Late surgical start time is associated with increased blood transfusion following gastric bypass surgery.

BACKGROUND: Surgical start time (SST) has demonstrated conflicting effects on perioperative outcomes due to confounding factors, such as increased acuity in later SST cases. This study investigated the effect of SST on blood transfusion after gastric bypass surgery, a complication-prone elective surgical procedure. METHODS: This retrospective cohort study included all patients undergoing gastric bypass surgery at a single academic medical center from 2016 through 2021 (n = 299). The primary independent variable was SST (before vs. after 15:00). The primary outcome was blood transfusion. Secondary outcomes included postoperative respiratory failure, length of stay, acute kidney injury, and mortality. The associations between SST and outcomes were investigated with univariate analyses. Multivariate and receiver operating characteristic (ROC) analyses were applied to the primary outcome, adjusting for demographic and operative characteristics. RESULTS: On univariate analysis, 15:00-18:43 SST was associated with an increased risk of blood transfusion (relative risk 4.32, 95% confidence interval 1.27 to 14.63, p = 0.032), but not postoperative respiratory failure, acute kidney injury, length of stay, or mortality. On multivariate analysis, the only independent predictor of postoperative blood transfusion was a 15:00-18:43 SST (adjusted odds ratio 4.32, 95% confidence interval 1.06 to 15.96, c-statistic = 0.638). ROC analysis demonstrated that compared to the 15:00 threshold, a 14:34 threshold predicted postoperative blood transfusion with better accuracy (sensitivity = 70.0%, specificity = 83.0%). CONCLUSIONS: Despite having similar demographic and operative characteristics, gastric bypass patients in the late SST cohort had a greater incidence of postoperative blood transfusion in this single-center study.

Pregnancy, labor, and delivery outcomes of women with and without spinal cord injury.

Objectives: Compare outcomes in pregnant women with and without Spinal Cord Injury (SCI).Design: Case study and inception cohort comparison.Setting: Community, primary care/referral center and university practice.Participants: Twenty-eight pregnant women (12 with SCI ( = PW-SCI) and 16 without SCI ( = PW-AB)) were enrolled. Six PW-SCI left study and six completed data collection and were matched, by age, parity, and race, with 12 PW-AB (1:2 ratio, respectively). Final analysis included 18 (78%) subjects.Interventions: Not applicable.Main Outcome Measures: Utilizing standardized, templated medical records (published by NIH/NICHHD and DHHS) and self-report, prospective, longitudinal and retrospective details of pregnancy, labor and delivery experiences/complications were recorded for all women and their neonates. Data collection included vital signs, urinalysis, pregnancy-related conditions/complications (i.e. UTIs, hyperglycemia), and labor, delivery, fetal outcomes. For PW-SCI, demographics, occurrences of autonomic dysreflexia (AD), pressure sores, worsening SCI conditions (i.e. spasticity, bladder spasms, lost independence) were recorded.Results: PW-SCI had statistically greater (P < .05) UTIs than PW-AB (three (50%) to 0 (0%), respectively). One PW-SCI (17%) reported pressure sores and one AD. Three (50%) PW-SCI and 4 (33%) PW-AB experienced a complication at delivery. Newborn mean birth weight (2854 g vs 3578 g; P = 0.12), and length (49.3 vs 45.8 cm; P = 0.32) were lower for PW-SCI than PW-AB. Head circumference was significantly less for PW-SCI than PW-AB (30.3 vs 34.5 cm; P = 0.04).Conclusions: Women with SCI tend to have more complicated courses of pregnancy, labor and delivery and smaller newborns than non-SCI peers. Neonatal head circumference is significantly smaller.

Factors associated with hepatitis B testing among Vietnamese Americans.

BACKGROUND: Chronic hepatitis B and hepatitis B-associated liver cancer is a major health disparity among Vietnamese Americans, who have a chronic hepatitis B prevalence rate of 7-14% and an incidence rate for liver cancer six times that of non-Latino whites. OBJECTIVE: Describe factors associated with hepatitis B testing among Vietnamese Americans. DESIGN: A population-based telephone survey conducted in 2007-2008. PARTICIPANTS: Vietnamese Americans age 18-64 and living in the Northern California and Washington, DC areas (N = 1,704). MAIN MEASURES: Variables included self-reports of sociodemographics, health care factors, and hepatitis B-related behaviors, knowledge, beliefs, and communication with others. The main outcome variable was self-reported receipt of hepatitis B testing. KEY RESULTS: The cooperation rate was 63.1% and the response rate was 27.4%. Only 62% of respondents reported having received a hepatitis B test and 26%, hepatitis B vaccination. Only 54% knew that hepatitis B could be transmitted by sexual intercourse. In multivariable analyses, factors negatively associated with testing included: age 30-49 years, US residence for >10 years, less Vietnamese fluency, lower income, and believing that hepatitis B can be deadly. Factors positively associated with testing included: Northern California residence, having had hepatitis B vaccination, having discussed hepatitis B with family/friends, and employer requested testing. Physician recommendation of hepatitis B testing (OR 4.46, 95% CI 3.36, 5.93) and respondent's request for hepatitis B testing (OR 8.37, 95% CI 5.95, 11.78) were strongly associated with test receipt. CONCLUSION: Self-reports of hepatitis B testing among Vietnamese Americans remain unacceptably low. Physician recommendation and patient request were the factors most strongly associated with test receipt. A comprehensive effort is needed to promote hepatitis B testing in this population, including culturally-targeted community outreach, increased access to testing, and physician education.

Design, synthesis, and biological evaluation of 3-[4-(2-hydroxyethyl)piperazin-1-yl]-7-(6-methoxypyridin-3-yl)-1-(2-propoxyethyl)pyrido[3,4-b]pyrazin-2(1H)-one, a potent, orally active, brain penetrant inhibitor of phosphodiesterase 5 (PDE5).

We recently described a novel series of aminopyridopyrazinones as PDE5 inhibitors. Efforts toward optimization of this series culminated in the identification of 3-[4-(2-hydroxyethyl)piperazin-1-yl]-7-(6-methoxypyridin-3-yl)-1-(2-propoxyethyl)pyrido[3,4-b]pyrazin-2(1H)-one, which possessed an excellent potency and selectivity profile and demonstrated robust in vivo blood pressure lowering in a spontaneously hypertensive rat (SHR) model. Furthermore, this compound is brain penetrant and will be a useful agent for evaluating the therapeutic potential of central inhibition of PDE5. This compound has recently entered clinical trials.