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One-year survival in recipients older than 50 bridged to heart transplant with Impella 5.5 via axillary approach

Journal of Geriatric Cardiology 2023年第5期20卷 319-329页

作者： Smit Paghdar smruti desai Ji-Min Jang Jose Ruiz Sharan Malkani Parag Patel Daniel S Yip Juan C Leoni Jose Nativi Basar Sareyyupoglu Kevin Landolfo Si Pham Rohan M Goswami Division of Heart Failure and Transplant Mayo Clinic in FloridaUSA Department of Cardiothoracic Surgery Mayo Clinic in FloridaUSA

BACKGROUND Optimizing patients with advanced heart failure before orthotopic heart transplantation(OHT), especially in patients greater than 50 years old, is imperative to achieving successful post-transplant outcomes. Complications are well-described for patients bridged to transplant(BTT) with durable left ventricular assist device(LVAD) support. Given the lack of data available in older recipients after the recent increase in mechanical support use, we felt it crucial to report our center’s one-year outcomes in older recipients after heart transplantation with percutaneously placed Impella 5.5 as a *** Forty-nine OHT patients were supported with the Impella 5.5 intended as a bridge between December 2019 and October 2022 at Mayo Clinic in Florida. Data were extracted from the electronic health record at baseline and during their transplant episode of care after Institutional Review Boards approval as exempt for retrospective data *** Thirty-eight patients aged 50 or older were supported with Impella 5.5 as BTT. Ten patients underwent heart and kidney transplantation within this cohort. The median age at OHT was 63(58–68) years, with 32 male(84%) and six female patients(16%). Etiology was divided into ischemic(63%) and non-ischemic cardiomyopathy(37%). The baseline median ejection fraction was 19%(15–24). Most patients were in blood group O(60%), and 50% were diabetic. The average duration of support was 27 days(range 6–94). The median duration of follow-up is 488 days(185–693). For patients that have reached the 1-year follow-up timeframe(22 of 38, 58%), the 1-year post-transplant survival is 95%.CONCLUSION Our single-center data provides awareness for using the Impella 5.5 percutaneously placed axillary support device in older heart failure patients in cardiogenic shock as a bridge to transplantation. One-year survival outcomes after heart transplantation are excellent despite the older recipient’s age and prolonged pre-transplant support.

关键词： One approval transplant

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Migration of intra-aortic balloon pump causing obstruction of the superior mesenteric artery

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Journal of Geriatric Cardiology 2022年第11期19卷 928-929页

作者： Sharan Malkani Jose Ruiz smruti desai Smit Paghdar Parag C.Patel Juan Carlos Leoni Moreno Melissa Lyle Maedeh Ganji Daniel Yip Rohan M.Goswami Division of Transplant Cardiology Mayo ClinicJacksonvilleFLUSA Division of Cardiology First Coast Heart&VascularJacksonvilleFLUSA

Axillary intra-aortic balloon pump(IABP)used has increased in the recent few years after UNOs allocation system ***’s design and counterpulsation mechanism is highly regarded for its safety profile,simplicity and relative ease in management and ***,despite continuous innovative efforts,the potential for complications still *** Benchmark registry is widely regarded as the tool for monitoring the evolving practice of *** most common complications reported are balloon perforation,bleeding,migration,limb *** continuous innovative efforts,the potential for complications still exists.

关键词： balloon IABP pump

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Decay rates of charmonia within a quark-antiquark confining potential

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Chinese Physics C 2016年第5期40卷 14-23页

作者： smruti Patel P.C.Vinodkumar Shashank Bhatnagar Department of Physics Sardar Patel University Department of Physics Addis Ababa University

In this work, we investigate the spectroscopy and decay rates of charmonia within the framework of the non-relativistic SchrSdinger equation by employing an approximate inter quark-antiquark potential. The spin hyperfine, spin-orbit and tensor components of the one gluon exchange interaction are employed to compute the spectroscopy of the excited S states and a few low-lying P and D waves. The resultant wave functions at zero inter- quark separation as well as some finite separations are employed to predict the di-gamma, di-leptonic and di-gluon decay rates of charmonia states using the conventional Van Royen-Weisskopf formula. The di-gamma and di-leptonic decay widths are also computed by incorporating the relativistic corrections of order v4 within the NRQCD formalism. We have observed that the NRQCD predictions with their matrix elements computed at finite radial separation yield results which are found to be in better agreement with experimentM values for both di-gamma and di-leptonic decays. The same scenario is seen in the case when di-gamma and di-leptonic decay widths are computed with the Van Royen- Weisskopf formula. It is also observed that the di-gluon decay width with the inclusion of binding energy effects are in better agreement with the experimental data available for 1S-2S and 1P. The di-gluon decay width of 3S and 2P waves waves are Mso predicted. Thus, the present study of decay rates clearly indicates the importance of binding energy effects.

关键词： potential models heavy quarkonia radiative decays non relativistic quark model

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Colorectal cancer screening in an academic center compared to the national average

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World Journal of Gastrointestinal Oncology 2015年第11期7卷 356-360页

作者： Manuel O Gonzalez Lilly M Sadri Alfred B Leong smruti R Mohanty Parag Mehta Department of Gastroenterology New York Methodist Hospital Department of Medicine Stony Brook University Hospital Department of Medicine New York Methodist Hospital

AIM: To investigate if the increased emphases on training and education on current colorectal cancer(CRC) screening guidelines has resulted in improved national CRC screening rates in an internal medicine training program,and to determine if the doctor's post graduate year(PGY) level of training affected CRC screening ***: We conducted a cross sectional study of every patient who presented to the outpatient clinic of New York Methodist Hospital,Brooklyn,NY,over the span of six continuous weeks in 2011.A questionnaire was integrated into every patient's medical interview that helped determine that patient's current CRC screening status,screening mammography status if applicable,Papanicolaou smear status if applicable,and current pneumococcal vaccination *** the same time,patient demographics were also *** of the questionnaire data was collected at the end of each medical visit and was compiled by a designated *** all the data points were collected,it was ensured that the patient has been seen by his or her continuity care resident at least twice in the *** was then compiled into a secure,encrypted database to then be analyzed by our ***: Data from 547 consecutive clinic visits were *** these,we reviewed 483 charts that met all of the inclusion criteria and did not meet the exclusion *** data was then analyzed for differences between PGY levels,patient's sex,race,and educational *** study population consisted of 138 men and 345 women.35 patients were white(7.40%),174 were black(39.79%) and 264 were Hispanic(55.81%).Our CRC screening rates were: 66% for PGY-1's,72% for PGY-2's and 77% for PGY-3'*** was no statistical difference noted between the three groups(P ≤ 0.05) or was there any difference sex,insurance status or educational *** CRC screening rate was 72% which was not different from the New York State average(P < 0.05).There was a statistically significant higher ra

关键词： Screening Colorectal cancer Post graduate year Res

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Glycogenic hepatopathy:A narrative review

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World Journal of Hepatology 2018年第2期10卷 172-185页

作者： Jagannath M Sherigar Joline De Castro Yong Mei Yin Debra Guss smruti R Mohanty Department of Gastroenterology and Hepatology NYP-Brooklyn Methodist HospitalBrooklynNY 11215United States NYP-Brooklyn Methodist Hospital BrooklynNY 11215United States

Glycogenic hepatopathy(GH) is a rare complication of the poorly controlled diabetes mellitus characterized by the transient liver dysfunction with elevated liver enzymes and associated hepatomegaly caused by the reversible accumulation of excess glycogen in the hepatocytes. It is predominantly seen in patients with longstanding type 1 diabetes mellitus and rarely reported in association with type 2 diabetes mellitus. Although it was first observed in the pediatric population, since then, it has been reported in adolescents and adults with or without ketoacidosis. The association of GH with hyperglycemia in diabetes has not been well established. One of the essential elements in the pathophysiology of development of GH is the wide fluctuation in both glucose and insulin levels. GH and non-alcoholic fatty liver disease(NAFLD) are clinically indistinguishable, and latter is more prevalent in diabetic patients and can progress to advanced liver disease and cirrhosis. Gradient dual-echo MRI can distinguish GH from NAFLD; however, GH can reliably be diagnosed only by liver biopsy. Adequate glycemic control can result in complete remission of clinical, laboratory and histological abnormalities. There has been a recent report of varying degree of liver fibrosis identified in patients with GH. Future studies are required to understand the biochemical defects underlying GH, noninvasive, rapid diagnostic tests for GH, and to assess the consequence of the fibrosis identified as severe fibrosis may progress to cirrhosis. Awareness of this entity in the medical community including specialists is low. Here we briefly reviewed the English literature on pathogenesis involved, recent progress in the evaluation, differential diagnosis, and management.

关键词： Glycogenic hepatopathy Diabetes mellitus Hepatomegaly Mauriac syndrome Elevated liver enzymes Liver biopsy Gradient dual-echo MRI

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Greywater reuse as a key enabler for improving urban wastewater management

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Environmental Science and Ecotechnology 2023年第4期16卷 52-64页

作者： Arjen Van de Walle Minseok Kim Md Kawser Alam Xiaofei Wang Di Wu smruti Ranjan Dash Korneel Rabaey Jeonghwan Kim Center for Microbial Ecology and Technology Ghent University9052GhentBelgium Department of Environmental Engineering Program of Environmental and Polymeric EngineeringInha University22212IncheonRepublic of Korea Center for Environmental and Energy Research Ghent University Global Campus119-5IncheonRepublic of Korea

Sustainable water management is essential to guaranteeing access to safe water and addressing the challenges posed by climate change,urbanization,and population *** a typical household,greywater,which includes everything but toilet waste,constitutes 50e80%of daily wastewater generation and is characterized by low organic strength and high *** can be an issue for large urban wastewater treatment plants designed for high-strength *** of greywater at the source for decentralized wastewater treatment is therefore necessary for its proper management using separate treatment *** reuse may thus lead to increased resilience and adaptability of local water systems,reduction in transport costs,and achievement of fit-for-purpose *** covering greywater characteristics,we present an overview of existing and upcoming technologies for greywater *** treatment technologies,such as nature-based technologies,biofilm technologies,and membrane bioreactors(MBR),conjugate with physicochemical treatment methods,such as membrane filtration,sorption and ion exchange technologies,and ultraviolet(UV)disinfection,may be able to produce treated water within the allowable parameters for *** also provide a novel way to tackle challenges like the demographic variance of greywater quality,lack of a legal framework for greywater management,monitoring and control systems,and the consumer perspective on greywater ***,benefits,such as the potential water and energy savings and sustainable future of greywater reuse in an urban context,are discussed.

关键词： Greywater reuse Urban wastewater Decentralized wastewater treatment Sustainable wastewater management

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Histopathological differences utilizing the nonalcoholic fatty liver disease activity score criteria in diabetic(type 2 diabetes mellitus) and non-diabetic patients with nonalcoholic fatty liver disease

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World Journal of Hepatology 2015年第25期7卷 2610-2618页

作者： Bharat K Puchakayala Siddharth Verma Pushpjeet Kanwar John Hart Raghavendra R Sanivarapu smruti R Mohanty Center for Liver Diseases Division of Gastroenterology and HepatologyNew York Methodist Hospital at Weill Cornell Medical College Department of Pathology University of Chicago Medical Center

AIM: To study clinical and histopathological features of nonalcoholic fatty liver disease(NAFLD) in patients with and without type 2 diabetes mellitus(T2DM) using updated nonalcoholic steatohepatitis clinical research network(NASH-CRN) grading ***: We retrospectively analyzed data of 235 patients with biopsy proven NAFLD with and without T2 *** database was utilized in the previously published study comparing ethnicity outcomes in NAFLD by the same corresponding *** pathology database from University of Chicago was utilized for enrolling consecutive patients who met the criteria for NAFLD and their detailed clinical and histopathology findings were obtained for *** relevant clinical profile of patients was collected from the Electronic Medical Records around the time of liver biopsy and the histology was read by a single well-trained *** updated criteria for type 2 diabetes have been utilized for *** data of patients with NASH and NAFLD has been *** mean differences were compared using χ2 and t-test along with regression analysis to evaluate the predictors of NASH and advanced ***: Patients with NAFLD and T2 DM were significantly older(49.9 vs 43.0,P < 0.01),predominantly female(71.4 vs 56.3,P < 0.02),had higher rate of metabolic syndrome(88.7 vs 36.4,P < 0.01),had significantly higher aspartate transaminase(AST)/alanine transaminase(ALT) ratio(0.94 vs 0.78,P < 0.01) and Fib-4 index(1.65 vs 1.06,P < 0.01) as markers of NASH,showed higher mean NAFLD activity score(3.5 vs 3.0,P = 0.03) and higher mean fibrosis score(1.2 vs 0.52,P < 0.01) compared to patients with NAFLD without T2 ***,advanced fibrosis(32.5 vs 12.0,P < 0.01) and ballooning(27.3 vs 13.3,P < 0.01) was significantly higher among patients with NAFLD and T2 DM compared to patients with NAFLD without T2 *** multivariate analysis,T2 DM was independently associated with NASH(OR = 3.27,95%CI: 1.43-7.50,P < 0.01)

关键词： Non-alcoholic steatohepatitis Non-alcoholic fatty liver disease Advanced fibrosis Non-alcoholic fatty liver disease activity score Type 2 diabetes Liver biopsy

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Selecting lymph node-positive patients for adjuvant therapy after radical prostatectomy and extended pelvic lymphadenectomy:An outcome analysis of 100 node-positive patients managed without adjuvant therapy

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Current Urology 2022年第4期16卷 232-239页

作者： Ashwin Sunil Tamhankar Saurabh Patil Shanky Singh Danny Darlington Carbin smruti Mokal Puneet Ahluwalia Gagan Gautam Urologic Oncology and Robotic Surgery Max Institute of Cancer CareNew Delhi110017India

Objective:The aim of the study is to evaluate the effect of deferred androgen deprivation therapy on biochemical recurrence(BCR)and other survival parameters in node-positive prostate cancer patients after robot-assisted radical prostatectomy with bilateral extended pelvic lymph node dissection(RARP+EPLND).Materials and methods:Of the 453 consecutive RARP procedures performed from 2011 to 2018,100 patients with no prior use of androgen deprivation therapy were found to be lymph node(LN)positive and were observed,with initiation of salvage treatment at the time of BCR *** were divided into 1 or 2 LNs(67)-and more than 2 LNs(33)-positive groups to assess survival ***:At a median follow-up of 21 months(1-70 months),the LN group(p<0.000),preoperative prostate-specific antigen(PSA,p=0.013),tumor volume(TV,p=0.031),and LND(p=0.004)were significantly associated with *** multivariate analysis,only the LN group(p=0.035)and PSA level(p=0.026)were statistically *** estimated BCR-free survival rates in the 1/2 LN group were 37.6%(27%-52.2%),26.5%(16.8%-41.7%),and 19.9%(9.6%-41.0%)at 1,3,and 5 years,respectively,with a hazard of developing BCR of 0.462(0.225-0.948)compared with the more than 2 LN-positive *** 5-year overall survival,cancer-specific,metastasis-free,and local recurrence-free survival rates were 88.4%(73.1%-100%),89.5%(74%-100%),65.1%(46.0%-92.1%),and 94.8%(87.2%-100.0%),respectively,for which none of the factors were *** on cutoff values for PSA,TV,and LND of 30 ng/mL,30%,and 10%,respectively,the 1/2 LN group was substratified,wherein the median BCR-free survival for the low-and intermediate-risk groups was 40 and 12 months,***:Nearly one fourth and one fifth of 1/2 node-positive patients were BCR-free at 3 and 5 years after RARP+*** substratification using PSA,TV,and LN density may help in providing individualized care regarding the initiation of adjuvant therapy.

关键词： Adjuvant therapy Extended pelvic lymph node dissection Prostate cancer Robotic radical prostatectomy

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Acute inflammatory demyelinating polyneuropathy associated with pegylated interferon α 2a therapy for chronic hepatitis C virus infection

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World Journal of Gastroenterology 2008年第2期14卷 318-321页

作者： Vijay Khiani Thomas Kelly Adeel Shibli Donald Jensen smruti R Mohanty Department of Medicine Case Western Reserve University Cleveland OH United States Department of Neurology The University of ChicagoChicago IL United States Department of Medicine Weiss Memorial Hospital Chicago IL United States Department of Medicine Center for Liver Diseases The University of Chicago Chicago IL United States

The combination of pegylated interferon (Peg-IFN) and ribavirin is the standard of care for chronic hepatitis C virus (HCV) infection treatment. In general, common side effects related to this combination therapy are mild and are very well tolerated. However, peripheral neuropathy including demyelinating polyneuropathy related to Peg-IFN is extremely rare. We present the first case of an acute inflammatory demyelinating polyneuropathy (AIDP) associated with Peg-IFN-α 2a (Pegasys) after 16 wk of a combination therapy with Pegasys and ribavirin in a 65-year-old woman with chronic HCV infection. She developed tingling, numbness, and weakness of her upper and lower extremities and was hospitalized for acute neurological deficits. Her clinical course, neurological findings, an electromyogram (EMG), nerve conductions studies (NCS), muscle biopsy, and a sural nerve biopsy were all consistent with AIDP likely related to Pegasys use. The patient recovered completely with the use of intravenous immunoglobulin (IVIG) including physical therapy and neurological rehabilitation. It is very important that gastroenterologists and/or hepatologists recognize this rare neurological complication related to Peg-IFN treatment very early, since it requires a prompt discontinuation of therapy including an immediate referral to a neurologist for the confirmation of diagnosis, management, and the prevention of long-term neurological deficits.

关键词： Neuropathy Pegylated interferon Pegasys

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Reactivation of hepatitis B after liver transplantation: Current knowledge, molecular mechanisms and implications in management

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World Journal of Hepatology 2018年第3期10卷 352-370页

作者： Ranjit Chauhan Shilpa Lingala Chiranjeevi Gadiparthi Nivedita Lahiri smruti R Mohanty Jian Wu Tomasz I Michalak Sanjaya K Satapathy Molecular Virology and Hepatology Research Group Division of Bio Medical SciencesHealth Sciences Centre Memorial University Division of Transplant Surgery Methodist University Hospital Transplant Institute University of Tennessee Health Sciences Center Division of Rheumatology Immunology and Allergy Brigham Women's Hospital Harvard Medical School Division of Gastroenterology and Hepatobiliary Disease New York-Presbyterian Brooklyn Methodist Hospital Department of Medical Microbiology Key Laboratory of Molecular Virology Fudan University School of Basic Medical Sciences

Chronic hepatitis B(CHB) is a major global health problem affecting an estimated 350 million people with more than 786000 individuals dying annually due to complications, such as cirrhosis, liver failure and hepatocellular carcinoma(HCC). Liver transplantation(LT) is considered gold standard for treatment of hepatitis B virus(HBV)-related liver failure and HCC. However, post-transplant viral reactivation can be detrimental to allograft function, leading to poor survival. Prophylaxis with high-dose hepatitis B immunoglobulin(HBIG) and anti-viral drugs have achieved remarkable progress in LT by suppressingviral replication and improving long-term survival. The combination of lamivudine(LAM) plus HBIG has been for many years the most widely used. However, life-long HBIG use is both cumbersome and costly, whereas long-term use of LAM results in resistant virus. Recently, in an effort to develop HBIG-free protocols, high potency nucleos(t)ide analogues, such as Entecavir or Tenofovir, have been tried either as monotherapy or in combination with low-dose HBIG with excellent results. Current focus is on novel antiviral targets, especially for covalently closed circular DNA(ccc DNA), in an effort to eradicate HBV infection instead of viral suppression. However, there are several other molecular mechanisms through which HBV may reactivate and need equal attention. The purpose of this review is to address post-LT HBV reactivation, its risk factors, underlying molecular mechanisms, and recent advancements and future of anti-viral therapy.

关键词： Hepatitis B virus Liver transplantation Reactivation Hepatitis B immunoglobulin Recurrence Prophylaxis Antivirals

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