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Zhang L, Ma L, Sun F, Tang Z, Chan P. A Multicenter Study of Multimorbidity in Older Adult Inpatients in China. J Nutr Health Aging 2020; 24:269-276. [PMID: 32115607 PMCID: PMC7026204 DOI: 10.1007/s12603-020-1311-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Accepted: 10/18/2019] [Indexed: 12/29/2022]
Abstract
OBJECTIVES Multimorbidity is common in older hospitalized adults. To date, however, few studies have addressed multimorbidity in the older population of Chinese inpatients. We aimed to investigate the multimorbidity rate and associated risk factors in older adult inpatients in China. DESIGN, SETTING, PARTICIPANTS This study was conducted in the medical wards of a tertiary-care hospital from. The patients were recruited aged between 60 to 101 (74.14±8.46) years. MEASUREMENTS Data were obtained from the China Comprehensive Geriatric Assessment Study, conducted in 2011-2012 in China. A total of 4,633 inpatients older than 60 years was recruited from 12 hospitals in 7 cities throughout China. The prevalence of comorbidity, distribution of common chronic diseases, and the associated risk factors were studied. RESULTS A total of 4,348 people aged 60 to 101 (74.14±8.46) years completed questionnaires. The average frequency of multimorbidity was 69.3% (95% CI, 67.9% to 70.6%). The prevalence of multimorbidity increased with age and was higher in men (71.6%; 95% CI, 69.9% to 73.3%) than in women (65.3%, 95% CI 63.0% to 67.6%), and higher in the northern region (71.7%, 95% CI 69.9% to 73.5%) than in the southern region (66.0%; 95% CI, 63.8% to 68.1%). The most frequent chronic diseases were hypertension, coronary heart disease, diabetes, cataract, and stroke. Area (OR=0.556; 95% CI, 0.465 to 0.666), region (OR=0.834; 95% CI, 0.723 to 0.962), body mass index (BMI) (OR=1.124; 95% CI, 1.017 to 1.242), and impairment of activities of daily living (OR=0.911; 95% CI, 0.855 to 0.970) were independent factors associated with multimorbidity. CONCLUSIONS Multimorbidity is common in older Chinese inpatients with a national prevalence of 69.3% that increases in line with age. Age, region, area, BMI, and daily activities were independent factors significantly associated with multimorbidity in older inpatients. Clinicians should therefore focus more attention on multimorbidity.
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Thoren KL, Eveillard M, Chan P, Doddi S, Cho S, Murata K. Identification of gamma heavy chain disease using MALDI-TOF mass spectrometry. Clin Biochem 2019; 77:57-61. [PMID: 31884198 DOI: 10.1016/j.clinbiochem.2019.12.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 11/27/2019] [Accepted: 12/19/2019] [Indexed: 11/25/2022]
Abstract
We describe the use of MALDI-TOF mass spectrometry in the analysis of a suspected case of gamma heavy chain disease. The patient had an abnormal serum immunofixation result where a monoclonal gamma heavy chain band was present without a corresponding light chain. Analysis by MALDI-TOF mass spectrometry revealed large peaks in the spectrum following IgG-specific purification. The m/z values of the peaks were outside the expected range for normal heavy chains or light chains. Corresponding peaks were not present in mass spectra of the kappa- or lambda-specific purifications. MALDI-TOF MS confirmed the presence of a truncated heavy chain without associated light chains. This case report demonstrates the value of mass spectrometry in interpreting challenging cases such as the identification of heavy chain disease.
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Tan T, Huang MS, Mathew J, Fitzgerald M, Chan P, Hunn MK, Tee J. Anterior versus posterior approach in the management of AO Type B1 & B2 traumatic thoracolumbar fractures: A level 1 trauma centre study. J Clin Neurosci 2019; 72:219-223. [PMID: 31859179 DOI: 10.1016/j.jocn.2019.11.039] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Accepted: 11/30/2019] [Indexed: 11/28/2022]
Abstract
The authors perform a retrospective trauma registry study to compare clinical, surgical and radiographical variables between anterior and posterior approaches in the management of AO Type B1 and B2 traumatic thoracolumbar fractures. Consecutive patients with surgically-managed AO Type B1 and B2 thoracolumbar fractures were included. Baseline demographics, surgical outcomes (including duration of surgery, postoperative morbidity etc.), neurological outcomes and radiographical outcomes (Cobb angle, Gardner angle) were compared between the anterior and posterior approaches. A total of 108 patients (anterior: n = 25, posterior: n = 83) were included. There were no significant between-group differences in baseline demographics and co-morbidities. Duration of surgery was longer in the anterior compared to posterior group (251 ± 91 min vs. 175 ± 69 min respectively, p < 0.00003). At six-months post-surgery, there was a trend towards improvement of at least one AIS grade in the posterior compared to the anterior group (85.7% vs. 33.3% respectively, p = 0.08). Postoperative complication profile showed no difference between approaches. The posterior approach resulted in better sagittal correction (Cobb angle; anterior: +1.05 ± 8.61 deg, posterior: -3.87 ± 9.88 deg, p = 0.03) and smaller loss of correction at 6-months post-surgery (Cobb angle; anterior: 8.36 ± 9.47 deg, posterior: 4.88 ± 6.62 deg, p = 0.048). This is the first study investigating surgical approach in flexion-distraction thoracolumbar fractures. Besides a shorter operative duration, the posterior approach seems to portend more favourable radiological correction at 6 months when compared to the anterior approach. Given the inherent selection bias of this study, definitive recommendations regarding the anterior versus posterior approach cannot be made. Further well-defined, prospective studies are necessary.
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Mohsen W, Chan P, Whelan M, Glass A, Mouton M, Young E, Tran Q, Arora S, Davison S, Lama T, Cobrador C, Levy M. Hepatitis C treatment for difficult to access populations: can telementoring (as distinct from telemedicine) help? Intern Med J 2019; 49:351-357. [PMID: 30091164 DOI: 10.1111/imj.14072] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2018] [Revised: 07/21/2018] [Accepted: 07/23/2018] [Indexed: 12/22/2022]
Abstract
BACKGROUND Although hepatitis C virus (HCV) infection is curable, treatment of difficult to access populations (DTAP) presents unique challenges. Project ECHO (PE) (Extension for Community Healthcare Outcomes) is a telementoring programme adopted to support clinicians treating DTAP. AIMS To determine if the PE model supports primary care clinicians treating HCV and to compare cohort of PE patients with those in a tertiary liver clinic (TLC). METHODS Weekly PE group video conferences were conducted. Clinical information, laboratory indices, psychosocial elements and treatment outcomes, including sustained virological response (SVR) data were recorded in the first 100 consecutive cases and retrospectively compared to 100 consecutive patients seen at a TLC from July 2016 to April 2017. RESULTS Some patient characteristics were similar between PE and TLC: gender (72% vs 75% male; P = 0.23), median age (45 vs 50; P = 0.344) and the proportion of treatment naïve patients (95.0% vs 90.9%). Treatment for HCV was commenced in 78% of the PE patients and 81% of the TLC patients; 67/68 of the TLC patients and 60/61 PE patients with virological follow up who completed treatment and attended follow up have confirmed SVR. PE patients are more likely to have ongoing substance use (44% vs 17% P < 0.001), be active intravenous drug users (32% vs 17%; P < 0.001) and polysubstance abusers (26% vs 7%; P < 0.001) and were more likely to be taking opioid substitution therapy (74% vs 20%; P < 0.001). Indigenous patients were three times more greatly represented in PE (15% vs 5%; P = 0.018). CONCLUSION PE is an effective model to support primary healthcare providers treating HCV in DTAP with similar rates of treatment uptake and SVR compared to patients in TLC.
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Han C, Lu Y, Cheng H, Wang C, Chan P. The impact of long-term exposure to ambient air pollution and second-hand smoke on the onset of Parkinson disease: a review and meta-analysis. Public Health 2019; 179:100-110. [PMID: 31770719 DOI: 10.1016/j.puhe.2019.09.020] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2019] [Revised: 09/04/2019] [Accepted: 09/30/2019] [Indexed: 12/21/2022]
Abstract
OBJECTIVES Long-term exposure to particulate and gaseous air pollution (AP) may trigger the development of Parkinson disease (PD), but this association remains controversial. The relationship between second-hand smoke (SS) and PD risk is also inconclusive. We aimed to systematically review epidemiological studies investigating the association between these AP exposures and PD risk. STUDY DESIGN This was a systematic review and meta-analysis of studies investigating the relationship of ambient AP and SS with PD risk. METHODS PubMed, Embase, Web of Science, Cochrane Library, and Google Scholar databases were searched. We used a random-effects model to derive pooled estimates of relative risk (RR) and corresponding 95% confidence intervals (CIs) per increment in pollutant concentration. The studied AP included particulate matter with aerodynamic diameter <2.5 μm (PM2.5), <10 μm (PM10), nitrogen dioxides (NO2, NOx), ozone (O3), and carbon monoxide (CO). RESULTS In total, 21 studies with 222,051 patients with PD were eligible for inclusion. We found marginally significant increased risk of PD with per 10-μg/m3 increase in concentration of PM2.5 (RR = 1.08, 95% CI = 0.98-1.19), NO2 (RR = 1.03, 95% CI = 0.99-1.07), and O3 (RR = 1.01, 95% CI = 1.00-1.02). A positive but non-significant association was also detected for CO (RR = 1.32, 95% CI = 0.82-2.11). Furthermore, an inverse PD-SS relationship was noted irrespective of exposure occasions and timing (at home: RR = 0.73, 95% CI = 0.56-0.95; at work: RR = 0.82, 95% CI = 0.57-1.17; in children: RR = 0.91, 95% CI = 0.76-1.08). Both sensitivity and subgroup analyses generated results comparable with those of the overall analyses. CONCLUSIONS Our study suggested that exposure to PM2.5, NO2, and O3 might contribute to higher risk of PD, whereas SS conferring reduced PD risk. Public and environmental health strategies that aim at reducing outdoor AP levels might reduce the burden of PD. More prospective cohort studies with personal exposure measurements are warranted in the future.
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Falck RS, Best JR, Davis JC, Chan P, Backhouse D, Landry GJ, Liu-Ambrose T. MULTIMODAL PERSONALIZED CHRONOTHERAPY IMPROVES SLEEP IN ADULTS WITH MILD COGNITIVE IMPAIRMENT: A RANDOMIZED TRIAL. Innov Aging 2019. [PMCID: PMC6840131 DOI: 10.1093/geroni/igz038.1342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Poor sleep is common among older adults with Mild Cognitive Impairment (MCI) and may contribute to their increased risk for dementia. Chronotherapy is a set of intervention strategies which can improve sleep quality by strengthening the entrainment of the biological clock to the solar light-dark cycle, and includes strategies such as: 1) bright light therapy (BLT); 2) physical activity (PA); and 3) good sleep hygiene. Thus, in this 24-week randomized controlled trial (RCT; NCT02926157), we aimed to examine the efficacy of a multimodal, personalized chronotherapy intervention to improve sleep quality among older adults with MCI. Ninety-six older adults (65+ years) with MCI were randomized to either: 1) a multimodal personalized chronotherapy group (INT); or 2) a waitlist-plus-education control group (CON). Participants allocated to the INT received four once-weekly, general sleep hygiene education classes, followed by 20 weeks of 1) individually-timed BLT; and 2) bi-weekly, individually-tailored PA counselling in conjunction with receiving a consumer-available PA tracker (Fitbit® FlexTM). We found a significant group x time interaction for objectively measured sleep fragmentation (5.01; p< 0.01) and also for Pittsburgh Sleep Quality Index (PSQI) score (p= 0.03), such that the INT: 1) maintained sleep fragmentation while CON worsened at 12 weeks (p< 0.01); and 2) had improved PSQI score compared to CON at both 12 weeks (p< 0.01) and 24 weeks (p= 0.04). Our results provide novel evidence that a multimodal personalized chronotherapy approach may promote both objective and subjective aspects of sleep quality in older adults with MCI.
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Hsu CL, Best JR, Crockett RA, Chan P, Liu-Ambrose T. ABERRANT FUNCTIONAL CONNECTIVITY UNDERPINNING CHANGES IN LIFE-SPACE MOBILITY IN OLDER ADULTS. Innov Aging 2019. [PMCID: PMC6840725 DOI: 10.1093/geroni/igz038.1763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Subtle, but observable, changes in mobility often exist among older adults. Life-space mobility defines the frequency and extent of movements in the environment, and lower life-space mobility is associated with adverse health outcomes and mild cognitive impairment (MCI). Currently, the underlying mechanism of this association is not well understood. The aim of this study was to examine the functional neural correlates of reduced life-space mobility over 12 months. Thirty-five older adults over the age of 65 years with MCI were recruited and enrolled into this 12-month prospective study. Resting-state functional magnetic resonance imaging was completed at study baseline. Clinical assessment of anthropometric, behavioural measurements, and life-space mobility was conducted at study baseline and at the 12-month period. Over the 12-month study, the 35 participants demonstrated a significant reduction in LSA scores (paired sample t-test mean change=-6.53, p=0.01); greater baseline connectivity between the default mode network and the sensorimotor network was significantly associated with lower life-space mobility (R2=0.44, p=0.04). These findings suggest reduced life-space mobility in older adults may be partially due to altered inter-network connectivity in the brain such that normal neuro-cognitive motor behaviours is disrupted. Therefore, the maintenance of functional architecture of the brain may be essential in preserving the extent and frequency of older individuals’ movement in their environment.
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Lee HQ, Kow CY, Ng JS, Chan P, Ton L, Etherington G, Liew S, Hunn M, Fitzgerald M, Tee J. Correlation of Anterior Interbody Graft Choice With Patient-Reported Outcomes in Cervical Spine Trauma. Global Spine J 2019; 9:735-742. [PMID: 31552155 PMCID: PMC6745640 DOI: 10.1177/2192568219828720] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
STUDY DESIGN Ambispective observational cohort study. OBJECTIVES Synthetic graft usage avoids morbidity associated with harvest and reduces operative time. This study aims to evaluate outcomes of anterior cervical stabilization surgery using a synthetic cage in comparison with iliac crest bone graft (ICBG) following cervical spine trauma. METHODS An ambispective review was conducted on patients from the Alfred Trauma Registry. Consecutive patients treated at a level 1 trauma center, aged 18 years and older who were treated with standalone anterior cervical stabilization following spine trauma (2011-2016) were included in the study. Primary outcome measures were patient overall satisfaction, Neck Disability Index (NDI), neck pain 10-point visual analogue scale (VAS-neck) and arm pain 10-point visual analogue scale (VAS-arm). Secondary outcome measures were radiographic evidence of fusion and rate of revision surgery. All patients had follow-up for at least 1 year. RESULTS Between 2011 and 2016, 114 traumatic disc levels in 104 patients were treated. ICBG was used in 32% and polyetheretherketone (PEEK) cage in 68% of the patients. Both groups had similar demographic metrics. There was no significant difference in primary outcome measures between the graft types: (1) patient satisfaction (P = .15), (2) NDI (P = .11), (3) VAS-neck (P = .13), and (4) VAS-arm (P = .20). Radiology based fusion assessment 6 months postsurgery did not show statistical significance (P = .10). The rates of revision surgery were similar. CONCLUSIONS This study showed no significant difference in patient-reported outcome measures when comparing the usage of PEEK cage and ICBG in anterior stand alone cervical spine stabilization. Level 1 evidence studies are required to further investigate this finding.
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Pekker I, Lim L, Simon J, Gormley M, Li Z, Pollak J, Potts K, Watford S, Posey J, Chan P, Urtishak K, Garg K, Hosseini A, Li M. Analytical performance of the resolution-HRD plasma assay used to identify mCRPC patients with biallelic disruption of DNA repair genes for treatment with niraparib. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz257.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Miller J, Bruen C, Wilburn J, Mackey C, Prekker M, Chan P, Peacock W, Stauderman K, Dunn M, Hebbar S. 353 An Open-Label, Dose-Response Study of CM4620-Injectable Emulsion in Emergency Department Patients With Acute Pancreatitis. Ann Emerg Med 2019. [DOI: 10.1016/j.annemergmed.2019.08.314] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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D'Angelo MP, Kilic A, Chan P, Sultan I. Total thrombotic occlusion of the right coronary artery after surgical aortic valve replacement. J Card Surg 2019; 34:1359-1360. [PMID: 31478237 DOI: 10.1111/jocs.14243] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Davis JC, Falck RS, Best JR, Chan P, Doherty S, Liu-Ambrose T. Examining the Inter-relations of Depression, Physical Function, and Cognition with Subjective Sleep Parameters among Stroke Survivors: A Cross-sectional Analysis. J Stroke Cerebrovasc Dis 2019; 28:2115-2123. [DOI: 10.1016/j.jstrokecerebrovasdis.2019.04.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 04/03/2019] [Accepted: 04/05/2019] [Indexed: 12/28/2022] Open
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Chhetri JK, Chan P, Ma L, Peng D, Rodríguez-Mañas L, Cesari M, Vellas B. Prevention of Disability in the Frail Chinese Older Population. J Frailty Aging 2019; 8:2-6. [PMID: 30734823 DOI: 10.14283/jfa.2018.27] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
As aging is becoming a global phenomenon, the burden of population aging is increasing rapidly, and is soon expected to be the highest in low-and middle-income countries. China represents the world's largest population, and will face the largest number of older individuals, while the economy still remains developing. There is an urgent need to address the negative consequences of aging such as disability, that creates a myriad of challenges, including financial burden to the economy. In order to achieve successful aging-i.e., aging without being frail or disabled, the traditional healthcare model based on a disease-centered approach is not enough, but require a more holistic course. Here, we briefly outline the current scenario of aging and disability in the Chinese older population, its impact and challenges. We strongly believe that public health initiatives centered on frailty, a clinically distinguishable state of extreme vulnerability in older adults, could be the most relevant approach to meet the current needs of the aging population. Such initiatives are immediately needed to reshape the existing model of geriatric healthcare, to promote healthy aging and to reduce the burden of disability in the Chinese population.
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Ma L, Tang Z, Chan P, Walston JD. Novel Frailty Screening Questionnaire (FSQ) Predicts 8-year Mortality in Older Adults in China. J Frailty Aging 2019; 8:33-38. [PMID: 30734829 DOI: 10.14283/jfa.2018.38] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Although frailty status greatly impacts health care in countries with rapidly aging populations, little is known about the frailty status in Chinese older adults. OBJECTIVES Given the increased health care needs associated with frailty, we sought to develop an easily applied self-report screening tool based on four of the syndromic frailty components and sought to validate it in a population of older adults in China. DESIGN Prospective epidemiological cohort study. SETTING Community-dwelling residents living in Beijing, China. PARTICIPANTS 1724 community-dwelling adults aged ≥60 years in 2004 with an 8-year follow up. MEASUREMENTS We developed a simple self-report frailty screening tool-the Frailty Screening Questionnaire (FSQ)-based on the modified Fried frailty components. The predictive ability for outcome was assessed by age and sex adjusted Cox proportional hazards model. RESULTS According to FSQ criteria, 7.1% of the participants were frail. Frailty was associated with poor physical function, fractures, falls, and mortality. Both frailty and pre-frailty were associated with a higher mortality rate: frailty-hazards ratio (HR), 3.94, 95% confidence interval (CI), 3.16-4.92, P<0.001; pre-frailty-HR, 1.89; 95% CI, 1.57-2.27, P <0.001; adjusted models for this variable did not affect the estimates of the association. Among the four frailty components, slowness was the strongest predictor of mortality. The combination of the four components provided the best risk prediction. CONCLUSIONS FSQ is a self-report frailty measurement tool that can be rapidly performed to identify older adults with higher risk of adverse health outcomes.
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Herrero MB, Lusignan MF, Son WY, Sabbah M, Buckett W, Chan P. ICSI outcomes using testicular spermatozoa in non-azoospermic couples with recurrent ICSI failure and no previous live births. Andrology 2019; 7:281-287. [PMID: 30734539 DOI: 10.1111/andr.12591] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 12/21/2018] [Accepted: 01/09/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND The use of testicular over ejaculated spermatozoa for ICSI has been presented as an alternative to overcome infertility in men with poor semen parameters or high levels of sperm DNA fragmentation. OBJECTIVE To evaluate the efficacy of testicular ICSI outcomes in couples with no previous live birth and recurrent ICSI failure using ejaculated spermatozoa by comparison to the outcomes of couples with similar history of recurrent ICSI using ejaculated spermatozoa only. MATERIALS AND METHODS A total of 145 couples undergoing ejaculated or testicular ICSI cycles with no previous live births and with at least two previous failed ICSI cycles with ejaculated spermatozoa were evaluated retrospectively. ICSI was performed either with ejaculated (E-ICSI) or with testicular (T-ICSI) spermatozoa. Semen parameters and sperm DNA quality were assessed prior to the oocyte collection day. Primary outcomes included cumulative live birth and pregnancy rates. Secondary analysis included percentage of DNA fragmentation in ejaculated spermatozoa (SCSA® and TUNEL). RESULTS Patients undergoing T-ICSI (n = 77) had a significantly higher clinical pregnancy rate/fresh embryo transfer (ET) (27.9%; 17/61) and cumulative live birth rate (23.4%; 15/64) compared to patients using E-ICSI (n = 68) (clinical pregnancy rate/fresh ET: 10%; 6/60 and cumulative live birth rate: 11.4%; 7/61). Further, T-ICSI yield significantly better cumulative live birth rates than E-ICSI for men with high TUNEL (≥36%) (T-ICSI: 20%; 3/15 vs. E-ICSI: 0%; 0/7, p < 0.025), high SCSA® (≥25%) scores (T-ICSI: 21.7%; 5/23 vs. E-ICSI: 9.1%; 1/11, p < 0.01), or abnormal semen parameters (T-ICSI: 28%; 7/25 vs. E-ICSI: 6.7%; 1/15, p < 0.01). CONCLUSIONS The use of testicular spermatozoa for ICSI in non-azoospermic couples with no previous live births, recurrent ICSI failure, and high sperm DNA fragmentation yields significantly better live birth outcomes than a separate cohort of couples with similar history of ICSI failure entering a new ICSI cycle with ejaculated spermatozoa.
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Liao JM, Chan P, Cornwell L, Tsai PI, Joo JH, Bakaeen FG, Luketich JD, Chu D. Feasibility of primary sternal plating for morbidly obese patients after cardiac surgery. J Cardiothorac Surg 2019; 14:25. [PMID: 30691502 PMCID: PMC6350305 DOI: 10.1186/s13019-019-0841-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2018] [Accepted: 01/14/2019] [Indexed: 12/03/2022] Open
Abstract
Background Morbidly obese patients (body mass index [BMI] ≥ 35 kg/m2) who undergo cardiac surgery involving median sternotomy have a higher-than-normal risk of sternal dehiscence. To explore a potential solution to this problem, we examined the utility of transverse sternal plating for primary sternal closure in morbidly obese cardiac surgical patients. Methods We retrospectively reviewed data from cardiac surgical patients who underwent single primary xiphoid transverse titanium plate reinforcement for primary sternal closure from August 2009 to July 2010 (n = 8), and we compared their outcomes with those of patients with BMI ≥35 kg/m2 who underwent cardiac surgery without sternal plate reinforcement from April 2008 to July 2009 (n = 14). All cases were performed by the same surgeon. Results The 2 groups of patients had similar demographics and comorbidities (P > 0.05 for all). All patients with sternal plate reinforcement reported sternal stability at last follow-up (at a median of 27 months postoperatively; range, 8.4–49.3 months), whereas 1 patient (7.1%) who underwent standard closure developed sterile sternal dehiscence (P = 0.4). Postoperative patient-controlled analgesia (PCA) morphine usage was significantly higher for patients without sternal plate reinforcement than for patients who had sternal plate reinforcement (3.6 mg/h vs 1.3 mg/h, P = 0.008). No patient in the sternal plate group had wound seroma or perioperative complications attributable to sternal closure technique. Conclusion Single xiphoid transverse plate reinforcement for primary sternal closure is a feasible option for morbidly obese patients, who are otherwise at high risk of developing sternal dehiscence. Using this technique may decrease postoperative narcotics usage. Ultramini abstract Morbidly obese patients (body mass index ≥35 kg/m2) have a higher-than-normal risk of sternal dehiscence after cardiac surgery. In a pilot study, we found that those who underwent transverse sternal plating (n = 8) had no sternal dehiscence and required less postoperative analgesia than patients who underwent standard wire closure (n = 14).
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Chan P. PO179 Novel Cardiac Protective Agent, AFC1, Attenuated Ischemic Reperfusion Induced Ventricular Remodeling via Inhibiting PDGFR and JAK/STAT Pathways. Glob Heart 2018. [DOI: 10.1016/j.gheart.2018.09.157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Nobis S, Morin A, Achamrah N, Belmonte L, Legrand R, Chan P, Do Rego J, Vaudry D, Dechelotte P, Goichon A, Coeffier M. Ralentissement de la vidange gastrique dans le modèle animal d’anorexie « activity-based anorexia » : rôle du métabolisme protéique ? NUTR CLIN METAB 2018. [DOI: 10.1016/j.nupar.2018.09.188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Novanta A, Herpe G, Vesselle G, Guibal A, Velasco S, Chan P, Ingrand P, Boucebi S, Tasu JP. Chart for renal tumor microwave ablation from human study. Diagn Interv Imaging 2018; 99:609-614. [DOI: 10.1016/j.diii.2018.05.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Revised: 04/28/2018] [Accepted: 05/15/2018] [Indexed: 10/28/2022]
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Villamor GA, Andras LM, Chan P, Jalloh H, Sanders AE, Yang J, Choi PD, Tolo VT, Skaggs DL. Stomaching the pain of spinal fusion: gastrointestinal discomfort is as severe as back pain in 50% of adolescent idiopathic scoliosis patients following posterior spinal fusion. J Child Orthop 2018; 12:539-543. [PMID: 30294380 PMCID: PMC6169568 DOI: 10.1302/1863-2548.12.180037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
PURPOSE There have been no prospective studies investigating gastrointestinal (GI) symptoms of patients with adolescent idiopathic scoliosis (AIS) following posterior spinal fusion (PSF). The purpose of this study was to evaluate the incidence and severity of self-reported GI symptoms following PSF. METHODS In all, 40 AIS patients undergoing PSF were prospectively enrolled between March 2015 and October 2016. Patients completed a survey on each postoperative, inpatient day regarding nausea, emesis, constipation, abdominal pain and back pain, rating their pain on a scale of 1 to 10. RESULTS Abdominal pain (50%), emesis (63%), nausea (65%) and constipation (68%) were experienced by the majority of patients. Of those reporting back pain, the mean pain level during the postoperative period was 5.1 (0.2 to 9.6). Of those reporting abdominal pain, the mean pain level during the postoperative period was 5.5 (1.4 to 8.6), which was not different than the severity of their back-pain levels (mean = 6.0, p = 0.31). CONCLUSIONS Gastrointestinal issues in AIS patients following PSF are common. Abdominal pain was as severe as the back pain for half of the patients. LEVEL OF EVIDENCE II.
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Kirzner N, Etherington G, Ton L, Chan P, Paul E, Liew S, Humadi A. Relationship between facet joint distraction during anterior cervical discectomy and fusion for trauma and functional outcome. Bone Joint J 2018; 100-B:1201-1207. [DOI: 10.1302/0301-620x.100b9.bjj-2018-0199.r1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Aims The purpose of this retrospective study was to investigate the clinical relevance of increased facet joint distraction as a result of anterior cervical decompression and fusion (ACDF) for trauma. Patients and Methods A total of 155 patients (130 men, 25 women. Mean age 42.7 years; 16 to 87) who had undergone ACDF between 1 January 2001 and 1 January 2016 were included in the study. Outcome measures included the Neck Disability Index (NDI) and visual analogue scale (VAS) for pain. Lateral cervical spine radiographs taken in the immediate postoperative period were reviewed to compare the interfacet distance of the operated segment with those of the facet joints above and below. Results There was a statistically significant relationship between greater facet distraction and increased NDI and VAS pain scores. This was further confirmed by Spearman correlation, which showed evidence of a moderate correlation between both NDI score and facet joint distraction (Spearman correlation coefficient 0.34; p < 0.001) and VAS score and facet distraction (Spearman correlation coefficient 0.52; p < 0.001). Furthermore, there was a discernible transition point between outcome scores. Significantly worse outcomes, in terms of both NDI scores (17.8 vs 8.2; p < 0.001) and VAS scores (4.5 vs 1.3; p < 0.001), were seen with facet distraction of 3 mm or more. Patients who went on to have a posterior fusion also had increased NDI and VAS scores, independent of facet distraction. Conclusion After undergoing ACDF for the treatment of cervical spine injury, patients with facet joint distraction of 3 mm or more have worse NDI and VAS pain scores. Cite this article: Bone Joint J 2018;100-B:1201–7.
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Chan P, Kim S, Garavalia L, Wang J. Implementing a strategy for promoting long-term meaningful learning in a pharmacokinetics course. CURRENTS IN PHARMACY TEACHING & LEARNING 2018; 10:1048-1054. [PMID: 30314540 DOI: 10.1016/j.cptl.2018.05.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Revised: 02/07/2018] [Accepted: 05/11/2018] [Indexed: 06/08/2023]
Abstract
INTRODUCTION The purpose of this paper is to describe the evolution and effectiveness of instructional strategies that were implemented over a seven-year period to enhance the authenticity of instruction and assessment in a pharmacokinetics (PK) course. METHODS Baseline data from 2011 and 2012 were analyzed to identify opportunities for improvement. In 2013 and 2014, lectures, PK workshops, and exam questions were modified to represent more authentic learning and assessment. Counter to expectations, 2013 and 2014 exam scores were significantly lower when compared to 2011 and 2012 scores. The course was modified further in 2015 to incorporate post-workshop quizzes that provided corrective feedback and required the use of retrieval as a learning strategy. Exam scores were compared across the three phases of course improvement (2011/2012 vs. 2013/2014 vs. 2015/2016/2017) using statistical analyses. RESULTS The average final examination score in 2011-2012 was 84.6%. After increasing the number of authentic assessment exam items, the average on the final examination in 2013-2014 decreased to 80.3% (p < 0.0001). Following the implementation of the post-workshop quizzes, the average final examination scores increased from 2015-2017 to 85.9% (p < 0.0001, compared to 2013-2014; p = 0.08, compared to 2011-2012). DISCUSSION Implementation of these evidence-based learning and instructional strategies (authentic learning, retrieval of new learning, and corrective feedback) was associated with higher student performance on the final examination over time. CONCLUSION These strategies may be valuable in improving student learning outcomes in other challenging professional program courses.
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Yau S, Chan P, Sapkin J, Hsieh E. Short-term use of oral amiodarone causing torsades de pointes. Clin Case Rep 2018; 6:1554-1556. [PMID: 30147903 PMCID: PMC6099002 DOI: 10.1002/ccr3.1659] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Revised: 05/03/2018] [Accepted: 05/08/2018] [Indexed: 01/08/2023] Open
Abstract
Amiodarone is one of the most commonly used antiarrhythmic drugs. Despite its well-known side effects, amiodarone is considered to be a relatively safe drug, especially in short-term usage to prevent life-threatening ventricular arrhythmias. Our case demonstrates an instance where short-term usage can yield drug side effect.
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Hoffman I, Lewis B, Chan P. Circulation of cosmogenic 22Na using the global monitoring network of the Comprehensive Nuclear-Test-Ban Treaty Organization (CTBTO). JOURNAL OF ENVIRONMENTAL RADIOACTIVITY 2018; 187:8-15. [PMID: 29459255 DOI: 10.1016/j.jenvrad.2018.01.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Revised: 01/23/2018] [Accepted: 01/23/2018] [Indexed: 06/08/2023]
Abstract
Using a recently published global data set of 22Na and 7Be from the global monitoring network of the Comprehensive Nuclear-Test-Ban Treaty Organization (CTBTO), atmospheric circulation and stratosphere-troposphere interactions are examined. Cosmogenic 22Na has a half-life well-suited to environmental processes with durations from several months to a decade. Combined with corresponding 7Be observations, these two cosmogenic isotopes form a useful environmental tracer and new radiochronometer to study physical interactions of air masses in the stratosphere and troposphere.
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Nobis S, Morin A, Achamrah N, Belmonte L, Legrand R, Chan P, do Rego JL, Vaudry D, Gourcerol G, Déchelotte P, Goichon A, Coëffier M. Delayed gastric emptying and altered antrum protein metabolism during activity-based anorexia. Neurogastroenterol Motil 2018; 30:e13305. [PMID: 29411462 DOI: 10.1111/nmo.13305] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Accepted: 01/05/2018] [Indexed: 12/17/2022]
Abstract
BACKGROUND Anorexia nervosa, a restrictive eating disorder, is often associated with gastrointestinal disorders, particularly a delayed gastric emptying. However, the mechanisms remained poorly documented. Thus, we aimed to evaluate gastric emptying and antrum protein metabolism in the Activity-Based Anorexia model (ABA). METHODS Females C57Bl/6 mice were randomized into 3 groups: Control, ABA, and Limited Food Access (LFA). Food access has been progressively limited from 6 h/day at day 6 to 3 h/day at day 9 and until day 17. ABA mice had free access to an activity wheel. Gastric emptying was assessed. On gastric extracts, a proteomic analysis was performed, as well as an evaluation of protein synthesis and protein oxidation. KEY RESULTS Both LFA and ABA mice exhibited a delayed gastric emptying compared with Controls (P < .05). Proteomic approach revealed 15 proteins that were differentially expressed. Among these proteins, we identified 2 clusters of interest contributing to (i) the organization of muscle fiber with ACTA2, VCL, KRT19, KRT8, and DES proteins and (ii) "heat shock proteins" with STIP1, HSPD1, and HSPA8 proteins. ABA mice specifically exhibited an increased rate of gastric oxidized proteins. CONCLUSIONS AND INFERENCES Delayed gastric emptying observed in anorectic conditions appears to be secondary to malnutrition. However, an oxidative stress is specifically present in the stomach of ABA mice. Its role remains to be further studied.
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