1
|
Li R, Sidawy A, Nguyen BN. Comparative assessment of racial disparity in 30-day outcomes for Asian Americans undergoing carotid endarterectomy. J Vasc Surg 2024; 79:1132-1141. [PMID: 38142944 DOI: 10.1016/j.jvs.2023.12.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 11/29/2023] [Accepted: 12/19/2023] [Indexed: 12/26/2023]
Abstract
OBJECTIVE Carotid endarterectomy (CEA) is an effective treatment for carotid stenosis. All previous studies on racial disparity of CEA outcomes omitted Asian Americans. This study aimed to address this gap by investigating racial disparities in 30-day outcomes following CEA among Asian Americans. METHODS Asian American and Caucasian patients who underwent CEA were identified in the American College of Surgeons National Surgical Quality Improvement Program targeted database from 2011 to 2021. Patients with age less than 18 years old were excluded. Patients with symptomatic and asymptomatic carotid stenosis were examined separately. A 1:5 propensity-score matching was used to address preoperative differences. Thirty perioperative outcomes were assessed. RESULTS There were 380 Asian Americans (2.27%) and 13,250 Caucasians (79.18%) with symptomatic carotid stenosis who underwent CEA. Also, 289 Asian Americans (1.40%) and 18,257 Caucasians (88.14%) with asymptomatic carotid stenosis had CEA. Asian Americans undergoing CEA presented with higher comorbid burdens and more severe symptomology. Also, asymptomatic Asian Americans were more likely to undergo surgeries for mild stenosis (<50%), which is not in line with practice guidelines. After 1:5 propensity-matching, all symptomatic Asian Americans were matched to 1550 Caucasian patients, and all asymptomatic Asian Americans were matched to 1445 Caucasians; preoperative differences were addressed. Asian Americans exhibited low overall 30-day mortality (symptomatic, 1.61%; asymptomatic, 0.35%) and stroke (symptomatic, 2.26%; asymptomatic, 0.69%). All perioperative outcomes were comparable to Caucasians, with the exception that Asian Americans experienced longer operation times. CONCLUSIONS Evidence suggested that Asian Americans with asymptomatic stenosis were underrepresented in CEA. After propensity-score matching, Asian Americans demonstrated comparable 30-day outcomes to Caucasians. These suggest that, when afforded equal access to quality health care, CEA serves as an effective treatment for carotid stenosis among Asian Americans. Therefore, efforts may be aimed at addressing health care access, potentially in the screening for asymptomatic carotid stenosis in Asian Americans. This would ensure they have equitable benefits from CEA. Nevertheless, the exact preoperative differences and long-term CEA outcomes in Asian Americans should warrant further examination in future studies.
Collapse
Affiliation(s)
- Renxi Li
- The George Washington University School of Medicine and Health Sciences, Washington, DC.
| | - Anton Sidawy
- The George Washington University Hospital, Department of Surgery, Washington, DC
| | - Bao-Ngoc Nguyen
- The George Washington University Hospital, Department of Surgery, Washington, DC
| |
Collapse
|
2
|
Shen L, Ding J, Wang Y, Fan W, Feng X, Liu K, Qin X, Shao Z, Li R. Spatial-temporal trends in leprosy burden and its associations with socioeconomic and physical geographic factors: results from the Global Burden of Disease Study 2019. Public Health 2024; 230:172-182. [PMID: 38560955 DOI: 10.1016/j.puhe.2024.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 02/23/2024] [Accepted: 03/05/2024] [Indexed: 04/04/2024]
Abstract
OBJECTIVES The purpose of our study was to assess the multiscalar changes in leprosy burden and its associated risk factors over the last three decades. STUDY DESIGN We conducted an in-depth examination of leprosy's spatial-temporal trends at multiple geographical scale (global, regional, and national), utilizing information from Global Burden of Disease, Injuries, and Risk Factors Study (GBD 2019). METHODS Incidence and the estimated annual percentage change (EAPC) in age-standardized incidence rate (ASIR) of leprosy were determined, with countries categorized based on leprosy incidence changes. We examined socioeconomic and physical geography influences on leprosy incidence via Spearman correlation analysis, using ternary phase diagrams to reveal the synergetic effects on leprosy occurrence. RESULTS Globally, incident cases of leprosy decreased by 27.86% from 1990 to 2019, with a reduction in ASIR (EAPC = -2.53), yet trends were not homogeneous across regions. ASIR and EAPC correlated positively with sociodemographic index (SDI), and an ASIR growth appeared in high SDI region (EAPC = 3.07). Leprosy burden was chiefly distributed in Tropical Latin America, Oceania, Central Sub-Saharan Africa, and South Asia. Negative correlations were detected between the incidence of leprosy and factors of SDI, GDP per capita, urban population to total population, and precipitation, whereas the number of refugee population, temperature, and elevation showed opposite positive results. CONCLUSIONS Despite a global decline in leprosy over the past three decades, the disparities of disease occurrence at regional and national scales still persisted. Socioeconomic and physical geographic factors posed an obvious influence on the transmission risk of leprosy. The persistence and regional fluctuations of leprosy incidence necessitate the ongoing dynamic and multilayered control strategies worldwide in combating this ancient disease.
Collapse
Affiliation(s)
- L Shen
- School of Remote Sensing and Information Engineering, Wuhan University, Wuhan 430079, China
| | - J Ding
- School of Public Health, Wuhan University, Wuhan 430071, China
| | - Y Wang
- School of Remote Sensing and Information Engineering, Wuhan University, Wuhan 430079, China
| | - W Fan
- School of Remote Sensing and Information Engineering, Wuhan University, Wuhan 430079, China
| | - X Feng
- School of Public Health, Fudan University, Shanghai 200032, China
| | - K Liu
- Department of Epidemiology, Ministry of Education Key Lab of Hazard Assessment and Control in Special Operational Environment, School of Public Health, Air Force Medical University, Xi'an 710032, China.
| | - X Qin
- Department of Epidemiology, Ministry of Education Key Lab of Hazard Assessment and Control in Special Operational Environment, School of Public Health, Air Force Medical University, Xi'an 710032, China; School of Public Health, Baotou Medical College, Baotou 014000, China.
| | - Z Shao
- Department of Epidemiology, Ministry of Education Key Lab of Hazard Assessment and Control in Special Operational Environment, School of Public Health, Air Force Medical University, Xi'an 710032, China.
| | - R Li
- Department of Epidemiology, Ministry of Education Key Lab of Hazard Assessment and Control in Special Operational Environment, School of Public Health, Air Force Medical University, Xi'an 710032, China.
| |
Collapse
|
3
|
Li R, Wang XY, Ye QY, Wang YZ, Zhang XG, Ge XT, Wang QT. [A preliminary in vitro and in vivo study of endothelial cell pyroptosis in the periodontal inflammatory environment]. Zhonghua Kou Qiang Yi Xue Za Zhi 2024; 59:487-496. [PMID: 38637003 DOI: 10.3760/cma.j.cn112144-20230817-00095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Subscribe] [Scholar Register] [Indexed: 04/20/2024]
Abstract
Objective: To observe whether endothelial cells undergo pyroptosis in the inflammatory periodontal environment by using a model in vivo and in vitro, providing an experimental basis for indepth understanding of the underlying pathogenesis of periodontitis. Methods: According to the classification of periodontal diseases of 2018, gingival tissues were collected from periodontally healthy subjects and patients with stage Ⅲ-Ⅳ, grade C periodontitis, who presented Department of Oral and Maxillofacial Surgery and Department of Periodontology, School of Stomatology, The Fourth Military Medical University from April to May 2022. Immunohistochemical staining was performed to detect the expression level and distribution of gasdermin D (GSDMD), a hallmark protein of cell pyroptosis, in gingival tissues. Periodontitis models were established in each group by ligating the maxillary second molar teeth of three mice for 2 weeks (ligation group). The alveolar bone resorption was determined by micro-CT (mice without ligation treatment were used as the control group), and the colocalization of GSDMD and CD31 were quantitatively analyzed by immunofluorescence staining in gingival tissues of healthy and inflammatory mice. Human umbilical vein endothelial cells (HUVECs) were cultured in vitro and treated with lipopolysaccharide (LPS) of Porphyromonas gingivalis (Pg) combined with adenosine triphosphate (ATP) at various concentrations of 0.5, 1.0, 2.5, 5.0, and 10.0 mg/L, respectively, and the 0 mg/L group was set as the control group at the same time. Scanning electron microscopy was used to observe the morphology of HUVECs. Western blotting was used to detect the expression of gasdermin D-N terminal domains (GSDMD-N) protein and immunofluorescence cell staining was used to detect the expression and distribution of GSDMD. Cell counting kit-8 (CCK-8) was used to detect the proliferative ability of HUVECs, and propidium iodide (PI) staining was used to detect the integrity of cell membrane of HUVECs. Results: Immunohistochemistry showed that GSDMD in gingival tissues of periodontitis was mainly distributed around blood vessels and its expression level was higher than that in healthy tissues. Micro-CT showed that alveolar bone resorption around the maxillary second molar significantly increased in ligation group mice compared with control subjects (t=8.88, P<0.001). Immunofluorescence staining showed significant colocalization of GSDMD with CD31 in the gingival vascular endothelial cells in mice of ligation group. The results of scanning electron microscopy showed that there were pores of different sizes, the typical morphology of pyroptosis, on HUVECs cell membranes in the inflammatory environment simulated by ATP combined with different concentrations of LPS, and 2.5 mg/L group showed the most dilated and fused pores on cell membranes, with the cells tended to lyse and die. Western blotting showed that the expression of GSDMD-N, the hallmark protein of cell pyroptosis, was significantly higher in 2.5 and 5.0 mg/L groups than that in the control group (F=3.86, P<0.01). Immunofluorescence cell staining showed that the average fluorescence intensity of GSDMD in 2.5 mg/L group elevated the most significantly in comparison with that in the control group (F=35.25, P<0.001). The CCK-8 proliferation assay showed that compared to the control group (1.00±0.02), 0.5 mg/L (0.52±0.07), 1.0 mg/L (0.57±0.10), 2.5 mg/L (0.58±0.04), 5.0 mg/L (0.55±0.04), 10.0 mg/L (0.61±0.03) groups inhibited cell proliferation (F=39.95, P<0.001). PI staining showed that the proportion of positive stained cells was highest [(56.07±3.22)%] in 2.5 mg/L group (F=88.24, P<0.001). Conclusions: Endothelial cells undergo significant pyroptosis in both and periodontal inflammatory environments, suggesting that endothelial cell pyroptosis may be an important pathogenic factor contributing to the pathogenesis of periodontitis.
Collapse
Affiliation(s)
- R Li
- Department of Periodontology, School of Stomatology, The Fourth Military Medical University, State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, National Clinical Research Center for Oral Diseases, Shaanxi International Joint Research Center for Oral Diseases, Xi'an 710032, China
| | - X Y Wang
- Department of Periodontology, School of Stomatology, The Fourth Military Medical University, State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, National Clinical Research Center for Oral Diseases, Shaanxi International Joint Research Center for Oral Diseases, Xi'an 710032, China
| | - Q Y Ye
- Digital Dentistry Center, School of Stomatology, The Fourth Military Medical University, State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, National Clinical Research Center for Oral Diseases, Shaanxi Key Laboratory of Stomatology, Xi'an 710032, China
| | - Y Z Wang
- Department of Periodontology, School of Stomatology, The Fourth Military Medical University, State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, National Clinical Research Center for Oral Diseases, Shaanxi International Joint Research Center for Oral Diseases, Xi'an 710032, China
| | - X G Zhang
- Department of Periodontology, School of Stomatology, The Fourth Military Medical University, State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, National Clinical Research Center for Oral Diseases, Shaanxi International Joint Research Center for Oral Diseases, Xi'an 710032, China
| | - X T Ge
- Department of Periodontology, School of Stomatology, The Fourth Military Medical University, State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, National Clinical Research Center for Oral Diseases, Shaanxi International Joint Research Center for Oral Diseases, Xi'an 710032, China
| | - Q T Wang
- Department of Periodontology, School of Stomatology, The Fourth Military Medical University, State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, National Clinical Research Center for Oral Diseases, Shaanxi International Joint Research Center for Oral Diseases, Xi'an 710032, China
| |
Collapse
|
4
|
Li R, Ranganath B. In hospital outcomes of autologous and implant-based breast reconstruction in patients with diabetes mellitus: A population-based study of 2015-2020 national inpatient sample. World J Surg 2024; 48:903-913. [PMID: 38498001 DOI: 10.1002/wjs.12136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 03/05/2024] [Indexed: 03/19/2024]
Abstract
BACKGROUND Breast reconstruction encompasses autologous (ABR) and implant-based breast reconstruction (IBR) each with its own sets of potential complications. Diabetes mellitus (DM) is associated with breast reconstruction complications, although most of the studies did not differentiate between the reconstruction procedures. This study conducted a population-based study examining impact of DM on inhospital outcomes in ABR and IBR. METHODS Patients underwent ABR or IBR were identified in National Inpatient Sample from Q4 2015 to 2020. A 1:2 propensity score matching was used to address differences in demographics, hospital characteristics, primary payer status, comorbidities, and reconstruction staging between DM and non-DM patients. In hospital outcomes were assessed separately in ABR and IBR. RESULTS There were 997 (7.68%) DM and 11,987 (92.32%) non-DM patients in ABR. Meanwhile, 1325 (7.38%) DM and 16,638 (92.62%) non-DM patients underwent IBR. DM cohorts in ABR and IBR were matched to 1930 and 2558 non-DM patients, respectively. After matching, DM patients in both ABR and IBR had higher risks of renal complications (ABR, 3.73% vs. 1.76%, p < 0.01; IBR, 1.83% vs. 0.78%, p = 0.01) and longer length of stay (ABR, p = 0.01; IBR, p = 0.04). In ABR, DM patients had higher respiratory complications (2.82% vs. 1.19%, p < 0.01), excessive scarring (2.72% vs. 1.55%, p = 0.03), and infection (2.42% vs. 1.14%, p = 0.01), while in IBR, DM patients had higher hemorrhage/hematoma (5.40% vs. 3.40%, p < 0.01) and transfer out (1.52% vs. 0.78%, p = 0.04). CONCLUSION DM was associated with distinct sets of inhospital complications in ABR and IBR, which can be valuable for preoperative risk stratification and informing clinical decision-making for DM patients.
Collapse
Affiliation(s)
- Renxi Li
- The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
| | - Bharat Ranganath
- Department of Surgery, The George Washington University Hospital, Washington, District of Columbia, USA
| |
Collapse
|
5
|
Li R, Luo Q, Green D, Huddleston SJ. Weekend Admission is Associated with Higher Kidney Failures after Thoracic Endovascular Aneurysm Repair for Stanford Type B Aortic Dissection. Vasc Endovascular Surg 2024; 58:372-381. [PMID: 37978945 DOI: 10.1177/15385744231217622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
BACKGROUND Weekend effect characterized by worse perioperative outcomes has been demonstrated in some surgery patients admitted on weekends, as opposed to weekdays. This study aimed to examine weekend effect on open surgical repair or thoracic endovascular aneurysm repair (TEVAR) for Stanford Type B Aortic Dissection (TBAD). METHODS Patients who underwent TBAD repair were identified in National/Nationwisde Inpatient Sample from Q4 2015-2020. Open surgery and TEVAR were examined separately. Multivariable analyses were performed comparing in-hospital perioperative outcomes of patients under weekday and weekend admission. Adjusted preoperative variables included sex, age, race, socioeconomic status, hospital characteristics, clinical symptoms, comorbidities, and elective/non-elective admission. Also, length of stay, days from admission to operation, and total hospital charge were compared. RESULTS Among patients who underwent open TBAD repair, 1321 were admitted on weekdays and 340 on weekends. Among patients who underwent TEVAR for TBAD, 2018 were admitted on weekdays and 440 wereadmitted on weekends. There was no difference in open repair outcomes between those admitted on weekdays vs weekends. In TEVAR, weekend admission was associated with higher post-procedural kidney failure (1.14% vs .20%, aOR = 4.11, P = .04) and superficial wound complications (2.73% vs 1.49%, aOR = 2.2, P = .03) but lower respiratory complications (5.80% vs 3.64%, aOR = .47, P = .01). Also, in TEVAR, weekend admission was associated with longer time from admission to operation (3.92 ± .27 vs 2.35 ± .09 days, P < .01). CONCLUSIONS Renal malperfusion was a common indication for TBAD repair. TBAD patients admitted over the weekend and underwent TEVAR had higher post-procedural kidney failure, which may be due to delayed diagnosis and treatment.
Collapse
Affiliation(s)
- Renxi Li
- The George Washington University School of Medicine and Health Sciences, Washington, DOC, USA
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Qianyun Luo
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Derrick Green
- Division of Vascular Surgery, Department of Surgery, University of Minnesota Medical School, Minneapolis, MN, USA
- Minneapolis Veterans Administration Medical Center, USA
| | - Stephen J Huddleston
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, University of Minnesota Medical School, Minneapolis, MN, USA
| |
Collapse
|
6
|
Li R, Yang KL, Chen MP, Zhang HB, Mao JF, Li M, Zhu HJ, Wang T, Yang HB. [Type A insulin resistance syndrome complicated with tuberous sclerosis: a case report]. Zhonghua Nei Ke Za Zhi 2024; 63:419-421. [PMID: 38561290 DOI: 10.3760/cma.j.cn112138-20230713-00002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Affiliation(s)
- R Li
- Department of Endocrinology, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Key Laboratory of Endocrinology of National Health Commission, State Key Laboratory of Complex Severe and Rare Diseases, Beijing 100730, China
| | - K L Yang
- Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing 100730, China
| | - M P Chen
- Department of Endocrinology, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Key Laboratory of Endocrinology of National Health Commission, State Key Laboratory of Complex Severe and Rare Diseases, Beijing 100730, China
| | - H B Zhang
- Department of Endocrinology, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Key Laboratory of Endocrinology of National Health Commission, State Key Laboratory of Complex Severe and Rare Diseases, Beijing 100730, China
| | - J F Mao
- Department of Endocrinology, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Key Laboratory of Endocrinology of National Health Commission, State Key Laboratory of Complex Severe and Rare Diseases, Beijing 100730, China
| | - M Li
- Department of Endocrinology, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Key Laboratory of Endocrinology of National Health Commission, State Key Laboratory of Complex Severe and Rare Diseases, Beijing 100730, China
| | - H J Zhu
- Department of Endocrinology, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Key Laboratory of Endocrinology of National Health Commission, State Key Laboratory of Complex Severe and Rare Diseases, Beijing 100730, China
| | - T Wang
- Department of Dermatology, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing 100730, China
| | - H B Yang
- Department of Endocrinology, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Key Laboratory of Endocrinology of National Health Commission, State Key Laboratory of Complex Severe and Rare Diseases, Beijing 100730, China
| |
Collapse
|
7
|
Zhang Q, Chen G, Zhu Q, Liu Z, Li Y, Li R, Zhao T, Liu X, Zhu Y, Zhang Z, Li H. Construct validation of machine learning for accurately predicting the risk of postoperative surgical site infection following spine surgery. J Hosp Infect 2024; 146:232-241. [PMID: 38029857 DOI: 10.1016/j.jhin.2023.09.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 09/15/2023] [Accepted: 09/22/2023] [Indexed: 12/01/2023]
Abstract
BACKGROUND This study aimed to evaluate the risk factors for machine learning (ML) algorithms in predicting postoperative surgical site infection (SSI) following spine surgery. METHODS This prospective cohort study included 986 patients who underwent spine surgery at Taizhou People's Hospital Affiliated to Nanjing Medical University from January 2015 to October 2022. Supervised ML algorithms included support vector machine, logistic regression, random forest, XGboost, decision tree, k-nearest neighbour, and naïve Bayes (NB), which were tested and trained to develop a predicting model. The ML model performance was evaluated from the test dataset. We gradually analysed their accuracy, sensitivity, and specificity, as well as the positive predictive value, negative predictive value, and area under the curve. RESULTS The rate of SSI was 9.33%. Using a backward stepwise approach, we identified that the remarkable risk factors predicting SSI in the multi-variate Cox regression analysis were age, body mass index, smoking, cerebrospinal fluid leakage, drain duration and pre-operative albumin level. Compared with other ML algorithms, the NB model had the highest performance in seven ML models, with an average area under the curve of 0.95, sensitivity of 0.78, specificity of 0.88, and accuracy of 0.87. CONCLUSIONS The NB model in the ML algorithm had excellent calibration and accurately predicted the risk of SSI compared with the existing models, and might serve as an important tool for the early detection and treatment of SSI following spinal infection.
Collapse
Affiliation(s)
- Q Zhang
- Department of Orthopedics, Taizhou People's Hospital, Nanjing Medical University, Taizhou, People's Republic of China; Postgraduate School, Dalian Medical University, Dalian, People's Republic of China
| | - G Chen
- Department of Orthopedics, Taizhou People's Hospital, Nanjing Medical University, Taizhou, People's Republic of China; Postgraduate School, Dalian Medical University, Dalian, People's Republic of China
| | - Q Zhu
- Taizhou Clinical Medical School of Nanjing Medical University, Taizhou, People's Republic of China
| | - Z Liu
- Taizhou Clinical Medical School of Nanjing Medical University, Taizhou, People's Republic of China
| | - Y Li
- Taizhou Clinical Medical School of Nanjing Medical University, Taizhou, People's Republic of China
| | - R Li
- Department of Orthopedics, Taizhou People's Hospital, Nanjing Medical University, Taizhou, People's Republic of China; Postgraduate School, Dalian Medical University, Dalian, People's Republic of China
| | - T Zhao
- Department of Orthopedics, Taizhou People's Hospital, Nanjing Medical University, Taizhou, People's Republic of China; Postgraduate School, Dalian Medical University, Dalian, People's Republic of China
| | - X Liu
- School of Medicine, Nantong University, Nantong, People's Republic of China
| | - Y Zhu
- Department of Orthopedics, Taizhou People's Hospital, Nanjing Medical University, Taizhou, People's Republic of China; Taizhou Clinical Medical School of Nanjing Medical University, Taizhou, People's Republic of China
| | - Z Zhang
- Department of Orthopedics, Taizhou People's Hospital, Nanjing Medical University, Taizhou, People's Republic of China; Taizhou Clinical Medical School of Nanjing Medical University, Taizhou, People's Republic of China
| | - H Li
- Department of Orthopedics, Taizhou People's Hospital, Nanjing Medical University, Taizhou, People's Republic of China; Taizhou Clinical Medical School of Nanjing Medical University, Taizhou, People's Republic of China.
| |
Collapse
|
8
|
Li R. Preoperative hypocoagulative state is an independent risk factor for wound complications and infection in gender-affirming bottom surgeries. J Plast Reconstr Aesthet Surg 2024; 91:413-420. [PMID: 38479123 DOI: 10.1016/j.bjps.2024.02.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 02/06/2024] [Accepted: 02/22/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND Bottom gender affirmation surgery (GAS) involves the risks of bleeding and associated complications. Effective preoperative blood management is paramount across surgical disciplines with international normalized ratio (INR)≤1.5 advised prior to certain surgeries. This study aimed to examine the proportion of patients who were hypocoagulative before they underwent bottom GAS and assess the influence of hypocoagulability on their 30-day post-operative outcomes. METHOD A retrospective study on female-to-male (FtM) and male-to-female (MtF) bottom GAS was performed based on American college of surgeons national surgical quality improvement program (ACS-NSQIP) database from 2005 to 2021. Patients with hypocoagulation were identified when PTT> 60 s, PT > 30 s, and/or INR> 2. Multivariable logistic regression was used to compare the 30-day perioperative outcomes between patients with hypocoagulation and controls. RESULTS In this study, 380 patients (182 FtM, 198 MtF) with hypocoagulation and 1176 controls (886 FtM, 310 MtF) were included. Mortality and organ system complications were infrequent in both groups. Patients with hypocoagulation had higher wound complication rates (13.68% vs. 2.64%, aOR 2.858, p < 0.01), especially wound dehiscence (10.00% vs. 0.60%, aOR 4.424, p < 0.01) and organ space infection rates (2.11% vs. 0.26%, aOR 12.77, p < 0.01). Additionally, patients with hypocoagulation had higher sepsis (0.79% vs. 0.09%, aOR 15.508, p = 0.04) and readmission rates (4.74% vs. 2.47%, aOR 1.919, p = 0.03), but lower rates of discharge not to home (7.92% vs. 25.38%, aOR 0.324, p < 0.01). CONCLUSION Preoperative hypocoagulative state is observed in approximately a quarter of the patients undergoing bottom GAS and is an independent risk factor for increased risks of 30-day wound complications and infections. Therefore, meticulous monitoring of preoperative hemostasis and implementing hemostasis control before surgery may be necessary. Thus, it may be advisable to discontinue oral anticoagulants before the surgery.
Collapse
Affiliation(s)
- Renxi Li
- The George Washington University School of Medicine and Health Sciences, 2300 I St NW, Washington, DC 20052, USA.
| |
Collapse
|
9
|
Li R, Sidawy A, Nguyen BN. The 5-Factor Modified Frailty Index is a Concise and Effective Predictor of 30-Day Adverse Outcomes in Carotid Endarterectomy. J Surg Res 2024; 296:507-515. [PMID: 38330676 DOI: 10.1016/j.jss.2024.01.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 11/29/2023] [Accepted: 01/15/2024] [Indexed: 02/10/2024]
Abstract
INTRODUCTION Frailty is a clinically identifiable condition characterized by heightened vulnerability. The 5-item Modified Frailty Index provides a concise calculation of frailty that has proven effective in predicting adverse perioperative outcomes across a variety of surgical disciplines. However, there is a paucity of research examining the validity of 11-item Modified Frailty Index (mFI-5) in carotid endarterectomy (CEA). This study aimed to investigate the association between mFI-5 and 30-day outcomes of CEA. METHODS Patients underwent CEA were identified from American College of Surgeons National Surgical Quality Improvement Program targeted database from 2012 to 2021. Patients with age<18 were excluded. Patients were stratified into four cohorts based on their mFI-5 scores: 0, 1, 2, or 3+. Multivariable logistic regression was used to compare 30-day perioperative outcomes adjusting for preoperative variables with P value<0.1. RESULTS Compared to controls (mFI-5 = 0), patients mFI-5 = 1 had higher risk of stroke (adjusted odds ratio [aOR] = 1.333, P = 0.02), unplanned operation (aOR = 1.38, P < 0.01), and length of stay (LOS) > 7 days (aOR = 0.814, P < 0.01). Patients with mFI-5 = 2 had higher stroke (aOR = 1.719, P < 0.01), major adverse cardiovascular events (MACE) (aOR = 1.315, P = 0.01), sepsis (aOR = 2.243, P = 0.01), discharge not to home (aOR = 1.200, P < 0.01), 30-day readmission (aOR = 1.405, P < 0.01). Compared with controls, patients with mFI-5≥3 had higher mortality (aOR = 1.997 P = 0.02), MACE (aOR = 1.445, P = 0.03), cardiac complications (aOR = 1.901, P < 0.01), pulmonary events (aOR = 2.196, P < 0.01), sepsis (aOR = 3.65, P < 0.01), restenosis (aOR = 2.606, P = 0.02), unplanned operation (aOR = 1.69, P < 0.01), LOS>7 days (aOR = 1.425, P < 0.01), discharge not to home (aOR = 2.127, P < 0.01), and 30-day readmission (aOR = 2.427, P < 0.01). CONCLUSIONS The mFI-5 is associated with 30-day mortality and complications including stroke, MACE, cardiac complications, pulmonary complications, sepsis, and restenosis. Additionally, elevated mFI-5 scores correlate with an increased likelihood of unplanned operations, extended LOS, discharge to facilities other than home, and 30-day readmissions, all of which could negatively impact long-term prognosis. Therefore, mFI-5 can serve as a concise yet effective metric of frailty in patients undergoing CEA.
Collapse
Affiliation(s)
- Renxi Li
- The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia; Division of Vascular Surgery, Department of Surgery, The George Washington University Hospital, Washington, District of Columbia.
| | - Anton Sidawy
- Division of Vascular Surgery, Department of Surgery, The George Washington University Hospital, Washington, District of Columbia
| | - Bao-Ngoc Nguyen
- Division of Vascular Surgery, Department of Surgery, The George Washington University Hospital, Washington, District of Columbia
| |
Collapse
|
10
|
Li R, Qurashi A, Sidawy A, Nguyen BN. Letter re: Misidentification of Transcarotid Artery Revascularization by Current Procedural Terminology. Vasc Endovascular Surg 2024:15385744241241856. [PMID: 38525816 DOI: 10.1177/15385744241241856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/26/2024]
Abstract
In this letter, we discussed the selection of patients undergoing Transcarotid Artery Revascularization (TCAR) using the Current Procedural Terminology (CPT) codes. We examined a previous study using CPT code 37215 to identify TCAR cases using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database. As an ACS-NSQIP participating site, we have complete access to the ACS-NSQIP database, and we performed a more in-depth examination of the method. We found significant discrepancies in the method described and conclude that it is methodologically flawed to use CPT code 37215 to differentiate TCAR cases. This study not only re-evaluates the validity of the previous study but also has the potential to prevent other researchers from employing the erroneous methodology for TCAR selection using the CPT code, which is one of the most widely used standardizations of medical communication for surgical procedures. This is particularly pertinent given the recent "TCAR revolution", where significant attention has been focused on TCAR.
Collapse
Affiliation(s)
- Renxi Li
- The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Adham Qurashi
- Department of Surgery, The George Washington University Hospital, Washington, DC, USA
| | - Anton Sidawy
- Department of Surgery, The George Washington University Hospital, Washington, DC, USA
| | - Bao-Ngoc Nguyen
- Department of Surgery, The George Washington University Hospital, Washington, DC, USA
| |
Collapse
|
11
|
Li R, Sidawy A, Nguyen BN. Locoregional Anesthesia Has Lower Risks of Cardiac Complications Than General Anesthesia After Prolonged Endovascular Repair of Abdominal Aortic Aneurysms. J Cardiothorac Vasc Anesth 2024:S1053-0770(24)00214-3. [PMID: 38631930 DOI: 10.1053/j.jvca.2024.03.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 02/27/2024] [Accepted: 03/18/2024] [Indexed: 04/19/2024]
Abstract
OBJECTIVES Although general anesthesia is the primary anesthesia in endovascular aneurysm repair (EVAR), some studies suggest locoregional anesthesia could be a feasible alternative for eligible patients. However, most evidence was from retrospective studies and was subjected to an inherent selection bias that general anesthesia is often chosen for more complex and prolonged cases. To mitigate this selection bias, this study aimed to compare 30-day outcomes of prolonged, nonemergent, intact, infrarenal EVAR in patients undergoing locoregional or general anesthesia. In addition, risk factors associated with prolonged operative time in EVAR were identified. DESIGN Retrospective large-scale national registry study. SETTING American College of Surgeons National Surgical Quality Improvement Program targeted database from 2012 to 2022. PARTICIPANTS A total of 4,075 out of 16,438 patients (24.79%) had prolonged EVAR. Among patients with prolonged EVAR, 324 patients (7.95%) were under locoregional anesthesia. There were 3,751 patients (92.05%) under general anesthesia, and 955 of them were matched to the locoregional anesthesia cohort. INTERVENTIONS Patients undergoing infrarenal EVAR were included. Exclusion criteria included age <18 years, emergency cases, ruptured abdominal aortic aneurysm, and acute intraoperative conversion to open. Only cases with prolonged operative times (>157 minutes) were selected. A 1:3 propensity-score matching was used to address demographics, baseline characteristics, aneurysm diameter, distant aneurysm extent, and concomitant procedures between patients under locoregional and general anesthesia. Thirty-day postoperative outcomes were assessed. Moreover, factors associated with prolonged EVAR were identified by multivariate logistic regression. MEASUREMENTS AND MAIN RESULTS Except for general anesthesia contraindications, patients undergoing locoregional or general anesthesia exhibited largely similar preoperative characteristics. After propensity-score matching, patients under locoregional and general anesthesia had a lower risk of myocardial infarction (0.93% v 2.83%, p = 0.04), but comparable 30-day mortality (3.72% v 2.72%, p = 0.35) and other complications. Specific concomitant procedures, aneurysm anatomy, and comorbidities associated with prolonged EVAR were identified. CONCLUSIONS Locoregional anesthesia can be a safe and effective alternative to general anesthesia, particularly in EVAR cases with anticipated complexity and prolonged operative times, as it offers the potential benefit of reduced cardiac complications. Risk factors associated with prolonged EVAR can aid in preoperative risk stratification and inform the decision-making process regarding anesthesia choice.
Collapse
Affiliation(s)
- Renxi Li
- George Washington University School of Medicine and Health Sciences, Washington, DC.
| | - Anton Sidawy
- George Washington University Hospital, Department of Surgery, Washington, DC
| | - Bao-Ngoc Nguyen
- George Washington University Hospital, Department of Surgery, Washington, DC
| |
Collapse
|
12
|
Li R, Ranganath B. In hospital outcomes of autologous and implant-based breast reconstruction in patients with chronic obstructive pulmonary disease. World J Surg 2024. [PMID: 38497975 DOI: 10.1002/wjs.12139] [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: 12/21/2023] [Accepted: 03/05/2024] [Indexed: 03/19/2024]
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is a common comorbid condition that can be associated with postoperative mortality and morbidity. However, the outcome profile of patients with COPD after breast reconstruction has yet to be established. Therefore, this study aimed to assess the postoperative outcomes in patients with COPD who underwent autologous (ABR) and implant-based breast reconstruction (IBR). METHODS National Inpatient Sample was used to identify patients who underwent ABR or IBR from Q4 2015 to 2020. Multivariable logistic regressions were used to compare inhospital outcomes between COPD and non-COPD patients while adjusting for demographics, primary payer status, hospital characteristics, and comorbidities. RESULTS There were 1288 (9.92%) COPD and 11,696 non-COPD patients who underwent ABR. Meanwhile, 1742 (9.70%) COPD and 16,221 non-COPD patients underwent IBR. In both ABR and IBR, patients with COPD had higher rates of seroma (ABR, aOR = 1.863, 95% CI = 1.022-3.397, and p = 0.04; IBR, aOR = 1.524, 95% CI = 1.014-2.291, and p = 0.04), infection (ABR, aOR = 1.863, 95% CI = 1.022-3.397, and p = 0.04; IBR, aOR = 1.956, 95% CI = 1.205-3.176, and p = 0.01), and prolonged LOS (p < 0.01). Specifically, patients with COPD in ABR had higher risks of respiratory complications (aOR = 1.991, 95% CI = 1.291-3.071, and p < 0.01) and incurred higher total hospital charges (p < 0.01). Meanwhile, patients with COPD undergoing IBR had elevated risks of renal complications (aOR = 3.421, 95% CI = 2.108-5.55, and p < 0.01), deep wound complications (aOR = 3.191, 95% CI = 1.423-7.153, and p < 0.01), and a higher rate of transfers out (aOR = 1.815, 95% CI = 1.081-3.05, and p = 0.02). CONCLUSION COPD is an independent risk factor associated with distinct adverse outcomes in ABR and IBR. These findings can be valuable for preoperative risk stratification, determining surgical candidacy, and planning postoperative management in patients with COPD.
Collapse
Affiliation(s)
- Renxi Li
- The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
| | - Bharat Ranganath
- Department of Surgery, The George Washington University Hospital, Washington, District of Columbia, USA
| |
Collapse
|
13
|
Li R, Ranganath B. Effect of hypothyroidism on short-term outcomes after autologous and implant-based breast reconstruction. Updates Surg 2024:10.1007/s13304-024-01791-w. [PMID: 38489128 DOI: 10.1007/s13304-024-01791-w] [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: 12/04/2023] [Accepted: 02/24/2024] [Indexed: 03/17/2024]
Abstract
Hypothyroidism has high prevalence in elderly women, which overlaps with the patient population who opt for post-mastectomy breast reconstruction. While hypothyroidism was shown to impact outcomes in other surgeries, its effect on breast reconstruction has not been established. This study aimed to compare the short-term outcomes of patients with and without hypothyroidism who underwent autologous (ABR) and implant-based breast reconstruction (IBR), respectively. Patients having ABR or IBR were identified in the National Inpatient Sample from Q4 2015-2020. Multivariable logistic regressions were used to compare in-hospital outcomes between patients with and without hypothyroidism, adjusted for demographics, socioeconomic status, comorbidities, and hospital characteristics. There were 12,765 patients underwent ABR, where 1591 (12.46%) of them had hypothyroidism, while 17,670 patients had IBR with 1,984 (11.23%) having hypothyroidism. Hypothyroid patients had a higher risk of hemorrhage/hematoma (aOR = 1.254, 95 CI 1.079-1.457, p < 0.01) after ABR. However, there were no differences in terms of mortality and organ system complications, nor wound dehiscence, superficial/deep wound complications, seroma, flap revision, excessive scarring, venous thromboembolism, pulmonary embolism, vascular complications, infection, sepsis, transfer out, length of stay (LOS), nor hospital charge between patients with and without hypothyroidism after ABR. All postoperative outcomes were comparable between hypothyroid patients and controls after IBR. While breast reconstruction is generally safe for hypothyroid patients, preoperative screening for hypothyroidism may be beneficial for those undergoing ABR. In ABR, hypothyroidism correction and blood management may help prevent bleeding complications in hypothyroid patients. Future studies should explore the long-term prognosis of hypothyroid patients after breast reconstruction.
Collapse
Affiliation(s)
- Renxi Li
- George Washington University School of Medicine and Health Sciences, 2300 I St NW, Washington, DC, 20052, USA.
| | - Bharat Ranganath
- Department of Surgery, George Washington University Hospital, Washington, DC, USA
| |
Collapse
|
14
|
Li R, Sidawy A, Nguyen BN. The 5-Factor Modified Frailty Index is a succinct yet effective predictor of adverse outcomes in patients undergoing open surgery for abdominal aortic aneurysm. Ann Vasc Surg 2024:S0890-5096(24)00094-3. [PMID: 38492726 DOI: 10.1016/j.avsg.2023.12.085] [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: 10/05/2023] [Revised: 12/07/2023] [Accepted: 12/19/2023] [Indexed: 03/18/2024]
Abstract
BACKGROUND Frailty is an age-related, clinically recognizable state marked by increased susceptibility. The 5-item Modified Frailty Index (mFI-5) offers a concise assessment of frailty and has demonstrated its efficacy in various surgical fields. While the mFI-5 has been validated for Endovascular Aneurysm Repair (EVAR) for Abdominal Aortic Aneurysm (AAA), its applicability in open surgical repair (OSR) for AAA remains largely unexplored. This study sought to evaluate the utility of mFI-5 in predicting 30-day outcomes following OSR for AAA. METHODS Patients underwent OSR for AAA were identified in ACS-NSQIP targeted database from 2012-2021. Patients were stratified into three cohorts: mFI-5 score of 0 (control), 1, and 2+. Multivariable logistic regression was used to compare 30-day perioperative outcomes between frail patients and controls adjusting preoperative variables with p-value<0.1. RESULTS Of the 5,249 patients who underwent OSR for AAA, 1,043 were controls, 2,938 had an mFI-5 score of 1, and 1,268 had an mFI-5 score of 2+. When compared to the control group, patients with an mFI-5=1 were more likely to have pulmonary events (aOR=1.452, p<0.01), bleeding events (aOR=1.33, p<0.01), wound complications (aOR=2.214, p<0.01), ischemic colitis (aOR=1.616, p=0.01), and unplanned reoperation (aOR=1.292, p=0.04). Those with an mFI-5=2+ demonstrated higher risks of mortality (aOR=1.709, p<0.01), MACE (aOR=1.347, p=0.04), pulmonary events (aOR=2.045, p<0.01), renal dysfunction (aOR=1.568, p<0.01), sepsis (aOR=1.587, p=0.01), bleeding events (aOR=1.429, p<0.01), wound complications (aOR=2.338, p<0.01), ischemic colitis (aOR=1.775, p=0.01), unplanned reoperation (aOR=1.445, p=0.01), operation over 4 hours (aOR=1.34, p<0.01), length of stay over 7 days (aOR=1.324, <0.01), discharge not to home (aOR=1.547, p<0.01), 30-day readmission (aOR=1.657, p=0.01). CONCLUSION The mFI-5 emerges as a succinct yet effective indicator of frailty for patients undergoing OSR for AAA. Especially, a mFI-5 score of 2+ is linked with increased 30-day mortality and complications. As such, mFI-5 can be used as a valuable screening tool for frailty in patients undergoing OSR for AAA.
Collapse
Affiliation(s)
- Renxi Li
- The George Washington University School of Medicine and Health Sciences, Washington, D.C; Division of Vascular Surgery, Department of Surgery, The George Washington University Hospital, Washington, D.C.
| | - Anton Sidawy
- Division of Vascular Surgery, Department of Surgery, The George Washington University Hospital, Washington, D.C
| | - Bao-Ngoc Nguyen
- Division of Vascular Surgery, Department of Surgery, The George Washington University Hospital, Washington, D.C
| |
Collapse
|
15
|
Li R, Prastein DJ. Patients with alcohol abuse have higher risks of complications after coronary artery bypass grafting: a population-based study of National Inpatient Sample from 2015 to 2020. Alcohol 2024:S0741-8329(24)00038-7. [PMID: 38452863 DOI: 10.1016/j.alcohol.2024.03.002] [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: 02/12/2024] [Revised: 02/25/2024] [Accepted: 03/04/2024] [Indexed: 03/09/2024]
Abstract
BACKGROUND Alcohol abuse (AA) has s high prevalence, affecting 10 to 15 million Americans. While AA was demonstrated to negatively impact cardiovascular health, limited evidence from existing studies presents conflicting findings regarding the effects of AA on coronary artery bypass grafting (CABG) outcomes. This study aimed to compare the in-hospital outcomes after CABG between AA and non-AA patients. METHODS Patients who underwent CABG were identified in National Inpatient Sample from Q4 2015-2020. Exclusion criteria included age<18 years and concomitant procedures. A 1:3 propensity-score matching was used to address differences in demographics, socioeconomic status, primary payer status, hospital characteristics, comorbidities, and transfer/admission status between AA and non-AA patients. In-hospital outcomes after CABG were examined. RESULTS There were 5,694 (3.39%) AA patients who underwent CABG. After matching, 17,315 from 162,488 non-AA patients were matched to all AA patients. AA and non-AA patients had comparable mortality (1.64% vs 1.55%, p=0.67) and MACE (2.46% vs 2.56%, p=0.73). However, AA patients had higher cardiogenic shock (8.31% vs 7.43%, p=0.03), mechanical ventilation (11.51% vs 7.96%, p<0.01), hemorrhage/hematoma (57.49% vs 54.75%, p<0.01), superficial (0.99% vs 0.61%, p<0.01) and deep wound complications (0.37% vs 0.18%, p=0.02), reopen surgery for bleeding control (0.92% vs 0.63%, p=0.03), transfer out (21.00% vs 16.38%, p<0.01), longer time from admission to operation (p<0.01), longer length of stay (p<0.01), and higher hospital charge (p<0.01). CONCLUSION While AA was not found to be linked with in-hospital mortality or MACE after CABG, it was independently associated with postoperative complications. These findings could enhance preoperative risk stratification for AA patients and inform postoperative management following CABG.
Collapse
Affiliation(s)
- Renxi Li
- The George Washington University School of Medicine and Health Sciences, Washington, DC.
| | - Deyanira J Prastein
- The George Washington University Hospital, Department of Surgery, Washington, DC
| |
Collapse
|
16
|
Li R, Ranganath B. Higher 30-day pulmonary and wound complications among current smokers in bottom gender affirmation surgery. J Plast Reconstr Aesthet Surg 2024; 90:70-72. [PMID: 38364670 DOI: 10.1016/j.bjps.2024.02.046] [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] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 12/07/2023] [Accepted: 02/04/2024] [Indexed: 02/18/2024]
Affiliation(s)
- Renxi Li
- George Washington University School of Medicine and Health Sciences, Washington, DC, USA.
| | - Bharat Ranganath
- George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| |
Collapse
|
17
|
Li R, Sarin S. Advanced chronic renal disease is an independent risk factor for inpatient mortality following transjugular intrahepatic portosystemic shunt procedure. Eur J Gastroenterol Hepatol 2024; 36:332-337. [PMID: 38179873 DOI: 10.1097/meg.0000000000002703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2024]
Abstract
BACKGROUND Transjugular intrahepatic portosystemic shunt (TIPS) is a procedure used to alleviate portal hypertension in patients with decompensated liver cirrhosis. However, the risks and outcomes associated with TIPS in patients with advanced chronic kidney disease (CKD) remain uncertain. This study aimed to investigate the perioperative outcomes of TIPS procedures in patients with advanced CKD using the National Inpatient Sample (NIS) database, a comprehensive all-payer inpatient database in the US. METHODS The study identified patients who underwent TIPS procedures in the NIS database from Q4 2015 to 2020. Patients with advanced CKD were identified using specific ICD-10-CM codes, and they were compared to patients without CKD. Preoperative variables, including demographics, indications for TIPS, comorbidities, APR-DRG subclass, primary payer status, and hospital characteristics, were noted. Perioperative outcomes were examined by multivariable logistic regression. RESULTS A total of 248 patients with advanced CKD and 5511 patients without CKD undergoing TIPS procedures were identified in the NIS database. Compared to non-CKD, patients with advanced CKD had higher mortality (13.70% vs. 8.60%, aOR = 1.56, P = 0.03), acute kidney injury (51.21% vs. 29.34, aOR = 1.46, P < 0.01), transfer out (25.00% vs. 12.84%, aOR = 1.88, P < 0.01), and length of stay over 7 days (64.11% vs. 38.97%, aOR = 2.34, P < 0.01). However, there was no difference in hepatic encephalopathy (31.85% vs. 27.19%, aOR = 1.12, P = 0.42). CONCLUSION Advanced CKD patients undergoing TIPS are at higher risk of mortality and AKI compared to patients without CKD; HE was mildly elevated but NS. Long-term prognosis of patients with advanced CKD who had TIPS is needed in future studies.
Collapse
Affiliation(s)
- Renxi Li
- The George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Shawn Sarin
- The George Washington University Hospital, Department of Interventional Radiology, Washington, DC, USA
| |
Collapse
|
18
|
Akosman S, Li R, Kwon B, West W, Asahi M, Wroblewski KJ. Sociodemographic and Clinical Predictors of Prolonged Length of Corneal Ulcer Hospitalizations. JAMA Ophthalmol 2024; 142:235-241. [PMID: 38329762 PMCID: PMC10853861 DOI: 10.1001/jamaophthalmol.2023.6512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 11/28/2023] [Indexed: 02/09/2024]
Abstract
Importance The length of stay (LOS) of hospitalizations may be a useful indicator of the burden of disease of corneal ulcers. Identifying variables associated with longer LOS may help to enhance delivery of care for high-risk patients. Objective To investigate the sociodemographic, social, and clinical factors associated with LOS in hospitalizations for corneal ulcers in the US. Design, Setting, and Participants This was a retrospective cross-sectional study of adult patients (aged >18 years) admitted with a primary diagnosis of corneal ulcer between quarter 4 of 2015 through 2020 and conducted using data from the National Inpatient Sample (NIS). Patients were stratified into 2 even cohorts based on LOS: LOS of 4 days or less and LOS greater than 4 days. Individual-level sociodemographic, social risk factors, and medical comorbidities associated with longer LOS were examined by multivariable regression. Data were analyzed from October 2015 to December 2020. Exposure Potential sociodemographics or medical comorbidities at hospital admission. Main Outcome and Measure The primary outcome of interest was factors associated with extended length of stay. The hypothesis being tested was formulated during data collection. Results A total of 1187 patients (mean [SD] age, 53.5 [20.9] years; 602 female [50.7%]) were included for analysis. The cohort with LOS greater than 4 days had higher total charges than the cohort with LOS of 4 days or less (mean [SD] charges, $79 504 [$86 719] vs $26 474 [$20 743]; P < .001). Sociodemographic variables associated with LOS greater than 4 days were Black race (adjusted odds ratio [aOR], 1.41; 95% CI, 1.03-1.92; P = .03), Medicare insurance (aOR, 1.42; 95% CI, 1.09-1.85; P = .009), and housing insecurity (aOR, 1.99; 95% CI, 1.29-3.06; P = .002). Medical comorbidities associated with LOS greater than 4 days were alcohol use (aOR, 1.50; 95% CI, 1.00-2.26; P = .05), dementia (aOR, 2.35; 95% CI, 1.36-4.07; P = .002), complicated diabetes (aOR, 1.75; 95% CI, 1.21-2.53; P = .003), uncomplicated diabetes (aOR, 1.57; 95% CI, 1.02-2.42; P = .04), drug misuse (aOR, 1.66; 95% CI, 1.08-2.57; P = .02), and legal blindness (aOR, 3.42; 95% CI, 1.19-9.82; P = .02). Based on NIS national estimates, corneal ulcers were estimated to have a direct annual health care expenditure of $35 819 590 in the US. Conclusion and Relevance Corneal ulcer hospitalizations represent a significant burden of disease for patients and health care systems. This study highlights sociodemographic and clinical factors that may help clinicians identify high-risk patients vulnerable to complications and morbidity due to corneal ulcers.
Collapse
Affiliation(s)
- Sinan Akosman
- Department of Ophthalmology, George Washington University, Washington, DC
| | - Renxi Li
- Department of Ophthalmology, George Washington University, Washington, DC
| | - Bryan Kwon
- Department of Ophthalmology, George Washington University, Washington, DC
| | - William West
- Department of Ophthalmology, George Washington University, Washington, DC
| | - Masumi Asahi
- Gavin Herbert Eye Institute, University of California Irvine, Irvine
| | | |
Collapse
|
19
|
Li R, Sidawy A, Nguyen BN. Development of a comorbidity index for patients undergoing abdominal aortic aneurysm repair. J Vasc Surg 2024; 79:547-554. [PMID: 37890642 DOI: 10.1016/j.jvs.2023.10.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 10/18/2023] [Accepted: 10/19/2023] [Indexed: 10/29/2023]
Abstract
BACKGROUND Endovascular aneurysm repair (EVAR) and open surgical repair (OSR) are two modalities to treat patients with abdominal aortic aneurysm (AAA). Alternative to individual comorbidity adjustment, a summary comorbidity index is a weighted composite score of all comorbidities that can be used as standard metric to control for comorbidity burden in clinical studies. This study aimed to develop summary comorbidity indices for patients who underwent AAA repair. METHODS Patients who went under EVAR or OSR were identified in National Inpatient Sample (NIS) between the last quarter of 2015 to 2020. In each group, patients were randomly sampled into experimental (2/3) and validation (1/3) groups. The weights of Elixhauser comorbidities were determined from a multivariable logistic regression and single comorbidity indices were developed for EVAR and OAR groups, respectively. RESULTS There were 34,668 patients underwent EVAR (2.19% mortality) and 4792 underwent OSR (10.98% mortality). Both comorbidity indices had moderate discriminative power (EVAR c-statistic, 0.641; 95% confidence interval [CI], 0.616-0.665; OSR c-statistic, 0.600; 95% CI, 0.563-0.630) and good calibration (EVAR Brier score, 0.021; OSR Brier score, 0.096). The indices had significantly better discriminative power (DeLong P <.001) than the Elixhauser Comorbidity Index (ECI) (EVAR c-statistic, 0.572; 95% CI, 0.546-0.597; OSR c-statistic, 0.502; 95% CI, 0.472-0.533). For internal validation, both indices had similar performance compared with individual comorbidity adjustment (EVAR DeLong P = .650; OSR DeLong P = .431). These indices demonstrated good external validation, exhibiting comparable performance to their respective validation groups (EVAR DeLong P = .891; OSR DeLong P = .757). CONCLUSIONS ECI, the comorbidity index formulated for the general population, exhibited suboptimal performance in patients who underwent AAA repair. In response, we developed summary comorbidity indices for both EVAR and OSR for AAA repair, which were internally and externally validated. The EVAR and OSR comorbidity indices outperformed the ECI in discriminating in-hospital mortality rates. They can standardize comorbidity measurement for clinical studies in AAA repair, especially for studies with small samples such as single-institute data sources to facilitate replication and comparison of results across studies.
Collapse
Affiliation(s)
- Renxi Li
- George Washington University School of Medicine and Health Sciences, Washington, DC.
| | - Anton Sidawy
- Department of Surgery, George Washington University Hospital, Washington, DC
| | - Bao-Ngoc Nguyen
- Department of Surgery, George Washington University Hospital, Washington, DC
| |
Collapse
|
20
|
Li R, Ranganath B. Bottom gender affirming surgery is safe in patients with obesity: A national perspective from ACS-NSQIP database from 2005 to 2021. J Plast Reconstr Aesthet Surg 2024; 90:67-69. [PMID: 38364669 DOI: 10.1016/j.bjps.2024.02.028] [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] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 02/04/2024] [Indexed: 02/18/2024]
Affiliation(s)
- Renxi Li
- The George Washington University School of Medicine and Health Sciences, Washington, DC, USA.
| | - Bharat Ranganath
- The George Washington University Hospital, Department of Surgery, Washington, DC, USA
| |
Collapse
|
21
|
Li R, Sarin S. Disparity Among African Americans in Transjugular Intrahepatic Portosystemic Shunt Procedure: A National Inpatient Sample Analysis from 2015 to 2020. Dig Dis Sci 2024; 69:713-719. [PMID: 38319431 DOI: 10.1007/s10620-024-08273-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 01/02/2024] [Indexed: 02/07/2024]
Abstract
BACKGROUND Transjugular intrahepatic portosystemic shunt (TIPS) is a procedure used to alleviate patients with chronic liver cirrhosis and portal hypertension. Racial disparities were present in TIPS where numerous studies suggested African American patients experience higher in-hospital mortality rates. However, the incidence of post-TIPS surgical complications, such as HE, has yet to be examined among African Americans. Therefore, this study aimed to provide a comprehensive examination of the disparities in TIPS procedures among African American patients. METHODS The study compared African American and Caucasian patients who underwent TIPS procedures in the National Inpatient Sample (NIS) database from the last quarter of 2015-2020 after ICD-10 change. Preoperative variables, including demographics, comorbidities, primary payer status, and hospital characteristics, were examined and multivariable analysis was used to assess outcomes correcting preoperative variables with p < 0.1. RESULTS Compared to Caucasians, African Americans had higher in-hospital mortality (16.18 vs 8.22%, aOR 1.781, p < 0.01), hepatic encephalopathy (33.09 vs 27.44%, aOR 1.300, p = 0.05), and acute kidney injury (45.59 vs 29.60%, aOR 2.019, p < 0.01). Using the generalized linear model, African Americans have longer length of stay (11.04 ± 0.77 days vs 8.54 ± 0.16 days, p < 0.01). CONCLUSION Despite a higher prevalence of cirrhosis, African Americans continue to have marked underrepresentation in TIPS procedures in recent years. Their underrepresentation, in conjunction with higher mortality, morbidity, and increased comorbidity conditions, could imply disparity in accessing care. This finding underscores the necessity for improved access to diagnostic and therapeutic services for African Americans with liver cirrhosis.
Collapse
Affiliation(s)
- Renxi Li
- The George Washington University School of Medicine and Health Sciences, 2300 I St NW, Washington, DC, 20052, USA.
| | - Shawn Sarin
- Department of Interventional Radiology, George Washington University Hospital, Washington, DC, USA
| |
Collapse
|
22
|
Li R, Chen GL, Zhang YL, Li DZ. NSF-related fetal anemia and hydrops: new entity? Ultrasound Obstet Gynecol 2024; 63:421-422. [PMID: 37767567 DOI: 10.1002/uog.27500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Revised: 09/14/2023] [Accepted: 09/18/2023] [Indexed: 09/29/2023]
Affiliation(s)
- R Li
- Prenatal Diagnostic Center, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - G-L Chen
- Prenatal Diagnostic Center, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Y-L Zhang
- Prenatal Diagnostic Center, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - D-Z Li
- Prenatal Diagnostic Center, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, China
| |
Collapse
|
23
|
Li R, Sidawy A, Nguyen BN. Acute Intraoperative Conversion from Endovascular to Open vs Planned Open Operation for Abdominal Aortic Aneurysm: A Propensity-Score Matched Study from the American College of Surgeons NSQIP Targeted Database. J Am Coll Surg 2024:00019464-990000000-00919. [PMID: 38372301 DOI: 10.1097/xcs.0000000000001050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2024]
Abstract
BACKGROUND Evaluating outcomes for acute intraoperative conversion to open surgery during endovascular aneurysm repair (EVAR) for abdominal aortic aneurysm (AAA) was difficult due to low incidence. This study aimed to compare 30-day outcomes between patients with acute intraoperative conversion during EVAR and planned open surgery, and to identify risk factors associated with acute conversion. METHODS Patients underwent EVAR or planned open AAA repair were identified in ACS-NSQIP targeted databases 2012-2021. Patients with acute intraoperative conversion during EVAR were selected. A 1:3 propensity-score matching was used to match demographics, baseline characteristics, surgical indications, aneurysm size and extent, and emergency cases between the conversion open and planned open groups. Thirty-day postoperative outcomes were assessed. RESULTS Out of 20,566 EVAR, 177 (0.86%) had acute intraoperative conversion to open surgery. The conversion open group was matched to 504 out of 5,249 planned open patients. Conversion open and planned open groups had comparable 30-day mortality (23.43% vs 17.46%, p=0.09) and organ system complications including MACE (14.86% vs 10.71%, p=0.17), pulmonary complications (17.71% vs 24.01%, p=0.09), and renal complications (8.57% vs 11.11%, p=0.39). The conversion open group had lower bleeding requiring transfusion (48.57% vs 75.60%, p<0.01), shorter operation time (p<0.01), and shorter length of stay (p<0.01). Other postoperative outcomes did not differ. Risk factors associated with acute intraoperative conversion included ruptured aneurysm with or without hypotension. Protective factors included hypertension and aortic distal aneurysm extent. CONCLUSION While this study does not endorse a universal "EVAR first" strategy for all patients with AAA, EVAR can be attempted first in eligible AAA patients. Even when EVAR is unsuccessful, intraoperative conversion to open surgery still appears to be safe compared to planned open repair.
Collapse
Affiliation(s)
- Renxi Li
- The George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Anton Sidawy
- The George Washington University Hospital, Department of Surgery, Washington, DC
| | - Bao-Ngoc Nguyen
- The George Washington University Hospital, Department of Surgery, Washington, DC
| |
Collapse
|
24
|
Li R, Luo Q, Huddleston SJ. African Americans have worse outcomes after transcatheter and surgical aortic valve replacement: A national inpatient sample analysis from 2015 to 2020. J Cardiol 2024:S0914-5087(24)00021-2. [PMID: 38373538 DOI: 10.1016/j.jjcc.2024.02.003] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 02/07/2024] [Accepted: 02/12/2024] [Indexed: 02/21/2024]
Abstract
BACKGROUND Racial disparities in transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR) are controversial among African Americans (AA). This study investigated racial disparities comparing AA and Caucasians undergoing aortic valve replacement. METHODS Patients who underwent SAVR and TAVR for aortic stenosis were identified in National Inpatient Sample from Q4 2015-2020. In-hospital perioperative outcomes, length of stay, days from admission to operation, and total hospital charge, were compared between AA and Caucasians using multivariable analysis, adjusting for sex, age, socioeconomic status, comorbidity, and hospital characteristics. RESULTS In TAVR, 51,394 (84.41 %) were Caucasians and 2433 (4.00 %) were AA. In SAVR, there were 50,080 (78.52 %) Caucasians and 3565 (5.59 %) AA. Compared to Caucasians, AA underwent TAVR had a higher risk of complications such as major adverse cardiovascular events (MACE) [adjusted odds ratio (aOR) = 1.335, p = 0.02)], respiratory complications (aOR = 1.363, p = 0.01), acute kidney injury (AKI) (aOR = 1.468, p < 0.01), pulmonary embolism (aOR = 4.65, p = 0.05), hemorrhage/hematoma (aOR = 1.202, p < 0.01), or superficial wound complication (aOR = 1.414, p = 0.04). AA who underwent SAVR had higher risks of morality (aOR = 1.184, p < 0.05) and surgical complications including MACE (aOR = 1.263, p < 0.01), pericardial complications (aOR = 1.563, p < 0.01), cardiogenic shock (aOR = 1.578, p < 0.01), respiratory complications (aOR = 1.261, p < 0.01), AKI (aOR = 1.642, p < 0.01), venous thromboembolism (aOR = 1.613, p < 0.01), hemorrhage/hematoma (aOR = 1.129, p < 0.01), infection (aOR = 1.234, p < 0.01), superficial wound complications (aOR = 1.756, p < 0.01), vascular complications (aOR = 1.592, p < 0.01), and diaphragmatic paralysis (aOR = 2.181, p = 0.02). In both TAVR and SAVR, AA had longer waiting times from admission to operation (p < 0.01), longer hospital stays (p < 0.01), and higher hospital charges (p < 0.01). CONCLUSION AA were underrepresented, especially in TAVR. AA experienced higher in-hospital mortality post-SAVR, but not after TAVR. Furthermore, AA had more complications for both TAVR and SAVR. These findings underscore the pronounced disparities among AA in aortic valve replacement.
Collapse
Affiliation(s)
- Renxi Li
- The George Washington University School of Medicine and Health Sciences, Washington, DC, USA; Division of Cardiovascular and Thoracic Surgery, Department of Surgery, University of Minnesota Medical School, Minneapolis, MN, USA.
| | - Qianyun Luo
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Stephen J Huddleston
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, University of Minnesota Medical School, Minneapolis, MN, USA
| |
Collapse
|
25
|
He W, Yu W, Huang Y, Liao S, Zhang G, Wang Q, Li R, Yang L, Yao R, Zhang Z, Zhong B, Liu Y, Wang Q. [Effectiveness of comprehensive echinococcosis control measures with emphasis on management of infectious source in Sichuan Province from 2010 to 2022]. Zhongguo Xue Xi Chong Bing Fang Zhi Za Zhi 2024; 35:614-620. [PMID: 38413022 DOI: 10.16250/j.32.1374.2023116] [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] [Subscribe] [Scholar Register] [Indexed: 02/29/2024]
Abstract
OBJECTIVE To evaluate the effectiveness of comprehensive echinococcosis control measures with emphasis on management of infectious source in Sichuan Province from 2010 to 2022, so as to provide insights into formulation of future control interventions. METHODS Data pertaining to comprehensive echinococcosis control measures with emphasis on management of infectious source and echinococcosis surveillance in Sichuan Province from 2010 to 2022 were collected. The effectiveness of comprehensive echinococcosis control measures with emphasis on management of infectious source was evaluated with prevalence of human echinococcosis, detection of newly diagnosed echinococcosis patients, prevalence of Echinococcus infection in domestic dogs, prevalence of cystic echinococcosis in livestock, prevalence of alveolar echinococcosis in small mammals and awareness of echinococcosis control knowledge, and Spearman's rank correlation analysis. RESULTS The prevalence of human echinococcosis reduced from 1.08% in 2010 to 0.40% in 2022 in Sichuan Province (χ2 = 1 482.97, P < 0.05), with a reduction from 0.30% to 0.02% in the detection of newly diagnosed echinococcosis cases (χ2 = 2 776.41, P < 0.05), a reduction from 15.87% to 0.46% in the prevalence of Echinococcus infection in domestic dogs (χ2 = 20 823.96, P < 0.05), a reduction from 8.05% to 1.07% in the prevalence of cystic echinococcosis in livestock (χ2 = 1 296.02, P < 0.05), and the awareness of echinococcosis control knowledge increased from 50.65% to 95.24% (χ2 = 34 938.63, P < 0.05); in addition, there was a year-specific prevalence rate of alveolar echinococcosis in small mammals (χ2 = 164.07, P < 0.05). Spearman's rank correlation analysis revealed that the detection of newly diagnosed echinococcosis cases correlated positively with the prevalence of Echinococcus infections in domestic dogs (rs = 0.823, P < 0.05) and the prevalence of cystic echinococcosis in livestock (rs = 0.795, P < 0.05), and correlated negatively with the awareness of echinococcosis control knowledge (rs = - 0.918, P < 0.05), and the prevalence of Echinococcus infection in domestic dogs correlated positively with the prevalence of cystic echinococcosis in livestock (rs = 0.753, P < 0.05) and negatively with the awareness of echinococcosis control knowledge (rs = -0.747, P < 0.05); however, there was no correlation between the prevalence of Echinococcus infections in domestic dogs and the prevalence of alveolar echinococcosis in small mammals (rs = -0.750, P > 0.05). CONCLUSIONS The comprehensive echinococcosis control measures with emphasis on management of infectious source had achieved remarkable effectiveness in Sichuan Province; however, the transmission chain of echinococcosis has not been interrupted. Reinforced comprehensive echinococcosis control measures with emphasis on management of infectious source and sustained tracking evaluation of the effectiveness are recommended in Sichuan Province.
Collapse
Affiliation(s)
- W He
- Institute of Parasitic Diseases, Sichuan Provincial Center for Disease Control and Prevention, Chengdu, Sichuan 610041, China
| | - W Yu
- Institute of Parasitic Diseases, Sichuan Provincial Center for Disease Control and Prevention, Chengdu, Sichuan 610041, China
| | - Y Huang
- Institute of Parasitic Diseases, Sichuan Provincial Center for Disease Control and Prevention, Chengdu, Sichuan 610041, China
| | - S Liao
- Institute of Parasitic Diseases, Sichuan Provincial Center for Disease Control and Prevention, Chengdu, Sichuan 610041, China
| | - G Zhang
- Institute of Parasitic Diseases, Sichuan Provincial Center for Disease Control and Prevention, Chengdu, Sichuan 610041, China
| | - Q Wang
- Institute of Parasitic Diseases, Sichuan Provincial Center for Disease Control and Prevention, Chengdu, Sichuan 610041, China
| | - R Li
- Institute of Parasitic Diseases, Sichuan Provincial Center for Disease Control and Prevention, Chengdu, Sichuan 610041, China
| | - L Yang
- Institute of Parasitic Diseases, Sichuan Provincial Center for Disease Control and Prevention, Chengdu, Sichuan 610041, China
| | - R Yao
- Institute of Parasitic Diseases, Sichuan Provincial Center for Disease Control and Prevention, Chengdu, Sichuan 610041, China
| | - Z Zhang
- Institute of Parasitic Diseases, Sichuan Provincial Center for Disease Control and Prevention, Chengdu, Sichuan 610041, China
| | - B Zhong
- Institute of Parasitic Diseases, Sichuan Provincial Center for Disease Control and Prevention, Chengdu, Sichuan 610041, China
| | - Y Liu
- Institute of Parasitic Diseases, Sichuan Provincial Center for Disease Control and Prevention, Chengdu, Sichuan 610041, China
| | - Q Wang
- Institute of Parasitic Diseases, Sichuan Provincial Center for Disease Control and Prevention, Chengdu, Sichuan 610041, China
| |
Collapse
|
26
|
Li R, Luo Q, Yanavitski M, Huddleston SJ. Disparity among Asian Americans in transcatheter and surgical aortic valve replacement. Cardiovasc Revasc Med 2024; 59:84-90. [PMID: 37673721 DOI: 10.1016/j.carrev.2023.08.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 08/30/2023] [Accepted: 08/30/2023] [Indexed: 09/08/2023]
Abstract
BACKGROUND Racial disparities in transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR) outcomes have been established, but research has predominantly focused on African Americans and Hispanics, leaving a gap in Asian Americans. This study aimed to investigate disparities in aortic valve replacement outcomes among Asian Americans. METHODS Patients who underwent SAVR and TAVR were identified in National Inpatient Sample from the last quarter of 2015-2020. A 1:2 propensity score matching was applied to Asian Americans and Caucasians. In-hospital perioperative outcomes, length of stay, days from admission to operation, and total hospital charge, were compared. RESULTS In TAVR, 51,394 (84.41 %) were Caucasians and 795 (1.31 %) were Asian Americans. In SAVR, there were 50,080 (78.52 %) Caucasians and 1233 (1.93 %) Asian Americans. No significant difference was found in post-TAVR complications. However, Asian Americans experienced longer waiting time until operation (p = 0.03) and higher costs (p < 0.01) in TAVR. In SAVR, Asian Americans had higher risks of in-hospital mortality (3.91 % vs 2.39 %, p = 0.01), cardiogenic shock (8.71 % vs 6.74 %, p = 0.03), respiratory complications (14.08 % vs 11.2 %, p = 0.01), mechanical ventilation (13.83 % vs 9.09 %, p < 0.01), acute kidney injury (25.47 % vs 20.13 %, p < 0.01), and hemorrhage/hematoma (72.01 % vs 62.95 %, p < 0.01). Additionally, Asian Americans underwent SAVR had longer lengths of stay (p < 0.01) and higher costs (p < 0.01). CONCLUSIONS Asian Americans were underrepresented in aortic valve replacement. Asian Americans, while having similar post-TAVR outcomes to Caucasians, faced greater risks of post-SAVR mortality and surgical complications. These disparities among Asian Americans call for targeted actions to ensure equitable health outcomes.
Collapse
Affiliation(s)
- Renxi Li
- The George Washington University School of Medicine and Health Sciences, Washington, DC, United States of America; Division of Cardiovascular and Thoracic Surgery, Department of Surgery, University of Minnesota Medical School, Minneapolis, MN, United States of America.
| | - Qianyun Luo
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, University of Minnesota Medical School, Minneapolis, MN, United States of America
| | - Marat Yanavitski
- M Health University of Minnesota Physicians, Cardiology East Division, Minneapolis, MN, United States of America
| | - Stephen J Huddleston
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, University of Minnesota Medical School, Minneapolis, MN, United States of America
| |
Collapse
|
27
|
Wu J, Li D, Gao J, Cui A, Li R, Wu S. Multi-channel synthetic aperture infrared imaging and experimental research. Appl Opt 2024; 63:976-981. [PMID: 38437394 DOI: 10.1364/ao.508139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 12/21/2023] [Indexed: 03/06/2024]
Abstract
The synthetic aperture infrared radio imaging method based on laser local oscillator coherent detection has potential application value for astronomical observations. This paper studies the multi-channel synthetic aperture infrared imaging method and conducts experimental verification using a principle prototype. In the short-wave infrared band, five beam-expanding fiber collimators are used to build an observation structure of five laser local oscillator coherent detection channels at a near-field distance of 5 m to carry out physical experiments. The laser local oscillator wavelength is 1.55 µm, and the AD sampling rate is 4 GHz. For the infrared radiation source signal, the phase relationship of the infrared signals between channels acquired by the prototype principle is stable, and the five-channel synthetic aperture imaging results are consistent with the computer simulated results. The experiment verified the effectiveness of the laser local oscillator comprehensive aperture infrared radio imaging method.
Collapse
|
28
|
Shi TS, Ma HP, Li DH, Pan L, Wang TR, Li R, Ren XW. Prenatal exposure to PM 2.5 components and the risk of different types of preterm birth and the mediating effect of pregnancy complications: a cohort study. Public Health 2024; 227:202-209. [PMID: 38241901 DOI: 10.1016/j.puhe.2023.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Revised: 11/28/2023] [Accepted: 12/05/2023] [Indexed: 01/21/2024]
Abstract
OBJECTIVES This study aims to reveal the single and mixed associations of PM2.5 and its components with very, moderately, and late preterm births and to explore the potential mediating role of pregnancy complications in PM2.5-induced preterm birth. STUDY DESIGN This was a retrospective cohort study. METHODS We enrolled 168,852 mothers and matched the concentrations of PM2.5 and its five components (OM, SO42-, BC, NO3-, and NH4+) based on their geographical location. Next, we used generalized linear models, quantile g-computation, and mediation analysis to evaluate the associations of PM2.5 and its components with very, moderately, and late preterm births and the mediating role of pregnancy complications. RESULTS Prenatal exposure to PM2.5 and its components was associated with preterm birth, and the association was strongest in the third trimester. Preterm birth was associated with co-exposure to a mixture of PM2.5 components in the third trimester, and the contributions of NO3-, NH4+, and BC to the risk of preterm birth were positive. Meanwhile, pregnancy complications mediated PM2.5-induced preterm birth. Moreover, very and moderately preterm births were associated with PM2.5 and its components in the second and third trimesters, and very and late preterm births were associated with co-exposure to a mixture of PM2.5 components in the third trimester. CONCLUSIONS Later exposure to PM2.5 during pregnancy will cause earlier preterm birth. Targeted and positive interventions for anthropogenic sources of specific PM2.5 components and pregnancy complications are helpful for preterm birth prevention.
Collapse
Affiliation(s)
- T S Shi
- Institute of Epidemiology and Health Statistics, School of Public Health, Lanzhou University, Lanzhou, Gansu, China
| | - H P Ma
- Lanzhou Maternal and Child Health Hospital, Lanzhou, Gansu, China
| | - D H Li
- Institute of Epidemiology and Health Statistics, School of Public Health, Lanzhou University, Lanzhou, Gansu, China
| | - L Pan
- Lanzhou Maternal and Child Health Hospital, Lanzhou, Gansu, China
| | - T R Wang
- Institute of Epidemiology and Health Statistics, School of Public Health, Lanzhou University, Lanzhou, Gansu, China
| | - R Li
- Institute of Epidemiology and Health Statistics, School of Public Health, Lanzhou University, Lanzhou, Gansu, China
| | - X W Ren
- Institute of Epidemiology and Health Statistics, School of Public Health, Lanzhou University, Lanzhou, Gansu, China.
| |
Collapse
|
29
|
Ren P, Chen M, Liu Q, Wu J, Li R, Lin Z, Li J. Gga-let-7a-3p inhibits the proliferation and differentiation of chicken intramuscular preadipocytes. Br Poult Sci 2024; 65:34-43. [PMID: 37807894 DOI: 10.1080/00071668.2023.2264807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Accepted: 09/11/2023] [Indexed: 10/10/2023]
Abstract
1. Intramuscular fat (IMF) is a key parameter for chicken meat quality. IMF deposition is driven by genetic, nutritional and management factors, with genetics being the determining factor. Previous whole transcriptome sequencing revealed that microRNA gga-let-7a-3p was related to lipid metabolism in breast muscle. This study further investigated the potential role of gga-let-7a-3p in IMF deposition.2. The mimic and inhibitor of gga-let-7a-3p were individually transfected into chicken intramuscular preadipocytes. Subsequently, the proliferation and differentiation states of the cells were detected. Transcriptome sequencing was performed on cells transfected with gga-let-7a-3p mimic.3. The results indicated that gga-let-7a-3p suppressed the mRNA levels of proliferation and differentiation-related genes, as well as the protein levels. EdU and Oil Red O assays revealed that gga-let-7a-3p restrained preadipocyte proliferation and differentiation. In addition, a total of 333 up-regulated genes and 807 down-regulated genes were identified in cells transfected with gga-let-7a-3p mimic. Using Kyoto Encyclopaedia of Genes and Genomes (KEGG) and Gene Ontology (GO) analysis, differential genes were found to be enriched in processes such as the peroxisome proliferator activated receptor (PPAR) signalling pathway and oxidative phosphorylation.4. The study demonstrated that gga-let-7a-3p inhibits the proliferation and differentiation of chicken intramuscular preadipocytes, which provides new understanding to further unravel the function of gga-let-7a-3p.
Collapse
Affiliation(s)
- P Ren
- School of Life Science and Engineering, Southwest University of Science and Technology, Mianyang, Sichuan, China
| | - M Chen
- School of Life Science and Engineering, Southwest University of Science and Technology, Mianyang, Sichuan, China
| | - Q Liu
- School of Life Science and Engineering, Southwest University of Science and Technology, Mianyang, Sichuan, China
| | - J Wu
- Institute of Animal Science and Technology of Aba Tibetan and Qiang Autonomous Prefecture, Aba, Sichuan, China
| | - R Li
- Institute of Animal Science and Technology of Aba Tibetan and Qiang Autonomous Prefecture, Aba, Sichuan, China
| | - Z Lin
- Farm Animal Genetic Resources Exploration and Innovation Key Laboratory of Sichuan Province, Sichuan Agricultural University, Chengdu, Sichuan, China
| | - J Li
- School of Life Science and Engineering, Southwest University of Science and Technology, Mianyang, Sichuan, China
| |
Collapse
|
30
|
Rienas W, Li R, Lee SE, Rienas C. Current Smoking Status Is Not a Risk Factor for Perioperative Outcomes in Patients with Aneurysmal Subarachnoid Hemorrhage Who Underwent Craniotomy Repair. World Neurosurg 2024; 182:e635-e643. [PMID: 38065355 DOI: 10.1016/j.wneu.2023.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 12/01/2023] [Accepted: 12/02/2023] [Indexed: 12/29/2023]
Abstract
BACKGROUND Aneurysmal subarachnoid hemorrhage is a rupture leading to blood accumulating in the subarachnoid region. Smoking status is often a risk factor for postoperative complications for vascular procedures. This study aims to retrospectively examine the effect of being a current tobacco smoker on postoperative outcomes in patients with nontraumatic subarachnoid hemorrhage. METHODS Patients with aneurysmal subarachnoid hemorrhage who underwent craniotomy were identified in the American College of Surgeons-National Surgical Quality Improvement Program database. The 30-day perioperative outcomes of current smokers were compared with those of control individuals, who were patients who had not smoked tobacco in the past year. Postoperative outcomes included death, cardiac complications, stroke, operation time >4 hours, bleeding, and other events. In addition, this study examined the same surgical outcomes in patients older than 65 years. RESULTS We found no significant difference between these 2 groups across all adverse outcomes analyzed. In patients aged >65 years, we again found no significant differences between these 2 groups across all adverse outcomes analyzed. CONCLUSIONS This study shows that although current tobacco smoker status is commonly a risk factor for vascular diseases and postoperative complications, it is not a risk factor for the postoperative variables that we analyzed during craniotomy for aneurysmal subarachnoid hemorrhage. Additional research should be conducted to determine if different procedures to treat aneurysmal subarachnoid hemorrhage may have different outcomes among smokers.
Collapse
Affiliation(s)
- William Rienas
- The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA.
| | - Renxi Li
- The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
| | - Seung Eun Lee
- The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
| | | |
Collapse
|
31
|
Li R, Jobson BT, Wen M, Li AL, Huangfu Y, Zhang W, Hardy R, O'Keeffe P, Simpson J, Fauci M, Paden N. Anthropogenic, biogenic, and photochemical influences on surface formaldehyde and its significant decadal (2006-2017) decrease in the Lewiston-Clarkston valley of the northwestern United States. Chemosphere 2024; 349:140962. [PMID: 38104739 DOI: 10.1016/j.chemosphere.2023.140962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 12/06/2023] [Accepted: 12/12/2023] [Indexed: 12/19/2023]
Abstract
Formaldehyde (HCHO) is a key carcinogen and plays an important role in atmospheric chemistry. Both field measurements and Positive Matrix Factorization (PMF) modeling have been employed to investigate the concentrations and sources of HCHO in the Lewiston-Clarkston (LC) valley of the mountainous northwestern U.S. Different instruments were deployed to measure surface formaldehyde and other related compounds in July of 2016 and 2017. The measurements reveal that the average HCHO concentrations have significantly decreased to 2-5 ppb in the LC valley in comparison to its levels (10-20 ppb) observed in July 2006. This discovery with surface measurements deserves attention given that satellite retrievals showed an increasing long-term trend from 2005 to 2014 in total vertical column density of HCHO in the region, suggesting that satellite instruments may not adequately resolve small valleys in the mountainous region. Our PMF modeling identified four major sources of HCHO in the valley: (1) emissions from a local paper mill, (2) secondary formation and background, (3) biogenic sources, and (4) traffic. This study reveals that the emissions from the paper mill cause high HCHO spikes (6-19 ppb) in the early morning. It is found that biogenic volatile organic compounds (VOCs) in the area are influenced by national forests surrounding the region (e.g., Nez Perce-Clearwater, Umatilla, Wallowa-Whitman, and Idaho Panhandle National Forests). The results provide useful information for developing strategies to control HCHO levels and have implications for future HCHO studies in atmospheric chemistry, which affects secondary aerosols and ozone formation.
Collapse
Affiliation(s)
- R Li
- Idaho Department of Environmental Quality, Boise, ID, USA.
| | - B T Jobson
- Laboratory for Atmospheric Research, Department of Civil & Environmental Engineering, Washington State University, Pullman, WA, USA
| | - M Wen
- Laboratory for Atmospheric Research, Department of Civil & Environmental Engineering, Washington State University, Pullman, WA, USA
| | - A L Li
- Boise High School, Boise, ID, USA
| | - Y Huangfu
- Laboratory for Atmospheric Research, Department of Civil & Environmental Engineering, Washington State University, Pullman, WA, USA
| | - W Zhang
- Idaho Department of Environmental Quality, Boise, ID, USA
| | - R Hardy
- Idaho Department of Environmental Quality, Boise, ID, USA
| | - P O'Keeffe
- Laboratory for Atmospheric Research, Department of Civil & Environmental Engineering, Washington State University, Pullman, WA, USA
| | - J Simpson
- Air Quality Program, Nez Perce Tribe, Lapwai, ID, USA
| | - M Fauci
- Air Quality Program, Nez Perce Tribe, Lapwai, ID, USA
| | - N Paden
- Idaho Department of Environmental Quality, Boise, ID, USA
| |
Collapse
|
32
|
Lin MM, Ge YM, Yang S, Yang R, Li R. [Rudimentary horn pregnancy: clinical analysis of 12 cases and literature review]. Zhonghua Fu Chan Ke Za Zhi 2024; 59:49-55. [PMID: 38228515 DOI: 10.3760/cma.j.cn112141-20231112-00184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/18/2024]
Abstract
Objective: To investigate the clinical characteristics, treatments and fertility recovery of rudimentary horn pregnancy (RHP). Methods: The clinical data of 12 cases with RHP diagnosed and treated in Peking University Third Hospital from January 1, 2010 to December 31, 2022 were retrospectively analyzed. Clinical informations, diagnosis and treatments of RHP and the pregnancy status after surgery were analyzed. Results: The median age of 12 RHP patients was 29 years (range: 24-37 years). Eight cases of pregnancy in residual horn of uterus occurred in type Ⅰ residual horn of uterus, 4 cases occurred in type Ⅱ residual horn of uterus; among which 5 cases were misdiagnosed by ultrasound before surgery. All patients underwent excision of residual horn of uterus and affected salpingectomy. After surgery, 9 patients expected future pregnancy, and 3 cases of natural pregnancy, 2 cases of successful pregnancy through assisted reproductive technology. Four pregnancies resulted in live birth with cesarean section, and 1 case resulted in spontaneous abortion during the first trimester of pregnancy. No uterine rupture or ectopic pregnancy occurred in subsequent pregnancies. Conclusions: Ultrasonography could aid early diagnosis of RHP while misdiagnosis occurred in certain cases. Thus, a comprehensive judgment and decision ought to be made based on medical history, physical examination and assisted examination. Surgical exploration is necessary for diagnosis and treatment of RHP. For infertile patients, assisted reproductive technology should be applied when necessary. Caution to prevent the occurrence of pregnancy complications such as uterine rupture, and application of cesarean section to terminate pregnancy are recommended.
Collapse
Affiliation(s)
- M M Lin
- Department of Obstetrics and Gynecology, Peking University Third Hospital, National Clinical Research Center for Obstetric and Gynecologic Diseases, Key Laboratory of Assisted Reproduction, Ministry of Education, Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology, Beijing 100191, China
| | - Y M Ge
- Department of Obstetrics and Gynecology, Peking University Third Hospital, National Clinical Research Center for Obstetric and Gynecologic Diseases, Key Laboratory of Assisted Reproduction, Ministry of Education, Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology, Beijing 100191, China
| | - S Yang
- Department of Obstetrics and Gynecology, Peking University Third Hospital, National Clinical Research Center for Obstetric and Gynecologic Diseases, Key Laboratory of Assisted Reproduction, Ministry of Education, Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology, Beijing 100191, China
| | - R Yang
- Department of Obstetrics and Gynecology, Peking University Third Hospital, National Clinical Research Center for Obstetric and Gynecologic Diseases, Key Laboratory of Assisted Reproduction, Ministry of Education, Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology, Beijing 100191, China
| | - R Li
- Department of Obstetrics and Gynecology, Peking University Third Hospital, National Clinical Research Center for Obstetric and Gynecologic Diseases, Key Laboratory of Assisted Reproduction, Ministry of Education, Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology, Beijing 100191, China
| |
Collapse
|
33
|
Kuo A, Imam MZ, Li R, Lin L, Raboczyj A, Bohmer AE, Nicholson JR, Corradini L, Smith MT. J-2156, a small molecule somatostatin type 4 receptor agonist, alleviated hindpaw hypersensitivity in the streptozotocin-induced rat model of painful diabetic neuropathy but with a 2-fold decrease in potency at an advanced stage in the model, mimicking morphine. Front Pharmacol 2024; 15:1346801. [PMID: 38318132 PMCID: PMC10839067 DOI: 10.3389/fphar.2024.1346801] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 01/09/2024] [Indexed: 02/07/2024] Open
Abstract
There is a large unmet need for novel pain-killers to improve relief of painful diabetic neuropathy (PDN). Herein, we assessed the efficacy of the somatostatin type 4 (SST4) receptor agonist, J-2156, for relief of PDN in rats. Diabetes was induced with streptozotocin (STZ; 70 mg/kg) and bilateral hindpaw hypersensitivity was fully developed by 8-week post-STZ. In the intervals, 8-12-weeks (morphine-sensitive phase; Phase 1) and 16-18-weeks (morphine-hyposensitive phase; Phase 2) post-STZ, rats received a single dose of intraperitoneal (i.p.) J-2156 (10, 20, 30 mg/kg), gabapentin (100 mg/kg i.p.), subcutaneous morphine (1 mg/kg) or vehicle. Hindpaw withdrawal thresholds (PWTs) were assessed using von Frey filaments pre-dose and at regular intervals over 3-h post-dose. In Phase 1, J-2156 at 30 mg/kg evoked significant anti-allodynia in the hindpaws with maximal effect at 1.5 h compared with 1 h for gabapentin and morphine. The durations of action for all three compounds were greater than 3 h. The corresponding mean (±SEM) extent and duration of anti-allodynia (ΔPWT AUC) for gabapentin did not differ significantly from that for J-2156 (30 mg/kg) or morphine. However, in Phase 2, the ΔPWT AUC for morphine was reduced to approximately 25% of that in Phase 1, mirroring our previous work. Similarly, the mean (±SEM) ΔPWT AUC for J-2156 (30 mg/kg) in Phase 2 was approximately 45% of that for Phase 1 whereas for gabapentin the mean (±SEM) ΔPWT AUCs did not differ significantly (p > 0.05) between the two phases. Our findings further describe the preclinical pain relief profile of J-2156 and complement previous work in rat models of inflammatory pain, neuropathic pain and low back pain. SST4 receptor agonists hold promise as novel therapeutics for the relief of PDN, a type of peripheral neuropathic pain that is often intractable to relief with clinically used drug treatment options.
Collapse
Affiliation(s)
- A. Kuo
- School of Biomedical Sciences, Faculty of Medicine, The University of Queensland, St Lucia, QLD, Australia
| | - M. Z. Imam
- School of Biomedical Sciences, Faculty of Medicine, The University of Queensland, St Lucia, QLD, Australia
| | - R. Li
- School of Biomedical Sciences, Faculty of Medicine, The University of Queensland, St Lucia, QLD, Australia
| | - L. Lin
- School of Biomedical Sciences, Faculty of Medicine, The University of Queensland, St Lucia, QLD, Australia
| | - A. Raboczyj
- School of Biomedical Sciences, Faculty of Medicine, The University of Queensland, St Lucia, QLD, Australia
| | - A. E. Bohmer
- School of Biomedical Sciences, Faculty of Medicine, The University of Queensland, St Lucia, QLD, Australia
| | - J. R. Nicholson
- Boehringer Ingelheim Pharma GmbH & Co. KG, Biberach an der Riss, Germany
| | - L. Corradini
- Boehringer Ingelheim Pharma GmbH & Co. KG, Biberach an der Riss, Germany
| | - M. T. Smith
- School of Biomedical Sciences, Faculty of Medicine, The University of Queensland, St Lucia, QLD, Australia
| |
Collapse
|
34
|
Backley S, Bergh E, Garnett J, Li R, Maroufy V, Jain R, Fletcher S, Tsao K, Austin M, Johnson A, Papanna R. Fetal cardiovascular changes during open and fetoscopic in-utero spina bifida closure. Ultrasound Obstet Gynecol 2024. [PMID: 38207160 DOI: 10.1002/uog.27579] [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] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 11/30/2023] [Accepted: 12/21/2023] [Indexed: 01/13/2024]
Abstract
OBJECTIVE Laparotomy-assisted fetoscopic closure of spina bifida utilizing heated-humidified carbon dioxide gas has been associated with less maternal morbidity than open in-utero spina bifida closure. Fetal cardiovascular changes during these surgical interventions are not well defined. Our objective was to compare fetal bradycardia (defined as fetal heart rate (FHR)<110 bpm over 10 minutes) and changes in umbilical artery Doppler parameters throughout open in-utero closure with those observed during laparotomy-assisted fetoscopic closure. METHODS We conducted a prospective cohort study of 22 open and 46 fetoscopic consecutive in-utero closures between 2019 and 2023. Both cohorts had similar preoperative counseling and clinical management. FHR and umbilical artery velocimetry were systematically obtained during preoperative assessment, every 5 minutes during the intraoperative period, and in the postoperative assessment. FHR, pulsatility indexes and end-diastolic flows were segmented into hourly periods during surgery, and the lowest values were averaged for analysis. Umbilical vein maximum velocities were measured in the fetoscopic cohort. Each fetal heart rate recording time point was correlated to maternal parameters, including heart rate, systolic and diastolic blood pressures. RESULTS Fetal bradycardia occurred in 4/22 cases (18.2%) of open in-utero closure and in 21/46 cases (45.7%) of fetoscopic closure. FHR gradually decreased in both cohorts after general anesthesia and decreased further during surgery. FHR were significantly lower after two hours of surgery in the fetoscopic closure than in the open in-utero closure group. In addition, the FHR (BPM) change in the final stages of the fetal surgery from the baseline FHR was significantly lower in the fetoscopic cohort (-32.3 (-35.7, -29.1)) compared to the open cohort (-23.5 (-28.1, -18.8)) (p=0.002). Abnormal end-diastolic flow (defined as absent or reversed end-diastolic flow) in the umbilical artery Doppler velocity occurred in 3/22 (13.6%) of the open closure cohort and in 23/46 (50%) of the fetoscopic closure cohort (p=0.004). There were no differences in umbilical artery end-diastolic flow and pulsatility index between closure techniques during the various stages of assessment. CONCLUSIONS We observed a decrease in the FHR and abnormalities in umbilical artery Doppler parameters in both open in-utero and fetoscopic closure groups. Fetal bradycardia was more prominent during fetoscopic closure following heated-humidified carbon dioxide insufflation, but the FHR recovered after cessation of the heated-humidified carbon dioxide. Changes in FHR and umbilical artery Doppler parameters during in-utero spina bifida closure were observed to be transient, no cases required emergency delivery and no fetoscopic closure were converted to open closure. These observations should inform algorithms for perioperative management of fetal bradycardia associated with in-utero spina bifida closure. This article is protected by copyright. All rights reserved.
Collapse
Affiliation(s)
- S Backley
- Division of Fetal Intervention, Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
- The Fetal Center at Children's Memorial Hermann Hospital, Houston, TX, USA
| | - E Bergh
- Division of Fetal Intervention, Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
- The Fetal Center at Children's Memorial Hermann Hospital, Houston, TX, USA
| | - J Garnett
- Division of Fetal Intervention, Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
- The Fetal Center at Children's Memorial Hermann Hospital, Houston, TX, USA
| | - R Li
- Department of Biostatistics and Data Science, UTHealth School of Public Health, Houston, Texas, USA
| | - V Maroufy
- Department of Biostatistics and Data Science, UTHealth School of Public Health, Houston, Texas, USA
| | - R Jain
- The Fetal Center at Children's Memorial Hermann Hospital, Houston, TX, USA
- Division of Pediatric Anesthesia, Department of Anesthesiology, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - S Fletcher
- The Fetal Center at Children's Memorial Hermann Hospital, Houston, TX, USA
- Division of Pediatric Neurosurgery, Departments of Pediatric Surgery and Neurosurgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - K Tsao
- The Fetal Center at Children's Memorial Hermann Hospital, Houston, TX, USA
- Department of Pediatric Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - M Austin
- The Fetal Center at Children's Memorial Hermann Hospital, Houston, TX, USA
- Department of Pediatric Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - A Johnson
- Division of Fetal Intervention, Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
- The Fetal Center at Children's Memorial Hermann Hospital, Houston, TX, USA
| | - R Papanna
- Division of Fetal Intervention, Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
- The Fetal Center at Children's Memorial Hermann Hospital, Houston, TX, USA
| |
Collapse
|
35
|
Ayres NJ, Ban G, Bison G, Bodek K, Bondar V, Bouillaud T, Bowles D, Chanel E, Chen W, Chiu PJ, Crawford C, Naviliat-Cuncic O, Doorenbos CB, Emmenegger S, Fertl M, Fratangelo A, Griffith WC, Grujic ZD, Harris PG, Kirch K, Kletzl V, Krempel J, Lauss B, Lefort T, Lejuez A, Li R, Mullan P, Pacura S, Pais D, Piegsa FM, Rienäcker I, Ries D, Pignol G, Rebreyend D, Roccia S, Rozpedzik D, Saenz-Arevalo W, Schmidt-Wellenburg P, Schnabel A, Segarra EP, Severijns N, Svirina K, Tavakoli Dinani R, Thorne J, Vankeirsbilck J, Voigt J, Yazdandoost N, Zejma J, Ziehl N, Zsigmond G, nEDM collaboration at PSI T. Achieving ultra-low and -uniform residual magnetic fields in a very large magnetically shielded room for fundamental physics experiments. Eur Phys J C Part Fields 2024; 84:18. [PMID: 38205101 PMCID: PMC10774228 DOI: 10.1140/epjc/s10052-023-12351-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 12/08/2023] [Indexed: 01/12/2024]
Abstract
High-precision searches for an electric dipole moment of the neutron (nEDM) require stable and uniform magnetic field environments. We present the recent achievements of degaussing and equilibrating the magnetically shielded room (MSR) for the n2EDM experiment at the Paul Scherrer Institute. We present the final degaussing configuration that will be used for n2EDM after numerous studies. The optimized procedure results in a residual magnetic field that has been reduced by a factor of two. The ultra-low field is achieved with the full magnetic-field-coil system, and a large vacuum vessel installed, both in the MSR. In the inner volume of ∼ 1.4 m 3 , the field is now more uniform and below 300 pT. In addition, the procedure is faster and dissipates less heat into the magnetic environment, which in turn, reduces its thermal relaxation time from 12 h down to 1.5 h .
Collapse
Affiliation(s)
- N. J. Ayres
- Institute for Particle Physics and Astrophysics, ETH Zürich, 8093 Zurich, Switzerland
| | - G. Ban
- Normandie Université, ENSICAEN, UNICAEN, CNRS/IN2P3, LPC Caen, 14000 Caen, France
| | - G. Bison
- Paul Scherrer Institut, 5232 Villigen PSI, Switzerland
| | - K. Bodek
- Marian Smoluchowski Institute of Physics, Jagiellonian University, 30-348 Kraków, Poland
| | - V. Bondar
- Institute for Particle Physics and Astrophysics, ETH Zürich, 8093 Zurich, Switzerland
| | - T. Bouillaud
- Université Grenoble Alpes, CNRS, Grenoble INP, LPSC-IN2P3, 38026 Grenoble, France
| | - D. Bowles
- Department of Physics and Astronomy, University of Kentucky, Lexington, KY 40506 USA
| | - E. Chanel
- Laboratory for High Energy Physics and Albert Einstein Center for Fundamental Physics, University of Bern, 3012 Bern, Switzerland
| | - W. Chen
- Institute for Particle Physics and Astrophysics, ETH Zürich, 8093 Zurich, Switzerland
- Paul Scherrer Institut, 5232 Villigen PSI, Switzerland
| | - P.-J. Chiu
- University of Zürich, 8057 Zurich, Switzerland
| | - C. B. Crawford
- Department of Physics and Astronomy, University of Kentucky, Lexington, KY 40506 USA
| | - O. Naviliat-Cuncic
- Normandie Université, ENSICAEN, UNICAEN, CNRS/IN2P3, LPC Caen, 14000 Caen, France
| | - C. B. Doorenbos
- Institute for Particle Physics and Astrophysics, ETH Zürich, 8093 Zurich, Switzerland
- Paul Scherrer Institut, 5232 Villigen PSI, Switzerland
| | - S. Emmenegger
- Institute for Particle Physics and Astrophysics, ETH Zürich, 8093 Zurich, Switzerland
| | - M. Fertl
- Institute of Physics, Johannes Gutenberg University, 55128 Mainz, Germany
| | - A. Fratangelo
- Laboratory for High Energy Physics and Albert Einstein Center for Fundamental Physics, University of Bern, 3012 Bern, Switzerland
| | - W. C. Griffith
- Department of Physics and Astronomy, University of Sussex, Falmer, Brighton, BN1 9QH UK
| | - Z. D. Grujic
- Institute of Physics, Photonics Center, University of Belgrade, Belgrade, 11080 Serbia
| | - P. G. Harris
- Department of Physics and Astronomy, University of Sussex, Falmer, Brighton, BN1 9QH UK
| | - K. Kirch
- Institute for Particle Physics and Astrophysics, ETH Zürich, 8093 Zurich, Switzerland
- Paul Scherrer Institut, 5232 Villigen PSI, Switzerland
| | - V. Kletzl
- Institute for Particle Physics and Astrophysics, ETH Zürich, 8093 Zurich, Switzerland
- Paul Scherrer Institut, 5232 Villigen PSI, Switzerland
| | - J. Krempel
- Institute for Particle Physics and Astrophysics, ETH Zürich, 8093 Zurich, Switzerland
| | - B. Lauss
- Paul Scherrer Institut, 5232 Villigen PSI, Switzerland
| | - T. Lefort
- Normandie Université, ENSICAEN, UNICAEN, CNRS/IN2P3, LPC Caen, 14000 Caen, France
| | - A. Lejuez
- Normandie Université, ENSICAEN, UNICAEN, CNRS/IN2P3, LPC Caen, 14000 Caen, France
| | - R. Li
- Instituut voor Kern-en Stralingsfysica, University of Leuven, 3001 Leuven, Belgium
| | - P. Mullan
- Institute for Particle Physics and Astrophysics, ETH Zürich, 8093 Zurich, Switzerland
| | - S. Pacura
- Marian Smoluchowski Institute of Physics, Jagiellonian University, 30-348 Kraków, Poland
| | - D. Pais
- Institute for Particle Physics and Astrophysics, ETH Zürich, 8093 Zurich, Switzerland
- Paul Scherrer Institut, 5232 Villigen PSI, Switzerland
| | - F. M. Piegsa
- Laboratory for High Energy Physics and Albert Einstein Center for Fundamental Physics, University of Bern, 3012 Bern, Switzerland
| | - I. Rienäcker
- Paul Scherrer Institut, 5232 Villigen PSI, Switzerland
| | - D. Ries
- Paul Scherrer Institut, 5232 Villigen PSI, Switzerland
| | - G. Pignol
- Université Grenoble Alpes, CNRS, Grenoble INP, LPSC-IN2P3, 38026 Grenoble, France
| | - D. Rebreyend
- Université Grenoble Alpes, CNRS, Grenoble INP, LPSC-IN2P3, 38026 Grenoble, France
| | - S. Roccia
- Université Grenoble Alpes, CNRS, Grenoble INP, LPSC-IN2P3, 38026 Grenoble, France
| | - D. Rozpedzik
- Marian Smoluchowski Institute of Physics, Jagiellonian University, 30-348 Kraków, Poland
| | - W. Saenz-Arevalo
- Normandie Université, ENSICAEN, UNICAEN, CNRS/IN2P3, LPC Caen, 14000 Caen, France
| | | | - A. Schnabel
- Physikalisch-Technische Bundesanstalt, Abbestr. 2-12, 10587 Berlin, Germany
| | - E. P. Segarra
- Paul Scherrer Institut, 5232 Villigen PSI, Switzerland
| | - N. Severijns
- Instituut voor Kern-en Stralingsfysica, University of Leuven, 3001 Leuven, Belgium
| | - K. Svirina
- Université Grenoble Alpes, CNRS, Grenoble INP, LPSC-IN2P3, 38026 Grenoble, France
| | - R. Tavakoli Dinani
- Instituut voor Kern-en Stralingsfysica, University of Leuven, 3001 Leuven, Belgium
| | - J. Thorne
- Laboratory for High Energy Physics and Albert Einstein Center for Fundamental Physics, University of Bern, 3012 Bern, Switzerland
| | - J. Vankeirsbilck
- Instituut voor Kern-en Stralingsfysica, University of Leuven, 3001 Leuven, Belgium
| | - J. Voigt
- Physikalisch-Technische Bundesanstalt, Abbestr. 2-12, 10587 Berlin, Germany
| | - N. Yazdandoost
- Department of Chemistry-TRIGA Site, Johannes Gutenberg University Mainz, 55128 Mainz, Germany
| | - J. Zejma
- Marian Smoluchowski Institute of Physics, Jagiellonian University, 30-348 Kraków, Poland
| | - N. Ziehl
- Institute for Particle Physics and Astrophysics, ETH Zürich, 8093 Zurich, Switzerland
| | - G. Zsigmond
- Paul Scherrer Institut, 5232 Villigen PSI, Switzerland
| | - The nEDM collaboration at PSI
- Institute for Particle Physics and Astrophysics, ETH Zürich, 8093 Zurich, Switzerland
- Normandie Université, ENSICAEN, UNICAEN, CNRS/IN2P3, LPC Caen, 14000 Caen, France
- Paul Scherrer Institut, 5232 Villigen PSI, Switzerland
- Marian Smoluchowski Institute of Physics, Jagiellonian University, 30-348 Kraków, Poland
- Université Grenoble Alpes, CNRS, Grenoble INP, LPSC-IN2P3, 38026 Grenoble, France
- Department of Physics and Astronomy, University of Kentucky, Lexington, KY 40506 USA
- Laboratory for High Energy Physics and Albert Einstein Center for Fundamental Physics, University of Bern, 3012 Bern, Switzerland
- University of Zürich, 8057 Zurich, Switzerland
- Institute of Physics, Johannes Gutenberg University, 55128 Mainz, Germany
- Department of Physics and Astronomy, University of Sussex, Falmer, Brighton, BN1 9QH UK
- Institute of Physics, Photonics Center, University of Belgrade, Belgrade, 11080 Serbia
- Instituut voor Kern-en Stralingsfysica, University of Leuven, 3001 Leuven, Belgium
- Physikalisch-Technische Bundesanstalt, Abbestr. 2-12, 10587 Berlin, Germany
- Department of Chemistry-TRIGA Site, Johannes Gutenberg University Mainz, 55128 Mainz, Germany
| |
Collapse
|
36
|
Li R, Luo Q, Gutierrez ID. Asian Americans have higher 30-day surgical complications after esophagectomy: A propensity-score matched study from ACS-NSQIP database. Am J Surg 2024:S0002-9610(24)00007-2. [PMID: 38199873 DOI: 10.1016/j.amjsurg.2024.01.005] [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: 10/09/2023] [Revised: 12/28/2023] [Accepted: 01/04/2024] [Indexed: 01/12/2024]
Abstract
BACKGROUND Despite Asian Americans having a heightened risk profile for esophageal cancer, racial disparities within this group have not been investigated. This study seeks to evaluate the 30-day postoperative outcomes for Asian Americans following esophagectomy. METHODS A retrospective analysis was performed using ACS-NSQIP esophagectomy targeted database 2016-2021. A 1:3 propensity-score matching was applied to Asian Americans and Caucasians who underwent esophagectomy to compare their 30-day outcomes. RESULTS There were 229 Asian Americans and 5303 Caucasians identified. Asian Americans were more likely to have squamous cell carcinoma than adenocarcinoma. After matching, 687 Caucasians were included. Asian Americans had higher pulmonary complications (22.27 % vs 16.01 %, p = 0.04) especially pneumonia (16.59 % vs 11.06 %, p = 0.04), renal dysfunction (2.62 % vs 0.44 %, p = 0.01) especially progressive renal insufficiency (1.31 % vs 0.15 %, p < 0.05), and bleeding events (18.34 % vs 9.02 %, p < 0.01). In addition, Asian Americans had longer LOS (11.83 ± 9.39 vs 10.23 ± 7.34 days, p = 0.03). CONCLUSION Asian Americans were found to face higher 30-day surgical complications following esophagectomy. Continued investigation into the underlying causes and potential mitigation strategies for these disparities are needed.
Collapse
Affiliation(s)
- Renxi Li
- The George Washington University School of Medicine and Health Sciences, United States; Division of Cardiovascular and Thoracic Surgery, Department of Surgery, University of Minnesota Medical School, United States.
| | - Qianyun Luo
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, University of Minnesota Medical School, United States
| | - Ilitch Diaz Gutierrez
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, University of Minnesota Medical School, United States
| |
Collapse
|
37
|
Wang X, Guo J, Wu YY, Lu YK, Liu DP, Li MC, Li R, Wang YY, Kang WQ. [Comparing the prognostic value of 3 diagnostic criteria of bronchopulmonary dysplasia in preterm infants]. Zhonghua Er Ke Za Zhi 2024; 62:36-42. [PMID: 38154975 DOI: 10.3760/cma.j.cn112140-20230824-00127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 12/30/2023]
Abstract
Objective: To compare the prognostic value of 3 diagnostic criteria of bronchopulmonary dysplasia (BPD) in preterm infants with gestational age<32 weeks. Methods: The retrospective cohort study was conducted to collect the clinical data of 285 preterm infants with BPD admitted to the Department of Neonatology, Children's Hospital Affiliated to Zhengzhou University from January 2019 to September 2021, who were followed up regularly after discharge. The primary composite adverse outcome was defined as death or severe respiratory morbidity from 36 weeks of corrected gestational age to 18 months of corrected age, and the secondary composite adverse outcome was defined as death or neurodevelopmental impairment. According to the primary or secondary composite adverse outcomes, the preterm infants were divided into the adverse prognosis group and the non-adverse prognosis group. The 2001 National Institute of Child Health and Human Development (NICHD) criteria, 2018 NICHD criteria, and 2019 Neonatal Research Network (NRN) criteria were used to diagnose and grade BPD in preterm infants. Chi-square test, Logistic regression analysis, receiver operating characteristic (ROC) curve and Delong test were used to analyze the prognostic value of the 3 diagnostic criteria. Results: The 285 preterm infants had a gestational age of 29.4 (28.1, 30.6) weeks and birth weight of 1 230 (1 000, 1 465) g, including 167 males (58.6%). Among 285 premature infants who completed follow-up, the primary composite adverse outcome occurred in 124 preterm infants (43.5%), and the secondary composite adverse outcome occurred in 40 preterm infants (14.0%). Multivariate Logistic regression analysis showed that severe BPD according to the 2001 NICHD criteria, gradeⅡand Ⅲ BPD according to the 2018 NICHD criteria and grade 2 and 3 BPD according to the 2019 NRN criteria were all risk factors for primary composite adverse outcomes (all P<0.05). ROC curve showed that the area under the curve (AUC) of the 2018 NICHD criteria and 2019 NRN criteria were both higher than that of the 2001 NICHD criteria (0.70 and 0.70 vs. 0.61, Z=4.49 and 3.35, both P<0.001), but there was no significant difference between the 2018 NICHD and 2019 NRN criteria (Z=0.38, P=0.702). Multivariate Logistic regression analysis showed that the secondary composite adverse outcomes were all associated with grade Ⅲ BPD according to the 2018 NICHD criteria and grade 3 BPD according to the 2019 NRN criteria (both P<0.05). ROC curve showed that the AUC of the 2018 NICHD criteria and 2019 NRN criteria were both higher than that of the 2001 NICHD criteria (0.71 and 0.71 vs. 0.58, Z=2.93 and 3.67, both P<0.001), but there was no statistically significant difference between the 2018 NICHD and 2019 NRN criteria (Z=0.02, P=0.984). Conclusion: The 2018 NICHD and 2019 NRN criteria demonstrate good and comparable predictive value for the primary and secondary composite adverse outcomes in preterm infants with BPD, surpassing the predictive efficacy of the 2001 NICHD criteria.
Collapse
Affiliation(s)
- X Wang
- Neonatal Intensive Care Unit, Children's Hospital Affiliated to Zhengzhou University, Zhengzhou Key Laboratory of Neonatal Disease Research, Zhengzhou 450018, China
| | - J Guo
- Neonatal Intensive Care Unit, Children's Hospital Affiliated to Zhengzhou University, Zhengzhou Key Laboratory of Neonatal Disease Research, Zhengzhou 450018, China
| | - Y Y Wu
- Neonatal Intensive Care Unit, Children's Hospital Affiliated to Zhengzhou University, Zhengzhou Key Laboratory of Neonatal Disease Research, Zhengzhou 450018, China
| | - Y K Lu
- Neonatal Intensive Care Unit, Children's Hospital Affiliated to Zhengzhou University, Zhengzhou Key Laboratory of Neonatal Disease Research, Zhengzhou 450018, China
| | - D P Liu
- Neonatal Intensive Care Unit, Children's Hospital Affiliated to Zhengzhou University, Zhengzhou Key Laboratory of Neonatal Disease Research, Zhengzhou 450018, China
| | - M C Li
- Neonatal Intensive Care Unit, Children's Hospital Affiliated to Zhengzhou University, Zhengzhou Key Laboratory of Neonatal Disease Research, Zhengzhou 450018, China
| | - R Li
- Neonatal Intensive Care Unit, Children's Hospital Affiliated to Zhengzhou University, Zhengzhou Key Laboratory of Neonatal Disease Research, Zhengzhou 450018, China
| | - Y Y Wang
- Neonatal Intensive Care Unit, Children's Hospital Affiliated to Zhengzhou University, Zhengzhou Key Laboratory of Neonatal Disease Research, Zhengzhou 450018, China
| | - W Q Kang
- Neonatal Intensive Care Unit, Children's Hospital Affiliated to Zhengzhou University, Zhengzhou Key Laboratory of Neonatal Disease Research, Zhengzhou 450018, China
| |
Collapse
|
38
|
Li R, Lee S, Ranganath B. Patients with metastasis have a higher risk of bleeding in delayed breast reconstruction: A population-based study of National Inpatient Sample from 2015 to 2020. J Plast Reconstr Aesthet Surg 2024; 88:316-319. [PMID: 38052125 DOI: 10.1016/j.bjps.2023.11.043] [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] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 11/26/2023] [Indexed: 12/07/2023]
Affiliation(s)
- Renxi Li
- The George Washington University School of Medicine and Health Sciences, Washington, DC, USA.
| | - SeungEun Lee
- The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Bharat Ranganath
- Department of Surgery, The George Washington University Hospital, Washington, DC, USA
| |
Collapse
|
39
|
Wang X, Zhang RS, Li R, Ye SB, Li Q, Chen H, Xia QY, Wu N, Rao Q. [Clinicopathological and molecular features of metaplastic thymoma]. Zhonghua Bing Li Xue Za Zhi 2023; 52:1237-1243. [PMID: 38058040 DOI: 10.3760/cma.j.cn112151-20230907-00145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Subscribe] [Scholar Register] [Indexed: 12/08/2023]
Abstract
Objective: To investigate the clinicopathological features, and molecular genetic alterations of metaplastic thymoma (MT). Methods: A total of ten MT cases, diagnosed from 2011 to 2021, were selected from the Department of Pathology of Jinling Hospital, Nanjing University Medical School, Nanjing, China for clinicopathological and immunohistochemical (IHC) examination and clinical follow-up. Fluorescence in situ hybridization (FISH), next-generation sequencing (NGS), and YAP1 C-terminus (YAP1-CT) IHC were performed to detect YAP1::MAML2 fusions. Results: There were four males and six females, ranging in age from 29 to 60 years (mean 50 years, median 54 years). Microscopically, all tumors showed a typical biphasic morphology consisting of epithelial components and gradually or abruptly transitioning spindle cell components. The two components were present in varying proportions in different cases. Immunophenotypically, the epithelial cells were diffusely positive for CKpan, CK5/6 and p63. The spindle cells were diffusely positive for vimentin and focally positive for EMA. TdT was negative in the background lymphocytes. Ki-67 proliferation index was less than 5%. YAP1 and MAML2 break-apart FISH analyses showed that all ten cases had narrow split signals with a distance of nearly 2 signal diameters and may be considered false-negative. Using YAP1::MAML2 fusion FISH assays, abnormal fusion signals were observed in all the ten cases. NGS demonstrated YAP1::MAML2 fusions in all eight cases with adequate nucleic acids; in two cases the fusions were detected by DNA sequencing and in eight cases by RNA sequencing. All ten cases of MT demonstrated loss of YAP1 C-terminal expression in epithelioid cells. Conclusions: MT is a rare and low-grade thymic tumor characterized by a biphasic pattern and YAP1::MAML2 fusions. Break-apart FISH assays may sometimes show false-negative results due to the proximity of YAP1 and MAML2, while YAP1 C-terminal IHC is a highly sensitive and specific marker for MT. Loss of YAP1 C-terminal expression can also be used to screen YAP1::MAML2 fusions for possible MT cases.
Collapse
Affiliation(s)
- X Wang
- Department of Pathology, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing 210002, China
| | - R S Zhang
- Department of Pathology, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing 210002, China
| | - R Li
- Department of Pathology, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing 210002, China
| | - S B Ye
- Department of Pathology, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing 210002, China
| | - Q Li
- Department of Pathology, the Third Affiliated Hospital of Soochow University, Changzhou 213003, China
| | - H Chen
- Department of Pathology, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing 210002, China
| | - Q Y Xia
- Department of Pathology, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing 210002, China
| | - N Wu
- Department of Pathology, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing 210002, China
| | - Q Rao
- Department of Pathology, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing 210002, China
| |
Collapse
|
40
|
Gao MX, Lei Y, Guo LR, Qu JW, Wang HF, Liu XM, Li R, Kong M, Zhuang ZC, Tan ZL, Li XY, Zhang Y. [Periodic dynamic observation and analysis of cellular and humoral immunity indexes of adults infected with Omicron BA.1]. Zhonghua Yu Fang Yi Xue Za Zhi 2023; 57:2117-2121. [PMID: 38186164 DOI: 10.3760/cma.j.cn112150-20230526-00410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 01/09/2024]
Abstract
Objective: To analyze the immunological characteristics and antibody changes of patients infected with the Omicron BA.1 and evaluate the possibility of secondary infection. Methods: A total of 104 patients infected with Omicron BA.1 in the Jinnan District of Tianjin from January 8 to February 2, 2022, were included in the study. The control group and case group were matched 1∶1 based on age, sex and vaccination status. Serum was collected from the case group and control group at 3, 6 and 9 months after infection. The serum levels of interleukin4 (IL-4), IL-5 and interferon-gamma (IFN-γ), as well as the positive rates of IgG, IgG1 and IgG2, were detected by ELISA. Results: The highest concentration of IFN-γ in the case group at 6 months after infection was 145.4 pg/ml, followed by a decrease in concentration. The concentrations of IL-4 and IL-5 began to decrease at 6 months after infection (all P<0.001). There was no significant difference in the IgG2 positive rate between the case group and the control group at 6 months after BA.1 infection. However, at 9 months, there was a significant decrease compared to the control group (P=0.003). The ratio of IFN-γ/IL4 at 3 months after infection in the case group was lower than that in the control group (P<0.001). There was no significant difference in the ratio between the case group and the control group at 9 months after infection. Conclusion: The cellular immune function has been impaired at 3 months after infection with BA.1, and the specific cellular immune and humoral immune functions decrease significantly after 6 months, and the risk of secondary infection increases.
Collapse
Affiliation(s)
- M X Gao
- School of Public Health, Tianjin Medical University, Tianjin 300070, China Institute of Microbiology, Tianjin Center for Disease Control and Prevention, Tianjin 300011, China
| | - Y Lei
- Institute of Microbiology, Tianjin Center for Disease Control and Prevention, Tianjin 300011, China Tianjin Key Laboratory of Pathogenic Microorganisms for Infectious Diseases, Tianjin Center for Disease Control and Prevention, Tianjin 300011, China
| | - L R Guo
- Institute of Microbiology, Tianjin Center for Disease Control and Prevention, Tianjin 300011, China Tianjin Key Laboratory of Pathogenic Microorganisms for Infectious Diseases, Tianjin Center for Disease Control and Prevention, Tianjin 300011, China
| | - J W Qu
- Institute of immunization, Tianjin Center for Disease Control and Prevention, Tianjin 300011, China
| | - H F Wang
- Institute of immunization, Tianjin Center for Disease Control and Prevention, Tianjin 300011, China
| | - X M Liu
- School of Public Health, Tianjin Medical University, Tianjin 300070, China Institute of Microbiology, Tianjin Center for Disease Control and Prevention, Tianjin 300011, China
| | - R Li
- School of Public Health, Tianjin Medical University, Tianjin 300070, China Institute of Microbiology, Tianjin Center for Disease Control and Prevention, Tianjin 300011, China
| | - M Kong
- Institute of Microbiology, Tianjin Center for Disease Control and Prevention, Tianjin 300011, China Tianjin Key Laboratory of Pathogenic Microorganisms for Infectious Diseases, Tianjin Center for Disease Control and Prevention, Tianjin 300011, China
| | - Z C Zhuang
- Institute of Microbiology, Tianjin Center for Disease Control and Prevention, Tianjin 300011, China Tianjin Key Laboratory of Pathogenic Microorganisms for Infectious Diseases, Tianjin Center for Disease Control and Prevention, Tianjin 300011, China
| | - Z L Tan
- Institute of Microbiology, Tianjin Center for Disease Control and Prevention, Tianjin 300011, China Tianjin Key Laboratory of Pathogenic Microorganisms for Infectious Diseases, Tianjin Center for Disease Control and Prevention, Tianjin 300011, China
| | - X Y Li
- School of Public Health, Tianjin Medical University, Tianjin 300070, China Institute of Microbiology, Tianjin Center for Disease Control and Prevention, Tianjin 300011, China Tianjin Key Laboratory of Pathogenic Microorganisms for Infectious Diseases, Tianjin Center for Disease Control and Prevention, Tianjin 300011, China
| | - Y Zhang
- Department of Director, Tianjin Center for Disease Control and Prevention, Tianjin 300011, China
| |
Collapse
|
41
|
Li R, Choi BG. Native Americans have comparable transcatheter aortic valve replacement outcomes but higher stroke and venous thromboembolism after surgical aortic valve replacement. Cardiovasc Revasc Med 2023:S1553-8389(23)00924-7. [PMID: 38052718 DOI: 10.1016/j.carrev.2023.12.001] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 11/30/2023] [Accepted: 12/01/2023] [Indexed: 12/07/2023]
Abstract
BACKGROUND Racial disparities in aortic valve replacement outcomes have been established. However, the current literature lacks comprehensive studies that examine the outcomes for Native Americans, probably due to their limited population size. This study aimed to investigate whether disparities in transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR) also exist for outcomes among Native Americans. METHODS Patients who underwent SAVR and TAVR were identified in National Inpatient Sample from the last quarter of 2015 to 2020. A 1:5 propensity score matching was conducted between Native Americans and Caucasians. In-hospital perioperative outcomes, length of stay, wait from admission to operation, and total hospital charge, were compared. RESULTS In TAVR, 51,394 (84.41 %) were Caucasians and 171 (0.28 %) were Native Americans. In SAVR, there were 50,080 (78.52 %) Caucasians and 279 (0.44 %) Native Americans. After propensity matching, no significant difference was found in post-TAVR outcomes between Native Americans and Caucasians. However, Native Americans have a higher risk of neurological complications (2.88 % vs 0.79 %, p < 0.01) with stroke being the primary contributor (2.52 % vs 0.5 %, p < 0.01), as well as a higher incidence of venous thromboembolism (1.8 % vs 0.57 %, p < 0.05) after SAVR. CONCLUSIONS This study is the first to examine aortic valve replacement outcomes in Native Americans. Native Americans were found to be more likely to undergo SAVR than TAVR. Moreover, Native Americans were found to have five times higher stroke and three times higher VTE after SAVR. These disparities faced by Native Americans underscore the need for increased attention and targeted actions to guarantee health equity.
Collapse
Affiliation(s)
- Renxi Li
- The George Washington University School of Medicine and Health Sciences, Washington, DC, United States of America.
| | - Brian G Choi
- The George Washington University School of Medicine and Health Sciences, Washington, DC, United States of America
| |
Collapse
|
42
|
Ghelani GH, Zerdan MB, Jacob J, Spiess PE, Li R, Necchi A, Grivas P, Kamat A, Danziger N, Lin D, Huang R, Decker B, Sokol ES, Cheng L, Pavlick D, Ross JS, Bratslavsky G, Basnet A. HPV-positive clinically advanced squamous cell carcinoma of the urinary bladder (aBSCC): A comprehensive genomic profiling (CGP) study. Urol Oncol 2023; 41:486.e15-486.e23. [PMID: 37821306 DOI: 10.1016/j.urolonc.2023.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Revised: 08/31/2023] [Accepted: 09/03/2023] [Indexed: 10/13/2023]
Abstract
BACKGROUND Advanced bladder squamous cell carcinoma (aBSCC) is an uncommon form of urinary bladder malignancy when compared with the much higher urothelial carcinoma incidence. We studied the genomic alteration (GA) landscape in a series of aBSCC based on the association with human papilloma virus (HPV) to determine if differences in GA would be observed between the positive and negative groups. METHODS Using a hybrid capture-based FDA-approved CGP assay, a series of 171 aBSCC were sequenced to evaluate all classes of GA. Tumor mutational burden (TMB) was determined on up to 1.1 Mbp of sequenced DNA and microsatellite instability (MSI) was determined on up to 114 loci. Programmed cell death ligand -1 (PD-L1) expression was determined by IHC (Dako 22C3) with negative expression when PD-L1 was 0, lower expression of positivity set at 1 to 49%, and higher expression set at ≥50% expression. RESULTS Overall, 11 (6.4%) of the aBSCC were found to harbor HPV sequences (10 HPV16 and 1 HPV 11). HPV+ status was identified slightly more often in women (NS) and in younger patients (P = 0.04); 2 female patients with aBSCC had a prior history of SCC including 1 anal SCC and 1 vaginal SCC. HPV+ aBSCC had fewer GA/tumor (P < 0.0001), more inactivating mutations in RB1 (P = 0.032), and fewer inactivating GA in CDKN2A (P < 0.0001), CDKN2B (P = 0.05), TERT promoter (P = 0.0004) and TP53 (P < 0.0001). GA in genes associated with urothelial carcinoma including FGFR2 and FGFR3 were similar in both HPV+ and HPV- aBSCC groups. MTAP loss (homozygous deletion) which has emerged as a biomarker for PRMT5 inhibitor-based clinical trials was not identified in any of the 11 HPV+ aBSCC cases, which was significantly lower than the 28% positive frequency of MTAP loss in the HPV- aBSCC group (P < 0.0001). MTOR and PIK3CA pathway GA were not significantly different in the 2 groups. Putative biomarkers associated with immunotherapy (IO) response, including MSI and TMB status, were also similar in the 2 groups. PD-L1 expression data was available for a subset of both HPV+ and HPV- cases and showed high frequencies of positive staining which was not different in the 2 groups. CONCLUSIONS HPV+ aBSCC tends to occur more often in younger patients. As reported in other HPV-associated squamous cell carcinomas, HPV+ aBSCC demonstrates significantly reduced frequencies of inactivating mutations in cell cycle regulatory genes with similar GA in MTOR and PIK3CA pathways. The implication of HPV in the pathogenesis of bladder cancer remains unknown but warrants further exploration and clinical validation.
Collapse
Affiliation(s)
| | | | - J Jacob
- Upstate Medical University, Syracuse, NY
| | - P E Spiess
- Department of GU Oncology, Moffitt Cancer Center, Tampa, FL
| | - R Li
- Department of GU Oncology, Moffitt Cancer Center, Tampa, FL
| | - A Necchi
- IRCCS San Raffaele Hospital and Scientific Institute, Milan, Italy
| | - P Grivas
- University of Washington, Seattle, WA
| | - A Kamat
- University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - D Lin
- Foundation Medicine, Cambridge, MA
| | - R Huang
- Foundation Medicine, Cambridge, MA
| | - B Decker
- Foundation Medicine, Cambridge, MA
| | | | - L Cheng
- Department of Pathology and Laboratory Medicine, Brown University Warren Alpert Medical School, Lifespan Academic Medical Center, and the Legorreta Cancer Center at Brown University, Providence, RI
| | | | - J S Ross
- Upstate Medical University, Syracuse, NY
| | | | - A Basnet
- Upstate Medical University, Syracuse, NY
| |
Collapse
|
43
|
Li R, Huddleston S. Development of Comorbidity Index for in-hospital mortality for patients who underwent coronary artery revascularization. J Cardiovasc Surg (Torino) 2023; 64:678-685. [PMID: 37987738 DOI: 10.23736/s0021-9509.23.12833-3] [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] [Subscribe] [Scholar Register] [Indexed: 11/22/2023]
Abstract
BACKGROUND For myocardial revascularization, coronary artery bypass grafting (CAGB) and percutaneous coronary intervention (PCI) are two common modalities but with high in-hospital mortality. A Comorbidity Index is useful to predict mortality or can be used with other covariates to develop point-scoring systems. This study aimed to develop specific comorbidity indices for patients who underwent coronary artery revascularization. METHODS Patients who underwent CABG or PCI were identified in the National Inpatient Sample database between Q4 2015-2020. Patients of age <40 were excluded for congenital heart defects. Patients were randomly sampled into experimental (70%) and validation (30%) groups. Thirty-eight Elixhauser comorbidities were identified and included in multivariable regression to discriminate in-hospital mortality. Weight for each comorbidity was assigned and single indices, Li CABG Mortality Index (LCMI) and Li PCI Mortality Index (LPMI), were developed. RESULTS Mortality discrimination by LCMI approached adequacy (c-statistic=0.691, 95% CI=0.682-0.701) and was comparable to multivariable regression with comorbidities (c-statistic=0.685, 95% CI=0.675-0.694). LCMI discrimination performed significantly better than Elixhauser Comorbidity Index (ECI) (c-statistic=0.621, 95% CI=0.611-0.631) and can be further improved by adjusting age (c-statistic=0.721, 95% CI=0.712-0.730). All models were well-calibrated (Brier score=0.021-0.022). LPMI moderately discriminated in-hospital mortality (c-statistic=0.666, 95% CI=0.660-0.672) and performed significantly better than ECI (c-statistic=0.610, 95% CI=0.604-0.616). LPMI performed better than the all-comorbidity multivariable regression (c-statistic=0.658, 95% CI=0.652-0.663). After age adjustment, LPMI discrimination was significantly increased and was approaching adequacy (c-statistic=0.695, 95% CI=0.690-0.701). All models were well-calibrated (Brier score=0.025-0.026). CONCLUSIONS LCMI and LPMI effectively discriminated and predicted in-hospital mortality. These indices were validated and performed superior to ECI. These indices can standardize comorbidity measurement as alternatives to ECI to help replicate and compare results across studies.
Collapse
Affiliation(s)
- Renxi Li
- George Washington University School of Medicine and Health Sciences, Washington, DC, USA -
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, University of Minnesota Medical School, Minneapolis, MN, USA -
| | - Stephen Huddleston
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, University of Minnesota Medical School, Minneapolis, MN, USA
| |
Collapse
|
44
|
Li R, Luo Q, Yanavitski M, Huddleston SJ. Smoker's paradox in transcatheter aortic valve replacement: A National Inpatient Sample analysis from 2015 to 2020. Cardiovasc Revasc Med 2023:S1553-8389(23)00921-1. [PMID: 38052714 DOI: 10.1016/j.carrev.2023.11.021] [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: 09/14/2023] [Revised: 11/22/2023] [Accepted: 11/29/2023] [Indexed: 12/07/2023]
Abstract
BACKGROUND While smoking is recognized as a risk factor for multiple cardiovascular conditions, prior research has identified a smoker paradox, wherein smokers had better post-procedural outcomes following transcatheter aortic valve replacement (TAVR) in the initial years of its introduction among high-risk patients only. In recent years, TAVR has expanded to significant larger groups of low-risk patients and became the dominate approach for aortic valve replacement. Consequently, the study cohort from the previous research can no longer represent the current patient populations undergoing TAVR. This study aimed to examine the impact of smoking on TAVR outcomes in the later post-TAVR era. METHODS Patients who underwent TAVR were identified in the National Inpatient Sample (NIS) database from the last quarter of 2015-2020 by ICD-10-PCS. Patients were stratified into two cohorts based on smoker status. Multivariable analysis was performed comparing in-hospital post-TAVR outcomes. Adjusted pre-procedural variables included sex, age, race, socioeconomic status, comorbidities, and hospital characteristics. RESULTS A total number of 58,934 patients who underwent TAVR were identified including 23,683 smokers and 35,251 non-smokers. Compared to non-smokers, smokers had lower in-hospital mortality (aOR 0.589, p < 0.01), MACE (aOR 0.678, p < 0.01), MI (aOR 0.719, p < 0.01), stroke (aOR 0.599, p < 0.01), neurological complications (aOR 0.653, p < 0.01), pacemaker implantation (aOR 0.911, p < 0.01), cardiogenic shock (aOR 0.762, p < 0.01), respiratory complications (aOR 0.822, p < 0.01), mechanical ventilation (aOR 0.669, p < 0.01), AKI (aOR 0.745, p < 0.01), VTE (aOR 0.578, p < 0.01), hemorrhage/hematoma (aOR 0.921, p < 0.01), infection (aOR 0.625, p < 0.01), vascular complications (aOR 0.802, p < 0.01), reopen surgery (aOR 0.453), and transfer out to another facility (aOR 0.79, p < 0.01). In addition, cigarette smokers had shorter LOS (p < 0.01), and less hospital charge (p < 0.01). CONCLUSION This study identified the smoker paradox in the later post-TAVR era with remarkably broad protection from many complications and lower mortality. The reasons underlying this apparent smoker paradox merit deeper investigation.
Collapse
Affiliation(s)
- Renxi Li
- The George Washington University School of Medicine and Health Sciences, Washington, DC, United States of America; Division of Cardiovascular and Thoracic Surgery, Department of Surgery, University of Minnesota Medical School, Minneapolis, MN, United States of America.
| | - Qianyun Luo
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, University of Minnesota Medical School, Minneapolis, MN, United States of America
| | - Marat Yanavitski
- M Health University of MN Physicians Cardiology East Division, Minneapolis, MN, United States of America
| | - Stephen J Huddleston
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, University of Minnesota Medical School, Minneapolis, MN, United States of America
| |
Collapse
|
45
|
Li R, Li WL, Yuan GS, Pang HJ, Li Q, Hu XY, Guo YB, Chen JZ, Zang MY. [Study on the comparison of postoperative liver injury caused by hepatic arterial perfusion chemotherapy combined with targeted immunotherapy with hepatic arterial chemoembolization combined with targeted immunotherapy for intermediate-and advanced-stage liver cancer]. Zhonghua Gan Zang Bing Za Zhi 2023; 31:1163-1168. [PMID: 38238949 DOI: 10.3760/cma.j.cn501113-20230827-00070] [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] [Subscribe] [Scholar Register] [Indexed: 01/23/2024]
Abstract
Objective: To compare the postoperative liver function injury condition in patients with intermediate-and advanced-stage hepatocellular carcinoma (HCC) treated with hepatic artery infusion chemotherapy (HAIC) and hepatic artery chemoembolization (TACE) combined with immune checkpoint inhibitors (ICIs) and multi-target tyrosine kinase inhibitors (TKIs). Methods: Patients with intermediate-and advanced-stage HCC who were admitted and treated with HAIC/TACE+ICIs+TKIs therapy at Nanfang Hospital of Southern Medical University from January 2019 to November 2021, with follow-up up to July 2023, were retrospectively enrolled. The results of liver function tests within one week before interventional surgery and on the first day after surgery were recorded. The degree of postoperative liver injury was graded according to the common terminology criteria for adverse events 5.0 (CTCAE 5.0). The treatment efficacy was evaluated according to RECIST 1.1 criteria. Measurement data were compared between groups using a t-test or a non-parametric rank sum test. Enumeration data were compared between the groups using the χ(2) test or Fisher's exact probability method. The survival condition differences were analyzed by the log-rank method. Results: This study included 82 and 77 cases in the HAIC and TACE groups. There were no statistically significant differences between the two groups of patients in terms of gender, age, physical condition score, number of tumors, presence or absence of liver cirrhosis, Child-Pugh grade, albumin-bilirubin (ALBI) grade, and combined ICIs and TKIs . The HAIC group had later tumor staging, a greater tumor burden, poorer liver reserve function, and a larger proportion of patients in stage C (81.7% vs. 63.6%), χ(2)=6.573, P = 0.01). There were 53 cases (64.6% vs. 32.5%) with a maximum tumor diameter of ≥ 10cm, χ(2)=16.441, P < 0.001), and more patients had a retention rate of ≥ 10% for indocyanine green (ICG) at 15 minutes (68.3% vs. 51.9%, P = 0.035). The postoperative incidence rate of increased levels of alanine aminotransferase, aspartate aminotransferase, and total bilirubin was significantly lower in the HAIC group than that in the TACE group (28.0% vs. 63.6%, χ(2)=20.298, P < 0.001, 54.9% vs. 85.7%, χ(2)=17.917, P < 0.001;40.2% vs. 55.8%, χ(2)=3.873, P = 0.049). The number of patients with postoperative ALBI grade 3 was significantly lower in the HAIC group than that in the TACE group (6.1% vs. 16.9%, χ(2)=4.601, P = 0.032). There was no statistically significant difference in the incidence rate of postoperative hypoalbuminemia, activated partial thromboplastin time, or increased international standardized ratio between the two groups of patients. There was no statistically significant difference in median progression-free survival (7.3 months vs. 8.2 months, P = 0.296) or median overall survival (16.5 months vs. 21.9 months, P = 0.678) between the two groups of patients. Conclusion: The incidence rate of postoperative liver injury is higher in patients with intermediate-and advanced-stage HCC treated with TACE combined with ICIs and TKIs than in patients with HAIC combined with ICIs and TKIs.
Collapse
Affiliation(s)
- R Li
- Hepatology Unit and Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - W L Li
- Hepatology Unit and Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - G S Yuan
- Hepatology Unit and Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - H J Pang
- Division of Vascular and Interventional Radiology, Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - Q Li
- Hepatology Unit and Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - X Y Hu
- Hepatology Unit and Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - Y B Guo
- Hepatology Unit and Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - J Z Chen
- Hepatology Unit and Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - M Y Zang
- Hepatology Unit and Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| |
Collapse
|
46
|
Li R, An P, Lin X, Liu X, Zhao L, He Y. A comprehensive analysis of LINC00958 as a prognostic biomarker for head and neck squamous cell carcinomaLi et al. Int J Oral Maxillofac Surg 2023:S0901-5027(23)00268-0. [PMID: 37923576 DOI: 10.1016/j.ijom.2023.09.014] [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: 09/03/2022] [Revised: 08/30/2023] [Accepted: 09/14/2023] [Indexed: 11/07/2023]
Abstract
This work focused on exploring whether the long intergenic non-protein coding RNA LINC00958 is associated with the prognosis of head and neck squamous cell carcinoma (HNSCC). Associations of the LINC00958 expression level with clinicopathological features of HNSCC were investigated by logistic regression and Wilcoxon signed-rank test. The Kaplan-Meier method was applied to evaluate patient survival. Clinical data and expression profiles were obtained from The Cancer Genome Atlas (TCGA). Associations of patient clinical characteristics with overall survival (OS), progression-free interval (PFI), and disease-specific survival (DSS) were assessed by univariate and multivariate analysis using the Cox proportional hazard model. Immune cell infiltration analysis and gene set enrichment analysis (GSEA) were applied to determine any significant effects of LINC00958. High LINC00958 expression was related to early pT stage (P < 0.01), primary therapy outcome (P < 0.01), HPV status (P < 0.001), lymphovascular invasion (P < 0.001), and perineural invasion (P < 0.01). The receiver operating characteristic curve showed strong prognostic power for LINC00958 (area under curve = 0.886). High LINC00958 expression predicted poor OS (P = 0.007), DSS (P = 0.036), and PFI (P = 0.040). LINC00958 was related to signalling pathways and the infiltration of certain immune cells. miR-27b-5p was significantly associated with LINC00958, and downstream NT5E predicted poor survival in HNSCC cases. LINC00958 may affect the prognosis by regulating NT5E via miR-27b-5p, and could serve as a possible factor to predict the prognosis of HNSCC, especially oral squamous cell carcinoma.
Collapse
Affiliation(s)
- R Li
- Department of Oral Maxillofacial and Head and Neck Oncology, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China; National Center of Stomatology, National Clinical Research Center for Oral Disease, Shanghai, China; Qingdao Stomatological Hospital Affiliated to Qingdao University, Qingdao, Shandong Province, China
| | - P An
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China
| | - X Lin
- Qingdao Stomatological Hospital Affiliated to Qingdao University, Qingdao, Shandong Province, China
| | - X Liu
- Qingdao Stomatological Hospital Affiliated to Qingdao University, Qingdao, Shandong Province, China
| | - L Zhao
- Center of Oral Medicine, Qingdao Municipal Hospital, Qingdao, Shandong Province, China
| | - Y He
- Department of Oral Maxillofacial and Head and Neck Oncology, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China; National Center of Stomatology, National Clinical Research Center for Oral Disease, Shanghai, China.
| |
Collapse
|
47
|
Hu HM, Zhang WL, Huang DS, Li R, Gu HL, Li J, Gao YN. [Establishment of a patient-derived xenograft humanized mouse model for hepatoblastoma in children]. Zhonghua Gan Zang Bing Za Zhi 2023; 31:1075-1080. [PMID: 38016773 DOI: 10.3760/cma.j.cn501113-20220218-00075] [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] [Subscribe] [Scholar Register] [Indexed: 11/30/2023]
Abstract
Objective: To establish a patient-derived xenograft (PDX) humanized mouse model for hepatoblastoma in children. In addition, compare the biological consistency between successfully modeled PDX tumors and primary tumors in children while comparing and analyzing the influence of PDX model modeling success as a key factor. Methods: A PDX tumor model was constructed from fresh tumor tissue samples from 39 children with hepatoblastoma. The tumor growth time and volume size were recorded in detail. Simultaneously, 39 children's data were collected for experimental and clinical analysis. The difference in tumorigenesis rate between different parameters was analyzed by χ (2) test (categorical variable). Continuous variables with a normal distribution were compared using the t-test. Results: After cell passage and pathological diagnosis, 21 cases of hepatoblastoma PDX models were successfully constructed, with a success rate of 53.8% (21/39). Tumor samples from each generation of successfully modeled PDX models had pathology results that were consistent with those of the corresponding primary tumors. The analysis of the key factors affecting the tumor formation rate of PDX revealed that the metastasis rate was more successful in primary tumors than in liver in situ tumors (7/8 vs. 14/31, P = 0.049). However, there was no significant difference between tumor formation rates and pathological subtypes. According to the PDX tumor formation group comparison between the primary tumor and the metastatic tumor, there was no statistically significant difference between the two groups in terms of tumor formation time and tumor volume. Hematoxylin-eosin staining in hepatoblastoma's PDX mouse was consistent with the primary tumor. Immunohistochemistry positivity rates of four proteins, namely hepatocyte antigen (Hepatocyte), phosphatidylinositol glycan 3, β-catenin, and alpha-fetoprotein, in primary tumor tissues and PDX mouse models were 100% vs. 100%, 100% vs. 95.24%, 100% vs. 100%, and 95.24% vs. 85.71%, respectively. Conclusion: A PDX mouse model for hepatoblastoma has been successfully established in children. The tumor formation rate is high, with metastatic tumors having a higher tumor formation rate than primary tumors and transplanted tumors retaining the biological characteristics of primary tumors.
Collapse
Affiliation(s)
- H M Hu
- Department of Pediatrics, Beijing Tongren Hospital, Capital Medical University, Beijing 100176, China
| | - W L Zhang
- Department of Pediatrics, Beijing Tongren Hospital, Capital Medical University, Beijing 100176, China
| | - D S Huang
- Department of Pediatrics, Beijing Tongren Hospital, Capital Medical University, Beijing 100176, China
| | - R Li
- Department of Pathology, Beijing Tongren Hospital, Capital Medical University, Beijing 100176, China
| | - H L Gu
- Department of Pediatrics, Beijing Tongren Hospital, Capital Medical University, Beijing 100176, China
| | - J Li
- Department of Pediatrics, Beijing Tongren Hospital, Capital Medical University, Beijing 100176, China
| | - Y N Gao
- Department of Pediatrics, Beijing Tongren Hospital, Capital Medical University, Beijing 100176, China
| |
Collapse
|
48
|
Lawrence E, Johri G, Dave R, Li R, Gandhi A. A contemporary analysis of the pre- and intraoperative recognition of multigland parathyroid disease. Langenbecks Arch Surg 2023; 408:389. [PMID: 37806985 PMCID: PMC10560634 DOI: 10.1007/s00423-023-03087-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 08/28/2023] [Indexed: 10/10/2023]
Abstract
BACKGROUND Despite advances in biochemical and radiological identification of parathyroid gland enlargement, primary hyperparathyroidism (PHPT) due to sporadic multigland parathyroid disease (MGPD) remains a perioperative diagnostic dilemma. Failure to recognise MGPD pre- or intraoperatively may negatively impact surgical cure rates and result in persistent PHPT and ongoing patient morbidity. METHODS We have conducted a comprehensive review of published literature in attempt to determine factors that could aid in reliably diagnosing sporadic MGPD pre- or intraoperatively. We discuss preoperative clinical features and examine pre- and intraoperative biochemical and imaging findings concentrating on those areas that give practicing surgeons and the wider multi-disciplinary endocrine team indications that a patient has MGDP. This could alter surgical strategy. CONCLUSION Biochemistry can provide diagnosis of PHPT but cannot reliably discriminate parathyroid pathology. Histopathology can aid diagnosis between MGPD and adenoma, but histological appearance can overlap. Multiple negative imaging modalities indicate that MGPD may be more likely than a single parathyroid adenoma, but the gold standard for diagnosis is still intraoperative identification during BNE. MGPD remains a difficult disease to both diagnose and treat.
Collapse
Affiliation(s)
- E Lawrence
- Wythenshawe Hospital and Nightingale Breast Cancer Centre, Manchester University Foundation Trust, Southmoor Road, Manchester, M23 9LT, UK
| | - G Johri
- Wythenshawe Hospital and Nightingale Breast Cancer Centre, Manchester University Foundation Trust, Southmoor Road, Manchester, M23 9LT, UK
| | - R Dave
- Wythenshawe Hospital and Nightingale Breast Cancer Centre, Manchester University Foundation Trust, Southmoor Road, Manchester, M23 9LT, UK
| | - R Li
- Wythenshawe Hospital and Nightingale Breast Cancer Centre, Manchester University Foundation Trust, Southmoor Road, Manchester, M23 9LT, UK
| | - A Gandhi
- Wythenshawe Hospital and Nightingale Breast Cancer Centre, Manchester University Foundation Trust, Southmoor Road, Manchester, M23 9LT, UK.
- Division of Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Oglesby Cancer Research Building, M20 4GJ, Manchester, UK.
| |
Collapse
|
49
|
Peng H, Huang TW, Jiang K, Li R, Wu CN, Yu MY, Riconda C, Weber S, Zhou CT, Ruan SC. Coherent Subcycle Optical Shock from a Superluminal Plasma Wake. Phys Rev Lett 2023; 131:145003. [PMID: 37862653 DOI: 10.1103/physrevlett.131.145003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 07/30/2023] [Accepted: 08/31/2023] [Indexed: 10/22/2023]
Abstract
We propose exploiting the superluminal plasma wake for coherent Cherenkov radiation by injecting a relativistic electron beam (REB) into a plasma with a slowly varying density up-ramp. Using three-dimensional particle-in-cell and far-field time-domain radiation simulations, we show that an isolated subcycle pulse is coherently emitted towards the Cherenkov angle by bubble-sheath electrons successively at the rear of the REB-induced superluminal plasma wake. A theoretical model based on a superluminal current dipole has been developed to interpret such coherent radiation, and agrees well with the simulation results. This radiation has ultrashort attosecond-scale duration and high intensity, and exhibits excellent directionality with ultralow angular divergence and stable carrier envelope phase. Its intensity increases with the square of the propagation length and its central frequency can be easily tuned over a wide range, from the far infrared to the ultraviolet.
Collapse
Affiliation(s)
- H Peng
- Shenzhen Key Laboratory of Ultraintense Laser and Advanced Material Technology, Center for Advanced Material Diagnostic Technology, and College of Engineering Physics, Shenzhen Technology University, Shenzhen 518118, China
| | - T W Huang
- Shenzhen Key Laboratory of Ultraintense Laser and Advanced Material Technology, Center for Advanced Material Diagnostic Technology, and College of Engineering Physics, Shenzhen Technology University, Shenzhen 518118, China
| | - K Jiang
- Shenzhen Key Laboratory of Ultraintense Laser and Advanced Material Technology, Center for Advanced Material Diagnostic Technology, and College of Engineering Physics, Shenzhen Technology University, Shenzhen 518118, China
| | - R Li
- Shenzhen Key Laboratory of Ultraintense Laser and Advanced Material Technology, Center for Advanced Material Diagnostic Technology, and College of Engineering Physics, Shenzhen Technology University, Shenzhen 518118, China
| | - C N Wu
- Shenzhen Key Laboratory of Ultraintense Laser and Advanced Material Technology, Center for Advanced Material Diagnostic Technology, and College of Engineering Physics, Shenzhen Technology University, Shenzhen 518118, China
| | - M Y Yu
- Shenzhen Key Laboratory of Ultraintense Laser and Advanced Material Technology, Center for Advanced Material Diagnostic Technology, and College of Engineering Physics, Shenzhen Technology University, Shenzhen 518118, China
| | - C Riconda
- LULI, Sorbonne Université, CNRS, École Polytechnique, CEA, F-75252 Paris, France
| | - S Weber
- Extreme Light Infrastructure ERIC, ELI Beamlines Facility, 25241 Dolní Břežany, Czech Republic
| | - C T Zhou
- Shenzhen Key Laboratory of Ultraintense Laser and Advanced Material Technology, Center for Advanced Material Diagnostic Technology, and College of Engineering Physics, Shenzhen Technology University, Shenzhen 518118, China
| | - S C Ruan
- Shenzhen Key Laboratory of Ultraintense Laser and Advanced Material Technology, Center for Advanced Material Diagnostic Technology, and College of Engineering Physics, Shenzhen Technology University, Shenzhen 518118, China
| |
Collapse
|
50
|
Shreya S, Jenkins AS, Rezaeiyan Y, Li R, Böhnert T, Benetti L, Ferreira R, Moradi F, Farkhani H. Granular vortex spin-torque nano oscillator for reservoir computing. Sci Rep 2023; 13:16722. [PMID: 37794052 PMCID: PMC10550924 DOI: 10.1038/s41598-023-43923-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 09/30/2023] [Indexed: 10/06/2023] Open
Abstract
In this paper, we investigate the granularity in the free layer of the magnetic tunnel junctions (MTJ) and its potential to function as a reservoir for reservoir computing where grains act as oscillatory neurons while the device is in the vortex state. The input of the reservoir is applied in the form of a magnetic field which can pin the vortex core into different grains of the device in the magnetic vortex state. The oscillation frequency and MTJ resistance vary across different grains in a non-linear fashion making them great candidates to be served as the reservoir's outputs for classification objectives. Hence, we propose an experimentally validated area-efficient single granular vortex spin-torque nano oscillator (GV-STNO) device in which pinning sites work as random reservoirs that can emulate neuronal functions. We harness the nonlinear oscillation frequency and resistance exhibited by the vortex core granular pinning of the GV-STNO reservoir computing system to demonstrate waveform classification.
Collapse
Affiliation(s)
- S Shreya
- Electrical and Computer Engineering Department, Aarhus University, 8200, Aarhus, Denmark.
| | - A S Jenkins
- International Iberian Nanotechnology Laboratory (INL), Braga, Portugal
| | - Y Rezaeiyan
- Electrical and Computer Engineering Department, Aarhus University, 8200, Aarhus, Denmark
| | - R Li
- Electrical and Computer Engineering Department, Aarhus University, 8200, Aarhus, Denmark
| | - T Böhnert
- International Iberian Nanotechnology Laboratory (INL), Braga, Portugal
| | - L Benetti
- International Iberian Nanotechnology Laboratory (INL), Braga, Portugal
| | - R Ferreira
- International Iberian Nanotechnology Laboratory (INL), Braga, Portugal
| | - F Moradi
- Electrical and Computer Engineering Department, Aarhus University, 8200, Aarhus, Denmark
| | - H Farkhani
- Electrical and Computer Engineering Department, Aarhus University, 8200, Aarhus, Denmark.
| |
Collapse
|