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Hou HY, Tang DS, Zhang YN, Wang KY, Ao M, Luo HX, Li B. [Antitumor effects of redox-responsive nanoparticles containing platinum(Ⅳ)in ovarian cancer]. Zhonghua Zhong Liu Za Zhi 2024; 46:76-85. [PMID: 38246783 DOI: 10.3760/cma.j.cn112152-20231024-00239] [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] [Grants] [Subscribe] [Scholar Register] [Indexed: 01/23/2024]
Abstract
Objectives: To explore the antitumor effects of redox-responsive nanoparticles containing platinum(Ⅳ)-NP@Pt(Ⅳ) in ovarian cancer. Methods: Redox-responsive polymer carriers were synthesized. Polymer carriers and platinum(Ⅳ)-Pt(Ⅳ) can self-assemble into NP@Pt(Ⅳ). Inductively coupled plasma mass spectrometry was performed to detect the platinum release from NP@Pt(Ⅳ) in reducing environment and the platinum content in ovarian cancer cells ES2 treated with cisplatin, Pt(Ⅳ) and NP@Pt(Ⅳ). The proliferation ability of the ovarian cancer cells were detected by 3-(4,5-Dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay. Cellular apoptosis was assessed by flow cytometry. Collection of primary ovarian cancer tissues from patients with primary high-grade serous ovarian cancer who were surgically treated at the Cancer Hospital of the Chinese Academy of Medical Sciences from October to December 2022. The high-grade serous ovarian cancer patient-derived xenograft (PDX) mice were intravenously injected with Cy7.5 labeled NP@Pt(Ⅳ) followed by in vivo imaging system. Mice were treated with PBS, cisplatin and NP@Pt(Ⅳ). Tumor volume and weight were measured in each group. Necrosis, apoptosis and cell proliferation of tumor tissues were detected by hematoxylin-eosin (HE) staining, TUNEL fluorescence staining and Ki-67 immunohistochemistry staining. Body weight and HE staining of heart, liver, spleen, lung and kidney of mice in each group were measured. Results: The platinum release of NP@Pt(Ⅳ) after 48 hours in reducing environment was 76.29%, which was significantly higher than that of 26.82% in non-reducing environment (P<0.001). The platinum content in ES2 cells after 4 hours and 7 hours of treatment with NP@Pt(Ⅳ) (308.59, 553.15 ng/million cells) were significantly higher than those of Pt(Ⅳ) (100.21, 180.31 ng/million cells) and cisplatin (43.36, 50.36 ng/million cells, P<0.05). The half inhibitory concentrations of NP@Pt(Ⅳ) in ovarian cancer cells ES2, A2780, A2780DDP were 1.39, 1.42 and 4.62 μmol/L, respectively, which were lower than those of Pt(IV) (2.89, 7.27, and 16.74 μmol/L) and cisplatin (5.21, 11.85, and 71.98 μmol/L). The apoptosis rate of ES2 cells treated with NP@Pt(Ⅳ) was (33.91±3.80)%, which was significantly higher than that of Pt(Ⅳ) [(16.28±2.41)%] and cisplatin [(15.01±1.17)%, P<0.05]. In high-grade serous ovarian cancer PDX model, targeted accumulation of Cy7.5 labeled NP@Pt(Ⅳ) at tumor tissue could be observed. After the treatment, the tumor volume of mice in NP@Pt(IV) group was (130±98) mm3, which was significantly lower than those in control group [(1 349±161) mm3, P<0.001] and cisplatin group [(715±293) mm3, P=0.026]. The tumor weight of mice in NP@Pt(IV) group was (0.17±0.09)g, which was significantly lower than those in control group [(1.55±0.11)g, P<0.001] and cisplatin group [(0.82±0.38)g, P=0.029]. The areas of tumor necrosis and apoptosis in mice treated with NP@Pt(Ⅳ) were higher than those in mice treated with cisplatin. Immunohistochemical staining revealed that there were low expressions of Ki-67 at tumor tissues of mice treated with NP@Pt(Ⅳ) compared with cisplatin. The change in body weight of mice in NP@Pt(Ⅳ) group was not significantly different from that of the control group [(18.56±2.04)g vs.(20.87±0.79)g, P=0.063]. Moreover, the major organs of the heart, liver, spleen, lung, and kidney were also normal by HE staining. Conclusion: Redox-responsive NP@Pt(Ⅳ), produced in this study can enhance the accumulation of cisplatin in ovarian cancer cells and improve the efficacy of ovarian cancer chemotherapy.
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Affiliation(s)
- H Y Hou
- Department of Gynecologic Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China Department of Obstetrics and Gynecology, Peking University People's Hospital, Beijing 100044, China
| | - D S Tang
- Beijing National Laboratory for Molecular Sciences, Laboratory of Polymer Physics and Chemistry, Institute of Chemistry, Chinese Academy of Sciences, Beijing 100190, China
| | - Y N Zhang
- Department of Gynecologic Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - K Y Wang
- Department of Gynecologic Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - M Ao
- Department of Gynecologic Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - H X Luo
- Department of Gynecologic Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - B Li
- Department of Gynecologic Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
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Harris AB, Wang KY, Mo K, Kebaish F, Raad M, Puvanesarajah V, Musharbash F, Neuman B, Khanna AJ, Kebaish KM. Bone Mineral Density T-Score is an Independent Predictor of Major Blood Loss in Adult Spinal Deformity Surgery. Global Spine J 2024; 14:153-158. [PMID: 35608515 PMCID: PMC10676180 DOI: 10.1177/21925682221097912] [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] [Indexed: 11/17/2022] Open
Abstract
STUDY DESIGN Retrospective Cohort Study. OBJECTIVE The purpose of this study was to determine the effect of low bone mineral density (BMD), as assessed by preoperative Dual-energy X-ray Absorptiometry (DEXA) scans, on intraoperative blood loss following adult spinal deformity (ASD) surgery. METHODS Patients who received spinal fusion for ASD (>5 levels fused) at a single academic center from 2010-2018 were included in this study. The lowest preoperative T-score was recorded for patients who had preoperative DEXA scans within a year of surgery. Patients with liver/kidney disease or on prescription anticoagulant medication were excluded. Major blood loss was a binary variable defined as above or below the 90th percentile of our cohort. Binomial regression was performed controlling for age, number of vertebrae fused, 3-column osteotomy, primary vs. revision surgery, preoperative platelet count, and if the patient was taking medication for osteoporosis. RESULTS 91 patients were identified in the cohort. Mean age was 63 ± 11.6 years, 81% female. 56 (62%) of cases included revision of previous instrumentation. Patients had a mean SVA of 9.6 ± 8.6 cm and median of 9 vertebrae fused (range 5-22). The average T-score was -1.2 ± 1.0. Each point lower T-score was associated with significantly higher odds of major blood loss (OR 2.5, 95% CI 1.0 - 5.9) when controlling for age, number of vertebrae fused, 3-column osteotomy, preoperative platelet count and primary vs. revision surgery. CONCLUSIONS Preoperative T-score is independently associated with increased odds of major blood loss in ASD surgery.
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Affiliation(s)
- Andrew B. Harris
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD, USA
| | - Kevin Y. Wang
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD, USA
| | - Kevin Mo
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD, USA
| | - Floreana Kebaish
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD, USA
| | - Michael Raad
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD, USA
| | - Varun Puvanesarajah
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD, USA
| | - Farah Musharbash
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD, USA
| | - Brian Neuman
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD, USA
| | - Akhil Jay Khanna
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD, USA
| | - Khaled M. Kebaish
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD, USA
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Agarwal AR, Wang KY, Xu AL, Ramamurti P, Zhao A, Best MJ, Srikumaran U. Outpatient Versus Inpatient Total Shoulder Arthroplasty: A Matched Cohort Analysis of Postoperative Complications, Surgical Outcomes, and Reimbursements. J Am Acad Orthop Surg Glob Res Rev 2023; 7:01979360-202311000-00010. [PMID: 37973033 PMCID: PMC10656088 DOI: 10.5435/jaaosglobal-d-23-00008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 07/11/2023] [Accepted: 08/21/2023] [Indexed: 11/19/2023]
Abstract
INTRODUCTION There has been a trend toward performing arthroplasty in the ambulatory setting. The primary purpose of this study was to compare outpatient and inpatient total shoulder arthroplasties (TSAs) for postoperative medical complications, healthcare utilization outcomes, and surgical outcomes. METHODS Patients who underwent outpatient TSA or inpatient TSA with a minimum 5-year follow-up were identified in the PearlDiver database. These cohorts were propensity-matched based on age, sex, Charlson Comorbidity Index, smoking status, and obesity (body mass index > 30). All outcomes were analyzed using chi square and Student t-tests where appropriate. RESULTS Outpatient TSA patients had markedly lower rates of various 90-day medical complications. Outpatient TSA patients had lower risk of aseptic loosening at 2 years postoperation and lower risk of periprosthetic joint infection at 5 years postoperation relative to inpatient TSA patients. Outpatient TSA reimbursements were markedly lower than inpatient TSA reimbursements at the 30-day, 90-day, and 1-year postoperative intervals. CONCLUSION This study found patients undergoing outpatient TSA to be at lowers odds for both postoperative medical and surgical complications compared with those undergoing inpatient TSA. Despite increased risk of postoperative healthcare utilization for readmissions and emergency department visits, outpatient TSA was markedly less expensive at every postoperative time point assessed.
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Affiliation(s)
- Amil R. Agarwal
- From the Johns Hopkins Department of Orthopaedic Surgery, Columbia, MD (Mr. Agarwal, Dr. Xu, Dr. Best, and Dr. Srikumaran); the Department of Orthopaedic Surgery, George Washington School of Medicine and Health Sciences, Washington, DC (Mr. Agarwal and Ms. Zhao); the Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA (Dr. Wang); and the Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA (Dr. Ramamurti)
| | - Kevin Y. Wang
- From the Johns Hopkins Department of Orthopaedic Surgery, Columbia, MD (Mr. Agarwal, Dr. Xu, Dr. Best, and Dr. Srikumaran); the Department of Orthopaedic Surgery, George Washington School of Medicine and Health Sciences, Washington, DC (Mr. Agarwal and Ms. Zhao); the Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA (Dr. Wang); and the Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA (Dr. Ramamurti)
| | - Amy L. Xu
- From the Johns Hopkins Department of Orthopaedic Surgery, Columbia, MD (Mr. Agarwal, Dr. Xu, Dr. Best, and Dr. Srikumaran); the Department of Orthopaedic Surgery, George Washington School of Medicine and Health Sciences, Washington, DC (Mr. Agarwal and Ms. Zhao); the Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA (Dr. Wang); and the Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA (Dr. Ramamurti)
| | - Pradip Ramamurti
- From the Johns Hopkins Department of Orthopaedic Surgery, Columbia, MD (Mr. Agarwal, Dr. Xu, Dr. Best, and Dr. Srikumaran); the Department of Orthopaedic Surgery, George Washington School of Medicine and Health Sciences, Washington, DC (Mr. Agarwal and Ms. Zhao); the Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA (Dr. Wang); and the Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA (Dr. Ramamurti)
| | - Amy Zhao
- From the Johns Hopkins Department of Orthopaedic Surgery, Columbia, MD (Mr. Agarwal, Dr. Xu, Dr. Best, and Dr. Srikumaran); the Department of Orthopaedic Surgery, George Washington School of Medicine and Health Sciences, Washington, DC (Mr. Agarwal and Ms. Zhao); the Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA (Dr. Wang); and the Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA (Dr. Ramamurti)
| | - Matthew J. Best
- From the Johns Hopkins Department of Orthopaedic Surgery, Columbia, MD (Mr. Agarwal, Dr. Xu, Dr. Best, and Dr. Srikumaran); the Department of Orthopaedic Surgery, George Washington School of Medicine and Health Sciences, Washington, DC (Mr. Agarwal and Ms. Zhao); the Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA (Dr. Wang); and the Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA (Dr. Ramamurti)
| | - Uma Srikumaran
- From the Johns Hopkins Department of Orthopaedic Surgery, Columbia, MD (Mr. Agarwal, Dr. Xu, Dr. Best, and Dr. Srikumaran); the Department of Orthopaedic Surgery, George Washington School of Medicine and Health Sciences, Washington, DC (Mr. Agarwal and Ms. Zhao); the Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA (Dr. Wang); and the Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA (Dr. Ramamurti)
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Wang KY, Quan T, Kapoor S, Gu A, Best MJ, Kreulen RT, Srikumaran U. The influence of elevated international normalized ratio on complications following total shoulder arthroplasty. Shoulder Elbow 2023; 15:53-64. [PMID: 37692874 PMCID: PMC10492533 DOI: 10.1177/17585732221088974] [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: 11/06/2021] [Revised: 01/16/2022] [Accepted: 02/21/2022] [Indexed: 09/12/2023]
Abstract
Background Identifying preoperative risk factors for complications following total shoulder arthroplasty (TSA) has both clinical and financial implications. The purpose of this study was to determine the influence of different degrees of preoperative INR elevation on complications following TSA. Methods Patients undergoing primary TSA from 2007 to 2018 were identified in a national database. Patients were stratified into 4 cohorts: INR of <1.0, INR of >1.0 to 1.25, INR of >1.25 to 1.5, and INR of >1.5. Postoperative complications were assessed. Multivariate logistic regressions were performed to adjust for differences in demographics and comorbidities among the INR groups. Results Following adjustment and relative to patients with an INR of <1.0, those with INR of >1.0-1.25, >1.25-1.5, and >1.5 had 1.6-times, 2.4-times, and 2.8-times higher odds of having postoperative bleeding requiring transfusion, respectively (p < 0.05 for all). Relative to patients with INR <1.0, those with INR of > 1.25-1.5 and INR of >1.5 had 7.8-times and 7.0-times higher odds of having pulmonary complications, respectively (p < 0.05 for both). Discussion With increasing INR levels, there is an independent and step-wise increase in odd ratios for postoperative complications. Current guidelines for preoperative INR thresholds may need to be adjusted for more predictive risk-stratification for TSA. Level of Evidence III.
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Affiliation(s)
- Kevin Y Wang
- Department of Orthopaedic Surgery, Johns Hopkins, Columbia, MD, USA
| | - Theodore Quan
- Department of Orthopaedic Surgery, George Washington Hospital, Washington, DC, USA
| | - Shrey Kapoor
- Department of Orthopaedic Surgery, Johns Hopkins, Columbia, MD, USA
| | - Alex Gu
- Department of Orthopaedic Surgery, George Washington Hospital, Washington, DC, USA
| | - Matthew J Best
- Department of Orthopaedic Surgery, Johns Hopkins, Columbia, MD, USA
| | | | - Uma Srikumaran
- Department of Orthopaedic Surgery, Johns Hopkins, Columbia, MD, USA
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Best MJ, Wang KY, Nayar SK, Agarwal AR, Kreulen RT, Sharma S, McFarland EG, Srikumaran U. Epidemiology of shoulder instability procedures: A comprehensive analysis of complications and costs. Shoulder Elbow 2023; 15:398-404. [PMID: 37538528 PMCID: PMC10395401 DOI: 10.1177/17585732221116814] [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: 04/07/2022] [Revised: 06/24/2022] [Accepted: 07/12/2022] [Indexed: 08/05/2023]
Abstract
Background Recurrent shoulder instability is a debilitating condition that can lead to chronic pain, decreased function, and inability to return to activities or sport. This retrospective epidemiology study was performed to report 90-day postoperative complications and costs of Latarjet, anterior bone block reconstruction, arthroscopic, and open Bankart repair for shoulder instability. Methods Patients 18 years and older who underwent four primary shoulder surgeries from 2010 to 2019 were identified using national claims data. Patient demographics, comorbidities, and 90-day postoperative complications were analyzed using univariate analysis and multivariable logistic regression. Total and itemized 90-day reimbursements were determined for each procedure. Results The 90-day medical and surgery-specific complication rates were highest for anterior bone block reconstruction, followed by Latarjet. Arthroscopic Bankart repair had the highest 90-day costs and primary procedure costs compared to other procedures. Conclusion Anterior bone block reconstruction and Latarjet procedures were associated with the highest rates of 90-day medical and surgery-specific complications, while arthroscopic Bankart repair was associated with the highest costs.
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Affiliation(s)
- Matthew J Best
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Kevin Y Wang
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Suresh K Nayar
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Amil R Agarwal
- George Washington University School of Medicine, Washington DC, USA
| | - R Timothy Kreulen
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Sribava Sharma
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Edward G McFarland
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Uma Srikumaran
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Mo K, Ikwuezunma I, Mun F, Ortiz-Babilonia C, Wang KY, Suresh KV, Uppal A, Sethi I, Mesfin A, Jain A. Racial Disparities in Spine Surgery: A Systematic Review. Clin Spine Surg 2023; 36:243-252. [PMID: 35994052 DOI: 10.1097/bsd.0000000000001383] [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: 03/20/2022] [Accepted: 06/29/2022] [Indexed: 11/26/2022]
Abstract
STUDY DESIGN Systematic Review. OBJECTIVES To synthesize previous studies evaluating racial disparities in spine surgery. METHODS We queried PubMed, Embase, Cochrane Library, and Web of Science for literature on racial disparities in spine surgery. Our review was constructed in accordance with Preferred Reporting Items and Meta-analyses guidelines and protocol. The main outcome measures were the occurrence of racial disparities in postoperative outcomes, mortality, surgical management, readmissions, and length of stay. RESULTS A total of 1753 publications were assessed. Twenty-two articles met inclusion criteria. Seventeen studies compared Whites (Ws) and African Americans (AAs) groups; 14 studies reported adverse outcomes for AAs. When compared with Ws, AA patients had higher odds of postoperative complications including mortality, cerebrospinal fluid leak, nervous system complications, bleeding, infection, in-hospital complications, adverse discharge disposition, and delay in diagnosis. Further, AAs were found to have increased odds of readmission and longer length of stay. Finally, AAs were found to have higher odds of nonoperative treatment for spinal cord injury, were more likely to undergo posterior approach in the treatment of cervical spondylotic myelopathy, and were less likely to receive cervical disk arthroplasty compared with Ws for similar indications. CONCLUSIONS This systematic review of spine literature found that when compared with W patients, AA patients had worse health outcomes. Further investigation of root causes of these racial disparities in spine surgery is warranted.
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Affiliation(s)
- Kevin Mo
- Department of Orthopaedic Surgery, Johns Hopkins University, Baltimore, MD
| | - Ijezie Ikwuezunma
- Department of Orthopaedic Surgery, Johns Hopkins University, Baltimore, MD
| | - Frederick Mun
- Department of Orthopaedic Surgery, Johns Hopkins University, Baltimore, MD
| | | | - Kevin Y Wang
- Department of Orthopaedic Surgery, Johns Hopkins University, Baltimore, MD
| | - Krishna V Suresh
- Department of Orthopaedic Surgery, Johns Hopkins University, Baltimore, MD
| | | | | | - Addisu Mesfin
- Department of Orthopaedic Surgery, University of Rochester
| | - Amit Jain
- Department of Orthopaedic Surgery, Johns Hopkins University, Baltimore, MD
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Kamalapathy PN, Wang KY, Puvanesarajah V, Raad M, Hassanzadeh H. Presence and Severity of Mental Illness Is Associated With Increased Risk of Postoperative Emergency Visits, Readmission, and Reoperation Following Outpatient ACDF: A National Database Analysis. Global Spine J 2023; 13:1267-1272. [PMID: 34212775 PMCID: PMC10416597 DOI: 10.1177/21925682211026913] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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] [Indexed: 11/15/2022] Open
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVE The purpose was to compare rates of postoperative ED visits, readmission, and reoperation between patients with and without preexisting mental illness undergoing outpatient anterior cervical discectomy and fusion (ACDF). METHODS A retrospective review of the Mariner Database was conducted on patients who underwent ACDF between 2010 and 2017. Exclusion criteria included same day revision surgery and patients with a history of spine infection, trauma, or neoplasm. Patients were grouped into 3 categories: those with existing history of anxiety and/or depression, those with severe mental illness, and those without any history of mental illness. Severe mental illness was defined as a combination of diagnosis including schizophrenia, bipolar disorder, and/or psychotic disorder. Outcome measures were analyzed by comparing groups using multivariate logistic regression. Significance was set at P < 0.05. RESULTS Patients with anxiety/depression and patients with severe mental illness both had significantly increased risk of ED visits and readmission at 30-day and 90-day intervals. Compared to patients without mental illness, patients with severe mental illness (OR 1.93, P < 0.001) had significantly increased rates of reoperation at 90-days and 1-years postoperatively. Patients with anxiety/depression did not have increased rates of reoperation relative to patients without anxiety/depression at any time interval (P > 0.05). CONCLUSION Anxiety/depression as well as more severe psychiatric disease such as Schizophrenia and Bipolar disorder were significantly associated with increased healthcare utilization following outpatient ACDF. Patients with preexisting mental illness undergoing outpatient ACDF should be carefully evaluated preoperatively and closely followed postoperatively to reduce risk of adverse events.
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Affiliation(s)
| | - Kevin Y. Wang
- Department of Orthopaedic Surgery, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Varun Puvanesarajah
- Department of Orthopaedic Surgery, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Micheal Raad
- Department of Orthopaedic Surgery, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Hamid Hassanzadeh
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA, USA
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Babu JM, Wang KY, Jami M, Durand WM, Neuman BJ, Kebaish KM. Sarcopenia as a Risk Factor for Complications Following Pedicle Subtraction Osteotomy. Clin Spine Surg 2023; 36:190-194. [PMID: 37264520 DOI: 10.1097/bsd.0000000000001455] [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: 05/23/2022] [Accepted: 01/25/2023] [Indexed: 06/03/2023]
Abstract
STUDY DESIGN Retrospective cohort. OBJECTIVE The objective was to determine if sarcopenia is an independent risk factor for complications in adult spinal deformity (ASD) patients undergoing pedicle subtraction osteotomy (PSO) and define categories of complication risk by sarcopenia severity. SUMMARY OF BACKGROUND DATA Sarcopenia is linked to morbidity and mortality in several orthopedic procedures. Data concerning sarcopenia in ASD surgery is limited, particularly with respect to complex techniques performed such as PSO. With the high surgical burden of PSOs, appropriate patient selection is critical for minimizing complications. METHODS We identified 73 ASD patients with lumbar CT/MRI scans who underwent PSO with spinal fusion ≥5 levels at a tertiary care center from 2005 to 2014. Sarcopenia was assessed by the psoas-lumbar vertebral index (PLVI). Using stratum-specific likelihood ratio analysis, patients were separated into 3 sarcopenia groups by complication risk. The primary outcome measure was any 2-year complication. Secondary outcome measures included intraoperative blood loss and length of stay. RESULTS The mean PLVI was 0.84±0.28, with 47% of patients having complications. Patients with a complication had a 27% lower PLVI on average than those without complications (0.76 vs. 0.91, P=0.021). Stratum-specific likelihood ratio analysis produced 3 complication categories: 32% complication rate for PLVI ≥ 0.81; 61% for PLVI 0.60-0.80; and 69% for PLVI < 0.60. Relative to patients with PLVI ≥ 0.81, those with PLVI 0.60-0.80 and PLVI < 0.60 had 3.2× and 4.3× greater odds of developing a complication (P<0.05). For individual complications, patients with PLVI < 1.0 had a significantly higher risk of proximal junctional kyphosis (34% vs. 0%, P=0.022), while patients with PLVI < 0.8 had a significantly higher risk of wound infection (12% vs. 0%, P=0.028) and dural tear (14% vs. 0%, P=0.019). There were no significant associations between sarcopenia, intraoperative blood loss, and length of stay. CONCLUSIONS The increasing severity of sarcopenia is associated with a significantly and incrementally increased risk of complications following ASD surgery that require PSO. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Jacob M Babu
- Illinois Bone & Joint Institute, 720 Florsheim Drive, Libertyville, IL
| | - Kevin Y Wang
- Department of Orthopaedic Surgery, The Johns Hopkins University, 601 N. Caroline Street, Baltimore, MD
| | - Meghana Jami
- Department of Orthopaedic Surgery, The Johns Hopkins University, 601 N. Caroline Street, Baltimore, MD
| | - Wesley M Durand
- Department of Orthopaedic Surgery, The Johns Hopkins University, 601 N. Caroline Street, Baltimore, MD
| | - Brian J Neuman
- Department of Orthopaedic Surgery, The Johns Hopkins University, 601 N. Caroline Street, Baltimore, MD
| | - Khaled M Kebaish
- Department of Orthopaedic Surgery, The Johns Hopkins University, 601 N. Caroline Street, Baltimore, MD
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Zhang YN, Li B, Li YQ, Liu SH, Hou HY, Wang KY, Ao M, Song Y. [Signal transducer and activator of transcription 3 and cancer associated fibroblasts jointly generate chemo-resistance and affect prognosis in epithelial ovarian cancer]. Zhonghua Fu Chan Ke Za Zhi 2023; 58:368-377. [PMID: 37217344 DOI: 10.3760/cma.j.cn112141-20230210-00062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Objective: To investigate the mechanism of signal transducer and activator of transcription 3 (STAT3) and cancer associated fibroblasts (CAF) jointly generate chemo-resistance in epithelial-ovarian cancer and their effect on prognosis. Methods: A total of 119 patients with high-grade ovarian serous cancer who received surgery in Cancer Hospital of Chinese Academy of Medical Sciences from September 2009 to October 2017 were collected. The clinico-pathological data and follow-up data were complete. Multivariate Cox regression model was used to analyze the prognostic factors. Ovarian cancer tissue chips of patients in our hospital were prepared. EnVision two-step method immunohistochemistry was used to detect the protein expression levels of STAT3, the specific markers of CAF activation, fibroblast activating protein (FAP), and type Ⅰ collagen (COL1A1) secreted by CAF. The relationship between the expression of STAT3, FAP, COL1A1 protein and drug resistance and prognosis of ovarian cancer patients was analyzed, and the correlation between the expression of three proteins was analyzed. These results were verified through the gene expression and prognostic information of human ovarian cancer tissues collected in the GSE26712 dataset of gene expression omnibus (GEO) database. Results: (1) Multivariate Cox regression model analysis showed that chemotherapy resistance was an independent risk factor for overall survival (OS) of ovarian cancer (P<0.001). (2) The expression levels of STAT3, FAP, and COL1A1 proteins in chemotherapy resistant patients were significantly higher than those in chemotherapy sensitive patients (all P<0.05). Patients with high expression of STAT3, FAP, and COL1A1 had significantly shorter OS than those with low expression (all P<0.05). According to the human ovarian cancer GSE26712 dataset of GEO database, patients with high expression of STAT3, FAP, and COL1A1 also showed shorter OS than patients with low expression (all P<0.05), the verification results were consistent with the detection results of ovarian cancer patients in our hospital. (3) Correlation analysis showed that the protein level of STAT3 was positively correlated with FAP and COL1A1 in our hospital's ovarian cancer tissue chips (r=0.47, P<0.001; r=0.30, P=0.006), the analysis of GEO database GSE26712 dataset showed that the expression of STAT3 gene and FAP, COL1A1 gene were also significantly positively correlated (r=0.31, P<0.001; r=0.52, P<0.001). Conclusion: STAT3 and CAF could promote chemotherapy resistance of ovarian cancer and lead to poor prognosis.
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Affiliation(s)
- Y N Zhang
- Department of Gynecology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - B Li
- Department of Gynecology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Y Q Li
- Department of Gynecology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - S H Liu
- Department of Gynecology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - H Y Hou
- Department of Gynecology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - K Y Wang
- Department of Gynecology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - M Ao
- Department of Gynecology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Y Song
- Department of Pathology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
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10
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Wang KY, Luo M, Luo MJ, Chen Q, Liu XM, Zhu XY, Shi LX, Zhang Q. [A case of multiple endocrine neoplasia syndrome type 2A combined with autoimmune polyendocrine syndrome type Ⅲ]. Zhonghua Nei Ke Za Zhi 2023; 62:550-553. [PMID: 37096283 DOI: 10.3760/cma.j.cn112138-20221020-00769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Indexed: 04/26/2023]
Affiliation(s)
- K Y Wang
- Department of Endocrinology & Metabolism, Guiqian International General Hospital, Guiyang 550018, China
| | - M Luo
- Department of Endocrinology & Metabolism, Guiqian International General Hospital, Guiyang 550018, China
| | - M J Luo
- Department of Endocrinology & Metabolism, Guiqian International General Hospital, Guiyang 550018, China
| | - Q Chen
- Department of Endocrinology & Metabolism, Guiqian International General Hospital, Guiyang 550018, China
| | - X M Liu
- Department of Endocrinology & Metabolism, Guiqian International General Hospital, Guiyang 550018, China
| | - X Y Zhu
- Department of Pathology, Guiqian International General Hospital, Guiyang 550018, China
| | - L X Shi
- Department of Endocrinology & Metabolism, Guiqian International General Hospital, Guiyang 550018, China
| | - Q Zhang
- Department of Endocrinology & Metabolism, Guiqian International General Hospital, Guiyang 550018, China
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11
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Mo K, Mazzi J, Laljani R, Ortiz-Babilonia C, Wang KY, Raad M, Musharbash F, Farii HA, Lee SH. Laminectomy vs Fusion for Intradural Extramedullary Tumors. Int J Spine Surg 2023; 17:198-204. [PMID: 36977535 PMCID: PMC10165638 DOI: 10.14444/8430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/30/2023] Open
Abstract
BACKGROUND Laminectomy (LA) and LA with fusion (LAF) have been demonstrated as surgical techniques that treat intradural extramedullary tumors (IDEMTs). The purpose of the present study was to compare the rate of 30-day complications following LA vs LAF for IDEMTs. METHODS Patients undergoing LA for IDEMTs from 2012 to 2018 were identified in the National Surgical Quality Improvement Program database. Patients undergoing LA for IDEMTs were substratified into 2 cohorts: those who received LAF and those who did not. In this analysis, preoperative patient characteristics and demographic variables were assessed. 30-day wound, sepsis, cardiac, pulmonary, renal, and thromboembolic complications, as well as mortality, postoperative transfusions, extended length of stay, and reoperation, were assessed. Bivariate analyses, including χ 2 and t tests, and multivariable logistical regression were performed. RESULTS Of 2027 total patients undergoing LA for IDEMTs, 181 (9%) also had fusion. There were 72/373 (19%) LAF in the cervical region, 67/801 (8%) LAF in the thoracic region, and 42/776 (5%) LAF in the lumbar region. Following adjustment, patients who received LAF were more likely to have increased length of stay (OR 2.73, P < 0.001) and increased rate of postoperative transfusion (OR 3.15, P < 0.001). Patients undergoing LA in the cervical spine for IDEMTs tended to receive additional fusion (P < 0.001). CONCLUSIONS Increased length of stay and rate of postoperative transfusion were associated with LAF for IDEMTs. LA in the cervical spine for IDEMTs was associated with additional fusion. LEVEL OF EVIDENCE: 3
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Affiliation(s)
- Kevin Mo
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD, USA
| | - Jessica Mazzi
- Western University of Health Sciences, Pomona, CA, USA
| | - Rohan Laljani
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD, USA
| | | | - Kevin Y Wang
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD, USA
| | - Micheal Raad
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD, USA
| | - Farah Musharbash
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD, USA
| | - Humaid Al Farii
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD, USA
| | - Sang Hun Lee
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD, USA
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12
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Kreulen RT, Agarwal AR, Nayar SK, Wang KY, Miller AS, Best MJ, Srikumaran U. SLAP repair and bicep tenodesis: a comparison of utilization and revision rates for SLAP tears. JSES Int 2023; 7:290-295. [PMID: 36911775 PMCID: PMC9998736 DOI: 10.1016/j.jseint.2022.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Hypothesis The management of superior labrum anterior to posterior (SLAP) tears typically consists of either repair or biceps tenodesis (BT). While repair is more frequently recommended in younger patients, patients older than 40 years are often treated with BT. The purpose of this study is to determine whether there has been a change in utilization of these procedures over the past decade with respect to patient age as well as compare reoperation rates between the two procedures. Methods The Pearldiver database was queried to identify BT and SLAP repairs indicated for SLAP tears performed from 2010 to 2019. The primary outcome was utilization rate, stratified by age. A secondary outcome was 2-year shoulder reoperation rates. Trends were reported in terms of compounded annual growth rate. Outcome analysis was conducted using univariate and multivariable analysis. Results From 2010 to 2019, SLAP repair was the most common procedure performed for SLAP tears. Regardless of age, BT performed for SLAP tear had a significantly increased utilization rate; whereas, SLAP repair had a significantly decreased utilization rate. SLAP repair was more commonly performed in younger patients compared to BT. Following multivariable analysis, patients who underwent SLAP repair had significantly higher odds (odds ratio (OR): 1.453; 95% confidence interval (CI): 1.26-1.68; P < .001) of requiring an arthroscopic reoperation within 2 years when compared to those who underwent BT with no significant difference with respect to 2-year open reoperation. Conclusion Although SLAP repair is still more commonly used to treat SLAP tears than BT, especially for younger patients, the utilization of SLAP repair is decreasing while BT is increasing. The increased utilization of BT may be associated with lower rates of shoulder reoperation for problematic SLAP tears.
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Affiliation(s)
| | | | | | | | | | | | - Uma Srikumaran
- Johns Hopkins Hospital, Baltimore, MD, USA
- Corresponding author: Uma Srikumaran, MD, MBA, MPH, Johns Hopkins Orthopaedic Surgery at Howard County General Hospital, 10700 Charter Drive, Suite 310, Columbia, MD 21044, USA.
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13
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Wang KY, Puvanesarajah V, Suresh KV, Xu AL, Ficke JR, LaPorte D, Kebaish KM. Social Media Presence Is Associated With Diversity and Application Volume for Orthopedic Surgery Residency Programs. Orthopedics 2023; 46:47-53. [PMID: 36314878 DOI: 10.3928/01477447-20221024-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
The purpose of this study was to assess the association between social media presence (Twitter and Instagram), diversity in orthopedic surgery residency programs, and the number of applications received by a program. Data from Twitter and Instagram for 179 orthopedic residency programs accredited by the Accreditation Council for Graduate Medical Education were collected, including the presence of a social media account, date of first post, number of posts, and number of followers. Residency program data were collected from the Association of American Medical Colleges Residency Explorer Tool and included percentage of Whiteresidents, percentage of male residents, residency ranking, and number of applications submitted during the 2019 application cycle. Bivariate and multivariable analyses were performed with adjustment for program ranking. Of 179 residency programs, 34.6% (n=62) had Twitter, and 16.7% (n=30) had Instagram. Overall, 39.7% (n=71) had a social media presence, defined as having at least one of the two forms of social media. Programs with social media presences had higher average rankings (48.1 vs 99.6 rank, P<.001). After adjusting for program ranking, social media presence was associated with increased applications during the 2019 application cycle (odds ratio [OR]=2.76, P=.010). Social media presence was associated with increased odds of gender diversity (OR=3.07, P=.047) and racial diversity (OR=2.21, P=.041). Individually, Twitter presence was associated with increased odds of gender (OR=4.81, P=.018) and racial diversity (OR=4.00, P=.021), but Instagram was not (P>.05). Social media presence is associated with more residency program applications and increased resident diversity. Social media can be used to highlight inclusivity measures and related opportunities. [Orthopedics. 2023;46(1):47-53.].
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14
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Neuman BJ, Wang KY, Harris AB, Raad M, Hostin RA, Protopsaltis TS, Ames CP, Passias PG, Gupta MC, Klineberg EO, Hart R, Bess S, Kebaish KM. Return to work after adult spinal deformity surgery. Spine Deform 2023; 11:197-204. [PMID: 36219391 DOI: 10.1007/s43390-022-00552-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 07/02/2022] [Indexed: 10/17/2022]
Abstract
PURPOSE To determine the proportions of patients returning to work at various points after adult spinal deformity (ASD) surgery and the associations between surgical invasiveness and time to return to work. METHODS Using a multicenter database of patients treated surgically for ASD from 2008 to 2015, we identified 188 patients (mean age 51 ± 15 years) who self-reported as employed preoperatively and had 2-year follow-up. Per the ASD-Surgical and Radiographical Invasiveness Index (ASD-SR), 118 patients (63%) underwent high-invasiveness (HI) surgery (ASD-SR ≥ 100) and 70 (37%) had low-invasiveness (LI) surgery (ASD-SR < 100). Patients who self-reported ≥ 75% normal level of work/school activity were considered to be working full time. Chi-squared and Fisher exact tests were used to compare categorical variables (α = .05). RESULTS Preoperatively, 69% of employed patients worked full time. Postoperatively, 15% of employed patients were full time at 6 weeks, 70% at 6 months, 83% at 1 year, and 84% at 2 years. Percentage of employed patients working full time at 2 years was greater than preoperatively (p < .001); percentage of patients returning to full time at 6 weeks was lower in the HI (5%) than in the LI group (19%) (p = .03), a difference not significant at later points. CONCLUSIONS Most adults returned to full-time work after ASD surgery. A smaller percentage of patients in the HI group than in the LI group returned to full-time work at 6 weeks. Patients employed full time preoperatively will likely return to full-time employment after ASD surgery. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Brian J Neuman
- Department of Orthopaedic Surgery, The Johns Hopkins University, 601 N. Caroline Street, JHOC 5223, Baltimore, MD, 21287, USA
| | - Kevin Y Wang
- Department of Orthopaedic Surgery, The Johns Hopkins University, 601 N. Caroline Street, JHOC 5223, Baltimore, MD, 21287, USA
| | - Andrew B Harris
- Department of Orthopaedic Surgery, The Johns Hopkins University, 601 N. Caroline Street, JHOC 5223, Baltimore, MD, 21287, USA
| | - Micheal Raad
- Department of Orthopaedic Surgery, The Johns Hopkins University, 601 N. Caroline Street, JHOC 5223, Baltimore, MD, 21287, USA
| | - Richard A Hostin
- Department of Orthopaedic Surgery, Baylor Scoliosis Center, Plano, TX, USA
| | | | - Christopher P Ames
- Department of Neurologic Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Peter G Passias
- Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, NY, USA
| | - Munish C Gupta
- Department of Orthopaedic Surgery, Washington University, St. Louis, MO, USA
| | - Eric O Klineberg
- Department of Orthopaedic Surgery, University of California Davis School of Medicine, Sacramento, CA, USA
| | - Robert Hart
- Department of Orthopaedic Surgery, Oregon Health & Science University, Portland, OR, USA
| | - Shay Bess
- Department of Orthopaedic Surgery, Denver International Spine Center, Denver, CO, USA
| | - Khaled M Kebaish
- Department of Orthopaedic Surgery, The Johns Hopkins University, 601 N. Caroline Street, JHOC 5223, Baltimore, MD, 21287, USA.
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Wang KY, LaVelle MJ, Gazgalis A, Bender JM, Geller JA, Neuwirth AL, Cooper HJ, Shah RP. Bilateral Total Knee Arthroplasty: Current Concepts Review. JBJS Rev 2023; 11:01874474-202301000-00011. [PMID: 36722826 DOI: 10.2106/jbjs.rvw.22.00194] [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: 02/02/2023]
Abstract
» Bilateral total knee arthroplasty (BTKA) is an effective surgical treatment for bilateral knee arthritis and can be performed as a simultaneous surgery under a single anesthetic setting or as staged surgeries on separate days. » Appropriate patient selection is important for simultaneous BTKA with several factors coming into consideration such as age, comorbidities, work status, and home support, among others. » While simultaneous BTKA is safe when performed on appropriately selected patients, current evidence suggests that the risk of complications after simultaneous BTKA remains higher than for staged BTKA. » When staged surgery is preferred, current evidence indicates that complication risks are minimized if the 2 knees are staged at least 3 months apart. » Simultaneous BTKA is the economically advantageous treatment option relative to staged BTKA, primarily because of shorter total operative time and total hospital stay.
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Affiliation(s)
- Kevin Y Wang
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, New York
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16
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Sachdev R, Mo K, Wang KY, Zhang B, Musharbash FN, Vadhera A, Ochuba AJ, Kebaish KM, Skolasky RL, Neuman BJ. Preoperative patient activation predicts minimum clinically important difference for PROMIS pain and physical function in patients undergoing elective spine surgery. Spine J 2023; 23:85-91. [PMID: 36029964 DOI: 10.1016/j.spinee.2022.08.007] [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: 02/14/2022] [Revised: 07/21/2022] [Accepted: 08/17/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Patient activation is a patient's willingness to take independent actions to manage their own health care. PURPOSE The goal of this study is to determine whether preoperative patient activation measure (PAM) predicts minimum clinically important difference (MCID) for Patient-Reported Outcomes Measurement Information System (PROMIS) pain, physical function, depression, and anxiety for patients undergoing elective spine surgery. STUDY DESIGN/SETTING Retrospective review. PATIENT SAMPLE A single-institution, academic database of patients undergoing elective spine surgery. OUTCOME MEASURE MCID at 1-year follow-up for PROMIS pain, physical function, depression and anxiety. METHODS We retrospectively reviewed a single-institution, academic database of patients undergoing elective spine surgery. Preoperative patient activation was evaluated using the PAM-13 survey, which was used to stratify patients into four activation stages. Primary outcome variable was achieving MCID at 1-year follow-up for PROMIS pain and physical function. Multivariable logistic regression analysis was used to determine impact of patient activation on PROMIS pain and the physical function. RESULTS Of the 430 patients, 220 (51%) were female with a mean age of 58.2±16.8. Preoperatively, 34 (8%) were in activation stage 1, 45 (10%) in stage 2, 98 (23%) in stage 3, and 253 (59%) in stage 4. At 1-year follow up, 248 (58%) achieved MCID for PROMIS physical function, 256 (60%) achieved MCID for PROMIS pain, 151 (35.28%) achieved MCID for PROMIS depression, and 197 (46%) achieved MCID for PROMIS anxiety. For PROMIS physical function, when compared to patients at stage 1 activation, patients at stage 2 (aOR:3.49, 95% CI:1.27, 9.59), stage 3 (aOR:3.54, 95% CI:1.40, 8.98) and stage 4 (aOR:7.88, 95% CI:3.29, 18.9) were more likely to achieve MCID. For PROMIS pain, when compared against patients at stage 1, patients at stage 3 (aOR:2.82, 95% CI:1.18, 6.76) and stage 4 (aOR:5.44, 95% CI:2.41, 12.3) were more likely to achieve MCID. For PROMIS depression, when compared against patients at stage 1, patients at stage 4 were more likely to achieve MCID (Adjusted Odds Ratio (aOR):2.59, 95% CI:1.08-6.19). For PROMIS anxiety, when compared against patients at stage 1, stage 3 (Adjusted Odds Ratio (aOR):3.21, 95% CI:1.20-8.57), and stage 4 (aOR:5.56, 95% CI:2.20-14.01) were more likely to achieve MCID. CONCLUSION Patients at higher stages of activation were more likely to achieve MCID for PROMIS pain, physical function, depression, and anxiety at 1-year follow-up. Routine preoperative assessment of patient activation may help identify patients at risk of poor outcomes.
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Affiliation(s)
- Rahul Sachdev
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, 601 North Caroline Street JHOC 5241, Baltimore, MD 21287, USA
| | - Kevin Mo
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, 601 North Caroline Street JHOC 5241, Baltimore, MD 21287, USA
| | - Kevin Y Wang
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, 601 North Caroline Street JHOC 5241, Baltimore, MD 21287, USA
| | - Bo Zhang
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, 601 North Caroline Street JHOC 5241, Baltimore, MD 21287, USA
| | - Farah N Musharbash
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, 601 North Caroline Street JHOC 5241, Baltimore, MD 21287, USA
| | - Amar Vadhera
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, 601 North Caroline Street JHOC 5241, Baltimore, MD 21287, USA
| | - Arinze J Ochuba
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, 601 North Caroline Street JHOC 5241, Baltimore, MD 21287, USA
| | - Khaled M Kebaish
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, 601 North Caroline Street JHOC 5241, Baltimore, MD 21287, USA
| | - Richard L Skolasky
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, 601 North Caroline Street JHOC 5241, Baltimore, MD 21287, USA
| | - Brian J Neuman
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, 601 North Caroline Street JHOC 5241, Baltimore, MD 21287, USA.
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Wang KY, Shah P, Skavla B, Fayaaz F, Chi J, Rhodes JM. Vaccination efficacy in patients with chronic lymphocytic leukemia. Leuk Lymphoma 2023; 64:42-56. [PMID: 36270021 DOI: 10.1080/10428194.2022.2133538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Chronic lymphocytic leukemia (CLL) is a disorder of mature malignant B cells with multiple elements of immune dysfunction. Infections are common in CLL patients due to complex immunodeficiency. Vaccines are used as preventative measures for common diseases including influenza, pneumococcus, tetanus/diphtheria and shingles in the general population. Vaccines are utilized to mitigate this risk, although there have been some concerns regarding the efficacy of vaccines in the CLL population due to the inherent complex immune dysfunction associated with the disease. In this review, we describe the clinical and laboratory indicators for efficacy of the vaccines in the CLL population (including COVID-19, influenza, pneumonia, herpes zoster, and tetanus) and discuss immunization recommendations for patients with CLL.
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Affiliation(s)
- Kevin Y Wang
- Department of Internal Medicine, Northwell Health, Manhasset, NY, USA
| | - Pratik Shah
- Department of Internal Medicine, Northwell Health, Manhasset, NY, USA
| | - Brandon Skavla
- Department of Internal Medicine, Northwell Health, Manhasset, NY, USA
| | - Fatima Fayaaz
- Department of Hematology Oncology, Northwell Health, Manhasset, NY, USA
| | - Jeffrey Chi
- Department of Hematology Oncology, Northwell Health, Manhasset, NY, USA
| | - Joanna M Rhodes
- Department of Hematology Oncology, Northwell Health, Manhasset, NY, USA.,Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
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18
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Agarwal AR, Gu A, Wang KY, Harris AB, Campbell JC, Thakkar SC, Golladay GJ. Interval Time of at Least 6 Weeks Between Bilateral Total Knee Arthroplasties is Associated With Decreased Postoperative Complications. J Arthroplasty 2022; 38:1063-1069. [PMID: 36566996 DOI: 10.1016/j.arth.2022.12.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 12/17/2022] [Accepted: 12/18/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Staged, bilateral total knee arthroplasty (TKA) has an increased risk of complications if the second procedure is performed before physiologic recovery from the first. The aims of this study were to 1) determine whether there is a time-dependent relationship between TKA staging and rates of revisions and complications and 2) identify data-driven time intervals that reduce risk of revisions and complications. METHODS Data were collected from a national insurance database from 2015 to 2018. Staged intervals were initially assessed using fixed 6-week intervals. Stratum-specific likelihood ratio analyses were subsequently conducted to observe data-driven staging thresholds. Bivariate and multivariable regression analyses were conducted to determine the associations between the time intervals and 2-year rates of revision surgery and 90-day major complications. We included 25,527 patients undergoing staged bilateral TKA. RESULTS In comparison to the shortest fixed time interval (1-6 weeks), as the staging interval increased the odds of 2-year all-cause revision and 90-day major complications significantly decreased (P < .05 for all). Stratum-specific likelihood ratio analysis identified 3 data-driven staging categories 1-5, 6-17, and 18-24 weeks that maximized the difference in both 2-year rates of revision and 90-day major complications. CONCLUSION Our data showed a time-dependent relationship between the timing of TKA stages and complications. If staging is considered, a delayed interval of at least 6 weeks between procedures may significantly reduce revision and major complications. LEVEL OF EVIDENCE Level III Therapeutic Study.
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Affiliation(s)
- Amil R Agarwal
- Department of Orthopaedic Surgery, George Washington University Hospital, Washington, District of Columbia; Department of Orthopaedic Surgery, Adult Reconstruction Division, Johns Hopkins University, Columbia, Maryland
| | - Alex Gu
- Department of Orthopaedic Surgery, George Washington University Hospital, Washington, District of Columbia
| | - Kevin Y Wang
- Department of Orthopaedic Surgery, Adult Reconstruction Division, Johns Hopkins University, Columbia, Maryland
| | - Andrew B Harris
- Department of Orthopaedic Surgery, Adult Reconstruction Division, Johns Hopkins University, Columbia, Maryland
| | - Joshua C Campbell
- Department of Orthopaedic Surgery, George Washington University Hospital, Washington, District of Columbia
| | - Savyasachi C Thakkar
- Department of Orthopaedic Surgery, Adult Reconstruction Division, Johns Hopkins University, Columbia, Maryland
| | - Gregory J Golladay
- Department of Orthopedic Surgery, Virginal Commonwealth University Medical Center Orthopaedics, Richmond, Virginia
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Tufano-Sugarman AM, Wang KY, Kohn N, Ghaly M, Parashar B, Frank D, Kamdar D, Pereira L, Fantasia J, Seetharamu N. Osteoradionecrosis versus Cancer Recurrence: An Unresolved Clinical Dilemma. ORL J Otorhinolaryngol Relat Spec 2022; 85:28-35. [PMID: 36455537 DOI: 10.1159/000527261] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Accepted: 08/05/2022] [Indexed: 12/04/2022]
Abstract
INTRODUCTION Osteoradionecrosis is a rare and debilitating risk of definitive chemoradiotherapy for head and neck squamous cell carcinoma. It is difficult to distinguish between osteoradionecrosis and recurrent or progressive disease, as clinical and radiologic features may be similar. Our aim was to compare the clinical presentation and radiologic features of osteonecrosis with those of recurrent or progressive cancer. METHODS We conducted a single-center case series of 19 patients with head and neck squamous cell carcinoma diagnosed between 2011 and 2019 who subsequently developed clinical and/or radiological suspicion of osteoradionecrosis. The population was a referred sample from head and neck cancer physicians at Northwell Health Cancer Institute. Clinician notes and imaging reports were reviewed to assign a final diagnosis of either cancer, osteonecrosis, or indeterminate. RESULTS No differences were found in the clinical presentation or radiologic features between groups. Median time between treatment and development of symptoms was longer in patients with a final diagnosis of osteoradionecrosis than recurrent or progressive disease (5 vs. 3 months), but this difference was not statistically significant. Radiation dose and type were not associated with diagnosis. Mean standard uptake value maximums on positron emission tomography/computed tomography were significantly higher in the cancer group (median 14.8 vs. 9.1, p < 0.0152). At 1 year after first suspicion of osteoradionecrosis, 100% of osteoradionecrosis patients were alive, versus 28.6% of cancer patients. DISCUSSION/CONCLUSION There is significant overlap in clinical and radiologic features of osteoradionecrosis and cancer. Standard uptake maximums may be helpful in predicting diagnosis. Occurrence of symptoms within 6 months of completing chemoradiotherapy should raise the concern for malignancy.
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Affiliation(s)
- Andrea M Tufano-Sugarman
- Department of Hematology Oncology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York, USA
| | - Kevin Y Wang
- Department of Hematology Oncology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York, USA
| | - Nina Kohn
- Biostatistics Department, Feinstein Institutes for Medical Research, Manhasset, New York, USA
| | - Maged Ghaly
- Department of Hematology Oncology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York, USA
| | - Bhupesh Parashar
- Department of Hematology Oncology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York, USA
| | - Douglas Frank
- Department of Hematology Oncology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York, USA
| | - Dev Kamdar
- Department of Hematology Oncology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York, USA
| | - Lucio Pereira
- Department of Hematology Oncology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York, USA
| | - John Fantasia
- Department of Hematology Oncology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York, USA
| | - Nagashree Seetharamu
- Department of Hematology Oncology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York, USA
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20
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Liao GH, Cheng B, Yu HY, Wang KY, Hu WJ, Chen J. [A case of intramuscular injection of methomyl poisoning]. Zhonghua Lao Dong Wei Sheng Zhi Ye Bing Za Zhi 2022; 40:865-866. [PMID: 36510725 DOI: 10.3760/cma.j.cn121094-20220114-00019] [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: 12/15/2022]
Abstract
Methomyl is a carbamate insecticide widely used in pesticides. Most of the poisoning methods are through digestive tract, respiratory tract and skin contact. At present, there is no report of poisoning caused by intramuscular injection. A case of poisoning caused by intramuscular injection of methomyl was analyzed retrospectively. About 4 minutes later, cholinergic crisis and central inhibition occurred. Venovenous-Extracorporeal Membrane Oxygenation (VV-ECMO) and atropine were given quickly. Finally, the patient was successfully rescued and had a good prognosis. After intramuscular injection of methomyl, cholinergic crisis can occur rapidly, and the onset rate is significantly faster than that of digestive tract, respiratory tract and skin contact.
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Affiliation(s)
- G H Liao
- Department of Emergency, Second Affiliated Hospital of Nanchang University, Nanchang 330006, China
| | - B Cheng
- Department of Emergency, Second Affiliated Hospital of Nanchang University, Nanchang 330006, China
| | - H Y Yu
- Department of Emergency, Second Affiliated Hospital of Nanchang University, Nanchang 330006, China
| | - K Y Wang
- Department of Emergency, Second Affiliated Hospital of Nanchang University, Nanchang 330006, China
| | - W J Hu
- Department of Emergency, Second Affiliated Hospital of Nanchang University, Nanchang 330006, China
| | - J Chen
- Medical Imaging Department, Ji'an Central People's Hospital, Jian 343000, China
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21
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Harris AB, Wang KY, Reddy R, Agarwal AR, Rao SS, Golladay GJ, Thakkar SC. A Novel Method for Stratification of Major Complication Risk Using Body Mass Index Thresholds for Patients Undergoing Total Hip Arthroplasty: A National Cohort of 224,413 Patients. J Arthroplasty 2022; 37:2049-2052. [PMID: 35504445 DOI: 10.1016/j.arth.2022.04.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 04/09/2022] [Accepted: 04/22/2022] [Indexed: 02/02/2023] Open
Abstract
INTRODUCTION Elevated body mass index (BMI) is associated with complications following Total Hip Arthroplasty (THA). Since obese individuals are almost 10 times more likely to require THA compared to non-obese individuals, we need to understand the risk-benefit continuum while considering THA in obese patients. We aimed to determine data-driven thresholds for BMI at which the risk of major complications following THA increases significantly. METHODS Patients were identified in a national database who underwent primary THA from 2010 to 2020. BMI thresholds were identified using the stratum-specific likelihood ratio (SSLR) methodology, which is an adaptive technique that allows for identification of BMI cut-offs, at which the risk of major complications is increased significantly . BMI cutoffs identified using SSLR were used to create a logistic regression model. RESULTS A total of 224,413 patients were identified with a mean age of 66 ± 10, BMI 32 ± 6.7, and 7,186 (3%) sustained a major complication. BMI thresholds were defined as 19-31, 32-37, 38-49 and 50+. Overall, the absolute risk of major complications increased from 2.9% in the lowest BMI strata to 7.5% in the highest BMI strata. Compared to patients with a BMI between 19-31, the odds of sustaining a major complication sequentially increased by 1.2, 1.6, and 2.5-times for patients in each higher BMI strata (all, P < .05). CONCLUSIONS We have identified BMI cutoffs using SSLR that categorizes patients into four categories of risk for major complications in a nationally representative patient sample. These thresholds can be used in the surgical decision-making process between patients and surgeons.
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Affiliation(s)
- Andrew B Harris
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, Maryland; Orthopaedic Research Collaborative (ORC)
| | - Kevin Y Wang
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, Maryland; Orthopaedic Research Collaborative (ORC)
| | - Rohan Reddy
- Orthopaedic Research Collaborative (ORC); The Johns Hopkins University, Baltimore, Maryland
| | - Amil R Agarwal
- Orthopaedic Research Collaborative (ORC); Department of Orthopaedic Surgery, The George Washington University, Washington, District of Columbia
| | - Sandesh S Rao
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, Maryland; Orthopaedic Research Collaborative (ORC)
| | - Gregory J Golladay
- Orthopaedic Research Collaborative (ORC); Departrment of Orthopaedic Surgery, Virginia Commonwealth University
| | - Savyasachi C Thakkar
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, Maryland; Orthopaedic Research Collaborative (ORC)
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22
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Hao X, Deng SY, Wang KY, Chen L, Hou JL, Wei WW, Chen J. [Application of liquid biopsy in early screening and recurrence prediction of hepatocellular carcinoma]. Zhonghua Gan Zang Bing Za Zhi 2022; 30:814-819. [PMID: 36207938 DOI: 10.3760/cma.j.cn501113-20220627-00352] [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: 06/16/2023]
Abstract
The incidence and mortality of HCC in China account for approximately 50% of all cases worldwide. Low early diagnosis rate and high postoperative recurrence rate are two major causes for poor 5-year survival rate of HCC patients in China. At present, multiple problems such as low performance and compliance of screening technology and lack of effective markers for predicting postoperative recurrence, remain to be resolved. Due to the simplicity and accuracy, new molecular markers, such as liquid biopsy, are expected to serve as supplementary tools to traditional screening and early warning approaches, thereby realizing early detection and accurate treatment of HCC. In this article, research progress upon the clinical application of liquid biopsy in early screening and prediction of postoperative recurrence of HCC was reviewed, and prospects the future research.
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Affiliation(s)
- X Hao
- Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, State Key Laboratory of Organ Failure Research, Guangdong Provincial Key Laboratory of Viral Hepatitis Research, Guangdong Provincial Institute of Liver Diseases, Guangzhou 510515, China
| | - S Y Deng
- Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, State Key Laboratory of Organ Failure Research, Guangdong Provincial Key Laboratory of Viral Hepatitis Research, Guangdong Provincial Institute of Liver Diseases, Guangzhou 510515, China
| | - K Y Wang
- Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, State Key Laboratory of Organ Failure Research, Guangdong Provincial Key Laboratory of Viral Hepatitis Research, Guangdong Provincial Institute of Liver Diseases, Guangzhou 510515, China
| | - L Chen
- National Center for liver Cancer/Eastern Hepatobiliary Surgery Hospital, Navy Medical University, Shanghai 200433,China
| | - J L Hou
- Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, State Key Laboratory of Organ Failure Research, Guangdong Provincial Key Laboratory of Viral Hepatitis Research, Guangdong Provincial Institute of Liver Diseases, Guangzhou 510515, China
| | - W W Wei
- Medical Affairs Department, Berry Oncology Clinical Laboratory, Fuzhou 350200, China
| | - Jinzhang Chen
- Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, State Key Laboratory of Organ Failure Research, Guangdong Provincial Key Laboratory of Viral Hepatitis Research, Guangdong Provincial Institute of Liver Diseases, Guangzhou 510515, China
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23
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Jin M, Zhong XM, Zhu HJ, Ning MJ, Wang KY, Yao LM, Guo XY, Shi X. [Two children of autoimmune enteropathy]. Zhonghua Er Ke Za Zhi 2022; 60:596-597. [PMID: 35658370 DOI: 10.3760/cma.j.cn112140-20211027-00909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Affiliation(s)
- M Jin
- Department of Gastroenterology Medicine, Children's Hospital,Capital Institute of Pediatrics, Beijing 100020, China
| | - X M Zhong
- Department of Gastroenterology Medicine, Children's Hospital,Capital Institute of Pediatrics, Beijing 100020, China
| | - H J Zhu
- Department of Gastroenterology Medicine, Children's Hospital,Capital Institute of Pediatrics, Beijing 100020, China
| | - M J Ning
- Department of Gastroenterology Medicine, Children's Hospital,Capital Institute of Pediatrics, Beijing 100020, China
| | - K Y Wang
- Department of Gastroenterology Medicine, Children's Hospital,Capital Institute of Pediatrics, Beijing 100020, China
| | - L M Yao
- Department of Gastroenterology Medicine, Children's Hospital,Capital Institute of Pediatrics, Beijing 100020, China
| | - X Y Guo
- Department of Pathology, Peking University Third Hospital, Beijing 100081, China
| | - Xueying Shi
- Department of Pathology, Peking University Third Hospital, Beijing 100081, China
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LiBrizzi CL, Rao SS, Wang KY, Levin AS, Morris CD. Survey of sarcoma surgery principles among orthopaedic oncologists. Surg Oncol 2022; 42:101782. [DOI: 10.1016/j.suronc.2022.101782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 04/26/2022] [Accepted: 05/07/2022] [Indexed: 10/18/2022]
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Wang KY, Puvanesarajah V, Xu A, Zhang B, Raad M, Hassanzadeh H, Kebaish KM. Growing Racial Disparities in the Utilization of Adult Spinal Deformity Surgery: An Analysis of Trends From 2004 to 2014. Spine (Phila Pa 1976) 2022; 47:E283-E289. [PMID: 34405826 DOI: 10.1097/brs.0000000000004180] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [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: 02/01/2023]
Abstract
STUDY DESIGN Retrospective. OBJECTIVE The purpose of this study was to assess trends in utilization rates of adult spinal deformity (ASD) surgery, as well as perioperative surgical metrics between Black and White patients undergoing operative treatment for ASD in the United States. SUMMARY OF BACKGROUND DATA Racial disparities in access to care, complications, and surgical selection have been shown to exist in the field of spine surgery. However, there is a paucity of data concerning racial disparities in the management of ASD patients. METHODS Adult patients undergoing ASD surgery from 2004 to 2014 were identified in the nationwide inpatient sample (NIS). Utilization rates, major complications rates, and length of stay (LOS) for Black patients and White patients were trended over time. Utilization rates were reported per 1,000,000 people and determined using annual census data among subpopulations stratified by race. All reported complication rates and prolonged hospital stay rates are adjusted for Elixhauser Comorbidity Index, income quartile by zip code, and insurance payer status. RESULTS From 2004 to 2014, ASD utilization for Black patients increased from 24.0 to 50.9 per 1,000,000 people, whereas ASD utilization for White patients increased from 29.9 to 73.1 per 1,000,000 people, indicating a significant increase in racial disparities in ASD utilization (P-trend < 0.001). There were no significant differences in complication rates or rates of prolonged hospital stay between Black and White patients across the time period studied (P > 0.05 for both). CONCLUSION Although Black and White patients undergoing ASD surgery do not differ significantly in terms of postoperative complications and length of hospital stay, there is a growing disparity in utilization of ASD surgery between White and Black patients from 2004 to 2014 in the United States. There is need for continued focus on identifying ways to reduce racial disparities in surgical selection and perioperative management in spine deformity surgery.Level of Evidence: 3.
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Affiliation(s)
- Kevin Y Wang
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD
| | - Varun Puvanesarajah
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD
| | - Amy Xu
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD
| | - Bo Zhang
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD
| | - Micheal Raad
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD
| | - Hamid Hassanzadeh
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA
| | - Khaled M Kebaish
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD
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Wang KY, Agarwal AR, Xu AL, Best MJ, Kreulen RT, Jami M, McFarland EG, Srikumaran U. Increased Risk of Surgical-Site Infection and Need for Manipulation Under Anesthesia for Those Who Undergo Open Versus Arthroscopic Rotator Cuff Repair. Arthrosc Sports Med Rehabil 2022; 4:e527-e533. [PMID: 35494279 PMCID: PMC9042754 DOI: 10.1016/j.asmr.2021.11.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 11/13/2021] [Indexed: 11/19/2022] Open
Abstract
Purpose Methods Results Conclusions Level of Evidence
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Affiliation(s)
- Kevin Y. Wang
- Department of Orthopaedic Surgery, Johns Hopkins, Columbia, Maryland, U.S.A
| | - Amil R. Agarwal
- Department of Orthopaedic Surgery, George Washington School of Medicine and Health Sciences, Washington DC, U.S.A
| | - Amy L. Xu
- Department of Orthopaedic Surgery, Johns Hopkins, Columbia, Maryland, U.S.A
| | - Matthew J. Best
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts, U.S.A
| | - R. Timothy Kreulen
- Department of Orthopaedic Surgery, Johns Hopkins, Columbia, Maryland, U.S.A
| | - Meghana Jami
- Department of Orthopaedic Surgery, Johns Hopkins, Columbia, Maryland, U.S.A
| | | | - Uma Srikumaran
- Department of Orthopaedic Surgery, Johns Hopkins, Columbia, Maryland, U.S.A
- Address correspondence to Uma Srikumaran, M.D., M.B.A., M.P.H., Department of Orthopaedic Surgery, Adult Reconstruction Division, Johns Hopkins, 10700 Charter Dr., Suite 205, Columbia, MD 21044.
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27
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Shu HF, Wang KY, Liu SL, Zhang M, Song T. [Progress in prevention and control of Nipah virus disease]. Zhonghua Liu Xing Bing Xue Za Zhi 2022; 43:286-291. [PMID: 35184498 DOI: 10.3760/cma.j.cn112338-20210706-00529] [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: 06/14/2023]
Abstract
Nipah virus disease (NVD) is a newly emerged zoonosis with a case fatality rate of 40%-75%. NVD is a severe threat to human health and the development of livestock farming. NVD has become one of the emerging infectious diseases with great concern globally during more than 20 years. Nipah virus (NiV) is a pathogen for NVD, the natural host of which is Fruit bats of the Pteropodidae family. The clinical spectrum of NiV infection is broad, including asymptomatic infection, acute respiratory infection, fatal encephalitis, and even death. Since NiV was first identified in Malaysia in 1999, it has been prevalent mainly in Southeast Asia and South Asia. NiV is primarily transmitted to humans through bat-pig-human, contaminated food. Currently, there are no specific therapeutic drugs and vaccines for NVD. Although there are no cases of NVD reported in China, which has close personnel and trade exchanges with major NVD-endemic countries, and NiV antibody has also been detected in relevant bats. There is a potential risk of importing NVD and domestic outbreaks in the future in this country. This paper provides a systematic review of the research progress in the prevention and control of NVD etiology, epidemiology, clinical manifestations and laboratory diagnosis to help relevant staff to understand NVD more comprehensively and systematically.
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Affiliation(s)
- H F Shu
- School of Public Health, Guangdong Pharmaceutical University, Guangzhou 510315, China
| | - K Y Wang
- School of Public Health, Guangdong Pharmaceutical University, Guangzhou 510315, China
| | - S L Liu
- Department of Communicable Disease Control and Prevention, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou 310051, China
| | - M Zhang
- Institute for Communicable Disease Control and Prevention, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou 511430, China
| | - T Song
- Guangdong Provincial Center for Disease Control and Prevention, Guangzhou 511430, China
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Wang KY, Puvanesarajah V, Raad M, Barry K, Srikumaran U, Thakkar SC. The BTK Safety Score: A Novel Scoring System for Risk Stratifying Patients Undergoing Simultaneous Bilateral Total Knee Arthroplasty. J Knee Surg 2022; 36:702-709. [PMID: 34979584 DOI: 10.1055/s-0041-1741000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Selection of appropriate candidates for simultaneous bilateral total knee arthroplasty (si-BTKA) is crucial for minimizing postoperative complications. The aim of this study was to develop a scoring system for identifying patients who may be appropriate for si-BTKA. Patients who underwent si-BTKA were identified in the National Surgical Quality Improvement Program database. Patients who experienced a major 30-day complication were identified as high-risk patients for si-BTKA who potentially would have benefitted from staged bilateral total knee arthroplasty. Major complications included deep wound infection, pneumonia, renal insufficiency or failure, cerebrovascular accident, cardiac arrest, myocardial infarction, pulmonary embolism, sepsis, or death. The predictive model was trained using randomly split 70% of the dataset and validated on the remaining 30%. The scoring system was compared against the American Society of Anesthesiologists (ASA) score, the Charlson Comorbidity Index (CCI), and legacy risk-stratification measures, using area under the curve (AUC) statistic. Total 4,630 patients undergoing si-BTKA were included in our cohort. In our model, patients are assigned points based on the following risk factors: +1 for age ≥ 75, +2 for age ≥ 82, +1 for body mass index (BMI) ≥ 34, +2 for BMI ≥ 42, +1 for hypertension requiring medication, +1 for pulmonary disease (chronic obstructive pulmonary disease or dyspnea), and +3 for end-stage renal disease. The scoring system exhibited an AUC of 0.816, which was significantly higher than the AUC of ASA (0.545; p < 0.001) and CCI (0.599; p < 0.001). The BTK Safety Score developed and validated in our study can be used by surgeons and perioperative teams to risk stratify patients undergoing si-BTKA. Future work is needed to assess this scoring system's ability to predict long-term functional outcomes.
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Affiliation(s)
- Kevin Y Wang
- Department of Orthopedic Surgery, The Johns Hopkins University, Baltimore, Maryland
| | - Varun Puvanesarajah
- Department of Orthopedic Surgery, The Johns Hopkins University, Baltimore, Maryland
| | - Micheal Raad
- Department of Orthopedic Surgery, The Johns Hopkins University, Baltimore, Maryland
| | - Kawsu Barry
- Department of Orthopedic Surgery, The Johns Hopkins University, Baltimore, Maryland
| | - Umasuthan Srikumaran
- Department of Orthopedic Surgery, The Johns Hopkins University, Baltimore, Maryland
| | - Savyasachi C Thakkar
- Department of Orthopedic Surgery, The Johns Hopkins University, Baltimore, Maryland
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Pollard TG, Wang KY, Fassihi SC, Gu A, Farley B, Ramamurti P, DeBritz JN, Golladay G, Thakkar SC. Does Prior Lumbar Fusion Influence Dislocation Risk in Hip Arthroplasty Performed for Femoral Neck Fracture? J Arthroplasty 2022; 37:62-68. [PMID: 34592357 DOI: 10.1016/j.arth.2021.09.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 08/04/2021] [Revised: 09/08/2021] [Accepted: 09/21/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Immobility of the lumbar spine predicts instability following elective total hip arthroplasty (THA). The purpose of this study is to determine how prior lumbar fusion (LF) influenced dislocation rates and revision rates for patients undergoing THA or hemiarthroplasty (HA) for femoral neck fracture (FNF). METHODS A retrospective cohort analysis was conducted utilizing the PearlDiver database from 2010 to 2018. Patients who underwent arthroplasty for FNF were identified based on history of LF and whether they underwent THA or HA. Univariate and multivariate analyses were performed. RESULTS A total of 328 patients with prior LF and FNF who underwent THA were at increased risk for 1-year dislocation (odds ratio [OR] 2.19, P < .001) and 2-year revision (OR 2.22, P < .001) compared to 14,217 patients without LF. The 461 patients with prior LF and FNF who underwent HA were at increased risk for dislocation (OR 2.22, P < .001) compared to 42,327 patients without LF. Patients with prior LF and FNF who underwent THA had higher rates of revision than patients with prior LF who underwent HA for FNF (OR 2.11, P < .001). In patients with prior LF and FNF, THA was associated with significantly increased risk for dislocation (OR 3.07, P < .001) and revision (OR 2.53, P < .001) compared to THA performed for osteoarthritis. CONCLUSION Patients with prior LF who sustained an FNF and underwent THA or HA were at increased risk for early dislocation and revision compared to those without prior LF. This risk of dislocation and revision is even greater than that observed in patients with prior LF who underwent THA for osteoarthritis. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Tom G Pollard
- Department of Orthopedic Surgery, George Washington University, Washington, DC
| | - Kevin Y Wang
- Johns Hopkins, Department of Orthopaedic Surgery, Adult Reconstruction Division, Columbia, MD
| | - Safa C Fassihi
- Department of Orthopedic Surgery, George Washington University, Washington, DC
| | - Alex Gu
- Department of Orthopedic Surgery, George Washington University, Washington, DC
| | - Benjamin Farley
- Department of Orthopedic Surgery, George Washington University, Washington, DC
| | - Pradip Ramamurti
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville VA, USA
| | - James N DeBritz
- Department of Orthopedic Surgery, George Washington University, Washington, DC
| | - Gregory Golladay
- Department of Orthopaedic Surgery, Virginia Commonwealth University, Richmond, VA, USA
| | - Savyasachi C Thakkar
- Johns Hopkins, Department of Orthopaedic Surgery, Adult Reconstruction Division, Columbia, MD
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Suresh KV, Karius A, Wang KY, Sadowsky C, Sponseller PD. Scoliosis in Pediatric Patients With Acute Flaccid Myelitis. Top Spinal Cord Inj Rehabil 2022; 28:34-41. [PMID: 35145333 PMCID: PMC8791420 DOI: 10.46292/sci21-00017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Acute flaccid myelitis (AFM) is an anterior horn disorder that manifests as rapid onset muscle weakness or paralysis. Development of scoliosis in pediatric AFM patients has been anecdotally reported, but associated risk factors or incidence have yet to be determined. METHODS Pediatric AFM patients treated over a 10-year period at a tertiary care center were identified. Patients were considered to have scoliosis if there was radiographic evidence of coronal curvature ≥15 degrees. Number of limbs affected, independent ambulation and head control, ventilator requirement at initial admission, and long-term ventilatory support (≥1 year) were recorded. Muscle strength and functional status were assessed by manual muscle testing (MMT) and Physical Abilities and Mobility Scale (PAMS), respectively. Areas of spinal cord lesion on initial MRI were recorded. Bivariate analyses were performed, with alpha set to 0.05. RESULTS Fifty-six AFM patients (27 scoliosis, 29 no scoliosis) were identified. Mean time from AFM presentation to scoliosis diagnosis was 0.93 years. Mean major Cobb angle at first radiograph was 31.7 ± 14.3 degrees. Lack of independent ambulation, ventilator dependence at time of admission or long term, number of limbs affected, and decreased MMT and PAMS scores were more common in patients who developed scoliosis (all, p < .05). Patients who developed scoliosis had more extensive thoracic spinal cord involvement on initial MRI (p = .03). CONCLUSION AFM patients who develop scoliosis are more likely to be ventilator dependent, lack independent ambulation, and have more extensive thoracic SCI.
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Affiliation(s)
- Krishna V. Suresh
- Department of Orthopaedic Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Alexander Karius
- Department of Orthopaedic Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Kevin Y. Wang
- Department of Orthopaedic Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Cristina Sadowsky
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, Maryland
,International Center for Spinal Cord Injury, Kennedy Krieger Institute, Baltimore, Maryland
| | - Paul D. Sponseller
- Department of Orthopaedic Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Raad M, Puvanesarajah V, Wang KY, McDaniel CM, Srikumaran U, Levin AS, Morris CD. Do Disparities in Wait Times to Operative Fixation for Pathologic Fractures of the Long Bones and 30-day Complications Exist Between Black and White Patients? A Study Using the NSQIP Database. Clin Orthop Relat Res 2022; 480:57-63. [PMID: 34356036 PMCID: PMC8673988 DOI: 10.1097/corr.0000000000001908] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 06/30/2021] [Indexed: 01/31/2023]
Abstract
BACKGROUND Racial disparities in outcomes after orthopaedic surgery have been well-documented in the fields of arthroplasty, trauma, and spine surgery; however, little research has assessed differences in outcomes after surgery for oncologic musculoskeletal disease. If racial disparities exist in the treatment of patients with pathologic long bone fractures, then they should be identified and addressed to promote equity in patient care. QUESTIONS/PURPOSES (1) How do wait times between hospital admission and operative fixation for pathologic fractures of long bones differ between Black and non-Hispanic white patients, after controlling for confounding variables using propensity score matching? (2) How does the proportion of patients with 30-day postoperative complication differ between these groups after controlling for confounding variables using propensity score matching? METHODS Using the National Surgical Quality Improvement Program database, we analyzed 828 patients who underwent fixation for pathologic fractures from 2012 to 2018. This database not only provides a large enough sample of pathologic long bone fracture patients to conduct the present study, but also it contains variables such as time from hospitalization to surgery that other national databases do not. After excluding patients with incomplete data (4% of the initial cohort), 775 patients were grouped by self-reported race as Black (12% [94]) or white (88% [681]). Propensity score matching using a 1:1 nearest-neighbor match was then used to match 94 Black patients with 94 white patients according to age, gender, BMI, American Society of Anesthesiologists physical status classification, anemia, endstage renal disease, independence in performing activities of daily living, congestive heart failure, and pulmonary disease. The primary outcome of interest was the number of days between hospital admission and operative fixation, which we assessed using a Poisson regression and report as an incidence risk ratio. The secondary outcomes were the occurrences of major 30-day postoperative adverse events (failure to wean off mechanical ventilation, cerebrovascular events, renal failure, cardiovascular events, reoperation, death), minor 30-day adverse events (reintubation, wound complications, pneumonia, and thromboembolic events), and any 30-day adverse events (defined as the pooling of all adverse events, including readmissions). These outcomes were analyzed using a bivariate analysis and logistic regression with robust estimates of variance and are reported as odds ratios. Because any results on disparities rely on rigorous control of other baseline demographics, we performed this multivariable approach to ensure we were controlling for confounding variables as much as possible. RESULTS After controlling for potentially confounding variables such as age and gender, we found that Black patients had a longer mean wait time (incidence risk ratio 1.5 [95% CI 1.1 to 2.1]; p = 0.01) than white patients. After controlling for confounding variables, Black patients also had greater odds of having any postoperative adverse event (OR 2.1 [95% CI 1.1 to 3.8]; p = 0.02), including readmission (OR 3.3 [95% CI 1.5 to 7.6]; p = 0.004). CONCLUSION The racial disparities in pathologic long bone fracture care found in our study may be attributed to fundamental racial biases, as well as systemic socioeconomic disparities in the US healthcare system. Identifying and eliminating the racial, socioeconomic, and sociocultural biases that drive these disparities would improve care for patients with orthopaedic oncologic conditions. One possible way to reduce these disparities would be to implement standardized surgical care pathways for pathological long bone fractures across different institutions to minimize variation in important aspects of care, such as time to surgical fixation. Further insight is needed on the types of standardized care pathways and the implementation mechanisms that are most effective. LEVEL OF EVIDENCE Level III, therapeutic study.
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Affiliation(s)
- Micheal Raad
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD, USA
| | - Varun Puvanesarajah
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD, USA
| | - Kevin Y. Wang
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD, USA
| | - Claire M. McDaniel
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD, USA
| | - Uma Srikumaran
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD, USA
| | - Adam S. Levin
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD, USA
- Department of Oncology, The Johns Hopkins University, Baltimore, MD, USA
| | - Carol D. Morris
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD, USA
- Department of Oncology, The Johns Hopkins University, Baltimore, MD, USA
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Fassihi SC, Mathur A, Best MJ, Chen AZ, Gu A, Quan T, Wang KY, Wei C, Campbell JC, Thakkar SC. Neural network prediction of 30-day mortality following primary total hip arthroplasty. J Orthop 2021; 28:91-95. [PMID: 34898926 DOI: 10.1016/j.jor.2021.11.013] [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: 08/11/2021] [Accepted: 11/21/2021] [Indexed: 11/18/2022] Open
Abstract
Purpose The purpose is to utilize an artificial neural network (ANN) model to determine the most important variables in predicting mortality following total hip arthroplasty (THA). Methods Patients that underwent primary THA were included from a national database. Demographic, preoperative, and intraoperative variables were analyzed based on their contribution to 30-day mortality with the use of an ANN model. Results The five most important factors in predicting mortality following THA were preoperative international normalized ratio, age, body mass index, operative time, and preoperative hematocrit. Conclusion ANN modeling represents a novel approach to determining perioperative factors that predict mortality following THA.
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Affiliation(s)
- Safa C Fassihi
- Department of Orthopedic Surgery, George Washington Hospital, 2300 M St NW, Washington, DC, 20037, USA
| | - Abhay Mathur
- Department of Orthopedic Surgery, George Washington Hospital, 2300 M St NW, Washington, DC, 20037, USA
| | - Matthew J Best
- Johns Hopkins Department of Orthopaedic Surgery, Adult Reconstruction Division, 10700 Charter Drive, Suite 205, Columbia, MD, 21044, USA
| | - Aaron Z Chen
- Weill Cornell Medical College, 1300 York Avenue, New York, NY, 10021, USA
| | - Alex Gu
- Department of Orthopedic Surgery, George Washington Hospital, 2300 M St NW, Washington, DC, 20037, USA
| | - Theodore Quan
- Department of Orthopedic Surgery, George Washington Hospital, 2300 M St NW, Washington, DC, 20037, USA
| | - Kevin Y Wang
- Johns Hopkins Department of Orthopaedic Surgery, Adult Reconstruction Division, 10700 Charter Drive, Suite 205, Columbia, MD, 21044, USA
| | - Chapman Wei
- Department of Orthopedic Surgery, George Washington Hospital, 2300 M St NW, Washington, DC, 20037, USA
| | - Joshua C Campbell
- Department of Orthopedic Surgery, George Washington Hospital, 2300 M St NW, Washington, DC, 20037, USA
| | - Savyasachi C Thakkar
- Johns Hopkins Department of Orthopaedic Surgery, Adult Reconstruction Division, 10700 Charter Drive, Suite 205, Columbia, MD, 21044, USA
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Wang KY, McNeely EL, Dhanjani SA, Raad M, Puvanesarajah V, Neuman BJ, Cohen D, Khanna AJ, Kebaish F, Hassanzadeh H, Kebaish KM. COVID-19 Significantly Impacted Hospital Length of Stay and Discharge Patterns for Adult Spinal Deformity Patients. Spine (Phila Pa 1976) 2021; 46:1551-1556. [PMID: 34431833 PMCID: PMC8552912 DOI: 10.1097/brs.0000000000004204] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 07/03/2021] [Accepted: 07/21/2021] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective review. OBJECTIVE The primary aim was to compare length of stay (LOS) and discharge disposition of adult spinal deformity (ASD) patients undergoing surgery before and during the pandemic. Secondary aims were to compare the rates of 30-day complications, reoperations, readmissions, and unplanned emergency department (ED) visits. SUMMARY OF BACKGROUND DATA ASD patients often require extended LOS and non-routine discharge. Given resource limitations during the Coronavirus Disease 2019 (COVID-19) pandemic and caution regarding hospital stays, surgeons modified standard postoperative protocols to minimize patient exposure. METHODS We identified all patients who underwent elective thoracolumbar ASD surgery with more than or equal to five levels fusion at a tertiary care center during two distinct time intervals: July to December 2019 (Pre-COVID, N = 60) and July to December 2020 (During-COVID, N = 57). Outcome measures included LOS and discharge disposition (home vs. non-home), as well as 30-day major complications, reoperations, readmissions, and ED visits. Regression analyses controlled for demographic and surgical factors. RESULTS Patients who underwent ASD surgery during the pandemic were younger (61 vs. 67 yrs) and had longer fusion constructs (nine vs. eight levels) compared with before the pandemic (P < 0.05 for both). On bivariate analysis, patients undergoing surgery during the pandemic had shorter LOS (6 vs. 9 days) and were more likely to be discharged home (70% vs. 28%) (P < 0.05 for both). After controlling for age and levels fused on multivariable regression, patients who had surgery during the pandemic had shorter LOS (IRR = 0.83, P = 0.015) and greater odds of home discharge (odds ratios [OR] = 7.2, P < 0.001). Notably, there were no differences in major complications, reoperations, readmissions, or ED visits between the two groups. CONCLUSION During the COVID-19 pandemic, LOS for patients undergoing thoracolumbar ASD surgery decreased, and more patients were discharged home without adversely affecting complication or readmission rates. Lessons learned during the pandemic may help improve resource utilization without negatively influencing short-term outcomes.Level of Evidence: 3.
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Affiliation(s)
- Kevin Y Wang
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD
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Bian Y, Miao Y, Wang KY, Jia SS, Zhong XL, Qiu F. [Analysis of characteristics of collateral circulation pathways in dizziness patients caused by severe bilateral vertebral artery stenosis/occlusion]. Zhonghua Yi Xue Za Zhi 2021; 101:3244-3247. [PMID: 34689538 DOI: 10.3760/cma.j.cn112137-20210325-00743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The clinical data of 47 patients [41 males, 6 females, aged (62±7) years] treated at the Department of Neurology of the Sixth Medical Center of PLA General Hospital from October 2018 to October 2020 who were diagnosed with severe bilateral vertebral artery stenosis/occlusion through Digital Subtraction Angiography (DSA) were retrospectively collected, and the characteristics of the compensatory pathways of collateral circulation were determined. Results showed that there were 8 intracranial and extracranial compensatory pathways, with posterior communicating artery as the major type (21 cases) for intracranial ones and deep carotid artery as the major type (16 cases) for extracranial ones. As the establishment of the compensatory pathway is closely related to the lesion site, DSA assessment for patients with severe bilateral vertebral artery stenosis/occlusion is helpful for clinicians to make judgement on prognosis of patients and choose individualized treatment plans.
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Affiliation(s)
- Y Bian
- Department of Neurology, the 6th Medical Center of PLA General Hospital, Beijing 100048, China
| | - Y Miao
- Department of Neurology, the 6th Medical Center of PLA General Hospital, Beijing 100048, China
| | - K Y Wang
- Department of Neurology, the 6th Medical Center of PLA General Hospital, Beijing 100048, China
| | - S S Jia
- Department of Neurology, the 6th Medical Center of PLA General Hospital, Beijing 100048, China
| | - X L Zhong
- Department of Neurology, the 6th Medical Center of PLA General Hospital, Beijing 100048, China
| | - F Qiu
- Department of Neurology, the 6th Medical Center of PLA General Hospital, Beijing 100048, China
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Wang KY, Suresh KV, Mo K, Harris AB, Marrache M, Kebaish KM. Preoperative Hyponatremia is an Independent Risk Factor for Prolonged Hospital Stay Following Anterior Cervical Discectomy and Fusion. World Neurosurg 2021; 161:e18-e24. [PMID: 34688933 DOI: 10.1016/j.wneu.2021.10.125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Revised: 10/14/2021] [Accepted: 10/15/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To determine the effects of preoperative hyponatremia on short-term postoperative complications and healthcare utilization (length of stay, readmissions) following anterior cervical fusion and discectomy (ACDF). METHODS Patients who underwent ACDF were identified in the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database. Patients who had revision surgery, trauma, vertebral malignancy, or infection were excluded. Eunatremia was defined as sodium (Na) level between 135 and 145 mEq/L, whereas hyponatremia was defined as Na < 135 mEq/L. Preoperatively hyponatremic patients were matched 1:1 with eunatremic patients using propensity-score matching based upon age, gender, American Society of Anesthesiology (ASA) score, and baseline comorbidities. Minor adverse events included superficial infection, dehiscence, urinary tract infection, pneumonia, and renal insufficiency or failure. Serious adverse events included deep wound infection, reintubation, pulmonary embolism, cerebrovascular accident, cardiac arrest, deep vein thrombosis, sepsis, return to operating room, and death within 30 days. Complications were analyzed using bivariate and logistic analysis with significance set at p<0.05. RESULTS Of the 9,094 patients undergoing ACDF, 3.64% (331 patients) were preoperatively hyponatremic. Preoperative hyponatremia was an independent risk factor for postoperative pneumonia following ACDF (OR=4.47; p=0.020) as well as extended length of hospital stay greater than one standard deviation above the mean (OR=1.71; p=0.042). Preoperative hyponatremia was an independent risk factor for having a serious adverse event (OR=2.40; p=0.005), as well as any adverse event (OR=2.44; p=0.009). CONCLUSION Preoperative hyponatremia is an independent risk factor for pneumonia and prolonged length of stay following ACDF.
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Affiliation(s)
- Kevin Y Wang
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD
| | - Krishna V Suresh
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD
| | - Kevin Mo
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD
| | - Andrew B Harris
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD
| | - Majd Marrache
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD
| | - Khaled M Kebaish
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD.
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Gwam CU, Emara AK, Chughtai N, Javed S, Luo TD, Wang KY, Chughtai M, O'Gara T, Plate JF. Trends and risk factors for opioid administration for non-emergent lower back pain. World J Orthop 2021; 12:700-709. [PMID: 34631453 PMCID: PMC8472449 DOI: 10.5312/wjo.v12.i9.700] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 04/08/2021] [Accepted: 08/24/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Non-emergent low-back pain (LBP) is one of the most prevalent presenting complaints to the emergency department (ED) and has been shown to contribute to overcrowding in the ED as well as diverting attention away from more serious complaints. There has been an increasing focus in current literature regarding ED admission and opioid prescriptions for general complaints of pain, however, there is limited data concerning the trends over the last decade in ED admissions for non-emergent LBP as well as any subsequent opioid prescriptions by the ED for this complaint.
AIM To determine trends in non-emergent ED visits for back pain; annual trends in opioid administration for patients presenting to the ED for back pain; and factors associated with receiving an opioid-based medication for non-emergent LBP in the ED
METHODS Patients presenting to the ED for non-emergent LBP from 2010 to 2017 were retrospectively identified from the National Hospital Ambulatory Medical Care Survey database. The “year” variable was transformed to two-year intervals, and a weighted survey analysis was conducted utilizing the weighted variables to generate incidence estimates. Bivariate statistics were used to assess differences in count data, and logistic regression was performed to identify factors associated with patients being discharged from the ED with narcotics. Statistical significance was set to a P value of 0.05.
RESULTS Out of a total of 41658475 total ED visits, 3.8% (7726) met our inclusion and exclusion criteria. There was a decrease in the rates of non-emergent back pain to the ED from 4.05% of all cases during 2010 and 2011 to 3.56% during 2016 and 2017. The most common opioids prescribed over the period included hydrocodone-based medications (49.1%) and tramadol-based medications (16.9), with the combination of all other opioid types contributing to 35.7% of total opioids prescribed. Factors significantly associated with being prescribed narcotics included age over 43.84-years-old, higher income, private insurance, the obtainment of radiographic imaging in the ED, and region of the United States (all, P < 0.05). Emergency departments located in the Midwest [odds ratio (OR): 2.42, P < 0.001], South (OR: 2.35, < 0.001), and West (OR: 2.57, P < 0.001) were more likely to prescribe opioid-based medications for non-emergent LBP compared to EDs in the Northeast.
CONCLUSION From 2010 to 2017, there was a significant decrease in the number of non-emergent LBP ED visits, as well as a decrease in opioids prescribed at these visits. These findings may be attributed to the increased focus and regulatory guidelines on opioid prescription practices at both the federal and state levels. Since non-emergent LBP is still a highly common ED presentation, conclusions drawn from opioid prescription practices within this cohort is necessary for limiting unnecessary ED opioid prescriptions.
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Affiliation(s)
- Chukwuweike U Gwam
- Department of Orthopedic Surgery, Wake Forest School of Medicine, Winston-Salem, NC 27157, United States
| | - Ahmed K Emara
- Department of Orthopedic Surgery, Cleveland Clinic Foundation, Cleveland, OH 44195, United States
| | - Noor Chughtai
- Department of Orthopedic Surgery, Cleveland Clinic Foundation, Cleveland, OH 44195, United States
| | - Sameer Javed
- Department of Orthopedic Surgery, Cleveland Clinic Foundation, Cleveland, OH 44195, United States
| | - T David Luo
- Department of Orthopedic Surgery, Wake Forest School of Medicine, Winston-Salem, NC 27157, United States
| | - Kevin Y Wang
- Department of Orthopedic Surgery, Wake Forest School of Medicine, Winston-Salem, NC 27157, United States
| | - Morad Chughtai
- Department of Orthopedic Surgery, Cleveland Clinic Foundation, Cleveland, OH 44195, United States
| | - Tadhg O'Gara
- Department of Orthopedic Surgery, Wake Forest School of Medicine, Winston-Salem, NC 27157, United States
| | - Johannes F Plate
- Department of Orthopaedic Surgery, University of Pittsburgh, 5200 Centre Avenue, Suite 415, Pittsburgh, PA 15232, USA
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Xu AL, Petrusky O, Babu J, Wang KY, Durand WM, Gross JM, Neuman BJ. Surgically Managed Malakoplakia of the Spine: A Case Report. JBJS Case Connect 2021; 11:01709767-202109000-00105. [PMID: 34473660 DOI: 10.2106/jbjs.cc.21.00328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE A 66-year-old woman with polymyositis and recurrent urinary tract infections presented with lumbar pain and progressive lower extremity neuropathy. Imaging showed lytic destruction of the vertebral bone from L2 to L4 with extension into adjacent musculature. Histological examination demonstrated Michaelis-Gutmann bodies consistent with malakoplakia. The patient underwent revision T12-sacrum posterior fusion, L2-5 laminectomy, and anterior L3-4 corpectomy, followed by L2-4 anterior stabilization and a 6-week course of ceftriaxone. At 3 months postoperatively, she was asymptomatic without recurrence. CONCLUSION Malakoplakia of bone should be considered in the differential diagnosis of lytic bone lesions and can be effectively treated with surgical debulking with penetrative antibiotics.
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Affiliation(s)
- Amy L Xu
- From the Department of Orthopaedics, The Johns Hopkins Hospital, Baltimore, Maryland
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Zhang M, Li YG, Wang KY, Wang X, Dai LP, Wang P, Ye H, Shi JX, Yang XA, Zhang SX, Zhang JY. [Cost-effectiveness of anti-tumor associated antigen autoantibody screening for hepatocellular carcinoma in the population with chronic hepatitis B-related cirrhosis]. Zhonghua Yi Xue Za Zhi 2021; 101:2544-2551. [PMID: 34407581 DOI: 10.3760/cma.j.cn112137-20201229-03502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To evaluate the cost-effectiveness of anti-tumor associated antigen autoantibody (TAAb) for hepatocellular carcinoma (HCC) screening in cirrhosis population with chronic hepatitis B (CHB). Methods: A simulated cohort of 40-year-old patients with CHB cirrhosis was established with a sample size of 10 000. Using TAAb screening alone or TAAb and AFP screening in parallel (TAAb + AFP) as the research strategy, and liver ultrasound and AFP screening in parallel (liver ultrasound + AFP) as the control strategy, the decision analysis Markov model was constructed and the model validity was evaluated. The 6-month cycle was simulated using TreeAge Pro 2020 software. Cost and quality-adjusted life years (QALY) were calculated. Incremental cost-effectiveness ratio (ICER) was used to compare the two strategies, and sensitivity analysis was used to evaluate the uncertainty of results. Results: The Markov model had a total of 11 outcomes, of which 7 were natural outcomes and 4 wereclinical intervention outcomes, and the goodness of fit was 0.969. The lifetime screening cost of TAAb+AFP strategy for HCC screening was 249 612 yuan/case, and the QALY per capita was 7.704 years. Compared with liver ultrasound +AFP strategy (247 805 yuan/case), the total health cost increased by 1 807 yuan/case, and the QALY obtained was 0.014. The ICER was 127 635 yuan /QALY. When the TAAb screening fee was higher than 889.552 yuan, or the discount rate was higher than 0.068, or the antiviral treatment compliance was lower than 45.1%, ICER > 212 676 yuan /QALY. When the single TAAb screening fee was 400-600 yuan, the TAAB+AFP strategy had cost effective value. When the willingness to pay was 70 892, 141 784 and 212 676 yuan /QALY, the probability of cost-effectiveness of TAAb+AFP strategy was 70.6%, 75.3% and 77.8%, respectively. Conclusion: It is cost-effective to use TAAb+AFP for early screening of liver cancer in Chinese population with CHB cirrhosis.
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Affiliation(s)
- M Zhang
- Department of Epidemiology and Health statistics & Henan Key Laboratory for Tumor Epidemiology, College of Public Health, Zhengzhou University, Zhengzhou 450001, China
| | - Y G Li
- Department of Epidemiology and Health statistics & Henan Key Laboratory for Tumor Epidemiology, College of Public Health, Zhengzhou University, Zhengzhou 450001, China
| | - K Y Wang
- Henan Institute of Medical and Pharmaceutical Sciences, Zhengzhou University, Zhengzhou 450001, China
| | - X Wang
- Henan Institute of Medical and Pharmaceutical Sciences, Zhengzhou University, Zhengzhou 450001, China
| | - L P Dai
- Henan Institute of Medical and Pharmaceutical Sciences, Zhengzhou University, Zhengzhou 450001, China
| | - P Wang
- Department of Epidemiology and Health statistics & Henan Key Laboratory for Tumor Epidemiology, College of Public Health, Zhengzhou University, Zhengzhou 450001, China
| | - H Ye
- Department of Epidemiology and Health statistics & Henan Key Laboratory for Tumor Epidemiology, College of Public Health, Zhengzhou University, Zhengzhou 450001, China
| | - J X Shi
- Henan Institute of Medical and Pharmaceutical Sciences, Zhengzhou University, Zhengzhou 450001, China
| | - X A Yang
- Henan Institute of Medical and Pharmaceutical Sciences, Zhengzhou University, Zhengzhou 450001, China
| | - S X Zhang
- Henan Institute of Medical and Pharmaceutical Sciences, Zhengzhou University, Zhengzhou 450001, China
| | - J Y Zhang
- Department of Epidemiology and Health statistics & Henan Key Laboratory for Tumor Epidemiology, College of Public Health, Zhengzhou University, Zhengzhou 450001, China
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Jing H, Cui P, Qiu MR, Zhang F, Wang BB, Wu Y, Liu HM, Li CC, Wang KY. [One case report of pneumoconiosis in porcelain teeth workers]. Zhonghua Lao Dong Wei Sheng Zhi Ye Bing Za Zhi 2021; 39:619-620. [PMID: 34488275 DOI: 10.3760/cma.j.cn121094-20201012-00572] [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
Porcelain tooth technology is widely used in the treatment of oral diseases, but there are few reports on the possible occupational hazard factors in the process of porcelain tooth production. Porcelain teeth production will produced a large amount of silica dust and metal dust during the grinding process. The technical workers who have been engaged in this work for a long time are very prone to pneumoconiosis due to their poor personal protection awareness. This paper analyzed the clinical data of a pneumoconiosis patient engaged in porcelain tooth making, and analyzed the possible occupational hazard factors in the process of porcelain teeth production, so as to improve the understanding of relevant enterprises, technical workers and medical personnel on the disease and reduce the risk of porcelain teeth production workers suffering from pneumoconiosis.
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Affiliation(s)
- H Jing
- Shandong Academy of Occupational Health and Occupational Medicine, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan 250002, China
| | - P Cui
- Shandong Academy of Occupational Health and Occupational Medicine, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan 250002, China
| | - M R Qiu
- Shandong Academy of Occupational Health and Occupational Medicine, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan 250002, China
| | - F Zhang
- Shandong Academy of Occupational Health and Occupational Medicine, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan 250002, China
| | - B B Wang
- Shandong Academy of Occupational Health and Occupational Medicine, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan 250002, China
| | - Y Wu
- Shandong Academy of Occupational Health and Occupational Medicine, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan 250002, China
| | - H M Liu
- Shandong Academy of Occupational Health and Occupational Medicine, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan 250002, China
| | - C C Li
- Shandong Academy of Occupational Health and Occupational Medicine, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan 250002, China
| | - K Y Wang
- Shandong Academy of Occupational Health and Occupational Medicine, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan 250002, China
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Wei C, Quan T, Wang KY, Gu A, Fassihi SC, Kahlenberg CA, Malahias MA, Liu J, Thakkar S, Gonzalez Della Valle A, Sculco PK. Artificial neural network prediction of same-day discharge following primary total knee arthroplasty based on preoperative and intraoperative variables. Bone Joint J 2021; 103-B:1358-1366. [PMID: 34334050 DOI: 10.1302/0301-620x.103b8.bjj-2020-1013.r2] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS This study used an artificial neural network (ANN) model to determine the most important pre- and perioperative variables to predict same-day discharge in patients undergoing total knee arthroplasty (TKA). METHODS Data for this study were collected from the National Surgery Quality Improvement Program (NSQIP) database from the year 2018. Patients who received a primary, elective, unilateral TKA with a diagnosis of primary osteoarthritis were included. Demographic, preoperative, and intraoperative variables were analyzed. The ANN model was compared to a logistic regression model, which is a conventional machine-learning algorithm. Variables collected from 28,742 patients were analyzed based on their contribution to hospital length of stay. RESULTS The predictability of the ANN model, area under the curve (AUC) = 0.801, was similar to the logistic regression model (AUC = 0.796) and identified certain variables as important factors to predict same-day discharge. The ten most important factors favouring same-day discharge in the ANN model include preoperative sodium, preoperative international normalized ratio, BMI, age, anaesthesia type, operating time, dyspnoea status, functional status, race, anaemia status, and chronic obstructive pulmonary disease (COPD). Six of these variables were also found to be significant on logistic regression analysis. CONCLUSION Both ANN modelling and logistic regression analysis revealed clinically important factors in predicting patients who can undergo safely undergo same-day discharge from an outpatient TKA. The ANN model provides a beneficial approach to help determine which perioperative factors can predict same-day discharge as of 2018 perioperative recovery protocols. Cite this article: Bone Joint J 2021;103-B(8):1358-1366.
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Affiliation(s)
- Chapman Wei
- Department of Orthopaedic Surgery, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
| | - Theodore Quan
- Department of Orthopaedic Surgery, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
| | - Kevin Y Wang
- Johns Hopkins Department of Orthopaedic Surgery, Adult Reconstruction Division, John Hopkins Medicine, Baltimore, Maryland, USA
| | - Alex Gu
- Department of Orthopaedic Surgery, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA.,The Stavros Niarchos Foundation Complex Joint Reconstruction Center, Department of Orthopaedic Surgery, Hospital for Special Surgery, Washington, District of Columbia, USA
| | - Safa C Fassihi
- Department of Orthopaedic Surgery, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
| | - Cynthia A Kahlenberg
- Adult Reconstruction and Joint Replacement Division, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, USA
| | - Michael-Alexander Malahias
- Adult Reconstruction and Joint Replacement Division, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, USA
| | - Jiabin Liu
- Department of Anesthesiology, Critical Care & Pain Management, Hospital for Special Surgery, New York, New York, USA
| | - Savyasachi Thakkar
- Johns Hopkins Department of Orthopaedic Surgery, Adult Reconstruction Division, John Hopkins Medicine, Baltimore, Maryland, USA
| | - Alejandro Gonzalez Della Valle
- The Stavros Niarchos Foundation Complex Joint Reconstruction Center, Department of Orthopaedic Surgery, Hospital for Special Surgery, Washington, District of Columbia, USA
| | - Peter K Sculco
- The Stavros Niarchos Foundation Complex Joint Reconstruction Center, Department of Orthopaedic Surgery, Hospital for Special Surgery, Washington, District of Columbia, USA
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Quan T, Wang KY, Gu A, Gioia C, Malahias MA, Stoll WT, Thakkar SC, Campbell JC. Conversion total knee arthroplasty: A case complexity between primary and revision total knee arthroplasty. Knee 2021; 31:180-187. [PMID: 34256348 DOI: 10.1016/j.knee.2021.06.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 04/13/2021] [Accepted: 06/23/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Conversion total knee arthroplasty (TKA) may represent a more complex procedure compared with primary TKA. The purpose of this study was to compare 30-day complications between conversion TKA and primary, non-conversion TKA as well as between conversion TKA and revision TKA on a national scale using a multi-center surgical registry. METHODS Adult patients undergoing conversion TKA from 2006 to 2018 were identified in the National Surgical Quality Improvement Program database and were compared with patients who underwent primary TKA and aseptic revision TKA. In this analysis, 30-day complications were assessed. Bivariate analyses, including chi-squared and analysis of variance, and multivariate logistic regressions were performed. RESULTS Of 299,065 total patients undergoing knee arthroplasty, 1,310 (0.4%) underwent conversion TKA, 275,470 (92.1%) underwent primary TKA, and 22,285 (7.5%) underwent revision TKA. Following adjustment, patients who underwent conversion TKA were more likely to have increased risks of any complications (P < 0.001), mortality (P = 0.021), wound complications (P < 0.001), cardiac issues (P = 0.018), bleeding requiring transfusion (P < 0.001), and reoperation (P = 0.002) relative to primary TKA patients. Compared with patients who underwent revision TKA, conversion TKA patients were less likely to have septic complications (P = 0.009). CONCLUSION Conversion TKA is associated with significantly higher rates of complications compared with primary, non-conversion TKA, but less risk of sepsis compared with revision TKA. Because current reimbursement classifications do not account for the case complexity of a conversion TKA, new classifications should be implemented with reimbursements for conversion TKA approximating reimbursements for revision TKA.
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Affiliation(s)
- Theodore Quan
- Department of Orthopedic Surgery, George Washington Hospital, Washington, DC, USA
| | - Kevin Y Wang
- Johns Hopkins Department of Orthopaedic Surgery, Adult Reconstruction Division, Columbia, MD, USA
| | - Alex Gu
- Department of Orthopedic Surgery, George Washington Hospital, Washington, DC, USA.
| | - Casey Gioia
- Department of Orthopedic Surgery, George Washington Hospital, Washington, DC, USA
| | - Michael-Alexander Malahias
- Adult Reconstruction and Joint Replacement Division, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - William T Stoll
- Department of Orthopedic Surgery, George Washington Hospital, Washington, DC, USA
| | - Savyasachi C Thakkar
- Johns Hopkins Department of Orthopaedic Surgery, Adult Reconstruction Division, Columbia, MD, USA
| | - Joshua C Campbell
- Department of Orthopedic Surgery, George Washington Hospital, Washington, DC, USA
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42
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Bian Y, Wang KY, Miao Y, Zhong XL, Jia SS, Qiu F. [Collateral circulation pathway in patients with basilar artery occlusion/severe stenosis: a single-center case series]. Zhonghua Nei Ke Za Zhi 2021; 60:734-738. [PMID: 34304449 DOI: 10.3760/cma.j.cn112138-20210217-00131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To investigate the collateral circulation compensation model in patients with favorable prognosis of basilar artery occlusion/severe stenosis treated with drugs or endovascular therapy. Methods: Clinical data of patients with basilar artery occlusion/severe stenosis and good clinical outcome were retrospectively collected in the Department of Neurology, Sixth Medical Center of PLA General Hospital from January 2019 to January 2020. They were divided into intensive drug therapy group and combined endovascular therapy group. The number and ways of collateral compensation pathway described by digital substraction angiography (DSA) were analyzed, and the characteristics of the collateral compensation model were summarized. SPSS22.0 software was used for statistical analysis, and the constituent ratio (%) was used for statistical description of the enumeration data. Results: A total of 32 eligible patients were included, including 27 males and 5 females, with an average age 45-76 (59±10) years. The compensation model included posterior communicating artery-posterior cerebral artery (13 cases, 40.6%), posterior communicating artery-posterior cerebral artery-basilar artery (10 cases, 31.2%), cerebellar artery-anastomotic branches of superior cerebellar artery (8 cases, 25.0%), anterior choroid artery-anastomotic branches of posterior choroid artery (2 cases, 6.2%), collateral circulation not established (11 cases, 34.4%).In drug treatment group, collateral compensation was found in the majority (14/15), with mainly posterior communicating artery (10/14).Most patients in combined treatment group did not develop collateral compensation (10/17), anastomotic branches of PICA-SCA were the main routes (6/7). Conclusion: In patients with basilar artery occlusion/severe stenosis, favorable clinical outcome can be achieved in both groups of patients treated with intensive drug therapy or endovascular therapy.
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Affiliation(s)
- Y Bian
- Department of Neurology, the Sixth Medical Center of PLA General Hospital, Beijing 100048, China
| | - K Y Wang
- Department of Neurology, the Sixth Medical Center of PLA General Hospital, Beijing 100048, China
| | - Y Miao
- Department of Neurology, the Sixth Medical Center of PLA General Hospital, Beijing 100048, China
| | - X L Zhong
- Department of Neurology, the Sixth Medical Center of PLA General Hospital, Beijing 100048, China
| | - S S Jia
- Department of Neurology, the Sixth Medical Center of PLA General Hospital, Beijing 100048, China
| | - F Qiu
- Department of Neurology, the Sixth Medical Center of PLA General Hospital, Beijing 100048, China
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Levy JF, Wang KY, Ippolito BN, Ficke JR, Jain A. The Impact of the COVID-19 Pandemic on Elective Inpatient Surgical Admissions: Evidence From Maryland. J Surg Res 2021; 268:389-393. [PMID: 34403856 PMCID: PMC8363779 DOI: 10.1016/j.jss.2021.07.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 06/29/2021] [Accepted: 07/12/2021] [Indexed: 10/27/2022]
Abstract
BACKGROUND The COVID-19 pandemic led to large-scale cancellation and deferral of elective surgeries. We quantified volume declines, and subsequent recoveries, across all hospitals in Maryland. MATERIALS AND METHODS Data on elective inpatient surgical volumes were assembled from the Maryland Health Service Cost Review Commission for years 2019-2020. The data covered all hospitals in the state. We compared the volume of elective inpatient surgeries in the second (Q2) and fourth quarters (Q4) of 2020 to those same quarters in 2019. Analysis was stratified by patient, hospital, and service characteristics. RESULTS Surgical volumes were 55.8% lower in 2020 Q2 than in 2019 Q2. Differences were largest for orthopedic surgeries (74.3% decline), those on Medicare (61.4%), and in urban hospitals (57.3%). By 2020 Q4, volumes for most service lines were within 15% of volumes in 2019 Q4. Orthopedic surgery remained most affected (44.5% below levels in 2019 Q4) and Plastic Surgery (21.9% lower). CONCLUSIONS COVID-19 led to large volume declines across hospitals in Maryland followed by a partial recovery. We observed large variability, particularly across service lines. These results can help contextualize case-specific experiences and inform research studying potential health effects of these delays and cancellations.
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Affiliation(s)
- Joseph F Levy
- Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | - Kevin Y Wang
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, Maryland
| | | | - James R Ficke
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, Maryland
| | - Amit Jain
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, Maryland.
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Liu IZ, Wang KY, Robin JX, McGeary I, Hemal K, Boyd CJ. Chronicling the effect of COVID-19 on orthopedic literature. J Orthop 2021; 26:107-110. [PMID: 34312577 PMCID: PMC8294776 DOI: 10.1016/j.jor.2021.07.016] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Accepted: 07/20/2021] [Indexed: 11/05/2022] Open
Abstract
Background The novel coronavirus disease (COVID-19) has had a significant impact on orthopedic surgery practice, but there has been little investigation of the effects of COVID-19 on the orthopedic surgery literature. Additionally, because orthopedic research plays a vital role in physician education, changes to the characteristics and content of published literature can have lasting impacts on future teaching and learning. This paper represents the first known analysis of the COVID-19 pandemic's impact on peer-reviewed articles published in orthopedic surgery journals. Methods The 20 orthopedic journals with the highest impact factors in 2019, according to the Journal Citation Reports, were included in this study. Using PubMed and COVID-19 related keywords as well as manual screening, a final count of 199 articles were assessed for this study and subsequently sorted by country of origin, orthopedic subspecialty, article type, and general theme. Kruskal Wallis and Pearson's Chi-squared tests were used to analyze continuous and categorical variables, respectively. Results Fourteen journals published articles relating to COVID-19, representing 26 countries with the United States (37%) and United Kingdom (13%) publishing the greatest proportion of all COVID-19 articles. Sixty percent of publications discussed COVID-19's impact on the overall field of orthopedic surgery, with the remainder focusing on specific subspecialties. Forty-seven percent of publications were original research articles while 46% were editorials or commentaries. The median time to publication for all COVID-19 related articles was 24.5 days, compared to the 129 days reported for orthopedic journals prior to the COVID-19 pandemic (p < 0.001). In the first 100 articles published, 49% (n = 49) originated exclusively from United States institutions, whereas only 25% (n = 25) of the next ninety-nine articles had US-only institutions (p < 0.001). Conclusions The COVID-19 pandemic has significantly impacted the characteristics, content, and time to publication of the orthopedic surgery literature. The data and ideas presented in this paper should help streamline future, formal analysis on the lasting implications of COVID-19 on orthopedic surgery practice, teaching, and learning.
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Affiliation(s)
- Ivan Z Liu
- The Medical College of Georgia, Augusta University, 1120 15th St, Augusta, GA, 30912, United States
| | - Kevin Y Wang
- Wake Forest School of Medicine, 475 Vine St, Winston-Salem, NC, 27101, United States
| | - Joseph X Robin
- Department of Orthopedic Surgery, NYU Langone, 301 East 17th Street, Suite 1402, New York, NY, 10003, United States
| | - Ian McGeary
- Hackensack Meridian School of Medicine, 340 Kingsland St, Nutley, NJ, 07110, United States
| | - Kshipra Hemal
- Wake Forest School of Medicine, 475 Vine St, Winston-Salem, NC, 27101, United States
| | - Carter J Boyd
- Hansjörg Wyss Department of Plastic Surgery, NYU Langone, 222 East 41 Street, New York, NY, 10017, United States
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Abstract
A 65-year-old man presented with symptoms of severe subcutaneous bleeding in his arm, which led to compartment syndrome requiring fasciotomy and massive blood transfusion protocol. Medical history was significant for history of autoimmune thyroid disease. Workup revealed elevated partial thromboplastin time, decreased factor VIII levels and elevated factor VIII inhibitor levels. He was worked up for causes of acquired haemophilia A and was found to have an elevated SARS-CoV-2 antibody level. Given his negative workup for other secondary aetiologies, we suspect that the cause of his haemophilia A was from his SARS-CoV-2 infection, which has been observed previously in various case reports.
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Affiliation(s)
- Kevin Y Wang
- Department of Internal Medicine, NSLIJ Health System, New Hyde Park, New York, USA
| | - Pratik Shah
- Department of Internal Medicine, NSLIJ Health System, New Hyde Park, New York, USA
| | - Dennis T Roarke
- Department of Internal Medicine, Northwell Health, New Hyde Park, New York, USA
| | - Shams A Shakil
- Department of Hematology Oncology, Northwell Health, New Hyde Park, New York, USA
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Wang KY, Ikwuezunma I, Puvanesarajah V, Babu J, Margalit A, Raad M, Jain A. Using Predictive Modeling and Supervised Machine Learning to Identify Patients at Risk for Venous Thromboembolism Following Posterior Lumbar Fusion. Global Spine J 2021; 13:1097-1103. [PMID: 34036817 DOI: 10.1177/21925682211019361] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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] [Indexed: 11/15/2022] Open
Abstract
STUDY DESIGN Retrospective review. OBJECTIVE To use predictive modeling and machine learning to identify patients at risk for venous thromboembolism (VTE) following posterior lumbar fusion (PLF) for degenerative spinal pathology. METHODS Patients undergoing single-level PLF in the inpatient setting were identified in the National Surgical Quality Improvement Program database. Our outcome measure of VTE included all patients who experienced a pulmonary embolism and/or deep venous thrombosis within 30-days of surgery. Two different methodologies were used to identify VTE risk: 1) a novel predictive model derived from multivariable logistic regression of significant risk factors, and 2) a tree-based extreme gradient boosting (XGBoost) algorithm using preoperative variables. The methods were compared against legacy risk-stratification measures: ASA and Charlson Comorbidity Index (CCI) using area-under-the-curve (AUC) statistic. RESULTS 13, 500 patients who underwent single-level PLF met the study criteria. Of these, 0.95% had a VTE within 30-days of surgery. The 5 clinical variables found to be significant in the multivariable predictive model were: age > 65, obesity grade II or above, coronary artery disease, functional status, and prolonged operative time. The predictive model exhibited an AUC of 0.716, which was significantly higher than the AUCs of ASA and CCI (all, P < 0.001), and comparable to that of the XGBoost algorithm (P > 0.05). CONCLUSION Predictive analytics and machine learning can be leveraged to aid in identification of patients at risk of VTE following PLF. Surgeons and perioperative teams may find these tools useful to augment clinical decision making risk stratification tool.
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Affiliation(s)
- Kevin Y Wang
- Department of Orthopaedic Surgery, 1501The Johns Hopkins Hospital, Baltimore, MD, USA
| | - Ijezie Ikwuezunma
- Department of Orthopaedic Surgery, 1501The Johns Hopkins Hospital, Baltimore, MD, USA
| | - Varun Puvanesarajah
- Department of Orthopaedic Surgery, 1501The Johns Hopkins Hospital, Baltimore, MD, USA
| | - Jacob Babu
- Department of Orthopaedic Surgery, 1501The Johns Hopkins Hospital, Baltimore, MD, USA
| | - Adam Margalit
- Department of Orthopaedic Surgery, 1501The Johns Hopkins Hospital, Baltimore, MD, USA
| | - Micheal Raad
- Department of Orthopaedic Surgery, 1501The Johns Hopkins Hospital, Baltimore, MD, USA
| | - Amit Jain
- Department of Orthopaedic Surgery, 1501The Johns Hopkins Hospital, Baltimore, MD, USA
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Wang KY, Newman J, Lee CS, Seetharamu N. Epidemiology and clinicopathological features of lung cancer in patients with prior history of breast cancer. SAGE Open Med 2021; 9:20503121211017757. [PMID: 34104436 PMCID: PMC8155786 DOI: 10.1177/20503121211017757] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 03/25/2021] [Indexed: 11/16/2022] Open
Abstract
Breast cancer is the most common malignancy in women, and lung cancer, the leading cause of cancer-related mortality in the United States, is the most common subsequent primary cancer among breast cancer survivors. In this review, we examine the risk factors that cause subsequent primary lung cancer after breast cancer (referred to herein as BCLC patients) as well as the prognostic factors that may affect survival. Notable clinicopathological features include patient characteristics such as age, smoking history, and the presence of EGFR or BRCA mutations, as well as factors related to the treatment of breast cancer such as radiation, surgery, chemotherapy, stage, anti-estrogen therapy, and ER/PR/HER2 status.
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Affiliation(s)
- Kevin Y Wang
- Department of Internal Medicine, Northshore University Hospital, Manhasset, NY, USA
| | - James Newman
- Department of Hematology Oncology, Northshore University Hospital, Manhasset, NY, USA
| | - Chung-Shien Lee
- St. John's University College of Pharmacy and Health Sciences, Queens, NY, USA
| | - Nagashree Seetharamu
- Department of Hematology Oncology, Northshore University Hospital, Manhasset, NY, USA
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Liu HY, Wang KY, Fan R, Hou JL. [New progress in the diagnosis and treatment of hepatocellular carcinoma: a decade of grinding sword]. Zhonghua Gan Zang Bing Za Zhi 2021; 29:111-115. [PMID: 33685077 DOI: 10.3760/cma.j.cn501113-20210205-00069] [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
Globally, hepatocellular carcinoma (HCC) is one of the most highly morbid, fatal, and malignant tumors, with a poor prognosis in advanced stage. In the past decade, new advances have been emerged in the field of HCC therapy, including surgery, ablation, transvascular intervention, external radiotherapy, and systemic therapy. Among them, systemic treatments, particularly targeted and immune checkpoint drugs have made outstanding progress, significantly improving the five-year survival rate of liver cancer patients. In addition, the management of liver cancer patients, especially the screening management and multidisciplinary collaborative diagnosis and treatment of high-risk populations, has significantly increased the early diagnosis rate and improved the overall treatment efficacy. Considering our country's condition and the development of existing treatment, the most effective strategy to reduce HCC mortality in the future is to accurately identify high-risk populations, increase the early diagnosis rate, and formulate personalized treatment strategies.
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Affiliation(s)
- H Y Liu
- Hepatology Unit and Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - K Y Wang
- Hepatology Unit and Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - R Fan
- Hepatology Unit and Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - J L Hou
- Hepatology Unit and Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China Hepatology Unit, Shenzhen Hospital, Southern Medical University, Shenzhen 518133, China
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Abstract
Convalescent plasma, which contains antibodies from recovered individuals, has been used as an effective treatment for infectious diseases in the past and is currently being used as a potential treatment option for COVID-19. Multiple studies have reported this treatment to be safe. We report a case of a patient who developed acute respiratory distress syndrome (ARDS) with features suggestive of transfusion-related acute lung injury after being treated with convalescent plasma for COVID-19. We emphasise the need to be aware of the potential risk of transfusion reactions and disease worsening with convalescent plasma administration and to weigh the risk and benefits of this therapy before administration to patients and propose that further study be done regarding the potential risks of convalescent plasma.
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Affiliation(s)
- Kevin Y Wang
- Internal Medicine, Northwell Health, Great Neck, New York, USA
| | - Pratik Shah
- Internal Medicine, Northwell Health, Great Neck, New York, USA
| | - Matthew Pierce
- Internal Medicine, Northwell Health, Great Neck, New York, USA
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Wang KY, Wang T, Liu Y, Lian C. Abstract 220: Disease monitoring of mycosis fungoides via high throughput sequencing of CDR3. Cancer Res 2020. [DOI: 10.1158/1538-7445.am2020-220] [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: 11/16/2022]
Abstract
Abstract
Background
High-throughput T-cell receptor sequencing (HTS) has been shown to be both sensitive and specific at diagnosing Mycosis Fungoides (MF); a sensitivity of 85% was achieved with superiority to TCRγ; PCR in detecting monoclonality and a specificity of 99.89% was achieved in detecting minimal residual disease, specifically Sezary Syndrome cells with superiority to flow cytometry. In this study, we look at the potential application of HTS as a method for monitoring treatment response in patients with MF.
Methods
We sequenced the CDR3 region of the T-cell receptor (TCR) subunit of T cells in the skin lesional tissue, as well as in pre- and post-treatment blood samples of 7 patients with late stage Mycosis Fungoides (stage IIB-IV). DNA and RNA were extracted from peripheral blood and skin samples. Library preparation followed the manufacturer's instructions (Illumina). The template DNA fragments of the constructed libraries were hybridized to the surface of Nimblegen sequence Capture chip and detected with Hiseq2000 platform. Raw data was analyzed and verified to obtain aberrantly expressed genes. A multiplex PCR system was used to amplify the specific CDR3 region. Distinct TCR CDR3 sequences were plotted on the basis of their frequency of appearance to generate the TCR “repertoire”. The malignant clonal TCR signature was determined by the highest frequency CDR3 sequence of the tumor cells from skin biopsy specimens and confirmed by pathological diagnosis. This malignant sequence was identified in pre-treatment blood and monitored in post-treatment blood. Further analysis of each patient's TCR repertoire allowed us to calculate a diversity index (Simpson's diversity index) for each patient's skin sample. Results of diversity index calculation was analyzed with unpaired T-test using GraphPad Prism version 7 (GraphPad Software, La Jolla, CA). All p-values were two-tailed, with a p<0.05 considered statistically significant.
Results
Frequency of the identified malignant TCR clone remained high in the post-treatment blood samples of the patients with poor treatment response, while the number of TCR signature clones diminished in the post-treatment blood samples of the patients with good treatment response. Higher levels of diversity of TCR was also seen in the skin pre-treatment for good responders to treatment.
Conclusion
This study used HTS to identify malignant TCR signatures from skin biopsy specimens and to monitor the changes in blood samples in MF patients. The findings suggest that HTS is a potential ancillary blood test to monitor treatment response in MF patients by comparing the levels of the TCR signature before and after therapy. A greater diversity of T-cells in the skin may also predict a better treatment response in MF, as the presence of tumor infiltrating lymphocytes has been correlated with better outcomes in many different cancers.
Citation Format: Kevin Y. Wang, Tao Wang, Yuehua Liu, Christine Lian. Disease monitoring of mycosis fungoides via high throughput sequencing of CDR3 [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 220.
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Affiliation(s)
| | - Tao Wang
- 2Peking Union Medical College, Beijing, China
| | - Yuehua Liu
- 2Peking Union Medical College, Beijing, China
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