Publications by authors named "Vincent Chan"

533 Publications

No Benefits of Adding Dexmedetomidine, Ketamine, Dexamethasone and Nerve Blocks to an Established Multimodal Analgesic Regimen after Total Knee Arthroplasty.

Anesthesiology 2022 Jul 25. Epub 2022 Jul 25.

Professor. Department of Anesthesia & Pain Management, Toronto Western Hospital. University Health Network. University of Toronto. Ontario, Canada.

Background.: An optimal opioid-sparing multimodal analgesic regimen to treat severe pain can enhance recovery after total knee arthroplasty. We hypothesized that adding 5 recently described IV and regional interventions to multimodal analgesic regimen can further reduce opioid consumption.

Methods.: In a double-blinded fashion, seventy-eight patients undergoing elective total knee arthroplasty were randomized to either (1) a control group (n=39) that received spinal anesthesia with intrathecal morphine, periarticular local anesthesia infiltration, IV dexamethasone and a single injection adductor canal block or (2) a study group (n=39) that received the same set of analgesic treatments plus 5 additional interventions - local anesthetic infiltration between the popliteal artery and capsule of the posterior knee, intraoperative IV dexmedetomidine and ketamine, and postoperatively, 1 additional IV dexamethasone bolus, and 2 additional adductor canal block injections. The primary outcome measure was 24-hour cumulative opioid consumption after surgery and secondary outcomes were other analgesic, patient recovery and functional outcomes and adverse events.

Results.: Opioid consumption was not different between groups at 24 hours (oral morphine equivalents, mean ± SD), study: 23.7 ± 18.0 mg vs. control: 29.3 ± 18.7 mg; mean difference [95% CI], -5.6 mg [-2.7, 13.9]; P = 0.189) and all other time points after surgery. There were no major differences in pain scores, quality of recovery, or time to reach rehabilitation milestones. Hypotensive episodes occurred more frequently in the study group (25/39 (64.1%) vs. 13/39 (33.3%), p= 0.010).

Conclusions.: In the presence of periarticular local anesthesia infiltration, intrathecal morphine, single shot adductor canal block and dexamethasone, the addition of 5 analgesic interventions - local anesthetic infiltration between the popliteal artery and capsule of the posterior knee, IV dexmedetomidine, IV ketamine, an additional IV dexamethasone dose and repeated adductor canal block injections - failed to further reduce opioid consumption, pain scores or improve functional outcomes after total knee arthroplasty.
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http://dx.doi.org/10.1097/ALN.0000000000004326DOI Listing
July 2022

Fabrication of Gelatin Nanofibers by Electrospinning-Mixture of Gelatin and Polyvinyl Alcohol.

Polymers (Basel) 2022 Jun 27;14(13). Epub 2022 Jun 27.

Division of Cardiovascular Surgery, Heart Center, Cheng Hsin General Hospital, Taipei 11246, Taiwan.

Gelatin, one of the most abundant, naturally derived biomacromolecules from collagen, is widely applicable in food additives, cosmetic ingredients, drug formulation, and wound dressing based on their non-toxicity and biodegradability. In parallel, polyvinyl alcohol (PVA), a synthetic polymer, has been commonly applied as a thickening agent for coating processes in aqueous systems and a major component in healthcare products for cartilage replacements, eye lubrication, and contact lenses. In this study, a new type of mixed hydrogel nanofiber was fabricated from gelatin and polyvinyl alcohol by electrospinning under a feasible range of polymer compositions. To determine the optimal composition of gelatin and polyvinyl alcohol in nanofiber fabrication, several key physicochemical properties of mixed polymer solutions such as viscosity, surface tension, pH, and electrical conductance were thoroughly characterized by a viscometer, surface tensiometer, water analyzer, and carbon electron probe. Moreover, the molecular structures of polymeric chains within mixed hydrogel nanofibers were investigated with Fourier-transform infrared spectroscopy. The morphologies and surface elemental compositions of the mixed hydrogel nanofibers were examined by the scanning electron microscope and energy-dispersive X-ray spectroscopy, respectively. The measurement of water contact angles was performed for measuring the hydrophilicity of nanofiber surfaces. Most importantly, the potential cytotoxicity of the electrospun nanofibers was evaluated by the in vitro culture of 3T3 fibroblasts. Through our extensive study, it was found that a PVA-rich solution (a volumetric ratio of gelatin/polyvinyl alcohol <1) would be superior for the efficient production of mixed hydrogel nanofibers by electrospinning techniques. This result is due to the appropriate balance between the higher viscosity (~420-~4300 10 poise) and slightly lower surface tension (~35.12-~32.68 mN/m) of the mixed polymer solution. The regression on the viscosity data also found a good fit by the Lederer-Rougier's model for a binary mixture. For the hydrophilicity of nanofibers, the numerical analysis estimates that the value of interfacial energy for the water contact on nanofibers is around ~-0.028 to ~-0.059 J/m.
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http://dx.doi.org/10.3390/polym14132610DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9269508PMC
June 2022

Risk Factors for Postrepair Elevated Mitral Gradient: A Post-hoc Analysis of a Randomized Trial.

Ann Thorac Surg 2022 Jun 29. Epub 2022 Jun 29.

Division of Cardiac Surgery, Li Ka Shing Knowledge Institute of St Michael's Hospital, Toronto, Ontario, Canada; Department of Surgery, University of Toronto, Toronto, Ontario, Canada; Department of Pharmacology and Toxicology, University of Toronto, Toronto, Ontario, Canada. Electronic address:

Background: Predischarge elevated mean mitral gradients (>5 mm Hg) may occur after repair for degenerative mitral regurgitation. We sought to identify risk factors associated with elevated gradients and to evaluate its impact on functional outcomes at 12 months in this subanalysis of the Canadian Mitral Research Alliance CardioLink-2 trial.

Methods: One hundred four patients with degenerative mitral regurgitation undergoing mitral repair were randomized to either a leaflet resection or preservation strategy. Logistic regression was used to identify risk factors associated with an elevated gradient. Functional outcomes at 12 months were compared between participants with and without elevated gradients.

Results: Elevated gradients was identified in 15 participants (14.4%), which was not significantly different based on allocation to each repair strategy (P = .10). Patients with elevated gradients were more likely to be women (odds ratio [OR], 4.28; 95% confidence interval [CI], 1.29-14.19; P = .02) and to have a lower preoperative hemoglobin level (OR, 0.93; 95% CI, 0.89-0.98; P = .01) and smaller intercommissural diameter (OR, 0.86; 95% CI, 0.76-0.97; P = .02) and mitral annuloplasty size (OR, 0.71; 95% CI, 0.57-0.87; P = .001). The ratio of intercommissural diameter-to-annuloplasty size was similar between those with and without elevated gradients (both 0.8 ± 0.1, P = .69). At 12 months those with elevated gradients had a worse New York Heart Association functional status (P = .0001), lower peak oxygen saturation in exercise test (P = .01), smaller body weight-walk distance product (P = .02), and higher Borg scale (P = .01) in the 6-minute walk test.

Conclusions: Female gender, smaller mitral anatomy sizes, and lower preoperative hemoglobin levels were associated with postoperative elevated mitral gradients, which was in turn were associated with reduced functional status. Further research is warranted to investigate these potential risk factors.
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http://dx.doi.org/10.1016/j.athoracsur.2022.05.053DOI Listing
June 2022

Chronic thrombosis of bioprostheses: Diagnosis and management.

Prog Cardiovasc Dis 2022 May-Jun;72:15-20. Epub 2022 Jun 25.

Department of Cardiovascular Medicine, Mayo Clinic, Rochester, USA.

Acquired valvular heart disease is associated with increased mortality and morbidity. While the etiology of the valvular dysfunction determines the mode of treatment, over 100,000 valve operations are performed annually in the US with the use of bioprosthetic valves comprising up to 90%. While bioprosthetic valves do not require life long anticoagulation, the incidence of prosthetic valve thrombosis is continuously increasing. This article reviews the current status on diagnosis, treatment modalities and management of bioprosthetic valve thrombosis.
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http://dx.doi.org/10.1016/j.pcad.2022.06.008DOI Listing
July 2022

Stage-based approach to predict left ventricular reverse remodeling after mitral repair.

Clin Cardiol 2022 Jun 24. Epub 2022 Jun 24.

Division of Cardiac Surgery, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada.

Background: Although predictors of reverse left ventricular (LV) remodeling postmitral valve repair are critical for guiding perioperative decision-making, there remains a paucity of randomized, prospective data to support the criteria that potential predictor variables must meet.

Methods And Results: The CAMRA CardioLink-2 randomized trial allocated 104 patients to either leaflet resection or preservation strategies for mitral repair. The correlation of indexed left ventricular end-systolic volume (LVESVI), indexed left ventricular end-diastolic volume (LVEDVI), and left ventricular ejection fraction (LVEF) were tested with univariate analysis and subsequently with multivariate analysis to determine independent predictors of reverse remodeling at discharge and at 12 months postoperatively. At discharge, both LVESVI and LVEDVI were independently associated with their preoperative values (p < .001 for both) and LVEF by preoperative LVESVI (p < .001). Mitral ring size was favorably associated with the change in LVESVI (p < .05) and LVEF (p < .01) from predischarge to 12 months, while the mean mitral valve gradient after repair was adversely associated with the change in LVESVI (p < .05) and LVEDVI (p < .05). No significant associations were found between reverse remodeling and coaptation height nor mitral repair technique.

Conclusions: Beyond confirming the lack of impact of mitral repair technique on reverse remodeling, this investigation suggests that recommending surgery before significant LV dilatation or dysfunction, as well as higher postoperative mitral valve hemodynamic performance, may enhance remodeling capacity following mitral repair.
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http://dx.doi.org/10.1002/clc.23879DOI Listing
June 2022

Isolated Splenic Infarction: An Initial Manifestation of Postoperative Atrial Fibrillation.

J Investig Med High Impact Case Rep 2022 Jan-Dec;10:23247096221103384

Department of Pulmonary and Critical Care, Thomas Jefferson University, Philadelphia, PA, USA.

Splenic infarction is an uncommon cause of abdominal pain. In this article, we present a case of isolated splenic infarction presenting with severe abdominal pain, nausea, and with associated generalized weakness. Computed tomography (CT) abdomen and pelvis with contrast revealed multiple splenic infarctions of the entire lower pole with occlusion of the branch splenic arteries, while CT abdomen without contrast was unremarkable. Etiology was later revealed to be thromboembolism secondary to atrial fibrillation. It was managed with anticoagulation. To our knowledge, this is the second case of splenic infarction presenting as an initial manifestation of atrial fibrillation (AF), reported in the literature.
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http://dx.doi.org/10.1177/23247096221103384DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9201299PMC
June 2022

Recent Advances in Fluorescence Recovery after Photobleaching for Decoupling Transport and Kinetics of Biomacromolecules in Cellular Physiology.

Polymers (Basel) 2022 May 7;14(9). Epub 2022 May 7.

Department of Biomedical Engineering, Khalifa University of Science and Technology, Abu Dhabi P.O. Box 127788, United Arab Emirates.

Among the new molecular tools available to scientists and engineers, some of the most useful include fluorescently tagged biomolecules. Tools, such as green fluorescence protein (GFP), have been applied to perform semi-quantitative studies on biological signal transduction and cellular structural dynamics involved in the physiology of healthy and disease states. Such studies focus on drug pharmacokinetics, receptor-mediated endocytosis, nuclear mechanobiology, viral infections, and cancer metastasis. In 1976, fluorescence recovery after photobleaching (FRAP), which involves the monitoring of fluorescence emission recovery within a photobleached spot, was developed. FRAP allowed investigators to probe two-dimensional (2D) diffusion of fluorescently-labelled biomolecules. Since then, FRAP has been refined through the advancements of optics, charged-coupled-device (CCD) cameras, confocal microscopes, and molecular probes. FRAP is now a highly quantitative tool used for transport and kinetic studies in the cytosol, organelles, and membrane of a cell. In this work, the authors intend to provide a review of recent advances in FRAP. The authors include epifluorescence spot FRAP, total internal reflection (TIR)/FRAP, and confocal microscope-based FRAP. The underlying mathematical models are also described. Finally, our understanding of coupled transport and kinetics as determined by FRAP will be discussed and the potential for future advances suggested.
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http://dx.doi.org/10.3390/polym14091913DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9105003PMC
May 2022

Significant Valvular Dysfunction and Outcomes in Cardiogenic Shock: Insights From the Randomized DOREMI Trial.

Can J Cardiol 2022 Aug 14;38(8):1211-1219. Epub 2022 Apr 14.

CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, Ontario, Canada. Electronic address:

Background: Patients with cardiogenic shock (CS) suffer high rates of in-hospital mortality, with little evidence guiding management. The impact of valvular heart disease in patients with CS remains unclear. We therefore conducted a post hoc analysis of the randomized Dobutamine Compared to Milrinone (DOREMI) trial to determine the impact of valvular disease on outcomes in patients with CS.

Methods: We defined significant valvular disease as moderate to severe or greater valvular stenosis or regurgitation and divided participants into a group of those with significant valvular disease and those without. Our primary outcome was all-cause in-hospital mortality. Secondary endpoints included resuscitated cardiac arrest; cardiac transplantation or mechanical circulatory support; nonfatal myocardial infarction; stroke; initiation of renal replacement therapy; as well as changes in renal function, perfusion, and hemodynamics over time.

Results: One hundred eighty-nine (98.4%) participants from the DOREMI trial were included in our analysis, and 74 (39.2%) had significant valvular dysfunction. Thirty-six (48.7%) patients with valvular disease died in hospital, compared with 37 (32.2%) in the comparator group (relative risk, 1.5; 95% confidence interval 1.06-2.15; P = 0.02). Patients with aortic stenosis (2.42, 1.56-3.75; P < 0.01) and patients with mitral regurgitation (1.63, 1.1-2.43; P = 0.02) also had increased incidence of in-hospital mortality. There was no significant difference in any secondary outcomes among groups, apart from variances in mean arterial pressure observed in patients with valvular disease (P < 0.01).

Conclusions: Significant valvular dysfunction is associated with increased in-hospital mortality in patients with CS. Randomized clinical trial data are needed to further elucidate the role of transcatheter valvular interventions as a therapeutic target in this population.
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http://dx.doi.org/10.1016/j.cjca.2022.04.004DOI Listing
August 2022

Utility of a smartphone application in assessing palmar circulation prior to radial artery harvesting for coronary artery bypass grafting: rationale and design of the randomised CAPITAL iRADIAL-CABG trial.

BMJ Open 2022 04 8;12(4):e055580. Epub 2022 Apr 8.

CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada

Introduction: There is emerging evidence supporting the use of the radial artery (RA) as a preferred secondary conduit for coronary artery bypass grafting (CABG) as it is associated with higher rates of graft patency at 5 years when compared with saphenous vein grafts (SVG). The modified Allen's test (MAT) is traditionally regarded as the standard of care in the assessment of ulnar artery (UA) patency prior to RA harvesting. Unfortunately, due to high false-positive rates, a substantial number of pre-CABG patients are found to have an abnormal MAT despite normal UA patency, resulting in inappropriate exclusion from RA harvesting. The SVG is generally used in its place when this occurs, resulting in potentially lower rates of long-term graft patency.

Methods And Analysis: The CAPITAL iRADIAL-CABG trial is currently enrolling participants 18 years of age or older undergoing CABG for whom the treating physician is considering the use of an RA conduit. Eligible patients will be randomised in a 1:1 fashion to MAT or smartphone-based photoplethysmography application assessment to assess collateral palmar circulation prior to RA harvesting. The primary outcome of the trial is the use of the RA as a conduit during CABG. The primary safety outcome is postoperative palmar ischaemia as determined by clinical assessment or requirement of vascular intervention. Secondary outcomes include vascular complications, early graft failure, need for rescue percutaneous coronary intervention during the index hospitalisation and a composite cardiovascular outcome of myocardial infarction, stroke and cardiovascular death prior to discharge from hospital. A total of 236 participants are planned to be recruited.

Ethics And Dissemination: The study was approved by the Ottawa Heart Science Network Research Ethics Board (approval number 20180865-01H). The study results will be disseminated via conference presentations and peer-reviewed publications.

Trial Registration Number: NCT03810729.
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http://dx.doi.org/10.1136/bmjopen-2021-055580DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8995949PMC
April 2022

Regional anesthesia and enhanced recovery: we need more data.

Reg Anesth Pain Med 2022 08 6;47(8):507-508. Epub 2022 Apr 6.

Department of Anesthesia and Pain Medicine, University of Toronto Faculty of Medicine, Toronto, Ontario, Canada.

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http://dx.doi.org/10.1136/rapm-2022-103661DOI Listing
August 2022

Successful Explantation of a Ball and Cage Mitral Valve Prosthesis 48 Years After Initial Implantation.

CJC Open 2022 Mar 21;4(3):344-346. Epub 2021 Nov 21.

Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.

A 58-year-old female had undergone previous mechanical mitral replacement with a Starr-Edwards ball and cage valve (Edwards Lifesciences, Irvine, CA) at 11 years of age for rheumatic disease. The valve functioned well until pannus resulted in prosthetic valve stenosis with class IV dyspnea and pulmonary hypertension. She underwent reoperative mitral replacement with an On-X mechanical mitral prosthesis (Cryolife, Kennesaw, GA) 48 years after initial implantation. To our knowledge, this case represents the longest known implant period of a ball and cage mitral valve in the literature. This presentation highlights the durability of this historic prosthesis, along with the role of reoperative surgery decades after initial implantation.
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http://dx.doi.org/10.1016/j.cjco.2021.11.007DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8978051PMC
March 2022

Linking Alzheimer's Disease and Type 2 Diabetes: Characterization and Inhibition of Cytotoxic Aβ and IAPP Hetero-Aggregates.

Front Mol Biosci 2022 17;9:842582. Epub 2022 Mar 17.

Department of Biomedical Engineering and Healthcare Engineering Innovation Center, Khalifa University of Science and Technology, Abu Dhabi, United Arab Emirates.

The cytotoxic self-aggregation of β-amyloid (Aβ) peptide and islet amyloid polypeptide (IAPP) is implicated in the pathogenesis of Alzheimer's disease (AD) and Type 2 diabetes (T2D), respectively. Increasing evidence, particularly the co-deposition of Aβ and IAPP in both brain and pancreatic tissues, suggests that Aβ and IAPP cross-interaction may be responsible for a pathological link between AD and T2D. Here, we examined the nature of IAPP-Aβ40 co-aggregation and its inhibition by small molecules. In specific, we characterized the kinetic profiles, morphologies, secondary structures and toxicities of IAPP-Aβ40 hetero-assemblies and compared them to those formed by their homo-assemblies. We demonstrated that monomeric IAPP and Aβ40 form stable hetero-dimers and hetero-assemblies that further aggregate into β-sheet-rich hetero-aggregates that are toxic (cell viability <50%) to both PC-12 cells, a neuronal cell model, and RIN-m5F cells, a pancreatic cell model for β-cells. We then selected polyphenolic candidates to inhibit IAPP or Aβ40 self-aggregation and examined the inhibitory effect of the most potent candidate on IAPP-Aβ40 co-aggregation. We demonstrated that epigallocatechin gallate (EGCG) form inter-molecular hydrogen bonds with each of IAPP and Aβ40. We also showed that EGCG reduced hetero-aggregate formation and resulted in lower β-sheets content and higher unordered structures in IAPP-Aβ40-EGCG samples. Importantly, we showed that EGCG is highly effective in reducing the toxicity of IAPP-Aβ40 hetero-aggregates on both cell models, specifically at concentrations that are equivalent to or are 2.5-fold higher than the mixed peptide concentrations. To the best of our knowledge, this is the first study to report the inhibition of IAPP-Aβ40 co-aggregation by small molecules. We conclude that EGCG is a promising candidate to prevent co-aggregation and cytotoxicity of IAPP-Aβ40, which in turn, contribute to the pathological link between AD and T2D.
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http://dx.doi.org/10.3389/fmolb.2022.842582DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8968156PMC
March 2022

Effectiveness of qigong and tai chi in the quality of life of patients with cancer: protocol for an umbrella review.

BMJ Open 2022 04 1;12(4):e057980. Epub 2022 Apr 1.

School of Health and Biomedical Sciences, RMIT University, Bundoora, Victoria, Australia

Introduction: Qigong and tai chi (QTC) have been adopted by many patients with cancer as a complementary treatment with their conventional mainstream cancer management. Findings from current systematic reviews are inconsistent. Some research indicated that either qigong or tai chi interventions could enhance quality of life (QoL), and improve cancer-related symptoms such as fatigue, sleep disturbance and anxiety; while others argued that there was a lack of efficacy of QTC on QoL improvement. This umbrella review will analyse and synthesise the findings from published systematic reviews and meta-analyses regarding the effectiveness of QTC in the QoL of patients with cancer. Twenty-five databases will be searched from their respective inception to December 2021.

Methods And Analysis: We will conduct a search in 21 English and 4 Chinese databases to identify qualified systematic reviews and meta-analyses. Two reviewers will independently screen all the titles and abstracts, and determine whether the article meets the inclusion criteria. After the identified systematic reviews and/or meta-analyses are confirmed, important information from each article will be extracted to the characteristics table by two reviewers independently. Two reviewers will independently analyse the quality of the selected reviews based on the Assessment of Multiple Systematic Reviews guideline. Findings from the systematic reviews and/or meta-analyses will be summarised and reported.

Ethics And Dissemination: This review does not require ethics approval as the study is based on the published articles. The results drawn from the present review will be submitted to peer-reviewed journals for publication or presented at conferences.

Prospero Registration Number: CRD42021253216.
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http://dx.doi.org/10.1136/bmjopen-2021-057980DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8977801PMC
April 2022

Role of regional anesthesia and analgesia in enhanced recovery after colorectal surgery: a systematic review of randomized controlled trials.

Reg Anesth Pain Med 2022 05 9;47(5):282-292. Epub 2022 Mar 9.

Department of Anesthesiology and Pain Medicine, University of Toronto Faculty of Medicine, Toronto, Ontario, Canada.

Background: Effective analgesia is an important element of enhanced recovery after surgery (ERAS), but the clinical impact of regional anesthesia and analgesia for colorectal surgery remains unclear.

Objective: We aimed to determine the impact of regional anesthesia following colorectal surgery in the setting of ERAS.

Evidence Review: We performed a systematic review of nine databases up to June 2020, seeking randomized controlled trials comparing regional anesthesia versus control in an ERAS pathway for colorectal surgery. We analyzed the studies with successful ERAS implementation, defined as ERAS protocols with a hospital length of stay of ≤5 days. Data were qualitatively synthesized. Risk of bias was assessed using the Cochrane Risk of Bias 2 tool.

Findings: Of the 29 studies reporting ERAS pathways, only 13 comprising 1170 patients were included, with modest methodological quality and poor reporting of adherence to ERAS pathways. Epidural analgesia had limited evidence of outcome benefits in open surgery, while spinal analgesia with intrathecal opioids may potentially be associated with improved outcomes with no impact on length of stay in laparoscopic surgery, though dosing must be further investigated. There was limited evidence for fascial plane blocks or other regional anesthetic techniques.

Conclusions: Although there was variable methodological quality and reporting of ERAS, we found little evidence demonstrating the clinical benefits of regional anesthetic techniques in the setting of successful ERAS implementation, and future studies must report adherence to ERAS in order for their interventions to be generalizable to modern clinical practice.

Prospero Registration Number: CRD42020161200.
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http://dx.doi.org/10.1136/rapm-2021-103256DOI Listing
May 2022

Artificial intelligence in diagnosis of knee osteoarthritis and prediction of arthroplasty outcomes: a review.

Arthroplasty 2022 Mar 5;4(1):16. Epub 2022 Mar 5.

Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong, China.

Background: Artificial intelligence is an emerging technology with rapid growth and increasing applications in orthopaedics. This study aimed to summarize the existing evidence and recent developments of artificial intelligence in diagnosing knee osteoarthritis and predicting outcomes of total knee arthroplasty.

Methods: PubMed and EMBASE databases were searched for articles published in peer-reviewed journals between January 1, 2010 and May 31, 2021. The terms included: 'artificial intelligence', 'machine learning', 'knee', 'osteoarthritis', and 'arthroplasty'. We selected studies focusing on the use of AI in diagnosis of knee osteoarthritis, prediction of the need for total knee arthroplasty, and prediction of outcomes of total knee arthroplasty. Non-English language articles and articles with no English translation were excluded. A reviewer screened the articles for the relevance to the research questions and strength of evidence.

Results: Machine learning models demonstrated promising results for automatic grading of knee radiographs and predicting the need for total knee arthroplasty. The artificial intelligence algorithms could predict postoperative outcomes regarding patient-reported outcome measures, patient satisfaction and short-term complications. Important weaknesses of current artificial intelligence algorithms included the lack of external validation, the limitations of inherent biases in clinical data, the requirement of large datasets in training, and significant research gaps in the literature.

Conclusions: Artificial intelligence offers a promising solution to improve detection and management of knee osteoarthritis. Further research to overcome the weaknesses of machine learning models may enhance reliability and allow for future use in routine healthcare settings.
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http://dx.doi.org/10.1186/s42836-022-00118-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8897859PMC
March 2022

The application of close incisional negative pressure wound therapy in revision arthroplasty among asian patients: a comparative study.

Arthroplasty 2021 Nov 3;3(1):38. Epub 2021 Nov 3.

Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong SAR, China.

Introduction: Peri-prosthetic joint infection (PJI) was one of the main causes of revision of arthroplasty. In order to reduce wound complications and surgical site infections, close incisional negative pressure wound therapy (ciNPWT) has been introduced into arthroplasty. This study was designed to review the clinical benefits of the application of ciNPWT in revision arthroplasty.

Methods: This was a single-centre retrospective comparative study approved by the Institutional Review Board. Patients, who underwent revision total knee arthroplasty or revision total hip arthroplasty at the author's institution from January 2016 to October 2019, were included in this study. The ciNPWT cohort included all eligible patients, who underwent operations from January 2018 to October 2019, with the use of ciNPWT(n = 36). The control cohort included all eligible patients, who underwent operations from January 2016 to December 2017 with the use of conventional dressing(n = 48). The incidences of wound complications were compared to both cohorts.

Results: There was a statistically significant difference in the rate of superficial surgical site infection (SSI) between control cohort and ciNPWT cohort (12.5% in control vs 0% in ciNPWT, p = 0.035). However, there was no statistically significance of the overall wound complication rate for both cohorts. (14.6% in control vs 8.3% in ciNPWT, p = 0.504).

Conclusions: The application of ciNPWT could result in a lower rate of superficial surgical site infection when compared with conventional dressing among the patients undergoing revision total knee and total hip arthroplasties.

Trial Registration: UW19-706.
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http://dx.doi.org/10.1186/s42836-021-00094-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8796595PMC
November 2021

Use of a modular hip dual-mobility articulation in patients with high risk of dislocation: a relatively small-sized acetabulum in Asian patients may limit its use.

Arthroplasty 2021 May 3;3(1). Epub 2021 May 3.

Department of Orthopaedics & Traumatology, Queen Mary Hospital, The University of Hong Kong, 102 Pok Fu Lam Road, Hong Kong, Hong Kong SAR.

Background: Dual-mobility hip component is widely used in Europe and North America, because it effectively reduces hip dislocation in primary and revision total hip arthroplasties. However, reports were limited on the use of dual-mobility articulation in Asian populations.

Purpose: The aim of this retrospective study was to review the use of modular dual-mobility hip articulation in Asian patients with the high risk factor for hip dislocation. We also discussed the potential concern on the use of dual-mobility articulation in Asian patients.

Methods: From Jan 2018 to June 2019, 17 patients were included in this study. The mean age of the patients was (73.8 ± 9.5) years (range: 57-88 years). The mean size of acetabular cup and modular DM liner were (49.5 ± 3.4) mm (range, 46-58 mm) and (40.7 ± 3.4) mm (range, 38-48 mm), respectively. The mean follow-up period was (15.8 ± 3.9) months (range, 11-24 months). The primary outcome was the rate of hip dislocation. The secondary outcomes included the Harris Hip Score. Differences were considered statistically significant at p < 0.05.

Results: Hip dislocation, loosening, peri-prosthetic fractures, or intra-prosthetic dislocation was not found in the series. The mean preoperative and postoperative Harris Hip Scores were 42.2 ± 17.2 (range, 15-80) and 74.7 ± 13.5 (range, 52-97), respectively, giving a mean improvement of 32.5 ± 17.2 (range, 4-72). The improvement was statistically significant (p < 0.05).

Conclusions: In Asian patients with high risk of hip dislocation, the use of modular dual-mobility hip component produces promising outcomes without hip dislocation, but the relatively small-sized acetabulum may limit it widespread application in other populations worldwide.

Trial Registration: HKUCTR-2913 .
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http://dx.doi.org/10.1186/s42836-020-00066-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8796556PMC
May 2021

Holistic Characterization of Tumor Monocyte-to-Macrophage Differentiation Integrates Distinct Immune Phenotypes in Kidney Cancer.

Cancer Immunol Res 2022 04;10(4):403-419

Department of Pathology and ImmunoX, University of California, San Francisco, San Francisco, California.

The tumor immune microenvironment (TIME) is commonly infiltrated by diverse collections of myeloid cells. Yet, the complexity of myeloid-cell identity and plasticity has challenged efforts to define bona fide populations and determine their connections to T-cell function and their relationship to patient outcome. Here, we have leveraged single-cell RNA-sequencing analysis of several mouse and human tumors and found that monocyte-macrophage diversity is characterized by a combination of conserved lineage states as well as transcriptional programs accessed along the differentiation trajectory. We also found in mouse models that tumor monocyte-to-macrophage progression was profoundly tied to regulatory T cell (Treg) abundance. In human kidney cancer, heterogeneity in macrophage accumulation and myeloid composition corresponded to variance in, not only Treg density, but also the quality of infiltrating CD8+ T cells. In this way, holistic analysis of monocyte-to-macrophage differentiation creates a framework for critically different immune states.
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http://dx.doi.org/10.1158/2326-6066.CIR-21-0588DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8982148PMC
April 2022

Leaflet Resection vs Preservation for Degenerative Mitral Regurgitation: Functional Outcomes and Mitral Stenosis at 12 Months in a Randomized Trial.

Can J Cardiol 2022 06 21;38(6):808-814. Epub 2022 Jan 21.

Division of Cardiac Surgery, Li Ka Shing Knowledge Institute of St Michael's Hospital, Toronto, Ontario, Canada; Department of Surgery, University of Toronto, Ontario, Canada; Department of Pharmacology and Toxicology, University of Toronto, Ontario, Canada. Electronic address:

Background: Mitral valve repair is the gold standard treatment for degenerative mitral regurgitation (MR). The Canadian Mitral Research Alliance (CAMRA) CardioLink-2 trial showed no significant association between repair strategy, that is, leaflet resection vs preservation, and risk of functional mitral stenosis. In this subanalysis, we compared outcomes and functional tests at 12 months.

Methods: CAMRA CardioLink-2 was a multicentre randomized controlled trial that allocated patients with degenerative MR and posterior leaflet prolapse to leaflet resection (n = 54) or preservation (n = 50). Stress echocardiography and functional status assessments, including the 6-minute walk test, were compared 12 months after repair.

Results: Baseline demographics, stress echocardiographic findings, and mitral annuloplasty prosthesis size (33.0 ± 3.0 vs 33.6 ± 3.4 mm; P = 0.4) were similar between the two groups. There were no readmissions for heart failure or deaths during the follow-up period. At 12 months, a larger percentage of patients were in NYHA functional class ≥ 2 in the resection group compared with the preservation group (P = 0.01). Exercise capacity, rate-pressure product, 6-minute walk distance, and mean mitral valve gradients were not significantly different between the groups at 12 months. A more prominent increase in mean mitral gradient with smaller annuloplasty sizes was observed in the resection group at both rest (P = 0.03) and peak exercise (P = 0.005) in the linear regression model.

Conclusions: At 12 months, there were no significant differences in mitral valve gradient, exercise capacity, and 6-minute walk test between repair strategies. Leaflet preservation may offer a larger mitral valve orifice with improved gradients in patients requiring smaller annuloplasty sizes.
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http://dx.doi.org/10.1016/j.cjca.2022.01.013DOI Listing
June 2022

Commentary: The mitral annulus in normal valve function. Does shape matter?

JTCVS Tech 2021 Dec 21;10:45-46. Epub 2021 Oct 21.

Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.

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http://dx.doi.org/10.1016/j.xjtc.2021.10.034DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8691944PMC
December 2021

Lessons learnt from the impact of COVID-19 on arthroplasty services in Hong Kong: how to prepare for the next pandemic?

Arthroplasty 2021 6;3(1):36. Epub 2021 Sep 6.

Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong, China.

Background: Arthroplasty services worldwide have been significantly disrupted by the pandemic of coronavirus disease 2019 (COVID-19). This retrospective comparative study aimed to characterize its impact on arthroplasty services in Hong Kong.

Methods: From January 1 to June 30, 2020, the patients of "COVID-19 cohort" underwent elective total hip or knee replacement in Hong Kong public hospitals. The cohort was compared to the "control cohort" during the same period in 2019. Data analysis was performed to compare the two cohorts' numbers of operations, hospital admission, orthopaedic clinic attendances, and waiting time.

Results: A total of 33,111 patient episodes were analyzed. During the study period, the elective arthroplasty operations and hospitalizations decreased by 53 and 54%, respectively ( < 0.05). Reductions were most drastic from February to April, with surgical volume declining by 86% ( < 0.05). The primary arthroplasty operations decreased by 91% ( < 0.05), while the revision operations remained similar. Nevertheless, 14 public hospitals continued performing elective arthroplasty for patients with semi-urgent indications, including infection, progressive bone loss, prosthesis loosening, dislocation or mechanical failure of arthroplasty, and tumor. At the institution with the highest arthroplasty surgical volume, infection (28%) was the primary reason for surgery, followed by prosthesis loosening (22%) and progressive bone loss (17%). The orthopaedic clinic attendances also decreased by 20% ( < 0.05). Increases were observed in waiting time and the total number of patients on the waiting list for elective arthroplasty.

Conclusions: Despite the challenges, public hospitals in Hong Kong managed to continue providing elective arthroplasty services for high-priority patients. Arthroplasty prioritization, infection control measures, and post-pandemic service planning can enhance hospital preparedness to mitigate the impact of current and future pandemics.
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http://dx.doi.org/10.1186/s42836-021-00093-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8418902PMC
September 2021

Psychosis-Induced Exertional Rhabdomyolysis without Acute Kidney Injury or Myoglobinuria.

Am J Case Rep 2022 Jan 3;23:e934943. Epub 2022 Jan 3.

Department of Psychiatry, Jefferson Abington Hospital, Abington, PA, USA.

BACKGROUND Rhabdomyolysis is a clinical syndrome that results from skeletal muscle breakdown and the release of intracellular enzymes into systemic circulation [1,2]. We present a case of non-traumatic rhabdomyolysis with transaminitis, without myoglobinuria or acute kidney injury. Cases reports of rhabdomyolysis with elevation of serum creatine kinase (hyperCKemia) in the absence of myoglobinuria or renal failure are limited in the literature. CASE REPORT A 21-year-old man presented to the Emergency Department following an acute psychotic episode. One week earlier, his bloodwork had been within normal limits. Biochemical investigations on admission revealed hyperCKemia (590 000 U/L), transaminitis (AST, 628; ALT, 160), and normal creatinine (0.83), without myoglobinuria. Non-traumatic rhabdomyolysis was suspected, and the patient was treated with aggressive intravenous fluid resuscitation and transferred to Inpatient Psychiatry on day 10 of hospitalization. The complete metabolic panel was trended daily, without indication of kidney injury. The creatine kinase (CK) and liver function tests trended downward. CONCLUSIONS This report presents a rare case of exertional rhabdomyolysis with CK levels nearly 3000 times the upper limit of normal, without myoglobinuria or acute kidney injury. Acute kidney injury is a dangerous complication of rhabdomyolysis. Traditionally, clinicians use serum CK levels to predict the likelihood of acute kidney injury and/or renal failure in rhabdomyolysis. Ultimately, this patient was diagnosed with exertional rhabdomyolysis with hyperCKemia and transaminitis without myoglobinuria or acute kidney injury. More research is needed to elucidate the protective patient characteristics against rhabdomyolysis-associated acute kidney injury, associations between CK and myoglobinuria, and diagnostic criteria for psychosis-associated hyperCKemia.
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http://dx.doi.org/10.12659/AJCR.934943DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8740536PMC
January 2022

Discovering dominant tumor immune archetypes in a pan-cancer census.

Cell 2022 01 27;185(1):184-203.e19. Epub 2021 Dec 27.

Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA 94143, USA.

Cancers display significant heterogeneity with respect to tissue of origin, driver mutations, and other features of the surrounding tissue. It is likely that individual tumors engage common patterns of the immune system-here "archetypes"-creating prototypical non-destructive tumor immune microenvironments (TMEs) and modulating tumor-targeting. To discover the dominant immune system archetypes, the University of California, San Francisco (UCSF) Immunoprofiler Initiative (IPI) processed 364 individual tumors across 12 cancer types using standardized protocols. Computational clustering of flow cytometry and transcriptomic data obtained from cell sub-compartments uncovered dominant patterns of immune composition across cancers. These archetypes were profound insofar as they also differentiated tumors based upon unique immune and tumor gene-expression patterns. They also partitioned well-established classifications of tumor biology. The IPI resource provides a template for understanding cancer immunity as a collection of dominant patterns of immune organization and provides a rational path forward to learn how to modulate these to improve therapy.
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http://dx.doi.org/10.1016/j.cell.2021.12.004DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8862608PMC
January 2022

Genetic and immunologic features of recurrent stage I lung adenocarcinoma.

Sci Rep 2021 12 8;11(1):23690. Epub 2021 Dec 8.

Department of Surgery, Division of Cardiothoracic Surgery, University of California San Francisco, 500 Parnassus Ave, MUW-405, San Francisco, CA, 94143, USA.

Although surgery for early-stage lung cancer offers the best chance of cure, recurrence still occurs between 30 and 50% of the time. Why patients frequently recur after complete resection of early-stage lung cancer remains unclear. Using a large cohort of stage I lung adenocarcinoma patients, distinct genetic, genomic, epigenetic, and immunologic profiles of recurrent tumors were analyzed using a novel recurrence classifier. To characterize the tumor immune microenvironment of recurrent stage I tumors, unique tumor-infiltrating immune population markers were identified using single cell RNA-seq on a separate cohort of patients undergoing stage I lung adenocarcinoma resection and applied to a large study cohort using digital cytometry. Recurrent stage I lung adenocarcinomas demonstrated higher mutation and lower methylation burden than non-recurrent tumors, as well as widespread activation of known cancer and cell cycle pathways. Simultaneously, recurrent tumors displayed downregulation of immune response pathways including antigen presentation and Th1/Th2 activation. Recurrent tumors were depleted in adaptive immune populations, and depletion of adaptive immune populations and low cytolytic activity were prognostic of stage I recurrence. Genomic instability and impaired adaptive immune responses are key features of stage I lung adenocarcinoma immunosurveillance escape and recurrence after surgery.
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http://dx.doi.org/10.1038/s41598-021-02946-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8654957PMC
December 2021

Surgical antimicrobial prophylaxis in open reduction internal fixation procedures at a metropolitan hospital in Australia: a retrospective audit.

BMC Surg 2021 Nov 23;21(1):404. Epub 2021 Nov 23.

Department of Orthopaedics, Northern Health, Epping, VIC, Australia.

Background: Open reduction internal fixation (ORIF) of closed fractures is a required indication for surgical antimicrobial prophylaxis (SAP). Guidelines contain recommendations on how best to prescribe SAP, however, adherence to SAP guidelines remains suboptimal. The Australian Therapeutic Guidelines: Antibiotic v16 (updated April 2019) advocates for single dose prophylaxis for ORIF procedures. There is a paucity of information on how SAP is prescribed for ORIF of closed fractures in Australian hospitals. The aim of this study was to identify prescribing practice and to evaluate guideline adherence pre- and post-guideline update.

Methods: A retrospective audit was conducted for patients undergoing an ORIF of closed fractures at a metropolitan teaching hospital in a 6-month period during 2018 (pre-guideline update) and 2019 (post-guideline update). Data were collected on prescribing practice (perioperative antibiotics prescribed, dose, time and route of administration and duration of prophylaxis) and compared to SAP recommendations in Therapeutic Guidelines: Antibiotic v15 (2018) and v16 (2019). Descriptive statistics and Chi square tests were used to report categorical variables. Binary logistic regression was used to identify factors associated with guideline adherence. A p-value < 0.05 was deemed statistically significant.

Results: Data were collected for a total of 390 patients (n = 185, 2018; n = 205, 2019). Cefazolin was the most commonly prescribed antibiotic as per guideline recommendations, with variable, yet appropriate doses observed across the two audit periods. While 78.3% of patients received SAP for the correct duration in 2018, only 20.4% of patients received single dose prophylaxis in 2019. Overall adherence to guidelines was 63.2% in the 2018, and 18.0% in the 2019 audit periods respectively. Patient age was significantly associated with an increase in overall guideline adherence, while lower limb fractures, an American Society of Anesthesiologists (ASA) score of 3 and emergency admissions were associated with decreased overall adherence to SAP guidelines.

Conclusion: Adherence to guidelines was greater with v15 (2018) compared with v16 (2019). Patient factors, including limb fracture site and ASA score, had little impact on guideline adherence. Further research is required to understand what influences guideline adherence in the orthopaedic setting.
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http://dx.doi.org/10.1186/s12893-021-01398-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8609780PMC
November 2021

Study of synergistic disinfection by UVC and positive/negative air ions for aerosolized Escherichia coli, Salmonella typhimurium, and Staphylococcus epidermidis in ventilation duct flow.

Indoor Air 2022 01 19;32(1):e12957. Epub 2021 Nov 19.

Department of Architecture and Civil Engineering, City University of Hong Kong, Hong Kong, China.

The efficacy of the in-duct application of ultraviolet waveband C (UVC) emitting at 254 nm wavelength and air ions against aerosolized bacteria was studied in a full-scale 9-m long ventilation duct. Combined positive and negative ion polarities (bipolar ions) and combined UVC and ions were tested. The UVC was generated by a mercury-type UVC lamp and air ions were generated by positive and negative polarity ionizers. Escherichia coli (E. coli), Salmonella typhimurium (S. typhimurium), and Staphylococcus epidermidis (S. epidermidis)were tested at a concentration of 10 to 10 cells in 50 ml of sterilized distilled water. The case in which the positive ionizer was placed first, followed by the negative ionizer, demonstrated significantly higher disinfection efficiencies for E. coli (p = 0.007) and S. typhimurium (p < 0.001), but lower efficiency for S. epidermidis (p = 0.01) than the reversed sequence. The combination of UVC (3.71 J/m ) and air ions (1.13 × 10  ions/m for positive ions and 8.00 × 10  ions/m for negative ions) led to higher inactivation than individual disinfection agents operating under the same dose. A synergetic inactivation effect was observed for S. epidermidis under the combined UVC and positive ion case, while the combined UVC and negative ion case showed significant synergy effects for E. coli and S. typhimurium.
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http://dx.doi.org/10.1111/ina.12957DOI Listing
January 2022

Mitral repair with leaflet preservation versus leaflet resection and ventricular reverse remodeling from a randomized trial.

J Thorac Cardiovasc Surg 2021 Sep 15. Epub 2021 Sep 15.

Division of Cardiology, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Department of Physiology, University of Toronto, Toronto, Ontario, Canada.

Objectives: In the Canadian Mitral Research Alliance (CAMRA) Trial CardioLink-2 leaflet resection versus preservation techniques for posterior leaflet prolapse was investigated and no difference was shown in their effect on mean mitral gradient at peak exercise at 12 months postoperatively. The purpose of this subanalysis was to evaluate the effect of the 2 strategies on left ventricular (LV) reverse remodeling after repair.

Methods: A total of 104 patients were randomized to either a leaflet resection or leaflet preservation strategy. Echocardiograms, performed at baseline (preoperative), predischarge, and 12 months postoperatively, were analyzed in a blinded fashion at a core laboratory.

Results: All patients underwent successful mitral repair. At discharge, 3 patients showed moderate mitral regurgitation, whereas the remainder showed mild or less regurgitation. Compared with the baseline echocardiogram, the indexed end diastolic volume was reduced at the discharge echocardiogram (P < .0001) and was further reduced at the 12-month echocardiogram (P = .01). In contrast, the indexed end systolic volume did not significantly change from baseline assessed at the predischarge echocardiogram (P = .32) but improved at 12 months postoperatively (P < .0001), resulting in a corresponding improvement in ejection fraction at 12 months (P < .0001). The type of mitral repair strategy had no significant effect on LV reverse remodeling trends.

Conclusions: The mitral repair strategies used did not influence postoperative LV reverse remodeling, which occurred in stages. Although LV end diastolic dimensions recovered before discharge, improvements in LV end systolic dimension were evident 12 months after repair.
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http://dx.doi.org/10.1016/j.jtcvs.2021.08.081DOI Listing
September 2021

Impact of Transcatheter Mitral Valve Repair on Preprocedural and Postprocedural Hospitalization Rates.

JACC Cardiovasc Interv 2021 10;14(20):2274-2281

ICES, Toronto, Ontario, Canada; Schulich Heart Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada.

Objectives: The objective of this study was to determine the effect of transcatheter mitral valve repair (TMVr) on hospitalization rates by assessing pre- and postprocedural hospitalization patterns.

Background: TMVr has emerged as the treatment of choice for selected patients with mitral regurgitation, but the impact of these procedures on hospital utilization remains unclear.

Methods: All patients who underwent TMVr in Ontario, Canada, between 2011 and 2017 were included in this observational study using population-based data. Hospitalization person-year rates were assessed in the years before and after TMVr and 4 predefined intervals: 1 to 30, 31 to 90, 91 to 182, and 183 to 365 days. Main outcomes of interest were all-cause and heart failure (HF) hospitalizations. Poisson regression models were used to compare incidence rates across all time periods.

Results: The study cohort included 523 patients. In the year preceding TMVr, 66.2% of patients were hospitalized compared with 47.4% in the year following. There were stepwise increases in both all-cause and HF hospitalization rates in the periods preceding the index procedure, and all postprocedural periods had significantly lower hospitalization rates. The adjusted rate ratios for all-cause and HF-related hospitalization in the year after TMVr were 0.65 (95% CI: 0.56-0.76) and 0.38 (95% CI: 0.29-0.51), respectively. All time periods had significant reductions in all-cause and HF hospitalization in the adjusted analysis.

Conclusions: In this population-based study, significant reductions were observed in both all-cause and HF-related hospitalizations in all time periods after TMVr compared with the year prior. This suggests that TMVr has a sustained effect on hospitalization rates despite a high-risk population.
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http://dx.doi.org/10.1016/j.jcin.2021.08.007DOI Listing
October 2021

Overview of Innervation of Knee Joint.

Phys Med Rehabil Clin N Am 2021 11 14;32(4):767-778. Epub 2021 Jul 14.

Division of Anatomy, Department of Surgery, Temerty Faculty of Medicine, University of Toronto, 1 King's College Circle, Room 1158, Toronto, Ontario M5S 1A8, Canada.

Image-guided diagnostic block and radiofrequency ablation of the knee joint to manage pain require detailed understanding of joint innervation in relation to soft tissue and bony landmarks. In this article, the origin, course, and relationship to anatomic landmarks of articular nerves supplying the knee joint are discussed. The innervation pattern of the anterior and posterior aspects of the knee joint capsule is relatively consistent, with some variation in supply by the saphenous, anterior division of obturator, and common fibular nerves. To improve nerve capture rates for diagnostic block and radiofrequency ablation, multiple target sites could be beneficial.
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http://dx.doi.org/10.1016/j.pmr.2021.05.011DOI Listing
November 2021

Ischemic mitral regurgitation: when should one intervene?

Curr Opin Cardiol 2021 11;36(6):755-763

Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.

Purpose Of Review: Optimal timing of intervention for ischemic mitral regurgitation remains to be elucidated. This review summarizes the data on the management of ischemic mitral regurgitation, and their implications on current practice and future research.

Recent Findings: Mechanistically, ischemic mitral regurgitation can present as Type I, Type IIIb or mixed Type I and IIIb disease. Severity of mitral regurgitation is typically quantified with echocardiography, either transthoracic or transesophageal echocardiography, but may also be assessed via cardiac MRI. In patients with moderate ischemic mitral regurgitation, revascularization can lead to left ventricular reverse remodeling in some. In patients with severe ischemic mitral regurgitation, mitral valve replacement may be associated with fewer adverse events related to heart failure and cardiovascular readmissions, compared with valve repair, although reverse remodeling may be better in patients following successful mitral repair. Transcatheter edge-to-edge repair also further complements the treatment of ischemic mitral regurgitation.

Summary: A tailored approach to patients should be considered for each patient presenting with ischemic mitral regurgitation.
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http://dx.doi.org/10.1097/HCO.0000000000000916DOI Listing
November 2021
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