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Kreinin Y, Talmon Y, Levi M, Khoury M, Or I, Raad M, Bolotin G, Sznitman J, Korin N. A Fibrin-Thrombin Based In Vitro Perfusion System to Study Flow-Related Prosthetic Heart Valves Thrombosis. Ann Biomed Eng 2024:10.1007/s10439-024-03480-6. [PMID: 38459196 DOI: 10.1007/s10439-024-03480-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 02/20/2024] [Indexed: 03/10/2024]
Abstract
Prosthetic heart valve (PHV) replacement has increased the survival rate and quality of life for heart valve-diseased patients. However, PHV thrombosis remains a critical problem associated with these procedures. To better understand the PHV flow-related thrombosis problem, appropriate experimental models need to be developed. In this study, we present an in vitro fibrin clot model that mimics clot accumulation in PHVs under relevant hydrodynamic conditions while allowing real-time imaging. We created 3D-printed mechanical aortic valve models that were inserted into a transparent glass aorta model and connected to a system that simulates human aortic flow pulse and pressures. Thrombin was gradually injected into a circulating fibrinogen solution to induce fibrin clot formation, and clot accumulation was quantified via image analysis. The results of valves positioned in a normal versus a tilted configuration showed that clot accumulation correlated with the local flow features and was mainly present in areas of low shear and high residence time, where recirculating flows are dominant, as supported by computational fluid dynamic simulations. Overall, our work suggests that the developed method may provide data on flow-related clot accumulation in PHVs and may contribute to exploring new approaches and valve designs to reduce valve thrombosis.
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Affiliation(s)
- Yevgeniy Kreinin
- Department of Biomedical Engineering, Technion-IIT, 3200003, Haifa, Israel
| | - Yahel Talmon
- Department of Biomedical Engineering, Technion-IIT, 3200003, Haifa, Israel
| | - Moran Levi
- Department of Biomedical Engineering, Technion-IIT, 3200003, Haifa, Israel
| | - Maria Khoury
- Department of Biomedical Engineering, Technion-IIT, 3200003, Haifa, Israel
| | - Itay Or
- Department of Cardiac Surgery, Rambam Health Care Campus, 3109601, Haifa, Israel
| | - Mahli Raad
- Department of Cardiac Surgery, Rambam Health Care Campus, 3109601, Haifa, Israel
| | - Gil Bolotin
- Department of Cardiac Surgery, Rambam Health Care Campus, 3109601, Haifa, Israel
- The Ruth Bruce Rappaport Faculty of Medicine, Technion-IIT, 3525433, Haifa, Israel
| | - Josué Sznitman
- Department of Biomedical Engineering, Technion-IIT, 3200003, Haifa, Israel
| | - Netanel Korin
- Department of Biomedical Engineering, Technion-IIT, 3200003, Haifa, Israel.
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Amin RM, Raad M, Rao SS, Musharbash F, Best MJ, Amanatullah DF. Survival bias may explain the appearance of the obesity paradox in hip fracture patients. Osteoporos Int 2021; 32:2555-2562. [PMID: 34245343 PMCID: PMC8819709 DOI: 10.1007/s00198-021-06046-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 06/21/2021] [Indexed: 01/29/2023]
Abstract
UNLABELLED Patients with low-energy hip fractures do not follow the obesity paradox as previously reported. In datasets where injury mechanism is not available, the use of age >50 years (as opposed to commonly used >65 years) as a surrogate for a low-energy hip fracture patients may be a more robust inclusion criterion. PURPOSE: In elderly patients with a hip fracture, limited data suggests that obese patients counterintuitively have improved survival compared to normal-weight patients. This "obesity paradox" may be the byproduct of selection bias. We hypothesized that the obesity paradox would not apply to elderly hip fracture patients. METHODS The National Surgical Quality Improvement Project dataset identified 71,685 hip fracture patients ≥50 years-of-age with complete body mass index (BMI) data that underwent surgery. Patients were stratified into under and over 75-year-old cohorts (n=18,956 and 52,729, respectively). Within each age group, patients were stratified by BMI class and compared with respect to preoperative characteristics and 30-day mortality. Significant univariate characteristics (p<0.1) were included in multivariate analysis to determine the independent effect of obesity class on 30-day mortality (p<0.05). RESULTS Multivariate analysis of <75-year-old patients with class-III obesity were more likely to die within 30-days than similarly aged normal-weight patients (OR 1.91, CI 1.06-3.42, p=0.030). Multivariate analysis of ≥75-year-old overweight (OR 0.69, CI 0.62-0.77, p<0.001), class-I obese (OR 0.62, CI 0.51-0.74, p<0.001), or class-II obese (OR=0.69, CI 0.50-0.95, p=0.022) patients were less likely to die within 30-days when compared to similarly aged normal-weight patients. CONCLUSIONS Our data suggest that obesity is a risk factor for mortality in low-energy hip fracture patients, but the appearance of the "obesity paradox" in elderly hip fracture patients results from statistical bias that is only evident upon subgroup analysis.
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Affiliation(s)
- R M Amin
- Department of Orthopaedic Surgery, Stanford Medicine University, 450 Broadway Street, Redwood City, CA, 94063, USA
| | - M Raad
- Department of Orthopedic Surgery, Johns Hopkins University, Baltimore, MD, USA
| | - S S Rao
- Department of Orthopedic Surgery, Johns Hopkins University, Baltimore, MD, USA
| | - F Musharbash
- Department of Orthopedic Surgery, Johns Hopkins University, Baltimore, MD, USA
| | - M J Best
- Department of Orthopedic Surgery, Johns Hopkins University, Baltimore, MD, USA
| | - D F Amanatullah
- Department of Orthopaedic Surgery, Stanford Medicine University, 450 Broadway Street, Redwood City, CA, 94063, USA.
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Cheema K, Raad M, Sehjal R, Virani S, Relwani J. Atypical mycobacterium infection of sternoclavicular joint: A unique case. Shoulder Elbow 2020; 12:349-352. [PMID: 33093873 PMCID: PMC7545528 DOI: 10.1177/1758573219859466] [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: 02/11/2019] [Revised: 05/21/2019] [Accepted: 06/03/2019] [Indexed: 11/17/2022]
Abstract
We report a rare case of atypical Mycobacterium intracellulare infection encountered in a left sternoclavicular joint of an immunocompetent patient. The 34-year-old female patient presented with a one-year history of left sternoclavicular joint pain and swelling. The patient had multiple radiological investigations, which were suspicious for an infective cause. The patient had a biopsy of the joint, which returned showing acid-fast bacilli. The patient consequently received a prolonged course of medical treatment for M. intracellulare.
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Affiliation(s)
- K Cheema
- K Cheema, William Harvey Hospital – Trauma and Orthopaedics, Kennington Road, Ashford TN24 0LZ, UK.
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Abstract
BACKGROUND Although miR-410 acts as a cancer inducer in colorectal cancer, there is limited data on the clinical implications of miR-410 expression levels in patients. We hypothesized a link between miR-410 expression and its potential clinical values in patients with colorectal cancer. MATERIAL AND METHODS 120 colorectal cancer tissue specimens and 120 adjacent non-tumour tissues were obtained. Quantification of miR-410 expression levels was determined by, quantitative RT-PCR. Expression was analysed by clinical features. RESULTS miR-410 was up-regulated in malignant tissues compared with corresponding normal tissues (P < 0.01), with TNM stage and lymph node metastasis (P = 0.03, P = 0.004, respectively), and with worse overall survival (P = 0.002). Multivariate survival analysis identified it as an independent risk factor for outcome (P = 0.021, HR = 2.19; 95% CI = 1.12-4.25). CONCLUSION Compared to normal non-cancerous tissues, miR-410 was overexpressed in tumour tissues and is independently associated with the unfavourable outcome. Levels of MiR-410 might a useful laboratory tool in managing and predicting the prognosis of colorectal cancer.
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Affiliation(s)
- P Abedi
- Department of Biology, Science and Research Branch, Islamic Azad University , Tehran, Iran
| | - A Bayat
- Department of Cell and Molecular Biology and Microbiology, Faculty of Biological Sciences and Technology, University of Isfahan , Isfahan, Iran.,Hematology-Oncology and Stem Cell Transplantation Research Center, Tehran University of Medical Sciences , Tehran, Iran
| | - S Ghasemzadeh
- Institute of Biochemistry and Biophysics, University of Tehran , Tehran, Iran
| | - M Raad
- Department of Biology, Faculty of Sciences, University of Guilan , Rasht, Iran
| | - H Pashaiefar
- Department of Medical Genetics, School of Medicine, Tehran University of Medical Sciences , Tehran, Iran
| | - M Ahmadvand
- Hematology-Oncology and Stem Cell Transplantation Research Center, Tehran University of Medical Sciences , Tehran, Iran
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Raad M, Salehi Z, Habibzaadeh Baalsini M, Mashayekhi F, Saeidi Saedi H. Association of rs2620381 polymorphism in miR-627 and gastric cancer. Br J Biomed Sci 2020; 77:76-80. [DOI: 10.1080/09674845.2019.1692762] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- M Raad
- Department of Biology, Faculty of Sciences, University of Guilan, Rasht, Iran
| | - Z Salehi
- Department of Biology, Faculty of Sciences, University of Guilan, Rasht, Iran
| | | | - F Mashayekhi
- Department of Biology, Faculty of Sciences, University of Guilan, Rasht, Iran
| | - H Saeidi Saedi
- Department of Radiation Oncology, Cancer Research Center, Guilan University of Medical Sciences (GUMS), Rasht, Iran
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Raad M, Salehi Z, Sasani ST, Mashayekhi F, Aminian K, Koutenayi MH. Aberrant methylation of miR-125b1 in gastric cancer: A case-control study. Neoplasma 2019; 66:603-608. [DOI: 10.4149/neo_2018_180925n716] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Accepted: 01/08/2019] [Indexed: 11/08/2022]
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Raad M, Astafan A, Hamieh S, Toufaily J, Hamieh T, Comparot J, Canaff C, Daou T, Patarin J, Pinard L. Catalytic properties of Ga-containing MFI-type zeolite in cyclohexane dehydrogenation and propane aromatization. J Catal 2018. [DOI: 10.1016/j.jcat.2018.06.029] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Urbanski PP, Raad M, Lenos A, Bougioukakis P, Zacher M, Diegeler A. Open aortic arch replacement in the era of endovascular techniques†. Eur J Cardiothorac Surg 2013; 44:431-6; discussion 436-7. [DOI: 10.1093/ejcts/ezt030] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Urbanski PP, Raad M, Wagner M, Heinz N, Reents W, Diegeler A. Cardiac surgery in patients with a porcelain aorta in the era of transcatheter valve implantation. Eur J Cardiothorac Surg 2013; 44:48-53. [PMID: 23324792 DOI: 10.1093/ejcts/ezs695] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVES New surgical and perfusion techniques allow the avoidance of deep hypothermia during open aortic arch surgery, which is generally necessary in patients with an unclampable porcelain aorta. The aim of the study was to evaluate operative and long-term results in patients with a porcelain aorta who underwent conventional cardiac surgery using current surgical and perfusion techniques. METHODS Between November 2003 and February 2012, 30 consecutive patients (mean age 68 ± 11 years, 10 patients had previous cardiac surgery with use of glue in 5 of them) with porcelain aorta diagnosed by computed tomography and defined as a severe circular calcification of the proximal thoracic aorta were referred for cardiac surgery. All patients underwent conventional surgery with arterial cannulation of the innominate (8) or a carotid artery (22) for arterial return. During mild hypothermic circulatory arrest, unilateral cerebral perfusion through the arterial line was performed for cerebral protection. The valve surgery consisted of aortic, mitral or double valve repair in 23, 3 and 4 cases, respectively. Aortic surgery (17 complete root replacements with valve composite grafts and 22 arch replacements) and coronary revascularization due to coronary heart disease (15) were the most frequent concomitant procedures. RESULTS Thirty-day mortality was 3.3% (1 patient died of bowel ischaemia caused by severe stenosis of the celiac and upper mesenteric arteries) and the rate of permanent neurological deficit was 3.3% as well. Two further patients died during the follow-up at age 91 and 82 years, respectively; however, no death was cardiac or valve related. The actuarial survival at 5 years was 87.3 ± 7.2%. There were no cardiac reoperations, new interventions or aortic- or valve-related events noted during the median follow-up of 45 months (range 0.1-106.0). CONCLUSIONS Conventional cardiac and aortic surgery offers definitive repair and can be performed safely using current perfusion and operative techniques. Although more invasive, this surgical technique provides mortality and morbidity rates that do not exceed those reported for transcatheter valve implantation. The curative replacement of the pathological proximal aorta, which is one of the most main sources of cerebral embolism, leads to excellent neurological outcome during mid- to long-term follow-up.
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Affiliation(s)
- Paul P Urbanski
- Department of Cardiovascular Surgery, Cardiovascular Clinic Bad Neustadt, Bad Neustadt, Germany.
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Urbanski PP, Raad M, Lenos A, Bougioukakis P, Diegeler A. Complete aortic arch replacement using cerebral perfusion and mild hypothermia. Thorac Cardiovasc Surg 2012. [DOI: 10.1055/s-0031-1297847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Abstract
The effect of vitamin D supplementation on inorganic sulfate metabolism was examined in very low birth weight (less than 1,500 g) infants at biweekly intervals after birth until 6 weeks of postnatal age. Baseline serum sulfate concentrations were significantly higher in all infants (471 +/- 24 mumol/l, n = 80) than in adults (299 +/- 25 mumol/l, n = 17). In controls, the levels did not change significantly over the ensuing 6 weeks, although serum creatinine declined. Urinary sulfate excretion rose significantly to near adult levels by 2 weeks. Both urine and serum sulfate were correlated with weight gain but not with estimated glomerular filtration rate, suggesting that factors other than renal clearance have a preponderant influence on serum sulfate in these infants. At 6 weeks, the mean serum sulfate in the high-dose group (receiving 2,170 +/- 23 U/day of vitamin D, n = 41) was significantly higher than in controls (receiving 360 +/- 22 U/day, n = 40). In all infants, there was a significant correlation (r = 0.36, p less than 0.001) between serum sulfate and 25(OH)-vitamin D concentrations, but not other analytes or clinical variables, suggesting that vitamin D may be one of the factors modulating sulfate metabolism in the newborn period.
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Affiliation(s)
- D E Cole
- Department of Pediatrics, Dalhousie University, Halifax, Canada
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Abstract
Oculodento-osseous dysplasia (ODOD) has been recognised in three South African patients from two kindreds of Dutch descent. Their ocular, nasal, dental and digital stigmata resembled those of previously reported cases, but their cranial hyperostosis and mandibular overgrowth were of much greater degree. In addition, the two survivors had serious neurological complications consequent upon spinal cord compression at the base of the skull and calcification of the basal ganglia. Two of the patients were the product of marriages between a pair of brothers and a pair of sisters, who were themselves clinically normal. This situation is best explained by autosomal recessive inheritance. As ODOD is usually transmitted as an autosomal dominant, and in view of the unusual severity of the manifestations in our patients, it is possible that the condition is heterogeneous and that they had a distinct autosomal recessive form of the disorder. The presence of minimal stigmata in the mother and two prior generations of our third patient could be equally well interpreted as representing great variation in phenotypic expression of a single dominant gene or manifestation in a heterozygote for a recessive gene.
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