1
|
Gill G, Rowe G, Zubair MM, Chen Q, Thomas J, Chiu P, Osho A, Sood V, Schumacher KR, Emerson D, Bowdish ME, Chikwe J, Fynn-Thompson F. Impact of donor-recipient age-difference in adolescent heart transplantation. Clin Transplant 2023; 37:e15146. [PMID: 37776273 PMCID: PMC10841908 DOI: 10.1111/ctr.15146] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 08/26/2023] [Accepted: 09/21/2023] [Indexed: 10/02/2023]
Abstract
INTRODUCTION The relationship between donor age and adolescent heart transplant outcomes remains incompletely understood. We aimed to explore the effect of donor-recipient age difference on survival after adolescent heart transplantation. METHODS The United Network for Organ Sharing database was used to identify 2,855 adolescents aged 10-17 years undergoing isolated primary heart transplantation from 1/1/2000 to 12/31/2022. The primary outcome was 10-year post-transplant survival. Multivariable Cox regression identified predictors of mortality after adjusting for donor and recipient characteristics. A restricted cubic spline assessed the non-linear association between donor-recipient age-difference and the adjusted relative mortality hazard. RESULTS The median donor-recipient age-difference was +3 (range -13 to +47) years, and 17.7% (n = 504) of recipients had an age- difference > 10 years. Recipients with an age-difference > 10 years had a less favorable pre-transplant profile, including a higher incidence of priority status 1A (81.6%, n = 411 vs. 73.6%, n = 1730; p = .01). The 10-year survival rate was 54.6% (95% confidence interval (CI) 48.8- 60.4) among recipients with a donor-recipient age-difference > 10 years and 66.9% (95% CI: 64.4-69.4) among those with an age-difference ≤10 years. An age-difference > 10 years was an independent predictor of mortality (hazard ratio 1.43, 95% CI: 1.18-1.72, p < .001). Spline analysis demonstrated that the adjusted mortality hazard increased with increasingly positive donor-recipient age-difference and became significantly higher at an age-difference of 11 years. CONCLUSION A donor-recipient age-difference > 11 years is independently associated with higher long-term mortality after adolescent heart transplantation. This finding may help inform acceptable donor selection practice for adolescent heart transplant candidates.
Collapse
Affiliation(s)
- George Gill
- Department of Cardiac Surgery, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Georgina Rowe
- Department of Cardiac Surgery, Cedars-Sinai Medical Center, Los Angeles, CA
| | - M. Mujeeb Zubair
- Department of Cardiac Surgery, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Qiudong Chen
- Department of Cardiac Surgery, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Jason Thomas
- Department of Cardiac Surgery, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Peter Chiu
- Department of Cardiac Surgery, Boston Children’s Hospital, Boston, MA
| | - Asishana Osho
- Department of Cardiac Surgery, Cedars-Sinai Medical Center, Los Angeles, CA
- Department of Cardiac Surgery, Boston Children’s Hospital, Boston, MA
| | - Vikram Sood
- Department of Cardiac Surgery, University of Michigan Congenital Heart Center, C. S. Mott Children’s Hospital, Ann Arbor, MI
| | - Kurt R. Schumacher
- Department of Pediatrics, University of Michigan Congenital Heart Center, C. S. Mott Children’s Hospital, Ann Arbor, MI
| | - Dominic Emerson
- Department of Cardiac Surgery, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Michael E. Bowdish
- Department of Cardiac Surgery, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Joanna Chikwe
- Department of Cardiac Surgery, Cedars-Sinai Medical Center, Los Angeles, CA
| | | |
Collapse
|
2
|
Puche-Sanz I, Chiu P, Morillo AC, Gomez-Gomez E. Prognostic impact of serum testosterone in metastatic hormone-naive prostate cancer: a systematic review and meta-analysis. Curr Opin Urol 2023; 33:472-481. [PMID: 37747431 DOI: 10.1097/mou.0000000000001132] [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: 09/26/2023]
Abstract
PURPOSE OF REVIEW In daily practice, there is an unmet medical need for biomarkers that facilitate therapeutic decision-making in the metastatic hormone sensitive prostate cancer (mHSPC) scenario. Although recent studies have highlighted the potential of testosterone as a prognostic and predictive marker in prostate cancer, the evidence is controversial. The objective of this review was to summarize and analyze the scientific evidence regarding the prognostic role of basal testosterone levels in patients with mHSPC. METHODS A systematic review was performed. Three authors selected the articles from Web of Science, PubMed, Scopus, and Cochrane Library electronic databases. Risk of bias was assessed by the Newcastle Ottawa Scale. RECENT FINDINGS Most of the selected articles suggest that low testosterone levels before starting hormonal blockade imply a worse prognosis for patients with mHSPC. However, the quality of the evidence is poor, the studies are heterogeneous, and it is not possible to meta-analyze most of the published results. SUMMARY Testosterone is an accessible and affordable biomarker. If it were correctly demonstrated that it harbors a prognostic and/or predictive role in the mHSPC setting, it could represent an advance in decision-making in these patients. Well designed prospective studies are needed to correctly answer this question.
Collapse
Affiliation(s)
- Ignacio Puche-Sanz
- Department of Urology. Instituto de Investigación Biosanitaria IBS. Granada. Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - Peter Chiu
- SH Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China
| | - Ana C Morillo
- Department of Urology. Hospital Universitario Reina Sofía, IMIBIC, UCO, Córdoba. Spain
| | - Enrique Gomez-Gomez
- Department of Urology. Hospital Universitario Reina Sofía, IMIBIC, UCO, Córdoba. Spain
| |
Collapse
|
3
|
Chiu P. The pendulum swings: the return of primary surgical repair in paediatric aortic valve disease? Eur J Cardiothorac Surg 2023; 64:ezad310. [PMID: 37688567 DOI: 10.1093/ejcts/ezad310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Accepted: 09/07/2023] [Indexed: 09/11/2023] Open
Affiliation(s)
- Peter Chiu
- Department of Cardiac Surgery, Boston Children's Hospital, Boston, MA, USA
| |
Collapse
|
4
|
Agarwal A, Farkouh A, Saleh R, Abdel-Meguid Hamoda TAA, Harraz AM, Kavoussi P, Arafa M, Salvio G, Rambhatla A, Toprak T, Gül M, Phuoc NHV, Boitrelle F, Birowo P, Ghayda RA, Cannarella R, Kuroda S, Durairajanayagam D, Zini A, Wyns C, Sarikaya S, Tremellen K, Mostafa T, Sokolakis I, Evenson DP, Henkel R, Zohdy W, Chung E, Ziouziou I, Falcone M, Russo GI, Al-Hashimi M, Calogero AE, Ko E, Colpi G, Lewis S, Serefoglu EC, Bahar F, Martinez M, Nguyen Q, Ambar RF, Bakircioglu ME, Kandil H, Mogharabian N, Sabbaghian M, Taniguchi H, Tsujimura A, Sajadi H, Ibrahim W, Atmoko W, Vogiatzi P, Gunes S, Gilani MAS, Roychoudhury S, Güngör ND, Hakim L, Adriansjah R, Kothari P, Jindal S, Amar E, Park HJ, Long TQT, Homa S, Karthikeyan VS, Zilaitiene B, Rosas IM, Marino A, Pescatori E, Ozer C, Akhavizadegan H, Garrido N, Busetto GM, Adamyan A, Al-Marhoon M, Elbardisi H, Dolati P, Darbandi M, Darbandi S, Balercia G, Pinggera GM, Micic S, Ho CCK, Moussa M, Preto M, Zenoaga-Barbăroşie C, Smith RP, Kosgi R, de la Rosette J, El-Sakka AI, Abumelha SM, Mierzwa TC, Ong TA, Banihani SA, Bowa K, Fukuhara S, Boeri L, Danacıoğlu YO, Gokalp F, Selim OM, Cho CL, Tadros NN, Ugur MR, Ozkent MS, Chiu P, Kalkanli A, Khalafalla K, Vishwakarma RB, Finocchi F, Andreadakis S, Giulioni C, Çeker G, Ceyhan E, Malhotra V, Yilmaz M, Timpano M, Barrett TL, Kim SHK, Ahn ST, Giacone F, Palani A, Duarsa GWK, Kadioglu A, Gadda F, Zylbersztejn DS, Aydos K, Kulaksız D, Gupte D, Calik G, Karna KK, Drakopoulos P, Baser A, Kumar V, Molina JMC, Rajmil O, Ferreira RH, Leonardi S, Avoyan A, Sogutdelen E, Franco G, Ramsay J, Ramirez L, Shah R. Controversy and Consensus on Indications for Sperm DNA Fragmentation Testing in Male Infertility: A Global Survey, Current Guidelines, and Expert Recommendations. World J Mens Health 2023; 41:575-602. [PMID: 37118960 PMCID: PMC10307662 DOI: 10.5534/wjmh.220282] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [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: 12/23/2022] [Accepted: 01/02/2023] [Indexed: 04/30/2023] Open
Abstract
PURPOSE Sperm DNA fragmentation (SDF) testing was recently added to the sixth edition of the World Health Organization laboratory manual for the examination and processing of human semen. Many conditions and risk factors have been associated with elevated SDF; therefore, it is important to identify the population of infertile men who might benefit from this test. The purpose of this study was to investigate global practices related to indications for SDF testing, compare the relevant professional society guideline recommendations, and provide expert recommendations. MATERIALS AND METHODS Clinicians managing male infertility were invited to take part in a global online survey on SDF clinical practices. This was conducted following the CHERRIES checklist criteria. The responses were compared to professional society guideline recommendations related to SDF and the appropriate available evidence. Expert recommendations on indications for SDF testing were then formulated, and the Delphi method was used to reach consensus. RESULTS The survey was completed by 436 experts from 55 countries. Almost 75% of respondents test for SDF in all or some men with unexplained or idiopathic infertility, 39% order it routinely in the work-up of recurrent pregnancy loss (RPL), and 62.2% investigate SDF in smokers. While 47% of reproductive urologists test SDF to support the decision for varicocele repair surgery when conventional semen parameters are normal, significantly fewer general urologists (23%; p=0.008) do the same. Nearly 70% would assess SDF before assisted reproductive technologies (ART), either always or for certain conditions. Recurrent ART failure is a common indication for SDF testing. Very few society recommendations were found regarding SDF testing. CONCLUSIONS This article presents the largest global survey on the indications for SDF testing in infertile men, and demonstrates diverse practices. Furthermore, it highlights the paucity of professional society guideline recommendations. Expert recommendations are proposed to help guide clinicians.
Collapse
Affiliation(s)
- Ashok Agarwal
- Global Andrology Forum, American Center for Reproductive Medicine, Moreland Hills, OH, USA
- Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Ala’a Farkouh
- Global Andrology Forum, American Center for Reproductive Medicine, Moreland Hills, OH, USA
| | - Ramadan Saleh
- Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Sohag University, Sohag, Egypt
| | - Taha Abo-Almagd Abdel-Meguid Hamoda
- Department of Urology, King Abdulaziz University, Jeddah, Saudi Arabia
- Department of Urology, Faculty of Medicine, Minia University, Minia, Egypt
| | - Ahmed M. Harraz
- Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
- Department of Surgery, Urology Unit, Farwaniya Hospital, Farwaniya, Kuwait
- Department of Urology, Sabah Al Ahmad Urology Center, Kuwait City, Kuwait
| | - Parviz Kavoussi
- Department of Reproductive Urology, Austin Fertility & Reproductive Medicine/Westlake IVF, Austin, TX, USA
| | - Mohamed Arafa
- Department of Urology, Hamad Medical Corporation, Doha, Qatar
- Department of Urology, Weill Cornell Medical-Qatar, Doha, Qatar
- Department of Andrology, Sexology and STIs, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Gianmaria Salvio
- Department of Endocrinology, Polytechnic University of Marche, Ancona, Italy
| | - Amarnath Rambhatla
- Department of Urology, Henry Ford Health System, Vattikuti Urology Institute, Detroit, MI, USA
| | - Tuncay Toprak
- Department of Urology, Fatih Sultan Mehmet Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Murat Gül
- Department of Urology, Selçuk University School of Medicine, Konya, Turkey
| | - Nguyen Ho Vinh Phuoc
- Department of Andrology, Binh Dan Hospital, Ho Chi Minh City, Vietnam
- Department of Urology and Andrology, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam
| | - Florence Boitrelle
- Reproductive Biology, Fertility Preservation, Andrology, CECOS, Poissy Hospital, Poissy, France
- Department of Biology, Reproduction, Epigenetics, Environment and Development, Paris Saclay University, UVSQ, INRAE, BREED, Jouy-en-Josas, France
| | - Ponco Birowo
- Department of Urology, Cipto Mangunkusumo General Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Ramy Abou Ghayda
- Urology Institute, University Hospitals, Case Western Reserve University, Cleveland, OH, USA
| | - Rossella Cannarella
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | | | - Damayanthi Durairajanayagam
- Department of Physiology, Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh Campus, Selangor, Malaysia
| | - Armand Zini
- Department of Surgery, McGill University, Montreal, QC, Canada
| | - Christine Wyns
- Department of Gynaecology-Andrology, Cliniques universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Selcuk Sarikaya
- Department of Urology, Gülhane Research and Training Hospital, University of Health Sciences, Ankara, Turkey
| | - Kelton Tremellen
- Department of Obstetrics Gynaecology and Reproductive Medicine, Flinders University, Bedford Park, Australia
| | - Taymour Mostafa
- Department of Andrology, Sexology and STIs, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Ioannis Sokolakis
- Department of Urology, Martha-Maria Hospital Nuremberg, Nuremberg, Germany
| | | | - Ralf Henkel
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
- Department of Medical Bioscience, University of the Western Cape, Bellville, South Africa
- LogixX Pharma, Theale, Berkshire, UK
| | - Wael Zohdy
- Department of Andrology, Sexology and STIs, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Eric Chung
- Department of Urology, Princess Alexandra Hospital, University of Queensland, Brisbane, QLD, Australia
| | - Imad Ziouziou
- Department of Urology, College of Medicine and Pharmacy, Ibn Zohr University, Agadir, Morocco
| | - Marco Falcone
- Department of Urology, Molinette Hospital, A.O.U. Città della Salute e della Scienza, University of Turin, Torino, Italy
| | | | - Manaf Al-Hashimi
- Department of Urology, Burjeel Hospital, Abu Dhabi, UAE
- Department of Urology, Clinical Urology, Khalifa University, College of Medicine and Health Sciences, Abu Dhabi, UAE
| | - Aldo E. Calogero
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Edmund Ko
- Department of Urology, Loma Linda University Health, Loma Linda, CA, USA
| | - Giovanni Colpi
- Andrology and IVF Center, Next Fertility Procrea, Lugano, Switzerland
| | | | - Ege Can Serefoglu
- Department of Urology, Biruni University School of Medicine, Istanbul, Turkey
| | - Fahmi Bahar
- Andrology Section, Siloam Sriwijaya Hospital, Palembang, Indonesia
| | - Marlon Martinez
- Section of Urology, Department of Surgery, University of Santo Tomas Hospital, Manila, Philippines
| | - Quang Nguyen
- Center for Andrology and Sexual Medicine, Viet Duc University Hospital, Hanoi, Vietnam
- Department of Urology, Andrology and Sexual Medicine, University of Medicine and Pharmacy, Vietnam National University, Hanoi, Vietnam
| | - Rafael F. Ambar
- Department of Urology, Centro Universitario em Saude do ABC, Santo André, Brazil
- Andrology Group at Ideia Fertil Institute of Human Reproduction, Santo André, Brazil
| | | | | | - Nasser Mogharabian
- Sexual Health and Fertility Research Center, Shahroud University of Medical Sciences, Shahroud, Iran
| | - Marjan Sabbaghian
- Department of Andrology, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Hisanori Taniguchi
- Department of Urology and Andrology, Kansai Medical University, Hirakata, Osaka, Japan
| | - Akira Tsujimura
- Department of Urology, Juntendo University Urayasu Hospital, Chiba, Japan
| | - Hesamoddin Sajadi
- Department of Andrology, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Wael Ibrahim
- Department of Obstetrics Gynaecology and Reproductive Medicine, Fertility Care Center in Cairo, Cairo, Egypt
| | - Widi Atmoko
- Department of Urology, Cipto Mangunkusumo General Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Paraskevi Vogiatzi
- Andromed Health & Reproduction, Fertility & Reproductive Health Diagnostic Center, Athens, Greece
| | - Sezgin Gunes
- Department of Medical Biology, Medical Faculty, Ondokuz Mayis University, Samsun, Turkey
| | - Mohammad Ali Sadighi Gilani
- Department of Andrology, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | | | - Nur Dokuzeylül Güngör
- Department of Obstetrics and Gynecology, Reproductive Endocrinology and IVF Unit, School of Medicine, Bahcesehir University, Istanbul, Turkey
| | - Lukman Hakim
- Department of Urology, Faculty of Medicine Universitas Airlangga, Universitas Airlangga Teaching Hospital, Surabaya, Indonesia
| | - Ricky Adriansjah
- Department of Urology, Faculty of Medicine Universitas Padjajaran, Hasan Sadikin General Hospital, Bandung, Indonesia
| | - Priyank Kothari
- Department of Urology, Topiwala National Medical College, B.Y.L Nair Ch Hospital, Mumbai, India
| | - Sunil Jindal
- Department of Andrology and Reproductive Medicine, Jindal Hospital, Meerut, India
| | - Edouard Amar
- Department of Urology, American Hospital of Paris, Paris, France
| | - Hyun Jun Park
- Department of Urology, Pusan National University School of Medicine, Busan, Korea
- Medical Research Institute of Pusan National University Hospital, Busan, Korea
| | - Tran Quang Tien Long
- Department of Obstetrics and Gynecology, Hanoi Obstetric and Gynecology Hospital, Hanoi, Vietnam
| | - Sheryl Homa
- Department of Biosciences, University of Kent, Canterbury, UK
| | | | - Birute Zilaitiene
- Institute of Endocrinology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | | | - Angelo Marino
- Reproductive Medicine Unit, ANDROS Day Surgery Clinic, Palermo, Italy
| | - Edoardo Pescatori
- Andrology and Reproductive Medicine Unit, Gynepro Medical, Bologna, Italy
| | - Cevahir Ozer
- Department of Urology, Faculty of Medicine, Baskent University, Ankara, Turkey
| | - Hamed Akhavizadegan
- Department of Urology, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Nicolas Garrido
- IVI Foundation, Instituto de Investigación Sanitaria La Fe (IIS La Fe), Valencia, Spain
| | - Gian Maria Busetto
- Department of Urology and Renal Transplantation, University of Foggia, Policlinico Riuniti, Foggia, Italy
| | - Aram Adamyan
- IVF Department, Astghik Medical Center, Yerevan, Armenia
| | - Mohamed Al-Marhoon
- Division of Urology, Department of Surgery, Sultan Qaboos University, Muscat, Sultanate of Oman
| | - Haitham Elbardisi
- Department of Urology, Hamad Medical Corporation, Doha, Qatar
- Department of Urology, Weill Cornell Medical-Qatar, Doha, Qatar
| | - Parisa Dolati
- Department of Animal Science, Faculty of Agriculture, University of Shiraz, Iran
| | - Mahsa Darbandi
- Fetal Health Research Center, Hope Generation Foundation, Tehran, Iran
- Gene Therapy and Regenerative Medicine Research Center, Hope Generation Foundation, Tehran, Iran
| | - Sara Darbandi
- Fetal Health Research Center, Hope Generation Foundation, Tehran, Iran
- Gene Therapy and Regenerative Medicine Research Center, Hope Generation Foundation, Tehran, Iran
| | - Giancarlo Balercia
- Department of Endocrinology, Polytechnic University of Marche, Ancona, Italy
| | | | - Sava Micic
- Department of Andrology, Uromedica Polyclinic, Belgrade, Serbia
| | | | - Mohamad Moussa
- Department of Urology, Lebanese University, Beirut, Lebanon
- Department of Urology, Al Zahraa Hospital, UMC, Lebanon
| | - Mirko Preto
- Department of Urology, Molinette Hospital, A.O.U. Città della Salute e della Scienza, University of Turin, Torino, Italy
| | | | - Ryan P. Smith
- Department of Urology, University of Virginia School of Medicine, Virginia, USA
| | - Raghavender Kosgi
- Department of Urology, Andrology and Renal Transplant, AIG Hospitals, Hyderabad, India
| | - Jean de la Rosette
- Department of Urology, Istanbul Medipol Mega University Hospital, Istanbul, Turkey
| | | | - Saad Mohammed Abumelha
- Division of Urology, Department of Surgery, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | | | - Teng Aik Ong
- Department of Surgery, University of Malaya, Kuala Lumpur, Malaysia
| | - Saleem A. Banihani
- Department of Medical Laboratory Sciences, Jordan University of Science and Technology, Irbid, Jordan
| | - Kasonde Bowa
- Department of Urology, University of Lusaka, Lusaka, Zambia
| | - Shinichiro Fukuhara
- Department of Urology, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Luca Boeri
- Department of Urology, IRCCS Fondazione Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Yavuz Onur Danacıoğlu
- Department of Urology, University of Health Science Istanbul Bakırköy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Fatih Gokalp
- Department of Urology, Hatay Mustafa Kemal University, Antakya, Turkey
| | - Osama Mohamed Selim
- Department of Andrology, Sexology and STIs, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Chak-Lam Cho
- S. H. Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong
| | | | | | | | - Peter Chiu
- S. H. Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong
| | - Arif Kalkanli
- Department of Urology, Taksim Education and Research Hospital, Istanbul, Turkey
| | - Kareim Khalafalla
- Department of Urology, Hamad Medical Corporation, Doha, Qatar
- Department of Urology, University of Illinois, Chicago, IL, USA
| | | | - Federica Finocchi
- Department of Endocrinology, Polytechnic University of Marche, Ancona, Italy
- Unit of Andrology and Reproductive Medicine, University of Padua, Padua, Italy
| | | | - Carlo Giulioni
- Department of Urology, Polytechnic University of Marche Region, Ancona, Italy
| | - Gökhan Çeker
- Department of Urology, Başakşehir Çam and Sakura City Hospital, Istanbul, Turkey
- Department of Embryology and Histology, Zonguldak Bülent Ecevit University Institute of Health Sciences, Zonguldak, Turkey
| | - Erman Ceyhan
- Department of Urology, Faculty of Medicine, Baskent University, Ankara, Turkey
| | - Vineet Malhotra
- Department of Urology, SCM Clinic and Hospital, New Delhi, India
| | - Mehmet Yilmaz
- Department of Urology, Faculty of Medicine, University of Freiburg-Medical Centre, Freiburg, Germany
| | - Massimiliano Timpano
- Department of Urology, Molinette Hospital, A.O.U. Città della Salute e della Scienza, University of Turin, Torino, Italy
| | | | - Shannon Hee Kyung Kim
- IVF Australia, Sydney, Australia
- Macquarie School of Medicine, Macquaire University, Sydney, Australia
| | - Sun-Tae Ahn
- Department of Urology, Korea University College of Medicine, Seoul, Korea
| | - Filippo Giacone
- Centro HERA, Unità di Medicina della Riproduzione, Sant'Agata Li Battiati, Catania, Italy
| | - Ayad Palani
- Research Centre, University of Garmian, Kalar, Iraq
| | | | - Ates Kadioglu
- Section of Andrology, Department of Urology, Istanbul University, Istanbul, Turkey
| | - Franco Gadda
- Department of Urology, IRCCS Fondazione Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | | | - Kaan Aydos
- Department of Urology, Ankara University, Ankara, Turkey
| | - Deniz Kulaksız
- Department of Obstetrics and Gynecology, University of Health Sciences Kanuni Training and Research Hospital, Trabzon, Turkey
| | - Deepak Gupte
- Department of Urology, Bombay Hospital and Medical Research Center, Mumbai, India
| | - Gokhan Calik
- Department of Urology, Istanbul Medipol University, Istanbul, Turkey
| | - Keshab Kumar Karna
- Department of Molecular Cell and Cancer Biology, University of Massachusetts Medical School, Worcester, MA, USA
| | - Panagiotis Drakopoulos
- Centre for Reproductive Medicine, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
- IVF Athens, Athens, Greece
| | - Aykut Baser
- Department of Urology, Bandirma Onyedi Eylül University, Balikesir, Turkey
| | - Vijay Kumar
- Department of Microbiology, Kurukshetra University, Kurukshetra, India
| | | | - Osvaldo Rajmil
- Department of Andrology, Fundacio Puigvert, Barcelona, Spain
| | | | - Sofia Leonardi
- Central Laboratory, Hospital Publico Materno Infantil de Salta, Salta, Argentina
| | - Armen Avoyan
- Urology Department, Astghik Medical Center, Yerevan, Armenia
| | | | - Giorgio Franco
- Department of Urology, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | | | - Liliana Ramirez
- IVF Laboratory, CITMER Reproductive Medicine, Mexico City, Mexico
| | - Rupin Shah
- Department of Urology, Lilavati Hospital and Research Centre, Mumbai, India
| | | |
Collapse
|
5
|
Chiu P, Zendejas B, Baird C. Multidisciplinary approach to vascular rings and vascular-related aerodigestive compression: a clinical practice review. Transl Pediatr 2023; 12:1258-1277. [PMID: 37427058 PMCID: PMC10326748 DOI: 10.21037/tp-23-39] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 01/19/2023] [Accepted: 06/06/2023] [Indexed: 07/11/2023] Open
Abstract
Vascular rings, including double aortic arch and right aortic arch with aberrant left subclavian and left ligamentum, are part of a larger group of vascular-related aerodigestive compression syndromes that also includes innominate artery compression syndrome, dysphagia lusoria, aortic arch anomalies, and aneurysms of either the aorta or pulmonary artery. Additionally, post-surgical airway compression is a distinct entity in itself. The approach to the diagnosis and management of these varied phenomena has been streamlined by the multidisciplinary team at Boston Children's Hospital. Echocardiography, computed tomographic angiography, esophagram, and three-phase dynamic bronchoscopy are routinely performed in these patients in order to produce a comprehensive understanding of the unique anatomic challenges that each patient presents. Adjunctive diagnostic techniques include modified barium swallow, routine preoperative and postoperative screening of the vocal cords, and radiographic identification of the artery of Adamkiewicz. Beyond the vascular reconstruction, which ranges from subclavian-to-carotid transposition to descending aortic translocation, we liberally apply tracheobronchopexy and rotational esophagoplasty to relieve respiratory and esophageal symptoms. Due to the heightened risk for recurrent laryngeal nerve injury, intraoperative recurrent laryngeal nerve monitoring has become routine in these cases. The comprehensive care of these patients requires the coordinated efforts of a large team of dedicated personnel in order to achieve the optimal result.
Collapse
Affiliation(s)
- Peter Chiu
- Department of Cardiac Surgery, Boston Children’s Hospital, Boston, MA, USA
| | | | - Christopher Baird
- Department of Cardiac Surgery, Boston Children’s Hospital, Boston, MA, USA
| |
Collapse
|
6
|
Chiu P, Baird CW. Commentary: One Ring to Rule Them All? J Thorac Cardiovasc Surg 2022:S0022-5223(22)01158-8. [DOI: 10.1016/j.jtcvs.2022.10.036] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 10/28/2022] [Indexed: 11/05/2022]
|
7
|
Reed AK, Chiu P, Carreon CK, Sanders SP, Del Nido PJ, Baird CW. Unrepairable Infant Mitral Valve: An Unexpected Case of Decompensated Heart Failure. Circulation 2022; 145:1175-1178. [PMID: 35404678 DOI: 10.1161/circulationaha.121.056881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | - Peter Chiu
- Department of Cardiac Surgery (P.C., P.J.d.N., C.W.B.), Boston Children's Hospital/Harvard Medical School, MA
| | - Chrystalle Katte Carreon
- Department of Pathology (C.K.C., S.P.S.), Boston Children's Hospital/Harvard Medical School, MA.,Cardiac Registry, Departments of Cardiology, Pathology, and Cardiac Surgery, Boston Children's Hospital, MA (C.K.C., S.P.S.)
| | - Stephen P Sanders
- Department of Pathology (C.K.C., S.P.S.), Boston Children's Hospital/Harvard Medical School, MA.,Cardiac Registry, Departments of Cardiology, Pathology, and Cardiac Surgery, Boston Children's Hospital, MA (C.K.C., S.P.S.)
| | - Pedro J Del Nido
- Department of Cardiac Surgery (P.C., P.J.d.N., C.W.B.), Boston Children's Hospital/Harvard Medical School, MA
| | - Christopher W Baird
- Department of Cardiac Surgery (P.C., P.J.d.N., C.W.B.), Boston Children's Hospital/Harvard Medical School, MA
| |
Collapse
|
8
|
Heidegger I, Kesch C, Kretschmer A, Tsaur I, Ceci F, Valerio M, Tilki D, Marra G, Preisser F, Fankhauser CD, Zattoni F, Chiu P, Puche-Sanz I, Olivier J, van den Bergh RCN, Kasivisvanathan V, Pircher A, Virgolini I, Gandaglia G. Biomarkers to personalize treatment with 177Lu-PSMA-617 in men with metastatic castration-resistant prostate cancer - a state of the art review. Ther Adv Med Oncol 2022; 14:17588359221081922. [PMID: 35273651 PMCID: PMC8902011 DOI: 10.1177/17588359221081922] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 02/02/2022] [Indexed: 01/11/2023] Open
Abstract
Radioligand therapy with Lutetium-177 (177Lu)-Prostate-specific membrane antigen (PSMA) has shown to prolong survival in metastatic castration resistant prostate cancer (mCRPC). One of the major challenges for clinicians in the future is to select those patients who would benefit most from this therapy to position it in the treatment landscape of mCRPC. This, in turn, will lead to the delivery of personalized therapies. In this narrative review article we summarize recent studies investigating both predictive and prognostic clinical, imaging-based, and molecular biomarkers to predict treatment response to 177Lu-PSMA-617 radioligand therapy with the aim of identifying men who should be considered for this approach. Of note, the evidence on the role of biomarkers currently relies on small retrospective trials and their validation in larger prospective cohorts is necessary before these results can be translated in the clinical practice.
Collapse
Affiliation(s)
- Isabel Heidegger
- Professor of Urology, Department of Urology, Medical University Innsbruck, 6020 Innsbruck, Austria
| | - Claudia Kesch
- Department of Urology, Essen University Hospital, Essen, Germany
| | | | - Igor Tsaur
- Department of Urology and Pediatric Urology, Mainz University Medicine, Mainz, Germany
| | - Francesco Ceci
- Division of Nuclear Medicine, IEO European Institute of Oncology, IRCCS, Milan, Italy
| | - Massimo Valerio
- Department of Urology, Lausanne University Hospital, Lausanne, Switzerland
| | - Derya Tilki
- Martini-Klinik Prostate Cancer Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Urology, Koç University Hospital, Istanbul, Turkey
| | - Giancarlo Marra
- Department of Urology, San Giovanni Battista Hospital, University of Torino, Turin, Italy
| | - Felix Preisser
- Department of Urology, University Hospital Frankfurt, Frankfurt, Germany
| | | | - Fabio Zattoni
- Urology Unit, Azienda Sanitaria Universitaria Integrata di Udine, Udine, Italy
| | - Peter Chiu
- Department of Surgery, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Ignacio Puche-Sanz
- Department of Urology, Bio-Health Research Institute, Hospital Universitario Virgende las Nieves, University of Granada, Granada, Spain
| | | | | | - Veeru Kasivisvanathan
- Division of Surgery and Interventional Science, University College London, London, UK
| | - Andreas Pircher
- Hematology and Oncology, Department of Internal Medicine V, Medical University Innsbruck, Innsbruck, Austria
| | - Irene Virgolini
- Department of Nuclear Medicine, Medical University Innsbruck, Innsbruck, Austria
| | - Giorgio Gandaglia
- Division of Oncology and Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
| |
Collapse
|
9
|
Wong C, Chu P, Teoh J, Chiu P, Yee CH, Chau L, Chan M, Wan H, Leung S, Ng CF. Risks of metabolic diseases and androgen deprivation therapy for prostate cancer in a Chinese population: a prospective multi-centre cohort study. Int Urol Nephrol 2022; 54:993-1000. [PMID: 35217907 DOI: 10.1007/s11255-022-03151-2] [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] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Accepted: 02/06/2022] [Indexed: 10/19/2022]
Abstract
PURPOSE Androgen deprivation therapy (ADT) use in prostate cancer (PCa) has seen a rising trend. We are looking into the relationship between ADT and development of metabolic diseases in Chinese patients. METHODS This is a prospective multi-centre cohort yielded from the READT database (Real-life experience of ADT in Asia), in which patients diagnosed of PCa and offered ADT were prospectively recruited since 2016. Chinese patients recruited from Hong Kong were selected and compared to another cohort of newly diagnosed PCa patients in Hong Kong (HK-Cap database), which was collected prospectively and retrieved retrospectively for this study. Patient outcomes are followed through for 2 years. We compared between the groups the new diagnoses of hypertension, diabetes and hyper-lipidaemia, as well as the initiation of related medication for these conditions. Baseline characteristics including pre-treatment comorbidities, medications and tumour characteristics are documented. RESULTS 151 patients receiving ADT (from READT database) and 447 patients not receiving ADT (from HK-Cap database) were analysed. ADT is related to higher risks of developing any of concerned medical co-morbidities (23.8% vs 13.0*, p = 0.001) and new-onset DM (16.6% vs 4.4%, p < 0.001). Initiation of new medications is also more common in ADT patients. New anti-hypertensives (37.8% vs 12.5%, p < 0.001), oral hypoglycemic agents (12.6% vs 4.9%, p = 0.001), insulin (4.0% vs 0.05%, p = 0.001) and statin (23.7% vs 12.8%, p = 0.023) are more commonly added in ADT cohort. CONCLUSION Chinese receiving ADT are exposed to increased risks of new-onset hypertension, diabetes and hyper-lipidaemia, and a higher likelihood of stepping up pharmaceutical control for pre-existing comorbidities. This highlights physicians' role to monitor metabolic profiles in at-risk men upon offering ADT.
Collapse
Affiliation(s)
- Chris Wong
- SH Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China.,Division of Urology, Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR, China
| | - Peggy Chu
- Urology Division, Department of Surgery, Tuen Mun Hospital, Tuen Mun, Hong Kong, China.,Urology Division, Department of Surgery, Pok Oi Hospital, Yuen Long, Hong Kong, China
| | - Jeremy Teoh
- SH Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China.,Division of Urology, Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR, China
| | - Peter Chiu
- SH Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China.,Division of Urology, Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR, China
| | - C H Yee
- SH Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China.,Division of Urology, Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR, China
| | - Lysander Chau
- Urology Division, Department of Surgery, Tuen Mun Hospital, Tuen Mun, Hong Kong, China.,Urology Division, Department of Surgery, Pok Oi Hospital, Yuen Long, Hong Kong, China
| | - Marco Chan
- Urology Division, Department of Surgery, Tuen Mun Hospital, Tuen Mun, Hong Kong, China.,Urology Division, Department of Surgery, Pok Oi Hospital, Yuen Long, Hong Kong, China
| | - Helen Wan
- SH Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China
| | - Steven Leung
- SH Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China
| | - C F Ng
- SH Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China. .,Division of Urology, Department of Surgery, Alice Ho Miu Ling Nethersole Hospital, Tai Po, Hong Kong, China. .,Division of Urology, Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR, China. .,Division of Urology, Department of Surgery, North District Hospital, Sheung Shui, Hong Kong, China.
| |
Collapse
|
10
|
Kretschmer A, van den Bergh RCN, Martini A, Marra G, Valerio M, Tsaur I, Heidegger I, Kasivisvanathan V, Kesch C, Preisser F, Fankhauser CD, Zattoni F, Ceci F, Olivier J, Chiu P, Puche-Sanz I, Thibault C, Gandaglia G, Tilki D. Assessment of Health-Related Quality of Life in Patients with Advanced Prostate Cancer-Current State and Future Perspectives. Cancers (Basel) 2021; 14:cancers14010147. [PMID: 35008310 PMCID: PMC8749907 DOI: 10.3390/cancers14010147] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 12/22/2021] [Accepted: 12/25/2021] [Indexed: 11/25/2022] Open
Abstract
Simple Summary In recent years, evidence regarding survival outcomes of novel therapies has increased significantly. However, less is known regarding the impact of novel therapy combinations on quality of life aspects of the treated patients. In the current comprehensive review, we discuss the importance of quality of life for patients with advanced prostate cancer, and present the most frequently used tools to evaluate quality of life in recent randomized trials. Further, we discuss the ease of use of these validated questionnaires for clinicians and try to focus on the suggested appropriate use as well as potential strategies for improvement of quality of life evaluation in these clinical scenarios of advanced prostate cancer. Abstract With the therapeutic landscape of advanced prostate cancer rapidly evolving and oncological benefits being shown for a plethora of new agents and indications, health-related quality of life (HRQOL)-associated evidence is still subpar. In the current comprehensive review, we discuss the importance of HRQOL for patients with advanced PC (metastatic hormone-sensitive prostate cancer (mHSPC), metastatic castration-resistant prostate cancer (mCRPC) and non-metastatic castration-resistant prostate cancer (nmCRPC)), and present the most frequently used tools to evaluate HRQOL in recent randomized trials. Furthermore, we discuss the ease of use of these validated questionnaires for clinicians and try to focus on the suggested appropriate use in clinical practice, as well as potential strategies for improvement of HRQOL evaluation in these clinical scenarios of advanced prostate cancer.
Collapse
Affiliation(s)
- Alexander Kretschmer
- Department of Urology, Ludwig-Maximilians University, 81377 Munich, Germany
- Correspondence: ; Tel.: +49-89440076531
| | | | - Alberto Martini
- Unit of Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, 20132 Milan, Italy; (A.M.); (G.G.)
| | - Giancarlo Marra
- Department of Urology, San Giovanni Battista Hospital, University of Torino, 10126 Torino, Italy;
| | - Massimo Valerio
- Department of Urology, CHUV Lausanne, 1011 Lausanne, Switzerland;
| | - Igor Tsaur
- Department of Urology and Pediatric Urology, Mainz University Medicine, 55131 Mainz, Germany;
| | - Isabel Heidegger
- Department of Urology, Medical University Innsbruck, 6020 Innsbruck, Austria;
| | - Veeru Kasivisvanathan
- Division of Surgery and Interventional Science, University College London, London W1W 7TY, UK;
| | - Claudia Kesch
- Department of Urology, University Hospital Essen, 45147 Essen, Germany;
| | - Felix Preisser
- Department of Urology, University Hospital Frankfurt, 60590 Frankfurt, Germany;
| | | | - Fabio Zattoni
- Department of Surgery, Oncology and Gastroenterology, University of Padua, 35128 Padua, Italy;
- Urology Unit, Academical Medical Centre Hospital, 33100 Udine, Italy
| | - Francesco Ceci
- Division of Nuclear Medicine, IEO European Institute of Oncology, 20141 Milan, Italy;
| | - Jonathan Olivier
- Department of Urology, Lille University Hospital, 59000 Lille, France;
| | - Peter Chiu
- SH Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China;
| | - Ignacio Puche-Sanz
- Department of Urology, Bio-Health Research Institute, Hospital Universitario Virgen de las Nieves, University of Granada, 18014 Granada, Spain;
| | - Constance Thibault
- Department of Medical Oncology, European Georges Pompidou Hospital, Assistance Publique des Hôpitaux de Paris, Paris Descartes University, 75004 Paris, France;
| | - Giorgio Gandaglia
- Unit of Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, 20132 Milan, Italy; (A.M.); (G.G.)
| | - Derya Tilki
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, 20246 Hamburg, Germany;
- Department of Urology, University Hospital Hamburg-Eppendorf, 20246 Hamburg, Germany
- Department of Urology, Koc University Hospital, 34010 Istanbul, Turkey
| | | |
Collapse
|
11
|
Chiu P, Lee HP, Dalal AR, Koyano T, Nguyen M, Connolly AJ, Chaudhuri O, Fischbein MP. Relative strain is a novel predictor of aneurysmal degeneration of the thoracic aorta: An ex vivo mechanical study. JVS Vasc Sci 2021; 2:235-246. [PMID: 34806052 PMCID: PMC8585654 DOI: 10.1016/j.jvssci.2021.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 08/28/2021] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE Current guidelines for prophylactic replacement of the thoracic aorta, primarily based on size alone, may not be adequate in identifying patients at risk for either progression of disease or aortic catastrophe. We undertook the current study to determine whether the mechanical properties of the aorta might be able to predict aneurysmal dilatation of the aorta using a clinical database and benchtop mechanical testing of human aortic tissue. METHODS Using over 400 samples from 31 patients, mechanical properties were studied in (a) normal aorta and then (b) between normal and diseased aorta using linear mixed-effects models. A machine learning technique was used to predict aortic growth rate over time using mechanical properties and baseline clinical characteristics. RESULTS Healthy aortic tissue under in vivo loading conditions, after accounting for aortic segment location, had lower longitudinal elastic modulus compared with circumferential elastic modulus: -166.8 kPa (95% confidence interval [CI]: -210.8 to -122.7, P < .001). Fracture toughness was also lower in the longitudinal vs circumferential direction: -201.2 J/m3 (95% CI: -272.9 to -129.5, P < .001). Finally, relative strain was lower in the longitudinal direction compared with the circumferential direction: -0.01 (95% CI: -0.02 to -0.004, P = .002). Patients with diseased aorta, after accounting for segment location and sample direction, had decreased toughness compared with normal aorta, -431.7 J/m3 (95% CI: -628.6 to -234.8, P < .001), and increased relative strain, 0.09 (95% CI: 0.04 to 0.14, P = .003). CONCLUSIONS Increasing relative strain was identified as a novel independent predictor of aneurysmal degeneration. Noninvasive measurement of relative strain may aid in the identification and monitoring of patients at risk for aneurysmal degeneration. (JVS-Vascular Science 2021;2:1-12.). CLINICAL RELEVANCE Aortic aneurysm surveillance and prophylactic surgical recommendations are based on computed tomographic angiogram aortic dimensions and growth rate measurements. However, aortic catastrophes may occur at small sizes, confounding current risk stratification models. Herein, we report that increasing aortic relative strain, that is, greater distensibility, is associated with growth over time, thus potentially identifying patients at risk for dissection/rupture.
Collapse
Affiliation(s)
- Peter Chiu
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford University, Stanford, Calif
| | - Hong-Pyo Lee
- Department of Mechanical Engineering, Stanford University, Stanford, Calif
| | - Alex R. Dalal
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford University, Stanford, Calif
| | - Tiffany Koyano
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford University, Stanford, Calif
| | - Marie Nguyen
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford University, Stanford, Calif
| | - Andrew J. Connolly
- Department of Pathology, University of California San Francisco, San Francisco, Calif
| | - Ovijit Chaudhuri
- Department of Mechanical Engineering, Stanford University, Stanford, Calif
| | - Michael P. Fischbein
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford University, Stanford, Calif
| |
Collapse
|
12
|
Lo KL, Leung D, Lai Z, Li C, Ma SF, Wong J, Yuen KK, Li J, Chiu P, Mak SK, Wong J, Ng CF. Picture-in-picture video demonstration of systematic transperineal prostate biopsy. Hong Kong Med J 2021; 27:304-305. [PMID: 34413262 DOI: 10.12809/hkmj208864] [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: 11/05/2022] Open
Affiliation(s)
- K L Lo
- Department of Surgery, The Chinese University of Hong Kong, Hong Kong
| | - D Leung
- Department of Surgery, The Chinese University of Hong Kong, Hong Kong
| | - Z Lai
- Department of Surgery, The Chinese University of Hong Kong, Hong Kong
| | - C Li
- Department of Surgery, The Chinese University of Hong Kong, Hong Kong
| | - S F Ma
- Department of Surgery, The Chinese University of Hong Kong, Hong Kong
| | - J Wong
- Department of Surgery, The Chinese University of Hong Kong, Hong Kong
| | - K K Yuen
- Department of Surgery, The Chinese University of Hong Kong, Hong Kong
| | - J Li
- Department of Surgery, The Chinese University of Hong Kong, Hong Kong
| | - P Chiu
- Department of Surgery, The Chinese University of Hong Kong, Hong Kong
| | - S K Mak
- Department of Surgery, The Chinese University of Hong Kong, Hong Kong
| | - J Wong
- Department of Surgery, The Chinese University of Hong Kong, Hong Kong
| | - C F Ng
- Department of Surgery, The Chinese University of Hong Kong, Hong Kong
| |
Collapse
|
13
|
Aikens RC, Rigdon J, Lee J, Baiocchi M, Goldstone AB, Chiu P, Woo YJ, Chen JH. stratamatch: Prognostic Score Stratification Using a Pilot Design. R J 2021; 13:614-630. [PMID: 35821911 PMCID: PMC9273035 DOI: 10.32614/rj-2021-063] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
In a block-randomized controlled trial, individuals are subdivided by prognostically important baseline characteristics (e.g., age group, sex, or smoking status), prior to randomization. This step reduces the heterogeneity between the treatment groups with respect to the baseline factors most important to determining the outcome, thus enabling more precise estimation of treatment effect. The stratamatch package extends this approach to the observational setting by implementing functions to separate an observational data set into strata and interrogate the quality of different stratification schemes. Once an acceptable stratification is found, treated and control individuals can be matched by propensity score within strata, thereby recapitulating the block-randomized trial design for the observational study. The stratification scheme implemented by stratamatch applies a "pilot design" approach (Aikens, Greaves, and Baiocchi 2019) to estimate a quantity called the prognostic score (Hansen 2008), which is used to divide individuals into strata. The potential benefits of such an approach are twofold. First, stratifying the data enables more computationally efficient matching of large data sets. Second, methodological studies suggest that using a prognostic score to inform the matching process increases the precision of the effect estimate and reduces sensitivity to bias from unmeasured confounding factors (Aikens et al. 2019; Leacy and Stuart 2014; Antonelli, Cefalu, Palmer, and Agniel 2018). A common mistake is to believe reserving more data for the analysis phase of a study is always better. Instead, the stratamatch approach suggests how clever use of data in the design phase of large studies can lead to major benefits in the robustness of the study conclusions.
Collapse
|
14
|
Chiu P, Jennings RW, Marx G, Baird CW. Aortic elongation and bronchial splint for late bronchial complication after neonatal arch reconstruction. JTCVS Tech 2021; 8:126-128. [PMID: 34401831 PMCID: PMC8350805 DOI: 10.1016/j.xjtc.2021.04.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 04/15/2021] [Indexed: 11/25/2022] Open
Affiliation(s)
- Peter Chiu
- Department of Cardiac Surgery, Boston Children's Hospital, Boston, Mass
| | | | - Gerald Marx
- Department of Cardiology, Boston Children's Hospital, Boston, Mass
| | | |
Collapse
|
15
|
Chiu P, Emani S. Left Ventricular Recruitment in Patients With Hypoplastic Left Heart Syndrome. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 2021; 24:30-36. [PMID: 34116780 DOI: 10.1053/j.pcsu.2021.03.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 12/29/2020] [Revised: 02/22/2021] [Accepted: 03/05/2021] [Indexed: 11/11/2022]
Abstract
Hypoplastic left heart complex with "borderline left ventricle" and intact ventricular septum is a clinical conundrum for the congenital heart surgeon. The choice between neonatal biventricular repair and single ventricle palliation can be challenging, and the current tools to aid in the decision-making process fail to account for the morbidity associated with intermediate and late diastolic dysfunction. Staged ventricular recruitment, consisting of valvular repair techniques, resection of endocardial fibroelastosis, atrial septal restriction, and augmentation of pulmonary blood flow, has been shown to improve left ventricular size and function culminating in eventual biventricular circulation. Despite staged ventricular recruitment, some patients cannot undergo biventricular conversion. Strategies to address these complex patients, including the "reverse" double switch, are the next frontier in biventricular repair.
Collapse
Affiliation(s)
- Peter Chiu
- Department of Cardiac Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Sitaram Emani
- Department of Cardiac Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts.
| |
Collapse
|
16
|
Baiocchi M, Woo YJ, Chiu P, Goldstone AB. The role and significance of sensitivity analyses in enhancing the statistical validity of clinical studies. J Thorac Cardiovasc Surg 2020; 163:749-753. [DOI: 10.1016/j.jtcvs.2020.09.134] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 08/31/2020] [Accepted: 09/03/2020] [Indexed: 01/30/2023]
|
17
|
Bäumler K, Vedula V, Sailer AM, Seo J, Chiu P, Mistelbauer G, Chan FP, Fischbein MP, Marsden AL, Fleischmann D. Fluid-structure interaction simulations of patient-specific aortic dissection. Biomech Model Mechanobiol 2020; 19:1607-1628. [PMID: 31993829 DOI: 10.1007/s10237-020-01294-8] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [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: 08/26/2019] [Accepted: 01/14/2020] [Indexed: 12/01/2022]
Abstract
Credible computational fluid dynamic (CFD) simulations of aortic dissection are challenging, because the defining parallel flow channels-the true and the false lumen-are separated from each other by a more or less mobile dissection membrane, which is made up of a delaminated portion of the elastic aortic wall. We present a comprehensive numerical framework for CFD simulations of aortic dissection, which captures the complex interplay between physiologic deformation, flow, pressures, and time-averaged wall shear stress (TAWSS) in a patient-specific model. Our numerical model includes (1) two-way fluid-structure interaction (FSI) to describe the dynamic deformation of the vessel wall and dissection flap; (2) prestress and (3) external tissue support of the structural domain to avoid unphysiologic dilation of the aortic wall and stretching of the dissection flap; (4) tethering of the aorta by intercostal and lumbar arteries to restrict translatory motion of the aorta; and a (5) independently defined elastic modulus for the dissection flap and the outer vessel wall to account for their different material properties. The patient-specific aortic geometry is derived from computed tomography angiography (CTA). Three-dimensional phase contrast magnetic resonance imaging (4D flow MRI) and the patient's blood pressure are used to inform physiologically realistic, patient-specific boundary conditions. Our simulations closely capture the cyclical deformation of the dissection membrane, with flow simulations in good agreement with 4D flow MRI. We demonstrate that decreasing flap stiffness from [Formula: see text] to [Formula: see text] kPa (a) increases the displacement of the dissection flap from 1.4 to 13.4 mm, (b) decreases the surface area of TAWSS by a factor of 2.3, (c) decreases the mean pressure difference between true lumen and false lumen by a factor of 0.63, and (d) decreases the true lumen flow rate by up to 20% in the abdominal aorta. We conclude that the mobility of the dissection flap substantially influences local hemodynamics and therefore needs to be accounted for in patient-specific simulations of aortic dissection. Further research to accurately measure flap stiffness and its local variations could help advance future CFD applications.
Collapse
Affiliation(s)
- Kathrin Bäumler
- 3D and Quantitative Imaging Laboratory, Department of Radiology, Stanford University, Stanford, CA, 94305, USA.
| | - Vijay Vedula
- Department of Pediatrics (Cardiology), Stanford University, Stanford, CA, 94305, USA
| | - Anna M Sailer
- 3D and Quantitative Imaging Laboratory, Department of Radiology, Stanford University, Stanford, CA, 94305, USA
| | - Jongmin Seo
- Department of Pediatrics (Cardiology), Stanford University, Stanford, CA, 94305, USA
| | - Peter Chiu
- Department of Cardiothoracic Surgery, Stanford University, Stanford, CA, 94305, USA
| | - Gabriel Mistelbauer
- Department of Simulation and Graphics, University of Magdeburg, Magdeburg, Germany
| | - Frandics P Chan
- 3D and Quantitative Imaging Laboratory, Department of Radiology, Stanford University, Stanford, CA, 94305, USA
| | - Michael P Fischbein
- Department of Cardiothoracic Surgery, Stanford University, Stanford, CA, 94305, USA
| | - Alison L Marsden
- Department of Bioengineering, Stanford University, Stanford, CA, 94305, USA
| | - Dominik Fleischmann
- 3D and Quantitative Imaging Laboratory, Department of Radiology, Stanford University, Stanford, CA, 94305, USA
| |
Collapse
|
18
|
Ogawa Y, Watkins AC, Lingala B, Nathan I, Chiu P, Iwakoshi S, He H, Lee JT, Fischbein M, Woo YJ, Dake MD. Improved midterm outcomes after endovascular repair of nontraumatic descending thoracic aortic rupture compared with open surgery. J Thorac Cardiovasc Surg 2019; 161:2004-2012. [PMID: 31926735 DOI: 10.1016/j.jtcvs.2019.10.156] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [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: 04/03/2019] [Revised: 10/23/2019] [Accepted: 10/24/2019] [Indexed: 01/16/2023]
Abstract
BACKGROUND Thoracic endovascular aortic repair (TEVAR) has become first-line treatment for descending thoracic aortic rupture (DTAR), but its midterm and long-term outcomes remain undescribed. This study evaluated whether TEVAR would improve midterm outcomes of nontraumatic DTAR relative to open surgical repair (OSR). METHODS Between December 1999 and October 2018, 118 patients with DTAR were treated with either OSR (n = 39) or TEVAR (n = 79) at a single center. Primary end points were 30-day and long-term all-cause mortalities. Secondary end points included stroke, permanent spinal cord ischemia (SCI), prolonged ventilation support or tracheostomy, permanent hemodialysis, and aortic reintervention. RESULTS Thirty-day mortality was significantly lower with TEVAR (OSR, 38.5%; TEVAR, 16.5%; P = .01). Stroke (15.6% vs 3.8%; P = .03), permanent SCI (15.6% vs 2.5%; P = .02), prolonged ventilation (30.8% vs 8.9%; P = .002), and tracheostomy (12.8% vs 2.5%; P = .04) were significantly lower after TEVAR than OSR. Need for hemodialysis trended higher after OSR (12.8% vs 5.1%; P = .2). Mean follow ups were 1048 ± 1591 days for OSR group and 828 ± 1258 days for TEVAR. All-cause mortality at last follow-up was significantly lower after TEVAR than OSR (35.4% vs 66.7%; P = .001). Aortic reintervention was required more frequently within 30 days after TEVAR (15.2% vs 2.6%; P = .06). By multivariate analysis, TAAA was an independent predictor for mortality. CONCLUSIONS TEVAR improves both early and midterm outcomes of DTAR relative to OSR. TAAA was a predictor of mortality. Endovascular approach to DTAR may provide the greatest chance at survival.
Collapse
Affiliation(s)
- Yukihisa Ogawa
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, Calif
| | - A Claire Watkins
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, Calif
| | - Bharathi Lingala
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, Calif
| | - Itoga Nathan
- Division of Vascular Surgery, Stanford University School of Medicine, Stanford, Calif
| | - Peter Chiu
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, Calif
| | - Shinichi Iwakoshi
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, Calif
| | - Hao He
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, Calif
| | - Jason T Lee
- Division of Vascular Surgery, Stanford University School of Medicine, Stanford, Calif
| | - Michael Fischbein
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, Calif
| | - Y Joseph Woo
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, Calif
| | - Michael D Dake
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, Calif; University of Arizona Heath Sciences, Tucson, Ariz.
| |
Collapse
|
19
|
Lin J, Matthews G, Wohleber RW, Funke GJ, Calhoun GL, Ruff HA, Szalma J, Chiu P. Overload and automation-dependence in a multi-UAS simulation: Task demand and individual difference factors. J Exp Psychol Appl 2019; 26:218-235. [PMID: 31621357 DOI: 10.1037/xap0000248] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Future unmanned aerial systems (UAS) operations will require control of multiple vehicles. Operators are vulnerable to cognitive overload, despite support from system automation. This study tested whether attentional resource theory predicts impacts of cognitive demands on performance measures, including automation-dependence and stress. It also investigated individual differences in response to demands. One-hundred and 1 university student participants performed a multi-UAS simulation mission incorporating 2 surveillance tasks. Cognitive demands and level of automation (LOA) of key tasks were manipulated between-subjects. Results were partially consistent with predictions. Higher task demands impaired performance and elevated distress and workload, as expected. Higher LOA produced greater dependence on automation, but failed to mitigate workload. It was expected that, as the automation was quite reliable, participants would attempt to conserve resources by depending more on automation under high demand. In fact, the opposite tendency was observed. Individuals high in conscientiousness were especially likely to override the automation under high demand, apparently taking charge personally. Neuroticism and distress were also associated with performance, but results did not fit a resource theory interpretation. Thus, understanding impacts of overload in the multi-UAS context requires understanding operator strategy as well as resource insufficiency. Findings have implications for system design, and operator selection and training. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
Collapse
|
20
|
Goldstone AB, Chiu P, Baiocchi M, Lingala B, Lee J, Rigdon J, Fischbein MP, Woo YJ. Interfacility Transfer of Medicare Beneficiaries With Acute Type A Aortic Dissection and Regionalization of Care in the United States. Circulation 2019; 140:1239-1250. [PMID: 31589488 PMCID: PMC9856243 DOI: 10.1161/circulationaha.118.038867] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [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: 01/23/2023]
Abstract
BACKGROUND The feasibility and effectiveness of delaying surgery to transfer patients with acute type A aortic dissection-a catastrophic disease that requires prompt intervention-to higher-volume aortic surgery hospitals is unknown. We investigated the hypothesis that regionalizing care at high-volume hospitals for acute type A aortic dissections will lower mortality. We further decomposed this hypothesis into subparts, investigating the isolated effect of transfer and the isolated effect of receiving care at a high-volume versus a low-volume facility. METHODS We compared the operative mortality and long-term survival between 16 886 Medicare beneficiaries diagnosed with an acute type A aortic dissection between 1999 and 2014 who (1) were transferred versus not transferred, (2) underwent surgery at high-volume versus low-volume hospitals, and (3) were rerouted versus not rerouted to a high-volume hospital for treatment. We used a preference-based instrumental variable design to address unmeasured confounding and matching to separate the effect of transfer from volume. RESULTS Between 1999 and 2014, 40.5% of patients with an acute type A aortic dissection were transferred, and 51.9% received surgery at a high-volume hospital. Interfacility transfer was not associated with a change in operative mortality (risk difference, -0.69%; 95% CI, -2.7% to 1.35%) or long-term mortality. Despite delaying surgery, a regionalization policy that transfers patients to high-volume hospitals was associated with a 7.2% (95% CI, 4.1%-10.3%) absolute risk reduction in operative mortality; this association persisted in the long term (hazard ratio, 0.81; 95% CI, 0.75-0.87). The median distance needed to reroute each patient to a high-volume hospital was 50.1 miles (interquartile range, 12.4-105.4 miles). CONCLUSIONS Operative and long-term mortality were substantially reduced in patients with acute type A aortic dissection who were rerouted to high-volume hospitals. Policy makers should evaluate the feasibility and benefits of regionalizing the surgical treatment of acute type A aortic dissection in the United States.
Collapse
Affiliation(s)
- Andrew B. Goldstone
- Department of Cardiothoracic Surgery, Stanford University, Stanford, California,Department of Health Research and Policy, Stanford University, Stanford, California
| | - Peter Chiu
- Department of Cardiothoracic Surgery, Stanford University, Stanford, California,Department of Health Research and Policy, Stanford University, Stanford, California
| | - Michael Baiocchi
- Stanford Prevention Research Center, Department of Medicine, Stanford University, Stanford, California
| | - Bharathi Lingala
- Department of Cardiothoracic Surgery, Stanford University, Stanford, California
| | - Justin Lee
- Quantitative Sciences Unit, Department of Medicine, Stanford University, Stanford, California
| | - Joseph Rigdon
- Quantitative Sciences Unit, Department of Medicine, Stanford University, Stanford, California
| | | | - Y. Joseph Woo
- Department of Cardiothoracic Surgery, Stanford University, Stanford, California
| |
Collapse
|
21
|
Collier PN, Twin HC, Knegtel RMA, Boyall D, Brenchley G, Davis CJ, Keily S, Mak C, Miller A, Pierard F, Settimo L, Bolton CM, Chiu P, Curnock A, Doyle E, Tanner AJ, Jimenez JM. Discovery of Selective, Orally Bioavailable Pyrazolopyridine Inhibitors of Protein Kinase Cθ (PKCθ) That Ameliorate Symptoms of Experimental Autoimmune Encephalomyelitis. ACS Med Chem Lett 2019; 10:1134-1139. [PMID: 31417666 DOI: 10.1021/acsmedchemlett.9b00134] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 06/27/2019] [Indexed: 11/28/2022] Open
Abstract
PKCθ plays an important role in T cell biology and is a validated target for a number of disease states. A series of potent and selective PKCθ inhibitors were designed and synthesized starting from a HTS hit compound. Cell activity, while initially a challenge to achieve, was built into the series by transforming the nitrile unit of the scaffold into a primary amine, the latter predicted to form a new hydrogen bond to Asp508 near the entrance of the ATP binding site of PKCθ. Significant improvements in physiochemical parameters were observed on introduction of an oxetane group proximal to a primary amine leading to compound 22, which demonstrated a reduction of symptoms in a mouse model of multiple sclerosis.
Collapse
Affiliation(s)
- Philip N. Collier
- Vertex Pharmaceuticals Inc., 50 Northern Avenue, Boston, Massachusetts 02210, United States
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Elisabeth Doyle
- Vertex Pharmaceuticals Inc., 50 Northern Avenue, Boston, Massachusetts 02210, United States
| | | | | |
Collapse
|
22
|
Chiu P, Goldstone AB, Schaffer JM, Lingala B, Miller DC, Mitchell RS, Woo YJ, Fischbein MP, Dake MD. Endovascular Versus Open Repair of Intact Descending Thoracic Aortic Aneurysms. J Am Coll Cardiol 2019; 73:643-651. [PMID: 30765029 PMCID: PMC6675458 DOI: 10.1016/j.jacc.2018.10.086] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [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: 08/06/2018] [Revised: 10/22/2018] [Accepted: 10/30/2018] [Indexed: 01/16/2023]
Abstract
BACKGROUND For the management of descending thoracic aortic aneurysms, recent evidence has suggested that outcomes of open surgical repair may surpass thoracic endovascular aortic repair (TEVAR) in as early as 2 years. OBJECTIVES The purpose of this study was to evaluate the comparative effectiveness of TEVAR and open surgical repair in the treatment of intact descending thoracic aortic aneurysms. METHODS Using the Medicare database, a retrospective study using regression discontinuity design and propensity score matching was performed on patients with intact descending thoracic aortic aneurysms who underwent TEVAR or open surgical repair between 1999 and 2010 with follow-up through 2014. Survival was assessed with restricted mean survival time. Perioperative mortality was assessed with logistic regression. Reintervention was evaluated as a secondary outcome. RESULTS Matching created comparable groups with 1,235 open surgical repair patients matched to 2,470 TEVAR patients. The odds of perioperative mortality were greater for open surgical repair: high-volume center, odds ratio (OR): 1.97 (95% confidence interval [CI]: 1.53 to 2.61); low-volume center, OR: 3.62 (95% CI: 2.88 to 4.51). The restricted mean survival time difference favored TEVAR at 9 years, -209.2 days (95% CI: -298.7 to -119.7 days; p < 0.001) for open surgical repair. Risk of reintervention was lower for open surgical repair, hazard ratio: 0.40 (95% CI: 0.34 to 0.60; p < 0.001). CONCLUSIONS Open surgical repair was associated with increased odds of early postoperative mortality but reduced late hazard of death. Despite the late advantage of open repair, mean survival was superior for TEVAR. TEVAR should be considered the first line for repair of intact descending thoracic aortic aneurysms in Medicare beneficiaries.
Collapse
Affiliation(s)
- Peter Chiu
- Department of Cardiothoracic Surgery, Stanford University, School of Medicine, Stanford, California; Department of Health and Research Policy, Stanford University, School of Medicine, Stanford, California
| | - Andrew B Goldstone
- Department of Cardiothoracic Surgery, Stanford University, School of Medicine, Stanford, California; Department of Health and Research Policy, Stanford University, School of Medicine, Stanford, California
| | | | - Bharathi Lingala
- Department of Cardiothoracic Surgery, Stanford University, School of Medicine, Stanford, California
| | - D Craig Miller
- Department of Cardiothoracic Surgery, Stanford University, School of Medicine, Stanford, California
| | - R Scott Mitchell
- Department of Cardiothoracic Surgery, Stanford University, School of Medicine, Stanford, California
| | - Y Joseph Woo
- Department of Cardiothoracic Surgery, Stanford University, School of Medicine, Stanford, California
| | - Michael P Fischbein
- Department of Cardiothoracic Surgery, Stanford University, School of Medicine, Stanford, California
| | - Michael D Dake
- Department of Cardiothoracic Surgery, Stanford University, School of Medicine, Stanford, California.
| |
Collapse
|
23
|
Chiu P, Rotto TJ, Goldstone AB, Whisenant JB, Woo YJ, Fischbein MP. Time-to-operation does not predict outcome in acute type A aortic dissection complicated by neurologic injury at presentation. J Thorac Cardiovasc Surg 2018; 158:665-672. [PMID: 30712911 DOI: 10.1016/j.jtcvs.2018.12.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 12/02/2018] [Accepted: 12/07/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVE Neurologic injury complicating the presentation of acute type A aortic dissection remains a challenge for cardiac surgeons. METHODS This was a retrospective review of patients undergoing open repair of acute type A aortic dissection at our institution between January 2005 and December 2015. Evidence of neurologic injury at the time of presentation was abstracted from the medical record. Propensity-score matching was used to account for baseline differences between groups, and outcome analysis was performed using logistic regression and Kaplan-Meier analysis. Among patients with persistent neurologic deficits, a threshold for time-to-operation was evaluated using receiver operating characteristic curves. RESULTS There were 345 patients who underwent open repair for acute type A aortic dissection; 50 patients presented with neurologic injury. In the matched analysis, in-hospital mortality was greater among patients who presented with neurologic deficits (odds ratio, 4.42; 95% confidence interval, 1.15-16.97; P = .03). Among patients with persistent neurologic deficits at presentation, receiver operating characteristic curve analysis with cross-validation suggested that time-to-operation was a poor predictor of both neurologic outcome (area under the curve, 0.40) and death (area under the curve, 0.49). CONCLUSIONS Neurologic injury at the time of presentation with acute type A aortic dissection was associated with an increased risk of in-hospital mortality. Among patients with persistent neurological deficits, time-to-operation failed to predict either neurologic outcome or perioperative mortality suggesting that longer time from onset of symptoms of neurologic injury should not act as a contraindication to proceeding to the operating room for expedient repair.
Collapse
Affiliation(s)
- Peter Chiu
- Department of Cardiothoracic Surgery, School of Medicine, Stanford University, Stanford, Calif
| | - Torsten J Rotto
- Department of Cardiothoracic Surgery, School of Medicine, Stanford University, Stanford, Calif
| | - Andrew B Goldstone
- Department of Cardiothoracic Surgery, School of Medicine, Stanford University, Stanford, Calif
| | - Joshua B Whisenant
- Department of Cardiothoracic Surgery, School of Medicine, Stanford University, Stanford, Calif
| | - Y Joseph Woo
- Department of Cardiothoracic Surgery, School of Medicine, Stanford University, Stanford, Calif
| | - Michael P Fischbein
- Department of Cardiothoracic Surgery, School of Medicine, Stanford University, Stanford, Calif.
| |
Collapse
|
24
|
Chiu P, Goldstone AB, Woo YJ. Would evolving recommendations for mechanical mitral valve replacement further raise the bar for successful mitral valve repair? Eur J Cardiothorac Surg 2018; 54:622-626. [PMID: 30165483 DOI: 10.1093/ejcts/ezy284] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Peter Chiu
- Department of Cardiothoracic Surgery, Stanford University, Stanford, CA, USA
| | - Andrew B Goldstone
- Department of Cardiothoracic Surgery, Stanford University, Stanford, CA, USA
| | - Y Joseph Woo
- Department of Cardiothoracic Surgery, Stanford University, Stanford, CA, USA
| |
Collapse
|
25
|
Chiu P, Tsou S, Goldstone AB, Louie M, Woo YJ, Fischbein MP. Immediate operation for acute type A aortic dissection complicated by visceral or peripheral malperfusion. J Thorac Cardiovasc Surg 2018; 156:18-24.e3. [DOI: 10.1016/j.jtcvs.2018.01.096] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Revised: 11/23/2017] [Accepted: 01/07/2018] [Indexed: 10/18/2022]
|
26
|
Hughes M, Lin C, Chiu P, Hsieh Y, Shieh S, Wong T, Chuong C. 1297 Lanyu pig skin pigment regeneration model. J Invest Dermatol 2018. [DOI: 10.1016/j.jid.2018.03.1313] [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: 11/25/2022]
|
27
|
Goldstone AB, Chiu P, Baiocchi M, Wang H, Lingala B, Boyd JH, Woo YJ. Second Arterial Versus Venous Conduits for Multivessel Coronary Artery Bypass Surgery in California. Circulation 2018; 137:1698-1707. [PMID: 29242351 PMCID: PMC9856244 DOI: 10.1161/circulationaha.117.030959] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [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] [Received: 08/05/2017] [Accepted: 11/29/2017] [Indexed: 01/24/2023]
Abstract
BACKGROUND Whether a second arterial conduit improves outcomes after multivessel coronary artery bypass grafting remains unclear. Consequently, arterial conduits other than the left internal thoracic artery are seldom used in the United States. METHODS Using a state-maintained clinical registry including all 126 nonfederal hospitals in California, we compared all-cause mortality and rates of stroke, myocardial infarction, repeat revascularization, and sternal wound infection between propensity score-matched cohorts who underwent primary, isolated multivessel coronary artery bypass grafting with the left internal thoracic artery, and who received a second arterial conduit (right internal thoracic artery or radial artery, n=5866) or a venous conduit (n=53 566) between 2006 and 2011. Propensity score matching using 34 preoperative characteristics yielded 5813 matched sets. A subgroup analysis compared outcomes between propensity score-matched recipients of a right internal thoracic artery (n=1576) or a radial artery (n=4290). RESULTS Second arterial conduit use decreased from 10.7% in 2006 to 9.1% in 2011 (P<0.0001). However, receipt of a second arterial conduit was associated with significantly lower mortality (13.1% versus 10.6% at 7 years; hazard ratio, 0.79; 95% confidence interval [CI], 0.72-0.87), and lower risks of myocardial infarction (hazard ratio, 0.78; 95% CI, 0.70-0.87) and repeat revascularization (hazard ratio, 0.82; 95% CI, 0.76-0.88). In comparison with radial artery grafts, right internal thoracic artery grafts were associated with similar mortality rates (right internal thoracic artery 10.3% versus radial artery 10.7% at 7 years; hazard ratio, 1.10; 95% CI, 0.89-1.37) and individual risks of cardiovascular events, but the risk of sternal wound infection was increased (risk difference, 1.07%; 95% CI, 0.15-2.07). CONCLUSIONS Second arterial conduit use in California is low and declining, but arterial grafts were associated with significantly lower mortality and fewer cardiovascular events. A right internal thoracic artery graft offered no benefit over that of a radial artery, but did increase risk of sternal wound infection. These findings suggest surgeons should consider lowering their threshold for using arterial grafts, and the radial artery may be the preferred second conduit.
Collapse
Affiliation(s)
- Andrew B. Goldstone
- Department of Cardiothoracic Surgery, 300 Pasteur Drive, Falk Building, Stanford University, Stanford, CA 94305,Department of Health Research and Policy, 150 Governor’s Lane, HRP Redwood Building, Stanford University, Stanford, CA 94305
| | - Peter Chiu
- Department of Cardiothoracic Surgery, 300 Pasteur Drive, Falk Building, Stanford University, Stanford, CA 94305,Department of Health Research and Policy, 150 Governor’s Lane, HRP Redwood Building, Stanford University, Stanford, CA 94305
| | - Michael Baiocchi
- Stanford Prevention Research Center, Department of Medicine, 1265 Welch Road, Stanford University, Stanford, CA 94305
| | - Hanjay Wang
- Department of Cardiothoracic Surgery, 300 Pasteur Drive, Falk Building, Stanford University, Stanford, CA 94305
| | - Bharathi Lingala
- Department of Cardiothoracic Surgery, 300 Pasteur Drive, Falk Building, Stanford University, Stanford, CA 94305
| | - Jack H. Boyd
- Department of Cardiothoracic Surgery, 300 Pasteur Drive, Falk Building, Stanford University, Stanford, CA 94305
| | - Y. Joseph Woo
- Department of Cardiothoracic Surgery, 300 Pasteur Drive, Falk Building, Stanford University, Stanford, CA 94305
| |
Collapse
|
28
|
Affiliation(s)
| | - Peter Chiu
- Stanford University School of Medicine, Stanford, CA
| | - Y Joseph Woo
- Stanford University School of Medicine, Stanford, CA
| |
Collapse
|
29
|
Abstract
INTRODUCTION Elderly patients are at risk of drug-related problems. This study aimed to determine whether a pharmacist-led medication review programme could reduce inappropriate medications and hospital readmissions among geriatric in-patients in Hong Kong. METHODS This prospective controlled study was conducted in a geriatric unit of a regional hospital in Hong Kong. The study period was from December 2013 to September 2014. Two hundred and twelve patients were allocated to receive either routine care (104) or pharmacist intervention (108) that included medication reconciliation, medication review, and medication counselling. Medication appropriateness was assessed by a pharmacist using the Medication Appropriateness Index. Recommendations made by the pharmacist were communicated to physicians. RESULTS At hospital admission, 51.9% of intervention and 58.7% of control patients had at least one inappropriate medication (P=0.319). Unintended discrepancy applied in 19.4% of intervention patients of which 90.7% were due to omissions. Following pharmacist recommendations, 60 of 93 medication reviews and 32 of 41 medication reconciliations (68.7%) were accepted by physicians and implemented. After the program and at discharge, the proportion of subjects with inappropriate medications in the intervention group was significantly lower than that in the control group (28.0% vs 56.4%; P<0.001). The unplanned hospital readmission rate 1 month after discharge was significantly lower in the intervention group than that in the control group (13.2% vs 29.1%; P=0.005). Overall, 98.0% of intervention subjects were satisfied with the programme. There were no differences in the length of hospital stay, number of emergency department visits, or mortality rate between the intervention and control groups. CONCLUSIONS A pharmacist-led medication review programme that was supported by geriatricians significantly reduced the number of inappropriate medications and unplanned hospital readmissions among geriatric in-patients.
Collapse
Affiliation(s)
- P Chiu
- Geriatric Medical Unit, Grantham Hospital, Wong Chuk Hang, Hong Kong
| | - A Lee
- Pharmacy, Grantham Hospital, Wong Chuk Hang, Hong Kong
| | - T See
- Pharmacy, Grantham Hospital, Wong Chuk Hang, Hong Kong
| | - F Chan
- Geriatric Medical Unit, Grantham Hospital, Wong Chuk Hang, Hong Kong
| |
Collapse
|
30
|
Zhang XX, Ko RYY, Xie XQ, Qi WP, Li PC, Chiu P. Application of a rhodium-catalyzed cyclization cycloaddition cascade strategy to the total synthesis of (−)-curcumol. Org Chem Front 2018. [DOI: 10.1039/c7qo01150d] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The first de novo total synthesis of (−)-curcumol was accomplished using a rhodium-catalyzed cyclization–cycloaddition cascade reaction as the key step.
Collapse
Affiliation(s)
- X. X. Zhang
- College of Pharmaceutical Sciences
- Zhejiang University of Technology
- Hangzhou
- P. R. China
| | - R. Y. Y. Ko
- Department of Chemistry and State Key Laboratory of Synthetic Chemistry
- The University of Hong Kong
- P. R. China
| | - X. Q. Xie
- College of Pharmaceutical Sciences
- Zhejiang University of Technology
- Hangzhou
- P. R. China
| | - W. P. Qi
- College of Pharmaceutical Sciences
- Zhejiang University of Technology
- Hangzhou
- P. R. China
| | - P. C. Li
- College of Pharmaceutical Sciences
- Zhejiang University of Technology
- Hangzhou
- P. R. China
| | - P. Chiu
- Department of Chemistry and State Key Laboratory of Synthetic Chemistry
- The University of Hong Kong
- P. R. China
| |
Collapse
|
31
|
Abstract
BACKGROUND In patients undergoing aortic-valve or mitral-valve replacement, either a mechanical or biologic prosthesis is used. Biologic prostheses have been increasingly favored despite limited evidence supporting this practice. METHODS We compared long-term mortality and rates of reoperation, stroke, and bleeding between inverse-probability-weighted cohorts of patients who underwent primary aortic-valve replacement or mitral-valve replacement with a mechanical or biologic prosthesis in California in the period from 1996 through 2013. Patients were stratified into different age groups on the basis of valve position (aortic vs. mitral valve). RESULTS From 1996 through 2013, the use of biologic prostheses increased substantially for aortic-valve and mitral-valve replacement, from 11.5% to 51.6% for aortic-valve replacement and from 16.8% to 53.7% for mitral-valve replacement. Among patients who underwent aortic-valve replacement, receipt of a biologic prosthesis was associated with significantly higher 15-year mortality than receipt of a mechanical prosthesis among patients 45 to 54 years of age (30.6% vs. 26.4% at 15 years; hazard ratio, 1.23; 95% confidence interval [CI], 1.02 to 1.48; P=0.03) but not among patients 55 to 64 years of age. Among patients who underwent mitral-valve replacement, receipt of a biologic prosthesis was associated with significantly higher mortality than receipt of a mechanical prosthesis among patients 40 to 49 years of age (44.1% vs. 27.1%; hazard ratio, 1.88; 95% CI, 1.35 to 2.63; P<0.001) and among those 50 to 69 years of age (50.0% vs. 45.3%; hazard ratio, 1.16; 95% CI, 1.04 to 1.30; P=0.01). The incidence of reoperation was significantly higher among recipients of a biologic prosthesis than among recipients of a mechanical prosthesis. Patients who received mechanical valves had a higher cumulative incidence of bleeding and, in some age groups, stroke than did recipients of a biologic prosthesis. CONCLUSIONS The long-term mortality benefit that was associated with a mechanical prosthesis, as compared with a biologic prosthesis, persisted until 70 years of age among patients undergoing mitral-valve replacement and until 55 years of age among those undergoing aortic-valve replacement. (Funded by the National Institutes of Health and the Agency for Healthcare Research and Quality.).
Collapse
Affiliation(s)
- Andrew B Goldstone
- From the Departments of Cardiothoracic Surgery (A.B.G., P.C., B.L., W.L.P., M.P.F., Y.J.W.) and Health Research and Policy (A.B.G., P.C.) and the Stanford Prevention Research Center, Department of Medicine (M.B.), School of Medicine, Stanford University, Stanford, CA
| | - Peter Chiu
- From the Departments of Cardiothoracic Surgery (A.B.G., P.C., B.L., W.L.P., M.P.F., Y.J.W.) and Health Research and Policy (A.B.G., P.C.) and the Stanford Prevention Research Center, Department of Medicine (M.B.), School of Medicine, Stanford University, Stanford, CA
| | - Michael Baiocchi
- From the Departments of Cardiothoracic Surgery (A.B.G., P.C., B.L., W.L.P., M.P.F., Y.J.W.) and Health Research and Policy (A.B.G., P.C.) and the Stanford Prevention Research Center, Department of Medicine (M.B.), School of Medicine, Stanford University, Stanford, CA
| | - Bharathi Lingala
- From the Departments of Cardiothoracic Surgery (A.B.G., P.C., B.L., W.L.P., M.P.F., Y.J.W.) and Health Research and Policy (A.B.G., P.C.) and the Stanford Prevention Research Center, Department of Medicine (M.B.), School of Medicine, Stanford University, Stanford, CA
| | - William L Patrick
- From the Departments of Cardiothoracic Surgery (A.B.G., P.C., B.L., W.L.P., M.P.F., Y.J.W.) and Health Research and Policy (A.B.G., P.C.) and the Stanford Prevention Research Center, Department of Medicine (M.B.), School of Medicine, Stanford University, Stanford, CA
| | - Michael P Fischbein
- From the Departments of Cardiothoracic Surgery (A.B.G., P.C., B.L., W.L.P., M.P.F., Y.J.W.) and Health Research and Policy (A.B.G., P.C.) and the Stanford Prevention Research Center, Department of Medicine (M.B.), School of Medicine, Stanford University, Stanford, CA
| | - Y Joseph Woo
- From the Departments of Cardiothoracic Surgery (A.B.G., P.C., B.L., W.L.P., M.P.F., Y.J.W.) and Health Research and Policy (A.B.G., P.C.) and the Stanford Prevention Research Center, Department of Medicine (M.B.), School of Medicine, Stanford University, Stanford, CA
| |
Collapse
|
32
|
Murphy GH, Chiu P, Triantafyllopoulou P, Barnoux M, Blake E, Cooke J, Forrester-Jones RVE, Gore NJ, Beecham JK. Offenders with intellectual disabilities in prison: what happens when they leave? J Intellect Disabil Res 2017; 61:957-968. [PMID: 28573662 DOI: 10.1111/jir.12374] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Revised: 01/11/2017] [Accepted: 03/14/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND People with intellectual disabilities, if convicted of offences, may be sentenced to prison, but little is known about their life when they are released. METHOD This study followed up men with intellectual disabilities who were leaving prisons in England. RESULTS The men were hard to contact, but 38 men were interviewed, on average 10 weeks after leaving prison. The men were living in a variety of situations and often were very under-occupied, with limited social networks. A total of 70% were above the clinical cut-off for anxiety, and 59.5% were above the clinical cut-off for depression. The men were receiving little support in the community, and many had been reinterviewed by police. CONCLUSIONS Community teams need to provide better support to this very vulnerable group.
Collapse
Affiliation(s)
- G H Murphy
- Tizard Centre, University of Kent, Canterbury, UK
| | - P Chiu
- Tizard Centre, University of Kent, Canterbury, UK
| | | | - M Barnoux
- Tizard Centre, University of Kent, Canterbury, UK
| | - E Blake
- Tizard Centre, University of Kent, Canterbury, UK
| | - J Cooke
- Tizard Centre, University of Kent, Canterbury, UK
| | | | - N J Gore
- Tizard Centre, University of Kent, Canterbury, UK
| | | |
Collapse
|
33
|
Chiu P, Trojan J, Tsou S, Goldstone AB, Woo YJ, Fischbein MP. Limited root repair in acute type A aortic dissection is safe but results in increased risk of reoperation. J Thorac Cardiovasc Surg 2017; 155:1-7.e1. [PMID: 29042100 DOI: 10.1016/j.jtcvs.2017.08.137] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [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: 05/10/2017] [Revised: 06/28/2017] [Accepted: 08/24/2017] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Management of the aortic root is a challenge for surgeons treating acute type A aortic dissection. METHODS We performed a retrospective review of the acute type A aortic dissection experience at Stanford Hospital between 2005 and 2015 and identified patients who underwent either limited root repair or aortic root replacement. Differences in baseline characteristics were balanced with inverse probability weighting to estimate the average treatment effect on the controls. Weighted logistic regression was used to evaluate in-hospital mortality. Weighted Cox proportional hazards regression was used to evaluate differences in the hazard for mid-term death. Reoperation was evaluated with death as a competing risk with the Fine-Gray subdistribution hazard. RESULTS After we excluded patients managed either nonoperatively or with definitive endovascular repair, there were 293 patients without connective tissue disease who underwent either limited root repair or aortic root replacement. There was no difference in weighted perioperative mortality, odds ratio 0.89 (95% confidence interval [CI], 0.44-1.76, P = .7), and there was no difference in weighted survival, hazard ratio 1.12 (95% CI, 0.54-2.31, P = .8). Risk of reoperation was greater in limited root repair (11.8%, 95% CI, 0.0%-23.8%) than for root replacement (0%), P < .001. CONCLUSIONS Limited root repair was associated with increased risk of late reoperation after repair of acute type A aortic dissection. Surgeons with adequate experience may consider aortic root replacement in well-selected patients. However, given good outcomes after limited root repair, surgeons should not feel compelled to perform this more-complex operation.
Collapse
Affiliation(s)
- Peter Chiu
- Department of Cardiothoracic Surgery, Stanford University, School of Medicine, Stanford, Calif; Division of Health Research and Policy, Stanford University, School of Medicine, Stanford, Calif
| | - Jeffrey Trojan
- Department of Cardiothoracic Surgery, Stanford University, School of Medicine, Stanford, Calif
| | - Sarah Tsou
- Department of Cardiothoracic Surgery, Stanford University, School of Medicine, Stanford, Calif
| | - Andrew B Goldstone
- Department of Cardiothoracic Surgery, Stanford University, School of Medicine, Stanford, Calif; Division of Health Research and Policy, Stanford University, School of Medicine, Stanford, Calif
| | - Y Joseph Woo
- Department of Cardiothoracic Surgery, Stanford University, School of Medicine, Stanford, Calif
| | - Michael P Fischbein
- Department of Cardiothoracic Surgery, Stanford University, School of Medicine, Stanford, Calif.
| |
Collapse
|
34
|
Chiu P, Edmonson A, Brewer ZE, Woo YJ. Resection of a Giant Cardiac Lymphovenous Malformation Involving the Right Atrioventricular Groove. Ann Thorac Surg 2017; 104:e257-e259. [PMID: 28838522 DOI: 10.1016/j.athoracsur.2017.04.052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Revised: 04/15/2017] [Accepted: 04/19/2017] [Indexed: 10/19/2022]
Abstract
Lymphovenous malformations of the heart are rare, and optimal management is uncertain. We present a case of a 39-year-old gentleman with a giant symptomatic lymphovenous malformation involving the right atrium, ventricle, and coronary artery. Radical resection was performed with replacement of the tricuspid valve and bovine pericardial reconstruction of the atrium and ventricle. Additional coronary artery bypass grafting was performed to the acute marginal and distal right coronary artery. Radical resection for this benign process is feasible and may be considered given the possibility of recurrence seen with lymphatic malformations of other parts of the body.
Collapse
Affiliation(s)
- Peter Chiu
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, California
| | - Amanda Edmonson
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, California
| | - Zachary E Brewer
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, California
| | - Y Joseph Woo
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, California.
| |
Collapse
|
35
|
Wong V, Yung M, Chan L, Lee J, Lee K, Chiu P, Wong S, Ng E. OR38: Does Early Total Parenteral Nutrition Improve Post-Operative Outcome for Intestinal Obstruction? – A Randomized Controlled Trial. Clin Nutr 2017. [DOI: 10.1016/s0261-5614(17)30749-5] [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]
|
36
|
Loong H, Mo F, Li L, Lee C, Lam KC, Koh J, Chiu P, Teoh A, Chan A, Ng E, Yeo W. A Phase I/II study everolimus in combination with paclitaxel-carboplatin in patients with advanced adenocarcinoma of the stomach. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx367.035] [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: 11/14/2022] Open
|
37
|
Chiu P, Sailer AM, Baiocchi M, Goldstone AB, Schaffer JM, Trojan J, Fleischmann D, Mitchell RS, Miller DC, Dake MD, Woo YJ, Lee JT, Fischbein MP. Impact of Discordant Views in the Management of Descending Thoracic Aortic Aneurysm. Semin Thorac Cardiovasc Surg 2017; 29:283-291. [PMID: 29195571 DOI: 10.1053/j.semtcvs.2017.05.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/23/2017] [Indexed: 11/11/2022]
Abstract
Thoracic endovascular aortic repair has a lower perceived risk than open surgical repair and has become an increasingly popular alternative. Whether general consensus exists regarding candidacy for either operation among open and endovascular specialists is unknown. A retrospective review of isolated descending thoracic aortic aneurysm at our institution between January 2005 and October 2015 was performed, excluding trauma and dissection. Two cardiac surgeons, 2 cardiovascular surgeons, 1 vascular surgeon, and 1 interventional radiologist gave their preference for open vs endovascular repair. Interobserver agreement was assessed with the kappa coefficient. k-means clustering agnostically grouped various patterns of agreement. The mean rating was predicted using least absolute shrinkage and selection operator regression. Negative binomial regression predicted the discrepancy between our panel of raters and the historical operation. Generalized estimating equation modeling was then used to evaluate the association between the extent of discrepancy and the adverse perioperative outcome. There were 77 patients with preoperative imaging studies. Pairwise interobserver agreement was only fair (median weighted kappa 0.270 [interquartile range 0.211-0.404]). Increasing age and proximal neck length predicted an increasing preference for thoracic endovascular aortic repair in our panel; larger proximal neck diameter predicted a general preference for open surgical repair. Increasing proximal neck diameter predicted a larger discrepancy between our panel and the historical operation. Greater discrepancy was associated with adverse outcome. Substantial disagreement existed among our panel, and an exploratory analysis of the effect of increasing discrepancy demonstrated an association with adverse perioperative outcome. An investigation of the effect of a thoracic aortic team with open and endovascular specialists is warranted.
Collapse
Affiliation(s)
- Peter Chiu
- Department of Cardiothoracic Surgery, Stanford University, School of Medicine, Stanford, California
| | | | - Michael Baiocchi
- Stanford Prevention Center, Stanford University, School of Medicine, Stanford, California
| | - Andrew B Goldstone
- Department of Cardiothoracic Surgery, Stanford University, School of Medicine, Stanford, California
| | - Justin M Schaffer
- Department of Cardiothoracic Surgery, Stanford University, School of Medicine, Stanford, California
| | - Jeff Trojan
- Department of Cardiothoracic Surgery, Stanford University, School of Medicine, Stanford, California
| | - Dominik Fleischmann
- Department of Radiology, Stanford University, School of Medicine, Stanford, California
| | - R Scott Mitchell
- Department of Cardiothoracic Surgery, Stanford University, School of Medicine, Stanford, California
| | - D Craig Miller
- Department of Cardiothoracic Surgery, Stanford University, School of Medicine, Stanford, California
| | - Michael D Dake
- Department of Cardiothoracic Surgery, Stanford University, School of Medicine, Stanford, California
| | - Y Joseph Woo
- Department of Cardiothoracic Surgery, Stanford University, School of Medicine, Stanford, California
| | - Jason T Lee
- Division of Vascular Surgery, Stanford University, School of Medicine, Stanford, California
| | - Michael P Fischbein
- Department of Cardiothoracic Surgery, Stanford University, School of Medicine, Stanford, California.
| |
Collapse
|
38
|
Sailer AM, Nelemans PJ, Hastie TJ, Chin AS, Huininga M, Chiu P, Fischbein MP, Dake MD, Miller DC, Schurink GW, Fleischmann D. Prognostic significance of early aortic remodeling in acute uncomplicated type B aortic dissection and intramural hematoma. J Thorac Cardiovasc Surg 2017; 154:1192-1200. [PMID: 28668458 DOI: 10.1016/j.jtcvs.2017.04.064] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [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: 10/20/2016] [Revised: 03/02/2017] [Accepted: 04/03/2017] [Indexed: 01/16/2023]
Abstract
BACKGROUND Patients with Stanford type B aortic dissections (ADs) are at risk of long-term disease progression and late complications. The aim of this study was to evaluate the natural course and evolution of acute type B AD and intramural hematomas (IMHs) in patients who presented without complications during their initial hospital admission and who were treated with optimal medical management (MM). METHODS Databases from 2 aortic centers in Europe and the United States were used to identify 136 patients with acute type B AD (n = 92) and acute type B IMH (n = 44) who presented without complications during their index admission and were treated with MM. Computed tomography angiography scans were available at onset (≤14 days) and during follow-up for those patients. Relevant data, including evidence of adverse events during follow-up (AE; defined according to current guidelines), were retrieved from medical records and by reviewing computed tomography scan images. Aortic diameters were measured with dedicated 3-dimensional software. RESULTS The 1-, 2-, and 5-year event-free survival rates of patients with type B AD were 84.3% (95% confidence interval [CI], 74.4-90.6), 75.4% (95% CI, 64.0-83.7), and 62.6% (95% CI, 68.9-73.6), respectively. Corresponding estimates for IMH were 76.5% (95% CI, 57.8-87.8), 76.5% (95% CI, 57.8-87.8), and 68.9% (95% CI, 45.2-83.9), respectively. In patients with type B AD, risk of an AE increased with aortic growth within the first 6 months after onset. A diameter increase of 5 mm in the first half year was associated with a relative risk for AE of 2.29 (95% CI, 1.70-3.09) compared with the median 6 months' growth of 2.4 mm. In approximately 60% of patients with IMH, the abnormality resolved within 12 months and in the patients with nonresolving IMH, risk of an adverse event was greatest in the first year after onset and remained stable thereafter. CONCLUSIONS More than one third of patients with initially uncomplicated type B AD suffer an AE under MM within 5 years of initial diagnosis. In patients with nonresolving IMH, most adverse events are observed in the first year after onset. In patients with type B AD an early aortic growth is associated with a greater risk of AE.
Collapse
Affiliation(s)
- Anna M Sailer
- Department of Radiology, Stanford University School of Medicine, Stanford, Calif; Department of Radiology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Patricia J Nelemans
- Department of Epidemiology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Trevor J Hastie
- Department of Biomedical Data Sciences, Stanford University School of Medicine, Stanford, Calif; Department of Statistics, Stanford University, Stanford, Calif
| | - Anne S Chin
- Department of Radiology, Stanford University School of Medicine, Stanford, Calif
| | - Mark Huininga
- Department of Vascular Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Peter Chiu
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, Calif
| | - Michael P Fischbein
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, Calif
| | - Michael D Dake
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, Calif; Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, Calif
| | - D Craig Miller
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, Calif
| | - G W Schurink
- Department of Vascular Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Dominik Fleischmann
- Department of Radiology, Stanford University School of Medicine, Stanford, Calif; Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, Calif.
| |
Collapse
|
39
|
Sailer AM, van Kuijk SMJ, Nelemans PJ, Chin AS, Kino A, Huininga M, Schmidt J, Mistelbauer G, Bäumler K, Chiu P, Fischbein MP, Dake MD, Miller DC, Schurink GWH, Fleischmann D. Computed Tomography Imaging Features in Acute Uncomplicated Stanford Type-B Aortic Dissection Predict Late Adverse Events. Circ Cardiovasc Imaging 2017; 10:CIRCIMAGING.116.005709. [PMID: 28360261 DOI: 10.1161/circimaging.116.005709] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [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: 09/21/2016] [Accepted: 02/16/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND Medical treatment of initially uncomplicated acute Stanford type-B aortic dissection is associated with a high rate of late adverse events. Identification of individuals who potentially benefit from preventive endografting is highly desirable. METHODS AND RESULTS The association of computed tomography imaging features with late adverse events was retrospectively assessed in 83 patients with acute uncomplicated Stanford type-B aortic dissection, followed over a median of 850 (interquartile range 247-1824) days. Adverse events were defined as fatal or nonfatal aortic rupture, rapid aortic growth (>10 mm/y), aneurysm formation (≥6 cm), organ or limb ischemia, or new uncontrollable hypertension or pain. Five significant predictors were identified using multivariable Cox regression analysis: connective tissue disease (hazard ratio [HR] 2.94, 95% confidence interval [CI]: 1.29-6.72; P=0.01), circumferential extent of false lumen in angular degrees (HR 1.03 per degree, 95% CI: 1.01-1.04, P=0.003), maximum aortic diameter (HR 1.10 per mm, 95% CI: 1.02-1.18, P=0.015), false lumen outflow (HR 0.999 per mL/min, 95% CI: 0.998-1.000; P=0.055), and number of intercostal arteries (HR 0.89 per n, 95% CI: 0.80-0.98; P=0.024). A prediction model was constructed to calculate patient specific risk at 1, 2, and 5 years and to stratify patients into high-, intermediate-, and low-risk groups. The model was internally validated by bootstrapping and showed good discriminatory ability with an optimism-corrected C statistic of 70.1%. CONCLUSIONS Computed tomography imaging-based morphological features combined into a prediction model may be able to identify patients at high risk for late adverse events after an initially uncomplicated type-B aortic dissection.
Collapse
Affiliation(s)
- Anna M Sailer
- From the Department of Radiology (A.M.S., A.S.C., A.K., K.B., D.F.), Department of Cardiothoracic Surgery (P.C., M.P.F., M.D.D., D.C.M.), and the Stanford Cardiovascular Institute (M.D.D., D.F.), Stanford University School of Medicine, CA; Department of Radiology (A.M.S.), Department of Clinical Epidemiology and Medical Technology Assessment (S.M.J.v.K.), Department of Epidemiology (P.J.N.), and Department of Vascular Surgery (M.H., G.W.H.S.), Maastricht University Medical Center, The Netherlands; Institute of Simulation and Graphics, Otto von Guericke University Magdeburg, Germany (G.M.); and the Institute for Computer Graphics, Vienna University of Technology, Austria (J.S., G.M.)
| | - Sander M J van Kuijk
- From the Department of Radiology (A.M.S., A.S.C., A.K., K.B., D.F.), Department of Cardiothoracic Surgery (P.C., M.P.F., M.D.D., D.C.M.), and the Stanford Cardiovascular Institute (M.D.D., D.F.), Stanford University School of Medicine, CA; Department of Radiology (A.M.S.), Department of Clinical Epidemiology and Medical Technology Assessment (S.M.J.v.K.), Department of Epidemiology (P.J.N.), and Department of Vascular Surgery (M.H., G.W.H.S.), Maastricht University Medical Center, The Netherlands; Institute of Simulation and Graphics, Otto von Guericke University Magdeburg, Germany (G.M.); and the Institute for Computer Graphics, Vienna University of Technology, Austria (J.S., G.M.)
| | - Patricia J Nelemans
- From the Department of Radiology (A.M.S., A.S.C., A.K., K.B., D.F.), Department of Cardiothoracic Surgery (P.C., M.P.F., M.D.D., D.C.M.), and the Stanford Cardiovascular Institute (M.D.D., D.F.), Stanford University School of Medicine, CA; Department of Radiology (A.M.S.), Department of Clinical Epidemiology and Medical Technology Assessment (S.M.J.v.K.), Department of Epidemiology (P.J.N.), and Department of Vascular Surgery (M.H., G.W.H.S.), Maastricht University Medical Center, The Netherlands; Institute of Simulation and Graphics, Otto von Guericke University Magdeburg, Germany (G.M.); and the Institute for Computer Graphics, Vienna University of Technology, Austria (J.S., G.M.)
| | - Anne S Chin
- From the Department of Radiology (A.M.S., A.S.C., A.K., K.B., D.F.), Department of Cardiothoracic Surgery (P.C., M.P.F., M.D.D., D.C.M.), and the Stanford Cardiovascular Institute (M.D.D., D.F.), Stanford University School of Medicine, CA; Department of Radiology (A.M.S.), Department of Clinical Epidemiology and Medical Technology Assessment (S.M.J.v.K.), Department of Epidemiology (P.J.N.), and Department of Vascular Surgery (M.H., G.W.H.S.), Maastricht University Medical Center, The Netherlands; Institute of Simulation and Graphics, Otto von Guericke University Magdeburg, Germany (G.M.); and the Institute for Computer Graphics, Vienna University of Technology, Austria (J.S., G.M.)
| | - Aya Kino
- From the Department of Radiology (A.M.S., A.S.C., A.K., K.B., D.F.), Department of Cardiothoracic Surgery (P.C., M.P.F., M.D.D., D.C.M.), and the Stanford Cardiovascular Institute (M.D.D., D.F.), Stanford University School of Medicine, CA; Department of Radiology (A.M.S.), Department of Clinical Epidemiology and Medical Technology Assessment (S.M.J.v.K.), Department of Epidemiology (P.J.N.), and Department of Vascular Surgery (M.H., G.W.H.S.), Maastricht University Medical Center, The Netherlands; Institute of Simulation and Graphics, Otto von Guericke University Magdeburg, Germany (G.M.); and the Institute for Computer Graphics, Vienna University of Technology, Austria (J.S., G.M.)
| | - Mark Huininga
- From the Department of Radiology (A.M.S., A.S.C., A.K., K.B., D.F.), Department of Cardiothoracic Surgery (P.C., M.P.F., M.D.D., D.C.M.), and the Stanford Cardiovascular Institute (M.D.D., D.F.), Stanford University School of Medicine, CA; Department of Radiology (A.M.S.), Department of Clinical Epidemiology and Medical Technology Assessment (S.M.J.v.K.), Department of Epidemiology (P.J.N.), and Department of Vascular Surgery (M.H., G.W.H.S.), Maastricht University Medical Center, The Netherlands; Institute of Simulation and Graphics, Otto von Guericke University Magdeburg, Germany (G.M.); and the Institute for Computer Graphics, Vienna University of Technology, Austria (J.S., G.M.)
| | - Johanna Schmidt
- From the Department of Radiology (A.M.S., A.S.C., A.K., K.B., D.F.), Department of Cardiothoracic Surgery (P.C., M.P.F., M.D.D., D.C.M.), and the Stanford Cardiovascular Institute (M.D.D., D.F.), Stanford University School of Medicine, CA; Department of Radiology (A.M.S.), Department of Clinical Epidemiology and Medical Technology Assessment (S.M.J.v.K.), Department of Epidemiology (P.J.N.), and Department of Vascular Surgery (M.H., G.W.H.S.), Maastricht University Medical Center, The Netherlands; Institute of Simulation and Graphics, Otto von Guericke University Magdeburg, Germany (G.M.); and the Institute for Computer Graphics, Vienna University of Technology, Austria (J.S., G.M.)
| | - Gabriel Mistelbauer
- From the Department of Radiology (A.M.S., A.S.C., A.K., K.B., D.F.), Department of Cardiothoracic Surgery (P.C., M.P.F., M.D.D., D.C.M.), and the Stanford Cardiovascular Institute (M.D.D., D.F.), Stanford University School of Medicine, CA; Department of Radiology (A.M.S.), Department of Clinical Epidemiology and Medical Technology Assessment (S.M.J.v.K.), Department of Epidemiology (P.J.N.), and Department of Vascular Surgery (M.H., G.W.H.S.), Maastricht University Medical Center, The Netherlands; Institute of Simulation and Graphics, Otto von Guericke University Magdeburg, Germany (G.M.); and the Institute for Computer Graphics, Vienna University of Technology, Austria (J.S., G.M.)
| | - Kathrin Bäumler
- From the Department of Radiology (A.M.S., A.S.C., A.K., K.B., D.F.), Department of Cardiothoracic Surgery (P.C., M.P.F., M.D.D., D.C.M.), and the Stanford Cardiovascular Institute (M.D.D., D.F.), Stanford University School of Medicine, CA; Department of Radiology (A.M.S.), Department of Clinical Epidemiology and Medical Technology Assessment (S.M.J.v.K.), Department of Epidemiology (P.J.N.), and Department of Vascular Surgery (M.H., G.W.H.S.), Maastricht University Medical Center, The Netherlands; Institute of Simulation and Graphics, Otto von Guericke University Magdeburg, Germany (G.M.); and the Institute for Computer Graphics, Vienna University of Technology, Austria (J.S., G.M.)
| | - Peter Chiu
- From the Department of Radiology (A.M.S., A.S.C., A.K., K.B., D.F.), Department of Cardiothoracic Surgery (P.C., M.P.F., M.D.D., D.C.M.), and the Stanford Cardiovascular Institute (M.D.D., D.F.), Stanford University School of Medicine, CA; Department of Radiology (A.M.S.), Department of Clinical Epidemiology and Medical Technology Assessment (S.M.J.v.K.), Department of Epidemiology (P.J.N.), and Department of Vascular Surgery (M.H., G.W.H.S.), Maastricht University Medical Center, The Netherlands; Institute of Simulation and Graphics, Otto von Guericke University Magdeburg, Germany (G.M.); and the Institute for Computer Graphics, Vienna University of Technology, Austria (J.S., G.M.)
| | - Michael P Fischbein
- From the Department of Radiology (A.M.S., A.S.C., A.K., K.B., D.F.), Department of Cardiothoracic Surgery (P.C., M.P.F., M.D.D., D.C.M.), and the Stanford Cardiovascular Institute (M.D.D., D.F.), Stanford University School of Medicine, CA; Department of Radiology (A.M.S.), Department of Clinical Epidemiology and Medical Technology Assessment (S.M.J.v.K.), Department of Epidemiology (P.J.N.), and Department of Vascular Surgery (M.H., G.W.H.S.), Maastricht University Medical Center, The Netherlands; Institute of Simulation and Graphics, Otto von Guericke University Magdeburg, Germany (G.M.); and the Institute for Computer Graphics, Vienna University of Technology, Austria (J.S., G.M.)
| | - Michael D Dake
- From the Department of Radiology (A.M.S., A.S.C., A.K., K.B., D.F.), Department of Cardiothoracic Surgery (P.C., M.P.F., M.D.D., D.C.M.), and the Stanford Cardiovascular Institute (M.D.D., D.F.), Stanford University School of Medicine, CA; Department of Radiology (A.M.S.), Department of Clinical Epidemiology and Medical Technology Assessment (S.M.J.v.K.), Department of Epidemiology (P.J.N.), and Department of Vascular Surgery (M.H., G.W.H.S.), Maastricht University Medical Center, The Netherlands; Institute of Simulation and Graphics, Otto von Guericke University Magdeburg, Germany (G.M.); and the Institute for Computer Graphics, Vienna University of Technology, Austria (J.S., G.M.)
| | - D Craig Miller
- From the Department of Radiology (A.M.S., A.S.C., A.K., K.B., D.F.), Department of Cardiothoracic Surgery (P.C., M.P.F., M.D.D., D.C.M.), and the Stanford Cardiovascular Institute (M.D.D., D.F.), Stanford University School of Medicine, CA; Department of Radiology (A.M.S.), Department of Clinical Epidemiology and Medical Technology Assessment (S.M.J.v.K.), Department of Epidemiology (P.J.N.), and Department of Vascular Surgery (M.H., G.W.H.S.), Maastricht University Medical Center, The Netherlands; Institute of Simulation and Graphics, Otto von Guericke University Magdeburg, Germany (G.M.); and the Institute for Computer Graphics, Vienna University of Technology, Austria (J.S., G.M.)
| | - Geert Willem H Schurink
- From the Department of Radiology (A.M.S., A.S.C., A.K., K.B., D.F.), Department of Cardiothoracic Surgery (P.C., M.P.F., M.D.D., D.C.M.), and the Stanford Cardiovascular Institute (M.D.D., D.F.), Stanford University School of Medicine, CA; Department of Radiology (A.M.S.), Department of Clinical Epidemiology and Medical Technology Assessment (S.M.J.v.K.), Department of Epidemiology (P.J.N.), and Department of Vascular Surgery (M.H., G.W.H.S.), Maastricht University Medical Center, The Netherlands; Institute of Simulation and Graphics, Otto von Guericke University Magdeburg, Germany (G.M.); and the Institute for Computer Graphics, Vienna University of Technology, Austria (J.S., G.M.)
| | - Dominik Fleischmann
- From the Department of Radiology (A.M.S., A.S.C., A.K., K.B., D.F.), Department of Cardiothoracic Surgery (P.C., M.P.F., M.D.D., D.C.M.), and the Stanford Cardiovascular Institute (M.D.D., D.F.), Stanford University School of Medicine, CA; Department of Radiology (A.M.S.), Department of Clinical Epidemiology and Medical Technology Assessment (S.M.J.v.K.), Department of Epidemiology (P.J.N.), and Department of Vascular Surgery (M.H., G.W.H.S.), Maastricht University Medical Center, The Netherlands; Institute of Simulation and Graphics, Otto von Guericke University Magdeburg, Germany (G.M.); and the Institute for Computer Graphics, Vienna University of Technology, Austria (J.S., G.M.).
| |
Collapse
|
40
|
Okamura H, Emrich F, Trojan J, Chiu P, Dalal AR, Arakawa M, Sato T, Penov K, Koyano T, Pedroza A, Connolly AJ, Rabinovitch M, Alvira C, Fischbein MP. Long-term miR-29b suppression reduces aneurysm formation in a Marfan mouse model. Physiol Rep 2017; 5:5/8/e13257. [PMID: 28455451 PMCID: PMC5408287 DOI: 10.14814/phy2.13257] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Accepted: 03/23/2017] [Indexed: 11/24/2022] Open
Abstract
Aortic root aneurysm formation and subsequent dissection and/or rupture remain the leading cause of death in patients with Marfan syndrome. Our laboratory has reported that miR‐29b participates in aortic root/ascending aorta extracellular matrix remodeling during early aneurysm formation in Fbn1C1039G/+ Marfan mice. Herein, we sought to determine whether miR‐29b suppression can reduce aneurysm formation long‐term. Fbn1C1039G/+ Marfan mice were treated with retro‐orbital LNA‐anti‐miR‐29b inhibitor or scrambled‐control‐miR before aneurysms develop either (1) a single dose prenatally (pregnant Fbn1C1039G/+ mice at 14.5 days post‐coitum) (n = 8–10, each group) or (2) postnatally every other week, from 2 to 22 weeks of age, and sacrificed at 24 weeks (n = 8–10, each group). To determine if miR‐29b blockade was beneficial even after aneurysms develop, a third group of animals were treated every other week, starting at 8 weeks of age, until sacrificed (n = 4–6, each group). miR‐29b inhibition resulted in aneurysm reduction, increased elastogenesis, decreased matrix metalloproteinase activity and decreased elastin breakdown. Prenatal LNA‐anti‐miR‐29b inhibitor treatment decreased aneurysm formation up to age 32 weeks, whereas postnatal treatment was effective up to 16 weeks. miR‐29b blockade did not slow aortic growth once aneurysms already developed. Systemic miR‐29b inhibition significantly reduces aneurysm development long‐term in a Marfan mouse model. Drug administration during aortic wall embryologic development appears fundamental. miR‐29b suppression could be a potential therapeutic target for reducing aneurysm formation in Marfan syndrome patients.
Collapse
Affiliation(s)
- Homare Okamura
- Department of Cardiothoracic Surgery, Stanford University, Stanford, California
| | - Fabian Emrich
- Department of Cardiothoracic Surgery, Stanford University, Stanford, California
| | - Jeffrey Trojan
- Department of Cardiothoracic Surgery, Stanford University, Stanford, California
| | - Peter Chiu
- Department of Cardiothoracic Surgery, Stanford University, Stanford, California
| | - Alex R Dalal
- Department of Cardiothoracic Surgery, Stanford University, Stanford, California
| | - Mamoru Arakawa
- Department of Cardiothoracic Surgery, Stanford University, Stanford, California
| | - Tetsuya Sato
- Department of Cardiothoracic Surgery, Stanford University, Stanford, California
| | - Kiril Penov
- Department of Cardiothoracic Surgery, Stanford University, Stanford, California
| | - Tiffany Koyano
- Department of Cardiothoracic Surgery, Stanford University, Stanford, California
| | - Albert Pedroza
- Department of Cardiothoracic Surgery, Stanford University, Stanford, California
| | | | | | - Cristina Alvira
- Department of Pediatrics, Stanford University, Stanford, California
| | - Michael P Fischbein
- Department of Cardiothoracic Surgery, Stanford University, Stanford, California
| |
Collapse
|
41
|
Goldstone AB, Chiu P, Baiocchi M, Ligala B, Boyd J, Woo YJ. EFFECTIVENESS OF A SECOND ARTERIAL CONDUIT FOR MULTI VESSEL CORONARY BYPASS: A STATE-WIDE ANALYSIS OF 60,897 PATIENTS. J Am Coll Cardiol 2017. [DOI: 10.1016/s0735-1097(17)33415-0] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
42
|
Lin J, Wohleber R, Matthews G, Chiu P, Calhoun G, Ruff H, Funke G. Video Game Experience and Gender as Predictors of Performance and Stress During Supervisory Control of Multiple Unmanned Aerial Vehicles. ACTA ACUST UNITED AC 2016. [DOI: 10.1177/1541931215591175] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [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
To keep pace with increasing applications of Unmanned Aerial Vehicles (UAVs), recruitment of operators will need to be expanded to include groups not traditionally engaged in UAV pilot training. The present study may inform this process as it investigated the relationship between video game experience and gender on performance of imaging and weapon release tasks in a simulated multi-UAV supervisory control station. Each of 101 participants completed a 60 minute experimental trial. Workload and Level of Automation (LOA) were manipulated. Video gaming expertise correlated with performance on a demanding surveillance task component. Video gamers also placed more trust in the automation in demanding conditions and exhibited higher subjective task engagement and lower distress and worry. Results may encourage recruitment of UAV operators from nontraditional populations. Gamers may have a particular aptitude, and with gaming experience controlled, women show no disadvantage relative to men.
Collapse
Affiliation(s)
- Jinchao Lin
- Institute for Simulation & Training, University of Central Florida, Orlando, FL
| | - Ryan Wohleber
- Institute for Simulation & Training, University of Central Florida, Orlando, FL
| | - Gerald Matthews
- Institute for Simulation & Training, University of Central Florida, Orlando, FL
| | - Peter Chiu
- University of Cincinnati, Cincinnati, OH
| | | | | | - Gregory Funke
- Air Force Research Laboratory, Wright-Patterson AFB, OH
| |
Collapse
|
43
|
Chiu P, Palmon I, Fischbein MP. Giant saphenous vein graft aneurysm compressing the lingular bronchus. J Thorac Cardiovasc Surg 2016; 153:e1-e3. [PMID: 27771028 DOI: 10.1016/j.jtcvs.2016.08.062] [Citation(s) in RCA: 2] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Revised: 08/26/2016] [Accepted: 08/30/2016] [Indexed: 11/19/2022]
Affiliation(s)
- Peter Chiu
- Department of Cardiothoracic Surgery, Stanford University, School of Medicine, Stanford, Calif
| | - Itai Palmon
- Department of Cardiothoracic Surgery, Stanford University, School of Medicine, Stanford, Calif
| | - Michael P Fischbein
- Department of Cardiothoracic Surgery, Stanford University, School of Medicine, Stanford, Calif.
| |
Collapse
|
44
|
Fallon C, Matthews G, Chiu P, Lange R. Predicting trust in a selfish teammate. Personality and Individual Differences 2016. [DOI: 10.1016/j.paid.2016.05.131] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
45
|
|
46
|
Abstract
Acute type A aortic dissection (AcA-AoD) is a surgical emergency associated with very high morbidity and mortality. Unfortunately, the early outcome of emergency surgical repair has not improved substantially over the last 20 years. Many of the same debates occur repeatedly regarding operative extent and optimal conduct of the operation. The question remains: are patients suffering from too large an operation or too small? The pendulum favoring routine aortic valve resuspension, when feasible, has swung towards frequent aortic root replacement. This already aggressive approach is now being challenged with the even more extensive valve-sparing aortic root replacement (V-SARR) in selected patients. Distally, open replacement of most of the transverse arch is best in most patients. The need for late aortic re-intervention has not been shown to be affected by more extensive distal operative procedures, but the contemporary enthusiasm for a distal frozen elephant trunk (FET) only seems to build. It must be remembered that the first and foremost goal of the operation is to have an operative survivor; additional measures to reduce late morbidity are secondary aspirations. With increasing experience, true contraindications to emergency surgical operation have dwindled, but patients with advanced age, multiple comorbidities, and major neurological deficits do not fare well. The endovascular revolution, moreover, has spawned innovative options for modern practice, including ascending stent graft and adaptations of the old flap fenestration technique. Despite the increasingly complex operations and ever expanding therapies, this life-threatening disease remains a stubborn challenge for all cardiovascular surgeons. Development of specialized thoracic aortic teams and regionalization of care for patients with AcA-AoD offers the most promise to improve overall results.
Collapse
Affiliation(s)
- Peter Chiu
- Department of Cardiothoracic Surgery, Stanford University, School of Medicine, Stanford, CA, USA
| | - D Craig Miller
- Department of Cardiothoracic Surgery, Stanford University, School of Medicine, Stanford, CA, USA
| |
Collapse
|
47
|
Affiliation(s)
- Peter Chiu
- From Department of Cardiothoracic Surgery, Stanford University School of Medicine, CA (P.C., D.C.M.); University of Pennsylvania, Perelman School of Medicine, Philadelphia (M.I.); Department of Pathology, Stanford University School of Medicine, CA (M.v.d.R.); and Division of Cardiovascular Medicine, Stanford University School of Medicine, CA (D.H.L.)
| | - Mallory Irons
- From Department of Cardiothoracic Surgery, Stanford University School of Medicine, CA (P.C., D.C.M.); University of Pennsylvania, Perelman School of Medicine, Philadelphia (M.I.); Department of Pathology, Stanford University School of Medicine, CA (M.v.d.R.); and Division of Cardiovascular Medicine, Stanford University School of Medicine, CA (D.H.L.)
| | - Matt van de Rijn
- From Department of Cardiothoracic Surgery, Stanford University School of Medicine, CA (P.C., D.C.M.); University of Pennsylvania, Perelman School of Medicine, Philadelphia (M.I.); Department of Pathology, Stanford University School of Medicine, CA (M.v.d.R.); and Division of Cardiovascular Medicine, Stanford University School of Medicine, CA (D.H.L.)
| | - David H Liang
- From Department of Cardiothoracic Surgery, Stanford University School of Medicine, CA (P.C., D.C.M.); University of Pennsylvania, Perelman School of Medicine, Philadelphia (M.I.); Department of Pathology, Stanford University School of Medicine, CA (M.v.d.R.); and Division of Cardiovascular Medicine, Stanford University School of Medicine, CA (D.H.L.)
| | - D Craig Miller
- From Department of Cardiothoracic Surgery, Stanford University School of Medicine, CA (P.C., D.C.M.); University of Pennsylvania, Perelman School of Medicine, Philadelphia (M.I.); Department of Pathology, Stanford University School of Medicine, CA (M.v.d.R.); and Division of Cardiovascular Medicine, Stanford University School of Medicine, CA (D.H.L.).
| |
Collapse
|
48
|
|
49
|
Pollard J, Reaper P, Peek A, Hughes S, Gladwell S, Jones J, Chiu P, Wood M, Tolman C, Johnson M, Littlewood P, Penney M, McDermott K, Hare B, Fields SZ, Asmal M, O’Carrigan B, Yap TA. Abstract 3717: Defining optimal dose schedules for ATR inhibitors in combination with DNA damaging drugs: Informing clinical studies of VX-970, the first-in-class ATR inhibitor. Cancer Res 2016. [DOI: 10.1158/1538-7445.am2016-3717] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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
Proficient repair of DNA damage is a cause of the poor response many patients experience when treated with commonly used DNA-damaging drugs such as cisplatin, carboplatin and gemcitabine. The protein kinase ataxia telangiectasia mutated and Rad3 related (ATR) is recruited to DNA damage lesions caused by such drugs during the S and G2 phase of cell cycle, where it coordinates a series of responses including checkpoint activation and DNA repair by homologous recombination.
Inhibition of ATR potentiates the cytotoxic activity of DNA damaging drugs in many cancer cells. In stark contrast, non-cancer cells survive inhibition of ATR with just transient growth arrest. Cancer cells carrying common defects in a compensatory repair pathway mediated by the kinase ataxia telangiectasia mutated (ATM) and its principle substrate, p53, are especially sensitive to ATR inhibition. Two ATR inhibitors are in clinical development in combination with DNA damaging drugs, however a comprehensive assessment of dose schedule considerations has not been reported.
In pre-clinical models, the efficacy of an ATR inhibitor in combination with multiple DNA damaging drugs was shown to be dependent on dose schedule. In vitro, transient exposure of cancer cells to an ATR inhibitor (2 hours) was highly effective when added after the DNA damaging drug. Maximum activity was observed when addition of the ATR inhibitor was timed to coincide with peak accumulation of cells in S-phase and concomitant activation of ATR (P-Chk1), following treatment with the DNA damaging drug. In mouse xenograft models, strong synergistic activity was achieved from just a single dose of the ATR inhibitor given once per cycle of the DNA damaging drug.
Optimal efficacy was achieved by administering the ATR inhibitor 12-24 hours after the DNA damaging drug. Dosing the ATR inhibitor prior to, or greater than 48 hours after, the DNA damaging drug provided limited benefit. On this schedule, addition of the ATR inhibitor had minimal impact on the tolerability profile of the DNA damaging drug. VX-970, the first-in-class ATR inhibitor, is being assessed as monotherapy and in combination with gemcitabine, cisplatin and carboplatin in Ph1/2 clinical studies. Based on pre-clinical data, VX-970 is being dosed approximately 24 hours after the DNA damaging drug. Preliminary tumor biomarker data from three patients showed high P-Chk1 24 hours after treatment with carboplatin, which is inhibited by VX-970.
These data suggest the importance of dose scheduling on the efficacy of ATR inhibitors and DNA damaging drug combinations and inform the design of ongoing clinical studies.
Citation Format: John Pollard, Phil Reaper, Adele Peek, Stuart Hughes, Scott Gladwell, Julie Jones, Peter Chiu, Mark Wood, Crystal Tolman, Mac Johnson, Peter Littlewood, Marina Penney, Katherine McDermott, Brian Hare, Scott Z. Fields, Mohammed Asmal, Brent O’Carrigan, Timothy A. Yap. Defining optimal dose schedules for ATR inhibitors in combination with DNA damaging drugs: Informing clinical studies of VX-970, the first-in-class ATR inhibitor. [abstract]. In: Proceedings of the 107th Annual Meeting of the American Association for Cancer Research; 2016 Apr 16-20; New Orleans, LA. Philadelphia (PA): AACR; Cancer Res 2016;76(14 Suppl):Abstract nr 3717.
Collapse
Affiliation(s)
- John Pollard
- 1Vertex Pharmaceuticals Inc, Abingdon, United Kingdom
| | - Phil Reaper
- 1Vertex Pharmaceuticals Inc, Abingdon, United Kingdom
| | - Adele Peek
- 1Vertex Pharmaceuticals Inc, Abingdon, United Kingdom
| | - Stuart Hughes
- 1Vertex Pharmaceuticals Inc, Abingdon, United Kingdom
| | | | - Julie Jones
- 1Vertex Pharmaceuticals Inc, Abingdon, United Kingdom
| | - Peter Chiu
- 1Vertex Pharmaceuticals Inc, Abingdon, United Kingdom
| | - Mark Wood
- 2Vertex Pharmaceuticals Inc, Boston, MA
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
50
|
Anderson ML, Kennedy PC, Blanchard MT, Barbano L, Chiu P, Walker RL, Manzer M, Hall MR, King DP, Stott JL. Histochemical and Immunohistochemical Evidence of a Bacterium Associated with Lesions of Epizootic Bovine Abortion. J Vet Diagn Invest 2016; 18:76-80. [PMID: 16566260 DOI: 10.1177/104063870601800110] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Epizootic bovine abortion (EBA), a tick-transmitted disease of pregnant cattle grazing foothill pastures, is a major cause of reproductive failure in California and adjacent states. Affected fetuses develop a chronic disease, resulting in late-term abortion or premature calving. Despite investigations spanning 50 years, to the authors' knowledge, the etiologic agent of EBA has not yet been isolated from affected fetuses or the tick vector. The diagnosis of EBA is based on gross and microscopic lesions. Recently, documentation that the etiologic agent is susceptible to antibiotics and identification of a unique 16S deltaproteobacterial rDNA gene sequence in 90% of thymus tissues from aborted fetuses have supported the role of a bacterial infection as the cause of EBA. To determine whether bacteria could be detected in the tissues, histochemical staining and immunohistochemical procedures were used on formalin-fixed, paraffin-embedded tissues. Use of a modified Steiner silver stain revealed small numbers of intracytoplasmic bacterial rods in 37 of 42 thymic samples from EBA-affected fetuses. Improved detection was achieved by use of immunohistochemical staining with serum from EBA-affected fetuses that resulted in detection of numerous bacterial rods in the cytoplasm of histiocytic cells in the thymus from all 42 EBA-affected fetuses. Immunohistochemical examination of additional tissues from 21 field and experimental EBA cases revealed positively stained intracytoplasmic bacterial rods in many organs with inflammatory lesions. Use of the modified Steiner stain and immunohistochemical staining of tissues from negative-control fetuses failed to reveal organisms. To the authors' knowledge, this is the first report to document morphologic evidence of a bacterium associated with the lesions of EBA.
Collapse
Affiliation(s)
- M L Anderson
- California Animal Health and Food Safety Laboratory, University of California, Davis 95616, USA
| | | | | | | | | | | | | | | | | | | |
Collapse
|