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The prognostic nutritional index as a risk factor for severe COVID-19 infection among hospitalized patients: A multicenter historical cohort study
No full textINTRODUCTION: Malnutrition is a critical prognostic factor in COVID-19, affecting up to 50 % of hospitalized patients and increasing their mortality risk tenfold compared to well-nourished patients. The prognostic nutritional index (PNI) assesses nutritional and immune status and can help gauge the severity of COVID-19.
OBJECTIVE: To evaluate whether PNI was independently associated with the severity of COVID-19 infection among hospitalized patients in the United States.
METHODS: This study was a historical cohort study of adult patients with COVID-19 hospitalized in five hospitals in southeast Michigan. Data collected from the electronic medical record were analyzed using SPSS v. 29.0, and a p-value \u3c 0.05 was considered statistically significant.
RESULTS: Data were included on 286 patients, with a mean age of 58.7 ± 17.5 years, 53.5 % (153/286) female, and 48.3 % (138/286) black/African American. The most common comorbidities were hypertension (62.9 %), obesity (54.2 %) and type 2 diabetes mellitus (32.1 %). Of the 286 patients, 144 (50.3) had severe/ critical disease. Patients with severe COVID-19 had significantly lower mean PNI levels than those with mild to moderate disease (35.1 ± 5.2 vs 37.7 ± 6.4, p \u3c 0.001). After controlling for smoking status, vaccination status, race, and home steroid use, PNI remained an independent predictor for severe/ critical COVID-19 (OR=0.92, p \u3c 0.001).
CONCLUSIONS: This study demonstrated that PNI is an independent predictor of severe COVID-19. The PNI score can be easily calculated from routine blood tests for every patient and helps risk stratify hospitalized COVID-19 patients. Additional research is needed to confirm these results
Cemented and Cementless Robotic-Assisted versus Manual Total Knee Arthroplasty Outcomes: A Single Center Michigan Arthroplasty Registry Collaborative Quality Initiative-Based Study
No full textBACKGROUND: The purpose of our study was to determine whether a difference existed between cemented and cementless robotic-assisted total knee arthroplasty (RA-TKA) and manual TKA with regard to revision rates and 90-day outcomes. We hypothesized these techniques would have similar results.
METHODS: A single center\u27s data from the Michigan Arthroplasty Registry Collaborative Quality Initiative were queried for all primary TKAs from January 2012 to July 2023. The RA-TKA and manual cohorts were compared for revisions and 90-day complications, including emergency department (ED) visits, readmissions, and returns to the operating room Chi-square and Fisher\u27s exact tests were used for categorical data, and t-tests for continuous data. Of the 7,417 cemented TKAs (mean age 67 ± 9.6 years, 70% women), 273 were RA-TKA and 7,144 were manual. Of the 2,407 cementless TKAs (mean age 65 ± 8.6 years, 53% women), 730 were RA-TKA and 1,677 were manual.
RESULTS: Cemented RA-TKA had more periprosthetic joint infection revisions, more 90-day ED visits, and readmissions for wound complications compared to cemented manual TKA. Cementless RA-TKA had more 90-day readmissions for wound complications, while manual TKA had more 90-day ED visits for postoperative pain. Cemented and cementless RA-TKA had longer surgical time, shorter length of stay, and shorter time to revision. There were 283 revisions performed on cemented manual TKA (nine RA-TKAs, 3.2%, 274 manual, 3.8%, (P = 0.87)). There were 56 revisions performed on cementless knees (13 RA-TKAs, 1.7%, 43 manual 2.5% (P = 0.303)). Cumulative percent revision at 5 years was 3.9% for cemented RA-TKA, 3.5% for cemented manual TKA, 1.8% for cementless RA-TKA, and 2.8% for cementless manual TKA.
CONCLUSIONS: Both RA-TKA and manual TKA have similar revision rates, while RA-TKA had more wound complications. Cementless RA-TKA may be beneficial in reducing postoperative pain
Achieving the Centers for Medicare and Medicaid Services Defined Substantial Clinical Benefit Following Total Knee Arthroplasty and Total Hip Arthroplasty in the Michigan Arthroplasty Registry Collaborative Quality Initiative
No full textBACKGROUND: The Centers for Medicare & Medicaid Services (CMS) mandates patient-reported outcome measure (PROM) reporting for inpatient total hip arthroplasty (THA) and total knee arthroplasty (TKA) starting July 1, 2024, requiring preoperative (0 to 90 days) and postoperative (300 to 425 days) scores for ≥ 50% of claims. Substantial clinical benefit (SCB) is defined as a 22-point Hip Dysfunction and Osteoarthritis Outcome Score for Joint Replacement improvement for THA and a 20-point Knee injury and Osteoarthritis Outcome Score for Joint Replacement improvement for TKA, with a CMS-defined goal for hospitals to achieve SCB for ≥ 60% of patients. The purpose of this study was to assess the Michigan Arthroplasty Registry Collaborative Quality Initiative (MARCQI) sites\u27 readiness to meet these CMS patient-reported outcome measures collection requirements and their success in achieving SCB thresholds.
METHODS: We analyzed 8,826 THAs and 12,210 TKAs performed between January 1, 2022, and June 30, 2022, in MARCQI. Matched pre and postoperative PROMs and SCB rates were assessed across 81 sites.
RESULTS: Only 22.1% of the patients who underwent THA and 22.7% of the patients who underwent TKA had matched PROMs, and 7.4% of sites met CMS thresholds for collection. However, 90% of sites with matched PROMs met the SCB threshold.
CONCLUSIONS: For a statewide registry in Michigan, few sites met CMS collection requirements, but most achieved SCB targets. These findings reflect the experience of a diverse group of MARCQI sites and may not be generalizable to other states or institutions
The Application of Microfluidic Chips in Primary Urological Cancer: Recent Advances and Future Perspectives
No full textThe research of primary urological cancers, including bladder cancer (BCa), prostate cancer (PCa), and renal cancer (RCa), has developed rapidly. Microfluidic technology provides a good variety of benefits compared to the heterogeneity of animal models and potential ethical issues of human study. Microfluidic technology and its application with cell culture (e.g., organ-on-a-chip, OOC) are extensively used in urological cancer studies in preclinical and clinical settings. The application has provided diagnostic and therapeutic benefits for patients with urological diseases, especially by evaluating biomarkers for urinary malignancies. In this review, we go through the applications of OOC in BCa, Pca and Rca, and discuss the prospects of reducing the cost and improving the repeatability and amicability of the intelligent integration of urinary system organ chips
Prenatal PFAS exposure and outcomes related to maternal gut microbiome composition in later pregnancy
No full textThe composition of the gut microbiome is dependent on factors including diet, lifestyle, and exposure to environmental chemicals, and has implications for human health. Per- and polyfluoroalkyl substances (PFAS), a class of man-made chemicals that have nonstick and flame-retardant properties may impact on gut microbiome composition. Our objective was to elucidate links between PFAS and maternal gut microbiome composition in two geographically diverse sites of the Environmental Influences on Child Health Outcomes program. The present analysis includes participants in the Atlanta African American Maternal Child Cohort; ATL AA and a predominately non-Hispanic White subsample of the Michigan Archive for Research on Child Health Cohort; MARCH with serum or plasma PFAS concentrations measured in early or late pregnancy and 16s rRNA sequencing from maternal gut microbiome samples available primarily in later pregnancy (2nd-3rd trimester). Linear regression models tested associations between prenatal PFAS levels (separately for the 1st/3rd trimesters) and measures of alpha diversity, bacterial composition differences, and differential taxonomic abundance. Bayesian Kernel Machine Regression and Elastic net regression mixture modeling were also incorporated. In both cohorts, multiple PFAS were significantly associated with the relative abundance of specific microbiome taxa even after adjustment for covariates including maternal diet, age, race, BMI, and smoking; A total of 16 significant family-level associations were identified for ATL AA (e.g., PFOA with Clostridiaceae; natural log fold change = 0.94) and 13 significant family-level associations identified for MARCH e.g., PFOS with Desulfovibrionaceae; natural log fold change = -1.53 (p(FDR) \u3c 0.05), but similarities between cohorts were lacking. Mixture analyses did not identify interactive or combined effects but did provide modest evidence of inclusion of individual PFAS in beta diversity models in both cohorts. In 2 distinct cohorts, there were significant associations between prenatal PFAS and the relative abundance of several bacterial taxa, but these differences were cohort-specific. This work suggests that PFAS may modulate the gut microbiome during pregnancy
Prevention of Pain Interference in Insomnia Patients via Digital Cognitive-Behavioral Therapy for Insomnia
No full textOBJECTIVES: Insomnia disorder is co-morbid with and predictive of developing pain conditions and a key factor in pain interference (PI) - the extent to which pain impedes daily living. Emerging literature suggests treating insomnia with cognitive-behavioral therapy for insomnia reduces co-occurring PI. This secondary data analysis tested the extent to which digital CBT-I (dCBT-I) vs. sleep education reduces and prevents significant PI by treating insomnia.
METHODS: Insomnia disorder participants were randomized into dCBT-I (n = 697) and sleep education (n = 623) and reported pre- and post-treatment insomnia and PI. Logistic regressions evaluated intervention effects: 1) reduction of insomnia severity changes in PI and 2) prevention of treatment condition on PI.
RESULTS: The reduction model showed that dCBT-I participants with moderate-to-severe pre-treatment PI experienced 17% odds increase in reduced PI for each one-point reduction in insomnia severity compared to control, OR = 1.17, 95% CI [1.01, 1.35]. In the prevention model, dCBT-I participants with little-to-no pre-treatment PI exhibited a 32% odds reduction of post-treatment progression to moderate-to-severe PI compared to control, OR = 0.68, 95% CI [0.51, 0.90].
CONCLUSION: dCBT-I demonstrated significant and clinically meaningful reduction and prevention effects against PI in a large sample. dCBT-I may help providers address sleep issues to restore pain-related impairments to daytime function, quality of life, and overall sleep
Battle of the Bots: Assessing the Ability of Four Large Language Models to Tackle Different Surgery Topics
No full textObjective: Our study aims to compare the performance of different large language model chatbots on surgical questions of different topics and categories.
Materials and Methods: Four different chatbots (ChatGPT 4.0, Medical Chat, Google Bard, and Copilot Ai) were used for our study. 114 multiple-choice surgical questions covering 9 different topics were entered into each chatbot, and their answers were recorded.
Results: The performance of ChatGPT was significantly better than Bard (P \u3c 0.0001) and Medical Chat (P = 0.0013) but not significantly better than Copilot (P = 0.9663). We also found a statistically significant difference in ENT (P = 0.0199) and GI (P = 0.0124) questions between each chatbot when we assessed their performances per surgical specialty. Finally, the mean scores of Bard, Copilot, Medical Chat, and ChatGPT 4.0 on the diagnosis questions were higher than those in the management questions. The difference was only statistically significant, however, for Bard (P = 0.0281).
Conclusion: Our study offers insight into the performance of different chatbots on surgery-related questions and topics. The strengths and shortcomings of each can provide us with a better understanding of how to use Chatbots in the surgical field, including surgical education
Surgical Infection Society Multi-Center Observational Study: Empiric Anti-Fungal Coverage after Non-Colonic Gastrointestinal Perforation
No full textBackground: Empiric anti-fungals are frequently administered in patients with non-colonic gastrointestinal (GI) perforations, but there is limited evidence of their benefit. We hypothesized that empiric anti-fungals would offer no clinical benefit compared with a standard course of antimicrobial therapy.
Methods: This multi-center prospective cohort study included patients ≥ 18 years old undergoing operative management for non-colonic GI perforations across 15 centers between August 2021 and January 2024. The primary outcome was organ-space surgical site infection (SSI). We performed propensity score matching to adjust for confounders and a backward stepwise regression model to identify predictors of an organ-space SSI. A subgroup analysis of spontaneous upper GI perforations was performed as well.
Results: A total of 192 patients were included; 138 (71.88%) received empiric anti-fungal therapy, and 17.7% developed an organ-space SSI. Before matching, empiric anti-fungal use was frequent in critically ill patients although not associated with organ-space SSI. After matching, there were no differences in organ-space SSI (17.5% vs. 17.5%, p = 0.99). In multi-variable regression, American Society of Anesthesiologists physical status classification system (ASA) category 3 increased the risk of organ-space SSI (odds ratio [OR] 2.49, p = 0.04), whereas perioperative proton-pump inhibitor (PPI) use was protective (OR 0.15, p = 0.004). In the subgroup analysis (N = 150), empiric anti-fungal therapy did not reduce infection risk. Pre-operative shock increased the risk of organ-space SSI (OR 2.83, p = 0.04), whereas PPI use remained protective (OR 0.15, p = 0.01).
Conclusion: Empiric anti-fungal use was not associated with reduced organ-space SSI, even after adjusting for confounders. Given the lack of benefit, we caution against the use of routine empiric anti-fungal therapy in non-colonic GI perforations
Association of Frailty With Readmissions and Outcomes After Impella Mechanical Circulatory Support
No full textBACKGROUND: Frailty is associated with a greater risk of readmission after cardiovascular procedures. However, the impact of frailty on readmission rates and outcomes after Impella mechanical circulatory support (MCS) remains unknown. We aimed to explore the impact of frailty on readmission outcomes in patients who received Impella MCS.
METHODS: Using the National Readmissions Database, patients aged 65 years and older who received Impella MCS between January 2016 and December 2020 were identified. Frailty was determined by the Hospital Frailty Risk Score (HFRS), which stratifies patients into 3 frailty risk categories as low (\u3c 5), intermediate (5-15), and high (\u3e15), with intermediate- and high-risk groups defined as frail. The impact of frailty on short-term (within 30 days) and midterm (31-180 days) readmission rates and in-hospital outcomes was assessed.
RESULTS: Of the 16,289 patients identified in the 30-day cohort, 8647 (53.1%) were identified as frail (HFRS ≥5) and 2185 (13.4%) had an unplanned readmission at 30 days. After adjusting for age, sex and comorbidities, frailty status (HFRS ≥5) was associated with a greater risk of 30-day readmission (odds ratio [OR] 1.27, 95% confidence interval [CI] 1.17-1.37), death (OR 2.0, 95% CI 1.22-3.30), major adverse events (OR 1.73, 95% CI 1.29-2.33), length of stay \u3e4 days (OR 1.80, 95% CI 1.44-2.26) and greater hospitalization expenditures (OR 1.44, 95% CI 1.17-1.80) during readmission. Of the 6497 patients identified in the 31-180-day cohort, 3521 (54.2%) were considered frail and 1809 (27.8%) experienced unplanned readmissions. An HFRS ≥5 was associated with a greater risk of readmission (OR 2.10, 95% CI 1.88-2.34), in-hospital death (OR 3.02, 95% CI 1.33-6.86), length of stay \u3e4 days (OR 1.66, 95% CI 1.29-2.14), and greater hospital expenditures (OR 1.36, 95% CI 1.05-1.75) during 31-180-day readmission.
CONCLUSIONS: Frailty is common among patients undergoing Impella MCS and is associated with higher rates of readmission and adverse outcomes during readmission
Outcomes in New User Cohorts of SGLT2 Inhibitors or GLP-1 Receptor Agonists with Type 2 Diabetes and Chronic Kidney Disease
No full textINTRODUCTION: People with chronic kidney disease (CKD) and type 2 diabetes (T2D) have an increased risk of kidney failure and cardiovascular disease. Sodium-glucose cotransporter-2 inhibitors (SGLT2i) and glucagon-like peptide-1 receptor agonists (GLP-1 RA) have shown cardiorenal protective effects. The objective of this multinational, multidatabase study was to describe the incidence of kidney and cardiovascular outcomes in separate, non-mutually exclusive cohorts of patients with CKD and T2D who initiated either an SGLT2i or a GLP-1 RA.
METHODS: Data describing adults (≥ 18 years) with T2D and CKD who were new users of either SGLT2i or GLP-1 RA from 2012 to 2019 were assessed from population-based Danish National Health Registers (DNHR) and Valencia Health System Integrated Database (VID), hospital-based Japan Chronic Kidney Disease Database Extension (J-CKD-DB-Ex), and US Optum(®) de-identified Electronic Health Record dataset (Optum(®) EHR). Crude incidence rates (IRs) and 95% confidence intervals (CIs) for primary outcomes (kidney failure, acute coronary syndrome, stroke, new-onset congestive heart failure, new-onset atrial fibrillation) and cumulative incidence by follow-up time for primary and secondary outcomes (laboratory measurements of kidney function) were estimated.
RESULTS: SGLT2i cohorts comprised 12,501 patients in DNHR, 22,404 in VID, 811 in J-CKD-DB-Ex, and 54,308 in Optum(®) EHR. GLP-1 RA cohorts comprised 10,696 in DNHR, 8317 in VID, 219 in J-CKD-DB-Ex, and 78,934 in Optum(®) EHR. Baseline clinical profile differences were observed for GLP-1 RA and SGLT2i new users, and crude IRs of kidney and heart failure tended to be higher in the GLP-1 RA cohorts than in the SGLT2i cohorts across data sources.
CONCLUSION: Understanding the incidence of kidney failure and cardiovascular outcomes in people receiving antidiabetic medications with cardiorenal protective effects is important for future studies aiming to compare the incidence of kidney and cardiovascular outcomes related to new and existing CKD treatments