Publications by authors named "Ernest Chan"

Purpose: Delayed chest closure (DCC) during lung transplantation (LTx) is a controversial surgical approach that lacks research in systemic sclerosis (SSc) patients. We investigated outcomes, clinical risk factors, and CT-based lung size-matching parameters associated with DCC in SSc recipients.

Methods: This retrospective study included 92 SSc recipients (age 51 years ± 10, 56/92 (61.

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  • - The study investigates the effects of extracorporeal membrane oxygenation (ECMO) on airway complications in patients with severe primary graft dysfunction (PGD3) following lung transplantation, highlighting the potential benefits of early ECMO use.
  • - Results showed that patients on veno-venous ECMO (VV-ECMO) had lower instances of PGD3 and reduced risk of chronic allograft dysfunction compared to those solely on mechanical ventilation (MV).
  • - The findings suggest VV-ECMO may help prevent ischemic reperfusion injury and lower the severity of airway complications post-transplantation, indicating a need for further research to understand the underlying mechanisms.
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Multiorgan transplantation is offered to a selected group of patients every year. The sequence in which organs are transplanted depends on ischemic time graft tolerance and the sickest organ first strategy. In the case of Lung-Liver transplantation, lung allografts are usually implanted before the liver.

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  • The study investigates the occurrence of subcutaneous emphysema (SE) after robotic cardiac surgery, analyzing data from 116 patients who underwent various procedures.
  • SE was found in 45.7% of patients, with most cases being mild; however, severe cases required additional medical intervention like CT scans and chest tubes.
  • Factors such as low body weight, low BMI, small body surface area, and older age are linked to a higher incidence of SE, particularly in those undergoing robotic mitral valve repair compared to other robotic surgeries.
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  • The study analyzed outcomes of lung transplantation using ex vivo lung perfusion (EVLP) in high-risk recipients, defined by specific medical conditions.
  • Results indicated that high-risk candidates faced a significantly greater risk of dying on the waitlist, and EVLP was linked to higher rates of acute kidney injury, increased mortality on admission, and longer hospital stays compared to standard lung procurement.
  • Despite the associated complications and shorter survival rates for portable EVLP, the study suggests this technique remains a viable option due to the high mortality risk for patients on the transplant waitlist.
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Pneumatosis intestinalis (PI) and pneumoperitoneum are some of the complications after lung transplantation (LT). But only limited reports are published. The purpose of this study is to review our experience and perform a systematic review to discuss the possible causes, risk factors, and management.

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The elevated level of replication stress is an intrinsic characteristic of cancer cells. Targeting the mechanisms that maintain genome stability to further increase replication stress and thus induce severe genome instability has become a promising approach for cancer treatment. Here, we identify histone deacetylase 8 (HDAC8) as a drug target whose inactivation synergized with the inhibition of checkpoint kinases to elicit substantial replication stress and compromise genome integrity selectively in cancer cells.

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Objective: Lung transplantation is a complex surgical procedure performed by specialized teams. Practice changes to eliminate overnight lung transplants were implemented at our center and patient outcomes were evaluated.

Methods: Patient and donor organ selection were performed in the standard fashion.

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  • The study compares two anticoagulation protocols used during intraoperative VA-ECMO support in double lung transplant patients from 2016 to 2023.
  • One protocol used a high-target activated clotting time (ACT) while the other used a low-dose heparin approach with a TXA infusion.
  • Results showed that the low heparin group had shorter surgery times and less need for blood products, with no significant differences in post-operative complications or severe primary graft dysfunction rates.
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Objectives: The current understanding of survival prediction of lung transplant (LTx) patients with systemic sclerosis (SSc) is limited. This study aims to identify novel image features from preoperative chest CT scans associated with post-LTx survival in SSc patients and integrate them into comprehensive prediction models.

Materials And Methods: We conducted a retrospective study based on a cohort of SSc patients with demographic information, clinical data, and preoperative chest CT scans who underwent LTx between 2004 and 2020.

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  • Persistent acute kidney injury (pAKI) has a worse prognosis than transient acute kidney injury (AKI) in critically ill patients, but its impact and definitions are less understood in organ transplant recipients.
  • A systematic review of 25 studies involving 6,330 patients showed a wide variation in the incidence and definitions of pAKI among heart, lung, and liver transplant recipients.
  • pAKI is linked to higher rates of new chronic kidney disease, graft dysfunction, and long-term mortality, highlighting the need for standardized definitions in future research.
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The nuclear factor erythroid 2-related factor 2-Kelch-like ECH-associated protein 1 (NRF2-KEAP1) pathway plays an important role in the cellular response to oxidative stress but may also contribute to metabolic changes and drug resistance in cancer. However, despite its pervasiveness and important role, most of nuclear factor erythroid 2-related factor 2 (NRF2) target genes are defined in context-specific experiments and analysis, making it difficult to translate from one situation to another. Our study investigates whether a core NRF2 gene signature can be derived and used to represent NRF2 activation in various contexts, allowing better reproducibility and understanding of NRF2.

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Background: Understanding routes of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission in long-term care facilities is essential for the development of effective control measures.

Methods: Between March 1, 2020, and August 31, 2023, we identified coronavirus disease 2019 (COVID-19) cases among residents and employees in a Veterans Affairs community living center that conducted routine screening for asymptomatic COVID-19. Contact tracing was conducted to identify suspected transmission events, and whole genome sequencing was performed to determine the relatedness of SARS-CoV-2 samples.

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Background: Lung retransplantation is offered to select patients with chronic allograft dysfunction. Given the increased risk of morbidity and mortality conferred by retransplantation, post-transplant function should be considered in the decision of who and when to list. The aim of this study is to identify predictors of post-operative disability in patients undergoing lung retransplantation.

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Intracortical microelectrodes (IMEs) are devices designed to be implanted into the cerebral cortex for various neuroscience and neuro-engineering applications. A critical feature of these devices is their ability to detect neural activity from individual neurons. Currently, IMEs are limited by chronic failure, largely considered to be caused by the prolonged neuroinflammatory response to the implanted devices.

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Background: Traditional thoracotomy, an invasive surgical procedure, has been the standard approach for extended lobectomy in treating non-small cell lung cancer (NSCLC). However, minimally invasive surgery (MIS) has gained traction with advancements in surgical techniques. Despite this, the outcomes of extended lobectomy via a minimally invasive approach remain largely uncharted.

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  • The study investigates how gender influences the expression of Th17-associated immune pathways in patients with ankylosing spondylitis (AS), focusing on inflammatory cytokine genes.
  • Researchers collected and analyzed IL-17-enriched peripheral blood mononuclear cells from 10 female and 11 male AS patients using RNA sequencing techniques.
  • Results showed significant gender differences in gene expression related to Th17 cell function, with specific inflammatory markers being upregulated in males, potentially explaining varying disease phenotypes between genders.
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Background: Experience with lung transplantation (LT) in patients with human immunodeficiency virus (HIV) is limited. Many studies have demonstrated the success of kidney and liver transplantation in HIV-seropositive (HIV+) patients. Our objective was to conduct a national registry analysis comparing LT outcomes in HIV+ to HIV-seronegative (HIV-) recipients.

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Background: With new variants challenging the effectiveness of preventive measures, we are beginning to recognize the reality that COVID-19 will continue to pose an endemic threat. The manifestations of COVID-19 in lung transplant recipients during index admission are poorly understood with very few cases reported in recent lung transplant recipients. Optimal management of immunosuppression and antiviral therapy in recent transplant recipients is challenging.

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  • - The study aimed to identify genetic biomarkers linked to the risk of recurrent pressure injuries (PIs) in individuals with spinal cord injuries (SCI), focusing on veterans receiving care at specialized centers.
  • - Researchers conducted thorough assessments over several years, analyzing blood samples and health records to explore genetic variations and their connection to PI history, specifically identifying 260 genes related to fat metabolism and biological processes.
  • - Findings suggest that integrating genomic data with electronic health records could enhance the management of complex health issues like PIs in SCI patients, potentially enabling better-targeted care for higher-risk individuals.
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Cirrhosis is usually regarded as a contraindication to isolated lung transplantation (ILT). We sought to determine which patients with cirrhosis could safely undergo ILT. Based on a retrospective analysis of patients with cirrhosis who underwent ILT at our center between 2007 and 2020, we developed an exclusionary algorithm (PENS-CEPT: Pittsburgh ExclusioN Score in Cirrhotics Evaluated for Pulmonary Transplant) to help determine which patients can undergo ILT with minimal incurred risk from their underlying liver disease.

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Objectives: During the postoperative phase of lung transplantation, the surgical creation of a gastro-jejunostomy (GJ) may be deemed necessary for patients with severe oesophageal dysmotility, prolonged oral intake difficulties stemming from use of a ventilator or marked malnutrition. We explored the effects of postoperative GJ tube on survival and bronchiolitis obliterans syndrome in lung transplant recipients.

Methods: We retrospectively reviewed all lung transplants performed at our institution between 2011 and 2022.

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  • The study aimed to evaluate the trends and outcomes of lung transplants in patients aged 70 and older, using data from the UNOS database from May 2005 to December 2022.
  • Out of 34,957 lung transplant recipients, 3,236 (9.3%) were aged 70 or older, with an increasing rate of transplants among this age group, especially in low-volume centers (LVCs) where their outcomes were similar to higher-volume centers (HVCs).
  • Older recipients had shorter survival times compared to younger ones, with a higher likelihood of dying from cardiovascular issues or cancer, highlighting the need for better selection and care strategies for this age group in transplant programs.
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