1
|
Abstract
Perioperative neurocognitive disorders are common and concerning complications in older adults undergoing surgery that can manifest as acute or chronic cognitive decline. It is hypothesized that cognitive prehabilitation can prepare the brain for the stress of surgery as for any other organ system. In this mini review we discuss the rationale for using cognitive prehabilitation, some of the interventions that have been assessed, and the effects of these interventions on postoperative cognition. PATIENT SUMMARY: Training the brain before surgery can potentially reduce the risk of cognitive decline after surgery in older adults. This mini review discusses some of the trials that examined how to train the brain before surgery and the results from these trials.
Collapse
Affiliation(s)
- Adam Fink
- Department of Anesthesiology and Pain Medicine, Harborview Medical Center, University of Washington, Seattle, WA, USA
| | - Michelle Humeidan
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Itay Bentov
- Department of Anesthesiology and Pain Medicine, Harborview Medical Center, University of Washington, Seattle, WA, USA.
| |
Collapse
|
2
|
Zelber-Sagi S, O'Reilly-Shah VN, Fong C, Ivancovsky-Wajcman D, Reed MJ, Bentov I. Liver Fibrosis Marker and Postoperative Mortality in Patients Without Overt Liver Disease. Anesth Analg 2022; 135:957-966. [PMID: 35417420 DOI: 10.1213/ane.0000000000006044] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Nonalcoholic fatty liver disease (NAFLD) can progress to advanced fibrosis, which, in the nonsurgical population, is associated with poor hepatic and extrahepatic outcomes. Despite its high prevalence, NAFLD and related liver fibrosis may be overlooked during the preoperative evaluation, and the role of liver fibrosis as an independent risk factor for surgical-related mortality has yet to be tested. The aim of this study was to assess whether fibrosis-4 (FIB-4), which consists of age, aspartate aminotransferase (AST), alanine aminotransferase (ALT), and platelets, a validated marker of liver fibrosis, is associated with postoperative mortality in the general surgical population. METHODS A historical cohort of patients undergoing general anesthesia at an academic medical center between 2014 and 2018 was analyzed. Exclusion criteria included known liver disease, acute liver disease or hepatic failure, and alcohol use disorder. FIB-4 score was categorized into 3 validated predefined categories: FIB-4 ≤1.3, ruling out advanced fibrosis; >1.3 and <2.67, inconclusive; and ≥2.67, suggesting advanced fibrosis. The primary analytic method was propensity score matching (FIB-4 was dichotomized to indicate advanced fibrosis), and a secondary analysis included a multivariable logistic regression. RESULTS Of 19,861 included subjects, 1995 (10%) had advanced fibrosis per FIB-4 criteria. Mortality occurred intraoperatively in 15 patients (0.1%), during hospitalization in 272 patients (1.4%), and within 30 days of surgery in 417 patients (2.1%). FIB-4 ≥2.67 was associated with increased intraoperative mortality (odds ratio [OR], 3.63; 95% confidence interval [CI], 1.25-10.58), mortality during hospitalization (OR, 3.14; 95% CI, 2.37-4.16), and within 30 days from surgery (OR, 2.46; 95% CI, 1.95-3.10), after adjusting for other risk factors. FIB-4 was related to increased mortality in a dose-dependent manner for the 3 FIB-4 categories ≤1.3 (reference), >1.3 and <2.67, and ≥2.67, respectively; during hospitalization (OR, 1.89; 95% CI, 1.34-2.65 and OR, 4.70; 95% CI, 3.27-6.76) and within 30 days from surgery (OR, 1.77; 95% CI, 1.36-2.31 and OR, 3.55; 95% CI, 2.65-4.77). In a 1:1 propensity-matched sample (N = 1994 per group), the differences in mortality remained. Comparing the FIB-4 ≥2.67 versus the FIB-4 <2.67 groups, respectively, mortality during hospitalization was 5.1% vs 2.2% (OR, 2.70; 95% CI, 1.81-4.02), and 30-day mortality was 6.6% vs 3.4% (OR, 2.26; 95% CI, 1.62-3.14). CONCLUSIONS A simple liver fibrosis marker is strongly associated with perioperative mortality in a population without apparent liver disease, and may aid in future surgical risk stratification and preoperative optimization.
Collapse
Affiliation(s)
- Shira Zelber-Sagi
- From the School of Public Health, University of Haifa, Haifa, Israel
| | - Vikas N O'Reilly-Shah
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington
| | - Christine Fong
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington
| | | | - May J Reed
- Division of Gerontology and Geriatric Medicine, Department of Medicine, University of Washington, Seattle, Washington
| | - Itay Bentov
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington
| |
Collapse
|
3
|
Russell DW, Casey JD, Gibbs KW, Ghamande S, Dargin JM, Vonderhaar DJ, Joffe AM, Khan A, Prekker ME, Brewer JM, Dutta S, Landsperger JS, White HD, Robison SW, Wozniak JM, Stempek S, Barnes CR, Krol OF, Arroliga AC, Lat T, Gandotra S, Gulati S, Bentov I, Walters AM, Dischert KM, Nonas S, Driver BE, Wang L, Lindsell CJ, Self WH, Rice TW, Janz DR, Semler MW. Effect of Fluid Bolus Administration on Cardiovascular Collapse Among Critically Ill Patients Undergoing Tracheal Intubation: A Randomized Clinical Trial. JAMA 2022; 328:270-279. [PMID: 35707974 PMCID: PMC9204618 DOI: 10.1001/jama.2022.9792] [Citation(s) in RCA: 36] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 05/25/2022] [Indexed: 12/12/2022]
Abstract
Importance Hypotension is common during tracheal intubation of critically ill adults and increases the risk of cardiac arrest and death. Whether administering an intravenous fluid bolus to critically ill adults undergoing tracheal intubation prevents severe hypotension, cardiac arrest, or death remains uncertain. Objective To determine the effect of fluid bolus administration on the incidence of severe hypotension, cardiac arrest, and death. Design, Setting, and Participants This randomized clinical trial enrolled 1067 critically ill adults undergoing tracheal intubation with sedation and positive pressure ventilation at 11 intensive care units in the US between February 1, 2019, and May 24, 2021. The date of final follow-up was June 21, 2021. Interventions Patients were randomly assigned to receive either a 500-mL intravenous fluid bolus (n = 538) or no fluid bolus (n = 527). Main Outcomes and Measures The primary outcome was cardiovascular collapse (defined as new or increased receipt of vasopressors or a systolic blood pressure <65 mm Hg between induction of anesthesia and 2 minutes after tracheal intubation, or cardiac arrest or death between induction of anesthesia and 1 hour after tracheal intubation). The secondary outcome was the incidence of death prior to day 28, which was censored at hospital discharge. Results Among 1067 patients randomized, 1065 (99.8%) completed the trial and were included in the primary analysis (median age, 62 years [IQR, 51-70 years]; 42.1% were women). Cardiovascular collapse occurred in 113 patients (21.0%) in the fluid bolus group and in 96 patients (18.2%) in the no fluid bolus group (absolute difference, 2.8% [95% CI, -2.2% to 7.7%]; P = .25). New or increased receipt of vasopressors occurred in 20.6% of patients in the fluid bolus group compared with 17.6% of patients in the no fluid bolus group, a systolic blood pressure of less than 65 mm Hg occurred in 3.9% vs 4.2%, respectively, cardiac arrest occurred in 1.7% vs 1.5%, and death occurred in 0.7% vs 0.6%. Death prior to day 28 (censored at hospital discharge) occurred in 218 patients (40.5%) in the fluid bolus group compared with 223 patients (42.3%) in the no fluid bolus group (absolute difference, -1.8% [95% CI, -7.9% to 4.3%]; P = .55). Conclusions and Relevance Among critically ill adults undergoing tracheal intubation, administration of an intravenous fluid bolus compared with no fluid bolus did not significantly decrease the incidence of cardiovascular collapse. Trial Registration ClinicalTrials.gov Identifier: NCT03787732.
Collapse
Affiliation(s)
- Derek W. Russell
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Alabama Heersink School of Medicine, Birmingham
- Pulmonary Section, Birmingham Veteran’s Affairs Medical Center, Birmingham, Alabama
| | - Jonathan D. Casey
- Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Kevin W. Gibbs
- Section of Pulmonary, Critical Care, Allergy, and Immunologic Disease, Department of Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Shekhar Ghamande
- Division of Pulmonary Disease and Critical Care Medicine, Department of Medicine, Baylor Scott & White Medical Center, Temple, Texas
| | - James M. Dargin
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Lahey Hospital and Medical Center, Burlington, Massachusetts
| | - Derek J. Vonderhaar
- Department of Pulmonary and Critical Care Medicine, Ochsner Health System, New Orleans, Louisiana
| | - Aaron M. Joffe
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle
| | - Akram Khan
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Oregon Health and Science University School of Medicine, Portland
| | - Matthew E. Prekker
- Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, Minnesota
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Hennepin County Medical Center, Minneapolis, Minnesota
| | - Joseph M. Brewer
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of Mississippi Medical Center, Jackson
| | - Simanta Dutta
- Section of Pulmonary, Critical Care, Allergy, and Immunologic Disease, Department of Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Janna S. Landsperger
- Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Heath D. White
- Division of Pulmonary Disease and Critical Care Medicine, Department of Medicine, Baylor Scott & White Medical Center, Temple, Texas
| | - Sarah W. Robison
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Alabama Heersink School of Medicine, Birmingham
| | - Joanne M. Wozniak
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Lahey Hospital and Medical Center, Burlington, Massachusetts
| | - Susan Stempek
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Lahey Hospital and Medical Center, Burlington, Massachusetts
| | | | - Olivia F. Krol
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Oregon Health and Science University School of Medicine, Portland
| | - Alejandro C. Arroliga
- Division of Pulmonary Disease and Critical Care Medicine, Department of Medicine, Baylor Scott & White Medical Center, Temple, Texas
| | - Tasnim Lat
- Division of Pulmonary Disease and Critical Care Medicine, Department of Medicine, Baylor Scott & White Medical Center, Temple, Texas
| | - Sheetal Gandotra
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Alabama Heersink School of Medicine, Birmingham
| | - Swati Gulati
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Alabama Heersink School of Medicine, Birmingham
| | - Itay Bentov
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle
| | - Andrew M. Walters
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle
| | - Kevin M. Dischert
- Department of Pulmonary and Critical Care Medicine, Ochsner Health System, New Orleans, Louisiana
| | - Stephanie Nonas
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Oregon Health and Science University School of Medicine, Portland
| | - Brian E. Driver
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Hennepin County Medical Center, Minneapolis, Minnesota
| | - Li Wang
- Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, Tennessee
| | | | - Wesley H. Self
- Department of Emergency Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Todd W. Rice
- Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - David R. Janz
- University Medical Center New Orleans, New Orleans, Louisiana
- Section of Pulmonary/Critical Care and Allergy/Immunology, Department of Medicine, Louisiana State University School of Medicine, New Orleans
| | - Matthew W. Semler
- Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee
| |
Collapse
|
4
|
Damodarasamy M, Khaing ZZ, Hyde J, Keene CD, Bentov I, Banks WA, Reed MJ. Viable human brain microvessels for the study of aging and neurodegenerative diseases. Microvasc Res 2022; 140:104282. [PMID: 34813858 PMCID: PMC8846932 DOI: 10.1016/j.mvr.2021.104282] [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: 06/09/2021] [Revised: 11/15/2021] [Accepted: 11/16/2021] [Indexed: 01/28/2023]
Abstract
The brain microvasculature is altered in normal aging and in the presence of disease processes, such as neurodegeneration or ischemia, but there are few methods for studying living tissues. We now report that viable microvessels (MV) are readily isolated from brain tissue of subjects enrolled in studies of neurodegenerative diseases who undergo rapid autopsy (performed with <12 h postmortem interval - PMI). We find that these MV retain their morphology and cellular components and are fairly uniform in size. Sufficient MV (~3-5000) are obtained from 3 to 4 g of tissue to allow for studies of cellular composition as well as extracellular matrix (ECM). Using live/dead assays, these MV are viable for up to 5 days in tissue culture media (2D) designed to support endothelial cells and up to 11 days post-isolation in a 3-dimensional (3D) matrix (Low Growth Factor Matrigel™). Assays that measure the reducing potential of live cells \demonstrated that the majority of the MV maintain high levels of metabolic activity for a similar number of days as the live/dead assays. Functional cellular components (such as tight junctions and transporter proteins) and ECM of MV in tissue culture media, and to a lesser extent in 3D matrices, were readily visualized using immunofluorescence techniques. MV in tissue culture media are lysed and protein content analyzed, but MV in 3D matrix first require removal of the supporting matrix, which can confound the analysis of MV ECM. Finally, MV can be preserved in cryoprotective media, whereby over 50% retain their baseline viability upon thawing. In summary, we find that MV isolated from human brains undergoing rapid autopsy are viable in standard tissue culture for up to 5 days and the timeframe for experiments can be extended up to 11 days by use of a supportive 3D matrix. Viable human MV allow for temporal and spatial analysis of relevant cellular and ECM components that have implications for microvascular function in neurodegenerative diseases, vascular brain injury, and neurotrauma.
Collapse
Affiliation(s)
- Mamatha Damodarasamy
- Department of Medicine, Division of Gerontology and Geriatric Medicine, University of Washington, Seattle, WA, USA,VA Puget Sound Health Care System, Geriatric Research Education and Clinical Center, Seattle, WA, USA
| | - Zin Z Khaing
- Department of Neurosurgery, University of Washington, Seattle, WA, USA
| | - Jeffrey Hyde
- Department of Neurosurgery, University of Washington, Seattle, WA, USA
| | - C Dirk Keene
- Department of Laboratory Medicine and Pathology, Division of Neuropathology, University of Washington, Seattle, WA, USA
| | - Itay Bentov
- Department of Pain and Anesthesia, University of Washington, Seattle, WA, USA
| | - William A Banks
- Department of Medicine, Division of Gerontology and Geriatric Medicine, University of Washington, Seattle, WA, USA,VA Puget Sound Health Care System, Geriatric Research Education and Clinical Center, Seattle, WA, USA
| | - May J Reed
- Department of Medicine, Division of Gerontology and Geriatric Medicine, University of Washington, Seattle, WA, USA; VA Puget Sound Health Care System, Geriatric Research Education and Clinical Center, Seattle, WA, USA.
| |
Collapse
|
5
|
Ivancovsky-Wajcman D, Fliss-Isakov N, Webb M, Bentov I, Shibolet O, Kariv R, Zelber-Sagi S. Ultra-processed food is associated with features of metabolic syndrome and non-alcoholic fatty liver disease. Liver Int 2021; 41:2635-2645. [PMID: 34174011 DOI: 10.1111/liv.14996] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [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: 05/01/2021] [Revised: 06/15/2021] [Accepted: 06/22/2021] [Indexed: 12/30/2022]
Abstract
BACKGROUND & AIMS High consumption of ultra-processed food (UPF) is associated with mortality and chronic morbidity but has not been studied concerning to non-alcoholic fatty liver disease (NAFLD). We aimed to test the association of UPF consumption with metabolic syndrome, NAFLD and related-liver damage. METHODS A cross-sectional study among volunteers who underwent abdominal ultrasound (AUS), anthropometrics, blood pressure measurements, and fasting blood tests including FibroMax for non-invasive assessment of NASH and significant fibrosis. A food-frequency questionnaire was used to evaluate UPF consumption using the NOVA classification. RESULTS A total of 789 subjects were included in the total sample (mean age 58.83 ± 6.58 years, 52.60% men), a reliable FibroMax test was obtained from 714 subjects, 305 subjects were diagnosed with NAFLD. High consumption of UPF was associated with higher odds for metabolic syndrome (OR = 1.88, 95% CI 1.31-2.71, P = .001) and its components; hypertension, hypertriglyceridemia, and low HDL, among the entire sample (OR = 1.53, 1.07-2.19, P = .026; OR = 1.51, 1.08-2.11, P = .017; OR = 1.55, 1.05-2.29, P = .028). In addition, it was associated with higher odds for NASH and hypertension (OR = 1.89, 1.07-3.38, P = .030; OR = 2.26, 1.20-4.26, P = .012 respectively) among subjects with NAFLD. Stratification by smoking status revealed an association between high UPF consumption and significant fibrosis among ever smokers in the entire sample and among subjects with NAFLD (OR = 1.89, 95% CI 1.03-3.45, P = .039; OR = 2.85, 1.14-7.14, P = .026 respectively). CONCLUSIONS High UPF consumption is associated with metabolic syndrome in the general population, and among those with NAFLD it is associated with NASH marker. Ever-smoking may act synergistically with UPF to amplify the risk for fibrosis.
Collapse
Affiliation(s)
| | - Naomi Fliss-Isakov
- Department of Gastroenterology, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Muriel Webb
- Department of Gastroenterology, Tel Aviv Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Itay Bentov
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, USA
| | - Oren Shibolet
- Department of Gastroenterology, Tel Aviv Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Revital Kariv
- Department of Gastroenterology, Tel Aviv Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shira Zelber-Sagi
- School of Public Health, University of Haifa, Haifa, Israel.,Department of Gastroenterology, Tel Aviv Medical Center, Tel Aviv, Israel
| |
Collapse
|
6
|
Driver B, Semler MW, Self WH, Ginde AA, Gandotra S, Trent SA, Smith LM, Gaillard JP, Page DB, Whitson MR, Vonderhaar DJ, Joffe AM, West JR, Hughes C, Landsperger JS, Howell MP, Russell DW, Gulati S, Bentov I, Mitchell S, Latimer A, Doerschug K, Koppurapu V, Gibbs KW, Wang L, Lindsell CJ, Janz D, Rice TW, Prekker ME, Casey JD. BOugie or stylet in patients UnderGoing Intubation Emergently (BOUGIE): protocol and statistical analysis plan for a randomised clinical trial. BMJ Open 2021; 11:e047790. [PMID: 34035106 PMCID: PMC8154972 DOI: 10.1136/bmjopen-2020-047790] [Citation(s) in RCA: 3] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Intubation-related complications are less frequent when intubation is successful on the first attempt. The rate of first attempt success in the emergency department (ED) and intensive care unit (ICU) is typically less than 90%. The bougie, a semirigid introducer that can be placed into the trachea to facilitate a Seldinger-like technique of tracheal intubation and is typically reserved for difficult or failed intubations, might improve first attempt success. Evidence supporting its use, however, is from a single academic ED with frequent bougie use. Validation of these findings is needed before widespread implementation. METHODS AND ANALYSIS The BOugie or stylet in patients Undergoing Intubation Emergently trial is a prospective, multicentre, non-blinded randomised trial being conducted in six EDs and six ICUs in the USA. The trial plans to enrol 1106 critically ill adults undergoing orotracheal intubation. Eligible patients are randomised 1:1 for the use of a bougie or use of an endotracheal tube with stylet for the first intubation attempt. The primary outcome is successful intubation on the first attempt. The secondary outcome is severe hypoxaemia, defined as an oxygen saturation less than 80% between induction until 2 min after completion of intubation. Enrolment began on 29 April 2019 and is expected to be completed in 2021. ETHICS AND DISSEMINATION The trial protocol was approved with waiver of informed consent by the Central Institutional Review Board at Vanderbilt University Medical Center or the local institutional review board at an enrolling site. The results will be submitted for publication in a peer-reviewed journal and presented at scientific conferences. TRIAL REGISTRATION NUMBER ClinicalTrials.gov Registry (NCT03928925).
Collapse
Affiliation(s)
- Brian Driver
- Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, Minnesota, USA
| | - Matthew W Semler
- Department of Medicine, Division of Allergy, Pulmonary and Critical Care Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Wesley H Self
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Adit A Ginde
- Department of Emergency Medicine, University of Colorado Denver School of Medicine, Aurora, Colorado, USA
| | - Sheetal Gandotra
- Department of Medicine, Division of Allergy, Pulmonary and Critical Care Medicine, The University of Alabama at Birmingham, Birmingham, Alabama, USA
- Pulmonary Section, Birmingham Veteran's Affairs Medical Center, Birmingham, Alabama, USA
| | - Stacy A Trent
- Department of Emergency Medicine, University of Colorado Denver School of Medicine, Aurora, Colorado, USA
- Department of Emergency Medicine, Denver Health Medical Center, Denver, Colorado, USA
| | - Lane M Smith
- Department of Emergency Medicine, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina, USA
| | - John P Gaillard
- Department of Emergency Medicine, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina, USA
| | - David B Page
- Department of Emergency Medicine, The University of Alabama at Birmingham, Birmingham, Alabama, USA
- Department of Medicine, Division of Pulmonary, Allergy & Critical Care Medicine, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Micah R Whitson
- Department of Emergency Medicine, The University of Alabama at Birmingham, Birmingham, Alabama, USA
- Department of Medicine, Division of Pulmonary, Allergy & Critical Care Medicine, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Derek J Vonderhaar
- Department of Pulmonary/Critical Care Medicine, Ochsner Health System, New Orleans, Louisiana, USA
| | - A M Joffe
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington, USA
| | - Jason R West
- Department of Emergency Medicine, Lincoln Medical Center, Bronx, New York, USA
| | - Christopher Hughes
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Janna S Landsperger
- Department of Medicine, Division of Allergy, Pulmonary and Critical Care Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Michelle P Howell
- Department of Emergency Medicine, University of Colorado Denver School of Medicine, Aurora, Colorado, USA
| | - Derek W Russell
- Department of Medicine, Division of Allergy, Pulmonary and Critical Care Medicine, The University of Alabama at Birmingham, Birmingham, Alabama, USA
- Pulmonary Section, Birmingham Veteran's Affairs Medical Center, Birmingham, Alabama, USA
| | - Swati Gulati
- Department of Medicine, Division of Allergy, Pulmonary and Critical Care Medicine, The University of Alabama at Birmingham, Birmingham, Alabama, USA
- Pulmonary Section, Birmingham Veteran's Affairs Medical Center, Birmingham, Alabama, USA
| | - Itay Bentov
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington, USA
| | - Steven Mitchell
- Department of Emergency Medicine, University of Washington, Seattle, Washington, USA
| | - Andrew Latimer
- Department of Emergency Medicine, University of Washington, Seattle, Washington, USA
| | - Kevin Doerschug
- Department of Internal Medicine, University of Iowa Hospitals and Clinics Pathology, Iowa City, Iowa, USA
| | - Vikas Koppurapu
- Department of Internal Medicine, University of Iowa Hospitals and Clinics Pathology, Iowa City, Iowa, USA
| | - Kevin W Gibbs
- Department of Medicine, Section of Pulmonary, Critical Care, Allergy and Immunologic Disease, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Li Wang
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | | | - David Janz
- Section of Pulmonary/Critical Care Medicine & Allergy/Immunology, Louisiana State University, New Orleans, Louisiana, USA
| | - Todd W Rice
- Department of Medicine, Division of Allergy, Pulmonary and Critical Care Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Matthew E Prekker
- Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, Minnesota, USA
- Department of Medicine, Division of Pulmonary/Critical Care Medicine, Hennepin County Medical Center, Minneapolis, Minnesota, USA
| | - Jonathan D Casey
- Department of Medicine, Division of Allergy, Pulmonary and Critical Care Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| |
Collapse
|
7
|
Abstract
Malnutrition and sarcopenia that lead to functional deterioration, frailty, and increased risk for complications and mortality are common in cirrhosis. Sarcopenic obesity, which is associated with worse outcomes than either condition alone, may be overlooked. Lifestyle intervention aiming for moderate weight reduction can be offered to obese compensated cirrhotic patients, with diet consisting of reduced caloric intake, achieved by reduction of carbohydrate and fat intake, while maintaining high protein intake. Dietary and moderate exercise interventions in patients with cirrhosis are beneficial. Cirrhotic patients with malnutrition should have nutritional counseling, and all patients should be encouraged to avoid a sedentary lifestyle.
Collapse
Affiliation(s)
- Shira Zelber-Sagi
- School of Public Health, University of Haifa, 199 Aba Khoushy Ave, Haifa 3498838, Israel; Liver Unit, Department of Gastroenterology, Tel-Aviv Medical Center, 6 Weizmann Street, Tel Aviv 6423906, Israel.
| | | | - Liane Rabinowich
- Liver Unit, Department of Gastroenterology, Tel-Aviv Medical Center, 6 Weizmann Street, Tel Aviv 6423906, Israel; Sackler Faculty of Medicine, Tel Aviv University, P.O. Box 39040, Tel Aviv 6997801, Israel
| | - Itay Bentov
- Department of Anesthesiology and Pain Medicine, University of Washington, Harborview Medical Center, 325 Ninth Avenue, Seattle, WA 98104, USA
| | - Liat Deutsch
- Liver Unit, Department of Gastroenterology, Tel-Aviv Medical Center, 6 Weizmann Street, Tel Aviv 6423906, Israel; Sackler Faculty of Medicine, Tel Aviv University, P.O. Box 39040, Tel Aviv 6997801, Israel
| |
Collapse
|
8
|
Auckley ED, Bentov N, Zelber-Sagi S, Jeong L, Reed MJ, Bentov I. Frailty status as a potential factor in increased postoperative opioid use in older adults. BMC Geriatr 2021; 21:189. [PMID: 33736611 PMCID: PMC7977609 DOI: 10.1186/s12877-021-02101-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 02/22/2021] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Prescription opioids are commonly used for postoperative pain relief in older adults, but have the potential for misuse. Both opioid side effects and uncontrolled pain have detrimental impacts. Frailty syndrome (reduced reserve in response to stressors), pain, and chronic opioid consumption are all complex phenomena that impair function, nutrition, psychologic well-being, and increase mortality, but links among these conditions in the acute postoperative setting have not been described. This study seeks to understand the relationship between frailty and patterns of postoperative opioid consumption in older adults. METHODS Patients ≥ 65 years undergoing elective surgery with a planned hospital stay of at least one postoperative day were recruited for this cohort study at pre-anesthesia clinic visits. Preoperatively, frailty was assessed by Edmonton Frailty and Clinical Frailty Scales, pain was assessed by Visual Analog and Pain Catastrophizing Scales, and opioid consumption was recorded. On the day of surgery and subsequent hospitalization days, average pain ratings and total opioid consumption were recorded daily. Seven days after hospital discharge, patients were interviewed using uniform questionnaires to measure opioid prescription use and pain rating. RESULTS One hundred seventeen patients (age 73.0 (IQR 67.0, 77.0), 64 % male), were evaluated preoperatively and 90 completed one-week post discharge follow-up. Preoperatively, patients with frailty were more likely than patients without frailty to use opioids (46.2 % vs. 20.9 %, p = 0.01). Doses of opioids prescribed at hospital discharge and the prescribed morphine milligram equivalents (MME) at discharge did not differ between groups. Seven days after discharge, the cumulative MME used were similar between cohorts. However, patients with frailty used a larger fraction of opioids prescribed to them (96.7 % (31.3, 100.0) vs. 25.0 % (0.0, 83.3), p = 0.007) and were more likely (OR 3.7, 95 % CI 1.13-12.13) to use 50 % and greater of opioids prescribed to them. Patients with frailty had higher pain scores before surgery and seven days after discharge compared to patients without frailty. CONCLUSIONS Patterns of postoperative opioid use after discharge were different between patients with and without frailty. Patients with frailty tended to use almost all the opioids prescribed while patients without frailty tended to use almost none of the opioids prescribed.
Collapse
Affiliation(s)
| | - Nathalie Bentov
- Department of Family Medicine, University of Washington, Harborview Medical Center, Seattle, WA, USA
| | - Shira Zelber-Sagi
- School of Public Health, University of Haifa, 3498838, Haifa, Israel
| | - Lily Jeong
- University of Washington School of Medicine, Seattle, WA, USA
| | - May J Reed
- Division of Gerontology and Geriatric Medicine, Department of Medicine, University of Washington, WA, Seattle, USA
| | - Itay Bentov
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, USA
| |
Collapse
|
9
|
Zelber-Sagi S, Schonmann Y, Yeshua H, Bentov I. Reply to: "Assessment of hepatic fibrosis in MAFLD: a new player in the evaluation of residual cardiovascular risk?". Dig Liver Dis 2021; 53:385-386. [PMID: 33509738 DOI: 10.1016/j.dld.2021.01.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 01/15/2021] [Indexed: 12/11/2022]
Affiliation(s)
- Shira Zelber-Sagi
- School of Public Health, University of Haifa, 3498838 Haifa, Israel; Liver Unit, Department of Gastroenterology, Tel-Aviv Medical Center, 6423906 Tel-Aviv, Israel.
| | - Yochai Schonmann
- Siaal Research Center for Family Medicine and Primary Care, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel; Department of Quality Measurements and Research, Clalit Health Services, Tel Aviv, Israel
| | - Hanny Yeshua
- Clalit Health Services, Tel-Aviv District, Israel; Department of Family Medicine, Rabin Medical Center, Petah Tikva, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Itay Bentov
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, United States
| |
Collapse
|
10
|
Kaplan SJ, Zhao KL, Koren M, Bentov I, Reed MJ, Pham TN. Thresholds and Mortality Associations of Paraspinous Muscle Sarcopenia in Older Trauma Patients. JAMA Surg 2021; 155:662-664. [PMID: 32347915 DOI: 10.1001/jamasurg.2020.0435] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Stephen J Kaplan
- Division of Geriatrics and Gerontology, Department of Medicine, Harborview Medical Center, University of Washington, Seattle.,Section of General, Thoracic, and Vascular Surgery, Department of Surgery, Virginia Mason Medical Center, Seattle, Washington
| | - K Lynn Zhao
- University of Washington School of Medicine, Seattle
| | - Melanie Koren
- Division of Geriatrics and Gerontology, Department of Medicine, Harborview Medical Center, University of Washington, Seattle.,Albert Einstein College of Medicine, Bronx, New York
| | - Itay Bentov
- Department of Anesthesiology & Pain Medicine, Harborview Medical Center, University of Washington, Seattle
| | - May J Reed
- Division of Geriatrics and Gerontology, Department of Medicine, Harborview Medical Center, University of Washington, Seattle
| | - Tam N Pham
- Division of Trauma, Burn, and Critical Care Surgery, Department of Surgery, Harborview Medical Center, University of Washington, Seattle
| |
Collapse
|
11
|
Schonmann Y, Yeshua H, Bentov I, Zelber-Sagi S. Liver fibrosis marker is an independent predictor of cardiovascular morbidity and mortality in the general population. Dig Liver Dis 2021; 53:79-85. [PMID: 33144054 DOI: 10.1016/j.dld.2020.10.014] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [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: 07/30/2020] [Revised: 10/08/2020] [Accepted: 10/13/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND A growing body of evidence suggests that Non-alcoholic fatty liver disease (NAFLD) and liver fibrosis are associated with cardiovascular disease (CVD). However, the independent role of liver fibrosis markers in the prediction of CVD in the general population is seldom tested. AIMS To assess whether a marker of liver fibrosis predicts the first occurrence of a CVD event in a large sample of community-based general population. METHODS Historical cohort using data from a large health provider that operates a centralized computerized medical record. The level of liver fibrosis was measured by the fibrosis-4 (FIB-4) score, and the association with CVD was adjusted for the European Systematic Coronary Risk Evaluation calculator (SCORE). RESULTS The study included 8,511 individuals, 3,292 with inconclusive fibrosis and 195 with advanced fibrosis (FIB-4 ≥ 2.67). People with advanced fibrosis had higher risk for CVD, after adjustment for sociodemographic characteristics, the SCORE, use of statins and aspirin (HR [95%CI], 1.63 [1.29-2.06]). The association persisted in both women and men. Using age-specific cut-offs, there was a dose-response association between inconclusive and advanced fibrosis and CVD (HR [95%CI], 1.15 [1.01-1.31]) and HR [95%CI], 1.60 [1.27-2.01], respectively, P for trend<0.001). CONCLUSIONS A simple fibrosis score is independently associated with CVD, suggesting that fibrosis markers should be considered in primary-care risk assessment.
Collapse
Affiliation(s)
- Yochai Schonmann
- Siaal Research Center for Family Medicine and Primary Care, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel; Department of Quality Measurements and Research, Clalit Health Services, Tel Aviv, Israel
| | - Hanny Yeshua
- Clalit Health Services, Tel-Aviv District, Israel; Department of Family Medicine, Rabin Medical Center, Petah Tikva, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Itay Bentov
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, United States
| | - Shira Zelber-Sagi
- School of Public Health, University of Haifa, Haifa 3498838, Israel; Department of Gastroenterology, Tel-Aviv Medical Center, Tel-Aviv 6423906, Israel.
| |
Collapse
|
12
|
Russell DW, Casey JD, Gibbs KW, Dargin JM, Vonderhaar DJ, Joffe AM, Ghamande S, Khan A, Dutta S, Landsperger JS, Robison SW, Bentov I, Wozniak JM, Stempek S, White HD, Krol OF, Prekker ME, Driver BE, Brewer JM, Wang L, Lindsell CJ, Self WH, Rice TW, Semler MW, Janz D. Protocol and statistical analysis plan for the PREventing cardiovascular collaPse with Administration of fluid REsuscitation during Induction and Intubation (PREPARE II) randomised clinical trial. BMJ Open 2020; 10:e036671. [PMID: 32948554 PMCID: PMC7511643 DOI: 10.1136/bmjopen-2019-036671] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Cardiovascular collapse is a common complication during tracheal intubation of critically ill adults. Whether administration of an intravenous fluid bolus prevents cardiovascular collapse during tracheal intubation remains uncertain. A prior randomised trial found fluid bolus administration to be ineffective overall but suggested potential benefit for patients receiving positive pressure ventilation during tracheal intubation. METHODS AND ANALYSIS The PREventing cardiovascular collaPse with Administration of fluid REsuscitation during Induction and Intubation (PREPARE II) trial is a prospective, multi-centre, non-blinded randomised trial being conducted in 13 academic intensive care units in the USA. The trial will randomise 1065 critically ill adults undergoing tracheal intubation with planned use of positive pressure ventilation (non-invasive ventilation or bag-mask ventilation) between induction and laryngoscopy to receive 500 mL of intravenous crystalloid or no intravenous fluid bolus. The primary outcome is cardiovascular collapse, defined as any of: systolic blood pressure <65 mm Hg, new or increased vasopressor administration between induction and 2 min after intubation, or cardiac arrest or death between induction and 1 hour after intubation. The primary analysis will be an unadjusted, intention-to-treat comparison of the primary outcome between patients randomised to fluid bolus administration and patients randomised to no fluid bolus administration using a χ2 test. The sole secondary outcome is 28-day in-hospital mortality. Enrolment began on 1 February 2019 and is expected to conclude in June 2020. ETHICS AND DISSEMINATION The trial was approved by either the central institutional review board at Vanderbilt University Medical Center or the local institutional review board at each trial site. Results will be submitted for publication in a peer-reviewed journal and presented at scientific conferences. TRIAL REGISTRATION NUMBER NCT03787732.
Collapse
Affiliation(s)
- Derek W Russell
- Department of Medicine, Division of Pulmonary, Allergy, & Critical Care Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Veterans Integrated Service Network 7, Department of Veterans Affairs, Washington, District of Columbia, USA
| | - Jonathan D Casey
- Department of Medicine, Division of Allergy, Pulmonary and Critical Care Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Kevin W Gibbs
- Department of Medicine, Section of Pulmonary, Critical Care, Allergy and Immunologic Disease, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - James M Dargin
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Lahey Hospital and Medical Center, Burlington, Massachusetts, USA
| | - Derek J Vonderhaar
- Department of Pulmonary and Critical Care Medicine, Ochsner Health System, New Orleans, Louisiana, USA
| | - A M Joffe
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington, USA
| | - Shekhar Ghamande
- Department of Medicine, Division of Pulmonary Disease and Critical Care Medicine, Baylor Scott & White Medical Center, Temple, Texas, USA
| | - Akram Khan
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Oregon Health & Science University School of Medicine, Portland, Oregon, USA
| | - Simanta Dutta
- Department of Medicine, Section of Pulmonary, Critical Care, Allergy and Immunologic Disease, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Janna S Landsperger
- Department of Medicine, Division of Allergy, Pulmonary and Critical Care Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Sarah W Robison
- Department of Medicine, Division of Pulmonary, Allergy, & Critical Care Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Itay Bentov
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington, USA
| | - Joanne M Wozniak
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Lahey Hospital and Medical Center, Burlington, Massachusetts, USA
| | - Susan Stempek
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Lahey Hospital and Medical Center, Burlington, Massachusetts, USA
| | - Heath D White
- Department of Medicine, Division of Pulmonary Disease and Critical Care Medicine, Baylor Scott & White Medical Center, Temple, Texas, USA
| | - Olivia F Krol
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Oregon Health & Science University School of Medicine, Portland, Oregon, USA
| | - Matthew E Prekker
- Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, Minnesota, USA
- Department of Medicine, Division of Pulmonary/Critical Care Medicine, Hennepin County Medical Center, Minneapolis, Minnesota, USA
| | - Brian E Driver
- Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, Minnesota, USA
| | - Joseph M Brewer
- Department of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Li Wang
- Department of Medicine, Division of Allergy, Pulmonary and Critical Care Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Christopher John Lindsell
- Department of Medicine, Division of Allergy, Pulmonary and Critical Care Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Wesley H Self
- Department of Emergency Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Todd W Rice
- Department of Medicine, Division of Allergy, Pulmonary and Critical Care Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Matthew W Semler
- Department of Medicine, Division of Allergy, Pulmonary and Critical Care Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - David Janz
- Department of Medicine, Section of Pulmonary/Critical Care Medicine and Allergy/Immunology, Louisiana State University School of Medicine in New Orleans, New Orleans, Louisiana, USA
| |
Collapse
|
13
|
Tanabe C, Reed MJ, Pham TN, Penn K, Bentov I, Kaplan SJ. Association of Brain Atrophy and Masseter Sarcopenia With 1-Year Mortality in Older Trauma Patients. JAMA Surg 2020; 154:716-723. [PMID: 31066880 DOI: 10.1001/jamasurg.2019.0988] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Importance Older adults are disproportionately affected by trauma and accounted for 47% of trauma fatalities in 2016. In many populations and disease processes, described risk factors for poor clinical outcomes include sarcopenia and brain atrophy, but these remain to be fully characterized in older trauma patients. Sarcopenia and brain atrophy may be opportunistically evaluated via head computed tomography, which is often performed during the initial trauma evaluation. Objective To investigate the association of masseter sarcopenia and brain atrophy with 1-year mortality among trauma patients older than 65 years by using opportunistic computed tomography imaging. Design, Setting, and Participants This retrospective cohort study was conducted in a level 1 trauma center from January 1, 2011, to December 31, 2014, with a 1-year follow-up to assess mortality. Washington state residents 65 years or older who were admitted to the trauma intensive care unit with a head Abbreviated Injury Scale score of less than 3 were eligible. Patients with incomplete data and death within 1 day of admission were excluded. Data analysis was completed from June 2017 to October 2018. Exposures Masseter muscle cross-sectional area and brain atrophy index were measured using a standard clinical Picture Archiving and Communication System application to assess for sarcopenia and brain atrophy, respectively. Main Outcomes and Measures Primary outcome was 1-year mortality. Secondary outcomes were discharge disposition and 30-day mortality. Results The study cohort included 327 patients; 72 (22.0%) had sarcopenia only, 71 (21.7%) had brain atrophy only, 92 (28.1%) had both, and 92 (28.1%) had neither. The mean (SD) age was 77.8 (8.6) years, and 159 patients (48.6%) were women. After adjustment for age, comorbidity, complications, and injury characteristics, masseter sarcopenia and brain atrophy were both independently and cumulatively associated with mortality (masseter muscle cross-sectional area per SD less than the mean: hazard ratio, 2.0 [95% CI, 1.2-3.1]; P = .005; brain atrophy index per SD greater than the mean: hazard ratio, 2.0 [95% CI, 1.1-3.5]; P = .02). Conclusions and Relevance Masseter muscle sarcopenia and brain atrophy were independently and cumulatively associated with 1-year mortality in older trauma patients after adjustment for other clinical factors. These radiologic indicators are easily measured opportunistically through standard imaging software. The results can potentially guide conversations regarding prognosis and interventions with patients and their families.
Collapse
Affiliation(s)
- Christopher Tanabe
- John A. Burns School of Medicine, University of Hawai'i at Mānoa, Honolulu.,Division of Geriatrics and Gerontology, Department of Medicine, University of Washington, Harborview Medical Center, Seattle
| | - May J Reed
- Division of Geriatrics and Gerontology, Department of Medicine, University of Washington, Harborview Medical Center, Seattle
| | - Tam N Pham
- Division of Trauma, Burn, and Critical Care Surgery, Department of Surgery, University of Washington, Harborview Medical Center, Seattle
| | - Kevin Penn
- Division of Geriatrics and Gerontology, Department of Medicine, University of Washington, Harborview Medical Center, Seattle
| | - Itay Bentov
- Department of Anesthesiology & Pain Medicine, University of Washington, Harborview Medical Center, Seattle
| | - Stephen J Kaplan
- Division of Geriatrics and Gerontology, Department of Medicine, University of Washington, Harborview Medical Center, Seattle.,Section of General, Thoracic, and Vascular Surgery, Department of Surgery, Virginia Mason Medical Center, Seattle, Washington
| |
Collapse
|
14
|
Sheffy N, Tellem R, Bentov I. Anesthetic Challenges in Treating the Older Adult Trauma Patient: an Update. Curr Anesthesiol Rep 2020. [DOI: 10.1007/s40140-020-00378-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
15
|
Janz DR, Casey JD, Semler MW, Russell DW, Dargin J, Vonderhaar DJ, Dischert KM, West JR, Stempek S, Wozniak J, Caputo N, Heideman BE, Zouk AN, Gulati S, Stigler WS, Bentov I, Joffe AM, Rice TW, Janz DR, Vonderhaar DJ, Hoffman R, Turlapati N, Samant S, Clark P, Krishnan A, Gresens J, Hill C, Matthew B, Henry J, Miller J, Paccione R, Majid-Moosa A, Santanilla JI, Semler MW, Rice TW, Casey JD, Heideman BE, Wilfong EM, Hewlett JC, Halliday SJ, Kerchberger VE, Brown RM, Huerta LE, Merrick CM, Atwater T, Kocurek EG, McKown AC, Winters NI, Habegger LE, Mart MF, Berg JZ, Noblit CC, Flemmons LN, Dischert K, Joffe A, Bentov I, Archibald T, Arenas A, Baldridge C, Bansal G, Barnes C, Bishop N, Bryce B, Byrne L, Clement R, DeLaCruz C, Deshpande P, Gong Z, Green J, Henry A, Herstein A, Huang J, Heier J, Jenson B, Johnston L, Langeland C, Lee C, Nowlin A, Reece-Nguyen T, Schultz H, Segal G, Slade I, Solomon S, Stehpey S, Thompson R, Trausch D, Welker C, Zhang R, Russell D, Zouk A, Gulati S, Stigler W, Fain J, Garcia B, Lafon D, He C, O'Connor J, Campbell D, Powner J, McElwee S, Bardita C, D'Souza K, Pereira GB, Robinson S, Blumhof S, Dargin J, Stempek S, Wozniak J, Pataramekin P, Desai D, Yayarovich E, DeMatteo R, Somalaraiu S, Adler C, Reid C, Plourde M, Winnicki J, Noland T, Geva T, Gazourian L, Patel A, Eissa K, Giacotto J, Fitelson D, Colancecco M, Gray A, West JR, Caputo N, Ryan M, Parry T, Azan B, Khairat A, Morton R, Lewandowski D, Vaca C. Effect of a fluid bolus on cardiovascular collapse among critically ill adults undergoing tracheal intubation (PrePARE): a randomised controlled trial. The Lancet Respiratory Medicine 2019; 7:1039-1047. [DOI: 10.1016/s2213-2600(19)30246-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Revised: 05/29/2019] [Accepted: 06/13/2019] [Indexed: 01/17/2023]
|
16
|
Powelson EB, Reed MJ, Bentov I. Perioperative Management of Delirium in Geriatric Patients. Curr Anesthesiol Rep 2019. [DOI: 10.1007/s40140-019-00353-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
17
|
Shoultz TH, Moore M, Reed MJ, Kaplan SJ, Bentov I, Hough C, Taitsman LA, Mitchell SH, So GE, Arbabi S, Phelan H, Pham T. Trauma Providers' Perceptions of Frailty Assessment: A Mixed-Methods Analysis of Knowledge, Attitudes, and Beliefs. South Med J 2019; 112:159-163. [PMID: 30830229 DOI: 10.14423/smj.0000000000000948] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES Quality improvement in geriatric trauma depends on timely identification of frailty, yet little is known about providers' knowledge and beliefs about frailty assessment. This study sought to understand trauma providers' understanding, beliefs, and practices for frailty assessment. METHODS We developed a 20-question survey using the Health Belief Model of health behavior and surveyed physicians, advanced practice providers, and trainees on the trauma services at a single institution that does not use formal frailty screening of all injured seniors. Results were analyzed via mixed methods. RESULTS One hundred fifty-one providers completed the survey (response rate 92%). Respondents commonly included calendar age as an integral factor in their determinations of frailty but also included a variety of other factors, highlighting limited definitional consensus. Respondents perceived frailty as important to older adult patient outcomes, but assessment techniques were varied because only 24/151 respondents (16%) were familiar with current formal frailty assessment tools. Perceived barriers to performing a formal frailty screening on all injured older adults included the burdensome nature of assessment tools, insufficient training, and lack of time. When prompted for solutions, 20% of respondents recommended automation of the screening process by trained, dedicated team members. CONCLUSIONS Providers seem to recognize the impact that a diagnosis of frailty has on outcomes, but most lack a working knowledge of how to assess for frailty syndrome. Some providers recommended screening by designated, formally trained personnel who could notify decision makers of a positive screen result.
Collapse
Affiliation(s)
- Thomas H Shoultz
- From the Department of Surgery, Division of Trauma, Burn, and Critical Care Surgery, University of Washington, Seattle, the School of Social Work, University of Washington, Seattle, the Department of Medicine, Division of Gerontology and Geriatric Medicine, University of Washington, Seattle, the Department of Surgery, Section of General, Thoracic, and Vascular Surgery, Virginia Mason Medical Center, Seattle, Washington, the Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, the Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Washington, Seattle, the Department of Orthopedics and Sports Medicine, University of Washington, Seattle, the Department of Emergency Medicine, University of Washington, Seattle, the Department of Medicine, Division of Gerontology and Geriatric Medicine, University of Washington, Seattle, Washington, the Department of Surgery, Division of General and Acute Care Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, and the Department of Surgery, Division of Trauma, Burn, and Critical Care Surgery, University of Washington, Seattle, Washington
| | - Megan Moore
- From the Department of Surgery, Division of Trauma, Burn, and Critical Care Surgery, University of Washington, Seattle, the School of Social Work, University of Washington, Seattle, the Department of Medicine, Division of Gerontology and Geriatric Medicine, University of Washington, Seattle, the Department of Surgery, Section of General, Thoracic, and Vascular Surgery, Virginia Mason Medical Center, Seattle, Washington, the Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, the Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Washington, Seattle, the Department of Orthopedics and Sports Medicine, University of Washington, Seattle, the Department of Emergency Medicine, University of Washington, Seattle, the Department of Medicine, Division of Gerontology and Geriatric Medicine, University of Washington, Seattle, Washington, the Department of Surgery, Division of General and Acute Care Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, and the Department of Surgery, Division of Trauma, Burn, and Critical Care Surgery, University of Washington, Seattle, Washington
| | - May J Reed
- From the Department of Surgery, Division of Trauma, Burn, and Critical Care Surgery, University of Washington, Seattle, the School of Social Work, University of Washington, Seattle, the Department of Medicine, Division of Gerontology and Geriatric Medicine, University of Washington, Seattle, the Department of Surgery, Section of General, Thoracic, and Vascular Surgery, Virginia Mason Medical Center, Seattle, Washington, the Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, the Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Washington, Seattle, the Department of Orthopedics and Sports Medicine, University of Washington, Seattle, the Department of Emergency Medicine, University of Washington, Seattle, the Department of Medicine, Division of Gerontology and Geriatric Medicine, University of Washington, Seattle, Washington, the Department of Surgery, Division of General and Acute Care Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, and the Department of Surgery, Division of Trauma, Burn, and Critical Care Surgery, University of Washington, Seattle, Washington
| | - Stephen J Kaplan
- From the Department of Surgery, Division of Trauma, Burn, and Critical Care Surgery, University of Washington, Seattle, the School of Social Work, University of Washington, Seattle, the Department of Medicine, Division of Gerontology and Geriatric Medicine, University of Washington, Seattle, the Department of Surgery, Section of General, Thoracic, and Vascular Surgery, Virginia Mason Medical Center, Seattle, Washington, the Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, the Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Washington, Seattle, the Department of Orthopedics and Sports Medicine, University of Washington, Seattle, the Department of Emergency Medicine, University of Washington, Seattle, the Department of Medicine, Division of Gerontology and Geriatric Medicine, University of Washington, Seattle, Washington, the Department of Surgery, Division of General and Acute Care Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, and the Department of Surgery, Division of Trauma, Burn, and Critical Care Surgery, University of Washington, Seattle, Washington
| | - Itay Bentov
- From the Department of Surgery, Division of Trauma, Burn, and Critical Care Surgery, University of Washington, Seattle, the School of Social Work, University of Washington, Seattle, the Department of Medicine, Division of Gerontology and Geriatric Medicine, University of Washington, Seattle, the Department of Surgery, Section of General, Thoracic, and Vascular Surgery, Virginia Mason Medical Center, Seattle, Washington, the Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, the Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Washington, Seattle, the Department of Orthopedics and Sports Medicine, University of Washington, Seattle, the Department of Emergency Medicine, University of Washington, Seattle, the Department of Medicine, Division of Gerontology and Geriatric Medicine, University of Washington, Seattle, Washington, the Department of Surgery, Division of General and Acute Care Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, and the Department of Surgery, Division of Trauma, Burn, and Critical Care Surgery, University of Washington, Seattle, Washington
| | - Catherine Hough
- From the Department of Surgery, Division of Trauma, Burn, and Critical Care Surgery, University of Washington, Seattle, the School of Social Work, University of Washington, Seattle, the Department of Medicine, Division of Gerontology and Geriatric Medicine, University of Washington, Seattle, the Department of Surgery, Section of General, Thoracic, and Vascular Surgery, Virginia Mason Medical Center, Seattle, Washington, the Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, the Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Washington, Seattle, the Department of Orthopedics and Sports Medicine, University of Washington, Seattle, the Department of Emergency Medicine, University of Washington, Seattle, the Department of Medicine, Division of Gerontology and Geriatric Medicine, University of Washington, Seattle, Washington, the Department of Surgery, Division of General and Acute Care Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, and the Department of Surgery, Division of Trauma, Burn, and Critical Care Surgery, University of Washington, Seattle, Washington
| | - Lisa A Taitsman
- From the Department of Surgery, Division of Trauma, Burn, and Critical Care Surgery, University of Washington, Seattle, the School of Social Work, University of Washington, Seattle, the Department of Medicine, Division of Gerontology and Geriatric Medicine, University of Washington, Seattle, the Department of Surgery, Section of General, Thoracic, and Vascular Surgery, Virginia Mason Medical Center, Seattle, Washington, the Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, the Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Washington, Seattle, the Department of Orthopedics and Sports Medicine, University of Washington, Seattle, the Department of Emergency Medicine, University of Washington, Seattle, the Department of Medicine, Division of Gerontology and Geriatric Medicine, University of Washington, Seattle, Washington, the Department of Surgery, Division of General and Acute Care Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, and the Department of Surgery, Division of Trauma, Burn, and Critical Care Surgery, University of Washington, Seattle, Washington
| | - Steven H Mitchell
- From the Department of Surgery, Division of Trauma, Burn, and Critical Care Surgery, University of Washington, Seattle, the School of Social Work, University of Washington, Seattle, the Department of Medicine, Division of Gerontology and Geriatric Medicine, University of Washington, Seattle, the Department of Surgery, Section of General, Thoracic, and Vascular Surgery, Virginia Mason Medical Center, Seattle, Washington, the Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, the Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Washington, Seattle, the Department of Orthopedics and Sports Medicine, University of Washington, Seattle, the Department of Emergency Medicine, University of Washington, Seattle, the Department of Medicine, Division of Gerontology and Geriatric Medicine, University of Washington, Seattle, Washington, the Department of Surgery, Division of General and Acute Care Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, and the Department of Surgery, Division of Trauma, Burn, and Critical Care Surgery, University of Washington, Seattle, Washington
| | - Grace E So
- From the Department of Surgery, Division of Trauma, Burn, and Critical Care Surgery, University of Washington, Seattle, the School of Social Work, University of Washington, Seattle, the Department of Medicine, Division of Gerontology and Geriatric Medicine, University of Washington, Seattle, the Department of Surgery, Section of General, Thoracic, and Vascular Surgery, Virginia Mason Medical Center, Seattle, Washington, the Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, the Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Washington, Seattle, the Department of Orthopedics and Sports Medicine, University of Washington, Seattle, the Department of Emergency Medicine, University of Washington, Seattle, the Department of Medicine, Division of Gerontology and Geriatric Medicine, University of Washington, Seattle, Washington, the Department of Surgery, Division of General and Acute Care Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, and the Department of Surgery, Division of Trauma, Burn, and Critical Care Surgery, University of Washington, Seattle, Washington
| | - Saman Arbabi
- From the Department of Surgery, Division of Trauma, Burn, and Critical Care Surgery, University of Washington, Seattle, the School of Social Work, University of Washington, Seattle, the Department of Medicine, Division of Gerontology and Geriatric Medicine, University of Washington, Seattle, the Department of Surgery, Section of General, Thoracic, and Vascular Surgery, Virginia Mason Medical Center, Seattle, Washington, the Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, the Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Washington, Seattle, the Department of Orthopedics and Sports Medicine, University of Washington, Seattle, the Department of Emergency Medicine, University of Washington, Seattle, the Department of Medicine, Division of Gerontology and Geriatric Medicine, University of Washington, Seattle, Washington, the Department of Surgery, Division of General and Acute Care Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, and the Department of Surgery, Division of Trauma, Burn, and Critical Care Surgery, University of Washington, Seattle, Washington
| | - Herb Phelan
- From the Department of Surgery, Division of Trauma, Burn, and Critical Care Surgery, University of Washington, Seattle, the School of Social Work, University of Washington, Seattle, the Department of Medicine, Division of Gerontology and Geriatric Medicine, University of Washington, Seattle, the Department of Surgery, Section of General, Thoracic, and Vascular Surgery, Virginia Mason Medical Center, Seattle, Washington, the Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, the Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Washington, Seattle, the Department of Orthopedics and Sports Medicine, University of Washington, Seattle, the Department of Emergency Medicine, University of Washington, Seattle, the Department of Medicine, Division of Gerontology and Geriatric Medicine, University of Washington, Seattle, Washington, the Department of Surgery, Division of General and Acute Care Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, and the Department of Surgery, Division of Trauma, Burn, and Critical Care Surgery, University of Washington, Seattle, Washington
| | - Tam Pham
- From the Department of Surgery, Division of Trauma, Burn, and Critical Care Surgery, University of Washington, Seattle, the School of Social Work, University of Washington, Seattle, the Department of Medicine, Division of Gerontology and Geriatric Medicine, University of Washington, Seattle, the Department of Surgery, Section of General, Thoracic, and Vascular Surgery, Virginia Mason Medical Center, Seattle, Washington, the Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, the Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Washington, Seattle, the Department of Orthopedics and Sports Medicine, University of Washington, Seattle, the Department of Emergency Medicine, University of Washington, Seattle, the Department of Medicine, Division of Gerontology and Geriatric Medicine, University of Washington, Seattle, Washington, the Department of Surgery, Division of General and Acute Care Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, and the Department of Surgery, Division of Trauma, Burn, and Critical Care Surgery, University of Washington, Seattle, Washington
| |
Collapse
|
18
|
Bentov I, Kaplan SJ, Pham TN, Reed MJ. Frailty assessment: from clinical to radiological tools. Br J Anaesth 2019; 123:37-50. [PMID: 31056240 DOI: 10.1016/j.bja.2019.03.034] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [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: 08/13/2018] [Revised: 02/05/2019] [Accepted: 03/05/2019] [Indexed: 12/21/2022] Open
Abstract
Frailty is a syndrome of cumulative decline across multiple physiological systems, which predisposes vulnerable adults to adverse events. Assessing vulnerable patients can potentially lead to interventions that improve surgical outcomes. Anaesthesiologists who care for older patients can identify frailty to improve preoperative risk stratification and subsequent perioperative planning. Numerous clinical tools to diagnose frailty exist, but none has emerged as the standard tool to be used in clinical practice. Radiological modalities, such as computed tomography and ultrasonography, are widely performed before surgery, and are therefore available to be used opportunistically to objectively evaluate surrogate markers of frailty. This review presents the importance of frailty assessment by anaesthesiologists; lists common clinical tools that have been applied; and proposes that utilising radiological imaging as an objective surrogate measure of frailty is a novel, expanding approach for which anaesthesiologists can significantly contribute to broad implementation.
Collapse
Affiliation(s)
- Itay Bentov
- Department of Anesthesiology and Pain Medicine, Harborview Medical Center, University of Washington, Seattle, WA, USA.
| | - Stephen J Kaplan
- Section of General, Thoracic, and Vascular Surgery, Department of Surgery, Virginia Mason Medical Center, Seattle, WA, USA
| | - Tam N Pham
- Division of Trauma, Burn, and Critical Care Surgery, Department of Surgery, Harborview Medical Center, University of Washington, Seattle, WA, USA
| | - May J Reed
- Division of Gerontology and Geriatric Medicine, Department of Medicine, Harborview Medical Center, University of Washington, Seattle, WA, USA
| |
Collapse
|
19
|
Casey JD, Janz DR, Russell DW, Vonderhaar DJ, Joffe AM, Dischert KM, Brown RM, Zouk AN, Gulati S, Heideman BE, Lester MG, Toporek AH, Bentov I, Self WH, Rice TW, Semler MW. Bag-Mask Ventilation during Tracheal Intubation of Critically Ill Adults. N Engl J Med 2019; 380:811-821. [PMID: 30779528 PMCID: PMC6423976 DOI: 10.1056/nejmoa1812405] [Citation(s) in RCA: 109] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Hypoxemia is the most common complication during tracheal intubation of critically ill adults and may increase the risk of cardiac arrest and death. Whether positive-pressure ventilation with a bag-mask device (bag-mask ventilation) during tracheal intubation of critically ill adults prevents hypoxemia without increasing the risk of aspiration remains controversial. METHODS In a multicenter, randomized trial conducted in seven intensive care units in the United States, we randomly assigned adults undergoing tracheal intubation to receive either ventilation with a bag-mask device or no ventilation between induction and laryngoscopy. The primary outcome was the lowest oxygen saturation observed during the interval between induction and 2 minutes after tracheal intubation. The secondary outcome was the incidence of severe hypoxemia, defined as an oxygen saturation of less than 80%. RESULTS Among the 401 patients enrolled, the median lowest oxygen saturation was 96% (interquartile range, 87 to 99) in the bag-mask ventilation group and 93% (interquartile range, 81 to 99) in the no-ventilation group (P = 0.01). A total of 21 patients (10.9%) in the bag-mask ventilation group had severe hypoxemia, as compared with 45 patients (22.8%) in the no-ventilation group (relative risk, 0.48; 95% confidence interval [CI], 0.30 to 0.77). Operator-reported aspiration occurred during 2.5% of intubations in the bag-mask ventilation group and during 4.0% in the no-ventilation group (P = 0.41). The incidence of new opacity on chest radiography in the 48 hours after tracheal intubation was 16.4% and 14.8%, respectively (P = 0.73). CONCLUSIONS Among critically ill adults undergoing tracheal intubation, patients receiving bag-mask ventilation had higher oxygen saturations and a lower incidence of severe hypoxemia than those receiving no ventilation. (Funded by Vanderbilt Institute for Clinical and Translational Research and others; PreVent ClinicalTrials.gov number, NCT03026322.).
Collapse
Affiliation(s)
- Jonathan D. Casey
- Division of Allergy, Pulmonary, and Critical Care Medicine (J.D.C., R.M.B., B.E.H., M.G.L., A.H.T., T.W.R., M.W.S.), and the Department of Emergency Medicine (W.H.S.), Vanderbilt University Medical Center, Nashville; the Section of Pulmonary, Critical Care, and Allergy and Immunology (D.R.J.), and the Section of Emergency Medicine (D.J.V.), Louisiana State University School of Medicine– New Orleans, and the Department of Pulmonary and Critical Care Medicine, Ochsner Health System (D.J.V., K.M.D.) — both in New Orleans; the Division of Pulmonary, Allergy, and Critical Care Medicine, University of Alabama at Birmingham, Birmingham (D.W.R., A.N.Z., S.G.); and the Department of Anesthesiology and Pain Medicine (A.M.J.) and the Division of Pulmonary and Critical Care (I.B.), University of Washington School of Medicine, Seattle. Address reprint requests to Dr. Casey at the Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, T-1210 MCN, 1161 21st Ave. S., Nashville, TN 37232-2650, or at
| | - David R. Janz
- Division of Allergy, Pulmonary, and Critical Care Medicine (J.D.C., R.M.B., B.E.H., M.G.L., A.H.T., T.W.R., M.W.S.), and the Department of Emergency Medicine (W.H.S.), Vanderbilt University Medical Center, Nashville; the Section of Pulmonary, Critical Care, and Allergy and Immunology (D.R.J.), and the Section of Emergency Medicine (D.J.V.), Louisiana State University School of Medicine– New Orleans, and the Department of Pulmonary and Critical Care Medicine, Ochsner Health System (D.J.V., K.M.D.) — both in New Orleans; the Division of Pulmonary, Allergy, and Critical Care Medicine, University of Alabama at Birmingham, Birmingham (D.W.R., A.N.Z., S.G.); and the Department of Anesthesiology and Pain Medicine (A.M.J.) and the Division of Pulmonary and Critical Care (I.B.), University of Washington School of Medicine, Seattle. Address reprint requests to Dr. Casey at the Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, T-1210 MCN, 1161 21st Ave. S., Nashville, TN 37232-2650, or at
| | - Derek W. Russell
- Division of Allergy, Pulmonary, and Critical Care Medicine (J.D.C., R.M.B., B.E.H., M.G.L., A.H.T., T.W.R., M.W.S.), and the Department of Emergency Medicine (W.H.S.), Vanderbilt University Medical Center, Nashville; the Section of Pulmonary, Critical Care, and Allergy and Immunology (D.R.J.), and the Section of Emergency Medicine (D.J.V.), Louisiana State University School of Medicine– New Orleans, and the Department of Pulmonary and Critical Care Medicine, Ochsner Health System (D.J.V., K.M.D.) — both in New Orleans; the Division of Pulmonary, Allergy, and Critical Care Medicine, University of Alabama at Birmingham, Birmingham (D.W.R., A.N.Z., S.G.); and the Department of Anesthesiology and Pain Medicine (A.M.J.) and the Division of Pulmonary and Critical Care (I.B.), University of Washington School of Medicine, Seattle. Address reprint requests to Dr. Casey at the Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, T-1210 MCN, 1161 21st Ave. S., Nashville, TN 37232-2650, or at
| | - Derek J. Vonderhaar
- Division of Allergy, Pulmonary, and Critical Care Medicine (J.D.C., R.M.B., B.E.H., M.G.L., A.H.T., T.W.R., M.W.S.), and the Department of Emergency Medicine (W.H.S.), Vanderbilt University Medical Center, Nashville; the Section of Pulmonary, Critical Care, and Allergy and Immunology (D.R.J.), and the Section of Emergency Medicine (D.J.V.), Louisiana State University School of Medicine– New Orleans, and the Department of Pulmonary and Critical Care Medicine, Ochsner Health System (D.J.V., K.M.D.) — both in New Orleans; the Division of Pulmonary, Allergy, and Critical Care Medicine, University of Alabama at Birmingham, Birmingham (D.W.R., A.N.Z., S.G.); and the Department of Anesthesiology and Pain Medicine (A.M.J.) and the Division of Pulmonary and Critical Care (I.B.), University of Washington School of Medicine, Seattle. Address reprint requests to Dr. Casey at the Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, T-1210 MCN, 1161 21st Ave. S., Nashville, TN 37232-2650, or at
| | - Aaron M. Joffe
- Division of Allergy, Pulmonary, and Critical Care Medicine (J.D.C., R.M.B., B.E.H., M.G.L., A.H.T., T.W.R., M.W.S.), and the Department of Emergency Medicine (W.H.S.), Vanderbilt University Medical Center, Nashville; the Section of Pulmonary, Critical Care, and Allergy and Immunology (D.R.J.), and the Section of Emergency Medicine (D.J.V.), Louisiana State University School of Medicine– New Orleans, and the Department of Pulmonary and Critical Care Medicine, Ochsner Health System (D.J.V., K.M.D.) — both in New Orleans; the Division of Pulmonary, Allergy, and Critical Care Medicine, University of Alabama at Birmingham, Birmingham (D.W.R., A.N.Z., S.G.); and the Department of Anesthesiology and Pain Medicine (A.M.J.) and the Division of Pulmonary and Critical Care (I.B.), University of Washington School of Medicine, Seattle. Address reprint requests to Dr. Casey at the Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, T-1210 MCN, 1161 21st Ave. S., Nashville, TN 37232-2650, or at
| | - Kevin M. Dischert
- Division of Allergy, Pulmonary, and Critical Care Medicine (J.D.C., R.M.B., B.E.H., M.G.L., A.H.T., T.W.R., M.W.S.), and the Department of Emergency Medicine (W.H.S.), Vanderbilt University Medical Center, Nashville; the Section of Pulmonary, Critical Care, and Allergy and Immunology (D.R.J.), and the Section of Emergency Medicine (D.J.V.), Louisiana State University School of Medicine– New Orleans, and the Department of Pulmonary and Critical Care Medicine, Ochsner Health System (D.J.V., K.M.D.) — both in New Orleans; the Division of Pulmonary, Allergy, and Critical Care Medicine, University of Alabama at Birmingham, Birmingham (D.W.R., A.N.Z., S.G.); and the Department of Anesthesiology and Pain Medicine (A.M.J.) and the Division of Pulmonary and Critical Care (I.B.), University of Washington School of Medicine, Seattle. Address reprint requests to Dr. Casey at the Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, T-1210 MCN, 1161 21st Ave. S., Nashville, TN 37232-2650, or at
| | - Ryan M. Brown
- Division of Allergy, Pulmonary, and Critical Care Medicine (J.D.C., R.M.B., B.E.H., M.G.L., A.H.T., T.W.R., M.W.S.), and the Department of Emergency Medicine (W.H.S.), Vanderbilt University Medical Center, Nashville; the Section of Pulmonary, Critical Care, and Allergy and Immunology (D.R.J.), and the Section of Emergency Medicine (D.J.V.), Louisiana State University School of Medicine– New Orleans, and the Department of Pulmonary and Critical Care Medicine, Ochsner Health System (D.J.V., K.M.D.) — both in New Orleans; the Division of Pulmonary, Allergy, and Critical Care Medicine, University of Alabama at Birmingham, Birmingham (D.W.R., A.N.Z., S.G.); and the Department of Anesthesiology and Pain Medicine (A.M.J.) and the Division of Pulmonary and Critical Care (I.B.), University of Washington School of Medicine, Seattle. Address reprint requests to Dr. Casey at the Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, T-1210 MCN, 1161 21st Ave. S., Nashville, TN 37232-2650, or at
| | - Aline N. Zouk
- Division of Allergy, Pulmonary, and Critical Care Medicine (J.D.C., R.M.B., B.E.H., M.G.L., A.H.T., T.W.R., M.W.S.), and the Department of Emergency Medicine (W.H.S.), Vanderbilt University Medical Center, Nashville; the Section of Pulmonary, Critical Care, and Allergy and Immunology (D.R.J.), and the Section of Emergency Medicine (D.J.V.), Louisiana State University School of Medicine– New Orleans, and the Department of Pulmonary and Critical Care Medicine, Ochsner Health System (D.J.V., K.M.D.) — both in New Orleans; the Division of Pulmonary, Allergy, and Critical Care Medicine, University of Alabama at Birmingham, Birmingham (D.W.R., A.N.Z., S.G.); and the Department of Anesthesiology and Pain Medicine (A.M.J.) and the Division of Pulmonary and Critical Care (I.B.), University of Washington School of Medicine, Seattle. Address reprint requests to Dr. Casey at the Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, T-1210 MCN, 1161 21st Ave. S., Nashville, TN 37232-2650, or at
| | - Swati Gulati
- Division of Allergy, Pulmonary, and Critical Care Medicine (J.D.C., R.M.B., B.E.H., M.G.L., A.H.T., T.W.R., M.W.S.), and the Department of Emergency Medicine (W.H.S.), Vanderbilt University Medical Center, Nashville; the Section of Pulmonary, Critical Care, and Allergy and Immunology (D.R.J.), and the Section of Emergency Medicine (D.J.V.), Louisiana State University School of Medicine– New Orleans, and the Department of Pulmonary and Critical Care Medicine, Ochsner Health System (D.J.V., K.M.D.) — both in New Orleans; the Division of Pulmonary, Allergy, and Critical Care Medicine, University of Alabama at Birmingham, Birmingham (D.W.R., A.N.Z., S.G.); and the Department of Anesthesiology and Pain Medicine (A.M.J.) and the Division of Pulmonary and Critical Care (I.B.), University of Washington School of Medicine, Seattle. Address reprint requests to Dr. Casey at the Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, T-1210 MCN, 1161 21st Ave. S., Nashville, TN 37232-2650, or at
| | - Brent E. Heideman
- Division of Allergy, Pulmonary, and Critical Care Medicine (J.D.C., R.M.B., B.E.H., M.G.L., A.H.T., T.W.R., M.W.S.), and the Department of Emergency Medicine (W.H.S.), Vanderbilt University Medical Center, Nashville; the Section of Pulmonary, Critical Care, and Allergy and Immunology (D.R.J.), and the Section of Emergency Medicine (D.J.V.), Louisiana State University School of Medicine– New Orleans, and the Department of Pulmonary and Critical Care Medicine, Ochsner Health System (D.J.V., K.M.D.) — both in New Orleans; the Division of Pulmonary, Allergy, and Critical Care Medicine, University of Alabama at Birmingham, Birmingham (D.W.R., A.N.Z., S.G.); and the Department of Anesthesiology and Pain Medicine (A.M.J.) and the Division of Pulmonary and Critical Care (I.B.), University of Washington School of Medicine, Seattle. Address reprint requests to Dr. Casey at the Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, T-1210 MCN, 1161 21st Ave. S., Nashville, TN 37232-2650, or at
| | - Michael G. Lester
- Division of Allergy, Pulmonary, and Critical Care Medicine (J.D.C., R.M.B., B.E.H., M.G.L., A.H.T., T.W.R., M.W.S.), and the Department of Emergency Medicine (W.H.S.), Vanderbilt University Medical Center, Nashville; the Section of Pulmonary, Critical Care, and Allergy and Immunology (D.R.J.), and the Section of Emergency Medicine (D.J.V.), Louisiana State University School of Medicine– New Orleans, and the Department of Pulmonary and Critical Care Medicine, Ochsner Health System (D.J.V., K.M.D.) — both in New Orleans; the Division of Pulmonary, Allergy, and Critical Care Medicine, University of Alabama at Birmingham, Birmingham (D.W.R., A.N.Z., S.G.); and the Department of Anesthesiology and Pain Medicine (A.M.J.) and the Division of Pulmonary and Critical Care (I.B.), University of Washington School of Medicine, Seattle. Address reprint requests to Dr. Casey at the Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, T-1210 MCN, 1161 21st Ave. S., Nashville, TN 37232-2650, or at
| | - Alexandra H. Toporek
- Division of Allergy, Pulmonary, and Critical Care Medicine (J.D.C., R.M.B., B.E.H., M.G.L., A.H.T., T.W.R., M.W.S.), and the Department of Emergency Medicine (W.H.S.), Vanderbilt University Medical Center, Nashville; the Section of Pulmonary, Critical Care, and Allergy and Immunology (D.R.J.), and the Section of Emergency Medicine (D.J.V.), Louisiana State University School of Medicine– New Orleans, and the Department of Pulmonary and Critical Care Medicine, Ochsner Health System (D.J.V., K.M.D.) — both in New Orleans; the Division of Pulmonary, Allergy, and Critical Care Medicine, University of Alabama at Birmingham, Birmingham (D.W.R., A.N.Z., S.G.); and the Department of Anesthesiology and Pain Medicine (A.M.J.) and the Division of Pulmonary and Critical Care (I.B.), University of Washington School of Medicine, Seattle. Address reprint requests to Dr. Casey at the Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, T-1210 MCN, 1161 21st Ave. S., Nashville, TN 37232-2650, or at
| | - Itay Bentov
- Division of Allergy, Pulmonary, and Critical Care Medicine (J.D.C., R.M.B., B.E.H., M.G.L., A.H.T., T.W.R., M.W.S.), and the Department of Emergency Medicine (W.H.S.), Vanderbilt University Medical Center, Nashville; the Section of Pulmonary, Critical Care, and Allergy and Immunology (D.R.J.), and the Section of Emergency Medicine (D.J.V.), Louisiana State University School of Medicine– New Orleans, and the Department of Pulmonary and Critical Care Medicine, Ochsner Health System (D.J.V., K.M.D.) — both in New Orleans; the Division of Pulmonary, Allergy, and Critical Care Medicine, University of Alabama at Birmingham, Birmingham (D.W.R., A.N.Z., S.G.); and the Department of Anesthesiology and Pain Medicine (A.M.J.) and the Division of Pulmonary and Critical Care (I.B.), University of Washington School of Medicine, Seattle. Address reprint requests to Dr. Casey at the Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, T-1210 MCN, 1161 21st Ave. S., Nashville, TN 37232-2650, or at
| | - Wesley H. Self
- Division of Allergy, Pulmonary, and Critical Care Medicine (J.D.C., R.M.B., B.E.H., M.G.L., A.H.T., T.W.R., M.W.S.), and the Department of Emergency Medicine (W.H.S.), Vanderbilt University Medical Center, Nashville; the Section of Pulmonary, Critical Care, and Allergy and Immunology (D.R.J.), and the Section of Emergency Medicine (D.J.V.), Louisiana State University School of Medicine– New Orleans, and the Department of Pulmonary and Critical Care Medicine, Ochsner Health System (D.J.V., K.M.D.) — both in New Orleans; the Division of Pulmonary, Allergy, and Critical Care Medicine, University of Alabama at Birmingham, Birmingham (D.W.R., A.N.Z., S.G.); and the Department of Anesthesiology and Pain Medicine (A.M.J.) and the Division of Pulmonary and Critical Care (I.B.), University of Washington School of Medicine, Seattle. Address reprint requests to Dr. Casey at the Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, T-1210 MCN, 1161 21st Ave. S., Nashville, TN 37232-2650, or at
| | - Todd W. Rice
- Division of Allergy, Pulmonary, and Critical Care Medicine (J.D.C., R.M.B., B.E.H., M.G.L., A.H.T., T.W.R., M.W.S.), and the Department of Emergency Medicine (W.H.S.), Vanderbilt University Medical Center, Nashville; the Section of Pulmonary, Critical Care, and Allergy and Immunology (D.R.J.), and the Section of Emergency Medicine (D.J.V.), Louisiana State University School of Medicine– New Orleans, and the Department of Pulmonary and Critical Care Medicine, Ochsner Health System (D.J.V., K.M.D.) — both in New Orleans; the Division of Pulmonary, Allergy, and Critical Care Medicine, University of Alabama at Birmingham, Birmingham (D.W.R., A.N.Z., S.G.); and the Department of Anesthesiology and Pain Medicine (A.M.J.) and the Division of Pulmonary and Critical Care (I.B.), University of Washington School of Medicine, Seattle. Address reprint requests to Dr. Casey at the Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, T-1210 MCN, 1161 21st Ave. S., Nashville, TN 37232-2650, or at
| | - Matthew W. Semler
- Division of Allergy, Pulmonary, and Critical Care Medicine (J.D.C., R.M.B., B.E.H., M.G.L., A.H.T., T.W.R., M.W.S.), and the Department of Emergency Medicine (W.H.S.), Vanderbilt University Medical Center, Nashville; the Section of Pulmonary, Critical Care, and Allergy and Immunology (D.R.J.), and the Section of Emergency Medicine (D.J.V.), Louisiana State University School of Medicine– New Orleans, and the Department of Pulmonary and Critical Care Medicine, Ochsner Health System (D.J.V., K.M.D.) — both in New Orleans; the Division of Pulmonary, Allergy, and Critical Care Medicine, University of Alabama at Birmingham, Birmingham (D.W.R., A.N.Z., S.G.); and the Department of Anesthesiology and Pain Medicine (A.M.J.) and the Division of Pulmonary and Critical Care (I.B.), University of Washington School of Medicine, Seattle. Address reprint requests to Dr. Casey at the Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, T-1210 MCN, 1161 21st Ave. S., Nashville, TN 37232-2650, or at
| | | |
Collapse
|
20
|
Palmer A, Taitsman LA, Reed MJ, Nair BG, Bentov I. Utility of Geriatric Assessment in the Projection of Early Mortality Following Hip Fracture in the Elderly Patients. Geriatr Orthop Surg Rehabil 2018; 9:2151459318813976. [PMID: 30546923 PMCID: PMC6287303 DOI: 10.1177/2151459318813976] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Revised: 09/16/2018] [Accepted: 09/22/2018] [Indexed: 01/10/2023] Open
Abstract
Hip fractures result in significant morbidity and mortality in elders. Indicators of frailty are associated with poor outcomes. Commonly used frailty tools rely on motor skills that cannot be performed by this population. We determined the association between the Charlson Comorbidity Score (CCS), intraoperative hypotension (IOH), and a geriatric medicine consult index (GCI) with short-term mortality in hip fracture patients. A retrospective cohort study was conducted at a single institution over a 2-year period. Patients aged 65 years and older who sustained a hip fracture following a low-energy mechanism were identified using billing records and our orthopedic fracture registry. Medical records were reviewed to collect demographic data, fracture classification and operative records, calculation of CCS, intraoperative details including hypotension, and assessments recorded in the geriatric consult notes. The GCI was calculated using 30 dichotomous variables contained within the geriatric consult note. The index, ranging from 0 to 1, included markers for physical and cognitive function, as well as medications. A higher GCI score indicated more markers for frailty. One hundred eight patients met inclusion criteria. Sixty-four (59%) were females and the average age was 77.3 years. Thirty-five (32%) patients sustained femoral neck fractures, and 73 (68%) patients sustained inter-/pertrochanteric hip fractures. The 30-day mortality was 6%; the 90-day mortality was 13%. The mean GCI was 0.30 in the 30-day survivor group as compared to 0.52 in those who died. The mean GCI was 0.28 in patients who were alive at 90 days as compared to 0.46 in those who died. In contrast, the CCS and IOH were not associated with 30- or 90-day mortality. In our older hip fracture patients, an index calculated from information routinely obtained in the geriatric consult evaluation was associated with 30- and 90-day mortality, whereas the CCS and measures of IOH were not.
Collapse
Affiliation(s)
| | | | - May J Reed
- Harborview Medical Center, Seattle, WA, USA
| | | | | |
Collapse
|
21
|
Kim M, Kaplan SJ, Mitchell SH, Gatewood M, Bentov I, Bennett KA, Crawford CA, Sutton PR, Matsuwaka D, Damodarasamy M, Reed MJ. The Effect of Computerized Physician Order Entry Template Modifications on the Administration of High-Risk Medications in Older Adults in the Emergency Department. Drugs Aging 2018; 34:793-801. [PMID: 28956283 DOI: 10.1007/s40266-017-0489-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND Older adults are more susceptible to adverse events when administered certain medications at doses appropriate for younger adults. OBJECTIVE The aim of this study was to investigate the effect of default geriatric dosing on computerized physician order entry (CPOE) templates on the subsequent administration of recommended starting doses of opioids, benzodiazepines (BZDs) and non-steroidal anti-inflammatory drugs (NSAIDs) to older adults in the emergency department (ED). METHODS This was a before-after comparison of the frequency of the recommended starting doses of high-risk medications to adults aged 65 years and older. Computerized records were queried for the administration of the above medication classes in two academic EDs over two similar 4-month periods in 2015 and 2016. Between study periods, the doses of high-risk medications on ED CPOE templates were adjusted for older adults based on established pharmacy guidelines and expert consensus. RESULTS There was a significant improvement in the rate of recommended dose administration of all medications of interest (27.3 vs. 32.5%, p < 0.001). Not surprisingly, the medications that were maximally impacted were also those most frequently prescribed, with a significant increase in the recommended dosing of opioids (29.0 vs. 35.2%, p < 0.001) accounting for the majority of the change. Although there were no differences in BZDs as a group, there were significant differences in selected BZDs such as midazolam and diazepam. Changes in the recommended dosing of NSAIDs could not be determined due to low numbers of administered doses in both phases of the study. CONCLUSION Simple changes in the CPOE template resulted in increased administration of the recommended starting doses of high-risk medications to older adults in the ED.
Collapse
Affiliation(s)
- Mitchell Kim
- Department of Emergency Medicine, University of Washington, Box 359702, 325 Ninth Avenue, Seattle, WA, USA.
| | - Stephen J Kaplan
- Division of Gerontology and Geriatric Medicine, Department of Medicine, University of Washington, Harborview Medical Center, Seattle, WA, USA.,Section of General, Thoracic, and Vascular Surgery, Department of Surgery, Virginia Mason Medical Center, Seattle, WA, USA
| | - Steven H Mitchell
- Department of Emergency Medicine, University of Washington, Box 359702, 325 Ninth Avenue, Seattle, WA, USA
| | - Medley Gatewood
- Department of Emergency Medicine, University of Washington, Box 359702, 325 Ninth Avenue, Seattle, WA, USA
| | - Itay Bentov
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, USA
| | - Katherine A Bennett
- Division of Gerontology and Geriatric Medicine, Department of Medicine, University of Washington, Harborview Medical Center, Seattle, WA, USA
| | | | - Paul R Sutton
- Division of General Internal Medicine, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Diane Matsuwaka
- School of Pharmacy, University of Washington, Seattle, WA, USA
| | - Mamatha Damodarasamy
- Division of Gerontology and Geriatric Medicine, Department of Medicine, University of Washington, Harborview Medical Center, Seattle, WA, USA
| | - May J Reed
- Division of Gerontology and Geriatric Medicine, Department of Medicine, University of Washington, Harborview Medical Center, Seattle, WA, USA
| |
Collapse
|
22
|
Kim M, Mitchell SH, Gatewood M, Bennett KA, Sutton PR, Crawford CA, Bentov I, Damodarasamy M, Kaplan SJ, Reed MJ. Older adults and high-risk medication administration in the emergency department. Drug Healthc Patient Saf 2017; 9:105-112. [PMID: 29184448 PMCID: PMC5685141 DOI: 10.2147/dhps.s143341] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Older adults are susceptible to adverse effects from opioids, nonsteroidal anti-inflammatory drugs (NSAIDs), and benzodiazepines (BZDs). We investigated factors associated with the administration of elevated doses of these medications of interest to older adults (≥65 years old) in the emergency department (ED). PATIENTS AND METHODS ED records were queried for the administration of medications of interest to older adults at two academic medical center EDs over a 6-month period. Frequency of recommended versus elevated ("High doses" were defined as doses that ranged between 1.5 and 3 times higher than the recommended starting doses; "very high doses" were defined as higher than high doses) starting doses of medications, as determined by geriatric pharmacy/medicine guidelines and expert consensus, was compared by age groups (65-69, 70-74, 75-79, 80-84, and ≥85 years), gender, and hospital. RESULTS There were 17896 visits representing 11374 unique patients >65 years of age (55.3% men, 44.7% women). A total of 3394 doses of medications of interest including 1678 high doses and 684 very high doses were administered to 1364 different patients. Administration of elevated doses of medications was more common than that of recommended doses. Focusing on opioids and BZDs, the 65-69-year age group was much more likely to receive very high doses (1481 and 412 doses, respectively) than the ≥85-year age groups (relative risk [RR] 5.52, 95% CI 2.56-11.90), mainly reflecting elevated opioid dosing (RR 8.28, 95% CI 3.69-18.57). Men were more likely than women to receive very high doses (RR 1.47, 95% CI 1.26-1.72), primarily due to BZDs (RR 2.12, 95% CI 2.07-2.16). CONCLUSION Administration of elevated doses of opioids and BZDs in the older population occurs frequently in the ED, especially to the 65-69-year age group and men. Further attention to potentially unsafe dosing of high-risk medications to older adults in the ED is warranted.
Collapse
Affiliation(s)
- Mitchell Kim
- Department of Emergency Medicine, University of Washington
| | | | | | - Katherine A Bennett
- Division of Gerontology and Geriatric Medicine, Department of Medicine, University of Washington
| | - Paul R Sutton
- Division of General Internal Medicine, Department of Medicine, University of Washington
| | | | - Itay Bentov
- Department of Anesthesiology and Pain Medicine, University of Washington
| | - Mamatha Damodarasamy
- Division of Gerontology and Geriatric Medicine, Department of Medicine, University of Washington
| | - Stephen J Kaplan
- Section of General, Thoracic and Vascular Surgery, Department of Surgery, Virginia Mason Medical Center, Seattle, WA, USA
| | - May J Reed
- Division of Gerontology and Geriatric Medicine, Department of Medicine, University of Washington
| |
Collapse
|
23
|
Kaplan SJ, Penn K, Koren M, Gross JA, Taitsman LA, Bentov I, Arbabi S, Hough CL, Reed MJ, Pham TN. Paraspinous Muscle Sarcopenia Predicts 1-Year Mortality in Older Adult Trauma Patients: Development and Validation of Prognostic Thresholds. J Am Coll Surg 2017. [DOI: 10.1016/j.jamcollsurg.2017.07.207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
24
|
Janz DR, Semler MW, Joffe AM, Casey JD, Lentz RJ, deBoisblanc BP, Khan YA, Santanilla JI, Bentov I, Rice TW. A Multicenter Randomized Trial of a Checklist for Endotracheal Intubation of Critically Ill Adults. Chest 2017; 153:816-824. [PMID: 28917549 DOI: 10.1016/j.chest.2017.08.1163] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Revised: 08/02/2017] [Accepted: 08/16/2017] [Indexed: 10/18/2022] Open
Abstract
BACKGROUND Hypoxemia and hypotension are common complications during endotracheal intubation of critically ill adults. Verbal performance of a written, preintubation checklist may prevent these complications. We compared a written, verbally performed, preintubation checklist with usual care regarding lowest arterial oxygen saturation or lowest systolic BP experienced by critically ill adults undergoing endotracheal intubation. METHODS A multicenter trial in which 262 adults undergoing endotracheal intubation were randomized to a written, verbally performed, preintubation checklist (checklist) or no preintubation checklist (usual care). The coprimary outcomes were lowest arterial oxygen saturation and lowest systolic BP between the time of procedural medication administration and 2 min after endotracheal intubation. RESULTS The median lowest arterial oxygen saturation was 92% (interquartile range [IQR], 79-98) in the checklist group vs 93% (IQR, 84-100) with usual care (P = .34). The median lowest systolic BP was 112 mm Hg (IQR, 94-133) in the checklist group vs 108 mm Hg (IQR, 90-132) in the usual care group (P = .61). There was no difference between the checklist and usual care in procedure duration (120 vs 118 s; P = .49), number of laryngoscopy attempts (one vs one attempt; P = .42), or severe life-threatening procedural complications (40.8% vs 32.6%; P = .20). CONCLUSIONS The verbal performance of a written, preprocedure checklist does not increase the lowest arterial oxygen saturation or lowest systolic BP during endotracheal intubation of critically ill adults compared with usual care. TRIAL REGISTRY ClinicalTrials.gov; No.: NCT02497729; URL: www.clinicaltrials.gov.
Collapse
Affiliation(s)
- David R Janz
- Department of Medicine, Section of Pulmonary/Critical Care Medicine and Allergy/Immunology, Louisiana State University School of Medicine New Orleans, New Orleans, LA.
| | - Matthew W Semler
- Department of Medicine, Division of Allergy, Pulmonary and Critical Care Medicine, Vanderbilt University School of Medicine, Nashville, TN
| | - Aaron M Joffe
- Department of Anesthesiology and Pain Medicine, University of Washington School of Medicine, Seattle, WA
| | - Jonathan D Casey
- Department of Medicine, Division of Allergy, Pulmonary and Critical Care Medicine, Vanderbilt University School of Medicine, Nashville, TN
| | - Robert J Lentz
- Department of Medicine, Division of Allergy, Pulmonary and Critical Care Medicine, Vanderbilt University School of Medicine, Nashville, TN
| | - Bennett P deBoisblanc
- Department of Medicine, Section of Pulmonary/Critical Care Medicine and Allergy/Immunology, Louisiana State University School of Medicine New Orleans, New Orleans, LA
| | - Yasin A Khan
- Department of Medicine, Section of Pulmonary/Critical Care Medicine and Allergy/Immunology, Louisiana State University School of Medicine New Orleans, New Orleans, LA
| | - Jairo I Santanilla
- Department of Medicine, Section of Pulmonary/Critical Care Medicine and Allergy/Immunology, Louisiana State University School of Medicine New Orleans, New Orleans, LA; Department of Medicine, Section of Emergency Medicine, Louisiana State University School of Medicine New Orleans, New Orleans, LA; Department of Pulmonary and Critical Care Medicine, Ochsner Health System New Orleans, New Orleans, LA
| | - Itay Bentov
- Department of Anesthesiology and Pain Medicine, University of Washington School of Medicine, Seattle, WA
| | - Todd W Rice
- Department of Medicine, Division of Allergy, Pulmonary and Critical Care Medicine, Vanderbilt University School of Medicine, Nashville, TN
| | | | | |
Collapse
|
25
|
Sheffy N, Bentov I, Mills B, Nair BG, Rooke GA, Vavilala MS. Perioperative hypotension and discharge outcomes in non-critically injured trauma patients, a single centre retrospective cohort study. Injury 2017; 48:1956-1963. [PMID: 28733043 DOI: 10.1016/j.injury.2017.06.023] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Revised: 06/20/2017] [Accepted: 06/22/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND There is a lack of information on the effect of age on perioperative care and outcomes after minor trauma in the elderly. We examined the association between perioperative hypotension and discharge outcome among non-critically injured adult patients. METHODS We conducted a retrospective study of non-critically ill patients (ISS <9 or discharged within less than 24h) who received anaesthesia care for surgery and Recovery Room care at a level-1 trauma centre between 5/1/2012 and 11/30/2013. Perioperative hypotension was defined as systolic blood pressure (SBP) <90mmHg (traditional measure) for all patients, and SBP <110mmHg (strict measure) for patients ≥65years. Poor outcome was defined as death or discharge to skilled nursing facility/hospice. RESULTS 1744 patients with mean ISS 4.4 across age groups were included; 169 (10%) were ≥65years. Among patients≥65years, intraoperative hypotension occurred in >75% (131/169, traditional measure) and in >95% (162/169, strict measure); recovery room hypotension occurred in 2% (4/169) and 29% (49/169), respectively. Mean age-adjusted anaesthetic agent concentration (MAC) was similar across age groups. Opioid use decreased from 9.3 (SD 5.7) mg/h morphine equivalents in patients <55years to 6.2 (SD 4.0) mg/h in patients over 85 years. Adjusted for gender, ASA score, anaesthesia duration, morphine equivalent/hr, fluid balance, MAC and surgery type, and using traditional definition, older patients were more likely than patients <55 to experience perioperative hypotension: aRR 1.21, 95% CI 1.11-1.30 for 55-64 and aRR 1.19, 95% CI 1.07-1.32 for ages 65-74. Perioperative hypotension was associated with poor discharge outcome (aRR 1.55; 95% CI 1.04-2.31 and aRR 1.87; 95% CI 1.17-2.98, respectively). CONCLUSION Despite age related reduction in doses of volatile anaesthetic and opioids administered during anaesthesia care, and regardless of hypotension definition used, non-critically injured patients undergoing surgery experience a large perioperative hypotension burden. This burden is higher for patients 55-74 years and older and is a risk factor for poor discharge outcomes, independent of age and ASA status.
Collapse
Affiliation(s)
- Nadav Sheffy
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, United States; Department of Anesthesiology, Rabin Medical Center, Petah Tikva, Israel(2).
| | - Itay Bentov
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, United States
| | - Brianna Mills
- Harborview Injury Prevention and Research Center, Seattle, WA, United States; Department of Epidemiology, University of Washington, Seattle, WA, United States; Center for Studies in Demography and Ecology, University of Washington, Seattle, WA, United States
| | - Bala G Nair
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, United States; Harborview Injury Prevention and Research Center, Seattle, WA, United States
| | - G Alec Rooke
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, United States
| | - Monica S Vavilala
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, United States; Harborview Injury Prevention and Research Center, Seattle, WA, United States
| |
Collapse
|
26
|
Hayanga HK, Barnett DJ, Shallow NR, Roberts M, Thompson CB, Bentov I, Demiralp G, Winters BD, Schwengel DA. Anesthesiologists and Disaster Medicine: A Needs Assessment for Education and Training and Reported Willingness to Respond. Anesth Analg 2017; 124:1662-1669. [PMID: 28431426 DOI: 10.1213/ane.0000000000002002] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Anesthesiologists provide comprehensive health care across the emergency department, operating room, and intensive care unit. To date, anesthesiologists' perspectives regarding disaster medicine and public health preparedness have not been described. METHODS Anesthesiologists' thoughts and attitudes were assessed via a Web-based survey at 3 major academic institutions. Frequencies, percentages, and odds ratios (ORs) were used to assess self-reported perceptions of knowledge and skills, as well as attitudes and beliefs regarding education and training, employee development, professional obligation, safety, psychological readiness, efficacy, personal preparedness, and willingness to respond (WTR). Three representative disaster scenarios (natural disaster [ND], radiological event [RE], and pandemic influenza [PI]) were investigated. Results are reported as percent or OR (95% confidence interval). RESULTS Participants included 175 anesthesiology attendings (attendings) and 95 anesthesiology residents (residents) representing a 47% and 51% response rate, respectively. A minority of attendings indicated that their hospital provides adequate pre-event preparation and training (31% [23-38] ND, 14% [9-21] RE, and 40% [31-49] PI). Few residents felt that their residency program provided them with adequate preparation and training (22% [14-33] ND, 16% [8-27] RE, and 17% [9-29] PI). Greater than 85% of attendings (89% [84-94] ND, 88% [81-92] RE, and 87% [80-92] PI) and 70% of residents (81% [71-89] ND, 71% [58-81] RE, and 82% [70-90] PI) believe that their hospital or residency program, respectively, should provide them with preparation and training. Approximately one-half of attendings and residents are confident that they would be safe at work during response to a ND or PI (55% [47-64] and 58% [49-67] of attendings; 59% [48-70] and 48% [35-61] of residents, respectively), whereas approximately one-third responded the same regarding a RE (31% [24-40] of attendings and 28% [18-41] of residents). Fewer than 40% of attendings (34% [26-43]) and residents (38% [27-51]) designated who would take care of their family obligations in the event they were called into work during a disaster. Regardless of severity, 79% (71-85) of attendings and 73% (62-82) of residents indicated WTR to a ND, whereas 81% (73-87) of attendings and 70% (58-81) of residents indicated WTR to PI. Fewer were willing to respond to a RE (63% [55-71] of attendings and 52% [39-64] of residents). In adjusted logistic regression analyses, those anesthesiologists who reported knowing one's role in response to a ND (OR, 15.8 [4.5-55.3]) or feeling psychologically prepared to respond to a ND (OR, 6.9 [2.5-19.0]) were found to be more willing to respond. Similar results were found for RE and PI constructs. Both attendings and residents were willing to respond in whatever capacity needed, not specifically to provide anesthesia. CONCLUSIONS Few anesthesiologists reported receiving sufficient education and training in disaster medicine and public health preparedness. Providing education and training and enhancing related employee services may further bolster WTR and help to build a more capable and effective medical workforce for disaster response.
Collapse
Affiliation(s)
- Heather K Hayanga
- From the *Division of Cardiac Anesthesiology, Department of Anesthesiology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania; †Department of Environmental Health Sciences, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; ‡Independent Contractor at Natasha Shallow MD SC, Brookfield, Wisconsin; §Department of Anesthesiology, The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma; ‖Johns Hopkins Bloomberg School of Public Health Biostatistics Center, Baltimore, Maryland; ¶Department of Anesthesiology and Pain Medicine, Harborview Medical Center, University of Washington Medical Center, Seattle, Washington; and #Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins Hospital, Baltimore, Maryland
| | | | | | | | | | | | | | | | | |
Collapse
|
27
|
Bentov I, Damodarasamy M, Spiekerman C, Reed MJ. Lidocaine Impairs Proliferative and Biosynthetic Functions of Aged Human Dermal Fibroblasts. Anesth Analg 2017; 123:616-23. [PMID: 27537755 DOI: 10.1213/ane.0000000000001422] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND The aged are at increased risk of postoperative wound healing complications. Because local anesthetics are infiltrated commonly into the dermis of surgical wounds, we sought to determine whether local anesthetics adversely affect proliferative and biosynthetic functions of dermal fibroblasts. We also evaluated the effect of local anesthetics on insulin-like growth factor-1 (IGF-1) and transforming growth factor-β1 (TGF-β1), growth factors that are important regulators of wound healing. METHODS Human dermal fibroblasts (HFB) from aged and young donors were exposed to local anesthetic agents at clinically relevant concentrations. We screened the effects of lidocaine, bupivacaine, mepivacaine, and ropivacaine on proliferation of HFB. Lidocaine was most detrimental to proliferation in HFB. We then evaluated the effect of lidocaine on expression and function of the growth factors, IGF-1 and TGF-β1. Lastly, concurrent exposure to lidocaine and IGF-1 or TGF-β1 was evaluated for their effects on proliferation and expression of dermal collagens, respectively. RESULTS Lidocaine and mepivacaine inhibited proliferation in aged HFB (for lidocaine 88% of control, 95% confidence interval [CI], 80%-98%, P = .009 and for mepivacaine 90% of control, 95% CI, 81%-99%, P = .032) but not in young HFB. Ropivacaine and bupivacaine did not inhibit proliferation. Because of the clinical utility of lidocaine relative to mepivacaine, we focused on lidocaine. Lidocaine decreased proliferation in aged HFB, which was abrogated by IGF-1. Lidocaine inhibited transcripts for IGF-1 and insulin-like growth factor-1 receptor (IGF1R) in fibroblasts from aged donors (IGF-1, log2 fold-change -1.25 [42% of control, 95% CI, 19%-92%, P = .035] and IGF1R, log2 fold-change -1.00 [50% of control, 95% CI, 31%-81%, P = .014]). In contrast, lidocaine did not affect the expression of IGF-1 or IGF1R transcripts in the young HFB. Transcripts for collagen III were decreased after lidocaine exposure in aged and young HFB (log2 fold-change -1.28 [41% of control, 95% CI, 20%-83%, P = .022] in aged HFB and log2 fold-change -1.60 [33% of control, 95% CI, 15%-73%, P = .019] in young HFB). Transcripts for collagen I were decreased in aged HFB (log2 fold-change -1.82 [28% of control, 95% CI, 14%-58%, P = .006]) but not in the young HFB. Similar to the transcripts, lidocaine also inhibited the protein expression of collagen III in young and aged HFB (log2 fold-change -1.79 [29% of control, 95% CI, 18%-47%, P = .003] in young HFB and log2 fold-change -1.76 [30% of control, 95% CI, 9%-93%, P = .043] in aged HFB). The effect of lidocaine on the expression of collagen III protein was obviated by TGF-β1 in both young and aged HFB. CONCLUSIONS Our results show that lidocaine inhibits processes relevant to dermal repair in aged HFB. The detrimental responses to lidocaine are due, in part, to interactions with IGF-1 and TGF-β1.
Collapse
Affiliation(s)
- Itay Bentov
- From the *Department of Anesthesiology and Pain Medicine and †Division of Gerontology and Geriatric Medicine, Department of Medicine, Harborview Medical Center, University of Washington, Seattle, Washington; and ‡Center for Biomedical Statistics, Institute for Translational Health Sciences, University of Washington, Seattle, Washington
| | | | | | | |
Collapse
|
28
|
Reed MJ, Vernon RB, Damodarasamy M, Chan CK, Wight TN, Bentov I, Banks WA. Microvasculature of the Mouse Cerebral Cortex Exhibits Increased Accumulation and Synthesis of Hyaluronan With Aging. J Gerontol A Biol Sci Med Sci 2017; 72:740-746. [PMID: 28482035 PMCID: PMC6075594 DOI: 10.1093/gerona/glw213] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [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: 05/18/2016] [Accepted: 10/10/2016] [Indexed: 01/28/2023] Open
Abstract
The microvasculature of the aged brain is less dense and more vulnerable to dysfunction than that of the young brain. Brain microvasculature is supported by its surrounding extracellular matrix, which is comprised largely of hyaluronan (HA). HA is continually degraded into lower molecular weight forms that induce neuroinflammation. We examined HA associated with microvessels (MV) of the cerebral cortex of young (4 months), middle-aged (14 months), and aged (24-26 months) mice. We confirmed that the density of cortical MV decreased with age. Perivascular HA levels increased with age, but there was no age-associated change in HA molecular weight profile. MV isolated from aged cortex had more HA than MV from young cortex. Examination of mechanisms that might account for elevated HA levels with aging showed increased HA synthase 2 (HAS2) mRNA and protein in aged MV relative to young MV. In contrast, mRNAs for HA-degrading hyaluronidases or hyaladherins that mitigate HA degradation showed no changes with age. Corresponding to increased HAS2, aged MV synthesized significantly more HA (of all molecular weight classes) in vitro than young MV. We propose that increased HA synthesis and accumulation in brain MV contributes to neuroinflammation and reduced MV density and function in aging.
Collapse
Affiliation(s)
- May J Reed
- Department of Medicine, University of Washington, Seattle
| | - Robert B Vernon
- Matrix Biology Program, Benaroya Research Institute at Virginia Mason, Seattle, Washington
| | | | - Christina K Chan
- Matrix Biology Program, Benaroya Research Institute at Virginia Mason, Seattle, Washington
| | - Thomas N Wight
- Matrix Biology Program, Benaroya Research Institute at Virginia Mason, Seattle, Washington
| | - Itay Bentov
- Department of Anesthesia and Pain Medicine, University of Washington, Seattle
| | - William A Banks
- Department of Medicine, University of Washington, Seattle
- VA Puget Sound Health Care System, Geriatric Research Education and Clinical Center, Seattle, Washington
| |
Collapse
|
29
|
Kaplan SJ, Pham TN, Arbabi S, Gross JA, Damodarasamy M, Bentov I, Taitsman LA, Mitchell SH, Reed MJ. Association of Radiologic Indicators of Frailty With 1-Year Mortality in Older Trauma Patients: Opportunistic Screening for Sarcopenia and Osteopenia. JAMA Surg 2017; 152:e164604. [PMID: 28030710 DOI: 10.1001/jamasurg.2016.4604] [Citation(s) in RCA: 86] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Importance Assessment of physical frailty in older trauma patients admitted to the intensive care unit is often not feasible using traditional frailty assessment instruments. The use of opportunistic computed tomography (CT) scans to assess sarcopenia and osteopenia as indicators of underlying frailty may provide complementary prognostic information on long-term outcomes. Objective To determine whether sarcopenia and/or osteopenia are associated with 1-year mortality in an older trauma patient population. Design, Setting, and Participants A retrospective cohort constructed from a state trauma registry was linked to the statewide death registry and Comprehensive Hospital Abstract Reporting System for readmission data analyses. Admission abdominopelvic CT scans from patients 65 years and older admitted to the intensive care unit of a single level I trauma center between January 2011 and May 2014 were analyzed to identify patients with sarcopenia and/or osteopenia. Patients with a head Injury Severity Score of 3 or greater, an out-of-state address, or inadequate CT imaging or who died within 24 hours of admission were excluded. Exposures Sarcopenia and/or osteopenia, assessed via total cross-sectional muscle area and bone density at the L3 vertebral level, compared with a group with no sarcopenia or osteopenia. Main Outcomes and Measures One-year all-cause mortality. Secondary outcomes included 30-day all-cause mortality, 30-day readmission, hospital length of stay, hospital cost, and discharge disposition. Results Of the 450 patients included in the study, 269 (59.8%) were male and 394 (87.6%) were white. The cohort was split into 4 groups: 74 were retrospectively diagnosed with both sarcopenia and osteopenia, 167 with sarcopenia only, 48 with osteopenia only, and 161 with no radiologic indicators. Among the 408 who survived to discharge, sarcopenia and osteopenia were associated with higher risks of 1-year mortality alone and in combination. After adjustment, the hazard ratio was 9.4 (95% CI, 1.2-75.4; P = .03) for sarcopenia and osteopenia, 10.3 (95% CI, 1.3-78.8; P = .03) for sarcopenia, and 11.9 (95% CI, 1.3-107.4; P = .03) for osteopenia. Conclusions and Relevance More than half of older trauma patients in this study had sarcopenia, osteopenia, or both. Each factor was independently associated with increased 1-year mortality. Given the prevalent use of abdominopelvic CT in trauma centers, opportunistic screening for radiologic indicators of frailty provides an additional tool for early identification of older trauma patients at high risk for poor outcomes, with the potential for targeted interventions.
Collapse
Affiliation(s)
- Stephen J Kaplan
- Section of General, Thoracic, and Vascular Surgery, Department of Surgery, Virginia Mason Medical Center, Seattle, Washington2Division of Gerontology and Geriatric Medicine, Department of Medicine, Harborview Medical Center, University of Washington, Seattle
| | - Tam N Pham
- Division of Trauma, Burn, and Critical Care Surgery, Department of Surgery, Harborview Medical Center, University of Washington, Seattle
| | - Saman Arbabi
- Division of Trauma, Burn, and Critical Care Surgery, Department of Surgery, Harborview Medical Center, University of Washington, Seattle
| | - Joel A Gross
- Department of Radiology, Harborview Medical Center, University of Washington, Seattle
| | - Mamatha Damodarasamy
- Division of Gerontology and Geriatric Medicine, Department of Medicine, Harborview Medical Center, University of Washington, Seattle
| | - Itay Bentov
- Department of Anesthesiology and Pain Medicine, Harborview Medical Center, University of Washington, Seattle
| | - Lisa A Taitsman
- Department of Orthopaedics and Sports Medicine, Harborview Medical Center, University of Washington, Seattle
| | - Steven H Mitchell
- Division of Emergency Medicine, Department of Medicine, Harborview Medical Center, University of Washington, Seattle
| | - May J Reed
- Division of Gerontology and Geriatric Medicine, Department of Medicine, Harborview Medical Center, University of Washington, Seattle
| |
Collapse
|
30
|
Abstract
Aging is associated with a progressive loss of function in all organs. Under normal conditions the physiologic compensation for age-related deficits is sufficient, but during times of stress the limitations of this reserve become evident. Explanations for this reduction in reserve include the changes in the microcirculation that occur during the normal aging process. The microcirculation is defined as the blood flow through arterioles, capillaries and venules, which are the smallest vessels in the vasculature and are embedded within organs and tissues. Optimal strategies to maintain the microvasculature following surgery and other stressors must use multifactorial approaches. Using skin as the model organ, we will review the anatomical and functional changes in the microcirculation with aging, and some of the available clinical strategies to potentially mitigate the effect of these changes on important clinical outcomes.
Collapse
Affiliation(s)
- Itay Bentov
- Department of Anesthesiology and Pain Medicine, Harborview Medical Center, University of Washington, Seattle, USA.
| | - May J Reed
- Division of Gerontology and Geriatric Medicine, Department of Medicine, Harborview Medical Center, University of Washington, Seattle, USA
| |
Collapse
|
31
|
Damodarasamy M, Johnson RS, Bentov I, MacCoss MJ, Vernon RB, Reed MJ. Hyaluronan enhances wound repair and increases collagen III in aged dermal wounds. Wound Repair Regen 2015; 22:521-6. [PMID: 25041621 DOI: 10.1111/wrr.12192] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2013] [Accepted: 04/02/2014] [Indexed: 12/29/2022]
Abstract
Age-related changes in the extracellular matrix contribute to delayed wound repair in aging. Hyaluronan, a linear nonsulfated glycosaminoglycan, promotes synthesis and assembly of key extracellular matrix components, such as the interstitial collagens, during wound healing. The biological effects of hyaluronan are mediated, in part, by hyaluronan size. We have previously determined that dermal wounds in aged mice, relative to young mice, have deficits in the generation of lower molecular weight hyaluronan (defined as <300 kDa). Here, we tested the effect of exogenous hyaluronan of 2, 250, or 1,000 kDa sizes on full-thickness excisional wounds in aged mice. Only wounds treated with 250 kDa hyaluronan (HA250) were significantly improved over wounds that received carrier (water) alone. Treatment with HA250 was associated with increased expression of transcripts for the hyaluronan receptors CD44 and RHAMM, as well as collagens III and I. Analyses of dermal protein content by mass spectrometry and Western blotting confirmed significantly increased expression of collagen III in wounds treated with HA250 relative to control wounds. In summary, we find that HA250 improves wound repair and increases the synthesis of collagen III in aged dermal wounds.
Collapse
|
32
|
Bentov I, Damodarasamy M, Plymate S, Reed MJ. Decreased proliferative capacity of aged dermal fibroblasts in a three dimensional matrix is associated with reduced IGF1R expression and activation. Biogerontology 2014; 15:329-37. [PMID: 24770843 DOI: 10.1007/s10522-014-9501-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2013] [Accepted: 04/10/2014] [Indexed: 12/21/2022]
Abstract
Skin aging results in increased susceptibility to injury and impaired wound healing. Proliferation of fibroblasts is reduced in aged dermis, which contributes to delays in wound closure. Age-associated differences are regulated, in part, by local or systemic factors such as the IGF-1/IGF1R system. The aim of this study was to determine if expression and activation of IGF1R in aged human dermal fibroblasts, when compared to young fibroblasts, is associated with altered proliferative capacity in a 3D collagen matrix that better simulates the dermal extracellular matrix in vivo. The proliferation of young and aged human dermal fibroblasts in 3D collagen and its association with baseline levels of IGF1R expression were measured. The effect of stimulation and inhibition of Erk phosphorylation on the proliferative capacity of fibroblasts in a 3D collagen matrix was defined. Our results show that proliferation and Erk phosphorylation is reduced in aged dermal fibroblasts relative to young fibroblasts. Activation of Erk phosphorylation in aged fibroblasts is associated with a significant increase in fibroblast proliferation in 3D collagen.
Collapse
Affiliation(s)
- Itay Bentov
- Department of Anesthesiology and Pain Medicine, Harborview Medical Center, University of Washington, Box 359724, 325 Ninth Avenue, Seattle, WA, 98104, USA,
| | | | | | | |
Collapse
|
33
|
Bentov I, Damodarasamy M, Plymate S, Reed MJ. B16/F10 tumors in aged 3D collagen in vitro simulate tumor growth and gene expression in aged mice in vivo. In Vitro Cell Dev Biol Anim 2013; 49:395-9. [PMID: 23661088 DOI: 10.1007/s11626-013-9623-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2012] [Accepted: 04/16/2013] [Indexed: 10/26/2022]
Abstract
Although the incidence of cancer rises with age, tumor growth is often slowed in older hosts. The B16/F10 melanoma cell line is commonly used in murine models of age-related tumor growth suppression. We wished to determine if the growth pattern and gene expression of B16/10 tumors grown in aged mice could be simulated in 3D collagen matrices derived from aged mice. Outcome measures were tumor size in vitro and gene expression of the key growth regulatory molecules: growth hormone receptor (GHR), IL-10Rβ, IL-4Rα, and IL-6. B16/F10 tumors were grown in 20-25-mo-old C57/BL6 male mice. Tumor sizes ranged from 30 to 4,910 mg in vivo. Tumors from a subset of mice were removed after euthanasia, and equivalent amounts of each tumor were placed in aged 3D collagen and grown for 5 d. Tumor sizes in aged 3D collagen correlated highly with their original tumor size in vivo. Gene expression changes noted in vivo were also maintained during tumor growth in aged 3D collagen in vitro. The relative expression of GHR was increased, IL-10Rβ was unchanged, and IL-4Rα and IL-6 were decreased in the larger tumors relative to the smaller tumors in vitro, in a pattern similar to that noted in vivo. We propose that 3D matrices from aged mice provide an in vitro model of tumor growth that correlates highly with tumor size and expression of key regulatory molecules in vivo.
Collapse
Affiliation(s)
- Itay Bentov
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, USA
| | | | | | | |
Collapse
|
34
|
Schayek H, Bentov I, Jacob-Hirsch J, Yeung C, Khanna C, Helman LJ, Plymate SR, Werner H. Global methylation analysis identifies PITX2 as an upstream regulator of the androgen receptor and IGF-I receptor genes in prostate cancer. Horm Metab Res 2012; 44:511-9. [PMID: 22495974 DOI: 10.1055/s-0032-1311566] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [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] [Indexed: 10/28/2022]
Abstract
The insulin-like growth factor-I (IGF-IR) and androgen (AR) receptors are important players in prostate cancer. Functional interactions between the IGF-I and androgen signaling pathways have crucial roles in the progression of prostate cancer from early to advanced stages. DNA methylation is a major epigenetic alteration affecting gene expression. Hypermethylation of tumor suppressor promoters is a frequent event in human cancer, leading to inactivation and repression of specific genes. The aim of the present study was to identify the entire set of methylated genes ("methylome") in a cellular model that replicates prostate cancer progression. The methylation profiles of the P69 (early stage, benign) and M12 (advanced stage, metastatic) prostate cancer cell lines were established by treating cells with the demethylating agent 5-aza-2'-deoxycytidine (5-Aza) followed by DNA microarray analysis. Comparative genome-wide methylation analyses of 5-Aza-treated versus untreated cells identified 297 genes overexpressed in P69 and 191 genes overexpressed in M12 cells. 102 genes were upregulated in both benign and metastatic cell lines. In addition, our analyses identified the PITX2 gene as a master regulator upstream of the AR and IGF-IR genes. The PITX2 promoter was semi-methylated in P69 cells but fully methylated (i. e., silenced) in M12 cells. Epigenetic regulation of PITX2 during the course of the disease may lead to orchestrated control of the AR and IGF signaling pathways. In summary, our results provide new insights into the epigenetic changes associated with progression of prostate cancer from an organ confined, androgen-sensitive disorder to an aggressive, androgen-insensitive disease.
Collapse
Affiliation(s)
- H Schayek
- Department of Human Molecular Genetics and Biochemistry, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | | | | | | | | | | | | |
Collapse
|
35
|
Attias-Geva Z, Bentov I, Kidron D, Amichay K, Sarfstein R, Fishman A, Bruchim I, Werner H. p53 Regulates insulin-like growth factor-I receptor gene expression in uterine serous carcinoma and predicts responsiveness to an insulin-like growth factor-I receptor-directed targeted therapy. Eur J Cancer 2011; 48:1570-80. [PMID: 22033326 DOI: 10.1016/j.ejca.2011.09.014] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2011] [Revised: 09/02/2011] [Accepted: 09/14/2011] [Indexed: 01/22/2023]
Abstract
The role of the insulin-like growth factors (IGF) in endometrial cancer has been well established. The IGF-I receptor (IGF-IR), which mediates the biological actions of IGF-I, is usually overexpressed in endometrial tumours. Uterine serous carcinoma (USC) constitutes a defined histological category among endometrial cancers. Mutation of the p53 gene appears early in the course of the disease and is considered a key event in the initiation of USC. The aim of the present study was to evaluate the potential interactions between p53 and the IGF-IR in USC. In addition, we investigated the role of p53 as a biomarker in IGF-IR targeted therapies. Immunohistochemical analysis in a collection of 35 USC specimens revealed that IGF-IR is highly expressed in primary and metastatic USC. Likewise, p53 was expressed in 85.7% of primary tumours and 100% of metastases. A significant negative correlation between p53 expression and survival was noticed. In addition, using USC-derived cell lines we provide evidence that p53 regulates IGF-IR gene expression via a mechanism that involves repression of the IGF-IR promoter. We show that the mechanism of action of p53 involves interaction with zinc finger protein Sp1, a potent transactivator of the IGF-IR gene. Finally, we demonstrate that USC tumours overexpressing p53 are more likely to benefit from anti-IGF-IR therapies. In summary, we provide evidence that p53 regulates IGF-IR gene expression in USC cells via a mechanism that involves repression of the IGF-IR promoter. The interplay between the p53 and IGF-I signalling pathways is of major basic and translational relevance.
Collapse
Affiliation(s)
- Zohar Attias-Geva
- Department of Human Molecular Genetics and Biochemistry, Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
| | | | | | | | | | | | | | | |
Collapse
|
36
|
Attias-Geva Z, Bentov I, Ludwig DL, Fishman A, Bruchim I, Werner H. Insulin-like growth factor-I receptor (IGF-IR) targeting with monoclonal antibody cixutumumab (IMC-A12) inhibits IGF-I action in endometrial cancer cells. Eur J Cancer 2011; 47:1717-26. [PMID: 21450456 DOI: 10.1016/j.ejca.2011.02.019] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2010] [Revised: 02/22/2011] [Accepted: 02/25/2011] [Indexed: 12/20/2022]
Abstract
Specific insulin-like growth factor-I receptor (IGF-IR) targeting emerged in recent years as a promising therapeutic strategy in cancer. Endometrial cancer is the most common gynaecological cancer in the Western world. The aim of this study was to evaluate the potential of cixutumumab (IMC-A12, ImClone Systems), a fully human monoclonal antibody against the IGF-IR, to inhibit IGF-I-mediated biological actions and cell signalling events in four endometrial carcinoma-derived cell lines (ECC-1, Ishikawa, USPC-1 and USPC-2). Our results demonstrate that cixutumumab was able to block the IGF-I-induced autophosphorylation of the IGF-IR. In addition, the PI3K and MAPK downstream signalling pathways were also inactivated by cixutumumab in part of the cell lines. Prolonged (24h and 48h) exposures to cixutumumab reduced IGF-IR expression. Furthermore, confocal microscopy of GFP-tagged receptors shows that cixutumumab treatment led to IGF-IR redistribution from the cell membrane to the cytoplasm. Antiapoptotic effects were evaluated by cleavage of caspase 3 and PARP, and mitogenicity and transformation by proliferation and cell cycle assays. Results obtained showed that cixutumumab abrogated the IGF-I-stimulated increase in proliferation rate, and increased caspase-3 and PARP cleavage, two markers of apoptosis. Of importance, cixutumumab had no effect neither on insulin receptor (IR) expression nor on IGF-I activation of IR. In summary, in a cellular model of endometrial cancer cixutumumab was able to inhibit the IGF-I-induced activation of intracellular cascades, apoptosis and proliferation.
Collapse
Affiliation(s)
- Zohar Attias-Geva
- Department of Human Molecular Genetics and Biochemistry, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | | | | | | | | |
Collapse
|
37
|
Attias-Geva Z, Bentov I, Fishman A, Werner H, Bruchim I. Insulin-like growth factor-I receptor inhibition by specific tyrosine kinase inhibitor NVP-AEW541 in endometrioid and serous papillary endometrial cancer cell lines. Gynecol Oncol 2011; 121:383-9. [PMID: 21295335 DOI: 10.1016/j.ygyno.2011.01.008] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2010] [Revised: 12/27/2010] [Accepted: 01/05/2011] [Indexed: 01/06/2023]
Abstract
PURPOSE The role of the insulin-like growth factor (IGF) system in endometrial cancer has been well established. The IGF-I receptor (IGF-IR) emerged as a promising therapeutic target in a number of cancers. NVP-AEW541 (Novartis Pharma) is a pyrrolo(2,3-d)pyrimidine derivative with specific IGF-IR tyrosine kinase inhibitory activity. NVP-AEW541 has been shown to abrogate IGF-I-mediated IGF-IR autophosphorylation and to reduce activation of the IGF-IR signaling pathways. The aim of the present study was to investigate the anti-proliferative activity of NVP-AEW541 in Type I (endometrioid) and Type II (uterine serous papillary endometrial carcinoma, USPC) endometrial cancer cell lines. METHODS Type I (ECC-1, Ishikawa) and Type II (USPC-1, USPC-2) endometrial cancer cell lines were treated with NVP-AEW541 in the presence of IGF-I, and the following parameters were measured: IGF-IR, AKT and ERK phosphorylation, apoptosis, proliferation, cell cycle progression and IGF-IR internalization. RESULTS Results obtained showed that NVP-AEW541 abolished the IGF-I stimulated IGF-IR phosphorylation in all of the cell lines investigated, whereas it abolished AKT and ERK phosphorylation preferentially in ECC-1 and USPC-1 cells. Furthermore, the inhibitor prevented from IGF-I from exerting its antiapoptotic effect in ECC-1, USPC-1 and USPC-2 cells. In addition, proliferation assays showed that NVP-AEW541 caused a decrease in proliferation rate in all of the cell lines. NVP-AEW541 had no major effect on the insulin receptor. CONCLUSION Our results suggest that specific IGF-IR inhibition by NVP-AEW541 might be a promising therapeutic tool in endometrial cancer.
Collapse
Affiliation(s)
- Zohar Attias-Geva
- Department of Human Molecular Genetics and Biochemistry, Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
| | | | | | | | | |
Collapse
|
38
|
Schayek H, Bentov I, Sun S, Plymate SR, Werner H. Progression to metastatic stage in a cellular model of prostate cancer is associated with methylation of the androgen receptor gene and transcriptional suppression of the insulin-like growth factor-I receptor gene. Exp Cell Res 2010; 316:1479-88. [PMID: 20338164 PMCID: PMC2873092 DOI: 10.1016/j.yexcr.2010.03.007] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [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: 09/02/2009] [Revised: 02/21/2010] [Accepted: 03/09/2010] [Indexed: 01/08/2023]
Abstract
The progression of prostate cancer from an organ-confined, androgen-sensitive disease to a metastatic one is associated with dysregulation of androgen receptor (AR)-regulated target genes and with a decrease in insulin-like growth factor-I receptor (IGF1R) expression. DNA methylation of CpG islands is an epigenetic mechanism associated with gene silencing. Recent studies have demonstrated that methylation occurs early in prostate carcinogenesis and, furthermore, may contribute to androgen independence. The methylation status of the AR and IGF1R genes was evaluated in a series of prostate cancer cell lines corresponding to early (benign) and advanced (metastatic) stages of the disease. Results of 5-Aza-2'-deoxycytidine (5-Aza) experiments, methylation-specific PCR, and sodium bisulfite-direct DNA sequencing revealed that the AR promoter is hypermethylated in metastatic M12, but not in benign P69, cells. On the other hand, no methylation was seen in the IGF1R promoter at any stage of the disease. We show, however, that 5-Aza treatment, which caused demethylation of the AR promoter, led to a significant increase in IGF1R mRNA levels, whereas addition of the AR inhibitor flutamide decreased the IGF1R mRNA levels to basal values measured prior to the 5-Aza treatment. Given that the IGF1R gene has been identified as a downstream target for AR action, our data is consistent with a model in which the AR gene undergoes methylation during progression of the disease, leading to dysregulation of AR targets, including the IGF1R gene, at advanced metastatic stages.
Collapse
MESH Headings
- Androgen Antagonists/pharmacology
- Androgens/pharmacology
- Azacitidine/analogs & derivatives
- Azacitidine/pharmacology
- Blotting, Western
- CpG Islands/genetics
- DNA Methylation
- DNA Modification Methylases/antagonists & inhibitors
- Decitabine
- Dihydrotestosterone
- Disease Progression
- Down-Regulation
- Enzyme Inhibitors/pharmacology
- Flutamide/pharmacology
- Gene Expression Regulation, Neoplastic
- Humans
- Male
- Promoter Regions, Genetic/genetics
- Prostatic Neoplasms/genetics
- Prostatic Neoplasms/metabolism
- Prostatic Neoplasms/secondary
- RNA, Messenger/genetics
- RNA, Messenger/metabolism
- Receptor, IGF Type 1/genetics
- Receptor, IGF Type 1/metabolism
- Receptors, Androgen/genetics
- Receptors, Androgen/metabolism
- Reverse Transcriptase Polymerase Chain Reaction
- Transcription, Genetic
- Tumor Cells, Cultured
Collapse
Affiliation(s)
- Hagit Schayek
- Department of Human Molecular Genetics and Biochemistry, Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
| | - Itay Bentov
- Department of Human Molecular Genetics and Biochemistry, Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
| | - Shihua Sun
- Departments of Medicine, Gerontology and Geriatric Medicine, University of Washington, Seattle, WA 98104, U.S.A
| | - Stephen R. Plymate
- Departments of Medicine, Gerontology and Geriatric Medicine, University of Washington, Seattle, WA 98104, U.S.A
| | - Haim Werner
- Department of Human Molecular Genetics and Biochemistry, Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
| |
Collapse
|
39
|
Schayek H, Bentov I, Rotem I, Pasmanik-Chor M, Ginsberg D, Plymate SR, Werner H. Transcription factor E2F1 is a potent transactivator of the insulin-like growth factor-I receptor (IGF-IR) gene. Growth Horm IGF Res 2010; 20:68-72. [PMID: 19703789 DOI: 10.1016/j.ghir.2009.08.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [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: 05/01/2009] [Revised: 07/29/2009] [Accepted: 08/03/2009] [Indexed: 01/19/2023]
Abstract
OBJECTIVES The insulin-like growth factor-I receptor (IGF-IR) plays an important role in cancer development. The E2F1 transcription factor activates S-phase promoting genes and mediates apoptosis. Microarray analyses of E2F1-induced genes revealed that genes associated with proliferation as well as apoptosis are upregulated by E2F1. Among other candidate genes, DNA microarrays identified the IGF-IR gene as a putative E2F1 target. The aim of this study was to investigate the involvement of E2F1 in regulation of IGF-IR gene transcription. METHODS To examine the potential regulation of IGF-IR gene expression by E2F1, an E2F1 expression vector was transfected into P69 and M12 prostate cancer cell lines, after which IGF-IR levels were measured by Western blots. Transient transfections were used to evaluate IGF-IR promoter activity and chromatin immunoprecipitation (ChIP) assays were employed to assess E2F1-binding to the IGF-IR promoter. RESULTS Results obtained showed that E2F1 expression induced a significant increment in endogenous IGF-IR levels. ChIP assays showed enhanced E2F1-binding to the IGF-IR promoter in E2F1-expressing cells. Transient coexpression of an E2F1 vector along with an IGF-IR promoter-luciferase reporter resulted in a approximately 140-fold increase in IGF-IR promoter activity. Furthermore, deletion and bioinformatic analyses indicate that the ability of E2F1 to stimulate IGF-IR promoter activity was correlated with the number of E2F1 sites in the promoter region. CONCLUSIONS In summary, we provide evidence that E2F1 regulates IGF-IR gene transcription in prostate cancer cells via a mechanism that involves direct binding to specific elements in the proximal IGF-IR promoter.
Collapse
Affiliation(s)
- Hagit Schayek
- Department of Human Molecular Genetics and Biochemistry, Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
| | | | | | | | | | | | | |
Collapse
|
40
|
Bentov I, Narla G, Schayek H, Akita K, Plymate SR, LeRoith D, Friedman SL, Werner H. Insulin-like growth factor-i regulates Kruppel-like factor-6 gene expression in a p53-dependent manner. Endocrinology 2008; 149:1890-7. [PMID: 18174288 DOI: 10.1210/en.2007-0844] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [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] [Indexed: 12/27/2022]
Abstract
High-circulating IGF-I concentrations are associated with an increased risk for breast, prostate, and colorectal cancer. Krüppel-like factor-6 (KLF6) is a zinc finger tumor suppressor inactivated in prostate and other types of cancer. We have previously demonstrated that KLF6 is a potent transactivator of the IGF-I receptor promoter. The aim of the present study was to examine the potential regulation of KLF6 gene expression by IGF-I. The human colon cancer cell lines HCT116 +/+ and -/- (with normal and disrupted p53, respectively) were treated with IGF-I. Western blots, quantitative RT-PCR, and transfection assays were used to evaluate the effect of IGF-I on KLF-6 production. Signaling pathway inhibitors were used to identify the mechanisms responsible for regulation of KLF6 expression. Small interfering RNA against p53 and KLF6 was used to assess the role of p53 in regulation of KLF6 expression by IGF-I and to evaluate KLF6 involvement in cell cycle control. Results obtained showed that IGF-I stimulated KLF-6 transcription in cells with normal, but not disrupted, p53, suggesting that KLF6 is a downstream target for IGF-I action. Stimulation of KLF6 expression by IGF-I in a p53-dependent manner may constitute a novel mechanism of action of IGF-I, with implications in normal cell cycle progression and cancer biology.
Collapse
Affiliation(s)
- Itay Bentov
- Department of Human Molecular Genetics and Biochemistry, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | | | | | | | | | | | | |
Collapse
|
41
|
Abstract
Insulin and the insulin-like growth factors (IGF-I, IGF-II) are pleiotropic hormones that have multiple roles in regulating vital metabolic and developmental processes. Although most early data suggested that insulin is mainly involved in metabolic activities (e.g. control of sugar levels) and IGF-I/II control growth and differentiation events (e.g. bone elongation, cell division), today, it is clear that there is cross-talk between the various ligands and receptors of the IGF family. As a result of these complex interactions, the spectrum of activities that were classically assigned to insulin or IGF-I/II has greatly expanded, and the signalling events mediated by the insulin and IGF receptors is the subject of intensive research. This review provides a comparative analysis of the structures, receptors, and signalling pathways of insulin and IGF-I.
Collapse
Affiliation(s)
- Haim Werner
- Department of Human Molecular Genetics and Biochemistry, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | | | | |
Collapse
|
42
|
Bentov I, Werner H. IGF, IGF receptor and overgrowth syndromes. Pediatr Endocrinol Rev 2004; 1:352-60. [PMID: 16437028] [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] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
The insulin-like growth factors are a family of growth factors, binding proteins and receptors that are involved in normal growth as well as in a number of pathological states. Overgrowth syndromes are a group of disorders characterized by a phenotype of excessive somatic and visceral growth. In addition, patients suffering from overgrowth syndromes are predisposed to develop cancer. Several specific defects linked to the insulin-like growth factor system were elucidated for a group of these disorders, including Simpson-Golabi-Behmel syndrome, Bannayan-Ruvalcaba-Riley syndrome and Beckwith-Wiedemann syndrome. The aim of this review is to examine recent data linking the phenotype of overgrowth syndromes, visceral growth and increased risk of neoplasia, with the molecular machinery of the IGF system.
Collapse
Affiliation(s)
- Itay Bentov
- Department of Clinical Biochemistry, Sackler Faculty of Medicine, Tel Aviv University and Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | | |
Collapse
|
43
|
Abstract
IGF-I stimulates cell division in numerous cell types after activation of the IGF-I receptor, a transmembrane heterotetramer linked to the ras-raf-MAPK and phosphatidylinositol 3-kinase signaling pathways. The WT1 Wilms' tumor suppressor is a zinc finger-containing transcription factor that is involved in a number of developmental processes, as well as in the etiology of certain neoplasias. In the present study, we demonstrated that IGF-I reduced WT1 expression in osteosarcoma-derived Saos-2 cells in a time- and dose-dependent manner. This effect was mediated through the MAPK signaling pathway, as shown by the ability of the specific inhibitor UO126 to abrogate IGF-I action. Furthermore, the effect of IGF-I involved repression of transcription from the WT1 gene promoter, as demonstrated using transient transfection assays. Taken together, our results suggest that the WT1 gene is a novel downstream target for IGF-I action. Reduced levels of WT1 may facilitate IGF-I-stimulated cell cycle progression. Most importantly, inhibition of WT1 gene expression by IGF-I may have significant implications in terms of cancer initiation and/or progression.
Collapse
Affiliation(s)
- Itay Bentov
- Department of Clinical Biochemistry, Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
| | | | | |
Collapse
|
44
|
Becker Y, Sprecher E, Bentov I, Berkowitz C. Bone marrow-derived dendritic cells and the protection against X-ray-induced thymic leukemia in mice. A new interpretation. In Vivo 1993; 7:281-4. [PMID: 8357971] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
About forty years ago, Henry Kaplan and collaborators reported that four weekly X-ray doses of 160 rads each were highly leukemogenic in C57BL mice. A single dose of 350 Rads had a week leukemogenic effect. These authors also demonstrated that lead shielding of the thigh during irradiation prevented the development of leukemia. They reported that intravenous injection of syngeneic bone marrow cells into irradiated mice facilitated the regeneration of the thymus and prevented the development of X-ray-induced tumors. We characterized the thymic Ia+ dendritic cells (DC) with the aid of a fluorescence-activated cell-sorter (FACS). It was found that exposure of mice to a leukemogenic regimen of fractionated X-irradiation treatment led to a gradual decrease in the number of thymic DC. The disappearance of thymic DC and the development of leukemia were prevented by intravenous injection of syngeneic bone marrow or by lead shielding of the femur during irradiation. These results indicated that the fractionated irradiation caused a decline in the number of DC and, as a result, diminution of the natural defense against the developing tumor. Homing of the injected bone marrow DC into the thymus can be connected to the prevention of tumor development. Since leukemogenic T cells produce interleukin-4(IL-4), we tested the effect of the conditioned medium in which YAB-3 cells (tumorigenic Th cells: CD4+, CD8-, Thy-1+) were cultivated. Following injection of the conditioned medium into the mouse footpads, the number of skin Langerhans cells (LC) decreased.(ABSTRACT TRUNCATED AT 250 WORDS)
Collapse
Affiliation(s)
- Y Becker
- Department of Molecular Virology, Faculty of Medicine, Hebrew University of Jerusalem, Israel
| | | | | | | |
Collapse
|
45
|
Robbins SL, Bentov I. The kinetics of viscous flow in a model vessel. Effect of stenoses of varying size, shape, and length. J Transl Med 1967; 16:864-74. [PMID: 6058255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
|