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Sun J.,Cardiothoracic Surgery
Molecular Medicine Reports | Year: 2013

Single nucleotide polymorphisms (SNPs) of Xeroderma pigmentosum group D (XPD) are associated with various types of cancer. However, previous studies of correlations between SNPs in this gene and esophageal squamous cell carcinoma (ESCC) have generated conflicting results. In the present study, we investigated the potential relationship between SNPs in two key regions of XPD, codons 312 and 751 and ESCC in a Chinese population. Polymerase chain reaction-restriction fragment length polymorphism was used to analyze genotypes at codons 312 and 751 of XPD in 400 ESCC patients (case group) and 400 healthy individuals (control group). Logistic regression was used to analyze the relationship between genotypes and ESCC. No statistically significant difference was observed for the genotype or allele frequencies of codon 312 between case and control groups (P>0.05). However, a statistically significant difference was observed in the genotype and allele frequencies of codon 751 between the case and control groups (P<0.05). Specifically, compared with the AA genotype at codon 751, a significant increase in risk of ESCC was detected for individuals with the CC genotype (OR=1.600; 95% CI, 1.137-2.253; P=0.007). Therefore, XPD polymorphism at codon 312 is not correlated with ESCC, while polymorphism at codon 751 is associated with ESCC and the CC genotype may confer increased susceptibility to the disease. Copyright © 2013 Spandidos Publications Ltd.

Weinstein S.,Montefiore Medical Center | Bello R.,Montefiore Medical Center | Pizarro C.,DuPont Company | Fynn-Thompson F.,Cardiac Surgery | And 7 more authors.
Journal of Thoracic and Cardiovascular Surgery | Year: 2014

Introduction The frequency and successful use of pediatric ventricular assist devices (VADs) as a bridge to cardiac transplantation have been steadily increasing since 2003, but the experience in patients with complex congenital heart disease has not been well described. Using a large prospectively collected dataset of children supported with the Berlin Heart EXCOR VAD, we have reviewed the experience in children with single ventricular anatomy or physiology (SV), and compared the results with those supported with biventricular circulation (BV) over the same time period. Methods The EXCOR Investigational Device Exemption study database was retrospectively reviewed. VAD implants under the primary cohort and compassionate use cohort between May 2007 and December 2011 were included in this review. Results Twenty-six of 281 patients supported with a VAD were SV. The most common diagnosis was hypoplastic left heart syndrome (15 of 26). Nine patients were supported after neonatal palliative surgery (Blalock-Taussig shunt or Sano), 12 after a superior cavopulmonary connection (SCPC), and 5 after total cavopulmonary connection (TCPC). Two patients received biventricular assist devices, 1 after stage I surgery and 1 after stage II. SV patients were supported for a median time of 10.5 days (range, 1-363 days) versus 39 days (range, 0-435 days) for BV (P =.01). The ability to be bridged to transplant or recovery in SV patients is lower than for BV patients (11 of 26 [42.3%] vs 185 of 255 [72.5%]; P =.001). Three of 5 patients with TCPC were successfully bridged to transplant and were supported with 1 VAD. Seven of 12 patients with SCPC were bridged to transplant, and only 1 of 9 patients supported after a stage I procedure survived. Conclusions The EXCOR Pediatric VAD can provide a bridge to transplant for children with SV anatomy or physiology, albeit less successfully than in children with BV. In this small series, results are better in patients with SCPC and TCPC. VAD support for patients with shunted sources of pulmonary blood flow should be applied with caution. Copyright © 2014 by The American Association for Thoracic Surgery.

Willemink M.J.,University Utrecht | Leiner T.,University Utrecht | De Jong P.A.,University Utrecht | De Heer L.M.,Cardiothoracic Surgery | And 3 more authors.
European Radiology | Year: 2013

Objectives: To present the results of a systematic literature search aimed at determining to what extent the radiation dose can be reduced with iterative reconstruction (IR) for cardiopulmonary and body imaging with computed tomography (CT) in the clinical setting and what the effects on image quality are with IR versus filtered back-projection (FBP) and to provide recommendations for future research on IR. Methods: We searched Medline and Embase from January 2006 to January 2012 and included original research papers concerning IR for CT. Results: The systematic search yielded 380 articles. Forty-nine relevant studies were included. These studies concerned: the chest(n = 26), abdomen(n = 16), both chest and abdomen(n = 1), head(n = 4), spine(n = 1), and no specific area (n = 1). IR reduced noise and artefacts, and it improved subjective and objective image quality compared to FBP at the same dose. Conversely, low-dose IR and normal-dose FBP showed similar noise, artefacts, and subjective and objective image quality. Reported dose reductions ranged from 23 to 76 % compared to locally used default FBP settings. However, IR has not yet been investigated for ultra-low-dose acquisitions with clinical diagnosis and accuracy as endpoints. Conclusion: Benefits of IR include improved subjective and objective image quality as well as radiation dose reduction while preserving image quality. Future studies need to address the value of IR in ultra-low-dose CT with clinically relevant endpoints. Key Points: • Iterative reconstruction improves image quality of CT images at equal acquisition parameters. • IR preserves image quality compared to normal-dose filtered back-projection. • The reduced radiation dose made possible by IR is advantageous for patients. • IR has not yet been investigated with clinical diagnosis and accuracy as endpoints. © 2013 European Society of Radiology.

John R.,University of Minnesota | Naka Y.,Cardiothoracic Surgery | Park S.J.,Mayo Medical School | Sai-Sudhakar C.,Ohio State University | And 4 more authors.
Journal of Thoracic and Cardiovascular Surgery | Year: 2014

Background Preexisting valve pathology is common in patients with end-stage heart failure undergoing left ventricular assist device (LVAD) placement. The indications and subsequent benefits of performing valvular procedures in these patients are unclear. The objective of this study was to determine the impact of performing concurrent surgical valve procedures in a large cohort of patients receiving LVADs. Methods One thousand one hundred six patients received the HeartMate II (HMII) LVAD in the bridge to transplant (n = 470) and destination therapy (n = 636) clinical trials. Of these, 374 patients (34%) had concurrent cardiac surgery procedures as follows: 242 patients (21%) with 281 concurrent valve procedures (VP) (aortic 80, mitral 45, and tricuspid 156), and 641 patients had only HMII LVAD. The focus of this study was to determine the clinical outcomes of patients undergoing HMII + VP compared with those who received HMII alone. Results Patients undergoing HMII + VP were significantly older, had higher blood urea nitrogen levels and central venous pressure, and decreased right ventricular stroke work index; intraoperatively, the median cardiopulmonary bypass times were also longer. The unadjusted 30-day mortality was significantly higher in patients undergoing HMII + VP (10.3% vs 4.8% for LVAD alone, P =.005). Subgroup analysis of individual VPs showed that higher mortality occurred in patients with HMII plus 2 or more VPs (13.5%, P =.04) followed by trends for increased mortality with HMII plus mitral alone (11.5%, P = NS), HMII plus aortic alone (10.9%, P = NS), and HMII plus tricuspid (8.9%, P = NS) procedures. Of these various groups, only patients undergoing HMII + isolated aortic VP (P =.001) and HMII + multiple VPs (P =.046) had significantly worse long-term survival compared with patients undergoing HMII alone. Right heart failure and right ventricular assist device use was increased in patients undergoing VPs, but there was no difference in the incidence of bleeding or stroke. Conclusions Patients frequently require concurrent VPs at the time of LVAD placement; these patients are sicker and have higher early mortality. Furthermore, right ventricular dysfunction is increased in these patients. Further studies to develop selection criteria for concurrent valve interventions are important to further improve clinical outcomes. Copyright © 2014 by The American Association for Thoracic Surgery.

Fraccaro C.,University of Padua | Al-Lamee R.,San Raffaele Hospital | Tarantini G.,University of Padua | Maisano F.,Cardiothoracic Surgery | And 7 more authors.
Circulation: Cardiovascular Interventions | Year: 2012

Background-Few data exist about transcatheter aortic valve implantation (TAVI) in patients with low ejection fraction. The aim of the study was to analyze safety, feasibility, and efficacy of TAVI in patients with severe left ventricular dysfunction. Methods and Results-The study sample (384 patients) was divided into 2 groups: group A (50 patients) with left ventricular ejection fraction (LVEF) ≤35%, and group B (334 patients) with LVEF >35%. Clinical, anatomic, and hemodynamic variables, as well as procedural results and follow-up outcomes, were compared between the groups. Procedural success was reached in 88%, with no significant difference between the groups. The incidence of periprosthetic leak >2+/4 after TAVI was higher in group A. All other complications were similar between the 2 groups. Group A showed a significant and early improvement in LVEF (from 27.7±6.0 -35.2±11.1 after TAVI; P<0.0001). Thirty-day mortality was 4%; however, this was higher in group A compared with group B (10% versus 3%; P=0.010). Predictors of the cumulative late mortality were congestive heart failure, logistic euroSCORE, and moderate-to-severe periprosthetic leakage after TAVI. Estimated survival by Kaplan Meier at 1 year was, respectively, 69% in group A and 87% in group B (log rank <0.0001). Conclusions-Transcatheter aortic valve implantation is a safe and effective procedure, even in patients with severe left ventricular dysfunction, leading to a high procedural success rate with an acceptable rate of complications and 30-day mortality. Also in these critically ill patients, TAVI provides clinical amelioration, with early improvement in LVEF. © 2012 American Heart Association, Inc.

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