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James CA, Hogan MJ, Seay RP, James LT, Jensen HK, Kaukis NA, Moore MB, Braswell LE. Percutaneous cecostomy: 25-year two institution experience. Pediatr Radiol 2024:10.1007/s00247-024-05936-2. [PMID: 38693250 DOI: 10.1007/s00247-024-05936-2] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 04/18/2024] [Accepted: 04/19/2024] [Indexed: 05/03/2024]
Abstract
BACKGROUND Reports of technical success, adverse events, and long-term outcome of percutaneous cecostomy in children are limited. OBJECTIVE To characterize technical success, 30-day severe adverse events, and long-term outcome of percutaneous cecostomy at two centers. MATERIALS AND METHODS A retrospective review of hospital course and long-term follow-up (through May 2022) of percutaneous cecostomy tubes placed May 1997 to August 2011 at two children's hospitals was used. Outcomes assessed included technical success (defined as successful tube placement into the colon allowing antegrade colonic enemas), length of stay, 30-day severe adverse events, surgery consults, surgical repair, VP shunt infection, ongoing flushes, tube removal, duration between maintenance tube exchanges, and deaths. RESULTS A total of 215 procedures were performed in 208 patients (90 institution A, 125 institution B). Tubes were placed for neurogenic bowel (72.1%, n = 155) and functional constipation (27.9%, n = 60). Technical success was 98.1% (211/215) and did not differ between centers (p = 0.74). Surgical repair was required for bowel leakage in 5.1% (11/215) and VP shunt infection was managed in 2.1% (2/95). Compared to functional constipation, patients with neurogenic bowel had higher % tube remaining (65.3% [96/147] versus 25.9% [15/58], p < 0.001) and higher ongoing flushes at follow-up (42.2% [62/147] versus 12.1% [7/58], p < 0.001). Tube removal for dissatisfaction occurred in 15.6% [32/205] and did not differ between groups (p = 0.98). Eight deaths due to co-morbidity occurred after a median of 7.4 years (IQR 9.3) of tube access. CONCLUSION Percutaneous cecostomy is technically successful in the vast majority of patients and provided durable access in most. Bowel leakage and VP shunt infection are uncommon, severe adverse events.
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Affiliation(s)
- Charles A James
- Department of Radiology, Arkansas Children's Hospital, University of Arkansas for Medical Sciences, Slot 105, 1 Children's Way, Little Rock, 72202, AR, USA.
| | - Mark J Hogan
- Department of Radiology, Nationwide Children's Hospital, Ohio State University, Columbus, OH, USA
| | - Ryan P Seay
- Department of Radiology, Nationwide Children's Hospital, Ohio State University, Columbus, OH, USA
| | - Luke T James
- Department of Radiology, Arkansas Children's Hospital, University of Arkansas for Medical Sciences, Slot 105, 1 Children's Way, Little Rock, 72202, AR, USA
| | - Hanna K Jensen
- Department of Radiology, Arkansas Children's Hospital, University of Arkansas for Medical Sciences, Slot 105, 1 Children's Way, Little Rock, 72202, AR, USA
| | - Nicholas A Kaukis
- Department of Biostatistics, College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Mary B Moore
- Department of Radiology, Arkansas Children's Hospital, University of Arkansas for Medical Sciences, Slot 105, 1 Children's Way, Little Rock, 72202, AR, USA
| | - Leah E Braswell
- Department of Radiology, Nationwide Children's Hospital, Ohio State University, Columbus, OH, USA
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Mehta PM, Prajapati P, Kumar S, Jain N, Vilanilam GK, Purushothaman R, Jensen HK, Kaukis N, Ram R. Review of the demographic and educational profiles of abdominal imaging fellowship program directors in the United States. Curr Probl Diagn Radiol 2024; 53:384-388. [PMID: 38281843 DOI: 10.1067/j.cpradiol.2024.01.014] [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: 10/20/2023] [Accepted: 01/16/2024] [Indexed: 01/30/2024]
Abstract
PURPOSE To evaluate demographics, academic backgrounds, and scholarly activities of Program Directors (PDs) in Abdominal Imaging Fellowships in the United States (US), emphasizing gender representation, international origins, and academic milestones. METHODS A list of Fellowships in Abdominal Imaging programs in the US was obtained from the Society of Abdominal Radiology. The search was expanded using the Fellowship and Residency Electronic Interactive Database. Data for PDs were sourced from program websites, Healthgrades, Doximity, and Elsevier's Scopus. Metrics such as age, gender, education, academic rank, additional qualifications, prior leadership roles, publications, and h-indices were analyzed using R software. A two-tailed unpaired t-test was used to calculate the difference in means of scholarly activity between male and female PDs. RESULTS 113 programs were identified: South (36.28%), Northeast (25.66%), Mid-West (20.35%), West (17.69%). Of 107 PDs, 54% male, 41% female, and average age 48 ± 9.4 years. 66.6% were US graduates, 29.2% were international graduates. Most were Assistant Professors (36.28%). 19.46% had degrees like M.P.H. or M.B.A. 45% had prior leadership roles. Average year of residency graduation was 2007. Mean publication count was 54.16, and mean h-index was 14.663. Male PDs had higher publication counts and h-indices than female PDs (p= 0.009 and p= 0.0019 respectively). CONCLUSION In Abdominal Imaging Fellowship programs in the US, there is an increasing representation of females in Program Director roles. However, research led by female PDs remains less prevalent. The field of Abdominal Imaging values contributions from international graduates and insights from Assistant Professors.
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Affiliation(s)
- Parv M Mehta
- Department of Radiology, Mayo Clinic, 611 3rd Avenue SW, Rochester, Minnesota 55902, United States
| | - Priyanka Prajapati
- Department of Radiology, Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114, United States
| | - Shruti Kumar
- Department of Radiology, University of Arkansas for Medical Sciences, 4301 W Markham St, Slot 556, Little Rock, AR 72205, United States.
| | - Navita Jain
- Department of Medicine, Lady Hardinge Medical College, Delhi 110001, India
| | - George K Vilanilam
- Department of Radiology, University of Arkansas for Medical Sciences, 4301 W Markham St, Slot 556, Little Rock, AR 72205, United States
| | - Rangarajan Purushothaman
- Department of Radiology, University of Arkansas for Medical Sciences, 4301 W Markham St, Slot 556, Little Rock, AR 72205, United States
| | - Hanna K Jensen
- Department of Radiology, University of Arkansas for Medical Sciences, 4301 W Markham St, Slot 556, Little Rock, AR 72205, United States
| | - Nicholas Kaukis
- Department of Biostatistics, University of Arkansas for Medical Sciences, 4301 W Markham St, Little Rock, AR 72205, United States
| | - Roopa Ram
- Department of Radiology, University of Arkansas for Medical Sciences, 4301 W Markham St, Slot 556, Little Rock, AR 72205, United States
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Thind T, Heye T, Henson C, Reif R, Jensen HK, Kalkwarf KJ, Bhavaraju A, Robertson R, Jenkins A. Weight-Based Dosing for Low-Molecular-Weight Heparin (Enoxaparin) Administration to Achieve Optimal VTE Prophylaxis in Trauma Patients. Am Surg 2024:31348241241620. [PMID: 38518208 DOI: 10.1177/00031348241241620] [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] [Indexed: 03/24/2024]
Abstract
INTRODUCTION Patients admitted after traumatic injuries are at high risk for developing venous thromboembolism (VTE). Low-molecular-weight heparin (LMWH) is commonly used to prevent VTE in this patient population; however, the optimal dosing strategy has yet to be determined. To address this question, a fixed-dosing strategy of LMWH was compared to a weight-based dosing strategy of LMWH for VTE prophylaxis. METHODS A retrospective, pre-post implementation cohort study compared a fixed vs a weight-based dosing strategy of LMWH for VTE prophylaxis. Patients admitted to our level 1 trauma center were included if they had an estimated glomerular filtration rate >30 mL/min/1.73 m2, received at least 3 doses of LMWH, and had an appropriately drawn anti-Xa level on their initial dosing regimen. Patients in the pre-cohort received 30 mg LMWH subcutaneously twice daily as the initial dosing regimen. Patients in the post-cohort received .5 mg/kg (max 60 mg) LMWH subcutaneously every 12 h as the initial dosing regimen. A goal anti-Xa of .2-.4 IU/mL was targeted for prophylaxis. RESULTS There were 817 patients in the fixed-dosing group (FDG) and 874 patients in the weight-based dosing group (WBDG). In the FDG, 42.8% of the patients achieved the goal initial anti-Xa level, with 54.1% and 3.1% reaching sub- and supratherapeutic doses, respectively. In the WBDG, 66.5% of patients reached goal initial anti-Xa levels, with 23.5% and 10.1% at sub- and supratherapeutic levels. The distribution of dose ranges was significantly different between the dosing strategies (P-value <.001). There was no difference in the number of patients who received blood products (39.1% vs 41.7%. P-value = .299). CONCLUSIONS In our study, weight-based dosing of LMWH yielded a significantly higher proportion of patients who achieved goal prophylactic anti-Xa levels than fixed-dosing of LMWH. Larger-scale studies are needed to assess the risk of VTE events and bleeding with these dosing strategies.
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Affiliation(s)
- Tarendeep Thind
- College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Thomas Heye
- College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Curran Henson
- College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Rebecca Reif
- Department of Surgery, Division of Trauma and Acute Care Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA
- Department of Health Policy and Management, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Hanna K Jensen
- Department of Surgery, Division of Trauma and Acute Care Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Kyle J Kalkwarf
- Department of Surgery, Division of Trauma and Acute Care Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Avi Bhavaraju
- Department of Surgery, Division of Trauma and Acute Care Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Ronald Robertson
- Department of Surgery, Division of Trauma and Acute Care Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Allison Jenkins
- Department of Surgery, Division of Trauma and Acute Care Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA
- College of Pharmacy, University of Arkansas for Medical Sciences, Little Rock, AR, USA
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Wade DJ, Pilkington C, Henson JC, Jensen HK, Kalkwarf K, Bhavaraju A, Bruce N, Bowman S, Margolick J. Higher Doses of Calcium Associated With Survival in Trauma Patients. J Surg Res 2024:S0022-4804(24)00094-5. [PMID: 38519359 DOI: 10.1016/j.jss.2024.02.014] [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: 02/28/2023] [Revised: 01/17/2024] [Accepted: 02/16/2024] [Indexed: 03/24/2024]
Abstract
INTRODUCTION Calcium is required for coagulation, cardiac output, and peripheral vascular resistance. Between 85% and 94% of trauma patients treated with massive blood transfusion develop hypocalcemia.1 The aim of this study is to evaluate the relationship between increased intravenous calcium administration during massive transfusion and improved survival of trauma patients. METHODS We performed a retrospective analysis of trauma patients who received massive transfusion over a 2-y period. Doses of elemental calcium administered per unit of blood product transfused were calculated by calcium to blood product ratio (CBR). Chi-square test evaluated association between coagulopathy and 30-d mortality. Two-sample t-test evaluated association between CBR and coagulopathy. Bivariate regression analysis evaluated association between CBR and blood products transfused per patient. Multivariable logistic regression analysis, controlling for age, sex, coagulopathy, and Injury Severity Score evaluated the association between CBR and mortality. RESULTS The study included 77 patients. Coagulopathy was associated with increased 30-d mortality (P < 0.05). Patients who survived had higher CBR than those who died (P < 0.05). CBR was associated with a significant reduction in total blood products transfused per patient (P < 0.05). CBR was not associated with coagulopathy (P = 0.24). Multivariable logistic regression analysis demonstrated that Injury Severity Score ≥16, coagulopathy and decreased CBR were significant predictors of mortality (P < 0.05). CBR above 50 mg was a predictor of survival (P < 0.05). CONCLUSIONS Higher doses of calcium given per blood product transfused were associated with improved 30-d survival and decreased blood product transfusions.
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Affiliation(s)
- Dillon J Wade
- Division of Trauma and Acute Care Surgery, Department of Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Collin Pilkington
- Division of Trauma and Acute Care Surgery, Department of Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - J Curran Henson
- Division of Trauma and Acute Care Surgery, Department of Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Hanna K Jensen
- Division of Trauma and Acute Care Surgery, Department of Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Kyle Kalkwarf
- Division of Trauma and Acute Care Surgery, Department of Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Avi Bhavaraju
- Division of Trauma and Acute Care Surgery, Department of Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Nolan Bruce
- Division of Trauma and Acute Care Surgery, Department of Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Stephen Bowman
- Department of Health Policy and Management, Fay W. Boozman College of Public Health, Little Rock, Arkansas
| | - Joseph Margolick
- Division of Trauma and Acute Care Surgery, Department of Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas.
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Hicks ED, Heft ME, Hameed MY, Jackson KE, Kaukis N, Jensen HK, Wong K. Factors for which radiology residents choose fellowship. Curr Probl Diagn Radiol 2024:S0363-0188(24)00025-2. [PMID: 38302302 DOI: 10.1067/j.cpradiol.2024.01.025] [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: 11/13/2023] [Accepted: 01/17/2024] [Indexed: 02/03/2024]
Abstract
PURPOSE The objective of this study is to assess factors that influence radiology residents' decision to pursue fellowship. Historically a large majority of Diagnostic Radiology (DR) residents have pursued fellowship, but with changes in the job market and the Covid-19 pandemic, this study analyzes the current trends associated with radiology fellowship choice. MATERIALS AND METHODS An anonymous 28-question survey was constructed based on literature review and pilot feedback from university radiology residents. The survey was distributed through APDR and to all program coordinators to be distributed to residents. Demographic information and questions related to fellowship choice were assessed. The survey was conducted through RedCap and consisted of multiple choice and sliding scale questions. RESULTS 214 radiology residents responded, representing 4.6 % of US DR residents across 199 programs. The top fellowship choices included neuroradiology (20.5 %), musculoskeletal imaging (17.3 %), body imaging (16.8 %), and breast imaging (16.4 %). Most influential factors for fellowship selection were strong personal interest, enjoyable rotation, work hours, job security, and compensation. Least influential factors were research opportunities and specific group practice. CONCLUSION The decision to pursue fellowship remains almost unanimous among US DR residents. Strong personal interest, enjoyable rotations, and favorable work hours were rated as the most important factors in the decision to pursue fellowship. Neuroradiology, musculoskeletal, and body imaging remained the most popular specialties, with a notable increase in interest in breast radiology compared to literature. To attract prospective fellows, residency and fellowship programs should emphasize aforementioned factors and offer more early exposure to subspecialties during residency.
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Affiliation(s)
- Evan D Hicks
- College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
| | - Mallory E Heft
- Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA
| | - Muhammad Y Hameed
- College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Kyle E Jackson
- Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA
| | - Nicholas Kaukis
- Department of Biomedical Informatics, Little Rock, AR 72205, USA
| | - Hanna K Jensen
- Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA
| | - Kevin Wong
- Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA
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Vawter K, Kuhn S, Pitt H, Wells A, Jensen HK, Mavros MN. Complications and failure-to-rescue after pancreatectomy and hospital participation in the targeted American College of Surgeons National Surgical Quality Improvement Program registry. Surgery 2023; 174:1235-1240. [PMID: 37612210 PMCID: PMC10592020 DOI: 10.1016/j.surg.2023.07.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 07/16/2023] [Accepted: 07/18/2023] [Indexed: 08/25/2023]
Abstract
BACKGROUND More than 700 hospitals participate in the American College of Surgeons National Surgical Quality Improvement Program, but most pancreatectomies are performed in 165 centers participating in the pancreas procedure-targeted registry. We hypothesized that these hospitals ("targeted hospitals") might provide more specialized care than those not participating ("standard hospitals"). METHODS The 2014 to 2019 pancreas-targeted and standard American College of Surgeons National Surgical Quality Improvement Program registry were reviewed regarding patient demographics, comorbidities, and perioperative outcomes using standard univariate and multivariable logistic regression analyses. Primary outcomes included 30-day mortality and serious morbidity. RESULTS The registry included 30,357 pancreatoduodenectomies (80% in targeted hospitals) and 14,800 distal pancreatectomies (76% in targeted hospitals). Preoperative and intraoperative characteristics of patients treated at targeted versus standard hospitals were comparable. On multivariable analysis, pancreatoduodenectomies performed at targeted hospitals were associated with a 39% decrease in 30-day mortality (odds ratio, 0.61; 95% confidence interval, 0.50-0.75), 17% decrease in serious morbidity (odds ratio, 0.83; 95% confidence interval, 0.77-0.89), and 41% decrease in failure-to-rescue (odds ratio, 0.59; 95% confidence interval, 0.47-0.74). These differences did not apply to distal pancreatectomies. Participation in the targeted registry was associated with higher rates of optimal surgery for both pancreatoduodenectomy (odds ratio, 1.33; 95% confidence interval, 1.25-1.41) and distal pancreatectomy (odds ratio, 1.17; 95% confidence interval, 1.06-1.30). CONCLUSION Mortality and failure-to-rescue rates after pancreatoduodenectomy in targeted hospitals were nearly half of rates in standard American College of Surgeons National Surgical Quality Improvement Program hospitals. Further research should delineate factors underlying this effect and highlight opportunities for improvement.
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Affiliation(s)
- Kate Vawter
- Department of Surgery, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Savana Kuhn
- Department of Surgery, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Henry Pitt
- Department of Surgery, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Allison Wells
- Department of Surgery, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Hanna K Jensen
- Department of Surgery, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR; Department of Surgery, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Michail N Mavros
- Department of Surgery, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR; Department of Surgery, University of Arkansas for Medical Sciences, Little Rock, AR.
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Heye T, Thind T, Jenkins A, Reif R, Jensen HK, Sexton K, Kalkwarf K, Bhavaraju A. Weight-Based Dosing for Venous Thromboembolism Prophylaxis in Spinal Trauma Patients Appears Safe. J Surg Res 2023; 290:209-214. [PMID: 37285702 DOI: 10.1016/j.jss.2023.04.019] [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: 11/03/2022] [Revised: 04/18/2023] [Accepted: 04/30/2023] [Indexed: 06/09/2023]
Abstract
INTRODUCTION Venous thromboembolism (VTE) is a substantial cause of morbidity and mortality in trauma patients. VTE prophylaxis (VTEP) initiation is often delayed in certain patients due to the perceived risk of bleeding complications. Our VTEP guideline was changed from fixed-dosing to a weight-based dosing strategy using enoxaparin in June 2019. We investigated the rate of postoperative bleeding complications with a weight-based and a standard dosing protocol in traumatic spine injury patients requiring surgical stabilization. METHODS A retrospective pre-post cohort study using an institutional trauma database was conducted, comparing bleeding complications between fixed and weight-based VTEP protocols. Patients undergoing surgical stabilization of a spine injury were included. The preintervention cohort received fixed-dose thromboprophylaxis (30 mg twice daily or 40 mg daily); the postcohort received weight-based thromboprophylaxis (0.5 mg/kg q12 h with anti-factor Xa monitoring). All patients received VTEP 24-48 h after surgery. International Classification of Diseases codes were used to identify bleeding complications. RESULTS There were 68 patients in the pregroup and 68 in the postgroup with comparable demographics. Incidence of bleeding complications in the pre- and postgroups were 2.94% and 0% respectively. CONCLUSIONS VTEP initiated 24-48 h after surgical stabilization of a spine fracture using a weight-based dosing strategy and has a similar rate of bleeding complications as a standard dose protocol. Our study is limited by the low overall incidence of bleeding complications and small sample size. These findings could be validated by a larger multicenter trial.
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Affiliation(s)
- Thomas Heye
- University of Arkansas for Medical Sciences, College of Medicine, Little Rock, Arkansas
| | - Tarendeep Thind
- University of Arkansas for Medical Sciences, College of Medicine, Little Rock, Arkansas
| | - Allison Jenkins
- Department of Pharmacy, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Rebecca Reif
- Division of Trauma and Acute Care Surgery, Department of Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Hanna K Jensen
- Division of Trauma and Acute Care Surgery, Department of Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Kevin Sexton
- Division of Trauma and Acute Care Surgery, Department of Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas; Department of Biomedical Informatics, UAMS College of Medicine, Little Rock, Arkansas; Department of Health Policy and Management, UAMS Fay. W. Boozman College of Public Health, Little Rock, Arkansas; Division of Pharmaceutical Evaluation & Policy, Department of Pharmacy Practice, UAMS College of Pharmacy, Little Rock, Arkansas
| | - Kyle Kalkwarf
- Division of Trauma and Acute Care Surgery, Department of Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Avi Bhavaraju
- Division of Trauma and Acute Care Surgery, Department of Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas.
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Hameed MY, Al-Hindi L, Ali S, Jensen HK, Shoults CC. Broadening the Understanding of Medical Students' Discussion of Radiology Online: A Social Listening Study of Reddit. Curr Probl Diagn Radiol 2023; 52:377-382. [PMID: 37179205 DOI: 10.1067/j.cpradiol.2023.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 04/13/2023] [Indexed: 05/15/2023]
Abstract
Reddit.com contains one of the largest online social forums for medical students, the 'r/medicalschool' subreddit. The platform provides an opportunity to share news and discuss a variety of topics including specialty choice and residency applications. In this study we analyze posts on the subreddit r/medicalschool with the aim of understanding how medical students perceive radiology as a career and what factors influence their decision to pursue radiology. Reddit posts to were collected from the r/medicalschool subreddit (2009-2022) and a randomized sample of the corpus was labeled to yield 2000 posts that discussed radiology as career and 1542 posts not discussing radiology. Sentiment analysis of the labeled corpus was conducted using the SiEBRT RoBERTa transformer sentiment pipeline, a machine trained English language text analyzer. Student's t-test was used to compare sentiment of posts discussing radiology to nonradiology posts by career keywords. Posts discussing radiology as a career had an overall positive sentiment but were lower than nonradiology posts' sentiment (p<.001). Key words associated with a positive sentiment score were "procedure", "lifestyle", "income", "fit", "personality", "anatomy", "tech", "physics", "research," and "match." Negative sentiment score included key words "AI", "burnout", "culture", "job market", "midlevel", "sue", "teleradiology." "Procedures" had the most positive sentiment score, while "AI" had the most negative score. Our study highlights aspects of radiology as a career that are discussed positively and negatively on Reddit. These posts are read by medical students around the world and may influence their choice of specialty.
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Affiliation(s)
- Muhammad Y Hameed
- College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR.
| | - Layth Al-Hindi
- College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR.
| | - Sumera Ali
- Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, AR.
| | - Hanna K Jensen
- Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, AR.
| | - Catherine C Shoults
- Department of Biomedical Informatics, University of Arkansas for Medical Sciences, Little Rock, AR.
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Heft ME, Wong K, James CA, Lewis PS, Hicks ED, Jensen HK, Liu DS, Kaukis NA, Shashi KK, Ashton DJ. Establishing a pediatric interventional radiology inpatient consult service. Pediatr Radiol 2023; 53:1951-1960. [PMID: 37150788 PMCID: PMC10164614 DOI: 10.1007/s00247-023-05664-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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 03/29/2023] [Accepted: 04/04/2023] [Indexed: 05/09/2023]
Abstract
OBJECTIVE To delineate pediatric interventional radiology (IR) inpatient consult growth and resulting collections after implementation of a pediatric IR consult service. METHODS An inpatient IR consult process was created at a single academic children's hospital in October 2019. IR consult note templates were created in Epic (Epic Systems Corporation, Verona, Wisconsin) and utilized by 4 IR physicians. Automatic charge generation was linked to differing levels of evaluation and management (E&M) service relating to current procedural terminology (CPT) inpatient consult codes 99251-99255. The children's hospital informatics division identified IR consult notes entered from the implementation of the consult service: October 2019 to January 2022. The university radiology department billing office provided IR service E&M charge, payment, and relative value units (RVU) information during this study period. A chart review was performed to determine the IR procedure conversion rate. Mann-Whitney and a two-sample t-test statistical analyses compared use of the 25-modifier, monthly consult growth and monthly payment growth. P-value < 0.05 was considered statistically significant. RESULTS: Within this 27-month period, a total of 2153 inpatient IR consults were performed during 1757 Epic hospital encounters; monthly consult peak was reached 5 months into the study period. Consult level breakdown by CPT codes: 99251-8.7%, 99252-81.7%, and 99253-8.8%. 69.7% of IR consults had consult-specific billing with payments in 96.4% resulting in $143,976 new revenue. From 2020 to 2021, IR consult volume trended upward by 13.4% (P =0.069), and consult-specific payments increased by 84.1% (P<0.001). IR consult procedure conversion rate was 96.5%. CONCLUSION An inpatient pediatric IR consult service was quickly established and maintained by four physicians over a 27-month study period. Annual IR consult volume trended upward and consult-specific payments increased, resulting in previously uncaptured IR service revenue.
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Affiliation(s)
- Mallory E Heft
- College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Kevin Wong
- Department of Radiology, Arkansas Children's Hospital and University of Arkansas for Medical Sciences, Slot 105, 1 Children's Way, Little Rock, AR, 72202, USA
| | - Charles A James
- Department of Radiology, Arkansas Children's Hospital and University of Arkansas for Medical Sciences, Slot 105, 1 Children's Way, Little Rock, AR, 72202, USA.
| | - P Spencer Lewis
- Department of Radiology, Arkansas Children's Hospital and University of Arkansas for Medical Sciences, Slot 105, 1 Children's Way, Little Rock, AR, 72202, USA
| | - Evan D Hicks
- College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Hanna K Jensen
- Department of Radiology, Arkansas Children's Hospital and University of Arkansas for Medical Sciences, Slot 105, 1 Children's Way, Little Rock, AR, 72202, USA
| | - Daniel S Liu
- Department of Pediatrics and Biomedical Informatics, Arkansas Children's Hospital and University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Nicholas A Kaukis
- Department of Biostatistics, University of Arkansas for Medical Sciences, College of Public Health, Little Rock, AR, USA
| | - Kumar K Shashi
- Department of Radiology, Arkansas Children's Hospital and University of Arkansas for Medical Sciences, Slot 105, 1 Children's Way, Little Rock, AR, 72202, USA
| | - Daniel J Ashton
- Department of Radiology, Arkansas Children's Hospital and University of Arkansas for Medical Sciences, Slot 105, 1 Children's Way, Little Rock, AR, 72202, USA
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Norys JH, Sexton KW, Jensen HK, Deneke M, Priddy EE. Deep vein thrombosis causing abdominal wall varicosities. J Surg Case Rep 2023; 2023:rjad004. [PMID: 36778964 PMCID: PMC9908091 DOI: 10.1093/jscr/rjad004] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 01/02/2023] [Indexed: 02/11/2023] Open
Abstract
Deep venous thrombosis (DVT) is a common medical finding occurring in ~25% of hospitalized patients with roughly half of these patients experiencing post-thrombotic complications [Baldwin, Moore, Rudarakanchana, Gohel, Davies (Post-thrombotic syndrome: a clinical review. J Thromb Haemost 2013;11:795-805.)]. There are many associated complications of DVTs, including pulmonary embolism and lower extremity swelling; however, the occurrence of abdominal wall varicosities with DVT's is rare [Baldwin, Moore, Rudarakanchana, Gohel, Davies (Post-thrombotic syndrome: a clinical review. J Thromb Haemost 2013;11:795-805.)]. The purpose of this case study is to rare presentation of abdominal vein varicosities as manifestation of DVT.
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Affiliation(s)
- John H Norys
- College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Kevin W Sexton
- Department of Surgery, Division of Trauma and Acute Care Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Hanna K Jensen
- Department of Surgery, Division of Trauma and Acute Care Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Matthew Deneke
- Department of Internal Medicine, Division of Gastroenterology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Erin E Priddy
- Correspondence address. Department of Radiology, University of Arkansas for Medical Sciences (UAMS), 4110 Outpatient Circle, Little Rock, AR 72205, USA. Tel: +1-501-686-6124; E-mail:
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11
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Crimmins-Pierce LD, Bonvillain GP, Henry KR, Hayat MA, Villafranca AA, Stephens SE, Jensen HK, Sanford JA, Wu J, Sexton KW, Jensen MO. Critical Information from High Fidelity Arterial and Venous Pressure Waveforms During Anesthesia and Hemorrhage. Cardiovasc Eng Technol 2022; 13:886-898. [PMID: 35545752 DOI: 10.1007/s13239-022-00624-4] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 04/08/2022] [Indexed: 01/27/2023]
Abstract
PURPOSE Peripheral venous pressure (PVP) waveform analysis is a novel, minimally invasive, and inexpensive method of measuring intravascular volume changes. A porcine cohort was studied to determine how venous and arterial pressure waveforms change due to inhaled and infused anesthetics and acute hemorrhage. METHODS Venous and arterial pressure waveforms were continuously collected, while each pig was under general anesthesia, by inserting Millar catheters into a neighboring peripheral artery and vein. The anesthetic was varied from inhaled to infused, then the pig underwent a controlled hemorrhage. Pearson correlation coefficients between the power of the venous and arterial pressure waveforms at each pig's heart rate frequency were calculated for each variation in the anesthetic, as well as before and after hemorrhage. An analysis of variance (ANOVA) test was computed to determine the significance in changes of the venous pressure waveform means caused by each variation. RESULTS The Pearson correlation coefficients between venous and arterial waveforms decreased as anesthetic dosage increased. In an opposing fashion, the correlation coefficients increased as hemorrhage occurred. CONCLUSION Anesthetics and hemorrhage alter venous pressure waveforms in distinctly different ways, making it critical for researchers and clinicians to consider these confounding variables when utilizing pressure waveforms. Further work needs to be done to determine how best to integrate PVP waveforms into clinical decision-making.
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Affiliation(s)
| | - Gabriel P Bonvillain
- Department of Biomedical Engineering, University of Arkansas, Fayetteville, AR, USA
| | - Kaylee R Henry
- Department of Biomedical Engineering, University of Arkansas, Fayetteville, AR, USA
| | - Md Abul Hayat
- Department of Electrical Engineering, University of Arkansas, Fayetteville, AR, USA
| | - Adria Abella Villafranca
- Department of Biomedical Informatics, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Sam E Stephens
- Department of Biomedical Engineering, University of Arkansas, Fayetteville, AR, USA
| | - Hanna K Jensen
- Department of Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Joseph A Sanford
- Department of Anesthesiology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
- Department of Biomedical Informatics, University of Arkansas for Medical Sciences, Little Rock, AR, USA
- Institute for Digital Health and Innovation, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Jingxian Wu
- Department of Electrical Engineering, University of Arkansas, Fayetteville, AR, USA
| | - Kevin W Sexton
- Department of Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA
- Department of Biomedical Informatics, University of Arkansas for Medical Sciences, Little Rock, AR, USA
- Institute for Digital Health and Innovation, University of Arkansas for Medical Sciences, Little Rock, AR, USA
- Department of Health Policy and Management, University of Arkansas for Medical Sciences, Little Rock, AR, USA
- Department of Pharmacy Practice, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Morten O Jensen
- Department of Biomedical Engineering, University of Arkansas, Fayetteville, AR, USA.
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12
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James CA, Lewis PS, Moore MB, Wong K, Rader EK, Roberson PK, Ghaleb NA, Jensen HK, Pezeshkmehr AH, Stroud MH, Ashton DJ. Efficacy of standardizing fibrinolytic therapy for parapneumonic effusion. Pediatr Radiol 2022; 52:2413-2420. [PMID: 35451632 PMCID: PMC9023697 DOI: 10.1007/s00247-022-05365-z] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 12/15/2021] [Accepted: 03/21/2022] [Indexed: 10/25/2022]
Abstract
BACKGROUND While chest tube placement with pleural fibrinolytic medication is the established treatment of pediatric empyema, treatment failure is reported in up to 20% of these children. OBJECTIVE Standardizing fibrinolytic administration among interventional radiology (IR) physicians to improve patient outcomes in pediatric parapneumonic effusion. MATERIALS AND METHODS We introduced a hospital-wide clinical pathway for parapneumonic effusion (1-2 mg tissue plasminogen activator [tPA] twice daily based on pleural US grade); we then collected prospective data for IR treatment May 2017 through February 2020. These data included demographics, co-morbidities, pediatric intensive care unit (PICU) admission, pleural US grade, culture results, daily tPA dose average, twice-daily dose days, skipped dose days, pleural therapy days, need for chest CT/a second IR procedure/surgical drainage, and length of stay. We compared the prospective data to historical controls with IR treatment from January 2013 to April 2017. RESULTS Sixty-three children and young adults were treated after clinical pathway implementation. IR referrals increased (P = 0.02) and included higher co-morbidities (P = 0.005) and more PICU patients (P = 0.05). Mean doses per day increased from 1.5 to 1.9 (P < 0.001), twice-daily dose days increased from 38% to 79% (P < 0.001) and median pleural therapy days decreased from 3.5 days to 2.5 days (P = 0.001). No IR patients needed surgical intervention. No statistical differences were observed for gender/age/weight, US grade, need for a second IR procedure or length of stay. US grade correlated with greater positive cultures, need for chest CT/second IR procedure, and pleural therapy days. CONCLUSION Interventional radiology physician standardization improved on a clinical pathway for fibrinolysis of parapneumonic effusion. Despite higher patient complexity, pleural therapy duration decreased. There were no chest tube failures needing surgical drainage.
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Affiliation(s)
- Charles A James
- Radiology Department, Arkansas Children's Hospital and University of Arkansas for Medical Sciences, Slot 105, 1 Children's Way, Little Rock, AR, 72202, USA.
| | - P Spencer Lewis
- Radiology Department, Arkansas Children's Hospital and University of Arkansas for Medical Sciences, Slot 105, 1 Children's Way, Little Rock, AR, 72202, USA
| | - Mary B Moore
- Radiology Department, Arkansas Children's Hospital and University of Arkansas for Medical Sciences, Slot 105, 1 Children's Way, Little Rock, AR, 72202, USA
| | - Kevin Wong
- Radiology Department, Arkansas Children's Hospital and University of Arkansas for Medical Sciences, Slot 105, 1 Children's Way, Little Rock, AR, 72202, USA
| | - Emily K Rader
- Quality, Risk, and Safety Department, Arkansas Children's Hospital, Little Rock, AR, USA
| | - Paula K Roberson
- Biostatistics Department, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Nancy A Ghaleb
- Anesthesia Department, Detroit Medical Center and Wayne State University, Detroit, MI, USA
| | - Hanna K Jensen
- Radiology Department, Arkansas Children's Hospital and University of Arkansas for Medical Sciences, Slot 105, 1 Children's Way, Little Rock, AR, 72202, USA
| | - Amir H Pezeshkmehr
- Radiology Department, Texas Children's Hospital and Baylor College of Medicine, Houston, TX, USA
| | - Michael H Stroud
- Pediatrics Department, Arkansas Children's Hospital and University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Daniel J Ashton
- Radiology Department, Arkansas Children's Hospital and University of Arkansas for Medical Sciences, Slot 105, 1 Children's Way, Little Rock, AR, 72202, USA
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13
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Harris LB, Osborn TA, Bennett JL, Jensen HK, Giorgakis E, Mavros MN. Morbidity of Colectomy During Pancreatoduodenectomy: An Analysis of the Pancreas‐targeted American College of Surgeons National Surgical Quality Improvement Program Registry. J Hepato Biliary Pancreat 2022; 30:655-663. [DOI: 10.1002/jhbp.1259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 09/16/2022] [Accepted: 09/27/2022] [Indexed: 11/05/2022]
Affiliation(s)
- Larkin B. Harris
- College of Medicine, University of Arkansas for Medical Sciences Little Rock AR USA
| | - Tamara A. Osborn
- Department of Surgery University of Arkansas for Medical Sciences Little Rock AR USA
| | - Judy L. Bennett
- Department of Surgery University of Arkansas for Medical Sciences Little Rock AR USA
| | - Hanna K. Jensen
- College of Medicine, University of Arkansas for Medical Sciences Little Rock AR USA
- Department of Surgery University of Arkansas for Medical Sciences Little Rock AR USA
| | - Emmanouil Giorgakis
- College of Medicine, University of Arkansas for Medical Sciences Little Rock AR USA
- Department of Surgery University of Arkansas for Medical Sciences Little Rock AR USA
| | - Michail N. Mavros
- College of Medicine, University of Arkansas for Medical Sciences Little Rock AR USA
- Department of Surgery University of Arkansas for Medical Sciences Little Rock AR USA
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14
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Svensson A, Carlson J, Jensen HK, Dahlberg P, Bundgaard H, Christensen AH, Boonstra MJ, Svendsen JH, Cadrin Tourigny J, Te Riele ASJ, Platonov PG. Arrhythmogenic right ventricular cardiomyopathy – evolution of electrocardiographic markers during long-term follow-up prior to ascertainment of diagnosis. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Depolarization and repolarization abnormalities are part of the diagnostic Task Force Criteria of 2010 (TFC2010) for arrhythmogenic right ventricular cardiomyopathy (ARVC). These abnormalities are thought to be progressive but have also been described as dynamic and sometimes reversible. Evolution of ECG abnormalities prior to clinical ARVC diagnosis is poorly studied.
Objective
To assess the evolution of ECG depolarization and repolarization characteristics in patients with ARVC prior to diagnosis and to identify markers of disease progression at a preclinical stage.
Methods
353 patients with definite ARVC from Sweden, Denmark, the Netherlands and Canada with at least one 12-lead digital ECG (65% males, 67% probands, 56% mutation carriers, median age at diagnosis 42 [IQR 29–53] years and median age at first ECG 44 [30–55] years) were included. Digital ECGs were extracted from regional ECG archives. ECGs with left bundle branch block, ventricular pacing or recorded either prior to 15 years of age or after heart transplantation were excluded. Remaining 6,871 ECGs were digitally processed and automatically analysed using the Glasgow algorithm. Median values for overall QRS duration, terminal activation delay (TAD) in lead V1 as well as amplitudes of QRS-T-components in precordial leads per patient per year were used for analyses and graphically represented using Lowess smoothing with cubic splines (Figure 1). Blue lines indicate smoothed conditional mean with 95% confidence interval (shadow). Time “0” (red line) indicates the time when TFC2010 were fulfilled for definite diagnosis.
A database of 18,564 anonymized digital ECGs (58% males, median age at latest ECG 41 years [IQR 32–52]) who were in contact with health care during 2020–2021 was processed using the same exclusion criteria and signal-processing methodology as in the ARVC group and used as a reference (black line).
Results
TAD in lead V1 and overall QRS duration demonstrated a significant increase years before ARVC diagnosis, and significant reductions were seen in QRS-T voltages measured as R wave amplitude, QRS amplitude (the absolute sum of R wave and S wave), and T wave amplitude (Table 1 and Figure 1). The changes were seen in all precordial leads, not only the right-sided, and visually diverging from the controls.
Conclusion
Development of the ARVC ECG phenotype started several years before diagnosis and continued afterwards. QRS duration and TAD increased, QRS voltages decrease, and T wave amplitude decreased eventually leading to T wave inversion. These changes might be visually assessed but also measured with available ECG software. These findings may be clinically useful in the screening and follow-up of ARVC relatives.
Funding Acknowledgement
Type of funding sources: Public hospital(s). Main funding source(s): Governmental funding of clinical research (ALF), Region Ostergotland, Sweden.The Swedish Heart-Lung Foundation.
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Affiliation(s)
- A Svensson
- Department of Cardiology, Department of Medical, Health and Caring Sciences, Linkoping University , Linkoping , Sweden
| | - J Carlson
- Department of Cardiology, Clinical Sciences, Lund University , Lund , Sweden
| | - H K Jensen
- Aarhus University Hospital, Department of Clinical Medicine, Aarhus University Hospital , Aarhus , Denmark
| | - P Dahlberg
- Institute of Medicine - Sahlgrenska Academy - University of Gothenburg , Gothenburg , Sweden
| | - H Bundgaard
- Rigshospitalet - Copenhagen University Hospital, Department of Clinical Medicine University of Copenhagen , Copenhagen , Denmark
| | - A H Christensen
- Gentofte University Hospital, Department of Clinical Medicine University of Copenhagen , Copenhagen , Denmark
| | - M J Boonstra
- Division Heart & Lungs, Department of Cardiology, University Medical Center Utrecht, Utrecht University , Utrecht , The Netherlands
| | - J H Svendsen
- Rigshospitalet - Copenhagen University Hospital, Department of Clinical Medicine University of Copenhagen , Copenhagen , Denmark
| | - J Cadrin Tourigny
- Cardiovascular Genetics Center, Montreal Heart Center, Montreal, Quebec, Canada , Montreal , Canada
| | - A S J Te Riele
- Division Heart & Lungs, Department of Cardiology, University Medical Center Utrecht, Utrecht University , Utrecht , The Netherlands
| | - P G Platonov
- Arrhythmia Clinic, Skane University Hospital Lund and, Department of Cardiology, Clinical Sciences, Lund University , Lund , Sweden
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15
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Fletchinger T, Jensen HK, Wells A, Giorgakis E, Patel RB, Barone GW, Khan N, Burdine M, Sharma A, Bhusal S, Burdine L. Impact of Prolonged Cold Ischemia Time on One Year Kidney Transplant Outcomes. Transplant Proc 2022; 54:2170-2173. [DOI: 10.1016/j.transproceed.2022.08.019] [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] [Received: 04/17/2022] [Revised: 08/08/2022] [Accepted: 08/26/2022] [Indexed: 10/14/2022]
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Abstract
OBJECTIVE Current equestrian sport-related acute injury research is sparse. The goal of this study is to explore equestrian injury types stratified by population and equestrian discipline. DESIGN Injury reports from the US Equestrian Federation (USEF) were compiled from 2015 through 2019, and the prevalence of different injury types within the main equestrian disciplines was calculated. SETTING Retrospective cohort study from USEF accident report data. PARTICIPANTS Athletes competing at USEF sanctioned equestrian events. INDEPENDENT VARIABLES Equestrian participant's age group, sex, and equestrian event type are the independent variables. MAIN OUTCOME MEASURES Frequency of types of injuries in equestrian events stratified by equestrian discipline, age (junior vs senior), and sex. RESULTS Three thousand four hundred thirty equestrian athletes injured from 441 816 total athlete exposures during 2015 to 2019 were analyzed showing an injury rate between 0.06% and 1.18% for each discipline with an overall injury rate of 780 per 100 000 athlete exposures. Hunter-jumper and 3-day eventing had the highest injury rates. Head injuries and bone injuries were the most common types. No clinically significant differences in injury rates were observed between males and females or junior and senior equestrian athletes. CONCLUSIONS Equestrian sports have an overall injury rate of 780 per 100 000 athlete exposures in the certified competition setting. Hunter-jumper and 3-day eventing have an increased injury rate compared with nonjumping disciplines. These data should help equestrian event clinicians to anticipate the types of injuries and help outpatient clinicians make preparticipation medical eligibility and assist in counseling for equestrian sports.
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Affiliation(s)
- Carver Haines
- Department of Family Medicine, University of Arkansas for Medical Sciences, Northwest Regional Campus, Fayetteville, Arkansas
| | - Hanna K Jensen
- College of Medicine, University of Arkansas for Medical Sciences, Northwest Regional Campus, Fayetteville, Arkansas
| | - Saleema A Karim
- Department of Health Policy and Management, Fay W. Boozman College of Public Health, Little Rock, Arkansas
| | - Linda McGhee
- Department of Family Medicine, University of Arkansas for Medical Sciences, Northwest Regional Campus, Fayetteville, Arkansas
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17
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Wang HP, Reif RJ, Kalkwarf KJ, Jensen HK, Jenkins AK, Bhavaraju A. Prophylactic Antibiotics in Patients with Traumatic Pneumocephalus or Cerebrospinal Fluid Leak. Am Surg 2022:31348221117041. [PMID: 35979960 DOI: 10.1177/00031348221117041] [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] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Pneumocephalus and cerebrospinal fluid (CSF) leaks are uncommon after trauma, but they expose the sterile CSF to environmental pathogens and create theoretical risk of central nervous system infection (CNSI). Prophylactic antibiotics are commonly given to these patients, but there is a paucity of evidence to guide this practice. We aim to quantify the incidences of these entities and analyze the efficacy of prophylactic antibiotics in preventing CNSIs. METHODS A retrospective cohort study was conducted using our institutional trauma registry. All patients admitted from January 2014 to July 2020 with traumatic pneumocephalus (TP) or basilar skull fracture with CSF leak (BSF-CSF) were included. ICD-9 and ICD-10 codes were used to identify CNSIs. CNSI rates among defined prophylactic antibiotic regimens, no antibiotics, and other antibiotic regimens were evaluated. ANOVA was used to analyze differences between the groups. RESULTS 365 patients met inclusion criteria: 360 with TP; 5 with BSF-CSF. 1.1% (4/365) of patients developed CNSI, all with isolated traumatic pneumocephalus. 1.4% of patients (1/72) without antibiotics; 1.2% (3/249) receiving IV antibiotics outside of a defined regimen; and 1.1% (1/88) on a designated prophylactic regimen developed CNSIs. ANOVA indicated the incidence of CNSI was not significantly different among patients who received antibiotics or not, regardless of the regimen (p-value 0.958). CONCLUSION TP and BSF-CSF are rare diagnoses among trauma patients. The rate of CNSI is marginal and antibiotics do not appear to confer a protective advantage. A larger trial is needed to elucidate the true effect of antibiotics on preventing CNSIs in patients with these uncommon diagnoses.
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Affiliation(s)
- Hsin-Ping Wang
- Department of Surgery, Division of Trauma and Acute Care Surgery, 12215University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Rebecca J Reif
- Department of Health Policy and Management, Fay W. Boozman College of Public Health, Little Rock, AR, USA
| | - Kyle J Kalkwarf
- Department of Surgery, Division of Trauma and Acute Care Surgery, 12215University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Hanna K Jensen
- Department of Surgery, Division of Trauma and Acute Care Surgery, 12215University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Allison K Jenkins
- Department of Surgery, Division of Trauma and Acute Care Surgery, 12215University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Avi Bhavaraju
- Department of Surgery, Division of Trauma and Acute Care Surgery, 12215University of Arkansas for Medical Sciences, Little Rock, AR, USA
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18
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Wood K, Stephens SE, Xu F, Hazaa A, Meek JC, Jensen HK, Jensen MO, Wickramasinghe R. In Vitro Blood Clot Formation and Dissolution for Testing New Stroke-Treatment Devices. Biomedicines 2022; 10:biomedicines10081870. [PMID: 36009417 PMCID: PMC9405282 DOI: 10.3390/biomedicines10081870] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 07/18/2022] [Accepted: 07/23/2022] [Indexed: 12/30/2022] Open
Abstract
Strokes are among the leading causes of death worldwide. Ischemic stroke, due to plaque or other buildup blocking blood flow to the brain, is the most common type. Although ischemic stroke is treatable, current methods have severe shortcomings with high mortality rates. Clot retrieval devices, for example, can result in physically damaged vessels and death. This study aims to create blood clots that are representative of those found in vivo and demonstrate a new method of removing them. Static blood clots were formed using a 9:1 ratio of whole sheep blood and 2.45% calcium chloride solution. This mixture was heated in a water bath at 37 °C for approximately one hour until solidified. Following clot solidification, human plasmin was introduced by various methods, including soaking, injection, and membrane perfusion, and the resulting dissolution percentages were determined. Different clot types, representative of the wide range found physiologically, were also manufactured and their dissolution characteristics evaluated. A method to reproducibly create blood clots, characteristic of those found in vivo, is essential for the production of stroke retrieval devices that can efficiently and effectively remove clots from patients with low mortality rates and little/no damage to the surrounding vessels.
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Affiliation(s)
- Kayla Wood
- Department of Biomedical Engineering, University of Arkansas, Fayetteville, AR 72701, USA; (K.W.); (S.E.S.); (F.X.); (A.H.)
| | - Sam E. Stephens
- Department of Biomedical Engineering, University of Arkansas, Fayetteville, AR 72701, USA; (K.W.); (S.E.S.); (F.X.); (A.H.)
| | - Feng Xu
- Department of Biomedical Engineering, University of Arkansas, Fayetteville, AR 72701, USA; (K.W.); (S.E.S.); (F.X.); (A.H.)
| | - Alshaimaa Hazaa
- Department of Biomedical Engineering, University of Arkansas, Fayetteville, AR 72701, USA; (K.W.); (S.E.S.); (F.X.); (A.H.)
| | - James C. Meek
- Interventional Radiology Clinic, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA;
| | - Hanna K. Jensen
- Departments of Radiology and Surgery, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA;
| | - Morten O. Jensen
- Department of Biomedical Engineering, University of Arkansas, Fayetteville, AR 72701, USA; (K.W.); (S.E.S.); (F.X.); (A.H.)
- Correspondence: (M.O.J.); (R.W.); Tel.: +1-479-575-4216 (M.O.J.); +1-479-575-8475 (R.W.)
| | - Ranil Wickramasinghe
- Ralph E Martin Department of Chemical Engineering, University of Arkansas, Fayetteville, AR 72701, USA
- Correspondence: (M.O.J.); (R.W.); Tel.: +1-479-575-4216 (M.O.J.); +1-479-575-8475 (R.W.)
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19
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Goodman EM, Wells A, Jensen HK, Kalkwarf KJ. Opioid Prescribing Behaviors Among Surgical Intensive Care Unit Attending Physicians. Am Surg 2022; 88:1479-1483. [PMID: 35337200 DOI: 10.1177/00031348221082280] [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] [Indexed: 11/15/2022]
Abstract
BACKGROUND More than 5 million Americans misuse opioids. Six percent of patients who receive opioids for acute pain progress to chronic use; this increases with higher doses and longer prescriptions. Prescribing variation exists within trauma centers and after emergency surgery but has not been demonstrated among intensivists. METHODS Milligram morphine equivalents (MME) per patient-ICU-day provided by eleven surgical intensivists were analyzed. The patients were separated into 2 groups based on their percentage of time intubated in the surgical ICU. Both study groups were compared using demographics and comorbidity scores. The attendings were divided into high- and low-prescribing groups based on their MME/pt-ICU-day for intubated patients, and bivariate statistical analyses were performed. A similar analysis compared surgery vs anesthesia intensivists. RESULTS The analysis included 257 patients in the "long-vent group" (LVG) and 668 patients in the "short-vent group" (SVG). The average MME/pt-ICU-day for the LVG was 222. Despite no significant differences in age, sex, or Elixhauser Comorbidity Index, there was a 45% difference between the high- and low-prescribing physicians in the LVG (253.7 vs 175.4 MME/pt-ICU-day; P = .008). This difference was not observed for patients in the SVG (74.3 vs 93.1 MME/pt-ICU-day; P = .141) nor based on intensivist specialty (LVG: 217.9 vs 209.5 MME/pt-ICU-day; P = .8) (SVG: 79.0 vs 93.3 MME/pt-ICU-day; P = .288).
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Affiliation(s)
- Emily M Goodman
- College of Medicine, 12215University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Allison Wells
- Department of Surgery, College of Medicine, 12215University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Hanna K Jensen
- Department of Surgery, College of Medicine, 12215University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Kyle J Kalkwarf
- Department of Surgery, College of Medicine, 12215University of Arkansas for Medical Sciences, Little Rock, AR, USA
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20
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Pilkington CW, Simmons CD, Klutts G, Jensen HK, Kalkwarf KJ. Recognition of Laceration of an Aberrant Superficial Ulnar Artery With Intraoperative Allen Test and Primary Repair. Am Surg 2022; 88:1570-1572. [PMID: 35337202 DOI: 10.1177/00031348221084942] [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] [Indexed: 11/16/2022]
Abstract
There are variations in anatomy that may alter the vasculature of an individual. This case report demonstrates an abnormal branching pattern of a lacerated ulnar artery and its successful surgical repair. Without proper identification, anatomical variations can negatively impact a trauma patient.
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Affiliation(s)
- Collin W Pilkington
- College of Medicine, 12215University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Christian D Simmons
- Division of Vascular Surgery, Department of Surgery, 12215University of Arkansas for Medical Sciences, Little Rock AR, USA
| | - Garrett Klutts
- Department of Surgery, 12215University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Hanna K Jensen
- Departments of Surgery and Radiology, 12215University of Arkansas for Medical Sciences, Fayetteville, AR, USA
| | - Kyle J Kalkwarf
- Division of Trauma & Acute Care Surgery, Department of Surgery, 12215University of Arkansas for Medical Sciences, Little Rock, AR, USA
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21
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Elmer KM, Bean MJ, Uretsky BF, Stephens SE, Jensen HK, Jensen MO. Customizable Angioplasty Balloon-Forming Machine: Towards Precision Medicine in Coronary Bifurcation Lesion Interventions. J Cardiovasc Transl Res 2022; 15:1119-1128. [PMID: 35312960 DOI: 10.1007/s12265-022-10229-w] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 02/25/2022] [Indexed: 10/18/2022]
Abstract
The ability to customize the size and shape of angioplasty balloons may be useful in many clinical and research applications of coronary and endovascular intervention. Fully customizable balloons are outside the reach of most researchers due to their prohibitive cost. A small-scale balloon-forming machine was developed to produce fully customizable balloons. This study describes the creation of this customizable balloon-forming machine and identifies the key components of manufacturing a patient-specific balloon. Using a standard balloon-shaped mold created with a novel application of 3D stereolithography-printed resin, 104 PET balloon formation tests were conducted. A statistical study was conducted in which molding temperature and inflation air pressure were independent variables ranging from 100 to 130 °C and from 3.7 to 6.8 atm, respectively. The criteria for balloon-forming success were defined; pressure and temperature combined were found to have a significant impact on the success (p = 0.011), with 120 °C and 4.76 atm resulting in the highest chance for success based on a regression model.
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Affiliation(s)
- Kaitlyn M Elmer
- Department of Biomedical Engineering, University of Arkansas, Fayetteville, AR, USA
| | - Maxwell J Bean
- Department of Biomedical Engineering, University of Arkansas, Fayetteville, AR, USA
| | - Barry F Uretsky
- Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Sam E Stephens
- Department of Biomedical Engineering, University of Arkansas, Fayetteville, AR, USA
| | - Hanna K Jensen
- Departments of Surgery and Radiology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Morten O Jensen
- Department of Biomedical Engineering, University of Arkansas, Fayetteville, AR, USA.
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22
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Stephens SE, Kammien AJ, Paris JC, Applequist AP, Ingels NB, Jensen HK, Rodgers DE, Cole CR, Wenk JF, Jensen MO. In Vitro Mitral Valve Model with Unrestricted Ventricular Access: Using Vacuum to Close the Valve and Enable Static Trans-Mitral Pressure. J Cardiovasc Transl Res 2022; 15:845-854. [PMID: 34993757 PMCID: PMC9256857 DOI: 10.1007/s12265-021-10199-5] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 12/13/2021] [Indexed: 11/27/2022]
Abstract
Current in vitro models of the left heart establish the pressure difference required to close the mitral valve by sealing and pressurizing the ventricular side of the valve, limiting important access to the subvalvular apparatus. This paper describes and evaluates a system that establishes physiological pressure differences across the valve using vacuum on the atrial side. The subvalvular apparatus is open to atmospheric pressure and accessible by tools and sensors, establishing a novel technique for experimentation on atrioventricular valves. Porcine mitral valves were excised and closed by vacuum within the atrial chamber. Images were used to document and analyze closure of the leaflets. Papillary muscle force and regurgitant flow rate were measured to be 4.07 N at 120 mmHg and approximately 12.1 ml/s respectively, both of which are within clinically relevant ranges. The relative ease of these measurements demonstrates the usefulness of improved ventricular access at peak pressure/force closure.
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Affiliation(s)
- Sam E Stephens
- Department of Biomedical Engineering, University of Arkansas, Fayetteville, AR, USA
| | - Alexander J Kammien
- Department of Biomedical Engineering, University of Arkansas, Fayetteville, AR, USA
| | - Jacob C Paris
- Department of Biomedical Engineering, University of Arkansas, Fayetteville, AR, USA
| | - Alexis P Applequist
- Department of Biomedical Engineering, University of Arkansas, Fayetteville, AR, USA
| | - Neil B Ingels
- Department of Biomedical Engineering, University of Arkansas, Fayetteville, AR, USA
| | - Hanna K Jensen
- Department of Biomedical Engineering, University of Arkansas, Fayetteville, AR, USA.,Department of Surgery, University of Arkansas for Medical Sciences, Fayetteville, AR, USA
| | - Drew E Rodgers
- Department of Anesthesiology, Washington Regional Medical Center, Fayetteville, AR, USA
| | - Charles R Cole
- Department of Cardiovascular Surgery, Washington Regional Medical Center, Fayetteville, AR, USA
| | - Jonathan F Wenk
- Department of Mechanical Engineering, University of Kentucky, Lexington, KY, USA
| | - Morten O Jensen
- Department of Biomedical Engineering, University of Arkansas, Fayetteville, AR, USA.
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23
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Massanelli J, Sexton KW, Lesher CT, Jensen HK, Kimbrough MK, Privratsky A, Taylor JR, Bhavaraju A. Integration of Web Analytics Into Graduate Medical Education: Usability Study. JMIR Form Res 2021; 5:e29748. [PMID: 34898459 PMCID: PMC8713092 DOI: 10.2196/29748] [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] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 08/17/2021] [Accepted: 09/18/2021] [Indexed: 11/13/2022] Open
Abstract
Background Web analytics is the measurement, collection, analysis, and reporting of website and web application usage data. While common in the e-commerce arena, web analytics is underutilized in graduate medical education (GME). Objective The University of Arkansas for Medical Sciences Department of Surgery website was revamped with input from in-house surgeons in August 2017. This study investigated the use of web analytics to gauge the impact of our department’s website redesign project. Methods Google Analytics software was used to measure website performance before and after implementation of the new website. Eight-month matched periods were compared. Factors tracked included total users, new users, total sessions, sessions per user, pages per session, average session duration, total page views, and bounce rate (the percentage of visitors who visit a site and then leave [ie, bounce] without continuing to another page on the same site). Results Analysis using a nonpaired Student t test demonstrated a statistically significant increase for total page views (before vs after: 33,065 vs 81,852; P<.001) and decrease for bounce rate (before vs after: 50.70% vs 0.23%; P<.001). Total users, new users, total sessions, sessions per user, and pages per session showed improvement. The average session duration was unchanged. Subgroup analysis showed that after the main page, the next 3 most frequently visited pages were related to GME programs in our department. Conclusions Web analytics is a practical measure of a website’s efficacy. Our data suggest that a modern website significantly improves user engagement. An up-to-date website is essential for contemporary GME recruitment, will likely enhance engagement of residency applicants with GME programs, and warrants further investigation.
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Affiliation(s)
- Jackson Massanelli
- College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, United States
| | - Kevin W Sexton
- Division of Trauma and Acute Care Surgery, Department of Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, United States
| | - Chris T Lesher
- College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, United States
| | - Hanna K Jensen
- Division of Trauma and Acute Care Surgery, Department of Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, United States
| | - Mary K Kimbrough
- Division of Trauma and Acute Care Surgery, Department of Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, United States
| | - Anna Privratsky
- Division of Trauma and Acute Care Surgery, Department of Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, United States
| | - John R Taylor
- Division of Trauma and Acute Care Surgery, Department of Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, United States
| | - Avi Bhavaraju
- Division of Trauma and Acute Care Surgery, Department of Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, United States
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24
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Cook MD, Karim SA, Jensen HK, Bennett JL, Burdine LJ, Bhavaraju A, Sexton KW, Kalkwarf KJ. Percutaneous Cholecystostomy Tubes versus Medical Management for Acute Cholecystitis. Am Surg 2021; 88:828-833. [PMID: 34747221 DOI: 10.1177/00031348211054567] [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] [Indexed: 12/07/2022]
Abstract
BACKGROUND Cholecystitis is one of the most common infections treated surgically in the United States. Surgical risk is prohibitive in some patients, leading to alternative therapeutic strategies, including medical management (antibiotics) with or without percutaneous cholecystostomy tube (PCT) drainage. MATERIALS AND METHODS Using the Healthcare Cost and Utilization Project (HCUP) National Readmission Database (NRD), we performed a retrospective review to compare medically managed patients with or without PCT placement by evaluating 60-day readmissions rates, health care costs, and hospital length of stay (LOS). Both study groups were matched using the Elixhauser comorbidity index, age, and sex. Univariate and multivariate statistical analyses were performed using STATA. RESULTS 776,766 patients were included in the analysis. The population receiving PCT placement was on average 16 years older (69.9 vs 53.6 years; P < .01), less likely to be female (40.7% vs 59.3%; P < .01), and had almost twice as many comorbidities (3.36 vs 1.81; P < .01) compared to the population receiving medical management. After matching our data to account for these incongruities, PCT patients were still 10.4 times more likely to be readmitted, had a 11.6% increase in the cost of care, and a 37.6% increase in LOS compared to those managed medically. DISCUSSION Percutaneous cholecystostomy tube placement for cholecystitis is associated with a higher readmission rate, increased charges, and increased LOS compared to antibiotic therapy alone, even after correcting for age, sex, and comorbidities.
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Affiliation(s)
- Madeline D Cook
- College of Medicine, 12215University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Saleema A Karim
- Department of Health Administration, College of Health Professions, Virginia Commonwealth 12215University, Richmond, Virginia, USA
| | - Hanna K Jensen
- Division of Trauma and Acute Care Surgery, Department of Surgery, 12215University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Judy L Bennett
- Division of Trauma and Acute Care Surgery, Department of Surgery, 12215University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Lyle J Burdine
- Division of Trauma and Acute Care Surgery, Department of Surgery, 12215University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Avi Bhavaraju
- Division of Trauma and Acute Care Surgery, Department of Surgery, 12215University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Kevin W Sexton
- Division of Trauma and Acute Care Surgery, Department of Surgery, 12215University of Arkansas for Medical Sciences, Little Rock, AR, USA.,Department of Biomedical Informatics, 12215University of Arkansas for Medical Sciences, Little Rock, AR, USA.,Department of Health Policy and Management, Fay W. Boozman College of Public Health, 12215University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Kyle J Kalkwarf
- Division of Trauma and Acute Care Surgery, Department of Surgery, 12215University of Arkansas for Medical Sciences, Little Rock, AR, USA
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25
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Rose RH, Cherney SM, Jensen HK, Karim SA, Mears SC. Variations in Cost and Readmissions of Patients in the Bundled Payment for Care Improvement Bundle for Hip and Femur Fractures. Geriatr Orthop Surg Rehabil 2021; 12:21514593211049664. [PMID: 34671508 PMCID: PMC8521722 DOI: 10.1177/21514593211049664] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 08/26/2021] [Accepted: 09/08/2021] [Indexed: 01/08/2023] Open
Abstract
Introduction The Bundled Payment for Care Improvement (BPCI) for hip and femur fractures is an effort to increase care quality and coordination at a lower cost. The bundle includes all patients undergoing an operative fixation of a hip or femur fracture (diagnosis-related group codes 480-482). This study aims to investigate variance in the hospital cost and readmission rates for patients within the bundle. Materials and Methods The study is a retrospective analysis of patients ≥65 years old billed for a diagnosis-related groups 480-482 in 2016 in the National Readmission Database. Cost of admission and length of stay were compared between patients who were or were not readmitted. Regression analysis was used to determine the effects of the primary procedure code and anatomical location of the femur fracture on costs, length of stay, and readmission rates. Results Patients that were readmitted within 90 days of surgery had an increased cost on initial admission ($18,427 vs $16,844, P < .0001), and an increased length of stay (6.24 vs 5.42, P < .0001). When stratified by procedure, patients varied in readmission rates (20.7% vs 19.6% vs 21.8%), initial cost, and length of stay (LOS). Stratification by anatomical location also led to variation in readmission rates (20.7% vs 18.3% vs 20.6%), initial cost, and LOS. Conclusion The hip and femur fractures bundle includes a great number of procedures with variance in cost, readmission, and length of stay. This amount of variation may make standardization difficult and may put the hospital at potential financial risk.
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Affiliation(s)
- Ryan Hunter Rose
- Department of Orthopaedic Surgery, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Steven M. Cherney
- Department of Orthopaedic Surgery, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Hanna K. Jensen
- Division of Trauma and Acute Care Surgery, Department of Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Saleema A. Karim
- Department of Health Policy and Management, Fay W Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Simon C. Mears
- Department of Orthopaedic Surgery, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
- Simon C. Mears, Department of Orthopaedic Surgery, College of Medicine, University of Arkansas for Medical Sciences, 4301 West Markham, Little Rock, AR 72205, USA.
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26
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Drolshagen H, Bhavaraju A, Kalkwarf KJ, Karim SA, Reif R, Sexton KW, Jensen HK. Correction to: Surgical and non-surgical treatment of inguinal hernia during non-elective admissions in the Nationwide Readmissions Database. Hernia 2021; 26:383. [PMID: 34313856 DOI: 10.1007/s10029-021-02479-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- H Drolshagen
- College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, 72205, USA
| | - A Bhavaraju
- Department of Surgery, Division of Trauma and Acute Care Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, 72205, USA
| | - K J Kalkwarf
- Department of Surgery, Division of Trauma and Acute Care Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, 72205, USA
| | - S A Karim
- Department of Health Policy and Management, Fay W. Boozman College of Public Health, Little Rock, AR, 72205, USA
| | - R Reif
- Department of Health Policy and Management, Fay W. Boozman College of Public Health, Little Rock, AR, 72205, USA
| | - K W Sexton
- Department of Surgery, Division of Trauma and Acute Care Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, 72205, USA.,Department of Biomedical Informatics, College of Medicine, University of Arkansas, Little Rock, USA
| | - H K Jensen
- Department of Surgery, Division of Trauma and Acute Care Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, 72205, USA.
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27
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Drolshagen H, Bhavaraju A, Kalkwarf KJ, Karim SA, Reif R, Sexton KW, Jensen HK. Surgical and non-surgical treatment of inguinal hernia during non-elective admissions in the Nationwide Readmissions Database. Hernia 2021; 25:1259-1264. [PMID: 34218347 DOI: 10.1007/s10029-021-02441-5] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 06/09/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Inguinal hernia repair is one of the most common surgical operations, yet the optimal treatment strategy remains undefined. Treatment of symptomatic inguinal hernias include both surgical and non-surgical approaches. The objective of this study was to determine differences in population, readmission rates, and costs between operative and non-operative approaches for patients admitted non-electively for an inguinal hernia in a national dataset. In addition, we sought to define the baseline characteristics of the two groups and identify potential predictive factors in the non-surgically managed subgroup who were readmitted and treated operatively within 90 days of their first visit. METHODS This study was a retrospective review of data from the Nationwide Readmissions Database (NRD) from 2010 to 2014. Patients above age 18 who were admitted non-electively for a primary diagnosis of inguinal hernia were included. Patients whose length of stay was < 1% or > 95% percentile or died during the initial visit were excluded. Readmissions within 90 days of the initial visit were flagged. Patients were classified according to initial management strategy: operative versus non-operative. Demographic, clinical, and organizational characteristics were compared between the two cohorts. RESULTS 14,249 patients met inclusion criteria and were operative (n = 8996, 63.13%) and non-operative (n = 5255, 36.88%) cohorts. When comparing the two groups, readmission rate was lower (0.49% for surgical, 1.78% for non-surgical, p < 0.01), mean length of stay (LOS) longer (3.27 [SE = 0.05] days for surgical, 2.76 days [SE = 0.06] for non-surgical, p < 0.01), and mean total cost higher ($9597 for surgical, $7167 for non-surgical, p < 0.01) in surgically treated patients. The non-surgical population was on average older (63.05 years for surgical, 64.52 years for non-surgical, p < 0.01) with more chronic conditions (3.57 for surgical, 4.05 for non-surgical, p < 0.01). Of the patients initially managed non-surgically, 1.78% (n = 91) were readmitted, and of them, 62.63% (n = 57) were readmitted and managed surgically within 90 days of initial admission (i.e., crossed over from watchful waiting to surgical treatment). Average number of chronic conditions (3.79 versus 4.03, p = 0.74), average number of comorbidities (2.26 versus 2.18, p = 0.87), and average total number of ICD-9 discharge codes (7.44 versus 8.23 p = 0.54 did not differ significantly between the operative versus non-operative sample of the readmitted population. The total cost ($5562.38 versus $8737.28, p = 0.01) was greater in the operative versus non-operative sample. CONCLUSION Watchful-waiting strategy is the most common treatment approach in patients admitted non-electively for symptomatic inguinal hernia. Readmission after non-elective hospitalization for inguinal hernia is rare, but surgical intervention decreased the likelihood of readmission compared to non-operative management, while also increasing LOS and cost of care. Our data supports a patient centric approach to the management; non-surgical treatment is a viable temporary option even in symptomatic inguinal hernias, while surgical treatment may reduce the likelihood of future readmission.
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Affiliation(s)
- H Drolshagen
- College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, 72205, USA
| | - A Bhavaraju
- Department of Surgery, Division of Trauma and Acute Care Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, 72205, USA
| | - K J Kalkwarf
- Department of Surgery, Division of Trauma and Acute Care Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, 72205, USA
| | - S A Karim
- Department of Health Policy and Management, Fay W. Boozman College of Public Health, Little Rock, AR, 72205, USA
| | - R Reif
- Department of Health Policy and Management, Fay W. Boozman College of Public Health, Little Rock, AR, 72205, USA
| | - K W Sexton
- Department of Surgery, Division of Trauma and Acute Care Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, 72205, USA.,Department of Biomedical Informatics, College of Medicine, University of Arkansas, Little Rock, USA
| | - H K Jensen
- Department of Surgery, Division of Trauma and Acute Care Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, 72205, USA.
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28
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Gongola A, Bradshaw JC, Jin J, Jensen HK, Bhavaraju A, Margolick J, Sexton KW, Robertson R, Kalkwarf KJ. Retrospective study on rib fractures: smoking and alcohol matter for mortality and complications. Trauma Surg Acute Care Open 2021; 6:e000732. [PMID: 34212116 PMCID: PMC8207992 DOI: 10.1136/tsaco-2021-000732] [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] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 05/23/2021] [Indexed: 11/17/2022] Open
Abstract
Background Rib fractures and substance use are both common in trauma patients, but there is little data on how smoking and alcohol use may be associated with outcomes in these patients. We assessed the association between smoking or alcohol use disorder (AUD) and outcomes in patients with rib fractures. Methods We used institutional databases to conduct a retrospective review of patients with rib fractures at the only American College of Surgeons-verified adult level 1 trauma center in a rural state between 2015 and 2019. The key exposure variables were smoking and AUD. The key outcome variables were mortality and pulmonary complications (pneumonia, adult respiratory distress syndrome, and pneumothorax). We used multivariable regression for analysis and directed acyclic graphs to identify variables for adjustment. Results We identified 1880 eligible patients with rib fractures, including 693 (37%) who were smokers and 204 (11%) who had AUD. Compared with non-smokers, smokers were younger, more often male, and had lower mortality rates. Regression showed that smokers had a lower likelihood of mortality (OR 0.48; 95% CI 0.27 to 0.87; p=014). Likelihood of pneumonia, ARDS, and pneumothorax was not different between smokers and non-smokers. Compared with patients without AUD, patients with AUD were older, more often male, and had higher likelihood of pneumonia and lower likelihood of pneumothorax. Regression showed that patients with AUD had higher likelihood of pneumonia (OR 1.82; 95% CI 1.24 to 2.68; p=0.002) and lower likelihood of pneumothorax (OR 0.51; 95% CI 0.33 to 0.75; p=0.002). Discussion In trauma patients with rib fractures treated at a level 1 trauma center over 5 years, smoking was associated with decreased risk of mortality. These findings have implications for risk stratification and clinical decision-making for patients with rib fractures. Level of evidence III
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Affiliation(s)
| | - Jace C Bradshaw
- University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Jing Jin
- University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Hanna K Jensen
- Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Avi Bhavaraju
- Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Joseph Margolick
- Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Kevin W Sexton
- Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Ronald Robertson
- Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Kyle J Kalkwarf
- Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
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29
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Fyenbo D, Sommer A, Noergaard BL, Kronborg MB, Kristensen J, Gerdes C, Jensen HK, Jensen JM, Nielsen JC. No prognostic benefit of multimodality imaging-guided left ventricular lead placement in cardiac resynchronization therapy: Long-term follow-up of the ImagingCRT study. Europace 2021. [DOI: 10.1093/europace/euab116.439] [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
Funding Acknowledgements
Type of funding sources: Foundation. Main funding source(s): Aarhus University, the Danish Heart Foundation, Health Research Foundation of Central Denmark Region, and Gangstedfonden.
Background
Observational data indicate that left ventricular (LV) lead placement at the latest contracting region and separate from myocardial scar is associated with improved prognosis in cardiac resynchronization therapy (CRT). In a double-blinded, randomized controlled trial (ImagingCRT), we tested the strategy of multimodality imaging-guided LV lead placement towards the latest mechanically activated non-scarred myocardial segment in CRT. Patients were included between 2011 and 2014 and allocated either to (1) imaging-guided LV lead placement using cardiac computed tomography, 99mTechnetium myocardial perfusion imaging, and speckle-tracking echocardiography (imaging group, n = 89) or to (2) routine LV lead implantation in a posterolateral region with late electrical activation (control group, n = 93). The multimodality imaging-guided strategy was found to reduce proportion of non-responders to CRT after 6 months. Impact on long-term clinical outcome is unknown.
Purpose
To evaluate the long-term effect of individualized multimodality imaging-guided LV lead placement compared to a routine fluoroscopic approach on the composite endpoint of death or heart failure (HF) hospitalization after CRT.
Method
We reviewed follow-up data until November 2020 for all 182 patients included in the ImagingCRT trial for the occurrence of HF hospitalization and all-cause death. Continuous variables are presented as median (interquartile range) or mean ± standard deviation. We used Kaplan-Meier plot and Cox proportional hazard regression analysis (unadjusted) to assess the risk of HF hospitalization and all-cause death, and used log-rank test for comparison between the two groups.
Results
All patients had standard CRT indication (left bundle branch block, New York Heart Association functional class II/ III/ IV 84 [46%]/ 92 [51%]/ 6 [3%], LV ejection fraction 25 ± 6%, QRS width 166 ± 22 milliseconds). Mean age was 70 ± 9 years, and 39 (21%) were female. During a median follow-up period of 6.7 years (3.3–7.9 years), the proportion of patients meeting the composite endpoint of HF hospitalization (n = 45 [25%]) or all-cause death (n = 56 [31%]) was 60% (n = 53) in the imaging group compared with 52% (n = 48) in the control group (hazard ratio [HR] 1.22, 95% confidence interval [CI] 0.83–1.81, p = 0.31) (Figure 1).
Neither the risk of HF hospitalization (HR 1.11, 95% CI 0.62–1.99, p = 0.72) or of all-cause death differed between the two groups (HR 1.23, 95% CI 0.82–1.85, p = 0.32).
Conclusion
An individualized multimodality imaging-guided strategy targeting LV lead placement towards the latest mechanically activated non-scarred myocardial segment during CRT implantation did not reduce the composite outcome of HF hospitalization or all-cause death during long-term follow-up. Abstract Figure 1
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Affiliation(s)
- D Fyenbo
- Aarhus University Hospital, Department of Cardiology, Aarhus, Denmark
| | - A Sommer
- Aalborg University Hospital, Department of Cardiology, Aalborg, Denmark
| | - BL Noergaard
- Aarhus University Hospital, Department of Cardiology, Aarhus, Denmark
| | - MB Kronborg
- Aarhus University Hospital, Department of Cardiology, Aarhus, Denmark
| | - J Kristensen
- Aarhus University Hospital, Department of Cardiology, Aarhus, Denmark
| | - C Gerdes
- Aarhus University Hospital, Department of Cardiology, Aarhus, Denmark
| | - HK Jensen
- Aarhus University Hospital, Department of Cardiology, Aarhus, Denmark
| | - JM Jensen
- Aarhus University Hospital, Department of Cardiology, Aarhus, Denmark
| | - JC Nielsen
- Aarhus University Hospital, Department of Cardiology, Aarhus, Denmark
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30
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Al-Alawi AZ, Henry KR, Crimmins LD, Bonasso PC, Hayat MA, Dassinger MS, Burford JM, Jensen HK, Sanford J, Wu J, Sexton KW, Jensen MO. Anesthetics affect peripheral venous pressure waveforms and the cross-talk with arterial pressure. J Clin Monit Comput 2021; 36:147-159. [PMID: 33606187 PMCID: PMC8894218 DOI: 10.1007/s10877-020-00632-6] [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] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 12/09/2020] [Indexed: 11/30/2022]
Abstract
Analysis of peripheral venous pressure (PVP) waveforms is a novel method of monitoring intravascular volume. Two pediatric cohorts were studied to test the effect of anesthetic agents on the PVP waveform and cross-talk between peripheral veins and arteries: (1) dehydration setting in a pyloromyotomy using the infused anesthetic propofol and (2) hemorrhage setting during elective surgery for craniosynostosis with the inhaled anesthetic isoflurane. PVP waveforms were collected from 39 patients that received propofol and 9 that received isoflurane. A multiple analysis of variance test determined if anesthetics influence the PVP waveform. A prediction system was built using k-nearest neighbor (k-NN) to distinguish between: (1) PVP waveforms with and without propofol and (2) different minimum alveolar concentration (MAC) groups of isoflurane. 52 porcine, 5 propofol, and 7 isoflurane subjects were used to determine the cross-talk between veins and arteries at the heart and respiratory rate frequency during: (a) during and after bleeding with constant anesthesia, (b) before and after propofol, and (c) at each MAC value. PVP waveforms are influenced by anesthetics, determined by MANOVA: p value < 0.01, η2 = 0.478 for hypovolemic, and η2 = 0.388 for euvolemic conditions. The k-NN prediction models had 82% and 77% accuracy for detecting propofol and MAC, respectively. The cross-talk relationship at each stage was: (a) ρ = 0.95, (b) ρ = 0.96, and (c) could not be evaluated using this cohort. Future research should consider anesthetic agents when analyzing PVP waveforms developing future clinical monitoring technology that uses PVP.
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Affiliation(s)
- Ali Z Al-Alawi
- Department of Biomedical Engineering, University of Arkansas, Fayetteville, AR, USA
| | - Kaylee R Henry
- Department of Biomedical Engineering, University of Arkansas, Fayetteville, AR, USA
| | - Lauren D Crimmins
- Department of Biomedical Engineering, University of Arkansas, Fayetteville, AR, USA
| | - Patrick C Bonasso
- Division of Pediatric Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Md Abul Hayat
- Department of Electrical Engineering, University of Arkansas, Fayetteville, AR, USA
| | - Melvin S Dassinger
- Division of Pediatric Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Jeffrey M Burford
- Division of Pediatric Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Hanna K Jensen
- Department of Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Joseph Sanford
- Department of Anesthesiology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Jingxian Wu
- Department of Electrical Engineering, University of Arkansas, Fayetteville, AR, USA
| | - Kevin W Sexton
- Department of Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Morten O Jensen
- Department of Biomedical Engineering, University of Arkansas, Fayetteville, AR, USA.
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Brayson D, Holohan S, Bardswell SC, Arno M, Lu H, Jensen HK, Tran PK, Barallobre‐Barreiro J, Mayr M, dos Remedios CG, Tsang VT, Frigiola A, Kentish JC. Right Ventricle Has Normal Myofilament Function But Shows Perturbations in the Expression of Extracellular Matrix Genes in Patients With Tetralogy of Fallot Undergoing Pulmonary Valve Replacement. J Am Heart Assoc 2020; 9:e015342. [PMID: 32805183 PMCID: PMC7660801 DOI: 10.1161/jaha.119.015342] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Accepted: 05/28/2020] [Indexed: 02/06/2023]
Abstract
Background Patients with repair of tetralogy of Fallot (rToF) who are approaching adulthood often exhibit pulmonary valve regurgitation, leading to right ventricle (RV) dilatation and dysfunction. The regurgitation can be corrected by pulmonary valve replacement (PVR), but the optimal surgical timing remains under debate, mainly because of the poorly understood nature of RV remodeling in patients with rToF. The goal of this study was to probe for pathologic molecular, cellular, and tissue changes in the myocardium of patients with rToF at the time of PVR. Methods and Results We measured contractile function of permeabilized myocytes, collagen content of tissue samples, and the expression of mRNA and selected proteins in RV tissue samples from patients with rToF undergoing PVR for severe pulmonary valve regurgitation. The data were compared with nondiseased RV tissue from unused donor hearts. Contractile performance and passive stiffness of the myofilaments in permeabilized myocytes were similar in rToF-PVR and RV donor samples, as was collagen content and cross-linking. The patients with rToF undergoing PVR had enhanced mRNA expression of genes associated with connective tissue diseases and tissue remodeling, including the small leucine-rich proteoglycans ASPN (asporin), LUM (lumican), and OGN (osteoglycin), although their protein levels were not significantly increased. Conclusions RV myofilaments from patients with rToF undergoing PVR showed no functional impairment, but the changes in extracellular matrix gene expression may indicate the early stages of remodeling. Our study found no evidence of major damage at the cellular and tissue levels in the RV of patients with rToF who underwent PVR according to current clinical criteria.
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Affiliation(s)
- Daniel Brayson
- School of Cardiovascular Medicine and SciencesKing's College London BHF Centre for Research ExcellenceLondonUnited Kingdom
| | - So‐Jin Holohan
- School of Cardiovascular Medicine and SciencesKing's College London BHF Centre for Research ExcellenceLondonUnited Kingdom
| | - Sonya C. Bardswell
- School of Cardiovascular Medicine and SciencesKing's College London BHF Centre for Research ExcellenceLondonUnited Kingdom
| | - Matthew Arno
- Genomics CentreFaculty of Life Sciences and MedicineKing’s College LondonLondonUnited Kingdom
| | - Han Lu
- Genomics CentreFaculty of Life Sciences and MedicineKing’s College LondonLondonUnited Kingdom
| | | | | | - Javier Barallobre‐Barreiro
- School of Cardiovascular Medicine and SciencesKing's College London BHF Centre for Research ExcellenceLondonUnited Kingdom
| | - Manuel Mayr
- School of Cardiovascular Medicine and SciencesKing's College London BHF Centre for Research ExcellenceLondonUnited Kingdom
| | | | | | - Alessandra Frigiola
- Great Ormond Street HospitalLondonUnited Kingdom
- Guys and St Thomas’ NHS Foundation TrustSt Thomas’ HospitalLondonUnited Kingdom
- School of Biomedical Engineering and Imaging SciencesKings CollegeLondonUnited Kingdom
| | - Jonathan C. Kentish
- School of Cardiovascular Medicine and SciencesKing's College London BHF Centre for Research ExcellenceLondonUnited Kingdom
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Smith AR, Karim SA, Reif RR, Beck WC, Taylor JR, Davis BL, Bhavaraju AV, Jensen HK, Kimbrough MK, Sexton KW. ROTEM as a Predictor of Mortality in Patients With Severe Trauma. J Surg Res 2020; 251:107-111. [PMID: 32114212 DOI: 10.1016/j.jss.2020.01.013] [Citation(s) in RCA: 5] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 01/10/2020] [Accepted: 01/25/2020] [Indexed: 12/30/2022]
Abstract
BACKGROUND Hemorrhage, especially when complicated by coagulopathy, is the most preventable cause of death in trauma patients. We hypothesized that assessing hemostatic function using rotational thromboelastometry (ROTEM) or conventional coagulation tests can predict the risk of mortality in patients with severe trauma indicated by an injury severity score greater than 15. METHODS We retrospectively reviewed trauma patients with an injury severity score >15 who were admitted to the emergency department between November 2015 and August 2017 in a single level I trauma center. Patients with available ROTEM and conventional coagulation data (partial thromboplastin time [PTT], prothrombin time [PT], and international normalized ratio) were included in the study cohort. Logistic regression was performed to assess the relationship between coagulation status and mortality. RESULTS The study cohort included 301 patients with an average age of 47 y, and 75% of the patients were males. Mortality was 23% (n = 68). Significant predictors of mortality included abnormal APTEM (thromboelastometry (TEM) assay in which fibrinolysis is inhibited by aprotinin (AP) in the reagent) parameters, specifically a low APTEM alpha angle, a high APTEM clot formation time, and a high APTEM clotting time. In addition, an abnormal international normalized ratio significantly predicted mortality, whereas abnormal PT and PTT did not. CONCLUSIONS A low APTEM alpha angle, an elevated APTEM clot formation time, and a high APTEM clotting time significantly predicted mortality, whereas abnormal PT and PTT did not appear to be associated with increased mortality in this patient population. Viscoelastic testing such as ROTEM appears to have indications in the management and stabilization of trauma patients.
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Affiliation(s)
- Alaina R Smith
- Division of Trauma and Acute Care Surgery, Department of Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Saleema A Karim
- The Department of Health Policy and Management, Fay W. Boozman College of Public Health, Little Rock, Arkansas
| | - Rebecca R Reif
- Division of Trauma and Acute Care Surgery, Department of Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - William C Beck
- Division of Trauma and Acute Care Surgery, Department of Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - John R Taylor
- Division of Trauma and Acute Care Surgery, Department of Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Benjamin L Davis
- Division of Trauma and Acute Care Surgery, Department of Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Avi V Bhavaraju
- Division of Trauma and Acute Care Surgery, Department of Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Hanna K Jensen
- Division of Trauma and Acute Care Surgery, Department of Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Mary K Kimbrough
- Division of Trauma and Acute Care Surgery, Department of Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Kevin W Sexton
- Division of Trauma and Acute Care Surgery, Department of Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas.
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Gowen JT, Sexton KW, Thrush C, Privratsky A, Beck WC, Taylor JR, Davis B, Kimbrough MK, Jensen HK, Robertson RD, Bhavaraju A. Hemorrhage-Control Training in Medical Education. J Med Educ Curric Dev 2020; 7:2382120520973214. [PMID: 33283050 PMCID: PMC7682227 DOI: 10.1177/2382120520973214] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Accepted: 10/23/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVES To evaluate and analyze the efficacy of implementation of hemorrhage-control training into the formal medical school curriculum. We predict this training will increase the comfort and confidence levels of students with controlling major hemorrhage and they will find this a valuable skill set for medical and other healthcare professional students. METHODS After IRB and institutional approval was obtained, hemorrhage-control education was incorporated into the surgery clerkship curriculum for 96 third-year medical students at the University of Arkansas for Medical Sciences using the national Stop The Bleed program. Using a prospective study design, participants completed pre- and post-training surveys to gauge prior experiences and comfort levels with controlling hemorrhage and confidence levels with the techniques taught. Course participation was mandatory; survey completion was optional. The investigators were blinded as to the individual student's survey responses. A knowledge quiz was completed following the training. RESULTS Implementation of STB training resulted in a significant increase in comfort and confidence among students with all hemorrhage-control techniques. There was also a significant difference in students' perceptions of the importance of this training for physicians and other allied health professionals. CONCLUSION Hemorrhage-control training can be effectively incorporated into the formal medical school curriculum via a single 2-hour Stop The Bleed course, increasing students' comfort level and confidence with controlling major traumatic bleeding. Students value this training and feel it is a beneficial addition to their education. We believe this should be a standard part of undergraduate medical education.
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Affiliation(s)
- Jared T Gowen
- Jared T Gowen, Division of Trauma and Acute Care Surgery, Department of Surgery, University of Arkansas for Medical Sciences (UAMS), 4301 West Markham St., Little Rock, AR 72205, USA.
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Christiansen MK, Nissen L, Winther S, Frost L, Johansen JK, Jensen HK, Botker HE, Bottcher M, Nyegaard M. P870A genetic risk score is associated with increased coronary plaque burden but not specific plaque features: a coronary computed tomography study. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz747.0467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Genetic risk scores (GRSs) based on risk variants identified from genome-wide association studies (GWASs) predict coronary artery disease (CAD) risk. However, it is unknown whether the GRS is associated with coronary plaque burden or specific high-risk plaque features responsible for the clinical disease onset.
Purpose
To investigate if a GRS is associated with coronary plaque burden and specific plaque characteristics, in patients with suspected stable CAD referred for coronary computed tomography angiography (CTA).
Methods
We consecutively included and genotyped 1645 patients undergoing coronary CTA. Using LDPred, a previously validated GRS was calculated as the weighted sum of the number of CAD risk variants identified from the CARDIoGRAMplusC4D GWAS meta-analysis. Plaques were evaluated using an 18-segment model and characterized by stenosis severity (0%, 1–49%, 50–69%, 70–100%) and composition (calcified (>80% calcified), mixed-calcified (50–80% calcified), mixed-soft (20–50% calcified), or soft (<20% calcified)). The segment stenosis score and the coronary artery calcium score (CACS) were used as measures of plaque burden. Multivariate regression models were used to assess the effect per standard deviation (SD) of the GRS with adjustment for age, sex, hypertension, hypercholesterolemia, BMI, chest pain symptoms, and active smoking.
Results
For each SD increase in the GRS, the segment stenosis score increased with 49% (p=8.6e-27) and CACS increased with 110% (p=2.3e-24). The GRS was associated with a higher risk of plaque stenosis >50% (OR: 1.74, p=3.2e-15), calcified (OR: 1.65, p=3.0e-16), mixed-calcified (OR: 1.64, p=1.5e-8), mixed-soft (OR: 1.44, p=1.6e-6), and soft plaques (OR: 1.40, p=3.0e-6), and all coronary vessels were more often affected with plaques (all p-values <1.0e-4).
When analyzing the plaque characteristics (3007 plaques in 849 patients), the GRS was associated with stenosis severity (OR per severity category: 1.15 (p=0.005), but not with extent of calcification, proximal location, or presence in any of the major coronary vessels (all p-values >0.05).
GRS and Plaque burden
Conclusion
The GRS was strongly associated with the extent and severity of CAD at coronary CTA, but not any specific plaque characteristics per se. The results may suggest that polygenic risk based on large CAD-GWAS increases CAD risk through increased coronary plaque burden rather than specific plaque features.
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Affiliation(s)
- M K Christiansen
- Aarhus University Hospital, Department of Cardiology, Aarhus, Denmark
| | - L Nissen
- Region Hospital Herning, Department of Cardiology, Herning, Denmark
| | - S Winther
- Aarhus University Hospital, Department of Cardiology, Aarhus, Denmark
| | - L Frost
- Regional Hospital Central Jutland, Department of Cardiology, Silkeborg, Denmark
| | - J K Johansen
- Regional Hospital Central Jutland, Department of Cardiology, Silkeborg, Denmark
| | - H K Jensen
- Aarhus University Hospital, Department of Cardiology, Aarhus, Denmark
| | - H E Botker
- Aarhus University Hospital, Department of Cardiology, Aarhus, Denmark
| | - M Bottcher
- Region Hospital Herning, Department of Cardiology, Herning, Denmark
| | - M Nyegaard
- Aarhus University, Department of Biomedicine, Aarhus, Denmark
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Platonov PG, Carlson J, Castrini I, Svensson A, Christiansen MK, Gilljam T, Madsen T, Hansen J, Astrom MA, Haagua K, Jensen HK, Edvardsen T, Svendsen JH. P2247Pregnancies and childbirth in women with arrhythmogenic right ventricular cardiomyopathy are associated with low risk of ventricular arrhythmias. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Background
Arrhythmogenic right ventricular cardiomyopathy (ARVC) is associated with a risk of ventricular arrhythmias (VA) and sudden cardiac death (SCD). Even though female patients with ARVC are considered to be at lower risk of VA, the impact of pregnancy and child birth on the arrhythmic risk and development of arrhythmic substrate in the context of ARVC remains insufficiently studied.
Objective
To assess the risk of VA in relation to childbirth in women with ARVC and the impact of multiple pregnancies on progression of arrhythmic manifestations of the disease.
Methods
The study included 186 females with definite ARVC (n=107, 70 probands) or unaffected mutation-carriers (n=79) with median age at the end of follow up of 48 (IQR 34–60) years. Seventeen women had 1, 59 had 2 and 29 had ≥3 child births by the age of 40 years. VA was defined as ventricular tachycardia, appropriate ICD therapy, aborted cardiac arrest or SCD. Proportions of patients who experienced VA by the age of 40 years were compared between nulliparous women (n=81) and those with reported child births (n=105). VA-free survival after accomplished pregnancies was assessed for women ≥40 years of age (n=119). Cumulative probability of VA for each pregnancy (n=230) was assessed from conception through 2 years after child birth and compared between those that occurred before ARVC diagnosis (Pre-Ds, n=164), after it (Post-Ds, n=11) and in unaffected mutation carriers (No-Ds, n=55).
Results
The nulliparous women had lower age at ARVC diagnosis (37 vs 44, p=0.023) and more often had VA before the age of 40 (31% vs 13%, p=0.003) while the number of child births was not related to the prevalence of VA (18% among women with 1 childbirth, 12% in those with 2 and 14% in those with 3 or more, ns). Three women suffered SCD before the age of 40. VA-free survival after 40 years did not differ between nulliparous and those who gave birth (Figure A). Only four pregnancy-related events were documented (Figure B): 1 in the Post-Ds group and three in the Pre-Ds group. No pregnancy-related events were reported in the unaffected mutation carriers.
Conclusion
In this Scandinavian cohort of women with ARVC we observed no indication of an increased VA risk either associated with pregnancies or during long-term follow up after the last child birth.
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Affiliation(s)
| | - J Carlson
- Lund University, Department of Cardiology, Clinical Sciences, Lund, Sweden
| | | | | | | | - T Gilljam
- Sahlgrenska Academy, Gothenburg, Sweden
| | - T Madsen
- Aalborg University Hospital, Aalborg, Denmark
| | - J Hansen
- Gentofte University Hospital, Gentofte, Denmark
| | | | - K Haagua
- University of Oslo, Oslo, Norway
| | - H K Jensen
- Aarhus University Hospital, Aarhus, Denmark
| | | | - J H Svendsen
- Rigshospitalet - Copenhagen University Hospital, Copenhagen, Denmark
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Christiansen MK, Haugaa K, Svensson A, Gilljam T, Madsen T, Hansen J, Holst A, Bundgaard H, Edvardsen T, Svendsen JH, Platonov P, Jensen HK. P992Incidence, predictors, and success of ventricular tachycardia catheter ablation in arrhythmogenic right ventricular cardiomyopathy (ARVC): A long-term cohort study from the Nordic ARVC registry. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz747.0585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Catheter ablation may reduce ventricular tachycardia (VT) burden in arrhythmogenic right ventricular cardiomyopathy (ARVC) patients. However, little is known about factors predicting need for ablation and various outcomes have been reported.
Purpose
We sought to investigate predictors and use of VT ablation and to evaluate the post-procedural outcome in ARVC patients.
Methods
We studied 435 patients from the Nordic ARVC registry including 220 probands with definite ARVC according to the 2010 task force criteria and 215 mutation-carrying relatives identified through cascade screening. Patients were followed until first-time VT ablation, death, heart transplantation, or January 1st 2018. Additionally, patients undergoing VT ablation were further followed from the time of ablation for recurrent ventricular arrhythmias.
Results
Cumulative use of VT ablation was 4% (95% CI 3%-6%) and 11% (95% CI 8%-15%) after 1 and 10 years. All procedures were performed in probands in whom the cumulative use was 8% (95% CI 5%-12%) and 20% (95% CI 15%-26%). In adjusted analyses restricted to probands, only young age predicted need for ablation. In patients undergoing ablation, risk of recurrent arrhythmias was 59% (95% CI 44%-71%) and 74% (95% CI 59%-84%) 1 and 5 years after the procedure. Despite high recurrence rates, the burden of ventricular arrhythmias was reduced after ablation (p=0.0042). Young age, use of several antiarrhythmic drugs and inducibility to VT immediately after ablation were associated with an unfavorable outcome.
Conclusions
Twenty percent of ARVC probands developed a clinical indication for VT ablation within 10 years after diagnosis whereas mutation-carrying relatives were without such need. Although the burden of ventricular arrhythmias decreased after ablation, risk of recurrence was substantial.
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Affiliation(s)
- M K Christiansen
- Aarhus University Hospital, Department of Cardiology, Aarhus, Denmark
| | - K Haugaa
- Oslo University Hospital, Department of cardiology, Oslo, Norway
| | - A Svensson
- Linkoping University, Department of Cardiology, Linkoping, Sweden
| | - T Gilljam
- Sahlgrenska Academy, Department of Cardiology, Gothenburg, Sweden
| | - T Madsen
- Aalborg University Hospital, Department of Cardiology, Aalborg, Denmark
| | - J Hansen
- Gentofte University Hospital, Department of Cardiology, Gentofte, Denmark
| | - A Holst
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - H Bundgaard
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - T Edvardsen
- Oslo University Hospital, Department of cardiology, Oslo, Norway
| | - J H Svendsen
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - P Platonov
- Lund University, Department of Cardiology, Lund, Sweden
| | - H K Jensen
- Aarhus University Hospital, Department of Cardiology, Aarhus, Denmark
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Bonasso PC, Sexton KW, Hayat MA, Wu J, Jensen HK, Jensen MO, Burford JM, Dassinger MS. Venous Physiology Predicts Dehydration in the Pediatric Population. J Surg Res 2019; 238:232-239. [PMID: 30776742 DOI: 10.1016/j.jss.2019.01.036] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Revised: 12/01/2018] [Accepted: 01/11/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND No standard dehydration monitor exists for children. This study attempts to determine the utility of Fast Fourier Transform (FFT) of a peripheral venous pressure (PVP) waveform to predict dehydration. MATERIALS AND METHODS PVP waveforms were collected from 18 patients. Groups were defined as resuscitated (serum chloride ≥ 100 mmol/L) and hypovolemic (serum chloride < 100 mmol/L). Data were collected on emergency department admission and after a 20 cc/kg fluid bolus. The MATLAB (MathWorks) software analyzed nonoverlapping 10-s window signals; 2.4 Hz (144 bps) was the most demonstrative frequency to compare the PVP signal power (mmHg). RESULTS Admission FFTs were compared between 10 (56%) resuscitated and 8 (44%) hypovolemic patients. The PVP signal power was higher in resuscitated patients (median 0.174 mmHg, IQR: 0.079-0.374 mmHg) than in hypovolemic patients (median 0.026 mmHg, IQR: 0.001-0.057 mmHg), (P < 0.001). Fourteen patients received a bolus regardless of laboratory values: 6 (43%) resuscitated and 8 (57%) hypovolemic. In resuscitated patients, the signal power did not change significantly after the fluid bolus (median 0.142 mmHg, IQR: 0.032-0.383 mmHg) (P = 0.019), whereas significantly increased signal power (median 0.0474 mmHg, IQR: 0.019-0.110 mmHg) was observed in the hypovolemic patients after a fluid bolus at 2.4 Hz (P < 0.001). The algorithm predicted dehydration for window-level analysis (sensitivity 97.95%, specificity 93.07%). The algorithm predicted dehydration for patient-level analysis (sensitivity 100%, specificity 100%). CONCLUSIONS FFT of PVP waveforms can predict dehydration in hypertrophic pyloric stenosis. Further work is needed to determine the utility of PVP analysis to guide fluid resuscitation status in other pediatric populations.
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Affiliation(s)
- Patrick C Bonasso
- Department of Pediatric Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas.
| | - Kevin W Sexton
- Department of Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Md Abul Hayat
- Department of Electrical Engineering, University of Arkansas, Fayetteville, Arkansas
| | - Jingxian Wu
- Department of Electrical Engineering, University of Arkansas, Fayetteville, Arkansas
| | - Hanna K Jensen
- Department of Biomedical Engineering, University of Arkansas, Fayetteville, Arkansas
| | - Morten O Jensen
- Department of Biomedical Engineering, University of Arkansas, Fayetteville, Arkansas
| | - Jeffrey M Burford
- Department of Pediatric Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Melvin S Dassinger
- Department of Pediatric Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas
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Bonasso PC, Sexton KW, Hayat A, Al-Alawi A, Wu J, Jensen HK, Jensen MO, Smith SD, Burford JM, Dassinger MS. Venous Physiology Predicts Anesthetic Induced Hypotension in Infants. J Am Coll Surg 2018. [DOI: 10.1016/j.jamcollsurg.2018.08.313] [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: 10/28/2022]
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39
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Svensson A, Haugaa KH, Zareba W, Jensen HK, Bundgaard H, Gilljam T, Madsen T, Hansen J, Karlsson L, Green A, Polonsky B, Edvardsen T, Svendsen JH, Gunnarsson C, Platonov PG. P688Genetic variant score predicts cardiac events in arrhythmogenic right ventricular cardiomyopathy. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy564.p688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- A Svensson
- Department of Cardiology and Department of Medical and Health Sciences, Linkoping University, Linkoping, Sweden
| | - K H Haugaa
- Department of Cardiology, Centre for Cardiological Innovation, Institute for Surgical Research, Oslo University Hospital, Rikshospitalet, Oslo, Norway and University of Oslo, Oslo, Norway
| | - W Zareba
- University of Rochester Medical Center, Rochester, NY, Rochester, United States of America
| | - H K Jensen
- Department of Cardiology, Aarhus University Hospital, and Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - H Bundgaard
- Unit for Inherited Cardiac Diseases, the Heart Center, National University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - T Gilljam
- Department of Cardiology, Institute of Medicine at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - T Madsen
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - J Hansen
- Department of Cardiology, Herlev-Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
| | - L Karlsson
- Department of Cardiology and Department of Medical and Health Sciences, Linkoping University, Linkoping, Sweden
| | - A Green
- Department of Clinical Genetics, Department of Clinical Experimental Medicine, Linköping University, Linkoping, Sweden
| | - B Polonsky
- University of Rochester Medical Center, Rochester, NY, Rochester, United States of America
| | - T Edvardsen
- Department of Cardiology, Centre for Cardiological Innovation, Institute for Surgical Research, Oslo University Hospital, Rikshospitalet, Oslo, Norway and University of Oslo, Oslo, Norway
| | - J H Svendsen
- Department of Cardiology, the Heart Centre, Rigshospitalet, University of Copenhagen, Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - C Gunnarsson
- Department of Clinical Genetics, Department of Clinical Experimental Medicine, Linköping University, Centre for Rare Diseases in South East Region of Sweden, Linköping University, Linkoping, Sweden
| | - P G Platonov
- Department of Cardiology, Clinical Sciences, Lund University, and Arrhythmia Clinic, Skåne University Hospital, Lund, Sweden
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Giehm-Reese M, Lukac P, Kritiansen SB, Nielsen JM, Kronborg MB, Kristensen J, Gerdes C, Jensen HK, Nielsen JC. P5754Outcome after catheter ablation for left atrial flutter. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p5754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- M Giehm-Reese
- Skejby University Hospital, Department of Cardiology, Aarhus, Denmark
| | - P Lukac
- Skejby University Hospital, Department of Cardiology, Aarhus, Denmark
| | - S B Kritiansen
- Skejby University Hospital, Department of Cardiology, Aarhus, Denmark
| | - J M Nielsen
- Skejby University Hospital, Department of Cardiology, Aarhus, Denmark
| | - M B Kronborg
- Skejby University Hospital, Department of Cardiology, Aarhus, Denmark
| | - J Kristensen
- Skejby University Hospital, Department of Cardiology, Aarhus, Denmark
| | - C Gerdes
- Skejby University Hospital, Department of Cardiology, Aarhus, Denmark
| | - H K Jensen
- Skejby University Hospital, Department of Cardiology, Aarhus, Denmark
| | - J C Nielsen
- Skejby University Hospital, Department of Cardiology, Aarhus, Denmark
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Christiansen MK, Larsen SB, Nyegaard M, Neergaard-Petersen S, Wurtz M, Grove EL, Hvas AM, Jensen HK, Kristensen SD. P804The AB0 gene locus is associated with increased platelet aggregation in stable coronary artery disease patients. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy564.p804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- M K Christiansen
- Aarhus University Hospital, Department of Cardiology, Aarhus, Denmark
| | - S B Larsen
- Aarhus University Hospital, Department of Cardiology, Aarhus, Denmark
| | - M Nyegaard
- Aarhus University, Department of Biomedicine, Aarhus, Denmark
| | | | - M Wurtz
- Aarhus University Hospital, Department of Cardiology, Aarhus, Denmark
| | - E L Grove
- Aarhus University Hospital, Department of Cardiology, Aarhus, Denmark
| | - A.-M Hvas
- Aarhus University Hospital, Department of Clinical Biochemistry, Aarhus, Denmark
| | - H K Jensen
- Aarhus University Hospital, Department of Cardiology, Aarhus, Denmark
| | - S D Kristensen
- Aarhus University Hospital, Department of Cardiology, Aarhus, Denmark
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Stokke MK, Edvardsen TE, Astrom Aneq M, Jensen HK, Bundgaard H, Hansen J, Giljam T, Platonov PG, Haugaa KH. P769Electrical changes do not precede changes in cardiac morphology or function in a substantial subset of patients with arrhythmogenic cardiomyopathy. Europace 2018. [DOI: 10.1093/europace/euy015.373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- M K Stokke
- Oslo University Hospital, Rikshospitalet, Department of Cardiology and Center for Cardiological Innovation, Oslo, Norway
| | - T E Edvardsen
- Oslo University Hospital, Rikshospitalet, Department of Cardiology and Center for Cardiological Innovation, Oslo, Norway
| | - M Astrom Aneq
- Linkoping University, Dept. of Clinical physiology and Dept. of Medical and Health Sciences, Linkoping, Sweden
| | - H K Jensen
- Aarhus University Hospital, Dept. of Cardiology, Aarhus, Denmark
| | - H Bundgaard
- The National University Hospital, Rigshospitalet, Unit for Inherited Cardiac Diseases, The Heart Center, Copenhagen, Denmark
| | - J Hansen
- Gentofte Hospital - Copenhagen University Hospital, Dep. of Cardiology, Hellerup, Denmark
| | - T Giljam
- University of Gothenburg, Dept. of Cardiology, Institute of Medicine at Sahlgrenska Academy, Gothenburg, Sweden
| | - P G Platonov
- Skane University Hospital, Dept. of Cardiology, Lund University and Arrhythmia Clinic, Lund, Sweden
| | - K H Haugaa
- Oslo University Hospital, Rikshospitalet, Department of Cardiology and Center for Cardiological Innovation, Oslo, Norway
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Kronborg MB, Sommer A, Fyenbo DB, Norgaard BL, Gerdes C, Jensen JM, Jensen HK, Kristensen J, Nielsen JC. 269Left ventricular regional remodeling and lead position during CRT. Europace 2018. [DOI: 10.1093/europace/euy015.081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- M B Kronborg
- Aarhus university Hospital, Skejby, Aarhus, Denmark
| | - A Sommer
- Aarhus university Hospital, Skejby, Aarhus, Denmark
| | - D B Fyenbo
- Aarhus university Hospital, Skejby, Aarhus, Denmark
| | - B L Norgaard
- Aarhus university Hospital, Skejby, Aarhus, Denmark
| | - C Gerdes
- Aarhus university Hospital, Skejby, Aarhus, Denmark
| | - J M Jensen
- Aarhus university Hospital, Skejby, Aarhus, Denmark
| | - H K Jensen
- Aarhus university Hospital, Skejby, Aarhus, Denmark
| | - J Kristensen
- Aarhus university Hospital, Skejby, Aarhus, Denmark
| | - J C Nielsen
- Aarhus university Hospital, Skejby, Aarhus, Denmark
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Dideriksen JTR, Christiansen MK, Johansen JB, Bundgaard H, Nielsen JC, Jensen HK. 111Aetiologies of atrioventricular block in patients younger than 50 years at time of first pacemaker implantation -A nationwide Danish study. Europace 2018. [DOI: 10.1093/europace/euy015.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- J T R Dideriksen
- Aarhus University Hospital, Department of Cardiology, Aarhus, Denmark
| | - M K Christiansen
- Aarhus University Hospital, Department of Cardiology, Aarhus, Denmark
| | - J B Johansen
- Odense University Hospital, Department of Cardiology, Odense, Denmark
| | - H Bundgaard
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - J C Nielsen
- Aarhus University Hospital, Department of Cardiology, Aarhus, Denmark
| | - H K Jensen
- Aarhus University Hospital, Department of Cardiology, Aarhus, Denmark
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Condado JF, Babaliaros VC, Thourani VH, Jensen HK, Kim DW, Kaebnick BW, Block PC, Lerakis S. A complex transcatheter mitral valve replacement and repair for the treatment of refractory severe mitral regurgitation. Hellenic J Cardiol 2017; 57:348-350. [PMID: 28126445 DOI: 10.1016/j.hjc.2015.06.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Accepted: 06/18/2015] [Indexed: 11/17/2022] Open
Affiliation(s)
- Jose F Condado
- Structural Heart and Valve Center, Divisions of Cardiology, Emory University School of Medicine, Atlanta, GA, USA
| | - Vasilis C Babaliaros
- Structural Heart and Valve Center, Divisions of Cardiology, Emory University School of Medicine, Atlanta, GA, USA.
| | - Vinod H Thourani
- Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Hanna K Jensen
- Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Dennis W Kim
- Division of Pediatric Cardiology, Emory University School of Medicine, Atlanta, GA, USA
| | - Brian W Kaebnick
- Structural Heart and Valve Center, Divisions of Cardiology, Emory University School of Medicine, Atlanta, GA, USA
| | - Peter C Block
- Structural Heart and Valve Center, Divisions of Cardiology, Emory University School of Medicine, Atlanta, GA, USA
| | - Stamatios Lerakis
- Structural Heart and Valve Center, Divisions of Cardiology, Emory University School of Medicine, Atlanta, GA, USA
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Henriksen DP, Havshøj U, Pedersen PB, Laursen CB, Jensen HK, Brabrand M, Lassen AT. Hospitalized acute patients with fever and severe infection have lower mortality than patients with hypo- or normothermia: a follow-up study. QJM 2016; 109:473-479. [PMID: 26961550 DOI: 10.1093/qjmed/hcw022] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Severe infection is a frequent cause of admission to an acute medical unit (AMU). However, not all infected patients present with fever. The aim was to assess differences in 30-day mortality among patients hospitalized with community-acquired severe infection presenting with hypothermia, normothermia or fever. METHODS A retrospective single-center follow-up at an AMU from August 1, 2009 to August 31, 2011. Patients were included the first time they presented with severe infection within the study period. Temperature was categorized into hypothermia (<36.0ºC), normothermia (36.0ºC-38.0ºC) and fever (>38.0ºC). Severe infection was defined as a discharge diagnosis indicating infection combined with organ failure within the first 24 h after arrival. Multivariable Cox regression analysis was computed to assess the association between temperature and 30-day mortality. RESULTS A total of 2128 patients with severe infection were included. 3.0% (N = 64) were hypothermic, 57.1% (N = 1216) normothermic and 39.9% (N = 848) had fever at arrival. Crude 30-day mortality was 16.1% (N = 342, 95%CI 14.5-17.7%); 37.5% (N = 24, 95% CI 25.7-50.5%) for hypothermic patients, 18.3% (N = 223, 95%CI 16.2-20.6%) for normothermic patients and 11.2% (N = 95, 95%CI 9.2-13.5%) for patients with fever. Compared to normothermic patients, the adjusted hazard ratio of 30-day mortality among hypothermic patients was 1.62 (95%CI 1.06-2.49) and 0.74 (95%CI 0.58-0.94) among patients with fever. CONCLUSIONS Over half of the patients admitted to an AMU with severe infection were normothermic at arrival. Hypothermia was associated with an increased risk of short-term mortality, whereas patients with fever were associated with a lower risk compared to those with normothermia.
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Affiliation(s)
- D P Henriksen
- Department of Respiratory Medicine, Odense University Hospital, Odense C DK-5000, Denmark
| | - U Havshøj
- Department of Emergency Medicine, Odense University Hospital, Odense C DK-5000, Denmark
| | - P B Pedersen
- Department of Respiratory Medicine, Odense University Hospital, Odense C DK-5000, Denmark
| | - C B Laursen
- Department of Respiratory Medicine, Odense University Hospital, Odense C DK-5000, Denmark
| | - H K Jensen
- Department of Emergency Medicine, Odense University Hospital, Odense C DK-5000, Denmark
| | - M Brabrand
- Department of Emergency Medicine, Odense University Hospital, Odense C DK-5000, Denmark
| | - A T Lassen
- Department of Emergency Medicine, Odense University Hospital, Odense C DK-5000, Denmark
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Rasmussen TB, Hansen J, Nissen PH, Palmfeldt J, Dalager S, Jensen UB, Kim WY, Heickendorff L, Mølgaard H, Jensen HK, Sørensen KE, Baandrup UT, Bross P, Mogensen J. Protein expression studies of desmoplakin mutations in cardiomyopathy patients reveal different molecular disease mechanisms. Clin Genet 2012; 84:20-30. [PMID: 23137101 DOI: 10.1111/cge.12056] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2012] [Revised: 11/06/2012] [Accepted: 06/11/2012] [Indexed: 11/29/2022]
Abstract
Mutations in the gene for desmoplakin (DSP) may cause arrhythmogenic right ventricular cardiomyopathy (ARVC) and Carvajal syndrome (CS). Desmoplakin is part of all desmosomes, which are abundantly expressed in both myocardial and epidermal tissue and serve as intercellular mechanical junctions. This study aimed to investigate protein expression in myocardial and epidermal tissue of ARVC and CS patients carrying DSP mutations in order to elucidate potential molecular disease mechanisms. Genetic investigations identified three ARVC patients carrying different heterozygous DSP mutations in addition to a homozygous DSP mutation in a CS patient. The protein expression of DSP in mutation carriers was evaluated in biopsies from myocardial and epidermal tissue by immunohistochemistry. Keratinocyte cultures were established from skin biopsies of mutation carriers and characterized by reverse transcriptase polymerase chain reaction, western blotting, and protein mass spectrometry. The results showed that the mutation carriers had abnormal DSP expression in both myocardial and epidermal tissue. The investigations revealed that the disease mechanisms varied accordingly to the specific types of DSP mutation identified and included haploinsufficiency, dominant-negative effects, or a combination hereof. Furthermore, the results suggest that the keratinocytes cultured from patients are a valuable and easily accessible resource to elucidate the effects of desmosomal gene mutations in humans.
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Affiliation(s)
- T B Rasmussen
- Department of Cardiology; Research Unit for Molecular Medicine, Odense University Hospital, Sdr. Boulevard 29, Odense C, Denmark
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Jeppesen AN, Jensen HK, Donskov F, Marcussen N, von der Maase H. Hyponatremia as a prognostic and predictive factor in metastatic renal cell carcinoma. Br J Cancer 2010; 102:867-72. [PMID: 20145619 PMCID: PMC2833254 DOI: 10.1038/sj.bjc.6605563] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background: Low serum sodium has recently been associated with poor survival in localised renal cell carcinoma (RCC). We now show the prognostic effect of serum sodium in patients with metastatic RCC (mRCC). Methods: Cohort A comprised 120 consecutive patients with mRCC receiving subcutaneous, low-dose interleukin-2 and interferon-α. Hyponatremia was assessed in univariate and multivariate analyses. An independent cohort of another 120 patients with mRCC was used for validation (cohort B). Results: In cohort A, estimated 5-year survival was 15% and median survival was 15.1 months. Serum sodium ranged between 126 and 144 mM. Twenty-four patients (20%) had serum sodium levels below normal range (<136 mM). In multivariate analysis, significant independent risk factors for short survival were low serum sodium (P=0.014), high neutrophils (P=0.018), lactate dehydrogenase >1.5 upper normal level (P=0.002), and number of metastatic sites (+3) (P=0.003). In cohort B, serum sodium ranged between 128 and 146 mM. Seventeen patients (14%) had sodium levels below normal range. In multivariate analysis, serum sodium was validated as an independent prognostic factor (P=0.001). A significant association between lack of response and hyponatremia was observed in both cohorts (P=0.003 and P=0.02, respectively). Conclusion: Low serum sodium is a new, validated, independent prognostic, and predictive factor in patients with mRCC.
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Affiliation(s)
- A N Jeppesen
- Department of Oncology, Aarhus University Hospital, Nørrebrogade 44, Aarhus C, Denmark.
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Pontoppidan J, Nielsen JC, Poulsen SH, Jensen HK, Walfridsson H, Pedersen AK, Hansen PS. Prophylactic cavotricuspid isthmus block during atrial fibrillation ablation in patients without atrial flutter: a randomised controlled trial. Heart 2009; 95:994-9. [PMID: 19261602 DOI: 10.1136/hrt.2008.153965] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES This randomised trial evaluated if patients with atrial fibrillation (AF) and no history of atrial flutter (AFL) had any benefit of prophylactic cavotricuspid isthmus block (CTIB) in addition to circumferential pulmonary vein ablation (CPVA). METHODS 149 patients with AF (54% paroxysmal) were randomised to CPVA and CTIB (group CTIB+, n = 73) or CPVA alone (group CTIB-, n = 76). Patients were followed for 12 months with repetitive 7-day Holter monitoring after 3, 6 and 12 months. RESULTS Six patients (4%) had cardiac tamponade, and one patient had a stroke. No difference was found in the cumulative AFL-free rate between the two treatment groups (CTIB+: 88% vs CTIB-: 84%, hazard ratio (HR) 0.80, 95% CI (0.34 to 1.90), p = 0.61). There was no difference in the cumulative AF-free rate between the groups (CTIB+: 34% vs CTIB-: 32%, HR 0.93, 95% CI (0.63 to 1.38), p = 0.71). Overall, 33% of the patients were free of AF after a single procedure. Including reprocedures, a complete or partial beneficial effect was noted in 62% of the patients at 12 months. At 12-month follow-up, 24 (50%) patients with documented AF or AFL in the Holter recordings were asymptomatic. CONCLUSIONS It was not possible to demonstrate any beneficial effect of CTIB in addition to CPVA with regard to AFL or AF recurrences during follow-up. Repetitive long-term Holter monitoring demonstrated a 33% rate of freedom from AF during a 1-year follow-up. Including additional CPVA procedures, a clinical effect was noted in 62% of the patients at 12 months. Patients with AF or AFL recurrences were often asymptomatic.
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Affiliation(s)
- J Pontoppidan
- Department of Cardiology, Aarhus University Hospital Skejby, Aarhus, Denmark.
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Pontoppidan J, Nielsen JC, Poulsen SH, Mortensen PT, Pedersen AK, Jensen HK, Hansen PS. Radiofrequency ablation of atrial fibrillation: effectiveness and safety in 102 consecutive patients. Heart 2005; 91:1611-2. [PMID: 16287751 PMCID: PMC1769213 DOI: 10.1136/hrt.2004.053660] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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