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Zhu JR, Galivanche AR, Gouzoulis MJ, Kammien AJ, Gillinov SM, Jayaram RH, Grauer JN. International Classification of Diseases Coding for Inflammatory Arthritides. JAMA Netw Open 2024; 7:e246544. [PMID: 38635274 DOI: 10.1001/jamanetworkopen.2024.6544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/19/2024] Open
Abstract
This quality improvement study investigates usage patterns of codes for inflammatory arthritides under International Statistical Classification of Diseases and Related Health Problems, Tenth Revision vs International Classification of Diseases, Ninth Revision.
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Affiliation(s)
- Justin R Zhu
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut
| | - Anoop R Galivanche
- Department of Orthopaedics, University of California, San Francisco School of Medicine, San Francisco
| | - Michael J Gouzoulis
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut
| | - Alexander J Kammien
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut
| | - Stephen M Gillinov
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut
| | - Rahul H Jayaram
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut
| | - Jonathan N Grauer
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut
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Gouzoulis MJ, Joo PY, Jeong S, Jabbouri SS, Moran J, Zhu JR, Grauer JN. A 10-year perspective on the question of whether surgeries for adolescent idiopathic scoliosis are "one and done"? Spine Deform 2024:10.1007/s43390-024-00858-3. [PMID: 38555557 DOI: 10.1007/s43390-024-00858-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 02/28/2024] [Indexed: 04/02/2024]
Abstract
PURPOSE Posterior scoliosis fusion (PSF) for adolescent idiopathic scoliosis (AIS) is considered a highly successful surgery with excellent outcomes. However, especially as many patients "graduate" from their pediatric surgeons, there is the need to quantify the long-term outcomes of such surgeries. METHODS The 2010-2022 Pearldiver M161 dataset was queried for those who were 10 to 18 years old with AIS undergoing PSF with at least 10 years follow-up. Patient characteristics were abstracted. Reoperations were identified based on coding for any subsequent thoracic/lumbar surgery/revision. The 10-year reoperation rate and reasons for reoperation were determined, and multivariate regression was performed to determine risk factors. RESULTS In total, 3,373 AIS PSF patients were identified. Of the study cohort, 324 (9.6%) underwent reoperation within 10-years with an interquartile range for timing of surgery of 81-658 days, of which 29.6% were done for infection. Reoperations were done within the first three months for 152 (46.9% of reoperations), three months to 2 years for 97 (29.9%), and 2 years to 10 years for 74 (22.8%). Based on multivariate regression, need for reoperation was associated with male sex (OR: 1.70), asthma (OR: 1.36) and greater than thirteen segments of instrumentation (OR: 1.48) (p < 0.05 for each) but not age, other comorbidities, or insurance. CONCLUSIONS The current study of a large national AIS PSF population found 9.6% to undergo reoperation in the 10 years following their index operation. Although specifics about the curve pattern could not be determined, the reoperation incidence and correlation with specific risk factors are notable and important for patient counselling.
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Affiliation(s)
- Michael J Gouzoulis
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, 47 College Street, 208071, New Haven, CT, 06510, USA
| | - Peter Y Joo
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, 47 College Street, 208071, New Haven, CT, 06510, USA
| | - Seongho Jeong
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, 47 College Street, 208071, New Haven, CT, 06510, USA
| | - Sahir S Jabbouri
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, 47 College Street, 208071, New Haven, CT, 06510, USA
| | - Jay Moran
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, 47 College Street, 208071, New Haven, CT, 06510, USA
| | - Justin R Zhu
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, 47 College Street, 208071, New Haven, CT, 06510, USA
| | - Jonathan N Grauer
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, 47 College Street, 208071, New Haven, CT, 06510, USA.
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Zhu JR, Jimenez AE. Editorial Commentary: Irreparable, Symptomatic, Hip Labral Tears Should Be Reconstructed in Patients without Osteoarthritis. However, Comparison of the Two, as Well as Allograft versus Autograft Reconstruction, Is Challenging. Arthroscopy 2024; 40:630-631. [PMID: 38296454 DOI: 10.1016/j.arthro.2023.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 07/01/2023] [Indexed: 02/15/2024]
Abstract
Hip acetabular labrum plays a chondroprotective role by maintaining stability, providing a suction seal, and contributing to load distribution. In symptomatic patients without osteoarthritis, arthroscopic labral repair has strong clinical and biomechanical data to support its use. For irreparable tears, the labrum should be reconstructed. Biomechanically, labral reconstruction does not demonstrate superiority when compared to labral repair or the intact native labrum state. However, it is superior to labral excision. One challenge in making these comparisons is the heterogeneity in surgical technique. Labral reconstruction techniques can vary significantly. In terms of reconstruction, allograft offers the advantage of no donor site morbidity, but availability, costs, and risks must be considered. Autograft use is limited by donor site morbidity and increased operative time. Direct comparisons again show no clear evidence to suggest superiority of one over the other.
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Halperin SJ, Zhu JR, Francis JS, Grauer JN. Are Medical School Curricula Adapting With Their Students? A Survey on How Medical Students Study and How it Relates to USMLE Step 1 Scores. J Med Educ Curric Dev 2024; 11:23821205241228455. [PMID: 38268729 PMCID: PMC10807313 DOI: 10.1177/23821205241228455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 01/08/2024] [Indexed: 01/26/2024]
Abstract
OBJECTIVES Over the years, medical schools have evolved their curricula in response to the medical field, faculty, and students. The current study aims to examine how medical students study, what resources they most commonly use, and how it relates to United States Medical Licensing Examination (USMLE) Step 1 scores. METHODS A cross-sectional survey study of United States medical students was distributed via social media, GroupMe school chats, and school listservs from September 8, 2020, to December 12, 2020. The survey gathered data including, demographic and school information, resources students, time spent using each resource, and USMLE Step 1 scores. RESULTS The survey was completed by 560 students from 102 different United States medical schools. Study guides as online resources (83.2%) were mostly used, lecture (82.5%), Anki (spaced repetition flashcards, 68.3%), and school-organized sessions (workshops, labs, and small groups) (60.7%). Of the students surveyed, 90% attended schools with a recorded lecture option. Only 54% of these students watched their lectures live. When watched online, the average watching speed was 1.75 ± 0.4× with a mode of 2× speed. In examining different medical school styles, schools with a 1.5-year preclinical curriculum had higher USMLE Step 1 scores (244.5 ± 15.6 vs 236.9 ± 16.2, P-score = .024) compared to schools that did not (1- or 2-year preclinical curriculum). CONCLUSION Medical students seem to be using third-party resources in addition to their medical school curriculums. Because students are already broadly using these, medical schools could allow their curriculums to reference, require, or complement third-party online resources. Additionally, because of their increased cost, medical schools could consider ways to alleviate the cost on medical students as a means of equitable support. Lastly, Step 1 scores significantly correlated with schools with a 1.5-year preclinical curriculum, although the exact reasoning for this remains uncertain.
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Affiliation(s)
| | | | | | - Jonathan N Grauer
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT, USA
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Joo PY, Zhu JR, Wilhelm C, Tang K, Day W, Moran J, Grauer JN. Anterior Cervical Discectomy and Fusion Outcomes in Patients With and Without Bariatric Surgery-Weight Loss Does Make a Difference. Spine (Phila Pa 1976) 2023; 48:400-406. [PMID: 36735637 DOI: 10.1097/brs.0000000000004580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 12/30/2022] [Indexed: 02/04/2023]
Abstract
STUDY DESIGN A retrospective comparative cohort study. OBJECTIVE To compare outcomes of elective non-obese anterior cervical discectomy and fusion (ACDF) patients with those that underwent bariatric surgery (BS). SUMMARY OF BACKGROUND DATA Morbid obesity (MO) has been associated with an increased risk of complications following procedures such as elective ACDF. While pre-emptive BS has been considered for those with MO (body mass index [BMI] ≥35 kg/m 2 ), the impact of this intervention on BMI and its resultant correlation with surgical outcomes remains limited. METHODS The PearlDiver 2010-Q1 2020 MSpine database was used to identify patients undergoing elective isolated ACDF. Three sub-cohorts were defined as follows: (1) Non-obese controls without a history of BS, (2) patients with BS procedure within two years with a BMI <35 kg/m 2 (BS+MO-), and (3) patients with BS procedure within the two years with a BMI ≥35 kg/m 2 (BS+MO+). Univariate and multivariate regression analyses were performed to compare 90-day adverse event rates adjusting for age, sex, Elixhauser Comorbidity Index, and length of stay. Kaplan-Meier analysis was performed to assess five-year cervical reoperation rates. RESULTS Of 160,166 elective ACDF patients, prior BS was identified for 479. Of these, 136 patients were BS+MO- and 343 were BS+MO+. On multivariate analysis, BS+MO- were not at increased odds of adverse events, but BS+MO+ were at greater odds of 90-day pulmonary embolism (odds ratio 3.28, P =0.043), wound dehiscence (5.02, P <0.001), hematomas (2.52, P =0.042), and overall minor adverse events (1.61, P =0.011) compared with controls. Five-year reoperation rates were not significantly different between the groups. CONCLUSION Twenty-eight percent of those with BS before ACDF fell out of the categorization of MO. Among this group, the odds of adverse events were similar to non-obese patients. These findings suggest that the psychological preparation and BS alone are insufficient to reduce the risk of adverse events after ACDF. Weight reduction must be achieved as well, ideally moving patients out of the BMI range for morbid obesity.
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Affiliation(s)
- Peter Y Joo
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT
| | - Justin R Zhu
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT
| | - Christopher Wilhelm
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT
| | - Kevin Tang
- Department of Orthopaedics and Rehabilitation, Albert Einstein College of Medicine, New York, NY
| | - Wesley Day
- Department of Orthopaedics and Rehabilitation, Albert Einstein College of Medicine, New York, NY
| | - Jay Moran
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT
| | - Jonathan N Grauer
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT
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Gillinov SM, Joo PY, Zhu JR, Moran J, Rubin LE, Grauer JN. Incidence, Timing, and Predictors of Hip Dislocation After Primary Total Hip Arthroplasty for Osteoarthritis. J Am Acad Orthop Surg 2022; 30:1047-1053. [PMID: 35947825 PMCID: PMC9588560 DOI: 10.5435/jaaos-d-22-00150] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 06/11/2022] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION Total hip arthroplasty (THA) may be complicated by dislocation. The incidence of and risk factors for dislocation are incompletely understood. This study aimed to determine the incidence and predictors of hip dislocation within 2 years of primary THA. METHODS The 2010 to 2020 PearlDiver MHip database was used to identify patients undergoing primary THA for osteoarthritis with a minimum of 2 years of postoperative data. Dislocation was identified by associated codes. Age, sex, body mass index, Elixhauser Comorbidity Index, fixation method, and bearing surface were compared for patients with dislocation versus control subjects by multivariate regression. Timing and cumulative incidence of dislocation were assessed. RESULTS Among 155,185 primary THAs, dislocation occurred within 2 years in 3,630 (2.3%). By multivariate analysis, dislocation was associated with younger age (<65 years), female sex, body mass index < 20, higher Elixhauser Comorbidity Index, cemented prosthesis, and use of metal-on-poly or metal-on-metal implants ( P< 0.05 for each). Among patients who experienced at least one dislocation, 52% of first-time dislocations occurred in the first 3 months; 57% had more than one and 11% experienced >5 postoperative dislocation events. Revision surgery was done within 2 years of index THA for 45.6% of those experiencing dislocation versus 1.8% of those who did not ( P < 0.001). CONCLUSION This study found that 2.3% of a large cohort of primary THA patients experienced dislocation within 2 years, identified risk factors for dislocation, and demonstrated that most patients experiencing dislocation had recurrent episodes of instability and were more likely to require revision surgery.
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Affiliation(s)
- Stephen M Gillinov
- From the Yale School of Medicine, New Haven, CT (Gillinov, Joo, Zhu, and Moran); Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT (Rubin and Grauer)
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Joo PY, Caruana DL, Gouzoulis MJ, Moore HG, Zhu JR, Ameri B, Grauer JN. Marfan syndrome and adolescent idiopathic scoliosis patients have similar 90-day postoperative outcomes and 5-year reoperation rates after spinal deformity surgery. Spine Deform 2022; 10:1169-1174. [PMID: 35362940 DOI: 10.1007/s43390-022-00501-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Accepted: 03/19/2022] [Indexed: 11/24/2022]
Abstract
PURPOSE Outcomes after spinal deformity surgery in patients with Marfan syndrome (MFS) are poorly characterized given the rarity of the condition. Updated analyses from nationally representative samples, and comparison to outcomes after more commonly performed procedures for conditions such as adolescent idiopathic scoliosis (AIS) could help define the relative risks. METHODS Using the 2010-2020 PearlDiver administrative databases, patients who underwent posterior spinal fusion for > 7 segments were extracted. MFS patients were matched 1:4 to AIS patients based on age, sex, and Elixhauer comorbidity index (ECI). Ninety-day outcomes and 5-year reoperation rates were compared. Significance was set at p < 0.05. RESULTS In total, 206 MFS patients were matched to 825 AIS patients. After adjusting for age, sex, and ECI, multivariate odds ratios (OR) for 90-day any, serious, and minor adverse events, as well as readmissions, were not significantly different for those with MFS compared to those with AIS (p > 0.05 for each). Five-year reoperation rates were also not significantly different (13.1% for the MFS cohort and 13.0% for the AIS cohort (no difference by log-rank, p = 0.9). CONCLUSION While deformity surgery is much less commonly performed for MFS than AIS, it is not uncommonly considered for patients with this condition. Despite some known technical challenges for MFS deformity surgery, the current study leveraged a large, national database to find that 90-day adverse events and 5-year reoperations were not different for matched MFS and AIS patients undergoing deformity surgery. For select patients, these findings should be useful for surgical planning and patient counseling.
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Affiliation(s)
- Peter Y Joo
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, 47 College Street, New Haven, CT, 06510, USA
| | - Dennis L Caruana
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, 47 College Street, New Haven, CT, 06510, USA
| | - Michael J Gouzoulis
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, 47 College Street, New Haven, CT, 06510, USA
| | - Harold G Moore
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, 47 College Street, New Haven, CT, 06510, USA
| | - Justin R Zhu
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, 47 College Street, New Haven, CT, 06510, USA
| | - Bijan Ameri
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, 47 College Street, New Haven, CT, 06510, USA
| | - Jonathan N Grauer
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, 47 College Street, New Haven, CT, 06510, USA.
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Gouzoulis MJ, Kammien AJ, Zhu JR, Gillinov SM, Moore HG, Grauer JN. Single-level posterior lumbar fusions in patients with Ehlers Danlos Syndrome not found to be associated with increased postoperative adverse events or five-year reoperations. N Am Spine Soc J 2022; 11:100136. [PMID: 35783003 PMCID: PMC9241136 DOI: 10.1016/j.xnsj.2022.100136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 05/19/2022] [Accepted: 06/08/2022] [Indexed: 11/15/2022]
Abstract
Background Ehlers Danlos Syndrome (EDS) is a rare connective tissue disorder that results from mutations in collagen genes. Potentially related to laxity and resultant degenerative changes, adult EDS patients may require posterior lumbar fusion (PLF). However, with low numbers, adequately powered outcome studies have been limited. The purpose of this study was to investigate risk of complications, readmissions and reoperations in adult patients with EDS following single-level PLF. Methods A retrospective study using the 2010 to 2020 MSpine Pearldiver dataset was performed. Adult patients undergoing single-level PLF (excluding any with anterior procedures) with and without EDS for which at least 90-day follow up was available were identified. Any cases performed for trauma, tumor, or infection were excluded.Single-level PLF EDS patients were then matched 1:4 with PLF non-EDS patients based on age, sex, and Elixhauser Comorbidity Index (ECI). Rates of ninety-day any, severe, and minor adverse events as well as readmissions were tabulated and compared with chi-square tests. Multivariate logistical regression was then performed (controlling for age, sex, and ECI).Reoperation surgeries over five years were assessed, Kaplan-Meier survival curves generated, and curves of those with and without EDS were compared with log rank test. Results In total, there were 170,100 single-level PLF case identified, of which 242 (0.14%) had EDS. After matching, there were 957 without EDS and 239 with EDS. On multivariate regression, there were no significant differences in 90-day any, severe, or minor adverse events, or readmissions (p>0.05 for each). Over five years, there were also not significant differences in rates of reoperation (p> 0.05). Conclusions For EDS patients undergoing PLF, the current study identified similar 90-day adverse events and 5-year reoperation rates compared to those without EDS. These findings may be useful for patient counseling and surgical planning for those with this rare condition.
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Affiliation(s)
- Michael J. Gouzoulis
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT
| | - Alexander J. Kammien
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT
| | - Justin R. Zhu
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT
| | - Stephen M. Gillinov
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT
| | | | - Jonathan N. Grauer
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT
- Corresponding Author: Jonathan N. Grauer, MD, PO Box 208071, New Haven, CT 06520-8071, Tel: 203-737-7464, Fax: 203-785-7132
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Joo PY, Zhu JR, Kammien AJ, Gouzoulis MJ, Arnold PM, Grauer JN. Clinical outcomes following one-, two-, three-, and four-level anterior cervical discectomy and fusion: a national database study. Spine J 2022; 22:542-548. [PMID: 34774751 DOI: 10.1016/j.spinee.2021.11.002] [Citation(s) in RCA: 5] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 10/15/2021] [Accepted: 11/01/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND CONTEXT Anterior cervical discectomy and fusion (ACDF) is a common surgical procedure. There is markedly less data on outcomes after three- and four-level cases than one- and two-level cases. PURPOSE To compare perioperative 90-day adverse events and 5-year reoperation rates between isolated one-, two-, three-, and four-level ACDF cases. STUDY DESIGN/SETTING Retrospective review of a large national database. PATIENT SAMPLE Overall, 97,081 patients undergoing ACDF were identified, of which one-level cases were 42,382 (43.7%), two-level cases were 24,055 (24.8%), three-level cases were 28,293 (29.1%), and four-level cases were 2,361 (2.4%). OUTCOME MEASURES Ninety-day adverse events and 5-year reoperation rates. METHODS The 2010 to Q1 2020 PearlDiver database was queried to identify patients who underwent elective ACDF for degenerative pathology without corpectomy or concomitant posterior procedures. Univariate and multivariate analyses were performed to compare outcomes of subcohorts with varying number of levels addressed by ACDF. RESULTS Of the 97,081 cases identified, patient characteristics and complication rates differed between the cohorts defined by levels treated. Univariate analyses revealed statistically different rates of 90-day any, serious, and minor adverse event rates between the groups, but the differences were all less than 2.5%. Readmission rates were statistically different by 2.9%, dysphagia by 3.2%, and prolonged length of stay by 6.3%.By multivariate analyses, three-level ACDF cases were not found to have greater 90-day adverse outcomes than two-level cases. Four-level ACDF cases were found to have significantly greater odds ratios of readmission, dysphagia, and prolonged length of stay (relative to one-level cases, OR 1.28, 1.63, and 1.97, respectively) but not other 90-day adverse events. Reoperation rates at five years for one-, two-, three-, and four-level cases were 13.0%, 13.5%, 15.0%, and 22.1%, respectively (log-rank p<.001). CONCLUSIONS The current study represents one of the largest comparative studies of patients undergoing one-, two-, three-, and four-level ACDF. While odds of 90-day adverse events were not greater for three- versus two-level cases, four-level cases had several that were higher odds than one-level cases. Reoperation and dysphagia rates were higher for four-level cases than lesser levels. While these outcomes were found to be acceptable, they should help guide hospital planning and patient counseling.
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Affiliation(s)
- Peter Y Joo
- Department of Orthopedics and Rehabilitation, Yale School of Medicine, 47 College St, New Haven, CT 06510, USA
| | - Justin R Zhu
- Department of Orthopedics and Rehabilitation, Yale School of Medicine, 47 College St, New Haven, CT 06510, USA
| | - Alexander J Kammien
- Department of Orthopedics and Rehabilitation, Yale School of Medicine, 47 College St, New Haven, CT 06510, USA
| | - Michael J Gouzoulis
- Department of Orthopedics and Rehabilitation, Yale School of Medicine, 47 College St, New Haven, CT 06510, USA
| | | | - Jonathan N Grauer
- Department of Orthopedics and Rehabilitation, Yale School of Medicine, 47 College St, New Haven, CT 06510, USA.
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Kammien AJ, Zhu JR, Gouzoulis MJ, Moore HG, Galivanche AR, Medvecky MJ, Grauer JN. Emergency Department Visits Within 90 Days of Anterior Cruciate Ligament Reconstruction. Orthop J Sports Med 2022; 10:23259671221083586. [PMID: 35340726 PMCID: PMC8941698 DOI: 10.1177/23259671221083586] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 12/15/2021] [Indexed: 11/26/2022] Open
Abstract
Background: Emergency department (ED) visits after orthopaedic surgery such as anterior
cruciate ligament reconstruction (ACLR) affect patients and health care
systems and should be better understood. Purpose: To determine the incidence, predictors, and reasons for ED visits within 90
days after ACLR. Study Design: Descriptive epidemiologic study. Methods: Patients who had undergone ACLR between 2010 and 2020 were identified in a
national database, and 90-day ED visits, readmissions, risk factors, and
primary diagnoses for visits were determined. One-year postoperative data
were used to establish baseline weekly ED visits for the cohort. Patient
age, sex, Elixhauser comorbidity index, region of the country (Northeast,
Midwest, West, South), and insurance coverage (Medicare, Medicaid, and
commercial) were extracted, and these variables were compared using
univariate analysis and multivariate logistic regression. Results: Out of 81,179 patients, ED visits were identified for 6764 (8.3%), and
readmissions were identified for 592 (0.7%). Overall, 5300 patients had 1 ED
visit, 1020 patients had 2 visits, 275 patients had 3 visits, and 169
patients had ≥4 or more visits; visits occurred within 2 weeks of surgery
38% of the time. Notably, weekly visits returned to baseline at week 3.
Independent predictors of ED utilization from multivariate analysis were
insurance type (relative to commercial insurance: Medicaid [odds ratio [OR],
2.41; 95% CI, 2.23-2.60] and Medicare [OR, 1.38; 95% CI, 1.19-1.60]), higher
Elixhauser comorbidity index (per 2-point increase: OR, 2.24; 95% CI,
2.18-2.29), younger age (per 10-year decrease: OR, 1.23; 95% CI, 1.21-1.24),
female sex (OR, 1.05; 95% CI, 1.02-1.08), and region of the country
(relative to the West: Midwest [OR, 1.33; 95% CI, 1.26-1.39], Northeast [OR,
1.24; 95% CI, 1.18-1.30], and South [OR, 1.17; 95% CI, 1.12-1.23]). In the
first 2 weeks, 67.5% of ED visits were for issues involving the surgical
site, most commonly surgical-site pain (29% of all visits). In the total
90-day period, 39.4% of visits involved the surgical site. Conclusion: Within 90 days of ACLR, >8% of patients visited the ED, while 0.7% were
readmitted. ED visits increased in the first 2 postoperative weeks and
returned to baseline rates around week 3. Within the first 2 weeks,
two-thirds of visits involved the surgical site. Younger patients, patients
with greater comorbidity burden, those in certain regions of the country,
and those with Medicaid had greater odds of ED utilization.
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Affiliation(s)
- Alexander J Kammien
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut, USA
| | - Justin R Zhu
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut, USA
| | - Michael J Gouzoulis
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut, USA
| | | | - Anoop R Galivanche
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut, USA
| | - Michael J Medvecky
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut, USA
| | - Jonathan N Grauer
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut, USA
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Ye Y, Xiong YY, Zhu JR, Sun J. [Comparison of adaptation and microstructure of titanium upper complete denture base fabricated by selecting laser melting and electron beam melting]. Zhonghua Kou Qiang Yi Xue Za Zhi 2017; 52:346-350. [PMID: 28613055 DOI: 10.3760/cma.j.issn.1002-0098.2017.06.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To fabricate Ti alloy frameworks for a maxillary complete denture with three-dimensional printing (3DP) technique, such as selective laser melting (SLM) and electron beam melting (EBM), and to evaluate the microstructure of these frameworks and their adaptation to the die stone models. Methods: Thirty pairs of edentulous casts were divided into 3 groups randomly and equally. In each group, one of the three techniques (SLM, EBM, conventional technique) was used to fabricate Ti alloy frameworks. The base-cast sets were transversally sectioned into 3 sections at the distal of canines, mesial of first molars, and the posterior palatal zone. The gap between the metal base and cast was measured in the 3 sections. Stereoscopic microscope was used to measure the gap. Three pieces of specimens of 5 mm diameter were fabricated with Ti alloy by SLM, EBM and the traditional casting technology (as mentioned above). Scanning electron microscope (SEM) was used to evaluate the differences of microstructure among these specimens. Results: The gaps between the metal base and cast were (99.4±17.0), (98.2±26.1), and (99.6± 16.1) μm in conventional method; (99.4 ± 22.8), (83.1 ± 19.3), and (103.3 ± 13.8) μm in SLM technique; (248.3±70.3), (279.1±71.9), and (189.1±31.6) μm in EBM technique. There was no statistical difference in the value of gaps between SLM Ti alloy and conventional method Ti alloy group (P>0.05). There was statistical difference among EBM Ti alloy, conventional method Ti alloy and SLM Ti alloy group (P<0.05). The SLM Ti alloy showed more uniform and compact microstructure than the cast Ti alloy and EBM Ti alloy did. Conclusions: SLM technique showed initial feasibility to manufacture the dental base of complete denture. The mechanical properties and microstructure of the denture frameworks prepared by SLM indicate that these dentures are appropriate for clinical use. EBM technique is inadequate to make a complete denture now.
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Affiliation(s)
- Y Ye
- Department of Prosthodontics, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine & Shanghai Key Laboratory of Stomatology, Shanghai 200011, China
| | - Y Y Xiong
- Department of Prosthodontics, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine & Shanghai Key Laboratory of Stomatology, Shanghai 200011, China
| | - J R Zhu
- Department of Prosthodontics, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine & Shanghai Key Laboratory of Stomatology, Shanghai 200011, China [Present address: Department of Stomatology, Kashgar Prefecture Second People's Hospital, Xinjiang Uygur Autonomous Region 844000, China]
| | - J Sun
- Department of Prosthodontics, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine & Shanghai Key Laboratory of Stomatology, Shanghai 200011, China
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Li D, Zhu JR, Hou XQ, Du F, Liu B, Wang WJ, Li YL. [Preliminary clinical efficacy of percutaneous transcystic papilla balloon dilation for removing common bile duct stones]. Zhonghua Yi Xue Za Zhi 2017; 97:2454-2457. [PMID: 28835049 DOI: 10.3760/cma.j.issn.0376-2491.2017.31.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To evaluate the feasibility, safety, and preliminary efficacy of percutaneous transcystic papilla balloon dilation for the common bile duct stones. Methods: A total of 11 patients with the common bile duct stones without dilatation of the intrahepatic bile ducts treated with percutaneous transcystic papilla balloon dilation in multiple center from April 2013 to May 2015 were analyzed retrospectively.In these 11 patients, there were 3 males and 8 females.And the average age was 68(52-91) years old.All patients had no obviously dilated intrahepatic bile duct, 6 patients were not suitable for endoscopic treatment or surgery, 4 patients refused endoscopic or surgical treatment and 1 patient had a history of failed endoscopic treatment.The white blood cell count, CA19-9, total bilirubin, direct bilirubin, AST, ALT and serum amylase level were recorded before the procedure, 1 week, and 1 month later.Early complications, such as cholangitis, pancreatitis, hemorrhage, and perforation were evaluated. Results: Technical success was achieved in all the 11 cases.The level of CA19-9, total bilirubin and direct bilirubin decreased significantly 1 week and 1 month after the procedure.One patient suffered from biliary tract infection.No severe complications, such as perforation of biliary or gastrointestinal tract, occurred during the follow up.Common bile duct stone recurred in 1 patient 2 years after the procedure. Conclusions: For cases who are not suitable for endoscopic treatment, surgery, or percutaneous transhepatic approach to treat the common bile duct stones, percutaneous transcystic papilla dilation is technically feasible and safe, and seems to be an appropriate alternative strategy.
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Affiliation(s)
- D Li
- Department of Interventional Medicine, the Second Hospital of Shandong University, Jinan 250033, China
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Lu X, Zhou H, Pan YB, Chen CY, Zhu JR, Chen PH, Li YR, Cai Q, Chen RK. Segregation analysis of microsatellite (SSR) markers in sugarcane polyploids. Genet Mol Res 2015; 14:18384-95. [PMID: 26782486 DOI: 10.4238/2015.december.23.26] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
No information is available on segregation analysis of DNA markers involving both pollen and self-progeny. Therefore, we used capillary electrophoresis- and fluorescence-based DNA fingerprinting together with single pollen collection and polymerase chain reaction (PCR) to investigate simple sequence repeat (SSR) marker segregation among 964 single pollens and 288 self-progenies (S1) of sugarcane cultivar LCP 85-384. Twenty SSR DNA fragments (alleles) were amplified by five polymorphic SSR markers. Only one non-parental SSR allele was observed in 2392 PCRs. SSR allele inheritance was in accordance with Mendelian laws of segregation and independent assortment. Highly significant correlation coefficients were found between frequencies of observed and expected genotypes in pollen and S1 populations. Within the S1 population, the most frequent genotype of each SSR marker was the parental genotype of the same marker. The number of genotypes was higher in pollen than S1 population. PIC values of the five SSR markers were greater in pollen than S1 populations. Eleven of 20 SSR alleles (55%) were segregated in accordance with Mendelian segregation ratios expected from pollen and S1 populations of a 2n = 10x polyploid. Six of 20 SSR alleles were segregated in a 3:1 (presence:absence) ratio and were simplex markers. Four and one alleles were segregated in 77:4 and 143:1 ratios and considered duplex and triplex markers, respectively. Segregation ratios of remaining alleles were unexplainable. The results provide information about selection of crossing parents, estimation of seedling population optimal size, and promotion of efficient selection, which may be valuable for sugarcane breeders.
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Affiliation(s)
- X Lu
- Sugarcane Research Laboratory, Agricultural Research Service, United States Department of Agriculture, Houma, LA, USA.,Yunnan Key Laboratory of Sugarcane Genetic Improvement, Sugarcane Research Institute, Yunnan Academy of Agricultural Sciences, Kaiyuan, Yunnan, China
| | - H Zhou
- Sugarcane Research Laboratory, Agricultural Research Service, United States Department of Agriculture, Houma, LA, USA.,Laboratory of Sugarcane Biotechnology and Genetic Improvement (Guangxi), Ministry of Agriculture and Sugarcane Research Institute, Guangxi Academy of Agricultural Sciences, Nanning, Guangxi, China
| | - Y-B Pan
- Sugarcane Research Laboratory, Agricultural Research Service, United States Department of Agriculture, Houma, LA, USA
| | - C Y Chen
- Department of Crop, Soil and Environmental Sciences, Auburn University, Auburn, AL, USA
| | - J R Zhu
- Sugarcane Research Laboratory, Agricultural Research Service, United States Department of Agriculture, Houma, LA, USA.,Yunnan Key Laboratory of Sugarcane Genetic Improvement, Sugarcane Research Institute, Yunnan Academy of Agricultural Sciences, Kaiyuan, Yunnan, China
| | - P H Chen
- Key Laboratory of Eco-Physiology & Genetic Improvement for Sugarcane, Ministry of Agriculture and Fujian Agriculture and Forestry University, Fujian Normal University, Fuzhou, Fujian, China
| | - Y-R Li
- Laboratory of Sugarcane Biotechnology and Genetic Improvement (Guangxi), Ministry of Agriculture and Sugarcane Research Institute, Guangxi Academy of Agricultural Sciences, Nanning, Guangxi, China
| | - Q Cai
- Yunnan Key Laboratory of Sugarcane Genetic Improvement, Sugarcane Research Institute, Yunnan Academy of Agricultural Sciences, Kaiyuan, Yunnan, China
| | - R K Chen
- Key Laboratory of Eco-Physiology & Genetic Improvement for Sugarcane, Ministry of Agriculture and Fujian Agriculture and Forestry University, Fujian Normal University, Fuzhou, Fujian, China
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Liu YQ, Kong YH, Zhang R, Zhang X, Wong FS, Tay JH, Zhu JR, Jiang WJ, Liu WT. Microbial population dynamics of granular aerobic sequencing batch reactors during start-up and steady state periods. Water Sci Technol 2010; 62:1281-1287. [PMID: 20861541 DOI: 10.2166/wst.2010.408] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
This study investigates microbial population dynamics in granular sequencing batch reactors (GSBR). The experimental results of DGGE fingerprint of sludge demonstrated that the microbial community structure of sludge shifted significantly during granulation period and nutrient removal improvement period. After reactor performance and physical characteristics of sludge reached steady state, microbial population of sludge became relatively stable. The high similarity of microbial community structure between co-existed flocculated sludge and granular sludge in GSBR at different operation phases indicated that similar microbial consortium could exist in compact aggregated form or in amorphous flocculated form. Therefore, strong selection pressure was still required to wash out flocs to maintain the stability of reactor operation. In addition, it was found that substrate type had considerable impact on microbial species selection and enrichment in granular sludge. The clone library of granular sludge showed that microbial species in divisions of α-Proteobacteria, β-Proteobacteria, γ-Proteobacteria and Bacteroidetes existed within acetate-fed granule communities and Thauera spp. from β-Proteobacteria accounted for 49% of the total clones in the whole clone library. It is thus speculated that Thauera spp. are important for the formation of acetate-fed granules under the conditions used in this study, maintaining the integrity of granules or substrate degradation.
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Affiliation(s)
- Y Q Liu
- Institute of Environmental Science and Engineering, Nanyang Technological University, 18, Nanyang Drive, Singapore 637723, Singapore.
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Zhu JR, Bai J, Cai NS, Tang B, Fan WH, Guo JZ, Ke YN, Guo JX, Sheng LH, Lu ZY, Cheng NN. Efficacy and safety of telmisartan vs. losartan in control of mild-to-moderate hypertension: a multicentre, randomised, double-blind study. Int J Clin Pract 2005:46-9. [PMID: 15617459 DOI: 10.1111/j.1742-1241.2004.00410.x] [Citation(s) in RCA: 19] [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: 12/01/2022] Open
Abstract
This multicentre, randomised, double-blind, double-dummy, parallel-group study compared the efficacy and safety of telmisartan with those of losartan after 8 weeks' treatment. In total, 330 patients with mild-to-moderate hypertension (systolic blood pressure [SBP] <180 mmHg; diastolic blood pressure [DBP] 95-109 mmHg) were randomly assigned to receive once-daily treatment with telmisartan 40 mg (n = 164) or losartan 50 mg (n = 166). After 4 weeks' treatment, if a patient's DBP was > or = 90 mmHg, the dose was increased to telmisartan 80 mg or losartan 100 mg, respectively. The results show that mean trough seated blood pressure was reduced significantly more in the telmisartan group than that in the losartan group (SBP 12.5 mmHg vs. 9.4 mmHg, p = 0.037; DBP 10.9 mmHg vs. 9.3 mmHg, p = 0.030). The overall DBP response rate (reduction from baseline in mean seated DBP > or = 10 mmHg and/or a mean seated DBP <90 mmHg) at the end of the study in the telmisartan group was higher than that in losartan group (70.1% vs. 58.7%, p = 0.020). At both the low and high doses, the DBP response rates for telmisartan were significantly higher than those for losartan (telmisartan 40 mg vs. losartan 50 mg: 46.3% vs. 32.5%, p = 0.010; telmisartan 80 mg vs. losartan 100 mg: 79.3% vs. 65.3%, p = 0.008). Adverse events with the two treatments were comparable (telmisartan vs. losartan 23.2% vs. 22.9%, p = 0.952). Most events were mild in intensity and abated within 72 h. Thus, telmisartan 40 mg or 80 mg administered once daily can reduce SBP and DBP effectively and safely.
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Affiliation(s)
- J R Zhu
- Zhongshan Hospital, Fu Dan University, Shanghai, China.
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16
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Chung N, Cho SY, Choi DH, Zhu JR, Lee K, Lee PY, Lee SH, Lee S, Wang JJ, Yin WH, Young MS, Koh KK, Son JW, Sangwatanaroj S, Panchavinnin P, Phankingthongkum R, Cai NS, Fan WF. STATT: a titrate-to-goal study of simvastatin in Asian patients with coronary heart disease. Simvastatin Treats Asians to Target. Clin Ther 2001; 23:858-70. [PMID: 11440286 DOI: 10.1016/s0149-2918(01)80074-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Most published studies on the use of lipid-lowering agents to treat hypercholesterolemia have focused on Western populations, with few data on Asian populations. OBJECTIVE The Simvastatin Treats Asians to Target (STATT) study used a titrate-to-goal protocol to evaluate the efficacy and tolerability of simvastatin 20 to 80 mg/d in the treatment of Asian patients with coronary heart disease. METHODS This was a multicenter, open-label, uncontrolled, 14-week study in patients with coronary heart disease and serum low-density lipoprotein cholesterol (LDL-C) levels of 115-180 mg/dL and triglyceride levels of < or = 400 mg/dL. The dose of simvastatin was titrated from 20 to 80 mg/d to achieve the National Cholesterol Education Program (NCEP) LDL-C target of < or = 100 mg/dL. The primary efficacy measure was the percentage of patients achieving the NCEP target. Among secondary measures were the percentage of patients achieving European Society of Cardiology/European Atherosclerosis Society/European Society of Hypertension target LDL-C levels of < or = 115 mg/dL and the percentage change from baseline in lipid parameters. Tolerability was assessed in terms of the overall incidence of adverse experiences and the incidences of the most commonly reported adverse experiences. RESULTS The intent-to-treat analysis included 133 Asian patients (93 men, 40 women; mean age, 59.5 years), of whom 125 completed 14 weeks of therapy. Their mean blood pressure was 130.2/79.4 mm Hg. Overall, 104 (78.2%) patients treated with simvastatin achieved LDL-C levels < or = 100 mg/dL at week 14, and 125 (94.0%) achieved this target at some point during the study. Similarly, 122 (91.7%) patients achieved an LDL-C level < or = 115 mg/dL at week 14, and 130 (97.7%) achieved this target at some point during the study. Treatment with simvastatin had favorable effects on the lipid profile, producing significant percentage changes from baseline in all parameters (P < 0.001). Simvastatin was well tolerated across the dose range. Overall, 40 patients (30.1%) had > or = 1 clinical adverse experience. Only 14 (10.5%) had adverse experiences that were possibly, probably, or definitely related to study drug; none of these experiences were considered serious. The most common adverse experiences (> or = 3% incidence) were abdominal pain (6%); chest pain (5%); dizziness (4%); and asthenia/fatigue, fibromyalgia, headache, insomnia, and upper respiratory tract infection (3% each). No new or unexpected adverse experiences were seen at the higher doses. CONCLUSIONS Simvastatin was effective and well tolerated at doses of 20, 40, and 80 mg/d in Asian patients with coronary heart disease. Titration enabled the majority to achieve target LDL-C levels of < or = 100 mg/dL.
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Affiliation(s)
- N Chung
- Cardiology Division, Yonsei University College of Medicine, Seoul, Korea.
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Manolis AJ, Grossman E, Jelakovic B, Jacovides A, Bernhardi DC, Cabrera WJ, Watanabe LA, Barragan J, Matadamas N, Mendiola A, Woo KS, Zhu JR, Mejia AD, Bunt T, Dumortier T, Smith RD. Effects of losartan and candesartan monotherapy and losartan/hydrochlorothiazide combination therapy in patients with mild to moderate hypertension. Losartan Trial Investigators. Clin Ther 2000; 22:1186-203. [PMID: 11110230 DOI: 10.1016/s0149-2918(00)83062-3] [Citation(s) in RCA: 70] [Impact Index Per Article: 2.9] [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: 12/01/2022]
Abstract
OBJECTIVE The goal of this multicenter, double-blind, randomized, parallel-group study was to compare the effects of losartan potassium (hereafter referred to as losartan), candesartan cilexitil (hereafter referred to as candesartan), and losartan/hydrochlorothiazide (HCTZ) in patients with mild to moderate hypertension (sitting diastolic blood pressure [SiDBP] 95-115 mm Hg). METHODS A total of 1161 patients were randomized in a 2:2:1 ratio to 12 weeks of treatment with losartan 50 mg QD, possibly titrated to 100 mg QD (n = 461); candesartan 8 mg QD, possibly titrated to 16 mg QD (n = 468); or losartan 50 mg QD, possibly titrated to losartan 50 mg plus HCTZ 12.5 mg QD (n = 232). At 6 weeks, the regimens of patients not reaching a goal SiDBP <90 mm Hg were titrated as described, whereas patients achieving this goal continued with low-dose monotherapy. The single primary end point at 12 weeks tested the equivalence of the 2 monotherapy regimens, predefined as a maximum between-treatment difference in the mean change from baseline trough SiDBP of 2.5 mm Hg. RESULTS At 12 weeks, changes in SiDBP/sitting systolic blood pressure (SiSBP) of -12.4/-14.4 mm Hg with losartan 50 mg/100 mg and -13.1/-15.8 mm Hg with candesartan 8 mg/16 mg demonstrated equivalence between the 2 monotherapy regimens (95% CI for difference in SiDBP, -1.6 to 0.2). At 12 weeks, the losartan 50 mg/50 mg plus HCTZ 12.5 mg regimen had reduced SiDBP/SiSBP significantly more (-14.3/-18.0 mm Hg) than either the candesartan 8 mg/16 mg (SiDBP, P = 0.045; SiSBP, P = 0.017) or losartan 50 mg/100 mg regimen (SiDBP and SiSBP, P = 0.001). During the last 6 weeks, patients whose regimen had been titrated to losartan 50 mg plus HCTZ 12.5 mg (n = 114) showed a greater reduction in SiDBP/SiSBP (-14.5/ -18.7 mm Hg) than did those whose regimen had been titrated to either losartan 100 mg (-10.5/-12.3 mm Hg; n = 211) or candesartan 16 mg (-11.5/-13.2 mm Hg; n = 206), representing a clinically meaningful > or = 2.5-mm Hg) difference. All 3 treatments were well tolerated, with few patients experiencing drug-related adverse events (6.9% losartan 50 mg/100 mg, 7.5% candesartan 8 mg/16 mg, 3.0% losartan 50 mg/ 50 mg plus HCTZ 12.5 mg). Candesartan 8 mg/16 mg increased serum uric acid levels (0.13 mg/dL; 95% CI, 0.04 to 0.23), whereas losartan 50 mg/100 mg decreased them (-0.14 mg/dL; 95% CI, -0.24 to -0.04), and losartan 50 mg/50 mg plus HCTZ 12.5 mg left them unchanged (0.06 mg/dL; 95% CI, -0.07 to 0.20). CONCLUSIONS Losartan 50 mg/100 mg and candesartan 8 mg/16 mg were comparable treatments in terms of blood pressure reduction. After titration, losartan 50 mg plus HCTZ 12.5 mg was superior to either candesartan 16 mg or losartan 100 mg in reducing hypertension. Losartan, but not candesartan, lowered serum uric acid levels and attenuated the expected increase in uric acid levels with HCTZ 12.5 mg.
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Taylor SH, Chen MF, Lee SJ, Koanantakul B, Zhu JR, Santoso T, Sy RG, Tai YT. Efficacy and Tolerability of Amlodipine in the General Practice Treatment of Essential Hypertension in an Asian Multinational Population. Clin Drug Investig 1998; 16:177-85. [DOI: 10.2165/00044011-199816030-00001] [Citation(s) in RCA: 3] [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: 11/02/2022]
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Wu ZL, Wang JP, Pan WK, Zhu JR, Guo MY, Liao LT. The presentation, treatment and outcome of acute glomerulonephritis in the elderly. Clin Nephrol 1996; 45:277-9. [PMID: 8861806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
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Abstract
This study included 125 patients with chronic parotitis, and it presents in particular, a long-term clinical, laboratory, and sialographic study of 22 patients who were diagnosed as having adult recurrent sialadenitis of the parotid glands (ARSPG). Twelve of the 22 patients with ARSPG were shown to have Sjögren's syndrome (SS). These patients had recurrent parotid gland swelling for 1.5-14 years (mean, 5.2 years) before xerostomia and keratoconjunctivitis sicca occurred. Ten of the 22 patients with ARSPG did not develop SS, but did experience recurrent parotitis which extended from childhood into adulthood. The ARSPG underwent remission in seven of these patients. It is suggested that patients with ARSPG, but without a history of parotid gland swellings in childhood, should be diagnosed provisionally as having subclinical SS (SCSS).
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Affiliation(s)
- S L Wang
- Salivary Gland Disease Center, Beijing Hospital for Stomatology, Capital Institute of Medicine, China
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21
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Zhu JR. [Progress in cardiovascular pharmacology]. Zhonghua Xin Xue Guan Bing Za Zhi 1993; 21:358-60. [PMID: 7913889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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22
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Zhu JR, Cai QS. [Advances in cardiovascular diseases in China]. Zhonghua Yi Xue Za Zhi 1993; 73:707-8. [PMID: 8143165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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23
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Guo WY, Zhu JR, Li ZS, Jiang WD, Yang JM. [Pharmacokinetics of moracizine and moracizine sulfoxide in healthy volunteers]. Zhongguo Yao Li Xue Bao 1993; 14:433-6. [PMID: 8010035] [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: 01/28/2023]
Abstract
The pharmacokinetics of moracizine (Mor) and moracizine sulfoxide (Mor-SO) determined by reversed phase HPLC was reported. The data in 6 volunteers after a single oral dose (600 mg) showed an one-compartment open model. The peak concentration in plasma (2.1 +/- 0.4 micrograms.ml-1) of Mor reached within 1-2 h. The Mor-SO concentration in plasma was much lower (0.19 +/- 0.06 micrograms.ml-1) than that of Mor, but its elimination T1/2 (2.3 +/- 1.0 h) was similar to that of Mor (1.5 +/- 1.0 h). The recoveries of Mor, Mor-SO, moracizine sulfone (Mor-SO2) in urine within 48 h were 0.07%, 0.25%, and 0.06% of the total dose, respectively. The Mor and Mor-SO concentration ranges in plasma for 9 arrhythmic patients after 2-wk therapeutic trial were 0.09 +/- 0.07 to 0.9 +/- 0.5 microgram.ml-1 and 0.040 +/- 0.023 to 0.15 +/- 0.06 micrograms.ml-1, respectively. These results suggested that cumulative doses would not result in accumulation of the drug and the anti-arrhythmic effect of Mor-SO might not be realized.
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Affiliation(s)
- W Y Guo
- Laboratory of Clinical Pharmacology, Zhong Shan Hospital, Shanghai Medical University, China
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Abstract
Clinical, sialographic, and sequential quantitative scintigraphic characteristics of 92 cases of chronic obstructive parotitis (in 117 diseased parotid glands) are reported, and the treatment investigated. The cardinal feature of this disease is obstruction or retarded salivary flow resulting in recurrent swellings and retrograde infection. The main characteristic seen in sialograms is irregular dilation of the main and branching ducts. On the basis of sialographic findings, the ducts are classified into four types. This classification reflects the severity of the disease and can also be used as a guide to treatment.
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Affiliation(s)
- Z J Zou
- Department of Oral Radiology, School of Stomatology, Beijing Medical University, China
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25
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Zou ZJ, Wang SL, Zhu JR, Yu SF, Ma DQ, Wu YT. Recurrent parotitis in children. A report of 102 cases. Chin Med J (Engl) 1990; 103:576-82. [PMID: 2119975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
This article presents 102 cases of recurrent parotitis in children with studies of clinical findings, sialographic manifestations, dynamic functions of the parotid gland examined with radionuclide, laboratory findings and follow-up studies of 28 cases with sialography. The following conclusions are reached: 1. Retrograde infection induced by the mumps virus and upper respiratory infection seem to play a major role in the etiology of recurrent parotitis. Familial abnormalities are potential factors. Incomplete immune functions of the children are factors related to the pathogenesis, and following growth and development of the immune system, this disease will undergo remission; 2. Sequential scintigraphy shows normal uptake and retarded excretion function of the parotid; 3. Long-term follow-up studies demonstrate that the patients are free from symptoms for many years, but the punctate dilatation in sialography may diminish, disappear, or be unchanged; and 4. If the disease is not cured in childhood, it may continue into adulthood and healing will take place eventually. Relationship with Sjogren's syndrome has not been revealed.
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Affiliation(s)
- Z J Zou
- Department of Oral Radiology, School of Stomatology, Beijing Medical University
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Yang YZ, Jin PY, Gúo Q, Wang QD, Li ZS, Ye YC, Shan YF, Zhao HY, Zhu JR, Pu SY. Effect of Astragulas membranaceus on natural killer cell activity and induction of alpha- and gamma-interferon in patients with Coxsackie B viral myocarditis. Chin Med J (Engl) 1990; 103:304-7. [PMID: 2167822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
The patients suffering from Coxsackie B viral myocarditis with depressed natural killer (NK) activity were treated with Astragulas membranaceus (AM) intramuscularly for 3-4 months. After the treatment, the NK activity was increased significantly from 11.5 +/- 11.9% before therapy to 44.9 +/- 15.0%. Another 6 patients of Coxsackie B viral myocarditis with depressed NK activity were treated with conventional therapy. The NK activity remained unchanged in 12.9 +/- 6%. The general condition and symptoms improved in all patients with AM therapy, while the titers of neutralizing antibody remained at the same level. Two days after AM treatment, the mean titers of alpha- and gamma-interferon (IFN) markedly increased in comparison with those before therapy and 3 weeks after AM therapy in 16 patients with Coxsackie B viral myocarditis, with left ventricular ejection fraction (LVEF) less than 65% and/or weak ventricular wall motion assayed by radionuclide angiocardiography. Whereas, in 12 patients treated with conventional therapy, there was no statistical difference among the results before and 2 days and 3 weeks after treatment. The results indicate that AM could partly regulate the lost of control of cellular immunity in patients with viral myocarditis.
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Affiliation(s)
- Y Z Yang
- Shanghai Institute of Cardiovascular Disease, Zhongshan Hospital, Shanghai Medical University
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27
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Chen Y, Zhu JR, Li ZS. [Blood levels, clinical effects and pharmacokinetics during treatment with oral ethmozine]. Zhonghua Xin Xue Guan Bing Za Zhi 1987; 15:34-6, 63. [PMID: 2440654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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28
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Zhu JR, Li ZS, Zhao HY. [Effect of diltiazem on left ventricular function in hypertrophic cardiomyopathy]. Zhonghua Nei Ke Za Zhi 1986; 25:584-6, 636. [PMID: 3568837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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29
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Zhu JR, Shen XD, Shi YF. [A clinical study of degenerative calcific valvular disease in the elderly]. Zhonghua Nei Ke Za Zhi 1985; 24:463-6, 509-10. [PMID: 4053808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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30
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Chen WZ, Wang CG, Yang XY, Cai NS, Zhu JR. [Clinical pharmacokinetics of the anti-arrhythmic agent changrolin]. Yao Xue Xue Bao 1985; 20:505-8. [PMID: 4096242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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31
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Zhu JR. [Clinical value of perfusion lung scanning in patients with a lung mass]. Zhonghua Jie He He Hu Xi Xi Ji Bing Za Zhi 1985; 8:22-4, 61. [PMID: 3996129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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32
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Zhu JR, Li QS, Yang XY, Li ZS, Wang XP, Zhao HY. [Effects of oral diltiazem on left ventricular function in patients of coronary disease]. Zhongguo Yao Li Xue Bao 1984; 5:254-257. [PMID: 6242217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
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33
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Zhu JR, Li QS, Yang XY, Li ZS, Wang XP, Zhao HY. [Effects of oral diltiazem on left ventricular function in patients with coronary disease]. Zhongguo Yao Li Xue Bao 1984; 5:254-7. [PMID: 6240900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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34
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Zhu JR. [Clinical value of bone scanning of the maxillofacial region]. Zhonghua Kou Qiang Ke Za Zhi 1983; 18:25-8. [PMID: 6575894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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35
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Zhu JR, Yao ZY. [Possible causes of prominent anterior forces]. Zhonghua Xin Xue Guan Bing Za Zhi 1982; 10:104-8. [PMID: 6215239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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36
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Zhu JR. [Evaluation and management of noncardiac operations in aged patients with heart diseases---with analysis of 161 cases (author's transl)]. Zhonghua Nei Ke Za Zhi 1982; 21:15-8. [PMID: 7075360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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