Publications (32) View all
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Article: Reassessing the Role of Supplemental Oxygen in the Prevention of Surgical Site Infection.
Annals of surgery 10/2012; · 7.90 Impact Factor -
Article: Does Clinically Relevant Temperature Change miRNA and Cytokine Expression in Whole Blood?
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ABSTRACT: Unintentional hypothermia is a well-described risk factor for death and complications after elective and emergency surgery. The molecular mechanisms by which hypothermia exerts its detrimental effects are not well understood. Differences in cytokine production and the overall cell function have been reported under hypothermic conditions. We investigated the effect of a range of clinically relevant temperatures on cytokine production and microRNA (miRNA) expression in a whole-blood model. We found that there was a wide variation in tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), and IL-10 production among different subjects, ranging from low to high TNF-α producers. The intersubject variation can also be found on the transcriptional level: high producers had higher upregulation of TNF-α messenger RNA than intermediate and low producers. This variation in TNF-α was reproducible in each individual. Temperature seems to modulate TNF-α production among these different groups. miRNA expression was modulated by temperature. miRNA-181a might control, or be a part of the mechanism which controls, TNF-α production. However, an analysis of whole-leukocyte RNA does not allow the investigation of mechanisms in a specific leukocyte subpopulation such as monocytes, because these changes may be concealed by miRNA expression changes in the other leukocyte subsets. In conclusion, TNF-α, IL-6, and IL-10 production is highly variable among different persons, but temperature affects the expression of miRNAs, which may consequently alter the production of TNF-α.Journal of interferon & cytokine research: the official journal of the International Society for Interferon and Cytokine Research 08/2012; 32(10):485-94. · 1.63 Impact Factor -
Article: Mortality after elective colon resection: the search for outcomes that define quality in surgical practice.
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ABSTRACT: Process measures constitute the focal point of surgical quality studies. High levels of compliance with such processes have not correlated with improved outcomes. Wide ranges of reported hospital death rates led us to hypothesize that survival after elective colon resection would be a legitimate outcomes measure for quality of surgical practice. We studied risk-adjusted hospital mortality rates of 85,260 patients in teaching hospitals as reported to the University HealthSystem Consortium (UHC) January 1, 2005 to March 31, 2011. Data were analyzed by institution and surgeon (deidentified). There were 34,504 patients from the HealthCare Utilization Project (HCUP, 2007-2008), who provided a comparison group for nonteaching hospitals. Surgeons with less than 1 year of reported data were excluded. Elective colon resection mortality rates were densely concentrated around 1.56% for teaching hospitals and at 1.08% for defined surgeons. HCUP data demonstrated a 1.38% nonteaching hospital mortality rate. Neither hospital nor surgeon volume were determinants of mortality, and lower volume entities displayed the widest mortality variations. Among 193 teaching hospitals, there were 6 outliers (4.1%), defined as >2 standard deviations (SDs) above the mean. Similarly, 32 of 681 individual surgeons (4.7%) had a risk-adjusted hospital mortality rate >2SDs above the mean. Elective colon resection is a safe procedure in both teaching hospitals and nonteaching hospitals, with an impressively homogenous mean mortality rate of 1.56% in teaching hospitals, and 1.38% in nonteaching hospitals. We reject our original hypothesis because the data do not sufficiently discriminate to permit the use of death after elective colon resection as a differentiating quality measure; however, the data do identify individual poor performers. Poor performing institutions/surgeons should seek extramural guidance to improve their outcomes or discontinue performing such operations.Journal of the American College of Surgeons 03/2012; 214(4):436-43; discussion 443-4. · 4.55 Impact Factor -
Article: Sump syndrome as a complication of choledochoduodenostomy.
Digestive Diseases and Sciences 12/2011; 57(8):2011-5. · 2.12 Impact Factor -
Article: Abdominal mass, anemia, diabetes mellitus, and necrolytic migratory erythema.
Digestive Diseases and Sciences 11/2011; 57(6):1465-8. · 2.12 Impact Factor
