Publications by authors named "Xiaoyue Ma"

80 Publications

Ordered Packing of β-Sheet Nanofibrils into Nanotubes: Multi-hierarchical Assembly of Designed Short Peptides.

Nano Lett 2021 Dec 6;21(24):10199-10207. Epub 2021 Dec 6.

State Key Laboratory of Heavy Oil Processing and Center for Biotechnology and Bioengineering, China University of Petroleum (East China), 66 Changjiang West Road, Qingdao 266580, China.

Although it is well-known proteins and their complexes are hierarchically organized and highly ordered structures, it remains a major challenge to replicate their hierarchical self-assembly process and to fabricate multihierarchical architectures with well-defined shapes and monodisperse characteristic sizes via peptide self-assembly. Here we describe an amphiphilic short peptide Ac-IGGHK-NH that first preassembles into thin, left-handed β-sheet nanofibrils, followed by their ordered packing into right-handed nanotubes. The key intermediate morphology and structures featuring the hierarchical process are simultaneously demonstrated. Further mechanistic exploration with the variants Ac-IGGGK-NH, Ac-IGGFK-NH, and Ac-IGGHK-NH reveals the vital role of multiple His-His side chain interactions between nanofibrils in mediating higher-order assembly and architectures. Altogether, our findings not only advance current understanding of hierarchical assembly of peptides and proteins but also afford a paradigm of how to take advantage of side chain interactions to construct higher-order assemblies with enhanced complexities.
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http://dx.doi.org/10.1021/acs.nanolett.1c02944DOI Listing
December 2021

Effects of an Immersive Virtual Reality Exergame on University Students' Anxiety, Depression, and Perceived Stress: Pilot Feasibility and Usability Study.

JMIR Serious Games 2021 Nov 22;9(4):e29330. Epub 2021 Nov 22.

Department of Computing, School of Advanced Technology, Xi'an Jiaotong-Liverpool University, Suzhou, China.

Background: In recent years, there has been an increase in the number of students with depression, anxiety, and perceived stress. A solution that has been increasingly used for improving health and well-being is exergaming. The effects and acceptability of exergames have been studied widely but mostly with older adults. The feasibility and usability of exergames among university students, especially those of immersive virtual reality (iVR) exergames, remain unexplored.

Objective: This study aimed to explore the feasibility of a 6-week iVR exergame-based intervention in reducing anxiety, depression, and perceived stress among university students and to examine the usability and acceptability of such games.

Methods: A total of 31 university students were recruited to participate in a 6-week study in which they needed to play a boxing-style iVR exergame called FitXR (FitXR Limited) twice per week (30 minutes per session). Their anxiety (Beck Anxiety Inventory), depression (Beck Depression Inventory-II), and perceived stress (Perceived Stress Scale) levels were measured before and after intervention.

Results: A total of 15 participants completed the 6-week study. Our results suggested that participants' mean depression scores decreased significantly from 8.33 (SD 5.98) to 5.40 (SD 5.14) after the intervention (P=.01). In addition, most participants (14/15, 93%) believed that the iVR exergame has good usability. Furthermore, most participants (14/15, 93%) were satisfied with the iVR gameplay experience and would play the iVR exergame again in the future. Of the 15 participants, 11 (73%) would recommend the iVR exergame to their friends.

Conclusions: The results gained from this study show that the iVR exergame has good usability, is highly acceptable, and has the potential to reduce depression levels among university students.
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http://dx.doi.org/10.2196/29330DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8663481PMC
November 2021

Deep learning-based GTV contouring modeling inter- and intra- observer variability in sarcomas.

Radiother Oncol 2021 Nov 19;167:269-276. Epub 2021 Nov 19.

Gordon Center for Medical Imaging, Department of Radiology, Massachusetts General Hospital, Boston, United States; Harvard Medical School, Boston, United States. Electronic address:

Background And Purpose: The delineation of the gross tumor volume (GTV) is a critical step for radiation therapy treatment planning. The delineation procedure is typically performed manually which exposes two major issues: cost and reproducibility. Delineation is a time-consuming process that is subject to inter- and intra-observer variability. While methods have been proposed to predict GTV contours, typical approaches ignore variability and therefore fail to utilize the valuable confidence information offered by multiple contours.

Materials And Methods: In this work we propose an automatic GTV contouring method for soft-tissue sarcomas from X-ray computed tomography (CT) images, using deep learning by integrating inter- and intra-observer variability in the learned model. Sixty-eight patients with soft tissue and bone sarcomas were considered in this evaluation, all underwent pre-operative CT imaging used to perform GTV delineation. Four radiation oncologists and radiologists performed three contouring trials each for all patients. We quantify variability by defining confidence levels based on the frequency of inclusion of a given voxel into the GTV and use a deep convolutional neural network to learn GTV confidence maps.

Results: Results were compared to confidence maps from the four readers as well as ground-truth consensus contours established jointly by all readers. The resulting continuous Dice score between predicted and true confidence maps was 87% and the Hausdorff distance was 14 mm.

Conclusion: Results demonstrate the ability of the proposed method to predict accurate contours while utilizing variability and as such it can be used to improve clinical workflow.
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http://dx.doi.org/10.1016/j.radonc.2021.09.034DOI Listing
November 2021

Plaque Character and Progression According to the Location of Coronary Atherosclerotic Plaque.

Am J Cardiol 2021 11 29;158:15-22. Epub 2021 Aug 29.

Cardiovascular Imaging Unit, SDN IRCCS, Naples, Italy.

Although acute coronary syndrome culprit lesions occur more frequently in the proximal coronary artery, whether the proximal clustering of high-risk plaque is reflected in earlier-stage atherosclerosis remains unclarified. We evaluated the longitudinal distribution of stable atherosclerotic lesions on coronary computed tomography angiography (CCTA) in 1,478 patients (mean age, 61 years; men, 58%) enrolled from a prospective multinational registry of consecutive patients undergoing serial CCTA. Of 3,202 coronary artery lesions identified, 2,140 left lesions were classified (based on the minimal lumen diameter location) into left main (LM, n = 128), proximal (n = 739), and other (n = 1,273), and 1,062 right lesions were classified into proximal (n = 355) and other (n = 707). Plaque volume (PV) was the highest in proximal lesions (median, 26.1 mm), followed by LM (20.6 mm) and other lesions (15.0 mm, p <0.001), for left lesions, and was lager in proximal (25.8 mm) than in other lesions (15.2 mm, p <0.001) for right lesions. On both sides, proximally located lesions tended to have greater necrotic core and fibrofatty components than other lesions (left: LM, 10.6%; proximal, 5.8%; other, 3.4% of the total PV, p <0.001; right: proximal, 8.4%; other 3.1%, p <0.001), with less calcified plaque component (left: LM, 18.3%; proximal, 30.3%; other, 37.7%, p <0.001; right: proximal, 23.3%, other, 36.6%, p <0.001), and tended to progress rapidly (adjusted odds ratios: left: LM, reference; proximal, 0.95, p = 0.803; other, 0.64, p = 0.017; right: proximal, reference; other, 0.52, p <0.001). Proximally located plaques were larger, with more risky composition, and progressed more rapidly.
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http://dx.doi.org/10.1016/j.amjcard.2021.07.040DOI Listing
November 2021

Association of Statin Treatment With Progression of Coronary Atherosclerotic Plaque Composition.

JAMA Cardiol 2021 11;6(11):1257-1266

Department of Pathology, CVPath Institute, Gaithersburg, Maryland.

Importance: The density of atherosclerotic plaque forms the basis for categorizing calcified and noncalcified morphology of plaques.

Objective: To assess whether alterations in plaque across a range of density measurements provide a more detailed understanding of atherosclerotic disease progression.

Design, Setting, And Participants: This cohort study enrolled 857 patients who underwent serial coronary computed tomography angiography 2 or more years apart and had quantitative measurements of coronary plaques throughout the entire coronary artery tree. The study was conducted from 2013 to 2016 at 13 sites in 7 countries.

Main Outcomes And Measures: The main outcome was progression of plaque composition of individual coronary plaques. Six plaque composition types were defined on a voxel-level basis according to the plaque attenuation (expressed in Hounsfield units [HU]): low attenuation (-30 to 75 HU), fibro-fatty (76-130 HU), fibrous (131-350 HU), low-density calcium (351-700 HU), high-density calcium (701-1000 HU), and 1K (>1000 HU). The progression rates of these 6 compositional plaque types were evaluated according to the interaction between statin use and baseline plaque volume, adjusted for risk factors and time interval between scans. Plaque progression was also examined based on baseline calcium density. Analysis was performed among lesions matched at baseline and follow-up. Data analyses were conducted from August 2019 through March 2020.

Results: In total, 2458 coronary lesions in 857 patients (mean [SD] age, 62.1 [8.7] years; 540 [63.0%] men; 548 [63.9%] received statin therapy) were included. Untreated coronary lesions increased in volume over time for all 6 compositional types. Statin therapy was associated with volume decreases in low-attenuation plaque (β, -0.02; 95% CI, -0.03 to -0.01; P = .001) and fibro-fatty plaque (β, -0.03; 95% CI, -0.04 to -0.02; P < .001) and greater progression of high-density calcium plaque (β, 0.02; 95% CI, 0.01-0.03; P < .001) and 1K plaque (β, 0.02; 95% CI, 0.01-0.03; P < .001). When analyses were restricted to lesions without low-attenuation plaque or fibro-fatty plaque at baseline, statin therapy was not associated with a change in overall calcified plaque volume (β, -0.03; 95% CI, -0.08 to 0.02; P = .24) but was associated with a transformation toward more dense calcium. Interaction analysis between baseline plaque volume and calcium density showed that more dense coronary calcium was associated with less plaque progression.

Conclusions And Relevance: The results suggest an association of statin use with greater rates of transformation of coronary atherosclerosis toward high-density calcium. A pattern of slower overall plaque progression was observed with increasing density. All findings support the concept of reduced atherosclerotic risk with increased densification of calcium.
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http://dx.doi.org/10.1001/jamacardio.2021.3055DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8374741PMC
November 2021

Impact of preoperative opioid use disorder on outcomes following lumbar-spine surgery.

Clin Neurol Neurosurg 2021 Sep 3;208:106865. Epub 2021 Aug 3.

Department of Anesthesiology, Weill Cornell Medicine, New York City, NY, United States of America. Electronic address:

Objectives: Opioid use disorder (OUD) has previously been shown to negatively impact postoperative outcomes. As the number of spine surgeries continues to rise annually, more patients with preexisting OUD will be seen in operating rooms. Our retrospective cohort study aims to expand on the independent association between preoperative OUD and outcomes following lumbar-spine surgery.

Patients And Methods: Using 2007-2014 data from the State Inpatient Databases (SID) for the states of California (2007-2011), Florida, New York, Maryland, and Kentucky, we identified patients ≥18 years of age undergoing lumbar-spine surgery. Our primary variable of interest was present-on-admission OUD. Outcomes of interest included a range of postoperative complications divided into those specific to spinal surgery and general surgical complications, length of stay (LOS), 30- and 90-day readmission rates, and total hospital charges.

Results: Of the 267,976 patients undergoing lumbar-spine surgery, 1902 patients were identified as having OUD. After adjusting for patient- and hospital-level confounders, we found that patients with OUD were more likely to experience complications related specifically to spine surgery (aOR = 1.51, 95%CI = 1.33-1.71) as well as general postoperative complications (aOR = 1.63, 95%CI = 1.36-1.96) compared to those without OUD. OUD was additionally associated with longer LOS (aIRR = 1.29, CI = 1.24-1.34) and higher total charges (aIRR = 1.14, CI = 1.11-1.18). Whereas no statistically significant difference was detected for 30-day-readmission rates, patients with OUD experienced higher rates of readmission within 90 days of discharge (aOR = 1.20, CI = 1.08-1.35).

Conclusions: Our study strengthens the evidence that patients with OUD fare poorly after lumbar-spine surgery. More research is needed to determine whether reducing opioid use before surgery can mitigate the postoperative risks associated with OUD.
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http://dx.doi.org/10.1016/j.clineuro.2021.106865DOI Listing
September 2021

Development of an AI system for accurately diagnose hepatocellular carcinoma from computed tomography imaging data.

Br J Cancer 2021 10 7;125(8):1111-1121. Epub 2021 Aug 7.

Department of Abdominal Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, China.

Background And Aims: Computed tomography (CT) scan is frequently used to detect hepatocellular carcinoma (HCC) in routine clinical practice. The aim of this study is to develop a deep-learning AI system to improve the diagnostic accuracy of HCC by analysing liver CT imaging data.

Methods: We developed a deep-learning AI system by training on CT images from 7512 patients at Henan Provincial Peoples' Hospital. Its performance was validated on one internal test set (Henan Provincial Peoples' Hospital, n = 385) and one external test set (Henan Provincial Cancer Hospital, n = 556). The area under the receiver-operating characteristic curve (AUROC) was used as the primary classification metric. Accuracy, sensitivity, specificity, precision, negative predictive value and F1 metric were used to measure the performance of AI systems and radiologists.

Results: AI system achieved high performance in identifying HCC patients, with AUROC of 0.887 (95% CI 0.855-0.919) on the internal test set and 0.883 (95% CI 0.855-0.911) on the external test set. For internal test set, accuracy was 81.0% (76.8-84.8%), sensitivity was 78.4% (72.4-83.7%), specificity was 84.4% (78.0-89.6%) and F1 (harmonic average of precision and recall rate) was 0.824. For external test set, accuracy was 81.3% (77.8-84.5%), sensitivity was 89.4% (85.0-92.8%), specificity was 74.0% (68.5-78.9%) and F1 was 0.819. Compared with radiologists, AI system achieved comparable accuracy and F1 metric on internal test set (0.853 versus 0.818, P = 0.107; 0.863 vs. 0.824, P = 0.082) and external test set (0.805 vs. 0.793, P = 0.663; 0.810 vs. 0.814, P = 0.866). The predicted HCC risk scores by AI system in HCC patients with multiple tumours and high fibrosis stage were higher than those with solitary tumour and low fibrosis stage (tumour number: 0.197 vs. 0.138, P = 0.006; fibrosis stage: 0.183 vs. 0.127, P < 0.001). Radiologists' review showed that the accuracy of saliency heatmaps predicted by algorithms was 92.1% (95% CI: 89.2-95.0%).

Conclusions: AI system achieved high performance in the detection of HCC compared with a group of specialised radiologists. Further investigation by prospective clinical trials was necessitated to verify this model.
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http://dx.doi.org/10.1038/s41416-021-01511-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8505513PMC
October 2021

Variation in the Use of Active Surveillance for Low-Risk Prostate Cancer Across US Census Regions.

Front Oncol 2021 19;11:644885. Epub 2021 May 19.

Department of Urology, Weill Cornell Medicine, New York Presbyterian Hospital, New York, NY, United States.

Substantial geographic variation in healthcare practices exist. Active surveillance (AS) has emerged as a critical tool in the management of men with low-risk prostate cancer. Whether there have been regional differences in adoption is largely unknown. The SEER "Prostate with Watchful Waiting Database" was used to identify patients diagnosed with localized low-risk prostate cancer and managed with AS across US census regions between 2010 and 2016. Multivariable logistic regression models were used to determine the impact of region on undergoing AS and factors associated with AS use within each US census region. Between 2010 and 2016, the proportion of men managed with AS increased from 20.8% to 55.9% in the West, 11.5% to 50.0% in Northeast, 9.9% to 43.4% in the South and 15.1% to 56.2% in Midwest ( < 0.0001). On multivariable analysis, as compared to the West, men in all regions were less likely to undergo AS ( < 0.001). Black men in the West (OR 1.36, 95%CI 1.25-1.49) and Midwest (OR 1.62, 95%CI 1.35-1.95) were more likely to undergo AS, but less likely in Northeast (OR 0.80, 95%CI 0.69-0.92). Men with higher socioeconomic status (SES) were more likely to undergo AS in the West (OR 1.47, 95%CI 1.39-1.55), Northeast (OR 1.57, 95%CI 1.36-1.81), and South (OR 1.24, 95%CI 1.13-1.37) but not in the Midwest (OR 0.85, 95%CI 0.73-0.98). We found striking regional differences in the uptake of AS according to race and SES. Geography must be taken into consideration when assessing barriers to AS use.
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http://dx.doi.org/10.3389/fonc.2021.644885DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8170083PMC
May 2021

Unexpected Role of Achiral Glycine in Determining the Suprastructural Handedness of Peptide Nanofibrils.

ACS Nano 2021 06 28;15(6):10328-10341. Epub 2021 May 28.

State Key Laboratory of Heavy Oil Processing and School of Materials Science and Engineering, China University of Petroleum (East China), 66 Changjiang West Road, Qingdao 266580, China.

Helical supramolecular architectures play important structural and functional roles in biological systems. Although their occurrence is widely perceived to correlate to fundamental chiral units including l-amino acids and d-sugars, the detailed relationship between molecular and supramolecular handedness is still unclear. At the same time, although achiral units are practically always in close proximity to chiral ones by covalent linkage along a polymeric chain, their effect on supramolecular handedness has received relatively less attention. Here, we designed a set of short amphiphilic peptides, in which an achiral glycine residue was incorporated at the interface between the hydrophobic and hydrophilic segments. We observed that glycine incorporation caused dramatic variations in suprastructural handedness in self-assembled peptide nanofibrils, and the effect of the hydrophilic charged residue at the C-terminus on supramolecular handedness was demolished, leading to chiral truncation. Furthermore, molecular dynamics simulations and quantum chemistry calculations revealed that the unanticipated role of the glycine residue in regulating supramolecular handedness originated from its effect on the conformational preference of single β-strands. Importantly, reduced density gradient analyses on single β-strands indicated that, due to the lack of a side chain in glycine, intricate noncovalent interactions were produced among the neighboring amino acid side chains of the incorporated glycine and its local backbone, resulting in diverse β-strand conformations.
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http://dx.doi.org/10.1021/acsnano.1c02547DOI Listing
June 2021

Hospital safety-net burden is associated with increased inpatient mortality after elective total knee arthroplasty: a retrospective multistate review, 2007-2018.

Reg Anesth Pain Med 2021 08 14;46(8):663-670. Epub 2021 May 14.

Department of Anesthesiology, Weill Cornell Medicine, New York, New York, USA

Background: Total knee arthroplasty (TKA) is among the most common surgical procedures performed in the USA and comprises an outsized proportion of Medicare expenditures. Previous work-associated higher safety-net burden hospitals with increased morbidity and in-hospital mortality following total hip arthroplasty. Here, we examine the association of safety-net burden on postoperative outcomes after TKA.

Methods: We retrospectively analyzed 1 141 587 patients aged ≥18 years undergoing isolated elective TKA using data from the State Inpatient Databases for Florida, Kentucky, Maryland, New York and Washington from 2007 through 2018. Hospitals were grouped into tertiles by safety-net burden status, defined by the proportion of inpatient cases billed to Medicaid or unpaid (low: 0%-16.83%, medium: 16.84%-30.45%, high: ≥30.45%). Using generalized estimating equation models, we assessed the association of hospital safety-net burden status on in-hospital mortality, patient complications and length of stay (LOS). We also analyzed outcomes by anesthesia type in New York State (NYS), the only state with this data.

Results: Most TKA procedures were performed at medium safety-net burden hospitals (n=6 16 915, 54%), while high-burden hospitals performed the fewest (n=2 04 784, 17.9%). Overall in-patient mortality was low (0.056%), however, patients undergoing TKA at medium-burden hospitals were 40% more likely to die when compared with patients at low-burden hospitals (low: 0.043% vs medium: 0.061%, adjusted OR (aOR): 1.40, 95% CI 1.09 to 1.79, p=0.008). Patients who underwent TKA at medium or high safety-net burden hospitals were more likely to experience intraoperative complications (low: 0.2% vs medium: 0.3%, aOR: 1.94, 95% CI 1.34 to 2.83, p<0.001; low: 0.2% vs high: 0.4%, aOR: 1.91, 95% CI 1.35 to 2.72, p<0.001). There were no statistically significant differences in other postoperative complications or LOS between the different safety-net levels. In NYS, TKA performed at high safety-net burden hospitals was more likely to use general rather than regional anesthesia (low: 26.7% vs high: 59.5%, aOR: 4.04, 95% CI 1.05 to 15.5, p=0.042).

Conclusions: Patients undergoing TKA at higher safety-net burden hospitals are associated with higher odds of in-patient mortality than those at low safety-net burden hospitals. The source of this mortality differential is unknown but could be related to the increased risk of intraoperative complications at higher burden centers.
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http://dx.doi.org/10.1136/rapm-2020-101731DOI Listing
August 2021

Rabies surveillance in the United States during 2019.

J Am Vet Med Assoc 2021 Jun;258(11):1205-1220

Objective: To provide epidemiological information on animal and human cases of rabies occurring in the United States during 2019 and summaries of 2019 rabies surveillance for Canada and Mexico.

Animals: All animals submitted for laboratory diagnosis of rabies in the United States during 2019.

Procedures: State and territorial public health departments and USDA Wildlife Services provided data on animals submitted for rabies testing in the United States during 2019. Data were analyzed temporally and geographically to assess trends in domestic and wildlife rabies cases.

Results: During 2019, 53 jurisdictions submitted 97,523 animal samples for rabies testing, of which 94,770 (97.2%) had a conclusive (positive or negative) test result. Of these, 4,690 tested positive for rabies, representing a 5.3% decrease from the 4,951 cases reported in 2018. Texas (n = 565 [12.0%]), New York (391 [8.3%]), Virginia (385 [8.2%]), North Carolina (315 [6.7%]), California (276 [5.9%]), and Maryland (269 [5.7%]) together accounted for almost half of all animal rabies cases reported in 2019. Of the total reported rabid animals, 4,305 (91.8%) were wildlife, with raccoons (n = 1,545 [32.9%]), bats (1,387 [29.6%]), skunks (915 [19.5%]), and foxes (361 [7.7%]) as the primary species confirmed with rabies. Rabid cats (n = 245 [5.2%]) and dogs (66 [1.4%]) accounted for > 80% of rabies cases involving domestic animals in 2019. No human rabies cases were reported in 2019.

Conclusions And Clinical Relevance: The overall number of animal rabies cases decreased from 2018 to 2019. Laboratory diagnosis of rabies in animals is critical to ensure that human rabies postexposure prophylaxis is administered judiciously.
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http://dx.doi.org/10.2460/javma.258.11.1205DOI Listing
June 2021

Inflammatory tumor microenvironment responsive neutrophil exosomes-based drug delivery system for targeted glioma therapy.

Biomaterials 2021 06 31;273:120784. Epub 2021 Mar 31.

School of Medicine, Chongqing University, Chongqing, 400044, China; Key Laboratory of Biorheological Science and Technology, Ministry of Education, College of Bioengineering, Chongqing University, Chongqing, 400044, China. Electronic address:

Clinical treatment of malignant glioma remains a major challenge due to high infiltrative growth and chemotherapeutic resistance of tumors and the presence of the blood brain barrier (BBB). Advanced nanoplatforms that can efficiently cross the BBB and target to brain tumor are urgently needed. Encouraged by the intrinsic inflammatory chemotaxis and excellent BBB-crossing capability of neutrophils, a bioinspired neutrophil-exosomes (NEs-Exos) system for delivering loaded doxorubicin (DOX) drug for glioma treatment is proposed and systematically investigated. In vivo zebrafish and C6-Luc glioma-bearing mice models show that NEs-Exos carrying the drug rapidly penetrate the BBB and migrate into the brain. Additionally, a transwell BBB model and mouse brain inflammatory study show that NEs-Exos can respond chemotactically to inflammatory stimuli and target infiltrating tumor cells in inflamed brain tumors. Moreover, intravenous injection of NEs-Exos/DOX efficiently suppress tumor growth and prolong survival time in a glioma mouse model. On the basis of these results, NEs-Exos are confirmed to have neutrophil-like chemotactic function and BBB penetration. This novel NEs-Exos/DOX delivery platform represents a promising chemotherapeutic approach for clinical treatment of glioma and other solid tumor or brain diseases.
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http://dx.doi.org/10.1016/j.biomaterials.2021.120784DOI Listing
June 2021

Findings from the initial Stepwise Approach to Rabies Elimination (SARE) Assessment in China, 2019.

PLoS Negl Trop Dis 2021 03 29;15(3):e0009274. Epub 2021 Mar 29.

Division of High-Consequence Pathogens and Pathology, United States Centers for Disease Control and Prevention, Atlanta, United States of America.

In 2015, China and other member states of the United Nations adopted the goal of eliminating dog-mediated rabies by 2030. China has made substantial progress in reducing dog-mediated human rabies since peaking with more than 3,300 reported cases in 2007. To further improve coordination and planning, the Chinese Center for Disease Control and Prevention, in collaboration with the United States Centers for Disease Control and Prevention, conducted a Stepwise Approach towards Rabies Elimination (SARE) assessment in March 2019. Assessment goals included outlining progress and identifying activities critical for eliminating dog-mediated rabies. Participants representing national, provincial and local human and animal health sectors in China used the SARE assessment tool to answer 115 questions about the current dog-mediated rabies control and prevention programs in China. The established surveillance system for human rabies cases and availability of post-exposure prophylaxis were identified as strengths. Low dog vaccination coverage and limited laboratory confirmation of rabid dogs were identified gaps, resulting in an overall score of 1.5 on a scale of 0 to 5. Participants outlined steps to increase cross-sectoral information sharing, improve surveillance for dog rabies, increase dog vaccination coverage, and increase laboratory capacity to diagnose rabies at the provincial level. All assessment participants committed to strengthening cross-sector collaboration using a One Health approach to achieve dog-mediated human rabies elimination by 2030.
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http://dx.doi.org/10.1371/journal.pntd.0009274DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8006992PMC
March 2021

The Consequences of Inadvertent Radical Nephrectomy in the Treatment of Upper Tract Urothelial Carcinoma.

Urology 2021 Aug 22;154:127-135. Epub 2021 Mar 22.

Department of Urology, New York Presbyterian Hospital, Weill Cornell Medicine, New York, NY.

Objective: To determine factors associated with performing inadvertent radical nephrectomy (RN) for upper tract urothelial carcinoma (UTUC), and to assess the impact of radical nephrectomy on overall survival (OS) compared to radical nephroureterectomy (NU).

Methods: Using the National Cancer Database (NCDB), patients with UTUC of the renal pelvis who were diagnosed with renal cortical tumors and underwent RN (n = 820) with subsequent surgical pathology demonstrating urothelial carcinoma were identified. These patients were compared to those diagnosed with renal pelvis tumors who appropriately underwent NU (n = 16,464) between 2005 and 2015. Multivariable logistic regression was used to determine patient, facility and tumor-related factors associated with undergoing RN. The impact of surgery (RN vs NU) on OS was determined by Cox-regression after propensity score matching.

Results: A total of 4.7% patients with UTUC underwent inadvertent RN. Black race (adjusted odds ratio [aOR] 1.62, 95%CI 1.23-2.13), larger tumors, advanced tumor stage, and high-grade tumors (P < 0.0001) were associated with RN. However, surgery at a facility performing a higher volume of NU/year was associated with lower odds of having RN performed (aOR 0.85, 95%CI 0.75-0.97). After propensity score matching, the 5-year OS was 39.9% for those undergoing RN vs 49.9% for those undergoing NU (hazard ratio 1.45, 95%CI 1.30-1.62).

Conclusion: Inadvertent RN is not uncommon, occurring in almost 5% of patients with UTUC in the NCDB. Patients who underwent RN had significantly worse OS as compared to those treated with NU. These data highlight that accurate diagnosis of UTUC is paramount and clinicians should not hesitate to perform further workup when imaging findings are equivocal.
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http://dx.doi.org/10.1016/j.urology.2021.03.003DOI Listing
August 2021

Understanding the True Prevalence of Prostate Cancer Genomic Subtypes: Use of Inverse Probability Weighting to Correct for Biases in Molecularly Profiled Cohorts.

J Urol 2021 Jun 27;205(6):1551-1553. Epub 2021 Jan 27.

Department of Urology, New York Presbyterian Hospital - Weill Cornell Medicine, New York, New York.

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http://dx.doi.org/10.1097/JU.0000000000001627DOI Listing
June 2021

Factors Driving Citizen Engagement With Government TikTok Accounts During the COVID-19 Pandemic: Model Development and Analysis.

J Med Internet Res 2021 02 4;23(2):e21463. Epub 2021 Feb 4.

College of Engineering, Design and Physical Sciences, Brunel University London, London, United Kingdom.

Background: During the COVID-19 pandemic, growth in citizen engagement with social media platforms has enabled public health departments to accelerate and improve health information dissemination, developing transparency and trust between governments and citizens. In light of these benefits, it is imperative to learn the antecedents and underlying mechanisms for this to maintain and enhance engagement.

Objective: The aim of this study is to determine the factors and influencing mechanisms related to citizen engagement with the TikTok account of the National Health Commission of China during the COVID-19 pandemic.

Methods: Using a web crawler, 355 short videos were collected from the Healthy China account on TikTok (with more than 3 million followers throughout China), covering the period from January 21, 2020, to April 25, 2020. The title and video length, as well as the number of likes, shares, and comments were collected for each video. After classifying them using content analysis, a series of negative binomial regression analyses were completed.

Results: Among the 355 videos, 154 (43.4%) related to guidance for clinicians, patients, and ordinary citizens, followed by information concerning the government's handling of the pandemic (n=100, 28.2%), the latest news about COVID-19 (n=61, 17.2%), and appreciation toward frontline emergency services (n=40, 11.3%). Video length, titles, dialogic loop, and content type all influenced the level of citizen engagement. Specifically, video length was negatively associated with the number of likes (incidence rate ratio [IRR]=0.19, P<.001) and comments (IRR=0.39, P<.001). Title length was positively related to the number of shares (IRR=24.25, P=.01), likes (IRR=8.50, P=.03), and comments (IRR=7.85, P=.02). Dialogic loop negatively predicted the number of shares (IRR=0.56, P=.03). In comparison to appreciative information, information about the government's handling of the situation (IRR=5.16, P<.001) and guidelines information (IRR=7.31, P<.001) were positively correlated with the number of shares, while the latest news was negatively related to the number of likes received (IRR=0.46, P=.004). More importantly, the relationship between predictors and citizen engagement was moderated by the emotional valence of video titles. Longer videos with positive titles received a higher number of likes (IRR=21.72, P=.04) and comments (IRR=10.14, P=.047). Furthermore, for short videos related to government handling of the pandemic (IRR=14.48, P=.04) and guidance for stakeholders (IRR=7.59, P=.04), positive titles received a greater number of shares. Videos related to the latest news (IRR=66.69, P=.04) received more likes if the video title displayed higher levels of positive emotion.

Conclusions: During the COVID-19 pandemic, videos were frequently published on government social media platforms. Video length, title, dialogic loop, and content type significantly influenced the level of citizen engagement. These relationships were moderated by the emotional valence of the video's title. Our findings have implications for maintaining and enhancing citizen engagement via government social media.
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http://dx.doi.org/10.2196/21463DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7864626PMC
February 2021

Thirty-day hospital readmission in systemic sclerosis associated pulmonary hypertension: A nationwide study.

Semin Arthritis Rheum 2021 02 8;51(1):324-330. Epub 2021 Jan 8.

Hospital for Special Surgery, Department of Medicine, Division of Rheumatology, 535 East 70th Street, New York, NY 10021, United States. Electronic address:

Objective: To identify risk-factors for 30-day hospital readmission in systemic sclerosis pulmonary hypertension (SSc-PH) and to compare trends and characteristics of 30-day readmissions in SSc-PH versus non-SSc pulmonary arterial hypertension (non-SSc PAH).

Methods: In this retrospective study, we identified SSc-PH and non-SSc PAH hospitalizations using ICD-9 codes within the Healthcare Cost and Utilization Project-National Readmission Database. Thirty-day readmission rates were calculated between 2010 and 2015. Characteristics were compared using chi-square, Wilcoxon rank-sum, or two-sample t-tests between (A) SSc-PH patients with versus without readmission and (B) patients with ≥1 readmission with SSc-PH versus non-SSc PAH. Adjusted logistic regression models were generated for readmission in SSc-PH.

Results: 4,846 of 22,420 (22%) with SSc-PH and 10,573 of 49,254 (21%) with non-SSc PAH had ≥1 30-day readmission. Between 2010-2015, readmission rate decreased in non-SSc PAH (23% to 20%; p<0.001) and was unchanged in SSc-PH (23% to 23%; p = 0.77). In SSc-PH, independent predictors of 30-day readmission include male sex, age <60, Medicare or Medicaid, higher Charlson/Deyo comorbidity index, and congestive heart failure (CHF). A higher proportion of patients with SSc-PH (vs. non-SSc PAH) died during index hospitalizations (p = 0.001) and readmissions (p <0.001). Readmitted patients with SSc-PH (vs. non-SSc PAH) were younger and less often had CHF. In SSc-PH, the most common readmission primary diagnosis was infection, followed by respiratory and heart failure.

Conclusion: In SSc-PH, 30-day readmission is frequent, and in-hospital deaths occur at a higher rate compared to those with non-SSc PAH. This study identifies factors that may characterize those with SSc-PH at highest risk for readmission.
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http://dx.doi.org/10.1016/j.semarthrit.2021.01.002DOI Listing
February 2021

Progression of whole-heart Atherosclerosis by coronary CT and major adverse cardiovascular events.

J Cardiovasc Comput Tomogr 2021 Jul-Aug;15(4):322-330. Epub 2021 Jan 1.

Department of Imaging and Medicine, Cedars Sinai Medical Center, Los Angeles, CA, USA.

Background: The current study aimed to examine the independent prognostic value of whole-heart atherosclerosis progression by serial coronary computed tomography angiography (CCTA) for major adverse cardiovascular events (MACE).

Methods: The multi-center PARADIGM study includes patients undergoing serial CCTA for symptomatic reasons, ≥2 years apart. Whole-heart atherosclerosis was characterized on a segmental level, with co-registration of baseline and follow-up CCTA, and summed to per-patient level. The independent prognostic significance of atherosclerosis progression for MACE (non-fatal myocardial infarction [MI], death, unplanned coronary revascularization) was examined. Patients experiencing interval MACE were not omitted.

Results: The study population comprised 1166 patients (age 60.5 ​± ​9.5 years, 54.7% male) who experienced 139 MACE events during 8.2 (IQR 6.2, 9.5) years of follow up (15 death, 5 non-fatal MI, 119 unplanned revascularizations). Whole-heart percent atheroma volume (PAV) increased from 2.32% at baseline to 4.04% at follow-up. Adjusted for baseline PAV, the annualized increase in PAV was independently associated with MACE: OR 1.23 (95% CI 1.08, 1.39) per 1 standard deviation increase, which was consistent in multiple subpopulations. When categorized by composition, only non-calcified plaque progression associated independently with MACE, while calcified plaque did not. Restricting to patients without events before follow-up CCTA, those with future MACE showed an annualized increase in PAV of 0.93% (IQR 0.34, 1.96) vs 0.32% (IQR 0.02, 0.90), P ​< ​0.001.

Conclusions: Whole-heart atherosclerosis progression examined by serial CCTA is independently associated with MACE, with a prognostic threshold of 1.0% increase in PAV per year.
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http://dx.doi.org/10.1016/j.jcct.2020.12.007DOI Listing
December 2021

Social determinants of health affect unplanned readmissions following acute myocardial infarction.

J Comp Eff Res 2021 01 13;10(1):39-54. Epub 2021 Jan 13.

Department of Anesthesiology, New York-Presbyterian/Weill Cornell Medical Center, 525 East 68th Street, Box 124, NY 10065, USA.

Low socioeconomic status predicts inferior clinical outcomes in many patient populations. The effects of patient insurance status and hospital safety-net status on readmission rates following acute myocardial infarction are unclear. A retrospective review of State Inpatient Databases for New York, California, Florida and Maryland, 2007-2014.  A total of 1,055,162 patients were included. Medicaid status was associated with 37.7 and 44.0% increases in risk-adjusted readmission odds at 30 and 90 days (p < 0.0001). Uninsured status was associated with reduced odds of readmission at both time points. High-burden safety-net status was associated with 9.6 and 9.5% increased odds of readmission at 30 and 90 days (p < 0.0003). Insurance status and hospital safety-net burden affect readmission odds following acute myocardial infarction.
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http://dx.doi.org/10.2217/cer-2020-0135DOI Listing
January 2021

Comparative differences in the atherosclerotic disease burden between the epicardial coronary arteries: quantitative plaque analysis on coronary computed tomography angiography.

Eur Heart J Cardiovasc Imaging 2021 02;22(3):322-330

Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.

Aims: Anatomic series commonly report the extent and severity of coronary artery disease (CAD), regardless of location. The aim of this study was to evaluate differences in atherosclerotic plaque burden and composition across the major epicardial coronary arteries.

Methods And Results: A total of 1271 patients (age 60 ± 9 years; 57% men) with suspected CAD prospectively underwent coronary computed tomography angiography (CCTA). Atherosclerotic plaque volume was quantified with categorization by composition (necrotic core, fibrofatty, fibrous, and calcified) based on Hounsfield Unit density. Per-vessel measures were compared using generalized estimating equation models. On CCTA, total plaque volume was lowest in the LCx (10.0 ± 29.4 mm3), followed by the RCA (32.8 ± 82.7 mm3; P < 0.001), and LAD (58.6 ± 83.3 mm3; P < 0.001), even when correcting for vessel length or volume. The prevalence of ≥2 high-risk plaque features, such as positive remodelling or spotty calcification, occurred less in the LCx (3.8%) when compared with the LAD (21.4%) or RCA (10.9%, P < 0.001). In the LCx, the most stenotic lesion was categorized as largely calcified more often than in the RCA and LAD (55.3% vs. 39.4% vs. 32.7%; P < 0.001). Median diameter stenosis was also lowest in the LCx (16.2%) and highest in the LAD (21.3%; P < 0.001) and located more distal along the LCx when compared with the RCA and LAD (P < 0.001).

Conclusion: Atherosclerotic plaque, irrespective of vessel volume, varied across the epicardial coronary arteries; with a significantly lower burden and different compositions in the LCx when compared with the LAD and RCA. These volumetric and compositional findings support a diverse milieu for atherosclerotic plaque development and may contribute to a varied acute coronary risk between the major epicardial coronary arteries.
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http://dx.doi.org/10.1093/ehjci/jeaa275DOI Listing
February 2021

Trends in Diagnosis and Disparities in Initial Management of High-Risk Prostate Cancer in the US.

JAMA Netw Open 2020 08 3;3(8):e2014674. Epub 2020 Aug 3.

Department of Radiation Oncology, Weill Cornell Medicine, New York, New York.

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http://dx.doi.org/10.1001/jamanetworkopen.2020.14674DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7489870PMC
August 2020

Subtalar Fusion for Correction of Forefoot Abduction in Stage II Adult-Acquired Flatfoot Deformity.

Foot Ankle Spec 2020 Aug 24:1938640020951050. Epub 2020 Aug 24.

Premier Orthopedic Specialists of Tulsa, Tulsa, Oklahoma (JPD).

Background: Correction of talonavicular uncoverage (TNU) in adult-acquired flatfoot deformities (AAFD) can be a challenge. Lateral column lengthening (LCL) traditionally is utilized to address this. The primary study objective is examining stage II AAFD patients and determining if correction can be achieved with subtalar fusion (STF) comparable to LCL.

Methods: Following institutional review board approval, retrospective chart review performed identifying patients meeting criteria for stage IIB AAFD who underwent either STF with concomitant flatfoot procedures (but not LCL) to correct TNU, or who underwent LCL as part of their flatfoot reconstruction. Patients indicated for STF had one or more of the following: higher body mass index (BMI), were older, had greater deformity, lateral impingement pain, intraoperative spring ligament hyperlaxity. Patients without 1-year follow-up or compete records were excluded. All other patients were included. A total of 27 isolated STFs identified, along with 143 who underwent LCL. Pre-/postoperative radiographic parameters obtained as well as PROMIS (Patient-Reported Outcomes Measurement Information System) and FAOS (Foot and Ankle Outcome Score) scores. Radiographic and patient reported outcomes both preoperatively and at 1-year follow-up evaluated for both groups.

Results: STF patients were older ( < .05), with higher BMIs ( < .004). STF had significantly worse TNU ( < .001) than LCL patients, and average change in STF TNU was larger than LCL change postoperatively ( = .006), after adjusting for age, BMI, gender. PROMIS STF improvement reached statistical significance in Physical Function (P 0.011), for FAOS Pain (P 0.025) and Function ( = 0.04).

Conclusions: STF can be used in appropriately indicated patients to correct flatfoot deformity without compromising radiographic or clinical, correcting not only hindfoot valgus, but also talonavicular uncoverage (TNU) and corresponding medial arch collapse.

Levels Of Evidence: Level III: Retrospective chart review comparison study (case control).
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http://dx.doi.org/10.1177/1938640020951050DOI Listing
August 2020

Temporal trends in the number of men electing for conservative management for low-risk prostate cancer in the United States.

Prostate Cancer Prostatic Dis 2020 12 13;23(4):714-717. Epub 2020 Jul 13.

Department of Urology, New York Presbyterian Hospital, Weill Cornell Medicine, New York, New York, USA.

Background: Concurrent with the decrease in the number of men diagnosed with prostate cancer (PCa), the proportion of men with low-risk PCa managed conservatively (active surveillance or watchful waiting) has increased in the United States. We aimed to determine whether this increase is a result of more men being managed conservatively or rather a higher proportion of the diminishing number of low-risk PCa managed this way.

Methods: The SEER "Prostate Watchful Waiting Database" identified men managed initially with conservative management between 2010 and 2016. Men > 40 years old who were diagnosed with low-risk (Gleason score 3 + 3, T1-T2a, PSA level < 10 ng/mL) PCa were included. Age-standardized and age-specific PCa incidence and conservative management rates were calculated per 100,000 man-years. The annual percent change in rates for the entire time period was also calculated.

Results: The incidence of low-risk PCa declined by 11.8% per year (95% confidence interval [CI] -15.4% to -8.0%), whereas the number of men assigned to conservative management for low-risk disease did not increase significantly, rising by +3.7% per year (95% CI -0.7% to 8.4%). In age-specific analysis, the number of men < 60 years and those who were 60-69 years managed conservatively increased by +9.6% per year (95% CI 2.7% to 16.9%) and 4.5% per year (95% CI 0.1% to 9.1%), respectively, whereas the number of men ≥ 70 years electing conservative management remained stable at -4% per year (95% CI -11.2% to 3.7%).

Conclusions: The number of men electing conservative management has remained largely stable between 2010 and 2016, despite an increase in the proportion of low-risk PCa managed in this manner.
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http://dx.doi.org/10.1038/s41391-020-0252-0DOI Listing
December 2020

Active Surveillance for Men with Intermediate Risk Prostate Cancer.

J Urol 2021 Jan 13;205(1):115-121. Epub 2020 Jul 13.

Department of Radiation Oncology, Weill Cornell Medicine, New York, New York.

Purpose: Optimal treatment of intermediate risk prostate cancer remains unclear. National Comprehensive Cancer Network® guidelines recommend active surveillance, prostatectomy or radiotherapy. Recent trials demonstrated no difference in prostate cancer specific mortality for men undergoing active surveillance for low risk prostate cancer compared to prostatectomy or radiotherapy. The use of active surveillance for intermediate risk prostate cancer is less clear. In this study we characterize U.S. national trends for demographic, clinical and socioeconomic factors associated with active surveillance for men with intermediate risk prostate cancer.

Materials And Methods: This retrospective cohort study examined 176,122 men diagnosed with intermediate risk prostate cancer from 2010 to 2016 in the National Cancer Database. Temporal trends in demographic, clinical and socioeconomic factors among men with intermediate risk prostate cancer and association with the use of active surveillance were characterized. The analysis was performed in April 2020.

Results: In total, 176,122 men were identified with intermediate risk prostate cancer from 2010 to 2016. Of these men 57.3% underwent prostatectomy, 36.4% underwent radiotherapy and 3.2% underwent active surveillance. Active surveillance nearly tripled from 1.6% in 2010 to 4.6% in 2016 (p <0.001). On multivariate analysis use of active surveillance was associated with older age, diagnosis in recent years, lower Gleason score and tumor stage, type of insurance, treatment at an academic center and proximity to facility, and attaining higher education (p <0.05). Race and comorbidities were not associated with active surveillance.

Conclusions: Our findings highlight increasing active surveillance use for men with intermediate risk prostate cancer demonstrating clinical and socioeconomic disparities. Prospective data and improved risk stratification are needed to guide optimal treatment for men with intermediate risk prostate cancer.
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http://dx.doi.org/10.1097/JU.0000000000001241DOI Listing
January 2021

Altered Effective Connectivity of Bilateral Hippocampus in Type 2 Diabetes Mellitus.

Front Neurosci 2020 23;14:657. Epub 2020 Jun 23.

Henan Key Laboratory of Neurological Imaging, Department of Medical Imaging, Zhengzhou University People's Hospital & Henan Provincial People's Hospital, Zhengzhou, China.

Patients with type 2 diabetes mellitus (T2DM) experience cognitive deficits but the underlying pathophysiologic mechanisms are not known. We therefore applied Granger causality analysis of resting-state functional magnetic resonance imaging to study the effective connectivity (EC) of the hippocampus in patients with T2DM. Eighty six patients with T2DM and 84 matched healthy controls (HC) were recruited. The directional EC between anatomically defined seeds in left hippocampus (LHIP) and right hippocampus (RHIP) and other brain regions was compared between T2DM and HC and Pearson correlation analysis was performed to determine whether alterations in EC were related to clinical characteristics of diabetes. Compared with HC, patients with T2DM had altered EC between LHIP and RHIP and the default mode network (DMN), occipital cortex and cerebellum. In addition, for LHIP only duration of diabetes positively correlated with decreased inflow from right postcentral gyrus and right parietal lobe, glycosylated hemoglobin (HbA1c) negatively correlated with decreased inflow from right thalamus ( = -0.255, = 0.018) and Montreal Cognitive Assessment (MoCA) negatively correlated with decreased inflow from left inferior parietal lobe ( = -0.206, = 0.05). The altered EC between hippocampus and DMN is interpreted to be related to cognitive deficits in patients with T2DM particularly affecting memory and learning.
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http://dx.doi.org/10.3389/fnins.2020.00657DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7325692PMC
June 2020

Preoperative Opioid Use Disorder Is Associated With Poorer Outcomes After Coronary Bypass and Valve Surgery: A Multistate Analysis, 2007-2014.

J Cardiothorac Vasc Anesth 2020 Dec 10;34(12):3267-3274. Epub 2020 Jun 10.

Department of Anesthesiology, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, NY.

Objective: To determine the effect of preoperative opioid use disorder (OUD) on postoperative outcomes in patients undergoing coronary artery bypass grafting (CABG) and heart valve surgery.

Design: Retrospective, observational study using data from the State Inpatient Database and the Healthcare Cost and Utilization Project.

Setting: Inpatient data from Florida, California, New York, Maryland, and Kentucky between 2007 and 2014.

Participants: A total of 377,771 CABG patients and 194,469 valve surgery patients age ≥18 years.

Interventions: None.

Measurements And Main Results: The prevalence of OUD was 2,136 (0.57%) in the CABG group and 2,020 (1.04%) in the valve surgery group. There was no significant difference in mortality between the OUD and non-OUD groups in both surgical cohorts (both p > 0.05). On adjusted analyses, preoperative OUD was significantly associated with increased adjusted odds ratios (aORs) of 30-day hospital readmission (CABG aOR 1.47 [95% confidence interval {CI} 1.30-1.66]; valve surgery aOR 1.41 [95% CI 1.27-1.56]) and 90-day hospital readmission (CABG aOR 1.47 [95% CI 1.31-1.64]; valve surgery aOR 1.33 [95% CI 1.23-1.43]). Preoperative OUD was significantly associated with increased adjusted risk ratios (aRRs) of hospital length of stay (CABG aRR 1.13 [95% CI 1.10-1.16]; valve surgery aRR 1.63 [95% CI 1.54-1.72]) and total hospitalization charges (CABG aRR 1.05 [95% CI 1.03-1.07]; valve surgery aRR 1.28 [95% CI 1.24-1.32]).

Conclusion: Preoperative OUD is significantly associated with poorer outcomes after cardiac surgery, including increased 30- and 90-day readmissions, hospital length of stay, and total hospitalization charges. Opioid use should be considered a modifiable risk factor in cardiac surgery, and interventions should be attempted preoperatively.
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http://dx.doi.org/10.1053/j.jvca.2020.06.006DOI Listing
December 2020

The impact of hospital safety-net burden on mortality and readmission after CABG surgery.

J Card Surg 2020 Sep 29;35(9):2232-2241. Epub 2020 Jun 29.

Department of Anesthesiology, New York-Presbyterian/Weill Cornell Medical Center, New York, New York.

Background And Aim: Safety-net hospitals (SNHs) serve high proportions of uninsured and Medicaid patients. Data conflict as to the impact of hospital safety-net status on perioperative complications. Our goal was to assess the effect of hospital safety-net burden on mortality and readmission following coronary artery bypass graft (CABG) surgery.

Methods: A retrospective analysis was performed using five State Inpatient Databases (2007-2014) for isolated CABG surgery. High, medium, and low burden hospitals were those with the highest, middle, and lowest tertiles of uninsured and Medicaid admissions, respectively. We compared patient demographics and hospital characteristics by safety-net status. Multivariable logistic regression models assessed adjusted odds of in-hospital mortality and 30- and 90-day readmission.

Results: About 304 080 patients were included in our analysis. On univariate analysis, high burden hospitals had higher inpatient mortality (2.06% vs 1.71%; P < .001) and 30 day- (16.3% vs 15.3%; P < .001) and 90-day readmission rates (24.6% vs 23.0%; P < .001). On multivariate analysis, high-burden status was not associated with significantly increased adjusted odds of inpatient mortality (OR, 1.047; 95% CI, 0.878-1.249), or readmission at 30 (OR, 1.035; 95% CI, 0.958-1.118) or 90 days (OR, 1.040; 95% CI, 0.968-1.117).

Conclusion: SNHs do not have worse mortality and readmission outcomes following CABG, after adjusting for patient and hospital characteristics. These findings are reassuring regarding the quality of cardiac surgery care provided to underinsured patient groups. More research is needed to further elucidate trends in outcomes.
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http://dx.doi.org/10.1111/jocs.14738DOI Listing
September 2020

Sex Differences in Outcomes After Coronary Artery Bypass Grafting.

J Cardiothorac Vasc Anesth 2020 Dec 14;34(12):3259-3266. Epub 2020 May 14.

Department of Anesthesiology, Weill Cornell Medicine, New York, NY. Electronic address:

Objective: To examine sex differences in inpatient mortality and 30-day and 90-day readmissions after coronary artery bypass grafting (CABG) among a multistate population.

Design: A retrospective analysis of patient hospitalization and discharge records.

Setting: All-payer patients in nonpsychiatric hospitals in New York, Maryland, Florida, Kentucky, and California.

Participants: A total of 304,080 patients from the State Inpatient Databases Healthcare Cost and Utilization Project, Agency for Healthcare Research and Quality from January 2007 to December 2014 who underwent CABG surgery.

Interventions: Bivariate analysis and multivariate logistic regression were performed to obtain unadjusted rates and adjusted odds ratios, respectively, for in-hospital mortality and readmissions by sex.

Measurements And Main Results: Of the patients who underwent CABG, 5,699 patients (1.87%) died, including 2,131 women (2.65%) and 3,568 men (1.60%). The authors found that women were 32% more likely to die compared with men (adjusted odds ratio [aOR]: 1.32, 95% confidence interval [CI]: 1.25-1.40) after adjusting for age, race, insurance status, median income, Elixhauser comorbidity index measures, year of procedure, state, and hospital surgical volume. Women, compared with men, also had significantly increased adjusted odds of 30-day and 90-day readmissions (30-day aOR: 1.24, 95% CI: 1.21-1.28; 90-day aOR: 1.25, 95% CI: 1.22-1.28).

Conclusion: This study demonstrated that female patients who undergo CABG are at a greater risk of in-hospital death and 30-day and 90-day readmission compared with men. This sex-based disparity in outcomes has persisted since identification some 40 years ago.
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http://dx.doi.org/10.1053/j.jvca.2020.04.030DOI Listing
December 2020

Application of the amide proton transfer-weighted imaging and diffusion kurtosis imaging in the study of cervical cancer.

Eur Radiol 2020 Oct 18;30(10):5758-5767. Epub 2020 May 18.

Department of Radiology, Zhengzhou University People's Hospital & Henan Provincial People's Hospital, Zhengzhou, Henan, China.

Objectives: To analyze the value of amide proton transfer-weighted imaging (APTWI) and diffusion kurtosis imaging (DKI) in differentiating cervical cancer (CC) pathological type, grade, and stage.

Methods: One hundred and twelve women underwent pelvic APTWI and DKI. The magnetization transfer ratio asymmetry (MTRasym, 3.5 ppm), apparent kurtosis coefficient (K), and non-Gaussian diffusion coefficient (D) were calculated by histological subtype, grade, and stage. The differences, efficacy, and correlation between parameters were determined.

Results: The MTRasym(3.5 ppm) and D values of the adenocarcinoma (CA) group were higher than those of the cervical squamous carcinoma (CSC) group, while the K values were lower than those of the CSC group. The MTRasym(3.5 ppm) and K values of the high-grade group were higher than those of the low-grade group, while the D values were lower than those of the low-grade group. The D values of the advanced-stage group were lower than those of the early-stage group, while the K values were greater than those of the early-stage group. The K showed the highest efficacy in differentiating CSC and CA, high- and low-grade CC, and advanced- and early-stage CC. In the CSC and CA groups, both the K and D were highly correlated with pathological grade, and the MTRasym(3.5 ppm) was weakly correlated with pathological grade. The K, D, and MTRasym(3.5 ppm) were all weakly correlated with pathological stage.

Conclusion: Both DKI and APTWI can be used in preliminary evaluations of CC, but DKI has advantages in the identification of pathological type, grade, and stage.

Key Points: • PTWI and DKI provide new information regarding cervical cancer. • MTRasym(3.5 ppm), D, and K are valid parameters to characterize tissue microstructure. • DKI is superior to APTWI in the study of cervical cancer.
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http://dx.doi.org/10.1007/s00330-020-06884-9DOI Listing
October 2020

Insurance Status and Socioeconomic Factors Affect Early Mortality After Cardiac Valve Surgery.

J Cardiothorac Vasc Anesth 2020 Dec 19;34(12):3234-3242. Epub 2020 Apr 19.

Department of Anesthesiology, New York-Presbyterian/Weill Cornell Medical Center, New York, NY.

Objective: To characterize the effects markers of socioeconomic status (SES), including race and ethnicity, health insurance status, and median household income by zip code on in-patient mortality after cardiac valve surgery.

Design: Retrospective cohort study of adult valve surgery patients included in the State Inpatient Databases and Healthcare Cost and Utilization Project. The primary outcome was mortality during the index admission. Bivariate analyses and multivariate regression models were used to assess the independent effects of race and ethnicity, payer status, and median income by patient zip code on in-hospital mortality.

Design: Multistate database of hospitalizations from 2007 to 2014 from New York, Florida, Kentucky, California, and Maryland.

Participants: In total, 181,305 patients ≥18 years old underwent mitral or aortic valve repair or replacement and met the inclusion criteria.

Interventions: None.

Measurements And Main Results: Mortality rates were higher among black (5.59%) than white patients (4.28%, p < 0.001) and among Medicaid (4.66%), Medicare (5.22%), and uninsured (4.58%) patients compared with private insurance (2.45%, p < 0.001). After controlling for age, sex, presenting comorbidities, urgent or emergent operative status, and hospital case volume, mortality odds remained significantly elevated for black (odds ratio [OR] 1.127, confidence interval [CI] 1.038-1.223), uninsured (OR 1.213, CI 1.020-1.444), Medicaid (OR 1.270, 95% CI 1.116-1.449) and Medicare (OR 1.316, 95% CI 1.216-1.415) patients.

Conclusions: Markers of low SES, including race/ethnicity, insurance status, and household income, are associated with increased risk of in-hospital mortality following cardiac valve surgery. Further research is warranted to understand and help decrease mortality risk in underinsured, less-wealthy and non-white patients undergoing cardiac valve surgery.
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http://dx.doi.org/10.1053/j.jvca.2020.03.044DOI Listing
December 2020
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