Mahmud, Nadim

Background and Objectives: Normothermic regional perfusion (NRP) is an effective technique to improve recipient outcomes. However, no valid methods for determining liver viability exist. Identifying relevant biological markers with clinical correlation to liver viability and recipient clinical outcomes is imperative to improve decision-making. Materials and Methods: Fifty-four donors undergoing NRP and their recipients were included. FMN was measured at the start, 1 h, and end of NRP. Lactate was measured at the start, 30, 60, and 90 min of NRP. Primary outcomes were early allograft function using the early allograft dysfunction (EAD) criteria and the model for early allograft function (MEAF). Secondary outcomes included the association with donor warm ischemia time (DWIT), stratified by 30 min. Spearman’s rho assessed correlations. Results: Forty (74%) livers were transplanted, with 5 (12.5%) recipients developing EAD and the mean MEAF score was 3.13 (1.49). FMN at all time points was significantly greater in the EAD group compared to the non-EAD group and was significantly correlated with the MEAF score (Peak FMN: rho = 0.507, p = 0.001). FMN during perfusion did not differ between DWIT < and ≥30 min. Lactate levels were similar across all groups and did not discriminate for adverse allograft outcomes. However, lactate levels during perfusion were higher in the DWIT ≥ 30 min group. Conclusions: These findings suggest that during NRP, elevated FMN, but not lactate, is associated with early allograft function.

Background The purpose of this study was to examine gender differences in authorship of manuscripts in select high‐impact cardiology journals during the early coronavirus disease 2019 (COVID‐19) pandemic. Methods and Results All manuscripts published between March 1, 2019 to June 1, 2019 and March 1, 2020 to June 1, 2020 in 4 high‐impact cardiology journals ( Journal of the American College of Cardiology , Circulation , JAMA Cardiology , and European Heart Journal ) were identified using bibliometric data. Authors' genders were determined by matching first name with predicted gender using a validated multinational database (Genderize.io) and manual adjudication. Proportions of women and men first, co‐first, senior, and co‐senior authors, manuscript types, and whether the manuscript was COVID‐19 related were recorded. In 2019, women were first authors of 176 (22.3%) manuscripts and senior authors of 99 (15.0%) manuscripts. In 2020, women first authored 230 (27.4%) manuscripts and senior authored 138 (19.3%) manuscripts. Proportions of woman first and senior authors were significantly higher in 2020 compared with 2019. Women were more likely to be first authors if the manuscript's senior author was a woman (33.8% for woman first/woman senior versus 23.4% for woman first/man senior; P <0.001). Women were less likely to be first authors of COVID‐19‐related original research manuscripts ( P =0.04). Conclusions Representation of women as key authors of manuscripts published in major cardiovascular journals increased during the early COVID‐19 pandemic compared with similar months in 2019. However, women were significantly less likely to be first authors of COVID‐19‐related original research manuscripts. Future investigation into the gender‐disparate impacts of COVID‐19 on academic careers is critical.

The burden of cirrhosis hospitalizations is increasing. The admission Model for End‐Stage Liver Disease–lactate (MELD‐lactate) was recently demonstrated to be a superior predictor of in‐hospital mortality compared with MELD in limited cohorts. We identified specific classes of hospitalizations where MELD‐lactate may be especially useful and evaluated the predictive role of lactate clearance. This was a retrospective cohort study of 1036 cirrhosis hospitalizations for gastrointestinal bleeding, infection, or other portal hypertension–related indications in the Veterans Health Administration where MELD‐lactate was measured on admission. Performance characteristics for in‐hospital mortality were compared between MELD‐lactate and MELD/MELD‐sodium (MELD‐Na), with stratified analyses of MELD categories (≤15, >15 to <25, ≥25) and reason for admission. We also incorporated day 3 lactate levels into modeling and tested for an interaction between day 1 MELD‐lactate and day 3 lactate clearance. MELD‐lactate had superior discrimination for in‐hospital mortality compared with MELD or MELD‐Na (area under the curve [AUC] 0.789 versus 0.776 versus 0.760, respectively; P < 0.001) and superior calibration. MELD‐lactate had higher discrimination among hospitalizations with MELD ≤15 (AUC 0.763 versus 0.608 for MELD, global P = 0.01) and hospitalizations for infection (AUC 0.791 versus 0.674 for MELD, global P < 0.001). We found a significant interaction between day 1 MELD‐lactate and day 3 lactate clearance; heat maps were created as clinical tools to risk‐stratify patients based on these clinical data. MELD‐lactate had significantly superior performance in predicting in‐hospital mortality among patients hospitalized for infection and/or with MELD ≤15 when compared with MELD or MELD‐Na. Incorporating day 3 lactate clearance may further improve prognostication.

AbstractBackground and AimTumor genotyping may allow for improved prognostication and targeted therapy for pancreatic ductal adenocarcinoma (PDAC). We aimed to compare endoscopic ultrasonography (EUS) with fine needle aspiration (FNA) to fine needle biopsy (FNB) for obtaining sufficient tissue for genomic analysis and theranostic potential.MethodsA retrospective cohort study of patients that underwent EUS‐FNA or EUS‐FNB with either positive or suspicious cytology for PDAC between March 2016 and December 2017. Demographic, procedural, and cytology data were recorded. Genetic alterations were recorded, and Kaplan–Meier survival curves were calculated.ResultsThe study included 167 patients: 145 patients had FNA and 22 patients underwent FNB. Overall, 117 samples (70.1%) were sufficient for targeted next‐generation sequencing. FNB resulted in a higher proportion of patients with sufficient samples compared with FNA (90.9% vs 66.9%; P = 0.02). In multivariable modeling, only FNB (odds ratio 4.95, 95% confidence interval 1.11–22.05, P = 0.04) was associated with sufficient sampling for genomic testing. FNB was more likely to obtain sufficient tissue from tumors ≤ 3 cm (100% vs 68.4%, P = 0.017) and tumors located in the head/neck of the pancreas (100% vs 63.1%, P = 0.03) compared with FNA. The most commonly identified alterations were in KRAS (88%), TP53 (68%), and SMAD4 (16%).ConclusionsEndoscopic ultrasonography can reliably obtain sufficient tissue from PDAC for targeted genomic sequencing for prognostication and theranostics. FNB should be considered when tumor genotyping is requested, especially for tumors ≤ 3 cm or tumors located in the head/neck of the pancreas.