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Allsbrook A, To JQ, Pulido OR, Morgan ME, Perea LL, Shin H, Muller A, Ong A, Butts CA, Braverman MA. Body Mass Index Does Not Predict Injury Pattern or Outcome After Motorcycle Crash. J Surg Res 2024; 296:88-92. [PMID: 38241772 DOI: 10.1016/j.jss.2023.12.010] [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: 03/01/2023] [Revised: 11/11/2023] [Accepted: 12/17/2023] [Indexed: 01/21/2024]
Abstract
INTRODUCTION The obesity epidemic plagues the United States, affecting approximately 42% of the population. The relationship of obesity with injury severity and outcomes has been poorly studied among motorcycle collisions (MCC). This study aimed to compare injury severity, mortality, injury regions, and hospital and intensive care unit length of stay (LOS) between obese and normal-weight MCC patients. METHODS Trauma registries from three Pennsylvania Level 1 trauma centers were queried for adult MCC patients (January 1, 2016, and December 31, 2020). Obesity was defined as adult patients with body mass index ≥ 30 kg/m2 and normal weight was defined as body mass index < 30 kg/m2 but > 18.5 kg/m2. Demographics and injury characteristics including injury severity score (ISS), abbreviated injury score, mortality, transfusions and LOS were compared. P ≤ 0.05 was considered significant. RESULTS One thousand one hundred sixty-four patients met the inclusion criteria: 40% obese (n = 463) and 60% nonobese (n = 701). Comparison of ISS demonstrated no statistically significant difference between obese and normal-weight patients with median ISS (interquartile range) 9 (5-14) versus 9 (5-14), respectively (P = 0.29). Obese patients were older with median age 45 (32-55) y versus 38 (26-54) y, respectively (P < 0.01). Comorbidities were equally distributed among both groups except for the incidence of hypertension (30 versus 13.8%, P < 0.01) and diabetes (11 versus 4.4%, P < 0.01). There was no statistically significant difference in Trauma Injury Severity Score or abbreviated injury score. Hospital LOS, intensive care unit LOS, and 30-day mortality among both groups were similar. CONCLUSIONS Obese patients experiencing MCC had no differences in distribution of injury, mortality, or injury severity, mortality, injury regions, and hospital compared to normal-weight adults. Our study differs from current data that obese motorcycle drivers may have different injury characteristics and increased LOS.
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Affiliation(s)
- Anthony Allsbrook
- Division of Acute Care Surgical Services, Department of Surgery, St. Luke's University Health Network, Bethlehem, Pennsylvania
| | - Jennifer Q To
- Division of Acute Care Surgical Services, Department of Surgery, St. Luke's University Health Network, Bethlehem, Pennsylvania
| | - Odessa R Pulido
- Department of Surgery, Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania
| | - Madison E Morgan
- Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania
| | - Lindsey L Perea
- Division of Trauma and Acute Care Surgery, Department of Surgery, Penn Medicine Lancaster General Health, Lancaster, Pennsylvania
| | - Hannah Shin
- Department of Surgery, Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania
| | - Alison Muller
- Division of Trauma, Department of Surgery, Acute Care Surgery & Surgical Critical Care, Reading Hospital- Tower Health, West Reading, Pennsylvania
| | - Adrian Ong
- Division of Trauma, Department of Surgery, Acute Care Surgery & Surgical Critical Care, Reading Hospital- Tower Health, West Reading, Pennsylvania
| | - Christopher A Butts
- Division of Trauma, Department of Surgery, Acute Care Surgery & Surgical Critical Care, Reading Hospital- Tower Health, West Reading, Pennsylvania
| | - Maxwell A Braverman
- Division of Acute Care Surgical Services, Department of Surgery, St. Luke's University Health Network, Bethlehem, Pennsylvania.
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Viswanathan A, Na HY, Breckenridge L, Muller A, Butts C, Reilly E, Geng T, Sigal A, Michels R, Ong A. Hypotension in the Emergency Department and Contrast Extravasation on Computerized Tomography Predict Blood Transfusion in Low-Energy Pelvic Fractures. J Surg Res 2024; 296:310-315. [PMID: 38306936 DOI: 10.1016/j.jss.2024.01.001] [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: 10/30/2023] [Revised: 11/29/2023] [Accepted: 01/02/2024] [Indexed: 02/04/2024]
Abstract
INTRODUCTION Although low-energy pelvic fractures seldom present with significant hemorrhage, early recognition of at-risk patients is essential. We aimed to identify predictors of transfusion requirements in this cohort. METHODS A 7-y retrospective chart review was performed. Low-energy mechanism was defined as falls of ≤5 feet. Fracture pattern was classified using the Orthopedic Trauma Association/Arbeitsgemeinschaft für Osteosynthesefragen system as A, B, or C. Primary outcome was transfusion of ≥2 units of packed red blood cells in the first 48 h. Univariable analysis and logistic regression analysis were performed. A P value ≤0.05 was considered significant. RESULTS Five hundred forty six patients were included with median (interquartile range) age of 86 (79-91) and median (interquartile range) Injury Severity Score of 5 (4-8). Five hundred forty one (99%) had type A fractures. Twenty six (5%) had the primary outcome and 17 (3%) died. Logistic regression found that systolic blood pressure <100 mmHg at any time in the Emergency Department, Injury Severity Score, and pelvic angiography were predictors of the primary outcome. Seventeen percent of those who had the primary outcome died compared with 2% who did not (P = 0.0004). Three hundred sixty four (67%) received intravenous contrast for computerized tomography scans and of these, 44 (12%) had contrast extravasation (CE). CE was associated with the primary outcome but not mortality. CONCLUSIONS Hypotension at any time in the Emergency Department and CE on computerized tomography predicted transfusion of ≥2 units packed red blood cells in the first 48 h in patients with low-energy pelvic fractures.
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Affiliation(s)
| | - Hee Yun Na
- Drexel University College of Medicine, Wyomissing, Pennsylvania
| | - Leigham Breckenridge
- Department of Surgery, Reading Hospital, Tower Health System, West Reading, Pennsylvania
| | - Alison Muller
- Department of Surgery, Reading Hospital, Tower Health System, West Reading, Pennsylvania
| | - Christopher Butts
- Department of Surgery, Reading Hospital, Tower Health System, West Reading, Pennsylvania
| | - Eugene Reilly
- Department of Surgery, Reading Hospital, Tower Health System, West Reading, Pennsylvania
| | - Thomas Geng
- Department of Surgery, Reading Hospital, Tower Health System, West Reading, Pennsylvania
| | - Adam Sigal
- Department of Emergency Medicine, Reading Hospital, Tower Health System, West Reading, Pennsylvania
| | - Ryan Michels
- Department of Surgery, Reading Hospital, Tower Health System, West Reading, Pennsylvania
| | - Adrian Ong
- Department of Surgery, Reading Hospital, Tower Health System, West Reading, Pennsylvania.
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Shin H, Pulido OR, Sullivan MC, Perea LL, Dammann K, To JQ, Braverman M, Wasser T, Muller A, Ong A, Butts CA. Geriatric Motorcycle-Related Outcomes: A Pennsylvania Multicenter Study. J Surg Res 2024; 296:249-255. [PMID: 38295712 DOI: 10.1016/j.jss.2023.12.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 11/30/2023] [Accepted: 12/27/2023] [Indexed: 03/19/2024]
Abstract
INTRODUCTION Geriatric patients (GeP) often experience increased morbidity and mortality following traumatic insult and as a result, require more specialized care due to lower physiologic reserve and underlying medical comorbidities. Motorcycle injuries (MCCI) occur across all age groups; however, no large-scale studies evaluating outcomes of GeP exist for this particular subset of patients. Data thus far are limited to elderly participation in recreational activities such as water and alpine skiing, snowboarding, equestrian, snowmobiles, bicycles, and all-terrain vehicles. We hypothesized that GeP with MCCI will have a higher rate of mortality when compared with their younger counterparts despite increased helmet usage. METHODS We performed a multicenter retrospective review of MCCI patients at three Pennsylvania level I trauma centers from January 2016 to December 2020. Data were extracted from each institution's electronic medical records and trauma registry. GeP were defined as patients aged more than or equal to 65 y. The primary outcome was mortality. Secondary outcomes included ventilator days; hospital, intensive care unit, and intermediate unit length of stays; complications; and helmet use. 3:1 nongeriatric patients (NGeP) to GeP propensity score matching (PSM) was based on sex, abbreviated injury scale (AIS), and injury severity score (ISS). P ≤ 0.05 was considered significant. RESULTS One thousand five hundred thirty eight patients were included (GeP: 7% [n = 113]; NGP: 93% [n = 1425]). Prior to PSM, GeP had higher median Charlson Comorbidity Index (GeP: 3.0 versus NGeP: 0.0; P ≤ 0.001) and greater helmet usage (GeP: 73.5% versus NGeP: 54.6%; P = 0.001). There was a statistically significant difference between age cohorts in terms of ISS (GeP: 10.0 versus NGeP: 6.0, P = 0.43). There was no significant difference for any AIS body region. Mortality rates were similar between groups (GeP: 1.7% versus NGeP: 2.6%; P = 0.99). After PSM matching for sex, AIS, and ISS, GeP had significantly more comorbidities than NGeP (P ≤ 0.05). There was no difference in trauma bay interventions or complications between cohorts. Mortality rates were similar (GeP: 1.8% versus NGeP: 3.2%; P = 0.417). Differences in ventilator days as well as intensive care unit length of stay, intermediate unit length of stay, and hospital length of stay were negligible. Helmet usage between groups were similar (GeP: 64.5% versus NGeP: 66.8%; P = 0.649). CONCLUSIONS After matching for sex, ISS, and AIS, age more than 65 y was not associated with increased mortality following MCCI. There was also no significant difference in helmet use between groups. Further studies are needed to investigate the effects of other potential risk factors in the aging patient, such as frailty and anticoagulation use, before any recommendations regarding management of motorcycle-related injuries in GeP can be made.
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Affiliation(s)
- Hannah Shin
- Department of Surgery, Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania
| | - Odessa R Pulido
- Department of Surgery, Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania
| | - Megan C Sullivan
- Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania
| | - Lindsey L Perea
- Division of Trauma and Acute Care Surgery, Department of Surgery, Penn Medicine Lancaster General Health, Lancaster, Pennsylvania
| | - Kyle Dammann
- Division of Acute Care Surgical Services, Department of Surgery, St. Luke's University Health Network, Bethlehem, Pennsylvania
| | - Jennifer Q To
- Division of Acute Care Surgical Services, Department of Surgery, St. Luke's University Health Network, Bethlehem, Pennsylvania
| | - Maxwell Braverman
- Division of Acute Care Surgical Services, Department of Surgery, St. Luke's University Health Network, Bethlehem, Pennsylvania
| | - Tom Wasser
- Division of Trauma, Acute Care Surgery & Surgical Critical Care, Department of Surgery, Reading Hospital- Tower Health, West Reading, Pennsylvania
| | - Alison Muller
- Division of Trauma, Acute Care Surgery & Surgical Critical Care, Department of Surgery, Reading Hospital- Tower Health, West Reading, Pennsylvania
| | - Adrian Ong
- Division of Trauma, Acute Care Surgery & Surgical Critical Care, Department of Surgery, Reading Hospital- Tower Health, West Reading, Pennsylvania
| | - Christopher A Butts
- Division of Trauma, Acute Care Surgery & Surgical Critical Care, Department of Surgery, Reading Hospital- Tower Health, West Reading, Pennsylvania.
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Villa NAE, Shum K, Atkinson A, Ong A, Muller A, Espiridion E. Opioid Use in Pelvic Fractures: The Impact of Opioid Prescribing Laws in Pennsylvania. Am Surg 2024:31348241241644. [PMID: 38516756 DOI: 10.1177/00031348241241644] [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: 03/23/2024]
Abstract
Pennsylvania's Prescription Drug Monitoring Program (PDMP) was established in 2016, but its impact on opioid use for pelvic fractures is understudied. We compared opioid use in 277 pelvic fracture cases between two periods: 2015-2017 (T1) and 2018-2020 (T2). Outcomes included daily inpatient morphine milligram equivalents (MME), long-term opioid use (LOU) 60-90 days post-discharge, and intermediate-term opioid use (IOU) 30-60 days post-discharge. T1 and T2 had comparable baseline characteristics. T2 was associated with a decrease in average daily inpatient MME (58.6 vs 78.5, P = .02), particularly in younger patients. Regression analyses showed age and Injury Severity Score (ISS) were significant predictors for daily inpatient MME, while time period was not. Geriatric patients in T2 had significantly decreased IOU (30% vs 9%, P = .05). Pelvic fracture type and daily MME predicted IOU, while pelvic fracture type predicted LOU. This study suggests a modest impact of these laws, but further study is needed.
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Affiliation(s)
- Nicole Ann E Villa
- Drexel University College of Medicine at Tower Health, Wyomissing, PA, USA
| | - Kristina Shum
- Drexel University College of Medicine at Tower Health, Wyomissing, PA, USA
| | - Allison Atkinson
- Drexel University College of Medicine at Tower Health, Wyomissing, PA, USA
| | - Adrian Ong
- Department of Surgery, Tower Health Systems, Reading Hospital, West Reading, PA, USA
| | - Alison Muller
- Department of Surgery, Tower Health Systems, Reading Hospital, West Reading, PA, USA
| | - Eduardo Espiridion
- Drexel University College of Medicine at Tower Health, Wyomissing, PA, USA
- Department of Psychiatry, Tower Health Systems, Reading Hospital, West Reading, PA, USA
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Luck T, Zaki PG, Slotkin EM, Michels R, Ong A, Butts CA. Age-Adjusted Modified Frailty Index: Association With Hip Fracture Discharge Functional Dependence. J Surg Res 2024; 295:214-221. [PMID: 38039726 DOI: 10.1016/j.jss.2023.10.021] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 09/20/2023] [Accepted: 10/28/2023] [Indexed: 12/03/2023]
Abstract
INTRODUCTION Hip fractures are a common traumatic injury that carry significant morbidity and mortality, and prognostication of functional outcome is becoming increasingly salient. Across multiple surgical specialties, the five-item and 11-item Modified Frailty Index (mFI-5 and mFI-11) have been found to be convenient, quick, and sensitive tools for identifying patients at risk for perioperative complications. A prior study described the superiority of an Age-Adjusted Modified Frailty Index (aamFI) for predicting perioperative complications compared to the mFI-5 in an elective hip surgery. We sought to externally validate the aamFI in a multicenter hip fracture cohort and hypothesize that these risk scores would not only predict functional dependence (FD) at discharge, but that the aamFI would outperform the mFI-5 and mFI-11. METHODS The Pennsylvania Trauma Systems Foundation registry was queried from 2010 to 2020 for CPT codes, ICD-9 and ICD-10 codes pertaining to hip fracture patients. Patients with missing locomotion and transfer mobility data were excluded. FD status was determined by discharge locomotion and transfer mobility scores per existing methodology. Univariable and Multivariable analysis as well as receiver operator characteristic curves were used to evaluate and compare the three indices for prediction of functional status at discharge. P value < 0.05 was considered significant. RESULTS Twelve thousand seven hundred and forty patients met inclusion criteria (FD: 8183; functional independent 4557). On univariable logistic regression analysis, the mFI-11 (odds ratio [OR] 1.52, 95% confidence interval [CI] 1.47-1.58, P < 0.05), mFI-5 (OR 1.57, 95% CI 1.51-1.63), and aamFI (OR 1.57, 95% CI 1.52-1.62, P < 0.05) were associated with FD. On multivariable logistic regression analysis for predictors of FD, when controlling for age (for the mFI-11 and mFI-5), sex, injury severity score, and admission vitals (systolic blood pressure and respiratory rate), higher mFI-11 and mFI-5 scores independently predicted FD at discharge (OR 1.23, 95% CI 1.18-1.28, P < 0.05 and OR 1.23, 95% CI 1.18-1.29P < 0.05 respectively). Higher aaMFI scores had superior association with functional dependence (OR 1.59, 95% CI 1.54-1.64, P < 0.05). Receiver operator characteristic curves for the mFI-11, mFI-5, and aaMFI showed comparable diagnostic strength (area under curve [AUC] = 0.63 95% CI 0.62-0.64, P < 0.05; AUC = 0.63 95% CI 0.62-0.64, P < 0.05; and AUC = 0.67 95% CI 0.65-0.67, P < 0.05 respectively). CONCLUSIONS The mFI-11, mFI-5, and aamFI are predictive of functional outcome following hip fracture. By including age, the aamFI retains the ease of use of the mFI-5 while improving its prognostic utility for functional outcome.
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Affiliation(s)
- Trevor Luck
- Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Peter G Zaki
- Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Eric M Slotkin
- Division of Orthopedic Surgery, Department of Surgery, Reading Hospital, West Reading, Pennsylvania
| | - Ryan Michels
- Division of Orthopedic Surgery, Department of Surgery, Reading Hospital, West Reading, Pennsylvania
| | - Adrian Ong
- Division of Trauma, Department of Surgery, Acute Care Surgery, and Surgical Critical Care, Reading Hospital-Tower Health, West Reading, Pennsylvania
| | - Christopher A Butts
- Division of Trauma, Department of Surgery, Acute Care Surgery, and Surgical Critical Care, Reading Hospital-Tower Health, West Reading, Pennsylvania.
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Kelley W, Zreik K, Gergen A, Williams J, Jacobson LE, Nahmias J, Tatar A, Murry J, Grigorian A, Ong A, Stein DM, Scalea TM, Lauerman MH. Early Pharmacologic Therapy in Patients With Blunt Cerebrovascular Injury and TBI: Is it Safe and Effective? An EAST Multicenter Study. Am Surg 2024:31348241230094. [PMID: 38253324 DOI: 10.1177/00031348241230094] [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: 01/24/2024]
Abstract
BACKGROUND Blunt cerebrovascular injury (BCVI) with concurrent traumatic brain injury (TBI) presents increased risk of both ischemic stroke and bleeding. This study investigated the safety and survival benefit of BCVI treatment (antithrombotic and/or anticoagulant therapy) in this population. We hypothesized that treatment would be associated with fewer and later strokes in patients with BCVI and TBI without increasing bleeding complications. METHODS Patients with head AIS >0 were selected from a database of BCVI patients previously obtained for an observational trial. A Kaplan-Meier analysis compared stroke survival in patients who received BCVI treatment to those who did not. Logistic regression was used to evaluate for confounding variables. RESULTS Of 488 patients, 347 (71.1%) received BCVI treatment and 141 (28.9%) did not. BCVI treatment was given at a median of 31 h post-admission. BCVI treatment was associated with lower stroke rate (4.9% vs 24.1%, P < .001 and longer stroke-free survival (P < .001), but also less severe systemic injury. Logistic regression identified motor GCS and BCVI treatment as the only predictors of stroke. No patients experienced worsening TBI because of treatment. DISCUSSION Patients with BCVI and TBI who did not receive BCVI treatment had an increased rate of stroke early in their hospital stay, though this effect may be confounded by worse motor deficits and systemic injuries. BCVI treatment within 2-3 days of admission may be safe for patients with mean head AIS of 2.6. Future prospective trials are needed to confirm these findings and determine optimal timing of BCVI treatment in TBI patients with BCVI.
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Affiliation(s)
- William Kelley
- Department of Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Khaled Zreik
- Department of Surgery, Sanford Health, Sioux Falls, SD, USA
| | - Anna Gergen
- Department of Surgery, University of Colorado Denver, Aurora, CO, USA
| | - Jamie Williams
- Department of Surgery, Ascension St. Vincent Hospital, Indianapolis, IN, USA
| | - Lewis E Jacobson
- Department of Surgery, Ascension St. Vincent Hospital, Indianapolis, IN, USA
| | - Jeffry Nahmias
- Department of Surgery, University of California - Irvine, Irvine, CA, USA
| | - Anthony Tatar
- Department of Surgery, University of Massachusetts Medical School, Worcester, MA, USA
| | - Jason Murry
- Department of Surgery, UT Health Tyler, Tyler, TX, USA
| | - Areg Grigorian
- Department of Surgery, University of California - Irvine, Irvine, CA, USA
| | - Adrian Ong
- Department of Surgery, Towerhealth, West Reading, PA, USA
| | - Deborah M Stein
- Department of Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Thomas M Scalea
- Department of Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Margaret H Lauerman
- Department of Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
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Ardeshna S, Esposito E, Spalding C, Dunn J, Nahmias J, Grigorian A, Harmon L, Gergen A, Young A, Pascual J, Murry J, Ong A, Appelbaum R, Bugaev N, Tatar A, Zreik K, Scalea TM, Stein D, Lauerman M. Which Patients Receive Diagnostic Angiography? An EAST Multicenter Study Analysis of Internal Carotid Artery Blunt Cerebrovascular Injury. Am Surg 2023; 89:5183-5190. [PMID: 36417771 DOI: 10.1177/00031348221138083] [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: 12/22/2023]
Abstract
BACKGROUND Digital subtraction angiography (DSA) is the gold standard radiologic modality in blunt cerebrovascular injury (BCVI). However, computerized tomography angiography (CTA) is primarily used in modern practice with CTA's widespread availability and the decreased stroke rate with CTA use. The frequency and indications for DSA in BCVI is undefined. We hypothesized that DSA use in internal carotid artery (ICA) BCVI would be infrequent and dependent on radiologic features. METHODS This was a post hoc analysis of an EAST multicenter, prospective, observational trial of 16 trauma centers for stroke factors in BCVI. ICA BCVI was divided into those undergoing DSA and not undergoing DSA (no-DSA). Only ICA BCVI was included. RESULTS 332 ICA BCVI were included, 221 (66.6%) no-DSA and 111 (33.4%) DSA. Lower hospital trauma volume, non-urban environment, and non-academic status were associated with DSA use (all P ≤ .001). BCVI grade (P = .02) and presence of luminal stenosis (P = .005) were associated with DSA use while pseudoaneurysm presence was not. Median time to DSA was 1 hour. The most common indication for angiography was to determine the presence of injury in 71 (64%) ICA BCVI, followed by determining grade of injury in 16 (14.4%) and concerning imaging characteristics in 12 (10.8%). BCVI grade on initial imaging and on DSA were equivalent in 94 (84.7%) ICA BCVI. DISCUSSION DSA is frequently used in ICA BCVI, primarily early in the hospital course for injury diagnosis and grade determination. DSA appears primarily driven by hospital type, BCVI grade, and luminal stenosis.
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Affiliation(s)
| | | | | | - Julie Dunn
- University of Colorado-Anschutz Medical Campus, Aurora, CO, USA
| | | | | | | | - Anna Gergen
- University of Colorado Denver, Denver, CO, USA
| | - Andrew Young
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Jose Pascual
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | | | | | - Rachel Appelbaum
- Department of Surgery, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | | | - Antony Tatar
- Tufts University School of Medicine, Boston, MA, USA
| | | | | | - Deborah Stein
- R Adams Cowley Shock Trauma Center, Baltimore, MD, USA
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Abstract
BACKGROUND Opioids are effective in short-term pain treatment; however, their long-term effectiveness is unconfirmed. Many patients are exposed to opioids after pelvic injuries with little known about persistent use afterward. We assessed the prevalence and predictors of long-term opioid use following pelvic fractures. MATERIALS AND METHODS This retrospective study enrolled 277 patients with acute pelvic fractures over five years. Daily and total morphine milligram equivalents (MME) were calculated. The primary outcome was long-term opioid use (LOU) defined as ongoing opioid use 60-90 days post-discharge. The secondary outcome was intermediate-term opioid use (IOU) defined as ongoing opioid use 30-60 days post-discharge. Univariable and logistic regression analyses were performed. RESULTS Median (interquartile range) total inpatient opioid MME was 422 (157-1667) with a median daily MME of 69 (26-145). Long-term opioid use occurred in 16%, and IOU occurred in 29%. Univariable analysis found that total and daily inpatient opioid use were each significantly associated with LOU (median MME, 1241 vs 371; median MMEs, 127.7 vs 59.2, respectively) and IOU (median MME, 1140 vs 326; median MMEs, 111.8 vs 57.9, respectively). Logistic regression analysis found daily inpatient MME ≥50 (odds ratio [OR] 3.027, 95% confidence interval [CI] 1.059-8.652]) and pelvic fracture type (Tile B/C) (OR 2.992 [CI 1.324-6.763])were independent predictors of LOU. CONCLUSION Total and daily inpatient opioid use were significantly associated with LOU and IOU. Patients who received ≥50 MME/inpatient day had a higher likelihood of LOU. This study seeks to inform clinical decisions for pain management to prevent adverse outcomes.
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Affiliation(s)
| | - Kristina Shum
- Drexel University College of Medicine at Tower Health, Wyomissing, PA, USA
| | - Allison Atkinson
- Drexel University College of Medicine at Tower Health, Wyomissing, PA, USA
| | - Adrian Ong
- Department of Surgery, Reading Hospital, Reading, PA, USA
| | - Allison Muller
- Department of Surgery, Reading Hospital, Reading, PA, USA
| | - Eduardo Espiridion
- Drexel University College of Medicine at Tower Health, Wyomissing, PA, USA
- Department of Psychiatry, Reading Hospital, Reading, PA, USA
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Tian Y, Chen K, Zheng H, Kripalani DR, Zeng Z, Jarlöv A, Chen J, Bai L, Ong A, Du H, Kang G, Fang Q, Zhao L, Qi HJ, Wang Y, Zhou K. Additively Manufactured Dual-Faced Structured Fabric for Shape-Adaptive Protection. Adv Sci (Weinh) 2023:e2301567. [PMID: 37162222 PMCID: PMC10375195 DOI: 10.1002/advs.202301567] [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] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 04/06/2023] [Indexed: 05/11/2023]
Abstract
Fabric-based materials have demonstrated promise for high-performance wearable applications but are currently restricted by their deficient mechanical properties. Here, this work leverages the design freedom offered by additive manufacturing and a novel interlocking pattern to for the first time fabricate a dual-faced chain mail structure consisting of 3D re-entrant unit cells. The flexible structured fabric demonstrates high specific energy absorption and specific strength of up to 1530 J kg-1 and 5900 Nm kg-1 , respectively, together with an excellent recovery ratio of ≈80%, thereby overcoming the strength-recoverability trade-off. The designed dual-faced structured fabric compares favorably against a wide range of materials proposed for wearable applications, attributed to the synergetic strengthening of the energy-absorbing re-entrant unit cells and their unique topological interlocking. This work advocates the combined design of energy-absorbing unit cells and their interlocking to extend the application prospects of fabric-based materials to shape-adaptive protection.
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Affiliation(s)
- Yuanyuan Tian
- HP-NTU Digital Manufacturing Corporate Lab, Nanyang Technological University, 50 Nanyang Avenue, Singapore, 639798, Singapore
- Singapore Centre for 3D Printing, School of Mechanical and Aerospace Engineering, Nanyang Technological University, 50 Nanyang Avenue, Singapore, 639798, Singapore
- State Key Laboratory of Advanced Design and Manufacturing for Vehicle Body, Hunan University, Changsha, Hunan, 410082, China
| | - Kaijuan Chen
- HP-NTU Digital Manufacturing Corporate Lab, Nanyang Technological University, 50 Nanyang Avenue, Singapore, 639798, Singapore
| | - Han Zheng
- Singapore Centre for 3D Printing, School of Mechanical and Aerospace Engineering, Nanyang Technological University, 50 Nanyang Avenue, Singapore, 639798, Singapore
| | - Devesh R Kripalani
- Singapore Centre for 3D Printing, School of Mechanical and Aerospace Engineering, Nanyang Technological University, 50 Nanyang Avenue, Singapore, 639798, Singapore
| | - Zhuohong Zeng
- Singapore Centre for 3D Printing, School of Mechanical and Aerospace Engineering, Nanyang Technological University, 50 Nanyang Avenue, Singapore, 639798, Singapore
| | - Asker Jarlöv
- Singapore Centre for 3D Printing, School of Mechanical and Aerospace Engineering, Nanyang Technological University, 50 Nanyang Avenue, Singapore, 639798, Singapore
| | - Jiayao Chen
- HP-NTU Digital Manufacturing Corporate Lab, Nanyang Technological University, 50 Nanyang Avenue, Singapore, 639798, Singapore
- Singapore Centre for 3D Printing, School of Mechanical and Aerospace Engineering, Nanyang Technological University, 50 Nanyang Avenue, Singapore, 639798, Singapore
| | - Lichun Bai
- School of Traffic and Transportation Engineering, Central South University, Changsha, Hunan, 410083, China
| | - Adrian Ong
- HP-NTU Digital Manufacturing Corporate Lab, Nanyang Technological University, 50 Nanyang Avenue, Singapore, 639798, Singapore
| | - Hejun Du
- HP-NTU Digital Manufacturing Corporate Lab, Nanyang Technological University, 50 Nanyang Avenue, Singapore, 639798, Singapore
| | - Guozheng Kang
- School of Mechanics and Aerospace Engineering, Southwest Jiaotong University, Chengdu, Sichuan, 610031, China
| | - Qihong Fang
- State Key Laboratory of Advanced Design and Manufacturing for Vehicle Body, Hunan University, Changsha, Hunan, 410082, China
| | - Lihua Zhao
- HP-NTU Digital Manufacturing Corporate Lab, Nanyang Technological University, 50 Nanyang Avenue, Singapore, 639798, Singapore
- 3D Lab, HP Labs, HP Inc., Palo Alto, CA, 94304, USA
| | - H Jerry Qi
- The George W. Woodruff School of Mechanical Engineering, Georgia Institute of Technology, Atlanta, GA, 30332, USA
| | - Yifan Wang
- Singapore Centre for 3D Printing, School of Mechanical and Aerospace Engineering, Nanyang Technological University, 50 Nanyang Avenue, Singapore, 639798, Singapore
| | - Kun Zhou
- HP-NTU Digital Manufacturing Corporate Lab, Nanyang Technological University, 50 Nanyang Avenue, Singapore, 639798, Singapore
- Singapore Centre for 3D Printing, School of Mechanical and Aerospace Engineering, Nanyang Technological University, 50 Nanyang Avenue, Singapore, 639798, Singapore
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Kim EJ, Michels R, Schiffer H, Musso M, Ong A, Geng T, Butts CA. Traumatic Amputation From a Rollover Farming Incident in a 16-Year-Old. Am Surg 2023. [PMID: 36867081 DOI: 10.1177/00031348231161698] [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: 03/04/2023]
Abstract
There is very little literature on the overall management of adolescent traumatic amputation, specifically of the lower extremity. We present a case involving an adolescent patient involved in an industrial farm tractor rollover with substantial crush and degloving injuries requiring bilateral lower extremity amputations. The patient was initially assessed and acutely managed in the field before arriving at an adult level 1 trauma center having two right lower extremity tourniquets already applied and a pelvic binder in place. During his hospitalization, he was revised to bilateral above-knee amputations that required multiple debridements prior to being transferred to a pediatric trauma center due to the extent of the soft tissue injury and need for flap coverage. Our adolescent patient presented with an uncommon injury mechanism resulting in significantly mangled lower extremities highlighting the importance of a multidisciplinary approach in all aspects of the patient's prehospital, intrahospital, and posthospital care.
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Affiliation(s)
- Esther J Kim
- Department of Surgery, 6823Reading Hospital, West Reading, PA, USA
| | - Ryan Michels
- Division of Orthopedic Surgery, Department of Surgery, 6823Reading Hospital, West Reading, PA, USA
| | - Herbert Schiffer
- Department of Emergency Medicine, 6823Reading Hospital, West Reading, PA, USA
| | - Michael Musso
- Division of Trauma, Acute Care Surgery, and Surgical Critical Care, 6823Reading Hospital, West Reading, PA, USA
| | - Adrian Ong
- Division of Trauma, Acute Care Surgery, and Surgical Critical Care, 6823Reading Hospital, West Reading, PA, USA
| | - Thomas Geng
- Division of Trauma, Acute Care Surgery, and Surgical Critical Care, 6823Reading Hospital, West Reading, PA, USA
| | - Christopher A Butts
- Division of Trauma, Acute Care Surgery, and Surgical Critical Care, 6823Reading Hospital, West Reading, PA, USA
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11
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Sigal A, Butts CA, Deaner T, Wasser T, Bailey B, Bindra M, Muller A, Martin AP, Ong A. Potentially Inappropriate Medications are Associated With Geriatric Trauma Recidivism. J Surg Res 2023; 283:581-585. [PMID: 36442257 DOI: 10.1016/j.jss.2022.10.029] [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: 04/12/2022] [Revised: 10/17/2022] [Accepted: 10/19/2022] [Indexed: 11/27/2022]
Abstract
INTRODUCTION The American Geriatric Society has identified polypharmacy and categories of potentially inappropriate medication (PIM) that should be avoided in the elderly. These medications can potentially cause an increased risk of falls and traumatic events. MATERIALS AND METHODS We conducted a retrospective study on elderly patients with traumatic injuries at a Level 1 trauma center. We compared patients having only one traumatic event and those with one or more traumatic events with the presence of prescriptions for PIMs. RESULTS Identified high risk categories of anticoagulant and antiplatelet agents (odds ratio [OR] 1.18, 95% confidence interval [CI] 1.08-1.28), psychiatric and neurologic agents (OR 1.32, 95% CI 1.22-1.43), as well as medication with anticholinergic properties (OR 1.14, 95% CI 1.03-1.27) were associated with an increased risk of recurrent trauma. CONCLUSIONS We can quantify the risk of recurrent trauma with certain categories of PIM. Medication reconciliation and shared decision-making regarding the continued use of these medications may positively impact trauma recidivism.
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Affiliation(s)
- Adam Sigal
- Department of Emergency Medicine, Reading Hospital, West Reading, Pennsylvania.
| | - Christopher A Butts
- Division of Trauma, Acute Care and Surgical Critical Care, Department of Surgery, Reading Hospital, West Reading, Pennsylvania
| | - Traci Deaner
- Department of Emergency Medicine, Reading Hospital, West Reading, Pennsylvania
| | - Tom Wasser
- Department of Emergency Medicine, Reading Hospital, West Reading, Pennsylvania
| | - Blake Bailey
- Department of Emergency Medicine, Reading Hospital, West Reading, Pennsylvania
| | - Monisha Bindra
- Department of Emergency Medicine, Reading Hospital, West Reading, Pennsylvania
| | - Alison Muller
- Division of Trauma, Acute Care and Surgical Critical Care, Department of Surgery, Reading Hospital, West Reading, Pennsylvania
| | - Anthony P Martin
- Division of Trauma, Acute Care and Surgical Critical Care, Department of Surgery, Reading Hospital, West Reading, Pennsylvania
| | - Adrian Ong
- Division of Trauma, Acute Care and Surgical Critical Care, Department of Surgery, Reading Hospital, West Reading, Pennsylvania
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12
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Heidorn E, Costa M, Coots A, Ong A, Butts CA. Large Traumatic Lumbar Hernia: A Difficult and Uncommon Problem. Am Surg 2023:31348231157835. [PMID: 36803138 DOI: 10.1177/00031348231157835] [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: 02/22/2023]
Abstract
Lumbar hernias are congenital or acquired posterolateral abdominal wall hernias and are located in the superior or inferior lumbar triangle. Traumatic lumbar hernias are rare, and the optimal method to repair these is not well-defined. We present the case of a 59-year-old obese female who presented after a motor vehicle collision with an 8.8 cm traumatic right-sided inferior lumbar hernia and overlying complex abdominal wall laceration. The patient underwent an open repair with retro rectus polypropylene mesh and biologic mesh underlay several months after the abdominal wall wound healed, and the patient lost 60 pounds. The patient recovered well without complications or recurrence at the one-year follow-up. This case demonstrates a complex, open surgical approach to repair a large traumatic lumbar hernia not amenable to laparoscopic repair.
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Affiliation(s)
- Elise Heidorn
- Department of Surgery, 6823Reading Hospital, West Reading, PA, USA
| | - Margaret Costa
- Department of Surgery, 6823Reading Hospital, West Reading, PA, USA
| | - Abigail Coots
- Division of Trauma, Acute Care Surgery, and Surgical Critical Care, 6823Reading Hospital, West Reading, PA, USA
| | - Adrian Ong
- Division of Trauma, Acute Care Surgery, and Surgical Critical Care, 6823Reading Hospital, West Reading, PA, USA
| | - Christopher A Butts
- Division of Trauma, Acute Care Surgery, and Surgical Critical Care, 6823Reading Hospital, West Reading, PA, USA
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13
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Yoo R, Gaziano MD, Cortes V, Chauhan N, Bamberger PK, Reilly EF, Geng T, Butts CA, Ong A. Distal Pancreatic Necrosis After Splenic Angioembolization. Am Surg 2023:31348231157839. [PMID: 36803024 DOI: 10.1177/00031348231157839] [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: 02/19/2023]
Abstract
Pancreatic ischemia with necrosis is an extremely rare complication of splenic angioembolization (SAE). A 48-year-old male with a grade IV blunt splenic injury underwent angiography which demonstrated no active bleeding or pseudoaneurysm. Proximal SAE was performed. One week later, he developed severe sepsis. Repeat CT imaging showed nonperfusion of the distal pancreas, and laparotomy found necrosis of approximately 40% of the pancreas. Distal pancreatectomy and splenectomy were performed. He endured a prolonged hospital course with multiple complications. Clinicians should have a high index of suspicion for ischemic complications after SAE when sepsis develops.
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Affiliation(s)
- Rachel Yoo
- Department of Surgery, Division of Acute Care Surgery/Trauma, Reading Hospital, 419713Tower Health System, Reading, PA, USA
| | | | - Vicente Cortes
- Department of Surgery, Division of Acute Care Surgery/Trauma, Reading Hospital, 419713Tower Health System, Reading, PA, USA
| | - Nikunj Chauhan
- Department of Interventional Radiology, Reading Hospital, 419713Tower Health System, Reading, PA, USA
| | - Peter K Bamberger
- Department of Surgery, Division of Acute Care Surgery/Trauma, Reading Hospital, 419713Tower Health System, Reading, PA, USA
| | - Eugene F Reilly
- Department of Surgery, Division of Acute Care Surgery/Trauma, Reading Hospital, 419713Tower Health System, Reading, PA, USA
| | - Thomas Geng
- Department of Surgery, Division of Acute Care Surgery/Trauma, Reading Hospital, 419713Tower Health System, Reading, PA, USA
| | - Christopher A Butts
- Department of Surgery, Division of Acute Care Surgery/Trauma, Reading Hospital, 419713Tower Health System, Reading, PA, USA
| | - Adrian Ong
- Department of Surgery, Division of Acute Care Surgery/Trauma, Reading Hospital, 419713Tower Health System, Reading, PA, USA
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14
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Yoo R, Evanson D, Gaziano M, Muller A, Martin A, Chauhan N, Butts CA, Cortes V, Reilly EF, Bamberger PK, Geng T, Ong A. Negative Splenic Angiography in Blunt Trauma: Does Embolization Affect Splenic Salvage? Am Surg 2023:31348231157863. [PMID: 36794385 DOI: 10.1177/00031348231157863] [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: 02/17/2023]
Abstract
Angioembolization in blunt splenic trauma is used to maximize splenic preservation. Superiority of prophylactic embolization over expectant management in patients with a negative splenic angiography (SA) is debated. We hypothesized that embolization in negative SA would be associated with splenic salvage. Of 83 patients undergoing SA, 30 (36%) had a negative SA. Embolization was performed in 23 (77%). Grade of injury, contrast extravasation (CE) on computed tomography (CT) or embolization were not associated with splenectomy. In 20 patients with either a high-grade injury or CE on CT, 17 (85%) underwent embolization with a failure rate of 24%. In the remaining 10 without high-risk features, 6 underwent embolization with a 0% splenectomy rate. Despite embolization, the failure rate of nonoperative management (NOM) remains significant in those with high-grade injury or CE on CT. A low threshold for early splenectomy after prophylactic embolization is needed.
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Affiliation(s)
- Rachel Yoo
- Division of Acute Care Surgery/Trauma, Department of Surgery, 6823Reading Hospital, Reading, PA, USA; 419713Tower Health System, Reading, PA, USA
| | - Davin Evanson
- 12312Drexel University College of Medicine, Philadelphia, PA, USA
| | - Michael Gaziano
- 12312Drexel University College of Medicine, Philadelphia, PA, USA
| | - Alison Muller
- Division of Acute Care Surgery/Trauma, Department of Surgery, 6823Reading Hospital, Reading, PA, USA; 419713Tower Health System, Reading, PA, USA
| | - Anthony Martin
- Division of Acute Care Surgery/Trauma, Department of Surgery, 6823Reading Hospital, Reading, PA, USA; 419713Tower Health System, Reading, PA, USA
| | - Nikunj Chauhan
- Department of Interventional Radiology, 6823Reading Hospital, Reading, PA, USA; 419713Tower Health System, Reading, PA, USA
| | - Christopher A Butts
- Division of Acute Care Surgery/Trauma, Department of Surgery, 6823Reading Hospital, Reading, PA, USA; 419713Tower Health System, Reading, PA, USA
| | - Vicente Cortes
- Division of Acute Care Surgery/Trauma, Department of Surgery, 6823Reading Hospital, Reading, PA, USA; 419713Tower Health System, Reading, PA, USA
| | - Eugene F Reilly
- Division of Acute Care Surgery/Trauma, Department of Surgery, 6823Reading Hospital, Reading, PA, USA; 419713Tower Health System, Reading, PA, USA
| | - Peter K Bamberger
- Division of Acute Care Surgery/Trauma, Department of Surgery, 6823Reading Hospital, Reading, PA, USA; 419713Tower Health System, Reading, PA, USA
| | - Thomas Geng
- Division of Acute Care Surgery/Trauma, Department of Surgery, 6823Reading Hospital, Reading, PA, USA; 419713Tower Health System, Reading, PA, USA
| | - Adrian Ong
- Division of Acute Care Surgery/Trauma, Department of Surgery, 6823Reading Hospital, Reading, PA, USA; 419713Tower Health System, Reading, PA, USA
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15
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Ripa F, Ong A, Massella V, Johnston M, Pietropaolo A, Somani B. Role of ureteroscopy and stone treatment in management of recurrent UTIs: Prospective outcomes over a 10-year period. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)00193-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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16
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Ong A, Chedgy E. 895 Ensuring Quality Standard in the Introduction of a New Prostate Biopsy Service. Br J Surg 2022. [DOI: 10.1093/bjs/znac269.516] [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: 11/06/2022]
Abstract
Abstract
Aim
With the introduction of a fusion-guided prostate biopsy service at a university hospital, it was important to ensure that quality standards were being maintained. Cancer detection rates (CDR) of fusion-guided prostate biopsy were compared against the established precision point prostate biopsy service in the quality improvement project.
Method
Data was collected from patients undergoing precision point prostate biopsy between April - December 2020 to identify the quality standard. Data was collected for patients undergoing fusion-guided prostate biopsy at University Hospital Southampton between May - September 2021. Clinically significant cancer was defined according to Epstein criteria.
Results
The study included 514 precision point and 25 fusion-guided biopsies. 202 prostate cancers were identified from precision point biopsies setting a quality standard cancer detection rate of 39%, of which 88.6% were clinically significant. Fusion-guided biopsy detected 17 cancers giving a CDR of 68%, of which 32% were clinically significant.
Conclusions
This study demonstrated that fusion-guided prostate biopsy has a high cancer detection rate. However, more cancers were detected at earlier stages when compared with previous precision point biopsy. Further study is required to assess the long-term effects this will have on the cancer service.
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Affiliation(s)
- A Ong
- University Hospital Southampton , Southampton , United Kingdom
| | - E Chedgy
- University Hospital Southampton , Southampton , United Kingdom
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17
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Lee K, Le T, Lim R, Hanna G, Gee H, Vinod S, Dammak S, Palma D, Ong A, Yeghiaian-Alvandi R, Buck J, Hau E. PO-1276 A review into the radiological features predicting local recurrence post-SABR in patients with NSCLC. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)03240-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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18
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McCarley S, Yu B, Guay R, Ong A, Sacks D, Butts CA. Percutaneous Retrieval of Retained Gallstones. Am Surg 2022:31348221084944. [PMID: 35333657 DOI: 10.1177/00031348221084944] [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: 11/15/2022]
Abstract
Laparoscopic cholecystectomy has become the gold standard for patients with gallbladder disease. However, spilled gallstones occur in up to 18% of laparoscopic cholecystectomies, which may result in retained gallstones. Though most do not cause issues, there may be abscess formation from 4 months to 10 years postoperatively. We present a 78-year-old patient who formed a subhepatic abscess 3 months postoperatively from his laparoscopic cholecystectomy secondary to a 1 cm retained gallstone. The abscess was percutaneously drained by interventional radiology (IR), and the stone was subsequently removed by IR using a percutaneous approach. Open and laparoscopic approaches have been previously described for abscess drainage and removal of gallstones. In this case, both the abscess and stone were drained and removed percutaneously by IR. Though this is an uncommon entity, percutaneous decompression can aid in preventing such patients from undergoing additional surgery.
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Affiliation(s)
- Saudia McCarley
- Department of Surgery, 6823Reading Hospital-Tower Health, West Reading, PA, USA
| | - Bernice Yu
- Department of Surgery, 6823Reading Hospital-Tower Health, West Reading, PA, USA
| | - Robert Guay
- Department of Interventional Radiology, 6823Reading Hospital-Tower Health, West Reading, PA, USA
| | - Adrian Ong
- Division of Trauma, Acute Care Surgery, and Surgical Critical Care, Department of Surgery, 6823Reading Hospital-Tower Health, West Reading, PA, USA
| | - David Sacks
- Department of Interventional Radiology, 6823Reading Hospital-Tower Health, West Reading, PA, USA
| | - Christopher A Butts
- Division of Trauma, Acute Care Surgery, and Surgical Critical Care, Department of Surgery, 6823Reading Hospital-Tower Health, West Reading, PA, USA
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19
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Wan R, Docherty C, Bhatti H, Shin H, Spector C, Thai B, Muller A, Martin A, Gile K, Liu A, Ong A, Chen H. TRACHEOSTOMY DISLODGEMENT: ARE OBESE PATIENTS AT INCREASED LONG -TERM RISK? Am J Surg 2022; 223:569-570. [DOI: 10.1016/j.amjsurg.2022.02.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
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20
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Sigal AP, Deaner T, Woods S, Mannarelli E, Muller AL, Martin A, Schoener A, Brower M, Ong A, Geng T, Guillen F, Lahmann B, Wasser T, Valente C. External validation of a pediatric decision rule for blunt abdominal trauma. J Am Coll Emerg Physicians Open 2022; 3:e12623. [PMID: 35072160 PMCID: PMC8760953 DOI: 10.1002/emp2.12623] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 11/04/2021] [Accepted: 11/23/2021] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Blunt traumatic injuries are a leading cause of morbidity and mortality in the pediatric population. Contrast-enhanced multidetector computed tomography is the best imaging tool for screening patients at risk of blunt abdominal injury. The Pediatric Emergency Care Applied Research Network (PECARN) abdominal rule was derived to identify patients at low risk for significant abdominal injury who do not require imaging. METHODS We conducted a retrospective review of pediatric patients with blunt trauma to validate the PECARN rule in a non-pediatric specialized hospital from February 3, 2013, through December 31, 2019. We excluded those with penetrating or mild isolated head injury. The PECARN decision rule was retrospectively applied for the presence of a therapeutic intervention, defined as a laparotomy, angiographic embolization, blood transfusion, or administration of intravenous fluids for pancreatic or gastrointestinal injury. Sensitivity and specificity analysis were conducted along with the negative and positive predictive values. RESULTS A total of 794 patients were included in the final analysis; 23 patients met the primary outcome for an acute intervention. The PECARN clinical decision rule (CDR) had a sensitivity of 91.3%, a negative predictive value of 99.5, and a negative likelihood ration of 0.16. CONCLUSION In a non-pediatric specialty hospital, the PECARN blunt abdominal CDR performed with comparable sensitivity and negative predictive value to the derivation and external validation study performed at specialized children's hospitals.
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Affiliation(s)
- Adam P. Sigal
- Department of Emergency MedicineReading HospitalWest ReadingPennsylvaniaUSA
| | - Traci Deaner
- Department of Emergency MedicineReading HospitalWest ReadingPennsylvaniaUSA
| | - Sam Woods
- Department of Emergency MedicineReading HospitalWest ReadingPennsylvaniaUSA
| | | | - Alison L. Muller
- Department of SurgerySection of Trauma and Critical CareReading HospitalWest ReadingPennsylvaniaUSA
| | - Anthony Martin
- Department of SurgerySection of Trauma and Critical CareReading HospitalWest ReadingPennsylvaniaUSA
| | | | | | - Adrian Ong
- Department of SurgerySection of Trauma and Critical CareReading HospitalWest ReadingPennsylvaniaUSA
| | - Thomas Geng
- Department of SurgerySection of Trauma and Critical CareReading HospitalWest ReadingPennsylvaniaUSA
| | - Felipe Guillen
- Drexel University College of MedicinePhiladelphiaPennsylvaniaUSA
| | - Brian Lahmann
- Department of Emergency MedicineReading HospitalWest ReadingPennsylvaniaUSA
| | - Tom Wasser
- Department of Emergency MedicineReading HospitalWest ReadingPennsylvaniaUSA
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21
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Heidorn EF, Cortes V, Ong A. Severe Thoracic Vertebral Spine Injury as a Complication of Component of Cardiopulmonary Resuscitation. Am Surg 2022; 88:986-988. [PMID: 34979812 DOI: 10.1177/00031348211058619] [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: 11/15/2022]
Abstract
Chest compression has been a component of cardiopulmonary resuscitation (CPR) since 1960. Performance of high-quality CPR is critical for survival; however, chest compressions are traumatic and may result in injuries such as rib and sternal fractures. Spinal fractures have rarely been reported. We present a case of a 69-year-old male who suffered a cardiac arrest at home. He underwent 16 minutes of CPR with manual chest compressions, and no electrical shock and medications with return of spontaneous circulation (ROSC). Computed tomography scan showed unstable fracture of T9-T10. The patient was transferred to our Level I trauma center for continued post-arrest management and neurosurgical evaluation. An MRI confirmed the unstable spinal fracture which would have required surgical stabilization. The patient remained comatose, thus he was transitioned to comfort measures and expired. Spinal injuries following CPR are rare but should be considered in the post-arrest management stage. Computed tomography scan is the ideal screening modality.
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Affiliation(s)
- Elise F. Heidorn
- Department of Surgery, Tower Health, Reading, West Reading, PA, USA
| | - Vicente Cortes
- Department of Surgery, Tower Health, Reading, West Reading, PA, USA
| | - Adrian Ong
- Department of Surgery, Tower Health, Reading, West Reading, PA, USA
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22
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Williamson SL, Suresh A, Ong A. Spontaneous Intramural Small Bowel Hematoma in an Elderly Man with Multiple Myeloma. Am Surg 2021:31348211054541. [PMID: 34779258 DOI: 10.1177/00031348211054541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Sigrid L Williamson
- Department of Surgery, 419713Tower Health System, Reading, PA, USA.,Department of Surgery, 6823Reading Hospital, Reading, PA, USA
| | - Aishwarya Suresh
- 12312Drexel University College of Medicine, Philadelphia, PA, USA
| | - Adrian Ong
- Department of Surgery, 6823Reading Hospital, Reading, PA, USA
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23
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Wong R, Iyer P, Ong A, Bhattacharyya R, Looi W, Seng M, Chan M, Vijayakumari K, Pham T, Leung W, Tan A. Total Lymphatic Irradiation as Part of Conditioning in Pediatric Hematopoietic Stem Cell Transplantation: A Single Institution Experience From a Radiation Oncology Perspective. Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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24
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Butler S, Dimovitz C, Muller A, Daramola T, Becirovic S, Mancano L, Ong A. Documentation of Cognitive Rest After Concussion by Pediatric Primary Care Providers. J Nurse Pract 2021. [DOI: 10.1016/j.nurpra.2021.06.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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25
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Ong A, Williams F, Tokarz E, Shokri T, Hammer D, Ducic Y. Jaw in a Day: Immediate Dental Rehabilitation during Fibula Reconstruction of the Mandible. Facial Plast Surg 2021; 37:722-727. [PMID: 34380165 DOI: 10.1055/s-0041-1732478] [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: 10/20/2022] Open
Abstract
Reconstructing mandibular defects presents challenges to dental rehabilitation related to altered bone and soft tissue anatomy. Dental implants are the most reliable method to restore the lost dentition. Immediate dental implants have been placed for many years but with unacceptably low rates of dental/prosthetic success. Current virtual technology allows placement of both fibulas and guided implants in restoratively driven positions that also allow immediate dental rehabilitation. Inexpensive three-dimensional printing platforms can create provisional dental prostheses placed at the time of surgery. This article reviews our digital and surgical workflow to create an immediate dental prosthesis to predictably restore the dentition during major jaw reconstruction with fibula free flaps.
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Affiliation(s)
- Adrian Ong
- Otolaryngology and Facial Plastic Surgery Associates, Facial Plastic Surgery, Fort Worth, Texas
| | - Fayette Williams
- Department of Oral and Maxillofacial Surgery, John Peter Smith Health Network, Fort Worth, Texas
| | - Ellen Tokarz
- Department of Otolaryngology Head and Neck Surgery, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York
| | - Tom Shokri
- Department of Otolaryngology, Baylor All Saints Medical Center at Fort Worth, Fort Worth, Texas
| | - Daniel Hammer
- Department of Oral and Maxillofacial Surgery, Naval Medical Center San Diego, San Diego, California
| | - Yadranko Ducic
- Otolaryngology and Facial Plastic Surgery Associates, Facial Plastic Surgery, Fort Worth, Texas
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26
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Anderson SR, Pak KY, Vincent AG, Ong A, Ducic Y. Reconstruction of the Mandibular Condyle. Facial Plast Surg 2021; 37:728-734. [PMID: 33878796 DOI: 10.1055/s-0041-1726444] [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: 10/21/2022] Open
Abstract
The mandibular condyle is an integral structure in the temporomandibular joint (TMJ) serving not only as the hinge point for mandibular opening, but also facilitating mandibular growth and contributing to facial aesthetics. Significant compromise of the TMJ can be debilitating functionally, psychologically, and aesthetically. Reconstruction of the mandibular condyle is rarely straightforward. Multiple considerations must be accounted for when preparing for condylar reconstruction such as ensuring eradication of all chronically diseased or infected bone, proving clear oncologic margins following tumor resection, or achieving stability of the surrounding architecture in the setting of a traumatic injury. Today, there is not one single gold-standard reconstructive method or material; ongoing investigation and innovation continue to improve and transform condylar reconstruction. Herein, we review methods of condylar reconstruction focusing on autologous and alloplastic materials, surgical techniques, and recent technological advances.
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Affiliation(s)
- Spencer R Anderson
- Department of Plastic and Reconstructive Surgery, Wright State University Boonshoft School of Medicine, Dayton, Ohio
| | - Kaitlynne Y Pak
- Wright State University Boonshoft School of Medicine, Dayton, Ohio
| | | | - Adrian Ong
- Facial Plastic Surgery Associates, Fort Worth, Texas
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Barnsley J, Buckland G, Chan PE, Ong A, Ramos AS, Baxter M, Laskou F, Dennison EM, Cooper C, Patel HP. Pathophysiology and treatment of osteoporosis: challenges for clinical practice in older people. Aging Clin Exp Res 2021; 33:759-773. [PMID: 33742387 PMCID: PMC8084810 DOI: 10.1007/s40520-021-01817-y] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 02/13/2021] [Indexed: 12/12/2022]
Abstract
Osteoporosis, a common chronic metabolic bone disease is associated with considerable morbidity and mortality. As the prevalence of osteoporosis increases with age, a paralleled elevation in the rate of incident fragility fractures will be observed. This narrative review explores the origins of bone and considers physiological mechanisms involved in bone homeostasis relevant to management and treatment. Secondary causes of osteoporosis, as well as osteosarcopenia are discussed followed by an overview of the commonly used pharmacological treatments for osteoporosis in older people.
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Affiliation(s)
- J Barnsley
- Medicine for Older People, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - G Buckland
- Medicine for Older People, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - P E Chan
- Medicine for Older People, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - A Ong
- Medicine for Older People, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - A S Ramos
- Medicine for Older People, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - M Baxter
- Medicine for Older People, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - F Laskou
- MRC Lifecourse Epidemiology Centre, University of Southampton, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - E M Dennison
- MRC Lifecourse Epidemiology Centre, University of Southampton, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - C Cooper
- MRC Lifecourse Epidemiology Centre, University of Southampton, University Hospital Southampton NHS Foundation Trust, Southampton, UK
- University of Oxford, Oxford, UK
| | - Harnish P Patel
- Medicine for Older People, University Hospital Southampton NHS Foundation Trust, Southampton, UK.
- MRC Lifecourse Epidemiology Centre, University of Southampton, University Hospital Southampton NHS Foundation Trust, Southampton, UK.
- Academic Geriatric Medicine, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK.
- NIHR Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust and The University of Southampton, Southampton, UK.
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Abstract
With advanced head and neck ablative surgery comes the challenge to find an ideal reconstructive option that will optimize functional and aesthetic outcomes. Contemporary microvascular reconstructive surgery with free tissue transfer has become the standard for complex head and neck reconstruction. With continued refinements in surgical techniques, larger surgical volumes, and technological advancements, free flap success rates have exceeded 95%. Despite these high success rates, postoperative flap loss is a feared complication requiring the surgeon to be aware of potential options for successful salvage. The purpose of this article is to review free flap failure and ways to optimize surgical salvage in the scenario of flap compromise.
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Affiliation(s)
- Weitao Wang
- Otolaryngology and Facial Plastic Surgery Associates, Fort Worth, Texas
| | - Adrian Ong
- Department of Otolaryngology, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, New York
| | - Aurora G Vincent
- Otolaryngology and Facial Plastic Surgery Associates, Fort Worth, Texas
| | - Tom Shokri
- Otolaryngology and Facial Plastic Surgery Associates, Fort Worth, Texas
| | - Britney Scott
- Department of Otolaryngology - Head and Neck Surgery, Kettering Health Network, Dayton, Ohio
| | - Yadranko Ducic
- Otolaryngology and Facial Plastic Surgery Associates, Fort Worth, Texas
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Hashmi DL, Spector C, Ong A, Foster SM, Musso M, Moshkovsky F. A Rare Case of Total Rectal and Urethral Disruption After Blunt Trauma. Am Surg 2020; 87:149-151. [PMID: 32870027 DOI: 10.1177/0003134820943548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Danielle L Hashmi
- Department of Surgery, Philadelphia College of Osteopathic Medicine, Philadelphia, PA, USA
| | - Chelsea Spector
- Drexel University College of Medicine, Drexel University, Philadelphia, PA, USA
| | - Adrian Ong
- Department of Trauma and Critical Care, Tower Health-Reading Hospital, Reading, PA, USA
| | - Shannon M Foster
- Department of Trauma and Critical Care, Tower Health-Reading Hospital, Reading, PA, USA
| | - Michael Musso
- Department of Trauma and Critical Care, Tower Health-Reading Hospital, Reading, PA, USA
| | - Filip Moshkovsky
- Department of Trauma and Critical Care, Tower Health-Reading Hospital, Reading, PA, USA
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Wijaya RS, Read SA, Selvamani SP, Schibeci S, Azardaryany MK, Ong A, van der Poorten D, Lin R, Douglas MW, George J, Ahlenstiel G. Hepatitis C Virus (HCV) Eradication With Interferon-Free Direct-Acting Antiviral-Based Therapy Results in KLRG1+ HCV-Specific Memory Natural Killer Cells. J Infect Dis 2020; 223:1183-1195. [PMID: 32777077 DOI: 10.1093/infdis/jiaa492] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [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: 04/21/2020] [Accepted: 07/31/2020] [Indexed: 12/15/2022] Open
Abstract
Direct acting antiviral therapies rapidly clear chronic hepatitis C virus (HCV) infection and restore natural killer (NK) cell function. We investigated NK-cell memory formation following HCV clearance by examining NK-cell phenotype and responses from control and chronic HCV patients before and after therapy following sustained virologic response at 12 weeks post therapy (SVR12). NK-cell phenotype at SVR12 differed significantly from paired pretreatment samples, with an increase in maturation markers CD16, CD57, and KLRG1. HCV patients possessed stronger cytotoxic responses against HCV-infected cells as compared to healthy controls; a response that further increased following SVR12. The antigen-specific response was mediated by KLRG1+ NK cells, as demonstrated by increased degranulation and proliferation in response to HCV antigen only. Our data suggest that KLRG1+ HCV-specific memory NK cells develop following viral infection, providing insight into their role in HCV clearance and relevance with regard to vaccine design.
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Affiliation(s)
- Ratna S Wijaya
- Storr Liver Centre, The Westmead Institute for Medical Research, University of Sydney, Westmead, New South Wales, Australia.,Faculty of Medicine, Pelita Harapan University, Tangerang, Indonesia
| | - Scott A Read
- Storr Liver Centre, The Westmead Institute for Medical Research, University of Sydney, Westmead, New South Wales, Australia.,Blacktown Medical School, Western Sydney University, Blacktown, New South Wales, Australia.,Blacktown Hospital, Blacktown, New South Wales, Australia
| | - Sakthi P Selvamani
- Storr Liver Centre, The Westmead Institute for Medical Research, University of Sydney, Westmead, New South Wales, Australia
| | - Stephen Schibeci
- Storr Liver Centre, The Westmead Institute for Medical Research, University of Sydney, Westmead, New South Wales, Australia
| | - Mahmoud K Azardaryany
- Storr Liver Centre, The Westmead Institute for Medical Research, University of Sydney, Westmead, New South Wales, Australia
| | - Adrian Ong
- Blacktown Hospital, Blacktown, New South Wales, Australia
| | | | - Rita Lin
- Westmead Hospital, University of Sydney, New South Wales, Australia
| | - Mark W Douglas
- Storr Liver Centre, The Westmead Institute for Medical Research, University of Sydney, Westmead, New South Wales, Australia.,Westmead Hospital, University of Sydney, New South Wales, Australia.,Centre for Infectious Diseases and Microbiology, Marie Bashir Institute for Infectious Diseases and Biosecurity, University of Sydney at Westmead Hospital, Westmead, New South Wales, Australia
| | - Jacob George
- Storr Liver Centre, The Westmead Institute for Medical Research, University of Sydney, Westmead, New South Wales, Australia.,Westmead Hospital, University of Sydney, New South Wales, Australia
| | - Golo Ahlenstiel
- Storr Liver Centre, The Westmead Institute for Medical Research, University of Sydney, Westmead, New South Wales, Australia.,Blacktown Medical School, Western Sydney University, Blacktown, New South Wales, Australia.,Blacktown Hospital, Blacktown, New South Wales, Australia
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Kim JO, Hanumanthappa N, Chung YT, Beck J, Koul R, Bashir B, Cooke A, Dubey A, Butler J, Nashed M, Hunter W, Ong A. Does dissemination of guidelines alone increase the use of palliative single-fraction radiotherapy? Initial report of a longitudinal change management campaign at a provincial cancer program. Curr Oncol 2020; 27:190-197. [PMID: 32905177 PMCID: PMC7467795 DOI: 10.3747/co.27.6193] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Background Despite level 1 evidence demonstrating the equivalence of single-fraction radiotherapy (sfrt) and multiple-fraction radiotherapy (mfrt) for the palliation of painful bone metastases, sfrt remains underused. In 2015, to encourage the sustainable use of palliative radiation oncology resources, CancerCare Manitoba disseminated, to each radiation oncologist in Manitoba, guidelines from Choosing Wisely Canada (cwc) that recommend sfrt. We assessed whether dissemination of the guidelines influenced sfrt use in Manitoba in 2016, and we identified factors associated with mfrt. Methods All patients treated with palliative radiotherapy for bone metastasis in Manitoba from 1 January 2016 to 31 December 2016 were identified from the provincial radiotherapy database. Patient, treatment, and disease characteristics were extracted from the electronic medical record and tabulated by fractionation schedule. Univariable and multivariable logistic regression analyses were performed to identify risk factors associated with mfrt. Results In 2016, 807 patients (mean age: 70 years; range: 35-96 years) received palliative radiotherapy for bone metastasis, with 69% of the patients having uncomplicated bone metastasis. The most common primary malignancies were prostate (27.1%), lung (20.6%), and breast cancer (15.9%). In 62% of cases, mfrt was used-a proportion that was unchanged from 2015. On multivariable analysis, a gastrointestinal [odds ratio (or): 5.3] or lung primary (or: 3.3), complicated bone metastasis (or: 4.3), and treatment at a subsidiary site (or: 4.4) increased the odds of mfrt use. Conclusions Dissemination of cwc recommendations alone did not increase sfrt use by radiation oncologists in 2016. A more comprehensive knowledge translation effort is therefore warranted and is now underway to encourage increased uptake of sfrt in Manitoba.
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Affiliation(s)
- J O Kim
- Radiation Oncology, CancerCare Manitoba, Winnipeg
| | | | - Y T Chung
- Rady Faculty of Health Sciences, University of Manitoba, Winnipeg
| | - J Beck
- Medical Physics, CancerCare Manitoba, Winnipeg
| | - R Koul
- Radiation Oncology, CancerCare Manitoba, Winnipeg
| | - B Bashir
- Radiation Oncology, CancerCare Manitoba, Winnipeg
| | - A Cooke
- Radiation Oncology, CancerCare Manitoba, Winnipeg
| | - A Dubey
- Radiation Oncology, CancerCare Manitoba, Winnipeg
| | - J Butler
- Radiation Oncology, CancerCare Manitoba, Winnipeg
| | - M Nashed
- Radiation Oncology, CancerCare Manitoba, Winnipeg
| | - W Hunter
- Radiation Oncology, Western Manitoba Cancer Centre, Brandon, MB
| | - A Ong
- Radiation Oncology, CancerCare Manitoba, Winnipeg
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Magayr T, Streets A, Ong A. SAT-442 Identification of Exosome MicroRNAs as Novel Biomarkers for Rapid Disease Progression in Autosomal Dominant Polycystic Kidney Disease. Kidney Int Rep 2020. [DOI: 10.1016/j.ekir.2020.02.469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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De Silva K, Garikapati K, Ong A, Cooper M, Denniss A, Chow C. 478 Disparities in Time to Reperfusion in ST Elevation Myocardial Infarction (STEMI) at Extremes of Age. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Kazi S, Ong A, Denniss A, Chow C. 554 Smoking Rates Among Patients With First Presentation ST Elevation Myocardial Infarction (STEMI). Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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35
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Fernandez FB, Ong A, Martin AP, Schwab CW, Wasser T, Butts CA, McNicholas AR, Muller AL, Barbera CF, Trupp R, Sigal AP. Success Of An Expedited Emergency Department Triage Evaluation System For Geriatric Trauma Patients Not Meeting Trauma Activation Criteria. Open Access Emerg Med 2019; 11:241-247. [PMID: 31754315 PMCID: PMC6825467 DOI: 10.2147/oaem.s212617] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Accepted: 10/07/2019] [Indexed: 11/23/2022] Open
Abstract
Background Geriatric patients are at increased risk of injury following low-energy mechanisms and are less tolerant of injury. Current criteria for trauma team activation (TTA) often miss these injuries. We evaluated a novel triage process for an expedited Emergency Medicine Physician evaluation protocol (T3) for at-risk geriatric sub-populations not meeting trauma team activation (TTA) criteria. Methods Retrospective review of injured patients (≥65 years) from a Level II Trauma Center with an Injury Severity Score (ISS < 16), prior to (Pre-T3, Jan 2007-Oct 2009), and after (Post-T3, Jan 2010-Oct 2012), implementation of T3, as well as a contemporary period (CP, Jan 2013-Oct 2015). Demographics, physiologic variables, and timeliness of care were measured. Rates of ICU admission, operative procedures and lengths of stay and in-hospital mortality were compared for all periods. Logistic regression analysis determined variables independently associated with mortality. Results Post-T3, 49.2% of geriatric registry patients underwent T3 with a reduction in key time intervals. Median time to evaluation (42.1 mins vs 61.7 min, p<0.001), median time to CT (161.3 mins vs 212.9 mins, p<0.001) and EDLOS (364.6 mins vs 451.5 mins, p=0.023) were all reduced compared to non-expedited evaluations. There was no change in mortality after the implementation of the protocol. Conclusion The T3 protocol expedited patient evaluation of at-risk geriatric patients that would not otherwise meet TTA criteria. The new process met the goals of the American College of Surgeons Trauma Quality Improvement Program while conserving resources.
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Affiliation(s)
| | - Adrian Ong
- Trauma and Surgical Critical Care Reading Hospital, Reading, PA, USA
| | - Anthony P Martin
- Trauma and Surgical Critical Care Reading Hospital, Reading, PA, USA
| | - C William Schwab
- Trauma and Surgical Critical Care, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Tom Wasser
- Complete Statistical Services, Macungie, PA, USA
| | | | | | - Alison L Muller
- Trauma and Surgical Critical Care Reading Hospital, Reading, PA, USA
| | - Charles F Barbera
- Department of Emergency Medicine, Reading Hospital, Reading, PA, USA
| | - Rachael Trupp
- Department of Emergency Medicine, Reading Hospital, Reading, PA, USA
| | - Adam P Sigal
- Department of Emergency Medicine, Reading Hospital, Reading, PA, USA
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Durkie M, Chong J, Ong A. SAT-334 GENETIC TESTING OF FAMILIES WITH VERY EARLY ONSET POLYCYSTIC KIDNEY DISEASE REVEALS THE FUNCTIONAL SIGNIFICANCE OF HYPOMORPHIC VARIANTS. Kidney Int Rep 2019. [DOI: 10.1016/j.ekir.2019.05.380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Roy S, Loblaw A, Cheung P, Chu W, Chung HT, Vesprini D, Ong A, Chowdhury A, Panjwani D, Pang G, Korol R, Davidson M, Ravi A, McCurdy B, Helou J, Zhang L, Mamedov A, Deabreu A, Quon HC. Prostate-specific Antigen Bounce After Stereotactic Body Radiotherapy for Prostate Cancer: A Pooled Analysis of Four Prospective Trials. Clin Oncol (R Coll Radiol) 2019; 31:621-629. [PMID: 31126725 DOI: 10.1016/j.clon.2019.05.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 03/05/2019] [Accepted: 04/01/2019] [Indexed: 12/21/2022]
Abstract
AIMS We conducted a pooled analysis of four prospective stereotactic body radiotherapy (SBRT) trials of low- and intermediate-risk prostate cancer to evaluate the incidence of prostate-specific antigen (PSA) bounce and its correlation with the time-dose-fraction schedule. The correlation between bounce with PSA response at 4 years (nadir PSA < 0.4 ng/ml) and biochemical failure-free survival (BFFS) was also explored. MATERIALS AND METHODS The study included four treatment groups: 35 Gy/five fractions once per week (QW) (TG-1; n = 84); 40 Gy/five fractions QW (TG-2; n = 100); 40 Gy/five fractions every other day (TG-3; n = 73); and 26 Gy/two fractions QW (TG-4; n = 30). PSA bounce was defined as a rise in PSA by 0.2 ng/ml (nadir + 0.2) or 2 ng/ml (nadir + 2.0) above nadir followed by a decrease back to nadir. Patients with fewer than three follow-up PSA tests were excluded from the pooled analysis. RESULTS In total, 287 patients were included, with a median follow-up of 5.0 years. The pooled 5-year cumulative incidence of bounce by nadir + 2.0 was 8%. The 2-year cumulative incidences of PSA bounce by nadir + 0.2 were 28.9, 21, 19.6 and 16.7% (P = 0.12) and by nadir + 2.0 were 7.2, 8, 2.7 and 6.7% (P = 0.32) for TG-1 to TG-4, respectively. Multivariable analysis revealed that for nadir + 2.0, pre-treatment PSA (odds ratio 0.49; 95% confidence interval 0.26-0.97) correlated with PSA bounce. Although PSA bounce by nadir + 0.2 (odds ratio 0.10; 95% confidence interval 0.04-0.24) and nadir + 2.0 (odds ratio 0.29; 95% confidence interval 0.09-0.93) was associated with a lower probability of PSA response at 4 years, there was no association between bounce by nadir + 0.2 (hazard ratio 0.36; 95% confidence interval 0.08-1.74) or nadir + 2 (hazard ratio 1.77; 95% confidence interval 0.28-11.07) with BFFS. CONCLUSION The incidence of PSA bounce was independent of time-dose-fraction schedule for prostate SBRT. One in 13 patients experienced a bounce high enough to be misinterpreted as biochemical failure, and clinicians should avoid early salvage interventions in these patients. There was no association between PSA bounce and BFFS.
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Affiliation(s)
- S Roy
- Tom Baker Cancer Center, Department of Oncology, University of Calgary, Calgary, Canada
| | - A Loblaw
- Odette Cancer Center, Sunnybrook Health Sciences Center, University of Toronto, Toronto, Canada
| | - P Cheung
- Odette Cancer Center, Sunnybrook Health Sciences Center, University of Toronto, Toronto, Canada
| | - W Chu
- Odette Cancer Center, Sunnybrook Health Sciences Center, University of Toronto, Toronto, Canada
| | - H T Chung
- Odette Cancer Center, Sunnybrook Health Sciences Center, University of Toronto, Toronto, Canada
| | - D Vesprini
- Odette Cancer Center, Sunnybrook Health Sciences Center, University of Toronto, Toronto, Canada
| | - A Ong
- CancerCare Manitoba, University of Manitoba, Winnipeg, Canada
| | - A Chowdhury
- CancerCare Manitoba, University of Manitoba, Winnipeg, Canada
| | | | - G Pang
- Odette Cancer Center, Sunnybrook Health Sciences Center, University of Toronto, Toronto, Canada
| | - R Korol
- Odette Cancer Center, Sunnybrook Health Sciences Center, University of Toronto, Toronto, Canada
| | - M Davidson
- Odette Cancer Center, Sunnybrook Health Sciences Center, University of Toronto, Toronto, Canada
| | - A Ravi
- Odette Cancer Center, Sunnybrook Health Sciences Center, University of Toronto, Toronto, Canada
| | - B McCurdy
- CancerCare Manitoba, University of Manitoba, Winnipeg, Canada
| | - J Helou
- Princess Margaret Cancer Center, University of Toronto, Toronto, Canada
| | - L Zhang
- Odette Cancer Center, Sunnybrook Health Sciences Center, University of Toronto, Toronto, Canada
| | - A Mamedov
- Odette Cancer Center, Sunnybrook Health Sciences Center, University of Toronto, Toronto, Canada
| | - A Deabreu
- Odette Cancer Center, Sunnybrook Health Sciences Center, University of Toronto, Toronto, Canada
| | - H C Quon
- Tom Baker Cancer Center, Department of Oncology, University of Calgary, Calgary, Canada.
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Patel UA, Hernandez D, Shnayder Y, Wax MK, Hanasono MM, Hornig J, Ghanem TA, Old M, Jackson RS, Ledgerwood LG, Pipkorn P, Lin L, Ong A, Greene JB, Bekeny J, Yiu Y, Noureldine S, Li DX, Fontanarosa J, Greenbaum E, Richmon JD. Free Flap Reconstruction Monitoring Techniques and Frequency in the Era of Restricted Resident Work Hours. JAMA Otolaryngol Head Neck Surg 2019; 143:803-809. [PMID: 28570718 DOI: 10.1001/jamaoto.2017.0304] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Importance Free flap reconstruction of the head and neck is routinely performed with success rates around 94% to 99% at most institutions. Despite experience and meticulous technique, there is a small but recognized risk of partial or total flap loss in the postoperative setting. Historically, most microvascular surgeons involve resident house staff in flap monitoring protocols, and programs relied heavily on in-house resident physicians to assure timely intervention for compromised flaps. In 2003, the Accreditation Council for Graduate Medical Education mandated the reduction in the hours a resident could work within a given week. At many institutions this new era of restricted resident duty hours reshaped the protocols used for flap monitoring to adapt to a system with reduced resident labor. Objectives To characterize various techniques and frequencies of free flap monitoring by nurses and resident physicians; and to determine if adapted resident monitoring frequency is associated with flap compromise and outcome. Design, Setting, and Participants This multi-institutional retrospective review included patients undergoing free flap reconstruction to the head and/or neck between January 2005 and January 2015. Consecutive patients were included from different academic institutions or tertiary referral centers to reflect evolving practices. Main Outcomes and Measures Technique, frequency, and personnel for flap monitoring; flap complications; and flap success. Results Overall, 1085 patients (343 women [32%] and 742 men [78%]) from 9 institutions were included. Most patients were placed in the intensive care unit postoperatively (n = 790 [73%]), while the remaining were placed in intermediate care (n = 201 [19%]) or in the surgical ward (n = 94 [7%]). Nurses monitored flaps every hour (q1h) for all patients. Frequency of resident monitoring varied, with 635 patients monitored every 4 hours (q4h), 146 monitored every 8 hours (q8h), and 304 monitored every 12 hours (q12h). Monitoring techniques included physical examination (n = 949 [87%]), handheld external Doppler sonography (n = 739 [68%]), implanted Doppler sonography (n = 333 [31%]), and needle stick (n = 349 [32%]); 105 patients (10%) demonstrated flap compromise, prompting return to the operating room in 96 patients. Of these 96 patients, 46 had complete flap salvage, 22 had partial loss, and 37 had complete loss. The frequency of resident flap checks did not affect the total flap loss rate (q4h, 25 patients [4%]; q8h, 8 patients [6%]; and q12h, 8 patients [3%]). Flap salvage rates for compromised flaps were not statistically different. Conclusions and Relevance Academic centers rely primarily on q1h flap checks by intensive care unit nurses using physical examination and Doppler sonography. Reduced resident monitoring frequency did not alter flap salvage nor flap outcome. These findings suggest that institutions may successfully monitor free flaps with decreased resident burden.
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Affiliation(s)
- Urjeet A Patel
- Department of Otolaryngology-Head and Neck Surgery, Northwestern University, Chicago, Illinois
| | - David Hernandez
- Department of Otolaryngology-Head and Neck Surgery, Northwestern University, Chicago, Illinois
| | - Yelizaveta Shnayder
- Department of Otolaryngology-Head and Neck Surgery, University of Kansas, Kansas City
| | - Mark K Wax
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health Science University, Portland
| | - Matthew M Hanasono
- Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston
| | - Joshua Hornig
- Department of Otolaryngology-Head and Neck Surgery, Medical University South Carolina, Charleston
| | - Tamer A Ghanem
- Department of Otolaryngology-Head and Neck Surgery, Henry Ford Medical Group, Detroit, Michigan
| | - Matthew Old
- Department of Otolaryngology-Head and Neck Surgery, Ohio State University, Columbus
| | - Ryan S Jackson
- Department of Otolaryngology-Head and Neck Surgery, Washington University, St Louis, Missouri
| | - Levi G Ledgerwood
- Department of Otolaryngology-Head and Neck Surgery, University of Kansas, Kansas City
| | - Patrik Pipkorn
- Department of Otolaryngology-Head and Neck Surgery, Washington University, St Louis, Missouri
| | - Lawrence Lin
- Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston
| | - Adrian Ong
- Department of Otolaryngology-Head and Neck Surgery, Medical University South Carolina, Charleston
| | - Joshua B Greene
- Department of Otolaryngology-Head and Neck Surgery, Henry Ford Medical Group, Detroit, Michigan
| | - James Bekeny
- Department of Otolaryngology-Head and Neck Surgery, Ohio State University, Columbus
| | - Yin Yiu
- Department of Otolaryngology-Head and Neck Surgery, Ohio State University, Columbus
| | - Salem Noureldine
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Hospital, Baltimore, Maryland
| | - David X Li
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Hospital, Baltimore, Maryland
| | - Joel Fontanarosa
- Department of Otolaryngology-Head and Neck Surgery, Northwestern University, Chicago, Illinois
| | - Evan Greenbaum
- Department of Otolaryngology-Head and Neck Surgery, Northwestern University, Chicago, Illinois
| | - Jeremy D Richmon
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Hospital, Baltimore, Maryland
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Kazi S, Narayan A, Ong A, Denniss A, Tanous D, Sivagangabalan G, Chong J, Wynne D, Thakkar J, Kovoor P, Fahmy P, Chow C. Trends in Cardiovascular Risk Factors in STEMI Patients at an Urban Centre. Heart Lung Circ 2019. [DOI: 10.1016/j.hlc.2019.06.566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Almeida DM, Sin NL, Ong A. THE BENEFITS OF ENCOUNTERING STRESS: EXPLORING THE POSITIVE CORRELATES OF DAILY STRESS. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.2187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- D M Almeida
- Pennsylvania State University, University Park, Pennsylvania
| | - N L Sin
- University of British Columbia, Vancouver, British Columbia
| | - A Ong
- Cornell University, Ithaca, New York
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Malat J, Rivera L, Geng T, Powell D, Cortes V, Ong A. Fulminant Soft Tissue Infection with Intestinal Ischemia Associated with Staphylococcus lugdunensis. Am Surg 2018. [DOI: 10.1177/000313481808400931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Jaclyn Malat
- Department of Surgery Philadelphia College of Osteopathic Medicine Philadelphia, Pennsylvania
| | - Laura Rivera
- Department of Surgery Philadelphia College of Osteopathic Medicine Philadelphia, Pennsylvania
| | - Thomas Geng
- Department of Surgery Reading Hospital West Reading, Pennsylvania
| | - Debra Powell
- Department of Medicine Reading Hospital West Reading, Pennsylvania
| | - Vicente Cortes
- Department of Surgery Reading Hospital West Reading, Pennsylvania
| | - Adrian Ong
- Department of Surgery Reading Hospital West Reading, Pennsylvania
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Malat J, Rivera L, Geng T, Powell D, Cortes V, Ong A. Fulminant Soft Tissue Infection with Intestinal Ischemia Associated with Staphylococcus lugdunensis. Am Surg 2018; 84:e423-e425. [PMID: 30454522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
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Klepner S, Ong A, Martin A, Wasser T, Muller AL, Sigal A, Fernandez FB. Being Narrow Minded is Not Always Bad: Focusing on Emergent Interventions in Undertriage Initiatives Improves Mortality Prediction. Am Surg 2018. [DOI: 10.1177/000313481808400836] [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: 11/16/2022]
Abstract
The American College of Surgeons Committee on Trauma defines undertriage (UT) as any major trauma patient (injury severity score ≥ 16) not undergoing treatment at the highest level of trauma team activation. This methodology does not account for many important factors that may impact outcome. We performed a retrospective review of the Pennsylvania State Trauma Registry to determine the impact of treatment interventions on mortality. Patients were stratified by triage category as follows: UT, appropriate triage, and overtriage. Multiple prehospital (PH) and ED interventions were assessed. Increased mortality was observed in all triage groups in patients requiring intervention. A logistic regression analysis was performed to assess the independent effect of individual interventions on mortality for patients triaged to partial activation or consult. PH CPR (OR 66.13 [47.07–92.93]), ED CPR (OR 16.87 [8.82–32.27]), PH or ED intubation (OR 16.68 [13.90–20.03]), PH or ED packed red blood cell transfusion (OR 1.89 [1.54–2.33]), emergent operative intervention (OR 3.58 [3.07–4.19]), ED central venous access (OR 5.04 [2.31–10.97]) were all associated with worsening mortality. The American College of Surgeons Committee on Trauma methodology overestimates mortality risk when emergent interventions are not required and underestimates risk where such interventions are necessary. Future methodologies for assessing UT should include these interventions.
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Affiliation(s)
- Stephen Klepner
- Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania
| | - Adrian Ong
- Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania
- Department of Surgery, Section of Trauma, Acute Care Surgery, and Surgical Critical Care, Reading Hospital, West Reading, Pennsylvania
- Division of Trauma, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Anthony Martin
- Department of Surgery, Section of Trauma, Acute Care Surgery, and Surgical Critical Care, Reading Hospital, West Reading, Pennsylvania
| | - Tom Wasser
- Department of Surgery, Section of Trauma, Acute Care Surgery, and Surgical Critical Care, Reading Hospital, West Reading, Pennsylvania
| | - Alison L. Muller
- Department of Surgery, Section of Trauma, Acute Care Surgery, and Surgical Critical Care, Reading Hospital, West Reading, Pennsylvania
| | - Adam Sigal
- Department of Emergency Medicine, Reading Hospital, West Reading, Pennsylvania
| | - Forrest B. Fernandez
- Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania
- Department of Surgery, Section of Trauma, Acute Care Surgery, and Surgical Critical Care, Reading Hospital, West Reading, Pennsylvania
- Division of Trauma, University of Pennsylvania, Philadelphia, Pennsylvania
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Lund Laursen T, Brøckner Siggard C, Kazankov K, Damgaard Sandahl T, Møller HJ, Ong A, Douglas MW, George J, Tarp B, Hagelskjaer Kristensen L, Lund Laursen A, Hiramatsu A, Nakahara T, Chayama K, Grønbaek H. Rapid and persistent decline in soluble CD163 with successful direct-acting antiviral therapy and associations with chronic hepatitis C histology. Scand J Gastroenterol 2018; 53:986-993. [PMID: 29987961 DOI: 10.1080/00365521.2018.1481996] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND AIM Soluble CD 163 (sCD163) is released from activated liver macrophages in chronic viral hepatitis C (HCV) and serum levels reflect liver disease severity. The impact of direct-acting antiviral (DAA)-therapy on sCD163-levels and the ability of sCD163 to predict the presence of liver fibrosis remain unclear. In a combined observational and prospective study, we aimed to investigate changes in sCD163 with DAA-treatment, to investigate associations between sCD163 and histopathological activity and fibrosis and to validate the sCD163-based fibrosis score in HCV-patients. METHODS We examined three groups of patients: an Australian (n = 28) treated with pegylated-interferon and a first-generation DAA, a Danish (n = 38) treated with sofosbuvir-based DAA-regimens and a Japanese (n = 562) assessed for activity and fibrosis (Metavir scoring system) in liver biopsies. Serum sCD163-levels were quantified by ELISA. RESULTS Thirteen (46%) of the Australian patients achieved sustained virological response (SVR) and only these patients had significant decreases in sCD163-levels (2.7 (95%CI:1.9-3.6) vs. 4.1(2.9-5.7) mg L - 1, p = .008). In the Danish group, 37 (97%) patients achieved SVR at 12-weeks post-treatment with 32% reduction in sCD163-levels (5.0 (4.3-5.8) vs. 7.4 (6.3-8.7), p < .001). The decline was rapid and persisted 12 months after treatment cessation (p < .007). sCD163 levels increased in parallel with inflammatory activity and fibrosis (p < .001). The sCD163-based fibrosis score outperformed established fibrosis scores for significant fibrosis (areas under the receiver operating characteristics curves (AUROCs): 0.79 (0.75-0.83) vs. aspartate aminotransferase to platelet ratio index (APRI) 0.73 (0.69-0.77), Fibrosis-4 (FIB-4) 0.74 (0.70-0.78), p < .001). CONCLUSION sCD163-levels decline rapidly with successful DAA therapy and are associated with histological inflammatory activity and fibrosis, confirming a key role for macrophages in HCV inflammation and fibrosis and supporting sCD163 as a biomarker of treatment response.
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Affiliation(s)
- Tea Lund Laursen
- a Department of Hepatology & Gastroenterology , Aarhus University Hospital , Aarhus , Denmark
| | | | - Konstantin Kazankov
- a Department of Hepatology & Gastroenterology , Aarhus University Hospital , Aarhus , Denmark
| | - Thomas Damgaard Sandahl
- a Department of Hepatology & Gastroenterology , Aarhus University Hospital , Aarhus , Denmark
| | - Holger Jon Møller
- b Department of Clinical Biochemistry , Aarhus University Hospital , Aarhus , Denmark
| | - Adrian Ong
- c Storr Liver Centre , Westmead Institute for Medical Research, Westmead Hospital and University of Sydney , Sydney , Australia
| | - Mark W Douglas
- c Storr Liver Centre , Westmead Institute for Medical Research, Westmead Hospital and University of Sydney , Sydney , Australia
| | - Jacob George
- c Storr Liver Centre , Westmead Institute for Medical Research, Westmead Hospital and University of Sydney , Sydney , Australia
| | - Britta Tarp
- d Diagnostic Centre , Silkeborg Regional Hospital , Silkeborg , Denmark
| | | | - Alex Lund Laursen
- f Department of Infectious Diseases , Aarhus University Hospital , Aarhus , Denmark
| | - Akira Hiramatsu
- g Department of Gastroenterology and Metabolism , Institute of Biomedical and Health Sciences, Hiroshima University , Hiroshima , Japan
| | - Takashi Nakahara
- g Department of Gastroenterology and Metabolism , Institute of Biomedical and Health Sciences, Hiroshima University , Hiroshima , Japan
| | - Kazuaki Chayama
- g Department of Gastroenterology and Metabolism , Institute of Biomedical and Health Sciences, Hiroshima University , Hiroshima , Japan.,h Laboratory for Digestive Diseases , RIKEN Center for Integrative Medical Sciences , Hiroshima , Japan
| | - Henning Grønbaek
- a Department of Hepatology & Gastroenterology , Aarhus University Hospital , Aarhus , Denmark
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Klepner S, Ong A, Martin A, Wasser T, Muller AL, Sigal A, Fernandez FB. Being Narrow Minded Is Not Always Bad: Focusing on Emergent Interventions in Undertriage Initiatives Improves Mortality Prediction. Am Surg 2018; 84:1277-1283. [PMID: 30185300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The American College of Surgeons Committee on Trauma defines undertriage (UT) as any major trauma patient (injury severity score ≥ 16) not undergoing treatment at the highest level of trauma team activation. This methodology does not account for many important factors that may impact outcome. We performed a retrospective review of the Pennsylvania State Trauma Registry to determine the impact of treatment interventions on mortality. Patients were stratified by triage category as follows: UT, appropriate triage, and overtriage. Multiple prehospital (PH) and ED interventions were assessed. Increased mortality was observed in all triage groups in patients requiring intervention. A logistic regression analysis was performed to assess the independent effect of individual interventions on mortality for patients triaged to partial activation or consult. PH CPR (OR 66.13 [47.07-92.93]), ED CPR (OR 16.87 [8.82-32.27]), PH or ED intubation (OR 16.68 [13.90-20.03]), PH or ED packed red blood cell transfusion (OR 1.89 [1.54-2.33]), emergent operative intervention (OR 3.58 [3.07-4.19]), ED central venous access (OR 5.04 [2.31-10.97]) were all associated with worsening mortality. The American College of Surgeons Committee on Trauma methodology overestimates mortality risk when emergent interventions are not required and underestimates risk where such interventions are necessary. Future methodologies for assessing UT should include these interventions.
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46
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Ada C, Ong A. Comparing Patterns of Intravascular Ultrasound and Optical Coherence Tomography Daily Use in Practice. Heart Lung Circ 2018. [DOI: 10.1016/j.hlc.2018.06.1017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Burgess S, Bing R, Zhao J, Papapostolou S, Chan W, Juergens C, Ong A, Kurup R, Ng M, Kritharides L, Lo S, Yong A. A Rapidly Applicable Simplified SYNTAX Score Retains High Sensitivity and Specificity in Complex Coronary Artery Disease: A Multicentre Study. Heart Lung Circ 2018. [DOI: 10.1016/j.hlc.2018.06.878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Sigal A, Martin A, Ong A. Availability and use of hemostatic agents in prehospital trauma patients in Pennsylvania translation from the military to the civilian setting. Open Access Emerg Med 2017; 9:47-52. [PMID: 28740438 PMCID: PMC5505603 DOI: 10.2147/oaem.s134657] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To understand the translation of one innovation in trauma care from the military to the civilian setting, the adoption of topical hemostatic agents in the Emergency Medical Services (EMS) community and in Trauma Centers in Pennsylvania. METHOD We utilized an anonymous electronic survey of EMS Agency Administrative Officers and Trauma Center Coordinators. RESULTS We received responses from 23% (93/402) Advanced Life Support and Air Medical agencies in the State. Of the EMS agencies that responded, 46.6% (61/131) stock hemostatic products, with 55.5% (44/79) carrying QuickClot® Combat Gauze®. Of the agencies that carried hemostatic products, 50% utilized them at least once in the prior 6 months and 59% over the past 12 months. Despite the infrequent number of applications, prehospital providers ranked themselves as somewhat skilled and comfortable both with the application of the products and the indications for their use. CONCLUSION Our survey found that 46.6% of the respondents indicated they carry hemostatic products, a much greater number than found on prior surveys of EMS agencies. There is a steady acceptance by EMS of new innovations in trauma care although more work is needed in translating the exact role of hemostatic agents in the civilian setting.
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Affiliation(s)
| | | | - Adrian Ong
- Department of Surgery, Trauma Section, The Reading Hospital, West Reading, PA, USA
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Abstract
Objectives To determine the diagnostic value of HRAS, KRAS, and NRAS mutations in fine-needle aspiration biopsies of thyroid nodules that are nondiagnostic on cytology. Data Sources PubMed, Scopus, Embase, CINAHL. Review Methods Two authors independently searched the data sources. To be included, studies reported the RAS mutational status and postoperative histopathologic diagnosis of nodules that exhibited indeterminate cytology after fine-needle aspiration biopsy. Data were extracted to calculate sensitivity, specificity, and positive/negative predictive values of any HRAS, KRAS, or NRAS mutation. A meta-analysis was performed to generate pooled values for each parameter. Results A total of 7 studies with a combined 1025 patients met inclusion criteria. The pooled sensitivity of a RAS mutation for detecting cancer was 0.343 (95% confidence interval [95% CI], 0.198-0.506), while the pooled specificity was 0.935 (95% CI, 0.882-0.973). The weighted averages for positive predictive value and negative predictive value were 78.0% and 64.0%, respectively, with 68.0% accuracy. The positive likelihood ratio was 4.235 (95% CI, 1.506-11.910), and the negative likelihood ratio was 0.775 (95% CI, 0.630-0.953). Conclusion Our data suggest that testing for any RAS mutation is unlikely to change the clinical management of thyroid nodules that have indeterminate cytology. While a RAS mutation may rule in malignancy, the sensitivity of testing is low enough to merit further mutational analysis, repeat fine-needle aspiration, or surgical excision, even in the presence of a negative test.
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Affiliation(s)
- William Clinkscales
- 1 Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Adrian Ong
- 1 Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Shaun Nguyen
- 1 Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Elizabeth Emily Harruff
- 1 Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Marion Boyd Gillespie
- 1 Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
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Trivedi S, Cooper M, Ong A, Tanous D, Changsiri B, Burgess D, Denniss R. Very Low Incidence of Ischaemic Stroke Associated with Thrombus Aspiration in a Large Series of STEMI Patients Treated with Primary PCI. Heart Lung Circ 2017. [DOI: 10.1016/j.hlc.2017.06.133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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