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Chang JL, Goldberg AN, Alt JA, Alzoubaidi M, Ashbrook L, Auckley D, Ayappa I, Bakhtiar H, Barrera JE, Bartley BL, Billings ME, Boon MS, Bosschieter P, Braverman I, Brodie K, Cabrera-Muffly C, Caesar R, Cahali MB, Cai Y, Cao M, Capasso R, Caples SM, Chahine LM, Chang CP, Chang KW, Chaudhary N, Cheong CSJ, Chowdhuri S, Cistulli PA, Claman D, Collen J, Coughlin KC, Creamer J, Davis EM, Dupuy-McCauley KL, Durr ML, Dutt M, Ali ME, Elkassabany NM, Epstein LJ, Fiala JA, Freedman N, Gill K, Boyd Gillespie M, Golisch L, Gooneratne N, Gottlieb DJ, Green KK, Gulati A, Gurubhagavatula I, Hayward N, Hoff PT, Hoffmann OM, Holfinger SJ, Hsia J, Huntley C, Huoh KC, Huyett P, Inala S, Ishman SL, Jella TK, Jobanputra AM, Johnson AP, Junna MR, Kado JT, Kaffenberger TM, Kapur VK, Kezirian EJ, Khan M, Kirsch DB, Kominsky A, Kryger M, Krystal AD, Kushida CA, Kuzniar TJ, Lam DJ, Lettieri CJ, Lim DC, Lin HC, Liu SY, MacKay SG, Magalang UJ, Malhotra A, Mansukhani MP, Maurer JT, May AM, Mitchell RB, Mokhlesi B, Mullins AE, Nada EM, Naik S, Nokes B, Olson MD, Pack AI, Pang EB, Pang KP, Patil SP, Van de Perck E, Piccirillo JF, Pien GW, Piper AJ, Plawecki A, Quigg M, Ravesloot MJ, Redline S, Rotenberg BW, Ryden A, Sarmiento KF, Sbeih F, Schell AE, Schmickl CN, Schotland HM, Schwab RJ, Seo J, Shah N, Shelgikar AV, Shochat I, Soose RJ, Steele TO, Stephens E, Stepnowsky C, Strohl KP, Sutherland K, Suurna MV, Thaler E, Thapa S, Vanderveken OM, de Vries N, Weaver EM, Weir ID, Wolfe LF, Tucker Woodson B, Won CH, Xu J, Yalamanchi P, Yaremchuk K, Yeghiazarians Y, Yu JL, Zeidler M, Rosen IM. International Consensus Statement on Obstructive Sleep Apnea. Int Forum Allergy Rhinol 2023; 13:1061-1482. [PMID: 36068685 PMCID: PMC10359192 DOI: 10.1002/alr.23079] [Citation(s) in RCA: 34] [Impact Index Per Article: 34.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 08/12/2022] [Accepted: 08/18/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND Evaluation and interpretation of the literature on obstructive sleep apnea (OSA) allows for consolidation and determination of the key factors important for clinical management of the adult OSA patient. Toward this goal, an international collaborative of multidisciplinary experts in sleep apnea evaluation and treatment have produced the International Consensus statement on Obstructive Sleep Apnea (ICS:OSA). METHODS Using previously defined methodology, focal topics in OSA were assigned as literature review (LR), evidence-based review (EBR), or evidence-based review with recommendations (EBR-R) formats. Each topic incorporated the available and relevant evidence which was summarized and graded on study quality. Each topic and section underwent iterative review and the ICS:OSA was created and reviewed by all authors for consensus. RESULTS The ICS:OSA addresses OSA syndrome definitions, pathophysiology, epidemiology, risk factors for disease, screening methods, diagnostic testing types, multiple treatment modalities, and effects of OSA treatment on multiple OSA-associated comorbidities. Specific focus on outcomes with positive airway pressure (PAP) and surgical treatments were evaluated. CONCLUSION This review of the literature consolidates the available knowledge and identifies the limitations of the current evidence on OSA. This effort aims to create a resource for OSA evidence-based practice and identify future research needs. Knowledge gaps and research opportunities include improving the metrics of OSA disease, determining the optimal OSA screening paradigms, developing strategies for PAP adherence and longitudinal care, enhancing selection of PAP alternatives and surgery, understanding health risk outcomes, and translating evidence into individualized approaches to therapy.
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Affiliation(s)
- Jolie L. Chang
- University of California, San Francisco, California, USA
| | | | | | | | - Liza Ashbrook
- University of California, San Francisco, California, USA
| | | | - Indu Ayappa
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | | | | | | | - Maurits S. Boon
- Sidney Kimmel Medical Center at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Pien Bosschieter
- Academic Centre for Dentistry Amsterdam, Amsterdam, The Netherlands
| | - Itzhak Braverman
- Hillel Yaffe Medical Center, Hadera Technion, Faculty of Medicine, Hadera, Israel
| | - Kara Brodie
- University of California, San Francisco, California, USA
| | | | - Ray Caesar
- Stone Oak Orthodontics, San Antonio, Texas, USA
| | | | - Yi Cai
- University of California, San Francisco, California, USA
| | | | | | | | | | | | | | | | | | - Susmita Chowdhuri
- Wayne State University and John D. Dingell VA Medical Center, Detroit, Michigan, USA
| | - Peter A. Cistulli
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - David Claman
- University of California, San Francisco, California, USA
| | - Jacob Collen
- Uniformed Services University, Bethesda, Maryland, USA
| | | | | | - Eric M. Davis
- University of Virginia, Charlottesville, Virginia, USA
| | | | | | - Mohan Dutt
- University of Michigan, Ann Arbor, Michigan, USA
| | - Mazen El Ali
- University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | | | | | | | | | - Kirat Gill
- Stanford University, Palo Alto, California, USA
| | | | - Lea Golisch
- University Hospital Mannheim, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany
| | | | | | | | - Arushi Gulati
- University of California, San Francisco, California, USA
| | | | | | - Paul T. Hoff
- University of Michigan, Ann Arbor, Michigan, USA
| | - Oliver M.G. Hoffmann
- University Hospital Mannheim, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany
| | | | - Jennifer Hsia
- University of Minnesota, Minneapolis, Minnesota, USA
| | - Colin Huntley
- Sidney Kimmel Medical Center at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | | | | | - Sanjana Inala
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | | | | | | | | | | | | | | | | | - Meena Khan
- Ohio State University, Columbus, Ohio, USA
| | | | - Alan Kominsky
- Cleveland Clinic Head and Neck Institute, Cleveland, Ohio, USA
| | - Meir Kryger
- Yale School of Medicine, New Haven, Connecticut, USA
| | | | | | | | - Derek J. Lam
- Oregon Health and Science University, Portland, Oregon, USA
| | | | | | | | | | | | | | - Atul Malhotra
- University of California, San Diego, California, USA
| | | | - Joachim T. Maurer
- University Hospital Mannheim, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany
| | - Anna M. May
- Case Western Reserve University, Cleveland, Ohio, USA
| | - Ron B. Mitchell
- University of Texas, Southwestern and Children’s Medical Center Dallas, Texas, USA
| | | | | | | | | | - Brandon Nokes
- University of California, San Diego, California, USA
| | | | - Allan I. Pack
- University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | | | | | | | | | | | | | | | - Mark Quigg
- University of Virginia, Charlottesville, Virginia, USA
| | | | - Susan Redline
- Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Armand Ryden
- Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | | | - Firas Sbeih
- Cleveland Clinic Head and Neck Institute, Cleveland, Ohio, USA
| | | | | | | | | | - Jiyeon Seo
- University of California, Los Angeles, California, USA
| | - Neomi Shah
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | | | - Ryan J. Soose
- University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | | | - Erika Stephens
- University of California, San Francisco, California, USA
| | | | | | | | | | - Erica Thaler
- University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Sritika Thapa
- Yale School of Medicine, New Haven, Connecticut, USA
| | | | - Nico de Vries
- Academic Centre for Dentistry Amsterdam, Amsterdam, The Netherlands
| | | | - Ian D. Weir
- Yale School of Medicine, New Haven, Connecticut, USA
| | | | | | | | - Josie Xu
- University of Toronto, Ontario, Canada
| | | | | | | | | | | | - Ilene M. Rosen
- University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Kazaglis L, Hsia J, Green K, Iber C. 0706 Comparing the Dose-Response Curves of Upper Airway Stimulation and CPAP Usage on Changes in Epworth Sleepiness Scale. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.702] [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: 11/12/2022] Open
Abstract
Abstract
Introduction
Upper Airway Stimulation (UAS) and Continuous Positive Airway Pressure (CPAP) are trackable therapies for obstructive sleep apnea. We used recent big-data cohorts to compare changes in sleepiness versus usage.
Methods
ADHERE is an international registry of real-world UAS outcomes from 2016 to date. General UAS criteria are CPAP intolerance, AHI 15-65 (<25% central+mixed), and suggested BMI≤35. Baseline ESS is collected from the medical record, and follow-up ESS and usage is collected 2-4 months after therapy activation. M Health Fairview maintains a database of cross-linked CPAP and EHR data. All new adult sleep patients from 2015 onward were included paralleling ADHERE: BMI≤35, AHI 15-65, and daily CPAP-EHR data starting at least 60 days prior to 2nd ESS measurement. Baseline ESS was collected at consult, and follow-up ESS was collected approximately 6 months later. Device-reported usage hours were compared with the changes in ESS from baseline.
Results
UAS (n=690) and CPAP (n=514) groups were similar: age 59.7±10.8 versus 59.7±13.6, 78% versus 75% male, and AHI 35.3±14.4 versus 33.8±14.0. UAS group was slightly less obese, BMI 29.3±3.9 versus 30.0±3.4 (p=0.001), with higher baseline ESS, 11.4±5.6 versus 8.6±5.3 (p<0.001). UAS usage was higher at 6.4±2.0 hours/night versus 5.2±2.0 hours/night with CPAP (p<0.001). UAS group average ESS decreased 2.5 points for patients with 0-4 hours of use (n=81), decreasing to 3.8 points with at 4 or more hours of use (n=609). CPAP group average ESS decreased 2.5 points for patients with 0-4 hours of use (n=125), decreasing to 3.3 points with at 4 or more hours of use (n=389).
Conclusion
Compared to prior works and the UAS cohort, this CPAP cohort was more likely to have normal ESS at baseline. UAS and CPAP both demonstrate a dose-response curve associating increasing hourly usage with larger ESS reductions.
Support
Kent Lee of Inspire Medical Systems provided background information and access to a de-identified ADHERE data set for analysis.
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Affiliation(s)
| | - J Hsia
- M Health Fairview, Minneapolis, MN
| | - K Green
- University of Colorado, Denver, CO
| | - C Iber
- M Health Fairview, Minneapolis, MN
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Kezirian EJ, Heiser C, Steffen A, Boon M, Hofauer B, Doghramji K, Maurer JT, Sommer JU, Soose RJ, Schwab R, Thaler E, Withrow K, Kominsky A, Larsen CG, Hsia J, Mehra R, Waters T, Strohl K. Previous Surgery and Hypoglossal Nerve Stimulation for Obstructive Sleep Apnea. Otolaryngol Head Neck Surg 2019; 161:897-903. [DOI: 10.1177/0194599819856339] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective To examine whether previous palate or hypopharyngeal surgery was associated with efficacy of treatment of obstructive sleep apnea with hypoglossal nerve stimulation. Study Design Cohort (retrospective and prospective). Setting Eleven academic medical centers. Subjects and Methods Adults treated with hypoglossal nerve stimulation were enrolled in the ADHERE Registry. Outcomes were defined by the apnea-hypopnea index (AHI), in 3 ways: change in the AHI and 2 definitions of therapy response requiring ≥50% reduction in the AHI to a level <20 events/h (Response20) or 15 events/h (Response15). Previous palate and hypopharyngeal (tongue, epiglottis, or maxillofacial) procedures were documented. Linear and logistic regression examined the association between previous palate or hypopharyngeal surgery and outcomes, with adjustment for age, sex, and body mass index. Results The majority (73%, 217 of 299) had no previous palate or hypopharyngeal surgery, while 25% and 9% had previous palate or hypopharyngeal surgery, respectively, including 6% with previous palate and hypopharyngeal surgery. Baseline AHI (36.0 ± 15.6 events/h) decreased to 12.0 ± 13.3 at therapy titration ( P < .001) and 11.4 ± 12.6 at final follow-up ( P < .001). Any previous surgery, previous palate surgery, and previous hypopharyngeal surgery were not clearly associated with treatment response; for example, any previous surgery was associated with a 0.69 (95% CI: 0.37, 1.27) odds of response (Response20 measure) at therapy titration and a 0.55 (95% CI: 0.22, 1.34) odds of response (Response20 measure) at final follow-up. Conclusion Previous upper airway surgery was not clearly associated with efficacy of hypoglossal nerve stimulation.
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Affiliation(s)
- Eric J. Kezirian
- Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | - Clemens Heiser
- Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | | | - Maurits Boon
- Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Benedikt Hofauer
- Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Karl Doghramji
- Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | | | | | - Ryan J. Soose
- University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Richard Schwab
- University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Erica Thaler
- University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | | | | | - Jennifer Hsia
- University of Minnesota Fairview Hospital, Minneapolis, Minnesota, USA
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Heiser C, Steffen A, Boon M, Hofauer B, Doghramji K, Maurer JT, Sommer JU, Soose R, Strollo PJ, Schwab R, Thaler E, Withrow K, Kominsky A, Larsen C, Kezirian EJ, Hsia J, Chia S, Harwick J, Strohl K, Mehra R. Post-approval upper airway stimulation predictors of treatment effectiveness in the ADHERE registry. Eur Respir J 2019; 53:13993003.01405-2018. [PMID: 30487205 PMCID: PMC6319796 DOI: 10.1183/13993003.01405-2018] [Citation(s) in RCA: 90] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Accepted: 10/19/2018] [Indexed: 02/05/2023]
Abstract
Upper airway stimulation (UAS) has been shown to reduce severity of obstructive sleep apnoea. The aim of this study was to identify predictors of UAS therapy response in an international multicentre registry.Patients who underwent UAS implantation in the United States and Germany were enrolled in an observational registry. Data collected included patient characteristics, apnoea/hypopnoea index (AHI), Epworth sleepiness scale (ESS), objective adherence, adverse events and patient satisfaction measures. Post hoc univariate and multiple logistic regression were performed to evaluate factors associated with treatment success.Between October 2016 and January 2018, 508 participants were enrolled from 14 centres. Median AHI was reduced from 34 to 7 events·h-1, median ESS reduced from 12 to 7 from baseline to final visit at 12-month post-implant. In post hoc analyses, for each 1-year increase in age, there was a 4% increase in odds of treatment success. For each 1-unit increase in body mass index (BMI), there was 9% reduced odds of treatment success. In the multivariable model, age persisted in serving as statistically significant predictor of treatment success.In a large multicentre international registry, UAS is an effective treatment option with high patient satisfaction and low adverse events. Increasing age and reduced BMI are predictors of treatment response.
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Affiliation(s)
- Clemens Heiser
- Dept of Otorhinolaryngology, Head and Neck Surgery, Munich Technical University, Munich, Germany
| | - Armin Steffen
- Dept of Otorhinolaryngology, University of Lubeck, Lubeck, Germany
| | - Maurits Boon
- Dept of Otorhinolaryngology - Head and Neck Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Benedikt Hofauer
- Dept of Otorhinolaryngology, Head and Neck Surgery, Munich Technical University, Munich, Germany
| | - Karl Doghramji
- Dept of Otorhinolaryngology - Head and Neck Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Joachim T Maurer
- Dept of Otorhinolaryngology, Head and Neck Surgery, HELIOS University Hospital Wuppertal, Wuppertal, Germany
| | - J Ulrich Sommer
- Dept of Otorhinolaryngology, Head and Neck Surgery, HELIOS University Hospital Wuppertal, Wuppertal, Germany
| | - Ryan Soose
- Dept of Otorhinolaryngology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Patrick J Strollo
- Dept of Otorhinolaryngology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Richard Schwab
- Dept of Sleep Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Erica Thaler
- Dept of Sleep Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Kirk Withrow
- Dept of Otorhinolaryngology, University of Alabama, Birmingham, AL, USA
| | - Alan Kominsky
- Dept of Otorhinolaryngology, Cleveland Clinic, Cleveland, OH, USA
| | - Christopher Larsen
- Dept of Otorhinolaryngology - Head and Neck Surgery, Kansas University Medical Center, Kansas City, KS, USA
| | - Eric J Kezirian
- Dept of Otorhinolaryngology - Head and Neck Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Jennifer Hsia
- Dept of Otorhinolaryngology - Head and Neck Surgery, University of Minnesota Fairview Hospital, Minneapolis, MN, USA
| | - Stanley Chia
- Dept of Otorhinolaryngology, MedStar Washington Hospital Center, Washington, DC, USA
| | - John Harwick
- Dept of Otorhinolaryngology - Head and Neck Surgery, University of Florida, Gainesville, FL, USA
| | - Kingman Strohl
- Dept of Pulmonary and Critical Care Medicine and Sleep Medicine, University Hospital Cleveland Medical Center, Cleveland, OH, USA
| | - Reena Mehra
- Dept of Otorhinolaryngology, Cleveland Clinic, Cleveland, OH, USA
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5
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Green KK, Kent DT, D'Agostino MA, Hoff PT, Lin HS, Soose RJ, Boyd Gillespie M, Yaremchuk KL, Carrasco-Llatas M, Tucker Woodson B, Jacobowitz O, Thaler ER, Barrera JE, Capasso R, Liu SY, Hsia J, Mann D, Meraj TS, Waxman JA, Kezirian EJ. Drug-Induced Sleep Endoscopy and Surgical Outcomes: A Multicenter Cohort Study. Laryngoscope 2018; 129:761-770. [PMID: 30588639 DOI: 10.1002/lary.27655] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [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: 09/18/2018] [Revised: 10/06/2018] [Accepted: 10/10/2018] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To evaluate the association between findings of blinded reviews of preoperative drug-induced sleep endoscopy (DISE) examinations using the VOTE Classification and obstructive sleep apnea (OSA) surgical outcomes in a large multicenter, international cohort. METHODS Retrospective, multi-center cohort study of adults without tonsillar hypertrophy who underwent pharyngeal surgery for OSA. The study included only participants without enlarged tonsils. Four independent reviewers performed blinded review of preoperative DISE videos using the VOTE Classification system and scoring of a primary structure contributing to airway obstruction. DISE findings were examined for an association with surgical outcomes with univariate analyses and multiple regression. RESULTS Two hundred seventy-five study participants were included from 14 centers. Mean age was 51.4 ± 11.8 years, and body mass index was 30.1 ± 5.2 kg/m2 . There was moderate interrater reliability (kappa = 0.40-0.60) for DISE findings. Oropharyngeal lateral wall-related obstruction was associated with poorer surgical outcomes (adjusted odds ratio (AOR) 0.51; 95% CI 0.27, 0.93). Complete tongue-related obstruction was associated with a lower odds of surgical response in moderate to severe OSA (AOR 0.52; 95% CI 0.28, 0.98), with findings that were similar but not statistically significant in other analyses. Surgical outcomes were not clearly associated with the degree and configuration of velum-related obstruction or the degree of epiglottis-related obstruction. Surgical response was associated with tonsil size and body mass index (inversely). CONCLUSION DISE findings concerning the oropharyngeal lateral walls and tongue may be the most important findings of this evaluation technique. LEVEL OF EVIDENCE 2B Laryngoscope, 129:761-770, 2019.
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Affiliation(s)
- Katherine K Green
- Department of Otolaryngology, University of Colorado School of Medicine, Denver, Colorado, U.S.A
| | - David T Kent
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, U.S.A
| | - Mark A D'Agostino
- Southern New England Ear, Nose and Throat Group, Middlesex, Connecticut, USA.,Department of Surgery, Yale University School of Medicine, New Haven, Connecticut, U.S.A
| | - Paul T Hoff
- University of Michigan, Department of Otolaryngology-Head and Neck Surgery, Ann Arbor, Michigan, U.S.A
| | - Ho-Sheng Lin
- Department of Otolaryngology-Head and Neck Surgery, Wayne State University School of Medicine, Detroit, Michigan, U.S.A
| | - Ryan J Soose
- UPMC Department of Otolaryngology Head and Neck Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, U.S.A
| | - M Boyd Gillespie
- Department of Otolaryngology-Head and Neck Surgery, University of Tennessee Memphis, Memphis, Tennessee, U.S.A
| | - Kathleen L Yaremchuk
- Department of Otolaryngology-Head and Neck Surgery, Henry Ford Health System, Detroit, Michigan, U.S.A
| | | | - B Tucker Woodson
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsi, Milwaukee, Wisconsin, U.S.A
| | - Ofer Jacobowitz
- ENT and Allergy Associates, New York, New York, U.S.A.,Department of Otolaryngology, The Mount Sinai Hospital, New York, New York, U.S.A
| | - Erica R Thaler
- Department of Otorhinolaryngology: Head and Neck Surgery, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
| | - José E Barrera
- Department of Otolaryngology Head and Neck Surgery, Uniformed Services University, Washington, D.C., U.S.A.,Endormir Sleep and Sinus Institute, San Antonio, Texas, U.S.A
| | - Robson Capasso
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, U.S.A
| | - Stanley Yung Liu
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, U.S.A
| | - Jennifer Hsia
- Department of Otolaryngology, Head and Neck Surgery, University of Minnesota Medical School, Minneapolis, Minnesota, U.S.A
| | - Daljit Mann
- University of Oklahoma Health Sciences Center, Department of Otolaryngology-Head & Neck Surgery, Oklahoma City, Oklahoma, U.S.A
| | - Taha S Meraj
- Department of Otolaryngology Head and Neck Surgery, Wayne State University School of Medicine, Detroit, Michigan, U.S.A
| | - Jonathan A Waxman
- Department of Otolaryngology Head and Neck Surgery, Wayne State University School of Medicine, Detroit, Michigan, U.S.A
| | - Eric J Kezirian
- USC Caruso Department of Otolaryngology-Head & Neck Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California, U.S.A
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6
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Affiliation(s)
- Mitchell Creinin
- Department of Obstetrics and Gynecology, University of California, Sacramento, California
| | - Jennifer Hsia
- Department of Obstetrics and Gynecology, University of California, Sacramento, California
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7
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Hsia J, Zhang X, Puckcharern H. Estimation of Provincial Tobacco Use in Thailand Using Multilevel Small Area Estimation from a National Probability Sample. Int J Epidemiol 2015. [DOI: 10.1093/ije/dyv096.244] [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: 11/12/2022] Open
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Abstract
Obstructive sleep apnea (OSA) is a disease characterized by intermittent and repetitive narrowing of the airway during sleep. Surgical therapies for the treatment of OSA aim to improve airway patency by addressing selected site(s) of obstruction. Because several areas may each be responsible for the narrowing, different surgical modalities have also been developed. In this review, we give an overview of surgery for each of potential obstruction site(s). As a consequence of the multi-factorial and heterogeneous etiology of OSA, surgical therapies need to be selected and performed specifically for each patient, as there is no perfect surgery that will fit all patients. As with any other treatment modalities for OSA, surgical therapies have variable efficacy, but are a very important tool on OSA management in selected patients and have been shown effectiveness in decreasing the morbidity and mortality associated with the disease.
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Affiliation(s)
- Bettina Carvalho
- Department of Otolaryngology-Head and Neck Surgery, Stanford University Medical Center, Stanford, CA 94305-5739 USA
| | - Jennifer Hsia
- Department of Otolaryngology-Head and Neck Surgery, Stanford University Medical Center, Stanford, CA 94305-5739 USA
| | - Robson Capasso
- Department of Otolaryngology-Head and Neck Surgery, Stanford University Medical Center, Stanford, CA 94305-5739 USA
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Hu A, Weissbrod PA, Maronian NC, Hsia J, Davies JM, Sivarajan GK, Hillel AD. Hunsaker mon-jet tube ventilation: A 15-year experience. Laryngoscope 2012; 122:2234-9. [DOI: 10.1002/lary.23491] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2012] [Revised: 04/26/2012] [Accepted: 05/11/2012] [Indexed: 11/12/2022]
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10
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Hsia J, Samet J, Asma S, Nelson-Blutcher G. P2-417 Nicotine dependence among daily cigarette smokers in 14 countries. Br J Soc Med 2011. [DOI: 10.1136/jech.2011.142976l.47] [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: 11/03/2022]
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Abstract
Cardiovascular disease remains by far the leading cause of death for women worldwide. Despite a large body of research identifying effective interventions to reduce cardiovascular risk, translation into practice has been slow. This review pinpoints areas in particular need of improvement and summarizes gender-specific analyses in recent randomized trials assessing the impact of risk factor modulation on cardiovascular events.
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Affiliation(s)
- J Hsia
- AstraZeneca LP, 1800 Concord Pike, PO Box 15437, Wilmington, DE 19850-5437, USA.
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Zhang LY, Jejeebhoy S, Shah IH, Zhang LH, Hsia J, Im-em W. Access to contraceptive services among unmarried young people in the north-east of China. EUR J CONTRACEP REPR 2009; 9:147-54. [PMID: 15697104 DOI: 10.1080/13625180400007181] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE The concerns about the potential threats of human immunodeficiency virus (HIV) infection and acquired immunodeficiency syndrome (AIDS) have increased, since, in China, there is a lack of sexual education and condom use is rare. A community-based survey was conducted in September 2001 in Changchun city among 1227 unmarried young people aged 15-24 years (619 males and 608 females) to assess risky sexual practices and the obstacles to accessing appropriate contraceptive and other services. METHOD The study comprised a survey employing self-administered questionnaires, as well as key informant interviews, focus group discussions and in-depth interviews. This paper investigates the factors associated with young people's access to contraceptive services. RESULTS Results showed that 16% of young people had experienced premarital sexual intercourse and, among them, only 48.2% used contraceptive methods during the first sexual intercourse; 29.9% used a condom. Drug stores were the main source of contraceptives. CONCLUSIONS While data are sparse, findings suggest that the hostile and judgmental attitudes of providers, as well as the lack of counseling and privacy, were the key obstacles that unmarried youth encountered in their search for contraceptive services. Findings suggest the need for a reorientation of the contraceptive services to focus on unmarried youth, and generally to make contraceptive services more accessible to young people.
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Affiliation(s)
- L Y Zhang
- Institute for Population and Social Research, Mahidol University, Thailand
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13
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Solomon SD, Lin J, Solomon CG, Jablonski KA, Rice MM, Steffes M, Domanski M, Hsia J, Gersh BJ, Arnold JM, Rouleau J, Braunwald E, Pfeffer MA. Influence of albuminuria on cardiovascular risk in patients with stable coronary artery disease. Circulation 116: 2687-2693, 2007. Clin J Am Soc Nephrol 2008; 3:317-323. [PMID: 37001131 DOI: 10.2215/01.cjn.0000926956.32395.fc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2023]
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14
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Howard B, Rossouw J, Anderson G, Manson J, Hsia J, Wassertheil-Smoller S, Hendrix S, Chlebowski R, Stefanick M, Cauley J, Jackson R. Th-W59:1 Postmenopausal hormone therapy-lessons from the women's health initiative. ATHEROSCLEROSIS SUPP 2006. [DOI: 10.1016/s1567-5688(06)81936-7] [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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15
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Chen C, Hsia J. P-203 Adjuvant chemotherapy versus radiotherapy for resected state IIIA (N2) non small cell lung cancer, a phase III study. Lung Cancer 2005. [DOI: 10.1016/s0169-5002(05)80697-x] [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]
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16
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Melton SM, Kerby JD, McGiffin D, McGwin G, Smith JK, Oser RF, Cross JM, Windham ST, Moran SG, Hsia J, Rue LW. The Evolution of Chest Computed Tomography for the Definitive Diagnosis of Blunt Aortic Injury: A Single-Center Experience. ACTA ACUST UNITED AC 2004; 56:243-50. [PMID: 14960963 DOI: 10.1097/01.ta.0000111751.84052.24] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Chest computed tomography (CT) is an excellent screening tool for blunt aortic injuries (BAIs). Aortography is considered the "gold standard" for diagnosis. Recent evidence suggests that new-generation, multislice, helical CT technology can accurately diagnose BAI. METHODS A retrospective review of aortograms performed to evaluate for BAI was compared with the results of CT and operative findings. BAIs definitively diagnosed by CT alone were also studied. RESULTS Between July 1, 1996, and June 30, 2002, 113 aortograms were obtained, with 28 BAI cases confirmed. Of these, 27 were congruently diagnosed by CT. Only one computed tomographic scan diagnostic for BAI had a subsequent negative aortogram. Seventeen BAIs were diagnosed with CT alone. Ten were confirmed operatively and seven were treated nonoperatively because of age, comorbid conditions, severity of injury, or the presence of small intimal defects. CONCLUSION CT technology has evolved to allow for the definitive diagnosis and treatment of BAI. Aortography should still be used where new-generation CT is not available.
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Affiliation(s)
- Sherry M Melton
- Department of Surgery, Section of Trauma, Burns, and Surgical Critical Care, Division of General Surgery, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama 35294-0016, USA.
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17
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Pfeffer MA, Domanski M, Verter J, Dunlap M, Flaker GC, Gersh B, Hsia J, Goldberg AD, Limacher MC, Maggioni AP, Rosenberg Y, Rouleau JL, Warnica JW, Wasserman AG, Braunwald E. The continuation of the Prevention of Events With Angiotensin-Converting Enzyme Inhibition (PEACE) Trial. Am Heart J 2001; 142:375-7. [PMID: 11526345 DOI: 10.1067/mhj.2001.117603] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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18
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Abstract
Postmenopausal estrogen replacement, with or without progestin therapy, has a generally favorable impact on lipids, improves endothelial function, and has anti-inflammatory and antioxidant effects. These properties should favorably impact coronary risk; indeed, epidemiologic studies have consistently associated hormone replacement therapy with reduced coronary risk. Nonetheless, the Heart & Estrogen/progestin Replacement Study (HERS), a randomized, placebo-controlled, secondary prevention trial of conjugated estrogen with progestin, found no overall reduction in coronary events among women assigned to active hormone treatment. This review explores the role of estrogen replacement among interventions intended to prevent coronary heart disease in the post-HERS era.
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Affiliation(s)
- P S Khurana
- Divisions of Internal Medicine and Cardiology, Department of Medicine, George Washington University, 2150 Pennsylvania Avenue, NW #4-414, Washington, DC 20037, USA.
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Simon JA, Hsia J, Cauley JA, Richards C, Harris F, Fong J, Barrett-Connor E, Hulley SB. Postmenopausal hormone therapy and risk of stroke: The Heart and Estrogen-progestin Replacement Study (HERS). Circulation 2001; 103:638-42. [PMID: 11156873 DOI: 10.1161/01.cir.103.5.638] [Citation(s) in RCA: 262] [Impact Index Per Article: 11.4] [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: 11/16/2022]
Abstract
BACKGROUND Observational studies have shown that postmenopausal hormone therapy may increase, decrease, or have no effect on the risk of stroke. To date, no clinical trial has examined this question. To investigate the relation between estrogen plus progestin therapy and risk of stroke among postmenopausal women, we analyzed data collected from the Heart & Estrogen-progestin Replacement Study (HERS), a secondary coronary heart disease prevention trial. METHODS AND RESULTS Postmenopausal women (n=2763) were randomly assigned to take conjugated estrogen plus progestin or placebo. Primary outcomes for these analyses were stroke incidence and stroke death during a mean follow-up of 4.1 years. The number of women with strokes was compared with the number of women without strokes. A total of 149 women (5%) had 1 or more strokes, 85% of which were ischemic, resulting in 26 deaths. Hormone therapy was not significantly associated with risk of nonfatal stroke (relative hazard [RH] 1.18; 95% CI 0.83 to 1.66), fatal stroke (RH 1.61; 95% CI 0.73 to 3.55), or transient ischemic attack (RH 0.90; 95% CI 0.57 to 1.42). Independent predictors of stroke events included increasing age, hypertension, diabetes, current cigarette smoking, and atrial fibrillation. Black women were at increased risk compared with white women, and unexpectedly, body mass index was inversely associated with stroke risk. CONCLUSIONS Hormone therapy with conjugated equine estrogen and progestin had no significant effect on the risk for stroke among postmenopausal women with coronary disease.
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Affiliation(s)
- J A Simon
- General Internal Medicine Section, Medical Service, Veterans Affairs Medical Center, San Francisco, CA 94121, USA.
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20
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Hsia J, Simon JA, Lin F, Applegate WB, Vogt MT, Hunninghake D, Carr M. Peripheral arterial disease in randomized trial of estrogen with progestin in women with coronary heart disease: the Heart and Estrogen/Progestin Replacement Study. Circulation 2000; 102:2228-32. [PMID: 11056097 DOI: 10.1161/01.cir.102.18.2228] [Citation(s) in RCA: 64] [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: 11/16/2022]
Abstract
BACKGROUND Postmenopausal estrogen use has been associated with reduced carotid atherosclerosis in observational studies, but this relationship has not been confirmed in a clinical trial. The impact of estrogen on atherosclerotic disease in other peripheral arteries is unknown. METHODS AND RESULTS Postmenopausal women with coronary heart disease (CHD) and an intact uterus (n=2763) were randomly assigned to conjugated equine estrogens (0.625 mg) combined with medroxyprogesterone acetate (2.5 mg) daily or to placebo in a secondary CHD prevention trial. This analysis focuses on incident peripheral arterial procedures and deaths in the 2 treatment groups; peripheral vascular disease was a predefined secondary outcome. During a mean of 4.1 years of follow-up, 311 peripheral arterial events were reported in 213 women, an annual incidence of 2.9%. The number of women who had peripheral arterial events was 99 among those assigned to active estrogen/progestin and 114 among those assigned to placebo, a nonsignificant difference (relative hazard 0. 87, 95% CI 0.66 to 1.14). In the placebo group, hypertension and diabetes mellitus were independently associated with higher rates of peripheral arterial events, and plasma HDL cholesterol and body mass index were associated with lower rates of peripheral arterial events. In the estrogen/progestin group, current smoking and diabetes were independent predictors of peripheral arterial events. Incident peripheral arterial disease was not a significant predictor of coronary, cardiovascular, or total mortality. CONCLUSIONS Treatment with oral conjugated estrogen plus medroxyprogesterone acetate was not associated with a significant reduction in incident peripheral arterial events in postmenopausal women with preexisting CHD.
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Affiliation(s)
- J Hsia
- Department of Medicine, George Washington University, Washington, DC, USA.
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21
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Hsia J, Kemper E, Sofaer S, Bowen D, Kiefe CI, Zapka J, Mason E, Lillington L, Limacher M. Is insurance a more important determinant of healthcare access than perceived health? Evidence from the Women's Health Initiative. J Womens Health Gend Based Med 2000; 9:881-9. [PMID: 11074954 DOI: 10.1089/152460900750020919] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Our objectives were to explore health insurance status and insurance type, adjusted for self-reported and perceived health variables, as determinants of having and using a usual care provider in the Women's Health Initiative (WHI) Observational Study (OS). This analysis describes insurance status in a large, diverse group of older women and tests the hypothesis that insurance was a key predictor of their access to healthcare in the mid-1990s. Multiple logistic regression analysis was used to evaluate determinants of having visited a usual healthcare provider within the proceeding 12 months, using cross-sectional information provided by a population-based cohort of 55,278 postmenopausal women. Five percent of women younger than 65 years and 0.2% of women 65 or older in the OS cohort lacked health insurance. Among the 31,684 women, aged 50-64 years, Hispanic women and those with fewer years of education and lower household income and who were current smokers were less likely, and those lacking insurance were the least likely, to have seen their healthcare provider within the preceding year. Among 23,594 women, aged 65-79 years, African American and Hispanic women and those with lower household income, and Medicare only and those who were current smokers, were less likely to have seen their healthcare provider within the preceding year. In both age groups, women with chronic medical conditions and poorer perceived health scores and those with prepaid insurance were more likely to have seen their healthcare provider. In the WHI OS, both health (self-reported and perceived) and type of health insurance remained independently associated with having visited a usual healthcare provider after multivariate adjustment for one another as well as for pertinent sociodemographic characteristics.
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Affiliation(s)
- J Hsia
- Department of Medicine, George Washington University, Washington, DC, USA
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22
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Hsia J, Kemper E, Kiefe C, Zapka J, Sofaer S, Pettinger M, Bowen D, Limacher M, Lillington L, Mason E. The importance of health insurance as a determinant of cancer screening: evidence from the Women's Health Initiative. Prev Med 2000; 31:261-70. [PMID: 10964640 DOI: 10.1006/pmed.2000.0697] [Citation(s) in RCA: 201] [Impact Index Per Article: 8.4] [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: 11/22/2022]
Abstract
BACKGROUND Amid current changes in health care access across the United States, the importance of health insurance status and insurance type relative to demographic, actual, and perceived health variables as determinants of screening for breast, colorectal, and cervical cancer is uncertain. This analysis evaluates the hypothesis that health insurance independently predicts cancer screening in the Women's Health Initia tive Observational Study cohort. METHODS Questionnaire data from 55,278 women en rolled in the Women's Health Initiative Observational Study between September 1994 and February 1997 were analyzed by multiple logistic regression to identify predictors of self-reported mammography within 2 years, Pap smear within 3 years, and stool guaiac or flexible sigmoidoscopy within 5 years. RESULTS Positive determinants of reporting cancer screening were age, ethnic origin, household income, educational level, family history of cancer, having a usual care provider, time since last provider visit, and insurance status and type. Smoking, diabetes, and, among older women, prior cardiovascular events were negative determinants of cancer screening. Among women younger than 65, lacking health insurance or having fee-for-service insurance was strongly associated with failure to report cancer screening, independently of having or using a usual care provider and of demographics, self-perceived health, and health characteristics. Among women 65 and older, those with Medicare alone were less likely, whereas those with Medicare + prepaid insurance were more likely, to report cancer screening. CONCLUSIONS In the Women's Health Initiative Obser vational Study, a large, diverse group of older women, health insurance type and status were among the most important determinants of cancer screening indepen dent of demographics, chronic health conditions, and self-perceived health characteristics.
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Affiliation(s)
- J Hsia
- Department of Medicine, George Washington University, Washington, DC, USA.
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23
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Insull W, Rader D, Hsia J, Rhoads C, Stafford D, Boyett R, Crimet D. Effect of increasing doses of micronized fenofibrate on post-prandial triglycerides and fasting plasma lipids and lipoproteins in hypertriglyceridemic patients. Atherosclerosis 2000. [DOI: 10.1016/s0021-9150(00)80799-6] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abstract
BACKGROUND AND OBJECTIVE Pulsed dye lasers (PDL) operating at 585 nm wavelength and 0.45 msec pulsewidth offer effective treatment for port wine stains (PWS). Vessels in leg telangiectasias are larger than those in PWS. Longer pulsewidths and wavelengths may improve clearance of these larger vessels. STUDY DESIGN/MATERIALS AND METHODS Twenty patients were treated using PDL at 595 nm and 1.5 msec. Vessel diameters ranging from 0.635 to 1.067 mm were treated using energy densities of 15 and 18 J/cm2, and a 2 x 7 mm elliptical spot. Telangiectasia clearance and complications were scored at 6-weeks and 5-months following the single treatment. RESULTS Results demonstrated > 50% clearance by 6 weeks in 11/26 (42.3%) patients using 15 J/cm2, and 6/13 (45.2%) using 18 J/cm2. By 5 months > 50% clearance was noted in 18/34 (53.0%) using 15 J/cm2, and 11/17 (64.7%) using 18 J/cm2. Complications were minor and infrequent. CONCLUSION The long-pulse PDL may have a role in treating leg telangiectasias.
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Affiliation(s)
- J Hsia
- Candela Corporation, Wayland, Massachusetts 01778, USA
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25
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Abstract
BACKGROUND AND OBJECTIVE Many of the microscopic changes associated with photodamage reside in the dermis. It follows that subsurface heating of the skin might allow for cosmetic enhancement without loss of the epidermis. Accordingly, we investigated the clinical and microscopic changes produced by a mid-infrared laser coupled with a contact cooling device. STUDY DESIGN/MATERIALS AND METHODS Nine patients were treated with an erbium glass laser and sapphire cooling handpiece in contact with the skin. Postauricular sites were irradiated with pulse energies varying from 400-1,200 mJ and numbers of pulses from 4 to 40. Outcome measures included pain, edema, and erythema at predetermined postoperative intervals. Biopsies were performed just after treatment and 2 months postoperatively for selected pulse energy-pulse number combinations. RESULTS Erythema, edema, and pain increased with pulse energy and number of pulses. Likewise, immediate epidermal necrosis and subsequent scarring were observed for larger pulse energy-pulse number combinations. At sites with epidermal preservation, on biopsy, immediate dermal thermal damage was observed in a band-like pattern. The deep boundaries of this band were dependent on pulse energy and pulse number. After 8 weeks, biopsies showed dermal fibroplasia roughly correlating to the band of immediate dermal thermal damage. CONCLUSION Selective dermal heating can be achieved with a mid-infrared laser coupled to a contact surface cooling device. In this study, the range of fibroplasia and lack of clinically substantial cosmetic enhancement suggest that the dermal thermal damage achieved may be too deep and that the injury should be confined to more superficial levels to alter the most severely photodamaged dermis. Lasers Surg. Med. 26:186-195, 2000. Published 2000 Wiley-Liss, Inc.
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Affiliation(s)
- E V Ross
- Department of Dermatology, Naval Medical Center San Diego, San Diego, California 92134, USA.
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26
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Pearson GD, Veille JC, Rahimtoola S, Hsia J, Oakley CM, Hosenpud JD, Ansari A, Baughman KL. Peripartum cardiomyopathy: National Heart, Lung, and Blood Institute and Office of Rare Diseases (National Institutes of Health) workshop recommendations and review. JAMA 2000; 283:1183-8. [PMID: 10703781 DOI: 10.1001/jama.283.9.1183] [Citation(s) in RCA: 509] [Impact Index Per Article: 21.2] [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: 11/14/2022]
Abstract
OBJECTIVE Peripartum cardiomyopathy (PPCM) is a rare life-threatening cardiomyopathy of unknown cause that occurs in the peripartum period in previously healthy women. In April 1997, the National Heart, Lung, and Blood Institute (NHLBI) and the Office of Rare Diseases of the National Institutes of Health (NIH) convened a Workshop on Peripartum Cardiomyopathy to foster a systematic review of information and to develop recommendations for research and education. PARTICIPANTS Fourteen workshop participants were selected by NHLBI staff and represented cardiovascular medicine, obstetrics, immunology, and pathology. A representative subgroup of 8 participants and NHLBI staff formed the writing group for this article and updated the literature on which the conclusions were based. The workshop was an open meeting, consistent with NIH policy. EVIDENCE Data presented at the workshop were augmented by a MEDLINE search for English-language articles published from 1966 to July 1999, using the terms peripartum cardiomyopathy, cardiomyopathy, and pregnancy. Articles on the epidemiology, pathogenesis, pathophysiology, diagnosis, treatment, and prognosis of PPCM were included. RECOMMENDATION PROCESS: After discussion of data presented, workshop participants agreed on a standardized definition of PPCM, a general clinical approach, and the need for a registry to provide an infrastructure for future research. CONCLUSIONS Peripartum cardiomyopathy is a rare lethal disease about which little is known. Diagnosis is confined to a narrow period and requires echocardiographic evidence of left ventricular systolic dysfunction. Symptomatic patients should receive standard therapy for heart failure, managed by a multidisciplinary team. If subsequent pregnancies occur, they should be managed in collaboration with a high-risk perinatal center. Systematic data collection is required to answer important questions about incidence, treatment, and prognosis.
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Affiliation(s)
- G D Pearson
- Division of Heart and Vascular Diseases, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD 20892-7940, USA.
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Barnabei VM, Phillips TM, Hsia J. Plasma homocysteine in women taking hormone replacement therapy: the Postmenopausal Estrogen/Progestin Interventions (PEPI) Trial. J Womens Health Gend Based Med 1999; 8:1167-72. [PMID: 10595329 DOI: 10.1089/jwh.1.1999.8.1167] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Elevated plasma homocysteine levels have been associated with increased atherosclerotic disease risk. Estrogen and estrogen/progestin replacement therapy have been suggested to lower plasma homocysteine levels in postmenopausal women. To assess the impact of hormone replacement therapy (HRT) on plasma homocysteine, levels were measured in samples from adherent women randomized to placebo (n = 34), conjugated equine estrogens (n = 36), or continuous conjugated equine estrogens + progestin (n = 33) in the Postmenopausal Estrogen/Progestin Interventions (PEPI) Trial. Homocysteine levels decreased between baseline and follow-up (12 and 36 months) in all treatment groups. The magnitude of the reduction was greater in the conjugated estrogens group at 12 months compared with placebo (p = 0.036), even when adjusted for folate and B vitamin consumption, but this difference did not persist at 36 months. These data suggest that estrogen therapy has a modest, but transient, impact on plasma homocysteine levels in women with normal homocysteine at baseline.
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Affiliation(s)
- V M Barnabei
- George Washington University, Washington, D.C., USA
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Roberts AD, Muesing RA, Parenti DM, Hsia J, Wasserman AG, Simon GL. Alterations in serum levels of lipids and lipoproteins with indinavir therapy for human immunodeficiency virus-infected patients. Clin Infect Dis 1999; 29:441-3. [PMID: 10476757 DOI: 10.1086/520231] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Alterations in lipid metabolism have been associated with the use of protease inhibitors. Sequential lipid analyses were performed on serum samples from human immunodeficiency virus-infected antiretroviral-naive patients who received indinavir in combination with two nucleoside reverse transcriptase inhibitors. Serum levels of cholesterol, triglycerides, high-density lipoproteins (HDLs), and low-density lipoproteins (LDLs) were measured at baseline and at periodic intervals. After 48 weeks of indinavir therapy, mean serum levels +/- SD rose as follows: cholesterol, from 167.2 +/- 36.0 to 206.3 +/- 32.4 mg/dL (P < .0005); triglycerides, from 110.4 +/- 47.5 to 158.4 +/- 72.5 mg/dL (P < .0101); and LDLs, from 106.6 +/- 35.1 to 136.1 +/- 31.6 mg/dL (P = .0029). There was no significant change in the serum HDL fraction. Mean serum lipoprotein (a) levels +/- SD rose from 6.5 +/- 1.4 to 9.6 +/- 2.0 mg/dL after 30 weeks (P = .0695). Potential mechanisms for the noted increases include alterations in serum lipoprotein lipase activity or changes in hepatic lipid metabolism. The clinical significance of these changes remains to be determined.
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Affiliation(s)
- A D Roberts
- Department of Medicine, The George Washington University Medical Center, Washington, DC 20037, USA
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Abstract
Plasma lipids play a key role in the development of atherosclerosis. Recent trial data support early identification of asymptomatic adults with high-risk lipid profiles for primary prevention of coronary heart disease. 3-Hydroxy-3-methylglutaryl coenzyme A reductase inhibitors have been shown to reduce coronary events in both asymptomatic adults and those with known coronary heart disease. The optimal plasma low-density lipoprotein cholesterol for secondary coronary prevention remains controversial. The Second Report of the Expert Panel on Detection, Evaluation and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel II), published in 1993 by the National Cholesterol Education Program, recommends guidelines for evaluation and diagnosis of lipids. Subsequently, several clinical trials have identified populations benefiting from pharmacologic intervention and new approaches to the management of lipid disorders. Consequently, these guidelines should be applied with the interval evidence in mind.
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Affiliation(s)
- S Rekhraj
- George Washington University, Division of Cardiology, Washington, DC 20037, USA
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30
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Abstract
BACKGROUND Previous attempts to treat spider veins with the conventional 585 nm pulsed-dye laser with a 0.5-ms pulse duration have been relatively ineffective. Recently, a new pulsed-dye laser that is tunable from 585 to 600 nm with a pulse duration 3 times longer than previously available lasers has preliminarily been shown to be effective for treatment of spider veins. OBJECTIVE Our purpose was to evaluate the effectiveness of multiple treatments with the tunable long-pulse dye laser in treatment of spider veins of the lower extremity. METHODS Ten female volunteers were treated in two separate areas containing blue or red linear spider veins less than 1.5 mm in diameter. Treatments were administered with the pulsed-dye laser with a 1.5-ms pulse duration and 595-nm light at fluences of 15 and 20 J/cm2, and each subject received a total of 3 treatments at each site, administered at 6-week intervals. Photographs were taken before and 6 weeks after the last treatment. RESULTS Computer-based image analysis showed clearing of more than three fourths of veins after 3 treatments with 15 or 20 J/cm2. Side effects were minimal and the treatments were well tolerated. CONCLUSION The 595 nm, 1.5 ms pulse duration, pulsed-dye laser is safe and effective for treating blue or red spider veins of the lower extremities less than 1.5 mm in diameter in nontanned patients with Fitzpatrick skin types I and II. Multiple treatments improve on the results obtained after a single treatment.
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Affiliation(s)
- E F Bernstein
- Department of Dermatology and Cutaneous Biology, Jefferson Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania 19107-5541, USA.
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31
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Pfeffer MA, Domanski M, Rosenberg Y, Verter J, Geller N, Albert P, Hsia J, Braunwald E. Prevention of events with angiotensin-converting enzyme inhibition (the PEACE study design). Prevention of Events with Angiotensin-Converting Enzyme Inhibition. Am J Cardiol 1998; 82:25H-30H. [PMID: 9719019 DOI: 10.1016/s0002-9149(98)00488-3] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.7] [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: 11/17/2022]
Abstract
The Prevention of Events with Angiotensin-Converting Enzyme Inhibition (PEACE) trial is an 8,100 patient, randomized, double-blind, placebo-controlled trial designed to determine the usefulness of angiotensin-converting enzyme (ACE) inhibitors in treating coronary patients with preserved left ventricular ejection fraction. The hypothesis being tested in this trial is that patients with coronary disease and ejection fraction > or =40% who are treated with ACE inhibitors will experience a reduction in the incidence of cardiovascular death, nonfatal myocardial infarction, or a revascularization procedure compared with patients treated with conventional therapy. The design of the PEACE trial is described herein.
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Affiliation(s)
- M A Pfeffer
- Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts 02115, USA
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Abstract
Onset of acute atherothrombotic events (acute myocardial infarction, unstable angina, ischemic stroke) exhibit a circadian pattern that parallels the diurnal pattern of endogenous fibrinolytic activity. Hormone replacement therapy in postmenopausal women has been shown to enhance fibrinolytic capacity by lowering plasminogen activator inhibitor-1 (PAI-1) and tissue plasminogen activator inhibitor (tPA) antigen values. We evaluated the impact of 4 weeks of estrogen alone (Premarin 0.625 mg/day) and 2 weeks of estrogen plus progesterone (Provera 2.5 mg/day) on PAI-1 and tPA in 17 postmenopausal women at multiple time points to assess hormone impact on the diurnal pattern of fibrinolytic potential. At baseline, both PAI-1 and tPA exhibited circadian variability. Estrogen alone selectively lowered 8 A.M. PAI-1 (35.8 +/- 7.1 ng/ml at baseline, 19.8 +/- 3.7 ng/ml on estrogen; p = 0.0002 vs baseline). There was no significant change in the noon or 4 P.M. values, and the diurnal pattern was attenuated. The 8 A.M. PAI-1 remained low at 17.1 +/- 3.6 ng/ml (p = 0.0001 vs baseline) with total loss of the circadian rhythm. Estrogen supplementation reduced tPA antigen at all time points, and the diurnal pattern, although blunted, persisted. Addition of progesterone to estrogen did not reverse effects of the estrogen alone phase of either PAI-1 or tPA values. This hormone-associated reduction of PAI-1 was observed despite increased triglycerides, a known inducer of PAI-1 levels. These observations suggest that hormone replacement therapy may protect postmenopausal women from excess early morning acute ischemic events.
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Affiliation(s)
- R J Katz
- Department of Medicine, George Washington University School of Medicine, Washington, D.C., USA
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Hsia J, Tang T, Parrott M, Rogalla K. Augmentation of the immune response to influenza vaccine by acetylsalicylic acid: a clinical trial in a geriatric population. Methods Find Exp Clin Pharmacol 1994; 16:677-683. [PMID: 7746030] [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: 05/21/2023]
Abstract
The purpose of this placebo-controlled, double-blind, randomized trial was to evaluate the efficacy of oral acetylsalicylic acid (ASA), a comparatively safe, inexpensive biological response modifier, as an adjuvant to influenza vaccination in a geriatric population. 281 healthy adults, 65 years or older, received influenza vaccine and were randomized to ASA or placebo. Serum antibody against influenza A/Beijing and B/Panama, influenza antigen-stimulated blastogenesis and antigen-stimulated interleukin-2 production by peripheral blood mononuclear cells in vitro were increased following vaccination. Blastogenic response and interleukin-2 production increased to a similar extent in the two treatment groups. The proportion of participants with a 4-fold rise in specific antibody directed against influenza A/Beijing was greater among ASA recipients (p < 0.05). This difference was more marked in subjects > 75 years old (p < 0.01).
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Affiliation(s)
- J Hsia
- Division of Cardiology, George Washington University, Washington, DC, USA
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Asmail C, Hsia J, Parr A, Hoeft J. Rayleigh scattering limits for low-level bidirectional reflectance distribution function measurements. Appl Opt 1994; 33:6084-6091. [PMID: 20936025 DOI: 10.1364/ao.33.006084] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
The objective is to estimate the Rayleigh limit in bidirectional reflectance distribution function (BRDF) measurements caused by air in the laboratory, the wavelength, and the path length of light in the receiver field of view. Moreover, we intend to show the trend for the reduction of this limit by introducing a medium with small refractive index and by using a longer wavelength. Although the BRDF typically describes the angular distribution of scattered light from surfaces, the expression describing the equivalent BRDF caused by the optical scattering from gas molecules in the optical path is derived through the use of the Rayleigh scattering theory. The instrumentation is described, and the experimental results of the equivalent BRDF caused by gas scattering from molecules in clear air, nitrogen, and helium gases are reported. These results confirm the trends of the prediction.
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Affiliation(s)
- J Hsia
- Department of Medicine, George Washington University, Washington, D.C 20037
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36
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Abstract
Massive pulmonary embolism has been reported to occur with the use of lower extremity tourniquets. We used transesophageal echocardiography to determine the incidence of venous embolism during lower extremity orthopedic surgery performed with a pneumatic tourniquet. The hemodynamic and respiratory consequences of all embolic events were assessed. Venous emboli were detected after tourniquet deflation in 8 of 30 procedures. The incidence of embolism was unrelated to the type of surgical procedure performed or the duration of tourniquet inflation. There were no significant differences in preoperative characteristics or postdeflation hemodynamic and respiratory responses between patients with and without emboli. Venous embolization is a relatively common event after tourniquet deflation. The clinical significance of these events remains to be determined.
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Affiliation(s)
- B J McGrath
- Department of Anesthesiology, George Washington University Medical Center, Washington, DC
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Abstract
An erbium (Er):YAG laser can remove trabecular meshwork (TM) by photothermal ablation with minimal contiguous thermal damage. A variable pulse width Er:YAG laser was used to investigate the effect of varying pulse width on ablation of human TM. Trabecular photothermal ablation was performed on tissue obtained from eye bank eyes at pulse widths of 50, 150, and 250 microseconds, with energy held constant at 4 mJ. At this energy, a single laser pulse was sufficient for full-thickness ablation of TM. Laser energy was delivered through a 200-microns diameter optical fiber held in apposition to the tissue sample, which was immersed in physiologic saline. High-speed photography of the resultant steam bubbles also was performed. Light microscopy and scanning electron microscopy of TM ablated at 50 microseconds revealed the greatest variability in size (0-140 microns) of the full-thickness ablated areas and demonstrated blast effects, tissue shredding and < or = 10 microns thermal damage. At 150 microseconds, the full-thickness ablated areas were more consistent size (115-120 microns), showed no blast effects and 10 to 20 microns thermal damage. At 250 microseconds, the largest ablations were found (180-220 microns) and showed no blast damage; however, a significant amount of thermal damage (< or = 50 microns) was evident. The steam bubbles produced by the laser energy were largest at 50 microseconds and did not begin to collapse until well over twice the original pulse interval. At 150 and 250 microseconds, the steam bubbles were successively smaller and dissipated at the end of the laser pulse.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- R A Hill
- Beckman Laser Institute, Irvine, California 92717
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39
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Grath M, Hsia J, Boyd A, Shay P, Graeter J, Conry K, Naulty JS. TRANSESOPHAGEAL ECHOCARDIOGRAPHIC VISUALIZATION OF PULMONARY EMBOLIZATION FROM PNEUMATIC TOURNIQUET USE DURING ORTHOPEDIC SURGERY. Anesthesiology 1992. [DOI: 10.1097/00000542-199209001-01080] [Citation(s) in RCA: 2] [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: 11/25/2022]
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Hsia J, Kleiman N, Aguirre F, Chaitman BR, Roberts R, Ross AM. Heparin-induced prolongation of partial thromboplastin time after thrombolysis: relation to coronary artery patency. HART Investigators. J Am Coll Cardiol 1992; 20:31-5. [PMID: 1607535 DOI: 10.1016/0735-1097(92)90133-8] [Citation(s) in RCA: 63] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Having previously shown in the Heparin Aspirin Reperfusion Trial that the empiric use of early intravenous heparin after recombinant tissue-type plasminogen activator (rt-PA) is an important component in the overall treatment strategy, we examine in this report the specific relation between the degree of prolongation of activated partial thromboplastin time and coronary artery patency. To evaluate the hypothesis that arterial patency after administration of rt-PA for acute myocardial infarction is sustained by effective anticoagulation, activated partial thromboplastin time of heparin recipients was determined 8 and 12 h after the start of thrombolysis. Mean activated partial thromboplastin time was higher among patients with an open infarct-related artery than in those with a closed artery (81 +/- 4 vs. 54 +/- 9 s, p less than 0.02). Only 45% of patients with values less than 45 s at both 8 and 12 h had Thrombolysis in Myocardial Infarction (TIMI) flow grade 2 or 3 in the infarct-related artery at 18 h. In contrast, 88% of patients with activated partial thromboplastin time greater than 45 s and 95% of those with values greater than 60 s had an open infarct-related artery at 18 h (p = 0.003 and 0.0006, respectively). Among patients with an initially patent infarct-related artery who underwent repeat angiography at 7 days, activated partial thromboplastin time was similar in those with a persistently patent artery and those with late reocclusion. Excessive anticoagulation did not appear to increase hemorrhagic risk except that access site-related hemorrhage was more common in patients with activated partial thromboplastin time greater than 100 s at 8 h.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- J Hsia
- George Washington University, Washington, D.C
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Aguirre FV, Kern MJ, Hsia J, Serota H, Janosik D, Greenwalt T, Ross AM, Chaitman BR. Importance of myocardial infarct artery patency on the prevalence of ventricular arrhythmia and late potentials after thrombolysis in acute myocardial infarction. Am J Cardiol 1991; 68:1410-6. [PMID: 1746420 DOI: 10.1016/0002-9149(91)90272-m] [Citation(s) in RCA: 33] [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: 12/28/2022]
Abstract
Sustained infarct artery patency is an important determinant of survival in patients with acute myocardial infarction. We studied 61 patients with acute myocardial infarction who received intravenous recombinant tissue-type plasminogen activator, aspirin or heparin within 6 hours of symptom onset, to determine if infarct artery patency after intravenous thrombolytic therapy influences myocardial electrical stability as measured by the prevalence of spontaneous ventricular ectopy or late potential activity. Infarct artery patency was determined by angiographic evaluation 2.5 +/- 3 days after infarction. Forty-eight patients (79%) had a patent infarct-related artery and 13 (21%) patients had an occluded vessel. The mean number of ventricular premature complexes (VPCs)/hour (p less than 0.01) and the prevalence of late potentials (54 vs 19%; p less than 0.03) were significantly higher in patients with an occluded versus patent-infarct related vessel. Although VPC frequency and late potentials were not influenced by the time to thrombolytic treatment, patients with a patent infarct-related artery had a lower prevalence of late potentials regardless of whether treatment was initiated less than or equal to 2 hours (25% patent vs 50% occluded; p = not significant) or 2 to 6 hours (16% patent vs 55% occluded; p greater than 0.03) after symptom onset. Thus, successful thrombolysis decreases the frequency of ventricular ectopic activity and late potentials in the early postinfarction phase. The reduction in both markers of electrical instability may help explain why the prognosis after successful thrombolysis is improved after acute myocardial infarction.
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Affiliation(s)
- F V Aguirre
- Cardiology Division, St. Louis University Medical Center, Missouri 63110
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42
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Rodriguez ER, Nasim S, Hsia J, Sandin RL, Ferreira A, Hilliard BA, Ross AM, Garrett CT. Cardiac myocytes and dendritic cells harbor human immunodeficiency virus in infected patients with and without cardiac dysfunction: detection by multiplex, nested, polymerase chain reaction in individually microdissected cells from right ventricular endomyocardial biopsy tissue. Am J Cardiol 1991; 68:1511-20. [PMID: 1746436 DOI: 10.1016/0002-9149(91)90288-v] [Citation(s) in RCA: 63] [Impact Index Per Article: 1.9] [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: 12/28/2022]
Abstract
Two hundred fifteen patients infected with human immunodeficiency virus (HIV) participated in a prospective longitudinal study of HIV-related heart disease. Evaluation included signal-averaged electrocardiography and echocardiography. Fifteen patients underwent endomyocardial biopsy, 5 had cardiovascular symptoms and 10 did not. Cardiac myocytes or dendritic cells were prepared by individual cell microdissection to sort them from other cell types such as interstitial cells or circulating blood elements. HIV proviral sequences were amplified in samples of 15 to 20 cells of each type by multiplex, nested, polymerase chain reaction and hybridized to 32P-labeled probes specific for regions within the gag and pol genes of HIV-1. The results showed the presence of HIV sequences in myocytes of 2 of 5 patients with cardiac symptoms and in 6 of 10 without. Thus, symptomatic HIV cardiomyopathy did not appear to be a direct consequence of the virus on myocardial cells. In dendritic cells, HIV sequences were detected in 5 of 5 patients with cardiac symptoms and in 8 of 10 with apparently normal ventricular function. Furthermore, dendritic cells were somewhat more numerous in the myocardium of symptomatic than asymptomatic patients. Our studies are the first to directly detect the HIV genome in purified cardiac myocytes from patients with and without cardiac dysfunction. Our findings do not support a direct role of the virus in myocardial dysfunction. However, the results do suggest that the interstitial dendritic cells may be involved in some manner in the development of cardiac dysfunction observed in HIV-infected patients.
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Affiliation(s)
- E R Rodriguez
- Department of Pathology, George Washington University Medical Center, D.C
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Abstract
Signal-averaged electrocardiograms were performed in 225 patients with serologic evidence of human immunodeficiency virus infection as part of a prospective longitudinal study of patients with HIV-associated heart disease and 12 seronegative control subjects. The duration of signal-averaged QRS vector, root-mean-square voltage of the terminal 40 ms of the vector magnitude and the duration of the low-amplitude (less than 40 microV) signal were determined during serial visits at 4-month intervals. One or more of these variables was abnormal on initial visit in 59 of patients (26%); QRS duration was greater than 114 ms in 9 patients (4%), root-mean-square voltage less than 20 microV in 55 patients (24%) and low-amplitude signal duration greater than 39 ms in 43 (19%). In contrast, none of the seronegative control subjects had any abnormal variables (p less than 0.03). During follow-up (mean 10 +/- 8 months), 26 patients with initially normal studies developed abnormal variables and 24 with abnormal signal-averaged electrocardiograms reverted to normal. Left ventricular contractility was assessed by echocardiography using the rate-corrected velocity of fiber shortening-end-diastolic wall stress relation. Late potentials were not related to contractile abnormalities. Clinical arrhythmias were rare and did not appear more frequent among patients with late potentials. Thus, late potentials were both common and evanescent in patients infected with human immunodeficiency virus.
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Affiliation(s)
- J Hsia
- Department of Medicine, George Washington University, Washington, D.C. 20037
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44
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Hsia J. Heparin and aspirine as adjunctive therapy with plasminogen activator for acute myocardial infarction. Pharmacotherapy 1991. [DOI: 10.1016/0753-3322(91)90135-g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Affiliation(s)
- M Turco
- Department of Medicine, George Washington University, Washington, DC 20037
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46
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Hsia J, Hamilton WP, Kleiman N, Roberts R, Chaitman BR, Ross AM. A comparison between heparin and low-dose aspirin as adjunctive therapy with tissue plasminogen activator for acute myocardial infarction. Heparin-Aspirin Reperfusion Trial (HART) Investigators. N Engl J Med 1990; 323:1433-7. [PMID: 2122251 DOI: 10.1056/nejm199011223232101] [Citation(s) in RCA: 336] [Impact Index Per Article: 9.9] [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: 12/30/2022]
Abstract
BACKGROUND We report the results of the Heparin-Aspirin Reperfusion Trial, a collaborative study comparing early intravenous heparin with oral aspirin as adjunctive treatment when recombinant tissue plasminogen activator (rt-PA) is used for coronary thrombolysis during acute myocardial infarction. METHODS Two hundred five patients were randomly assigned to receive either immediate and then continuous intravenous heparin (starting with a 5000-unit bolus; n = 106) or immediate and then daily oral aspirin (80 mg; n = 99) together with rt-PA (100 mg intravenously over a six-hour period) initiated within six hours of the onset of symptoms. We evaluated the patency of the infarct-related artery by angiography 7 to 24 hours after beginning rt-PA infusion, the frequency of reocclusion of the artery by repeat angiography on day 7, and ischemic or hemorrhagic complications during the hospital stay. RESULTS At the time of the first angiogram, 82 percent of the infarct-related arteries in the patients assigned to heparin were patent, as compared with only 52 percent in the aspirin group (P less than 0.0001). Of the initially patent vessels, 88 percent remained patent after seven days in the heparin group, as compared with 95 percent in the aspirin group (P not significant). The numbers of hemorrhagic events (18 in the heparin and 15 in the aspirin group) and recurrent ischemic events (8 in the heparin and 2 in the aspirin group) were similar in the two groups. CONCLUSIONS Coronary patency rates associated with rt-PA are higher with early concomitant systemic heparin treatment than with concomitant low-dose oral aspirin. This observation has important implications for clinical practice and should be considered in the design and interpretation of clinical trials involving coronary thrombolytic therapy.
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Affiliation(s)
- J Hsia
- Department of Medicine, George Washington University, Washington, DC 20037
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47
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Hsia J, Goldstein AL, Simon GL, Sztein M, Hayden FG. Peripheral blood mononuclear cell interleukin-2 and interferon-gamma production, cytotoxicity, and antigen-stimulated blastogenesis during experimental rhinovirus infection. J Infect Dis 1990; 162:591-7. [PMID: 2167330 DOI: 10.1093/infdis/162.3.591] [Citation(s) in RCA: 48] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
To determine whether rhinovirus infection induced a systemic cellular immune response in humans, specific antigen-stimulated blastogenesis, natural killer cell activity, and mitogen-stimulated production of interleukin-2 and interferon-gamma by peripheral blood mononuclear cells (PBMC) were quantified during experimental rhinovirus infection of normal volunteers. Phytohemagglutinin-stimulated interleukin-2 production by PBMC collected on day 5 after rhinovirus inoculation was increased fourfold compared with production by PBMC collected before rhinovirus challenge (P less than .05); phytohemagglutinin-stimulated interferon-gamma production was doubled (P less than .05). An inverse relationship was observed between the increase in interleukin-2 production and both nasal mucus production (P less than .02) and the number of days virus was cultured from nasal washings (P less than .02). Natural killer cell-mediated cytotoxicity of PBMC collected on day 5 after rhinovirus challenge was also increased (P less than .01) compared with preinfection levels, as was specific antigen-stimulated blastogenesis on day 21 (P less than .05). The extent of blastogenic response correlated directly with both mucus production (P less than .05) and the number of days virus was cultured from nasal washings (P less than .05). These observations are consistent with the hypothesis that rhinovirus infection results in activation of a systemic cellular immune response.
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Affiliation(s)
- J Hsia
- Department of Biochemistry, George Washington University School of Medicine and Health Sciences, Washington, DC 20037
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48
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Hsia J, Sarin N, Oliver JH, Goldstein AL. Aspirin and thymosin increase interleukin-2 and interferon-gamma production by human peripheral blood lymphocytes. Immunopharmacology 1989; 17:167-73. [PMID: 2504679 DOI: 10.1016/0162-3109(89)90045-3] [Citation(s) in RCA: 31] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Interleukin-2 (IL-2) and interferon-gamma (IFN-gamma) have recently been added to the arsenal of synthetic biological response modifiers with important immunomodulatory activities. In this paper we have assessed the effects of acetylsalicylic acid (aspirin), thymosin alpha and thymosin fraction 5 (TF5), a partially purified calf thymic preparation, on production of IFN-gamma in vitro. Stimulation by oral aspirin of IL-2 and IFN-gamma production by peripheral blood lymphocytes (PBLs) was also studied in healthy human volunteers. Aspirin, thymosin alpha 1 and TF5 were all observed to enhance phytohemagglutinin (PHA)-stimulated production of IFN-gamma. Peak IFN-gamma production by PHA-stimulated PBLs was observed after 24 h of incubation with TF5 and after 72 h with aspirin. Stimulation by aspirin and TF5 required the presence of macrophages, and was additive and dose-dependent. The additive effects of aspirin and TF5 suggest that these agents act by different mechanisms. Oral administration of aspirin in normal volunteers significantly enhanced production of both IFN-gamma and IL-2. PHA-stimulated IFN-gamma production was greatest 24 h after aspirin ingestion; in contrast, IL-2 production was optimal 10 h after aspirin ingestion. These observations suggest that oral aspirin is an effective biological response modifier in humans and raise the possibility of a novel combination approach to immunomodulation involving cyclooxygenase inhibitors and thymosins.
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Affiliation(s)
- J Hsia
- Department of Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC 20037
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49
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Hsia J, Simon GL, Higgins N, Goldstein AL, Hayden FG. Immune modulation by aspirin during experimental rhinovirus colds. Bull N Y Acad Med 1989; 65:45-56. [PMID: 2557948 PMCID: PMC1807788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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50
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Buchanan CE, Hsia J, Strominger JL. Antibody to the D-alanine carboxypeptidase of Bacillus subtilis does not cross-react with other penicillin-binding proteins. J Bacteriol 1977; 131:1008-10. [PMID: 70424 PMCID: PMC235559 DOI: 10.1128/jb.131.3.1008-1010.1977] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
The fact that antibody to d-alanine carboxypeptidase of Bacillus subtilis does not cross-react with other penicillin-binding proteins suggests that these proteins are not precursors or multimers of the enzyme.
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