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Lanigan M, Siers D, Schramski M, Shaffer A, John R, Knoper R, Huddleston S, Gunn-Sandell L, Kaizer A, Perry TE. The Adherence to an Intraoperative Blood Product Transfusion Algorithm Is Associated With Reduced Blood Product Transfusions in Cardiac Surgical Patients Undergoing Coronary Artery Bypass Grafts and Aortic and/or Valve Replacement Surgery: A Single-Center, Observational Study. J Cardiothorac Vasc Anesth 2024; 38:1135-1143. [PMID: 38413344 DOI: 10.1053/j.jvca.2024.01.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 01/02/2024] [Accepted: 01/24/2024] [Indexed: 02/29/2024]
Abstract
OBJECTIVE To demonstrate the value of a viscoelastic-based intraoperative transfusion algorithm to reduce non-RBC product administration in adult cardiac surgical patients. DESIGN A prospective observational study. SETTING At a quaternary academic teaching hospital. PARTICIPANTS Cardiac surgical patients. INTERVENTIONS Viscoelastic-based intraoperative transfusion algorithm. MEASUREMENTS AND MAIN RESULTS The study authors compared intraoperative blood product transfusion rates in 184 cardiac surgical patients to 236 historic controls after implementing a viscoelastic-based algorithm. The authors found a non-significant reduction in transfusion of 23.8% for fresh frozen plasma (FFP) units (0.84 ± 1.4 v 0.64 ± 1.38; p = ns), 33.4% for platelet units (0.90 ± 1.39 v 0.60 ± 131; p = ns), and 15.8% for cryoprecipitate units (0.19 ± 0.54 v 0.16 ± 0.50; p = ns). They found a 43.9% reduction in red blood cell (RBC) units transfused (1.98 ± 2.24 v 0.55 ± 1.36; p = 0.008). There were no statistically significant differences in time to extubation (8.0 hours (4.0-21.0) v 8.0 (4.0-22.3), reoperation for bleeding (15 [12.3%] v 10 [10.6%]), intensive care unit length of stay (ICU LOS) (51.0 hours [28.0-100.5] v 53.5 [33.3-99.0]) or hospital LOS (9.0 days [6.0-15.0] v 10.0 [7.0-17.0]). Deviation from algorithm adherence was 32.7% (48/147). Packed RBC, FFP, platelets, cryoprecipitate, and cell saver were significantly reduced in the Algorithm Compliant Cohort compared with historic controls, whereas times to extubation, ICU LOS, and hospital LOS did not reach significance. CONCLUSIONS After the implementation of a viscoelastic-based algorithm, patients received fewer packed RBC, FFP, platelets, cryoprecipitate, and cell saver. Algorithm-compliant patients received fewer transfusions; however, reductions in times to extubation, ICU LOS, and hospital LOS were not statistically significant compared with historic controls.
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Affiliation(s)
- Megan Lanigan
- Department of Anesthesiology, University of Minnesota, Minneapolis, MN.
| | - Daniel Siers
- University of Minnesota Medical School, Minneapolis, MN
| | | | - Andrew Shaffer
- Department of Cardiothoracic Surgery, University of Minnesota, Minneapolis, MN
| | - Ranjit John
- Department of Cardiothoracic Surgery, University of Minnesota, Minneapolis, MN
| | - Ryan Knoper
- Department of Cardiothoracic Surgery, University of Minnesota, Minneapolis, MN
| | - Stephen Huddleston
- Department of Cardiothoracic Surgery, University of Minnesota, Minneapolis, MN
| | - Lauren Gunn-Sandell
- University of Colorado Anschutz Medical Campus, Department of Biostatistics and Informatics, Aurora, CO
| | - Alexander Kaizer
- University of Colorado Anschutz Medical Campus, Department of Biostatistics and Informatics, Aurora, CO
| | - Tjorvi E Perry
- Department of Anesthesiology, University of Minnesota, Minneapolis, MN
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Li R, Huddleston S. Development of Comorbidity Index for in-hospital mortality for patients who underwent coronary artery revascularization. J Cardiovasc Surg (Torino) 2023; 64:678-685. [PMID: 37987738 DOI: 10.23736/s0021-9509.23.12833-3] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2023]
Abstract
BACKGROUND For myocardial revascularization, coronary artery bypass grafting (CAGB) and percutaneous coronary intervention (PCI) are two common modalities but with high in-hospital mortality. A Comorbidity Index is useful to predict mortality or can be used with other covariates to develop point-scoring systems. This study aimed to develop specific comorbidity indices for patients who underwent coronary artery revascularization. METHODS Patients who underwent CABG or PCI were identified in the National Inpatient Sample database between Q4 2015-2020. Patients of age <40 were excluded for congenital heart defects. Patients were randomly sampled into experimental (70%) and validation (30%) groups. Thirty-eight Elixhauser comorbidities were identified and included in multivariable regression to discriminate in-hospital mortality. Weight for each comorbidity was assigned and single indices, Li CABG Mortality Index (LCMI) and Li PCI Mortality Index (LPMI), were developed. RESULTS Mortality discrimination by LCMI approached adequacy (c-statistic=0.691, 95% CI=0.682-0.701) and was comparable to multivariable regression with comorbidities (c-statistic=0.685, 95% CI=0.675-0.694). LCMI discrimination performed significantly better than Elixhauser Comorbidity Index (ECI) (c-statistic=0.621, 95% CI=0.611-0.631) and can be further improved by adjusting age (c-statistic=0.721, 95% CI=0.712-0.730). All models were well-calibrated (Brier score=0.021-0.022). LPMI moderately discriminated in-hospital mortality (c-statistic=0.666, 95% CI=0.660-0.672) and performed significantly better than ECI (c-statistic=0.610, 95% CI=0.604-0.616). LPMI performed better than the all-comorbidity multivariable regression (c-statistic=0.658, 95% CI=0.652-0.663). After age adjustment, LPMI discrimination was significantly increased and was approaching adequacy (c-statistic=0.695, 95% CI=0.690-0.701). All models were well-calibrated (Brier score=0.025-0.026). CONCLUSIONS LCMI and LPMI effectively discriminated and predicted in-hospital mortality. These indices were validated and performed superior to ECI. These indices can standardize comorbidity measurement as alternatives to ECI to help replicate and compare results across studies.
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Affiliation(s)
- Renxi Li
- George Washington University School of Medicine and Health Sciences, Washington, DC, USA -
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, University of Minnesota Medical School, Minneapolis, MN, USA -
| | - Stephen Huddleston
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, University of Minnesota Medical School, Minneapolis, MN, USA
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Subramaniam K, Loor G, Chan EG, Bottiger BA, Ius F, Hartwig MG, Daoud D, Zhang Q, Wei Q, Villavicencio-Theoduloz MA, Osho AA, Chandrashekaran S, Noguchi Machuca T, Van Raemdonck D, Neyrinck A, Toyoda Y, Kashem MA, Huddleston S, Ryssel NR, Sanchez PG. Intraoperative Red Blood Cell Transfusion and Primary Graft Dysfunction After Lung Transplantation. Transplantation 2023; 107:1573-1579. [PMID: 36959119 DOI: 10.1097/tp.0000000000004545] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/25/2023]
Abstract
BACKGROUND In this international, multicenter study of patients undergoing lung transplantation (LT), we explored the association between the amount of intraoperative packed red blood cell (PRBC) transfusion and occurrence of primary graft dysfunction (PGD) and associated outcomes. METHODS The Extracorporeal Life Support in LT Registry includes data on LT recipients from 9 high-volume (>40 transplants/y) transplant centers (2 from Europe, 7 from the United States). Adult patients who underwent bilateral orthotopic lung transplant from January 2016 to January 2020 were included. The primary outcome of interest was the occurrence of grade 3 PGD in the first 72 h after LT. RESULTS We included 729 patients who underwent bilateral orthotopic lung transplant between January 2016 and November 2020. LT recipient population tertiles based on the amount of intraoperative PRBC transfusion (0, 1-4, and >4 units) were significantly different in terms of diagnosis, age, gender, body mass index, mean pulmonary artery pressure, lung allocation score, hemoglobin, prior chest surgery, preoperative hospitalization, and extracorporeal membrane oxygenation requirement. Inverse probability treatment weighting logistic regression showed that intraoperative PRBC transfusion of >4 units was significantly ( P < 0.001) associated with grade 3 PGD within 72 h (odds ratio [95% confidence interval], 2.2 [1.6-3.1]). Inverse probability treatment weighting analysis excluding patients with extracorporeal membrane oxygenation support produced similar findings (odds ratio [95% confidence interval], 2.4 [1.7-3.4], P < 0.001). CONCLUSIONS In this multicenter, international registry study of LT patients, intraoperative transfusion of >4 units of PRBCs was associated with an increased risk of grade 3 PGD within 72 h. Efforts to improve post-LT outcomes should include perioperative blood conservation measures.
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Affiliation(s)
- Kathirvel Subramaniam
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Gabriel Loor
- Division of Cardiothoracic Transplantation and Mechanical Circulatory Support, Baylor College of Medicine, Houston, TX
| | - Ernest G Chan
- Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, PA
| | - Brandi A Bottiger
- Department of Anesthesiology, Duke University Medical Center, Durham, NC
| | - Fabio Ius
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Matthew G Hartwig
- Division of Cardiovascular and Thoracic Surgery, Duke University Medical Center, Durham, NC
| | - Daoud Daoud
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX
| | - Qianzi Zhang
- Surgical Research Core, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX
| | - Qi Wei
- Department of Statistics, Phastar Inc, Durham, NC
| | | | - Asishana A Osho
- Department of Cardiac Surgery, Massachusetts General Hospital, Boston, MA
| | - Satish Chandrashekaran
- Department of Pulmonary and Critical Care, McKelvey Lung Transplant Center, Emory University Hospital, Atlanta, GA
| | | | - Dirk Van Raemdonck
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Arne Neyrinck
- Division of Anesthesiology and Algology, University Hospitals Leuven, Leuven, Belgium
| | - Yoshiya Toyoda
- Division of Cardiovascular Surgery, Temple University, Philadelphia, PA
| | - Mohammed A Kashem
- Division of Cardiovascular Surgery, Temple University, Philadelphia, PA
| | - Stephen Huddleston
- Division of Cardiothoracic Surgery, University of Minnesota Medical School, Minneapolis, MI
| | - Naomi R Ryssel
- Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, PA
| | - Pablo G Sanchez
- Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, PA
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Huddleston S, Hertz M, Loor G, Garcha P, Hartwig M, Snyder L, Siddique A, Strah H, Kukreja J, Song T, Jablonski R, Smith M, Walia R, Arjuna A, Lozonschi L, Patel K, Katlaps G, Nemeh H, Suarez E, Huang H, Langer N, Madsen J, Lee A, Dhillon G, MacArthur J, Keshavamurthy S, Nandavaram S, Daneshmand M, Neujahr D, Bush E, Joyce D, Ardehali A, Budev M, McCurry K. Impact of National OCS Lung Procurement & Management Program on Post-Transplant Survival - Real World Data from the Thoracic Organ Perfusion (TOP) Post-Approval Registry. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.1012] [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: 04/05/2023] Open
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Villavicencio M, Kashem A, Loor G, D'Silva E, Hartwig M, Ghadimi K, Ius F, Jawad S, Langer N, Osho A, Chandrashekaran S, Machuca T, Sanchez P, Subramaniam K, Van Raemdonck D, Neyrinck A, Huddleston S, Shaffer A, Lahr B, Toyoda Y. International Multicenter Extracorporeal Life Support in Lung Transplantation Registry. Impact of Cold Ischemic Time on Primary Graft Dysfunction and One-Year Mortality. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.113] [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: 04/05/2023] Open
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de Manna N, Van Raemdonck D, Hartwig M, Bottiger B, Loor G, Leon A, Villavicencio M, Langer N, Emtiazjoo A, Chandrashekaran S, Neyrinck A, Toyoda Y, Kashem A, Huddleston S, Sanchez P, Subramaniam K, Warnecke G, Ius F. Effect of Surgical Exposure on Short-Term Outcomes after Bilateral Lung Transplantation. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.1033] [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: 04/05/2023] Open
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Loor G, Garcha P, Huddleston S, Hertz M, Hartwig M, Snyder L, Siddique A, Strah H, Kukreja J, Song T, Jablonski R, Smith M, Walia R, Arjuna A, Lozonschi L, Patel K, Katlaps G, Nemeh H, Suarez E, Huang H, Langer N, Madsen J, Lee A, Dhillon G, MacArthur J, Keshavamurthy S, Nandavaram S, Daneshmand M, Neujahr D, Bush E, Joyce D, Ardehali A, Budev M, McCurry K. Impact of OCS Lung Warm Perfusion Times on Post-Transplant Survival - "Real-World" Experience from Thoracic Organ Perfusion (TOP) Registry. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.1014] [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: 04/05/2023] Open
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Kashem A, Villavicencio M, Ius F, Loor G, Hartwig M, Ghadimi K, Salman J, Chandrashekaran S, Machuca T, Sanchez P, Subramaniam K, Van Raemdonck D, Neyrinck A, Warnick M, Huddleston S, Osho A, D'Silva E, Ramamurthy U, Pena AL, Shaffer A, Langer N, Emtiazjoo A, Toyoda Y. Results of ECLS Support Comparing DCD and DBD Lung Transplantation. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.1564] [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: 04/05/2023] Open
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Loor G, Garcha P, Huddleston S, Hertz M, Hartwig M, Snyder L, Siddique A, Strah H, Kukreja J, Song T, Jablonski R, Smith M, Walia R, Arjuna A, Lozonschi L, Patel K, Katlaps G, Nemeh H, Suarez E, Huang H, Langer N, Madsen J, Lee A, Dhillon G, MacArthur J, Keshavamurthy S, Nandavaram S, Daneshmand M, Neujahr D, Bush E, Joyce D, Ardehali A, Budev M, McCurry K. First Report of the Organ Care System (OCS) Thoracic Organ Perfusion (TOP) Post-Approval Registry. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.039] [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: 04/05/2023] Open
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Loor G, Warnecke G, Villavicencio M, Smith M, Kukreja J, Ardehali A, Hartwig M, Daneshmand M, Hertz M, Huddleston S, Haverich A, Madsen J, Neyrinck A, Van Raemdonck D. Long-Term Results of the OCS Lung Expand International Trial Using Organ Care System Lung Perfusion System (OCS) in Extended-Criteria Donor (ECD) and Donation After Circulatory Death (DCD) Donor Lungs. J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.097] [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: 11/26/2022] Open
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Lanigan M, Siers D, Wilkey A, Barakat A, Shaffer A, John R, Knoper R, Huddleston S, Kaizer A, Perry TE. The use of a viscoelastic based transfusion algorithm significantly reduces non-red blood cell transfusion in patients undergoing left ventricular assist device placement or heart transplantation: A single-center observational study. J Cardiothorac Vasc Anesth 2022; 36:3038-3046. [DOI: 10.1053/j.jvca.2022.03.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Revised: 02/10/2022] [Accepted: 03/17/2022] [Indexed: 11/11/2022]
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Loor G, Huddleston S, Hartwig M, Bottiger B, Daoud D, Wei Q, Zhang Q, Ius F, Warnecke G, Villavicencio MA, Tirabassi B, Machuca TN, Van Raemdonck D, Frick AE, Neyrinck A, Toyoda Y, Kashem MA, Landeweer M, Chandrashekaran S. Effect of mode of intraoperative support on post-lung transplant primary graft dysfunction. J Thorac Cardiovasc Surg 2022; 164:1351-1361.e4. [DOI: 10.1016/j.jtcvs.2021.10.076] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 10/13/2021] [Accepted: 10/21/2021] [Indexed: 10/31/2022]
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Kashem M, Loor G, Hartwig M, Villavicencio-Theoduloz M, Axtell A, Sanchez P, Ryssel N, Huddleston S, Bottiger B, Daoud D, Zhao H, Wei Q, Bussetty A, Ius F, Warnecke G, Machuca T, Van Raemdonck D, Frick A, Neyrinck A, Chandrashekaran S, Toyoda Y. Extracorporeal Life Support Registry: Analysis of Ex Vivo Lung Perfusion Utilization in Donor after Cardiac Death and Donor after Brain Death. J Heart Lung Transplant 2021. [DOI: 10.1016/j.healun.2021.01.875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Ius F, Van Raemdonck D, Hartwig M, Bottiger B, Loor G, Daoud D, Wei Q, Villavicencio-Theoduloz M, Osho A, Chandrashekaran S, Machuca T, Neyrinck A, Toyoda Y, Kashem M, Huddleston S, Myers M, Sanchez P, Ryssel N, Warnecke G. Effect of Surgical Exposure on Outcomes in Lung Transplantation: Insight from the International Multicenter Extracorporeal Life Support (ECLS) in Lung Transplantation Registry. J Heart Lung Transplant 2021. [DOI: 10.1016/j.healun.2021.01.489] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Kashem M, Loor G, Hartwig M, Villavicencio-Theoduloz M, Axtell A, Sanchez P, Ryssel N, Huddleston S, Bottiger B, Daoud D, Zhao H, Wei Q, Bussetty A, Ius F, Warnecke G, Machuca T, Van Raemdonck D, Frick A, Neyrinck A, Chandrashekaran S, Toyoda Y. Interim Results - The Effect of Donor Type (Donor after Cardiac Death vs Donor after Brain Death) and Use of Intraoperative Extracorporeal Lung Support on Survival after Lung Transplantation. J Heart Lung Transplant 2021. [DOI: 10.1016/j.healun.2021.01.1900] [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: 11/30/2022] Open
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Villavicencio M, Kashem M, Loor G, Hartwig M, Bottinger B, Ius F, Daoud D, Warnecke G, Wei Q, Chandrashekaran S, Machuca T, Van Raemdonck D, Neyrinck A, Huddleston S, Myers M, Moonsamy P, Toyoda Y. Impact of Cold Ischemic Time on Morbidity and Mortality after Lung Transplantation. An Updated Analysis of the International Multicenter Extracorporeal Life Support in Lung Transplantation Registry. J Heart Lung Transplant 2021. [DOI: 10.1016/j.healun.2021.01.1896] [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: 11/27/2022] Open
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Hartwig M, Loor G, Bottiger B, Warnecke G, Sommer W, Frick A, Neyrinck A, Villavicencio-Theoduloz M, Drezek K, Daoud D, Wei Q, Huddleston S, Landeweer M, Toyoda Y, Kashem M, Chandrashekaran S, Machuca T, Plascencia R, Smith M, Van Raemdonck D. Effect of Time of Intraoperative Circulatory Support on Incidence of High-Grade Primary Graft Dysfunction (PGD): Multicenter Analysis on Use of Extracorporeal Life Support (ECLS) during Lung Transplantation. J Heart Lung Transplant 2020. [DOI: 10.1016/j.healun.2020.01.346] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Loor G, Warnecke G, Villavicencio MA, Smith MA, Kukreja J, Ardehali A, Hartwig M, Daneshmand MA, Hertz MI, Huddleston S, Haverich A, Madsen JC, Van Raemdonck D. Portable normothermic ex-vivo lung perfusion, ventilation, and functional assessment with the Organ Care System on donor lung use for transplantation from extended-criteria donors (EXPAND): a single-arm, pivotal trial. Lancet Respir Med 2019; 7:975-984. [PMID: 31378427 DOI: 10.1016/s2213-2600(19)30200-0] [Citation(s) in RCA: 72] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 05/21/2019] [Accepted: 05/30/2019] [Indexed: 12/22/2022]
Abstract
BACKGROUND Donor lung use for transplantation is the lowest among solid organ tranplants because of several complex and multifactorial reasons; one area that could have a substantial role is the limited capabilities of cold ischaemic storage. The aim of the EXPAND trial was to evaluate the efficacy of normothermic portable Organ Care System (OCS) Lung perfusion and ventilation on donor lung use from extended-criteria donors and donors after circulatory death, which are rarely used. METHODS In this single-arm, pivotal trial done in eight institutions across the USA, Germany, and Belgium, lungs from extended-criteria donors were included if fulfilling one or more of the following criteria: a ratio of partial pressure of arterial oxygen (PaO2) to fractional concentration of oxygen inspired air (FiO2) in the donor lung of 300 mm Hg or less; expected ischaemic time longer than 6 h; donor age 55 years or older; or lungs from donors after circulatory death that were recruited and assessed using OCS Lung. Lungs were transplanted if they showed stability of OCS Lung variables, PaO2:FiO2 was more than 300 mm Hg, and they were accepted by the transplanting surgeon. Patients were adult bilateral lung transplant recipients. The primary efficacy endpoint was a composite of patient survival at day 30 post-transplant and absence of The International Society for Heart & Lung Tranplantation primary-graft dysfunction grade 3 (PGD3) within 72 h post-transplantation, with a prespecified objective performance goal of 65%. The primary analysis population was all transplanted recipients. This trial is registered with ClinicalTrials.gov, number NCT01963780, and is now complete. FINDINGS Between Jan 23, 2014, and Oct 23, 2016, 93 lung pairs were perfused, ventilated, and assessed on the OCS Lung. 12 lungs did not meet OCS transplantation criteria so 81 lungs were suitable for transplantation. Two lungs were excluded for logistical reasons, hence 79 (87%) of eligible lungs were transplanted. The primary endpoint was achieved in 43 (54%) of 79 patients and did not meet the objective performance goal. 35 (44%) of 79 patients had PGD3 within the initial 72 h. 78 (99%) of 79 patients had survived at 30 days post-transplant. The mean number of lung graft-related serious adverse events (respiratory failure and major pulmonary-related infection) was 0·3 events per patient (SD 0·5). INTERPRETATION Despite missing the objective primary endpoint, the portable OCS Lung resulted in 87% donor lung use for transplantation with excellent clinical outcomes. Many lungs declined by other transplant centres were successfully transplanted using this new technology, which implies its use has the potential to increase the number of lung transplants performed worldwide. Whether similar outcomes could be obtained if these lungs were preserved on ice is unknown and remains an area for future research. FUNDING TransMedics Inc.
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Affiliation(s)
- Gabriel Loor
- Department of Cardiothoracic Surgery, University of Minnesota, Minneapolis, MN, USA; Baylor College of Medicine, Baylor St Luke's Medical Center, Houston, TX, USA.
| | - Gregor Warnecke
- Department of Cardiac, Thoracic, Transplantation, and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Mauricio A Villavicencio
- Massachusetts General Transplant Center and Department of Cardiac Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Michael A Smith
- Department of General Thoracic Surgery, St Joseph's Medical Center, Phoenix, AZ, USA
| | - Jasleen Kukreja
- Department of Thoracic Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Abbas Ardehali
- Department of Surgery, Division of Cardiothoracic Surgery, Ronald Reagan University of California, Los Angeles Medical Center, Los Angeles, CA, USA
| | - Matthew Hartwig
- Division of Cardiovascular and Thoracic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Mani A Daneshmand
- Division of Cardiovascular and Thoracic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Marshall I Hertz
- Department of Pulmonary, Allergy, Critical Care and Sleep Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Stephen Huddleston
- Department of Cardiothoracic Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Axel Haverich
- Department of Cardiac, Thoracic, Transplantation, and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Joren C Madsen
- Massachusetts General Transplant Center and Department of Cardiac Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Dirk Van Raemdonck
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium
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Ceulemans L, Neyrinck A, Loor G, Warnecke G, Villavicencio M, Madsen J, Kukreja J, Hartwig M, Ardehali A, Huddleston S, Hertz M, Van Raemdonck D. Long (>6h) versus Short (<6h) Clinical Normothermic Ex-Vivo Portable Lung Preservation: Post-Hoc Analysis of OCS Lung EXPAND Trial. J Heart Lung Transplant 2019. [DOI: 10.1016/j.healun.2019.01.807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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21
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Ceulemans L, Neyrinck A, Loor G, Warnecke G, Villavicencio M, Madsen J, Kukreja J, Hartwig M, Ardehali A, Huddleston S, Hertz M, Van Raemdonck D. Lung Transplantation from Donation after Circulatory Death Donors Following Portable Ex-Vivo Lung Perfusion: Post-Hoc Analysis of OCS Lung EXPAND Trial. J Heart Lung Transplant 2019. [DOI: 10.1016/j.healun.2019.01.806] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Elde S, Huddleston S, Jackson S, Kelly R, Shumway S, Loor G. Tailored Approach to Surgical Exposure Reduces Surgical Site Complications after Bilateral Lung Transplantation. Surg Infect (Larchmt) 2017; 18:929-935. [PMID: 29053438 DOI: 10.1089/sur.2017.144] [Citation(s) in RCA: 5] [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] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND We evaluated the effects of tailoring the operative approach on major surgical site complications and outcomes in lung transplant recipients. PATIENTS AND METHODS Beginning in July 2013, bilateral lung transplants at a single institution were performed either through sternotomy or clamshell depending on proximity of hilar structures by computed tomography (CT), anticipated complexity, past surgical history, and surgeon experience. Patient demographics and outcomes were collected in the institution's Transplant Information Services (TIS). A major surgical site complication was defined as a sterile or infected incision requiring operative intervention. RESULTS One hundred six bilateral lung transplants (68 via clamshell and 38 via median sternotomy) were performed between July 2013 and June 2016. Median sternotomy patients were older (mean age 55 vs. 50 y, p = 0.04), and less likely to have cystic fibrosis (5 [13%] vs. 19 [28%], p = 0.21) or diabetes (5 [13%] vs. 26 [38%], p = 0.01). There was no statistically significant difference in mean lung allocation score (LAS) (45 vs. 48, p = 0.39) and body mass index (BMI; kg/m2; 25.3 vs. 24.4, p = 0.29) between the sternotomy and clamshell group. Fifteen (14.2%) patients experienced a total of 25 surgical site complications (19 major and 6 minor). No sternotomy patient had a major surgical site complication and 11 (16.2%) clamshell patients had a major surgical site complication (p = 0.01). Of these 11 patients, 5 (45%) required multiple operative revisions related to the surgical site. Freedom from major surgical site complications at three years was 100% for sternotomy patients and 80% for clamshell patients (p = 0.017). CONCLUSIONS Tailoring the operative approach can reduce surgical site complications in lung transplant patients by avoiding a clamshell whenever feasible.
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Affiliation(s)
- Stefan Elde
- 1 University of Minnesota Medical School Twin Cities , Minneapolis, Minnesota
| | - Stephen Huddleston
- 2 Department of Surgery, University of Minnesota Medical School Twin Cities , Minneapolis, Minnesota
| | | | - Rosemary Kelly
- 2 Department of Surgery, University of Minnesota Medical School Twin Cities , Minneapolis, Minnesota
| | - Sara Shumway
- 2 Department of Surgery, University of Minnesota Medical School Twin Cities , Minneapolis, Minnesota
| | - Gabriel Loor
- 4 Michael E. DeBakey Department of Surgery, Baylor College of Medicine , Houston, Texas
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Loor G, Huddleston S, Jackson S, Elde S, Grabowski T, Kelly R, Shumway S, Hertz M. Effect of Favorable Donor Factors on Outcomes After Bilateral Lung Transplantation: Preliminary Prospective Analysis of the University of Minnesota Donor Lung Quality Index (UMN-DLQI). J Heart Lung Transplant 2017. [DOI: 10.1016/j.healun.2017.01.1515] [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] Open
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Chaum E, Huddleston S, Mastellone J. Nasal Hemiretinal Vein Occlusion. Ophthalmology 2016; 123:399. [PMID: 26802710 DOI: 10.1016/j.ophtha.2015.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Revised: 12/02/2015] [Accepted: 12/03/2015] [Indexed: 10/22/2022] Open
Affiliation(s)
- Edward Chaum
- University of Tennessee Health Science Center, Hamilton Eye Institute, Memphis, Tennessee
| | - Stephen Huddleston
- University of Tennessee Health Science Center, Hamilton Eye Institute, Memphis, Tennessee
| | - Joseph Mastellone
- University of Tennessee Health Science Center, Hamilton Eye Institute, Memphis, Tennessee
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Affiliation(s)
- Stephen Huddleston
- Department of Ophthalmology, University of Tennessee Ophthalmology, Memphis, Tennessee
| | - James C Fleming
- Department of Ophthalmology, University of Tennessee Ophthalmology, Memphis, Tennessee
| | - Margaret E Phillips
- Department of Ophthalmology, University of Tennessee Ophthalmology, Memphis, Tennessee
| | - Syeda Hamadani
- Department of Ophthalmology, University of Tennessee Ophthalmology, Memphis, Tennessee
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Huddleston S, Hamadani S, Phillips ME, Fleming JC. Fire risk during ophthalmic plastic surgery. Ophthalmology 2013; 120:1309.e1. [PMID: 23732059 DOI: 10.1016/j.ophtha.2013.01.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2012] [Accepted: 01/10/2013] [Indexed: 11/30/2022] Open
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Huddleston S, McNall-Knapp RY, Siatkowski M, Odom C, Brennan R, Wilson MW. A novel translocation t(11;13) (q21;q14.2) in a child with suprasellar primitive neuroectodermal tumor and retinoblastoma. Ophthalmic Genet 2012; 34:97-100. [PMID: 22924820 DOI: 10.3109/13816810.2012.719058] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To report on a novel translocation related to a suprasellar primitive neuroectodermal tumor (sPNET) and retinoblastoma. DESIGN Case report. METHODS A 6-year-old girl underwent genetic testing after developing unilateral retinoblastoma subsequent to treatment (surgery, chemotherapy, and stem-cell rescue) for a sPNET found at 1 year of age. RESULTS Genetic testing found the girl's karyotype to be 46,XX,t(11;13)(q21;q14.2); a novel translocation not previously reported in patients with either retinoblastoma or sPNET. CONCLUSIONS Our patient had a novel translocation affecting the retinoblastoma 1 (RB1) gene, 46,XX,t(11;13)(q21;q14.2) resulting in the late development of unilateral retinoblastoma. Although she only developed unilateral retinoblastoma, her central nervous system was affected at a very early age. How her complex mutation resulted in retinoblastoma and antecedent sPNET remains unknown.
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Affiliation(s)
- Stephen Huddleston
- The Hamilton Eye Institute, Department of Ophthalmology, University of Tennessee Health Science Center, Memphis, Tennessee 38163, USA
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John R, Lietz K, Huddleston S, Matas A, Liao K, Shumway S, Joyce L, Bolman RM. Perioperative outcomes of cardiac surgery in kidney and kidney-pancreas transplant recipients. J Thorac Cardiovasc Surg 2007; 133:1212-9. [PMID: 17467431 DOI: 10.1016/j.jtcvs.2006.11.041] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2006] [Revised: 11/15/2006] [Accepted: 11/28/2006] [Indexed: 01/04/2023]
Abstract
OBJECTIVE Cardiovascular disease is a common cause of morbidity and mortality in organ transplant recipients, and cardiac surgery has become more common in this population. We performed a retrospective study of kidney transplant recipients who underwent cardiac surgery over the past 10 years at our institution with an emphasis on evaluating postoperative outcomes. METHODS Seventy-four patients with previous abdominal transplants underwent cardiac surgery (93% coronary artery bypass grafting, 5.4% bypass grafting plus valve, and 1.4% valve) between 1995 and 2005. These recipients were compared with 895 adult nontransplant patients undergoing cardiac surgery between 2000 and 2005. Only kidney and kidney-pancreas recipients were included in the analysis (n = 70) because there were only 2 liver and pancreas alone transplants. RESULTS As compared with nontransplant patients, kidney transplant patients were younger (mean age 52.1 +/- 10 years vs 61 +/- 13 years; P < .001) and had an increased incidence of diabetes (92.9% vs 39.1%; P < .001), peripheral vascular disease (37.1% vs 19.1%; P < .001), chronic kidney insufficiency (73.0% vs 13.4%; P < 0.001), and unstable angina (44.8% vs 25.7%; P = .005) There was no difference between the two groups in the complication rate at 30 days after surgery, except that transplant patients were more likely to have postoperative kidney dysfunction (32.6% vs 6.1%; P < .001) and require hemodialysis (11.7% vs 1.1%; P < .0001). Thirty-day postoperative mortality was similar between groups (1.4% vs 2.9%; P = not significant). By multivariable analysis, preoperative congestive heart failure, nonelective surgery, prolonged cardiopulmonary bypass times, peripheral vascular disease, and lower creatinine clearance were significant risk factors for postoperative mortality; however, prior kidney transplant was not an independent risk factor for 30-day postoperative mortality. CONCLUSIONS Despite their increased incidence of comorbid conditions, the postoperative outcomes of cardiac surgery in kidney transplant recipients are similar to those in the nontransplant population except for a higher incidence of kidney dysfunction in transplant patients.
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Affiliation(s)
- Ranjit John
- Division of Cardiothoracic Surgery, Department of Surgery, University of Minnesota, Minneapolis, Minn 55455, USA.
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Giele H, Tong A, Huddleston S. Adhesive retention dressings are more comfortable than alginate dressings on split skin graft donor sites--a randomised controlled trial. Ann R Coll Surg Engl 2001; 83:431-4. [PMID: 11777142 PMCID: PMC2503698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023] Open
Abstract
A prospective randomised trial examining the effectiveness, comparative comfort and ease of care of two different split skin graft donor site dressings was performed. One of the dressings was an alginate (Kaltostat), and the other an adhesive retention tape (Mefix). Alginates are the standard plastic surgical dressing, whereas the use of adhesive retention tapes as a donor site dressing presents a novel use of a readily available product. A total of 30 consecutive patients requiring split skin grafts were randomised to receive either alginate or retention donor site dressings. Dressings were assessed by interview and questionnaire at 24 h and 48 h and at 2 weeks, and by wound review at 2 weeks. Retention dressings were found to be more comfortable. They also required less nursing care and attention. The retention dressings allowed the patients easier mobility and a greater range of daily activities, especially washing. There was no significant difference in wound healing nor in complications. Adhesive retention tape applied directly to the split skin graft donor site wound is an effective, cheap and comfortable dressing requiring little postoperative care.
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Affiliation(s)
- H Giele
- Department of Plastic Surgery, Radcliffe Infirmary, Oxford, UK.
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Abstract
74 students enrolled in physical activity classes completed the happiness and sadness scales of the Emotional Assessment Scale each week for the 7-week course. A repeated measures analysis of variance indicated no significant change in mean mood state scores. Subjects' scores remained fairly happy throughout the length of the course, women having significantly happier scores than men.
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Affiliation(s)
- M G Mack
- University of Northern Iowa, Cedar Falls 50614-0241, USA
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Kolkhorst FW, Smaldino JJ, Wolf SC, Battani LR, Plakke BL, Huddleston S, Hensley LD. Influence of fitness on susceptibility to noise-induced temporary threshold shift. Med Sci Sports Exerc 1998; 30:289-93. [PMID: 9502359 DOI: 10.1097/00005768-199802000-00018] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE Two earlier reports indicated that cardiovascular fitness attenuates susceptibility to noise-induced temporary threshold shift (TTS) in hearing sensitivity; however, other parameters of fitness also may be related to this phenomenon. This study investigated the association of three different physical fitness indicators on TTS. METHODS Maximal aerobic power (VO2max), body composition. and recent activity history were determined in 33 normal-hearing females of various fitness levels. Audiometric thresholds were obtained at 2000, 3000, 4000, and 6000 Hz before and immediately after 10 min of exposure to 108-dB SPL narrow-band noise centered at 2000 Hz. RESULTS All postnoise measurements were significantly less than prenoise measurements (P < 0.0001) with the greatest TTS occurring at 3000 Hz. Similarly, the strongest Pearson-product correlations for VO2max, % fat, and recent activity history with TTS occurred at 3000 Hz (r = -0.68, 0.60, -0.59, respectively; P < 0.05). Canonical correlation analysis indicated a moderate correlation between physical fitness and TTS (Rc = 0.71: P < 0.01). Individually, VO2max, % fat, and recent activity history had correlations of -0.70, 0.62, and -0.63, respectively, to the TTS canonical variable. CONCLUSIONS From these results, we concluded that there is a moderate association of physical fitness and diminished temporary hearing loss experienced after noise exposure.
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Affiliation(s)
- F W Kolkhorst
- School of Health, Department of Communicative Disorders, University of Northern Iowa, Cedar Falls 50614-0241, USA.
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Huddleston S, Yallop CA, Charalambous BM. The identification and partial characterisation of a novel inducible extracellular thermostable esterase from the archaeon Sulfolobus shibatae. Biochem Biophys Res Commun 1995; 216:495-500. [PMID: 7488139 DOI: 10.1006/bbrc.1995.2650] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Extracellular esterases have so far only been reported in eubacteria, here we report the first identification and partial characterisation of a novel inducible extracellular esterase from the thermoacidophilic archaeon Sulfolobus shibatae. This esterase exhibits remarkable stability to both acid and heat. Esterase activity is induced by growth on a range of polyoxyethylenesorbitan (Tween) compounds as sole carbon source. Activity occurs over a wide temperature (25-99 degrees C) and pH (pH4.0-9.0) range and is optimal at 90 degrees C and pH6.0. It exhibits high thermal stability, with a half-life of 20 min at 120 degrees C, and shows a transient thermal activation of 60% at 90 degrees C. The thermal inactivation of function occurs by first order kinetics, and after 120 min incubation at 120 degrees C 50% of activity still remains. It is able to hydrolyse mono- and diglycerides, but is unable to hydrolyse the triglycerides olive oil and triolein, which is indicative of an esterase and not a lipase.
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Affiliation(s)
- S Huddleston
- Dept. of Biochemistry & Molecular Biology, Royal Free Hospital School of Medicine, University of London, United Kingdom
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Kolkhorst FW, Smaldino JJ, Huddleston S, Battani LR, Plakke BL. INFLUENCE OF PHYSICAL FITNESS ON SUSCEPTIBILITY TO TEMPORARY HEARING LOSS AFTER NOISE EXPOSURE. Med Sci Sports Exerc 1995. [DOI: 10.1249/00005768-199505001-00867] [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: 11/21/2022]
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Affiliation(s)
- S Huddleston
- Department of Protein & Molecular Biology, Royal Free Hospital School of Medicine, London, UK
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Abstract
A national public health goal is to reduce injuries and deaths from motor vehicle crashes (MVC). The development and psychometric evaluation of the 10-item Driving Practices Questionnaire (DPQ) to measure risky driving is described. Based on responses from 297 drivers divided into safe, unsafe, and injured groups, the DPQ was evaluated using item and factor analysis, and reliability and validity measures. Principal axis factor analysis isolated one factor with 42.3% of the variance explained. The alpha coefficient for the scale was .87 and test-retest correlation was .94. High DPQ scorers were three times more likely to have prior traffic violations. The identification of driver subtypes will assist the testing of injury prevention interventions.
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Affiliation(s)
- P Kidd
- University of Kentucky, College of Nursing, Lexington 40535-0232
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Huddleston S, Russell WL. Renal vascular injuries. J Tenn Med Assoc 1986; 79:764-5. [PMID: 3795937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Dawson R, Huddleston S. The action chair. Physiotherapy 1983; 69:38-42. [PMID: 6223328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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