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Searchinger C, Nalubwama H, Pulle J, Mehta R, Tumwbaze H, Kyarimpa R, Mwima R, Atukunda E, Bua B, Sarnacki R, Sherman MG, Oketcho M, Zimmerman M, Nakitto M, Longenecker CT, Webel A, Scheel A, Lwabi PS, Sable CA. Quality of Life in Ugandan Children and Young Adults After Surgery for Congenital Heart Disease: Mixed Methods Approach. Glob Heart 2024; 19:36. [PMID: 38638125 PMCID: PMC11025577 DOI: 10.5334/gh.1320] [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: 10/05/2023] [Accepted: 03/26/2024] [Indexed: 04/20/2024] Open
Abstract
Background Health-related quality of life (HRQOL) is a critical issue for patients undergoing surgery for congenital heart disease (CHD) but has never been assessed in a low-income country. We conducted a cross-sectional mixed methods study with age-matched healthy siblings serving as controls at the Uganda Heart Institute. Methods One-hundred fifteen CHD pediatric and young adult patients and sibling control participants were recruited. Health-related quality of life was assessed using the Pediatric Quality of Life Inventory Version 4.0 in participants ages 5-17 and 36-Item Short Form Survey for young adults aged 18-25. A subset of 27 participants completed face-to-face interviews to supplement quantitative findings. Results Eighty-six pediatric (age 5-17) sibling and parent pairs completed Peds QOL surveys, and 29 young adult (age 18-25) sibling pairs completed SF-36 surveys. One third of patients had surgery in Uganda. Ventricular septal defects and tetralogy of Fallot were the most common diagnoses. Health-related quality of life scores in patients were lower across all domains compared to control participants in children. Reductions in physical and emotional domains of HRQOL were also statistically significant for young adults. Variables associated with lower HRQOL score on multivariate analysis in pediatric patients were younger age in the physical and emotional domains, greater number of surgeries in the physical domain and surgery outside Uganda in the school domain. The only predictor of lower HRQOL score in young adults was surgery outside Uganda in the social domain. Qualitative interviews identified a number of themes that correlated with survey results including abandonment by family, isolation from peers and community, financial hardship and social stigmatization. Conclusion Health-related quality of life was lower in Ugandan patients after CHD surgery than siblings. Younger patients and those who had surgery outside of Uganda had lower HRQOL. These data have important implications for patients undergoing CHD surgery in LMIC and have potential to inform interventions.
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Affiliation(s)
- Chloe Searchinger
- Princeton University, Princeton, NJ, USA
- Division of Cardiology and Global Health Initiative, Children’s National Hospital, Washington, DC, USA
| | | | | | - Rittal Mehta
- Division of Cardiology and Global Health Initiative, Children’s National Hospital, Washington, DC, USA
| | | | | | | | | | | | - Rachel Sarnacki
- Division of Cardiology and Global Health Initiative, Children’s National Hospital, Washington, DC, USA
| | - Meredith G. Sherman
- Division of Cardiology and Global Health Initiative, Children’s National Hospital, Washington, DC, USA
| | | | | | | | - Chris T. Longenecker
- Division of Cardiology and Department of Global Health University of Washington School of Medicine, Seattle WA, USA
| | - Allison Webel
- University of Washington School of Nursing, Seattle WA, USA
| | - Amy Scheel
- Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | | | - Craig A. Sable
- Division of Cardiology and Global Health Initiative, Children’s National Hospital, Washington, DC, USA
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Kisamori E, Venna A, Chaudhry HE, Desai M, Tongut A, Mehta R, Clauss S, Yerebakan C, d'Udekem Y. Alarming rate of liver cirrhosis after the small conduit Extracardiac Fontan. A comparative analysis with the Lateral Tunnel. J Thorac Cardiovasc Surg 2024:S0022-5223(24)00311-8. [PMID: 38688450 DOI: 10.1016/j.jtcvs.2024.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Revised: 03/28/2024] [Accepted: 04/10/2024] [Indexed: 05/02/2024]
Abstract
BACKGROUND The association between the prevalence of cirrhosis and the types of Fontan operations remains unclear. METHODS We conducted a retrospective chart review of 332 patients who underwent the Fontan procedure at our institution. Four patients who underwent the atriopulmonary connection Fontan were excluded from the analysis. Patients who had intracardiac-extracardiac conduit (126) between 1989 and 2021 were pooled with those having extra-cardiac conduit (ECC) (134). The 260 patients who underwent the ECC and the 68 patients who had the lateral tunnel (LT) Fontan constitute the core of the study. RESULTS Median age at the Fontan procedure was 23.7 months (interquartile range [IQR]: 20.8-32.6) in the LT group, compared to 28.8 months (IQR: 24.6-39.5) in the ECC group (p<0.01). The median follow-up was 14.8 years (IQR: 12.5-16.5) in the lateral tunnel group and 7 years (IQR: 2.8-10.4) in the extracardiac conduit group. During the follow-up period, three patients (4.4%) with LT and 17 patients (6.5%) with ECC (11 patients with 16 mm or less conduit size) were diagnosed with cirrhosisThe prevalence of cirrhosis at 1, 5, 10, and 15 years was 0%, 0%, 0%, and 4.4% in the LT group, respectively, and 0%, 0.9%, 7.7% and 29.8% in the ECC group (p < 0.01) Rates of mortality, Fontan revision, Fontan takedown, transplant, and complications were comparable between the two groups. CONCLUSIONS The Extracardiac Conduit Fontan seems to be associated with faster development of cirrhosis.
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Affiliation(s)
- Eiri Kisamori
- Division of Cardiovascular Surgery, Children's National Heart Institute, Children's National Hospital, Washington, DC, USA
| | - Alyssia Venna
- Division of Cardiovascular Surgery, Children's National Heart Institute, Children's National Hospital, Washington, DC, USA
| | - Hamzah Ejaz Chaudhry
- Division of Cardiovascular Surgery, Children's National Heart Institute, Children's National Hospital, Washington, DC, USA
| | - Manan Desai
- Division of Cardiovascular Surgery, Children's National Heart Institute, Children's National Hospital, Washington, DC, USA
| | - Aybala Tongut
- Division of Cardiovascular Surgery, Children's National Heart Institute, Children's National Hospital, Washington, DC, USA
| | - Rittal Mehta
- Division of Cardiovascular Surgery, Children's National Heart Institute, Children's National Hospital, Washington, DC, USA
| | - Sarah Clauss
- Division of Cardiology, Children's National Heart Institute, Children's National Hospital, Washington, DC, USA
| | - Can Yerebakan
- Division of Cardiovascular Surgery, Children's National Heart Institute, Children's National Hospital, Washington, DC, USA
| | - Yves d'Udekem
- Division of Cardiovascular Surgery, Children's National Heart Institute, Children's National Hospital, Washington, DC, USA.
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Henmi S, Venna A, Haverty MC, Mehta R, Desai M, Tongut A, Yerebakan C, Donofrio MT, Munoz RA, d’Udekem Y. Survival benefits of the wait-and-grow approach in small babies (≤2000 g) requiring heart surgery. JTCVS Open 2024; 18:156-166. [PMID: 38690430 PMCID: PMC11056471 DOI: 10.1016/j.xjon.2024.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 11/08/2023] [Accepted: 01/03/2024] [Indexed: 05/02/2024]
Abstract
Objective The best approach to minimize the observed higher mortality of newborn infants with low birth weight who require congenital heart surgery is unclear. This retrospective study was designed to review outcomes of newborn infants weighing <2000 g who have undergone cardiovascular surgery to identify patient parameters and clinical strategies for care associated with higher survival. Methods A retrospective chart review of 103 patients who underwent cardiovascular surgery from 2010 to 2021 who were identified as having low birth weight (≤2000 g). Patients who underwent only patent ductus arteriosus ligation or weighing >3500 g at surgery were excluded. Results Median age was 24 days and weight at the time of surgery was 1920 g. Twenty-six (25%) operative mortalities were recorded. Median follow-up period was 2.7 years. The 1- and 3-year overall Kaplan-Meier survival estimate was 72.4% ± 4.5% and 69.1% ± 4.6%. The 1-year survival of patients who had a weight increase >300 g from birth to surgery was far superior to the survival of those who did not achieve such a weight gain (81.4% ± 5.6% vs 64.0% ± 6.7%; log-rank P = .04). By multivariable Cox-hazard regression analysis, the independent predictor of 1-year mortality was genetic syndrome (hazard ratio, 3.54; 95% CI, 1.67-7.82; P < .001), whereas following a strategy of increasing weight from birth to surgery resulted in lower mortality (hazard ratio, 0.49; 95% CI, 0.24-0.90; P = .02). Conclusions A strategy of wait and grow for newborn infants with very low birth weight requiring heart surgery results in better survival than immediate surgery provided that the patient's condition allows for this waiting period.
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Affiliation(s)
- Soichiro Henmi
- Department of Pediatric Cardiac Surgery, Heart Institute, Children's National Hospital, George Washington University, Washington, DC
| | - Alyssia Venna
- Department of Pediatric Cardiac Surgery, Heart Institute, Children's National Hospital, George Washington University, Washington, DC
| | - Mitchell C. Haverty
- Department of Pediatric Cardiac Surgery, Heart Institute, Children's National Hospital, George Washington University, Washington, DC
| | - Rittal Mehta
- Department of Pediatric Cardiac Surgery, Heart Institute, Children's National Hospital, George Washington University, Washington, DC
| | - Manan Desai
- Department of Pediatric Cardiac Surgery, Heart Institute, Children's National Hospital, George Washington University, Washington, DC
| | - Aybala Tongut
- Department of Pediatric Cardiac Surgery, Heart Institute, Children's National Hospital, George Washington University, Washington, DC
| | - Can Yerebakan
- Department of Pediatric Cardiac Surgery, Heart Institute, Children's National Hospital, George Washington University, Washington, DC
| | - Mary T. Donofrio
- Department of Cardiology, Heart Institute, Children's National Hospital, George Washington University, Washington, DC
| | - Ricardo A. Munoz
- Department of Cardiac Critical Care, Heart Institute, Children's National Hospital, George Washington University, Washington, DC
| | - Yves d’Udekem
- Department of Pediatric Cardiac Surgery, Heart Institute, Children's National Hospital, George Washington University, Washington, DC
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Staplin N, Haynes R, Judge PK, Wanner C, Green JB, Emberson J, Preiss D, Mayne KJ, Ng SYA, Sammons E, Zhu D, Hill M, Stevens W, Wallendszus K, Brenner S, Cheung AK, Liu ZH, Li J, Hooi LS, Liu WJ, Kadowaki T, Nangaku M, Levin A, Cherney D, Maggioni AP, Pontremoli R, Deo R, Goto S, Rossello X, Tuttle KR, Steubl D, Petrini M, Seidi S, Landray MJ, Baigent C, Herrington WG, Abat S, Abd Rahman R, Abdul Cader R, Abdul Hafidz MI, Abdul Wahab MZ, Abdullah NK, Abdul-Samad T, Abe M, Abraham N, Acheampong S, Achiri P, Acosta JA, Adeleke A, Adell V, Adewuyi-Dalton R, Adnan N, Africano A, Agharazii M, Aguilar F, Aguilera A, Ahmad M, Ahmad MK, Ahmad NA, Ahmad NH, Ahmad NI, Ahmad Miswan N, Ahmad Rosdi H, Ahmed I, Ahmed S, Ahmed S, Aiello J, Aitken A, AitSadi R, Aker S, Akimoto S, Akinfolarin A, Akram S, Alberici F, Albert C, Aldrich L, Alegata M, Alexander L, Alfaress S, Alhadj Ali M, Ali A, Ali A, Alicic R, Aliu A, Almaraz R, Almasarwah R, Almeida J, Aloisi A, Al-Rabadi L, Alscher D, Alvarez P, Al-Zeer B, Amat M, Ambrose C, Ammar H, An Y, Andriaccio L, Ansu K, Apostolidi A, Arai N, Araki H, Araki S, Arbi A, Arechiga O, Armstrong S, Arnold T, Aronoff S, Arriaga W, Arroyo J, Arteaga D, Asahara S, Asai A, Asai N, Asano S, Asawa M, Asmee MF, Aucella F, Augustin M, Avery A, Awad A, Awang IY, Awazawa M, Axler A, Ayub W, Azhari Z, Baccaro R, Badin C, Bagwell B, Bahlmann-Kroll E, Bahtar AZ, Baigent C, Bains D, Bajaj H, Baker R, Baldini E, Banas B, Banerjee D, Banno S, Bansal S, Barberi S, Barnes S, Barnini C, Barot C, Barrett K, Barrios R, Bartolomei Mecatti B, Barton I, Barton J, Basily W, Bavanandan S, Baxter A, Becker L, Beddhu S, Beige J, Beigh S, Bell S, Benck U, Beneat A, Bennett A, Bennett D, Benyon S, Berdeprado J, Bergler T, Bergner A, Berry M, Bevilacqua M, Bhairoo J, Bhandari S, Bhandary N, Bhatt A, Bhattarai M, Bhavsar M, Bian W, Bianchini F, Bianco S, Bilous R, Bilton J, Bilucaglia D, Bird C, Birudaraju D, Biscoveanu M, Blake C, Bleakley N, Bocchicchia K, Bodine S, Bodington R, Boedecker S, Bolduc M, Bolton S, Bond C, Boreky F, Boren K, Bouchi R, Bough L, Bovan D, Bowler C, Bowman L, Brar N, Braun C, Breach A, Breitenfeldt M, Brenner S, Brettschneider B, Brewer A, Brewer G, Brindle V, Brioni E, Brown C, Brown H, Brown L, Brown R, Brown S, Browne D, Bruce K, Brueckmann M, Brunskill N, Bryant M, Brzoska M, Bu Y, Buckman C, Budoff M, Bullen M, Burke A, Burnette S, Burston C, Busch M, Bushnell J, Butler S, Büttner C, Byrne C, Caamano A, Cadorna J, Cafiero C, Cagle M, Cai J, Calabrese K, Calvi C, Camilleri B, Camp S, Campbell D, Campbell R, Cao H, Capelli I, Caple M, Caplin B, Cardone A, Carle J, Carnall V, Caroppo M, Carr S, Carraro G, Carson M, Casares P, Castillo C, Castro C, Caudill B, Cejka V, Ceseri M, Cham L, Chamberlain A, Chambers J, Chan CBT, Chan JYM, Chan YC, Chang E, Chang E, Chant T, Chavagnon T, Chellamuthu P, Chen F, Chen J, Chen P, Chen TM, Chen Y, Chen Y, Cheng C, Cheng H, Cheng MC, Cherney D, Cheung AK, Ching CH, Chitalia N, Choksi R, Chukwu C, Chung K, Cianciolo G, Cipressa L, Clark S, Clarke H, Clarke R, Clarke S, Cleveland B, Cole E, Coles H, Condurache L, Connor A, Convery K, Cooper A, Cooper N, Cooper Z, Cooperman L, Cosgrove L, Coutts P, Cowley A, Craik R, Cui G, Cummins T, Dahl N, Dai H, Dajani L, D'Amelio A, Damian E, Damianik K, Danel L, Daniels C, Daniels T, Darbeau S, Darius H, Dasgupta T, Davies J, Davies L, Davis A, Davis J, Davis L, Dayanandan R, Dayi S, Dayrell R, De Nicola L, Debnath S, Deeb W, Degenhardt S, DeGoursey K, Delaney M, Deo R, DeRaad R, Derebail V, Dev D, Devaux M, Dhall P, Dhillon G, Dienes J, Dobre M, Doctolero E, Dodds V, Domingo D, Donaldson D, Donaldson P, Donhauser C, Donley V, Dorestin S, Dorey S, Doulton T, Draganova D, Draxlbauer K, Driver F, Du H, Dube F, Duck T, Dugal T, Dugas J, Dukka H, Dumann H, Durham W, Dursch M, Dykas R, Easow R, Eckrich E, Eden G, Edmerson E, Edwards H, Ee LW, Eguchi J, Ehrl Y, Eichstadt K, Eid W, Eilerman B, Ejima Y, Eldon H, Ellam T, Elliott L, Ellison R, Emberson J, Epp R, Er A, Espino-Obrero M, Estcourt S, Estienne L, Evans G, Evans J, Evans S, Fabbri G, Fajardo-Moser M, Falcone C, Fani F, Faria-Shayler P, Farnia F, Farrugia D, Fechter M, Fellowes D, Feng F, Fernandez J, Ferraro P, Field A, Fikry S, Finch J, Finn H, Fioretto P, Fish R, Fleischer A, Fleming-Brown D, Fletcher L, Flora R, Foellinger C, Foligno N, Forest S, Forghani Z, Forsyth K, Fottrell-Gould D, Fox P, Frankel A, Fraser D, Frazier R, Frederick K, Freking N, French H, Froment A, Fuchs B, Fuessl L, Fujii H, Fujimoto A, Fujita A, Fujita K, Fujita Y, Fukagawa M, Fukao Y, Fukasawa A, Fuller T, Funayama T, Fung E, Furukawa M, Furukawa Y, Furusho M, Gabel S, Gaidu J, Gaiser S, Gallo K, Galloway C, Gambaro G, Gan CC, Gangemi C, Gao M, Garcia K, Garcia M, Garofalo C, Garrity M, Garza A, Gasko S, Gavrila M, Gebeyehu B, Geddes A, Gentile G, George A, George J, Gesualdo L, Ghalli F, Ghanem A, Ghate T, Ghavampour S, Ghazi A, Gherman A, Giebeln-Hudnell U, Gill B, Gillham S, Girakossyan I, Girndt M, Giuffrida A, Glenwright M, Glider T, Gloria R, Glowski D, Goh BL, Goh CB, Gohda T, Goldenberg R, Goldfaden R, Goldsmith C, Golson B, Gonce V, Gong Q, Goodenough B, Goodwin N, Goonasekera M, Gordon A, Gordon J, Gore A, Goto H, Goto S, Goto S, Gowen D, Grace A, Graham J, Grandaliano G, Gray M, Green JB, Greene T, Greenwood G, Grewal B, Grifa R, Griffin D, Griffin S, Grimmer P, Grobovaite E, Grotjahn S, Guerini A, Guest C, Gunda S, Guo B, Guo Q, Haack S, Haase M, Haaser K, Habuki K, Hadley A, Hagan S, Hagge S, Haller H, Ham S, Hamal S, Hamamoto Y, Hamano N, Hamm M, Hanburry A, Haneda M, Hanf C, Hanif W, Hansen J, Hanson L, Hantel S, Haraguchi T, Harding E, Harding T, Hardy C, Hartner C, Harun Z, Harvill L, Hasan A, Hase H, Hasegawa F, Hasegawa T, Hashimoto A, Hashimoto C, Hashimoto M, Hashimoto S, Haskett S, Hauske SJ, Hawfield A, Hayami T, Hayashi M, Hayashi S, Haynes R, Hazara A, Healy C, Hecktman J, Heine G, Henderson H, Henschel R, Hepditch A, Herfurth K, Hernandez G, Hernandez Pena A, Hernandez-Cassis C, Herrington WG, Herzog C, Hewins S, Hewitt D, Hichkad L, Higashi S, Higuchi C, Hill C, Hill L, Hill M, Himeno T, Hing A, Hirakawa Y, Hirata K, Hirota Y, Hisatake T, Hitchcock S, Hodakowski A, Hodge W, Hogan R, Hohenstatt U, Hohenstein B, Hooi L, Hope S, Hopley M, Horikawa S, Hosein D, Hosooka T, Hou L, Hou W, Howie L, Howson A, Hozak M, Htet Z, Hu X, Hu Y, Huang J, Huda N, Hudig L, Hudson A, Hugo C, Hull R, Hume L, Hundei W, Hunt N, Hunter A, Hurley S, Hurst A, Hutchinson C, Hyo T, Ibrahim FH, Ibrahim S, Ihana N, Ikeda T, Imai A, Imamine R, Inamori A, Inazawa H, Ingell J, Inomata K, Inukai Y, Ioka M, Irtiza-Ali A, Isakova T, Isari W, Iselt M, Ishiguro A, Ishihara K, Ishikawa T, Ishimoto T, Ishizuka K, Ismail R, Itano S, Ito H, Ito K, Ito M, Ito Y, Iwagaitsu S, Iwaita Y, Iwakura T, Iwamoto M, Iwasa M, Iwasaki H, Iwasaki S, Izumi K, Izumi K, Izumi T, Jaafar SM, Jackson C, Jackson Y, Jafari G, Jahangiriesmaili M, Jain N, Jansson K, Jasim H, Jeffers L, Jenkins A, Jesky M, Jesus-Silva J, Jeyarajah D, Jiang Y, Jiao X, Jimenez G, Jin B, Jin Q, Jochims J, Johns B, Johnson C, Johnson T, Jolly S, Jones L, Jones L, Jones S, Jones T, Jones V, Joseph M, Joshi S, Judge P, Junejo N, Junus S, Kachele M, Kadowaki T, Kadoya H, Kaga H, Kai H, Kajio H, Kaluza-Schilling W, Kamaruzaman L, Kamarzarian A, Kamimura Y, Kamiya H, Kamundi C, Kan T, Kanaguchi Y, Kanazawa A, Kanda E, Kanegae S, Kaneko K, Kaneko K, Kang HY, Kano T, Karim M, Karounos D, Karsan W, Kasagi R, Kashihara N, Katagiri H, Katanosaka A, Katayama A, Katayama M, Katiman E, Kato K, Kato M, Kato N, Kato S, Kato T, Kato Y, Katsuda Y, Katsuno T, Kaufeld J, Kavak Y, Kawai I, Kawai M, Kawai M, Kawase A, Kawashima S, Kazory A, Kearney J, Keith B, Kellett J, Kelley S, Kershaw M, Ketteler M, Khai Q, Khairullah Q, Khandwala H, Khoo KKL, Khwaja A, Kidokoro K, Kielstein J, Kihara M, Kimber C, Kimura S, Kinashi H, Kingston H, Kinomura M, Kinsella-Perks E, Kitagawa M, Kitajima M, Kitamura S, Kiyosue A, Kiyota M, Klauser F, Klausmann G, Kmietschak W, Knapp K, Knight C, Knoppe A, Knott C, Kobayashi M, Kobayashi R, Kobayashi T, Koch M, Kodama S, Kodani N, Kogure E, Koizumi M, Kojima H, Kojo T, Kolhe N, Komaba H, Komiya T, Komori H, Kon SP, Kondo M, Kondo M, Kong W, Konishi M, Kono K, Koshino M, Kosugi T, Kothapalli B, Kozlowski T, Kraemer B, Kraemer-Guth A, Krappe J, Kraus D, Kriatselis C, Krieger C, Krish P, Kruger B, Ku Md Razi KR, Kuan Y, Kubota S, Kuhn S, Kumar P, Kume S, Kummer I, Kumuji R, Küpper A, Kuramae T, Kurian L, Kuribayashi C, Kurien R, Kuroda E, Kurose T, Kutschat A, Kuwabara N, Kuwata H, La Manna G, Lacey M, Lafferty K, LaFleur P, Lai V, Laity E, Lambert A, Landray MJ, Langlois M, Latif F, Latore E, Laundy E, Laurienti D, Lawson A, Lay M, Leal I, Leal I, Lee AK, Lee J, Lee KQ, Lee R, Lee SA, Lee YY, Lee-Barkey Y, Leonard N, Leoncini G, Leong CM, Lerario S, Leslie A, Levin A, Lewington A, Li J, Li N, Li X, Li Y, Liberti L, Liberti ME, Liew A, Liew YF, Lilavivat U, Lim SK, Lim YS, Limon E, Lin H, Lioudaki E, Liu H, Liu J, Liu L, Liu Q, Liu WJ, Liu X, Liu Z, Loader D, Lochhead H, Loh CL, Lorimer A, Loudermilk L, Loutan J, Low CK, Low CL, Low YM, Lozon Z, Lu Y, Lucci D, Ludwig U, Luker N, Lund D, Lustig R, Lyle S, Macdonald C, MacDougall I, Machicado R, MacLean D, Macleod P, Madera A, Madore F, Maeda K, Maegawa H, Maeno S, Mafham M, Magee J, Maggioni AP, Mah DY, Mahabadi V, Maiguma M, Makita Y, Makos G, Manco L, Mangiacapra R, Manley J, Mann P, Mano S, Marcotte G, Maris J, Mark P, Markau S, Markovic M, Marshall C, Martin M, Martinez C, Martinez S, Martins G, Maruyama K, Maruyama S, Marx K, Maselli A, Masengu A, Maskill A, Masumoto S, Masutani K, Matsumoto M, Matsunaga T, Matsuoka N, Matsushita M, Matthews M, Matthias S, Matvienko E, Maurer M, Maxwell P, Mayne KJ, Mazlan N, Mazlan SA, Mbuyisa A, McCafferty K, McCarroll F, McCarthy T, McClary-Wright C, McCray K, McDermott P, McDonald C, McDougall R, McHaffie E, McIntosh K, McKinley T, 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Nakamura J, Nakamura R, Nakamura T, Nakaoka M, Nakashima E, Nakata J, Nakata M, Nakatani S, Nakatsuka A, Nakayama Y, Nakhoul G, Nangaku M, Naverrete G, Navivala A, Nazeer I, Negrea L, Nethaji C, Newman E, Ng SYA, Ng TJ, Ngu LLS, Nimbkar T, Nishi H, Nishi M, Nishi S, Nishida Y, Nishiyama A, Niu J, Niu P, Nobili G, Nohara N, Nojima I, Nolan J, Nosseir H, Nozawa M, Nunn M, Nunokawa S, Oda M, Oe M, Oe Y, Ogane K, Ogawa W, Ogihara T, Oguchi G, Ohsugi M, Oishi K, Okada Y, Okajyo J, Okamoto S, Okamura K, Olufuwa O, Oluyombo R, Omata A, Omori Y, Ong LM, Ong YC, Onyema J, Oomatia A, Oommen A, Oremus R, Orimo Y, Ortalda V, Osaki Y, Osawa Y, Osmond Foster J, O'Sullivan A, Otani T, Othman N, Otomo S, O'Toole J, Owen L, Ozawa T, Padiyar A, Page N, Pajak S, Paliege A, Pandey A, Pandey R, Pariani H, Park J, Parrigon M, Passauer J, Patecki M, Patel M, Patel R, Patel T, Patel Z, Paul R, Paul R, Paulsen L, Pavone L, Peixoto A, Peji J, Peng BC, Peng K, Pennino L, Pereira E, Perez E, Pergola P, Pesce F, 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Effects of empagliflozin on progression of chronic kidney disease: a prespecified secondary analysis from the empa-kidney trial. Lancet Diabetes Endocrinol 2024; 12:39-50. [PMID: 38061371 PMCID: PMC7615591 DOI: 10.1016/s2213-8587(23)00321-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 10/24/2023] [Accepted: 10/25/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Sodium-glucose co-transporter-2 (SGLT2) inhibitors reduce progression of chronic kidney disease and the risk of cardiovascular morbidity and mortality in a wide range of patients. However, their effects on kidney disease progression in some patients with chronic kidney disease are unclear because few clinical kidney outcomes occurred among such patients in the completed trials. In particular, some guidelines stratify their level of recommendation about who should be treated with SGLT2 inhibitors based on diabetes status and albuminuria. We aimed to assess the effects of empagliflozin on progression of chronic kidney disease both overall and among specific types of participants in the EMPA-KIDNEY trial. METHODS EMPA-KIDNEY, a randomised, controlled, phase 3 trial, was conducted at 241 centres in eight countries (Canada, China, Germany, Italy, Japan, Malaysia, the UK, and the USA), and included individuals aged 18 years or older with an estimated glomerular filtration rate (eGFR) of 20 to less than 45 mL/min per 1·73 m2, or with an eGFR of 45 to less than 90 mL/min per 1·73 m2 with a urinary albumin-to-creatinine ratio (uACR) of 200 mg/g or higher. We explored the effects of 10 mg oral empagliflozin once daily versus placebo on the annualised rate of change in estimated glomerular filtration rate (eGFR slope), a tertiary outcome. We studied the acute slope (from randomisation to 2 months) and chronic slope (from 2 months onwards) separately, using shared parameter models to estimate the latter. Analyses were done in all randomly assigned participants by intention to treat. EMPA-KIDNEY is registered at ClinicalTrials.gov, NCT03594110. FINDINGS Between May 15, 2019, and April 16, 2021, 6609 participants were randomly assigned and then followed up for a median of 2·0 years (IQR 1·5-2·4). Prespecified subgroups of eGFR included 2282 (34·5%) participants with an eGFR of less than 30 mL/min per 1·73 m2, 2928 (44·3%) with an eGFR of 30 to less than 45 mL/min per 1·73 m2, and 1399 (21·2%) with an eGFR 45 mL/min per 1·73 m2 or higher. Prespecified subgroups of uACR included 1328 (20·1%) with a uACR of less than 30 mg/g, 1864 (28·2%) with a uACR of 30 to 300 mg/g, and 3417 (51·7%) with a uACR of more than 300 mg/g. Overall, allocation to empagliflozin caused an acute 2·12 mL/min per 1·73 m2 (95% CI 1·83-2·41) reduction in eGFR, equivalent to a 6% (5-6) dip in the first 2 months. After this, it halved the chronic slope from -2·75 to -1·37 mL/min per 1·73 m2 per year (relative difference 50%, 95% CI 42-58). The absolute and relative benefits of empagliflozin on the magnitude of the chronic slope varied significantly depending on diabetes status and baseline levels of eGFR and uACR. In particular, the absolute difference in chronic slopes was lower in patients with lower baseline uACR, but because this group progressed more slowly than those with higher uACR, this translated to a larger relative difference in chronic slopes in this group (86% [36-136] reduction in the chronic slope among those with baseline uACR <30 mg/g compared with a 29% [19-38] reduction for those with baseline uACR ≥2000 mg/g; ptrend<0·0001). INTERPRETATION Empagliflozin slowed the rate of progression of chronic kidney disease among all types of participant in the EMPA-KIDNEY trial, including those with little albuminuria. Albuminuria alone should not be used to determine whether to treat with an SGLT2 inhibitor. FUNDING Boehringer Ingelheim and Eli Lilly.
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Liew A, Liew YF, Lilavivat U, Lim SK, Lim YS, Limon E, Lin H, Lioudaki E, Liu H, Liu J, Liu L, Liu Q, Liu WJ, Liu X, Liu Z, Loader D, Lochhead H, Loh CL, Lorimer A, Loudermilk L, Loutan J, Low CK, Low CL, Low YM, Lozon Z, Lu Y, Lucci D, Ludwig U, Luker N, Lund D, Lustig R, Lyle S, Macdonald C, MacDougall I, Machicado R, MacLean D, Macleod P, Madera A, Madore F, Maeda K, Maegawa H, Maeno S, Mafham M, Magee J, Maggioni AP, Mah DY, Mahabadi V, Maiguma M, Makita Y, Makos G, Manco L, Mangiacapra R, Manley J, Mann P, Mano S, Marcotte G, Maris J, Mark P, Markau S, Markovic M, Marshall C, Martin M, Martinez C, Martinez S, Martins G, Maruyama K, Maruyama S, Marx K, Maselli A, Masengu A, Maskill A, Masumoto S, Masutani K, Matsumoto M, Matsunaga T, Matsuoka N, Matsushita M, Matthews M, Matthias S, Matvienko E, Maurer M, Maxwell P, Mayne KJ, Mazlan N, Mazlan SA, Mbuyisa A, McCafferty K, McCarroll F, McCarthy T, McClary-Wright C, McCray K, McDermott P, McDonald C, McDougall R, McHaffie E, McIntosh K, McKinley T, McLaughlin S, McLean N, McNeil L, Measor A, Meek J, Mehta A, Mehta R, Melandri M, Mené P, Meng T, Menne J, Merritt K, Merscher S, Meshykhi C, Messa P, Messinger L, Miftari N, Miller R, Miller Y, Miller-Hodges E, Minatoguchi M, Miners M, Minutolo R, Mita T, Miura Y, Miyaji M, Miyamoto S, Miyatsuka T, Miyazaki M, Miyazawa I, Mizumachi R, Mizuno M, Moffat S, Mohamad Nor FS, Mohamad Zaini SN, Mohamed Affandi FA, Mohandas C, Mohd R, Mohd Fauzi NA, Mohd Sharif NH, Mohd Yusoff Y, Moist L, Moncada A, Montasser M, Moon A, Moran C, Morgan N, Moriarty J, Morig G, Morinaga H, Morino K, Morisaki T, Morishita Y, Morlok S, Morris A, Morris F, Mostafa S, Mostefai Y, Motegi M, Motherwell N, Motta D, Mottl A, Moys R, Mozaffari S, Muir J, Mulhern J, Mulligan S, Munakata Y, Murakami C, Murakoshi M, Murawska A, Murphy K, Murphy L, Murray S, Murtagh H, Musa MA, Mushahar L, Mustafa R, Mustafar R, Muto M, Nadar E, Nagano R, Nagasawa T, Nagashima E, Nagasu H, Nagelberg S, Nair H, Nakagawa Y, Nakahara M, Nakamura J, Nakamura R, Nakamura T, Nakaoka M, Nakashima E, Nakata J, Nakata M, Nakatani S, Nakatsuka A, Nakayama Y, Nakhoul G, Nangaku M, Naverrete G, Navivala A, Nazeer I, Negrea L, Nethaji C, Newman E, Ng SYA, Ng TJ, Ngu LLS, Nimbkar T, Nishi H, Nishi M, Nishi S, Nishida Y, Nishiyama A, Niu J, Niu P, Nobili G, Nohara N, Nojima I, Nolan J, Nosseir H, Nozawa M, Nunn M, Nunokawa S, Oda M, Oe M, Oe Y, Ogane K, Ogawa W, Ogihara T, Oguchi G, Ohsugi M, Oishi K, Okada Y, Okajyo J, Okamoto S, Okamura K, Olufuwa O, Oluyombo R, Omata A, Omori Y, Ong LM, Ong YC, Onyema J, Oomatia A, Oommen A, Oremus R, Orimo Y, Ortalda V, Osaki Y, Osawa Y, Osmond Foster J, O'Sullivan A, Otani T, Othman N, Otomo S, O'Toole J, Owen L, Ozawa T, Padiyar A, Page N, Pajak S, Paliege A, Pandey A, Pandey R, Pariani H, Park J, Parrigon M, Passauer J, Patecki M, Patel M, Patel R, Patel T, Patel Z, Paul R, Paul R, Paulsen L, Pavone L, Peixoto A, Peji J, Peng BC, Peng K, Pennino L, Pereira E, Perez E, Pergola P, Pesce F, Pessolano G, Petchey W, Petr EJ, Pfab T, Phelan P, Phillips R, Phillips T, Phipps M, Piccinni G, Pickett T, Pickworth S, Piemontese M, Pinto D, Piper J, Plummer-Morgan J, Poehler D, Polese L, Poma V, Pontremoli R, Postal A, Pötz C, Power A, Pradhan N, Pradhan R, Preiss D, Preiss E, Preston K, Prib N, Price L, Provenzano C, Pugay C, Pulido R, Putz F, Qiao Y, Quartagno R, Quashie-Akponeware M, Rabara R, Rabasa-Lhoret R, Radhakrishnan D, Radley M, Raff R, Raguwaran S, Rahbari-Oskoui F, Rahman M, Rahmat K, Ramadoss S, Ramanaidu S, Ramasamy S, Ramli R, Ramli S, Ramsey T, Rankin A, Rashidi A, Raymond L, Razali WAFA, Read K, Reiner H, Reisler A, Reith C, Renner J, Rettenmaier B, Richmond L, Rijos D, Rivera R, Rivers V, Robinson H, Rocco M, Rodriguez-Bachiller I, Rodriquez R, Roesch C, Roesch J, Rogers J, Rohnstock M, Rolfsmeier S, Roman M, Romo A, Rosati A, Rosenberg S, Ross T, Rossello X, Roura M, Roussel M, Rovner S, Roy S, Rucker S, Rump L, Ruocco M, Ruse S, Russo F, Russo M, Ryder M, Sabarai A, Saccà C, Sachson R, Sadler E, Safiee NS, Sahani M, Saillant A, Saini J, Saito C, Saito S, Sakaguchi K, Sakai M, Salim H, Salviani C, Sammons E, Sampson A, Samson F, Sandercock P, Sanguila S, Santorelli G, Santoro D, Sarabu N, Saram T, Sardell R, Sasajima H, Sasaki T, Satko S, Sato A, Sato D, Sato H, Sato H, Sato J, Sato T, Sato Y, Satoh M, Sawada K, Schanz M, Scheidemantel F, Schemmelmann M, Schettler E, Schettler V, Schlieper GR, Schmidt C, Schmidt G, Schmidt U, Schmidt-Gurtler H, Schmude M, Schneider A, Schneider I, Schneider-Danwitz C, Schomig M, Schramm T, Schreiber A, Schricker S, Schroppel B, Schulte-Kemna L, Schulz E, Schumacher B, Schuster A, Schwab A, Scolari F, Scott A, Seeger W, Seeger W, Segal M, Seifert L, Seifert M, Sekiya M, Sellars R, Seman MR, Shah S, Shah S, Shainberg L, Shanmuganathan M, Shao F, Sharma K, Sharpe C, Sheikh-Ali M, Sheldon J, Shenton C, Shepherd A, Shepperd M, Sheridan R, Sheriff Z, Shibata Y, Shigehara T, Shikata K, Shimamura K, Shimano H, Shimizu Y, Shimoda H, Shin K, Shivashankar G, Shojima N, Silva R, Sim CSB, Simmons K, Sinha S, Sitter T, Sivanandam S, Skipper M, Sloan K, Sloan L, Smith R, Smyth J, Sobande T, Sobata M, Somalanka S, Song X, Sonntag F, Sood B, Sor SY, Soufer J, Sparks H, Spatoliatore G, Spinola T, Squyres S, Srivastava A, Stanfield J, Staplin N, Staylor K, Steele A, Steen O, Steffl D, Stegbauer J, Stellbrink C, Stellbrink E, Stevens W, Stevenson A, Stewart-Ray V, Stickley J, Stoffler D, Stratmann B, Streitenberger S, Strutz F, Stubbs J, Stumpf J, Suazo N, Suchinda P, Suckling R, Sudin A, Sugamori K, Sugawara H, Sugawara K, Sugimoto D, Sugiyama H, Sugiyama H, Sugiyama T, Sullivan M, Sumi M, Suresh N, Sutton D, Suzuki H, Suzuki R, Suzuki Y, Suzuki Y, Suzuki Y, Swanson E, Swift P, Syed S, Szerlip H, Taal M, Taddeo M, Tailor C, Tajima K, Takagi M, Takahashi K, Takahashi K, Takahashi M, Takahashi T, Takahira E, Takai T, Takaoka M, Takeoka J, Takesada A, Takezawa M, Talbot M, Taliercio J, Talsania T, Tamori Y, Tamura R, Tamura Y, Tan CHH, Tan EZZ, Tanabe A, Tanabe K, Tanaka A, Tanaka A, Tanaka N, Tang S, Tang Z, Tanigaki K, Tarlac M, Tatsuzawa A, Tay JF, Tay LL, Taylor J, Taylor K, Taylor K, Te A, Tenbusch L, Teng KS, Terakawa A, Terry J, Tham ZD, Tholl S, Thomas G, Thong KM, Tietjen D, Timadjer A, Tindall H, Tipper S, Tobin K, Toda N, Tokuyama A, Tolibas M, Tomita A, Tomita T, Tomlinson J, Tonks L, Topf J, Topping S, Torp A, Torres A, Totaro F, Toth P, Toyonaga Y, Tripodi F, Trivedi K, Tropman E, Tschope D, Tse J, Tsuji K, Tsunekawa S, Tsunoda R, Tucky B, Tufail S, Tuffaha A, Turan E, Turner H, Turner J, Turner M, Tuttle KR, Tye YL, Tyler A, Tyler J, Uchi H, Uchida H, Uchida T, Uchida T, Udagawa T, Ueda S, Ueda Y, Ueki K, Ugni S, Ugwu E, Umeno R, Unekawa C, Uozumi K, Urquia K, Valleteau A, Valletta C, van Erp R, Vanhoy C, Varad V, Varma R, Varughese A, Vasquez P, Vasseur A, Veelken R, Velagapudi C, Verdel K, Vettoretti S, Vezzoli G, Vielhauer V, Viera R, Vilar E, Villaruel S, Vinall L, Vinathan J, Visnjic M, Voigt E, von-Eynatten M, Vourvou M, Wada J, Wada J, Wada T, Wada Y, Wakayama K, Wakita Y, Wallendszus K, Walters T, Wan Mohamad WH, Wang L, Wang W, Wang X, Wang X, Wang Y, Wanner C, Wanninayake S, Watada H, Watanabe K, Watanabe K, Watanabe M, Waterfall H, Watkins D, Watson S, Weaving L, Weber B, Webley Y, Webster A, Webster M, Weetman M, Wei W, Weihprecht H, Weiland L, Weinmann-Menke J, Weinreich T, Wendt R, Weng Y, Whalen M, Whalley G, Wheatley R, Wheeler A, Wheeler J, Whelton P, White K, Whitmore B, Whittaker S, Wiebel J, Wiley J, Wilkinson L, Willett M, Williams A, Williams E, Williams K, Williams T, Wilson A, Wilson P, Wincott L, Wines E, Winkelmann B, Winkler M, Winter-Goodwin B, Witczak J, Wittes J, Wittmann M, Wolf G, Wolf L, Wolfling R, Wong C, Wong E, Wong HS, Wong LW, Wong YH, Wonnacott A, Wood A, Wood L, Woodhouse H, Wooding N, Woodman A, Wren K, Wu J, Wu P, Xia S, Xiao H, Xiao X, Xie Y, Xu C, Xu Y, Xue H, Yahaya H, Yalamanchili H, Yamada A, Yamada N, Yamagata K, Yamaguchi M, Yamaji Y, Yamamoto A, Yamamoto S, Yamamoto S, Yamamoto T, Yamanaka A, Yamano T, Yamanouchi Y, Yamasaki N, Yamasaki Y, Yamasaki Y, Yamashita C, Yamauchi T, Yan Q, Yanagisawa E, Yang F, Yang L, Yano S, Yao S, Yao Y, Yarlagadda S, Yasuda Y, Yiu V, Yokoyama T, Yoshida S, Yoshidome E, Yoshikawa H, Young A, Young T, Yousif V, Yu H, Yu Y, Yuasa K, Yusof N, Zalunardo N, Zander B, Zani R, Zappulo F, Zayed M, Zemann B, Zettergren P, Zhang H, Zhang L, Zhang L, Zhang N, Zhang X, Zhao J, Zhao L, Zhao S, Zhao Z, Zhong H, Zhou N, Zhou S, Zhu D, Zhu L, Zhu S, Zietz M, Zippo M, Zirino F, Zulkipli FH. Impact of primary kidney disease on the effects of empagliflozin in patients with chronic kidney disease: secondary analyses of the EMPA-KIDNEY trial. Lancet Diabetes Endocrinol 2024; 12:51-60. [PMID: 38061372 DOI: 10.1016/s2213-8587(23)00322-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 10/24/2023] [Accepted: 10/25/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND The EMPA-KIDNEY trial showed that empagliflozin reduced the risk of the primary composite outcome of kidney disease progression or cardiovascular death in patients with chronic kidney disease mainly through slowing progression. We aimed to assess how effects of empagliflozin might differ by primary kidney disease across its broad population. METHODS EMPA-KIDNEY, a randomised, controlled, phase 3 trial, was conducted at 241 centres in eight countries (Canada, China, Germany, Italy, Japan, Malaysia, the UK, and the USA). Patients were eligible if their estimated glomerular filtration rate (eGFR) was 20 to less than 45 mL/min per 1·73 m2, or 45 to less than 90 mL/min per 1·73 m2 with a urinary albumin-to-creatinine ratio (uACR) of 200 mg/g or higher at screening. They were randomly assigned (1:1) to 10 mg oral empagliflozin once daily or matching placebo. Effects on kidney disease progression (defined as a sustained ≥40% eGFR decline from randomisation, end-stage kidney disease, a sustained eGFR below 10 mL/min per 1·73 m2, or death from kidney failure) were assessed using prespecified Cox models, and eGFR slope analyses used shared parameter models. Subgroup comparisons were performed by including relevant interaction terms in models. EMPA-KIDNEY is registered with ClinicalTrials.gov, NCT03594110. FINDINGS Between May 15, 2019, and April 16, 2021, 6609 participants were randomly assigned and followed up for a median of 2·0 years (IQR 1·5-2·4). Prespecified subgroupings by primary kidney disease included 2057 (31·1%) participants with diabetic kidney disease, 1669 (25·3%) with glomerular disease, 1445 (21·9%) with hypertensive or renovascular disease, and 1438 (21·8%) with other or unknown causes. Kidney disease progression occurred in 384 (11·6%) of 3304 patients in the empagliflozin group and 504 (15·2%) of 3305 patients in the placebo group (hazard ratio 0·71 [95% CI 0·62-0·81]), with no evidence that the relative effect size varied significantly by primary kidney disease (pheterogeneity=0·62). The between-group difference in chronic eGFR slopes (ie, from 2 months to final follow-up) was 1·37 mL/min per 1·73 m2 per year (95% CI 1·16-1·59), representing a 50% (42-58) reduction in the rate of chronic eGFR decline. This relative effect of empagliflozin on chronic eGFR slope was similar in analyses by different primary kidney diseases, including in explorations by type of glomerular disease and diabetes (p values for heterogeneity all >0·1). INTERPRETATION In a broad range of patients with chronic kidney disease at risk of progression, including a wide range of non-diabetic causes of chronic kidney disease, empagliflozin reduced risk of kidney disease progression. Relative effect sizes were broadly similar irrespective of the cause of primary kidney disease, suggesting that SGLT2 inhibitors should be part of a standard of care to minimise risk of kidney failure in chronic kidney disease. FUNDING Boehringer Ingelheim, Eli Lilly, and UK Medical Research Council.
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Henmi S, Ryan JA, Mehta R, Haverty MC, Hovis IW, Puente BN, Ozturk M, Desai M, Tongut A, Yerebakan C, d'Udekem Y. A uniform strategy of primary repair of tetralogy of Fallot: Transventricular approach results in low reoperation rate in the first decade. J Thorac Cardiovasc Surg 2023; 166:1731-1738.e3. [PMID: 37301251 DOI: 10.1016/j.jtcvs.2023.05.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 04/27/2023] [Accepted: 05/30/2023] [Indexed: 06/12/2023]
Abstract
OBJECTIVES To review outcomes after a uniform strategy of transventricular repair of tetralogy of Fallot. METHODS A total of 244 consecutive patients underwent transventricular primary repair of tetralogy of Fallot from 2004 to 2019. Median age at operation was 71 days; 57 (23%) patients were premature; 57 (23%) patients had low birth weight (<2.5 kg), and 40 (16%) had genetic syndromes. The diameter of pulmonary valve annulus, right pulmonary artery (PA), and left PA were 6.0 ± 1.8 mm (z score, -1.7 ± 1.3), 4.3 ± 1.4 mm (z score, -0.9 ± 1.2) and 4.1 ± 1.5 mm (z score, -0.5 ± 1.3). RESULTS Three (1.2%) operative deaths were recorded. Ninety patients (37%) underwent transannular patching. Postoperative echocardiographic peak right ventricular outflow tract gradient decreased from 72 ± 27 mm Hg to 21 ± 16 mm Hg. Median intensive care unit and hospital stay were 3 and 7 days. The survival rate at 10 years was 94.6% ± 1.8%. Reintervention was required 86 times (55 catheter interventions) in 56 patients following tetralogy of Fallot repair. The freedom from all-cause reintervention rate at 10 years was 70.5% ± 3.6%. Cyanotic spells (hazard ratio, 2.14; 95% CI, 1.22-3.90; P < .01) and smaller pulmonary valve annulus z score (hazard ratio, 1.26; 95% CI, 1.01-1.59; P = .04) were associated with increasing risk of all reinterventions. Freedom from redo surgery for right ventricular outflow tract obstruction and right ventricular dilatation at 10 years were, respectively, 85.0% ± 3.1% and 98.7% ± 0.9%. Freedom from valve implantation was 96.7% ± 1.5% at 10 years. CONCLUSIONS A uniform strategy of primary repair of tetralogy of Fallot through a transventricular approach resulted in low reoperation rate in the first decade. The need of pulmonary valve implantation was limited to <4% at 10 years.
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Affiliation(s)
- Soichiro Henmi
- Division of Cardiovascular Surgery, Children's National Heart Institute, Children's National Hospital, The George Washington University School of Medicine and Health Science, Washington, DC
| | - Julia A Ryan
- The George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Rittal Mehta
- Division of Cardiovascular Surgery, Children's National Heart Institute, Children's National Hospital, The George Washington University School of Medicine and Health Science, Washington, DC
| | - Mitchell C Haverty
- Division of Cardiovascular Surgery, Children's National Heart Institute, Children's National Hospital, The George Washington University School of Medicine and Health Science, Washington, DC
| | - Ian W Hovis
- Division of Cardiology, Children's National Heart Institute, Children's National Hospital, The George Washington University School of Medicine and Health Science, Washington, DC
| | - Bao Nguyen Puente
- Division of Cardiac Critical Care Medicine, Children's National Heart Institute, Children's National Hospital, The George Washington University School of Medicine and Health Science, Washington, DC
| | - Mahmut Ozturk
- Division of Cardiovascular Surgery, Children's National Heart Institute, Children's National Hospital, The George Washington University School of Medicine and Health Science, Washington, DC
| | - Manan Desai
- Division of Cardiovascular Surgery, Children's National Heart Institute, Children's National Hospital, The George Washington University School of Medicine and Health Science, Washington, DC
| | - Aybala Tongut
- Division of Cardiovascular Surgery, Children's National Heart Institute, Children's National Hospital, The George Washington University School of Medicine and Health Science, Washington, DC
| | - Can Yerebakan
- Division of Cardiovascular Surgery, Children's National Heart Institute, Children's National Hospital, The George Washington University School of Medicine and Health Science, Washington, DC
| | - Yves d'Udekem
- Division of Cardiovascular Surgery, Children's National Heart Institute, Children's National Hospital, The George Washington University School of Medicine and Health Science, Washington, DC.
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Adachi I, Adamczyk K, Aggarwal L, Aihara H, Akopov N, Aloisio A, Anh Ky N, Asner DM, Atmacan H, Aushev T, Aushev V, Aversano M, Babu V, Bae H, Bahinipati S, Bambade P, Banerjee S, Barrett M, Baudot J, Bauer M, Baur A, Beaubien A, Becherer F, Becker J, Behera PK, Bennett JV, Bernlochner FU, Bertacchi V, Bertemes M, Bertholet E, Bessner M, Bettarini S, Bhuyan B, Bianchi F, Bilka T, Biswas D, Bobrov A, Bodrov D, Bolz A, Bondar A, Borah J, Bozek A, Bračko M, Branchini P, Briere RA, Browder TE, Budano A, Bussino S, Campajola M, Cao L, Casarosa G, Cecchi C, Cerasoli J, Chang MC, Chang P, Cheaib R, Cheema P, Chekelian V, Cheon BG, Chilikin K, Chirapatpimol K, Cho HE, Cho K, Choi SK, Choudhury S, Cochran J, Corona L, Cremaldi LM, Das S, Dattola F, De La Cruz-Burelo E, De La Motte SA, De Nardo G, De Nuccio M, De Pietro G, de Sangro R, Destefanis M, Dey S, Dhamija R, Di Canto A, Di Capua F, Dingfelder J, Doležal Z, Domínguez Jiménez I, Dong TV, Dorigo M, Dort K, Dossett D, Dreyer S, Dubey S, Dujany G, Ecker P, Eliachevitch M, Epifanov D, Feichtinger P, Ferber T, Ferlewicz D, Fillinger T, Finck C, Finocchiaro G, Fodor A, Forti F, Frey A, Fulsom BG, Gabrielli A, Ganiev E, Garcia-Hernandez M, Garg R, Garmash A, Gaudino G, Gaur V, Gaz A, Gellrich A, Ghevondyan G, Ghosh D, Ghumaryan H, Giakoustidis G, Giordano R, Giri A, Gobbo B, Godang R, Gogota O, Goldenzweig P, Gradl W, Granderath S, Graziani E, Greenwald D, Gruberová Z, Gu T, Guan Y, Gudkova K, Halder S, Han Y, Hara T, Hayasaka K, Hayashii H, Hazra S, Hearty C, Hedges MT, Heidelbach A, Heredia de la Cruz I, Hernández Villanueva M, Hershenhorn A, Higuchi T, Hill EC, Hoek M, Hohmann M, Horak P, Hsu CL, Iijima T, Inami K, Inguglia G, Ipsita N, Ishikawa A, Ito S, Itoh R, Iwasaki M, Jackson P, Jacobs WW, Jang EJ, Ji QP, Jia S, Jin Y, Johnson A, Junkerkalefeld H, Kaliyar AB, Kandra J, Kang KH, Karyan G, Kawasaki T, Keil F, Ketter C, Kiesling C, Kim CH, Kim DY, Kim KH, Kim YK, Kindo H, Kinoshita K, Kodyš P, Koga T, Kohani S, Kojima K, Konno T, Korobov A, Korpar S, Kovalenko E, Kowalewski R, Kraetzschmar TMG, Križan P, Krokovny P, Kuhr T, Kumar J, Kumar M, Kumara K, Kunigo T, Kuzmin A, Kwon YJ, Lacaprara S, Lai YT, Lam T, Lanceri L, Lange JS, Laurenza M, Leboucher R, Le Diberder FR, Leitl P, Levit D, Lewis PM, Li C, Li LK, Li Y, Libby J, Liu QY, Liu ZQ, Liventsev D, Longo S, Lueck T, Luo T, Lyu C, Ma Y, Maggiora M, Maharana SP, Maiti R, Maity S, Mancinelli G, Manfredi R, Manoni E, Manthei AC, Mantovano M, Marcantonio D, Marcello S, Marinas C, Martel L, Martellini C, Martini A, Martinov T, Massaccesi L, Masuda M, Matsuda T, Matvienko D, Maurya SK, McKenna JA, Mehta R, Meier F, Merola M, Metzner F, Milesi M, Miller C, Mirra M, Miyabayashi K, Mohanty GB, Molina-Gonzalez N, Mondal S, Moneta S, Moser HG, Mrvar M, Mussa R, Nakamura I, Nakazawa Y, Narimani Charan A, Naruki M, Natkaniec Z, Natochii A, Nayak L, Nazaryan G, Nisar NK, Nishida S, Ogawa S, Ono H, Oskin P, Otani F, Pakhlov P, Pakhlova G, Paladino A, Panta A, Paoloni E, Pardi S, Parham K, Park SH, Paschen B, Passeri A, Patra S, Paul S, Pedlar TK, Peruzzi I, Peschke R, Pestotnik R, Pham F, Piccolo M, Piilonen LE, Podesta-Lerma PLM, Podobnik T, Pokharel S, Praz C, Prell S, Prencipe E, Prim MT, Purwar H, Rad N, Rados P, Raeuber G, Raiz S, Reif M, Reiter S, Remnev M, Ripp-Baudot I, Rizzo G, Robertson SH, Roehrken M, Roney JM, Rostomyan A, Rout N, Russo G, Sahoo D, Sandilya S, Sangal A, Santelj L, Sato Y, Savinov V, Scavino B, Schmitt C, Schnepf M, Schwanda C, Seino Y, Selce A, Senyo K, Serrano J, Sevior ME, Sfienti C, Shan W, Sharma C, Shen CP, Shi XD, Shillington T, Shiu JG, Shtol D, Shwartz B, Sibidanov A, Simon F, Singh JB, Skorupa J, Sobie RJ, Sobotzik M, Soffer A, Sokolov A, Solovieva E, Spataro S, Spruck B, Starič M, Stavroulakis P, Stefkova S, Stottler ZS, Stroili R, Strube J, Sumihama M, Sumisawa K, Sutcliffe W, Svidras H, Takahashi M, Takizawa M, Tamponi U, Tanida K, Tenchini F, Thaller A, Tittel O, Tiwary R, Tonelli D, Torassa E, Toutounji N, Trabelsi K, Tsaklidis I, Uchida M, Ueda I, Uematsu Y, Uglov T, Unger K, Unno Y, Uno K, Uno S, Urquijo P, Ushiroda Y, Vahsen SE, van Tonder R, Varner GS, Varvell KE, Veronesi M, Vismaya VS, Vitale L, Vobbilisetti V, Volpe R, Wach B, Waheed E, Wakai M, Wallner S, Wang E, Wang MZ, Wang Z, Warburton A, Watanabe M, Watanuki S, Welsch M, Wessel C, Xu XP, Yabsley BD, Yamada S, Yan W, Yang SB, Yin JH, Yoshihara K, Yuan CZ, Zani L, Zhang Y, Zhilich V, Zhou JS, Zhou QD, Zhukova VI, Žlebčík R. Tests of Light-Lepton Universality in Angular Asymmetries of B^{0}→D^{*-}ℓν Decays. Phys Rev Lett 2023; 131:181801. [PMID: 37977641 DOI: 10.1103/physrevlett.131.181801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 09/29/2023] [Indexed: 11/19/2023]
Abstract
We present the first comprehensive tests of the universality of the light leptons in the angular distributions of semileptonic B^{0}-meson decays to charged spin-1 charmed mesons. We measure five angular-asymmetry observables as functions of the decay recoil that are sensitive to lepton-universality-violating contributions. We use events where one neutral B is fully reconstructed in ϒ(4S)→BB[over ¯] decays in data corresponding to 189 fb^{-1} integrated luminosity from electron-positron collisions collected with the Belle II detector. We find no significant deviation from the standard model expectations.
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Adachi I, Aggarwal L, Aihara H, Akopov N, Aloisio A, Anh Ky N, Asner DM, Atmacan H, Aushev T, Aushev V, Aversano M, Babu V, Bae H, Bahinipati S, Bambade P, Banerjee S, Barrett M, Baudot J, Bauer M, Baur A, Beaubien A, Becker J, Behera PK, Bennett JV, Bernlochner FU, Bertacchi V, Bertemes M, Bertholet E, Bessner M, Bettarini S, Bhuyan B, Bianchi F, Bilka T, Biswas D, Bodrov D, Bondar A, Bozek A, Bračko M, Branchini P, Briere RA, Browder TE, Budano A, Bussino S, Campajola M, Cao L, Casarosa G, Cecchi C, Cerasoli J, Chang MC, Chang P, Cheema P, Chekelian V, Cheon BG, Chilikin K, Chirapatpimol K, Cho HE, Cho K, Choi SK, Choudhury S, Cochran J, Corona L, Das S, Dattola F, De La Motte SA, de Marino G, De Nardo G, De Nuccio M, De Pietro G, de Sangro R, Destefanis M, Dey S, Dhamija R, Di Canto A, Di Capua F, Dingfelder J, Doležal Z, Domínguez Jiménez I, Dong TV, Dorigo M, Dort K, Dreyer S, Dubey S, Dujany G, Ecker P, Epifanov D, Feichtinger P, Ferlewicz D, Finck C, Finocchiaro G, Fodor A, Forti F, Frey A, Fulsom BG, Gabrielli A, Ganiev E, Garcia-Hernandez M, Garmash A, Gaudino G, Gaur V, Gaz A, Gellrich A, Ghevondyan G, Ghosh D, Ghumaryan H, Giakoustidis G, Giordano R, Giri A, Glazov A, Gobbo B, Godang R, Gogota O, Goldenzweig P, Gradl W, Graziani E, Greenwald D, Gruberová Z, Gu T, Guan Y, Gudkova K, Han Y, Hayasaka K, Hayashii H, Hazra S, Hearty C, Heredia de la Cruz I, Hershenhorn A, Higuchi T, Hill EC, Hoek M, Hohmann M, Hsu CL, Humair T, Iijima T, Inami K, Ipsita N, Ishikawa A, Ito S, Itoh R, Iwasaki M, Jackson P, Jacobs WW, Jaffe DE, Jang EJ, Ji QP, Jia S, Jin Y, Junkerkalefeld H, Kaliyar AB, Kandra J, Karyan G, Kawasaki T, Keil F, Ketter C, Kiesling C, Kim CH, Kim DY, Kim KH, Kim YK, Kindo H, Kinoshita K, Kodyš P, Koga T, Kohani S, Kojima K, Korobov A, Korpar S, Kowalewski R, Kraetzschmar TMG, Križan P, Krokovny P, Kuhr T, Kumar J, Kumar M, Kumar R, Kumara K, Kuzmin A, Kwon YJ, Lacaprara S, Lai YT, Lam T, Lange JS, Laurenza M, Leboucher R, Le Diberder FR, Leitl P, Levit D, Lewis PM, Li LK, Libby J, Liu QY, Liu ZQ, Liventsev D, Longo S, Lueck T, Lyu C, Ma Y, Maggiora M, Maharana SP, Maiti R, Maity S, Manfredi R, Manoni E, Mantovano M, Marcantonio D, Marcello S, Marinas C, Martellini C, Martini A, Martinov T, Massaccesi L, Masuda M, Matsuda T, Matsuoka K, Matvienko D, Maurya SK, McKenna JA, Mehta R, Meier F, Merola M, Metzner F, Milesi M, Miller C, Mirra M, Miyabayashi K, Mohanty GB, Molina-Gonzalez N, Mondal S, Moneta S, Moser HG, Mrvar M, Mussa R, Nakamura I, Nakazawa Y, Narimani Charan A, Naruki M, Natkaniec Z, Natochii A, Nayak L, Nazaryan G, Nisar NK, Nishida S, Ono H, Otani F, Oxford ER, Pakhlov P, Pakhlova G, Paladino A, Panta A, Paoloni E, Pardi S, Passeri A, Patra S, Paul S, Pedlar TK, Peruzzi I, Peschke R, Pestotnik R, Pham F, Piccolo M, Piilonen LE, Podobnik T, Pokharel S, Praz C, Prell S, Prencipe E, Prim MT, Purwar H, Rados P, Raeuber G, Raiz S, Reif M, Reiter S, Remnev M, Ripp-Baudot I, Rizzo G, Roney JM, Rostomyan A, Rout N, Russo G, Sandilya S, Sangal A, Santelj L, Sato Y, Savinov V, Scavino B, Schmitt C, Schwanda C, Schwartz AJ, Seino Y, Selce A, Senyo K, Serrano J, Sevior ME, Sfienti C, Shan W, Shi XD, Shillington T, Shiu JG, Shtol D, Sibidanov A, Simon F, Sobie RJ, Sobotzik M, Soffer A, Sokolov A, Solovieva E, Spataro S, Spruck B, Starič M, Stavroulakis P, Stottler ZS, Stroili R, Sumihama M, Svidras H, Takahashi M, Takizawa M, Tamponi U, Tanida K, Tenchini F, Tittel O, Tonelli D, Torassa E, Trabelsi K, Tsaklidis I, Unger K, Unno Y, Uno K, Uno S, Urquijo P, Ushiroda Y, Vahsen SE, van Tonder R, Varvell KE, Veronesi M, Vismaya VS, Vitale L, Volpe R, Wach B, Wallner S, Wang E, Wang MZ, Wang XL, Wang Z, Warburton A, Watanabe M, Wessel C, Won E, Xu XP, Yabsley BD, Yamada S, Yan W, Yang SB, Yoshihara K, Yuan CZ, Yusa Y, Zhang Y, Zhilich V, Zhou JS, Zhou QD, Zhukova VI, Žlebčík R. Precise Measurement of the D_{s}^{+} Lifetime at Belle II. Phys Rev Lett 2023; 131:171803. [PMID: 37955504 DOI: 10.1103/physrevlett.131.171803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 09/14/2023] [Indexed: 11/14/2023]
Abstract
We measure the lifetime of the D_{s}^{+} meson using a data sample of 207 fb^{-1} collected by the Belle II experiment running at the SuperKEKB asymmetric-energy e^{+}e^{-} collider. The lifetime is determined by fitting the decay-time distribution of a sample of 116×10^{3} D_{s}^{+}→ϕπ^{+} decays. Our result is τ_{D_{s}^{+}}=(499.5±1.7±0.9) fs, where the first uncertainty is statistical and the second is systematic. This result is significantly more precise than previous measurements.
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Adachi I, Adamczyk K, Aggarwal L, Ahmed H, Aihara H, Akopov N, Aloisio A, Anh Ky N, Asner DM, Atmacan H, Aushev T, Aushev V, Aversano M, Babu V, Bae H, Bahinipati S, Bambade P, Banerjee S, Bansal S, Barrett M, Baudot J, Bauer M, Baur A, Beaubien A, Becker J, Behera PK, Bennett JV, Bernieri E, Bernlochner FU, Bertacchi V, Bertemes M, Bertholet E, Bessner M, Bettarini S, Bhardwaj V, Bhuyan B, Bianchi F, Bilka T, Bilokin S, Biswas D, Bobrov A, Bodrov D, Bolz A, Borah J, Bozek A, Bračko M, Branchini P, Browder TE, Budano A, Bussino S, Campajola M, Cao L, Casarosa G, Cecchi C, Cerasoli J, Chang MC, Chang P, Cheaib R, Cheema P, Chekelian V, Chen YQ, Cheon BG, Chilikin K, Chirapatpimol K, Cho HE, Cho K, Cho SJ, Choi SK, Choudhury S, Cinabro D, Cochran J, Corona L, Cremaldi LM, Cunliffe S, Czank T, Das S, Dattola F, De La Cruz-Burelo E, De La Motte SA, de Marino G, De Nardo G, De Nuccio M, De Pietro G, de Sangro R, Destefanis M, Dey S, De Yta-Hernandez A, Dhamija R, Di Canto A, Di Capua F, Dingfelder J, Doležal Z, Domínguez Jiménez I, Dong TV, Dorigo M, Dort K, Dossett D, Dreyer S, Dubey S, Dujany G, Ecker P, Eliachevitch M, Epifanov D, Feichtinger P, Ferber T, Ferlewicz D, Fillinger T, Finck C, Finocchiaro G, Fodor A, Forti F, Frey A, Fulsom BG, Gabrielli A, Ganiev E, Garcia-Hernandez M, Garmash A, Gaudino G, Gaur V, Gaz A, Gellrich A, Ghevondyan G, Ghosh D, Ghumaryan H, Giakoustidis G, Giordano R, Giri A, Glazov A, Gobbo B, Godang R, Gogota O, Goldenzweig P, Gradl W, Grammatico T, Granderath S, Graziani E, Greenwald D, Gruberová Z, Gu T, Guan Y, Gudkova K, Guilliams J, Halder S, Han Y, Hara T, Hayasaka K, Hayashii H, Hazra S, Hearty C, Hedges MT, Heredia de la Cruz I, Hernández Villanueva M, Hershenhorn A, Higuchi T, Hill EC, Hirata H, Hoek M, Hohmann M, Hsu CL, Humair T, Iijima T, Inami K, Inguglia G, Ipsita N, Ishikawa A, Ito S, Itoh R, Iwasaki M, Jackson P, Jacobs WW, Jaffe DE, Jang EJ, Ji QP, Jia S, Jin Y, Johnson A, Joo KK, Junkerkalefeld H, Kakuno H, Kaleta M, Kalita D, Kaliyar AB, Kandra J, Kang KH, Kang S, Karl R, Karyan G, Kawasaki T, Keil F, Ketter C, Kiesling C, Kim CH, Kim DY, Kim KH, Kim YK, Kindo H, Kodyš P, Koga T, Kohani S, Kojima K, Konno T, Korobov A, Korpar S, Kovalenko E, Kowalewski R, Kraetzschmar TMG, Križan P, Krokovny P, Kuhr T, Kumar J, Kumar M, Kumar R, Kumara K, Kunigo T, Kuzmin A, Kwon YJ, Lacaprara S, Lai YT, Lam T, Lanceri L, Lange JS, Laurenza M, Lautenbach K, Leboucher R, Le Diberder FR, Leitl P, Levit D, Lewis PM, Li C, Li LK, Li YB, Libby J, Lieret K, Liu QY, Liu ZQ, Liventsev D, Longo S, Lozar A, Lueck T, Lyu C, Ma Y, Maggiora M, Maharana SP, Maiti R, Maity S, Manfredi R, Manoni E, Manthei AC, Mantovano M, Marcantonio D, Marcello S, Marinas C, Martel L, Martellini C, Martini A, Martinov T, Massaccesi L, Masuda M, Matsuda T, Matsuoka K, Matvienko D, Maurya SK, McKenna JA, Mehta R, Merola M, Metzner F, Milesi M, Miller C, Mirra M, Miyabayashi K, Miyake H, Mizuk R, Mohanty GB, Molina-Gonzalez N, Mondal S, Moneta S, Moser HG, Mrvar M, Mussa R, Nakamura I, Nakamura KR, Nakao M, Nakayama H, Nakazawa H, Nakazawa Y, Narimani Charan A, Naruki M, Narwal D, Natkaniec Z, Natochii A, Nayak L, Nayak M, Nazaryan G, Niebuhr C, Nisar NK, Nishida S, Ogawa S, Ono H, Onuki Y, Oskin P, Otani F, Pakhlov P, Pakhlova G, Paladino A, Panta A, Paoloni E, Pardi S, Parham K, Park J, Park SH, Paschen B, Passeri A, Patra S, Paul S, Pedlar TK, Peruzzi I, Peschke R, Pestotnik R, Pham F, Piccolo M, Piilonen LE, Pinna Angioni G, Podesta-Lerma PLM, Podobnik T, Pokharel S, Polat L, Praz C, Prell S, Prencipe E, Prim MT, Purwar H, Rad N, Rados P, Raeuber G, Raiz S, Ramirez Morales A, Reif M, Reiter S, Remnev M, Ripp-Baudot I, Rizzo G, Rizzuto LB, Robertson SH, Rodríguez Pérez D, Roehrken M, Roney JM, Rostomyan A, Rout N, Russo G, Sahoo D, Sanders DA, Sandilya S, Sangal A, Santelj L, Sato Y, Savinov V, Scavino B, Schnepf M, Schueler J, Schwanda C, Seino Y, Selce A, Senyo K, Serrano J, Sevior ME, Sfienti C, Shan W, Sharma C, Shen CP, Shi XD, Shillington T, Shiu JG, Shtol D, Shwartz B, Sibidanov A, Simon F, Singh JB, Skorupa J, Sobie RJ, Sobotzik M, Soffer A, Sokolov A, Solovieva E, Spataro S, Spruck B, Starič M, Stavroulakis P, Stefkova S, Stottler ZS, Stroili R, Strube J, Sue Y, Sumihama M, Sumisawa K, Sutcliffe W, Suzuki SY, Svidras H, Takahashi M, Takizawa M, Tamponi U, Tanaka S, Tanida K, Tanigawa H, Tenchini F, Thaller A, Tiwary R, Tonelli D, Torassa E, Toutounji N, Trabelsi K, Tsaklidis I, Uchida M, Ueda I, Uematsu Y, Uglov T, Unger K, Unno Y, Uno K, Uno S, Urquijo P, Ushiroda Y, Vahsen SE, van Tonder R, Varner GS, Varvell KE, Vinokurova A, Vismaya VS, Vitale L, Vobbilisetti V, Volpe R, Vossen A, Wach B, Wakai M, Wakeling HM, Wallner S, Wang E, Wang MZ, Wang XL, Wang Z, Warburton A, Watanabe M, Watanuki S, Welsch M, Wessel C, Won E, Xu XP, Yabsley BD, Yamada S, Yan W, Yang SB, Ye H, Yelton J, Yin JH, Yook YM, Yoshihara K, Yuan CZ, Yusa Y, Zani L, Zhai Y, Zhang Y, Zhilich V, Zhou JS, Zhou QD, Zhou XY, Zhukova VI, Žlebčík R. Search for a τ^{+}τ^{-} Resonance in e^{+}e^{-}→μ^{+}μ^{-}τ^{+}τ^{-} Events with the Belle II Experiment. Phys Rev Lett 2023; 131:121802. [PMID: 37802942 DOI: 10.1103/physrevlett.131.121802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 08/08/2023] [Indexed: 10/08/2023]
Abstract
We report the first search for a nonstandard-model resonance decaying into τ pairs in e^{+}e^{-}→μ^{+}μ^{-}τ^{+}τ^{-} events in the 3.6-10 GeV/c^{2} mass range. We use a 62.8 fb^{-1} sample of e^{+}e^{-} collisions collected at a center-of-mass energy of 10.58 GeV by the Belle II experiment at the SuperKEKB collider. The analysis probes three different models predicting a spin-1 particle coupling only to the heavier lepton families, a Higgs-like spin-0 particle that couples preferentially to charged leptons (leptophilic scalar), and an axionlike particle, respectively. We observe no evidence for a signal and set exclusion limits at 90% confidence level on the product of cross section and branching fraction into τ pairs, ranging from 0.7 to 24 fb, and on the couplings of these processes. We obtain world-leading constraints on the couplings for the leptophilic scalar model for masses above 6.5 GeV/c^{2} and for the axionlike particle model over the entire mass range.
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Adachi I, Adamczyk K, Aggarwal L, Ahmed H, Aihara H, Akopov N, Aloisio A, Anh Ky N, Asner DM, Atmacan H, Aushev T, Aushev V, Aversano M, Babu V, Bae H, Bahinipati S, Bambade P, Banerjee S, Barrett M, Baudot J, Bauer M, Baur A, Beaubien A, Becker J, Behera PK, Bennett JV, Bertacchi V, Bertemes M, Bertholet E, Bessner M, Bettarini S, Bhuyan B, Bianchi F, Bilka T, Biswas D, Bodrov D, Bondar A, Borah J, Bozek A, Bračko M, Branchini P, Briere RA, Browder TE, Budano A, Bussino S, Campajola M, Cao L, Casarosa G, Cecchi C, Cerasoli J, Chang P, Cheaib R, Cheema P, Chekelian V, Chen C, Cheon BG, Chilikin K, Chirapatpimol K, Cho HE, Cho K, Cho SJ, Choi SK, Choudhury S, Cochran J, Corona L, Cremaldi LM, Das S, Dattola F, De La Cruz-Burelo E, De La Motte SA, de Marino G, De Nuccio M, De Pietro G, de Sangro R, Destefanis M, De Yta-Hernandez A, Dhamija R, Di Canto A, Di Capua F, Dingfelder J, Doležal Z, Domínguez Jiménez I, Dong TV, Dorigo M, Dort K, Dreyer S, Dubey S, Dujany G, Ecker P, Eliachevitch M, Feichtinger P, Ferber T, Ferlewicz D, Fillinger T, Finck C, Finocchiaro G, Fodor A, Forti F, Fulsom BG, Gabrielli A, Ganiev E, Garcia-Hernandez M, Garg R, Garmash A, Gaudino G, Gaur V, Gaz A, Gellrich A, Ghosh D, Giakoustidis G, Giordano R, Giri A, Glazov A, Gobbo B, Godang R, Goldenzweig P, Gradl W, Grammatico T, Granderath S, Graziani E, Greenwald D, Gruberová Z, Gu T, Guan Y, Gudkova K, Halder S, Han Y, Hara K, Hara T, Hayasaka K, Hayashii H, Hazra S, Hearty C, Hedges MT, Heredia de la Cruz I, Hernández Villanueva M, Hershenhorn A, Higuchi T, Hill EC, Hoek M, Hohmann M, Hsu CL, Humair T, Iijima T, Inami K, Ipsita N, Ishikawa A, Ito S, Itoh R, Iwasaki M, Jackson P, Jacobs WW, Jang EJ, Ji QP, Jia S, Jin Y, Johnson A, Joo KK, Junkerkalefeld H, Kaleta M, Kaliyar AB, Kandra J, Kang KH, Kang S, Kar S, Karyan G, Kawasaki T, Keil F, Ketter C, Kiesling C, Kim CH, Kim DY, Kim KH, Kim YK, Kindo H, Kodyš P, Koga T, Kohani S, Kojima K, Korobov A, Korpar S, Kovalenko E, Kowalewski R, Kraetzschmar TMG, Križan P, Krokovny P, Kuhr T, Kumar J, Kumar M, Kumara K, Kunigo T, Kuzmin A, Kwon YJ, Lacaprara S, Lai YT, Lam T, Lange JS, Laurenza M, Leboucher R, Le Diberder FR, Leitl P, Levit D, Li C, Li LK, Libby J, Liu QY, Liu ZQ, Liventsev D, Longo S, Lueck T, Luo T, Lyu C, Ma Y, Maggiora M, Maharana SP, Maiti R, Maity S, Mancinelli G, Manfredi R, Manoni E, Mantovano M, Marcantonio D, Marcello S, Marinas C, Martel L, Martellini C, Martinov T, Massaccesi L, Masuda M, Matsuda T, Matsuoka K, Matvienko D, Maurya SK, McKenna JA, Mehta R, Meier F, Merola M, Metzner F, Milesi M, Miller C, Mirra M, Miyabayashi K, Mizuk R, Mohanty GB, Molina-Gonzalez N, Mondal S, Moneta S, Moser HG, Mrvar M, Mussa R, Nakamura I, Nakazawa Y, Narimani Charan A, Naruki M, Natochii A, Nayak L, Nayak M, Nazaryan G, Nisar NK, Nishida S, Ono H, Onuki Y, Oskin P, Pakhlov P, Pakhlova G, Paladino A, Paoloni E, Pardi S, Parham K, Park H, Park SH, Passeri A, Patra S, Paul S, Pedlar TK, Peschke R, Pestotnik R, Pham F, Piccolo M, Piilonen LE, Podesta-Lerma PLM, Podobnik T, Pokharel S, Praz C, Prell S, Prencipe E, Prim MT, Purwar H, Rad N, Rados P, Raeuber G, Raiz S, Reif M, Reiter S, Remnev M, Ripp-Baudot I, Rizzo G, Robertson SH, Roehrken M, Roney JM, Rostomyan A, Rout N, Russo G, Sahoo D, Sandilya S, Sangal A, Santelj L, Sato Y, Savinov V, Scavino B, Schmitt C, Schwanda C, Schwartz AJ, Seino Y, Selce A, Senyo K, Serrano J, Sevior ME, Sfienti C, Shan W, Sharma C, Shi XD, Shillington T, Shiu JG, Shtol D, Sibidanov A, Simon F, Singh JB, Skorupa J, Sobie RJ, Sobotzik M, Soffer A, Sokolov A, Solovieva E, Spataro S, Spruck B, Starič M, Stavroulakis P, Stefkova S, Stottler ZS, Stroili R, Sumihama M, Sumisawa K, Sutcliffe W, Svidras H, Takahashi M, Takizawa M, Tamponi U, Tanaka S, Tanida K, Tenchini F, Thaller A, Tittel O, Tiwary R, Tonelli D, Torassa E, Trabelsi K, Tsaklidis I, Uchida M, Ueda I, Uglov T, Unger K, Unno Y, Uno K, Uno S, Urquijo P, Ushiroda Y, Vahsen SE, van Tonder R, Varner GS, Varvell KE, Vinokurova A, Vismaya VS, Vitale L, Wach B, Wakai M, Wakeling HM, Wallner S, Wang E, Wang MZ, Wang Z, Warburton A, Watanabe M, Watanuki S, Welsch M, Wessel C, Won E, Xu XP, Yabsley BD, Yamada S, Yan W, Yang SB, Yin JH, Yoshihara K, Yuan CZ, Yusa Y, Zani L, Zhang Y, Zhilich V, Zhou QD, Zhukova VI. Measurement of CP Violation in B^{0}→K_{S}^{0}π^{0} Decays at Belle II. Phys Rev Lett 2023; 131:111803. [PMID: 37774261 DOI: 10.1103/physrevlett.131.111803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 07/26/2023] [Indexed: 10/01/2023]
Abstract
We report a measurement of the CP-violating parameters C and S in B^{0}→K_{S}^{0}π^{0} decays at Belle II using a sample of 387×10^{6} BB[over ¯] events recorded in e^{+}e^{-} collisions at a center-of-mass energy corresponding to the ϒ(4S) resonance. These parameters are determined by fitting the proper decay-time distribution of a sample of 415 signal events. We obtain C=-0.04_{-0.15}^{+0.14}±0.05 and S=0.75_{-0.23}^{+0.20}±0.04, where the first uncertainties are statistical and the second are systematic.
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Okholm Kryger K, Wang A, Mehta R, Impellizzeri F, Massey A, Harrison M, Glendinning R, McCall A. Can we evidence-base injury prevention and management in women's football? A scoping review. Res Sports Med 2023; 31:687-702. [PMID: 35164617 DOI: 10.1080/15438627.2022.2038161] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 01/10/2022] [Indexed: 10/19/2022]
Abstract
This review aimed, as part of a larger FIFA project aiming to steer women's football research, to scope literature on any level of competitive football for women, to understand the current quantity of research on women's football injuries. The study reviewed all injury-related papers scoped by a recent scoping review mapping all published women's football research with an updated search performed on 23 February 2021. Eligibility criteria assessment followed the recent scoping review with injury-specific research focus. A total of 497 studies were scoped. Most studies contained an epidemiological (N = 226; 45%) or risk factors assessment (N = 105; 21%). Less assessed areas included financial burden (N = 1; <1%) and injury awareness (N = 5; 1%). 159 studies (32%) assessed injuries of the whole body. The most common single location assessed in the literature was the knee (N = 134, 27%), followed by head/face (N =108, 22%). These numbers were, however, substantially lowered, when subdivided by playing level and age-group. The volume of research focuses especially on descriptive research and specific body locations (head/face and knee). Although information can be taken from studies in other sports, more football-specific studies to support management and prevention of injuries are warranted.
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Affiliation(s)
- K Okholm Kryger
- Faculty of Sport, Allied Health and Performance Science, St Mary's University, London, UK
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- Sports and Exercise Medicine, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - A Wang
- College of Medicine and Veterinary Medicine, The Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - R Mehta
- College of Medicine and Veterinary Medicine, The Football Association, London, UK
| | - Fm Impellizzeri
- Sport and Exercise Discipline Group, Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - A Massey
- College of Medicine and Veterinary Medicine, Fédération Internationale de Football Association, Zurich, Switzerland
| | - M Harrison
- College of Medicine and Veterinary Medicine, St Helen's and Knowsley Teaching Hospitals Nhs Trust, Prescot, UK
| | - R Glendinning
- College of Medicine and Veterinary Medicine, Arsenal Performance and Research Team, Arsenal Football Club, London, UK
| | - A McCall
- College of Medicine and Veterinary Medicine, Arsenal Performance and Research Team, Arsenal Football Club, London, UK
- College of Medicine and Veterinary Medicine, School of Applied Sport & Exercise Sciences, Edinburgh Napier University, Edinburgh, UK
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Mehta R, Moalic M, Krawczyk M, Saha S. Tunability of spin-wave spectra in a 2D triangular shaped magnonic fractals. J Phys Condens Matter 2023; 35. [PMID: 37116510 DOI: 10.1088/1361-648x/acd15f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Accepted: 04/28/2023] [Indexed: 05/13/2023]
Abstract
Reprogramming the structure of the magnonic bands during their operation is important for controlling spin waves in magnonic devices. Here, we report the tunability of the spin-wave spectra for a triangular shaped deterministic magnonic fractal, which is known as Sierpinski triangle by solving the Landau-Lifshitz-Gilbert equation using a micromagnetic simulations. The spin-wave dynamics change significantly with the variation of iteration number. A wide frequency gap is observed for a structure with an iteration number exceeding some value and a plenty of mini-frequency bandgaps at structures with high iteration number. The frequency gap could be controlled by varying the strength of the magnetic field. A sixfold symmetry in the frequency gap is observed with the variation of the azimuthal angle of the external magnetic field. The spatial distributions of the spin-wave modes allow to identify the bands surrounding the gap. The observations are important for the application of magnetic fractals as a reconfigurable aperiodic magnonic crystals.
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Affiliation(s)
- R Mehta
- Department of Physics, Ashoka University, Sonipat, Haryana 131029, India
| | - M Moalic
- Institute of Spintronic and Quantum Information, Faculty of Physics, Adam Mickiewicz University, Poznan, Uniwersytetu Poznanskiego 2, Poznan PL-61-614, Poland
| | - M Krawczyk
- Institute of Spintronic and Quantum Information, Faculty of Physics, Adam Mickiewicz University, Poznan, Uniwersytetu Poznanskiego 2, Poznan PL-61-614, Poland
| | - S Saha
- Department of Physics, Ashoka University, Sonipat, Haryana 131029, India
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Blair PW, Mehta R, Oppong CK, Tin S, Ko E, Tsalik EL, Chenoweth J, Rozo M, Adams N, Beckett C, Woods CW, Striegel DA, Salvador MG, Brandsma J, McKean L, Mahle RE, Hulsey WR, Krishnan S, Prouty M, Letizia A, Fox A, Faix D, Lawler JV, Duplessis C, Gregory MG, Vantha T, Owusu-Ofori AK, Ansong D, Oduro G, Schully KL, Clark DV. Screening tools for predicting mortality of adults with suspected sepsis: an international sepsis cohort validation study. BMJ Open 2023; 13:e067840. [PMID: 36806137 PMCID: PMC9944645 DOI: 10.1136/bmjopen-2022-067840] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/22/2023] Open
Abstract
OBJECTIVES We evaluated the performance of commonly used sepsis screening tools across prospective sepsis cohorts in the USA, Cambodia and Ghana. DESIGN Prospective cohort studies. SETTING AND PARTICIPANTS From 2014 to 2021, participants with two or more SIRS (Systemic Inflammatory Response Syndrome) criteria and suspected infection were enrolled in emergency departments and medical wards at hospitals in Cambodia and Ghana and hospitalised participants with suspected infection were enrolled in the USA. Cox proportional hazards regression was performed, and Harrell's C-statistic calculated to determine 28-day mortality prediction performance of the quick Sequential Organ Failure Assessment (qSOFA) score ≥2, SIRS score ≥3, National Early Warning Score (NEWS) ≥5, Modified Early Warning Score (MEWS) ≥5 or Universal Vital Assessment (UVA) score ≥2. Screening tools were compared with baseline risk (age and sex) with the Wald test. RESULTS The cohorts included 567 participants (42.9% women) including 187 participants from Kumasi, Ghana, 200 participants from Takeo, Cambodia and 180 participants from Durham, North Carolina in the USA. The pooled mortality was 16.4% at 28 days. The mortality prediction accuracy increased from baseline risk with the MEWS (C-statistic: 0.63, 95% CI 0.58 to 0.68; p=0.002), NEWS (C-statistic: 0.68; 95% CI 0.64 to 0.73; p<0.001), qSOFA (C-statistic: 0.70, 95% CI 0.64 to 0.75; p<0.001), UVA score (C-statistic: 0.73, 95% CI 0.69 to 0.78; p<0.001), but not with SIRS (0.60; 95% CI 0.54 to 0.65; p=0.13). Within individual cohorts, only the UVA score in Ghana performed better than baseline risk (C-statistic: 0.77; 95% CI 0.71 to 0.83; p<0.001). CONCLUSIONS Among the cohorts, MEWS, NEWS, qSOFA and UVA scores performed better than baseline risk, largely driven by accuracy improvements in Ghana, while SIRS scores did not improve prognostication accuracy. Prognostication scores should be validated within the target population prior to clinical use.
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Affiliation(s)
- Paul W Blair
- Austere environments Consortium for Enhanced Sepsis Outcomes (ACESO), Henry M Jackson Foundation for the Advancement of Military Medicine Inc, Bethesda, Maryland, USA
| | - Rittal Mehta
- Austere environments Consortium for Enhanced Sepsis Outcomes (ACESO), Henry M Jackson Foundation for the Advancement of Military Medicine Inc, Bethesda, Maryland, USA
| | | | - Som Tin
- Takeo Provincial Referral Hospital, Takeo, Cambodia
| | - Emily Ko
- Duke University School of Medicine, Durham, North Carolina, USA
| | - Ephraim L Tsalik
- Duke University School of Medicine, Durham, North Carolina, USA
- Danaher Diagnostics, Washington, D.C, USA
| | - Josh Chenoweth
- Austere environments Consortium for Enhanced Sepsis Outcomes (ACESO), Henry M Jackson Foundation for the Advancement of Military Medicine Inc, Bethesda, Maryland, USA
| | - Michelle Rozo
- Austere environments Consortium for Enhanced Sepsis Outcomes (ACESO), Henry M Jackson Foundation for the Advancement of Military Medicine Inc, Bethesda, Maryland, USA
| | - Nehkonti Adams
- Naval Medical Research Center Infectious Diseases Directorate, Bethesda, Maryland, USA
| | - Charmagne Beckett
- Naval Medical Research Center Infectious Diseases Directorate, Bethesda, Maryland, USA
| | - Christopher W Woods
- Duke University School of Medicine, Durham, North Carolina, USA
- Duke Global Health Institute, Durham, North Carolina, USA
| | - Deborah A Striegel
- Austere environments Consortium for Enhanced Sepsis Outcomes (ACESO), Henry M Jackson Foundation for the Advancement of Military Medicine Inc, Bethesda, Maryland, USA
| | - Mark G Salvador
- Austere environments Consortium for Enhanced Sepsis Outcomes (ACESO), Henry M Jackson Foundation for the Advancement of Military Medicine Inc, Bethesda, Maryland, USA
| | - Joost Brandsma
- Austere environments Consortium for Enhanced Sepsis Outcomes (ACESO), Henry M Jackson Foundation for the Advancement of Military Medicine Inc, Bethesda, Maryland, USA
| | - Lauren McKean
- Austere environments Consortium for Enhanced Sepsis Outcomes (ACESO), Henry M Jackson Foundation for the Advancement of Military Medicine Inc, Bethesda, Maryland, USA
| | - Rachael E Mahle
- Duke University School of Medicine, Durham, North Carolina, USA
| | - William R Hulsey
- Henry M Jackson Foundation for the Advancement of Military Medicine Inc, Bethesda, Maryland, USA
| | - Subramaniam Krishnan
- Henry M Jackson Foundation for the Advancement of Military Medicine Inc, Bethesda, Maryland, USA
| | - Michael Prouty
- US Naval Medical Research Unit No 2, Phnom Penh, Cambodia
| | - Andrew Letizia
- Naval Medical Research Unit-3 Ghana Detachment, Accra, Ghana
| | - Anne Fox
- Naval Medical Research Unit-3 Ghana Detachment, Accra, Ghana
| | - Dennis Faix
- US Naval Medical Research Unit No 2, Phnom Penh, Cambodia
| | - James V Lawler
- Global Center for Health Security, University of Nebraska Medical Center, Omaha, Nebraska, USA
- Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Chris Duplessis
- Austere environments Consortium for Enhanced Sepsis Outcomes (ACESO), Biological Defense Research Directorate, Naval Medical Research Center-Frederick, Frederick, Maryland, USA
| | - Michael G Gregory
- Austere environments Consortium for Enhanced Sepsis Outcomes (ACESO), Biological Defense Research Directorate, Naval Medical Research Center-Frederick, Frederick, Maryland, USA
| | - Te Vantha
- Takeo Provincial Referral Hospital, Takeo, Cambodia
| | | | - Daniel Ansong
- Emergency Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | | | - Kevin L Schully
- Austere environments Consortium for Enhanced Sepsis Outcomes (ACESO), Henry M Jackson Foundation for the Advancement of Military Medicine Inc, Bethesda, Maryland, USA
| | - Danielle V Clark
- Austere environments Consortium for Enhanced Sepsis Outcomes (ACESO), Henry M Jackson Foundation for the Advancement of Military Medicine Inc, Bethesda, Maryland, USA
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Kincaid B, Mehta R. A rare case of acute lymphocytic leukemia presenting with pediatric acute liver failure. Am J Med Sci 2023. [DOI: 10.1016/s0002-9629(23)00405-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Blair PW, Mehta R, Som T, Okello S, Tsalik EL, Wailagala A, Woods CW, Prouty M, Chenoweth J, Letizia A, Faix D, Adams N, Ko ER, Duplessis C, Lamorde M, Owusu-Ofori A, Naluyima P, Kayiira M, Oppong C, Rozo M, Fox A, Lawler J, Waitt P, Prouty A, Vantha T, Beckett C, Kibuuka H, Oduro G, Schully K, Clark D, Clark D, Clark D. 1169. Derivation And Validation of an International Clinical Prognostication Model for 28-day Sepsis Mortality. Open Forum Infect Dis 2022. [PMCID: PMC9752634 DOI: 10.1093/ofid/ofac492.1006] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background Survival prediction models have largely been derived and validated only in high-resource Western countries or in single center studies. We sought to create a prediction model for 28-day mortality using laboratory and physiologic parameters from 3 international sepsis cohorts and externally validated the model. Methods During 2014 to 2021, adult hospitalized patients with suspected infection were enrolled in Durham, United States (N=180) and those with suspected infection and ≥2 SIRS (Systemic Inflammatory Response Syndrome) criteria in Takeo, Cambodia (N=200), and Kumasi, Ghana (N=187). Twenty-five clinical laboratory and physiologic parameters were candidate covariates and sepsis screening scores included as comparators. First, bivariate Cox regression models were performed to determine risk of individual parameters. Then, a 10-fold cross-validated forward stepwise model selection technique was used to eliminate nonsignificant variables using a p-value < 0.10 and the cross-validated C-statistic was estimated. Lastly, this model was applied to an external cohort of hospitalized adults with suspected infection and ≥2 SIRS in Fort Portal, Uganda (N=331 with 9.3% 28-day mortality). Results Among 567 participants, overall mortality was 16.4% at 28-days. Mortality rate highest in Ghana (31.0%), followed by Cambodia (11.0%) and the United States (7.2%). Bivariate analyses identified hypernatremia ( >145 mEq/L) being associated with the highest risk of death (hazard ratio: 7.42; 95% CI: 3.65 to 15.10; Figure 1). On multivariable analysis, a 28-day mortality model including mean arterial pressure, Glasgow Coma score, blood sodium, lactate, and blood urea nitrogen (Table 1) resulted in a 10-fold cross-validated C-statistic of 0.80 (95% CI: 0.61 to 0.88). This model predicted mortality accurately in the validation cohort with a C-statistic of 0.74 (95%CI: 0.69 to 0.79).
![]() Forest plot for bivariate analyses for one month survival across United States, Cambodia, and Ghana cohorts. ![]() Conclusion Hypotension, altered mental status, serum sodium, serum BUN, and plasma lactate accurately identified risk of death by 28-days among those with suspected sepsis in 3 international derivation cohorts and in a validation cohort in Uganda. Our findings emphasize the importance of clinical laboratory results for sepsis risk stratification. Disclosures Ephraim L. Tsalik, MD PhD, Danaher Diagnostics, Predigen, and Biomeme: In the past 3 years, I have had held equity and consulted for Predigen and Biomeme. Currently, I am an employee of Danaher Diagnostics. Christopher W. Woods, MD MPH, Predigen, Inc: Co-founder.
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Affiliation(s)
- Paul W Blair
- Austere environments Consortium for Enhanced Sepsis Outcomes (ACESO), Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland
| | | | - Tin Som
- Takeo Provincial Referral Hospital, Takeo, Takeo, Cambodia
| | - Stephen Okello
- Makerere University Walter Reed Project, Kampala, Kampala, Uganda
| | - Ephraim L Tsalik
- Duke University Division of Infectious Diseases, Duke University School of Medicine, Durham, Durham, North Carolina
| | | | | | - Michael Prouty
- Naval Medical Research Unit-2, Phnom Penh, Phnom Penh, Cambodia
| | | | - Andrew Letizia
- Naval Medical Research Unit-3 Ghana Detachment, Accra, Greater Accra, Ghana
| | - Dennis Faix
- Naval Medical Research Unit-2, Phnom Penh, Phnom Penh, Cambodia
| | - Nehkonti Adams
- Naval Medical Research Center Infectious Diseases Directorate, Bethesda, Maryland
| | - Emily R Ko
- Duke University School of Medicine, Durham, Durham, NC
| | - Chris Duplessis
- Naval Medical Research Center Infectious Diseases Directorate, Bethesda, Maryland
| | | | | | - Prossy Naluyima
- Makerere University Walter Reed Project, Kampala, Kampala, Uganda
| | - Mubaraka Kayiira
- Infectious Diseases Institute, Kampala, Kampala, Kampala, Uganda
| | - Chris Oppong
- Komfo Anokye Teaching Hospital, bethesda, Maryland
| | - Michelle Rozo
- Austere environments Consortium for Enhanced Sepsis Outcomes (ACESO), Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland
| | - Ann Fox
- Naval Medical Research Unit-3 Ghana Detachment, Accra, Greater Accra, Ghana
| | - James Lawler
- Global Center for Health Security at Nebraska and Division of Infectious Disease, Department of Internal Medicine, Omaha, Nebraska
| | - Peter Waitt
- Infectious Diseases Institute, Kampala, Kampala, Uganda
| | - Angela Prouty
- Naval Medical Research Unit-2, Phnom Penh, Phnom Penh, Cambodia
| | - Te Vantha
- Takeo Provincial Referral Hospital, Takeo, Takeo, Cambodia
| | - Charmagne Beckett
- Naval Medical Research Center Infectious Diseases Directorate, Bethesda, Maryland
| | - Hannah Kibuuka
- Makerere University Walter Reed Project, Kampala, Kampala, Uganda
| | - George Oduro
- Komfo Anokye Teaching Hospital, bethesda, Maryland
| | - Kevin Schully
- Naval Medical Research Center Infectious Diseases Directorate, Bethesda, Maryland
| | - Danielle Clark
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, Bethesda, Maryland
| | - Danielle Clark
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, Bethesda, Maryland
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Abbasi A, Liu M, Riley-Gillis B, Waring J, Jacob H, Brown SM, Cheng T, Mehta R, Smaoui N. 079 Applying human phenomics to electronic health records provides a framework for understanding skin-aging related phenotypes. J Invest Dermatol 2022. [DOI: 10.1016/j.jid.2022.09.089] [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: 11/19/2022]
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Moukthika KVN, Krishnappa D, Patloori Sirish Chandra S, Bhole C, Deshpande S, Roshan J, Barthur A, Parameshwaran S, Mehta R, Padmanabhan D. Inflammation begets isolated atrioventricular conduction disturbances in young an observation from indian registry data. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.499] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
High grade AV block is less commonly encountered in patients <60 years. The aetiological role of inflammatory conditions is not well studied in this group of patients.
Purpose
To determine the prevalence of myocardial inflammation in young patients presenting with High grade AV block and assess its response to immunosuppression.
Methodology
This is a prospective, registry based, observational study conducted at two centers from Jan 2020 to Dec 2021. Myocardial inflammation was detected using Cardiac PET, and/or histopathological examination. Those with evidence of inflammation were started on graded immunosuppression.
Results
318 patients were enrolled. Mean EF was 55.2±7.0%. Cardiac PET was performed in 87/318 (27.3%). Myocardial inflammation was seen in 57/87 (65%). LV basal septum was most commonly involved. 44/57 (77%) were started on immunosuppressive therapy after excluding indolent tuberculosis.8 patients died during follow-up with all deaths being sudden in nature. 5/44 (11.3%) had reversal of CHB with resolution of cPET findings.
Conclusion
Significant proportion of young patients with High grade AV block have segmental myocardial inflammation. Immunosuppression helps restore AV conduction in some of these patients. Long-term studies are required to assess adverse impact of inflammation on cardiac contractile function.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- K V N Moukthika
- sri jayadeva institute of cardiovascular sciences and research, Bangalore , India , India
| | - D Krishnappa
- sri jayadeva institute of cardiovascular sciences and research, Bangalore , India , India
| | | | - C Bhole
- sri jayadeva institute of cardiovascular sciences and research, Bangalore , India , India
| | - S Deshpande
- sri jayadeva institute of cardiovascular sciences and research, Bangalore , India , India
| | - J Roshan
- Christian Medical College, electrophysiology , Vellore , India
| | - A Barthur
- sri jayadeva institute of cardiovascular sciences and research, Bangalore , India , India
| | - S Parameshwaran
- sri jayadeva institute of cardiovascular sciences and research, Bangalore , India , India
| | - R Mehta
- sri jayadeva institute of cardiovascular sciences and research, Bangalore , India , India
| | - D Padmanabhan
- sri jayadeva institute of cardiovascular sciences and research, Bangalore , India , India
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De Michieli L, Knott J, Attia Z, Ola O, Akula A, Mehta R, Dworak M, Lobo R, Hodge D, Tak T, Cagin C, Friedman P, Gulati R, Jaffe A, Sandoval Y. Artificial intelligence-enabled electrocardiographic algorithm for the detection of left ventricular dysfunction in emergency department patients undergoing high-sensitivity cardiac troponin T. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1330] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Artificial intelligence-augmented electrocardiogram (AI-ECG) algorithms have been developed from the standard 12-lead ECG and validated for the recognition of left ventricular systolic dysfunction (LVSD), defined as LV ejection fraction (LVEF)≤35%. Whether AI-ECG facilitates identification of LVSD and is associated with adverse outcomes in emergency department (ED) patients undergoing high-sensitivity cardiac troponin (hs-cTnT) testing is uncertain.
Purpose
To investigate the diagnostic and prognostic performance of AI-ECG in ED patients undergoing hs-cTnT measurement.
Methods
Observational US cohort study of ED patients undergoing hs-cTnT measurement. Cases with hs-cTnT increases >sex-specific 99th percentiles were adjudicated following the Fourth Universal Definition of Myocardial Infarction (MI). Post-discharge major adverse cardiac events (MACE) included death, MI, heart failure (HF) hospitalization, stroke or transient ischemic attack, and new onset atrial fibrillation/flutter during 2-years follow-up. The AI-ECG network output, which is a continuous number between 0–1, that provides a probability of LVSD, was obtained for each patient from the first ECG during the index presentation. An AI-ECG threshold of ≥0.256 indicates a positive screen that correlates with a high probability of LVSD.
Results
Among 1977 patients, 1729 (87%) had a negative AI-ECG screen, while 248 (13%) had a positive AI-ECG screen. Patients with a positive AI-ECG screen were older and had more comorbidities. As compared to patients with hs-cTnT≤99th percentile in whom AI-ECG was positive in 5.8%, those with hs-cTnT>99th percentile had a positive AI-ECG in 22% of cases (p<0.0001). Based on adjudicated diagnoses, the frequency of a positive AI-ECG was 20% in myocardial injury, 38% in type 1 MI, and 20% in type 2 MI. At 2-years follow-up, as compared to patients with a negative AI-ECG, those with a positive AI-ECG had a higher risk for MACE (48% vs. 21%, p<0.0001, adjusted HR 1.39, 95% CI 1.11–1.75) (Figure 1), mainly because of more deaths (43% vs. 30%, p=0.004) and HF hospitalizations (36% vs. 13%, p<0.0001). A positive AI-ECG was associated with a higher risk for MACE (60% vs. 41%, p<0.0001, adjusted HR 1.30, 95% CI 1.02–1.64) in those with hs-cTnT increases >99th percentile, but not in those without hs-cTnT increases. Among patients with an echocardiogram during index presentation or within 30-days (n=452), the diagnostic accuracy of AI-ECG for LVEF ≤35% was 81.4% (95% CI 77.5, 84.9) with a negative predictive value of 96.5% (95% CI 94.0, 98.2). A normal LVEF (>50%) was observed in 87% of those with a negative AI ECG, whereas in those with a positive AI-ECG LVEF was reduced (<50%) in 60%.
Conclusions
Among ED patients evaluated with hs-cTnT, a positive AI-ECG screen for LVSD identifies patients at high risk of MACE. These findings are largely because of more deaths and HF hospitalizations in those with hs-cTnT increases >sex-specific 99th percentiles.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
| | - J Knott
- Mayo Clinic , Rochester , United States of America
| | - Z Attia
- Mayo Clinic , Rochester , United States of America
| | - O Ola
- Franciscan Skemp Healthcare Mayo Health System , La Crosse , United States of America
| | - A Akula
- Franciscan Skemp Healthcare Mayo Health System , La Crosse , United States of America
| | - R Mehta
- Mayo Clinic , Rochester , United States of America
| | - M Dworak
- Franciscan Skemp Healthcare Mayo Health System , La Crosse , United States of America
| | - R Lobo
- Mayo Clinic , Rochester , United States of America
| | - D Hodge
- Mayo Clinic , Jacksonville , United States of America
| | - T Tak
- Franciscan Skemp Healthcare Mayo Health System , La Crosse , United States of America
| | - C Cagin
- Franciscan Skemp Healthcare Mayo Health System , La Crosse , United States of America
| | - P Friedman
- Mayo Clinic , Rochester , United States of America
| | - R Gulati
- Mayo Clinic , Rochester , United States of America
| | - A Jaffe
- Mayo Clinic , Rochester , United States of America
| | - Y Sandoval
- Mayo Clinic , Rochester , United States of America
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Pitters E, Puts M, Alqurini N, Strohschein F, Koneru R, Szumacher E, Mariano C, Monette J, Hsu T, Brennenstuhl S, McLean B, Wills A, Berger A, Amir E, Romanovsky L, Li A, Mehta R, Krzyzanowska M, Elser C, Jang R, Prica A, Wan-Chow-Wah D, Emmenegger U, Menjak I, Bergman S, Lemonde M, Krahn M, Beland F, Breunis H, Alibhai S. The impact of the COVID-19 pandemic on quality of life, health care use and mortality in older adults in the 5C study of geriatric assessment and management: secondary analysis. J Geriatr Oncol 2022. [PMCID: PMC9595410 DOI: 10.1016/s1879-4068(22)00376-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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20
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Puts M, Alqurini N, Strohschein F, Berger A, Romanovsky L, Monette J, Mehta R, Li A, Wan-Chow-Wah D, Hsu T, Brennenstuhl S, Koneru R, Szumacher E, Mariano C, McLean B, Wills A, Amir E, Krzyzanowska M, Elser C, Jang R, Prica A, Pitters E, Emmenegger U, Menjak I, Bergman S, Lemonde M, Breunis H, Beland F, Krahn M, Alibhai S. Recommendations and adherence to recommendations made based on a comprehensive geriatric assessment for Canadian older adults with cancer: Results of the 5C trial. J Geriatr Oncol 2022. [DOI: 10.1016/s1879-4068(22)00374-5] [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: 11/07/2022]
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21
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Nair VV, Sharma P, Rajendran N, Raja S, Rao PP, Mehta R. CASE REPORT ON RARE OUTCOME OF A RETROPERITONEAL MASS: MANAGEMENT CHALLENGES AND LESSONS LEARNT. IJMMR 2022. [DOI: 10.11603/ijmmr.2413-6077.2022.1.12674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Background. Gastrointestinal stromal tumours (GIST) are non-epithelial mesenchymal solid neoplasm with varied presentation. The study reports the case of a retroperitoneal GIST in a 21‑year‑old male presented with an abdominal lump for six months. The lesion was initially thought to be a retroperitoneal sarcoma. Exploratory laparotomy revealed an abdominopelvic mass covering the entire right side of abdomen and pelvis. The tumour was adherent to the terminal ileum and ascending colon. There were dense adhesions between the retroperitoneum with involvement of the middle third of the right ureter. The tumour was resected with right hemicolectomy with ileotransverse anastomosis. Post-operative histopathology revealed it as high-grade spindle cell type GIST. The patient is presently on post-operative chemotherapy with Imatinib mesylate.
Objective. Atypical presentations of GIST are seldom discussed but frequently encountered in clinical practice. This article depicts different challenges the surgeon has to face while diagnosing such atypical entity.
Methods. Case report of atypical GIST presenting as retroperitoneal lump.
Results. The patient underwent surgical resection and is presently on post-operative chemotherapy with good overall outcome for a one year follow up.
Conclusions. GISTs presenting as retroperitoneal lumps are very rare, they should be considered in their differential diagnosis of an atypical retroperitoneal mass.
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22
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Brandsma J, Chenoweth JG, Gregory MK, Krishnan S, Blair PW, Striegel DA, Mehta R, Schully KL, Dumler JS, Sikorski CDRCS, O’Connor K, Reichert-Scrivner SA, Paguirigan CM, Uyehara CFT, Ngauy COLV, Myers CA, Clark DV. Assessing the use of a micro-sampling device for measuring blood protein levels in healthy subjects and COVID-19 patients. PLoS One 2022; 17:e0272572. [PMID: 35947596 PMCID: PMC9365123 DOI: 10.1371/journal.pone.0272572] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Accepted: 07/21/2022] [Indexed: 11/29/2022] Open
Abstract
Background Venous phlebotomy performed by trained personnel is critical for patient diagnosis and monitoring of chronic disease, but has limitations in resource-constrained settings, and represents an infection control challenge during outbreaks. Self-collection devices have the potential to shift phlebotomy closer to the point of care, supporting telemedicine strategies and virtual clinical trials. Here we assess a capillary blood micro-sampling device, the Tasso Serum Separator Tube (SST), for measuring blood protein levels in healthy subjects and non-hospitalized COVID-19 patients. Methods 57 healthy controls and 56 participants with mild/moderate COVID-19 were recruited at two U.S. military healthcare facilities. Healthy controls donated Tasso SST capillary serum, venous plasma and venous serum samples at multiple time points, while COVID-19 patients donated a single Tasso SST serum sample at enrolment. Concentrations of 17 protein inflammatory biomarkers were measured in all biospecimens by Ella multi-analyte immune-assay. Results Tasso SST serum protein measurements in healthy control subjects were highly reproducible, but their agreements with matched venous samples varied. Most of the selected proteins, including CRP, Ferritin, IL-6 and PCT, were well-correlated between Tasso SST and venous serum with little sample type bias, but concentrations of D-dimer, IL-1B and IL-1Ra were not. Self-collection at home with delayed sample processing was associated with significant concentrations differences for several analytes compared to supervised, in-clinic collection with rapid processing. Finally, Tasso SST serum protein concentrations were significantly elevated in in non-hospitalized COVID-19 patients compared with healthy controls. Conclusions Self-collection of capillary blood with micro-sampling devices provides an attractive alternative to routine phlebotomy. However, concentrations of certain analytes may differ significantly from those in venous samples, and factors including user proficiency, temperature control and time lags between specimen collection and processing need to be considered for their effect on sample quality and reproducibility.
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Affiliation(s)
- Joost Brandsma
- Austere Environments Consortium for Enhanced Sepsis Outcomes, Henry M. Jackson Foundation for the Advancement of Military Medicine Inc., Bethesda, Maryland, United States of America
- * E-mail:
| | - Josh G. Chenoweth
- Austere Environments Consortium for Enhanced Sepsis Outcomes, Henry M. Jackson Foundation for the Advancement of Military Medicine Inc., Bethesda, Maryland, United States of America
| | - Melissa K. Gregory
- Austere Environments Consortium for Enhanced Sepsis Outcomes, Henry M. Jackson Foundation for the Advancement of Military Medicine Inc., Bethesda, Maryland, United States of America
| | - Subramaniam Krishnan
- Austere Environments Consortium for Enhanced Sepsis Outcomes, Henry M. Jackson Foundation for the Advancement of Military Medicine Inc., Bethesda, Maryland, United States of America
| | - Paul W. Blair
- Austere Environments Consortium for Enhanced Sepsis Outcomes, Henry M. Jackson Foundation for the Advancement of Military Medicine Inc., Bethesda, Maryland, United States of America
- Department of Pathology, School of Medicine, Uniformed Services University, Bethesda, Maryland, United States of America
| | - Deborah A. Striegel
- Austere Environments Consortium for Enhanced Sepsis Outcomes, Henry M. Jackson Foundation for the Advancement of Military Medicine Inc., Bethesda, Maryland, United States of America
| | - Rittal Mehta
- Austere Environments Consortium for Enhanced Sepsis Outcomes, Henry M. Jackson Foundation for the Advancement of Military Medicine Inc., Bethesda, Maryland, United States of America
| | - Kevin L. Schully
- Austere Environments Consortium for Enhanced Sepsis Outcomes, Biological Defense Research Directorate, Naval Medical Research Center-Frederick, Frederick, Maryland, United States of America
| | - J. Stephen Dumler
- Department of Pathology, School of Medicine, Uniformed Services University, Bethesda, Maryland, United States of America
| | | | - Kelsey O’Connor
- Austere Environments Consortium for Enhanced Sepsis Outcomes, Henry M. Jackson Foundation for the Advancement of Military Medicine Inc., Bethesda, Maryland, United States of America
- Tripler Army Medical Center, Honolulu, Hawaii, United States of America
| | - Susan A. Reichert-Scrivner
- Austere Environments Consortium for Enhanced Sepsis Outcomes, Henry M. Jackson Foundation for the Advancement of Military Medicine Inc., Bethesda, Maryland, United States of America
- Tripler Army Medical Center, Honolulu, Hawaii, United States of America
| | | | | | - COL Viseth Ngauy
- Tripler Army Medical Center, Honolulu, Hawaii, United States of America
| | | | - Danielle V. Clark
- Austere Environments Consortium for Enhanced Sepsis Outcomes, Henry M. Jackson Foundation for the Advancement of Military Medicine Inc., Bethesda, Maryland, United States of America
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Abrams RE, Pierre K, El-Murr N, Seung E, Wu L, Luna E, Mehta R, Li J, Larabi K, Ahmed M, Pelekanou V, Yang ZY, van de Velde H, Stamatelos SK. Quantitative systems pharmacology modeling sheds light into the dose response relationship of a trispecific T cell engager in multiple myeloma. Sci Rep 2022; 12:10976. [PMID: 35768621 PMCID: PMC9243109 DOI: 10.1038/s41598-022-14726-5] [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: 09/21/2021] [Accepted: 06/10/2022] [Indexed: 02/08/2023] Open
Abstract
In relapsed and refractory multiple myeloma (RRMM), there are few treatment options once patients progress from the established standard of care. Several bispecific T-cell engagers (TCE) are in clinical development for multiple myeloma (MM), designed to promote T-cell activation and tumor killing by binding a T-cell receptor and a myeloma target. In this study we employ both computational and experimental tools to investigate how a novel trispecific TCE improves activation, proliferation, and cytolytic activity of T-cells against MM cells. In addition to binding CD3 on T-cells and CD38 on tumor cells, the trispecific binds CD28, which serves as both co-stimulation for T-cell activation and an additional tumor target. We have established a robust rule-based quantitative systems pharmacology (QSP) model trained against T-cell activation, cytotoxicity, and cytokine data, and used it to gain insight into the complex dose response of this drug. We predict that CD3-CD28-CD38 killing capacity increases rapidly in low dose levels, and with higher doses, killing plateaus rather than following the bell-shaped curve typical of bispecific TCEs. We further predict that dose–response curves are driven by the ability of tumor cells to form synapses with activated T-cells. When competition between cells limits tumor engagement with active T-cells, response to therapy may be diminished. We finally suggest a metric related to drug efficacy in our analysis—“effective” receptor occupancy, or the proportion of receptors engaged in synapses. Overall, this study predicts that the CD28 arm on the trispecific antibody improves efficacy, and identifies metrics to inform potency of novel TCEs.
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Affiliation(s)
- R E Abrams
- Sanofi, 55 Corporate Dr, Bridgewater, NJ, 08807, USA.,Daichi Sankyo, 211 Mt. Airy Rd., Basking Ridge, NJ, 07920, USA
| | - K Pierre
- Sanofi, 55 Corporate Dr, Bridgewater, NJ, 08807, USA.
| | - N El-Murr
- Sanofi, 13 quai Jules Guesde 94403 Cedex, VITRY-SUR-SEINE, Vitry/Alfortville, France
| | - E Seung
- Sanofi, 270 Albany St., Cambridge, MA, 02139, USA.,Modex Therapeutics, 22 Strathmore Road, Natick, MA, 01760, USA
| | - L Wu
- Sanofi, 270 Albany St., Cambridge, MA, 02139, USA.,Modex Therapeutics, 22 Strathmore Road, Natick, MA, 01760, USA
| | | | | | - J Li
- Sanofi, 55 Corporate Dr, Bridgewater, NJ, 08807, USA
| | - K Larabi
- Sanofi, 13 quai Jules Guesde 94403 Cedex, VITRY-SUR-SEINE, Vitry/Alfortville, France
| | - M Ahmed
- Sanofi, 50 Binney St., Cambridge, MA, 02142, USA
| | - V Pelekanou
- Sanofi, 50 Binney St., Cambridge, MA, 02142, USA.,Bayer Pharmaceuticals, Cambridge, MA, 02142, USA
| | - Z-Y Yang
- Sanofi, 270 Albany St., Cambridge, MA, 02139, USA.,Modex Therapeutics, 22 Strathmore Road, Natick, MA, 01760, USA
| | | | - S K Stamatelos
- Sanofi, 55 Corporate Dr, Bridgewater, NJ, 08807, USA. .,Bayer Pharmaceuticals, PH100 Bayer Boulevard, Whippany, NJ, 07981, USA.
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Mehta R, Shardell M, Ryan A, Dong Y, Beamer B, Gallo J, Stuart E, Schuler M, Hochberg M, Rathbun A. POS1138 PERSISTENCY OF DEPRESSIVE SYMPTOMS AND PHYSICAL PERFORMANCE IN KNEE OSTEOARTHRITIS. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.5250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundKnee osteoarthritis (OA) is the most prevalent arthritic disorder, characterized by joint paint, which is exacerbated by chronic depressive episodes. Depression in knee OA is also associated with declines in physical activity level and greater disability; however, the impact of persistent depressive symptoms on physical performance remains unclear.ObjectivesTo determine how the persistence of depressive symptoms affects functional capacity in knee OA.MethodsParticipants (n=2,212) were from the Osteoarthritis Initiative cohort and included individuals with radiographic disease (Kellgren-Lawrence grade ≥ 2) and complete data on study measures at baseline. Depressive symptoms were assessed using the Center for Epidemiologic Studies Depression Scale (CES-D; range 0-60) at baseline and the first three follow-up visits. Physical Performance was measured using 20-meter gait speed (meters per second) during follow-up at the first four annual visits. Persistency of depressive symptoms was operationalized as a cumulative exposure using average severity over time. Gait speed was standardized so that outcome estimates could be interpreted in standard deviations. Time-invariant confounders measured at study enrollment included demographic, socioeconomic, and lifestyle factors. Time-varying confounders assessed concurrent to CES-D scores were body mass index, analgesic medications, pain, and other knee OA signs and symptoms. Marginal structural models accounting for time-dependent confounding and selective attrition were the primary method of analysis. The outcome model included all potential statistical interactions between depressive symptoms and follow-up time indicators. Post-estimation linear combinations estimated time-specific effects of time-averaged CES-D scores on standardized gait speed and differences in physical performance between participants with (i.e., CES-D=16) and without (i.e., CES-D=0) depressive symptoms satisfying screening criteria for major depression.ResultsThe interaction between depressive symptoms and time was statistically significant (P=<0.001). Time-specific associations indicated that the largest negative impact of depressive symptoms on physical performance was from baseline through year one (β = -0.0077; 95% CI: -0.0125, 0.0030). However, the effect of persistent depressive symptoms decreased over time and reversed in magnitude and directionality, evidenced by the time-specific associations between time-averaged CES-D scores from baseline through year one and year two and gait speed at year two (β = -0.0033; 95% CI: -0.0084, 0.0019) and year three (β = 0.0014; 95% CI: -0.0046, 0.0074), respectively. Consequently, the strongest negative affect of depressive symptoms on gait speed (β = -0.1232; 95% CI: -0.1998, -0.0473) between participants with and without depressive symptoms satisfying screening criteria for major depression was when depressive symptoms were first measured closest to the initial gait speed assessment.ConclusionIn the contrast to the dose-dependent relationship between chronic depressive episodes and pain in knee OA, study findings imply that the negative effect of depressive symptoms on physical performance decreases over time with increasing depression persistency. These results may reflect diminishing marginal effects, where the largest impact on physical performance in knee OA is during the first depressive episode closest to initial gait speed assessment, especially when averaged against improvement in symptoms over the same duration.AcknowledgementsThe OAI is a public-private partnership comprised of five contracts (N01-AR-2-2258; N01-AR-2-2259; N01-AR-2-2260; N01-AR-2-2261; N01-AR-2-2262) funded by the National Institutes of Health, a branch of the Department of Health and Human Services, and conducted by the OAI Study Investigators. Private funding partners include Merck Research Laboratories; Novartis Pharmaceuticals Corporation, GlaxoSmithKline; and Pfizer, Inc. Private sector funding for the OAI is managed by the Foundation for the National Institutes of Health. This manuscript was prepared using an OAI public use data set and does not necessarily reflect the opinions or views of the OAI investigators, the NIH, or the private funding partners.Disclosure of InterestsRhea Mehta: None declared, Michelle Shardell: None declared, Alice Ryan: None declared, Yu Dong: None declared, Brock Beamer: None declared, Joseph Gallo: None declared, Elizabeth Stuart: None declared, Megan Schuler: None declared, Marc Hochberg Shareholder of: Dr. Marc C. Hochberg is the President of Rheumcon Corporation., Consultant of: Dr. Marc C. Hochberg receives consulting fees from Bioiberica SA, Bristol-Myers Squibb, Eli Lilly, EMD Serono, Galapagos, IBSA Biotechniq SA, Novartis Pharma AG, Pfizer, Plexxikon, Samumed LLC, Theralogix LLC, and TissueGene Inc., Alan Rathbun: None declared
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Mehta R, Petrova A. Urinary levels of energy metabolism hormones in association with the proportional intake of maternal milk and weight gain in very preterm neonates. J Neonatal Perinatal Med 2022; 15:599-607. [PMID: 35342054 DOI: 10.3233/npm-210936] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND This study prospectively investigated the levels of energy metabolism hormones in very preterm neonates to identify their change over time, association with intake of maternal milk, and weight gain velocity. METHODS We measured and compared the leptin, adiponectin, ghrelin, and insulin-like growth factor I (IGF-1) levels in the urine of 70 very preterm neonates, before the initiation of any enteral feeding (baseline level) and twice within 14 days on full enteral feeding (FEF). Regression models identified the role of intake of maternal milk on the levels of the tested energy metabolism hormones in the enteral-fed infants. We also analyzed the adequacy of the weight gain velocity defined by the fetal-infant growth reference (FIGR). We also collected and analyzed the infants' clinical and feeding characteristics during the birth hospitalization. RESULTS The preterm infants' baseline levels of the energy metabolism hormones significantly predicted their increase at the end of two weeks of observation on FEF. The leptin level was associated with increased intake of maternal milk, whereas the feeding volume was associated with increased ghrelin and IGF-1, and decreased leptin and adiponectin. Infants with comparable FIGR had higher leptin levels than those with inadequate weight gain velocity. CONCLUSION Early postnatal levels of leptin, adiponectin, ghrelin, and IGF-1 predicted the increase of these hormones in the fully enteral fed very preterm neonates. Moreover, greater intake of maternal milk by the study infants contributed to an increased leptin-associated weight gain velocity.
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Affiliation(s)
- R Mehta
- Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - A Petrova
- Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
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26
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M S D, chikkanayakanahalli gurusiddaiah S, Aral K, shankar M, v L, Lingaraju U, Mehta R, muniannaiah K. POS-655 CLINICAL PROFILE AND OUTCOMES OF PATIENT ON MAINTENANCE HAEMODIALYSIS HOSPITALIZED WITH COVID 19 AT A TERTIARY CARE CENTRE. Kidney Int Rep 2022. [PMCID: PMC8854926 DOI: 10.1016/j.ekir.2022.01.688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Blair PW, Brandsma J, Epsi NJ, Richard SA, Striegel D, Chenoweth J, Mehta R, Clemens E, Malloy A, Lanteri C, Dumler JS, Tribble D, Burgess T, Pollett S, Agan B, Clark D. 438. Phenotypic Differences Between Distinct Immune Biomarker Clusters During the ‘Hyperinflammatory’ Middle-Phase of COVID-19. Open Forum Infect Dis 2021. [PMCID: PMC8644901 DOI: 10.1093/ofid/ofab466.637] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections peak during an inflammatory ‘middle’ phase and lead to severe illness predominately among those with certain comorbid noncommunicable diseases (NCDs). We used network machine learning to identify inflammation biomarker patterns associated with COVID-19 among those with NCDs. Methods SARS-CoV-2 RT-PCR positive subjects who had specimens available within 15-28 days post-symptom onset were selected from the DoD/USU EPICC COVID-19 cohort study. Plasma levels of 15 inflammation protein biomarkers were measured using a broad dynamic range immunoassay on samples collected from individuals with COVID-19 at 8 military hospitals across the United States. A network machine learning algorithm, topological data analysis (TDA), was performed using results from the ‘hyperinflammatory’ middle phase. Backward selection stepwise logistic regression was used to identify analytes associated with each cluster. NCDs with a significant association (0.05 significance level) across clusters using Fisher’s exact test were further evaluated comparing the NCD frequency in each cluster against all other clusters using a Kruskal-Wallis test. A sensitivity analysis excluding mild disease was also performed. Results The analysis population (n=129, 33.3% female, median 41.3 years of age) included 77 ambulatory, 31 inpatient, 16 ICU-level, and 5 fatal cases. TDA identified 5 unique clusters (Figure 1). Stepwise regression with a Bonferroni-corrected cutoff adjusted for severity identified representative analytes for each cluster (Table 1). The frequency of diabetes (p=0.01), obesity (p< 0.001), and chronic pulmonary disease (p< 0.001) differed among clusters. When restricting to hospitalized patients, obesity (8 of 11), chronic pulmonary disease (6 of 11), and diabetes (6 of 11) were more prevalent in cluster C than all other clusters. ![]()
Cluster differences in comorbid diseases and severity by cluster. 1A: bar plot of diabetes prevalence; 1B: bar plot of chronic lung disease ; 1C: bar plot of obesity prevalence; 1D: prevalence of steroid treatment ; 1E: Topologic data analysis network with clusters labeled; 1F: Bar plot of ordinal levels of severity. ![]()
Conclusion Machine learning clustering methods are promising analytical tools for identifying inflammation marker patterns associated with baseline risk factors and severe illness due to COVID-19. These approaches may offer new insights for COVID19 prognosis, therapy, and prevention. Disclosures Simon Pollett, MBBS, Astra Zeneca (Other Financial or Material Support, HJF, in support of USU IDCRP, funded under a CRADA to augment the conduct of an unrelated Phase III COVID-19 vaccine trial sponsored by AstraZeneca as part of USG response (unrelated work))
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Affiliation(s)
- Paul W Blair
- Uniformed Services University, Bethesda, Maryland
| | | | | | - Stephanie A Richard
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD and Henry M. Jackson Foundation, Bethesda, MD, Bethesda, Maryland
| | | | | | | | | | - Allison Malloy
- Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Charlotte Lanteri
- Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Boyds, Maryland
| | - J Stephen Dumler
- Uniformed Services University of the Health Sciences, Bethesda, MD
| | | | - Timothy Burgess
- Infectious Disease Clinical Research Program, Bethesda, Maryland
| | - Simon Pollett
- Uniformed Services University of the Health Sciences, Bethesda, MD
| | - Brian Agan
- Infectious Disease Clinical Research Program, USU/HJF, Bethesda, Maryland
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Puts M, Alqurini N, Strohschein F, Mariano C, Monette J, Wan-Chow-Wah D, Szumacher E, Koneru R, Mehta R, Li A, Hsu T, Brennenstuhl S, McLean B, Wills A, Amir E, Krzyzanowska M, Elser C, Pitters E, Breunis H, Berger A, Romanovsky L, Alibhai S. Comprehensive geriatric assessment and management for Canadian elders with Cancer: The 5C study. J Geriatr Oncol 2021. [DOI: 10.1016/s1879-4068(21)00402-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Ku G, Elimova E, Denlinger C, Mehta R, Lee KW, Iqbal S, Kang YK, Oh DY, Rha S, Kim Y, Seol Y, Mwatha T, Grim J, Ajani J. 1380P Phase (Ph) II study of zanidatamab + chemotherapy (chemo) in first-line (1L) HER2 expressing gastroesophageal adenocarcinoma (GEA). Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.1489] [Citation(s) in RCA: 6] [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] [Indexed: 11/25/2022] Open
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Kadoya K, Wheeler S, Kala R, Mehta R. LB811 Exosomes from human neonatal fibroblasts conditioned media play an important role in skin rejuvenation. J Invest Dermatol 2021. [DOI: 10.1016/j.jid.2021.07.126] [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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Beane JD, Hyer M, Mehta R, Onuma AE, Gleeson EM, Thompson VM, Pawlik TM, Pitt HA. Optimal hepatic surgery: Are we making progress in North America? Surgery 2021; 170:1741-1748. [PMID: 34325906 DOI: 10.1016/j.surg.2021.06.028] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 06/13/2021] [Accepted: 06/17/2021] [Indexed: 11/15/2022]
Abstract
BACKGROUND The aim of this analysis was to determine whether optimal outcomes have increased in recent years. Hepatic surgery is high risk, but regionalization and minimally invasive approaches have evolved. Best practices also have been defined with the goal of improving outcomes. METHODS The American College of Surgeons National Surgical Quality Improvement Program database was queried. Analyses were performed separately for partial (≤2 segments), major (≥3 segments), and all hepatectomies. Optimal hepatic surgery was defined as the absence of mortality, serious morbidity, need for a postoperative invasive procedure or reoperation, prolonged length of stay (<75th percentile) or readmission. Tests of trend, χ2, and multivariable analyses were performed. RESULTS From 2014 to 2018, 17,082 hepatectomies, including 11,862 partial hepatectomies and 5,220 major hepatectomies, were analyzed. Minimally invasive approaches increased from 25.6% in 2014 to 29.6% in 2018 (P < .01) and were performed more frequently for partial hepatectomies (34.2%) than major hepatectomies (14.4%) (P < .01). Operative time decreased from 220 minutes in 2014 to 208 minutes in 2018 (P < .05) and was lower in partial hepatectomies (189 vs 258 minutes for major hepatectomies) (P < .01). Mortality (0.7%) and length of stay (4 days) were lower for partial hepatectomies compared with major hepatectomies (1.9%; 6 days), and length of stay decreased for both partial hepatectomies (5 days in 2014 to 4 days in 2018) and major hepatectomies (6 days in 2014 to 6 days in 2018) (all P < .01). Postoperative sepsis (2.9% in 2014 and 2.4% in 2018), bile leaks (6% in 2014 and 4.8% in 2018), and liver failure (3.7% in 2014 and 3.3% in 2018) decreased for all patients (<.05). On multivariable analyses, overall morbidity decreased for major hepatectomies (OR 0.95, 95% CI 0.91-0.99) and all hepatectomies (OR 0.97, 95% CI 0.94-0.99, both P < .01), and optimal hepatic surgery increased over time for partial hepatectomies (OR 1.05, 95% CI 1.02-1.09) and all hepatectomies (OR 1.04, 95% CI 1.02-1.07, both P < .01). CONCLUSION Over a 5-year period in North America, minimally invasive hepatectomies have increased, while operative time, postoperative sepsis, bile leaks, liver failure, and prolonged length of stay have decreased. Optimal hepatic surgery has increased for partial and all hepatectomies and is achieved more often in partial than in major resections.
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Affiliation(s)
- Joal D Beane
- Department of Surgery, The James Cancer Center, Ohio State University, Columbus, OH.
| | - Madison Hyer
- Department of Surgery, The James Cancer Center, Ohio State University, Columbus, OH
| | - Rittal Mehta
- Department of Surgery, The James Cancer Center, Ohio State University, Columbus, OH
| | - Amblessed E Onuma
- Department of Surgery, The James Cancer Center, Ohio State University, Columbus, OH
| | - Elizabeth M Gleeson
- Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY
| | | | - Timothy M Pawlik
- Department of Surgery, The James Cancer Center, Ohio State University, Columbus, OH
| | - Henry A Pitt
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
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Mehta R, Tsilimigras DI, Pawlik TM. Assessment of Magnet status and Textbook Outcomes among medicare beneficiaries undergoing hepato-pancreatic surgery for cancer. J Surg Oncol 2021; 124:334-342. [PMID: 33961716 DOI: 10.1002/jso.26521] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 04/26/2021] [Accepted: 04/27/2021] [Indexed: 01/04/2023]
Abstract
BACKGROUND The relationship between hospital Magnet status recognition and postoperative outcomes following complex cancer surgery remains ill-defined. We sought to characterize Textbook Outcome (TO) rates among patients undergoing (HP) surgery for cancer in Magnet versus non-Magnet centers. METHODS Medicare beneficiaries undergoing HP surgery between 2015 and 2017 were identified. The association of postoperative TO (no complications/extended length-of-stay/90-day mortality/90-day readmission) with Magnet designation was examined after adjusting for competing risk factors. RESULTS Among 10,997 patients, 21.3% (n = 2337) patients underwent surgery at Magnet hospitals (non-Magnet centers: 78.7%, n = 8660). On multivariable analysis, patients undergoing HP surgery had comparable odds of achieving a TO at Magnet versus non-Magnet hospitals (hepatectomy: odds ratio [OR]: 1.05, 95% confidence interval [CI]: 0.94-1.17; pancreatectomy-OR: 0.88, 95% CI: 0.74-1.06). Patients treated at hospitals with a high nurse-to-bed ratio had higher odds of achieving a TO irrespective of whether they received surgery at Magnet (high vs. low nurse-to-bed ratio; OR: 1.38; 95% CI: 1.01-1.89) or non-Magnet centers (OR: 1.26; 95% CI: 1.10-1.45). Similarly, hospital HP volume was strongly associated with higher odds of TO following HP surgery in both Magnet (Leapfrog compliant vs. noncompliant; OR: 1.24, 95% CI: 1.06-1.44) and non-Magnet centers (OR: 1.18; 95% CI: 1.11-1.26). CONCLUSION Hospital Magnet designation was not an independent factor of superior outcomes after HP surgery. Rather, hospital-level factors such as nurse-to-bed ratio and HP procedural volume drove outcomes.
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Affiliation(s)
- Rittal Mehta
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | | | - Timothy M Pawlik
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
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Sahara K, Tsilimigras DI, Moro A, Mehta R, Hyer JM, Paredes AZ, Beane JD, Endo I, Pawlik TM. Variation in Drain Management Among Patients Undergoing Major Hepatectomy. J Gastrointest Surg 2021; 25:962-970. [PMID: 32342262 DOI: 10.1007/s11605-020-04610-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 04/08/2020] [Indexed: 01/31/2023]
Abstract
BACKGROUND Although previous studies have suggested that drain management is highly variable, data on drain placement and timing of drain removal among patients undergoing hepatic resection remain scarce. The objective of the current study was to define the utilization of drain placement among patients undergoing major hepatic resection. METHODS The ACS NSQIP-targeted hepatectomy database was used to identify patients who underwent major hepatectomy between 2014 and 2017. Association between day of drain removal, timing of discharge, and drain fluid bilirubin on postoperative day (POD) 3 (DFB-3) was assessed. Propensity score matching (PSM) was used to compare outcomes of patients with a drain removed before and after POD 3. RESULTS Among 5330 patients, most patients had an abdominal drain placed at the time of hepatic resection (n = 3075, 57.7%). Of 2495 patients with data on timing of drain removal, only 380 patients (15.2%) had their drain removed by POD 3. Almost 1 in 6 patients (n = 441, 17.7%) were discharged home with the drain in place. DFB-3 values correlated poorly with POD of drain removal (R2 = 0.0049). After PSM, early drain removal (≤ POD 3) was associated with lower rates of grade B or C bile leakage (2.1% vs. 7.1%, p = 0.008) and prolonged length of hospital stay (6.0% vs. 12.7%, p = 0.009) compared with delayed drain removal (> POD 3). CONCLUSIONS Roughly 3 in 5 patients had a drain placed at the time of major hepatectomy and only 1 in 7 patients had the drain removed early. This study demonstrated the potential benefits of early drain removal in an effort to improve the quality of care following major hepatectomy.
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Affiliation(s)
- Kota Sahara
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
- Gastroenterological Surgery Division, Yokohama City University School of Medicine, Yokohama, Japan
| | - Diamantis I Tsilimigras
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Amika Moro
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Rittal Mehta
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - J Madison Hyer
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Anghela Z Paredes
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Joal D Beane
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Itaru Endo
- Gastroenterological Surgery Division, Yokohama City University School of Medicine, Yokohama, Japan
| | - Timothy M Pawlik
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
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Feagan BG, Loftus EV, Danese S, Vermeire S, Sandborn WJ, Ritter T, Mehta R, Seidler U, Seibold F, Beales I, Kim H, McNally J, Yun C, Zhao S, Liu X, Tasset C, Besuyen R, Watanabe M, Schreiber S, Rogler G, Hibi T, Peyrin-Biroulet L. A15 EFFICACY AND SAFETY OF FILGOTINIB AS INDUCTION THERAPY FOR PATIENTS WITH MODERATELY TO SEVERELY ACTIVE ULCERATIVE COLITIS: RESULTS FROM THE PHASE 2B/3 SELECTION STUDY. J Can Assoc Gastroenterol 2021. [DOI: 10.1093/jcag/gwab002.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Aims
The SELECTION (NCT02914522) Induction Studies evaluated the efficacy/safety of filgotinib (FIL), a preferential JAK1 inhibitor, as induction therapy for patients (pts) with moderately to severely active ulcerative colitis (UC) who were biologic-naïve but failed conventional therapy (Induction Study A) or failed prior biologics (Induction Study B).
Methods
Pts were randomized 2:2:1 to once–daily FIL 200mg, FIL 100mg or placebo (PBO). The primary (clinical remission), key secondary (Mayo Clinic Score [MCS] remission, endoscopic remission, and histologic remission), and exploratory endpoints (MCS response and endoscopic improvement) were assessed at Week 10.
Results
In both studies, baseline demographics and disease characteristics were similar across treatment groups. In Study A, 659 pts were randomized and treated. Baseline mean MCS was 8.6 and 56% had a Mayo endoscopic subscore (ES)=3. A significantly higher proportion of biologic-naïve pts on FIL 200mg achieved clinical remission vs PBO and all key secondary endpoints (Table). In Study B, 689 pts were randomized and treated. Baseline mean MCS was 9.3 and 78% had ES=3. Prior treatment failures were: anti-TNF (86%), vedolizumab (52%) and both (dual-refractory; 43%). A significantly higher proportion of biologic-experienced pts on FIL 200mg achieved clinical remission vs PBO. In Studies A and B, a greater proportion of pts on FIL 200 mg achieved an MCS response and endoscopic improvement vs PBO.
The rates of AEs, serious AEs and discontinuations due to AEs were similar across FIL and PBO groups during induction. In the PBO, FIL 100mg and FIL 200mg groups, serious infections occurred in 0.7%, 0.7% and 0.4% pts in Study A and 1.4%, 1.4% and 0.8% pts in Study B; H Zoster occurred in <1% in both groups for both cohorts.
Conclusions
SELECTION included a high proportion of dual-refractory pts, and pts with severe endoscopic disease. Both doses of FIL were well tolerated. Filgotinib 200mg was effective induction therapy for both biologic-naïve/-experienced pts with moderately to severely active UC.
Funding Agencies
None
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Affiliation(s)
| | - E V Loftus
- Mayo Clinic College of Medicine, Rochester, MN
| | - S Danese
- Humanitas University, Milan, Italy
| | - S Vermeire
- University Hospitals Leuven, Leuven, Belgium
| | - W J Sandborn
- University of California San Diego, La Jolla, CA
| | | | - R Mehta
- Surat Institute of Digestive Science (SIDS), Surat, India
| | - U Seidler
- Hannover Medical School, Hannover, Germany
| | - F Seibold
- Seibold & Partner Crohn’s Colitis Center, Gastroenterological Practice Balsiger, Bern, Switzerland
| | - I Beales
- Norfolk and Norwich University Hospital, Norwich, United Kingdom
| | - H Kim
- Kyung Hee University Hospital, Center for Crohn’s and Colitis, Seoul, Korea (the Republic of)
| | - J McNally
- Gilead Sciences, Inc., Foster City, CA
| | - C Yun
- Gilead Sciences, Inc., Foster City, CA
| | - S Zhao
- Gilead Sciences, Inc., Foster City, CA
| | - X Liu
- Gilead Sciences, Inc., Foster City, CA
| | | | | | - M Watanabe
- Tokyo Medical and Dental University, Tokyo, Japan
| | - S Schreiber
- University Hospital Schleswig-Holstein, Department of Medicine I and Institute for Clinical Molecular Biology, Kiel, Germany
| | - G Rogler
- University Hospital of Zurich, Zurich, Switzerland
| | - T Hibi
- Kitasato University Kitasato Institute Hospital, Center for Advanced IBD Research and Treatment, Tokyo, Japan
| | - L Peyrin-Biroulet
- Lorraine University, Nancy University Hospital and Inserm U1256 NGERE, Vandoeuvre-les-Nancy, France
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Sahara K, Paredes AZ, Tsilimigras DI, Sasaki K, Moro A, Hyer JM, Mehta R, Farooq SA, Wu L, Endo I, Pawlik TM. Machine learning predicts unpredicted deaths with high accuracy following hepatopancreatic surgery. Hepatobiliary Surg Nutr 2021; 10:20-30. [PMID: 33575287 DOI: 10.21037/hbsn.2019.11.30] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Accepted: 11/12/2019] [Indexed: 12/26/2022]
Abstract
Background Machine learning to predict morbidity and mortality-especially in a population traditionally considered low risk-has not been previously examined. We sought to characterize the incidence of death among patients with a low estimated morbidity and mortality risk based on the National Surgical Quality Improvement Program (NSQIP) estimated probability (EP), as well as develop a machine learning model to identify individuals at risk for "unpredicted death" (UD) among patients undergoing hepatopancreatic (HP) procedures. Methods The NSQIP database was used to identify patients who underwent elective HP surgery between 2012-2017. The risk of morbidity and mortality was stratified into three tiers (low, intermediate, or high estimated) using a k-means clustering method with bin sorting. A machine learning classification tree and multivariable regression analyses were used to predict 30-day mortality with a 10-fold cross validation. C statistics were used to compare model performance. Results Among 63,507 patients who underwent an HP procedure, median patient age was 63 (IQR: 54-71) years. Patients underwent either pancreatectomy (n=38,209, 60.2%) or hepatic resection (n=25,298, 39.8%). Patients were stratified into three tiers of predicted morbidity and mortality risk based on the NSQIP EP: low (n=36,923, 58.1%), intermediate (n=23,609, 37.2%) and high risk (n=2,975, 4.7%). Among 36,923 patients with low estimated risk of morbidity and mortality, 237 patients (0.6%) experienced a UD. According to the classification tree analysis, age was the most important factor to predict UD (importance 16.9) followed by preoperative albumin level (importance: 10.8), disseminated cancer (importance: 6.5), preoperative platelet count (importance: 6.5), and sex (importance 5.9). Among patients deemed to be low risk, the c-statistic for the machine learning derived prediction model was 0.807 compared with an AUC of only 0.662 for the NSQIP EP. Conclusions A prognostic model derived using machine learning methodology performed better than the NSQIP EP in predicting 30-day UD among low risk patients undergoing HP surgery.
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Affiliation(s)
- Kota Sahara
- Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA.,Gastroenterological Surgery Division, Yokohama City University School of Medicine, Yokohama, Japan
| | - Anghela Z Paredes
- Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - Diamantis I Tsilimigras
- Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - Kazunari Sasaki
- Department of General Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Amika Moro
- Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - J Madison Hyer
- Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - Rittal Mehta
- Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - Syeda A Farooq
- Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - Lu Wu
- Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - Itaru Endo
- Gastroenterological Surgery Division, Yokohama City University School of Medicine, Yokohama, Japan
| | - Timothy M Pawlik
- Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
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Merath K, Mehta R, Tsilimigras DI, Farooq A, Sahara K, Paredes AZ, Wu L, Moro A, Ejaz A, Dillhoff M, Cloyd J, Tsung A, Pawlik TM. Quality of Care Among Medicare Patients Undergoing Pancreatic Surgery: Safety Grade, Magnet Recognition, and Leapfrog Minimum Volume Standards-Which Quality Benchmark Matters? J Gastrointest Surg 2021; 25:269-277. [PMID: 32040811 DOI: 10.1007/s11605-019-04504-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 12/16/2019] [Indexed: 01/31/2023]
Abstract
BACKGROUND The association of national quality benchmarking metrics with postoperative outcomes following complex surgery remains unknown. We assessed the relationship between the "quality trifactor" of Leapfrog minimum volume standards, Hospital Safety Grade A, and Magnet Recognition with outcomes of Medicare patients undergoing pancreatectomy. METHODS The Standard Analytic Files (SAF) merged with Leapfrog Hospital Survey and Leapfrog Safety Scores Denominator Files were reviewed to identify Medicare patients who underwent pancreatic procedures between 2013 and 2015. Primary outcomes were overall and serious complications, as well as 30- and 90-day mortality. Multivariable logistic regression analyses were conducted to evaluate possible associations among hospitals meeting the quality trifactor and short-term outcomes. RESULTS Among 4853 Medicare patients, 909 (18.7%) underwent pancreatectomy at hospitals meeting the quality trifactor. Among 260 hospitals, 7.3% (n = 19) met the quality trifactor. Safety Grade A (48.8%, n = 127) was the most commonly met criterion followed by Magnet Recognition (36.2%, n = 94); the Leapfrog minimum volume standards were achieved by 25% (n = 65) of hospitals. Patients undergoing surgery at hospitals that were only Safety Grade A and Magnet designated, but did not meet Leapfrog criteria, had higher odds of serious complications (OR 1.59, 95% CI 1.00-2.51). In contrast, patients undergoing treatment at hospitals having all three designations (i.e., the quality trifactor) had 40% and 39% lower odds of both serious complications (OR 0.60, 95% CI 0.37-0.97) and 90-day mortality (OR 0.61, 95% CI 0.42-0.89), respectively. In turn, patients undergoing pancreatectomy at quality trifactor hospitals had higher odds of experiencing the composite quality measure textbook outcome (OR 1.28, 95% CI 1.03-1.59) versus patients undergoing pancreatectomy at non-trifactor hospitals. CONCLUSION While Safety Grade A and Magnet designation alone were not associated with higher odds of an optimal composite outcome following pancreatectomy, compliance with Leapfrog criteria to achieve the "quality trifactor" metric was associated with lower odds of serious complications and mortality.
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Affiliation(s)
- Katiuscha Merath
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Rittal Mehta
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | | | - Ayesha Farooq
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Kota Sahara
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Anghela Z Paredes
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Lu Wu
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Amika Moro
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Aslam Ejaz
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Mary Dillhoff
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Jordan Cloyd
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Allan Tsung
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Timothy M Pawlik
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
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Sahara K, Tsilimigras DI, Moro A, Mehta R, Dillhoff M, Heidsma CM, Lopez-Aguiar AG, Maithel SK, Rocha FG, Kanji Z, Abbott DE, Fisher A, Fields RC, Krasnick BA, Idrees K, Smith PM, Poultsides GA, Makris E, Cho CS, Beems M, Endo I, Pawlik TM. Long-Term Outcomes after Spleen-Preserving Distal Pancreatectomy for Pancreatic Neuroendocrine Tumors: Results from the US Neuroendocrine Study Group. Neuroendocrinology 2021; 111:129-138. [PMID: 32040951 PMCID: PMC10182897 DOI: 10.1159/000506399] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 02/09/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND The adoption of spleen-preserving distal pancreatectomy (SPDP) for malignant disease such as pancreatic neuroendocrine tumors (pNETs) has been controversial. The objective of the current study was to assess the impact of SPDP on outcomes of patients with pNETs. METHODS Patients undergoing a distal pancreatectomy for pNET between 2002 and 2016 were identified in the US Neuroendocrine Tumor Study Group database. Propensity score matching (PSM) was used to compare short- and long-term outcomes of patients undergoing SPDP versus distal pancreatectomy with splenectomy (DPS). RESULTS Among 621 patients, 103 patients (16.6%) underwent an SPDP. Patients who underwent SPDP were more likely to have lower BMI (median, 27.5 [IQR 24.0-31.2] vs. 28.7 [IQR 25.7-33.6]; p = 0.005) and have undergone minimally invasive surgery (n = 56, 54.4% vs. n = 185, 35.7%; p < 0.001). After PSM, while the median total number of lymph nodes examined among patients who underwent an SPDP was lower compared with DPS (3 [IQR 1-8] vs. 9 [5-13]; p < 0.001), 5-year overall survival (OS) and recurrence-free survival (RFS) were comparable (OS: 96.8 vs. 92.0%, log-rank p = 0.21, RFS: 91.1 vs. 84.7%, log-rank p = 0.93). In addition, patients undergoing SPDP had less intraoperative blood loss (median, 100 mL [IQR 10-250] vs. 150 mL [IQR 100-400]; p = 0.001), lower incidence of serious complications (n = 13, 12.8% vs. n = 28, 27.5%; p = 0.014), and shorter length of stay (median: 5 days [IQR 4-7] vs. 6 days [IQR 5-13]; p = 0.049) compared with patients undergoing DPS. CONCLUSION SPDP for pNET was associated with acceptable perioperative and long-term outcomes that were comparable to DPS. SPDP should be considered for patients with pNET.
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Affiliation(s)
- Kota Sahara
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio, USA
- Department of Gastroenterological Surgery, Yokohama City University School of Medicine, Yokohama, Japan
| | - Diamantis I Tsilimigras
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio, USA
| | - Amika Moro
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio, USA
| | - Rittal Mehta
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio, USA
| | - Mary Dillhoff
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio, USA
| | - Charlotte M Heidsma
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio, USA
| | - Alexandra G Lopez-Aguiar
- Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
| | - Shishir K Maithel
- Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
| | - Flavio G Rocha
- Department of Surgery, Virginia Mason Medical Center, Seattle, Washington, USA
| | - Zaheer Kanji
- Department of Surgery, Virginia Mason Medical Center, Seattle, Washington, USA
| | - Daniel E Abbott
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Alexander Fisher
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Ryan C Fields
- Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Bradley A Krasnick
- Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Kamran Idrees
- Division of Surgical Oncology, Department of Surgery, Vanderbilt University, Nashville, Tennessee, USA
| | - Paula M Smith
- Division of Surgical Oncology, Department of Surgery, Vanderbilt University, Nashville, Tennessee, USA
| | | | | | - Clifford S Cho
- Division of Hepatopancreatobiliary and Advanced Gastrointestinal Surgery, Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Megan Beems
- Division of Hepatopancreatobiliary and Advanced Gastrointestinal Surgery, Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Itaru Endo
- Department of Gastroenterological Surgery, Yokohama City University School of Medicine, Yokohama, Japan
| | - Timothy M Pawlik
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio, USA,
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McDonald J, Hoffe S, Frakes J, Mehta R, Fontaine J, Pimiento J. Effect of Tumor Grade on Neoadjuvant Treatment Outcome in Esophageal Cancer. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.1989] [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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Farooq A, Paredes AZ, Merath K, Hyer JM, Mehta R, Sahara K, Tsilimigras DI, Moro A, Wu L, Cloyd J, Ejaz A, Pawlik TM. How Safe Are Safety-Net Hospitals? Opportunities to Improve Outcomes for Vulnerable Patients Undergoing Hepatopancreaticobiliary Surgery. J Gastrointest Surg 2020; 24:2570-2578. [PMID: 31792898 DOI: 10.1007/s11605-019-04428-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 09/30/2019] [Indexed: 01/31/2023]
Abstract
INTRODUCTION Safety-net hospitals are critical to the US health system as they provide care to vulnerable patients. The effect of hospital safety-net burden on patient outcomes in hepatopancreaticobiliary (HPB) surgery was examined. METHODS Discharge data between 2004 and 2014 from the National Inpatient Sample were utilized. Hospitals with a safety-net burden were divided into tertiles: low (LBH) (< 13.6%), medium (MBH) (13.6-33.3%), and high (HBH) (> 33.3%). The association of hospital safety-net burden with complications, in-hospital mortality, never events, and costs were defined. RESULTS Nearly 5% of the analytic cohort (n = 65,032) had surgery at a HBH. Patients treated at HBH were younger (median age, HBH 55 years vs LBH 62 years; p < 0.001), black or Hispanic (HBH 40.5% vs LBH 12.7%; p < 0.001), and of lowest income quartile (HBH 38.4% vs LBH 19.6%; p < 0.001). One-third of patients at HBH experienced a complication compared with only a quarter of patients at LBH (p < 0.001). HBH had higher rates of in-hospital mortality (HBH 6.5% vs. LBH 2.8%; p < 0.001), never events (HBH 5.4% vs. LBH 1.4%; p < 0.001), and a higher cost of surgery (HBH $30,716 vs. LBH $28,054; p < 0.001). CONCLUSION Perioperative outcomes were worse at HBH, highlighting that efforts are needed to improve their delivery of care.
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Affiliation(s)
- Ayesha Farooq
- Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - Anghela Z Paredes
- Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - Katiuscha Merath
- Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - J Madison Hyer
- Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - Rittal Mehta
- Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - Kota Sahara
- Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - Diamantis I Tsilimigras
- Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - Amika Moro
- Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - Lu Wu
- Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - Jordan Cloyd
- Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - Aslam Ejaz
- Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - Timothy M Pawlik
- Department of Surgery, The Urban Meyer III and Shelley Meyer Chair for Cancer Research, The Ohio State University, Columbus, OH, USA. .,Oncology, Health Services Management and Policy, The Ohio State University, Wexner Medical Center, 395 W. 12th Ave., Suite, Columbus, OH, 670, USA.
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Sahara K, Merath K, Hyer JM, Paredes AZ, Tsilimigras DI, Mehta R, Farooq SA, Moro A, Wu L, White S, Endo I, Pawlik TM. Impact of Preoperative Cholangitis on Short-term Outcomes Among Patients Undergoing Liver Resection. J Gastrointest Surg 2020; 24:2508-2516. [PMID: 31745898 DOI: 10.1007/s11605-019-04430-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Accepted: 10/14/2019] [Indexed: 01/31/2023]
Abstract
BACKGROUND The impact of preoperative cholangitis (PC) on perioperative outcomes among patients undergoing liver resection remains poorly defined. We sought to characterize the prevalence of PC among patients undergoing hepatectomy and define the impact of PC on postoperative outcomes. METHODS Patients who underwent liver resection between 2013 and 2015 were identified using the Center for Medicare Services (CMS) 100% Limited Data Set (LDS) Standard Analytic Files (SAFs). Short-term outcomes after liver resection, stratified by the presence of PC, were examined. Subgroup analyses were performed to evaluate the relationship between the timing of liver resection relative to PC. RESULTS Among 7392 patients undergoing liver resection, 251 patients (3.4%) experienced PC. Patients with PC were more likely to be male (59.0% vs. 50.6%) and to have a benign diagnosis (34.3% vs. 19.8%) compared with patients without PC (both p<0.05). On multivariable analysis, PC was associated with increased odds of experiencing a complication (OR 1.54, 95%CI 1.17-2.03), extended LOS (OR 2.60, 95%CI 1.99-3.39), 90-day mortality (OR 2.31, 95%CI 1.64-3.26), and higher Medicare expenditures (OR 3.32, 95%CI 2.55-4.32). Among patients with PC, requirement of both endoscopic and percutaneous biliary drainage (OR 5.16, 95%CI 1.36-9.61), as well as liver resection < 2 weeks after PC (OR 2.92, 95%CI 1.13-7.57) were associated with higher odds of 90-day mortality. CONCLUSION Approximately 1 in 30 Medicare beneficiaries undergoing liver resection had a history of PC. PC was associated with an increased risk of adverse short-term outcomes and higher healthcare expenditures among patients undergoing hepatectomy.
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Affiliation(s)
- Kota Sahara
- Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
- Gastroenterological Surgery Division, Yokohama City University School of Medicine, Yokohama, Japan
| | - Katiuscha Merath
- Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - J Madison Hyer
- Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - Anghela Z Paredes
- Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - Diamantis I Tsilimigras
- Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - Rittal Mehta
- Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - Syeda A Farooq
- Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - Amika Moro
- Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - Lu Wu
- Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - Susan White
- Division of Health Information Management and Systems, The Ohio State Wexner Medical Center, The Ohio State University, Columbus, OH, USA
| | - Itaru Endo
- Gastroenterological Surgery Division, Yokohama City University School of Medicine, Yokohama, Japan
| | - Timothy M Pawlik
- Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA.
- Department of Surgery, The Urban Meyer III and Shelley Meyer Chair for Cancer Research, Wexner Medical Center, The Ohio State University, 395 W. 12th Ave., Suite 670, Columbus, OH, USA.
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Merath K, Cerullo M, Farooq A, Canner JK, He J, Tsilimigras DI, Mehta R, Paredes AZ, Sahara K, Dillhoff M, Tsung A, Cloyd J, Ejaz A, Pawlik TM. Routine Intensive Care Unit Admission Following Liver Resection: What Is the Value Proposition? J Gastrointest Surg 2020; 24:2491-2499. [PMID: 31630368 DOI: 10.1007/s11605-019-04408-5] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 09/09/2019] [Indexed: 02/07/2023]
Abstract
INTRODUCTION The value of routine ICU admission after elective surgery has been debated due to the lack of robust evidence supporting its benefit, as well as the increased incurred costs. We sought to analyze outcomes of patients undergoing hepatectomy who were routinely admitted to the intensive care unit (ICU) compared with surgical ward admission. METHODS Patients were identified in the Truven Health Analytics MarketScan Commercial Claims and Encounters Database from 2010 to 2016. Routine postoperative ICU admission was defined as ICU admission for ≤ 24 h on postoperative day 0. Potential association between routine ICU admission with extended length-of-stay (LOS), failure-to-rescue, and total inpatient costs was analyzed. RESULTS In total 7970 patients underwent hepatectomy; 37.7% (n = 3001) had routine ICU admission and 62.3% (n = 4969) surgical ward admission. Among the 3001 patients who had routine ICU admission, 1137 (37.9%) had a major and 1864 (62.1%) had a minor hepatectomy. Routine ICU admission was not associated with lower failure-to-rescue (routine ICU 4.9% vs. ward 1.8%; p < 0.001). Patients routinely admitted to the ICU had longer median LOS (routine ICU 7 days, IQR 5-15 days vs. ward 5 days, IQR 4-7 days; p < 0.001). Median payments were higher for routine ICU admission than for surgical ward admission ($50,501, IQR $34,270-$80,459 vs. $39,774, IQR $28,555-$58,270, respectively). CONCLUSION Routine ICU admission was associated with longer LOS and higher hospital payments, yet did not translate into lower failure-to-rescue among patients undergoing hepatectomy.
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Affiliation(s)
- Katiuscha Merath
- Department of Surgery, The Ohio State University Wexner Medical Center, 395 W. 12th Ave., Suite, Columbus, OH, 670, USA
| | | | - Ayesha Farooq
- Department of Surgery, The Ohio State University Wexner Medical Center, 395 W. 12th Ave., Suite, Columbus, OH, 670, USA
| | - Joseph K Canner
- Department of Surgery, Johns Hopkins University, Baltimore, MD, USA
| | - Jen He
- Department of Surgery, Johns Hopkins University, Baltimore, MD, USA
| | - Diamantis I Tsilimigras
- Department of Surgery, The Ohio State University Wexner Medical Center, 395 W. 12th Ave., Suite, Columbus, OH, 670, USA
| | - Rittal Mehta
- Department of Surgery, The Ohio State University Wexner Medical Center, 395 W. 12th Ave., Suite, Columbus, OH, 670, USA
| | - Anghela Z Paredes
- Department of Surgery, The Ohio State University Wexner Medical Center, 395 W. 12th Ave., Suite, Columbus, OH, 670, USA
| | - Kota Sahara
- Department of Surgery, The Ohio State University Wexner Medical Center, 395 W. 12th Ave., Suite, Columbus, OH, 670, USA
| | - Mary Dillhoff
- Department of Surgery, The Ohio State University Wexner Medical Center, 395 W. 12th Ave., Suite, Columbus, OH, 670, USA
| | - Allan Tsung
- Department of Surgery, The Ohio State University Wexner Medical Center, 395 W. 12th Ave., Suite, Columbus, OH, 670, USA
| | - Jordan Cloyd
- Department of Surgery, The Ohio State University Wexner Medical Center, 395 W. 12th Ave., Suite, Columbus, OH, 670, USA
| | - Aslam Ejaz
- Department of Surgery, The Ohio State University Wexner Medical Center, 395 W. 12th Ave., Suite, Columbus, OH, 670, USA
| | - Timothy M Pawlik
- Department of Surgery, The Ohio State University Wexner Medical Center, 395 W. 12th Ave., Suite, Columbus, OH, 670, USA.
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Mehta R, Tang Qinghe, Tsilimigras DI, Paredes A, Dillhoff M, Cloyd JM, Ejaz A, Tsung A, Spolverato G, Pawlik TM. Long-term outcomes after resection of alcohol-related versus hepatitis-related hepatocellular carcinoma: A SEER-Medicare database analysis. Am J Surg 2020; 222:167-172. [PMID: 33131693 DOI: 10.1016/j.amjsurg.2020.10.033] [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: 06/01/2020] [Revised: 09/15/2020] [Accepted: 10/23/2020] [Indexed: 11/15/2022]
Abstract
BACKGROUND The objective of this study was to define the relative impact of alcohol and/or hepatitis-related HCC etiology on the outcomes of patients who underwent resection or transplantation for HCC. METHODS The SEER-Medicare database was used to identify patients with HCC between 2004 and 2015. Patients with history of alcohol abuse or hepatitis were identified. Overall survival (OS) and cancer-specific survival (CSS) were calculated using the Kaplan-Meier method and multivariable Cox regression analysis. RESULTS Among 1140 patients, 11.9% (n = 136) of patients had alcohol-related HCC, 30.0% (n = 342) hepatitis-related HCC, and 58.1% (n = 662) had other cause-related HCC. On multivariable analysis, patients with alcohol-related HCC (HR:1.06, 95%CI:0.82-1.35) or hepatitis-related HCC (HR:1.05, 95%CI:0.88-1.26) had similar hazards of death compared with patients who had non-alcohol/non-hepatitis-related HCC. Patients who had tumor size ≤5 cm had lower hazards of death (HR:0.81, 95%CI:0.68-0.97), while individuals who underwent liver resection (vs. transplantation) had almost a two-fold higher hazards of death (HR:1.99, 95%CI:1.47-2.69). CONCLUSION Tumor specific factors (i.e. tumor size and stage) and operative approach (i.e. resection vs. transplantation) -rather than HCC etiology- dictated both OS and CSS.
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Affiliation(s)
- Rittal Mehta
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Tang Qinghe
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA; Department of Hepatobiliary and Pancreatic Surgery, Shanghai East Hospital, Tongji University, Shanghai, China
| | | | - Anghela Paredes
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Mary Dillhoff
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Jordan M Cloyd
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Aslam Ejaz
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Allan Tsung
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Gaya Spolverato
- Department of Surgical, Gastroenterological and Oncological Sciences, University of Padova, Italy
| | - Timothy M Pawlik
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
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Erbele ID, Fink MR, Mankekar G, Son LS, Mehta R, Arriaga MA. Over-under cartilage tympanoplasty: technique, results and a call for improved reporting. J Laryngol Otol 2020; 1:1-7. [PMID: 33019948 DOI: 10.1097/ono.0000000000000005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
OBJECTIVE This study aimed to describe the microscopic over-under cartilage tympanoplasty technique, provide hearing results and detail clinically significant complications. METHOD This was a retrospective case series chart review study of over-under cartilage tympanoplasty procedures performed by the senior author between January 2015 and January 2019 at three tertiary care centres. Cases were excluded for previous or intra-operative cholesteatoma, if a mastoidectomy was performed during the procedure or if ossiculoplasty was performed. Hearing results and complications were obtained. RESULTS Sixty-eight tympanoplasty procedures met the inclusion criteria. The median age was 13 years (range, 3-71 years). The mean improvement in pure tone average was 6 dB (95 per cent confidence interval 4-9 dB; p < 0.0001). The overall perforation closure rate was 97 per cent (n = 66). Revision surgery was recommended for a total of 6 cases (9 per cent) including 2 post-operative perforations, 1 case of middle-ear cholesteatoma and 3 cases of external auditory canal scarring. CONCLUSION Over-under cartilage tympanoplasty is effective at improving clinically meaningful hearing with a low rate of post-operative complications.
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Affiliation(s)
- I D Erbele
- Department of Otolaryngology, Division of Neurotology, Louisiana State University Health Sciences Center, New Orleans, USA
- Our Lady of the Lake Hearing and Balance Center, Baton Rouge, USA
| | - M R Fink
- Medical School, Louisiana State University Health Sciences Center, New Orleans, USA
| | - G Mankekar
- Department of Otolaryngology, Division of Neurotology, Louisiana State University Health Sciences Center, New Orleans, USA
- Department of Otolaryngology, Louisiana State University Health Sciences Center, Shreveport, USA
| | - L S Son
- Department of Otolaryngology, Division of Neurotology, Louisiana State University Health Sciences Center, New Orleans, USA
- Our Lady of the Lake Hearing and Balance Center, Baton Rouge, USA
| | - R Mehta
- Department of Otolaryngology, Division of Neurotology, Louisiana State University Health Sciences Center, New Orleans, USA
- Our Lady of the Lake Hearing and Balance Center, Baton Rouge, USA
| | - M A Arriaga
- Department of Otolaryngology, Division of Neurotology, Louisiana State University Health Sciences Center, New Orleans, USA
- Our Lady of the Lake Hearing and Balance Center, Baton Rouge, USA
- Culicchia Neurological Clinic, New Orleans, USA
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Erbele ID, Fink MR, Mankekar G, Son LS, Mehta R, Arriaga MA. Over-under cartilage tympanoplasty: technique, results and a call for improved reporting. J Laryngol Otol 2020; 134:1-7. [PMID: 33019948 DOI: 10.1017/s0022215120001978] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE This study aimed to describe the microscopic over-under cartilage tympanoplasty technique, provide hearing results and detail clinically significant complications. METHOD This was a retrospective case series chart review study of over-under cartilage tympanoplasty procedures performed by the senior author between January 2015 and January 2019 at three tertiary care centres. Cases were excluded for previous or intra-operative cholesteatoma, if a mastoidectomy was performed during the procedure or if ossiculoplasty was performed. Hearing results and complications were obtained. RESULTS Sixty-eight tympanoplasty procedures met the inclusion criteria. The median age was 13 years (range, 3-71 years). The mean improvement in pure tone average was 6 dB (95 per cent confidence interval 4-9 dB; p < 0.0001). The overall perforation closure rate was 97 per cent (n = 66). Revision surgery was recommended for a total of 6 cases (9 per cent) including 2 post-operative perforations, 1 case of middle-ear cholesteatoma and 3 cases of external auditory canal scarring. CONCLUSION Over-under cartilage tympanoplasty is effective at improving clinically meaningful hearing with a low rate of post-operative complications.
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Affiliation(s)
- I D Erbele
- Department of Otolaryngology, Division of Neurotology, Louisiana State University Health Sciences Center, New Orleans, USA
- Our Lady of the Lake Hearing and Balance Center, Baton Rouge, USA
| | - M R Fink
- Medical School, Louisiana State University Health Sciences Center, New Orleans, USA
| | - G Mankekar
- Department of Otolaryngology, Division of Neurotology, Louisiana State University Health Sciences Center, New Orleans, USA
- Department of Otolaryngology, Louisiana State University Health Sciences Center, Shreveport, USA
| | - L S Son
- Department of Otolaryngology, Division of Neurotology, Louisiana State University Health Sciences Center, New Orleans, USA
- Our Lady of the Lake Hearing and Balance Center, Baton Rouge, USA
| | - R Mehta
- Department of Otolaryngology, Division of Neurotology, Louisiana State University Health Sciences Center, New Orleans, USA
- Our Lady of the Lake Hearing and Balance Center, Baton Rouge, USA
| | - M A Arriaga
- Department of Otolaryngology, Division of Neurotology, Louisiana State University Health Sciences Center, New Orleans, USA
- Our Lady of the Lake Hearing and Balance Center, Baton Rouge, USA
- Culicchia Neurological Clinic, New Orleans, USA
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Beane JD, Mehta R, Onuma AE, Gleeson EM, Thompson VM, Pawlik TM, Pitt HA. Optimal Hepatic Surgery: Are We Making Progress in North America? J Am Coll Surg 2020. [DOI: 10.1016/j.jamcollsurg.2020.08.086] [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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Farooq A, Paredes AZ, Merath K, Mehta R, Moro A, Wu L, Sahara K, Hyer JM, Tsilimigras DI, Diaz A, Pawlik TM. Hepatopancreatobiliary Surgery: the Role of Clinical Resources and Variation in Performance of Hospitals Located in "Distressed" Communities. J Gastrointest Surg 2020; 24:2277-2285. [PMID: 31621025 DOI: 10.1007/s11605-019-04401-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Accepted: 09/05/2019] [Indexed: 01/31/2023]
Abstract
INTRODUCTION The USA has one of the largest known income-based health disparities, with low-income adults being up to five times more likely to report being in poor health. We evaluated the association of hospital zip-code-based distressed communities index (DCI) with post-surgical outcomes following hepatopancreatobiliary (HPB) surgery. METHODS Adults undergoing HPB surgery were identified in the National Inpatient Sample. The association between hospital socioeconomic distress and outcomes including complications, mortality, failure to rescue (FTR), and never events were compared between high-distress facilities (HDF) and low-distress facilities (LDF). RESULTS A total of 11,119 (37.8%) patients underwent an operation at an HDF. Patients treated at HDF were younger (18-39 years, HDF: n = 1261, 11.3% vs. LDF: n = 966, 9.0%; p < 0.001), Black/Hispanic (HDF: n = 2060, 18.5% vs. LDF: n = 1440, 11.4%; p < 0.001) and in the lowest income quartile (HDF: n = 2825, 25.4% vs. LDF: n = 1116, 10.8%; p < 0.001). While complications were comparable at HDF versus LDF (HDF: n = 2483, 22.3% vs. LDF: n = 2370, 22.0%; p = 0.28), patients treated at HDF had higher odds of in-hospital mortality (OR, 1.31; 95% CI, 1.07-1.59), FTR (OR, 1.24; 95% CI, 1.02-1.52), and a never event (OR, 1.76; 95% CI, 1.29-2.39; all p < 0.001). Hospitals having advanced internal medicine services had reduced odds of mortality (OR, 0.61; 95% CI, 0.47-0.80) whereas high nurse-to-patient ratio was associated with reduced odds of a complication (OR, 0.89; 95% CI, 0.81-0.98). CONCLUSION Approximately 40% of patients were admitted to HDF. These patients were more likely to be Black/Hispanic and underinsured. Perioperative outcomes were worse at HDF following HPB surgery.
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Affiliation(s)
- Ayesha Farooq
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center, 395 W. 12th Ave., Suite 670, Columbus, OH, 43210, USA
| | - Anghela Z Paredes
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center, 395 W. 12th Ave., Suite 670, Columbus, OH, 43210, USA
| | - Katiuscha Merath
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center, 395 W. 12th Ave., Suite 670, Columbus, OH, 43210, USA
| | - Rittal Mehta
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center, 395 W. 12th Ave., Suite 670, Columbus, OH, 43210, USA
| | - Amika Moro
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center, 395 W. 12th Ave., Suite 670, Columbus, OH, 43210, USA
| | - Lu Wu
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center, 395 W. 12th Ave., Suite 670, Columbus, OH, 43210, USA
| | - Kota Sahara
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center, 395 W. 12th Ave., Suite 670, Columbus, OH, 43210, USA
| | - J Madison Hyer
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center, 395 W. 12th Ave., Suite 670, Columbus, OH, 43210, USA
| | - Diamantis I Tsilimigras
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center, 395 W. 12th Ave., Suite 670, Columbus, OH, 43210, USA
| | - Adrian Diaz
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center, 395 W. 12th Ave., Suite 670, Columbus, OH, 43210, USA
| | - Timothy M Pawlik
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center, 395 W. 12th Ave., Suite 670, Columbus, OH, 43210, USA. .,Department of Surgery, Division of Surgical Oncology, The Urban Meyer III and Shelley Meyer Chair for Cancer Research, The Ohio State University Wexner Medical Center, 395 W. 12th Ave., Suite 670, Columbus, OH, 43210, USA.
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Tsilimigras DI, Chen Q, Hyer JM, Paredes AZ, Mehta R, Dillhoff M, Cloyd JM, Ejaz A, Beane JD, Tsung A, Pawlik TM. The impact of individual surgeon on the likelihood of minimal invasive surgery among Medicare beneficiaries undergoing pancreatic resection. Surgery 2020; 169:550-556. [PMID: 32948338 DOI: 10.1016/j.surg.2020.07.044] [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: 05/03/2020] [Revised: 07/07/2020] [Accepted: 07/25/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND The objective of the current study was to evaluate the impact of the individual surgeon on the use of minimally invasive pancreatic resection. METHODS The Medicare 100% Standard Analytic Files were reviewed to identify Medicare beneficiaries who underwent pancreatic resection between 2013 and 2017. The impact of patient- and procedure-related factors on the likelihood of minimally invasive pancreatic resection was investigated. RESULTS A total of 12,652 (85.4%) patients underwent open pancreatic resection, whereas minimally invasive pancreatic resection was performed in 2,155 (14.6%) patients. Unadjusted rates of minimally invasive pancreatic resection ranged from 0% in the bottom volume tertile to 35.3% in the top tertile. Although patients with emergency admission were less likely to undergo minimally invasive pancreatic resection (odds ratio = 0.43, 95% confidence interval 0.32-0.58), patients operated on more recently had a higher chance of minimally invasive pancreatic resection (year 2017; odds ratio = 1.51, 95% confidence interval 1.28-1.79). On multivariable analysis, there was over a 3-fold variation in the odds that a patient underwent minimally invasive versus open pancreatic resection based on the individual surgeon (median odds ratio = 3.27, 95% confidence interval 2.98-3.56). Patients who underwent pancreatectomy by a low-volume, minimally invasive pancreatic resection surgeon had higher odds of 90-day mortality after surgery (odds ratio = 1.33, 95% confidence interval: 1.16-1.59), as well as higher observed/expected mortality compared with individuals treated by high-volume surgeons. CONCLUSION The likelihood of undergoing minimally invasive pancreatic resection among Medicare beneficiaries was markedly influenced by the individual treating surgeon rather than patient- or procedure-level factors.
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Affiliation(s)
- Diamantis I Tsilimigras
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH
| | - Qinyu Chen
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH
| | - J Madison Hyer
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH
| | - Anghela Z Paredes
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH
| | - Rittal Mehta
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH
| | - Mary Dillhoff
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH
| | - Jordan M Cloyd
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH
| | - Aslam Ejaz
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH
| | - Joal D Beane
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH
| | - Allan Tsung
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH
| | - Timothy M Pawlik
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH.
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Farooq A, Sahara K, Muneeb A, Farooq K, Tsilimigras DI, Merath K, Mehta R, Paredes A, Wu L, Hyer JM, Beal E, Pawlik TM, Dillhoff ME. Analysis of Authorship in Hepatopancreaticobiliary Surgery: Women Remain Underrepresented. J Gastrointest Surg 2020; 24:2070-2076. [PMID: 31396842 DOI: 10.1007/s11605-019-04340-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 07/21/2019] [Indexed: 01/31/2023]
Abstract
INTRODUCTION Given the need to increase female representation in hepatopancreatobiliary (HPB) surgery, as well as the need to increase the academic pipeline of women in this subspecialty, we sought to characterize the prevalence of female authorship in the HPB literature. In particular, the objective of the current study was to determine the proportion of women who published HPB research articles as first, second, or last author over the last decade. METHODS All articles pertaining to hepatopancreaticobiliary (HPB) surgery appearing in seven surgical journals (Annals of Surgery, British Journal of Surgery, JAMA Surgery, Annals of Surgical Oncology, HPB (Oxford), Surgery, and Journal of Gastrointestinal Surgery) were reviewed for the years 2008 and 2018. Information on sex of author, country of author's institution, and article type was collected and entered into a computerized database. RESULTS Among the 1473 index articles included in the final analytic cohort, 414 (28%) publications had a woman as the first or last author, while the vast majority (n = 1,059, 72%) had a man as the first or last author. The number of female first authors increased from 15.6% (n = 92/591) in 2008 to 25.7% (n = 227/882) in 2018 (p < 0.001). There were no differences in the proportion of second (n = 123/536, 23.0% vs n = 214/869, 24.6%, p = 0.47) or last (n = 44/564, 7.8% vs n = 88/875, 10.1%, p = 0.15) authors. Women were more likely to publish papers appearing in medium-impact journals (OR 1.40, 95% CI 1.04-1.88) and articles with a female author were more likely to be from a North American institution (referent: North America, Asia OR 0.43, 95% CI 0.31-0.59 vs Europe OR 0.67, 95% CI 0.51-0.87). CONCLUSION Women first/last authors in HPB research articles have increased over the past 10 years from 22 to 32%. Women as last authors remain low, however, as only 1 in 10 papers had a senior woman author. These data should prompt HPB leaders to find solutions to the gap in female authorship including mentorship of young female researchers and surgeons.
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Affiliation(s)
- Ayesha Farooq
- Department of Surgery, The Ohio State University Wexner Medical Center, N924 Doan Hall, 410 W 10th Ave., Columbus, OH, 43210, USA
| | - Kota Sahara
- Department of Surgery, The Ohio State University Wexner Medical Center, N924 Doan Hall, 410 W 10th Ave., Columbus, OH, 43210, USA
| | | | - Khadija Farooq
- Liaquat National Hospital and Medical College, Karachi, Pakistan
| | - Diamantis I Tsilimigras
- Department of Surgery, The Ohio State University Wexner Medical Center, N924 Doan Hall, 410 W 10th Ave., Columbus, OH, 43210, USA
| | - Katiuscha Merath
- Department of Surgery, The Ohio State University Wexner Medical Center, N924 Doan Hall, 410 W 10th Ave., Columbus, OH, 43210, USA
| | - Rittal Mehta
- Department of Surgery, The Ohio State University Wexner Medical Center, N924 Doan Hall, 410 W 10th Ave., Columbus, OH, 43210, USA
| | - Anghela Paredes
- Department of Surgery, The Ohio State University Wexner Medical Center, N924 Doan Hall, 410 W 10th Ave., Columbus, OH, 43210, USA
| | - Lu Wu
- Department of Surgery, The Ohio State University Wexner Medical Center, N924 Doan Hall, 410 W 10th Ave., Columbus, OH, 43210, USA
| | - J Madison Hyer
- Department of Surgery, The Ohio State University Wexner Medical Center, N924 Doan Hall, 410 W 10th Ave., Columbus, OH, 43210, USA
| | - Eliza Beal
- Department of Surgery, The Ohio State University Wexner Medical Center, N924 Doan Hall, 410 W 10th Ave., Columbus, OH, 43210, USA
| | - Timothy M Pawlik
- Department of Surgery, The Ohio State University Wexner Medical Center, N924 Doan Hall, 410 W 10th Ave., Columbus, OH, 43210, USA
| | - Mary E Dillhoff
- Department of Surgery, The Ohio State University Wexner Medical Center, N924 Doan Hall, 410 W 10th Ave., Columbus, OH, 43210, USA.
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Sahara K, Tsilimigras DI, Paredes AZ, Farooq SA, Hyer JM, Moro A, Mehta R, Wu L, Endo I, Ejaz A, Cloyd J, Pawlik TM. Development and validation of a real-time mortality risk calculator before, during and after hepatectomy: an analysis of the ACS NSQIP database. HPB (Oxford) 2020; 22:1158-1167. [PMID: 31812552 DOI: 10.1016/j.hpb.2019.10.2446] [Citation(s) in RCA: 2] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 10/24/2019] [Accepted: 10/30/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Although most conventional risk prediction models have been based on preoperative information, intra- and post-operative events may be more relevant to mortality after surgery. We sought to develop a mortality risk calculator based on real time characteristics associated with hepatectomy. METHODS Patients who underwent hepatectomy between 2014 and 2017 were identified in the ACS-NSQIP dataset. Three prediction models (pre-, intra-, post-operative) were developed and validated using perioperative data. RESULTS Among 14,720 patients, 197 (1.3%) experienced 30-day mortality. The predictive ability of the real-time mortality risk calculator was very good based on only preoperative factors (AUC; training cohort: 0.813, validation cohort: 0.731). Incorporating intra-operative variables into the model increased the AUC (training: 0.838, validation: 0.777), while the post-operative model achieved an AUC of 0.922 in the training and 0.885 in the validation cohorts, respectively. While patients with low preoperative risk had only very small fluctuations in the estimated 30-day mortality risk during the intraoperative (Δ0.4%) and postoperative (Δ0.6%) phases, patients who were already deemed high risk preoperatively had additional increased mortality risk based on factors that occurred in the intraoperative (Δ5.4%) and postoperative (Δ9.3%) periods. CONCLUSION A real-time mortality risk calculator may better help clinicians identify patients at risk of death at the different stages of the surgical episode.
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Affiliation(s)
- Kota Sahara
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA; Department of Gastroenterological Surgery, Yokohama City University School of Medicine, Yokohama, Japan
| | - Diamantis I Tsilimigras
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - Anghela Z Paredes
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - Syeda A Farooq
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - J Madison Hyer
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - Amika Moro
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - Rittal Mehta
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - Lu Wu
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - Itaru Endo
- Department of Gastroenterological Surgery, Yokohama City University School of Medicine, Yokohama, Japan
| | - Aslam Ejaz
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - Jordan Cloyd
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - Timothy M Pawlik
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA.
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Merath K, Hyer JM, Mehta R, Farooq A, Bagante F, Sahara K, Tsilimigras DI, Beal E, Paredes AZ, Wu L, Ejaz A, Pawlik TM. Use of Machine Learning for Prediction of Patient Risk of Postoperative Complications After Liver, Pancreatic, and Colorectal Surgery. J Gastrointest Surg 2020; 24:1843-1851. [PMID: 31385172 DOI: 10.1007/s11605-019-04338-2] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 07/21/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Surgical resection is the only potentially curative treatment for patients with colorectal, liver, and pancreatic cancers. Although these procedures are performed with low mortality, rates of complications remain relatively high following hepatopancreatic and colorectal surgery. METHODS The American College of Surgeons (ACS) National Surgical Quality Improvement Program was utilized to identify patients undergoing liver, pancreatic and colorectal surgery from 2014 to 2016. Decision tree models were utilized to predict the occurrence of any complication, as well as specific complications. To assess the variability of the performance of the classification trees, bootstrapping was performed on 50% of the sample. RESULTS Algorithms were derived from a total of 15,657 patients who met inclusion criteria. The algorithm had a good predictive ability for the occurrence of any complication, with a C-statistic of 0.74, outperforming the ASA (C-statistic 0.58) and ACS-Surgical Risk Calculator (C-statistic 0.71). The algorithm was able to predict with high accuracy thirteen out of the seventeen complications analyzed. The best performance was in the prediction of stroke (C-statistic 0.98), followed by wound dehiscence, cardiac arrest, and progressive renal failure (all C-statistic 0.96). The algorithm had a good predictive ability for superficial SSI (C-statistic 0.76), organ space SSI (C-statistic 0.76), sepsis (C-statistic 0.79), and bleeding requiring transfusion (C-statistic 0.79). CONCLUSION Machine learning was used to develop an algorithm that accurately predicted patient risk of developing complications following liver, pancreatic, or colorectal surgery. The algorithm had very good predictive ability to predict specific complications and demonstrated superiority over other established methods.
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Affiliation(s)
- Katiuscha Merath
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center, 395 W. 12th Ave., Suite 670, Columbus, OH, USA
| | - J Madison Hyer
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center, 395 W. 12th Ave., Suite 670, Columbus, OH, USA
| | - Rittal Mehta
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center, 395 W. 12th Ave., Suite 670, Columbus, OH, USA
| | - Ayesha Farooq
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center, 395 W. 12th Ave., Suite 670, Columbus, OH, USA
| | - Fabio Bagante
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center, 395 W. 12th Ave., Suite 670, Columbus, OH, USA
| | - Kota Sahara
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center, 395 W. 12th Ave., Suite 670, Columbus, OH, USA
| | - Diamantis I Tsilimigras
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center, 395 W. 12th Ave., Suite 670, Columbus, OH, USA
| | - Eliza Beal
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center, 395 W. 12th Ave., Suite 670, Columbus, OH, USA
| | - Anghela Z Paredes
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center, 395 W. 12th Ave., Suite 670, Columbus, OH, USA
| | - Lu Wu
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center, 395 W. 12th Ave., Suite 670, Columbus, OH, USA
| | - Aslam Ejaz
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center, 395 W. 12th Ave., Suite 670, Columbus, OH, USA
| | - Timothy M Pawlik
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center, 395 W. 12th Ave., Suite 670, Columbus, OH, USA.
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