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Alam A, Van Zyl J, Nayyar N, Hall S, Jermyn R. Improvement in Metabolic Co-Morbidities after Implantation of CardioMEMS in Patients with Heart Failure with Preserved Ejection Fraction Phenotype. J Clin Med 2021; 10:jcm10194308. [PMID: 34640323 PMCID: PMC8509547 DOI: 10.3390/jcm10194308] [Citation(s) in RCA: 4] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 08/22/2021] [Accepted: 09/16/2021] [Indexed: 12/27/2022] Open
Abstract
Background: Heart failure with preserved ejection fraction (HFpEF) patients often have other comorbidities, including obesity, dyslipidemia, hypertension, and diabetes, comprising the metabolic syndrome. The impacts of hemodynamic monitoring via CardioMEMS on these co-morbidities remain unknown. Methods: A retrospective analysis of 29 patients with HFpEF (EF 45% or greater) and CardioMEMS was performed at a single center. Weight, body mass index (BMI), systolic blood pressures (SBP), high-density lipoprotein (HDL), triglycerides (TGL), hemoglobin A1C (HbA1c), and pulmonary artery diastolic pressures (PADP) were assessed at baseline and six months post-implant. Paired t-tests and the Wilcoxon signed-rank test were used, as appropriate, to test differences between time points. Results: These patients were 69% female, with a mean age of 73 years, and 62% had non-ischaemic cardiomyopathies (NICM). At the time of CardioMEMS implantation, average PADP was 20.1 mmHg ± 5.7, weight was 102.6 kg ± 22.7, BMI was 38.0 kg/m2 ± 8.3, SBP was 135 mmHg ± 19, HDL was 42.4 mg/dL ± 11.3, and median TGL was 130 mg/dL (100, 180). At six months we witnessed a decrease by 20.9% in PADP to 15.9 mmHg ± 5.8, (p < 0.001). In addition, the following was noted: weight decreased by 2.5% to 100.0 kg ± 23.2, (p = 0.006), BMI reduced by 2.6% to 37.0 ± 8.2, (p = 0.002), SBP decreased by 6.7% to 126 mmHg ± 16 (p < 0.001), HDL increased by 10.8% to 47 mg/dL ± 11.9 (p < 0.001), and TGL decreased by 15.4% to 110 mg/dL (105, 135) (p = 0.001). 62% of patients were diabetic with no significant improvements in HbA1C values at the 6-month follow-up. Conclusion: The utilization of CardioMEMS to optimize PADP results in an improvement in the comorbidities associated with the metabolic syndrome. Further studies are warranted to validate these findings and delineate clinical significance.
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Affiliation(s)
- Amit Alam
- Baylor University Medical Center, Department of Advanced Heart Failure and Transplantation, Dallas, TX 75246, USA;
- College of Medicine, Texas A&M University, Bryan, TX 77801, USA;
- Correspondence: ; Tel.: +1-214-820-6856
| | - Johanna Van Zyl
- College of Medicine, Texas A&M University, Bryan, TX 77801, USA;
- Baylor University Medical Center, Department of Cardiovascular Research, Dallas, TX 75246, USA
| | - Navdeep Nayyar
- Department of Cardiology, St. Francis Hospital, Roslyn, New York, NY 10001, USA; (N.N.); (R.J.)
| | - Shelley Hall
- Baylor University Medical Center, Department of Advanced Heart Failure and Transplantation, Dallas, TX 75246, USA;
- College of Medicine, Texas A&M University, Bryan, TX 77801, USA;
| | - Rita Jermyn
- Department of Cardiology, St. Francis Hospital, Roslyn, New York, NY 10001, USA; (N.N.); (R.J.)
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Jermyn RA, Schecter S, Nayyar N, Alam A. How Acute Changes in Pacing Influences Cardiac Hemodynamics. J Card Fail 2019. [DOI: 10.1016/j.cardfail.2019.07.091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Schoenfeld E, Kanzaria H, Quigley D, Nayyar N, Sabbagh S, Probst M. 363 Patient Perceptions of Shared Decisionmaking in the Emergency Department: A Multi-Center Survey Study. Ann Emerg Med 2017. [DOI: 10.1016/j.annemergmed.2017.07.333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Mahato NK, Tripathi C, Nayyar N, Singh AK, Lal R. Pontibacter ummariensis sp. nov., isolated from a hexachlorocyclohexane-contaminated soil. Int J Syst Evol Microbiol 2015; 66:1080-1087. [PMID: 26652923 DOI: 10.1099/ijsem.0.000840] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
A Gram-stain-negative, pinkish-red, rod-shaped bacterium designated strain NKM1T was isolated from soil samples contaminated with hexachlorocyclohexane isomers, collected from Ummari village, Lucknow, Uttar Pradesh, India. The strain was characterized by a polyphasic taxonomic approach. 16S rRNA gene sequence analysis showed that strain NKM1T clustered exclusively with members of the genus Pontibacter of the family Cytophagaceae, phylum Bacteroidetes. The 16S rRNA gene sequence similarity to type strains of the genus Pontibacter ranged from 96.7 to 93.8 %, with the highest sequence similarity found with Pontibacter odishensis JC130T (96.7 %). Cells of strain NKM1T were aerobic, non-flagellated and non-motile. Strain NKM1T was catalase- and oxidase-positive but negative for nitrate reduction and hydrolysis of gelatin. The major fatty acids in strain NKM1T were anteiso-C15 : 0, iso-C15 : 0, C16 : 0, C18 : 1ω9c and summed feature 3 (C16 : 1ω7c and/or C16 : 1ω6c). The polar lipid profile of strain NKM1T showed the presence of phosphatidylethanolamine and unknown glycolipids as well as aminolipids. sym-Homospermidine was found to be the major polyamine and menaquinone 7 (MK-7) was the major respiratory quinone. The DNA G+C content of strain NKM1T was determined to be 58.6 mol%. Based on phenotypic, chemotaxonomic, physiological and biochemical evidence, it is proposed that isolate NKM1T represents a novel species that belongs to the genus Pontibacter, for which the name Pontibacter ummariensis sp. nov. is proposed. The type strain is NKM1T ( = DSM 100161T = KCTC 42944T = MCC 2777T).
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Affiliation(s)
- N K Mahato
- Molecular Biology Laboratory, Department of Zoology, University of Delhi, Delhi - 110007, India
| | - C Tripathi
- Molecular Biology Laboratory, Department of Zoology, University of Delhi, Delhi - 110007, India
| | - N Nayyar
- Molecular Biology Laboratory, Department of Zoology, University of Delhi, Delhi - 110007, India
| | - A K Singh
- Molecular Biology Laboratory, Department of Zoology, University of Delhi, Delhi - 110007, India
| | - R Lal
- Molecular Biology Laboratory, Department of Zoology, University of Delhi, Delhi - 110007, India
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Cruz RJ, Ranganathan S, Mazariegos G, Soltys K, Nayyar N, Sun Q, Bond G, Shaw PH, Haberman K, Krishnamurti L, Marsh JW, Humar A, Sindhi R. Analysis of national and single-center incidence and survival after liver transplantation for hepatoblastoma: new trends and future opportunities. Surgery 2013; 153:150-9. [PMID: 23331862 DOI: 10.1016/j.surg.2012.11.006] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2012] [Accepted: 11/06/2012] [Indexed: 12/27/2022]
Abstract
BACKGROUND Liver transplantation (LTx) for hepatoblastoma appears to be increasing. Favorable tumor histology is increasingly linked to survival after surgical resection and could also determine posttransplantation outcomes. METHODS To evaluate national trends in tumor and LTx incidence as the basis for observations at some LTx centers, and determinants of survival after LTx for hepatoblastoma, we queried the National Cancer Institute's Surveillance, Epidemiology and End Results (SEER) registry representing 9.451% of the U.S. population (1975-2007), the United Network for Organ Sharing (UNOS, 1988-2010, n = 332), and Children's Hospital of Pittsburgh database (CHP, 1987-2011, n = 35). RESULTS In the United States, hepatoblastoma cases increased 4-fold, LTx for hepatoblastoma increased 20-fold, and hepatoblastoma surpassed other unresectable liver malignancies requiring LTx by nearly 3-fold. Actuarial 5-year patient survival exceeded 75%. Recurrences in 16% were greater after segmental LTx in the total U.S. experience (P = .049). At CHP, 5 children died from recurrences (n = 4) and sepsis (n = 1). Tumors were epithelial (57%) or mixed epithelial-stromal (42%), Children's Oncology Group stage III (77%) or IV (23%). Recurrences were related to previous pulmonary metastases (P = .016), and tumor necrosis <50% (P = .013), but not to small cell undifferentiated tumor histology (P = NS). Hepatic artery thrombosis was more common after LTx for hepatoblastoma compared with nonmalignant indications (P = .0089). Thirty-three children received pre-LTx chemotherapy, 88.6% with cisplatin, and 85.7% received post-LTx chemotherapy. CONCLUSION Outcomes after LTx for hepatoblastoma may benefit from improved detection and treatment of pretransplantation metastases, adequate tumor lysis after chemotherapy, and perioperative antithrombotic agents but are unaffected by undifferentiated tumor histology.
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Affiliation(s)
- Ruy J Cruz
- Starzl Transplantation Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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Mazariegos GV, Morton DH, Sindhi R, Soltys K, Nayyar N, Bond G, Shellmer D, Shneider B, Vockley J, Strauss KA. Liver transplantation for classical maple syrup urine disease: long-term follow-up in 37 patients and comparative United Network for Organ Sharing experience. J Pediatr 2012; 160:116-21.e1. [PMID: 21839471 PMCID: PMC3671923 DOI: 10.1016/j.jpeds.2011.06.033] [Citation(s) in RCA: 127] [Impact Index Per Article: 10.6] [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] [Received: 03/05/2011] [Revised: 04/25/2011] [Accepted: 06/24/2011] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To assess clinical and neurocognitive function in children who have undergone liver transplantation for classical maple syrup urine disease (MSUD). STUDY DESIGN A total of 35 patients with classical MSUD (age 9.9 ± 7.9 years) underwent liver transplantation between 2004 and 2009. Six patients donated their liver to recipients without MSUD ("domino" transplant). We analyzed clinical outcomes for our cohort and 17 additional cases from the national United Network for Organ Sharing registry; 33 patients completed IQ and adaptive testing before transplantation, and 14 completed testing 1 year later. RESULTS Patient and graft survival were 100% at 4.5 ± 2.2 years of follow-up. Liver function was normal in all patients. Branched-chain amino acid levels were corrected within hours after surgery and remained stable, with leucine tolerance increasing more than 10-fold. All domino transplant recipients were alive and well with normal branched-chain amino acid homeostasis at the time of this report. Patient and graft survival for all 54 patients with MSUD undergoing liver transplantation in the United States during this period were 98% and 96%, respectively. One-third of our patients were mentally impaired (IQ ≤ 70) before transplantation, with no statistically significant change 1 year later. CONCLUSION Liver transplantation is an effective long-term treatment for classical MSUD and may arrest brain damage, but will not reverse it.
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Affiliation(s)
- George V. Mazariegos
- Division of Pediatric Transplantation, Children’s Hospital of Pittsburgh, University of Pittsburgh Medical Center and the Hillman Center for Pediatric Transplantation, Pittsburgh, PA
| | - D. Holmes Morton
- Clinic for Special Children, Strasburg, PA (D.M., K.S.); Biology Department, Franklin and Marshall College, Lancaster, PA
| | - Rakesh Sindhi
- Division of Pediatric Transplantation, Children’s Hospital of Pittsburgh, University of Pittsburgh Medical Center and the Hillman Center for Pediatric Transplantation, Pittsburgh, PA
| | - Kyle Soltys
- Division of Pediatric Transplantation, Children’s Hospital of Pittsburgh, University of Pittsburgh Medical Center and the Hillman Center for Pediatric Transplantation, Pittsburgh, PA
| | - Navdeep Nayyar
- Division of Pediatric Transplantation, Children’s Hospital of Pittsburgh, University of Pittsburgh Medical Center and the Hillman Center for Pediatric Transplantation, Pittsburgh, PA
| | - Geoffrey Bond
- Division of Pediatric Transplantation, Children’s Hospital of Pittsburgh, University of Pittsburgh Medical Center and the Hillman Center for Pediatric Transplantation, Pittsburgh, PA
| | - Diana Shellmer
- Division of Medical Genetics, Children’s Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Benjamin Shneider
- Division of Medical Genetics, Children’s Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA
| | | | - Kevin A. Strauss
- Clinic for Special Children, Strasburg, PA (D.M., K.S.); Biology Department, Franklin and Marshall College, Lancaster, PA,Lancaster General Hospital, Lancaster, PA,Department of Pediatrics, University of Pittsburgh School of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA
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Castellaneta A, Mazariegos G, Nayyar N, Zeevi A, Thomson A. Elevated HLA-G Expression On Myeloid Dendritic Cells Correlates With Regulatory T Cell Foxp3 Expression In Operationally Tolerant Pediatric Liver Transplant Recipients. J Surg Res 2011. [DOI: 10.1016/j.jss.2010.11.522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Nayyar N, Mazariegos G, Ranganathan S, Soltys K, Bond G, Jaffe R, Sun Q, Nucci A, Kosmach B, Squires R, Abu-Elmagd K, Sindhi R. Pediatric small bowel transplantation. Semin Pediatr Surg 2010; 19:68-77. [PMID: 20123276 DOI: 10.1053/j.sempedsurg.2009.11.009] [Citation(s) in RCA: 74] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The multivisceral liver-intestine-pancreas-stomach allograft was first described by Starzl nearly 50 years ago. Since then, over 1000 children have received small bowel transplantation (SBTx), alone or with the liver and other organs, for refractory short gut syndrome (SGS) because of a variety of congenital conditions. In 2001, SBTx was approved as definitive therapy for SGS by Medicare. Currently, 1- and 5-year graft survival routinely exceeds 90% and 80%, respectively. The expected outcomes also include freedom from parenteral nutrition, normalization of growth parameters, and quality of life. However, recurrent rejection, complications of high-dose immunosuppression, or chronic rejection, which is more likely to occur after SBTx without a liver graft, account for differences between early and late survival. Future efforts aimed at overcoming such challenges include preventing SBTx through early referral to comprehensive SGS management programs and understanding why the liver protects the small bowel allograft from rejection. Finally, inflammatory mechanisms, which predispose the highly immunogenic small bowel allograft to a protracted risk of resistant rejection must be elucidated, in order to ensure durable success.
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Affiliation(s)
- Navdeep Nayyar
- Hillman Center for Pediatric Transplantation, Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Di Perri C, Dwyer MG, Wack DS, Cox JL, Hashmi K, Saluste E, Hussein S, Schirda C, Stosic M, Durfee J, Poloni GU, Nayyar N, Bergamaschi R, Zivadinov R. Signal abnormalities on 1.5 and 3 Tesla brain MRI in multiple sclerosis patients and healthy controls. A morphological and spatial quantitative comparison study. Neuroimage 2009; 47:1352-62. [DOI: 10.1016/j.neuroimage.2009.04.019] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2008] [Revised: 03/31/2009] [Accepted: 04/01/2009] [Indexed: 10/20/2022] Open
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Das S, Bhirud RG, Nayyar N, Narayan KS, Kumar VV. Chemical shift changes on micellization of linear alkyl benzenesulfonate and oleate. ACTA ACUST UNITED AC 2002. [DOI: 10.1021/j100197a059] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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