Publications by authors named "Matthew Anderson"

390 Publications

Dual antiplatelet use in the management of COVID-19 associated acute ischemic stroke reocclusion.

Interv Neuroradiol 2022 May 12:15910199221097484. Epub 2022 May 12.

Department of Neurosurgery, Brown University, 12321The Warren Alpert Medical School, Providence, RI, USA.

Intro: SARS-CoV-2 (COVID-19) infection is associated with acute ischemic stroke (AIS), which may be due to a prothrombotic state. Early reports have suggested high rates of reocclusion following mechanical thrombectomy (MT) with poor radiographic and clinical outcomes. We report our early experience using intra-procedural antithrombotics to address SARS-CoV-2 reocclusion.

Methods: We identified 6 patients that experienced early reocclusion after MT for COVID-19-associated AIS through retrospective chart review abstracting their basic demographics, COVID-19 status, and stroke management. All these patients were treated after reocclusion with aspirin and cangrelor intra-procedurally, the latter of which was converted to ticagrelor post-procedurally. Some patients additionally received argatroban infusion intraprocedurally.

Results: Mean age was 54. There were 3 post-procedural and 3 intra-procedural re-occlusions. After repeat thrombectomy and treatment with aspirin and cangrelor, those with post-procedure reocclusion did not show further reocclusion, while those with intra-procedural reocclusion showed radiographic improvement with intraprocedural cangrelor administration. Outcomes for these patients were poor, with a median mRS of 4. Two patients developed petechial hemorrhage of their stroke which was managed conservatively, and one developed a retroperitoneal hemorrhage from femoral access requiring transfusion. There were no patients who developed new parenchymal hematomas.

Conclusion: COVID-19 AIS may be associated with a hypercoagulable state which risks malignant reocclusion complicating MT. We found antithrombotic treatment periprocedural cangrelor with or without argatroban transitioned to oral aspirin with ticagrelor to be a viable method for management of these patients.
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http://dx.doi.org/10.1177/15910199221097484DOI Listing
May 2022

Utility of automated MRI perfusion (RAPID) with or without MR angiography for detection of angiographic vasospasm after aneurysmal subarachnoid hemorrhage.

J Clin Neurosci 2022 Jun 22;100:143-147. Epub 2022 Apr 22.

Department of Neurosurgery, Warren Alpert School of Medicine, Brown University, Providence, RI 02903, United States.

Delayed cerebral ischemia (DCI) is a major etiology of poor neurologic outcomes after aneurysmal subarachnoid hemorrhage (aSAH). Although the development of DCI is certainly multifactorial, the presence of vasospasm is strongly correlated with it. Cerebral angiography remains the gold standard for evaluation of vasospasm, though it is not always practical or cost-effective. In this study, the authors assess the utility of automated MRI Perfusion imaging, with or without MR Angiography (MRA), as a confirmatory tool for suspected angiographic vasospasm. All patients admitted to a single institution with aneurysmal subarachnoid hemorrhage between January 2014 and February 2020 and who underwent MR Perfusion imaging with or without MRA for suspected vasospasm no >24 h prior to an angiogram were identified. 43 subjects were identified. 29 of these patients (67%) underwent simultaneous MRA. 25 patients (53%) received intra-arterial treatment for symptomatic vasospasm. The sensitivity, specificity, PPV, and NPV of MR Perfusion were 43%, 82%, 53%, and 75% for any angiographic vasospasm and 57%, 81%, 42%, and 89% for treated vasospasm. The sensitivity, specificity, PPV, and NPV of MR Perfusion in conjunction with MRA were 61%, 81%, 59%, and 82% for any angiographic vasospasm and 62%, 74%, 35%, and 89% for treated vasospasm. The sensitivity, specificity, PPV, and NPV of transcranial Dopplers (TCDs) in these patients were 35%, 93%, 71%, and 75% for angiographic vasospasm and 42%, 90%, 47%, and 88% for treated vasospasm. Automated MR Perfusion imaging demonstrated relatively low sensitivity and PPV for detection of angiographic and treated vasospasm in this subset of patients after aSAH.
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http://dx.doi.org/10.1016/j.jocn.2022.04.021DOI Listing
June 2022

FKBP51 Contributes to Uterine Leiomyoma Pathogenesis by Inducing Cell Proliferation and Extracellular Matrix Deposition.

Reprod Sci 2022 Jun 14;29(6):1939-1949. Epub 2022 Apr 14.

Department of Obstetrics and Gynecology, University of South Florida, Morsani College of Medicine, 560 Channelside Drive, Office MDD738, Tampa, FL, 33602, USA.

The FK506-binding protein 51 (FKBP51) binds progesterone receptor (PR), glucocorticoid receptor (GR), and androgen receptor (AR) to coregulate their transcriptional activity. We evaluated FKBP51 expression and function in human leiomyoma vs. myometrial tissues and primary cultures to discover FKBP51 role(s) in the pathogenesis of leiomyomas. Quantification of in situ FKBP51 mRNA and protein levels inpaired myometrial vs. leiomyoma tissues from proliferative and secretory phases were analyzed by qPCR (n = 14), immunoblotting (n = 20), and immunohistochemistry (n = 12). Control (scramble) vs. FKBP5 siRNA-transfected leiomyoma cell cultures were assessed for proliferation, apoptosis, and mRNA levels of genes involved in cell survival and extracellular matrix (ECM) formation. Significantly higher FKBP5 mRNA levels were detected in leiomyoma vs. paired myometrium (P < 0.001). Immunoblot (P = 0.001) and immunostaining (P ≤ 0.001) confirmed increased FKBP51 levels in leiomyoma vs. paired myometrium. Compared to control siRNA transfection, FKBP5-silenced leiomyoma cell cultures displayed significantly decreased cell survival factors and reduced proliferation (P < 0.05). Moreover, qPCR analysis revealed significantly lower mRNA levels of ECM, TIPM1, and TIPM3 proteins in FKBP5-silenced leiomyoma cell cultures (P < 0.05). Increased FKBP51 expression in leiomyoma likely involves dysregulation of steroid signaling by blocking GR and PR action and promoting proliferation and ECM production. Evaluating the effect of FKBP51 inhibition in preclinical studies will clarify its significance as a potential therapeutic approach against leiomyoma.
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http://dx.doi.org/10.1007/s43032-022-00921-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9009985PMC
June 2022

"Validation of the D:A:D Chronic Kidney Disease Risk Score Incorporating Proteinuria in People Living with HIV in Harare, Zimbabwe"​​.

J Acquir Immune Defic Syndr 2022 Apr 12. Epub 2022 Apr 12.

Department of Renal Medicine and Renal Transplant, Royal Prince Alfred Hospital, Missenden Rd, Camperdown, New South Wales, Australia.

Objective: We sought to validate the D:A:D risk score for chronic kidney disease (CKD) in people living with HIV (PLWH) in a cohort from Harare, Zimbabwe. Additionally, we aimed to evaluate proteinuria as a predictive variable in the risk score model, being the first study to do so.

Design: Data from PLWH attending a clinic in Harare was evaluated. Those with a baseline estimated glomerular filtration rate >60ml/min/1.73m2 and at least two subsequent eGFR measurements were included. A modified version of the D:A:D risk score model was applied to categorise participants as 'low', 'medium' and 'high-risk' of progression to CKD. Potential predictors of renal impairment were assessed by logistic regression in univariate and multivariate models. Proteinuria was evaluated in a nested model using D:A:D risk categories.

Results: 2793 participants were included. 40 participants (1.4% of the cohort) progressed to CKD during the median follow-up time of 4.2 years. Progression rates were 1%, 3% and 12% in the low, medium, and high-risk groups respectively. Proteinuria data was available for 2251 participants. Presence of proteinuria was strongly associated with progression to CKD [OR 7.8, 95% CI 3.9-15.7], and its inclusion in the risk score improved the discrimination of the model with the c-statistic increasing from 0.658 to 0.853).

Conclusion: A modified version of the D:A:D CKD risk score performed well in predicting CKD events among this Sub-Saharan African cohort of people living with HIV. Inclusion of proteinuria into the risk score model significantly improved predictability.
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http://dx.doi.org/10.1097/QAI.0000000000003002DOI Listing
April 2022

Circadian Rhythms and Sleep Are Dependent Upon Expression Levels of Key Ubiquitin Ligase .

Front Behav Neurosci 2022 23;16:837523. Epub 2022 Mar 23.

Department of Biological Sciences, Vanderbilt University, Nashville, TN, United States.

Normal neurodevelopment requires precise expression of the key ubiquitin ligase gene . Comparing newly generated mouse models for downregulation (models of Angelman syndrome) vs. upregulation (models for autism), we find reciprocal effects of gene dosage on phenotypes associated with circadian rhythmicity, including the amount of locomotor activity. Consistent with results from neurons in general, we find that is imprinted in neurons of the suprachiasmatic nuclei (SCN), the pacemaking circadian brain locus, despite other claims that SCN neurons were somehow exceptional to these imprinting rules. In addition, -deficient mice lack the typical drop in wake late in the dark period and have blunted responses to sleep deprivation. Suppression of physical activity by light in -deficient mice is not due to anxiety as measured by behavioral tests and stress hormones; quantification of stress hormones may provide a mechanistic link to sleep alteration and memory deficits caused by deficiency, and serve as an easily measurable biomarker for evaluating potential therapeutic treatments for Angelman syndrome. We conclude that reduced gene dosage affects not only neurodevelopment but also sleep patterns and circadian rhythms.
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http://dx.doi.org/10.3389/fnbeh.2022.837523DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8989470PMC
March 2022

Nurse, Parent, and Nurse Leader Perspective on Adoption of iPads for Pediatric Preoperative Anxiety Reduction.

J Perianesth Nurs 2022 Mar 21. Epub 2022 Mar 21.

Nursing Research, Intermountain Healthcare, Salt Lake City, UT.

Purpose: The purpose of this study was to examine the use of an iPad to facilitate distraction and reduce anxiety with preoperative pediatric patients.

Design: The authors conducted a descriptive case study in a Pre-Anesthesia Surgical Suite.

Methods: Nurses were trained on the use of the iPad, which came preloaded with games. The research staff took detailed notes during training and implementation. Research staff conducted interviews with nurses, leaders, and patient guardians for the study.

Findings: The authors discovered different perspectives among the clinical nurse, parent, and nursing leadership. The clinical nurse felt the iPad afforded them more focused time with the parents before surgery, though there was some hesitation at the beginning due to ownership of the devices. The parents felt the iPads were helpful to distract their child but worried there were not enough games appropriate for various age ranges. Nursing leadership found the iPads helpful in building a connection with the patient and their parents. Still, they felt many obstacles made integrating the use of the iPads in the nurses' workflow very difficult. There were technological issues that also delayed and discouraged the use of iPads. Once these preliminary issues were resolved, the iPad appeared to reduce anxiety in both patients and their parents.

Conclusions: The iPad is an evidence-based intervention used for preoperative anxiety reduction. This study identifies essential facilitators and barriers associated with adopting the technology from the perspective of key stakeholders (nurses, parents, and nursing leadership). Overall, the iPad was considered a valuable tool to help parents feel less stressed with their child, allowing them to interact more effectively with the clinician. However, additional work is indicated to address the limitations regarding sample size and actual measures of anxiety.
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http://dx.doi.org/10.1016/j.jopan.2021.09.005DOI Listing
March 2022

Impact of hematologic toxicities during concurrent chemoradiation for cervical cancer.

Obstet Gynecol Sci 2022 Mar 22;65(2):176-187. Epub 2022 Feb 22.

Department of Radiation Oncology, Department of Radiation Oncology, Baylor College of Medicine, Houston, TX, USA.

Objective: To evaluate the prognostic significance of hematological toxicities during cervical cancer treatment.

Methods: Patients treated for cervical carcinoma with definitive chemoradiation were identified. Toxicities were assessed during weeks 1 to 6 of concurrent external beam radiation and chemotherapy. Outcomes were analyzed using Cox regression analysis.

Results: One hundred twenty-one patients with Federation of Gynecology and Obstetrics stage I-III disease were eligible for analysis. Median age at diagnosis was 45 years (interquartile range, 40-52) with median follow-up time of 34 months (95% confidence interval, 30.8-37.2). All patients experienced some grade of hematologic toxicity. The most common grade 3+ toxicities were low absolute lymphocyte count (n=115, 95%), low white blood cell count (n=21, 17%), and anemia (n=11, 9%). The most common grade 4 toxicity was lymphopenia, experienced by 36% of patients (n=44). Grade 4 lymphopenia was associated with reduced overall survival (hazard ratio [HR], 4.5; P=0.005), progression-free survival (HR, 3.4; P=0.001), and local control (HR, 4.1; P=0.047). Anemia grade 3, 4 was also associated with reduced overall survival (HR, 4.1; P=0.014). After controlling for disease and treatment variables, grade 4 lymphopenia remained significantly associated with reduced overall survival (HR, 9.85; P=0.007). The association with grade 4 lymphopenia only remained significant in women of Hispanic ethnicity.

Conclusion: Severe lymphopenia was associated with reduced overall survival and progression-free survival in Hispanic women undergoing definitive chemoradiation for cervical cancer, but not associated with outcomes in non-Hispanic women.
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http://dx.doi.org/10.5468/ogs.21308DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8942745PMC
March 2022

Oxidized Regenerated Cellulose Mimicking a Retained Laparotomy Sponge.

Case Rep Surg 2022 1;2022:4718457. Epub 2022 Feb 1.

Department of Obstetrics & Gynecology, University of South Florida Morsani College of Medicine, Tampa, FL 33623, USA.

Oxidized regenerated cellulose (ORC) is an absorbable hemostat commonly used during gynecologic surgery. We present a case in which ORC was used in a patient undergoing posterior pelvic exenteration with ureteroneocystostomy for excision of a malignant pelvic mass. At the conclusion of these procedures, the laparotomy pad count was reported as incomplete likely due to the large number of laparotomy pads used and changes in nursing staff. Abdominal radiographs were obtained to verify no pads were retained in the abdominal cavity. These identified a poorly defined radiolucency deep in the patient's pelvis, requiring the surgical incision be reopened. Upon reexploration, no evidence of a retained surgical sponge could be identified. However, ORC was identified at the site of the radiolucency in question. Radiographs of this material, once removed, confirmed its radiolucent appearance. This experience clearly demonstrates that oxidized regenerated cellulose can mimic a retained surgical sponge on intraoperative radiographs. Dissemination of this knowledge will hopefully help to avoid radiographic misidentification of ORC in the perioperative window and minimizing the risk of unnecessary surgical interventions in the future.
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http://dx.doi.org/10.1155/2022/4718457DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8825672PMC
February 2022

Balancing openness with Indigenous data sovereignty: An opportunity to leave no one behind in the journey to sequence all of life.

Proc Natl Acad Sci U S A 2022 01;119(4)

Genome Informatics Section, Computational and Statistical Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD 20892.

The field of genomics has benefited greatly from its "openness" approach to data sharing. However, with the increasing volume of sequence information being created and stored and the growing number of international genomics efforts, the equity of openness is under question. The United Nations Convention of Biodiversity aims to develop and adopt a standard policy on access and benefit-sharing for sequence information across signatory parties. This standardization will have profound implications on genomics research, requiring a new definition of open data sharing. The redefinition of openness is not unwarranted, as its limitations have unintentionally introduced barriers of engagement to some, including Indigenous Peoples. This commentary provides an insight into the key challenges of openness faced by the researchers who aspire to protect and conserve global biodiversity, including Indigenous flora and fauna, and presents immediate, practical solutions that, if implemented, will equip the genomics community with both the diversity and inclusivity required to respectfully protect global biodiversity.
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http://dx.doi.org/10.1073/pnas.2115860119DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8795560PMC
January 2022

Parasexuality of Species.

Front Cell Infect Microbiol 2021 13;11:796929. Epub 2021 Dec 13.

Department of Microbiology, The Ohio State University, Columbus, OH, United States.

While most fungi have the ability to reproduce sexually, multiple independent lineages have lost meiosis and developed parasexual cycles in its place. Emergence of parasexual cycles is particularly prominent in medically relevant fungi from the CUG paraphyletic group of species. Since the discovery of parasex in roughly two decades ago, it has served as the model for species. Importantly, parasex in retains hallmarks of meiosis including genetic recombination and chromosome segregation, making it a potential driver of genetic diversity. Furthermore, key meiotic genes play similar roles in parasex and highlights parallels between these processes. Yet, the evolutionary role of parasex in adaptation and the extent of resulting genotypic and phenotypic diversity remain as key knowledge gaps in this facultative reproductive program. Here, we present our current understanding of parasex, the mechanisms governing its regulation, and its relevance to biology.
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http://dx.doi.org/10.3389/fcimb.2021.796929DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8711763PMC
January 2022

The Intersection of Palliative Care and Genetic Counseling in Cancer Care: A Case Discussion.

J Palliat Med 2022 01 1;25(1):167-171. Epub 2021 Dec 1.

Department of Gynecologic Oncology, University of South Florida, Tampa, Florida, USA.

Up to 10% of cancers have a strong hereditary component. The diagnosis of a hereditary cancer may alter treatment recommendations for the patient. However, the optimal timing and best practices for integrating genetic counseling and testing into the care of women diagnosed with cancer remains unclear. In this study, we demonstrate the potential benefits of discussing genetic testing and counseling in the context of palliative care through two cases. Incorporating referrals for genetic testing into the palliative care context is important. This provides an opportunity to perform previously missed genetic testing. It is also a chance for the patient to leave a legacy while also potentially allowing for alternate targeted treatment possibilities that may be well tolerated and provide a better quality of life for the patients themselves. The benefits of referral to palliative care by the genetics team includes assisting patients with the management of not only physical but also psychological symptoms as well as conducting advanced care planning in patients and families with hereditary mutations.
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http://dx.doi.org/10.1089/jpm.2021.0169DOI Listing
January 2022

Tumor-Derived Cell Culture Model for the Investigation of Meningioma Biology.

J Neuropathol Exp Neurol 2021 12;80(12):1117-1124

Department of Neurology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA.

Meningioma is the most common primary central nervous system tumor. Although mostly nonmalignant, meningioma can cause serious complications by mass effect and vasogenic edema. While surgery and radiation improve outcomes, not all cases can be treated due to eloquent location. Presently no medical treatment is available to slow meningioma growth owing to incomplete understanding of the underlying pathology, which in turn is due to the lack of high-fidelity tissue culture and animal models. We propose a simple and rapid method for the establishment of meningioma tumor-derived primary cultures. These cells can be maintained in culture for a limited time in serum-free media as spheres and form adherent cultures in the presence of 4% fetal calf serum. Many of the tissue samples show expression of the lineage marker PDG2S, which is typically retained in matched cultured cells, suggesting the presence of cells of arachnoid origin. Furthermore, nonarachnoid cells including vascular endothelial cells are also present in the cultures in addition to arachnoid cells, potentially providing a more accurate tumor cell microenvironment, and thus making the model more relevant for meningioma research and high-throughput drug screening.
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http://dx.doi.org/10.1093/jnen/nlab111DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8716066PMC
December 2021

A Retrospective Study on Human Leukocyte Antigen Types and Haplotypes in a South African Population.

Arch Pathol Lab Med 2021 12;145(12):1474a-1474

Diagnostic Laboratories, Versiti, Milwaukee, Wisconsin.

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http://dx.doi.org/10.5858/arpa.2021-0228-LEDOI Listing
December 2021

NCHL's "Best Organizations for Leadership Development" Program: A Case Study in Improving Evidence-based Practice through Benchmarking and Recognition.

Adv Health Care Manag 2021 12;20

Increasingly, addressing healthcare's grand challenges requires complex system-level adaptations involving continuously evolving teams and leaders. Although leadership development strategies have been shown to improve individual leader effectiveness, much less is known about how organization-level leadership development affects organization-level outcomes. To begin building an evidence base as well as encouraging evidence-based practices, the US-based National Center for Healthcare Leadership developed a program capitalizing on leaders' demonstrated interest in organizational competitiveness: the biennial program. In this chapter, we describe the philosophy behind this unique survey program and summarize research to date on relationships between survey dimensions and organizational outcomes such as patient experience and financial performance. We conclude with a description of promising areas for future study.
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http://dx.doi.org/10.1108/S1474-823120210000020008DOI Listing
December 2021

A survey study examining the motivations, concerns, and perspectives of medical students engaging in neurosurgical research.

Surg Neurol Int 2021 30;12:490. Epub 2021 Sep 30.

Department of Neurosurgery, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, United States.

Background: In a competitive landscape for neurosurgical residency admission, research productivity is increasingly important. Medical school applicants to neurosurgery report high numbers of "scholarly products" as published by the National Residency Match Program. Despite increased student involvement in research and productivity, to the best of our knowledge, no previous reported studies have examined student perspectives on their involvement in neurosurgical research.

Methods: For 2 consecutive years (February 2019 and February 2020), medical students ( = 55) from around the United States presented original research at the Student Neurosurgical Research Conference. Participants were administered a mixed-method survey designed to assess experiences and perspectives on engaging in neurosurgical research. Survey responses were analyzed independently by two researchers to assess for common themes and perspectives.

Results: Medical students engaged in all types of research work across nearly every neurosurgical subfield with "Basic/Bench Lab work" (38.5%) and "Chart Review" (23.1%) representing the majority of projects. Students commonly cited "curiosity/interest," and "residency application competitiveness" as main reasons for participation in research. About 66% of respondents reported experiencing anxiety/concern about research productivity "often" or "very often." Thematic analysis revealed that sources of research-related stress were (1) having enough publications to match into residency, and (2) having enough time in medical school to engage in research.

Conclusion: Medical students engaging in neurosurgical research are highly motivated students driven by scientific curiosity and pressure to prepare for competitive residency applications. Students experience anxiety due to time constraints in medical curricula and increasing demands for scholarly productivity.
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http://dx.doi.org/10.25259/SNI_742_2021DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8571239PMC
September 2021

Inactivation of Fgf3 and Fgf4 within the Fgf3/Fgf4/Fgf15 gene cluster reveals their redundant requirement for mouse inner ear induction and embryonic survival.

Dev Dyn 2022 05 12;251(5):877-884. Epub 2021 Nov 12.

Unidad de Excelencia, Instituto de Biología y Genética Molecular, Universidad de Valladolid y Consejo Superior de Investigaciones Científicas, Valladolid, Spain.

Background: Fibroblast growth factors (Fgfs) are required for survival and organ formation during embryogenesis. Fgfs often execute their functions redundantly. Previous analysis of Fgf3 mutants revealed effects on inner ear formation and embryonic survival with incomplete penetrance.

Results: Here, we show that presence of a neomycin resistance gene (neo) replacing the Fgf3 coding region leads to reduced survival during embryogenesis and an increased penetrance of inner ear defects. Fgf3 mutants showed reduced expression of Fgf4, which is positioned in close proximity to the Fgf3 locus in the mouse genome. Conditional inactivation of Fgf4 during inner ear development on a Fgf3 null background using Fgf3/4 cis mice revealed a redundant requirement between these Fgfs during otic placode induction. In contrast, inactivation of Fgf3 and Fgf4 in the pharyngeal region where both Fgfs are also co-expressed using a Foxg1-Cre driver did not affect development of the pharyngeal arches. However, these mutants showed reduced perinatal survival.

Conclusions: These results highlight the importance of Fgf signaling during development. In particular, different members of the Fgf family act redundantly to guarantee inner ear formation and embryonic survival.
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http://dx.doi.org/10.1002/dvdy.435DOI Listing
May 2022

Trends in ureteral surgery on an academic gynecologic oncology service.

Gynecol Oncol 2021 12 19;163(3):552-556. Epub 2021 Oct 19.

H. Lee Moffitt Cancer Center, Department of Gynecologic Oncology, Department of Oncologic Sciences, University of South Florida, Tampa, FL, United States of America.

Objective: To describe the incidence, complications, and trends associated with ureteral surgeries on a gynecologic oncology service in the context of a fellowship training program over a 24-year period.

Methods: We conducted a retrospective cohort analysis of ureteral surgeries by gynecologic oncologists at either Moffitt Cancer Center or Tampa General Hospital from 1997 to 2020. Patient characteristics, predisposing factors, location and type of injury, repair method, postoperative management and complications were abstracted from the medical record. The recent cohort (2005-2020) was compared to our prior series (1997-2004).

Results: Eighty-eight cases were included. The average number of ureteral surgeries per year decreased from 5.75 (1997-2004) to 2.63 (2005-2020). Of 46 iatrogenic injuries, 45 were recognized and repaired intraoperatively. Ureteral transection was the most common type (85% [39 of 46]) and the distal 5 cm was the most common location of injury (63% [29 of 46]). Ureteroneocystostomy was the most common method of repair (83% [73 of 88]). Postoperative management, including stenting and imaging, has not changed significantly. Length of urinary catheter usage decreased in the recent cohort without associated complications. Five patients had major postoperative complications and 4 involved the urinary tract. Of those with follow-up, 96% (66 of 69) of ureteroneocystostomies and 75% (9 of 12) of ureteroureterostomies had radiologically normal urinary tracts.

Conclusions: Ureteral surgery is necessary in the case of injury or involvement with invasive disease. There has been a decrease in number of procedures. Ureteroneocystostomy has remained the most common method of reconstruction for both injury and resection with acceptable postoperative complication rates.
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http://dx.doi.org/10.1016/j.ygyno.2021.10.009DOI Listing
December 2021

Optimal Timing of Administration of Direct-acting Antivirals for Patients With Hepatitis C-associated Hepatocellular Carcinoma Undergoing Liver Transplantation.

Ann Surg 2021 10;274(4):613-620

University of Michigan, Ann Arbor, Michigan.

Objective: To investigate the optimal timing of direct acting antiviral (DAA) administration in patients with hepatitis C-associated hepatocellular carcinoma (HCC) undergoing liver transplantation (LT).

Summary Of Background Data: In patients with hepatitis C (HCV) associated HCC undergoing LT, the optimal timing of direct-acting antivirals (DAA) administration to achieve sustained virologic response (SVR) and improved oncologic outcomes remains a topic of much debate.

Methods: The United States HCC LT Consortium (2015-2019) was reviewed for patients with primary HCV-associated HCC who underwent LT and received DAA therapy at 20 institutions. Primary outcomes were SVR and HCC recurrence-free survival (RFS).

Results: Of 857 patients, 725 were within Milan criteria. SVR was associated with improved 5-year RFS (92% vs 77%, P < 0.01). Patients who received DAAs pre-LT, 0-3 months post-LT, and ≥3 months post-LT had SVR rates of 91%, 92%, and 82%, and 5-year RFS of 93%, 94%, and 87%, respectively. Among 427 HCV treatment-naïve patients (no previous interferon therapy), patients who achieved SVR with DAAs had improved 5-year RFS (93% vs 76%, P < 0.01). Patients who received DAAs pre-LT, 0-3 months post-LT, and ≥3 months post-LT had SVR rates of 91%, 93%, and 78% (P < 0.01) and 5-year RFS of 93%, 100%, and 83% (P = 0.01).

Conclusions: The optimal timing of DAA therapy appears to be 0 to 3 months after LT for HCV-associated HCC, given increased rates of SVR and improved RFS. Delayed administration after transplant should be avoided. A prospective randomized controlled trial is warranted to validate these results.
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http://dx.doi.org/10.1097/SLA.0000000000005070DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8559662PMC
October 2021

Update on the Basic Science Concepts and Applications of Adipose-Derived Stem Cells in Hand and Craniofacial Surgery.

Plast Reconstr Surg 2021 Sep;148(3):475e-486e

From the College of Medicine and Division of Plastic and Reconstructive Surgery, University of Kentucky; Division of Plastic and Reconstructive Surgery, Virginia Tech Carilion School of Medicine; Division of Plastic and Reconstructive Surgery, Stanford University Medical Center; and Division of Plastic and Reconstructive Surgery, Mayo Clinic.

Summary: Adipose-derived stem cell therapy offers plastic surgeons a novel treatment alternative for conditions with few therapeutic options. Adipose-derived stem cells are a promising treatment because of their broad differentiation potential, capacity for self-renewal, and ease of isolation. Over the past decade, plastic surgeons have attempted to harness adipose-derived stem cells' unique cellular characteristics to improve the survival of traditional fat grafting procedures, a process known as cell-assisted lipotransfer. However, the full implications of cell-assisted lipotransfer in clinical practice remain incompletely understood, stressing the urgent need to assess the scientific evidence supporting adipose-derived stem cell-based interventions. Furthermore, with the strict regulatory climate surrounding tissue explantation therapies, reviewing the safety and efficacy of these treatments will clarify their regulatory viability moving forward. In this report, the authors provide a comprehensive, up-to-date appraisal of best evidence-based practices supporting adipose-derived stem cell-derived therapies, highlighting the known mechanisms behind current clinical applications in tissue engineering and regenerative medicine specific to plastic and reconstructive surgery. The authors outline best practices for the harvest and isolation of adipose-derived stem cells and discuss why procedure standardization will elucidate the scientific bases for their broad use. Finally, the authors discuss challenges posed by U.S. Food and Drug Administration oversight of these cell-based therapies and examine the role of adipose-derived stem cell-based applications in the future of plastic surgery.
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http://dx.doi.org/10.1097/PRS.0000000000008279DOI Listing
September 2021

Highly efficient on-DNA amide couplings promoted by micelle forming surfactants for the synthesis of DNA encoded libraries.

Chem Sci 2021 Jul 22;12(27):9475-9484. Epub 2021 Jun 22.

Cancer Research UK Newcastle Drug Discovery Unit, Chemistry, School of Natural and Environmental Sciences, Newcastle University Bedson Building Newcastle upon Tyne NE1 7RU UK

DNA encoded libraries (DELs) represent powerful new technology for finding small molecule ligands for proteins and are increasingly being applied to hit finding in medicinal chemistry. Crucial to the synthesis of high quality DELs is the identification of chemical reactions for their assembly that proceed with very high conversion across a range of different substrates, under conditions compatible with DNA-tagged substrates. Many current chemistries used in DEL synthesis do not meet this requirement, resulting in libraries of low fidelity. Amide couplings are the most commonly used reaction in synthesis of screening libraries and also in DELs. The ability to carry out highly efficient, widely applicable amide couplings in DEL synthesis would therefore be highly desirable. We report a method for amide coupling using micelle forming surfactants, promoted by a modified linker, that is broadly applicable across a wide range of substrates. Most significantly, this works exceptionally well for coupling of DNA-conjugated carboxylic acids (N-to-C) with amines in solution, a procedure that is currently very inefficient. The optimisation of separate procedures for coupling of DNA-conjugated acids and amines by reagent screening and statistically driven optimisation is described. The generality of the method is illustrated by the application to a wide range of examples with unprecedented levels of conversion. The utility of the (N-to-C) coupling of DNA-conjugated acids in DEL synthesis is illustrated by the three cycle synthesis of a fully DNA-encoded compound by two cycles of coupling of an aminoester, with intermediate ester hydrolysis, followed by capping with an amine. This methodology will be of great utility in the synthesis of high fidelity DELs.
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http://dx.doi.org/10.1039/d1sc03007hDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8278914PMC
July 2021

A Systematic Assessment of YouTube Content on Femoroacetabular Impingement: An Updated Review.

Orthop J Sports Med 2021 Jun 29;9(6):23259671211016340. Epub 2021 Jun 29.

Columbia University Irving Medical Center, New York, New York, USA.

Background: Online video-sharing platforms such as YouTube have become popular sources of medical information for patients. However, concern exists regarding the quality of such non-peer reviewed content. In fact, a previous investigation found the majority of YouTube information related to femoroacetabular impingement (FAI) to be of poor quality.

Purpose: To provide an updated assessment of the quality of FAI-related videos available on YouTube.

Study Design: Cross-sectional study.

Methods: The terms , , and were searched on YouTube, and exclusion criteria were applied to the first 100 results for each term. The diagnostic and treatment content of each video was graded and assigned a quality assessment rating based on a previously used rubric. Video characteristics (e.g. duration, views, "likes") were compared using both quality assessment rating and video source.

Results: A total of 142 videos were included in the final analysis. The most common video source was educational (48.6%), followed by physician-sponsored (30.3%). The majority of videos were graded as "somewhat useful" for both diagnostic and treatment content (59.4% and 61.6%, respectively); however, treatment content was rated "not useful" more often than diagnostic information (20.3% vs. 8.7%, respectively). Videos rated as "somewhat useful" received the most views per day on average, while educational videos were the most viewed by source (views and views per day). Educational videos had more views and likes on average than physician-sponsored videos ( < .05), but all other comparisons of video characteristics by source were not significant. Video duration was the only characteristic found to vary significantly by quality assessment rating ( < .001 for both diagnostic and treatment analyses), with higher-quality videos tending to be longer. Videos rated as "excellent" and "very useful" had mean durations >30 minutes but were viewed the least.

Conclusion: The overall quality of FAI-related content on YouTube remains low. Clinicians should be familiar with medical information available to patients on the internet, as it can influence patients' perspectives and shared decision-making processes. This review substantiates the need for more publicly available, high-quality video content regarding the diagnosis and treatment of FAI.
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http://dx.doi.org/10.1177/23259671211016340DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8246525PMC
June 2021

The Bakken Blind Field: Investigating Planetary Urbanization and Opaqueness in the Oil and Gas Fields of Eastern Montana, USA.

Ann Am Assoc Geogr 2021 27;111(2):591-608. Epub 2020 Jul 27.

Department of Social Sciences and Cultural Studies, Montana State University Billings.

This work advances the critical urban studies literature on "planetary urbanization" by emphasizing the everyday struggles experienced by the people who live in and through planetary transformations. Specifically, we empirically investigated people in Eastern Montana who experienced the intensive and extensive oil and gas production of the Bakken Boom via interview and survey data. In the process, we interrogated Henri Lefebvre's notion of the "blind field," and conclude that what we call the "Bakken blind field" represents a deeply engrained "habit of the mind" that functions for the energy industry as a means of neutralizing the transformative potential that always lurks in response to persistent socio-environmentally exploitative practices. We suggest that the degree of illumination that results from personal hardships can determine the degree to which local exploitation is rejected (or accepted) as a necessary result of living with oil and gas.
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http://dx.doi.org/10.1080/24694452.2020.1774351DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8259807PMC
July 2020

Using machine learning methods to predict nonhome discharge after elective total shoulder arthroplasty.

JSES Int 2021 Jul 20;5(4):692-698. Epub 2021 Apr 20.

New York-Presbyterian/Columbia University Irving Medical Center, New York, NY, USA.

Background: Machine learning has shown potential in accurately predicting outcomes after orthopedic surgery, thereby allowing for improved patient selection, risk stratification, and preoperative planning. This study sought to develop machine learning models to predict nonhome discharge after total shoulder arthroplasty (TSA).

Methods: The American College of Surgeons National Surgical Quality Improvement Program database was queried for patients who underwent elective TSA from 2012 to 2018. Boosted decision tree and artificial neural networks (ANN) machine learning models were developed to predict non-home discharge and 30-day postoperative complications. Model performance was measured using the area under the receiver operating characteristic curve (AUC) and overall accuracy (%). Multivariate binary logistic regression analyses were used to identify variables that were significantly associated with the predicted outcomes.

Results: There were 21,544 elective TSA cases identified in the National Surgical Quality Improvement Program registry from 2012 to 2018 that met inclusion criteria. Multivariate logistic regression identified several variables associated with increased risk of nonhome discharge including female sex (odds ratio [OR] = 2.83; 95% confidence interval [CI] = 2.53-3.17;  < .001), age older than 70 years (OR = 3.19; 95% CI = 2.86-3.57;  < .001), American Society of Anesthesiologists classification 3 or greater (OR = 2.70; 95% CI = 2.41-2.03;  < .001), prolonged operative time (OR = 1.38; 95% CI = 1.20-1.58;  < .001), as well as history of diabetes (OR = 1.56; 95% CI = 1.38-1.75;  < .001), chronic obstructive pulmonary disease (OR = 1.71; 95% CI = 1.46-2.01;  < .001), congestive heart failure (OR = 2.65; 95% CI = 1.72-4.01;  < .001), hypertension (OR = 1.35; 95% CI = 1.20-1.52;  = .004), dialysis (OR = 3.58; 95% CI = 2.01-6.39;  = .002), wound infection (OR = 5.67; 95% CI = 3.46-9.29;  < .001), steroid use (OR = 1.43; 95% CI = 1.18-1.74;  = .010), and bleeding disorder (OR = 1.84; 95% CI = 1.45-2.34;  < .001). The boosted decision tree model for predicting nonhome discharge had an AUC of 0.788 and an overall accuracy of 90.3%. The ANN model for predicting nonhome discharge had an AUC of 0.851 and an overall accuracy of 89.9%. For predicting the occurrence of 1 or more postoperative complications, the boosted decision tree model had an AUC of 0.795 and an overall accuracy of 95.5%. The ANN model yielded an AUC of 0.788 and an overall accuracy of 92.5%.

Conclusions: Both the boosted decision tree and ANN models performed well in predicting nonhome discharge with similar overall accuracy, but the ANN had higher discriminative ability. Based on the findings of this study, machine learning has the potential to accurately predict nonhome discharge after elective TSA. Surgeons can use such tools to guide patient expectations and to improve preoperative discharge planning, with the ultimate goal of decreasing hospital length of stay and improving cost-efficiency.
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http://dx.doi.org/10.1016/j.jseint.2021.02.011DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8245980PMC
July 2021

Short- and long-term opioid use in survivors of subarachnoid hemorrhage.

Clin Neurol Neurosurg 2021 08 22;207:106770. Epub 2021 Jun 22.

Department of Neurology, Rhode Island Hospital, Warren Alpert Medical School of Brown University, Providence, RI, United States.

Objectives: Opioids are frequently used for analgesia in patients with acute subarachnoid hemorrhage (SAH) due to a high prevalence of headache and neck pain. However, it is unclear if this practice may pose a risk for opioid dependence, as long-term opioid use in this population remains unknown. We sought to determine the prevalence of opioid use in SAH survivors, and to identify potential risk factors for opioid utilization.

Methods: We analyzed a cohort of consecutive patients admitted with non-traumatic and suspected aneurysmal SAH to an academic referral center. We included patients who survived hospitalization and excluded those who were not opioid-naïve. Potential risk factors for opioid prescription at discharge, 3 and 12 months post-discharge were assessed.

Results: Of 240 SAH patients who met our inclusion criteria (mean age 58.4 years [SD 14.8], 58% women), 233 (97%) received opioids during hospitalization and 152 (63%) received opioid prescription at discharge. Twenty-eight patients (12%) still continued to use opioids at 3 months post-discharge, and 13 patients (6%) at 12-month follow up. Although patients with poor Hunt and Hess grades (odds ratio 0.19, 95% CI 0.06-0.57) and those with intraventricular hemorrhage (odds ratio 0.38, 95% CI 0.18-0.87) were less likely to receive opioid prescriptions at discharge, we did not find significant differences between patients who had long-term opioid use and those who did not.

Conclusion: Opioids are regularly used in both the acute SAH setting and immediately after discharge. A considerable number of patients also continue to use opioids in the long-term. Opioid-sparing pain control strategies should be explored in the future.
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http://dx.doi.org/10.1016/j.clineuro.2021.106770DOI Listing
August 2021

Return-to-Competition Criteria After Ulnar Collateral Ligament Reconstruction: A Systematic Review and Meta-analysis.

Am J Sports Med 2022 03 28;50(4):1157-1165. Epub 2021 Jun 28.

Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, New York, USA.

Background: Injury to the ulnar collateral ligament of the elbow is common among overhead throwing athletes and can result in significant functional limitations. While surgical reconstruction offers high rates of return to competition, there are no validated or universally accepted guidelines for determining when an athlete can safely resume play.

Purpose: To assess the existing scientific literature for return-to-competition criteria utilized after ulnar collateral ligament reconstruction.

Study Design: Systematic review and meta-analysis; Level of evidence, 4.

Methods: The PubMed database was searched for clinical investigations of ulnar collateral ligament reconstruction in overhead throwing athletes published between January 2000 and June 2020. Only studies that had a minimum follow-up of 1 year and included at least 1 specific return-to-competition criterion were considered.

Results: A total of 15 studies were included in the final analysis, encompassing 1156 patients with an average age of 20.7 years (SD, 2.0 years). Baseball players composed 96.3% of patients for whom sport was specified, and 92.4% of baseball players were pitchers. The most common return-to-competition criterion, identified in 87% of studies, was completion of a return-to-throwing program, which started on average 16.7 weeks (range, 12-18 weeks) after surgery. A return-to-mound program was utilized in 53% of studies, starting on average 7.4 months (range, 6-9 months) postoperatively. Minimum time from surgery was used in 73% studies, with players waiting 7 to 12 months (mean, 9.7; SD, 1.4 months) after surgery before return-to-competition consideration. The overall rate of return to competition at the preinjury level or higher was 85.7% (SD, 8.5%) at an average of 12.2 months (SD, 0.6 months).

Conclusion: In general, we observed a paucity of literature describing the return-to-competition process after ulnar collateral ligament reconstruction in overhead throwing athletes. Only 3 explicit return-to-competition criteria were identified across all studies: completion of a return-to-throwing program, completion of a return-to-mound program for pitchers, and minimum time from surgery. Increased transparency regarding postoperative rehabilitation protocols and further research are necessary to identify and validate sport-specific return-to-competition criteria, which will ultimately help athletes return to play in a safe and timely fashion after ulnar collateral ligament reconstruction.
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http://dx.doi.org/10.1177/03635465211016839DOI Listing
March 2022

Transplant-associated penile Kaposi sarcoma managed with single agent paclitaxel chemotherapy: a case report.

BMC Urol 2021 Jun 7;21(1):87. Epub 2021 Jun 7.

Department of Renal Medicine and Renal Transplant, Royal Prince Alfred Hospital, Missenden Rd, Camperdown, NSW, Australia.

Background: Kaposi's sarcoma is an uncommon complication in renal transplant patients, and typically presents with cutaneous lesions on the lower extremities. Penile involvement has been reported only rarely. Management of cutaneous-limited disease is primarily reduction of immunosuppression and conversion to an mTOR-inhibitor, whereas the treatment of disseminated disease in transplant patients is more variable.

Case Presentation: A 75-year-old male, originally from Somalia, received a deceased-donor kidney transplant for diabetic and hypertensive nephropathy. Seven months post-transplant he presented with lower limb lesions, oedema and bilateral deep vein thromboses. He then developed a fast-growing painful lesion on his penile shaft. A biopsy of this lesion confirmed KS, and a PET scan demonstrated disseminated disease in the lower extremities, penis and thoracic lymph nodes. His tacrolimus was converted to sirolimus, and his other immunosuppression was reduced. He was treated with single agent paclitaxel chemotherapy in view of his rapidly progressing, widespread disease. The penile lesion completely resolved, and the lower extremity lesions regressed significantly. His kidney allograft function remained stable throughout treatment.

Conclusion: This case illustrates a rare presentation of an uncommon post-transplant complication and highlights the need for a high index of suspicion of KS in transplant patients presenting with atypical cutaneous lesions. It serves to demonstrate that the use of single agent paclitaxel chemotherapy, switch to an mTORi and reduction in immunosuppression where possible produces excellent short-term outcomes, adding to the body of evidence for this management strategy in disseminated Kaposi's sarcoma.
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http://dx.doi.org/10.1186/s12894-021-00855-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8186205PMC
June 2021

Case Report: Pentosan Polysulfate Sodium Maculopathy Originally Diagnosed as Pattern Macular Dystrophy.

Optom Vis Sci 2021 06;98(6):552-556

Department of Surgery, VA NIHCS Fort Wayne Campus, Fort Wayne, Indiana.

Significance: Pentosan polysulfate sodium (PPS) maculopathy is a clinical entity characterized by a pigmentary maculopathy in the setting of chronic exposure to PPS. Pentosan polysulfate sodium is indicated for discomfort related to interstitial cystitis/painful bladder syndrome. Given a reported interstitial cystitis/painful bladder syndrome prevalence up to 2%, recognition is critical to mitigate visual sequelae.

Purpose: We present an observational case report demonstrating typical findings of PPS maculopathy in a patient originally diagnosed with a pattern macular dystrophy. We demonstrate the importance of medical history, medication profile review, and multimodal imaging in the diagnosis and management. The patient provided written informed consent for medical information and images to be published.

Case Report: A 55-year-old White woman presented with a painless, bilateral loss of vision and bilateral pigmentary maculopathy that was initially diagnosed as pattern macular dystrophy. Detailed review of medical history, medication profile, and subsequent studies, including optical coherence tomography, near-infrared reflectance imaging, fundus autofluorescence, fluorescein angiography, and genetic studies, ultimately led to the diagnosis of PPS maculopathy. Pentosan polysulfate sodium was discontinued, and ongoing surveillance with multimodal imaging was encouraged.

Conclusions: Because toxic maculopathies are an uncommon diagnosis, screening and recognition of PPS maculopathy are critical in the primary eye care setting. Discontinuation of the insulting agent may be necessary to prevent potentially severe and irreversible vision loss in the at-risk population.
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http://dx.doi.org/10.1097/OPX.0000000000001702DOI Listing
June 2021
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