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Roberts ML, Kotchen T, Pan X, Li Y, Yang C, Liu P, Wang T, Laud P, Chelius TH, Munyura Y, Mattson DL, Liu Y, Cowley AW, Kidambi S, Liang M. Functional Annotation and Cross‐study Comparison of DNA Methylation Regions uniquely associated with 24‐hour Blood Pressure Phenotypes in African Americans. FASEB J 2022. [DOI: 10.1096/fasebj.2022.36.s1.r2896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Michelle L. Roberts
- PhysiologyCenter of Systems Molecular Medicine Medical College of WisconsinMilwaukeeWI
| | | | - Xiaoqing Pan
- Center of Systems Molecular Medicine Medical College of WisconsinMilwaukeeWI
| | - Yingchuan Li
- Center of Systems Molecular Medicine Medical College of WisconsinMilwaukeeWI
| | - Chun Yang
- Center of Systems Molecular Medicine Medical College of WisconsinMilwaukeeWI
| | - Pengyuan Liu
- Center of Systems Molecular Medicine Medical College of WisconsinMilwaukeeWI
| | - Tao Wang
- Division of BiostaticsInstitute for Health and Equity, Medical College of WisconsinMilwaukeeWI
| | - Purushottam Laud
- Division of BiostaticsInstitute for Health and Equity, Medical College of WisconsinMilwaukeeWI
| | - Thomas H. Chelius
- Division of EpidemiologyInstitute for Health and Equity, Medical College of WisconsinMilwaukeeWI
| | - Yannick Munyura
- Center of Systems Molecular Medicine Medical College of WisconsinMilwaukeeWI
| | - David L. Mattson
- Center of Systems Molecular Medicine Medical College of WisconsinMilwaukeeWI
| | - Yong Liu
- Center of Systems Molecular Medicine Medical College of WisconsinMilwaukeeWI
| | - Allen W. Cowley
- Center of Systems Molecular Medicine Medical College of WisconsinMilwaukeeWI
| | - Srividya Kidambi
- Center of Systems Molecular Medicine Medical College of WisconsinMilwaukeeWI
| | - Mingyu Liang
- Center of Systems Molecular Medicine Medical College of WisconsinMilwaukeeWI
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Roberts ML, Kotchen TA, Pan X, Li Y, Yang C, Liu P, Wang T, Laud PW, Chelius TH, Munyura Y, Mattson DL, Liu Y, Cowley AW, Kidambi S, Liang M. Unique Associations of DNA Methylation Regions With 24-Hour Blood Pressure Phenotypes in Blacks. Hypertension 2022; 79:761-772. [PMID: 34994206 PMCID: PMC8917053 DOI: 10.1161/hypertensionaha.121.18584] [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: 11/16/2022]
Abstract
BACKGROUND Epigenetic marks (eg, DNA methylation) may capture the effect of gene-environment interactions. DNA methylation is involved in blood pressure (BP) regulation and hypertension development; however, no studies have evaluated its relationship with 24-hour BP phenotypes (daytime, nighttime, and 24-hour average BPs). METHODS We examined the association of whole blood DNA methylation with 24-hour BP phenotypes and clinic BPs in a discovery cohort of 281 Blacks using reduced representation bisulfite sequencing. We developed a deep and region-specific methylation sequencing method, Bisulfite ULtrapLEx Targeted Sequencing and utilized it to validate our findings in a separate validation cohort (n=117). RESULTS Analysis of 38 215 DNA methylation regions (MRs), derived from 1 549 368 CpG sites across the genome, identified up to 72 regions that were significantly associated with 24-hour BP phenotypes. No MR was significantly associated with clinic BP. Two to 3 MRs were significantly associated with various 24-hour BP phenotypes after adjustment for age, sex, and body mass index. Together, these MRs explained up to 16.5% of the variance of 24-hour average BP, while age, sex, and BMI explained up to 11.0% of the variance. Analysis of one of the MRs in an independent cohort using Bisulfite ULtrapLEx Targeted Sequencing confirmed its association with 24-hour average BP phenotype. CONCLUSIONS We identified several MRs that explain a substantial portion of variances in 24-hour BP phenotypes, which might be excellent markers of cumulative effect of factors influencing 24-hour BP levels. The Bisulfite ULtrapLEx Targeted Sequencing workflow has potential to be suitable for clinical testing and population screenings on a large scale.
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Affiliation(s)
- Michelle L Roberts
- Center of Systems Molecular Medicine, Department of Physiology, Medical College of Wisconsin, Milwaukee. (M.L.R., X.P., Y.L., C.Y., P.L., F.L.M., A.W.C., M.L.)
| | - Theodore A Kotchen
- Department of Medicine, Medical College of Wisconsin, Milwaukee. (T.A.K., Y.M., S.K.)
| | - Xiaoqing Pan
- Center of Systems Molecular Medicine, Department of Physiology, Medical College of Wisconsin, Milwaukee. (M.L.R., X.P., Y.L., C.Y., P.L., F.L.M., A.W.C., M.L.).,Department of Mathematics, Shanghai Normal University, China (X.P.)
| | - Yingchuan Li
- Center of Systems Molecular Medicine, Department of Physiology, Medical College of Wisconsin, Milwaukee. (M.L.R., X.P., Y.L., C.Y., P.L., F.L.M., A.W.C., M.L.).,Department of Critical Care Medicine, Shanghai JiaoTong University affiliated the Sixth People's Hospital, China (Y.L.)
| | - Chun Yang
- Center of Systems Molecular Medicine, Department of Physiology, Medical College of Wisconsin, Milwaukee. (M.L.R., X.P., Y.L., C.Y., P.L., F.L.M., A.W.C., M.L.)
| | - Pengyuan Liu
- Center of Systems Molecular Medicine, Department of Physiology, Medical College of Wisconsin, Milwaukee. (M.L.R., X.P., Y.L., C.Y., P.L., F.L.M., A.W.C., M.L.).,The Sir Run Run Shaw Hospital, Institute of Translational Medicine, Zhejiang University, China (P.L.)
| | | | - Purushottam W Laud
- Division of Biostatistics, Institute for Health and Equity, Medical College of Wisconsin, Milwaukee. (P.W.L.)
| | - Thomas H Chelius
- Division of Epidemiology, Institute for Health and Equity, Medical College of Wisconsin, Milwaukee. (T.H.C.)
| | - Yannick Munyura
- Department of Medicine, Medical College of Wisconsin, Milwaukee. (T.A.K., Y.M., S.K.)
| | - David L Mattson
- Department of Physiology, Medical College of Georgia, Augusta (D.L.M.)
| | | | - Allen W Cowley
- Center of Systems Molecular Medicine, Department of Physiology, Medical College of Wisconsin, Milwaukee. (M.L.R., X.P., Y.L., C.Y., P.L., F.L.M., A.W.C., M.L.)
| | - Srividya Kidambi
- Department of Medicine, Medical College of Wisconsin, Milwaukee. (T.A.K., Y.M., S.K.)
| | - Mingyu Liang
- Center of Systems Molecular Medicine, Department of Physiology, Medical College of Wisconsin, Milwaukee. (M.L.R., X.P., Y.L., C.Y., P.L., F.L.M., A.W.C., M.L.)
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Dawson C, Syverson E, Chelius TH, Linn S, Reiser C, Stuewe K, Zoran S, Geurts JL. Does Supply Equal Demand? The Workforce of Direct Patient Care Genetic Counselors in Wisconsin. WMJ 2020; 119:158-164. [PMID: 33091282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
BACKGROUND Recent studies documented a shortage of direct patient care (DPC) genetic counselors in the United States. We aimed to survey genetic counselor members of the Wisconsin Genetic Counselors Association (WIGCA) to determine if the supply and demand was met within the state and where access to services can improve. METHODS An email invitation was sent to all genetic counselor members of the WIGCA with a link to a confidential online survey. Survey questions addressed the workforce composition, elements that impact services, and professional satisfaction of practicing genetic counselors. RESULTS The Wisconsin workforce currently has half of the projected need for full-time DPC genetic counselors. One-third of genetic counselors reported changing from direct to non-direct patient care positions. In-person services are concentrated within Milwaukee and Madison. Appointment wait times are decreased when patients meet with a genetic counselor only, and half of the genetic counselors reported moderate to high stress levels. DISCUSSION/CONCLUSION A shortage of DPC genetic counselors in Wisconsin is confirmed due to the total full-time effort in direct patient care. Data provided here can be used to identify targets for increasing the number of DPC genetic counselors, maximizing time spent on patient care, and improving access.
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Affiliation(s)
| | | | | | - Sarah Linn
- Medical College of Wisconsin, Milwaukee, Wisconsin
| | | | | | - Sara Zoran
- University of Wisconsin-Madison, Madison, Wisconsin
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Lal DR, Gadepalli SK, Downard CD, Minneci PC, Knezevich M, Chelius TH, Rapp CT, Billmire D, Bruch S, Carland Burns R, Deans KJ, Fallat ME, Fraser JD, Grabowski J, Hebel F, Helmrath MA, Hirschl RB, Kabre R, Kohler J, Landman MP, Leys CM, Mak GZ, Ostlie DJ, Raque J, Rymeski B, Saito JM, St Peter SD, von Allmen D, Warner BW, Sato TT. Infants with esophageal atresia and right aortic arch: Characteristics and outcomes from the Midwest Pediatric Surgery Consortium. J Pediatr Surg 2019; 54:688-692. [PMID: 30224238 DOI: 10.1016/j.jpedsurg.2018.08.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [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: 02/28/2018] [Revised: 07/25/2018] [Accepted: 08/02/2018] [Indexed: 11/25/2022]
Abstract
PURPOSE Right sided aortic arch (RAA) is a rare anatomic finding in infants with esophageal atresia with or without tracheoesophageal fistula (EA/TEF). In the presence of RAA, significant controversy exists regarding optimal side for thoracotomy in repair of the EA/TEF. The purpose of this study was to characterize the incidence, demographics, surgical approach, and outcomes of patients with RAA and EA/TEF. METHODS A multi-institutional, IRB approved, retrospective cohort study of infants with EA/TEF treated at 11 children's hospitals in the United States over a 5-year period (2009 to 2014) was performed. All patients had a minimum of one-year follow-up. RESULTS In a cohort of 396 infants with esophageal atresia, 20 (5%) had RAA, with 18 having EA with a distal TEF and 2 with pure EA. Compared to infants with left sided arch (LAA), RAA infants had a lower median birth weight, (1.96 kg (IQR 1.54-2.65) vs. 2.57 kg (2.00-3.03), p = 0.01), earlier gestational age (34.5 weeks (IQR 32-37) vs. 37 weeks (35-39), p = 0.01), and a higher incidence of congenital heart disease (90% vs. 32%, p < 0.0001). The most common cardiac lesions in the RAA group were ventricular septal defect (7), tetralogy of Fallot (7) and vascular ring (5). Seventeen infants with RAA underwent successful EA repair, 12 (71%) via right thoracotomy and 5 (29%) through left thoracotomy. Anastomotic strictures trended toward a difference in RAA patients undergoing right thoracotomy for primary repair of their EA/TEF compared to left thoracotomy (50% vs. 0%, p = 0.1). Side of thoracotomy in RAA patients undergoing EA/TEF repair was not significantly associated with mortality, anastomotic leak, recurrent laryngeal nerve injury, recurrent fistula, or esophageal dehiscence (all p > 0.29). CONCLUSION RAA in infants with EA/TEF is rare with an incidence of 5%. Compared to infants with EA/TEF and LAA, infants with EA/TEF and RAA are more severely ill with lower birth weight and higher rates of prematurity and complex congenital heart disease. In neonates with RAA, surgical repair of the EA/TEF is technically feasible via thoracotomy from either chest. A higher incidence of anastomotic strictures may occur with a right-sided approach. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Dave R Lal
- Division of Pediatric Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI.
| | - Samir K Gadepalli
- Section of Pediatric Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI
| | - Cynthia D Downard
- Division of Pediatric Surgery, Hiram C. Polk, Jr., M.D. Department of Surgery, University of Louisville, Louisville, KY
| | - Peter C Minneci
- Center for Surgical Outcomes Research, The Research Institute and Department of Surgery, Nationwide Children's Hospital, University of Ohio, Columbus, OH
| | - Michelle Knezevich
- Division of Pediatric Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI
| | - Thomas H Chelius
- Division of Epidemiology, Institute for Health and Society, Medical College of Wisconsin, Milwaukee, WI
| | - Cooper T Rapp
- Division of Pediatric Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI
| | - Deborah Billmire
- Division of Pediatric Surgery, Department of Surgery, Indiana University School of Medicine, Indianapolis, IN
| | - Steven Bruch
- Section of Pediatric Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI
| | - R Carland Burns
- Division of Pediatric Surgery, Department of Surgery, Indiana University School of Medicine, Indianapolis, IN
| | - Katherine J Deans
- Center for Surgical Outcomes Research, The Research Institute and Department of Surgery, Nationwide Children's Hospital, University of Ohio, Columbus, OH
| | - Mary E Fallat
- Division of Pediatric Surgery, Hiram C. Polk, Jr., M.D. Department of Surgery, University of Louisville, Louisville, KY
| | - Jason D Fraser
- Division of Pediatric Surgery, Department of Surgery, Children's Mercy Hospital, Kansas City, MO
| | - Julia Grabowski
- Division of Pediatric Surgery, Department of Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Ferdynand Hebel
- Division of Pediatric Surgery, Department of Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Michael A Helmrath
- Division of Pediatric Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Ronald B Hirschl
- Section of Pediatric Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI
| | - Rashmi Kabre
- Division of Pediatric Surgery, Department of Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Jonathan Kohler
- Division of Pediatric Surgery, Department of Surgery, University of Wisconsin, Madison, WI
| | - Matthew P Landman
- Division of Pediatric Surgery, Department of Surgery, Indiana University School of Medicine, Indianapolis, IN
| | - Charles M Leys
- Division of Pediatric Surgery, Department of Surgery, University of Wisconsin, Madison, WI
| | - Grace Z Mak
- Section of Pediatric Surgery, Department of Surgery, The University of Chicago Medicine and Biologic Sciences, Chicago, IL
| | - Daniel J Ostlie
- Division of Pediatric Surgery, Department of Surgery, University of Wisconsin, Madison, WI
| | - Jessica Raque
- Division of Pediatric Surgery, Hiram C. Polk, Jr., M.D. Department of Surgery, University of Louisville, Louisville, KY
| | - Beth Rymeski
- Division of Pediatric Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Jacqueline M Saito
- Division of Pediatric Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO
| | - Shawn D St Peter
- Division of Pediatric Surgery, Department of Surgery, Children's Mercy Hospital, Kansas City, MO
| | - Daniel von Allmen
- Division of Pediatric Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Brad W Warner
- Division of Pediatric Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO
| | - Thomas T Sato
- Division of Pediatric Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI
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Fawley J, Chelius TH, Arca MJ. Relationship between perioperative blood transfusion and surgical site infections in pediatric general and thoracic surgical patients. J Pediatr Surg 2018; 53:1105-1110. [PMID: 29602551 DOI: 10.1016/j.jpedsurg.2018.02.062] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [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: 02/17/2018] [Accepted: 02/27/2018] [Indexed: 01/29/2023]
Abstract
BACKGROUND Recently, perioperative transfusions were demonstrated to be associated with higher rate of surgical site infections (SSIs) in neonates. We sought to examine whether a similar relationship exists between perioperative blood transfusions and SSI among non-neonatal pediatric general surgical patients. METHODS We conducted an IRB-approved retrospective study reviewing non-neonatal patients (age greater than 28days and less than 18years) who underwent a general or thoracic surgical procedure in 2012, 2013, 2014, in the American College of Surgeons National Safety and Quality Improvement Project-Pediatric (ACS-NSQIP-P) Participant User Files. We used Chi-square analyses to perform a bivariate analysis comparing proportions of SSI's between patients who received blood transfusion to those who did not. Multiple logistic regression analyses compared the odds of SSIs in transfused versus nontransfused patients controlling for organ failure, steroid use, nutritional status, current infection, American Society of Anesthesiologists (ASA) Physical Status classification, and wound classification. RESULTS There were 55,133 patients with 1779 patients who received blood transfusion (≥25ml/kg body weight) during or within 72h of surgery. Bivariate analysis showed at least twice the rate of infection in transfused patients compared to nontransfused patients (p<0.01): superficial SSI 3.5% vs 1.5%; deep SSI 0.8% vs 0.2%, organ space SSI 3.8% vs 1.6%; deep dehiscence 2% vs 0.3%. Total wound infections and dehiscence for transfused patients were 10.5% vs 3.8% in nontransfused patients (p<0.01). Multiple regression analysis showed that nutritional issue, current infection, and wounds not classified as "clean" have statistically significant correlation with SSI. Although there was significant interaction between ASA and transfusion (p<0.0001), we found statistically significant associations between transfusions and SSI for ASA class 1-2 (OR=5.51, 95% CI 3.47-7.52), ASA class 3 (OR=2.06, 95% CI 1.63-2.61), and ASA class 4-5 (OR=1.67, 95% CI 1.15-2.42). CONCLUSION In non-newborn pediatric general and thoracic surgery patients, transfusions were associated with higher risk of SSI or wound dehiscence. Although there was a significant interaction between ASA and transfusion, OR for SSI was stronger for lower ASA classes. TYPE OF STUDY Retrospective Review. LEVEL OF EVIDENCE II.
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Affiliation(s)
| | | | - Marjorie J Arca
- Medical College of Wisconsin, Milwaukee, WI; Children's Hospital of Wisconsin, Milwaukee, WI.
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Luebke K, Samuels TL, Chelius TH, Sulman CG, McCormick ME, Kerschner JE, Johnston N, Chun RH. Pepsin as a biomarker for laryngopharyngeal reflux in children with laryngomalacia. Laryngoscope 2017; 127:2413-2417. [PMID: 28224634 DOI: 10.1002/lary.26537] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Revised: 01/17/2017] [Accepted: 01/23/2017] [Indexed: 11/08/2022]
Abstract
OBJECTIVES/HYPOTHESIS Laryngomalacia is a common cause of newborn stridor. Laryngopharyngeal reflux (LPR) has been associated with laryngomalacia. Although pepsin, a component of LPR, has been associated with inflammatory diseases of the aerodigestive tract, its presence in the airways of laryngomalacia patients is unknown. STUDY DESIGN Prospective case-control study comparing patients under age 3 years with laryngomalacia to children without laryngomalacia. METHODS Children less than 3 years old undergoing supraglottoplasty for laryngomalacia or surgery unrelated to the airway, without a history of laryngomalacia, reflux, or respiratory disease, were offered enrollment. Supraglottic lavage samples (3 mL) were obtained from all subjects. Two-millimeter arytenoid biopsies were collected from laryngomalacia patients. Pepsin Western blot and enzyme-linked immunosorbent assay were performed. RESULTS Ten laryngomalacia and five control subjects were enrolled. Pepsin was detected in lavages of laryngomalacia patients (8/10) but absent in controls (0/5; P = .007). Pepsin was observed more frequently in lavages (8/10) than biopsies (4/10; P = .046) of laryngomalacia subjects. Higher median pepsin concentration was observed in laryngomalacia than control lavages (P = .025). CONCLUSIONS Pepsin in supraglottic specimens demonstrated an association with laryngomalacia, supporting a role for refluxed pepsin in laryngomalacia. These data corroborate previous work implicating pepsin in inflammatory diseases of the upper airways. Further studies are warranted to investigate the contribution of pepsin to the pathophysiology of laryngomalacia. LEVEL OF EVIDENCE 3b. Laryngoscope, 127:2413-2417, 2017.
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Affiliation(s)
- Kendra Luebke
- Department of Otolaryngology, Children's Hospital of Wisconsin, Milwaukee, Wisconsin, U.S.A.,Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, U.S.A
| | - Tina L Samuels
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, U.S.A
| | - Thomas H Chelius
- Institute for Health and Society, Medical College of Wisconsin, Milwaukee, Wisconsin, U.S.A
| | - Cecille G Sulman
- Department of Otolaryngology, Children's Hospital of Wisconsin, Milwaukee, Wisconsin, U.S.A.,Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, U.S.A
| | - Michael E McCormick
- Department of Otolaryngology, Children's Hospital of Wisconsin, Milwaukee, Wisconsin, U.S.A.,Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, U.S.A
| | - Joseph E Kerschner
- Department of Otolaryngology, Children's Hospital of Wisconsin, Milwaukee, Wisconsin, U.S.A.,Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, U.S.A
| | - Nikki Johnston
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, U.S.A
| | - Robert H Chun
- Department of Otolaryngology, Children's Hospital of Wisconsin, Milwaukee, Wisconsin, U.S.A.,Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, U.S.A
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Fawley J, Chelius TH, Anderson Y, Cassidy LD, Arca MJ. Relationship between perioperative blood transfusion and surgical site infections in the newborn population: An ACS-NSQIP-Pediatrics analysis. J Pediatr Surg 2016; 51:1397-404. [PMID: 27325358 DOI: 10.1016/j.jpedsurg.2016.05.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Revised: 05/01/2016] [Accepted: 05/08/2016] [Indexed: 12/21/2022]
Abstract
BACKGROUND Adult data suggest that perioperative transfusion may have deleterious effects through immunomodulation. Limited data regarding the effect of transfusions exist in the pediatric population. We hypothesized that perioperative transfusions may be associated with surgical site infections (SSI) in newborns. METHODS The 2012 and 2013 American College of Surgeons National Safety and Quality Improvement Project-Pediatric (ACS-NSQIP-P) Participant User Files were queried to include all neonates that underwent surgical procedures. SSI rates in infants who had a perioperative blood transfusion were compared to those who were not transfused using a Fisher's Exact Test. Logistic regression analysis compared the odds of SSIs in transfused patients versus nontransfused patients. p Values <0.05 were statistically significant. RESULTS The study population included 6499 patients, of which 1109 (17.1%) had transfusions. Transfused patients had increased SSIs. In the multivariate analysis, patients with nutritional issues (OR=1.58, 95%CI 1.24-2.00), current infection (OR=1.98, 95%CI 1.52-2.57), and perioperative transfusion (OR=2.08, 95%CI 1.59-2.72) were associated with increased risk of SSI after controlling for all other variables. CONCLUSIONS Perioperative transfusions are associated with increased risk of SSIs. Further work to determine possible mechanisms of this association may be warranted.
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Affiliation(s)
- Jason Fawley
- Loma Linda University, 11175 Campus Street, #21108, Loma Linda, CA, USA
| | - Thomas H Chelius
- Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, USA
| | - Yvonne Anderson
- Children's Hospital of Wisconsin, 999 N 92nd Street Suite 320, Milwaukee, WI, USA
| | - Laura D Cassidy
- Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, USA
| | - Marjorie J Arca
- Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, USA; Children's Hospital of Wisconsin, 999 N 92nd Street Suite 320, Milwaukee, WI, USA.
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Kotchen TA, Kotchen JM, Grim CE, George V, Kaldunski ML, Cowley AW, Hamet P, Chelius TH. Genetic determinants of hypertension: identification of candidate phenotypes. Hypertension 2000; 36:7-13. [PMID: 10904005 DOI: 10.1161/01.hyp.36.1.7] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Our long-term objective is to identify genes whose expression results in hypertension and in phenotypic changes that may contribute to hypertension. The purpose of the present study was to describe evidence for the heritability of hypertension-related phenotypes in hypertensive, hyperlipidemic black sib pairs. Outpatient anthropomorphic measurements were obtained in >200 affected sib pairs. In addition, 68 of these sib pairs were studied under controlled, standardized conditions at an inpatient clinical research center while off both antihypertensive and lipid-lowering medications. Heritability was estimated on the basis of sib-sib correlations and with an association model. Higher heritability estimates for blood pressure were observed with multiple measurements averaged over 24 hours than with measurements at a single time point, and heritability estimates for nighttime blood pressures were higher than those for daytime blood pressures. Heritability estimates for several of the phenotypes were augmented by obtaining measurements in response to a standardized stimulus, including (1) blood pressure responses to the assumption of upright posture, standardized psychological stress, and norepinephrine infusion; (2) plasma renin, aldosterone, epinephrine, and cAMP and cGMP responses to the assumption of upright posture; (3) para-aminohippurate and inulin clearances in response to norepinephrine infusion; and (4) plasma arginine vasopressin in response to NaCl infusion. High heritability estimates were also observed for various measures of body size and body fat, left ventricular size, cardiac index, stroke volume, total peripheral resistance, and serum concentrations of LDL and HDL cholesterol and leptin. These heritability estimates identify the hypertension-related phenotypes that may facilitate the identification of specific genetic determinants of hypertension in blacks with hyperlipidemia.
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Affiliation(s)
- T A Kotchen
- Departments of Medicine, Medical College of Wisconsin, Milwaukee, WI 53226, USA
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Kotchen JM, Shakoor-Abdullah B, Walker WE, Chelius TH, Hoffmann RG, Kotchen TA. Hypertension control and access to medical care in the inner city. Am J Public Health 1998; 88:1696-9. [PMID: 9807539 PMCID: PMC1508561 DOI: 10.2105/ajph.88.11.1696] [Citation(s) in RCA: 45] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES This study assessed hypertension control among high-risk African Americans. METHODS We interviewed 583 African Americans aged 18 years and older residing in 438 randomly selected inner-city households. RESULTS Forty-two percent of the respondents were hypertensive. Blood pressure was uncontrolled in 74% of hypertensive persons, although 64% of hypertensive persons reported having seen a physician within the previous 3 months. Hypertension control was associated with female gender and higher socioeconomic strata but not with public versus private sources of medical care. CONCLUSIONS Hypertension control is inadequate in this population, although health care services are used frequently. Hypertension control efforts should focus on the effectiveness of health care delivery.
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Affiliation(s)
- J M Kotchen
- Division of Epidemiology, Medical College of Wisconsin, Milwaukee 53226, USA.
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Shakoor-Abdullah B, Kotchen JM, Walker WE, Chelius TH, Hoffmann RG. Incorporating socio-economic and risk factor diversity into the development of an African-American community blood pressure control program. Ethn Dis 1998; 7:175-83. [PMID: 9467699] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE To develop culturally competent community based blood pressure control programs for inner-city African Americans. DESIGN Cross sectional study of randomly selected households from three experimental and three control communities. SETTING Very low, moderately low and moderate socio-economic status (SES) inner-city communities in Chicago, Illinois. PARTICIPANTS 957 African Americans adults, aged 18 and over from target communities. MAIN OUTCOME MEASURE Household health assessments included employment, education and other demographic information, history of hypertension, disease prevalence, health behaviors, risk factor prevalence, stress, coping/John Henryism, social support, health care utilization and standardized assessments of blood pressure, height, and weight. RESULTS There were no significant gender differences in blood pressure levels. Men had more hypertension than women, and women in the very low SES community had significantly more hypertension than women in the moderately low SES community. There was significantly more hypertension overall in the moderately low SES community. Age, education and BMI were the only factors significantly associated with systolic and diastolic blood pressure in all three communities. The very low SES community had significantly more obesity and more uninsured persons than the other communities. CONCLUSIONS Intraracial diversity is an important factor to be considered in the development of community blood pressure control programs for African Americans. Age, gender, educational background and SES play a major role in influencing health behaviors and access to health care.
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