Now showing items 21-40 of 8963

    • Cardiac Sarcoidosis Diagnostic Challenges and Management: A Case Report and Literature Review

      Temple University. Hospital (2022-05-09)
      Sarcoidosis can be presented as cardiac sarcoidosis (CS), which is challenging to diagnose due to its clinical silence. Ventricular arrhythmias and atrioventricular blocks can be fatal and cause sudden death in patients with cardiac sarcoidosis. Five percent of sarcoidosis patients have clinically evident cardiac sarcoidosis. However, autopsy reports and imaging studies have shown a higher prevalence of cardiac involvement. Early recognition is important to prevent such detrimental consequences. Cardiac sarcoidosis is increasingly being diagnosed owing to increased awareness among physicians and new diagnostic tools like MRI and positron emission tomography (PET) scan replacing traditional endomyocardial biopsy. A definitive diagnosis of CS remains challenging due to the non-specific clinical findings that can present similar symptoms of common cardiac disease; therefore, the imaging and biopsies are substantial for diagnosis confirmation. Pharmacological and Implantable devices are two main therapeutic approaches in cardiac sarcoidosis, in which steroids and pacemaker therapy have shown better outcomes. This review summarizes the available data related to the prevalence, prognosis, diagnosis, and management of cardiac sarcoidosis.
    • Ukrainians in Flight: Politics, Race, and Regional Solutions

      Ramji-Nogales, Jaya; Ramji-Nogales|0009-0004-6107-6030 (2022-05-23)
      The situation of Ukrainians fleeing the Russian invasion exemplifies, as the organizers of this symposium note, both a shock to the international order and a powerful international response. Europeans, and Global North states more broadly, have welcomed Ukrainians with a generosity that sits in stark contrast to their treatment of the vast majority of contemporary refugees. This exceptional response demonstrates a key gap in the legal architecture, namely the absence of an international agreement on shared responsibility for hosting refugees. It also highlights a substantive shortcoming in international refugee law: its failure to protect most people fleeing armed conflict. In contrast, regional law from Africa and Latin America has for some time extended refugee protection to individuals escaping generalized violence. Beyond the substantive law, in many cases, regional protection is a preferable option for individuals fleeing violent conflict. In addition to these structural and substantive concerns, the exceptionally rapid and generous response to the Ukrainians demonstrates the deep politicization of international refugee policy and highlights the invidious role of race in the international legal order.
    • Over-Expression of Long Non-Coding RNA-AC099850.3 Correlates With Tumor Progression and Poor Prognosis in Lung Adenocarcinoma

      Sbarro Health Organization (SBHO) (Temple University) (2022-05-11)
      Lung adenocarcinoma (LUAD) is the most common histological lung cancer, and it is the leading cause of cancer-related deaths worldwide. Long noncoding RNAs (lncRNAs) have been implicated in the initiation and progression of various cancers. LncRNA-AC099850.3 is a novel lncRNA that is abnormally expressed in diverse cancer types including LUAD. However, the clinical significance, prognostic value, diagnostic value, immune role, and potential biological function of AC099850.3 LUAD remain elusive. In this study, we found that AC099850.3 was highly expressed in LUAD and associated with an advanced tumor stage, poor prognosis, and immune infiltration. Receiver operating curve analysis revealed the significant diagnostic ability of AC099850.3 (AUC=0.888). Functionally, the knockdown of AC099850.3 restrained LUAD cell proliferation and migration in vitro. Finally, we constructed a competitive endogenous RNAs (ceRNA) network that included hsa-miR-101-3p and 4 mRNAs (ESPL1, AURKB, BUB3, and FAM83D) specific to AC099850.3 in LUAD. Kaplan–Meier survival analysis showed that a lower expression of miR-101-3p and a higher expression of ESPL1, AURKB, BUB3, and FAM83D, were associated with adverse clinical outcomes in patients with LUAD. This finding provided a comprehensive view of the AC099850.3-mediated ceRNA network in LUAD, thereby highlighting its potential role in the diagnosis and prognosis of LUAD.
    • Retrospective Study of the Reasons and Time Involved for Dental Providers' Medical Consults

      Li, Shuning; Williams, Karmen S.; Medam, Jayanth Kumar; Patel, Jay; Gonzalez, Theresa; Thyvalikakath, Thankam P.; Patel|0000-0003-0559-5958 (2022-05-12)
      Background: Patient-reported medical histories and medical consults are primary approaches to obtaining patients' medical histories in dental settings. While patient-reported medical histories are reported to have inconsistencies, sparse information exists regarding the completeness of medical providers' responses to dental providers' medical consults. This study examined records from a predoctoral dental student clinic to determine the reasons for medical consults; the medical information requested, the completeness of returned responses, and the time taken to receive answers for medical consult requests. Methods: A random sample of 240 medical consult requests for 179 distinct patients were selected from patient encounters between 1 January 2015 and 31 December 2017. Descriptive statistics and summaries were calculated to determine the reasons for the consult, the type of information requested and returned, and the time interval for each consult. Results: The top two reasons for medical consults were to obtain more information (46.1%) and seek medical approval to proceed with treatment (30.3%). Laboratory and diagnostic reports (56.3%), recommendations/medical clearances (39.6%), medication information (38.3%), and current medical conditions (19.2%) were the frequent requests. However, medical providers responded fewer times to dental providers' laboratory and diagnostic report requests (41.3%), recommendations/medical clearances (19.2%), and current medical conditions (13.3%). While 86% of consults were returned in 30 days and 14% were completed after 30 days. Conclusions: The primary reasons for dental providers' medical consults are to obtain patient information and seek recommendations for dental care. Laboratory/diagnostic reports, current medical conditions, medication history, or modifications constituted the frequently requested information. Precautions for dental procedures, antibiotic prophylaxis, and contraindications included reasons to seek medical providers' recommendations. The results also highlight the challenges they experience, such as requiring multiple attempts to contact medical providers, the incompleteness of information shared, and the delays experienced in completing at least 25% of the consults. Practical Implications: The study results call attention to the importance of interdisciplinary care to provide optimum dental care and the necessity to establish systems such as integrated electronic dental record-electronic health record systems and health information exchanges to improve information sharing and communication between dental and medical providers.
    • Epistasis Creates Invariant Sites and Modulates the Rate of Molecular Evolution

      Institute for Genomics and Evolutionary Medicine (iGEM) (Temple University) (2022-05-16)
      Invariant sites are a common feature of amino acid sequence evolution. The presence of invariant sites is frequently attributed to the need to preserve function through site-specific conservation of amino acid residues. Amino acid substitution models without a provision for invariant sites often fit the data significantly worse than those that allow for an excess of invariant sites beyond those predicted by models that only incorporate rate variation among sites (e.g., a Gamma distribution). An alternative is epistasis between sites to preserve residue interactions that can create invariant sites. Through computer-simulated sequence evolution, we evaluated the relative effects of site-specific preferences and site-site couplings in the generation of invariant sites and the modulation of the rate of molecular evolution. In an analysis of ten major families of protein domains with diverse sequence and functional properties, we find that the negative selection imposed by epistasis creates many more invariant sites than site-specific residue preferences alone. Further, epistasis plays an increasingly larger role in creating invariant sites over longer evolutionary periods. Epistasis also dictates rates of domain evolution over time by exerting significant additional purifying selection to preserve site couplings. These patterns illuminate the mechanistic role of epistasis in the processes underlying observed site invariance and evolutionary rates.
    • Segmentation of Dental Restorations on Panoramic Radiographs Using Deep Learning

      Rohrer, Csaba; Krois, Joachim; Patel, Jay; Meyer-Lueckel, Hendrik; Rodrigues, Jonas Almeida; Schwendicke, Falk; Patel|0000-0003-0559-5958 (2022-05-25)
      Convolutional Neural Networks (CNNs) such as U-Net have been widely used for medical image segmentation. Dental restorations are prominent features of dental radiographs. Applying U-Net on the panoramic image is challenging, as the shape, size and frequency of different restoration types vary. We hypothesized that models trained on smaller, equally spaced rectangular image crops (tiles) of the panoramic would outperform models trained on the full image. A total of 1781 panoramic radiographs were annotated pixelwise for fillings, crowns, and root canal fillings by dental experts. We used different numbers of tiles for our experiments. Five-times-repeated three-fold cross-validation was used for model evaluation. Training with more tiles improved model performance and accelerated convergence. The F1-score for the full panoramic image was 0.7, compared to 0.83, 0.92 and 0.95 for 6, 10 and 20 tiles, respectively. For root canals fillings, which are small, cone-shaped features that appear less frequently on the radiographs, the performance improvement was even higher (+294%). Training on tiles and pooling the results thereafter improved pixelwise classification performance and reduced the time to model convergence for segmenting dental restorations. Segmentation of panoramic radiographs is biased towards more frequent and extended classes. Tiling may help to overcome this bias and increase accuracy.
    • The unvirtuous cycle of discrimination affecting people with hepatitis B: a multi-country qualitative assessment of key-informant perspectives

      Freeland, Catherine; Mendola, Lindsay; Cheng, Vivian; Cohen, Chari; Wallace, Jack (2022-05-31)
      Background: An estimated 296 million individuals live with chronic hepatitis B worldwide, most have not been diagnosed and remain at risk of liver disease and cancer. People with hepatitis B often face discrimination that denies them employment or education opportunities, results in unfair treatment at work or in school, limits their ability to emigrate to certain countries, and in some cases prohibits them from serving in the military. Discrimination specific to hepatitis B has not been widely documented within the literature. This study aims to investigate and describe hepatitis B related discrimination, document discrimination occurring around the globe, and provide initial recommendations for addressing discrimination using key informant interviews. Methods: Purposive and snowball sampling were used to identify potential key informants for qualitative interview. Key informants identified as community health leaders, public health scientists, doctors, and researchers, many of whom were also living with hepatitis B. Using a semi-structured guide, participants were asked to describe their experience and any challenges for people living with hepatitis B including marginalization and its’ consequences. A codebook was used to guide the organization of data for analysis, and all transcripts N = 17 were double coded. Results: The overarching themes identified from interviews demonstrate explicit experiences with discrimination of those directly affected, the psychological responses, and the negative health outcomes associated with the unvirtuous cycle of discrimination. All key informants reported on the substantial quality of life implications and often poorer health outcomes resulting from hepatitis B discrimination. Participants also identified the significant impact of hepatitis B discrimination occurring within a range of education-based services across several countries as well as military exclusion or removal if individuals are found to have hepatitis B. Conclusion: Our data demonstrate that hepatitis B discrimination has a significant impact. Discrimination can occur at various points in life from education, to seeking employment, to marriage, to restrictions on entry, travel and stay in other countries. This study demonstrates the impact of discrimination and the need for future research that can lead to policy change and protections for people living with and impacted by hepatitis B.
    • Identification of spatio-temporal clusters of lung cancer cases in Pennsylvania, USA: 2010–2017

      Camiña, Nuria; McWilliams, Tara L.; McKeon, Thomas P.; Penning, Trevor M.; Hwang, Wei-Ting; McKeon|0000-0002-2999-9175 (2022-05-17)
      Background: It is known that geographic location plays a role in developing lung cancer. The objectives of this study were to examine spatio-temporal patterns of lung cancer incidence in Pennsylvania, to identify geographic clusters of high incidence, and to compare demographic characteristics and general physical and mental health characteristics in those areas. Method: We geocoded the residential addresses at the time of diagnosis for lung cancer cases in the Pennsylvania Cancer Registry diagnosed between 2010 and 2017. Relative risks over the expected case counts at the census tract level were estimated using a log-linear Poisson model that allowed for spatial and temporal effects. Spatio-temporal clusters with high incidence were identified using scan statistics. Demographics obtained from the 2011–2015 American Community Survey and health variables obtained from 2020 CDC PLACES database were compared between census tracts that were part of clusters versus those that were not. Results: Overall, the age-adjusted incidence rates and the relative risk of lung cancer decreased from 2010 to 2017 with no statistically significant space and time interaction. The analyses detected 5 statistically significant clusters over the 8-year study period. Cluster 1, the most likely cluster, was in southeastern PA including Delaware, Montgomery, and Philadelphia Counties from 2010 to 2013 (log likelihood ratio = 136.6); Cluster 2, the cluster with the largest area was in southwestern PA in the same period including Allegheny, Fayette, Greene, Washington, and Westmoreland Counties (log likelihood ratio = 78.6). Cluster 3 was in Mifflin County from 2014 to 2016 (log likelihood ratio = 25.3), Cluster 4 was in Luzerne County from 2013 to 2016 (log likelihood ratio = 18.1), and Cluster 5 was in Dauphin, Cumberland, and York Counties limited to 2010 to 2012 (log likelihood ratio = 17.9). Census tracts that were part of the high incidence clusters tended to be densely populated, had higher percentages of African American and residents that live below poverty line, and had poorer mental health and physical health when compared to the non-clusters (all p < 0.001). Conclusions: These high incidence areas for lung cancer warrant further monitoring for other individual and environmental risk factors and screening efforts so lung cancer cases can be identified early and more efficiently.
    • A Perspective on Implementation Outcomes and Strategies to Promote the Uptake of COVID-19 Vaccines

      Pilar, Meagan; Elwy, A. Rani; Lushiniak, Larissa; Huang, Grace; McLoughlin, Gabriella; Hooley, Cole; Nadesan-Reddy, Nisha; Sandler, Brittney; Moshabela, Mosa; Alonge, Olakunle; Geng, Elvin; Proctor, Enola; McLoughlin|0000-0002-7731-2382 (2022-05-20)
      Recent articles have highlighted the importance of incorporating implementation science concepts into pandemic-related research. However, limited research has been documented to date regarding implementation outcomes that may be unique to COVID-19 vaccinations and how to utilize implementation strategies to address vaccine program-related implementation challenges. To address these gaps, we formed a global COVID-19 implementation workgroup of implementation scientists who met weekly for over a year to review the available literature and learn about ongoing research during the pandemic. We developed a hierarchy to prioritize the applicability of “lessons learned” from the vaccination-related implementation literature. We identified applications of existing implementation outcomes as well as identified additional implementation outcomes. We also mapped implementation strategies to those outcomes. Our efforts provide rationale for the utility of using implementation outcomes in pandemic-related research. Furthermore, we identified three additional implementation outcomes: availability, health equity, and scale-up. Results include a list of COVID-19 relevant implementation strategies mapped to the implementation outcomes.
    • Sequence and structural conservation reveal fingerprint residues in TRP channels

      Institute for Genomics and Evolutionary Medicine (iGEM) (Temple University) (2022-06-29)
      Transient receptor potential (TRP) proteins are a large family of cation-selective channels, surpassed in variety only by voltage-gated potassium channels. Detailed molecular mechanisms governing how membrane voltage, ligand binding, or temperature can induce conformational changes promoting the open state in TRP channels are still a matter of debate. Aiming to unveil distinctive structural features common to the transmembrane domains within the TRP family, we performed phylogenetic reconstruction, sequence statistics, and structural analysis over a large set of TRP channel genes. Here, we report an exceptionally conserved set of residues. This fingerprint is composed of twelve residues localized at equivalent three-dimensional positions in TRP channels from the different subtypes. Moreover, these amino acids are arranged in three groups, connected by a set of aromatics located at the core of the transmembrane structure. We hypothesize that differences in the connectivity between these different groups of residues harbor the apparent differences in coupling strategies used by TRP subgroups.
    • The Use of Photovoice Methodology to Assess Health Needs and Identify Opportunities Among Migrant Transgender Women in the U.S.-Mexico Border

      Chavez-Baray, Silvia M.; Martinez, Omar; Chaparro, Perla; Moya, Eva M. (2022-05-19)
      Psychosocial, social and structural conditions have rarely been studied among transgender women in the U.S.-Mexico Border. This study used Photovoice methodology to empower migrant transgender women of color (TWC) to reflect on realities from their own perspectives and experiences and promote critical dialogue, knowledge, and community action. Sixteen participants documented their daily experiences through photography, engaged in photo-discussions to assess needs and identify opportunities, and developed a community-informed Call to Action. Four major themes emerged from the participants' photographs, discussions, and engagement: (1) mental health, (2) migration experiences and challenges, (3) stigma, discrimination, and resiliency, and (4) impact of the COVID-19 pandemic. Through active community engagement, a Call to Action was developed. A binational advisory committee of decision makers and scholars reviewed a set of recommendations to better respond to the needs of TWC in the U.S.-Mexico Border. Photovoice served as an empowerment tool for TWC to assess the myriad of syndemic conditions, including mental health, stigma, discrimination and COVID-19, affecting them daily and identify initiatives for change.
    • Voltage Unbalance Compensation in Distribution Feeders Using Soft Open Points

      You, Rui; Lu, Xiaonan; Lu|0000-0002-0920-1939 (2022-05-26)
      Soft open points (SOPs) are power electronic devices that may replace conventional normally-open points in distribution networks. They can be used for active power flow control, reactive power compensation, fault isolation, and service restoration through network reconfiguration with enhanced operation flexibility and grid resiliency. Due to unbalanced loading conditions, the voltage unbalance issue, as a common problem in distribution networks, has negative impacts on distribution network operation. In this paper, a control strategy of voltage unbalance compensation for feeders using SOPs is proposed. With the power flow control, three-phase current is regulated simultaneously to mitigate the unbalanced voltage between neighboring feeders where SOPs are installed. Feeder voltage unbalance and current unbalance among three phases are compensated with the injection of negative-sequence and zero-sequence current from SOPs. Especially in response to power outages, three-phase voltage of isolated loads is regulated to be balanced by the control of SOPs connected to the feeders under faults, even if the loads are unbalanced. A MATLAB/Simulink model of the IEEE 13-bus test feeder with an SOP across feeder ends is implemented, and experimental tests on a hardware-in-the-loop platform are implemented to validate the effectiveness of the proposed control strategy.
    • Editorial: Strategies to Improve Cardiac Function: Novel Ideas and Future Concepts

      Center for Translational Medicine (Temple University) (2022-05-17)
    • Optimum Design of Reinforced Concrete Folded Plate Structures to ACI 318-11 Using Soft Computing Algorithm

      Yousif, Sayed; Saka, Mehmet Polat; Kim, Sanghun; Geem, Zong Woo; Kim|0000-0002-1423-6116 (2022-05-12)
      In this paper, an optimum design algorithm is presented for reinforced concrete folded plate structures. The design provisions are implemented by ACI 318-11 and ACI 318.2-14, which are quite complex to apply. The design variables are divided into three classes. The first class refers to the variables involving the plates, which are the number of supports, thicknesses of the plates, configurations of longitudinal and transverse reinforcement, span length of each plate, and angle of inclination of the inclined plates. The second class consists of the variables involving the auxiliary members’ (beams and diaphragms) depth and breadth and the configurations of longitudinal and shear reinforcement. The third class of variables can be the supporting columns, which involve the dimensions of the column along each axis and the configurations of longitudinal and shear reinforcement. The objective function is considered as the total cost of the folded plate structure, which consists of the cost of concrete, reinforcement, and formwork that is required to construct the building. With such formulation, the design problem becomes a discrete nonlinear programming problem. Its solution is obtained by using three different soft computing techniques, which are artificial bee colony, differential evolution, and enhanced beetle antennae search. The enhancement suggested makes use of the population of beetles instead of one, as is the case in the standard algorithm. With this novel improvement, the beetle antennae search algorithm became very efficient. Two folded plate structures are designed by the proposed optimum design algorithm. It is observed that the differential evolution algorithm performed better than the other two metaheuristics and achieved the cheapest solution.
    • A permeability- and perfusion-based PBPK model for improved prediction of concentration-time profiles

      Korzekwa, Ken; Radice, Casey; Nagar, Swati; Korzekwa|0000-0002-7119-9200; Nagar|0000-0003-2667-7063 (2022-05-31)
      To improve predictions of concentration-time (C-t) profiles of drugs, a new physiologically based pharmacokinetic modeling framework (termed ‘PermQ’) has been developed. This model includes permeability into and out of capillaries, cell membranes, and intracellular lipids. New modeling components include (i) lumping of tissues into compartments based on both blood flow and capillary permeability, and (ii) parameterizing clearances in and out of membranes with apparent permeability and membrane partitioning values. Novel observations include the need for a shallow distribution compartment particularly for bases. C-t profiles were modeled for 24 drugs (7 acidic, 5 neutral, and 12 basic) using the same experimental inputs for three different models: Rodgers and Rowland (RR), a perfusion-limited membrane-based model (Kp,mem), and PermQ. Kp,mem and PermQ can be directly compared since both models have identical tissue partition coefficient parameters. For the 24 molecules used for model development, errors in Vss and t1/2 were reduced by 37% and 43%, respectively, with the PermQ model. Errors in C-t profiles were reduced (increased EOC) by 43%. The improvement was generally greater for bases than for acids and neutrals. Predictions were improved for all 3 models with the use of parameters optimized for the PermQ model. For five drugs in a test set, similar results were observed. These results suggest that prediction of C-t profiles can be improved by including capillary and cellular permeability components for all tissues.
    • Editorial: Advances in CNS Repair, Regeneration, and Neuroplasticity: From Basic Mechanisms to Therapeutic Strategies

      Shriners Hospitals Pediatric Research Center (Temple University) (2022-05-27)
      Loss of neural cells and neuronal networks in the CNS frequently results in permanent functional deficits with minimal recovery. Current treatments for patients suffering from neurological functional deficits are largely limited. Recent studies have provided insight into secondary injury mechanisms and signaling pathways for controlling CNS repair and regeneration. Researchers have identified new molecular and cellular targets and effective therapeutic strategies for promoting cell survival, CNS regeneration, neural circuit reconnections, remyelination, and neuroplasticity in adult CNS. This Research Topic focuses on recent preclinical research advances in CNS repair, regeneration, and neuroplasticity. We published 29 articles on this Research Topic, including 17 reviews and 12 original research articles. These studies targeted multiple molecular and cellular components using several model systems, including traumatic brain injury (TBI), spinal cord injury (SCI), optic nerve crush (ONC), neurodegeneration, and in vitro cell cultures. Many articles focused on enhancing viability of neural cells and regeneration, reconnection, and plasticity of injured CNS neurons by targeting diverse CNS pathophysiology, including inflammatory cascades and regeneration failure of axotomized CNS axons.
    • Warfarin sensitivity is associated with increased hospital mortality in critically Ill patients

      Ma, Zhiyuan; Wang, Ping; Mahesh, Milan; Elmi, Cyrus P.; Atashpanjeh, Saeid; Khalighi, Bahar; Cheng, Gang; Krishnamurthy, Mahesh; Khalighi, Koroush (2022-05-05)
      Background: Warfarin is a widely used anticoagulant with a narrow therapeutic index and large interpatient variability in the therapeutic dose. Warfarin sensitivity has been reported to be associated with increased incidence of international normalized ratio (INR) > 5. However, whether warfarin sensitivity is a risk factor for adverse outcomes in critically ill patients remains unknown. In the present study, we aimed to evaluate the utility of different machine learning algorithms for the prediction of warfarin sensitivity and to determine the impact of warfarin sensitivity on outcomes in critically ill patients. Methods: Nine different machine learning algorithms for the prediction of warfarin sensitivity were tested in the International Warfarin Pharmacogenetic Consortium cohort and Easton cohort. Furthermore, a total of 7,647 critically ill patients was analyzed for warfarin sensitivity on in-hospital mortality by multivariable regression. Covariates that potentially confound the association were further adjusted using propensity score matching or inverse probability of treatment weighting. Results: We found that logistic regression (AUC = 0.879, 95% CI: 0.834–0.924) was indistinguishable from support vector machine with a linear kernel, neural network, AdaBoost and light gradient boosting trees, and significantly outperformed all the other machine learning algorithms. Furthermore, we found that warfarin sensitivity predicted by the logistic regression model was significantly associated with worse in-hospital mortality in critically ill patients with an odds ratio (OR) of 1.33 (95% CI, 1.01–1.77). Conclusions: Our data suggest that the logistic regression model is the best model for the prediction of warfarin sensitivity clinically and that warfarin sensitivity is likely to be a risk factor for adverse outcomes in critically ill patients.
    • A Case Report of Iatrogenic Bronchial Rupture following Endobronchial Blocker Placement

      Temple University. Hospital (2022-05-23)
      Physiologists Eduard Pfluger and Claude Bernard first introduced one lung ventilation (OLV) in 1871. Today, it is now a frequently used technique in open or minimally invasive cardiothoracic surgeries. One key benefit of the use of OLV is improved surgical exposure. Historically, lung isolation catheters used under fluoroscopic guidance or a Fogarty catheter were used to achieve OLV. In present times, endobronchial blockers (EBBs) in conjunction with single lumen endotracheal tubes and double lumen endotracheal tubes (DLTs) are used to achieve intraoperative OLV. Some complications of EBBs include mucosal injury, bleeding, bronchial rupture, pneumothorax, malpositioning-induced respiratory arrest, severe hypoxemia, and dislodgement. The incidence of iatrogenic tracheal rupture with single lumen endotracheal intubation is reported to be approximately 0.005%, and with double lumen ETT, the incidence may be between 0.05 and 0.19%. Mortality associated with tracheal rupture with DLTs is approximately 8.8%. Data on airway injury with endobronchial blockers is limited, and reported cases of bronchial perforations with use of EBBs are rare suggesting that EBBs may be the safer option for OLV. In this case report, we will be discussing a case of iatrogenic endobronchial rupture following endobronchial blocker placement.
    • Impact of Racial Disparities in Preoperative Cardiovascular Evaluation and Surgical Outcomes in Patients Undergoing Metabolic and Bariatric Surgery: A Retrospective Cohort Analysis

      Temple University. Hospital (2022-05-27)
      Background: We investigated preoperative referral patterns, rates of cardiovascular testing, surgical wait times, and postoperative outcomes in White versus Black, Hispanic, or other racial or ethnic groups of patients undergoing metabolic and bariatric surgery. Methods and Results: This was a single center retrospective cohort analysis of 797 consecutive patients undergoing metabolic and bariatric surgery from January 2014 to December 2018; 86% (n=682) were Black, Hispanic, or other racial or ethnic groups. White versus Black, Hispanic, or other racial or ethnic groups had similar baseline comorbidities and were referred for preoperative cardiovascular evaluation in similar proportion (65% versus 68%, P=0.529). Black, Hispanic, or other racial or ethnic groups of patients were less likely to undergo preoperative cardiovascular testing (unadjusted odds ratio [OR], 0.56; 95% CI, 0.33–0.95; P=0.031; adjusted for Revised Cardiac Risk Index OR, 0.59; 95% CI, 0.35–0.996; P=0.049). White patients had a shorter wait time for surgery (unadjusted hazard ratio [HR], 0.7; 95% CI, 0.58–0.87; P=0.001; adjusted HR, 0.7; 95% CI, 0.56–0.95; P=0.018). Reduction in body mass index at 6 months was greater in White patients (12.9 kg/m2 versus 12.0 kg/m2, P=0.0289), but equivalent at 1 year (14.9 kg/m2 versus 14.3 kg/m2, P=0.330). Conclusions: White versus Black, Hispanic, or other racial or ethnic groups of patients were referred for preoperative cardiovascular evaluation in similar proportion. White patients underwent more preoperative cardiac testing yet had a shorter wait time for surgery. Early weight loss was greater in White patients, but equivalent between groups at 12 months.