Chiu-Hsieh Hsu

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Scholarly Contributions

Books

• He, Y., Zhang, G., & Hsu, C. (2021). Multiple Imputation of Missing Data in Practice: Basic Theory and Analysis Strategies. Chapman & Hall/CRC.

Journals/Publications

• Rahimi, A. O., Soliman, D., Hsu, C. H., & Ghaderi, I. (2024). The impact of gender, race, and ethnicity on bariatric surgery outcomes. Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery.
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  The rates of postoperative complications can vary among specific patient populations.
• Succar, B., Chou, Y. H., Hsu, C. H., Rapcsak, S., Trouard, T., & Zhou, W. (2024). Carotid Revascularization is Associated with Improved Mood in Patients with Advanced Carotid Disease. Annals of surgery.
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  To investigate the impact of carotid interventions on patients' mental condition in patients with carotid stenosis.
• Bazikian, S., Urbina, D., Hsu, C. H., Gonzalez, K. A., Rosario, E. R., Chu, D. I., Tsui, J., & Tan, T. W. (2023). Examining health care access disparities in Hispanic populations with peripheral artery disease and diabetes. Vascular medicine (London, England), 28(6), 547-553.
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  This study investigated disparities in health care access for Hispanic adults with diabetes and peripheral artery disease (PAD) who are at risk of lower-extremity amputation and other cardiovascular morbidities and mortalities.
• Combs, D., Edgin, J., Hsu, C. H., Bottrill, K., Van Vorce, H., Gerken, B., Matloff, D., La Rue, S., & Parthasarathy, S. (2023). The combination of atomoxetine and oxybutynin for the treatment of obstructive sleep apnea in children with Down syndrome. Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine, 19(12), 2065-2073.
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  Children with Down syndrome (DS) are at very high risk for obstructive sleep apnea (OSA). Current OSA treatments have limited effectiveness in this population. We evaluated the effectiveness of atomoxetine and oxybutynin (ato-oxy) to treat OSA in children with Down syndrome.
• Desravines, N., Hsu, C. H., Mohnot, S., Sahasrabuddhe, V., House, M., Sauter, E., O'Connor, S., Bauman, J. E., Chow, H. S., & Rahangdale, L. (2023). Feasibility of 5-fluorouracil and imiquimod for the topical treatment of cervical intraepithelial neoplasias (CIN) 2/3. International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics, 163(3), 862-867.
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  To determine the feasibility (as measured by tolerability and safety) and efficacy of topical 5-fluorouracil (5-FU) and imiquimod for the treatment of cervical intraepithelial neoplasia (CIN) 2/3.
• Gordon, J. S., Armin, J. S., Giacobbi, P., Hsu, C. H., Marano, K., & Sheffer, C. E. (2023). Testing the Efficacy of a Scalable Telephone-Delivered Guided Imagery Tobacco Cessation Treatment: Protocol for a Randomized Clinical Trial. JMIR research protocols, 12, e48898.
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  Tobacco use continues to be a leading preventable cause of death and disease in the United States, accounting for >480,000 deaths each year. Although treatments for tobacco use are effective for many, there is substantial variability in outcomes, and these approaches are not effective for all individuals seeking to quit smoking cigarettes. New, effective therapeutic approaches are needed to meet the preferences of people who want to stop smoking. Guided imagery (GI) is a mind-body technique that involves the guided visualization of specific mental images, which is enhanced with other sensory modalities and emotions. Preliminary evidence provides initial support for the use of GI as a treatment for cigarette smoking. Meta-analyses have shown that standard treatment for cigarette smoking delivered over the telephone via quitlines is effective. A telephone-based intervention that uses GI might provide another effective treatment option and increase the reach and effectiveness of quitlines.
• Habib, S., Murakami, T., Takyar, V., Patel, K., Dominguez, C., Zhan, Y., Mehrpour, O., & Hsu, C. H. (2023). The Impact of Metabolic Syndrome on the Prognosis of High-Risk Alcoholic Hepatitis Patients: Redefining Alcoholic Hepatitis. Gastroenterology research, 16(1), 25-36.
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  Alcoholic hepatitis (AH) is characterized by acute symptomatic hepatitis associated with heavy alcohol use. This study was designed to assess the impact of metabolic syndrome on high-risk patients with AH with discriminant function (DF) score ≥ 32 and its effect on mortality.
• Hamidi, F., Anwari, E., Spaulding, C., Hauw-Berlemont, C., Vilfaillot, A., Viana-Tejedor, A., Kern, K. B., Hsu, C. H., Bergmark, B. A., Qamar, A., Bhatt, D. L., Furtado, R. H., Myhre, P. L., Hengstenberg, C., Lang, I. M., Frey, N., Freund, A., Desch, S., Thiele, H., , Preusch, M. R., et al. (2023). Early versus delayed coronary angiography in patients with out-of-hospital cardiac arrest and no ST-segment elevation: a systematic review and meta-analysis of randomized controlled trials. Clinical research in cardiology : official journal of the German Cardiac Society.
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  Recent randomized controlled trials did not show benefit of early/immediate coronary angiography (CAG) over a delayed/selective strategy in patients with out-of-hospital cardiac arrest (OHCA) and no ST-segment elevation. However, whether selected subgroups, specifically those with a high pretest probability of coronary artery disease may benefit from early CAG remains unclear.
• Hsu, C. H., He, Y., Hu, C., & Zhou, W. (2023). A multiple imputation-based sensitivity analysis approach for regression analysis with a missing not at random covariate. Statistics in medicine, 42(14), 2275-2292.
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  Missing covariate problems are common in biomedical and electrical medical record data studies while evaluating the relationship between a biomarker and certain clinical outcome, when biomarker data are not collected for all subjects. However, missingness mechanism is unverifiable based on observed data. If there is a suspicion of missing not at random (MNAR), researchers often perform sensitivity analysis to evaluate the impact of various missingness mechanisms. Under the selection modeling framework, we propose a sensitivity analysis approach with a standardized sensitivity parameter using a nonparametric multiple imputation strategy. The proposed approach requires fitting two working models to derive two predictive scores: one for predicting missing covariate values and the other for predicting missingness probabilities. For each missing covariate observation, the two predictive scores along with the pre-specified sensitivity parameter are used to define an imputing set. The proposed approach is expected to be robust against mis-specifications of the selection model and the sensitivity parameter since the selection model and the sensitivity parameter are not directly used to impute missing covariate values. A simulation study is conducted to study the performance of the proposed approach when MNAR is induced by Heckman's selection model. Simulation results show the proposed approach can produce plausible regression coefficient estimates. The proposed sensitivity analysis approach is also applied to evaluate the impact of MNAR on the relationship between post-operative outcomes and incomplete pre-operative Hemoglobin A1c level for patients who underwent carotid intervetion for advanced atherosclerotic disease.
• Maegawa, F. B., Patel, A. D., Serrot, F. J., Patel, S. G., Stetler, J. L., Patel, D. C., Ghaderi, I., Hsu, C. H., Ashouri, Y., Sarmiento, J. M., Konstantinidis, I. T., & Lin, E. (2023). Gastric Cancer Surgery in the US: a Contemporary Trend Analysis of Lymphadenectomy and the Impact of Minimally Invasive Approaches. Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract, 27(9), 1825-1836.
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  The National Comprehensive Cancer Network guidelines recommend harvesting 16 or more lymph nodes for the adequate staging of gastric adenocarcinoma. This study examines the rate of adequate lymphadenectomy over recent years, its predictors, and its impact on overall survival(OS).
• Rahimi, A. O., Ashouri, Y., Maegawa, F., Hsu, C. H., & Ghaderi, I. (2023). Robotic Bariatric Surgery in Older Adults, Is It Safer Than the Laparoscopic Approach? A 7-Year Analysis of Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) Database. Obesity surgery, 33(9), 2671-2678.
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  Utilization of the robotic platform in bariatric surgery has increased over the past several years. The population of older adults who benefit from bariatric surgery is also growing. This study evaluated the safety of robotic-assisted bariatric surgery in older adults using the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) Database.
• Rahimi, A. O., Hsu, C. H., Maegawa, F., Soliman, D., King, R. J., Ashouri, Y., & Ghaderi, I. (2023). First Assistant In Bariatric Surgery: A Comparison Between Laparoscopic And Robotic Approaches: A 4-Year Analysis of the MBSAQIP Database (2016-2019). Obesity surgery.
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  The first assistant (FA) plays an important role in the operating room for bariatric surgery. The aim of this study was to examine the relationship between the type of FA and operative time (OT) and postoperative outcomes comparing robotic and laparoscopic approaches in bariatric surgery.
• Succar, B., Chou, Y. H., Hsu, C. H., Rapcsak, S., Trouard, T., & Zhou, W. (2023). Cognitive effects of carotid revascularization in octogenarians. Surgery, 174(4), 1078-1082.
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  Cognitive impairment is the epitome of cerebrovascular diseases, causing a significant economic burden on our health care system. Growing evidence has indicated the benefits of carotid interventions in patients with severe carotid atherosclerosis. However, the neurocognitive outcome of carotid revascularization in octogenarians is not clearly understood. We aim to evaluate postintervention cognitive changes in seniors older than 80 years.
• Trejo, M. J., Batai, K., Chen, Y., Brezina, S., Chow, H. S., Ellis, N., Lance, P., Hsu, C. H., Pogreba-Brown, K., Bishop, M., Gsur, A., & Jacobs, E. T. (2023). Genome-Wide Association Study of Metachronous Colorectal Adenoma Risk among Participants in the Selenium Trial. Nutrition and cancer, 75(1), 143-153.
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  Genetic variants related to colorectal adenoma may help identify those who are at highest risk of colorectal cancer development or illuminate potential chemopreventive strategies. The purpose of this genome-wide association study was to identify genetic variants that are associated with risk of developing a metachronous colorectal adenoma among 1,215 study participants of European descent from the Selenium Trial. Associations of variants were assessed with logistic regression analyses and validated in an independent case-control study population of 1,491 participants from the Colorectal Cancer Study of Austria (CORSA). No statistically significant genome-wide associations between any variant and metachronous adenoma were identified after correction for multiple comparisons. However, an intron variant of gene, rs61901554, showed a suggestive association ( = 1.10 × 10) and was associated with advanced adenomas in CORSA ( = 0.04). Two intronic variants, rs12728998 and rs6699944 in were also observed to have suggestive associations with metachronous lesions ( = 2.00 × 10) in the Selenium Trial and were associated with advanced adenoma in CORSA ( = 0.03). Our results provide new areas of investigation for the genetic basis of the development of metachronous colorectal adenoma and support a role for involvement in the Wnt/β-catenin pathway leading to colorectal neoplasia.Trial Registration number: NCT00078897 (ClinicalTrials.gov).
• Zeng, J., Funk, J., Lee, B. R., Hsu, C. H., Messing, E. M., & Chipollini, J. (2023). Gemcitabine as first-line therapy for high-grade non-muscle invasive bladder cancer: results from a tertiary center in the contemporary BCG-shortage era. Translational andrology and urology, 12(6), 960-966.
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  To evaluate the safety profile and efficacy of intravesical gemcitabine as first-line adjuvant therapy for non-muscle invasive bladder cancer (NMIBC) in the setting of ongoing Bacillus Calmette-Guérin (BCG) shortage.
• Zeng, Y., Moscicki, A. B., Woo, H., Hsu, C. H., Kemp, T. J., Pinto, L. A., Szabo, E., Dimond, E., Bauman, J., Sahasrabuddhe, V. V., & Chow, H. S. (2023). HPV16/18 Antibody Responses After a Single Dose of Nonavalent HPV Vaccine. Pediatrics, 152(1).
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  A single dose of human papillomavirus (HPV) vaccine would simplify logistics and reduce costs of vaccination programs worldwide. We conducted a phase IIa trial to determine the stability of HPV type-specific antibody responses after a single dose of the nonavalent HPV vaccine, Gardasil9.
• Ashouri, Y., Ho, K., Ho, H., Hsu, C. H., Ghaderi, I., Riall, T. S., Konstantinidis, I. T., & Maegawa, F. B. (2022). Minimally invasive vs open pancreatoduodenectomy on oncological adequacy: a propensity score-matched analysis. Surgical endoscopy, 36(10), 7302-7311.
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  The adoption of minimally invasive pancreatoduodenectomy (MIPD) has increased over the last decade. Most of the data on perioperative and oncological outcomes derives from single-center high-volume hospitals. The impact of MIPD on oncological outcomes in a multicenter setting is poorly understood.
• Ashouri, Y., Hsu, C. H., Riall, T. S., Konstantinidis, I. T., & Maegawa, F. B. (2022). Aspartate Aminotransferase-to-Platelet Ratio Index Predicts Liver Failure After Resection of Colorectal Liver Metastases. Digestive diseases and sciences.
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  Chemotherapy agents for metastatic colorectal cancer can cause liver injury, increasing the risk of post-hepatectomy liver failure after hepatectomy for metastases. The role of noninvasive fibrosis markers in this setting is not well established.
• Batai, K., Sanderson, P. R., Joshweseoma, L., Burhansstipanov, L., Russell, D., Joshweseoma, L., & Hsu, C. H. (2022). Formative Assessment to Improve Cancer Screenings in American Indian Men: Native Patient Navigator and mHealth Texting. International journal of environmental research and public health, 19(11).
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  Cancer screening rates among American Indian men remain low, without programs specifically designed for men. This paper describes the Community-Based Participatory Research processes and assessment of cancer screening behavior and the appropriateness of the mHealth approach for Hopi men's promotion of cancer screenings. This Community-Based Participatory Research included a partnership with H.O.P.I. (Hopi Office of Prevention and Intervention) Cancer Support Services and the Hopi Community Advisory Committee. Cellular phone usage was assessed among male participants in a wellness program utilizing text messaging. Community surveys were conducted with Hopi men (50 years of age or older). The survey revealed colorectal cancer screening rate increased from 51% in 2012 to 71% in 2018, while prostate cancer screening rate had not changed (35% in 2012 and 37% in 2018). Past cancer screening was associated with having additional cancer screening. A cellular phone was commonly used by Hopi men, but not for healthcare or wellness. Cellular phone ownership increased odds of prostate cancer screening in the unadjusted model (OR 9.00, 95% CI: 1.11-73.07), but not in the adjusted model. Cellular phones may be applied for health promotion among Hopi men, but use of cellular phones to improve cancer screening participation needs further investigation.
• Bauman, J. E., Hsu, C. H., Centuori, S., Guillen-Rodriguez, J., Garland, L. L., Ho, E., Padi, M., Bageerathan, V., Bengtson, L., Wojtowicz, M., Szabo, E., & Chow, H. S. (2022). Randomized Crossover Trial Evaluating Detoxification of Tobacco Carcinogens by Broccoli Seed and Sprout Extract in Current Smokers. Cancers, 14(9).
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  Consumption of cruciferous vegetables, rich in the isothiocyanate glucoraphanin, is associated with reduced risk of tobacco-related cancers. Sulforaphane, released by hydrolysis of glucoraphanin, potently induces cytoprotective phase II enzymes. Sulforaphane decreased the incidence of oral cancer in the 4NQO carcinogenesis model. In residents of Qidong, China, broccoli seed and sprout extracts (BSSE) increased detoxification of air pollutants benzene and acrolein, also found in tobacco smoke. This randomized, crossover trial evaluated detoxification of tobacco carcinogens by the BSSE Avmacol in otherwise healthy smokers. Participants were treated for 2 weeks with both low and higher-dose BSSE (148 µmol vs. 296 µmol of glucoraphanin daily), separated by a 2-week washout, with randomization to low-high vs. high-low sequence. The primary endpoint was detoxification of benzene, measured by urinary excretion of its mercapturic acid, SPMA. Secondary endpoints included bioavailability, detoxification of acrolein and crotonaldehyde, modulation by genotype, and toxicity. Forty-nine participants enrolled, including 26 (53%) females with median use of 20 cigarettes/day. Low and higher-dose BSSE showed a mean bioavailability of 11% and 10%, respectively. Higher-dose BSSE significantly upregulated urinary excretion of the mercapturic acids of benzene ( = 0.04), acrolein ( < 0.01), and crotonaldehyde ( = 0.02), independent of genotype. Retention and compliance were high resulting in early study completion. In conclusion, BSSE significantly upregulated detoxification of the tobacco carcinogens benzene, acrolein, and crotonaldehyde in current tobacco smokers.
• Cruz, A., Dickerson, F., Pulling, K. R., Garcia, K., Gachupin, F. C., Hsu, C. H., Chipollini, J., Lee, B. R., & Batai, K. (2022). Impacts of Neighborhood Characteristics and Surgical Treatment Disparities on Overall Mortality in Stage I Renal Cell Carcinoma Patients. International journal of environmental research and public health, 19(4).
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  Racial/ethnic minority groups in the United States have high renal cell carcinoma (RCC) mortality rates. This study assessed surgical treatment disparities across racial/ethnic groups and impacts of neighborhood socioeconomic characteristics on surgical treatments and overall mortality. Stage I RCC patients diagnosed between 2004 and 2016 from National Cancer Database were included (n = 238,141). We assessed differences in associations between race/ethnicity and treatment patterns using logistic regression and between race/ethnicity and overall mortality using Cox regression with and without neighborhood characteristics in the regression models. When compared to non-Hispanic Whites (NHWs), American Indians/Alaska Natives and non-Hispanic Blacks (NHBs) were more likely not to receive surgical care and all racial/ethnic minority groups had significantly increased odds of undergoing radical rather than partial nephrectomy, even after adjusting for neighborhood characteristics. Including surgical treatment and neighborhood factors in the models slightly attenuated the association, but NHBs had a significantly increased risk of overall mortality. NHBs who underwent radical nephrectomy had an increased risk of mortality (HR 1.15, 95% CI: 1.08-1.23), but not for NHBs who underwent partial nephrectomy (HR 0.92, 95% CI: 0.84-1.02). Neighborhood factors were associated with surgical treatment patterns and overall mortality in both NHBs and NHWs. Neighborhood socioeconomic factors may only partly explain RCC disparities.
• Gachupin, F. C., Lee, B. R., Chipollini, J., Pulling, K. R., Cruz, A., Wong, A. C., Valencia, C. I., Hsu, C. H., & Batai, K. (2022). Renal Cell Carcinoma Surgical Treatment Disparities in American Indian/Alaska Natives and Hispanic Americans in Arizona. International journal of environmental research and public health, 19(3).
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  American Indians/Alaska Natives (AI/AN) and Hispanic Americans (HA) have higher kidney cancer incidence and mortality rates compared to non-Hispanic Whites (NHW). Herein, we describe the disparity in renal cell carcinoma (RCC) surgical treatment for AI/AN and HA and the potential association with mortality in Arizona. A total of 5111 stage I RCC cases diagnosed between 2007 and 2016 from the Arizona Cancer Registry were included. Statistical analyses were performed to test the association of race/ethnicity with surgical treatment pattern and overall mortality, adjusting for patients' demographic, healthcare access, and socioeconomic factors. AI/AN were diagnosed 6 years younger than NHW and were more likely to receive radical rather than partial nephrectomy (OR 1.49 95% CI: 1.07-2.07) compared to NHW. Mexican Americans had increased odds of not undergoing surgical treatment (OR 1.66, 95% CI: 1.08-2.53). Analysis showed that not undergoing surgical treatment and undergoing radical nephrectomy were statistically significantly associated with higher overall mortality (HR 1.82 95% CI: 1.21-2.76 and HR 1.59 95% CI: 1.30-1.95 respectively). Mexican Americans, particularly U.S.-born Mexican Americans, had an increased risk for overall mortality and RCC-specific mortality even after adjusting for neighborhood socioeconomic factors and surgical treatment patterns. Although statistically not significant after adjusting for neighborhood-level socioeconomic factors and surgical treatment patterns, AI/AN had an elevated risk of mortality.
• Gachupin, F. C., Lee, B. R., Chipollini, J., Pulling, K. R., Cruz, A., Wong, A. C., Valencia, C. I., Hsu, C., & Batai, K. (2022). Renal Cell Carcinoma Surgical Treatment Disparities in American Indian/Alaska Natives and Hispanic Americans in Arizona. International Journal of Environmental Research and Public Health, 19(3), 1185; https://doi.org/10.3390/ijerph19031185.
• Garland, L. L., Guillen-Rodriguez, J., Hsu, C. H., Davis, L. E., Szabo, E., Husted, C. R., Liu, H., LeClerc, A., Alekseyev, Y. O., Liu, G., Bauman, J. E., Spira, A. E., Beane, J., Wojtowicz, M., & Chow, H. S. (2022). Clinical Study of Aspirin and Zileuton on Biomarkers of Tobacco-Related Carcinogenesis in Current Smokers. Cancers, 14(12).
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  The chemopreventive effect of aspirin and other non-steroidal anti-inflammatory drugs (NSAIDs) on lung cancer risk is supported by epidemiologic and preclinical studies. Zileuton, a 5-lipoxygenase inhibitor, has additive activity with NSAIDs against tobacco carcinogenesis in preclinical models. We hypothesized that cyclooxygenase plus 5-lipoxygenase inhibition would be more effective than a placebo in modulating the nasal epithelium gene signatures of tobacco exposure and lung cancer. We conducted a randomized, double-blinded study of low-dose aspirin plus zileuton vs. double placebo in current smokers to compare the modulating effects on nasal gene expression and arachidonic acid metabolism. In total, 63 participants took aspirin 81 mg daily plus zileuton (Zyflo CR) 600 mg BID or the placebo for 12 weeks. Nasal brushes from the baseline, end-of-intervention, and one-week post intervention were profiled via microarray. Aspirin plus zilueton had minimal effects on the modulation of the nasal or bronchial gene expression signatures of smoking, lung cancer, and COPD but favorably modulated a bronchial gene expression signature of squamous dysplasia. Aspirin plus zileuton suppressed urinary leukotriene but not prostaglandin E2, suggesting shunting through the cyclooxygenase pathway when combined with 5-lipoxygenase inhibition. Continued investigation of leukotriene inhibitors is needed to confirm these findings, understand the long-term effects on the airway epithelium, and identify the safest, optimally dosed agents.
• Garland, L. L., Guillen-Rodriguez, J., Hsu, C., Davis, L. E., Szabo, E., Husted, C., Liu, H., LeClerc, A., Alekseyev, Y., Liu, G., Bauman, J. E., Spira, A., Beane, J., Wojtowicz, M., & Chow, H. (2022). Clinical study of aspirin and zileuton on biomarkers of tobacco-related carcinogenesis in current smokers. Cancer (Basel), 14(12).
• Ho, K., Hsu, C. H., Maegawa, F., Ashouri, Y., Ho, H., Ajmal, S., & Ghaderi, I. (2022). Operative Time and 30-Day Outcomes in Bariatric Surgery: Comparison between Robotic and Laparoscopic Approach: 4-Year MBSAQIP Database Analysis. Journal of the American College of Surgeons, 235(1), 138-144.
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  The main criticism of robotic surgery is longer operative time (OT). The aim of this study was to examine the variables that determine OT, the association between OT and 30-day outcomes, and the effect of the robotic approach in bariatric surgery.
• Kazui, T., Hsu, C. H., Hamidi, M., Acharya, D., Shanmugasundaram, M., Lee, K., Chatterjee, A., & Bull, D. (2022). Five-meter walk test before transcatheter aortic valve replacement and 1-year noncardiac mortality. JTCVS open, 12, 103-117.
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  The purpose of this study is to assess whether the 5-m walk test is associated with 1-year mortality after transcatheter aortic valve replacement.
• Kazui, T., Hsu, C. H., Lick, S. D., Hypes, C. D., Natt, B., Malo, J., Mosier, J. M., & Bull, D. A. (2022). Outcomes of Venovenous Extracorporeal Membrane Oxygenation in Viral Acute Respiratory Distress Syndrome. ASAIO journal (American Society for Artificial Internal Organs : 1992), 68(11), 1399-1406.
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  Our study assessed the relationship between the duration of venovenous extracorporeal membrane oxygenation (V-V ECMO) and patient outcomes. We studied patients undergoing V-V ECMO support for acute respiratory distress syndrome (ARDS) between 2009 and 2017 who were reported to the Extracorporeal Life Support Organization registry. We evaluated survival, major bleeding, renal failure, pulmonary complications, mechanical complications, neurologic complications, infection, and duration of V-V ECMO support. Multivariable regression modeling assessed risk factors for adverse events. Of the 4,636 patients studied, the mean support duration was 12.2 ± 13.7 days. There was a progressive increase in survival after the initiation of V-VECMO, peaking at a survival rate of 73% at 10 days of support. However, a single-day increase in V-V ECMO duration was associated with increased bleeding events (odds ratio [OR] 1.038; 95% confidence interval [CI]: 1.029-1.047; p < 0.0001), renal failure (OR 1.018; 95% CI: 1.010-1.027; p < 0.0001), mechanical complications (OR 1.065; 95% CI: 1.053-1.076; p < 0.0001), pulmonary complications (OR 1.04; 95% CI: 1.03-1.05; p < 0.0001), and infection (OR 1.04; 95% CI: 1.03-1.05; p < 0.0001). V-V ECMO progressively increases survival for ARDS over the first 10 days of support. Thereafter, rising complications associated with prolonged durations of support result in a progressive decline in survival.
• Komenaka, I. K., Hsu, C. H., Ramos, G. M., Nodora, J., & Martinez, M. E. (2022). Post Treatment Mastalgia is a Common Complaint but not an Indication of Recurrence or Second Primary Breast Cancer. Clinical breast cancer.
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  Post-treatment mastalgia is a common complaint in up to 68% of patients after treatment. This symptom is worrisome to patients as many believe it is a sign of recurrence. The current study was performed to evaluate if post-treatment mastalgia is associated with a second breast cancer diagnosis.
• Komenaka, I. K., Nodora, J., Martinez, M. E., Hsu, C. H., Wong, T., Shah, A., & Caruso, D. M. (2022). Mastalgia is Not An Indication for Mammogram. Journal of the American Board of Family Medicine : JABFM.
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  METHODS: RESULTS: CONCLUSIONS:
• Morris-Wiseman, L. F., Cañez, C., Romero Arenas, M. A., Hsu, C. H., & Nfonsam, V. N. (2022). Race, Gender, and International Medical Graduates: Leadership Trends in Academic Surgical Societies. The Journal of surgical research, 270, 430-436.
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  Non-White and female surgeons are underrepresented in academic surgery faculty. We hypothesized that the leadership of major U.S. regional and national general surgery societies reflects these same racial and gender disparities. We suspected that attending a medical school or residency program with academic prestige would be more common for surgeons from underrepresented backgrounds.
• Parsons, J. K., Pinto, P. A., Pavlovich, C. P., Uchio, E., Nguyen, M. N., Kim, H. L., Gulley, J. L., Sater, H. A., Jamieson, C., Hsu, C. H., Wojtowicz, M., House, M., Schlom, J., Donahue, R. N., Dahut, W. L., Madan, R. A., Bailey, S., Centuori, S., Bauman, J. E., , Parnes, H. L., et al. (2022). A Phase 2, Double-blind, Randomized Controlled Trial of PROSTVAC in Prostate Cancer Patients on Active Surveillance. European urology focus.
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  There is an unmet clinical need for interventions to prevent disease progression in patients with localized prostate cancer on active surveillance (AS).
• Rahimi, A. O., Ho, K., Chang, M., Gasper, D., Ashouri, Y., Dearmon-Moore, D., Hsu, C. H., & Ghaderi, I. (2022). A systematic review of robotic surgery curricula using a contemporary educational framework. Surgical endoscopy.
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  There has been a rising trend in robotic surgery. Thus, there is demand for a robotic surgery curriculum (RSC) for training surgical trainees and practicing surgeons. There are limited data available about current curricular designs and the extent to which they have incorporated educational frameworks. Our aim was to study the existing robotic surgery curricula using Kern's 6-step approach in curriculum development.
• Tzou, D. T., Stern, K. L., Duty, B. D., Hsi, R. S., Canvasser, N. E., De, S., Wong, A. C., Royal, C. R., Sloss, M. L., Ziemba, J. B., Harper, J. D., Bechis, S. K., Zampini, A. M., Borofsky, M. S., Bell, J. R., Friedlander, J. I., Leavitt, D. A., Nevo, A., Patel, N. D., , Patel, R. M., et al. (2022). Heterogeneity in stone culture protocols and endourologist practice patterns: a multi-institutional survey. Urolithiasis, 51(1), 15.
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  Kidney stone cultures can be beneficial in identifying bacteria not detected in urine, yet how stone cultures are performed among endourologists, under what conditions, and by what laboratory methods remain largely unknown. Stone cultures are not addressed by current clinical guidelines. A comprehensive REDCap electronic survey sought responses from directed (n = 20) and listserv elicited (n = 108) endourologists specializing in kidney stone disease. Questions included which clinical scenarios prompt a stone culture order, how results influence post-operative antibiotics, and what microbiology lab protocols exist at each institution with respect to processing and resulting stone cultures. Logistic regression statistical analysis determined what factors were associated with performing stone cultures. Of 128 unique responses, 11% identified as female and the mean years of practicing was 16 (range 1-46). A specific 'stone culture' order was available to only 50% (64/128) of those surveyed, while 32% (41/128) reported culturing stone by placing a urine culture order. The duration of antibiotics given for a positive stone culture varied, with 4-7 days (46%) and 8-14 days (21%) the most reported. More years in practice was associated with fewer stone cultures ordered, while higher annual volume of percutaneous nephrolithotomy was associated with ordering more stone cultures (p 
• Wiseman, J. E., Hsu, C. H., & Oviedo, R. J. (2022). Three-port laparoscopic cholecystectomy is safe and efficient in the treatment of surgical biliary disease: a retrospective cohort study. Journal of robotic surgery.
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  Multiple studies have suggested that three-port laparoscopic cholecystectomy is both feasible and safe. However, this approach has failed to gain acceptance outside of clinical trials, leaving adopters of this approach vulnerable to medico-legal scrutiny. We hypothesized that the three-port approach to laparoscopic cholecystectomy (LC) is safe and efficient in experienced hands. All LC (including robotic) cases were performed on patients 18 years and older between November 2018 and March 2020. Operations utilizing three ports were compared to those performed using more than three ports. The primary outcomes measured were total operative time, conversion-to-open rate, and the complication rate. A two-sample test was performed to compare operative times, and a Fisher's exact test was used to compare conversion-to-open and complication rates. Linear regression models were used to account for the effect of confounders. 924 total LCs were performed by 30 surgeons in the study period (71 three-port, 853 four or more ports). The mean operative time was 10 min shorter in the three-port group in comparison (64.1 ± 1.4 min vs. 74.4 ± 1.8 min, p 
• Wiseman, J. E., Morris-Wiseman, L. F., Hsu, C. H., & Riall, T. S. (2022). Attending Surgeon Influences Operative Time More Than Resident Level in Laparoscopic Cholecystectomy. The Journal of surgical research, 270, 564-570.
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  Prior studies on laparoscopic cholecystectomy (LC) have concluded that resident involvement lengthens operative time without impacting outcomes. However, the lack of effect of resident level on operative duration has not been explained. We hypothesized that attending-specific influence on average operative time for LC is more pronounced than resident post-graduate year level.
• Zakaria, E. R., Yousufzai, W., Obaid, O., Asmar, S., Hsu, C. H., & Joseph, B. (2022). Cellular Cytosolic Energy Replenishment Increases Vascularized Composite Tissue Tolerance to Extended Cold Ischemia Time. Military medicine.
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  Vascularized composite allotransplantation (VCA) is a restorative surgical procedure to treat whole or partially disfiguring craniofacial or limb injuries. The routine clinical use of this VCA surgery is limited using compromised allografts from deceased donors and by the failure of the current hypothermic preservation protocols to extend the allograft's cold ischemia time beyond 4 h. We hypothesized that the active replenishment of the cellular cytosolic adenosine-5`-triphosphate (ATP) stores by means of energy delivery vehicles (ATPv) encapsulating high-energy ATP is a better strategy to improve allograft's tolerance to extended cold ischemia times.
• Zeng, J., Bergersen, A., Price, E., Callegari, M., Austin, E., Oduyemi, O., Poling, K., Hsu, C. H., Funk, J., & Twiss, C. (2022). Symptom Resolution and Recurrent Urinary Incontinence Following Removal of Painful Midurethral Slings. Urology, 159, 78-82.
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  To evaluate pain improvement and recurrent stress incontinence (SUI) following painful synthetic midurethral sling (MUS) removal.
• Zhou, W., Succar, B., Murphy, D. P., Ashouri, Y., Chou, Y. H., Hsu, C. H., Rapcsak, S., & Trouard, T. (2022). Carotid Intervention Improves Cognitive Function in Patients With Severe Atherosclerotic Carotid Disease. Annals of surgery, 276(3), 539-544.
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  Carotid revascularization procedures are effective in stroke prevention in appropriately selected patients. We sought to understand the effects of the carotid intervention on cognitive function in a well-defined cohort of prospectively recruited patients.
• Algotar, A., Hsu, C., Chow, H., Dougherty, S. T., Babiker, H. M., Marrero, D., Abraham, I. L., Kumar, R., Ligibel, J. A., Courneya, C. S., Smith, T. E., Jones, P. A., Lopes, J., Niemiro, G., Ramakumar, S., Hoy, R., Mack, C., & Thomson, C. A. (2020). Comprehensive Lifestyle Improvement Program for Prostate Cancer (CLIPP) is associated wth improvement in weight and components of metabolic syndrome in men on androgen deprivation therapy for prostate cancer. Prostate Cancer and Prostatic Diseases.
• Algotar, A., Thomson, C. A., Ligibel, J. A., Kumar, R., Babiker, H. M., Abraham, I. L., Courneya, C. S., Dougherty, S. T., Hsu, C., Marrero, D., Smith, T. E., Chow, H., Smith, T. E., Chow, H., Marrero, D., Hsu, C., Courneya, C. S., Dougherty, S. T., Abraham, I. L., , Babiker, H. M., et al. (2021). Protocol for a feasibility study and early efficacy study of a Comprehensive Lifestyle Improvement Program for Prostate Cancer-2 (CLIPP2).. Contemporary Clinical Trials Communications, 21, 100701.
• Arrington, A. K., Hsu, C. H., Schaefer, K. L., O'Grady, C. L., Khreiss, M., & Riall, T. S. (2021). Survival after Margin-Positive Resection in the Era of Modern Chemotherapy for Pancreatic Cancer: Do Patients Still Benefit?. Journal of the American College of Surgeons, 233(1), 100-109.
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  R0 resection for pancreatic cancer is considered standard of care, but is not always achieved. This study looks at R1/R2 resection outcomes compared with chemotherapy alone. Our hypothesis is that patients with margin-positive disease have better outcomes than those receiving chemotherapy alone.
• Batai, K., Trejo, M. J., Chen, Y., Kohler, L. N., Lance, P., Ellis, N. A., Cornelis, M. C., Chow, H. S., Hsu, C. H., & Jacobs, E. T. (2021). Genome-Wide Association Study of Response to Selenium Supplementation and Circulating Selenium Concentrations in Adults of European Descent. The Journal of nutrition, 151(2), 293-302.
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  Selenium (Se) is a trace element that has been linked to many health conditions. Genome-wide association studies (GWAS) have identified variants for blood and toenail Se levels, but no GWAS has been conducted to date on responses to Se supplementation.
• Chipollini, J., Pollock, G., Hsu, C. H., Batai, K., Recio-Boiles, A., & Lee, B. R. (2021). National trends and survival outcomes of penile squamous cell carcinoma based on human papillomavirus status. Cancer medicine, 10(21), 7466-7474.
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  There are no series evaluating penile squamous cell carcinoma (pSCC) based on human papillomavirus (HPV) infection. Herein, we present national registry data on clinical and survival outcomes for pSCC based on HPV status.
• Crane, T. E., Badger, T. A., Sikorskii, A., Segrin, C., Hsu, C. H., & Rosenfeld, A. G. (2021). Symptom Profiles of Latina Breast Cancer Survivors: A Latent Class Analysis. Nursing research, 69(4), 264-271.
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  Symptom research among Latinas with breast cancer is limited-especially as it relates to multiple co-occurring symptoms.
• Dauch, J., Hamidi, M., Arrington, A. K., O'Grady, C. L., Hsu, C. H., Joseph, B., Riall, T. S., & Khreiss, M. (2021). The Impact of Frailty on Patients Undergoing Liver Resection for Colorectal Liver Metastasis. Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract.
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  The aim of this study is to assess the impact of frailty on short-term outcomes after hepatectomy for colorectal liver metastasis (CRLM).
• Dennis, L. K., Hsu, C. H., & Arrington, A. K. (2021). Reduction in Standard Cancer Screening in 2020 throughout the U.S. Cancers, 13(23).
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  Cancer screening is an important way to reduce the burden of cancer. The COVID-19 pandemic created delays in screening with the potential to increase cancer disparities in the United States (U.S.). Data from the 2014-2020 Behavioral Risk Factor Surveillance System (BRFSS) survey were analyzed to estimate the percentages of adults who reported cancer screening in the last 12 months consistent with the U.S. Preventive Services Task Force (USPSTF) recommendation for cervical (ages 21-65), breast (ages 50-74), and colorectal cancer (ages 50-75) prior to the pandemic. Cancer screening percentages for 2020 (April-December excluding January-March) were compared to screening percentages for 2014-2019 to begin to look at the impact of the COVID-19 pandemic. Screening percentages for 2020 were decreased from those for 2014-2019 including several underserved racial groups. Decreases in mammography and colonoscopy or sigmoidoscopy were higher among American Indian/Alaskan Natives, Hispanics, and multiracial participants, but decreases in pap test were also highest among Hispanics, Whites, Asians, and African-Americans/Blacks. Decreases in mammograms among women ages 40-49 were also seen. As the 2020 comparison is conservative, the 2021 decreases in cancer screening are expected to be much greater and are likely to increase cancer disparities substantially.
• Dill-Macky, A., Hsu, C. H., Neumayer, L. A., Nfonsam, V. N., & Turner, A. P. (2021). The Role of Implicit Bias in Surgical Resident Evaluations. Journal of surgical education.
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  Implicit bias is a key factor preventing the advancement and retention of women and underrepresented minorities in academic surgery.
• Fahim, S. M., Hsu, C. H., Lin, F. J., Qian, J., & Chou, C. (2021). Association between prior use of anti-diabetic medication and breast cancer stage at diagnosis. Expert opinion on drug safety, 20(2), 235-243.
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  Knowledge regarding antidiabetic medication (ADM) use prior to breast cancer (BC) diagnosis remains limited. The objectives were to (1) evaluate if the prior use of ADM was associated with BC stage at diagnosis and (2) identify and compare patient characteristics among BC patients using different ADMs.
• Gutkind, J. S., Molinolo, A. A., Wu, X., Wang, Z., Nachmanson, D., Harismendy, O., Alexandrov, L. B., Wuertz, B. R., Ondrey, F. G., Laronde, D., Rock, L. D., Rosin, M., Coffey, C., Butler, V. D., Bengtson, L., Hsu, C. H., Bauman, J. E., Hewitt, S. M., Cohen, E. E., , Chow, H. S., et al. (2021). Inhibition of mTOR signaling and clinical activity of metformin in oral premalignant lesions. JCI insight, 6(17).
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  BACKGROUNDThe aberrant activation of the PI3K/mTOR signaling circuitry is one of the most frequently dysregulated signaling events in head and neck squamous cell carcinoma (HNSCC). Here, we conducted a single-arm, open-label phase IIa clinical trial in individuals with oral premalignant lesions (OPLs) to explore the potential of metformin to target PI3K/mTOR signaling for HNSCC prevention.METHODSIndividuals with OPLs, but who were otherwise healthy and without diabetes, underwent pretreatment and posttreatment clinical exam and biopsy. Participants received metformin for 12 weeks (week 1, 500 mg; week 2, 1000 mg; weeks 3-12, 2000 mg daily). Pretreatment and posttreatment biopsies, saliva, and blood were obtained for biomarker analysis, including IHC assessment of mTOR signaling and exome sequencing.RESULTSTwenty-three participants were evaluable for response. The clinical response rate (defined as a ≥50% reduction in lesion size) was 17%. Although lower than the proposed threshold for favorable clinical response, the histological response rate (improvement in histological grade) was 60%, including 17% complete responses and 43% partial responses. Logistic regression analysis revealed that when compared with never smokers, current and former smokers had statistically significantly increased histological responses (P = 0.016). Remarkably, a significant correlation existed between decreased mTOR activity (pS6 IHC staining) in the basal epithelial layers of OPLs and the histological (P = 0.04) and clinical (P = 0.01) responses.CONCLUSIONTo our knowledge this is the first phase II trial of metformin in individuals with OPLs, providing evidence that metformin administration results in encouraging histological responses and mTOR pathway modulation, thus supporting its further investigation as a chemopreventive agent.TRIAL REGISTRATIONNCT02581137FUNDINGNIH contract HHSN261201200031I, grants R01DE026644 and R01DE026870.
• Harhash, A. A., May, T. L., Hsu, C. H., Agarwal, S., Seder, D. B., Mooney, M. R., Patel, N., McPherson, J., McMullan, P., Riker, R., Soreide, E., Hirsch, K. G., Stammet, P., Dupont, A., Rubertsson, S., Friberg, H., Nielsen, N., Rab, T., & Kern, K. B. (2021). Risk Stratification Among Survivors of Cardiac Arrest Considered for Coronary Angiography. Journal of the American College of Cardiology, 77(4), 360-371.
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  The American College of Cardiology Interventional Council published consensus-based recommendations to help identify resuscitated cardiac arrest patients with unfavorable clinical features in whom invasive procedures are unlikely to improve survival.
• Harhash, A. A., May, T., Hsu, C. H., Seder, D. B., Dankiewicz, J., Agarwal, S., Patel, N., McPherson, J., Riker, R., Soreide, E., Hirsch, K. G., Stammet, P., Dupont, A., Forsberg, S., Rubertsson, S., Friberg, H., Nielsen, N., Mooney, M. R., & Kern, K. B. (2021). Incidence of cardiac interventions and associated cardiac arrest outcomes in patients with nonshockable initial rhythms and no ST elevation post resuscitation. Resuscitation, 167, 188-197.
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  Out of Hospital Cardiac arrest (OHCA) survivors with ST elevation (STE) with or without shockable rhythms often benefit from coronary angiography (CAG) and, if indicated, percutaneous coronary intervention (PCI). However, the benefits of CAG and PCI in OHCA survivors with nonshockable rhythms (PEA/asystole) and no STE are debated.
• Howard, C., Rice, P. F., Keenan, M., Dominguez-Cooks, J., Heusinkveld, J., Hsu, C. H., & Barton, J. K. (2021). Study of fallopian tube anatomy and mechanical properties to determine pressure limits for endoscopic exploration. Journal of histotechnology, 1-11.
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  Falloposcopy is the endoscopic examination of the fallopian tubes, which are challenging to access due to their deep body location, small opening from the uterus, and lumen filled with plicae. We and others have developed endoscopes that are inserted through the uterus guided by a hysteroscope into the tubal ostium. To better understand how to utilize these endoscopes either as standalone devices or in concert with everting delivery balloons, a preliminary study of anatomy and mechanical behavior was performed on porcine and human fallopian tubes. Segments of fallopian tubes from the isthmus, ampulla and infundibulum were inflated with saline either to bursting or held at sub-burst pressures with saline or a saline-filled balloon. Formalin fixed, paraffin embedded tissue sections stained with Masson's trichrome were examined for damage to the mucosa and muscularis. Porcine fallopian tubes tolerated saline pressurization at 15 psi for 1 minute without morphological damage. Balloon inflation to 15 psi caused no apparent damage to the muscle layer or rupture of the fallopian tube, but balloon movement within the tube can denude the mucosal epithelial layer. Human fallopian tubes averaged higher burst pressure values than porcine tubes. Under pressurization, the external tube diameter expanded by minimal to moderate amounts. Human and porcine tissues were similar in histological appearance. These studies suggest that moderate pressurization is acceptable but will not appreciably expand the fallopian tube diameter. The results also indicate that pigs are a reasonable model to study damage from falloscopy as seen in human tissue.
• Knobbe, K., Partha, M., Seckeler, M. D., Klewer, S., Hsu, C. H., Edgin, J., Morgan, W. J., Provencio-Dean, N., Lopez, S., Parthasarathy, S., & Combs, D. (2021). Association Between Sleep Disturbances With Neurodevelopmental Problems and Decreased Health-Related Quality of Life in Children With Fontan Circulation. Journal of the American Heart Association, 10(21), e021749.
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  Background Children with Fontan circulation are known to be at increased risk for neurodevelopmental problems and decreased health-related quality of life (HRQOL), but many factors that may contribute to this risk are unknown. Sleep disturbances may be one previously unidentified factor that contributes to this risk. Methods and Results We analyzed data from the Pediatric Heart Network Fontan cross-sectional study to evaluate associations between a parent or child report of sleep disturbance with reported neurodevelopmental concerns and HRQOL in 558 children with Fontan circulation. Parent-reported sleep disturbance was present in 11% of participants and child-reported sleep disturbance was present in 15%. Parent-reported sleep disturbance was associated with a significantly higher risk of attention problems, anxiety, depression, behavioral problems, and developmental delay (
• Maegawa, F. B., Ashouri, Y., Hamidi, M., Hsu, C. H., & Riall, T. S. (2021). Gallbladder Cancer Surgery in the United States: Lymphadenectomy Trends and Impact on Survival. The Journal of surgical research, 258, 54-63.
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  Gallbladder cancer has a poor prognosis, and surgery is the only curative treatment. However, lymphadenectomy has been underperformed. We evaluate the trend of lymphadenectomy in the United States and its impact on survival.
• Miller, J. M., Dennis, L. K., Hsu, C. H., & Harvey, E. M. (2021). Objective Assessment of Spectacle Wear in Infants and Toddlers Using a Wearable Sensor. Translational vision science & technology, 10(9), 29.
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  To assess the feasibility of using a thermal microsensor to monitor spectacle wear in infants and toddlers, to determine the inter-method reliability of two methods of estimating spectacle wear from sensor data, and to validate sensor estimates of wear.
• Pollock, G., Hsu, C. H., Batai, K., Lee, B. R., & Chipollini, J. (2021). Postoperative and Survival Outcomes After Cytoreductive Surgery in the Treatment of Metastatic Upper Tract Urothelial Carcinoma. Urology.
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  To analyze utilization and outcomes of cytoreductive surgery (CRS) after systemic chemotherapy in select patients with metastatic upper tract urothelial carcinoma (UTUC).
• Quinonez-Zanabria, E., Valencia, C. I., Asif, W., Zeng, J., Wong, A. C., Cruz, A., Chipollini, J., Lee, B. R., Gachupin, F. C., Hsu, C. H., & Batai, K. (2021). Racial and Ethnic Disparities in Preoperative Surgical Wait Time and Renal Cell Carcinoma Tumor Characteristics. Healthcare (Basel, Switzerland), 9(9).
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  Racial/ethnic minority groups have a disproportionate burden of kidney cancer. The objective of this study was to assess if race/ethnicity was associated with a longer surgical wait time (SWT) and upstaging in the pre-COVID-19 pandemic time with a special focus on Hispanic Americans (HAs) and American Indian/Alaska Natives (AIs/ANs). Medical records of renal cell carcinoma (RCC) patients who underwent nephrectomy between 2010 and 2020 were retrospectively reviewed ( = 489). Patients with a prior cancer diagnosis were excluded. SWT was defined as the date of diagnostic imaging examination to date of nephrectomy. Out of a total of 363 patients included, 34.2% were HAs and 8.3% were AIs/ANs. While 49.2% of HA patients experienced a longer SWT (≥90 days), 36.1% of Non-Hispanic White (NHW) patients experienced a longer SWT. Longer SWT had no statistically significant impact on tumor characteristics. Patients with public insurance coverage had increased odds of longer SWT (OR 2.89, 95% CI: 1.53-5.45). Public insurance coverage represented 66.1% HA and 70.0% AIs/ANs compared to 56.7% in NHWs. Compared to NHWs, HAs had higher odds for longer SWT in patients with early-stage RCC (OR, 2.38; 95% CI: 1.25-4.53). HAs (OR 2.24, 95% CI: 1.07-4.66) and AIs/ANs (OR 3.79, 95% CI: 1.32-10.88) had greater odds of upstaging compared to NHWs. While a delay in surgical care for early-stage RCC is safe in a general population, it may negatively impact high-risk populations, such as HAs who have a prolonged SWT or choose active surveillance.
• Scarritt, T., Hsu, C. H., Maegawa, F. B., Ayala, A. E., Mobily, M., & Ghaderi, I. (2021). Trends in Utilization and Perioperative Outcomes in Robotic-assisted Bariatric surgery using the MBSAQIP database: A 4-Year Analysis. Obesity surgery, 31(2), 854-861.
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  Robotic-assisted surgery has become increasingly popular across surgical subspecialties. We aimed to analyze trends in the national utilization and outcomes in bariatric surgery.
• Taylor-Piliae, R. E., Morrison, H. W., Hsu, C. P., Whitman, S., & Grandner, M. (2021). The Feasibility of Tai Chi Exercise as a Beneficial Mind-Body Intervention in a Group of Community-Dwelling Stroke Survivors with Symptoms of Depression. Evidence-based complementary and alternative medicine : eCAM, 2021, 8600443.
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  Depression is prevalent among one-third to two-thirds of acute and chronic stroke survivors. Despite the availability of pharmacotherapies and/or psychotherapies, depression persists, even for 5-10 years after stroke, reflecting limited treatment responses and/or adherence to this conventional care. Mind-body interventions are commonly used among adults to ameliorate depressive symptoms. Thus, the feasibility of Tai Chi, alongside conventional care, to manage poststroke depression was investigated using a single-group pre-post intervention design. Recruitment and retention, intervention adherence, safety, acceptability, and fidelity were assessed. Symptoms of depression, anxiety, and stress were assessed using standardized questionnaires, objective sleep was assessed via a research-grade triaxial accelerometer, and blood samples were taken to measure oxidative stress, inflammatory markers, and a neurotrophic growth factor using commercially available kits per manufacturer's protocol. Pre-post intervention changes were assessed using paired -tests. We enrolled stroke survivors ( = 11, mean age = 69.7 ± 9.3) reporting depression symptoms. After the intervention, we observed significant reductions in symptoms of depression (-5.3 ± 5.9, =0.01), anxiety (-2.2 ± 2.4, =0.01), and stress (-4.6 ± 4.8, =0.01), along with better sleep efficiency (+1.8 ± 1.8, =0.01), less wakefulness after sleep onset (-9.3 ± 11.6, =0.04), and less time awake (-9.3 ± 11.6, =0.04). There was a 36% decrease in oxidative stress (=0.02), though no significant changes in the other biomarkers were found (all values >0.05). Tai Chi exercise is a feasible intervention that can be used alongside conventional care to manage poststroke depression, aid in reducing symptoms of anxiety and stress, and improve sleep.
• Valencia, C. I., Asmar, S., Hsu, C. H., Gachupin, F. C., Wong, A. C., Chipollini, J., Lee, B. R., & Batai, K. (2021). Renal Cell Carcinoma Health Disparities in Stage and Mortality among American Indians/Alaska Natives and Hispanic Americans: Comparison of National Cancer Database and Arizona Cancer Registry Data. Cancers, 13(5).
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  Renal cell carcinoma (RCC) is one of the top 10 cancers in the United States. This study assessed RCC health disparities in American Indians/Alaska Natives (AIs/ANs) and Hispanic Americans (HAs) focusing on advanced-stage and mortality. RCC patients' data were obtained from the National Cancer Database (NCDB) and Arizona Cancer Registry (ACR). Logistic and Cox regression analyses were performed to ascertain the effect of race/ethnicity on stage and mortality, adjusting for neighborhood socioeconomic factors, rural/urban residence pattern, and other factors. In both data sets, AIs/ANs had significantly increased odds of advanced-stage RCC in the unadjusted model, but not in adjusted models. Mexican Americans had higher odds of advanced-stage compared to non-Hispanic Whites in NCDB (OR 1.22, 95% CI: 1.11-1.35) and ACR (OR 2.02, 95% CI: 1.58-2.58), even after adjusting for neighborhood characteristics. AIs/ANs did not show increased mortality risk in NCDB after adjusting for neighborhood characteristics, while the association remained significant in ACR (HR 1.33, 95% CI: 1.03-1.72). The great risk of all-cause and RCC-specific mortality was observed in U.S.-born Mexican Americans in Arizona (HR 3.21, 95% CI: 2.61-3.98 and sub-distribution HR 2.79, 95% CI: 2.05-3.81). RCC disparities in AIs/ANs is partially explained by neighborhood factors, but not in HAs.
• Batai, K., Sanderson, P. R., Hsu, C. H., Joshweseoma, L., Russell, D., Joshweseoma, L., Ojeda, J., Burhansstipanov, L., Brown, S. R., Ami, D., Saboda, K., & Harris, R. B. (2020). Factors Associated with Cancer Screening Among Hopi Men. Journal of cancer education : the official journal of the American Association for Cancer Education.
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  Cancer screening rates remain low among American Indian men, and cancer screening behaviors and barriers to cancer screening among American Indian men are not well understood. This study evaluated cancer screening behaviors in 102 Hopi men who were 50 years of age or older from the Hopi Survey of Cancer and Chronic Disease. Reported cancer screening frequencies were 15.7%, 45.1%, and 35.3% for fecal occult blood test (FOBT), colonoscopy, and prostate-specific antigen (PSA) test, respectively. Among men who reported having had a FOBT, 81.2% had the test more than 1 year ago. Among men who reported a colonoscopy, 60.8% had colonoscopy within the past 3 years. Similarly, among men who reported having had PSA, 72.3% had PSA within the past 3 years. "No one told me" was the most common answer for not undergoing FOBT (33.7%), colonoscopy (48.2%), and PSA (39.4%). Men who reported having had a PSA or digital rectal exam were three times as likely to also report having a FOBT or colonoscopy (odds ratio [OR] 3.19, 95% confidence interval [CI]: 1.21-8.46). Younger age (
• Bergersen, A., Price, E., Callegari, M., Austin, E., Oduyemi, O., Hsu, C. H., Funk, J. T., & Twiss, C. O. (2020). Pain Resolution and Recurrent Prolapse Rates Following Vaginal Mesh Removal. Urology.
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  To evaluate pain resolution and recurrent prolapse following removal of painful pelvic organ prolapse (POP) mesh.
• Combs, D., Edgin, J. O., Klewer, S., Barber, B. J., Morgan, W. J., Hsu, C. H., Abraham, I., & Parthasarathy, S. (2020). OSA and Neurocognitive Impairment in Children With Congenital Heart Disease. Chest, 158(3), 1208-1217.
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  Children with congenital heart disease (CHD) have an increased risk of neurocognitive impairment. No prior studies have evaluated the role of OSA, which is associated with neurocognitive impairment in children without CHD.
• Combs, D., Hsu, C. H., Bailey, O., Patel, S. I., Mashaqi, S., Estep, L., Provencio-Dean, N., Lopez, S., & Parthasarathy, S. (2020). Differences in sleep timing and related effects between African Americans and non-Hispanic Whites. Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine.
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  Prior studies have shown a morning chronotype for African Americans compared to non-Hispanic Whites, yet self-reported sleep timing is delayed in African Americans compared to Whites.
• Ghaderi, I., Hsu, C. H., Hines, E. M., Alabagi, A., & Galvani, C. C. (2020). The Impact of Navigation Grid Overlay on Performance of Camera Assistants during Laparoscopic Abdominal Procedures: A Randomized Controlled Trial. Journal of surgical education.
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  Camera assistance is important for proper visualization of the operative field in laparoscopic surgery. Navigation grid (NG) has been designed to help the camera assistants focus the camera on the target operative field. This is a randomized, controlled trial to study the effect of the NG on performance of camera assistants.
• Habib, S., Yarlagadda, S., Carreon, T. A., Schader, L. M., & Hsu, C. H. (2020). Fungal Infection in Acutely Decompensated Cirrhosis Patients: Value of Model for End-Stage Liver Disease Score. Gastroenterology research, 13(5), 199-207.
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  Infection in acute-on-chronic liver failure (ACLF) patients is known to cause higher mortality. The current approach is to culture all patient samples. There are no published data evaluating fungal infections in acutely decompensated patients. In this study, we aim to identify clinical factors predictive of infections within ACLF patients and assess workup compliance within 24 h of hospital admission.
• Haddad, D. J., Jasty, V. S., Mohan, B., Hsu, C. H., Chong, C. C., Zhou, W., & Tan, T. W. (2020). Comparing Outcomes of Upper Extremity Brachiobasilic Arteriovenous Fistulas and Arteriovenous Grafts: A Systematic Review and Meta-Analysis. The journal of vascular access, 1129729820970789.
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  It is unclear what the optimal upper extremity hemodialysis access is for patients without a suitable cephalic vein for arteriovenous fistulas (AVFs). The objective of this systematic review and meta-analysis was to compare the outcomes for upper extremity transposed brachiobasilic AVFs (BBAVFs) and prosthetic arteriovenous grafts (AVGs).
• Harb-De la Rosa, A., Garcia-Castaneda, J., Hsu, C. H., Zeng, J., Batai, K., Lee, B. R., & Chipollini, J. (2020). Perioperative outcomes of open vs. robotic radical cystectomy: a nationwide comparative analysis (2008-2014). Central European journal of urology, 73(4), 427-431.
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  Radical cystectomy (RC) is a complex procedure with high perioperative morbidity. In an effort to reduce complications, robotic-assisted RC (RARC) has been adopted as a minimally invasive alternative to the open approach (ORC). Herein, we examine post-operative outcomes of the two surgical approaches in the United States (US) using a large all-payer database.
• Hsu, C. H., He, Y., Hu, C., & Zhou, W. (2020). A multiple imputation-based sensitivity analysis approach for data subject to missing not at random. Statistics in medicine, 39(26), 3756-3771.
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  Missingness mechanism is in theory unverifiable based only on observed data. If there is a suspicion of missing not at random, researchers often perform a sensitivity analysis to evaluate the impact of various missingness mechanisms. In general, sensitivity analysis approaches require a full specification of the relationship between missing values and missingness probabilities. Such relationship can be specified based on a selection model, a pattern-mixture model or a shared parameter model. Under the selection modeling framework, we propose a sensitivity analysis approach using a nonparametric multiple imputation strategy. The proposed approach only requires specifying the correlation coefficient between missing values and selection (response) probabilities under a selection model. The correlation coefficient is a standardized measure and can be used as a natural sensitivity analysis parameter. The sensitivity analysis involves multiple imputations of missing values, yet the sensitivity parameter is only used to select imputing/donor sets. Hence, the proposed approach might be more robust against misspecifications of the sensitivity parameter. For illustration, the proposed approach is applied to incomplete measurements of level of preoperative Hemoglobin A1c, for patients who had high-grade carotid artery stenosisa and were scheduled for surgery. A simulation study is conducted to evaluate the performance of the proposed approach.
• Kazui, T., Lick, S. D., Hsu, C. H., & Bull, D. A. (2020). Short-Term Risk of Bilateral Internal Mammary Artery Grafting in Diabetic Patients. Seminars in thoracic and cardiovascular surgery.
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  This study compares the morbidity and mortality at 30 days following the use of bilateral internal mammary arteries (BIMA) vs a single internal mammary artery (SIMA) at the time of coronary artery bypass grafting (CABG) in patients with a preoperative HbA1c. Patients undergoing CABG from January 2008 to December 2016 reported to the Society of Thoracic Surgeons database were retrospectively reviewed. The patients were divided into 2 groups: use of BIMA or use of SIMA and propensity matched. To assess the effect of preoperative HbA1c, both groups were further divided into 5 subgroups: patients without diabetes mellitus (DM), or patients with DM and a preoperative HbA1c level in one of four groups (< 7%, 7-9%, 9-11%, or >11%). The postoperative outcomes in both the BIMA and SIMA groups were compared. There were 700,504 and 28,115 patients with measured preoperative HbA1c levels in the SIMA and BIMA groups, respectively. Propensity score matching identified 23,635 comparable patients in each group for analysis. There was no difference in postoperative mortality between the BIMA and SIMA groups (1.3% vs 1.2%). The incidences of sternal wound infection (SWI) in patients undergoing placement of BIMA vs SIMA were: 0.8% vs 0.4% with no DM (P < 0.0001), 1.9% vs 1.0% with HbA1c < 7% (P < 0.001), 2.4% vs 1.2% with HbA1c 7-9% (P < 0.001), 2.8% vs 1.4% with HbA1c 9-11% (P = 0.02), 4.1% vs 1.5% with HbA1c > 11% (P = 0.01). Based on the incidence of SWI, BIMA is a reasonable approach with an HbA1c
• Kern, K. B., Radsel, P., Jentzer, J. C., Seder, D. B., Lee, K. S., Lotun, K., Janardhanan, R., Stub, D., Hsu, C. H., & Noc, M. (2020). Randomized Pilot Clinical Trial of Early Coronary Angiography Versus No Early Coronary Angiography After Cardiac Arrest Without ST-Segment Elevation: The PEARL Study. Circulation, 142(21), 2002-2012.
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  The benefit of emergency coronary angiography after resuscitation from out-of-hospital cardiac arrest is uncertain for patients without ST-segment elevation. The aim of this randomized trial was to evaluate the efficacy and safety of early coronary angiography and to determine the prevalence of acute coronary occlusion in resuscitated patients with out-of-hospital cardiac arrest without ST-segment elevation.
• Kraemer, C., Nisson, P., Wheeler, G., Guzmán Pérez-Carrillo, G. J., Bernstein, A., Hsu, C. H., Bock, D., Trouard, T., & Zhou, W. (2020). Patient risk factors associated with embolic stroke volumes after revascularization. Journal of vascular surgery, 72(6), 2061-2068.
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  Previous research has shown that subclinical, microembolic infarcts result in long-term cognitive changes. Whereas both carotid endarterectomy (CEA) and carotid artery stenting (CAS) have potential for microembolic events, CAS has been shown to have a larger volume of infarct. We have previously shown that large-volume infarction is associated with long-term memory deterioration. The purpose of this study was to identify independent risk factors that trend toward higher embolic volumes in both procedures.
• Thomson, C. A., Mack, C., Hoy, R., Ramakumar, S., Niemiro, G., Lopes, J., Jones, P. A., Smith, T. E., Courneya, C. S., Ligibel, J. A., Kumar, R., Abraham, I. L., Marrero, D., Babiker, H. M., Dougherty, S. T., Chow, H., Hsu, C., & Algotar, A. (2020). Comprehensive Lifestyle Improvement Program for Prostate Cancer (CLIPP) is associated wth improvement in weight and components of metabolic syndrome in men on androgen deprivation therapy for prostate cancer. Prostate Cancer and Prostatic Diseases.
• Algotar, A., Hsu, C. H., Sherry Chow, H. H., Dougherty, S., Babiker, H. M., Marrero, D., Abraham, I., Kumar, R., Ligibel, J., Courneya, K. S., & Thomson, C. (2019). Comprehensive Lifestyle Improvement Program for Prostate Cancer (CLIPP): Protocol for a Feasibility and Exploratory Efficacy Study in Men on Androgen Deprivation Therapy. JMIR research protocols, 8(2), e12579.
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  Androgen deprivation therapy (ADT) for prostate cancer is associated with adverse cardiometabolic effects such as reduced libido, hot flashes, metabolic syndrome, diabetes, myocardial infarction, and stroke. This reduces quality of life and potentially increases mortality. Several large clinical trials have demonstrated improvements in cardiometabolic risk with comprehensive multimodality lifestyle modification. However, there is a lack of data for such interventions in men on ADT for prostate cancer, and existing studies have used non-standardized interventions or lacked data on metabolic risk factors.
• Chen, H., Sells, E., Pandey, R., Abril, E. R., Hsu, C. H., Krouse, R. S., Nagle, R. B., Pampalakis, G., Sotiropoulou, G., & Ignatenko, N. A. (2019). Kallikrein 6 protease advances colon tumorigenesis induction of the high mobility group A2 protein. Oncotarget, 10(58), 6062-6078.
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  Kallikrein-related peptidase 6 (KLK6) overexpression is commonly observed in primary tumors of colorectal cancer (CRC) patients and has been associated with tumor aggressiveness, metastasis, and poor prognosis. We previously established a unique contribution of KLK6 in colon cancer metastasis via a specific network of microRNAs and mRNAs. Here we evaluated the cellular functions of KLK6 protease in Caco-2 colon adenocarcinoma cell line after introduction of the enzymatically active or inactive form of the enzyme. We found that proteolytically active KLK6 increased Caco-2 cells invasiveness and decreased the animal survival in the orthotopic colon cancer model. The active KLK6 induced phosphorylation of SMAD 2/3 proteins leading to the altered expression of the epithelial-mesenchymal transition (EMT) markers. KLK6 overexpression also induced the RNA-binding protein LIN28B and high-mobility group AT-hook 2 (HMGA2) transcription factor, two essential regulators of cell invasion and metastasis. In the CRC patients, KLK6 protein levels were elevated in the non-cancerous distant and adjacent tissues, compared to their paired tumor tissues ( < 0.0001 and = 0.0157, respectively). Patients with mutant K-RAS tumors had significantly higher level of KLK6 protein in the luminal surface of non-cancerous distant tissue, compared to the corresponding tissues of the patients with K-RAS wild type tumors ( ≤ 0.05). Furthermore, KLK6 and HMGA2 immunohistochemistry (IHC) scores in patients' tumors and paired adjacent tissues positively correlated (Spearman correlation < 0.01 and = 0.03, respectively). These findings demonstrate the critical function of the KLK6 enzyme in colon cancer progression and its contribution to the signaling network in colon cancer.
• Combs, D., Goodwin III, J. L., Quan, S. F., Morgan, W. J., Hsu, C., Edgin, J. O., & Parthasarathy, S. (2019). Mother knows best? Comparing child and parent report of sleep parameters with polysomnography. Journal of Clinical Sleep Medicine.
• Combs, D., Goodwin, J. L., Quan, S. F., Morgan, W. J., Hsu, C. H., Edgin, J. O., & Parthasarathy, S. (2019). Mother Knows Best? Comparing Child Report and Parent Report of Sleep Parameters With Polysomnography. Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine, 15(1), 111-117.
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  Parent report or child report is commonly used to obtain information on sleep in children. Data are lacking comparing the validity of parent-reported versus child-reported sleep parameters.
• Crane, T. E., Badger, T. A., Sikorskii, A., Segrin, C., Hsu, C. H., & Rosenfeld, A. G. (2019). Trajectories of Depression and Anxiety in Latina Breast Cancer Survivors. Oncology nursing forum, 46(2), 217-227.
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  To identify subgroups of Latina breast cancer survivors with unique trajectories of depression and anxiety and examine predictors associated with these subgroups.
• Davis, J., Cocco, D., Matz, S., Hsu, C. H., Brown, M. J., Lee, J., Bouton, M. E., Caruso, D. M., & Komenaka, I. K. (2019). Re-evaluating if observation continues to be the best management of idiopathic granulomatous mastitis. Surgery, 166(6), 1176-1180.
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  The presentation of idiopathic granulomatous mastitis can mimic breast cancer. Therefore, awareness of the condition is important for surgeons. The current series is the largest in a US population.
• Garland, L. L., Guillen-Rodriguez, J., Hsu, C. H., Yozwiak, M., Zhang, H. H., Alberts, D. S., Davis, L. E., Szabo, E., Merenstein, C., Lel, J., Zhang, X., Liu, H., Liu, G., Spira, A. E., Beane, J. E., Wojtowicz, M., & Chow, H. S. (2019). Effect of Intermittent Versus Continuous Low-Dose Aspirin on Nasal Epithelium Gene Expression in Current Smokers: A Randomized, Double-Blinded Trial. Cancer prevention research (Philadelphia, Pa.), 12(11), 809-820.
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  A chemopreventive effect of aspirin (ASA) on lung cancer risk is supported by epidemiologic and preclinical studies. We conducted a randomized, double-blinded study in current heavy smokers to compare modulating effects of intermittent versus continuous low-dose ASA on nasal epithelium gene expression and arachidonic acid (ARA) metabolism. Fifty-four participants were randomized to intermittent (ASA 81 mg daily for one week/placebo for one week) or continuous (ASA 81 mg daily) for 12 weeks. Low-dose ASA suppressed urinary prostaglandin E2 metabolite (PGEM; change of -4.55 ± 11.52 from baseline 15.44 ± 13.79 ng/mg creatinine for arms combined, = 0.02), a surrogate of COX-mediated ARA metabolism, but had minimal effects on nasal gene expression of nasal or bronchial gene-expression signatures associated with smoking, lung cancer, and chronic obstructive pulmonary disease. Suppression of urinary PGEM correlated with favorable changes in a smoking-associated gene signature ( < 0.01). Gene set enrichment analysis (GSEA) showed that ASA intervention led to 1,079 enriched gene sets from the Canonical Pathways within the Molecular Signatures Database. In conclusion, low-dose ASA had minimal effects on known carcinogenesis gene signatures in nasal epithelium of current smokers but results in wide-ranging genomic changes in the nasal epithelium, demonstrating utility of nasal brushings as a surrogate to measure gene-expression responses to chemoprevention. PGEM may serve as a marker for smoking-associated gene-expression changes and systemic inflammation. Future studies should focus on NSAIDs or agent combinations with broader inhibition of pro-inflammatory ARA metabolism to shift gene signatures in an anti-carcinogenic direction.
• Gondal, A. B., Hsu, C. H., Khoubyari, R., & Ghaderi, I. (2019). Development of a bariatric surgery specific risk assessment tool for perioperative myocardial infarction. Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery.
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  Perioperative myocardial infarction (PMI) is a feared complication after surgery. Bariatric surgery, due to its intraabdominal nature, is traditionally considered an intermediate risk procedure. However, there are limited data on MI rates and its predictors in patients undergoing bariatric surgery.
• Gondal, A. B., Hsu, C. H., Zeeshan, M., Hamidi, M., Joseph, B., & Ghaderi, I. (2019). A frailty index and the impact of frailty on postoperative outcomes in older patients after bariatric surgery. Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery, 15(9), 1582-1588.
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  The prognostic value of frailty in the elderly surgical population has been well studied across surgical specialties. However, no studies have yet explored the effects of frailty across the full spectrum of adverse events after bariatric surgery.
• Harhash, A. A., Huang, J. J., Howe, C. L., Hsu, C. H., & Kern, K. B. (2019). Coronary angiography and percutaneous coronary intervention in cardiac arrest survivors with non-shockable rhythms and no STEMI: A systematic review. Resuscitation, 143, 106-113.
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  Emergency coronary angiography (CAG) and percutaneous coronary intervention (PCI) are thought to improve outcomes in cardiac arrest (CA) survivors with ST segment elevation myocardial infarction (STEMI) and those without STEMI but likely cardiac etiology (shockable rhythms). However, the role of CAG ± PCI in OHCA survivors with non-shockable rhythms and no STEMI post-resuscitation remains unclear.
• Jacobs, E. T., Lance, P., Mandarino, L. J., Ellis, N. A., Chow, H. S., Foote, J., Martinez, J. A., Hsu, C. P., Batai, K., Saboda, K., & Thompson, P. A. (2019). Selenium supplementation and insulin resistance in a randomized, clinical trial. BMJ open diabetes research & care, 7(1), e000613.
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  While controversial, observational and randomized clinical trial data implicate the micronutrient selenium (Se) in the development of type 2 diabetes (T2D). The aim of this study was to test the hypothesis that Se supplementation adversely affects pancreatic β-cell function and insulin sensitivity.
• Kim, S., Bull, D. A., Hsu, C. H., & Hsu, C. C. (2019). The Role of Adjuvant Therapy in Advanced Thymic Carcinoma: A National Cancer Database Analysis. The Annals of thoracic surgery.
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  There is area of controversy and variability in recommendation for role of adjuvant therapy after R0 resection of a Masaoka stage IIB and III thymic carcinoma. This study investigated the role of adjuvant therapy in patients who had complete surgical resection for thymic carcinoma.
• Lotun, K., Truong, H. T., Cha, K. C., Alsakka, H., Gianotto-Oliveira, R., Smith, N., Rao, P., Bien, T., Chatelain, S., Kern, M. C., Hsu, C. H., Zuercher, M., & Kern, K. B. (2019). Cardiac Arrest in the Cardiac Catheterization Laboratory: Combining Mechanical Chest Compressions and Percutaneous LV Assistance. JACC. Cardiovascular interventions, 12(18), 1840-1849.
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  The aim of this study was to evaluate the optimal treatment approach for cardiac arrest (CA) occurring in the cardiac catheterization laboratory.
• Lwin, A. A., Hsu, C. H., & Chipollini, J. (2019). Urothelial Carcinoma of the Renal Pelvis and Ureter: Does Location Make a Difference?. Clinical genitourinary cancer.
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  There is a paucity of data on outcomes of upper tract urothelial carcinoma (UTUC) arising from the renal pelvis (RPUC) versus UTUC arising from the ureter (UUC). The published literature is conflicting, and there is no consensus on patient prognosis based on disease location. The aim of this study is to compare clinical and survival outcomes based on location of primary tumor using a large national registry.
• Sabat, J., Bock, D., Hsu, C. H., Tan, T. W., Weinkauf, C., Trouard, T., Perez-Carrillo, G. G., & Zhou, W. (2019). Risk factors associated with microembolization after carotid intervention. Journal of vascular surgery.
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  Microembolization after carotid artery stenting (CAS) and carotid endarterectomy (CEA) has been documented and may confer risk for neurocognitive impairment. Patients undergoing stenting are known to be at higher risk for microembolization. In this prospective cohort study, we compare the microembolization rates for patients undergoing CAS and CEA and perioperative characteristics that may be associated with microembolization.
• Sabat, J., Hsu, C. H., Samra, N., Chu, Q., Weinkauf, C., Goshima, K., Zhou, W., & Tan, T. W. (2019). Length of Stay and ICU Stay Are Increased With Repair of Traumatic Superior Mesenteric Vein Injury. The Journal of surgical research, 242, 94-99.
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  Traumatic superior mesenteric vein (SMV) injury is rare, and the ideal treatment is controversial. We compared the outcomes of ligation versus repair of SMV injury using the National Trauma Databank.
• Taylor-Piliae, R. E., Hsu, C., Toosizadeh, N., & Mohler, M. J. (2019). A Novel Dual-Task Balance Challenge to Prevent Falls in Older Adults: A Randomized Pilot Study. Journal of Geriatric Medicine and Gerontology, 5, 075. doi:Doi:10.23937/2469-5858/1510075
• VanderVelde, J., Walters, J. W., Hsu, C. H., Ferguson, E. M., Lee, J., Caruso, D. M., & Komenaka, I. K. (2019). Awareness of residents' technical ability can affect margin status in breast conserving operations. Breast cancer research and treatment, 177(3), 561-568.
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  The current study was performed to determine if awareness of the potential affect of residents could affect margin status.
• Vij, P., Chen, D., Hsu, C. H., Pandit, V., Omesiete, P., Elquza, E., Scott, A., Cruz, A., & Nfonsam, V. (2019). Racial disparities in the incidence of colon cancer in patients with inflammatory bowel disease. Journal of gastrointestinal oncology, 10(2), 254-258.
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  Studies have explored the relationship between inflammatory bowel disease (IBD) [ulcerative colitis (UC) and Crohn's disease (CD)] and colon cancer (CC). Additionally, racial disparities in the incidence of CC is well known. However, the impact of racial disparity in IBD patients who develop CC remains unclear. The aim of this study is to address the knowledge gap in this particular group of patients.
• Zeng, Y., Moscicki, A. B., Sahasrabuddhe, V. V., Garcia, F., Woo, H., Hsu, C. H., Szabo, E., Dimond, E., Vanzzini, S., Mondragon, A., Butler, V., DeRose, H., & Chow, H. S. (2019). A prospective, single-arm, open-label, non-randomized, phase IIa trial of a nonavalent prophylactic HPV vaccine to assess immunogenicity of a prime and deferred-booster dosing schedule among 9-11 year-old girls and boys - clinical protocol. BMC cancer, 19(1), 290.
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  Human papillomavirus (HPV) vaccines are indicated for the prevention of cancers and genital warts caused by vaccine-covered HPV types. Although the standard regimen requires a two or three-dose vaccine series, there is emerging data suggesting that a single dose of the bivalent or quadrivalent HPV vaccine generates persistently positive antibody titers. No similar data is yet available for the nonavalent HPV vaccine, currently the only HPV vaccine available in the United States. The overall objective of our study is to assess the stability and kinetics of antibody titers for 24 months following a single dose of the nonavalent HPV vaccine among preteen girls and boys.
• Algotar, A., Hsu, C., Abraham, I. L., Marrero, D., Thomson, C. A., & Chow, H. (2019). Comprehensive lifestyle improvement program for prostate cancer (CLIPP): Protocol for a feasibility and exploratory efficacy study in men on androgen deprivation therapy. Journal of Medical Internet Research.
• Cosgrove, R. H., Basken, R. L., Smith, R. G., Hsu, C. H., Kazui, T., Martinez, B. K., Burt, R. W., Crawford, E. S., Lick, S. D., & Khalpey, Z. (2018). Anticoagulant Bridge Comparison in Mechanical Circulatory Support Patients. ASAIO journal (American Society for Artificial Internal Organs : 1992).
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  Maintaining mechanical circulatory support (MCS) device patients in a specified therapeutic range for anticoagulation remains challenging. Subtherapeutic international normalized ratios (INRs) occur frequently while on warfarin therapy. An effective anticoagulant bridge strategy may improve the care of these patients. This retrospective review of MCS patients with subtherapeutic INRs compared an intravenous unfractionated heparin (UFH) strategy with a subcutaneous enoxaparin or fondaparinux strategy. Native thromboelastography (n-TEG) was used to evaluate anticoagulant effect with coagulation index (CI) as the primary outcome measure. Enoxaparin 0.5 mg/kg SC q12hrs or fondaparinux 2.5-5 mg SC daily were compared with an initial UFH rate of 5 units/kg/hr and titrated to stated n-TEG goal range. The anticoagulant groups UFH, enoxaparin, and fondaparinux were found to be statistically similar with regard to frequency in n-TEG goal range, above range (hypercoagulability), or below range (hypocoagulability). Clinical outcomes were similar among groups with three gastrointestinal bleeds in UFH, one in enoxaparin, and one in fondaparinux groups. Device thrombosis occurred in one UFH patient, while UFH and fondaparinux groups had one ischemic cerebrovascular accident event each. These strategies provided comparable n-TEG results and clinical outcomes when compared with intravenous UFH. Low-dose enoxaparin or fondaparinux may provide an alternative anticoagulant bridging option in MCS patients presenting with subtherapeutic INR.
• Gondal, A. B., Hsu, C. H., Serrot, F., Rodriguez-Restrepo, A., Hurbon, A. N., Galvani, C., & Ghaderi, I. (2018). Enhanced Recovery in Bariatric Surgery: A Study of Short-Term Outcomes and Compliance. Obesity surgery.
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  The implementation of Enhanced Recovery After Surgery (ERAS) guidelines has been widely studied among various surgical specialties. We aimed at comparing the perioperative outcomes and compliance with ERAS protocol in bariatric surgery at our center.
• Habib, S., Patel, N., Yarlagadda, S., Hsu, C. H., Patel, S., Schader, L., Walker, C., & Twesigye, I. (2018). Safety and efficacy of antibiotics among acutely decompensated cirrhosis patients. Journal of gastroenterology and hepatology, 33(11), 1882-1888.
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  Infection is a leading precipitant of acute-on-chronic liver failure. This study aims to determine the safety and efficacy of antibiotics within acute-on-chronic liver failure.
• Hsu, C. H., & Yu, M. (2018). Cox regression analysis with missing covariates via nonparametric multiple imputation. Statistical methods in medical research, 962280218772592.
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  We consider the situation of estimating Cox regression in which some covariates are subject to missing, and there exists additional information (including observed event time, censoring indicator and fully observed covariates) which may be predictive of the missing covariates. We propose to use two working regression models: one for predicting the missing covariates and the other for predicting the missing probabilities. For each missing covariate observation, these two working models are used to define a nearest neighbor imputing set. This set is then used to non-parametrically impute covariate values for the missing observation. Upon the completion of imputation, Cox regression is performed on the multiply imputed datasets to estimate the regression coefficients. In a simulation study, we compare the nonparametric multiple imputation approach with the augmented inverse probability weighted (AIPW) method, which directly incorporates the two working models into estimation of Cox regression, and the predictive mean matching imputation (PMM) method. We show that all approaches can reduce bias due to non-ignorable missing mechanism. The proposed nonparametric imputation method is robust to mis-specification of either one of the two working models and robust to mis-specification of the link function of the two working models. In contrast, the PMM method is sensitive to misspecification of the covariates included in imputation. The AIPW method is sensitive to the selection probability. We apply the approaches to a breast cancer dataset from Surveillance, Epidemiology and End Results (SEER) Program.
• Kohler, L. N., Florea, A., Kelley, C. P., Chow, S., Hsu, P., Batai, K., Saboda, K., Lance, P., & Jacobs, E. T. (2018). Higher Plasma Selenium Concentrations Are Associated with Increased Odds of Prevalent Type 2 Diabetes. The Journal of nutrition, 148(8), 1333-1340.
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  Selenium, an essential trace element, has been investigated as a potential cancer prevention agent. However, several studies have indicated that selenium supplementation may be associated with an increased risk of type 2 diabetes (T2D), although an equivocal relation of this nature requires confirmation.
• Kohler, L. N., Foote, J., Kelley, C. P., Florea, A., Shelly, C., Chow, H. S., Hsu, P., Batai, K., Ellis, N., Saboda, K., Lance, P., & Jacobs, E. T. (2018). Selenium and Type 2 Diabetes: Systematic Review. Nutrients, 10(12).
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  Several studies have investigated the potential role of selenium (Se) in the development of type 2 diabetes (T2D) with disparate findings. We conducted a systematic review and meta-analysis to synthesize the evidence of any association between Se and T2D. PubMed, Embase, and Scopus were searched following the Preferred Reporting Items for Systematic Reviews and Meta-analysis Approach (PRISMA). Sixteen studies from 15 papers met inclusion criteria defined for this review. Of the 13 observational studies included, 8 demonstrated a statistically significant positive association between concentrations of Se and odds for T2D, with odds ratios (95% confidence intervals) ranging from 1.52 (1.01⁻2.28) to 7.64 (3.34⁻17.46), and a summary odds ratio (OR) (95% confidence interval (CI)) of 2.03 (1.51⁻2.72). In contrast, among randomized clinical trials (RCTs) of Se, a higher risk of T2D was not observed for those who received Se compared to a placebo (OR = 1.18, 95% CI 0.95⁻1.47). Taken together, the results for the relationship between Se and T2D differ between observational studies and randomized clinical trials (RCTs). It remains unclear whether these differences are the result of uncontrolled confounding in the observational studies, or whether there is a modest effect of Se on the risk for T2D that may vary by duration of exposure. Further investigations on the effects of Se on glucose metabolism are needed.
• Korovin, L. N., Farrell, T. M., Hsu, C. H., White, M., & Ghaderi, I. (2018). Surgeons' expertise during critical event in laparoscopic cholecystectomy: An expert-novice comparison using protocol analysis. American journal of surgery.
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  The purpose of this study was to examine differences in thought processes between novice and experienced surgeons when they were presented with a critical situation during laparoscopic cholecystectomy.
• Lane, R. D., Reis, H. T., Hsu, C. H., Kern, K. B., Couderc, J. P., Moss, A. J., & Zareba, W. (2018). Abnormal Repolarization Duration during Everyday Emotional Arousal in Long QT Syndrome and Coronary Artery Disease. The American journal of medicine.
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  Rare high arousal negative emotions are known triggers of sudden death in individuals with preexisting heart disease. Whether everyday fluctuations in emotional arousal influence arrhythmia risk is unknown.
• Low, S. W., Lee, J. Z., Desai, H., Hsu, C. H., Sam, A. R., & Knepler, J. L. (2018). Endobronchial Valves Therapy for Advanced Emphysema: A Meta-Analysis of Randomized Trials. Journal of bronchology & interventional pulmonology.
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  Trials suggest that bronchoscopic lung volume reduction (BLVR) with endobronchial valve (EBV) implantation may produce similar effects as lung volume reduction surgery, by inducing atelectasis and reducing hyperinflation through a minimally invasive procedure. This study sought to investigate the efficacy and safety of BLVR with EBV for advanced emphysema.
• Parthasarathy, S., Edgin, J. O., Hsu, C., Morgan, W. J., Quan, S. F., Goodwin III, J. L., & Combs, D. (2018). Mother knows best? Comparing child and parent report of sleep parameters with polysomnography. Journal of Clinical Sleep Medicine.
• Raichlen, D. A., Klimentidis, Y. C., Hsu, C. H., & Alexander, G. E. (2018). Fractal complexity of daily physical activity patterns differs with age over the lifespan and is associated with mortality in older adults. The journals of gerontology. Series A, Biological sciences and medical sciences.
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  Accelerometers are included in a wide range of devices that monitor and track physical activity for health-related applications. However, the clinical utility of the information embedded in their rich time-series data has been greatly understudied and has yet to be fully realized. Here, we examine the potential for fractal complexity of actigraphy data to serve as a clinical biomarker for mortality risk.
• Rice, P. F., Ehrichs, K. G., Jones, M. S., Chen, H., Hsu, C. H., Abril, E. R., Nagle, R. B., Besselsen, D. G., Barton, J. K., & Ignatenko, N. A. (2018). Does MutatedOncogene Attenuate the Effect of Sulindac in Colon Cancer Chemoprevention?. Cancer prevention research (Philadelphia, Pa.), 11(1), 16-26.
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  The NSAID sulindac has been successfully used alone or in combination with other agents to suppress colon tumorigenesis in patients with genetic predisposition and also showed its efficacy in prevention of sporadic colon adenomas. At the same time, some experimental and clinical reports suggest that a mutantoncogene may negate sulindac antitumor efficacy. To directly assess sulindac activity at suppressing premalignant lesions carrying K-RAS mutation, we utilized a novel mouse model with an inducible colon-specific expression of the mutantoncogene (). Tumor development and treatment effects were monitored by minimally invasive endoscopic Optical coherence tomography. Expression of the mutantallele accelerated azoxymethane (AOM)-induced colon carcinogenesis in C57BL/6 mice, a strain otherwise resistant to this carcinogen. Sulindac completely prevented AOM-induced tumor formation inwild-type (wt) animals. In-mutant mice, a 38% reduction in tumor number, an 83% reduction in tumor volume (≤ 0.01) and an increase in the number of adenoma-free mice (= 0.04) were observed. The partial response ofanimals to sulindac treatment was evident by the decrease in mucosal thickness (< 0.01) and delay in progression of the precancerous aberrant crypt foci to adenomas. Molecular analyses showed significant induction in cyclooxygenase 2 (COX-2), cleaved caspase-3 (CC3), and Ki-67 expression by AOM, but not sulindac treatment, in all genotypes. Our data underscore the importance of screening formutations in individuals with colon polyps to provide more personalized interventions targeting mutantsignaling pathways..
• Sabat, J., Hsu, C. H., Chu, Q., & Tan, T. W. (2018). The mortality for surgical repair is similar to ligation in patients with traumatic portal vein injury. Journal of vascular surgery. Venous and lymphatic disorders.
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  Portal vein injury is uncommon, and the optimal treatment is controversial. We compared the outcomes of ligation vs repair of portal injury using the National Trauma Data Bank.
• Eubanks, R. D., Nodora, J. N., Hsu, C. H., Bagley, M., Bouton, M. E., Martinez, M. E., & Komenaka, I. K. (2017). The Feasibility and Time Required for Routine Health Literacy Assessment in Surgical Practice and Effect on Patient Satisfaction. The American surgeon, 83(5), 458-464.
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  Patients with limited health literacy (HL) have higher likelihood of problems with communication and may decrease patient satisfaction. This study was performed to determine the time required for routine HL assessment and its effect on patient satisfaction. Retrospective review over four years of consecutive patients who attended a breast clinic who underwent HL assessment as part of routine care. A total of 3126 consecutive patients from 2010 to 2014. Of the 3126 patients (96.9%), 3030 of were capable of undergoing HL assessment. No patients refused assessment, but one patient was inadvertently missed [3029 of 3030 patients (99.9%)]. The average age was 45 years and 10.5 years of education. The average time required was 1:57 minutes. Only 19 per cent of patients had adequate HL. Per each 1000 patients the time decreased (2:07, 1:58, 1:47; P < 0.001). Newest Vital Sign score did not change with time (1.6, 1.8, 1.7; P = NS). Patient satisfaction ratings increased during each subsequent year of HL assessments (P = 0.002). Routine HL assessment is feasible in surgical practice. HL assessment allows for identification of patients at risk for miscommunication. Implementation of communication strategies as described on the AMA website can improve patient-clinician communication and improve patient satisfaction.
• Fiero, M. H., Hsu, C. H., & Bell, M. L. (2017). A pattern-mixture model approach for handling missing continuous outcome data in longitudinal cluster randomized trials. Statistics in medicine, 36(26), 4094-4105.
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  We extend the pattern-mixture approach to handle missing continuous outcome data in longitudinal cluster randomized trials, which randomize groups of individuals to treatment arms, rather than the individuals themselves. Individuals who drop out at the same time point are grouped into the same dropout pattern. We approach extrapolation of the pattern-mixture model by applying multilevel multiple imputation, which imputes missing values while appropriately accounting for the hierarchical data structure found in cluster randomized trials. To assess parameters of interest under various missing data assumptions, imputed values are multiplied by a sensitivity parameter, k, which increases or decreases imputed values. Using simulated data, we show that estimates of parameters of interest can vary widely under differing missing data assumptions. We conduct a sensitivity analysis using real data from a cluster randomized trial by increasing k until the treatment effect inference changes. By performing a sensitivity analysis for missing data, researchers can assess whether certain missing data assumptions are reasonable for their cluster randomized trial.
• Habib, S., Khan, K., Hsu, C. H., Meister, E., Rana, A., & Boyer, T. (2017). Differential Simultaneous Liver and Kidney Transplant Benefit Based on Severity of Liver Damage at the Time of Transplantation. Gastroenterology research, 10(2), 106-115.
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  We evaluated the concept of whether liver failure patients with a superimposed kidney injury receiving a simultaneous liver and kidney transplant (SLKT) have similar outcomes compared to patients with liver failure without a kidney injury receiving a liver transplantation (LT) alone.
• Knight, E. P., Shea, K., Rosenfeld, A. G., Schmiege, S., Hsu, C. H., & DeVon, H. A. (2017). Symptom Trajectories After an Emergency Department Visit for Potential Acute Coronary Syndrome. Nursing research, 65(4), 268-78.
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  Many patients evaluated for acute coronary syndrome (ACS) in emergency departments (EDs) continue to experience troubling symptoms after discharge-regardless of their ultimate medical diagnosis. However, comprehensive understanding of common post-ED symptom trajectories is lacking.
• Kurzius-Spencer, M., da Silva, V., Thomson, C. A., Hartz, V., Hsu, C. H., Burgess, J. L., O'Rourke, M. K., & Harris, R. B. (2017). Nutrients in one-carbon metabolism and urinary arsenic methylation in the National Health and Nutrition Examination Survey (NHANES) 2003-2004. The Science of the total environment, 607-608, 381-390.
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  Exposure to inorganic arsenic (inAs), a potent toxicant, occurs primarily through ingestion of food and water. The efficiency with which it is methylated to mono and dimethyl arsenicals (MMA and DMA) affects toxicity. Folate, vitamins B12 and B6 are required for 1C metabolism, and studies have found that higher levels of these nutrients increase methylation capacity and are associated with protection against adverse health effects from inAs, especially in undernourished populations. Our aim was to determine whether 1C-related nutrients are associated with greater inAs methylation capacity in a general population sample with overall adequate nutrition and low levels of As exposure. Univariate and multivariable regression models were used to evaluate the relationship of dietary and blood nutrients to urinary As methylation in the National Health and Nutrition Examination Survey (NHANES) 2003-2004. Outcome variables were the percent of the sum of inAs and methylated As species (inAs+MMA+DMA) excreted as inAs, MMA, and DMA, and the ratio of MMA:DMA. In univariate models, dietary folate, vitamin B6 and protein intake were associated with lower urinary inAs% and greater DMA% in adults (≥18years), with similar trends in children (6-18). In adjusted models, vitamin B6 intake (p=0.011) and RBC folate (p=0.036) were associated with lower inAs%, while dietary vitamin B12 was associated with higher inAs% (p=0.002) and lower DMA% (p=0.030). Total plasma homocysteine was associated with higher MMA% (p=0.004) and lower DMA% (p=0.003), but not with inAs%; other blood nutrients showed no association with urinary As. Although effect size is small, these findings suggest that 1C nutrients can influence inAs methylation and potentially play an indirect role in reducing toxicity in a general population sample.
• Nguyen, M. M., Martinez, J. A., Hsu, C. H., Sokoloff, M., Krouse, R. S., Gibson, B. A., Nagle, R. B., Parnes, H. L., Cordova, C., & Chow, H. S. (2017). Bioactivity and prostate tissue distribution of metformin in a preprostatectomy prostate cancer cohort. European journal of cancer prevention : the official journal of the European Cancer Prevention Organisation (ECP).
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  Metformin has recently been shown to have potential to reduce prostate cancer risk. We conducted a randomized, double-blind, placebo-controlled trial to determine the modulating effects of metformin on tissue and systemic biomarkers of drug activity and its distribution into the prostate tissue. Twenty patients with prostate cancer scheduled to undergo prostatectomy were randomly assigned to receive either extended-release metformin or placebo for a median of 34 days before surgery. Prostatectomy and serum samples were analyzed for metformin concentrations, serum biomarkers of drug activity (prostate-specific antigen, insulin, insulin-like growth factor-1, insulin-like growth factor binding protein 3, sex hormone-binding globulin, and testosterone) and tissue biomarkers of proliferation, apoptosis, cell cycle regulation, and mTOR inhibition. For participants in the metformin arm, the prostate tissue and serum metformin concentrations ranged from 0.88 to 51.2 μg/g tissue and from not detectable to 3.6 μg/ml, respectively. There were no differences between the two groups in either the postintervention tissue biomarker expression in the prostatectomy tissue or pre to postintervention changes in serum biomarkers. We conclude that metformin distributes to human prostate tissue, suggesting that metformin could exert its effects directly on tissue targets. However, there was no difference in tissue and systemic drug effect biomarkers between the two treatment arms. Future studies with longer intervention duration and larger sample size should be considered in order to evaluate the potential of metformin for prostate cancer prevention.
• Shweikeh, F., Schwed, A. C., Hsu, C. H., & Nfonsam, V. N. (2017). Status of Resident Attrition From Surgical Residency in the Past, Present, and Future Outlook. Journal of surgical education.
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  To investigate the current rate of attrition in general surgery residency, assess the risk factors, and identify prevention strategies.
• Toosizadeh, N., Wendel, C., Hsu, C. H., Zamrini, E., & Mohler, J. (2017). Frailty assessment in older adults using upper-extremity function: index development. BMC geriatrics, 17(1), 117.
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  Numerous multidimensional assessment tools have been developed to measure frailty; however, the clinical feasibility of these tools is limited. We previously developed and validated an upper-extremity function (UEF) assessment method that incorporates wearable motion sensors. The purpose of the current study was to: 1) cross-sectionally validate the UEF method in a larger sample in comparison with the Fried index; 2) develop a UEF frailty index to predict frailty categories including non-frail, pre-frail, and frail based on UEF parameters and demographic information, using the Fried index as the gold standard; and 3) develop a UEF continuous score (points scores for each UEF parameter and a total frailty score) based on UEF parameters and demographic information, using the Fried index as the gold standard.
• Van Arsdale, S., Yost, S. E., Hsu, C. H., Meer, M., Schoentag, S., & Habib, S. (2017). Pyridoxine Deficiency After Solid Organ Transplant. Progress in transplantation (Aliso Viejo, Calif.), 27(3), 251-256.
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  Pyridoxine is 1 of 8 B vitamins that assist in a variety of essential functions including immune functions. The purpose of this study was to assess the risk factors associated with low pyridoxine levels in solid organ transplantation recipients.
• Winton, L. M., Ferguson, E. M., Hsu, C. H., Agee, N., Eubanks, R. D., O'Neill, P. J., Goldberg, R. F., Kopelman, T. R., Nodora, J. N., Caruso, D. M., & Komenaka, I. K. (2017). Does Self-Assessment Improve the Effectiveness of Grand Rounds Lectures in a Community-Based Teaching Hospital?. Journal of surgical education, 73(6), 968-973.
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  To determine whether use of self-assessment (SA) questions affects the effectiveness of weekly didactic grand rounds presentations.
• Zhai, J., Hsu, C. H., & Daye, Z. J. (2017). Ridle for sparse regression with mandatory covariates with application to the genetic assessment of histologic grades of breast cancer. BMC medical research methodology, 17(1), 12.
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  Many questions in statistical genomics can be formulated in terms of variable selection of candidate biological factors for modeling a trait or quantity of interest. Often, in these applications, additional covariates describing clinical, demographical or experimental effects must be included a priori as mandatory covariates while allowing the selection of a large number of candidate or optional variables. As genomic studies routinely require mandatory covariates, it is of interest to propose principled methods of variable selection that can incorporate mandatory covariates.
• Zhai, J., Hsu, C., & Daye, J. (2016). Ridle for sparse regression with mandatory covariates with application to the genetic assessment of histologic grades of breast cancer". BMC Medical Research Methodology.
• Zhou, M., He, Y., Yu, M., & Hsu, C. (2017). A Nonparametric Multiple Imputation Approach for Missing Categorical Data. BMC Medical Research Methodology.
• Zhou, M., He, Y., Yu, M., & Hsu, C. H. (2017). A nonparametric multiple imputation approach for missing categorical data. BMC medical research methodology, 17(1), 87.
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  Incomplete categorical variables with more than two categories are common in public health data. However, most of the existing missing-data methods do not use the information from nonresponse (missingness) probabilities.
• Banerjee, B., Shaheen, N. J., Martinez, J. A., Hsu, C. H., Trowers, E., Gibson, B. A., Della'Zanna, G., Richmond, E., & Chow, H. H. (2016). Clinical Study of Ursodeoxycholic Acid in Barrett's Esophagus Patients. Cancer prevention research (Philadelphia, Pa.), 9(7), 528-33.
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  Prior research strongly implicates gastric acid and bile acids, two major components of the gastroesophageal refluxate, in the development of Barrett's esophagus and its pathogenesis. Ursodeoxycholic acid (UDCA), a hydrophilic bile acid, has been shown to protect esophageal cells against oxidative stress induced by cytotoxic bile acids. We conducted a pilot clinical study to evaluate the clinical activity of UDCA in patients with Barrett's esophagus. Twenty-nine patients with Barrett's esophagus received UDCA treatment at a daily dose of 13 to 15 mg/kg/day for 6 months. The clinical activity of UDCA was assessed by evaluating changes in gastric bile acid composition and markers of oxidative DNA damage (8-hydroxydeoxyguanosine), cell proliferation (Ki67), and apoptosis (cleaved caspase-3) in Barrett's esophagus epithelium. The bile acid concentrations in gastric fluid were measured by liquid chromatography/mass spectrometry. At baseline, UDCA (sum of unchanged and glycine/taurine conjugates) accounted for 18.2% of total gastric bile acids. After UDCA intervention, UDCA increased significantly to account for 93.4% of total gastric bile acids (P < 0.0001). The expression of markers of oxidative DNA damage, cell proliferation, and apoptosis was assessed in the Barrett's esophagus biopsies by IHC. The selected tissue biomarkers were unchanged after 6 months of UDCA intervention. We conclude that high-dose UDCA supplementation for 6 months resulted in favorable changes in gastric bile acid composition but did not modulate selected markers of oxidative DNA damage, cell proliferation, and apoptosis in the Barrett's esophagus epithelium. Cancer Prev Res; 9(7); 528-33. ©2016 AACRSee related article by Brian J. Reid, p. 512.
• Bea, J. W., Bea, J. W., Lee, M. C., Lee, M. C., Going, S. B., Going, S. B., Hsu, C., Hsu, C., Lohman, T. G., Lohman, T. G., Blew, R. M., Blew, R. M., Lee, V. R., Lee, V. R., Caan, B., Caan, B., Kwan, M., & Kwan, M. (2016). Dual energy X-ray absorptiometry spine scans to determine abdominal fat in postmenopausal women. American Journal of Human Biology, 28(6), 918-926. doi:10.1002/ajhb.22892
• Heberer, M. A., Komenaka, I. K., Nodora, J. N., Hsu, C. H., Gandhi, S. G., Welch, L. E., Bouton, M. E., Aristizabal, P., Weiss, B. D., & Martinez, M. E. (2016). Factors associated with cervical cancer screening in a safety net population. World journal of clinical oncology, 7(5), 406-413.
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  To identify factors associated with Papanicolaou-smear (Pap-smear) cervical cancer screening rates in a safety net population.
• Kern, K. B., Hanna, J. M., Young, H. N., Ellingson, C. J., White, J. J., Heller, B., Illindala, U., Hsu, C. H., & Zuercher, M. (2016). Importance of Both Early Reperfusion and Therapeutic Hypothermia in Limiting Myocardial Infarct Size Post-Cardiac Arrest in a Porcine Model. JACC. Cardiovascular interventions, 9(23), 2403-2412.
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  The aim of this study was to test the hypothesis that hypothermia and early reperfusion are synergistic for limiting infarct size when an acutely occluded coronary is associated with cardiac arrest.
• Knolhoff, J. B., Djenic, B., Hsu, C. H., Bouton, M. E., & Komenaka, I. K. (2016). Missed Appointments in a Breast Clinic: Patient-Related Factors. The American journal of the medical sciences, 352(4), 337-342.
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  Missed appointments are problematic because they occupy an appointment that could have been used by another patient and represent lost resources for the hospital system. The objective of this study was to determine patient-related factors associated with missed appointments.
• Komenaka, I. K., Heberer, M. A., O'Neill, P. J., Hsu, C., Nesset, E. M., Goldberg, R. F., Winton, L. M., Bouton, M. E., & Caruso, D. M. (2016). The effect of an evidence-based medicine curriculum on breast cancer knowledge and satisfaction of surgical residents. Journal of surgical education, 72(4), 717-25.
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  The current study was performed to determine if evidence-based medicine (EBM) curriculum would affect education of surgical residents.
• Lander, E. M., Wertheim, B. C., Koch, S. M., Chen, Z., Hsu, C. H., & Thomson, C. A. (2016). Vegetable protein intake is associated with lower gallbladder disease risk: Findings from the Women's Health Initiative prospective cohort. Preventive medicine, 88, 20-6.
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  This study aimed to measure associations between gallbladder disease and protein intake patterns, separated by quantity and type (vegetable vs. animal), among postmenopausal women.
• López, A. M., Pruthi, S., Boughey, J. C., Perloff, M., Hsu, C., Lang, J. E., Ley, M., Frank, D., Taverna, J. A., & Chow, H. S. (2016). Double-Blind, Randomized Trial of Alternative Letrozole Dosing Regimens in Postmenopausal Women with Increased Breast Cancer Risk. Cancer prevention research (Philadelphia, Pa.), 9(2), 142-8.
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  Aromatase inhibitors (AI) profoundly suppress estrogen levels in postmenopausal women and are effective in breast cancer prevention among high-risk postmenopausal women. Unfortunately, AI treatment is associated with undesirable side effects that limit patient acceptance for primary prevention of breast cancer. A double-blind, randomized trial was conducted to determine whether low and intermittent doses of letrozole can achieve effective estrogen suppression with a more favorable side-effect profile. Overall, 112 postmenopausal women at increased risk for breast cancer were randomized to receive letrozole at 2.5 mg once daily (QD, standard dose arm), 2.5 mg every Monday, Wednesday, and Friday (Q-MWF), 1.0 mg Q-MWF, or 0.25 mg Q-MWF for 24 weeks. Primary endpoint was suppression in serum estradiol levels at the end of letrozole intervention. Secondary endpoints included changes in serum estrone, testosterone, C-telopeptide (marker of bone resorption), lipid profile, and quality-of-life measures (QoL) following treatment. Significant estrogen suppression was observed in all dose arms with an average of 75% to 78% and 86% to 93% reduction in serum estradiol and estrone levels, respectively. There were no differences among dose arms with respect to changes in C-telopeptide levels, lipid profile, adverse events (AE), or QoL measures. We conclude that low and intermittent doses of letrozole are not inferior to standard dose in estrogen suppression and resulted in a similar side-effect profile compared with standard dose. Further studies are needed to determine the feasibility of selecting an effective AI dosing schedule with better tolerability. Cancer Prev Res; 9(2); 142-8. ©2015 AACR.
• Thompson, P. A., Ashbeck, E. L., Roe, D. J., Fales, L., Buckmeier, J., Wang, F., Bhattacharyya, A., Hsu, C. H., Chow, H. H., Ahnen, D. J., Boland, C. R., Heigh, R. I., Fay, D. E., Hamilton, S. R., Jacobs, E. T., Martinez, M. E., Alberts, D. S., & Lance, P. (2016). Selenium Supplementation for Prevention of Colorectal Adenomas and Risk of Associated Type 2 Diabetes. Journal of the National Cancer Institute, 108(12).
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  Selenium supplementation may help to prevent colorectal cancer; as precursors of colorectal cancer, colorectal adenomas are a surrogate for colorectal cancer. Selenium supplementation may increase risk of type 2 diabetes (T2D).
• Thompson, P. A., Ashbeck, E. L., Roe, D. J., Fales, L., Buckmeier, J., Wang, F., Bhattacharyya, A., Hsu, C. H., Chow, S. H., Ahnen, D. J., Boland, C. R., Heigh, R. I., Fay, D. E., Hamilton, S. R., Jacobs, E. T., Martinez, E. M., Alberts, D. S., & Lance, P. (2016). Celecoxib for the Prevention of Colorectal Adenomas: Results of a Suspended Randomized Controlled Trial. Journal of the National Cancer Institute, 108(12).
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  Cyclooxygenase (COX)-2 inhibitors such as celecoxib were designed to preserve anti-inflammatory activity without inhibiting COX-1. Downregulation of COX-2 inhibits colorectal carcinogenesis.
• Winton, L. M., Nodora, J. N., Martinez, M. E., Hsu, C., Djenic, B., Bouton, M. E., Aristizabal, P., Ferguson, E. M., Weiss, B. D., & Komenaka, I. K. (2016). Factors associated with surgical management in an underinsured, safety net population. Surgery, 159(2), 580-90.
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  Few studies include significant numbers of racial and ethnic minority patients. The current study was performed to examine factors that affect breast cancer operations in an underinsured population.
• Zangbar, B., Rhee, P., Pandit, V., Hsu, C., Khalil, M., Okeefe, T., Neumayer, L., & Joseph, B. (2016). Seasonal Variation in Emergency General Surgery. Annals of surgery, 263(1), 76-81.
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  The aim of this study was to assess the seasonal variation in emergency general surgery (EGS) admissions.
• Bouton, M. E., Jayaram, L., O'Neill, P. J., Hsu, C., & Komenaka, I. K. (2015). Management of idiopathic granulomatous mastitis with observation. American journal of surgery, 210(2), 258-62.
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  Idiopathic granulomatous mastitis (IGM) is becoming more commonly recognized and reported more often. Currently, many recommend corticosteroids in its management.
• Curiel-Lewandrowski, C., Tang, J. Y., Einspahr, J. G., Bermudez, Y., Hsu, C. H., Rezaee, M., Lee, A. H., Tangrea, J., Parnes, H. L., Alberts, D. S., & Chow, H. S. (2015). Pilot study on the bioactivity of vitamin d in the skin after oral supplementation. Cancer prevention research (Philadelphia, Pa.), 8(6), 563-9.
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  Laboratory studies suggest that vitamin D (VD) supplementation inhibits skin carcinogenesis. However, epidemiologic studies report mixed findings in the association between circulating VD levels and skin cancer risk. We conducted a clinical study to determine whether oral cholecalciferol supplementation would exert direct bioactivity in human skin through modulation of the VD receptor (VDR). We enrolled 25 individuals with serum 25-hydroxyvitamin-D levels
• Derek, T., Malone, D. C., Warholak, T. L., Chong, J., Armstrong, E. P., Slack, M. K., Hsu, C., & Labiner, D. (2015). Healthcare Resource Burden of Newly Diagnosed Epilepsy Among the US Low-Income Elderly. European Geriatric Medicine, 6(3), 251-256.
• Derek, T., Malone, D. C., Warholak, T. L., Chong, J., Armstrong, E. P., Slack, M. K., Hsu, C., & Labiner, D. (2015). Healthcare Resource Burden of Newly Diagnosed Epilepsy Among the US Low-Income Elderly. European Geriatric Medicine, 6(3), 252-256. doi:10.1016
• Derek, T., Malone, D. C., Warholak, T. L., Chong, J., Armstrong, E. P., Slack, M. K., Hsu, C., & Labiner, D. (2015). Prevalence and incidence of epilepsy in the United States elderly and low income population. Journal of Clinical Neurology, ?(?), e pub ahead of print.
• Hsu, C., He, Y., Li, Y., Long, Q., & Friese, R. (2015). Doubly robust multiple imputation using kernel-based techniques. Biometrical journal. Biometrische Zeitschrift.
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  We consider the problem of estimating the marginal mean of an incompletely observed variable and develop a multiple imputation approach. Using fully observed predictors, we first establish two working models: one predicts the missing outcome variable, and the other predicts the probability of missingness. The predictive scores from the two models are used to measure the similarity between the incomplete and observed cases. Based on the predictive scores, we construct a set of kernel weights for the observed cases, with higher weights indicating more similarity. Missing data are imputed by sampling from the observed cases with probability proportional to their kernel weights. The proposed approach can produce reasonable estimates for the marginal mean and has a double robustness property, provided that one of the two working models is correctly specified. It also shows some robustness against misspecification of both models. We demonstrate these patterns in a simulation study. In a real-data example, we analyze the total helicopter response time from injury in the Arizona emergency medical service data.
• Hsu, C., Taylor, J. M., & Hu, C. (2015). Analysis of accelerated failure time data with dependent censoring using auxiliary variables via nonparametric multiple imputation. Statistics in medicine, 34(19), 2768-80.
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  We consider the situation of estimating the marginal survival distribution from censored data subject to dependent censoring using auxiliary variables. We had previously developed a nonparametric multiple imputation approach. The method used two working proportional hazards (PH) models, one for the event times and the other for the censoring times, to define a nearest neighbor imputing risk set. This risk set was then used to impute failure times for censored observations. Here, we adapt the method to the situation where the event and censoring times follow accelerated failure time models and propose to use the Buckley-James estimator as the two working models. Besides studying the performances of the proposed method, we also compare the proposed method with two popular methods for handling dependent censoring through the use of auxiliary variables, inverse probability of censoring weighted and parametric multiple imputation methods, to shed light on the use of them. In a simulation study with time-independent auxiliary variables, we show that all approaches can reduce bias due to dependent censoring. The proposed method is robust to misspecification of either one of the two working models and their link function. This indicates that a working proportional hazards model is preferred because it is more cumbersome to fit an accelerated failure time model. In contrast, the inverse probability of censoring weighted method is not robust to misspecification of the link function of the censoring time model. The parametric imputation methods rely on the specification of the event time model. The approaches are applied to a prostate cancer dataset.
• Kazui, T., Bull, D. A., Hsu, C., Lick, S. D., Lick, S. D., Hsu, C., Bull, D. A., & Kazui, T. (2020). Short term risk of bilateral internal mammary artery grafting in diabetic patients. Seminars in Thoracic and Cardiovascular Surgery.
• Kern, K. B., Lotun, K., Patel, N., Mooney, M. R., Hollenbeck, R. D., McPherson, J. A., McMullan, P. W., Unger, B., Hsu, C., Seder, D. B., & , I. R. (2015). Outcomes of Comatose Cardiac Arrest Survivors With and Without ST-Segment Elevation Myocardial Infarction: Importance of Coronary Angiography. JACC. Cardiovascular interventions, 8(8), 1031-40.
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  The aim of this study was to compare outcomes and coronary angiographic findings in post-cardiac arrest patients with and without ST-segment elevation myocardial infarction (STEMI).
• Klimentidis, Y. C., Chougule, A., Arora, A., Frazier-Wood, A. C., & Hsu, C. (2015). Triglyceride-Increasing Alleles Associated with Protection against Type-2 Diabetes. PLoS genetics, 11(5), e1005204.
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  Elevated plasma triglyceride (TG) levels are an established risk factor for type-2 diabetes (T2D). However, recent studies have hinted at the possibility that genetic risk for TG may paradoxically protect against T2D. In this study, we examined the association of genetic risk for TG with incident T2D, and the interaction of baseline TG with TG genetic risk on incident T2D in 13,247 European-Americans (EA) and 3,238 African-Americans (AA) from three prospective cohort studies. A TG genetic risk score (GRS) was calculated based on 31 validated single nucleotide polymorphisms (SNPs). We considered several baseline covariates, including body- mass index (BMI) and lipid traits. Among EA and AA, we find, as expected, that baseline levels of TG are strongly positively associated with incident T2D (p
• Komenaka, I. K., Nodora, J. N., Hsu, C., Martinez, M. E., Gandhi, S. G., Bouton, M. E., Klemens, A. E., Wikholm, L. I., & Weiss, B. D. (2015). Association of health literacy with adherence to screening mammography guidelines. Obstetrics and gynecology, 125(4), 852-9.
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  To investigate the relationship of health literacy and screening mammography.
• Kurzius-Spencer, M., Harris, R. B., Hartz, V., Roberge, J., Hsu, C., O'Rourke, M. K., & Burgess, J. L. (2015). Relation of dietary inorganic arsenic to serum matrix metalloproteinase-9 (MMP-9) at different threshold concentrations of tap water arsenic. Journal of exposure science & environmental epidemiology.
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  Arsenic (As) exposure is associated with cancer, lung and cardiovascular disease, yet the mechanisms involved are not clearly understood. Elevated matrix metalloproteinase-9 (MMP-9) levels are also associated with these diseases, as well as with exposure to water As. Our objective was to evaluate the effects of dietary components of inorganic As (iAs) intake on serum MMP-9 concentration at differing levels of tap water As. In a cross-sectional study of 214 adults, dietary iAs intake was estimated from 24-h dietary recall interviews using published iAs residue data; drinking and cooking water As intake from water samples and consumption data. Aggregate iAs intake (food plus water) was associated with elevated serum MMP-9 in mixed model regression, with and without adjustment for covariates. In models stratified by tap water As, aggregate intake was a significant positive predictor of serum MMP-9 in subjects exposed to water As≤10 μg/l. Inorganic As from food alone was associated with serum MMP-9 in subjects exposed to tap water As≤3 μg/l. Exposure to iAs from food and water combined, in areas where tap water As concentration is ≤10 μg/l, may contribute to As-induced changes in a biomarker associated with toxicity.Journal of Exposure Science and Environmental Epidemiology advance online publication, 21 January 2015; doi:10.1038/jes.2014.92.
• Lane, R. D., Hsu, C., Locke, D. E., Ritenbaugh, C., & Stonnington, C. M. (2015). Role of theory of mind in emotional awareness and alexithymia: Implications for conceptualization and measurement. Consciousness and cognition, 33, 398-405.
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  The goal of this study was to determine whether alexithymia, which is characterized by difficulty in recognizing and describing emotions, is associated with impairments in the ability to mentally represent emotional states. We studied 89 outpatients including 29 conversion disorder patients, 30 functional somatic syndrome [e.g. fibromyalgia] patients and 30 medical controls. Groups did not differ on affective or cognitive Theory of Mind (ToM) measures, the Levels of Emotional Awareness Scale (LEAS) or the Twenty-Item Toronto Alexithymia Scale (TAS-20) after adjusting for Positive and Negative Affect Scale (PANAS) variables. Across all patients, LEAS but not TAS-20 correlated positively with affective and cognitive ToM measures after adjusting for PANAS scores. Impairments in ToM functioning influence LEAS performance but not TAS-20 scores. These findings support the distinction between a milder "anomia" form of alexithymia associated with impaired emotion naming and a more severe "agnosia" form associated with impaired mental representation of emotion.
• LeGendre-McGhee, S., Rice, P. S., Wall, R. A., Sprute, K. J., Bommireddy, R., Luttman, A. M., Nagle, R. B., Abril, E. R., Farrell, K., Hsu, C., Roe, D. J., Gerner, E. W., Ignatenko, N. A., & Barton, J. K. (2015). Time-serial Assessment of Drug Combination Interventions in a Mouse Model of Colorectal Carcinogenesis Using Optical Coherence Tomography. Cancer growth and metastasis, 8(Suppl 1), 63-80.
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  Optical coherence tomography (OCT) is a high-resolution, nondestructive imaging modality that enables time-serial assessment of adenoma development in the mouse model of colorectal cancer. In this study, OCT was utilized to evaluate the effectiveness of interventions with the experimental antitumor agent α-difluoromethylornithine (DFMO) and a nonsteroidal anti-inflammatory drug sulindac during early [chemoprevention (CP)] and late stages [chemotherapy (CT)] of colon tumorigenesis. Biological endpoints for drug interventions included OCT-generated tumor number and tumor burden. Immunochistochemistry was used to evaluate biochemical endpoints [Ki-67, cleaved caspase-3, cyclooxygenase (COX)-2, β-catenin]. K-Ras codon 12 mutations were studied with polymerase chain reaction-based technique. We demonstrated that OCT imaging significantly correlated with histological analysis of both tumor number and tumor burden for all experimental groups (P < 0.0001), but allows more accurate and full characterization of tumor number and burden growth rate because of its time-serial, nondestructive nature. DFMO alone or in combination with sulindac suppressed both the tumor number and tumor burden growth rate in the CP setting because of DFMO-mediated decrease in cell proliferation (Ki-67, P < 0.001) and K-RAS mutations frequency (P = 0.04). In the CT setting, sulindac alone and DFMO/sulindac combination were effective in reducing tumor number, but not tumor burden growth rate. A decrease in COX-2 staining in DFMO/sulindac CT groups (COX-2, P < 0.01) confirmed the treatment effect. Use of nondestructive OCT enabled repeated, quantitative evaluation of tumor number and burden, allowing changes in these parameters to be measured during CP and as a result of CT. In conclusion, OCT is a robust minimally invasive method for monitoring colorectal cancer disease and effectiveness of therapies in mouse models.
• Lee, K. S., Lee, J. Z., Hsu, C., Husnain, M., Riaz, H., Riaz, I. B., Thai, H., Cassese, S., Finn, A., Samady, H., & Byrne, R. A. (2015). Temporal Trends in Strut-Level Optical Coherence Tomography Evaluation of Coronary Stent Coverage: A Systematic Review and Meta-Analysis. Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions.
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  We sought to pool data from all studies with reported strut-level data in human subjects evaluated by optical coherence tomography (OCT) surveillance and to compare the aggregate data of stent strut coverage on a longitudinal temporal timeline from initial implantation for different coronary stent subtypes.
• Shirah, G. R., Hsu, C., Heberer, M. A., Wikholm, L. I., Goodman, J. J., Bouton, M. E., & Komenaka, I. K. (2015). Teaching residents may affect the margin status of breast-conserving operations. Surgery today.
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  The current study was performed to evaluate the effects of teaching surgical residents on the margin status after lumpectomy.
• Tang, D. H., Malone, D. C., Warholak, T. L., Chong, J., Armstrong, E. P., Slack, M. K., Hsu, C. H., & Labiner, D. M. (2015). Prevalence and Incidence of Epilepsy in an Elderly and Low-Income Population in the United States. Journal of clinical neurology (Seoul, Korea), 11(3), 252-61.
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  The purpose of this study was to estimate the incidence and prevalence of epilepsy among an elderly and poor population in the United States.
• Tang, D. H., Malone, D. C., Warholak, T. L., Chong, J., Armstrong, E. P., Slack, M. K., Hsu, C., & Labiner, D. (2015). Prevalence and incidence of epilepsy in the United States elderly and low income population. Journal of Clinical Neurology, 11(3), e pub ahead of print 252-61.
• Bell, M. L., Fiero, M., Horton, N. J., & Hsu, C. (2014). Handling missing data in RCTs; a review of the top medical journals. BMC medical research methodology, 14, 118.
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  Missing outcome data is a threat to the validity of treatment effect estimates in randomized controlled trials. We aimed to evaluate the extent, handling, and sensitivity analysis of missing data and intention-to-treat (ITT) analysis of randomized controlled trials (RCTs) in top tier medical journals, and compare our findings with previous reviews related to missing data and ITT in RCTs.
• Chow, H. S., Garland, L. L., Heckman-Stoddard, B. M., Hsu, C., Butler, V. D., Cordova, C. A., Chew, W. M., & Cornelison, T. L. (2014). A pilot clinical study of resveratrol in postmenopausal women with high body mass index: effects on systemic sex steroid hormones. Journal of translational medicine, 12, 223.
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  Breast cancer risk is partially determined by several hormone-related factors. Preclinical and clinical studies suggested that resveratrol may modulate these hormonal factors.
• Garcia, F. A., Cornelison, T., Nuño, T., Greenspan, D. L., Byron, J. W., Hsu, C., Alberts, D. S., & Chow, H. S. (2014). Results of a phase II randomized, double-blind, placebo-controlled trial of Polyphenon E in women with persistent high-risk HPV infection and low-grade cervical intraepithelial neoplasia. Gynecologic oncology.
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  In vitro data and pilot data suggest that green tea catechins may possess chemopreventive activity for cervical cancer and precursor lesions. We conducted a randomized, double-blind, placebo-controlled trial of Polyphenon E (decaffeinated and enriched green tea catechin extract) in women with persistent human papillomavirus (HPV) infection and low-grade cervical intraepithelial neoplasia (CIN1) to evaluate the potential of Polyphenon E for cervical cancer prevention.
• Hollenbeck, R. D., McPherson, J. A., Mooney, M. R., Unger, B. T., Patel, N. C., McMullan, P. W., Hsu, C., Seder, D. B., & Kern, K. B. (2014). Early cardiac catheterization is associated with improved survival in comatose survivors of cardiac arrest without STEMI. Resuscitation, 85(1).
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  To determine if early cardiac catheterization (CC) is associated with improved survival in comatose patients who are resuscitated after cardiac arrest when electrocardiographic evidence of ST-elevation myocardial infarction (STEMI) is absent.
• Hsu, C. (2014). The impact of an evidence based medicine curriculum on breast cancer knowledge and satisfaction of surgical residents. J Surg Education.
• Hsu, C. -. (2014). Health literacy assessment and patient satisfaction in surgical practice.. Surgery.
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  I. K. Komenaka, J. N. Nodora, L. Machado, C.-H. Hsu, A. E. Klemens, M. E. Martinez, M. E. Bouton, K. L. Wilhelmson and B. D. Weiss. Health literacy assessment and patient satisfaction in surgical practice. Surgery (in press).
• Hsu, C., Long, Q., Li, Y., & Jacobs, E. (2014). A nonparametric multiple imputation approach for data with missing covariate values with application to colorectal adenoma data. Journal of biopharmaceutical statistics, 24(3), 634-48.
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  A nearest neighbor-based multiple imputation approach is proposed to recover missing covariate information using the predictive covariates while estimating the association between the outcome and the covariates. To conduct the imputation, two working models are fitted to define an imputing set. This approach is expected to be robust to the underlying distribution of the data. We show in simulation and demonstrate on a colorectal data set that the proposed approach can improve efficiency and reduce bias in a situation with missing at random compared to the complete case analysis and the modified inverse probability weighted method.
• Klemens, A. E., Olsen-Deeter, L., Hsu, C., Bouton, M. E., Djenic, B., Winton, L. M., & Komenaka, I. K. (2014). Factors which affect the use of lumpectomy and mastectomy in an underinsured, safety net hospital population. American journal of surgery.
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  This study was performed to evaluate variables that affect the use of mastectomy and lumpectomy in an underinsured population.
• Klimentidis, Y. C., Klimentidis, Y. C., Chen, Z., Chen, Z., Arora, A., Arora, A., Hsu, C., & Hsu, C. (2014). Association of physical activity with lower type 2 diabetes incidence is weaker among individuals at high genetic risk. Diabetologia, 57(12), 2530-4.
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  We examined whether or not the association of physical activity with type 2 diabetes incidence differs according to several types of genetic susceptibility.
• Komenaka, I. K., Nodora, J. N., Machado, L., Hsu, C., Klemens, A. E., Martinez, M. E., Bouton, M. E., Wilhelmson, K. L., & Weiss, B. D. (2014). Health literacy assessment and patient satisfaction in surgical practice. Surgery, 155(3), 374-83.
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  Individuals with limited health literacy have barriers to patient-physician communication. Problems in communication are known to contribute to malpractice litigation. Concern exists, however, about the feasibility and patient acceptance of a health literacy assessment. This study was performed to determine the feasibility of health literacy assessment in surgical practice and its effect on patient satisfaction.
• Komenaka, I. K., Winton, L. M., Bouton, M. E., Hsu, C., Nodora, J. N., Olson, L., Maffi, T. R., Nesset, E. M., & Martinez, M. E. (2014). Women's Impression of the Expected Breast Appearance and its Association with Breast Cancer Operations. Annals of surgical oncology.
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  Significant concern exists from clinicians in all fields that rates of bilateral mastectomy and prophylactic mastectomy are increasing. This study was performed to evaluate women's perception of breast appearance and its association with breast cancer operations.
• Olsen-Deeter, L., Hsu, C., Nodora, J. N., Bouton, M. E., Nalagan, J., Martinez, M. E., & Komenaka, I. K. (2014). Factors which affect use of breast conservation and mastectomy in an underinsured Hispanic population. Surgical oncology, 23(4), 186-191.
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  Despite no difference in overall survival between breast conservation and mastectomy, significant variation exists between institutions and within populations. Less data exists about racial and ethnic minority populations. The current study was performed to evaluate variables that affect use of breast conservation and mastectomy in an underinsured Hispanic population.
• Bartley, A. N., Parikh, N., Hsu, C., Roe, D. J., Buckmeier, J. A., Corley, L., Phipps, R. A., Gallick, G., Lance, P., Thompson, P. A., & Hamilton, S. R. (2013). Colorectal adenoma stem-like cell populations: associations with adenoma characteristics and metachronous colorectal neoplasia. Cancer prevention research (Philadelphia, Pa.), 6(11).
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  Cancer stem cells have tumor-initiation and tumor-maintenance capabilities. Stem-like cells are present in colorectal adenomas, but their relationship to adenoma pathology and patient characteristics, including metachronous development of an additional adenoma ("recurrence"), has not been studied extensively. We evaluated the expression of aldehyde dehydrogenase isoform 1A1 (ALDH1A1), a putative stem cell marker, in baseline adenomas from the placebo arm of chemoprevention trial participants with colonoscopic follow-up. An exploratory set of 20 baseline adenomas was analyzed by ALDH1A1 immunohistochemistry with morphometry, and a replication set of 89 adenomas from 76 high-risk participants was evaluated by computerized image analysis. ALDH1A1-labeling indices (ALI) were similar across patient characteristics and in advanced and nonadvanced adenomas. There was a trend toward higher ALIs in adenomas occurring in the right than left colon (P = 0.09). ALIs of synchronous adenomas were correlated (intraclass correlation coefficient 0.67). Participants in both sample sets who developed a metachronous adenoma had significantly higher ALIs in their baseline adenoma than participants who remained adenoma free. In the replication set, the adjusted odds for metachronous adenoma increased 1.46 for each 10% increase in ALIs (P = 0.03). A best-fit algorithm-based cutoff point of 22.4% had specificity of 75.0% and positive predictive value of 70.0% for metachronous adenoma development. A larger population of ALDH1A1-expressing cells in an adenoma is associated with a higher risk for metachronous adenoma, independent of adenoma size or histopathology. If confirmed, ALDH1A1 has potential as a novel biomarker in risk assessment and as a potential stem cell target for chemoprevention.
• Burgess, J. L., Harris, R. B., Hartz, V., Hsu, C., O'Rourke, M. K., Kurzius-Spencer, M., Burgess, J. L., Harris, R. B., Hartz, V., Hsu, C., O'Rourke, M. K., & Kurzius-Spencer, M. (2013). Measured versus modeled dietary arsenic and relation to urinary arsenic excretion and total exposure. Journal of Exposure Science and Environmental Epidemiology, 23(4), 442-449.
• Chou, C., Tulolo, A., Raver, E. W., Hsu, C., & Young, G. (2013). Effect of race and health insurance on health disparities: results from the National Health Interview Survey 2010. Journal of health care for the poor and underserved, 24(3).
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  Significant race-related disparities persist in the U.S. regarding access to health services. Initiatives to reduce such disparities have often focused on expanding health insurance coverage for vulnerable populations. Based on our analysis of 2010 data from the National Health Interview Survey, we found that race is a much greater factor than insurance status in accounting for disparities in access to health services. Expanding health insurance through reform initiatives such as the Patient Protection and Affordable Care Act may have relatively little impact on reducing racial and ethnic disparities in the US.
• Hsu, P. -. (2013). Rehabilitation after trauma: does age matter?. Journal of Surgical Research, 184, 541-545.
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  B. Joseph, V. Pandit, H. Aziz, A. Tang, N. Kulvatunyou, J. Wynne, P. Hsu, T. O’Keeffe, L. Gries, R. S. Friese, P. Rhee. 2013. Rehabilitation after trauma: does age matter? Journal ofSurgical Research 184: 541-545.
• Kurzius-Spencer, M., Burgess, J. L., Harris, R. B., Hartz, V., Roberge, J., Huang, S., Hsu, C., & O'Rourke, M. K. (2013). Contribution of diet to aggregate arsenic exposures-An analysis across populations. Journal of exposure science & environmental epidemiology.
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  The relative contribution of dietary arsenic (As) to aggregate daily exposure has not been well-characterized, especially in relation to the current EPA maximum contaminant level (MCL) of 10 p.p.b. for As in drinking water. Our objectives were to: (1) model exposure to inorganic and total As among non-seafood eaters using subject-specific data, (2) compare the contribution of food, drinking and cooking water to estimated aggregate exposure in households with variable background tap water As levels, and (3) describe the upper distribution of potential dose at different thresholds of tap water As. Dietary As intake was modeled in regional study populations and NHANES 2003-2004 using dietary records in conjunction with published food As residue data. Water As was measured in the regional studies. Among subjects exposed to tap water As >10 p.p.b., aggregate inorganic exposure was 24.5-26.1 μg/day, with approximately 30% of intake from food. Among subjects living in homes with tap water As ≤10, 5 or 3 p.p.b., aggregate inorganic As exposure was 8.6-11.8 μg/day, with 54-85% of intake from food. Median inorganic As potential dose was 0.42-0.50 μg/kg BW/day in subjects exposed to tap water As >10 p.p.b. and less than half that among subjects exposed to tap water As ≤10 p.p.b. The majority of inorganic and total As exposure is attributable to diet in subjects with tap water As
• Kurzius-Spencer, M., O'Rourke, M. K., Hsu, C., Hartz, V., Harris, R. B., & Burgess, J. L. (2013). Measured versus modeled dietary arsenic and relation to urinary arsenic excretion and total exposure. Journal of exposure science & environmental epidemiology, 23(4).
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  Chronic exposure to arsenic (As) in food and water is a significant public health problem. Person-specific aggregate exposure is difficult to collect and modeling based on limited food As residue databases is of uncertain reliability. Two cross-sectional population exposure studies, the National Human Exposure Assessment Survey-Arizona and Arizona Border Survey, had a combined total of 252 subjects with diet, water, and urinary As data. Total As was measured in 24-h duplicate diet samples and modeled using 24-h diet diaries in conjunction with several published food surveys of As. Two-stage regression was used to assess the effects of dietary As on urinary total As (uAs): (1) generalized linear mixed models of uAs above versus below the limit of detection (LOD); and (2) restricted models limited to those subjects with uAs>LOD, using bootstrap sampling and mixed models adjusted for age, sex, body mass index, ethnicity, current smoking, and As intake from drinking and cooking water. In restricted models, measured and modeled estimates were significant predictors of uAs. Modeled dietary As based on Total Diet Study mean residues greatly underestimated the dietary intake. In households with tap water As ≤10 p.p.b., over 93% of total arsenic exposure was attributable to diet.
• Miller, J. A., Lang, J. E., Ley, M., Nagle, R., Hsu, C., Thompson, P. A., Cordova, C., Waer, A., & Chow, H. S. (2013). Human breast tissue disposition and bioactivity of limonene in women with early-stage breast cancer. Cancer prevention research (Philadelphia, Pa.), 6(6).
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  Limonene is a bioactive food component found in citrus peel oil that has shown chemopreventive and chemotherapeutic activities in preclinical studies. We conducted an open-label pilot clinical study to determine the human breast tissue disposition of limonene and its associated bioactivity. We recruited 43 women with newly diagnosed operable breast cancer electing to undergo surgical excision to take 2 grams of limonene daily for two to six weeks before surgery. Blood and breast tissue were collected to determine drug/metabolite concentrations and limonene-induced changes in systemic and tissue biomarkers of breast cancer risk or carcinogenesis. Limonene was found to preferentially concentrate in the breast tissue, reaching high tissue concentration (mean = 41.3 μg/g tissue), whereas the major active circulating metabolite, perillic acid, did not concentrate in the breast tissue. Limonene intervention resulted in a 22% reduction in cyclin D1 expression (P = 0.002) in tumor tissue but minimal changes in tissue Ki67 and cleaved caspase-3 expression. No significant changes in serum leptin, adiponectin, TGF-β1, insulin-like growth factor binding protein-3 (IGFBP-3), and interleukin-6 (IL-6) levels were observed following limonene intervention. There was a small but statistically significant postintervention increase in insulin-like growth factor I (IGF-I) levels. We conclude that limonene distributed extensively to human breast tissue and reduced breast tumor cyclin D1 expression that may lead to cell-cycle arrest and reduced cell proliferation. Furthermore, placebo-controlled clinical trials and translational research are warranted to establish limonene's role for breast cancer prevention or treatment.
• Miller, J. A., Thompson, P. A., Hakim, I. A., Lopez, A. M., Thomson, C. A., Hsu, C., & Chow, H. S. (2013). Expression of epidermal growth factor, transforming growth factor-β1 and adiponectin in nipple aspirate fluid and plasma of pre and post-menopausal women. Biomarker research, 1(1).
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  Nipple aspirate fluid (NAF) contains large amounts of protein thought to reflect the microenvironment of the breast, and is of interest in breast cancer prevention research. The correlation between specific NAF proteins to plasma concentrations have not been well studied in healthy women. We collected matched NAF and plasma from 43 healthy pre and postmenopausal women participating in an early phase clinical study to compare the levels of putative cancer protein biomarkers. We compared baseline NAF and plasma levels of epidermal growth factor (EGF), transforming growth factor-beta 1 (TGF-β1), and adiponectin and evaluated menopausal status and body mass index (BMI) as potential modifying factors.
• Riaz, I. B., Dhoble, A., Mizyed, A., Hsu, C., Husnain, M., Lee, J. Z., Lotun, K., & Lee, K. S. (2013). Transcatheter patent foramen ovale closure versus medical therapy for cryptogenic stroke: a meta-analysis of randomized clinical trials. BMC cardiovascular disorders, 13.
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  There is an association between cryptogenic stroke and patent foramen ovale (PFO). The optimal treatment strategy for secondary prevention remains unclear. The purpose of this study was to analyze aggregate data examining the safety and efficacy of transcatheter device closure versus standard medical therapy in patients with PFO and cryptogenic stroke.
• Stonnington, C. M., Locke, D. E., Hsu, C., Ritenbaugh, C., & Lane, R. D. (2013). Somatization is associated with deficits in affective Theory of Mind. Journal of psychosomatic research, 74(6).
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  To determine whether deficits in mental representation of emotion may constitute a mechanism for somatization.
• Torabi, R., Hsu, C., Patel, P. N., Dave, H., Bouton, M. E., & Komenaka, I. K. (2013). Predictors of margin status after breast-conserving operations in an underscreened population. Langenbeck's archives of surgery / Deutsche Gesellschaft für Chirurgie, 398(3).
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  Negative margins after lumpectomy remain a prominent issue in breast surgery. The current study was performed to evaluate patient-related variables that affect risk for positive margins in an underscreened population.

Proceedings Publications

• Combs, D., Abraham, I. L., Hsu, C., Morgan, W. J., Patel, S. I., & Parthasarathy, S. (2019, December). Comparison of parent and child treatment preferences for obstructive sleep apnea. In Chest.
• Parthasarathy, S., Abraham, I. L., Hsu, C., Morgan, W. J., Barber, B. J., Edgin, J. O., & Combs, D. (2018, Fall). Sleep-disordered breathing is associated with neurocognitive impairment in children with congenital heart disease. In Sleep, 41, A277.
• Parthasarathy, S., Abraham, I. L., Hsu, C., Morgan, W. J., Klewer, S. E., Barber, B. J., Edgin, J. O., & Combs, D. (2018, Fall). Obstructive sleep apnea is a novel risk factor for neurocognitive impairment in children with congenital heart disease. In Circulation, 138(Suppl 1), 14956.
• Parthasarathy, S., Bailey, O., Morgan, W. J., Hsu, C., Abraham, I. L., & Combs, D. (2018, Spring). Parent treatment preferences for mild obstructive sleep apnea in children. In American Journal of Respiratory and Critical Care Medicine, 197, A2005.

Presentations

• Parthasarathy, S., Esparza, L., La Rue, S., Matloff, D., Gerken, B., Van Vorce, H., Bottrell, K., Hsu, C., Swanson, J. E., & Combs, D. A. (2023). Safety and efficacy of the combination of atomoxetine and oxybutynin for OSA treatment in children with Down Syndrome. Associated Professional Sleep Societies. Indianapolis, IN.
• Ajmal, S., Hsu, C., Ghaderi, I., Ho, K., & Ashouri, Y. (2022, June). The Impact of COVID-19 Pandemic on Access to Bariatric Surgery. ASMBS Annual Meeting 2022. Dallas: American Society for Metabolic and Bariatric Surgery (ASMBS).
• Ghaderi, I., Ho, H., Ho, K., Maegawa, F., Marisa, B., Ashouri, Y., & Hsu, C. (2021, October/Fall).

  Safety Of Robotic Bariatric Surgery In Older Adults: A 5-year Analysis Of The Metabolic And Bariatric Surgery Accreditation And Quality Improvement Program (MBSAQIP) Database

  . American College of SurgeonsAmerican College of Surgeons.
• Hsu, C., & Kazui, T. (2020, April). The high risk and prohibitive risk transcatheter aortic valve replacement in low risk era. The 120th Annual Congress of Japan Surgical Society. Yokohama, Japan: Japan Surgical Society.
• Bull, D. A., Lick, S. D., Hsu, C., Kazui, T., Bull, D. A., Hsu, C., Lick, S. D., & Kazui, T. (2019, January). Does use of bilateral mammary arteries increase short-term risk in diabetic patients? Results from The Society of Thoracic Surgeons Adult Cardiac Surgery Database. 55th STS annual meeting. San Diego: STS.
• Hsu, C., & O'Connor, P. (2019, 12). Survival analysis with presence of informative censoring via nonparametric multiple imputation. Academia Sinica.
• Hsu, C., Malo, J., Mosier, J. M., Natt, B., Hypes, C., Lick, S. D., & Bull, D. A. (2019, May/). Duration and Outcomes of Veno-Venous Extracorporeal Membrane Oxygenation Support in Acute Respiratory Distress Syndrome: Results from ELSO database. American association for thoracic surgery 99th annual meeting. Toronto: American association for thoracic surgery.
• Combs, D., Abraham, I. L., Hsu, C., Morgan, W. J., Bailey, O., & Parthasarathy, S. (2018, May). Parent treatment preferences for mild obstructive sleep apnea in children. 2018 International Meeting of the American Thoracic Society. San Diego, CA.
• Combs, D., Edgin, J. O., Barber, B. J., Morgan, W. J., Hsu, C., Abraham, I. L., & Parthasarathy, S. (2018, June). Sleep-disordered breathing is associated with neurocognitive impairment in children with congenital heart disease. 2018 meeting of the Associated Professional Sleep Societies. Baltimore, MD.
• Hsu, C., Hu, C., & He, Y. (2018, 08). An Alternatve Sensitivy Analysis Approach for Missing Not At Random. CompStat. Iasi, Romania.
• Hsu, C., Hu, C., & He, Y. (2018, December). An Alternatve Sensitivy Analysis Approach for Missing Not at Random. 11th International Conference of the ERCIM WG on Computational and Methodological Statistics (CMStatistics 2018). Pisa, Italy.
• Hu, C., Taylor, J., & Hsu, C. (2017, December). Survival analysis with informative censoring via nonparametric multiple imputation. 10th International Conference of the ERCIM WG on Computational and Methodological Statistics,. London, UK: European Research Consortium for Informatics and Mathematics Working Group.
• Hu, C., Taylor, J., & Hsu, C. (2017, June). Survival analysis with presence of informative censoring via nonparametric multiple imputation. 2017 ICSA Applied Statistics Symposium. Chicago, IL: International Chinese Statistical Association.
• Rosenfeld, A. G., Sikorskii, A., Hsu, C., Segrin, C. G., Badger, T. A., & Crane, T. E. (2017, February). Symptom Clusters in Latinas with Breast Cancer. APOS. Tampa Florida: APOS.
• Rosenfeld, A. G., Sikorskii, A., Hsu, C., Segrin, C. G., Badger, T. A., & Crane, T. E. (2017, February). Symptom Clusters in Latinas with Breast Cancer. American Psychosocial Oncology Society. Orlando, Florida: APOS.
• Rosenfeld, A. G., Sikorskii, A., Hsu, C., Segrin, C. G., Badger, T. A., & Crane, T. E. (2017, Spring). Symptom clusters in Latinas with breast cancer.. WIN. Denver, CO: Western Institute of Nursing 50th Annual Conference.
• Hsu, C. (2016, December). Cox regression analysis with missing covariates via nonparametric multiple imputation. CMStatistics. Sevilla, Spain: Computational and Financial Econometrics.
• Knight, E. P., Shea, K. D., Rosenfeld, A. G., Hsu, C., Schmiege, S., & DeVon, H. A. (2016, April). SYMPTOM TRAJECTORIES AFTER EMERGENT EVALUATION FOR ACUTE CORONARY SYNDROME. Western Institute of Nursing. Anaheim, CA: Western Institute of Nursing.
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  Background: Many patients evaluated for acute coronary syndrome (ACS) in emergency departments (EDs) experience ongoing or recurrent symptoms after discharge, regardless of their ultimate medical diagnosis. A comprehensive understanding of post-ED symptom trajectories is lacking.Aim: To identify common trajectories of symptom severity in the six months after an ED visit for potential ACS.Methods: This was a secondary data analysis from a study conducted in five U.S. EDs. Patients (n=1002) who had abnormal electrocardiogram or biomarker testing and were identified by the triage nurse as potentially having ACS were enrolled. Symptom severity was assessed in the hospital and 30 days and six months post-discharge using the 13-item ACS Symptom Checklist. Severity of the eight most commonly reported symptoms (chest pressure, chest discomfort, unusual fatigue, chest pain, shortness of breath, lightheadedness, upper back pain, and shoulder pain) was modeled across the three study time points using growth mixture modeling. Models with increasing numbers of classes were compared, and final model selection was based on a combination of interpretability, theoretical justification, and statistical fit indices. Results: The sample was 62.6% male with a mean age of 60.17 years, and 57.1% ruled-out for ACS. Between two and four distinct trajectory classes were identified for each symptom. Identified trajectories were labeled “tapering off,” “mild/persistent”, “moderate/persistent,” “moderate/worsening”, “moderate/improving,” “late onset”, and “severe/improving.” Implications: Research on the individual nature of symptom trajectories can contribute to patient-centered, rather than disease-centered, care. Further research is needed to verify the existence of multiple symptoms trajectories in diverse populations and to assess the antecedents and consequences of individual symptom trajectories.
• Knight, E. P., Shea, K. D., Rosenfeld, A. G., Hsu, C., Schmiege, S., DeVon, H. A., Knight, E. P., Shea, K. D., Rosenfeld, A. G., Hsu, C., Schmiege, S., & DeVon, H. A. (2016, April). SYMPTOM TRAJECTORIES AFTER EMERGENT EVALUATION FOR ACUTE CORONARY SYNDROME. Western Institute of Nursing, Nursing Annual Regional Conference. Anaheim, CA: Western Institute of Nursing.
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  Background: Many patients evaluated for acute coronary syndrome (ACS) in emergency departments (EDs) experience ongoing or recurrent symptoms after discharge, regardless of their ultimate medical diagnosis. A comprehensive understanding of post-ED symptom trajectories is lacking.Aim: To identify common trajectories of symptom severity in the six months after an ED visit for potential ACS.Methods: This was a secondary data analysis from a study conducted in five U.S. EDs. Patients (n=1002) who had abnormal electrocardiogram or biomarker testing and were identified by the triage nurse as potentially having ACS were enrolled. Symptom severity was assessed in the hospital and 30 days and six months post-discharge using the 13-item ACS Symptom Checklist. Severity of the eight most commonly reported symptoms (chest pressure, chest discomfort, unusual fatigue, chest pain, shortness of breath, lightheadedness, upper back pain, and shoulder pain) was modeled across the three study time points using growth mixture modeling. Models with increasing numbers of classes were compared, and final model selection was based on a combination of interpretability, theoretical justification, and statistical fit indices. Results: The sample was 62.6% male with a mean age of 60.17 years, and 57.1% ruled-out for ACS. Between two and four distinct trajectory classes were identified for each symptom. Identified trajectories were labeled “tapering off,” “mild/persistent”, “moderate/persistent,” “moderate/worsening”, “moderate/improving,” “late onset”, and “severe/improving.” Implications: Research on the individual nature of symptom trajectories can contribute to patient-centered, rather than disease-centered, care. Further research is needed to verify the existence of multiple symptoms trajectories in diverse populations and to assess the antecedents and consequences of individual symptom trajectories.
• Hsu, C. (2014, Feb). Multiple Imputation Using Smoothing Techniques.. ASA San Diego Chapter 2014 Business Meeting. San Diego: ASA.
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  Keynote Speaker
• Hsu, C. (2014, June). Survival Analysis with Missing Covariates. WNAR. Haiwaii: WNAR.

Poster Presentations

• Falk, T., Richards, S. S., Bartlett, M. J., Lind, A., Hsu, C., & Sherman, S. J. (2023, Fall 2023). Subanesthetic infusion of ketamine produces long-term reduction in levodopa-induced dyskinesia and depression in individuals with Parkinson’s Disease. . International Parkinson and Movement Disorders Society Abstracts. Copenhagen, Denmark.
• Bauman, J. E., Hsu, C., Centuori, S. M., Jose, G., Garland, L. L., Ho, E., Bengtson, L., Wojtowicz, M., Szabo, E., & Chow, H. (2021, April). Randomized crossover trial evaluating detoxication of tobacco carcinogens by broccoli seed and sprout extract in heavy smokers. American Association for Cancer Research (AACR),. Virtual Interactive 2021: AACR.
• Lee, B. R., Chipollini, J., Hsu, C., Gachupin, F. C., Cruz, A., Wong, A. C., Asif, W., Quinonez-Zanabira, E., & Batai, K. (2021, Fall). Impact of Preoperative Wait time on Tumor Characteristics and Racial and Ethnic Disparities. American Urological Association.
• Taylor-Piliae, R. E., Morrison, H. W., Hsu, C., & Grandner, M. (2021, Summer). Changes in Symptoms, Sleep, Oxidative Stress, and Inflammatory Markers Among Community-Dwelling Stroke Survivors After a Tai Chi Exercise Intervention.. European Society of Cardiology, EuroHeartCare 2021 Congress. online presentation due to COVID-19.
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  (Abstract selected for Press Release). Taylor-Piliae, R.E., Morrison, H., Hsu, C.H., Grandner, M. (2021). Changes in Symptoms, Sleep, Oxidative Stress, and Inflammatory Markers Among Community-Dwelling Stroke Survivors After a Tai Chi Exercise Intervention. European Journal of Cardiovascular Nursing, Volume 20, Issue Supplement_1, July 2021, zvab060.075, https://doi.org/10.1093/eurjcn/zvab060.075
• Thomson, C. A., Courneya, K. S., Ligibel, J., Kumar, R., Babiker, H. M., Dougherty, S., Marrero, D., Babiker, H. M., Abraham, I. L., Chow, H., Hsu, C., & Algotar, A. (2019, Spring). Comprehensive lifestyle improvement program for prostate cancer (CLIPP): A feasibility study in men with prostate cancer on ADT.. Genitourinary Cancers Symposium.
• Bull, D. A., Lick, S. D., Hypes, C., Natt, B., Mosier, J. M., Malo, J., Hsu, C., & Kazui, T. (2020, April). Interfacility transfer via a mobile intensive care unit following a double lumen catheter cannulation at the referring facility for veno-venous extracorporeal membrane oxygenation. THE INTERNATIONAL SOCIETY FOR HEART AND LUNG TRANSPLANTATION 2020 Scientific Program. Montreal, Canada: THE INTERNATIONAL SOCIETY FOR HEART AND LUNG TRANSPLANTATION.
• Burhansstipanov, L., Joshweseoma, L., Russell, D., Joshweseoma, L., Hsu, C. P., Sanderson, P. R., & Batai, K. (2020, March). Barriers to Cancer Screening among Southwest American Indian Men Living on a Reservation. American Society of Preventive Oncology Annual Meeting. Virtual: American Society of Preventive Oncology.
• Kazui, T., Hsu, C., Malo, J., Mosier, J. M., Natt, B., Hypes, C., Lick, S. D., & Bull, D. A. (2020, April). Interfacility transfer via a mobile intensive care unit following a double lumen catheter cannulation at the referring facility for veno-venous extracorporeal membrane oxygenation. THE INTERNATIONAL SOCIETY FOR HEART AND LUNG TRANSPLANTATION 2020 Scientific Program. Montreal, Canada: THE INTERNATIONAL SOCIETY FOR HEART AND LUNG TRANSPLANTATION.
• Seckeler, M., Combs, D. A., Seckeler, M., Fernandez, V., Klewer, S. E., Klewer, S. E., Parthasarathy, S., Barber, B. J., Parthasarathy, S., Andrews, J. G., Morgan, W. J., Andrews, J. G., Hsu, C., Hsu, C., Hsu, C., Morgan, W. J., Andrews, J. G., Morgan, W. J., Barber, B. J., , Parthasarathy, S., et al. (2020, November). Obstructive Sleep Apnea Is Associated with Cardiac Dysfunction In Children With Congenital Heart Disease. 2020 American Heart Association Scientific SessionsAmerican Heart Association.
• Combs, D., Combs, D., Abraham, I. L., Abraham, I. L., Hsu, C., Hsu, C., Morgan, W. J., Morgan, W. J., Patel, S. I., Patel, S. I., Parthasarathy, S., & Parthasarathy, S. (2018, December). Comparison of parent and child treatment preferences for obstructive sleep apnea. 2019 meeting of the Associated Professional Sleep Societies. San Antonio, TX.
• Hsu, C., He, Y., Hu, C., & Zhou, W. (2019, 7). An alternative sensitivity analysis approach for data subject to missing not at random. The 34th International Workshop on Statistical Modelling. Porto: Portugal.
• Kazui, T., Hsu, C., Lick, S. D., & Bull, D. A. (2019, October). Venovenous extracorporeal membrane oxygenation and risk factors for adverse outcomes in acute respiratory distress syndrome: Results from the extracorporeal life support organization database. 2nd Annual Scientific Meeting of the Japanese Association for Thoracic Surgery. Kyoto, Japan: Japanese Association for Thoracic Surgery.
• Macpherson, A. J., Hsu, C., Calhoun, E., Gomez, J., Prado, Y., & Bezies-Lopez, D. (2019, December). Identification of Barriers to Breast Cancer Screening That Affect Compliance. San Antonio Breast Cancer Symposium. San Antonio, TX: Breast Cancer Research Foundation.
• Macpherson, A. J., Prado, Y., Bezies-Lopez, D., Hsu, C., Calhoun, E., & Gomez, J. (2019, November). Identification of Barriers to Breast Cancer Screening That Affect Compliance. Arizona Community Health Outreach Workers (AZCHOW) 16th Annual Conference. Tucson, AZ: Breast Cancer Research Foundation.
• Parthasarathy, S., Patel, S. I., Morgan, W. J., Hsu, C., Abraham, I. L., & Combs, D. (2019, December). Comparison of parent and child treatment preferences for obstructive sleep apnea. 2019 meeting of the Associated Professional Sleep Societies. San Antonio, TX.
• Taylor-Piliae, R. E., Hsu, C., Toosizadeh, N., & Mohler, M. J. (2019, March). Novel Dual-Task Balance Challenge to Prevent Falls in Older Adults with Cardiovascular Disease Risk Factors. American Heart Association's 2019 EPI/Lifestyle Scientific Sessions. Houston, TX: American Heart Association.
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  accepted for presentation
• Thomson, C. A., Thomson, C. A., Algotar, A., Courneya, K. S., Courneya, K. S., Hsu, C., Ligibel, J., Ligibel, J., Chow, H., Kumar, R., Kumar, R., Abraham, I. L., Babiker, H. M., Babiker, H. M., Babiker, H. M., Dougherty, S., Dougherty, S., Marrero, D., Dougherty, S., , Marrero, D., et al. (2019, Spring). Comprehensive lifestyle improvement program for prostate cancer (CLIPP): A feasibility study in men with prostate cancer on ADT.. ASCO Genitourinary Cancers Symposium.
• Macpherson, A. J., Chalasani, P., Calhoun, E., Gomez, J., Hsu, C., Lang, L., & Yessenia, P. (2018, January). Breast Cancer Screening Strategies for Latin American Women. Arizona Community Healthcare Outreach Workers (AzCHOW) 15th Annual Conference. Tucson, AZ: Breast Cancer Research Association.
• Macpherson, A. J., Fitzpatrick, K. A., Borders, M. H., Calhoun, E., Gomez, J., Hsu, C., Prado, Y., & Bezies-Lopez, D. (2018, December). Identification of Barriers to Breast Cancer Screening That Affect Compliance. San Antonio Breast Cancer Symposium. San Antonio: Breast Cancer Research Foundation.
• Parthasarathy, S., Abraham, I. L., Hsu, C., Morgan, W. J., Barber, B. J., Edgin, J. O., & Combs, D. (2018, Fall). Sleep-disordered breathing is associated with neurocognitive impairment in children with congenital heart disease. Sleep Research SocietySleep Research Society.
• Parthasarathy, S., Abraham, I. L., Hsu, C., Morgan, W. J., Klewer, S. E., Barber, B. J., Edgin, J. O., & Combs, D. (2018, November). Obstructive Sleep Apnea is a Novel Risk Factor for Neurocognitive Impairment in Children with Congenital Heart Disease. 2018 American Heart Association Scientific Sessions. Chicago, IL.
• Parthasarathy, S., Bailey, O., Morgan, W. J., Hsu, C., Abraham, I. L., & Combs, D. (2018, Spring). Parent treatment preferences for mild obstructive sleep apnea in children. American Thoracic SocietyAmerican Thoracic Society.
• Parthasarathy, S., Hsu, C., Morgan, W. J., Klewer, S. E., Barber, B. J., Edgin, J. O., & Coombs, D. (2018, Nov). Obstructive sleep apnea is a novel risk factor for neurocognitive impairment in children with congenital heart disease. American Heart Association. Chicago.
• Thomson, C. A., Smith, T., Hsu, C., Dougherty, S. T., Babiker, H. M., Chow, H., Marrero, D., & Algotar, A. (2018, Fall). Abstract: Comprehensive lifestyle improvement program for prostate cancer (CLIPP) Survivors. UACC Scientific Retreat. Tucson, AZ.
• Parthasarathy, S., Parthasarathy, S., Abraham, I. L., Abraham, I. L., Hsu, C., Hsu, C., Morgan, W. J., Morgan, W. J., Barber, B. J., Barber, B. J., Edgin, J. O., Edgin, J. O., Combs, D., & Combs, D. (2017, July). Sleep-disordered breathing is associated with memory impairment in children with congenital heart disease. 15th International Symposium on Sleep and Breathing. Madison, WI.
• Rosenfeld, A. G., Rosenfeld, A. G., Hsu, C., McEwen, M. M., McEwen, M. M., & Hsu, C. (2016, April). Symptom experience of Mexican American women with diabetes & heart disease.. Western Institute of Nursing Communicating Nursing Research Conference. Anaheim CA: Western Institute of Nursing.
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  This was work from our Emmons grant.
• Klimentidis, Y. C., Chen, Z., Arora, A., & Hsu, C. (2014, October). Association of physical activity with lower type-2 diabetes incidence is weaker in those with high genetic risk. American Society of Human Genetics Annual Meeting. San Diego, CA.