Racial disparities in healthcare are well documented, however their effects on surgical outcomes remain controversial. While studies have examined outcomes along the white-black dichotomy, Asian populations remain frequently unstudied. We use the VQI to examine disparities among white, black and Asian patients undergoing infrainguinal bypass.
The VQI database was queried for black, white and Asian patients undergoing infrainguinal surgery between 2012 and 2017. Preoperative characteristics, disease severity, and perioperative characteristics were compared between the racial groups. Primary outcomes included overall mortality, time to death, long term loss of primary patency, and patency at discharge. Analyses were done using a 133 matched sample of Asian to whites to black patients.
Among the patients included, 139 (0.56%) were Asian, 4222 (16.9%) were black and 20,582 (82.5%) were white, of which 129 Asian patients were matched to 387 black and 387 white patients. Asian patients had more advanced disease as demonstrated by higher rates of tissue loss/acute ischemia (P<0.0001) and the highest percentage of below knee popliteal target sites (P=0.0011). There were no differences in mortality (P=0.6808) or long-term loss of primary patency (P=0.4500). However, black patients had higher rates of amputation (OR=1.68, P=0.0224) and reoperation (OR=2.22, P=0.0015).
Asian patients presented with more advanced disease requiring more distal bypass targets. Despite these disparities in presentation, overall long-term primary patency and mortality showed no significant difference.
Asian patients presented with more advanced disease requiring more distal bypass targets. Despite these disparities in presentation, overall long-term primary patency and mortality showed no significant difference.Chronic pain is a public health priority that affects about 20% of the general population, causing disability and impacting productivity and quality of life. It is often managed in the primary care setting. Chronic pain management is most effective when the pain mechanism has been identified and addressed by appropriate therapy. This document provides an overview of pharmacological therapy for chronic non-cancer pain in the primary care setting, with the aim of improving treatment decisions based on the underlying pain mechanisms and pain neuroscience.Chronic pain is considered a public health priority by the World Health Organization and European health institutions. https://www.selleckchem.com/products/caerulein.html It has reached alarming proportions in terms of disability, consumption of health and social resources, and impact on primary and specialist care services. Primary care physicians are often called on to manage this condition. Chronic pain management can be challenging due to its complexity. It has traditionally been considered to include nociceptive pain that that persists longer than the normal healing time, neuropathic pain lasting more than 3 months, or a combination of these. More recently, a third descriptor, nociplastic (primary) pain, was added to classify patients with chronic pain conditions such as fibromyalgia, nonspecific **** pain, or mixed pain that persists or other conditions in which altered central pain modulation results in central sensitization and chronic pain in the absence of actual or threatened damage to tissues, including in the somatosensory nervous system. This document provides an overview of pain types and their underlying mechanisms. Successful pain management is facilitated by identification of the pain type. A set of diagnostic tools and a pain algorithm are presented to guide the clinician toward the correct diagnosis. The algorithm identifies cases that may require referral to a pain specialist. Once the site of origin of the pain (the "pain generator") is identified, or a primary pain syndrome is suspected, the accompanying article provides information and rationale to support treatment decisions based on patient characteristics.Immunofluorescence staining is a widely used and powerful tool for the visualization and colocalization of two or more proteins and/or cellular organelles. For colocalization studies in fixed cells, one target protein/organelle is immunostained and visualized by one fluorophore and the other target protein/organelle is immunostained and visualized by a different fluorophore whose excitation emission spectra does not overlap with the first fluorophore. Parkin (PARK2) is an E3 ubiquitin ligase which performs ubiquitination of surface proteins of dysfunctional mitochondria to mark them for autolysosomal degradation. Here we describe the immunofluorescence staining of parkin protein and immunofluorescence or dye-based methods to visualize mitochondria and study the colocalization of parkin and mitochondria in primary human or mouse chondrocytes or cell lines.Chondrocytes, the only cells in articular cartilage, are metabolically active and responsible for the turnover of extracellular matrix and maintenance of the tissue homeostasis. Changes in chondrocyte function can cause degradation of the matrix and loss of articular cartilage integrity, leading to development and progression of osteoarthritis (OA). These changes are exemplified by accumulated mitochondrial damage and dysfunction. Because mitochondria are the critical organelles to produce energy and play a key role in cellular processes, the approaches to assess mitochondrial function under both physiological and pathological conditions enable us to uncover the mechanisms on how dysfunction of mitochondria in chondrocytes mediates signaling pathways that are involved in disturbance of cartilage homeostasis. In this chapter, we describe the methods to evaluate mitochondrial biogenesis, activity and mitochondrial DNA (mtDNA) integrity in chondrocytes.Chondrocytes are the main cells responsible for the maintenance of cartilage homeostasis and integrity. During development, extracellular matrix (ECM) macromolecules are produced and deposited by chondrocyte precursors. Autophagy, a highly dynamic process aimed at degradation of dysfunctional or pathogenic proteins, organelles, and intracellular microbes that can damage tissues, is one of the key processes required for sustained cartilage homeostasis. In different cell types it has been shown that, among others, autophagy is regulated by epigenetic mechanisms such as small noncoding RNAs (miRNAs, ~22 base pairs). Increasing evidence suggests that miRNAs are also involved in the regulation of autophagy in chondrocytes. Based on our previous research of gene and miRNA expression in articular cartilage, in this chapter we provide a summary of the tools models to direct in vitro and in vivo studies aimed at gaining a better understanding of the regulatory roles of miRNAs in chondrocyte autophagy.
Racial disparities in healthcare are well documented, however their effects on surgical outcomes remain controversial. While studies have examined outcomes along the white-black dichotomy, Asian populations remain frequently unstudied. We use the VQI to examine disparities among white, black and Asian patients undergoing infrainguinal bypass.
The VQI database was queried for black, white and Asian patients undergoing infrainguinal surgery between 2012 and 2017. Preoperative characteristics, disease severity, and perioperative characteristics were compared between the racial groups. Primary outcomes included overall mortality, time to death, long term loss of primary patency, and patency at discharge. Analyses were done using a 133 matched sample of Asian to whites to black patients.
Among the patients included, 139 (0.56%) were Asian, 4222 (16.9%) were black and 20,582 (82.5%) were white, of which 129 Asian patients were matched to 387 black and 387 white patients. Asian patients had more advanced disease as demonstrated by higher rates of tissue loss/acute ischemia (P<0.0001) and the highest percentage of below knee popliteal target sites (P=0.0011). There were no differences in mortality (P=0.6808) or long-term loss of primary patency (P=0.4500). However, black patients had higher rates of amputation (OR=1.68, P=0.0224) and reoperation (OR=2.22, P=0.0015).
Asian patients presented with more advanced disease requiring more distal bypass targets. Despite these disparities in presentation, overall long-term primary patency and mortality showed no significant difference.
Asian patients presented with more advanced disease requiring more distal bypass targets. Despite these disparities in presentation, overall long-term primary patency and mortality showed no significant difference.Chronic pain is a public health priority that affects about 20% of the general population, causing disability and impacting productivity and quality of life. It is often managed in the primary care setting. Chronic pain management is most effective when the pain mechanism has been identified and addressed by appropriate therapy. This document provides an overview of pharmacological therapy for chronic non-cancer pain in the primary care setting, with the aim of improving treatment decisions based on the underlying pain mechanisms and pain neuroscience.Chronic pain is considered a public health priority by the World Health Organization and European health institutions. https://www.selleckchem.com/products/caerulein.html It has reached alarming proportions in terms of disability, consumption of health and social resources, and impact on primary and specialist care services. Primary care physicians are often called on to manage this condition. Chronic pain management can be challenging due to its complexity. It has traditionally been considered to include nociceptive pain that that persists longer than the normal healing time, neuropathic pain lasting more than 3 months, or a combination of these. More recently, a third descriptor, nociplastic (primary) pain, was added to classify patients with chronic pain conditions such as fibromyalgia, nonspecific back pain, or mixed pain that persists or other conditions in which altered central pain modulation results in central sensitization and chronic pain in the absence of actual or threatened damage to tissues, including in the somatosensory nervous system. This document provides an overview of pain types and their underlying mechanisms. Successful pain management is facilitated by identification of the pain type. A set of diagnostic tools and a pain algorithm are presented to guide the clinician toward the correct diagnosis. The algorithm identifies cases that may require referral to a pain specialist. Once the site of origin of the pain (the "pain generator") is identified, or a primary pain syndrome is suspected, the accompanying article provides information and rationale to support treatment decisions based on patient characteristics.Immunofluorescence staining is a widely used and powerful tool for the visualization and colocalization of two or more proteins and/or cellular organelles. For colocalization studies in fixed cells, one target protein/organelle is immunostained and visualized by one fluorophore and the other target protein/organelle is immunostained and visualized by a different fluorophore whose excitation emission spectra does not overlap with the first fluorophore. Parkin (PARK2) is an E3 ubiquitin ligase which performs ubiquitination of surface proteins of dysfunctional mitochondria to mark them for autolysosomal degradation. Here we describe the immunofluorescence staining of parkin protein and immunofluorescence or dye-based methods to visualize mitochondria and study the colocalization of parkin and mitochondria in primary human or mouse chondrocytes or cell lines.Chondrocytes, the only cells in articular cartilage, are metabolically active and responsible for the turnover of extracellular matrix and maintenance of the tissue homeostasis. Changes in chondrocyte function can cause degradation of the matrix and loss of articular cartilage integrity, leading to development and progression of osteoarthritis (OA). These changes are exemplified by accumulated mitochondrial damage and dysfunction. Because mitochondria are the critical organelles to produce energy and play a key role in cellular processes, the approaches to assess mitochondrial function under both physiological and pathological conditions enable us to uncover the mechanisms on how dysfunction of mitochondria in chondrocytes mediates signaling pathways that are involved in disturbance of cartilage homeostasis. In this chapter, we describe the methods to evaluate mitochondrial biogenesis, activity and mitochondrial DNA (mtDNA) integrity in chondrocytes.Chondrocytes are the main cells responsible for the maintenance of cartilage homeostasis and integrity. During development, extracellular matrix (ECM) macromolecules are produced and deposited by chondrocyte precursors. Autophagy, a highly dynamic process aimed at degradation of dysfunctional or pathogenic proteins, organelles, and intracellular microbes that can damage tissues, is one of the key processes required for sustained cartilage homeostasis. In different cell types it has been shown that, among others, autophagy is regulated by epigenetic mechanisms such as small noncoding RNAs (miRNAs, ~22 base pairs). Increasing evidence suggests that miRNAs are also involved in the regulation of autophagy in chondrocytes. Based on our previous research of gene and miRNA expression in articular cartilage, in this chapter we provide a summary of the tools models to direct in vitro and in vivo studies aimed at gaining a better understanding of the regulatory roles of miRNAs in chondrocyte autophagy.
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