Medicine and Health Sciences Commons^™

Bilirubin Nanoparticles Reduce Diet-Induced Hepatic Steatosis, Improve Fat Utilization, And Increase Plasma Β-Hydroxybutyrate, Terry D. Hinds Jr., Justin F. Creeden, Darren M. Gordon, Donald F. Stec, Matthew C. Donald, David E. Stec

Pharmacology and Nutritional Sciences Faculty Publications

The inverse relationship of plasma bilirubin levels with liver fat accumulation has prompted the possibility of bilirubin as a therapeutic for non-alcoholic fatty liver disease. Here, we used diet-induced obese mice with non-alcoholic fatty liver disease treated with pegylated bilirubin (bilirubin nanoparticles) or vehicle control to determine the impact on hepatic lipid accumulation. The bilirubin nanoparticles significantly reduced hepatic fat, triglyceride accumulation, de novo lipogenesis, and serum levels of liver dysfunction marker aspartate transaminase and ApoB100 containing very-low-density lipoprotein. The bilirubin nanoparticles improved liver function and activated the hepatic β-oxidation pathway by increasing PPARα and acyl-coenzyme A oxidase 1. …

How Minority Parents Could Help Children Develop Healthy Eating Behaviors: Parent And Child Perspectives, Chishinga Callender, Denisse Velazquez, Meheret Adera, Jayna M Dave, Norma Olvera, Tzu-An Chen, Shana Alford, Debbe Thompson

Children’s Nutrition Research Center Staff Publications

Minority children and children living in under-resourced households are at the greatest risk for obesity and diet-related disparities. Identifying effective strategies to reduce these risks is an important step in child obesity prevention. Parents influence the home environment and play a critical role in child obesity prevention. Eighteen parent–child dyads living in under-resourced Houston area communities participated in a mixed methods study (online surveys, telephone interviews). The purpose of the research reported here was to conduct a secondary analysis of the qualitative data to explore Black/African American and Hispanic parent and child perspectives of the ways in which parents could …

Cd47 Differentially Regulates White And Brown Fat Function, Heather Norman-Burgdolf, Dong Li, Patrick G. Sullivan, Shuxia Wang

Pharmacology and Nutritional Sciences Faculty Publications

Mechanisms that enhance energy expenditure are attractive therapeutic targets for obesity. Previously we have demonstrated that mice lacking cd47 are leaner, exhibit increased energy expenditure, and are protected against diet-induced obesity. In this study, we further defined the physiological role of cd47 deficiency in regulating mitochondrial function and energy expenditure in both white and brown adipose tissue. We observed that cd47 deficient mice (under normal chow diet) had comparable amount of white fat mass but reduced white adipocyte size as compared to wild-type mice. Subsequent ex vivo and in vitro studies suggest enhanced lipolysis, and not impaired lipogenesis or energy …

Aligning Food Environments With Institutional Values: A Mixed Methods Study Of Oregon Health Care Organizations, Elizaveta Walker

Dissertations and Theses

A major driver of the obesity epidemic is obesogenic food environments, characterized by nutrient-poor and energy-dense foods that saturate the collective physical, economic and sociocultural conditions that influence nutritional status. Food environments in organizations such as hospitals and public health agencies warrant special consideration given their health-focused mission. Improving food environments within health care settings has been highlighted by the Centers for Disease Control and Prevention (CDC) as one of seven key strategies to prevent obesity. However, most of the refereed literature examining healthy food environment policies (HFEPs) within hospitals focuses on the inpatient dietary environment, leaving a paucity of …

Regional Disparities In Healthy Eating And Nutritional Status In South Korea: Korea National Health And Nutrition Examination Survey 2017, Jounghee Lee, Jaesin Sa

BACKGROUND/OBJECTIVES: Concerns about regional disparities in heathy eating and nutritional status among South Korean adults are increasing. This study aims to identify the magnitude of regional disparities in diet and nutritional status among Korean adults who completed the 2017 Korea National Health and Nutrition Examination Survey (KNHANES).

SUBJECTS/METHODS: The participants were a nationally representative sample of Korean adults aged 19 years and older from the 2017 KNHANES (n = 6,126). We employed the svy commands in STATA to accommodate the complex survey design. The relative concentration index (RCI), absolute concentration index (ACI) and index of disparity were used to measure …

The Lived Experience Of Obesity, Spirituality, And Health Behaviors In African American Women, Andrea S. Poynter

Electronic Theses and Dissertations

Obesity is one of the fastest-growing health concerns impacting all racial, ethnic, gender, and socioeconomic groups in the United States of America. More than one-third of the U.S. adult population is classified as being obese (Obesity Society, 2014). Novak and Brownell (2012) identified that “obesity rates are consistently rising higher each year than in previous years” (p. 2345). Obesity has reached epidemic proportions in all races and genders within the US with African American women comprising a majority of those impacted by this chronic health condition. Obesity rates are well documented within the literature but what is lacking is the …

Stat1 Dissociates Adipose Tissue Inflammation From Insulin Sensitivity In Obesity, Aaron R Cox, Natasha Chernis, David A Bader, Pradip K Saha, Peter M Masschelin, Jessica B Felix, Robert Sharp, Zeqin Lian, Vasanta Putluri, Kimal Rajapakshe, Kang Ho Kim, Dennis T Villareal, Reina Armamento-Villareal, Huaizhu Wu, Cristian Coarfa, Nagireddy Putluri, Sean M Hartig

Faculty, Staff and Students Publications

Obesity fosters low-grade inflammation in white adipose tissue (WAT) that may contribute to the insulin resistance that characterizes type 2 diabetes. However, the causal relationship of these events remains unclear. The established dominance of STAT1 function in the immune response suggests an obligate link between inflammation and the comorbidities of obesity. To this end, we sought to determine how STAT1 activity in white adipocytes affects insulin sensitivity. STAT1 expression in WAT inversely correlated with fasting plasma glucose in both obese mice and humans. Metabolomic and gene expression profiling established STAT1 deletion in adipocytes (STAT1a-KO) enhanced mitochondrial function …

A Step In The Right Direction: Point-Of-Care Ultrasound As An Evaluation Tool Of Achilles Tendon Injuries In The Emergency Department., Chase A Silvers, Robert Lowe, Eric Cortez

Trauma and Acute Care Articles

This report describes the diagnosis of an Achilles tendon tear in a female patient with an inconclusive physical exam, which was limited by the patient's body habitus. Expedient use of point-of-care ultrasound supported the diagnosis of an Achilles tear with findings of a tendinous defect, fibrous stranding, and surrounding anechoic fluid, suggestive of localized hemorrhage. The patient was splinted in plantar flexion and had prompt orthopedic referral with MRI that verified Achilles tear.

Obesity Indicators And C-Reactive Protein In Indonesian Adults (More Than Equal To 40 Years Old): The Indonesian Family Life Survey 5, Yeni Mahwati, Dieta Nurrika

Kesmas

C-reactive protein (CRP) is the best clinical marker for systemic inflammation. Obesity is associated with increased CRP levels. Systemic inflammation is present before morbidity occurs. Research reveals that the identification of obesity indicators and CRP levels is limited among Indonesians. The present study investigated the associations between obesity indicators (body mass index [BMI], waist circumference [WC], waist-to-hip ratio [WHR], waist-to-height ratio [WHtR]) and CRP levels among Indonesian adults. This cross-sectional study based on Indonesian Family Life Survey-5 2014–2015 was conducted among 3,386 adults (≥ 40 years) living in 13 provinces in Indonesia during the study period. All data were collected …

The Effect Of Obesity On Operative Time And Postoperative Complications For Peritrochanteric Femur Fractures., Hayden B Schuette, William M Durkin, Braden J Passias, Daniel Degenova, Carina Bertolini, Philip Myers, Benjamin C Taylor

Surgery Articles

Introduction The high prevalence of obesity among adults in the United States presents significant challenges to orthopedic surgeons. Obesity has been shown to increase operative time and complications in both elective and nonelective orthopedic surgeries. Despite this, there is a lack of literature evaluating the effect obesity has on operative time and postoperative complications following peritrochanteric fracture surgery. Methods and Materials We performed a retrospective review of patients who underwent isolated operative stabilization of a peritrochanteric femur fracture at our urban level one trauma center between 2010 and 2018. Patients were divided into an obese group, as defined by a …

Relationship Between Psychosocial-Cultural Factors And African American Women Obesity., Francoise Knox-Kazimierczuk

Journal of Health Disparities Research and Practice

Objective: To determine associations between African American female obesity and SEM variables.

Design: Data from the National Survey of American Life Self-Administered Questionnaire (NSAL-SAQ), a 2001–2003 nationally representative cross-sectional survey was used to extract data for African American women.

Participants: African American females at a BMI of 18.5 kg/m2 or greater were included in the final sample (n = 2,100) for analysis.

Main Outcome Measure(s): BMI

Analysis: Measures for socioecological model (SEM) were analyzed using a regression model in SPSS.

Results: Intrapersonal and community/institutional levels were found to be significantly associated with BMI. Two multiple regression analyses models were developed …

Attenuation Of Interferon Responses In The Obese Host And Ramifications For Influenza Virus Evolution, Rebekah Reed Honce

Theses and Dissertations (ETD)

The most insidious pandemic of modern life does not arise from an infectious agent but rather from malnutrition. With its global incidence tripling over the past three decades, obesity is a major public health concern. Obesity’s rising prevalence has also illuminated its impact on communicable diseases. Following the 2009 H1N1 influenza A virus pandemic, obesity was identified as a risk factor for increased disease severity and mortality in infected individuals. Obesity causes a chronic state of meta-inflammation with systemic implications for immunity, including delayed antiviral responses to influenza virus infection, poor recovery, and impaired immunological memory. However, the majority of …

Adipose Tissue As Pain Generator In The Lower Back And Lower Extremity: Application In Musculoskeletal Medicine, Se Won Lee, Craig Van Dien, Sun Jae Won

HCA Healthcare Journal of Medicine

Adipose tissue (AT) has diverse and important functions in body insulation, mechanical protection, energy metabolism and the endocrine system. Despite its relative abundance in the human body, the clinical significance of AT in musculoskeletal (MSK) medicine, particularly its role in painful MSK conditions, is under-recognized. Pain associated with AT can be divided into intrinsic (AT as a primary pain generator), extrinsic (AT as a secondary pain generator) or mixed origin. Understanding AT as an MSK pain generator, both by mechanism and its specific role in pain generation by body region, enhances the clinical decision-making process and guides therapeutic strategies in …

Psychological Impact Of Weight Management Interventions: Achieved Goals And Quality Of Life, Ali Samaha, Nidal Youssef, Maya Gebbawi, Hanan Al Nuqaidan, Mirna Fawaz

BAU Journal - Health and Wellbeing

Obesity is becoming a major health problem growing in strength and prevalence. It is often associated with large array of debilitating diseases and conditions including psychosocial impairments. Morbid obesity rarely responds to conservative treatment regimens but has been successfully managed with bariatric interventions that have been achieving sustained weight loss of about 50% of excess body weight with improvement or resolution of most obesity-associated conditions. This cross sectional study evaluates the impact of weight changes by bariatric interventions on psychosocial functioning among Lebanese patients. 38 participants who signed consent were examined at pre-interventional and 6-month follow-up period. The spectrum of …

High Molecular Weight Adiponectin Levels Are Inversely Associated With Adiposity In Pediatric Brain Tumor Survivors., Rebecca Ronsley, Shahrad Rod Rassekh, Adam Fleming, Brianna Empringham, William Jennings, Carol Portwine, Sarah Burrow, Shayna Zelcer, Donna L Johnston, Lehana Thabane, M Constantine Samaan

Paediatrics Publications

While children with brain tumors are surviving at record rates, survivors are at risk of cardiovascular disease and type 2 diabetes mellitus; these conditions may be driven by excess body fat. Adiponectin in an adipokine that is inversely associated with the fat mass, and has been linked to cardiometabolic risk stratification in the general population. However, adiponectin's profile and determinants in SCBT have not been established. We tested the hypothesis that high molecular weight (HMW) adiponectin levels, the more biologically active form of adiponectin, were associated with adiposity in SCBT similarly to non-cancer controls. Seventy-four SCBT (n = 32 female) …

Weight Status Of Children Aged 2-5 Years Old, Attending A Paediatric Outpatient Clinic And Its Association With Parental Feeding Style And Parental Perceptions Of Weight Status, Aisling Lee, Helen Callaghan, Dara Gallagher Dr, Annette Lalor, Louise Rattigan, Hilary Greaney, Laura Keaver

SURE Journal: Science Undergraduate Research Experience Journal

Background: A child’s weight status can allow health care professionals to assess their developmental growth. A child having a low or high weight for height could be due to an imbalance in nutrient intake occurring. It is important to balance dietary intake and physical activity to maintain a healthy weight status. Excessive consumption of food can lead to an overweight/obese weight status which is linked to non-communicable diseases. Parental feeding style can directly impact a child’s set of eating behaviours. Therefore, parents have a strong influence over a child’s growth pattern. In addition, parental awareness of childhood obesity is reported …

From The Democratic Republic Of The Congo To North Carolina: An Examination Of Chronic Disease Risk, Lauren R. Sastre Dr.

Journal of Refugee & Global Health

Refugees from the Democratic Republic of the Congo are one of the largest refugee groups globally and in the US, however, there is limited research with this group. Therefore, objectives of this study were to examine: 1) obesity and hypertension rates, 2) diet and lifestyle behavior changes, and 3) diet, lifestyle and social factors of obesity and hypertension risk of Congolese refugees in the US. This cross-sectional data collection utilized a survey developed specifically for this project. Clinical and anthropometric measures including height, weight and blood pressure were also obtained. Data analysis included descriptive and regression analysis. Participants (n=48, >18 …

Sensor-Measured Physical Activity Is Associated With Decreased Cardiovascular Disease Risk In African Americans, John A. Bernhart Ph.D., Mph, Ches, Gabrielle M. Turner-Mcgrievy Ph.D., Rd, Sarah Eustis, Mary J. Wilson Phd, Mph, Brent Hutto Msph, Sara Wilcox Phd, Edward A. Frongillo Jr. Ph.D., E. Angela Murphy

Faculty Publications

Introduction: Few studies have examined relationships between sensor-measured physical activity (PA) and cardiovascular disease (CVD) risk among African Americans. This study described relationships between PA and CVD risk in NEW Soul study participants. Methods: Participants completed a dual X-ray absorptiometry scan and measures of blood pressure, waist and hip circumference, height, and weight. Actigraph GTM accelerometers measured moderate to vigorous physical activity (MVPA). We assessed relationships between minutes/day of MVPA and total body fat percent, total lean body mass, total fat mass, total bone mass, total fat distribution, body mass index (BMI), systolic and diastolic blood pressure, and waist-to-hip ratio, …

Retrospective Study Examining Obesity Hypoventilation Syndrome In Covid+ Patients, Lily Chen, Areeb Masood, Ayman Khaddam, Alyssa Chen, Ildiko Lingvay, Henry Kwang

MEDI 9331 Scholarly Activities Clinical Years

Purpose: Coronavirus disease 2019 (COVID-19) has affected millions of people all over the world with worse proven outcomes in those with certain comorbid conditions, such as diabetes, cardiovascular disease, and pulmonary complications. The Rio Grande Valley located in South Texas with a largely Hispanic population has been hit especially hard during this pandemic with over 3,200 virus-related deaths. This region’s high population of diabetic and obese patients is likely correlated with the especially high mortality rate. While it is understood the impact that obesity has on worsening health outcomes, further research is needed to better understand whether more adverse COVID-19 …

The Central Melanocortin System And Human Obesity, Yongjie Yang, Yong Xu

Children’s Nutrition Research Center Staff Publications

The prevalence of obesity and the associated comorbidities highlight the importance of understanding the regulation of energy homeostasis. The central melanocortin system plays a critical role in controlling body weight balance. Melanocortin neurons sense and integrate the neuronal and hormonal signals, and then send regulatory projections, releasing anorexigenic or orexigenic melanocortin neuropeptides, to downstream neurons to regulate the food intake and energy expenditure. This review summarizes the latest progress in our understanding of the role of the melanocortin pathway in energy homeostasis. We also review the advances in the identification of human genetic variants that cause obesity via mechanisms that …

Differences In Adolescent Activity And Dietary Behaviors Across Home, School, And Other Locations Warrant Location-Specific Intervention Approaches., Adrian Ortega, Carolina M. Bejarano, Christopher C. Cushing, Vincent S. Staggs, Amy Papa, Chelsea Steel, Robin P. Shook, Debra K. Sullivan, Sarah C. Couch, Terry L. Conway, Brian E. Saelens, Karen Glanz, Lawrence D. Frank, Kelli L. Cain, Jacqueline Kerr, Jasper Schipperijn, James F Sallis, Jordan A. Carlson

Manuscripts, Articles, Book Chapters and Other Papers

BACKGROUND: Investigation of physical activity and dietary behaviors across locations can inform "setting-specific" health behavior interventions and improve understanding of contextual vulnerabilities to poor health. This study examined how physical activity, sedentary time, and dietary behaviors differed across home, school, and other locations in young adolescents.

METHODS: Participants were adolescents aged 12-16 years from the Baltimore-Washington, DC and the Seattle areas from a larger cross-sectional study. Participants (n = 472) wore an accelerometer and Global Positioning Systems (GPS) tracker (Mean days = 5.12, SD = 1.62) to collect location-based physical activity and sedentary data. Participants (n = 789) completed 24-h …

Winning In Weight-Loss: The Interaction Of Conscientiousness And Perceived Autonomy, Jason M. Curtis, Marc Lochbaum

Journal for Sports Neuroscience

ABSTRACT

Background

Understanding determinants for weight-loss is a national priority. Obesity is an epidemic with serious health consequences. Most of today’s obesity and overweight problems are being attributed to poor diets and not enough physical activity. These problems show no signs of slowing down with the behaviors of most Americans. The phenomenon of “The Biggest Loser” (different variants of weight-loss programs that consist of group exercise participation and nutrition therapy to elicit weight-loss, and hopefully behavior change) has spawned many variants in commercial health clubs. This prospectus study examined the direct and interactive or moderated effects of known determinants of …

The Impact Of Narratives And Active Video Games On Long-Term Moderate-To-Vigorous Physical Activity: A Randomized Controlled Trial Protocol, Dar Alon, Caio Victor Sousa, Tom Baranowski, Tiago V Barreira, Romina Cabrera-Perez, Kelly Chiu, Austin Fernandez, Amy Fleischman, Shirley Huang, Jungyun Hwang, Melanie C Green, I-Min Lee, Kelly Lee, Sarah Lessard, Lynne L Levitsky, Aika Misawa, Farzad Noubary, Ronald Samuels, Kyung Jin Sun, Debbe Thompson, Amy S Lu

Children’s Nutrition Research Center Staff Publications

Background: Although physical activity (PA) has been shown in helping prevent and treat obesity, current PA interventions are still not effective in ameliorating the obesity epidemic. Additional forms of PA need to be investigated to improve PA engagement and outcomes. We hypothesize that pairing a narrative (i.e., story) with an active video game (AVG), a less traditional form of PA, will increase participant engagement in PA. This paper presents the rationale, implementation, and pilot results of a study assessing the effect of narrative's impact on PA and a series of other health outcomes.

Objective: This paper presents the rationale, implementation, …

The Intertwined Relationship Between Malnutrition And Poverty, Faareha Siddiqui, Rehana Salam, Zohra S. Lassi, Jai K. Das

Woman and Child Health

Despite social and economic development, the burden of malnutrition across the globe remains unacceptably high. A vital relationship exists between nutritional status, human capital, and economic standing. Malnutrition adversely affects the physiological and mental capacity of individuals; which in turn hampers productivity levels, making them and their respective countries more susceptible to poverty. A two-way link exists between malnutrition and poverty, creating a vicious cycle with each fueling the other. Malnutrition produces conditions of poverty by reducing the economic potential of the population and likewise, poverty reinforces malnutrition by increasing the risk of food insecurity. The aim of the paper …

Increasing Patient Enrollment In The Move Program At The Va Medical Center: An Evidence-Based Practice Project, Mandy Spiers

Student Scholarly Projects

Practice Problem: This evidence-based practice project aimed to increase patient referrals to the MOVE program by educating providers about the importance and benefit of the Managing Obesity for Veterans Everywhere (MOVE) Program at the Biloxi, Veterans Affairs (VA) Medical Center.

PICOT: In obese, ambulatory care patients, what motivates increased referrals by practitioners to the MOVE Program to decrease BMI compared to the current referral system within two months?

Evidence: There was poor participation in the MOVE Program despite the high number of obese patients at the Biloxi, VA Medical Center. According to the data, only sixty of the 18,000 …

All-Cause Mortality In Metabolically Healthy Individuals Was Not Predicted By Overweight And Obesity, Qiuyue Tian, Anxin Wang, Yingting Zuo, Shuohua Chen, Haifeng Hou, Wei Wang, Shouling Wu, Youxin Wang

Research outputs 2014 to 2021

BACKGROUND

Metabolically healthy obesity (MHO) and metabolically healthy overweight (MH-OW) have been suggested to be important and emerging phenotypes with an increased risk of cardiovascular disease (CVD). However, whether MHO and MH-OW are associated with all-cause mortality remains inconsistent.

METHODS The association of MHO and MH-OW and all-cause mortality was determined in a Chinese community-based prospective cohort study (the Kailuan study), including 93,272 adults at baseline. Data were analyzed from 2006 to 2017. Participants were categorized into 6 mutually exclusive groups, according to BMI and metabolic syndrome (MetS) status. The primary outcome was all-cause death, and accidental deaths were excluded. …

Identifying, Adapting, And Implementing A Weight Management Program In Rural Primary Care, Gwenndolyn Porter

Theses & Dissertations

Rural adults are at heightened risk for obesity, yet evidence‐based interventions lack consistent translation into clinical practice. This multi-phase study addresses this gap. First, a systematic review and meta-analysis of rural adult weight loss interventions were conducted to assess overall impact. Though few studies reported participant representativeness, meta‐analyses revealed a significant weight reduction among interventions. Second, 10 focus groups were conducted with primary care (PC) staff to determine the feasibility of implementing a weight-management program through PC. Differences in responses among rural, micropolitan, and metropolitan was also assessed. Thematic analyses revealed rural PC currently lacks the capacity to manage patient …

Therapeutic Efficacy Of Antioxidants In Ameliorating Obesity Phenotype And Associated Comorbidities, Steven Tun, Caleb James Spainhower, Cameron Lee Cottrill, Hari Vishal Lakhani, Sneha S. Pillai, Anum Dilip, Hibba Chaudhry, Joseph I. Shapiro, Komal Sodhi

Pharmacology, Physiology and Toxicology

Obesity has been a worldwide epidemic for decades. Despite the abundant increase in knowledge regarding the etiology and pathogenesis of obesity, the prevalence continues to rise with estimates predicting considerably higher numbers by the year 2030. Obesity is characterized by an abnormal lipid accumulation, however, the physiological consequences of obesity are far more concerning. The development of the obesity phenotype constitutes dramatic alterations in adipocytes, along with several other cellular mechanisms which causes substantial increase in systemic oxidative stress mediated by reactive oxygen species (ROS). These alterations promote a chronic state of inflammation in the body caused by the redox …

Maternal Obesity Reduces Placental Autophagy Marker Expression In Uncomplicated Pregnancies, Matthew Cohen, Emily Guo, Aidan Pucchio, Barbra De Vrijer, Trevor G Shepherd, Genevieve Eastabrook

Obstetrics & Gynaecology Publications

AIM: Obesity has been associated with changes in autophagy and its increasing prevalence among pregnant women is implicated in higher rates of placental-mediated complications of pregnancy such as pre-eclampsia and intrauterine growth restriction. Autophagy is involved in normal placentation, thus changes in autophagy may lead to impaired placental function and development. The aim of this study was to investigate the connection between obesity and autophagy in the placenta in otherwise uncomplicated pregnancies.

METHODS: Immunohistochemistry and western blot analysis were done on placental and omental samples from obese (body mass index [BMI] ≥30 kg/m

RESULTS: As pre-pregnancy BMI increased, there was …

Obesity And Its Effect On Outcomes In Same-Day Bilateral Total Knee Arthroplasty, Ethan A Remily, Nequesha S Mohamed, Wayne A Wilkie, Tyler Smith, Anthony Judice, Salvador Forte, James Nace, Ronald E Delanois

Orthopedic Surgery Resident Research

Background: The niche surgery of same-day bilateral total knee arthroplasty (sd-BTKA) continues to create debate amongst specialists in arthroplasty. To date, there is a significant lack of literature on obese patients undergoing sd-BTKA, and no study has evaluated outcomes of this procedure when compared to non-obese patients. Therefore, this study will perform a retrospective analysis to compare (I) incidence, (II) demographics, and (III) complications of sd-BTKA in non-obese, obese, and morbidly obese patients in the United States from 2009 to 2016.

Methods: The National Inpatient Sample (NIS) database was queried for all individuals that underwent sd-BTKA from 2009 to 2016. …