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Article ; Online: Predicting Outcomes of High-Flow Nasal Cannula for Acute Respiratory Distress Syndrome. An Index that ROX.

Hill, Nicholas S / Ruthazer, Robin

American journal of respiratory and critical care medicine

2019 Volume 199, Issue 11, Page(s) 1300–1302

MeSH term(s)	Cannula ; Humans ; Noninvasive Ventilation ; Oxygen Inhalation Therapy ; Respiratory Distress Syndrome, Adult ; Respiratory Rate
Language	English
Publishing date	2019-02-15
Publishing country	United States
Document type	Journal Article ; Comment
ZDB-ID	1180953-x
ISSN	1535-4970 ; 0003-0805 ; 1073-449X
ISSN (online)	1535-4970
ISSN	0003-0805 ; 1073-449X
DOI	10.1164/rccm.201901-0079ED
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Article ; Online: Optimal Timing to Utilize Olfactory Stimulation with Maternal Breast Milk to Improve Oral Feeding Skills in the Premature Newborn.

Davidson, Jessica / Ruthazer, Robin / Maron, Jill L

Breastfeeding medicine : the official journal of the Academy of Breastfeeding Medicine

2019 Volume 14, Issue 4, Page(s) 230–235

Abstract: Background: ...

Abstract	Background:
MeSH term(s)	Breast Feeding ; Female ; Gestational Age ; Humans ; Infant Nutritional Physiological Phenomena ; Infant, Newborn ; Infant, Premature ; Kaplan-Meier Estimate ; Male ; Milk, Human/chemistry ; Mothers ; Odorants ; Prospective Studies ; Smell
Language	English
Publishing date	2019-03-18
Publishing country	United States
Document type	Journal Article ; Randomized Controlled Trial
ZDB-ID	2234680-6
ISSN	1556-8342 ; 1556-8253
ISSN (online)	1556-8342
ISSN	1556-8253
DOI	10.1089/bfm.2018.0180
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Article ; Online: Long-Wave Infrared Imaging for Intraoperative Cancer Detection-What is the True Temperature of a Cancer?

Vaughn, Stephanie / Ruthazer, Robin / Rosenblatt, Andrew / Jenkins, Roger L / Sorcini, Andrea P / Schnelldorfer, Thomas

Surgical innovation

2021 Volume 29, Issue 3, Page(s) 378–384

Abstract: Background: During cancer operations, the cancer itself is often hard to delineate-buried beneath healthy tissue and lacking discernable differences from the surrounding healthy organ. Long-wave infrared, or thermal, imaging poses a unique solution to ... ...

Abstract	Background: During cancer operations, the cancer itself is often hard to delineate-buried beneath healthy tissue and lacking discernable differences from the surrounding healthy organ. Long-wave infrared, or thermal, imaging poses a unique solution to this problem, allowing for the real-time label-free visualization of temperature deviations within the depth of tissues. The current study evaluated this technology for intraoperative cancer detection. Methods: In this diagnostic study, patients with gastrointestinal, hepatobiliary, and renal cancers underwent long-wave infrared imaging of the malignancy during routine operations. Results: It was found that 74% were clearly identifiable as hypothermic anomalies. The average temperature difference was 2.4°C (range 0.7 to 5.0) relative to the surrounding tissue. Cancers as deep as 3.3 cm from the surgical surface were visualized. Yet, 79% of the images had clinically relevant false positive signals [median 3 per image (range 0 to 10)] establishing an accuracy of 47%. Analysis suggests that the degree of temperature difference was primarily determined by features within the cancer and not peritumoral changes in the surrounding tissue. Conclusion: These findings provide important information on the unexpected hypothermal properties of intra-abdominal cancers, directions for future use of intraoperative long-wave infrared imaging, and new knowledge about the in vivo thermal energy expenditure of cancers and peritumoral tissue.
MeSH term(s)	Humans ; Neoplasms ; Temperature
Language	English
Publishing date	2021-10-12
Publishing country	United States
Document type	Journal Article
ZDB-ID	2182571-3
ISSN	1553-3514 ; 1553-3506
ISSN (online)	1553-3514
ISSN	1553-3506
DOI	10.1177/15533506211046096
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Zs.A 4269: Show issues

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Article ; Online: Understanding Longitudinal Changes in Pulmonary Vascular Resistance After Left Ventricular Assist Device Implantation.

Gulati, Gaurav / Ruthazer, Robin / Denofrio, David / Vest, Amanda R / Kent, David / Kiernan, Michael S

Journal of cardiac failure

2021 Volume 27, Issue 5, Page(s) 552–559

Abstract: Background: Elevated pulmonary vascular resistance (PVR) is common in patients with advanced heart failure. PVR generally improves after left ventricular assist device (LVAD) implantation, but the rate of decrease has not been quantified and the patient ...

Abstract	Background: Elevated pulmonary vascular resistance (PVR) is common in patients with advanced heart failure. PVR generally improves after left ventricular assist device (LVAD) implantation, but the rate of decrease has not been quantified and the patient characteristics most strongly associated with this improvement are unknown. Methods and results: We analyzed 1581 patients from the Interagency Registry for Mechanically Assisted Circulatory Support registry who received a primary continuous-flow LVAD, had a baseline PVR of ≥3 Wood units (WU), and had PVR measured at least once postoperatively. Multivariable linear mixed effects modeling was used to evaluate independent associations between postoperative PVR and patient characteristics. PVR decreased by 1.53 WU (95% confidence interval [CI] 1.27-1.79 WU) per month in the first 3 months postoperatively, and by 0.066 WU (95% CI 0.060-0.070 WU) per month thereafter. Severe mitral regurgitation at any time during follow-up was associated with a 1.29 WU (95% CI 1.05-1.52 WU) higher PVR relative to absence of mitral regurgitation at that time. In a cross-sectional analysis, 15%-25% of patients had persistently elevated PVR of ≥3 WU at any given time within 36 months after LVAD implantation. Conclusion: The PVR tends to decrease rapidly early after implantation, and only more gradually thereafter. Residual mitral regurgitation may be an important contributor to elevated postoperative PVR. Future research is needed to understand the implications of elevated PVR after LVAD implantation and the optimal strategies for prevention and treatment.
MeSH term(s)	Cross-Sectional Studies ; Heart Failure/therapy ; Heart Transplantation ; Heart-Assist Devices ; Humans ; Hypertension, Pulmonary ; Retrospective Studies ; Treatment Outcome ; Vascular Resistance
Language	English
Publishing date	2021-01-12
Publishing country	United States
Document type	Journal Article
ZDB-ID	1281194-4
ISSN	1532-8414 ; 1071-9164
ISSN (online)	1532-8414
ISSN	1071-9164
DOI	10.1016/j.cardfail.2021.01.004
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Article ; Online: Early Allograft Dysfunction Following Liver Transplant: Impact of Obesity, Diabetes, and Red Blood Cell Transfusion.

Hudcova, Jana / Qasmi, Syed Talha / Ruthazer, Robin / Waqas, Ahsan / Haider, Syed Basit / Schumann, Roman

Transplantation proceedings

2020 Volume 53, Issue 1, Page(s) 119–123

Abstract: Purpose: We examined the role of obesity and intraoperative red blood cell (RBC) and platelet transfusion in early allograft dysfunction (EAD) following liver transplantation (LT).: Methods: This is a retrospective analysis of 239 adult deceased- ... ...

Abstract	Purpose: We examined the role of obesity and intraoperative red blood cell (RBC) and platelet transfusion in early allograft dysfunction (EAD) following liver transplantation (LT). Methods: This is a retrospective analysis of 239 adult deceased-donor LT recipients over a 10-year period. EAD was defined by Olthoff's criteria. Data collection included donor (D) and recipient (R) age, body mass index (BMI) ≥ 35 kg/m Results: EAD occurred in 85 recipients (36%). Macrosteatosis data were available for 199 donors. In the multivariate analyses, BMI-D ≥ 35 kg/m Conclusion: We found a significant independent association of donor obesity and intraoperative RBC transfusion with EAD but no such association for platelet administration, MELD score, age, recipient obesity, and diabetes.
MeSH term(s)	Adult ; Cohort Studies ; Diabetes Mellitus ; Erythrocyte Transfusion/adverse effects ; Female ; Humans ; Liver Transplantation/adverse effects ; Male ; Middle Aged ; Obesity/complications ; Primary Graft Dysfunction/etiology ; Retrospective Studies ; Risk Factors
Language	English
Publishing date	2020-07-18
Publishing country	United States
Document type	Journal Article
ZDB-ID	82046-5
ISSN	1873-2623 ; 0041-1345
ISSN (online)	1873-2623
ISSN	0041-1345
DOI	10.1016/j.transproceed.2020.02.168
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Zs.A 835: Show issues

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Article ; Online: Targeting of the diabetes prevention program leads to substantial benefits when capacity is constrained.

Olchanski, Natalia / van Klaveren, David / Cohen, Joshua T / Wong, John B / Ruthazer, Robin / Kent, David M

Acta diabetologica

2021 Volume 58, Issue 6, Page(s) 707–722

Abstract: Objective: Approximately 84 million people in the USA have pre-diabetes, but only a fraction of them receive proven effective therapies to prevent type 2 diabetes. We estimated the value of prioritizing individuals at highest risk of progression to ... ...

Abstract	Objective: Approximately 84 million people in the USA have pre-diabetes, but only a fraction of them receive proven effective therapies to prevent type 2 diabetes. We estimated the value of prioritizing individuals at highest risk of progression to diabetes for treatment, compared to non-targeted treatment of individuals meeting inclusion criteria for the Diabetes Prevention Program (DPP). Methods: Using microsimulation to project outcomes in the DPP trial population, we compared two interventions to usual care: (1) lifestyle modification and (2) metformin administration. For each intervention, we compared targeted and non-targeted strategies, assuming either limited or unlimited program capacity. We modeled the individualized risk of developing diabetes and projected diabetic outcomes to yield lifetime costs and quality-adjusted life expectancy, from which we estimated net monetary benefits (NMB) for both lifestyle and metformin versus usual care. Results: Compared to usual care, lifestyle modification conferred positive benefits and reduced lifetime costs for all eligible individuals. Metformin's NMB was negative for the lowest population risk quintile. By avoiding use when costs outweighed benefits, targeted administration of metformin conferred a benefit of $500 per person. If only 20% of the population could receive treatment, when prioritizing individuals based on diabetes risk, rather than treating a 20% random sample, the difference in NMB ranged from $14,000 to $20,000 per person. Conclusions: Targeting active diabetes prevention to patients at highest risk could improve health outcomes and reduce costs compared to providing the same intervention to a similar number of patients with pre-diabetes without targeted selection.
MeSH term(s)	Adult ; Cohort Studies ; Cost-Benefit Analysis ; Diabetes Mellitus, Type 2/economics ; Diabetes Mellitus, Type 2/epidemiology ; Diabetes Mellitus, Type 2/prevention & control ; Female ; Health Services Accessibility/economics ; Health Services Accessibility/organization & administration ; Health Services Accessibility/statistics & numerical data ; Humans ; Hypoglycemic Agents/economics ; Hypoglycemic Agents/therapeutic use ; Life Expectancy ; Life Style ; Male ; Metformin/economics ; Metformin/therapeutic use ; Middle Aged ; Patient Selection ; Prediabetic State/economics ; Prediabetic State/epidemiology ; Prediabetic State/therapy ; Primary Prevention/economics ; Primary Prevention/methods ; Primary Prevention/organization & administration ; Primary Prevention/statistics & numerical data ; Quality of Life ; Risk Factors ; Standard of Care/economics ; Standard of Care/organization & administration ; Standard of Care/standards ; United States/epidemiology
Chemical Substances	Hypoglycemic Agents ; Metformin (9100L32L2N)
Language	English
Publishing date	2021-01-30
Publishing country	Germany
Document type	Journal Article
ZDB-ID	1097676-0
ISSN	1432-5233 ; 0940-5429
ISSN (online)	1432-5233
ISSN	0940-5429
DOI	10.1007/s00592-021-01672-3
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Zs.A 611: Show issues

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Article ; Online: Factors associated with neutropenia post heart transplantation.

Chow, Jennifer K L / Ruthazer, Robin / Boucher, Helen W / Vest, Amanda R / DeNofrio, David M / Snydman, David R

Transplant infectious disease : an official journal of the Transplantation Society

2021 Volume 23, Issue 4, Page(s) e13634

Abstract: Background: Neutropenia is a serious complication following heart transplantation (OHT); however, risk factors for its development and its association with outcomes is not well described. We sought to study the prevalence of neutropenia, risk factors ... ...

Abstract	Background: Neutropenia is a serious complication following heart transplantation (OHT); however, risk factors for its development and its association with outcomes is not well described. We sought to study the prevalence of neutropenia, risk factors associated with its development, and its impact on infection, rejection, and survival. Methods: A retrospective single-center analysis of adult OHT recipients from July 2004 to December 2017 was performed. Demographic, laboratory, medication, infection, rejection, and survival data were collected for 1 year post-OHT. Baseline laboratory measurements were collected within the 24 hours before OHT. Neutropenia was defined as absolute neutrophil count ≤1000 cells/mm3. Cox proportional hazards models explored associations with time to first neutropenia. Associations between neutropenia, analyzed as a time-dependent covariate, with secondary outcomes of time to infection, rejection, or death were also examined. Results: Of 278 OHT recipients, 84 (30%) developed neutropenia at a median of 142 days (range 81-228) after transplant. Factors independently associated with increased risk of neutropenia included lower baseline WBC (HR 1.12; 95% CI 1.11-1.24), pre-OHT ventricular assist device (1.63; 1.00-2.66), high-risk CMV serostatus [donor positive, recipient negative] (1.86; 1.19-2.88), and having a previous CMV infection (4.07; 3.92-13.7). Conclusions: Neutropenia is a fairly common occurrence after adult OHT. CMV infection was associated with subsequent neutropenia, however, no statistically significant differences in outcomes were found between neutropenic and non-neutropenic patients in this small study. It remains to be determined in future studies if medication changes in response to neutropenia would impact patient outcomes.
MeSH term(s)	Cytomegalovirus Infections ; Heart Transplantation/adverse effects ; Heart-Assist Devices/adverse effects ; Humans ; Neutropenia/epidemiology ; Retrospective Studies
Language	English
Publishing date	2021-06-01
Publishing country	Denmark
Document type	Journal Article
ZDB-ID	1476094-0
ISSN	1399-3062 ; 1398-2273
ISSN (online)	1399-3062
ISSN	1398-2273
DOI	10.1111/tid.13634
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Article ; Online: Can We Accurately Identify Peritoneal Metastases Based on Their Appearance? An Assessment of the Current Practice of Intraoperative Gastrointestinal Cancer Staging.

Schnelldorfer, Thomas / Ware, Matthew P / Liu, Li Ping / Sarr, Michael G / Birkett, Desmond H / Ruthazer, Robin

Annals of surgical oncology

2019 Volume 26, Issue 6, Page(s) 1795–1804

Abstract: Background: Peritoneal lesions are common findings during operative abdominal cancer staging. The decision to perform biopsy is made subjectively by the surgeon, a practice the authors hypothesized to be imprecise. This study aimed to describe optical ... ...

Abstract	Background: Peritoneal lesions are common findings during operative abdominal cancer staging. The decision to perform biopsy is made subjectively by the surgeon, a practice the authors hypothesized to be imprecise. This study aimed to describe optical characteristics differentiating benign peritoneal lesions from peritoneal metastases. Methods: The study evaluated laparoscopic images of 87 consecutive peritoneal lesions biopsied during staging laparoscopies for gastrointestinal malignancies from 2014 to 2017. A blinded survey assessing these lesions was completed by 10 oncologic surgeons. Three senior investigators categorized optical features of the lesions. Computer-aided digital image processing and machine learning was used to classify the lesions. Results: Of the 87 lesions, 28 (32%) were metastases. On expert survey, surgeons on the average misidentified 36 ± 19% of metastases. Multivariate analysis identified degree of nodularity, border transition, and degree of transparency as independent predictors of metastases (each p < 0.03), with an area under the receiver operating characteristics curve (AUC) of 0.82 (95% confidence interval [CI], 0.72-0.91). Image processing demonstrated no difference using image color segmentation, but showed a difference in gradient magnitude between benign and metastatic lesions (AUC, 0.66; 95% CI 0.54-0.78; p = 0.02). Machine learning using a neural network with a tenfold cross-validation obtained an AUC of only 0.47. Conclusions: To date, neither experienced oncologic surgeons nor computerized image analysis can differentiate peritoneal metastases from benign peritoneal lesions with an accuracy that is clinically acceptable. Although certain features correlate with the presence of metastases, a substantial overlap in optical appearance exists between benign and metastatic peritoneal lesions. Therefore, this study suggested the need to perform biopsy for all peritoneal lesions during operative staging, or at least to lower the threshold significantly.
MeSH term(s)	Adenocarcinoma/pathology ; Adenocarcinoma/surgery ; Adult ; Aged ; Aged, 80 and over ; Cohort Studies ; Female ; Follow-Up Studies ; Gastrointestinal Neoplasms/pathology ; Gastrointestinal Neoplasms/surgery ; Humans ; Image Processing, Computer-Assisted/methods ; Intraoperative Care ; Laparoscopy ; Machine Learning ; Male ; Middle Aged ; Neoplasm Staging ; Peritoneal Neoplasms/secondary ; Peritoneal Neoplasms/surgery ; Practice Patterns, Physicians'/trends ; Prognosis
Language	English
Publishing date	2019-03-25
Publishing country	United States
Document type	Journal Article
ZDB-ID	1200469-8
ISSN	1534-4681 ; 1068-9265
ISSN (online)	1534-4681
ISSN	1068-9265
DOI	10.1245/s10434-019-07292-0
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Article ; Online: In Response.

Hudcova, Jana / Ruthazer, Robin / Schumann, Roman

Anesthesia and analgesia

2015 Volume 122, Issue 3, Page(s) 917

MeSH term(s)	Female ; Humans ; Hypernatremia/blood ; Hyponatremia/blood ; Liver Transplantation ; Male ; Sodium/blood
Chemical Substances	Sodium (9NEZ333N27)
Language	English
Publishing date	2015-06-26
Publishing country	United States
Document type	Letter ; Comment
ZDB-ID	80032-6
ISSN	1526-7598 ; 0003-2999
ISSN (online)	1526-7598
ISSN	0003-2999
DOI	10.1213/ANE.0000000000001052
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Article ; Online: Hodgkin lymphoma post-transplant lymphoproliferative disorder: A comparative analysis of clinical characteristics, prognosis, and survival.

Rosenberg, Aaron S / Klein, Andreas K / Ruthazer, Robin / Evens, Andrew M

American journal of hematology

2016 Volume 91, Issue 6, Page(s) 560–565

Abstract: Hodgkin lymphoma post-transplant lymphoproliferative disorder (HL-PTLD) is an uncommon PTLD with unclear prognosis and differences between HL-PTLD and immunocompetent HL are not well defined. Patient characteristics were compared among 192 patients with ... ...

Abstract	Hodgkin lymphoma post-transplant lymphoproliferative disorder (HL-PTLD) is an uncommon PTLD with unclear prognosis and differences between HL-PTLD and immunocompetent HL are not well defined. Patient characteristics were compared among 192 patients with HL-PTLD from the Scientific Registry of Transplant Recipients and 13,847 HL patients in SEER (HL-SEER). Overall survival (OS) and disease-specific survival (DSS) were compared after exact matching. Additionally, multivariable analyses were used to identify prognostic markers of survival and associations between treatment and survival. Median time from transplant to HL-PTLD diagnosis was 88 months. When compared with HL-SEER, patients with HL-PTLD were older (median age, 52 vs. 36 years, P = 0.001), more likely male (73% vs. 54%, P < 0.001), Caucasian (81% vs. 70%, P = 0.02), and had extranodal disease (42% vs. 3%, P < 0.001). Five-year OS for patients with HL-PTLD was 57% versus 80% for HL-SEER (P < 0.001); DSS was also inferior (P < 0.001). For patients with HL-PTLD, the use of any chemotherapy was associated with decreased hazard of death (HR = 0.36, P < 0.001). Furthermore, patients who received no chemotherapy or nontraditional HL regimens had increased hazard of death (aHR = 2.94, P = 0.001 and 2.01, P = 0.04) versus HL-specific chemotherapy regimens. In multivariable analysis, advanced age and elevated creatinine were associated with inferior OS (aHR = 1.26/decade P < 0.001 and 1.64/0.1 mg/dL increase P = 0.02). A prognostic score based on the number of these adverse factors (0, 1, 2) was associated with 10-year OS rates of 79%, 53%, and 11%, respectively (P < 0.001). Altogether, HL-PTLD patients have inferior survival when compared with HL-SEER. Furthermore, treatment with HL-specific chemotherapy was associated with improved OS, whereas age and creatinine identified patients with markedly divergent survival. Am. J. Hematol. 91:560-565, 2016. © 2016 Wiley Periodicals, Inc.
MeSH term(s)	Adult ; Age Factors ; Antineoplastic Agents/therapeutic use ; Creatine/blood ; Female ; Hodgkin Disease/mortality ; Hodgkin Disease/therapy ; Humans ; Lymphoproliferative Disorders/mortality ; Lymphoproliferative Disorders/therapy ; Male ; Middle Aged ; Prognosis ; Registries ; Survival Analysis ; Survival Rate ; Treatment Outcome ; Young Adult
Chemical Substances	Antineoplastic Agents ; Creatine (MU72812GK0)
Language	English
Publishing date	2016-04-26
Publishing country	United States
Document type	Comparative Study ; Journal Article ; Research Support, N.I.H., Extramural ; Research Support, U.S. Gov't, P.H.S.
ZDB-ID	196767-8
ISSN	1096-8652 ; 0361-8609
ISSN (online)	1096-8652
ISSN	0361-8609
DOI	10.1002/ajh.24346
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