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Risk scoring model for prediction of non-home discharge after transcatheter aortic valve replacement

Journal of Geriatric Cardiology 2020年第10期17卷 621-627页

作者： Alexis K Okoh Ebru Ozturk Justin Gold Emaad Siddiqui Nehal Dhaduk Bruce Haik Chun-Guang CHEN marc cohen Mark J Russo Cardiovascular Outcomes Research Institute RWJ Barnabas Health-NBIMCNewarkNew JerseyUSA Department of Medicine Division of BiostatisticsHacettepe UniversityAnkaraTurkey Rutgers New Jersey Medical School NewarkNew JerseyUSA Department of Surgery Division of Cardiothoracic SurgeryRutgers Robert Wood Johnson Medical SchoolNew BrunswickNew JerseyUSA

Background Patients undergoing transcatheter aortic valve replacement(TAVR) are likely to be discharged to a location other than home. We aimed to determine the association between preoperative risk factors and non-home discharge after TAVR. Methods Patients discharged alive after TAVR at three centers were identified from a prospectively maintained database randomly divided into 80% derivation and 20% validation cohorts. Logistic regression models were fit to identify preoperative factors associated with non-home discharge in the derivation cohort. Multivariable models were developed and a nomogram based risk-scoring system was developed for use in preoperative counseling. Results Between June 2012 and December 2018, a total of 1,163 patients had TAVR at three centers. Thirty-seven patients who died before discharge were excluded. Of the remaining 1,126 patients(97%) who were discharged alive, the incidence of non-home discharge was 25.6%(n = 289). The patient population was randomly divided into the 80%(n = 900) derivation cohort and 20%(n = 226) validation cohort. Mean ± SD age of the study population was 83 ± 8 years. In multivariable analysis, factors that were significantly associated with non-home discharge were extreme age, female sex, higher STS scores, use of general anesthesia, elective procedures, chronic liver disease, non-transfemoral approach and postoperative complications. The unbiased estimate of the C-index was 0.81 and the model had excellent calibration. Conclusions One out of every four patients undergoing TAVR is discharged to a location other than home. Identification of preoperative factors associated with non-home discharge can assist patient counseling and postoperative disposition planning.

关键词： Aortic valve replacement Non-home discharge Postoperative risk Transcatheter Transfemoral

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Integrating Basic Concepts in Eastern Medicine and Western Science

Integrating Basic Concepts in Eastern Medicine and Western S...

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第二次世界中西医结合大会

作者： marc cohen Australian Integrative Medicine Association（AIMA） Department of Complementary MedicineRMIT UniversityBundoora3081Australia

＜正＞ Eastern medicine includes a wide range of different therapeutic and diagnostic approaches based on the idesthat life is dependent on a subtle form of *** energy has been described by many different healingtraditions and has been termed’life energy’,’vital force’,’prana,’chi’,or’Qi’.Bioenergy is described as

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Skull base chordomas review of current treatment paradigms

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World Journal of Otorhinolaryngology-Head and Neck Surgery 2020年第2期6卷 125-131页

作者： Dan Yaniv Ethan Soudry Yulia Strenov marc A.cohen Aviram Mizrachi Department of Otolaryngology-Head and Neck Surgery Rabin Medical CenterPetah Tikva and Sackler Faculty of MedicineTel Aviv UniversityTel AvivIsrael Department of Pathology Rabin Medical CenterPetah Tikva and Sackler Faculty of MedicineTel Aviv UniversityTel AvivIsrael Head and Neck Service Department of SurgeryMemorial Sloan-Kettering Cancer CenterNew YorkNYUSA

Background:Chordomas are locally invasive neoplasms,arising from notochordal remnants and can appear anywhere along the axial *** recurrences are common,and distant metastases may occur years after the initial ***:Literature review of current treatment strategies for chordomas of the skull ***:Surgery is the mainstay of treatment and complete resection has paramount importance for *** complete resection is not achieved recurrent disease is *** anatomical complexity of the skull base makes resection *** endoscopic approaches to the clivus has become increasingly favored in recent years although addressing reconstruction of the skull base to prevent CSF leak may be *** suggests that radiotherapy should not be considered as a primary single modality when trying to achieve cure of the ***,immediate post-operative radiotherapy improves *** strategies have been suggested to preserve sensitive vital structures in the skull base during treatment but as for survival there is no evidence of advantage when comparing adjuvant therapy with photon radiotherapy,gamma knife surgery,proton beam therapy,and carbon ion radiation *** is no evidence to support cytotoxic chemotherapy in the treatment of chordomas but targeted therapies have started to show *** optional molecular targets *** is overexpressed in 95%of chordomas but not in other mesenchymal ***,its precise role in chordoma pathogenesis is currently unclear,and its cellular location in the nucleus makes it difficult to *** inhibition of brachyury in chordoma cell lines induces growth arrest and *** does not have clinical application to *** are retrospective results with different molecular targeted therapies for advanced chordomas with some ***:Despite improvements made in the past 10 years in our knowledge of chordoma bio

关键词： Skull Base Chordoma Surgery Review Targeted therapy

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Perioperative management of endoscopic transsphenoidal pituitary surgery

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World Journal of Otorhinolaryngology-Head and Neck Surgery 2020年第2期6卷 84-93页

作者： Martin Hanson Hao Li Eliza Geer Sasan Karimi Viviane Tabar marc A.cohen Multidisciplinary Pituitary and Skull Base Tumour Program Memorial Sloan Kettering Cancer Center1275 York AveNew YorkNYUSA

The contemporary embrace of endoscopic technology in the approach to the anterior skull base has altered the perioperative landscape for patients requiring pituitary *** of a multi-disciplinary unit in management decisions facilitates the delivery of optimal *** of technology and surgical expertise in pituitary surgery mandates ongoing review of all components of the care central to these *** many areas of potential variability in the pre,intra and post-operative timeline of pituitary surgery are readily *** undertakings and contemporary controversies in the peri-operative management of patients undergoing endoscopic transsphenoidal pituitary surgery are assessed against the available literature with a view to providing guidance for the best evidence-based practice.

关键词： Pituitary Pituitary surgery Endoscopic skull base surgery Perioperative management

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Retrospective evaluation of frozen section use for thyroid nodules with a prior fine needle aspiration diagnosis of Bethesda Ⅱ-Ⅵ: The Weill Cornell Medical College experience

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World Journal of Otorhinolaryngology-Head and Neck Surgery 2015年第1期1卷 -页

作者： marc A.cohen Krupa R.Patel Jonathan Gromis David I.Kutler William I.Kuhel Brian J.Stater Aaron Schulman Department of Otolaryngology-Head and Neck Surgery New York Presbyterian Hospital/Weill Cornell Medical Center New York NY 10065 USA Weill Cornell Medical College New York NY 10065 USA Department of Endocrinology New York Presbyterian Hospital/Weill Cornell Medical CenterNew York NY 10065 USA

Objective: To evaluate the Weill Cornell Medical CoLlege (WCMC)/New York Presbyterian Hospital (NYPH) experience with intraoperative frozen (IOF) section in the management of thyroid nodules with a fine needle aspiration (FNA) diagnosis of Bethesda Ⅱ-Ⅵ and to analyze the cost and pathology benefit it ***: The surgical and cytopathology files at WCMC/NYPH were searched within the time period of January 2008 to May 2013.A total of 435 thyroid specimens were identified for which both an FNA and subsequent IOF section was *** FNA was correlated with the locations of the resected nodule and the nodule frozen for intraoperative *** results of the FNA were compared to the IOF section diagnosis and final diagnosis (FD).Results: Among 435 cases, the FNA diagnosis was Bethesda Ⅱ:149 cases, Bethesda Ⅲ:170 cases, Bethesda Ⅳ: 91 cases, Bethesda Ⅴ: 19 cases, and Bethesda Ⅵ: 6 *** were a total of 83 carcinomas identified on FD, which included 69 papillary thyroid carcinomas (PTCs), 12 follicular carcinomas, and 2 poorly differentiated *** preoperative FNA diagnosis for these carcinomas was as follows: Bethesda Ⅱ, 11/149 (7.4％), Bethesda Ⅲ, 24/170 (14％), Bethesda Ⅳ, 26/91 (29％), Bethesda Ⅴ, 16/19 (84％), and Bethesda Ⅵ, 6/6 (100％).IOF section contributed to the diagnosis of malignancy in 16/429 (4％) cases: 1/149 (0.7％) Bethesda Ⅱ, 5/170 (3％) Bethesda Ⅲ, 2/91 (1.1％) Bethesda Ⅳ, and 8/19 (42％) Bethesda Ⅴ.The diagnosis of malignancy was confirmed in the 6 Bethesda Ⅵl cases by IOF *** were no false positives on IOF *** had a sensitivity and specificity of 26％ and 100％, ***: The role of IOF section is limited in the evaluation of thyroid *** section is most useful for nodules with an FNA diagnosis of Bethesda V *** diagnosis of follicular variant of PTC remains difficult on frozen section.

关键词： Thyroid Nodule Frozen section Fine-needle aspiration Sensitivity Specificity

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Integration of an enhanced recovery after surgery program for patients undergoing pituitary surgery

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World Journal of Otorhinolaryngology-Head and Neck Surgery 2022年第4期8卷 330-338页

作者： Stephanie Flukes llya Laufer Jennifer Cracchiolo Eliza Geer Andrew L.Lin Jess Brallier Van Tsui Anoushka Afonso Viviane Tabar marc A.cohen Head and Neck Service Department of SurgeryMemorial Sloan Kettering Cancer CenterNew YorkNYUSA Department of Neurosurgery Memorial Sloan Kettering Cancer CenterNew YorkNYUSA Multidisciplinary Pituitary and Skull Base Tumor Center Memorial Sloan Kettering Cancer CenterNew YorkNYUSA Department of Medicine Memorial Sloan Kettering Cancer CenterNew YorkNYUSA Department of Anesthesiology and Critical Care Medicine Memorial Sloan Kettering Cancer CenterNew YorkNYUSA

Evidence-based enhanced recovery after surgery(ERAS)programs aim to improve patient outcomes and shorten hospital *** objective of this study is to describe the development,implementation,and evolution of an ERAS protocol to optimize the perioperative management for patients undergoing endoscopic skull base surgery for pituitary tumors.A systematic review of the literature was performed,best practices were discussed with stakeholders,and institutional guidelines were established and *** performance indicators(KPI)were measured and patient-reported outcome surveys were *** ERAS protocol was introduced successfully at our *** describe the process of initiation of the program and the perioperative management of our *** demonstrated the feasibility of integration of ERAS protocols for pituitary tumors with multidisciplinary engagement,with a particular emphasis on the use of data informatics and metrics to monitor *** expect that this approach will translate to improved quality of care for these often-complex patients.

关键词： Enhanced recovery after surgery Endoscopic skull base surgery Pituitary surgery Outcomes improvement

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Value within otolaryngology:Assessment of the cost-utility analysis literature

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World Journal of Otorhinolaryngology-Head and Neck Surgery 2016年第1期2卷 -页

作者： Krupa R. Patel David J. Phillips Jason M. Leibowitz Theresa Scognamiglio Victoria E. Banuchi William I. Kuhel David I. Kutler marc A. cohen Weill Cornell Medical College New York NY 10065 USA Department of 0tolaryngology-Head and Neck Surgery New York Presbyterian Hospital/Weill Cornell Medical Center New York NY 10065 USA Department of 0tolaryngology-Head and Neck Surgery University of Miami Miami FL 33136 USA Department of Pathology&Laboratory Medicine New York Presbyterian Hospital/Weill Cornell Medical Center New York NY 10065 USA

Objective:To assess the characteristics and quality of cost utility analyses (CUA) related to otolaryngology within the CEA registry and to summarize their collective results. Methods:All cost-utility analyses published between 1976 and 2011 contained in the Cost-Effectiveness Analysis Registry (CEA Registry) were evaluated. Topics that fall within the care of an otolaryngologist were included in the review regardless of the presence of an otolaryn-gologist author. Potential associations between various study characteristics and CEA registry quality scores were evaluated using the Pearson product moment correlation coefficient. Results:Sixty-one of 2913 (2.1%) total CUA publications screened were related to otolaryn-gology. Eighteen of 61 (29.5%) publications included an otolaryngologist as an author. Fourteen studies agreed on the cost effectiveness of at least unilateral cochlear implantation and six of seven (85.7%) studies demonstrated the cost effectiveness of continuous positive airway pres-sure (CPAP) for obstructive sleep apnea (OSA). Forty-six percent (28 of 61) of all manuscripts were published between 2008 and 2011. A more recent publication year was associated with a higher CEA registry quality score while the presence of an otolaryngologist author and journal impact factor had no significant correlation with the quality of the CUA. Conclusion:Based on current evidence in the CEA registry, unilateral cochlear implantation for hearing loss and CPAP for OSA are both cost-effective therapeutic interventions. Although CUAs in otolaryngology have increased in quantity and improved in quality in more recent years, there is a relative lack of CUAs in otolaryngology in comparison to other subspecialties. Copyright a 2016 Chinese Medical Association. Production and hosting by Elsevier B.V. on behalf of KeAi Communications Co., Ltd. This is an open access article under the CC BY-NC-SA license (http://***/licenses/by-nc-sa/4.0/).

关键词： Cost-utility analysis

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NON SPURIOUS SPECTRAL-LIKE ELEMENT METHODS FOR MAXWELL'S EQUATIONS

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Journal of Computational Mathematics 2007年第3期25卷 282-304页

作者： Gary cohen marc Duruflé INRIA Domaine de VoluceauRocquencourt-BP 10578153 Le Chesnay CedexFrance

In this paper, we give the state of the art for the so called “mixed spectral elements” for Maxwell＇s equations. Several families of elements, such as edge elements and discon-tinuous Galerkin methods （DGM） are presented and discussed. In particular, we show the need of introducing some numerical dissipation terms to avoid spurious modes in these methods. Such terms are classical for DGM but their use for edge element methods is novel approach described in this paper. Finally, numerical experiments show the fast and low-cost character of these elements.

关键词： Maxwell's equations Discontinuous Galerkin methods Edge elements Masslumping.

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Evolution in surgery for the anterior skull base

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World Journal of Otorhinolaryngology-Head and Neck Surgery 2020年第2期6卷 83-83页

作者： marc A.cohen Department of Surgery Surgical DirectorSkull Base Tumor CenterMemorial Sloan Kettering Cancer Center1275 York AvenueNew YorkNY10065US

In the past four decades,skull base surgery has undergone dramatic paradigm *** in understanding of physiology and anatomy coupled with advances in technology and training have completely revolutionized management of patients with benign and malignant conditions of the anterior skull ***“Skull Base Surgeon”requires broad and deep knowledge related to pathology,surgical approach and reconstruction with open and endoscopic techniques,perioperative management,and adjuvant and neoadjuvant indications and techniques.

关键词： surgery anatomy base

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非ST段抬高急性冠脉综合征患者随机应用依诺肝素或普通肝素抗凝治疗的疗效和出血并发症：系统综述

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美国医学会杂志（中文版） 2005年第4期24卷 209-216页

作者： John L. Petersen Kenneth W. Mahaffey Vic Hasselblad Elliott M. Antman marc cohen Shaun G. Goodman Anatoly Langer Michael A. Blazing Anne Le-Moigne-Amrani James A. de Lemos Christopher C. Nessel Robert A. Harrington James J. Ferguson Eugene Braunwald Robert M. Califf 徐成斌（译） Duke Clinical Research Institute Durham NC Cardiovascular Division Department of Medicine Brigham and Women＇s Hospital Boston Mass Division of Cardiology Newark Beth Israel Medical Center. Newark. NJ Canadian Heart Research Centre and Terrence Donnelly Heart Centre Division of Cardiology St Michael＇s Hospital University of TorontoToronto Ontario Division of Cardiology University of Texas Southwestem Dallas Aventis Inc BridgewaterNJ St Luke＇s-Episcopal Hospital Texas Heart InstituteHouston

背景：抗凝疗法已成为急性冠脉综合征（acute coronary syndrome，ACS）治疗指南推荐的标准疗法。但是，最近某些试验在ACS患者中对依诺肝素（enoxaparin）与普通肝素（unfractionated heparin）的应用进行了比较，发现这些抗凝疗法的... 详细信息

背景：抗凝疗法已成为急性冠脉综合征（acute coronary syndrome，ACS）治疗指南推荐的标准疗法。但是，最近某些试验在ACS患者中对依诺肝素（enoxaparin）与普通肝素（unfractionated heparin）的应用进行了比较，发现这些抗凝疗法的疗效及安全性并不及既往试验结果。目的：有6项随机对照试验对依诺肝素与普通肝素治疗ACS患者进行了比较，对其终点（即全因死亡及非致死性心肌梗死）、输血与大出血进行系统评估。资料来源：从杜克临床研究所（Duke Clinical Research Institute）获取ESSENCE、A to Z及SYNERGY试验的原始数据。由TIMI 11B、ACUTEⅡ及INTERACT研究的主要研究人员提供各自的基线特征和事件发生频率。研究选取：在非ST段抬高ACS患者中比较依诺肝素与普通肝素的6项随机对照试验均人选进行分析。数据提取：从全部试验人群和随机分组前未接受抗凝治疗的亚人群中获取疗效终点和安全性终点。数据综合：应用随机效应经验性贝叶斯模型（random—effects empirical Bayes model），系统评估21946例患者的结果。依诺肝素与普通肝素30天死亡率无显著差异（3．0％比3．0％，优势比[odds ratio，OR]，1．00；95％可信区间[confidence interval，CI]，0．85～1．17）。在所有试验人群中，依诺肝素与普通肝素相比，30天死亡或非致死性心肌梗死（myocardial infarction，MI）联合终点显著下降，具有统计学差异（10．1％比11．0％；OR，0．91；95％CI，0．83～0．99；所需治疗例数107）。随机分组前未接受抗凝治疗的依诺肝素组患者30天死亡或MI联合终点亦显著下降，具有统计学差异（8．0％比9．4％；OR，0．81；95％CI，0．70～0．94；所需治疗例数72）。随机分组后第7天，总体安全人群或者随机分组前未接受抗凝治疗的人群输血（OR，1．01；95％CI，0．89～1．14）或大出血的发生率（OR，1．04；95％CI，0．83～1．30）无显著差异。结论：对近22000例各类ACS患者进行系统回顾发现，在预防死亡或MI联合终点方面依诺肝素较普通肝素更有效。

关键词：非ST段抬高急性冠脉综合征随机对照试验依诺肝素普通肝素抗凝治疗出血并发症患者系统综述疗效

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