Nicole Lin

All Publications

• Obesity portends an increased risk of thromboembolic events in severely injured geriatric trauma, a retrospective study. American journal of surgery Zangbar, B., Lin, N., Rafieezadeh, A., Kirsch, J., Shnaydman, I., Eckenberg, L., Froula, G., Klein, J., Bronstein, M., Prabhakaran, K. 2025; 240: 116139

  Abstract

  Obesity is a known risk factor for thromboembolic complications in trauma patients. The aim of our study is to evaluate the prevalence of thrombotic complications in obese geriatric patients.We performed a retrospective analysis of TQIP (2017-2019). A total of 119,906 patients≥65 years who sustained severe trauma were included. Primary outcomes were thrombotic complications including stroke/cerebrovascular accidents (CVA), myocardial infarction (MI), deep vein thrombosis (DVT) and pulmonary embolism (PE). Outcomes were compared between patients with obesity (BMI≥30 ​kg∖m2) and overweight (25 ​kg∖m2≤BMI<30 ​kg∖m2) and normal weight (19 ​kg∖m2≤BMI<25 ​kg∖m2) patients.A total number of 30,356 (26.8 ​%) patients were obese. All clotting complications (stroke/CVA, MI, DVT and PE) were significantly more frequent among obese patients (p ​< ​0.001for all). Multivariate logistic regression showed that obese patients had significantly increased odds of stroke/CVA (OR ​= ​1.207), MI (OR ​= ​1.301), DVT (OR ​= ​1.311) and PE (OR ​= ​1.241) (p ​< ​0.001 for all).Obese geriatric patients who sustain severe traumatic injuries are at increased risk of thromboembolic complications compared to non-obese patients.Level III retrospective study.

  View details for DOI 10.1016/j.amjsurg.2024.116139

  View details for PubMedID 39671969

• The association of chylothorax with aggressiveness of lymph node management during pulmonary resection. The Annals of thoracic surgery Kamtam, D. N., Berry, M. F., Lin, N., Kapula, N., Kim, J. J., Wallen, B., Satoyoshi, M., Elliott, I. A., Guenthart, B. A., Liou, D. Z., Lui, N. S., Backhus, L. M., Shrager, J. B. 2025

  Abstract

  Chylothorax is a morbid and costly complication that can originate in lymph node resection beds. We hypothesized a close association between the occurrence of chylothorax and the extent/aggressiveness of lymph node dissection.We conducted a nested case-control study of 1728 non-small cell lung cancer patients who underwent resection at our institution January 2005-July 2023. Cases were defined as patients who developed chylothorax. Each case was matched with 3 control subjects who did not develop chylothorax, based on year of diagnosis, clinical N-descriptor, presence of granulomatous lymph nodes, extent of resection, and tumor laterality. Using conditional logistic regression, we estimated risk ratios with 95% confidence intervals to examine the association between the occurrence of chylothorax and several measures of the extent of lymph node resection.The incidence of chylothorax was 33/1728 (1.9%). In the matched groups, patients with chylothorax had higher rates of complete lymphadenectomy (82% vs. 65%, p=0.059) and systematic lymph node dissection as defined by IASLC/ESMO/ESTS (85% vs. 52%, p=0.002). Station 2 was resected significantly more often in the chylothorax group (48.5% vs. 29%, p=0.04). The chylothorax group had a longer median in-hospital stay (7 vs. 4 days, p=0.003), and higher reoperation (18% vs. 1.0%, p=0.006) and readmission (18% vs. 5%, p=0.03) rates.In matched groups, chylothorax is associated with several measures of more aggressive lymph node management and results in substantial postoperative morbidity. This finding provides additional support for more selective lymph node management approaches when resecting smaller, less-solid, less 18-fluorodeoxyglucose-avid tumors.

  View details for DOI 10.1016/j.athoracsur.2025.01.019

  View details for PubMedID 39894428

• Surgeon specialty and surveillance after resection for non-small cell lung cancer JTCVS OPEN Lin, N., Wu, J., Adams, S., Asch, S., Zeliadt, S., Sox-Harris, A., Han, S., Backhus, L. 2024; 22: 470-475

  View details for DOI 10.1016/j.xjon.2024.09.001

  View details for Web of Science ID 001389190400001

• Trends in the Use of Minimally Invasive Approaches to Lobectomy for Early-Stage Lung Cancer Resection: A Nationwide Analysis Lin, N., Guenthart, B., Kapula, N., Lui, N., Backhus, L. M., Berry, M. LIPPINCOTT WILLIAMS & WILKINS. 2024: S486

  View details for Web of Science ID 001348680703180

• National Trend of Surgical Stabilization of Rib Fractures: Indications, Approaches, and Disparities. The Journal of surgical research Zangbar, B., Rafieezadeh, A., Kirsch, J., Lin, N., Prabhakaran, K. 2024; 303: 691-698

  Abstract

  Rib fractures are among the most frequent injuries in trauma. This study aims to assess the current nationwide trends in operative rib fixation and identify predictors of surgical stabilization of rib fractures (SSRFs).A 5-y (2017-2021) retrospective analysis of the Trauma Quality Improvement Program database was performed. Adult trauma patients who had at least one rib fracture were included. We analyzed data regarding type of SSRF including open and thoracoscopic approaches and its trends.A total of 780,275 patients were identified, of which 15,339 patients (1.9%) were managed with SSRF. Trends of both open and endoscopic approaches were increasing during the study period. Patients with ≤2 rib fractures had a decreasing rate of SSRF. Flail chest (odds ratio = 13.42, P < 0.001) was the strongest predictor of SSRF.SSRF is gaining popularity in the management of chest trauma. The presence of a flail segment and multiplicity of rib fractures is among the predictors of SSRF.

  View details for DOI 10.1016/j.jss.2024.09.080

  View details for PubMedID 39447478

• Commentary: Re-consult surgery for lung cancer patients? The role of resection after initial non-operative therapy. The Journal of thoracic and cardiovascular surgery Lin, N., Berry, M. F. 2024

  View details for DOI 10.1016/j.jtcvs.2024.01.002

  View details for PubMedID 38211895

• Pelvic Exenteration and Abdomino-perineal Resection in a Transgender Female with Squamous Cell Carcinoma of Unknown Origin. Urology Alter, K., Baruch, D., Ambinder, D., Vaserman, G., Lin, N., Saji, A., Bassily, D., White, C., Rahman, M., Tang, X., Ritter, E., Choudhury, M., Bendl, R., Phillips, J. 2023; 175: e13-e14

  View details for DOI 10.1016/j.urology.2023.02.023

  View details for PubMedID 36868412

• Elective surgery system strengthening: development, measurement, and validation of the surgical preparedness index across 1632 hospitals in 119 countries. Lancet (London, England) 2022; 400 (10363): 1607-1617

  Abstract

  The 2015 Lancet Commission on global surgery identified surgery and anaesthesia as indispensable parts of holistic health-care systems. However, COVID-19 exposed the fragility of planned surgical services around the world, which have also been neglected in pandemic recovery planning. This study aimed to develop and validate a novel index to support local elective surgical system strengthening and address growing backlogs.First, we performed an international consultation through a four-stage consensus process to develop a multidomain index for hospital-level assessment (surgical preparedness index; SPI). Second, we measured surgical preparedness across a global network of hospitals in high-income countries (HICs), middle-income countries (MICs), and low-income countries (LICs) to explore the distribution of the SPI at national, subnational, and hospital levels. Finally, using COVID-19 as an example of an external system shock, we compared hospitals' SPI to their planned surgical volume ratio (SVR; ie, operations for which the decision for surgery was made before hospital admission), calculated as the ratio of the observed surgical volume over a 1-month assessment period between June 6 and Aug 5, 2021, against the expected surgical volume based on hospital administrative data from the same period in 2019 (ie, a pre-pandemic baseline). A linear mixed-effects regression model was used to determine the effect of increasing SPI score.In the first phase, from a longlist of 103 candidate indicators, 23 were prioritised as core indicators of elective surgical system preparedness by 69 clinicians (23 [33%] women; 46 [67%] men; 41 from HICs, 22 from MICs, and six from LICs) from 32 countries. The multidomain SPI included 11 indicators on facilities and consumables, two on staffing, two on prioritisation, and eight on systems. Hospitals were scored from 23 (least prepared) to 115 points (most prepared). In the second phase, surgical preparedness was measured in 1632 hospitals by 4714 clinicians from 119 countries. 745 (45·6%) of 1632 hospitals were in MICs or LICs. The mean SPI score was 84·5 (95% CI 84·1-84·9), which varied between HIC (88·5 [89·0-88·0]), MIC (81·8 [82·5-81·1]), and LIC (66·8 [64·9-68·7]) settings. In the third phase, 1217 (74·6%) hospitals did not maintain their expected SVR during the COVID-19 pandemic, of which 625 (51·4%) were from HIC, 538 (44·2%) from MIC, and 54 (4·4%) from LIC settings. In the mixed-effects model, a 10-point increase in SPI corresponded to a 3·6% (95% CI 3·0-4·1; p<0·0001) increase in SVR. This was consistent in HIC (4·8% [4·1-5·5]; p<0·0001), MIC (2·8 [2·0-3·7]; p<0·0001), and LIC (3·8 [1·3-6·7%]; p<0·0001) settings.The SPI contains 23 indicators that are globally applicable, relevant across different system stressors, vary at a subnational level, and are collectable by front-line teams. In the case study of COVID-19, a higher SPI was associated with an increased planned surgical volume ratio independent of country income status, COVID-19 burden, and hospital type. Hospitals should perform annual self-assessment of their surgical preparedness to identify areas that can be improved, create resilience in local surgical systems, and upscale capacity to address elective surgery backlogs.National Institute for Health Research (NIHR) Global Health Research Unit on Global Surgery, NIHR Academy, Association of Coloproctology of Great Britain and Ireland, Bowel Research UK, British Association of Surgical Oncology, British Gynaecological Cancer Society, and Medtronic.

  View details for DOI 10.1016/S0140-6736(22)01846-3

  View details for PubMedID 36328042

  View details for PubMedCentralID PMC9621702

• Risk Factors of Mortality in Patients Hospitalized With Chronic Duodenal Ulcers. The American surgeon Lin, N., Smiley, A., Goud, M., Lin, C., Latifi, R. 2022; 88 (4): 764-769

  Abstract

  We aimed to identify risk factors of mortality in patients hospitalized with duodenal ulcers (DUs).A National Inpatient Sample-based retrospective cohort study from 2005 to 2014 was conducted on patients undergoing emergency admission for chronic DUs. Demographics, clinical data, and outcomes were collected. Multivariable logistic regression model was applied to find the risk factors of mortality.70 641 patients were included in this study, of which 30 525 (43%) were non-elderly (< 65 years) and 40 116 (57%) were elderly (65+ years) patients. 72% of non-elderly and 57% of elderly patients were males. Mortality rate of men vs women was similar in non-elderly group (1.9% vs 2%, respectively), whereas it significantly differed in elderly patients (4.5% vs 5.3%, respectively, P<.0001). Time to operation was 1.15 (1.83) days in survived vs 1.55 (3.86) days in deceased non-elderly patients (P < .001). Time to operation was .85 (1.73) days in survived vs 1.79 (7.28) days in deceased elderly patients (P < .001). In patients with operation, age, delayed operation, frailty, and presence of perforation were the main risk factors of mortality in both elderly and non-elderly patients. Invasive diagnostic procedure was shown as a protective factor in elderly patients. In the final model for patients with no operation, age, hospital length of stay, and frailty were the main risk factors of mortality in both elderly and non-elderly patients. Invasive diagnostic procedure was revealed as a protective factor in all patients as well.Early operation in patients with DU requiring surgical intervention is essential to improve the outcomes.

  View details for DOI 10.1177/00031348211054074

  View details for PubMedID 34978521

• Alternative Access Transcatheter Aortic Valve Replacement in Nonagenarians versus Younger Patients. The Thoracic and cardiovascular surgeon Lin, N., Nores, M. A., James, T. M., Rothenberg, M., Stamou, S. C. 2021; 69 (5): 437-444

  Abstract

   Numerous studies have documented the safety of alternatives access (AA) transcatheter aortic valve replacement (TAVR) for patients who are not candidates for transfemoral or surgical approach. There is a scarcity of studies relating use of AA TAVR in nonagenarian patients, a high-risk, frail group. Our study sought to investigate the clinical outcomes of nonagenarians who underwent AA TAVR for aortic stenosis, with comparison of nonagenarians age ≥90 years with patients age <90 years. A cohort study of 171 consecutive patients undergoing AA TAVR (transapical [TA, n = 101, 59%], transaxillary [TAX, n = 56, 33%], transaortic [TAO, n = 11, 6%], and transcarotid [TC, n = 3, 2%]) from 2012 to 2019 was analyzed. Baseline, operative, and postoperative characteristics, as well as actuarial survival outcomes, were compared. AA TAVR patients had decreased aortic valve gradients with no difference detected in nonagenarians and younger patients. Operative mortality was 8% (n = 14; nine TA, three TAO, and two TAX). Compared to younger patients, significantly more nonagenarians were recorded to have new onset atrial fibrillation (7 vs. 5%, p < 0.01*). No significant difference in mortality or postoperative complications, such as stroke, pacemaker requirements, was detected. Actuarial survival at 1 and 5 years was 86 versus 87% (nonagenarians vs younger patients) and 36 versus 22%, respectively, with log-rank = 0.97. AA TAVR in nonagenarian patients who are not candidates for transfemoral approach can be efficaciously performed with comparable clinical outcomes to younger patients, age <90 years. Furthermore, some access sites should be avoided when possible; notably TA was associated with increased mortality, stroke, and new onset atrial fibrillation.

  View details for DOI 10.1055/s-0040-1708478

  View details for PubMedID 32252113

• Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study. Lancet (London, England) 2021; 398 (10297): 325-339

  Abstract

  Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality.We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung's disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis.We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung's disease) from 264 hospitals (89 in high-income countries, 166 in middle-income countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36-39) and median bodyweight at presentation was 2·8 kg (2·3-3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in low-income countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88-4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59-2·79], p<0·0001), sepsis at presentation (1·20 [1·04-1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4-5 vs ASA 1-2, 1·82 [1·40-2·35], p<0·0001; ASA 3 vs ASA 1-2, 1·58, [1·30-1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02-1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41-2·71], p=0·0001; parenteral nutrition 1·35, [1·05-1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47-0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50-0·86], p=0·0024) or percutaneous central line (0·69 [0·48-1·00], p=0·049) were associated with lower mortality.Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between low-income, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030.Wellcome Trust.

  View details for DOI 10.1016/S0140-6736(21)00767-4

  View details for PubMedID 34270932

  View details for PubMedCentralID PMC8314066

• Head injury and neuropsychiatric sequelae in asylum seekers. Neurology McMurry, H. S., Tsang, D. C., Lin, N., Symes, S. N., Dong, C., Monteith, T. S. 2020; 95 (19): e2605-e2609

  Abstract

  Asylum seekers experience a high burden of physical and psychological trauma, yet there is a scarcity of literature regarding the epidemiology and sequelae of head injury (HI) in asylum seekers. We examined HI prevalence and association with neuropsychiatric comorbidities in asylum seekers.A retrospective cross-sectional study was performed through review of 139 medical affidavits from an affidavit database. Affidavits written from 2010 to 2018 were included. Demographic and case-related data were collected and classified based on the presence of HI. For neuropsychiatric sequelae, the primary study outcome was headache and the secondary outcomes were depression, posttraumatic stress disorder, and anxiety. Multivariable logistic regression was performed to examine the association between HI and neuropsychiatric sequelae, adjusted for demographic and clinical characteristics.A total of 139 medical affidavits of asylum seekers were included. The mean age was 27.4 ± 12.1 years, 56.8% were female, and 38.8% were <19 years. Almost half (42.5%) explicitly self-reported history of HI. Compared to clients who did not report HI, clients with HI were older and more likely to report a history of headache, physical abuse, physical trauma, concussion, and loss of consciousness. After adjustment for demographic and clinical characteristics, clients with HI had greater odds for neuropsychological sequelae such as headache (odds ratio [OR] 4.2, 95% confidence interval [CI] 2.0-8.7) and depression (OR 2.5, 95% CI 1.1-5.7).We observed a high prevalence of HI in asylum seekers. Comprehensive screening for HI and neuropsychiatric comorbidities is encouraged when evaluating asylum seekers.

  View details for DOI 10.1212/WNL.0000000000010929

  View details for PubMedID 33004606

• Human rights-based approach to global surgery: A scoping review. International journal of surgery (London, England) Ma, X., Marinos, J., De Jesus, J., Lin, N., Sung, C. Y., Vervoort, D. 2020; 82: 16-23

  Abstract

  Health is a basic human right, yet surgery remains a neglected stepchild of global health. Worldwide, five billion people lack access to safe, timely, and affordable surgical and anesthesia care when needed. This disparity results in over 18 million preventable deaths each year and is responsible for one-third of the global burden of disease. Here, we evaluate the role of surgical care in protecting human rights and attempt to make a human rights argument for universal access to safe surgical care.A scoping review was done using the PubMed/MEDLINE, Embase, and Scopus databases to identify articles evaluating human rights and disparities in accessing surgical care globally. A conceptual framework is proposed to implement global surgical interventions with a human rights-based approach.Disparities in accessing surgical care remain prevalent around the world, including but not limited to gender inequality, socioeconomic differentiation, sexual stigmatization, racial and religious disparities, and cultural beliefs. Lack of access to surgery impedes lives in full health and economic prosperity, and thus violates human rights. Our normative framework proposes human rights principles to make surgical policy interventions more inclusive and effective.Acknowledging human rights in the provision of surgical care around the world is critical to attain and sustain the Sustainable Development Goals and universal health coverage. National Surgical, Obstetric, and Anesthesia Planning and wider health systems strengthening require the integration of human rights principles in developing and implementing policy interventions to ensure equal and universal access to comprehensive health care services.

  View details for DOI 10.1016/j.ijsu.2020.08.004

  View details for PubMedID 32828980

• A right to surgery: Navigating global surgery through a human rights lens. American journal of surgery Ma, X., Lin, N., Marinos, J., Vervoort, D. 2020; 220 (2): 294-295

  View details for DOI 10.1016/j.amjsurg.2020.04.011

  View details for PubMedID 32334801

• Diffuse large B-cell and follicular lymphoma presenting as a slowly growing compressive goiter: A case report and literature review. International journal of surgery case reports Lin, N., Vargas-Pinto, S., Gisriel, S., Xu, M., Gibson, C. E. 2020; 72: 615-619

  Abstract

  Neck ultrasonography with fine-needle aspiration cytology (FNAC) is the diagnostic modality of choice for clinicians who routinely work up a thyroid mass. Distinguishing chronic lymphocytic infiltration from a lymphoproliferative process with FNAC in patients with Hashimoto's thyroiditis presenting with a goiter can be particularly challenging.A 58 y.o. female with a history of a goiter showing interval growth and compressive symptoms over 18 months, was treated with a thyroid lobectomy. Surgical pathology demonstrated a thyroid lymphoma (TL) with mixed follicular and diffuse large B cell (DLBCL) components, not initially diagnosed by FNAC. Staging workup showed the involvement of chest lymph nodes only, consistent with Stage IIE disease. She was treated with combination chemotherapy and immunotherapy, followed by involved-field radiotherapy.TL often arises in a background of chronic lymphocytic thyroiditis which can make its histological diagnosis a challenge. The disease is heterogeneous in histological subtype and progression.While TL usually presents as a rapidly growing neck mass, indolent types can present as a slow growing mass with subsequent transformation. Patients may benefit from avoiding unnecessary diagnostic steps, including surgery, and potential delays in treatment by performing a core needle biopsy when a lymphoproliferative process cannot be excluded if FNAC was initially performed.

  View details for DOI 10.1016/j.ijscr.2020.06.029

  View details for PubMedID 32698301

  View details for PubMedCentralID PMC7334388

• Warm Blood Cardioplegia for Myocardial Protection: Concepts and Controversies. Texas Heart Institute journal James, T. M., Nores, M., Rousou, J. A., Lin, N., Stamou, S. C. 2020; 47 (2): 108-116

  Abstract

  Warm blood cardioplegia has been an established cardioplegic method since the 1990s, yet it remains controversial in regard to myocardial protection. This review will describe the physiologic and technical concepts behind warm blood cardioplegia, as well as outline the current basic and clinical research that evaluates its usefulness. Controversies regarding this technique will also be reviewed. A long history of experimental data indicates that warm blood cardioplegia is safe and effective and thus suitable myocardial protection during cardiopulmonary bypass surgeries.

  View details for DOI 10.14503/THIJ-18-6909

  View details for PubMedID 32603472

  View details for PubMedCentralID PMC7328091

• Geospatial Analysis of Trauma Burden and Surgical Care Capacity in Teso Sub-region of Eastern Uganda. World journal of surgery Lin, N., Nwanna-Nzewunwa, O., Carvalho, M., Wange, A., Ajiko, M. M., Juillard, C., Dicker, R. A. 2019; 43 (11): 2666-2673

  Abstract

  Over 90% of injury-related deaths occur in low- and middle-income countries. Relating spatial distribution of injury burden and trauma care capacity is crucial for effective resource allocation. Our study assesses trauma burden and emergency and essential surgical care (EESC) quality in Teso Sub-region Eastern Uganda through a spatial analysis of trauma burden in relation to surgical capacity at the district level.In this study, we surveyed trauma patients presenting at Soroti Regional Referral Hospital (SRRH) and assessed EESC capacity of district hospitals. We used geospatial techniques to relate trauma burden and capacity and characterized delay using the three-delay framework.We surveyed 131 trauma patients presenting to SRRH for trauma-related injuries from June 1 to July 15, 2017. Almost all trauma incidents (n = 129, 98.4%) occurred within a 2-h ideal drive time to SRRH. From time of injury to receiving care, median time totaled to approximately 9.25 h. District hospital exhibited decreased EESC capacity (personnel, infrastructure, procedures, equipment, and supplies (PIPES) score range 2.2-5.5, mean 4.2) compared to SRRH (PIPES score 8.1).Trauma patients face delays in each step of the care-seeking process from deciding to seek care, arriving at care site, and receiving treatment. Synergistic effects of a poor prehospital care, EESC deficiencies on district and regional levels, cost of seeking care contribute to delays that likely result in increased morbidity and mortality. Improved resource allocation, training at the district level, and strengthening system-level organization of emergency medical services could avert preventable death and disability.

  View details for DOI 10.1007/s00268-019-05095-8

  View details for PubMedID 31388707

• Alternative Access Versus Transfemoral Transcatheter Aortic Valve Replacement in Nonagenarians. The Journal of invasive cardiology Stamou, S. C., Lin, N., James, T., Rothenberg, M., Lovitz, L., Faber, C., Kapila, A., Nores, M. A. 2019; 31 (6): 171-175

  Abstract

  Previous studies suggest that alternative access (AA) such as transapical (TA) approach to transcatheter aortic valve replacement (TAVR) is inferior to transfemoral (TF) approach. However, there is a paucity of data characterizing these outcomes, and studies often do not consider transaortic (TAO) and transaxillary (TAX) TAVR approaches. Therefore, the purpose of this study was to compare the outcomes of nonagenarians undergoing AA-TAVR compared to TF-TAVR.A concurrent cohort study of 148 consecutive nonagenarian patients (≥90 years old) undergoing TAVR from April 2012 to July 2017 was carried out. We stratified the patient cohort into two groups based on access approach: TF-TAVR (n = 112); and AA-TAVR (n = 36), which included TA (n = 24), TAX (n = 8), and TAO (n = 4) approaches. Preoperative, operative, and postoperative outcomes and 5-year actuarial survival rates were analyzed.Compared to TF-TAVR, patients undergoing AA-TAVR were more likely to require blood transfusions (28% vs 69%; P<.001) and readmission (16% vs 58%; P<.001). AA-TAVR also resulted in significantly higher rates of postoperative complications, such as stroke (1% vs 8%; P=.02) and atrial fibrillation (19% vs 36%; P=.03). There was no significant difference in aortic valve gradients (P>.05), operative mortality rate (6% vs 8%; P=.66), or actuarial 5-year survival rate (68% vs 44%, log-rank P=.10).There is a higher risk of adverse events following AA-TAVR compared with TF-TAVR. Therefore, TF-TAVR is recommended when feasible, with AA approach as a viable back-up option in nonagenarians.

  View details for PubMedID 30982779

• Recent Advances in Understanding the Pathogenesis of Cardiovascular Diseases and Development of Treatment Modalities. Cardiovascular & hematological disorders drug targets Mittal, R., Jhaveri, V. M., Kay, S. S., Greer, A., Sutherland, K. J., McMurry, H. S., Lin, N., Mittal, J., Malhotra, A. K., Patel, A. P. 2019; 19 (1): 19-32

  Abstract

  Cardiovascular Diseases (CVDs) are a leading cause of morbidity and mortality worldwide. The underlying pathology for cardiovascular disease is largely atherosclerotic in nature and the steps include fatty streak formation, plaque progression and plaque rupture. While there is optimal drug therapy available for patients with CVD, there are also underlying drug delivery obstacles that must be addressed. Challenges in drug delivery warrant further studies for the development of novel and more efficacious medical therapies. An extensive understanding of the molecular mechanisms of disease in combination with current challenges in drug delivery serves as a platform for the development of novel drug therapeutic targets for CVD. The objective of this article is to review the pathogenesis of atherosclerosis, first-line medical treatment for CVD, and key obstacles in an efficient drug delivery.

  View details for DOI 10.2174/1871529X18666180508111353

  View details for PubMedID 29737266

• Recent treatment modalities for cardiovascular diseases with a focus on stem cells, aptamers, exosomes and nanomedicine. Artificial cells, nanomedicine, and biotechnology Mittal, R., Jhaveri, V. M., McMurry, H. S., Kay, S. S., Sutherland, K. J., Nicole, L., Mittal, J., Jayant, R. D. 2018; 46 (sup1): 831-840

  Abstract

  Cardiovascular diseases (CVDs) are the leading cause of morbidity and mortality worldwide. Due to the significant impact of CVD on humans, there is a need to develop novel treatment modalities tailored to major classes of cardiac diseases including hypertension, coronary artery disease, cardiomyopathies, arrhythmias, valvular disease and inflammatory diseases. In this article, we discuss recent advancements regarding development of therapeutic strategies based on stem cells, aptamers, exosomes, drug-eluting and dissolvable stents, immunotherapy and nanomedicine for the treatment of CVD. We summarize current research and clinical advances in cardiovascular therapeutics, with a focus on therapies that move beyond current oral- or sublingual-based regimens. This review article provides insight into current research and future treatment strategies that hold a great relevance for future clinical practice in pursuit of improving quality of life of patients suffering from CVD.

  View details for DOI 10.1080/21691401.2018.1436555

  View details for PubMedID 29447002