Serotonergic Antidepressants Are Associated with Increased Blood Loss and Risk for Transfusion in Single-Level Lumbar Fusion Surgery

Paul Schadler,Jennifer Shue,Mohamed Moawad,Federico P. Girardi,Frank P. Cammisa,Andrew A. Sama,Russel C. Huang,Darren R. Lebl,Chad M. Craig,Alexander P. Hughes 대한척추외과학회 2017 Asian Spine Journal Vol.11 No.4

Study Design: Retrospective case-control study. Purpose: The purpose of this study was to examine the effect of antidepressants on blood loss and transfusion requirements in spinal surgery patients. Overview of Literature: Several studies have shown an increase in perioperative bleeding in orthopedic surgery patients on antidepressant drug therapy, yet no study has examined the impact of these agents on spinal surgery patients. Methods: Charts of patients who underwent single-level spinal fusion (posterior lumbar interbody fusion with posterior instrumentation) performed by five fellowship-trained surgeons at a tertiary spine center between 2008 and 2013, were retrospectively reviewed. Exclusion criteria included select medical comorbidities, select drug therapy, and Amercian Society of Anesthesiologists Physical Status Classification score of greater than 2. Serotonergic antidepressants were examined in multivariate analysis to assess their predictive value on estimated blood loss and risk of transfusion. Results: A total of 235 patients, of which 52% were female, were included. Allogeneic blood was transfused in 7% of patients. The average estimated blood loss was 682±463 mL. Selective serotonin reuptake inhibitors were taken by 10% of all patients. Multivariable regression analysis showed that intake of selective serotonin reuptake inhibitors was a significant predictor for blood loss (average increase of 34%, p =0.015) and for the need of allogeneic blood transfusion (odds ratio, 4.550; p =0.029). Conclusions: There was a statistically significant association between selective serotonin reuptake inhibitors and both increased blood loss and risk of allogeneic red blood cell transfusion. Surgeons and perioperative providers should take these findings into account when assessing patients’ preoperative risk for blood loss and transfusion.

TRPC channels as STIM1-regulated SOCs.

Yuan, Joseph P,Kim, Min Seuk,Zeng, Weizhong,Shin, Dong Min,Huang, Guo,Worley, Paul F,Muallem, Shmuel Landes Bioscience 2009 Channels Vol.3 No.4

<P>Store-operated Ca(2+) channels (SOCs) are Ca(2+) influx channels at the plasma membrane whose opening is determined by the level of Ca(2+) stored in the endoplasmic reticulum lumen. SOCs are activated in response to receptor-mediated or passive depletion of ER Ca(2+) to regulate many Ca(2+)-dependent cellular functions. Early work implicated the TRPC channels as SOCs. More recently, it was found that the Orai channels mediate the CRAC current and that the Ca(2+) binding protein STIM1 functions as the ER Ca(2+) sensor that mediates activation of the SOCs in response to depletion of ER Ca(2+). Key questions are whether both TRPC and Orai channels are opened by STIM1 and the molecular mechanism by which STIM1 opens the SOCs. Ample biochemical and functional evidence indicate interaction of the TRPC channels with STIM1. Furthermore, it was found that STIM1 gates TRPC channels by electrostatic interaction of STIM1(K684,K685) in the polybasic domain of STIM1 with two negative charges (aspartates or glutamates) that are conserved in all TRPC channels. Charge mutants of STIM1(K684,K685) and TRPC1(D639,D640) and TRPC3(D697,D698) were used to develop further direct evidence for the function of TRPC channels as SOCs. The evidence in favor of TRPC channels as SOCs are discussed.</P>

Integrated analysis of genome-wide DNA methylation and gene expression profiles in molecular subtypes of breast cancer

Rhee, Je-Keun,Kim, Kwangsoo,Chae, Heejoon,Evans, Jared,Yan, Pearlly,Zhang, Byoung-Tak,Gray, Joe,Spellman, Paul,Huang, Tim H.-M.,Nephew, Kenneth P.,Kim, Sun Oxford University Press 2013 Nucleic acids research Vol.41 No.18

<P>Aberrant DNA methylation of CpG islands, CpG island shores and first exons is known to play a key role in the altered gene expression patterns in all human cancers. To date, a systematic study on the effect of DNA methylation on gene expression using high resolution data has not been reported. In this study, we conducted an integrated analysis of MethylCap-sequencing data and Affymetrix gene expression microarray data for 30 breast cancer cell lines representing different breast tumor phenotypes. As well-developed methods for the integrated analysis do not currently exist, we created a series of four different analysis methods. On the computational side, our goal is to develop methylome data analysis protocols for the integrated analysis of DNA methylation and gene expression data on the genome scale. On the cancer biology side, we present comprehensive genome-wide methylome analysis results for differentially methylated regions and their potential effect on gene expression in 30 breast cancer cell lines representing three molecular phenotypes, luminal, basal A and basal B. Our integrated analysis demonstrates that methylation status of different genomic regions may play a key role in establishing transcriptional patterns in molecular subtypes of human breast cancer.</P>

Epidural Blood Patch Performed for Severe Intracranial Hypotension Following Lumbar Cerebrospinal Fluid Drainage for Intracranial Aneurysm Surgery. Retrospective Series and Literature Review

Omar Tanweer,Stephen P. Kalhorn,Jamaal T. Snell,Taylor A. Wilson,Bryan A. Lieber,Nitin Agarwal,Paul P. Huang,Kenneth M. Sutin 대한뇌혈관외과학회 2015 Journal of Cerebrovascular and Endovascular Neuros Vol.17 No.4

Intracranial hypotension (IH) can occur following lumbar drainage for clipping of an intracranial aneurysm. We observed 3 cases of IH, which were all successfully treated by epidural blood patch (EBP). Herein, the authors report our cases.

Posterior Spinal Artery Aneurysm Presenting with Leukocytoclastic Vasculitis

Travis C. Hill,Paul P. Huang,Omar Tanweer,Cheddhi Thomas,John Engler,Maksim Shapiro,Tibor Becske 대한뇌혈관외과학회 2016 Journal of Cerebrovascular and Endovascular Neuros Vol.18 No.1

Rupture of isolated posterior spinal artery (PSA) aneurysms is a rare cause of subarachnoid hemorrhage (SAH) that presents unique diagnostic challenges owing to a nuanced clinical presentation. Here, we report on the diagnosis and management of the first known case of an isolated PSA aneurysm in the context of leukocytoclastic vasculitis. A 53-year-old male presented to an outside institution with acute bilateral lower extremity paralysis 9 days after admission for recurrent cellulitis. Early magnetic resonance imaging was read as negative and repeat imaging 15 days after presentation revealed SAH and a compressive spinal subdural hematoma. Angiography identified a PSA aneurysm at T9, as well as other areas suspicious for inflammatory or post-hemorrhagic reactive changes. The patient underwent a multilevel laminectomy for clot evacuation and aneurysm resection to prevent future hemorrhage and to establish a diagnosis. The postoperative course was complicated by medical issues and led to the diagnosis of leukocytoclastic vasculitis that may have predisposed the patient to aneurysm development. Literature review reveals greater mortality for cervical lesions than thoracolumbar lesions and that the presence of meningitic symptoms portents better functional outcome than symptoms of cord compression. The outcome obtained in this case is consistent with outcomes reported in the literature.

Effects of the Microstructure of Copper Through-Silicon Vias on their Thermally Induced Linear Elastic Mechanical Behavior

ZhiYong Wu,Zhiheng Huang,Yucheng Ma,Hua Xiong,Paul P. Conway 대한금속·재료학회 2014 ELECTRONIC MATERIALS LETTERS Vol.10 No.1

Through-silicon vias (TSVs) have been investigated extensively in recent years. However, the physical mechanisms behind some of the common problems associated with TSVs, such as the protrusion of Cu vias, are still unknown. In addition, since the dimensions of TSVs have been shrunk to microscopic levels, the sizes of the microstructural features of TSVs are no longer small compared to the dimensions of the vias. Therefore, the role and importance of the microstructural features of TSVs need to be studied to enable more accurate reliability predictions. This study focused on the effects the microstructural features of TSVs, i.e., the Cu grains and their [111] texture, grain size distribution, and morphology, have on the thermally induced linear elastic behavior of the vias. The results of the study indicate that stress distribution in the model that takes into account the Cu grains, whose Young’s moduli and Poisson’s ratios are set according to their crystallographic orientations, is more heterogeneous than that in a reference model in which the bulk properties of Cu are used. Stresses as high as 250 MPa are observed in the via of the model that takes into consideration the Cu grains, while stresses in the via of the reference model are all lower than 150 MPa. In addition, smaller Cu grains in the vias result in higher stresses; however, the variation in stress owning to changes in the grain size is within 20 MPa. The frequency of the stresses ranging from 80 MPa to 100 MPa was the highest in the stress distribution of the vias, depending on boundary conditions. The stress level in the vias decreases with the decrease in the number of grains with the [111] texture. Finally, the stress level is lower in the model in which the grain structure is generated using a phase field model and is closer to that of the microstructures present in real materials.