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Noche JA, Radhakrishnan H, Ubele MF, Boaz K, Mefford JL, Jones ED, Perpich JA, McCarty K, Meacham B, Smiley J, Bailey SAB, Puskás LG, Powell DK, Sordo L, Phelan MJ, Norris CM, Head E, Stark CEL. Age-related brain atrophy and the positive effects of behavioral enrichment in middle-aged beagles. J Neurosci 2024:e2366232024. [PMID: 38561226 DOI: 10.1523/jneurosci.2366-23.2024] [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] [Received: 12/15/2023] [Revised: 02/08/2024] [Accepted: 02/28/2024] [Indexed: 04/04/2024] Open
Abstract
Aging dogs serve as a valuable preclinical model for Alzheimer's disease (AD) due to their natural age-related development of beta-amyloid (Aβ) plaques, human-like metabolism, and large brains that are ideal for studying structural brain aging trajectories from serial neuroimaging. Here we examined the effects of chronic treatment with the calcineurin inhibitor (CNI) tacrolimus or the nuclear factor of activated T cells (NFAT)-inhibiting compound Q134R on age-related canine brain atrophy from a longitudinal study in middle-aged beagles (36 females, 7 males) undergoing behavioral enrichment. Annual MRI was analyzed using modern, automated techniques for region-of-interest -based and voxel-based volumetric assessments. We found that the frontal lobe showed accelerated atrophy with age, while the caudate nucleus remained relatively stable. Remarkably, the hippocampus increased in volume in all dogs. None of these changes were influenced by tacrolimus or Q134R treatment. Our results suggest that behavioral enrichment can prevent atrophy and increase the volume of the hippocampus but does not prevent aging-associated prefrontal cortex atrophy.Significance Statement Aging canines naturally show significant neuropathological similarities to human aging and AD, making them valuable translational models for testing disease-modifying treatments. We applied modern, state-of-the-art longitudinal volumetric analysis approaches to evaluate treatment effects from structural MRI in a large cohort of middle-aged beagles treated with the FDA approved calcineurin inhibitor, tacrolimus, or the experimental NFAT inhibitor, Q134R, while undergoing extensive behavioral enrichment. We show increased hippocampal volumes across all dogs, even control placebo dogs, compelling evidence for a strong enrichment-related benefit on hippocampal structural integrity. Our findings are the first of its kind to demonstrate benefits of behavioral intervention on longitudinal structural brain changes in a higher mammalian model of aging and AD.
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Affiliation(s)
| | - Hamsanandini Radhakrishnan
- University of California, Irvine, Irvine, CA, USA, 92697
- University of Pennsylvania, Philadelphia, PA, USA, 19104
| | | | - Kathy Boaz
- University of Kentucky, Lexington, KY, USA, 40506
| | | | - Erin D Jones
- University of Kentucky, Lexington, KY, USA, 40506
| | | | | | | | | | | | | | | | - Lorena Sordo
- University of California, Irvine, Irvine, CA, USA, 92697
| | | | | | - Elizabeth Head
- University of California, Irvine, Irvine, CA, USA, 92697
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Rafferty S, Bond U, Dunlea E, Phelan MJ, Harty L. Longitudinal audit of outcomes subsequent to teriparatide therapy. Ir Med J 2023; 116:806. [PMID: 37606211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 08/23/2023]
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Sordo L, Ubele MF, Boaz K, Mefford JL, Jones ED, Smiley J, Bresch F, Phelan MJ, Puskas LG, Norris CM, Head E. Effect of calcineurin inhibitors on cognition in a canine model of Alzheimer’s disease. Alzheimers Dement 2022. [DOI: 10.1002/alz.069099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Queder N, Phelan MJ, Taylor L, Tustison N, Doran E, Hom C, Nguyen D, Lai F, Pulsifer M, Price J, Kreisl WC, Rosas HD, Krinsky‐McHale S, Brickman AM, Yassa MA, Schupf N, Silverman W, Lott IT, Head E, Mapstone M, Keator DB, Ances BM, Andrews HF, Bell K, Birn RM, Brickman AM, Bulova P, Cheema A, Chen K, Christian BT, Clare I, Clark L, Cohen AD, Constantino JN, Doran EW, Fagan A, Feingold E, Foroud TM, Handen BL, Hartley SL, Head E, Henson R, Hom C, Honig L, Ikonomovic MD, Johnson SC, Jordan C, Kamboh MI, Keator D, Klunk WE, Kofler JK, Kreisl WC, Krinsky‐McHale SJ, Lai F, Lao P, Laymon C, Lee JH, Lott IT, Lupson V, Mapstone M, Mathis CA, Minhas DS, Nadkarni N, O'Bryant S, Pang D, Petersen M, Price JC, Pulsifer M, Reiman E, Rizvi B, Rosas HD, Schupf N, Silverman WP, Tudorascu DL, Tumuluru R, Tycko B, Varadarajan B, White DA, Yassa MA, Zaman S, Zhang F. Joint-label fusion brain atlases for dementia research in Down syndrome. Alzheimers Dement (Amst) 2022; 14:e12324. [PMID: 35634535 PMCID: PMC9131930 DOI: 10.1002/dad2.12324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 03/28/2022] [Accepted: 04/25/2022] [Indexed: 01/07/2023]
Abstract
Research suggests a link between Alzheimer's Disease in Down Syndrome (DS) and the overproduction of amyloid plaques. Using Positron Emission Tomography (PET) we can assess the in-vivo regional amyloid load using several available ligands. To measure amyloid distributions in specific brain regions, a brain atlas is used. A popular method of creating a brain atlas is to segment a participant's structural Magnetic Resonance Imaging (MRI) scan. Acquiring an MRI is often challenging in intellectually-imparied populations because of contraindications or data exclusion due to significant motion artifacts or incomplete sequences related to general discomfort. When an MRI cannot be acquired, it is typically replaced with a standardized brain atlas derived from neurotypical populations (i.e. healthy individuals without DS) which may be inappropriate for use in DS. In this project, we create a series of disease and diagnosis-specific (cognitively stable (CS-DS), mild cognitive impairment (MCI-DS), and dementia (DEM-DS)) probabilistic group atlases of participants with DS and evaluate their accuracy of quantifying regional amyloid load compared to the individually-based MRI segmentations. Further, we compare the diagnostic-specific atlases with a probabilistic atlas constructed from similar-aged cognitively-stable neurotypical participants. We hypothesized that regional PET signals will best match the individually-based MRI segmentations by using DS group atlases that aligns with a participant's disorder and disease status (e.g. DS and MCI-DS). Our results vary by brain region but generally show that using a disorder-specific atlas in DS better matches the individually-based MRI segmentations than using an atlas constructed from cognitively-stable neurotypical participants. We found no additional benefit of using diagnose-specific atlases matching disease status. All atlases are made publicly available for the research community. Highlight Down syndrome (DS) joint-label-fusion atlases provide accurate positron emission tomography (PET) amyloid measurements.A disorder-specific DS atlas is better than a neurotypical atlas for PET quantification.It is not necessary to use a disease-state-specific atlas for quantification in aged DS.Dorsal striatum results vary, possibly due to this region and dementia progression.
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Affiliation(s)
- Nazek Queder
- Department of Psychiatry and Human BehaviorUniversity of California IrvineIrvineCaliforniaUSA,Department of Neurobiology and Behavior and Center for the Neurobiology of Learning and MemoryUniversity of California IrvineIrvineCaliforniaUSA
| | - Michael J. Phelan
- Institute for Memory Impairments and Neurological DisordersUniversity of California IrvineIrvineCaliforniaUSA
| | - Lisa Taylor
- Department of Psychiatry and Human BehaviorUniversity of California IrvineIrvineCaliforniaUSA
| | - Nicholas Tustison
- Department of RadiologyUniversity of VirginiaCharlottesvilleVirginiaUSA
| | - Eric Doran
- Department of PediatricsUniversity of CaliforniaIrvine Medical CenterOrangeCaliforniaUSA
| | - Christy Hom
- Department of Psychiatry and Human BehaviorUniversity of California IrvineIrvineCaliforniaUSA
| | - Dana Nguyen
- Department of Psychiatry and Human BehaviorUniversity of California IrvineIrvineCaliforniaUSA
| | - Florence Lai
- Massachusetts General HospitalHarvard UniversityBostonMassachusettsUSA
| | - Margaret Pulsifer
- Massachusetts General HospitalHarvard UniversityBostonMassachusettsUSA
| | - Julie Price
- Massachusetts General HospitalHarvard UniversityBostonMassachusettsUSA
| | | | - Herminia D. Rosas
- Massachusetts General HospitalHarvard UniversityBostonMassachusettsUSA
| | - Sharon Krinsky‐McHale
- New York State Institute for Basic Research in Developmental DisabilitiesNew YorkNew YorkUSA
| | - Adam M. Brickman
- Department of NeurologyColumbia UniversityNew YorkNew YorkUSA,Taub Institute for Research on Alzheimer's Disease and the Aging BrainDepartment of NeurologyVagelos College of Physicians and SurgeonsColumbia UniversityNew YorkNew YorkUSA
| | - Michael A. Yassa
- Department of Psychiatry and Human BehaviorUniversity of California IrvineIrvineCaliforniaUSA,Department of Neurobiology and Behavior and Center for the Neurobiology of Learning and MemoryUniversity of California IrvineIrvineCaliforniaUSA,Department of NeurologyUniversity of California IrvineIrvineCaliforniaUSA
| | - Nicole Schupf
- Department of NeurologyColumbia UniversityNew YorkNew YorkUSA,Taub Institute for Research on Alzheimer's Disease and the Aging BrainDepartment of NeurologyVagelos College of Physicians and SurgeonsColumbia UniversityNew YorkNew YorkUSA
| | - Wayne Silverman
- Department of PediatricsUniversity of CaliforniaIrvine Medical CenterOrangeCaliforniaUSA
| | - Ira T. Lott
- Department of PediatricsUniversity of CaliforniaIrvine Medical CenterOrangeCaliforniaUSA
| | - Elizabeth Head
- Department of Pathology & Laboratory MedicineUniversity of California IrvineIrvineCaliforniaUSA
| | - Mark Mapstone
- Department of NeurologyUniversity of California IrvineIrvineCaliforniaUSA
| | - David B. Keator
- Department of Psychiatry and Human BehaviorUniversity of California IrvineIrvineCaliforniaUSA
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Woodworth DC, Sheikh-Bahaei N, Scambray KA, Phelan MJ, Perez-Rosendahl M, Corrada MM, Kawas CH, Sajjadi SA. Dementia is associated with medial temporal atrophy even after accounting for neuropathologies. Brain Commun 2022; 4:fcac052. [PMID: 35350552 PMCID: PMC8952251 DOI: 10.1093/braincomms/fcac052] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 12/30/2021] [Accepted: 03/03/2022] [Indexed: 11/18/2022] Open
Abstract
Brain atrophy is associated with degenerative neuropathologies and the clinical status of dementia. Whether dementia is associated with atrophy independent of neuropathologies is not known. In this study, we examined the pattern of atrophy associated with dementia while accounting for the most common dementia-related neuropathologies. We used data from National Alzheimer’s Coordinating Center (n = 129) and Alzheimer’s Disease Neuroimaging Initiative (n = 47) participants with suitable in vivo 3D-T1w MRI and autopsy data. We determined dementia status at the visit closest to MRI. We examined the following dichotomized neuropathological variables: Alzheimer’s disease neuropathology, hippocampal sclerosis, Lewy bodies, cerebral amyloid angiopathy and atherosclerosis. Voxel-based morphometry identified areas associated with dementia after accounting for neuropathologies. Identified regions of interest were further analysed. We used multiple linear regression models adjusted for neuropathologies and demographic variables. We also examined models with dementia and Clinical Dementia Rating sum of the boxes as the outcome and explored the potential mediating effect of medial temporal lobe structure volumes on the relationship between pathology and cognition. We found strong associations for dementia with volumes of the hippocampus, amygdala and parahippocampus (semi-partial correlations ≥ 0.28, P < 0.0001 for all regions in National Alzheimer’s Coordinating Center; semi-partial correlations ≥ 0.35, P ≤ 0.01 for hippocampus and parahippocampus in Alzheimer’s Disease Neuroimaging Initiative). Dementia status accounted for more unique variance in atrophy in these structures (∼8%) compared with neuropathological variables; the only exception was hippocampal sclerosis which accounted for more variance in hippocampal atrophy (10%). We also found that the volumes of the medial temporal lobe structures contributed towards explaining the variance in Clinical Dementia Rating sum of the boxes (ranging from 5% to 9%) independent of neuropathologies and partially mediated the association between Alzheimer’s disease neuropathology and cognition. Even after accounting for the most common neuropathologies, dementia still had among the strongest associations with atrophy of medial temporal lobe structures. This suggests that atrophy of the medial temporal lobe is most related to the clinical status of dementia rather than Alzheimer's disease or other neuropathologies, with the potential exception of hippocampal sclerosis.
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Affiliation(s)
- Davis C. Woodworth
- Department of Neurology, University of California, Irvine, CA, USA
- Institute for Memory Impairments and Neurological Disorders, University of California, Irvine, CA, USA
| | - Nasim Sheikh-Bahaei
- Department of Radiology, University of Southern California, Los Angeles, CA, USA
| | - Kiana A. Scambray
- Department of Neurology, University of California, Irvine, CA, USA
- Institute for Memory Impairments and Neurological Disorders, University of California, Irvine, CA, USA
| | - Michael J. Phelan
- Institute for Memory Impairments and Neurological Disorders, University of California, Irvine, CA, USA
| | - Mari Perez-Rosendahl
- Department of Neurology, University of California, Irvine, CA, USA
- Department of Pathology and Laboratory Medicine, University of California, Irvine, CA, USA
| | - María M. Corrada
- Department of Neurology, University of California, Irvine, CA, USA
- Institute for Memory Impairments and Neurological Disorders, University of California, Irvine, CA, USA
- Department of Epidemiology, University of California, Irvine, CA, USA
| | - Claudia H. Kawas
- Department of Neurology, University of California, Irvine, CA, USA
- Institute for Memory Impairments and Neurological Disorders, University of California, Irvine, CA, USA
- Department of Neurobiology and Behavior, University of California, Irvine, CA, USA
| | - Seyed Ahmad Sajjadi
- Department of Neurology, University of California, Irvine, CA, USA
- Institute for Memory Impairments and Neurological Disorders, University of California, Irvine, CA, USA
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Melikyan ZA, Phelan MJ, Kawas CH, Corrada MM. High education, but not occupation or work experience, is related to a lower risk of dementia in the oldest‐old: The 90+ Study. Alzheimers Dement 2021. [DOI: 10.1002/alz.053295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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7
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Woodworth DC, Nguyen HL, Phelan MJ, Greenia DE, Corrada MM, Kawas CH, Sajjadi SA. Associations of TDP‐43 vs. Alzheimer’s disease neuropathology with brain atrophy in the oldest‐old: Initial imaging‐pathological results from
The 90+ Study. Alzheimers Dement 2021. [DOI: 10.1002/alz.056545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Keator DB, Doran E, Taylor L, Phelan MJ, Hom C, Tseung K, van Erp TGM, Potkin SG, Brickman AM, Rosas DH, Yassa MA, Silverman W, Lott IT. Brain amyloid and the transition to dementia in Down syndrome. Alzheimers Dement (Amst) 2020; 12:e12126. [PMID: 33204814 PMCID: PMC7656170 DOI: 10.1002/dad2.12126] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 09/30/2020] [Accepted: 10/01/2020] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Down syndrome (DS) is associated with elevated risk for Alzheimer's disease (AD) due to amyloid beta (Aβ) lifelong accumulation. We hypothesized that the spatial distribution of brain Aβ predicts future dementia conversion in individuals with DS. METHODS We acquired 18F-florbetapir positron emission tomography scans from 19 nondemented individuals with DS at baseline and monitored them for 4 years, with five individuals transitioning to dementia. Machine learning classification using an independent test set determined features on 18F-florbetapir standardized uptake value ratio maps that predicted transition. RESULTS In addition to "AD signature" regions including the inferior parietal cortex, temporal lobes, and the cingulum, we found that Aβ cortical binding in the prefrontal and superior frontal cortices distinguished subjects who transitioned to dementia. Classification did well in predicting transitioners. DISCUSSION Our study suggests that specific regional profiles of brain amyloid in older adults with DS may predict cognitive decline and are informative in evaluating the risk for dementia.
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Affiliation(s)
- David B. Keator
- Department of Psychiatry and Human BehaviorUniversity of California, IrvineIrvineCaliforniaUSA
| | - Eric Doran
- Department of PediatricsIrvine Medical CenterUniversity of CaliforniaOrangeCaliforniaUSA
| | - Lisa Taylor
- Department of Psychiatry and Human BehaviorUniversity of California, IrvineIrvineCaliforniaUSA
| | - Michael J. Phelan
- Department of StatisticsUniversity of California, IrvineIrvineCaliforniaUSA
| | - Christy Hom
- Department of Psychiatry and Human BehaviorUniversity of California, IrvineIrvineCaliforniaUSA
| | | | - Theo G. M. van Erp
- Department of Psychiatry and Human BehaviorUniversity of California, IrvineIrvineCaliforniaUSA
- Center for the Neurobiology of Learning and MemoryUniversity of California, IrvineIrvineCaliforniaUSA
| | - Steven G. Potkin
- Department of Psychiatry and Human BehaviorUniversity of California, IrvineIrvineCaliforniaUSA
| | - Adam M. Brickman
- Department of NeurologyCollege of Physicians and SurgeonsColumbia University, New YorkTaub Institute for Research on Alzheimer's Disease and the Aging BrainNew YorkUSA
| | - Diana H. Rosas
- Massachusetts General HospitalHarvard UniversityBostonMassachusettsUSA
| | - Michael A. Yassa
- Department of Psychiatry and Human BehaviorUniversity of California, IrvineIrvineCaliforniaUSA
- Center for the Neurobiology of Learning and MemoryUniversity of California, IrvineIrvineCaliforniaUSA
- Department of Neurobiology and BehaviorUniversity of California, IrvineIrvineCaliforniaUSA
| | - Wayne Silverman
- Department of PediatricsIrvine Medical CenterUniversity of CaliforniaOrangeCaliforniaUSA
| | - Ira T. Lott
- Department of PediatricsIrvine Medical CenterUniversity of CaliforniaOrangeCaliforniaUSA
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Keator DB, Phelan MJ, Taylor L, Doran E, Krinsky‐McHale S, Price J, Ballard EE, Kreisl WC, Hom C, Nguyen D, Pulsifer M, Lai F, Rosas DH, Brickman AM, Schupf N, Yassa MA, Silverman W, Lott IT. Down syndrome: Distribution of brain amyloid in mild cognitive impairment. Alzheimers Dement (Amst) 2020; 12:e12013. [PMID: 32435685 PMCID: PMC7233421 DOI: 10.1002/dad2.12013] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 01/21/2020] [Indexed: 12/22/2022]
Abstract
INTRODUCTION Down syndrome (DS) is associated with a higher risk of dementia. We hypothesize that amyloid beta (Aβ) in specific brain regions differentiates mild cognitive impairment in DS (MCI-DS) and test these hypotheses using cross-sectional and longitudinal data. METHODS 18F-AV-45 (florbetapir) positron emission tomography (PET) data were collected to analyze amyloid burden in 58 participants clinically classified as cognitively stable (CS) or MCI-DS and 12 longitudinal CS participants. RESULTS The study confirmed our hypotheses of increased amyloid in inferior parietal, lateral occipital, and superior frontal regions as the main effects differentiating MCI-DS from the CS groups. The largest annualized amyloid increases in longitudinal CS data were in the rostral middle frontal, superior frontal, superior/middle temporal, and posterior cingulate cortices. DISCUSSION This study helps us to understand amyloid in the MCI-DS transitional state between cognitively stable aging and frank dementia in DS. The spatial distribution of Aβ may be a reliable indicator of MCI-DS in DS.
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Affiliation(s)
- David B. Keator
- Department of Psychiatry and Human BehaviorUniversity of CaliforniaIrvineCalifornia
| | - Michael J. Phelan
- Institute for Memory Impairments and Neurological Disorders, UCIrvineCalifornia
| | - Lisa Taylor
- Department of Psychiatry and Human BehaviorUniversity of CaliforniaIrvineCalifornia
| | - Eric Doran
- Department of PediatricsUniversity of CaliforniaIrvine Medical CenterOrangeCalifornia
| | - Sharon Krinsky‐McHale
- New York State Institute for Basic Research in Developmental DisabilitiesNew YorkNew York
| | - Julie Price
- Massachusetts General HospitalHarvard UniversityBostonMassachusetts
| | - Erin E. Ballard
- Department of Psychiatry and Human BehaviorUniversity of CaliforniaIrvineCalifornia
| | | | - Christy Hom
- Department of Psychiatry and Human BehaviorUniversity of CaliforniaIrvineCalifornia
| | - Dana Nguyen
- Department of Psychiatry and Human BehaviorUniversity of CaliforniaIrvineCalifornia
| | | | - Florence Lai
- Massachusetts General HospitalHarvard UniversityBostonMassachusetts
| | - Diana H. Rosas
- Massachusetts General HospitalHarvard UniversityBostonMassachusetts
| | - Adam M. Brickman
- Department of Neurology and of EpidemiologyColumbia UniversityNew YorkNew York
| | - Nicole Schupf
- Department of Neurology and of EpidemiologyColumbia UniversityNew YorkNew York
| | - Michael A. Yassa
- Department of Psychiatry and Human BehaviorUniversity of CaliforniaIrvineCalifornia
- Department of Neurobiology and Behavior and Center for the Neurobiology of Learning and MemoryUniversity of CaliforniaIrvineCalifornia
| | - Wayne Silverman
- Department of PediatricsUniversity of CaliforniaIrvine Medical CenterOrangeCalifornia
| | - Ira T. Lott
- Department of PediatricsUniversity of CaliforniaIrvine Medical CenterOrangeCalifornia
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Gahagan JV, Whealon MD, Phelan MJ, Mills S, Jafari MD, Carmichael JC, Stamos MJ, Zell JA, Pigazzi A. Improved survival with adjuvant chemotherapy in locally advanced rectal cancer patients treated with preoperative chemoradiation regardless of pathologic response. Surg Oncol 2019; 32:35-40. [PMID: 31726418 DOI: 10.1016/j.suronc.2019.10.021] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [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: 09/04/2018] [Revised: 07/18/2019] [Accepted: 10/28/2019] [Indexed: 12/23/2022]
Abstract
OBJECTIVE The aim of this study is to examine the effect of postoperative chemotherapy on survival in patients with stage II or III rectal adenocarcinoma who undergo neoadjuvant chemoradiation (CRT) and surgical resection. METHODS A retrospective review of the National Cancer Database (NCDB) from 2006 to 2013 was performed. Cases were analyzed based on pathologic complete response (pCR) status and use of adjuvant therapy. The Kaplan-Meier method was used to estimate overall survival probabilities. RESULTS 23,045 cases were identified, of which 5832 (25.31%) achieved pCR. In the pCR group, 1513 (25.9%) received adjuvant chemotherapy, and in the non-pCR group, 5966 (34.7%) received adjuvant therapy. In the pCR group, five-year survival probability was 87% (95% CI 84%-89%) with adjuvant therapy and 81% (95% CI 79%-82%) without adjuvant therapy. In the non-pCR group, five-year survival probability was 78% (95% CI 76%-79%) with adjuvant therapy and 70% (95% CI 69%-71%) without adjuvant therapy. In the non-pCR and node-negative subgroup (ypN-), five-year survival probability was 86% (95% CI 84%-88%) with adjuvant therapy and 76% (95% CI 74%-77%) without adjuvant therapy. In the non-pCR and node-positive subgroup (ypN+), five-year survival probability was 67% (95% CI 65%-70%) with adjuvant therapy and 60% (95% CI 58%-63%) without adjuvant therapy. CONCLUSIONS Adjuvant chemotherapy in stage II or III rectal adenocarcinoma is associated with increased five-year survival probability regardless of pCR status. We observed similar survival outcomes among non-pCR ypN- treated with adjuvant chemotherapy compared with patients achieving pCR treated with adjuvant chemotherapy.
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Affiliation(s)
- John V Gahagan
- Department of Surgery, University of California, Irvine School of Medicine, Irvine, CA, USA
| | - Matthew D Whealon
- Department of Surgery, University of California, Irvine School of Medicine, Irvine, CA, USA
| | - Michael J Phelan
- Department of Statistics, University of California Irvine, Irvine, CA, USA
| | - Steven Mills
- Department of Surgery, University of California, Irvine School of Medicine, Irvine, CA, USA
| | - Mehraneh D Jafari
- Department of Surgery, University of California, Irvine School of Medicine, Irvine, CA, USA
| | - Joseph C Carmichael
- Department of Surgery, University of California, Irvine School of Medicine, Irvine, CA, USA
| | - Michael J Stamos
- Department of Surgery, University of California, Irvine School of Medicine, Irvine, CA, USA
| | - Jason A Zell
- Department of Medicine, University of California, Irvine School of Medicine, Irvine, CA, USA
| | - Alessio Pigazzi
- Department of Surgery, University of California, Irvine School of Medicine, Irvine, CA, USA.
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Fitzgerald G, O’Connor MB, Phelan MJ. Giant Cell Arteritis Presenting as an Ischaemic Upper Limb. Ir Med J 2018; 111:791. [PMID: 30520618] [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: 06/09/2023]
Abstract
Aim To present an interesting case of giant cell arteritis presenting as ischaemic upper limb. Methods Data was collected from the patient’s chart and from radiology and laboratory systems in our institution. Results The patient had a temporal artery biopsy confirming the diagnosis of temporal arteritis. This was successfully treated with high dose steroids leading to resolution of symptoms in the arm. Conclusion Arteritis is an important consideration to consider in patients who present with limb ischaemia as it is a reversible cause which can be treated effectively.
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Affiliation(s)
- G Fitzgerald
- Department of Rheumatology, Mercy University Hospital, Cork, Ireland
| | - M B O’Connor
- Department of Rheumatology, Mercy University Hospital, Cork, Ireland
| | - M J Phelan
- Department of Rheumatology, Mercy University Hospital, Cork, Ireland
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Head E, Phelan MJ, Doran E, Kim RC, Poon WW, Schmitt FA, Lott IT. Cerebrovascular pathology in Down syndrome and Alzheimer disease. Acta Neuropathol Commun 2017; 5:93. [PMID: 29195510 PMCID: PMC5709935 DOI: 10.1186/s40478-017-0499-4] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Accepted: 11/21/2017] [Indexed: 01/02/2023] Open
Abstract
People with Down syndrome (DS) are at high risk for developing Alzheimer disease (AD) with age. Typically, by age 40 years, most people with DS have sufficient neuropathology for an AD diagnosis. Interestingly, atherosclerosis and hypertension are atypical in DS with age, suggesting the lack of these vascular risk factors may be associated with reduced cerebrovascular pathology. However, because the extra copy of APP leads to increased beta-amyloid peptide (Aβ) accumulation in DS, we hypothesized that there would be more extensive and widespread cerebral amyloid angiopathy (CAA) with age in DS relative to sporadic AD. To test this hypothesis CAA, atherosclerosis and arteriolosclerosis were used as measures of cerebrovascular pathology and compared in post mortem tissue from individuals with DS (n = 32), sporadic AD (n = 80) and controls (n = 37). CAA was observed with significantly higher frequencies in brains of individuals with DS compared to sporadic AD and controls. Atherosclerosis and arteriolosclerosis were rare in the cases with DS. CAA in DS may be a target for future interventional clinical trials.
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Hanna MH, Jafari MD, Jafari F, Phelan MJ, Rinehart J, Sun C, Carmichael JC, Mills SD, Stamos MJ, Pigazzi A. Randomized Clinical Trial of Epidural Compared with Conventional Analgesia after Minimally Invasive Colorectal Surgery. J Am Coll Surg 2017; 225:622-630. [PMID: 28782603 DOI: 10.1016/j.jamcollsurg.2017.07.1063] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2017] [Revised: 07/03/2017] [Accepted: 07/05/2017] [Indexed: 02/04/2023]
Abstract
BACKGROUND The effectiveness of thoracic epidural analgesia (EA) vs conventional IV analgesia (IA) after minimally invasive surgery is still unproven. We designed a randomized controlled trial comparing EA with IA after minimally invasive colorectal surgery. STUDY DESIGN A total of 87 patients who underwent minimally invasive colorectal procedures at a single institution between 2011 and 2014 were enrolled. Eight patients were excluded and 38 were randomized to EA and 41 to IA. Pain was assessed with the Visual Analogue Scale and quality of life with the Overall Benefit of Analgesia Score daily until discharge. RESULTS Mean age was 57 ± 14 years, 43% of patients were female, and mean BMI was 28.6 ± 6 kg/m2. The 2 groups were similar in demographic characteristics and distribution of diagnoses and procedures. Epidural analgesia had a higher incidence of hypotensive systolic blood pressure (<90 mmHg) episodes (9 vs 2; p < 0.05) and a trend toward longer Foley catheter duration (3 ± 2 days vs 2 ± 4 days; p > 0.05). Epidural and IA had equivalent mean lengths of stay (4 ± 3 days vs 4 ± 3 days), daily Visual Analogue Scale scores (2.4 ± 2.0 vs 3.0 ± 2.0), and Overall Benefit of Analgesia Scores (3.2 ± 2.0 vs 3.2 ± 2.0), and similar time to start oral diet (2.8 ± 2 days vs 2.2 ± 1 days). Epidural analgesia patients used a higher total dose of narcotics (147.5 ± 192.0 mg vs 98.1 ± 112.0 mg; p > 0.05). Epidural and IV analgesia had equivalent total hospital charges ($144,991 ± $67,636 vs $141,339 ± $75,579; p > 0.05). CONCLUSIONS This study indicates that EA has no added clinical benefit in patients undergoing minimally invasive colorectal surgery. A trend toward higher total narcotics use and complications with EA was demonstrated.
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Affiliation(s)
- Mark H Hanna
- Department of Surgery, School of Medicine, University of California, Irvine, CA
| | - Mehraneh D Jafari
- Department of Surgery, School of Medicine, University of California, Irvine, CA
| | - Fariba Jafari
- Department of Surgery, School of Medicine, University of California, Irvine, CA
| | | | - Joseph Rinehart
- Department of Anesthesia, School of Medicine, University of California, Irvine, CA
| | - Coral Sun
- Department of Anesthesia, School of Medicine, University of California, Irvine, CA
| | - Joseph C Carmichael
- Department of Surgery, School of Medicine, University of California, Irvine, CA
| | - Steven D Mills
- Department of Surgery, School of Medicine, University of California, Irvine, CA
| | - Michael J Stamos
- Department of Surgery, School of Medicine, University of California, Irvine, CA
| | - Alessio Pigazzi
- Department of Surgery, School of Medicine, University of California, Irvine, CA.
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Gahagan JV, Whealon MD, Phelan MJ, Mills S, Pigazzi A, Stamos MJ, Nguyen NT, Carmichael JC. Lymph Node Positivity in Appendiceal Adenocarcinoma: Should Size Matter? J Am Coll Surg 2017; 225:69-75. [DOI: 10.1016/j.jamcollsurg.2017.01.056] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Revised: 01/09/2017] [Accepted: 01/10/2017] [Indexed: 11/30/2022]
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16
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Whealon MD, Blondet JJ, Gahagan JV, Phelan MJ, Nguyen NT. Volume and outcomes relationship in laparoscopic diaphragmatic hernia repair. Surg Endosc 2017; 31:4224-4230. [PMID: 28342131 DOI: 10.1007/s00464-017-5482-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Accepted: 02/16/2017] [Indexed: 12/26/2022]
Abstract
BACKGROUND There is no published data regarding the relationship between hospital volume and outcomes in patients undergoing laparoscopic diaphragmatic hernia repair. We hypothesize that hospitals performing high case volume have improved outcomes compared to low-volume hospitals. MATERIALS AND METHODS We reviewed the National Inpatient Sample (NIS) database between 2008 and 2012 for adults with the diagnosis of diaphragmatic hernia who underwent elective laparoscopic repair of diaphragmatic Hernia and/or Nissen fundoplication. Pediatric, emergent, and open cases were excluded. Main outcome measures included logistic regression analysis of factors predictive of in-hospital mortality and outcomes according to annual hospital case volume. RESULTS A total of 31,228 laparoscopic diaphragmatic hernia operations were analyzed. The overall in-hospital mortality was 0.14%. Risk factors for higher in-hospital mortality included renal failure (AOR: 6.26; 95% CI: 2.48-15.78; p < 0.001), age>60 years (AOR: 5.06; 95% CI: 2.38-10.76; p < 0.001), and CHF (AOR: 3.80; 95% CI: 1.39-10.38; p = 0.009) while an incremental increase in volume of 10 cases/year (AOR: 0.89; 95% CI: 0.81-0.98; p = 0.019) and diabetes (AOR: 0.34; 95% CI: 0.12-0.93; p = 0.036) decreases mortality. There was a small but significant inverse relationship between hospital case volume and mortality with a 10% reduction in adjusted odds of in-hospital mortality for every increase in 10 cases per year. Using 10 cases per year as the volume threshold, low-volume hospitals (≤10 cases/year) had almost a twofold higher mortality compared to high-volume hospitals (0.23 vs. 0.12%, respectively, p = 0.02). CONCLUSIONS There was a small but significant inverse relationship between the hospitals' case volume and mortality in laparoscopic diaphragmatic hernia repair.
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Affiliation(s)
- Matthew D Whealon
- Department of Surgery, University of California, Irvine School of Medicine, Irvine, 333 City Bldg. West, Suite 1600, Orange, CA, 92868, USA
| | - Juan J Blondet
- Department of Surgery, University of California, Irvine School of Medicine, Irvine, 333 City Bldg. West, Suite 1600, Orange, CA, 92868, USA
| | - John V Gahagan
- Department of Surgery, University of California, Irvine School of Medicine, Irvine, 333 City Bldg. West, Suite 1600, Orange, CA, 92868, USA
| | - Michael J Phelan
- Department of Statistics, University of California, Irvine, Irvine, California, CA, USA
| | - Ninh T Nguyen
- Department of Surgery, University of California, Irvine School of Medicine, Irvine, 333 City Bldg. West, Suite 1600, Orange, CA, 92868, USA.
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Doran E, Keator D, Head E, Phelan MJ, Kim R, Totoiu M, Barrio JR, Small GW, Potkin SG, Lott IT. Down Syndrome, Partial Trisomy 21, and Absence of Alzheimer's Disease: The Role of APP. J Alzheimers Dis 2017; 56:459-470. [PMID: 27983553 PMCID: PMC5662115 DOI: 10.3233/jad-160836] [Citation(s) in RCA: 114] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Overexpression of the amyloid precursor protein (APP) gene on chromosome 21 in Down syndrome (DS) has been linked to increased brain amyloid levels and early-onset Alzheimer's disease (AD). An elderly man with phenotypic DS and partial trisomy of chromosome 21 (PT21) lacked triplication of APP affording an opportunity to study the role of this gene in the pathogenesis of dementia. Multidisciplinary studies between ages 66-72 years comprised neuropsychological testing, independent neurological exams, amyloid PET imaging with 11C-Pittsburgh compound-B (PiB), plasma amyloid-β (Aβ) measurements, and a brain autopsy examination. The clinical phenotype was typical for DS and his intellectual disability was mild in severity. His serial neuropsychological test scores showed less than a 3% decline as compared to high functioning individuals with DS who developed dementia wherein the scores declined 17-28% per year. No dementia was detected on neurological examinations. On PiB-PET scans, the patient with PT21 had lower PiB standard uptake values than controls with typical DS or sporadic AD. Plasma Aβ42 was lower than values for demented or non-demented adults with DS. Neuropathological findings showed only a single neuritic plaque and neurofibrillary degeneration consistent with normal aging but not AD. Taken together the findings in this rare patient with PT21 confirm the obligatory role of APP in the clinical, biochemical, and neuropathological findings of AD in DS.
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Affiliation(s)
- Eric Doran
- Department of Pediatrics, University of California, Irvine, Orange, CA, USA
| | - David Keator
- Department of Psychiatry and Human Behavior, University of California, Irvine, CA, USA
| | - Elizabeth Head
- Sanders-Brown Center on Aging, University of Kentucky, Lexington, KY, USA
| | - Michael J. Phelan
- Department of Statistics, University of California, Irvine, Irvine, CA, USA
| | - Ron Kim
- Department of Pathology, University of California, Irvine, Orange, CA, USA
| | - Minodora Totoiu
- Department of Pediatrics, University of California, Irvine, Orange, CA, USA
| | - Jorge R. Barrio
- Department of Molecular and Medical Pharmacology, David Geffen School of Medicine at University of California, Los Angeles, CA, USA
| | - Gary W. Small
- Department of Psychiatry and Biobehavioral Sciences and the Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine at the University of California, Los Angeles, CA, USA
| | - Steven G. Potkin
- Department of Psychiatry and Human Behavior, University of California, Irvine, CA, USA
| | - Ira T. Lott
- Department of Pediatrics, University of California, Irvine, Orange, CA, USA,Corresponding author: Ira T. Lott, MD, Address: University of California, Irvine Medical Center, 101 The City Drive South, ZC 4482, Orange, CA 92868, Phone: 714-456-5333, Fax: 714-456-8466,
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18
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Gahagan JV, Maximus S, Whealon MD, Phelan MJ, Demirjian A, Joe VC. Analysis of Endoscopic Retrograde Cholangiopancreatography after Positive Intraoperative Cholangiogram: Is it Necessary? Am Surg 2016. [DOI: 10.1177/000313481608201028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
The necessity of routine endoscopic retrograde cholangiopancreatography (ERCP) after positive intraoperative cholangiogram (IOC) during laparoscopic cholecystectomy is not well defined. We aimed to examine the incidence of positive IOC among patients who undergo IOC during cholecystectomy and the rate of subsequent ERCP stone extraction. The Nationwide Inpatient Sample database was reviewed for all patients undergoing cholecystectomy with IOC from 2002 to 2012. Patients were then analyzed for ERCP and stone extraction. A total of 73,508 patients who underwent cholecystectomy with IOC for a diagnosis of acute cholecystitis and found to have a bile duct stone were identified. Of these patients, 5915 underwent subsequent ERCP. In the patients that underwent subsequent ERCP, 1478 had a documented stone extraction during ERCP. The rate of stone extraction in the ERCP subset is 25 per cent, which is 2 per cent of all patients who had a positive IOC. The rate of stone extraction after positive IOC is low. Positive IOC may not warrant a routine postoperative ERCP. Our results suggest that clinical monitoring of patients with positive IOC is reasonable, as the majority of patients with a positive IOC ultimately have no stone extraction.
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Affiliation(s)
- John V. Gahagan
- Department of Surgery, University of California Irvine School of Medicine, Irvine, California and the
| | - Steven Maximus
- Department of Surgery, University of California Irvine School of Medicine, Irvine, California and the
| | - Matthew D. Whealon
- Department of Surgery, University of California Irvine School of Medicine, Irvine, California and the
| | - Michael J. Phelan
- Department of Statistics, University of California Irvine, Irvine, California
| | - Aram Demirjian
- Department of Surgery, University of California Irvine School of Medicine, Irvine, California and the
| | - Victor C. Joe
- Department of Surgery, University of California Irvine School of Medicine, Irvine, California and the
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Gahagan JV, Hanna MH, Whealon MD, Maximus S, Phelan MJ, Lekawa M, Barrios C, Bernal NP. Racial Disparities in Access and Outcomes of Cholecystectomy in the United States. Am Surg 2016. [DOI: 10.1177/000313481608201013] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Disparities in access to health care between white and minority patients are well described. We aimed to analyze the trends and outcomes of cholecystectomy based on racial classification. The Nationwide Inpatient Sample database was reviewed for all patients undergoing cholecystectomy from 2009 to 2012. Patients were stratified as white or non-white. A total of 243,536 patients were analyzed: 159,901 white and 83,635 non-white. Non-white patients had significantly higher proportions of Medicaid (25% vs 9.3%), self-pay (14% vs 7.1%), and no-charge (1.8% vs 0.64%). Non-white patients had significantly higher rates of emergent admission (84% vs 78%) compared with the white patients. Multivariate analysis revealed that non-whites had a significantly longer length of stay [mean difference of 0.14 days, 95% confidence interval (CI) 0.08–0.20] and higher total hospital charges (mean difference of $6748.00, 95% CI 5994.19–7501.81) than whites, despite a lower morbidity (odds ratio 0.94, 95% CI 0.90–0.98). Use of laparoscopy and mortality were not different. These differences persisted on subgroup analysis by insurance type. These findings suggest a gap in access to and outcomes of cholecystectomy in the minority population nationwide.
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Affiliation(s)
- John V. Gahagan
- Department of Surgery, University of California, Irvine School of Medicine, Irvine, California and
| | - Mark H. Hanna
- Department of Surgery, University of California, Irvine School of Medicine, Irvine, California and
| | - Matthew D. Whealon
- Department of Surgery, University of California, Irvine School of Medicine, Irvine, California and
| | - Steven Maximus
- Department of Surgery, University of California, Irvine School of Medicine, Irvine, California and
| | - Michael J. Phelan
- Department of Statistics, University of California Irvine, Irvine, California
| | - Michael Lekawa
- Department of Surgery, University of California, Irvine School of Medicine, Irvine, California and
| | - Cristobal Barrios
- Department of Surgery, University of California, Irvine School of Medicine, Irvine, California and
| | - Nicole P. Bernal
- Department of Surgery, University of California, Irvine School of Medicine, Irvine, California and
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20
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Whealon MD, Morell M, Gahagan JV, Phelan MJ, Nguyen NT. Perioperative Outcomes of African-American Patients Undergoing Bariatric Surgery. J Am Coll Surg 2016. [DOI: 10.1016/j.jamcollsurg.2016.06.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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21
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Gahagan JV, Hanna MH, Whealon MD, Maximus S, Phelan MJ, Lekawa M, Barrios C, Bernal NP. Racial Disparities in Access and Outcomes of Cholecystectomy in the United States. Am Surg 2016; 82:921-925. [PMID: 27779974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Disparities in access to health care between white and minority patients are well described. We aimed to analyze the trends and outcomes of cholecystectomy based on racial classification. The Nationwide Inpatient Sample database was reviewed for all patients undergoing cholecystectomy from 2009 to 2012. Patients were stratified as white or non-white. A total of 243,536 patients were analyzed: 159,901 white and 83,635 non-white. Non-white patients had significantly higher proportions of Medicaid (25% vs 9.3%), self-pay (14% vs 7.1%), and no-charge (1.8% vs 0.64%). Non-white patients had significantly higher rates of emergent admission (84% vs 78%) compared with the white patients. Multivariate analysis revealed that non-whites had a significantly longer length of stay [mean difference of 0.14 days, 95% confidence interval (CI) 0.08-0.20] and higher total hospital charges (mean difference of $6748.00, 95% CI 5994.19-7501.81) than whites, despite a lower morbidity (odds ratio 0.94, 95% CI 0.90-0.98). Use of laparoscopy and mortality were not different. These differences persisted on subgroup analysis by insurance type. These findings suggest a gap in access to and outcomes of cholecystectomy in the minority population nationwide.
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Affiliation(s)
- John V Gahagan
- Department of Surgery, University of California, Irvine School of Medicine, Irvine, California, USA
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22
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Gahagan JV, Maximus S, Whealon MD, Phelan MJ, Demirjian A, Joe VC. Analysis of Endoscopic Retrograde Cholangiopancreatography after Positive Intraoperative Cholangiogram: Is It Necessary? Am Surg 2016; 82:985-988. [PMID: 27779989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
The necessity of routine endoscopic retrograde cholangiopancreatography (ERCP) after positive intraoperative cholangiogram (IOC) during laparoscopic cholecystectomy is not well defined. We aimed to examine the incidence of positive IOC among patients who undergo IOC during cholecystectomy and the rate of subsequent ERCP stone extraction. The Nationwide Inpatient Sample database was reviewed for all patients undergoing cholecystectomy with IOC from 2002 to 2012. Patients were then analyzed for ERCP and stone extraction. A total of 73,508 patients who underwent cholecystectomy with IOC for a diagnosis of acute cholecystitis and found to have a bile duct stone were identified. Of these patients, 5915 underwent subsequent ERCP. In the patients that underwent subsequent ERCP, 1478 had a documented stone extraction during ERCP. The rate of stone extraction in the ERCP subset is 25 per cent, which is 2 per cent of all patients who had a positive IOC. The rate of stone extraction after positive IOC is low. Positive IOC may not warrant a routine postoperative ERCP. Our results suggest that clinical monitoring of patients with positive IOC is reasonable, as the majority of patients with a positive IOC ultimately have no stone extraction.
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Affiliation(s)
- John V Gahagan
- Department of Surgery, University of California Irvine School of Medicine, Irvine, California, USA
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Whealon MD, Young MT, Phelan MJ, Nguyen NT. Effect of Resident Involvement on Patient Outcomes in Complex Laparoscopic Gastrointestinal Operations. J Am Coll Surg 2016; 223:186-92. [DOI: 10.1016/j.jamcollsurg.2016.03.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2016] [Revised: 03/08/2016] [Accepted: 03/08/2016] [Indexed: 12/21/2022]
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24
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Young MT, Phelan MJ, Nguyen NT. A Decade Analysis of Trends and Outcomes of Male vs Female Patients Who Underwent Bariatric Surgery. J Am Coll Surg 2016; 222:226-31. [DOI: 10.1016/j.jamcollsurg.2015.11.033] [Citation(s) in RCA: 72] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2015] [Accepted: 11/25/2015] [Indexed: 12/28/2022]
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25
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Nguyen NT, Vu S, Kim E, Bodunova N, Phelan MJ. Trends in utilization of bariatric surgery, 2009-2012. Surg Endosc 2015; 30:2723-7. [PMID: 26659240 DOI: 10.1007/s00464-015-4535-9] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [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: 05/22/2015] [Accepted: 08/28/2015] [Indexed: 12/11/2022]
Abstract
BACKGROUND Utilization of bariatric surgery has changed dramatically over the past two decades. The aim of this study was to update the trends in volume and procedural type of bariatric surgery in the USA. Data were derived from the National Inpatient Sample from 2009 through 2012. METHODS We used ICD-9 diagnosis and procedural codes to identify all hospitalizations during which a bariatric procedure was performed for the treatment of severe obesity. The data were reviewed for patient demographics and characteristics, annual number of bariatric operations, and specific procedural types and proportion of laparoscopic cases. The US Census data were used to calculate the population-based annual rate of bariatric surgery per 100,000 adults. RESULTS Between 2009 and 2012, the number of inpatient bariatric operations ranged between 81,005 and 114,780 cases annually. During this time period, the annual rate of bariatric procedures was highest for 2012 at 47.3 procedures per 100,000 adults. The bariatric surgery approach most commonly performed continues to be laparoscopic, ranging between 93.1 and 97.1 %. In 2012, there was a precipitous reduction in the number of gastric bypass and gastric banding operations and replaced by an increase in the number of sleeve gastrectomy operation. The in-hospital mortality rate remains low, ranging from 0.07 to 0.10 %. CONCLUSIONS In the USA, the annual volume of inpatient bariatric surgery continues to be stable. Utilization of the laparoscopic approach to bariatric surgery remains high, while the in-hospital mortality continues to be low at ≤0.10 % throughout the 4-year period.
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Affiliation(s)
- Ninh T Nguyen
- Department of Surgery, University of California Irvine Medical Center, 333 City Bldg. West, Suite 1600, Orange, CA, 92868, USA.
| | - Stephen Vu
- Department of Surgery, University of California Irvine Medical Center, 333 City Bldg. West, Suite 1600, Orange, CA, 92868, USA
| | - Eric Kim
- Department of Surgery, University of California Irvine Medical Center, 333 City Bldg. West, Suite 1600, Orange, CA, 92868, USA
| | - Natalia Bodunova
- Department of Surgery, Moscow Clinical Scientific Center, Moscow, Russia
| | - Michael J Phelan
- Department of Statistics, University of California Irvine, Irvine, CA, USA
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Jafari MD, Jafari F, Foe-Paker JE, Phelan MJ, Carmichael JC, Pigazzi A, Mills S, Stamos MJ. Adhesive Small Bowel Obstruction in the United States: Has Laparoscopy Made an Impact? Am Surg 2015. [DOI: 10.1177/000313481508101023] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Adhesions account for 74 per cent of admissions for small bowel obstruction (SBO). There is a lack of data regarding the usage and outcomes of laparoscopy (LS) for SBO. A retrospective review of urgent admissions for SBO using the Nationwide Inpatient Sample 2001 to 2011 was conducted. Among the estimated 3,948,987 SBO admissions, 36.7 per cent underwent operative management and LS was performed in 26.5 per cent with a 22.5 per cent conversion rate. Admissions increased by 3.1 per cent annually, whereas nonoperative management increased by 3.8 per cent annually. Operative management increased by 1.8 per cent annually, whereas LS increased by 8.9 per cent annually and open surgery decreased by 0.6 per cent annually. LS small bowel resection increased by a mean of 25 per cent annually. LS was associated with a 24.4 per cent in-hospital morbidity with intra-abdominal abscess/enteric fistulas (8.3%) and ileus (8.9%) as the most common complications. In-hospital mortality was 0.9 per cent with length of stay of 13 ± 9 days and a hospital charge of $80,080 ± 6,634. The majority of patients were operated on hospital day (HD) 1 (43.0%). Patients who underwent LS on HD >7 had a higher risk-adjusted mortality compared with earlier HD (odds ratio = 2.63; 95% confidence interval: 2.40–2.89; P < 0.01). There has been an increase in admissions for SBO and an increase in LS over the past 11 years. There seems to be an increase in mortality and morbidity with a later HD operation.
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Affiliation(s)
- Mehraneh D. Jafari
- Department of Surgery, University of California, Irvine, Orange, California
| | - Fariba Jafari
- Department of Surgery, University of California, Irvine, Orange, California
| | | | - Michael J. Phelan
- Department of Surgery, University of California, Irvine, Orange, California
| | | | - Alessio Pigazzi
- Department of Surgery, University of California, Irvine, Orange, California
| | - Steven Mills
- Department of Surgery, University of California, Irvine, Orange, California
| | - Michael J. Stamos
- Department of Surgery, University of California, Irvine, Orange, California
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Jafari MD, Jafari F, Foe-Paker JE, Phelan MJ, Carmichael JC, Pigazzi A, Mills S, Stamos MJ. Adhesive Small Bowel Obstruction in the United States: Has Laparoscopy Made an Impact? Am Surg 2015; 81:1028-1033. [PMID: 26463302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Adhesions account for 74 per cent of admissions for small bowel obstruction (SBO). There is a lack of data regarding the usage and outcomes of laparoscopy (LS) for SBO. A retrospective review of urgent admissions for SBO using the Nationwide Inpatient Sample 2001 to 2011 was conducted. Among the estimated 3,948,987 SBO admissions, 36.7 per cent underwent operative management and LS was performed in 26.5 per cent with a 22.5 per cent conversion rate. Admissions increased by 3.1 per cent annually, whereas nonoperative management increased by 3.8 per cent annually. Operative management increased by 1.8 per cent annually, whereas LS increased by 8.9 per cent annually and open surgery decreased by 0.6 per cent annually. LS small bowel resection increased by a mean of 25 per cent annually. LS was associated with a 24.4 per cent in-hospital morbidity with intra-abdominal abscess/enteric fistulas (8.3%) and ileus (8.9%) as the most common complications. In-hospital mortality was 0.9 per cent with length of stay of 13 ± 9 days and a hospital charge of $80,080 ± 6,634. The majority of patients were operated on hospital day (HD) 1 (43.0%). Patients who underwent LS on HD >7 had a higher risk-adjusted mortality compared with earlier HD (odds ratio = 2.63; 95% confidence interval: 2.40-2.89; P < 0.01). There has been an increase in admissions for SBO and an increase in LS over the past 11 years. There seems to be an increase in mortality and morbidity with a later HD operation.
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Affiliation(s)
- Mehraneh D Jafari
- Department of Surgery, University of California, Irvine, Orange, California, USA
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Hanna MH, Jafari MD, Moghadamyeghaneh Z, Phelan MJ, Carmichael JC, Mills SD, Imagawa DK, Pigazzi A, Stamos MJ. Discharge Destination after High-Risk Surgery: Impact on Readmission and Mortality. J Am Coll Surg 2015. [DOI: 10.1016/j.jamcollsurg.2015.07.149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Hwang GS, Moghadamyeghaneh Z, Phelan MJ, Mil S, Pigazzi A, Stamos MJ, Carmichael JC, Hanna MH. Outcomes Associated with Resident Participation in Laparoscopic Colorectal Surgery: Assessing the “Resident Effect”. J Am Coll Surg 2015. [DOI: 10.1016/j.jamcollsurg.2015.07.064] [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]
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Hwang GS, Moghadamyeghaneh Z, Hanna MH, Phelan MJ, Stamos MJ, Imagawa DK, Demirjian A. MELD as a predictor of mortality after cholecystectomy. J Am Coll Surg 2015. [DOI: 10.1016/j.jamcollsurg.2015.08.163] [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]
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Young MT, Phelan MJ, Nguyen NT. A Decade Analysis of Trends and Outcomes of Bariatric Surgery in Male Compared to Female Patients. J Am Coll Surg 2015. [DOI: 10.1016/j.jamcollsurg.2015.07.016] [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]
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Gohil SK, Datta R, Cao C, Phelan MJ, Nguyen V, Rowther AA, Huang SS. Impact of Hospital Population Case-Mix, Including Poverty, on Hospital All-Cause and Infection-Related 30-Day Readmission Rates. Clin Infect Dis 2015; 61:1235-43. [PMID: 26129752 DOI: 10.1093/cid/civ539] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Accepted: 06/24/2015] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Reducing hospital readmissions, including preventable healthcare-associated infections, is a national priority. The proportion of readmissions due to infections is not well-understood. Better understanding of hospital risk factors for readmissions and infection-related readmissions may help optimize interventions to prevent readmissions. METHODS Retrospective cohort study of California acute care hospitals and their patient populations discharged between 2009 and 2011. Demographics, comorbidities, and socioeconomic status were entered into a hierarchical generalized linear mixed model predicting all-cause and infection-related readmissions. Crude verses adjusted hospital rankings were compared using Cohen's kappa. RESULTS We assessed 30-day readmission rates from 323 hospitals, accounting for 213 879 194 post-discharge person-days of follow-up. Infection-related readmissions represented 28% of all readmissions and were associated with discharging a high proportion of patients to skilled nursing facilities. Hospitals serving populations with high proportions of males, comorbidities, prolonged length of stay, and populations living in a federal poverty area, had higher all-cause and infection-related readmission rates. Academic hospitals had higher all-cause and infection-related readmission rates (odds ratio 1.24 and 1.15, respectively). When comparing adjusted vs crude hospital rankings for infection-related readmission rates, adjustment revealed 31% of hospitals changed performance category for infection-related readmissions. CONCLUSIONS Infection-related readmissions accounted for nearly 30% of all-cause readmissions. High hospital infection-related readmissions were associated with serving a high proportion of patients with comorbidities, long lengths of stay, discharge to skilled nursing facility, and those living in federal poverty areas. Preventability of these infections needs to be assessed.
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Affiliation(s)
- Shruti K Gohil
- Division of Infectious Diseases and Health Policy Research Institute, University of California Irvine School of Medicine
| | - Rupak Datta
- Department of Medicine, Yale School of Medicine
| | - Chenghua Cao
- Division of Infectious Diseases and Health Policy Research Institute, University of California Irvine School of Medicine
| | | | - Vinh Nguyen
- Department of Statistics, University of California, Irvine
| | - Armaan A Rowther
- Division of Infectious Diseases and Health Policy Research Institute, University of California Irvine School of Medicine
| | - Susan S Huang
- Division of Infectious Diseases and Health Policy Research Institute, University of California Irvine School of Medicine
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Young MT, Gebhart A, Phelan MJ, Nguyen NT. Use and Outcomes of Laparoscopic Sleeve Gastrectomy vs Laparoscopic Gastric Bypass: Analysis of the American College of Surgeons NSQIP. J Am Coll Surg 2015; 220:880-5. [DOI: 10.1016/j.jamcollsurg.2015.01.059] [Citation(s) in RCA: 98] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2014] [Revised: 01/27/2015] [Accepted: 01/27/2015] [Indexed: 01/07/2023]
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Moghadamyeghaneh Z, Hwang G, Hanna MH, Phelan MJ, Carmichael JC, Mills SD, Pigazzi A, Dolich MO, Stamos MJ. Even modest hypoalbuminemia affects outcomes of colorectal surgery patients. Am J Surg 2015; 210:276-84. [PMID: 25892597 DOI: 10.1016/j.amjsurg.2014.12.038] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [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: 08/08/2014] [Revised: 12/15/2014] [Accepted: 12/22/2014] [Indexed: 12/28/2022]
Abstract
BACKGROUND A small decrease in the serum albumin from the normal level is a common condition in preoperative laboratory tests of colorectal surgery patients; however, there is limited data examining these patients. We sought to identify outcomes of such patients. METHODS The National Surgical Quality Improvement Program database was used to evaluate all patients who had modest levels of hypoalbuminemia (3 ≤ serum albumin < 3.5 g/dL) before colorectal resection from 2005 to 2012. Multivariate analysis using logistic regression was performed to quantify complications associated with modest hypoalbuminemia. RESULTS A total of 108,898 patients undergoing colorectal resection were identified, of which 16,962 (15.6%) had modest levels of preoperative hypoalbuminemia. Postsurgical complications significantly associated (P < .05) with modest hypoalbuminemia were as follows: hospitalization more than 30 days (adjusted odds ratio [AOR], 1.77), deep vein thrombosis (AOR, 1.64), unplanned intubation (AOR, 1.42), ventilator dependency for more than 48 hours (AOR, 1.30), and wound disruption (AOR, 1.22). CONCLUSIONS Modest hypoalbuminemia is a common preoperative condition in patients undergoing colorectal resection. Our analysis demonstrates that modest hypoalbuminemia has associations with increased postoperative complications, especially pulmonary complications.
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Affiliation(s)
- Zhobin Moghadamyeghaneh
- Department of Surgery, School of Medicine, University of California, Irvine, 333 City Boulevard, West Suite 1600, Orange, CA, USA
| | - Grace Hwang
- Department of Surgery, School of Medicine, University of California, Irvine, 333 City Boulevard, West Suite 1600, Orange, CA, USA
| | - Mark H Hanna
- Department of Surgery, School of Medicine, University of California, Irvine, 333 City Boulevard, West Suite 1600, Orange, CA, USA
| | - Michael J Phelan
- Department of Statistics, University of California, Irvine, CA, USA
| | - Joseph C Carmichael
- Department of Surgery, School of Medicine, University of California, Irvine, 333 City Boulevard, West Suite 1600, Orange, CA, USA
| | - Steven D Mills
- Department of Surgery, School of Medicine, University of California, Irvine, 333 City Boulevard, West Suite 1600, Orange, CA, USA
| | - Alessio Pigazzi
- Department of Surgery, School of Medicine, University of California, Irvine, 333 City Boulevard, West Suite 1600, Orange, CA, USA
| | - Matthew O Dolich
- Department of Surgery, School of Medicine, University of California, Irvine, 333 City Boulevard, West Suite 1600, Orange, CA, USA
| | - Michael J Stamos
- Department of Surgery, School of Medicine, University of California, Irvine, 333 City Boulevard, West Suite 1600, Orange, CA, USA.
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Young MT, Crawshaw BP, Phelan MJ, Mills SD, Carmichael JC, Pigazzi A, Delaney CP, Stamos MJ. Expanding the HospitAl stay, Readmission and Mortality (HARM) score: measuring quality and outcomes in colorectal and gastrointestinal surgery. J Am Coll Surg 2014. [DOI: 10.1016/j.jamcollsurg.2014.07.791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Young MT, Gebhart A, Phelan MJ, Nguyen NT. Utilization and outcomes of laparoscopic sleeve gastrectomy versus laparoscopic gastric bypass: analysis of the American College of Surgeons National Surgical Quality Improvement Program. J Am Coll Surg 2014. [DOI: 10.1016/j.jamcollsurg.2014.07.396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Jafari MD, Wexner SD, Martz JE, McLemore EC, Margolin DA, Sherwinter DA, Lee SW, Senagore AJ, Phelan MJ, Stamos MJ. Perfusion assessment in laparoscopic left-sided/anterior resection (PILLAR II): a multi-institutional study. J Am Coll Surg 2014; 220:82-92.e1. [PMID: 25451666 DOI: 10.1016/j.jamcollsurg.2014.09.015] [Citation(s) in RCA: 345] [Impact Index Per Article: 34.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2014] [Revised: 09/11/2014] [Accepted: 09/11/2014] [Indexed: 12/13/2022]
Abstract
BACKGROUND Our primary objective was to demonstrate the utility and feasibility of the intraoperative assessment of colon and rectal perfusion using fluorescence angiography (FA) during left-sided colectomy and anterior resection. Anastomotic leak (AL) after colorectal resection increases morbidity, mortality, and, in cancer cases, recurrence rates. Inadequate perfusion may contribute to AL. The PINPOINT Endoscopic Fluorescence Imaging System allows for intraoperative assessment of anastomotic perfusion. STUDY DESIGN This is a prospective, multicenter, open-label, clinical trial that assessed the feasibility and utility of FA for intraoperative perfusion assessment during left-sided colectomy and anterior resection at 11 centers in the United States. RESULTS A total of 147 patients were enrolled, of whom 139 were eligible for analysis. Diverticulitis (44%), rectal cancer (25%), and colon cancer (21%) were the most prevalent indications for surgery. The mean level of anastomosis was 10 ± 4 cm from the anal verge. Splenic-flexure mobilization was performed in 81% and high ligation of the inferior mesenteric artery in 61.9% of patients. There was a 99% success rate for FA, and FA changed surgical plans in 11 (8%) patients, with the majority of changes occurring at the time of transection of the proximal margin (7%). Overall morbidity rates were 17%. The anastomotic leak rate was 1.4% (n = 2). There were no anastomotic leaks in the 11 patients who had a change in surgical plan based on intraoperative perfusion assessment with FA. CONCLUSIONS PINPOINT is a safe and feasible tool for intraoperative assessment of tissue perfusion during colorectal resection. There were no anastomotic leaks in patients in whom the anastomosis was revised based on inadequate perfusion with FA.
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Affiliation(s)
- Mehraneh D Jafari
- Department of Surgery, University of California, Irvine Medical Center, Orange, CA
| | - Steven D Wexner
- Department of Colorectal Surgery, Cleveland Clinic Florida, Weston, FL
| | - Joseph E Martz
- Department of Surgery, Beth Israel Medical Center, New York, NY
| | - Elisabeth C McLemore
- Department of Surgery, University of California San Diego Medical Center, La Jolla, CA
| | - David A Margolin
- Department of Colon and Rectal Surgery, Ochsner Clinic Foundation, New Orleans, LA
| | | | - Sang W Lee
- Department of Surgery, New York Presbyterian Hospital, Weill Cornell Medical Center, New York, NY
| | - Anthony J Senagore
- Surgical Disciplines, Central Michigan University, College of Medicine, Saginaw, MI
| | - Michael J Phelan
- Department of Surgery, University of California, Irvine Medical Center, Orange, CA
| | - Michael J Stamos
- Department of Surgery, University of California, Irvine Medical Center, Orange, CA.
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Tehrani DM, Phelan MJ, Cao C, Billimek J, Datta R, Nguyen H, Kwark H, Huang SS. Substantial shifts in ranking of California hospitals by hospital-associated methicillin-resistant Staphylococcus aureus infection following adjustment for hospital characteristics and case mix. Infect Control Hosp Epidemiol 2014; 35:1263-70. [PMID: 25203180 DOI: 10.1086/678069] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND States have established public reporting of hospital-associated (HA) infections-including those of methicillin-resistant Staphylococcus aureus (MRSA)-but do not account for hospital case mix or postdischarge events. OBJECTIVE Identify facility-level characteristics associated with HA-MRSA infection admissions and create adjusted hospital rankings. METHODS A retrospective cohort study of 2009-2010 California acute care hospitals. We defined HA-MRSA admissions as involving MRSA pneumonia or septicemia events arising during hospitalization or within 30 days after discharge. We used mandatory hospitalization and US Census data sets to generate hospital population characteristics by summarizing across admissions. Facility-level factors associated with hospitals' proportions of HA-MRSA infection admissions were identified using generalized linear models. Using state methodology, hospitals were categorized into 3 tiers of HA-MRSA infection prevention performance, using raw and adjusted values. RESULTS Among 323 hospitals, a median of 16 HA-MRSA infections (range, 0-102) per 10,000 admissions was found. Hospitals serving a greater proportion of patients who had serious comorbidities, were from low-education zip codes, and were discharged to locations other than home were associated with higher HA-MRSA infection risk. Total concordance between all raw and adjusted hospital rankings was 0.45 (95% confidence interval, 0.40-0.51). Among 53 community hospitals in the poor-performance category, more than 20% moved into the average-performance category after adjustment. Similarly, among 71 hospitals in the superior-performance category, half moved into the average-performance category after adjustment. CONCLUSIONS When adjusting for nonmodifiable facility characteristics and case mix, hospital rankings based on HA-MRSA infections substantially changed. Quality indicators for hospitals require adequate adjustment for patient population characteristics for valid interhospital performance comparisons.
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Affiliation(s)
- David M Tehrani
- Division of Infectious Disease and Health Policy Research Institute, University of California Irvine School of Medicine, Irvine, California
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Young MT, Jafari MD, Gebhart A, Phelan MJ, Nguyen NT. A Decade Analysis of Trends and Outcomes of Bariatric Surgery in Medicare Beneficiaries. J Am Coll Surg 2014; 219:480-8. [DOI: 10.1016/j.jamcollsurg.2014.04.010] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2014] [Revised: 04/13/2014] [Accepted: 04/15/2014] [Indexed: 11/25/2022]
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40
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Pietrzkowski Z, Phelan MJ, Keller R, Shu C, Argumedo R, Reyes-Izquierdo T. Short-term efficacy of calcium fructoborate on subjects with knee discomfort: a comparative, double-blind, placebo-controlled clinical study. Clin Interv Aging 2014; 9:895-9. [PMID: 24940052 PMCID: PMC4051624 DOI: 10.2147/cia.s64590] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Calcium fructoborate (CFB) at a dose of 110 mg twice per day was previously reported to improve knee discomfort during the first 14 days of treatment. In this study, 60 participants with self-reported knee discomfort were randomized into two groups receiving CFB or placebo. Initial levels of knee discomfort were evaluated by Western Ontario and McMaster Universities Arthritis Index (WOMAC) and McGill Pain Questionnaire (MPQ) scores at the beginning of the study and also at 7 and 14 days after treatment. Results showed that supplementation with CFB significantly improved knee discomfort in the study subjects; significant reductions of mean within-subject change in WOMAC and MPQ scores were observed for the CFB group compared to the placebo group at both 7 and 14 days after treatment. Estimated treatment differences for the MPQ score were -5.8 (P=0.0009) and -8.9 (P<0.0001) at Day 7 and 14, respectively. Estimated differences for the WOMAC score were -5.3 (P=0.06) and -13.73 (P<0.0001) at Day 7 and 14, respectively. Negative values indicate greater reductions in reported discomfort. On both Day 7 and Day 14, the trend was toward greater improvement in the CFB group. The placebo group did not exhibit any change in the WOMAC and MPQ scores. In conclusion, supplementation with 110 mg CFB twice per day was associated with improving knee discomfort during the 2 weeks of intake.
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Affiliation(s)
- Zbigniew Pietrzkowski
- FutureCeuticals, Inc., Applied BioClinical Laboratory, University of California at Irvine, CA, USA
| | - Michael J Phelan
- Department of Statistics, School of Information and Computer Science, University of California at Irvine, CA, USA
| | | | - Cynthia Shu
- FutureCeuticals, Inc., Applied BioClinical Laboratory, University of California at Irvine, CA, USA
| | - Ruby Argumedo
- FutureCeuticals, Inc., Applied BioClinical Laboratory, University of California at Irvine, CA, USA
| | - Tania Reyes-Izquierdo
- FutureCeuticals, Inc., Applied BioClinical Laboratory, University of California at Irvine, CA, USA
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O'Connor MB, Bond U, Phelan MJ. Osteoporotic vertebral fractures. Ir Med J 2014; 107:29. [PMID: 24592650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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O'Connor MB, Nolan TJ, Bond U, Swan J, Phelan MJ. Infections and vaccinations among rheumatology patients. Ir Med J 2012; 105:347-348. [PMID: 23495551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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O'Connor MB, Phelan MJ. Rituximab and lung disease. Ir Med J 2012; 105:314. [PMID: 23240291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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O'Connor MB, Murphy M, Phelan MJ. VACTERL association or VATER syndrome. Ir Med J 2012; 105:284-285. [PMID: 23155922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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45
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O'Connor MB, Phelan MJ. Safety of body piercings for rheumatology patients on immunosuppressive medications. Ir Med J 2012; 105:157. [PMID: 22803501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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O'Connor MB, Phelan MJ. Should rheumatology patients on immunosuppressive medications be advised against getting tattoos? Ir Med J 2012; 105:124. [PMID: 22708233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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O'Connor MB, Phelan MJ. Fibromyalgia, is it a true rheumatological or a psychogenic condition? Ir Med J 2012; 105:60. [PMID: 22455246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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Grubert MA, Phelan MJ, Bird MH. Use of a Durometer to Differentiate Between Soft- and Hard-Shelled Mud Crabs (Scylla serrata). Journal of Aquatic Food Product Technology 2012. [DOI: 10.1080/10498850.2011.576805] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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49
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O'Connor MB, Phelan MJ. Outpatient clinic reminders. Ir Med J 2011; 104:284. [PMID: 22132602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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50
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O'Connor MB, Phelan MJ. H1N1 and vaccination of rheumatology patients. Ir Med J 2011; 104:154. [PMID: 21739630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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