Sneha Shah Jain MD, MBA

All Publications

• Association of Coronary Artery Calcium Detected by Routine Ungated CT Imaging With Cardiovascular Outcomes. Journal of the American College of Cardiology Peng, A. W., Dudum, R., Jain, S. S., Maron, D. J., Patel, B. N., Khandwala, N., Eng, D., Chaudhari, A. S., Sandhu, A. T., Rodriguez, F. 2023; 82 (12): 1192-1202

  Abstract

  Coronary artery calcium (CAC) is a strong predictor of cardiovascular events across all racial and ethnic groups. CAC can be quantified on nonelectrocardiography (ECG)-gated computed tomography (CT) performed for other reasons, allowing for opportunistic screening for subclinical atherosclerosis.The authors investigated whether incidental CAC quantified on routine non-ECG-gated CTs using a deep-learning (DL) algorithm provided cardiovascular risk stratification beyond traditional risk prediction methods.Incidental CAC was quantified using a DL algorithm (DL-CAC) on non-ECG-gated chest CTs performed for routine care in all settings at a large academic medical center from 2014 to 2019. We measured the association between DL-CAC (0, 1-99, or ≥100) with all-cause death (primary outcome), and the secondary composite outcomes of death/myocardial infarction (MI)/stroke and death/MI/stroke/revascularization using Cox regression. We adjusted for age, sex, race, ethnicity, comorbidities, systolic blood pressure, lipid levels, smoking status, and antihypertensive use. Ten-year atherosclerotic cardiovascular disease risk was calculated using the pooled cohort equations.Of 5,678 adults without ASCVD (51% women, 18% Asian, 13% Hispanic/Latinx), 52% had DL-CAC >0. Those with DL-CAC ≥100 had an average 10-year ASCVD risk of 24%; yet, only 26% were on statins. After adjustment, patients with DL-CAC ≥100 had increased risk of death (HR: 1.51; 95% CI: 1.28-1.79), death/MI/stroke (HR: 1.57; 95% CI: 1.33-1.84), and death/MI/stroke/revascularization (HR: 1.69; 95% CI: 1.45-1.98) compared with DL-CAC = 0.Incidental CAC ≥100 was associated with an increased risk of all-cause death and adverse cardiovascular outcomes, beyond traditional risk factors. DL-CAC from routine non-ECG-gated CTs identifies patients at increased cardiovascular risk and holds promise as a tool for opportunistic screening to facilitate earlier intervention.

  View details for DOI 10.1016/j.jacc.2023.06.040

  View details for PubMedID 37704309

• ANTIRACIST AI: A MACHINE LEARNING MODEL USING ELECTROCARDIOGRAMS AND ECHOCARDIOGRAMS CAN DETECT TRANSTHYRETIN CARDIAC AMYLOIDOSIS AND DECREASE RACIAL BIAS IN DIAGNOSTIC TESTING Jain, S. S., Sun, T., Brown, K., Ramlall, V., Tatonetti, N., Elhadad, N., Rodriguez, F., Witteles, R., Maurer, M. S., Poterucha, T., Elias, P. ELSEVIER SCIENCE INC. 2023: 338

  View details for Web of Science ID 000990866100339

• Impact of Periprocedural AdverseEventsAfter PCI and CABGon5-Year Mortality: The EXCEL Trial. JACC. Cardiovascular interventions Jain, S. S., Li, D., Dressler, O., Kotinkaduwa, L., Serruys, P. W., Kappetein, A. P., Sabik, J. F., Morice, M., Puskas, J., Kandzari, D. E., Karmpaliotis, D., Lembo, N. J., Brown, W. M., Banning, A. P., Stone, G. W. 2023; 16 (3): 303-313

  Abstract

  BACKGROUND: The relative risks for different periprocedural major adverse events (MAE) after percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) on subsequent mortality have not been described.OBJECTIVES: The aim of this study was to assess the association between periprocedural MAE occurring within 30days postprocedure and early and late mortality after left main coronary artery revascularization by PCI and CABG.METHODS: In the EXCEL (Evaluation of XIENCE Versus Coronary Artery Bypass Surgery for Effectiveness of Left Main Revascularization) trial, patients with left main disease were randomized to PCI vs CABG. The associations between 12 prespecified nonfatal MAE and subsequent 5-year all-cause and cardiovascular death in 1,858 patients were examined using logistic regression.RESULTS: One or more nonfatal MAE occurred in 111 of 935 patients (11.9%) after PCI and 419 of 923 patients (45.4%) after CABG (P< 0.0001). Patients with MAE were older and had more baseline comorbidities. Within 5 years, all-cause death occurred in 117 and 87 patients after PCI and CABG, respectively. Experiencing an MAE was a strong independent predictor of 5-year mortality after both PCI (adjusted OR: 4.61; 95%CI: 2.71-7.82) and CABG (adjusted OR: 3.25; 95%CI: 1.95-5.41). These associations were present within the first 30days and between 30days and 5 years postprocedure. Major or minor bleeding with blood transfusion≥2 U was an independent predictor of 5-year mortality after both procedures. Stroke, unplanned revascularization for ischemia, and renal failure were significantly associated with mortality only after CABG.CONCLUSIONS: In the EXCEL trial, nonfatal periprocedural MAE were strongly associated with early and late mortality after both PCI and CABG for left main disease.

  View details for DOI 10.1016/j.jcin.2022.10.011

  View details for PubMedID 36792254

• Outflow Graft Narrowing of the HeartMate 3 Left Ventricular Assist Device. The Annals of thoracic surgery Jain, S. S., Clerkin, K. J., Anstey, D. E., Liu, Q., Fried, J. A., Raikhelkar, J., Griffin, J. M., Marshall, D., Colombo, P., Yuzefpolskaya, M., Topkara, V., Naka, Y., Takeda, K., Sayer, G., Uriel, N., Leb, J. 2022

  Abstract

  Outflow graft narrowing has been reported in patients with the HeartMate 3 (HM3) left ventricular assist device (LVAD) due to accumulation of biodebris either internal or external to the graft. This study describes the prevalence, imaging findings, and clinical outcomes associated with HM3 LVAD outflow graft narrowing.A single-center retrospective cohort study was performed among patients who received a HM3 LVAD between 11/2014-7/2019. All patients with a Computed Tomography (CT) Angiography or CT with IV contrast sufficient to evaluate the outflow graft lumen were included. A narrowing was defined as a hypodensity of ≥3mm.Of 165 HM3 LVAD patients, 46 (28%) had qualifying imaging. Outflow graft narrowing was present in 33% (15/46). One patient had complete obstruction requiring emergency surgery, while 14 had a median (interquartile range) hypodensity of 4.5 mm (3.3-5.8). The presence of outflow graft narrowing was significantly associated with longer duration of LVAD support (588.2±277.5 vs. 131.5±170.9 days, p<0.0001). One-year survival after identification of narrowing was 93%, with death occurring in one patient with complete obstruction. Left ventricular (LV) unloading (mean percent decrease in LV end diastolic diameter at time of CT imaging vs. pre-LVAD) was 16.7% vs 17.7% in patients with and without narrowing, respectively (p=0.86).Among patients with adequate imaging, one-third have evidence of narrowing. Outflow graft narrowing due to biodebris was more likely to be found in HM3 LVAD patients with longer duration of LVAD support. There was no significant difference in LV unloading between patients with and without narrowing.

  View details for DOI 10.1016/j.athoracsur.2021.12.014

  View details for PubMedID 34998738

• Prognostic Importance of Health Status Versus Functional Status in Heart Failure and Secondary Mitral Regurgitation JACC-HEART FAILURE Arnold, S. V., Stone, G. W., Jain, S. S., Mack, M. J., Saxon, J. T., Zhang, Z., Lindenfeld, J., Abraham, W. T., Cohen, D. J., COAPT Investigators 2021; 9 (9): 684-692

  Abstract

  This study sought to understand the extent to which health status and exercise capacity are independently associated with long-term outcomes in patients with heart failure (HF) and secondary mitral regurgitation (MR).Secondary MR in patients with HF leads to impaired health status (Kansas City Cardiomyopathy Questionnaire Overall Summary Score [KCCQ-OS]) and exercise capacity (6-minute walk distance [6MWD]), both of which improve after transcatheter mitral valve repair (TMVr).The study used data from the COAPT trial (N = 604) to examine the association of baseline KCCQ-OS and 6MWD with 2-year mortality and HF hospitalization, adjusting for treatment arm and patient factors. We also examined the association of change in KCCQ-OS and 6MWD from baseline to 1 month with risk of outcomes from 1 month to 2 years. Interactions of KCCQ-OS and 6MWD with treatment assignment were explored.Mean baseline KCCQ-OS was 53 ± 23 points, and 6MWD was 240 ± 125 meters. In models including both measures, greater baseline 6MWD (but not KCCQ-OS) was associated with reduced 2-year mortality (HR per 125 meters: 0.75, 95% CI: 0.61-0.92). When stratified by treatment group, both baseline KCCQ-OS and 6MWD were independently associated with HF hospitalization in patients treated with medical therapy, whereas only KCCQ-OS was associated with HF hospitalization in patients treated with TMVr. In separate analyses, 1-month improvements in KCCQ-OS and 6MWD were each associated with lower subsequent risk of mortality and HF hospitalization, independent of treatment group.Among patients with HF and severe secondary MR, assessment of both health status and exercise capacity provide complementary prognostic information for patients with HF and severe secondary MR-both before and after TMVr. (Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients With Functional Mitral Regurgitation [The COAPT Trial]; NCT01626079).

  View details for DOI 10.1016/j.jchf.2021.04.012

  View details for Web of Science ID 000691471800011

  View details for PubMedID 34391740

• Defining a Clinically Important Change in 6-Minute Walk Distance in Patients With Heart Failure and Mitral Valve Disease CIRCULATION-HEART FAILURE Jain, S. S., Cohen, D. J., Zhang, Z., Uriel, N., Sayer, G., Lindenfeld, J., Abraham, W. T., Mack, M. J., Stone, G. W., Arnold, S. V. 2021; 14 (3): 405-407

  View details for DOI 10.1161/CIRCHEARTFAILURE.120.007564

  View details for Web of Science ID 000639303800007

  View details for PubMedID 33663234

• Admission Cardiac Diagnostic Testing with Electrocardiography and Troponin Measurement Prognosticates Increased 30-Day Mortality in COVID-19 JOURNAL OF THE AMERICAN HEART ASSOCIATION Poterucha, T. J., Elias, P., Jain, S. S., Sayer, G., Redfors, B., Burkhoff, D., Rosenblum, H., DeFilippis, E. M., Gupta, A., Lawlor, M., Madhavan, M. V., Griffin, J., Raikhelkar, J., Fried, J., Clerkin, K. J., Kim, A., Perotte, A., Maurer, M. S., Saluja, D., Dizon, J., Ehlert, F. A., Morrow, J. P., Yarmohammadi, H., Biviano, A. B., Garan, H., Rabbani, L., Leon, M. B., Schwartz, A., Uriel, N., Wan, E. Y. 2021; 10 (1): e018476

  Abstract

  Background Cardiovascular involvement in coronavirus disease 2019 (COVID-19) is common and leads to worsened mortality. Diagnostic cardiovascular studies may be helpful for resource appropriation and identifying patients at increased risk for death. Methods and Results We analyzed 887 patients (aged 64±17 years) admitted with COVID-19 from March 1 to April 3, 2020 in New York City with 12 lead electrocardiography within 2 days of diagnosis. Demographics, comorbidities, and laboratory testing, including high sensitivity cardiac troponin T (hs-cTnT), were abstracted. At 30 days follow-up, 556 patients (63%) were living without requiring mechanical ventilation, 123 (14%) were living and required mechanical ventilation, and 203 (23%) had expired. Electrocardiography findings included atrial fibrillation or atrial flutter (AF/AFL) in 46 (5%) and ST-T wave changes in 306 (38%). 27 (59%) patients with AF/AFL expired as compared to 181 (21%) of 841 with other non-life-threatening rhythms (P<0.001). Multivariable analysis incorporating age, comorbidities, AF/AFL, QRS abnormalities, and ST-T wave changes, and initial hs-cTnT ≥20 ng/L showed that increased age (HR 1.04/year), elevated hs-cTnT (HR 4.57), AF/AFL (HR 2.07), and a history of coronary artery disease (HR 1.56) and active cancer (HR 1.87) were associated with increased mortality. Conclusions Myocardial injury with hs-cTnT ≥20 ng/L, in addition to cardiac conduction perturbations, especially AF/AFL, upon hospital admission for COVID-19 infection is associated with markedly increased risk for mortality than either diagnostic abnormality alone.

  View details for DOI 10.1161/JAHA.120.018476

  View details for Web of Science ID 000607087000019

  View details for PubMedID 33169643

  View details for PubMedCentralID PMC7955502

• Clinical and economic burden of obstructive hypertrophic cardiomyopathy in the United States JOURNAL OF MEDICAL ECONOMICS Jain, S. S., Li, S. S., Xie, J., Sutton, M. B., Fine, J. T., Edelberg, J. M., Gao, W., Spertus, J. A., Cohen, D. J. 2021; 24 (1): 1115-1123

  Abstract

  Obstructive hypertrophic cardiomyopathy (oHCM) is a disease of the cardiomyocyte in which dynamic left ventricular outflow track obstruction may lead to heart failure, valvular disease, and sudden death. Little is known about healthcare resource utilization (HRU) and costs associated with oHCM. This study investigated the clinical and economic burden of oHCM in patients with or without symptoms associated with oHCM.We used the US IBM MarketScan Commercial and Medicare Supplemental database to identify patients with oHCM (January 2009-March 2019). Control patients without cardiomyopathy were matched to each patient with oHCM based on age, sex, region, and index year (3:1 ratio). One-year HRU and cost data were compared between all oHCM, symptomatic oHCM, and asymptomatic oHCM subgroups, and their respective controls.Among 11,401 eligible patients with oHCM (mean age 57 years, 42% female), 5,667 (50%) were symptomatic (23% chest pain, 57% dyspnea, 29% fatigue, 17% syncope). oHCM was associated with significant increases in all-cause hospitalizations, hospital days, outpatient visits, and total healthcare costs (mean ± standard deviation: $26,929 ± 77,720 vs. $6,808 ± 25,712, p<.001) compared with matched controls. These differences were driven mainly by the clinical and economic burden of symptomatic oHCM, which was associated with significant increases in 1-year hospitalization rates (38.0 vs. 6.9%), hospital days (3.7 ± 9.9 vs. 0.4 ± 3.0), and total healthcare costs ($43,586 ± 103,756 vs. $6,768 ± 27,618; all p<.001). Adjustment for comorbidities had minimal impact on these differences.The use of claims data relies on International Classification of Diseases (ICD-9 and ICD-10) diagnosis codes, which might be inaccurate. Only commercially insured patients were included.In a real-world population, oHCM was associated with substantial increases in HRU and incremental costs of ∼$20,000/year when compared with matched controls-a difference that increased to ∼$35,000/year among symptomatic patients. Further studies are warranted to understand the potential impact of specific therapies on HRU and the economic burden of oHCM.

  View details for DOI 10.1080/13696998.2021.1978242

  View details for Web of Science ID 000697876100001

  View details for PubMedID 34493144

• The Evolving Roles of Digital Health, Big Data and AI: "Tech-celeration" in CV Care Jain, S. S. Cardiology Magazine. 2021
• An Evaluation of Biometric Monitoring Technologies for Vital Signs in the Era of COVID-19 CTS-CLINICAL AND TRANSLATIONAL SCIENCE Manta, C., Jain, S. S., Coravos, A., Mendelsohn, D., Izmailova, E. S. 2020; 13 (6): 1034-1044

  Abstract

  The novel coronavirus disease 2019 (COVID-19) global pandemic has shifted how many patients receive outpatient care. Telehealth and remote monitoring have become more prevalent, and measurements taken in a patient's home using biometric monitoring technologies (BioMeTs) offer convenient opportunities to collect vital sign data. Healthcare providers may lack prior experience using BioMeTs in remote patient care, and, therefore, may be unfamiliar with the many versions of BioMeTs, novel data collection protocols, and context of the values collected. To make informed patient care decisions based on the biometric data collected remotely, it is important to understand the engineering solutions embedded in the products, data collection protocols, form factors (physical size and shape), data quality considerations, and availability of validation information. This article provides an overview of BioMeTs available for collecting vital signs (temperature, heart rate, blood pressure, oxygen saturation, and respiratory rate) and discusses the strengths and limitations of continuous monitoring. We provide considerations for remote data collection and sources of validation information to guide BioMeT use in the era of COVID-19 and beyond.

  View details for DOI 10.1111/cts.12874

  View details for Web of Science ID 000579560400001

  View details for PubMedID 32866314

  View details for PubMedCentralID PMC7719373

• The Prognostic Value of Electrocardiogram at Presentation to Emergency Department in Patients With COVID-19 MAYO CLINIC PROCEEDINGS Elias, P., Poterucha, T. J., Jain, S. S., Sayer, G., Raikhelkar, J., Fried, J., Clerkin, K., Griffin, J., DeFilippis, E. M., Gupta, A., Lawlor, M., Madhavan, M., Rosenblum, H., Roth, Z. B., Natarajan, K., Hripcsak, G., Perotte, A., Wan, E. Y., Saluja, A., Dizon, J., Ehlert, F., Morrow, J. P., Yarmohammadi, H., Kumaraiah, D., Redford, B., Gavin, N., Kirtane, A., Rabbani, L., Burkhoff, D., Moses, J., Schwartz, A., Leon, M., Uriel, N. 2020; 95 (10): 2099-2109

  Abstract

  To study whether combining vital signs and electrocardiogram (ECG) analysis can improve early prognostication.This study analyzed 1258 adults with coronavirus disease 2019 who were seen at three hospitals in New York in March and April 2020. Electrocardiograms at presentation to the emergency department were systematically read by electrophysiologists. The primary outcome was a composite of mechanical ventilation or death 48 hours from diagnosis. The prognostic value of ECG abnormalities was assessed in a model adjusted for demographics, comorbidities, and vital signs.At 48 hours, 73 of 1258 patients (5.8%) had died and 174 of 1258 (13.8%) were alive but receiving mechanical ventilation with 277 of 1258 (22.0%) patients dying by 30 days. Early development of respiratory failure was common, with 53% of all intubations occurring within 48 hours of presentation. In a multivariable logistic regression, atrial fibrillation/flutter (odds ratio [OR], 2.5; 95% CI, 1.1 to 6.2), right ventricular strain (OR, 2.7; 95% CI, 1.3 to 6.1), and ST segment abnormalities (OR, 2.4; 95% CI, 1.5 to 3.8) were associated with death or mechanical ventilation at 48 hours. In 108 patients without these ECG abnormalities and with normal respiratory vitals (rate <20 breaths/min and saturation >95%), only 5 (4.6%) died or required mechanical ventilation by 48 hours versus 68 of 216 patients (31.5%) having both ECG and respiratory vital sign abnormalities.The combination of abnormal respiratory vital signs and ECG findings of atrial fibrillation/flutter, right ventricular strain, or ST segment abnormalities accurately prognosticates early deterioration in patients with coronavirus disease 2019 and may assist with patient triage.

  View details for DOI 10.1016/j.mayocp.2020.07.028

  View details for Web of Science ID 000581142500014

  View details for PubMedID 33012341

  View details for PubMedCentralID PMC7428764

• Indications for and Findings on Transthoracic Echocardiography in COVID-19 JOURNAL OF THE AMERICAN SOCIETY OF ECHOCARDIOGRAPHY Jain, S. S., Liu, Q., Raikhelkar, J., Fried, J., Elias, P., Poterucha, T. J., DeFilippis, E. M., Rosenblum, H., Wang, E. Y., Redfors, B., Clerkin, K., Griffin, J. M., Abdalla, M., Bello, N. A., Hahn, R. T., Shimbo, D., Weiner, S. D., Kirtane, A. J., Kodali, S. K., Burkhoff, D., Rabbani, L. E., Schwartz, A., Leon, M. B., Homma, S., Di Tullio, M. R., Sayer, G., Uriel, N., Anstey, D. 2020; 33 (10): 1278-1284

  Abstract

  Despite growing evidence of cardiovascular complications associated with coronavirus disease 2019 (COVID-19), there are few data regarding the performance of transthoracic echocardiography (TTE) and the spectrum of echocardiographic findings in this disease.A retrospective analysis was performed among adult patients admitted to a quaternary care center in New York City between March 1 and April 3, 2020. Patients were included if they underwent TTE during the hospitalization after a known positive diagnosis for COVID-19. Demographic and clinical data were obtained using chart abstraction from the electronic medical record.Of 749 patients, 72 (9.6%) underwent TTE following positive results on severe acute respiratory syndrome coronavirus-2 polymerase chain reaction testing. The most common clinical indications for TTE were concern for a major acute cardiovascular event (45.8%) and hemodynamic instability (29.2%). Although most patients had preserved biventricular function, 34.7% were found to have left ventricular ejection fractions ≤ 50%, and 13.9% had at least moderately reduced right ventricular function. Four patients had wall motion abnormalities suggestive of stress-induced cardiomyopathy. Using Spearman rank correlation, there was an inverse relationship between high-sensitivity troponin T and left ventricular ejection fraction (ρ = -0.34, P = .006). Among 20 patients with prior echocardiograms, only two (10%) had new reductions in LVEF of >10%. Clinical management was changed in eight individuals (24.2%) in whom TTE was ordered for concern for acute major cardiovascular events and three (14.3%) in whom TTE was ordered for hemodynamic evaluation.This study describes the clinical indications for use and diagnostic performance of TTE, as well as findings seen on TTE, in hospitalized patients with COVID-19. In appropriately selected patients, TTE can be an invaluable tool for guiding COVID-19 clinical management.

  View details for DOI 10.1016/j.echo.2020.06.009

  View details for Web of Science ID 000576958500018

  View details for PubMedID 32782131

  View details for PubMedCentralID PMC7298489

• The Variety of Cardiovascular Presentations of COVID-19 CIRCULATION Fried, J. A., Ramasubbu, K., Bhatt, R., Topkara, V. K., Clerkin, K. J., Horn, E., Rabbani, L., Brodie, D., Jain, S. S., Kirtane, A. J., Masoumi, A., Takeda, K., Kumaraiah, D., Burkhoff, D., Leon, M., Schwartz, A., Uriel, N., Sayer, G. 2020; 141 (23): 1930-1936

  View details for DOI 10.1161/CIRCULATIONAHA.120.047164

  View details for Web of Science ID 000545970000018

  View details for PubMedID 32243205

  View details for PubMedCentralID PMC7314498

• COVID-19 and Cardiovascular Disease CIRCULATION Clerkin, K. J., Fried, J. A., Raikhelkar, J., Sayer, G., Griffin, J. M., Masoumi, A., Jain, S. S., Burkhoff, D., Kumaraiah, D., Rabbani, L., Schwartz, A., Uriel, N. 2020; 141 (20): 1648-1655

  Abstract

  Coronavirus disease 2019 (COVID-19) is a global pandemic affecting 185 countries and >3 000 000 patients worldwide as of April 28, 2020. COVID-19 is caused by severe acute respiratory syndrome coronavirus 2, which invades cells through the angiotensin-converting enzyme 2 receptor. Among patients with COVID-19, there is a high prevalence of cardiovascular disease, and >7% of patients experience myocardial injury from the infection (22% of critically ill patients). Although angiotensin-converting enzyme 2 serves as the portal for infection, the role of angiotensin-converting enzyme inhibitors or angiotensin receptor blockers requires further investigation. COVID-19 poses a challenge for heart transplantation, affecting donor selection, immunosuppression, and posttransplant management. There are a number of promising therapies under active investigation to treat and prevent COVID-19.

  View details for DOI 10.1161/CIRCULATIONAHA.120.046941

  View details for Web of Science ID 000536791300012

  View details for PubMedID 32200663

• Leading Change – A National Survey of Chief Innovation Officers in Health Systems Health Management, Policy & Innovation Shah, S. P., McCourt, L., Jakobson, K., Saddington, A., Harvey, K., Schulman, K. A. 2018; 3 (1)
• Committing To Transformation: Chief Innovation Officers And The Role Of Organizational Redesign Jain, S. S., Schulman, K. a. Health Affairs Forefront. 2018
• Why are patients being readmitted after surgery for esophageal cancer? JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY Shah, S. P., Xu, T., Hooker, C. M., Hulbert, A., Battafarano, R. J., Brock, M. V., Mungo, B., Molena, D., Yang, S. C. 2015; 149 (5): 1384-1389

  Abstract

  Readmission after surgery is an unwanted adverse event that is costly to the healthcare system. We sought to evaluate factors associated with increased risk of readmission and to characterize the nature of these readmissions in patients who have esophageal cancer.A retrospective cohort study was performed in 306 patients with esophageal carcinoma who underwent neoadjuvant chemoradiation followed by esophagectomy at Johns Hopkins Hospital between 1993 and 2011. Logistic regression was used to identify factors associated with 30-day readmission. Readmissions were defined as inpatient admissions to our institution within 30 days of discharge.The median age at surgery was 61 years; the median postoperative length of stay was 9 days; and 48% of patients had ≥1 postoperative complication (POC). The 30-day readmission rate was 13.7% (42 of 306). In univariate analysis, length of stay and having ≥1 POC were significantly associated with readmission. In multivariate analysis, having ≥1 POC was significantly associated with a >2-fold increase in risk for 30-day readmission (odds ratio 2.35, with 95% confidence interval [1.08-5.09], P = .031) when controlling for age at diagnosis and length of stay. Of the 42 patients who were readmitted, 67% experienced POCs after surgery; 50% of patients who experienced POCs were readmitted for reasons related to their postoperative complication. The most common reasons for readmission were pulmonary issues (29%), anastomotic complications (20%), gastrointestinal concerns (17%), and venous thromboembolism (14%).Complications not adequately managed before discharge may lead to readmission. Quality improvement efforts surrounding venous thromboembolism prophylaxis, and discharging patients nothing-by-mouth, may be warranted.

  View details for DOI 10.1016/j.jtcvs.2015.01.064

  View details for Web of Science ID 000354567100038

  View details for PubMedID 25983251

• Notch-1 and Notch-4 Receptors as Prognostic Markers in Breast Cancer INTERNATIONAL JOURNAL OF SURGICAL PATHOLOGY Yao, K., Rizzo, P., Rajan, P., Albain, K., Rychlik, K., Shah, S., Miele, L. 2011; 19 (5): 607-613

  Abstract

  Studies looking at immunohistochemical (IHC) staining of Notch receptors in breast cancer and correlation with known prognostic factors are sparse.IHC staining for nuclear, cytoplasmic, and membrane Notch-1 (N1), Notch-4 (N4), and Jagged-1 (JAG1) was performed and correlated with known prognostic factors.Of 48 breast cancers, 36 (67%) were invasive, mean age was 50 years (range 43-86 years), 37 (77%) were estrogen receptor (ERα) positive, and 13 (27%) node positive. There was significantly more marked N1 membranous staining in ERα-positive tumors (P < .05). On univariate analysis, cytoplasmic N1 was significantly correlated with node status and tumor grade (P < .05); both cytoplasmic and membranous N4 significantly correlated with Ki67 (P < .05); and membranous JAG1 significantly correlated with Ki67 (P < .05). On multivariate analysis, only cytoplasmic N1 significantly correlated with node status.IHC of Notch markers is feasible and correlates with known prognostic factors consistent with a biological role of Notch signaling in breast cancer progression.

  View details for DOI 10.1177/1066896910362080

  View details for Web of Science ID 000297077900008

  View details for PubMedID 20444726

• The 2.5 angstrom Structure of CD1c in Complex with a Mycobacterial Lipid Reveals an Open Groove Ideally Suited for Diverse Antigen Presentation IMMUNITY Scharf, L., Li, N., Hawk, A. J., Garzon, D., Zhang, T., Fox, L. M., Kazen, A. R., Shah, S., Haddadian, E. J., Gumperz, J. E., Saghatelian, A., Faraldo-Gomez, J. D., Meredith, S. C., Piccirilli, J. A., Adams, E. J. 2010; 33 (6): 853-862

  Abstract

  CD1 molecules function to present lipid-based antigens to T cells. Here we present the crystal structure of CD1c at 2.5 Å resolution, in complex with the pathogenic Mycobacterium tuberculosis antigen mannosyl-β1-phosphomycoketide (MPM). CD1c accommodated MPM's methylated alkyl chain exclusively in the A' pocket, aided by a unique exit portal underneath the α1 helix. Most striking was an open F' pocket architecture lacking the closed cavity structure of other CD1 molecules, reminiscent of peptide binding grooves of classical major histocompatibility complex molecules. This feature, combined with tryptophan-fluorescence quenching during loading of a dodecameric lipopeptide antigen, provides a compelling model by which both the lipid and peptide moieties of the lipopeptide are involved in CD1c presentation of lipopeptides.

  View details for DOI 10.1016/j.immuni.2010.11.026

  View details for Web of Science ID 000286293900007

  View details for PubMedID 21167756

  View details for PubMedCentralID PMC3010391