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JOURNAL ARTICLE
Jonathan R Krebs, Amanda C Filiberto, Brian Fazzone, Christopher R Jacobs, Erik M Anderson, Zain Shahid, Martin Back, Gilbert R Upchurch, Michol Cooper
BACKGROUND: Recently the SVS and STS published contemporary guidelines clearly defining complicated vs uncomplicated acute type B aortic dissections (TBADs) with an additional high-risk grouping. Few studies have evaluated outcomes associated with "high-risk" TBADs. The objective of this study was to assess differences in demographics, clinical presentation, symptom onset, and outcomes in high-risk patients that underwent either thoracic endovascular aortic repair (TEVAR) or best medical management for acute TBAD compared to those with complicated and uncomplicated acute TBAD...
April 2, 2024: Annals of Vascular Surgery
#2
JOURNAL ARTICLE
Christopher R Jacobs, Salvatore T Scali, Benjamin N Jacobs, Amanda C Filiberto, Erik M Anderson, Brian Fazzone, Martin R Back, Gilbert R Upchurch, Kristina A Giles, Thomas S Huber
INTRODUCTION: Clinical practice guidelines have recommended an endovascular-first approach(ENDO) for management of patients with chronic mesenteric ischemia(CMI) while open mesenteric bypass(OMB) is proposed for subjects deemed to be poor ENDO candidates. However, the impact of a previous failed endovascular or open mesenteric reconstruction on subsequent OMB is unknown. Accordingly, this study was designed to examine the results of a remedial OMB(R-OMB) after a failed ENDO or primary OMB(P-OMB) for patients with recurrent CMI...
March 27, 2024: Journal of Vascular Surgery
#3
Paolo Bellotti, Zachary Ladd, Victoria Leroy, Gang Su, Shiven Sharma, Joseph B Hartman, Jonathan Krebs, Chelsea Viscardi, Robert Maile, Lyle L Moldawer, Phillip Efron, Ashish K Sharma, Gilbert R Upchurch
Abdominal aortic aneurysm (AAA) formation is a chronic vascular pathology characterized by inflammation, leukocyte infiltration and vascular remodeling. The aim of this study was to delineate the protective role of Resolvin D2 (RvD2), a bioactive isoform of specialized proresolving lipid mediators, via G-protein coupled receptor 18 (GPR18) receptor signaling in attenuating AAAs. Importantly, RvD2 and GPR18 levels were significantly decreased in aortic tissue of AAA patients compared with controls. Furthermore, using an established murine model of AAA in C57BL/6 (WT) mice, we observed that treatment with RvD2 significantly attenuated aortic diameter, pro-inflammatory cytokine production, immune cell infiltration (neutrophils and macrophages), elastic fiber disruption and increased smooth muscle cell α-actin expression as well as increased TGF-β2 and IL-10 expressions compared to untreated mice...
February 26, 2024: bioRxiv
#4
JOURNAL ARTICLE
Amin A Mirzaie, Nancy C Hanson, Dan Neal, Scott A Berceli, Martin R Back, Salvatore T Scali, Thomas S Huber, Gilbert R Upchurch, Samir K Shah
BACKGROUND: Health literacy is a crucial aspect of informed decision-making, and limited health literacy has been associated with worse health care outcomes. To date, health literacy has not been examined in vascular surgery patients. Therefore, we conducted a prospective observational study to determine the prevalence and factors associated with poor health literacy in vascular surgery patients. METHODS: The Newest Vital Sign (Pfizer, New York, NY), a validated instrument, was used to appraise the health literacy of 150 patients who visited the outpatient vascular clinic at UF Health Shands Hospital between April 2022 and August 2022...
March 9, 2024: Surgery
#5
EDITORIAL
Jeremy A Balch, Barbara J Evans, Benjamin Shickel, Azra Bihorac, Gilbert R Upchurch, Tyler J Loftus
No abstract text is available yet for this article.
February 26, 2024: Surgery
#6
MerTK-dependent efferocytosis by monocytic-MDSCs mediates resolution of post-lung transplant injury.
Victoria Leroy, Denny J Manual Kollareth, Zhenxiao Tu, Jeff Arni C Valisno, Makena Woolet-Stockton, Biplab Saha, Amir M Emtiazjoo, Mindaugas Rackauskas, Lyle L Moldawer, Philip A Efron, Guoshuai Cai, Carl Atkinson, Gilbert R Upchurch, Ashish K Sharma
RATIONALE: Patients with end stage lung diseases require lung transplantation (LTx) that can be impeded by ischemia-reperfusion injury (IRI) leading to subsequent chronic lung allograft dysfunction (CLAD) and inadequate outcomes. OBJECTIVES: We examined the undefined role of MerTK (receptor Mer tyrosine kinase) on monocytic myeloid-derived suppressor cells (M-MDSCs) in efferocytosis (phagocytosis of apoptotic cells) to facilitate resolution of lung IRI. METHODS: Single-cell RNA sequencing of lung tissue and BAL from post-LTx patients was analyzed...
January 23, 2024: bioRxiv
#7
JOURNAL ARTICLE
Amanda C Filiberto, Tyler J Loftus, Cristina J Crippen, Die Hu, Jeremy A Balch, Philip A Efron, George A Sarosi, Gilbert R Upchurch
BACKGROUND: Variability in operating room supply cost is a modifiable cause of suboptimal resource use and low value of care (outcomes/costs). This study describes implementation of a quality improvement intervention to decrease operating room supply costs. STUDY DESIGN: An automated electronic health record data pipeline harmonized operating room supply cost data with patient and case characteristics and outcomes. For inpatient procedures, predicted mortality and length of stay were used to calculate observed-to-expected ratios and value of care using validated equations...
January 15, 2024: Journal of the American College of Surgeons
#8
JOURNAL ARTICLE
Gwoncheol Park, Jennifer A Munley, Lauren S Kelly, Kolenkode B Kannan, Robert T Mankowski, Ashish Sharma, Gilbert Upchurch, Gemma Casadesus, Paramita Chakrabarty, Shannon M Wallet, Robert Maile, Letitia E Bible, Bo Wang, Lyle L Moldawer, Alicia M Mohr, Philip A Efron, Ravinder Nagpal
BACKGROUND: Sepsis and trauma are known to disrupt gut bacterial microbiome communities, but the impacts and perturbations in the fungal (mycobiome) community after severe infection or injury, particularly in patients experiencing chronic critical illness (CCI), remain unstudied. METHODS: We assess persistence of the gut mycobiome perturbation (dysbiosis) in patients experiencing CCI following sepsis or trauma for up to two-to-three weeks after intensive care unit hospitalization...
January 11, 2024: Critical Care: the Official Journal of the Critical Care Forum
#9
JOURNAL ARTICLE
Brian Fazzone, Erik M Anderson, Jonathan Krebs, Walker Ueland, Chelsea Viscardi, Chris Jacobs, John R Spratt, Salvatore T Scali, Eric Jeng, Gilbert R Upchurch, M Libby Weaver, Michol A Cooper
BACKGROUND: Venous thromboembolism (VTE) incidence after thoracic and fenestrated endovascular aortic repair (TEVAR/FEVAR) is high (up to 6-7%) relative to other vascular procedures; however, the etiology for this discrepancy remains unknown. Notably, patients undergoing TEVAR/FEVAR commonly receive cerebrospinal fluid drains (CSFDs) for neuroprotection, requiring interruption of perioperative anticoagulation and prolonged immobility. We hypothesized that CSFDs are a risk factor for VTE after TEVAR/FEVAR...
November 14, 2023: Annals of Vascular Surgery
#10
JOURNAL ARTICLE
Tyler J Loftus, Lonn D McDowell, Gilbert R Upchurch
Maintaining financial stability is important for leaders in surgery because it (1) allows consistent, fair (market value) reimbursement for employees, which conveys that they are valued; (2) enables strategic investment in new programs that may not generate direct financial gains but are required; and (3) builds trust with stakeholders outside the department while strengthening the department's position in negotiations. Key strategies that we have used to increase revenue (income) over the past 6 years have been hiring more faculty, advocating for greater operating room and staffing capacity, staffing surgeons at other institutions using affiliation agreements, attempting to shift grant-funded efforts to non-clinical (research) faculty to mitigate National Institutes of Health salary cap penalties, and increasing efforts to identify external funding for educational and administrative tasks performed by surgeons (eg, increasing contact hours with medical students to secure a greater proportion of state general revenue)...
October 14, 2023: Surgery
#11
JOURNAL ARTICLE
Brian Fazzone, Erik M Anderson, Jonathan R Krebs, M Libby Weaver, Eric Pruitt, John R Spratt, Samir K Shah, Salvatore T Scali, Thomas S Huber, Gilbert R Upchurch, George Arnaoutakis, Michol A Cooper
BACKGROUND: Traditionally, acute uncomplicated type B aortic dissections are managed medically, and acute complicated dissections are managed surgically. Self-pay patients with medically managed acute uncomplicated type B aortic dissections may fare worse than their insured counterparts. METHODS: In this single-center, retrospective cohort study, demographics, follow-up, and outcomes of patients with acute type B aortic dissections from 2011 to 2020 were analyzed...
September 15, 2023: Surgery
#12
JOURNAL ARTICLE
Jonathan R Krebs, Brian Fazzone, Erik M Anderson, Walker Ueland, John R Spratt, Martin R Back, Zain Shahid, Thomas S Huber, Gilbert R Upchurch, Michol A Cooper
OBJECTIVES: Endovascular repair of thoracoabdominal aortic aneurysms (TAAA) and juxtarenal aortic aneurysms (JAA) with fenestrated and/or branched endografts (B/FEVAR) has become common. Physician modified endografts (PMEGs) for patients presenting with symptomatic or contained ruptures has made B/FEVAR a feasible option in nonelective settings. The purpose of this study was to describe our 10-year institutional experience with endovascular interventions for TAAA in elective and nonelective cases to evaluate differences in outcomes and the clinical risk factors associated with nonelective presentation...
September 13, 2023: Annals of Vascular Surgery
#13
REVIEW
Jeremy A Balch, Matthew M Ruppert, Tyler J Loftus, Ziyuan Guan, Yuanfang Ren, Gilbert R Upchurch, Tezcan Ozrazgat-Baslanti, Parisa Rashidi, Azra Bihorac
BACKGROUND: Machine learning-enabled clinical information systems (ML-CISs) have the potential to drive health care delivery and research. The Fast Healthcare Interoperability Resources (FHIR) data standard has been increasingly applied in developing these systems. However, methods for applying FHIR to ML-CISs are variable. OBJECTIVE: This study evaluates and compares the functionalities, strengths, and weaknesses of existing systems and proposes guidelines for optimizing future work with ML-CISs...
August 24, 2023: JMIR Medical Informatics
#14
JOURNAL ARTICLE
Amanda C Filiberto, Kenneth L Abbott, Benjamin Shickel, Brian C George, Amalia L Cochran, George A Sarosi, Gilbert R Upchurch, Tyler J Loftus
OBJECTIVES: This study tests the null hypotheses that overall sentiment and gendered words in verbal feedback and resident operative autonomy relative to performance are similar for female and male residents. BACKGROUND: Female and male surgical residents may experience training differently, affecting the quality of learning and graduated autonomy. METHODS: A longitudinal, observational study using a Society for Improving Medical Professional Learning collaborative dataset describing resident and attending evaluations of resident operative performance and autonomy and recordings of verbal feedback from attendings from surgical procedures performed at 54 US general surgery residency training programs from 2016 to 2021...
March 2023: Annals of surgery open: perspectives of surgical history, education, and clinical approaches
#15
JOURNAL ARTICLE
Amin A Mirzaie, Walker R Ueland, Katherine A Lambert, Amanda M Delgado, Jordan W Rosen, Carlos A Valdes, Salvatore T Scali, Thomas S Huber, Gilbert R Upchurch, Samir K Shah
OBJECTIVE: The American College of Surgeons National Surgical Quality Improvement Program (NSQIP) is an important data source for observational studies. While there are guides to ensure appropriate study reporting, there has been no evaluation of NSQIP studies in vascular surgery. We sought to evaluate the adherence of vascular-surgery related NSQIP studies to best reporting practices. METHODS: In January 2022, we queried PubMed for all vascular surgery NSQIP studies...
July 15, 2023: Vascular and Endovascular Surgery
#16
JOURNAL ARTICLE
Gilbert R Upchurch
My wife Nancy is a voluminous reader of books (you remember the things printed on paper). After 30 years of marriage, it dawned on me that we have never really shared books. Therefore, we decided to try and enrich our marriage by exchanging books. I asked her to pick out five books that she enjoyed and share them with me so that we could talk about them and have them "in common." Incidentally, when I asked my wife to pre-read this article, she said, "you make me sound like a total downer" based on the books she had given me to read...
July 12, 2023: American Surgeon
#17
JOURNAL ARTICLE
Amanda C Filiberto, Esra Adiyeke, Tezcan Ozrazgat-Baslanti, Christopher R Jacobs, Brian Fazzone, Azra Bihorac, Gilbert R Upchurch, Michol Cooper
OBJECTIVE: Postoperative acute kidney injury (AKI) is common after major surgery and is associated with increased morbidity, mortality and cost. Additionally, there are recent studies demonstrating that time to renal recovery may have a substantial impact on clinical outcomes. We hypothesized that patients with delayed renal recovery after major vascular surgery will have increased complications, mortality, and hospital cost. METHODS: A single center retrospective cohort of patients undergoing non-emergent major vascular surgery between 6/1/2014-10/1/2020 was analyzed...
July 7, 2023: Annals of Vascular Surgery
#18
JOURNAL ARTICLE
Amanda C Filiberto, Shunshun Miao, Yuanfang Ren, Tezcan Ozrazgat-Baslanti, Sara E Hensley, Christopher R Jacobs, M Libby Weaver, Gilbert R Upchurch, Azra Bihorac, Michol Cooper
BACKGROUND: Incidental atherosclerotic renal artery stenosis (RAS) is common in patients undergoing vascular surgery and has been shown to be associated with postoperative AKI among patients undergoing major non-vascular surgeries. We hypothesized that patients with RAS undergoing major vascular procedures would have a higher incidence of AKI and postoperative complications than those without RAS. METHODS: A single-center retrospective cohort study of 200 patients who underwent elective open aortic or visceral bypass surgery (100 with postoperative AKI; 100 without AKI) were identified...
August 2023: Surgery open science
#19
Eric M Isselbacher, Ourania Preventza, James Hamilton Black, John G Augoustides, Adam W Beck, Michael A Bolen, Alan C Braverman, Bruce E Bray, Maya M Brown-Zimmerman, Edward P Chen, Tyrone J Collins, Abe DeAnda, Christina L Fanola, Leonard N Girardi, Caitlin W Hicks, Dawn S Hui, William Schuyler Jones, Vidyasagar Kalahasti, Karen M Kim, Dianna M Milewicz, Gustavo S Oderich, Laura Ogbechie, Susan B Promes, Elsie Gyang Ross, Marc L Schermerhorn, Sabrina Singleton Times, Elaine E Tseng, Grace J Wang, Y Joseph Woo, David P Faxon, Gilbert R Upchurch, Aaron W Aday, Ali Azizzadeh, Michael Boisen, Beau Hawkins, Christopher M Kramer, Jessica G Y Luc, Thomas E MacGillivray, S Christopher Malaisrie, Kathryn Osteen, Himanshu J Patel, Parag J Patel, Wanda M Popescu, Evelio Rodriguez, Rebecca Sorber, Philip S Tsao, Annabelle Santos Volgman, Joshua A Beckman, Catherine M Otto, Patrick T O'Gara, Anastasia Armbruster, Kim K Birtcher, Lisa de Las Fuentes, Anita Deswal, Dave L Dixon, Bulent Gorenek, Norrisa Haynes, Adrian F Hernandez, José A Joglar, W Schuyler Jones, Daniel Mark, Debabrata Mukherjee, Latha Palaniappan, Mariann R Piano, Tanveer Rab, Erica S Spatz, Jacqueline E Tamis-Holland, Y Joseph Woo
AIM: The "2022 ACC/AHA Guideline for the Diagnosis and Management of Aortic Disease" provides recommendations to guide clinicians in the diagnosis, genetic evaluation and family screening, medical therapy, endovascular and surgical treatment, and long-term surveillance of patients with aortic disease across its multiple clinical presentation subsets (ie, asymptomatic, stable symptomatic, and acute aortic syndromes). METHODS: A comprehensive literature search was conducted from January 2021 to April 2021, encompassing studies, reviews, and other evidence conducted on human subjects that were published in English from PubMed, EMBASE, the Cochrane Library, CINHL Complete, and other selected databases relevant to this guideline...
November 2023: Journal of Thoracic and Cardiovascular Surgery
#20
JOURNAL ARTICLE
Amin A Mirzaie, Michol A Cooper, M Libby Weaver, Christopher R Jacobs, Morgan L Cox, Scott A Berceli, Salvatore T Scali, Martin R Back, Thomas S Huber, Gilbert R Upchurch, Samir K Shah
INTRODUCTION: The National Institutes of Health (NIH) is an essential source of funding for vascular surgeons conducting research. NIH funding is frequently used to benchmark institutional and individual research productivity, help determine eligibility for academic promotion, and as a measure of scientific quality. We sought to appraise the current scope of NIH funding to vascular surgeons by appraising the characteristics of NIH funded investigators and projects. In addition, we also sought to determine whether funded grants addressed recent Society for Vascular Surgery (SVS) research priorities...
June 14, 2023: Journal of Vascular Surgery
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