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Xia Y, Kim ST, Dacey M, Sayah D, Biniwale R, Ardehali A. Characteristics and outcomes of lung transplants performed with ex-situ lung perfusion. J Heart Lung Transplant 2024; 43:217-225. [PMID: 37643655 DOI: 10.1016/j.healun.2023.08.017] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 07/22/2023] [Accepted: 08/23/2023] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND Ex-situ lung perfusion (ESLP) can be used to assess and rehabilitate donor lungs, potentially expanding the donor pool. We examined the characteristics and outcomes of lung transplants performed with ESLP in the United States. METHODS Retrospective review of the United Network for Organ Sharing registry of primary adult lung transplant recipients from February 28, 2018, to June 30, 2021, was performed, comparing baseline characteristics, in-hospital outcomes, and 1-year survival of ESLP vs no ESLP lung transplants. RESULTS Of 8204 lung transplants, 426 (5.2%) were performed with ESLP. ESLP donors were older, more donation after circulatory death (DCD), and had lower PaO2:FiO2 (P:F) ratios. Recipients had lower lung allocation scores. ESLP lungs traveled further, had longer preservation times, and were more likely double lung transplants. Reintubation rates, extracorporeal membrane oxygenation at 72 hours, and hospital length of stay were greater in the ESLP group. On multivariable analysis, ESLP was not an independent predictor of 1-year survival. However, further analysis showed that DCD lungs managed on ESLP had worse 1-year survival compared to DCD lungs preserved with standard cold storage or with donation after brain death donor lungs. CONCLUSIONS ESLP is used in a small percentage of lung transplants in the US and is not independently associated with 1-year survival. ESLP combined with DCD lungs, however, is associated with worse 1-year survival and warrants further investigation.
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Affiliation(s)
- Yu Xia
- Department of Surgery, Division of Cardiothoracic Surgery, University of Wisconsin, Madison, Wisconsin.
| | - Samuel T Kim
- Department of Surgery, Division of Cardiac Surgery, University of California, Los Angeles, California
| | - Michael Dacey
- Department of Surgery, Division of Cardiac Surgery, University of California, Los Angeles, California
| | - David Sayah
- Department of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, University of California, Los Angeles, California
| | - Reshma Biniwale
- Department of Surgery, Division of Cardiac Surgery, University of California, Los Angeles, California
| | - Abbas Ardehali
- Department of Surgery, Division of Cardiac Surgery, University of California, Los Angeles, California
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2
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Meredith J, Whitehead N, Dacey M. Aligning Semantic Interoperability Frameworks with the FOXS Stack for FAIR Health Data. Methods Inf Med 2023. [PMID: 36473495 DOI: 10.1055/a-1993-8036] [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: 12/12/2022]
Abstract
BACKGROUND FAIR Guiding Principles present a synergy with the use cases for digital health records, in that clinical data need to be found, accessible within a range of environments, and data must interoperate between systems and subsequently reused. The use of HL7 FHIR, openEHR, IHE XDS, and SNOMED CT (FOXS) together represents a specification to create an open digital health platform for modern health care applications. OBJECTIVES To describe where logical FOXS components align to the European Open Science Cloud Interoperability Framework (EOSC-IF) reference architecture for semantic interoperability. This should provide a means of defining if FOXS aligns to FAIR principles and to establish the data models and structures that support longitudinal care records as being fit to underpin scientific research. METHODS The EOSC-IF Semantic View is a representation of semantic interoperability where meaning is preserved between systems and users. This was analyzed and cross-referenced with FOXS architectural components, mapping concepts, and objects that describe content such as catalogues and semantic artifacts. RESULTS Majority of conceptual Semantic View components were featured within the FOXS architecture. Semantic Business Objects are composed of a range of elements such as openEHR archetypes and templates, FHIR resources and profiles, SNOMED CT concepts, and XDS document identifiers. Semantic Functional Content comprises catalogues of metadata that were also supported by openEHR and FHIR tools. CONCLUSIONS Despite some elements of EOSC-IF being vague (e.g., FAIR Digital Object), there was a broad conformance to the framework concepts and the components of a FOXS platform. This work supports a health-domain-specific view of semantic interoperability and how this may be achieved to support FAIR data for health research via a standardized framework.
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Affiliation(s)
- John Meredith
- Wales Institute of Digital Information, Digital Health and Care Wales, Cardiff, United Kingdom
| | - Nik Whitehead
- School of Applied Computing, University of Wales Trinity Saint David, Swansea, United Kingdom
| | - Michael Dacey
- School of Applied Computing, University of Wales Trinity Saint David, Swansea, United Kingdom
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3
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Boyce A, Dacey M, Bashford T. An Effective Approach for Extending Medical Data to the Cloud Through Synthetic Data Generation for Educational Environments. Stud Health Technol Inform 2022; 298:147-151. [PMID: 36073474 DOI: 10.3233/shti220925] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
When taking advantage of technology, healthcare is often met with considerably more barriers to entry than business. Cloud platforms can offer great benefits such as scalability, reduced cost and the ability to effortlessly collaborate across services, and indeed, across the world [6] yet healthcare has been slow to take advantage of these gains. This paper explores the challenges faced by healthcare, how using synthetic data can avoid the initial information governance barriers, provide the experience to effectively evaluate cloud platforms, enable effective research collaboration with education and industry, and support the digital transformation journey.
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Affiliation(s)
- Alan Boyce
- National Data Resource (NDR), Digital Health and Care Wales (DHCW), Wales, United Kingdom
| | - Michael Dacey
- School of Computing, University of Wales Trinity Saint David
| | - Tim Bashford
- School of Computing, University of Wales Trinity Saint David
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4
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Kim WJ, Dacey M, Samarage HM, Zarrin D, Goel K, Chan C, Qi X, Wang A, Shivkumar K, Ardell J, Colby G. Sympathetic nervous system hyperactivity results in potent cerebral hypoperfusion in swine. Auton Neurosci 2022; 241:102987. [DOI: 10.1016/j.autneu.2022.102987] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 04/14/2022] [Accepted: 05/04/2022] [Indexed: 11/28/2022]
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Meredith J, Whitehead N, Dacey M. Utilising the FOXS Stack for FAIR Architected Data Access. Stud Health Technol Inform 2021; 287:134-138. [PMID: 34795097 DOI: 10.3233/shti210832] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
A FOXS stack assembles HL7 FHIR, openEHR, IHE XDS and SNOMED CT as an operational clinical data platform to build digital systems. This paper analyses its applicability for FAIR-enabled medical research based on a summary of key principles. It highlights the benefit of the blended approach to operational technology stacks for health systems, and a need for industry standard technologies to enable greater semantic coherence for primary/secondary data use.
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Kluge N, Dacey M, Hadaya J, Shivkumar K, Chan SA, Ardell JL, Smith C. Rapid measurement of cardiac neuropeptide dynamics by capacitive immunoprobe in the porcine heart. Am J Physiol Heart Circ Physiol 2021; 320:H66-H76. [PMID: 33095651 PMCID: PMC7847069 DOI: 10.1152/ajpheart.00674.2020] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 10/22/2020] [Accepted: 10/22/2020] [Indexed: 01/09/2023]
Abstract
Sympathetic control of regional cardiac function occurs through postganglionic innervation from stellate ganglia and thoracic sympathetic chain. Whereas norepinephrine (NE) is their primary neurotransmitter, neuropeptide Y (NPY) is an abundant cardiac cotransmitter. NPY plays a vital role in homeostatic processes including angiogenesis, vasoconstriction, and cardiac remodeling. Elevated sympathetic stress, resulting in increased NE and NPY release, has been implicated in the pathogenesis of several cardiovascular disorders including hypertension, myocardial infarction, heart failure, and arrhythmias, which may result in sudden cardiac death. Current methods for the detection of NPY in myocardium are limited in their spatial and temporal resolution and take days to weeks to provide results [e.g., interstitial microdialysis with subsequent analysis by enzyme-linked immunosorbent assay (ELISA), high performance liquid chromatography (HPLC), or mass spectrometry]. In this study, we report a novel approach for measurement of interstitial and intravascular NPY using a minimally invasive capacitive immunoprobe (C.I. probe). The first high-spatial and temporal resolution, multichannel measurements of NPY release in vivo are provided in both myocardium and transcardiac vascular space in a beating porcine heart. We provide NPY responses evoked by sympathetic stimulation and ectopic ventricular pacing and compare these to NE release and hemodynamic responses. We extend this approach to measure both NPY and vasoactive intestinal peptide (VIP) and show differential release profiles under sympathetic stimulation. Our data demonstrate rapid and local changes in neurotransmitter profiles in response to sympathetic cardiac stressors. Future implementations include real-time intraoperative determination of cardiac neuropeptides and deployment as a minimally invasive catheter.NEW & NOTEWORTHY The sympathetic nervous system regulates cardiac function through release of neurotransmitters and neuropeptides within the myocardium. Neuropeptide Y (NPY) acts as an acute cardiac vasoconstrictor and chronically to regulate angiogenesis and cardiac remodeling. Current methodologies for the measure of NPY are not capable of providing rapid readouts on a single-sample basis. Here we provide the first in vivo methodology to report dynamic, localized NPY levels within both myocardium and vascular compartments in a beating heart.
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Affiliation(s)
- Nicholas Kluge
- Department of Physiology and Biophysics, Case Western Reserve University, Cleveland, Ohio
| | - Michael Dacey
- UCLA Cardiac Arrhythmia Center, David Geffen School of Medicine, University of California, Los Angeles, California
- UCLA Neurocardiology Research Program of Excellence, University of California, Los Angeles, California
- Molecular, Cellular, and Integrative Physiology Program, University of California, Los Angeles, California
| | - Joseph Hadaya
- UCLA Cardiac Arrhythmia Center, David Geffen School of Medicine, University of California, Los Angeles, California
- UCLA Neurocardiology Research Program of Excellence, University of California, Los Angeles, California
- Molecular, Cellular, and Integrative Physiology Program, University of California, Los Angeles, California
| | - Kalyanam Shivkumar
- UCLA Cardiac Arrhythmia Center, David Geffen School of Medicine, University of California, Los Angeles, California
- UCLA Neurocardiology Research Program of Excellence, University of California, Los Angeles, California
| | - Shyue-An Chan
- Department of Physiology and Biophysics, Case Western Reserve University, Cleveland, Ohio
| | - Jeffrey L Ardell
- UCLA Cardiac Arrhythmia Center, David Geffen School of Medicine, University of California, Los Angeles, California
- UCLA Neurocardiology Research Program of Excellence, University of California, Los Angeles, California
| | - Corey Smith
- Department of Physiology and Biophysics, Case Western Reserve University, Cleveland, Ohio
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Massoumi RL, Crain N, Zhu C, Moore A, Oland G, Ghukasyan R, Lu Y, Ye L, Hadaya J, Dacey M, Schumm M, Oh N, Mederos M, Graham D, Aboulian A. Postoperative Physician Phone Calls as a Method to Decrease Urgent Care and Emergency Department Returns After Ambulatory General Surgery. Am Surg 2020; 86:1373-1378. [PMID: 33103465 DOI: 10.1177/0003134820964463] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Unplanned returns after ambulatory surgery pose a burden to patients and health care providers alike. We hypothesized that a postoperative phone call by a physician would decrease avoidable returns to urgent care (UC) or the emergency department (ED) in the week after anorectal (AR), laparoscopic cholecystectomy (LC), inguinal hernia repair (IHR), and umbilical hernia repair (UHR) operations. A retrospective analysis from 1/2011 to 12/2015 across 14 Kaiser hospitals was conducted to determine baseline UC/ED return rates of patients pre-call. Between 10/2017 and 06/2019, physicians placed phone calls to patients within postoperative days (PODs) 1-4. The cohorts were compared using chi-squared analysis with significance determined at P < .05. In total, 276 patients received a call, with the majority placed on PODs 1-3. There were no statistically significant differences in return rates between the pre- and post-call groups. All of the AR, 50.0% of LC, 66.7% of IHR, and 50.0% of UHR patients returned prior to phone call placement. Our data indicate that a physician phone call does not help in decreasing UC/ED returns. However, it is noteworthy that many of the returns occurred pre-call placement. Future directions should be aimed at placing earlier postoperative phone calls.
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Affiliation(s)
- Roxanne L Massoumi
- Southern California Kaiser Permanente Medical Group, Woodland Hills, CA, USA
| | - Nikhil Crain
- Southern California Kaiser Permanente Medical Group, Woodland Hills, CA, USA
| | - Catherine Zhu
- Southern California Kaiser Permanente Medical Group, Woodland Hills, CA, USA
| | - Alexandra Moore
- Southern California Kaiser Permanente Medical Group, Woodland Hills, CA, USA
| | - Gabriel Oland
- Southern California Kaiser Permanente Medical Group, Woodland Hills, CA, USA
| | - Razmik Ghukasyan
- Southern California Kaiser Permanente Medical Group, Woodland Hills, CA, USA
| | - Yang Lu
- Southern California Kaiser Permanente Medical Group, Woodland Hills, CA, USA
| | - Linda Ye
- Southern California Kaiser Permanente Medical Group, Woodland Hills, CA, USA
| | - Joseph Hadaya
- Southern California Kaiser Permanente Medical Group, Woodland Hills, CA, USA
| | - Michael Dacey
- Southern California Kaiser Permanente Medical Group, Woodland Hills, CA, USA
| | - Max Schumm
- Southern California Kaiser Permanente Medical Group, Woodland Hills, CA, USA
| | - Nicholas Oh
- Southern California Kaiser Permanente Medical Group, Woodland Hills, CA, USA
| | - Michael Mederos
- Southern California Kaiser Permanente Medical Group, Woodland Hills, CA, USA
| | - Danielle Graham
- Southern California Kaiser Permanente Medical Group, Woodland Hills, CA, USA
| | - Armen Aboulian
- Southern California Kaiser Permanente Medical Group, Woodland Hills, CA, USA
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Boukens BJD, Dacey M, Meijborg VMF, Janse MJ, Hadaya J, Hanna P, Swid MA, Opthof T, Ardell JL, Shivkumar K, Coronel R. Mechanism of ventricular premature beats elicited by left stellate ganglion stimulation during acute ischaemia of the anterior left ventricle. Cardiovasc Res 2020; 117:2083-2091. [PMID: 32853334 PMCID: PMC8318107 DOI: 10.1093/cvr/cvaa253] [Citation(s) in RCA: 5] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 07/06/2020] [Accepted: 08/20/2020] [Indexed: 11/13/2022] Open
Abstract
AIMS Enhanced sympathetic activity during acute ischaemia is arrhythmogenic, but the underlying mechanism is unknown. During ischaemia, a diastolic current flows from the ischaemic to the non-ischaemic myocardium. This 'injury' current can cause ventricular premature beats (VPBs) originating in the non-ischaemic myocardium, especially during a deeply negative T wave in the ischaemic zone. We reasoned that shortening of repolarization in myocardium adjacent to ischaemic myocardium increases the 'injury' current and causes earlier deeply negative T waves in the ischaemic zone, and re-excitation of the normal myocardium. We tested this hypothesis by activation and repolarization mapping during stimulation of the left stellate ganglion (LSG) during left anterior descending coronary artery (LAD) occlusion. METHODS AND RESULTS In nine pigs, five subsequent episodes of acute ischaemia, separated by 20 min of reperfusion, were produced by occlusion of the LAD and 121 epicardial local unipolar electrograms were recorded. During the third occlusion, left stellate ganglion stimulation (LSGS) was initiated after 3 min for a 30-s period, causing a shortening of repolarization in the normal myocardium by about 100 ms. This resulted in more negative T waves in the ischaemic zone and more VPBs than during the second, control, occlusion. Following the decentralization of the LSG (including removal of the right stellate ganglion and bilateral cervical vagotomy), fewer VPBs occurred during ischaemia without LSGS. During LSGS, the number of VPBs was similar to that recorded before decentralization. CONCLUSION LSGS, by virtue of shortening of repolarization in the non-ischaemic myocardium by about 100 ms, causes deeply negative T waves in the ischaemic tissue and VPBs originating from the normal tissue adjacent to the ischaemic border.
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Affiliation(s)
- Bastiaan J D Boukens
- Department of Medical Biology, Amsterdam UMC, University of Amsterdam, Heart Center, Meibergdreef 9, P.O. Box 22660, 1100 DD Amsterdam, The Netherlands.,Department of Experimental Cardiology, Amsterdam UMC, University of Amsterdam, Heart Center, Meibergdreef 9, P.O. Box 22660, 1100 DD Amsterdam, The Netherlands
| | - Michael Dacey
- UCLA Cardiac Arrhythmia Center, Los Angeles, CA, USA
| | - Veronique M F Meijborg
- Department of Experimental Cardiology, Amsterdam UMC, University of Amsterdam, Heart Center, Meibergdreef 9, P.O. Box 22660, 1100 DD Amsterdam, The Netherlands
| | - Michiel J Janse
- Department of Experimental Cardiology, Amsterdam UMC, University of Amsterdam, Heart Center, Meibergdreef 9, P.O. Box 22660, 1100 DD Amsterdam, The Netherlands
| | - Joseph Hadaya
- UCLA Cardiac Arrhythmia Center, Los Angeles, CA, USA
| | - Peter Hanna
- UCLA Cardiac Arrhythmia Center, Los Angeles, CA, USA
| | - M Amer Swid
- UCLA Cardiac Arrhythmia Center, Los Angeles, CA, USA
| | - Tobias Opthof
- Department of Experimental Cardiology, Amsterdam UMC, University of Amsterdam, Heart Center, Meibergdreef 9, P.O. Box 22660, 1100 DD Amsterdam, The Netherlands
| | | | | | - Ruben Coronel
- Department of Experimental Cardiology, Amsterdam UMC, University of Amsterdam, Heart Center, Meibergdreef 9, P.O. Box 22660, 1100 DD Amsterdam, The Netherlands.,L'Institut de RYtmologie et de Modelisation Cardiaque (LIRYC), Universite de Bordeaux, Bordeaux, France
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Moss A, Achanta S, Robbins S, Turick S, Nieves S, Hanna P, Dacey M, Swid MA, Ardell J, Shivkumar K, Schwaber JS, Vadigepalli R. SPARC: A Comprehensive Single Neuron Molecular Phenotype Map of the Right Atrial Ganglionated Plexus in the Pig Heart. FASEB J 2020. [DOI: 10.1096/fasebj.2020.34.s1.07160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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10
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Abstract
We aimed to determine factors that affect the quality of life of patients undergoing a standardized surgical and postoperative management protocol for knee dislocations. A total of 31 patients (33 knees) were included in this study. We contacted patients at a minimum of 12 months postoperatively (mean: 38 months; range, 12-111 months) and administered the previously validated Multiligament Quality of Life questionnaire (ML-QOL), 2000 International Knee Documentation Committee Subjective Knee Form (IKDC), and Lysholm Knee Scoring Scale. We performed independent two-sample t-tests and age-adjusted multivariable linear regression analysis to examine the difference in these scores. Patients who underwent previous knee ligament surgery had significantly worse mean ML-QOL scores relative to patients who did not undergo previous knee ligament surgery (114.3 versus 80.4; p = 0.004) (higher score indicates worse quality of life). All other differences in the ML-QOL scores were not statistically significant. IKDC and Lysholm scores did not differ significantly with regards to the studied variables. Among patients with no previous knee ligament surgery, patients undergoing surgery within 3 weeks of injury had significantly worse mean ML-QOL scores relative to patients undergoing surgery greater than 3 weeks after their injury (98.7 versus 74.7; p = 0.042) and patients with Schenck classification of III or IV had significantly worse mean ML-QOL scores relative to patient with a Schenck classification of I or II (88.7 versus 62.9; p = 0.015). We found that patients with a previous history of knee ligament surgery had a significantly worse quality of life relative to those with no history of knee ligament surgery. This is a level III, retrospective cohort study.
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Affiliation(s)
- George F Rick Hatch
- Department of Orthopaedic Surgery, University of Southern California Keck School of Medicine, Los Angeles, California
| | - Diego Villacis
- Department of Orthopaedic Surgery, University of Southern California Keck School of Medicine, Los Angeles, California
| | - Dhanur Damodar
- Department of Orthopaedic Surgery, University of Southern California Keck School of Medicine, Los Angeles, California
| | - Michael Dacey
- Department of Orthopaedic Surgery, University of Southern California Keck School of Medicine, Los Angeles, California
| | - Anthony Yi
- Department of Orthopaedic Surgery, University of Southern California Keck School of Medicine, Los Angeles, California
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Joseph B, Jehan F, Dacey M, Kulvatunyou N, Khan M, Zeeshan M, Gries L, O'Keeffe T, Riall TS. Evaluating the Relevance of the 2013 Tokyo Guidelines for the Diagnosis and Management of Cholecystitis. J Am Coll Surg 2018; 227:38-43.e1. [PMID: 29580879 DOI: 10.1016/j.jamcollsurg.2018.02.016] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Accepted: 02/05/2018] [Indexed: 12/24/2022]
Abstract
BACKGROUND The 2013 Tokyo Guidelines (TG13) are used to diagnose, grade severity, and guide management of acute cholecystitis (AC). The aim of our study was to verify the diagnostic criteria, severity assessment, and management protocols based on the TG13. STUDY DESIGN Our prospectively maintained emergency general surgery registry was used to review patients who had a surgical consultation for right upper quadrant pain (from 2013 to 2015). Diagnosis and severity were graded based on TG13 and compared with pathology reports. Our institutional management protocols were compared with TG13. RESULTS Nine hundred and fifty-two patients were analyzed, of which 857 had biliary diseases. Mean age was 42 ± 18 years and 67% were female. Seven hundred and seventy-nine had a cholecystectomy, 15 underwent cholecystostomy tube placement, and 63 patients were managed conservatively. Only 4% were febrile on presentation and 51% of patients had leukocytosis. Fifty-nine percent of patients did not have any signs of AC on ultrasonography. The TG13 criteria had a sensitivity of 53% for diagnosing AC (definitive 27%, suspected 26%, and undiagnosed 47%) when compared with the final pathology report; 92.5% of patients with grade I, 93% with grade II, and even 64% with grade III, underwent cholecystectomy safely at our institute. There were no differences in complication rates (3.7% vs 4.7%; p = 0.81), return to operating room rates (0.6% vs 0.7%; p = 0.95), or mortality rates (0.3% vs 0%; p = 0.96) between grade I and grade II patients who underwent early cholecystectomy. CONCLUSIONS The TG13 diagnostic criteria lack sensitivity and missed more than half of the patients with AC, as many patients lack clinical signs (fever and leukocytosis). The TG13 recommendations for conservative management and delayed cholecystectomy in grade II and grade III disease are not warranted.
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Affiliation(s)
- Bellal Joseph
- Division of Trauma, Critical Care, Emergency Surgery, and Burns, College of Medicine, University of Arizona, Tucson, AZ.
| | - Faisal Jehan
- Division of Trauma, Critical Care, Emergency Surgery, and Burns, College of Medicine, University of Arizona, Tucson, AZ
| | - Michael Dacey
- Department of Surgery, College of Medicine, University of Arizona, Tucson, AZ
| | - Narong Kulvatunyou
- Division of Trauma, Critical Care, Emergency Surgery, and Burns, College of Medicine, University of Arizona, Tucson, AZ
| | - Muhammad Khan
- Division of Trauma, Critical Care, Emergency Surgery, and Burns, College of Medicine, University of Arizona, Tucson, AZ
| | - Muhammad Zeeshan
- Division of Trauma, Critical Care, Emergency Surgery, and Burns, College of Medicine, University of Arizona, Tucson, AZ
| | - Lynn Gries
- Division of Trauma, Critical Care, Emergency Surgery, and Burns, College of Medicine, University of Arizona, Tucson, AZ
| | - Terence O'Keeffe
- Division of Trauma, Critical Care, Emergency Surgery, and Burns, College of Medicine, University of Arizona, Tucson, AZ
| | - Taylor S Riall
- Department of Surgery, College of Medicine, University of Arizona, Tucson, AZ
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Jackson A, Palmer S, Davis RD, Pappendick A, Pearson E, Savik K, Ormaza S, Hertz M, Dacey M, Miller L, Reinsmoen NL. Cytokine genotypes in kidney, heart, and lung recipients: consequences for acute and chronic rejection. Transplant Proc 2001; 33:489-90. [PMID: 11266922 DOI: 10.1016/s0041-1345(00)02106-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- A Jackson
- Duke University Medical Center, Durham, North Carolina, USA
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