Claudia Leonardi - Academia.edu (original) (raw)

Papers by Claudia Leonardi

Research paper thumbnail of Minimally Invasive Surgery is Associated with Improved Outcomes Following Urgent Inpatient Colectomy

JSLS, 2022

Objectives:The use of minimally invasive techniques for urgent colectomies remains understudied. ... more Objectives:The use of minimally invasive techniques for urgent colectomies remains understudied. This study compares short-term outcomes following urgent minimally invasive colectomies to those following open colectomies.Methods & Procedures:The American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) colectomy database was queried between January 1, 2013 and December 31, 2018. Patients who underwent elective and emergency colectomies, based on the respective NSQIP variables, were excluded. The remaining patients were divided into two groups, minimally invasive surgery (MIS) and open. MIS colectomies with unplanned conversion to open were included in the MIS group. Baseline characteristics and 30-day outcomes were compared using univariable and multivariable regression analyses.Results:A total of 29,345 patients were included in the study; 12,721 (43.3%) underwent MIS colectomy, while 16,624 (56.7%) underwent open colectomy. Patients undergoing MIS colectomy were younger (60.6 vs 63.8 years) and had a lower prevalence of either American Society of Anesthesiology (ASA) IV (9.9 vs 15.5%) or ASA V (0.08% vs 2%). After multivariable analysis, MIS colectomy was associated with lower odds of mortality (odds ratio = 0.75, 95% confidence interval: 0.61, 0.91 95% confidence interval), and most short-term complications recorded in the ACS NSQIP. While MIS colectomies took longer to perform (161 vs 140 min), the length of stay was shorter (12.2 vs 14.1 days).Conclusions:MIS colectomy affords better short-term complication rates and a reduced length of stay compared to open colectomy for patients requiring urgent surgery. If feasible, minimally invasive colectomy should be offered to patients necessitating urgent colon resection.

Research paper thumbnail of Trends in Open, Laparoscopic, and Robotic Approaches to Colorectal Operations

The American Surgeon™

The use of robotic approach has gained momentum in colorectal surgery. We analyzed the trends in ... more The use of robotic approach has gained momentum in colorectal surgery. We analyzed the trends in the adoption of robotic-assisted platform (RAP) for colorectal surgery over a 6-year period (2013-2018) using the American College of Surgeons National Surgical Quality Improvement Project. We assessed yearly prevalence of robotic, laparoscopic, and open approaches, and evaluated trends in the adoption of RAP across age, gender, BMI, and American Society of Anesthesiology (ASA) subgroups. Overall, the frequency of open, laparoscopic, and robotic approach was 36%, 46.8%, and 7.8%, respectively. While the use of laparoscopic cases remained stable over the study period, the prevalence of RAP increased from 2.8% to 11.4%. This was accompanied by a concomitant decline in the use of open approach, from 40.8% to 33%. The use of RAP also increased across all age, gender, BMI, and ASA subgroups. Robotic-assisted platform is increasingly utilized for higher risk, older, and obese patients, allowin...

Research paper thumbnail of Morbid Obesity Not a Risk for Serious Complications Following Outpatient Surgery

The American Surgeon™

Patients with class III obesity are often excluded from surgery in ambulatory surgery centers (AS... more Patients with class III obesity are often excluded from surgery in ambulatory surgery centers (ASCs). We hypothesize that class III obesity is not a risk factor for serious post-operative complications following outpatient operations. ACS-NSQIP database from 2012 to 2018 was queried. Patients undergoing outpatient inguinal hernia repair (IHR) and laparoscopic cholecystectomy (LC) were grouped by BMI. Baseline characteristics and 30-day outcomes were compared using univariate and multivariate analyses. Of these, 79,916 patients underwent IHR and 107,471 patients underwent LC. Multivariable analysis in IHR showed increased odds of superficial SSIs in all classes of obesity compared to normal weight ( P < .0001). In the LC group, there were higher rates of SSIs with obesity ( P < .0001). For both surgeries, a higher rate of readmissions to the hospital were observed in class II and IIIa obesity (both P < .0001), although rates were relatively low (<3%). Class III obesity de...

Research paper thumbnail of O34 AUTOLOGOUS Fenestrated Cutis Grafts for Ventral Hernia Repair in Patients with Obesity

British Journal of Surgery, 2021

Aim Traditional approaches to ventral hernia repair involve implantation of synthetic mesh (SM), ... more Aim Traditional approaches to ventral hernia repair involve implantation of synthetic mesh (SM), primary suture (PS) repair, and the use of biologic prostheses (BP). A body mass index (BMI) > 30 increases recurrence rates and complications for such repairs. We have begun to use Autologous Fenestrated Cutis Grafts (CG) as an alternative hernia repair. We investigated the impact of obesity on the recurrence and complication rates of CG compared to traditional repairs. Material and Methods A five-surgeon, retrospective study included all ventral/incisional, epigastric and umbilical hernia repairs (SM, PS, and BP from 2015-2020; CG repairs from 2018-2020). Patients with a BMI ≥ 30 were stratified according to surgical approach. Outcomes included recurrence and complication rates. Descriptive statistics for demographics and outcomes were compared and logistic regression performed with p < 0.05 considered significant. Results A total of 301 hernia repairs were performed (173 CGs, 54...

Research paper thumbnail of Factors Associated with Loss-to-Follow-Up during Behavioral Interventions and HIV Testing Cohort among Men Who Have Sex with Men in Nanjing, China

Research paper thumbnail of The safety of efalizumab in patients with moderate to severe plaque psoriasis: summary of clinical trial experience

Journal of the American Academy of Dermatology, 2004

Background: The efficacy and safety of efalizumab have been evaluated in multiple clinical trials... more Background: The efficacy and safety of efalizumab have been evaluated in multiple clinical trials. ObjectiveThe purpose of this review is to provide an overview of the safety profile of efalizumab during the clinical trials. Methods: Twelve-week data from four placebo-controlled trials were pooled and analyzed. Data from patients receiving 13-60 weeks of efalizumab therapy were pooled to evaluate longer-term safety. Results: The most common adverse events were mild to moderate, self-limiting, flulike symptoms that were most frequent following the first two efalizumab doses; by the third dose the incidence was comparable to placebo. Serious adverse events were observed in 2.2% and 1.7% of efalizumab-and placebo-treated patients, respectively. Nonserious adverse events leading to withdrawal were infrequent and similar to placebo (2.8% vs 1.8%). There does not appear to be increased risk of end-organ toxicity, infection, or malignancy in efalizumab-treated patients. Conclusion: Efalizumab was well tolerated, with a favorable safety profile. Sommaire Antecedents: L'efficacite et l'innocuite de l'efalizumab ont ete evaluees dans plusieurs essais cliniques. Objectif: La presente etude donne un apen;;u du profil d'innocuite de l'efalizumab durant les essais cliniques. Methodesfres donnees sur 12 semaines de quatre etudes controlees au placebo ont ete analysees, Des donnees sur des patients recevant de 13 a60 semaines de traitement ont ete regroupees afin d'evaluer l'innocuite aplus long terme. Resultats: L'effet indesirable le plus frequent s'est presence sous forme de symptornes pseudogrippaux autolimitatifs, Iegers amoderes, qui apparaissaient Ie plus frequemment apres les deux premieres doses d'efalizumab; apres la troisieme dose, l'incidence etait comparable acelle du groupe recevant le placebo. Des effets secondaires graves etaient observes chez 2.2 % des patients traites al'efalizumab et chez 1.7 % des patients recevant le placebo. Des evenements indesirables non graves qui ont pu causer l'abandon n'etaient pas frequents (2.8 % contre 1.8 % dans le groupe de controle), II ne semble pas avoir de risque accru de toxicite, d'infection ou de malignite dans l'organe cible, chez les personnes traitees al'efalizumab. ConclusionL'efalizumab etait bien tolere et presente un profil d'innocuite favorable.

Research paper thumbnail of Global vascular surgeons' experience, stressors, and coping during the coronavirus disease 2019 pandemic

Journal of Vascular Surgery, 2020

Research paper thumbnail of Minimally Invasive Surgery Is Associated with Decreased Overall Hospital Costs in Elective Colorectal Procedures

Journal of the American College of Surgeons, 2014

METHODS: Elective colorectal resections from January 2010 to June 2013 were included in a retrosp... more METHODS: Elective colorectal resections from January 2010 to June 2013 were included in a retrospective, single institution study. Chart abstraction was used to assess colectomy type, operative approach, and patient candidacy for MIS among the open procedures (prior surgery, extent of disease, etc.). Matching was performed based on colectomy type, indication (neoplasm, diverticulitis, etc.), and BMI. Outcomes were collected from NSQIP data. Operative and overall hospital costs were obtained from the hospital decision support system.

Research paper thumbnail of Patterns Of Stepping Cadence In The 2005-2006 NHANES

Medicine & Science in Sports & Exercise, 2011

PURPOSE: To compare steps detected by the Yamax pedometer (PEDO) versus the GT3X accelerometer (A... more PURPOSE: To compare steps detected by the Yamax pedometer (PEDO) versus the GT3X accelerometer (ACCEL) in free-living adults. METHODS: Daily PEDO and ACCEL steps were collected from a sample of 23 overweight and obese participants (18 females; mean ± sd: age = 52.6 ± 8.4 yr.; body mass index = 31.0 ± 3.7 m•kg-2). Participants were instructed to wear both devices for 7 consecutive days, removing them only at the end of each day and during any water activities. The analysis sample included 93 valid days based on wear time ≥ 10 hours for ACCEL and available data for both instruments. Because a pedometer is more likely to be used in a community-based intervention program, it was used as the standard for comparison. Percent difference (PD) and absolute percent difference (APD) were calculated to examine agreement between the PEDO (the standard measure) and the ACCEL. In addition, days were categorized based on PD: a) under-counted (>-10 PD), b) corresponded (-10 to 10 PD) and c) over-counted (> 10 PD).

Research paper thumbnail of Microwave Assisted Extraction of Biodiesel Feedstock from the Seeds of Invasive Chinese Tallow Tree

Environmental Science & Technology, 2010

Chinese tallow tree (TT) seeds are a rich source of lipids and have the potential to be a biodies... more Chinese tallow tree (TT) seeds are a rich source of lipids and have the potential to be a biodiesel feedstock, but currently, its invasive nature does not favor large scale cultivation. Being a nonfood material, they have many advantages over conventional crops that are used for biodiesel production. The purpose of this study was to determine optimal oil extraction parameters in a batch-type and laboratory scale continuous-flow microwave system to obtain maximum oil recovery from whole TT seeds using ethanol as the extracting solvent. For the batch system, extractions were carried out for different time-temperature combinations ranging from 60 to 120 degrees C for up to 20 min. The batch system was modified for continuous extractions, which were carried out at 50, 60, and 73 degrees C and maintained for various residence times of up to 20 min. Control runs were performed under similar extraction conditions and the results compared well, especially when accounting for extremely short extraction times (minutes vs hours). Maximum yields of 35.32% and 32.51% (by weight of dry mass) were obtained for the continuous and batch process, respectively. The major advantage of microwave assisted solvent extraction is the reduced time of extraction required to obtain total recoverable lipids, with corresponding reduction in energy consumption costs per unit of lipid extracted. This study indicates that microwave extraction using ethanol as a solvent can be used as a viable alternative to conventional lipid extraction techniques for TT seeds.

Research paper thumbnail of A phase III randomized, double-blind, placebo-controlled trial of gabapentin in the management of hot flashes in men (N00CB)

Annals of Oncology, 2008

Hot flashes represent a significant problem in men undergoing androgen deprivation therapy. Mater... more Hot flashes represent a significant problem in men undergoing androgen deprivation therapy. Materials and methods: Via a prospective, double-blind, placebo-controlled clinical trial, men with hot flashes, on a stable androgen deprivation therapy program for prostate cancer, received a placebo or gabapentin at target doses of 300, 600, or 900 mg/day. Hot flash frequencies and severities were recorded daily during a baseline week and for 4 weeks while the patients took the study medication. Results: In the 214 eligible patients who began the study drug on this trial, comparing the fourth treatment week to the baseline week, mean hot flash scores decreased in the placebo group by 4.1 units and in the three increasing dose gabapentin groups by, 3.2, 4.6, and 7.0 units. Comparing the three combined gabapentin arms to the placebo arm did not result in significant hot flash differences. Wilcoxon rank-sum P values for change in hot flash scores and frequencies after 4 weeks of treatment were 0.10 and 0.02, comparing the highest dose gabapentin arm to the placebo arm, respectively. The gabapentin was well tolerated in this trial. Conclusion: These results support that gabapentin decreases hot flashes, to a moderate degree, in men with androgen ablation-related vasomotor dysfunction.

Research paper thumbnail of Biological aging alters circadian mechanisms in murine adipose tissue depots

Research paper thumbnail of Minimalistic approach to enhanced recovery after pediatric scoliosis surgery

Spine Deformity

Purpose Prior studies of enhanced recovery protocols (ERP) have been conducted at large instituti... more Purpose Prior studies of enhanced recovery protocols (ERP) have been conducted at large institutions with abundant resources. These results may not apply at institutions with less resources directed to quality improvement efforts. The purpose of this study was to assess the value of a minimalistic enhanced recovery protocol in reducing length of stay (LOS) following PSF for adolescent idiopathic scoliosis. We hypothesized that accelerated transition to oral pain medications and mobilization alone could shorten hospital length of stay in the absence of a formal multimodal pain regimen. Methods AIS patients aged 10–18 who underwent PSF at a tertiary pediatric hospital between January 1, 2014 and December 31, 2017 were reviewed. The study population was further narrowed to consecutive patients from a single surgeon’s practice that piloted the modified ERP. Reservation from key stakeholders regarding the feasibility of implementing widespread protocol change led to the minimal alteratio...

Research paper thumbnail of Delayed Surgery Does Not Increase Risk in Urgent Colectomy for Ulcerative Colitis

The American Surgeon, 2020

Background Medical management is the cornerstone of therapy for ulcerative colitis (UC). In the s... more Background Medical management is the cornerstone of therapy for ulcerative colitis (UC). In the setting of fulminant disease, hospitalized patients may undergo medical rescue therapy (MRT) or urgent surgery. We hypothesized that delayed attempts at MRT result in increased morbidity and mortality following urgent surgery for UC. Objective The aim is to assess the outcomes for patients requiring urgent, inpatient surgery for UC in a prompt or delayed fashion. Design The American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) general and colectomy-specific databases from 2013 to 2016 were queried. Urgent surgery was defined as nonelective, nonemergency surgery. Patients were divided into prompt and delayed groups based on time from admission to surgery of <48 hours or >48 hours. Baseline characteristics and 30-day outcomes were compared using univariate and multivariate analyses. Setting The ACS NSQIP database from 2013 to 2016 was evaluated. Patien...

Research paper thumbnail of Laparoscopic Colectomy for Acute Diverticulitis in the Urgent Setting is Associated with Similar Outcomes to Open

The American Surgeon, 2021

Purpose/Background The role of minimally invasive surgery (MIS) for the surgical treatment of div... more Purpose/Background The role of minimally invasive surgery (MIS) for the surgical treatment of diverticular disease is evolving. The aim of this study is to compare the outcomes of MIS colectomy to those of open surgery for patients with acute diverticulitis requiring urgent surgery. Methods The American college of Surgeons National Surgical Quality Improvement Project database was queried for all patients undergoing an urgent colectomy for acute diverticulitis between 2013 and 2018. The patients were then divided into 2 groups: MIS and open. Baseline characteristics and short-term outcomes were compared using univariable and multivariable regression analyses. Results/Outcomes 3487 patients were included in the analysis. Of these, 1272 (36.5%) underwent MIS colectomy and 2215 (63.5%) underwent open colectomy. Patients undergoing MIS colectomy were younger (58.7 vs 61.9 years) and less likely to be American Society of Anesthesiologists Classification (ASA) III (52.5 vs 57.9%) or IV (6...

Research paper thumbnail of Emergency, Urgent, and Elective Colectomies: A Comparison of Outcomes Using the American College of Surgeons National Surgical Quality Improvement Program

Journal of the American College of Surgeons, 2019

other factors, that colon cancer patients with MELD score ! 12 have 2.26 times higher chances to ... more other factors, that colon cancer patients with MELD score ! 12 have 2.26 times higher chances to have higher 30-day mortality rate when compared with patients with MELD score <12 (p < 0.001). The area under the ROC curve was 0.757 for the MELD cutoff value of 12 (p < 0.001) (Figure). CONCLUSION: Preoperative MELD score is an independent prognosticator of 30-day survival rate after colectomy for colon cancer. Patients with MELD score ! 12 are at higher risk of early postoperative death and should undergo optimization before surgery to improve outcomes. Figure. Receiver operating characteristic curve for mortality. Optimal MELD cutoff value was ! 12

Research paper thumbnail of The Social Determinants of Health Core: Taking a Place-Based Approach

American Journal of Preventive Medicine, 2017

Introduction-There is growing recognition that health disparities research needs to incorporate s... more Introduction-There is growing recognition that health disparities research needs to incorporate social determinants in the local environment into explanatory models. In the transdisciplinary setting of the Mid-South Transdisciplinary Collaborative Center (TCC), the Social Determinants (SDH) Core developed an approach to incorporating SDH across a variety of studies. This placedof Health based approach, which is geographically based, transdisciplinary, and inherently multilevel, is discussed. Methods-From 2014 through 2016, the SDH Core consulted on a variety of Mid-South TCC approach used geospatial methods (e.g., geocoding) to link individual data files with measures of the physical and social environment in the SDH Core database. Once linked, the method permitted various types of analysis (e.g., multilevel analysis) to determine if racial disparities could be explained in terms of social determinants in the local environment. Results-The SDH Core consulted on five Mid-South TCC research projects. In resulting analyses for all the studies, a significant portion of the variance in one or more outcomes was partially explained by a social determinant from the SDH Core database. Conclusions-The SDH Core approach to addressing health disparities by linking neighborhood social and physical environment measures to an individual-level data file proved to be a successful approach across Mid-South TCC research projects.

Research paper thumbnail of Effects of ketamine and lidocaine in combination on the sevoflurane minimum alveolar concentration in alpacas

Canadian journal of veterinary research = Revue canadienne de recherche vétérinaire, 2016

This study investigated the effects of ketamine and lidocaine in combination on the minimum alveo... more This study investigated the effects of ketamine and lidocaine in combination on the minimum alveolar concentration of sevoflurane (MACSEVO) in alpacas. Eight healthy, intact male, adult alpacas were studied on 2 separate occasions. Anesthesia was induced with SEVO, and baseline MAC (MACB) determination began 45 min after induction. After MACB determination, alpacas were randomly given either an intravenous (IV) loading dose (LD) and infusion of saline or a loading dose [ketamine = 0.5 mg/kg body weight (BW); lidocaine = 2 mg/kg BW] and an infusion of ketamine (25 μg/kg BW per minute) in combination with lidocaine (50 μg/kg BW per minute), and MACSEVO was re-determined (MACT). Quality of recovery, time-to-extubation, and time-to-standing, were also evaluated. Mean MACB was 1.88% ± 0.13% and 1.89% ± 0.14% for the saline and ketamine + lidocaine groups, respectively. Ketamine and lidocaine administration decreased (P < 0.05) MACB by 57% and mean MACT was 0.83% ± 0.10%. Saline admini...

Research paper thumbnail of Association between BMI and Elevation of Residence: A Multilevel Study Using NHANES Participants

Background: The literature has shown that leptin concentrations tend to rise at high altitudes. H... more Background: The literature has shown that leptin concentrations tend to rise at high altitudes. However, few studies have examined the association between obesity and elevation of residence, especially at small geographical scales. The purpose of this study was to determine whether elevation of residence is associated with BMI at the census tract level. Methods: Multilevel analyses of Continuous NHANES 2003-2006 participants (n=4,190) nested in the census tract of residence were conducted. BMI was derived from the directly measured individual height and weight in NHANES. Elevation data was obtained from the 2009 National Elevation Database (NED) and used to calculate tract-level mean elevation by using ArcGIS 10.2 zonal statistics. Additional individual level characteristics potentially associated with BMI (i.e., age, race/ethnicity, gender, household income, marital status, education, smoking status, and nativity) were also included in our models. Results: ANOVA analysis of BMI in ...

Research paper thumbnail of Dramatic Reduction in Opioid Prescribing for Common Outpatient Orthopaedic Lower Extremity Surgical Procedures at a Louisiana University-Based Safety-Net Hospital After Enactment of Opioid-Limiting State Legislation

Journal of the American Academy of Orthopaedic Surgeons

Introduction: The opioid epidemic in the United States has been fueled by overprescribing opioids... more Introduction: The opioid epidemic in the United States has been fueled by overprescribing opioids, which is particularly apparent in orthopaedics. Stakeholders, including state legislatures, have attempted to curb opioid overprescribing to reduce related abuse/dependence, overdose deaths, and diversion. Objective: To examine trends in opioid prescribing for common outpatient lower extremity orthopaedic surgeries in a population vulnerable to prolonged opioid use before and after the enactment of a 2017 Louisiana state law limiting opioid prescribing for acute pain. Methods: Eligible patients were adults who underwent one of the five most common outpatient lower extremity orthopaedic surgeries done during 2013 to 2018 at an urban tertiary care academic medical center. Excluded were prisoners and patients who required inpatient hospitalization, had no documented discharge opioid prescription, or filled an opioid prescription unrelated to their orthopaedic procedure within 30 days befo...

Research paper thumbnail of Minimally Invasive Surgery is Associated with Improved Outcomes Following Urgent Inpatient Colectomy

JSLS, 2022

Objectives:The use of minimally invasive techniques for urgent colectomies remains understudied. ... more Objectives:The use of minimally invasive techniques for urgent colectomies remains understudied. This study compares short-term outcomes following urgent minimally invasive colectomies to those following open colectomies.Methods & Procedures:The American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) colectomy database was queried between January 1, 2013 and December 31, 2018. Patients who underwent elective and emergency colectomies, based on the respective NSQIP variables, were excluded. The remaining patients were divided into two groups, minimally invasive surgery (MIS) and open. MIS colectomies with unplanned conversion to open were included in the MIS group. Baseline characteristics and 30-day outcomes were compared using univariable and multivariable regression analyses.Results:A total of 29,345 patients were included in the study; 12,721 (43.3%) underwent MIS colectomy, while 16,624 (56.7%) underwent open colectomy. Patients undergoing MIS colectomy were younger (60.6 vs 63.8 years) and had a lower prevalence of either American Society of Anesthesiology (ASA) IV (9.9 vs 15.5%) or ASA V (0.08% vs 2%). After multivariable analysis, MIS colectomy was associated with lower odds of mortality (odds ratio = 0.75, 95% confidence interval: 0.61, 0.91 95% confidence interval), and most short-term complications recorded in the ACS NSQIP. While MIS colectomies took longer to perform (161 vs 140 min), the length of stay was shorter (12.2 vs 14.1 days).Conclusions:MIS colectomy affords better short-term complication rates and a reduced length of stay compared to open colectomy for patients requiring urgent surgery. If feasible, minimally invasive colectomy should be offered to patients necessitating urgent colon resection.

Research paper thumbnail of Trends in Open, Laparoscopic, and Robotic Approaches to Colorectal Operations

The American Surgeon™

The use of robotic approach has gained momentum in colorectal surgery. We analyzed the trends in ... more The use of robotic approach has gained momentum in colorectal surgery. We analyzed the trends in the adoption of robotic-assisted platform (RAP) for colorectal surgery over a 6-year period (2013-2018) using the American College of Surgeons National Surgical Quality Improvement Project. We assessed yearly prevalence of robotic, laparoscopic, and open approaches, and evaluated trends in the adoption of RAP across age, gender, BMI, and American Society of Anesthesiology (ASA) subgroups. Overall, the frequency of open, laparoscopic, and robotic approach was 36%, 46.8%, and 7.8%, respectively. While the use of laparoscopic cases remained stable over the study period, the prevalence of RAP increased from 2.8% to 11.4%. This was accompanied by a concomitant decline in the use of open approach, from 40.8% to 33%. The use of RAP also increased across all age, gender, BMI, and ASA subgroups. Robotic-assisted platform is increasingly utilized for higher risk, older, and obese patients, allowin...

Research paper thumbnail of Morbid Obesity Not a Risk for Serious Complications Following Outpatient Surgery

The American Surgeon™

Patients with class III obesity are often excluded from surgery in ambulatory surgery centers (AS... more Patients with class III obesity are often excluded from surgery in ambulatory surgery centers (ASCs). We hypothesize that class III obesity is not a risk factor for serious post-operative complications following outpatient operations. ACS-NSQIP database from 2012 to 2018 was queried. Patients undergoing outpatient inguinal hernia repair (IHR) and laparoscopic cholecystectomy (LC) were grouped by BMI. Baseline characteristics and 30-day outcomes were compared using univariate and multivariate analyses. Of these, 79,916 patients underwent IHR and 107,471 patients underwent LC. Multivariable analysis in IHR showed increased odds of superficial SSIs in all classes of obesity compared to normal weight ( P < .0001). In the LC group, there were higher rates of SSIs with obesity ( P < .0001). For both surgeries, a higher rate of readmissions to the hospital were observed in class II and IIIa obesity (both P < .0001), although rates were relatively low (<3%). Class III obesity de...

Research paper thumbnail of O34 AUTOLOGOUS Fenestrated Cutis Grafts for Ventral Hernia Repair in Patients with Obesity

British Journal of Surgery, 2021

Aim Traditional approaches to ventral hernia repair involve implantation of synthetic mesh (SM), ... more Aim Traditional approaches to ventral hernia repair involve implantation of synthetic mesh (SM), primary suture (PS) repair, and the use of biologic prostheses (BP). A body mass index (BMI) > 30 increases recurrence rates and complications for such repairs. We have begun to use Autologous Fenestrated Cutis Grafts (CG) as an alternative hernia repair. We investigated the impact of obesity on the recurrence and complication rates of CG compared to traditional repairs. Material and Methods A five-surgeon, retrospective study included all ventral/incisional, epigastric and umbilical hernia repairs (SM, PS, and BP from 2015-2020; CG repairs from 2018-2020). Patients with a BMI ≥ 30 were stratified according to surgical approach. Outcomes included recurrence and complication rates. Descriptive statistics for demographics and outcomes were compared and logistic regression performed with p < 0.05 considered significant. Results A total of 301 hernia repairs were performed (173 CGs, 54...

Research paper thumbnail of Factors Associated with Loss-to-Follow-Up during Behavioral Interventions and HIV Testing Cohort among Men Who Have Sex with Men in Nanjing, China

Research paper thumbnail of The safety of efalizumab in patients with moderate to severe plaque psoriasis: summary of clinical trial experience

Journal of the American Academy of Dermatology, 2004

Background: The efficacy and safety of efalizumab have been evaluated in multiple clinical trials... more Background: The efficacy and safety of efalizumab have been evaluated in multiple clinical trials. ObjectiveThe purpose of this review is to provide an overview of the safety profile of efalizumab during the clinical trials. Methods: Twelve-week data from four placebo-controlled trials were pooled and analyzed. Data from patients receiving 13-60 weeks of efalizumab therapy were pooled to evaluate longer-term safety. Results: The most common adverse events were mild to moderate, self-limiting, flulike symptoms that were most frequent following the first two efalizumab doses; by the third dose the incidence was comparable to placebo. Serious adverse events were observed in 2.2% and 1.7% of efalizumab-and placebo-treated patients, respectively. Nonserious adverse events leading to withdrawal were infrequent and similar to placebo (2.8% vs 1.8%). There does not appear to be increased risk of end-organ toxicity, infection, or malignancy in efalizumab-treated patients. Conclusion: Efalizumab was well tolerated, with a favorable safety profile. Sommaire Antecedents: L'efficacite et l'innocuite de l'efalizumab ont ete evaluees dans plusieurs essais cliniques. Objectif: La presente etude donne un apen;;u du profil d'innocuite de l'efalizumab durant les essais cliniques. Methodesfres donnees sur 12 semaines de quatre etudes controlees au placebo ont ete analysees, Des donnees sur des patients recevant de 13 a60 semaines de traitement ont ete regroupees afin d'evaluer l'innocuite aplus long terme. Resultats: L'effet indesirable le plus frequent s'est presence sous forme de symptornes pseudogrippaux autolimitatifs, Iegers amoderes, qui apparaissaient Ie plus frequemment apres les deux premieres doses d'efalizumab; apres la troisieme dose, l'incidence etait comparable acelle du groupe recevant le placebo. Des effets secondaires graves etaient observes chez 2.2 % des patients traites al'efalizumab et chez 1.7 % des patients recevant le placebo. Des evenements indesirables non graves qui ont pu causer l'abandon n'etaient pas frequents (2.8 % contre 1.8 % dans le groupe de controle), II ne semble pas avoir de risque accru de toxicite, d'infection ou de malignite dans l'organe cible, chez les personnes traitees al'efalizumab. ConclusionL'efalizumab etait bien tolere et presente un profil d'innocuite favorable.

Research paper thumbnail of Global vascular surgeons' experience, stressors, and coping during the coronavirus disease 2019 pandemic

Journal of Vascular Surgery, 2020

Research paper thumbnail of Minimally Invasive Surgery Is Associated with Decreased Overall Hospital Costs in Elective Colorectal Procedures

Journal of the American College of Surgeons, 2014

METHODS: Elective colorectal resections from January 2010 to June 2013 were included in a retrosp... more METHODS: Elective colorectal resections from January 2010 to June 2013 were included in a retrospective, single institution study. Chart abstraction was used to assess colectomy type, operative approach, and patient candidacy for MIS among the open procedures (prior surgery, extent of disease, etc.). Matching was performed based on colectomy type, indication (neoplasm, diverticulitis, etc.), and BMI. Outcomes were collected from NSQIP data. Operative and overall hospital costs were obtained from the hospital decision support system.

Research paper thumbnail of Patterns Of Stepping Cadence In The 2005-2006 NHANES

Medicine & Science in Sports & Exercise, 2011

PURPOSE: To compare steps detected by the Yamax pedometer (PEDO) versus the GT3X accelerometer (A... more PURPOSE: To compare steps detected by the Yamax pedometer (PEDO) versus the GT3X accelerometer (ACCEL) in free-living adults. METHODS: Daily PEDO and ACCEL steps were collected from a sample of 23 overweight and obese participants (18 females; mean ± sd: age = 52.6 ± 8.4 yr.; body mass index = 31.0 ± 3.7 m•kg-2). Participants were instructed to wear both devices for 7 consecutive days, removing them only at the end of each day and during any water activities. The analysis sample included 93 valid days based on wear time ≥ 10 hours for ACCEL and available data for both instruments. Because a pedometer is more likely to be used in a community-based intervention program, it was used as the standard for comparison. Percent difference (PD) and absolute percent difference (APD) were calculated to examine agreement between the PEDO (the standard measure) and the ACCEL. In addition, days were categorized based on PD: a) under-counted (>-10 PD), b) corresponded (-10 to 10 PD) and c) over-counted (> 10 PD).

Research paper thumbnail of Microwave Assisted Extraction of Biodiesel Feedstock from the Seeds of Invasive Chinese Tallow Tree

Environmental Science & Technology, 2010

Chinese tallow tree (TT) seeds are a rich source of lipids and have the potential to be a biodies... more Chinese tallow tree (TT) seeds are a rich source of lipids and have the potential to be a biodiesel feedstock, but currently, its invasive nature does not favor large scale cultivation. Being a nonfood material, they have many advantages over conventional crops that are used for biodiesel production. The purpose of this study was to determine optimal oil extraction parameters in a batch-type and laboratory scale continuous-flow microwave system to obtain maximum oil recovery from whole TT seeds using ethanol as the extracting solvent. For the batch system, extractions were carried out for different time-temperature combinations ranging from 60 to 120 degrees C for up to 20 min. The batch system was modified for continuous extractions, which were carried out at 50, 60, and 73 degrees C and maintained for various residence times of up to 20 min. Control runs were performed under similar extraction conditions and the results compared well, especially when accounting for extremely short extraction times (minutes vs hours). Maximum yields of 35.32% and 32.51% (by weight of dry mass) were obtained for the continuous and batch process, respectively. The major advantage of microwave assisted solvent extraction is the reduced time of extraction required to obtain total recoverable lipids, with corresponding reduction in energy consumption costs per unit of lipid extracted. This study indicates that microwave extraction using ethanol as a solvent can be used as a viable alternative to conventional lipid extraction techniques for TT seeds.

Research paper thumbnail of A phase III randomized, double-blind, placebo-controlled trial of gabapentin in the management of hot flashes in men (N00CB)

Annals of Oncology, 2008

Hot flashes represent a significant problem in men undergoing androgen deprivation therapy. Mater... more Hot flashes represent a significant problem in men undergoing androgen deprivation therapy. Materials and methods: Via a prospective, double-blind, placebo-controlled clinical trial, men with hot flashes, on a stable androgen deprivation therapy program for prostate cancer, received a placebo or gabapentin at target doses of 300, 600, or 900 mg/day. Hot flash frequencies and severities were recorded daily during a baseline week and for 4 weeks while the patients took the study medication. Results: In the 214 eligible patients who began the study drug on this trial, comparing the fourth treatment week to the baseline week, mean hot flash scores decreased in the placebo group by 4.1 units and in the three increasing dose gabapentin groups by, 3.2, 4.6, and 7.0 units. Comparing the three combined gabapentin arms to the placebo arm did not result in significant hot flash differences. Wilcoxon rank-sum P values for change in hot flash scores and frequencies after 4 weeks of treatment were 0.10 and 0.02, comparing the highest dose gabapentin arm to the placebo arm, respectively. The gabapentin was well tolerated in this trial. Conclusion: These results support that gabapentin decreases hot flashes, to a moderate degree, in men with androgen ablation-related vasomotor dysfunction.

Research paper thumbnail of Biological aging alters circadian mechanisms in murine adipose tissue depots

Research paper thumbnail of Minimalistic approach to enhanced recovery after pediatric scoliosis surgery

Spine Deformity

Purpose Prior studies of enhanced recovery protocols (ERP) have been conducted at large instituti... more Purpose Prior studies of enhanced recovery protocols (ERP) have been conducted at large institutions with abundant resources. These results may not apply at institutions with less resources directed to quality improvement efforts. The purpose of this study was to assess the value of a minimalistic enhanced recovery protocol in reducing length of stay (LOS) following PSF for adolescent idiopathic scoliosis. We hypothesized that accelerated transition to oral pain medications and mobilization alone could shorten hospital length of stay in the absence of a formal multimodal pain regimen. Methods AIS patients aged 10–18 who underwent PSF at a tertiary pediatric hospital between January 1, 2014 and December 31, 2017 were reviewed. The study population was further narrowed to consecutive patients from a single surgeon’s practice that piloted the modified ERP. Reservation from key stakeholders regarding the feasibility of implementing widespread protocol change led to the minimal alteratio...

Research paper thumbnail of Delayed Surgery Does Not Increase Risk in Urgent Colectomy for Ulcerative Colitis

The American Surgeon, 2020

Background Medical management is the cornerstone of therapy for ulcerative colitis (UC). In the s... more Background Medical management is the cornerstone of therapy for ulcerative colitis (UC). In the setting of fulminant disease, hospitalized patients may undergo medical rescue therapy (MRT) or urgent surgery. We hypothesized that delayed attempts at MRT result in increased morbidity and mortality following urgent surgery for UC. Objective The aim is to assess the outcomes for patients requiring urgent, inpatient surgery for UC in a prompt or delayed fashion. Design The American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) general and colectomy-specific databases from 2013 to 2016 were queried. Urgent surgery was defined as nonelective, nonemergency surgery. Patients were divided into prompt and delayed groups based on time from admission to surgery of <48 hours or >48 hours. Baseline characteristics and 30-day outcomes were compared using univariate and multivariate analyses. Setting The ACS NSQIP database from 2013 to 2016 was evaluated. Patien...

Research paper thumbnail of Laparoscopic Colectomy for Acute Diverticulitis in the Urgent Setting is Associated with Similar Outcomes to Open

The American Surgeon, 2021

Purpose/Background The role of minimally invasive surgery (MIS) for the surgical treatment of div... more Purpose/Background The role of minimally invasive surgery (MIS) for the surgical treatment of diverticular disease is evolving. The aim of this study is to compare the outcomes of MIS colectomy to those of open surgery for patients with acute diverticulitis requiring urgent surgery. Methods The American college of Surgeons National Surgical Quality Improvement Project database was queried for all patients undergoing an urgent colectomy for acute diverticulitis between 2013 and 2018. The patients were then divided into 2 groups: MIS and open. Baseline characteristics and short-term outcomes were compared using univariable and multivariable regression analyses. Results/Outcomes 3487 patients were included in the analysis. Of these, 1272 (36.5%) underwent MIS colectomy and 2215 (63.5%) underwent open colectomy. Patients undergoing MIS colectomy were younger (58.7 vs 61.9 years) and less likely to be American Society of Anesthesiologists Classification (ASA) III (52.5 vs 57.9%) or IV (6...

Research paper thumbnail of Emergency, Urgent, and Elective Colectomies: A Comparison of Outcomes Using the American College of Surgeons National Surgical Quality Improvement Program

Journal of the American College of Surgeons, 2019

other factors, that colon cancer patients with MELD score ! 12 have 2.26 times higher chances to ... more other factors, that colon cancer patients with MELD score ! 12 have 2.26 times higher chances to have higher 30-day mortality rate when compared with patients with MELD score <12 (p < 0.001). The area under the ROC curve was 0.757 for the MELD cutoff value of 12 (p < 0.001) (Figure). CONCLUSION: Preoperative MELD score is an independent prognosticator of 30-day survival rate after colectomy for colon cancer. Patients with MELD score ! 12 are at higher risk of early postoperative death and should undergo optimization before surgery to improve outcomes. Figure. Receiver operating characteristic curve for mortality. Optimal MELD cutoff value was ! 12

Research paper thumbnail of The Social Determinants of Health Core: Taking a Place-Based Approach

American Journal of Preventive Medicine, 2017

Introduction-There is growing recognition that health disparities research needs to incorporate s... more Introduction-There is growing recognition that health disparities research needs to incorporate social determinants in the local environment into explanatory models. In the transdisciplinary setting of the Mid-South Transdisciplinary Collaborative Center (TCC), the Social Determinants (SDH) Core developed an approach to incorporating SDH across a variety of studies. This placedof Health based approach, which is geographically based, transdisciplinary, and inherently multilevel, is discussed. Methods-From 2014 through 2016, the SDH Core consulted on a variety of Mid-South TCC approach used geospatial methods (e.g., geocoding) to link individual data files with measures of the physical and social environment in the SDH Core database. Once linked, the method permitted various types of analysis (e.g., multilevel analysis) to determine if racial disparities could be explained in terms of social determinants in the local environment. Results-The SDH Core consulted on five Mid-South TCC research projects. In resulting analyses for all the studies, a significant portion of the variance in one or more outcomes was partially explained by a social determinant from the SDH Core database. Conclusions-The SDH Core approach to addressing health disparities by linking neighborhood social and physical environment measures to an individual-level data file proved to be a successful approach across Mid-South TCC research projects.

Research paper thumbnail of Effects of ketamine and lidocaine in combination on the sevoflurane minimum alveolar concentration in alpacas

Canadian journal of veterinary research = Revue canadienne de recherche vétérinaire, 2016

This study investigated the effects of ketamine and lidocaine in combination on the minimum alveo... more This study investigated the effects of ketamine and lidocaine in combination on the minimum alveolar concentration of sevoflurane (MACSEVO) in alpacas. Eight healthy, intact male, adult alpacas were studied on 2 separate occasions. Anesthesia was induced with SEVO, and baseline MAC (MACB) determination began 45 min after induction. After MACB determination, alpacas were randomly given either an intravenous (IV) loading dose (LD) and infusion of saline or a loading dose [ketamine = 0.5 mg/kg body weight (BW); lidocaine = 2 mg/kg BW] and an infusion of ketamine (25 μg/kg BW per minute) in combination with lidocaine (50 μg/kg BW per minute), and MACSEVO was re-determined (MACT). Quality of recovery, time-to-extubation, and time-to-standing, were also evaluated. Mean MACB was 1.88% ± 0.13% and 1.89% ± 0.14% for the saline and ketamine + lidocaine groups, respectively. Ketamine and lidocaine administration decreased (P < 0.05) MACB by 57% and mean MACT was 0.83% ± 0.10%. Saline admini...

Research paper thumbnail of Association between BMI and Elevation of Residence: A Multilevel Study Using NHANES Participants

Background: The literature has shown that leptin concentrations tend to rise at high altitudes. H... more Background: The literature has shown that leptin concentrations tend to rise at high altitudes. However, few studies have examined the association between obesity and elevation of residence, especially at small geographical scales. The purpose of this study was to determine whether elevation of residence is associated with BMI at the census tract level. Methods: Multilevel analyses of Continuous NHANES 2003-2006 participants (n=4,190) nested in the census tract of residence were conducted. BMI was derived from the directly measured individual height and weight in NHANES. Elevation data was obtained from the 2009 National Elevation Database (NED) and used to calculate tract-level mean elevation by using ArcGIS 10.2 zonal statistics. Additional individual level characteristics potentially associated with BMI (i.e., age, race/ethnicity, gender, household income, marital status, education, smoking status, and nativity) were also included in our models. Results: ANOVA analysis of BMI in ...

Research paper thumbnail of Dramatic Reduction in Opioid Prescribing for Common Outpatient Orthopaedic Lower Extremity Surgical Procedures at a Louisiana University-Based Safety-Net Hospital After Enactment of Opioid-Limiting State Legislation

Journal of the American Academy of Orthopaedic Surgeons

Introduction: The opioid epidemic in the United States has been fueled by overprescribing opioids... more Introduction: The opioid epidemic in the United States has been fueled by overprescribing opioids, which is particularly apparent in orthopaedics. Stakeholders, including state legislatures, have attempted to curb opioid overprescribing to reduce related abuse/dependence, overdose deaths, and diversion. Objective: To examine trends in opioid prescribing for common outpatient lower extremity orthopaedic surgeries in a population vulnerable to prolonged opioid use before and after the enactment of a 2017 Louisiana state law limiting opioid prescribing for acute pain. Methods: Eligible patients were adults who underwent one of the five most common outpatient lower extremity orthopaedic surgeries done during 2013 to 2018 at an urban tertiary care academic medical center. Excluded were prisoners and patients who required inpatient hospitalization, had no documented discharge opioid prescription, or filled an opioid prescription unrelated to their orthopaedic procedure within 30 days befo...