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Jarman MP, Jin G, Chen A, Losina E, Weissman JS, Berry SD, Salim A. Short-term outcomes of prehospital opioid pain management for older adults with fall-related injury. J Am Geriatr Soc 2024. [PMID: 38418369 DOI: 10.1111/jgs.18830] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 02/02/2024] [Accepted: 02/07/2024] [Indexed: 03/01/2024]
Abstract
BACKGROUND Opioids are recommended for pain management in patients being cared for and transported by emergency medical services, but no specific guidelines exist for older adults with fall-related injury. Prior research suggests prehospital opioid administration can effectively manage pain in older adults, but less is known about safety in this population. We compared short-term safety outcomes, including delirium, disposition, and length of stay, among older adults with fall-related injury according to whether they received prehospital opioid analgesia. METHODS We linked Medicare claims data with prehospital patient care reports for older adults (≥65) with fall-related injury in Illinois between January 1, 2014 and December 31, 2015. We used weighted regression models (logistic, multinomial logistic, and Poisson) to assess the association between prehospital opioid analgesia and incidence of inpatient delirium, hospital disposition, and length of stay. RESULTS Of 28,150 included older adults, 3% received prehospital opioids. Patients receiving prehospital opioids (vs. no prehospital opioids) were less likely to be discharged home from the emergency department (adjusted probability = 0.30 [95% CI: 0.25, 0.34] vs. 0.47 [95% CI: 0.46, 0.48]), more likely to be discharged to a non-home setting after an inpatient admission (adjusted probability = 0.43 [95% CI: 0.39, 0.48] vs. 0.30 [95% CI: 0.30, 0.31]), had inpatient length of stay 0.4 days shorter (p < 0.001) and ICU length of stay 0.7 days shorter (p = 0.045). Incidence of delirium did not vary between treatment and control groups. CONCLUSIONS Few older adults receive opioid analgesia in the prehospital setting. Prehospital opioid analgesia may be associated with hospital disposition and length of stay for older adults with fall-related injury. However, our findings do not provide evidence of an association with inpatient delirium. These findings should be considered when developing guidelines for prehospital pain management specific to the older adult population.
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Affiliation(s)
- Molly P Jarman
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Department of Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | - Ginger Jin
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Annie Chen
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Elena Losina
- Department of Surgery, Harvard Medical School, Boston, Massachusetts, USA
- Orthopaedic and Arthritis Center for Outcomes Research, Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Joel S Weissman
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Department of Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | - Sarah D Berry
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
- Hinda and Arthur Marcus Institute for Aging Research and Department of Medicine, Hebrew SeniorLife, Boston, Massachusetts, USA
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Ali Salim
- Department of Surgery, Harvard Medical School, Boston, Massachusetts, USA
- Division of Trauma, Burn, and Surgical Critical Care, Brigham and Woemn's Hospital, Boston, Massachusetts, United States
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Minami CA, Jin G, Freedman RA, Schonberg MA, King TA, Mittendorf EA. ASO Visual Abstract: Trends in Locoregional Therapy in Older Women with Early-Stage Hormone Receptor-Positive Breast Cancer by Frailty and Life Expectancy. Ann Surg Oncol 2024; 31:1021-1022. [PMID: 37985526 DOI: 10.1245/s10434-023-14600-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2023]
Affiliation(s)
- Christina A Minami
- Division of Breast Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA.
- Breast Oncology Program, Dana-Farber/Brigham and Women's Cancer Center, Boston, MA, USA.
- Harvard Medical School, Boston, MA, USA.
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA, USA.
| | - Ginger Jin
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA, USA
| | - Rachel A Freedman
- Breast Oncology Program, Dana-Farber/Brigham and Women's Cancer Center, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA, USA
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Mara A Schonberg
- Harvard Medical School, Boston, MA, USA
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Tari A King
- Division of Breast Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA
- Breast Oncology Program, Dana-Farber/Brigham and Women's Cancer Center, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Elizabeth A Mittendorf
- Division of Breast Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA
- Breast Oncology Program, Dana-Farber/Brigham and Women's Cancer Center, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
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Minami CA, Jin G, Freedman RA, Schonberg MA, King TA, Mittendorf EA. Trends in Locoregional Therapy in Older Women with Early-Stage Hormone Receptor-Positive Breast Cancer by Frailty and Life Expectancy. Ann Surg Oncol 2024; 31:920-930. [PMID: 37851196 PMCID: PMC10826462 DOI: 10.1245/s10434-023-14446-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 10/02/2023] [Indexed: 10/19/2023]
Abstract
BACKGROUND In women ≥ 70 years of age with T1N0 hormone receptor-positive (HR+)/human epidermal growth factor receptor 2-negative (HER2-) breast cancer, breast surgery type and omission of axillary surgery or radiation therapy (RT) do not impact overall survival. Although frailty and life expectancy ideally factor into therapy decisions, their impact on therapy receipt is unclear. We sought to identify trends in and factors associated with locoregional therapy type by frailty and life expectancy. METHODS Women ≥ 70 years of age with T1N0 HR+/HER2- breast cancer diagnosed in the Surveillance, Epidemiology, and End Results (SEER)-Medicare database between 2010 and 2015 were stratified by validated claims-based frailty and life expectancy measures. Therapy trends over time by regimen intensity ('high intensity': lumpectomy + axillary surgery + RT, or mastectomy + axillary surgery; 'moderate intensity': lumpectomy + RT, lumpectomy + axillary surgery, or mastectomy only; or 'low intensity': lumpectomy only) were analyzed. Factors associated with therapy type were identified using generalized linear mixed models. RESULTS Of 16,188 women, 21.8% were frail, 22.2% had a life expectancy < 5 years, and only 12.3% fulfilled both criteria. In frail women with a life expectancy < 5 years, high-intensity regimens decreased significantly (48.8-31.2%; p < 0.001) over the study period, although in 2015, 30% still received a high-intensity regimen. In adjusted analyses, frailty and life expectancy < 5 years were not associated with breast surgery type but were associated with a lower likelihood of axillary surgery (frailty: odds ratio [OR] 0.86, 95% confidence interval [CI] 0.76-0.96; life expectancy < 5 years: OR 0.22, 95% CI 0.20-0.25). Life expectancy < 5 years was also associated with a lower likelihood of RT receipt in breast-conserving surgery patients (OR 0.30, 95% CI 0.27-0.34). CONCLUSIONS Rates of high-intensity therapy are decreasing but overtreatment persists in this population. Continued efforts aimed at appropriate de-escalation of locoregional therapy are needed.
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Affiliation(s)
- Christina A Minami
- Division of Breast Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA.
- Breast Oncology Program, Dana-Farber/Brigham and Women's Cancer Center, Boston, MA, USA.
- Harvard Medical School, Boston, MA, USA.
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA, USA.
| | - Ginger Jin
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA, USA
| | - Rachel A Freedman
- Breast Oncology Program, Dana-Farber/Brigham and Women's Cancer Center, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Mara A Schonberg
- Harvard Medical School, Boston, MA, USA
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Tari A King
- Division of Breast Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA
- Breast Oncology Program, Dana-Farber/Brigham and Women's Cancer Center, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Elizabeth A Mittendorf
- Division of Breast Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA
- Breast Oncology Program, Dana-Farber/Brigham and Women's Cancer Center, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
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Jin G, Chang Y, Bao X. Generation of chimeric antigen receptor macrophages from human pluripotent stem cells to target glioblastoma. Immunooncol Technol 2023; 20:100409. [PMID: 38192614 PMCID: PMC10772262 DOI: 10.1016/j.iotech.2023.100409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/10/2024]
Abstract
Background Glioblastoma (GBM) is an aggressive brain tumor giving a poor prognosis with the current treatment options. The advent of chimeric antigen receptor (CAR) T-cell therapy revolutionized the field of immunotherapy and has provided a new set of therapeutic options for refractory blood cancers. In an effort to apply this therapeutic approach to solid tumors, various immune cell types and CAR constructs are being studied. Notably, macrophages have recently emerged as potential candidates for targeting solid tumors, attributed to their inherent tumor-infiltrating capacity and abundant presence in the tumor microenvironment. Materials and methods In this study, we developed a chemically defined differentiation protocol to generate macrophages from human pluripotent stem cells (hPSCs). A GBM-specific CAR was genetically incorporated into hPSCs to generate CAR hPSC-derived macrophages. Results The CAR hPSC-derived macrophages exhibited potent anticancer activity against GBM cells in vitro. Conclusion Our findings demonstrate the feasibility of generating functional CAR-macrophages from hPSCs for adoptive immunotherapy, thereby opening new avenues for the treatment of solid tumors, particularly GBM.
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Affiliation(s)
- G. Jin
- Davidson School of Chemical Engineering, Purdue University, West Lafayette
- Purdue University Center for Cancer Research, West Lafayette, USA
| | - Y. Chang
- Davidson School of Chemical Engineering, Purdue University, West Lafayette
- Purdue University Center for Cancer Research, West Lafayette, USA
| | - X. Bao
- Davidson School of Chemical Engineering, Purdue University, West Lafayette
- Purdue University Center for Cancer Research, West Lafayette, USA
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Zhu LY, Guo SW, Jin G. [Establishment of the quality assessment system for pancreatic cancer surgery: from "single complication assessment" to "textbook outcome"]. Zhonghua Wai Ke Za Zhi 2023; 61:833-838. [PMID: 37653984 DOI: 10.3760/cma.j.cn112139-20230308-00097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Abstract
With the development of neoadjuvant therapy and a multidisciplinary team, the treatment of pancreatic cancer has gradually expanded from "resection" to "cure"."Curative resection" as the core part of the integrated treatment model for patients, its quality directly determines the short-term outcome and affects the long-term prognosis. Previously, the "single complication assessment" model was used to measure the quality of pancreatic cancer surgery. However, the incidence of any specific complication cannot cover the entire surgical procedure, making it difficult to quantify and standardize the interpretation of the outcomes. Recently, the concept of textbook outcome, a comprehensive indicator, has gained popularity in surgical research. Textbook outcome includes multiple complication parameters and reflects optimal surgical outcomes in an "all or none" approach. Implementing a quality improvement program that focuses on textbook outcome will increase the overall standard of complex surgery, ultimately advancing the surgical care of pancreatic cancer in the future. In this article, the latest advances in relevant research are analyzed to provide a brief overview of the textbook outcome of pancreatic cancer.
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Affiliation(s)
- L Y Zhu
- Department of Pancreatic Hepatobiliary Surgery, Changhai Hospital, Naval Medical University, Shanghai 200433, China
| | - S W Guo
- Department of Pancreatic Hepatobiliary Surgery, Changhai Hospital, Naval Medical University, Shanghai 200433, China
| | - G Jin
- Department of Pancreatic Hepatobiliary Surgery, Changhai Hospital, Naval Medical University, Shanghai 200433, China
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Wang M, Jin G, Cheng Y, Zheng J, Tian L, Zhang S, Hong W. [Prevalence of comorbid depression and anxiety and effect of psychological interventions among schistosomiasis patients in China: a meta-analysis]. Zhongguo Xue Xi Chong Bing Fang Zhi Za Zhi 2023; 35:340-348. [PMID: 37926468 DOI: 10.16250/j.32.1374.2023018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 11/07/2023]
Abstract
OBJECTIVE To investigate the prevalence of comorbid depression and anxiety and to evaluate the effect of psychological interventions among schistosomiasis patients in China, so as to provide insights into improvements of psychological health among schistosomiasis patients. METHODS Publications pertaining to comorbid depression and anxiety and psychological interventions among Chinese schistosomiasis patients were retrieved in electronic databases, including CNKI, Wanfang Data, PubMed, Web of Science, and Embase. The prevalence of comorbidity, psychological interventions, and scores for the Self-Rating Depression Scale (SDS) and Self-Rating Anxiety Scale (SAS) before and after psychological interventions among Chinese schistosomiasis patients were extracted. The prevalence of comorbid depression and anxiety was investigated among Chinese schistosomiasis patients using a meta-analysis, and the effect of psychological interventions for depression and anxiety was evaluated. RESULTS A total of 231 publications were retrieved, and 14 publications that met the inclusion and exclusion criteria were included in the final analysis, including 2 English publications and 12 Chinese publications. Meta-analysis showed that the prevalence rates of comorbid depression and anxiety were 61% [95% confidential interval (CI): (48%, 72%)] and 64% [95% CI: (42%, 81%)] among Chinese schistosomiasis patients. Both the SDS [1.45 points, 95% CI: (1.30, 1.60) points] and SAS scores [2.21 points, 95% CI: (2.05, 2.38) points] reduced among Chinese schistosomiasis patients after psychological interventions than before psychological interventions, and the SDS [-0.47 points, 95% CI: (-6.90, -0.25) points] and SAS scores [-1.30 points, 95% CI: (-1.52, -1.09) points] reduced among Chinese schistosomiasis patients in the case group than in the control group. CONCLUSIONS The comorbid anxiety and depression are common among Chinese schistosomiasis patients, and conventional psychological interventions facilitate the improvements of anxiety and depression among schistosomiasis patients.
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Affiliation(s)
- M Wang
- The Sixth Department of Clinical Medicine, Shanghai Mental Health Center Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 201100, China
| | - G Jin
- Yangpu District Mental Health Center, Shanghai Municipality, China
| | - Y Cheng
- The Sixth Department of Clinical Medicine, Shanghai Mental Health Center Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 201100, China
| | - J Zheng
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention (Chinese Center for Tropical Diseases Research), National Health Commission Key Laboratory of Parasite and Vector Biology, WHO Collaborating Centre for Tropical Diseases, National Center for International Research on Tropical Diseases, School of Global Health, Shanghai Jiaotong University School of Medicine and Chinese Center for Tropical Diseases Research, Shanghai 200025, China
| | - L Tian
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention (Chinese Center for Tropical Diseases Research), National Health Commission Key Laboratory of Parasite and Vector Biology, WHO Collaborating Centre for Tropical Diseases, National Center for International Research on Tropical Diseases, School of Global Health, Shanghai Jiaotong University School of Medicine and Chinese Center for Tropical Diseases Research, Shanghai 200025, China
| | - S Zhang
- Institute of Respiratory Diseases, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai 200032, China
| | - W Hong
- The Sixth Department of Clinical Medicine, Shanghai Mental Health Center Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 201100, China
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai 201100, China
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Ren YW, Guo SW, Li G, Jin G. [Quality assessment indictors and benchmarks for pancreatic surgery]. Zhonghua Wai Ke Za Zhi 2023; 61:562-566. [PMID: 37402684 DOI: 10.3760/cma.j.cn112139-20221229-00551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 07/06/2023]
Abstract
Pancreatic surgery is the most complex type of abdominal surgery,with high technical requirements and long learning curve,and the quality of surgery is directly related to the prognosis of the patients. In recent years,more and more indicators have been used to evaluate the quality of pancreatic surgery,such as operation time,intraoperative blood loss,morbidity,mortality, prognosis and so on,and different evaluation systems have been established,including benchmarking,auditing,outcome evaluation based on risk factor adjustment and textbook outcomes. Among them,the benchmark is the most widely used to evaluate surgical quality and is expected to become the standard for comparison among peers. This article reviews existing quality evaluation indicators and benchmarks for pancreatic surgery and anticipates its future application prospects.
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Affiliation(s)
- Y W Ren
- Department of Hepatobiliary Pancreatic Surgery,Changhai Hospital,Naval Medical University,Shanghai 200433,China
| | - S W Guo
- Department of Hepatobiliary Pancreatic Surgery,Changhai Hospital,Naval Medical University,Shanghai 200433,China
| | - G Li
- Department of Hepatobiliary Pancreatic Surgery,Changhai Hospital,Naval Medical University,Shanghai 200433,China
| | - G Jin
- Department of Hepatobiliary Pancreatic Surgery,Changhai Hospital,Naval Medical University,Shanghai 200433,China
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Minami CA, Jin G, Freedman RA, Schonberg MA, King TA, Mittendorf EA. Association of Surgery With Frailty Status in Older Women With Early-Stage Breast Cancer. JAMA Surg 2023; 158:664-666. [PMID: 36920410 PMCID: PMC10018401 DOI: 10.1001/jamasurg.2022.8146] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 11/19/2022] [Indexed: 03/16/2023]
Abstract
This cohort study examines associations between type of breast cancer surgery and changes in frailty status among US women aged 70 years or older with early-stage breast cancer.
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Affiliation(s)
- Christina A. Minami
- Breast Oncology Program, Dana-Farber/Brigham and Women’s Cancer Center, Boston, Massachusetts
| | - Ginger Jin
- Center for Surgery and Public Health, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Rachel A. Freedman
- Breast Oncology Program, Dana-Farber/Brigham and Women’s Cancer Center, Boston, Massachusetts
| | - Mara A. Schonberg
- Division of General Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Tari A. King
- Breast Oncology Program, Dana-Farber/Brigham and Women’s Cancer Center, Boston, Massachusetts
| | - Elizabeth A. Mittendorf
- Breast Oncology Program, Dana-Farber/Brigham and Women’s Cancer Center, Boston, Massachusetts
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Bergmark RW, Jin G, Semco RS, Santolini M, Olsen MA, Dhand A. Association of hospital centrality in inter-hospital patient-sharing networks with patient mortality and length of stay. PLoS One 2023; 18:e0281871. [PMID: 36920981 PMCID: PMC10016671 DOI: 10.1371/journal.pone.0281871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 02/02/2023] [Indexed: 03/16/2023] Open
Abstract
OBJECTIVE The interdependence of hospitals is underappreciated in patient outcomes studies. We used a network science approach to foreground this interdependence. Specifically, within two large state-based interhospital networks, we examined the relationship of a hospital's network position with in-hospital mortality and length of stay. METHODS We constructed interhospital network graphs using data from the Healthcare Cost and Utilization Project and the American Hospital Association Annual Survey for Florida (2014) and California (2011). The exposure of interest was hospital centrality, defined as weighted degree (sum of all ties to a given hospital from other hospitals). The outcomes were in-hospital mortality and length of stay with sub-analyses for four acute medical conditions: pneumonia, heart failure, ischemic stroke, myocardial infarction. We compared outcomes for each quartile of hospital centrality relative to the most central quartile (Q4), independent of patient- and hospital-level characteristics, in this retrospective cross-sectional study. RESULTS The inpatient cohorts had 1,246,169 patients in Florida and 1,415,728 in California. Compared to Florida's central hospitals which had an overall mortality 1.60%, peripheral hospitals had higher in-hospital mortality (1.97%, adjusted OR (95%CI): Q1 1.61 (1.37, 1.89), p<0.001). Hospitals in the middle quartiles had lower in-hospital mortality compared to central hospitals (%, adjusted OR (95% CI): Q2 1.39%, 0.79 (0.70, 0.89), p<0.001; Q3 1.33%, 0.78 (0.70, 0.87), p<0.001). Peripheral hospitals had longer lengths of stay (adjusted incidence rate ratio (95% CI): Q1 2.47 (2.44, 2.50), p<0.001). These findings were replicated in California, and in patients with heart failure and pneumonia in Florida. These results show a u-shaped distribution of outcomes based on hospital network centrality quartile. CONCLUSIONS The position of hospitals within an inter-hospital network is associated with patient outcomes. Specifically, hospitals located in the peripheral or central positions may be most vulnerable to diminished quality outcomes due to the network. Results should be replicated with deeper clinical data.
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Affiliation(s)
- Regan W. Bergmark
- Center for Surgery and Public Health, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, United States of America
- Brigham and Women’s Hospital and Dana Farber Cancer Institute and Department of Otolaryngology-Head and Neck Surgery, Division of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, MA, United States of America
| | - Ginger Jin
- Center for Surgery and Public Health, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, United States of America
| | - Robert S. Semco
- Center for Surgery and Public Health, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, United States of America
| | - Marc Santolini
- Université Paris Cité, Inserm, System Engineering and Evolution Dynamics, Paris, France
- Network Science Institute, Northeastern University, Boston, MA, United States of America
| | - Margaret A. Olsen
- Department of Medicine, Division of Infectious Disease, Washington University School of Medicine, St. Louis, MO, United States of America
| | - Amar Dhand
- Network Science Institute, Northeastern University, Boston, MA, United States of America
- Department of Neurology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, United States of America
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Jing W, Ren YW, Gao SZ, Liu WC, Shi XH, Guo SW, Jin G. [Diagnosis and treatment of blunt high-grade pancreatic trauma]. Zhonghua Yi Xue Za Zhi 2023; 103:287-290. [PMID: 36660790 DOI: 10.3760/cma.j.cn112137-20220623-01383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
The clinical data of 20 patients with blunt high-grade pancreatic trauma who were admitted to the Department of Hepatobiliary and Pancreatic Surgery of Changhai Hospital Affiliated to Naval Military Medical University from December 2003 to February 2022 were retrospectively analyzed. There were 15 males and 5 females with a median age of 39 years (range: 14-54 years). The degree of pancreatic injury was graded according to the American Association for the Surgery of Trauma (AAST) scale, including 10 cases of grade Ⅲ (50%), 8 cases of grade Ⅳ (40%), and 2 cases of grade Ⅴ (10%). Then, the strategy of diagnosis and treatment for blunt high-grade pancreatic trauma was summarized. The diagnostic rate of CT was 78.9%. Finally, 17 cases (85%) were cured and 3 cases (15%) died. Among the 10 patients with grade Ⅲ pancreatic injury, 7 cases received distal pancreatectomy and splenectomy, 1 case received distal pancreatectomy with spleen preserved, 1 case received pancreatic duct stent placement under endoscopic retrograde cholangiopancreatography (ERCP) and percutaneous catheter drainage (PCD), and 1 case received only PCD. Among 8 cases of grade Ⅳ, 3 cases underwent Roux-en-Y pancreaticojejunostomy, 1 case received distal pancreatectomy and splenectomy, 1 case underwent distal pancreatectomy with spleen preserved, 2 cases received necrotic tissue removal+external drainage of pancreatic duct+abdominal drainage, and 1 case received exploratory laparotomy and gauze packing hemostasis. For 2 cases of grade Ⅴ, 1 underwent pylorus preserving pancreaticoduodenectomy, and the other case underwent pancreaticoduodenectomy combined with right hemicolectomy and splenectomy. Therefore, the treatment of blunt high-grade pancreatic trauma should follow the individualized treatment strategy, pay attention to the control of bleeding, extensive external drainage, appropriate debridement and resection and rational application of damage control surgery, select appropriate patients for conservative treatment, and ultimately benefit the patient.
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Affiliation(s)
- W Jing
- Department of Hepatobiliary Pancreatic Surgery, Changhai Hospital, Naval Military Medical University, Shanghai 200433, China
| | - Y W Ren
- Department of Hepatobiliary Pancreatic Surgery, Changhai Hospital, Naval Military Medical University, Shanghai 200433, China
| | - S Z Gao
- Department of Hepatobiliary Pancreatic Surgery, Changhai Hospital, Naval Military Medical University, Shanghai 200433, China
| | - W C Liu
- Department of Hepatobiliary Pancreatic Surgery, Changhai Hospital, Naval Military Medical University, Shanghai 200433, China
| | - X H Shi
- Department of Hepatobiliary Pancreatic Surgery, Changhai Hospital, Naval Military Medical University, Shanghai 200433, China
| | - S W Guo
- Department of Hepatobiliary Pancreatic Surgery, Changhai Hospital, Naval Military Medical University, Shanghai 200433, China
| | - G Jin
- Department of Hepatobiliary Pancreatic Surgery, Changhai Hospital, Naval Military Medical University, Shanghai 200433, China
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Yue H, Jin T, Shao S, Jin G. Design, Synthesis and Study of a Novel Antitumor Active Sinomeninylethylenesulfamide. Russ J Bioorg Chem 2022. [DOI: 10.1134/s1068162023010302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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12
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Minami CA, Jin G, Freedman RA, Schonberg MA, King TA, Mittendorf EA. Physician-level variation in axillary surgery in older adults with T1N0 hormone receptor–positive breast cancer. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.28_suppl.284] [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: 11/20/2022] Open
Abstract
284 Background: Randomized controlled trial data support safe omission of axillary surgery in patients >70 years old with T1N0 hormone receptor-positive (HR+) breast cancer, but utilization of axillary surgery in the U.S. remains > 80%. We sought to assess the proportion of variance in axillary surgery receipt that is attributable to surgeon-level differences vs. patient level differences, and assess the patient- and surgeon-level factors that affect axillary surgery receipt in this population. Methods: Women >70 years old with T1N0 HR+/HER2-negative breast cancer diagnosed from 2013-2015 in SEER-Medicare were linked to surgeon-level data from the American Medical Association Masterfile. Patients of low-volume surgeons (surgeons treating < 5 patients in this population over the study period) were excluded. To assess patient-and surgeon-level factors associated with axillary surgery receipt, we estimated hierarchical logistic regression models regressing receipt of axillary surgery on surgeon-specific random intercepts (null model). We then re-estimated this model including patient factors (age, Charlson Comorbidity Index (CCI), and a validated claims-based frailty index). Our final model included other surgeon-, patient-, and disease-level factors. The intracluster correlation (ICC) was used to estimate the proportion of total variance in the outcome attributable to the surgeon level. Results: Of 4,410 women included, 58.3% were >75 years old, 20.7% were frail, and 13.9% had a CCI>2; 86.1% of women underwent axillary surgery. Of 432 surgeons represented, 52.6% were female and 9.5% identified as surgical oncologists. In the null model, 10.5% of the variance in the axillary evaluation was attributable to the surgeon-level, with 89.5% attributable to patient-level differences (Table). Adjusting for key patient-level variables (age, CCI, and frailty status) reduced unexplained patient-level variance, resulting in a greater proportion of total unexplained variance attributable to the surgeon level (13%). In our final model, physician subspecialty and years in practice were non-significant, but patients of female surgeons were less likely to undergo axillary surgery (OR 0.69, 95% CI [0.51-0.95]). Conclusions: In older women with T1N0 HR+ disease, patient-level differences reassuringly account for most of the variation in receipt of axillary surgery. Drivers of residual patient-level variation may include unmeasured factors such as differences in surgeon-patient communication and patient preferences.[Table: see text]
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Affiliation(s)
- Christina Ahn Minami
- Division of Breast Surgery, Department of Surgery, Brigham and Women's Hospital, Breast Oncology Program, Dana Farber/Brigham and Women's Cancer Center, Boston, MA
| | - Ginger Jin
- Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Boston, MA
| | | | | | - Tari A. King
- Breast Oncology Program, Dana-Farber/Brigham and Women’s Cancer Center, Boston, MA
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Jin G, Johnston G, Berg A, Morris C. Abstract No. 314 Adjunctive cadaveric bone chip and demineralized bone matrix administration for sclerotherapy treatment of symptomatic pediatric unicameral bone cysts. J Vasc Interv Radiol 2022. [DOI: 10.1016/j.jvir.2022.03.395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Minami CA, Jin G, Freedman RA, Schonberg MA, King TA, Mittendorf EA. Locoregional therapy trends by frailty and life expectancy in older adults with T1N0 hormone receptor-positive breast cancer. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.12047] [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: 11/20/2022] Open
Abstract
12047 Background: Women >70 years old with T1N0 hormone receptor-positive (HR+) breast cancer face complex locoregional therapy decisions, as breast surgery type, and omission of axillary surgery or radiation therapy (RT), do not impact overall survival. Although frailty status and life expectancy (LE) ideally factor into therapy decisions, their impact on decision-making is unclear. We sought to identify trends in, and factors associated with locoregional therapy type by frailty and LE, and to determine if therapy type was associated with cause of death. Methods: Women >70 years old with T1N0 HR+/HER2-negative breast cancer diagnosed 2010-2015 were identified in SEER-Medicare. Stratified by validated claims-based frailty (Kim et al) and LE (Tan et al) measures, trends in therapy (lumpectomy, lumpectomy + axillary surgery, lumpectomy + RT, mastectomy, lumpectomy + axillary surgery + RT, and mastectomy + axillary surgery, with the last two combinations deemed “more intense” therapy) were analyzed. Generalized linear mixed models were used to identify factors associated with therapy receipt (breast surgery type, axillary surgery, and RT) and, among the women who died in this cohort, to explore potential associations between local therapy received and cause of death. Results: Of the 16,188 women included, 21.8% were frail, 22.2% had a LE<5 years, but only 12.3% were both frail and had a LE<5 years. In frail women who had a LE < 5 years, more intense therapy regimens decreased significantly (lumpectomy + axillary surgery + RT: 27.5% to 17.3%, p<0.001; mastectomy + axillary surgery: 20.8% to 13.9%, p=0.02) over the study period. However, in 2015, 30% of frail women with a LE<5 years still underwent a more intense regimen. On multivariable analysis, frailty and LE<5 years were associated with a lower likelihood of axillary surgery (frailty: OR 0.65, 95% CI [0.57-0.73]; LE<5 years: OR 0.67, 95% CI [0.59-0.76]) and RT (frailty: OR 0.77, 95% CI [0.69-0.86]; LE<5 years: OR 0.73, 95% CI [0.65-0.83]), but not with breast surgery type. Of the 1868 women who died, 306 (16.4%) died of breast cancer and those undergoing more intense therapy were as likely to die of breast cancer vs other causes (Table). Conclusions: In older women with T1N0 HR+ disease, rates of more intense therapy are decreasing but 30% of frail women with a limited LE still underwent more intense therapy in the final study year. As therapy intensity does not affect breast cancer-specific mortality, appropriate de-escalation of locoregional therapy is needed. [Table: see text]
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Affiliation(s)
- Christina Ahn Minami
- Division of Breast Surgery, Department of Surgery, Brigham and Women's Hospital, Breast Oncology Program, Dana Farber/Brigham and Women's Cancer Center, Boston, MA
| | - Ginger Jin
- Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Boston, MA
| | | | | | - Tari A. King
- Division of Breast Surgery, Department of Surgery, BWH, Breast Oncology Program, Dana-Farber/Brigham and Women’s Cancer Center, Boston, MA
| | - Elizabeth A. Mittendorf
- Division of Breast Surgery, Department of Surgery, BWH, Breast Oncology Program, Dana-Farber/Brigham and Women’s Cancer Center, Boston, MA
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Mody GN, Choi B, Townsend K, Kerwin C, Larios D, Boukedes S, Coppolino A, Singh S, Jin G, Wolfe D, Mallidi H, Goldberg H. Steroid dosing and delirium after lung transplant surgery. Gen Hosp Psychiatry 2022; 76:57-59. [PMID: 35131114 DOI: 10.1016/j.genhosppsych.2022.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 01/25/2022] [Accepted: 01/27/2022] [Indexed: 11/25/2022]
Affiliation(s)
- Gita N Mody
- Department of Surgery, University of North Carolina, 4001 Burnett-Womack Building CB #7050, Chapel Hill, NC 27599, United States of America.
| | - Bina Choi
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, United States of America.
| | - Keri Townsend
- Pharmacy, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, United States of America.
| | - Clara Kerwin
- University of Colorado School of Medicine, 13001 East 17(th) Place, Campus Box C290, Aurora, CO 80045, United States of America
| | - Dalia Larios
- Radiation Oncology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, United States of America.
| | - Steve Boukedes
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, United States of America.
| | - Antonio Coppolino
- Department of Surgery, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, United States of America.
| | - Steve Singh
- Regional Cardiac Health Program, Trillium Health Partners, 100 Queensway West, Mississauga, Ontario, Canada
| | - Ginger Jin
- Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, United States of America.
| | - David Wolfe
- Department of Psychiatry, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, United States of America.
| | - Hari Mallidi
- Department of Surgery, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, United States of America.
| | - Hilary Goldberg
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, United States of America.
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Minami CA, Jin G, Schonberg MA, Freedman RA, King TA, Mittendorf EA. ASO Visual Abstract: Variation in Deescalated Axillary Surgical Practices in Older Women with Early-Stage Breast Cancer. Ann Surg Oncol 2022. [DOI: 10.1245/s10434-022-11778-9] [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: 11/18/2022]
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Minami CA, Jin G, Schonberg MA, Freedman RA, King TA, Mittendorf EA. Variation in Deescalated Axillary Surgical Practices in Older Women with Early-Stage Breast Cancer. Ann Surg Oncol 2022; 29:10.1245/s10434-022-11677-z. [PMID: 35385998 PMCID: PMC9982465 DOI: 10.1245/s10434-022-11677-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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 03/07/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Randomized controlled trials show that certain axillary surgical practices can be safely deescalated in older adults with early-stage breast cancer. Hospital volume is often equated with surgical quality, but it is unclear whether this includes performance of low-value surgeries. We sought to describe how utilization of two low-value axillary surgeries has varied by time and hospital volume. METHODS Women aged ≥ 70 years diagnosed with breast cancer from 2013 to 2016 were identified in the National Cancer Database. The outcomes of interest were sentinel lymph node biopsy (SLNB) in cT1N0 hormone receptor-positive cancer patients and axillary lymph node dissection (ALND) in cT1-2N0 patients undergoing breast-conserving surgery with ≤ 2 pathologically positive nodes. Time trends in procedure use and multivariable regression with restricted cubic splines were performed, adjusting for patient, disease, and hospital factors. RESULTS Overall, 83.4% of 44,779 women eligible for omission of SLNB underwent SLNB and 20.0% of 7216 patients eligible for omission of ALND underwent ALND. SLNB rates did not change significantly over time and remained significantly different by age group (70-74 years: 93.5%; 75-79 years: 89.7%, 80-84 years: 76.7%, ≥ 85 years: 48.9%; p < 0.05). ALND rates decreased over the study period across all age groups included (22.5 to 16.9%, p < 0.001). In restricted cubic splines models, lower hospital volume was associated with higher likelihood of undergoing SLNB and ALND. CONCLUSIONS ALND omission has been more widely adopted than SLNB omission in older adults, but lower hospital volume is associated with higher likelihood of both procedures. Practice-specific deimplementation strategies are needed, especially for lower-volume hospitals.
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Affiliation(s)
- Christina A Minami
- Division of Breast Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA.
- Breast Oncology Program, Dana-Farber/Brigham and Women's Cancer Center, Boston, MA, USA.
| | - Ginger Jin
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA, USA
| | - Mara A Schonberg
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Rachel A Freedman
- Breast Oncology Program, Dana-Farber/Brigham and Women's Cancer Center, Boston, MA, USA
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Tari A King
- Division of Breast Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA
- Breast Oncology Program, Dana-Farber/Brigham and Women's Cancer Center, Boston, MA, USA
| | - Elizabeth A Mittendorf
- Division of Breast Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA
- Breast Oncology Program, Dana-Farber/Brigham and Women's Cancer Center, Boston, MA, USA
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Jarman MP, Jin G, Weissman JS, Ash AS, Tjia J, Salim A, Haider A, Cooper Z. Association of Trauma Center Designation With Postdischarge Survival Among Older Adults With Injuries. JAMA Netw Open 2022; 5:e222448. [PMID: 35294541 PMCID: PMC8928003 DOI: 10.1001/jamanetworkopen.2022.2448] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 01/12/2022] [Indexed: 01/14/2023] Open
Abstract
Importance Trauma centers improve outcomes for young patients with serious injuries. However, most injury-related hospital admissions and deaths occur in older adults, and it is not clear whether trauma center care provides the same benefit in this population. Objective To examine whether 30- and 365-day mortality of injured older adults is associated with the treating hospital's trauma center level. Design, Setting, and Participants This prospective, population-based cohort study used Medicare claims data from January 1, 2013, to December 31, 2016, for all fee-for-service Medicare beneficiaries 66 years or older with inpatient admission for traumatic injury in 2014 to 2015. Data analysis was performed from January 1 to June 31, 2021. Preinjury health was measured using 2013 claims, and outcomes were measured through 2016. The population was stratified by anatomical injury pattern. Propensity scores for level I trauma center treatment were estimated using the Abbreviated Injury Scale, age, and residential proximity to trauma center and then used to match beneficiaries from each trauma level (I, II, III, and IV/non-trauma centers) by injury type. Exposure Admitting hospital's trauma center level. Main Outcomes and Measures Case fatality rates (CFRs) at 30 and 365 days after injury, estimated in the matched sample using multivariable, hierarchical logistic regression models. Results A total of 433 169 Medicare beneficiaries (mean [SD] age, 82.9 [8.3] years; 68.4% female; 91.5% White) were included in the analysis. A total of 206 275 (47.6%) were admitted to non-trauma centers and 161 492 (37.3%) to level I or II trauma centers. Patients with isolated extremity fracture had the fewest deaths (365-day CFR ranged from 16.1% [95% CI, 11.2%-22.4%] to 17.4% [95% CI, 11.8%-24.6%] by trauma center status). Patients with both hip fracture and traumatic brain injury had the most deaths (365-day CFRs ranged from 33.4% [95% CI, 25.8%-42.1%] to 35.8% [95% CI, 28.9%-43.5%]). Conclusions and Relevance These findings suggest that older adults do not benefit from existing trauma center care, which is designed with younger patients in mind. There is a critical need to improve trauma care practices to address common injury mechanisms and types of injury in older adults.
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Affiliation(s)
- Molly P. Jarman
- Center for Surgery and Public Health, Department of Surgery, Brigham and Women’s Hospital, Boston, Massachusetts
- Department of Surgery, Harvard Medical School, Boston, Massachusetts
| | - Ginger Jin
- Center for Surgery and Public Health, Department of Surgery, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Joel S. Weissman
- Center for Surgery and Public Health, Department of Surgery, Brigham and Women’s Hospital, Boston, Massachusetts
- Department of Surgery, Harvard Medical School, Boston, Massachusetts
| | - Arlene S. Ash
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worchester
| | - Jennifer Tjia
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worchester
| | - Ali Salim
- Department of Surgery, Harvard Medical School, Boston, Massachusetts
- Division of Trauma, Burn and Surgical Critical Care, Department of Surgery, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Adil Haider
- Center for Surgery and Public Health, Department of Surgery, Brigham and Women’s Hospital, Boston, Massachusetts
- Medical College, The Aga Khan University, Karachi, Pakistan
| | - Zara Cooper
- Center for Surgery and Public Health, Department of Surgery, Brigham and Women’s Hospital, Boston, Massachusetts
- Department of Surgery, Harvard Medical School, Boston, Massachusetts
- Division of Trauma, Burn and Surgical Critical Care, Department of Surgery, Brigham and Women’s Hospital, Boston, Massachusetts
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Dalton MK, Riviello R, Kubasiak JC, Sokas CM, Osman SY, Jin G, Nitzschke SL, Ortega G. The impact of the Affordable Care Act's medicaid expansion on patients admitted for burns: An analysis of national data. Burns 2021; 48:1340-1346. [PMID: 34903411 DOI: 10.1016/j.burns.2021.10.018] [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: 03/04/2021] [Revised: 10/24/2021] [Accepted: 10/29/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The first states began implementing the Medicaid expansion provisions of the Patient Protection and Affordable Care Act (ACA) in 2014. Studies have yet to address its impact on burn patients. METHODS Burn patients in geographic regions that expanded Medicaid coverage were compared to patients in regions that did not expand Medicaid before and after implementation of the ACA using bivariate statistics and a difference-in-differences model. A multivariable logistic regression was used to identify factors associated with having Medicaid insurance. The primary outcome of this study was the rate of Medicaid insurance. RESULTS Of 25,331 discharges, we found greater increases in Medicaid coverage after the ACA in the Medicaid expander regions (23.4-40.2%) compared to the non-expander regions (18.5-20.1%). The difference-in-differences estimate between the expander and non-expander regions was 0.15 (95% CI: 0.11-0.18, p < 0.001). Patients admitted in expander regions were more likely to be insured by Medicaid (OR 1.57 [95%CI 1.21-2.05]), as were patients of Black race (OR 1.25 [95%CI 1.19-1.32), Hispanic ethnicity (OR 1.29 [95%CI 1.14-1.46]), and female sex (OR 1.59 [95%CI 1.11-2.27]). We also found a significant interaction between time period (pre-ACA/post-ACA) and expander region location (OR 2.10 [95%CI 1.67-2.62]). CONCLUSIONS The Medicaid expansion provision of the ACA led to increased Medicaid coverage among burn patients which was significantly higher in areas with widespread implementation of the expansion.
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Affiliation(s)
- Michael K Dalton
- Center for Surgery and Public Health, Harvard Medical School, Harvard T. H. Chan School of Public Health, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA; Department of Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA.
| | - Robert Riviello
- Division of Trauma, Burns, and Surgical Critical Care, Brigham and Women's Hospital, Boston, MA, USA
| | - John C Kubasiak
- Division of Trauma, Burns, and Surgical Critical Care, Brigham and Women's Hospital, Boston, MA, USA
| | - Claire M Sokas
- Center for Surgery and Public Health, Harvard Medical School, Harvard T. H. Chan School of Public Health, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA; Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Samia Y Osman
- Center for Surgery and Public Health, Harvard Medical School, Harvard T. H. Chan School of Public Health, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Ginger Jin
- Center for Surgery and Public Health, Harvard Medical School, Harvard T. H. Chan School of Public Health, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA
| | | | - Gezzer Ortega
- Center for Surgery and Public Health, Harvard Medical School, Harvard T. H. Chan School of Public Health, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA.
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Fong ZV, Hashimoto DA, Jin G, Haynes AB, Perez N, Qadan M, Ferrone CR, Castillo CFD, Warshaw AL, Lillemoe KD, Traeger LN, Chang DC. Simulated Volume-Based Regionalization of Complex Procedures: Impact on Spatial Access to Care. Ann Surg 2021; 274:312-318. [PMID: 31449139 PMCID: PMC7032992 DOI: 10.1097/sla.0000000000003574] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE This study simulates the regionalization of pancreatectomies to assess its impact on spatial access in terms of patient driving times. BACKGROUND Although policies to regionalize complex procedures to high-volume centers may improve outcomes, the impact on patient access is unknown. METHODS Patients who underwent pancreatectomies from 2005 to 2014 were identified from California's statewide database. Round-trip driving times between patients' home ZIP code and hospital addresses were calculated via Google Maps. Regionalization was simulated by eliminating hospitals performing <20 pancreatectomies/yr, and reassigning patients to the next closest hospital that satisfied the volume threshold. Sensitivity analyses were performed for New York and Medicare patients to assess for influence of geography and insurance coverage, respectively. RESULTS Of 13,317 pancreatectomies, 6335 (47.6%) were performed by hospitals with <20 cases/yr. Patients traveled a median of 49.8 minutes [interquartile range (IQR) 30.8-96.2] per round-trip. A volume-restriction policy would increase median round-trip driving time by 24.1 minutes (IQR 4.5-53.5). Population in-hospital mortality rates were estimated to decrease from 6.7% to 2.8% (P < 0.001). Affected patients were more likely to be racial minorities (44.6% vs 36.5% of unaffected group, P < 0.001) and covered by Medicaid or uninsured (16.3% vs 9.8% of unaffected group, P < 0.001). Sensitivity analyses revealed a 17.8 minutes increment for patients in NY (IQR 0.8-47.4), and 27.0 minutes increment for Medicare patients (IQR 6.2-57.1). CONCLUSIONS A policy that limits access to low-volume pancreatectomy hospitals will increase round-trip driving time by 24 minutes, but up to 54 minutes for 25% of patients. Population mortality rates may improve by 1.5%.
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Affiliation(s)
- Zhi Ven Fong
- Department of Surgery, Massachusetts General Hospital, Boston, MA
| | | | - Ginger Jin
- Department of Surgery, Massachusetts General Hospital, Boston, MA
| | - Alex B Haynes
- Department of Surgery, Massachusetts General Hospital, Boston, MA
| | - Numa Perez
- Department of Surgery, Massachusetts General Hospital, Boston, MA
| | - Motaz Qadan
- Department of Surgery, Massachusetts General Hospital, Boston, MA
| | | | | | - Andrew L Warshaw
- Department of Surgery, Massachusetts General Hospital, Boston, MA
| | - Keith D Lillemoe
- Department of Surgery, Massachusetts General Hospital, Boston, MA
| | - Lara N Traeger
- Behavioral Medicine Service, Department of Psychiatry, Massachusetts General Hospital, Boston, MA
| | - David C Chang
- Department of Surgery, Massachusetts General Hospital, Boston, MA
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21
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Scully RE, Sharma G, Soo Hoo AJ, Walsh J, Jin G, Menard MT, Ozaki CK, Belkin M. Comparative analysis of open abdominal aortic aneurysm repair outcomes across national registries. J Vasc Surg 2021; 75:162-167.e1. [PMID: 34302936 DOI: 10.1016/j.jvs.2021.07.105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 07/02/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE In a recent analysis, we discovered lower mortality after open abdominal aortic aneurysm repair (OAAA) in the Society for Vascular Surgery Vascular Quality Initiative (VQI) database when compared with previously published reports of other national registries. Understanding differentials in these registries is essential for their utility because such datasets increasingly inform clinical guidelines and health policy. METHODS The VQI, American College of Surgeons National Surgical Quality Improvement Program (NSQIP), and National Inpatient Sample (NIS) databases were queried to identify patients who had undergone elective OAAA between 2013 and 2016. χ2 tests were used for frequencies and analysis of variance for continuous variables. RESULTS In total, data from 8775 patients were analyzed. Significant differences were seen across the baseline characteristics included. Additionally, the availability of patient and procedural data varied across datasets, with VQI including a number of procedure-specific variables and NIS with the most limited clinical data. Length of stay, primary insurer, and discharge destination differed significantly. Unadjusted in-hospital mortality also varied significantly between datasets: NIS, 5.5%; NSQIP, 5.2%; and VQI, 3.3%; P < .001. Similarly, 30-day mortality was found to be 3.5% in VQI and 5.9% in NSQIP (P < .001). CONCLUSIONS There are fundamental important differences in patient demographic/comorbidity profiles, payer mix, and outcomes after OAAA across widely used national registries. This may represent differences in outcomes between institutions that elect to participate in the VQI and NSQIP compared with patient sampling in the NIS. In addition to avoiding direct comparison of information derived from these databases, it is critical these differences are considered when making policy decisions and guidelines based on these "real-world" data repositories.
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Affiliation(s)
- Rebecca E Scully
- Division of Vascular and Endovascular Surgery, Brigham and Women's Hospital, Boston, Mass.
| | - Gaurav Sharma
- Division of Vascular Surgery, Kaiser Permanente, Santa Clara, Calif
| | - Andrew J Soo Hoo
- Division of Vascular and Endovascular Surgery, Brigham and Women's Hospital, Boston, Mass
| | - Jillian Walsh
- Department of Surgery, Capital Health Surgical Group, Hopewell, NJ
| | - Ginger Jin
- Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Boston, Mass
| | - Matthew T Menard
- Division of Vascular and Endovascular Surgery, Brigham and Women's Hospital, Boston, Mass
| | - C Keith Ozaki
- Division of Vascular and Endovascular Surgery, Brigham and Women's Hospital, Boston, Mass
| | - Michael Belkin
- Division of Vascular and Endovascular Surgery, Brigham and Women's Hospital, Boston, Mass
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22
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Yan XH, Dong QL, Jin G, Zhu YN, Zhang LP. Effect of Interleukin-17 gene on glomerular ultrastructure and podocyte injury in adriamycin nephropathy rat models. J BIOL REG HOMEOS AG 2021; 35:1001-1010. [PMID: 34159767 DOI: 10.23812/20-741-a] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The aim of this study was to investigate the mechanism of interleukin-17 (IL-17) gene in renal tissues of rats suffering from adriamycin (ADM) nephropathy and its effect on the expression level of characteristic proteins, such as Podocalyxin and Nephrin, in podocytes. Sprague-Dawley (SD) rats were randomly divided into a control group (treated with normal saline) and an ADM group (treated with adriamycin). ADM model rats were transfected with lentivirus and divided into a transfection group (transfected with recombinant plasmid IL-17-shRNA) and a negative control group (transfected with plasmid shNC). Coomassie brilliant blue G-250 (CBB) method was adopted to detect the levels of albumin in urine to validate the model. The ultrastructure of rat glomeruli was observed, and the ratio of T helper 17 cells/regulatory T cells (Th17/Treg) was measured by flow cytometry (FCM). The expression levels of IL-17, forkhead box P3 (Foxp3), Nephrin, and Podocalyxin were detected by real-time quantitative PCR (RT-qPCR) and western blot analysis. Results of the study showed that the proteinuria content of the ADM group was significantly higher than that of the control group (P<0.05). In the ADM group, the glomerular basement membrane had uneven thickness and incomplete structure, which showed foot process fusion and electron dense accumulation. However, the glomerular basal membrane in the transfected rats was thin and intact, and a small amount of epithelial foot process fusion and electron density accumulation were observed. The percentages of Th17 cells and IL-17 levels in the ADM group were significantly higher than those in the control group, while the percentages of Treg cells, Foxp3, Nephrin, and Podocalyxin levels were significantly lower than those in the control group (P<0.05). The percentages of Th17 cells, IL-17, Nephrin, and Podocalyxin in the transfection group were significantly higher than those in the ADM group and the negative control group, while the percentages of Treg cells and Foxp3 were significantly lower than those in the ADM group and the negative control group (P<0.05). The results of this study showed that abnormal activation of Th17/IL-17 cells caused podocyte injury and promoted the occurrence and progression of ADM nephropathy. In addition, inhibition of IL-17 gene expression could improve the imbalance of number of Th17 and Treg cells, which may be potentially applied in treatment of patients with primary nephrotic syndrome (PNS).
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Affiliation(s)
- X H Yan
- Kidney Disease and Dialysis Center, Shaanxi Provincial People's Hospital, Xian, Shaanxi, China
| | - Q L Dong
- Kidney Disease and Dialysis Center, Shaanxi Provincial People's Hospital, Xian, Shaanxi, China
| | - G Jin
- Kidney Disease and Dialysis Center, Shaanxi Provincial People's Hospital, Xian, Shaanxi, China
| | - Y N Zhu
- Kidney Disease and Dialysis Center, Shaanxi Provincial People's Hospital, Xian, Shaanxi, China
| | - L P Zhang
- Kidney Disease and Dialysis Center, Shaanxi Provincial People's Hospital, Xian, Shaanxi, China
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23
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Li B, Guo SW, Shi XH, Shen S, Zhang GX, Gao SZ, Pan YQ, Xu XF, Jin G. [Diagnostic efficacy for predicting intraductal papillary mucinous neoplasms of the pancreas with high grade dysplasia or invasive carcinoma based on the surgery indications in different guidelines]. Zhonghua Wai Ke Za Zhi 2021; 59:359-365. [PMID: 33915626 DOI: 10.3760/cma.j.cn112139-20200507-00365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To evaluate the performance of the European Evidence-based Guidelines on Pancreatic Cystic Neoplasms (EEGPCN)(2018) and International Association of Pancreatology(IAP) Guideline(Version 2017) in predicting high grade dysplasia/invasive carcinoma-intraductal papillary mucinous neoplasm(HGD/INV-IPMN). Methods: A retrospective analysis of 363 patients,who underwent surgical resection in Changhai Hospital affiliated to Navy Medical University from January 2012 to December 2018 and were pathologically identified as (intraductal papillary mucinous neoplasm, IPMN),was performed. The patients,including 230 males and 133 females,aging (61.7±10.1) years(range:19 to 83 years). The proportion of HGD/INV-IPMN who met with the absolute indication(AI) of EEGPCN and high risk stigma(HRS) of IAP were compared. The binary Logistic regression analysis was used to find the independent risk factors of HGD/INV-IPMN.Eight combinations of risk factors derived from relative indication/worrisome feature or risk factors in this study,were made to evaluate the diagnostic efficacy. The area under curve(AUC) of receiver operating characteristics was used to evaluate the the cutoff value of risk factors(①CA19-9≥37 U/ml,②diameter of main pancreatic duct 5.0-9.9 mm,③enhancing mural nodule<5 mm,④(acute) pancreatiti,⑤acyst diameter ≥40 mm,⑤bcyst diameter ≥30 mm, ⑥thickened or enhancing cyst walls,⑦neutrophile granulocyte to lymphocyte ratio(NLR)≥2, ⑧cyst located in head, uncinate or neck,⑨carcinoembryonic antigen(CEA) ≥5 μg/L) number for predicting HGD/INV-IPMN.The accuracy,sensitivity,specificity,positive predictive value,negative predictive value,true positive,true negative,false positive,false negative,positive likelihood ratio,negative likelihood ratio,Youden index and F1 score were calculated. Results: Ninety-two patients(49.5%) of 186 ones who met AI and 85 patients(48.3%) of 176 ones who met HRS were respectively confirmed as HGD/INV-IPMN. In those patients who were not met AI,tumor location,thickened/enhancing cyst wall,CA19-9 elevated,NLR≥2 and CEA elevated were significantly (P<0.05) correlated with HGD/INV-IPMN. And tumor location(head/uncinate/neck vs. body/tail,OR=3.284,95%CI:1.268-8.503,P=0.014),thickened/enhancement cyst wall (with vs.without,OR=2.713,95%CI:1.177-6.252,P=0.019),CA19-9(≥37 U/L vs.<37 U/L, OR=5.086,95%CI:2.05-12.62,P<0.01) and NLR(≥2 vs.<2,OR=2.380,95%CI:1.043-5.434,P=0.039) were the independent risk factors of HGD/INV-IPMN. Patients with ≥4 risk factors of 9 in combination Ⅷ(①②③④⑤b⑥⑦⑧⑨) were diagnosed as HGD/INV-IPMN with the moderate accuracy(71.0%),moderate sensitivity (62.0%) and moderate specificity (73.0%). Patients with ≥4 risk factors of 9 in Combination Ⅶ(①②③④⑤a⑥⑦⑧⑨) were diagnosed as HGD/INV-IPMN with the highest specificity(83.0%) and patients with ≥3 risk factors of 8 in combination Ⅵ(①②③④⑤b⑥⑧⑨) were diagnosed as HGD/INV-IPMN with the highest sensitivity(74.0%). The AUC for diagnosis of HGD/INV-IPMN in combination Ⅵ,Ⅶ and Ⅷ were 0.72,0.75 and 0.75,respectively. Older patients and younger patients could respectively refer to combination Ⅶ and combination Ⅵ to improve the management of IPMN. Conclusions: Patients who meet AI of EEGPCN should undertake resection, otherwise the method we explored is recommended. The method of improvement for diagnosis of HGD/INV-IPMN is relatively applicable and efficient for decision-making of surgery, especially for younger patients with decreasing of missed diagnosis and elder patients with decreasing of misdiagnosis.
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Affiliation(s)
- B Li
- Department of Hepatobiliary Pancreatic Surgery,Changhai Hospital Affiliated to Navy Medical University,Shanghai 200433,China
| | - S W Guo
- Department of Hepatobiliary Pancreatic Surgery,Changhai Hospital Affiliated to Navy Medical University,Shanghai 200433,China
| | - X H Shi
- Department of Hepatobiliary Pancreatic Surgery,Changhai Hospital Affiliated to Navy Medical University,Shanghai 200433,China
| | - S Shen
- Department of Hepatobiliary Pancreatic Surgery,Changhai Hospital Affiliated to Navy Medical University,Shanghai 200433,China
| | - G X Zhang
- Department of Hepatobiliary Pancreatic Surgery,Changhai Hospital Affiliated to Navy Medical University,Shanghai 200433,China
| | - S Z Gao
- Department of Hepatobiliary Pancreatic Surgery,Changhai Hospital Affiliated to Navy Medical University,Shanghai 200433,China
| | - Y Q Pan
- Department of Hepatobiliary Pancreatic Surgery,Changhai Hospital Affiliated to Navy Medical University,Shanghai 200433,China
| | - X F Xu
- Department of Hepatobiliary Pancreatic Surgery,Changhai Hospital Affiliated to Navy Medical University,Shanghai 200433,China
| | - G Jin
- Department of Hepatobiliary Pancreatic Surgery,Changhai Hospital Affiliated to Navy Medical University,Shanghai 200433,China
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Adler JT, Tsai TC, Jin G, Cron DC, Ross-Driscoll KH, Malek SK, Tullius SG, Weissman JS. Association of balanced abdominal organ transplant center volumes with patient outcomes. Clin Transplant 2021; 35:e14217. [PMID: 33405324 DOI: 10.1111/ctr.14217] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 12/12/2020] [Accepted: 12/30/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND The volume-outcome relationship for organ-specific transplantation is well-described; it is unknown if the relative balance of kidney compared with liver volumes within an institution relates to organ-specific outcomes. We assessed the association between relative balance within a transplant center and outcomes. METHODS National retrospective analysis of isolated kidney and liver transplants in United States 2005-2014 followed through 2019. Latent class analysis defined transplant center phenotypes. Multivariate Cox models estimated death-censored graft loss and mortality. RESULTS Latent class analysis identified four phenotypes: kidney only (n = 117), kidney dominant (n = 36), mixed/balanced (n = 90), and liver dominant (n = 13). Compared to mixed centers, the risk of kidney graft loss was higher at kidney-dominant (HR 1.07, p < .001) and liver-dominant (HR 1.10, p < .001) centers, while kidney-only (HR 1.06, p = .01) centers had higher mortality. Liver graft loss was not associated with phenotype, but risk of patient death was lower (HR 0.93, p = .02) at liver dominant and higher (HR 1.06, p = .02) at kidney-dominant centers. CONCLUSIONS A mixed phenotype was associated with improved kidney transplant outcomes, whereas liver transplant outcomes were best at liver-dominant centers. While these findings need to be verified with center-level resources, optimization of shared resources could improve patient and organ outcomes.
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Affiliation(s)
- Joel T Adler
- Division of Transplantation, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA.,Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA, USA
| | - Thomas C Tsai
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA, USA.,Division of General and Gastrointestinal Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Ginger Jin
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA, USA
| | - David C Cron
- Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Katherine H Ross-Driscoll
- Department of Epidemiology, Rollins School of Public Health, Emory University School of Medicine, Emory University, Atlanta, GA, USA
| | - Sayeed K Malek
- Division of Transplantation, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Stefan G Tullius
- Division of Transplantation, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Joel S Weissman
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA, USA
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25
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Li B, Jin G. [Overview of tumor stroma ratio in pancreatic ductal adenocarcinoma]. Zhonghua Wai Ke Za Zhi 2020; 58:813-816. [PMID: 32993270 DOI: 10.3760/cma.j.cn112139-20200505-00360] [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] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The current studies show that tumor microenvironment of malignant tumor plays critical roles in the tumor progression. The stroma is the main component of tumor microenvironment and the tumor-stroma ratio (TSR) may reflect the relationship of tumor and tumor microenvironment, which has drawn increasing attention from the field of clinical research of cancer.With poor survival,pancreatic ductal adenocarcinoma (PDAC) is an aggressive disease characterized by an intense fibrotic stromal response and the clinical researches related with TSR in PDAC are more significant for patients management compared with that in other tumors.The evaluation methods for TSR are not inconsistent in different studies. But the evaluation result of TSR in pathological method based on whole-mount slide image agrees with that in radiological method, so as the prognosis prediction, that TSR>1 indicated poor prognosis.So TSR can be a stratification marker for patients with PDAC to optimize the tumor stage system used currently. The radiological evaluation before surgery widen the clinical application of TSR in the precise and individual management of patients with PDAC.The comparison for evaluation methods of TSR and the relationship of TSR and prognosis are still needed thorough investigation in ongoing studies with a larger number of patients in multiple centers.
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Affiliation(s)
- B Li
- Department of Hepatobiliary Pancreatic Surgery, Changhai Hospital Affiliated to Navy Medical University, Shanghai 200433, China
| | - G Jin
- Department of Hepatobiliary Pancreatic Surgery, Changhai Hospital Affiliated to Navy Medical University, Shanghai 200433, China
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Zhao N, Mao XF, Zheng KL, Zhang YJ, Jin G. [Research progress on the occurrence and prevention of low back pain in naval officers and soldiers]. Zhonghua Lao Dong Wei Sheng Zhi Ye Bing Za Zhi 2020; 38:794-796. [PMID: 33142392 DOI: 10.3760/cma.j.cn121094-20190526-00169] [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] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Low back pain (LBP) is a common occupational disease among naval officers and soldiers. This article reviewed the incidence of LBP in naval personnel in different positions in recent years, and analyzed the causes combined with the operating environment and occupational characteristics of personnel in different positions in order to clarify the causes of LBP in naval officers and soldiers in different positions and improve their awareness of the disease. Moreover, this study aims to help naval officers and soldiers to take protective measures in training life to reduce the incidence of LBP.
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Affiliation(s)
- N Zhao
- The Naval Medical University, Shanghai 200433, China
| | - X F Mao
- Department of Psychology, The Naval Medical University, Shanghai 200433, China
| | - K L Zheng
- Department of General Surgery, Changhai Hospital, The Naval Medical University, Shanghai 200433, China
| | - Y J Zhang
- Department of General Surgery, Changhai Hospital, The Naval Medical University, Shanghai 200433, China
| | - G Jin
- Department of General Surgery, Changhai Hospital, The Naval Medical University, Shanghai 200433, China
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27
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Liu X, He Q, Liang Z, Wu H, Li Y, Zhang Z, Yu L, Dai M, Guo S, Jin G, Shen S, Su Z, Ma C, Xie Z, Liu R. 118MO Circulating tumour DNA methylation are markers for early detection of pancreatic ductal adenocarcinoma (PDAC). Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.10.139] [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: 10/22/2022] Open
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28
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Minami CA, Jin G, King TA, Mittendorf EA. Is less more? The association between hospital volume and low-value breast cancer surgeries. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.29_suppl.68] [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: 11/20/2022] Open
Abstract
68 Background: Hospital volume is often equated with surgical quality. In breast surgical oncology, higher hospital volume has been associated with higher overall survival rates, but whether it is a proxy for quality with respect to low-value care remains unexplored. We thus examined the association between hospital volume and the use of three breast surgeries identified as low-value by the Choosing Wisely campaign. Methods: Patients with stage 0-III unilateral breast cancer diagnosed from 2013-2016 were identified in the National Cancer Database. The outcomes of interest were: 1) contralateral prophylactic mastectomy (CPM), 2) axillary lymph node dissection (ALND) for breast conserving therapy (BCT) patients with cT1-2N0 disease and <2 positive nodes, and 3) sentinel lymph node biopsy (SLNB) in women >70 years old with cT1N0 hormone receptor-positive (HR+) cancer. Multivariable regression models with restricted cubic splines were used to examine the association between annual hospital volume and outcomes of interest, after adjusting for patient-, disease-, and hospital-level risk factors. Results: Overall, 13.6% of 841,610 women with unilateral Stage I-III breast cancer underwent CPM, 9.2% of 832,205 BCT patients with clinical T1-T2N0 disease underwent ALND, and 85.7% of women >70 years of age with cT1N0 HR+ cancer underwent SLNB over the study period. In adjusted analyses that defined hospital volume by decile, patients treated in the first and tenth decile hospitals had lower odds of undergoing CPM as compared to those treated in the middle deciles (Table). BCT patients with cT1-2N0 disease treated in hospitals in the first and second decile had higher odds of undergoing an ALND than patients treated at higher volume hospitals. Hospital volume did not have an overall significant association with SLNB use in women >70 years old with cT1N0 HR+ disease. Conclusions: The relationship between hospital volume and performance of low-value breast surgeries differed for each Choosing Wisely recommendation, indicating that hospital volume is not a reliable proxy for quality with respect to low-value practices. Additional studies to identify practice-specific deimplementation strategies are needed. [Table: see text]
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Affiliation(s)
- Christina Ahn Minami
- Breast Oncology Program, Dana-Farber/Brigham and Women's Cancer Center, Boston, MA
| | - Ginger Jin
- Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Boston, MA
| | - Tari A. King
- Breast Oncology Program, Dana-Farber/Brigham and Women’s Cancer Center, Boston, MA
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Jin G, Zhao J, Yang L. PCN53 Cost-Utility Analysis of Dacomitinib As First-LINE Treatment for Patients with Locally Advanced or Metastatic NON-SMALL CELL LUNG Cancer in China. Value Health Reg Issues 2020. [DOI: 10.1016/j.vhri.2020.07.103] [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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30
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Scully RE, Sharma G, Soo Hoo AJ, Walsh J, Jin G, Menard MT, Ozaki CK, Belkin M. Comparative Analysis of Open Abdominal Aortic Aneurysm Repair Outcomes Across National Registries. J Vasc Surg 2020. [DOI: 10.1016/j.jvs.2020.06.037] [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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31
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Liu X, He Q, Su Z, Guo S, Liang Z, Jin G. 1211P Early detection of pancreatic ductal adenocarcinoma (PDAC) using methylation signatures in circulating tumour DNA. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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32
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Gupta A, Jin G, Reich A, Prigerson HG, Ladin K, Kim D, Ashana DC, Cooper Z, Halpern SD, Weissman JS. Association of Billed Advance Care Planning with End-of-Life Care Intensity for 2017 Medicare Decedents. J Am Geriatr Soc 2020; 68:1947-1953. [PMID: 32853429 DOI: 10.1111/jgs.16683] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 04/21/2020] [Accepted: 05/19/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND/OBJECTIVE The Centers for Medicare & Medicaid Services (CMS) reimburses clinicians for advance care planning (ACP) discussions with Medicare patients. The objective of the study was to examine the association of CMS-billed ACP visits with end-of-life (EOL) healthcare utilization. DESIGN Patient-level analyses of claims for the random 20% Medicare fee-for-service (FFS) sample of decedents in 2017. To account for multiple comparisons, Bonferroni adjusted P value <.008 was considered statistically significant. SETTING Nationally representative sample of Medicare FFS beneficiaries. PARTICIPANTS A total of 237,989 Medicare FFS beneficiaries who died in 2017 and included those with and without a billed ACP visit during 2016-17. INTERVENTION The key exposure variable was receipt of first billed ACP (none, >1 month before death). MEASUREMENTS Six measures of EOL healthcare utilization or intensity (inpatient admission, emergency department [ED] visit, intensive care unit [ICU] stay, and expenditures within 30 days of death, in-hospital death, and first hospice within 3 days of death). Analyses was adjusted for age, race, sex, Charlson Comorbidity Index, expenditure by Dartmouth hospital referral region (high, medium, or low), and dual eligibility. RESULTS Overall, 6.3% (14,986) of the sample had at least one billed ACP visit. After multivariable adjustment, patients with an ACP visit experienced significantly less intensive EOL care on four of six measures: hospitalization (odds ratio [OR] = .77; 95% confidence interval [CI] = .74-.79), ED visit (OR = .77; 95% CI = .75-.80), or ICU stay (OR = .78; 95% CI = .74-.81) within a month of death; and they were less likely to die in the hospital (OR = .79; 95% CI = .76-.82). There were no differences in the rate of late hospice enrollment (OR = .97; 95% CI = .92-1.01; P = .119) or mean expenditures ($242.50; 95% CI = -$103.63 to $588.61; P = .169). CONCLUSION Billed ACP visits were relatively uncommon among Medicare FFS decedents, but their occurrence was associated with less intensive EOL utilization. Further research on the variables affecting hospice use and expenditures in the EOL period is recommended to understand the relative role of ACP.
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Affiliation(s)
- Avni Gupta
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Department of Public Health Policy and Management, School of Global Public Health, New York University, New York, USA
| | - Ginger Jin
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Amanda Reich
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Holly G Prigerson
- Cornell Center for Research on End-of-Life Care, Weill Cornell Medicine, New York, New York, USA
| | - Keren Ladin
- Department of Occupational Therapy and Community Health, Tufts University, Boston, Massachusetts, USA.,Research on Ethics, Aging, and Community Health (REACH), Tufts University, Boston, Massachusetts, USA
| | - Dae Kim
- Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts, USA
| | - Deepshikha Charan Ashana
- Palliative and Advanced Illness Research (PAIR) Center, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Zara Cooper
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Scott D Halpern
- Palliative and Advanced Illness Research (PAIR) Center, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Joel S Weissman
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts, USA
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Yang WF, Qin N, Song X, Jiang C, Li T, Ji P, Li Y, Ding D, Wang C, Dai J, Jin G, Chen TW, Chang YS, Ouyang DQ, Liao GQ, Hu Z, Chang KP, Su YX, Ma H. Genomic Signature of Mismatch Repair Deficiency in Areca Nut-Related Oral Cancer. J Dent Res 2020; 99:1252-1261. [PMID: 32527169 DOI: 10.1177/0022034520930641] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 12/30/2022] Open
Abstract
Areca nut (AN) chewing contributes to an increase of oral squamous cell carcinoma (OSCC) cases in South and Southeast Asia; however, genomic events underlying the carcinogenesis process of AN-related OSCC remain unclear. Here, we comprehensively describe the genomic and transcriptome alterations of 113 Chinese OSCC patients (89 AN related and 24 AN negative) by whole-exome sequencing and RNA sequencing, and we compared the genomic differences between AN-related and AN-negative samples by integrating sequencing data of 325 OSCC patients from The Cancer Genome Atlas database and 50 from a published Taiwanese study. We identified 11 significantly mutated genes for OSCC, including 4 novel ones (ATG2A, WEE1, DST, and TSC2), of which WEE1 and ATG2A mutated with significantly higher rates in AN-related samples (P = 0.04 and P = 0.003, respectively). Mutational signature analysis revealed that AN-related OSCCs were specially characterized by the genomic signature of mismatch repair deficiency (dMMR), which could also predict the prognosis status of AN-related OSCC. In addition, an elevated PD-L1 expression was also observed in both AN-related patients (P = 3.71 × 10-11) and those with a high dMMR level (P = 1.99 × 10-4). Further differential expression analysis and in vitro experiments confirmed the role of dMMR in the development of OSCC induced by AN exposure. Taken together, this study first revealed the molecular profiles and highlighted the role of dMMR in AN-related OSCC among the Chinese population and identified that AN-related OSCC may represent a potential cohort for effective anti-PD-1/L1 immunotherapy.
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Affiliation(s)
- W F Yang
- Oral and Maxillofacial Surgery, Faculty of Dentistry, The University of Hong Kong, Hong Kong, China
| | - N Qin
- Department of Epidemiology, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, Mainland China.,Jiangsu Key Lab of Cancer Biomarkers, Prevention and Treatment, Collaborative Innovation Center for Cancer Medicine, Nanjing Medical University, Nanjing, Mainland China
| | - X Song
- Department of Epidemiology, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, Mainland China.,Jiangsu Key Lab of Cancer Biomarkers, Prevention and Treatment, Collaborative Innovation Center for Cancer Medicine, Nanjing Medical University, Nanjing, Mainland China
| | - C Jiang
- Department of Oral and Maxillofacial Surgery, Xiangya Hospital, Central South University, Changsha, Mainland China
| | - T Li
- Department of Oral and Maxillofacial Surgery, Xiangya Hospital, Central South University, Changsha, Mainland China
| | - P Ji
- Department of Epidemiology, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, Mainland China.,Jiangsu Key Lab of Cancer Biomarkers, Prevention and Treatment, Collaborative Innovation Center for Cancer Medicine, Nanjing Medical University, Nanjing, Mainland China
| | - Y Li
- Department of Epidemiology, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, Mainland China.,Jiangsu Key Lab of Cancer Biomarkers, Prevention and Treatment, Collaborative Innovation Center for Cancer Medicine, Nanjing Medical University, Nanjing, Mainland China
| | - D Ding
- Department of Epidemiology, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, Mainland China.,Jiangsu Key Lab of Cancer Biomarkers, Prevention and Treatment, Collaborative Innovation Center for Cancer Medicine, Nanjing Medical University, Nanjing, Mainland China
| | - C Wang
- Department of Epidemiology, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, Mainland China.,Jiangsu Key Lab of Cancer Biomarkers, Prevention and Treatment, Collaborative Innovation Center for Cancer Medicine, Nanjing Medical University, Nanjing, Mainland China.,Department of Bioinformatics, School of Biomedical Engineering and Informatics, Nanjing Medical University, Nanjing, Mainland China
| | - J Dai
- Department of Epidemiology, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, Mainland China.,Jiangsu Key Lab of Cancer Biomarkers, Prevention and Treatment, Collaborative Innovation Center for Cancer Medicine, Nanjing Medical University, Nanjing, Mainland China
| | - G Jin
- Department of Epidemiology, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, Mainland China.,Jiangsu Key Lab of Cancer Biomarkers, Prevention and Treatment, Collaborative Innovation Center for Cancer Medicine, Nanjing Medical University, Nanjing, Mainland China
| | - T W Chen
- Molecular Medicine Research Center, Chang Gung University, Taoyuan, Taiwan
| | - Y S Chang
- Molecular Medicine Research Center, Chang Gung University, Taoyuan, Taiwan.,Department of Otolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - D Q Ouyang
- Department of Oral and Maxillofacial Surgery, Guanghua School of Stomatology, Sun Yat-sen University, Guangzhou, Mainland China
| | - G Q Liao
- Department of Oral and Maxillofacial Surgery, Guanghua School of Stomatology, Sun Yat-sen University, Guangzhou, Mainland China
| | - Z Hu
- Department of Epidemiology, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, Mainland China.,Jiangsu Key Lab of Cancer Biomarkers, Prevention and Treatment, Collaborative Innovation Center for Cancer Medicine, Nanjing Medical University, Nanjing, Mainland China
| | - K P Chang
- Molecular Medicine Research Center, Chang Gung University, Taoyuan, Taiwan.,Department of Otolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Y X Su
- Oral and Maxillofacial Surgery, Faculty of Dentistry, The University of Hong Kong, Hong Kong, China
| | - H Ma
- Department of Epidemiology, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, Mainland China.,Jiangsu Key Lab of Cancer Biomarkers, Prevention and Treatment, Collaborative Innovation Center for Cancer Medicine, Nanjing Medical University, Nanjing, Mainland China
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Jin G, Yang Y, Tuo G, Wang W, Zhu Z. LncRNA TUG1 promotes tumor growth and metastasis of esophageal squamous cell carcinoma by regulating XBP1 via competitively binding to miR-498. Neoplasma 2020; 67:751-761. [PMID: 32305055 DOI: 10.4149/neo_2020_190805n717] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 09/18/2019] [Indexed: 11/08/2022]
Abstract
Esophageal squamous cell carcinoma (ESCC) is a major subtype of esophageal cancer with high mortality. Previous reports suggested that lncRNA taurine upregulated gene 1 (TUG1) functioned as an oncogene in numerous cancers. The purpose of this study was to explore the potential mechanism of TUG1 carcinogenesis in ESCC. The expression of TUG1 and miR-498 was measured by a quantitative real-time polymerase chain reaction (qRT-PCR). Cell proliferation and apoptosis were assessed by 3-(4, 5-dimethyl-2-thiazolyl)-2, 5-diphenyl-2-H-tetrazolium bromide (MTT) assay and flow cytometry. Cell migration and invasion were identified through the transwell assay. The interaction between miR-498 and TUG1 or X-box binding protein 1 (XBP1) was predicted by bioinformatics software starBase and verified by luciferase reporter assay. The expression of XBP1 was quantified by qRT-PCR and western blot analysis. Xenograft tumor mouse model was established to determine the function of TUG1 in vivo. TUG1 was upregulated in ESCC tissues and cells, and its high expression was associated with tumor lymph node metastasis and low cumulative survival. TUG1 knockdown inhibited proliferation, migration, and invasion but promoted apoptosis in ESCC cells. It was confirmed that miR-498 was a target of TUG1, and XBP1 was a target of miR-498. The expression of miR-498 was reduced in ESCC tissues while XBP1 expression was notably enhanced. Mechanism analysis manifested that TUG1 regulated proliferation, apoptosis, migration, and invasion by upregulating XBP1 via targeting miR-498 in vitro. Furthermore, knockdown of TUG1 attenuated tumor growth in vivo. TUG1 accelerated tumorigenesis and metastasis by inducing XBP1 expression through directly targeting miR-498 in ESCC.
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Affiliation(s)
- G Jin
- Department of Thoracis Surgery 2, Gansu Provincial Hospital, Lanzhou, China
| | - Y Yang
- Department of Clinical Medicine, Gansu University of Traditional Chinese Medicine, Lanzhou, China
| | - G Tuo
- Department of Clinical Medicine, Gansu University of Traditional Chinese Medicine, Lanzhou, China
| | - W Wang
- Department of Thoracis Surgery 2, Gansu Provincial Hospital, Lanzhou, China
| | - Z Zhu
- Department of Thoracis Surgery 2, Gansu Provincial Hospital, Lanzhou, China
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Fong ZV, Chang DC, Hur C, Jin G, Tramontano A, Sell NM, Warshaw AL, Fernandez-Del Castillo C, Ferrone CR, Lillemoe KD, Qadan M. Variation in long-term oncologic outcomes by type of cancer center accreditation: An analysis of a SEER-Medicare population with pancreatic cancer. Am J Surg 2020; 220:29-34. [PMID: 32265013 DOI: 10.1016/j.amjsurg.2020.03.035] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [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: 03/23/2020] [Revised: 03/26/2020] [Accepted: 03/27/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND Cancer center accreditation is designed to identify centers that provide high-quality cancer care. This also guides patients and referring physicians towards centers of excellence for specialized care. We sought to examine if cancer center accreditation was associated with improved long-term oncologic outcomes in patients with pancreatic adenocarcinoma. METHODS Using the SEER-Medicare database, we identified patients who underwent pancreatectomy for pancreatic adenocarcinoma from 1996 to 2013. Hospitals were categorized into three groups: National Cancer Institute-designated (NCI-designated) centers, Commission on Cancer (CoC)-accredited centers, and "non-accredited" (NA) centers. Multilevel mixed-effects models were used to calculate adjusted examined lymph nodes, disease-specific survival (DSS), and overall survival (OS). RESULTS We identified 5,118 patients who underwent pancreatectomy at 632 hospitals (41.0% NA, 49.6% CoC, 9.4% NCI). NCI-designated centers had a greater median number of lymph nodes examined compared with CoC-accredited or NA centers (14 vs. 10 vs. 11.0 nodes, respectively; p < 0.001). Patients treated at NCI centers had a higher 5-year DSS compared to those treated at CoC or NA centers (31.2% vs. 23.6% vs. 23.0%, respectively; p < 0.001). Finally, patients treated at NCI centers had a higher 5-year OS compared to those treated at CoC or NA centers (23.5% vs. 18.9% vs. 17.9%, respectively; p < 0.001). The associations held true when adjusted analyses were performed. CONCLUSION Patients with resected pancreatic cancer treated at NCI-designated centers were associated with improved long-term oncologic outcomes. There was no difference between CoC-accredited centers compared with NA centers. Meticulous validation of accreditation is warranted globally prior to implementation.
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Affiliation(s)
- Zhi Ven Fong
- Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - David C Chang
- Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Chin Hur
- Institute for Technology Assessment, Massachusetts General Hospital, Boston, MA, USA
| | - Ginger Jin
- Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Angela Tramontano
- Institute for Technology Assessment, Massachusetts General Hospital, Boston, MA, USA
| | - Naomi M Sell
- Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Andrew L Warshaw
- Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
| | | | | | - Keith D Lillemoe
- Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Motaz Qadan
- Department of Surgery, Massachusetts General Hospital, Boston, MA, USA.
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Wang HR, Li J, Li ZL, Tu JP, Jin G, Su J, Wang JJ. [Five million wear simulation and particle analysis of carbon-based nano-multilayer coatings titanium alloy femoral head]. Zhonghua Yi Xue Za Zhi 2020; 100:546-551. [PMID: 32164109 DOI: 10.3760/cma.j.issn.0376-2491.2020.07.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To analyze the wear debris characteristics ofcarbon-based nano- multilayer coatings on Ti(6)Al(4)V alloys and compared with the cobalt chromium molybdenum alloy (CoCrMo) femoral head to evaluate the friction and wear performance of the new coated femoral head. Methods: Three groups were set up in the wear simulation experiment according to the type of femoral head. Group A: imported Cobalt-Chromium-Molybdenum alloy femoral head (CoCrMo); group B: Titanium alloy femoral head (Ti(6)Al(4)V) with carbon-based nano-multilayer coatings; group C: domestic Cobalt-Chromium-Molybdenum alloy femoral head (CoCrMo). All heads were jointed with an ultra-high molecular weight polyethylene (UHMWPE) acetabular cup. Serum samples were collected and stored in the hip joint simulator. After the sample has been digested and diluted, it was filtered through 5 μm, 1.2 μm and 0.4 μm filters, and the filter paper was collected for testing. Scanning electron microscope (SEM) was used to randomly select regions on the filter to obtain images of wear debris. Energy dispersive X-ray spectroscopy (EDS) was used to determine the elemental type of the particle and to eliminate possible contamination. The composition and structure of the abrasive chips were measured using Fourier transform infrared spectrometer (FTIR). The parameters related to the wear debris includingparticle size, shape, number and volume were calculated. The differences in correlation parameters between the groups were compared to evaluate the friction and wear properties of the new coated joints. Results: The main component of the wear debris produced was UHMWPE, and the particle size was mostly below 1 μm. The submicron particle ratio of group B was 49.4%, which was significantly lower than that of the group A and C (75% and 60%, respectively; χ(2)=66.032, 31.754, both P<0.017). The shape was mainly round, and there was no statistical difference between the groups (χ(2)=0.590, P=0.744). The number of particles in group B was significantly less than that of group C on all filters (t=9.960, 8.019, 5.790, all P<0.01), and less than group A on the 0.4 μm filter (t=7.810, P=0.000). Conclusion: The frictional wear performance of the new carbon-based nano-multilayer coatings femoral head is significantly better than that of the domestic femoral head, and even partially exceeds the imported femoral head level, which helps to reduce the production of particles and prevent osteolysis and aseptic loosening induced by UHMWPE particles.
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Affiliation(s)
- H R Wang
- Department of Orthopedics, People's Liberation Army General Hospital, Beijing 100853, China
| | - J Li
- Department of Orthopedics, People's Liberation Army General Hospital, Beijing 100853, China
| | - Z L Li
- Department of Orthopedics, People's Liberation Army General Hospital, Beijing 100853, China
| | - J P Tu
- School of Materials Science and Engineering, Zhejiang University, Hangzhou 310027, China
| | - G Jin
- Zhongaohuicheng Technology Co., Beijing 100176, China
| | - J Su
- Beijing Institute of Medical Instruments, Beijing 101111, China
| | - J J Wang
- Beijing Institute of Medical Instruments, Beijing 101111, China
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Reich AJ, Jin G, Gupta A, Kim D, Lipstiz S, Prigerson HG, Tjia J, Ladin K, Halpern SD, Cooper Z, Weissman JS. Utilization of ACP CPT codes among high-need Medicare beneficiaries in 2017: A brief report. PLoS One 2020; 15:e0228553. [PMID: 32023311 PMCID: PMC7001931 DOI: 10.1371/journal.pone.0228553] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Accepted: 01/17/2020] [Indexed: 01/03/2023] Open
Abstract
Importance Medicare beneficiaries with high medical needs can benefit from Advance Care Planning (ACP). Medicare reimburses clinical providers for ACP discussions, but it is unknown whether high-need beneficiaries are receiving this service. Objective To compare rates of billed ACP discussions among a cohort of high-need Medicare beneficiaries with the non-high-needs Medicare population. Design Retrospective analysis of Medicare Fee-for-Service (FFS) claims in 2017 comparing high-need beneficiaries (seriously ill, frail, ESRD, and disabled) with non-high need beneficiaries. Setting Nationally representative FFS Medicare 20% sample Participants Medicare beneficiaries were assigned to one of the following classifications: seriously ill (65+), frail (65+), seriously ill & frail (65+); non-high need (65+); end stage renal disease (ESRD) or disabled (<65). All participants had data available for years 2016–2017. Exposure Receipt of a billed ACP discussion, CPT codes 99497 or 99498. Main outcome and measure Rates of billed ACP visits were compared between high-need patients and non-high-need patients. Rates were adjusted for the 65+ population for sex, age, race/ethnicity, Charlson comorbidity index, Medicare/Medicaid dual eligibility status, and Hospital Referral Region. Results Among the 65+ groups, those most likely to have a billed ACP discussion included seriously ill & frail (5.2%), seriously ill (4.2%), and frail (3.3%). Rates remained consistent after adjusting (4.5%, 4.0%, 3.1%, respectively). Each subgroup differed significantly (p < .05) from non-high need beneficiaries (2.3%) in both unadjusted and adjusted analyses. Among the <65 high need groups, the rates were 2.7% for ESRD and 1.3% for the disabled (the latter p < .05 compared with non-high needs). Conclusions and relevance While rates of billed ACP discussions varied among patient groups with high medical needs, overall they were relatively low, even among a cohort of patients for whom ACP may be especially relevant.
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Affiliation(s)
- Amanda J. Reich
- Center for Surgery and Public Health, Brigham and Women’s Hospital, Boston, MA, United States of America
- * E-mail:
| | - Ginger Jin
- Center for Surgery and Public Health, Brigham and Women’s Hospital, Boston, MA, United States of America
| | - Avni Gupta
- Center for Surgery and Public Health, Brigham and Women’s Hospital, Boston, MA, United States of America
- Department of Health Policy, College of Global Public Health, New York University, New York, NY, United States of America
| | - Dae Kim
- Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA, United States of America
| | - Stuart Lipstiz
- Center for Surgery and Public Health, Brigham and Women’s Hospital, Boston, MA, United States of America
| | - Holly G. Prigerson
- Cornell Center for Research on End-of-Life Care, Weill Cornell Medicine, New York, NY, United States of America
| | - Jennifer Tjia
- Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, United States of America
| | - Keren Ladin
- Center for Surgery and Public Health, Brigham and Women’s Hospital, Boston, MA, United States of America
- Research on Ethics, Aging, and Community Health (REACH), Tufts University, Boston, MA, United States of America
| | - Scott D. Halpern
- Palliative and Advanced Illness Research (PAIR) Center, University of Pennsylvania, Philadelphia, PA, United States of America
- The Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Pennsylvania, Philadelphia, PA, United States of America
| | - Zara Cooper
- Center for Surgery and Public Health, Brigham and Women’s Hospital, Boston, MA, United States of America
| | - Joel S. Weissman
- Center for Surgery and Public Health, Brigham and Women’s Hospital, Boston, MA, United States of America
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Shi XH, Jin G. [Practice and challenge of precision medicine for pancreatic cancer]. Zhonghua Wai Ke Za Zhi 2020; 58:37-41. [PMID: 31902168 DOI: 10.3760/cma.j.issn.0529-5815.2020.01.009] [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] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Pancreatic cancer is the most lethal malignancy with an overall 5-year survival rate less than 9%, mainly due to late diagnosis and lack of effective therapeutic options.In the last decade, post-operative survival has been enhanced with advent of neoadjuvant therapy and combined adjuvant therapy.Furthermore, the information gained from the omics data, including next generation sequencing data, hasn't yet begun to affect treatment of pancreatic cancer patients.However, in terms of precision medicine, pancreatic cancer has always lagged behind other tumors.Therefore, combined with practical experience, summary of the latest development and research progress of precise medical treatment of pancreatic cancer, especially from the fields of molecular biology and experimental models, is of critical importance. Further development of precise medicine for pancreatic cancer based on platforms using PDX and organoid model would promisingly help in effective improvement of clinical treatment.
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Affiliation(s)
- X H Shi
- Department of Hepatobiliary Pancreatic Surgery, Changhai Hospital, Navy Military Medical University, Shanghai 200433, China
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Tully KH, Nguyen DD, Herzog P, Jin G, Noldus J, Nguyen PL, Kibel AS, Sun M, McGregor B, Basaria S, Trinh QD. Risk of Dementia and Depression in Young and Middle-aged Men Presenting with Nonmetastatic Prostate Cancer Treated with Androgen Deprivation Therapy. Eur Urol Oncol 2019; 4:66-72. [PMID: 31624049 DOI: 10.1016/j.euo.2019.08.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [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: 06/09/2019] [Revised: 07/17/2019] [Accepted: 08/13/2019] [Indexed: 02/05/2023]
Abstract
BACKGROUND Previous studies have found an association between androgen deprivation therapy (ADT) and an increased risk of dementia and depression in elderly men. This association remains controversial, and little is known about the effects of ADT in younger men. OBJECTIVE To examine the association between the receipt of ADT and these outcomes in young men aged 40-64 yr presenting with nonmetastatic prostate cancer (PCa). DESIGN, SETTING, AND PARTICIPANTS For this observational study, we identified 9117 men aged 40-64 yr diagnosed with localized PCa between 2007 and 2014, without a pre-existing neurocognitive diagnosis, using the TRICARE military database. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Kaplan-Meier curves were fitted to compare ADT versus no ADT. We also performed a subgroup analysis in patients undergoing ADT for ≥12 mo. The association between ADT and new-onset dementia or depression was evaluated using inverse-probability-of treatment-weight-adjusted Cox proportional hazards regression analysis. RESULTS AND LIMITATIONS Patients receiving ADT had a significantly higher incidence of depression (30.2 vs 15.8 per 1000 person years) and dementia (17.9 vs 7.5 per 1000 person years). The risk of developing either outcome was higher in the ADT cohort (depression: hazard ratio [HR] 2.07, p < 0.001; dementia: HR 1.70, p = 0.052). Additionally, there was a dose-response relationship between the duration of ADT and either outcome. CONCLUSIONS In our cohort of young men with PCa, the receipt of ADT was associated with an increased risk of developing dementia and depression. Long-term use of ADT was associated with the highest risk of neurocognitive outcomes. PATIENT SUMMARY In this study, we looked at the risk of dementia and depression in patients <65 yr of age undergoing androgen deprivation therapy (ADT) for prostate cancer. We found that these patients had a higher risk of dementia and depression than those who did not undergo ADT.
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Affiliation(s)
- Karl H Tully
- Division of Urological Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Department of Urology and Neurourology, Marien Hospital Herne, Ruhr-University Bochum, Herne, Germany
| | - David-Dan Nguyen
- Division of Urological Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Faculty of Medicine, McGill University, Montreal, QC, Canada
| | - Peter Herzog
- Division of Urological Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Ginger Jin
- Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Joachim Noldus
- Department of Urology and Neurourology, Marien Hospital Herne, Ruhr-University Bochum, Herne, Germany
| | - Paul L Nguyen
- Department of Radiation Oncology, Dana Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Adam S Kibel
- Division of Urological Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Maxine Sun
- Lank Center for Genitourinary Oncology, Dana Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Bradley McGregor
- Lank Center for Genitourinary Oncology, Dana Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Shehzad Basaria
- Research Program in Men's Health: Aging and Metabolism, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Quoc-Dien Trinh
- Division of Urological Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
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Wang X, Liu Y, Meng Z, Wu Y, Wang S, Jin G, Qin Y, Wang F, Wang J, Wang L, Bai J, Shi X, Wen Z, Jia X, Fu X, Wang X, Qin Q, Gao Y, Guo W, Lu S. Impact of plasma EGFR mutation fractions on response to first generation tyrosine-kinase inhibitor in treatment of naïve non-small cell lung cancer patients. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz259.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Wang H, Shao Z, Guo SW, Jing W, Song B, Li G, He TL, Zhou XY, Zhang YJ, Zhou YQ, Hu XG, Jin G. [Analysis of prognostic factors for hyperamylasemia following pancreaticoduodenectomy]. Zhonghua Wai Ke Za Zhi 2019; 57:534-539. [PMID: 31269617 DOI: 10.3760/cma.j.issn.0529-5815.2019.07.011] [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] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To investigate the prognostic factors of hyperamylasemia following pancreaticoduodenectomy (PD) . Methods: Clinical data of 359 patients were collected prospectively who underwent PD by the same group at Changhai Hospital of Navy Medical University from January 2017 to June 2018.There were 212 males and 147 females.The median age was 63 years old (range: 23 to 82 years old) .According to whether the patient's serum amylase was greater than 120 U/L at 0 or 1 day after surgery,the patients were divided into hyperamylasemia group and non-hyperamylasemia group. Univariate analysis and multivariate analysis were used to find out the prognostic factors of hyperamylasemia after PD. Results: Of the 359 patients, 238 cases (66.3%) developed hyperamylasemia.The incidence rate of clinically related pancreatic fistula (15.1% vs.2.5%, P<0.01) , grade B/C post pancreatectomy hemorrhage (8.8% vs. 2.5%, P<0.01) , and surgical site infection (9.2% vs. 3.3%, P=0.04) was significantly higher in the hyperamylasemia group.The severity of complications (CD grade≥Ⅲ: 11.3% vs.4.1%, P=0.023) and postoperative hospital stay (11 days vs. 9 days, P=0.001) were higher in the hyperamylasemia group.In the multivariate analysis, the main pancreatic duct diameter (MPD) ≤3 mm (OR=4.469, 95% CI: 2.563-7.793, P<0.01) , pathological type of disease (pancreatic cancer or pancreatitis) (OR=0.230, 95% CI: 0.122-0.436, P<0.01) and soft texture of pancreas (OR=3.297, 95%CI: 1.930-5.635, P<0.01) were independent prognostic factors for hyperamylasemia. Conclusions: Post-PD hyperamylasemia increased the incidence and severity of postoperative complications after PD.MPD≤3 mm, soft texture of pancreas and pathological type of disease were independent prognostic factors of hyperamylasemia.
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Affiliation(s)
- H Wang
- Department of Hepato-Biliary-Pancreatic Surgery, Changhai Hospital, Navy Medical University, Shanghai 200433, China
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Castillo-Angeles M, Uribe-Leitz T, Jarman M, Jin G, Feeney T, Salim A, Havens JM. Transferred Emergency General Surgery Patients Are at Increased Risk of Death: A NSQIP Propensity Score Matched Analysis. J Am Coll Surg 2019; 228:871-877. [DOI: 10.1016/j.jamcollsurg.2019.01.014] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 12/24/2018] [Accepted: 01/22/2019] [Indexed: 11/28/2022]
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Mody G, Townsend K, Kerwin C, Chavez DL, Boukedes S, Coppolino A, Singh S, Jin G, Wolfe D, Mallidi H, Goldberg H. Steroid Dosing and Delirium after Lung Transplant Surgery. J Heart Lung Transplant 2019. [DOI: 10.1016/j.healun.2019.01.1049] [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: 10/27/2022] Open
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Wu TS, Fu HP, Jin G, Wu HF, Bai HM. Prediction of the livestock carrying capacity using neural network in the meadow steppe. Rangel J 2019. [DOI: 10.1071/rj18058] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
In order to predict the livestock carrying capacity in meadow steppe, a method using back propagation neural network is proposed based on the meteorological data and the remote-sensing data of Normalised Difference Vegetation Index. In the proposed method, back propagation neural network was first utilised to build a behavioural model to forecast precipitation during the grass-growing season (June–July–August) from 1961 to 2015. Second, the relationship between precipitation and Normalised Difference Vegetation Index during the grass-growing season from 2000 to 2015 was modelled with the help of back propagation neural network. The prediction results demonstrate that the proposed back propagation neural network-based model is effective in the forecast of precipitation and Normalised Difference Vegetation Index. Thus, an accurate prediction of livestock carrying capacity is achieved based on the proposed back propagation neural network-based model. In short, this work can be used to improve the utilisation of grassland and prevent the occurrence of vegetation degradation by overgrazing in drought years for arid and semiarid grasslands.
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Shen J, Guo SW, Jin G. [Progress in clinical research of pancreatic cancer: from "resection" to "cure"]. Zhonghua Wai Ke Za Zhi 2019; 57:72-77. [PMID: 30612395] [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] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Because of the high malignancy of pancreatic ductal adenocarcinoma, the cancer-related mortality of pancreatic ductal adenocarcinoma is increasing year by year. Despite advance in surgical techniques, the 5-year survival rate of patients after resection is still less than 30%. Recent studies have found that pancreatic ductal adenocarcinoma is a systemic disease, which may not be cured completely by up-front resection, but requires perioperative multidisciplinary therapy. With the concept of "potentially curable pancreatic cancer" , clinicians need to evaluate the resectability of pancreatic ductal adenocarcinoma accurately before operation, and use the innovative multidisciplinary therapy including neoadjuvant chemoradiotherapy,surgery and adjuvant chemoradiotherapy to improve the R0 resection rate and reduce the risk of early metastasis. Therefore, the therapeutic goal of pancreatic ductal adenocarcinoma is no longer "simple resection" , but long survival through perioperative multidisciplinary treatment. In this article, we briefly introduce the progress of resectability assessment, surgical techniques and perioperative adjuvant therapy of "potentially curable pancreatic cancer" .
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Affiliation(s)
- J Shen
- Department of Hepato-Biliary-Pancreatic Surgery, Changhai Hospital, the Second Military Medical University, Shanghai 200433, China (Shen Jing is working on the Department of General Surgery, No.971 Hospital of NAVY, Qingdao 266071, China)
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Jiang T, Huang M, Jiang T, Gu Y, Wang Y, Wu Y, Ma H, Jin G, Dai J, Hu Z. Genome-wide compound heterozygosity analysis highlighted 4 novel susceptibility loci for congenital heart disease in Chinese population. Clin Genet 2018; 94:296-302. [PMID: 29774522 DOI: 10.1111/cge.13384] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Revised: 04/25/2018] [Accepted: 05/15/2018] [Indexed: 01/25/2023]
Abstract
Genome-wide association studies (GWASs) have achieved great success in deciphering the genetic cause of congenital heart disease (CHD). However, the heritability of CHD remains to be clarified, and numerous genetic factors responsible for occurrence of CHD are yet unclear. In this study, we performed a genome-wide search for relaxed forms of compound heterozygosity (CH) in association with CHD using our existing GWAS data including 2265 individuals (957 CHD cases and 1308 controls). CollapsABEL was used to iteratively test the association between the CH genotype and the CHD phenotype in a sliding window manner. We highlighted 17 genetic loci showing suggestive CH-like associations with CHD (P < 5 × 10-8 ), among which 4 genetic loci had expression quantitative trait loci (eQTL) effects in blood (PeQTL < 0.01). After conditional association analysis, each loci had only 1 independently effective signal reaching the significance threshold (rs2071477/rs3129299 at 6p21.32, P = 2.47 × 10-10 ; rs10773097/rs2880921 at 12q24.31, P = 3.30 × 10-8 ; rs73032040/rs7259476 at 19q13.11, P = 1.14 × 10-8 ; rs10416386/rs4239517 at 19q13.31, P = 1.15 × 10-9 ), together explained 7.83% of the CHD variance. Among these 4 associated loci, outstanding candidates for CHD-associated genes included UBC, CFM2, ZNF302, LYPD3 and CADM4. Although replication studies with larger sample size are warranted, the first CH GWAS of CHD may extend our current knowledge of the genetic contributions to CHD in the Han Chinese population.
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Affiliation(s)
- T Jiang
- State Key Laboratory of Reproductive Medicine, Nanjing Medical University, Nanjing, China.,Department of Epidemiology and Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, China
| | - M Huang
- Department of Epidemiology and Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, China
| | - T Jiang
- State Key Laboratory of Reproductive Medicine, Nanjing Medical University, Nanjing, China.,Department of Epidemiology and Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Y Gu
- State Key Laboratory of Reproductive Medicine, Nanjing Medical University, Nanjing, China.,Department of Epidemiology and Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Y Wang
- State Key Laboratory of Reproductive Medicine, Nanjing Medical University, Nanjing, China.,Department of Epidemiology and Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Y Wu
- Department of Epidemiology and Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, China
| | - H Ma
- Department of Epidemiology and Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, China
| | - G Jin
- State Key Laboratory of Reproductive Medicine, Nanjing Medical University, Nanjing, China.,Department of Epidemiology and Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, China
| | - J Dai
- Department of Epidemiology and Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Z Hu
- State Key Laboratory of Reproductive Medicine, Nanjing Medical University, Nanjing, China.,Department of Epidemiology and Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, China
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Li Y, Yang X, Zhang F, Zhao S, Jin G, Zhao L, Li P, Zhou Y. Abstract No. 576 Orthotopic ovarian cancer: molecular imaging-monitored radiofrequency hyperthermia-enhanced intratumoral herpes simplex virus-thymidine kinase (HSV-TK) gene therapy. J Vasc Interv Radiol 2018. [DOI: 10.1016/j.jvir.2018.01.621] [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] Open
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Jin G, Zheng KL, Guo SW, Shao Z, Liu C, Shi XH, Liu RD, Bai SJ, Jiang H, Bian Y, Hu XG. [Analysis on the clinical therapeutic effects of arterial first approach pancreatoduodenectomy in the treatment of borderline resectable pancreatic adenocarcinoma]. Zhonghua Wai Ke Za Zhi 2017; 55:909-915. [PMID: 29224265 DOI: 10.3760/cma.j.issn.0529-5815.2017.12.007] [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] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To compare the clinical therapeutic effects of arterial first approach pancreaticoduodenectomy(AFA-PD) with standard approach pancreaticoduodenectomy(SPD) in the treatment of borderline resectable pancreatic cancer (BRPC). Methods: A retrospective analysis of the clinical data of 113 cases of pancreatic cancer patients from January 2014 to August 2015 at Department of Hepato-Biliary-Pancreatic Surgery, Changhai Hospital, the Second Military Medical University, including 43 cases in AFA-PD group and 70 cases in SPD group.Every patient had gone high-resolusion computed tomography before the surgery, when BRPC was definitely diagnosed by both experienced radiologist and pancreatic surgeon.There were 24 males and 19 females in the AFA-PD group, with average age of (61.6±10.2)years.And in the SPD group, there were 47 males and 23 females, with average age of (62.7±9.4)years. Results: The operation time was (210.7±31.5)minutes in AFA-PD group, (187.9±27.4)minutes in SPD group, and peroperative bleeding volume was (1 007.1±566.3)ml in AFA-PD group, (700.0±390.0)ml in the other group.Those two indicators of AFA-PD group, compared with SPD group, were relatively higher, the difference was statistically significant(all P<0.01). And with regard to postoperative diarrhea(9.3% vs.5.7%), postoperative 1, 3 days of white blood cells(postoperative 1 day: (13.3±1.1)×10(9)/L vs.(12.4±2.4)×10(9)/L; postoperative 3 days: (12.7±1.6)×10(9)/L vs.(11.7±2.5)×10(9)/L), postoperative 1, 3, 5 days of peritoneal drainage fluid volume(postoperative 1 day: (184±42)ml vs.(156±54)ml; postoperative 3 days: (155±48)ml vs.(133±35)ml; postoperative 5 days: (66±20)ml vs.(47±31)ml), the differences between the two groups were statistically significant (all P<0.05). One patient in the SPD group was treated with unplanned secondary surgery for postoperative intraperitoneal hemorrhage, and the patient was cured and discharged.There was no death in the two groups within 30 days after surgical operation and no patient with positive gastric margin, duodenal margin, or anterior margin.The resection rate of superiormesenteric artery(SMA) margin R0 in AFA-PD group was higher than that in SPD group (P=0.019). The two groups were followed up for 14 to 30 months.As for AFA-PD group, the average survival time, progression free survival time and median survival time was respectively (20.4±1.2)months, (21.5±1.4)months and 20 months.There were 3 cases(7.0%) with local recurrence and 8 cases(18.6%) with liver metastasis or distant metastasis.In the SPD group, the average survival time, progression free survival time and median survival time was (17.1±1.1)months, (16.4±1.3)months and 16 months, respectively.There were 13 cases(18.6%) with local recurrence and 25 cases(35.7%) with liver metastasis or distant metastasis.As a result, the AFA-PD group had longer survival time(P=0.001)and progression free survival time(P=0.002). However, the lower local recurrence and distant metastasis rate in AFA-PD group did not reach statistical standard (P>0.05). Conclusion: The arterial first approach pancreaticoduodenectomy is safe and effective in the treatment of borderline resectable pancreatic cancer, which can improve the resection rate of SMA margin R0, and prolong patient survival time.
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Affiliation(s)
- G Jin
- Department of Hepato-Biliary-Pancreatic Surgery, Changhai Hospital, the Second Military Medical University, Shanghai 200433, China
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Yu L, Zhou L, Xu E, Bi Y, Hu X, Pei X, Jin G. Levothyroxine monotherapy versus levothyroxine and selenium combination therapy in chronic lymphocytic thyroiditis. J Endocrinol Invest 2017; 40:1243-1250. [PMID: 28534148 DOI: 10.1007/s40618-017-0693-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Accepted: 05/12/2017] [Indexed: 12/18/2022]
Abstract
PURPOSE New strategies are needed for prevention and treatment of chronic lymphocytic thyroiditis (CLT). This study aimed to assess whether combination of levothyroxine treatment and selenium (Se) supplementation results in improved therapeutic effects in CLT compared with levothyroxine monotherapy. METHODS An open-label, randomized controlled study was performed in 60 CLT patients assigned to two groups. Levothyroxine group (LT) patients (n = 24) received levothyroxine alone for 3 months; meanwhile, the combination (LTSS) group (n = 36) was administered levothyroxine with selenium yeast capsule. Blood selenium concentrations, anti-thyroid peroxidase (TPO) and anti-thyroglobulin (Tg) antibody levels, and inflammatory cytokine amounts were compared between both groups before and after treatment. RESULTS At baseline, similar values were obtained in both groups for all the parameters assessed (p > 0.05). After treatment, significantly increased blood selenium levels (µg/L) [90.05 (80.69, 107.76) vs. 39.64 (29.42, 51.10), p < 0.001] and decreased anti-TPO antibody (23.63 ± 9.31 vs. 32.00 ± 10.41%, p = 0.002), anti-Tg antibody (35.84 ± 15.21 vs. 45.47 ± 14.24%, p = 0.015) and IL-2 amounts (pg/mL) [159.29 (124.54, 189.70) vs. 226.48 (190.74, 266.56), p < 0.001] were observed in the LTSS group compared with the LT group post-treatment; meanwhile, similar IL-10 concentrations [23.14 (21.65, 28.56) pg/mL vs. 24.68 (21.71, 29.67) pg/mL] were obtained in both groups. Subgroup analysis of patients with hypothyroidism showed the same trend observed in the whole population; in patients with normal thyroid function, only Se and IL-2 amounts differed between the two treatment groups. Correlation analysis of of the indexes: in HT patients, the basal serum selenium concentration was positively correlated with TT4 (r = 0.294, p < 0.05), significantly negatively correlated with TSH (r = -0.343, p < 0.01), and had no significant correlation with TT3 (p > 0.05). CONCLUSIONS These findings indicated that levothyroxine and selenium combination results in improved therapeutic effects than the levothyroxine monotherapy in preventing CLT progression.
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Affiliation(s)
- L Yu
- Department of Endocrinology, The First Affiliated Hospital of Bengbu Medical College, No. 287 Changhuai Road, Bengbu, 233004, Anhui, China
| | - L Zhou
- Department of Endocrinology, The Second Affiliated Hospital of Bengbu Medical College, Bengbu, 233004, Anhui, China
| | - E Xu
- Room of Physical Diagnostics, Bengbu Medical College, Bengbu, 233030, Anhui, China
| | - Y Bi
- Department of Endocrinology, The First Affiliated Hospital of Bengbu Medical College, No. 287 Changhuai Road, Bengbu, 233004, Anhui, China
| | - X Hu
- Department of Endocrinology, The First Affiliated Hospital of Bengbu Medical College, No. 287 Changhuai Road, Bengbu, 233004, Anhui, China
| | - X Pei
- Department of Endocrinology, The First Affiliated Hospital of Bengbu Medical College, No. 287 Changhuai Road, Bengbu, 233004, Anhui, China
| | - G Jin
- Department of Endocrinology, The First Affiliated Hospital of Bengbu Medical College, No. 287 Changhuai Road, Bengbu, 233004, Anhui, China.
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Jin G. The relationship between serum CXCL16 level and carotid vulnerable plaque in patients with ischemic stroke. Eur Rev Med Pharmacol Sci 2017; 21:3911-3915. [PMID: 28975971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
OBJECTIVE We investigated the relationship between the serum macrophage chemokine ligand 16 (CXCL16) levels and the vulnerable carotid plaque in patients with ischemic stroke. PATIENTS AND METHODS We successively selected 118 cases of patients with an initial diagnosis of acute ischemic stroke (time of onset < 72 h), recorded risk factors, including gender, age, family history, smoking, body mass index, blood glucose levels, blood lipid levels, average systolic pressure and diastolic blood pressure (DBP) and homocysteine levels. ELISA was used to detect the levels of serum CXCL16. GE-3000 color Doppler ultrasound diagnostic instrument was applied for the detection of the cervical artery (including a bilateral common carotid artery, internal carotid artery and external carotid artery) intima-media thickness (IMT), plaque number, size, nature (stable and vulnerable) and luminal stenosis rate. Delica EMS-9EBx2P type transcranial Doppler ultrasound (TCD) was used to detect micro-arterial micro-embolic signals (MES). Stroke, according to etiologic type, was divided into large artery atherosclerosis (LAA), small artery occlusion (SAA) and others. RESULTS Serum CXCL16 levels were not significantly correlated with sex, age, family history, smoking, BMI, blood glucose levels, blood lipid levels, mean systolic blood pressure, diastolic blood pressure, and homocysteine levels. Serum CXCL16 levels increased with an increase of IMT, plaque area and lumen stenosis rate. Serum CXCL16 levels of vulnerable plaques were significantly higher than those of stable plaques; differences were statistically significant (p<0.05). It has nothing to do with the number of atherosclerotic plaques. The levels of serum CXCL16 in MES positive group were significantly higher than that in MES negative group; differences were statistically significant (p<0.05). The serum CXCL16 levels of LAA patients were significantly higher than that of SAA and other types of patients; differences were statistically significant (p<0.05). CONCLUSIONS The levels of serum CXCL16 are not related to high-risk factors for acute stroke and closely related to characteristics of atherosclerotic plaque, micro-embolic signals and stroke subtypes.
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Affiliation(s)
- G Jin
- Department of Laboratory Medicine, Brain Hospital, Siping, Jilin Province, China.
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