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Korvink M, Hung CW, Wong PK, Martin J, Halawi MJ. Development of a Novel Prospective Model to Predict Unplanned 90-Day Readmissions After Total Hip Arthroplasty. J Arthroplasty 2023; 38:124-128. [PMID: 35931268 DOI: 10.1016/j.arth.2022.07.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 07/18/2022] [Accepted: 07/20/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND For hospitals participating in bundled payment programs, unplanned readmissions after surgery are often termed "bundle busters." The aim of this study was to develop the framework for a prospective model to predict 90-day unplanned readmissions after elective primary total hip arthroplasty (THA) at a macroscopic hospital-based level. METHODS A national, all-payer, inpatient claims and cost accounting database was used. A mixed-effect logistic regression model measuring the association of unplanned 90-day readmissions with a number of patient-level and hospital-level characteristics was constructed. RESULTS Using 427,809 unique inpatient THA encounters, 77 significant risk factors across 5 domains (ie, comorbidities, demographics, surgical history, active medications, and intraoperative factors) were identified. The highest frequency domain was comorbidities (64/100) with malignancies (odds ratio [OR] 2.26), disorders of the respiratory system (OR 1.75), epilepsy (OR 1.5), and psychotic disorders (OR 1.5), being the most predictive. Other notable risk factors identified by the model were the use of opioid analgesics (OR 7.3), Medicaid coverage (OR 1.8), antidepressants (OR 1.6), and blood-related medications (OR 1.6). The model produced an area under the curve of 0.715. CONCLUSION We developed a novel model to predict unplanned 90-day readmissions after elective primary THA. Fifteen percent of the risk factors are potentially modifiable such as use of tranexamic acid, spinal anesthesia, and opioid medications. Given the complexity of the factors involved, hospital systems with vested interest should consider incorporating some of the findings from this study in the form of electronic medical records predictive analytics tools to offer clinicians with real-time actionable data.
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Affiliation(s)
| | - Chun Wai Hung
- Department of Orthopedic Surgery, Baylor College of Medicine, Houston, Texas
| | - Peter K Wong
- Department of Performance & Organizational Excellence, St. Luke's Health, CHI Texas Division, Houston, Texas
| | - John Martin
- ITS Data Science, Premier, Inc, Charlotte, North Carolina
| | - Mohamad J Halawi
- Department of Orthopedic Surgery, Baylor College of Medicine, Houston, Texas
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Matsumoto H, Boby AZ, Sinha R, Campbell ML, Hung CW, Gbolo FC, Marciano GF, Levine S, Fano AN, Simhon ME, Quan T, Bainton NM, George A, Mizerik AS, Roye BD, Roye DP, Vitale MG. Development and Validation of a Health-Related Quality-of-Life Measure in Older Children and Adolescents with Early-Onset Scoliosis: Early-Onset Scoliosis Self-Report Questionnaire (EOSQ-SELF). J Bone Joint Surg Am 2022; 104:1393-1405. [PMID: 35726883 DOI: 10.2106/jbjs.21.01508] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The 24-question Early-Onset Scoliosis Questionnaire (EOSQ-24) is a proxy measure assessing health-related quality of life (HRQoL) among patients with early-onset scoliosis (EOS). There exists an increasing need to assess HRQoL through a child's own perspective, particularly for older children and adolescents with EOS. The purpose of this study was to develop and validate a self-reported questionnaire, the Early-Onset Scoliosis Self-Report Questionnaire (EOSQ-SELF), to assess HRQoL in older children and adolescents with EOS. METHODS A literature review, an expert focus group, and patient interviews were used to generate a preliminary survey of appropriate domains and question items. This survey was provided to English-speaking patients with EOS who were 8 to 18 years of age and capable of answering survey questions. Content validity was assessed for clarity and relevance of questions. Confirmatory factors analysis was performed to reduce the number of items and determine domains that fit items. Reliability was evaluated by measuring the internal consistency of items and test-retest reliability. Construct validity was evaluated by convergent, discriminant, and known-group validity. RESULTS The literature review, expert focus group, and patient interviews identified 59 questions in 14 domains. Psychometric analysis reduced these to 30 questions across 12 domains: General Health, Pain/Discomfort, Pulmonary Function, Transfer, Physical Function/Daily Living, Participation, Fatigue/Energy Level, Sleep, Appearance, Relationships, Emotion, and Satisfaction. The final questionnaire was found to have good content and construct validity and adequate reliability. CONCLUSIONS The EOSQ-SELF is a valid and reliable instrument for measuring self-reported HRQoL among older children and adolescents with EOS (ages 8 to 18 years). This will serve as an important research outcome measure and enhance clinical care by providing a better understanding of HRQoL for these patients. LEVEL OF EVIDENCE Diagnostic Level II . See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Hiroko Matsumoto
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, NY.,Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY
| | - Afrain Z Boby
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, NY
| | - Rishi Sinha
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, NY
| | - Megan L Campbell
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, Utah
| | - Chun Wai Hung
- Department of Orthopedic Surgery, Baylor College of Medicine, Houston, Texas
| | - Fay C Gbolo
- Center for Liver Disease and Transplantation, Department of Surgery, Columbia University Irving Medical Center, New York, NY
| | - Gerard F Marciano
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, NY
| | - Sonya Levine
- Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania
| | - Adam N Fano
- Rutgers New Jersey Medical School, Newark, New Jersey
| | - Matthew E Simhon
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, NY
| | - Theodore Quan
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, NY
| | - Nicole M Bainton
- Division of Pediatric Orthopaedic Surgery, New York-Presbyterian Morgan Stanley Children's Hospital, Columbia University Irving Medical Center, New York, NY
| | - Ameeka George
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, NY
| | - Amber S Mizerik
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, NY
| | - Benjamin D Roye
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, NY.,Division of Pediatric Orthopaedic Surgery, New York-Presbyterian Morgan Stanley Children's Hospital, Columbia University Irving Medical Center, New York, NY
| | - David P Roye
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, NY
| | - Michael G Vitale
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, NY.,Division of Pediatric Orthopaedic Surgery, New York-Presbyterian Morgan Stanley Children's Hospital, Columbia University Irving Medical Center, New York, NY
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Hung CW, Zhang TS, Harrington MA, Halawi MJ. Incidence and risk factors for acute kidney injury after total joint arthroplasty. Arthroplasty 2022; 4:18. [PMID: 35501928 PMCID: PMC9063071 DOI: 10.1186/s42836-022-00120-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 03/13/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Acute kidney injury (AKI) is one of the most common medical causes for readmission following total joint arthroplasty (TJA). This study aimed to (1) examine whether the incidence of AKI has changed over the past decade with the adoption of modern perioperative care pathways and (2) identify the risk factors and concomitant adverse events (AEs) associated with AKI. METHODS 535,291 primary TJA procedures from the American College of Surgeons National Surgical Quality Improvement Program from 2011 to 2018 were retrospectively reviewed. The annual incidence of AKI was analyzed for significant changes over time. Matched cohort analyses were performed to identify the risk factors and AEs associated with AKI using multivariate logistic regression. RESULTS The mean incidence of AKI was 0.051%, which remained unchanged during the study period (P = 0.121). Factors associated with AKI were diabetes (OR 1.96, P = 0.009), bilateral procedure (OR 6.93, P = 0.030), lower preoperative hematocrit level (OR 1.09, P = 0.015), body mass index (OR 1.04, P = 0.025), and higher preoperative BUN (OR 1.03, P = 0.043). AKI was associated with length of stay (LOS) > 2 days (OR 4.73, P < 0.001), non-home discharge (OR 0.25, P < 0.001), 30-day readmission (OR 12.29, P < 0.001), and mortality (OR 130.7, P < 0.001). CONCLUSIONS The incidence of AKI has not changed over the past decade, and it remains a major bundle buster resulting in greater LOS, non-home discharge, readmissions, and mortality. Avoidance of bilateral TJA in patients with DM and high BMI as well as preoperative optimization of anemia and BUN levels are advised.
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Affiliation(s)
- Chun Wai Hung
- Department of Orthopedic Surgery, Baylor College of Medicine, Houston, TX, USA
| | | | - Melvyn A Harrington
- Department of Orthopedic Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Mohamad J Halawi
- Department of Orthopedic Surgery, Baylor College of Medicine, Houston, TX, USA.
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Hung CW, Riggan ND, Hunt TR, Halawi MJ. What's Important: A Rallying Call for Nonsteroidal Anti-Inflammatory Drugs in Musculoskeletal Pain: Improving Value of Care While Combating the Opioid Epidemic. J Bone Joint Surg Am 2022; 104:659-663. [PMID: 34437306 DOI: 10.2106/jbjs.21.00466] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Chun Wai Hung
- Department of Orthopaedic Surgery, Baylor College of Medicine, Houston, Texas
| | | | - Thomas R Hunt
- Department of Orthopaedic Surgery, Baylor College of Medicine, Houston, Texas
| | - Mohamad J Halawi
- Department of Orthopaedic Surgery, Baylor College of Medicine, Houston, Texas
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5
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Matsumoto H, Auran E, Fields MW, Hung CW, Hilaire TS, Roye B, Sturm P, Garg S, Sanders J, Oetgen M, Levine S, Roye D, Vitale M. Serial casting for early onset scoliosis and its effects on health-related quality of life during and after discontinuation of treatment. Spine Deform 2020; 8:1361-1367. [PMID: 32757176 DOI: 10.1007/s43390-020-00175-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 07/27/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Serial body casting plays an important role in the treatment of early onset scoliosis (EOS), serving as a safer method compared to surgical intervention. There is no published evidence documenting the impact of casting on health-related quality of life (HRQoL) of patients and their caregivers. The purpose of this study was to utilize the 24-Item Early Onset Scoliosis Questionnaire (EOSQ-24) to compare the HRQoL of patients with EOS and the burden of care for their caregivers before, during, and after treatment with Mehta casting. METHODS In this multicenter retrospective cohort study, two EOS databases were queried for patients with EOS who underwent serial casting from 2005 to 2016. Patients who had treatment prior to their initial cast application, including bracing or surgical intervention, were excluded from the study. Patients were stratified into two subgroups and analyzed separately: those with idiopathic etiology, and those with non-idiopathic etiology. HRQoL and burden of care were assessed using the EOSQ-24 completed before, during, and after cast treatment. RESULTS 91 patients were identified in this study (mean age at the index casting: 2.1 ± 1.2 years, mean age at final cast removal: 4.1 ± 1.3 years). 59 (64.8%) had EOS of idiopathic etiology, while 32 (35.2%) had EOS of non-idiopathic etiology, including 10 congenital, 6 neuromuscular, and 16 syndromic. Idiopathic patients and non-idiopathic patients experienced an improvement in the coronal deformity from 45° pre-cast to 26° post-cast, and from 59° pre-cast to 34° post-cast, respectively. Patients with idiopathic scoliosis experienced a decrease from baseline in nearly all EOSQ-24 sub-domain scores except for general health. Furthermore, even after the removal of the cast, patients with idiopathic etiology suffered residual negative effects of casting on emotion and transfer sub-domains. Among patients with non-idiopathic etiology, decreased scores from baseline were observed only in transfer and emotion sub-domains during the casting intervention. After brace removal, patients with non-idiopathic etiology had increased scores compared to their baseline scores in most sub-domains. DISCUSSION Serial body casting can prevent curve correction in patients with EOS. However, the psychosocial stresses secondary to this non-operative intervention can have significant negative impacts on HRQoL for both idiopathic and non-idiopathic patients during the course of treatment. Although non-idiopathic patients experience improved HRQoL following treatment, idiopathic patients do not seem to exhibit much improvement in HRQoL from baseline even years after the final cast removal.
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Affiliation(s)
- Hiroko Matsumoto
- Department of Orthopaedic Surgery, Columbia University Medical Center, 3959 Broadway, 8 North, New York, NY, 10032, USA.
| | - Emily Auran
- Department of Orthopaedic Surgery, Columbia University Medical Center, 3959 Broadway, 8 North, New York, NY, 10032, USA
| | - Michael W Fields
- Department of Orthopaedic Surgery, Columbia University Medical Center, 3959 Broadway, 8 North, New York, NY, 10032, USA
| | - Chun Wai Hung
- Baylor College of Medicine Medical Center, Houston, TX, USA
| | | | - Benjamin Roye
- Department of Orthopaedic Surgery, Columbia University Medical Center, 3959 Broadway, 8 North, New York, NY, 10032, USA
| | - Peter Sturm
- San Diego Center for Spinal Disorders, San Diego, CA, USA
| | - Sumeet Garg
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | | | | | - Sonya Levine
- Department of Orthopaedic Surgery, Columbia University Medical Center, 3959 Broadway, 8 North, New York, NY, 10032, USA
| | - David Roye
- Department of Orthopaedic Surgery, Columbia University Medical Center, 3959 Broadway, 8 North, New York, NY, 10032, USA
| | - Michael Vitale
- Department of Orthopaedic Surgery, Columbia University Medical Center, 3959 Broadway, 8 North, New York, NY, 10032, USA
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Hung CW, Matsumoto H, Ball JR, Plachta S, Dutkowsky JP, Kim H, Hyman JE, Riew KD, Roye DP. Symptomatic cervical spinal stenosis in spastic cerebral palsy. Dev Med Child Neurol 2020; 62:1147-1153. [PMID: 32639039 DOI: 10.1111/dmcn.14607] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 05/08/2020] [Accepted: 05/12/2020] [Indexed: 12/30/2022]
Abstract
AIM To describe the prevalence of symptomatic cervical spinal stenosis (CSS) in spastic cerebral palsy (CP) and associated characteristics. METHOD This cross-sectional study of adults (>18y) with CP (2006-2016) at a single institution compared the patient characteristics (demographics, comorbidities, surgical history, medications, Gross Motor Function Classification System [GMFCS] level, and CP type) of patients with and without CSS. RESULTS Of 424 patients (mean age 33y 4mo, SD 13y 6mo, range 18-78y; 225 females, 199 males), 32 patients (7.5%) had symptomatic CSS. GMFCS levels in the study cohort were distributed as follows: level I, 25%; level II, 25%; level III, 22%; level IV, 19%; level V, 9%. Twenty-five out of 32 (78.1%) patients had spastic CP, two (6.3%) had dystonic CP, and one (3.1%) had mixed characteristics. Individuals with CSS were older (mean age 54y 6mo, SD 10y 5mo vs mean age 31y 7mo, SD 12y 1mo, p<0.05) and had a higher body mass index (26.1, SD 4.8 vs 23.4, SD 6.2, p<0.05) than those without CSS. Presentations included upper-extremity symptoms (73%), ambulation decline (70%), neck pain (53%), and incontinence (30%). Common stenosis levels were C5-C6 (59%), C4-C5 (56%), and C6-C7 (53%). INTERPRETATION Symptomatic CSS was identified in 7.5% of this adult cohort during the 2006 to 2016 period. Diagnosis in CP is difficult due to impaired communication and pre-existing gait abnormalities and spasticity. Given the high prevalence of symptomatic CSS in adults, we propose developing screening guidelines. Physicians must maintain a high level of suspicion for CSS if patients present with changes in gait or spasticity.
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Affiliation(s)
- Chun Wai Hung
- Weinberg Family Cerebral Palsy Center, Columbia University Medical Center, New York, NY, USA.,Department of Orthopaedic Surgery, Columbia University Medical Center, New York, NY, USA
| | - Hiroko Matsumoto
- Weinberg Family Cerebral Palsy Center, Columbia University Medical Center, New York, NY, USA.,Department of Orthopaedic Surgery, Columbia University Medical Center, New York, NY, USA.,Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY
| | - Jacob R Ball
- Weinberg Family Cerebral Palsy Center, Columbia University Medical Center, New York, NY, USA.,Department of Orthopaedic Surgery, Columbia University Medical Center, New York, NY, USA
| | - Stephen Plachta
- Weinberg Family Cerebral Palsy Center, Columbia University Medical Center, New York, NY, USA.,Department of Orthopaedic Surgery, Columbia University Medical Center, New York, NY, USA
| | - Joseph P Dutkowsky
- Weinberg Family Cerebral Palsy Center, Columbia University Medical Center, New York, NY, USA.,Department of Orthopaedic Surgery, Columbia University Medical Center, New York, NY, USA
| | - Heakyung Kim
- Weinberg Family Cerebral Palsy Center, Columbia University Medical Center, New York, NY, USA.,Department of Rehabilitation and Regenerative Medicine, Columbia University Medical Center, New York, NY, USA
| | - Joshua E Hyman
- Weinberg Family Cerebral Palsy Center, Columbia University Medical Center, New York, NY, USA.,Department of Orthopaedic Surgery, Columbia University Medical Center, New York, NY, USA
| | - K Daniel Riew
- Department of Orthopedic Surgery, Columbia University, The Spine Hospital at NY-Presbyterian/Allen Hospital, New York, NY, USA
| | - David P Roye
- Weinberg Family Cerebral Palsy Center, Columbia University Medical Center, New York, NY, USA.,Department of Orthopaedic Surgery, Columbia University Medical Center, New York, NY, USA
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Hung CW, Vitale MG, Samdani A, Matsumoto H, Smith JT, Sturm PF, Sponseller PD, Luhmann SJ, St Hilaire T, El-Hawary R, Sawyer JR. Outcomes of Primary and Conversion Magnetically Controlled Growth Rods Are Different at Two-Year Follow-up: Results of North American Release. Spine Deform 2019; 7:829-835. [PMID: 31495485 DOI: 10.1016/j.jspd.2019.01.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 12/26/2018] [Accepted: 01/06/2019] [Indexed: 11/17/2022]
Abstract
STUDY DESIGN Multicenter retrospective review. OBJECTIVES To compare the radiographic outcomes and complication rates in patients with primary and conversion magnetically controlled growing rod (MCGR) implants at one and two years after surgery. SUMMARY OF BACKGROUND DATA Many initial early-onset scoliosis (MCGR) implantations in the United States were conversions from other types of growth-friendly systems, and the outcome similarities and differences between primary and conversion MCGR implantation procedures are still relatively unknown. METHODS Multicenter retrospective review of EOS patients from two multicenter EOS registries identified consecutive EOS patients treated from 2014 to 2017 with a minimum of one-year follow-up. In addition, a subset of these patients who had two-year follow-up were further analyzed. RESULTS In total, 383 MCGR patients were identified, of which 272 (71%) were primary (P) and 111 (29%) were conversion (C). Group P patients had significantly greater coronal curves at the time of MCGR implantation and greater initial coronal correction. There was no statistically significant difference in Cobb correction at one year or between follow-up at one and two years. The preimplantation thoracic spine height was identical in both groups, with statistically greater improvement at initial implantation in P than in C patients. Significantly greater height gains were seen in P than in C patients in the one-year follow-up cohort. There was a higher rate of complications in the C group than in the P group; however, the difference was not statistically significant. Overall, most complications were implant-related. No loss of curve correction occurred in either group. CONCLUSIONS Patients with primary MCGR insertion can be expected to have greater radiographic correction and spine length gain than those with conversion from growth-friendly instrumentation to MCGR, most likely because of increased spine stiffness in conversion patients. The rate of complications, primarily implant-related, remains higher in conversion than in primary insertion patients. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Chun Wai Hung
- Division of Pediatric Orthopedics, Columbia University Medical Center, 630 West 168th Street, New York, NY 10032, USA
| | - Michael G Vitale
- Division of Pediatric Orthopedics, Columbia University Medical Center, 630 West 168th Street, New York, NY 10032, USA
| | - Amer Samdani
- Shriners Hospital for Children, 3551 N Broad St, Philadelphia, PA 19140, USA
| | - Hiroko Matsumoto
- Division of Pediatric Orthopedics, Columbia University Medical Center, 630 West 168th Street, New York, NY 10032, USA
| | - John T Smith
- Department of Orthopaedics, University of Utah, 201 Presidents Cir, Salt Lake City, UT 84112, USA
| | - Peter F Sturm
- Cincinnati Children's Hospital, 3333 Burnet Avenue, Cincinnati, OH 45229-3026, USA
| | | | - Scott J Luhmann
- Shriners Hospital for Children, 4400 Clayton Ave, St. Louis, MO 63110, USA
| | - Tricia St Hilaire
- Children's Spine Foundation, P. O. Box 397, Valley Forge, PA 19481, USA
| | - Ron El-Hawary
- Dalhousie University, Halifax, Nova Scotia, Canada B3H 4R2
| | - Jeffrey R Sawyer
- Department of Orthopaedic Surgery, University of Tennessee-Campbell Clinic, 1211 Union Avenue, Suite 510, Memphis, TN 38104, USA; Le Bonheur Children's Hospital, 848 Adams Ave, Memphis, TN 38103, USA.
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Feinberg N, Matsumoto H, Hung CW, St Hilaire T, Pawelek J, Sawyer JR, Akbarnia BA, Skaggs DL, Roye BD, Roye DP, Vitale MG. Expert Consensus and Equipoise: Planning a Randomized Controlled Trial of Magnetically Controlled Growing Rods. Spine Deform 2019; 6:303-307. [PMID: 29735141 DOI: 10.1016/j.jspd.2017.11.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Revised: 10/30/2017] [Accepted: 11/07/2017] [Indexed: 10/17/2022]
Abstract
STUDY DESIGN Expert consensus building using combined Delphi method and Nominal group technique. OBJECTIVES To identify the current state of equipoise surrounding the use of magnetically controlled growing rods (MCGRs) and to determine consensus for planning a randomized controlled trial (RCT) with MCGRs. BACKGROUND The use of MCGRs for the treatment of early-onset scoliosis (EOS) is a new technology. Optimal use has not been thoroughly investigated and much uncertainty exists. Areas of uncertainty include construct architecture, timing of lengthenings, and amount of distraction per lengthening. Expert discussion and consensus is useful at this early juncture and necessary when designing an RCT. METHODS Two rounds of surveys were administered to a group of experienced pediatric spine surgeons, followed by a 2-hour, face-to-face meeting in November 2015 and a 1-hour, face-to-face meeting in February 2016. The first survey used example cases to establish agreement around the proper use of MCGRs and identified areas of equipoise and disagreement. The second survey again used example cases-this time selected for their equipoise status-to solicit trial arms for a potential RCT of MCGRs and identified important open questions in the use of MCGRs. Lastly, the face-to-face meetings employed iterative voting to preliminarily plan an RCT of MCGRs. RESULTS Following the Delphi survey rounds and the two Nominal face-to-face meetings, the group of experts decided on an MCGR RCT design that standardized all patients to bidirectional constructs, and randomized to a lengthening interval of 6 versus 16 weeks with a standardized equation for calculating the total yearly lengthening that approximates normal spine growth. CONCLUSION This endeavor indicates expert support for the use of MCGR in children older than 6 years, with curves greater than 60°. The uncertainty surrounding frequency of lengthening justifies an RCT of MCGRs. LEVEL OF EVIDENCE Level V.
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Affiliation(s)
- Nicholas Feinberg
- Columbia University Medical Center, 3959 Broadway, 8 North, New York, NY 10032, USA
| | - Hiroko Matsumoto
- Growing Spine Foundation, 555 E Wells St, Milwaukee, WI 53202, USA.
| | - Chun Wai Hung
- Columbia University Medical Center, 3959 Broadway, 8 North, New York, NY 10032, USA
| | | | - Jeff Pawelek
- Growing Spine Foundation, 555 E Wells St, Milwaukee, WI 53202, USA
| | - Jeffrey R Sawyer
- Campbell Clinic Orthopaedics, 1211 Union Ave, Memphis, TN 38104, USA
| | - Behrooz A Akbarnia
- University of California, San Diego, 9500 Gilman Dr, La Jolla, CA 92093, USA
| | - David L Skaggs
- Children's Hospital of Los Angeles, 4650 Sunset Blvd, Los Angeles, CA 90027, USA
| | - Benjamin D Roye
- Columbia University Medical Center, 3959 Broadway, 8 North, New York, NY 10032, USA
| | - David P Roye
- Columbia University Medical Center, 3959 Broadway, 8 North, New York, NY 10032, USA
| | - Michael G Vitale
- Columbia University Medical Center, 3959 Broadway, 8 North, New York, NY 10032, USA
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9
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Yasui Y, Shimozono Y, Hung CW, Marangon A, Wollstein A, Gianakos AL, Murawski CD, Kennedy JG. Postoperative Reoperations and Complications in 32,307 Ankle Fractures With and Without Concurrent Ankle Arthroscopic Procedures in a 5-Year Period Based on a Large U.S. Healthcare Database. J Foot Ankle Surg 2019; 58:6-9. [PMID: 30243789 DOI: 10.1053/j.jfas.2018.03.030] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Indexed: 02/03/2023]
Abstract
Residual symptoms often persist even after successful operative reduction and internal fixation (ORIF) of ankle fractures. Concurrent ankle arthroscopic procedures (CAAPs) have been proposed to improve clinical outcomes; however, a dearth of evidence is available supporting this practice. The purpose of the present study was to investigate the reoperation and complication rates after ORIF of ankle fractures with and without CAAPs. Reoperations and complications after ORIF of ankle fractures were identified using the PearlDiver database from January 2007 to December 2011. The CAAPs included bone marrow stimulation, debridement, synovectomy, and unspecified cartilage procedures. Reoperation procedures consisted of ankle fracture repeat fixation, arthroscopic procedures, osteochondral autograft transfers, and ankle arthrodesis. Of the 32,307 patients who underwent ankle fracture fixation, 248 received CAAP and 32,059 did not. No significant difference was found in the reoperation rate between the 2 groups (7.7% versus 8.6%; odds ratio 0.89; 95% confidence interval 0.55 to 1.42; p = .61). Of the 248 patients in the CAAP group, 19 (7.7%) underwent reoperation, of which 13 (68.4%) were arthroscopic debridement and 6 were either ankle refixation or osteochondral autograft transfer. For the non-CAAP group, 3021 reoperation procedures were performed, consisting of ankle refixation in 83.2%, arthroscopic procedures in 14.3%, and ankle arthrodesis in 2.5%. The complication rate in the non-CAAP group included wound dehiscence in 2.4%, wound surgery in 0.4%, deep vein thrombosis in 0.8%, and pulmonary embolism in 0.4%. No complications were detected in the CAAP group. Ankle fracture fixation with CAAPs did not increase the postoperative reoperation rate compared with ankle fracture fixation without CAAPs.
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Affiliation(s)
- Youichi Yasui
- Orthopaedic Surgeon, Department of Orthopaedic Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | | | - Chun Wai Hung
- Medical Student, New York Medical College, Valhalla, NY
| | | | - Adi Wollstein
- Medical Student, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | | | | | - John G Kennedy
- Attending Orthopaedic Surgeon, Hospital for Special Surgery, New York, NY.
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Yasui Y, Vig KS, Tonogai I, Hung CW, Murawski CD, Takao M, Kawano H, Kennedy JG. Incidence of reoperation and wound dehiscence in patients treated for peroneal tendon dislocations: comparison between osteotomy versus soft tissue procedures. Knee Surg Sports Traumatol Arthrosc 2018; 26:897-902. [PMID: 27904935 DOI: 10.1007/s00167-016-4383-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Accepted: 11/15/2016] [Indexed: 11/28/2022]
Abstract
PURPOSES There is a lack of substantial clinical evidence endorsing the clinical outcomes of osteotomy for peroneal tendon dislocations. The aim of this study was to compare the post-operative reoperation rates following osteotomy techniques and soft tissues procedures using large database in order to investigate the efficacy of bony techniques. METHODS Patients who underwent osteotomy and soft tissue procedures for peroneal tendon dislocations were identified and subsequently analysed using the United Healthcare Orthopedic and the Medicare datasets (PearlDiver Patient Record Database, PearlDiver Technologies Inc., Fort Wayne, IN). The investigated period was from 2005 to 2012. The annual incidence, gender distribution, and incidences of reoperation and wound dehiscence following primary operative procedures were determined in these cohorts. RESULTS Of 6122 patients who received operative treatment for peroneal tendon dislocations, 1416 patients (23.1%) received the osteotomy technique, while 4706 (76.9%) were treated with the soft tissue techniques. The incidence of these operative procedures did not change significantly over the time periods of each database. In both databases, reoperation rates were 2.8% (40/1416) for osteotomy patients and 3.4% (158/4706) for soft tissue repair patients, with no statistical difference (2.8 vs. 3.4%. odds ratio 0.8, 95% confidence interval [CI] 0.6-1.2, [n.s.]) between them. Based on both databases, wound dehiscence occurred in 2.6% (37/1416) of the osteotomy patients and 2.3% (110/4706) of soft tissue repair patients with no statistical difference (2.6 vs. 2.3%, odds ratio 1.1, 95% CI 0.8-1.6, [n.s.]) between the groups. CONCLUSION The results of this study show that osteotomy techniques were frequently performed for patients with peroneal tendon dislocations. Nevertheless, osteotomy techniques for peroneal tendon dislocations are not associated with a lower risk of reoperation. In conclusion, soft tissue procedures offer a satisfactory method of treating peroneal tendon dislocations without any additional risk of reoperation when compared to osteotomy techniques that have potentially greater complication rates. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Youichi Yasui
- Department of Foot and Ankle Surgery, Hospital for Special Surgery, 523 East 72nd Street, Suite 507, New York, NY, 10021, USA.,Department of Orthopaedic Surgery, Teikyo University, Tokyo, Japan
| | - Khushdeep S Vig
- Department of Foot and Ankle Surgery, Hospital for Special Surgery, 523 East 72nd Street, Suite 507, New York, NY, 10021, USA.,Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Ichiro Tonogai
- Department of Foot and Ankle Surgery, Hospital for Special Surgery, 523 East 72nd Street, Suite 507, New York, NY, 10021, USA.,Department of Orthopedic Surgery, Tokushima University, Tokushima, Japan
| | - Chun Wai Hung
- Department of Foot and Ankle Surgery, Hospital for Special Surgery, 523 East 72nd Street, Suite 507, New York, NY, 10021, USA.,New York Medical College, Valhalla, NY, USA
| | - Christopher D Murawski
- Department of Foot and Ankle Surgery, Hospital for Special Surgery, 523 East 72nd Street, Suite 507, New York, NY, 10021, USA.,University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Masato Takao
- Department of Orthopaedic Surgery, Teikyo University, Tokyo, Japan
| | - Hirotaka Kawano
- Department of Orthopaedic Surgery, Teikyo University, Tokyo, Japan
| | - John G Kennedy
- Department of Foot and Ankle Surgery, Hospital for Special Surgery, 523 East 72nd Street, Suite 507, New York, NY, 10021, USA.
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Nandam N, Gaebler-Spira D, Byrne R, Wolfman J, Reis JP, Hung CW, Todd A, Durkin J, Marciniak C. Breast cancer screening in women with cerebral palsy: Could care delivery be improved? Disabil Health J 2018; 11:435-441. [PMID: 29500093 DOI: 10.1016/j.dhjo.2018.02.002] [Citation(s) in RCA: 8] [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] [Received: 08/03/2017] [Revised: 02/09/2018] [Accepted: 02/14/2018] [Indexed: 11/17/2022]
Abstract
BACKGROUND Women with disabilities (WWD) have reported lower mammography rates than the general population, however rates for women with cerebral palsy (CP) have not been specifically studied. OBJECTIVE To evaluate mammography rates in women with CP and to identify strengths and barriers with their screening experience. METHODS Women with CP 40 years or older (n = 118) participating in a prospective cross-sectional survey were queried regarding screening status, imaging modality, and accommodation needs and availability. Categorical variables were summarized and Chi-square testing used to assess factors contributing to screening compliance. The effect of functional factors on screening was evaluated using logistic regression. RESULTS 77 women (65.3%) had mammograms within the past two years; 56 (47.5%) were screening mammograms. Severity of fine motor deficits was associated with lack of screening (OR 0.559, p = 0.019). 85 (72.0%) experienced positive staff attitudes. Facilities most often met needs for ramps, elevators, and/or wide doorways (92.9%), exam explanations (84.4%), and accessible parking (82.5%). Needs least often met included accommodations for standing (59.3%) or for difficulties with arm/shoulder positioning (57.1%), and wheelchair-accessible mammogram machines (59.1%). CONCLUSIONS The screening compliance rate for women with CP is low, although the 2-year mammography rate is comparable to that reported for WWD and the general female U.S. POPULATION Women were usually offered respectful care. Adequate physical accommodations during the procedure were reported less often than overall facility environmental accommodations. These findings demonstrate the need for improved screening rates in women with CP, and highlight areas for improving their screening experience.
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Affiliation(s)
- Neeharika Nandam
- Northwestern University Feinberg School of Medicine, 420 E. Superior St., Chicago, IL 60611, USA
| | - Deborah Gaebler-Spira
- Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, 710 North Lake Shore Drive, #1022, Chicago, IL 60611, USA; Department of Pediatrics, Northwestern University Feinberg School of Medicine, 225 E. Chicago Avenue #86, Chicago, IL 606111, USA; Shirley Ryan AbilityLab, 355 East Erie Street, Chicago, IL 60611, USA
| | - Rachel Byrne
- Cerebral Palsy Foundation, 3 Columbus Circle, 15th Floor, New York, NY 10019, USA; Division of Pediatric Orthopedics, Columbia University Medical Center, New York-Presbyterian Morgan Stanley Children's Hospital, 3959 Broadway, Room 800N, New York, NY 10032, USA
| | - Judith Wolfman
- Department of Radiology, Northwestern University Feinberg School of Medicine, 676 N. St. Clair St., Suite 800, Chicago, IL 60611, USA; Lynn Sage Breast Center, 250 E. Superior St., Chicago, IL 60611, USA
| | - Judy Panko Reis
- Access Living, 115 West Chicago Avenue, Chicago, IL 60654, USA
| | - Chun Wai Hung
- Division of Pediatric Orthopedics, Columbia University Medical Center, New York-Presbyterian Morgan Stanley Children's Hospital, 3959 Broadway, Room 800N, New York, NY 10032, USA
| | - Allison Todd
- Shirley Ryan AbilityLab, 355 East Erie Street, Chicago, IL 60611, USA
| | - Jordyn Durkin
- Division of Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine, 676 N. St. Clair St., 14th Floor, Chicago, IL 60611, USA
| | - Christina Marciniak
- Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, 710 North Lake Shore Drive, #1022, Chicago, IL 60611, USA; Shirley Ryan AbilityLab, 355 East Erie Street, Chicago, IL 60611, USA; Department of Neurology, Northwestern University Feinberg School of Medicine, 303 East Chicago Avenue, Ward 12-140, Chicago, IL 60611, USA.
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Roye B, Hung CW, Matsumoto H, Campbell M, Roye DP, Vitale M. Paper #23: Comparison of Complications and unplanned OR visits between Magnetically Controlled Growing Rods and Vertical Expandable Prosthetic Titanium Rib. Spine Deform 2017; 5:451-452. [PMID: 31997187 DOI: 10.1016/j.jspd.2017.09.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Patients undergoing primary insertion of magnetically controlled growing rod (MCGR) compared to Vertical Expandable Prosthetic Titanium Rib (VEPTR) have higher overall complication and implant-related complications per procedure despite similar complication risk per patient. While there was a reduction in total repetitive surgeries in patients with MCGR implants, there was no significant difference in mean unplanned OR visits per patient between the groups.
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Wan KS, Wu WF, Chen TC, Wu CS, Hung CW, Chang YS. Comparison of amoxicillin + clavulanate with or without intranasal fluticasone for the treatment of uncomplicated acute rhinosinusitis in children. Minerva Pediatr 2015; 67:489-494. [PMID: 26530491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
AIM Intranasal corticosteroids (INS) have been proven effective in controlling postnasal drip, decreasing inflammatory response, reducing nasal swelling, and increasing aeration of the sinuses such that INS are recommended as treatment of sinusitis. METHODS Fifty children with acute rhinosinusitis, 50 children with acute rhiniosinusitis and allergic rhinitis (AR), and 20 rhiniosinusitis children as control were selected for investigation. Each group had a single-blind treatment of three types: with coamoxiclav only, with coamoxiclav plus INS, and with matched placebo (without antibiotics and INS) for two weeks. Nasal symptoms were then evaluated. The outcome was measured by using major symptom score (MSS) after treatment for 14 days. RESULTS Therapeutic effectiveness was 92% in rhinosinusitis patients treated with co-amoxiclav and 84% in those treated with co-amoxiclav plus INS. Among patients with sinusitis combined with AR, therapeutic efficacy was 88% for those treated with co-amoxiclav and 96% for those treated with co-amoxiclav plus INS. Only 30% of the symptoms were reduced in the placebo group. CONCLUSION There are no statistical differences in the acute sinusitis group treated with co-amoxiclav with or without INS. In the sinusitis with AR group, the efficacy of co-amoxiclav with INS is higher than in children treated with co-amoxiclav alone.
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Affiliation(s)
- K S Wan
- Department of Pediatrics, Taipei City Hospital, Renai Branch, Taiwan -
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Tsai CF, Hung CW, Lirng JF, Wang SJ, Fuh JL. Differences in brain metabolism associated with agitation and depression in Alzheimer's disease. East Asian Arch Psychiatry 2013; 23:86-90. [PMID: 24088401] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
OBJECTIVE Agitation and depression are among the commonest behavioural and psychological symptoms exhibited by Alzheimer's disease patients. However, their pathophysiology remains unclear. We therefore investigated the relationship between the brain metabolism in the posterior cingulate gyrus and the dorsolateral prefrontal cortex, and agitation and depression in patients diagnosed with Alzheimer's disease. METHODS We recruited 26 patients (14 women and 12 men) with a mean age of 75 years and probable Alzheimer's disease. All patients completed the Mini-Mental State Examination (MMSE), the Geriatric Depression Scale-Short Form (GDS) assessment, and the Cohen-Mansfield Agitation Inventory (CMAI) in order to evaluate cognition, depression, and agitation, respectively. All subjects underwent magnetic resonance imaging and (1)H-magnetic resonance spectroscopy of the brain. The ratios of N-acetylaspartate (NAA), choline (Cho), and myo-inositol (mI) to creatine (Cr) in the posterior cingulate gyrus and the dorsolateral prefrontal cortex were measured and compared with neuropsychological test results. RESULTS The MMSE scores correlated positively with the NAA/Cr ratio in the left posterior cingulate gyrus (r = 0.56; p = 0.001). The CMAI scores correlated negatively with the NAA/Cr ratio in the left posterior cingulate gyrus (r = -0.46; p = 0.02). The GDS scores correlated positively with the Cho/Cr ratio in the left dorsolateral prefrontal cortex (r = 0.59; p = 0.01), and mI/Cr in both left (r = 0.47; p = 0.03) and right (r = 0.47; p = 0.03) cingulate gyri. CONCLUSIONS Agitation and depression levels correlated with different neurochemical metabolites in specific brain areas. We conclude that various neuropsychiatric symptoms might have separate pathophysiologies.
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Affiliation(s)
- C F Tsai
- Department of Psychiatry, Taipei Veterans General Hospital; Institute of Brain Science / Faculty of Medicine / Brain Research Center, National Yang-Ming University Schools of Medicine, Taipei, Taiwan
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Liao PC, Li CM, Hung CW, Chen SH. Quantitative detection of N(7)-(2-hydroxyethyl)guanine adducts in DNA using high-performance liquid chromatography/electrospray ionization tandem mass spectrometry. J Mass Spectrom 2001; 36:336-343. [PMID: 11312526 DOI: 10.1002/jms.132] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
High-performance liquid chromatography (HPLC) was combined with electrospray ionization tandem mass spectrometry (ESI-MS/MS) to develop a sensitive and selective method for the quantitative measurement of N(7)-(2-hydroxyethyl)guanine (N(7)-HEG) adducts in DNA obtained from ethylene oxide-exposed biological samples. Selected reaction monitoring (SRM) was used as the detection mode while the fragmentation product ion at m/z 152 generated from the precursor protonated N(7)-HEG (m/z 196) was monitored. The detection limits for N(7)-HEG were estimated by twofold serial dilution and determined to be 4 fmol in neat standard solution and 16 fmol when a matrix effect is considered. When the mass spectrometer was operated in the selected ion monitoring mode using only the first quadrupole (without MS/MS function), the detection limits increased to 128 fmol and 1 pmol (when matrix effect is considered), respectively. A good linear correlation (R(2) = 0.999) was observed for signal intensities obtained by injecting 16 fmol--33 pmol of N(7)-HEG into the HPLC/ESI-MS/MS system. Hep G2 cells were incubated for 8 h with medium containing various concentrations of ethylene oxide (ranging from 0.05 to 5.0 mM). A dose-response relationship was established, indicating that the adduct formation increases with the exposure level. The method shows potential, although the detection limit needs to be lowered for practical applications, for use in monitoring N(7)-HEG formation in other biological systems.
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Affiliation(s)
- P C Liao
- Department of Environmental and Occupational Health, National Cheng Kung Medical College, Tainan 70101, Taiwan.
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