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Smithson S, Mirocha J, Horgan R, Graebe R, Massaro R, Accortt E. Unplanned Cesarean delivery is associated with risk for postpartum depressive symptoms in the immediate postpartum period. J Matern Fetal Neonatal Med 2020; 35:3860-3866. [PMID: 33108930 DOI: 10.1080/14767058.2020.1841163] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE Postpartum depression (PPD) is a common pregnancy complication. The association between cesarean delivery (CD) and PPD has shown conflicting results in prior studies, although emergent CD appears to be a clear risk factor. Establishing PPD risk is critical and may, however, be related to the unplanned nature of the CD, rather than the surgery itself. Our objective was to determine whether women who underwent unplanned CD were more likely than those with vaginal delivery to have higher depressive symptoms and thus screen positive for PPD risk in the immediate postpartum period. MATERIALS AND METHODS This cohort study was conducted at a community medical center using data for deliveries between 8/2015-1/2016. Women were screened in the hospital for depressive symptoms (PPD risk) using the Edinburgh Postnatal Depression Scale (EPDS) within 4 days post-delivery. Logistic regression, adjusting for maternal race/ethnicity and parity, was performed to evaluate the association between delivery route (vaginal vs planned vs unplanned CD) and PPD risk (EPDS ≥ 10). RESULTS A total of 2094 women had complete data for analysis. Overall, 44 women (2.1%) screened positive for PPD risk. Logistic regression results showed that unplanned CD was significantly associated with PPD risk (OR = 2.28, 95% CI 1.13-4.57, p = .022), after adjusting for parity and race/ethnicity. Planned CD was not associated with PPD risk. CONCLUSION Unplanned CD may be an independent risk factor for PPD risk in the immediate postpartum period. This finding might explain why some previous studies have demonstrated different results with regards to risk of CD where the unplanned nature of the delivery was not accounted for.
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Affiliation(s)
- S Smithson
- Department of Obstetrics and Gynecology, Monmouth Medical Center, Long Branch, NJ, USA.,Department of Obstetrics and Gynecology, Cedars Sinai Medical Center, Los Angeles, CA, USA
| | - J Mirocha
- Department of Obstetrics and Gynecology, Cedars Sinai Medical Center, Los Angeles, CA, USA
| | - R Horgan
- Department of Obstetrics and Gynecology, Monmouth Medical Center, Long Branch, NJ, USA
| | - R Graebe
- Department of Obstetrics and Gynecology, Monmouth Medical Center, Long Branch, NJ, USA
| | - R Massaro
- Department of Obstetrics and Gynecology, Monmouth Medical Center, Long Branch, NJ, USA
| | - E Accortt
- Department of Obstetrics and Gynecology, Cedars Sinai Medical Center, Los Angeles, CA, USA
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Kafi A, Lindgren B, Chaux G, Mirocha J, Cheng W, Ramzy D, Falk J. Low Correlation Between PCWP and LVEDP in Patients With End-Stage Lung Disease. J Heart Lung Transplant 2018. [DOI: 10.1016/j.healun.2018.01.1170] [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: 11/16/2022] Open
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Moser FG, Watterson CT, Weiss S, Austin M, Mirocha J, Prasad R, Wang J. High Signal Intensity in the Dentate Nucleus and Globus Pallidus on Unenhanced T1-Weighted MR Images: Comparison between Gadobutrol and Linear Gadolinium-Based Contrast Agents. AJNR Am J Neuroradiol 2018; 39:421-426. [PMID: 29419400 DOI: 10.3174/ajnr.a5538] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Accepted: 11/15/2017] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE In view of the recent observations that gadolinium deposits in brain tissue after intravenous injection, our aim of this study was to compare signal changes in the globus pallidus and dentate nucleus on unenhanced T1-weighted MR images in patients receiving serial doses of gadobutrol, a macrocyclic gadolinium-based contrast agent, with those seen in patients receiving linear gadolinium-based contrast agents. MATERIALS AND METHODS This was a retrospective analysis of on-site patients with brain tumors. Fifty-nine patients received only gadobutrol, and 60 patients received only linear gadolinium-based contrast agents. Linear gadolinium-based contrast agents included gadoversetamide, gadobenate dimeglumine, and gadodiamide. T1 signal intensity in the globus pallidus, dentate nucleus, and pons was measured on the precontrast portions of patients' first and seventh brain MRIs. Ratios of signal intensity comparing the globus pallidus with the pons (globus pallidus/pons) and dentate nucleus with the pons (dentate nucleus/pons) were calculated. Changes in the above signal intensity ratios were compared within the gadobutrol and linear agent groups, as well as between groups. RESULTS The dentate nucleus/pons signal ratio increased in the linear gadolinium-based contrast agent group (t = 4.215, P < .001), while no significant increase was seen in the gadobutrol group (t = -1.422, P = .08). The globus pallidus/pons ratios followed similarly, with an increase in the linear gadolinium-based contrast agent group (t = 2.931, P < .0001) and no significant change in those receiving gadobutrol (t = 0.684, P = .25). CONCLUSIONS Successive doses of gadobutrol do not result in T1 shortening compared with changes seen in linear gadolinium-based contrast agents.
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Affiliation(s)
- F G Moser
- From the Department of Imaging (F.G.M., C.T.W., S.W., R.P.), S. Mark Taper Foundation Imaging Center
| | - C T Watterson
- From the Department of Imaging (F.G.M., C.T.W., S.W., R.P.), S. Mark Taper Foundation Imaging Center
| | - S Weiss
- From the Department of Imaging (F.G.M., C.T.W., S.W., R.P.), S. Mark Taper Foundation Imaging Center
| | - M Austin
- Department of Radiology (M.A.), Lahey Clinic, Burlington, Massachusetts
| | - J Mirocha
- Samuel Oschin Comprehensive Cancer Institute (J.M.), Cedars Sinai Medical Center, Los Angeles, California
| | - R Prasad
- From the Department of Imaging (F.G.M., C.T.W., S.W., R.P.), S. Mark Taper Foundation Imaging Center
| | - J Wang
- Bayer Healthcare (J.W.), Whippany, New Jersey
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Rad S, Beauchamp S, Morales C, Mirocha J, Esakoff TF. Defining fetal growth restriction: abdominal circumference as an alternative criterion. J Matern Fetal Neonatal Med 2017; 31:3089-3094. [PMID: 28817998 DOI: 10.1080/14767058.2017.1364723] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE The purpose of this study is to determine if using abdominal circumference percentile (AC) to define fetal growth restriction (FGR) improves ultrasound at ≥36 weeks as a screening test for small for gestational age (SGA). MATERIALS AND METHODS All non-anomalous singletons undergoing ultrasound at a single center at ≥36 weeks during 12/2008-5/2014 were included. FGR was defined as (estimated fetal weight) estimated fetal weight (EFW) and/or abdominal circumference (AC) < 10 for gestational age (GA). The primary outcome was SGA (birthweight ≤10th percentile for GA). Data were stratified by maternal race/ethnicity and BMI. Sensitivity, specificity, false-positive rate (FPR), positive- and negative-predictive values (positive-predictive value (PPV), negative-predictive value (NPV)), and areas under the receiver-operating characteristic (ROC) curve (AUC were calculated. RESULTS There were 1594 ultrasounds. Median (IQR) ultrasound GA was 37.3 (36.6-38.0), days to delivery 10.6 (5.0-18.4), and delivery GA 39.29 (38.6-39.9). EFW <10 had the following characteristics: sensitivity 50.6%, FPR 2.0%, PPV 83.8%, and AUC 0.743. Using AC <10, these were 64.0, 2.9, 81.3, and 0.806, respectively. Using AC or EFW <10, these were 67.5, 3.3, 80.3, and 0.821, respectively; this criterion has the largest AUC (p < .008). This finding persisted when stratified by maternal race/ethnicity and BMI. CONCLUSIONS AC <10 is more sensitive and has a similar PPV compared with EFW <10 for SGA. Using AC <10 or EFW <10 has the best balance of sensitivity and specificity as a screening test and has a low FPR. AC may be a reasonable alternative criterion to EFW for FGR diagnosis.
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Affiliation(s)
- Steve Rad
- a Division of Maternal Fetal Medicine, Department of Obstetrics & Gynecology , Cedars-Sinai Medical Center , Los Angeles , CA , USA
| | - S Beauchamp
- a Division of Maternal Fetal Medicine, Department of Obstetrics & Gynecology , Cedars-Sinai Medical Center , Los Angeles , CA , USA
| | - C Morales
- a Division of Maternal Fetal Medicine, Department of Obstetrics & Gynecology , Cedars-Sinai Medical Center , Los Angeles , CA , USA
| | - J Mirocha
- b Biostatistics Research Institute, Cedars-Sinai Medical Center , Los Angeles , CA , USA
| | - T F Esakoff
- a Division of Maternal Fetal Medicine, Department of Obstetrics & Gynecology , Cedars-Sinai Medical Center , Los Angeles , CA , USA
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Awad M, Czer LSC, Esmailian F, Jordan S, De Robertis MA, Mirocha J, Patel J, Chang DH, Kittleson M, Ramzy D, Arabia F, Chung JS, Cohen JL, Trento A, Kobashigawa JA. Combined Heart and Kidney Transplantation: A 23-Year Experience. Transplant Proc 2017; 49:348-353. [PMID: 28219597 DOI: 10.1016/j.transproceed.2016.11.040] [Citation(s) in RCA: 15] [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: 10/12/2016] [Accepted: 11/10/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND We report clinical experience with combined heart and kidney transplantation (HKTx) over a 23-year time period. METHODS From June 1992 to August 2015, we performed 83 combined HKTx procedures at our institution. We compared the more recent cohort of 53 HKTx recipients (group 2, March 2009 to August 2015) with the initial 30 previously reported HKTx recipients (group 1, June 1992 to February 2009). Pre-operative patient characteristics, peri-operative factors, and post-operative outcomes including survival were examined. RESULTS The baseline characteristics of the two groups were similar, except for a lower incidence of ethanol use and higher pre-operative left-ventricular ejection fraction, cardiac output, and cardiac index in group 2 when compared with group 1 (P = .007, .046, .037, respectively). The pump time was longer in group 2 compared with group 1 (153.30 ± 38.68 vs 129.60 ± 37.60 minutes; P = .007), whereas the graft ischemic time was not significantly different between the groups, with a trend to a longer graft ischemic time in group 2 versus group 1 (195.17 ± 45.06 vs 178.07 ± 52.77 minutes; P = .056, respectively). The lengths of intensive care unit (ICU) and hospital stay were similar between the groups (P = .083 and .39, respectively). In addition, pre-operative and post-operative creatinine levels at peak, discharge, 1 year, and 5 years and the number of people on post-operative dialysis were similar between the groups (P = .37, .75, .54, .87, .56, and P = .139, respectively). Overall survival was not significantly different between groups 2 and 1 for the first 5 years after transplant, with a trend toward higher survival in group 2 (P = .054). CONCLUSIONS The most recent cohort of combined heart and kidney transplant recipients had similar ICU and hospital lengths of stay and post-operative creatinine levels at peak, discharge, and 1 and 5 years and a similar number of patients on post-operative dialysis when compared with the initial cohort. Overall survival was not significantly different between the later and earlier groups, with a trend toward higher overall survival at 5 years in the more recent cohort of patients. In selected patients with co-existing heart and kidney failure, combined heart and kidney transplantation is safe to perform and has excellent outcomes.
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Affiliation(s)
- M Awad
- Division of Cardiology, Cedars-Sinai Heart Institute, Los Angeles, California; Multiorgan Transplant Program, Cedars-Sinai Medical Center, Los Angeles, California
| | - L S C Czer
- Division of Cardiology, Cedars-Sinai Heart Institute, Los Angeles, California; Multiorgan Transplant Program, Cedars-Sinai Medical Center, Los Angeles, California.
| | - F Esmailian
- Division of Cardiothoracic Surgery, Cedars-Sinai Heart Institute, Los Angeles, California; Multiorgan Transplant Program, Cedars-Sinai Medical Center, Los Angeles, California
| | - S Jordan
- Division of Pediatric Nephrology, Cedars-Sinai Medical Center, Los Angeles, California; Multiorgan Transplant Program, Cedars-Sinai Medical Center, Los Angeles, California
| | - M A De Robertis
- Division of Cardiothoracic Surgery, Cedars-Sinai Heart Institute, Los Angeles, California
| | - J Mirocha
- Section of Biostatistics and Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California
| | - J Patel
- Division of Cardiology, Cedars-Sinai Heart Institute, Los Angeles, California; Multiorgan Transplant Program, Cedars-Sinai Medical Center, Los Angeles, California
| | - D H Chang
- Division of Cardiology, Cedars-Sinai Heart Institute, Los Angeles, California; Multiorgan Transplant Program, Cedars-Sinai Medical Center, Los Angeles, California
| | - M Kittleson
- Division of Cardiology, Cedars-Sinai Heart Institute, Los Angeles, California; Multiorgan Transplant Program, Cedars-Sinai Medical Center, Los Angeles, California
| | - D Ramzy
- Division of Cardiothoracic Surgery, Cedars-Sinai Heart Institute, Los Angeles, California; Multiorgan Transplant Program, Cedars-Sinai Medical Center, Los Angeles, California
| | - F Arabia
- Division of Cardiothoracic Surgery, Cedars-Sinai Heart Institute, Los Angeles, California; Multiorgan Transplant Program, Cedars-Sinai Medical Center, Los Angeles, California
| | - J S Chung
- Division of Cardiothoracic Surgery, Cedars-Sinai Heart Institute, Los Angeles, California; Multiorgan Transplant Program, Cedars-Sinai Medical Center, Los Angeles, California
| | - J L Cohen
- Multiorgan Transplant Program, Cedars-Sinai Medical Center, Los Angeles, California
| | - A Trento
- Division of Cardiothoracic Surgery, Cedars-Sinai Heart Institute, Los Angeles, California; Multiorgan Transplant Program, Cedars-Sinai Medical Center, Los Angeles, California
| | - J A Kobashigawa
- Division of Cardiology, Cedars-Sinai Heart Institute, Los Angeles, California; Multiorgan Transplant Program, Cedars-Sinai Medical Center, Los Angeles, California
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Awad M, Czer LSC, Mirocha J, Ruzza A, de Robertis M, Rafiei M, Reich H, Sasevich M, Rihbany K, Kass R, Kobashigawa J, Arabia F, Trento A, Esmailian F, Ramzy D. Similar Mortality and Morbidity of Orthotopic Heart Transplantation for Patients 70 Years of Age and Older Compared With Younger Patients. Transplant Proc 2017; 48:2782-2791. [PMID: 27788818 DOI: 10.1016/j.transproceed.2016.06.039] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2016] [Accepted: 06/06/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND The upper age limit of heart transplantation remains controversial. The goal of the present study was to investigate the mortality and morbidity of orthotopic heart transplantation (HT) for recipients ≥70 compared with those <70 years of age. METHODS Of 704 adults who underwent HT from December 1988 to June 2012 at our institution, 45 were ≥70 years old (older group) and 659 were <70 years old (younger group). Survival, intraoperative blood product usage, intensive care unit (ICU) and hospital stays, and frequency of reoperation for chest bleeding, dialysis, and >48 hours ventilation were examined after HT. RESULTS The older group had 100% 30-day and 60-day survival compared with 96.8 ± 0.7% 30-day and 95.9 ± 0.8% 60-day survival rates in the younger group. The older and younger groups had similar 1-year (93.0 ± 3.9% vs 92.1 ± 1.1%; P = .79), 5-year (84.2 ± 6.0% vs 73.4 ± 1.9%; P = .18), and 10-year (51.2 ± 10.7% vs 50.2 ± 2.5%; P = .43) survival rates. Recipients in the older group had higher preoperative creatinine levels, frequency of coronary artery disease, and more United Network for Organ Sharing status 2 and fewer status 1 designations than recipients in the younger group (P < .05 for all). Pump time and intraoperative blood usage were similar between the 2 groups (P = NS); however, donor-heart ischemia time was higher in the older group (P = .002). Older recipients had higher postoperative creatinine levels at peak (P = .003) and at discharge (P = .007). Frequency of postoperative complications, including reoperation for chest bleeding, dialysis, >48 hours ventilation, pneumonia, pneumothorax, sepsis, in-hospital and post-discharge infections, were similar between groups (P = NS for all comparisons). ICU and hospital length of stays were similar between groups (P = .35 and P = .87, respectively). In Cox analysis, recipient age ≥70 years was not identified as a predictor of lower long-term survival after HT. CONCLUSIONS HT recipients ≥70 years old had similar 1, 5, and 10-year survival rates compared with younger recipients. Both patient groups had similar intra- and postoperative blood utilization and frequencies of many postoperative complications. Older and younger patients had similar morbidity and mortality rates following HT. Carefully selected older patients (≥70 years) can safely undergo HT and should not be excluded from HT consideration based solely on age.
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Affiliation(s)
- M Awad
- Division of Cardiology, Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - L S C Czer
- Division of Cardiology, Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California.
| | - J Mirocha
- Section of Biostatistics, Research Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - A Ruzza
- Division of Cardiothoracic Surgery, Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - M de Robertis
- Division of Cardiology, Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - M Rafiei
- Division of Cardiology, Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - H Reich
- Division of Cardiothoracic Surgery, Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - M Sasevich
- Division of Cardiothoracic Surgery, Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - K Rihbany
- Division of Cardiology, Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - R Kass
- Division of Cardiothoracic Surgery, Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - J Kobashigawa
- Division of Cardiology, Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - F Arabia
- Division of Cardiothoracic Surgery, Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - A Trento
- Division of Cardiothoracic Surgery, Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - F Esmailian
- Division of Cardiothoracic Surgery, Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - D Ramzy
- Division of Cardiothoracic Surgery, Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
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Volod O, Lam L, Barglowski M, Mirocha J, Runyan C, Moriguchi J, Czer L, Arabia F. Comparison of Activated Partial Thromboplastin Time (aPTT) and Anti-Factor Xa for Low Intensity Unfractionated Heparin Monitoring in Patients with Mechanical Circulatory Support Devices (MCSD). J Heart Lung Transplant 2017. [DOI: 10.1016/j.healun.2017.01.1268] [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: 11/17/2022] Open
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Reich H, Ramzy D, Mirocha J, De Robertis M, Chung J, Esmailian F, Chang D, Moriguchi J, Czer L, Trento A, Arabia F. Not All INTERMACS Level 1’s Are the Same: Survival After Total Artificial Heart Implantation with or without Temporary Circulatory Support. J Heart Lung Transplant 2017. [DOI: 10.1016/j.healun.2017.01.977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Zhang X, Mirocha J, Aintablian T, Moriguchi J, Arabia F, Kobashigawa J, Reinsmoen N. Revealing a New Mode of Sensitization Induced by Mechanical Circulatory Support Devices (MCS): Impact of Anti-AT1R Antibodies. J Heart Lung Transplant 2017. [DOI: 10.1016/j.healun.2017.01.072] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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10
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Gutovich J, Lipshutz G, Van Allan R, Saouaf R, Butenschoen K, Allegretto B, Hendifar A, Mirocha J, Amersi F, Annamalai A, Nissen N, Friedman M. Effects and prognostic factors of Y-90 radioembolization on metastatic neuroendocrine tumor to the liver: a retrospective single-institution review. J Vasc Interv Radiol 2017. [DOI: 10.1016/j.jvir.2016.12.1121] [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] Open
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11
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Toyoda M, Thomas D, Ahn G, Kahwaji J, Mirocha J, Chu M, Vo A, Suviolahti E, Ge S, Jordan SC. JC polyomavirus viremia and progressive multifocal leukoencephalopathy in human leukocyte antigen-sensitized kidney transplant recipients desensitized with intravenous immunoglobulin and rituximab. Transpl Infect Dis 2016; 17:838-47. [PMID: 26437369 DOI: 10.1111/tid.12465] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Revised: 07/27/2015] [Accepted: 09/07/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND Desensitization (DES) with intravenous immunoglobulin (IVIG) + rituximab is effective, safe, and increases the transplantation rate in human leukocyte antigen-sensitized patients. However, reports of progressive multifocal leukoencephalopathy (PML) caused by JC polyomavirus (JCPyV) in autoimmune patients treated with rituximab is concerning. Here, we report on the JCPyV viremia and PML status in kidney transplant patients with/without DES (non-DES). METHODS In total 1195 and 699 DNA samples from plasma in 117 DES (78% lymphocyte-depleting [LyD] induction) and 100 non-DES patients (45% LyD), respectively, were submitted for JCPyV-polymerase chain reaction. Results were compared in both groups. RESULTS No patients in either DES or non-DES developed PML or presented with any neurological symptoms. The JCPyV viremia rate was similar in DES and non-DES patients (3/117 vs. 9/100, P = 0.07). The JCPyV levels were low (median peak levels, 1025 copies/mL) and JCPyV viremia was observed only once during the study period in most patients. All 3 DES patients with JCPyV(+) received 1 dose rituximab and no DES patients with >1 dose rituximab showed JCPyV(+). All 3 JCPyV(+) DES patients received LyD induction, while only 2 of 9 JCPyV(+) non-DES patients did so, and the remaining 7 received non-LyD or no induction. JCPyV in leukocyte was mostly negative in DES and non-DES patients. Immunosuppression in patients with or without JCPyV(+) was similar. BK polyomavirus viremia was observed more commonly in patients with JCPyV(+) than in those without (P < 0.02). CONCLUSIONS Patients with IVIG + rituximab DES followed by transplantation with LyD induction and additional rituximab rarely show JCPyV viremia and appear at low risk for PML.
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Affiliation(s)
- M Toyoda
- Transplant Immunology Laboratory, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - D Thomas
- Transplant Immunology Laboratory, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - G Ahn
- Transplant Immunology Laboratory, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - J Kahwaji
- Comprehensive Transplant Center, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - J Mirocha
- Biostatistics Core, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - M Chu
- Transplant Immunology Laboratory, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - A Vo
- Comprehensive Transplant Center, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - E Suviolahti
- Transplant Immunology Laboratory, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - S Ge
- Transplant Immunology Laboratory, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - S C Jordan
- Comprehensive Transplant Center, Cedars-Sinai Medical Center, Los Angeles, California, USA
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Awad M, Czer L, De Robertis M, Mirocha J, Ruzza A, Rafiei M, Reich H, Trento A, Moriguchi J, Kobashigawa J, Esmailian F, Arabia F, Ramzy D. Adult Heart Transplantation Following Ventricular Assist Device Implantation: Early and Late Outcomes. Transplant Proc 2016; 48:158-66. [DOI: 10.1016/j.transproceed.2015.12.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Accepted: 12/07/2015] [Indexed: 10/22/2022]
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13
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Liou DZ, Singer MB, Barmparas G, Harada MY, Mirocha J, Bukur M, Salim A, Ley EJ. Insulin-dependent diabetes and serious trauma. Eur J Trauma Emerg Surg 2015; 42:491-496. [PMID: 26253885 DOI: 10.1007/s00068-015-0561-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Accepted: 07/31/2015] [Indexed: 01/04/2023]
Abstract
PURPOSE Trauma patients with diabetes mellitus (DM) represent a unique population as the acute injury and the underlying disease may both cause hyperglycemia that leads to poor outcomes. We investigated how insulin-dependent DM (IDDM) and noninsulin-dependent DM (NIDDM) impact mortality after serious trauma without brain injury. METHODS The National Trauma Data Bank (NTDB) version 7.0 was queried for all patients with moderate to severe traumatic injury [injury severity score (ISS) >9]. Patients were excluded if missing data, age <10 years, severe brain injury [head abbreviated injury scale (AIS) >3], dead on arrival or any AIS = 6. Logistic regression modeled the association between DM and mortality as well as IDDM, NIDDM and mortality. RESULTS Overall 166,103 trauma patients without brain injury were analyzed. Mortality was 7.6 and 4.4 % in patients with and without DM, respectively (p < 0.01). Mortality was 9.9 % for patients with IDDM and 6.7 % for NIDDM (p < 0.01). The increased mortality associated with DM was only significantly higher for DM patients in their forties (5.6 vs. 3.3 %, p < 0.01). Regression analyses demonstrated that DM (AOR 1.14, p = 0.04) and IDDM (AOR 1.46, p < 0.01) were predictors of mortality compared to no DM, but NIDDM was not (AOR 1.02, p = 0.83). CONCLUSIONS While DM was a predictor for higher mortality after serious trauma, this increase was only observed in IDDM and not NIDDM. Our findings suggest IDDM patients who present after serious trauma are unique and attention to their hyperglycemia and related insulin therapy may play a critical role in recovery.
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Affiliation(s)
- D Z Liou
- Division of Trauma and Critical Care, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - M B Singer
- Division of Trauma and Critical Care, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - G Barmparas
- Division of Trauma and Critical Care, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
| | - M Y Harada
- Division of Trauma and Critical Care, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - J Mirocha
- Division of Trauma and Critical Care, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - M Bukur
- Department of Trauma and Critical Care, Delray Medical Center, Delray Beach, FL, USA.,Broward General Medical Center, Fort Lauderdale, FL, USA
| | - A Salim
- Division of Trauma, Burn, and Surgical Critical Care, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA
| | - E J Ley
- Division of Trauma and Critical Care, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
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Kansara P, Czer L, Awad M, Arabia F, Mirocha J, De Robertis M, Moriguchi J, Ramzy D, Kass RM, Esmailian F, Trento A, Kobashigawa J. Heart transplantation with and without prior sternotomy: analysis of the United Network for Organ Sharing database. Transplant Proc 2015; 46:249-55. [PMID: 24507061 DOI: 10.1016/j.transproceed.2013.09.027] [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: 08/29/2013] [Accepted: 09/26/2013] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Patients with history of prior sternotomy may have poorer outcomes after heart transplantation. Quantitation of risk from prior sternotomy has not been well established. The United Network for Organ Sharing (UNOS) database was analyzed to assess early and late survival and predictors of outcome in adult heart transplant recipients with and without prior sternotomy. METHODS Of 11,266 adults with first heart-only transplantation from 1997 to 2011, recipients were divided into 2 groups: those without prior sternotomy (first sternotomy group; n = 6006 or 53.3%) and those with at least 1 prior sternotomy (redo sternotomy group; n = 5260 or 46.7%). A multivariable Cox model was used to identify predictors of mortality. RESULTS Survival was lower in the redo group at 60 days (92.6% vs 95.9%; hazard ratio [HR] 1.83, 95% confidence interval [CI]: 1.56-2.15; P < .001). Conditional 5-year survival in 60-day survivors was similar in the 2 groups (HR = 1.01, 95% CI 0.90-1.12, P = .90). During the first 60 days post-transplant, the redo group had more cardiac reoperations (12.3% vs 8.8%, P = .0008), a higher frequency of dialysis (8.9% vs 5.2%, P < .0001), a greater percentage of drug-treated infections (23.2% vs 19%, P = .003), and a higher percentage of strokes (2.5% vs 1.4%, P = .0001). A multivariable Cox proportional hazards model identified prior sternotomy as a significant independent predictor of mortality, in addition to age, female gender, congenital cardiomyopathy, need for ventilation, mechanical circulatory support, dialysis prior to transplant, pretransplant serum bilirubin (≥ 3 mg/dL), and preoperative serum creatinine (≥ 2 mg/dL). CONCLUSIONS Prior sternotomy is associated with an excess 3.3% mortality and higher morbidity within the first 60 days after heart transplantation, as measured by frequency of dialysis, drug-treated infections, and strokes. Conditional 5-year survival after 60 days is unaffected by prior sternotomy. These findings should be taken into account for risk assessment of patients undergoing heart transplantation.
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Affiliation(s)
- P Kansara
- Division of Cardiology, Cedars-Sinai Heart Institute, Los Angeles, California, USA
| | - L Czer
- Division of Cardiology, Cedars-Sinai Heart Institute, Los Angeles, California, USA.
| | - M Awad
- Division of Cardiology, Cedars-Sinai Heart Institute, Los Angeles, California, USA
| | - F Arabia
- Division of Cardiothoracic Surgery, Cedars-Sinai Heart Institute, Los Angeles, California, USA
| | - J Mirocha
- Division of Cardiology, Cedars-Sinai Heart Institute, Los Angeles, California, USA
| | - M De Robertis
- Division of Cardiothoracic Surgery, Cedars-Sinai Heart Institute, Los Angeles, California, USA
| | - J Moriguchi
- Section of Biostatistics, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - D Ramzy
- Division of Cardiothoracic Surgery, Cedars-Sinai Heart Institute, Los Angeles, California, USA
| | - R M Kass
- Division of Cardiothoracic Surgery, Cedars-Sinai Heart Institute, Los Angeles, California, USA
| | - F Esmailian
- Division of Cardiothoracic Surgery, Cedars-Sinai Heart Institute, Los Angeles, California, USA
| | - A Trento
- Division of Cardiothoracic Surgery, Cedars-Sinai Heart Institute, Los Angeles, California, USA
| | - J Kobashigawa
- Division of Cardiology, Cedars-Sinai Heart Institute, Los Angeles, California, USA
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Awad M, Czer L, Rihbany K, Sasevich M, Ruzza A, Rafiei M, Mirocha J, De Robertis M, Kass R, Arabia F, Trento A, Esmailian F, Ramzy D. Comparable Mortality and Morbidity of Orthotopic Heart Transplantation for Patients Younger and Older Than 70 Years. J Heart Lung Transplant 2014. [DOI: 10.1016/j.healun.2014.01.205] [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: 11/30/2022] Open
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16
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Coleman B, Phillips A, Mirocha J, Patel J, Arabia F, Kobashigawa J. Antithymocyte Globulin But Not Basiliximab Is Beneficial After Infant Heart Transplantation - Analysis of the UNOS Database. J Heart Lung Transplant 2014. [DOI: 10.1016/j.healun.2014.01.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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17
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Reinsmoen N, Haas M, Patel J, Lai C, Naim M, Ong G, Wang Q, Mirocha J, Yu Z, Liou F, Kobashigawa J. Does the Presence of Complement Binding De Novo DSA Distinguish Different Pathology Defined Rejection Patterns in Heart Transplant Recipients? J Heart Lung Transplant 2014. [DOI: 10.1016/j.healun.2014.01.754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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18
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Kransdorf EP, Czer LSC, Luthringer DJ, Patel JK, Montgomery SP, Velleca A, Mirocha J, Zakowski PC, Zabner R, Gaultier CR, Qvarnstrom Y, Benedict T, Steurer F, Bosserman E, Paddock CD, Rafiei M, Kobashigawa JA. Heart transplantation for Chagas cardiomyopathy in the United States. Am J Transplant 2013; 13:3262-8. [PMID: 24165397 PMCID: PMC10183729 DOI: 10.1111/ajt.12507] [Citation(s) in RCA: 52] [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: 06/24/2013] [Revised: 08/12/2013] [Accepted: 09/12/2013] [Indexed: 01/25/2023]
Abstract
Since an initial case in 2006, we noted multiple patients undergoing heart transplantation (HTx) for Chagas cardiomyopathy (CC) at our transplant program. The clinical characteristics, laboratory results and outcomes of patients with CC undergoing HTx in the United States have not been reported previously. In 2010, we implemented a systematic screening and management program for patients undergoing HTx for CC. Before HTx, all patients with idiopathic dilated cardiomyopathy who were born in a Chagas disease endemic country were screened for Trypanosoma cruzi (TC) infection with serology. After HTx, monitoring for TC reactivation was performed using clinical visits, echocardiography, endomyocardial biopsy and serial whole blood polymerase chain reaction (PCR) testing. Between June 2006 and January 2012, 11 patients underwent HTx for CC. One patient was empirically treated due to the presence of TC amastigotes in explanted cardiac tissue. Two patients experienced allograft dysfunction due to TC reactivation and three patients experienced subclinical reactivation (positive PCR results), which were treated. Chagas disease is a common cause of dilated cardiomyopathy in patients from endemic countries undergoing HTx at a transplant program in the United States. Reactivation is common after transplantation and can cause adverse outcomes.
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Reinsmoen N, Lai CH, Mirocha J, Cao K, Ong G, Naim M, Wang Q, Riega S, Rafiei M, Patel J, Kobashigawa J. Increased Negative Impact of Anti-Angiotensin Type 1 Receptor Antibodies Together with De Novo Donor HLA Specific Antibodies on Graft Outcome in Heart Transplant Recipients. J Heart Lung Transplant 2013. [DOI: 10.1016/j.healun.2013.01.237] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Mathur R, Amichai M, Chua KS, Mirocha J, Barlow GM, Pimentel M. Methane and hydrogen positivity on breath test is associated with greater body mass index and body fat. J Clin Endocrinol Metab 2013; 98:E698-702. [PMID: 23533244 PMCID: PMC3615195 DOI: 10.1210/jc.2012-3144] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.2] [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: 12/15/2022]
Abstract
CONTEXT Colonization of the gastrointestinal tract with methanogenic archaea (methanogens) significantly affects host metabolism and weight gain in animal models, and breath methane is associated with a greater body mass index (BMI) among obese human subjects. OBJECTIVE The objective of the study was to characterize the relationship between methane and hydrogen on breath test (as a surrogate for colonization with the hydrogen requiring methanogen, Methanobrevibacter smithii), body weight, and percent body fat in a general population cohort. DESIGN AND SUBJECTS This was a prospective study (n = 792) of consecutive subjects presenting for breath testing. SETTING The study was conducted at a tertiary care center. OUTCOME MEASUREMENTS BMI and percent body fat were measured. RESULTS Subjects were classified into 4 groups based on breath testing: normal (N) (methane <3 ppm and hydrogen <20 ppm at or before 90 minutes); hydrogen positive only (H+) [methane <3 ppm and hydrogen ≥20 ppm); methane positive only (M+) (methane ≥3 ppm and hydrogen <20 ppm), or methane and hydrogen positive (M+/H+) (methane ≥3 ppm and hydrogen ≥20 ppm]. There were significant differences in age but not in gender across the groups. After controlling for age as a confounding variable, M+/H+ subjects had significantly higher BMI than other groups (N: 24.1 ± 5.2 kg/m(2); H+: 24.2 ± 4.5 kg/m(2); M+: 24.0 ± 3.75 kg/m(2); M+/H+: 26.5 ± 7.1 kg/m(2), P < .02) and also had significantly higher percent body fat (N: 28.3 ± 10.0%; H+: 27.5 ± 9.0%; M+: 28.0 ± 8.9%; M+/H+; 34.1 ± 10.9%, P < .001). CONCLUSIONS The presence of both methane and hydrogen on breath testing is associated with increased BMI and percent body fat in humans. We hypothesize that this is due to colonization with the hydrogen-requiring M smithii, which affects nutrient availability for the host and may contribute to weight gain.
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Affiliation(s)
- R Mathur
- Division of Endocrine Diabetes and Metabolism, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA.
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Ruzza A, Esmailian F, Vespignani R, Yanagida R, Awad M, Mirocha J, Ramzy D, Moriguchi J, Trento A, Czer L. Renal Dysfunction Does Not Contraindicate Ventricular Assist Device as Destination Therapy or as Bridge to Single Heart or Combined Heart and Kidney Transplantation. J Heart Lung Transplant 2013. [DOI: 10.1016/j.healun.2013.01.591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Coleman B, Patel J, Czer L, Mirocha J, Kobashigawa J. 256 Use of Thymoglobulin after Heart Transplantation: Is There a Role in African American Patients? J Heart Lung Transplant 2012. [DOI: 10.1016/j.healun.2012.01.263] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Cao K, Lai CH, Flores S, Rafiei M, Mirocha J, Haas M, Ong G, Naim M, Wang Q, Constanza L, Patel J, Reinsmoen N, Kobashigawa J. 463 Anti -Angiotensin Type 1 Receptor (AT1R) Antibodies Together with Anti-HLA Donor Specific Antibodies (HLA-DSA) Identify Patients at Risk for Immune Complication in Heart Transplant. J Heart Lung Transplant 2012. [DOI: 10.1016/j.healun.2012.01.474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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24
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Amini Hadjibashi A, Bukur M, Ley E, Mirocha J, Chung R, Malinoski D, Margulies D, Salim A. Incidence and Outcomes of Venous Thromboembolism After Inferior Vena Cava Injury. J Surg Res 2012. [DOI: 10.1016/j.jss.2011.11.243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Czer L, Ruzza A, Vespignani R, Jordan S, De Robertis M, Mirocha J, Gallagher S, Patel K, Schwarz E, Kass R, Trento A. Survival and Allograft Rejection Rates after Combined Heart and Kidney Transplantation in Comparison with Heart Transplantation Alone. Transplant Proc 2011; 43:3869-76. [DOI: 10.1016/j.transproceed.2011.08.095] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2011] [Accepted: 08/04/2011] [Indexed: 02/07/2023]
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Haas M, Mirocha J. Early ultrastructural changes in renal allografts: correlation with antibody-mediated rejection and transplant glomerulopathy. Am J Transplant 2011; 11:2123-31. [PMID: 21827618 DOI: 10.1111/j.1600-6143.2011.03647.x] [Citation(s) in RCA: 97] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Transplant glomerulopathy (TG) is associated with antibody-mediated renal allograft rejection (AMR) and reduced graft survival. Histologically, TG is typically seen >1 year posttransplantation. However, ultrastructural changes including glomerular endothelial swelling, subendothelial widening and early glomerular basement membrane duplication are associated with development of TG but appear much earlier. We examined the specificity of these changes for AMR, and whether these are inevitably associated with development of TG. Of 98 for cause renal allograft biopsies carried out within 3 months of transplantation with available serologic data, 17 showed C4d-positive AMR and 16 had histologic changes of AMR and donor-specific antibodies (DSA), but no C4d. All three ultrastructural changes were seen in 11 of 17 biopsies with C4d-positive AMR, 8 of 16 with histologic changes of AMR and DSA but no C4d, and 0 of 65 without histologic changes of AMR and/or DSA (p < 0.0001 for both of the former groups vs. the latter). Twenty patients with positive DSA (18 with histologic changes of AMR and 11 C4d-positive) had ≥1 follow-up biopsy; eight developed overt TG 3.5-30 months posttransplantation. Among the 18 patients with DSA and histologic changes of AMR, 11 C4d-positive and 7 C4d-negative, treatment for AMR after the early biopsy significantly reduced subsequent development of overt TG.
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Affiliation(s)
- M Haas
- Department of Pathology and Laboratory Medicine Biostatistics Core, Research Institute and General Clinical Research Center, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
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Goland S, Siegel RJ, Burton K, De Robertis MA, Rafique A, Schwarz E, Zivari K, Mirocha J, Trento A, Czer LSC. Changes in left and right ventricular function of donor hearts during the first year after heart transplantation. Heart 2011; 97:1681-6. [DOI: 10.1136/hrt.2010.220871] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Yanagida R, Czer L, Ruzza A, Vespignani R, Simsir S, Schwarz E, De Robertis M, Mirocha J, Coleman B, Runyon C, Jocson R, Olay C, Kass R, Kobashigawa J, Trento A. 478 Ventricular Assist Device Implantation Provides Opportunity for Significant Weight Loss in Obese Patients with Advanced Heart Failure. J Heart Lung Transplant 2011. [DOI: 10.1016/j.healun.2011.01.488] [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: 11/27/2022] Open
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Phan A, Czer L, Rafiei M, Pixton J, Mirocha J, Schwarz E, De Robertis M, Coleman B, Luthringer D, Vespignani R, Ruzza A, Yanagida R, Kass R, Trento A. 416 Anti-Thymocyte Globulin Induction Therapy after Heart Transplantation: Impact on Rejection Rates, Survival, and CMV Infection. J Heart Lung Transplant 2011. [DOI: 10.1016/j.healun.2011.01.425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Hadjibashi AA, Berry C, Ley E, Bukur M, Mirocha J, Salim A. Alcohol Is Protective For Pneumonia After Moderate To Severe Traumatic Brain Injury. J Surg Res 2011. [DOI: 10.1016/j.jss.2010.11.675] [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: 11/16/2022]
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31
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Berry C, Ley E, Mirocha J, Margulies D, Salim A. Race Does Play a Role in Mortality in Moderate to Severe Traumatic Brain Injury. J Surg Res 2010. [DOI: 10.1016/j.jss.2009.11.323] [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]
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Karlin NJ, Chopra I, Mirocha J, Feldman N. An association between thyroid disease and breast cancer. J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.21063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
21063 Background: Anecdotal studies and isolated case reports have observed an association of thyroid disease and breast cancer. This purported association remains controversial. We describe a retrospective case-control study on the prevalence of breast cancer in patients with abnormal thyroid function studies. Age-matched subjects served as controls. Methods: We reviewed 6211 cases of abnormal TSH values between 1/04 and 12/05 and determined the number of cases with breast cancer. We compared those data to 3,151 control subjects with normal TSH seen during the same period. We excluded patients with thyroid cancer from the total number of malignancies in both groups because abnormal TSH would be expected to result from its treatment. We also reviewed the ER, PR, her 2 neu status and free thyroxine of patients with breast cancers. Results: Breast cancer rate of 36% of all cancers (37/102) in the abnormal TSH group was significantly higher than that of 18% (14/77) in the normal TSH group. (p = 0.012). Breast cancers in the study group with abnormal thyroid function were more frequently hormone receptor positive (74% vs. 67%) and her 2 neu negative (67% vs. 50%). Conclusions: The data suggest that there is an increased rate of breast cancer in patients with abnormal thyroid function. The trend of hormone receptor positive disease in the abnormal TSH group suggests that the IGF receptor may play an important role in the relationship between thyroid disease and breast cancer. The IGF receptor may be a potential target for therapeutic drug development for breast cancer prevention and management. Further studies are warranted. No significant financial relationships to disclose.
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Affiliation(s)
- N. J. Karlin
- UCLA Olive View Medical Center, Sylmar, CA; UCLA, Los Angeles, CA; Cedars-Sinai Medical Center, Los Angeles, CA
| | - I. Chopra
- UCLA Olive View Medical Center, Sylmar, CA; UCLA, Los Angeles, CA; Cedars-Sinai Medical Center, Los Angeles, CA
| | - J. Mirocha
- UCLA Olive View Medical Center, Sylmar, CA; UCLA, Los Angeles, CA; Cedars-Sinai Medical Center, Los Angeles, CA
| | - N. Feldman
- UCLA Olive View Medical Center, Sylmar, CA; UCLA, Los Angeles, CA; Cedars-Sinai Medical Center, Los Angeles, CA
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Czer L, Goland S, Kass R, de Robertis M, Mirocha J, Zivari K, Lee J, Coleman B, Trento A. 479: Induction therapy with thymoglobulin after heart transplantation: Impact of therapy duration on lymphocyte depletion and recovery, rejection and CMV infection rates. J Heart Lung Transplant 2007. [DOI: 10.1016/j.healun.2006.11.502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Goland S, Czer L, Kass R, Siegel R, Mirocha J, de Robertis M, Lee J, Coleman B, Raissi S, Cheng W, Fontana G, Trento A. 344: Utilization of cardiac allografts with mild or moderate LVH is safe and can expand the donor pool. J Heart Lung Transplant 2007. [DOI: 10.1016/j.healun.2006.11.364] [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: 11/17/2022] Open
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Shazer R, Bharne A, Nepomuceno E, Mirocha J, Ramirez C, Luthringer D, Holden S, Agus DB, Gross M. Biomarkers and obesity in surgically treated patients with prostate cancer. J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.14536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
14536 Background: Obesity is associated with poor outcomes in prostate cancer (PC). We explored if biomarkers for proliferation and estrogen signaling relate to obesity and surgical outcomes in PC patients (pts) treated by radical prostatectomy (RP). Methods: Pts with RP at a single institution between 1993 and 2002 were reviewed (1156 pts). The analysis subset included pts with full preoperative staging and anthropometric variables (541 pts). Clinical variables examined included: age, PSA, pre-operative hemoglobin (Hgb), ethnicity, and body mass index (BMI). Surgical outcomes included: estimated blood loss (EBL), Gleason score ≥ 7 (GS >7), extra-capsular extension (ECE), positive margins (MR+), and pathologic stage (pT2 vs. pT3/T4). Biomarkers examined in a convenience subset (n = 61) included proliferation index (Ki67% in cancer cells) and ERα positivity (nuclei staining ≥5% in cancer or peri-tumoral stromal cells). Obesity was defined as BMI ≥ 30 kg/m2. A step-wise logistic regression analysis was used to determine odds ratio (OR) in relation to obesity. Results: Mean ± standard deviation for pre-operative data included: age 62.7 ± 7.5 yrs; PSA 8.4 ± 6.8 ng/dl; Hgb 13.6 ± 1.8 g/dl; and BMI 26.5 ± 3.8 kg/m2. Pt reported ethnicities included: white (432 pts), Black/African-American (69 pts), Asian/Pacific Islander (20 pts), Hispanic (16 pts). BMI correlated highly with race (Kruskal-Wallis p = 0.002) and weakly with EBL (Spearman 0.11, p = 0.009) and Hgb (Spearman 0.15, p = 0.002). No correlation was observed between obesity and Gleason score. Regression models showed obesity was independently associated with ECE (OR 2.5, 95% CI 1.2–5.3) and pT3/T4 (OR 1.9, 95% CI 1.0–3.3). Biomarker analysis showed Ki67% correlated with GS >7, (Spearman 0.25, p = 0.048), but not BMI. No ERα positivity was noted in cancer cells. Stromal ERα positivity was noted in 21/30=70% of non-obese and 15/31=48% of obese pts (Fisher’s exact test p = 0.12). Conclusion: We confirm the association between obesity, ethnicity, and poor surgical outcomes. Biomarker analysis shows that obesity has no effect on proliferation index or tumor grade. However, we observe a trend towards down-regulation of stromal ERα expression in obese patients. No significant financial relationships to disclose.
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Affiliation(s)
- R. Shazer
- Cedars-Sinai Medical Center, Los Angeles, CA
| | - A. Bharne
- Cedars-Sinai Medical Center, Los Angeles, CA
| | | | - J. Mirocha
- Cedars-Sinai Medical Center, Los Angeles, CA
| | - C. Ramirez
- Cedars-Sinai Medical Center, Los Angeles, CA
| | | | - S. Holden
- Cedars-Sinai Medical Center, Los Angeles, CA
| | - D. B. Agus
- Cedars-Sinai Medical Center, Los Angeles, CA
| | - M. Gross
- Cedars-Sinai Medical Center, Los Angeles, CA
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Goland S, Czer L, Kass R, Mirocha J, Chapelli C, Coleman B, De Robertis M, Raissi S, Cheng W, Fontana G, Trento A. 40. J Heart Lung Transplant 2006. [DOI: 10.1016/j.healun.2005.11.042] [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: 12/01/2022] Open
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Coleman B, Czer L, Jordan S, Mirocha J, Goland S, Raissi S, Chen W, Fontana G, Kass R, Trento A, Tyan D. 8. J Heart Lung Transplant 2006. [DOI: 10.1016/j.healun.2005.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Gross M, Jo S, Huang D, Mirocha J, Shazer R, Holden S, Agus D. Obesity, ethnicity, and surgical outcomes for clinically localized prostate cancer. J Clin Oncol 2005. [DOI: 10.1200/jco.2005.23.16_suppl.9615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- M. Gross
- Cedars-Sinai Medcl Ctr, Los Angeles, CA; Cedars Sinai Medical Center
| | - S. Jo
- Cedars-Sinai Medcl Ctr, Los Angeles, CA; Cedars Sinai Medical Center
| | - D. Huang
- Cedars-Sinai Medcl Ctr, Los Angeles, CA; Cedars Sinai Medical Center
| | - J. Mirocha
- Cedars-Sinai Medcl Ctr, Los Angeles, CA; Cedars Sinai Medical Center
| | - R. Shazer
- Cedars-Sinai Medcl Ctr, Los Angeles, CA; Cedars Sinai Medical Center
| | - S. Holden
- Cedars-Sinai Medcl Ctr, Los Angeles, CA; Cedars Sinai Medical Center
| | - D. Agus
- Cedars-Sinai Medcl Ctr, Los Angeles, CA; Cedars Sinai Medical Center
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Jeon DS, Atar S, Brasch AV, Luo H, Mirocha J, Naqvi TZ, Kraus R, Berman DS, Siegel RJ. Association of mitral annulus calcification, aortic valve sclerosis and aortic root calcification with abnormal myocardial perfusion single photon emission tomography in subjects age < or =65 years old. J Am Coll Cardiol 2001; 38:1988-93. [PMID: 11738305 DOI: 10.1016/s0735-1097(01)01678-3] [Citation(s) in RCA: 62] [Impact Index Per Article: 2.7] [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: 11/21/2022]
Abstract
OBJECTIVES We examined the hypothesis that mitral annulus calcification (MAC), aortic valve sclerosis (AVS) and aortic root calcification (ARC) are associated with coronary artery disease (CAD) in subjects age < or =65 years. BACKGROUND Mitral annulus calcification, AVS and ARC frequently coexist and are associated with coronary risk factors and CAD in the elderly. METHODS We studied 338 subjects age < or =65 years who underwent evaluation of chest pain with myocardial perfusion single photon emission computed tomography (SPECT) and a two-dimensional transthoracic echocardiogram for other indications. The association of MAC, AVS and ARC with abnormal SPECT was evaluated by using chi-square analyses and logistic regression analyses. RESULTS Compared with no or one calcium deposit and no or one coronary risk factor other than diabetes, multiple (> or =2) calcium (or sclerosis) deposits with diabetes or multiple (> or =2) coronary risk factors were significantly associated with abnormal SPECT in women age < or =55 years old (odds ratio [OR], 20.00), in women age >55 years old (OR, 10.00) and in men age < or =55 years old (OR, 5.55). Multivariate analyses identified multiple calcium deposits as a significant predictor for an abnormal SPECT in women (p < 0.001), younger subjects age < or =55 years (p < 0.05) and the total group of subjects (p < 0.01). CONCLUSIONS When coronary risk factors are also taken into consideration, the presence of multiple calcium deposits in the mitral annulus, aortic valve or aortic root appears to be a marker of CAD in men < or =55 years old and women.
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Affiliation(s)
- D S Jeon
- Division of Cardiology, Cedars-Sinai Medical Center, Los Angeles, California 90048, USA
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Abstract
OBJECTIVES The purpose of this study was to describe the injuries sustained by displaced people returning home after a military conflict when landmines were not removed. METHOD This study describes the landmine injuries to patients at the Jaffna Teaching Hospital in northern Sri Lanka over a 20-month period, from May 1, 1996, to December 31, 1997. RESULTS There were definite and identifiable landmine injury patterns. Patients were most often wounded in the lower extremities, had multiple wounds, and were injured together in groups. Victims were most often male, but there were unusually high numbers of women, children, and elderly injured. Mortality rates and amputation rates were high. Deaths occurred early after injury. Higher incidences of mine injuries could be associated with two important activities: returning home and agriculture. CONCLUSIONS Civilians returning home after armed conflicts are at risk of injury when landmines are not removed. No one is spared. This problem is preventable.
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Affiliation(s)
- P Meade
- Medecins Sans Frontieres/Doctors Without Borders, Department of Surgery, King Drew Medical Center, Los Angeles, California 90059, USA
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