27 results on '"J. Randall Patrinely"'
Search Results
2. Combination anti-PD1 and ipilimumab therapy in patients with advanced melanoma and pre-existing autoimmune disorders
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Andrew Haydon, Shahneen Sandhu, Georgina V Long, Prachi Bhave, Alison Weppler, Matteo S Carlino, Lauren J Brown, Clara Allayous, J. Randall Patrinely Jr, and Alexander A Menzies
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Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,RC254-282 - Abstract
Background Clinical trials of immunotherapy have excluded patients with pre-existing autoimmune disease. While the safety and efficacy of single agent ipilimumab and anti-PD1 antibodies in patients with autoimmune disease has been examined in retrospective studies, no data are available for combination therapy which has significantly higher toxicity risk. We sought to establish the safety and efficacy of combination immunotherapy for patients with advanced melanoma and pre-existing autoimmune diseases.Methods We performed a retrospective study of patients with advanced melanoma and pre-existing autoimmune disease who received combination ipilimumab and anti-PD1 at 10 international centers from March 2015 to February 2020. Data regarding the autoimmune disease, treatment, toxicity and outcomes were examined in patients.Results Of the 55 patients who received ipilimumab and anti-PD1, the median age was 63 years (range 23–83). Forty-six were treated with ipilimumab and nivolumab and nine with ipilimumab and pembrolizumab.Eighteen patients (33%) had a flare of their autoimmune disease including 4 of 7 with rheumatoid arthritis, 3 of 6 with psoriasis, 5 of 10 with inflammatory bowel disease, 3 of 19 with thyroiditis, 1 of 1 with Sjogren’s syndrome, 1 of 1 with polymyalgia and 1 of 1 with Behcet’s syndrome and psoriasis. Eight (44%) patients ceased combination therapy due to flare. Thirty-seven patients (67%) had an unrelated immune-related adverse event (irAE), and 20 (36%) ceased combination immunotherapy due to irAEs. There were no treatment-related deaths. Patients on immunosuppression (OR 4.59; p=0.03) had a higher risk of flare.The overall response rate was 55%, with 77% of responses ongoing. Median progression free survival and overall survival were 10 and 24 months, respectively. Patients on baseline immunosuppression had an overall survival of 11 months (95% CI 3.42 to 18.58) compared with 31 months without (95% CI 20.89 to 41.11, p=0.005).Conclusions In patients with pre-existing autoimmune disease, not on immunosuppression and advanced melanoma, combination ipilimumab and anti-PD1 has similar efficacy compared with previously reported trials. There is a risk of flare of pre-existing autoimmune disorders, particularly in patients with inflammatory bowel disease and rheumatologic conditions, and patients on baseline immunosuppression.
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- 2021
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3. A multicenter characterization of hepatitis associated with immune checkpoint inhibitors
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J. Randall Patrinely, Ben McGuigan, Sunandana Chandra, Sarah E. Fenton, Akansha Chowdhary, Lucy B. Kennedy, Meghan J. Mooradian, Marisa Palmeri, Daniella Portal, Sara N. Horst, Elizabeth A. Scoville, Georgina V. Long, Chanjuan Shi, Janice M. Mehnert, Ryan J. Sullivan, April K. Salama, Jeffrey A. Sosman, Alexander M. Menzies, and Douglas B. Johnson
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hepatitis ,immune checkpoint inhibitors ,survival ,toxicity ,immune-related adverse events ,Immunologic diseases. Allergy ,RC581-607 ,Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,RC254-282 - Abstract
Immune checkpoint inhibitors (ICI) predispose patients to immune-related adverse events (irAEs). Although hepatitis is a potentially lethal toxicity, the timing and outcomes have not been well described. In this retrospective study, patients from six international institutions were included if they were treated with ICIs and developed immune-related hepatitis. Patient and tumor characteristics, and hepatitis management and outcomes were evaluated. Of the 164 patients included, most were male (53.7%) with a median age of 63.0 years. Most patients had melanoma (83.5%) and stage IV disease (86.0%). Median follow-up was 585 days; median OS and PFS were not reached. The initial grade of hepatitis was most often grade 2 (30.5%) or 3 (45.7%) with a median time to onset of 61 days. Patients were most commonly asymptomatic (46.2%), but flu-like symptoms, including fatigue/anorexia (17.1%), nausea/emesis (14.0%), abdominal/back pain (11.6%), and arthralgias/myalgias (8.5%) occurred. Most patients received glucocorticoids (92.1%); the median time to improvement by one grade was 13.0 days, and the median time to complete resolution was 52.0 days. Second-line immunosuppression was required in 37 patients (22.6%), and steroid-dose re-escalation in 45 patients (27.4%). Five patients (3%) died of ICI-hepatitis or complications of hepatitis treatment. Ninety-one patients (58.6%) did not resume ICI; of 66 patients (40 grade 1/2, 26 grade 3/4) that were rechallenged, only 25.8% (n = 17) had recurrence. In this multi-institutional cohort, immune-related hepatitis was associated with excellent outcomes but frequently required therapy discontinuation, high-dose steroids, and second-line immunosuppression. Rechallenge was associated with a modest rate of hepatitis recurrence.
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- 2021
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4. Abstract 12: Ethics Education in Plastic Surgery Training Programs
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J. Randall Patrinely, Jr, Brian C. Drolet, Galen Perdikis, and Jeffrey Janis
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Surgery ,RD1-811 - Published
- 2019
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5. On the cusp: Considering the impact of artificial intelligence language models in healthcare
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Rachel S. Goodman, J. Randall Patrinely, Travis Osterman, Lee Wheless, and Douglas B. Johnson
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General Medicine - Published
- 2023
6. Plastic Surgeons as Institutional Leaders
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Matthew J. Davis, Berkay Başağaoğlu, J. Randall Patrinely, Edward M. Reece, Galen Perdikis, Larry H. Hollier, and Amjed Abu-Ghname
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Medical education ,business.industry ,education ,Specialty ,MEDLINE ,030230 surgery ,Officer ,03 medical and health sciences ,surgical procedures, operative ,0302 clinical medicine ,030220 oncology & carcinogenesis ,Statistical analyses ,Honor ,Credibility ,Health care ,Medicine ,Surgery ,business ,health care economics and organizations ,National leadership - Abstract
Background Physicians, especially plastic surgeons, are underrepresented in hospital leadership. As such, the steps an aspiring plastic surgeon should take toward assuming a high-level administrative role remain unclear. The authors aim to profile the chief executive officers and surgeons-in-chief at top-ranked U.S. hospitals with the goal of better characterizing the attributes of institutional leaders. Methods Chief executive officers and surgeons-in-chief at top-ranking hospitals in the 2019 to 2020 U.S. News and World Report "Best Hospitals Honor Roll" were included in this study. For each leader, sex, title, degrees, years of experience, total number of publications, practice specialty (for physician leaders), and previous leadership roles in national societies were reviewed. Descriptive statistical analyses were performed. Results A total of 99 leadership positions at 66 institutions were included. Of these, 67 were chief executive officers and 32 were surgeons-in-chief. Overall, 28 of 67 chief executive officers (42 percent) were physicians-23 nonsurgeons and five surgeons. Of all surgeon executives, only two were plastic surgeons, and both were surgeons-in-chief. The "average" physician-chief executive officer had 24 years of experience, no M.B.A., over 100 publications, zero to one fellowship, and was involved in national leadership. There was no difference in professional qualifications (defined as years of experience, business training, number of publications and fellowships, and leadership positions) between nonsurgeon- and surgeon-chief executive officers, or between plastic surgeons and other surgeons in leadership positions. Conclusions Despite possessing adequate qualifications, plastic surgeons are underrepresented in American health care institutional leadership roles. Aspiring plastic surgeon leaders should lean on their peer credibility and experience delivering patient-centered care to succeed in leadership roles.
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- 2020
7. The modern dermatology program director: A cross-sectional study on personal and professional characteristics
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J. Randall Patrinely and Anna K. Dewan
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Adult ,Male ,Medical education ,Cross-sectional study ,business.industry ,Sexism ,Internship and Residency ,Program director ,Dermatology ,Middle Aged ,United States ,Leadership ,Cross-Sectional Studies ,Educational Status ,Humans ,Medicine ,Female ,business - Published
- 2021
8. Supraorbital Neuralgia Associated With Thyroid Eye Disease
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Kristy L. Hamilton, Charles N. S. Soparkar, Robert B. Parke, J. Randall Patrinely, and James R. Patrinely
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medicine.medical_specialty ,Eye disease ,03 medical and health sciences ,0302 clinical medicine ,Humans ,Medicine ,Strabismus ,PERIORBITAL PAIN ,Retrospective Studies ,business.industry ,Thyroid ,Retrospective cohort study ,General Medicine ,medicine.disease ,humanities ,Surgery ,Inactive phase ,Graves Ophthalmopathy ,Ophthalmology ,Supraorbital neuralgia ,medicine.anatomical_structure ,030221 ophthalmology & optometry ,Etiology ,Neuralgia ,business ,Orbit - Abstract
PURPOSE To identify the relationship between thyroid eye disease (TED) and supraorbital neuralgia (SON) and establish a reliable approach to the diagnosis and management of TED-associated SON. METHODS This retrospective study included 1,126 patients. Demographics, active and inactive phase status and duration, and reactivation rate were noted. TED clinical activity was determined using the vision, inflammation, strabismus, and appearance assessment system, and TED severity was classified using the European Group of Graves' Orbitopathy system. Subtypes of periorbital pain were identified, and suspected SON was confirmed by supraorbital nerve block. RESULTS Of the study's 1,126 patients, 935 (83%) were deemed "active" at some point during the follow up and 34 (3%) remained "active" at the study's conclusion. Of the 2,251 eyes studied, 1,193 (53%) underwent orbital decompression. Of the 1,126 patients, 946 (84%) reported a retrobulbar "pressure" or "aching," but a distinct, more debilitating pain suggestive of SON was reported in 91 (8%). All 91 patients were given a supraorbital nerve block, and all had complete pain resolution lasting from hours to weeks. Eighty-eight (97%) of the 91 patients with SON-type pain underwent orbital decompression compared to 496 (48%) of the 1,035 without SON-type pain (p < 0.00001). A difference was found in the rate of TED reactivation between those with SON-type symptoms (8%) as compared to those without (2%), p = 0.01. CONCLUSIONS SON of uncertain etiology appears to be a previously underreported but significant pain associated with TED. Paradoxically, although the SON does not appear to be related to the type or severity of TED on standard rating scales, the presence of SON was found to be associated with increased likelihood of both orbital decompression and TED reactivation.
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- 2020
9. Trigger Finger Corticosteroid Injection With and Without Local Anesthetic: A Randomized, Double-Blind Controlled Trial
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Shepard P. Johnson, Brian C. Drolet, and J. Randall Patrinely
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Triamcinolone acetonide ,Lidocaine ,medicine.drug_class ,Placebo ,030207 dermatology & venereal diseases ,03 medical and health sciences ,0302 clinical medicine ,Adrenal Cortex Hormones ,medicine ,Humans ,Orthopedics and Sports Medicine ,Anesthetics, Local ,Surgery Articles ,030222 orthopedics ,business.industry ,Local anesthetic ,medicine.disease ,Epinephrine ,Trigger Finger Disorder ,Anesthesia ,Anesthetic ,Corticosteroid ,Surgery ,Trigger finger ,business ,Anesthesia, Local ,medicine.drug - Abstract
Background: The first-line treatment for trigger finger is a corticosteroid injection. Although the injectable solution is often prepared with a local anesthetic, we hypothesize that patients receiving an injection with anesthetic will experience more pain at the time of injection. Methods: C Patients with trigger finger were prospectively randomized into 2 cohorts to receive triamcinolone (1 mL, 40 mg) plus 1% lidocaine with epinephrine (1 mL) or triamcinolone (1 mL, 40 mg) plus normal saline (1 mL, placebo). Both patient and surgeon were blinded to the treatment arm. The primary outcome was pain measured using a (VAS) immediately following the injection. Results: Seventy-three patients with a total of 110 trigger fingers were enrolled (57 lidocaine with epinephrine and 53 placebo). Immediate postinjection pain scores were significantly higher for injections containing lidocaine with epinephrine compared with placebo (VAS 3.5 vs 2.0). Conclusions: In the treatment of trigger finger, corticosteroid injections are effective and have relatively little associated pain. This study shows there is more injection-associated pain when lidocaine with epinephrine is included with the corticosteroid. Therefore, surgeons looking to decrease injection pain should exclude the anesthetic, but they should discuss the trade-off of foregoing short-term anesthesia with patients. Using only a single drug (ie, corticosteroid alone) is not only less painful but is also more simple, efficient, and safe; this has therefore become our preferred treatment method.
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- 2019
10. Association of Adjuvant Immunotherapy Duration With Chronic Immune-Related Adverse Events-Reply
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Douglas B. Johnson, J. Randall Patrinely, and Fei Ye
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Oncology ,Cancer Research ,medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,MEDLINE ,Immunotherapy ,Immune system ,Nivolumab ,Internal medicine ,medicine ,Humans ,Immunologic Factors ,Duration (project management) ,Adverse effect ,business ,Adjuvant - Published
- 2021
11. USMLE Step 1 Changes: Dermatology Program Director Perspectives and Implications
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Danny Zakria, Brian C. Drolet, and J. Randall Patrinely
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Medical education ,business.industry ,MEDLINE ,Medicine ,Program director ,Humans ,Internship and Residency ,Dermatology ,Educational Measurement ,business ,Licensure, Medical ,United States - Published
- 2021
12. The Importance of Financial Metrics in Physician Funding and Performance Evaluation
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Amjed Abu-Ghname, J. Randall Patrinely, Antonio J. Forte, Umraz Khan, Brian C. Drolet, Sallie H. Walker, Matthew J. Davis, Gabriella E. Glassman, and Galen Perdikis
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Finance ,Relative value ,Leverage (finance) ,Contribution margin ,business.industry ,Financial Contributions ,030230 surgery ,03 medical and health sciences ,Benchmarking ,0302 clinical medicine ,Resource (project management) ,Multicenter study ,030220 oncology & carcinogenesis ,Transparency (graphic) ,Medicine ,Surgery ,Performance indicator ,Surgery, Plastic ,business - Abstract
BACKGROUND Financial key performance indicators are often used to evaluate performance. Understanding of key performance indicators can be crucial for career advancement and bargaining leverage in resource negotiations. This study aimed to identify the most important key performance indicators used in surgical funding requests and understand how to use these metrics in clinical practice. METHODS In two tertiary medical centers, funding requests for surgeon gap support (2019 to 2020) and equipment (2017 to 2019) within departments of surgery were reviewed. The requesting department, approval status, and amount allotted were recorded. In requests for gap support, projections for contribution margin, operating room volume, charges, collections, and relative value units were tracked. Projected contribution margin and cost savings were recorded for equipment funding requests. RESULTS There were 40 gap support and 24 equipment requests, and all were approved. Most gap support requests included collections (90.0 percent), charges (87.5 percent), operating room cases (80.0 percent), relative value units (77.5 percent), and hospital contribution margin (77.5 percent). The most represented departments were general surgery (37.5 percent), neurosurgery (22.5 percent), and plastic surgery (15.0 percent). The departments that submitted the most equipment requests were general surgery (28.0 percent) and neurosurgery (28.0 percent). Most requests included projections for contribution margin (95.8 percent) and cost savings (87.4 percent). Projected hospital contribution margin correlated with the amount of funds allotted for surgeon support (r = 0.409; p = 0.022). CONCLUSIONS This multicenter study identified the importance of using key performance indicators for a successful financial outcome in funding requests. In addition, the authors demonstrate the need for surgeons to understand their own key performance indicators. Surgeons should advocate for increased transparency to better understand their financial contributions and performance.
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- 2021
13. A multicenter characterization of hepatitis associated with immune checkpoint inhibitors
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Sarah E. Fenton, April K.S. Salama, Sunandana Chandra, Lucy Boyce Kennedy, Georgina V. Long, Akansha Chowdhary, Chanjuan Shi, Daniella E Portal, J. Randall Patrinely, Sara N. Horst, Marisa Palmeri, Janice M. Mehnert, Alexander M. Menzies, Douglas B. Johnson, Meghan J. Mooradian, Jeffrey A. Sosman, Elizabeth A. Scoville, Ryan J. Sullivan, and Ben McGuigan
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0301 basic medicine ,Male ,medicine.medical_specialty ,Nausea ,medicine.medical_treatment ,Immunology ,Gastroenterology ,Asymptomatic ,survival ,Hepatitis ,immune checkpoint inhibitors ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,medicine ,Immunology and Allergy ,Humans ,Adverse effect ,Melanoma ,RC254-282 ,Original Research ,Retrospective Studies ,business.industry ,Infant, Newborn ,Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,toxicity ,Retrospective cohort study ,Immunosuppression ,RC581-607 ,medicine.disease ,Discontinuation ,030104 developmental biology ,Oncology ,030220 oncology & carcinogenesis ,Cohort ,immune-related adverse events ,Immunologic diseases. Allergy ,medicine.symptom ,Neoplasm Recurrence, Local ,business ,Research Article - Abstract
Immune checkpoint inhibitors (ICI) predispose patients to immune-related adverse events (irAEs). Although hepatitis is a potentially lethal toxicity, the timing and outcomes have not been well described. In this retrospective study, patients from six international institutions were included if they were treated with ICIs and developed immune-related hepatitis. Patient and tumor characteristics, and hepatitis management and outcomes were evaluated. Of the 164 patients included, most were male (53.7%) with a median age of 63.0 years. Most patients had melanoma (83.5%) and stage IV disease (86.0%). Median follow-up was 585 days; median OS and PFS were not reached. The initial grade of hepatitis was most often grade 2 (30.5%) or 3 (45.7%) with a median time to onset of 61 days. Patients were most commonly asymptomatic (46.2%), but flu-like symptoms, including fatigue/anorexia (17.1%), nausea/emesis (14.0%), abdominal/back pain (11.6%), and arthralgias/myalgias (8.5%) occurred. Most patients received glucocorticoids (92.1%); the median time to improvement by one grade was 13.0 days, and the median time to complete resolution was 52.0 days. Second-line immunosuppression was required in 37 patients (22.6%), and steroid-dose re-escalation in 45 patients (27.4%). Five patients (3%) died of ICI-hepatitis or complications of hepatitis treatment. Ninety-one patients (58.6%) did not resume ICI; of 66 patients (40 grade 1/2, 26 grade 3/4) that were rechallenged, only 25.8% (n = 17) had recurrence. In this multi-institutional cohort, immune-related hepatitis was associated with excellent outcomes but frequently required therapy discontinuation, high-dose steroids, and second-line immunosuppression. Rechallenge was associated with a modest rate of hepatitis recurrence.
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- 2021
14. A Multicenter Analysis of Immune Checkpoint Inhibitors as Adjuvant Therapy Following Treatment of Isolated Brain Metastasis
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Geoffrey T. Gibney, Matteo S. Carlino, Khang Nguyen, Elisa Funck-Brentano, Joe-Elie Salem, Douglas B. Johnson, J. Randall Patrinely, Suthee Rapisuwon, Vanderbilt University School of Medicine [Nashville], Biomarqueurs et essais cliniques en Cancérologie et Onco-Hématologie (BECCOH), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)-Université Paris-Saclay, Westmead Hospital [Sydney], Georgetown Lombardi Comprehensive Cancer Center, Unité de Recherche sur les Maladies Cardiovasculaires, du Métabolisme et de la Nutrition = Institute of cardiometabolism and nutrition (ICAN), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-CHU Pitié-Salpêtrière [AP-HP], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Unité de Recherche sur les Maladies Cardiovasculaires, du Métabolisme et de la Nutrition = Research Unit on Cardiovascular and Metabolic Diseases (ICAN), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU)-Institut de Cardiométabolisme et Nutrition = Institute of Cardiometabolism and Nutrition [CHU Pitié Salpêtrière] (IHU ICAN), CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), and HAL-SU, Gestionnaire
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Cancer Research ,medicine.medical_specialty ,Combination therapy ,medicine.medical_treatment ,Ipilimumab ,Radiosurgery ,Metastasis ,03 medical and health sciences ,0302 clinical medicine ,Adjuvant therapy ,Medicine ,Combined Modality Therapy ,Humans ,030212 general & internal medicine ,Immune Checkpoint Inhibitors ,Retrospective Studies ,[SDV.MHEP] Life Sciences [q-bio]/Human health and pathology ,business.industry ,Brain Neoplasms ,medicine.disease ,3. Good health ,Surgery ,Oncology ,030220 oncology & carcinogenesis ,Nivolumab ,Neoplasm Recurrence, Local ,business ,Brief Communications ,[SDV.MHEP]Life Sciences [q-bio]/Human health and pathology ,medicine.drug ,Brain metastasis - Abstract
Background The objective of this work was to characterize outcomes of patients with isolated brain metastases managed with local therapy followed by immune checkpoint inhibitor (ICI) therapy. Materials and Methods Patients from four medical centers were included if they presented with isolated brain metastases treated with local therapy and received adjuvant treatment with ICIs. Results Eleven patients with median size of largest brain metastasis of 3.9 cm, treated with surgical resection (n = 8) and/or stereotactic radiosurgery (SRS; n = 6), were included. Ipilimumab/nivolumab was the adjuvant ICI used in four patients, of whom one recurred (25%) and none died, compared with three of seven (43%) who recurred and two of seven (29%) who died following adjuvant treatment with ICI monotherapy. All recurrences were intracranial. Conclusion Patients with isolated brain metastases treated with surgery or SRS appeared to benefit from adjuvant ICI therapy, particularly with combination therapy. Recurrences in this setting appear to largely occur intracranially.
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- 2020
15. Clinical Characteristics, Disease Course, and Outcomes of Patients With Acute Generalized Exanthematous Pustulosis in the US
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Andrew, Creadore, Sheena, Desai, Allireza, Alloo, Anna K, Dewan, Mina, Bakhtiar, Carla, Cruz-Diaz, Alisa, Femia, Lindy, Fox, Kimberly L, Katz, Robert, Micheletti, Caroline A, Nelson, Alex G, Ortega-Loayza, J Randall, Patrinely, Molly, Plovanich, Misha, Rosenbach, Sheila, Shaigany, Bridget E, Shields, Jamal Z, Saleh, Zakariyah, Sharif-Sidi, Kanade, Shinkai, Jacob, Smith, Chang, Su, Karolyn A, Wanat, Jill K, Wieser, Shari, Wright, Megan H, Noe, and Arash, Mostaghimi
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Acute Generalized Exanthematous Pustulosis ,Adolescent ,Humans ,Female ,Dermatology ,Middle Aged ,Glucocorticoids ,Anti-Bacterial Agents ,Retrospective Studies ,Skin ,Original Investigation - Abstract
IMPORTANCE: Acute generalized exanthematous pustulosis (AGEP) is a rare, severe cutaneous adverse reaction associated with systemic complications. Currently available data are largely limited to small retrospective case series. OBJECTIVE: To describe the clinical characteristics, disease course, and outcomes of a heterogeneous group of patients with AGEP across the US. DESIGN, SETTING, AND PARTICIPANTS: A retrospective review of a case series of patients was conducted from January 1, 2000, through July 31, 2020. All 340 included cases throughout 10 academic health systems in the US were scored retrospectively using the EuroSCAR scoring system, and patients with a score corresponding to probable or definite AGEP and aged 18 years or older were included. MAIN OUTCOMES AND MEASURES: Patient demographic characteristics, clinical course, suspected causative agent, treatment, and short- and long-term outcomes. RESULTS: Most of the 340 included patients were women (214 [62.9%]), White (206 [60.6%]), and non-Hispanic (239 [70.3%]); mean (SD) age was 57.8 (17.4) years. A total of 154 of 310 patients (49.7%) had a temperature greater than or equal to 38.0 °C that lasted for a median of 2 (IQR, 1-4) days. Of 309 patients, 263 (85.1%) developed absolute neutrophilia and 161 patients (52.1%) developed either absolute or relative eosinophilia. Suspected causes of AGEP were medications (291 [85.6%]), intravenous contrast agents (7 [2.1%]), infection (3 [0.9%]), or unknown (39 [11.5%]). In 151 cases in which a single medication was identified, 63 (41.7%) were β-lactam antimicrobials, 51 (33.8%) were non–β-lactam antimicrobials, 9 (6.0%) were anticonvulsants, and 5 (3.3%) were calcium channel blockers. The median time from medication initiation to AGEP start date was 3 (IQR, 1-9) days. Twenty-five of 298 patients (8.4%) had an acute elevation of aspartate aminotransferase and alanine aminotransferase levels, with a peak at 6 (IQR, 3-9) days. Twenty-five of 319 patients (7.8%) experienced acute kidney insufficiency, with the median time to peak creatinine level being 4 (IQR, 2-5) days after the AGEP start date. Treatments included topical corticosteroids (277 [81.5%], either alone or in combination), systemic corticosteroids (109 [32.1%]), cyclosporine (10 [2.9%]), or supportive care only (36 [10.6%]). All-cause mortality within 30 days was 3.5% (n = 12), none of which was suspected to be due to AGEP. CONCLUSIONS AND RELEVANCE: This retrospective case series evaluation of 340 patients, the largest known study cohort to date, suggests that AGEP onset is acute, is usually triggered by recent exposure to an antimicrobial, may be associated with liver or kidney complications in a minority of patients, and that discontinuation of the triggering treatment may lead to improvement or resolution.
- Published
- 2022
16. Cover Image
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Inga Saknite, Zijun Zhao, J. Randall Patrinely, Michael Byrne, Madan Jagasia, and Eric R. Tkaczyk
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Physiology ,Physiology (medical) ,Cardiology and Cardiovascular Medicine ,Molecular Biology - Published
- 2020
17. The Discrepancy Between Perceived Importance and Actual Delivery of Business Education in Residency: A Survey of Program Directors
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Edward M. Reece, Matthew J. Davis, Amjed Abu-Ghname, Galen Perdikis, and J. Randall Patrinely
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Response rate (survey) ,Surgeons ,Medical education ,business.industry ,Business education ,MEDLINE ,Internship and Residency ,030230 surgery ,Surgical training ,Business curriculum ,United States ,03 medical and health sciences ,0302 clinical medicine ,Education, Medical, Graduate ,030220 oncology & carcinogenesis ,Surveys and Questionnaires ,Health care ,Medicine ,Humans ,Surgery ,Curriculum ,Surgery, Plastic ,business ,Graduation - Abstract
Background In the contemporary healthcare environment, there is a need for physicians to understand business fundamentals. Nonsurgical residencies have implemented formal business education, but surgical training programs have been slower to adapt. Further research is needed to evaluate the status of business education in plastic surgery residency. Methods A 12-question survey was created. Ninety program director (PD) e-mails were obtained and the survey was distributed using SurveyMonkey. The survey evaluated program demographics and current resources, commitments, and attitudes toward business training. The survey also identified the most important topics to include in a business curriculum. Results Thirty-six surveys were completed (response rate = 40%). Whereas most PDs agreed that business education in plastic surgery residency was important (78%) and that their programs should have more business training (73%), only 39% currently offered business training. Only 42% of PDs believed that their chief residents were competent to handle the business aspects of plastic surgery upon graduation. No programs offered a formal gap year to pursue a professional business degree. The most important topics identified for a business curriculum were economics and finance (83.3%), management (64%), and marketing (53%). Conclusions There is disconnect between perceived importance and resources available for plastic surgery residents to receive business education. Increased attention is needed to resolve this discrepancy to ensure that future plastic surgeons are equipped to excel in their personal careers and stimulate the advancement of the field. Future research should aim to outline a business curriculum for plastic surgery trainees.
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- 2020
18. Post-transplant Leukocyte Motion in Human Skin Microvasculature by Noninvasive Reflectance Confocal Video Microscopy
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Inga Saknite, Zijun Zhao, Madan Jagasia, Eric R. Tkaczyk, Michael Byrne, and J. Randall Patrinely
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Hematopoietic cell ,business.industry ,Confocal ,Human skin ,Video microscopy ,Reflectivity ,Post transplant ,law.invention ,Transplantation ,Confocal microscopy ,law ,Medicine ,business ,Biomedical engineering - Abstract
We explore the potential of reflectance confocal video microscopy of human skin microvasculature to noninvasively track immune cell activity following hematopoietic cell transplantation. In three patients, we tracked leukocyte-endothelial interactions over time.
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- 2020
19. Chronic Immune-Related Adverse Events Following Adjuvant Anti–PD-1 Therapy for High-risk Resected Melanoma
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Andrew Haydon, Rebecca N. Johnson, Hui Ling Yeoh, Georgina V. Long, Janice M. Mehnert, Prachi Bhave, Aleigha Lawless, J. Randall Patrinely, Alexander M. Menzies, Elizabeth J. Davis, Marisa Palmeri, Run Fan, Suthee Rapisuwon, Ryan J. Sullivan, Matteo S. Carlino, Douglas B. Johnson, Iman Osman, Amelia Sawyers, Maya Dimitrova, and Fei Ye
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Cancer Research ,medicine.medical_specialty ,Myocarditis ,business.industry ,Incidence (epidemiology) ,Arthritis ,medicine.disease ,Discontinuation ,03 medical and health sciences ,0302 clinical medicine ,Oncology ,030220 oncology & carcinogenesis ,Internal medicine ,Adjuvant therapy ,Medicine ,030212 general & internal medicine ,Colitis ,business ,Adverse effect ,Cohort study - Abstract
Importance Agents targeting programmed cell death 1 (PD-1)/PD ligand 1 (PD-L1) improve long-term survival across many advanced cancers and are now used as adjuvant therapy for resected stage III and IV melanomas. The incidence and spectrum of chronic immune-related adverse events (irAEs) have not been well defined. Objective To determine the incidence, time course, spectrum, and associations of chronic irAEs arising from adjuvant anti-PD-1 therapy. Design, setting, and participants This retrospective multicenter cohort study was conducted between 2015 and 2020 across 8 academic medical centers in the United States and Australia. Patients with stage III to IV melanomas treated with anti-PD-1 in the adjuvant setting were included. Main outcomes and measures Incidence, types, and time course of chronic irAEs (defined as irAEs persisting at least 12 weeks after therapy cessation). Results Among 387 patients, the median (range) age was 63 (17-88) years, and 235 (60.7%) were male. Of these patients, 267 (69.0%) had any acute irAE, defined as those arising during treatment with anti-PD-1, including 52 (19.5%) with grades 3 through 5 events; 1 patient each had fatal myocarditis and neurotoxicity. Chronic irAEs, defined as those that persisted beyond 12 weeks of anti-PD-1 discontinuation, developed in 167 (43.2%) patients, of which most (n = 161; 96.4%) were mild (grade 1 or 2) and most persisted until last available follow-up (n = 143; 85.6%). Endocrinopathies (73 of 88; 83.0%), arthritis (22 of 45; 48.9%), xerostomia (9 of 17; 52.9%), neurotoxicities (11 of 15; 73.3%), and ocular events (5 of 8; 62.5%) were particularly likely to become chronic. In contrast, irAEs affecting visceral organs (liver, colon, lungs, kidneys) had much lower rates of becoming chronic irAEs; for example, colitis became chronic in 6 of 44 (13.6%) cases, of which 4 of 6 (66.7%) resolved with prolonged follow-up. Age, gender, time of onset, and need for steroids were not associated with the likelihood of chronicity of irAEs. Conclusion and relevance In this multicenter cohort study, chronic irAEs associated with anti-PD-1 therapy appear to be more common than previously recognized and frequently persisted even with prolonged follow-up, although most were low grade. The risks of chronic irAEs should be integrated into treatment decision-making.
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- 2021
20. Combination anti-PD1 and ipilimumab therapy in patients with advanced melanoma and pre-existing autoimmune disorders
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Alexander Menzies, Prachi Bhave, Alison Weppler, Lauren Julia Brown, Georgina V. Long, Douglas B. Johnson, Clara Allayous, Shahneen Sandhu, Andrew Haydon, Patrick A. Ott, J. Randall Patrinely, Matteo S. Carlino, and Céleste Lebbé
- Subjects
Male ,Cancer Research ,Skin Neoplasms ,Time Factors ,medicine.medical_treatment ,Programmed Cell Death 1 Receptor ,Autoimmunity ,Pembrolizumab ,Inflammatory bowel disease ,0302 clinical medicine ,Antineoplastic Combined Chemotherapy Protocols ,Immunology and Allergy ,Medicine ,030212 general & internal medicine ,Immune Checkpoint Inhibitors ,RC254-282 ,Clinical/Translational Cancer Immunotherapy ,Aged, 80 and over ,Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,Immunosuppression ,Middle Aged ,Progression-Free Survival ,Nivolumab ,Oncology ,030220 oncology & carcinogenesis ,Molecular Medicine ,Female ,immunotherapy ,Immunosuppressive Agents ,medicine.drug ,CTLA-4 antigen ,Adult ,medicine.medical_specialty ,Combination therapy ,Immunology ,Ipilimumab ,Antibodies, Monoclonal, Humanized ,Autoimmune Diseases ,Young Adult ,03 medical and health sciences ,Internal medicine ,melanoma ,Humans ,Progression-free survival ,Aged ,Retrospective Studies ,Pharmacology ,Autoimmune disease ,business.industry ,medicine.disease ,business - Abstract
BackgroundClinical trials of immunotherapy have excluded patients with pre-existing autoimmune disease. While the safety and efficacy of single agent ipilimumab and anti-PD1 antibodies in patients with autoimmune disease has been examined in retrospective studies, no data are available for combination therapy which has significantly higher toxicity risk. We sought to establish the safety and efficacy of combination immunotherapy for patients with advanced melanoma and pre-existing autoimmune diseases.MethodsWe performed a retrospective study of patients with advanced melanoma and pre-existing autoimmune disease who received combination ipilimumab and anti-PD1 at 10 international centers from March 2015 to February 2020. Data regarding the autoimmune disease, treatment, toxicity and outcomes were examined in patients.ResultsOf the 55 patients who received ipilimumab and anti-PD1, the median age was 63 years (range 23–83). Forty-six were treated with ipilimumab and nivolumab and nine with ipilimumab and pembrolizumab.Eighteen patients (33%) had a flare of their autoimmune disease including 4 of 7 with rheumatoid arthritis, 3 of 6 with psoriasis, 5 of 10 with inflammatory bowel disease, 3 of 19 with thyroiditis, 1 of 1 with Sjogren’s syndrome, 1 of 1 with polymyalgia and 1 of 1 with Behcet’s syndrome and psoriasis. Eight (44%) patients ceased combination therapy due to flare. Thirty-seven patients (67%) had an unrelated immune-related adverse event (irAE), and 20 (36%) ceased combination immunotherapy due to irAEs. There were no treatment-related deaths. Patients on immunosuppression (OR 4.59; p=0.03) had a higher risk of flare.The overall response rate was 55%, with 77% of responses ongoing. Median progression free survival and overall survival were 10 and 24 months, respectively. Patients on baseline immunosuppression had an overall survival of 11 months (95% CI 3.42 to 18.58) compared with 31 months without (95% CI 20.89 to 41.11, p=0.005).ConclusionsIn patients with pre-existing autoimmune disease, not on immunosuppression and advanced melanoma, combination ipilimumab and anti-PD1 has similar efficacy compared with previously reported trials. There is a risk of flare of pre-existing autoimmune disorders, particularly in patients with inflammatory bowel disease and rheumatologic conditions, and patients on baseline immunosuppression.
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- 2021
21. Individual cell motion in healthy human skin microvasculature by reflectance confocal video microscopy
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Inga Saknite, Madan Jagasia, Eric R. Tkaczyk, Zijun Zhao, J. Randall Patrinely, and Michael Byrne
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Adult ,Male ,Endothelium ,Adolescent ,Physiology ,Confocal ,Video microscopy ,Human skin ,030204 cardiovascular system & hematology ,Article ,Microcirculation ,03 medical and health sciences ,0302 clinical medicine ,Forearm ,Physiology (medical) ,medicine ,Humans ,Molecular Biology ,Aged ,Skin ,Microscopy, Confocal ,Microscopy, Video ,business.industry ,Blood flow ,Middle Aged ,medicine.anatomical_structure ,Female ,Cardiology and Cardiovascular Medicine ,business ,030217 neurology & neurosurgery ,Blood Flow Velocity ,Biomedical engineering ,Blood vessel - Abstract
Objective To describe upper dermal microvasculature of healthy human skin in terms of density and size of cutaneous blood vessels, leukocyte velocity, and leukocyte interactions with the endothelium. Methods We used a reflectance confocal microscope, the VivaScope 1500, to acquire videos of individual cell motion. Results We found no rolling leukocytes in the upper microvasculature of ten healthy subjects. We observed "paused" leukocytes, that is, leukocytes that temporarily stop, coinciding with the simultaneous stopping of the rest of the blood flow. We imaged more paused (median: 1.0 per subject) and adherent (1.5) leukocytes in the forearm than in the chest (median 0 paused and 0 adherent per subject) per 5 minutes of videos per body site. Leukocytes were paused for a median of 7 seconds in the forearm and 3 seconds in the chest, and we found no correlation between this parameter and the blood vessel or leukocyte size. We visualized blood flow change direction. Flowing leukocyte velocities followed a lognormal distribution and were on average higher in the chest (117 µm/s) than in the forearm (66 µm/s). Conclusion The proposed method and reported values in healthy skin provide new insights into intact human skin microcirculation.
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- 2019
22. 18728 Reflectance confocal video microscopy reveals altered cutaneous microcirculation in acute graft-versus-host disease: A cross-sectional study
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Madan Jagasia, J. Randall Patrinely, Michael Byrne, Eric R. Tkaczyk, Zijun Zhao, and Inga Saknite
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Pathology ,medicine.medical_specialty ,business.industry ,Confocal ,Acute graft versus host disease ,Medicine ,Video microscopy ,Cutaneous microcirculation ,Dermatology ,business ,Reflectivity - Published
- 2020
23. 12712 Use of local anesthetic for intralesional corticosteroid injections: A double-blinded randomized controlled trial
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Anna K. Dewan, Danny Zakria, Brian C. Drolet, J. Randall Patrinely, Albers Se, and Lee Wheless
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Randomized controlled trial ,Local anesthetic ,medicine.drug_class ,Double blinded ,business.industry ,law ,Anesthesia ,medicine ,Dermatology ,business ,Intralesional corticosteroid ,law.invention - Published
- 2020
24. 18669 Study of individual cell motion in healthy human skin microcirculation by in vivo reflectance confocal video microscopy
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Madan Jagasia, Inga Saknite, Zijun Zhao, Michael Byrne, Eric R. Tkaczyk, and J. Randall Patrinely
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In vivo ,business.industry ,Confocal ,Medicine ,Human skin ,Video microscopy ,Dermatology ,Cell motion ,business ,Reflectivity ,Biomedical engineering ,Microcirculation - Published
- 2020
25. Ethics Education in Plastic Surgery Training Programs
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Brian C. Drolet, Jeffrey E. Janis, Galen Perdikis, and J. Randall Patrinely
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Surgeons ,medicine.medical_specialty ,Medical education ,business.industry ,MEDLINE ,Internship and Residency ,Plastic Surgery Procedures ,Plastic surgery ,Humans ,Medicine ,Ethics education ,Ethics, Medical ,Surgery ,Curriculum ,Surgery, Plastic ,business - Published
- 2019
26. Abstract 12
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Jeffrey E. Janis, Galen Perdikis, J. Randall Patrinely, and Brian C. Drolet
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Plastic surgery ,medicine.medical_specialty ,Medical education ,business.industry ,lcsh:Surgery ,medicine ,Ethics education ,Surgery ,lcsh:RD1-811 ,business ,Training (civil) ,ACAPS 2019 Abstract Supplement - Published
- 2019
27. A Multicenter Analysis of Immune Checkpoint Inhibitors as Adjuvant Therapy Following Treatment of Isolated Brain Metastasis.
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Randall Patrinely J Jr.,, Funck-Brentano E, Nguyen K, Rapisuwon S, Salem JE, Gibney GT, Carlino M, and Johnson DB
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- Combined Modality Therapy, Humans, Immune Checkpoint Inhibitors, Neoplasm Recurrence, Local surgery, Retrospective Studies, Brain Neoplasms drug therapy, Brain Neoplasms surgery, Radiosurgery
- Abstract
Background: The objective of this work was to characterize outcomes of patients with isolated brain metastases managed with local therapy followed by immune checkpoint inhibitor (ICI) therapy., Materials and Methods: Patients from four medical centers were included if they presented with isolated brain metastases treated with local therapy and received adjuvant treatment with ICIs., Results: Eleven patients with median size of largest brain metastasis of 3.9 cm, treated with surgical resection (n = 8) and/or stereotactic radiosurgery (SRS; n = 6), were included. Ipilimumab/nivolumab was the adjuvant ICI used in four patients, of whom one recurred (25%) and none died, compared with three of seven (43%) who recurred and two of seven (29%) who died following adjuvant treatment with ICI monotherapy. All recurrences were intracranial., Conclusion: Patients with isolated brain metastases treated with surgery or SRS appeared to benefit from adjuvant ICI therapy, particularly with combination therapy. Recurrences in this setting appear to largely occur intracranially., (© 2020 AlphaMed Press.)
- Published
- 2021
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