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Article ; Online: In-hospital mortality of high-risk pulmonary embolism: a nationwide population-based cohort study in Portugal from 2010 to 2018.

Calé, R / Ascenção, R / Bulhosa, C / Pereira, H / Borges, M / Costa, J / Caldeira, D

2024

Abstract: Background: The mortality associated with high-risk pulmonary embolism (PE) is remarkably high, and reperfusion to unload right ventricle should be a priority. However, several registries report reperfusion underuse. In Portugal, epidemiological data ... ...

Abstract	Background: The mortality associated with high-risk pulmonary embolism (PE) is remarkably high, and reperfusion to unload right ventricle should be a priority. However, several registries report reperfusion underuse. In Portugal, epidemiological data about the incidence, rate of reperfusion and mortality of high-risk PE are not known. Methods: Nationwide population-based temporal trend study in the incidence and outcome of high-risk PE, who were admitted to hospitals of the National Health Service in Portugal between 2010 and 2018. High-risk PE was defined as patients with PE who developed cardiogenic shock or cardiac arrest. International Classification of Diseases (ICD), 9th and 10th revision, Clinical Modification codes, were used for data from the period between 2010 and 2016 (ICD-9-CM) and 2017-2018 (ICD-10-CM), respectively. The assessment focused on trends in the use of reperfusion treatment, which was defined by application of thrombolysis or pulmonary embolectomy. A comparison was made between the use or non-use of reperfusion therapy in order to examine trends in in-hospital mortality among high-risk PE cases. Results: From 2010 and 2018, there were 40.311 hospitalization episodes for PE in adult patients at hospitals of the National Health Service in mainland Portugal. There was a significant increase in the annual incidence of PE (41/100.000 inhabitants in 2010 to 46/100.000 in 2018; R Conclusion: In Portugal, between 2010 and 2018, very few patients with PE developed high-risk forms of the disease, but the mortality rate among those patients was high. The low reperfusion rate could be associated with high in-hospital mortality and highlights the need to implement advanced therapies, as an alternative to systemic thrombolysis.
Language	English
Publishing date	2024-02-01
Publishing country	Spain
Document type	Journal Article
ZDB-ID	3009651-0
ISSN	2531-0437 ; 2531-0429
ISSN (online)	2531-0437
ISSN	2531-0429
DOI	10.1016/j.pulmoe.2023.11.002
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Article ; Online: Chronic thromboembolic pulmonary hypertension - the challenging approach of a young patient with distal disease.

Martinho, M / Calé, R / Ferreira, F / Alegria, S / Santos, A / Vieira, A C / Repolho, D / Vitorino, S / Saraiva, C / Pereira, H

Pulmonology

2023 Volume 29, Issue 5, Page(s) 435–437

MeSH term(s)	Humans ; Hypertension, Pulmonary/diagnosis ; Hypertension, Pulmonary/etiology ; Pulmonary Embolism/complications ; Pulmonary Embolism/diagnosis ; Pulmonary Artery/diagnostic imaging
Language	English
Publishing date	2023-04-06
Publishing country	Spain
Document type	Letter
ZDB-ID	3009651-0
ISSN	2531-0437 ; 2531-0429
ISSN (online)	2531-0437
ISSN	2531-0429
DOI	10.1016/j.pulmoe.2023.03.001
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Article ; Online: A Fluorescence-Based Assay for N

Sharma, Marcella F / Sharma, Shiv K / Streeter, Cale C / Firestine, Steven M

Chembiochem : a European journal of chemical biology

2023 Volume 24, Issue 18, Page(s) e202300347

Abstract: The enzyme ... ...

Abstract	The enzyme N
MeSH term(s)	Humans ; Ribonucleotides ; Escherichia coli ; Isatin ; Fluorescence ; Intramolecular Transferases
Chemical Substances	Ribonucleotides ; Isatin (82X95S7M06) ; Intramolecular Transferases (EC 5.4.-)
Language	English
Publishing date	2023-08-16
Publishing country	Germany
Document type	Journal Article ; Research Support, N.I.H., Extramural
ZDB-ID	2020469-3
ISSN	1439-7633 ; 1439-4227
ISSN (online)	1439-7633
ISSN	1439-4227
DOI	10.1002/cbic.202300347
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Article ; Online: Prevalence and predictors of chronic thromboembolic pulmonary hypertension following severe forms of acute pulmonary embolism.

Pargana, Joana / Calé, Rita / Martinho, Mariana / Santos, João / Lourenço, Cândida / Castro Pereira, José Alberto / Araújo, Patrícia / Morgado, João / Pereira, Ernesto / Judas, Tiago / Alegria, Sofia / Ferreira, Filipa / Delerue, Francisca / Pereira, Hélder

Revista portuguesa de cardiologia : orgao oficial da Sociedade Portuguesa de Cardiologia = Portuguese journal of cardiology : an official journal of the Portuguese Society of Cardiology

2023 Volume 42, Issue 12, Page(s) 947–958

Abstract: Introduction and objectives: The true prevalence of chronic thromboembolic pulmonary hypertension (CTEPH) after pulmonary embolism (PE) in the Portuguese population remains unknown. We aimed to assess the prevalence and predictors of CTEPH two years ... ...

Abstract	Introduction and objectives: The true prevalence of chronic thromboembolic pulmonary hypertension (CTEPH) after pulmonary embolism (PE) in the Portuguese population remains unknown. We aimed to assess the prevalence and predictors of CTEPH two years after a symptomatic high- (HR) or intermediate-high risk (IHR) PE. Methods: We conducted a retrospective cohort study of patients admitted with PE between 2014 and 2019 to a Portuguese referral center for pulmonary hypertension. Results: In this single-center registry of 969 patients admitted with PE (annual incidence of 46/100000 population), 194 had HR (5.4%) and IHR (14.7%) PE. After excluding patients who died or had no follow-up in the first three months, 129 patients were included in the analysis. The overall prevalence of suspected CTEPH by clinical assessment, Doppler echocardiography and V/Q lung scan was 6.2% (eight patients). CTEPH was confirmed by right heart catheterization in four of these (3.1%). Increased pulmonary artery systolic pressure (PASP) at admission (OR 1.12; 95% CI 1.04-1.22; p=0.005) and the presence of varicose veins in the lower limbs (OR 7.47; 95% CI 1.53-36.41; p=0.013) were predictors of CTEPH. PASP >60 mmHg at admission identified patients with CTEPH at follow-up with sensitivity and specificity of 83.3% and 76.3%, respectively. All patients diagnosed with CTEPH had at least two radiological findings suggestive of CTEPH at the index event. Conclusions: In our cohort, the prevalence of CTEPH in survivors of severe forms of acute PE was 6.2%. PASP above 60 mmHg and supporting radiological findings on the index computed tomography scan are highly suggestive of acute-on-chronic CTEPH.
MeSH term(s)	Humans ; Hypertension, Pulmonary/complications ; Hypertension, Pulmonary/epidemiology ; Prevalence ; Retrospective Studies ; Pulmonary Embolism/complications ; Pulmonary Embolism/diagnostic imaging ; Pulmonary Embolism/epidemiology ; Sensitivity and Specificity ; Acute Disease ; Chronic Disease
Language	Portuguese
Publishing date	2023-08-29
Publishing country	Portugal
Document type	Journal Article
ZDB-ID	632718-7
ISSN	2174-2030 ; 0870-2551 ; 0304-4750
ISSN (online)	2174-2030
ISSN	0870-2551 ; 0304-4750
DOI	10.1016/j.repc.2023.06.007
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Article ; Online: Randomized Controlled Trials on Platelet-Rich Plasma for Knee Osteoarthritis Poorly Adhere to the Minimum Information for Studies Evaluating Biologics in Orthopaedics (MIBO) Guidelines: A Systematic Review.

Stone, Austin V / Abed, Varag / Owens, Mitchell / Brunty, Nathan / Skinner, Matthew / Jacobs, Cale

The American journal of sports medicine

2024 , Page(s) 3635465231185289

Abstract: Background: Platelet-rich plasma (PRP) treatment for knee osteoarthritis has grown exponentially over the past decade; however, its scientific evaluation is highly variable. The American Academy of Orthopaedic Surgeons addressed the need for the ... ...

Abstract	Background: Platelet-rich plasma (PRP) treatment for knee osteoarthritis has grown exponentially over the past decade; however, its scientific evaluation is highly variable. The American Academy of Orthopaedic Surgeons addressed the need for the standardization of orthobiologics studies by publishing the Minimum Information for Studies Evaluating Biologics in Orthopaedics (MIBO) guidelines in May 2017. In total, the MIBO guidelines are divided into 12 categories, encompassing 23 checklist items. Hypothesis/purpose: The purpose of this study was to analyze how well randomized controlled trials (RCTs) on PRP interventions for knee osteoarthritis adhered to the MIBO guidelines. We hypothesized that most articles would report <80% of the MIBO criteria. Study design: Systematic review; Level of evidence, 1. Methods: PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were used to perform a systematic review in the PubMed/MEDLINE and Web of Science databases. Inclusion criteria included English-language RCTs that assessed PRP interventions for knee osteoarthritis and reported beginning patient enrollment in June 2017 or later. The original 23 MIBO checklist items were separated and modified into a 44-point checklist. Adherence was determined by calculating the total percentage of checklist items that each article adequately and clearly reported from the 44-point checklist. Results: A total of 25 RCTs (2356 patients) were included in this study. The weighted mean age was 57.7 ± 4.4 years, with 42.9% being male. On average, only 53.1% ± 10.4% (range, 31.8%-77.3%) of the 44-point MIBO checklist items were reported per article. No articles had adherence rates ≥80%, 5 (20.0%) had rates between 60% and 79.9%, and 20 (80.0%) had rates ≤59.9%. Categories fluctuated in adherence, with "Intervention" having the greatest adherence (100.0%) and "Activation" having the lowest (14.0%). Additionally, 4 (33.3%) categories had adherence rates ≥80%, 0 had rates from 60% to 79.9%, and 8 (66.7%) had rates ≤59.9%. Conclusion: The overall mean adherence to MIBO guidelines by RCTs on PRP interventions for knee osteoarthritis was 53.1%. To increase the reproducibility, improve transparency, and assess the treatment efficacy of future PRP studies, reporting of MIBO guidelines should be improved.
Language	English
Publishing date	2024-01-29
Publishing country	United States
Document type	Journal Article
ZDB-ID	197482-8
ISSN	1552-3365 ; 0363-5465
ISSN (online)	1552-3365
ISSN	0363-5465
DOI	10.1177/03635465231185289
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Article ; Online: The Relationship Between Intra-Articular Fracture Energy and a Patient's Inflammatory Response.

Haller, Justin M / Fink, Diane / Smith, Hannah / Olsen, Zachary / Jacobs, Cale / Anderson, Donald

Journal of orthopaedic trauma

2024

Abstract: Objectives: Prior studies have demonstrated elevated inflammatory cytokine concentrations in the synovial fluid of articular fracture patients post-injury. Similarly, CT-based fracture energy measurements have been correlated to PTOA risk after pilon ... ...

Abstract	Objectives: Prior studies have demonstrated elevated inflammatory cytokine concentrations in the synovial fluid of articular fracture patients post-injury. Similarly, CT-based fracture energy measurements have been correlated to PTOA risk after pilon fracture. The purpose of this study was to determine the associations between synovial fluid cytokine levels, fracture energy, and overall trauma to the body in articular fracture patients. Methods: Acute tibial plateau, tibial plafond, and rotational ankle fracture patients were prospectively enrolled from December 2011 through January 1, 2019. Synovial fluid concentrations of IL-1β, IL-1RA, IL-6, IL-8, IL-10, MMP-1, MMP-3, and MMP-13 were quantified. Patient CT scans were used to calculate fracture energy. The Injury Severity Score (ISS) was used to relate cytokine levels to whole-body injury severity. Spearman's rho correlation coefficients were calculated to assess the relationship between injury severity metrics and synovial fluid cytokine, chemokine, and MMP concentrations. Results: Eighty-seven patients were enrolled with 42 had a tibial plateau fractures (OTA/AO 41B1 - 2, 41B2-14, 41B3-3, 41C1-3, 41C2-4, 41C3-16), 24 patients had a tibial plafond fracture (OTA/AO 43B1 - 2, 43B2 - 4, 43B3 - 5, 43C1 - 2, 43C2-3, 43C3-8), and 21 had a rotational ankle fracture (OTA/AO 44B1-3, 44B2-3, 44B3-6, 44C1-4, 44C2-5). Fracture energy significantly differed between fracture patterns, with ankle fractures involving substantially less fracture energy (median = 2.92 J) than plafond (10.85 J, p<0.001) and plateau fractures (13.05 J, p<0.001). After adjustment for multiple comparisons, MMP-3 was significantly correlated with transformed fracture energy (r=0.41, 95% CI 0.22-0.58, p<0.001), while IL-1β was significantly correlated with ISS, (Spearman's ρ=0.31, 95% CI 0.08 - 0.49, p=0.004). Conclusions: Synovial fluid MMP-3 concentration was significantly correlated with CT-quantified fracture energy in intra-articular fracture patients. Given that in clinical practice fracture energy tends to correlate with post-traumatic osteoarthritis (PTOA) risk, MMP-3 may warrant further investigation for its role in PTOA development after articular fracture.
Language	English
Publishing date	2024-03-12
Publishing country	United States
Document type	Journal Article
ZDB-ID	639099-7
ISSN	1531-2291 ; 0890-5339
ISSN (online)	1531-2291
ISSN	0890-5339
DOI	10.1097/BOT.0000000000002800
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Zs.A 2234: Show issues

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Article: Characterization of Samples with Minor P3 Peak Elevations in a High Pressure Liquid Chromatography System for HbA1c: Contributions of Hemoglobin Variants and Storage Conditions.

Zheng, Yu Zi / Kovacic, Cassandra / Potz, Julie / McCale, Mitchell / Ondrejka, Sarah L / Colón-Franco, Jessica M

The journal of applied laboratory medicine

2023 Volume 8, Issue 2, Page(s) 347–352

Abstract: Background: In the Bio-Rad D-100TM (Bio-Rad, Hercules, CA) HPLC system for hemoglobin A1c (HbA1c) measurement, 7 peaks elute: HbA1a, HbA1b, HbF, LA1c, HbA1c, P3, and HbA0. HbA1c is calculated from the ratio of the HbA1c peak area to the total area, ... ...

Abstract	Background: In the Bio-Rad D-100TM (Bio-Rad, Hercules, CA) HPLC system for hemoglobin A1c (HbA1c) measurement, 7 peaks elute: HbA1a, HbA1b, HbF, LA1c, HbA1c, P3, and HbA0. HbA1c is calculated from the ratio of the HbA1c peak area to the total area, excluding HbF and peaks after HbA0, if present. A P3 peak >10% flags for potential interferences. Methods: We investigated 26 samples with elevated P3 peaks to determine the presence of hemoglobin variants, the effect of prolonged specimen storage in the P3 peak. The relationship between the P3 peak and the HbA1c concentration were also investigated. Results: No hemoglobin variants were identified when the P3 peak was <14% (n = 14). Hemoglobin variants were detected in 7 of 12 with a P3 peak between 17.0% and 28.2%. Sample storage at room temperature had minimum impact on the P3 peak area (n = 20); the average P3 bias was -0.5 (-8.1% bias) after 3 days and 0.6 (12.2% bias) after 5 days. P3 increased with increasing HbA1c concentrations in samples with P3 < 10%. Most samples with P3 above 10 and up to 14% had marked HbA1c elevations. Conclusions: Minor elevations of the P3 peak were due only in part to hemoglobin variants, particularly in samples with P3 above 17% (below 28.2%). These elevations caused a decrease in HbA1c, whether hemoglobin variants are detected or not. Prolonged storage at room temperature did not cause P3 peaks to increase above 10%.
MeSH term(s)	Humans ; Glycated Hemoglobin ; Chromatography, High Pressure Liquid ; Hematologic Tests
Chemical Substances	Glycated Hemoglobin
Language	English
Publishing date	2023-01-06
Publishing country	England
Document type	Journal Article
ISSN	2576-9456
ISSN	2576-9456
DOI	10.1093/jalm/jfac090
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Article ; Online: Underuse of reperfusion therapy with systemic thrombolysis in high-risk acute pulmonary embolism in a Portuguese center.

Martinho, Mariana / Calé, Rita / Grade Santos, João / Rita Pereira, Ana / Alegria, Sofia / Ferreira, Filipa / José Loureiro, Maria / Judas, Tiago / Ferreira, Melanie / Gomes, Ana / Morgado, Gonçalo / Martins, Cristina / Gonzalez, Filipe / Lohmann, Corinna / Delerue, Francisca / Pereira, Hélder

Revista portuguesa de cardiologia : orgao oficial da Sociedade Portuguesa de Cardiologia = Portuguese journal of cardiology : an official journal of the Portuguese Society of Cardiology

2023 Volume 43, Issue 2, Page(s) 55–64

Abstract: Introduction: Reperfusion therapy is generally recommended in acute high-risk pulmonary embolism (HR-PE), but several population-based studies report that it is underused. Data on epidemiology, management and outcomes of HR-PE in Portugal are scarce.: ...

Abstract	Introduction: Reperfusion therapy is generally recommended in acute high-risk pulmonary embolism (HR-PE), but several population-based studies report that it is underused. Data on epidemiology, management and outcomes of HR-PE in Portugal are scarce. Objective: To determine the reperfusion rate in HR-PE patients, the reasons for non-reperfusion, and how it influences outcomes. Methods: In this retrospective cohort study of consecutive HR-PE patients admitted to a thromboembolic disease referral center between 2008 and 2018, independent predictors for non-reperfusion were assessed by multivariate logistic regression. PE-related mortality and long-term MACE (cardiovascular mortality, PE recurrence and chronic thromboembolic disease) were calculated according to the Kaplan-Meier method. Differences stratified by reperfusion were assessed using the log-rank test. Results: Of 1955 acute PE patients, 3.8% presented with hemodynamic instability. The overall reperfusion rate was 50%: 35 patients underwent systemic thrombolysis, one received first-line percutaneous embolectomy and one rescue endovascular treatment. Independent predictors of non-reperfusion were: age, with >75 years representing 12 times the risk of non-treatment (OR 11.9, 95% CI 2.7-52.3, p=0.001); absolute contraindication for thrombolysis (31.1%), with recent major surgery and central nervous system disease as the most common reasons (OR 16.7, 95% CI 3.2-87.0, p<0.001); and being hospitalized (OR 7.7, 95% CI 1.4-42.9, p=0.020). At a mean follow-up of 2.5±3.3 years, the survival rate was 33.8%. Although not reaching statistical significance for hospital mortality, mortality in the reperfusion group was significantly lower at 30 days, 12 months and during follow-up (relative risk reduction of death of 64% at 12 months, p=0.013). Similar results were found for MACE. Conclusions: In this population, the recommended reperfusion therapy was performed in only 50% of patients, with advanced age and absolute contraindications to fibrinolysis being the main predictors of non-reperfusion. In this study, thrombolysis underuse was associated with a significant increase in short- and long-term mortality and events.
MeSH term(s)	Humans ; Aged ; Fibrinolysis ; Thrombolytic Therapy/methods ; Portugal ; Retrospective Studies ; Pulmonary Embolism/drug therapy ; Acute Disease ; Reperfusion/methods ; Treatment Outcome
Language	Portuguese
Publishing date	2023-11-06
Publishing country	Portugal
Document type	Journal Article
ZDB-ID	632718-7
ISSN	2174-2030 ; 0870-2551 ; 0304-4750
ISSN (online)	2174-2030
ISSN	0870-2551 ; 0304-4750
DOI	10.1016/j.repc.2023.07.005
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Article ; Online: Price Transparency for Primary Hip & Knee Arthroplasty: An Overview of the Top 50 US News and World Report Orthopedic Hospitals.

Cale, John B / Stambough, Jeffrey B / Mears, Simon C / Hutchinson, Johnny D / Barnes, C Lowry / Stronach, Benjamin M

The Journal of arthroplasty

2022 Volume 37, Issue 8, Page(s) 1514–1519

Abstract: Background: The Centers for Medicare and Medicaid Services (CMS) has mandated all hospitals to publish the charges of 300 common procedures to provide price transparency. The aims of our study are to evaluate 50 top orthopedic hospitals to determine ... ...

Abstract	Background: The Centers for Medicare and Medicaid Services (CMS) has mandated all hospitals to publish the charges of 300 common procedures to provide price transparency. The aims of our study are to evaluate 50 top orthopedic hospitals to determine compliance with this mandate and to assess the ease of finding cost information for arthroplasty procedures. Methods: The websites of the top 50 US News and World Report (USNWR) orthopedic hospitals were searched to find publicly accessible procedural charges. Data included the number of clicks to locate pricing documents, number of files provided, and number of data rows pertaining to arthroplasty. Charge data was queried based on Diagnosis related group (DRG) codes (469, 470), Current Procedural Technology (CPT) codes (27130, 27477), and keyword searches ("arthroplasty", "total hip", and "total knee"). Results: Forty-four (88%) of the top 50 USNWR Orthopedic institutions had publicly accessible files containing cost information. Thirty three of the 44 institutions provided results with DRG search while less than 10 institutions used CPT and keyword searches. There was an average of 226,190 (range 304-1,121,876) rows of data per file. Average charges varied depending on the use of DRG, CPT or keyword searches ($6,663-$117,072). Conclusion: The majority of compliant hospitals published large data files requiring the use of DRG codes to find cost information with extreme variation in resultant charges provided. These findings underscore the lack of direct patient benefit afforded by the current mandate, as pricing determinations require expert knowledge in medical coding and have a high variability in the reported charges.
MeSH term(s)	Aged ; Arthroplasty, Replacement, Hip/economics ; Arthroplasty, Replacement, Knee/economics ; Cost of Illness ; Hospitals ; Humans ; Medicare ; Orthopedics ; United States
Language	English
Publishing date	2022-03-26
Publishing country	United States
Document type	Journal Article
ZDB-ID	632770-9
ISSN	1532-8406 ; 0883-5403
ISSN (online)	1532-8406
ISSN	0883-5403
DOI	10.1016/j.arth.2022.03.070
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Article ; Online: Anatomy Nights: An international public engagement event increases audience knowledge of brain anatomy.

Sanders, Katherine A / Philp, Janet A C / Jordan, Crispin Y / Cale, Andrew S / Cunningham, Claire L / Organ, Jason M

PloS one

2022 Volume 17, Issue 6, Page(s) e0267550

Abstract: Anatomy Nights is an international public engagement event created to bring anatomy and anatomists back to public spaces with the goal of increasing the public's understanding of their own anatomy by comparison with non-human tissues. The event consists ... ...

Abstract	Anatomy Nights is an international public engagement event created to bring anatomy and anatomists back to public spaces with the goal of increasing the public's understanding of their own anatomy by comparison with non-human tissues. The event consists of a 30-minute mini-lecture on the anatomy of a specific anatomical organ followed by a dissection of animal tissues to demonstrate the same organ anatomy. Before and after the lecture and dissection, participants complete research surveys designed to assess prior knowledge and knowledge gained as a result of participation in the event, respectively. This study reports the results of Anatomy Nights brain events held at four different venues in the UK and USA in 2018 and 2019. Two general questions were asked of the data: 1) Do participant post-event test scores differ from pre-event scores; and 2) Are there differences in participant scores based on location, educational background, and career. We addressed these questions using a combination of generalized linear models (R's glm function; R version 4.1.0 [R Core Team, 2014]) that assumed a binomial distribution and implemented a logit link function, as well as likelihood estimates to compare models. Survey data from 91 participants indicate that scores improve on post-event tests compared to pre-event tests, and these results hold irrespective of location, educational background, and career. In the pre-event tests, participants performed well on naming structures with an English name (frontal lobe and brainstem), and showed signs of improvement on other anatomical names in the post-test. Despite this improvement in knowledge, we found no evidence that participation in Anatomy Nights improved participants' ability to apply this knowledge to neuroanatomical contexts (e.g., stroke).
MeSH term(s)	Anatomy/education ; Brain ; Curriculum ; Dissection ; Education, Medical, Undergraduate/methods ; Educational Measurement ; Head ; Humans ; Students, Medical ; Surveys and Questionnaires
Language	English
Publishing date	2022-06-09
Publishing country	United States
Document type	Journal Article
ZDB-ID	2267670-3
ISSN	1932-6203 ; 1932-6203
ISSN (online)	1932-6203
ISSN	1932-6203
DOI	10.1371/journal.pone.0267550
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