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Article ; Online: Homelessness, organ donation, transplantation, and a call for equity in the United States

Ashley Warman / Lauren Sparber / Alexia Hebe Molmenti / Ernesto P. Molmenti

The Lancet Regional Health. Americas, Vol 22, Iss , Pp 100523- (2023)

2023

Abstract: Summary: While social justice is a pillar that society seeks to uphold, in the area of organ transplantation, social justice, equity, and inclusion fail in the unbefriended and undomiciled population. Due to lack of social support of the homeless ... ...

Abstract	Summary: While social justice is a pillar that society seeks to uphold, in the area of organ transplantation, social justice, equity, and inclusion fail in the unbefriended and undomiciled population. Due to lack of social support of the homeless population, such status often renders these individuals ineligible to be organ recipients. Though it can be argued that organ donation by an unbefriended, undomciled patient benefits the greater good, there is clear inequity in the fact that homeless individuals are denied transplants due to inadequate social support. To illustrate such social breakdown, we describe two unbefriended, undomiciled patients brought to our hospitals by emergency services with diagnoses of intracerebral haemorrhage that progressed to brain death. This proposal represents a call to action to remediate the broken system: how the inherent inequity in organ donation by unbefriended, undomiciled patients would be ethically optimized if social support systems were implemented to allow for their candidacy for organ transplantation.
Keywords	Homelessness ; Organ donation ; Transplantation ; Ethics ; Public aspects of medicine ; RA1-1270
Subject code	300
Language	English
Publishing date	2023-06-01T00:00:00Z
Publisher	Elsevier
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: A method for measuring the molecular ratio of inhalation to exhalation and effect of inspired oxygen levels on oxygen consumption

Koichiro Shinozaki / Yu Okuma / Kota Saeki / Santiago J. Miyara / Tomoaki Aoki / Ernesto P. Molmenti / Tai Yin / Junhwan Kim / Joshua W. Lampe / Lance B. Becker

Scientific Reports, Vol 11, Iss 1, Pp 1-

2021 Volume 13

Abstract: Abstract Using a new method for measuring the molecular ratio (R) of inhalation to exhalation, we investigated the effect of high fraction of inspired oxygen (FIO2) on oxygen consumption (VO2), carbon dioxide generation (VCO2), and respiratory quotient ( ... ...

Abstract	Abstract Using a new method for measuring the molecular ratio (R) of inhalation to exhalation, we investigated the effect of high fraction of inspired oxygen (FIO2) on oxygen consumption (VO2), carbon dioxide generation (VCO2), and respiratory quotient (RQ) in mechanically ventilated rats. Twelve rats were equally assigned into two groups by anesthetics: intravenous midazolam/fentanyl vs. inhaled isoflurane. R, VO2, VCO2, and RQ were measured at FIO2 0.3 or 1.0. R error was ± 0.003. R was 1.0099 ± 0.0023 with isoflurane and 1.0074 ± 0.0018 with midazolam/fentanyl. R was 1.0081 ± 0.0017 at an FIO2 of 0.3 and 1.0092 ± 0.0029 at an FIO2 of 1.0. There were no differences in VCO2 among the groups. VO2 increased at FIO2 1.0, which was more notable when midazolam/fentanyl was used (isoflurane-FIO2 0.3: 15.4 ± 1.1; isoflurane-FIO2 1.0: 17.2 ± 1.8; midazolam/fentanyl-FIO2 0.3: 15.4 ± 1.1; midazolam/fentanyl-FIO2 1.0: 21.0 ± 2.2 mL/kg/min at STP). The RQ was lower at FIO2 1.0 than FIO2 0.3 (isoflurane-FIO2 0.3: 0.80 ± 0.07; isoflurane-FIO2 1.0: 0.71 ± 0.05; midazolam/fentanyl-FIO2 0.3: 0.79 ± 0.03; midazolam/fentanyl-FIO2 1.0: 0.59 ± 0.04). R was not affected by either anesthetics or FIO2. Inspired 100% O2 increased VO2 and decreased RQ, which might be more remarkable when midazolam/fentanyl was used.
Keywords	Medicine ; R ; Science ; Q
Language	English
Publishing date	2021-06-01T00:00:00Z
Publisher	Nature Portfolio
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Inhaled Gases as Therapies for Post–Cardiac Arrest Syndrome

Kei Hayashida / Santiago J. Miyara / Koichiro Shinozaki / Ryosuke Takegawa / Tai Yin / Daniel M. Rolston / Rishabh C. Choudhary / Sara Guevara / Ernesto P. Molmenti / Lance B. Becker

Frontiers in Medicine, Vol

A Narrative Review of Recent Developments

2021 Volume 7

Abstract: Despite recent advances in the management of post–cardiac arrest syndrome (PCAS), the survival rate, without neurologic sequelae after resuscitation, remains very low. Whole-body ischemia, followed by reperfusion after cardiac arrest (CA), contributes to ...

Abstract	Despite recent advances in the management of post–cardiac arrest syndrome (PCAS), the survival rate, without neurologic sequelae after resuscitation, remains very low. Whole-body ischemia, followed by reperfusion after cardiac arrest (CA), contributes to PCAS, for which established pharmaceutical interventions are still lacking. It has been shown that a number of different processes can ultimately lead to neuronal injury and cell death in the pathology of PCAS, including vasoconstriction, protein modification, impaired mitochondrial respiration, cell death signaling, inflammation, and excessive oxidative stress. Recently, the pathophysiological effects of inhaled gases including nitric oxide (NO), molecular hydrogen (H2), and xenon (Xe) have attracted much attention. Herein, we summarize recent literature on the application of NO, H2, and Xe for treating PCAS. Recent basic and clinical research has shown that these gases have cytoprotective effects against PCAS. Nevertheless, there are likely differences in the mechanisms by which these gases modulate reperfusion injury after CA. Further preclinical and clinical studies examining the combinations of standard post-CA care and inhaled gas treatment to prevent ischemia–reperfusion injury are warranted to improve outcomes in patients who are being failed by our current therapies.
Keywords	cardiac arrest ; cardiopulmonary resuscitation ; ischemia-reperfusion injury ; neuroprotection ; nitric oxide ; xenon ; Medicine (General) ; R5-920
Subject code	610
Language	English
Publishing date	2021-01-01T00:00:00Z
Publisher	Frontiers Media S.A.
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Multi-Drug Cocktail Therapy Improves Survival and Neurological Function after Asphyxial Cardiac Arrest in Rodents

Rishabh C. Choudhary / Muhammad Shoaib / Kei Hayashida / Tai Yin / Santiago J. Miyara / Cristina d’Abramo / William G. Heuser / Koichiro Shinozaki / Nancy Kim / Ryosuke Takegawa / Mitsuaki Nishikimi / Timmy Li / Casey Owens / Ernesto P. Molmenti / Mingzhu He / Sonya Vanpatten / Yousef Al-Abed / Junhwan Kim / Lance B. Becker

Cells, Vol 12, Iss 1548, p

2023 Volume 1548

Abstract: Background: Cardiac arrest (CA) can lead to neuronal degeneration and death through various pathways, including oxidative, inflammatory, and metabolic stress. However, current neuroprotective drug therapies will typically target only one of these ... ...

Abstract	Background: Cardiac arrest (CA) can lead to neuronal degeneration and death through various pathways, including oxidative, inflammatory, and metabolic stress. However, current neuroprotective drug therapies will typically target only one of these pathways, and most single drug attempts to correct the multiple dysregulated metabolic pathways elicited following cardiac arrest have failed to demonstrate clear benefit. Many scientists have opined on the need for novel, multidimensional approaches to the multiple metabolic disturbances after cardiac arrest. In the current study, we have developed a therapeutic cocktail that includes ten drugs capable of targeting multiple pathways of ischemia–reperfusion injury after CA. We then evaluated its effectiveness in improving neurologically favorable survival through a randomized, blind, and placebo-controlled study in rats subjected to 12 min of asphyxial CA, a severe injury model. Results: 14 rats were given the cocktail and 14 received the vehicle after resuscitation. At 72 h post-resuscitation, the survival rate was 78.6% among cocktail-treated rats, which was significantly higher than the 28.6% survival rate among vehicle-treated rats (log-rank test; p = 0.006). Moreover, in cocktail-treated rats, neurological deficit scores were also improved. These survival and neurological function data suggest that our multi-drug cocktail may be a potential post-CA therapy that deserves clinical translation. Conclusions: Our findings demonstrate that, with its ability to target multiple damaging pathways, a multi-drug therapeutic cocktail offers promise both as a conceptual advance and as a specific multi-drug formulation capable of combatting neuronal degeneration and death following cardiac arrest. Clinical implementation of this therapy may improve neurologically favorable survival rates and neurological deficits in patients suffering from cardiac arrest.
Keywords	brain injury ; cell death ; cardiac arrest ; cardiopulmonary resuscitation ; cardiopulmonary bypass resuscitation ; ischemic damage ; Biology (General) ; QH301-705.5
Subject code	610
Language	English
Publishing date	2023-06-01T00:00:00Z
Publisher	MDPI AG
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Examination of patient characteristics and hydroxychloroquine use based on the US Food and Drug Administration’s recommendation

Martin Lesser / Kevin Coppa / Jamie S Hirsch / Sara Abrahams / Jennifer Johnson / Karina W Davidson / Stuart L Cohen / Stephen C Machnicki / Alex Makhnevich / Prashant Malhotra / Lyndonna Marrast / Ramanak Mitra / Ernesto P Molmenti / M Wasif Saif / Sanjaya Satapathy / Shalin Shah

BMJ Open, Vol 11, Iss

a cross-sectional analysis in New York

2021 Volume 2

Abstract: Objective To describe the pattern of hydroxychloroquine use and examine the association between hydroxychloroquine use and clinical outcomes arising from changes in the US Food and Drug Administration (FDA)’s recommendation during the coronavirus disease ...

Abstract	Objective To describe the pattern of hydroxychloroquine use and examine the association between hydroxychloroquine use and clinical outcomes arising from changes in the US Food and Drug Administration (FDA)’s recommendation during the coronavirus disease 2019 (COVID-19) pandemic.Design A retrospective cross-sectional analysis.Setting and participants We included hospitalised adult patients at Northwell Health hospitals with confirmed COVID-19 infections between 1 March 2020 and 11 May 2020. We categorised changes in the FDA’s recommendation as pre-FDA approval (1 March 2020–27 March 2020), FDA approval (28 March 2020–23 April 2020), and FDA warning (24 April 2020–11 May 2020). The hydroxychloroquine-treated group received at least one dose within 48 hours of hospital admission.Primary outcome A composite of intubation and inpatient death.Results The percentages of patients who were treated with hydroxychloroquine were 192/2202 (8.7%) pre-FDA approval, 2902/6741 (43.0%) FDA approval, and 176/1066 (16.5%) FDA warning period (p<0.001). Using propensity score matching, there was a higher rate of the composite outcome among patients treated with hydroxychloroquine (49/192, 25.5%) compared with no hydroxychloroquine (66/384, 17.2%) in the pre-FDA approval period (p=0.03) but not in the FDA approval period (25.5% vs 22.6%, p=0.08) or the FDA warning (21.0% vs 15.1%, p=0.11) periods. Coincidently, there was an increase in number of patients with COVID-19 and disease severity during the FDA approval period (24.1% during FDA approval vs 21.4% during pre-FDA approval period had the composite outcome). Hydroxychloroquine use was associated with increased odds of the composite outcome during the pre-FDA approval period (OR=1.65 (95% CI 1.09 to 2.51)) but not during the FDA approval (OR=1.17 (95% CI 0.99 to 1.39)) and FDA warning (OR=1.50 (95% CI 0.94 to 2.39)) periods.Conclusions Hydroxychloroquine use was associated with adverse clinical outcomes only during the pre-FDA approval period but not during the FDA approval and ...
Keywords	Medicine ; R
Subject code	330
Language	English
Publishing date	2021-02-01T00:00:00Z
Publisher	BMJ Publishing Group
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Totally laparoscopic left hepatectomy using the Torsional Ultrasonic Scalpel

Athanasios Voutsarakis / Ernesto P Molmenti / Petros Charalampoudis / Paraskevas Stamopoulos / Georgios C Sotiropoulos / Gregory Kouraklis

World Journal of Gastroenterology, Vol 19, Iss 35, Pp 5929-

2013 Volume 5932

Abstract: Minimal invasive techniques have allowed for major surgical advances. We report our initial experience of performing total laparoscopic left hepatectomy (segments II-IV) with the Lotus (laparoscopic operation by torsional ultrasound) Ultrasonic Scalpel. ... ...

Abstract	Minimal invasive techniques have allowed for major surgical advances. We report our initial experience of performing total laparoscopic left hepatectomy (segments II-IV) with the Lotus (laparoscopic operation by torsional ultrasound) Ultrasonic Scalpel. The perioperative and postoperative courses of the young female patient were uneventful and she is in a good general condition without complaints 18 mo after surgery. To the best of our knowledge, this is the first total laparoscopic hemihepatectomy to be performed in Greece, as well as the first laparoscopic liver resection using Lotus shears.
Keywords	Laparoscopic surgery ; Liver resection ; Minimally invasive surgery ; Hepatectomy ; Bloodless surgery ; Ultrasonic Scalpel ; Ultrasonic dissector ; Parenchyma transection ; Liver adenoma ; Focal nodular hyperplasia ; Diseases of the digestive system. Gastroenterology ; RC799-869 ; Specialties of internal medicine ; RC581-951 ; Internal medicine ; RC31-1245 ; Medicine ; R ; DOAJ:Gastroenterology ; DOAJ:Medicine (General) ; DOAJ:Health Sciences
Subject code	610
Language	English
Publishing date	2013-01-01T00:00:00Z
Publisher	Baishideng Publishing Group Co., Limited
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Bilateral Spontaneous Pneumothorax in a COVID-19 and HIV-Positive Patient

Frontiers in Medicine, Vol

A Case Report

2021 Volume 8

Abstract: This case report describes a 60 year-old Black-American male with a past medical history of human immunodeficiency virus (HIV) infection and hyperthyroidism, who suffered a bilateral spontaneous pneumothorax (SP) in the setting of coronavirus disease ... ...

Abstract	This case report describes a 60 year-old Black-American male with a past medical history of human immunodeficiency virus (HIV) infection and hyperthyroidism, who suffered a bilateral spontaneous pneumothorax (SP) in the setting of coronavirus disease 2019 (COVID-19) pneumonia. SP is a well-established complication in HIV-positive patients and only recently has been associated with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection. While HIV and COVID-19 infections have been independently linked with increased risk of SP development, it is unknown if both infections interact in a synergistic fashion to exacerbate SP risk. According to the Centers for Disease Control and Prevention (CDC), patients living with HIV have a higher risk of developing severe COVID-19 infection and the mechanism remains to be elucidated. To the best of our knowledge, this is the first report of a HIV-positive patient, who in the setting of SARS-CoV-2 infection, developed bilateral apical spontaneous pneumothorax and was later found to have a left lower lobe tension pneumothorax. This case highlights the importance of considering SP on the differential diagnosis when HIV-positive patients suddenly develop respiratory distress in the setting of SARS-CoV-2 infection.
Keywords	COVID-19 ; SARS-CoV-2 ; spontaneous pneumothorax ; tension pneumothorax ; bilateral pneumothorax ; HIV/AIDS ; Medicine (General) ; R5-920
Subject code	610
Language	English
Publishing date	2021-12-01T00:00:00Z
Publisher	Frontiers Media S.A.
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Hydrogen gas with extracorporeal cardiopulmonary resuscitation improves survival after prolonged cardiac arrest in rats

Journal of Translational Medicine, Vol 19, Iss 1, Pp 1-

2021 Volume 12

Abstract: Abstract Background Despite the benefits of extracorporeal cardiopulmonary resuscitation (ECPR) in cohorts of selected patients with cardiac arrest (CA), extracorporeal membrane oxygenation (ECMO) includes an artificial oxygenation membrane and circuits ... ...

Abstract	Abstract Background Despite the benefits of extracorporeal cardiopulmonary resuscitation (ECPR) in cohorts of selected patients with cardiac arrest (CA), extracorporeal membrane oxygenation (ECMO) includes an artificial oxygenation membrane and circuits that contact the circulating blood and induce excessive oxidative stress and inflammatory responses, resulting in coagulopathy and endothelial cell damage. There is currently no pharmacological treatment that has been proven to improve outcomes after CA/ECPR. We aimed to test the hypothesis that administration of hydrogen gas (H2) combined with ECPR could improve outcomes after CA/ECPR in rats. Methods Rats were subjected to 20 min of asphyxial CA and were resuscitated by ECPR. Mechanical ventilation (MV) was initiated at the beginning of ECPR. Animals were randomly assigned to the placebo or H2 gas treatment groups. The supplement gas was administered with O2 through the ECMO membrane and MV. Survival time, electroencephalography (EEG), brain functional status, and brain tissue oxygenation were measured. Changes in the plasma levels of syndecan-1 (a marker of endothelial damage), multiple cytokines, chemokines, and metabolites were also evaluated. Results The survival rate at 4 h was 77.8% (7 out of 9) in the H2 group and 22.2% (2 out of 9) in the placebo group. The Kaplan–Meier analysis showed that H2 significantly improved the 4 h-survival endpoint (log-rank P = 0.025 vs. placebo). All animals treated with H2 regained EEG activity, whereas no recovery was observed in animals treated with placebo. H2 therapy markedly improved intra-resuscitation brain tissue oxygenation and prevented an increase in central venous pressure after ECPR. H2 attenuated an increase in syndecan-1 levels and enhanced an increase in interleukin-10, vascular endothelial growth factor, and leptin levels after ECPR. Metabolomics analysis identified significant changes at 2 h after CA/ECPR between the two groups, particularly in d-glutamine and d-glutamate metabolism. Conclusions H2 therapy ...
Keywords	Heart arrest ; Extracorporeal cardiopulmonary resuscitation ; Extracorporeal membrane oxygenation ; Hydrogen ; Ischemia reperfusion injury ; Medicine ; R
Subject code	610
Language	English
Publishing date	2021-11-01T00:00:00Z
Publisher	BMC
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Approach to the Pretransplant Evaluation of the Living Kidney Donor

Mala Sachdeva / Madhu Bhaskaran / Ernesto P. Molmenti / Donna Dalton / Joseph Mattana

Journal of Transplantation, Vol

2011 Volume 2011

Keywords	Surgery ; RD1-811 ; Medicine ; R
Language	English
Publishing date	2011-01-01T00:00:00Z
Publisher	Hindawi Publishing Corporation
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: An asymptomatic tubular villous adenoma in a young male

John Procaccino / Gene F. Coppa / Ernesto P. Molmenti / Tamar Lipof / Kavin Shah

Journal of Solid Tumors, Vol 1, Iss

A case report

2011 Volume 1

Abstract: Polyps of the colon are a common occurrence, and whose incidence increases with age. Polyps have the ability to transform into neoplasms, and the polyp’s likelihood of becoming cancerous is closely related to its size. The larger a polyp grows, the more ... ...

Abstract	Polyps of the colon are a common occurrence, and whose incidence increases with age. Polyps have the ability to transform into neoplasms, and the polyp’s likelihood of becoming cancerous is closely related to its size. The larger a polyp grows, the more likely it is to become cancerous. Once a polyp reaches 2 cm, the risk of malignant transformation is in excess of 20%. There are several subtypes of polyps: tubular, villous, or tubulovillous. Villous adenomas are the most likely to transform, whereas tubular adenomas carry the least risk. Symptoms range from anemia and constipation, to abdominal pain and obstruction, depending on the size and location of the lesion. As a general rule, the larger the size of the polyp, the likelihood for pain and obstruction increases. Herein we present a case of a young patient presenting with mild anemia who was found to have a giant tubulovillous adenoma.
Keywords	Neoplasms. Tumors. Oncology. Including cancer and carcinogens ; RC254-282 ; Internal medicine ; RC31-1245 ; Medicine ; R ; DOAJ:Oncology ; DOAJ:Medicine (General) ; DOAJ:Health Sciences
Subject code	170
Language	English
Publishing date	2011-09-01T00:00:00Z
Publisher	Sciedu Press
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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