, Via Orus 2, 35129 Padova, Italy
| | - Stefano Ciciliot
- Venetian Institute of Molecular Medicine, Via Orus 2, 35129 Padova, Italy
| | - Lauren E Wright
- Department of Biomedical Sciences, University of Padova, Italy
| | - Rasmus S Biensø
- Department of Biology, Molecular Integrative Physiology, University of Copenhagen, Denmark
| | | | - Vishal R Patel
- Department of Computer Science, Institute for Genomics and Bioinformatics, UC Irvine, USA
| | - Mattia Forcato
- Center for Genome Research, Department of Life Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Marcia I Peña-Paz
- Venetian Institute of Molecular Medicine, Via Orus 2, 35129 Padova, Italy
| | - Anders Gudiksen
- Department of Biology, Molecular Integrative Physiology, University of Copenhagen, Denmark
| | - Francesca Solagna
- Venetian Institute of Molecular Medicine, Via Orus 2, 35129 Padova, Italy
| | - Mattia Albiero
- Venetian Institute of Molecular Medicine, Via Orus 2, 35129 Padova, Italy
| | - Irene Moretti
- Venetian Institute of Molecular Medicine, Via Orus 2, 35129 Padova, Italy ; CNR Institute of Neuroscience, Padova, Italy
| | | | - Pierre Baldi
- Department of Computer Science, Institute for Genomics and Bioinformatics, UC Irvine, USA
| | | | - Rosario Rizzuto
- Department of Biomedical Sciences, University of Padova, Italy ; CNR Institute of Neuroscience, Padova, Italy
| | - Silvio Bicciato
- Center for Genome Research, Department of Life Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Henriette Pilegaard
- Department of Biology, Molecular Integrative Physiology, University of Copenhagen, Denmark
| | - Bert Blaauw
- Venetian Institute of Molecular Medicine, Via Orus 2, 35129 Padova, Italy ; Department of Biomedical Sciences, University of Padova, Italy
| | - Stefano Schiaffino
- Venetian Institute of Molecular Medicine, Via Orus 2, 35129 Padova, Italy ; CNR Institute of Neuroscience, Padova, Italy
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Zeller M, Magnan CN, Patel VR, Rigor P, Sender L, Baldi P. A Genomic Analysis Pipeline and Its Application to Pediatric Cancers. IEEE/ACM Trans Comput Biol Bioinform 2014; 11:826-839. [PMID: 26356856 DOI: 10.1109/tcbb.2014.2330616] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
We present a cancer genomic analysis pipeline which takes as input sequencing reads for both germline and tumor genomes and outputs filtered lists of all genetic mutations in the form of short ranked list of the most affected genes in the tumor, using either the Complete Genomics or Illumina platforms. A novel reporting and ranking system has been developed that makes use of publicly available datasets and literature specific to each patient, including new methods for using publicly available expression data in the absence of proper control data. Previously implicated small and large variations (including gene fusions) are reported in addition to probable driver mutations. Relationships between cancer and the sequenced tumor genome are highlighted using a network-based approach that integrates known and predicted protein-protein, protein-TF, and protein-drug interaction data. By using an integrative approach, effects of genetic variations on gene expression are used to provide further evidence of driver mutations. This pipeline has been developed with the aim to be used in assisting in the analysis of pediatric tumors, as an unbiased and automated method for interpreting sequencing results along with identifying potentially therapeutic drugs and their targets. We present results that agree with previous literature and highlight specific findings in a few patients.
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Abstract
Circadian oscillations play a critical role in coordinating the physiology, homeostasis, and behavior of biological systems. Once thought to only be controlled by a master clock, recent high-throughput experiments suggest many genes and metabolites in a cell are potentially capable of circadian oscillations. Each cell can reprogram itself and select a relatively small fraction of this broad repertoire for circadian oscillations, as a result of genetic, environmental, and even diet changes.
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Affiliation(s)
- V R Patel
- Department of Computer Science, University of California - Irvine, Irvine, CA 92697, USA; Institute for Genomics and Bioinformatics, University of California - Irvine, Irvine, CA 92697, USA
| | - K Eckel-Mahan
- Department of Biological Chemistry, University of California - Irvine, Irvine, CA 92697, USA; Center for Epigenetics and Metabolism, University of California - Irvine, Irvine, CA 92697, USA
| | - P Sassone-Corsi
- Institute for Genomics and Bioinformatics, University of California - Irvine, Irvine, CA 92697, USA; Department of Biological Chemistry, University of California - Irvine, Irvine, CA 92697, USA; Center for Epigenetics and Metabolism, University of California - Irvine, Irvine, CA 92697, USA
| | - P Baldi
- Department of Computer Science, University of California - Irvine, Irvine, CA 92697, USA; Institute for Genomics and Bioinformatics, University of California - Irvine, Irvine, CA 92697, USA; Department of Biological Chemistry, University of California - Irvine, Irvine, CA 92697, USA; Center for Epigenetics and Metabolism, University of California - Irvine, Irvine, CA 92697, USA.
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Eckel-Mahan KL, Patel VR, de Mateo S, Orozco-Solis R, Ceglia NJ, Sahar S, Dilag-Penilla SA, Dyar KA, Baldi P, Sassone-Corsi P. Reprogramming of the circadian clock by nutritional challenge. Cell 2013; 155:1464-78. [PMID: 24360271 PMCID: PMC4573395 DOI: 10.1016/j.cell.2013.11.034] [Citation(s) in RCA: 472] [Impact Index Per Article: 42.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2013] [Revised: 10/16/2013] [Accepted: 11/21/2013] [Indexed: 12/29/2022]
Abstract
Circadian rhythms and cellular metabolism are intimately linked. Here, we reveal that a high-fat diet (HFD) generates a profound reorganization of specific metabolic pathways, leading to widespread remodeling of the liver clock. Strikingly, in addition to disrupting the normal circadian cycle, HFD causes an unexpectedly large-scale genesis of de novo oscillating transcripts, resulting in reorganization of the coordinated oscillations between coherent transcripts and metabolites. The mechanisms underlying this reprogramming involve both the impairment of CLOCK:BMAL1 chromatin recruitment and a pronounced cyclic activation of surrogate pathways through the transcriptional regulator PPARγ. Finally, we demonstrate that it is specifically the nutritional challenge, and not the development of obesity, that causes the reprogramming of the clock and that the effects of the diet on the clock are reversible.
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Affiliation(s)
- Kristin L Eckel-Mahan
- Center for Epigenetics and Metabolism, Department of Biological Chemistry, University of California, Irvine, Irvine, CA 92697, USA
| | - Vishal R Patel
- Institute for Genomics and Bioinformatics, School of Information and Computer Sciences, University of California, Irvine, Irvine, CA 92697, USA
| | - Sara de Mateo
- Center for Epigenetics and Metabolism, Department of Biological Chemistry, University of California, Irvine, Irvine, CA 92697, USA
| | - Ricardo Orozco-Solis
- Center for Epigenetics and Metabolism, Department of Biological Chemistry, University of California, Irvine, Irvine, CA 92697, USA
| | - Nicholas J Ceglia
- Institute for Genomics and Bioinformatics, School of Information and Computer Sciences, University of California, Irvine, Irvine, CA 92697, USA
| | - Saurabh Sahar
- Center for Epigenetics and Metabolism, Department of Biological Chemistry, University of California, Irvine, Irvine, CA 92697, USA
| | - Sherry A Dilag-Penilla
- Center for Epigenetics and Metabolism, Department of Biological Chemistry, University of California, Irvine, Irvine, CA 92697, USA
| | - Kenneth A Dyar
- Venetian Institute of Molecular Medicine, Padova 35129, Italy
| | - Pierre Baldi
- Institute for Genomics and Bioinformatics, School of Information and Computer Sciences, University of California, Irvine, Irvine, CA 92697, USA
| | - Paolo Sassone-Corsi
- Center for Epigenetics and Metabolism, Department of Biological Chemistry, University of California, Irvine, Irvine, CA 92697, USA.
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Dyar KA, Ciciliot S, Wright LE, Biensø RS, Tagliazucchi GM, Patel VR, Forcato M, Paz MIP, Gudiksen A, Solagna F, Albiero M, Moretti I, Eckel-Mahan KL, Baldi P, Sassone-Corsi P, Rizzuto R, Bicciato S, Pilegaard H, Blaauw B, Schiaffino S. Muscle insulin sensitivity and glucose metabolism are controlled by the intrinsic muscle clock. Mol Metab 2013; 3:29-41. [PMID: 24567902 PMCID: PMC3929910 DOI: 10.1016/j.molmet.2013.10.005] [Citation(s) in RCA: 289] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2013] [Revised: 10/14/2013] [Accepted: 10/17/2013] [Indexed: 12/21/2022] Open
Abstract
Circadian rhythms control metabolism and energy homeostasis, but the role of the skeletal muscle clock has never been explored. We generated conditional and inducible mouse lines with muscle-specific ablation of the core clock gene Bmal1. Skeletal muscles from these mice showed impaired insulin-stimulated glucose uptake with reduced protein levels of GLUT4, the insulin-dependent glucose transporter, and TBC1D1, a Rab-GTPase involved in GLUT4 translocation. Pyruvate dehydrogenase (PDH) activity was also reduced due to altered expression of circadian genes Pdk4 and Pdp1, coding for PDH kinase and phosphatase, respectively. PDH inhibition leads to reduced glucose oxidation and diversion of glycolytic intermediates to alternative metabolic pathways, as revealed by metabolome analysis. The impaired glucose metabolism induced by muscle-specific Bmal1 knockout suggests that a major physiological role of the muscle clock is to prepare for the transition from the rest/fasting phase to the active/feeding phase, when glucose becomes the predominant fuel for skeletal muscle.
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Key Words
- 2-DG, 2-Deoxyglucose
- BSA, bovine serum albumin
- Bmal1
- Circadian rhythms
- GSEA, Gene Set Enrichment Analysis
- Glucose metabolism
- Glucose uptake
- HK2, hexokinase 2
- KHB, Krebs–Henseleit buffer
- Muscle insulin resistance
- PDH, pyruvate dehydrogenase
- PDK, PDH kinase
- PDP, PDH phosphatase
- SCN, suprachiasmatic nucleus
- Skeletal muscle
- ZT, Zeitgeber time
- imKO, inducible muscle-specific Bmal1 knockout
- mKO, muscle-specific Bmal1 knockout
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Affiliation(s)
- Kenneth A Dyar
- Venetian Institute of Molecular Medicine, Via Orus 2, 35129 Padova, Italy
| | - Stefano Ciciliot
- Venetian Institute of Molecular Medicine, Via Orus 2, 35129 Padova, Italy
| | - Lauren E Wright
- Department of Biomedical Sciences, University of Padova, Italy
| | - Rasmus S Biensø
- Department of Biology, Molecular Integrative Physiology, University of Copenhagen, Denmark
| | - Guidantonio M Tagliazucchi
- Center for Genome Research, Department of Life Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Vishal R Patel
- Department of Computer Science, Institute for Genomics and Bioinformatics, UC Irvine, USA
| | - Mattia Forcato
- Center for Genome Research, Department of Life Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Marcia I P Paz
- Venetian Institute of Molecular Medicine, Via Orus 2, 35129 Padova, Italy
| | - Anders Gudiksen
- Department of Biology, Molecular Integrative Physiology, University of Copenhagen, Denmark
| | - Francesca Solagna
- Venetian Institute of Molecular Medicine, Via Orus 2, 35129 Padova, Italy
| | - Mattia Albiero
- Venetian Institute of Molecular Medicine, Via Orus 2, 35129 Padova, Italy
| | - Irene Moretti
- Venetian Institute of Molecular Medicine, Via Orus 2, 35129 Padova, Italy ; CNR Institute of Neuroscience, Padova, Italy
| | | | - Pierre Baldi
- Department of Computer Science, Institute for Genomics and Bioinformatics, UC Irvine, USA
| | | | - Rosario Rizzuto
- Department of Biomedical Sciences, University of Padova, Italy ; CNR Institute of Neuroscience, Padova, Italy
| | - Silvio Bicciato
- Center for Genome Research, Department of Life Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Henriette Pilegaard
- Department of Biology, Molecular Integrative Physiology, University of Copenhagen, Denmark
| | - Bert Blaauw
- Venetian Institute of Molecular Medicine, Via Orus 2, 35129 Padova, Italy ; Department of Biomedical Sciences, University of Padova, Italy
| | - Stefano Schiaffino
- Venetian Institute of Molecular Medicine, Via Orus 2, 35129 Padova, Italy ; CNR Institute of Neuroscience, Padova, Italy
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Aguilar-Arnal L, Hakim O, Patel VR, Baldi P, Hager GL, Sassone-Corsi P. Cycles in spatial and temporal chromosomal organization driven by the circadian clock. Nat Struct Mol Biol 2013; 20:1206-13. [PMID: 24056944 PMCID: PMC3885543 DOI: 10.1038/nsmb.2667] [Citation(s) in RCA: 94] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2013] [Accepted: 08/08/2013] [Indexed: 01/10/2023]
Abstract
Dynamic transitions in the epigenome have been associated with regulated patterns of nuclear organization. The accumulating evidence that chromatin remodeling is implicated in circadian function prompted us to explore whether the clock may control nuclear architecture. We applied the chromosome conformation capture on chip technology in mouse embryonic fibroblasts (MEFs) to demonstrate the presence of circadian long-range interactions using the clock-controlled Dbp gene as bait. The circadian genomic interactions with Dbp were highly specific and were absent in MEFs whose clock was disrupted by ablation of the Bmal1 gene (also called Arntl). We establish that the Dbp circadian interactome contains a wide variety of genes and clock-related DNA elements. These findings reveal a previously unappreciated circadian and clock-dependent shaping of the nuclear landscape.
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Affiliation(s)
- Lorena Aguilar-Arnal
- Center for Epigenetics and Metabolism, Department of Biological Chemistry, University of California Irvine, Irvine, California, U.S.A
| | - Ofir Hakim
- Laboratory of Receptor Biology and Gene Expression, National Cancer Institute, National Institute of Health, Bethesda, Maryland, U.S.A
| | - Vishal R. Patel
- Institute for Genomics and Bioinformatics, Department of Computer Science, University of California Irvine, Irvine, California, U.S.A
| | - Pierre Baldi
- Institute for Genomics and Bioinformatics, Department of Computer Science, University of California Irvine, Irvine, California, U.S.A
| | - Gordon L. Hager
- Laboratory of Receptor Biology and Gene Expression, National Cancer Institute, National Institute of Health, Bethesda, Maryland, U.S.A
| | - Paolo Sassone-Corsi
- Center for Epigenetics and Metabolism, Department of Biological Chemistry, University of California Irvine, Irvine, California, U.S.A
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Patel VR, Patel RK. Simultaneous analysis and quantification of markers of manjisthadi churna using high performance thin layer chromatography. Indian J Pharm Sci 2013; 75:106-9. [PMID: 23901170 PMCID: PMC3719138 DOI: 10.4103/0250-474x.113541] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [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: 05/14/2012] [Revised: 01/19/2013] [Accepted: 01/22/2013] [Indexed: 11/12/2022] Open
Abstract
Manjisthadi churna has been traditionally used in the Ayurvedic system of medicine and by traditional medical practices of India to treat hyperlipidemia. A rapid, simple and accurate method with high performance thin layer chromatography has been developed to standardised Manjisthadi churna using rubiadin, sennoside and ellagic acid as markers. Methanol extract of Manjisthadi churna were used for high performance thin layer chromatography on silica gel plates. The Rf of rubiadin, sennoside-A and ellagic acid were found to 0.48, 0.23 and 0.72, respectively with densitometric scanning at 280 nm and the calibration plot were linear in the range of 100-600 ng of markers. The correlation coefficients were higher than 0.99 were indicative of good linear dependence of peaks area on concentration. The rubiadin, sennoside-A and ellagic acid contents in Manjisthadi churna were found to be 0.014, 0.038 and 0.534% w/w, respectively. This method permits reliable quantification of rubiadin, sennoside-A and ellagic acid with good resolution and separation of the same from other constitutes of the extract of Manjisthadi churna. Recovery value from 95.66-102.33% showed the reliability and reproducibility of the method. The proposed high performance thin layer chromatography method for simultaneous quantification of markers in Manjisthadi churna can be used for routine quality testing.
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Affiliation(s)
- V R Patel
- Baroda College of Pharmacy, Parul Group of Institutes, Limda, Waghodia, Vadodara 391 760, India
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Ou YC, Yang CK, Wang J, Hung SW, Cheng CL, Tewari AK, Patel VR. The trifecta outcome in 300 consecutive cases of robotic-assisted laparoscopic radical prostatectomy according to D'Amico risk criteria. Eur J Surg Oncol 2012; 39:107-13. [PMID: 23085148 DOI: 10.1016/j.ejso.2012.10.003] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2012] [Revised: 08/02/2012] [Accepted: 10/03/2012] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND To analyze the trifecta outcome (continence, potency, and cancer control) in 300 cases of robotic-assisted laparoscopic radical prostatectomy (RARP). METHODS A prospective assessment of outcomes in 300 consecutive patients that underwent a RARP performed by a single surgeon. Patients were grouped according to D'Amico risk criteria: Group I consisted of 'low-risk' cases (n = 64), Group II consisted of 'intermediate-risk' cases (n = 88), and Group III consisted of 'high-risk' cases (n = 148). Patients were evaluated for perioperative complications and the trifecta outcome. RESULTS The operation time, blood loss, post-operative stay, duration of urethral catheterization, and perioperative complication rate were similar among all groups. The incidence of bilateral neurovascular bundle (NVB) preservation was significantly decreased with the increasing risk of cases (P < 0.001). The continence rates at the 1-week, 1-month, 3-month, 6-month, and 12-month follow-ups did not differ significantly between groups. The potency rates at the 12-month follow-up were not significantly different. The positive surgical margin and positive lymph node metastasis rate increased with the increasing risk of cases (P < 0.001). The biochemical recurrence rate (BCR, PSA >0.2 ng/mL) was 3.1, 11.36, and 19.59% in Groups I, II and III, respectively (P = 0.004). The trifecta outcome for RARP with bilateral NVB preservation showed no significant differences among groups. CONCLUSIONS Undergoing a RARP is safe and feasible in high-risk prostate cancer patients. Compared to low-risk and intermediate-risk groups, the high-risk group had a significant higher incidence of positive surgical margin, positive lymph node metastasis, and BCR rate.
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Affiliation(s)
- Y C Ou
- Division of Urology, Department of Surgery, Taichung Veterans General Hospital, National Yang-Ming University, Taiwan.
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Abstract
One of the major problems associated with poorly soluble drugs is very low bioavailability. The problem is even more complex for drugs like itraconazole, simvastatin, and carbamazepine which are poorly soluble in both aqueous and nonaqueous media, belonging to BCS class II as classified by biopharmaceutical classification system. Formulation as nanosuspension is an attractive and promising alternative to solve these problems. Nanosuspension consists of the pure poorly water-soluble drug without any matrix material suspended in dispersion. Preparation of nanosuspension is simple and applicable to all drugs which are water insoluble. A nanosuspension not only solves the problems of poor solubility and bioavailability, but also alters the pharmacokinetics of drug and thus improves drug safety and efficacy. This review article describes the preparation methods, characterization, and applications of the nanosuspension.
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Affiliation(s)
- Vishal R Patel
- Institute of Research and Development, Gujarat Forensic Sciences University, Sector 18/A, B/H Police Bhavan, Gandhinagar, Gujarat, India
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Kao A, Randall A, Yang Y, Patel VR, Kandur W, Guan S, Rychnovsky SD, Baldi P, Huang L. Mapping the structural topology of the yeast 19S proteasomal regulatory particle using chemical cross-linking and probabilistic modeling. Mol Cell Proteomics 2012; 11:1566-77. [PMID: 22550050 DOI: 10.1074/mcp.m112.018374] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Structural characterization of proteasome complexes is an essential step toward understanding the ubiquitin-proteasome system. Currently, high resolution structures are not available for the 26S proteasome holocomplex as well as its subcomplex, the 19S regulatory particle (RP). Here we have employed a novel integrated strategy combining chemical cross-linking with multistage tandem mass spectrometry to define the proximity of subunits within the yeast 19S RP to elucidate its topology. This has resulted in the identification of 174 cross-linked peptides of the yeast 19S RP, representing 43 unique lysine-lysine linkages within 24 nonredundant pair-wise subunit interactions. To map the spatial organization of the 19S RP, we have developed and utilized a rigorous probabilistic framework to derive maximum likelihood (ML) topologies based on cross-linked peptides determined from our analysis. Probabilistic modeling of the yeast 19S AAA-ATPase ring (i.e., Rpt1-6) has produced an ML topology that is in excellent agreement with known topologies of its orthologs. In addition, similar analysis was carried out on the 19S lid subcomplex, whose predicted ML topology corroborates recently reported electron microscopy studies. Together, we have demonstrated the effectiveness and potential of probabilistic modeling for unraveling topologies of protein complexes using cross-linking data. This report describes the first study of the 19S RP topology using a new integrated strategy combining chemical cross-linking, mass spectrometry, and probabilistic modeling. Our results have provided a solid foundation to advance our understanding of the 19S RP architecture at peptide level resolution. Furthermore, our methodology developed here is a valuable proteomic tool that can be generalized for elucidating the structures of protein complexes.
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Affiliation(s)
- Athit Kao
- Department of Physiology & Biophysics, University of California Irvine, Irvine, CA 92697, USA
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Fang L, Kaake RM, Patel VR, Yang Y, Baldi P, Huang L. Mapping the protein interaction network of the human COP9 signalosome complex using a label-free QTAX strategy. Mol Cell Proteomics 2012; 11:138-47. [PMID: 22474085 DOI: 10.1074/mcp.m111.016352] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
The COP9 signalosome (CSN) is a multi-subunit protein complex that performs critical roles in controlling diverse cellular and developmental processes. Aberrant regulation of the CSN complex has been shown to lead to tumorigenesis. Despite its biological significance, our current knowledge of the function and regulation of the CSN complex is very limited. To explore CSN biology, we have developed and employed a new version of the tag team-based QTAX strategy (quantitative analysis of tandem affinity purified in vivo cross-linked (X) protein complexes) by incorporating a label-free MS method for quantitation. Coupled with protein interaction network analysis, this strategy produced a comprehensive and detailed assessment of the protein interaction network of the human CSN complex. In total, we quantitatively characterized 825 putative CSN-interacting proteins, with 270 classified as core interactors (captured by all three bait purifications). Biochemical validation further confirms the validity of selected identified interactors. This work presents the most complete analysis of the CSN interaction network to date, providing an inclusive set of physical interaction data consistent with physiological roles for the CSN. Moreover, the methodology described here is a general proteomic tool for the comprehensive study of protein interaction networks.
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Affiliation(s)
- Lei Fang
- Departments of Physiology & Biophysics and Developmental & Cell Biology, University of California, Irvine, California 92697, USA
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Patel RK, Patel VR, Patel MG. Development and validation of a RP-HPLC method for the simultaneous determination of Embelin, Rottlerin and Ellagic acid in Vidangadi churna. J Pharm Anal 2012; 2:366-371. [PMID: 29403768 PMCID: PMC5760769 DOI: 10.1016/j.jpha.2012.03.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2011] [Accepted: 03/06/2012] [Indexed: 11/28/2022] Open
Abstract
Vidangadi churna is a popular Ayurvedic formulation described in the chapter Krimicikitsa of the Ayurvedic literature Cakradatta for the treatment of Krimiroga. The preparation is a composite mixture of the fine powder of fruits of Vidang (Embelia ribs), glandular trichomes of the fruits of Kamala (Mallotus philippensis), mature fruits of Harde (Terminalia chebula), Saindhava and Yavakshara. The use of reversed phase C18 column eluted with gradient mobile phase of acetonitrile and water enabled the efficient separation of the chemical markers in 22 min. Validation of the method was performed in order to demonstrate its selectivity, accuracy, precision, repeatability and recovery. All calibration curves showed good linear correlation coefficients (r2>0.995) within the tested ranges. Three markers in Vidangadi churna were quantified with respect to Embelin (0.647%, w/w), Rottlerin (4.419%, w/w), and Ellagic acid (0.459%, w/w). Intra-and inter-day RSDs of retention times and peak areas were less than 3.12%. The recoveries were between 99.66% and 102.33%. In conclusion, a method has been developed for the simultaneous quantification of three markers in Vidangadi churna. The RP-HPLC method was simple, precise and accurate and can be used for the quality control of the raw materials as well as formulations.
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Affiliation(s)
- Rakesh K Patel
- S.K. Patel College of Pharmaceutical Education and Research, Kherva, Mehsana, India
| | - Vishal R Patel
- Department of Pharmacognosy, Baroda College of Pharmacy, Parul Group of Institutes, Limda, Vadodara, Gujarat 391760, India
| | - Madhavi G Patel
- Parul Institute of Pharmacy, Parul Group of Institutes, Limda, Vadodara, India
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Daily K, Patel VR, Rigor P, Xie X, Baldi P. MotifMap: integrative genome-wide maps of regulatory motif sites for model species. BMC Bioinformatics 2011; 12:495. [PMID: 22208852 PMCID: PMC3293935 DOI: 10.1186/1471-2105-12-495] [Citation(s) in RCA: 131] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2011] [Accepted: 12/30/2011] [Indexed: 12/20/2022] Open
Abstract
Background A central challenge of biology is to map and understand gene regulation on a genome-wide scale. For any given genome, only a small fraction of the regulatory elements embedded in the DNA sequence have been characterized, and there is great interest in developing computational methods to systematically map all these elements and understand their relationships. Such computational efforts, however, are significantly hindered by the overwhelming size of non-coding regions and the statistical variability and complex spatial organizations of regulatory elements and interactions. Genome-wide catalogs of regulatory elements for all model species simply do not yet exist. Results The MotifMap system uses databases of transcription factor binding motifs, refined genome alignments, and a comparative genomic statistical approach to provide comprehensive maps of candidate regulatory elements encoded in the genomes of model species. The system is used to derive new genome-wide maps for yeast, fly, worm, mouse, and human. The human map contains 519,108 sites for 570 matrices with a False Discovery Rate of 0.1 or less. The new maps are assessed in several ways, for instance using high-throughput experimental ChIP-seq data and AUC statistics, providing strong evidence for their accuracy and coverage. The maps can be usefully integrated with many other kinds of omic data and are available at http://motifmap.igb.uci.edu/.
Conclusions MotifMap and its integration with other data provide a foundation for analyzing gene regulation on a genome-wide scale, and for automatically generating regulatory pathways and hypotheses. The power of this approach is demonstrated and discussed using the P53 apoptotic pathway and the Gli hedgehog pathways as examples.
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Affiliation(s)
- Kenneth Daily
- Department of Computer Science, University of California Irvine, Irvine, CA 92697, USA
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Valero R, Ko YH, Chauhan S, Schatloff O, Sivaraman A, Coelho RF, Ortega F, Palmer KJ, Sanchez-Salas R, Davila H, Cathelineau X, Patel VR. [Robotic surgery: history and teaching impact]. Actas Urol Esp 2011; 35:540-5. [PMID: 21696860 DOI: 10.1016/j.acuro.2011.04.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [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: 03/29/2011] [Accepted: 04/09/2011] [Indexed: 11/16/2022]
Abstract
CONTEXT The purpose of this article is to review the history of robotic surgery, its impact on teaching as well as a description of historical and current robots used in the medical arena. SUMMARY OF EVIDENCE Although the history of robots dates back to 2000 years or more, the last two decades have seen an outstanding revolution in medicine, due to all the changes that robotic surgery has made in the way of performing, teaching and practicing surgery. CONCLUSIONS Robotic surgery has evolved into a complete and self-contained field, with enormous potential for future development. The results to date have shown that this technology is capable of providing good outcomes and quality care for patients.
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Affiliation(s)
- R Valero
- Global Robotics Institute, Florida Hospital Celebration Health, Celebration, USA
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Rocco B, Coelho RF, Albo G, Patel VR. [Robot-assisted laparoscopic prostatectomy: surgical technique]. MINERVA UROL NEFROL 2010; 62:295-304. [PMID: 20940698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Prostate tumours are among the most frequently diagnosed solid tumours in males (a total of 192,280 new cases in the USA in 2009); since the approval of the PSA test by the Food and Drug Administration in 1986, incidence has risen significantly, particularly in the '90s; furthermore the spread of the PSA test has led to an increased frequency of cancer diagnosis at the localised stage. The standard treatment for tumour of the prostate is retropubic radical prostatectomy (RRP) which however is not morbidity-free, e.g. intraoperative bleeding, urinary incontinence and erectile dysfunction. This is why the interest of the scientific community has turned increasingly to mini-invasive surgical procedures able to achieve the same oncological results as the open procedure, but which also reduce the impact of the treatment on these patients' quality of life. The first step in this direction was laparoscopic prostatectomy described by Schuessler in 1992 and standardised by Gaston in 1997. However, the technical difficulty inherent in this procedure has limited its more widespread use. In May 2000 Binder and Kramer published a report on the first robot-assisted prostatectomy (RARP) using the Da Vinci system (da Vinci TM, Intuitive Surgical, Sunnyvale, CA, USA). From the original experience, RARP, which exploits the advantages of an enlarged, three-dimensional view and the ability of the instruments to move with 7 degrees of freedom, the technique has spread enormously all over the world. At the time of writing, in the USA, RARP is the most common therapeutic option for the treatment of prostate tumour at localised stage. In the present study we describe the RARP technique proposed by dr. Vipul Patel, head of the Global Robotic Institute (Orlando Fl).
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Affiliation(s)
- B Rocco
- Divisione di Urologia, Istituto Europeo di Oncologia, Milano, Italia
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Kao A, Chiu CL, Vellucci D, Yang Y, Patel VR, Guan S, Randall A, Baldi P, Rychnovsky SD, Huang L. Development of a novel cross-linking strategy for fast and accurate identification of cross-linked peptides of protein complexes. Mol Cell Proteomics 2010; 10:M110.002212. [PMID: 20736410 DOI: 10.1074/mcp.m110.002212] [Citation(s) in RCA: 261] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Knowledge of elaborate structures of protein complexes is fundamental for understanding their functions and regulations. Although cross-linking coupled with mass spectrometry (MS) has been presented as a feasible strategy for structural elucidation of large multisubunit protein complexes, this method has proven challenging because of technical difficulties in unambiguous identification of cross-linked peptides and determination of cross-linked sites by MS analysis. In this work, we developed a novel cross-linking strategy using a newly designed MS-cleavable cross-linker, disuccinimidyl sulfoxide (DSSO). DSSO contains two symmetric collision-induced dissociation (CID)-cleavable sites that allow effective identification of DSSO-cross-linked peptides based on their distinct fragmentation patterns unique to cross-linking types (i.e. interlink, intralink, and dead end). The CID-induced separation of interlinked peptides in MS/MS permits MS(3) analysis of single peptide chain fragment ions with defined modifications (due to DSSO remnants) for easy interpretation and unambiguous identification using existing database searching tools. Integration of data analyses from three generated data sets (MS, MS/MS, and MS(3)) allows high confidence identification of DSSO cross-linked peptides. The efficacy of the newly developed DSSO-based cross-linking strategy was demonstrated using model peptides and proteins. In addition, this method was successfully used for structural characterization of the yeast 20 S proteasome complex. In total, 13 non-redundant interlinked peptides of the 20 S proteasome were identified, representing the first application of an MS-cleavable cross-linker for the characterization of a multisubunit protein complex. Given its effectiveness and simplicity, this cross-linking strategy can find a broad range of applications in elucidating the structural topology of proteins and protein complexes.
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Affiliation(s)
- Athit Kao
- Department of Physiology and Biophysics and Developmental and Cell Biology, University of California, Irvine, California 92697, USA
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Abstract
Open retropubic radical prostatectomy is the gold standard treatment for localised prostate cancer. However, the procedure has inherent morbidity associated to it. Therefore, less invasive surgical techniques have been sought, one such alternative is robotic-assisted laparoscopic radical prostatectomy. The advantages provided by robotic technology have the potential to minimise patient morbidity while improving both functional and oncological outcomes. Although it is a recent technological advancement, robotic surgery has shown an increasing rate of adoption worldwide. Currently more than 30,000 patients have undergone this procedure worldwide. We present a review of the available literature on robotic-assisted laparoscopic radical prostatectomy.
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Affiliation(s)
- V R Patel
- Centre for Robotic Urologic Surgery, Ohio State University, Columbus, OH, USA.
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Joshi JK, Patel VR, Patel K, Rana D, Shah K, Patel R, Patel R. Synthesis and antiinflammatory activity of n-aryl anthranilic acid and its derivatives. Indian J Pharm Sci 2007. [DOI: 10.4103/0250-474x.38483] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Affiliation(s)
- S J Mellor
- Rowley Bristow Orthopaedic Unit, St Peter's Hospital, Chertsey, Surrey, United Kingdom
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Patel VR, Menon DK, Pool RD, Simonis RB. Nonunion of the humerus after failure of surgical treatment. Management using the Ilizarov circular fixator. J Bone Joint Surg Br 2000; 82:977-83. [PMID: 11041585 DOI: 10.1302/0301-620x.82b7.10180] [Citation(s) in RCA: 76] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We used the Ilizarov circular external fixator to treat 16 patients with persistent nonunion of the diaphysis of the humerus despite surgical treatment. All patients had pain and severe functional impairment of the affected arm. In ten, nonunion followed intramedullary nailing. We successfully treated these by a closed technique. The nail was left in place and the fracture compressed over it. The fractures of the other six patients had previously been fixed by various methods. We explored these nonunions, removed the fixation devices and excised fibrous tissue and dead bone before stabilising with the Ilizarov fixator. In five patients union was achieved. Bone grafting was not required. In the single patient in whom treatment failed, there had been a severely comminuted open fracture. All except one patient had reduction of pain, and all reported an improvement in function.
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Affiliation(s)
- V R Patel
- Rowley Bristow Orthopaedic Unit, St Peter's Hospital, Chertsey, England, UK
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