Publications by authors named "Leonard Y Lee"

62 Publications

Early Discharge After Minimally Invasive Aortic and Mitral Valve Surgery.

Ann Thorac Surg 2021 Aug 19. Epub 2021 Aug 19.

Rutgers Robert Wood Johnson Medical School, Department of Surgery, Division of Cardiothoracic Surgery, 125 Paterson St., New Brunswick, NJ 08901; Robert Wood Johnson University Hospital, 1 Robert Wood Johnson Pl., New Brunswick, NJ 08901. Electronic address:

Background: We investigated patient outcomes in relation to their postoperative length of stay after minimally invasive valve surgery.

Methods: All adults who survived elective, uncomplicated minimally invasive aortic or mitral valve surgery at a single center between 2012 and 2019 were classified by postoperative length of stay: early discharge (≤ 3 days) or late discharge (> 3 days). The trend in early discharge was investigated over the study period, predictors of early discharge were identified using multivariable logistic regression modeling, and one-to-one propensity score matching was used to determine which patients in the late-discharge cohort of similar health to patients discharged early. Adjusted outcomes of 30-day mortality, readmission, and direct costs were analyzed.

Results: Among 1,262 consecutive minimally invasive valve patients, 618 were elective and uncomplicated, 25% (n=162) of whom were discharged early. The proportion of early-discharge patients increased over time (p for trend <0.05). A history of congestive heart failure, stroke, or smoking and higher Society of Thoracic Surgeons predictive risk of mortality score negatively predicted early discharge (p<0.05). Propensity score matching identified 101 (22%) late-discharge patients comparable to early-discharge counterparts. Adjusted 30-day mortality and readmission rates were comparable between cohorts. The median direct costs per patient ($20,046 vs. $22,124; p<0.05) were significantly lower in the early-discharge cohort.

Conclusions: In well-selected patients, early discharge after minimally invasive valve surgery was associated with lower costs but comparable postoperative outcomes. About one fifth of patients who remain in the hospital beyond postoperative day 3 may be candidates for earlier discharge.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.athoracsur.2021.07.047DOI Listing
August 2021

Response to Alam et al. regarding our manuscript "Impact of risk factors on in-hospital mortality for octogenarians undergoing cardiac surgery".

J Card Surg 2021 Oct 29;36(10):3997. Epub 2021 Jul 29.

Department of Cardiothoracic Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/jocs.15883DOI Listing
October 2021

MitraClip Implantation in a Patient With Post-Surgical Repair of Primum Atrial Septal Defect and Residual Mitral Cleft.

JACC Case Rep 2020 Oct 21;2(12):2027-2029. Epub 2020 Oct 21.

Advanced Cardiac Imaging, Robert Wood Johnson Medical School, Rutgers, New Jersey.

This paper presents the case of a 67-year-old female with primum atrial septal defect and congenital mitral cleft status-post surgical repair 40 years previously who was recently found to have severe mitral regurgitation. Percutaneous mitral valve repair was successfully performed using implantation of 2 MitraClips with mild residual mitral regurgitation. ().
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jaccas.2020.07.055DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8299242PMC
October 2020

Trends in Early Discharge and Associated Costs after Transcatheter Aortic Valve Replacement: A National Perspective.

Innovations (Phila) 2021 Jul-Aug;16(4):373-378. Epub 2021 Jun 16.

459812287 Division of Cardiac Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA.

Objective: The current study aims to report trends of early discharges and identify associated direct costs using a nationally representative database of real-world data experience.

Methods: We used nationally weighted data on all patients who had transfemoral transcatheter aortic valve replacement (TAVR) from 2012 to 2017 and discharged alive from the National Inpatient Sample. Patients were divided into early (discharge ≤3 days of admission) and late discharge. Demographics and clinical characteristics were compared. Trends in early discharge and costs associated with admissions were analyzed over the study period.

Results: Of the 125,188 patients identified, 59,424 (46.9%) were discharged early. The proportion of early discharge increased from 15% in early 2012 to 68% in late 2017 ( < 0.001), with the largest increase occurring from 2014 to 2015. Overall, the average cost of TAVR decreased from $58,408 in 2012 to $49,875 in 2017 ( < 0.001). Compared to late discharge, patients discharged early reported costs savings of ≥$20,000 over the study period. Among the early discharge group, no significant differences in costs were observed for patients discharged on 0 to 1, 2, or 3 days after the procedure.

Conclusions: Postoperative length of stay after TAVR has decreased dramatically within the last decade with an observed reduction in procedural costs. While discharge within 3 days appeared cost effective, no differences in costs were noted among patients discharged ≤3 days.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/15569845211013355DOI Listing
June 2021

Case report: surgical resection of right ventricular cardiac fibroma in an adult patient.

J Cardiothorac Surg 2021 May 20;16(1):136. Epub 2021 May 20.

Division of Cardiothoracic Surgery, Department of Surgery, Rutgers-Robert Wood Johnson Medical School, 125 Paterson Street, New Brunswick, NJ, USA.

Background: Cardiac fibromas are rare benign cardiac neoplasms, most frequently occurring in the pediatric population; with very rare cases identified in adults. The tumors are comprised of spindled cells with myofibroblastic ultrastructural features embedded in generally collagenous and elastic stroma. The tumors are intramural in the ventricles, most commonly the left ventricle. Clinical symptoms vary by location and size of tumor and some are asymptomatic. Surgical resection is curative, but rare cases require cardiac transplantation.

Case Presentation: We report an asymptomatic, large, right ventricular fibroma in a 64-year-old woman. The patient underwent open incisional tumor biopsy via lower hemi-sternotomy, followed by complete tumor resection via full sternotomy a week later after confirming the tumor is benign. The tumor was resected using cardiopulmonary bypass, and the defect of right ventricular free wall was repaired using a prosthetic double-patch technique. The postoperative course was uneventful. The patient was discharged to home on day 4 post-complete tumor resection.

Conclusion: This report expands the existing literature for better comprehension and detection of cardiac fibroma patients and also highlights the various imaging modalities, surgical management, and histological analysis.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/s13019-021-01514-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8139114PMC
May 2021

CREG1 promotes lysosomal biogenesis and function.

Autophagy 2021 May 8:1-17. Epub 2021 May 8.

Department of Surgery, Rutgers University-Robert Wood Johnson Medical School, New Brunswick, NJ, USA.

CREG1 is a small glycoprotein which has been proposed as a transcription repressor, a secretory ligand, a lysosomal, or a mitochondrial protein. This is largely because of lack of antibodies for immunolocalization validated through gain- and loss-of-function studies. In the present study, we demonstrate, using antibodies validated for immunofluorescence microscopy, that CREG1 is mainly localized to the endosomal-lysosomal compartment. Gain- and loss-of-function analyses reveal an important role for CREG1 in both macropinocytosis and clathrin-dependent endocytosis. CREG1 also promotes acidification of the endosomal-lysosomal compartment and increases lysosomal biogenesis. Functionally, overexpression of CREG1 enhances macroautophagy/autophagy and lysosome-mediated degradation, whereas knockdown or knockout of CREG1 has opposite effects. The function of CREG1 in lysosomal biogenesis is likely attributable to enhanced endocytic trafficking. Our results demonstrate that CREG1 is an endosomal-lysosomal protein implicated in endocytic trafficking and lysosomal biogenesis. AIFM1/AIF: apoptosis inducing factor mitochondria associated 1; AO: acridine orange; ATP6V1H: ATPase H+ transporting V1 subunit H; CALR: calreticulin; CREG: cellular repressor of E1A stimulated genes; CTSC: cathepsin C; CTSD: cathepsin D; EBAG9/RCAS1: estrogen receptor binding site associated antigen 9; EIPA: 5-(N-ethyl-N-isopropyl)amiloride; ER: endoplasmic reticulum; GFP: green fluorescent protein; HEXA: hexosaminidase subunit alpha; IGF2R: insulin like growth factor 2 receptor; LAMP1: lysosomal associated membrane protein 1; M6PR: mannose-6-phosphate receptor, cation dependent; MAPK1/ERK2: mitogen-activated protein kinase 1; MTORC1: mechanistic target of rapamycin kinase complex 1; PDIA2: protein disulfide isomerase family A member 2; SQSTM1/p62: sequestosome 1; TF: transferrin; TFEB: transcription factor EB.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/15548627.2021.1909997DOI Listing
May 2021

Impact of risk factors on in-hospital mortality for octogenarians undergoing cardiac surgery.

J Card Surg 2021 Jul 6;36(7):2400-2406. Epub 2021 Apr 6.

Department of Cardiothoracic Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA.

Background: Octogenarians undergoing cardiac surgery have higher mortality than their younger counterparts.

Objectives: To determine if various risk factors have the same effect on mortality in octogenarians as in younger patients.

Methods: The National Inpatient Sample data set from 2004 to 2014 was queried to select patients aged 65 years and older who underwent either coronary artery bypass grafting (CABG), valvular heart surgery (VHS), or both (CABG + VHS) within 10 days of hospital admission. The patients were divided into two groups 65-79 years and 80 years and greater. Hospital mortality, patient demographics, comorbidities, and type of hospital admission was evaluated and compared using χ and multivariable logistic regressions.

Results: About 397,713 patients were identified including 86,345 (21.7%) aged 80 and above. Octogenarians had higher in-hospital mortality for all procedures: CABG (4.94% vs. 2.39%, p < .001), VHS (5.49% vs. 4.08%, p < .001), and CABG + VHS (7.59% vs. 5.95%, p < .001), and this relationship persisted when gender, race, comorbidities, and type of hospital admission were controlled for: CABG (odds ratio [OR] = 1.71; 95% confidence interval [CI] 1.62-1.81); VHS (OR = 1.18; 95% CI 1.11-1.27); and CABH + VHS (OR = 1.17; 95%CI 1.10-1.26). Female gender, renal, or heart failure, nonelective admission, and CABG + VHS were associated with increased risk of in-hospital mortality. Octogenarians had higher rates of these factors (p < .001). The effect size of renal and heart failure and type of surgery was smaller for octogenarians.

Conclusions: Octogenarians undergoing cardiac surgery have higher rates of nonelective admissions, renal and heart failure, and female gender, which are most strongly associated with in-hospital mortality. Differing effect sizes suggest that certain risk factors, such as renal and heart failure, contribute more to mortality in younger patients.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/jocs.15532DOI Listing
July 2021

Change in Renal Function and Its Impact on Survival in Chronic Kidney Disease Patients Bridged to Heart Transplantation With a Left Ventricular Assist Device.

ASAIO J 2021 Mar 22. Epub 2021 Mar 22.

From the Heart and Lung Research Center, Department of Medicine, Rutgers Health, Newark Beth Israel Medical Center, Newark, New Jersey Department of Surgery, Division of Cardiac Surgery, Rutgers Robert Wood Johnson University Hospital, New Brunswick, New Jersey Department of Medicine, Division of Cardiology, Rutgers Robert Wood Johnson University Hospital, New Brunswick, New Jersey Department of Surgery, Division of Cardiac Surgery, Brigham and Women's Hospital, Boston, Massachusetts.

The study investigates the incidence of change in renal function and its impact on survival in renal dysfunction patients who were bridged to heart transplantation with a left ventricular assist device (BTT-LVAD). BTT-LVAD patients with greater than or equal to moderately reduced renal function (estimated glomerular filtration rate [eGFR] ≤ 60 ml/min/1.73 m2) at the time of listing between 2008 and 2018 were identified from a prospectively maintained database of the United Network for Organ Sharing. Patients with a baseline eGFR less than or equal to 15 ml/min/1.73 m2 or on dialysis were excluded. Patients were divided into three groups based on percent change ([Pretransplant eGFR - listing eGFR/listing glomerular filtration rate (GFR)] × 100) in eGFR: Improvement greater than or equal to 10%, no change, decline greater than or equal to 10%, and their operative outcomes were compared. Posttransplant survival was estimated and compared among the three groups with the Kaplan-Meier survival curves and the log-rank test. Cox proportional hazards modeling was used to identify predictors of posttransplant survival. Out of 14,395 LVAD patients, 1,622 (11%) met the inclusion criteria. At the time of transplant, 900 (55%) had reported an improvement in eGFR greater than or equal to 10%, 436 (27%) had no change, and 286 (18%) experienced a decline greater than or equal to 10%. Postoperatively, the incidence of dialysis was higher in the decline than in the unchanged or improved groups (22% vs. 12% vs. 12%; p = 0.002). After a median follow-up of 5 years, there was no difference in posttransplant survival among the stratified groups (improved eGFR: 24.8%, unchanged eGFR: 23.2%, declined eGFR: 20.3%; p = 0.680). On Cox proportional hazard modeling, independent predictors of worse survival were: [hazard ratio: 95% CI; p] history of diabetes (1.43 [1.13-1.81]; p = 0.002) or tobacco use (1.40 [1.11-1.79]; p = 0.005) and ischemic time greater than 4 hours (1.36 [1.03-1.76]; p = 0.027). More than half of the patients with compromised renal function who undergo BTT-LVAD demonstrate an improvement in renal function at the time of transplant. A 10% change in GFR while listed was not associated with worse posttransplant survival.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/MAT.0000000000001384DOI Listing
March 2021

Health and Healthcare Disparities: Impact on Resource Utilization and Costs After Transcatheter Aortic Valve Replacement.

Innovations (Phila) 2021 May-Jun;16(3):262-266. Epub 2021 Mar 18.

4598 Department of Surgery, Division of Cardiac Surgery, Rutgers Robert Wood Johnson University Hospital, New Brunswick, NJ, USA.

Objective: We investigated health and healthcare disparities in the treatment of aortic stenosis with transcatheter aortic valve replacement (TAVR) and how they affect resource utilization and costs.

Methods: We retrospectively reviewed all patients who were discharged alive after TAVR between 2012 and 2017 from the National Inpatient Sample. Patients were stratified by race and outcomes investigated were in-hospital complications, total procedural costs, and resource utilization. High resource utilization (HRU) was defined as length of stay (LOS) ≥7 days or discharge to a nonhome location. Multivariable regression models were used to identify predictors of HRU.

Results: TAVR patients ( = 29,464) were stratified into Caucasians ( = 25,691), others ( = 1,274), Hispanics ( = 1,267), and African Americans (AA, = 1,232). More AA and Hispanics had TAVR at urban teaching centers ( = 0.003) and were less likely to be Medicare beneficiaries ( < 0.001). Distribution of TAVR patients in the lowest income quartile showed AA (50%) versus Caucasian (20%) versus Hispanic (33%, < 0.001). In-hospital complications were higher among Hispanics and AA than Caucasians with prolonged LOS, procedural costs, and HRU. On multivariable analysis, independent predictors of HRU were TAVR year ( < 0.001), advanced age ( < 0.001), female sex ( < 0.001), non-Caucasian race ( = 0.038), history of coronary artery bypass grafting ( < 0.001), smoking ( < 0.001), chronic lung disease ( = 0.003), stroke ( < 0.001), and lowest income quartile ( = 0.002).

Conclusions: There exist significant healthcare and health disparities among patients undergoing TAVR in the United States. Consequently, this unequal access to care and determinants of heath translate into higher resource utilization and costs.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/1556984521996694DOI Listing
March 2021

Femoral arterial cannulation remains a safe and reliable option for aortic dissection repair.

J Thorac Dis 2021 Feb;13(2):1005-1010

Rutgers Robert Wood Johnson Medical Center, New Brunswick, USA.

Background: The optimal cannulation site for repair of type A aortic dissection remains controversial. The concern for Malperfusion syndrome has initiated a national trend away from femoral cannulation to axillary artery and direct ascending aortic cannulation. The purpose of this study was to report a single center experience with femoral artery cannulation for the repair of a type A dissection.

Methods: A retrospective study was performed on 52 patients who underwent surgical repair for a type A dissection between January 1, 2012 and June 30, 2019 at a single institution. Of the 52 patients analyzed, 35 (67.3%) underwent femoral artery, 11 (21.2%) direct ascending aortic, and 6 (11%) axillary artery cannulation for arterial access. Deep hypothermic circulatory arrest was used in all the patients. Rates of postoperative complication and mortality were reported.

Results: The mortality and bleeding rates for all the patients undergoing repair of the type A dissection repairs were 27% (14/52) and 19% (10/52), respectively. Cardiopulmonary bypass was established in 100% of the patients that had femoral arterial cannulation. There were no complications specifically related to femoral arterial cannulation nor the axillary or direct aortic approach. Specifically, there was no episodes of malperfusion syndrome, bleeding, or injury with femoral artery cannulation. Bleeding rates were higher in cases that proceeded with a femoral (13%) versus alternate (6%) approach however; neither of the bleeding was related to the cannulation site. None of the mortalities identified were directly attributable to the cannulation approach in each case.

Conclusions: Despite the recent shift away from femoral cannulation, the results of the study show that femoral artery cannulation is safe and produces excellent results for establishing cardiopulmonary bypass. The concerns for malperfusion syndrome related to femoral cannulation were not seen.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.21037/jtd-20-2549DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7947496PMC
February 2021

Expedited MitraClip: Rapid Evaluation, Treatment, and Discharge in the COVID-19 Era.

Cardiovasc Revasc Med 2021 07 16;28S:54-56. Epub 2020 Nov 16.

Department of Surgery, Division of Cardiac Surgery, Robert Wood Johnson University Hospital, New Brunswick, NJ, United States of America; Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, United States of America.

Undertreatment of patients with severe mitral regurgitation (MR) has been exaggerated during the coronavirus disease of 2019 (COVID-19) pandemic. Expedited workup and shortened post-procedural hospital stay after percutaneous mitral valve repair (PMVR) would be incredibly helpful to relieve the constrain in the era of the COVID-19 pandemic and immediately afterward. We report a patient who underwent PMVR with a simplified pre-operative workup, a shortened hospital stay, and expedited discharge.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.carrev.2020.11.012DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7667389PMC
July 2021

The role of the axillary Impella 5.0 device on patients with acute cardiogenic shock.

J Cardiothorac Surg 2020 Aug 14;15(1):218. Epub 2020 Aug 14.

Division of Cardiothoracic Surgery, Department of Surgery, RUTGERS-Robert Wood Johnson Medical School, 125 Paterson Street, New Brunswick, NJ, 08903, USA.

Background: Acute cardiogenic shock is associated with high mortality rates. The Impella device is a microaxial left ventricular assist device that can be inserted through the axillary artery. The purpose of our study is to determine the role of the Axillary Impella devices on patients with acute cardiogenic shock.

Methods: A retrospective chart review was conducted to identify patients who underwent Axillary Impella device placement for acute cardiogenic shock from January 1st, 2014 to September 30th, 2018 at a single institution. In-patient records were examined to determine duration of device, length of stay (LOS), postoperative complications, and 30-day in-hospital mortality.

Results: A total of 40 patients, who were primarily men (N = 29) with a mean age of 61.2 ± 10.7 years old, underwent Axillary Impella placement for cardiogenic shock. The primary reasons for implant were (1) required upgraded support from an Impella CP or intra-aortic balloon pump (iabp) to Impella 5.0, (2) to treat left ventricular (LV) distention for patients on extracorporeal mechanical oxygenation (ECMO), and (3) to provide longer term support and allow for mobilization of the patients in whom a device was already indwelling. Twenty-three of the patients had previous devices already in place including a Femoral Impella CP device or an iabp and 9 patients were on ECMO support. The duration of the device was 21.05 ± 17 days with the LOS of 40.8 ± 28 days for those patients. Seventeen of the patients went on to additional surgery including (1) Heartmate 3 device placement (N = 6), (2) other cardiac procedures such as surgical revascularization (N = 9), and orthotopic heart transplantation (N = 2). A total of 21 patients of the 40 (52%) died during their hospitalization with 7 patients (17%) having complications related to the Impella device. These complications included right arm ischemia or neuropathy (N = 3) and Impella malfunction requiring device replacement (N = 4). The majority of these devices were placed in the right axillary artery (N = 38) versus the left axillary artery (N = 2).

Conclusions: A total of 58% (N = 23) of the study patients had previous mechanical support and 23% (N = 9) were on ECMO demonstrating the severity of disease and accounting for the high mortality. The Axillary Impella device allows for a minimally invasively placed device that is durable with a mean duration of 3 weeks. The Axillary artery Impella 5.0 provides upgraded full cardiac support while allowing for mobilization of the patient. In addition, it treats LV distention in patients on ECMO while avoiding sternotomy. Finally, the Axillary Impella provides time for decision making for explant, additional therapy with either long-term devices or orthotopic heart transplant.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/s13019-020-01251-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7427736PMC
August 2020

PTEN suppresses epithelial-mesenchymal transition and cancer stem cell activity by downregulating Abi1.

Sci Rep 2020 07 29;10(1):12685. Epub 2020 Jul 29.

Department of Surgery, Rutgers University Robert Wood Johnson Medical School, 125 Paterson Street, MEB-687, New Brunswick, NJ, 08093, USA.

The epithelial-mesenchymal transition (EMT) is an embryonic program frequently reactivated during cancer progression and is implicated in cancer invasion and metastasis. Cancer cells can also acquire stem cell properties to self-renew and give rise to new tumors through the EMT. Inactivation of the tumor suppressor PTEN has been shown to induce the EMT, but the underlying molecular mechanisms are less understood. In this study, we reconstituted PTEN-deficient breast cancer cells with wild-type and mutant PTEN, demonstrating that restoration of PTEN expression converted cancer cells with mesenchymal traits to an epithelial phenotype and inhibited cancer stem cell (CSC) activity. The protein rather than the lipid phosphatase activity of PTEN accounts for the reversal of the EMT. PTEN dephosphorylates and downregulates Abi1 in breast cancer cells. Gain- and loss-of-function analysis indicates that upregulation of Abi1 mediates PTEN loss-induced EMT and CSC activity. These results suggest that PTEN may suppress breast cancer invasion and metastasis via dephosphorylating and downregulating Abi1.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1038/s41598-020-69698-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7391766PMC
July 2020

Racial disparities and outcomes of left ventricular assist device implantation as a bridge to heart transplantation.

ESC Heart Fail 2020 10 6;7(5):2744-2751. Epub 2020 Jul 6.

Department of Surgery, Division of Cardiac Surgery, Rutgers Robert Wood Johnson University Hospital, New Brunswick, NJ, USA.

Aims: This study investigated outcomes after continuous flow left ventricular assist device (CF-LVAD) implantation as bridge to heart transplantation (BTT) in advanced heart failure patients stratified by race.

Methods And Results: De-identified data from the United Network for Organ Sharing database was obtained for all patients who had a CF-LVAD as BTT from 2008 to 2018. Patients were stratified into four groups on the basis of ethnicity [Caucasian, African American (AA), Hispanic, and others (Asian, Pacific Islanders, and American Indian)]. Outcomes investigated were waitlist mortality or delisting and post-transplant 5 year survival. Cox proportional hazards modelling was used to identify independent predictors of waitlist mortality or delisting and post-transplant survival. We used Kaplan-Meier survival curves and the log-rank test to estimate and compare survival among groups. A total of 14 234 patients who had CF-LVADs as BTT were identified. Of these, 64% (n = 9058) were Caucasians, 26% (n = 3677) were AA, 7% (n = 997) were Hispanic, and 3% (n = 502) had a different race. Compared with Caucasian, AA, and Hispanic patients had higher body mass indexes and a lower level of education and are more likely to be public health insurance beneficiaries. There was a significantly lower incidence of transplantation in AAs compared with Caucasians, Hispanics, and others at 12, 24, and 60 months, respectively (Gray's test, P < 0.001). The AA race was a significant predictor of waitlist mortality or delisting owing to worsening clinical status [hazard ratio, 95% confidence interval: 1.10 (1.01 to 1.16; P < 0.001)]. Among those who were successfully BTT, risk-adjusted post-transplant survival was similar among the four groups (log-rank test: P = 0.589).

Conclusions: Disparities exist among different races that receive a CF-LVAD as a BTT. These disparities translate into increased waitlist morbidity and mortality but not long-term post-transplant survival among those who successfully reach transplant.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/ehf2.12866DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7524221PMC
October 2020

The impact of age on outcomes of coronary artery bypass grafting.

J Cardiothorac Surg 2020 Jul 1;15(1):158. Epub 2020 Jul 1.

Division of Cardiothoracic Surgery, Department of Surgery, RUTGERS-Robert Wood Johnson Medical School, 125 Paterson Street, New Brunswick, New Jersey, 08903, USA.

Objective: As the population ages, increasing number of older patients are undergoing adult cardiac surgery. The purpose of the study is to assess the impact of age on postoperative outcomes in patients that undergo coronary artery bypass grafting (CABG).

Methods: Patients that are ≥70 years old who underwent CABG were selected from the Nationwide/National Inpatient Sample from 2010 to 2015 using ICD-9-CM diagnosis and procedure codes. The patients who were 70-79 years old were compared to patients aged 80-89 years old to determine if the age difference of the patients had an impact on surgical outcomes. In addition, a secondary endpoint is to compare surgical outcomes between the 2 genders of the patients 80-89 years old. The rates of postoperative complications, and mortality were compared.

Results: A total of 67,568 patients were identified who were ≥ 70 years old and underwent CABG. Compared to the Septuagenarians, the Octogenarians were more likely to develop cardiac complications (OR [odds ratio] =1.20, 95% CI [confidence interval] 1.12-1.23. They were also more likely to develop renal complications (P < 0001), and respiratory complications (P < 0001). The Octogenarians were also more likely to bleed postoperatively (P < 0.0001) and have a higher mortality (P < 0001). Furthermore, the female Octogenarians had a higher mortality (OR 1.25 95% CI 1.07-1.46) compared to males in the same age group.

Conclusions: The patients who were ≥ 80-89 years old had worse postoperative outcomes. The Octogenarians who were females had a higher mortality compared to their male counterparts.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/s13019-020-01201-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7328264PMC
July 2020

Outcomes of Obese Patients Bridged to Heart Transplantation with a Left Ventricular Assist Device.

ASAIO J 2021 02;67(2):137-143

Division of Cardiothoracic Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey.

The current study aims to investigate the impact of left ventricular assist device (LVAD) implantation on weight loss and functional status in obese patients bridged to transplantation (BTT). The United Network for Organ Sharing (UNOS) database was queried to identify patients with body mass index (BMI) ≥ 30 who underwent LVAD implantation as BTT from 2008 to 2018. Patients were divided into three groups based the World Health Organization classification of obesity: obesity class I (BMI, 30.0-34.9 kg/m2), obesity class II (BMI, 35-39.9 kg/m2), and obesity class III (BMI, >40 kg/m2). Patients with incomplete data on BMI were excluded. The primary outcome was a change in BMI while listed. Secondary outcomes included a change in functional status after LVAD implantation and posttransplant morbidity and survival. Out of 14,191 patients who had an LVAD while listed within the study period, 5,354 (37.7%) had a BMI ≥30 kg/m2. Obesity was classified as class I in 3,909 (73%), class II in 1,275 (23.8%), and class III in 170 (3.2%) patients. Among patients with complete data on BMI, 18.9% (n = 394) reported a change in BMI, leading to an improvement in their obesity class, and this was similar for all obesity classes (22% [n = 331], 50% [n = 111], and 60% [n = 43] for classes I, II, and III, respectively). All groups reported an improvement in functional status (65% vs. 62% and 61% for classes I, II, and III, respectively). Posttransplant survival was not significantly different between obese groups (p = 0.787). Compared with classes I and II, the incidence of thrombosis (p = 0.0006) and device malfunction (p = 0.036) was significantly higher in the class III group. About one out of every five obese patients listed for heart transplantation with an LVAD loses weight, leading to a change in their BMI class. Most patients reported a significant improvement in their functional status. Among those successfully BTT, posttransplant survival was similar.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/MAT.0000000000001188DOI Listing
February 2021

Delay in coronary artery bypass grafting for STEMI patients improves hospital morbidity and mortality.

J Cardiothorac Surg 2020 May 12;15(1):86. Epub 2020 May 12.

Division of Cardiothoracic Surgery, Department of Surgery, RUTGERS-Robert Wood Johnson Medical School, 125 Paterson Street, New Brunswick, New Jersey, 08903, USA.

Objectives: The optimal timing of coronary artery bypass grafting (CABG) in patients with ST elevated acute myocardial infarction (STEMI) is unclear. The purpose of the study is to evaluate and compare the outcomes in STEMI patients who underwent CABG within the various time intervals within the first 7 days of either emergent or urgent hospital admission.

Methods: Patients aged 30 years old and older diagnosed with STEMI who underwent CABG within first 7 days after non-elective hospital admission were selected from the National Inpatient Sample 2010-2014 using the appropriate ICD-9-CM diagnosis and procedure codes. These patients were divided into 3 cohorts based on timing of surgery: within 24 h (group A), 2nd-3rd day (group B), and 4th-7th day (group C). The rates of postoperative complications, mortality, and postoperative hospital length of stay (LOS) were compared using the Chi-square test, multivariable logistic regression analysis, and Wilcoxon rank sum test.

Results: A total of 5963 patients were identified: group A = 28.5%, group B = 36.1%, group C = 35.4%. Mean age overall was 63.1 ± 11.1 years; 76.9% were males and 72.9% were whites. Compared to groups B and C, patients in group A were more likely to develop cardiac complications (OR [odds ratio] =1.33, 95%CI [confidence interval] 1.12-1.59 and OR = 1.39, 95%CI 1.17-1.67, respectively) and respiratory complications (OR = 1.31, 95%CI 1.13-1.51 and OR = 1.53, 95%CI 1.32-1.78, respectively). They were also more likely to have renal complications (OR = 1.31, 95%CI 1.11-1.54) and bleeding (OR = 1.20, 95%CI 1.05-1.37) than patients in group B and had a similar tendency compared to group C. We did not find significant differences in the above complications between groups B and C. Postoperative stroke and sternal wound infection rates were similar between all three groups. In-hospital mortality was also higher in group A (8.2%) compared to group B (3.5%) and group C (2.9%, P < 0.0001 for both); differences between groups B and C were not significant. This was confirmed in the multivariable logistic regression analysis with controlling for age, gender, race, the Elixhauser Comorbidity Index, and complications (group A vs B: OR = 1.85, 95%CI 1.52-2.25; group A vs C: OR = 2.21; 95%CI 1.82-2.68). Patients in group A had a significantly longer postoperative LOS (median 7 days with IQR [interquartile range] 5-10 days) compared to those in group B (median 6 days, IQR 5-8 days) and group C (median 6 days, IQR 4-8 days; P < 0.0001 for both).

Conclusions: The results of this study show that despite the urgency and severity of STEMI, patients who undergo CABG within the first 24 h after non-elective hospital admission have increased hospital morbidity and mortality. These findings suggest that a delay in surgery beyond the first 24 h may be beneficial to patient outcomes. Furthermore, there is a significant cost effectiveness when the patients delay surgery because the hospital length of stay is reduced as well as the subsequent hospital costs.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/s13019-020-01134-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7216497PMC
May 2020

Periprocedural Complications After Transcatheter Aortic Valve Replacement and Their Impact on Resource Utilization.

Cardiovasc Revasc Med 2020 09 4;21(9):1086-1090. Epub 2020 Feb 4.

Cardiovascular Research Unit, RWJ Barnabas Health, NBIMC, Newark, NJ, United States of America; Rutgers/Robert Wood Johnson University Hospital, New Brunswick, NJ, United States of America.

Background: To examine the incidence and trends of peri-procedural complications after TAVR and their impact on resource utilization.

Methods: The incidence of complications by type [acute kidney injury (AKI), permanent pacemaker (PPM), vascular, paravalvular leak, in-hospital mortality, others] was calculated for TAVR patients at a high-volume center between 2012 and 2018. Clinical data were matched with hospital-billing data of patients. Trends in high resource utilization (discharge to a rehabilitation facility or PLOS >7 days) (HRU) and complication rates were assessed. Multivariable logistic regression models were used to determine predictors of HRU.

Results: Out of 1163 patients, 966 (83%) had no complications, others in 95 (8%), PPM in 56 (5%), AKI alone in 32 (3%), vascular in 31 (3%), in-hospital mortality in 28 (2%) and PVL in 10 (1%). A significant decreasing trend in the incidence of complications (29% vs 10%; p trend <0.001) and HRU (75% vs 12%; p trend <0.001) was observed between 2012 and 2018 respectively. Mean ± SD direct procedure cost of having a complication was $58,234 ± $24,568, was associated with an incremental cost of $10, 649 and a prolonged stay of 3-days. On multivariable logistic regression analysis, PPM, vascular complications, high STS risk score, NYHA class III/IV, frailty and ≥ moderate tricuspid regurgitation were significantly associated with HRU. TAVR year was protective against HRU.

Conclusions: We established that, post-TAVR resource utilization and morbidity is high among frail and patients with higher STS risk scores. However, these rates decrease over time with experience.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.carrev.2020.01.025DOI Listing
September 2020

Placement of a rapid deployment aortic valve in a patient with severely calcified aortic root homograft.

J Card Surg 2020 Mar 25;35(3):706-709. Epub 2020 Jan 25.

Division of Cardiothoracic Surgery, Rutgers Robert Wood Johnson University Hospital, New Brunswick, New Jersey.

Significant aortic calcification is a known sequelae of homograft aortic root replacement and creates a treatment challenge if these patients require cardiac reintervention. The standard surgical option for patients requiring an aortic valve replacement in the setting of a calcified aortic homograft has been a Bentall procedure, which is high-risk with extended cross-clamp, cardiopulmonary bypass and operative times. We present a patient with a severely calcified aortic homograft who underwent successful valve replacement using a rapid deployment aortic valve leaving the aortic root and arch intact and avoiding the more extensive redo aortic root replacement. Similar cases in the literature are rare.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/jocs.14435DOI Listing
March 2020

Association between increased-risk donor social behaviors and recipient outcomes after heart transplantation.

Clin Transplant 2020 03 3;34(3):e13787. Epub 2020 Feb 3.

Cardiovascular Outcomes Research Institute, RWJ Barnabas Health Heart Centers, NBIMC, Newark, New Jersey.

Background: This study aims to investigate the association between social behaviors of increased-risk donors (IRD) and recipient outcomes after heart transplantation.

Methods: The United Network for Organ Sharing (UNOS) database was queried to identify patients who received a heart transplant between 2004 and 2015. Patients were grouped based on donor's risk status (IRD vs standard risk donor [SRD]). Recipients of IRD were categorized based on donor social behaviors (SB), and recipient survival was assessed. Cox regression analysis was used to identify associations between SB of donors and recipient survival.

Results: Out of 22 333 heart transplantations performed during the study period, 2769 (12%) received an IRD graft with the following SB: Unprofessional tattoos or piercings (n = 1722) (63%), cocaine use (n = 916) (33%), heavy smoking (n = 437) (16%), and heavy alcohol abuse (n = 610) (22%). Viral screens detected 72(3%) hepatitis B virus (HBV) positive and 12 (0.4%) hepatitis C virus (HCV) positive at donation. There was no difference in recipient survival based on both donor risk and their social behaviors. Cox regression analysis found only donor HCV infection and non-identical ABO mismatch to be associated with poor recipient survival among recipients of IR grafts.

Conclusion: Cardiac allografts from IRD, serologically negative for viruses, can safely be used. There is no association between social behaviors of IRD and recipient survival.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/ctr.13787DOI Listing
March 2020

Intratumoral injection of the seasonal flu shot converts immunologically cold tumors to hot and serves as an immunotherapy for cancer.

Proc Natl Acad Sci U S A 2020 01 30;117(2):1119-1128. Epub 2019 Dec 30.

Department of Internal Medicine, Section of Hematology, Oncology, and Cell Therapy, Rush University Medical Center, Chicago, IL 60612.

Reprogramming the tumor microenvironment to increase immune-mediated responses is currently of intense interest. Patients with immune-infiltrated "hot" tumors demonstrate higher treatment response rates and improved survival. However, only the minority of tumors are hot, and a limited proportion of patients benefit from immunotherapies. Innovative approaches that make tumors hot can have immediate impact particularly if they repurpose drugs with additional cancer-unrelated benefits. The seasonal influenza vaccine is recommended for all persons over 6 mo without prohibitive contraindications, including most cancer patients. Here, we report that unadjuvanted seasonal influenza vaccination via intratumoral, but not intramuscular, injection converts "cold" tumors to hot, generates systemic CD8 T cell-mediated antitumor immunity, and sensitizes resistant tumors to checkpoint blockade. Importantly, intratumoral vaccination also provides protection against subsequent active influenza virus lung infection. Surprisingly, a squalene-based adjuvanted vaccine maintains intratumoral regulatory B cells and fails to improve antitumor responses, even while protecting against active influenza virus lung infection. Adjuvant removal, B cell depletion, or IL-10 blockade recovers its antitumor effectiveness. Our findings propose that antipathogen vaccines may be utilized for both infection prevention and repurposing as a cancer immunotherapy.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1073/pnas.1904022116DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6969546PMC
January 2020

Early and intermediate outcomes for surgical management of infective endocarditis.

J Cardiothorac Surg 2019 Dec 3;14(1):211. Epub 2019 Dec 3.

Division of Cardiothoracic Surgery, Department of Surgery, RUTGERS-Robert Wood Johnson Medical School, 125 Paterson Street, New Brunswick, NJ, 08903, USA.

Objective: The treatment of active infective endocarditis (IE) presents a clinical dilemma with uncertain outcomes. This study sets out to determine the early and intermediate outcomes of patients treated surgically for active IE at an academic medical center.

Methods: A retrospective chart review was conducted to identify patients who underwent surgical intervention for IE at our institution from July 1st, 2011 to June 30th, 2018. In-patient records were examined to determine etiology of disease, surgical intervention type, postoperative complications, length of stay (LOS), 30-day in-hospital mortality, and 1-year survival.

Results: Twenty-five patients underwent surgical intervention for active IE. The average age of the patients was 47 ± 14 years old and most of the patients were male (N = 15). The majority of the patients had the mitral valve replaced (N = 10), with the remaining patients having tricuspid (N = 8) and aortic (N = 7) valve replacements. The etiology varied and included intravenous drug use (IVDU), and presence of transvenous catheters. The 30-day in-hospital mortality was 4% with 1 patient death and the 1-year survival was 80%. The average LOS was 27 days ±15 and the longest LOS was 65 days.

Conclusions: Surgical management of IE can be difficult and challenging however mortality can be minimized with acceptable morbidity. The most common complication was CVA. The average LOS is longer than traditional adult cardiac surgery procedures and the recurrence rate of valvular infection is not minimal especially if the underlying etiology is IVDU.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/s13019-019-1029-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6889706PMC
December 2019

Surgical pericardial drainage procedures have a limited diagnostic sensitivity.

J Card Surg 2019 Dec 12;34(12):1573-1576. Epub 2019 Nov 12.

Division of Cardiothoracic Surgery, Department of Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey.

Purpose: Cardiothoracic surgeons are frequently called upon to perform surgical pericardial drainage procedures (pericardial window) for pericardial effusions. These procedures have therapeutic value, but the diagnostic value of such procedures is debated. We set out to determine the sensitivity of pericardial drainage to detect the disease when cytology, microbiology, and pathology are evaluated.

Methods: A retrospective chart review of patients who underwent pericardial windows from 1 July 2011 to 1 January 2018 at a single academic institution was conducted. All patients who had undergone a recent trauma or cardiac procedure were excluded. Cytology, microbiology, and pathology were examined. The charts were then carefully reviewed to determine if a clinical diagnosis was reached. Sensitivity was then calculated for all diseases and for those that should have been able to be detected.

Results: One hundred sixty-two patients who had undergone a pericardial drainage procedure were identified; 49 patients were excluded for recent cardiac procedure or trauma. Of the 113 patients who met our inclusion criteria, 56 patients (49.6%) were female with a mean age of 59.7 ± 15.1 years. A diagnosis based on the pathology, microbiology, or cytology was obtained for 27 patients. The most common pathologies detected were adenocarcinoma (11), bacteremia (9), and small cell lung cancer (3); 56 patients had underlying pathologies that would have been possible to detect with either pathology, microbiology, or cytology. The most common detectable diagnoses were adenocarcinoma (20), bacteremia (12), and lymphoma (7). The most common undetectable diagnoses were idiopathic (17), cardiorenal fluid overload (17), and viral (11). The sensitivity of a pericardial drainage procedure for detecting disease was 0.24 for all cases, and 0.48 when restricted to cases where a detectable disease was present.

Conclusion: Cytology, microbiology, and pathology for pericardial drainage procedures were unable to detect a diagnosis for 76% of all cases and greater than 50% of cases with the theoretically detectable disease. Pericardial drainage procedures have a clear therapeutic value, but they have limited diagnostic utility.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/jocs.14337DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6916171PMC
December 2019

Improved operative and recovery times with mini-thoracotomy aortic valve replacement.

J Cardiothorac Surg 2019 May 9;14(1):91. Epub 2019 May 9.

Division of Cardiothoracic Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA.

Background: The small incisions of minimally invasive surgery have the proposed benefit of less surgical trauma, less pain, and faster recovery. This study was done to compare minimally invasive techniques for aortic valve replacement, including right anterior mini-thoracotomy and mini-sternotomy, to conventional sternotomy.

Methods: We retrospectively reviewed 503 patients who underwent isolated aortic valve replacement at our institution from 2012 to 2015 using one of three techniques: 1) Mini-thoracotomy, 2) Mini-sternotomy, 3) Conventional sternotomy. Demographics, operative morbidity, mortality, and postoperative complications were compared.

Results: Of the 503 cases, 267 (53.1%) were mini-thoracotomy, 120 (23.8%) were mini-sternotomy, and 116 (23.1%) were conventional sternotomy. Mini-thoracotomy patients, compared to mini-sternotomy and conventional sternotomy, had significantly shorter bypass times [82 (IQ 67-113) minutes; vs. 117 (93.5-139.5); vs. 102.5 (85.5-132.5), respectively (p < 0.0001)], a lower incidence of prolonged ventilator support [3.75% vs. 9.17 and 12.9%, respectively (p = 0.0034)], and required significantly shorter ICU and postoperative stays, resulting in an overall shorter hospitalization [6 (IQ 5-9) days; vs. 7 (5-14.5); vs 9 (6-15.5), respectively (p < 0.05)]. Incidence of other postoperative complications were lower in the mini-thoracotomy group compared to mini-sternotomy and conventional sternotomy, without significance. Minimally invasive techniques trended towards better survival [mini-thoracotomy 1.5%, mini-sternotomy 1.67%, and conventional sternotomy 5.17% (p = 0.13)].

Conclusions: Minimally invasive aortic valve replacement approaches are safe, effective alternatives to conventional sternotomy. The mini-thoracotomy approach showed decreased operative times, decreased lengths of stay, decreased incidence of prolonged ventilator time, and a trend towards lower mortality when compared to mini-sternotomy and conventional sternotomy.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/s13019-019-0912-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6509756PMC
May 2019

TLR4 counteracts BVRA signaling in human leukocytes via differential regulation of AMPK, mTORC1 and mTORC2.

Sci Rep 2019 05 7;9(1):7020. Epub 2019 May 7.

Department of Surgery, Rutgers Robert Wood Johnson Medical School (RWJMS), New Brunswick, 08903, NJ, USA.

TLR4 is implicated in diseases associated with chronic low-grade inflammation, yet homeostatic signaling mechanisms that prevent and/or are affected by chronic TLR4 activation are largely uncharacterized. We recently reported that LPS/TLR4 activates in human leukocytes signaling intermediates (SI), abbreviated TLR4-SI, which include mTORC1-specific effectors and targets, and that leukocytes of patients with T2D or after cardiopulmonary bypass (CPB) expressed similar SI. Extending these previous findings, here we show that TLR4-SI expression post-CPB was associated with low serum bilirubin and reduced preoperative expression of biliverdin reductase A (BVRA), the enzyme that converts biliverdin to bilirubin, in patient's leukocytes. Biliverdin inhibited TLR4 signaling in leukocytes and triggered phosphorylation of mTORC2-specific targets, including Akt, PKCζ, AMPKα-LKB1-TSC1/2, and their association with BVRA. Torin, PP242, and a PKCζ inhibitory peptide, but not rapamycin, prevented these biliverdin-induced responses and TLR4 inhibition. In contrast, LPS/TLR4 triggered decreases in BVRA, AMPKα and PKCζ expression, and an increase in haptoglobin, a heme binding protein, in leukocytes in vivo and in vitro, indicating that activated TLR4 may suppress biliverdin/BVRA signaling. Significantly, compared to non-diabetics, BVRA and PKCζ expression was low and haptoglobin was high in T2D patients leukocytes. Sustained TLR4 activation may deregulate homeostatic anti-inflammatory BVRA/mTORC2 signaling and thereby contribute to chronic inflammatory diseases.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1038/s41598-019-43347-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6504875PMC
May 2019

The Structure and Biological Function of CREG.

Front Cell Dev Biol 2018 26;6:136. Epub 2018 Oct 26.

Department of Surgery, Robert Wood Johnson Medical School, Rutgers, The State University of New Jersey, New Brunswick, NJ, United States.

The cellular repressor of E1A-stimulated genes (CREG) is a 220 amino acid glycoprotein structurally similar to oxidoreductases. However, CREG does not have enzymatic activities because it cannot bind to the cofactor flavin mononucleotide. Although CREG can be secreted, it is mainly an intracellular protein localized in the endocytic-lysosomal compartment. It undergoes proteolytic maturation mediated by lysosomal cysteine proteases. Biochemical studies have demonstrated that CREG interacts with mannose-6-phosphate/insulin-like growth factor-2 receptor (M6P/IGF2R) and exocyst Sec8. CREG inhibits proliferation and induces differentiation and senescence when overexpressed in cultured cells. In Drosophila, RNAi-mediated knockdown of CREG causes developmental lethality at the pupal stage. In mice, global deletion of the CREG1 gene leads to early embryonic death. These findings establish an essential role for CREG in development. CREG1 haploinsufficient and liver-specific knockout mice are susceptible to high fat diet-induced obesity, hepatic steatosis and insulin resistance. The purpose of this review is to provide an overview of what we know about the biochemistry and biology of CREG and to discuss the important questions that remain to be addressed in the future.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3389/fcell.2018.00136DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6212480PMC
October 2018

Pericardial windows have limited diagnostic success.

J Cardiothorac Surg 2018 Jul 18;13(1):87. Epub 2018 Jul 18.

Division of Cardiothoracic Surgery, Department of Surgery, RUTGERS-Robert Wood Johnson Medical School, 125 Paterson Street, New Brunswick, NJ, 08903, USA.

Background: Pericardial effusion (PE) is a common finding in patients who have chronic cardiac failure, who had undergone cardiac surgery, or who have certain other benign and malignant diseases. Pericardial drainage procedures are often requested for both diagnostic and therapeutic purposes. The perceived benefit is that it allows for diagnosis of malignancy or infection for patients with PEs of unclear etiology. The purpose of the study is to determine the diagnostic yield of surgical drainage procedures.

Methods: We conducted a retrospective chart review of patients who underwent surgical drainage procedures of PEs from July 1st, 2011 to January 1st, 2017 at a single institution. The variables included data on preoperative, intraoperative, and postoperative findings; morbidity; and survival.

Results: A total of 145 patients with an average age of 61 ± 5 and primarily men (53%) were evaluated. All of the surgical drainage procedures were performed through the sub-xiphoid approach. Twenty-five of the 145 patients (17.2%) had diagnostic findings in either the pericardial tissue or fluid. The cytology alone was diagnostic in 4.8% (N = 7) of patients with mixed findings including adenocarcinoma of the lung and breast. The pathology was diagnostic for cancer in 1.4% (N = 2) of patients with Melanoma and Lung cancer identified. The cytology and pathology were concordant in 4.0% (N = 6) identifying cancers that included mesothelioma and adenocarcinoma. Infection was identified in the pericardial fluid in 6.9% (N = 10) of the patients.

Conclusion: Surgical pericardial drainage procedures allow for removal of PE that may lead to tamponade physiology and potential mortality. Although there is therapeutic benefit from these procedures there is only a small diagnostic benefit.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/s13019-018-0774-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6052520PMC
July 2018

Interferon Lambda: Toward a Dual Role in Cancer.

J Interferon Cytokine Res 2019 01 18;39(1):22-29. Epub 2018 Jul 18.

2 Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey.

Interferon (IFN)-λ, a type III interferon (IFN), is a member of a new family of pleotropic cytokines that share high similarity with classical IFNs α and β (IFN-α/β), type I IFNs. IFN-λ acts as an antiviral agent and displays distinct biological functions, including tumor suppression. Although it activates the common Janus kinase (JAK) and signal transducer and activator of transcription (STAT) pathways, similar to IFN-α/β, IFN-λ differentially induces the expression of IFN-stimulated genes (ISGs). Novel evidence indicates that IFN-λ acts quite differently from IFN-α/β under both homeostasis and pathological situations. In contrast to IFN-α/β, IFN-λ is not involved in over-stimulation of the immune response or exacerbation of inflammation. However, the emergence of unexpected characteristics of IFN-λ, in the control of inflammation and promotion of immune suppression and cancer, reveals novel challenges and offers more strategic opportunities in the context of cancer and beyond. In this article, we discuss new evidence and potential consequences associated with the biology of IFN-λ and provide a different vision for building novel therapeutic strategies in oncology.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1089/jir.2018.0046DOI Listing
January 2019

Ruptured Giant Coronary Artery Aneurysm With Coronary Artery to Pulmonary Artery Fistula Presenting as Cardiac Tamponade Diagnosed by Intraoperative Transesophageal Echocardiography: A Case Report.

A A Pract 2018 Aug;11(3):68-70

Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey.

A 63-year-old woman presented with cardiac tamponade because of a ruptured giant left anterior descending coronary artery aneurysm with a fistula to the main pulmonary artery. The diagnosis was made intraoperatively during an emergent subxiphoid pericardial window using transesophageal echocardiography and confirmed by intraoperative coronary angiography. Because of this prompt diagnosis, the patient was successfully managed with immediate surgical repair of the aneurysm and fistula.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1213/XAA.0000000000000740DOI Listing
August 2018
-->