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Rahimi AO, Soliman D, Hsu CH, Ghaderi I. The impact of gender, race, and ethnicity on bariatric surgery outcomes. Surg Obes Relat Dis 2024; 20:454-461. [PMID: 38326184 DOI: 10.1016/j.soard.2023.12.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Revised: 12/19/2023] [Accepted: 12/25/2023] [Indexed: 02/09/2024]
Abstract
BACKGROUND The rates of postoperative complications can vary among specific patient populations. OBJECTIVES The aim of this study is to examine how gender, race, and ethnicity can affect short-term postoperative complications in bariatric surgery patients. SETTING United States. METHODS Patients who underwent bariatric surgery between the years 2016 and 2021 were included and stratified based on gender, race/ethnicity, and procedure type. The 30-day outcomes were assessed using Clavien-Dindo (CD) classification of III-V. Wilcoxon rank-sum test was performed to compare continuous variables among groups and Chi-squared test for categorical variables. Logistic regression was performed to examine the effects of gender, race/ethnicity on CD classification ≥ III complications by the procedure type. RESULTS A total of 975,642 bariatric surgery patients were included. Descriptive univariate analysis showed that CD ≥ III complications were higher among non-Hispanic blacks (NHB) and lowest in Hispanic patients, regardless of their gender, except in the duodenal switch DS group, where non-Hispanic whites (NHW) had the lowest complication rate. There was no difference between male and female patients with regards to postoperative complications, except in the sleeve gastrectomy (SG) group, where NHW males had more complications than NHW females. Sleeve gastrectomy showed the lowest complication rates followed by gastric bypass and DS in all groups. In multivariate logistic regression model, for both females and males NHBs had higher odds of postoperative complications compared to NHWs in sleeve gastrectomy (Female aOR:1.31, 95% CI: [1.23-1.40]; Male aOR:1.24, 95% CI: [1.08-1.43], P < .001) and gastric bypass (Female aOR:1.24, 95% CI: [1.16-1.33]; Male aOR:1.25, 95% CI: [1.06-1.48], P < .01). CONCLUSIONS Non-Hispanic Black patients are at a higher rate of developing CD ≥ III complications compared to non-Hispanic Whites after bariatric surgery. The male gender was not a significant risk factor for serious postoperative complications. Among the different types of bariatric procedures, sleeve gastrectomy has the lowest rates of severe complications, followed by gastric bypass and duodenal switch. These results highlight the significance of considering gender, race, ethnicity, and procedure type during preoperative evaluation, surgical planning, and postoperative care.
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Affiliation(s)
- Ahmad Omid Rahimi
- Section of Minimally Invasive, Robotic and Bariatric Surgery, Department of Surgery, University of Arizona College of Medicine, Tucson, Arizona
| | - Diaa Soliman
- Section of Minimally Invasive, Robotic and Bariatric Surgery, Department of Surgery, University of Arizona College of Medicine, Tucson, Arizona
| | - Chiu-Hsieh Hsu
- Epidemiology and Biostatistics Department, University of Arizona College of Public Health, Tucson, Arizona
| | - Iman Ghaderi
- Section of Minimally Invasive, Robotic and Bariatric Surgery, Department of Surgery, University of Arizona College of Medicine, Tucson, Arizona.
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Hamidi F, Anwari E, Spaulding C, Hauw-Berlemont C, Vilfaillot A, Viana-Tejedor A, Kern KB, Hsu CH, Bergmark BA, Qamar A, Bhatt DL, Furtado RHM, Myhre PL, Hengstenberg C, Lang IM, Frey N, Freund A, Desch S, Thiele H, Preusch MR, Zelniker TA. Early versus delayed coronary angiography in patients with out-of-hospital cardiac arrest and no ST-segment elevation: a systematic review and meta-analysis of randomized controlled trials. Clin Res Cardiol 2024; 113:561-569. [PMID: 37495798 PMCID: PMC10954865 DOI: 10.1007/s00392-023-02264-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 06/30/2023] [Indexed: 07/28/2023]
Abstract
BACKGROUND Recent randomized controlled trials did not show benefit of early/immediate coronary angiography (CAG) over a delayed/selective strategy in patients with out-of-hospital cardiac arrest (OHCA) and no ST-segment elevation. However, whether selected subgroups, specifically those with a high pretest probability of coronary artery disease may benefit from early CAG remains unclear. METHODS We included all randomized controlled trials that compared a strategy of early/immediate versus delayed/selective CAG in OHCA patients and no ST elevation and had a follow-up of at least 30 days. The primary outcome of interest was all-cause death. Odds ratios (OR) were calculated and pooled across trials. Interaction testing was used to assess for heterogeneity of treatment effects. RESULTS In total, 1512 patients (67 years, 26% female, 23% prior myocardial infarction) were included from 5 randomized controlled trials. Early/immediate versus delayed/selective CAG was not associated with a statistically significant difference in odds of death (OR 1.12, 95%-CI 0.91-1.38), with similar findings for the composite outcome of all-cause death or neurological deficit (OR 1.10, 95%-CI 0.89-1.36). There was no effect modification for death by age, presence of a shockable initial cardiac rhythm, history of coronary artery disease, presence of an ischemic event as the presumed cause of arrest, or time to return of spontaneous circulation (all P-interaction > 0.10). However, early/immediate CAG tended to be associated with higher odds of death in women (OR 1.52, 95%-CI 1.00-2.31, P = 0.050) than in men (OR 1.04, 95%-CI 0.82-1.33, P = 0.74; P-interaction 0.097). CONCLUSION In OHCA patients without ST-segment elevation, a strategy of early/immediate versus delayed/selective CAG did not reduce all-cause mortality across major subgroups. However, women tended to have higher odds of death with early CAG.
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Affiliation(s)
- Fardin Hamidi
- Division of Cardiology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Elaaha Anwari
- Division of Cardiology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Christian Spaulding
- Department of Cardiology, European Hospital Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Paris Cité University, Sudden Cardiac Death Expert Center, Paris, France
| | - Caroline Hauw-Berlemont
- Medical Intensive Care Unit, European Hospital Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Université Paris Cité, Paris, France
| | - Aurélie Vilfaillot
- Biostatistique et Santé Publique, European Hospital Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Ana Viana-Tejedor
- Acute Cardiac Care Unit, Department of Cardiology, University Hospital Clínico San Carlos, Madrid, Spain
| | - Karl B Kern
- University of Arizona Sarver Heart Center, Tucson, AZ, USA
| | - Chiu-Hsieh Hsu
- University of Arizona Sarver Heart Center, Tucson, AZ, USA
| | - Brian A Bergmark
- TIMI Study Group, Cardiovascular Division, Brigham and Women's Hospital and Harvard Medical School, Boston, USA
| | - Arman Qamar
- Cardiovascular Outcomes Research and Innovation Laboratory, Section of Interventional Cardiology and Vascular Medicine, NorthShore University Health System, Evanston, USA
| | - Deepak L Bhatt
- Mount Sinai Heart, Icahn School of Medicine at Mount Sinai Health System, New York, NY, USA
| | - Remo H M Furtado
- Brazilian Clinical Research Institute, Sao Paulo, Brazil
- Instituto do Coracao (InCor), Hospital das Clinicas da Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Peder L Myhre
- Department of Medicine, Division of Cardiology, Akershus University Hospital and K.G. Jebsen Center for Cardiac Biomarkers, University of Oslo, Oslo, Norway
| | - Christian Hengstenberg
- Division of Cardiology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Irene M Lang
- Division of Cardiology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Norbert Frey
- Department of Cardiology, Angiology, and Pneumology, University Hospital of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Heidelberg/Mannheim, Heidelberg, Germany
| | - Anne Freund
- Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Leipzig, Germany
| | - Steffen Desch
- Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Leipzig, Germany
| | - Holger Thiele
- Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Leipzig, Germany
| | - Michael R Preusch
- Department of Cardiology, Angiology, and Pneumology, University Hospital of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany.
- DZHK (German Centre for Cardiovascular Research), Partner Site Heidelberg/Mannheim, Heidelberg, Germany.
| | - Thomas A Zelniker
- Division of Cardiology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
- Department of Cardiology, Angiology, and Pneumology, University Hospital of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany.
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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.
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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.
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Rahimi AO, Hsu CH, Maegawa F, Soliman D, King RJ, Ashouri Y, Ghaderi I. First Assistant In Bariatric Surgery: A Comparison Between Laparoscopic And Robotic Approaches: A 4-Year Analysis of the MBSAQIP Database (2016-2019). Obes Surg 2024; 34:866-873. [PMID: 38114775 DOI: 10.1007/s11695-023-06996-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 12/08/2023] [Accepted: 12/11/2023] [Indexed: 12/21/2023]
Abstract
PURPOSE The first assistant (FA) plays an important role in the operating room for bariatric surgery. The aim of this study was to examine the relationship between the type of FA and operative time (OT) and postoperative outcomes comparing robotic and laparoscopic approaches in bariatric surgery. METHODS AND MATERIALS The Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) data for 2016-2019 was queried. Log-normal regression was performed to evaluate the association of FAs and OT variations within and between groups. We used logistic regression to examine the relationship between the type of FA and 30-day outcomes across all procedures and approaches. RESULTS A total of 691,789 patients who underwent robotic (R), and laparoscopic (L) sleeve gastrectomy (SG), Roux-en-Y gastric-bypass (RYGB), and duodenal switch (DS) were included. The percentage variation of OT was higher in the laparoscopic group (L-SG: 8.18%, L-RYGB: 9.88%, and L-DS: 15.00%) compared to the robotic group (R-SG: 2.43%, R-RYGB: 5.76%, and R-DS: 0.80%). There was not a significant difference in 30-day outcomes between laparoscopic and robotic approaches for the same procedures. CONCLUSIONS The FA was associated with a decreased variability in OT in the robotic cohort compared to the laparoscopic group with no significant difference in complication rates. These results suggest that the robotic approach may decrease the need for skilled FAs in bariatric procedures.
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Affiliation(s)
- Ahmad Omid Rahimi
- Section of Minimally Invasive, Robotic and Bariatric Surgery, Department of Surgery, University of Arizona College of Medicine, 1501N. Campbell Avenue, P.O. Box 245066, Tucson, AZ, 85724-5066, USA
| | - Chiu-Hsieh Hsu
- Epidemiology and Biostatistics Department, University of Arizona College of Public Health, Tucson, AZ, USA
| | - Felipe Maegawa
- Division of General & GI Surgery, Department of Surgery, Emory University, 5673 Peachtree Dunwoody Rd, Suite 680, Atlanta, GA, 30342, USA
| | - Diaa Soliman
- Section of Minimally Invasive, Robotic and Bariatric Surgery, Department of Surgery, University of Arizona College of Medicine, 1501N. Campbell Avenue, P.O. Box 245066, Tucson, AZ, 85724-5066, USA
| | - Robert J King
- Section of Minimally Invasive, Robotic and Bariatric Surgery, Department of Surgery, University of Arizona College of Medicine, 1501N. Campbell Avenue, P.O. Box 245066, Tucson, AZ, 85724-5066, USA
| | - Yazan Ashouri
- Section of Minimally Invasive, Robotic and Bariatric Surgery, Department of Surgery, University of Arizona College of Medicine, 1501N. Campbell Avenue, P.O. Box 245066, Tucson, AZ, 85724-5066, USA
| | - Iman Ghaderi
- Section of Minimally Invasive, Robotic and Bariatric Surgery, Department of Surgery, University of Arizona College of Medicine, 1501N. Campbell Avenue, P.O. Box 245066, Tucson, AZ, 85724-5066, USA.
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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] [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.
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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
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Bazikian S, Urbina D, Hsu CH, Gonzalez KA, Rosario ER, Chu DI, Tsui J, Tan TW. Examining health care access disparities in Hispanic populations with peripheral artery disease and diabetes. Vasc Med 2023; 28:547-553. [PMID: 37642640 PMCID: PMC10712238 DOI: 10.1177/1358863x231191546] [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: 08/31/2023]
Abstract
INTRODUCTION This study investigated disparities in health care access for Hispanic adults with diabetes and peripheral artery disease (PAD) who are at risk of lower-extremity amputation and other cardiovascular morbidities and mortalities. METHODS We utilized the health care access survey data from the All of Us research program to examine adults (⩾ 18 years) with either diabetes and/or PAD. The primary associations evaluated were: could not afford medical care and delayed getting medical care in the past 12 months. Multivariable logistic regression models were used to assess the association of Hispanic ethnicity and survey responses, adjusting for age, sex, income, health insurance, and employment status. RESULTS Among 24,104 participants, the mean age was 54.9 years and 67% were women. Of these, 8.2% were Hispanic adults. In multivariable analysis, Hispanic adults were more likely to be unable to afford seeing a health care provider, and receiving emergency care, follow-up care, and prescription medications (p < 0.05) than non-Hispanic adults. Furthermore, Hispanic adults were more likely to report being unable to afford medical care due to cost (odds ratios [OR] 1.72, 95% CI 1.50-1.99), more likely to purchase prescription drugs from another country (OR 2.20, 95% CI 1.69-2.86), and more likely to delay getting medical care due to work (OR 1.46, 95% CI 1.22-1.74) and child care (OR 1.80, 95% CI 1.35-2.39) issues than non-Hispanic White adults. CONCLUSION The Hispanic population with diabetes and PAD faces substantial barriers in health care access, including a higher likelihood of delaying medical care and being unable to afford it.
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Affiliation(s)
- Sebouh Bazikian
- Keck School of Medicine at University of Southern California, Los Angeles, CA, USA
| | | | | | | | - Emily R. Rosario
- Research Institute at Case Colina Hospital and Centers for Healthcare, Pamona, CA, USA
| | - Dan I. Chu
- Heershink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jennifer Tsui
- Keck School of Medicine at University of Southern California, Los Angeles, CA, USA
| | - Tze-Woei Tan
- Keck School of Medicine at University of Southern California, Los Angeles, CA, USA
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Combs D, Edgin J, Hsu CH, Bottrill K, Van Vorce H, Gerken B, Matloff D, La Rue S, Parthasarathy S. The combination of atomoxetine and oxybutynin for the treatment of obstructive sleep apnea in children with Down syndrome. J Clin Sleep Med 2023; 19:2065-2073. [PMID: 37555595 PMCID: PMC10692944 DOI: 10.5664/jcsm.10764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 08/02/2023] [Accepted: 08/02/2023] [Indexed: 08/10/2023]
Abstract
STUDY OBJECTIVES Children with Down syndrome (DS) are at very high risk for obstructive sleep apnea (OSA). Current OSA treatments have limited effectiveness in this population. We evaluated the effectiveness of atomoxetine and oxybutynin (ato-oxy) to treat OSA in children with Down syndrome. METHODS Children ages 6-7 years old with Down syndrome and OSA participated in a double-blind crossover clinical trial evaluating two dose regimens of ato-oxy. Participants received low-dose ato-oxy (0.5 mg/kg atomoxetine and 5 mg oxybutynin) and high-dose ato-oxy (1.2 mg/kg atomoxetine and 5 mg oxybutynin) for 1 month in random order. The primary study outcome was change in obstructive apnea-hypopnea index. Health-related quality of life as measured by the OSA-18 as well as changes in sleep architecture were secondary outcomes. RESULTS Fifteen participants qualified for randomization and 11 participants had complete data at all points. Baseline obstructive apnea-hypopnea index was 7.4 ± 3.7 (mean ± standard deviation), obstructive apnea-hypopnea index with low-dose ato-oxy was 3.6 ± 3.3 (P = .001 vs baseline), and obstructive apnea-hypopnea index with high-dose ato-oxy was 3.9 ± 2.8 (P = .003 vs baseline). No significant sleep architecture differences were present with ato-oxy. No significant difference in OSA-18 score was present. OSA-18 total score was 51 ± 19 at baseline, 45 ± 17 (P = .09) at the end of 4 weeks of low-dose ato-oxy, and 45 ± 16 (P = .37) at the end of high-dose ato-oxy therapy. The most common adverse effects were irritability and fatigue, and these were generally mild. CONCLUSIONS Ato-oxy is a promising treatment for OSA in children with Down syndrome. CLINICAL TRIAL REGISTRATION Registry: Clinicaltrials.gov; Name: Medications for Obstructive Sleep Apnea In Children With Down Syndrome (MOSAIC); URL: https://clinicaltrials.gov/ct2/show/NCT04115878; Identifier: NCT04115878. CITATION Combs D, Edgin J, Hsu C-H, et al. The combination of atomoxetine and oxybutynin for the treatment of obstructive sleep apnea in children with Down syndrome. J Clin Sleep Med. 2023;19(12):2065-2073.
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Affiliation(s)
- Daniel Combs
- UAHS Center for Sleep & Circadian Sciences, University of Arizona, Tucson, Arizona
- Department of Pediatrics, University of Arizona, Tucson, Arizona
| | - Jamie Edgin
- Department of Psychology, University of Arizona, Tucson, Arizona
| | - Chiu-Hsieh Hsu
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona
| | - Kenneth Bottrill
- Department of Psychology, University of Arizona, Tucson, Arizona
| | - Hailey Van Vorce
- Department of Psychology, University of Arizona, Tucson, Arizona
| | - Blake Gerken
- UAHS Center for Sleep & Circadian Sciences, University of Arizona, Tucson, Arizona
| | - Daniel Matloff
- UAHS Center for Sleep & Circadian Sciences, University of Arizona, Tucson, Arizona
| | - Sicily La Rue
- UAHS Center for Sleep & Circadian Sciences, University of Arizona, Tucson, Arizona
| | - Sairam Parthasarathy
- UAHS Center for Sleep & Circadian Sciences, University of Arizona, Tucson, Arizona
- Department of Medicine, University of Arizona, Tucson, Arizona
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Desravines N, Hsu CH, Mohnot S, Sahasrabuddhe V, House M, Sauter E, O’Connor S, Bauman JE, Chow HHS, Rahangdale L. Feasibility of 5-fluorouracil and imiquimod for the topical treatment of cervical intraepithelial neoplasias (CIN) 2/3. Int J Gynaecol Obstet 2023; 163:862-867. [PMID: 37431689 PMCID: PMC10782812 DOI: 10.1002/ijgo.14983] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 06/06/2023] [Accepted: 06/16/2023] [Indexed: 07/12/2023]
Abstract
OBJECTIVES To determine the feasibility (as measured by tolerability and safety) and efficacy of topical 5-fluorouracil (5-FU) and imiquimod for the treatment of cervical intraepithelial neoplasia (CIN) 2/3. METHODS This pilot prospective study was conducted in women aged 18-45 years with p16+ CIN 2/3. Participants underwent an 8-week alternating regimen of self-applied 5% 5-FU on weeks 1, 3, 5, and 7 and physician-applied imiquimod on weeks 2, 4, 6, and 8. Adverse events (AEs) were collected by symptom diary and clinical exam. Feasibility was measured by tolerability and safety (AEs) of the study intervention. Tolerability was assessed as the number of participants able to apply 50% or more of the treatment doses. The safety outcome was calculated as the number of participants who experienced "specified AEs" defined as possibly, probably, or definitely related grade 2 or worse AE or grade 1 genital AEs (blisters, ulcerations, or pustules) lasting more than 5 days. The efficacy of the intervention was determined by histology and high-risk human papillomavirus (hrHPV) testing was done after treatment. RESULTS The median age of the 13 participants was 27 ± 2.9 years. Eleven (84.61%) participants applied 50% or more of the treatment. All participants reported grade 1 AEs; 6 (46.15%) reported grade 2 AEs; and 0 reported grade 3/4 AEs. Three (23.08%) participants had specified AEs. Histologic regression to normal or CIN 1 among those completing 50% or more of the treatment doses was observed in 10 (90.91%) participants, and 7 (63.63%) tested negative for hr-HPV at the end of the study. CONCLUSIONS Topical treatment for CIN 2/3 with 5-FU/imiquimod is feasible, with preliminary evidence of efficacy. Topical therapies need further investigation as adjuncts or alternatives to surgical therapy for CIN 2/3.
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Affiliation(s)
- Nerlyne Desravines
- Johns Hopkins School of Medicine, Department of Gynecology and Obstetrics, Baltimore, MD, USA
| | | | | | - Vikrant Sahasrabuddhe
- Breast and Gynecologic Cancer Research Group, Division of Cancer Prevention, Bethesda, MD, USA
| | - Margaret House
- Breast and Gynecologic Cancer Research Group, Division of Cancer Prevention, Bethesda, MD, USA
| | - Edward Sauter
- Breast and Gynecologic Cancer Research Group, Division of Cancer Prevention, Bethesda, MD, USA
| | - Siobhan O’Connor
- University of North Carolina Department of Pathology and Laboratory Medicine, Chapel Hill, NC, USA
| | | | | | - Lisa Rahangdale
- University of North Carolina Department of Obstetrics and Gynecology, Chapel Hill, NC, USA
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Hsu FM, Huang TC, Guo JC, Hsu CH, Lee JM, Huang PM, Chang YL, Cheng JCH. A Prospective Study of Bevacizumab and Neoadjuvant Concurrent Chemoradiation in Locally Advanced Esophageal Squamous Cell Carcinoma: Paradoxical Increase in Circulating Vascular Endothelial Growth Factor-A and Effect on Outcome. Int J Radiat Oncol Biol Phys 2023; 117:e302-e303. [PMID: 37785104 DOI: 10.1016/j.ijrobp.2023.06.2320] [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: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) In the prior prospective biomarker study, high serum vascular endothelial growth factor-A (VEGF-A) was associated with a poor prognosis. We conducted a prospective phase II trial of adding Bevacizumab, an anti-VEGF-A monoclonal antibody, to neoadjuvant concurrent chemoradiation (neoCCRT) for patients with locally advanced esophageal squamous cell carcinoma (LA-ESCC). This prospective biomarker study aims to evaluate the expressions of angiogenesis-associated circulating biomarkers before and after neoCCRT and compare clinical outcomes for patients receiving platinum/5-fluorouracil (PF) with or without Bevacizumab. MATERIALS/METHODS Patients with biopsy-proven resectable non-T4 LA-ESCC were enrolled for the prospective phase II trial investigating PF-neoCCRT plus Bevacizumab (BPF group). A parallel patient cohort enrolled in a prospective biomarker study receiving PF-neoCCRT was included in the present analysis as the control group (PF group). Radiotherapy was delivered with 40 Gy in 20 fractions. All patients had restaging workups after enoCCRT and underwent radical esophagectomy if the disease remained resectable. Serums were collected before and after neoCCRT. The serum concentrations of angiogenesis-associated biomarkers were determined by the multiplex enzyme-linked immunosorbent assay. Survival analyses were performed by the Kaplan-Meier method. The t-test and log-rank test were used to compare differences in biomarker expression and survival between groups. RESULTS From 2016 to 2019, 43 patients (BPF/PF group: 21/22) were enrolled in the study. Twenty patients in each group had serum samples available for biomarker analysis. 15 out of 21 patients in the BPF group and 20 out of 22 patients in the PF group underwent radical esophagectomy. Six patients in the BPF group and nine patients in the PF group achieved pathological complete responses. The median overall survival for the BPF and PF group was 20.8 months and not-reached, respectively (hazard ratio = 1.33, long rank p = 0.58). In the BPF group, the serum VEGF-A level was significantly increased from an average value of 446 pg/mL to 723 pg/mL after neoCCRT (p = 0.037), while its level was decreased from 815 ng/mL to 380 pg/mL in the PF group (p = 0.104). In addition, the expression value of circulating Angiopoietin-1 was not changed in the BPF group (before neoCCRT, mean value = 828 pg/mL; after neoCCRT, mean value 762 pg/mL, p = 0.67). In contrast, serum Angiopoietin-1 level was reduced from an average value of 659 pg/mL before neoCCRT to 271 pg/mL after neoCCRT (p = 0.002) in the PF group. CONCLUSION The addition of Bevacizumab to PF-neoCCRT did not improve pathological or survival outcomes in patients with resectable LA-ESCC. Adding a single dose of Bevacizumab paradoxically increases circulating VEGF-A while maintaining the Angiopoietin-1 serum level after neoCCRT. Further investigation by using additional VEGF-A inhibition may be required to achieve sustained angiogenesis blocked for tumor control.
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Affiliation(s)
- F M Hsu
- Department of Radiation Oncology, National Taiwan University Cancer Center, Taipei, Taiwan; Graduate Institute of Oncology, National Taiwan University College of Medicine, Taipei, Taiwan
| | - T C Huang
- Graduate Institute of Oncology, National Taiwan University College of Medicine, Taipei, Taiwan; Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan
| | - J C Guo
- Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan
| | - C H Hsu
- Graduate Institute of Oncology, National Taiwan University College of Medicine, Taipei, Taiwan; Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan
| | - J M Lee
- Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan
| | - P M Huang
- Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan
| | - Y L Chang
- Department of Pathology, National Taiwan University Hospital, Taipei, Taiwan
| | - J C H Cheng
- Graduate Institute of Oncology, National Taiwan University College of Medicine, Taipei, Taiwan; Division of Radiation Oncology, Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan
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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.
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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.
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Maegawa FB, Patel AD, Serrot FJ, Patel SG, Stetler JL, Patel DC, Ghaderi I, Hsu CH, Ashouri Y, Sarmiento JM, Konstantinidis IT, Lin E. Gastric Cancer Surgery in the US: a Contemporary Trend Analysis of Lymphadenectomy and the Impact of Minimally Invasive Approaches. J Gastrointest Surg 2023; 27:1825-1836. [PMID: 37340110 DOI: 10.1007/s11605-023-05735-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Accepted: 05/30/2023] [Indexed: 06/22/2023]
Abstract
BACKGROUND The National Comprehensive Cancer Network guidelines recommend harvesting 16 or more lymph nodes for the adequate staging of gastric adenocarcinoma. This study examines the rate of adequate lymphadenectomy over recent years, its predictors, and its impact on overall survival(OS). STUDY DESIGN The National Cancer Database was utilized to identify patients who underwent surgical treatment for gastric adenocarcinoma between 2006-2019. Trend analysis was performed for lymphadenectomy rates during the study period. Logistic regression, Kaplan-Meier survival plots, and Cox proportional hazard regression were utilized. RESULTS A total of 57,039 patients who underwent surgical treatment for gastric adenocarcinoma were identified. Only 50.5% of the patients underwent a lymphadenectomy of ≥ 16 nodes. Trend analysis showed that this rate significantly improved over the years, from 35.1% in 2006 to 63.3% in 2019 (p < .0001). The main independent predictors of adequate lymphadenectomy included high-volume facility with ≥ 31 gastrectomies/year (OR: 2.71; 95%CI:2.46-2.99), surgery between 2015-2019 (OR: 1.68; 95%CI: 1.60-1.75), and preoperative chemotherapy (OR:1.49; 95%CI:1.41-1.58). Patients with adequate lymphadenectomy had better OS than patients who did not: median survival: 59 versus 43 months (Log-Rank: p < .0001). Adequate lymphadenectomy was independently associated with improved OS (HR:0.79; 95%CI:0.77-0.81). Laparoscopic and robotic gastrectomies were independently associated with adequate lymphadenectomy compared to open, OR: 1.11, 95%CI:1.05-1.18 and OR: 1.24, 95%CI:1.13-1.35, respectively. CONCLUSION Although the rate of adequate lymphadenectomy improved over the study period, a large number of patients still lacked adequate lymph node dissection, negatively impacting their OS despite multimodality therapy. Laparoscopic and robotic surgeries were associated with a significantly higher rate of lymphadenectomy ≥ 16 nodes.
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Affiliation(s)
- Felipe B Maegawa
- Division of General & GI Surgery, Department of Surgery, Emory University, 5673 Peachtree Dunwoody Rd, Suite 680, Atlanta, GA, 30342, USA.
| | - Ankit D Patel
- Division of General & GI Surgery, Department of Surgery, Emory University, 5673 Peachtree Dunwoody Rd, Suite 680, Atlanta, GA, 30342, USA
| | - Federico J Serrot
- Division of General & GI Surgery, Department of Surgery, Emory University, 5673 Peachtree Dunwoody Rd, Suite 680, Atlanta, GA, 30342, USA
| | - Snehal G Patel
- Division of General & GI Surgery, Department of Surgery, Emory University, 5673 Peachtree Dunwoody Rd, Suite 680, Atlanta, GA, 30342, USA
| | - Jamil L Stetler
- Division of General & GI Surgery, Department of Surgery, Emory University, 5673 Peachtree Dunwoody Rd, Suite 680, Atlanta, GA, 30342, USA
| | - Dipan C Patel
- Division of General & GI Surgery, Department of Surgery, Emory University, 5673 Peachtree Dunwoody Rd, Suite 680, Atlanta, GA, 30342, USA
| | - Iman Ghaderi
- Department of Surgery, University of Arizona, Tucson, AZ, USA
| | - Chiu-Hsieh Hsu
- Department of Surgery, University of Arizona, Tucson, AZ, USA
| | - Yazan Ashouri
- Saint Vincent Medical Center, Mercy Health, Toledo, OH, USA
| | - Juan M Sarmiento
- Division of General & GI Surgery, Department of Surgery, Emory University, 5673 Peachtree Dunwoody Rd, Suite 680, Atlanta, GA, 30342, USA
| | - Ioannis T Konstantinidis
- Division of Surgical Oncology, Department of Surgery, Texas Tech University Health Sciences Center, El Paso, TX, USA
| | - Edward Lin
- Division of General & GI Surgery, Department of Surgery, Emory University, 5673 Peachtree Dunwoody Rd, Suite 680, Atlanta, GA, 30342, USA
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Rahimi AO, Ashouri Y, Maegawa F, Hsu CH, Ghaderi I. Robotic Bariatric Surgery in Older Adults, Is It Safer Than the Laparoscopic Approach? A 7-Year Analysis of Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) Database. Obes Surg 2023; 33:2671-2678. [PMID: 37434018 DOI: 10.1007/s11695-023-06720-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 06/25/2023] [Accepted: 06/28/2023] [Indexed: 07/13/2023]
Abstract
BACKGROUND Utilization of the robotic platform in bariatric surgery has increased over the past several years. The population of older adults who benefit from bariatric surgery is also growing. This study evaluated the safety of robotic-assisted bariatric surgery in older adults using the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) Database. METHODS Adults who underwent gastric bypass or sleeve gastrectomy and were ≥ 65 years old between the years 2015 and 2021 were included. The 30-day outcomes were assessed and stratified based on Clavien-Dindo (CD) classification of III-V. Univariable and multivariable logistic regressions were performed to identify predictors of CD ≥ III complications. RESULTS A total of 62,973 bariatric surgery patients were included. Most of the patients (90%) underwent laparoscopic surgery, and the remainder (10%) underwent robotic surgery. Robotic sleeve gastrectomy (R-SG) was associated with lower odds of developing CD ≥ III complications compared to three other procedures (adjusted odds ratio (aOR), 0.741; confidence interval (CI), 0.584-0.941; p 0.014). CONCLUSIONS Bariatric surgery using a robotic approach is considered safe for older patients. Robotic sleeve gastrectomy (R-SG) has the lowest morbidity and mortality rates compared to laparoscopic sleeve gastrectomy (L-SG), laparoscopic Roux-en-Y gastric bypass (L-RYGB), and robotic Roux-en-Y gastric bypass (R-RYGB). The findings of this study can help surgeons and their elderly patients to make informed decisions regarding the safety of different bariatric surgical approaches.
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Affiliation(s)
- Ahmad Omid Rahimi
- Section of Minimally Invasive, Robotic and Bariatric Surgery, Department of Surgery, University of Arizona College of Medicine, 1501N, Campbell Avenue, P.O. Box 245066, Tucson, AZ, 85724-5066, USA
| | - Yazan Ashouri
- Section of Minimally Invasive, Robotic and Bariatric Surgery, Department of Surgery, University of Arizona College of Medicine, 1501N, Campbell Avenue, P.O. Box 245066, Tucson, AZ, 85724-5066, USA
| | - Felipe Maegawa
- Section of Minimally Invasive, Robotic and Bariatric Surgery, Department of Surgery, University of Arizona College of Medicine, 1501N, Campbell Avenue, P.O. Box 245066, Tucson, AZ, 85724-5066, USA
| | - Chiu-Hsieh Hsu
- Epidemiology and Biostatistics Department, University of Arizona College of Public Health, Tucson, AZ, USA
| | - Iman Ghaderi
- Section of Minimally Invasive, Robotic and Bariatric Surgery, Department of Surgery, University of Arizona College of Medicine, 1501N, Campbell Avenue, P.O. Box 245066, Tucson, AZ, 85724-5066, USA.
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Zakaria ER, Yousufzai W, Obaid O, Asmar S, Hsu CH, Joseph B. Cellular Cytosolic Energy Replenishment Increases Vascularized Composite Tissue Tolerance to Extended Cold Ischemia Time. Mil Med 2023; 188:2960-2968. [PMID: 36308325 DOI: 10.1093/milmed/usac331] [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: 10/10/2022] [Accepted: 10/10/2022] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND Vascularized composite allotransplantation (VCA) is a restorative surgical procedure to treat whole or partially disfiguring craniofacial or limb injuries. The routine clinical use of this VCA surgery is limited using compromised allografts from deceased donors and by the failure of the current hypothermic preservation protocols to extend the allograft's cold ischemia time beyond 4 h. We hypothesized that the active replenishment of the cellular cytosolic adenosine-5`-triphosphate (ATP) stores by means of energy delivery vehicles (ATPv) encapsulating high-energy ATP is a better strategy to improve allograft's tolerance to extended cold ischemia times. MATERIALS AND METHODS We utilized established rat model of isolated bilateral in-situ non-cycled perfusions of both hind limbs. Ipsilateral and contralateral limbs in the anesthetized animal were randomized for simultaneous perfusions with either the University of Wisconsin (UW) solution, with/without O2 supplementation (control), or with the UW solution supplemented with the ATPv, with/without O2 supplementation (experimental). Following perfusion, the hind limbs were surgically removed and stored at 4°C for 12, 16, or 24 hours as extended cold ischemia times. At the end of each respective storage time, samples of skin, and soleus, extensor digitalis longus, and tibialis anterior muscles were recovered for assessment using tissue histology and tissue lysate studies. RESULTS Control muscle sections showed remarkable microvascular and muscle damage associated with loss of myocyte transverse striation and marked decrease in myocyte nucleus density. A total of 1,496 nuclei were counted in 179 sections of UW-perfused control muscles in contrast to 1,783 counted in 130 sections of paired experimental muscles perfused with the ATPv-enhanced perfusate. This yielded 8 and 13 nuclei/field for the control and experimental muscles, respectively (P < .004). Oxygenation of the perfusion solutions before use did not improve the nucleus density of either the control or experimental muscles (n = 7 animals, P > .05). Total protein isolated from the muscle lysates was similar in magnitude regardless of muscle type, perfusion protocol, or duration of cold ischemia time. Prolonged static cold preservation of the hind limbs completely degraded the composite tissue's Ribonucleic acid (RNA). This supplementary result confirms the notion that that reverse transcription-Polymerase Chain Reaction, enzyme-linked immunosorbent assay, or the respiratory complex II enzyme activity techniques should not be used as indices of graft quality after prolonged static cold storage. CONCLUSIONS In conclusion, this study demonstrates that active cellular cytosolic ATP replenishment increases hind limb composite tissue tolerance to extended cold ischemia times. Quality indicators and clinically relevant biomarkers that define composite tissue viability and function during static cold storage are warranted.
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Affiliation(s)
- El Rasheid Zakaria
- Department of Surgery, Division of Trauma, Surgical Critical Care, Burns, and Acute Care Surgery, College of Medicine, The University of Arizona, Tucson, AZ 85724, USA
| | - Wali Yousufzai
- Department of Medicine, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA
| | - Omar Obaid
- Department of Surgery, Division of Trauma, Surgical Critical Care, Burns, and Acute Care Surgery, College of Medicine, The University of Arizona, Tucson, AZ 85724, USA
| | - Samer Asmar
- Department of Surgery, Staten Island University Hospital, Staten Island, NY 10305, USA
| | - Chiu-Hsieh Hsu
- Department of Surgery, Division of Trauma, Surgical Critical Care, Burns, and Acute Care Surgery, College of Medicine, The University of Arizona, Tucson, AZ 85724, USA
- The Mel and Enid Zuckerman College of Public, The University of Arizona, Tucson, AZ 85724, USA
| | - Bellal Joseph
- Department of Surgery, Division of Trauma, Surgical Critical Care, Burns, and Acute Care Surgery, College of Medicine, The University of Arizona, Tucson, AZ 85724, USA
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Zeng J, Funk J, Lee BR, Hsu CH, Messing EM, Chipollini J. Gemcitabine as first-line therapy for high-grade non-muscle invasive bladder cancer: results from a tertiary center in the contemporary BCG-shortage era. Transl Androl Urol 2023; 12:960-966. [PMID: 37426602 PMCID: PMC10323448 DOI: 10.21037/tau-22-772] [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: 11/22/2022] [Accepted: 03/16/2023] [Indexed: 07/11/2023] Open
Abstract
Background To evaluate the safety profile and efficacy of intravesical gemcitabine as first-line adjuvant therapy for non-muscle invasive bladder cancer (NMIBC) in the setting of ongoing Bacillus Calmette-Guérin (BCG) shortage. Methods We performed an institutional, retrospective review of patients treated with intravesical gemcitabine induction and maintenance therapy from March 2019 to October 2021. Patients with intermediate or high-risk NMIBC who were BCG-naïve or experienced a high-grade (HG) recurrence after 12 months since the last dose of BCG were included in the analysis. The primary endpoint was complete response (CR) rate at the 3-month visit. Secondary endpoints were recurrence-free survival (RFS) and assessment of adverse events. Results A total of 33 patients were included. All had HG disease and 28 (84.8%) were BCG-naive. The median follow-up was 21.4 months (range, 4.1-39.4). Tumor stages were cTa in 39.4%, cT1 in 54.5%, and cTis in 6.1% of patients. Most patients (90.9%) were in the AUA high-risk category. The 3-month CR was 84.8%. Among patients who achieved CR with adequate follow-up, 86.9% (20/23) remained disease-free at 6 months. The 6-month and 12-month RFS were 87.2% and 76.5%, respectively. The estimated median RFS was not reached. Approximately 78.8% of patients were able to complete full induction. Common adverse events (incidence ≥10%) included dysuria and fatigue/myalgia. Conclusions Intravesical gemcitabine for intermediate and high-risk NMIBC in areas where BCG supply is limited was safe and feasible at short-term follow-up. Larger prospective studies are needed to better ascertain the oncologic efficacy of gemcitabine.
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Affiliation(s)
- Jiping Zeng
- Department of Urology, The University of Arizona College of Medicine, Tucson, AZ, USA
| | - Joel Funk
- Department of Urology, The University of Arizona College of Medicine, Tucson, AZ, USA
| | - Benjamin R. Lee
- Department of Urology, The University of Arizona College of Medicine, Tucson, AZ, USA
| | - Chiu-Hsieh Hsu
- Department of Epidemiology and Biostatistics, University of Arizona, Tucson, AZ, USA
| | | | - Juan Chipollini
- Department of Urology, The University of Arizona College of Medicine, Tucson, AZ, USA
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Hsu CH, He Y, Hu C, Zhou W. A multiple imputation-based sensitivity analysis approach for regression analysis with a missing not at random covariate. Stat Med 2023; 42:2275-2292. [PMID: 36997162 DOI: 10.1002/sim.9723] [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: 01/31/2022] [Revised: 12/12/2022] [Accepted: 03/18/2023] [Indexed: 04/01/2023]
Abstract
Missing covariate problems are common in biomedical and electrical medical record data studies while evaluating the relationship between a biomarker and certain clinical outcome, when biomarker data are not collected for all subjects. However, missingness mechanism is unverifiable based on observed data. If there is a suspicion of missing not at random (MNAR), researchers often perform sensitivity analysis to evaluate the impact of various missingness mechanisms. Under the selection modeling framework, we propose a sensitivity analysis approach with a standardized sensitivity parameter using a nonparametric multiple imputation strategy. The proposed approach requires fitting two working models to derive two predictive scores: one for predicting missing covariate values and the other for predicting missingness probabilities. For each missing covariate observation, the two predictive scores along with the pre-specified sensitivity parameter are used to define an imputing set. The proposed approach is expected to be robust against mis-specifications of the selection model and the sensitivity parameter since the selection model and the sensitivity parameter are not directly used to impute missing covariate values. A simulation study is conducted to study the performance of the proposed approach when MNAR is induced by Heckman's selection model. Simulation results show the proposed approach can produce plausible regression coefficient estimates. The proposed sensitivity analysis approach is also applied to evaluate the impact of MNAR on the relationship between post-operative outcomes and incomplete pre-operative Hemoglobin A1c level for patients who underwent carotid intervetion for advanced atherosclerotic disease.
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Affiliation(s)
- Chiu-Hsieh Hsu
- Department of Epidemiology and Biostatistics, College of Public Health, University of Arizona, Tucson, Arizona, USA
| | - Yulei He
- National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, Maryland, USA
| | - Chengcheng Hu
- Department of Epidemiology and Biostatistics, College of Public Health, University of Arizona, Tucson, Arizona, USA
| | - Wei Zhou
- Department of Surgery, University of Arizona, Tucson, Arizona, USA
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Gordon JS, Armin JS, Giacobbi P, Hsu CH, Marano K, Sheffer CE. Testing the Efficacy of a Scalable Telephone-Delivered Guided Imagery Tobacco Cessation Treatment: Protocol for a Randomized Clinical Trial. JMIR Res Protoc 2023; 12:e48898. [PMID: 37351932 DOI: 10.2196/48898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 05/26/2023] [Accepted: 05/29/2023] [Indexed: 06/24/2023] Open
Abstract
BACKGROUND Tobacco use continues to be a leading preventable cause of death and disease in the United States, accounting for >480,000 deaths each year. Although treatments for tobacco use are effective for many, there is substantial variability in outcomes, and these approaches are not effective for all individuals seeking to quit smoking cigarettes. New, effective therapeutic approaches are needed to meet the preferences of people who want to stop smoking. Guided imagery (GI) is a mind-body technique that involves the guided visualization of specific mental images, which is enhanced with other sensory modalities and emotions. Preliminary evidence provides initial support for the use of GI as a treatment for cigarette smoking. Meta-analyses have shown that standard treatment for cigarette smoking delivered over the telephone via quitlines is effective. A telephone-based intervention that uses GI might provide another effective treatment option and increase the reach and effectiveness of quitlines. OBJECTIVE This study aims to test the efficacy of Be Smoke Free, a telephone-delivered GI treatment for smoking cessation. METHODS This multisite randomized clinical trial (RCT) will compare a novel telephone-delivered GI tobacco cessation treatment with a standard evidence-based behavioral treatment. The study will be conducted over 5 years. In phase 1, we refined protocols and procedures for the New York State and West Virginia sites for use in the RCT. During phase 2, we will conduct an RCT with 1200 participants: 600 (50%) recruited via quitlines and 600 (50%) recruited via population-based methods. Participants will be randomly assigned to either the GI condition or the behavioral condition; both treatments will be delivered by trained study coaches located at the University of Arizona. Assessments will be conducted at baseline and 3 and 6 months after enrollment by University of Arizona research staff. The primary outcome will be self-reported 30-day point prevalence abstinence 6 months after enrollment. Secondary outcomes include biochemically verified 7-day point prevalence abstinence 6 months after enrollment. RESULTS Recruitment in West Virginia and New York began in October 2022. As of March 31, 2023, a total of 242 participants had been enrolled. Follow-up assessments began in November 2022. As of March 31, 2023, of the 118 eligible participants, 97 (82.2%) had completed the 3-month assessment, and 93% (26/28) of eligible participants had completed the 6-month assessment. Biochemical verification and qualitative interviews began in April 2023. Recruitment will continue through 2025 and follow-up assessments through 2026. Primary results are expected to be published in 2027. CONCLUSIONS The Be Smoke Free study is a first-of-its-kind RCT that incorporates GI into telephone-based tobacco cessation treatment. If successful, Be Smoke Free will have substantial benefits for the long-term health of people who use tobacco across the United States. TRIAL REGISTRATION ClinicalTrials.gov NCT05277831; https://clinicaltrials.gov/ct2/show/NCT05277831. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/48898.
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Affiliation(s)
- Judith S Gordon
- College of Nursing, University of Arizona, Tucson, AZ, United States
| | - Julie S Armin
- Department of Family and Community Medicine, University of Arizona, Tucson, AZ, United States
| | - Peter Giacobbi
- College of Applied Human Sciences, West Virginia University, Morgantown, WV, United States
- School of Public Health, West Virginia University, Morgantown, WV, United States
| | - Chiu-Hsieh Hsu
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, United States
| | - Kari Marano
- College of Nursing, University of Arizona, Tucson, AZ, United States
| | - Christine E Sheffer
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, United States
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Zeng Y, Moscicki AB, Woo H, Hsu CH, Kemp TJ, Pinto LA, Szabo E, Dimond E, Bauman J, Sahasrabuddhe VV, Chow HHS. HPV16/18 Antibody Responses After a Single Dose of Nonavalent HPV Vaccine. Pediatrics 2023:e2022060301. [PMID: 37317810 DOI: 10.1542/peds.2022-060301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/06/2023] [Indexed: 06/16/2023] Open
Abstract
OBJECTIVES A single dose of human papillomavirus (HPV) vaccine would simplify logistics and reduce costs of vaccination programs worldwide. We conducted a phase IIa trial to determine the stability of HPV type-specific antibody responses after a single dose of the nonavalent HPV vaccine, Gardasil9. METHODS Two hundred-and-one healthy 9 to 11-year-old girls and boys were enrolled at 2 centers in the United States to receive a prime dose of the nonavalent vaccine at baseline, a delayed dose at month 24, and an optional third dose at month 30. Blood samples were collected to measure HPV type-specific antibodies at baseline and at 6, 12, 18, 24, and 30 months after the prime dose. The primary outcomes were serum HPV16 and HPV18 antibody responses. RESULTS In both girls and boys, geometric mean concentrations of HPV16 and HPV18 antibodies increased at 6 months, declined between months 6 to 12, and then remained stable and high (at 20- and 10-times those at baseline for HPV16 and HPV18, respectively) throughout months 12, 18, and 24 (prebooster) visits. Both HPV16 and HPV18 antibody responses demonstrated anamnestic boosting effect at 30-months after the delayed (24-month) booster dose. CONCLUSIONS A single dose of the nonavalent HPV vaccine induced persistent and stable HPV16 and HPV18 antibody responses up to 24 months. This study contributes important immunogenicity data to inform feasibility of the single dose HPV vaccination paradigm. Further research is needed to assess the long-term antibody stability and individual clinical and public health benefit of the single dose schedule.
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Affiliation(s)
| | - Anna-Barbara Moscicki
- Department of Pediatrics, University of California Los Angeles, Los Angeles, California
| | - Heide Woo
- Department of Pediatrics, University of California Los Angeles, Los Angeles, California
| | - Chiu-Hsieh Hsu
- University of Arizona Cancer Center, University of Arizona, Tucson, Arizona
| | - Troy J Kemp
- Vaccine, Immunity and Cancer Directorate, Frederick National Laboratory for Cancer Research, Frederick, Maryland; and
| | - Ligia A Pinto
- Vaccine, Immunity and Cancer Directorate, Frederick National Laboratory for Cancer Research, Frederick, Maryland; and
| | - Eva Szabo
- Division of Cancer Prevention, National Cancer Institute, Rockville, Maryland
| | - Eileen Dimond
- Division of Cancer Prevention, National Cancer Institute, Rockville, Maryland
| | - Julie Bauman
- University of Arizona Cancer Center, University of Arizona, Tucson, Arizona
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Parsons JK, Pinto PA, Pavlovich CP, Uchio E, Nguyen MN, Kim HL, Gulley JL, Sater HA, Jamieson C, Hsu CH, Wojtowicz M, House M, Schlom J, Donahue RN, Dahut WL, Madan RA, Bailey S, Centuori S, Bauman JE, Parnes HL, Chow HHS. A Phase 2, Double-blind, Randomized Controlled Trial of PROSTVAC in Prostate Cancer Patients on Active Surveillance. Eur Urol Focus 2023; 9:447-454. [PMID: 36517408 PMCID: PMC10258223 DOI: 10.1016/j.euf.2022.12.002] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 09/17/2022] [Accepted: 12/01/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND There is an unmet clinical need for interventions to prevent disease progression in patients with localized prostate cancer on active surveillance (AS). OBJECTIVE To determine the immunologic response to the PROSTVAC vaccine and the clinical indicators of disease progression in patients with localized prostate cancer on AS. DESIGN, SETTING, AND PARTICIPANTS This was a phase 2, double-blind, randomized controlled trial in 154 men with low- or intermediate-risk prostate cancer on AS. INTERVENTION Participants were randomized (2:1) to receive seven doses of subcutaneous PROSTVAC, a vaccinia/fowlpox viral vector-based immunotherapy containing a prostate-specific antigen (PSA) transgene and three T-cell co-stimulatory molecules, or an empty fowlpox vector (EV) over 140 d. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS The primary outcome was the change from baseline in CD4 and CD8 T-cell infiltration in biopsy tumor tissue. Key secondary outcomes were safety and changes in prostate biopsy tumor pathology, peripheral antigen-specific T cells, and serum PSA. Continuous variables were compared using nonparametric tests. Categorical variables were compared using Fisher's exact test. RESULTS AND LIMITATIONS The PROSTVAC/EV vaccination was well tolerated. All except one participant completed the vaccination series. Changes in CD4 or CD8 density in biopsy tumor tissue did not differ between the PROSTVAC and EV arms. The proportions of patients with Gleason upgrading to grade group 3 after treatment was similar between the arms. There were no differences in postvaccination peripheral T-cell responses or the PSA change from baseline to 6-mo post-treatment follow-up between the groups. CONCLUSIONS In this first-of-kind trial of immunotherapy in patients on AS for prostate cancer, PROSTVAC did not elicit more favorable prostate tissue or peripheral T-cell responses than the EV. There was no difference between the arms in clinicopathologic effects. Despite the null findings, this is the first study reporting the feasibility and acceptability of an immunotherapy intervention in the AS setting. PATIENT SUMMARY We looked at responses after an experimental prostate cancer vaccine in patients with prostate cancer on active surveillance (AS). Participants who received the vaccine did not show more favorable outcomes than those receiving the control. Despite these findings, this is the first report showing the feasibility and acceptability of immunotherapy for prostate cancer in patients on AS.
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Affiliation(s)
- J Kellogg Parsons
- Department of Urology, UC San Diego Moores Cancer Center, La Jolla, CA, USA
| | | | | | - Edward Uchio
- Department of Urology, UC Irvine, Orange, CA, USA
| | - Mike N Nguyen
- Department of Urology, University of Southern California, Los Angeles, CA, USA
| | - Hyung L Kim
- Division of Urology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | | | | | - Christina Jamieson
- Department of Urology, UC San Diego Moores Cancer Center, La Jolla, CA, USA
| | | | | | | | | | | | | | | | | | - Sara Centuori
- University of Arizona Cancer Center, Tucson, AZ, USA
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Komenaka IK, Hsu CH, Ramos GM, Nodora J, Martinez ME. Post Treatment Mastalgia is a Common Complaint but not an Indication of Recurrence or Second Primary Breast Cancer. Clin Breast Cancer 2023; 23:330-337. [PMID: 36641323 DOI: 10.1016/j.clbc.2022.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 11/14/2022] [Accepted: 12/11/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Post-treatment mastalgia is a common complaint in up to 68% of patients after treatment. This symptom is worrisome to patients as many believe it is a sign of recurrence. The current study was performed to evaluate if post-treatment mastalgia is associated with a second breast cancer diagnosis. MATERIALS AND METHODS Patients included were seen from January 1, 2000 to December 31, 2020. All patients who were treated for breast cancer and then presented with breast pain during follow up were considered to have post-treatment mastalgia. All patients who were diagnosed with a second breast cancer but did not experience post-treatment mastalagia were also evaluated. RESULTS 1799 patients had a mean age 52.9 years. 36% of patients experienced post-treatment mastalgia. Of patients who complained of post-treatment mastalgia, 19 were diagnosed with a chest wall recurrence (CW), ipsilateral breast tumor recurrence (IBTR), or contralateral breast cancer (CBC). 17 of the 19 patients had breast pain after the second diagnosis and treatment were completed. The average duration between their second diagnosis and initial complaint of breast pain was 6.2 years. The two patients who complained of breast pain prior to their second diagnosis did not have mastalgia at the time of their second diagnosis. Local recurrence or contralateral breast cancer were more common in patients without post treatment mastalgia (10.1% vs 0.3%, p < 0.0001) during follow up. CONCLUSION Post treatment mastalgia is not associated with recurrence. Interval or repeat imaging does not appear necessary and instead patient education and reassurance are important in its management.
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Affiliation(s)
- Ian K Komenaka
- Ironwood Cancer and Research Centers, Chandler, AZ; Arizona Cancer Center, University of Arizona, Tucson, AZ.
| | - Chiu-Hsieh Hsu
- Arizona Cancer Center, University of Arizona, Tucson, AZ; Mel and Enid Zuckerman Arizona College of Public Health, University of Arizona, Tucson, AZ
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Fahim SM, Qian J, Hsu CH, Zeng P, Lin FJ, McDaniel CC, Chou C. Associations between antidiabetic medication use and breast cancer survival outcomes among medicare beneficiaries. Journal of Pharmaceutical Health Services Research 2023. [DOI: 10.1093/jphsr/rmad002] [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: 02/16/2023]
Abstract
Abstract
Objective
This study examined the associations between mortality (all-cause and breast cancer-specific) and different antidiabetic medication use before breast cancer diagnosis.
Methods
This study used a longitudinal, retrospective cohort design. Linked Surveillance, Epidemiology and End Results (SEER)-Medicare databases from 2007 to 2013 were used to identify female beneficiaries who had continuous Medicare enrollment, a new breast cancer diagnosis between 2008 and 2013, and exposure to the antidiabetic medication. Different classes of antidiabetic medications from one year before their breast cancer diagnosis were considered as users while all other non-users were excluded. Both all-cause mortality and breast cancer-specific mortality were treated as outcomes. Cox proportional hazards models for all-cause mortality and sub-distribution hazards models for breast cancer-specific mortality were employed to estimate both unadjusted and adjusted hazard ratios and 95% confidence intervals (CI) for risks of survival outcomes, controlling for severity of diabetes and other covariates.
Key findings
A total of 1715 women with breast cancer used antidiabetic medications one year before their breast cancer diagnosis. Compared to metformin, women using insulin, sulfonylurea and combination treatments before their breast cancer diagnosis had a higher risk for all-cause mortality (adjusted Hazard Ratio, aHR: 1.64, 95% CI 1.29, 2.07; aHR: 1.35, 95% CI 1.04, 1.75 and aHR: 1.44, 95% CI 1.14, 1.83, respectively). Women with advanced-stage breast cancer and higher levels of diabetes severity were more likely to get all-cause mortality (all P < 0.05). Women with combination treatments had a statistically higher risk of breast cancer-specific mortality (aHR: 1.52, 95% CI 1.05, 2.19) than metformin users.
Conclusions
Among women with breast cancer, mortality risk is associated with pre-diagnosis exposure to different types of antidiabetic medications.
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Affiliation(s)
- Shahariar Mohammed Fahim
- Department of Health Outcomes Research and Policy, Harrison School of Pharmacy, Auburn University , Auburn, AL , USA
| | - Jingjing Qian
- Department of Health Outcomes Research and Policy, Harrison School of Pharmacy, Auburn University , Auburn, AL , USA
| | - Chiu-Hsieh Hsu
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, The University of Arizona , Tucson, AZ , USA
| | - Peng Zeng
- Department of Mathematics and Statistics, Auburn University , Auburn, AL , USA
| | - Fang-Ju Lin
- Department of Pharmacy, National Taiwan University Hospital , Taipei , Taiwan
- Graduate Institute of Clinical Pharmacy, School of Pharmacy, College of Medicine, National Taiwan University , Taipei , Taiwan
| | - Cassidi C McDaniel
- Department of Health Outcomes Research and Policy, Harrison School of Pharmacy, Auburn University , Auburn, AL , USA
| | - Chiahung Chou
- Department of Health Outcomes Research and Policy, Harrison School of Pharmacy, Auburn University , Auburn, AL , USA
- Department of Medical Research, China Medical University Hospital , Taichung , Taiwan
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Wiseman JE, Hsu CH, Oviedo RJ. Three-port laparoscopic cholecystectomy is safe and efficient in the treatment of surgical biliary disease: a retrospective cohort study. J Robot Surg 2023; 17:147-154. [PMID: 35403958 DOI: 10.1007/s11701-022-01410-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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 03/27/2022] [Indexed: 11/26/2022]
Abstract
Multiple studies have suggested that three-port laparoscopic cholecystectomy is both feasible and safe. However, this approach has failed to gain acceptance outside of clinical trials, leaving adopters of this approach vulnerable to medico-legal scrutiny. We hypothesized that the three-port approach to laparoscopic cholecystectomy (LC) is safe and efficient in experienced hands. All LC (including robotic) cases were performed on patients 18 years and older between November 2018 and March 2020. Operations utilizing three ports were compared to those performed using more than three ports. The primary outcomes measured were total operative time, conversion-to-open rate, and the complication rate. A two-sample test was performed to compare operative times, and a Fisher's exact test was used to compare conversion-to-open and complication rates. Linear regression models were used to account for the effect of confounders. 924 total LCs were performed by 30 surgeons in the study period (71 three-port, 853 four or more ports). The mean operative time was 10 min shorter in the three-port group in comparison (64.1 ± 1.4 min vs. 74.4 ± 1.8 min, p < 0.01), despite a threefold higher rate of intraoperative cholangiogram in these cases (23.0% vs. 7.9%, p < 0.001). There was no significant difference in either the conversion-to-open rate (1.6% vs. 5.1%, p = 0.35), or the overall complication rate (7.1% vs. 8.7%, p = 0.82). Operative time for LC performed through three ports was significantly less than those performed through the traditional four port approach, despite utilizing intraoperative cholangiogram nearly three times as often. There was no difference in the conversion-to open rate or complication rate. These results provide considerable evidence that three-port laparoscopic cholecystectomy is comparable to four-port laparoscopic cholecystectomy in operative duration, conversion-to-open rate, and complication rate.
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Affiliation(s)
- James E Wiseman
- Department of Surgery, Johns Hopkins University, 600 N. Wolfe St. Blalock 655, Baltimore, MD, 21287, USA.
| | - Chiu-Hsieh Hsu
- Mel and Enid Zuckerman College of Public Health, The University of Arizona, 1295 N. Martin, Drachman Hall A232, Tucson, AZ, 85724, USA
| | - Rodolfo J Oviedo
- Department of Surgery, Houston Methodist Hospital, 6550 Fannin St. Suite 1501, Houston, TX, 77030, USA
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22
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Habib S, Murakami T, Takyar V, Patel K, Dominguez C, Zhan Y, Mehrpour O, Hsu CH. The Impact of Metabolic Syndrome on the Prognosis of High-Risk Alcoholic Hepatitis Patients: Redefining Alcoholic Hepatitis. Gastroenterology Res 2023; 16:25-36. [PMID: 36895697 PMCID: PMC9990531 DOI: 10.14740/gr1556] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 10/03/2022] [Indexed: 03/11/2023] Open
Abstract
Background Alcoholic hepatitis (AH) is characterized by acute symptomatic hepatitis associated with heavy alcohol use. This study was designed to assess the impact of metabolic syndrome on high-risk patients with AH with discriminant function (DF) score ≥ 32 and its effect on mortality. Methods We searched the hospital database for ICD-9 diagnosis codes of acute AH, alcoholic liver cirrhosis, and alcoholic liver damage. The entire cohort was categorized into two groups: AH and AH with metabolic syndrome. The effect of metabolic syndrome on mortality was evaluated. Also, an exploratory analysis was used to create a novel risk measure score to assess mortality. Results A large proportion (75.5%) of the patients identified in the database who had been treated as AH had other etiologies and did not meet the American College of Gastroenterology (ACG)-defined diagnosis of acute AH, thus had been misdiagnosed as AH. Such patients were excluded from analysis. The mean body mass index (BMI), hemoglobin (Hb), hematocrit (HCT), and alcoholic liver disease/non-alcoholic fatty liver disease index (ANI) were significantly different between two groups (P < 0.05). The results of a univariate Cox regression model showed that age, BMI, white blood cells (WBCs), creatinine (Cr), international normalized ratio (INR), prothrombin time (PT), albumin levels, albumin < 3.5, total bilirubin, Na, Child-Turcotte-Pugh (CTP), model for end-stage liver disease (MELD), MELD ≥ 21, MELD ≥ 18, DF score, and DF ≥ 32 had a significant effect on mortality. Patients with a MELD greater than 21 had a hazard ratio (HR) (95% confidence interval (CI) of 5.81 (2.74 - 12.30) (P < 0.001). The adjusted Cox regression model results showed that age, Hb, Cr, INR, Na, MELD score, DF score, and metabolic syndrome were independently associated with high patient mortality. However, the increase in BMI and mean corpuscular volume (MCV) and sodium significantly reduced the risk of death. We found that a model including age, MELD ≥ 21, and albumin < 3.5 was the best model in identifying patient mortality. Our study showed that patients admitted with a diagnosis of alcoholic liver disease with metabolic syndrome had an increased mortality risk compared to patients without metabolic syndrome, in high-risk patients with DF ≥ 32 and MELD ≥ 21. A bivariate correlation analysis revealed that patients with AH with metabolic syndrome were more likely to have infection (43%) compared to AH (26%) with correlation coefficient of 0.176 (P = 0.03, CI: 0.018 - 1.0). Conclusion In clinical practice, the diagnosis of AH is inaccurately applied. Metabolic syndrome significantly increases the mortality risk in high-risk AH. It signifies that the presence of features of metabolic syndrome modifies the behavior of AH in acute settings, warranting different therapeutic strategies. We propose that in defining AH, patients overlapping with metabolic syndrome may need to be excluded as their outcome is different with regard to risk of renal dysfunctions, infections and death.
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Affiliation(s)
| | | | | | | | | | - Yongcheng Zhan
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA
| | | | - Chiu-Hsieh Hsu
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA
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23
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Tzou DT, Stern KL, Duty BD, Hsi RS, Canvasser NE, De S, Wong AC, Royal CR, Sloss ML, Ziemba JB, Harper JD, Bechis SK, Zampini AM, Borofsky MS, Bell JR, Friedlander JI, Leavitt DA, Nevo A, Patel ND, Patel RM, Okeke Z, Rivera ME, Hsu CH, Chi T, Vedantam G, Lainhart WD. Heterogeneity in stone culture protocols and endourologist practice patterns: a multi-institutional survey. Urolithiasis 2022; 51:15. [PMID: 36507964 DOI: 10.1007/s00240-022-01373-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 10/23/2022] [Accepted: 10/31/2022] [Indexed: 12/14/2022]
Abstract
Kidney stone cultures can be beneficial in identifying bacteria not detected in urine, yet how stone cultures are performed among endourologists, under what conditions, and by what laboratory methods remain largely unknown. Stone cultures are not addressed by current clinical guidelines. A comprehensive REDCap electronic survey sought responses from directed (n = 20) and listserv elicited (n = 108) endourologists specializing in kidney stone disease. Questions included which clinical scenarios prompt a stone culture order, how results influence post-operative antibiotics, and what microbiology lab protocols exist at each institution with respect to processing and resulting stone cultures. Logistic regression statistical analysis determined what factors were associated with performing stone cultures. Of 128 unique responses, 11% identified as female and the mean years of practicing was 16 (range 1-46). A specific 'stone culture' order was available to only 50% (64/128) of those surveyed, while 32% (41/128) reported culturing stone by placing a urine culture order. The duration of antibiotics given for a positive stone culture varied, with 4-7 days (46%) and 8-14 days (21%) the most reported. More years in practice was associated with fewer stone cultures ordered, while higher annual volume of percutaneous nephrolithotomy was associated with ordering more stone cultures (p < 0.01). Endourologists have differing practice patterns with respect to ordering stone cultures and utilizing the results to guide post-operative antibiotics. With inconsistent microbiology lab stone culture protocols across multiple institutions, more uniform processing is needed for future studies to assess the clinical benefit of stone cultures and direct future guidelines.
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Affiliation(s)
- David T Tzou
- Department of Urology, University of Arizona College of Medicine, 1501 N. Campbell Ave, PO Box 245077, Tucson, AZ, 85724, USA.
| | - Karen L Stern
- Department of Urology, Mayo Clinic Arizona, 5777 E. Mayo Blvd, Phoenix, AZ, 85054, USA
| | - Brian D Duty
- Department of Urology, Oregon Health and Science University, 3303 SW Bond Ave, CH10U, Portland, OR, 97239, USA
| | - Ryan S Hsi
- Department of Urology, Vanderbilt University Medical Center, A-1302 Medical Center North, Nashville, TN, 37232, USA
| | - Noah E Canvasser
- Department of Urology, University of California Davis, 4860 Y Street, Suite 3500, Sacramento, CA, 95817, USA
| | - Smita De
- Department of Urology, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH, 44195, USA
| | - Ava C Wong
- Department of Urology, University of Arizona College of Medicine, 1501 N. Campbell Ave, PO Box 245077, Tucson, AZ, 85724, USA
| | - Charis R Royal
- Department of Urology, University of Arizona College of Medicine, 1501 N. Campbell Ave, PO Box 245077, Tucson, AZ, 85724, USA
| | - Meleighe L Sloss
- Department of Urology, University of Arizona College of Medicine, 1501 N. Campbell Ave, PO Box 245077, Tucson, AZ, 85724, USA
| | - Justin B Ziemba
- Division of Urology, University of Pennsylvania, 3PCAM West, 3400 Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - Jonathan D Harper
- Department of Urology, University of Washington, 1959 NE Pacifica St, Seattle, WA, 98195, USA
| | - Seth K Bechis
- Department of Urology, University of California San Diego, 200 W. Arbor Drive #8897, San Diego, CA, 92103, USA
| | - Anna M Zampini
- Department of Urology, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH, 44195, USA
| | - Michael S Borofsky
- Department of Urology, University of Minnesota, 420 Delaware St SE, Box 394 Mayo, Minneapolis, MN, 55455, USA
| | - John Roger Bell
- Department of Urology, University of Kentucky, MS 277 Medical Science Bldg., Lexington, KY, 40536, USA
| | - Justin I Friedlander
- Temple Health/Fox Chase Cancer Center, 2705 Dekalb Pike, Medical Arts Pavilion, Suite 310, East Norriton, PA, 19041, USA
| | - David A Leavitt
- Vattikui Urology Institute, Henry Ford Hospital, 2799 W. Grand Blvd, Detroit, MI, 48202, USA
| | - Amihay Nevo
- Department of Urology, Case Western Reserve University, 11100 Euclid Ave, Cleveland, OH, 44106, USA
| | - Nishant D Patel
- Department of Urology, University of Virginia, 500 Ray C. Hunt Drive, Charlottesville, VA, 22903, USA
| | - Roshan M Patel
- Department of Urology, University of California, Irvine. 333 City Blvd. West, Suite 2100, Orange, CA, 92868, USA
| | - Zeph Okeke
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, 450 Lakeville Road, Suite M41, Lake Success, NY, 11042, USA
| | - Marcelino E Rivera
- Indiana University, Methodist Prof Bldg MPC1 220. 1801 N. Senate Blvd, Indianapolis, IN, 46202, USA
| | - Chiu-Hsieh Hsu
- College of Public Health, University of Arizona, Roy P. Drachman Hall, Rm. A232, Tucson, AZ, 85721, USA
| | - Thomas Chi
- Department of Urology, University of California San Francisco, 400 Parnassus Ave, San Francisco, CA, 94122, USA
| | - Gayatri Vedantam
- College of Animal Sciences, University of Arizona. Animal and Comparative Bio Sci, Rm 227, Tucson, AZ, 85721, USA
| | - William D Lainhart
- Departments of Pathology and Medicine, University of Arizona College of Medicine, 1501 N. Campbell Ave, Tucson, AZ, 85724, USA
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Rahimi AO, Ho K, Chang M, Gasper D, Ashouri Y, Dearmon-Moore D, Hsu CH, Ghaderi I. A systematic review of robotic surgery curricula using a contemporary educational framework. Surg Endosc 2022; 37:2833-2841. [PMID: 36481821 DOI: 10.1007/s00464-022-09788-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 11/27/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND There has been a rising trend in robotic surgery. Thus, there is demand for a robotic surgery curriculum (RSC) for training surgical trainees and practicing surgeons. There are limited data available about current curricular designs and the extent to which they have incorporated educational frameworks. Our aim was to study the existing robotic surgery curricula using Kern's 6-step approach in curriculum development. METHODS A systematic review was conducted using PubMed, PubMed Central, Cochrane, Embase, and Scopus (we searched studies from 2001 to 2021). PRISMA Guidelines was used to guide the search. Curriculum designed for general surgery and its subspecialties were included. Urology and gynecology were excluded. The articles were reviewed by five reviewers. RESULTS Our review yielded 71 articles, including 39 curricula at 9 different settings. Using Kern's framework, we demonstrated that the majority of robotic surgery curricula contained all the elements of Kern's curricular design. However, there were significant deficiencies in important aspects of these curricula i.e., implementation, the quality of assessment tools for measurement of performance and evaluation of the educational value of these interventions. Most institutions used commercial virtual reality simulators (VRS) as the main component of their RSC and 23% of curricula only used VRS. CONCLUSIONS Although majority of these studies contained all the elements of Kern's framework, there are critical deficiencies in the components of existing curricula. Future curricula should be designed using established educational frameworks to improve the quality of robotic surgery training.
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Ashouri Y, Hsu CH, Riall TS, Konstantinidis IT, Maegawa FB. Aspartate Aminotransferase-to-Platelet Ratio Index Predicts Liver Failure After Resection of Colorectal Liver Metastases. Dig Dis Sci 2022; 67:4950-4958. [PMID: 34981310 DOI: 10.1007/s10620-021-07333-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 11/15/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND Chemotherapy agents for metastatic colorectal cancer can cause liver injury, increasing the risk of post-hepatectomy liver failure after hepatectomy for metastases. The role of noninvasive fibrosis markers in this setting is not well established. AIMS To evaluate the aspartate aminotransferase-to-platelet ratio index (APRI) as a predictor of postoperative liver failure. METHODS The National Surgical Quality Improvement Program database was utilized to identify patients who received preoperative chemotherapy and underwent hepatectomy for colorectal metastases between 2015 and 2017. Concordance index analysis was conducted to determine APRI's contribution to the prediction of liver failure. The optimal cutoff value was defined and its ability to predict post-hepatectomy liver failure and perioperative bleeding were examined. RESULTS A total of 2374 patients were identified and included in the analysis. APRI demonstrated to be a better predictor of postoperative liver failure than MELD score, with a statistically significant larger area under the curve. The optimal APRI cutoff value to predict liver failure was 0.365. The multivariable logistic regression showed that APRI ≥ 0.365 was independently associated with PHLF, odds ratio (OR) 2.51, 95% confidence interval (CI) 1.67-3.77, P < .0001. Likewise, APRI ≥ 0.365 was independently associated with perioperative bleeding complications requiring transfusions, OR 1.41, 95% CI 1.13-1.77, P = 0.002. MELD score was not statistically associated with PHLF or bleeding complications. CONCLUSIONS APRI was independently associated with post-hepatectomy liver failure and perioperative bleeding requiring transfusions after resection of colorectal metastases in patients who received preoperative chemotherapy. Concordance index showed APRI to add significant contribution as a predictor of postoperative liver failure.
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Affiliation(s)
- Yazan Ashouri
- Department of Surgery, Southern Arizona VA Health Care System, University of Arizona, Tucson, AZ, USA
| | - Chiu-Hsieh Hsu
- Mel&Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA
| | - Taylor S Riall
- Department of Surgery, University of Arizona, Tucson, AZ, USA
| | | | - Felipe B Maegawa
- Division of General and GI Surgery, Department of Surgery, Emory University, 5673 Peachtree Dunwoody Road, Suite 680, Atlanta, GA, 30342, USA.
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Komenaka IK, Nodora J, Martinez ME, Hsu CH, Wong T, Shah A, Caruso DM. Mastalgia is Not An Indication for Mammogram. J Am Board Fam Med 2022:jabfm.2022.AP.210476. [PMID: 36096656 DOI: 10.3122/jabfm.2022.ap.210476] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 02/23/2022] [Accepted: 03/01/2022] [Indexed: 03/21/2023] Open
Abstract
BACKGROUND Mastalgia is a common breast complaint that is worrisome to patients. This study was performed to determine if mastalgia is a sign of breast cancer and to evaluate the benefit of its work up. METHODS: Retrospective review of prospectively collected data on 8960 consecutive patients at a safety net institution from June 1, 2006 to December 31, 2020. Data on patient reported mastalgia and diagnosis of breast cancer were collected. RESULTS: 8960 patients had a mean age of 45 years. The population was predominantly underinsured, 70% Hispanic, and 16% had adequate health literacy. Approximately 31% (2820 of 8960) of patients presented with a complaint of breast pain. Of 2820 patients with breast pain, 20 (0.7%) were found to have breast cancer. The average age of patients with breast cancer was 49 years. Physical examination identified a mass in 6 patients and only 3 patients had pain limited to the side of the cancer (10 bilateral, 7 contralateral). Of 1280 patients who were under age 40 years, 88% underwent breast imaging. The Cancer Detection Rate (CDR) was 0.9 per 1000 examinations. For 950 patients age 40 to 49 years and 590 patients age 50 years and older, 98% and 99% underwent breast imaging, respectively. The CDR was 10 per 1000 examinations for age 40 to 49 and 14 per 1000 examinations for age 50 years and older. CONCLUSIONS: Mastalgia is rarely associated with breast cancer. In the absence of other findings, imaging of patients less than age 40 is not recommended. Any workup beyond routine screening mammography in age-appropriate patients, to identify the "cause" of breast pain, does not seem warranted.
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Affiliation(s)
- Ian K Komenaka
- From Valleywise Health/Maricopa Medical Center, Phoenix, AZ (IKK, JN, MEM, CH, TW, AS, DMC); Ironwood Cancer and Research Centers, Chandler, AZ(IK); Arizona Cancer Center, University of Arizona, Tucson (IKK, CH); Moores UCSD Cancer Center, San Diego, CA (JN, MEM); Mel and Enid Zuckerman Arizona College of Public Health, University of Arizona, Tucson (CH); Maricopa Medical Center, Phoenix, AZ (TW, AS, DMC)
| | - Jesse Nodora
- From Valleywise Health/Maricopa Medical Center, Phoenix, AZ (IKK, JN, MEM, CH, TW, AS, DMC); Ironwood Cancer and Research Centers, Chandler, AZ(IK); Arizona Cancer Center, University of Arizona, Tucson (IKK, CH); Moores UCSD Cancer Center, San Diego, CA (JN, MEM); Mel and Enid Zuckerman Arizona College of Public Health, University of Arizona, Tucson (CH); Maricopa Medical Center, Phoenix, AZ (TW, AS, DMC)
| | - Maria Elena Martinez
- From Valleywise Health/Maricopa Medical Center, Phoenix, AZ (IKK, JN, MEM, CH, TW, AS, DMC); Ironwood Cancer and Research Centers, Chandler, AZ(IK); Arizona Cancer Center, University of Arizona, Tucson (IKK, CH); Moores UCSD Cancer Center, San Diego, CA (JN, MEM); Mel and Enid Zuckerman Arizona College of Public Health, University of Arizona, Tucson (CH); Maricopa Medical Center, Phoenix, AZ (TW, AS, DMC)
| | - Chiu-Hsieh Hsu
- From Valleywise Health/Maricopa Medical Center, Phoenix, AZ (IKK, JN, MEM, CH, TW, AS, DMC); Ironwood Cancer and Research Centers, Chandler, AZ(IK); Arizona Cancer Center, University of Arizona, Tucson (IKK, CH); Moores UCSD Cancer Center, San Diego, CA (JN, MEM); Mel and Enid Zuckerman Arizona College of Public Health, University of Arizona, Tucson (CH); Maricopa Medical Center, Phoenix, AZ (TW, AS, DMC)
| | - Tina Wong
- From Valleywise Health/Maricopa Medical Center, Phoenix, AZ (IKK, JN, MEM, CH, TW, AS, DMC); Ironwood Cancer and Research Centers, Chandler, AZ(IK); Arizona Cancer Center, University of Arizona, Tucson (IKK, CH); Moores UCSD Cancer Center, San Diego, CA (JN, MEM); Mel and Enid Zuckerman Arizona College of Public Health, University of Arizona, Tucson (CH); Maricopa Medical Center, Phoenix, AZ (TW, AS, DMC)
| | - Anushi Shah
- From Valleywise Health/Maricopa Medical Center, Phoenix, AZ (IKK, JN, MEM, CH, TW, AS, DMC); Ironwood Cancer and Research Centers, Chandler, AZ(IK); Arizona Cancer Center, University of Arizona, Tucson (IKK, CH); Moores UCSD Cancer Center, San Diego, CA (JN, MEM); Mel and Enid Zuckerman Arizona College of Public Health, University of Arizona, Tucson (CH); Maricopa Medical Center, Phoenix, AZ (TW, AS, DMC)
| | - Daniel M Caruso
- From Valleywise Health/Maricopa Medical Center, Phoenix, AZ (IKK, JN, MEM, CH, TW, AS, DMC); Ironwood Cancer and Research Centers, Chandler, AZ(IK); Arizona Cancer Center, University of Arizona, Tucson (IKK, CH); Moores UCSD Cancer Center, San Diego, CA (JN, MEM); Mel and Enid Zuckerman Arizona College of Public Health, University of Arizona, Tucson (CH); Maricopa Medical Center, Phoenix, AZ (TW, AS, DMC)
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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.
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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
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Kazui T, Hsu CH, Hamidi M, Acharya D, Shanmugasundaram M, Lee K, Chatterjee A, Bull D. Five-meter walk test before transcatheter aortic valve replacement and 1-year noncardiac mortality. JTCVS Open 2022; 12:103-117. [PMID: 36590743 PMCID: PMC9801278 DOI: 10.1016/j.xjon.2022.08.003] [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] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 07/31/2022] [Accepted: 08/11/2022] [Indexed: 01/04/2023]
Abstract
Objective The purpose of this study is to assess whether the 5-m walk test is associated with 1-year mortality after transcatheter aortic valve replacement. Methods Included in the analysis were 304 patients who received the 5-m walk test and underwent transcatheter aortic valve replacement from September 2012 to March 2019. They were classified into 3 groups based on their test score: ≤7, >7, and unable to walk. Preprocedure characteristics, postprocedure outcomes, and follow-up outcomes were compared between the groups. Results For the 5-m walk test, 145 had a score ≤7 (Group N), 111 had a score >7 (Group S), and 48 were unable to walk (Group I). Average age in years was 80.2 ± 8.7 years in Group N, 81.2 ± 9.4 years in Group S, and 79.4 ± 9.2 in Group I (P = .23). The aortic valve mean gradient at discharge was 9.5 ± 4.1 mm Hg in Group N, 10.4 ± 5.5 mm Hg in Group S, and 8.2 ± 4.2 mm Hg in Group I (P = .05). The discharge survival was 97.2% in Group N, 96.4% in Group S, and 95.8% in Group I (P = .76). One-year survival was 92.8% in Group N, 84.1% in Group S, and 75% in Group I (P < .01) after adjusting for preprocedure characteristics. Noncardiac death was 5.1% in Group N, 13.1% in Group S, and 22.7% in Group I (P = .03). This indicates that the 5-m walk test was a risk factor for 1-year mortality. More specifically, a poor 5-m walk test score was associated with 1-year noncardiac mortality. Conclusions The 5-m walk test score before transcatheter aortic valve replacement was associated with 1-year mortality, especially noncardiac mortality. It may help identify patients at high risk for 1-year mortality.
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Affiliation(s)
- Toshinobu Kazui
- Division of Cardiothoracic Surgery, Department of Surgery, Banner University Medical Center-Tucson/University of Arizona, Tucson, Ariz,Department of Surgery, Banner University Medical Center-Tucson/University of Arizona, Tucson, Ariz,Address for reprints: Toshinobu Kazui, MD, PhD, Division of Cardiothoracic Surgery, The University of Arizona/Banner University Medical Center-Tucson, 1501 N Campbell Ave, Rm 4302, PO Box 245071, Tucson, AZ 85724-5071.
| | - Chiu-Hsieh Hsu
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, The University of Arizona, Tucson, Ariz
| | - Mohammad Hamidi
- Department of Surgery, Banner University Medical Center-Tucson/University of Arizona, Tucson, Ariz
| | - Deepak Acharya
- Division of Cardiology, Department of Medicine, Sarver Heart Center, Banner University Medical Center-Tucson/University of Arizona, Tucson, Ariz
| | - Madhan Shanmugasundaram
- Division of Cardiology, Department of Medicine, Sarver Heart Center, Banner University Medical Center-Tucson/University of Arizona, Tucson, Ariz
| | - Kwan Lee
- Division of Cardiology, Department of Medicine, Sarver Heart Center, Banner University Medical Center-Tucson/University of Arizona, Tucson, Ariz
| | - Arka Chatterjee
- Division of Cardiology, Department of Medicine, Sarver Heart Center, Banner University Medical Center-Tucson/University of Arizona, Tucson, Ariz
| | - David Bull
- Division of Cardiothoracic Surgery, Department of Surgery, Banner University Medical Center-Tucson/University of Arizona, Tucson, Ariz,Department of Surgery, Banner University Medical Center-Tucson/University of Arizona, Tucson, Ariz
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Batai K, Sanderson PR, Hsu CH, Joshweseoma L, Russell D, Joshweseoma L, Ojeda J, Burhansstipanov L, Brown SR, Ami D, Saboda K, Harris RB. Factors Associated with Cancer Screening Among Hopi Men. J Cancer Educ 2022; 37:915-923. [PMID: 33083892 PMCID: PMC8560009 DOI: 10.1007/s13187-020-01900-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/11/2020] [Indexed: 05/06/2023]
Abstract
Cancer screening rates remain low among American Indian men, and cancer screening behaviors and barriers to cancer screening among American Indian men are not well understood. This study evaluated cancer screening behaviors in 102 Hopi men who were 50 years of age or older from the Hopi Survey of Cancer and Chronic Disease. Reported cancer screening frequencies were 15.7%, 45.1%, and 35.3% for fecal occult blood test (FOBT), colonoscopy, and prostate-specific antigen (PSA) test, respectively. Among men who reported having had a FOBT, 81.2% had the test more than 1 year ago. Among men who reported a colonoscopy, 60.8% had colonoscopy within the past 3 years. Similarly, among men who reported having had PSA, 72.3% had PSA within the past 3 years. "No one told me" was the most common answer for not undergoing FOBT (33.7%), colonoscopy (48.2%), and PSA (39.4%). Men who reported having had a PSA or digital rectal exam were three times as likely to also report having a FOBT or colonoscopy (odds ratio [OR] 3.19, 95% confidence interval [CI]: 1.21-8.46). Younger age (< 65) was associated with reduced odds of ever having prostate cancer screening (OR 0.28, 95% CI: 0.10-0.77). Ever having colorectal cancer screening and previous diagnosis of cancer increased odds of ever having prostate cancer screening (OR 3.15, 95% CI: 1.13-8.81 and OR 5.28, 95% CI: 1.15-24.18 respectively). This study illustrates the importance of community cancer education for men to improve cancer screening participation.
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Affiliation(s)
- Ken Batai
- Department of Urology, University of Arizona, Tucson, AZ, USA.
- University of Arizona Cancer Center, 1515 N. Campbell Ave., PO Box 245024, Tucson, AZ, 85724, USA.
| | - Priscilla R Sanderson
- Health Sciences Department, Student & Academic Services Center, College of Health and Human Services, Northern Arizona University, 1100 South Beaver Street, PO Box #15095, Flagstaff, AZ, 86011, USA.
| | - Chiu-Hsieh Hsu
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA
| | | | - Dana Russell
- HOPI Cancer Support Services, Department of Health and Human Services, Hopi Tribe, Kykotsmovi, AZ, USA
| | | | - Jordan Ojeda
- Health Sciences Department, Student & Academic Services Center, College of Health and Human Services, Northern Arizona University, 1100 South Beaver Street, PO Box #15095, Flagstaff, AZ, 86011, USA
| | | | - Sylvia R Brown
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA
| | - Delores Ami
- HOPI Cancer Support Services, Department of Health and Human Services, Hopi Tribe, Kykotsmovi, AZ, USA
| | - Kathylynn Saboda
- University of Arizona Cancer Center, 1515 N. Campbell Ave., PO Box 245024, Tucson, AZ, 85724, USA
| | - Robin B Harris
- University of Arizona Cancer Center, 1515 N. Campbell Ave., PO Box 245024, Tucson, AZ, 85724, USA
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA
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Trejo MJ, Batai K, Chen Y, Brezina S, Chow HHS, Ellis N, Lance P, Hsu CH, Pogreba-Brown K, Bishop M, Gsur A, Jacobs ET. Genome-Wide Association Study of Metachronous Colorectal Adenoma Risk among Participants in the Selenium Trial. Nutr Cancer 2022; 75:143-153. [PMID: 35815403 PMCID: PMC10120393 DOI: 10.1080/01635581.2022.2096910] [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: 02/04/2022] [Revised: 06/02/2022] [Accepted: 06/28/2022] [Indexed: 12/15/2022]
Abstract
Genetic variants related to colorectal adenoma may help identify those who are at highest risk of colorectal cancer development or illuminate potential chemopreventive strategies. The purpose of this genome-wide association study was to identify genetic variants that are associated with risk of developing a metachronous colorectal adenoma among 1,215 study participants of European descent from the Selenium Trial. Associations of variants were assessed with logistic regression analyses and validated in an independent case-control study population of 1,491 participants from the Colorectal Cancer Study of Austria (CORSA). No statistically significant genome-wide associations between any variant and metachronous adenoma were identified after correction for multiple comparisons. However, an intron variant of FAT3 gene, rs61901554, showed a suggestive association (P = 1.10 × 10-6) and was associated with advanced adenomas in CORSA (P = 0.04). Two intronic variants, rs12728998 and rs6699944 in NLRP3 were also observed to have suggestive associations with metachronous lesions (P = 2.00 × 10-6) in the Selenium Trial and were associated with advanced adenoma in CORSA (P = 0.03). Our results provide new areas of investigation for the genetic basis of the development of metachronous colorectal adenoma and support a role for FAT3 involvement in the Wnt/β-catenin pathway leading to colorectal neoplasia.Trial Registration number: NCT00078897 (ClinicalTrials.gov).
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Affiliation(s)
- Mario Jesus Trejo
- Department of Epidemiology and Biostatistics, University of Arizona, Tucson, AZ, USA
| | - Ken Batai
- Department of Urology, University of Arizona, Tucson, AZ, USA
| | - Yuliang Chen
- Department of Epidemiology and Biostatistics, University of Arizona, Tucson, AZ, USA
| | - Stefanie Brezina
- Center for Cancer Research, Medical University of Vienna, Vienna, Austria
| | - H-H Sherry Chow
- University of Arizona Cancer Center, Tucson, AZ, USA
- Department of Molecular and Cellular Biology, College of Science, University of Arizona, Tucson, AZ, USA
| | - Nathan Ellis
- Department of Cellular and Molecular Medicine, University of Arizona, Tucson, AZ, USA
| | - Peter Lance
- University of Arizona Cancer Center, Tucson, AZ, USA
- Department of Molecular and Cellular Biology, College of Science, University of Arizona, Tucson, AZ, USA
| | - Chiu-Hsieh Hsu
- Department of Epidemiology and Biostatistics, University of Arizona, Tucson, AZ, USA
| | - Kristen Pogreba-Brown
- Department of Epidemiology and Biostatistics, University of Arizona, Tucson, AZ, USA
| | - Maria Bishop
- Department of Medicine, College of Medicine, University of Arizona, Tucson, AZ, USA
| | - Andrea Gsur
- Center for Cancer Research, Medical University of Vienna, Vienna, Austria
| | - Elizabeth T Jacobs
- Department of Epidemiology and Biostatistics, University of Arizona, Tucson, AZ, USA
- University of Arizona Cancer Center, Tucson, AZ, USA
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Ho K, Hsu CH, Maegawa F, Ashouri Y, Ho H, Ajmal S, Ghaderi I. Operative Time and 30-Day Outcomes in Bariatric Surgery: Comparison between Robotic and Laparoscopic Approach: 4-Year MBSAQIP Database Analysis. J Am Coll Surg 2022; 235:138-144. [PMID: 35703971 DOI: 10.1097/xcs.0000000000000246] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The main criticism of robotic surgery is longer operative time (OT). The aim of this study was to examine the variables that determine OT, the association between OT and 30-day outcomes, and the effect of the robotic approach in bariatric surgery. STUDY DESIGN MBSAQIP data for 2016 to 2019 were queried. Logistic regression was performed to examine the association between OT and outcomes for each surgical approach while adjusting for patients' characteristics. The results of each fitted logistic regression model were reported as odds ratio and the associated 95% CI. RESULTS A total of 666,182 patients underwent robotic sleeve gastrectomy (R-SG), laparoscopic sleeve gastrectomy, robotic Roux-en-Y gastric bypass (R-RYGB), laparoscopic Roux-en-Y gastric bypass, robotic duodenal switch (R-DS), and laparoscopic duodenal switch). More patients underwent laparoscopic surgery (89.7%) than robotic surgery (10.3%). OT for robotic cases was longer than for laparoscopic cases (p < 0.0001). Longer OT was associated with increased odds of adverse 30-day outcomes irrespective of the surgical approach. The association between OT and adverse outcomes was stronger in the laparoscopic cohort. There was no significant difference in postoperative outcomes when comparing the laparoscopic and robotic approaches after adjusting for OT, except a lower reoperation rate for R-SG (p = 0.03) and readmission rates in R-RYGB and R-DS (p < 0.01). The variability of OT was higher in the laparoscopic group and was more affected by the first assistant. CONCLUSIONS The outcomes in robotic bariatric surgery were comparable with the laparoscopic approach despite longer OT. Use of robotic surgery decreased the variability in OT.
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Affiliation(s)
- Katherine Ho
- From the University of Arizona Medical Center - University Campus, Banner University Medical Center, Tucson, AZ
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Garland LL, Guillen-Rodriguez J, Hsu CH, Davis LE, Szabo E, Husted CR, Liu H, LeClerc A, Alekseyev YO, Liu G, Bauman JE, Spira AE, Beane J, Wojtowicz M, Chow HHS. Clinical Study of Aspirin and Zileuton on Biomarkers of Tobacco-Related Carcinogenesis in Current Smokers. Cancers (Basel) 2022; 14:cancers14122893. [PMID: 35740559 PMCID: PMC9221101 DOI: 10.3390/cancers14122893] [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: 04/20/2022] [Revised: 05/24/2022] [Accepted: 05/25/2022] [Indexed: 12/04/2022] Open
Abstract
Simple Summary Aspirin and related drugs with anti-inflammatory effects have lung cancer prevention effects in laboratory studies and through their use in populations at risk for lung cancer. We studied aspirin plus zileuton compared to two placebo pills for 3 months in smokers. We studied genes associated with lung cancer, smoking, and lung disease. We used nasal swabs to collect nasal cells that were smoke exposed to look for changes in these genes. We found that most of the gene panels in the nasal cells related to smoking and lung cancer lung disease did not change in a favorable way, but we did see a favorable change in a gene panel representing abnormal squamous cells that may progress to lung cancer. We think this finding is of interest and can be studied further using deep lung biopsies to understand if this drug effect occurs where squamous cell lung cancer actually starts. Abstract The chemopreventive effect of aspirin and other non-steroidal anti-inflammatory drugs (NSAIDs) on lung cancer risk is supported by epidemiologic and preclinical studies. Zileuton, a 5-lipoxygenase inhibitor, has additive activity with NSAIDs against tobacco carcinogenesis in preclinical models. We hypothesized that cyclooxygenase plus 5-lipoxygenase inhibition would be more effective than a placebo in modulating the nasal epithelium gene signatures of tobacco exposure and lung cancer. We conducted a randomized, double-blinded study of low-dose aspirin plus zileuton vs. double placebo in current smokers to compare the modulating effects on nasal gene expression and arachidonic acid metabolism. In total, 63 participants took aspirin 81 mg daily plus zileuton (Zyflo CR) 600 mg BID or the placebo for 12 weeks. Nasal brushes from the baseline, end-of-intervention, and one-week post intervention were profiled via microarray. Aspirin plus zilueton had minimal effects on the modulation of the nasal or bronchial gene expression signatures of smoking, lung cancer, and COPD but favorably modulated a bronchial gene expression signature of squamous dysplasia. Aspirin plus zileuton suppressed urinary leukotriene but not prostaglandin E2, suggesting shunting through the cyclooxygenase pathway when combined with 5-lipoxygenase inhibition. Continued investigation of leukotriene inhibitors is needed to confirm these findings, understand the long-term effects on the airway epithelium, and identify the safest, optimally dosed agents.
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Affiliation(s)
- Linda L. Garland
- Department of Medicine, University of Arizona, Tucson, AZ 85724, USA;
- University of Arizona Cancer Center, University of Arizona, Tucson, AZ 85724, USA; (J.G.-R.); (C.-H.H.); (H.-H.S.C.)
- Correspondence:
| | - José Guillen-Rodriguez
- University of Arizona Cancer Center, University of Arizona, Tucson, AZ 85724, USA; (J.G.-R.); (C.-H.H.); (H.-H.S.C.)
| | - Chiu-Hsieh Hsu
- University of Arizona Cancer Center, University of Arizona, Tucson, AZ 85724, USA; (J.G.-R.); (C.-H.H.); (H.-H.S.C.)
| | - Lisa E. Davis
- College of Pharmacy, University of Arizona, Tucson, AZ 85721, USA;
| | - Eva Szabo
- Division of Cancer Prevention, National Cancer Institute, Bethesa, MD 20892, USA; (E.S.); (M.W.)
| | - Christopher R. Husted
- Section of Computational Biomedicine, Department of Medicine, School of Medicine, Boston University, Boston, MA 02118, USA; (C.R.H.); (H.L.); (G.L.); (A.E.S.); (J.B.)
| | - Hanqiao Liu
- Section of Computational Biomedicine, Department of Medicine, School of Medicine, Boston University, Boston, MA 02118, USA; (C.R.H.); (H.L.); (G.L.); (A.E.S.); (J.B.)
| | - Ashley LeClerc
- Department of Pathology and Laboratory Medicine, School of Medicine, Boston University, Boston, MA 02118, USA; (A.L.); (Y.O.A.)
| | - Yuriy O. Alekseyev
- Department of Pathology and Laboratory Medicine, School of Medicine, Boston University, Boston, MA 02118, USA; (A.L.); (Y.O.A.)
| | - Gang Liu
- Section of Computational Biomedicine, Department of Medicine, School of Medicine, Boston University, Boston, MA 02118, USA; (C.R.H.); (H.L.); (G.L.); (A.E.S.); (J.B.)
| | - Julie E. Bauman
- Department of Medicine, University of Arizona, Tucson, AZ 85724, USA;
- University of Arizona Cancer Center, University of Arizona, Tucson, AZ 85724, USA; (J.G.-R.); (C.-H.H.); (H.-H.S.C.)
- Division of Hematology/Oncology, Department of Medicine, George Washington (GW) University and GW Cancer Center, Washington, DC 20037, USA
| | - Avrum E. Spira
- Section of Computational Biomedicine, Department of Medicine, School of Medicine, Boston University, Boston, MA 02118, USA; (C.R.H.); (H.L.); (G.L.); (A.E.S.); (J.B.)
| | - Jennifer Beane
- Section of Computational Biomedicine, Department of Medicine, School of Medicine, Boston University, Boston, MA 02118, USA; (C.R.H.); (H.L.); (G.L.); (A.E.S.); (J.B.)
| | - Malgorzata Wojtowicz
- Division of Cancer Prevention, National Cancer Institute, Bethesa, MD 20892, USA; (E.S.); (M.W.)
| | - H.-H. Sherry Chow
- University of Arizona Cancer Center, University of Arizona, Tucson, AZ 85724, USA; (J.G.-R.); (C.-H.H.); (H.-H.S.C.)
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Combs D, Partha M, Hsu CH, Edgin J, Seckeler M, Klewer S, Parthasarathy S, Cooper D. 0484 Trouble Sleeping Predicts Future Decreased Quality of Life in Young Children with Fontan Circulation. Sleep 2022. [DOI: 10.1093/sleep/zsac079.481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
Children with congenital heart disease who undergo a Fontan procedure are at higher risk of reduced health-related quality of life (HR-QOL) compared to age-matched peers. We have previously shown that current sleep disturbances are associated with decreased HR-QOL, but there is no existing longitudinal data on the relationship between sleep disturbance and HR-QOL in children with Fontan circulation.
Methods
We analyzed data from the Pediatric Heart Network Single Ventricle Reconstruction follow up study to evaluate associations between parent-reported trouble sleeping with HR-QOL as measured by the child health questionnaire (CHQ, measured at age 6 years) as well as the Pediatric Quality of Life questionnaire (PedsQL, measured at baseline as well as age 4, 5 and 6 years) in children with Fontan circulation. Presence of trouble sleeping was assessed at baseline and quality of life was assessed at baseline (age 3 years old) and annually for 3 years. Analysis was performed using the Wilcoxon sum rank test.
Results
227 participants had data at baseline (age 3 years), and 196 participants completed HR-QOL measures at all time points. Parent-reported trouble sleeping was reported “often” or “almost always” in 11% of participants. Baseline trouble sleeping predicted decreased HR-QOL at all future time points, particularly psychosocial HR-QOL. Psychosocial HR-QOL as measured by the Peds QL was significantly lower at all time points in the group with trouble sleeping. At age 6 years, psychosocial HR-QOL remained significantly lower in the group with trouble sleeping at baseline on both the PedsQL (median score 78 [interquartile range 63, 90] vs 65 [58, 83], p=0.03) and the CHQ (median t-score 54 [47, 59] vs 47 [42, 53], p=0.002).
Conclusion
Trouble sleeping in children with Fontan circulation predicts future decreased HR-QOL. Better understanding of sleep problems is needed in children with Fontan circulation as sleep disorder treatment may lead to improved HR-QOL in this at-risk population.
Support (If Any)
Funding to DC from the American Heart Association and NIH-NHLBI. Single Ventricle Reconstruction study data obtained from the Pediatric Heart Network.
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Dill-Macky A, Hsu CH, Neumayer LA, Nfonsam VN, Turner AP. The Role of Implicit Bias in Surgical Resident Evaluations. J Surg Educ 2022; 79:761-768. [PMID: 34973900 DOI: 10.1016/j.jsurg.2021.12.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Revised: 08/31/2021] [Accepted: 12/02/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND Implicit bias is a key factor preventing the advancement and retention of women and underrepresented minorities in academic surgery. PURPOSE We examined the role of implicit bias in the technical component of the residency performance evaluation. The Fundamentals of Laparoscopic Surgery (FLS) score, an objective measure of technical performance, was compared to the subjective technical skills (TS) score given by attending surgeons. PROCEDURES FLS scores and the average TS scores from chief resident evaluations at a university program were analyzed from 2015 to 2019 (n = 29 residents; female 22%, underrepresented minorities 27%). The average TS score for each resident was calculated, scores dichotomized above and below the mean for the program and analyzed across gender and racial identity. MAIN FINDINGS There were no significant differences in FLS or TS scores between male and female trainees or racial identity. The Kappa correlation coefficient between the 2 dichotomized scores was significantly lower for female (-0.50) versus male (0.23) trainees (p < 0.01); it was not significantly different between racial groups (p = 0.34). PRINCIPAL CONCLUSIONS There was statistically significant difference in agreement between the FLS and TS scores of individual female and male trainees, suggesting the presence of implicit bias in our pilot study. Further research with a larger sample size is warranted. OBJECTIVE To investigate the presence of implicit bias against women and underrepresented minorities in the technical component of the residency performance evaluation. We hypothesized that women and underrepresented racial minorities would have lower subjective technical skills (TS) scores as compared to their objective FLS scores, relative to the mean for the training program. DESIGN FLS scores and the average TS scores from chief resident performance evaluations were analyzed from 2015-2019. Both FLS and the average TS scores were dichotomized above and below the mean for the program and analyzed across gender and racial identity. Research was approved by institutional IRB. SETTING This study was conducted at the University of Arizona General Surgery Residency Program at Banner University Medical Center in Tucson, Arizona. This is a tertiary care university training program. PARTICIPANTS Educational records of graduated general surgery chief residents from 2015 to 2019 were accessed for the study. We analyzed 37 TS scores from attending performance evaluations and 29 FLS scores reported to the program during the study period (22% female, 27% underrepresented racial minorities). RESULTS There were no significant differences in FLS or TS scores between male and female trainees or racial identity. The Kappa correlation coefficient between the 2 dichotomized scores was significantly lower for female (-0.50) versus male (0.23) trainees (p < 0.01); it was not significantly different between racial groups (p = 0.34). CONCLUSIONS There was a statistically significant difference in agreement between the FLS and TS score of individual female and male trainees, suggesting the presence of implicit bias in this pilot study. Further research with a larger sample size is warranted.
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Affiliation(s)
- Arabella Dill-Macky
- Department of Surgery, College of Medicine, The University of Arizona, Tucson, Arizona
| | - Chiu-Hsieh Hsu
- Department of Surgery, College of Medicine, The University of Arizona, Tucson, Arizona
| | - Leigh A Neumayer
- Department of Surgery, College of Medicine, The University of Florida, Jacksonville, Florida
| | - Valentine N Nfonsam
- Department of Surgery, College of Medicine, The University of Arizona, Tucson, Arizona
| | - Alexandra P Turner
- Department of Surgery, College of Medicine, The University of Arizona, Tucson, Arizona.
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Bauman JE, Hsu CH, Centuori S, Guillen-Rodriguez J, Garland LL, Ho E, Padi M, Bageerathan V, Bengtson L, Wojtowicz M, Szabo E, Chow HHS. Randomized Crossover Trial Evaluating Detoxification of Tobacco Carcinogens by Broccoli Seed and Sprout Extract in Current Smokers. Cancers (Basel) 2022; 14:cancers14092129. [PMID: 35565256 PMCID: PMC9105060 DOI: 10.3390/cancers14092129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 04/13/2022] [Accepted: 04/15/2022] [Indexed: 01/25/2023] Open
Abstract
Consumption of cruciferous vegetables, rich in the isothiocyanate glucoraphanin, is associated with reduced risk of tobacco-related cancers. Sulforaphane, released by hydrolysis of glucoraphanin, potently induces cytoprotective phase II enzymes. Sulforaphane decreased the incidence of oral cancer in the 4NQO carcinogenesis model. In residents of Qidong, China, broccoli seed and sprout extracts (BSSE) increased detoxification of air pollutants benzene and acrolein, also found in tobacco smoke. This randomized, crossover trial evaluated detoxification of tobacco carcinogens by the BSSE Avmacol® in otherwise healthy smokers. Participants were treated for 2 weeks with both low and higher-dose BSSE (148 µmol vs. 296 µmol of glucoraphanin daily), separated by a 2-week washout, with randomization to low-high vs. high-low sequence. The primary endpoint was detoxification of benzene, measured by urinary excretion of its mercapturic acid, SPMA. Secondary endpoints included bioavailability, detoxification of acrolein and crotonaldehyde, modulation by GST genotype, and toxicity. Forty-nine participants enrolled, including 26 (53%) females with median use of 20 cigarettes/day. Low and higher-dose BSSE showed a mean bioavailability of 11% and 10%, respectively. Higher-dose BSSE significantly upregulated urinary excretion of the mercapturic acids of benzene (p = 0.04), acrolein (p < 0.01), and crotonaldehyde (p = 0.02), independent of GST genotype. Retention and compliance were high resulting in early study completion. In conclusion, BSSE significantly upregulated detoxification of the tobacco carcinogens benzene, acrolein, and crotonaldehyde in current tobacco smokers.
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Affiliation(s)
- Julie E. Bauman
- Department of Medicine, Division of Hematology/Oncology, University of Arizona (UA) and UA Cancer Center, Tucson, AZ 85724, USA; (S.C.); (L.L.G.); (H.-H.S.C.)
- Department of Medicine, Division of Hematology/Oncology, George Washington (GW) University and GW Cancer Center, Washington, DC 20037, USA
- Correspondence:
| | - Chiu-Hsieh Hsu
- Department of Epidemiology and Biostatistics, UA and UA Cancer Center, Tucson, AZ 85724, USA;
| | - Sara Centuori
- Department of Medicine, Division of Hematology/Oncology, University of Arizona (UA) and UA Cancer Center, Tucson, AZ 85724, USA; (S.C.); (L.L.G.); (H.-H.S.C.)
| | - Jose Guillen-Rodriguez
- Biostatistics and Bioinformatics Shared Resource, UA Cancer Center, Tucson, AZ 85724, USA; (J.G.-R.); (M.P.); (V.B.)
| | - Linda L. Garland
- Department of Medicine, Division of Hematology/Oncology, University of Arizona (UA) and UA Cancer Center, Tucson, AZ 85724, USA; (S.C.); (L.L.G.); (H.-H.S.C.)
| | - Emily Ho
- Linus Pauling Institute, College of Public Health and Human Sciences, Oregon State University, Corvallis, OR 97331, USA;
| | - Megha Padi
- Biostatistics and Bioinformatics Shared Resource, UA Cancer Center, Tucson, AZ 85724, USA; (J.G.-R.); (M.P.); (V.B.)
- Department of Molecular and Cellular Biology, UA, Tucson, AZ 85724, USA
| | - Vignesh Bageerathan
- Biostatistics and Bioinformatics Shared Resource, UA Cancer Center, Tucson, AZ 85724, USA; (J.G.-R.); (M.P.); (V.B.)
| | - Lisa Bengtson
- Division of Cancer Prevention, National Cancer Institute, Bethesda, MD 20892, USA; (L.B.); (M.W.); (E.S.)
| | - Malgorzata Wojtowicz
- Division of Cancer Prevention, National Cancer Institute, Bethesda, MD 20892, USA; (L.B.); (M.W.); (E.S.)
| | - Eva Szabo
- Division of Cancer Prevention, National Cancer Institute, Bethesda, MD 20892, USA; (L.B.); (M.W.); (E.S.)
| | - H.-H. Sherry Chow
- Department of Medicine, Division of Hematology/Oncology, University of Arizona (UA) and UA Cancer Center, Tucson, AZ 85724, USA; (S.C.); (L.L.G.); (H.-H.S.C.)
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Dauch J, Hamidi M, Arrington AK, O'Grady CL, Hsu CH, Joseph B, Riall TS, Khreiss M. The Impact of Frailty on Patients Undergoing Liver Resection for Colorectal Liver Metastasis. J Gastrointest Surg 2022; 26:608-614. [PMID: 34545542 DOI: 10.1007/s11605-021-05149-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Accepted: 08/21/2021] [Indexed: 01/31/2023]
Abstract
BACKGROUND The aim of this study is to assess the impact of frailty on short-term outcomes after hepatectomy for colorectal liver metastasis (CRLM). METHODS Patients were identified using the National Surgical Quality Improvement Program (NSQIP). Patients were divided into 3 categories using the 5-item Modified Frailty Index (mFI). RESULTS There were 5230 patients included. 52%, 35%, and 13% had mFI scores of 0, 1, and ≥ 2 respectively. Patients with a ≥ 2 mFI score were more likely to experience minor complication (OR 1.34, 95% CI 1.06-1.69), major complication (OR 1.56, 95% CI 1.15-2.12), readmission (OR 1.55, 95% CI 1.12-2.14), unfavorable discharge (OR 2.48, 95% CI 1.62-3.80), 30-day mortality (OR 3.02, 95% CI 1.02-8.95), prolonged length of stay (OR 1.47, 95% CI 1.18-1.83), and bile leak (OR 1.51, 95% CI 1.02-2.24). CONCLUSION Frailty is associated with increased post-operative complications. The 5-item mFI can guide risk stratification, optimization, and counseling.
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Affiliation(s)
| | | | | | | | - Chiu-Hsieh Hsu
- University of Arizona College of Medicine, Tucson, AZ, USA
| | - Bellal Joseph
- University of Arizona College of Medicine, Tucson, AZ, USA
| | - Taylor S Riall
- University of Arizona College of Medicine, Tucson, AZ, USA
| | - Mohammad Khreiss
- University of Arizona College of Medicine, Tucson, AZ, USA.
- Department of Surgery, University of Arizona, 1501 N. Campbell Ave, Tucson, AZ, USA.
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Howard C, Rice PFS, Keenan M, Dominguez-Cooks J, Heusinkveld J, Hsu CH, Barton JK. Study of fallopian tube anatomy and mechanical properties to determine pressure limits for endoscopic exploration. J Histotechnol 2022; 45:10-20. [PMID: 34496720 PMCID: PMC10566563 DOI: 10.1080/01478885.2021.1972250] [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: 10/20/2022]
Abstract
Falloposcopy is the endoscopic examination of the fallopian tubes, which are challenging to access due to their deep body location, small opening from the uterus, and lumen filled with plicae. We and others have developed endoscopes that are inserted through the uterus guided by a hysteroscope into the tubal ostium. To better understand how to utilize these endoscopes either as standalone devices or in concert with everting delivery balloons, a preliminary study of anatomy and mechanical behavior was performed ex vivo on porcine and human fallopian tubes. Segments of fallopian tubes from the isthmus, ampulla and infundibulum were inflated with saline either to bursting or held at sub-burst pressures with saline or a saline-filled balloon. Formalin fixed, paraffin embedded tissue sections stained with Masson's trichrome were examined for damage to the mucosa and muscularis. Porcine fallopian tubes tolerated saline pressurization at 15 psi for 1 minute without morphological damage. Balloon inflation to 15 psi caused no apparent damage to the muscle layer or rupture of the fallopian tube, but balloon movement within the tube can denude the mucosal epithelial layer. Human fallopian tubes averaged higher burst pressure values than porcine tubes. Under pressurization, the external tube diameter expanded by minimal to moderate amounts. Human and porcine tissues were similar in histological appearance. These studies suggest that moderate pressurization is acceptable but will not appreciably expand the fallopian tube diameter. The results also indicate that pigs are a reasonable model to study damage from falloscopy as seen in human tissue.
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Affiliation(s)
- Caitlin Howard
- Department of Biomedical Engineering, University of Arizona, Tucson, AZ, USA
| | - Photini F S Rice
- Department of Biomedical Engineering, University of Arizona, Tucson, AZ, USA
| | - Molly Keenan
- Department of Biomedical Engineering, University of Arizona, Tucson, AZ, USA
| | | | - John Heusinkveld
- Department of Obstetrics and Gynecology, University of Arizona, Tucson, AZ, USA
| | - Chiu-Hsieh Hsu
- Department of Epidemiology and Biostatistics, University of Arizona, Tucson, AZ, USA
| | - Jennifer K Barton
- Department of Biomedical Engineering, University of Arizona, Tucson, AZ, USA
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Parsons JK, Pinto PA, Parnes HL, Pavlovich CP, Uchio EM, Nguyen MM, Kim HL, Gulley JL, Sater HA, Jamieson C, Hsu CH, Wojtowicz ME, Schlom J, Donahue RN, Centuori S, Bailey S, Bauman JE, Chow HH. Immunotherapy to prevent progression on active surveillance study (IPASS): A phase II, randomized, double-blind, controlled trial of PROSTVAC in prostate cancer patients who are candidates for active surveillance. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.6_suppl.249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
249 Background: Immunotherapy could potentially prevent disease progression for early-stage prostate cancer. In this randomized Phase 2 clinical trial, we evaluated the clinical effects of PROSTVAC, a vaccinia/fowlpox viral vector-based immunotherapy that contains PSA and three T-cell costimulatory molecules, in patients with localized prostate cancer. Methods:154 patients with clinically localized, low- or favorable intermediate-risk prostate cancer active surveillance were randomized (2:1) to receive 7 doses of subcutaneous PROSTVAC or placebo (empty fowlpox vector) over 140 days. Post-intervention prostate biopsy was performed 7-14 days after the last dose. Participants were followed for 6 months post-treatment. The primary outcome was change from baseline to post-vaccination in CD4 and CD8 T cell infiltration in biopsy tumor tissue. Secondary outcomes included changes in prostate biopsy Gleason grade (Grade Group) and serum PSA. Results: There were no differences in CD4 and CD8 densities (count of cells/mm2) in post-treatment biopsy tumor tissue between groups ( p = 0.63 and p = 0.75, respectively). Compared to placebo, patients who received PROSTVAC were less likely to demonstrate upgrading at follow-up biopsy, but this difference did not attain significance (22% vs. 40%, p= 0.08). There was no difference in the change of PSA from baseline to 6 months post-treatment between arms ( p= 0.30). Conclusions: In this first-of-kind trial of immunotherapy for localized prostate cancer, PROSTVAC was well tolerated but did not elicit significant prostate tissue T-cell responses compared to placebo. The favorable post-treatment biopsy grade findings in PROSTVAC patients merit further evaluation and longer-term clinical follow-up. Clinical trial information: NCT02326805.
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Affiliation(s)
| | - Peter A. Pinto
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Howard L. Parnes
- National Cancer Institute at the National Institutes of Health, Bethesda, MD
| | | | | | | | | | - James L. Gulley
- National Cancer Institute, National Institutes of Health, Bethesda, MD
| | | | | | | | | | - Jeffrey Schlom
- Laboratory of Tumor Immunology and Biology, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Renee Nicole Donahue
- Laboratory of Tumor Immunology and Biology, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | | | | | | | - H H Chow
- The University of Arizona Cancer Center, Tucson, AK
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Cruz A, Dickerson F, Pulling KR, Garcia K, Gachupin FC, Hsu CH, Chipollini J, Lee BR, Batai K. Impacts of Neighborhood Characteristics and Surgical Treatment Disparities on Overall Mortality in Stage I Renal Cell Carcinoma Patients. Int J Environ Res Public Health 2022; 19:2050. [PMID: 35206240 PMCID: PMC8872003 DOI: 10.3390/ijerph19042050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 01/15/2022] [Accepted: 02/09/2022] [Indexed: 12/20/2022]
Abstract
Racial/ethnic minority groups in the United States have high renal cell carcinoma (RCC) mortality rates. This study assessed surgical treatment disparities across racial/ethnic groups and impacts of neighborhood socioeconomic characteristics on surgical treatments and overall mortality. Stage I RCC patients diagnosed between 2004 and 2016 from National Cancer Database were included (n = 238,141). We assessed differences in associations between race/ethnicity and treatment patterns using logistic regression and between race/ethnicity and overall mortality using Cox regression with and without neighborhood characteristics in the regression models. When compared to non-Hispanic Whites (NHWs), American Indians/Alaska Natives and non-Hispanic Blacks (NHBs) were more likely not to receive surgical care and all racial/ethnic minority groups had significantly increased odds of undergoing radical rather than partial nephrectomy, even after adjusting for neighborhood characteristics. Including surgical treatment and neighborhood factors in the models slightly attenuated the association, but NHBs had a significantly increased risk of overall mortality. NHBs who underwent radical nephrectomy had an increased risk of mortality (HR 1.15, 95% CI: 1.08-1.23), but not for NHBs who underwent partial nephrectomy (HR 0.92, 95% CI: 0.84-1.02). Neighborhood factors were associated with surgical treatment patterns and overall mortality in both NHBs and NHWs. Neighborhood socioeconomic factors may only partly explain RCC disparities.
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Affiliation(s)
- Alejandro Cruz
- Department of Urology, University of Arizona, Tucson, AZ 85724, USA; (A.C.); (F.D.); (K.R.P.); (K.G.); (J.C.); (B.R.L.)
| | - Faith Dickerson
- Department of Urology, University of Arizona, Tucson, AZ 85724, USA; (A.C.); (F.D.); (K.R.P.); (K.G.); (J.C.); (B.R.L.)
| | - Kathryn R. Pulling
- Department of Urology, University of Arizona, Tucson, AZ 85724, USA; (A.C.); (F.D.); (K.R.P.); (K.G.); (J.C.); (B.R.L.)
| | - Kyle Garcia
- Department of Urology, University of Arizona, Tucson, AZ 85724, USA; (A.C.); (F.D.); (K.R.P.); (K.G.); (J.C.); (B.R.L.)
| | - Francine C. Gachupin
- Department of Family and Community Medicine, University of Arizona, Tucson, AZ 85711, USA;
| | - Chiu-Hsieh Hsu
- Department of Epidemiology and Biostatistics, University of Arizona, Tucson, AZ 85724, USA;
| | - Juan Chipollini
- Department of Urology, University of Arizona, Tucson, AZ 85724, USA; (A.C.); (F.D.); (K.R.P.); (K.G.); (J.C.); (B.R.L.)
| | - Benjamin R. Lee
- Department of Urology, University of Arizona, Tucson, AZ 85724, USA; (A.C.); (F.D.); (K.R.P.); (K.G.); (J.C.); (B.R.L.)
| | - Ken Batai
- Department of Urology, University of Arizona, Tucson, AZ 85724, USA; (A.C.); (F.D.); (K.R.P.); (K.G.); (J.C.); (B.R.L.)
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Gachupin FC, Lee BR, Chipollini J, Pulling KR, Cruz A, Wong AC, Valencia CI, Hsu CH, Batai K. Renal Cell Carcinoma Surgical Treatment Disparities in American Indian/Alaska Natives and Hispanic Americans in Arizona. Int J Environ Res Public Health 2022; 19:1185. [PMID: 35162208 PMCID: PMC8834853 DOI: 10.3390/ijerph19031185] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 01/17/2022] [Accepted: 01/19/2022] [Indexed: 12/04/2022]
Abstract
American Indians/Alaska Natives (AI/AN) and Hispanic Americans (HA) have higher kidney cancer incidence and mortality rates compared to non-Hispanic Whites (NHW). Herein, we describe the disparity in renal cell carcinoma (RCC) surgical treatment for AI/AN and HA and the potential association with mortality in Arizona. A total of 5111 stage I RCC cases diagnosed between 2007 and 2016 from the Arizona Cancer Registry were included. Statistical analyses were performed to test the association of race/ethnicity with surgical treatment pattern and overall mortality, adjusting for patients' demographic, healthcare access, and socioeconomic factors. AI/AN were diagnosed 6 years younger than NHW and were more likely to receive radical rather than partial nephrectomy (OR 1.49 95% CI: 1.07-2.07) compared to NHW. Mexican Americans had increased odds of not undergoing surgical treatment (OR 1.66, 95% CI: 1.08-2.53). Analysis showed that not undergoing surgical treatment and undergoing radical nephrectomy were statistically significantly associated with higher overall mortality (HR 1.82 95% CI: 1.21-2.76 and HR 1.59 95% CI: 1.30-1.95 respectively). Mexican Americans, particularly U.S.-born Mexican Americans, had an increased risk for overall mortality and RCC-specific mortality even after adjusting for neighborhood socioeconomic factors and surgical treatment patterns. Although statistically not significant after adjusting for neighborhood-level socioeconomic factors and surgical treatment patterns, AI/AN had an elevated risk of mortality.
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Affiliation(s)
- Francine C. Gachupin
- Department of Family and Community Medicine, College of Medicine, University of Arizona, Tucson, AZ 85711, USA;
| | - Benjamin R. Lee
- Department of Urology, College of Medicine, University of Arizona, Tucson, AZ 85724, USA; (B.R.L.); (J.C.); (K.R.P.); (A.C.); (A.C.W.); (K.B.)
| | - Juan Chipollini
- Department of Urology, College of Medicine, University of Arizona, Tucson, AZ 85724, USA; (B.R.L.); (J.C.); (K.R.P.); (A.C.); (A.C.W.); (K.B.)
| | - Kathryn R. Pulling
- Department of Urology, College of Medicine, University of Arizona, Tucson, AZ 85724, USA; (B.R.L.); (J.C.); (K.R.P.); (A.C.); (A.C.W.); (K.B.)
| | - Alejandro Cruz
- Department of Urology, College of Medicine, University of Arizona, Tucson, AZ 85724, USA; (B.R.L.); (J.C.); (K.R.P.); (A.C.); (A.C.W.); (K.B.)
| | - Ava C. Wong
- Department of Urology, College of Medicine, University of Arizona, Tucson, AZ 85724, USA; (B.R.L.); (J.C.); (K.R.P.); (A.C.); (A.C.W.); (K.B.)
| | - Celina I. Valencia
- Department of Family and Community Medicine, College of Medicine, University of Arizona, Tucson, AZ 85711, USA;
| | - Chiu-Hsieh Hsu
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ 85724, USA;
| | - Ken Batai
- Department of Urology, College of Medicine, University of Arizona, Tucson, AZ 85724, USA; (B.R.L.); (J.C.); (K.R.P.); (A.C.); (A.C.W.); (K.B.)
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Cruz A, Dickerson F, Pulling KR, Garcia K, Gachupin FC, Hsu CH, Chipollini J, Lee BR, Batai K. Abstract PO-169: Impacts of neighborhood characteristics and surgical treatment disparities on overall mortality in stage I renal cell carcinoma patients. Cancer Epidemiol Biomarkers Prev 2022. [DOI: 10.1158/1538-7755.disp21-po-169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract
Background Racial/ethnic minority groups in the United States have high kidney cancer mortality rates. Disparities in treatments may contribute to higher mortality in racial/ethnic minority groups, but the relationship between treatment disparities and kidney cancer mortality is not well understood. In this study, we assessed if there are differences in surgical treatments across racial/ethnic groups and surgical treatments influence disparities in overall mortality. Methods Stage I renal cell carcinoma patients who were diagnosed between 2004 and 2016 from National Cancer Database were included. Logistic regression was performed to assess associations between race/ethnicity and treatment patterns adjusting for neighborhood socioeconomic (SES) and other factors. Cox regression analysis was performed to assess associations between race/ethnicity and overall mortality. Results A total of 238,141 patients were included in the analysis. Compared to non-Hispanic Whites, American Indians/Alaska Natives, and non-Hispanic Blacks (NHBs) were more likely not to receive surgical care even after adjusting for neighborhood SES (OR 1.85, 95% CI: 1.28-2.70 and OR 1.32 95% CI: 1.20-1.45 respectively). Although all racial/ethnic groups had significantly increased odds of undergoing radical nephrectomy rather than partial nephrectomy,. NHBs had the greatest odds of receiving radical rather than partial nephrectomy (OR 1.38, 95% CI: 1.33-1.44).. The associations were slightly attenuated after including healthcare access and neighborhood SESNHBs had an elevated risk of overall mortality, while Asian Americans and Hispanic Americans had reduced risk. Including surgical treatment, health access and neighborhood factors slightly attenuated the association for NHBs, but the associations between race/ethnicity and overall mortality remained significant. Analysis was performed stratifying samples based on surgical treatment to further assess effects of surgical treatment disparities on associations between race/ethnicity and overall mortality. NHBs who had surgical treatment had increased risk of mortality (HR 1.11, 95% CI:1.06-1.17).. Among patients who underwent nephrectomy, NHBs who underwent radical nephrectomy had increased risk of mortality (HR 1.15, 95% CI: 1.08-1.23), but not NHBs who underwent partial nephrectomy (HR 0.92, 95% CI:0.84-1.02). Conclusion Racial/ethnic minority patients were more likely not to receive surgical treatment. When they do, they are likely to have less optimal surgical treatment (radical rather than partial nephrectomy). Surgical treatment disparities account for high kidney cancer mortality in NHBs.
Citation Format: Alejandro Cruz, Faith Dickerson, Kathryn R. Pulling, Kyle Garcia, Francine C. Gachupin, Chiu-Hsieh Hsu, Juan Chipollini, Benjamin R. Lee, Ken Batai. Impacts of neighborhood characteristics and surgical treatment disparities on overall mortality in stage I renal cell carcinoma patients [abstract]. In: Proceedings of the AACR Virtual Conference: 14th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2021 Oct 6-8. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr PO-169.
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Zeng J, Bergersen A, Price E, Callegari M, Austin E, Oduyemi O, Poling K, Hsu CH, Funk J, Twiss C. Symptom Resolution and Recurrent Urinary Incontinence Following Removal of Painful Midurethral Slings. Urology 2022; 159:78-82. [PMID: 34474043 DOI: 10.1016/j.urology.2021.08.024] [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] [Received: 05/24/2021] [Revised: 08/14/2021] [Accepted: 08/17/2021] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To evaluate pain improvement and recurrent stress incontinence (SUI) following painful synthetic midurethral sling (MUS) removal. METHODS We conducted a retrospective review of patients who underwent synthetic MUS removal at our institution from 2009-2016 for the indication of pain. We recorded sling type (transobturator vs retropubic), complete vs partial removal, and presenting symptoms. Postoperative pain improvement was categorized as resolved (pain resolved, requiring no further therapy), improved (pain less bothersome, may require further therapy), or unresolved (no/minimal improvement, requiring further management). Recurrent incontinence and further reconstructive procedures were assessed. RESULTS 87 patients (49 complete and 38 partial removal) with pain as the primary indication for removal were included. Median age at intervention was 54 years with median follow-up of 8 months. Overall, pain improved or resolved in 78.1% of cases. Complete removal was associated with significantly greater percentage of pain resolution (63.3%) compared to partial removal (26.3%) (P = 0.002) regardless of sling type. No significant differences in recurrent SUI were noted in complete vs partial removal. Additional reconstructive procedures were performed in 28 patients, most commonly sling placement, with no significant difference in complete (20.4%) vs partial (28.9%) removal groups (P = 0.36). The overall complication rate was low (5.7%), a majority of which were transfusions (4.6%). CONCLUSION Following MUS removal, most patients experienced resolution or improvement of pain. Complete sling removal was associated with significantly greater percentage of pain resolution compared to partial removal in both retropubic and transobturator slings. Rates of recurrent SUI and reintervention for SUI were not related to the extent of sling removal.
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Affiliation(s)
- Jiping Zeng
- Department of Urology, University of Arizona College of Medicine, Tucson, Arizona
| | - Andrew Bergersen
- Department of Urology, University of Arizona College of Medicine, Tucson, Arizona
| | - Elinora Price
- Department of Urology, University of Arizona College of Medicine, Tucson, Arizona
| | | | - Evan Austin
- Department of Urology, University of Arizona College of Medicine, Tucson, Arizona
| | - Odutoyosi Oduyemi
- Department of Urology, University of Arizona College of Medicine, Tucson, Arizona
| | - Kristi Poling
- Department of Urology, University of Arizona College of Medicine, Tucson, Arizona
| | - Chiu-Hsieh Hsu
- Department of Surgery, University of Arizona College of Medicine, Tucson, Arizona
| | - Joel Funk
- Department of Urology, University of Arizona College of Medicine, Tucson, Arizona
| | - Christian Twiss
- Department of Urology, University of Arizona College of Medicine, Tucson, Arizona.
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Wiseman JE, Morris-Wiseman LF, Hsu CH, Riall TS. Attending Surgeon Influences Operative Time More Than Resident Level in Laparoscopic Cholecystectomy. J Surg Res 2021; 270:564-570. [PMID: 34839227 DOI: 10.1016/j.jss.2021.09.038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 08/23/2021] [Accepted: 09/21/2021] [Indexed: 01/13/2023]
Abstract
BACKGROUND Prior studies on laparoscopic cholecystectomy (LC) have concluded that resident involvement lengthens operative time without impacting outcomes. However, the lack of effect of resident level on operative duration has not been explained. We hypothesized that attending-specific influence on average operative time for LC is more pronounced than resident post-graduate year level. MATERIALS AND METHODS We retrospectively analyzed all LC cases performed on patients 18 y and older between November 2018 and March 2020 at 2 academic medical center-affiliated hospitals. Regression models were used to compare operative times, conversion to open rates, and complication rates by attending surgeon and resident level. RESULTS Nine hundred twenty-five LCs were performed over the study period, 862 (93.1%) with resident participation. Of the 44.5% variation in operative time was explained by differences in attending surgeon, as compared to 11.0% attributable to differences in resident level (P < 0.0001). This effect persisted after adjusting for patient and disease factors (33.0% versus 7.1%, P < 0.0001). Neither attending surgeon (P = 0.80), nor the level of the involved resident (P = 0.94) demonstrated a significant effect on the conversion-to-open rate (4.9%). Similarly, neither the attending surgeon (P = 0.33), nor resident level (P = 0.81) significantly affected the complication rate (8.58%). CONCLUSIONS Operative time for LC is primarily determined by patient- and disease-specific factors; resident level has no effect on conversion to open or complication rates. Attending influence on operative time was more pronounced than resident level influence. These findings suggest attending surgeon-related factors are more important than resident experience in determining operative duration for LC.
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Affiliation(s)
- James E Wiseman
- Department of Surgery, The University of Arizona College of Medicine - Tucson, Tucson, Arizona.
| | - Lilah F Morris-Wiseman
- Department of Surgery, The University of Arizona College of Medicine - Tucson, Tucson, Arizona
| | - Chiu-Hsieh Hsu
- Mel and Enid Zuckerman College of Public Health, The University of Arizona, Tucson, Arizona
| | - Taylor S Riall
- Department of Surgery, The University of Arizona College of Medicine - Tucson, Tucson, Arizona
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Dennis LK, Hsu CH, Arrington AK. Reduction in Standard Cancer Screening in 2020 throughout the U.S. Cancers (Basel) 2021; 13:cancers13235918. [PMID: 34885028 PMCID: PMC8656505 DOI: 10.3390/cancers13235918] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 11/19/2021] [Accepted: 11/19/2021] [Indexed: 12/20/2022] Open
Abstract
Cancer screening is an important way to reduce the burden of cancer. The COVID-19 pandemic created delays in screening with the potential to increase cancer disparities in the United States (U.S.). Data from the 2014-2020 Behavioral Risk Factor Surveillance System (BRFSS) survey were analyzed to estimate the percentages of adults who reported cancer screening in the last 12 months consistent with the U.S. Preventive Services Task Force (USPSTF) recommendation for cervical (ages 21-65), breast (ages 50-74), and colorectal cancer (ages 50-75) prior to the pandemic. Cancer screening percentages for 2020 (April-December excluding January-March) were compared to screening percentages for 2014-2019 to begin to look at the impact of the COVID-19 pandemic. Screening percentages for 2020 were decreased from those for 2014-2019 including several underserved racial groups. Decreases in mammography and colonoscopy or sigmoidoscopy were higher among American Indian/Alaskan Natives, Hispanics, and multiracial participants, but decreases in pap test were also highest among Hispanics, Whites, Asians, and African-Americans/Blacks. Decreases in mammograms among women ages 40-49 were also seen. As the 2020 comparison is conservative, the 2021 decreases in cancer screening are expected to be much greater and are likely to increase cancer disparities substantially.
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Affiliation(s)
- Leslie K. Dennis
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ 85724, USA;
- University of Arizona Cancer Center, Tucson, AZ 85724, USA;
- Environment, Exposure Science and Risk Assessment Center, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ 85724, USA
- Correspondence:
| | - Chiu-Hsieh Hsu
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ 85724, USA;
- University of Arizona Cancer Center, Tucson, AZ 85724, USA;
| | - Amanda K. Arrington
- University of Arizona Cancer Center, Tucson, AZ 85724, USA;
- Department of Surgery, Houston Methodist Hospital, Houston, TX 77030, USA
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Morris-Wiseman LF, Cañez C, Romero Arenas MA, Hsu CH, Nfonsam VN. Race, Gender, and International Medical Graduates: Leadership Trends in Academic Surgical Societies. J Surg Res 2021; 270:430-436. [PMID: 34798425 DOI: 10.1016/j.jss.2021.09.043] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 03/01/2021] [Revised: 08/26/2021] [Accepted: 09/21/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Non-White and female surgeons are underrepresented in academic surgery faculty. We hypothesized that the leadership of major U.S. regional and national general surgery societies reflects these same racial and gender disparities. We suspected that attending a medical school or residency program with academic prestige would be more common for surgeons from underrepresented backgrounds. MATERIALS AND METHODS Race/ethnicity and gender of the 2020-21 executive council members and 2012-21 society presidents of 25 major general surgery societies (7 regional, 18 national) was assessed. Academic prestige was determined by reputational top 25 programs, identified using U.S. News and World Report and Doximity rankings for medical school and residency, respectively. RESULTS Surgical society executive council members (n = 204) were predominantly White (75.5%) and male (67.2%). The 50 non-White council members were Asian (n = 37), Black (n = 7), and Latinx (n = 6). 14 (6.9%) were international medical graduates (IMGs). 56.4% attended a school or program ranked in the Top 25 (n = 115). Surgical society presidents 2012-21 (n = 242) have been mostly White (87.6%) and male (83.4%). Non-White, male surgical society presidents were Asian (n = 13), Black (n = 9), and Latino (n = 6). Of the 41 female surgery society presidents, 92.7% were White, 7.3% (n = 3) Asian, and none Black or Latina. 13 were IMGs (5.3%). 55.0% of society presidents attended Top 25 (n = 133) schools or programs. The three non-White, female presidents all attended Top 25 schools/programs (100%). Of the 15 unique individuals who were male, non-White presidents, 12 attended top 25 schools or programs (80%). CONCLUSION Women, non-White surgeons, and IMGs are underrepresented in U.S. surgical society leadership. Increasing racial diversity in U.S. surgical society leadership may require intentionality in mentorship and sponsorship, particularly for surgeons who did not attend prestigious schools or programs.
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Affiliation(s)
| | - Christina Cañez
- Department of Surgery, University of Arizona, College of Medicine Tucson, Arizona
| | - Minerva A Romero Arenas
- Department of Surgery, Weill Cornell Medicine/New York Presbyterian-Brooklyn Methodist Hospital, Brooklyn, New York
| | - Chiu-Hsieh Hsu
- Department of Surgery, University of Arizona, College of Medicine Tucson, Arizona
| | - Valentine N Nfonsam
- Department of Surgery, University of Arizona, College of Medicine Tucson, Arizona
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Knobbe K, Partha M, Seckeler MD, Klewer S, Hsu CH, Edgin J, Morgan WJ, Provencio-Dean N, Lopez S, Parthasarathy S, Combs D. Association Between Sleep Disturbances With Neurodevelopmental Problems and Decreased Health-Related Quality of Life in Children With Fontan Circulation. J Am Heart Assoc 2021; 10:e021749. [PMID: 34668394 PMCID: PMC8751823 DOI: 10.1161/jaha.121.021749] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Background Children with Fontan circulation are known to be at increased risk for neurodevelopmental problems and decreased health-related quality of life (HRQOL), but many factors that may contribute to this risk are unknown. Sleep disturbances may be one previously unidentified factor that contributes to this risk. Methods and Results We analyzed data from the Pediatric Heart Network Fontan cross-sectional study to evaluate associations between a parent or child report of sleep disturbance with reported neurodevelopmental concerns and HRQOL in 558 children with Fontan circulation. Parent-reported sleep disturbance was present in 11% of participants and child-reported sleep disturbance was present in 15%. Parent-reported sleep disturbance was associated with a significantly higher risk of attention problems, anxiety, depression, behavioral problems, and developmental delay (P<0.001 for all). Similarly, parent-reported disturbance was associated with decreased HRQOL on both parent and child-reported HRQOL (P<0.001 for most domains). Child-reported sleep disturbances were associated with increased odds of anxiety, depression, and attention problems as well as worse HRQOL. These associations were present even after adjustment for cardiac, demographic, and socioeconomic factors that may affect HRQOL and neurodevelopmental status. Conclusions Sleep disturbances in children with Fontan circulation are associated with an increased risk of neurodevelopmental problems as well as reduced HRQOL compared with those without sleep disturbance. Better understanding of sleep disturbances is needed in children with Fontan circulation, as sleep disturbances may represent a reversible cause of neurodevelopmental problems and decreased HRQOL in this population.
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Affiliation(s)
- Kirstin Knobbe
- UAHS Center for Sleep & Circadian Sciences University of Arizona Tucson AZ
| | - Meghana Partha
- UAHS Center for Sleep & Circadian Sciences University of Arizona Tucson AZ
| | | | - Scott Klewer
- Department of Pediatrics University of Arizona Tucson AZ
| | - Chiu-Hsieh Hsu
- Mel and Enid Zuckerman College of Public Health University of Arizona Tucson AZ
| | - Jamie Edgin
- Department of Psychology University of Arizona Tucson AZ.,Sonoran University Center for Excellence in Developmental DisabilitiesUniversity of Arizona Tucson AZ
| | - Wayne J Morgan
- Department of Pediatrics University of Arizona Tucson AZ
| | | | - Silvia Lopez
- UAHS Center for Sleep & Circadian Sciences University of Arizona Tucson AZ
| | | | - Daniel Combs
- UAHS Center for Sleep & Circadian Sciences University of Arizona Tucson AZ.,Department of Pediatrics University of Arizona Tucson AZ
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Ashouri Y, Ho KL, Ho H, Bartz-Kurycki M, Hsu CH, Ghaderi I, Konstantinidis IT, Maegawa FB. Association Between Hospital Volume and Surgical Outcomes after Hepato-pancreato-biliary Surgery Among US Veterans: A Veterans Affairs Surgical Quality Improvement Program Analysis. J Am Coll Surg 2021. [DOI: 10.1016/j.jamcollsurg.2021.08.288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Ho HY, Hsu CH, Ho KL, Bartz-Kurycki MA, Maegawa FB, Ashouri Y, Ghaderi I. Safety of Robotic Bariatric Surgery in Older Adults: A 5-year Analysis of the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) Database. J Am Coll Surg 2021. [DOI: 10.1016/j.jamcollsurg.2021.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Harhash AA, May T, Hsu CH, Seder DB, Dankiewicz J, Agarwal S, Patel N, McPherson J, Riker R, Soreide E, Hirsch KG, Stammet P, Dupont A, Forsberg S, Rubertsson S, Friberg H, Nielsen N, Mooney MR, Kern KB. Incidence of cardiac interventions and associated cardiac arrest outcomes in patients with nonshockable initial rhythms and no ST elevation post resuscitation. Resuscitation 2021; 167:188-197. [PMID: 34437992 DOI: 10.1016/j.resuscitation.2021.08.026] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 03/29/2021] [Revised: 08/02/2021] [Accepted: 08/12/2021] [Indexed: 12/29/2022]
Abstract
BACKGROUND Out of Hospital Cardiac arrest (OHCA) survivors with ST elevation (STE) with or without shockable rhythms often benefit from coronary angiography (CAG) and, if indicated, percutaneous coronary intervention (PCI). However, the benefits of CAG and PCI in OHCA survivors with nonshockable rhythms (PEA/asystole) and no STE are debated. METHODS Using the International Cardiac Arrest Registry (INTCAR 2.0), representing 44 centers in the US and Europe, comatose OHCA survivors with known presenting rhythms and post resuscitation ECGs were identified. Survival to hospital discharge, neurological recovery on discharge, and impact of CAG with or without PCI on such outcome were assessed and compared with other groups (shockable rhythms with or without STE). RESULTS Total of 2113 OHCA survivors were identified and described as; nonshockable/no STE (Nsh-NST) (n = 940, 44.5%), shockable/no STE (Sh-NST) (n = 716, 33.9%), nonshockable/STE (Nsh-ST) (n = 110, 5.2%), and shockable/STE (Sh-ST) (n = 347, 16.4%). Of Nsh-NST, 13.7% (129) were previously healthy before CA and only 17.3% (161) underwent CAG; of those, 30.4% (52) underwent PCI. A total of 18.6% (174) Nsh-NST patients survived to hospital discharge, with 57.5% (100) of such survivors having good neurological recovery (cerebral performance category 1 or 2) on discharge. Coronary angiography was associated with improved odds for survival and neurological recovery among all groups, including those with NSh-NST. CONCLUSIONS Nonshockable initial rhythms with no ST elevation post resuscitation was the most common presentation after OHCA. Although most of these patients did not undergo coronary angiography, among those who did, 1 in 4 patients had a culprit lesion and underwent revascularization. Invasive CAG should be at least considered for all OHCA survivors, including those with nonshockable rhythms and no ST elevation post resuscitation. BRIEF ABSTRACT Out of hospital cardiac arrest (OHCA) survivors with ST elevation and/or shockable rhythms benefit from coronary angiography and revascularization. Nonshockable cardiac arrest survivors with no ST elevation have the worst prognosis and rarely undergo coronary angiography. Nonshockable rhythms with no ST elevation was the most common presentation after OHCA and among a small subgroup underwent coronary angiography, 1 in 4 patients with had culprit lesion and underwent revascularization. Coronary angiography was associated with high prevalence of acute culprit coronary lesions and should be considered for those with a probably cardiac cause for their arres.
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Affiliation(s)
- Ahmed A Harhash
- University of Arizona Sarver Heart Center, Tucson, AZ, United States; University of Vermont Medical Center, Burlington, VT, United States
| | - Teresa May
- Maine Medical Center, Portland, ME, United States
| | - Chiu-Hsieh Hsu
- University of Arizona College of Public Health, Tucson, AZ, United States
| | | | | | | | - Nainesh Patel
- Lehigh Valley Heart Institute, Allentown, PA, United States
| | - John McPherson
- Vanderbilt University Medical Center, Nashville, TN, United States
| | | | | | | | | | | | | | | | | | - Niklas Nielsen
- Lund University, Helsingborg Hospital, Helsingborg, Sweden
| | | | - Karl B Kern
- University of Arizona Sarver Heart Center, Tucson, AZ, United States.
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Harhash AA, May TL, Hsu CH, Agarwal S, Seder DB, Mooney MR, Patel N, McPherson J, McMullan P, Riker R, Soreide E, Hirsch KG, Stammet P, Dupont A, Rubertsson S, Friberg H, Nielsen N, Rab T, Kern KB. Risk Stratification Among Survivors of Cardiac Arrest Considered for Coronary Angiography. J Am Coll Cardiol 2021; 77:360-371. [PMID: 33509392 DOI: 10.1016/j.jacc.2020.11.043] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 11/12/2020] [Accepted: 11/16/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND The American College of Cardiology Interventional Council published consensus-based recommendations to help identify resuscitated cardiac arrest patients with unfavorable clinical features in whom invasive procedures are unlikely to improve survival. OBJECTIVES This study sought to identify how many unfavorable features are required before prognosis is significantly worsened and which features are most impactful in predicting prognosis. METHODS Using the INTCAR (International Cardiac Arrest Registry), the impact of each proposed "unfavorable feature" on survival to hospital discharge was individually analyzed. Logistic regression was performed to assess the association of such unfavorable features with poor outcomes. RESULTS Seven unfavorable features (of 10 total) were captured in 2,508 patients successfully resuscitated after cardiac arrest (ongoing cardiopulmonary resuscitation and noncardiac etiology were exclusion criteria in our registry). Chronic kidney disease was used in lieu of end-stage renal disease. In total, 39% survived to hospital discharge. The odds ratio (OR) of survival to hospital discharge for each unfavorable feature was as follows: age >85 years OR: 0.30 (95% CI: 0.15 to 0.61), time-to-ROSC >30 min OR: 0.30 (95% CI: 0.23 to 0.39), nonshockable rhythm OR: 0.39 (95% CI: 0.29 to 0.54), no bystander cardiopulmonary resuscitation OR: 0.49 (95% CI: 0.38 to 0.64), lactate >7 mmol/l OR: 0.50 (95% CI: 0.40 to 0.63), unwitnessed arrest OR: 0.58 (95% CI: 0.44 to 0.78), pH <7.2 OR: 0.78 (95% CI: 0.63 to 0.98), and chronic kidney disease OR: 0.96 (95% CI: 0.70 to 1.33). The presence of any 3 or more unfavorable features predicted <40% survival. Presence of the 3 strongest risk factors (age >85 years, time-to-ROSC >30 min, and non-ventricular tachycardia/ventricular fibrillation) together or ≥6 unfavorable features predicted a ≤10% chance of survival to discharge. CONCLUSIONS Patients successfully resuscitated from cardiac arrest with 6 or more unfavorable features have a poor long-term prognosis. Delaying or even forgoing invasive procedures in such patients is reasonable.
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Affiliation(s)
- Ahmed A Harhash
- University of Arizona Sarver Heart Center, Tucson, Arizona, USA; University of Vermont, Burlington, Vermont, USA
| | | | - Chiu-Hsieh Hsu
- University of Arizona College of Public Health, Tucson, Arizona, USA
| | | | | | | | - Nainesh Patel
- Lehigh Valley Medical Center, Lehigh, Pennsylvania, USA
| | - John McPherson
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | | | | | | | | | | | | | | | | | | | - Tanveer Rab
- Emory University School of Medicine, Atlanta, Georgia, USA
| | - Karl B Kern
- University of Arizona Sarver Heart Center, Tucson, Arizona, USA.
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