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Pig-to-human heart xenotransplantation in two recently deceased human recipients

Moazami, Nader; Stern, Jeffrey M; Khalil, Karen; Kim, Jacqueline I; Narula, Navneet; Mangiola, Massimo; Weldon, Elaina P; Kagermazova, Larisa; James, Les; Lawson, Nikki; Piper, Greta L; Sommer, Philip M; Reyentovich, Alex; Bamira, Daniel; Saraon, Tajinderpal; Kadosh, Bernard S; DiVita, Michael; Goldberg, Randal I; Hussain, Syed T; Chan, Justin; Ngai, Jennie; Jan, Thomas; Ali, Nicole M; Tatapudi, Vasishta S; Segev, Dorry L; Bisen, Shivani; Jaffe, Ian S; Piegari, Benjamin; Kowalski, Haley; Kokkinaki, Maria; Monahan, Jeffrey; Sorrells, Lori; Burdorf, Lars; Boeke, Jef D; Pass, Harvey; Goparaju, Chandra; Keating, Brendan; Ayares, David; Lorber, Marc; Griesemer, Adam; Mehta, Sapna A; Smith, Deane E; Montgomery, Robert A
Genetically modified xenografts are one of the most promising solutions to the discrepancy between the numbers of available human organs for transplantation and potential recipients. To date, a porcine heart has been implanted into only one human recipient. Here, using 10-gene-edited pigs, we transplanted porcine hearts into two brain-dead human recipients and monitored xenograft function, hemodynamics and systemic responses over the course of 66 hours. Although both xenografts demonstrated excellent cardiac function immediately after transplantation and continued to function for the duration of the study, cardiac function declined postoperatively in one case, attributed to a size mismatch between the donor pig and the recipient. For both hearts, we confirmed transgene expression and found no evidence of cellular or antibody-mediated rejection, as assessed using histology, flow cytometry and a cytotoxic crossmatch assay. Moreover, we found no evidence of zoonotic transmission from the donor pigs to the human recipients. While substantial additional work will be needed to advance this technology to human trials, these results indicate that pig-to-human heart xenotransplantation can be performed successfully without hyperacute rejection or zoonosis.
PMID: 37488288
ISSN: 1546-170x
CID: 5595152

Preoperative Care Practice for Female Cardiac Patients: A Survey From the Society of Cardiovascular Anesthesiologists [Letter]

Nanegrungsunk, Danop; Patel, Shayna; Jan, Thomas; Ngai, Jennie Y
PMID: 34776353
ISSN: 1532-8422
CID: 5048912

The Optimal Angle of Head Rotation for Internal Jugular Cannulation as Determined by Ultrasound Evaluation

DeAngelis, Vincent; Denny, John; Chyu, Darrick; Jan, Thomas; Lemaire, Anthony; Chiricolo, Antonio; Solina, Al
OBJECTIVES/OBJECTIVE:The aim of this study was to determine the degree of head rotation that creates the maximal anatomic separation between the right internal jugular vein and the carotid artery. DESIGN/METHODS:Single-center prospective, observational cohort study. SETTING/METHODS:University medical center. PARTICIPANTS/METHODS:Fifty patients aged>21 years and undergoing cardiac surgery. INTERVENTIONS/METHODS:An ultrasound machine equipped with a digital caliper was used to determine the relational anatomy of the internal jugular vein and the carotid artery, with patients in the Trendelenburg position at head angles of -15°, 0°,+15°,+30°,+45°,+60°,+75°, and+90°. MEASUREMENTS AND MAIN RESULTS/RESULTS:When examining the percentage of the internal jugular vein vertical diameter that is not overlapped by the carotid artery (vertically unencumbered), there was a difference between the head angle groups (p<0.01). Unencumbered vertical distance was different between+75° versus 0°, and+75° versus+15°. At+75°, 60.3%±5.3% of the internal jugular vein was unencumbered vertically, whereas at 0°, it was 37.2%±3.9%, and at+15° it was 40.3%±3.8%. Only 72% of the patients were able to position their head at+75°, and 54% of the subjects were able to position their head at+90°. CONCLUSION/CONCLUSIONS:The authors found the internal jugular vein becomes more vertically separated from the carotid artery at more extreme angles of contralateral head rotation.
PMID: 25998069
ISSN: 1532-8422
CID: 3142222

Lower incidence of hypo-magnesemia in surgical intensive care unit patients in 2011 versus 2001

Denny, John T; Pantin, Enrique; Chiricolo, Antonio; Tse, James; Jan, Thomas; Chaudhry, Mohammad; Barsoum, Sylviana; Denny, Angela M; Papp, Denes; Morgan, Sharon L
BACKGROUND:Hypo-magnesemia is described to occur in as many as 65% of intensive care unit (ICU) patients. Magnesium (Mg) is a cofactor in over 300 enzymatic reactions involving energy metabolism, protein, and nucleic acid synthesis. The membrane pump that creates the electrical gradient across the cell membrane is dependent on Mg, and it is important in the activity of electrically excitable tissues. Since Mg regulates the movement of calcium in smooth muscle cells, it is also important in peripheral vascular tone and blood pressure. Studies have linked hypo-magnesemia to multiple chronic diseases and to a higher mortality rate. METHODS:To explore trends within our own tertiary care surgical ICU, we sampled our patients' laboratory records in 2001 and in 2011. Hypo-magnesemia in our ICU is defined as an Mg less than 2.0 mg/dL. RESULTS:This retrospective review of all SICU patients from October to December revealed that there was a significant increase (P < 0.01) in the patients with their serum Mg level measured between 2001 (89%) and 2011 (95%). There was a significant decrease (P < 0.001) in patients with hypomagnesemia (< 2 mg/dL) between 2001 (47.5%) and 2011 (33.0%). On the other hand, there was a significant increase (P < 0.001) in patients with normal serum Mg level (> 2 mg/dL) between 2001 (52.5%) and 2011 (67.0%). CONCLUSIONS:There was not only more monitoring of Mg in 2011, but a lower incidence of hypo-Mg compared to 2001. Possible explanations include changing patterns of antibiotic and diuretic use, less amphotericin use, more frequent laboratory surveillance, and better trained ICU practitioners.
PMCID:4330018
PMID: 25699122
ISSN: 1918-3003
CID: 3142212

Racial disparity and their impact on hepatocellular cancer outcomes in inner-city New Orleans

Jan, Thomas; Medvedev, Sabeen; Cannon, Robert M; Saggi, Bob; McGee, Jennifer; Paramesh, Anil; Killackey, Mary; Shores, Nathan J; Slakey, Douglas P; Balart, Luis; Buell, Joseph F
BACKGROUND:The role of socioeconomic factors that affect survival, particularly for hepatocellular cancer (HCC), has yet to be fully analyzed. This study attempts to elucidate those racial and socioeconomic factors that affect differences in survival for patients with HCC. METHODS:In a retrospective cohort study of 206 patients with HCC diagnosed in an inner-city urban center from 2003 to 2011, outcomes by race (African Americans versus white) were analyzed. Additional attention was paid to socioeconomic factors. Continuous variables were compared with the Student t-test, and categorical variables were compared with the χ(2) or Fisher exact test. Multivariate analysis was conducted using a logistic regression model. Patient death and survival data were analyzed with Kaplan-Meier and Cox proportional hazards. RESULTS:Comparison of 138 white and 68 African-American patients revealed that African-American patients were more likely to present with larger tumor size at the time of diagnosis (4.7 vs 3.7 cm; P < .05). African-American patients were also more likely to be intravenous drug users (25.4% vs 11.6%; P < .05) and have cirrhosis from hepatitis C (81% vs 60%; P < .01). African-American patients were less likely to have private insurance compared with white patients (68% vs 92%; P < .01). Despite these findings in our inner-city practice, there was no difference in liver transplantation rates or survival rates between the 2 groups. CONCLUSION/CONCLUSIONS:Despite presentation with less-favorable tumor characteristics, African-American patients are able to achieve survival that is comparable with their white counterparts when treated in a program that is attuned to the challenges faced by their specific population.
PMID: 22935095
ISSN: 1532-7361
CID: 3142202

Gender Differences in Urinary Angiotensinogen in Individuals with Obesity and Diabetes Mellitus [Meeting Abstract]

Thethi, Tina K.; Kobori, Hiroyuki; Fonseca, Vivian; Wani, Javaid; Parsha, Kaushik; Leger, Sharice; Meyaski-Schulter, Mary; Jan, Thomas; Yau, Lillian; Ngantcha, Irene
ISI:000271231200071
ISSN: 1540-9996
CID: 3142232