Publications by authors named "Ajay Gupta"

460 Publications

COVID-19 and the Digitalisation of Cardiovascular Training and Education-A Review of Guiding Themes for Equitable and Effective Post-graduate Telelearning.

Front Cardiovasc Med 2021 2;8:666119. Epub 2021 Jul 2.

Department of Cardiology, Barts Heart Centre, Barts Health National Health Service Trust, London, United Kingdom.

The coronavirus disease-2019 (COVID-19) pandemic has had an unprecedented impact leading to novel adaptations in post-graduate medical education for cardiovascular and general internal medicine. Whilst the results of initial community COVID-19 vaccination are awaited, continuation of multimodality teaching and training that incorporates telelearning will have enduring benefit to post-graduate education and will place educational establishments in good stead to nimbly respond in future pandemic-related public health emergencies. With the rise in innovative virtual learning solutions, medical educators will have to leverage technology to develop electronic educational materials and virtual courses that facilitate adult learning. Technology-enabled virtual learning is thus a timely progression of hybrid classroom initiatives that are already adopted to varying degrees, with a need for faculty to serve as subject matter experts, to host and moderate online discussions, and to provide feedback and overall mentorship. As an extension from existing efforts, simulation-based teaching (SBT) and learning and the use of mixed reality technology should also form a greater core in the cardiovascular medicine curriculum. We highlight five foundational themes for building a successful e-learning model in cardiovascular and general post-graduate medical training: (1) digital solutions and associated infrastructure; (2) equity in access; (3) participant engagement; (4) diversity and inclusion; and (5) patient confidentiality and governance framework. With digitalisation impacting our everyday lives and now how we teach and train in medicine, these five guiding principles provide a cognitive scaffold for careful consideration of the required ecosystem in which cardiovascular and general post-graduate medical education can effectively operate. With due consideration of various e-learning options and associated infrastructure needs; and adoption of strategies for participant engagement under sound and just governance, virtual training in medicine can be effective, inclusive and equitable through the COVID-19 era and beyond.
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http://dx.doi.org/10.3389/fcvm.2021.666119DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8283504PMC
July 2021

Design and In-silico study of bioimaging fluorescence Graphene quantum dot-Bovine serum albumin complex synthesized by diimide-activated amidation.

Comput Biol Chem 2021 Jul 8;93:107543. Epub 2021 Jul 8.

Department of Research and Development, Ganpat University, Mehsana, Gujarat, India.

Graphene quantum dot possesses advantageous characteristics like tunable fluorescence, nanometer size, low cytotoxicity, high biocompatibility enabling them as an ideal material for fluorescence bio-imaging. It exhibits a unique characteristic of DNA cleavage activity enhancer, gene/drug carrier, and anticancer targeting applications. In this article, we discussed the preparation of graphene quantum dot through the bottom-up method. Carbodiimide-activated amidation reactions were used for the functionalization of graphene quantum dot with Bovine Serum Albumin. Fluorescence spectroscopy data showed that the graphene quantum dot has size-dependent fluorescence emission. TEM and AFM studies showed that the size of graphene quantum dot was around 20 nm with narrow size distribution. Carbodiimide-activated amidation conjugation was successful in binding the protein onto graphene quantum dot and these conjugates were characterized by DLS, FTIR, fluorescence spectroscopy, and agarose gel electrophoresis. We also studied the structural-based in-silico molecular dynamic simulation by AutoDock, PyRx, and Discovery Studio Visualizer. Based on the virtual screening analysis and higher negative energy incorporation, it is observed that graphene quantum dot conjugated with bovine serum albumin quickly and formed is highly stable complex, which makes them a potential candidate for future applications in the field of bio-imaging, bio-sensing, gene/drug delivery, and tumor theragnostic.
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http://dx.doi.org/10.1016/j.compbiolchem.2021.107543DOI Listing
July 2021

Long-Term Incidence of Stroke and Dementia in ASCOT.

Stroke 2021 Jul 1:STROKEAHA120033489. Epub 2021 Jul 1.

National Heart and Lung Institute, Imperial College London (A.G., S.R., A.W., J.M., P.S.S.).

Background And Purpose: Management of stroke risk factors might reduce later dementia. In ASCOT (Anglo-Scandinavian Outcome Trial), we determined whether dementia or stroke were associated with different blood pressure (BP)-lowering regimens; atorvastatin or placebo; and mean BP, BP variability, and mean cholesterol levels.

Methods: Participants with hypertension and ≥3 cardiovascular disease risk factors were randomly allocated to amlodipine- or atenolol-based BP-lowering regimen targeting BP <140/90 mm Hg for 5.5 years. Participants with total cholesterol ≤6.5 mmol/L were also randomly allocated to atorvastatin 10 mg or placebo for 3.3 years. Mean and LDL (low-density lipoprotein) cholesterol, BP, and SD of BP were calculated from 6 months to end of trial. UK participants were linked to electronic health records to ascertain deaths and hospitalization in general and mental health hospitals. Dementia and stroke were ascertained by validated code lists and within-trial ascertainment.

Results: Of 8580 UK participants, 7300 were followed up to 21 years from randomization. Atorvastatin for 3.3 years had no measurable effect on stroke (264 versus 272; adjusted hazard ratio [HR], 0.92 [95% CI, 0.78-1.09]; =0.341) or dementia (238 versus 227; adjusted HR, 0.98 [95% CI, 0.82-1.18]; =0.837) compared with placebo. Mean total cholesterol was not associated with later stroke or dementia. An amlodipine-based compared with an atenolol-based regimen for 5.5 years reduced stroke (443 versus 522; adjusted HR, 0.82 [95% CI, 0.72-0.93]; =0.003) but not dementia (450 versus 465; adjusted HR, 0.94 [95% CI, 0.82-1.07]; =0.334) over follow-up. BP variability (SD mean BP) was associated with a higher risk of dementia (per 5 mm Hg HR, 1.14 [95% CI, 1.06-1.24]; <0.001) and stroke (HR, 1.21 [95% CI, 1.12-1.32]; <0.001) adjusted for mean BP.

Conclusions: An amlodipine-based BP regimen reduced the long-term incidence of stroke compared with an atenolol-based regimen but had no measurable effect on dementia. Atorvastatin had no effect on either stroke or dementia. Higher BP variability was associated with a higher incidence of later dementia and stroke.
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http://dx.doi.org/10.1161/STROKEAHA.120.033489DOI Listing
July 2021

Low-dose aspirin for early COVID-19: does the early bird catch the worm?

Expert Opin Investig Drugs 2021 Jul 12:1-4. Epub 2021 Jul 12.

Division of Nephrology, Hypertension and Kidney Transplantation, University of California, Irvine, School of Medicine, Irvine, CA, USA.

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http://dx.doi.org/10.1080/13543784.2021.1950687DOI Listing
July 2021

Epilepsy surgery in infants up to 3 months of age: Safety, feasibility, and outcomes: A multicenter, multinational study.

Epilepsia 2021 Jun 14. Epub 2021 Jun 14.

Department of Neurosurgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.

Objective: Drug-resistant epilepsy (DRE) during the first few months of life is challenging and necessitates aggressive treatment, including surgery. Because the most common causes of DRE in infancy are related to extensive developmental anomalies, surgery often entails extensive tissue resections or disconnection. The literature on "ultra-early" epilepsy surgery is sparse, with limited data concerning efficacy controlling the seizures, and safety. The current study's goal is to review the safety and efficacy of ultra-early epilepsy surgery performed before the age of 3 months.

Methods: To achieve a large sample size and external validity, a multinational, multicenter retrospective study was performed, focusing on epilepsy surgery for infants younger than 3 months of age. Collected data included epilepsy characteristics, surgical details, epilepsy outcome, and complications.

Results: Sixty-four patients underwent 69 surgeries before the age of 3 months. The most common pathologies were cortical dysplasia (28), hemimegalencephaly (17), and tubers (5). The most common procedures were hemispheric surgeries (48 procedures). Two cases were intentionally staged, and one was unexpectedly aborted. Nearly all patients received blood products. There were no perioperative deaths and no major unexpected permanent morbidities. Twenty-five percent of patients undergoing hemispheric surgeries developed hydrocephalus. Excellent epilepsy outcome (International League Against Epilepsy [ILAE] grade I) was achieved in 66% of cases over a median follow-up of 41 months (19-104 interquartile range [IQR]). The number of antiseizure medications was significantly reduced (median 2 drugs, 1-3 IQR, p < .0001). Outcome was not significantly associated with the type of surgery (hemispheric or more limited resections).

Significance: Epilepsy surgery during the first few months of life is associated with excellent seizure control, and when performed by highly experienced teams, is not associated with more permanent morbidity than surgery in older infants. Thus surgical treatment should not be postponed to treat DRE in very young infants based on their age.
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http://dx.doi.org/10.1111/epi.16959DOI Listing
June 2021

Distribution of Fluoride in Plasma, Brain, and Bones and Associated Oxidative Damage After Induced Chronic Fluorosis in Wistar Rats.

Biol Trace Elem Res 2021 Jun 14. Epub 2021 Jun 14.

Division of Veterinary Animal Nutrition, Faculty of Veterinary Sciences and Animal Husbandry, SKUAST-J, Ranbir Singh Pura, 181102, Jammu and Kashmir, India.

The study was aimed to determine fluoride levels in plasma, brain, and bones of Wistar rats following chronic administration of fluoride at different dose levels and the consequent oxidative damage inflicted in these tissues. Brain histomorphology and bone radiographs were also evaluated to assess the extent of damage in these organs. Eighteen rats were randomly divided into three groups with six animals in each group. Group I served as control and groups II and III received 50 and 100 ppm fluoride in tap water, respectively for 180 days. A dose-dependent rise in the levels of fluoride in plasma, brain, and bones was observed in rats. Significant (P < 0.05) alterations in levels of total thiols, glutathione peroxidase, glutathione reductase, acetylcholinesterase, catalase, superoxide dismutase, lipids, as well as protein peroxidation in blood and brain were observed as compared to control in a dose-dependent manner. Radiological examination of bone revealed thinning of bone cortex with haphazard ossification, reduced bone density, and widening of marrow cavity indicating occurrence of flawed bone remodeling upon chronic fluoride exposure. Improper mineralization in bones of intoxicated rats indirectly reflected reduced bone tensile strength. Moreover, alterations in plasma Ca:P ratio and high levels of fluoride in bone ash indicated that chronic fluoride exposure leads to alterations in the bone matrix further corroborating the radio-graphical findings. Additionally, severe microscopic alterations were recorded in the cerebrum and cerebellum of treated rats which included neuronal necrosis, gliosis, spongiosis, perivascular cuffing, congestion, and hemorrhage which correlated well with oxidative changes induced by fluoride intoxication in the brain tissue of rats.
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http://dx.doi.org/10.1007/s12011-021-02782-3DOI Listing
June 2021

Temporal clustering, tissue composition, and total variation for mapping oxygen extraction fraction using QSM and quantitative BOLD.

Magn Reson Med 2021 Jun 10. Epub 2021 Jun 10.

Department of Radiology, Weill Cornell Medical College, New York, New York, USA.

Purpose: To improve the accuracy of quantitative susceptibility mapping plus quantitative blood oxygen level-dependent magnitude (QSM+qBOLD or QQ) based mapping of oxygen extraction fraction (OEF) and cerebral metabolic rate of oxygen (CMRO ) using temporal clustering, tissue composition, and total variation (CCTV).

Methods: Three-dimensional multi-echo gradient echo and arterial spin labeling images were acquired from 11 healthy subjects and 33 ischemic stroke patients. Diffusion-weighted imaging (DWI) was also obtained from patients. The CCTV mapping was developed for incorporating tissue-type information into clustering of the previous cluster analysis of time evolution (CAT) and applying total variation (TV). The QQ-based OEF and CMRO were reconstructed with CAT, CAT+TV (CATV), and the proposed CCTV, and results were compared using region-of-interest analysis, Kruskal-Wallis test, and post hoc Wilcoxson rank sum test.

Results: In simulation, CCTV provided more accurate and precise OEF than CAT or CATV. In healthy subjects, QQ-based OEF was less noisy and more uniform with CCTV than CAT. In subacute stroke patients, OEF with CCTV had a greater contrast-to-noise ratio between DWI-defined lesions and the unaffected contralateral side than with CAT or CATV: 1.9 ± 1.3 versus 1.1 ± 0.7 (P = .01) versus 0.7 ± 0.5 (P < .001).

Conclusion: The CCTV mapping significantly improves the robustness of QQ-based OEF against noise.
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http://dx.doi.org/10.1002/mrm.28875DOI Listing
June 2021

Management of Patients with Asymptomatic Carotid Stenosis May Need to Be Individualized: A Multidisciplinary Call for Action.

J Stroke 2021 May 31;23(2):202-212. Epub 2021 May 31.

Department of Neurology & Stroke Program, University of Maryland School of Medicine, Baltimore, MD, USA.

The optimal management of patients with asymptomatic carotid stenosis (ACS) is the subject of extensive debate. According to the 2017 European Society for Vascular Surgery guidelines, carotid endarterectomy should (Class IIa; Level of Evidence: B) or carotid artery stenting may be considered (Class IIb; Level of Evidence: B) in the presence of one or more clinical/imaging characteristics that may be associated with an increased risk of late ipsilateral stroke (e.g., silent embolic infarcts on brain computed tomography/magnetic resonance imaging, progression in the severity of ACS, a history of contralateral transient ischemic attack/stroke, microemboli detection on transcranial Doppler, etc.), provided documented perioperative stroke/death rates are <3% and the patient's life expectancy is >5 years. Besides these clinical/imaging characteristics, there are additional individual, ethnic/racial or social factors that should probably be evaluated in the decision process regarding the optimal management of these patients, such as individual patient needs/patient choice, patient compliance with best medical treatment, patient sex, culture, race/ethnicity, age and comorbidities, as well as improvements in imaging/operative techniques/outcomes. The present multispecialty position paper will present the rationale why the management of patients with ACS may need to be individualized.
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http://dx.doi.org/10.5853/jos.2020.04273DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8189852PMC
May 2021

A Multicentric, Randomized, Controlled Phase III Study of Centhaquine (Lyfaquin) as a Resuscitative Agent in Hypovolemic Shock Patients.

Drugs 2021 Jun 1;81(9):1079-1100. Epub 2021 Jun 1.

New Era Hospital, Nagpur, Maharashtra, India.

Introduction: Centhaquine (Lyfaquin) showed significant safety and efficacy in preclinical and clinical phase I and II studies.

Methods: A prospective, multicentric, randomized phase III study was conducted in patients with hypovolemic shock, systolic blood pressure (SBP) ≤ 90 mmHg, and blood lactate levels ≥ 2 mmol/L. Patients were randomized in a 2:1 ratio to the centhaquine group (n = 71) or the control (saline) group (n = 34). Every patient received standard of care (SOC) and was followed for 28 days. The study drug (normal saline or centhaquine 0.01 mg/kg) was administered in 100 mL of normal saline infusion over 1 h. The primary objectives were to determine changes (mean through 48 h) in SBP, diastolic blood pressure (DBP), blood lactate levels, and base deficit. The secondary objectives included the amount of fluids, blood products, and vasopressors administered in the first 48 h, duration of hospital stay, time in intensive care units, time on ventilator support, change in acute respiratory distress syndrome (ARDS), multiple organ dysfunction syndrome (MODS), and the proportion of patients with 28-day all-cause mortality.

Results: The demographics of patients and baseline vitals in both groups were comparable. The cause of hypovolemic shock was trauma in 29.4 and 47.1% of control group and centhaquine group patients, respectively, and gastroenteritis in 44.1 and 29.4%, respectively. Shock index (SI) and quick sequential organ failure assessment at baseline were similar in the two groups. An equal amount of fluids and blood products were administered in both groups during the first 48 h of resuscitation. A lesser amount of vasopressors was needed in the first 48 h of resuscitation in the centhaquine group. An increase in SBP from baseline was consistently higher up to 48 h (12.9% increase in area under the curve from 0 to 48 h [AUC]) in the centhaquine group than in the control group. A significant increase in pulse pressure (48.1% increase in AUC) in the centhaquine group compared with the control group suggests improved stroke volume due to centhaquine. The SI was significantly lower in the centhaquine group from 1 h (p = 0.032) to 4 h (p = 0.049) of resuscitation. Resuscitation with centhaquine resulted in a significantly greater number of patients with improved blood lactate (control 46.9%; centhaquine 69.3%; p = 0.03) and the base deficit (control 43.7%; centhaquine 69.8%; p = 0.01) than in the control group. ARDS and MODS improved with centhaquine, and an 8.8% absolute reduction in 28-day all-cause mortality was observed in the centhaquine group.

Conclusion: Centhaquine is an efficacious resuscitative agent for treating hypovolemic shock. The efficacy of centhaquine in distributive shock is being explored.

Trial Registration: Clinical Trials Registry, India; ctri.icmr.org.in, CTRI/2019/01/017196; clinicaltrials.gov, NCT04045327.
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http://dx.doi.org/10.1007/s40265-021-01547-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8167383PMC
June 2021

An Investigator-Initiated, Prospective, Single-Center, Open-Label Clinical Study to Evaluate Safety and Performance of Intra-Articular Hyaluronic Acid (IA-HA) (Biovisc Ortho) in Patients with Osteoarthritis (OA) of the Knee.

Clin Pharmacol 2021 11;13:73-82. Epub 2021 May 11.

Department of Physical Medicine & Rehabilitation, VMM College and Safdarjang Hospital, New Delhi, 110029, India.

Objective: IA-HA is injected into the osteoarthritis knee as a viscosupplementation for therapeutic purposes. This clinical trial was carried out for evaluating the efficacy and safety of Biovisc Ortho IA-HA (20 mg/2 mL) in a 2 mL prefilled syringe.

Design: The study was conducted as an open-label, single-center, single-arm clinical trial in India. Patients of knee OA with moderate to severe symptoms for a minimum duration of 3 months were included in the study. Five visits were conducted at weekly intervals and the investigational product was administered at each visit. Two follow-up visits were conducted at 3 and 6 months after the completion of the last injection cycle. The primary outcome variable was change in KOOS pain score from baseline. The secondary outcome variables were analyzed for other KOOS scales and safety of the device.

Results: Change in KOOS pain score at 6 months from baseline was 29.71±15.74 and the change in mean KOOS score for pain was statistically significant (<0.0001) for all post-baseline visits. Statistically significant improvement was observed for mean values of efficacy assessments (KOOS) during the study period (6 months) for all the domains evaluated, including pain, joint function and quality of life.

Conclusion: Despite being an open, noncomparative study, the safety and efficacy results of IA-HA establish the therapeutic effect of the treatment throughout the study period of 6 months and are safe.
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http://dx.doi.org/10.2147/CPAA.S298589DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8123980PMC
May 2021

Spotlight on Air Pollution and Cardiovascular Disease: A Call for Urgent Action.

Authors:
Ajay K Gupta

J Am Heart Assoc 2021 May 4;10(10):e022209. Epub 2021 May 4.

William Harvey Research Institute Barts and the London School of Medicine and Dentistry Queen Mary University of London United Kingdom.

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http://dx.doi.org/10.1161/JAHA.121.022209DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8200705PMC
May 2021

Population-based input function for TSPO quantification and kinetic modeling with [C]-DPA-713.

EJNMMI Phys 2021 Apr 29;8(1):39. Epub 2021 Apr 29.

Department of Radiology, Weill Cornell Medical College, New York, NY, 10021, USA.

Introduction: Quantitative positron emission tomography (PET) studies of neurodegenerative diseases typically require the measurement of arterial input functions (AIF), an invasive and risky procedure. This study aims to assess the reproducibility of [C]DPA-713 PET kinetic analysis using population-based input function (PBIF). The final goal is to possibly eliminate the need for AIF.

Materials And Methods: Eighteen subjects including six healthy volunteers (HV) and twelve Parkinson disease (PD) subjects from two [C]-DPA-713 PET studies were included. Each subject underwent 90 min of dynamic PET imaging. Five healthy volunteers underwent a test-retest scan within the same day to assess the repeatability of the kinetic parameters. Kinetic modeling was carried out using the Logan total volume of distribution (V) model. For each data set, kinetic analysis was performed using a patient-specific AIF (PSAIF, ground-truth standard) and then repeated using the PBIF. PBIF was generated using the leave-one-out method for each subject from the remaining 17 subjects and after normalizing the PSAIFs by 3 techniques: (a) Weight×Dose, (b) area under AIF curve (AUC), and (c) Weight×AUC. The variability in the V measured with PSAIF, in the test-retest study, was determined for selected brain regions (white matter, cerebellum, thalamus, caudate, putamen, pallidum, brainstem, hippocampus, and amygdala) using the Bland-Altman analysis and for each of the 3 normalization techniques. Similarly, for all subjects, the variabilities due to the use of PBIF were assessed.

Results: Bland-Altman analysis showed systematic bias between test and retest studies. The corresponding mean bias and 95% limits of agreement (LOA) for the studied brain regions were 30% and ± 70%. Comparing PBIF- and PSAIF-based V estimate for all subjects and all brain regions, a significant difference between the results generated by the three normalization techniques existed for all brain structures except for the brainstem (P-value = 0.095). The mean % difference and 95% LOA is -10% and ±45% for Weight×Dose; +8% and ±50% for AUC; and +2% and ± 38% for Weight×AUC. In all cases, normalizing by Weight×AUC yielded the smallest % bias and variability (% bias = ±2%; LOA = ±38% for all brain regions). Estimating the reproducibility of PBIF-kinetics to PSAIF based on disease groups (HV/PD) and genotype (MAB/HAB), the average V values for all regions obtained from PBIF is insignificantly higher than PSAIF (%difference = 4.53%, P-value = 0.73 for HAB; and %difference = 0.73%, P-value = 0.96 for MAB). PBIF also tends to overestimate the difference between PD and HV for HAB (% difference = 32.33% versus 13.28%) and underestimate it in MAB (%difference = 6.84% versus 20.92%).

Conclusions: PSAIF kinetic results are reproducible with PBIF, with variability in V within that obtained for the test-retest studies. Therefore, V assessed using PBIF-based kinetic modeling is clinically feasible and can be an alternative to PSAIF.
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http://dx.doi.org/10.1186/s40658-021-00381-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8085191PMC
April 2021

Extracranial Vascular Disease: Carotid Stenosis and Plaque Imaging.

Neuroimaging Clin N Am 2021 May;31(2):157-166

Department of Radiology, Weill Cornell Medicine, 525 East 68th Street, Box 141, New York, NY 10021, USA; Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, New York, NY, USA.

Carotid atherosclerosis is an important contributor to ischemic stroke. When imaging carotid atherosclerosis, it is essential to describe both the degree of luminal stenosis and specific plaque characteristics because both are risk factors for cerebrovascular ischemia. Carotid atherosclerosis can be accurately assessed using multiple imaging techniques, including ultrasonography, computed tomography angiography, and magnetic resonance angiography. By understanding the underlying histopathology, the specific plaque characteristics on each of these imaging modalities can be appreciated. This article briefly describes some of the most commonly encountered plaque features, including plaque calcification, intraplaque hemorrhage, lipid-rich necrotic core, and plaque ulceration.
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http://dx.doi.org/10.1016/j.nic.2021.02.002DOI Listing
May 2021

Aspirin Resistance in Obese and Elderly Patients with COVID-19?

Am J Med 2021 04;134(4):e297

Department of Medicine, School of Medicine, University of California Irvine, Irvine. Electronic address:

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http://dx.doi.org/10.1016/j.amjmed.2020.09.006DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8054641PMC
April 2021

Pediatric Epilepsy Surgery: Indications and Evaluation.

Indian J Pediatr 2021 Mar 19. Epub 2021 Mar 19.

Center of Excellence & Advanced Research on Childhood Neurodevelopmental Disorders, Child Neurology Division, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, 110029, India.

Epilepsy is a common neurological condition in children. It is usually amenable to drug therapy. However, nearly one-third of patients may be refractory to antiseizure drugs. Poor compliance and nonepileptic events should be ruled out as possible causes of drug-resistant epilepsy (DRE). After failing adequate trials of two appropriate antiseizure drugs, patients with focal DRE or poorly classifiable epilepsy or epileptic encephalopathy with focal electro-clinical features should be worked up for surgical candidacy. A randomized controlled trial provided a class I evidence for epilepsy surgery in pediatric DRE. Pre-surgical screening workup typically includes a high-resolution epilepsy protocol brain magnetic resonance imaging (MRI) and a high-quality in-patient video electroencephalography evaluation. Advanced investigations such as positron emission tomography (PET), single-photon emission computed tomography (SPECT), and magnetoencephalography (MEG) may be required in selected cases especially when brain MRI is normal, and further evidence for anatomo-electro-clinical concordance is necessary to refine candidacy for surgery and surgical strategy. Some children may also need functional MRI to map eloquent regions of interest such as motor, sensory, and language functions to avoid unacceptable neurological deficits after surgery. Selected children may need invasive long-term electroencephalographic monitoring using stereotactically implanted intracranial depth electrodes or subdural grids. Surgical options include resective surgeries (lesionectomy, lobectomy, multilobar resections) and disconnective surgeries (corpus callosotomy, etc.) with the potential to obtain seizure freedom. Other surgical procedures, typically considered to be palliative are neuromodulation [deep brain stimulation (DBS), vagal nerve stimulation (VNS), and responsive neural stimulation (RNS)]. DBS and RNS are currently not approved in children. Pediatric DRE should be evaluated early considering the risk of epileptic encephalopathy and negative impact on cognition.
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http://dx.doi.org/10.1007/s12098-021-03668-xDOI Listing
March 2021

Effectiveness of convalescent plasma in Indian patients with COVID-19.

Blood Cells Mol Dis 2021 05 18;88:102548. Epub 2021 Feb 18.

Hematology & Bone Marrow Transplant Division, Max Healthcare, New Delhi, India. Electronic address:

Background: Convalescent plasma (CP) is being used as a treatment option in hospitalized patients with COVID-19. Till date, there is conflicting evidence on efficacy of CP in reducing COVID-19 related mortality.

Objective: To evaluate the effect of CP on 28-day mortality reduction in patients with COVID-19.

Methods: We did a multi-centre, retrospective case control observational study from 1st May 2020 to 31st August 2020. A total of 1079 adult patients with moderate and severe COVID-19 requiring oxygen, were reviewed. Of these, 694 patients were admitted to ICU. Out of these, 333 were given CP along with best supportive care and remaining 361 received best supportive care only.

Results: In the overall group of 1079 patients, mortality in plasma vs no plasma group was statistically not significant (22.4% vs 18.5%; p = 0.125; OR = 1.27, 95% CI: 0.94--1.72). However, in patients with COVID-19 admitted to ICU, mortality was significantly lower in plasma group (25.5% vs 33.2%; p = 0.026; OR = 0.69, 95%CI: 0.50-0.96). This benefit of reduced mortality was most seen in age group 60 to 74 years (26.7% vs 43.0%; p = 0.004; OR = 0.48, 95% CI: 0.29-0.80), driven mostly by females of this age group (23.1% vs 53.5%; p = 0.013; OR = 0.26, 95% CI: 0.09-0.78). Significant difference in mortality was observed in patients with one comorbidity (22.3% vs 36.5%; p = 0.004; OR = 0.50, 95% CI: 0.31-0.80). Moreover, patients on ventilator had significantly lower mortality in the plasma arm (37.2% vs 49.3%; p = 0.009; OR = 0.61, 95% CI: 0.42-0.89); particularly so for patients on invasive mechanical ventilation (63.9% vs 82.9%; p = 0.014; OR = 0.37, 95% CI: 0.16-0.83).

Conclusion: The use of CP was associated with reduced mortality in COVID-19 elderly patients admitted in ICU, above 60 years of age, particularly females, those with comorbidities and especially those who required some form of ventilation.
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http://dx.doi.org/10.1016/j.bcmd.2021.102548DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7891064PMC
May 2021

Early and Mid-Term Implications of the COVID-19 Pandemic on the Physical, Behavioral and Mental Health of Healthcare Professionals: The CoPE-HCP Study Protocol.

Front Psychol 2021 2;12:616280. Epub 2021 Feb 2.

Barts Heart Centre, St. Bartholomew's Hospital, Barts Health NHS Trust, London, United Kingdom.

Introduction: The COVID-19 pandemic has led to unprecedented strain to healthcare systems worldwide and posed unique challenges to the healthcare professionals (HCPs) and the general public.

Objectives: The aim of this study is to evaluate the impact of COVID-19 on the mental health, behavioral, and physical wellbeing of HCPs in the early and mid-term periods of the pandemic in comparison to non-HCPs. Thus, facilitating and guiding optimum planning and delivery of support to HCPs.

Methods And Analysis: An observational cross-sectional survey and cohort study aiming to enroll over 1050 participants (minimum, 800 HCPs and 250 controls). Study questionnaires will be completed at baseline and after 6-weeks and 4-months. Recruitment initiated July 2020. The study was designed in London, United Kingdom, but open to participants worldwide. Baseline: Questionnaires comprising of validated self-administered screening tools for depression, anxiety, sleep-related issues, wellbeing, and burnout. The questionnaires also explore changes in behavior and physical wellbeing of the participants. In addition, associations of these mental health and behavioral factors with work-related factors and support will be explored. Six-weeks and 4-months follow-up: Follow-up questionnaires will assess change in symptoms of anxiety and depression, sleep disorders, use of alcohol and other substances, behavioral or interpersonal relationship changes. Physical wellbeing will be assessed through the presence of suspected or confirmed COVID-19 infection and absence from work. We will also evaluate the impact of variable provision of personal protection equipment (supply and training), extended working hours, and concern for the wellbeing of family members, anxiety levels, and evidence of burnout.

Statistical Considerations: The study has 80% power to detect a 10% difference of combined depression and/or anxiety symptoms between the groups using two-sided type 1 error at 0.05 at baseline. Assuming that only 50% of these HCPs agree to be a part of a cohort survey, we will have 80% power to detect around 12% difference in the two groups in reported physical symptoms (20% vs. 32.3%), or prevalence of depression and/or anxiety at the end of the study.

Ethics: The study was approved by the Cambridge East, Research Ethics Committee (20/EE/0166).

Trial Registration Number: ClinicalTrials.gov, NCT04433260.
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http://dx.doi.org/10.3389/fpsyg.2021.616280DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7884763PMC
February 2021

The COVID-Kidney Controversy: Can SARS-CoV-2 Cause Direct Renal Infection?

Nephron 2021 18;145(3):275-279. Epub 2021 Feb 18.

Division of Nephrology, Hypertension and Kidney Transplantation, University of California Irvine School of Medicine, Orange, California, USA,

Context: Determining whether SARS-CoV-2 causes direct infection of the kidneys is challenging due to limitations in imaging and molecular tools. Subject of Review: A growing number of conflicting kidney biopsy and autopsy reports highlight this controversial issue. Second Opinion: Based on the collective evidence, therapies that improve hemodynamic stability and oxygenation, or dampen complement activation, are likely to ameliorate acute kidney injury in COVID-19. At this time, whether inhibition of viral infection and replication directly modulates kidney damage is inconclusive.
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http://dx.doi.org/10.1159/000513789DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8018211PMC
May 2021

SARS-CoV-2 infection in acute pancreatitis increases disease severity and 30-day mortality: COVID PAN collaborative study.

Gut 2021 06 5;70(6):1061-1069. Epub 2021 Feb 5.

Auckland City Hospital, Auckland, New Zealand.

Objective: There is emerging evidence that the pancreas may be a target organ of SARS-CoV-2 infection. This aim of this study was to investigate the outcome of patients with acute pancreatitis (AP) and coexistent SARS-CoV-2 infection.

Design: A prospective international multicentre cohort study including consecutive patients admitted with AP during the current pandemic was undertaken. Primary outcome measure was severity of AP. Secondary outcome measures were aetiology of AP, intensive care unit (ICU) admission, length of hospital stay, local complications, acute respiratory distress syndrome (ARDS), persistent organ failure and 30-day mortality. Multilevel logistic regression was used to compare the two groups.

Results: 1777 patients with AP were included during the study period from 1 March to 23 July 2020. 149 patients (8.3%) had concomitant SARS-CoV-2 infection. Overall, SARS-CoV-2-positive patients were older male patients and more likely to develop severe AP and ARDS (p<0.001). Unadjusted analysis showed that SARS-CoV-2-positive patients with AP were more likely to require ICU admission (OR 5.21, p<0.001), local complications (OR 2.91, p<0.001), persistent organ failure (OR 7.32, p<0.001), prolonged hospital stay (OR 1.89, p<0.001) and a higher 30-day mortality (OR 6.56, p<0.001). Adjusted analysis showed length of stay (OR 1.32, p<0.001), persistent organ failure (OR 2.77, p<0.003) and 30-day mortality (OR 2.41, p<0.04) were significantly higher in SARS-CoV-2 co-infection.

Conclusion: Patients with AP and coexistent SARS-CoV-2 infection are at increased risk of severe AP, worse clinical outcomes, prolonged length of hospital stay and high 30-day mortality.
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http://dx.doi.org/10.1136/gutjnl-2020-323364DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7871229PMC
June 2021

Correction: Aggregation-induced emission active metal complexes: a promising strategy to tackle bacterial infections.

Chem Commun (Camb) 2021 Feb;57(13):1679

School of Physical Sciences, Jawaharlal Nehru University, New Delhi 110067, India.

Correction for 'Aggregation-induced emission active metal complexes: a promising strategy to tackle bacterial infections' by Puja Prasad et al., Chem. Commun., 2021, 57, 174-186, DOI: 10.1039/D0CC06037B.
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http://dx.doi.org/10.1039/d1cc90031eDOI Listing
February 2021

Increased Toxicity Among Adolescents and Young Adults Compared with Children Hospitalized with Acute Lymphoblastic Leukemia at Children's Hospitals in the United States.

J Adolesc Young Adult Oncol 2021 Jan 28. Epub 2021 Jan 28.

Division of Pediatric Hematology/Oncology, Rainbow Babies & Children's Hospital, Cleveland, Ohio, USA.

Adolescent and young adult (AYA) patients (15-39 years old) with acute lymphoblastic leukemia (ALL) have less favorable outcomes and higher treatment-related mortality as compared with older children with ALL. Minimal data exist regarding how well AYA patients tolerate the intensity of chemotherapy at doses and regimens designed for children, and the toxicities suffered by this population at children's hospitals have not been thoroughly characterized. Pediatric Health Information Systems database was queried to analyze health care outcomes in pediatric (ages 10-14) and AYA patients (ages 15-39) with ALL hospitalized between January 1999 and December 2014. We extracted relevant ICD-9 data for each patient related to grades 3 or 4 toxicities as outlined by the NCI. A total of 5345 hospital admissions met inclusion criteria, representing 4046 unique patients. Of these admissions, 2195 (41.1%) were in the AYA age group, and the remainder were in the 10-14-year-old group. AYA patients had a significantly higher incidence of intensive care unit stay but no difference in median hospital stay nor mortality. AYA patients had increased toxicities in almost every organ system as compared with older children. In this large multicenter US database study, we found an overall increased number of toxicities among AYA patients with ALL in children's hospitals. Compared with children between the ages of 10 and 15, AYA patients developed disproportionately higher toxicities from drugs commonly used in pediatric protocols for ALL. Prospective studies are needed to assess whether dose modifications for certain chemotherapeutics may improve the toxicity profile and health care burden of AYA patients with ALL treated in children's hospitals.
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http://dx.doi.org/10.1089/jayao.2020.0154DOI Listing
January 2021

COVID-19: Causes of anxiety and wellbeing support needs of healthcare professionals in the UK: A cross-sectional survey.

Clin Med (Lond) 2021 Jan;21(1):66-72

Newham University Hospital, London, UK and honorary senior clinical lecturer, William Harvey Research Institute, London, UK.

Background: COVID-19 has caused acute changes in healthcare delivery; this may impact mental health and wellbeing needs of healthcare professionals (HCPs).

Aims: We aimed to identify the causes of anxiety in HCPs during the COVID-19 pandemic, to assess whether HCPs felt they had adequate mental health and wellbeing support and to identify their unmet support needs.

Method: We used a web-based survey utilising an online tool circulated to UK HCPs over 5 weeks. Self-perceived anxiety levels prior to and during the COVID-19 pandemic were measured on a 10-point Likert-type rating scale.

Results: The survey was completed by 558 HCPs. During the pandemic, self-perceived anxiety scores significantly increased from a median of 2 to 7 (paired Wilcoxon signed-rank test; p<0.001). The main reasons were concerns about exposure to SARS-CoV-2 and lack of personal protective equipment. Other wide-ranging reasons were identified. Only 41% of respondents felt there was adequate support. Thematic analysis of what support HCPs wanted identified 13 wide-ranging themes; including effective leadership and peer support.

Conclusion: Anxiety levels in HCPs significantly increased during the COVID-19 pandemic and the main causes were identified. Many HCPs felt there was inadequate support and identified what support they needed. Implementing effective strategies to support HCPs' unmet wellbeing needs are required as a matter of urgency.
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http://dx.doi.org/10.7861/clinmed.2020-0502DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7850214PMC
January 2021

Diffusion-Weighted Imaging Lesions After Intracerebral Hemorrhage and Risk of Stroke: A MISTIE III and ATACH-2 Analysis.

Stroke 2021 Jan 20;52(2):595-602. Epub 2021 Jan 20.

Division of Neurosciences Critical Care, Johns Hopkins University School of Medicine, Baltimore, MD (S.-M.C., L.R.-L., W.C.Z.).

Background And Purpose: Punctate ischemic lesions noted on diffusion-weighted imaging (DWI) are associated with poor functional outcomes after intracerebral hemorrhage (ICH). Whether these lesions increase long-term risk of stroke is poorly understood.

Methods: We pooled individual patient data from the ATACH-2 trial (Antihypertensive Treatment of Acute Cerebral Hemorrhage) and the MISTIE III trial (Minimally Invasive Surgery Plus Alteplase for Intracerebral Hemorrhage Evacuation Phase 3). We included subjects with a magnetic resonance imaging scan. The exposure was a DWI lesion. The primary outcome was any stroke, defined as a composite of ischemic stroke or recurrent ICH, whereas secondary outcomes were incident ischemic stroke and recurrent ICH. Using multivariate Cox regression analysis, we evaluated the risk of stroke.

Results: Of 505 patients with ICH with magnetic resonance imaging, 466 were included. DWI lesions were noted in 214 (45.9%) subjects, and 34 incident strokes (20 ischemic stroke and 14 recurrent ICH) were observed during a median follow-up of 324 days (interquartile range, 91-374). Presence of a DWI lesion was associated with a 6.9% (95% CI, 2.2-11.6) absolute increase in risk of all stroke (hazard ratio, 2.6 [95% CI, 1.2-5.7]). Covariate adjustment with Cox regression models also demonstrated this increased risk. In the secondary analyses, there was an increased risk of ischemic stroke (hazard ratio, 3.5 [95% CI, 1.1-11.0]) but not recurrent ICH (hazard ratio, 1.7 [95% CI, 0.6-5.1]).

Conclusions: In a heterogeneous cohort of patients with ICH, presence of a DWI lesion was associated with a 2.5-fold heightened risk of stroke among ICH survivors. This elevated risk persisted for ischemic stroke but not for recurrent ICH.
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http://dx.doi.org/10.1161/STROKEAHA.120.031628DOI Listing
January 2021

Advances in Multimodality Carotid Plaque Imaging: Expert Panel Narrative Review.

AJR Am J Roentgenol 2021 Jul 13;217(1):16-26. Epub 2021 Jan 13.

Department of Radiology & Nuclear Medicine, Erasmus MC, Doctor Molewaterplein 40, 3015 GD Rotterdam, The Netherlands.

Contemporary imaging methods provide detailed visualization of carotid athero-sclerotic plaque, enabling a major evolution of in vivo carotid plaque imaging evaluation. The degree of luminal stenosis in the carotid artery bifurcation, as assessed by ultrasound, has historically served as the primary imaging feature for determining ischemic stroke risk and the potential need for surgery. However, stroke risk may be more strongly driven by the presence of specific characteristics of vulnerable plaque, as visualized on CT and MRI, than by traditional ultrasound-based assessment of luminal narrowing. This review highlights six promising imaging-based plaque characteristics that harbor unique information regarding plaque vulnerability: maximum plaque thickness and volume, calcification, ulceration, intraplaque hemorrhage, lipid-rich necrotic core, and thin or ruptured fibrous cap. Increasing evidence supports the association of these plaque characteristics with risk of ischemic stroke, although these characteristics have varying suitability for clinical implementation. Key aspects of CT and MRI protocols for carotid plaque imaging are also considered. Practical next steps and hurdles are explored for implementing routine imaging assessment of these plaque characteristics in addition to, or even as replacement for, traditional assessment of the degree of vascular stenosis on ultrasound, in the identification of individuals at high risk of ischemic stroke.
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http://dx.doi.org/10.2214/AJR.20.24869DOI Listing
July 2021

Studying the onset of galvanic steel corrosion in situ using thin films: film preparation, characterization and application to pitting.

J Phys Condens Matter 2020 Dec 18. Epub 2020 Dec 18.

Diamond Light Source Ltd, Diamond Light Source, Didcot, Oxfordshire, OX11 0DE, UNITED KINGDOM OF GREAT BRITAIN AND NORTHERN IRELAND.

This work reports about a novel approach for investigating surface processes during the early stages of galvanic corrosion of stainless steel in situ by employing ultra-thin films and synchrotron X-radiation. Characterized by X-ray techniques and voltammetry, such films, sputter deposited from austenitic steel, were found representing useful replicas of the target material. Typical for stainless steel, the surface consists of a passivation layer of Fe- and Cr-oxides, a couple of nm thick, that is depleted of Ni. Films of ≈ 4 nm thickness were studied in situ in an electrochemical cell under potential control (-0.6 to +0.8 V vs Ag/AgCl) during exposure to 0.1 M KCl. Material transport was recorded with better than 1/10 monolayer sensitivity by X-ray spectroscopy. Leaching of Fe was observed in the cathodic range and the therefor necessary reduction of Fe-oxide appears to be accelerated by atomic hydrogen. Except for minor leaching, reduction of Ni, while expected from Pourbaix diagram, was not observed until at ≈ +0.8 V Cr-oxide was removed from the film. After couple of minutes exposure at +0.8 V, the current in the electrochemical cell revealed a rapid pitting event that was simultaneously monitored by X-ray spectroscopy. Continuous loss of Cr and Ni was observed during the induction time leading to the pitting, suggesting a causal connection with the event. Finally, a spectroscopic image of a pit was recorded ex situ with 50 nm lateral and 1 nm depth resolution by soft X-ray scanning absorption microscopy at the Fe L2,3-edges by using a 80 nm film on a SiN membrane, which is further demonstrating the usefulness of thin films for corrosion studies.
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http://dx.doi.org/10.1088/1361-648X/abd523DOI Listing
December 2020

Aggregation-induced emission active metal complexes: a promising strategy to tackle bacterial infections.

Chem Commun (Camb) 2021 Jan 11;57(2):174-186. Epub 2020 Dec 11.

Department of Chemical Engineering, Indian Institute of Technology Delhi, New Delhi 110016, India.

Bacterial infection is a major global threat to human health and currently one of the leading causes of death worldwide. The development of probes for rapid diagnosis of bacteria with desired sensitivity and selectivity along with antibacterial activity against multidrug-resistant (MDR) bacteria has remained a great challenge. Whilst the traditional methods such as cell culture and colony counting, polymerase chain reaction and immunoassays are used for bacterial infection detection, these are time consuming, laborious and require a skilled operator. On the other hand, the rapid emergence of MDR bacteria is also posing another serious public health threat. Hence, it is an utmost urgency to develop novel therapeutics and rapid diagnostic agents for tackling MDR bacteria. Over the last few years, significant progress has been made towards the development of metal-based aggregation-induced emission luminogens (AIEgens) for bacterial management. These AIEgen materials offer potential applications for simultaneous detection and image-guided elimination of bacteria for the treatment of bacterial infections. In this Feature Article, we have highlighted the recent progress in the development of metal-based AIEgens for detection, discrimination and decimation of bacteria. In addition, the potential challenges in developing antibacterial agents and several future perspectives of metal-based AIEgens in this field have also been discussed.
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http://dx.doi.org/10.1039/d0cc06037bDOI Listing
January 2021

Carotid artery plaque characteristics: current reporting practices on CT angiography.

Neuroradiology 2021 Jul 24;63(7):1013-1018. Epub 2020 Nov 24.

Department of Radiology, Weill Cornell Medicine, New York, NY, USA.

Purpose: Extracranial ICA imaging has largely focused on the degree of luminal stenosis, but recent advances suggest specific plaque features are crucial in stroke risk assessment. We evaluated the current state of reporting carotid plaque features on neck CTAs at an academic institution.

Methods: In this retrospective observational study, we included neck CTAs performed on patients over age 50 with any reported carotid plaque. We evaluated reports for mention of the following: degree of luminal stenosis, soft plaque, calcified plaque, plaque thickness, quantification of soft and calcified plaque, plaque ulceration, and increased risk associated with specific features. We used Fisher's exact test to compare how often each feature was mentioned.

Results: We included a total of 651 reports from unique patients (mean age, 68.1 ± 13.3 years). A total of 639 reports (98.1%) explicitly mentioned degree of stenosis per NASCET criteria. Specific plaque features were less frequently characterized: soft plaque in 116 (17.8%); calcified plaque in 166 (25.5%); quantification of the amount of soft plaque and calcified plaque in 24 (3.7%) and 16 (2.5%) reports, respectively; plaque thickness in 12 (1.8%); plaque ulceration in 476 (73.1%); and increased risk associated with plaque in 2 (0.3%). Degree of stenosis was statistically more likely to be mentioned than any other plaque feature (p < 0.001).

Conclusion: Currently, nearly all reports mention the degree of luminal stenosis on neck CTAs while a significant minority mention specific plaque features. Despite mounting evidence of the importance of carotid plaque features in stroke risk assessment, radiology reports do not routinely report these findings.
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http://dx.doi.org/10.1007/s00234-020-02610-wDOI Listing
July 2021

Efficacy of Intralesional Platelet-Rich Plasma in Diabetic Foot Ulcer.

J Am Podiatr Med Assoc 2021 May;111(3)

Background: Diabetic foot ulcer (DFU) is well managed by infection control, euglycemic state, and debridement of the ulcer followed by appropriate dressing and off-loading of the foot. Studies show that approximately 90% of DFUs that are properly off-loaded heal in nearly 6 weeks. Platelet-rich plasma (PRP) serves as a growth factor agonist and has mitogenic and chemotactic properties that help in DFU healing. We sought to evaluate the efficacy of local application of PRP with respect to healing rate and ulcer area reduction in treating DFUs.

Methods: Sixty noninfected patients with DFUs (plantar surface area, ≤20 cm2; Meggitt-Wagner grades 1 and 2) were randomized to receive normal saline dressing (control group [CG]) or PRP dressing (study group [SG]) along with total-contact casting for 6 weeks or until complete ulcer healing, whichever was earlier. Healing rate and change in ulcer area were evaluated weekly.

Results: Mean ± SD ulcer area at baseline was 4.96 ± 2.89 cm2 (CG) and 5.22 ± 3.82 cm2 (SG) (P = .77), decreasing to 1.15 ± 1.35 cm2 (CG) and 0.96 ± 1.53 cm2 (SG) (P = .432) at 6 weeks. Mean ± SD percentage reduction in healing area at 6 weeks was 81.72% ± 17.2% (CG) and 85.98% ± 13.42% (SG) (P = .29). Mean ± SD healing rate at 6 weeks was 0.64 ± 0.36 cm2 (CG) and 0.71 ± 0.46 cm2 (SG) (P = .734).

Conclusions: The PRP dressing is no more efficacious than normal saline dressing in the management of DFU in conjunction with total-contact casting.
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http://dx.doi.org/10.7547/19-149DOI Listing
May 2021

Quantitative transport mapping (QTM) of the kidney with an approximate microvascular network.

Magn Reson Med 2021 04 18;85(4):2247-2262. Epub 2020 Nov 18.

Department of Radiology, Weill Medical College of Cornell University, New York, New York, USA.

Purpose: Proof-of-concept study of mapping renal blood flow vector field according to the inverse solution to a mass transport model of time resolved tracer-labeled MRI data.

Theory And Methods: To determine tissue perfusion according to the underlying physics of spatiotemporal tracer concentration variation, the mass transport equation is integrated over a voxel with an approximate microvascular network for fitting time-resolved tracer imaging data. The inverse solution to the voxelized transport equation provides the blood flow vector field, which is referred to as quantitative transport mapping (QTM). A numerical microvascular network modeling the kidney with computational fluid dynamics reference was used to verify the accuracy of QTM and the current Kety's method that uses a global arterial input function. Multiple post-label delay arterial spin labeling (ASL) of the kidney on seven subjects was used to assess QTM in vivo feasibility.

Results: Against the ground truth in the numerical model, the error in flow estimated by QTM (18.6%) was smaller than that in Kety's method (45.7%, 2.5-fold reduction). The in vivo kidney perfusion quantification by QTM (cortex: 443 ± 58 mL/100 g/min and medulla: 190 ± 90 mL/100 g/min) was in the range of that by Kety's method (482 ± 51 mL/100 g/min in the cortex and 242 ± 73 mL/100 g/min in the medulla), and QTM provided better flow homogeneity in the cortex region.

Conclusions: QTM flow velocity mapping is feasible from multi-delay ASL MRI data based on inverting the transport equation. In a numerical simulation, QTM with deconvolution in space and time provided more accurate perfusion quantification than Kety's method with deconvolution in time only.
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http://dx.doi.org/10.1002/mrm.28584DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7839791PMC
April 2021

Transpulmonary Bubble Transit in Severe COVID-19: Pulmonary Vasodilatation or Angiogenesis?

Am J Respir Crit Care Med 2021 02;203(3):388-389

University of California, Irvine, School of Medicine Irvine, California.

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http://dx.doi.org/10.1164/rccm.202009-3642LEDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7874321PMC
February 2021