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Abdool PS, Supasitthumrong T, Patel K, Mulsant BH, Rajji TK. Using an Integrated Care Pathway for Late-Life Schizophrenia Improves Monitoring of Adverse Effects of Antipsychotics and Reduces Antipsychotic Polypharmacy. Am J Geriatr Psychiatry 2019; 27:84-90. [PMID: 30396766 DOI: 10.1016/j.jagp.2018.09.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 08/28/2018] [Accepted: 09/09/2018] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Antipsychotic use in older patients is associated with many adverse effects, including tardive dyskinesia and extrapyramidal symptoms, which, in turn, increase the risk of falling. Antipsychotics are also associated with metabolic syndrome and cognitive impairment in older patients. Integrated care pathways (ICPs) are designed to manage specific conditions using standardized assessments and measurement-based interventions. This study aims to compare the use of recommended tools to monitor for adverse effects associated with antipsychotics in older patients managed within an ICP and those managed under usual care conditions-i.e., treatment as usual (TAU). METHODS We reviewed and compared the health records of 100 older patients enrolled in an ICP for late-life schizophrenia with those of 100 older patients treated with antipsychotics under TAU conditions. RESULTS Monitoring rates were significantly higher in the ICP group than in the TAU group for all assessments: extrapyramidal symptoms (94% versus 5%), metabolic disturbances (91% versus 25%), fall risk (82% versus 35%), and cognitive impairment (72% versus 28%). Rates of antipsychotic polypharmacy were also six times higher in the TAU group. CONCLUSION Older patients with schizophrenia treated with antipsychotics within an ICP experience higher rates of monitoring and less psychotropic polypharmacy than older patients treated with antipsychotics under TAU conditions. These findings suggest that an ICP can improve the quality of antipsychotic pharmacotherapy in older patients and thus possibly its effectiveness. This needs to be confirmed by a randomized controlled trial.
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Affiliation(s)
- Petal S Abdool
- Adult Neurodevelopment and Geriatric Psychiatry Division (PSA, TS, KP, BHM, TKR), Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Psychiatry (PSA, TS, KP, BHM, TKR), University of Toronto, Toronto, Ontario, Canada.
| | - T Supasitthumrong
- Adult Neurodevelopment and Geriatric Psychiatry Division (PSA, TS, KP, BHM, TKR), Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Psychiatry (PSA, TS, KP, BHM, TKR), University of Toronto, Toronto, Ontario, Canada; Department of Psychiatry (TS), King Chulalongkorn University, Bangkok, Thailand
| | - K Patel
- Adult Neurodevelopment and Geriatric Psychiatry Division (PSA, TS, KP, BHM, TKR), Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Psychiatry (PSA, TS, KP, BHM, TKR), University of Toronto, Toronto, Ontario, Canada
| | - B H Mulsant
- Adult Neurodevelopment and Geriatric Psychiatry Division (PSA, TS, KP, BHM, TKR), Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Psychiatry (PSA, TS, KP, BHM, TKR), University of Toronto, Toronto, Ontario, Canada
| | - T K Rajji
- Adult Neurodevelopment and Geriatric Psychiatry Division (PSA, TS, KP, BHM, TKR), Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Psychiatry (PSA, TS, KP, BHM, TKR), University of Toronto, Toronto, Ontario, Canada
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202
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Murray S, Ginnelly A, Patel K. A therapy assistant in the intensive care unit (ICU): a pilot project. Physiotherapy 2019. [DOI: 10.1016/j.physio.2018.11.194] [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: 11/25/2022]
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203
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MacNeil SD, Patel K, Liu K, Shariff S, Yoo J, Nichols A, Fung K, Garg AX. Survival of patients with subglottic squamous cell carcinoma. ACTA ACUST UNITED AC 2018; 25:e569-e575. [PMID: 30607125 DOI: 10.3747/co.25.3864] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective Subglottic squamous cell carcinoma is a rare subsite of laryngeal cancer that behaves more aggressively and portends a worse prognosis. Using a population-based cancer registry, our objective was to report overall survival (os) and laryngectomy-free survival (lfs) in patients diagnosed with subglottic squamous cell carcinoma, and to determine whether primary laryngectomy results in improved survival. Methods This retrospective population-based study considered patients with a new diagnosis of squamous cell carcinoma in the province of Ontario over a 15-year period (1995-2009). The Ontario Cancer Registry was examined for patients with the diagnosis of interest during the period of interest. Linked population-based databases were used to obtain patient demographics, comorbidity measures, staging, survival, and primary treatment with laryngectomy. Results Of 4927 patients identified to have laryngeal carcinoma, 89 were defined as having primary subglottic carcinoma (1.8%). In the subglottic cohort, 68 patients were men (76.4%), and mean age at diagnosis was 68 years (interquartile range: 60-77 years). The 5-year os was 47.2%, and the 5-year lfs was 31.5%. In 13 patients (15%), the primary treatment was laryngectomy, which, compared with primary radiation, did not predict for improved os. No differences in os or lfs were observed during the 15-year study period (os p = 0.42, lfs p = 0.83). Conclusions The survival of patients with subglottic carcinoma is poor and has remained stable over time (1995-2009). Compared with primary radiation, primary treatment with laryngectomy does not appear to improve os.
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Affiliation(s)
- S D MacNeil
- Department of Otolaryngology-Head and Neck Surgery, Western University, London, ON.,Institute for Clinical Evaluative Sciences, Toronto, ON
| | - K Patel
- Department of Otolaryngology-Head and Neck Surgery, Western University, London, ON
| | - K Liu
- Institute for Clinical Evaluative Sciences, Toronto, ON
| | - S Shariff
- Institute for Clinical Evaluative Sciences, Toronto, ON
| | - J Yoo
- Department of Otolaryngology-Head and Neck Surgery, Western University, London, ON
| | - A Nichols
- Department of Otolaryngology-Head and Neck Surgery, Western University, London, ON
| | - K Fung
- Department of Otolaryngology-Head and Neck Surgery, Western University, London, ON
| | - A X Garg
- Institute for Clinical Evaluative Sciences, Toronto, ON.,Department of Epidemiology and Biostatistics, Western University, London, ON.,Division of Nephrology, Department of Medicine, Western University, London, ON
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204
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Zanjani F, Falls K, McQueen Gibson E, Patel K, Price E, Sargent L, Slattum P, Parsons P. RICHMOND HEALTH AND WELLNESS PROGRAM: COMMUNITY ADVISORY COUNCIL OUTCOMES. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.1859] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
| | - K Falls
- Virginia Commonwealth University
| | | | - K Patel
- Virginia Commonwealth University, Richmond, VA, USA
| | - E Price
- Virginia Commonwealth University, Richmond, VA, USA
| | | | - P Slattum
- School of Pharmacy, Virginia Commonwealth University
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205
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Prabhu R, Soltys S, Turner B, Marcrom S, Fiveash J, Foreman P, Press R, Patel K, Curran W, Breen W, Brown P, Jethwa K, Grills I, Arden J, Foster L, Manning M, Stern J, Asher A, Burri S. Patterns of Failure and Outcomes Based On Management of Leptomeningeal Disease after Surgical Resection and Radiosurgery for Brain Metastases: A Multi-Institutional Analysis. Int J Radiat Oncol Biol Phys 2018. [DOI: 10.1016/j.ijrobp.2018.06.348] [Citation(s) in RCA: 1] [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: 10/28/2022]
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206
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Hunt L, Ritchie C, Patel K, Stephens C, Cataldo J, Smith A. PAIN AND EMERGENCY DEPARTMENT USE IN THE LAST MONTH OF LIFE BY OLDER ADULTS WITH DEMENTIA. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.2370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- L Hunt
- San Francisco VA Health Care Center
| | - C Ritchie
- Division of Geriatrics, University of California, San Francisco
| | - K Patel
- Division of Geriatrics, University of California, San Francisco
| | - C Stephens
- Department of Community Health Systems, School of Nursing, University of California, San Francisco
| | - J Cataldo
- Department of Physiological Nursing, University of California, San Francisco
| | - A Smith
- Division of Geriatrics, University of California, San Francisco
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207
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Patel K, Immaneni S, Singam V, Rastogi S, Silverberg J. A SYSTEMATIC REVIEW AND META-ANALYSIS OF DEPRESSION AND SUICIDE IN ATOPIC DERMATITIS. Ann Allergy Asthma Immunol 2018. [DOI: 10.1016/j.anai.2018.09.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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208
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Elhammali A, Gunther J, Milgrom S, Pinnix C, Andraos T, Weber D, Orlowski R, Manasanch E, Patel K, Lee H, Thomas S, Amini B, Garg N, Dabaja B. Involved Site and Reduced Dose Radiation Therapy for Multiple Myeloma: Should It be the New Standard? Int J Radiat Oncol Biol Phys 2018. [DOI: 10.1016/j.ijrobp.2018.06.232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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209
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Zhang H, Sours C, Gullapalli R, Patel K, Mistry N, Kwok Y, Regine W, D'Souza W. Feasibility and Benefit of Dose Reduction to Network Supporting Cognitive Function for Patients with Primary Brain Tumors. Int J Radiat Oncol Biol Phys 2018. [DOI: 10.1016/j.ijrobp.2018.07.1536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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210
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Prabhu R, Miller K, Asher A, Heinzerling J, Moeller B, Patel K, Burri S. Preoperative Radiosurgery for Resected Brain Metastases: Updated Analysis of Efficacy and Toxicity of a Novel Treatment Paradigm. Int J Radiat Oncol Biol Phys 2018. [DOI: 10.1016/j.ijrobp.2018.06.345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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211
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Jairam V, Kann B, Park H, Miccio J, Beckta J, Yu J, Gao S, Prabhu R, Mehta M, Curran W, Bindra R, Contessa J, Patel K. Defining an Intermediate Risk Group for Low Grade Glioma? An Analysis of the National Cancer Database. Int J Radiat Oncol Biol Phys 2018. [DOI: 10.1016/j.ijrobp.2018.07.827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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212
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Elhammali A, Dabaja B, Gunther J, Yoder A, Moon B, Weber D, Thomas S, Andraos T, Garg N, Amini B, Manasanch E, Patel K, Orlowski R, Lee H, Bird J, Satcher R, Lin P, Pinnix C, Milgrom S. Involved Site vs Extended Field Radiation Therapy for Multiple Myeloma of Long Bones after Internal Fixation. Int J Radiat Oncol Biol Phys 2018. [DOI: 10.1016/j.ijrobp.2018.07.705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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213
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Maltese G, Fountoulakis N, Drakatos P, Shah D, Patel K, Sharma A, Thomas S, Pengo MF, Karalliedde J. Elevated obstructive sleep apnoea risk score is associated with poor healing of diabetic foot ulcers: a prospective cohort study. Diabet Med 2018; 35:1494-1498. [PMID: 30022522 DOI: 10.1111/dme.13780] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/17/2018] [Indexed: 12/31/2022]
Abstract
AIMS To assess the prevalence of risk factors for obstructive sleep apnoea in people with diabetic foot ulcers and to determine whether this risk predicts diabetic foot ulcer healing. METHODS We studied 94 consecutive people (69% men) with diabetic foot ulcers (Type 2 diabetes, n=66, Type 1 diabetes, n=28) attending a university hospital foot unit. All participants were screened for obstructive sleep apnoea using the STOP-BANG questionnaire, with a score ≥4 identifying high risk of obstructive sleep apnoea. The primary outcome was poor diabetic foot ulcer healing, defined as diabetic foot ulcer recurrence (diabetic foot ulcers which healed and re-ulcerated in same anatomical position) and/or diabetic foot ulcer persistence (no evidence of healing on clinical examination). All participants were evaluated at 12 months. RESULTS Of the 94 participants, 60 (64%) had a STOP-BANG score ≥4. Over 12 months, 27 participants with a score ≥4 had poor diabetic foot ulcer healing as compared to seven with a score <4 (45% vs 20.5%; P=0.025). A STOP-BANG score ≥4 significantly increased the relative risk of poor healing more than twofold, independently of other risk factors in multivariable analyses. CONCLUSIONS There is a high prevalence of features and risk of obstructive sleep apnoea in people with diabetic foot ulcers. A STOP-BANG score ≥4 predicts poor diabetic foot ulcer healing. Obstructive sleep apnoea may be a potential, modifiable risk factor/treatment target to improve diabetic foot ulcer outcomes.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Cohort Studies
- Diabetes Mellitus, Type 1/complications
- Diabetes Mellitus, Type 1/diagnosis
- Diabetes Mellitus, Type 1/epidemiology
- Diabetes Mellitus, Type 1/physiopathology
- Diabetes Mellitus, Type 2/complications
- Diabetes Mellitus, Type 2/diagnosis
- Diabetes Mellitus, Type 2/epidemiology
- Diabetes Mellitus, Type 2/physiopathology
- Diabetic Foot/complications
- Diabetic Foot/diagnosis
- Diabetic Foot/epidemiology
- Diabetic Foot/physiopathology
- Female
- Humans
- Male
- Middle Aged
- Prognosis
- Prospective Studies
- Research Design
- Risk Factors
- Sleep Apnea, Obstructive/complications
- Sleep Apnea, Obstructive/diagnosis
- Sleep Apnea, Obstructive/epidemiology
- Sleep Apnea, Obstructive/physiopathology
- Wound Healing/physiology
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Affiliation(s)
- G Maltese
- Department of Diabetes and Endocrinology, Guy's and St Thomas' NHS Trust, London, UK
| | - N Fountoulakis
- Department of Diabetes and Endocrinology, Guy's and St Thomas' NHS Trust, London, UK
| | - P Drakatos
- Sleep Disorders Centre, Guy's and St Thomas' NHS Trust, London, UK
| | - D Shah
- Department of Diabetes and Endocrinology, Guy's and St Thomas' NHS Trust, London, UK
| | - K Patel
- Department of Diabetes and Endocrinology, Guy's and St Thomas' NHS Trust, London, UK
| | - A Sharma
- Department of Diabetes and Endocrinology, Guy's and St Thomas' NHS Trust, London, UK
| | - S Thomas
- Department of Diabetes and Endocrinology, Guy's and St Thomas' NHS Trust, London, UK
| | - M F Pengo
- Sleep Disorders Centre, Guy's and St Thomas' NHS Trust, London, UK
| | - J Karalliedde
- Department of Diabetes and Endocrinology, Guy's and St Thomas' NHS Trust, London, UK
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214
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Pang M, Bartel MJ, Brand EC, Brahmbhatt B, Patel K, Simons-Linares CR, Wolfsen HC, Raimondo M, Wallace MB, Woodward TA. Outcome of long benign esophageal strictures undergoing endoscopictherapy: a tertiary center experience. Dis Esophagus 2018; 31:4990672. [PMID: 29718161 DOI: 10.1093/dote/doy040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
- M Pang
- Division of Gastroenterology and Hepatology, Mayo Clinic
| | - M J Bartel
- Division of Gastroenterology and Hepatology, Mayo Clinic.,Section of Gastroenterology, Fox Chase Cancer Center, Temple Health, Philadelphia, Pennsylvania
| | - E C Brand
- Division of Gastroenterology and Hepatology, Mayo Clinic.,Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, Netherlands
| | - B Brahmbhatt
- Division of Gastroenterology and Hepatology, Mayo Clinic
| | - K Patel
- Division of Gastroenterology and Hepatology, Mayo Clinic.,University of North Florida, Jacksonville, Florida
| | - C R Simons-Linares
- Division of Gastroenterology and Hepatology, Mayo Clinic.,Department of Medicine, John Stronger Hospital, Cook County, Chicago, Illinois, USA
| | - H C Wolfsen
- Division of Gastroenterology and Hepatology, Mayo Clinic
| | - M Raimondo
- Division of Gastroenterology and Hepatology, Mayo Clinic
| | - M B Wallace
- Division of Gastroenterology and Hepatology, Mayo Clinic
| | - T A Woodward
- Division of Gastroenterology and Hepatology, Mayo Clinic
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215
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Patel K, Idle M, Awadallah M, Kademani D. UPPER Airway Stimulator for Management of Moderate to Severe Obstructive SLEEP Apnea. J Oral Maxillofac Surg 2018. [DOI: 10.1016/j.joms.2018.06.140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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216
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Blum J, McCune S, Salkeni M, Anderson D, Migas J, Lakhanpal S, Patel K, Bardia A, Rocque G, Wang J, Cappelleri J, Comstock G, Wang Y, Tripathy D. First report of real-world patient characteristics and treatment patterns from POLARIS: Palbociclib in hormone receptor-positive (HR+) advanced breast cancer: A prospective, multicenter, noninterventional study. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy272.334] [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: 11/13/2022] Open
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217
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Harrison Palmer D, Ross P, Silcocks P, Greenhalf W, Faluyi O, Ma Y, Wadsley J, Rawcliffe C, Neoptolemos J, Valle J, Wasan H, Starling N, Patel K, Bridgewater J. ACELARATE: A randomised phase III, open label, clinical study comparing NUC-1031 with gemcitabine in patients with metastatic pancreatic carcinoma. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy282.171] [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: 11/13/2022] Open
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218
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Hoimes C, Albany C, Hoffman-Censits J, Fleming M, Trabulsi E, Picus J, Cary C, Koch M, Walling R, Kelly W, Godwin J, Cooney M, Fu P, Nelson A, Patel K, Eitman C, Breen T, Neal A, Kaimakliotis H. A phase Ib/II study of neoadjuvant pembrolizumab (pembro) and chemotherapy for locally advanced urothelial cancer (UC). Ann Oncol 2018. [DOI: 10.1093/annonc/mdy424.039] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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219
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Al Bakir I, Adaba F, Patel K, Nightingale J. Topical magnesium therapy treats hypomagnesaemia in some ileostomy patients. Clin Nutr 2018. [DOI: 10.1016/j.clnu.2018.06.1284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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220
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Patel K, Chehab O, Barakat MF, Jerrum M, Queenan H, Bedford K, Broyd C, Ozkor M, Kennon S, Mathur A, Mullen M. P6314Outcomes with transcathether aortic valve implantation in patients with acute decompensated aortic stenosis. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p6314] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- K Patel
- Barts Health NHS Trust, Structural Heart disease, Cardiology, London, United Kingdom
| | - O Chehab
- Barts Health NHS Trust, Structural Heart disease, Cardiology, London, United Kingdom
| | - M F Barakat
- King's College London, Cardiology, London, United Kingdom
| | - M Jerrum
- Barts Health NHS Trust, Structural Heart disease, Cardiology, London, United Kingdom
| | - H Queenan
- Barts Health NHS Trust, Structural Heart disease, Cardiology, London, United Kingdom
| | - K Bedford
- Barts Health NHS Trust, Structural Heart disease, Cardiology, London, United Kingdom
| | - C Broyd
- Barts Health NHS Trust, Structural Heart disease, Cardiology, London, United Kingdom
| | - M Ozkor
- Barts Health NHS Trust, Structural Heart disease, Cardiology, London, United Kingdom
| | - S Kennon
- Barts Health NHS Trust, Structural Heart disease, Cardiology, London, United Kingdom
| | - A Mathur
- Barts Health NHS Trust, Structural Heart disease, Cardiology, London, United Kingdom
| | - M Mullen
- Barts Health NHS Trust, Structural Heart disease, Cardiology, London, United Kingdom
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221
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Aiello D, Patel K, Lasagna E. Themyostatingene: an overview of mechanisms of action and its relevance to livestock animals. Anim Genet 2018; 49:505-519. [DOI: 10.1111/age.12696] [Citation(s) in RCA: 66] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/24/2018] [Indexed: 12/27/2022]
Affiliation(s)
- D. Aiello
- Dipartimento di Scienze Agrarie, Alimentari e Ambientali; Università degli Studi di Perugia; Borgo XX Giugno 74 06121 Perugia Italy
| | - K. Patel
- School of Biological Sciences; University of Reading; Berkshire RG6 6UB UK
| | - E. Lasagna
- Dipartimento di Scienze Agrarie, Alimentari e Ambientali; Università degli Studi di Perugia; Borgo XX Giugno 74 06121 Perugia Italy
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222
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Eiros R, Treibel T, Scully P, Bhuva A, Patel K, Badiani S, Lopez B, Gonzalez A, Fontana M, Manistry C, Diez J, Moon JC. P6490Myocardial T2 in aortic stenosis: compensatory vasodilatation or subacute inflammation? Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p6490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- R Eiros
- University Clinic of Navarra, Cardiology, Navarra, Spain
| | - T Treibel
- Barts Health NHS Trust, London, United Kingdom
| | - P Scully
- Barts Health NHS Trust, London, United Kingdom
| | - A Bhuva
- Barts Health NHS Trust, London, United Kingdom
| | - K Patel
- Barts Health NHS Trust, London, United Kingdom
| | - S Badiani
- Barts Health NHS Trust, London, United Kingdom
| | - B Lopez
- CIMA, Program of Cardiovascular Diseases, Pamplona, Spain
| | - A Gonzalez
- CIMA, Program of Cardiovascular Diseases, Pamplona, Spain
| | - M Fontana
- Barts Health NHS Trust, London, United Kingdom
| | - C Manistry
- Barts Health NHS Trust, London, United Kingdom
| | - J Diez
- CIMA, Program of Cardiovascular Diseases, Pamplona, Spain
| | - J C Moon
- Barts Health NHS Trust, London, United Kingdom
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223
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Wierzbicki A, Kohli M, Patel K, McMahon Z, Ramachandran R, Crook M, Reynolds T. Pro-protein subtilisin kexin-9 (PCSK9) inhibition in practice: Lipid clinic experience in 2 contrasting UK centres. Atherosclerosis 2018. [DOI: 10.1016/j.atherosclerosis.2018.06.274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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224
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George E, Bellaby J, Day S, Dhillon R, Horton S, Patel K, Fanning H, Whitmore J, Millward V, Williams M, Cramb R. The west midlands familial hypercholesterolaemia screening project: Design and implementation. Atherosclerosis 2018. [DOI: 10.1016/j.atherosclerosis.2018.06.227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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225
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Birdi H, Kapila A, Tharmaratnam M, Davies N, Patel K, Ejtehadi F, Srinivasaiah N. Two week wait referrals of suspected colorectal cancer in young adults before and after UK NICE [NG12] guideline publication. Int J Surg 2018. [DOI: 10.1016/j.ijsu.2018.05.207] [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]
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226
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George J, Hu A, Patel K, Thakrar J, Al-Mukhtar A. Improving antibiotic compliance: The five-audit junior-led experience. Int J Surg 2018. [DOI: 10.1016/j.ijsu.2018.05.183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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227
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Sigmund EE, Baete SH, Luo T, Patel K, Wang D, Rossi I, Duarte A, Bruno M, Mossa D, Femia A, Ramachandran S, Stoffel D, Babb JS, Franks AG, Bencardino J. MRI assessment of the thigh musculature in dermatomyositis and healthy subjects using diffusion tensor imaging, intravoxel incoherent motion and dynamic DTI. Eur Radiol 2018; 28:5304-5315. [DOI: 10.1007/s00330-018-5458-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Revised: 03/23/2018] [Accepted: 04/03/2018] [Indexed: 12/20/2022]
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228
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Adibe C, Varghese S, Patel K, Erowele G, Birtcher K, Fernandez J. Impact of a Pharmacy-Led Medication History Program In the Emergency Center of an Academic Hospital. Res Social Adm Pharm 2018. [DOI: 10.1016/j.sapharm.2018.04.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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229
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Patel K. Young dentists: breaking the silence. Br Dent J 2018; 224:767-768. [PMID: 29795502 DOI: 10.1038/sj.bdj.2018.359] [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] [Accepted: 03/20/2018] [Indexed: 11/09/2022]
Abstract
Now is the time for young dentists to voice their concerns - to ensure policy-makers understand problems faced by the dental workforce of tomorrow. This opinion article highlights the pertinent factors which have reduced young dentists to provide defensive dentistry provided in a far from ideal NHS environment.
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Affiliation(s)
- K Patel
- King's College Dental Institute
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230
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Sigmund EE, Baete SH, Patel K, Wang D, Stoffel D, Otazo R, Parasoglou P, Bencardino J. Spatially resolved kinetics of skeletal muscle exercise response and recovery with multiple echo diffusion tensor imaging (MEDITI): a feasibility study. MAGMA 2018; 31:599-608. [PMID: 29761414 DOI: 10.1007/s10334-018-0686-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Revised: 03/26/2018] [Accepted: 04/23/2018] [Indexed: 12/20/2022]
Abstract
OBJECTIVES We describe measurement of skeletal muscle kinetics with multiple echo diffusion tensor imaging (MEDITI). This approach allows characterization of the microstructural dynamics in healthy and pathologic muscle. MATERIALS AND METHODS In a Siemens 3-T Skyra scanner, MEDITI was used to collect dynamic DTI with a combination of rapid diffusion encoding, radial imaging, and compressed sensing reconstruction in a multi-compartment agarose gel rotation phantom and within in vivo calf muscle. An MR-compatible ergometer (Ergospect Trispect) was employed to enable in-scanner plantar flexion exercise. In a HIPAA-compliant study with written informed consent, post-exercise recovery of DTI metrics was quantified in eight volunteers. Exercise response of DTI metrics was compared with that of T2-weighted imaging and characterized by a gamma variate model. RESULTS Phantom results show quantification of diffusivities in each compartment over its full dynamic rotation. In vivo calf imaging results indicate larger radial than axial exercise response and recovery in the plantar flexion-challenged gastrocnemius medialis (fractional response: nT2w = 0.385 ± 0.244, nMD = 0.163 ± 0.130, nλ1 = 0.110 ± 0.093, nλrad = 0.303 ± 0.185). Diffusion and T2-weighted response magnitudes were correlated (e.g., r = 0.792, p = 0.019 for nMD vs. nT2w). CONCLUSION We have demonstrated the feasibility of MEDITI for capturing spatially resolved diffusion tensor data in dynamic systems including post-exercise skeletal muscle recovery following in-scanner plantar flexion.
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Affiliation(s)
- E E Sigmund
- Department of Radiology, New York University Langone Health, New York, NY, USA. .,Center for Advanced Imaging and Innovation (CAI2R), New York University Langone Health, New York, NY, USA.
| | - S H Baete
- Department of Radiology, New York University Langone Health, New York, NY, USA.,Center for Advanced Imaging and Innovation (CAI2R), New York University Langone Health, New York, NY, USA
| | - K Patel
- Department of Radiology, New York University Langone Health, New York, NY, USA.,NYU Tandon School of Engineering, Brooklyn, NY, USA
| | - D Wang
- Department of Radiology, New York University Langone Health, New York, NY, USA.,NYU Tandon School of Engineering, Brooklyn, NY, USA
| | - D Stoffel
- Department of Radiology, New York University Langone Health, New York, NY, USA.,Center for Advanced Imaging and Innovation (CAI2R), New York University Langone Health, New York, NY, USA
| | - R Otazo
- Department of Radiology, New York University Langone Health, New York, NY, USA.,Center for Advanced Imaging and Innovation (CAI2R), New York University Langone Health, New York, NY, USA.,Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - P Parasoglou
- Department of Radiology, New York University Langone Health, New York, NY, USA.,Center for Advanced Imaging and Innovation (CAI2R), New York University Langone Health, New York, NY, USA
| | - J Bencardino
- Department of Radiology, New York University Langone Health, New York, NY, USA
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231
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Brunner P, Israel A, Zhang N, Leonard A, Patel K, Ramsey K, Murphrey M, Krueger J, Paller A, Guttman-Yassky E. 648 The barrier abnormality of early-onset pediatric atopic dermatitis results from abnormalities in tight junctions and epidermal lipids, but not differentiation proteins. J Invest Dermatol 2018. [DOI: 10.1016/j.jid.2018.03.657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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232
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Patel K. 586 Trends in psoriasis care at teaching versus non-teaching hospitals: A meta-analysis. J Invest Dermatol 2018. [DOI: 10.1016/j.jid.2018.03.594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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233
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Dashti HS, Jones S, Lane JM, Wang H, Song Y, Patel K, Gill S, Gottlieb D, Tiemeier H, Ray DW, Frayling TM, Rutter MK, Weedon MN, Saxena R. 0013 Genome-wide Association Analysis Identifies >75 Genetic Loci Associated With Sleep Duration In UK Biobank Participants. Sleep 2018. [DOI: 10.1093/sleep/zsy061.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- H S Dashti
- Massachusetts General Hospital, Boston, MA
| | - S Jones
- University of Exeter Medical School, Exeter, UNITED KINGDOM
| | - J M Lane
- Massachusetts General Hospital, Boston, MA
| | - H Wang
- Brigham and Women’s Hospital, Boston, MA
| | - Y Song
- Massachusetts General Hospital, Boston, MA
| | - K Patel
- Massachusetts General Hospital, Boston, MA
| | - S Gill
- Massachusetts General Hospital, Boston, MA
| | - D Gottlieb
- Brigham and Women’s Hospital, Boston, MA
| | - H Tiemeier
- Harvard Chan School of Public Health, Boston, MA
| | - D W Ray
- The University of Manchester, Manchester, UNITED KINGDOM
| | - T M Frayling
- University of Exeter Medical School, Exeter, UNITED KINGDOM
| | - M K Rutter
- The University of Manchester, Manchester, UNITED KINGDOM
| | - M N Weedon
- University of Exeter Medical School, Exeter, UNITED KINGDOM
| | - R Saxena
- Massachusetts General Hospital, Boston, MA
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234
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Wang H, Lane JM, Dashti HS, Jones S, Cade BE, Song Y, Patel K, Frayling TM, Weedon MN, Lawlor DA, Rutter MK, Redline S, Saxena R. 0014 Genome-wide Association Analysis Of Excessive Daytime Sleepiness In The Uk Biobank Identifies 42 Novel Loci. Sleep 2018. [DOI: 10.1093/sleep/zsy061.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- H Wang
- Division of Sleep and Circadian Disorder, Brigham and Women’s Hospital, Boston, MA
| | - J M Lane
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA
| | - H S Dashti
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA
| | - S Jones
- Genetics of Complex Traits, University of Exeter Medical School, Exeter, UNITED KINGDOM
| | - B E Cade
- Division of Sleep and Circadian Disorder, Brigham and Women’s Hospital, Boston, MA
| | - Y Song
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA
| | - K Patel
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA
| | - T M Frayling
- Genetics of Complex Traits, University of Exeter Medical School, Exeter, UNITED KINGDOM
| | - M N Weedon
- Genetics of Complex Traits, University of Exeter Medical School, Exeter, UNITED KINGDOM
| | - D A Lawlor
- MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, UNITED KINGDOM
| | - M K Rutter
- Division of Endocrinology, Diabetes and Gastroenterology, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UNITED KINGDOM
| | - S Redline
- Division of Sleep and Circadian Disorder, Brigham and Women’s Hospital, Boston, MA
| | - R Saxena
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA
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235
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Tajsic T, Patel K, Farmer R, Mannion RJ, Trivedi RA. Spinal navigation for minimally invasive thoracic and lumbosacral spine fixation: implications for radiation exposure, operative time, and accuracy of pedicle screw placement. Eur Spine J 2018; 27:1918-1924. [DOI: 10.1007/s00586-018-5587-z] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Revised: 01/16/2018] [Accepted: 04/03/2018] [Indexed: 10/17/2022]
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236
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Patel K. The maintenance of muscle mass through the neutralisation of Myostatin activity in diseases and aging. Neuromuscul Disord 2018. [DOI: 10.1016/s0960-8966(18)30296-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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237
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Ahmed O, Rabei R, Patel K, Patel M, Ginsburg M, Clayton B, Arslan B. Abstract No. 454 Percutaneous interventions for hemodialysis access: national trends in. . . the Medicare population. J Vasc Interv Radiol 2018. [DOI: 10.1016/j.jvir.2018.01.499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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238
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Madan S, Patel S, Patel K, Sims D, Saeed O, Forest S, Jakobleff W, Murthy S, Shin J, Goldstein D, Jorde U. Human Immunodeficiency Virus (HIV), Heart Transplantation And Mechanical Circulatory Support (MCS): Where Do We Stand? J Heart Lung Transplant 2018. [DOI: 10.1016/j.healun.2018.01.253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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239
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Alyodawi K, Patel K. Prevent skeletal muscle aging signs in progeric mice model: is it possible? Neuromuscul Disord 2018. [DOI: 10.1016/s0960-8966(18)30399-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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240
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Mroz E, Patel K, Rocco J. TCGA Data on Head and Neck Squamous Cell Carcinoma Suggest Therapy-Specific Implications of Intratumor Heterogeneity. Int J Radiat Oncol Biol Phys 2018. [DOI: 10.1016/j.ijrobp.2017.12.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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241
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Song Y, Morrison S, Lyons J, Patel K, Coyle C, Elliot P, Logue J, Tran A, Wylie J, Conroy R, Choudhury A. EP-1586: Docetaxel – Mitigating the high price of success. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)31895-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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242
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Shetty A, Ramkissoon R, Patel K. A35 ACUTE HEPATITIS AS AN ATYPICAL PRESENTATION OF GRAFT-VERSUS-HOST DISEASE IN A PATIENT POST HEMATOPOIETIC STEM CELL TRANSPLANTATION. J Can Assoc Gastroenterol 2018. [DOI: 10.1093/jcag/gwy008.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- A Shetty
- Gastroenterology, University of Toronto, Toronto, ON, Canada
| | | | - K Patel
- Gastroenterology, University of Toronto, Toronto, ON, Canada
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243
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Zegard A, Umar F, Taylor RJ, Acquaye E, Gubran C, Chalil S, Patel K, Panting J, Marshall H, Qiu T, Leyva F. 667Long-term clinical outcomes of cardiac resynchronization therapy with or without defibrillation: impact of the aetiology of cardiomyopathy. Europace 2018. [DOI: 10.1093/europace/euy015.341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- A Zegard
- Aston University, Birmingham, United Kingdom
| | - F Umar
- Centre for Cardiovascular Sciences, University of Birmingham, Queen Elizabeth Hospital, Birmingham, United Kingdom
| | - R J Taylor
- Centre for Cardiovascular Sciences, University of Birmingham, Queen Elizabeth Hospital, Birmingham, United Kingdom
| | - E Acquaye
- Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
| | - C Gubran
- Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
| | - S Chalil
- Centre for Cardiovascular Sciences, University of Birmingham, Queen Elizabeth Hospital, Birmingham, United Kingdom
| | - K Patel
- Heart of England NHS Foundation Trust, Birmingham, United Kingdom
| | - J Panting
- Heart of England NHS Foundation Trust, Birmingham, United Kingdom
| | - H Marshall
- Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
| | - T Qiu
- Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
| | - F Leyva
- Aston University, Birmingham, United Kingdom
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244
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Zegard A, Taylor R, Foley PWX, Umar F, Patel K, Panting J, Ferro CJ, Marshall H, Qiu T, Leyva F. 273Renal function and the long term clinical outcomes of cardiac resynchronization therapy with or without defibrillation. Europace 2018. [DOI: 10.1093/europace/euy015.085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- A Zegard
- Aston University, Birmingham, United Kingdom
| | - R Taylor
- Institute of Cardiovascular Sciences, University of Birmingham, United Kingdom, Birmingham, United Kingdom
| | - PWX Foley
- Great Western Hospitals NHS Foundation Trust, Swindon, United Kingdom, Swindon, United Kingdom
| | - F Umar
- Institute of Cardiovascular Sciences, University of Birmingham, United Kingdom, Birmingham, United Kingdom
| | - K Patel
- Good Hope Hospital, Sutton Coldfield, Birmingham, United Kingdom, Birmingham, United Kingdom
| | - J Panting
- Good Hope Hospital, Sutton Coldfield, Birmingham, United Kingdom, Birmingham, United Kingdom
| | - C J Ferro
- Institute of Cardiovascular Sciences, University of Birmingham, United Kingdom, Birmingham, United Kingdom
| | - H Marshall
- Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
| | - T Qiu
- Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
| | - F Leyva
- Aston University, Birmingham, United Kingdom
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245
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Zegard A, Patel K, Panting J, Marshall H, Qiu T, Leyva F. P818Clinical outcomes after upgrading from pacemakers to cardiac resynchronization therapy. Europace 2018. [DOI: 10.1093/europace/euy015.422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- A Zegard
- Aston University, Birmingham, United Kingdom
| | - K Patel
- Heart of England NHS Foundation Trust, Birmingham, United Kingdom
| | - J Panting
- Heart of England NHS Foundation Trust, Birmingham, United Kingdom
| | - H Marshall
- Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
| | - T Qiu
- Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
| | - F Leyva
- Aston University, Birmingham, United Kingdom
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246
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Ahmed O, Rodrigues DM, Brahmania M, Patel K. A188 LOW INCIDENCE OF SPONTANEOUS BACTERIAL PERITONITIS IN ASYMPTOMATIC OUTPATIENTS WITH CIRRHOSIS UNDERGOING PARACENTESIS: A SYSTEMATIC REVIEW AND META-ANALYSIS. J Can Assoc Gastroenterol 2018. [DOI: 10.1093/jcag/gwy009.188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- O Ahmed
- University of Toronto, Toronto, ON, Canada
| | | | - M Brahmania
- Gastroenterology, University of Toronto, Toronto, ON, Canada
| | - K Patel
- Gastroenterology, University of Toronto, Toronto, ON, Canada
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247
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Zegard A, Taylor R, Foley PWX, Umar F, Patel K, Panting J, Van Dam P, Prinzen FW, Marshall H, Qiu T, Leyva F. P1136Long-term outcomes of cardiac resynchronization therapy using apical versus non-apical left ventricular pacing. Europace 2018. [DOI: 10.1093/europace/euy015.622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- A Zegard
- Aston University, Birmingham, United Kingdom
| | - R Taylor
- Centre for Cardiovascular Sciences, University of Birmingham, Queen Elizabeth Hospital, Birmingham, United Kingdom
| | - PWX Foley
- Blackpool Victoria Hospital, Blackpool, United Kingdom
| | - F Umar
- Centre for Cardiovascular Sciences, University of Birmingham, Queen Elizabeth Hospital, Birmingham, United Kingdom
| | - K Patel
- Heart of England NHS Foundation Trust, Birmingham, United Kingdom
| | - J Panting
- Heart of England NHS Foundation Trust, Birmingham, United Kingdom
| | - P Van Dam
- PEACS, Arnhem, The Netherlands, Arnhem, Netherlands
| | - F W Prinzen
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht, Netherlands
| | - H Marshall
- Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
| | - T Qiu
- Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
| | - F Leyva
- Aston University, Birmingham, United Kingdom
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Abstract
CA 125 is an epithelial membrane marker which can be detected in the serum of patients with ovarian cancer and which may reflect tumour burden. In a group of 42 patients, the level of this marker has also been shown to be significantly related to survival.
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Affiliation(s)
- D Parker
- Oncology Unit, Bradford Royal Infirmary
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249
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Jonczyk MM, Patel K, Graham R, Naber S, Erban J, Chen L, Chatterjee A. Abstract P4-13-06: Does large volume displacement oncoplastic surgery still offer an advantage of a low positive margin rate using the new SSO/ASBrS/ASTRO margin guidelines? Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p4-13-06] [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: 11/16/2022]
Abstract
Abstract
Purpose
Breast conservation has become the mainstay of surgical management for early stage breast cancer. Large volume displacement oncoplastic surgery (LVOS) uses reconstructive mastopexy and breast reduction techniques to allow for larger oncologic resections while providing good aesthetic outcomes in a single operation. Oncoplastic surgery publications have recently increased by 220%, demonstrating the increasing popularity of this surgical technique, 2 and many of these studies have demonstrated excellent oncologic outcomes.4 To date, however, no study has used the most recent SSO/ASBrS/ASTRO surgical margin recommendations to assess oncoplastic surgery. 4 Recent SSO/ASBrS/ASTRO guidelines established no ink on tumor as an adequate margin for invasive breast cancer and at least 2mm as adequate margins for ductal carcinoma in situ. The purpose of this study was to investigate the surgical margin rates of LVOS using the new SSO/ASBrS/ASTRO guidelines. We presumed that under the newer, stricter guidelines, LVOS would have a higher positive margin rate than reported in the past literature.
Methods:
Our study consisted of two parts. First, a literature review to assess margin rates before the introduction of SSO/ASBrS/ASTRO guidelines was done using PRISMA guidelines with an international Pubmed search and reviewed by two blinded authors. The search included keywords such as “oncoplastic breast surgery,” “lumpectomy,” “partial mastectomy,” and “positive margins associated with breast surgery.” All articles either pertained to LVOS, standard lumpectomy (SL) or both. The inclusion criteria for our study included histology discrepancy, and new guideline margin status. From this, we determined the published positive margin for SL and LVOS. Second, we analyzed all LVOS performed at our institution since the adoption of the new SSO/ASBrS/ASTRO margin guidelines and compared these margin rates to the literature review outcomes using Z tests.
Results:
Our study consisted of 1702 patients. There were 847 patients in LVOS group and 855 patients in the SL group. Of the 45 papers evaluated, 34 were not included due to exclusion criteria (missing: new margin guidelines, histology, or margin status). The pre-guideline positive margin rate for LVOS was lower than with SL (12.51% vs. 20.4%, P-value <0.001). Of the 50 LVOS operations done at our institution since adoption of the SSO/ASBrS/ASTRO margin guidelines, no statistical difference in the positive margin rates was noted when compared to the literature rates (10% vs. 12.67% respectively, P-value 0.5796). Positive margin rates for LVOS at our institution were lower than SL margin rates reported in the literature (P-value 0.0358).
Conclusions:
This study demonstrates that even with the stricter margin SSO/ASBrS/ASTRO guidelines, LVOS still has a low positive margin rate comparable to pre-guideline literature reports. LVOS continues to have a significantly lower positive margin rate than SL. This is the first study to report margin rates for LVOS after the adoption of the SSO/ASBrS/ASTRO guidelines, and confirms the importance of LVOS in providing optimal oncologic outcomes for patient with large locally advanced breast cancer.
Citation Format: Jonczyk MM, Patel K, Graham R, Naber S, Erban J, Chen L, Chatterjee A. Does large volume displacement oncoplastic surgery still offer an advantage of a low positive margin rate using the new SSO/ASBrS/ASTRO margin guidelines? [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P4-13-06.
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Affiliation(s)
- MM Jonczyk
- Tufts Medical Center, Surgery, Boston, MA
| | - K Patel
- Tufts Medical Center, Surgery, Boston, MA
| | - R Graham
- Tufts Medical Center, Surgery, Boston, MA
| | - S Naber
- Tufts Medical Center, Surgery, Boston, MA
| | - J Erban
- Tufts Medical Center, Surgery, Boston, MA
| | - L Chen
- Tufts Medical Center, Surgery, Boston, MA
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250
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Shee K, Hinds JW, Yang W, Hampsch RA, Patel K, Varn FS, Cheng C, Jenkins NP, Kettenbach AN, Demidenko E, Owens P, Lanari C, Faber AC, Golub TR, Straussman R, Miller TW. Abstract PD4-08: A microenvironment secretome screen reveals FGF2 as a mediator of resistance to anti-estrogens and PI3K/mTOR pathway inhibitors in ER+ breast cancer. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-pd4-08] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Despite the clinical success of anti-estrogen therapies, phosphatidylinositol 3-kinase inhibitors (PI3Ki), and mechanistic target of rapamycin complex I inhibitors (mTORC1i) for the treatment of patients with ER+ breast cancer, disease recurrence and progression are common. We found that a tumor transcriptional profile reflecting high stromal fibroblast content was associated with poor outcome in 3 cohorts of patients with ER+ breast cancer. We hypothesized that individual factors in the tumor microenvironment (TME) significantly contribute to drug resistance.
To test this hypothesis, we screened 297 recombinant secreted proteins for ability to confer resistance to the anti-estrogen fulvestrant in MCF-7 and T47D ER+ breast cancer cells. Screen results were validated, and expansion screening included the anti-estrogen tamoxifen, the PI3Ki pictilisib, and the mTORC1i everolimus in 4 cell lines. To identify hits are most likely to be relevant to ER+ breast cancer, a bioinformatics filter was developed utilizing gene and protein expression in human tissues relevant to the TMEs of ER+ breast cancer. After filtering, the top screening hit was fibroblast growth factor 2 (FGF2), which confers resistance to anti-estrogens, PI3Ki, and mTORC1i, and is highly expressed in tissues and cell types associated with ER+ breast cancer. FGF2 did not rescue cells from the CDK4/6i palbociclib or the DNA-damaging agent doxorubicin, demonstrating pathway selectivity in the rescue phenotype. FGF2 rescued cells from anti-estrogen-, PI3Ki-, and mTORC1i-induced apoptosis and cell cycle arrest via activation of FGFR signaling through FRS2a, MEK1/2, ERK1/2, and downstream upregulation of cyclin D1 and degradation of Bim. FGF2-mediated anti-cancer effects were abrogated by co-treatment with the FGF2-neutralizing antibody GAL-F2, the pan-FGFR inhibitor PD-173074, the MEK inhibitor trametinib, or palbociclib. Cell cycle- and apoptosis-specific effects of FGF2 were abrogated by RNAi targeting cyclin D1 and Bim, respectively.
We generated a transcriptional signature of FGF2 response by RNA-seq of fulvestrant-treated MCF-7 and T47D cells treated +/- FGF2. In 3 cohorts of patients with ER+ breast cancer, a signature of FGF2 signaling was significantly associated with poor prognosis and predictive of anti-estrogen resistance, including in a multivariate analysis including age, tumor grade, tumor stage, and FGFR amplification status. Finally, the therapeutic potential of targeting FGF2 was confirmed in 3 mouse models of ER+ breast cancer: 1) FGF2 rescue MCF-7 xenografts from fulvestrant; 2) GAL-F2 synergized with fulvestrant to suppress growth of 59-2-HI murine mammary adenocarcinomas that recruit FGF2-secreting stroma; 3) GAL-F2 synergized with fulvestrant to induce regression of HCI-003 patient-derived xenografts. Therapeutic effects coincided with increased tumor cell apoptosis and decreased proliferation, but not changes in tumor vasculature. These findings warrant consideration of FGF2 as a novel therapeutic target in ER+ breast cancer.
Citation Format: Shee K, Hinds JW, Yang W, Hampsch RA, Patel K, Varn FS, Cheng C, Jenkins NP, Kettenbach AN, Demidenko E, Owens P, Lanari C, Faber AC, Golub TR, Straussman R, Miller TW. A microenvironment secretome screen reveals FGF2 as a mediator of resistance to anti-estrogens and PI3K/mTOR pathway inhibitors in ER+ breast cancer [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr PD4-08.
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Affiliation(s)
- K Shee
- Geisel School of Medicine at Dartmouth, Lebanon, NH; Vanderbilt University School of Medicine, Nashville, TN; Instituto de Biología y Medicina Experimental, Buenos Aires, Argentina; Virginia Commonwealth University, Richmond, VA; Broad Institute of MIT and Harvard, Cambridge, MA; Weizmann Institute of Science, Rehovot, Israel
| | - JW Hinds
- Geisel School of Medicine at Dartmouth, Lebanon, NH; Vanderbilt University School of Medicine, Nashville, TN; Instituto de Biología y Medicina Experimental, Buenos Aires, Argentina; Virginia Commonwealth University, Richmond, VA; Broad Institute of MIT and Harvard, Cambridge, MA; Weizmann Institute of Science, Rehovot, Israel
| | - W Yang
- Geisel School of Medicine at Dartmouth, Lebanon, NH; Vanderbilt University School of Medicine, Nashville, TN; Instituto de Biología y Medicina Experimental, Buenos Aires, Argentina; Virginia Commonwealth University, Richmond, VA; Broad Institute of MIT and Harvard, Cambridge, MA; Weizmann Institute of Science, Rehovot, Israel
| | - RA Hampsch
- Geisel School of Medicine at Dartmouth, Lebanon, NH; Vanderbilt University School of Medicine, Nashville, TN; Instituto de Biología y Medicina Experimental, Buenos Aires, Argentina; Virginia Commonwealth University, Richmond, VA; Broad Institute of MIT and Harvard, Cambridge, MA; Weizmann Institute of Science, Rehovot, Israel
| | - K Patel
- Geisel School of Medicine at Dartmouth, Lebanon, NH; Vanderbilt University School of Medicine, Nashville, TN; Instituto de Biología y Medicina Experimental, Buenos Aires, Argentina; Virginia Commonwealth University, Richmond, VA; Broad Institute of MIT and Harvard, Cambridge, MA; Weizmann Institute of Science, Rehovot, Israel
| | - FS Varn
- Geisel School of Medicine at Dartmouth, Lebanon, NH; Vanderbilt University School of Medicine, Nashville, TN; Instituto de Biología y Medicina Experimental, Buenos Aires, Argentina; Virginia Commonwealth University, Richmond, VA; Broad Institute of MIT and Harvard, Cambridge, MA; Weizmann Institute of Science, Rehovot, Israel
| | - C Cheng
- Geisel School of Medicine at Dartmouth, Lebanon, NH; Vanderbilt University School of Medicine, Nashville, TN; Instituto de Biología y Medicina Experimental, Buenos Aires, Argentina; Virginia Commonwealth University, Richmond, VA; Broad Institute of MIT and Harvard, Cambridge, MA; Weizmann Institute of Science, Rehovot, Israel
| | - NP Jenkins
- Geisel School of Medicine at Dartmouth, Lebanon, NH; Vanderbilt University School of Medicine, Nashville, TN; Instituto de Biología y Medicina Experimental, Buenos Aires, Argentina; Virginia Commonwealth University, Richmond, VA; Broad Institute of MIT and Harvard, Cambridge, MA; Weizmann Institute of Science, Rehovot, Israel
| | - AN Kettenbach
- Geisel School of Medicine at Dartmouth, Lebanon, NH; Vanderbilt University School of Medicine, Nashville, TN; Instituto de Biología y Medicina Experimental, Buenos Aires, Argentina; Virginia Commonwealth University, Richmond, VA; Broad Institute of MIT and Harvard, Cambridge, MA; Weizmann Institute of Science, Rehovot, Israel
| | - E Demidenko
- Geisel School of Medicine at Dartmouth, Lebanon, NH; Vanderbilt University School of Medicine, Nashville, TN; Instituto de Biología y Medicina Experimental, Buenos Aires, Argentina; Virginia Commonwealth University, Richmond, VA; Broad Institute of MIT and Harvard, Cambridge, MA; Weizmann Institute of Science, Rehovot, Israel
| | - P Owens
- Geisel School of Medicine at Dartmouth, Lebanon, NH; Vanderbilt University School of Medicine, Nashville, TN; Instituto de Biología y Medicina Experimental, Buenos Aires, Argentina; Virginia Commonwealth University, Richmond, VA; Broad Institute of MIT and Harvard, Cambridge, MA; Weizmann Institute of Science, Rehovot, Israel
| | - C Lanari
- Geisel School of Medicine at Dartmouth, Lebanon, NH; Vanderbilt University School of Medicine, Nashville, TN; Instituto de Biología y Medicina Experimental, Buenos Aires, Argentina; Virginia Commonwealth University, Richmond, VA; Broad Institute of MIT and Harvard, Cambridge, MA; Weizmann Institute of Science, Rehovot, Israel
| | - AC Faber
- Geisel School of Medicine at Dartmouth, Lebanon, NH; Vanderbilt University School of Medicine, Nashville, TN; Instituto de Biología y Medicina Experimental, Buenos Aires, Argentina; Virginia Commonwealth University, Richmond, VA; Broad Institute of MIT and Harvard, Cambridge, MA; Weizmann Institute of Science, Rehovot, Israel
| | - TR Golub
- Geisel School of Medicine at Dartmouth, Lebanon, NH; Vanderbilt University School of Medicine, Nashville, TN; Instituto de Biología y Medicina Experimental, Buenos Aires, Argentina; Virginia Commonwealth University, Richmond, VA; Broad Institute of MIT and Harvard, Cambridge, MA; Weizmann Institute of Science, Rehovot, Israel
| | - R Straussman
- Geisel School of Medicine at Dartmouth, Lebanon, NH; Vanderbilt University School of Medicine, Nashville, TN; Instituto de Biología y Medicina Experimental, Buenos Aires, Argentina; Virginia Commonwealth University, Richmond, VA; Broad Institute of MIT and Harvard, Cambridge, MA; Weizmann Institute of Science, Rehovot, Israel
| | - TW Miller
- Geisel School of Medicine at Dartmouth, Lebanon, NH; Vanderbilt University School of Medicine, Nashville, TN; Instituto de Biología y Medicina Experimental, Buenos Aires, Argentina; Virginia Commonwealth University, Richmond, VA; Broad Institute of MIT and Harvard, Cambridge, MA; Weizmann Institute of Science, Rehovot, Israel
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