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Biomedical subjects

G Craig Wood

Publications and source records attributed to G Craig Wood.

16 recordsLinked to original sources
PubMed2006

Obesity disease burden and surgical risk.

BACKGROUND: The rapid national expansion in bariatric surgical procedures has been accompanied by recent reports of significant complication rates. This has resulted in increased public scrutiny of bariatric surgery outcomes, restrictions on patient eligibility criteria by payors, and credentialing requirements for providers. This focus on outcomes has resulted in interest in bariatric risk analysis. METHODS: During an 8-year period, 1210 patients were evaluated for bariatric surgery. Clinical information was recorded prospectively. Co-morbid medical conditions were analyzed according to proven surgical risk factors: age, body mass index (BMI), and male gender. RESULTS: The prevalence of many co-morbid conditions and the total number of co-morbid conditions correlate highly with increasing age, increasing BMI, and male gender. CONCLUSION: The established surgical risk factors, age, BMI, and male gender, are markers for a sicker patient population, as evidenced by a greater obesity disease burden.

Adolescent↗
PubMed2006

Perioperative outcomes and risk factors in gastric surgery for morbid obesity: a 9-year experience.

OBJECTIVE: Surgical treatment of severe obesity is the most rapidly growing specialty area of surgery. The rapid expansion of bariatric surgery has raised questions and concerns regarding possible increased surgical mortality and morbidity rates in both academic and community settings. The purpose of this study was to evaluate postoperative outcomes and risk factors for bariatric gastric surgery for severe obesity. METHODS: A community experience of 1009 consecutive patients who underwent open surgical treatment of morbid obesity during a 9-year period was reviewed from a prospective database. The series included 858 primary gastric bypass operations and 151 revision operations. Perioperative outcomes, late complications, and weight loss results were recorded. Morbidity and mortality rates were analyzed according to patient age, body mass index (BMI), and gender. RESULTS: The mortality rate in the series was 0.6%, and the morbidity rate was 20%. The major complication rate was 6.6%. There were no deaths in the 151 revision patients. The gastrointestinal leak rate was 0.8%, and the thromboembolism rate was 1%. Statistical analysis indicates that BMI is a risk factor for surgical complications. CONCLUSION: Open gastric surgery for morbid obesity can be carried out in the community setting with low mortality and morbidity rates. BMI is a proven surgical risk factor.

Adult↗
PubMed2006

Academics or private practice? The future of dermatologic surgery education.

BACKGROUND: The career choices of Mohs fellows have important implications for ensuring the quality of dermatologic surgery training during residency. No published data examine the career choices of fellows in Mohs micrographic surgery. OBJECTIVE: To determine the number of Mohs fellows entering academics and to examine the influence of fellowship characteristics, scholarly activities, and personal background on career decision. METHODS: A voluntary survey was distributed by mail in June 2004 to all Mohs fellows-in-training during 2003-2004. RESULTS: Twenty-nine percent (12 of 42) of the fellows chose jobs in an academic or university setting. The practice setting of the fellowship, personal factors, and scholarly activities prior to fellowship did not correlate with career decision. By contrast, increased scholarly activities during fellowship and an interest in teaching did correlate with the choice to enter academics. CONCLUSIONS: A significant percentage of Mohs fellows pursued academics. Increased academic productivity during the fellowship and an interest in teaching correlated with the decision to pursue an academic career. Fellowship directors interested in encouraging academic careers may find these data useful to structure their curricula and to mentor fellows inquiring about academic careers.

Academic Medical Centers↗
PubMed2006

Breast cancer in elderly women: outcome as affected by age, tumor features, comorbidities, and treatment approach.

PURPOSE: The current work assessed the independent contributions of age, comorbidities, tumor features, and treatment approach to the outcome of elderly patients with breast cancer. PATIENTS AND METHODS: Records of consecutive women aged > or = 70 years with a histologic diagnosis of first invasive breast cancer between 1971 and 2001 and available medical information were reviewed. Restaging to the 2002 TNM system and comorbidity data abstraction were performed. Primary outcomes were overall survival (OS) and breast cancer-specific survival (BCSS). RESULTS: There were 992 patients with a median diagnosis age of 76 years, of whom 840 were approached with a curative intent. Significant comorbidities were recorded as none and > or = 3 in 13% and 44% of patients, respectively. The 5- and 10-year OS rates were 59% and 34%; corresponding BCSS rates were 74% and 62%, respectively. Of 693 patients who died during the study period, only 298 (43%) died from their tumors. Stage emerged as the strongest predictor determining OS and BCSS (P = 0.001). In curatively approached patients, age was the next dominant factor affecting survival length (P = 0.001). The comorbidities with significant effect on OS differed by stage and included heart failure, diabetes, and other common comorbidities in early tumors but only extremely debilitating ones in advanced-stage disease (P < 0.05). Significant favorable effect of systemic therapy emerged only in the univariate model. CONCLUSION: This study confirms tumor stage as the strongest predictor of survival in elderly patients with breast cancer. It also indicates a significant role for age and comorbidities that varies by stage. Treatment effect should be interpreted with caution because of the retrospective study nature.

Age Factors↗
PubMed2006

Morphoproteomic and pharmacoproteomic rationale for mTOR effectors as therapeutic targets in head and neck squamous cell carcinoma.

Head and neck squamous cell carcinoma (HNSCC) has a relatively high mortality rate and poor prognosis. Recently, we showed that overexpression of phosphorylated (p) nuclear factor-kappaB (NF-kappaB) in squamous cell carcinoma of the tonsil (SCCT) and high grade dysplasia is associated with a poor prognosis. Because the mammalian target of the rapamycin (mTOR) pathway contributes to the activation of NF-kappaB through immunophilin/mTOR signaling, we investigated: (a) the immunohistochemical expression and state of activation and potential clinical significance of components of the mTOR signal transduction pathway in SCCT patients (morphoproteomics); and (b) the inhibitory effects of rapamycin on the growth and state of activation of mTOR in 2 HNSCC cell lines (pharmacoproteomics). Archival biopsy materials from 39 patients with SCCT were studied by immunohistochemistry for the expression of p-mTOR (Ser 2448), and p-p70S6K (Thr 389), and/or cyclin D1. Results for SCCT were compared with adjacent non-neoplastic epithelium, when present, and with normal tonsillar epithelium from approximately age-matched controls; clinical outcomes were also assessed. SCCT showed mTOR (Ser 2448) expression in 93% (30/32 cases) with 2+ or 3+ plasmalemmal and/or cytoplasmic intensity in 84% vs 42% in surface epithelium from normal tonsils (p <0.001). The mean combined expression score (signal intensity x percentage of positive cells) for p-p70S6K was significantly greater in the SCCT group vs adjacent non-neoplastic squamous epithelium and normal tonsillar epithelium of the control group (p <0.05). A relationship existed between higher p-p70S6K expression levels in the non-neoplastic squamous epithelium adjacent to the SCCT and increased risk of death from disease (hazard ratio = 7.9; 95% confidence interval (CI) = 2.1 to 29.9; p = 0.002). There was also a relationship between nuclear expression of cyclin D1 in SCCT and shortened recurrence-free survival (p = 0.015). Two human HNSCC cell lines, SCC-15 and FaDu, were incubated with and without rapamycin to assess its impact on growth and on the expression of p-mTOR. Rapamycin in a dose-dependent fashion inhibited growth more in SCC-15, which correlated with a greater reduction in constitutively activated p-mTOR (Ser 2448) as shown by Western blotting. In conclusion, these morphoproteomic and pharmacoproteomic data collectively provide a rationale for selecting mTOR effectors as therapeutic targets in HNSCC.

Antineoplastic Agents↗
PubMed2005

Overexpression of phosphorylated nuclear factor-kappa B in tonsillar squamous cell carcinoma and high-grade dysplasia is associated with poor prognosis.

Intracellular signals along the epidermal growth factor receptor (EGFR)-Akt-nuclear factor-kappa B (NF-kappaB) pathway have been associated with carcinogenesis in various malignant neoplasms. This investigation was to evaluate the expression of EGFR, phosphorylated(p)-Akt and p-NF-kappaB and correlate them with clinical outcomes in patients with squamous cell carcinoma of the tonsil. A total of 45 patients with squamous cell carcinoma of the tonsil were studied by immunohistochemistry to evaluate the expression levels of EGFR, p-Akt and p-NF-kappaB. Results for squamous cell carcinoma of the tonsil were compared with those for associated high-grade dysplasia and adjacent normal appearing epithelium, when present. In addition, tonsillar epithelium from non-neoplastic specimens of age-matched patients also was stained for the same markers. High-grade dysplasia and squamous cell carcinoma of the tonsil demonstrated a similar pattern of expression, which differed from the pattern seen in the adjacent normal epithelium and tonsillar epithelium from normal controls (an overexpression for each of these three protein analytes in high-grade dysplasia and squamous cell carcinoma of the tonsil as demonstrated by immunohistochemistry). When markers from squamous cell carcinoma of the tonsil were correlated with survival status, only increasing levels of p-NF-kappaB immunoreactivity (a relative overexpression) were statistically significant predictors of poor survival. No markers in squamous cell carcinoma of the tonsil were significantly related to rate of recurrence. When analyzing marker scores from tissue with high-grade dysplasia, relative overexpressions of both p-Akt and p-NF-kappaB were significantly related to poor survival. Additionally, increasing levels of p-NF-kappaB immunopositivity from tissue with high-grade dysplasia were also significantly related to rate of recurrence. In summary, p-NF-kappaB, overexpressed in high-grade dysplasia and squamous cell carcinoma of the tonsil, is associated with worse prognosis in terms of high recurrence and poor survival, respectively. This significant finding in patients with squamous cell carcinoma of the tonsil, in combination with previous animal and in vitro studies, suggests that p-NF-kappaB represents a potential therapeutic target in head and neck squamous cell carcinoma.

Aged↗
PubMed2005

Hunting-related shooting incidents in Pennsylvania, 1987-1999.

BACKGROUND: Characteristics and rates of shooting injuries associated with hunting various game species are unreported. METHODS: For the 1,345 hunting-related shooting incidents in Pennsylvania from 1987 to 1999, age-adjusted hunter injury rates and case-fatality ratios were calculated for each of seven species hunted. Differences in the incidents and injuries were tested (p < 0.05). RESULTS: Fall turkey hunters had the highest (7.5 per 100,000 hunters) and grouse hunters the lowest (1.9 per 100,000) injury rate. The case-fatality ratio was highest for deer hunters (10.3%) and lowest for pheasant hunters (1.3%). Poor skill was the leading cause of deer hunting injuries, and poor judgment the leading cause for injuries during the hunting of other species. Coinciding with changes in regulations requiring orange clothing for hunters, the injury rates for fall turkey hunters initially decreased (rate ratio, 4.1), then increased (rate ratio, 0.5). Hunters younger than 20 years had the highest injury rates. CONCLUSIONS: The rates and characteristics of hunting-related shooting injuries varied by hunted species. Hunter orange clothing regulations appeared to reduce fall turkey hunting injury rates.

Accidents↗
PubMed2005

Improved outcomes during cardiac surgery: a multifactorial enhancement of cardiopulmonary bypass techniques.

Patients presenting for cardiac surgery with cardiopulmonary bypass (CPB) are more likely to have pre-existing comorbidities, which has resulted in a steady increase in the risk associated with CPB. The resulting challenge has mandated the optimization of perfusion care. The purpose of this study was to retrospectively evaluate the impact of a number of simultaneous, evidence based perfusion care changes on patient outcome. After Institutional Review Board approval, two groups of patients were compared. The control group (n = 317) included all patients undergoing CPB in a 12-month period preceding a multifaceted change in perfusion techniques. The treatment group (n = 259) included all patients undergoing CPB in the 12-month period after the changes, which included the incorporation of updated continuous blood gas monitoring, biocompatible circuitry, updated centrifugal blood propulsion, continuous autotransfusion technology, new generation myocardial protection instrumentation, plasmapheresis, topical platelet gel application, excluding hetastarch while increasing the use of albumin, viscoelastographic coagulation monitoring, and implementing a quantitative quality improvement program. After univariate analysis, propensity scoring and multiple conditional logistical regression were used to control for demographic, preoperative, operative, and postoperative parameters. Results of the primary endpoints revealed a lower mortality rate in the treatment group (4% vs. 9% [95% confidence interval 1.33, 7.72], p = 0.009), lower transfusion rate (51% vs. 59% [1.00, 2.11], p = 0.048), and lower complication rate (55% vs. 65% [1.06,2.19], p = 0.025) despite having similar predicted mortality (11 [2,22] vs. 11[3,22], p = NS) and other preoperative and operative parameters. The lower mortality rate was concurrent with a trend towards a lower incidence of complications, consistent with the differences in primary outcomes. In conclusion, the patients treated after the implementation of a multifactorial improvement plan using evidence based changes in CPB care had decreased complication and mortality rates.

Aged↗
PubMed2004

Angiographic adverse events during percutaneous coronary intervention fail to predict creatine kinase-MB elevation.

We attempted to determine if aggressive detection of angiographic adverse events during coronary intervention could predict subsequent creatine kinase (CK)-MB elevations. During coronary intervention, both fluoroscopy and cine angiography were used to detect angiographic adverse events. At least one angiographic adverse event occurred in 133/251 (53%) of procedures. CK-MB elevation occurred in 24% of procedures. Slow flow during the procedure (P=0.002) and chest discomfort at the end of the procedure (P=0.007) were the strongest predictors of CK-MB elevation. Among procedures with no angiographic adverse events, CK-MB elevation occurred in 15/121 (12%), accounting for 25% of CK-MB elevations. We conclude that CK-MB elevation occurs after angiographically uncomplicated coronary interventions even when angiographic adverse events are aggressively detected. Routine monitoring of cardiac enzymes is necessary to detect all patients who will experience myocardial injury after coronary intervention.

Aged↗
PubMed2004

Using mobile DXA to improve access to osteoporosis care: unit design, program development, implementation, and outcomes.

Osteoporosis diagnosis and monitoring is best accomplished with dual X-ray absorptiometry (DXA), but technology availability can hinder access to care. We designed a mobile DXA program incorporating a Hologic Delphi-C trade mark bone densitometer housed in a specially configured 30-ft Winnebago trade mark. The mobile DXA program provided osteoporosis testing and education at the convenience of the patient's primary care site within our rural health care system. DXA results were sent electronically to the patient's physician within 48-72 h. The mobile DXA patient group tended to be older and at high risk for future fracture. The service provided was rated as excellent by patients. Given the volume of patients studied, the program was financially self-sustaining. Other healthcare systems or groups should consider development of a similar program.

Absorptiometry, Photon↗
PubMed2003

Microarray analysis of gene expression in proliferating Schwann cells: synergistic response of a specific subset of genes to the mitogenic action of heregulin plus forskolin.

Cultured Schwann cells treated with heregulin growth factor require costimulation with a cyclic adenosine monophosphate-elevating agent to produce maximal cell proliferation. Gene chip expression analysis was used to identify genes that are induced or repressed when Schwann cells are treated with heregulin and/or forskolin. By utilizing arrays that contained 8799 probes, the expression of over 1000 genes was found to be significantly changed after 30 hr of treatment with heregulin, forskolin, or heregulin plus forskolin. Hierarchical clustering revealed groups of genes with distinct expression patterns. Of particular interest was a cluster of 140 genes that were up-regulated by heregulin plus forskolin but not by heregulin or forskolin alone. Many of the genes in this group have roles in cell division, such as cyclin B, cyclin D3, E2F-5, cdc 25B, polo-like kinase, and protein kinase C type III. These findings identify a profile of gene expression for Schwann cell proliferation.

Animals↗
PubMed2003

Clinical predictors of 30-day cardiac events in patients with acute coronary syndrome at a community hospital.

OBJECTIVE: We sought to determine predictors of coronary events (cardiac death, acute myocardial infarction, and urgent revascularization) within 30 days after admission. METHODS: We prospectively collected data on 400 patients admitted through our emergency room for unstable angina and acute coronary syndromes. Patients with ST-segment elevation myocardial infarction and those who required thrombolysis were excluded. RESULTS: Of 383 patients who were eligible, 120 patients had coronary events within 30 days. Statistically significant variables associated with coronary events were advanced age, male sex, family history of premature coronary artery disease (CAD), diabetes mellitus, tobacco abuse, prior congestive heart failure, prior myocardial infarction, and history of CAD. Symptoms at presentation associated with cardiac events were typical angina and shortness of breath. Objective measures of ischemia associated with cardiac events were elevated troponin T, elevated creatine kinase MB, and ischemic electrocardiographic changes. Using forward stepwise regression analysis, we generated a model to predict 30-day major adverse cardiac events. The strongest predicting variable was serum troponin T (accounting for 33% of predicting r2, P < 0.001) followed by typical angina (r2 increasing to 37%), ischemic electrocardiographic changes (40%), prior CAD (42%), family history of premature CAD (44%), shortness of breath (46%), and positive creatine kinase MB (48%). The positive predictive power of the complete model was r2 = 48%, P < 0.001. CONCLUSION: Our model incorporating elements from the patient's demographic, medical history, presentation, and ischemic assessment identified 48% of patients presenting with unstable angina and acute coronary syndromes who will suffer a major adverse cardiac event within 30 days of admission. Although the strongest predictor was identified as serum troponin T, other clinical criteria offered improvement in our predictive abilities. Therefore, good initial clinical evaluation in addition to simple tests such as serum cardiac markers and electrocardiography are valuable in risk stratification of patients presenting with acute coronary syndromes and cardiac chest pain. Additional testing may be necessary to improve the positive predictive value of the model. Cardiac enzymes and electrocardiographic changes have the highest negative predictive value for occurrence of major adverse cardiac events. Identification of high-risk patients is essential to direct resources toward these patients and to avoid unnecessary costs and risk to the low-risk population.

Acute Disease↗
PubMed2002

Body mass index and physical function in older women.

OBJECTIVE: We modified existing standardized measurement tools in the Physical Performance Test and tasks from the Frailty and Injuries: Cooperative Studies of Intervention Technique Study to evaluate physical function in older women. Our objectives were (1) to characterize physical function themes based on combinations of tasks (deriving factors or components) and (2) to quantify the correlation between derived factors and body mass index (BMI). RESEARCH METHODS AND PROCEDURES: Nutrition risk screens from enrollees in a Medicare-managed risk program served as the sampling frame. To obtain adequate representation for a range of BMI, a random sample was obtained of 90 women from the following BMI strata: BMI, 22 to <27 kg/m(2); BMI, 27 to <30 kg/m(2); and BMI, > or =30 kg/m(2). Subjects were asked to perform a series of 18 functional tasks during a home visit. RESULTS: The mean age was similar in the three BMI groups with an overall mean age of 71 +/- 4.9 years (SD). Factors characterized by lower-body function, upper-body function, coordination, and strength were responsible for 30%, 11%, 9%, and 9% of the variance in task scores, respectively. BMI, controlling for age, explained 5%, 14%, 3%, and 0% of the variation in these factors, respectively. Higher BMI is associated significantly with poorer upper- and lower-body function but is not associated significantly to strength or coordination. DISCUSSION: Higher BMI seems to differentially impede specific aspects of physical function, especially upper-body function, and to a lesser extent, lower-body function. BMI does not seem to be associated with levels of coordination or strength. Better understanding of how BMI impacts physical function will aid in the design of interventions to promote independent living in elderly, obese women.

Aged↗
PubMed2002

Pelvic fractures in pregnancy: factors influencing maternal and fetal outcomes.

BACKGROUND: The purpose of this study was to determine factors influencing maternal and fetal outcomes associated with pelvic fractures in pregnancy. METHODS: A literature review of pelvic and acetabular fractures during pregnancy was performed, providing 101 cases for analysis (1 case report was included). Factors influencing maternal and fetal mortality were evaluated. RESULTS: Pelvic and acetabular fractures during pregnancy were associated with a high maternal (9%) and a higher fetal (35%) mortality rate. Automobile-pedestrian collisions had a trend toward a higher maternal mortality rate, and vehicular collisions had a trend toward a higher fetal mortality rate, compared with falls. Injury severity influenced both maternal and fetal outcomes. Fracture classification (simple vs. complex), fracture type (acetabular vs. pelvic), the trimester of pregnancy, and the era of literature reviewed did not influence mortality rates. When considering potential causes of fetal death, direct trauma to the uterus, placenta, or fetus was not associated with a higher fetal mortality rate, compared with maternal hemorrhage. Pelvic and acetabular fracture surgery has rarely been reported in this patient population. CONCLUSION: Pelvic and acetabular fractures in pregnancy continue to be associated with a high fetal mortality rate. Mechanism of injury and injury severity appeared to influence mortality rates, whereas the fracture classification, the fracture type, the trimester of pregnancy, and the era of literature reviewed did not.

Accidents, Traffic↗
PubMedDate not supplied

Use of prehospital fluids in hypotensive blunt trauma patients.

OBJECTIVE: To compare the outcomes of blunt trauma victims with systolic blood pressure < or = 90 mm Hg who received prehospital fluids with the outcomes of those who did not receive prehospital fluids. METHODS: This matched-pairs case-control study used records of blunt trauma patients with scene systolic blood pressure < or = 90 mm Hg obtained from the Pennsylvania Trauma Systems Foundation. Patients who received > 500 mL prehospital fluids (n = 75) were matched by Injury Severity Score (ISS) and systolic blood pressure on scene with those who did not receive any prehospital fluids (n = 75). Outcomes compared included change in systolic blood pressure, survival to discharge, and length of hospital stay. RESULTS: Those who received fluids were more likely to have an increase in systolic blood pressure at arrival to the emergency department [odds ratio for fluid use = 2.41; 95% confidence interval (95% CI) = 1.02, 5.73; p = 0.046]. There was no significant difference in survival to discharge (odds ratio for fluid use = 1.02; 95% CI = 0.40, 2.60; p = 0.969). There was no significant difference in length of hospital stay: 5.4 days (SD = 2.8) for those with fluids; 5.2 days (SD = 2.8) for those with no fluids; difference = 0.2 days; 95% CI = -1.6, 1.8; p = 0.870. CONCLUSIONS: This study suggests that prehospital fluid resuscitation of blunt injured trauma patients with systolic blood pressure < or = 90 increases systolic blood pressure but has no effect on survival or length of hospital stay.

Adult↗