Clinical Focus


  • Postdoctoral Fellow
  • Neuro-oncology
  • Fellow

Honors & Awards


  • Future Clinical Researchers in Neurology and Neuroscience Scholarship, American Academy of Neurology (2017)
  • Honors Certificate in Medical Education, Stanford University School of Medicine (2017)
  • Palatucci Advocacy Leadership Forum, American Academy of Neurology (2017)
  • Member, Stanford Society of Physician Scholars (2016)
  • Research Career Development Symposium: How to be Successful in Academic Neuroscience Scholarship, American Academy of Neurology (2016)
  • Translational and Clinical Research Course, American Neurological Association (2016)
  • Neurologist-In-Training Clinical Ethics Elective, American Academy of Neurology (2015-6)
  • Outstanding PGY-1 Resident Award, ETSU James H. Quillen College of Medicine Department of Internal Medicine (2013)
  • 3rd Prize Team (among 78 proposals/44 universities) for “Therapeutic Gaming for Autistic Children”, Center for Integration of Medicine and Innovative Technology (CIMIT) Prize for Primary Healthcare (2009)
  • Dee S. and Patricia Osborne Endowed Scholarship in the Neurosciences, University of Texas MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences (2009)
  • Educational Travel Stipend, International Society for Magnetic Resonance in Medicine 17th Scientific Meeting (2009)
  • Early Career Scholars Program Travel Award, American Society for Bioethics and Humanities (2007)
  • Student of the Year Award, Texas Medical Association Medical Student Section (2007)
  • Daily Point of Light, Points of Light Foundation (2005)
  • Excellence in Medicine Leadership Award, American Medical Association Foundation (2005)
  • Five Outstanding Young Texans Award, Texas Junior Chamber of Commerce Foundation (2005)
  • Lewis Hine Award, National Child Labor Committee (2005)
  • Physician Oncology Education Program Medical Student Scholarship, Texas Medical Association (2004)
  • Diversity Recognition Award, Johns Hopkins University Diversity Leadership Council (2003)
  • Governor's Volunteer & Service Award, Maryland Governor's Office on Service & Volunteerism (2002)
  • Martin Luther King, Jr. Award for Community Service, Johns Hopkins University (2002)

Boards, Advisory Committees, Professional Organizations


  • Member, American Association for Cancer Research (2016 - Present)
  • Member, Society for Neuro-Oncology (2014 - Present)
  • Member, American Physician Scientists Association (2005 - Present)
  • Member, American Academy of Neurology (2005 - Present)
  • Member, Sigma Xi (2005 - Present)

Professional Education


  • Residency, University of California at Los Angeles David Geffen School of Medicine, Adult Neurology
  • Internship, East Tennessee State University James H. Quillen College of Medicine, Internal Medicine
  • MD, University of Texas at Houston McGovern Medical School
  • PhD, University of Texas MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences
  • MSE, Johns Hopkins University, Biomedical Engineering
  • BS, Johns Hopkins University, Biomedical Engineering

Stanford Advisors


Current Clinical Interests


  • Neuro-oncology
  • Neuroimaging
  • Glioblastoma
  • Neurology

Research Projects


  • Stanford Society of Physician Scholars Grant

    Time Period

    2017 - 2017

    Location

    Palo Alto, CA

  • American Brain Tumor Association Basic Research Fellowship (supported by the Ryan J. Hanrahan Memorial)

    Time Period

    2017 - 2019

    Location

    Palo Alto, CA

  • Stanford Cancer Institute Fellowship Award for Cancer Research

    Time Period

    2017 - 2018

    Location

    Palo Alto, CA

  • NINDS Translational Neuroscience R25 Training Grant (R25NS065741)

    Time Period

    2016 - 2017

    Location

    Palo Alto, CA

  • American Medical Association Foundation Research Seed Grant

    Time Period

    2015 - 2016

    Location

    Los Angeles, CA

  • NINDS Translational Neuroscience R25 Training Grant (R25NS065723)

    Time Period

    2015 - 2016

    Location

    Los Angeles, CA

  • Radiological Society of North America Research and Education Foundation Research Medical Student Grant

    Time Period

    2009 - 2009

    Location

    Houston, TX

  • American Medical Association Ethics Group Ethics in Action Grant

    Time Period

    2006 - 2008

    Location

    Houston, TX

  • Epilepsy Foundation of America Health Sciences Student Fellowship

    Time Period

    2002 - 2002

    Location

    Baltimore, MD

  • JHU Whiting School of Engineering Dean's Research Award for Biomedical Engineering Students

    Time Period

    2000 - 2002

    Location

    Baltimore, MD

Graduate and Fellowship Programs


  • Oncology (Fellowship Program)

All Publications


  • Synergistic inhibition of glioma cell proliferation by Withaferin A and tumor treating fields. Journal of neuro-oncology Chang, E., Pohling, C., Beygui, N., Patel, C. B., Rosenberg, J., Ha, D. H., Gambhir, S. S. 2017

    Abstract

    Glioblastoma (GBM) is the most aggressive and lethal form of brain cancer. Standard therapies are non-specific and often of limited effectiveness; thus, efforts are underway to uncover novel, unorthodox therapies against GBM. In previous studies, we investigated Withaferin A, a steroidal lactone from Ayurvedic medicine that inhibits proliferation in cancers including GBM. Another novel approach, tumor treating fields (TTFields), is thought to disrupt mitotic spindle formation and stymie proliferation of actively dividing cells. We hypothesized that combining TTFields with Withaferin A would synergistically inhibit proliferation in glioblastoma. Human glioblastoma cells (GBM2, GBM39, U87-MG) and human breast adenocarcinoma cells (MDA-MB-231) were isolated from primary tumors. The glioma cell lines were genetically engineered to express firefly luciferase. Proliferative potential was assessed either by bioluminescence imaging or cell counting via hemocytometer. TTFields (4 V/cm) significantly inhibited growth of the four cancer cell lines tested (n = 3 experiments per time point, four measurements per sample, p < 0.02 at least; 2-way ANOVA, control vs. treatment). The combination of Withaferin A (10-100 nM) with TTFields significantly inhibited the growth of the glioma cells to a degree beyond that of Withaferin A or TTFields alone. The interaction of the Withaferin A and TTFields on glioma cells was found to be synergistic in nature (p < 0.01, n = 3 experiments). These findings were validated by both bioluminescence and hemocytometric measurements. The combination of Withaferin A with TTFields represents a novel approach to treat GBM in a manner that is likely better than either treatment alone and that is synergistic.

    View details for DOI 10.1007/s11060-017-2534-5

    View details for PubMedID 28681243

  • Needs Assessment of Neuro-Oncology Education in the Stanford School of Medicine’s Undergraduate Medical and Neurology Residency Curricula Second Stanford Innovations in Medical Education Conference Patel, C. B., Pelpola, J. S., Pompei, P., Thomas, R. P.
  • Neurological Manifestations of West Nile Virus at Olive View Ucla Medical Center 2012-2013 American Neurological Association Mishra, S., Patel, C. B., Mathisen, G., Trikamji, B. : S57–8

    View details for DOI 10.1002/ana.24247

  • Unbiased frequency estimation of narrowband signals using Procrustes type subspace rotation IEEE International Conference on Acoustics, Speech, and Signal Processing Paul, J. S., Patel, C. B., Asari, V. K., Sherman, D. L. : 1–4
  • The Impact of a Brief Intervention on Medical Students' Readiness to Screen for DV - Changes in Decisional Balance and Self-Efficacy UTHealth Advances in Teaching and Learning Day Patel, C. B., Benjamins, L. J.
  • MRI Ventral Nerve Root Enhancement In 3 Patients Presenting With Lower Extremity Weakness Secondary To West Nile Virus American Academy of Neurology Patel, C. B., Mishra, S., Trikamji, B., Zipser, B. : P2.311
  • Angiopoietin-1 Reduces Blood-Spinal Cord Barrier Permeability and Lesion Volume in the Acute Phase of Spinal Cord Injury: MRI and Histological Studies Second Joint Symposium of The International & National Neurotrauma Societies Patel, C. B., Narayana, P. A. : A-28

    View details for DOI 10.1089/neu.2009.9953

  • Residual entropy reveals effects of deep brain stimulation on neural activity in PTZ-induced epilepsy 25th Annual International Conference of the IEEE Engineering in Medicine and Biology Society Patel, C. B., Sherman, D. L., Paul, J. S., Zhang, N., Mirski, M. A. : 2281–84
  • 3D Probability Distribution of Treatment Targets: A New Way to Define 3D Organ Motion for Prostate Cancer Radiotherapy American Society for Radiation Oncology Patel, C. B., Wang, H., Zhang, J., Dong, L. : S523
  • A Student-Initiated Elective in Medical Ethics: Innovations in Design and Institutionalization UTHealth Advances in Teaching and Learning Day Muallem, G., Patel, C. B., Boisaubin, E. V.
  • Developing a Novel Therapeutic Game for Children with Autism Spectrum Disorder First AMA-IEEE Conference on Medical Technology Po, M. J., Lin, R., Chen, B., Patel, C. B., Awon, J., Allen, L., Lantz, J., Gerber, A. J.
  • Impact of preoperative radiation dose escalation on pathologic outcomes and radiation toxicity in locally advanced rectal cancer (LARC): A matched-pair analysis American Society of Clinical Oncology Patel, C. B., Kattepogu, K. M., Park, I. J., Eng, C., Delclos, M. E., Feig, B. W., Crane, C. H., Skibber, J. M., Das, P., Rodriguez-Bigas, M. A., Krishnan, S., Chang, G. J. : e14036
  • A single demyelinating attack is enough to limit brain growth in children. Neurology Hacohen, Y., Patel, C. B., Hintzen, R. 2017

    View details for DOI 10.1212/WNL.0000000000003894

    View details for PubMedID 28381511

  • Movements Here Today, Gone Tomorrow: Images in Clinical Neurology Case of Hyperglycemic Hemichorea. The Neurohospitalist Chang, T. S., Patel, C. B., Keener, A. M., Keselman, I., Jamal, N. I. 2017; 7 (3): 150

    View details for DOI 10.1177/1941874416671648

    View details for PubMedID 28634509

    View details for PubMedCentralID PMC5467814

  • Natural Language Processing-Enabled and Conventional Data Capture Methods for Input to Electronic Health Records: A Comparative Usability Study. JMIR medical informatics Kaufman, D. R., Sheehan, B., Stetson, P., Bhatt, A. R., Field, A. I., Patel, C., Maisel, J. M. 2016; 4 (4)

    Abstract

    The process of documentation in electronic health records (EHRs) is known to be time consuming, inefficient, and cumbersome. The use of dictation coupled with manual transcription has become an increasingly common practice. In recent years, natural language processing (NLP)-enabled data capture has become a viable alternative for data entry. It enables the clinician to maintain control of the process and potentially reduce the documentation burden. The question remains how this NLP-enabled workflow will impact EHR usability and whether it can meet the structured data and other EHR requirements while enhancing the user's experience.The objective of this study is evaluate the comparative effectiveness of an NLP-enabled data capture method using dictation and data extraction from transcribed documents (NLP Entry) in terms of documentation time, documentation quality, and usability versus standard EHR keyboard-and-mouse data entry.This formative study investigated the results of using 4 combinations of NLP Entry and Standard Entry methods ("protocols") of EHR data capture. We compared a novel dictation-based protocol using MediSapien NLP (NLP-NLP) for structured data capture against a standard structured data capture protocol (Standard-Standard) as well as 2 novel hybrid protocols (NLP-Standard and Standard-NLP). The 31 participants included neurologists, cardiologists, and nephrologists. Participants generated 4 consultation or admission notes using 4 documentation protocols. We recorded the time on task, documentation quality (using the Physician Documentation Quality Instrument, PDQI-9), and usability of the documentation processes.A total of 118 notes were documented across the 3 subject areas. The NLP-NLP protocol required a median of 5.2 minutes per cardiology note, 7.3 minutes per nephrology note, and 8.5 minutes per neurology note compared with 16.9, 20.7, and 21.2 minutes, respectively, using the Standard-Standard protocol and 13.8, 21.3, and 18.7 minutes using the Standard-NLP protocol (1 of 2 hybrid methods). Using 8 out of 9 characteristics measured by the PDQI-9 instrument, the NLP-NLP protocol received a median quality score sum of 24.5; the Standard-Standard protocol received a median sum of 29; and the Standard-NLP protocol received a median sum of 29.5. The mean total score of the usability measure was 36.7 when the participants used the NLP-NLP protocol compared with 30.3 when they used the Standard-Standard protocol.In this study, the feasibility of an approach to EHR data capture involving the application of NLP to transcribed dictation was demonstrated. This novel dictation-based approach has the potential to reduce the time required for documentation and improve usability while maintaining documentation quality. Future research will evaluate the NLP-based EHR data capture approach in a clinical setting. It is reasonable to assert that EHRs will increasingly use NLP-enabled data entry tools such as MediSapien NLP because they hold promise for enhancing the documentation process and end-user experience.

    View details for PubMedID 27793791

    View details for PubMedCentralID PMC5106560

  • MRI Ventral Nerve Root Enhancement in Five Patients Presenting With Extremity Weakness Secondary to Neuroinvasive West Nile Virus. Journal of clinical neuromuscular disease Patel, C. B., Trikamji, B., Mathisen, G., Yim, C., Zipser, B., Mishra, S. 2016; 18 (1): 41-43

    View details for DOI 10.1097/01.cnd.0000496973.95654.fd

    View details for PubMedID 27552389

  • Multiple calcifying pseudoneoplasms of the neuraxis (MCAPNON): Distinct entity, CAPNON variant, or old neurocysticercosis? Neuropathology : official journal of the Japanese Society of Neuropathology Abdaljaleel, M., Mazumder, R., Patel, C. B., Im, K., Pope, W., Liau, L. M., Vinters, H. V., Yong, W. H. 2016

    Abstract

    We report a case of multiple calcifying pseudoneoplasms of the neuraxis (MCAPNON) with associated multifocal perivascular microcalcifications and vascular calcinosis. Calcifying pseudoneoplasm of the neuraxis (CAPNON) is a very rare condition that may arise in extra-axial and occasionally, in intra-axial locations. Moreover, it is nearly always a solitary mass with only one case with two lesions reported. While the etiology and pathogenesis of CAPNON remains unclear, the histopathology findings of this entity have been well described. We report a case of a 62-year-old woman with 18 calcifying radiologic lesions involving bilateral cerebral hemispheres. Histologically, these lesions have features similar to that reported for CAPNON, including nodular calcification with fibro-osseous components and peripheral histiocytic reaction. The patient had a poorly documented diagnosis of neurocyticercosis 32 years prior, although without tissue confirmation. The lack of detectable cysticercus serum antibody titers, and absence of residual larval or cyst wall tissue render multifocal calcific involution of that parasite unprovable although still plausible. We also raise the possibility of a blood-brain barrier derangement and/or a metabolic disorder as an alternative etiology. Whether this case of MCAPNON shares the same pathogenesis as the usual solitary CAPNON is unclear.

    View details for DOI 10.1111/neup.12349

    View details for PubMedID 27862397

  • The effects of anesthesia on the morphoproteomic expression of head and neck squamous cell carcinoma: a pilot study TRANSLATIONAL RESEARCH Ferrell, J. K., Cattano, D., Brown, R. E., Patel, C. B., Karni, R. J. 2015; 166 (6): 674-682

    View details for DOI 10.1016/j.trsl.2015.09.001

    View details for Web of Science ID 000366444400013

    View details for PubMedID 26423449

  • Challenges and opportunities for reinvigorating the physician-scientist pipeline JOURNAL OF CLINICAL INVESTIGATION Daye, D., Patel, C. B., Ahn, J., Nguyen, F. T. 2015; 125 (3): 883-887

    Abstract

    Physician-scientists, with in-depth training in both medicine and research, are uniquely poised to address pressing challenges at the forefront of biomedicine. In recent years, a number of organizations have outlined obstacles to maintaining the pipeline of physician-scientists, classifying them as an endangered species. As in-training and early-career physician-scientists across the spectrum of the pipeline, we share here our perspective on the current challenges and available opportunities that might aid our generation in becoming independent physician-scientists. These challenges revolve around the difficulties in recruitment and retention of trainees, the length of training and lack of support at key training transition points, and the rapidly and independently changing worlds of medical and scientific training. In an era of health care reform and an environment of increasingly sparse NIH funding, these challenges are likely to become more pronounced and complex. As stakeholders, we need to coalesce behind core strategic points and regularly assess the impact and progress of our efforts with appropriate metrics. Here, we expand on the challenges that we foresee and offer potential opportunities to ensure a more sustainable physician-scientist workforce.

    View details for DOI 10.1172/JCI80933

    View details for Web of Science ID 000350616500001

    View details for PubMedID 25689260

  • Critical appraisal of learning curve for single incision laparoscopic right colectomy SURGICAL ENDOSCOPY AND OTHER INTERVENTIONAL TECHNIQUES Haas, E. M., Nieto, J., Ragupathi, M., Aminian, A., Patel, C. B. 2013; 27 (12): 4499-4503

    Abstract

    Single-incision laparoscopic colectomy (SILC) has emerged as a viable minimally invasive surgical approach with benefits and limitations yet to be fully elucidated. Although shown to be safe and feasible, characterization of the learning curve has not been addressed. Our aim was to identify a learning curve for SILC right hemicolectomy and to determine the incidence of operative failure and complication rates during this phase.Over a 2-year period, data from 54 consecutive SILC cases performed by the same surgeon were tabulated in an institutional review board-approved database. A learning curve was generated utilizing cumulative sum (CUSUM) methodology to assess changes in total operative time (OT) across the case sequence. A separate learning curve was generated utilizing risk-adjusted CUSUM analysis, taking into account patient risk factors (i.e., age, American Society of Anesthesiologists score, body mass index, prior abdominal surgeries, and tumor size for malignant cases) and operative failure (i.e., prolonged OT, conversion to open surgery, intraoperative and 30-day postoperative complications, prolonged length of stay, reoperation, readmission, and mortality).Patients had a mean age of 63.6 ± 11.5 years, mean body mass index of 27.3 ± 3.9 kg/m(2), and median American Society of Anesthesiologists score of 2. Mean OT and length of stay were 123.5 ± 28.9 min and 3.9 ± 2.4 days, respectively. There were no conversions or oncologic failures. Six patients developed 30-day postoperative complications. CUSUM analysis of OT identified achievement of the learning phase after 30 cases. When taking into account both analyses, the rate of operative failure was not statistically different between the initial 30 and the final 24 cases.In our experience, the learning curve is achieved between 30 to 36 cases. Offering this minimally invasive surgical approach does not result in increased complications or harmful results even in the early phases of the learning curve.

    View details for DOI 10.1007/s00464-013-3096-z

    View details for Web of Science ID 000327144800012

    View details for PubMedID 23877765

  • Optical rhinometry in nonallergic irritant rhinitis: a capsaicin challenge study INTERNATIONAL FORUM OF ALLERGY & RHINOLOGY Lambert, E. M., Patel, C. B., Fakhri, S., Citardi, M. J., Luong, A. 2013; 3 (10): 795-800

    Abstract

    Patients with nonallergic irritant rhinitis (NAIR) have symptoms of nasal congestion, nasal irritation, rhinorrhea, and sneezing in response to nasal irritants. We currently have no reliable objective means to quantify these patients' subjective symptoms. In this study, we used the transient receptor potential vanilloid receptor (TRPV1) receptor agonist, capsaicin, as an intranasal challenge while comparing the changes in blood flow with optical rhinometry between subjects with NAIR and healthy controls (HCs).Six HCs and 6 NAIR subjects were challenged intranasally with saline solution followed by increasing concentrations of capsaicin (0.005 mM, 0.05 mM, and 0.5 mM) at 15-minute intervals. We recorded maximum optical density (OD) and numeric analog scores (NAS) for nasal congestion, nasal irritation, rhinorrhea, and sneezing for each subject after each challenge. Correlations between NAS and maximum OD were calculated.Maximum OD increased with increasing concentrations of intranasal capsaicin in NAIR subjects. There were significant differences in maximum OD obtained for 0.05 mM and 0.5 mM capsaicin between NAIR subjects and HCs. Significant differences were found in the NAS for nasal irritation at 0.005 mM, 0.05 mM, and 0.5 mM, and nasal congestion at 0.5 mM. Correlation between maximum OD and mean NAS was most significant for 0.05 mM capsaicin.Optical rhinometry with intranasal capsaicin challenge could prove a viable option in the diagnosis of NAIR. Further studies will investigate its use to monitor a patient's response to pharmacologic therapy and provide further information about the underlying mechanisms of NAIR.

    View details for DOI 10.1002/alr.21184

    View details for Web of Science ID 000328223500004

    View details for PubMedID 23733747

  • Predictive Analytics: The Fifth Clinical Element SOUTHERN MEDICAL JOURNAL Peiris, A. N., Patel, C. B. 2013; 106 (4): 290-291

    View details for DOI 10.1097/SMJ.0b013e31828d95f5

    View details for Web of Science ID 000317104700010

    View details for PubMedID 23558420

  • Diffuse large B-cell lymphoma: A metabolic disorder? The American journal of case reports Tanios, G., Aranguren, I. M., Goldstein, J. S., Patel, C. B. 2013; 14: 518-525

    Abstract

    Patient Male, 81 FINAL DIAGNOSIS: Non-Hodgkin lymphoma Symptoms: General weakness • hypoglycemia • metabolic acidosis- Clinical Procedure: - Specialty: Hematology.Challenging differential diagnosis.B cell lymphoma constitutes 80-85% of cases of Non Hodgkin's lymphoma in the Untied States. Metabolic complications may arise from the disease itself or through its end organ involvement.We describe a case of a diffuse large B cell lymphoma diagnosed by abdominal computed tomography after it initially presented as hypoglycemia not correctable by dextrose infusion that instead resulted in increased anion gap metabolic acidosis with elevated lactate levels.The case illustrates how lymphomas can present unusually with hypoglycemia and lactic acidosis, the latter being an ominous sign that can occur without liver involvement. In this regard, the case demonstrates the metabolic sequelae of lymphoma that should raise suspicion for an underlying process. This has implications for diagnosis, treatment, and patient survival. Attention should be paid especially in the primary care setting in order to minimize delays in diagnosis.

    View details for PubMedID 24349605

  • Efficacy of 3% saline vs. conivaptan in achieving hyponatremia treatment goals. Methodist DeBakey cardiovascular journal Dominguez, M., Perez, J. A., Patel, C. B. 2013; 9 (1): 49-53

    Abstract

    Hyponatremia is the most common electrolyte abnormality encountered in clinical practice, but its optimal management is still evolving. While guidelines for infusion rates of hypertonic saline (HS) have been introduced, there is a risk of underestimating the response in serum sodium concentration after therapy. Guidelines also have evaluated the use of vasopressin receptor antagonists as alternatives or supplements to standard therapies. This single-center retrospective study from The Methodist Hospital (TMH) compared the effect of HS and conivaptan intervention in the management of 49 patients with hyponatremia from January 2009 through November 2010. Demographics, volume status, medical history, medication data, and serum sodium concentration correction over 48 hours were analyzed. No significant difference was noted with regard to age, ethnicity, gender, volume status, use of medications known to cause hyponatremia, or comorbidities. Baseline serum sodium concentration was not significantly different between HS (120.5 ± 3.8 mEq/L) and conivaptan (118.3 ± 6.7 mEq/L) groups. Regardless of whether the patient was euvolemic or hypervolemic, no significant difference was noted in serum sodium concentration at 4, 12, 24, or 48 hours after initiation of treatment or in frequency of over-correction between groups. This study compares the effect of HS to conivaptan intervention in the management of hyponatremia. No significant differences were identified in adherence to treatment guidelines. Further, based on this small retrospective study, neither agent poses a significant risk of over-correction at 4, 24, or 48 hours of therapy.

    View details for PubMedID 23519387

  • Pilot Study Comparing Total Intravenous Anesthesia to Inhalational Anesthesia in Endoscopic Sinus Surgery: Novel Approach of Blood Flow Quantification ANNALS OF OTOLOGY RHINOLOGY AND LARYNGOLOGY Gomez-Rivera, F., Cattano, D., Ramaswamy, U., Patel, C. B., Altamirano, A., Man, L., Luong, A., Chen, Z., Citardi, M. J., Fakhri, S. 2012; 121 (11): 725-732

    Abstract

    We compared anesthesia with sevoflurane-remifentanil hydrochloride (SR) to total intravenous anesthesia with propofol-remifentanil hydrochloride (PR) in patients undergoing endoscopic sinus surgery for chronic rhinosinusitis in terms of sinonasal mucosal blood flow, the surgical field visualization score, and blood loss.We performed a double-blinded prospective study at a tertiary care center in 23 adults scheduled to undergo endoscopic sinus surgery for chronic rhinosinusitis. The patients were randomized to receive SR or PR. The sinonasal mucosal blood flow was measured by optical rhinometry. The surgical field visualization score was based on the Boezaart scale.The groups had similar clinical characteristics. During the 60- to 90-minute and 90- to 120-minute operative time windows, the blood flow was significantly greater in the PR group than in the SR group (p = 0.04 and p = 0.03, respectively). The amounts of blood loss in the PR and SR groups were 152.9 +/- 161.3 mL and 355.9 +/- 393.4 mL, respectively (p = 0.12). The median ratios of the surgical field visualization score to the number of sinuses operated on in the PR and SR groups were 2.1 and 1.8, respectively (p = 0.52).The intraoperative blood flow, as determined by optical rhinometry, was significantly greater with anesthesia with PR than with anesthesia with SR, 1 hour into the procedure; however, this difference did not translate into differences in the amounts of operative blood loss or in the surgical field visualization scores.

    View details for Web of Science ID 000311468000005

    View details for PubMedID 23193905

  • Clinical evaluation of the C-MAC D-Blade videolaryngoscope in severely obese patients: a pilot study BRITISH JOURNAL OF ANAESTHESIA Cattano, D., Corso, R. M., Altamirano, A. V., Patel, C. B., Meese, M. M., Seitan, C., Hagberg, C. A. 2012; 109 (4): 647-648

    View details for DOI 10.1093/bja/aes333

    View details for Web of Science ID 000308886700030

    View details for PubMedID 22976864

  • Prevalence of Bipolar Disorder and Schizophrenia in Houston Outreach Medicine, Education, and Social Services (HOMES) Clinic Patients: Implications for Student-Managed Clinics for Underserved Populations ACADEMIC MEDICINE Welsh, K. J., Patel, C. B., Fernando, R. C., Torres, J. D., Medrek, S. K., Schnapp, W. B., Brown, C. A., Buck, D. S. 2012; 87 (5): 656-661

    Abstract

    Psychiatric conditions require aggressive management that is challenging to provide in free clinics. The purpose of this study was to determine the prevalence of certain mental illnesses and comorbid conditions among the patients of a student-managed free clinic for the homeless.The authors conducted a retrospective analysis of the records of patients who visited the student-run Houston Outreach Medicine, Education, and Social Services (HOMES) Clinic from May 2007 through May 2008. They assessed the prevalence of bipolar disorder and schizophrenia among patients. They compared demographics, health insurance status, comorbid medical conditions, and social habit data of patients with these mental illnesses with those of other clinic patients.Of 286 patients (74.5% male, mean age 45.8 years), 25 (8.7%) had a diagnosis of schizophrenia and 45 (15.7%) had bipolar disorder. Compared with other clinic patients, patients with bipolar disorder or schizophrenia were less likely to be male (P < .0001) and were more likely to have publicly funded insurance (P = .024). They were also more likely to have certain comorbid conditions, including asthma (P = .0004), seizures (P = .0007), kidney disease (P = .01), and heart disease (P = .02).The high prevalence of these mental illnesses combined with the increased burden of medical comorbidity among HOMES Clinic patients has implications for student-managed free clinics, which often operate on limited budgets. Strategies for providing care for these patients in this setting include integrated care, street medicine, and case management.

    View details for DOI 10.1097/ACM.0b013e31824d4540

    View details for Web of Science ID 000303384700029

    View details for PubMedID 22450177

  • Toward a Better Understanding of the Retention of Physician-Scientists in the Career Pipeline ACADEMIC MEDICINE Patel, C. B., Schauberger, E. M., Nguyen, F. T. 2012; 87 (4): 390-391

    View details for DOI 10.1097/ACM.0b013e318248c0ad

    View details for Web of Science ID 000302143200006

    View details for PubMedID 22452911

  • Nutrition Mission. Texas medicine Patel, C. B., Strommen, J. J., Elliott, A. M., Muallem, G., Eissa, M. A. 2012; 108 (4)

    Abstract

    The prevalence rate of childhood obesity in Houston exceeds the national figures. Nutrition Mission, a 14-week health promotion and education intervention, was conducted to determine its feasibility and whether it would increase the nutrition and exercise (NE) knowledge of students in an elementary school. This novel student-initiated program used 44 medical students as volunteer instructors in 3 fifth-grade classrooms in a Houston, Texas, elementary school, in which most of the 35 students were socioeconomically disadvantaged and members of ethnic minorities. Research subjects completed pretests and posttests containing demographic, lifestyle, and knowledge-based multiple-choice questions regarding NE content. The Nutrition Mission intervention consisted of weekly programs between September 2007 and December 2007. Outcomes were measured by responses to NE lifestyle and knowledge questions. We found a significant increase in NE knowledge as a result of the intervention (68.1% compared with 78.1%, P<0.001). Subjects' gender and ethnicity affected responses to 2 lifestyle and 3 knowledge questions. The Nutrition Mission showed that a 14-week health promotion and education intervention conceptualized and implemented by medical students is feasible and can improve elementary school students' knowledge of NE. Future studies will include student volunteers from other health care professions and assess whether improved knowledge contributes to improved measurable health outcomes.

    View details for PubMedID 22714889

  • Intraoperative conversion to open technique: is informed consent implied? journal of clinical ethics Patel, C. B., Cattano, D. 2012; 23 (1): 60-67

    Abstract

    This case raises issues regarding the anesthesia and surgical components of preoperative informed consent and the differing views of anesthesiologists and surgeons with regards to informed consent, in the context of conversion to open surgery from a minimally invasive approach.

    View details for PubMedID 22462385

  • Modified criteria for determining cardiometabolic syndrome in Asian Indians living in the USA: Report from the diabetes among Indian Americans national study INTERNATIONAL JOURNAL OF CARDIOLOGY Kotha, P., Patel, C. B., Vijayaraghavan, K., Patel, T. G., Misra, R. 2012; 155 (2): 343-345

    View details for DOI 10.1016/j.ijcard.2011.12.040

    View details for Web of Science ID 000300233700056

    View details for PubMedID 22261694

  • Single-incision versus conventional laparoscopic sigmoid colectomy: a case-matched series SURGICAL ENDOSCOPY AND OTHER INTERVENTIONAL TECHNIQUES Ramos-Valadez, D. I., Ragupathi, M., Nieto, J., Patel, C. B., Miller, S., Pickron, T. B., Haas, E. M. 2012; 26 (1): 96-102

    Abstract

    Single-incision laparoscopic surgery is an emerging modality that has proven to be safe and feasible for colon resection in multiple case reports and series. Nonetheless, comparative analyses with established techniques are limited in the published literature. We evaluated the efficacy of single-incision laparoscopic colectomy (SILC) for the treatment of sigmoid disease through a matched-case comparison with conventional laparoscopic colectomy (CLC).Twenty patients who underwent single-incision laparoscopic sigmoid resection for benign or malignant disease between July 2009 and September 2010 were matched to patients who underwent conventional laparoscopic sigmoid colectomy. Demographic, intraoperative, and postoperative data were assessed.Twenty SILC and CLC cases each were paired based on gender (p < 1.0), age (p < 0.47), pathology (p < 1.0), and surgical procedure (p < 1.0). Ten patients (50%) in the SILC group and eight patients (40%) in the CLC group had a history of prior abdominal surgery (p < 0.53). There were no conversions to open surgery; however, one SILC procedure (5%) required conversion to CLC (p < 0.31). There was no significant difference in mean operating time between groups (p < 0.80). Mean estimated blood loss was significantly lower for SILC compared to CLC (p < 0.007). Mean lymph node extraction was comparable between groups in the subset of patients with malignant disease (p < 0.68). Two postoperative complications were encountered in each group. The mean length of hospital stay for SILC and CLC was 3.2 ± 1.0 and 3.8 ± 2.1 days, respectively (p < 0.25). There were no readmissions or reoperative interventions in either group.Compared with conventional laparoscopic technique, single-incision laparoscopic surgery results in similar intraoperative and postoperative outcomes. The technique avoids use of multiple trocar sites and may safely be performed in patients with a history of previous abdominal surgery while maintaining a short length of hospital stay and low complication rate.

    View details for DOI 10.1007/s00464-011-1833-8

    View details for Web of Science ID 000298301300014

    View details for PubMedID 21792717

  • Robotic-assisted laparoscopic surgery for restorative proctocolectomy with ileal J pouch-anal anastomosis MINIMALLY INVASIVE THERAPY & ALLIED TECHNOLOGIES Pedraza, R., Patel, C. B., Ramos-Valadez, D. I., Haas, E. M. 2011; 20 (4): 234-239

    Abstract

    Restorative proctocolectomy (RP) with ileal pouch-anal anastomosis (IPAA) is the surgical procedure of choice for chronic ulcerative colitis (CUC). Robotic-assisted laparoscopic surgery (RALS) has been shown to have its greatest merits in colorectal procedures involving the pelvis. The aim of this study was to evaluate the safety and feasibility of RP with IPAA using an innovative robotic technique. A total of five consecutive patients underwent RALS RP with IPAA between August 2008 and February 2010. Patient demographics, intraoperative parameters, and postoperative outcomes were tabulated and assessed. Surgery was indicated for medically intractable CUC in three patients (60%), CUC-related dysplasia in one patient (20%) and CUC-related adenocarcinoma in one patient (20%). An ileal pouch-anal anastomosis was successful in all five cases. The mean operative time was 330 min and estimated blood loss was 200 cc. There were no intraoperative complications or conversions. The mean length of hospital stay was 5.6 days and no patients developed major postoperative complications. RALS is an innovative technique offering technical and visual advantages to the colorectal surgeon and can be offered for those who are seeking restorative proctolectomy for chronic ulcerative colitis.

    View details for DOI 10.3109/13645706.2010.536355

    View details for Web of Science ID 000293245900006

    View details for PubMedID 21417830

  • Xenon exposure in the neonatal rat brain: effects on genes that regulate apoptosis MINERVA ANESTESIOLOGICA Cattano, D., Valleggi, S., Cavazzana, A. O., Patel, C. B., Ma, D., Maze, M., Giunta, F. 2011; 77 (6): 571-578

    Abstract

    In the developing rodent brain, exposure to volatile anesthetics causes widespread neuronal apoptosis in several regions of the brain. Increasing evidence points to a possible neuroprotective role for the anesthetic gas xenon, following neuronal injury. To address this gap in understanding, we explored the transcriptional consequences of xenon in the brains of postnatal day 7 (P7) rats exposed to xenon compared to those of air-breathing animals, with particular emphasis on the mRNA transcript levels of Akt and c-Jun N-terminal kinase kinase 1 (JNKK1), which are important for cell survival and the activation of extrinsic neuroapoptotic pathways, respectively.P7 Sprague/Dawley rats were exposed to air (75% nitrogen, 25% oxygen) or xenon (75% xenon, 25% oxygen) for 120 min (N=6/group). Forebrains were harvested for reverse transcription polymerase chain reaction, which enabled quantification of Akt and JNKK1 mRNA transcripts. Suppression subtractive hybridization was used to explore the "genetic signature" of xenon exposure.Compared to control air-breathing animals, xenon-breathing rats exhibited a 0.7-fold decrease in Akt mRNA expression (P<0.01) and a 1.6-fold increase in JNKK1 mRNA levels (P<0.05).The concomitant decrease in the Akt mRNA expression level and increase in the JNKK1 mRNA transcript level provide evidence that xenon has a neuroapoptotic effect in the developing rodent forebrain. Given these results, further study into the paradoxical neuroprotective and neuroapoptotic effects of xenon is warranted.

    View details for Web of Science ID 000292058300004

    View details for PubMedID 21617619

  • Single-incision laparoscopic colectomy: outcomes of an emerging minimally invasive technique INTERNATIONAL JOURNAL OF COLORECTAL DISEASE Ramos-Valadez, D. I., Patel, C. B., Ragupathi, M., Bokhari, M. B., Pickron, T. B., Haas, E. M. 2011; 26 (6): 761-767

    Abstract

    Single-incision laparoscopic colectomy (SILC) is an emerging procedure in the field of minimally invasive colon and rectal surgery. The purpose of this study was to evaluate the safety and feasibility of this procedure.Between July 2009 and April 2010, SILC was performed for 35 patients presenting with pathology of the colon. Surgical procedures included right hemicolectomy, sigmoid resection, and total colectomy. Demographic data, intraoperative parameters, and short-term postoperative outcomes were assessed.Thirty two of the 35 patients (91.4%) underwent successful completion of SILC while 3 patients required laparoscopic modifications. The mean incision length was 3.4 cm with a range of 2-6 cm. The mean total operative time (OT) for right, left, and total colectomies was 158.8 ± 31.8 min, 127.0 ± 37.1 min, and 216.3 ± 72.6 min, respectively. Overall, the OT was not significantly different between patients with a body mass index (BMI) ≥ 25 kg/m(2) (147.9 ± 47.9 min) compared to those with a BMI <25 kg/m(2) (123.1 ± 40.9 min). In the subset of patients with malignant disease, the mean lymph node extraction was 23.5 ± 12.0 and all margins were negative. There were no intraoperative complications, and the overall mean length of hospital stay was 2.9 ± 1.0 days (range 2-6 days). The postoperative morbidity rate was 11.4%.Single-incision laparoscopic colectomy is a safe and feasible procedure for benign and malignant diseases of the colon. This modality can be successfully applied for various colorectal procedures without conversion to open surgery, resulting in a short length of hospital stay and a minimal short-term complication rate.

    View details for DOI 10.1007/s00384-011-1185-9

    View details for Web of Science ID 000290808900011

    View details for PubMedID 21445554

  • Learning curve for robotic-assisted laparoscopic colorectal surgery SURGICAL ENDOSCOPY AND OTHER INTERVENTIONAL TECHNIQUES Bokhari, M. B., Patel, C. B., Ramos-Valadez, D. I., Ragupathi, M., Haas, E. M. 2011; 25 (3): 855-860

    Abstract

    Robotic-assisted laparoscopic surgery (RALS) is evolving as an important surgical approach in the field of colorectal surgery. We aimed to evaluate the learning curve for RALS procedures involving resections of the rectum and rectosigmoid.A series of 50 consecutive RALS procedures were performed between August 2008 and September 2009. Data were entered into a retrospective database and later abstracted for analysis. The surgical procedures included abdominoperineal resection (APR), anterior rectosigmoidectomy (AR), low anterior resection (LAR), and rectopexy (RP). Demographic data and intraoperative parameters including docking time (DT), surgeon console time (SCT), and total operative time (OT) were analyzed. The learning curve was evaluated using the cumulative sum (CUSUM) method.The procedures performed for 50 patients (54% male) included 25 AR (50%), 15 LAR (30%), 6 APR (12%), and 4 RP (8%). The mean age of the patients was 54.4 years, the mean BMI was 27.8 kg/m(2), and the median American Society of Anesthesiologists (ASA) classification was 2. The series had a mean DT of 14 min, a mean SCT of 115.1 min, and a mean OT of 246.1 min. The DT and SCT accounted for 6.3% and 46.8% of the OT, respectively. The SCT learning curve was analyzed. The CUSUM(SCT) learning curve was best modeled as a parabola, with equation CUSUM(SCT) in minutes equal to 0.73 × case number(2) - 31.54 × case number - 107.72 (R = 0.93). The learning curve consisted of three unique phases: phase 1 (the initial 15 cases), phase 2 (the middle 10 cases), and phase 3 (the subsequent cases). Phase 1 represented the initial learning curve, which spanned 15 cases. The phase 2 plateau represented increased competence with the robotic technology. Phase 3 was achieved after 25 cases and represented the mastery phase in which more challenging cases were managed.The three phases identified with CUSUM analysis of surgeon console time represented characteristic stages of the learning curve for robotic colorectal procedures. The data suggest that the learning phase was achieved after 15 to 25 cases.

    View details for DOI 10.1007/s00464-010-1281-x

    View details for Web of Science ID 000287749900027

    View details for PubMedID 20734081

    View details for PubMedCentralID PMC3044842

  • A Three-Arm (Laparoscopic, Hand-Assisted, and Robotic) Matched-Case Analysis of Intraoperative and Postoperative Outcomes in Minimally Invasive Colorectal Surgery DISEASES OF THE COLON & RECTUM Patel, C. B., Ragupathi, M., Ramos-Valadez, D. I., Haas, E. M. 2011; 54 (2): 144-150

    Abstract

    Robotic-assisted laparoscopic surgery is an emerging modality in the field of minimally invasive colorectal surgery. However, there is a dearth of data comparing outcomes with other minimally invasive techniques. We present a 3-arm (conventional, hand-assisted, and robotic) matched-case analysis of intraoperative and short-term outcomes in patients undergoing minimally invasive colorectal procedures.Between August 2008 and October 2009, 70 robotic cases of the rectum and rectosigmoid were performed. Thirty of these were organized into triplets with conventional and hand-assisted cases based on the following 6 matching criteria: 1) surgeon; 2) sex; 3) body mass index; 4) operative procedure; 5) pathology; and 6) history of neoadjuvant therapy in malignant cases. Demographics, intraoperative parameters, and postoperative outcomes were assessed. Pathological outcomes were analyzed in malignant cases. Data were stratified by postoperative diagnosis and operative procedure.There was no significant difference in intraoperative complications, estimated blood loss (126.1 ± 98.5 mL overall), or postoperative morbidity and mortality among the groups. Robotic technique required longer operative time compared with conventional laparoscopic (P < .01) and hand-assisted (P < .001) techniques; however, this difference was not maintained in cases with low pelvic anastomoses. The overall mean length of stay was 3.3 ± 1.8 days with no significant difference between the groups. Pathological analysis of malignant cases revealed a median lymph node extraction of 17 with no significant difference among the 3 modalities.In this 3-arm case-matched series, the robotic approach results in short-term outcomes comparable to conventional and hand-assisted laparoscopic approaches for benign and malignant diseases of the rectum and rectosigmoid. With 3-dimensional visualization, additional freedom of motion, and improved ergonomics, this enabling technology may play an important role when performing colorectal procedures involving the pelvic anatomy.

    View details for DOI 10.1007/DCR.0b013e3181fec377

    View details for Web of Science ID 000286180000004

    View details for PubMedID 21228660

  • Diagnostic nuclear medicine in the ED AMERICAN JOURNAL OF EMERGENCY MEDICINE Amini, B., Patel, C. B., Lewin, M. R., Kim, T., Fisher, R. E. 2011; 29 (1): 91-101

    Abstract

    Although the decision to use nuclear medicine (NM) modalities in the acute care setting is limited by several factors, there are instances in which the use of NM techniques can provide elegant and efficient solutions to otherwise expensive and resource consuming situations. Herein, we describe the indications and NM techniques used for the evaluation of low-risk patients with chest pain, suspected pulmonary embolus, acute cholecystitis, gastrointestinal bleeding, acute scrotum, and the radiographically occult fracture.

    View details for DOI 10.1016/j.ajem.2009.03.008

    View details for Web of Science ID 000285400500016

    View details for PubMedID 20825918

  • Robotic-assisted laparoscopic surgery for recurrent diverticulitis: experience in consecutive cases and a review of the literature SURGICAL ENDOSCOPY AND OTHER INTERVENTIONAL TECHNIQUES Ragupathi, M., Ramos-Valadez, D. I., Patel, C. B., Haas, E. M. 2011; 25 (1): 199-206

    Abstract

    Robotic-assisted laparoscopic surgery has recently gained enthusiasm for application in colorectal surgery. We present the safety and feasibility of using the da Vinci® robotic system for the surgical treatment of sigmoid diverticulitis.Between August 2008 and November 2009, robotic-assisted laparoscopic anterior rectosigmoid resection (RALS-AR) for diverticulitis was performed in 24 consecutive patients. Demographic data, intraoperative parameters, and postoperative outcomes were assessed.RALS-AR was performed in 14 male (58.3%) and 10 female (41.7%) patients with a diagnosis of recurrent diverticulitis. The mean patient age and BMI were 49.8 ± 9.3 years (range = 30-62 years) and 29.9 ± 6.3 kg/m(2) (range = 15.9-46.9 kg/m(2)), respectively. Disease stratification identified 15 cases of uncomplicated (62.5%) and 9 cases of complicated (37.5%) disease. The procedures required 14.1 ± 6.7 min (range = 6-30 min) for robotic docking, 100.5 ± 31.0 min (range = 50-180 min) for surgeon console time, and 224.2 ± 47.1 min (range = 150-330 min) for the total operative time. Robotic docking and surgeon console time represented 51.9% of the total operative time. A primary colorectal anastomosis was fashioned with avoidance of colostomy in all patients. There were no significant intraoperative complications, and none of the procedures required conversion to open, hand-assisted, or conventional laparoscopic technique. The length of hospital stay was 3.4 ± 2.6 days (range = 2-14 days), and the postoperative complication rate was 12.5% (n = 3). There were no anastomotic leaks, secondary surgical interventions, or hospital readmissions.Robotic-assisted laparoscopic technique is a safe and feasible option for the surgical treatment of diverticulitis. The approach may be offered to patients with uncomplicated or complicated disease, and it results in a short hospital stay and low complication rate.

    View details for DOI 10.1007/s00464-010-1159-y

    View details for Web of Science ID 000285754000030

    View details for PubMedID 20567850

  • Patient Satisfaction and Symptomatic Outcomes Following Stapled Transanal Rectal Resection for Obstructed Defecation Syndrome JOURNAL OF SURGICAL RESEARCH Patel, C. B., Ragupathi, M., Bhoot, N. H., Pickron, T. B., Haas, E. M. 2011; 165 (1): E15-E21

    Abstract

    Obstructed defecation syndrome (ODS) is recognized as a functional (e.g., anismus) and anatomic (e.g., rectocele and rectal intussusception) defecatory disorder of the pelvic floor. This study was designed to evaluate outcomes and patient satisfaction following stapled transanal rectal resection (STARR) for the surgical treatment of ODS.Between May 2006 and July 2009, 37 patients underwent STARR for correction of ODS secondary to rectocele and internal intussusception. Demographic data and postoperative outcomes were tabulated. Symptomatic outcomes were assessed by comparing pre- and postoperative subsets of the Wexner constipation scoring system, and quality outcomes were evaluated with patient satisfaction surveys.Thirty-seven female patients with a mean age of 52.9 ± 11.2 y underwent STARR. All patients had clinically significant rectocele as evidenced on defecography and 81.1% had concomitant internal rectal intussusception. Postoperative complications occurred in 13 patients (35.1%). Two of these patients required re-intervention: dilation of stricture and transanal excision of staple granuloma. Mean quality of life follow-up occurred at 20.3 ± 6.5 mo (median: 20 mo, range: 9-36 mo). Mean preoperative and postoperative constipation subset scores were 11.1 ± 3.6 and 4.6 ± 3.9, respectively (P < 0.00001). Overall outcome was reported as "excellent" or "good" in 71.9% of patients, "adequate" in 15.6%, and "poor" in 12.5%. When asked if they would undergo the procedure again, 81.3% responded affirmatively.The STARR procedure results in improved symptomatic outcomes, high patient satisfaction, and an acceptable complication rate. In selected patients, this minimally invasive approach was an acceptable procedure for the surgical correction of ODS secondary to rectocele and intussusception.

    View details for DOI 10.1016/j.jss.2010.07.045

    View details for Web of Science ID 000285136000002

    View details for PubMedID 21067778

  • Single-Incision Versus Hand-Assisted Laparoscopic Colectomy: A Case-Matched Series JOURNAL OF GASTROINTESTINAL SURGERY Gandhi, D. P., Ragupathi, M., Patel, C. B., Ramos-Valadez, D. I., Pickron, T. B., Haas, E. M. 2010; 14 (12): 1875-1880

    Abstract

    Single-incision laparoscopic colorectal surgery is an emerging modality. We incorporated this technique as an alternative to hand-assisted laparoscopic surgery. We investigated intraoperative and short-term outcomes following single-incision laparoscopic colectomy compared with hand-assisted laparoscopic colectomy.Between July and November 2009, single-incision colorectal procedures were performed and matched to hand-assisted procedures based on five criteria: gender, age, body mass index, pathology, and type of procedure. Demographic, intraoperative, and postoperative data were assessed.Twenty-four pairs of patients with a mean age of 55.1 years and mean body mass index of 28.5 kg/m(2) were matched. The majority of cases (79.2%) were right hemicolectomies. The ranges of incision length were 2-6 cm (single incision) and 5-11 cm (hand-assisted). Mean operating time was significantly longer for single-incision procedures (143.2 min) compared with hand-assisted procedures (112.8 min), p < 0.0004. There was no significant difference in the groups regarding conversions or intraoperative complications (p < 0.083 and p < 1.0, respectively). Mean length of stay for the single-incision approach (2.7 days) was significantly shorter compared with the hand-assisted approach (3.3 days), p < 0.02.Single-incision laparoscopic colectomy is a safe and feasible alternative to hand-assisted laparoscopic surgery. Although the technique required longer operative time, it resulted in smaller incision size and significantly shorter length of hospitalization.

    View details for DOI 10.1007/s11605-010-1355-z

    View details for Web of Science ID 000285070300003

    View details for PubMedID 20922576

  • Robotic-assisted laparoscopic abdominoperineal resection for anal cancer: feasibility and technical considerations INTERNATIONAL JOURNAL OF MEDICAL ROBOTICS AND COMPUTER ASSISTED SURGERY Patel, C. B., Ramos-Valadez, D. I., Haas, E. M. 2010; 6 (4): 399-404

    Abstract

    Robotic-assisted laparoscopic surgery is an emerging technology that may prove advantageous for complex colorectal procedures involving the irradiated pelvis, such as abdominoperineal resection for recurrent anal cancer. The authors' initial experience is presented, with assessment of feasibility, safety, and oncologic principles.Over a 6 month period, five abdominoperineal resections were performed using the da Vinci® robot for recurrent anal cancer in patients initially treated with definitive chemoradiation therapy. Demographics, intraoperative parameters, pathology, and outcomes were assessed.Five patients underwent surgery with a mean age of 58.8 years and body mass index of 24.9 kg m(-2) . The interval between chemoradiation and salvage APR was 14.2 ± 10.0 months. Operative time was 204 ± 39.1 min with robotic docking time 12.2 ± 2.8 min and console time 93.0 ± 24.9 min. The mean estimated blood loss was 150 cc and there were no intraoperative complications. The mean hospital length of stay was 5.4 days. Pathology analysis revealed that all surgical margins were adequate. There was one postoperative complication consisting of a seroma.Robotic-assisted laparoscopic surgery for anal cancer was found to be a safe and feasible procedure. It facilitated enhanced visualization and dissection through deep irradiated pelvic structures.

    View details for DOI 10.1002/rcs.348

    View details for Web of Science ID 000285223000005

    View details for PubMedID 20827795

  • Single Incision Laparoscopic-Assisted Right Hemicolectomy: Technique and Application (With Video) SURGICAL LAPAROSCOPY ENDOSCOPY & PERCUTANEOUS TECHNIQUES Patel, C. B., Ramos-Valadez, D. I., Ragupathi, M., Haas, E. M. 2010; 20 (5): E146-E149

    Abstract

    Most commonly employed for surgery of the gallbladder and appendix, single-incision laparoscopic surgery (SILS) is rapidly evolving in the field of minimally invasive surgery. The purpose of this report is to describe the feasibility and technique for SILS right hemicolectomy, which has not been widely reported.We describe a laparoscopic right hemicolectomy with a modified single-incision technique for the management of a precancerous polyp of the ascending colon.The procedure was successfully performed in 105 minutes using 3 transumbilical trocars placed through a single port, and readily available nonarticulating laparoscopic instruments. In addition, we review the literature of SILS procedures involving the colon and discuss differences between our approach and those reported elsewhere.SILS is a feasible modality applicable to minimally invasive surgery of the colon and can offer benefits to the patient.

    View details for DOI 10.1097/SLE.0b013e3181ee039f

    View details for Web of Science ID 000283486000001

    View details for PubMedID 20975489

  • Single-incision laparoscopic right hemicolectomy: safety and feasibility in a series of consecutive cases SURGICAL ENDOSCOPY AND OTHER INTERVENTIONAL TECHNIQUES Ramos-Valadez, D. I., Patel, C. B., Ragupathi, M., Pickron, T. B., Haas, E. M. 2010; 24 (10): 2613-2616

    Abstract

    Single-incision laparoscopic colectomy (SILC) is rapidly emerging in the field of minimally invasive colon and rectal surgery. This report presents the safety and feasibility of performing SILC right hemicolectomy with the SILS™ Port Multiple Instrument Access Port.Between July 2009 and October 2009, SILC right hemicolectomy was performed for 13 consecutive, unselected patients presenting with benign or malignant pathology. Demographic data, intraoperative parameters, and postoperative outcomes were assessed.For 11 of the 13 patients (84.6%), the SILC procedure was performed with a mean incision length of 3.1 ± 1.1 cm (range, 2.5-6.0 cm) and a mean operative time of 131.5 ± 36.2 min (range, 79-180 min). Two cases required conversion to hand-assisted technique. Overall, the operative time was found to be significantly longer for the patients with a body mass index (BMI) greater than 25 kg/m(2) (152.1 ± 26.6 min) compared with the patients with a BMI less than 25 kg/m(2) (93.3 ± 11.6 min) (p < 0.002). For the subset of patients with malignant disease (five adenocarcinomas and one carcinoid), the mean number of lymph nodes extracted was 26.7 ± 14.5. There were no intraoperative complications, and the overall mean hospital stay was 2.5 ± 0.7 days (range, 2-4 days). One postoperative complication occurred (7.7%).The SILC procedure is a safe and feasible method for benign and malignant diseases requiring a right hemicolectomy. This method results in a low complication rate and a short postoperative hospital stay.

    View details for DOI 10.1007/s00464-010-1017-y

    View details for Web of Science ID 000282181500038

    View details for PubMedID 20364353

  • Management of extensive squamous cell carcinoma on the site of radiation-induced dermatitis with severe fibrosis: a case report J Radiother Pract Patel, C. B., Rashid, R. M., Nguyen, T. H. 2010; 9 (2): 125-8
  • Robotic-Assisted Laparoscopic "Salvage" Rectopexy for Recurrent Ileoanal J-Pouch Prolapse GASTROENTEROLOGY RESEARCH AND PRACTICE Ragupathi, M., Patel, C. B., Ramos-Valadez, D. I., Haas, E. M. 2010

    Abstract

    Total restorative proctocolectomy with ileal pouch-anal anastomosis (RP/IPAA) has become the standard of care for the surgical treatment of ulcerative colitis. Despite its correlation with an excellent quality of life and favorable long-term outcomes, RP/IPAA has been associated with several complications. Prolapse of the ileoanal pouch is a rare and debilitating complication that should be considered in the differential diagnosis of pouch failure. Limited data exist regarding the prevalence and treatment of pouch prolapse. We present the case of a recurrent J-pouch prolapse treated with a novel minimally invasive "salvage" approach involving a robotic-assisted laparoscopic rectopexy with mesh.

    View details for DOI 10.1155/2010/790462

    View details for Web of Science ID 000284930100001

    View details for PubMedID 20414343

    View details for PubMedCentralID PMC2855981

  • Consider using diffusion tensor imaging in Geron phase I trial. AJNR. American journal of neuroradiology Patel, C. B. 2009; 30 (7): E97-?

    View details for DOI 10.3174/ajnr.A1632

    View details for PubMedID 19386734

  • Letter by Patel Regarding Article, "A Primer in Longitudinal Data Analysis" CIRCULATION Patel, C. B. 2009; 120 (4): E25-E25
  • Effect of VEGF Treatment on the Blood-Spinal Cord Barrier Permeability in Experimental Spinal Cord Injury: Dynamic Contrast-Enhanced Magnetic Resonance Imaging JOURNAL OF NEUROTRAUMA Patel, C. B., Cohen, D. M., Ahobila-Vajjula, P., Sundberg, L. M., Chacko, T., Narayana, P. A. 2009; 26 (7): 1005-1016

    Abstract

    Compromised blood-spinal cord barrier (BSCB) is a factor in the outcome following traumatic spinal cord injury (SCI). Vascular endothelial growth factor (VEGF) is a potent stimulator of angiogenesis and vascular permeability. The role of VEGF in SCI is controversial. Relatively little is known about the spatial and temporal changes in the BSCB permeability following administration of VEGF in experimental SCI. Dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) studies were performed to noninvasively follow spatial and temporal changes in the BSCB permeability following acute administration of VEGF in experimental SCI over a post-injury period of 56 days. The DCE-MRI data was analyzed using a two-compartment pharmacokinetic model. Animals were assessed for open field locomotion using the Basso-Beattie-Bresnahan score. These studies demonstrate that the BSCB permeability was greater at all time points in the VEGF-treated animals compared to saline controls, most significantly in the epicenter region of injury. Although a significant temporal reduction in the BSCB permeability was observed in the VEGF-treated animals, BSCB permeability remained elevated even during the chronic phase. VEGF treatment resulted in earlier improvement in locomotor ability during the chronic phase of SCI. This study suggests a beneficial role of acutely administered VEGF in hastening neurobehavioral recovery after SCI.

    View details for DOI 10.1089/neu.2008.0860

    View details for Web of Science ID 000267965500006

    View details for PubMedID 19226205

  • Blood-spinal cord barrier permeability in experimental spinal cord injury: dynamic contrast-enhanced MRI NMR IN BIOMEDICINE Cohen, D. M., Patel, C. B., Ahobila-Vajjula, P., Sundberg, L. M., Chacko, T., Liu, S., Narayana, P. A. 2009; 22 (3): 332-341

    Abstract

    After a primary traumatic injury, spinal cord tissue undergoes a series of pathobiological changes, including compromised blood-spinal cord barrier (BSCB) integrity. These vascular changes occur over both time and space. In an experimental model of spinal cord injury (SCI), longitudinal dynamic contrast-enhanced MRI (DCE-MRI) studies were performed up to 56 days after SCI to quantify spatial and temporal changes in the BSCB permeability in tissue that did not show any visible enhancement on the post-contrast MRI (non-enhancing tissue). DCE-MRI data were analyzed using a two-compartment pharmacokinetic model. These studies demonstrate gradual restoration of BSCB with post-SCI time. However, on the basis of DCE-MRI, and confirmed by immunohistochemistry, the BSCB remained compromised even at 56 days after SCI. In addition, open-field locomotion was evaluated using the 21-point Basso-Beattie-Bresnahan scale. A significant correlation between decreased BSCB permeability and improved locomotor recovery was observed.

    View details for DOI 10.1002/nbm.1343

    View details for Web of Science ID 000264578200012

    View details for PubMedID 19023867

  • Averting the proliferation of acronymophilia. in dermatology: Effectively avoiding ADCOMSUBORDCOMPHIBSPAC JOURNAL OF THE AMERICAN ACADEMY OF DERMATOLOGY Patel, C. B., Rashid, M. R. 2009; 60 (2): 340-344

    View details for DOI 10.1016/j.jaad.2008.10.035

    View details for Web of Science ID 000262617700024

    View details for PubMedID 19150279

  • The effect of dental artifacts, contrast media, and experience on interobserver contouring variations in head and neck anatomy Am J Clin Oncol O'Daniel, J. C., Rosenthal, D. I., Garden, A. S., Barker, J. L., Ahamad, A. A., Ang, K. K., Asper, J. A., Blanco, A. I., de Crevoisier, R., Holsinger, F. C., Patel, C. B., Schwartz, D. L., Wang, H., Dong, L. 2007; 30 (2): 191-8
  • Cultural humility in medicine: beyond the K-20 pipeline. Texas medicine Patel, C. B. 2006; 102 (4): 7-?

    View details for PubMedID 17128753

  • Sinusoidal modeling of ictal activity along a thalamus-to-cortex seizure pathway I: New coherence approaches ANNALS OF BIOMEDICAL ENGINEERING Sherman, D. L., Patel, C. B., Zhang, N., Rossell, L. A., Tsai, Y. C., Thakor, N. V., Mirski, M. A. 2004; 32 (9): 1252-1264

    Abstract

    Understanding associations in neuronal circuitry is critical for tracing epilepsy pathways. Two new methods of measuring coherence between field potentials and EEG channels are proposed for modeling the level of linear association between channels during epileptic seizures. These methods rely upon modeling the repetitive clonic seizure activity as a sum of sinusoids with varying degrees of phase locking. Estimating the amplitude of sinusoids from correlation and cross-correlation time domain data, we can find the coherences from a ratio of these amplitudes. One method utilizes amplitude finding from the multiple signal classification (MUSIC) technique. The other method uses alterations in amplitude of individual sinusoids and their ratios in a matrix pencil equation formed from cross- and auto-correlation matrices. The corresponding generalized eigenvalues of these equations form the coherence ratios. This utilizes the estimation of signal parameters using rotational invariance techniques (ESPRIT) algorithm to arrive at coherence amplitude ratios. Simulations illustrate that the MUSIC method provides better noise immunity as it out-performs the conventional Fourier transform-based method for coherence estimation. Both coherence estimators reflect presence of sinusoidal components that are propagated or not propagated along a particular transmission pathway. We illustrate the value of both methods by examining the strength of correlation between seizure EEG from specific thalamic nuclei and cortex in a rodent model of generalized epilepsy. The pentylenetetrazol (PTZ) chemoconvulsant model in rats reflects selective activation of the anterior thalamic nucleus. Using both methods, this neuronal element has much larger coherence with cortex than another thalamic region, the posterior thalamus (p < 0.05). These methods isolate the unique contribution of anterior thalamus in the formation of an ictal network and corroborate earlier conventional or periodogram techniques.

    View details for Web of Science ID 000223549700008

    View details for PubMedID 15493512

  • Prediction of PTZ-induced seizures using wavelet-based residual entropy of cortical and subcortical field potentials IEEE TRANSACTIONS ON BIOMEDICAL ENGINEERING Paul, J. S., Patel, C. B., Al-Nashash, H., Zhang, N., Ziai, W. C., Mirski, M. A., Sherman, D. L. 2003; 50 (5): 640-648

    Abstract

    Our proposed algorithm for seizure prediction is based on the principle that seizure build-up is always preceded by constantly changing bursting levels. We use a novel measure of residual subband wavelet entropy (RSWE) to directly estimate the entropy of bursts, which is otherwise obscured by the ongoing background activity. Our results are obtained using a slow infusion anesthetized pentylenetetrazol (PTZ) rat model in which we record field potentials (FPs) from frontal cortex and two thalamic areas (anterior and posterior nuclei). In each frequency band, except for the theta-delta frequency bands, we observed a significant build-up of RSWE from the preictal period to the first ictal event (p < or = 0.05) in cortex. Significant differences were observed between cortical and thalamic RSWE (p < or = 0.05) subsequent to seizure development. A key observation is the twofold increase in mean cortical RSWE from the preictal to interictal period. Exploiting this increase, we develop a slope change detector to discern early acceleration of entropy and predict the approaching seizure. We use multiple observations through sequential detection of slope changes to enhance the sensitivity of our prediction. Using the proposed method applied to a cohort of four rats subjected to PTZ infusion, we were able to predict the first seizure episode 28 min prior to its occurrence.

    View details for DOI 10.1109/TBME.2003.810683

    View details for Web of Science ID 000182870900012

    View details for PubMedID 12769440

  • Wilms' tumor suppressor gene (WT1) is expressed in primary breast tumors despite tumor-specific promoter methylation CANCER RESEARCH Loeb, D. M., Evron, E., Patel, C. B., Sharma, P. M., Niranjan, B., Buluwela, L., Weitzman, S. A., Korz, D., Sukumar, S. 2001; 61 (3): 921-925

    Abstract

    We analyzed Wilms' tumor suppressor 1 (WT1) expression and its regulation by promoter methylation in a panel of normal breast epithelial samples and primary carcinomas. Contrary to previous reports, WT1 protein was strongly expressed in primary carcinomas (27 of 31 tumors) but not in normal breast epithelium (1 of 20 samples). Additionally, the WT1 promoter was methylated in 6 of 19 (32%) primary tumors, which nevertheless expressed WT1. The promoter is not methylated in normal epithelium. Thus, although tumor-specific methylation of WT1 is established in primary breast cancer at a low frequency, other transcriptional regulatory mechanisms appear to supercede its effects in these tumors. Our results demonstrate expression of WT1 in mammary neoplasia, and that WT1 may not have a tumor suppressor role in breast cancer.

    View details for Web of Science ID 000167020100027

    View details for PubMedID 11221883