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Jodidio M, Panse NS, Prasath V, Trivedi R, Arjani S, Chokshi RJ. Cost-effectiveness of staging laparoscopy with peritoneal cytology in pancreatic adenocarcinoma. Curr Probl Surg 2024; 61:101442. [PMID: 38462312 DOI: 10.1016/j.cpsurg.2024.101442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 01/09/2024] [Indexed: 03/12/2024]
Affiliation(s)
- Maya Jodidio
- Division of Surgical Oncology, Department of Surgery, Rutgers New Jersey Medical School, Newark, NJ
| | - Neal S Panse
- Division of Surgical Oncology, Department of Surgery, Rutgers New Jersey Medical School, Newark, NJ
| | - Vishnu Prasath
- Rutgers New Jersey Medical School, Newark, NJ; Department of Medicine, The Ohio State University College of Medicine, Columbus, OH
| | | | | | - Ravi J Chokshi
- Division of Surgical Oncology, Department of Surgery, Rutgers New Jersey Medical School, Newark, NJ.
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Prasath V, Quinn PL, Arjani S, Li S, Oliver JB, Mahmoud O, Jaloudi M, Hajifathalian K, Chokshi RJ. Locally Advanced Gastric Cancer Management: A Cost-Effectiveness Analysis. Am Surg 2024:31348241227180. [PMID: 38225880 DOI: 10.1177/00031348241227180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2024]
Abstract
Across the nation, patients with locally advanced gastric cancer (LAGC) are managed with modalities including upfront surgery (US) and perioperative chemotherapy (PCT). Preoperative therapies have demonstrated survival benefits over US and thus long-term outcomes are expected to vary between the options. However, as these 2 modalities continue to be regularly employed, we sought to perform a decision analysis comparing the costs and quality-of-life associated with the treatment of patients with LAGC to identify the most cost-effective option. We designed a decision tree model to investigate the survival and costs associated with the most commonly utilized management modalities for LAGC in the United States: US and PCT. The tree described costs and treatment strategies over a 6-month time horizon. Costs were derived from 2022 Medicare reimbursement rates using the third-party payer perspective for physicians and hospitals. Effectiveness was represented using quality-adjusted life-years (QALYs). One-way, two-way, and probabilistic sensitivity analyses were utilized to test the robustness of our findings. PCT was the most cost-effective treatment modality for patients with LAGC over US with a cost of $40,792.16 yielding 3.11 QALYs. US has a cost of $55,575.57 while yielding 3.15 QALYs; the incremental cost-effectiveness ratio (ICER) was $369,585.25. One-way and two-way sensitivity analyses favored PCT in all variations of variables across their standard deviations. Across 100,000 Monte Carlo simulations, 100% of trials favored PCT. In our model simulating patients with LAGC, the most cost-effective treatment strategy was PCT. While US demonstrated improved QALYs over PCT, the associated cost was too great to justify its use.
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Affiliation(s)
- Vishnu Prasath
- Department of Medicine, Rutgers New Jersey Medical School, Newark, NJ, USA
- Department of Medicine, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Patrick L Quinn
- Department of Surgery, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Simran Arjani
- Department of Medicine, Rutgers New Jersey Medical School, Newark, NJ, USA
- Department of Medicine, Montefiore Medical Center, Bronx, NY, USA
| | - Sharon Li
- Division of Hematology/Oncology, Department of Medicine, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Joseph B Oliver
- Department of Surgery, East Orange Veterans Affairs Medical Center, East Orange, NJ, USA
| | - Omar Mahmoud
- Department of Radiation Oncology, Baptist MD Anderson, Jacksonville, FL, USA
| | - Mohammed Jaloudi
- Division of Hematology/Oncology, Department of Medicine, Rutgers New Jersey Medical School, Newark, NJ, USA
- Division of Medical Oncology, Scripps MD Anderson Cancer Center, La Jolla, CA, USA
| | - Kaveh Hajifathalian
- Division of Gastroenterology, Department of Medicine, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Ravi J Chokshi
- Division of Surgical Oncology, Department of Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
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Selvakumar T, Mu SZ, Prasath V, Arjani S, Chokshi RJ, Kra J. Colon cancer epidemiology, race and socioeconomic status: Comparing trends in counties served by an urban hospital in Newark, NJ with overall NJ-state and nation-wide patterns. Cancer Epidemiol 2023; 86:102412. [PMID: 37421846 DOI: 10.1016/j.canep.2023.102412] [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: 05/01/2023] [Revised: 06/28/2023] [Accepted: 06/29/2023] [Indexed: 07/10/2023]
Abstract
PURPOSE Disparities in colorectal cancer (CRC) trends are linked with socioeconomic status (SES) and race. To better understand the colon cancer trends at our medical center, this study characterizes the racial and socioeconomic profile of the population served by our center to identify modifiable risk factors amenable to interventions. METHODS Colon cancer data from our center as well as New Jersey (NJ) and United States (US) were obtained from National Cancer Database. Demographic data on race and SES for NJ counties were obtained from public databases that sourced data from the American Community Survey and the US census. We compared the odds of being diagnosed with early-onset and late-stage colon cancer (III or IV), respectively in NJ and US, across different racial groups. We also quantified the association between Social Vulnerability Index (SVI) and age-adjusted CRC mortality in NJ counties, with and without accounting for the racial composition of each county. RESULTS In 2015, our center recorded higher proportions of late-stage and early-onset colon cancer diagnoses compared to all hospitals in NJ and US. Trends for stage and patient age at diagnosis of colon cancer for NJ and the US (2010-2019) showed that Black, Hispanic, and Asian/Pacific Islander individuals had greater odds of being diagnosed with early-onset (age<50) and late-stage colon cancer (Stage III/IV) when compared to White population. NJ counties served by our center showed an overrepresentation of either Black or Hispanic-Latino populations and reported significant disadvantage in SES. For NJ counties, each 25 percentile increase in social vulnerability was associated with 1.04 times the rate of age-adjusted colorectal cancer death (95 % CI: 1.00-1.07). CONCLUSION Public data on race and SES of the target population can help identify areas of social disparities at the county-level to guide targeted interventions such as improving healthcare access and screening rates.
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Affiliation(s)
| | - Scott Ziming Mu
- Department of Surgery, Rutgers New Jersey Medical School, Newark, NJ, United States
| | - Vishnu Prasath
- Rutgers New Jersey Medical School, Newark, NJ, United States
| | - Simran Arjani
- Department of Medicine, Montefiore Medical Center, Bronx, NY, United States
| | - Ravi J Chokshi
- Division of Surgical Oncology, Department of Surgery, Rutgers New Jersey Medical School, Newark, NJ, United States
| | - Joshua Kra
- Department of Medicine, Rutgers New Jersey Medical School, Newark, NJ, United States; Rutgers Cancer Institute of New Jersey at University Hospital, United States.
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Panse NS, Prasath V, Quinn PL, Chokshi RJ. Economic evaluation of robotic and laparoscopic paraesophageal hernia repair. Surg Endosc 2023; 37:6806-6817. [PMID: 37264228 DOI: 10.1007/s00464-023-10119-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 05/08/2023] [Indexed: 06/03/2023]
Abstract
BACKGROUND Robotic approach in paraesophageal hernia (PEH) repair may improve outcomes over laparoscopic approach, though at additional cost. This study aimed to compare cost-effectiveness of robotic and laparoscopic PEH repair. METHODS A decision tree was created analyzing cost-effectiveness of robotic and laparoscopic PEH repair. Costs were obtained from 2021 Medicare data and were accumulated within 60 months after surgery. Effectiveness was measured in quality-adjusted life-years (QALYs). Branch-point probabilities and costs of robotic surgery consumables were obtained from published literature. The primary outcome of interest was incremental cost-effectiveness ratio (ICER). One-way, two-way, and probabilistic sensitivity analyses were performed. A secondary analysis including attributable capital and maintenance costs of robotic surgery was conducted as well. RESULTS Laparoscopic repair yielded 3.660 QALYs at $35,843.82. Robotic repair yielded 3.661 QALYs at $36,342.57, with an ICER of $779,488.62/QALY. Robotic repair was favored when rates of open conversion and symptom recurrence were low, or with reduced cost of robotic instruments. A probabilistic sensitivity analysis favored laparoscopic repair in 100% of simulations. When accounting for costs of robotic technology, robotic approach was preferred only in unrealistic clinical scenarios. CONCLUSIONS Laparoscopic repair is likely more cost-effective for most institutions, though results were relatively similar. With experienced surgeons who surpass the initial learning curve, robotic surgery may improve outcomes enough to be cost-effective, but only when excluding capital and maintenance fees.
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Affiliation(s)
- Neal S Panse
- Division of Surgical Oncology, Department of Surgery, Rutgers New Jersey Medical School, 185 South Orange Avenue, Newark, NJ, 07103, USA
| | - Vishnu Prasath
- Rutgers New Jersey Medical School, 185 South Orange Avenue, Newark, NJ, 07103, USA
| | - Patrick L Quinn
- Department of Surgery, The Ohio State University Wexner Medical Center, 410 West 10th Avenue, Columbus, OH, 43210, USA
| | - Ravi J Chokshi
- Division of Surgical Oncology, Department of Surgery, Rutgers New Jersey Medical School, 185 South Orange Avenue, Newark, NJ, 07103, USA.
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Mittal A, Le A, Kahlam A, Haider SF, Prasath V, Khrais A, Chokshi R. Pancreatic Cancer Biopsy Modalities: Comparing Insurance Status, Length of Stay, and Hospital Complications Based on Percutaneous, Endoscopic, and Surgical Biopsy Methods. Cureus 2023; 15:e39660. [PMID: 37388621 PMCID: PMC10306347 DOI: 10.7759/cureus.39660] [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] [Accepted: 05/29/2023] [Indexed: 07/01/2023] Open
Abstract
BACKGROUND Pancreatic cancer is diagnosed histologically through percutaneous biopsy (PB), endoscopic biopsy (EB), or surgical biopsy (SB). Factors and outcomes associated with method type are not clearly understood. We aimed to evaluate the relationship between insurance status, length of hospital stay (LOS), complications, and different pancreatic biopsy modalities. STUDY The 2001-2013 database from the National (Nationwide) Inpatient Sample (NIS) was queried for those with pancreatic cancer who underwent biopsies using International Classification of Diseases, Ninth Revision (ICD-9) codes. Data regarding insurance status, hospital stay, demographics, and complications were analyzed using chi-square and multivariate analysis with α < 0.001. RESULTS A total of 824,162 patients with pancreatic cancer were identified. Uninsured and Medicaid patients were more likely to get PB compared to SB. Patients were more likely to have acute renal failure (ARF) with an EB compared to SB. Patients were more likely to have a urinary tract infection (UTI) with EB or PB compared to SB. All biopsy types were less likely to have pneumonia; pancreatitis was more prevalent in EB compared to PB and SB. CONCLUSIONS Uninsured and Medicaid patients were most likely to have a PB compared to EB despite unclear indications which may represent an underlying discrepancy in healthcare utilization. EB patients had the shortest LOS while SB patients stayed three more days; those who underwent a combination of biopsies had the greatest LOS. Patients with EB were more likely to develop ARF, UTI, and pancreatitis than SB, possibly attributed to the advanced nature of endoscopic ultrasound. It is important to establish appropriate algorithm contributors to guide decision-making.
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Affiliation(s)
- Anmol Mittal
- Department of Medicine, Rutgers University New Jersey Medical School, Newark, USA
| | - Alexander Le
- Department of Medicine, Rutgers University New Jersey Medical School, Newark, USA
| | - Aaron Kahlam
- Department of Medicine, Rutgers University New Jersey Medical School, Newark, USA
| | - Syed F Haider
- Department of General Surgery, Rutgers University New Jersey Medical School, Newark, USA
| | - Vishnu Prasath
- Department of General Surgery, Rutgers University New Jersey Medical School, Newark, USA
| | - Ayham Khrais
- Department of Medicine, Rutgers University New Jersey Medical School, Newark, USA
| | - Ravi Chokshi
- Department of Surgical Oncology, Rutgers University New Jersey Medical School, Newark, USA
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Quinn PL, Kim JK, Prasath V, Panse N, Knackstedt TJ, Chokshi RJ. Sentinel lymph node biopsy for head and neck cutaneous squamous cell carcinoma using the Brigham and Women's staging system: a cost analysis. Arch Dermatol Res 2023; 315:371-378. [PMID: 35303163 DOI: 10.1007/s00403-022-02347-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 02/04/2022] [Accepted: 03/02/2022] [Indexed: 11/02/2022]
Abstract
The objective is to determine the cost-effectiveness of sentinel lymph node biopsy (SLNB) for cutaneous squamous cell carcinoma (CSCC) according to the Brigham and Women's Hospital (BWH) Tumor Staging system. A decision analysis was utilized to examine costs and outcomes associated with the use of SLNB in patients with high-risk head and neck CSCC. Decision tree outcome probabilities were obtained from published literature. Costs were derived from Medicare reimbursement rates (US$) and effectiveness was represented by quality-adjusted life-years (QALYs). The primary outcome was the incremental cost-effectiveness ratio (ICER), with a willingness-to-pay set at $100,000 per QALY gained. SLNB was found to be a cost-effective tool for patients with T3 tumors, with an ICER of $18,110.57. Withholding SLNB was the dominant strategy for both T2a and T2b lesions, with ICERs of - $2468.99 and - $16,694.00, respectively. Withholding SLNB remained the dominant strategy when examining immunosuppressed patients with T2a or T2b lesions. In patients with head and neck CSCC, those with T3 or T2b lesions with additional risk factors not accounted for in the staging system alone, may be considered for SLNB, while in other tumor stages it may be impractical. SLNB should only be offered on an individual patient basis.
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Affiliation(s)
- Patrick L Quinn
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
- Division of Surgical Oncology, Department of Surgery, Rutgers New Jersey Medical School, 205 South Orange Ave, F1222, Newark, NJ, 07103, USA
| | - Jin K Kim
- Division of Surgical Oncology, Department of Surgery, Rutgers New Jersey Medical School, 205 South Orange Ave, F1222, Newark, NJ, 07103, USA
| | - Vishnu Prasath
- Division of Surgical Oncology, Department of Surgery, Rutgers New Jersey Medical School, 205 South Orange Ave, F1222, Newark, NJ, 07103, USA
| | - Neal Panse
- Division of Surgical Oncology, Department of Surgery, Rutgers New Jersey Medical School, 205 South Orange Ave, F1222, Newark, NJ, 07103, USA
| | - Thomas J Knackstedt
- Department of Dermatology, Metrohealth System, Cleveland, OH, USA
- School of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Ravi J Chokshi
- Division of Surgical Oncology, Department of Surgery, Rutgers New Jersey Medical School, 205 South Orange Ave, F1222, Newark, NJ, 07103, USA.
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Singh A, Panse NS, Prasath V, Arjani S, Chokshi RJ. Cost-effectiveness analysis of robotic cholecystectomy in the treatment of benign gallbladder disease. Surgery 2023; 173:1323-1328. [PMID: 36914510 DOI: 10.1016/j.surg.2023.01.017] [Citation(s) in RCA: 3] [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] [Received: 09/25/2022] [Revised: 01/24/2023] [Accepted: 01/31/2023] [Indexed: 03/13/2023]
Abstract
BACKGROUND Laparoscopic cholecystectomy is the current standard of care treatment for benign gallbladder disease. Robotic cholecystectomy is another approach for performing cholecystectomy that offers a surgeon better dexterity and visualization. However, robotic cholecystectomy may increase cost without sufficient evidence to suggest an improvement in clinical outcomes. The purpose of this study was to construct a decision tree model to compare cost-effectiveness of laparoscopic cholecystectomy and robotic cholecystectomy. METHODS Complication rates and effectiveness associated with robotic cholecystectomy and laparoscopic cholecystectomy over a 1-year time frame were compared using a decision tree model populated with data from the published literature. Cost was calculated using Medicare data. Effectiveness was represented by quality-adjusted life-years. The primary outcome of the study was incremental cost-effectiveness ratio, which compares the cost per quality-adjusted life-year of the 2 interventions. The willingness-to-pay threshold was set at $100,000/quality-adjusted life-year. Results were confirmed with 1-way, 2-way, and probabilistic sensitivity analyses varying branch-point probabilities. RESULTS The studies used in our analysis included 3,498 patients who underwent laparoscopic cholecystectomy, 1,833 patients who underwent robotic cholecystectomy, and 392 patients who required conversion to open cholecystectomy. Laparoscopic cholecystectomy produced 0.9722 quality-adjusted life-years, costing $9,370.06. Robotic cholecystectomy produced an additional 0.0017 quality-adjusted life-years at an additional $3,013.64. These results equate to an incremental cost-effectiveness ratio of $1,795,735.21/quality-adjusted life-year. This exceeds the willingness-to-pay threshold, making laparoscopic cholecystectomy the more cost-effective strategy. Sensitivity analyses did not alter results. CONCLUSION Traditional laparoscopic cholecystectomy is the more cost-effective treatment modality for benign gallbladder disease. At present, robotic cholecystectomy is not able to improve clinical outcomes enough to justify its added cost.
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Affiliation(s)
- Adityabikram Singh
- Division of Surgical Oncology, Department of Surgery, Rutgers New Jersey Medical School, Newark, NJ. https://twitter.com/ad_singh09
| | - Neal S Panse
- Division of Surgical Oncology, Department of Surgery, Rutgers New Jersey Medical School, Newark, NJ. https://twitter.com/NealPanse
| | - Vishnu Prasath
- Rutgers New Jersey Medical School, Newark, NJ. https://twitter.com/Vishnu__Prasath
| | - Simran Arjani
- Rutgers New Jersey Medical School, Newark, NJ. https://twitter.com/SimranArjani
| | - Ravi J Chokshi
- Division of Surgical Oncology, Department of Surgery, Rutgers New Jersey Medical School, Newark, NJ.
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Arjani S, Prasath V, Suri N, Li S, Ahlawat S, Chokshi RJ. Neoadjuvant Treatment Versus Upfront Surgery in Resectable Pancreatic Cancer: A Cost-Effectiveness Analysis. JCO Oncol Pract 2023; 19:e439-e448. [PMID: 36548928 DOI: 10.1200/op.22.00536] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
PURPOSE Pancreatic cancer (PC) has an overall 5-year survival rate of 10%. The use of neoadjuvant chemoradiation is debated in resectable disease. The purpose of this study is to evaluate the cost-effectiveness of neoadjuvant chemoradiation followed by pancreaticoduodenectomy (NACRT) versus upfront pancreaticoduodenectomy and adjuvant chemotherapy (USR) in resectable PC. METHODS A decision tree model was used to estimate the cost-effectiveness of NACRT versus USR. Values from the published literature populate the tree: costs from Medicare (FY2021) reimbursements, and morbidity and survival data for quality-adjusted life-years (QALYs). Patients with resectable pancreatic adenocarcinoma who qualified for resection were included. The ICER was the primary outcome. The model was validated using one-way and two-way deterministic, as well as probabilistic sensitivity analyses. RESULTS The base case was modeled using a 65-year-old male. NACRT yielded 1.61 QALYs at $45,483.52 USD. USR yielded 1.47 QALYs at a discount of $6,840.96 USD. The ICER was $48,130 USD, which favors NACRT. One-way sensitivity analyses upheld these results except when ≤ 21.0% of NACRT patients proceeded to surgery and when ≤ 85.4% of NACRT patients were resectable at surgery. Two-way sensitivity analyses also favored NACRT except in cases when the proportion of resected disease after NACRT decreased. NACRT was favored in 94.3% of 100,000 random-sampling simulations. CONCLUSION It is more cost-effective to administer NACRT before surgery for patients with resectable PC. On the basis of sensitivity analyses, USR with adjuvant therapy is only favored if rates of resection and eligibility for resection after NACRT decrease. NACRT should be considered in all patients unless there is an absolute contraindication.
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Affiliation(s)
| | | | - Nipun Suri
- Department of Internal Medicine, Rutgers New Jersey Medical School, Newark, NJ
| | - Sharon Li
- Division of Hematology/Oncology, Department of Internal Medicine, Rutgers New Jersey Medical School, Newark, NJ
| | - Sushil Ahlawat
- Division of Gastroenterology & Hepatology, Department of Internal Medicine, Rutgers New Jersey Medical School, Newark, NJ
| | - Ravi J Chokshi
- Division of Surgical Oncology, Department of Surgery, Rutgers New Jersey Medical School, Newark, NJ
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Prasath V, Naides AI, Weisberger JS, Quinn PL, Ayyala HS, Lee ES, Girard AO, Chokshi RJ. Perineal reconstruction after radical pelvic surgery: A cost-effectiveness analysis. Surgery 2023; 173:521-528. [PMID: 36418205 DOI: 10.1016/j.surg.2022.09.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 08/25/2022] [Accepted: 09/11/2022] [Indexed: 11/21/2022]
Abstract
BACKGROUND Radical resection of pelvic and low rectal malignancies leads to complex reconstructive challenges. Many pelvic reconstruction options have been described including primary closure, omental flaps, and various fasciocutaneous and myocutaneous flaps. Little consensus exists in the literature on which of the various options in the reconstructive armamentarium provides a superior outcome. The authors of this study set out to determine the costs and quality-of-life outcomes of primary closure, vertical rectus abdominus muscle flap, gluteal thigh flap, and gracilis flap to aid surgeons in identifying an optimal reconstructive algorithm. METHODS A decision tree analysis was performed to analyze the cost, complications, and quality-of-life associated with reconstruction by primary closure, gluteal thigh flap, vertical rectus abdominus muscle flap, and gracilis flap. Costs were derived from Medicare reimbursement rates (FY2021), while quality-adjusted life-years were obtained from the literature. RESULTS Gluteal thigh flap was the most cost-effective treatment strategy with an overall cost of $62,078.28 with 6.54 quality-adjusted life-years and an incremental cost-effectiveness ratio of $5,649.43. Gluteal thigh flap was always favored as the most cost-effective treatment strategy in our 1-way sensitivity analysis. Gracilis flap became more cost-effective than gluteal thigh flap, in the scenario where gluteal thigh flap complication rates increased by roughly 4% higher than gracilis flap complication rates. CONCLUSION Our data suggest that, when available, gluteal thigh flap be the first-line option for reconstruction of pelvic defects as it provides the best quality-of-life at the most cost-effective price point. However, future studies directly comparing outcomes of gluteal thigh flap to vertical rectus abdominus muscle and gracilis flap are needed to further delineate superiority.
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Affiliation(s)
| | | | - Joseph S Weisberger
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Rutgers New Jersey Medical School, Newark, NJ
| | - Patrick L Quinn
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Haripriya S Ayyala
- Division of Plastic and Reconstructive Surgery, Memorial Sloan Kettering Cancer Center, New York, NY; Division of Plastic & Reconstructive Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT
| | - Edward S Lee
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Rutgers New Jersey Medical School, Newark, NJ
| | - Alisa O Girard
- Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Ravi J Chokshi
- Division of Surgical Oncology, Department of Surgery, Rutgers New Jersey Medical School, Newark, NJ.
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10
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Arjani S, Bostonian TJ, Prasath V, Quinn PL, Chokshi RJ. Cost-effectiveness of adrenal vein sampling- vs computed tomography-guided adrenalectomy for unilateral adrenaloma in primary aldosteronism. J Endocrinol Invest 2022; 45:1899-1908. [PMID: 35612811 DOI: 10.1007/s40618-022-01821-7] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 05/05/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE Adrenalectomies performed for the treatment of primary aldosteronism due to unilateral adenoma are traditionally confirmed with, and guided by, results from adrenal vein sampling (AVS). However, the usefulness of AVS at the expense of cost and complications is debated, and many institutions have independent protocols that use AVS to varying degrees. METHODS Cost-effectiveness of AVS- vs computed tomography (CT)-based adrenalectomy was calculated using decision tree models. The tree was populated with values describing biochemical post-operative outcomes from the published literature; patients were placed into AVS- or CT-dependent treatment arms. Biochemical outcomes were defined based on patients' potassium levels and aldosterone-renin ratios. Patients underwent adrenalectomies and received medical management dosed based on surgical outcomes. Costs were represented by Medicare (FY2021) reimbursement rates (US$) and quality-adjusted life-years (QALYs) were calculated using published morbidity and survival data. A willingness-to-pay of $100,000 per QALY gained was set to determine the most cost-effective strategy. The primary outcome was the incremental cost-effectiveness ratio (ICER) associated with biochemical outcomes. RESULTS The base case analyses favored the use of AVS-guided care, which cost $307.65 more but yielded 0.78 more QALYs, resulting in an ICER of $392.57. These results were upheld by all one-way and two-way sensitivity analyses. In 100,000 random-sampling simulations, AVS-guided care was favored 100% of the time. CONCLUSIONS For patients with primary aldosteronism receiving adrenalectomies with curative intent, the more cost-effective method based on biochemical outcomes is AVS-based care. Recent literature suggests biochemical resolution should be favored over clinical resolution, due to long-term detriments of increased aldosterone independent of clinical symptoms.
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Affiliation(s)
- S Arjani
- Rutgers New Jersey Medical School, Newark, NJ, USA
| | | | - V Prasath
- Rutgers New Jersey Medical School, Newark, NJ, USA
| | - P L Quinn
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - R J Chokshi
- Department of Surgery, Division of Surgical Oncology, Rutgers New Jersey Medical School, 205 South Orange Ave, F1222, Newark, NJ, 07103, USA.
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Prasath V, Quinn PL, Oliver JB, Arjani S, Ahlawat SK, Chokshi RJ. Cost-effectiveness analysis of infected necrotizing pancreatitis management in an academic setting. Pancreatology 2022; 22:185-193. [PMID: 34879998 DOI: 10.1016/j.pan.2021.11.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 11/22/2021] [Accepted: 11/30/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS Traditional management for infected necrotizing pancreatitis (INP) often utilizes open necrosectomy, which carries high morbidity and complication rates. Thus, minimally invasive strategies have gained favor, specifically step-up approaches utilizing endoscopic or minimally-invasive surgery (MIS); however, the ideal management modality for INP has not been identified. METHODS A decision tree model was designed to analyze costs and survival associated with open necrosectomy, endoscopic step-up, and MIS step-up protocols for management of INP after 4 weeks of necrosis development with adequate retroperitoneal access. Costs were based on a third-party payer perspective using Medicare reimbursement rates. The model's effectiveness was represented by quality-adjusted life-years (QALYs). Sensitivity analyses were performed to validate results. RESULTS Endoscopic step-up was the dominant economic strategy with 7.92 QALYs for $90,864.09. Surgical step-up resulted in a decrease of 0.09 QALYs and a cost increase of $10,067.89 while open necrosectomy resulted in a decrease of 0.4 QALYs and an increased cost of $18,407.52 over endoscopic step-up. In 100,000 random-sampling simulations, 65.5% of simulations favored endoscopic step-up. MIS step-up was favored when MIS acute mortality rates fell and when MIS drainage success rates rose. CONCLUSIONS In our simulated patients with INP, the most cost-effective management strategy is endoscopic step-up. Cost-effectiveness varies with changes in acute mortality and drainage success, which will depend on local expertise.
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Affiliation(s)
- Vishnu Prasath
- Division of Surgical Oncology, Department of Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA.
| | - Patrick L Quinn
- Division of Surgical Oncology, Department of Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA.
| | - Joseph B Oliver
- Division of Minimally Invasive Surgery, Department of Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA.
| | - Simran Arjani
- Division of Surgical Oncology, Department of Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA.
| | - Sushil K Ahlawat
- Division of Gastroenterology and Hepatology, Department of Medicine, Rutgers New Jersey Medical School, Newark, NJ, USA.
| | - Ravi J Chokshi
- Division of Surgical Oncology, Department of Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA.
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12
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Prasath V, Quinn PL, Oliver JB, Mahmoud O, Jaloudi M, Akkaraju V, Arjani S, Ahlawat S, Chokshi R. Cost-effectiveness analysis of gastric cancer management using perioperative chemotherapy versus adjuvant chemoradiation therapy. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.e16079] [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
e16079 Background: The most commonly used treatment options for gastric cancer include complete resection with adequate margins with either perioperative chemotherapy (PCT) or adjuvant chemoradiotherapy (CRT). While both treatment strategies have shown superiority over surgical resection alone, it is not clear which treatment strategy is more optimal. Methods: Our decision tree model was built to analyze the survival and costs associated with the two major management methods: perioperative chemotherapy and adjuvant chemoradiation therapy. Costs were obtained from Medicare reimbursement rates using a third-party payer perspective. Our model’s effectiveness was represented using quality-adjusted life years (QALYs). Our analysis tested the robustness of our conclusions by utilizing one-way, two-way, and probabilistic sensitivity analyses. Results: PCT was the preferred treatment strategy for diagnosed gastric cancer over CRT, with a cost of $54,326.10 and 4.08 QALYs. CRT was the costliest economic strategy with a cost of $77,987.52 and 4.28 QALYs and an ICER of 115,907.48. We set a threshold of $100,000 per QALYs gained which CRT surpassed making PCT the preferred treatment modality. Over 100,000 simulations, 51.4% of simulations favored PCT. CRT became favored when CRT non-curative procedure rates rose 3% higher than PCT non-curative procedure rates and when PCT complication rates rose 15% higher than CRT complication rates. Conclusions: In our simulated patients with diagnosed gastric cancer, the most cost-effective treatment strategy was PCT. We see cost-effectiveness alternating to favor CRT with changes in non-curative procedure rates and adjuvant therapy complication rates.[Table: see text]
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Affiliation(s)
| | | | | | | | - Mohammed Jaloudi
- Rutgers Cancer Institute of New Jersey at University Hospital, Newark, NJ
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13
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Song JH, Tieu AH, Cheng Y, Ma K, Akshintala VS, Simsek C, Prasath V, Shin EJ, Ngamruengphong S, Khashab MA, Abraham JM, Meltzer SJ. Novel Long Noncoding RNA miR205HG Functions as an Esophageal Tumor-Suppressive Hedgehog Inhibitor. Cancers (Basel) 2021; 13:cancers13071707. [PMID: 33916875 PMCID: PMC8038513 DOI: 10.3390/cancers13071707] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 03/24/2021] [Indexed: 12/12/2022] Open
Abstract
Simple Summary Barrett’s esophagus (BE) is a precursor to esophageal adenocarcinoma (EAC). Long noncoding RNAs (lncRNAs) have been identified as key regulators of biological pathways and we identified lncRNA, miR205HG, as a tumor suppressor in the development of Barrett’s esophagus and esophageal adenocarcinoma, in part through its effect on the Hedgehog signaling pathway. The aims of the current study were: (1) to study involvement of miR205HG in the development of BE and EAC (2) to clarify the role of miR205HG in in vitro and in vivo experiments; and (3) to investigate the mechanism of miR205HG involving the Hedgehog (Hh) signaling pathway Abstract Barrett’s esophagus (BE) is a precursor to esophageal adenocarcinoma (EAC). Recently, long noncoding RNAs (lncRNAs) have been identified as key regulators of biological pathways. However, involvement of lncRNAs in the development of BE and EAC has not been well-studied. The aims of the current study were: (1) to study involvement of the lncRNA, miR205HG, in the development of BE and EAC; (2) to clarify the role of miR205HG in in vitro and in vivo experiments; and (3) to investigate the mechanism of miR205HG involving the Hedgehog (Hh) signaling pathway. These experiments revealed that miR205HG was downregulated in EAC vs. normal esophageal epithelia (NE) as well as in EAC cell lines, and its forced overexpression inhibited EAC cell proliferation and cell cycle progression in vitro. Similarly, overexpression of miR205HG inhibited xenograft tumor growth in mice In vivo. Finally, we show that one mechanism of action of miR205HG involves the Hh signaling pathway: miR205HG and Hh expression levels were inversely correlated in both EAC (r = −0.73) and BE (r = −0.83) tissues, and in vitro studies revealed details of Hh signaling inhibition induced by miR205HG. In conclusion, these findings establish that lncRNA miR205HG functions as a tumor suppressor in the development of BE and EAC, at least in part through its effect on the Hh signaling pathway.
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Affiliation(s)
- Jee Hoon Song
- Division of Gastroenterology and Hepatology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD 21287, USA; (J.H.S.); (A.H.T.); (Y.C.); (K.M.); (V.S.A.); (C.S.); (V.P.); (E.J.S.); (S.N.); (M.A.K.); (J.M.A.)
- Department of Medicine, University of Maryland School of Medicine, Baltimore, MD 21287, USA
| | - Alan H. Tieu
- Division of Gastroenterology and Hepatology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD 21287, USA; (J.H.S.); (A.H.T.); (Y.C.); (K.M.); (V.S.A.); (C.S.); (V.P.); (E.J.S.); (S.N.); (M.A.K.); (J.M.A.)
- Division of Gastroenterology and Hepatology, Department of Medicine, Eastern Virginia Medical School, Norfolk, VA 23456, USA
| | - Yulan Cheng
- Division of Gastroenterology and Hepatology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD 21287, USA; (J.H.S.); (A.H.T.); (Y.C.); (K.M.); (V.S.A.); (C.S.); (V.P.); (E.J.S.); (S.N.); (M.A.K.); (J.M.A.)
| | - Ke Ma
- Division of Gastroenterology and Hepatology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD 21287, USA; (J.H.S.); (A.H.T.); (Y.C.); (K.M.); (V.S.A.); (C.S.); (V.P.); (E.J.S.); (S.N.); (M.A.K.); (J.M.A.)
| | - Venkata S. Akshintala
- Division of Gastroenterology and Hepatology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD 21287, USA; (J.H.S.); (A.H.T.); (Y.C.); (K.M.); (V.S.A.); (C.S.); (V.P.); (E.J.S.); (S.N.); (M.A.K.); (J.M.A.)
| | - Cem Simsek
- Division of Gastroenterology and Hepatology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD 21287, USA; (J.H.S.); (A.H.T.); (Y.C.); (K.M.); (V.S.A.); (C.S.); (V.P.); (E.J.S.); (S.N.); (M.A.K.); (J.M.A.)
| | - Vishnu Prasath
- Division of Gastroenterology and Hepatology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD 21287, USA; (J.H.S.); (A.H.T.); (Y.C.); (K.M.); (V.S.A.); (C.S.); (V.P.); (E.J.S.); (S.N.); (M.A.K.); (J.M.A.)
| | - Eun Ji Shin
- Division of Gastroenterology and Hepatology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD 21287, USA; (J.H.S.); (A.H.T.); (Y.C.); (K.M.); (V.S.A.); (C.S.); (V.P.); (E.J.S.); (S.N.); (M.A.K.); (J.M.A.)
| | - Saowanee Ngamruengphong
- Division of Gastroenterology and Hepatology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD 21287, USA; (J.H.S.); (A.H.T.); (Y.C.); (K.M.); (V.S.A.); (C.S.); (V.P.); (E.J.S.); (S.N.); (M.A.K.); (J.M.A.)
| | - Mouen A. Khashab
- Division of Gastroenterology and Hepatology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD 21287, USA; (J.H.S.); (A.H.T.); (Y.C.); (K.M.); (V.S.A.); (C.S.); (V.P.); (E.J.S.); (S.N.); (M.A.K.); (J.M.A.)
| | - John M. Abraham
- Division of Gastroenterology and Hepatology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD 21287, USA; (J.H.S.); (A.H.T.); (Y.C.); (K.M.); (V.S.A.); (C.S.); (V.P.); (E.J.S.); (S.N.); (M.A.K.); (J.M.A.)
| | - Stephen J. Meltzer
- Division of Gastroenterology and Hepatology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD 21287, USA; (J.H.S.); (A.H.T.); (Y.C.); (K.M.); (V.S.A.); (C.S.); (V.P.); (E.J.S.); (S.N.); (M.A.K.); (J.M.A.)
- Correspondence: ; Tel.: +410-502-6071
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14
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Siotos C, Aravind P, Prasath V, Rubano A, Youssef M, Habibi M, Manahan MA, Cooney CM, Rosson GD. Pure fat grafting for breast reconstruction: An alternative autologous breast reconstruction. Breast J 2020; 26:1788-1792. [PMID: 32945041 DOI: 10.1111/tbj.13887] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2019] [Revised: 04/27/2020] [Accepted: 04/29/2020] [Indexed: 11/29/2022]
Abstract
Plastic surgeons offer various options for breast reconstruction based on patient preference, underlying disease, and comorbidities. An alternative form of breast reconstruction exists, which includes tissue expansion with tissue expander and subsequent fat grafting without the use of implant or flap. We retrospectively reviewed the breast cancer patients who underwent breast reconstruction at our institution to identify those with pure fat grafting. Demographic information, complications, operative details, and BREAST-Q scores were abstracted. From 2010-2015, 10 patients were identified. Patients with unilateral or bilateral mastectomy followed by pure fat grafting had a median of 3.5 or 4 sessions and a total median fat grafting volume of 380 or 974.5 cc, respectively. Patients were followed for 12 months, and no complications or breast cancer recurrences were noted. Finally, BREAST-Q scores at the 12-month follow-up were comparable to the preoperative values.
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Affiliation(s)
- Charalampos Siotos
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Division of Plastic and Reconstructive Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Pathik Aravind
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Vishnu Prasath
- Department of General Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Amanda Rubano
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Mohanad Youssef
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Mehran Habibi
- Department of General Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Michele A Manahan
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Carisa M Cooney
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Gedge D Rosson
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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15
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Dembinski R, Prasath V, Bohnak C, Siotos C, Sebai ME, Psoter K, Gani F, Canner J, Camp MS, Azizi A, Jacobs L, Habibi M. Estrogen Receptor Positive and Progesterone Receptor Negative Breast Cancer: the Role of Hormone Therapy. Discov Oncol 2020; 11:148-154. [PMID: 32519274 DOI: 10.1007/s12672-020-00387-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 06/01/2020] [Indexed: 11/26/2022] Open
Abstract
ER+/PR- (estrogen receptor positive and progesterone receptor negative) tumors constitute only a small portion of the breast cancer population. Patients with ER+/PR- tumors, however, are characterized by worse survival compared to patients with ER+/PR+ (estrogen receptor positive and progesterone receptor positive) tumors. Controversy exists regarding the efficacy of hormone blocking therapy for patients with ER+/PR- tumors. The NCDB was queried between 2004 and 2015, and patients with invasive ER+/PR- tumors were identified. We employed univariate Cox proportional hazards to compare outcomes among patients that did or did not receive hormone blocking therapy. We identified 138,398 patients with invasive ER+/PR- tumors, 32,044 (23%) of whom did not receive hormone blocking therapy. The reasons for not receiving hormone blocking therapy included contraindications to treatment, death, patient refusal, and unknown. There were no significant differences in race, income quartile, or education quartile between patients who did and did not receive hormone blocking therapy. Patients who did not receive hormone blocking therapy underwent surgical assessment of the axilla more frequently than those who did receive hormone therapy. Our analysis demonstrated that hormone blocking therapy administration was associated with increased overall survival for up to 10 years of follow up (HR: 0.58; 95% CI: 0.56-0.59, p < 0.001). Hormone blocking therapy may be associated with increased survival for breast cancer patients with ER+/PR- tumors. Although this benefit may last for years after completion of the course, up to 25% of patients do not receive this treatment. Strategies to increase the utilization and adherence to hormone blocking therapy regimens may improve patient survival outcomes.
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Affiliation(s)
- Robert Dembinski
- Department of Surgery, Johns Hopkins Hospital, Johns Hopkins University School of Medicine, Bayview Campus, Building A, 5th Floor, 4940 Eastern Avenue, Baltimore, MD, 21224, USA
| | - Vishnu Prasath
- Department of Surgery, Johns Hopkins Hospital, Johns Hopkins University School of Medicine, Bayview Campus, Building A, 5th Floor, 4940 Eastern Avenue, Baltimore, MD, 21224, USA
| | - Carisa Bohnak
- Department of Surgery, Johns Hopkins Hospital, Johns Hopkins University School of Medicine, Bayview Campus, Building A, 5th Floor, 4940 Eastern Avenue, Baltimore, MD, 21224, USA
| | - Charalampos Siotos
- Department of Surgery, Johns Hopkins Hospital, Johns Hopkins University School of Medicine, Bayview Campus, Building A, 5th Floor, 4940 Eastern Avenue, Baltimore, MD, 21224, USA
| | - Mohamad E Sebai
- Department of Surgery, Johns Hopkins Hospital, Johns Hopkins University School of Medicine, Bayview Campus, Building A, 5th Floor, 4940 Eastern Avenue, Baltimore, MD, 21224, USA
| | - Kevin Psoter
- Department of Pediatrics, Johns Hopkins Bayview Medical Center, Baltimore, MD, USA
| | - Faiz Gani
- Department of Surgery, Johns Hopkins Hospital, Johns Hopkins University School of Medicine, Bayview Campus, Building A, 5th Floor, 4940 Eastern Avenue, Baltimore, MD, 21224, USA
| | - Joe Canner
- Department of Surgery, Johns Hopkins Hospital, Johns Hopkins University School of Medicine, Bayview Campus, Building A, 5th Floor, 4940 Eastern Avenue, Baltimore, MD, 21224, USA
| | - Melissa S Camp
- Department of Surgery, Johns Hopkins Hospital, Johns Hopkins University School of Medicine, Bayview Campus, Building A, 5th Floor, 4940 Eastern Avenue, Baltimore, MD, 21224, USA
| | - Armina Azizi
- Department of Surgery, Johns Hopkins Hospital, Johns Hopkins University School of Medicine, Bayview Campus, Building A, 5th Floor, 4940 Eastern Avenue, Baltimore, MD, 21224, USA
| | - Lisa Jacobs
- Department of Surgery, Johns Hopkins Hospital, Johns Hopkins University School of Medicine, Bayview Campus, Building A, 5th Floor, 4940 Eastern Avenue, Baltimore, MD, 21224, USA
| | - Mehran Habibi
- Department of Surgery, Johns Hopkins Hospital, Johns Hopkins University School of Medicine, Bayview Campus, Building A, 5th Floor, 4940 Eastern Avenue, Baltimore, MD, 21224, USA.
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16
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Akhtar Z, Stearns V, Cartwright P, Blackford AL, Prasath V, Klein C, Jelovac D, Asrari F, Habibi M. The effect of 1-day multidisciplinary clinic on breast cancer treatment. Breast Cancer Res Treat 2020; 182:623-629. [PMID: 32507956 DOI: 10.1007/s10549-020-05721-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 06/02/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE A delay in breast cancer treatment is associated with inferior survival outcomes; however, no clear guidelines exist defining the appropriate time frame from diagnosis to definitive treatment of breast cancer. A multidisciplinary approach for breast cancer treatment can minimize the time from diagnosis to first treatment. We hypothesized single-day multidisciplinary clinic (MDC) may accelerate the time to first treatment on complex breast cancer cases at our institution. METHODS We identified patients who were treated at Johns Hopkins for stage II or III breast cancer, who were at least 18 years of age, and were seen in a new single-day MDC with coordination between two or three specialties or by specialists from varying disciplines on different days (IDC). Patients who initiated treatment between May 2015 (initiation of MDC clinic) and December 2017 were included in our study. RESULTS A total of 296 patient records were reviewed independently. The mean (SD) patient age was 55 (13) years. The median time to first neoadjuvant chemotherapy (NACT) was significantly reduced for patients seen in the MDC (12.7 days), compared to those seen at the IDC (24.4 days, logrank p < 0.001). The median time to definitive surgery was similar between groups (31 and 32 days for the MDC and IDC cohorts, respectively). CONCLUSIONS A single-day MDC visit is associated with a reduced time from diagnosis to NACT. Further studies are needed to determine if a shorter interval can improve the management and the outcome of complex breast cancer cases.
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Affiliation(s)
- Zohaib Akhtar
- School of Medicine, Johns Hopkins University, 4940 Eastern Ave, Room A-562, Baltimore, MD, 21224, USA.
| | - Vered Stearns
- Women's Malignancies Disease Group, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, MD, USA
| | - Paul Cartwright
- Johns Hopkins Breast Center on the Johns Hopkins Bayview Campus, Baltimore, MD, USA
| | - Amanda L Blackford
- Division of Biostatistics, Department of Oncology, Johns Hopkins University, Baltimore, MD, USA
| | - Vishnu Prasath
- Department of Surgery, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Catherine Klein
- Department of Surgery, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Danijela Jelovac
- Breast Cancer Program, Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD, USA
| | - Fariba Asrari
- Johns Hopkins Breast Center - Green Spring Station, Johns Hopkins University, Baltimore, MD, USA
| | - Mehran Habibi
- Johns Hopkins Breast Center on the Johns Hopkins Bayview Campus, Baltimore, MD, USA
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17
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Azizi A, Prasath V, Canner J, Gharib M, Sadat Fattahi A, Naser Forghani M, Sajjadi S, Farhadi E, Vasigh M, Kaviani A, Omranipour R, Habibi M. Idiopathic granulomatous mastitis: Management and predictors of recurrence in 474 patients. Breast J 2020; 26:1358-1362. [PMID: 32249491 DOI: 10.1111/tbj.13822] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [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: 11/27/2019] [Revised: 03/03/2020] [Accepted: 03/10/2020] [Indexed: 01/23/2023]
Abstract
Idiopathic Granulomatous Mastitis (IGM) is an uncommon inflammatory disease of the breast, with similar presentations as breast cancer and a relatively high recurrence rate. We reviewed the demographics, clinical presentations, and treatment modalities of a large cohort of patients in Iran. Most of the patients had history of pregnancy and breastfeeding. The most common clinical finding was pain and a palpable mass, respectively. Most of the patients received medical treatment, and about half of the patients had surgery. The recurrence rate was 24.8%, and breast skin lesions were associated with a significantly higher odds of recurrence.
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Affiliation(s)
- Armina Azizi
- Department of General Surgery, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Vishnu Prasath
- Department of General Surgery, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Joseph Canner
- Department of General Surgery, Johns Hopkins Hospital, Baltimore, MD, USA
| | | | | | | | | | - Effat Farhadi
- Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mahtab Vasigh
- Breast Disease Research Center, Tehran University of Medical Science, Tehran, Iran
| | - Ahmad Kaviani
- Breast Disease Research Center, Tehran University of Medical Science, Tehran, Iran
| | - Ramesh Omranipour
- Breast Disease Research Center, Tehran University of Medical Science, Tehran, Iran
| | - Mehran Habibi
- Department of General Surgery, Johns Hopkins Hospital, Baltimore, MD, USA
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18
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Hannah M, Prasath V, Habibi M. Utilizing business intelligence and lean system applications to improve efficiency in breast surgery by reducing case delays. Breast 2019. [DOI: 10.1016/s0960-9776(19)30446-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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19
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Wang Z, Kambhampati S, Cheng Y, Ma K, Simsek C, Tieu AH, Abraham JM, Liu X, Prasath V, Duncan M, Stark A, Trick A, Tsai HL, Wang H, He Y, Khashab MA, Ngamruengphong S, Shin EJ, Wang TH, Meltzer SJ. Methylation Biomarker Panel Performance in EsophaCap Cytology Samples for Diagnosing Barrett's Esophagus: A Prospective Validation Study. Clin Cancer Res 2019; 25:2127-2135. [PMID: 30670490 DOI: 10.1158/1078-0432.ccr-18-3696] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 12/28/2018] [Accepted: 01/17/2019] [Indexed: 12/19/2022]
Abstract
PURPOSE Barrett's esophagus is the only known precursor of esophageal adenocarcinoma (EAC). Although endoscopy and biopsy are standard methods for Barrett's esophagus diagnosis, their high cost and risk limit their use as a screening modality. Here, we sought to develop a Barrett's esophagus detection method based on methylation status in cytology samples captured by EsophaCap using a streamlined sensitive technique, methylation on beads (MOB). EXPERIMENTAL DESIGN We conducted a prospective cohort study on 80 patients (52 in the training set; 28 in the test set). We used MOB to extract and bisulfite-convert DNA, followed by quantitative methylation-specific PCR to assess methylation levels of 8 previously selected candidate markers. Lasso regression was applied to establish a prediction model in the training set, which was then tested on the independent test set. RESULTS In the training set, five of eight candidate methylation biomarkers (p16, HPP1, NELL1, TAC1, and AKAP12) were significantly higher in Barrett's esophagus patients than in controls. We built a four-biomarker-plus-age lasso regression model for Barrett's esophagus diagnosis. The AUC was 0.894, with sensitivity 94.4% [95% confidence interval (CI), 71%-99%] and specificity 62.2% (95% CI, 44.6%-77.3%) in the training set. This model also performed with high accuracy for Barrett's esophagus diagnosis in an independent test set: AUC = 0.929 (P < 0.001; 95% CI, 0.810%-1%), with sensitivity=78.6% (95% CI, 48.8%-94.3%) and specificity = 92.8% (95% CI, 64.1%-99.6%). CONCLUSIONS EsophaCap, in combination with an epigenetic biomarker panel and the MOB method, is a promising, well-tolerated, low-cost esophageal sampling strategy for Barrett's esophagus diagnosis. This approach merits further prospective studies in larger populations.
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Affiliation(s)
- Zhixiong Wang
- Gastrointestinal Surgical Center, First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China.,Center of Gastric Cancer, Sun Yat-Sen University, Guangzhou, China
| | - Swetha Kambhampati
- Division of Hematology/Oncology, Department of Medicine, Helen Diller Family Comprehensive Cancer Center, UCSF Medical Center, San Francisco, California.,Department of Medicine, Johns Hopkins Hospital, Baltimore, Maryland
| | - Yulan Cheng
- Division of Gastroenterology, Department of Medicine and Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Ke Ma
- Division of Gastroenterology, Department of Medicine and Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Cem Simsek
- Division of Gastroenterology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Alan H Tieu
- Division of Gastroenterology, Department of Medicine and Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - John M Abraham
- Division of Gastroenterology, Department of Medicine and Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Xi Liu
- Department of Pathology, the First Affiliated Hospital of Xi' an Jiaotong University, Xi' an, Shaanxi, China
| | - Vishnu Prasath
- Department of Surgery, Johns Hopkins University, Baltimore, Maryland
| | - Mark Duncan
- Department of Surgery, Johns Hopkins University, Baltimore, Maryland
| | - Alejandro Stark
- Departments of Mechanical Engineering and Biomedical Engineering, Whiting School of Engineering, Johns Hopkins University, Baltimore, Maryland
| | - Alexander Trick
- Departments of Mechanical Engineering and Biomedical Engineering, Whiting School of Engineering, Johns Hopkins University, Baltimore, Maryland
| | - Hua-Ling Tsai
- Division of Biostatistics, Department of Oncology, Department of Medicine and Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Hao Wang
- Division of Biostatistics, Department of Oncology, Department of Medicine and Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Yulong He
- Gastrointestinal Surgical Center, First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China.,Center of Gastric Cancer, Sun Yat-Sen University, Guangzhou, China.,Gastrointestinal Surgical Center, Seventh Affiliated Hospital of Sun Yat-Sen University, Shenzhen, China
| | - Mouen A Khashab
- Division of Gastroenterology, Department of Medicine and Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Saowanee Ngamruengphong
- Division of Gastroenterology, Department of Medicine and Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Eun J Shin
- Division of Gastroenterology, Department of Medicine and Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Tza-Huei Wang
- Department of Medicine, Johns Hopkins Hospital, Baltimore, Maryland
| | - Stephen J Meltzer
- Division of Gastroenterology, Department of Medicine and Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland.
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20
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Gharpure SJ, Padmaja, Prasath V, Shelke YG. Cascade Radical Cyclization on Alkynyl Vinylogous Carbonates for the Divergent Synthesis of Tetrasubstituted Furans and Dihydrofurans. Org Lett 2019; 21:223-227. [PMID: 30582819 DOI: 10.1021/acs.orglett.8b03668] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
A single alkynyl vinylogous carbonate was elaborated to tetrasubstituted furan or dihydrofuran via a cascade inter-intramolecular radical reaction by changing the radical being added. The strategy could be used in the synthesis of polycyclic heterocycles as well as bis-furan exhibiting atropisomerism. Installation of a new furan motif on the existing one was feasible by iteration. Stannyl dihydrofuran derivative was used in Stille coupling, whereas intramolecular Friedel-Crafts acylation on the furan gave furanonaphthol.
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Affiliation(s)
- Santosh J Gharpure
- Department of Chemistry , Indian Institute of Technology Bombay , Powai, Mumbai 400076 , India
| | - Padmaja
- Department of Chemistry , Indian Institute of Technology Bombay , Powai, Mumbai 400076 , India
| | - V Prasath
- Department of Chemistry , Indian Institute of Technology Bombay , Powai, Mumbai 400076 , India
| | - Yogesh G Shelke
- Department of Chemistry , Indian Institute of Technology Bombay , Powai, Mumbai 400076 , India
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Siotos C, Stergios K, Prasath V, Seal SM, Duncan MD, Sakran JV, Habibi M. Irrigation Versus Suction in Laparoscopic Appendectomy for Complicated Appendicitis: A Meta-analysis. J Surg Res 2018; 235:237-243. [PMID: 30691801 DOI: 10.1016/j.jss.2018.10.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [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: 05/04/2018] [Revised: 09/09/2018] [Accepted: 10/02/2018] [Indexed: 01/07/2023]
Abstract
BACKGROUND Acute appendicitis is currently one of the most common surgical emergencies. Intra-abdominal abscesses (IAA) are a fearsome complication, which may occur. Irrigation during the appendectomy is one of the factors suggested to affect the rates of IAA. We sought to investigate the evidence regarding the use of irrigation versus suction alone and the development of IAA after laparoscopic appendectomy for complicated appendicitis. METHODS We searched PubMed, Scopus, Embase, Cochrane, and the Web of Science through November 10, 2017, according to Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines. We extracted information of interest, including rates of postoperative (IAA), and performed meta-analysis using random-effects model using the RevMan software. RESULTS We identified five eligible studies with 2511 patients in total. Use of irrigation overall did not demonstrate significant increase in IAA (odds ratio [OR] = 2.39, 95% confidence interval [CI; 0.49, 11.74], P = 0.28). For the adult subpopulation, the use of irrigation was associated with nonsignificant lower odds of IAAs (OR = 0.42, 95% CI [0.15, 1.16]), whereas in pediatric with nonsignificant higher risk (OR = 2.98, 95% CI [0.25, 35.34]). Performance of irrigation led to the addition of, on average, 7 min to the duration of the operation (mean difference = 7.16, 95% CI [3.23, 11.09], P < 0.001). Irrigation did not affect postoperative length of stay (mean difference = -0.80, 95% CI [-2.30, 0.69], P = 0.29). CONCLUSIONS Performance of irrigation during laparoscopic appendectomy does not seem to prevent the development of IAA in neither adults nor pediatric patients.
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Affiliation(s)
- Charalampos Siotos
- Department of Surgery, Johns Hopkins University, Baltimore, Maryland; Laboratory of Experimental Surgery and Surgical Research N.S. Christeas, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Konstantinos Stergios
- Laboratory of Experimental Surgery and Surgical Research N.S. Christeas, Medical School, National and Kapodistrian University of Athens, Athens, Greece; Department of General Surgery, Watford General Hospital NHS Trust, Watford, UK
| | - Vishnu Prasath
- Department of Surgery, Johns Hopkins University, Baltimore, Maryland
| | - Stella M Seal
- Welch Medical Library, Johns Hopkins University, Baltimore, Maryland
| | - Mark D Duncan
- Department of Surgery, Johns Hopkins University, Baltimore, Maryland
| | - Joseph V Sakran
- Department of Surgery, Johns Hopkins University, Baltimore, Maryland
| | - Mehran Habibi
- Department of Surgery, Johns Hopkins University, Baltimore, Maryland.
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Prasath V, Harmon JW, DiBrito SR, Blair AB, Habibi M, Duncan MD. Prophylactic Total Gastrectomy for CDH1 Mutation: An Institutional Experience. J Am Coll Surg 2018. [DOI: 10.1016/j.jamcollsurg.2018.08.153] [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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Prasath V, Habibi M. Recent Trends in Local-Regional Recurrence Rates: Implications for Therapeutic Intervention. Curr Breast Cancer Rep 2018. [DOI: 10.1007/s12609-018-0270-2] [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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He L, Tao J, Maity D, Si F, Wu Y, Wu T, Prasath V, Wirtz D, Sun SX. Role of membrane-tension gated Ca 2+ flux in cell mechanosensation. J Cell Sci 2018; 131:jcs208470. [PMID: 29361533 PMCID: PMC5868948 DOI: 10.1242/jcs.208470] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [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: 08/29/2017] [Accepted: 01/12/2018] [Indexed: 01/10/2023] Open
Abstract
Eukaryotic cells are sensitive to mechanical forces they experience from the environment. The process of mechanosensation is complex, and involves elements such as the cytoskeleton and active contraction from myosin motors. Ultimately, mechanosensation is connected to changes in gene expression in the cell, known as mechanotransduction. While the involvement of the cytoskeleton in mechanosensation is known, the processes upstream of cytoskeletal changes are unclear. In this paper, by using a microfluidic device that mechanically compresses live cells, we demonstrate that Ca2+ currents and membrane tension-sensitive ion channels directly signal to the Rho GTPase and myosin contraction. In response to membrane tension changes, cells actively regulate cortical myosin contraction to balance external forces. The process is captured by a mechanochemical model where membrane tension, myosin contraction and the osmotic pressure difference between the cytoplasm and extracellular environment are connected by mechanical force balance. Finally, to complete the picture of mechanotransduction, we find that the tension-sensitive transcription factor YAP family of proteins translocate from the nucleus to the cytoplasm in response to mechanical compression.
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Affiliation(s)
- Lijuan He
- Department of Chemical and Biomolecular Engineering, Johns Hopkins University, Baltimore, Maryland 21218, USA
| | - Jiaxiang Tao
- Department of Mechanical Engineering, Johns Hopkins University, Baltimore, Maryland 21218, USA
| | - Debonil Maity
- Department of Chemical and Biomolecular Engineering, Johns Hopkins University, Baltimore, Maryland 21218, USA
- Physical Sciences in Oncology Center (PSOC), Johns Hopkins University, Baltimore, Maryland 21218, USA
| | - Fangwei Si
- Department of Physics, University of California San Diego, San Diego, CA 92010, USA
| | - Yi Wu
- Department of Cell Biology, University of Connecticut Health Center, Farmington, CT 06030, USA
| | - Tiffany Wu
- Department of Molecular and Cellular Biology, Johns Hopkins University, Baltimore, Maryland 21218, USA
| | - Vishnu Prasath
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, Maryland 21218, USA
| | - Denis Wirtz
- Department of Chemical and Biomolecular Engineering, Johns Hopkins University, Baltimore, Maryland 21218, USA
- Physical Sciences in Oncology Center (PSOC), Johns Hopkins University, Baltimore, Maryland 21218, USA
| | - Sean X Sun
- Department of Mechanical Engineering, Johns Hopkins University, Baltimore, Maryland 21218, USA
- Physical Sciences in Oncology Center (PSOC), Johns Hopkins University, Baltimore, Maryland 21218, USA
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He L, Sneider A, Chen W, Karl M, Prasath V, Wu PH, Mattson G, Wirtz D. Mammalian Cell Division in 3D Matrices via Quantitative Confocal Reflection Microscopy. J Vis Exp 2017. [PMID: 29286363 DOI: 10.3791/56364] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
The study of how mammalian cell division is regulated in a 3D environment remains largely unexplored despite its physiological relevance and therapeutic significance. Possible reasons for the lack of exploration are the experimental limitations and technical challenges that render the study of cell division in 3D culture inefficient. Here, we describe an imaging-based method to efficiently study mammalian cell division and cell-matrix interactions in 3D collagen matrices. Cells labeled with fluorescent H2B are synchronized using the combination of thymidine blocking and nocodazole treatment, followed by a mechanical shake-off technique. Synchronized cells are then embedded into a 3D collagen matrix. Cell division is monitored using live-cell microscopy. The deformation of collagen fibers during and after cell division, which is an indicator of cell-matrix interaction, can be monitored and quantified using quantitative confocal reflection microscopy. The method provides an efficient and general approach to study mammalian cell division and cell-matrix interactions in a physiologically relevant 3D environment. This approach not only provides novel insights into the molecular basis of the development of normal tissue and diseases, but also allows for the design of novel diagnostic and therapeutic approaches.
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Affiliation(s)
- Lijuan He
- Department of Chemical and Biomolecular Engineering, Johns Hopkins University; Johns Hopkins Physical Sciences - Oncology Center, Johns Hopkins University
| | - Alexandra Sneider
- Department of Chemical and Biomolecular Engineering, Johns Hopkins University
| | - Weitong Chen
- Department of Chemical and Biomolecular Engineering, Johns Hopkins University
| | - Michelle Karl
- Department of Chemical and Biomolecular Engineering, Johns Hopkins University
| | - Vishnu Prasath
- Department of Biomedical Engineering, Johns Hopkins University
| | - Pei-Hsun Wu
- Department of Chemical and Biomolecular Engineering, Johns Hopkins University; Johns Hopkins Physical Sciences - Oncology Center, Johns Hopkins University
| | - Gunnar Mattson
- Department of Biomedical Engineering, Johns Hopkins University
| | - Denis Wirtz
- Department of Chemical and Biomolecular Engineering, Johns Hopkins University; Johns Hopkins Physical Sciences - Oncology Center, Johns Hopkins University; Departments of Oncology and Pathology and Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine;
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Kaur K, Singh R, Prasath V, Magu S, Tanwar M. Computed tomographic-based morphometric study of thoracic spine and its relevance to anaesthetic and spinal surgical procedures. J Clin Orthop Trauma 2016; 7:101-8. [PMID: 27182147 PMCID: PMC4857161 DOI: 10.1016/j.jcot.2015.12.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [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: 11/22/2015] [Accepted: 12/18/2015] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND To collect a baseline computer software aided normative morphometric data of thoracic spine in the Indian population and analyze it to give pre-procedural guidelines to clinicians for safe surgical and anaesthetic procedures in the thoracic spine. METHODS CT scans of thoracic spine of patients free from spinal disorders were reviewed in a total of 600 vertebrae in 50 patients. Parameters recorded with the help of computer software were pedicle width, length and height, transverse pedicle angles, chord length, canal dimensions, body width and height, spinous process angle and transverse process length. RESULTS Pedicle width decreased from T1 (9.27 ± 1.01) to T4 (4.5 ± 0.93) and increased to T12 (8.31 ± 1.83). At T4 76% and at T5 62% of the pedicles were smaller than 5 mm and would not accept 4 mm screw with 1.0-mm clearance. However, at T1 2%, at T11 7% and at T12 8% would not accept a 4 mm screw. Chord length gradually increased in upper thoracic vertebrae and was relatively constant in middle and decreased in lower thoracic vertebrae. Shortest estimated chord length was at T1 (30.30 ± 2.11). On an average, from T1 to T6 and at T11 and T12, a screw length of 25-30 mm could be accommodated and from T7 to T10, 30-35 mm screw length could be accommodated. Transverse pedicle angle decreased from T1 (35.4 ± 2.21) to T12 (-9.8 ± 2.39). Canal dimensions were narrowest at T4/T5 (20.02 ± 1.23) in anteroposterior and 21.12 ± 1.23 in interpedicular diameters. Spinous process angle increased from T1 (30.11 ± 6.74) to T6 (57.89 ± 9.31) and decreased to 16.21 ± 7.38 at T12. Transverse process length increased from T1 to T7 (23.54 + 2.12 to 31.21 + 1.91) and then decreased to 12.11 + 2.3 at T12. Vertebral body dimensions showed increasing trends from T1 to T12. CONCLUSIONS A thorough knowledge of anatomical and radiological characteristics of the spine and their variations is essential for the clinicians. Data collected in the present study provides baseline normative values in Indian population and will help in guiding safe and effective completion of both surgical and anaesthetic procedures in the thoracic spine. Computer software aided morphometric data can help in selecting appropriate size and optimal placement of the implant with minimal procedural difficulties and complications during spine surgery.
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Affiliation(s)
- Kiranpreet Kaur
- Assistant Professor, Department of Anaesthesiology & Critical Care, Pt. B.D. Sharma PGIMS, Rohtak, Haryana, India
| | - Roop Singh
- Senior Professor, Department of Orthopaedic Surgery, Paraplegia & Rehabilitation, Pt. B.D. Sharma PGIMS, Rohtak, Haryana, India
| | - Vishnu Prasath
- Ex-Resident, Department of Orthopaedic Surgery, Paraplegia & Rehabilitation, Pt. B.D. Sharma PGIMS, Rohtak, Haryana, India
| | - Sarita Magu
- Senior Professor, Department of Radiology, Pt. B.D. Sharma PGIMS, Rohtak, Haryana, India
| | - Milind Tanwar
- Resident, Department of Orthopaedic Surgery, Paraplegia & Rehabilitation, Pt. B.D. Sharma PGIMS, Rohtak, Haryana, India
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Seenivasan R, Prasath V, Mohanraj R. Restoration of sodic soils involving chemical and biological amendments and phytoremediation by Eucalyptus camaldulensis in a semiarid region. Environ Geochem Health 2015; 37:575-586. [PMID: 25547478 DOI: 10.1007/s10653-014-9674-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2014] [Accepted: 12/23/2014] [Indexed: 06/04/2023]
Abstract
Salt-affected soils in semiarid regions impede the agricultural productivity and degrade the ecosystem health. In South India, several hectares of land are salt-affected, where the evapotranspiration exceeds the annual precipitation. This study is an attempt to ameliorate sodic soils, by an experiment involving chemical treatment (addition of gypsum), organic amendments (decomposed bagasse pith and green manuring with Sesbania rostrata) and phytoremediation by plantation of Eucalyptus camaldulensis. The prime focus is to minimize the use of gypsum and improve the soil health in terms of nutrients, microbial population and enzyme activity in addition to sodicity reclamation. At the end of the third year, a reduction of 10 % in soil pH, 33 % in electrical conductivity and 20 % in exchangeable sodium percentage was achieved compared to the initial values. Three- to fourfold increases in organic carbon content were observed. Significant improvement in the available major and micronutrients of soil, microbial growth and enzyme activity was observed, suggesting phytoremediation by E. camaldulensis as a sustainable option for restoration of similar kind of degraded lands.
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Affiliation(s)
- R Seenivasan
- Department of Environmental Management, Bharathidasan University, Tiruchirappalli, 620024, India
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Gharpure SJ, Prasath V, Kumar V. Stereoselective synthesis of 2,3-disubstituted indoline, pyrrolidine and cyclic ether-fused 1,2-dihydroquinoline derivatives using alkyne iminium ion cyclization of vinylogous carbamates: switch of regioselectivity using an internal hydroxy group as a nucleophile. Chem Commun (Camb) 2015; 51:13623-6. [DOI: 10.1039/c5cc05292k] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
TMSOTf promoted alkyne iminium ion cyclization of vinylogous carbamates gives stereoselective access to indolines, pyrrolidines and dihydroquinolines.
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Affiliation(s)
- Santosh J. Gharpure
- Department of Chemistry
- Indian Institute of Technology Bombay
- Mumbai – 400076
- India
| | - V. Prasath
- Department of Chemistry
- Indian Institute of Technology Bombay
- Mumbai – 400076
- India
| | - Vinod Kumar
- Department of Chemistry
- Indian Institute of Technology Bombay
- Mumbai – 400076
- India
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Gharpure SJ, Prasath V. Stereoselective synthesis of C-fused pyranoindoles, pyranobenzofurans and pyranobenzothiophene scaffolds using oxa-Pictet–Spengler type reaction of vinylogous carbonates. Org Biomol Chem 2014; 12:7397-409. [DOI: 10.1039/c4ob01387e] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
C-fused pyranoheterocycles can be assembled in a highly diastereoselective manner using an intramolecular oxa-Pictet–Spengler type reaction of vinylogous carbonates.
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Affiliation(s)
- Santosh J. Gharpure
- Department of Chemistry
- Indian Institute of Technology Bombay
- Mumbai – 400076, India
| | - V. Prasath
- Department of Chemistry
- Indian Institute of Technology Bombay
- Mumbai – 400076, India
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