1
|
Vella MA, Zone A, Succar B, Cheng M, Maiga AW, Appelbaum RD, Notario L, Pannell D, Holena DN, Dumas RP. Teamwork matters: The association between nontechnical skills and cardiac arrest in trauma patients presenting with hypotension. Surgery 2024; 175:1595-1599. [PMID: 38472080 DOI: 10.1016/j.surg.2024.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 01/20/2024] [Accepted: 02/08/2024] [Indexed: 03/14/2024]
Abstract
BACKGROUND The impact of trauma team dynamics on outcomes in injured patients is not completely understood. We sought to evaluate the association between trauma team function, as measured by a modified Trauma Non-Technical Skills assessment, and cardiac arrest in hypotensive trauma patients. We hypothesized that better team function is associated with a decreased probability of developing cardiac arrest. METHODS Trauma video review was used to collect data from resuscitations of adult hypotensive trauma patients at 19 centers. Hypotension at emergency department presentation was defined as an initial systolic blood pressure <90 mm Hg or an initial systolic blood pressure ≥90 mm Hg followed by a systolic blood pressure <90 mm Hg within the first 5 minutes. Team dynamics were scored using a modified Trauma Non-Technical Skills assessment composed of 5 domains with combined scores ranging from 5 (best) to 15 (worst). Scores were compared between cardiac arrest/noncardiac arrest cases in the trauma bay. Logistic regression was used to evaluate the independent association between the Trauma Non-Technical Skills assessment and cardiac arrest. RESULTS A total of 430 patients were included (median age 43 years [interquartile range: 29-61]; 71.8% male; 36% penetrating mechanism; median Injury Severity Score 20 [10-33]; 11% experienced cardiac arrest in trauma bay). The median total Trauma Non-Technical Skills assessment score was 7 (6-9), higher in patients who experienced cardiac arrest in the trauma bay (9 [6-10] vs 7 [6-9]; P = .016). This association persisted after controlling for age, sex, mechanism, injury severity, initial systolic blood pressure, and initial Glasgow Coma Scale score (adjusted odds ratio: 1.28; 95% confidence interval:1.11-1.48; P < .001), indicating a ∼3% higher predicted probability of cardiac arrest per Trauma Non-Technical Skills point. CONCLUSION Better team function is independently associated with a decreased probability of cardiac arrest in trauma patients presenting with hypotension. This suggests that trauma team training may improve outcomes in peri-arrest patients.
Collapse
Affiliation(s)
- Michael A Vella
- University of Rochester Medical Center Division of Acute Care Surgery, Rochester, NY. http://www.twitter.com/MichealVella32
| | - Alea Zone
- UT Southwestern Medical Center, Division of Burn Trauma Acute and Critical Care Surgery, Dallas, TX
| | - Bahaa Succar
- UT Southwestern Medical Center, Division of Burn Trauma Acute and Critical Care Surgery, Dallas, TX. http://www.twitter.com/B_Succar
| | - Mingyuan Cheng
- UT Southwestern Medical Center, Division of Burn Trauma Acute and Critical Care Surgery, Dallas, TX
| | - Amelia W Maiga
- Vanderbilt University Medical Center, Division of Acute Care Surgery, Nashville, TN. http://www.twitter.com/AmeliaMaiga
| | - Rachel D Appelbaum
- Vanderbilt University Medical Center, Division of Acute Care Surgery, Nashville, TN. http://www.twitter.com/AppelbaumMD
| | | | | | - Daniel N Holena
- Medical College of Wisconsin Division of Trauma and Acute Care Surgery Milwaukee, WI. http://www.twitter.com/Daniel_Holena
| | - Ryan P Dumas
- UT Southwestern Medical Center, Division of Burn Trauma Acute and Critical Care Surgery, Dallas, TX.
| |
Collapse
|
2
|
Wolf S, Ashouri Y, Succar B, Hsu CH, Abuhakmeh Y, Goshima K, Devito P, Zhou W. Follow-up compliance in patients undergoing abdominal aortic aneurysm repair at Veterans Affairs hospitals. J Vasc Surg 2024:S0741-5214(24)00421-X. [PMID: 38462060 DOI: 10.1016/j.jvs.2024.02.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 01/28/2024] [Accepted: 02/01/2024] [Indexed: 03/12/2024]
Abstract
OBJECTIVE The Society for Vascular Surgery guidelines recommend annual imaging surveillance following endovascular aneurysm repair (EVAR) and every 5 years following open surgical repairs (OSR) of abdominal aortic aneurysms (AAAs). Adherence to these guidelines is low outside of clinical trials, and compliance at Veterans Affairs (VA) hospitals is not yet well-established. We examined imaging follow-up compliance and mortality rates after AAA repair at VA hospitals. METHODS We queried the VA Surgical Quality Improvement Program database for elective infrarenal AAA repairs, EVAR and OSR, then merged in follow-up imaging and mortality information. Mortality rate over time was derived using Kaplan-Meier estimation. Generalized estimating equation with a logit link and a sandwich standard error estimate was performed to compare the probability of having annual follow-up imaging over time between procedure types and to identify variables associated with follow-up imaging for EVAR patients. RESULTS Our analysis included 11,668 patients who underwent EVAR and 4507 patients who underwent OSR at VA hospitals between the years 2000 and 2019. The 30-day mortality rate for EVAR and OSR was 0.37% and 0.82%, respectively. OSR was associated with lower long-term mortality after adjusting age, sex, American Society of Anesthesiologists classification and preoperative renal failure with an adjusted hazard ratio of 0.88 (95% confidence interval, 0.84-0.92; P < .01). Of surviving patients, the follow-up imaging rate was 69.1% by 1 year post-EVAR. The follow-up rate after 5 years was 45.6% post-EVAR compared with 63.6% post-OSR of surviving patients. A history of smoking or drinking, baseline hypertension, and known cardiac disease were independently associated with poor follow-up after EVAR. CONCLUSIONS Patients undergoing elective open AAA repair in the VA hospital system had lower long-term mortality compared with patients who underwent endovascular repair. Compliance with post-EVAR imaging is low. Patient factors associated with poor post-EVAR imaging surveillance were smoking within the last year, excess alcohol consumption, and cardiac risk factors including hypertension, prior myocardial infarction, and congestive heart failure.
Collapse
Affiliation(s)
- Sona Wolf
- University of Arizona College of Medicine, Tucson, AZ
| | - Yazan Ashouri
- University of Arizona, Division of Vascular Surgery, Department of Surgery, Tucson, AZ
| | - Bahaa Succar
- University of Arizona, Division of Vascular Surgery, Department of Surgery, Tucson, AZ
| | - Chiu-Hsieh Hsu
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ
| | - Yousef Abuhakmeh
- University of Arizona, Division of Vascular Surgery, Department of Surgery, Tucson, AZ
| | - Karou Goshima
- University of Arizona, Division of Vascular Surgery, Department of Surgery, Tucson, AZ
| | - Peter Devito
- University of Arizona, Division of Vascular Surgery, Department of Surgery, Tucson, AZ
| | - Wei Zhou
- University of Arizona, Division of Vascular Surgery, Department of Surgery, Tucson, AZ.
| |
Collapse
|
3
|
Succar B, Vella MA, Holena DN, Dumas RP. Navigating the challenges of vascular access in hypotensive injured patients. Surgery 2024; 175:559-560. [PMID: 37980201 DOI: 10.1016/j.surg.2023.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 10/17/2023] [Indexed: 11/20/2023]
Affiliation(s)
- Bahaa Succar
- UT Southwestern Medical Center, Division of Burn Trauma Acute and Critical Care Surgery, Dallas, TX. https://twitter.com/B_Succar
| | - Michael A Vella
- University of Rochester Medical Center, Division of Acute Care Surgery, Rochester, NY. https://twitter.com/MichaelVella32
| | - Daniel N Holena
- Medical College of Wisconsin, Division of Trauma and Acute Care Surgery, Milwaukee, WI
| | - Ryan P Dumas
- UT Southwestern Medical Center, Division of Burn Trauma Acute and Critical Care Surgery, Dallas, TX.
| |
Collapse
|
4
|
Succar B, Vella MA, Holena DN, Dumas RP. Response to "Letter To The Editor" on "Moving the needle on time to resuscitation: An EAST prospective multicenter study of vascular access in hypotensive injured patients using trauma video review". J Trauma Acute Care Surg 2024; 96:e17-e18. [PMID: 37936274 DOI: 10.1097/ta.0000000000004178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2023]
|
5
|
Succar B, Chou YH, Hsu CH, Rapcsak S, Trouard T, Zhou W. Carotid Revascularization is Associated with Improved Mood in Patients with Advanced Carotid Disease. Ann Surg 2024:00000658-990000000-00754. [PMID: 38258598 DOI: 10.1097/sla.0000000000006216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2024]
Abstract
OBJECTIVE To investigate the impact of carotid interventions on patients' mental condition in patients with carotid stenosis. SUMMARY BACKGROUND DATA Ongoing research highlights the impact of carotid interventions on neurocognitive function in patients with advanced carotid atherosclerosis. However, data regarding the impact of carotid revascularization on mood is scarce. METHODS A total of 157 patients undergoing carotid revascularization were prospectively recruited. The primary outcome was depression, evaluated pre-operatively, and at 1-,6- and 12-month post-intervention using the long form of the geriatric depression scale (GDS-30) questionnaire. Other tests were also used to assess cognition at the respective timepoints. Statistical analyses were performed to assess the postoperative outcomes compared to baseline. RESULTS Baseline depression (GDS>9) was observed in 49(31%) subjects, whereas 108(69%) patients were not depressed (GDS≤9). The average pre-operative GDS score was 15.42 ± 4.40(14.2-16.7) and 4.28 ±2.9(3.7-4.8) in the depressed and non-depressed groups, respectively. We observed a significant improvement in GDS scores within the depressed group at 1-month (P=0.002), 6-months (P=0.027), and 1-year (P<0.001) post-intervention compared to preop, whereas the non-depressed group had similar post-op GDS scores at all time points compared to baseline. Significant improvement in measures of executive function was seen in non-depressed patients at all three timepoints whereas depressed patients showed an improvement at 1-year follow-up. CONCLUSIONS Our study highlights improvement in mood among patients with advanced carotid disease who screened positive for depression at baseline. Further studies with larger sample sizes are warranted to investigate the association between depression, carotid disease, and carotid intervention.
Collapse
Affiliation(s)
- Bahaa Succar
- The University of Arizona, Department of Surgery, Division of Vascular Surgery, Tucson, AZ
| | - Ying-Hui Chou
- The University of Arizona, Department of Psychiatry, Tucson, AZ
| | - Chiu-Hsieh Hsu
- The University of Arizona, Mel and Enid Zuckerman College of Public Health, Tucson, AZ
| | - Steven Rapcsak
- The University of Arizona, Department of Psychiatry, Tucson, AZ
| | - Theodore Trouard
- The University of Arizona, Department of Biomedical Imaging, Tucson, AZ
| | - Wei Zhou
- The University of Arizona, Department of Surgery, Division of Vascular Surgery, Tucson, AZ
| |
Collapse
|
6
|
Kourie HR, Zouein J, Succar B, Mardirossian A, Ahmadieh N, Chouery E, Mehawej C, Jalkh N, kattan J, Nemr E. Genetic Polymorphisms Involved in Bladder Cancer: A Global Review. Oncol Rev 2023; 17:10603. [PMID: 38025894 PMCID: PMC10657888 DOI: 10.3389/or.2023.10603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 10/06/2023] [Indexed: 12/01/2023] Open
Abstract
Bladder cancer (BC) has been associated with genetic susceptibility. Single peptide polymorphisms (SNPs) can modulate BC susceptibility. A literature search was performed covering the period between January 2000 and October 2020. Overall, 334 articles were selected, reporting 455 SNPs located in 244 genes. The selected 455 SNPs were further investigated. All SNPs that were associated with smoking and environmental exposure were excluded from this study. A total of 197 genes and 343 SNPs were found to be associated with BC, among which 177 genes and 291 SNPs had congruent results across all available studies. These genes and SNPs were classified into eight different categories according to their function.
Collapse
Affiliation(s)
- Hampig Raphael Kourie
- Hematology-Oncology Department, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Joseph Zouein
- Hematology-Oncology Department, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Bahaa Succar
- Hematology-Oncology Department, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Avedis Mardirossian
- Hematology-Oncology Department, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Nizar Ahmadieh
- Hematology-Oncology Department, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Eliane Chouery
- Department of Human Genetics, Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Beirut, Lebanon
| | - Cybel Mehawej
- Department of Human Genetics, Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Beirut, Lebanon
| | - Nadine Jalkh
- Medical Genetics Unit, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Joseph kattan
- Hematology-Oncology Department, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Elie Nemr
- Urology Department, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| |
Collapse
|
7
|
Succar B, Chou YH, Hsu CH, Rapcsak S, Trouard T, Zhou W. Cognitive effects of carotid revascularization in octogenarians. Surgery 2023; 174:1078-1082. [PMID: 37550167 PMCID: PMC10528540 DOI: 10.1016/j.surg.2023.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 06/01/2023] [Accepted: 07/08/2023] [Indexed: 08/09/2023]
Abstract
BACKGROUND Cognitive impairment is the epitome of cerebrovascular diseases, causing a significant economic burden on our health care system. Growing evidence has indicated the benefits of carotid interventions in patients with severe carotid atherosclerosis. However, the neurocognitive outcome of carotid revascularization in octogenarians is not clearly understood. We aim to evaluate postintervention cognitive changes in seniors older than 80 years. METHODS We prospectively recruited 170 patients undergoing carotid interventions. Neurocognitive testing was performed preoperatively and at 1, 6, and 12 months postoperatively. Episodic memory was assessed with Rey's Auditory Verbal Learning Test. Other executive functions and language measures were also evaluated at individual time points. Raw test scores were converted to z-scores or scaled scores adjusted for age and education. The sample was divided into 2 groups based on age: octogenarian (≥80 years) and nonoctogenarian (<80 years old). Postoperative cognitive scores were compared to baseline within each subcohort. RESULTS A total of 23 subjects (13%) were octogenarians, and 147 (87%) were younger than 80 years. Younger patients demonstrated significant cognitive improvements up to 12 months postop compared to the baseline. However, octogenarians exhibited a lack of improvement in verbal memory, measures of executive function, and language at all 3 postintervention time points. CONCLUSION Carotid interventions improve cognitive functions in younger patients with carotid occlusive atherosclerosis. However, no cognitive benefits were seen in male seniors older than 80 years. Further investigations are warranted to better understand the postinterventional cognitive changes in octogenarians.
Collapse
Affiliation(s)
- Bahaa Succar
- Department of Surgery, Division of Vascular Surgery, The University of Arizona, Tucson, AZ
| | - Ying-Hui Chou
- Department of Psychiatry, The University of Arizona, Tucson, AZ
| | - Chiu-Hsieh Hsu
- Mel and Enid Zuckerman College of Public Health, The University of Arizona, Tucson, AZ
| | - Steven Rapcsak
- Department of Psychiatry, The University of Arizona, Tucson, AZ
| | - Theodore Trouard
- Department of Biomedical Imaging, The University of Arizona, Tucson, AZ
| | - Wei Zhou
- Department of Surgery, Division of Vascular Surgery, The University of Arizona, Tucson, AZ.
| |
Collapse
|
8
|
Succar B, Zhou W. Does Carotid Intervention Improve Cognitive Function? Adv Surg 2023; 57:267-277. [PMID: 37536858 DOI: 10.1016/j.yasu.2023.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/05/2023]
Abstract
Carotid artery disease has been linked to baseline cognitive impairment, even in asymptomatic patients. Therefore, there has been a persistent interest in investigating the impact of carotid revascularization on cognitive functions, but the results have been heterogeneous. Our recent prospective evaluation showed improved cognitive scores across multiple cognitive measures following carotid intervention. Herein, we summarize the studies published to date, identify the potential contributors to the inconsistency of post-interventional cognitive outcomes, and explore further opportunities in cognitive evaluations.
Collapse
Affiliation(s)
- Bahaa Succar
- Division of Vascular Surgery, Department of Surgery, University of Arizona, Tucson, AZ, USA
| | - Wei Zhou
- Division of Vascular Surgery, Department of Surgery, University of Arizona, Tucson, AZ, USA.
| |
Collapse
|
9
|
Succar B, Chou YH, Hsu CH, Rapcsak S, Trouard T, Zhou W. Abstract WMP78: Predictors Of Memory And Carotid Intervention-related Memory Changes. Stroke 2023. [DOI: 10.1161/str.54.suppl_1.wmp78] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Introduction:
Carotid atherosclerosis is the culprit of stroke and dementia. It has been linked to cognitive impairment in cerebrovascular diseases . A bulk of evidence suggests that carotid interventions improve cognitive functions in appropriately selected patients. We aim to investigate the factors that modulate changes in episodic memory following carotid recanalization procedures.
Methods:
A total of 170 subjects undergoing carotid revascularization procedures were recruited prospectively. Neuropsychometric testing was performed preoperatively, and at 1-,6-, and 12-month postoperatively. Rey Auditory Verbal Learning Test (RAVLT) was used to assess episodic memory. Changes in RAVLT sum scores at individual time points were compared to the baseline. Linear and logistic regression models were fitted to predict RAVLT sum baseline score, and postop changes at each time point compared to preop, respectively. Univariate and multivariate analyses (after adjusting for risk factors and patient demographics) were performed and variables with p <0.25 were included in the multivariable analysis.
Results:
At baseline, having a prior stroke, and being older than 80 years of age were independent predictors of a low preop RAVLT sum score (p=0.001 and p=0.001 respectively). Interestingly, a low preop RAVLT sum score is the only independent predictor of post-intervention cognitive improvement at all three time points compared to preop (P<0.01). CEA and Age <80 years predicted short-term improvement at 1 and 6 months postop. Conversely, carotid artery stenting (CAS) is an independent predictor of verbal memory decline at 1-month post-intervention (p=0.039), while being older than 80 years of age predicted the decline at 1-month (p= 0.046) and 6-month (p= 0.043) postoperatively.
Conclusion:
Younger patients with severe atherosclerotic carotid disease and low baseline episodic memory scores benefit most from carotid intervention, specifically CEA, whereas age ≥80 years predicts poor baseline memory score and worse intervention-related memory change. Further studies with larger sample sizes are necessary to confirm the characteristics of patients with carotid occlusive disease who could benefit from revascularization procedures.
Collapse
|
10
|
Kourie HR, Succar B, Chouery E, Mehawej C, Ahmadieh N, Zouein J, Mardirossian A, Jalkh N, Sleilaty G, Kattan J, Nemr E. Genetic susceptibility of bladder cancer in the Lebanese population. BMC Med Genomics 2022; 15:217. [PMID: 36253817 PMCID: PMC9575197 DOI: 10.1186/s12920-022-01372-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 07/11/2022] [Accepted: 09/05/2022] [Indexed: 12/24/2022] Open
Abstract
Background Bladder cancer (BC) is the 10th most frequent tumor worldwide. Evidence shows an association between elevated risk of BC and various single nucleotide polymorphisms (SNP). BC incidence was the highest in Lebanon according to Globocan 2018 report, but little is known about the genetic susceptibility of Lebanese people to this disease. We aim to evaluate whether this prominent incidence of BC in Lebanon is attributable to known coding genetic variants. Methods A case-control study was conducted at Hotel-Dieu de France Hospital, Beirut. A cohort of 51 Lebanese patients with BC were recruited between 2017 and 2020. Whole Exome Sequencing (WES) was performed on peripheral blood samples to detect coding genetic variants in the patients. An in-house database including WES data from 472 Lebanese individuals served as control. Literature review of the genetic predisposition to BC was conducted to establish a database of variants known to influence the risk of BC. In-common SNPs were identified between cases and the aforecited database, and their allelic frequencies was quantified in the former and in controls. Comparative analysis of the allelic frequencies of each in-common SNP was carried out between cases, controls, and the genome aggregation database (gnomAD). Analysis was performed by applying the binomial law and setting the p-value to 10− 10. Results 484 polymorphisms associated with BC were extracted from the literature review ;151 of which were in-common with the 206 939 variations detected by WES in our cases. Statistically significant differences (p-value < 10− 10) in allelic frequencies was seen in 11 of the 151 in-common SNPs, but none of which corresponds with a higher BC risk. Moreover, rs4986782 variant in the NAT1 gene is not associated with BC in the Lebanese population. `. Conclusion This is the first next-generation sequencing (NGS)- based study investigating BC risk in a Lebanese cohort of 51 patients. The majority of known exonic variants in the literature were not associated with BC in our patients. Further studies with larger sample sizes are warranted to explore the association of BC in our population with known non-coding genetic variants, and the remainder of WES-generated private Lebanese variants. Supplementary Information The online version contains supplementary material available at 10.1186/s12920-022-01372-z.
Collapse
Affiliation(s)
- Hampig Raphael Kourie
- Hematology-Oncology Department, Faculty of Medicine, Saint Joseph University of Beirut, Beirut, Lebanon.
| | - Bahaa Succar
- Hematology-Oncology Department, Faculty of Medicine, Saint Joseph University of Beirut, Beirut, Lebanon
| | - Eliane Chouery
- Medical Genetics Unit, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon.,Department of Human Genetics, Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Byblos, Lebanon
| | - Cybel Mehawej
- Medical Genetics Unit, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon.,Department of Human Genetics, Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Byblos, Lebanon
| | - Nizar Ahmadieh
- Hematology-Oncology Department, Faculty of Medicine, Saint Joseph University of Beirut, Beirut, Lebanon
| | - Joseph Zouein
- Hematology-Oncology Department, Faculty of Medicine, Saint Joseph University of Beirut, Beirut, Lebanon
| | - Avedis Mardirossian
- Hematology-Oncology Department, Faculty of Medicine, Saint Joseph University of Beirut, Beirut, Lebanon
| | - Nadine Jalkh
- Medical Genetics Unit, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Ghassan Sleilaty
- Hematology-Oncology Department, Faculty of Medicine, Saint Joseph University of Beirut, Beirut, Lebanon
| | - Joseph Kattan
- Hematology-Oncology Department, Faculty of Medicine, Saint Joseph University of Beirut, Beirut, Lebanon
| | - Elie Nemr
- Urology Department, Faculty of Medicine, Saint Joseph University of Beirut, Beirut, Lebanon
| |
Collapse
|
11
|
Zhou W, Succar B, Murphy DP, Ashouri Y, Chou YH, Hsu CH, Rapcsak S, Trouard T. Carotid Intervention Improves Cognitive Function in Patients With Severe Atherosclerotic Carotid Disease. Ann Surg 2022; 276:539-544. [PMID: 35972513 PMCID: PMC9387545 DOI: 10.1097/sla.0000000000005555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Carotid revascularization procedures are effective in stroke prevention in appropriately selected patients. We sought to understand the effects of the carotid intervention on cognitive function in a well-defined cohort of prospectively recruited patients. METHODS A total of 170 consecutive patients undergoing carotid intervention for severe carotid stenosis were recruited. Patients received neuropsychometric testing preintervention, and at 1, 6, and 12 months postoperative. Patients were screened with the Mini-Mental State Examination. Rey Auditory Verbal Learning test (RAVLT) test was the primary outcome measure and multiple cognitive tests were used to evaluate executive function. Paired t test and McNemar test were performed to compare age-adjusted and education-adjusted postoperative scores at the individual time point with the preoperative scores. RESULTS Our patients had a high prevalence of cardiovascular risks and 51.2% of whom were symptomatic. The usages of statin and antiplatelet were high (88.8% and 69.4%, respectively). A total of 140 patients had 1 or more postoperative neuropsychometric tests in addition to their preoperative tests were included. The average RAVLT preoperative score was lower ( z =-0.79, SD=1.3, confidence interval: -1 to -0.53) than the age-adjusted norm. We observed a significant improvement in RAVLT memory scores at 1 and 6 months postoperative compared with preoperative. We also observed significant improvement in multiple executive functions measures up to 12 months postoperative. The improvement on patients with preoperative stroke symptoms was less consistent. CONCLUSIONS This prospective study showed that carotid intervention improved memory and executive function in patients with the severe carotid occlusive disease. It highlights the cognitive benefit of the carotid intervention in appropriately selected patients.
Collapse
Affiliation(s)
- Wei Zhou
- Department of Surgery, University of Arizona, Tucson, AZ
| | - Bahaa Succar
- Department of Surgery, University of Arizona, Tucson, AZ
| | - Devin P Murphy
- Department of Biomedical Engineering, University of Arizona, Tucson, AZ
| | - Yazan Ashouri
- Department of Surgery, University of Arizona, Tucson, AZ
| | - Ying-Hui Chou
- Department of Psychiatry, University of Arizona, Tucson, AZ
| | - Chiu-Hsieh Hsu
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ
| | - Steven Rapcsak
- Department of Psychiatry, University of Arizona, Tucson, AZ
| | - Theodore Trouard
- Department of Biomedical Engineering, University of Arizona, Tucson, AZ
- Department of Biomedical Imaging, University of Arizona, Tucson, AZ
| |
Collapse
|
12
|
Succar B, Abuhakmeh Y, Khreiss M, Zhou W. Mobile Primary Renal Vein Lipoma with an accelerated growth pattern. J Vasc Surg Cases Innov Tech 2022; 8:670-673. [PMID: 36325313 PMCID: PMC9618676 DOI: 10.1016/j.jvscit.2022.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 09/11/2022] [Indexed: 12/02/2022] Open
Abstract
Primary intravascular lipoma is a rare proliferation of adipose tissue originating from the wall of blood vessels. We have described an unusual case of a benign, but fast-growing, primary intravascular lipoma of the left renal vein with the mobile edge extending to the cavoatrial junction within just a few months. We have discussed the surgical indications, management, and technical considerations and highlighted the importance of surgical planning for similar cases.
Collapse
Affiliation(s)
- Bahaa Succar
- Division of Vascular Surgery, Department of Surgery, University of Arizona, Tucson, AZ
| | - Yousef Abuhakmeh
- Division of Vascular Surgery, Department of Surgery, University of Arizona, Tucson, AZ
| | - Mohammad Khreiss
- Division of Surgical Oncology, Department of Surgery, University of Arizona, Tucson, AZ
| | - Wei Zhou
- Division of Vascular Surgery, Department of Surgery, University of Arizona, Tucson, AZ
- Correspondence: Wei Zhou, MD, Division of Vascular Surgery, Department of Surgery, University of Arizona, 1501 N Campbell Ave, Tucson, AZ 85724
| |
Collapse
|
13
|
Moly PK, Haider N, Zayed M, Black J, Succar B, Saad E, Zhou W. Abstract P2095: Role Of Intraplaque Lipids In Atherosclerotic Plaque Vulnerability. Circ Res 2022. [DOI: 10.1161/res.131.suppl_1.p2095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
Hyperlipidemia plays a pivotal role in the pathogenesis of diabetes, atherosclerosis, and cardiovascular diseases. Specific lipids of atherosclerotic plaques are potentially one of the local factors which render them susceptible to rupture. Their underlying unresolved inflammation and oxidative stress contribute to the transition from stable to unstable plaques. Therefore, we aimed to identify, characterize, and compare the intraplaque lipids composition among diabetic and non-diabetic patients and to ascertain their role in inflammation, and atherosclerotic plaque destabilization and rupture.
Methods:
Approved by the IRB, University of Arizona, Tucson Lipids were analyzed by liquid chromatography-mass spectrometry (LC-MS) from 40 surgically removed endarterectomy specimens that include
Asymptomatic & Non-diabetic
(n=13),
Symptomatic & Non-diabetic
(n=17),
Asymptomatic & Diabetic
(n=5) iv.
Symptomatic & Diabetic
(n=5) patients. Seventy nine lipid species from the main lipid classes phosphatidylcholine (PC), phosphatidylserine (PS), phosphatidylethanolamine (PE), phosphatidylinositol (PI), cholesteryl ester (CE) phosphatidylglycerol (PG), sphingomyelin (SM), and ceramide (Cer) were included in this lipidomic profiling.
Results:
LC-MS data analysis identified a significant difference (p<0.05) in 2 individual lipid species – a long chain polyunsaturated PC(40:7) and SM(18:1) between diabetic and non-diabetic (Table:1). A total of 23 lipid species were significantly (p<0.05 to p<0.005) differentially present between symptomatic and asymptomatic samples. Symptomatic diabetic and nondiabetic samples showed a significant (p<0.05 to p<0.005) difference in 13 lipids belonging to PC, SM and PE. Our studies also showed a higher peroxidation of intraplaque lipid from diabetic patients compared to non-diabetics, and a significant increase in reactive oxygen species (ROS) production in human coronary artery smooth muscle cells treated with lipids from diabetic plaques.
Conclusions:
This exploratory analysis showed distinct patterns of intraplaque lipid composition. Identification of these high-risk plaque lipid biomarkers will help to delineate the cellular and molecular mechanism responsible for stable to vulnerable plaques transition.
Collapse
|