Bian Liu

Seasonal Variations of Complete Blood Count and Inflammatory Biomarkers in the US Population - Analysis of NHANES Data

Background Recent studies reported seasonal differences in gene expression in white blood cells, adipose tissue, and inflammatory biomarkers of the immune system. There is no data on the seasonal variations of these biomarkers in the US general population of both children and adults. Then aim of this study is to explore the seasonal trends in complete blood count (CBC), and C-reactive protein (CRP) in a large non-institutionalized US population. Methods Seven cross-sectional data collected in the National Health and Nutrition Examination Survey (NHANES) during 1999–2012 were aggregated; participants reporting recent use of prescribed steroids, chemotherapy, immunomodulators and antibiotics were excluded. Linear regression models were used to compare levels of CBC and CRP between winter-spring (November-April) and summer-fall (May-October), adjusting for demographics, personal behavioral factors, and chronic disease conditions. Results A total of 27,478 children and 36,644 adults (≥18 years) were included in the study. Levels of neutrophils, white blood cell count (WBC), and CRP were higher in winter-spring than summer-fall (p≤0.05). Red blood cell components were lower in winter-spring than in summer-fall, while the opposite was seen for platelets. Conclusions This large population-based study found notable seasonal variations in blood cell composition and inflammatory biomarkers, with a more pro-inflammatory immune system seen in winter-spring than summer-fall. The red blood cell patterns could have implications for the observed cardio-vascular seasonality.

Longitudinal Impact of Hurricane Sandy Exposure on Mental Health Symptoms

Hurricane Sandy hit the eastern coast of the United States in October 2012, causing billions of dollars in damage and acute physical and mental health problems. The long-term mental health consequences of the storm and their predictors have not been studied. New York City and Long Island residents completed questionnaires regarding their initial Hurricane Sandy exposure and mental health symptoms at baseline and 1 year later (N = 130). There were statistically significant decreases in anxiety scores (mean difference = −0.33, p < 0.01) and post-traumatic stress disorder (PTSD) scores (mean difference = −1.98, p = 0.001) between baseline and follow-up. Experiencing a combination of personal and property damage was positively associated with long-term PTSD symptoms (ORadj 1.2, 95% CI [1.1–1.4]) but not with anxiety or depression. Having anxiety, depression, or PTSD at baseline was a significant predictor of persistent anxiety (ORadj 2.8 95% CI [1.1–6.8], depression (ORadj 7.4 95% CI [2.3–24.1) and PTSD (ORadj 4.1 95% CI [1.1–14.6]) at follow-up. Exposure to Hurricane Sandy has an impact on PTSD symptoms that persists over time. Given the likelihood of more frequent and intense hurricanes due to climate change, future hurricane recovery efforts must consider the long-term effects of hurricane exposure on mental health, especially on PTSD, when providing appropriate assistance and treatment.

The Impact of Margins on Outcomes After Wedge Resection for Stage I Non-Small Cell Lung Cancer

BACKGROUND The relationship between margin distance and recurrence and survival for stage I non-small cell lung carcinoma (NSCLC) less than or equal to 2 cm is not clear. METHODS Patient clinicopathologic data were reviewed from a pooled data set of stage I NSCLC lesions less than or equal to 2 cm resected by wedge resection at Brigham and Womens Hospital (BWH) between 2000 and 2005 and the International Early Lung and Cardiac Action Program (I-ELCAP) between 1999 and 2015. Multivariable models were constructed to evaluate the relationship between margin distance and recurrence and survival, adjusting for patient age, sex, tumor size, and histologic type. Optimal margin distance was determined for recurrence-free and overall survival using maximum χ2 values among survival distributions. RESULTS Of 182 cases, 138 tumors had margin distance reported (113 BWH and 25 I-ELCAP). The average tumor size was 13.3 mm, and margin distance was 8.3 mm. During a mean follow-up of 49.6 months, there were 33 recurrences and 59 deaths. Increased margin distance was independently associated with lower risk of recurrence (odds ratio [OR], 0.90; 95% confidence interval [CI], 0.83-0.98). Margin distance was also independently associated with longer survival (hazard ratio [HR], 0.94; 95% CI, 0.90-0.98). A margin distance greater than 9 mm was associated with longest recurrence-free survival and a margin distance greater than 11 mm was associated with longest overall survival. CONCLUSIONS Increased margin distance was independently associated with lower risk of recurrence and longer overall survival in patients undergoing wedge resection for NSCLC tumors less than or equal to 2 cm. These findings suggest that with a minimum appropriate margin distance, wedge resection may yield outcomes comparable to those of lobectomy.

Self-Reported and FEMA Flood Exposure Assessment after Hurricane Sandy: Association with Mental Health Outcomes

Hurricane Sandy caused extensive physical and economic damage; the long-term mental health consequences are unknown. Flooding is a central component of hurricane exposure, influencing mental health through multiple pathways that unfold over months after flooding recedes. Here we assess the concordance in self-reported and Federal Emergency Management (FEMA) flood exposure after Hurricane Sandy and determine the associations between flooding and anxiety, depression, and post-traumatic stress disorder (PTSD). Self-reported flood data and mental health symptoms were obtained through validated questionnaires from New York City and Long Island residents (N = 1231) following Sandy. Self-reported flood data was compared to FEMA data obtained from the FEMA Modeling Task Force Hurricane Sandy Impact Analysis. Multivariable logistic regressions were performed to determine the relationship between flooding exposure and mental health outcomes. There were significant discrepancies between self-reported and FEMA flood exposure data. Self-reported dichotomous flooding was positively associated with anxiety (ORadj: 1.5 [95% CI: 1.1–1.9]), depression (ORadj: 1.7 [1.3–2.2]), and PTSD (ORadj: 2.5 [1.8–3.4]), while self-reported continuous flooding was associated with depression (ORadj: 1.1 [1.01–1.12]) and PTSD (ORadj: 1.2 [1.1–1.2]). Models with FEMA dichotomous flooding (ORadj: 2.1 [1.5–2.8]) or FEMA continuous flooding (ORadj: 1.1 [1.1–1.2]) were only significantly associated with PTSD. Associations between mental health and flooding vary according to type of flood exposure measure utilized. Future hurricane preparedness and recovery efforts must integrate micro and macro-level flood exposures in order to accurately determine flood exposure risk during storms and realize the long-term importance of flooding on these three mental health symptoms.

Displacement during Hurricane Sandy: The impact on mental health

OBJECTIVE To assess the effect of displacement due to Hurricane Sandy on mental health outcomes among residents of the greater New York City (NYC) area. DESIGN Prospective, cross sectional. SETTING NYC area residents, including Queens, Staten Island, and Long Island. PARTICIPANTS In a 4.25 year period (June 2012 to September 2016), a convenience sample of 1,615 adult residents from the greater NYC area completed validated measures of hurricane exposure (including displacement), perceived stress, depression, anxiety, and post-traumatic stress disorder (PTSD) symptoms as well as indicators of alcohol, illicit substance, and tobacco use. MAIN OUTCOME MEASURES Perceived stress, depression, anxiety and PTSD symptoms and alcohol, illicit substance, and tobacco use. RESULTS Multivariable analyses indicated that displaced participants were more likely to have PTSD (adjusted odds ratio [AOR]: 2.21, 95% CI: 1.73-2.82), depression (AOR: 1.37, 95% CI: 1.05-1.79) and anxiety symptoms (AOR: 1.30, 95% CI: 1.01-1.67) and had a 1.16 unit increase in perceived stress score (SE = 0.38) compared to nondisplaced participants. Staying with friends/family versus at a shelter was significantly associated with a 48 percent decreased odds of having PTSD symptoms (AOR: 0.52, 95% CI: 0.31-0.88) and of being a current tobacco user (AOR: 0.52, 95% CI: 0.30-0.92). CONCLUSIONS Displacement is associated with negative mental health outcomes, particularly displacement to shelters. Disaster preparedness efforts should involve increasing mental health resources to those who are displaced and providing support services within the shelter setting.

Personal and hospital factors associated with limited surgical resection for lung cancer, in-hospital mortality and complications in New York State

Early stage lung cancer is generally treated with surgical resection. The objective of the study was to identify patient and hospital characteristics associated with the type of lung cancer surgical approach utilized in New York State (NYS), and to assess in‐hospital adverse events.

Outcomes for Thoracoscopy Versus Thoracotomy Not Just Technique Dependent: A Study of 9,787 Patients

BACKGROUND Studies reporting the benefits of video-assisted thoracoscopic surgery (VATS) lung cancer resection over thoracotomy have been subject to selection bias. We evaluated patient and hospital characteristics associated with type of surgery and the independent effect of VATS on outcomes. METHODS The Statewide Planning and Research Cooperative System of New York State database was queried to identify all lung cancer patients undergoing lobectomy or sublobar resection between 2007 and 2012. Multivariable logistic regression was performed to identify patient (age, sex, race, comorbidities, year, and insurance) and hospital (urban, teaching, and total lung surgery volume) cofactors associated with surgical technique and propensity scores were used to evaluate whether technique was independently associated with complications or in-hospital mortality. RESULTS There were 5,505 lobectomy and 4,282 sublobar resection patients, with 2,318 (42%) and 2,416 (56%) undergoing VATS, respectively. For lobectomy, VATS was associated with being female, lower comorbidity index, private insurance, older age, surgery in recent year, nonteaching hospital, and higher annual lung surgery volume. For sublobar resection, VATS was associated with black race, lower comorbidity index, Medicaid or other insurance, surgery in recent year, rural hospital, and higher annual lung surgery volume. Complication rate was significantly lower for VATS lobectomy and not sublobar resection, whereas in-hospital mortality was lower for VATS in both resection groups. CONCLUSIONS Numerous patient- and hospital-related variables that affect morbidity and mortality also affect whether a patient undergoes VATS or open lung resection. Studies evaluating VATS must account more accurately for selection bias and adjust for these confounders.

Temporal trends in centralization and racial disparities in utilization of high-volume hospitals for lung cancer surgery

Abstract Racial disparities have been suggested in hospital utilization and outcome for lung cancer surgery, but the effect of hospital centralization on closing this gap is unknown. We hypothesized that centralization has increased the utilization of high- or very-high-volume (HV/VHV) hospitals, a proxy for access to high-quality care, over the study period independently from race. Inpatient records were extracted from the New York Statewide Planning and Research Cooperative System database (1995–2012) according to Clinical Modification of the International Classification of Diseases, 9th Revision diagnosis codes 162.* and 165.* and surgical procedure codes 32.2–32.6 (n = 31,931). Patients treated exclusively with surgery of black or white race with a valid zip code were included. Logistic models were performed to determine factors associated with utilization of HV/VHV or low- or very-low-volume (LV/VLV) hospitals; these models were subsequently stratified by race. The percentage of both black and white patients utilizing HV/VHV hospitals increased over the study period (+22.7% and 13.9%, respectively). The distance to the nearest HV/VHV hospital and patient–hospital distance were significantly lower in black compared to white patients, however, blacks were consistently less likely to use HV/VHV than whites (odds ratioadj: 0.26; 95% confidence interval: 0.23–0.29), and were significantly more likely to utilize urban, teaching, and lower volume hospitals than whites. Likelihood of HV/VHV utilization decreased with an increasing distance from a HV/VHV hospital, overall and separately for black and white patients. Although centralization has increased the utilization of HV/VHV for both black and white patients, racial differences in access and utilization of HV hospitals persisted.

Review of malignant pleural mesothelioma survival after talc pleurodesis or surgery

Malignant pleural mesothelioma (MPM) is an aggressive tumor and the prognosis is still dismal despite the various proposed multimodal treatment plans. Currently, new palliative treatments, such as talc pleurodesis, are being explored besides traditional surgery. This review reports survival rates after talc pleurodesis in comparison to surgery in patients with malignant pleural mesothelioma. A systematic literature search yielded 49 articles eligible for this review. The mean survival in the talc pleurodesis group was 14 months compared to 17 and 24 months for the pleurectomy decortication (P/D) group and extrapleural pneumonectomy (EPP) group, respectively. Few studies reported on the 1-, 2-year overall survival for the talc pleurodesis group and the results were very heterogeneous. The pooled 1-year overall survival for the P/D and EPP groups were 55% [credibility limits (CL): 21-87%] and 67% (CL: 3-89%), the pooled 2-year overall survival were 32% (CL: 8-63%) and 36% (CL: 8-54%), respectively. The pooled 1- and 2-year survival for surgery independently from the type of surgery were 62% (CL: 38-84%) and 34% (CL: 16-54%). There was significant heterogeneity in all the analyses. This review shows that there is limited research on the survival rate after talc pleurodesis compared to surgery in the treatment of malignant pleural mesothelioma. A comparison study is necessary to accurately assess the best way to treat MPM patients, including assessment of the quality of life after treatment as an outcome measure.

The Relationship Between Tobacco Smoke Exposure and Airflow Obstruction in US Children: Analysis of the National Health and Nutrition Examination Survey (2007-2012)

BACKGROUND It has been difficult to determine the individual impact of prenatal and postnatal tobacco smoke exposure (TSE) on childhood lung function, as children are often exposed to both. OBJECTIVE The goal of this study was to determine the association between current TSE and airflow obstruction while adjusting for self‐reported prenatal TSE. METHODS Children aged 6 to 11 years who participated in the National Health and Nutrition Examination Survey (2007‐2012) who had serum cotinine levels measured and spirometry performed were included. Logistic regression was used to determine the association between log‐transformed serum cotinine level and airflow obstruction while adjusting for confounders; the analysis was then stratified according to asthma status. The final model included both log‐transformed serum cotinine level and prenatal exposure as covariates. RESULTS The sample consisted of 2,070 children; 9.6% had airflow obstruction. The association between cotinine levels and airflow obstruction was significant in an unadjusted analysis (OR, 1.12 [95% CI, 1.02‐1.23]). In the multivariate analysis with both exposures included as covariates, serum cotinine level was not significantly associated with airflow obstruction (ORadj, 1.07 [95% CI, 0.94‐1.21]), and no association was seen in children with asthma and nonasthmatic children. Prenatal smoking was associated with airflow obstruction in children with asthma (ORadj, 2.51 [95% CI, 1.08‐5.79]) but not in nonasthmatic children (ORadj, 1.08 [95% CI, 0.53‐2.18]). CONCLUSIONS Current TSE was not independently associated with airflow obstruction in school‐aged children. Prenatal TSE was associated with airflow obstruction in children with asthma. Repeated studies into potential mediators and confounders of this relationship are needed.