DigitalCommons@The Texas Medical Center
Not a member yet
41791 research outputs found
Sort by
Investigating Social Network Peer Effects on HIV Care Engagement Using a Fuzzy-Like Matching Approach: Cross-Sectional Secondary Analysis of the N2 Cohort Study
No full textBACKGROUND: Social network data are essential and informative for public health research and implementation as they provide details on individuals and their social context. For example, health information and behaviors, such as HIV-related prevention and care, may disseminate within a network or across society. By harmonizing egocentric and digital networks, researchers may construct a sociocentric-like fuzzy network based on a subgroup of the population.
OBJECTIVE: We aimed to generate a more complete sociocentric-like fuzzy network by harmonizing alternative sources of egocentric and digital network data to examine relationships between participants in the Neighborhoods and Networks (N2) cohort study. Further, we examined network peer effects of the status-neutral HIV care continuum cascade.
METHODS: Data were collected from January 2018 to December 2019 in Chicago, Illinois, United States, from a community health center and via peer referral sampling as part of the N2 cohort study, comprised of Black sexually minoritized men and gender expansive populations. Participants provided sociodemographics, social networks, sexual networks, mobile phone contacts, and Facebook friends list data. Lab-based information about the HIV care continuum cascade was also collected. We used an experimental approach to develop and test a fuzzy matching algorithm to construct a more complete network across social, sexual, phone, and Facebook networks using R and Excel. We calculated social network centrality measures for each of these networks and then described the HIV care continuum within the context of each network. We then used Spearman correlation and a network autocorrelation model to examine social network peer effects with HIV status and care engagement.
RESULTS: A total of 412 participants resulted in 2054 network connections (ties) across the confidant and sexual partner social networks (participants=387; ties=445), peer referral network (participants=412; ties=362), phone contacts (participants=273; ties=362), and Facebook network (participants=144; ties=1383), reaching the entire study sample in one fully connected fuzzy network. Results from the individual networks\u27 autocorrelation model suggest there are no peer effects on status-neutral HIV care engagement. Results from the final fuzzy-like sociocentric network autocorrelation model, adjusted for HIV serostatus, suggest that participants who were proximate to network members engaged in HIV care were significantly more likely to be engaged in care (ρ=0.128, SE 0.064; P=.045).
CONCLUSIONS: Using alternative sources of network data allowed us to fuzzy match a more complete network: fuzzy matching may identify hidden ties among participants that were missed by examining alternative sources of network data separately. Although sociocentric studies require significant resources to implement, more complete sociocentric-like networks may be generated using a fuzzy match approach that leverages egocentric, peer referral, and digital networks. Enriching offline networks with digital network data may provide insights into characteristics and norms that egocentric approaches may not be able to capture
Mapping the Transcriptional and Epigenetic Landscape of Organotypic Endothelial Diversity in the Developing and Adult Mouse
Get PDFThe vascular endothelium features unique molecular and functional properties across different vessel types, such as between arteries, veins and capillaries, as well as between different organs, such as the leaky sinusoidal endothelium of the liver versus the impermeable vessels of the brain. However, the transcriptional networks governing endothelial organ specialization remain unclear. Here we profile the accessible chromatin and transcriptional landscapes of the endothelium from the mouse liver, lung, heart, kidney, brain and retina, across developmental time, to identify potential transcriptional regulators of endothelial heterogeneity. We then determine which of these putative regulators are conserved in human brain endothelial cells, and using single-cell transcriptomic profiling, we define which regulatory networks are active during brain maturation. Finally, we show that the putative transcriptional regulators identified by these three approaches molecularly and functionally reprogram naive endothelial cells. Thus, this resource can be used to identify potential transcriptional regulators controlling the establishment and maintenance of organ-specific endothelial specialization
Atrial Fibroblast-Derived Macrophage Migration Inhibitory Factor Promotes Atrial Macrophage Accumulation in Postoperative Atrial Fibrillation
No full textNew study: Blocking MIF protein prevents irregular heartbeats after surgery by reducing harmful immune cell buildup in the atria
Single-Nucleus mRNA-Sequencing Reveals Dynamics of Lipogenic and Thermogenic Adipocyte Populations in Murine Brown Adipose Tissue in Response to Cold Exposure
Get PDFObjective and methods: Brown adipose tissue (BAT) comprises a heterogeneous population of adipocytes and non-adipocyte cell types. To characterize these cellular subpopulations and their adaptation to cold, we performed single-nucleus mRNA-sequencing (snRNA-seq) on interscapular BAT from mice maintained at room temperature or exposed to acute (24h) or chronic (10 days) cold (6 °C). To investigate the role of the de novo lipogenesis (DNL)-regulating transcription factor carbohydrate response element-binding protein (ChREBP), we analyzed control and brown adipocyte-specific ChREBP knockout mice.
Results: We identified different cell populations, including seven brown adipocyte subtypes with distinct metabolic profiles. One of them highly expressed ChREBP and DNL enzymes. Notably, these lipogenic adipocytes were highly sensitive to acute cold exposure, showing a marked depletion in BAT of control mice that was compensated by other brown adipocyte subtypes maintaining DNL. Chronic cold exposure resulted in an expansion of basal brown adipocytes and adipocytes putatively derived from stromal and endothelial precursors. In ChREBP-deficient mice, lipogenic adipocytes were almost absent under all conditions, identifying the transcription factor as a key determinant of this adipocyte subtype. Detailed expression analyses revealed Ttc25 as a specific marker of lipogenic brown adipocytes and as a downstream target of ChREBP. Furthermore, pathway and cell-cell interaction analyses implicated a Wnt-ChREBP axis in the maintenance of lipogenic adipocytes, with Wnt ligands from stromal and muscle cells providing instructive cues.
Conclusions: Our findings provide a comprehensive atlas of BAT cellular heterogeneity and reveal a critical role for ChREBP in lipogenic adipocyte identity, with implications for BAT plasticity and metabolic function
Are There Rural-Urban Disparities in Cardiovascular Disease Hospitalization and Other Outcomes in People With Gout? A Nationwide U.S. Study
Get PDFObjective: The objective of this study was to assess whether rural vs urban patient residence is associated with the risk of myocardial infarction (MI) hospitalization and other outcomes in people with gout.
Methods: We used the 2016-2019 U.S. National Inpatient Sample (NIS) database to assess whether rural patient residence is associated with a higher risk of MI hospitalizations in gout, while adjusting for demographics (age, sex, race), comorbidity, median household income, insurance payer, and hospital characteristics (location and teaching status, bed size, hospital control, and hospital region). We calculated adjusted odds ratios (aORs) and 95% CIs (CIs).
Results: We found that, compared with urban residents, people living in the rural areas had higher crude rates of MI, 2640 vs 3145 per 100 000 area-specific gout hospitalizations. In multivariable-adjusted analyses, compared with urban residents with gout, the rural area residents with gout were significantly more likely to have a MI hospitalization, with an odds ratio of 1.70 (95% CI, 1.61-1.79; P \u3c 0.001). The association was confirmed in multiple sensitivity analyses.
Conclusion: We demonstrated significant rural-urban disparities in the risk of MI hospitalization in people with gout. Policymakers and hospital systems need to design and implement interventions to reduce these disparities
Preoperative Dialysis Dose and Postoperative Outcomes in Patients Receiving Maintenance Hemodialysis
No full textBackground: Little is known about preoperative hemodialysis dosing for patients with end-stage kidney disease. We assessed whether changes in preoperative hemodialysis dose (compared to and controlling for baseline dose) are associated with postoperative mortality in patients receiving maintenance hemodialysis.
Methods: We identified fee-for-service Medicare beneficiaries receiving hemodialysis for end-stage kidney disease who underwent surgical procedures between January 1, 2011, and November 30, 2020. Follow-up ended December 31, 2020. The primary exposure was preoperative change in Kt/Vurea, defined as the difference between the Kt/Vurea in the hemodialysis session proximal to the procedure and the mean Kt/Vurea for the preceding 180 days. The primary outcome was postoperative 30-day mortality. The relation between preoperative change in Kt/Vurea and the primary outcome was modeled using a Cox proportional hazards regression model, adjusted for mean and standard deviation of Kt/Vurea in the 180 days preceding the procedure, and for other covariates.
Results: Among 151,240 procedures (median age, 65 years [25%-75% range, 56-73], 63,437 (41.9%) in women), 31,825 (21.0%) had a preoperative change in Kt/Vurea of \u3c -0.10, 43,790 (29.0%) had a preoperative change of -0.10 to \u3c 0, 45,058 (29.8%) had a preoperative change of 0 to \u3c +0.10, and 30,567 (20.2%) had a preoperative change of ≥+0.10. The median Kt/Vurea for the 180 days prior to the procedure was 1.58 (25th-75th percentiles, 1.45-1.74). In adjusted analysis, compared to patients with a preoperative change in Kt/Vurea of 0 to \u3c +0.10, 30-day mortality was 1.50 (95% CI, 1.32, 1.70) times higher with a preoperative Kt/Vurea change of ≤-0.10 and 1.16 (95% CI, 1.02, 1.31) times higher with a preoperative Kt/Vurea change of -0.10 to \u3c 0. Increases in preoperative Kt/Vurea that were greater than 0.10 were not significantly associated with 30-day mortality.
Conclusions: Among Medicare beneficiaries receiving maintenance hemodialysis, preoperative decreases in Kt/Vurea (compared to and controlling for mean Kt/Vurea) were significantly associated with postoperative mortality
Improving Door-In-Door-Out Times for STEMI Transfer Patients: Impact of a Protocolized Autolaunch Process
No full textBackground: The timely transfer of patients with ST-segment elevation myocardial infarction (STEMI) to percutaneous coronary intervention-capable centers is critical for improving outcomes. Although the American Heart Association recommends a door-in-door-out (DIDO) time of ≤30 minutes, national compliance remains low.
Project rationale: At Harris Health, no patients with STEMI met this benchmark before 2022. We implemented a quality improvement (QI) initiative, including an Autolaunch process, to expedite STEMI transfers.
Project summary: During 2022-2023, we introduced QI initiatives, including the Autolaunch protocol, for patients with unequivocal STEMI. This process included rapid emergency medical services activation, direct catheterization laboratory transfer, and prearrival cardiologist notification. Data were analyzed to assess DIDO times. Before intervention, the median DIDO time was 81 minutes, with 0% of patients meeting the ≤30-minute goal. Postimplementation, the DIDO time decreased to 41 minutes, and compliance reached 39.5%. In Autolaunch cases (n = 35), the median DIDO time was 26 minutes, and the compliance was 74.3%.
Take-home messages: The STEMI Autolaunch process significantly improved DIDO times. This protocolized approach may serve as a model for optimizing STEMI transfer efficiency and improving patient outcomes
Sequelae and Surgical Management of Giant Cardiac Myxoma
No full textCardiac myxomas are a rare phenomenon within the general population, and although there are reports of them, giant myxomas are not common in the medical literature. This report presents a case of a giant left atrial cardiac myxoma in a 57-year-old female patient who was largely asymptomatic until she presented with a diffuse thromboembolic stroke. This case report highlights the importance of surgical management of cardiac myxomas and discusses the difference in open vs minimally invasive surgical resection of giant cardiac myxomas
Outcomes of Coronary Revascularization in Patients With Metabolic Dysfunction-Associated Steatotic Liver Disease: A Systematic Review
No full textIntroduction: A growing amount of evidence suggests that metabolic dysfunction-associated steatotic liver disease (MASLD) may independently increase the risk of coronary artery disease and acute coronary syndrome, thus necessitating revascularization interventions such as percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) [2,3]. However, a limited number of studies have evaluated the impact of MASLD on the outcomes of these interventions.
Methods: A comprehensive search of the PubMed/MEDLINE and Embase databases was conducted to identify relevant studies from August 2015 to August 2025 using a combination of Medical Subject Headings (MeSH) terms and text words related to MASLD and cardiovascular revascularization.
Results: Two hundred nineteen papers from the PubMed/MEDLINE and Embase databases were reviewed. Six met the inclusion criteria ( Figure 1). Five studies covered PCI, and one covered CABG. Supplemental information was added using targeted PubMed/MEDLINE searches.
Conclusions: MASLD may pose an increased risk of in-hospital and long-term mortality following PCI. Risks for cardiogenic shock, cardiac arrest, in-stent thrombosis, gastrointestinal bleeding, or invasive mechanical ventilation following PCI may also be increased. Further studies are needed to determine the optimal coronary revascularization method and post-revascularization medical therapy for patients with MASLD
Novel Valve-in-Valve Transcatheter Systemic Tricuspid Valve Replacement in Congenitally Corrected Transposition of the Great Arteries
No full textA 41-year-old woman with history of situs inversus totalis, dextrocardia, congenitally corrected transposition of the great arteries, and systemic tricuspid valve replacement presented with worsening of her baseline orthopnea and exertional dyspnea caused by stenosis of the tricuspid valve. Given her high risk for surgery, valve-in-valve transcatheter tricuspid valve replacement was pursued and performed successfully, leading to resolution of her symptoms. Previous valve-in-valve tricuspid interventions are rare. This case is notable as the first systemic atrioventricular valve-in-valve replacement in a patient with dextrocardia through a septal approach