Publications by authors named "Amar Gupta"

88 Publications

Epidemiology of Nasal Bone Fractures.

Facial Plast Surg Aesthet Med 2021 Apr 13. Epub 2021 Apr 13.

New York University Langone Health, Otolaryngology-Head and Neck Surgery, New York, New York, USA.

Although nasal bones are the most common type of facial fracture given their natural projection and vulnerability to trauma, there is a paucity of data on its trends. To report on the trends and costs associated with open and closed nasal bone fractures across the United States. A retrospective analysis from 2006 to 2014 was conducted of the Nationwide Emergency Department Sample by using the International Classification of Disease, Ninth Revision codes for closed and open nasal bone fractures (802.0 and 802.1) presenting to emergency departments (ED). Trend analysis of total number and rate of visits, discharges, admissions, and associated costs were conducted. Data from 1,253,399.741 records were collected. The total number of ED visits decreased by 2.05% for both open and closed nasal fractures from 2006 to 2014 whereas their associated costs increased ( < 0.001 and  < 0.05 for closed and open nasal fractures). Notably, open fractures were consistently costlier whereas closed fractures had a greater percent-increase in costs (76.65%). This study identified a significant rise in nasal fracture costs, which can be reduced via use of cheaper diagnostic modalities and cost-effective endoscopic procedures.
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http://dx.doi.org/10.1089/fpsam.2020.0643DOI Listing
April 2021

Effect of subcutaneous tissue depth on outcomes of kidney transplantation.

Proc (Bayl Univ Med Cent) 2020 Dec 18;34(2):237-241. Epub 2020 Dec 18.

Department of Transplant Surgery, Simmons Transplant Institute, Baylor Scott & White All Saints Medical Center, Fort Worth, Texas.

Although post-kidney transplant (KT) wound complications are associated with elevated body mass index (BMI), BMI is not an accurate surrogate of obesity. On the other hand, subcutaneous depth (SQD) measurement is a direct marker of truncal obesity. We examined outcomes of differing intraoperative SQD measurements in 113 KT-only recipients over 20 months. Recipients' median age was 51 years; median BMI, 28 kg/m; and mean SQD, 2.9 cm. Patients were stratified into groups of SQD ≤2.5 cm, >2.5-5 cm, and >5 cm. An SQD of >2.5 to 5 cm correlated with a BMI of 30 kg/m (obesity) and an SQD >5 cm correlated with a BMI >35 kg/m (severe obesity). Degree of SQD was not associated with more frequent technical complications such as fascial dehiscence, lymphocele formation, renal artery thrombosis/stenosis, urine leak, or ureteral stenosis. However, an SQD >2.5 cm was a risk factor for requiring a wound vacuum-assisted closure device. There was no difference in graft or patient survival among the three SQD groups. Obesity, as measured directly by SQD, was not associated with increased technical complications or poor outcomes after KT. As expected, there was a higher incidence of wound complications in the higher SQD groups requiring intervention.
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http://dx.doi.org/10.1080/08998280.2020.1852835DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7901397PMC
December 2020

Non-Hyaluronic Acid Fillers for Midface Augmentation: A Systematic Review.

Facial Plast Surg 2021 Mar 1. Epub 2021 Mar 1.

Department of Otolaryngology-Head and Surgery, St. Elizabeth's Medical Center, Brighton, Massachusetts.

There has been an increasing role in the use of injectable fillers for rejuvenation of the aging face. In this systematic review, we aim to evaluate the existing literature related to soft tissue fillers of the midface. Specifically, we focus on the non-hyaluronic acid fillers including polymethylmethacrylate (PMMA), poly-L-lactic acid (PLLA), calcium hydroxyapatite (CaHA), and autologous fat. A systematic review was conducted in November 2020 in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines with PubMed and Embase databases. Medical Subject Headings terms used were "cheek" OR "midface" OR "malar" and "filler" OR "poly-L-lactic acid" OR "calcium hydroxyapatite," "autologous fat" OR "polymethylmethacrylate" OR "Artefill" OR "Bellafill" OR "Radiesse" OR "Sculptra." The initial search identified 271 articles. After 145 duplicates were removed, 126 studies were screened for relevance by title and abstract. A total of 114 studies were eliminated based on inclusion and exclusion criteria. Twelve articles underwent full-text review. Seven articles were included in the final analysis consisting of four non-hyaluronic filler products: PMMA, PLLA, CaHA, autologous fat. Most patients were highly satisfied with their results. Due to the gradual volumizing effects of PMMA, PLLA, and CaHA, patient satisfaction generally improved over time. Minor adverse reactions related to treatment included bruising, swelling, and pain. Nodule formation was reported in PLLA and CaHA studies. For autologous fat, 32% of the original injection volume remained at 16 months post-treatment, which still provided clinically improved malar enhancement. Dermal fillers are an attractive treatment option for the aging face due to their high patient satisfaction, long-lasting effects, and low side-effect profile. Patients should be appropriately counseled on the delayed effects of non-HA fillers. Autologous fat is a good option in many patients with the major drawback of unpredictable longevity, which may require a secondary procedure. Future studies should examine the longevity and long-term side effects of these fillers.
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http://dx.doi.org/10.1055/s-0041-1725164DOI Listing
March 2021

Hyaluronic Acid Fillers for Midface Augmentation: A Systematic Review.

Facial Plast Surg 2021 Feb 25. Epub 2021 Feb 25.

Department of Otolaryngology - Head and Surgery, St. Elizabeth's Medical Center, Brighton, Massachusetts.

Injectable fillers represent one of the most requested minimally invasive treatments to rejuvenate the aging face, and its popularity is steadily rising. A vast majority of filler treatments are with hyaluronic acid (HA). The aim of this systematic review is to evaluate patient outcomes, safety profile, and administration techniques of various HA fillers for malar augmentation. A systematic review of the published literature was conducted in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and included PubMed, Embase, and Science Direct databases. Medical Subject Headings (MeSH) terms used were "cheek" OR "midface" OR "malar" and "filler" OR "hyaluronic acid" OR "Juvederm" OR "Restylane" OR "Perlane" OR "Belotero." The initial search identified 699 articles; 256 duplicates were removed. Additional 12 studies were identified from reference lists. A total of 455 were screened by title and abstract and 387 studies were eliminated based on criteria. Also, 68 articles underwent full-text review, and 18 articles were included in the final review and involved seven different HA formulations. Men and women from many age groups were highly satisfied with their results following HA treatment for midface augmentation up to 24 months. The most common adverse events included bruising, swelling, and tenderness, and typically lasted no more than 2 weeks. Upper cheek filler injections near the zygoma should be placed in the submuscular plane while lower cheek injections should be placed in the subcutaneous tissue. HA is an attractive choice for midface augmentation due to its high patient satisfaction, long-lasting effects, and low side-effect profile. Due to the variability in technique, level of expertise, and subjective measurements across studies, one optimal regimen could not be concluded. However, midface augmentation treatment should be personalized to each patient. Additional clinical trials are required to more conclusively determine the most appropriate approach for this procedure.
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http://dx.doi.org/10.1055/s-0041-1724122DOI Listing
February 2021

Electric field-driven conformational changes in the elastin protein.

Phys Chem Chem Phys 2021 Feb;23(7):4195-4204

Department of Physics, Indian Institute of Technology Kharagpur, WB 721302, India.

The formation of aggregates and amyloids, a hallmark of many protein misfolding diseases, depends on many intrinsic and extrinsic factors. Many approaches (in vitro, in vivo, and in silico) have been attempted to inhibit the aggregation process so that the progression of these diseases can be controlled. We investigate the effect of a static electric field (EF; 120 V cm-1 and 200 V cm-1) on the conformational change of elastin protein using light scattering, spectroscopy, and microscopy techniques. Laser light scattering and photoluminescence spectroscopy show the formation of fibrils of unexposed elastin with aging, whereas disruption of fibril formation with EF exposed elastin. The size of EF exposed elastin first increases and exhibits an apex, and subsequently decreases with an increasing time of exposure. We observed that a decrease in the size of EF exposed elastin depends on the strength of the EF, faster decrement at higher EF. FTIR data show that EF modifies elastin protein's secondary structures; it facilitates the interconversion of β-sheets and turns into α-helix structures. The SEM images of unexposed and EF exposed elastin confirms the observation through light scattering and PL techniques. The effect of an EF on protein conformation and amyloids is promising to treat Parkinson's disease, a protein misfolding disease.
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http://dx.doi.org/10.1039/d0cp04813eDOI Listing
February 2021

Application of Bayesian networks to generate synthetic health data.

J Am Med Inform Assoc 2021 Mar;28(4):801-811

Clinical Informatics, Philips Research North America, Cambridge, Massachusetts, USA.

Objective: This study seeks to develop a fully automated method of generating synthetic data from a real dataset that could be employed by medical organizations to distribute health data to researchers, reducing the need for access to real data. We hypothesize the application of Bayesian networks will improve upon the predominant existing method, medBGAN, in handling the complexity and dimensionality of healthcare data.

Materials And Methods: We employed Bayesian networks to learn probabilistic graphical structures and simulated synthetic patient records from the learned structure. We used the University of California Irvine (UCI) heart disease and diabetes datasets as well as the MIMIC-III diagnoses database. We evaluated our method through statistical tests, machine learning tasks, preservation of rare events, disclosure risk, and the ability of a machine learning classifier to discriminate between the real and synthetic data.

Results: Our Bayesian network model outperformed or equaled medBGAN in all key metrics. Notable improvement was achieved in capturing rare variables and preserving association rules.

Discussion: Bayesian networks generated data sufficiently similar to the original data with minimal risk of disclosure, while offering additional transparency, computational efficiency, and capacity to handle more data types in comparison to existing methods. We hope this method will allow healthcare organizations to efficiently disseminate synthetic health data to researchers, enabling them to generate hypotheses and develop analytical tools.

Conclusion: We conclude the application of Bayesian networks is a promising option for generating realistic synthetic health data that preserves the features of the original data without compromising data privacy.
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http://dx.doi.org/10.1093/jamia/ocaa303DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7973486PMC
March 2021

Hb Yaizu: A rare beta-globin chain variant posing diagnostic dilemma in high-performance liquid chromatography.

Indian J Pathol Microbiol 2020 Oct-Dec;63(4):663-665

Department of Hematogenetics, National Institute of Immunohematology, Mumbai, Maharashtra, India.

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http://dx.doi.org/10.4103/IJPM.IJPM_851_19DOI Listing
November 2020

Hierarchical cage-frame type nanostructure of CeO for bio sensing applications: from glucose to protein detection.

Nanotechnology 2021 Jan;32(2):025504

School of Nanoscience and Technology, Indian Institute of Technology Kharagpur, Kharagpur 721302, India. Department of Physics, Indian Institute of Technology Kharagpur, Kharagpur 721302, India. Department of Metallurgical and Materials Engineering, Indian Institute of Technology Kharagpur, Kharagpur 721302, India. School of Energy Science and Engineering, Indian Institute of Technology Kharagpur, Kharagpur 721302, India.

Self-assembled hierarchical nanostructures are slowly superseding their conventional counterparts for use in biosensors. These morphologies show high surface area with tunable porosity and packing density. Modulating the interfacial interactions and subsequent particle assembly occurring at the water-and-oil interface in inverse miniemulsions, are amongst the best strategies to stabilize various type of hollow nanostructures. The paper presents a successful protocol to obtain CeO hollow structures based biosensors that are useful for glucose to protein sensing. The fabricated glucose sensor is able to deliver high sensitivity (0.495 μA cm nM), low detection limit (6.46 nM) and wide linear range (0 nM to 600 nM). CeO based bioelectrode can also be considered as a suitable candidate for protein sensors. It can detect protein concentrations varying from 0 to 30 µM, which is similar or higher than most reports in the literature. The limit of detection (LOD) for protein was ∼0.04 µM. Therefore, the hollow CeO electrodes, with excellent reproducibility, stability and repeatability, open a new area of application for cage-frame type particles.
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http://dx.doi.org/10.1088/1361-6528/abb8a8DOI Listing
January 2021

Anisotropy fluctuations in the fractal self-assembly of gold nanoparticles.

Soft Matter 2020 Aug;16(33):7778-7788

Biophysics and Soft Matter Laboratory, Department of Physics, Indian Institute of Technology, Kharagpur-721302, India.

In a recent report, the fractal self-assembly of gold nanoparticles (AuNPs) having a directional feature was observed in the presence of visible light. Therein, the visible light, an external parameter, was suspected to be responsible for the directional feature. Herein, we investigate the intrinsic factors, the aspect size ratio p and the size a of AuNPs, in modulating the fractal characteristics of their self-assemblies. Through light scattering experiments and microscopic imaging, we demonstrate the transition of morphologies from fractal-like to cross-shaped in gold colloidal aggregates with particles having nearly spherical and ellipsoidal shapes, respectively. The transition indicates the competitive role of anisotropy and fluctuations in deciding the morphological characteristics of the aggregates. By taking noise-reduced diffusion-limited aggregation (NRDLA) as a model system, we address the shape and size induced noise of the particles in the colloidal systems which are prone to form fractal aggregates. We qualitatively relate the noise due to the particles having a distinct aspect size ratio p and size a with the noise reduction parameter m of NRDLA. The realistic nature of the experimental systems, where the particles of different p and a are present during the growth process, is incorporated by introducing the Gaussian noise reduction in diffusion-limited aggregation (DLA). The morphological phase transition in Gaussian noise reduced DLA is characterized, and its relevance for accounting the shape and size originated noise fluctuations during the fractal growth process is discussed. The results of the present study may be used for tailored applications of AuNPs in drug delivery, biomedicine, biosensing, and cancer nanotechnology.
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http://dx.doi.org/10.1039/d0sm00485eDOI Listing
August 2020

Fibril growth captured by electrical properties of amyloid-β and human islet amyloid polypeptide.

Phys Rev E 2020 Jun;101(6-1):062413

BioMEMS Laboratory, School of Medical Science and Technology, Indian Institute of Technology Kharagpur, 721302, India.

The aggregation of amyloid-β (Aβ) and human islet amyloid polypeptide (hIAPP) proteins have attracted considerable attention because of their involvement in protein misfolding diseases. These proteins have mostly been investigated using atomic force microscopy, transmission electron microscopy, and fluorescence microscopy to study the directional growth of fibrils both perpendicular to and along the fibril axis. Here, we demonstrate the real-time monitoring of the directional growth of fibrils in terms of activation energy of proton transfer using an impedance spectroscopy technique. The activation energy is used to quantify the sensitivity of proton conduction to the different stages of protein aggregation. The decrement (increment) in activation energy is related to the fibril growth along (perpendicular to) the fibril axis in intrinsic protein aggregation. The entire aggregation process shows different phases of the directional growth for Aβ and hIAPP, indicating different pathways for their aggregation. The activation energy for hIAPP is found to be smaller than the activation energy of Aβ during the aggregation process. The oscillatory behavior of the activation energy of hIAPP reflects a rapid change in the directional growth of the protofilaments of hIAPP. The results indicate higher aggregation propensity of Aβ than hIAPP. In the presence of resveratrol, hIAPP exhibits slower aggregation compared to Aβ. Methods of this study may in general be used to reveal the modulated aggregation pathway of proteins in the presence of different ligands.
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http://dx.doi.org/10.1103/PhysRevE.101.062413DOI Listing
June 2020

The Evolution of Transplantation From Saving Lives to Fertility Treatment: DUETS (Dallas UtErus Transplant Study).

Ann Surg 2020 09;272(3):411-417

Annette C. and Harold C. Simmons Transplant Institute, Baylor University Medical Center, Dallas, Texas.

Objective: We report the results of the first 20 uterus transplants performed in our institution.

Summary Background Data: Uterus transplantation (UTx) aims at giving women affected by absolute uterine-factor infertility the possibility of carrying their own pregnancy. UTx has evolved from experimental to an established surgical procedure.

Methods: The Dallas Uterus Transplant Study (DUETS) program started in 2016. The uterus was transplanted in orthotopic position with vascular anastomoses to the external iliac vessels and removed when 1 or 2 live births were achieved. Immunosuppression lasted only for the duration of the uterus graft.

Results: Twenty women, median age 29.7 years, enrolled in the study, with 10 in phase 1 and 10 in phase 2. All but 2 recipients had a congenital absence of the uterus. Eighteen recipients received uteri from living donors and 2 from deceased donors. In phase 1, 50% of recipients had a technically successful uterus transplant, compared to 90% in phase 2. Four recipients with a technical success in phase 1 have delivered 1 or 2 babies, and the fifth recipient with a technical success is >30 weeks pregnant. In phase 2, 2 recipients have delivered healthy babies and 5 are pregnant.

Conclusions: UTx is a unique type of transplant; whose only true success is a healthy child birth. Based on results presented here, involving refinement of the surgical technique and donor selection process, UTx is now an established solution for absolute uterine-factor infertility.
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http://dx.doi.org/10.1097/SLA.0000000000004199DOI Listing
September 2020

Evaluation of clinician interaction with alerts to enhance performance of the tele-critical care medical environment.

Int J Med Inform 2020 07 6;139:104165. Epub 2020 May 6.

Massachusetts Institute of Technology, 32 Vassar Street, Cambridge, MA 02139, United States. Electronic address:

Objective: Identify opportunities to improve the interaction between clinicians and Tele-Critical Care (Tele-CC) programs through an analysis of alert occurrence and reactivation in a specific Tele-CC application.

Materials And Methods: Data were collected automatically through the Philips eCaremanager® software system used at multiple hospitals in the Avera health system. We evaluated the distribution of alerts per patient, frequency of alert types, time between consecutive alerts, and Tele-CC clinician choice of alert reactivation times.

Results: Each patient generated an average of 79.8 alerts during their ICU stay (median 31.0; 25th - 75th percentile 10.0-89.0) with 46.4 for blood pressure and 38.4 for oxygenation. The most frequent alerts for continuous physiological parameters were: MAP limit (28.9 %), O/RR (26.4 %), MAP trend (16.5 %), HR trend (12.1 %), and HR limit (11.3 %). The median time between consecutive alerts for one parameter was less than 10 min for 86 % of patients. Tele-CC providers responded to all alert types with immediate reactivation 47-88 % of the time. Limit alerts had longer reactivation times than their trend alert counterparts (p-value < .001).

Conclusions: The alert type specific differences in frequency, time occurrence and provider choice of reactivation time provide insight into how clinicians interact with the Tele-CC system. Systems engineering enhancements to Tele-CC software algorithms may reduce alert burden and thereby decrease clinicians' cognitive workload for alert assessment. Further study of Tele-CC alert generation, alert presentation to clinicians, and the clinicians' options to respond to these alerts may reduce provider workload, minimize alert desensitization, and optimize the ability of Tele-CC clinicians to provide efficient and timely critical care management.
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http://dx.doi.org/10.1016/j.ijmedinf.2020.104165DOI Listing
July 2020

A Case of Nodal Anthracosis Presenting as PET-Positive Mediastinal and Hilar Lymphadenopathies.

Mayo Clin Proc 2020 05;95(5):1080-1081

Department of Radiology, Cleveland Clinic Akron General, Akron, OH.

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http://dx.doi.org/10.1016/j.mayocp.2020.01.040DOI Listing
May 2020

Fractal self-assembly and aggregation of human amylin.

Soft Matter 2020 Mar 11;16(12):3143-3153. Epub 2020 Mar 11.

Biophysics and Soft Matter Laboratory, Department of Physics, Indian Institute of Technology, Kharagpur-721302, India.

Human amylin is an intrinsically disordered protein believed to have a central role in Type-II diabetes mellitus (T2DM). The formation of intermediate oligomers is a seminal event in the eventual self-assembled fibril structures of amylin. However, the recent experimental investigations have shown the presence of different self-assembled (oligomers, protofilaments, and fibrils) and aggregated structures (amorphous aggregates) of amylin formed during its aggregation. Here, we show that amylin under diffusion-limited conditions leads to fractal self-assembly. The pH and solvent sensitive fractal self-assemblies of amylin were observed using an optical microscope. Confocal microscopy and scanning electron microscopy (SEM) with energy dispersion X-ray analysis (EDAX) were used to confirm the fractal self-assembly of amylin in water and PBS buffer, respectively. The fractal characteristics of the self-assemblies and the aggregates formed during the aggregation of amylin under different pH conditions were investigated using laser light scattering. The hydropathy and the docking study indicated the interactions between the anisotropically distributed hydrophobic residues and polar/ionic residues on the solvent-accessible surface of the protein as the crucial interaction hot-spots for driving the self-assembly and aggregation of human amylin. The simultaneous presence of various self-assemblies of human amylin was observed through different microscopy techniques. The present study may help in designing different fractal-like nanomaterials with potential applications in drug delivery, sensing, and tissue engineering.
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http://dx.doi.org/10.1039/c9sm02463hDOI Listing
March 2020

Dallas UtErus Transplant Study: Early Outcomes and Complications of Robot-assisted Hysterectomy for Living Uterus Donors.

Transplantation 2021 Jan;105(1):225-230

Annette C. and Harold C. Simmons Transplant Institute, Baylor University Medical Center, Dallas, TX.

Background: Uterus transplantation is a treatment for absolute uterine infertility and can be performed with living and deceased donors. Given the safety and increased utilization of robotic assistance with other gynecologic and transplant donor operations, we adopted a robot-assisted approach to donor hysterectomy. This study compared early outcomes and morbidity of the robot-assisted approach to donor hysterectomy with the traditionally performed open approach and addressed whether the robot-assisted approach is safe and offers advantages for the donor.

Methods: Our institution has performed 18 living donor hysterectomies for uterus transplantation. This retrospective review compared the last 5 cases utilizing a robot-assisted technique and vaginal extraction of the uterus graft with the first 13 cases performed with an open laparotomy technique. Demographic, intraoperative, and postoperative data were examined.

Results: There were no differences between the robot-assisted and the open living donor group with respect to age, body mass index, or gynecological history. Although the median operative time was shorter for the open approach (6.27 versus 10.46 h), the donors' median estimated blood loss, length of hospital stay, and length of sick leave were less with the robot-assisted approach. There was no conversion to open hysterectomy in the robot-assisted cases, and the incidence of complications was similar between the 2 groups. There was no difference in early graft function.

Conclusions: These preliminary results show that robot-assisted living donor hysterectomy is feasible and safe for the donors; it allows a faster postoperative recovery and the same early graft function.
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http://dx.doi.org/10.1097/TP.0000000000003211DOI Listing
January 2021

Telemedicine for Pediatric Urological Postoperative Care is Safe, Convenient and Economical.

J Urol 2020 07 17;204(1):144-148. Epub 2020 Jan 17.

Boston Children's Hospital, Boston, Massachusetts.

Purpose: We compared virtual visits, ie remote patient encounters, via a live video system, with conventional in-person visits with respect to clinical outcomes, family experience and costs in a pediatric urology surgical population.

Materials And Methods: Patients were enrolled in a prospective cohort study comparing postoperative virtual and in-person visits during a 4-month period in 2018. Appointment status and time metrics were tracked. The primary outcome was the safety of virtual visits, assessed by comparing the number of additional in-person visits, emergency department encounters and hospital readmissions. Secondary outcomes included the family assessment of the encounter and associated costs. After each visit families were prompted to complete a survey that assessed missed work/school and direct costs. Opportunity cost was estimated using reported missed work time, average national hourly wage and visit duration.

Results: Overall 107 virtual and 100 in-person postoperative visits were completed. There was no difference in patient characteristics, appointment compliance or clinical outcomes between the cohorts. Travel and waiting for care accounted for 98.4% of the total time spent for an in-person visit. With the virtual visit significantly less work and school were missed by parents and children, respectively. The opportunity costs associated with an in-person visit were computed at $23.75 per minute of face time with a physician, compared to $1.14 for a virtual visit.

Conclusions: For pediatric postoperative care virtual visits are associated with shorter wait times, decreased missed work and school, and clinical outcomes similar to those of in-person visits. Telemedicine appears to reduce the costs associated with these brief but important encounters.
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http://dx.doi.org/10.1097/JU.0000000000000750DOI Listing
July 2020

Glucose-induced structural changes and anomalous diffusion of elastin.

Colloids Surf B Biointerfaces 2020 Apr 8;188:110776. Epub 2020 Jan 8.

Department of Physics, Indian Institute of Technology Kharagpur, W.B. 721302, India.

Elastin is the principal protein component of elastic fiber, which renders essential elasticity to connective tissues and organs. Here, we adopted a multi-technique approach to study the transport, viscoelastic, and structural properties of elastin exposed to various glucose concentrations (X=[gluc]/[elastin]). Laser light scattering experiments revealed an anomalous behavior (anomaly exponent, β <0.6) of elastin. In this regime (β <0.6), the diffusion constant decreases by 40% in the presence of glucose (X> 10), which suggests the structural change in elastin. We have observed a peculiar inverse temperature transition of elastin protein, which is a measure of structural change, at 40 °C through rheology experiments. Moreover, we observe its shift towards lower temperature with a higher X. FTIR revealed that the presence of glucose (X < 10) favors the formation of β-sheet structure in elastin. However, for X > 10, dominative crowding effect reduces the mobility of protein and favors the increase in β-turns and γ-turns by 25 ± 1% over the β-sheet (β-sheet decreases by 12 ± 0.8%) and α-helix (α-helix decreases by 13 ± 0.8%). The stiffness of protein is estimated through Flory characteristic ratio, C and found to be increasing with X. These glucose-based structural changes in the elastin may explain the role of glucose in age-related issues of the skin.
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http://dx.doi.org/10.1016/j.colsurfb.2020.110776DOI Listing
April 2020

Impact of microbial contamination of the islet product during total pancreatectomy with islet autotransplantation.

J Hepatobiliary Pancreat Sci 2020 Apr 12;27(4):211-218. Epub 2020 Feb 12.

Baylor Simmons Transplant Institute, Dallas, TX, USA.

Background: The combined use of interleukin-1β and tumor necrosis factor-α blockers in the peritransplant period has improved outcomes of total pancreatectomy with islet autotransplantation (TPIAT). However, these drugs may suppress the immune system, resulting in severe infection.

Methods: We retrospectively investigated the impact of microbial-contaminated islet product on posttransplant complications and metabolic outcomes of TPIAT patients receiving the IL-1β and TNF-blockade treatment at our center.

Results: Among 108 TPIAT patients, 37 patients (34%) received contaminated products. Preoperative stent treatment and fibrosis score were independent risk factors for the contamination. There were no significant differences between the contaminated and noncontaminated product groups in posttransplant infectious complication rate, length of hospitalization, or readmission rate. However, islet equivalents (P < .0001) and insulin independence rate (P = .036) at 6 months were significantly lower for patients receiving contaminated product.

Conclusions: These results suggest that combined anti-inflammatory drug use is safe and well tolerated in TPIAT patients who receive contaminated islet product and does not increase the rate of infectious complications; however, contaminated islet product is associated with poor metabolic outcomes.
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http://dx.doi.org/10.1002/jhbp.709DOI Listing
April 2020

Management of Lip Complications.

Facial Plast Surg Clin North Am 2019 Nov;27(4):565-570

Department of Otolaryngology-Head and Neck Surgery, New York University School of Medicine, 550 First Avenue, NBV 5E5, New York, NY 10016, USA. Electronic address:

This article discusses complications that may occur after procedures on the lips, specifically focusing on injectable fillers. Evidence-based guidelines and suggested methods to manage these complications are presented in a systematic format.
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http://dx.doi.org/10.1016/j.fsc.2019.07.011DOI Listing
November 2019

Teleneurology Consultations for Prognostication and Brain Death Diagnosis.

Telemed J E Health 2020 04 10;26(4):482-486. Epub 2019 Sep 10.

Harvard Medical School, Harvard University, Boston, Massachusetts.

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http://dx.doi.org/10.1089/tmj.2019.0033DOI Listing
April 2020

Quantification of protein aggregation rates and quenching effects of amylin-inhibitor complexes.

Phys Chem Chem Phys 2019 Sep;21(36):20083-20094

Department of Physics, Indian Institute of Technology Kharagpur, Kharagpur-721302, India.

The formation of amyloid aggregates is the hallmark of many protein misfolding diseases, including Type-II diabetes mellitus, which is caused by the fibrillation of amylin protein. It is established that nano-sized ligands such as curcumin, resveratrol and graphene quantum dots can modify protein aggregation rates. In this article, we report a comparative study of these ligands to estimate their protein aggregation rates and fluorescence quenching using various experimental techniques. Through light scattering experiments, the RH of bare amylin was found to increase at a rate of 43% per day, whereas in the presence of the ligands in different molar ratios (A1C10, A1R10 and A1GQDs20), the sizes of the complexes were found to grow at rates of 7%, 8% and 13% per day, respectively. We observed fluorescence quenching using photoluminescence experiments for all three protein-ligand complexes. The protein aggregation rate and fluorescence quenching exhibited a concentration-dependent competitive role in the inhibition process. Interestingly, for graphene quantum dots, the protein aggregation rate is more affected at lower concentrations, while fluorescence quenching dominates at higher concentrations; this is in contrast to curcumin and resveratrol, where fluorescence quenching dominates at all concentrations of the ligands in the complex. The FTIR data showed appreciable conversion of β-sheets into less aggregation-prone secondary structures for all three amylin-ligand ratios; however, the inhibition performance of curcumin overshadowed those of the other two inhibitors. The inhibition behavior of these three ligands was corroborated by analysis of analytical and high-resolution TEM images of the fibrils.
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http://dx.doi.org/10.1039/c9cp03238jDOI Listing
September 2019

All I Have Learned, I Have Learned from Google: Why Today's Facial Rejuvenation Patients are Prone to Misinformation, and the Steps We can take to Contend with Unreliable Information.

Facial Plast Surg 2019 Aug 14;35(4):387-392. Epub 2019 Aug 14.

Department of Otolaryngology-Head and Neck Surgery, Wayne State University School of Medicine, Detroit, Michigan.

A growing number of patients are seeking answers for their health concerns online. This study assesses the reliability, quality, and readability of online materials patients have access to through the Internet and evaluates the social media presence of information providers. An online search was conducted for facial rejuvenation by utilizing three ubiquitously used web search engines: Google, Bing, and Yahoo. The first 25 result pages were collected from each search engine, and exclusionary criteria were applied to exclude online stores and advertisements. Website reliability and quality were assessed via the DISCERN method. Readability was measured through six measurements: Flesch-Kincaid Grade Level (FKGL), Gunning Fox score, SMOG index, Coleman Liau index, and automated readability index. Social media presence and profile followers on Facebook, Twitter, and Instagram were determined to gauge social media presence. Exclusionary criteria yielded 41 unique websites, with the majority of websites authored by physicians (54%) followed by professional organizations (19%). The DISCERN method demonstrated that journal websites yielded the highest overall quality (4.00) and physician websites yielded the lowest (2.72). Readability analysis demonstrated that online forums proved the most challenging to read, and encyclopedia articles were the least challenging. Physician websites maintained the highest social media presence (95%) followed by professional organizations (75%). However, professional organizations had more social media followers in comparison to physician websites. Physician websites and professional organizations overwhelmingly command social media presence compared to other information providers and provide information with serious deficits in reliability and quality. A strong majority of online information also surpasses the health care literacy of patients. This poses a serious concern for physicians who need to provide and guide patients to high quality and reliable information.
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http://dx.doi.org/10.1055/s-0039-1693033DOI Listing
August 2019

Hemoglobin Titusville [α2 Codon 94 G>A]: A Rare Alpha Globin Chain Variant Causing Low Oxygen Saturation.

Indian J Hematol Blood Transfus 2019 Jul 11;35(3):593-595. Epub 2019 Apr 11.

Division of Hematogenetics, National Institute of Immunohematology, Mumbai, India.

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http://dx.doi.org/10.1007/s12288-019-01110-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6646431PMC
July 2019

Role of Living Donor Liver Transplantation in Acute Liver Failure.

Liver Transpl 2019 09;25(9):1308-1309

Baylor Simmons Transplant Institute, Baylor University Medical Center, Dallas, TX.

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http://dx.doi.org/10.1002/lt.25610DOI Listing
September 2019

Aggregation of amylin: Spectroscopic investigation.

Int J Biol Macromol 2019 Jul 25;133:1242-1248. Epub 2019 Apr 25.

Biophysics and Soft Matter Laboratory, Department of Physics, Indian Institute of Technology Kharagpur, 721302, India. Electronic address:

Apart from its relevance to pathology, protein misfolding disease like Type-II Diabetes Mellitus, caused by amyloids of amylin protein has attracted more attention due to structural changes occurring during the aggregation process. We report extensive spectroscopy data of amylin during fibril formation through Raman, FTIR, CD, UV-vis absorption and photoluminescence (PL) spectroscopy. UV-vis and PL spectrum showed the sigmoidal growth of fibril with a lag time of ~2 days, which is consistent with earlier reported work using dynamic light scattering (DLS). Raman spectra revealed the formation of parallel and anti-parallel β-sheet from 0% to 20% with ageing (1st day to 21st day) at pH 6.5 ± 0.1. The results are corroborated by CD and FTIR data. These show the change in β-sheet by 23% at pH 6.5 ± 0.1, 26% at pH = 1.0 ± 0.1 and 30% at pH = 12 ± 0.1. It is also shown that the formation and conversion of other secondary structures into β-sheet is very sensitive towards the pH and ageing. The study may be used for the development of therapeutic strategies that could inhibit or even reverse the process of aggregation.
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http://dx.doi.org/10.1016/j.ijbiomac.2019.04.167DOI Listing
July 2019

Diagnostic challenges posed by a rare alpha globin chain variant Hb Fontainebleau in a pregnant female and its potential effects in her children in view of multiple globin gene defects in her husband.

Indian J Pathol Microbiol 2019 Apr-Jun;62(2):323-325

Department of Hematology, Central Reference Laboratory, SRL Limited, Mumbai, Maharashtra, India.

Alpha globin chain variants per se do not cause severe morbidity and mortality but can modify - usually ameliorate - the clinical manifestations of beta globin chain variants when co-inherited with the latter. They also pose challenges in interpretation of high-performance liquid chromatography histograms and require molecular analysis for proper characterization. Hemoglobin (Hb) Fontainebleau is a rare alpha globin chain variant [alpha 21(B2) Ala→Pro], of which only three families have been reported from India in the past. Here, we describe a case of Hb fontainebleau detected in heterozygous condition in a 19-year-old primigravida. Her husband was found to have a double heterozygous state for HbQ India and beta-thalassemia trait. This opens up the possibility of multiple combinations of hemoglobinopathies in the offspring.
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http://dx.doi.org/10.4103/IJPM.IJPM_218_18DOI Listing
August 2019

DNA supported graphene quantum dots for Ag ion sensing.

Nanotechnology 2019 Jun 19;30(25):255501. Epub 2019 Feb 19.

School of Nanoscience and Technology, Indian Institute of Technology Kharagpur, Kharagpur-721302, India.

The use of graphene quantum dots can be extended for bio-sensing and metal ion detection. Synergistic combination of graphene quantum dots (GQDs) with DNA leads to high performance Ag-ion detection system. The thoroughly characterized GQDs were found to have spherical morphology, with dimensions in the range of 5-10 nm. The atomic force microscopy studies proved that the synthesized GQDs were mostly comprised of two to four graphene layers. To make the system biocompatible, GQDs/NGQDs were combined with DNA. Two properties of DNA were exploited, capacity to provide nitrogen to GQDs; and to synergistically contribute to Ag detection. In addition to Ag, the strong green photoluminescence (PL) of GQDs showed significant quenching, owing to the appearance of associated Förster resonance energy transfer processes. This led to high sensing efficiencies.
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http://dx.doi.org/10.1088/1361-6528/ab084cDOI Listing
June 2019

Massive hemoptysis in pulmonary infections: bronchial artery embolization.

J Thorac Dis 2018 Oct;10(Suppl 28):S3458-S3464

Imaging Institute, Cleveland Clinic, Cleveland, OH, USA.

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http://dx.doi.org/10.21037/jtd.2018.06.147DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6218368PMC
October 2018

Impact of Telemedicine in Pediatric Postoperative Care.

Telemed J E Health 2019 11 5;25(11):1083-1089. Epub 2018 Dec 5.

Institute for Medical Engineering and Science (IMES), Massachusetts Institute of Technology, Cambridge, Massachusetts.

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http://dx.doi.org/10.1089/tmj.2018.0246DOI Listing
November 2019

Repulsive interaction induces fibril formation and their growth.

Int J Biol Macromol 2019 Feb 30;123:20-25. Epub 2018 Oct 30.

Biophysics Laboratory, Department of Physics, Indian Institute of Technology, Kharagpur 721302, India. Electronic address:

In a type-II diabetes disease, amylin protein takes an incorrect structure that leads to the formation of the amyloid fibril. The conversion mechanism of amyloid fibril is not well understood. We have observed a repulsive interaction, in terms of second virial co-efficient (A), between protein molecules in their native state in the PBS buffer through laser light scattering technique. The A switches from repulsive (positive A) to attractive (negative A) interactions with elapsed time favoring the formation and growth of the fibril. We report aggregation and fibril growth kinetics of amylin protein in different environmental conditions. The measurement of shape factor (ρ) through light scattering experiment shows a transition from coil-like structure to rod-like growth. In addition to rod-like growth, sheet-like growth of fibril is also observed through analytical and high-resolution TEM imaging techniques. The nucleation leading to elongation of fibrils as well as stacking of individual fibril perpendicular to the fibril axis is held by hydrogen bonding observed through high-resolution TEM.
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http://dx.doi.org/10.1016/j.ijbiomac.2018.10.205DOI Listing
February 2019