127 results on '"John A. Kaufman"'
Search Results
2. Prevalence and Risk Factors of Elevated Blood Lead in Children in Gold Ore Processing Communities, Zamfara, Nigeria, 2012
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John A. Kaufman, Mary Jean Brown, Nasir T. Umar-Tsafe, Muhammad Bashir Adbullahi, Kabiru I. Getso, Ibrahim M. Kaita, Binta Bako Sule, Ahmed Ba'aba, Lora Davis, Patrick M. Nguku, and Nasir Sani-Gwarzo
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lead poisoning ,mining ,children's environmental health ,Environmental technology. Sanitary engineering ,TD1-1066 - Abstract
Background. In March 2010, Medecins Sans Frontieres/Doctors Without Borders detected an outbreak of acute lead poisoning in Zamfara State, northwestern Nigeria, linked to low-technology gold ore processing. The outbreak killed more than 400 children ≤5 years of age in the first half of 2010 and has left more than 2,000 children with permanent disabilities. Objectives. The aims of this study were to estimate the statewide prevalence of children ≤5 years old with elevated blood lead levels (BLLs) in gold ore processing and non-ore-processing communities, and to identify factors associated with elevated blood lead levels in children. Methods. A representative, population-based study of ore processing and non-ore-processing villages was conducted throughout Zamfara in 2012. Blood samples from children, outdoor soil samples, indoor dust samples, and survey data on ore processing activities and other lead sources were collected from 383 children ≤5 years old in 383 family compounds across 56 villages. Results. 17.2% of compounds reported that at least one member had processed ore in the preceding 12 months (95% confidence intervals (CI): 9.7, 24.7). The prevalence of BLLs ≥10 μg/dL in children ≤5 years old was 38.2% (95% CI: 26.5, 51.4) in compounds with members who processed ore and 22.3% (95% CI: 17.8, 27.7) in compounds where no one processed ore. Ore processing activities were associated with higher lead concentrations in soil, dust, and blood samples. Other factors associated with elevated BLL were a child's age and sex, breastfeeding, drinking water from a piped tap, and exposure to eye cosmetics. Conclusions. Childhood lead poisoning is widespread in Zamfara State in both ore processing and non-ore-processing settings, although it is more prevalent in ore processing areas. Although most children's BLLs were below the recommended level for chelation therapy, environmental remediation and use of safer ore processing practices are needed to prevent further exposures. Patient consent. Obtained Ethics approval. The study protocol was approved by the US Centers for Disease Control Institutional Review Board-A and the National Health Research Ethics Committee of Nigeria. Competing Interests. The authors declare no competing financial interests.
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- 2016
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3. Design and Rationale of the Best Endovascular Versus Best Surgical Therapy for Patients With Critical Limb Ischemia (BEST‐CLI) Trial
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Matthew T. Menard, Alik Farber, Susan F. Assmann, Niteesh K. Choudhry, Michael S. Conte, Mark A. Creager, Michael D. Dake, Michael R. Jaff, John A. Kaufman, Richard J. Powell, Diane M. Reid, Flora Sandra Siami, George Sopko, Christopher J. White, and Kenneth Rosenfield
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atherosclerosis ,cost‐effectiveness ,critical limb ischemia ,endovascular ,outcome ,quality ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
BackgroundCritical limb ischemia (CLI) is increasing in prevalence, and remains a significant source of mortality and limb loss. The decision to recommend surgical or endovascular revascularization for patients who are candidates for both varies significantly among providers and is driven more by individual preference than scientific evidence. Methods and ResultsThe Best Endovascular Versus Best Surgical Therapy for Patients With Critical Limb Ischemia (BEST‐CLI) Trial is a prospective, randomized, multidisciplinary, controlled, superiority trial designed to compare treatment efficacy, functional outcomes, quality of life, and cost in patients undergoing best endovascular or best open surgical revascularization. Approximately 140 clinical sites in the United States and Canada will enroll 2100 patients with CLI who are candidates for both treatment options. A pragmatic trial design requires consensus on patient eligibility by at least 2 investigators, but leaves the choice of specific procedural strategy within the assigned revascularization approach to the individual treating investigator. Patients with suitable single‐segment of saphenous vein available for potential bypass will be randomized within Cohort 1 (n=1620), while patients without will be randomized within Cohort 2 (n=480). The primary efficacy end point of the trial is Major Adverse Limb Event–Free Survival. Key secondary end points include Re‐intervention and Amputation‐Free‐Survival and Amputation Free‐Survival. ConclusionsThe BEST‐CLI trial is the first randomized controlled trial comparing endovascular therapy to open surgical bypass in patients with CLI to be carried out in North America. This landmark comparative effectiveness trial aims to provide Level I data to clarify the appropriate role for both treatment strategies and help define an evidence‐based standard of care for this challenging patient population. Clinical Trial RegistrationURL: https://www.clinicaltrials.gov/. Unique identifier: NCT02060630.
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- 2016
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4. IR Training in the United States
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John A. Kaufman
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Medical physics. Medical radiology. Nuclear medicine ,R895-920 - Published
- 2017
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5. Surgery or Endovascular Therapy for Chronic Limb-Threatening Ischemia
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Alik Farber, Matthew T. Menard, Michael S. Conte, John A. Kaufman, Richard J. Powell, Niteesh K. Choudhry, Taye H. Hamza, Susan F. Assmann, Mark A. Creager, Mark J. Cziraky, Michael D. Dake, Michael R. Jaff, Diane Reid, Flora S. Siami, George Sopko, Christopher J. White, Max van Over, Michael B. Strong, Maria F. Villarreal, Michelle McKean, Ezana Azene, Amir Azarbal, Andrew Barleben, David K. Chew, Leonardo C. Clavijo, Yvan Douville, Laura Findeiss, Nitin Garg, Warren Gasper, Kristina A. Giles, Philip P. Goodney, Beau M. Hawkins, Christine R. Herman, Jeffrey A. Kalish, Matthew C. Koopmann, Igor A. Laskowski, Carlos Mena-Hurtado, Raghu Motaganahalli, Vincent L. Rowe, Andres Schanzer, Peter A. Schneider, Jeffrey J. Siracuse, Maarit Venermo, and Kenneth Rosenfield
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General Medicine - Abstract
Patients with chronic limb-threatening ischemia (CLTI) require revascularization to improve limb perfusion and thereby limit the risk of amputation. It is uncertain whether an initial strategy of endovascular therapy or surgical revascularization for CLTI is superior for improving limb outcomes.In this international, randomized trial, we enrolled 1830 patients with CLTI and infrainguinal peripheral artery disease in two parallel-cohort trials. Patients who had a single segment of great saphenous vein that could be used for surgery were assigned to cohort 1. Patients who needed an alternative bypass conduit were assigned to cohort 2. The primary outcome was a composite of a major adverse limb event - which was defined as amputation above the ankle or a major limb reintervention (a new bypass graft or graft revision, thrombectomy, or thrombolysis) - or death from any cause.In cohort 1, after a median follow-up of 2.7 years, a primary-outcome event occurred in 302 of 709 patients (42.6%) in the surgical group and in 408 of 711 patients (57.4%) in the endovascular group (hazard ratio, 0.68; 95% confidence interval [CI], 0.59 to 0.79; P0.001). In cohort 2, a primary-outcome event occurred in 83 of 194 patients (42.8%) in the surgical group and in 95 of 199 patients (47.7%) in the endovascular group (hazard ratio, 0.79; 95% CI, 0.58 to 1.06; P = 0.12) after a median follow-up of 1.6 years. The incidence of adverse events was similar in the two groups in the two cohorts.Among patients with CLTI who had an adequate great saphenous vein for surgical revascularization (cohort 1), the incidence of a major adverse limb event or death was significantly lower in the surgical group than in the endovascular group. Among the patients who lacked an adequate saphenous vein conduit (cohort 2), the outcomes in the two groups were similar. (Funded by the National Heart, Lung, and Blood Institute; BEST-CLI ClinicalTrials.gov number, NCT02060630.).
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- 2022
6. Evaluation of a modified radiographic union scale for tibial fractures scoring system in staged bilateral tibial plateau leveling osteotomy procedures and comparison of first and second side radiographic bone healing
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Kyle J. Walker, John Litterine‐Kaufman, Roy F. Barnes, John M. French, Steven L. Tsai, and Deborah A. Keys
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Tibial Fractures ,Dogs ,Tibia ,General Veterinary ,Anterior Cruciate Ligament Injuries ,Animals ,Reproducibility of Results ,Dog Diseases ,Anterior Cruciate Ligament ,Stifle ,Retrospective Studies ,Osteotomy - Abstract
To evaluate the inter- and intra-rater reliability of the tibial plateau leveling osteotomy (TPLO) modified radiographic union scale for tibial fractures (mRUST), a semiquantitative scoring system, as compared with the subjective evaluation of radiographic union for staged TPLOs.Retrospective study.Forty-eight dogs, 96 stifles.Medical records were reviewed for dogs with bilateral cranial cruciate ligament injuries diagnosed at presentation that underwent staged bilateral TPLOs within 6 months and had both immediate and recheck postoperative radiographs. Radiographs were anonymized, reviewers were blinded, radiographic union was evaluated subjectively, and TPLO mRUST scores were assigned.The subjective evaluation's intra-rater reliability was 0.72 (Kappa 95% CI 0.65-0.79) and inter-rater reliability was 0.33 (Kappa 95% CI 0.28-0.39). The TPLO mRUST scoring system intra-rater reliability was 0.73 (95% CI 0.68-0.78) and inter-rater reliability was 0.56 (95% CI 0.41-0.68). There was no difference in the degree of bone healing quantified by the TPLO mRUST scoring system (95% CI - 0.1-1.2, P = .09) or subjective evaluation (P = .48) between the first and second side TPLOs. The TPLO mRUST scores were positively correlated with subjective healing (r = 0.94, 95% CI 0.92-0.96, P .0001, and for scores ≥10/12, 99%, 244/246) were subjectively assigned as radiographically healed.The TPLO mRUST scoring system improved inter-rater reliability compared to subjective evaluation of radiographic union.The TPLO mRUST scoring system should be considered as a semiquantitative supplemental tool for evaluating radiographic union.
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- 2022
7. Antithrombotic Therapy After Venous Interventions: AJR Expert Panel Narrative Review
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Sirish Kishore, Minhaj S. Khaja, Bartley Thornburg, Aditya M. Sharma, M-Grace Knuttinen, Fadi Shamoun, Simon Mantha, Kush R. Desai, Akhilesh K. Sista, Stephen A. Black, Gerard J. O'Sullivan, John A. Kaufman, Lawrence V. Hofmann, and Ronald S. Winokur
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Radiology, Nuclear Medicine and imaging ,General Medicine - Published
- 2022
8. Impact of Postthrombotic Vein Wall Biomechanics on Luminal Flow during Venous Angioplasty and Stent Placement: Computational Modeling Results
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Ningcheng Li, Jack Ferracane, Nicole Andeen, Steven Lewis, Randy Woltjer, Sandra Rugonyi, Younes Jahangiri, Barry Uchida, Khashayar Farsad, John A. Kaufman, and Ramsey Al-Hakim
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Sheep ,Treatment Outcome ,Angioplasty ,Animals ,Humans ,Computer Simulation ,Stents ,Radiology, Nuclear Medicine and imaging ,Iliac Vein ,Cardiology and Cardiovascular Medicine ,Biomechanical Phenomena - Abstract
This study characterized the impact of vein wall biomechanics on inflow diameter and luminal flow during venous angioplasty and stent placement, using postthrombotic and healthy biomechanical properties from an ovine venous stenosis and thrombosis model. Finite element analysis demonstrated more pronounced inflow channel narrowing in the postthrombotic vein compared with the healthy control vein during angioplasty and stent placement (relative inflow diameter reduction of 42% versus 13%, P.0001). Computational fluid dynamics modeling showed increased relative areas of low wall shear rate in the postthrombotic vein compared with the normal vein (0.46 vs 0.24 for shear rate50 s
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- 2022
9. Putting BEST-CLI into Perspective: Think like a Doctor, not a Proceduralist
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John A Kaufman
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Radiology, Nuclear Medicine and imaging ,Cardiology and Cardiovascular Medicine - Published
- 2023
10. Analysis of Costs and Payments for Inferior Vena Cava Filter Retrieval in the Medicare Population
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Jay Giri, Younes Jahangiri, Michael R. Jaff, John A. Kaufman, Ido Weinberg, and Timothy C. Huber
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medicine.medical_specialty ,Vena Cava Filters ,media_common.quotation_subject ,Ivc filter ,Inferior vena cava filter ,Vena Cava, Inferior ,Medicare ,Inferior vena cava ,Margin (machine learning) ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Device Removal ,Reimbursement ,Aged ,Retrospective Studies ,media_common ,business.industry ,Payment ,United States ,Surgery ,Pooled variance ,medicine.vein ,Medicare population ,Cardiology and Cardiovascular Medicine ,business - Abstract
Over the past decade, inferior vena cava (IVC) filter retrieval has been increasing, in part due to Food and Drug Administration recommendations and legal pressure. The costs and margin of IVC filter removal are poorly understood. Medicare claims data from 2016 for the 103 highest volume centers for IVC filter retrieval were examined. Pooled mean charges, costs, payments, and margin were calculated by institution. Mean ± SD charges, costs, and payments were $14,138.00 ± $8,400.48, $3,693.28 ± $2,294.27, and $1,949.82 ± $702.91, respectively. Average (range) margin was -$1,706.18 (-$7,509.93 to $362.77). The margin was negative in 99 of the 103 (96%) institutions evaluated. The most significant contributors to the total procedure cost were operating room, supplies, and recovery (44.5%, 23.5%, and 10.4%, respectively). While IVC filter retrieval is often medically indicated, it is typically associated with a financial loss under current reimbursement structure.
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- 2021
11. Epidemiology beyond its limits
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Lauren E. McCullough, Maret L. Maliniak, Avnika B. Amin, Julia M. Baker, Davit Baliashvili, Julie Barberio, Chloe M. Barrera, Carolyn A. Brown, Lindsay J. Collin, Alexa A. Freedman, David C. Gibbs, Maryam B. Haddad, Eric W. Hall, Sarah Hamid, Kristin R. V. Harrington, Aaron M. Holleman, John A. Kaufman, Mohammed A. Khan, Katie Labgold, Veronica C. Lee, Amyn A. Malik, Laura M. Mann, Kristin J. Marks, Kristin N. Nelson, Zerleen S. Quader, Katherine Ross-Driscoll, Supriya Sarkar, Monica P. Shah, Iris Y. Shao, Jonathan P. Smith, Kaitlyn K. Stanhope, Marisol Valenzuela-Lara, Miriam E. Van Dyke, Kartavya J. Vyas, and Timothy L. Lash
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Multidisciplinary - Abstract
In 1995, journalist Gary Taubes published an article in Science titled “Epidemiology faces its limits,” which questioned the utility of nonrandomized epidemiologic research and has since been cited more than 1000 times. He highlighted numerous examples of research topics he viewed as having questionable merit. Studies have since accumulated for these associations. We systematically evaluated current evidence of 53 example associations discussed in the article. Approximately one-quarter of those presented as doubtful are now widely viewed as causal based on current evaluations of the public health consensus. They include associations between alcohol consumption and breast cancer, residential radon exposure and lung cancer, and the use of tanning devices and melanoma. This history should inform current debates about the reproducibility of epidemiologic research results.
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- 2022
12. Birth outcomes associated with paternal polybrominated and polychlorinated biphenyl exposure
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Lawrence S. Redmond, John A. Kaufman, Metrecia L. Terrell, Melanie A. Pearson, Hillary Barton, Martha Scott Tomlinson, and Michele Marcus
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Male ,Polybrominated Biphenyls ,Infant, Newborn ,Infant ,Biochemistry ,Polychlorinated Biphenyls ,Fathers ,Semen ,Birth Weight ,Humans ,Premature Birth ,Environmental Pollutants ,Female ,Child ,General Environmental Science - Abstract
In 1973-74, a polybrominated biphenyl (PBB) flame retardant mixture was shipped to Michigan livestock feed mills in place of a nutritional supplement and contaminated the food supply. Following the accident, the Michigan PBB Registry was established to study the long-term health effects of halogenated compounds and is now led by a community-academic partnership. PBB exposure is associated with altered DNA methylation in sperm, which may lead to adverse birth outcomes in children whose fathers have increased levels of serum PBB or polychlorinated biphenyl (PCB). Paternal PBB and PCB levels of men enrolled in the Michigan PBB Registry (n = 155) were analyzed against matched offspring birthweight and gestational age (n = 336). Birthweight and gestational age were dichotomized at the 25th percentile and 37 weeks, respectively, and paternal PBB and PCB levels were examined as continuous measures and divided into tertiles. Associations of offspring birthweight and gestational age with paternal PBB and PCB serum concentrations were modeled using multivariable linear spline and log-risk regression, adjusting for family clustering, paternal health and lifestyle factors, maternal PBB, and PCB serum concentrations, sex, and offspring gestational age (for birthweight). Fathers in the middle and upper PBB and PCB tertiles had increased risks for lowest quartile birthweight compared to the first tertile, with adjusted risk ratios (aRR) = 1.67 (95% CI: 0.93, 2.99) and aRR = 2.06 (95% CI: 1.12, 3.79) for PBB, and aRR = 1.47 (95% CI: 0.79, 2.75) and aRR = 1.34 (95% CI: 0.70, 2.54) for PCB, respectively. Elevated paternal PBB levels were not associated with an increased risk for preterm birth, while PCB levels were associated with a small, but not significant, decrease in gestational age, β = -0.37 (95% CI: -0.76, 0.03) weeks per log unit increase PCB. The findings suggest that increased paternal PBB and PCB levels negatively impact offspring birthweight, and paternal PCB levels may negatively impact gestational age.
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- 2022
13. Current Controversies in Inferior Vena Cava Filter Placement: AJR Expert Panel Narrative Review
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David W. Trost, John A. Kaufman, Michael S. Stecker, Thein Hlaing Oo, Andrew Kesselman, and Matthew S. Johnson
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medicine.medical_specialty ,business.industry ,General surgery ,Inferior vena cava filter ,General Medicine ,medicine.disease ,Inferior vena cava ,030218 nuclear medicine & medical imaging ,Pulmonary embolism ,03 medical and health sciences ,0302 clinical medicine ,medicine.vein ,030220 oncology & carcinogenesis ,Occlusion ,cardiovascular system ,medicine ,Radiology, Nuclear Medicine and imaging ,In patient ,Narrative review ,Antibiotic prophylaxis ,Acute trauma ,business - Abstract
Despite inferior vena cava (IVC) filter practice spanning over 50 years, interventionalists face many controversies in proper utilization and management. This article reviews recent literature and offers opinions on filter practices. IVC filtration is most likely to benefit patients at high risk of iatrogenic pulmonary embolus during endovenous intervention. Filters should be used selectively in patients with acute trauma or undergoing bariatric surgery. Retrieval should be attempted for perforating filter and fractured filter fragments when imaging suggests feasibility and favorable risk-to-benefit ratio. Antibiotic prophylaxis should be considered when removing filters with confirmed gastrointestinal penetration. Anticoagulation solely because of filter presence is not recommended except in patients with active malignancy. Anticoagulation while filters remain in place may decrease long-term filter complications in these patients. Patients with a filter and symptomatic IVC occlusion should be offered filter removal and IVC reconstruction. Physicians implanting filters may maximize retrieval by maintaining physician-patient relationships and scheduling follow-up at time of placement. Annual follow-up allows continued evaluation for removal or replacement appropriateness. Advanced retrieval techniques increase retrieval rates but require caution. Select cases may require referral to experienced centers with additional retrieval resources. The views expressed should help guide clinical practice, future innovation, and research.
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- 2021
14. Augmentation of Pulmonary Perfusion by Conducted Effects of a Pulmonary Artery Ultrasound Catheter
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Matthew A. Muller, James Hodovan, Koya Ozawa, Matthew W. Hagen, Theodore R. Hobbs, John Templon, Yan Zhao, John A. Kaufman, and Jonathan R. Lindner
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Perfusion ,Catheters ,Acoustics and Ultrasonics ,Radiological and Ultrasound Technology ,Vasodilator Agents ,Biophysics ,Animals ,Radiology, Nuclear Medicine and imaging ,Vascular Resistance ,Pulmonary Artery ,Hypoxia ,Lung ,Macaca mulatta - Abstract
Ultrasound (US) generated by catheters used clinically for US-facilitated thrombolysis can release shear-dependent vasodilators from endothelial and red blood cells. We hypothesized that catheter-based US in the pulmonary artery (PA) decreases downstream vascular resistance and increases pulmonary blood flow. In rhesus macaques, a U.S. Food and Drug Administration-approved multi-element US catheter was placed in a pulmonary artery. Comprehensive echocardiography was performed (i) at baseline, (ii) during hypoxemia (12% FIOsub2/sub) to increase pulmonary vascular resistance (PVR) and (c) 15 min after initiating US during hypoxemia. Reduced FIOsub2/subproduced intended reductions in oxygen saturation (69 ± 3%) and PaOsub2/sub(34 ± 5 mm Hg), yet on echocardiography, hypoxemia did not create the intended model, with only modest hypoxia-related increases in PA systolic pressure (24 ± 4 to 28 ± 4 mm Hg, p = 0.05) and no significant change in PVR or multiparametric right ventricular (RV) function. Although US did not further change total PVR, onsup99m/supTc-macroalbumin aggregate single-photon-emission computed tomography imaging, lung perfusion was significantly higher in the lung ipsilateral to the US catheter versus the contralateral control lung (133 ± 48 cpm vs. 103 ± 43 × 10sup3/supcpm, p = 0.01). We conclude that PA catheter-based US increases regional lung perfusion, most likely from vasodilators that are conducted downstream.
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- 2022
15. Locoregional Challenges for Interventional Radiology Practice: USA
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John A, Kaufman
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Geography ,Humans ,Radiology, Interventional - Published
- 2022
16. Classification System for Inferior Vena Cava (IVC) Appearance Following Percutaneous IVC Filter Retrieval
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Ningcheng Li, Roberto Galuppo, Maxwell Cretcher, Dennis Barbon, Cameron Loudill, Dominik Prosser, Greg Rufener, Mckinna Tillotson, Joseph O’Sullivan, Ramsey Al-Hakim, Khashayar Farsad, Younes Jahangiri, and John A. Kaufman
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Vena Cava Filters ,Humans ,Reproducibility of Results ,Radiology, Nuclear Medicine and imaging ,Vena Cava, Inferior ,Cardiology and Cardiovascular Medicine ,Device Removal ,Retrospective Studies - Abstract
There is no classification system for describing inferior vena cava (IVC) injuries. The objective of this study was to develop a standardized grading system for venographic appearance of the IVC following percutaneous IVC filter retrieval.A classification system for the appearance of the IVC on cavograms following percutaneous IVC filter removal was developed consisting of two grading elements; luminal characteristics and extravasation. Luminal narrowing from 0% up to 50% from any cause is grade 1; narrowing between 50 and 99% is grade 2; occlusion is grade 3; and avulsion is grade 4. Absence of extravasation is grade A, contained extravasation is grade B, and free extravasation is grade C. This system was then applied retrospectively to pre- and post-IVC filter retrieval cavograms performed at a single institution from October 2004 through February 2019.546 retrieval attempts were identified with 509 (93.2%) filters successfully retrieved. 449 cases (88.2%) had both pre-retrieval and post-retrieval imaging appropriate for application of the proposed classification system. Inter-rater reliability was 0.972 for luminal characteristics, 0.967 for extravasation, and 0.969 overall. Consensus grading demonstrated a distribution of 97.3% grade 1, 1.3% grade 2, 1.3% grade 3, and 0.0% grade 4 for post-retrieval luminal characteristics. For extravasation classification, 96.4% of the cases were classified as grade A, 2.7% grade B, and 0.9% grade C.A classification system was developed for describing IVC appearance after IVC filter retrieval, and retrospectively validated using a single center dataset.
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- 2022
17. Society of Interventional Radiology Clinical Practice Guideline for Inferior Vena Cava Filters in the Treatment of Patients with Venous Thromboembolic Disease
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David L. Gillespie, Susan Murin, Rabih A. Chaer, Matthew S. Johnson, Sheena Patel, Robert T. Eberhardt, William T. Kuo, Geoffrey D. Barnes, Ido Weinberg, John A. Kaufman, Joseph Cuschieri, and Anita Rajasekhar
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medicine.medical_specialty ,medicine.diagnostic_test ,business.industry ,MEDLINE ,Interventional radiology ,Guideline ,Vascular surgery ,Inferior vena cava ,Clinical Practice ,Venous thromboembolic disease ,medicine.vein ,cardiovascular system ,medicine ,Radiology, Nuclear Medicine and imaging ,Cardiology and Cardiovascular Medicine ,business ,Intensive care medicine ,Vascular Medicine - Abstract
Purpose To provide evidence-based recommendations on the use of inferior vena cava (IVC) filters in the treatment of patients with or at substantial risk of venous thromboembolic disease. Materials and Methods A multidisciplinary expert panel developed key questions to address in the guideline, and a systematic review of the literature was conducted. Evidence was graded based on a standard methodology, which was used to inform the development of recommendations. Results The systematic review identified a total of 34 studies that provided the evidence base for the guideline. The expert panel agreed on 18 recommendations. Conclusions Although the evidence on the use of IVC filters in patients with or at risk of venous thromboembolic disease varies in strength and quality, the panel provides recommendations for the use of IVC filters in a variety of clinical scenarios. Additional research is needed to optimize care for this patient population.
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- 2020
18. Transjugular Intrahepatic Portosystemic Shunt Creation Using a Radiofrequency Wire: Prospective Clinical Safety and Feasibility Trial in Cirrhosis
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Lori Russell, Khashayar Farsad, Evan Narasimhan, and John A. Kaufman
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Liver Cirrhosis ,Male ,medicine.medical_specialty ,Catheters ,Time Factors ,Cirrhosis ,medicine.medical_treatment ,Operative Time ,Radiography, Interventional ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,Liver disease ,Postoperative Complications ,0302 clinical medicine ,Primary biliary cirrhosis ,medicine ,Humans ,Fluoroscopy ,Radiology, Nuclear Medicine and imaging ,Prospective Studies ,Ultrasonography, Interventional ,Aged ,Radiofrequency Ablation ,medicine.diagnostic_test ,business.industry ,Stent ,Middle Aged ,medicine.disease ,Surgery ,Catheter ,Treatment Outcome ,030220 oncology & carcinogenesis ,Feasibility Studies ,Female ,Portasystemic Shunt, Transjugular Intrahepatic ,Portosystemic shunt ,Cardiology and Cardiovascular Medicine ,business ,Transjugular intrahepatic portosystemic shunt - Abstract
Purpose To assess the safety and feasibility of using a radiofrequency (RF) wire for portosystemic shunt creation. Materials and Methods Ten patients undergoing elective creation of a transjugular intrahepatic portosystemic shunt (TIPS) or a direct intrahepatic portosystemic shunt (DIPS) were prospectively enrolled. Primary outcomes were the safety and feasibility of RF wire used for the creation of TIPS and DIPS. Median age was 66.5 ± 6.1 years. Causes of liver disease included alcohol (n = 5), nonalcoholic steatohepatitis (n = 2), hepatitis C virus (n = 1), primary biliary cirrhosis (n = 1), autoimmune hepatitis (n = 1). The median score for model for end-stage liver disease was 11 ± 4.3. The Rosch-Uchida TIPS set was used with intravascular ultrasonography guidance in all cases. A 0.035-inch RF wire was used in lieu of the trocar needle through the 5-F TIPS set catheter to create a track between the hepatic vein and the portal vein. All shunts were created using stent grafts. Results Technical success rate was 100%. In 7 of 10 patients, portal vein access was achieved with a single pass. A DIPS was created in 2 patients based on anatomic favorability. Median fluoroscopy time was 13.3 ± 3.8 min, and median total procedure time was 102 ± 19 min. The wire passed through parenchyma without subjective deflection. There was 1 case of extracapsular puncture with no clinical consequence. The RF wire was too stiff to curve into the main portal vein, requiring wire exchange in all but 1 case. Mean portosystemic gradient decreased from 13.9 ± 3.3 to 5.9 ± 2.1 mm Hg. No immediate complications were encountered. Shunt patency was 100% at 30 days. Conclusions Creation of TIPS and DIPS using an RF wire was safe and feasible, enabling creation of an intrahepatic track without subjective deflection in cirrhotic patients.
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- 2020
19. Effectiveness of Transarterial Embolization in Treatment of Symptomatic Hepatic Hemangiomas: Systematic Review and Meta-analysis
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Younes Jahangiri, J. Li, Pooya Torkian, and John A. Kaufman
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medicine.medical_specialty ,medicine.medical_treatment ,Bleomycin ,030218 nuclear medicine & medical imaging ,Hemangioma ,03 medical and health sciences ,chemistry.chemical_compound ,0302 clinical medicine ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Embolization ,Pingyangmycin ,business.industry ,Incidence (epidemiology) ,Liver Neoplasms ,medicine.disease ,Embolization, Therapeutic ,Confidence interval ,Treatment Outcome ,chemistry ,Meta-analysis ,Lipiodol ,Radiology ,Tomography, X-Ray Computed ,Cardiology and Cardiovascular Medicine ,business ,medicine.drug - Abstract
To evaluate the current evidence for the effectiveness of transarterial embolization (TAE) in treatment of symptomatic hepatic hemangiomas. A systematic literature review was conducted in PubMed, CINAHL and Scopus databases to identify studies of hepatic hemangiomas treated with transarterial embolization. Main outcome was defined as the mean difference between pre- and post-TAE hemangioma diameters. Treatment agents were categorized as Lipiodol based [bleomycin (L + BE), pingyangmycin (L + PYG) or ethanol (L + ethanol)] and non-Lipiodol based (polyvinyl-alcohol-only). Conventional random-effect meta-analysis technique was applied to analyze data. Of 3080 initially inspected publications, 21 studies were included in the meta-analysis comprising of 1450 patients with total of 1871 hemangiomas (36.2% male, mean age: 46.3 ± 3.6 years). One hundred and twenty-six, 1666, 41 and 38 lesions were treated with L + BE, L + PYG, L + ethanol and PVA, respectively. Median follow-up time after embolization was 12 months. Lipiodol-based treatments showed significant effect in reducing hemangioma size after TAE compared to PVA (P
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- 2020
20. Prevalence of Musculoskeletal Symptoms in Interventional Radiologists
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John A. Kaufman, Albert Jiao, Younes Jahangiri, Sean Robinson, and James J. Morrison
- Subjects
Adult ,Male ,medicine.medical_specialty ,Multivariate analysis ,Demographics ,MEDLINE ,Radiography, Interventional ,Occupational safety and health ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,0302 clinical medicine ,Risk Factors ,Radiologists ,Prevalence ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Musculoskeletal Diseases ,Occupational Health ,Response rate (survey) ,business.industry ,Mean age ,Middle Aged ,Health Surveys ,Occupational Diseases ,Job Description ,030220 oncology & carcinogenesis ,Physical therapy ,Female ,Cardiology and Cardiovascular Medicine ,business ,Body mass index - Abstract
Purpose To investigate the prevalence of musculoskeletal symptoms, defined as aches, pains, discomfort, or numbness, by using a validated assessment tool among interventional radiologists. Materials and Methods A Web-based survey using the Nordic Musculoskeletal Questionnaire was disseminated to interventional radiologist members by email in November 2015. Musculoskeletal symptoms were evaluated in 9 body areas. Information regarding participant demographics, practice details, use of radio-protective equipment, and exercise routines was also gathered. Univariate and multivariate analyses were performed to determine risk factors associated with more severe symptoms. Results Of 4,096 SIR members at the time of the survey, 640 completed the questionnaire in its entirety (16% response rate). Respondents consisted of 69 females (11%) and 571 males (89%), with a mean age of 47.5 ± 10.2 years old, a mean body mass index of 25.5 ± 3.9 kg/m2, and a mean practice length of 17.1 ± 9.8 years. Prevalence of musculoskeletal symptoms was 88% in the 12 months preceding the survey. For those reporting musculoskeletal issues, 58% attributed the symptoms to work-related activities. Lower back (61%), neck (56%), and shoulder complaints (46%) were the most common. Symptoms prevented 21.2% of respondents from being able to work over the same time period. Multivariate analysis identified female gender, above-normal body mass index, and a practice length of 10 years or more as factors associated with a higher risk of moderate-to-severe symptoms. Conclusions Musculoskeletal symptoms are prevalent among interventional radiologists, the majority of which are attributed to work-related causes.
- Published
- 2020
21. Venous Biomechanics of Angioplasty and Stent Placement: Implications of the Poisson Effect
- Author
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Francine Mendoza, Barry T. Uchida, Craig Bonsignore, Younes Jahangiri, Sandra Rugonyi, John A. Kaufman, Ramsey Al-Hakim, Ningcheng Li, and Khashayar Farsad
- Subjects
medicine.medical_specialty ,medicine.medical_treatment ,Finite Element Analysis ,Sus scrofa ,Constriction, Pathologic ,Iliac Vein ,Balloon ,030218 nuclear medicine & medical imaging ,Constriction ,03 medical and health sciences ,symbols.namesake ,0302 clinical medicine ,Animal model ,Angioplasty ,Internal medicine ,Animals ,Medicine ,Radiology, Nuclear Medicine and imaging ,Vascular Diseases ,Computational analysis ,business.industry ,Models, Cardiovascular ,Biomechanics ,Poisson's ratio ,Biomechanical Phenomena ,Disease Models, Animal ,Stent placement ,030220 oncology & carcinogenesis ,symbols ,Cardiology ,Stents ,Cardiology and Cardiovascular Medicine ,business ,Angioplasty, Balloon - Abstract
Purpose To characterize the Poisson effect in response to angioplasty and stent placement in veins and identify potential implications for guiding future venous-specific device design. Materials and Methods In vivo angioplasty and stent placement were performed in 3 adult swine by using an established venous stenosis model. Iron particle endothelium labeling was performed for real-time fluoroscopic tracking of the vessel wall during intervention. A finite-element computational model of a vessel was created with ADINA software (version 9.5) with arterial and venous biomechanical properties obtained from the literature to compare the response to radial expansion. Results In vivo angioplasty and stent placement in a venous stenosis animal model with iron particle endothelium labeling demonstrated longitudinal foreshortening that correlated with distance from the center of the balloon (R2 = 0.87) as well as adjacent segment narrowing that correlated with the increase in diameter of the treated stenotic segment (R2 = 0.89). Finite-element computational analysis demonstrated increased Poisson effect in veins relative to arteries (linear regression coefficient slope comparison, arterial slope 0.033, R2 = 0.9789; venous slope 0.204, R2 = 0.9975; P Conclusions Clinically observed adjacent segment narrowing during venous angioplasty and stent placement is a result of the Poisson effect, with redistribution of radially applied force to the longitudinal direction. The Poisson effect is increased in veins relative to arteries as a result of unique venous biomechanical properties, which may be relevant to consider in the design of future venous interventional devices.
- Published
- 2020
22. Management of Phlegmasia Cerulea Dolens with Percutaneous Mechanical Thrombectomy
- Author
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John A. Kaufman, Ramsey Al-Hakim, Alexander Boscanin, and David D. Prosser
- Subjects
medicine.medical_specialty ,Percutaneous ,medicine.medical_treatment ,Embolectomy ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,In patient ,High severity ,Thrombectomy ,Phlegmasia cerulea dolens ,Leg ,Ultrasonography, Doppler, Duplex ,business.industry ,Middle Aged ,Thrombophlebitis ,medicine.disease ,Alternative treatment ,Surgery ,Mechanical thrombectomy ,Pedal pulses ,Female ,Cardiology and Cardiovascular Medicine ,business - Abstract
Advanced cases of phlegmasia cerulea dolens (PCD) with absent pedal pulses, sensory/motor deficits, and/or venous gangrene likely require more rapid restoration of flow compared to cases without these factors to prevent progression and associated morbidity/mortality. We present a case of PCD with absent pedal pulses and sensory deficit managed successfully with emergent percutaneous mechanical thrombectomy using Inari ClotTriever (Inari Medical, Irvine, CA) with immediate clinical resolution, including restoration of pedal pulses ~ 45 min after thrombectomy. Percutaneous mechanical thrombectomy with the ClotTriever device has the ability to immediately restore venous flow reversing the pathophysiology of PCD in a short time period similar to surgical embolectomy and may be an alternative treatment strategy in patients with phlegmasia cerulea dolens of high severity.
- Published
- 2020
23. Transjugular Intrahepatic Portosystemic Shunt Creation Using a Radiofrequency Wire: Acute Feasibility Study in Swine
- Author
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Gareth Davies, Younes Jahangiri, Evan Narasimhan, Khashayar Farsad, Barry Uchida, John A. Kaufman, and Yun Uhm
- Subjects
medicine.medical_specialty ,medicine.medical_treatment ,Sus scrofa ,Technical success ,Portal vein ,Inferior vena cava ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Animals ,Fluoroscopy ,Radiology, Nuclear Medicine and imaging ,cardiovascular diseases ,Intravascular ultrasonography ,Portography ,Ultrasonography, Interventional ,medicine.diagnostic_test ,business.industry ,Stent ,medicine.vein ,Needles ,030220 oncology & carcinogenesis ,Models, Animal ,Catheter Ablation ,cardiovascular system ,Feasibility Studies ,Radiology ,Portasystemic Shunt, Transjugular Intrahepatic ,Cardiology and Cardiovascular Medicine ,business ,Transjugular intrahepatic portosystemic shunt ,Vascular Access Devices - Abstract
The feasibility of a radiofrequency (RF) wire to replace the needle trocar for the creation of a transjugular intrahepatic portosystemic shunt (TIPS) was assessed in 3 swine by using fluoroscopy and intravascular ultrasonography (IVUS). RF wire passes were successful from hepatic to portal vein and from inferior vena cava to portal vein. Technical success was achieved using both IVUS guidance and carbon dioxide portography. The wire tracked a straight course under RF energy application without subjective deflection and, when centrally advanced, served as the working wire for completing the TIPS in 2 attempts with stent graft deployment. No procedural adverse events from the use of RF wire were observed.
- Published
- 2020
24. Diagnostic Water-Soluble Contrast CT Lymphangiogram on Conventional CT Scanner with Local Anesthetic for Therapeutic Planning
- Author
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Ningcheng, Li, Alex, Dabrowiecki, Brett C, Sheppard, and John A, Kaufman
- Subjects
Contrast Media ,Humans ,Lymphography ,Water ,Anesthetics, Local ,Tomography, X-Ray Computed - Published
- 2021
25. A Review of Health Effects of Polybrominated Biphenyls Five Decades after Michigan Agricultural Contamination
- Author
-
Alicia K. Smith, John A. Kaufman, Melanie A. Pearson, Susan S. Buckenmaier, Michele Marcus, Tamar Wainstock, Metrecia L. Terrell, Kathleen P. Hartnett, Hillary Barton, and Sarah W. Curtis
- Subjects
Agriculture ,business.industry ,Environmental health ,General Earth and Planetary Sciences ,Environmental science ,Polybrominated Biphenyls ,Contamination ,business ,General Environmental Science - Published
- 2021
26. Birth Outcomes Associated with Paternal Polybrominated and Polychlorinated Biphenyl Exposure
- Author
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Melanie A. Pearson, Michele Marcus, Hillary Barton, John A. Kaufman, Lawrence S. Redmond, and Metrecia L. Terrell
- Subjects
chemistry.chemical_compound ,chemistry ,business.industry ,General Earth and Planetary Sciences ,Physiology ,Polychlorinated biphenyl ,Medicine ,business ,General Environmental Science - Published
- 2021
27. Differential Susceptibility to Aridity for Mortality Outcomes in South Africa: Application of Mixed-Effect Regression Tree Analysis to a Case-Only Design
- Author
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Jesse E. Bell, John A. Kaufman, Noah Scovronick, Matthew O. Gribble, Azar M. Abadi, and Rocky Bilotta
- Subjects
Regression tree analysis ,Mixed effects ,General Earth and Planetary Sciences ,Differential (mechanical device) ,Biology ,Arid ,General Environmental Science ,Demography - Abstract
BACKGROUND AND AIM: We investigated whether the relationship between recent aridity and mortality might be different according to demographic subgroups in South Africa over 1997-2013. METHODS: DESI...
- Published
- 2021
28. Prevalence of malignancy in masses from the mammary gland region of dogs with single or multiple masses
- Author
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John Litterine-Kaufman, Sue A. Casale, and Pamela J. Mouser
- Subjects
Pathology ,medicine.medical_specialty ,General Veterinary ,business.industry ,Mammary Neoplasms ,Mammary gland ,Mammary Neoplasms, Animal ,Malignancy ,medicine.disease ,Multiple masses ,Dogs ,Mammary Glands, Animal ,medicine.anatomical_structure ,stomatognathic system ,Neoplasms ,Prevalence ,medicine ,Animals ,Female ,Dog Diseases ,business - Abstract
OBJECTIVE To determine the prevalence of malignancy in masses from the mammary gland region of dogs with single or multiple masses. ANIMALS 95 female dogs from which mammary gland masses had been excised. PROCEDURES Medical records of all female dogs from which mammary gland tissue was submitted to the Angell Animal Medical Center Pathology Department from 2009 through 2014 were reviewed. For each dog, data were obtained on breed, body weight, age, reproductive status, and number, location, and histologic classification of masses. The prevalence of malignancy was compared between dogs with single versus multiple masses and among the 5 pairs of mammary glands. Dogs with single versus multiple masses were also compared with respect to age and reproductive status. RESULTS Among 161 evaluated masses, 137 (85%) were classified as benign or nonneoplastic and 24 (15%) as malignant. Five of 95 (5%) dogs had masses that were not of mammary gland origin. Age, reproductive status, and quantity of masses (single vs multiple) were not significantly associated with the prevalence of malignancy. The prevalence of malignancy in masses from the fourth (caudal abdominal) mammary gland was significantly lower than that in the other 4 mammary glands combined. CONCLUSIONS AND CLINICAL RELEVANCE Dogs with multiple masses in the mammary gland region were not significantly more likely than dogs with single masses to have a malignancy, suggesting that these 2 groups could be managed similarly. Further studies are needed to evaluate the clinical relevance of the lower prevalence of malignancy in masses from the fourth mammary gland.
- Published
- 2019
29. Long Road to Harpers Ferry
- Author
-
John R. Kaufman-McKivigan
- Abstract
Review of: Long Road to Harpers Ferry: The Rise of the First American Left, by Mark A. Lause.
- Published
- 2019
30. Determinants of oil-spill cleanup participation following the Deepwater Horizon oil spill
- Author
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Zachary E. Goldman, Matthew O. Gribble, John A. Kaufman, Amy Wolkin, and J. Danielle Sharpe
- Subjects
Adult ,Male ,medicine.medical_specialty ,010501 environmental sciences ,01 natural sciences ,Biochemistry ,Article ,Odds ,Environmental hazard ,03 medical and health sciences ,0302 clinical medicine ,Environmental health ,medicine ,Humans ,Petroleum Pollution ,030212 general & internal medicine ,Environmental Restoration and Remediation ,Aged ,0105 earth and related environmental sciences ,General Environmental Science ,Aged, 80 and over ,Estimation ,Gulf of Mexico ,Emergency management ,business.industry ,Public health ,Odds ratio ,Louisiana ,humanities ,Geography ,Deepwater horizon ,Oil spill ,Alabama ,Florida ,Female ,business - Abstract
Background On April 20, 2010, the Deepwater Horizon oil rig exploded, spilling over 4.9 million barrels of oil in the Gulf of Mexico over an 87-day period and developing into a long-term environmental disaster that affected people living in Gulf Coast states. Engagement of community members in recovery efforts is important for mitigating adverse effects of disasters and accelerating the rebuilding process for impacted communities; however, few studies have explored factors that determine participation in oil spill cleanups. Methods We analyzed data from the Gulf States Population Survey (GSPS) to study the determinants of participating in the Deepwater Horizon Oil Spill cleanup. The GSPS was a random-digit dialing survey conducted on 38,361 adults in counties and parishes in Alabama, Florida, Louisiana, and Mississippi impacted by the oil spill. Using survey estimation to account for the complex survey design, we estimated the probability of cleanup participation and used logistic regression to examine the association between sociodemographic factors and cleanup participation. Results Approximately 4.7% of residents in affected Gulf communities participated in the cleanup. Most participants were young, men, non-Hispanic white, and employed. Living in an affected coastal county was associated with higher odds of participation (unadjusted odds ratio [OR]: 1.69; 95% confidence interval [CI]: 1.28–2.24), as was having excellent or very good physical health (OR: 2.05; 95% CI: 1.11–3.81). Older persons were less likely to participate in the cleanup (OR for 65+ age group vs. 18–24 age group: 0.14; 95% CI: 0.05–0.36). Conclusions Understanding the demographics of cleanup participants may help inform civilian recruitment for future oil spill responses.
- Published
- 2019
31. Tailored treatment of patients with hepatocellular carcinoma with portal vein invasion: experience from a multidisciplinary hepatobiliary tumor program within a NCI comprehensive cancer center
- Author
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Sarah Walcott-Sapp, Erin Maynard, C. Kristian Enestvedt, Skye C. Mayo, Kenneth J. Kolbeck, Kevin G. Billingsley, Jesse Wagner, Susan L. Orloff, Khashayar Farsad, Scott Naugler, Jeong Youn Lim, and John A. Kaufman
- Subjects
medicine.medical_specialty ,Univariate analysis ,Multivariate analysis ,business.industry ,medicine.medical_treatment ,Brachytherapy ,Gastroenterology ,Portal vein ,Cancer ,030204 cardiovascular system & hematology ,medicine.disease ,03 medical and health sciences ,0302 clinical medicine ,030228 respiratory system ,Oncology ,Hepatocellular carcinoma ,Internal medicine ,Statistical significance ,medicine ,Original Article ,Liver function ,business - Abstract
Background: Hepatocellular carcinoma (HCC) with portal vein invasion (PVI) has a poor prognosis with limited treatment options. Intra-arterial brachytherapy (IAB) and transarterial chemoembolization (TACE) yield local control but risk accelerating liver dysfunction. The outcomes, survival, and safety of selective liver-directed treatment are reported. Methods: Thirty-seven consecutive patients with HCC and PVI treated between 2009 and 2015 were reviewed from a prospectively collected database. Univariate analysis, Kaplan-Meier plots using the log-rank method, and multivariate analyses were performed. Statistical significance was defined as P Results: Most patients (59%) had PVI identified at initial HCC diagnosis. The liver-directed therapy group (n=22) demonstrated a survival advantage versus the systemic/supportive care group (n=14) [23.6 (5.8, 30.9) vs . 6.0 (3.5, 8.8) months]. Patients indicated for liver directed therapy had unilateral liver involvement (100% vs . 43%, P vs . 208.0, P=0.002), and lower mean Child-Turcotte-Pugh (CTP) score (5.9 vs . 7.2, P=0.04) and tolerated treatment without serious complications. Conclusions: In HCC patients presenting with PVI, liver-directed therapy was safely performed in patients with limited venous involvement and preserved liver function. Liver-directed therapy extended survival for these patients indicated for palliative chemotherapy by traditional guidelines.
- Published
- 2018
32. Reducing Nontraumatic Lower-Extremity Amputations by 20% by 2030: Time to Get to Our Feet: A Policy Statement From the American Heart Association
- Author
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Sue Duval, Aruna D. Pradhan, Philip P. Goodney, Shipra Arya, Mark A. Creager, Laurie P. Whitsel, Kunihiro Matsushita, J. Antonio Gutierrez, Joshua A. Beckman, Amy W. Pollak, John A. Kaufman, and Karen E. Joynt Maddox
- Subjects
Chronic Limb-Threatening Ischemia ,Male ,medicine.medical_specialty ,Time Factors ,Arterial disease ,Statement (logic) ,medicine.medical_treatment ,Disease ,030204 cardiovascular system & hematology ,Amputation, Surgical ,03 medical and health sciences ,0302 clinical medicine ,Risk Factors ,Physiology (medical) ,medicine ,Humans ,030212 general & internal medicine ,Aged ,business.industry ,Public health ,General surgery ,American Heart Association ,United States ,Medical expenditure ,Policy ,Treatment Outcome ,Lower Extremity ,Amputation ,Female ,Cardiology and Cardiovascular Medicine ,business ,Complication - Abstract
Nontraumatic lower-extremity amputation is a devastating complication of peripheral artery disease (PAD) with a high mortality and medical expenditure. There are ≈150 000 nontraumatic leg amputations every year in the United States, and most cases occur in patients with diabetes. Among patients with diabetes, after an ≈40% decline between 2000 and 2009, the amputation rate increased by 50% from 2009 to 2015. A number of evidence-based diagnostic and therapeutic approaches for PAD can reduce amputation risk. However, their implementation and adherence are suboptimal. Some racial/ethnic groups have an elevated risk of PAD but less access to high-quality vascular care, leading to increased rates of amputation. To stop, and indeed reverse, the increasing trends of amputation, actionable policies that will reduce the incidence of critical limb ischemia and enhance delivery of optimal care are needed. This statement describes the impact of amputation on patients and society, summarizes medical approaches to identify PAD and prevent its progression, and proposes policy solutions to prevent limb amputation. Among the actions recommended are improving public awareness of PAD and greater use of effective PAD management strategies (eg, smoking cessation, use of statins, and foot monitoring/care in patients with diabetes). To facilitate the implementation of these recommendations, we propose several regulatory/legislative and organizational/institutional policies such as adoption of quality measures for PAD care; affordable prevention, diagnosis, and management; regulation of tobacco products; clinical decision support for PAD care; professional education; and dedicated funding opportunities to support PAD research. If these recommendations and proposed policies are implemented, we should be able to achieve the goal of reducing the rate of nontraumatic lower-extremity amputations by 20% by 2030.
- Published
- 2021
33. Defining the Value of Interventional Radiology to Healthcare Stakeholders: Proceedings from a Society of Interventional Radiology Research Consensus Panel
- Author
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Frank Dubeck, Sarah B. White, C. Matthew Hawkins, Richard Duszak, Jeremy C. Durack, Mark B. Canada, David A. Kooby, Andrew Resnick, Katharine L. Krol, Raymond W. Liu, Danny R. Hughes, and John A. Kaufman
- Subjects
Value (ethics) ,Medical education ,Consensus ,medicine.diagnostic_test ,business.industry ,Specialty ,MEDLINE ,Interventional radiology ,Research needs ,Radiology, Interventional ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,0302 clinical medicine ,030220 oncology & carcinogenesis ,Health care ,Medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Cardiology and Cardiovascular Medicine ,business ,Delivery of Health Care ,Strengths and weaknesses - Abstract
Interventional radiology (IR) has collectively struggled to articulate and prove its value to several external stakeholders. The goal of this research consensus panel was to provide a summary of the existing knowledge, identify current gaps in knowledge, identify the strengths and weaknesses in existing data, and prioritize research needs related to the value of IR. Panelists were asked to identify the critical relationships/alliances that should be fostered to advance the prioritized research and determine how the Society of Interventional Radiology and the Society of Interventional Radiology Foundation can further support these initiatives. Following presentations and discussions, it was determined that proving and quantifying how IR decreases the length of stay and prevents hospital admissions are the most salient, value-related research topics to pursue for the specialty.
- Published
- 2020
34. Society of Interventional Radiology Clinical Practice Guideline for Inferior Vena Cava Filters in the Treatment of Patients with Venous Thromboembolic Disease: Developed in collaboration with the American College of Cardiology, American College of Chest Physicians, American College of Surgeons Committee on Trauma, American Heart Association, Society for Vascular Surgery, and Society for Vascular Medicine
- Author
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John A, Kaufman, Geoffrey D, Barnes, Rabih A, Chaer, Joseph, Cuschieri, Robert T, Eberhardt, Matthew S, Johnson, William T, Kuo, Susan, Murin, Sheena, Patel, Anita, Rajasekhar, Ido, Weinberg, and David L, Gillespie
- Subjects
Prosthesis Implantation ,Consensus ,Treatment Outcome ,Vena Cava Filters ,Risk Factors ,Humans ,Patient Safety ,Venous Thromboembolism ,Radiology, Interventional ,Prosthesis Design - Abstract
To provide evidence-based recommendations on the use of inferior vena cava (IVC) filters in the treatment of patients with or at substantial risk of venous thromboembolic disease.A multidisciplinary expert panel developed key questions to address in the guideline, and a systematic review of the literature was conducted. Evidence was graded based on a standard methodology, which was used to inform the development of recommendations.The systematic review identified a total of 34 studies that provided the evidence base for the guideline. The expert panel agreed on 18 recommendations.Although the evidence on the use of IVC filters in patients with or at risk of venous thromboembolic disease varies in strength and quality, the panel provides recommendations for the use of IVC filters in a variety of clinical scenarios. Additional research is needed to optimize care for this patient population.
- Published
- 2020
35. Diagnostic and Interventional Radiology Case Volume and Education in the Age of Pandemics: Impact Analysis and Potential Future Directions
- Author
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Ningcheng Li, John A. Kaufman, James C. Anderson, Khashayar Farsad, Aly Aly Elbarbary, A. Gabr, and Ryan C. Schenning
- Subjects
medicine.medical_specialty ,Canada ,Quality management ,Coronavirus disease 2019 (COVID-19) ,Pneumonia, Viral ,Radiology, Interventional ,Article ,030218 nuclear medicine & medical imaging ,Education ,03 medical and health sciences ,Virtual training ,Betacoronavirus ,0302 clinical medicine ,COVID-19 Testing ,Artificial Intelligence ,Pandemic ,Medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Medical physics ,Pandemics ,Neuroradiology ,COVID ,Case volume ,medicine.diagnostic_test ,IR/DR Residency ,business.industry ,Clinical Laboratory Techniques ,SARS-CoV-2 ,COVID-19 ,Internship and Residency ,Interventional radiology ,Quality Improvement ,Test (assessment) ,Radiology Nuclear Medicine and imaging ,030220 oncology & carcinogenesis ,Female ,Augment ,business ,Coronavirus Infections - Abstract
Rationale and Objectives To assess the immediate impact of the COVID-19 pandemic on Diagnostic and Interventional Radiology education, and to propose measures to preserve and augment trainee education during future crises. Materials and Methods Diagnostic Radiology (DR) studies and Interventional Radiology (IR) procedures at a single tertiary-care teaching institution between 2015 and 2020 were reviewed. DR was divided by section: body, cardiothoracic, musculoskeletal (MSK), neuroradiology, nuclear medicine, pediatrics, and women's imaging. IR was divided by procedural types: arterial, venous, lymphatic, core, neuro, pediatrics, dialysis, cancer embolization or ablation, noncancer embolization, portal hypertension, and miscellaneous. Impact on didactic education was also assessed. ANOVA, t test, and multiple comparison correction were used for analysis. Results DR and IR caseloads decreased significantly in April 2020 compared to April of the prior 5 years (both p < 0.0001). Case volumes were reduced in body (49.2%, p < 0.01), MSK (54.2%, p < 0.05), neuro (39.3%, p < 0.05), and women's imaging (75.5%, p < 0.05) in DR, and in arterial (62.6%, p < 0.01), neuro IR (57.6%, p < 0.01) and core IR (42.6%, p < 0.05) in IR. IR trainee average caseload in April 2020 decreased 51.9% compared to April of the prior 5 years (p < 0.01). Utilization of online learning increased in April. Trainees saw significant increases in overall DR didactics (31.3%, p = 0.02) and no reduction in IR didactics, all online. Twelve major national and international DR and IR meetings were canceled or postponed between March and July. Conclusion Decreases in caseload and widespread cancellation of conferences have had significant impact on DR/IR training during COVID-19 restrictions. Remote learning technologies with annotated case recording, boards-style case reviews, procedural simulation and narrated live cases as well as online lectures and virtual journal clubs increased during this time. Whether remote learning can mitigate lost opportunities from in-person interactions remains uncertain. Optimizing these strategies will be important for potential future restricted learning paradigms and can also be extrapolated to augment trainee education during unrestricted times.
- Published
- 2020
36. Broadening Stakeholder Perspectives on Maintenance of Certification Research
- Author
-
Toby A. Gordon, John A. Kaufman, and Donald J. Flemming
- Subjects
Knowledge management ,Certification ,business.industry ,Stakeholder ,General Medicine ,United States ,Maintenance of Certification ,Radiography ,Radiologists ,Medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,business ,Radiology - Published
- 2020
37. Exercise Intolerance in Patients with Chronic Iliocaval Venous Occlusion: Initial Experience with Noninvasive Exercise Testing before and after Intervention
- Author
-
Jessica Ballin, Ivan P. Dimov, Alex Kanable, Kerry S. Kuehl, and John A. Kaufman
- Subjects
Male ,medicine.medical_specialty ,Time Factors ,Response to therapy ,Vena Cava, Inferior ,Exercise intolerance ,Iliac Vein ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,0302 clinical medicine ,Oxygen Consumption ,Predictive Value of Tests ,Intervention (counseling) ,Internal medicine ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,In patient ,Aged ,Retrospective Studies ,Venous Thrombosis ,Exercise Tolerance ,Venous occlusion ,business.industry ,Endovascular Procedures ,VO2 max ,Cardiorespiratory fitness ,Recovery of Function ,Middle Aged ,medicine.disease ,Thrombosis ,Treatment Outcome ,Cardiorespiratory Fitness ,030220 oncology & carcinogenesis ,Chronic Disease ,Cardiology ,Exercise Test ,Stents ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business - Abstract
Patients with chronic iliocaval occlusions after thrombosis often present with exercise intolerance, which improves after venous reconstruction. Three male patients with chronic iliocaval occlusions underwent a cardiorespiratory fitness test before and 2.5-11 months after venous reconstruction using stents. After the intervention, average absolute oxygen consumption increased by 29.5%, maximal oxygen consumption relative to body weight increased by 38.7%, total work at maximum exercise increased by 74.4%, and exercise time increased by 18.7%. The cardiorespiratory fitness test may be a useful noninvasive tool to objectively evaluate exercise intolerance due to chronic venous occlusions and response to therapy.
- Published
- 2020
38. Quality of life after pharmacomechanical catheter-directed thrombolysis for proximal deep vein thrombosis
- Author
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Susan R. Kahn, Jim A. Julian, Clive Kearon, Chu-Shu Gu, David J. Cohen, Elizabeth A. Magnuson, Anthony J. Comerota, Samuel Z. Goldhaber, Michael R. Jaff, Mahmood K. Razavi, Andrei L. Kindzelski, Joseph R. Schneider, Paul Kim, Rabih Chaer, Akhilesh K. Sista, Robert B. McLafferty, John A. Kaufman, Brandt C. Wible, Morey Blinder, Suresh Vedantham, Michael Sichlau, Athanasios Vlahos, Steven Smith, Quinn Thalheimer, Nisha Singh, Rekha Harting, John Gocke, Scott Guth, Neel Shah, Paul Brady, Marvin Schatz, Mindy Horrow, Peyman Markazi, Leli Forouzan, Terence A.S. Matalon, David Hertzog, Swapna Goday, Margaret Kennedy, Robert Kaplan, Thomas Campbell, Jamie Hartman, Elmer Nahum, Arvind Venkat, Venkataramu Krishnamurthy, John Rectenwald, Peter Henke, Jonathan Eliason, Jonathon Willatt, Guillermo Escobar, Shaun Samuels, Barry Katzen, James Benenati, Alex Powell, Constantino Pena, Howard Wallach, Ripal Gandhi, Joseph Schneider, Stanley Kim, Farrah Hashemi, Joseph Boyle, Nilesh Patel, Michael Verta, Daniel Leung, Marc Garcia, Phillip Blatt, Jamil Khatri, Dave Epstein, Randall Ryan, Tom Sweeny, Michael Stillabower, George Kimbiris, Tuhina Raman, Paul Sierzenski, Lelia Getto, Michael Dignazio, Mark Horvath, Heather Gornik, John Bartholomew, Mehdi Shishehbor, Frank Peacock, Douglas Joseph, Soo Hyum Kim, Natalia Fendrikova Mahlay, Daniel Clair, Sean Lyden, Baljendra Kapoor, Gordon McLennon, Gregory Pierce, James Newman, James Spain, Amanjiit Gill, Aaron Hamilton, Anthony Rizzo, Woosup Park, Alan Dietzek, Ira Galin, Dahlia Plummer, Richard Hsu, Patrick Broderick, Andrew Keller, Sameer Sayeed, Dennis Slater, Herb Lustberg, Jan Akus, Robert Sidman, Mandeep Dhami, Phillip Kohanski, Anca Bulgaru, Renuka Dulala, James Burch, Dinesh Kapur, Jie Yang, Mark Ranson, Alan Wladis, David Varnagy, Tarek Mekhail, Robert Winter, Manuel Perez-Izquierdo, Stephen Motew, Robin Royd-Kranis, Raymond Workman, Scott Kribbs, Gerald Hogsette, Phillip Moore, Bradley Thomason, William Means, Richard Bonsall, John Stewart, Daniel Golwya, Ezana Azene, Wayne Bottner, William Bishop, Dave Clayton, Lincoln Gundersen, Jody Riherd, Irina Shakhnovich, Kurt Ziegelbein, Thomas Chang, Karun Sharma, Sandra Allison, Fil Banovac, Emil Cohen, Brendan Furlong, Craig Kessler, Mike McCullough, Jim Spies, Judith Lin, Scott Kaatz, Todd Getzen, Joseph Miller, Scott Schwartz, Loay Kabbani, David McVinnie, John Rundback, Joseph Manno, Richard Schwab, Randolph Cole, Kevin Herman, David Singh, Ravit Barkama, Amish Patel, Anthony Comerota, John Pigott, Andrew Seiwert, Ralph Whalen, Todd Russell, Zakaria Assi, Sahira Kazanjian, Jonathan Yobbagy, Brian Kaminski, Allan Kaufman, Garett Begeman, Robert DiSalle, Subash Thakur, Marc Jacquet, Thomas Dykes, Joseph Gerding, Christopher Baker, Mark Debiasto, Derek Mittleider, George Higgins, Steven Amberson, Roger Pezzuti, Thomas Gallagher, Robert Schainfeld, Stephan Wicky, Sanjeeva Kalva, Gregory Walker, Gloria Salazar, Benjamin Pomerantz, Virenda Patel, Christopher Kabrhel, Shams Iqbal, Suvranu Gangull, Rahmi Oklu, Scott Brannan, Sanjay Misra, Haraldur Bjarnason, Aneel Ashrani, Michael Caccavale, Chad Fleming, Jeremy Friese, John Heit, Manju Kalra, Thanila Macedo, Robert McBane, Michael McKusick, Andrew Stockland, David Woodrum, Waldemar Wysokinski, Adarsh Verma, Andrew Davis, Jerry Chung, David Nicker, Brian Anderson, Robert Stein, Michael Weiss, Parag Patel, William Rilling, Sean Tutton, Robert Hieb, Eric Hohenwalter, M. Riccardo Colella, James Gosset, Sarah White, Brian Lewis, Kellie Brown, Peter Rossi, Gary Seabrook, Marcelo Guimaraes, J. Bayne Selby, William McGary, Christopher Hannegan, Jacob Robison, Thomas Brothers, Bruce Elliott, Nitin Garg, M. Bret Anderson, Renan Uflacker, Claudio Schonholz, Laurence Raney, Charles Greenberg, John Kaufman, Frederick Keller, Kenneth Kolbeck, Gregory Landry, Erica Mitchell, Robert Barton, Thomas DeLoughery, Norman Kalbfleisch, Renee Minjarez, Paul Lakin, Timothy Liem, Gregory Moneta, Khashayar Farsad, Ross Fleischman, Loren French, Vasco Marques, Yasir Al−Hassani, Asad Sawar, Frank Taylor, Rajul Patel, Rahul Malhotra, Farah Hashemi, Marvin Padnick, Melissa Gurley, Fred Cucher, Ronald Sterrenberg, G. Reshmaal Deepthi, Gomes Cumaranatunge, Sumit Bhatla, Darick Jacobs, Eric Dolen, Pablo Gamboa, L. Mark Dean, Thomas Davis, John Lippert, Sanjeev Khanna, Brian Schirf, Jeffrey Silber, Donald Wood, J. Kevin McGraw, Lucy LaPerna, Paul Willette, Timothy Murphy, Joselyn Cerezo, Rajoo Dhangana, Sun Ho Ahn, Gregory Dubel, Richard Haas, Bryan Jay, Ethan Prince, Gregory Soares, James Klinger, Robert Lambiase, Gregory Jay, Robert Tubbs, Michael Beland, Chris Hampson, Ryan O'Hara, Chad Thompson, Aaron Frodsham, Fenwick Gardiner, Abdel Jaffan, Lawrence Keating, Abdul Zafar, Radica Alicic, Rodney Raabe, Jayson Brower, David McClellan, Thomas Pellow, Christopher Zylak, Joseph Davis, M. Kathleen Reilly, Kenneth Symington, Camerson Seibold, Ryan Nachreiner, Daniel Murray, Stephen Murray, Sandeep Saha, Gregory Luna, Kim Hodgson, Robert McLafferty, Douglas Hood, Colleen Moore, David Griffen, Darren Hurst, David Lubbers, Daniel Kim, Brent Warren, Jeremy Engel, D.P. Suresh, Eric VanderWoude, Rahul Razdan, Mark Hutchins, Terry Rounsborg, Madhu Midathada, Daniel Moravec, Joni Tilford, Joni Beckman, Mahmood Razavi, Kurt Openshaw, D. Preston Flanigan, Christopher Loh, Howard Dorne, Michael Chan, Jamie Thomas, Justin Psaila, Michael Ringold, Jay Fisher, Any Lipcomb, Timothy Oskin, Brandt Wible, Brendan Coleman, David Elliott, Gary Gaddis, C. Doug Cochran, Kannan Natarajan, Stewart Bick, Jeffrey Cooke, Ann Hedderman, Anne Greist, Lorrie Miller, Brandon Martinez, Vincent Flanders, Mark Underhill, Lawrence Hofmann, Daniel Sze, William Kuo, John Louie, Gloria Hwang, David Hovsepian, Nishita Kothary, Caroline Berube, Donald Schreiber, Brooke Jeffrey, Jonathan Schor, Jonathan Deitch, Kuldeep Singh, Barry Hahn, Brahim Ardolic, Shilip Gupta, Riyaz Bashir, Angara Koneti Rao, Manish Garg, Pravin Patil, Chad Zack, Gary Cohen, Frank Schmieder, Valdimir Lakhter, David Sacks, Robert Guay, Mark Scott, Karekin Cunningham, Adam Sigal, Terrence Cescon, Nick Leasure, Thiruvenkatasamy Dhurairaj, Patrick Muck, Kurt Knochel, Joann Lohr, Jose Barreau, Matthew Recht, Jayapandia Bhaskaran, Ranga Brahmamdam, David Draper, Apurva Mehta, James Maher, Melhem Sharafuddin, Steven Lentz, Andrew Nugent, William Sharp, Timothy Kresowik, Rachel Nicholson, Shiliang Sun, Fadi Youness, Luigi Pascarella, Charles Ray, Martha-Gracia Knuttinen, James Bui, Ron Gaba, Valerie Dobiesz, Ejaz Shamim, Sangeetha Nimmagadda, David Peace, Aarti Zain, Alison Palumto, Ziv Haskal, Jon Mark Hirshon, Howard Richard, Avelino Verceles, Jade Wong-You-Chong, Bertrand Othee, Rahul Patel, Bogdan Iliescu, David Williams, Joseph Gemmete, Wojciech Cwikiel, Kyung Cho, James Schields, Ranjith Vellody, Paula Novelli, Narasimham Dasika, Thomas Wakefield, Jeffrey Desmond, James Froehlich, Minhajuddin Khaja, David Hunter, Jafar Golzarian, Erik Cressman, Yvonne Dotta, Nate Schmiechen, John Marek, David Garcia, Isaac Tawil, Mark Langsfeld, Stephan Moll, Matthew Mauro, Joseph Stavas, Charles Burke, Robert Dixon, Hyeon Yu, Blair Keagy, Kyuny Kim, Raj Kasthuri, Nigel Key, Michael Makaroun, Robert Rhee, Jae−Sung Cho, Donald Baril, Luke Marone, Margaret Hseih, Kristian Feterik, Roy Smith, Geetha Jeyabalan, Jennifer Rogers, Russel Vinik, Dan Kinikini, Larry Kraiss, Michelle Mueller, Robert Pendleton, Matthew Rondina, Mark Sarfati, Nathan Wanner, Stacy Johnson, Christy Hopkins, Daniel Ihnat, John Angle, Alan Matsumoto, Nancy Harthun, Ulku Turba, Wael Saad, Brian Uthlaut, Srikant Nannapaneni, David Ling, Saher Sabri, John Kern, B. Gail Macik, George Hoke, Auh Wahn Park, James Stone, Benjamin Sneed, Scott Syverud, Kelly Davidson, Aditya Sharma, Luke Wilkins, Carl Black, Mark Asay, Daniel Hatch, Robert Smilanich, Craig Patten, S. Douglas Brown, Ryan Nielsen, William Alward, John Collins, Matthew Nokes, Randolph Geary, Matthew Edwards, Christopher Godshall, Pavel Levy, Ronald Winokur, Akhilesh Sista, David Madoff, Kyungmouk Lee, Bradley Pua, Maria DeSancho, Raffaele Milizia, Jing Gao, Gordon McLean, Sanualah Khalid, Larry Lewis, Nael Saad, Mark Thoelke, Robert Pallow, Seth Klein, Gregorio Sicard, Heather L. Gornik, Jim Julian, Stephen Kee, Lawrence Lewis, Elizabeth Magnuson, and Timothy P. Murphy
- Subjects
Adult ,Male ,medicine.medical_specialty ,Time Factors ,Mechanical Thrombolysis ,medicine.medical_treatment ,Catheter directed thrombolysis ,030204 cardiovascular system & hematology ,Iliac Vein ,Article ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Fibrinolytic Agents ,Quality of life ,Randomized controlled trial ,law ,Surveys and Questionnaires ,Internal medicine ,Epidemiology ,Medicine ,Humans ,In patient ,Thrombolytic Therapy ,030212 general & internal medicine ,cardiovascular diseases ,Thrombus ,Venous Thrombosis ,business.industry ,Thrombolysis ,Femoral Vein ,Middle Aged ,medicine.disease ,United States ,humanities ,3. Good health ,Venous thrombosis ,Treatment Outcome ,Quality of Life ,Female ,Surgery ,Cardiology and Cardiovascular Medicine ,business - Abstract
After deep venous thrombosis (DVT), many patients have impaired quality of life (QOL). We aimed to assess whether pharmacomechanical catheter-directed thrombolysis (PCDT) improves short-term or long-term QOL in patients with proximal DVT and whether QOL is related to extent of DVT.The Acute Venous Thrombosis: Thrombus Removal with Adjunctive Catheter-Directed Thrombolysis (ATTRACT) trial was an assessor-blinded randomized trial that compared PCDT with no PCDT in patients with DVT of the femoral, common femoral, or iliac veins. QOL was assessed at baseline and 1 month, 6 months, 12 months, 18 months, and 24 months using the Venous Insufficiency Epidemiological and Economic Study on Quality of Life/Symptoms (VEINES-QOL/Sym) disease-specific QOL measure and the 36-Item Short Form Health Survey (SF-36) physical component summary (PCS) and mental component summary general QOL measures. Change in QOL scores from baseline to assessment time were compared in the PCDT and no PCDT treatment groups overall and in the iliofemoral DVT and femoral-popliteal DVT subgroups.Of 692 ATTRACT patients, 691 were analyzed (mean age, 53 years; 62% male; 57% iliofemoral DVT). VEINES-QOL change scores were greater (ie, better) in PCDT vs no PCDT from baseline to 1 month (difference, 5.7; P = .0006) and from baseline to 6 months (5.1; P = .0029) but not for other intervals. SF-36 PCS change scores were greater in PCDT vs no PCDT from baseline to 1 month (difference, 2.4; P = .01) but not for other intervals. Among iliofemoral DVT patients, VEINES-QOL change scores from baseline to all assessments were greater in the PCDT vs no PCDT group; this was statistically significant in the intention-to-treat analysis at 1 month (difference, 10.0; P .0001) and 6 months (8.8; P .0001) and in the per-protocol analysis at 18 months (difference, 5.8; P = .0086) and 24 months (difference, 6.6; P = .0067). SF-36 PCS change scores were greater in PCDT vs no PCDT from baseline to 1 month (difference, 3.2; P = .0010) but not for other intervals. In contrast, in femoral-popliteal DVT patients, change scores from baseline to all assessments were similar in the PCDT and no PCDT groups.Among patients with proximal DVT, PCDT leads to greater improvement in disease-specific QOL than no PCDT at 1 month and 6 months but not later. In patients with iliofemoral DVT, PCDT led to greater improvement in disease-specific QOL during 24 months.
- Published
- 2020
39. Current Data and Trends on Inferior Vena Cava Filter Placement and Retrieval
- Author
-
John A. Kaufman
- Subjects
Vena cava filters ,medicine.medical_specialty ,Percutaneous ,medicine.diagnostic_test ,Interventional cardiology ,business.industry ,Femoral vein ,Inferior vena cava filter ,Interventional radiology ,medicine.disease ,Inferior vena cava ,Surgery ,Pulmonary embolism ,medicine.vein ,cardiovascular system ,medicine ,cardiovascular diseases ,business - Abstract
Vena cava filters are important yet controversial devices utilized to prevent pulmonary embolism (PE). Originally designed to replace more invasive inferior vena cava (IVC) interruption techniques (such as plication or clip placement), the first filters still required surgical cutdown on the jugular or femoral vein for insertion [1]. Over time, percutaneous placement became the norm, with a simultaneous increase in the overall number of filter insertions and dissemination of the procedure to interventional radiology and interventional cardiology. In the late 1990s, nonpermanent vena cava filters became commercially available, and filter utilization increased even more rapidly [2]. With more widespread use came increased awareness of complications associated with these devices [3]. The current vena cava filter environment is one of doubt and uncertainty, which is reflected in the decreasing utilization [4, 5]. Nevertheless, vena cava filters remain clinically important tools for protecting patients at risk of PE who cannot be managed with conventional strategies (anticoagulation) [6].
- Published
- 2020
40. Principles of Vascular Access
- Author
-
John A. Kaufman and Claire Kaufman
- Subjects
medicine.medical_specialty ,Vascular anatomy ,business.industry ,Intervention (counseling) ,Hemostasis ,medicine ,Vascular access ,Intensive care medicine ,business ,Clinical scenario ,Selection (genetic algorithm) - Abstract
Invasive vascular diagnosis remains an essential competency in image-guided intervention. The interventionalist’s responsibility includes providing preprocedural consultation and postprocedure care as well as performing the procedure. Vascular access selection requires consideration of the target vascular bed, devices that will be used, and the ability to obtain hemostasis at the end of the procedure. Imaging (the blood vessels injected and images collected) should match the vascular anatomy, physiology, and clinical scenario.
- Published
- 2020
41. Superior Vena Cava Occlusive Disease
- Author
-
Hasnain Hasham, John A. Kaufman, and Claire Kaufman
- Subjects
Orthopnea ,medicine.medical_specialty ,business.industry ,Occlusive disease ,Collateral circulation ,Mediastinal fibrosis ,Blurred vision ,Superior vena cava ,Etiology ,Medicine ,Radiology ,medicine.symptom ,Presentation (obstetrics) ,business - Abstract
Superior vena cava (SVC) syndrome is a clinical entity with varied presentation and severity caused by obstruction of the central veins and superior vena cava. This can result from either malignant or benign etiologies. Benign etiologies include catheters or pacemakers, mediastinal fibrosis, hypercoagulability, and postsurgical or postradiation changes. Although historically malignant SVC obstruction has been much more common, there has been an increase in prevalence of benign SVC obstruction associated with the increasing use of intravenous devices. The symptoms and severity of SVC syndrome vary with the onset and severity of obstruction. In patients with slow progressive onset of obstruction, collateral circulation can develop to varied degrees over the chest wall and periscapular region, which may decrease the severity of patient symptoms. However, acute SVC syndrome is considered a medical emergency and can be life-threatening. Clinical symptoms include headache exacerbated by changes in position, disturbances in consciousness, facial and neck edema, pain in the face and neck, blurred vision, retroorbital pressure, hoarseness, and orthopnea.
- Published
- 2020
42. Antiplatelet Therapy is Associated with Stent Patency After Iliocaval Venous Stenting
- Author
-
Kenneth J. Kolbeck, Keng Wei Liang, Yasufumi Ohuchi, Robert E. Barton, Masahiro Horikawa, Masayuki Endo, John A. Kaufman, Younes Jahangiri, Khashayar Farsad, and Ryan C. Schenning
- Subjects
Adult ,Diagnostic Imaging ,Male ,medicine.medical_specialty ,Adolescent ,medicine.medical_treatment ,Vena Cava, Inferior ,Iliac Vein ,030204 cardiovascular system & hematology ,030218 nuclear medicine & medical imaging ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,Risk Factors ,Occlusion ,Antithrombotic ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,cardiovascular diseases ,Vascular Patency ,Aged ,Proportional Hazards Models ,Retrospective Studies ,Venous Thrombosis ,Aspirin ,business.industry ,Warfarin ,Anticoagulants ,Stent ,Middle Aged ,equipment and supplies ,medicine.disease ,Clopidogrel ,Thrombosis ,Surgery ,Stenosis ,surgical procedures, operative ,Drug Therapy, Combination ,Equipment Failure ,Female ,Stents ,Cardiology and Cardiovascular Medicine ,business ,Platelet Aggregation Inhibitors ,medicine.drug - Abstract
To examine the effectiveness of antithrombotic medications to prevent venous stent malfunction for iliocaval occlusive disease. A retrospective analysis was performed on 62 patients who underwent technically successful endovascular iliocaval stent placement between May 2008 and April 2017. Clinical records were reviewed for demographic information, procedure details, post-stenting antithrombotic prophylaxis and stent patency on follow-up. Stent malfunction was defined as > 50% stenosis or occlusion at follow-up. Risk factors for stent malfunction were assessed with univariable and multiple Cox proportional hazard models. The median follow-up period was 11.6 months (range 0.1–76.4). Overall primary and secondary cumulative patency rates at 12 months were 70.0% and 92.4%, respectively. After stent placement, 97% of patients received anticoagulation with warfarin, enoxaparin or a factor Xa inhibitor. In addition, 61% received antiplatelet prophylaxis with aspirin, clopidogrel or a combination. In multiple Cox regression analysis, post-stenting antiplatelet use remained significantly associated with primary stent patency (HR = 0.28, P = 0.022). After iliocaval venous stenting, stent patency was best predicted by concomitant antiplatelet and anticoagulation therapy rather than anticoagulation alone. This novel finding warrants further research underlying mechanisms leading to venous stent thrombosis, and has implications for optimal medical management after venous stenting.
- Published
- 2018
43. Evaluation and Management of Intermediate and High-Risk Pulmonary Embolism
- Author
-
Bishoy Zakhary, Ramsey Al-Hakim, Ningcheng Li, John A. Kaufman, Khashayar Farsad, Ryan C. Schenning, Stephanie Nonas, and Brandon C. Maughan
- Subjects
medicine.medical_specialty ,medicine.medical_treatment ,Embolectomy ,Risk Assessment ,030218 nuclear medicine & medical imaging ,Diagnosis, Differential ,03 medical and health sciences ,0302 clinical medicine ,Fibrinolytic Agents ,Internal medicine ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Thrombolytic Therapy ,Thrombus ,Evidence-Based Medicine ,business.industry ,Treatment options ,General Medicine ,Thrombolysis ,medicine.disease ,Right ventricular dysfunction ,Pulmonary embolism ,030220 oncology & carcinogenesis ,Practice Guidelines as Topic ,Cardiology ,Systemic anticoagulation ,business ,Pulmonary Embolism ,Hemodynamic instability - Abstract
OBJECTIVE. The evidence regarding pulmonary embolism treatment has greatly advanced over the past 10 years, particularly in patients with right ventricular dysfunction or hemodynamic instability. Treatment options include systemic anticoagulation, systemic thrombolysis, catheter-assisted thrombus removal (mechanical with or without catheter-directed thrombolysis), and surgical embolectomy. CONCLUSION. This article will review the data available for treatment options and summarize the evidence-based guidelines on treatment of intermediate- or high-risk pulmonary embolism.
- Published
- 2019
44. Long-Term Toxicity after Transarterial Radioembolization with Yttrium-90 Using Resin Microspheres for Neuroendocrine Tumor Liver Metastases
- Author
-
Ryan C. Schenning, Y. Tomozawa, Younes Jahangiri, Khashayar Farsad, John A. Kaufman, Priya Pathak, and Kenneth J. Kolbeck
- Subjects
Adult ,Male ,medicine.medical_specialty ,Tare weight ,medicine.medical_treatment ,Neuroendocrine tumors ,Radiography, Interventional ,Gastroenterology ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,Ascites ,medicine ,Humans ,Yttrium Radioisotopes ,Radiology, Nuclear Medicine and imaging ,Embolization ,Survival rate ,Aged ,Retrospective Studies ,Aged, 80 and over ,business.industry ,Liver Neoplasms ,Retrospective cohort study ,Middle Aged ,medicine.disease ,Embolization, Therapeutic ,Microspheres ,Survival Rate ,Neuroendocrine Tumors ,Treatment Outcome ,030220 oncology & carcinogenesis ,Toxicity ,Portal hypertension ,Female ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business - Abstract
Purpose To evaluate long-term effects of yttrium-90 (90Y) transarterial radioembolization (TARE) for unresectable hepatic metastases of neuroendocrine tumors (NETs). Materials and Methods Retrospective analysis of 93 patients (47 women, 46 men; mean age 59 y) who underwent resin-based 90Y TARE was performed. Variables associated with overall survival were analyzed using univariate and multivariate models. Changes in serologic values and imaging characteristics were assessed with long-term follow-up. Results Unilobar TARE was performed in 48 patients, and staged bilobar TARE was performed in 45 patients. In multivariate analysis, ascites (P = .002) and extrahepatic metastases (P = .038) at baseline were associated with poor survival. Among 52 patients who had > 1 year of follow-up, significant increases in alkaline phosphatase, aspartate aminotransferase, and alanine aminotransferase were observed; however, only 4 patients experienced grade 3 serologic toxicities. Imaging signs of cirrhosis-like morphology and portal hypertension were observed in 15 of 52 patients, more frequently in patients treated with bilobar TARE compared with unilobar TARE. Patients treated with bilobar TARE exhibited significantly increased hepatobiliary enzymes and decreased platelet count. Sustained increases in liver enzymes were observed in patients with > 4 years of follow-up. No radioembolization-related liver failure or grade 4 toxicity was observed. Conclusions 90Y radioembolization using resin microspheres demonstrated a high safety profile for NET liver metastases, with low-grade, although sustained, long-term liver toxicity evident > 4 years after treatment. Bilobar treatment suggested a trend for treatment-related portal hypertension. Ongoing research will help define parameters for optimizing durable safety and efficacy of radioembolization in this setting.
- Published
- 2018
45. Inferior Vena Cava Filters
- Author
-
John A. Kaufman
- Subjects
medicine.medical_specialty ,business.industry ,Ivc filter ,Inferior vena cava filter ,030204 cardiovascular system & hematology ,Inferior vena cava ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,0302 clinical medicine ,medicine.vein ,cardiovascular system ,medicine ,cardiovascular diseases ,Radiology ,Current (fluid) ,Cardiology and Cardiovascular Medicine ,business - Abstract
The inferior vena cava filter clinical environment is notable for the degree of controversy, uncertainty, and fear associated with these devices by both physicians and the public. This article reviews some of the more important current issues with these devices as well as emerging and future trends.
- Published
- 2018
46. Another Step Toward Rational Application of Inferior Vena Cava Filters
- Author
-
John A. Kaufman
- Subjects
Inpatients ,Vena cava filters ,medicine.medical_specialty ,Vena Cava Filters ,business.industry ,Bariatric Surgery ,medicine.disease ,Inferior vena cava ,Pulmonary embolism ,Treatment Outcome ,medicine.vein ,medicine ,Humans ,Radiology ,Pulmonary Embolism ,Cardiology and Cardiovascular Medicine ,business - Published
- 2019
47. The American Board of Radiology B. Leonard Holman Research Pathway to Initial Certification: Opportunities Lost for Diagnostic Radiology
- Author
-
Kaled M. Alektiar, John A. Kaufman, Lane F. Donnelly, and Paul E. Wallner
- Subjects
medicine.medical_specialty ,Certification ,business.industry ,General Medicine ,United States ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,0302 clinical medicine ,Specialty Boards ,030220 oncology & carcinogenesis ,Radiation oncology ,Radiation Oncology ,Medicine ,Radiology, Nuclear Medicine and imaging ,Radiology ,business - Abstract
In 1998, the American Board of Radiology introduced the B. Leonard Holman Research Pathway (HRP) to initial certification for trainees in diagnostic radiology (DR) and radiation oncology (RO) motivated to pursue research-oriented careers in academic DR and RO.The HRP Committee anticipated that there would be a relatively even distribution between DR and RO participants, but with 18 years of experience that has not been the case. This article focuses on the HRP and DR.
- Published
- 2019
48. Venous Stenosis Animal Model Utilizing Endovenous Radiofrequency Ablation
- Author
-
Ramsey Al-Hakim, Younes Jahangiri, Barry T. Uchida, John A. Kaufman, and Khashayar Farsad
- Subjects
Radiofrequency Ablation ,medicine.medical_specialty ,Radiofrequency ablation ,business.industry ,Sus scrofa ,Constriction, Pathologic ,Phlebography ,Iliac Vein ,law.invention ,Venous stenosis ,Disease Models, Animal ,Animal model ,law ,medicine ,Animals ,Radiology, Nuclear Medicine and imaging ,Vascular Diseases ,Radiology ,Cardiology and Cardiovascular Medicine ,business ,Angioplasty, Balloon - Published
- 2019
49. Risk factors for stent graft thrombosis after transjugular intrahepatic portosystemic shunt creation
- Author
-
Younes Jahangiri, Ryan C. Schenning, D. Dominik Prosser, Khashayar Farsad, John A. Kaufman, Anantnoor Brar, Lei Li, Timothy Kerrigan, and Johnathan Righetti
- Subjects
medicine.medical_specialty ,medicine.diagnostic_test ,business.industry ,Proportional hazards model ,medicine.medical_treatment ,Hazard ratio ,Stent ,medicine.disease ,Thrombosis ,030218 nuclear medicine & medical imaging ,Surgery ,03 medical and health sciences ,0302 clinical medicine ,Medicine ,Portal hypertension ,Original Article ,030211 gastroenterology & hepatology ,Liver function ,Cardiology and Cardiovascular Medicine ,business ,Liver function tests ,Transjugular intrahepatic portosystemic shunt - Abstract
To identify risk factors of stent graft thrombosis after transjugular intrahepatic portosystemic shunt (TIPS) creation.Patients who underwent TIPS creation between June 2003 and January 2016 and with follow-up assessing stent graft patency were included (n=174). Baseline comorbidities, liver function, procedural details and follow-up liver function tests were analyzed in association with hazards of thrombosis on follow-up. Competing risk cox regression models were used considering liver transplant after TIPS creation as the competing risk variable.One-, 2- and 5-year primary patency rates were 94.1%, 91.7% and 78.2%, respectively. Patient age [sub-hazard ratio (sHR): 1.13; P=0.001], body mass index (BMI)30 (sHR: 33.08; P=0.008) and a higher post-TIPS portosystemic pressure gradient (sHR: 1.14; P=0.023) were significantly associated with TIPS thrombosis in multivariate analysis. A higher rate of TIPS thrombosis was observed in those for whom the procedure was clinically unsuccessful (P=0.014). A significant increase in incidence of thrombosis was noted with increasing tertiles of post-TIPS portosystemic gradients (P value for trend=0.017).Older age, lower BMI and higher post-TIPS portosystemic gradients were associated with higher hazards of shunt thrombosis after TIPS creation using stent grafts. Higher rates of shunt thrombosis were seen in patients for whom TIPS creation was clinically unsuccessful. The association between TIPS thrombosis and higher post-TIPS portosystemic gradients may indicate impaired flow through the shunt, a finding which may be technical or anatomic in nature and should be assessed before procedure completion.
- Published
- 2017
50. IR Trainees and Their Value in Academic Medical Centers
- Author
-
John A. Kaufman
- Subjects
Academic Medical Centers ,medicine.medical_specialty ,business.industry ,MEDLINE ,Internship and Residency ,Workload ,Radiology, Interventional ,Radiography, Interventional ,Education, Medical, Graduate ,Radiologists ,Humans ,Medicine ,Radiology, Nuclear Medicine and imaging ,Medical physics ,Cardiology and Cardiovascular Medicine ,business ,Value (mathematics) - Published
- 2021
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