Author: "Michel S" / Topic: humans - Searchworks@Jio Institute Digital Library Search Results

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1. Chronic Traumatic Encephalopathy Presenting as Alzheimer’s Disease in a Retired Soccer Player

Author: Grinberg, Lea T, Anghinah, Renato, Nascimento, Camila Fernandes, Amaro, Edson, Leite, Renata P, da Graça M. Martin, Maria, Naslavsky, Michel S, Takada, Leonel T, Filho, Wilson Jacob, Pasqualucci, Carlos A, and Nitrini, Ricardo
Subjects: Biomedical and Clinical Sciences, Biological Psychology, Clinical Sciences, Neurosciences, Psychology, Acquired Cognitive Impairment, Brain Disorders, Neurodegenerative, Alzheimer's Disease including Alzheimer's Disease Related Dementias (AD/ADRD), Aging, Dementia, Alzheimer's Disease, Traumatic Head and Spine Injury, Physical Injury - Accidents and Adverse Effects, Traumatic Brain Injury (TBI), 2.1 Biological and endogenous factors, Neurological, Aged, 80 and over, Alzheimer Disease, Athletes, Athletic Injuries, Brain, Chronic Traumatic Encephalopathy, Diagnosis, Differential, Humans, Male, Sclerosis, Soccer, TDP-43 Proteinopathies, Injury (total) Accidents/Adverse Effects, Injury - Trauma - (Head and Spine), Injury - Traumatic brain injury, Alzheimer's disease, autopsy, chronic post-traumatic encephalopathy, dementia, humans, soccer, Alzheimer’s disease, Cognitive Sciences, Neurology & Neurosurgery, Clinical sciences, Biological psychology
Abstract: The relationship between soccer and chronic traumatic encephalopathy (CTE) is not well established. We report clinicopathological correlations in an 83-year-old retired center-back soccer player, with no history of concussion, manifesting typical Alzheimer-type dementia. Examination revealed mixed pathology including widespread CTE, moderate Alzheimer's disease, hippocampal sclerosis, and TDP-43 proteinopathy. This case adds to a few CTE cases described in soccer players. Furthermore, it corroborates that CTE may present clinically as typical Alzheimer-type dementia. Further studies investigating the extent to which soccer is a risk for CTE are needed.
Published: 2016

2. Differential Ratings of Perceived Exertion

Author: Kobe C. Houtmeyers, Pieter Robberechts, Arne Jaspers, Shaun J. McLaren, Michel S. Brink, Jos Vanrenterghem, Jesse J. Davis, Werner F. Helsen, and SMART Movements (SMART)
Subjects: Male, SOCCER, perceived effort, Physical Exertion, Football, Physical Therapy, Sports Therapy and Rehabilitation, TRAINING LOAD, EXERCISE, self-report, Dyspnea, data, Humans, Orthopedics and Sports Medicine, team sports, Muscle, Skeletal
Abstract: Purpose: To examine the utility of differential ratings of perceived exertion (dRPE) for monitoring internal intensity and load in association football. Methods: Data were collected from 2 elite senior male football teams during 1 season (N = 55). External intensity and load data (duration × intensity) were collected during each training and match session using electronic performance and tracking systems. After each session, players rated their perceived breathlessness and leg-muscle exertion. Descriptive statistics were calculated to quantify how often players rated the 2 types of rating of perceived exertion differently (dRPEDIFF). In addition, the association between dRPEDIFF and external intensity and load was examined. First, the associations between single external variables and dRPEDIFF were analyzed using a mixed-effects logistic regression model. Second, the link between dRPEDIFF and session types with distinctive external profiles was examined using the Pearson chi-square test of independence. Results: On average, players rated their session perceived breathlessness and leg-muscle exertion differently in 22% of the sessions (range: 0%–64%). Confidence limits for the effect of single external variables on dRPEDIFF spanned across largely positive and negative values for all variables, indicating no conclusive findings. The analysis based on session type indicated that players differentiated more often in matches and intense training sessions, but there was no pattern in the direction of differentiation. Conclusions: The findings of this study provide no evidence supporting the utility of dRPE for monitoring internal intensity and load in football.
Published: 2022
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3. Nonergodicity in Load and Recovery

Author: Niklas D. Neumann, Nico W. Van Yperen, Jur J. Brauers, Wouter Frencken, Michel S. Brink, Koen A.P.M. Lemmink, Laurentius A. Meerhoff, Ruud J.R. Den Hartigh, Developmental Psychology, and SMART Movements (SMART)
Subjects: Male, football, Adolescent, Physical Exertion, Physical Therapy, Sports Therapy and Rehabilitation, TRAINING LOAD, dynamical systems, PREVENTION, STATISTICS, SPORTS, monitoring, intraindividual variability, Athletes, Soccer, INJURY, Humans, Orthopedics and Sports Medicine, resilience, Physical Conditioning, Human
Abstract: Purpose: The study of load and recovery gained significant interest in the last decades, given its important value in decreasing the likelihood of injuries and improving performance. So far, findings are typically reported on the group level, whereas practitioners are most often interested in applications at the individual level. Hence, the aim of the present research is to examine to what extent group-level statistics can be generalized to individual athletes, which is referred to as the “ergodicity issue.” Nonergodicity may have serious consequences for the way we should analyze, and work with, load and recovery measures in the sports field. Methods: The authors collected load, that is, rating of perceived exertion × training duration, and total quality of recovery data among youth male players of a professional football club. This data were collected daily across 2 seasons and analyzed on both the group and the individual level. Results: Group- and individual-level analysis resulted in different statistical outcomes, particularly with regard to load. Specifically, SDs within individuals were up to 7.63 times larger than SDs between individuals. In addition, at either level, the authors observed different correlations between load and recovery. Conclusions: The results suggest that the process of load and recovery in athletes is nonergodic, which has important implications for the sports field. Recommendations for training programs of individual athletes may be suboptimal, or even erroneous, when guided by group-level outcomes. The utilization of individual-level analysis is key to ensure the optimal balance of individual load and recovery.
Published: 2022

4. The nurse-coordinated cardiac care bridge transitional care programme: a randomised clinical trial

Author: Jill Dekker, Patricia Jepma, Sara Daliri, Lotte Verweij, Su-San Liem, Fatma Karapinar-Çarkit, Corine H.M. Latour, José L. Klunder, Wilma Scholte op Reimer, Bianca M. Buurman, Michel S. Terbraak, Ron J.G. Peters, Gerben ter Riet, Arno H.M. Moons, University of Zurich, Jepma, Patricia, Cardiology, VU University medical center, ACS - Atherosclerosis & ischemic syndromes, Nursing, Geriatrics, APH - Aging & Later Life, APH - Quality of Care, Pharmacy, APH - Personalized Medicine, ACS - Diabetes & metabolism, ACS - Heart failure & arrhythmias, Faculteit Gezondheid, Urban Vitality, Lectoraat Integratie van Psychiatrische en Somatische Zorg, and Lectoraat Acute Ouderenzorg
Subjects: medicine.medical_specialty, Aging, medicine.medical_treatment, Pharmacist, 11549 Institute of Implementation Science in Health Care, Aftercare, ageing/3, 610 Medicine & health, 2717 Geriatrics and Gerontology, ageing/5, 030204 cardiovascular system & hematology, Patient Readmission, AcademicSubjects/MED00280, 03 medical and health sciences, 0302 clinical medicine, 1302 Aging, Humans, Medicine, case management, Single-Blind Method, Transitional care, 030212 general & internal medicine, Disease management (health), Aged, Aged, 80 and over, Rehabilitation, business.industry, transitional care, General Medicine, Patient Discharge, Integrated care, Clinical trial, cardiac rehabilitation, ageing/17, disease management, Cardiac Care Facilities, Relative risk, cardiology, Emergency medicine, Geriatrics and Gerontology, business, Research Paper
Abstract: Background after hospitalisation for cardiac disease, older patients are at high risk of readmission and death. Objective the cardiac care bridge (CCB) transitional care programme evaluated the impact of combining case management, disease management and home-based cardiac rehabilitation (CR) on hospital readmission and mortality. Design single-blind, randomised clinical trial. Setting the trial was conducted in six hospitals in the Netherlands between June 2017 and March 2020. Community-based nurses and physical therapists continued care post-discharge. Subjects cardiac patients ≥ 70 years were eligible if they were at high risk of functional loss or if they had had an unplanned hospital admission in the previous 6 months. Methods the intervention group received a comprehensive geriatric assessment-based integrated care plan, a face-to-face handover with the community nurse before discharge and follow-up home visits. The community nurse collaborated with a pharmacist and participants received home-based CR from a physical therapist. The primary composite outcome was first all-cause unplanned readmission or mortality at 6 months. Results in total, 306 participants were included. Mean age was 82.4 (standard deviation 6.3), 58% had heart failure and 92% were acutely hospitalised. 67% of the intervention key-elements were delivered. The composite outcome incidence was 54.2% (83/153) in the intervention group and 47.7% (73/153) in the control group (risk differences 6.5% [95% confidence intervals, CI −4.7 to 18%], risk ratios 1.14 [95% CI 0.91–1.42], P = 0.253). The study was discontinued prematurely due to implementation activities in usual care. Conclusion in high-risk older cardiac patients, the CCB programme did not reduce hospital readmission or mortality within 6 months. Trial registration Netherlands Trial Register 6,316, https://www.trialregister.nl/trial/6169
Published: 2021
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5. Initial Invasive or Conservative Strategy for Stable Coronary Disease

Author: Maron D. J., Hochman J. S., Reynolds H. R., Bangalore S., O'Brien S. M., Boden W. E., Chaitman B. R., Senior R., Lopez-Sendon J., Alexander K. P., Lopes R. D., Shaw L. J., Berger J. S., Newman J. D., Sidhu M. S., Goodman S. G., Ruzyllo W., Gosselin G., Maggioni A. P., White H. D., Bhargava B., Min J. K., John Mancini G. B., Berman D. S., Picard M. H., Kwong R. Y., Ali Z. A., Mark D. B., Spertus J. A., Krishnan M. N., Elghamaz A., Moorthy N., Hueb W. A., Demkow M., Mavromatis K., Bockeria O., Peteiro J., Miller T. D., Szwed H., Doerr R., Keltai M., Selvanayagam J. B., Gabriel Steg P., Held C., Kohsaka S., Mavromichalis S., Kirby R., Jeffries N. O., Harrell F. E., Rockhold F. W., Broderick S., Bruce Ferguson T., Williams D. O., Harrington R. A., Stone G. W., Rosenberg Y, ISCHEMIA Research Group: Joseph Ricci, A Tello Montoliu, A I Robero Aniorte, Abbey Mulder, Abhay A Laddu, Abhinav Goyal, Abhishek Dubey, Abhishek Goyal, Abigail Knighton, Abraham Oomman, Adam J Jaskowiak, Adam Kolodziej, Adam Witkowski, Adnan Hameed, Adriana Anesini, Afshan Hussain, Agne Juceviciene, Agne Urboniene, Agnes Jakal, Agnieszka Szramowska, Ahmad Khairuddin, Ahmed Abdel-Latif, Ahmed Adel, Ahmed Aljzeeri, Ahmed Kamal, Ahmed Talaat, Aimee Mann, Aira Contreras, Ajit Kumar, V K Kumar, Akemi Furukawa, Akshay Bagai, Akvile Smigelskaite, Alain Furber, Alain Rheault, Alaine Melanie Loehr, Alan Rosen, Albert Varga, Albertina Qelaj, Alberto Barioli, Aldo Russo, Alec Moorman, Alejandro Gisbert, Aleksandra Fratczak, Aleksandras Laucevicius, Alena Kuleshova, Alessandro Sionis, Alexander A Sirker, Alexander M Chernyavskiy, Alexandra Craft, Alexandra Vazquez, Alexandre Ciappina Hueb, Alexandre S Colafranseschi, Alexandre Schaan de Quadros, Alexandre Tognon, Ali Alghamdi, Alice Manica Muller, Aline Nogueira Rabaça, Aline Peixoto Deiro, Alison Hallam, Allegra Stone, Allison Schley, Almudena Castro, Alvaro Rabelo Ales, Amanda Germann, Amanda O'Malley, Amar Uxa, Amarachi Ojajuni, Amarino C Oliveira Jr, Amber B Hull, Ambuj Roy, Amer Zarka, Amir Janmohamed, Ammani Brown, Ammy Malinay, Amparo Martinez Monzonis, Amy J Richards, Amy Iskandrian, Amy Ollinger, Ana D Djordjevic-Dikic, Ana Fernández Martínez, Ana Gomes Almeida, Ana Paula Batista, Ana Rita Francisco, Ana S Mladenovic, Ana Santana, Anam Siddiqui, Anastasia M Kuzmina-Krutetskaya, Andras Vertes, Andre S Sousa, Andre Gabriel, André Schmidt, Andrea M Lundeen, Andrea Bartykowszki, Andrea Lorimer, Andrea Mortara, Andrea Pascual, Andreia Coelho, Andreia Rocha, Andrés García-Rincón, Andrew G Howarth, Andrew J Moriarty, Andrew Docherty, Andrew Starovoytov, Andrew Zurick, Andrzej Łabyk, Andrzej Swiatkowski, Andy Lam, Anelise Kawakami, Angela Hoye, Angela Kim, Angelique Smit, Angelo Nobre, Anil V Shah, Anja Ljubez, Anjali Anand, Ankush Sachdeva, Ann Greenberg, Ann Luyten, Ann Ostrander, Anna Di Donato, Anna Cichocka-Radwan, Anna Fojt, Anna Plachcinska, Anna Proietti, Anna Teresinska, Anne Marie Webb, Anne Cartwright, Anne Heath, Anne Mackin, Anong Amaritakomol, Anong Chaiyasri, Anoop Chauhan, Anoop Mathew, Anthony Gemignani, Anto Luigi Andres, Antonia Vega, Antonietta Hansen, Antonino Ginel Iglesias, Antonio Carlos Carvalho, Antonio Di Chiara, Antonio Serra Peñaranda, Antonio Carvalho, Antonio Colombo, Antonio Fiarresga, Anupama Rao, Aquiles Valdespino-Estrada, Araceli Boan, Areef Ishani, Ariel Diaz, Arijit Ghosh, Arintaya Prommintikul, Arline Roberts, Arnold H Seto, Arnold P Good, Arshed Quyyumi, Arthur J Labovitz, Arthur Kerner, Arturo S Campos-Santaolalla, Arunima Misra, Ashok Mukherjee, Ashok Seth, Ashraf Seedhom, Asim N Cheema, Asker Ahmed, Atul Mathur, Atul Verma, Audrey W Leong, Axel Åkerblom, Axelle Fuentes, Aynun Naher, Badhma Valaiyapathi, Baljeet Kaur, Bandula Guruge, Barbara Brzezińska, Barbara Nardi, Bartosz Czarniak, Bebek Singh, Begoña Igual, Bela Merkely, Belen Cid Alvarez, Benjamin J Spooner, Benjamin J W Chow, Benjamin Cheong, Benoy N Shah, Bernard de Bruyne, Bernardas Valecka, Bernhard Jäger, Beth A Archer, Beth Abramson, Beth Jorgenson, Bethany Harvey, Betsy O'Neal, Bev Atkinson, Bev Bozek, Bevin Lang, Bijulal Sasidharan, Bin Yang, Bin Zhang, Binoy Mannekkattukudy Kurian, Bjoern Goebel, Bob Hu, Bogdan A Popescu, Bogdan Crnokrak, Bolin Zhu, Bonnie J Kirby, Brandi D Zimbelman, Brandy Starks, Branko D Beleslin, Brenda Hart, Brian P Shapiro, Brian McCandless, Brianna Wisniewski, Brigham R Smith, Brooks Mirrer, Bruce McManus, Bruce Rutkin, Bruna Edilena Paulino, Bruna Maria Ascoli, Bryn Smith, Byron J Allen, C Michael Gibson, C Noel Bairey Merz, Calin Pop, Cameron Hague, Camila Thais de Ormundo, Candace Gopaul, Candice P Edillo, Carísi A Polanczyk, Carita Krannila, Carla Vicente, Carl-Éric Gagné, Carlo Briguori, Carlos Peña Gil, Carlos Alvarez, Carly Ohmart, Carmen C Beladan, Carmen Ginghina, Carol M Kartje, Caroline Alsweiler, Caroline Brown, Caroline Callison, Caroline Pinheiro, Caroline Rodgers, Caroline Spindler, Carolyn Corbett, Carrie Drum, Casey Riedberger, Catherine Bone, Catherine Fleming, Catherine Gordon, Catherine Jahrsdorfer, Catherine Lemay, Catherine Weick, Cathrine Patten, Cecilia Goletto, Cezary Kepka, Chandini Suvarna, Chang Xu, Chantale Mercure, Charle A Viljoen, Charlene Wiyarand, Charles Jia-Yin Hou, Charles Y Lui, Charles Cannan, Charles Cornet, Charlotte Pirro, Chataroon Rimsukcharoenchai, Chen Wang, Cheng-Ting Tsai, Chen-Yen Chien, Cheryl A Allardyce, Chester M Hedgepeth, Chetan Patel, Chiara Attanasio, Chih-Hsuan Yen, Chi-Ming Chow, Ching Min Er, Ching-Ching Ong, Cholenahally Nanjappa Manjunath, Chris Beck, Chris Buller, Christel Vassaliere, Christian Hamm, Christiano Caldeira, Christie Ballantyne, Christina Björklund, Christine R Hinton, Christine Bergeron, Christine Masson, Christine Roraff, Christine Shelley, Christophe Laure, Christophe Thuaire, Christopher Kinsey, Christopher McFarren, Christopher Spizzieri, Christopher Travill, Chun-Chieh Liu, Chung-Lieh Hung, Chunguang Li, Chun-Ho Yun, Chunli Xia, Ciarra Heard, Cidney Schultz, Clare Venn-Edmonds, Claudia P Hochberg, Claudia Wegmayr, Claudia Cortés, Claudia Escobar, Cláudia Freixo, Claudio T Mesquita, Clemens T Kadalie, Colin Berry, Constance Philander, Corine Thobois, Costantino Costantini, Courtney Page, Craig Atkinson, Craig Barr, Craig Paterson, Cristina Bare, Cynthia Baumann, Cynthia Burman, Dalisa Espinosa, Damien Collison, Dan Deleanu, Dan Elian, Dan Gao, Dana Oliver, Daniel P Vezina, Daniel O'Rourke, Daniele Komar, Danielle Schade, Darrel P Francis, Dastan Malaev, David A Bull, David E Winchester, David P Faxon, David Booth, David Cohen, David DeMets, David Foo, David Schlichting, David Taggart, David Waters, David Wohns, Davis Vo, Dawid Teodorczyk, Dawn Shelstad, Dawn Turnbull, Dayuan Li, Dean Kereiakes, Deborah O'Neill, Deborah Yip, Debra K Johnson, Debra Dees, Deepak L Bhatt, Deepika Gopal, Deepti Kumar, Deirdre Mattina, Deirdre Murphy, Delano R Small, Delsa K Rose, Dengke Jiang, Denis Carl Phaneuf, Denise Braganza, Denise Fine, Derek Cyr, Desiree Tobin, Diana Cukali, Diana Parra, Diane Camara, Diane Minshall Liu, Diego Adrián Vences, Diego Franca de Cunha, Dimitrios Stournaras, Dipti Patel, Dongze Li, Donna Exley, Dorit Grahl, Dragana Stanojevic, Duarte Cacela, Dwayne S G Conway, E Pinar Bermudez, Eapen Punnoose, Edgar L Tay, Edgar Karanjah, Edoardo Verna, Eduardo Hernandez-Rangel, Edward D Nicol, Edward O McFalls, Edward T Martin, Edyta Kaczmarska, Ekaterina I Lubinskaya, Elena A Demchenko, Elena Refoyo Salicio, Eli Feen, Elihú Durán-Cortés, Elisabeth M Janzen, Elise L Hannemann, Elise van Dongen, Elissa Restelli Piloto, Eliza Kaplan, Elizabeta Srbinovska Kostovska, Elizabeth Capasso-Gulve, Elizabeth Congdon, Elizabeth Ferguson, Elizaveta V Zbyshevskaya, Ellen Magedanz, Ellie Fridell, Ellis W Lader, Elvin Kedhi, Emanuela Racca, Emilie Tachot, Emily DeRosa, Encarnación Alonso-Álvarez, Eric Nicollet, Eric Peterson, Erick Alexánderson Rosas, Erick Donato Morales, Erin Orvis, Ermina Moga, Estelle Montpetit, Estevao Figueiredo, Eugene Passamani, Eugenia Nikolsky, Eunice Yeoh, Evgeniy I Kretov, Ewa Szczerba, Ewelina Wojtala, Expedito Eustáquio Ribeiro Silva, F Marin Ortuño, Fabio R Farias, Fabio Fimiani, Fabrizio Rolfo, Fa-Chang Yu, Fadi Hage, Fadi Matar, Fahim Haider Jafary, Fang Feng, Fang Liu, Fatima Ranjbaran, Fatima Rodriguez, Fausto J Pinto, Fauzia Rashid, Federica Ramani, Fei Wang, Fernanda Igansi, Filipa Silva, Filippo Ottani, Fiona Haines, Firas Al Solaiman, Flávia Egydio, Flavio Lyra, Florian Egger, Fran Farquharson, Frances Laube, Francesc Carreras Costa, Francesca de Micco, Francesca Bianchini, Francesca Pezzetta, Francesca Pietrucci, Francesco Orso, Francesco Pisano, Francis Burt, Francisca Patuleia Figueiras, Francisco Fernandez-Aviles, Francois Pierre Mongeon, Frans Van de Werf, Franziska Guenther, Fraser N Witherow, Fred Mohr, Frederico Dall'Orto, Fumiyuki Otsuka, G De La Morena, G Karthikeyan, Gabor Dekany, Gabor Kerecsen, Gabriel Galeote, Gabriel Grossmann, Gabriel Vorobiof, Gabriela Sanchez de Souza, Gabriela Guzman, Gabriela Zeballos, Gabriele Gabrielli, Gabriele Jakl-Kotauschek, Gail A Shammas, Gail Brandt, Gang Chen, Gary E Lane, Gary J Luckasen, Gautam Sharma, Gelmina Mikolaitiene, Gennie Yee, Georg Nickenig, George E Revtyak, George J Juang, Gerald Fletcher, Gerald Leonard, Gerard Patrick Devlin, Gerard Esposito, Gergely Ágoston, Gervasio Lamas, Geza Fontos, Ghada Mikhail, Gia Cobb, Gian Piero Perna, Gianpiero Leone, Giles Roditi, Gilles Barone-Rochette, Girish Mishra, Giuseppe Tarantini, Glenda Wong, Glenn S Hamroff, Glenn Rayos, Gong Cheng, Gonzalo Barge-Caballero, Goran Davidović, Goran Stankovic, Gordana Stevanovic, Grace Jingyan Wang, Grace M Young, Graceanne Wayser, Graciela Scaro, Graham S Hillis, Graham Wong, Grazyna Anna Szulczyk, Gregor Simonis, Gregory Kumkumian, Gretchen Ann Peichel, Grzegorz Gajos, Gudrun Steinmaurer, Guilherme G Rucatti, Guilherme Portugal, Guilhermina Cantinho Lopes, Guillem Pons Lladó, Gunnar Frostfelt, Gurpreet S Wander, Gurpreet Gulati, Gustavo Pucci, Hafidz Abd Hadi, Haibo Zhang, Haitao Wang, Halina Marciniak, Han Chen, Hanan Kerr, Hani Najm, Hanna Douglas, Hannah Phillips, Hao Dai, Haojian Dong, Haqeel Jamil, Harikrishnan Sivadasanpillai, Harry Suryapranata, Hassan Reda, Hayley Pomeroy, Heather Barrentine, Heather Golden, Heather Hurlburt, Heidi Wilson, Helen C Tucker, Helene Abergel, Hemalata Siddaram, Hermine Osseni, Herwig Schuchlenz, Hesong Zeng, Hicham Skali, Hilda Solomon, Hollie Horton, Holly Hetrick, Holly Little, Holly Park, Hongjie Chi, Hossam Mahrous, Howard A Levite, Hristo Pejkov, Huajun Li, Hugo Bloise-Adames, Hugo Marques, Hui Zhong, Hui-Min Zhang, Humayrah Hashim, Hung-I Yeh, Hussien El Fishawy, Ian Webb, Iftikhar Kullo, Igor O Grazhdankin, Ihab Hamzeh, Ikraam Hassan, Ikuko Ueda, Ileana L Pina, Ilona Tamasauskiene, Ilse Bouwhuis, Imran Arif, Ina Wenzelburger, Inês Zimbarra Cabrita, Ines Rodrigues, Inga H Robbins, Inga Soveri, Ingela Schnittger, Iqbal Karimullah, Ira M Dauber, Iram Rehman, Irena Peovska Mitevska, Irene Marthe Lang, Irina Subbotina, Irma Kalibataite-Rutkauskiene, Irni Yusnida, Isabel Estela Carvajal, Isabella C Palazzo, Isabelle Hogan, Isabelle Roy, Ishba Syed, Ishita Tejani, Ivan A Naryshkin, Ivana Jankovic, Iwona Niedzwiecka, J David Knight, Jacek Kusmierek, Jackie M White, Jackie Chow, Jacob Udell, Jacqueline E Tamis-Holland, Jacqueline Fannon, Jacquelyn A Quin, Jacquelyn Do, Jaekyeong Heo, Jakub Maksym, James E Davies, James H O'Keefe Jr, James J Jang, James Cha, James Harrison, James Hirsch, James Stafford, James Tatoulis, Jamie Rankin, Jan Henzel, Jan Orga, Jana Tancredi, Janaina Oliveira, Jane Burton, Jane Eckstein, Jane Marucci, Janet P Knight, Janet Blount, Janet Halliday, Janetta Kourzenkova, Janitha Raj, Jan-Malte Sinning, Jaqueline Pozzibon, Jaroslaw Drozdz, Jaroslaw Karwowski, Jason D Glover, Jason Loh Kwok, Jason T Call, Jason Linefsky, Jassira Gomes, Jati Anumpa, Javier J Garcia, Javier Courtis, Jay Meisner, K Jayakumar, Jayne Scales, Jean E Denaro, Jean Michel Juliard, Jean Ho, Jeanette K Stansborough, Jean-Michel Juliard, Jeanne Russo, Jeannette J M Schoep, Jeet Thambyrajah, Jeff Leimberger, Jeffery A Breall, Jeffrey A Kohn, Jeffrey C Milliken, Jeffrey Anderson, Jeffrey Blume, Jeffrey Kanters, Jeffrey Lorin, Jeffrey Moses, Jelena J Stepanovic, Jelena Celutkiene, Jelena Djokic, Jelena Stojkovic, Jenne M Jose, Jenne Manchery, Jennifer A Mull, Jennifer H Czerniak, Jennifer L Stanford, Jennifer Gillis, Jennifer Horst, Jennifer Isaacs, Jennifer Langdon, Jennifer Thomson, Jennifer Tomfohr, Jennifer White, Jen-Yuan Kuo, Jeremy Rautureau, Jerome Fleg, Jessica Berg, Jessica Rodriguez, Jessica Waldron, Jhina Patro, Jia Li, Jiajia Mao, Jiamin Liu, Jian'an Wang, Jianhua Li, Jianxin Zhang, Jie Qi, Jihyun Lyo, Jill Marcus, Jim Blankenship, Jing Zhang, Jingjing Liu, Jing-Yao Fan, Jiun-Yi Li, Jiwan Pradhan, Jiyan Chen, J M Rivera Caravaca, Jo Evans, Joan Garcia Picart, Joan Hecht, Joanna Jaroch, Joanna Zalewska, Joanne Kelly, Joanne Taaffe, João Reynaldo Abbud, João V Vitola, Joaquín V Peñafiel, Jocelyne Benatar, Jody Bindeman, Joe Sabik, Joel Klitch, Johann Christopher, Johannes Aspberg, John D Friedman, John F Beltrame, John F Heitner, John Joseph Graham, John R Davies, John Doan, John Kotter, John Kurian, John Mukai, John Pownall, Jolanta Sobolewska, Jon Kobashigawa, Jonathan L Goldberg, Jonathan W Bazeley, Jonathan Byrne, Jonathan Himmelfarb, Jonathan Leipsic, Jonean Thorsen, Jorge F Trejo Gutierrez, Jorge Escobedo, Jorik Timmer, José A Ortega-Ramírez, José Antonio Marin-Neto, Jose D Salas, Jose Enrique Castillo, Jose Francisco Saraiva, José J Cuenca-Castillo, Jose L Diez, José Luis Narro Villanueva, José Luiz da Vieira, José M Flores-Palacios, Jose Ramon Gonzalez, Jose Seijas Amigo, Jose Fragata, Josep Maria Padró, Josheph F X McGarvey Jr, Joseph Hannan, Joseph Sacco, Joseph Sweeny, Joseph Wiesel, Josephine D Abraham, Joshua P Loh, Joy Burkhardt, Joyce R White, Joyce Riestenberg-Smith, Judit Sebo, Judith L Meadows, Judith Wright, Judy Mae Foltz, Judy Hung, Judy Otis, Juergen Stumpf, Jui-Peng Tsai, Julia S Dionne, Julia de Aveiro Morata, Julie Bunke, Julie Morrow, Julio César Figal, Jun Fujita, Jun Jiang, Junhua Li, Junqing Yang, Juntima Euathrongchit, Jyotsna Garg, K Manjula Rani, K Preethi, Kaatje Goetschalckx, Kai Eggers, Kamalakar Surineni, Kanae Hirase, T R Kapilamoorthy, Karen Calfas, Karen Gratrix, Karen Hallett, Karen Hultberg, Karen Nugent, Karen Petrosyan, Karen Swan, Karolina Kryczka, Karolina Wojtczak-Soska, Karolina Wojtera, Karsten Lenk, Karthik Ramasamy, Katarzyna Łuczak, Katarzyna Malinowska, Kate Pointon, Kate Robb, Katherine Martin, Kathleen Claes, Kathryn Carruthers, Kathy E Siegel, Katia Drouin, Katie Fowler-Lehman, Kavita Rawat, Kay Rowe, Keiichi Fukuda, Keith A A Fox, Ken Mahaffey, Kendra Unterbrink, Kenneth Giedd, Kerrie Van Loo, Kerry Lee, Kerstin Bonin, Kevin R Bainey, Kevin T Harley, Kevin Anstrom, Kevin Chan, Kevin Croce, Kevin Landolfo, Kevin Marzo, Keyur Patel, Khaled Abdul-Nour, Khaled Alfakih, Khaled Dajani, Khaled Ziada, Khaula Baloch, Khrystyna Kushniriuk, Kian-Keong Poh, Kim F Ireland, Kim Holland, Kimberly Ann Byrne, Kimberly E Halverson, Kimberly Elmore, Kimberly Miller-Cox, Kiran Reddy, Kirsten J Quiles, Kirsty Abercrombie, Klaus Matschke, Konrad Szymczyk, Koo Hui Chan, Kotiboinna Preethi, Kozhaya Sokhon, Krissada Meemuk, Kristian Thygesen, Kristin M Salmi, Kristin Newby, Kristina Wippler, Kristine Arges, Kristine Teoh, Krystal Etherington, Krystyna Łoboz-Grudzień, Krzysztof W Reczuch, Krzysztof Bury, Krzysztof Drzymalski, Krzysztof Kukuła, Kuo-Tzu Sung, Kurt Huber, Ladda Douangvila, Lance Sullenberger, Larissa Miranda Trama, Laszlone Matics, Laura Drew, Laura Flint, Laura Keinaite, Laura Sarti, Laurel Kolakaluri, Lawrence M Phillips, Lawrence Friedman, Lawrence Phillips, Lazar Velicki, Leah Howell, Leandro C Maranan, Leanne Cox, Ledjalem Daba, Lei Zhang, Lekshmi Dharmarajan, Leo Bockeria, Leonardo Pizzol Caetano, Leonardo Bridi, Leonid L Bershtein, Leszek Sokalski, Li Hai Yan, Li Li, Lia Nijmeijer, Lidia Sousa, Lihong Xu, Lihua Zhang, Lili Zhang, Lilia Schiavi, Lilian Mazza Barbosa, Lillian L Khor, Lina Felix-Stern, Linda L Hall, Linda M Hollenweger, Linda Arcand, Linda Davidson-Ray, Linda Schwarz, Lindsey N Sikora, Lingping Chi, Lino Patricio, Liping Zhang, Lisa Chaytor, Lisa Hatch, Lisa McCloy, Lisa Wong, Liselotte Persson, Lixin Jiang, Liz Low, Ljiljana Pupic, Loïc Bière, Lorenzo Monti, Lori Christensen, Lori Pritchard, Loriane Black, Lori-Ann Desimone, Lori-Ann Larmand, Lorraine McGregor, Louise Morby, Louise Thomson, Luc Harvey, Luciana de Pádua Baptista, Lucilla Garcia, Ludivine Eliahou, Ludmila Helmer, Luis F Smidt, Luis Bernanrdes, Luis Guzman, Luiz A Carvalho, Luyang Xiong, Lynette L Teo, Lynn M Neeson, Lynne Winstanley, M Barbara Srichai-Parsia, M Quintana Giner, M Sowjanya Reddy, M Valdés Chávarri, M Grazia Rossi, Maarten Simoons, Maayan Konigstein, Maciej Lesiak, Maciej Olsowka, Mafalda Selas, Magalie Corfias, Magdalena Madero Rovalo, Magdalena Łanocha, Magdalena Miller, Magdalena Misztal-Teodorczyk, Magdalena Rantinella, Magdy Abdelhamid, Magnolia Jimenez, Mahboob Alam, Mahevamma Mylarappa, Mahfouz El Shahawy, Mahmoud Mohamed, Mahmud Al-Bustami, Majo X Joseph, Malgorzata Frach, Małgorzta Celińska-Spodar, Malte Helm, Manas Chacko, Mandy Murphy, Manitha Vinod, Manjula Rani, Manu Dhawan, Manuela Mombelli, Marcel Weber, Marcello Galvani, Marcelo Jamus Rodrigues, Marcia F Dubin, Marcia F Werner Bayer, Marcin Szkopiak, Marco Antonio Monsalve, Marco Bizzaro Santos, Marco Magnoni, Marco Marini, Marco Sicuro, Marco Zenati, Marcos Valério Coimbra Resende, Marek Roik, Margalit Bentzvi, Margaret Gilsenan, Margaret Iraola, Margot C Quinn, Maria A Alfonso, Maria Antonieta Pereira Moraes, María Dolores Martínez-Ruíz, María Fernanda Canales, Maria Inês Caetano, Maria P Corral, Maria Pérez García, Maria Victoria Actis, Maria Aguirre, Maria Andreasson, Maria Aprile, Maria Colton, Maria Eugenia Martin, Maria Lasala, Maria Lorenzo, Maria Posada, Maria Shier, Maria Thottam, Mariana V Furtado, Mariana Yumi Okada, Marianna D A Dracoulakis, Marianne De Andrade, Mariano Rubio, Marie Essermark, Marielle Scherrer-Crosbie, Marija T Petrovic, Marija Zdravkovic, Marilyn Black, Marina Garcia, Mario J Garcia, Mariola Szulik, Marisa Orgera, Mark A de Belder, Mark Harbinson, Mark Hyun, Mark Peterson, Mark Xavier, Marlowe Mosley, Marta Capinha, Marta Marcinkiewicz-Siemion, Marta Swiderek, Martha Meyer, Martina Ceseri, Martina Tricoli, Marvin Kronenberg, Mary Williams, Mary Ann Champagne, Mary Colleen Rogge, Mary R Soltau, Mary Streif, Massimo Villella, Massoud Leesar, Matei Claudia, Mateusz Solecki, Matías Nicolás Mungo, Matthew Wall Jr, Matthew Budoff, Matthew Jezior, Matthew Luckie, Matthias Friedrich, Mauren P Haeffner, Maximilian Tscharre, Max-Paul Winter, Mayana Almeida, Mayil S Krishnam, Mayuri Patel, Meenakshi Mishra, Megan Manocchia, Meghana Kakade, Melanie J Munro, Melissa D Chaplin, Melissa LeFevre, Mervyn Andiapen, Michael A Gibson, Michael B Rubens, Michael C Turner, Michael D Shapiro, Michael W Lee, Michael Berlowitz, Michael Davidson, Michael Mack, Michael McDaniel, Michael Mumma, Michal Wlodarczyk, Michel G Khouri, Michel S Slama, Michele Rawlins, Michelle M Bonner, Michelle M Seib, Michelle Chang, Michelle Crowder, Michelle Dixon, Michelle Mayon, Michelle McEvoy, Michelle Yee, Miguel M Fernandes, Miguel Nobre Menezes, Miguel Souto Bayarri, Miguel Barrero, Mikhail T Torosoff, Milan R Dobric, Milan Dobric, Milica Nikola Dekleva, Milind Avdhoot Gadkari, Millie Gomez, Min Tun Kyaw, Miriam Brooks, Miroslav Stevo Martinovic, Mitchel B Lustre, Mohammad Tariq Vakani, Mohammad El-Hajjar, Mohammed Al-Amoodi, 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Riezebos, Robert M Donnino, Robert Bojar, Robert Chilton, Robert Guyton, Robert Henderson, Robert Kornberg, Robert Leber, Robert Mao, Robert Stenberg, Roberta P Santos, Roberto René Favaloro, Roberto Amati, Rodolfo G S D Lima, Rodrigo J Cerci, Rogerio Tumelero, Rohit Tandon, Roma Tewari, Romalisa Miranda-Peats, Ron Wald, Ronald A Mastouri, Ronald G Morford, Ronald G Schwartz, Ronald P Pedalino, Rongrong Hu, Ronnell A Hansen, Ronny A Cohen, Rory Hachamovitch, Rosa Homem, Rosa Sandonato, Rosane Laimer, Rosann Gans, Roxanne Yost, Roy Mathew, Rubén Baleón-Espinosa, Ruben Ramos, Rubine Gevorgyan, Rui Ferreira, Rui Jing, Ruth Pérez-Fernández, S K Dwivedi, S Ramakrishnan, Saadat Khan, Sabahat Bokhari, Sabu Thomas, Sadath Lubna, Sajeeda Parveen Khan, Sajeev Chakanalil Govindan, Saket Girotra, Saleem Kassam, Sallie Canada, Salvador Cruz-Flores, Samaa Mohamed, Samantha Ly, Sameh El Kaffas, Samia Massalha, Sampoornima Setty, Samuel Nwosu, Sandeep Seth, Sandeep Singh, Sander R Niehe, Sandra M 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Vincent Setang, C P Vineeth, Virginai Pubull Nuñez, Virginia Fernández-Figares, Vitor Gomes, Viviana Gabriel, Viviane Dos Santos, Viviane Almeida, Vlad A Iliescu, Vladan Mudrenovic, Vladimir Dzavik, Vojislav L Giga, Walter Enrique Mogrovejo, Wan Xian Chan, Wanda C Marfori, Wanda Parker, Warangkana Mekara, Wassim Nona, Wayne Old, Wayne Pennachi, Weerachai Nawarawong, Wei Chen, Wei Su, Weibing Xing, Wei-Ren Lan, Wenda Crawford, Wendy L Stewart, Wendy Drewes, Wenhua Lin, William B Abernethy, William D Salerno, William F Fearon, William Vergoni, William Weintraub, Winnie C Sia, Wlodzimierz J Musial, Xacobe Flores-Ríos, Xavier Garcia-Moll Marimon, Xi Su, Xiang Ma, Xiangqiong Gu, Xiao Wang, Xiaomei Li, Xiaowei Yao, Xin Fu, Xin Su, Xin Zeng, Xinchun Yang, Xiuhong Li, Xuehua Fang, Xutong Wang, Yaming Geng, Yan Yan, Yanek Pépin-Dubois, Yanfu Wang, Yang Wang, Yanmeng Tian, Yaping Huang, Yechen Han, Yesenia Zambrano, Yi-Hsuan Yang, Ying Tung Sia, Yining Yang, Yitong Ma, Yolayfi Peralta, Yongjian Wu, Yu Kunwu, Yu Zhao, Yudong Peng, Yueh-Hung Lin, Yulan Zhao, Yumei Dong, Yunhai Zhao, Yutthaphan Wannasopha, Yvonne Taul, Zakir Sahul, Zalina Kudzoeva, Zbigniew Kalarus, Zeljko Z Markovic, Zhen Huang, Zheng Ji, Zhenyu Liu, Zhou Yue, Zhulin Zhang, Zhuxi Li, Zile Singh Meharwal, Ziliang Bai, Zixiang Yu, Zohra Huda, Zoltan Davidovits
Subjects: Male, Cardiac Catheterization, Computed Tomography Angiography, medicine.medical_treatment, Myocardial Ischemia, Coronary Disease, Coronary Artery Disease, Kaplan-Meier Estimate, 030204 cardiovascular system & hematology, Coronary Angiography, ISCHEMIA Research Group, law.invention, Angina, Coronary artery disease, 0302 clinical medicine, Randomized controlled trial, law, Cardiovascular Disease, Myocardial Revascularization, 030212 general & internal medicine, Coronary Artery Bypass, 11 Medical and Health Sciences, Cardiac catheterization, General Medicine, Middle Aged, humanities, Cardiovascular Diseases, Cardiology, Female, Human, medicine.medical_specialty, Ischemia, Article, 03 medical and health sciences, Geriatric cardiology, Percutaneous Coronary Intervention, General & Internal Medicine, Internal medicine, medicine, Humans, Angina, Unstable, Aged, business.industry, Coronary Artery Bypa, Percutaneous coronary intervention, Bayes Theorem, medicine.disease, Heart failure, Quality of Life, business
Abstract: BACKGROUND: Among patients with stable coronary disease and moderate or severe ischemia, whether clinical outcomes are better in those who receive an invasive intervention plus medical therapy than in those who receive medical therapy alone is uncertain. METHODS: We randomly assigned 5179 patients with moderate or severe ischemia to an initial invasive strategy (angiography and revascularization when feasible) and medical therapy or to an initial conservative strategy of medical therapy alone and angiography if medical therapy failed. The primary outcome was a composite of death from cardiovascular causes, myocardial infarction, or hospitalization for unstable angina, heart failure, or resuscitated cardiac arrest. A key secondary outcome was death from cardiovascular causes or myocardial infarction. RESULTS: Over a median of 3.2 years, 318 primary outcome events occurred in the invasive-strategy group and 352 occurred in the conservative-strategy group. At 6 months, the cumulative event rate was 5.3% in the invasive-strategy group and 3.4% in the conservative-strategy group (difference, 1.9 percentage points; 95% confidence interval [CI], 0.8 to 3.0); at 5 years, the cumulative event rate was 16.4% and 18.2%, respectively (difference, -1.8 percentage points; 95% CI, -4.7 to 1.0). Results were similar with respect to the key secondary outcome. The incidence of the primary outcome was sensitive to the definition of myocardial infarction; a secondary analysis yielded more procedural myocardial infarctions of uncertain clinical importance. There were 145 deaths in the invasive-strategy group and 144 deaths in the conservative-strategy group (hazard ratio, 1.05; 95% CI, 0.83 to 1.32). CONCLUSIONS: Among patients with stable coronary disease and moderate or severe ischemia, we did not find evidence that an initial invasive strategy, as compared with an initial conservative strategy, reduced the risk of ischemic cardiovascular events or death from any cause over a median of 3.2 years. The trial findings were sensitive to the definition of myocardial infarction that was used. (Funded by the National Heart, Lung, and Blood Institute and others; ISCHEMIA ClinicalTrials.gov number, NCT01471522.).
Published: 2020
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6. Monitoring Elite Youth Football Players' Physiological State Using a Small-Sided Game: Associations With a Submaximal Running Test

Author: Kobe C. Houtmeyers, Werner F. Helsen, Arne Jaspers, Sjaantje Nanne, Shaun McLaren, Jos Vanrenterghem, Michel S. Brink, and SMART Movements (SMART)
Subjects: SHUTTLE RUN TEST, SOCCER, Adolescent, Acceleration, Football, Physical Therapy, Sports Therapy and Rehabilitation, TRAINING LOAD, Athletic Performance, PERFORMANCE, submaximal fi tness tests, SPORTS, RATIOS, Running, TEST LEVEL 1, exercise intensity, RELIABILITY, Humans, Orthopedics and Sports Medicine, INTERMITTENT RECOVERY TEST, external load, team sports, HEART-RATE RESPONSES
Abstract: Purpose: To examine the utility of a standardized small-sided game (SSG) for monitoring within-player changes in mean exercise heart rate (HRex) when compared with a submaximal interval shuttle-run test (ISRT). Methods: Thirty-six elite youth football players (17 [1] y) took part in 6 test sessions across an in-season period (every 4 wk). Sessions consisted of the ISRT (20-m shuttles, 30″:15″ work:rest ratio, 70% maximal ISRT) followed by an SSG (7v7, 80 × 56 m, 6 min). HRex was collected during both protocols, with SSG external load measured as high-speed running distance (>19.8 km·h–1) and acceleration distance (>2 m·s−2). Data were analyzed using linear mixed-effect models. Results: Controlling for SSG external load improved the model fit describing the SSG–ISRT HRex relationship (χ2 = 12.6, P = .002). When SSG high-speed running distance and SSG acceleration distance were held constant, a 1% point change in SSG HRex was associated with a 0.5% point change in ISRT HRex (90% CI: 0.4 to 0.6). Inversely, when SSG HRex was held constant, the effects of a 100-m change in SSG high-speed running distance and a 21-m change in SSG acceleration distance on ISRT HRex were −1.0% (−1.5 to −0.4) and −0.6% points (−1.1 to 0.0), respectively. Conclusions: An SSG can be used to track within-player changes in HRex for monitoring physiological state. Given the uncertainty in estimates, we advise to only give meaning to changes in SSG HRex >2% points. Additionally, we highlight the importance of considering external load when monitoring SSG HRex.
Published: 2022

7. Biased pathogenic assertions of loss of function variants challenge molecular diagnosis of admixed individuals

Author: Eduardo Tarazona-Santos, Heinner Guio, Jaqueline Y. T. Wang, Yeda Aparecida de Oliveira Duarte, Marilia O. Scliar, Michel S Naslavsky, Guilherme L. Yamamoto, Diogo Meyer, Maria Rita Passos-Bueno, Mayana Zatz, and Kelly Nunes
Subjects: Prioritization, Population, Biology, Genetics, Humans, Exome, underrepresented populations, Allele, education, Mendelian disorders, Genetics (clinical), Loss function, Exome sequencing, Aged, Whole genome sequencing, education.field_of_study, Genetic Variation, High-Throughput Nucleotide Sequencing, Genomics, pathogenic assertions, whole-genome sequencing, NEOPLASIAS, Cohort, admixture, pLOF, Brazil
Abstract: Diagnosis of individuals affected by monogenic disorders was significantly improved by next-generation sequencing targeting clinically relevant genes. Whole exomes yield a large number of variants that require several filtering steps, prioritization, and pathogenicity classification. Among the criteria recommended by ACMG, those that rely on population databases critically affect analyses of individuals with underrepresented ancestries. Population-specific allelic frequencies need consideration when characterizing potential deleteriousness of variants. An orthogonal input for classification is annotation of variants previously classified as pathogenic as a criterion that provide supporting evidence widely sourced at ClinVar. We used a whole-genome dataset from a census-based cohort of 1,171 elderly individuals from São Paulo, Brazil, highly admixed, and unaffected by severe monogenic disorders, to investigate if pathogenic assertions in ClinVar are enriched with higher proportions of European ancestry, indicating bias. Potential loss of function (pLOF) variants were filtered from 4,250 genes associated with Mendelian disorders and annotated with ClinVar assertions. Over 1,800 single nucleotide pLOF variants were included, 381 had non-benign assertions. Among carriers (N = 463), average European ancestry was significantly higher than noncarriers (N = 708; p = .011). pLOFs in genomic contexts of non-European local ancestries were nearly three times less likely to have any ClinVar entry (OR = 0.353; p
Published: 2021
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8. The Cardiac Care Bridge randomized trial in high-risk older cardiac patients: A mixed-methods process evaluation

Author: Ron J.G. Peters, Wilma Scholte op Reimer, Lotte Verweij, Michel S. Terbraak, Corine H.M. Latour, Patricia Jepma, Bianca M. Buurman, Denise F. Spoon, Elderly care medicine, APH - Aging & Later Life, University of Zurich, Verweij, Lotte, Faculteit Gezondheid, Lectoraat Critical Care, Lectoraat Acute Ouderenzorg, Graduate School, Nursing, ACS - Atherosclerosis & ischemic syndromes, APH - Quality of Care, Amsterdam Movement Sciences, Other Research, Cardiology, ACS - Heart failure & arrhythmias, and Geriatrics
Subjects: caregivers, process assessment, media_common.quotation_subject, Health Personnel, nurses/midwives/nursing, Population, Psychological intervention, 11549 Institute of Implementation Science in Health Care, Fidelity, 610 Medicine & health, frailty, Original Research: Empirical Research ‐ Mixed Methods, law.invention, 03 medical and health sciences, 0302 clinical medicine, Nursing, Randomized controlled trial, law, Intervention (counseling), Medicine, Humans, Transitional care, 030212 general & internal medicine, education, 2900 General Nursing, Geriatric Assessment, General Nursing, media_common, Aged, education.field_of_study, Motivation, 030504 nursing, business.industry, transitional care, Original Research: Empirical Research–Mixed Methods, Research Papers, cardiology, Thematic analysis, 0305 other medical science, business, qualitative research, Qualitative research
Abstract: AimTo evaluate healthcare professionals' performance and treatment fidelity in the Cardiac Care Bridge (CCB) nurse‐coordinated transitional care intervention in older cardiac patients to understand and interpret the study results.DesignA mixed‐methods process evaluation based on the Medical Research Council Process Evaluation framework.MethodsQuantitative data on intervention key elements were collected from 153 logbooks of all intervention patients. Qualitative data were collected using semi‐structured interviews with 19 CCB professionals (cardiac nurses, community nurses and primary care physical therapists), from June 2017 until October 2018. Qualitative data‐analysis is based on thematic analysis and integrated with quantitative key element outcomes. The analysis was blinded to trial outcomes. Fidelity was defined as the level of intervention adherence.ResultsThe overall intervention fidelity was 67%, ranging from severely low fidelity in the consultation of in‐hospital geriatric teams (17%) to maximum fidelity in the comprehensive geriatric assessment (100%). Main themes of influence in the intervention performance that emerged from the interviews are interdisciplinary collaboration, organizational preconditions, confidence in the programme, time management and patient characteristics. In addition to practical issues, the patient's frailty status and limited motivation were barriers to the intervention.ConclusionAlthough involved healthcare professionals expressed their confidence in the intervention, the fidelity rate was suboptimal. This could have influenced the non‐significant effect of the CCB intervention on the primary composite outcome of readmission and mortality 6 months after randomization. Feasibility of intervention key elements should be reconsidered in relation to experienced barriers and the population.ImpactIn addition to insight in effectiveness, insight in intervention fidelity and performance is necessary to understand the mechanism of impact. This study demonstrates that the suboptimal fidelity was subject to a complex interplay of organizational, professionals' and patients' issues. The results support intervention redesign and inform future development of transitional care interventions in older cardiac patients.
Published: 2021

9. Admixture/fine-mapping in Brazilians reveals a West African associated potential regulatory variant (rs114066381) with a strong female-specific effect on body mass and fat mass indexes

Author: Meddly L. Santolalla, Fernanda S G Kehdy, Thiago P. Leal, Michel S Naslavsky, Meredith Yeager, Moara Machado, Eduardo Tarazona-Santos, Shane A. Norris, Hanaisa P Sant'Anna, Francisco Pereira Lobo, Victor Borda, Lucas Michelin, Alexandre C. Pereira, Sam M. Mbulaiteye, Robert H. Gilman, Guilherme L. Yamamoto, Edward D. Yeboah, Marcelo R. Luizon, Matthew E. B. Hansen, Sérgio Viana Peixoto, Camila Zolini, Nathalia M. Araujo, Julie Dutil, Timothy D O Connor, Isabela Alvim, Mateus H. Gouveia, Maria Rita Passos-Bueno, Ricardo Lyra, Marilia O. Scliar, Michèle Ramsay, Gilderlanio S. Araújo, Yeda Aparecida de Oliveira Duarte, Heinner Guio, Mayana Zatz, Maria Fernanda Lima-Costa, Wagner C. S. Magalhães, Sarah A. Tishkoff, Ananyo Choudhury, Bernardo L. Horta, Maíra R. Rodrigues, James E. Mensah, Mauricio Lima Barreto, and Ann W. Hsing
Subjects: Male, purl.org/pe-repo/ocde/ford#3.03.04 [https], Endocrinology, Diabetes and Metabolism, Population, Medicine (miscellaneous), Genetic admixture, 030209 endocrinology & metabolism, Single-nucleotide polymorphism, Regulatory Sequences, Nucleic Acid, Biology, Polymorphism, Single Nucleotide, Article, Body Mass Index, Young Adult, 03 medical and health sciences, Sex Factors, 0302 clinical medicine, Genetics, Humans, 030212 general & internal medicine, Allele, Young adult, Child, education, Alleles, Aged, Aged, 80 and over, education.field_of_study, Nutrition and Dietetics, purl.org/pe-repo/ocde/ford#3.02.18 [https], Chromosome Mapping, Middle Aged, Genetic architecture, Genetics, Population, Phenotype, Risk factors, Child, Preschool, Cohort, Female, Body mass index, Brazil, Demography
Abstract: Background/objectives: Admixed populations are a resource to study the global genetic architecture of complex phenotypes, which is critical, considering that non-European populations are severely underrepresented in genomic studies. Here, we study the genetic architecture of BMI in children, young adults, and elderly individuals from the admixed population of Brazil. Subjects/methods: Leveraging admixture in Brazilians, whose chromosomes are mosaics of fragments of Native American, European, and African origins, we used genome-wide data to perform admixture mapping/fine-mapping of body mass index (BMI) in three Brazilian population-based cohorts from Northeast (Salvador), Southeast (Bambui), and South (Pelotas). Results: We found significant associations with African-associated alleles in children from Salvador (PALD1 and ZMIZ1 genes), and in young adults from Pelotas (NOD2 and MTUS2 genes). More importantly, in Pelotas, rs114066381, mapped in a potential regulatory region, is significantly associated only in females (p = 2.76e-06). This variant is rare in Europeans but with frequencies of similar to 3% in West Africa and has a strong female-specific effect (95% CI: 2.32-5.65 kg/m(2) per each A allele). We confirmed this sex-specific association and replicated its strong effect for an adjusted fat mass index in the same Pelotas cohort, and for BMI in another Brazilian cohort from Sao Paulo (Southeast Brazil). A meta-analysis confirmed the significant association. Remarkably, we observed that while the frequency of rs114066381-A allele ranges from 0.8 to 2.1% in the studied populations, it attains similar to 9% among women with morbid obesity from Pelotas, Sao Paulo, and Bambui. The effect size of rs114066381 is at least five times higher than the FTO SNPs rs9939609 and rs1558902, already emblematic for their high effects. Conclusions: We identified six candidate SNPs associated with BMI. rs114066381 stands out for its high effect that was replicated and its high frequency in women with morbid obesity. We demonstrate how admixed populations are a source of new relevant phenotype-associated genetic variants.
Published: 2021
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10. Long-term safety and efficacy of patisiran for hereditary transthyretin-mediated amyloidosis with polyneuropathy: 12-month results of an open-label extension study

Author: David Adams, Michael Polydefkis, Alejandra González-Duarte, Jonas Wixner, Arnt V Kristen, Hartmut H Schmidt, John L Berk, Inés Asunción Losada López, Angela Dispenzieri, Dianna Quan, Isabel M Conceição, Michel S Slama, Julian D Gillmore, Theodoros Kyriakides, Senda Ajroud-Driss, Márcia Waddington-Cruz, Michelle M Mezei, Violaine Planté-Bordeneuve, Shahram Attarian, Elizabeth Mauricio, Thomas H Brannagan, Mitsuharu Ueda, Emre Aldinc, Jing Jing Wang, Matthew T White, John Vest, Erhan Berber, Marianne T Sweetser, Teresa Coelho, Giuseppe Vita, Vincenzo Rizzo, Massimo Russo, Anna Mazzeo, Luca Gentile, Caitlin Brueckner, Victoria Lazzari, Janice Wiesman, Douglas DeLong, Jennifer Victory, James Dalton, John May, Catherine Gilmore, Saran Diallo, Emilien Delmont, Jean Pouget, Annie Verschueren, Aude-Marie Grapperon, Emmanuelle Campana-Salort, Ana Lopes, Filipa Lamas, Carlos Neves, Jose Castro, Pedro Pereira, Isabel Castro, Ana Franco, Miguel Oliveira Santos, Conceição de Azevedo Coutinho, Catarina Falcao de Campos, Antonio Hipólito Reis, Nuno Correia, Javier M Perez, Ana Martins da Silva, Cristina Alves, Marcio Cardoso, Katia Valdrez, Julia R Monte, Bernardete Pessoa, Nadia Guimaraes, Monica Freitas, Joana Ramalho, Natalia Ferreira, Daisuke Kuzume, Celine Tard, Nawal Waucquier, Isabelle Rougeaux, Sylvie Brice, Emmanuelle Kasprzyk, Elise Elrezzi, Sayah Meguig, Eric Hachulla, Clement Gauvain, Maria-Claire Migaud-Chervy, Dominique Deplanque, Elsa Jozefowicz, Loic Lebellec, Line Balaya-Gouraya, Nathalie Jehan Lacour, Halima Bournane, Nathalie Martin, Mongia Elabed, Niamey Sacko, Yasmine Boubrit, Amina Gaouar, Fetra Rakotondratafika, Marie Théaudin-Saliou, Cécile Cauquil-Michon, Celine Labeyrie, Adeline Not, Abdallah Al-Salameh, Anne-Lise Lecoq, Maeva Stephant, Andoni Echaniz-Laguna, Laurent Becquemont, Guillemette Beaudonnet, Vincent Algalarrondo, Ludivine Eliahou, Antoine Rousseau, Aissatou Signate, Emeline Berthelot, Jocelyn Inamo, Laetitia Vervoitte, Cecile Focseneanu, Thierry Gendre, Raphaele Arrouasse, Samar S. Ayache, Laura Ernande, Philippe Le Corvoisier, Hayet Salhi, Ariane Choumert, Vincent Ehinger, Julie Ruiz, Cyril Charlin, Thomas Megelin, Thomas H Brannagan III, Raisy Fayerman, Arreum Kim, Allan Paras, Leidy J Gonzalez, Steven Tsang, Fernanda Wajnsztajn, Jeffrey Shije, Christina Ulane, Inna Kleyman, Louis Weimer, Comana Cioroiu, Sakis Lambrianides, Rana Abu-Manneh, Eleni Zamba-Papanicolaou, Petros Agathangelou, Eleni Leonidou, Satoshi Tada, Akemi Fujita, Masahiro Nagai, Rina Ando, Yuko Hosokawa, Yuki Yamanishi, J. Scott Overcash, Elena Giardino, Leslie Boyer, Lien Dang, An Le, Tyler Nguyen, Lien Giang, Peter Sellers, Leyla Tran, Nghi Truong, Maita Vinas, Nicole Hrkman, Sarah Miller, David Nguyen, Ashley Smith, Helen Pu, Steve Li, Thao Vuong, Holly Dioso, Sinikka Green, Kia Lee, Hanh Chu, Michael Waters, Derya J Coskun, Karla A Zepeda, William O'Riordan, Laura Obici, Andrea Cortese, Alessandro Lozza, Giampaolo Merlini, Vittorio Rosti, Mario Sabatelli, Giulia Bisogni, Daniela Bernardo, Marco Luigetti, Andrea Di Paolantonio, Valeria Guglielmino, Angela Romano, Hans Nienhuis, Janita Bulthuis-Kuiper, Olga Gerk, Hannah Ulbricht, Lenka Taylor, Eva Meyle, Natalia Kleinschmidt, David Meyrath, Simone Noe-Schwenn, Ulrike Meng, Ralf Bauer, Fabian aus dem Siepen, Selina Hein, Tetsuya Takahashi, Tomohiko Oshita, Yoko Koujin, Shuichiro Neshige, Tomohisa Nezu, Akiko Segawa, Hiroki Ueno, Hiroyuki Morino, Josep M Campistol, Lida Maria Rodas Marin, Josep Miquel Blasco Pelicano, Lucía Galán Dávila, Marta Palacios, Vanesa Pytel Cordoba, Antonio Guerrero Sola, Alejandro Horga, Julián García Feijoo, Leopoldo Perez de Isla, Wilson Marques Júnior, Mariana Moscardini, Debora Cristina Litcanov, Ana Flavia Viera Lima, Leonardo Rodrigues, Barbara Marques Coutinho, Carolina Lavigne Moreira, Vanessa Daccach Marques, Francisco Munoz Beamud, Álvaro Gragera Martínez, Cristina Borrachero, Eugenia Cisneros Barroso, Adrián Rodríguez Rodríguez, Monica Sanz, Elena Rigo Oliver, Juan González Moreno, Jose M Gamez Martinez, Cristina Descals, Mercedes Uson, Francisco Jose Vega, Antoni Figuerola, Carles Montala, Moises Dias da Silva, Renata Gervais de Santa Rosa, Luiz Felipe Pinto, Marcus Vinicius Pinto, Amanda Cardoso Berensztejn, Fabio Barroso, Andrea Lautre, Lucas G Orellana, Maria Alejandra González-Duarte Briseño, Karla Cárdenas-Soto, Brenda Poled Jiménez López, Sandra Lorena Pérez-Castañeda, Carlos Gerardo Cantú Brito, David Rivera de la Parra, Jose Pablo Hernandez Reyes, Maria del Mar Saniger Alba, Elia Criollo Mora, Yesim Parman, Kus Jülide Rezzan, Erdi Sahin, Nail G Serbest, Hacer Durmus, Arman Cakar, Nuriye Ilknur Tugal Tutkun, Sacit Karamursel, Ali Elitok, Nermin G Sirin Inan, Emre Altinkurt, Jing Ye, Adriane C Allen, Vinay Chaudhry, Raquel Jarrett, Neil Bressler, Kathleen L Burks, Qingfeng Liu, Mohammad Khoshnoodi, Daniel P Judge, Geno Vista, Syed Mahmood Shah, Hirotoshi Hamaguchi, Junko Oda, Emi Fukase, Ikuko Taniguchi, Tetsuya Oda, Hironobu Endo, Masahiro Shimomura, Kimitaka Katanazaka, Shusuke Koto, Takahiro Nakano, Christof Scheid, Andreas Zueiter, Lars Pester, Doreen Walter, Betül Özdemir, Lukas F Frenzel, Udo Holtick, Jeeyoung Oh, Hee Jin Kim, Hyun Jin Shin, Kyomin Choi, Taro Yamashita, Teruaki Masuda, Yohei Misumi, Akihiko Ueda, Keiichi Nakahara, Akiko Yorita, Seiko Tsuruhisa, Takayuki Taniwaki, Masaya Harada, Taiga Moritaka, Naonori Sakurada, Elizabeth A Mauricio, Amber Baskin, Elliot Dimberg, Amie Fonder, Miriam Hobbs, Stephen J Russell, Peter Dyck, Wilson Gonsalves, Nelson Leung, Thomas E Witzig, Steven R Zeldenrust, Lisa Hwa, Prashant Kapoor, Shaji K Kumar, Yi Lin, John A Lust, Vincent S Rajkumar, David Dingli, Morie A Gertz, Ronald Go, Suzanne R Hayman, Samir Dalia, Esmeralda Carrillo, Peter Gorevic, Garnette Mason, Chi-Chao Chao, Ming-Jen Lee, Jen-Jen Su, Sung-Tsang Hsieh, Li-Kai Tsai, Shin-Joe Yeh, Chih-Chao Yang, Senda Ajroud-Driss Ajroud-Driss, Patricia Casey, Benjamin C Joslin, Miriam Freimer, Alison Sankey, Amanda Kenepp, Sarah Heintzman, Samantha LoRusso, Youichi Hokezu, Byoung-Joon Kim, JuHyeon Kim, Ga Yeon Lee, Eun Bin Cho, Eun-Seok Jeon, Ju-Hong Min, Jin Myoung Seok, Hye Lim Lee, Jae Hong Park, Yoshiki Sekijima, Chinatsu Miyazawa, Nagaaki Kato, Dai Kishida, Akiyo Hineno, Minori Kodaira, Tsuneaki Yoshinaga, Teruyoshi Miyahara, Akira Imai, Kazuhiko Matsumoto, Kon-Ping Lin, Yi-Chung Lee, Malin Falk, Bjorn Pilebro, Ole Suhr, Per Lindqvist, Karin Soderberg, Fatima Pedrosa-Domellöf, Intissar Anan, Erik Nordh, Ivaylo Tournev, Sashka Zhelyazkova-Glaveeva, Zheyna Cherneva, Staiko Sarafov, Teodora Chamova, Sylvia Cherninkova-Gopina, Frauke Friebel, Andree Zibert, Natasa Mihailovic, Friederike Schubert, Elena Vorona, Larissa Lahme, Anna Huesing-Kabar, Matthias Schilling, Iyad Kabar, Ana Martinez-Naharro, Liza Chacko, Oliver Cohen, Steven Law, Tamer Rezk, Helen J Lachmann, Brianna Blume, Stacy Dixon, Soon Chai Low, Soo Looi Chan, He Eng Li Lim, Khean Jin Goh, Deborah Kraus, Kristin Jack, N. Kevin Wade, Glenn Lopate, Brittany Zwijack, Julaine Florence, R. Brian Sommerville, Graeme Stewart, Julie Ryder, Linda Mekhael, Mark Taylor, Daniel Suan, Karen Wells, Paula Stone, Amenze Itoya, Mercy Owusu-Sekyere, Desmond Thai, Ilonah Chahine, Salve Pedrosa, Thi Hoa (Therese) Do, and Repositório da Universidade de Lisboa
Subjects: Adult, Male, medicine.medical_specialty, Drug-Related Side Effects and Adverse Reactions, 030204 cardiovascular system & hematology, Placebo, Severity of Illness Index, Polyneuropathies, 03 medical and health sciences, 0302 clinical medicine, Quality of life, Internal medicine, Outcome Assessment, Health Care, Severity of illness, medicine, Humans, Prealbumin, RNA, Small Interfering, Infusions, Intravenous, Adverse effect, Aged, Amyloid Neuropathies, Familial, business.industry, Middle Aged, medicine.disease, Interim analysis, amyloidosis, transthyretin, polyneuropathy, patisiran, OLE study, Clinical trial, Female, Neurology (clinical), business, Polyneuropathy, 030217 neurology & neurosurgery, Progressive disease
Abstract: © 2020 Elsevier Ltd. All rights reserved., Background: Hereditary transthyretin-mediated amyloidosis is a rare, inherited, progressive disease caused by mutations in the transthyretin (TTR) gene. We assessed the safety and efficacy of long-term treatment with patisiran, an RNA interference therapeutic that inhibits TTR production, in patients with hereditary transthyretin-mediated amyloidosis with polyneuropathy. Methods: This multicentre, open-label extension (OLE) trial enrolled patients at 43 hospitals or clinical centres in 19 countries as of Sept 24, 2018. Patients were eligible if they had completed the phase 3 APOLLO or phase 2 OLE parent studies and tolerated the study drug. Eligible patients from APOLLO (patisiran and placebo groups) and the phase 2 OLE (patisiran group) studies enrolled in this global OLE trial and received patisiran 0·3 mg/kg by intravenous infusion every 3 weeks with plans to continue to do so for up to 5 years. Efficacy assessments included measures of polyneuropathy (modified Neuropathy Impairment Score +7 [mNIS+7]), quality of life, autonomic symptoms, nutritional status, disability, ambulation status, motor function, and cardiac stress, with analysis by study groups (APOLLO-placebo, APOLLO-patisiran, phase 2 OLE patisiran) based on allocation in the parent trial. The global OLE is ongoing with no new enrolment, and current findings are based on the interim analysis of the patients who had completed 12-month efficacy assessments as of the data cutoff. Safety analyses included all patients who received one or more dose of patisiran up to the data cutoff. This study is registered with ClinicalTrials.gov, NCT02510261. Findings: Between July 13, 2015, and Aug 21, 2017, of 212 eligible patients, 211 were enrolled: 137 patients from the APOLLO-patisiran group, 49 from the APOLLO-placebo group, and 25 from the phase 2 OLE patisiran group. At the data cutoff on Sept 24, 2018, 126 (92%) of 137 patients from the APOLLO-patisiran group, 38 (78%) of 49 from the APOLLO-placebo group, and 25 (100%) of 25 from the phase 2 OLE patisiran group had completed 12-month assessments. At 12 months, improvements in mNIS+7 with patisiran were sustained from parent study baseline with treatment in the global OLE (APOLLO-patisiran mean change -4·0, 95 % CI -7·7 to -0·3; phase 2 OLE patisiran -4·7, -11·9 to 2·4). Mean mNIS+7 score improved from global OLE enrolment in the APOLLO-placebo group (mean change from global OLE enrolment -1·4, 95% CI -6·2 to 3·5). Overall, 204 (97%) of 211 patients reported adverse events, 82 (39%) reported serious adverse events, and there were 23 (11%) deaths. Serious adverse events were more frequent in the APOLLO-placebo group (28 [57%] of 49) than in the APOLLO-patisiran (48 [35%] of 137) or phase 2 OLE patisiran (six [24%] of 25) groups. The most common treatment-related adverse event was mild or moderate infusion-related reactions. The frequency of deaths in the global OLE was higher in the APOLLO-placebo group (13 [27%] of 49), who had a higher disease burden than the APOLLO-patisiran (ten [7%] of 137) and phase 2 OLE patisiran (0 of 25) groups. Interpretation: In this interim 12-month analysis of the ongoing global OLE study, patisiran appeared to maintain efficacy with an acceptable safety profile in patients with hereditary transthyretin-mediated amyloidosis with polyneuropathy. Continued long-term follow-up will be important for the overall assessment of safety and efficacy with patisiran.
Published: 2021
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11. MUC22, HLA-A, and HLA-DOB variants and COVID-19 in resilient super-agers from Brazil

Author: Erick C. Castelli, Mateus V. de Castro, Michel S. Naslavsky, Marilia O. Scliar, Nayane S. B. Silva, Raphaela N. Pereira, Viviane A. O. Ciriaco, Camila F. B. Castro, Celso T. Mendes-Junior, Etiele de S. Silveira, Iuri M. de Oliveira, Eduardo C. Antonio, Gustavo F. Vieira, Diogo Meyer, Kelly Nunes, Larissa R. B. Matos, Monize V. R. Silva, Jaqueline Y. T. Wang, Joyce Esposito, Vivian R. Cória, Jhosiene Y. Magawa, Keity S. Santos, Edecio Cunha-Neto, Jorge Kalil, Raul H. Bortolin, Mário Hiroyuki Hirata, Luiz P. Dell’Aquila, Alvaro Razuk-Filho, Pedro B. Batista-Júnior, Amaro N. Duarte-Neto, Marisa Dolhnikoff, Paulo H. N. Saldiva, Maria Rita Passos-Bueno, and Mayana Zatz
Subjects: IDOSOS, HLA-A Antigens, SARS-CoV-2, Immunology, Genes, MHC Class II, Immunology and Allergy, Humans, COVID-19, Brazil, Aged
Abstract: BackgroundAlthough aging correlates with a worse prognosis for Covid-19, super elderly still unvaccinated individuals presenting mild or no symptoms have been reported worldwide. Most of the reported genetic variants responsible for increased disease susceptibility are associated with immune response, involving type I IFN immunity and modulation; HLA cluster genes; inflammasome activation; genes of interleukins; and chemokines receptors. On the other hand, little is known about the resistance mechanisms against SARS-CoV-2 infection. Here, we addressed polymorphisms in the MHC region associated with Covid-19 outcome in super elderly resilient patients as compared to younger patients with a severe outcome.MethodsSARS-CoV-2 infection was confirmed by RT-PCR test. Aiming to identify candidate genes associated with host resistance, we investigated 87 individuals older than 90 years who recovered from Covid-19 with mild symptoms or who remained asymptomatic following positive test for SARS-CoV-2 as compared to 55 individuals younger than 60 years who had a severe disease or died due to Covid-19, as well as to the general elderly population from the same city. Whole-exome sequencing and an in-depth analysis of the MHC region was performed. All samples were collected in early 2020 and before the local vaccination programs started.ResultsWe found that the resilient super elderly group displayed a higher frequency of some missense variants in the MUC22 gene (a member of the mucins’ family) as one of the strongest signals in the MHC region as compared to the severe Covid-19 group and the general elderly control population. For example, the missense variant rs62399430 at MUC22 is two times more frequent among the resilient super elderly (p = 0.00002, OR = 2.24).ConclusionSince the pro-inflammatory basal state in the elderly may enhance the susceptibility to severe Covid-19, we hypothesized that MUC22 might play an important protective role against severe Covid-19, by reducing overactive immune responses in the senior population.
Published: 2022

12. Nationwide trends in drug-coated balloon and drug-eluting stent utilization in the femoropopliteal arteries

Author: Zein Saadeddin, Abhisekh Mohapatra, Michael C. Madigan, Mohammad H. Eslami, Michel S. Makaroun, Georges E. Al-Khoury, and Daniel J. Bertges
Subjects: Male, medicine.medical_specialty, Atherectomy, medicine.medical_treatment, 030204 cardiovascular system & hematology, Balloon, Article, Lesion, Peripheral Arterial Disease, 03 medical and health sciences, 0302 clinical medicine, Coated Materials, Biocompatible, Angioplasty, medicine.artery, medicine, Humans, Popliteal Artery, 030212 general & internal medicine, Aged, Retrospective Studies, Aged, 80 and over, business.industry, Stent, Drug-Eluting Stents, Middle Aged, United States, Popliteal artery, Surgery, Femoral Artery, medicine.anatomical_structure, Drug-eluting stent, Female, medicine.symptom, Cardiology and Cardiovascular Medicine, business, Equipment and Supplies Utilization, Angioplasty, Balloon, Artery
Abstract: Drug-coated balloons (DCB) and drug-eluting stents (DES) have significantly altered treatment paradigms for femoropopliteal lesions. We aimed to describe changes in practice patterns as a result of the infusion of these technologies into the treatment of peripheral arterial disease.We queried the Vascular Quality Initiative registry from 2010 to 2017 for all peripheral vascular interventions involving the superficial femoral artery and/or the popliteal artery. Cases were divided into a PRE and a POST era with a cutoff of September 2016, when specific device identity was first recorded in Vascular Quality Initiative. For each artery, a primary treatment was identified as either plain balloon angioplasty, atherectomy, DCB, bare-metal stent, or DES. The relative distribution of primary treatments between the PRE and POST eras was evaluated, as were lesion characteristics associated with DCB and DES use and regional variability in the adoption of these new technologies.Of 210,666 arteries in the dataset, 91,864 femoropopliteal arteries (across 74,842 procedures in 55,437 patients) were included. Each artery received 1.5 ± 0.6 treatments. Primary treatment use changed from 40% balloon angioplasty, 45% stenting, and 15% atherectomy in the PRE era to 22% plain balloon angioplasty, 26% bare-metal stent, 8% atherectomy, 37% DCB, and 8% DES in the POST era (P .001). Forty-three percent of arteries received a drug-containing device as a primary or adjunctive therapy and 1.3% received both a DCB and DES in the POST era. DCB use as the primary treatment was highest in lesions with length 10.0 to 19.9 cm (42%), TransAtlantic InterSociety A, B, or C lesions (38%), and lesions with mild to no calcification (38%). DES use was highest in lesions with a length of 20 cm or more (12%), TransAtlantic InterSociety D lesions (13%), and lesions with moderate to severe calcification (9%). The range of use across 18 regions was 125 to 40% for DCB and 1% to 14% for DES. Regional variability was greater for DES (SD 4% vs mean 8%) than for DCB (SD 7% vs mean 29%).There has been a rapid dissemination of DCB and DES technology in the femoropopliteal vessels, with nearly one-half of arteries receiving a drug-containing therapy in modern practice. DCBs are most used in medium length, minimally calcified lesions and DESs are most used in longer, more heavily calcified lesions. There is significant regional variability in adoption, especially with DES.
Published: 2020
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13. Quantitative analysis of mRNA-1273 COVID-19 vaccination response in immunocompromised adult hematology patients

Author: Sabine Haggenburg, Birgit I. Lissenberg-Witte, Rob S. van Binnendijk, Gerco den Hartog, Michel S. Bhoekhan, Nienke J. E. Haverkate, Dennis M. de Rooij, Johan van Meerloo, Jacqueline Cloos, Neeltje A. Kootstra, Dorine Wouters, Suzanne S. Weijers, Ester M. M. van Leeuwen, Hetty J. Bontkes, Saïda Tonouh-Aajoud, Mirjam H. M. Heemskerk, Rogier W. Sanders, Elianne Roelandse-Koop, Quincy Hofsink, Kazimierz Groen, Lucia Çetinel, Louis Schellekens, Yvonne M. den Hartog, Belle Toussaint, Iris M. J. Kant, Thecla Graas, Emma de Pater, Willem A. Dik, Marije D. Engel, Cheyenne R. N. Pierie, Suzanne R. Janssen, Edith van Dijkman, Meliawati Poniman, Judith A. Burger, Joey H. Bouhuijs, Gaby Smits, Nynke Y. Rots, Sonja Zweegman, Arnon P. Kater, Tom van Meerten, Pim G. N. J. Mutsaers, Jaap A. van Doesum, Annoek E. C. Broers, Marit J. van Gils, Abraham Goorhuis, Caroline E. Rutten, Mette D. Hazenberg, Inger S. Nijhof, Hematology laboratory, AII - Cancer immunology, CCA - Cancer biology and immunology, Laboratory Medicine, Amsterdam Gastroenterology Endocrinology Metabolism, Hematology, Immunology, Stem Cell Aging Leukemia and Lymphoma (SALL), Graduate School, Clinical Haematology, Experimental Immunology, APH - Aging & Later Life, AII - Infectious diseases, Laboratory for General Clinical Chemistry, Medical Microbiology and Infection Prevention, Infectious diseases, and APH - Global Health
Subjects: COVID-19 Vaccines, SARS-CoV-2, COVID-19/prevention & control, Vaccination, COVID-19, Regular Article, lymphoma, Hematology, acute myeloid leukemia, myelodysplastic syndrome, mRNA-1273, multiple myeloma, SDG 3 - Good Health and Well-being, chronic myeloid leukemia, humoral immunity, hemic and lymphatic diseases, hematopoietic stem cell transplantation, hematologic malignancy, chronic lymphocytic leukemia, CAR T cell therapy, Humans, IgG antibodies, sickle cell disease, myeloproliferative disease, 2019-nCoV Vaccine mRNA-1273
Abstract: Vaccination guidelines for patients treated for hematological diseases are typically conservative. Given their high risk for severe COVID-19, it is important to identify those patients that benefit from vaccination. We prospectively quantified serum immunoglobulin G (IgG) antibodies to spike subunit 1 (S1) antigens during and after 2-dose mRNA-1273 (Spikevax/Moderna) vaccination in hematology patients. Obtaining S1 IgG ≥ 300 binding antibody units (BAUs)/mL was considered adequate as it represents the lower level of S1 IgG concentration obtained in healthy individuals, and it correlates with potent virus neutralization. Selected patients (n = 723) were severely immunocompromised owing to their disease or treatment thereof. Nevertheless, >50% of patients obtained S1 IgG ≥ 300 BAUs/mL after 2-dose mRNA-1273. All patients with sickle cell disease or chronic myeloid leukemia obtained adequate antibody concentrations. Around 70% of patients with chronic graft-versus-host disease (cGVHD), multiple myeloma, or untreated chronic lymphocytic leukemia (CLL) obtained S1 IgG ≥ 300 BAUs/mL. Ruxolitinib or hypomethylating therapy but not high-dose chemotherapy blunted responses in myeloid malignancies. Responses in patients with lymphoma, patients with CLL on ibrutinib, and chimeric antigen receptor T-cell recipients were low. The minimal time interval after autologous hematopoietic cell transplantation (HCT) to reach adequate concentrations was
Published: 2022
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14. Recurrence of COVID-19 associated with reduced T-cell responses in a monozygotic twin pair

Author: Mateus V. de Castro, Keity S. Santos, Juliana S. Apostolico, Edgar R. Fernandes, Rafael R. Almeida, Gabriel Levin, Jhosiene Y. Magawa, João Paulo S. Nunes, Mirian Bruni, Marcio M. Yamamoto, Ariane C. Lima, Monize V. R. Silva, Larissa R. B. Matos, Vivian R. Coria, Erick C. Castelli, Marilia O. Scliar, Andreia Kuramoto, Fernanda R. Bruno, Lucas C. Jacintho, Kelly Nunes, Jaqueline Y. T. Wang, Veronica P. Coelho, Miguel Mitne Neto, Rui M. B. Maciel, Michel S. Naslavsky, Maria Rita Passos-Bueno, Silvia B. Boscardin, Daniela S. Rosa, Jorge Kalil, Mayana Zatz, Edecio Cunha-Neto, Universidade de São Paulo (USP), Instituto Nacional de Ciência e Tecnologia - Iii-INCT, Universidade Federal de São Paulo (UNIFESP), Universidade Estadual Paulista (UNESP), and Fleury Laboratory
Subjects: Adult, Male, Immunity, Cellular, recurrence, Adolescent, SARS-CoV-2, QH301-705.5, T-Lymphocytes, Research, severe acute respiratory distress syndrome coronavirus 2, General Neuroscience, Immunology, Epitopes, T-Lymphocyte, COVID-19, T cell, Twins, Monozygotic, twins, immunity, General Biochemistry, Genetics and Molecular Biology, Humans, Female, Biology (General), IMUNOGENÉTICA, Research Articles
Abstract: Made available in DSpace on 2022-04-29T08:46:34Z (GMT). No. of bitstreams: 0 Previous issue date: 2022-01-01 Recurrence of COVID-19 in recovered patients has been increasingly reported. However, the immune mechanisms behind the recurrence have not been thoroughly investigated. The presence of neutralizing antibodies (nAbs) in recurrence/reinfection cases suggests that other types of immune response are involved in protection against recurrence. Here, we investigated the innate type I/III interferon (IFN) response, binding and nAb assays and T-cell responses to severe acute respiratory distress syndrome coronavirus 2 (SARS-CoV-2) with IFN gamma (IFNγ) enzyme-linked spot assay (ELISPOT) in three pairs of young adult monozygotic (MZ) twins with previous confirmed COVID-19, one of them presenting a severe recurrence four months after the initial infection. Twin studies have been of paramount importance to comprehend the immunogenetics of infectious diseases. Each MZ twin pair was previously exposed to SARS-CoV-2, as seen by clinical reports. The six individuals presented similar overall recovered immune responses except for the recurrence case, who presented a drastically reduced number of recognized SARS-CoV-2 T-cell epitopes on ELISPOT as compared to her twin sister and the other twin pairs. Our results suggest that the lack of a broad T-cell response to initial infection may have led to recurrence, emphasizing that an effective SARS-CoV-2-specific T-cell immune response is key for complete viral control and avoidance of clinical recurrence of COVID-19. Human Genome and Stem Cell Research Center (HUG-CELL) Biosciences Institute Universidade de São Paulo, SP Laboratory of Immunology Heart Institute (InCor) Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), SP Institute for Investigation in Immunology Instituto Nacional de Ciência e Tecnologia - Iii-INCT, SP Division of Clinical Immunology and Allergy Department of Medicine Faculdade de Medicina da Universidade de São Paulo (FMUSP), SP Department of Microbiology Immunology and Parasitology Universidade Federal de São Paulo (UNIFESP/EPM), SP Department of Parasitology Biosciences Institute Universidade de São Paulo, SP School of Medicine Universidade Estadual Paulista (UNESP), SP Fleury Laboratory, SP School of Medicine Universidade Estadual Paulista (UNESP), SP
Published: 2022
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15. Associations between organised leisure-time activities and mental health problems in children

Author: Mirte, Boelens, Michel S, Smit, Dafna A, Windhorst, Harrie J, Jonkman, Clemens M H, Hosman, Hein, Raat, and Wilma, Jansen
Subjects: Cross-Sectional Studies, Leisure Activities, Mental Health, Adolescent, Humans, Child, Exercise, Sports
Abstract: Previous studies conducted mainly among adolescents have found associations between participation in sport organised leisure-time activities (OLTAs) and mental health problems (MHP). Fewer research studies have been performed to primary school-aged children and to organised non-sport OLTAs. Therefore, the objective is to examine whether there is an association between participation in sport and non-sport OLTAs and a high risk of MHP in 4- to 12-year-olds. Data were used on 5010 children from a cross-sectional population-based survey conducted between May and July 2018 in Rotterdam, the Netherlands. Associations between sport OLTAs, non-sport OLTAs and breadth of OLTAs and a high risk of MHP were explored using logistic regression models adjusting for sociodemographic characteristics, stressful life events and physical activity. Of all children, 58% participated in sport OLTAs and 22% in non-sport OLTAs. The proportion of children with high risk of MHP among participants in sport OLTAs is smaller than among non-participants (OR 0.66, 95% CI: 0.53, 0.81). The proportion of children with high risk of MHP among participants in non-sport OLTAs is smaller than among non-participants (OR 0.69, 95% CI: 0.53, 0.91). The proportion of children with a high risk of MHP among participants in 1 category of OLTAs (OR 0.61, 95% CI: 0.49, 0.76) and in 2-5 categories of OLTAs (OR 0.48, 95% CI: 0.32, 0.71) is smaller than among non-participants. Conclusion: The proportion of children with high risk of MHP among participants in OLTAs is smaller than among non-participants. What is Known: • Around 10--20% of children and adolescents experiences mental health problems. • Sport organised leisure-time activities have been found to be associated with a lower risk of mental health problems in adolescents. What is New: • The proportion of children with a high risk of mental health problems in participants in organised leisure-time activities is smaller than among non-participants. • The proportion of children with a high risk of mental health problems in participants with a higher breadth of organised leisure-time activities is smaller compared to non-participants.
Published: 2022

16. Whole-genome sequencing of 1,171 elderly admixed individuals from São Paulo, Brazil

Author: Michel S, Naslavsky, Marilia O, Scliar, Guilherme L, Yamamoto, Jaqueline Yu Ting, Wang, Stepanka, Zverinova, Tatiana, Karp, Kelly, Nunes, José Ricardo Magliocco, Ceroni, Diego Lima, de Carvalho, Carlos Eduardo, da Silva Simões, Daniel, Bozoklian, Ricardo, Nonaka, Nayane, Dos Santos Brito Silva, Andreia, da Silva Souza, Heloísa, de Souza Andrade, Marília Rodrigues Silva, Passos, Camila Ferreira Bannwart, Castro, Celso T, Mendes-Junior, Rafael L V, Mercuri, Thiago L A, Miller, Jose Leonel, Buzzo, Fernanda O, Rego, Nathalia M, Araújo, Wagner C S, Magalhães, Regina Célia, Mingroni-Netto, Victor, Borda, Heinner, Guio, Carlos P, Rojas, Cesar, Sanchez, Omar, Caceres, Michael, Dean, Mauricio L, Barreto, Maria Fernanda, Lima-Costa, Bernardo L, Horta, Eduardo, Tarazona-Santos, Diogo, Meyer, Pedro A F, Galante, Victor, Guryev, Erick C, Castelli, Yeda A O, Duarte, Maria Rita, Passos-Bueno, Mayana, Zatz, Universidade de São Paulo (USP), Hospital Israelita Albert Einstein, Harvard Medical School, Laboratório DASA, University Medical Center Groningen, Universidade Estadual Paulista (UNESP), Hospital Sirio-Libanes, Universidade Federal de Minas Gerais (UFMG), Instituto Mário Penna, Instituto Nacional de Salud, Universidad de Huánuco, National Cancer Institute, Universidade Federal da Bahia (UFBA), Fundação Oswaldo Cruz, Universidade Federal de Pelotas, and Universidad Peruana Cayetano Heredia
Subjects: Whole Genome Sequencing, Haplotypes, Genome, Human, Humans, Rare variants, Genomics, Metagenomics, Structural variation, Polymorphism, Single Nucleotide, Data publication and archiving, Brazil, Mobile elements, Aged
Abstract: Made available in DSpace on 2022-04-29T08:46:40Z (GMT). No. of bitstreams: 0 Previous issue date: 2022-12-01 National Institute of General Medical Sciences As whole-genome sequencing (WGS) becomes the gold standard tool for studying population genomics and medical applications, data on diverse non-European and admixed individuals are still scarce. Here, we present a high-coverage WGS dataset of 1,171 highly admixed elderly Brazilians from a census-based cohort, providing over 76 million variants, of which ~2 million are absent from large public databases. WGS enables identification of ~2,000 previously undescribed mobile element insertions without previous description, nearly 5 Mb of genomic segments absent from the human genome reference, and over 140 alleles from HLA genes absent from public resources. We reclassify and curate pathogenicity assertions for nearly four hundred variants in genes associated with dominantly-inherited Mendelian disorders and calculate the incidence for selected recessive disorders, demonstrating the clinical usefulness of the present study. Finally, we observe that whole-genome and HLA imputation could be significantly improved compared to available datasets since rare variation represents the largest proportion of input from WGS. These results demonstrate that even smaller sample sizes of underrepresented populations bring relevant data for genomic studies, especially when exploring analyses allowed only by WGS. Human Genome and Stem Cell Research Center University of São Paulo, SP Department of Genetics and Evolutionary Biology Biosciences Institute University of São Paulo, SP Hospital Israelita Albert Einstein, SP Instituto da Criança Faculdade de Medicina da Universidade de São Paulo, SP Orthopedic Research Labs Boston Children’s Hospital and Department of Genetics Harvard Medical School Laboratório DASA Laboratory of Genome Structure and Ageing European Research Institute for the Biology of Ageing University Medical Center Groningen São Paulo State University (UNESP) Molecular Genetics and Bioinformatics Laboratory School of Medicine, State of São Paulo São Paulo State University (UNESP) Department of Pathology School of Medicine, State of São Paulo Departamento de Química Faculdade de Filosofia Ciências e Letras de Ribeirão Preto Universidade de São Paulo, São Paulo Centro de Oncologia Molecular Hospital Sirio-Libanes Department of Biochemistry Institute of Chemistry University of São Paulo São Paulo Bioinformatics Graduate program University of São Paulo Departamento de Genética Ecologia e Evolução Instituto de Ciências Biológicas Universidade Federal de Minas Gerais, MG Núcleo de Ensino e Pesquisa Instituto Mário Penna, MG Laboratorio de Biotecnologia y Biologia Molecular Instituto Nacional de Salud Universidad de Huánuco Division of Cancer Epidemiology and Genetics National Cancer Institute Instituto de Saúde Coletiva Universidade Federal da Bahia, BA Center for Data and Knowledge Integration for Health Institute Gonçalo Muniz Fundação Oswaldo Cruz, BA Instituto de Pesquisas René Rachou Fundação Oswaldo Cruz, MG Programa De Pós-Graduação em Saúde Pública Universidade Federal de Minas Gerais, MG Programa de Pós-Graduação em Epidemiologia Universidade Federal de Pelotas, RS Mosaico Translational Genomics Initiative Universidade Federal de Minas Gerais, MG Facultad de Salud Pública y Administración Universidad Peruana Cayetano Heredia Instituto de Estudos Avançados Transdisciplinares Universidade Federal de Minas Gerais, MG Medical-Surgical Nursing Department School of Nursing University of São Paulo, SP Epidemiology Department Public Health School University of São Paulo, SP São Paulo State University (UNESP) Molecular Genetics and Bioinformatics Laboratory School of Medicine, State of São Paulo São Paulo State University (UNESP) Department of Pathology School of Medicine, State of São Paulo National Institute of General Medical Sciences: R01 GM075091
Published: 2022

17. The 90 plus: longevity and COVID-19 survival

Author: Mayana, Zatz, Monize V R, Silva, Mateus V, de Castro, and Michel S, Naslavsky
Subjects: Aged, 80 and over, Cohort Studies, Longevity, COVID-19, Humans, Brazil, Genetic Association Studies, Aged
Abstract: The world population is getting older and studies aiming to enhance our comprehension of the underlying mechanisms responsible for health span are of utmost interest for longevity and as a measure for health care. In this review, we summarized previous genetic association studies (GWAS) and next-generation sequencing (NGS) of elderly cohorts. We also present the updated hypothesis for the aging process, together with the factors associated with healthy aging. We discuss the relevance of studying older individuals and build databanks to characterize the presence and resistance against late-onset disorders. The identification of about 2 million novel variants in our cohort of more than 1000 elderly Brazilians illustrates the importance of studying highly admixed populations of non-European ancestry. Finally, the ascertainment of nonagenarians and particularly of centenarians who were recovered from COVID-19 or remained asymptomatic opens new avenues of research aiming to enhance our comprehension of biological mechanisms associated with resistance against pathogens.
Published: 2021

18. Endovascular repair of abdominal and thoracoabdominal aneurysms using chimneys and periscopes is associated with poor outcomes

Author: Patrick Cherfan, Othman M. Abdul-Malak, Nathan L. Liang, Mohammad H. Eslami, Michael J. Singh, Michel S. Makaroun, and Rabih A. Chaer
Subjects: Blood Vessel Prosthesis Implantation, Treatment Outcome, Endoleak, Endovascular Procedures, Humans, Surgery, Stents, Cardiology and Cardiovascular Medicine, Prosthesis Design, Aortography, Aortic Aneurysm, Abdominal, Blood Vessel Prosthesis, Retrospective Studies
Abstract: Chimneys and periscopes are often used to treat pararenal or thoracoabdominal aneurysms de novo or after failed open or endovascular repair. We sought to describe our institutional experience, given their limited success and questionable long-term outcomes.We retrospectively reviewed the electronic records for patients treated with chimneys/periscopes from 1997 through 2020. Baseline characteristics, procedural details, periprocedural complications, reinterventions, and midterm outcomes were collected.Fifty-eight patients (86 vessels) were treated; the median follow-up was 32 months (range, 0.03-104 months). There were 36% (n = 21) juxta-renal, 2% (n = 1) para-visceral, and 21% (n = 12) thoracoabdominal aneurysms, and 41% (n = 24) had pararenal failure of prior endovascular aneurysm repair (n = 17) or open repair (n = 7). Stent configuration for the majority of the 86 vessels (n = 80; 93%) treated were chimney configuration (n = 6 periscopes; 7%). The most common stent graft utilized was Viabahn, and 8.1% (n = 7) were reinforced with a bare metal stent. Although the majority of the cases were elective, 36.2% (n = 21) of the cases were urgent/emergent. At the conclusion of the initial procedure, 16 of 58 patients had an endoleak (gutter, 50% [8/16]; type Ia, 25% [4/16]; and type II, 25% [4/16]). On follow-up, 14 of 58 patients developed one or more endoleaks, with the most common endoleaks being a gutter endoleak (35% [7/20]). Other endoleaks observed included 30% (6/20) type III, 15% (3/20) type Ia, 15% (3/20) type Ib, and 5% (1/20) type II. Eleven of 58 patients underwent interventions for one or more endoleak (gutter, 33% [5/15]; type Ib, 20% [3/15]; type II, 7% [1/15]; and type III, 40% [6/15]). Twelve of 58 patients returned to the operating room for one or more procedures during the index hospitalization (five laparotomies, three dialysis access, three acute limb ischemia, and four chimney/periscope interventions). Ten of 58 patients underwent angioplasty/stenting for chimney/periscope compression or occlusion during the follow-up period. Survival was 61.3% at 1 year by Kaplan-Meier analysis (75% for elective, 37% for urgent/emergent) (aneurysm-related death, 22%). Cox hazard modeling showed that aneurysm diameter (hazard ratio, 1.03; 95% confidence interval, 1.004-1.05; P = .02) and urgent/emergent interventions (hazard ratio, 3.6; 95% confidence interval, 1.33-9.74; P = .01) were predictors of mortality.Endovascular repair of aortic aneurysms with chimneys/periscopes is associated with poor outcomes, including limited technical success and aneurysm exclusion, as well as high morbidity and mortality, with a high rate of reinterventions both in the immediate postoperative period and on follow-up. They should be used only when other surgical or endovascular options are not possible.
Published: 2021

19. Characterization of immediate and early mortality after repair of ruptured abdominal aortic aneurysm

Author: Katherine M. Reitz, Amanda R. Phillips, Edith Tzeng, Michel S. Makaroun, Christine M. Leeper, and Nathan L. Liang
Subjects: Male, Aged, 80 and over, Aortic Rupture, Endovascular Procedures, Middle Aged, Blood Vessel Prosthesis Implantation, Treatment Outcome, Risk Factors, Odds Ratio, Humans, Female, Surgery, Cardiology and Cardiovascular Medicine, Aged, Aortic Aneurysm, Abdominal, Retrospective Studies
Abstract: We sought to compare immediate and early mortality among patients undergoing ruptured abdominal aortic aneurysm (RAAA) repair. Evaluation of RAAA has focused on 30-day postoperative mortality. Other emergency conditions such as trauma have demonstrated a multimodal mortality distribution within the 30-day window, expanding the pathophysiologic understanding and allowing for intervention investigations with practice changing and lifesaving results. However, the temporal distribution and risk factors of postoperative morbidity and mortality in RAAA have yet to be investigated.We evaluated factors associated with RAAA postoperative mortality in immediate (1 day) and early (1-30 days) postoperative periods in a landmarked retrospective cohort study using data from the Vascular Quality Initiative (2010-2020).We identified 5157 RAAA repairs (mean age, 72 ± 10 years; 77% male; 88% White; 61% endovascular). The mortality rate in the immediate period was 10.2% (528/5157) and the early mortality rate was 22.1% (918/4163). In multivariable regression analyses, signs of hemorrhagic shock (ie, hemoglobin 7 g/dL: adjusted odds ratio [aOR], 1.87 [95% confidence interval [CI], 1.14-3.06]; any preoperative systolic blood pressure 70 mm Hg: aOR, 1.40 [95% CI, 1.04-1.89]; and estimated blood loss40%: aOR, 3.65 [95% CI, 2.29-5.83]) were associated with an increased risk of immediate mortality. Comorbid conditions (heart failure: aOR, 1.38 [95% CI, 1.00-1.92]; pulmonary disease: aOR, 1.29 [95% CI, 1.05-1.58]; elevated creatinine: aOR 1.26 [95% CI, 1.31-1.41]) were associated with increased risk of early mortality.Immediate deaths were associated predominantly with shock from massive hemorrhage, whereas early deaths were associated with comorbid conditions predisposing patients to multisystem organ failure despite successful repair. These temporal distinctions should guide future mechanistic and intervention evaluations to improve RAAA mortality.
Published: 2022
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20. Retooling vascular surgery manpower

Author: Michel S. Makaroun
Subjects: Workforce, Humans, Surgery, Cardiology and Cardiovascular Medicine, Vascular Surgical Procedures, Specialties, Surgical
Published: 2021

21. MHC Variants Associated With Symptomatic

Author: Erick C, Castelli, Mateus V, de Castro, Michel S, Naslavsky, Marilia O, Scliar, Nayane S B, Silva, Heloisa S, Andrade, Andreia S, Souza, Raphaela N, Pereira, Camila F B, Castro, Celso T, Mendes-Junior, Diogo, Meyer, Kelly, Nunes, Larissa R B, Matos, Monize V R, Silva, Jaqueline Y T, Wang, Joyce, Esposito, Vivian R, Coria, Raul H, Bortolin, Mario H, Hirata, Jhosiene Y, Magawa, Edecio, Cunha-Neto, Verônica, Coelho, Keity S, Santos, Maria Lucia C, Marin, Jorge, Kalil, Miguel, Mitne-Neto, Rui M B, Maciel, Maria Rita, Passos-Bueno, and Mayana, Zatz
Subjects: Adult, Male, Genotype, SARS-CoV-2, Immunology, COVID-19, Middle Aged, Major Histocompatibility Complex, HLA, resistance, MICB, Histocompatibility Antigens, MICA, Exome Sequencing, Humans, asymptomatic, Female, Genetic Predisposition to Disease, MHC, Asymptomatic Infections, Brazil, Aged, Original Research
Abstract: Despite the high number of individuals infected by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) who develop coronavirus disease 2019 (COVID-19) symptoms worldwide, many exposed individuals remain asymptomatic and/or uninfected and seronegative. This could be explained by a combination of environmental (exposure), immunological (previous infection), epigenetic, and genetic factors. Aiming to identify genetic factors involved in immune response in symptomatic COVID-19 as compared to asymptomatic exposed individuals, we analyzed 83 Brazilian couples where one individual was infected and symptomatic while the partner remained asymptomatic and serum-negative for at least 6 months despite sharing the same bedroom during the infection. We refer to these as “discordant couples”. We performed whole-exome sequencing followed by a state-of-the-art method to call genotypes and haplotypes across the highly polymorphic major histocompatibility complex (MHC) region. The discordant partners had comparable ages and genetic ancestry, but women were overrepresented (65%) in the asymptomatic group. In the antigen-presentation pathway, we observed an association between HLA-DRB1 alleles encoding Lys at residue 71 (mostly DRB1*03:01 and DRB1*04:01) and DOB*01:02 with symptomatic infections and HLA-A alleles encoding 144Q/151R with asymptomatic seronegative women. Among the genes related to immune modulation, we detected variants in MICA and MICB associated with symptomatic infections. These variants are related to higher expression of soluble MICA and low expression of MICB. Thus, quantitative differences in these molecules that modulate natural killer (NK) activity could contribute to susceptibility to COVID-19 by downregulating NK cell cytotoxic activity in infected individuals but not in the asymptomatic partners.
Published: 2021

22. Impact of Medicaid Expansion of the Affordable Care on the Outcomes of Lower Extremity Bypass for Patients With Peripheral Artery Disease in the Vascular Quality Initiative Database

Author: Mohammad H. Eslami, Michel S. Makaroun, Hanaa Dakour-Aridi, Efthymios D. Avgerinos, and Mahmoud B. Malas
Subjects: Adult, Male, medicine.medical_specialty, Arterial disease, media_common.quotation_subject, Disease, Peripheral Arterial Disease, 03 medical and health sciences, Postoperative Complications, 0302 clinical medicine, medicine, Humans, Quality (business), Aged, Retrospective Studies, media_common, Aged, 80 and over, Medicaid, business.industry, Patient Protection and Affordable Care Act, Background data, Middle Aged, Quality Improvement, United States, Treatment Outcome, Lower Extremity, 030220 oncology & carcinogenesis, Emergency medicine, Female, 030211 gastroenterology & hepatology, Surgery, Lower extremity bypass, business, Vascular Surgical Procedures, Facilities and Services Utilization, Follow-Up Studies, Insurance coverage
Abstract: The aim of this study was to evaluate changes in the utilization and outcomes of surgery after Medicaid Expansion (ME) for patients with peripheral artery disease (PAD).Recent studies have demonstrated increased insurance coverage and improved care with the Affordable Care Act's (ACA) state expansion of Medicaid.Infrainguinal bypass procedures performed due to occlusive pathology in the Vascular Quality Initiative database between 2010 and 2017 were included. Primary outcomes including postoperative mortality and major adverse limb events (MALE) at 1-year of follow-up were analyzed using interrupted time-series analysis (ITS).Out of 26,446 infrainguinal bypass procedures, 13,955 (52.8%) were included in this analysis. ME states witnessed an annual decrease in infrainguinal surgery for acute ischemia [annual change in post vs pre-ME period (95% confidence interval): -4.3% (-7.5% to -1.0%), P = 0.02] and an increase in revascularization for claudication [3.7% (1.7%-5.6%), P = 0.01]. Among nonacute cases, elective procedures increased in ME states [3.9% (0.1%-7.7%), P = 0.05] along with a significant annual decrease in in-hospital mortality [-0.4% (-0.8 to -0.02), P = 0.04) and MALE at 1 year of follow up [-9.0% (-20.3 to 2.3), P = 0.09]. These results were statistically significant after comparing them with the annual trend changes in states which did not adopt ME.The adoption of ME in 2014 was associated with significant increase in the use of infrainguinal bypass for nonsevere and elective cases, along with improved in-hospital mortality and MALE at 1 year. Longer follow-up is needed to evaluate the impact of ME on other aspects of care and longer term outcomes of PAD patients.
Published: 2019
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23. Immediate-access grafts provide comparable patency to standard grafts, with fewer reinterventions and catheter-related complications

Author: Theodore H. Yuo, Eric S. Hager, Jason K. Wagner, Efthymios D. Avgerinos, Adham N. Abou Ali, Rabih A. Chaer, Sandra Truong, Ellen D. Dillavou, Uttara Nag, and Michel S. Makaroun
Subjects: Adult, Male, Catheterization, Central Venous, medicine.medical_specialty, Prosthesis-Related Infections, Time Factors, Adolescent, medicine.medical_treatment, 030204 cardiovascular system & hematology, Prosthesis Design, Article, Young Adult, 03 medical and health sciences, Arteriovenous Shunt, Surgical, Catheters, Indwelling, 0302 clinical medicine, Renal Dialysis, Risk Factors, Interquartile range, North Carolina, medicine, Overall survival, Central Venous Catheters, Humans, 030212 general & internal medicine, Tunneled catheter, Device Removal, Vascular Patency, Aged, Retrospective Studies, Aged, 80 and over, Proportional hazards model, business.industry, Graft Occlusion, Vascular, Dialysis catheter, Middle Aged, Pennsylvania, Blood Vessel Prosthesis, Surgery, Catheter, Treatment Outcome, Female, Hemodialysis, Arteriovenous grafts, Cardiology and Cardiovascular Medicine, business
Abstract: BACKGROUND: No independent comparisons, with midterm follow-up, of standard arteriovenous grafts (SAVGs) and immediate-access arteriovenous grafts (IAAVGs) exist. The goal of this study was to compare “real-world” performance of SAVGs and IAAVGs. METHODS: Consecutive patients who underwent placement of a hemodialysis graft between November 2014 and April 2016 were retrospectively identified from the electronic medical record and Vascular Quality Initiative database at two tertiary centers. Only primary graft placements were included for analysis. Patients were divided into two groups based on the type of graft implanted. Patients’ comorbidities, graft configuration, operative characteristics, and follow-up were collected and analyzed with respect to primary and secondary patency. Additional outcomes included graft-related complications, time to first cannulation, time to tunneled catheter removal, catheter-related complications, and overall survival. Patency was determined from the time of the index procedure; χ(2), Kaplan-Meier, and Cox regression analyses were used, with the P value set as significant at < .05. RESULTS: There were 210 grafts identified, 148 SAVGs and 62 IAAVGs. At baseline, the patients’ characteristics were similar between groups, except for a greater prevalence of preoperative central venous occlusions in the IAAVG group (16.3% vs6.8%; P < .04). Of the IAAVG group, 50 were Acuseal (W. L. Gore & Associates, Flagstaff, Ariz) and 12 were Flixene (Atrium Medical Corporation, Hudson, NH). Primary patency was similar at both 1 year (SAVG, 39.4%; IAAVG, 56.7%; P = .4) and 18 months (SAVG, 29.0%; IAAVG, 43.7%; P = .4). Secondary patency was similar at 1 year (SAVG, 50.7%; IAAVG, 52.1%; P = .73) and 18 months (SAVG, 42.3%; IAAVG, 46.3%; P = .73). Overall survival was 48% at 24 months. IAAVG patients required fewer overall additional procedures to maintain patency (mean number of procedures, 0.99 for SAVGs vs 0.61 for IAAVGs; P = .025). There was no difference in occurrence of steal syndrome (SAVG, 6.8%; IAAVG, 8.1%; P = .74) or graft infection (SAVG, 19.0%; IAAVG, 12.0%; P = .276). Seventy-five percent of all grafts were successfully cannulated, with shorter median time to first cannulation in the IAAVG group (6 days; interquartile range [IQR], 1–19 days) compared with the SAVG group (31 days; IQR, 26–47 days; P < .01). Of all pre-existing catheters, 65.75% were removed, with a shorter median time until catheter removal in the IAAVG cohort at 34 days (IQR, 22–50 days) vs 49 days (IQR, 39–67 days) in the SAVG group (P < .01). Catheter-related complications occurred less frequently in the IAAVG group (16.4% vs 2.9%; P < .045). CONCLUSIONS: IAAVGs allow earlier cannulation and tunneled catheter removal, thereby significantly decreasing catheter-related complications. Patency and infection rates were similar between SAVGs and IAAVGs, but fewer secondary procedures were performed in IAAVGs.
Published: 2019
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24. Occult type I or III endoleaks are a common cause of failure of type II endoleak treatment after endovascular aortic repair

Author: Michael C. Madigan, Michael J. Singh, Rabih A. Chaer, Michel S. Makaroun, and Georges E. Al-Khoury
Subjects: Reoperation, medicine.medical_specialty, Time Factors, Endoleak, 030204 cardiovascular system & hematology, Aortic repair, Risk Assessment, Blood Vessel Prosthesis Implantation, 03 medical and health sciences, 0302 clinical medicine, Aneurysm, Risk Factors, Interquartile range, medicine.artery, medicine, Humans, Initial treatment, Treatment Failure, 030212 general & internal medicine, Aortic sac, Retrospective Studies, Aorta, business.industry, Endovascular Procedures, medicine.disease, Occult, Aortic Aneurysm, Surgery, Increased risk, Cardiology and Cardiovascular Medicine, business
Abstract: Objective Most type II endoleaks have a benign natural history, but 6% to 8% are associated with sac enlargement and respond poorly to treatment. Our aim was to evaluate whether these enlargements are associated with delayed or occult type I and III endoleaks. Methods Patients with interventions for endoleak after endovascular aortic repair from 2000 to 2016 were reviewed retrospectively. Patient demographics, comorbidities, endoleak type, secondary procedures, aortic sac growth (≥5 mm), and mortality were collected. Successful treatment was defined as endoleak resolution with no further aortic sac growth. Secondary procedures, ruptures, endograft explant, and death were captured. Results There were 130 patients diagnosed with a primary type II endoleak after endovascular aortic repair at a median of 1.3 months (interquartile range, 1.0-13.3 months). One hundred eighteen had their initial treatment for a primary type II. Twelve of the 130 were initially stable and observed, but were treated for a delayed type I or III endoleak. The 130 patients underwent 279 procedures for endoleaks (mean of 2.2 ± 1.3) over 6.9 ± 3.8 years of follow-up. Of the 118 patients treated for primary type II endoleaks, 26 (22.0%) later required interventions for delayed type I and III endoleaks. The mean time to intervention for a delayed type I or III endoleak was 5.4 ± 2.8 years. Overall, there were 16 type IA, 11 type IB, 2 type III, 7 combined type IA/IB, and 2 type IA/III delayed endoleaks. The odds of harboring a delayed type I or III endoleak was 22.0% before the first attempt at type II endoleak treatment, 35.1% before the second, 44.8% before the third, and 66.6% before the fourth attempts. Rapid aortic sac growth of ≥5 mm/y before initial endoleak treatment was associated with increased risk for delayed type I or III endoleak (47.8 vs 14.1%; P = .003). Patients with delayed type I or III endoleaks had a lower successful treatment rate (8.3% vs 52.3%; P = .001) than those with only type II endoleaks. Late rupture was increased with delayed type I or III endoleak (P = .002), whereas mortality (P = .96) and aortic-related mortality (P = .46) were similar. Graft explant (P = .06) trended toward an increase with a delayed type I or III endoleak, but was not statistically significant. Conclusions Failed attempts treating type II endoleaks and/or a rapid aortic sac growth of 5 mm/y or greater should raise the suspicion of a delayed or occult type I or III endoleak. Occult endoleaks are associated with decreased chance of endoleak resolution.
Published: 2019
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25. Peroneal bypass versus endovascular peroneal intervention for critical limb ischemia

Author: Aureline Boitet, Jon C. Henry, Rabih A. Chaer, Eric S. Hager, Michel S. Makaroun, Abhisekh Mohapatra, Efthimios D. Avgerinos, and Othman Abdul Malak
Subjects: Male, medicine.medical_specialty, Time Factors, Critical Illness, medicine.medical_treatment, Ischemia, 030204 cardiovascular system & hematology, Revascularization, Amputation, Surgical, Article, Peripheral Arterial Disease, 03 medical and health sciences, Postoperative Complications, 0302 clinical medicine, Risk Factors, Diabetes mellitus, medicine, Humans, In patient, 030212 general & internal medicine, Myocardial infarction, Aged, Retrospective Studies, Aged, 80 and over, Peroneal Artery, Wound Healing, business.industry, Endovascular Procedures, Critical limb ischemia, Middle Aged, Limb Salvage, medicine.disease, Surgery, Treatment Outcome, Lower Extremity, Female, Vascular Grafting, medicine.symptom, Cardiology and Cardiovascular Medicine, business, Wound healing
Abstract: OBJECTIVES: The peroneal artery is a well-established target for bypass in patients with critical limb ischemia (CLI). The objective of this study was to evaluate the outcomes of peroneal artery revascularization in terms of wound healing and limb salvage in patients with CLI. METHODS: Patients presenting between 2006 and 2013 with critical limb ischemia (Rutherford IV- VI) and isolated peroneal runoff were included in the study. They were divided into patients who underwent bypass to the peroneal artery and those who underwent endovascular peroneal artery intervention. Demographics, comorbidities, and follow up data were recorded. Wounds were classified by Wound, Ischemia, foot Infection (WIfI) score. The primary outcome was wound healing; secondary outcomes included mortality, major amputation, and patency. RESULTS: Two hundred limbs with peroneal bypass and 138 limbs with endovascular peroneal intervention were included with mean follow-up of 24.0 ± 26.3 and 14.5 ± 19.1 months, respectively (P = .0001). The two groups were comparable in comorbidities with the exception of the endovascular group having more patients with cardiac and renal disease and diabetes mellitus, but fewer patients with smoking history. Based on WIfI criteria, ischemia scores were worse in bypass patients, but wound and foot infection scores were worse in endovascular patients. Peri-operatively, bypass patients had higher rates of myocardial infarction (4.5% vs. 0%, P = .012) and incisional complications (13.0% vs. 4.4%, P = .008). At 12 months, the bypass group compared to the endovascular group had better primary patency (47.9% vs. 23.4%, P = .002) and primary assisted patency (63.6% vs. 42.2%, P = .003) and a trend toward better secondary patency (74.2% vs. 63.5%, P = .11). There were no differences in the rate of wound healing (52.6% vs. 37.7% at one year, P = .09) or freedom from major amputation (81.5% vs. 74.7% at one year, P = .37). In a multivariate analysis, neuropathy was associated with improved wound healing, while WIfI wound score, cancer, chronic renal insufficiency, and smoking were associated with decreased wound healing. Treatment modality was not a significant predictor (P = .15). CONCLUSIONS: Endovascular peroneal artery intervention results in poorer primary and primary assisted patency rates than surgical bypass to the peroneal artery, but provides similar wound healing and limb salvage rates with a lower rate of complications. In appropriately selected patients, endovascular intervention to treat the peroneal artery is a low-risk intervention that may be sufficient to heal ischemic foot wounds.
Published: 2019
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26. Outcomes of operative and nonoperative management of blunt thoracic aortic injury

Author: Michael C. Madigan, Anthony J. Lewis, Nathan L. Liang, Robert Handzel, Eric Hager, Michel S. Makaroun, Rabih A. Chaer, and Mohammad H. Eslami
Subjects: Hematoma, Time Factors, Treatment Outcome, Thoracic Injuries, Endovascular Procedures, Humans, Aorta, Thoracic, Surgery, Vascular System Injuries, Wounds, Nonpenetrating, Cardiology and Cardiovascular Medicine, Aneurysm, False, Retrospective Studies
Abstract: Although the current guidelines for the management of blunt traumatic aortic injury (BTAI) have recommended intervention for grade 2 injuries or higher, a national trend has occurred for aggressive endovascular treatment of low-grade BTAIs. Little is known about the natural history of grade 1 and 2 injuries treated nonoperatively. We hypothesized that most of these low-grade injuries would remain stable with nonoperative management.We performed a review of BTAIs at a large referral level 1 trauma center from 2004 to 2020. The injuries were graded using a standard 1 to 4 scale. The outcomes of the nonoperative and thoracic endovascular aortic repair (TEVAR) management strategies were compared, including post-trauma morbidity, mortality, reinterventions, and lesion stability.A total of 176 patients with BTAIs and sufficient imaging studies and follow-up data available were identified during the study period, including 36 with grade 1, 24 with grade 2, 115 with grade 3, and 1 with a grade 4 injury. Of these 176 patients, 112 had undergone TEVAR and 64 had been treated nonoperatively. Most of the patients (90.2%) who had undergone TEVAR had had grade 3 injuries. Nonoperative management was performed for 97.2% of the grade 1 injuries and 62.5% of the grade 2 injuries. Endovascular reintervention after TEVAR was rare (2.7%). The rates of post-trauma morbidity within 30 days (stroke, 3.6% vs 3.1%; myocardial infarction/arrhythmia, 8.9% vs 1.6%; respiratory failure, 31.2% vs 28.1%; acute kidney injury, 9.8% vs 12.5%; urinary tract infection, 2.7% vs 4.8%; gastrointestinal bleeding, 3.6% vs 0.0%; pulmonary embolism, 10.9% vs 4.5%) and 1-year mortality after discharge (1.8% vs 3.1%) were comparable between the operative and nonoperative groups. The median follow-up was 1501 days (interquartile range [IQR], 475.6-2804 days) for the TEVAR group and 1170.5 days (IQR, 317-2173 days) for the nonoperative group. No lesion progression had occurred in the patients with low-grade (grade 1-2) injuries managed nonoperatively. Resolution of grade 1 and 2 injury had occurred in 20% of the patients at 30 days, which had improved to 44% at long-term follow-up. Fourteen patients with grade 3 injuries (12.2% of the grade 3 injuries in our series) were also observed and did not require future intervention. These patients had generally had smaller pseudoaneurysms with minimal periaortic hematoma. None of these 14 patients had experienced progression or rupture during follow-up (median, 454.5 days; IQR, 81-1199 days) using computed tomography.Nonoperative management of low-grade BTAIs did not result in long-term aortic complications or the need for reintervention. We found that grade 3 injuries with smaller pseudoaneurysms and minimal periaortic hematoma can be safely observed if the patients can be appropriately followed up. Thus, the indications for treatment of select grade 3 injuries merit further consideration.
Published: 2022
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27. Genomics, epigenomics and pharmacogenomics of familial hypercholesterolemia (FHBGEP): a study protocol

Author: Helena Strelow Thurow, Marcelo Ferraz Sampaio, Amanda G. M. R. Sousa, Jaqueline Yu Ting Wang, Glaucio Monteiro Ferreira, Patricia Moriel, André Arpad Faludi, Vivian Nogueira Silbiger, Rodrigo Marques Gonçalves, Hui Tzu Lin-Wang, Cristina Moreno Fajardo, Augusto Akira Mori, Jéssica Nayara Góes de Araújo, Carolina Dagli-Hernandez, Jéssica Bassani Borges, Alexandre C. Pereira, Michel S Naslavsky, André Ducati Luchessi, Mario Hiroyuki Hirata, Tayanne Silva Carmo, Dorotéia Rossi Silva Souza, Alvaro Cerda, Marcelo Arruda Nakazone, Thiago Dominguez Crespo Hirata, Raul Hernandes Bortolin, DB Araújo, Renata Caroline Costa de Freitas, Elisangela da Silva Rodrigues Marçal, Joao Italo Dias França, Henry Paulo Zatz, Victor Fernandes de Oliveira, Cinthia E. Jannes, Tania Cristina Pithon-Curi, Gisele Medeiros Bastos, Thales Kronenberger, Adriana Regina Garofalo, Adriana Bertolami, Thais Kristini Almendros Afonso Barbosa, Renata Gorjão, Bruna Los, Rosario Dominguez Crespo Hirata, Helder I. Nakaya, and Marcelo Chiara Bertolami
Subjects: Epigenomics, 0301 basic medicine, medicine.medical_specialty, In silico, Pharmaceutical Science, Genomics, Pharmacy, Familial hypercholesterolemia, Disease, Computational biology, 030204 cardiovascular system & hematology, Biology, Hyperlipoproteinemia Type II, 03 medical and health sciences, 0302 clinical medicine, medicine, Humans, CRISPR, medicine.disease, Molecular Docking Simulation, 030104 developmental biology, Pharmacogenetics, Pharmacogenomics, Medical genetics, SEQUENCIAMENTO GENÉTICO, Brazil
Abstract: Background Familial hypercholesterolemia (FH) is a genetic disease that affects millions of people worldwide. Objectives The study protocol FHBGEP was design to investigate the main genomic, epigenomic, and pharmacogenomic factors associated with FH and polygenic hypercholesterolemia (PH). Methods FH patients will be enrolled at six research centers in Brazil. An exon-targeted gene strategy will be used to sequence a panel of 84 genes related to FH, PH, pharmacogenomics and coronary artery disease. Variants in coding and regulatory regions will be identified using a proposed variant discovery pipeline and classified according to the American College Medical Genetics guidelines. Functional effects of variants in FH-related genes will be investigated by in vitro studies using lymphocytes and cell lines (HepG2, HUVEC and HEK293FT), CRISPR/Cas9 mutagenesis, luciferase reporter assay and other technologies. Functional studies in silico, such as molecular docking, molecular dynamics, and conformational analysis, will be used to explore the impact of novel variants on protein structure and function. DNA methylation profile and differential expression of circulating non-coding RNAs (miRNAs and lncRNAs) will be analyzed in FH patients and normolipidemic subjects (control group). The influence of genomic and epigenomic factors on metabolic and inflammatory status will be analyzed in FH patients. Pharmacogenomic studies will be conducted to investigate the influence of genomic and epigenomic factors on response to statins in FH patients. Summary The FHBGEP protocol has the potential to elucidate the genetic basis and molecular mechanisms involved in the pathophysiology of FH and PH, particularly in the Brazilian population. This pioneering approach includes genomic, epigenomic and functional studies, which results will contribute to the improvement of the diagnosis, prognosis and personalized therapy of FH patients.
Published: 2021

28. Elective cancer surgery in COVID-19–Free surgical pathways during the SARS-cov-2 pandemic: An international, multicenter, comparative cohort study

Author: James C Glasbey, Dmitri Nepogodiev, Joana Ff Simoes, Omar Omar, Elizabeth Li, Mary L Venn, Mohammad Abou Chaar, Vita Capizzi, Daoud Chaudhry, Anant Desai, Jonathan G Edwards, Jonathan P Evans, Marco Fiore, Jose Flavio Videria, Samuel J Ford, Ian Ganyli, Ewen A Griffiths, Rohan R Gujjuri, Angelos G Kolias, Haytham Ma Kaafarani, Ana Minaya-Bravo, Siobhan C McKay, Helen M Mohan, Keith Roberts, Carlos San Miguel-Méndez, Peter Pockney, Richard Shaw, Neil J Smart, Grant D Stewart, Sudha Sundar, Raghavan Vidya, Aneel A Bhangu, James C Glasbey, Omar Omar, Aneel A Bhangu, Kwabena Siaw-Acheampong, Ruth A Benson, Edward Bywater, Daoud Chaudhry, Brett E Dawson, Jonathan P Evans, James C Glasbey, Rohan R Gujjuri, Emily Heritage, Conor S Jones, Sivesh K Kamarajah, Chetan Khatri, Rachel A Khaw, James M Keatley, Andrew Knight, Samuel Lawday, Elizabeth Li, Harvinder S Mann, Ella J Marson, Kenneth A McLean, Siobhan C McKay, Emily C Mills, Dmitri Nepogodiev, Gianluca Pellino, Maria Picciochi, Elliott H Taylor, Abhinav Tiwari, Joana Ff Simoes, Isobel M Trout, Mary L Venn, Richard Jw Wilkin, Aneel A Bhangu, James C Glasbey, Neil J Smart, Ana Minaya-Bravo, Jonathan P Evans, Gaetano Gallo, Susan Moug, Francesco Pata, Peter Pockney, Salomone Di Saverio, Abigail Vallance, Dale Vimalchandran, Ewen A Griffiths, Sivesh K Kamarajah, Richard Pt Evans, Philip Townend, Keith Roberts, Siobhan McKay, John Isaac, Sohei Satoi, John Edwards, Aman S Coonar, Adrian Marchbank, Edward J Caruana, Georgia R Layton, Akshay Patel, Alessandro Brunelli, Samuel Ford, Anant Desai, Alessandro Gronchi, Marco Fiore, Max Almond, Fabio Tirotta, Sinziana Dumitra, Angelos Kolias, Stephen J Price, Daniel M Fountain, Michael D Jenkinson, Peter Hutchinson, Hani J Marcus, Rory J Piper, Laura Lippa, Franco Servadei, Ignatius Esene, Christian Freyschlag, Iuri Neville, Gail Rosseau, Karl Schaller, Andreas K Demetriades, Faith Robertson, Alex Alamri, Richard Shaw, Andrew G Schache, Stuart C Winter, Michael Ho, Paul Nankivell, Juan Rey Biel, Martin Batstone, Ian Ganly, Raghavan Vidya, Alex Wilkins, Jagdeep K Singh, Dinesh Thekinkattil, Sudha Sundar, Christina Fotopoulou, Elaine Leung, Tabassum Khan, Luis Chiva, Jalid Sehouli, Anna Fagotti, Paul Cohen, Murat Gutelkin, Rahel Ghebre, Thomas Konney, Rene Pareja, Rob Bristow, Sean Dowdy, T S Shylasree, R Kottayasamy Seenivasagam, Joe Ng, Keiiji Fujiwara, Grant D Stewart, Benjamin Lamb, Krishna Narahari, Alan McNeill, Alexandra Colquhoun, John McGrath, Steve Bromage, Ravi Barod, Veeru Kasivisvanathan, Tobias Klatte, Joana Ff Simoes, Tom Ef Abbott, Sadi Abukhalaf, Michel Adamina, Adesoji O Ademuyiwa, Arnav Agarwal, Murat Akkulak, Ehab Alameer, Derek Alderson, Felix Alakaloko, Markus Albertsmeiers, Osaid Alser, Muhammad Alshaar, Sattar Alshryda, Alexis P Arnaud, Knut Magne Augestad, Faris Ayasra, José Azevedo, Brittany K Bankhead-Kendall, Emma Barlow, David Beard, Ruth A Benson, Ruth Blanco-Colino, Amanpreet Brar, Ana Minaya-Bravo, Kerry A Breen, Chris Bretherton, Igor Lima Buarque, Joshua Burke, Edward J Caruana, Mohammad Chaar, Sohini Chakrabortee, Peter Christensen, Daniel Cox, Moises Cukier, Miguel F Cunha, Giana H Davidson, Anant Desai, Salomone Di Saverio, Thomas M Drake, John G Edwards, Muhammed Elhadi, Sameh Emile, Shebani Farik, Marco Fiore, J Edward Fitzgerald, Samuel Ford, Tatiana Garmanova, Gaetano Gallo, Dhruv Ghosh, Gustavo Mendonça Ataíde Gomes, Gustavo Grecinos, Ewen A Griffiths, Madalegna GrÜndl, Constantine Halkias, Ewen M Harrison, Intisar Hisham, Peter J Hutchinson, Shelley Hwang, Arda Isik, Michael D Jenkinson, Pascal Jonker, Haytham Ma Kaafarani, Debby Keller, Angelos Kolias, Schelto Kruijff, Ismail Lawani, Hans Lederhuber, Sezai Leventoglu, Andrey Litvin, Andrew Loehrer, Markus W Löffler, Maria Aguilera Lorena, Maria Marta Modolo, Piotr Major, Janet Martin, Hassan N Mashbari, Dennis Mazingi, Symeon Metallidis, Ana Minaya-Bravo, Helen M Mohan, Rachel Moore, David Moszkowicz, Susan Moug, Joshua S Ng-Kamstra, Mayaba Maimbo, Ionut Negoi, Milagros Niquen, Faustin Ntirenganya, Maricarmen Olivos, Kacimi Oussama, Oumaima Outani, Marie Dione Parreno-Sacdalanm, Francesco Pata, Carlos Jose Perez Rivera, Thomas D Pinkney, Willemijn van der Plas, Peter Pockney, Ahmad Qureshi, Dejan Radenkovic, Antonio Ramos-De la Medina, Keith Roberts, April C Roslani, Martin Rutegård, Juan José Segura-Sampedro, Irène Santos, Sohei Satoi, Raza Sayyed, Andrew Schache, Andreas A Schnitzbauer, Justina O Seyi-Olajide, Neil Sharma, Richard Shaw, Sebastian Shu, Kjetil Soreide, Antonino Spinelli, Grant D Stewart, Malin Sund, Sudha Sundar, Stephen Tabiri, Philip Townend, Georgios Tsoulfas, Gabrielle H van Ramshorst, Raghavan Vidya, Dale Vimalachandran, Oliver J Warren, Duane Wedderburn, Naomi Wright, C Allemand, L Boccalatte, M Figari, M Lamm, J Larrañaga, C Marchitelli, F Noll, D Odetto, M Perrotta, J Saadi, L Zamora, C Alurralde, E L Caram, D Eskinazi, J P Mendoza, M Usandivaras, R Badra, A Esteban, J S García, P M García, J I Gerchunoff, S M Lucchini, M A NIgra, L Vargas, T Hovhannisyan, A Stepanyan, T Gould, R Gourlay, B Griffiths, S Gananadha, M McLaren, J Cecire, N Joshi, S Salindera, A Sutherland, J H Ahn, G Charlton, S Chen, N Gauri, R Hayhurst, S Jang, F Jia, C Mulligan, W Yang, G Ye, H Zhang, M Ballal, D Gibson, D Hayne, J Moss, T Richards, P Viswambaram, U G Vo, J Bennetts, T Bright, M Brooke-Smith, R Fong, B Gricks, Y H Lam, B S Ong, M Szpytma, D Watson, K Bagraith, S Caird, E Chan, C Dawson, D Ho, E Jeyarajan, S Jordan, A Lim, G J Nolan, A Oar, D Parker, H Puhalla, A Quennell, L Rutherford, P Townend, M Von Papen, M Wullschleger, A Blatt, D Cope, N Egoroff, M Fenton, J Gani, N Lott, P Pockney, N Shugg, M Elliott, D Phung, D Phan, D Townend, C Bong, J Gundara, A Frankel, S Bowman, G R Guerra, J Bolt, K Buddingh, N N Dudi-Venkata, S Jog, H M Kroon, T Sammour, R Smith, C Stranz, M Batstone, K Lah, W McGahan, D Mitchell, A Morton, A Pearce, M Roberts, G Sheahan, B Swinson, N Alam, S Banting, L Chong, P Choong, S Clatworthy, D Foley, A Fox, M W Hii, B Knowles, J Mack, M Read, A Rowcroft, S Ward, G Wright, M Lanner, I Königsrainer, M Bauer, C Freyschlag, M Kafka, F Messner, D Öfner, I Tsibulak, K Emmanuel, M Grechenig, R Gruber, M Harald, L Öhlberger, J Presl, A Wimmer, I Namazov, E Samadov, D Barker, R Boyce, S Corbin, A Doyle, A Eastmond, R Gill, A Haynes, S Millar, M O'Shea, G Padmore, N Paquette, E Phillips, S St John, K Walkes, N Flamey, P Pattyn, W Oosterlinck, J Van den Eynde, R Van den Eynde, A Gatti, C Nardi, R Oliva, R De Cicco, I Cecconello, P Gregorio, L Pontual Lima, U Ribeiro Junior, F Takeda, R M Terra, M Sokolov, B Kidane, S Srinathan, M Boutros, N Caminsky, G Ghitulescu, G Jamjoum, J Moon, J Pelletier, T Vanounou, S Wong, M Boutros, S Dumitra, A Kouyoumdjian, B Johnston, C Russell, M Boutros, S Demyttenaere, R Garfinkle, J Abou-Khalil, C Nessim, J Stevenson, F Heredia, A Almeciga, A Fletcher, A Merchan, L O Puentes, J Mendoza Quevedo, G Bacic, D Karlovic, D 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Lewis-Lloyd, O Oyende, J Reilly, D Worku, P Cool, G Cribb, K Shepherd, C Bisset, S Moug, N Elson, G Faulkner, P Saleh, C Underwood, G Brixton, L Findlay, T Klatte, A Majkowska, J Manson, R Potter, A Bhalla, Z Chia, P Daliya, A Goyal, E Grimley, A Hamad, A Kumar, F L Malcolm, E Theophilidou, J Bowden, N Campain, I Daniels, C Evans, G Fowler, J John, L Massey, F McDermott, J McGrath, A McLennan, M Ng, J Pascoe, N Rajaretnam, S Bulathsinhala, B Davidson, G Fusai, C Hidalgo Salinas, N Machairas, T Pissanou, J M Pollok, D A Raptis, F Soggiu, H Tzerbinis, S E Xyda, A Beamish, E Davies, R Foulkes, D Magowan, H Nassa, R Ooi, C Price, L Smith, F Solari, A Tang, G Williams, Y Al-Tamimi, A Bacon, N Beasley, D Chew, M Crank, N Ilenkovan, M Macdonald, B Narice, O Rominiyi, A Thompson, I Varley, T Drake, E Harrison, G Linder, J Mayes, R McGregor, R Skipworth, V Zamvar, E Davies, P Hawkin, T Raymond, O Ryska, R Baron, D Dunne, S Gahunia, C Halloran, N Howes, R McKinney, F McNicol, J Russ, P Szatmary, J R Tan, A Thomas, P Whelan, A Anzak, A Banerjee, O Fuwa, F Hughes, J D Jayasinghe, C Knowles, H Kocher, I Leal Silva, F S Ledesma, A Minicozzi, L Navaratne, R Rahman, R Ramamoorthy, C Sohrabi, M Thaha, B Thakur, M Venn, V Yip, R Baumber, J Parry, S Evans, L Jeys, G Morris, M Parry, J Stevenson, N Ahmadi, G Aresu, Z M Barrett-Brown, A S Coonar, H Durio Yates, D Gearon, J Hogan, M King, A Peryt, I S Pradeep, C Smith, M Adishesh, R Atherton, K Baxter, M Brocklehurst, M Chaudhury, N Krishnamohan, J McAleer, G Owens, E Parkin, P Patkar, I Phang, A Aladeojebi, M Ali, B Barmayehvar, A Gaunt, M Gowda, E Halliday, M Kitchen, F Mansour, M Thomas, D Zakai, N Abbassi-Ghadi, H Assalaarachchi, A Currie, M Flavin, A Frampton, M Hague, C Hammer, J Hopper, J Horsnell, S Humphries, A Kamocka, T K Madhuri, S Preston, P Singh, J Stebbing, A Tailor, D Walker, F Aljanadi, M Jones, P Mhandu, C O'Donnell, R Turkington, Z Al-Ishaq, S Bhasin, A S Bodla, A Burahee, A Crichton, R Fossett, N Pigadas, S Pickford, E Rahman, D Snee, R Vidya, N Yassin, F Colombo, D Fountain, M T Hasan, K Karabatsou, R Laurente, O Pathmanaban, A Al-Mukhtar, S Brown, J Edwards, A Giblin, C Kelty, M Lee, G Lye, T Newman, A Sharkey, C Steele, N Sureshkumar Shah, E Whitehall, R Athwal, A Baker, L Jones, C Konstantinou, S Ramcharan, S Singh, J Vatish, R Wilkin, M Ethunandan, G K Sekhon, H Shields, R Singh, F Wensley, S Lawday, A Lyons, T Abbott, S Anwar, K Ghufoor, C Sohrabi, E Chung, R Hagger, A Hainsworth, A Karim, H Owen, A Ramwell, K Williams, C Baker, A Davies, J Gossage, M Kelly, W Knight, J Hall, G Harris, G James, C Kang, D J Lin, A D Rajgor, T Royle, R Scurrah, B Steel, L J Watson, D Choi, R Hutchison, A Jain, V Luoma, H Marcus, R May, A Menon, B Pramodana, L Webber, I A Aneke, P Asaad, B Brown, J Collis, S Duff, A Khan, F Moura, B Wadham, H Warburton, T Elmoslemany, M Jenkinson, C Millward, R Zakaria, S Mccluney, C Parmar, S Shah, J Allison, M S Babar, B Collard, S Goodrum, K Lau, A Patel, R Scott, E Thomas, H Whitmore, D Balasubramaniam, B Jayasankar, S Kapoor, A Ramachandran, A Elhamshary, Smb Imam, K Kapriniotis, V Kasivisvanathan, J Lindsay, S Rakhshani-Moghadam, N Beech, M Chand, L Green, N Kalavrezos, H Kiconco, R McEwen, C Schilling, D Sinha, J Pereca, J Singh, S Chopra, D Egbeare, R Thomas, T Combellack, Sef Jones, M Kornaszewska, M Mohammed, A Sharma, G Tahhan, V Valtzoglou, J Williams, P Eskander, K Gash, L Gourbault, M Hanna, T Maccabe, C Newton, J Olivier, S Rozwadowski, E Teh, D West, H Al-Omishy, M Baig, H Bates, G Di Taranto, K Dickson, N Dunne, C Gill, D Howe, D Jeevan, A Khajuria, K Martin-Ucar AMcEvoy, P Naredla, V Ng, S Robertson, M Sait, D R Sarma, S Shanbhag, T Shortland, S Simmonds, J Skillman, N Tewari, G Walton, M A Akhtar, A Brunt, J McIntyre, K Milne, M M Rashid, A Sgro, K E Stewart, A Turnbull, M Aguilar Gonzalez, S Talukder, C Boyle, D Fernando, K Gallagher, A Laird, D Tham, M Bath, P Patki, C Sohrabi, C Tanabalan, T Arif, C Magee, T Nambirajan, S Powell, R Vinayagam, I Flindall, A Hanson, V Mahendran, S Green, M Lim, L MacDonald, V Miu, L Onos, K Sheridan, R Young, F Alam, O Griffiths, C Houlden, R Jones, V S Kolli, A K Lala, S Leeson, R Peevor, Z Seymour, L Chen, E Henderson, A Loehrer, K Brown, D Fleming, A Haynes, C Heron, C Hill, H Kay, E Leede, K McElhinney, K Olson, E C Osterberg, C Riley, P Srikanth, M Thornhill, D Blazer, G DiLalla, E S Hwang, W Lee, M Lidsky, J Plichta, L Rosenberger, R Scheri, K Shah, K Turnage, J Visgauss, S Zani, J Farma, J Clark, D Kwon, E Etchill, H E Gabre-Kidan AJenny, A Kent, M Ladd, C Long, H Malapati, A Margalit, S Rapaport, J Rose, K Stevens, L Tsai, D Vervoort, P Yesantharao, A Dehal, D Klaristenfeld, K Huynh, L Brown, I Ganly, J Mullinax, N Gusani, J Hazelton, J Maines, J S Oh, A Ssentongo, P Ssentongo, M Azam, A Choudhry, W Marx, J Fleming, A Fuson, J Gigliotti, A Ovaitt, Y Ying, M K Abel, V Andaya, K Bigay, M A Boeck, L Chen, H Chern, C Corvera, I El-Sayed, A Glencer, P Ha, Bcs Hamilton, C Heaton, K Hirose, D M Jablons, K Kirkwood, L Z Kornblith, J R Kratz, R Lee, P N Miller, E Nakakura, B Nunez-Garcia, R O'Donnell, D Ozgediz, P Park, B Robinson, A Sarin, B Sheu, M Varma, K Wai, R Wustrack, M J Xu, D Beswick, J Goddard, J Manor, J Song, T Fullmer, C Gaskill, N Gross, K Kiong, C L Roland, S N Zafar, M Abdallah, A Abouassi, M Almasri, G Kulkarni, H Marwan, M Mehdi, S Aoun, V S Ban, H H Batjer, J Caruso, D Abbott, A Acher, T Aiken, J Barrett, E Foley, P Schwartz, S N Zafar, A Hawkins, A Maiga, J Laufer, S Scasso
Subjects: Aged, 80 and over, Male, Critical Care, SARS-CoV-2, International Cooperation, COVID-19, Middle Aged, Cohort Studies, Logistic Models, Postoperative Complications, Elective Surgical Procedures, Neoplasms, Outcome Assessment, Health Care, Humans, Female, Epidemics, Aged
Abstract: PURPOSE As cancer surgery restarts after the first COVID-19 wave, health care providers urgently require data to determine where elective surgery is best performed. This study aimed to determine whether COVID-19–free surgical pathways were associated with lower postoperative pulmonary complication rates compared with hospitals with no defined pathway. PATIENTS AND METHODS This international, multicenter cohort study included patients who underwent elective surgery for 10 solid cancer types without preoperative suspicion of SARS-CoV-2. Participating hospitals included patients from local emergence of SARS-CoV-2 until April 19, 2020. At the time of surgery, hospitals were defined as having a COVID-19–free surgical pathway (complete segregation of the operating theater, critical care, and inpatient ward areas) or no defined pathway (incomplete or no segregation, areas shared with patients with COVID-19). The primary outcome was 30-day postoperative pulmonary complications (pneumonia, acute respiratory distress syndrome, unexpected ventilation). RESULTS Of 9,171 patients from 447 hospitals in 55 countries, 2,481 were operated on in COVID-19–free surgical pathways. Patients who underwent surgery within COVID-19–free surgical pathways were younger with fewer comorbidities than those in hospitals with no defined pathway but with similar proportions of major surgery. After adjustment, pulmonary complication rates were lower with COVID-19–free surgical pathways (2.2% v 4.9%; adjusted odds ratio [aOR], 0.62; 95% CI, 0.44 to 0.86). This was consistent in sensitivity analyses for low-risk patients (American Society of Anesthesiologists grade 1/2), propensity score–matched models, and patients with negative SARS-CoV-2 preoperative tests. The postoperative SARS-CoV-2 infection rate was also lower in COVID-19–free surgical pathways (2.1% v 3.6%; aOR, 0.53; 95% CI, 0.36 to 0.76). CONCLUSION Within available resources, dedicated COVID-19–free surgical pathways should be established to provide safe elective cancer surgery during current and before future SARS-CoV-2 outbreaks.
Published: 2021

29. HLA-G genetic diversity and evolutive aspects in worldwide populations

Author: Nayane S. B. Silva, Eduardo Antônio Donadi, Gabriela Aguileta, Bibiana Sgorla de Almeida, Marília R S Passos, Daniel J. Smith, Mayana Zatz, Andrea Bamberg Migliano, Yara Costa Netto Muniz, Jaqueline Wang, Abigail E. Page, Jaume Bertranpetit, Michel S Naslavsky, Marilia O. Scliar, Celso T. Mendes-Junior, Andreia S. Souza, Yeda Aparecida de Oliveira Duarte, Mark Dyble, Maria Rita Passos-Bueno, Erick C. Castelli, Universidade Estadual Paulista (UNESP), Universidade de São Paulo (USP), Universidade Federal de Santa Catarina (UFSC), London School of Hygiene and Tropical Medicine, University College London (UCL), University of Bristol, Universitat Pompeu Fabra, Unversity of Zurich, Hospital Israelita Albert Einstein, Conselho Nacional de Desenvolvimento Científico e Tecnológico (Brasil), Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (Brasil), Fundação de Amparo à Pesquisa do Estado de São Paulo, University of Zurich, Castelli, Erick C, Donadi, Eduardo A, Castelli, Erick C [0000-0003-2142-7196], and Apollo - University of Cambridge Repository
Subjects: 10207 Department of Anthropology, Linkage disequilibrium, Genotype, Bioinformatics, Population genetics, Science, Population, Genes, MHC Class I, Human leukocyte antigen, Biology, Balancing selection, Global Health, Polymorphism, Single Nucleotide, Linkage Disequilibrium, Article, Evolution, Molecular, Gene Frequency, Immunogenetics, Humans, Genetic variability, education, 3' Untranslated Regions, ANTÍGENOS HLA, Alleles, Genetic association, HLA-G Antigens, 1000 Multidisciplinary, education.field_of_study, Genetic diversity, Multidisciplinary, Polymorphism, Genetic, 300 Social sciences, sociology & anthropology, Haplotype, Computational Biology, Genetic Variation, High-Throughput Nucleotide Sequencing, Immune Checkpoint Proteins, Introns, Genetics, Population, Haplotypes, Evolutionary biology, Medicine, Dimerization
Abstract: HLA-G is a promiscuous immune checkpoint molecule. The HLA-G gene presents substantial nucleotide variability in its regulatory regions. However, it encodes a limited number of proteins compared to classical HLA class I genes. We characterized the HLA-G genetic variability in 4640 individuals from 88 different population samples across the globe by using a state-of-the-art method to characterize polymorphisms and haplotypes from high-coverage next-generation sequencing data. We also provide insights regarding the HLA-G genetic diversity and a resource for future studies evaluating HLA-G polymorphisms in different populations and association studies. Despite the great haplotype variability, we demonstrated that: (1) most of the HLA-G polymorphisms are in introns and regulatory sequences, and these are the sites with evidence of balancing selection, (2) linkage disequilibrium is high throughout the gene, extending up to HLA-A, (3) there are few proteins frequently observed in worldwide populations, with lack of variation in residues associated with major HLA-G biological properties (dimer formation, interaction with leukocyte receptors). These observations corroborate the role of HLA-G as an immune checkpoint molecule rather than as an antigen-presenting molecule. Understanding HLA-G variability across populations is relevant for disease association and functional studies., We acknowledge Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq/Brazil, #302060/2019-7), Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES/Brazil, Finance code: 001), INCTC/FAPESP (Grant #465539/2014-9) for financial support, and FAPESP/Brazil (#Grant 2017/19223-0).
Published: 2021
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30. ADA2 deficiency (DADA2) associated with Evans syndrome and a severe ADA2 genotype

Author: Graziella Ribeiro de Sousa, Mariana Paes Leme Ferriani, Luciana Martins de Carvalho, Paula Sandrin-Garcia, Ronald Moura, Michel S Hershfield, and Elvis Terci Valera
Subjects: Pediatrics, medicine.medical_specialty, Evans syndrome, Adenosine Deaminase, MEDLINE, Mutation, Missense, Etanercept, Agammaglobulinemia, Genotype, Medicine, Humans, Immunologic Factors, Child, Glucocorticoids, Sequence Deletion, business.industry, ADA2 DEFICIENCY, Immunoglobulins, Intravenous, medicine.disease, Thrombocytopenia, Pedigree, Antirheumatic Agents, Intercellular Signaling Peptides and Proteins, Female, Severe Combined Immunodeficiency, Anemia, Hemolytic, Autoimmune, business
Published: 2020

31. Poor runoff and distal coverage below the knee are associated with poor long-term outcomes following endovascular popliteal aneurysm repair

Author: Andrew E. Leake, Mohammad H. Eslami, Eric S. Hager, Efthymios D. Avgerinos, Michel S. Makaroun, Mohamed S. Zaghloul, Elizabeth Andraska, and Rabih A. Chaer
Subjects: Male, medicine.medical_specialty, Time Factors, medicine.medical_treatment, 030204 cardiovascular system & hematology, Single Center, Risk Assessment, Popliteal aneurysm, 03 medical and health sciences, Blood Vessel Prosthesis Implantation, 0302 clinical medicine, Aneurysm, Risk Factors, medicine.artery, Occlusion, Medicine, Humans, Popliteal Artery, 030212 general & internal medicine, Treatment Failure, Vascular Patency, Aged, Retrospective Studies, Aged, 80 and over, business.industry, Proportional hazards model, Endovascular Procedures, Graft Occlusion, Vascular, Stent, Middle Aged, medicine.disease, Popliteal artery, Progression-Free Survival, Surgery, Regional Blood Flow, Female, medicine.symptom, Cardiology and Cardiovascular Medicine, business, Claudication
Abstract: Objective Reports of good short-term outcomes for endovascular repair of popliteal artery aneurysms have led to an increased use of the technique. However, data are lacking on long-term limb-related outcomes and factors associated with the failure of endovascular repair. Methods All patients who underwent endovascular popliteal aneurysm repair (EPAR) at a single institution from January 2006 to December 2018 were included in the study. Demographics, indications, anatomic and operative details, and outcomes were reviewed. Long-term patency, major adverse limb event-free survival (MALE-FS) and graft loss/occlusion were analyzed with multivariable cox regression analysis and Kaplan-Meier curves. Results We included 117 limbs from 101 patients with a mean follow-up of 55.6 months (range, 0.43-158 months). The average age was 73 ± 9.3 years. Thirty-two patients (29.1%) were symptomatic (claudication, rest pain, tissue loss, or rupture). The stent grafts crossed the knee joint in 91.4% of cases. In all, 36.8% of procedures used one stent graft, 41.0% used two stent grafts, and 22.2% of procedures used more than two stent grafts. The median arterial length covered was 100 mm, with an average length of stent overlap of 25 mm. Tapered configurations were used in 43.8% of cases. The majority of limbs (62.8%) had a three-vessel runoff, 20.2% had a two-vessel runoff, and 17% has a one-vessel runoff. The Kaplan-Meier estimates of graft occlusion at 1 and 3 years were 6.3% and 16.2%, respectively. The 1- and 3-year primary patency rates were 88.2% and 72.6%, and the 1- and 3-year major adverse limb event-free survival (MALE-FS) rates were 82% and 57.4%. The 1- and 3-year survival rates were 92.9% and 76.2%, respectively. On multivariable Cox regression, aneurysm size, one-vessel runoff, and coverage below the knee were associated with a lower 3-year MALE-FS. Coverage below the knee was also associated with a lower 3-year MALE-FS. Other anatomic or technical details were not associated with limb-related events or patency. Conclusions This study is the largest single center analysis to describe the predictors of poor outcomes after EPAR. EPAR is a safe and effective way to treat popliteal artery aneurysms. Factors associated with poor MALE-FS after EPAR include single-vessel tibial runoff and coverage below the knee.
Published: 2020

32. Evaluation of an educational course for primary care physiotherapists on comorbidity-adapted exercise therapy in knee osteoarthritis: an observational study

Author: Joost Dekker, Jorit J. L. Meesters, Wilfred F. Peter, Marike van der Leeden, T. Vredeveld, Martin van der Esch, Michel S. Terbraak, Willem F. Lems, Thea P. M. Vliet Vlieland, Mariëtte de Rooij, Leo D. Roorda, Lectoraat Interdisciplinaire Zorg voor Chronische Gewrichtsaandoeningen, Urban Vitality, Neuromechanics, AMS - Musculoskeletal Health, VU University medical center, Rehabilitation medicine, AMS - Ageing & Vitality, APH - Aging & Later Life, APH - Health Behaviors & Chronic Diseases, Rheumatology, AII - Inflammatory diseases, AMS - Tissue Function & Regeneration, Epidemiology and Data Science, APH - Mental Health, and APH - Societal Participation & Health
Subjects: medicine.medical_specialty, Nursing (miscellaneous), Physical Therapy, Sports Therapy and Rehabilitation, Osteoarthritis, Primary care, knee osteoarthritis, 03 medical and health sciences, primary care, 0302 clinical medicine, SDG 17 - Partnerships for the Goals, Rheumatology, medicine, Humans, Orthopedics and Sports Medicine, 030212 general & internal medicine, Competence (human resources), Research Articles, blended education, 030203 arthritis & rheumatology, exercise therapy, Primary Health Care, business.industry, Rehabilitation, Exercise therapy, Osteoarthritis, Knee, medicine.disease, Comorbidity, Physical Therapists, comorbidity, Vignette, Physical therapy, Observational study, Chiropractics, Exercise prescription, business, Research Article
Abstract: OBJECTIVE: The objectives of the present study were to: (1) evaluate the effect of an educational course on competence (knowledge and clinical reasoning) of primary care physical therapists (PTs) in treating patients with knee osteoarthritis (KOA) and comorbidity according to the developed strategy; and (2) identify facilitators and barriers for usage.METHOD: The present research was an observational study with a pretest-posttest design using mixed methods. PTs were offered a postgraduate course consisting of e-learning and two workshops (blended education) on the application of a strategy for exercise prescription in patients with KOA and comorbidity. Competences were measured by questionnaire on knowledge (administered before and 2 weeks after the course), and a patient vignette to measure clinical reasoning (administered before the course and after a 6 month period of treating patients). Facilitators and barriers for using the strategy were assessed by a questionnaire and semi-structured interviews.RESULTS: Thirty-four PTs were included. Competence (knowledge and clinical reasoning) improved significantly (p < 0.01). Fourteen out of 34 PTs had actually treated patients with KOA and comorbidity, during a 6-month period. The strategy was found to be feasible in daily practice. The main barriers included the limited number of (self-) referrals of patients, limited number of reimbursed treatment sessions by insurance companies and a suboptimal collaboration with (referring) physicians.CONCLUSION: A blended course on exercise therapy for patients with KOA and comorbidity seems to improve PTs' competence through increasing knowledge and clinical reasoning skills. Identified barriers should be solved before large-scale implementation of exercise therapy can take place in these complex patients.
Published: 2020
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33. The value of the modern vascular surgeon to the health care system: A report from the Society for Vascular Surgery Valuation Work Group

Author: Andres Schanzer, John V. White, Kellie R. Brown, Fred A. Weaver, Brad L. Johnson, Richard J. Powell, Mark G. Davies, Jeffrey V. Hsu, Michel S. Makaroun, Joseph P. Hart, and William P. Shutze
Subjects: medicine.medical_specialty, Leverage (finance), Cost-Benefit Analysis, Disease, Workload, 030204 cardiovascular system & hematology, Profit (economics), System a, 03 medical and health sciences, 0302 clinical medicine, Health care, medicine, Humans, 030212 general & internal medicine, Practice Patterns, Physicians', Personnel Selection, Physician's Role, Valuation (finance), Patient Care Team, Surgeons, Capitation, business.industry, Delivery of Health Care, Integrated, Health Care Costs, Vascular surgery, medicine.disease, Job Description, Surgery, Medical emergency, Cardiology and Cardiovascular Medicine, business, Vascular Surgical Procedures, Specialization
Abstract: Vascular surgeons provide an important service to the health care system. They are capable of treating a wide range of disease processes that affect both the venous and arterial systems. Their presence broadens the complexity and diversity of services that a health care system can offer both in the outpatient setting and in the inpatient setting. Because of their ability to control hemorrhage, they are critical to a safe operating room environment. The vascular surgery service line has a positive impact on hospital margin through both the direct vascular profit and loss and the indirect result of assisting other surgical and medical services in providing care. The financial benefits of a vascular service line will hold true for a wide range of alternative payment models, such as bundled payments or capitation. To fully leverage a modern vascular surgeon's skill set, significant investment is required from the health care system that is, however, associated with substantial return on the investment.
Published: 2020

34. Improved outcomes of endovascular repair of thoracic aortic injuries at higher volume institutions

Author: Mohammad H. Eslami, Alik Farber, Nathan L. Liang, Michel S. Makaroun, Marc L. Schermerhorn, and Abhisekh Mohapatra
Subjects: Adult, Male, medicine.medical_specialty, Hospitals, Low-Volume, Time Factors, Aorta, Thoracic, 030204 cardiovascular system & hematology, Aortic repair, Wounds, Nonpenetrating, Risk Assessment, Odds, 03 medical and health sciences, Blood Vessel Prosthesis Implantation, Young Adult, 0302 clinical medicine, Risk Factors, Internal medicine, medicine, Humans, 030212 general & internal medicine, Hospital Mortality, Registries, Quality Indicators, Health Care, Retrospective Studies, Case volume, business.industry, Endovascular Procedures, Odds ratio, Perioperative, Middle Aged, Vascular System Injuries, Quality Improvement, Confidence interval, United States, Outcome and Process Assessment, Health Care, Treatment Outcome, Concomitant, Cardiology, Surgery, Female, Cardiology and Cardiovascular Medicine, business, Hospitals, High-Volume, Volume (compression)
Abstract: Background The use of thoracic endovascular aortic repair (TEVAR) has significantly improved the ability to treat traumatic aortic injuries (tTEVAR). We sought to determine whether a greater center volume correlated with better outcomes. Methods Vascular Quality Initiative data of TEVAR (2011-2017) for trauma were used in the present analysis. Using the distribution of the annual case volume at the participating centers, the sample was stratified into three terciles. In-hospital mortality at high-volume centers (HVCs) and low-volume centers (LVCs) was compared after adjustment for risk factors established in our previous Vascular Quality Initiative-based risk model containing age, gender, renal impairment, left subclavian artery involvement, and select concomitant injuries. Results A total of 619 tTEVAR cases were studied across 74 centers. HVCs (n = 184 cases) had performed ≥4.9 cases annually and LVCs (n = 220 cases) had performed ≤2.4 cases annually. Both crude mortality (4.4% vs 8.6%; P = .22) and adjusted odds of mortality (odds ratio, 0.44; 95% confidence interval, 0.18-1.09; P = .08) showed a trend toward better outcomes for tTEVAR performed at HVCs than at LVCs. The addition of center volume to our previous multivariate model significantly improved its discriminative ability (C-statistic, 0.90 vs 0.88; P = .02). The overall TEVAR volume (for all indications) was not associated with increased odds of mortality for tTEVAR (odds ratio, 0.46; 95% confidence interval, 0.17-1.20; P = .11), nor did it improve the model's discriminative ability. Conclusions Higher volume centers showed improved perioperative mortality after tTEVAR. The thoracic aortic trauma volume was more predictive than the overall TEVAR volume, suggesting that technical expertise is not the driving factor. Stable patients might benefit from transfer to a higher volume center before repair.
Published: 2020

35. Five-year results of the INSPIRATION study for the INCRAFT low-profile endovascular aortic stent graft system

Author: Dennis Fry, Kimihiro Komori, Michel S. Makaroun, Inspiration Investigators, John P. Henretta, Takao Ohki, Kimihiko Kichikawa, Nathan L. Liang, Kenneth Ouriel, and Corey Teigen
Subjects: Male, medicine.medical_specialty, Time Factors, medicine.medical_treatment, Population, 030204 cardiovascular system & hematology, Prosthesis Design, Endovascular aneurysm repair, 03 medical and health sciences, Blood Vessel Prosthesis Implantation, 0302 clinical medicine, Aneurysm, Postoperative Complications, Occlusion, medicine, Humans, 030212 general & internal medicine, Prospective Studies, Adverse effect, education, Tokyo, Aged, Aged, 80 and over, education.field_of_study, business.industry, Endovascular Procedures, Stent, medicine.disease, Abdominal aortic aneurysm, United States, Surgery, Blood Vessel Prosthesis, Prosthesis Failure, Treatment Outcome, Cohort, Retreatment, Female, Stents, Cardiology and Cardiovascular Medicine, business, Aortic Aneurysm, Abdominal
Abstract: Objective We present the 5-year results of a prospective regulatory study of the INCRAFT device, a low-profile endovascular stent graft system for repair of abdominal aortic aneurysms. Methods This was an open-label prospective nonrandomized single-arm study enrolling in centers in the United States and Japan. The primary effectiveness outcome was successful aneurysm treatment and the primary safety outcome was the incidence of major adverse events at 30 days after the procedure. Major long-term outcomes were mortality, reintervention, adverse limb outcomes, and suprarenal stent fracture. Results One hundred and ninety patients (mean age, 73.8 ± 7.6 years; 90% male; 69% white and 30% Asian) were enrolled from 32 centers throughout the United States and Japan. Minimal access vessel size was less than 7 mm on both sides in 43.9% of the study cohort. Thirty-day major adverse events occurred in 3.2% of patients (6/190). Periprocedural technical success was 94.1% (176/187). Successful aneurysm treatment was 100% at 30 days and 87.9% at 1 year. Two patients required open conversion for thromboembolic complications, 3 developed new type I or III endoleaks, and 7 experienced graft or limb occlusion. Freedom from graft occlusion was 96 ± 2% at 1 year and 94 ± 2% at 5 years. Freedom from stent fracture was 97 ± 1% at 1 year and 87 ± 3% at 5 years. Freedom from aneurysm-related mortality was 99 ± 1% at 1 and 5 years. Conclusions This study demonstrates good efficacy and safety and a very low rate of aneurysm related deaths with the INCRAFT device in a population with a high proportion of challenging anatomy.
Published: 2020

36. Structural variation of the malaria-associated human glycophorin A-B-E region

Author: Fengtang Yang, Marilia O. Scliar, Faisal Almalki, Guilherme L. Yamamoto, Maria Rita Passos-Bueno, Michel S Naslavsky, Sandra Louzada, Walid Algady, Edward J. Hollox, Mayana Zatz, Paulina Brajer, Luciana W. Zuccherato, Eleanor Weyell, and Yeda Aparecida de Oliveira Duarte
Subjects: Erythrocytes, Recombination hotspot, lcsh:QH426-470, GYPE, lcsh:Biotechnology, Locus (genetics), Structural variation, 03 medical and health sciences, Chromosome Breakpoints, 0302 clinical medicine, lcsh:TP248.13-248.65, Gene cluster, Databases, Genetic, Genetics, Glycophorin, Humans, Copy-number variation, Glycophorins, 1000 Genomes Project, Malaria, Falciparum, Immune response, MALÁRIA, In Situ Hybridization, Fluorescence, GYPB, 030304 developmental biology, Disease Resistance, GYPA, 0303 health sciences, biology, Whole Genome Sequencing, Copy number variation, Inversion, Chromosome Mapping, 3. Good health, Malaria, lcsh:Genetics, 030220 oncology & carcinogenesis, Genomic Structural Variation, biology.protein, Sequence Alignment, 030217 neurology & neurosurgery, Biotechnology, Research Article
Abstract: Background Approximately 5% of the human genome shows common structural variation, which is enriched for genes involved in the immune response and cell-cell interactions. A well-established region of extensive structural variation is the glycophorin gene cluster, comprising three tandemly-repeated regions about 120 kb in length and carrying the highly homologous genes GYPA, GYPB and GYPE. Glycophorin A (encoded by GYPA) and glycophorin B (encoded by GYPB) are glycoproteins present at high levels on the surface of erythrocytes, and they have been suggested to act as decoy receptors for viral pathogens. They are receptors for the invasion of the protist parasite Plasmodium falciparum, a causative agent of malaria. A particular complex structural variant, called DUP4, creates a GYPB-GYPA fusion gene known to confer resistance to malaria. Many other structural variants exist across the glycophorin gene cluster, and they remain poorly characterised. Results Here, we analyse sequences from 3234 diploid genomes from across the world for structural variation at the glycophorin locus, confirming 15 variants in the 1000 Genomes project cohort, discovering 9 new variants, and characterising a selection of these variants using fibre-FISH and breakpoint mapping at the sequence level. We identify variants predicted to create novel fusion genes and a common inversion duplication variant at appreciable frequencies in West Africans. We show that almost all variants can be explained by non-allelic homologous recombination and by comparing the structural variant breakpoints with recombination hotspot maps, confirm the importance of a particular meiotic recombination hotspot on structural variant formation in this region. Conclusions We identify and validate large structural variants in the human glycophorin A-B-E gene cluster which may be associated with different clinical aspects of malaria.
Published: 2020

37. Contemporary Results of Surgical Management of Peripheral Mycotic Aneurysms

Author: Michel S. Makaroun, Stephen Leers, Becky Long, Eric S. Hager, Mohammad H. Eslami, Efthymios D. Avgerinos, Gregory G. Salzler, and Rabih A. Chaer
Subjects: Adult, Male, medicine.medical_specialty, Time Factors, medicine.medical_treatment, Clinical Decision-Making, Femoral artery, 030204 cardiovascular system & hematology, 030230 surgery, Revascularization, 03 medical and health sciences, Postoperative Complications, 0302 clinical medicine, Risk Factors, medicine.artery, medicine, Humans, Brachial artery, Ligation, Ulnar artery, Aged, Retrospective Studies, business.industry, External iliac artery, Extremities, General Medicine, Middle Aged, Mycotic aneurysm, Popliteal artery, Surgery, Treatment Outcome, Debridement, Amputation, Female, Cardiology and Cardiovascular Medicine, business, Aneurysm, Infected, Vascular Surgical Procedures
Abstract: Background Mycotic aneurysms of the extremities occur infrequently but can cause severe life and limb complications. Traditional treatment typically includes debridement and revascularization, though in select patients ligation may be well tolerated. We reviewed our experience with these aneurysms treated with these 2 modalities. Methods A retrospective review of patients treated for peripheral mycotic aneurysms at one institution from January 2005 to December 2015 was performed under an institutional review board–approved protocol. Demographics, perioperative details, and long-term outcomes were collected, and standard statistical methods were used to compare treatments. Results We identified 28 patients with 29 peripheral mycotic aneurysms. Most patients (19: 67.9%) were male with an average age of 60.1 ± 17 years. Among cases with a known cause, direct injury to artery was the most common precursor to mycotic aneurysm formation; iatrogenic causes were the most common (15: 51.7%) followed by intravenous drug use (5: 17.2%). Distal bacterial translocation was the other cause of mycotic aneurysm formation due to osteomyelitis (2:10.5%) and bacterial endocarditis (1:3.5%). The causes of the remainder of cases (6:20.7%) were unknown. Symptoms included fever (46.4%), drainage (42.9%), rupture (35.7%), erythema (21.4%), and limb ischemia (17.9%). Staphylococcus aureus was the most common bacteria isolated (38.5%, from 7 positive blood cultures and 3 positive wound cultures) with 30% of these being methicillin-resistant Staphylococcus aureus), followed by Streptococcus species (11.5%), and other Staphylococcus (7.7%). Eight (30.7%) patients had negative cultures. The most common location of arterial aneurysm was the common femoral artery (17:58.6%), with 17.2% (5) occurring in the popliteal artery, 13.8% (4) in the brachial artery, 10.3% (3) in the radial or ulnar artery, and 3.5% (1) in the external iliac artery. Eighteen patients underwent revascularization, whereas 11 had resection/ligation without revascularization (4 femoral, 2 popliteal, 3 radial/ulnar, 1 brachial, and 1 external iliac). There was no significant difference in limb-threatening ischemia between these 2 groups (P = 0.14). Of those who were not revascularized, 1 developed significant initial ischemia but died before amputation, and the other underwent revascularization within 1 year after tolerating the initial ligation. Upper extremity aneurysms were more likely to be reintervention-free than those in the lower extremities (P = 0.01). Conclusions In this series, resection or ligation of peripheral mycotic aneurysms without revascularization was well tolerated. With close follow-up of these patients, resection or ligation may obviate the more extensive initial revascularization procedures in these infected fields.
Published: 2018
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38. Current Experience and Midterm Follow-up of Immediate-Access Arteriovenous Grafts

Author: Rabih A. Chaer, Theodore H. Yuo, Sandra Truong, Jason K. Wagner, Efthymios D. Avgerinos, Eric S. Hager, Ellen D. Dillavou, and Michel S. Makaroun
Subjects: Adult, Male, medicine.medical_specialty, Time Factors, 030232 urology & nephrology, 030204 cardiovascular system & hematology, Prosthesis Design, Article, Catheterization, Blood Vessel Prosthesis Implantation, Young Adult, 03 medical and health sciences, Arteriovenous Shunt, Surgical, 0302 clinical medicine, Renal Dialysis, Blood vessel prosthesis, medicine, Humans, Vascular Patency, Tunneled catheter, Aged, Retrospective Studies, Aged, 80 and over, business.industry, Electronic medical record, Retrospective cohort study, General Medicine, Middle Aged, Blood Vessel Prosthesis, Surgery, Catheter, Treatment Outcome, Cohort, Female, Arteriovenous grafts, Cardiology and Cardiovascular Medicine, business
Abstract: Background No independent reviews, with midterm follow-up, of current experience with immediate-access arteriovenous grafts (IAAVGs) exist. The goal of this project was to assess the real-world performance of 2 different IAAVGs over a 2-year period at a large tertiary referral center. Methods Between January 2014 and April 2016, all consecutive patients who underwent placement of Acuseal (Gore) or Flixine (Maquet) IAAVGs were identified for retrospective analysis from the electronic medical record and Vascular Quality Initiative database. Primary, primary-assisted and secondary patency rates, time to first cannulation, time to tunneled catheter removal, and overall survival were recorded. Results Forty-three patients were identified to have undergone placement of IAAVG, 31 Acuseal (72%), and 12 Flixine (28%). Of the Acuseal cohort, 7 were implanted with outflow through a HeRO catheter system (Merit Medical). Mean follow-up time was 8.4 months. Overall survival was 57.4% at 18 months. Overall primary, primary assisted, and secondary patency at 18 months were 33.36%, 34.31%, and 51.03%, respectively. Eighty three percent of grafts were successfully cannulated, and 78% of preexisting catheters were removed. Mean time to successful graft cannulation and catheter removal were 14.85 and 32.26 days, respectively. Conclusions Real-world experience with novel arteriovenous access grafts is consistent with results from industry-sponsored studies. Early cannulation of immediate-access grafts can be successfully performed in a wide variety of patients. However, prolonged catheter dwell times persist despite increased rates of successful early-graft cannulation. Further study of methods for promoting catheter removal in this patient population is warranted.
Published: 2018
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39. Dramatic Dose Reduction in Three-Dimensional Rotational Angiography After Implementation of a Simple Dose Reduction Protocol

Author: Gregor J. Krings, Michel S. Koster, Savine C. S. Minderhoud, Mirella M C Molenschot, Johannes M.P.J. Breur, and Femke van der Stelt
Subjects: Male, Cardiac Catheterization, Adolescent, Image quality, Rotational angiography, Radiation dose reduction, 030204 cardiovascular system & hematology, Radiation Dosage, Effective dose (radiation), Catheterization, 03 medical and health sciences, 0302 clinical medicine, Imaging, Three-Dimensional, Medicine, Humans, 030212 general & internal medicine, Child, Effective dose, business.industry, Angiography, Infant, Three dimensional rotational angiography, Skin dose, Dose area product, Child, Preschool, Pediatrics, Perinatology and Child Health, Cohort, Dose reduction, Original Article, Female, Cardiology and Cardiovascular Medicine, business, Nuclear medicine
Abstract: Previously, median effective dose (ED) of 1.6 mSv per three-dimensional rotational angiography (3DRA) has been reported. This study evaluated ED and image quality in 3DRA after implementation of a simple dose reduction protocol in pediatric catheterizations. Simple conversion factors between 3DRA ED and readily available parameters at the cathlab were determined. The dose reduction protocol consisted of frame reduction (60–30 frames/s (f/s)), active collimation of the X-ray beam, usage of a readily available low dosage program, and a pre-3DRA run check. EDs were calculated with Monte Carlo PCXMC 2.0. Three observers blindly assessed 3DRA image quality of the dose reduction and normal-dose cohort. Between October 2014 and October 2015, 84 patients (median age 4.3 years) underwent 100 3DRAs with a median ED of 0.54 mSv (0.12–2.2) using the dose reduction protocol. Median ED in the normal-dose cohort (17 3DRAs) was 1.6 mSv (1.2–4.9). Image quality in the dose reduction cohort remained excellent. Correlations between ED and dose area product (DAP) and ED and skin dose were found with a ρ of 0.82 and 0.83, respectively. ED exposure of the entire catheterization was reduced to 2.64 mSv. Introduction of a simple protocol led to 66% dose reduction in 3DRA and 79% in the entire catheterization. 3DRA image quality in this group remained excellent. In 3DRA ED correlates well with DAP and skin dose, parameters readily available at the cathlab. Electronic supplementary material The online version of this article (10.1007/s00246-018-1943-3) contains supplementary material, which is available to authorized users.
Published: 2018

40. An Accumulated Deficits Model Predicts Perioperative and Long-term Adverse Events after Carotid Endarterectomy

Author: Efthymios D. Avgerinos, Mohammad H. Eslami, Bryan Wu, Rabih A. Chaer, Natalie Sridharan, and Michel S. Makaroun
Subjects: Carotid Artery Diseases, Male, Time Factors, medicine.medical_treatment, Myocardial Infarction, Comorbidity, Kaplan-Meier Estimate, Carotid endarterectomy, 030204 cardiovascular system & hematology, 0302 clinical medicine, Risk Factors, Odds Ratio, 030212 general & internal medicine, Myocardial infarction, Stroke, Endarterectomy, Aged, 80 and over, Endarterectomy, Carotid, Age Factors, General Medicine, Middle Aged, Treatment Outcome, Area Under Curve, Anesthesia, Female, medicine.symptom, Cardiology and Cardiovascular Medicine, medicine.medical_specialty, Risk Assessment, Asymptomatic, Article, Decision Support Techniques, 03 medical and health sciences, Sex Factors, Predictive Value of Tests, Internal medicine, medicine, Humans, Adverse effect, Aged, Proportional Hazards Models, Retrospective Studies, Chi-Square Distribution, Proportional hazards model, business.industry, Perioperative, Pennsylvania, medicine.disease, ROC Curve, Asymptomatic Diseases, Multivariate Analysis, Surgery, business
Abstract: There is increasing recognition that decreased reserve in multiple organ systems, known as accumulated deficits (AD), may better stratify perioperative risk than traditional risk indices. We hypothesized that an AD model would predict both perioperative adverse events and long-term survival after carotid endarterectomy (CEA), particularly important in asymptomatic patients.Consecutive patients undergoing CEA between 1st January 2000 and 31st December 2010 were retrospectively identified. Seven of the deficit items from the Canadian Study of Health and Aging-frailty index (coronary disease, renal insufficiency, pulmonary disease, peripheral vascular disease, heart failure, hypertension, and diabetes) were tabulated for each patient. Predictors of perioperative and long-term outcomes were evaluated using regression analysis.About 1,782 CEAs in 1,496 patients (mean age: 71.3 ± 9.3 years, 56.3% male, 35.4% symptomatic) were included. The risk of major adverse events (stroke, death, or myocardial infarction) at 30 days for patients with ≤3 deficits was 2.53% vs. 8.81% for patients with ≥4 deficits (P 0.001). For patients with ≥5 deficits, the risk was 15.18%. Each additional deficit increased the odds of a 30-day major adverse event and hospital stay2 days by 1.64 (P 0.001) and 1.15 (P 0.001), respectively. In multivariate analysis, the presence of ≥4 deficits was more predictive of perioperative major adverse events (odds ratio [OR] = 3.62, P 0.001) than symptomatology within 6 months (OR = 1.57, P = 0.08) or octogenarian status (OR = 2.00, P = 0.02). Kaplan-Meier analysis showed significantly decreased survival over time with accumulating deficits (P 0.001). Patients with ≥4 deficits have a hazards ratio for death of 2.6 compared to patients with ≤3 deficits (P 0.001). Overall survival is estimated at 79.5% (95% confidence interval [CI]: 0.77-0.82) at 5 years in patients with ≤3 deficits versus 52.4% (95% CI: 0.46-0.58) in patients with ≥4 deficits, respectively. In subgroup analysis of asymptomatic patients, 5-year survival for octogenarian male patients with ≥4 deficits was only 26.8%. For asymptomatic males aged 70-79 years with ≥4 deficits, 5-year survival was 59.9%.An AD model is more predictive of perioperative adverse events after CEA than age or symptomatic status. This model remains predictive of long-term survival. In asymptomatic male octogenarians with 4 or more AD, 5-year survival is severely limited.
Published: 2018
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41. Cost-effectiveness analysis of drug-coated therapies in the superficial femoral artery

Author: Natalie Sridharan, Mohammad H. Eslami, Michel S. Makaroun, Efthymios D. Avgerinos, Rabih A. Chaer, Kenneth J. Smith, Aureline Boitet, and Kathy Noorbakhsh
Subjects: medicine.medical_specialty, Cost-Benefit Analysis, medicine.medical_treatment, 030204 cardiovascular system & hematology, Balloon, Article, Amputation, Surgical, law.invention, Peripheral Arterial Disease, 03 medical and health sciences, 0302 clinical medicine, Randomized controlled trial, law, Angioplasty, medicine, Humans, Vascular Patency, 030212 general & internal medicine, Randomized Controlled Trials as Topic, business.industry, Hazard ratio, Stent, Cardiovascular Agents, Drug-Eluting Stents, Odds ratio, Cost-effectiveness analysis, Surgery, Femoral Artery, Treatment Outcome, Insurance, Health, Reimbursement, Health Expenditures, Cardiology and Cardiovascular Medicine, business, Angioplasty, Balloon
Abstract: Drug-coated balloons (DCBs) may increase durability of endovascular treatment of superficial femoral artery (SFA) disease while avoiding stent-related risks. The purpose of this study was to use meta-analytic data of DCB studies to compare the cost-effectiveness of potential SFA treatments: DCB, drug-eluting stent (DES), plain old balloon angioplasty (POBA), or bare-metal stent (BMS).A search for randomized controlled trials comparing DCB with POBA for treatment of SFA disease was performed. Hazard ratios were extracted to account for the time-to-event primary outcome of target lesion revascularization. Odds ratios were calculated for the secondary outcomes of primary patency (PP) and major amputation. Incorporating pooled data from the meta-analysis, cost-effectiveness analysis, assuming a payer perspective, used a decision model to simulate patency at 1 year and 2 years for each index treatment modality: POBA, BMS, DCB, or DES. Costs were based on current Medicare outpatient reimbursement rates.Eight studies (1352 patients) met inclusion criteria for meta-analysis. DCB outperformed POBA with respect to target lesion revascularization over time (pooled hazard ratio, 0.41; P .001). Risk of major amputation at 12 months was not significantly different between groups. There was significantly improved 1-year PP in the DCB group compared with POBA (pooled odds ratio, 3.30; P .001). In the decision model, the highest PP at 1 year was seen in the DES index therapy strategy (79%), followed by DCB (74%), BMS (71%), and POBA (64%). With a baseline cost of $9259.39 per patent limb at 1 year in the POBA-first group, the incremental cost per patent limb for each other strategy compared with POBA was calculated: $14,136.10/additional patent limb for DCB, $38,549.80/limb for DES, and $59,748,85/limb for BMS. The primary BMS option is dominated by being more expensive and less effective than DCB. Compared directly with DCB, DES costs $87,377.20 per additional patent limb at 1 year. Based on the projected PP at 1 year in the decision model, the number needed to treat for DES compared with DCB is 20. At current reimbursement, the use of more than two DCBs per procedure would no longer be cost-effective compared with DES. At 2 years, DCB emerges as the most cost-effective index strategy with the lowest overall cost and highest patency rates over that time horizon.Current data and reimbursements support the use of DCB as a cost-effective strategy for endovascular intervention in the SFA; any additional effectiveness of DES comes at a high price. Use of more than one DCB per intervention significantly decreases cost-effectiveness.
Published: 2018
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42. Early Postoperative Mortality Among US Veterans With a Robust Physiologic Reserve Undergoing Open or Endovascular Abdominal Aortic Aneurysm Repair

Author: Daniel E. Hall, Katherine M. Reitz, Nathan L. Liang, Edith Tzeng, and Michel S. Makaroun
Subjects: Male, medicine.medical_specialty, MEDLINE, Cohort Studies, Research Letter, Humans, Medicine, cardiovascular diseases, Postoperative Period, health care economics and organizations, Aged, Veterans, Open Abdomen Techniques, business.industry, Research, Endovascular Procedures, Age Factors, General Medicine, Middle Aged, medicine.disease, humanities, United States, Abdominal aortic aneurysm, Surgery, Online Only, Postoperative mortality, cardiovascular system, Female, business, Aortic Aneurysm, Abdominal
Abstract: This cohort study uses data from the Veterans Affairs Surgical Quality Improvement Program database to examine the risk of early postoperative mortality among US veterans with a robust physiologic reserve undergoing open or endovascular abdominal aortic aneurysm repair.
Published: 2021
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43. High mortality rates after both open surgical and endovascular thoracic aortic interventions in patients with end-stage renal disease

Author: Michel S. Makaroun, Nathan L. Liang, Michael J. Singh, Georges E. Al-Khoury, Eric S. Hager, and Theodore H. Yuo
Subjects: Male, Time Factors, Databases, Factual, medicine.medical_treatment, Aorta, Thoracic, Kaplan-Meier Estimate, 030204 cardiovascular system & hematology, Postoperative Complications, 0302 clinical medicine, Risk Factors, Odds Ratio, Thoracic aorta, 030212 general & internal medicine, education.field_of_study, Endovascular Procedures, Middle Aged, Treatment Outcome, Female, Cardiology and Cardiovascular Medicine, medicine.medical_specialty, Population, Aortic Diseases, Risk Assessment, Article, End stage renal disease, Blood Vessel Prosthesis Implantation, 03 medical and health sciences, Aneurysm, Renal Dialysis, medicine.artery, medicine, Humans, education, Survival analysis, Dialysis, Aged, Proportional Hazards Models, Retrospective Studies, Chi-Square Distribution, business.industry, Perioperative, Odds ratio, medicine.disease, United States, Surgery, Logistic Models, Multivariate Analysis, Kidney Failure, Chronic, business
Abstract: Morbidity and mortality have improved with the evolution of endovascular techniques (thoracic endovascular aortic repair [TEVAR]) for thoracic aortic disease, but results after aortic intervention in patients with end-stage renal disease (ESRD) remain unclear. The objective of this study was to evaluate outcomes of open and endovascular descending thoracic aortic repair in dialysis-dependent patients.We identified 352 patients with ESRD on dialysis undergoing open repair (n = 136) or TEVAR (n = 216) of the thoracic aorta from 2005 to 2008 using the United States Renal Data System database. Acute presentation was defined as ruptured aneurysm, dissection, or traumatic injury; all other interventions were considered elective. End points were 30-day mortality, overall survival, rates of perioperative complications, and procedural trends over time. Between-group comparisons and survival analysis used standard statistical methods. Logistic regression and Cox regression were performed using multivariate analysis.TEVAR subjects were older than those undergoing open repair (68.2 ± 11.5 vs 60.8 ± 13.2 years; P .001); no other demographics differed. There were 303 patients who had thoracic or thoracoabdominal aneurysms; 47 (13.4%) were ruptured on presentation. There were 44 patients (12.5%) who had aortic dissection and 5 (1.4%) with aortic trauma. Overall 30-day mortality was 21.3% (n = 75), and it was greater for open repair (n = 41 [30.1%]) than for TEVAR (n = 34 [15.7%]; P = .002). Elective 30-day mortality for open repair (n = 27 [29.3%]) was also greater than for TEVAR (n = 24 [14.3%]; P = .005). Those with acute presentation trended toward higher mortality for open repair (n = 14 [31.8%] vs n = 10 [15.7%]; P = .17). Respiratory failure was higher for open repair (n = 69 [50.7%] vs n = 56 [25.9%]; P .001); postoperative stroke was higher with TEVAR (n = 21 [9.7%] vs n 10 [7%]; P = .02). Estimated 1-year survival was 50% and did not differ between groups (44% for open repair, 53% for TEVAR). In multivariate analysis, TEVAR decreased odds of 30-day mortality compared with open repair (odds ratio, 0.41; 95% confidence interval, 0.24-0.71) but failed to demonstrate long-term survival advantage.In ESRD patients, TEVAR provides short-term mortality benefits compared with open repair, but long-term mortality remains high regardless of treatment modality. Elective intervention for thoracic aortic disease in this population remains high risk and should be approached with caution.
Published: 2017
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44. Five-year outcomes of the PYTHAGORAS U.S. clinical trial of the Aorfix endograft for endovascular aneurysm repair in patients with highly angulated aortic necks

Author: Kim J. Hodgson, Caitlin W. Hicks, Mahmoud B. Malas, Mark F. Fillinger, Michael Belkin, Joseph L. Mills, Michel S. Makaroun, and William D. Jordan
Subjects: Male, medicine.medical_specialty, Time Factors, medicine.medical_treatment, Kaplan-Meier Estimate, 030204 cardiovascular system & hematology, Prosthesis Design, Endovascular aneurysm repair, Disease-Free Survival, Aneurysm rupture, Blood Vessel Prosthesis Implantation, 03 medical and health sciences, Postoperative Complications, 0302 clinical medicine, Aneurysm, Risk Factors, medicine, Humans, In patient, High angle, Aorta, Abdominal, Prospective Studies, 030212 general & internal medicine, Aged, Fixation (histology), Aged, 80 and over, business.industry, Endovascular Procedures, Stent, medicine.disease, United States, Blood Vessel Prosthesis, Surgery, Clinical trial, Treatment Outcome, Retreatment, Female, Radiology, Cardiology and Cardiovascular Medicine, business, Aortic Aneurysm, Abdominal
Abstract: Early and midterm outcomes of the Prospective Aneurysm Trial: High Angle Aorfix Bifurcated Stent Graft (PYTHAGORAS) trial in patients with highly angulated aortic necks (≥60 degrees) have already been published and shown comparable outcomes to other endografts in normal anatomy. Herein, we present the long-term outcomes of the PYTHAGORAS trial of Aorfix (Lombard Medical, Irvine, Calif) for patients with highly angulated aortic neck anatomy.The Aorfix endograft is a highly conformable nitinol/polyester device designed for transrenal fixation. The U.S. trial enrolled 218 patients and observed all patients at 1 month, 6 months, and 12 months and then annually for a total of 5 years. Endovascular aneurysm repair (EVAR)-specific complications were compared between the standard-angle (60 degrees) and highly angulated (≥60 degrees) neck groups at 5 years using standard statistical methods. Kaplan-Meier analysis was performed to evaluate the overall 5-year survival and freedom from aneurysm rupture, aneurysm-related mortality, and reintervention.Of the 218 patients enrolled in the trial, there were 67 patients in the standard-angle neck group (I) and 151 patients in the highly angulated neck group (II). Mean proximal neck angle was 45 degrees in group I vs 83 degrees in group II (P .001). At 5 years, 87% of surviving patients were followed up. The 5-year EVAR-specific results showed no type I or type III endoleak in either group, 4% migration in group I vs 3% in group II, and 4% sac expansion in group I vs 15.0% in group II (P ≥ .27). The 5-year freedom from all-cause mortality was 69% (73% in group I vs 68% in group II; P = .43); from aneurysm-related mortality, 96% (99% vs 95%; P = .44); from aneurysm rupture, 99% (99% vs 99%; P = 1.0); and from device-related secondary intervention, 83% (88% vs 80%; P = .18). None of these differed between groups.The U.S. PYTHAGORAS trial of the Aorfix endograft is the first EVAR clinical trial to include a majority of highly angulated (≥60 degrees) infrarenal aortic necks and is the first to produce evidence after 5 years of implantation. Despite predictors of worse short- and long-term outcomes, pertinent outcomes were better than or similar to those of trials with less severe anatomy. These results support the use of this "on-label" endovascular option, particularly in patients with highly angulated aortic neck anatomy.
Published: 2017
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45. Predictors of failure and complications of catheter-directed interventions for pulmonary embolism

Author: Michael J. Singh, Adham N. Abou Ali, Michel S. Makaroun, Efthymios D. Avgerinos, Nathan L. Liang, Rabih A. Chaer, and Elizabeth A. Genovese
Subjects: Male, medicine.medical_specialty, genetic structures, medicine.medical_treatment, Hemorrhage, 030204 cardiovascular system & hematology, 03 medical and health sciences, 0302 clinical medicine, Fibrinolytic Agents, medicine, Humans, Decompensation, Hospital Mortality, Treatment Failure, 030212 general & internal medicine, Adverse effect, Contraindication, Ultrasonography, Interventional, Retrospective Studies, Univariate analysis, Heparin, business.industry, Angioplasty, Retrospective cohort study, Thrombolysis, Middle Aged, Prognosis, medicine.disease, Pulmonary embolism, Surgery, Catheter, Tissue Plasminogen Activator, Acute Disease, Female, Pulmonary Embolism, Cardiology and Cardiovascular Medicine, business
Abstract: Objective Catheter-directed interventions (CDIs) are increasingly performed for acute pulmonary embolism (PE) as they are presumed to provide similar therapeutic benefits to systemic thrombolysis while decreasing the dose of thrombolytic required and the associated risks. This study aimed to identify factors associated with CDI failure and to describe anticipated complications. Methods Consecutive patients who underwent CDI for massive or submassive PE between 2009 and 2015 were identified; outcomes and complications were retrospectively collected. CDI clinical failure was defined as major bleeding, perioperative stroke or other major adverse procedure-related event, decompensation for submassive or persistent shock for massive PE, need for surgical thromboembolectomy, or in-hospital death. Univariate analysis was used to study the factors associated with CDI failure. Results There were 102 patients who received a CDI during the study period (36 standard catheter thrombolysis, 60 ultrasound assisted, 6 other; age, 59.2 ± 15.9 years; male, 50 [49.0%]; massive PE, 14 [13.7%]). Five patients (4.9%) had a major contraindication and 15 patients (14.7%) had a minor contraindication to systemic thrombolysis. The mean alteplase dose was 28.2 ± 18.8 mg (range, 0-123 mg; three patients had already received systemic lysis). CDI failure occurred in 15 patients (14.7%; 7 in massive PE, 8 in submassive PE). Of these patients, seven had major bleeding events, whereas eight patients decompensated. Ten (9.8%) patients had minor bleeding events (four access related). Factors associated with CDI failure and major bleeding included massive PE, age ≥70 years, and major contraindication to thrombolytics. Both failures and bleeding events were independent of lysis dose and CDI technique. Conclusions CDIs for acute PE are not risk-free procedures, and their use should be individualized on the basis of a risk-benefit ratio. Particularly for patients with major contraindications to systemic thrombolytics, CDIs should be used selectively. Lytic dose, within the low-volume range administered in CDI, and type of CDI seem to have no impact on adverse events.
Published: 2017
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46. Acute superior mesenteric venous thrombosis results in high rates of readmission and morbidity

Author: Michael J. Singh, Katherine M. Reitz, Michel S. Makaroun, Mohammad H. Eslami, Efthymios D. Avgerinos, Xiaoyi Li, Rabih A. Chaer, Elizabeth Andraska, Rafael Ramos, and Lindsey Haga
Subjects: Adult, Male, medicine.medical_specialty, Abdominal pain, Time Factors, medicine.medical_treatment, Computed tomography, 030204 cardiovascular system & hematology, Patient Readmission, Risk Assessment, Article, 03 medical and health sciences, Mesenteric Venous Thrombosis, 0302 clinical medicine, Mesenteric Veins, Risk Factors, Mesenteric Vascular Occlusion, medicine, Humans, Thrombophilia, 030212 general & internal medicine, Splanchnic Circulation, Digestive System Surgical Procedures, Aged, Retrospective Studies, High rate, Venous Thrombosis, medicine.diagnostic_test, business.industry, Endovascular Procedures, Anticoagulants, Bowel resection, Middle Aged, medicine.disease, Surgery, Abdominal Pain, Treatment Outcome, Mesenteric ischemia, Lactic acidosis, Mesenteric Ischemia, Acute Disease, Female, medicine.symptom, Cardiology and Cardiovascular Medicine, business, Body mass index
Abstract: OBJECTIVE: Superior mesenteric venous thrombosis (MVT) is a poorly understood clinical entity, and as such, outcomes are poorly described. This study aimed to identify predictors of bowel ischemia after MVT and to compare outcomes for patients treated medically (group 1) with those for patients treated with bowel resection (group 2). METHODS: This was a retrospective, single-institution study capturing all patients diagnosed with symptomatic acute MVT on computed tomography imaging from 2008 to 2018. Demographics, comorbidities, imaging, laboratory values, and treatment were included. Predictors of bowel resection were analyzed by univariate and multivariate statistics. Outcomes including mortality, readmissions for abdominal pain, and chronic mesenteric venous congestion were compared using χ(2) test. RESULTS: There were 121 patients included in the study; 98 patients were treated medically (group 1), 19 patients were treated with bowel resection (group 2), and 4 patients were treated with endovascular recanalization (group 3). Group 1 and group 2 were compared directly. Patients requiring bowel resection tended to have higher body mass index (P = .051) and a hypercoagulable disorder (P = .003). Patients who required bowel resection were more likely to present with lactic acidosis (P < .001) and leukocytosis (P < .001) with bowel wall thickening on scan (P < .001). On multivariable analysis, a genetic thrombophilia was a strong predictor of bowel ischemia (odds ratio, 3.81; 95% confidence interval, 1.12–12.37). One-year mortality and readmission rates did not differ between groups. However, readmission rates for abdominal pain were high for both groups (group 1, 44.90%; group 2, 57.89%; P = .317), and a significant proportion of patients exhibited chronic mesenteric venous congestion on repeated scan (group 1, 42.86%; group 2, 47.37%; P = .104). CONCLUSIONS: A genetic hypercoagulable disorder is a predictor of bowel ischemia due to MVT. Regardless of treatment, outcomes after MVT are morbid, with high rates of readmission for abdominal pain. An alternative approach to treat these patients is needed, given the poor outcomes with current strategies.
Published: 2019

47. Inferior Mid-Term Durability with Comparable Survival for Younger Patients Undergoing Elective Endovascular Infrarenal vs. Open Abdominal Aortic Aneurysm Repair

Author: Bowen Xie, Katherine M. Reitz, Edith Tzeng, Nathan L. Liang, and Michel S. Makaroun
Subjects: Male, medicine.medical_specialty, Time Factors, medicine.medical_treatment, 030204 cardiovascular system & hematology, Endovascular aneurysm repair, Risk Assessment, Article, 030218 nuclear medicine & medical imaging, 03 medical and health sciences, Aortic aneurysm, Blood Vessel Prosthesis Implantation, 0302 clinical medicine, Risk Factors, medicine, Humans, cardiovascular diseases, Aged, Retrospective Studies, Surgical repair, business.industry, Endovascular Procedures, Age Factors, Retrospective cohort study, General Medicine, Perioperative, Middle Aged, medicine.disease, Abdominal aortic aneurysm, Surgery, Treatment Outcome, Elective Surgical Procedures, cardiovascular system, Female, Cardiology and Cardiovascular Medicine, Elective Surgical Procedure, business, Abdominal surgery, Aortic Aneurysm, Abdominal
Abstract: BACKGROUND: The durability of endovascular aneurysm repair (EVAR) when compared to open surgical repair (OSR) in younger patients for elective, infrarenal abdominal aortic aneurysms (AAA) remains unclear due to limited follow up. STUDY DESIGN: We identified all patients
Published: 2019

48. Novel bypass risk predictive tool is superior to the 5-Factor Modified Frailty Index in predicting postoperative outcomes

Author: Jacob C. Hodges, Michael J. Singh, Zein Saadeddin, Efthymios D. Avgerinos, Mohammad H. Eslami, Jeffrey J. Siracuse, Jeffrey D. Borrebach, and Michel S. Makaroun
Subjects: Male, medicine.medical_specialty, medicine.medical_treatment, Axillofemoral Bypass Grafting, Aortoiliac occlusive disease, 030204 cardiovascular system & hematology, Logistic regression, Iliac Artery, Risk Assessment, 03 medical and health sciences, Peripheral Arterial Disease, 0302 clinical medicine, Postoperative Complications, Risk Factors, Medicine, Intubation, Humans, 030212 general & internal medicine, Myocardial infarction, Hospital Mortality, Aorta, Aged, Retrospective Studies, Aged, 80 and over, Frailty, business.industry, Critical limb ischemia, Middle Aged, medicine.disease, Prognosis, Femoral Artery, Treatment Outcome, Bypass surgery, Lower Extremity, Elective Surgical Procedures, Heart failure, Emergency medicine, Axillary Artery, Surgery, Female, medicine.symptom, Cardiology and Cardiovascular Medicine, business, Vascular Surgical Procedures
Abstract: Objective This study aimed to develop risk predictive models of 30-day mortality, morbidity, and major adverse limb events (MALE) after bypass surgery for aortoiliac occlusive disease (AIOD) and to compare their performances with a 5-Factor Frailty Index. Methods The American College of Surgeons National Surgical Quality Improvement Program 2012-2017 Procedure Targeted Aortoiliac (Open) Participant Use Data Files were queried to identify all patients who had elective bypass for AIOD: femorofemoral bypass, aortofemoral bypass, and axillofemoral bypass (AXB). Outcomes assessed included mortality, major morbidity, and MALE within 30 days postoperatively. Major morbidity was defined as pneumonia, unplanned intubation, ventilator support for >48 hours, progressive or acute renal failure, cerebrovascular accident, cardiac arrest, or myocardial infarction. Demographics, comorbidities, procedure type, and laboratory values were considered for inclusion in the risk predictive models. Logistic regression models for mortality, major morbidity and MALE were developed. The discriminative ability of these models (C-indices) were compared with that of the 5-Factor Modified Frailty Index (mFI-5): a general frailty tool determined from diabetes, functional status, history of chronic obstructive pulmonary disease, history of congestive heart failure, and hypertension. Calculators were derived using the most significant variables for each of the three risk predictive models. Results A total of 2612 cases (mean age 65.0, 60% male) were identified, of which 1149 (44.0%) were femorofemoral bypass, 1138 (43.6%) were aortofemoral bypass, and 325 (12.4%) were axillofemoral bypass. Overall, the rates of mortality, major morbidity, and MALE were 2.0%, 8.5%, and 4.9%, respectively. Twenty preoperative risk factors were considered for incorporation in the risk tools. Apart from procedure type, age was the most statistically significant predictor of both mortality and morbidity. Preoperative anemia and critical limb ischemia were the most significant predictors of MALE. All three constructed models demonstrated significantly better discriminative ability (P Conclusions Our models outperformed the mFI-5 in predicting 30-day mortality, major morbidity, and adverse limb events in patients with AIOD undergoing elective bypass surgery. Calculators were created using the most statistically significant variables to help calculate individual patient's postoperative risks and allow for better informed consent and risk-adjusted comparison of provider outcomes.
Published: 2019

49. Risk factors for mortality after endovascular repair for blunt thoracic aortic injury

Author: Marc L. Schermerhorn, Mohammad H. Eslami, Nathan L. Liang, Abhisekh Mohapatra, Michel S. Makaroun, and Alik Farber
Subjects: Adult, Male, medicine.medical_specialty, Thoracic Injuries, Aorta, Thoracic, 030204 cardiovascular system & hematology, Logistic regression, Wounds, Nonpenetrating, Article, 03 medical and health sciences, 0302 clinical medicine, Blunt, Interquartile range, Risk Factors, medicine.artery, Medicine, Thoracic aorta, Humans, 030212 general & internal medicine, Hospital Mortality, business.industry, Mortality rate, Endovascular Procedures, Odds ratio, Middle Aged, Confidence interval, Surgery, Blunt trauma, Female, Cardiology and Cardiovascular Medicine, business
Abstract: Despite high use of endovascular repair, blunt thoracic aortic injury (BTAI) leads to significant mortality. We sought to identify risk factors and create a predictive model for mortality after thoracic endovascular aortic repair (TEVAR) based on available preoperative clinical data.We queried the Vascular Quality Initiative TEVAR dataset from April 2011 to November 2017 to identify patients with BTAI as the indication for repair. Patient characteristics, injury grade, timing of repair, and technical aspects including left subclavian artery (LSCA) involvement and coverage were evaluated. Logistic regression was used to identify univariable predictors of the primary outcome of in-hospital mortality. A multivariable model was constructed to predict in-hospital mortality after TEVAR for traumatic aortic injury. The model was tested as a prediction tool, internally validated using 10-fold cross-validation approach, externally validated using early and late split samples, and finally simplified into a scoring system.We identified 633 TEVAR cases performed for blunt trauma. The majority of patients were male (73.9%) with median age of 39 years (interquartile range, 27-56 years). Although 18.6% documented zone 2 or proximal involvement, 28.1% documented involvement or treatment of the LSCA. 8.9% of repairs were performed for a grade 1 injury, with an increase from 6.4% in 2014 to 16.7% in 2017 (P = .04). The overall in-hospital mortality rate was 7.3%. Independent predictors of mortality were age 60 year or greater (odds ratio [OR], 11.33; 95% confidence interval [CI], 5.30-24.23; P .001), creatinine 1.2 or greater (OR, 5.28; 95% CI, 2.46-11.34; P .001), male gender (OR, 4.26; 95% CI, 1.53-11.84; P = .005), Injury Severity Score of greater than 30 (OR, 3.86; 95% CI, 1.74-8.57; P = .001), and LSCA involvement (OR, 2.25; 95% CI, 1.11-4.53; P = .02). The model predicted in-hospital mortality with a C-statistic of 0.86 (95% CI, 0.80-0.92), and a simplified model based on a point system had a similar C-statistic of 0.86 (95% CI, 0.80-0.92; P = .44).TEVAR for BTAI is associated with a 7.3% in-hospital mortality in the Vascular Quality Initiative. Treatment of grade 1 injuries has increased significantly in recent years. Factors most strongly associated with mortality include age, male gender, renal impairment, LSCA involvement, and high ISS score. A simple point score model based on these variables robustly predicts in-hospital mortality and may assist in appropriate patient selection and risk stratification.
Published: 2019

50. New randomized controlled trials for abdominal aortic aneurysm treatment should focus on younger, good-risk patients

Author: Natalie Sridharan, Edith Tzeng, Michel S. Makaroun, Rabih A. Chaer, Katherine M. Reitz, Mohammad H. Eslami, and Nathan L. Liang
Subjects: medicine.medical_specialty, Focus (computing), business.industry, General surgery, Endovascular Procedures, medicine.disease, Abdominal aortic aneurysm, law.invention, Text mining, Randomized controlled trial, Elective Surgical Procedures, law, medicine, Humans, Surgery, Cardiology and Cardiovascular Medicine, business, Aortic Aneurysm, Abdominal, Randomized Controlled Trials as Topic
Published: 2021
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