Publications by authors named "Rahul Sharma"

407 Publications

Hybrid cytokine IL233 renders protection in murine acute graft vs host disease (aGVHD).

Cell Immunol 2021 Mar 23;364:104345. Epub 2021 Mar 23.

Center for Immunity, Inflammation and Regenerative Medicine (CIIR), Division of Nephrology, Department of Medicine, University of Virginia, Charlottesville, VA, USA. Electronic address:

Previously, we generated IL233, a hybrid cytokine composed of interleukin (IL)-2 and IL-33, with better therapeutic potential than either cytokine in multiple inflammatory diseases, in part through promoting T-regulatory cells (Tregs). Here we test the potential of IL233 pretreatment in a murine model of excessive Th1 activation, the parent-into-F1 model of acute GVHD (aGVHD). Five days of IL233 pretreatment of the recipients blocked or delayed the aGVHD-linked loss of B cells as seen in either the peripheral blood (day-11) or lymph nodes (day-14). IL233 pretreatment also prevented the expansion of donor CD8 T-cells in blood and LN at day-14 and significantly reduced day-14 serum IFNγ and TNFα compared to saline treated GVHD mice although, the level of Tregs did not statistically differ between saline and IL233-treated mice. Overall, the current study provides support for the use of IL233 as a therapeutic option in excessive Th1/CD8-driven conditions.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.cellimm.2021.104345DOI Listing
March 2021

Optic disc edema due to peripapillary choroidal neovascularization.

Taiwan J Ophthalmol 2021 Jan-Mar;11(1):93-96. Epub 2021 Jan 20.

Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia.

A 35-year-old myopic woman developed right-eye optic disc edema with normal visual function. The presence of a subtle crescent-shaped peripapillary subretinal hemorrhage in addition to the disc edema raised concern for a peripapillary choroidal neovascular membrane, which was confirmed by enhanced depth optical coherence tomography.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.4103/tjo.tjo_77_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7971433PMC
January 2021

Conservative treatments for acute nonarteritic central retinal artery occlusion: Do they work?

Taiwan J Ophthalmol 2021 Jan-Mar;11(1):16-24. Epub 2020 Nov 6.

Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia, USA.

Acute central retinal arterial occlusion has a very poor visual prognosis. Unfortunately, there is a dearth of evidence to support the use of any of the so-called "conservative" treatment options for CRAO, and the use of thrombolytics remains controversial. In this review, we address a variety of these "conservative" pharmacologic treatments (pentoxifylline, isosorbide dinitrate, and acetazolamide) and nonpharmacologic approaches (carbogen, hyperbaric oxygen, ocular massage, anterior chamber paracentesis, laser embolectomy, and hemodilution) that have been proposed as potential treatments of this condition. We conclude that the available evidence for all treatments is insufficient to conclude that any treatment will influence the natural history of this disorder. Management of CRAO patients should instead focus on reducing the risk of subsequent ischemic events, including cerebral stroke. Certain patients may be considered for acute treatment with thrombolytics, although further research must clarify the efficacy, safety, and optimal use of these therapies.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.4103/tjo.tjo_61_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7971444PMC
November 2020

Outcomes of HPV-Negative Oropharyngeal Cancer Treated With Transoral Robotic Surgery.

Otolaryngol Head Neck Surg 2021 Mar 23:194599821996647. Epub 2021 Mar 23.

Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.

Objective: The incidence of oropharyngeal squamous cell carcinoma (OPSCC) is increasing secondary to human papillomavirus (HPV)-related disease. Despite this, outcomes of patients with HPV-negative OPSCC undergoing transoral robotic surgery (TORS) are largely unknown.

Study Design: Analysis of the National Cancer Database (NCDB).

Setting: Not applicable.

Methods: The 2015 participant user file from the NCDB was analyzed between 2010 and 2015 for patients with OPSCC who underwent TORS and neck dissection. Kaplan-Meier survival analysis was used to estimate overall survival of the study population. Univariable Cox survival analyses was used to determine significant associations between demographic, tumor, and treatment characteristics and overall survival (OS).

Results: There were 164 patients (124 male and 40 female) with a mean age of 58 years (30-89 years). Median follow-up was 34 months. Five-year OS was 78% (95% CI, 70%-86%). Patients with early stage disease (pT1-2, N0-1) had significantly improved OS compared to patients with advanced T- or N-stage disease (log-rank 0.011; 5-year OS: 88% [95% CI, 78%-98%] vs 66% [95% CI, 50%-82%]).

Conclusion: Very few patients in the NCDB underwent TORS for HPV-negative OPSCC, but those who did had favorable outcomes, especially in early stage disease. Based on these findings, TORS may be considered in the treatment algorithm for patients with HPV-negative OPSCC.

Level Of Evidence: Level IV.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/0194599821996647DOI Listing
March 2021

Patient Harm Due to Diagnostic Error of Neuro-Ophthalmologic Conditions.

Ophthalmology 2021 Mar 11. Epub 2021 Mar 11.

Department of Ophthalmology, Emory University, Atlanta, Georgia; Department of Neurology, Emory University, Atlanta, Georgia. Electronic address:

Purpose: To prospectively examine diagnostic error of neuro-ophthalmic conditions and resultant harm at multiple sites.

Design: Prospective, cross-sectional study.

Participants: A total of 496 consecutive adult new patients seen at 3 university-based neuro-ophthalmology clinics in the United States in 2019 to 2020.

Methods: Collected data regarding demographics, prior care, referral diagnosis, final diagnosis, diagnostic testing, treatment, patient disposition, and impact of the neuro-ophthalmologic encounter. For misdiagnosed patients, we identified the cause of error using the Diagnosis Error Evaluation and Research (DEER) taxonomy tool and whether the patient experienced harm due to the misdiagnosis.

Main Outcome Measures: The primary outcome was whether patients who were misdiagnosed before neuro-ophthalmology referral experienced harm as a result of the misdiagnosis. Secondary outcomes included appropriateness of referrals, misdiagnosis rate, interventions undergone before referral, and the primary type of diagnostic error.

Results: Referral diagnosis was incorrect in 49% of cases. A total of 26% of misdiagnosed patients experienced harm, which could have been prevented by earlier referral to neuro-ophthalmology in 97%. Patients experienced inappropriate laboratory testing, diagnostic imaging, or treatment before referral in 23%, with higher rates for patients misdiagnosed before referral (34% of patients vs. 13% with a correct referral diagnosis, P < 0.0001). Seventy-six percent of inappropriate referrals were misdiagnosed, compared with 45% of appropriate referrals (P < 0.0001). The most common reasons for referral were optic neuritis or optic neuropathy (21%), papilledema (18%), diplopia or cranial nerve palsies (16%), and unspecified vision loss (11%). The most common sources of diagnostic error were the physical examination (36%), generation of a complete differential diagnosis (24%), history taking (24%), and use or interpretation of diagnostic testing (13%). In 489 of 496 patients (99%), neuro-ophthalmology consultation (NOC) affected patient care. In 2% of cases, neuro-ophthalmology directly saved the patient's life or vision; in an additional 10%, harmful treatment was avoided or appropriate urgent referral was provided; and in an additional 48%, neuro-ophthalmology provided a diagnosis and direction to the patient's care.

Conclusions: Misdiagnosis of neuro-ophthalmic conditions, mismanagement before referral, and preventable harm are common. Early appropriate referral to neuro-ophthalmology may prevent patient harm.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.ophtha.2021.03.008DOI Listing
March 2021

Trends and Outcomes of Surgical Management of Primary Papillary Carcinoma in the Pediatric Population.

J Surg Res 2021 Mar 6;263:207-214. Epub 2021 Mar 6.

Section of Endocrine Surgery, Columbia University Irving Medical Center, New York, New York. Electronic address:

Background: Childhood papillary thyroid cancer is more aggressive than carcinomas in adults. Current American Thyroid Association pediatric guidelines recommend a total or near-total thyroidectomy for all pediatric patients without gross evidence of lymph node metastases. Our objective is to analyze trends in the surgical management of pediatric papillary thyroid cancer and assess how well the guidelines are implemented.

Methods: A retrospective cohort study of pediatric patients (ages 19 y and under) who underwent a thyroidectomy was conducted using the Surveillance, Epidemiology, and End Results database 2006-2017. Procedure type was classified as lobectomy or less and subtotal or total thyroidectomy. Descriptive statistics to illustrate patient and tumor characteristics as well as chi-square analysis to evaluate frequency of treatment with total thyroidectomies versus lobectomy or less were performed. Logistic regression analysis controlling for age, sex, size of tumor, rural versus urban institutions, and surgery year was conducted to identify factors predictive of procedure type.

Results: A total of 2271 children underwent surgical management of papillary thyroid cancer between 2006 and 2017. Most patients received a subtotal or total thyroidectomy as surgical management (n = 2,085, 91.8%). One hundred eighty-six patients (8.2%) received a lobectomy or less. The number of lobectomies or less increased with time, with 41 (6.6%) patients between 2006 and 2009, 98 (8.0%) between 2009 and 2015, and 47 (11.1%) between 2016 and 2017 (P = 0.03). Mortality rates were low (n = 15, 0.7%). On logistic regression analysis, later stages, larger sizes, and earlier operative years were predictive of a near-total or total thyroidectomy.

Conclusions: Despite the American Thyroid Association Guidelines recommending a total thyroidectomy for pediatric well-differentiated thyroid cancer, the results of this study demonstrate that thyroid lobectomies are being performed in increasing frequency for smaller tumors in earlier stages of disease. Further investigation of whether this trend actually affects the outcomes in this patient cohort is needed.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jss.2021.01.043DOI Listing
March 2021

Randomized Evaluation of TriGuard 3 Cerebral Embolic Protection After Transcatheter Aortic Valve Replacement: REFLECT II.

JACC Cardiovasc Interv 2021 Mar 1;14(5):515-527. Epub 2021 Mar 1.

Division of Cardiology, Yale School of Medicine, New Haven, Connecticut, USA; Barts Heart Centre, London and Queen Mary University of London, London, United Kingdom. Electronic address:

Objectives: The REFLECT II (Randomized Evaluation of TriGuard 3 Cerebral Embolic Protection After Transcatheter Aortic Valve Implantation) trial was designed to investigate the safety and efficacy of the TriGUARD 3 (TG3) cerebral embolic protection in patients undergoing transcatheter aortic valve replacement.

Background: Cerebral embolization occurs frequently following transcatheter aortic valve replacement and procedure-related ischemic stroke occurs in 2% to 6% of patients at 30 days. Whether cerebral protection with TriGuard 3 is safe and effective in reducing procedure-related cerebral injury is not known.

Methods: This prospective, multicenter, single-blind, 2:1 randomized (TG3 vs. no TG3) study was designed to enroll up to 345 patients. The primary 30-day safety endpoint (Valve Academic Research Consortium-2 defined) was compared with a performance goal (PG). The primary hierarchical composite efficacy endpoint (including death or stroke at 30 days, National Institutes of Health Stroke Scale score worsening in hospital, and cerebral ischemic lesions on diffusion-weighted magnetic resonance imaging at 2 to 5 days) was compared using the Finkelstein-Schoenfeld method.

Results: REFLECT II enrolled 220 of the planned 345 patients (63.8%), including 41 roll-in and 179 randomized patients (121 TG3 and 58 control subjects) at 18 US sites. The sponsor closed the study early after the U.S. Food and Drug Administration recommended enrollment suspension for unblinded safety data review. The trial met its primary safety endpoint compared with the PG (15.9% vs. 34.4% (p < 0.0001). The primary hierarchal efficacy endpoint at 30 days was not met (mean scores [higher is better]: -8.58 TG3 vs. 8.08 control; p = 0.857). A post hoc diffusion-weighted magnetic resonance imaging analysis of per-patient total lesion volume above incremental thresholds showed numeric reductions in total lesion volume >500 mm (-9.7%) and >1,000 mm (-44.5%) in the TG3 group, which were more pronounced among patients with full TG3 coverage: -51.1% (>500 mm) and -82.9% (>1,000 mm).

Conclusions: The REFLECT II trial demonstrated that the TG3 was safe compared with a historical PG but did not meet its pre-specified primary superiority efficacy endpoint.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jcin.2020.11.011DOI Listing
March 2021

Genomics Integrated Systems Transgenesis (GENISYST) for gain-of-function disease modelling in Göttingen Minipigs.

J Pharmacol Toxicol Methods 2021 Feb 18;108:106956. Epub 2021 Feb 18.

Genome Biologics, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany; Institute of Cardiovascular Regeneration, Centre for Molecular Medicine, Goethe-University Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany. Electronic address:

Göttingen Minipigs show several anatomical, physiological, and pathogenetical similarities to humans and serve an important role in translational studies for example as large animal models of disease. In recent years, the number of transgenic Göttingen Minipigs models has increased, as advanced genetic techniques simplify the generation of animals with precisely tailored modifications. These modifications are designed to replicate genetic alterations responsible for human disease. In addition to serving as valuable large animal disease models, transgenic Göttingen Minipigs are also considered promising donors for xenotransplantation. Current technologies for generation of transgenic minipigs demand a long development and production time of typically 2-3 years. To overcome this limitation and expand the use of Göttingen Minipigs for disease modelling and drug testing, we developed the GENISYST (Genomics Integrated Systems Transgenesis) technology platform for rapid and efficient generation of minipigs based transgenic disease models. As proof of concept, we report the successful generation of transgenic minipigs expressing green fluorescent protein (GFP) in multiple disease-relevant tissues including liver, heart, kidney, lungs, and the central nervous system (CNS). Our data demonstrates the feasibility, efficiency, and utility of GENISYST for rapid one-step generation of transgenic minipigs for human disease modelling in drug discovery and development.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.vascn.2021.106956DOI Listing
February 2021

Two-year migration characteristics of a novel cementless femoral stem: a radiostereometric analysis and clinical outcomes study.

ANZ J Surg 2021 03 1;91(3):398-403. Epub 2021 Feb 1.

Department of Orthopaedic Surgery, Nepean Private Hospital, Penrith, New South Wales, Australia.

Background: Radiostereometric analysis (RSA) is an established high precision tool enabling us to detect early implant migration in total hip arthroplasty. The aim of this study is to present the RSA and clinical results of a new cementless hip stem and to compare those with established benchmarks.

Methods: A total of 45 patients (46 hips) undergoing total hip arthroplasty were available for full radiographic and clinical assessment at 2 years post-operatively. Mean patient age was 69 (range 43-85) years and mean body mass index was 29 (range 21-38) kg/m . RSA was undertaken at day 1, 6 weeks, 6 months and 1 and 2 years post-operatively. Oxford hip score and EQ-5D-5L scores were recorded preoperatively and at the same other time points. Results were compared to published data of established implants.

Results: At 2 years, mean subsidence and retroversion were 0.61 mm (standard deviation 0.7 mm, range -0.19 to 3.06 mm) and 0.44° (standard deviation 0.81°, range 0.98 to 3.29°), respectively. Stem migration occurred primarily in the first 6 weeks with no detectable subsidence or rotation at 6 months or 2 years. Mean Oxford hip score and EQ-5D-5L improved from 18.6 to 44.7, and 69 to 86, respectively. There was one cup-only revision and no revisions for stem loosening.

Conclusion: RSA serves as an accurate measure of femoral stem stability early in the post-operative period. Our data confirm that stability occurs as early as 6 weeks and is sustained at 2 years. The Paragon stem demonstrates stability parameters at 2 years that exceed other established benchmark implants.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/ans.16616DOI Listing
March 2021

Simultaneous multiple organ involvement with hydatid cyst: left lung, liver and pelvic cavity.

BMJ Case Rep 2021 Jan 28;14(1). Epub 2021 Jan 28.

CTVS, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1136/bcr-2020-241094DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7845667PMC
January 2021

Gene expression profiling of protease and non-protease genes in Trichophyton mentagrophytes isolates from dermatophytosis patients by qRT-PCR analysis.

Sci Rep 2021 Jan 11;11(1):403. Epub 2021 Jan 11.

Department of Dermatology, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, 110095, India.

Trichophyton mentagrophytes secretes Metallocarboxypeptidase A and B of the M14 family as endoproteases and exoprotease. T. mentagrophytes produce Metalloprotease 3 and 4 which degrades the protein into the short peptides and amino acids. To understand the host fungal relationship and identification of such genes expressed during infection is utmost important. T. mentagrophytes encodes some proteins which are associated with the glyoxylate cycle. The glyoxylate cycle enzymes have been involving in virulence of dermatophytes and their up-regulation during dermatophytes growth on keratin. On comparing the expression level of virulence protease and non-protease genes, we observed, among exoprotease protease genes, Metallocarboxypeptidase B was strongly up regulated (134.6 fold high) followed by Metallocarboxypeptidase A (115.6 fold high) and Di-peptidyl-peptidases V (10.1 fold high), in dermatophytic patients as compared to ATCC strain. Furthermore, among endoprotease, Metalloprotease 4 was strongly up regulated (131.6 fold high) followed by Metalloprotease 3 (16.7 fold high), in clinical strains as compared to T. mentagrophytes ATCC strain. While among non-protease genes, Citrate Synthase was highly expressed (118 fold high), followed by Isocitrate Lyase (101.6 fold high) and Malate Synthase (52.9 fold high). All the studied virulence genes were considered the best suitable ones by geNorm, Best keeper, Norm Finder and Ref finder.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1038/s41598-020-79839-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7801629PMC
January 2021

Telemedicine Surge for Pediatric Patients in Response to the COVID-19 Pandemic in New York City.

Telemed J E Health 2021 Jan 11. Epub 2021 Jan 11.

Department of Emergency Medicine, NewYork-Presbyterian and Weill Cornell Medicine, New York, New York, USA.

Our objective is to describe our pediatric virtual urgent care (VUC) experience at a large urban academic medical center, in response to the COVID-19 pandemic in New York City (NYC). We conducted a retrospective cohort study of our pediatric VUC program of patients less than age 18 years, from March 1 to May 31, 2020. We include data on expansion of staffing, patient demographics, virtual care, and outcomes. We rapidly onboarded, educated, and trained pediatric telemedicine providers. We evaluated 406 pediatric patients with median age 4.4 years and 53.9% male. Median call time was 5:12 pm, median time to provider was 5.7 min, and median duration of call was 11.1 min. The most common reasons for a visit were COVID-19-related symptoms (36%), dermatologic (15%), and trauma (10%). Virtual care for patients consisted of conservative management (72%), medication prescription (18%), and referral to an urgent care or pediatric emergency department (PED) (10%). Of 16 patients referred and presented to our emergency department, 2 required intensive care for multisystem inflammatory syndrome in children. Oral antibiotics were prescribed for 7.1% of all patients. Only 0.005% of patients had an unplanned 72-h PED visit resulting in hospitalization after a VUC visit. Pediatric emergency VUC allowed for high-quality efficient medical care for patients during the peak of the COVID-19 pandemic in NYC. Although most patients were managed conservatively in their home, telemedicine also enabled rapid identification of patients who required in-person emergency care.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1089/tmj.2020.0413DOI Listing
January 2021

Gender as a Predictor of Complications in Endoscopic Sinus Surgery.

Ann Otol Rhinol Laryngol 2021 Jan 8:3489420987418. Epub 2021 Jan 8.

Department of Otolaryngology-Head and Neck Surgery, Columbia University Vagelos College of Physicians and Surgeons, NewYork-Presbyterian/Columbia University Irving Medical Center, New York, NY, USA.

Background: Understanding patient-specific risk factors for complications of functional endoscopic sinus surgery (ESS) is critical. Previous work has investigated such risk factors, but a population-based analysis has not been performed to date.

Objectives: This study analyzes the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database to identify patient-specific risk factors associated with complications following ESS.

Methods: A retrospective cohort study of patients who underwent ESS was conducted using the NSQIP database from 2011 to 2017. Patients were identified using CPT-codes for ESS procedures. The primary outcome analyzed was any postoperative complication. Simultaneous procedures with ESS were controlled for with regression analysis. Post-operative complications and 30-day readmission were evaluated using multivariate logistic regression controlling for age, gender, race, comorbidities (diabetes mellitus, hypertension, chronic obstructive pulmonary disease, congestive heart failure, renal failure, steroid use, and cancer history), smoking history, and intraoperative factors.

Results: A total of 1279 patients who underwent ESS were identified. The average age of patients was 46.1 (SD = 16.8). Most patients (58.2%) had no major comorbidities. 594 (46.4%) patients had a tonsillectomy, adenoidectomy, or uvulopharyngoplasty at the same time as ESS. 101 (7.9%) patients experienced a complication post-operatively. 46 (3.6%) patients experienced a readmission postoperatively. The most common complication was reoperation (N = 40, 3.1%). Regression analysis revealed that gender was the only demographic factor associated with risk of post-operative complications, with women having a significantly lower risk than men (OR = 0.61, 95% CI 0.37-0.99,  = .046).

Conclusions: ESS is typically performed on a relatively young and healthy population. Women have a significantly lower risk of complications after controlling for comorbidities. Further analysis of gender-specific differences in surgical outcomes should be evaluated to understand this phenomenon.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/0003489420987418DOI Listing
January 2021

Idiopathic Intracranial Hypertension in Pregnancy.

J Obstet Gynaecol Can 2021 Jan 4. Epub 2021 Jan 4.

Department of Ophthalmology & Vision Sciences, University of Toronto, Toronto, ON. Electronic address:

Idiopathic intracranial hypertension (IIH) is a syndrome characterized by elevated intracranial pressure without an identifiable underlying cause. Pregnancy has unique and important diagnostic and therapeutic implications for patients with IIH. Despite these implications, there are no guidelines to assist clinicians in managing IIH during pregnancy. Our review aims to summarize the key considerations related to the diagnosis and management of IIH during pregnancy, to optimize the care of these patients and mitigate the risk of disease-related complications. The optimal management of IIH in pregnancy should include a multidisciplinary team, including an obstetrician (or maternal-fetal medicine specialist), a neurologist, and an ophthalmologist (or neuro-ophthalmologist).
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jogc.2020.12.019DOI Listing
January 2021

Unilateral Isolated Paucisymptomatic Optic Disc Edema.

J Neuroophthalmol 2020 Dec 22;Publish Ahead of Print. Epub 2020 Dec 22.

Departments of Ophthalmology (EH, RAS, JHP, MD, NJN, VB), Pediatrics (JHP), Neurology (NJN, VB), and Neurological Surgery (NJN), Emory University School of Medicine, Atlanta, Georgia.

Background: Unilateral isolated optic disc edema (UIODE) represents a challenging clinical presentation that frequently precipitates an extensive diagnostic work-up. Patients without an apparent diagnosis despite appropriate investigations are often categorized as having "papillophlebitis," an entity that is poorly defined in the existing literature. Our aim was to describe the characteristics of a series of patients with paucisymptomatic UIODE, determine the optimal diagnostic approach to such cases, and clarify the clinical features of presumed papillophlebitis.

Methods: We retrospectively identified 29 patients with UIODE who were seen by neuro-ophthalmologists at a single center between 2005 and 2019. Each patient presented with isolated, unilateral disc edema that was either entirely asymptomatic or associated with minimal visual symptoms. Patients underwent a comprehensive neuro-ophthalmic evaluation and several ophthalmic and systemic investigations. Data from the initial visit and all subsequent clinical visits were collected, including patient demographics, examination findings, and details of the diagnostic work-up.

Results: Our 29 patients with UIODE were found to have a variety of underlying diagnoses including unilateral papilledema due to idiopathic intracranial hypertension (10 patients), optic nerve sheath meningioma (5), incipient nonarteritic anterior ischemic neuropathy (4), vitreopapillary traction (3), orbital masses (2), a peripapillary choroidal neovascular membrane (1), and presumed papillophlebitis (4). The duration of disc edema varied considerably based on the etiology, but most patients had favorable visual outcomes.

Conclusions: A systematic approach to the evaluation of UIODE, combined with long-term follow-up, led to a definite diagnosis in a majority of patients, with only 4 patients presumed to have papillophlebitis, a diagnosis the actual existence of which remains controversial.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/WNO.0000000000001136DOI Listing
December 2020

Advanced Communication and Examination Skills in Telemedicine: A Structured Simulation-Based Course for Medical Students.

MedEdPORTAL 2020 12 17;16:11047. Epub 2020 Dec 17.

Professor of Clinical Emergency Medicine, Department of Emergency Medicine, New York-Presbyterian/Weill Cornell Medicine; Chair, Department of Emergency Medicine, New York-Presbyterian/Weill Cornell Medicine.

Introduction: Telemedicine has become part of mainstream medical practice. High quality virtual care is a skill that will be required of many physicians. Skills required for effective evaluation and communication during a video encounter differ from skills required at bedside, yet few rubrics for educational content and student performance evaluation in telemedicine training have been developed. Our objective was to develop, implement, and assess a training module designed to teach medical providers techniques to deliver professional, effective, and compassionate care during a telemedicine encounter.

Methods: We created a simulation-based, 8-hour modular curriculum using the PEARLS debriefing framework with video-based encounters focused on "web-side manner" as a critical corollary to traditional bedside manner. We recorded simulated cases for each student with standardized patients, guided debriefs, and incorporated small-group exercises to teach advanced communication and examination skills.

Results: Of medical students, 98 in their major clinical year participated in 2019. Of participants, 97% were enthusiastic about the course; 100% felt simulation was an effective mechanism for delivery of the educational material. After participation, 71% believed that telemedicine had the potential to become part of their future practice; 92% perceived an improvement in their comfort and ability to conduct video-based patient encounters.

Discussion: Teaching telemedicine using this methodology was well received by students, providing early exposure to this evolving aspect of medical practice. Qualitative comments were used for targeted improvements of the content and delivery for curriculum development. Objective assessment tools of students completing telemedicine encounters need to be created.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.15766/mep_2374-8265.11047DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7751329PMC
December 2020

The role of flow stasis in transcatheter aortic valve leaflet thrombosis.

J Thorac Cardiovasc Surg 2020 Nov 26. Epub 2020 Nov 26.

Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, Ga. Electronic address:

Objective: With the recent expanded indication for transcatheter aortic valve replacement to low-risk surgical patients, thrombus formation in the neosinus is of particular interest due to concerns of reduced leaflet motion and long-term transcatheter heart valve durability. Although flow stasis likely plays a role, a direct connection between neosinus flow stasis and thrombus severity is yet to be established.

Methods: Patients (n = 23) were selected to minimize potential confounding factors related to thrombus formation. Patient-specific 3-dimensional reconstructed in vitro models were created to replicate in vivo anatomy and valve deployment using the patient-specific cardiac output and idealized coronary flows. Dye was injected into each neosinus to quantify washout time as a measure of flow stasis.

Results: Flow stasis (washout time) showed a significant, positive correlation with thrombus volume in the neosinus (rho = 0.621, P < .0001). Neither thrombus volume nor washout time was significantly different in the left, right, and noncoronary neosinuses (P ≥ .54).

Conclusions: This is the first patient-specific study correlating flow stasis with thrombus volume in the neosinus post-transcatheter aortic valve replacement across multiple valve types and sizes. Neosinus-specific factors create hemodynamic and thrombotic variability within individual patients. Measurement of neosinus flow stasis may guide strategies to improve outcomes in transcatheter aortic valve replacement.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jtcvs.2020.10.139DOI Listing
November 2020

Smartphone-Based Applications to Detect Hearing Loss: A Review of Current Technology.

J Am Geriatr Soc 2021 02 29;69(2):307-316. Epub 2020 Dec 29.

Department of Otolaryngology-Head and Neck Surgery, Columbia University Vagelos College of Physicians and Surgeons, NewYork-Presbyterian/Columbia University Irving Medical Center, New York, New York, USA.

Background/objectives: Age-related hearing loss (ARHL) is a widely prevalent yet manageable condition that has been linked to neurocognitive and psychiatric comorbidities. Multiple barriers hinder older individuals from being diagnosed with ARHL through pure-tone audiometry. This is especially true during the COVID-19 pandemic, which has resulted in the closure of many outpatient audiology and otolaryngology offices. Smartphone-based hearing assessment apps may overcome these challenges by enabling patients to remotely self-administer their own hearing examination. The objective of this review is to provide an up-to-date overview of current mobile health applications (apps) that claim to assess hearing.

Design: Narrative review.

Measurements: The Apple App Store and Google Play Store were queried for apps that claim to assess hearing. Relevant apps were downloaded and used to conduct a mock hearing assessment. Names of included apps were searched on four literature databases (PubMed/MEDLINE, EMBASE, Cochrane Library, and CINAHL) to determine which apps had been validated against gold standard methods.

Results: App store searches identified 44 unique apps. Apps differed with respect to the type of test offered (e.g., hearing threshold test), cost, strategies to reduce ambient noise, test output (quantitative vs qualitative results), and options to export results. Validation studies were identified for seven apps.

Conclusion: Given their low cost and relative accessibility, smartphone-based hearing apps may facilitate screening for ARHL, particularly in the setting of limitations on in-person medical care due to COVID-19. However, app features vary widely, few apps have been validated, and user-centered designs for older adults are largely lacking. Further research and validation efforts are necessary to determine whether smartphone-based hearing assessments are a feasible and accurate screening tool for ARHL. Key Points Age-related hearing loss is a prevalent yet undertreated condition among older adults. Why Does this Paper Matter?     Smartphone-based hearing test apps may facilitate remote screening for hearing loss, but limitations surrounding app validation, usability, equipment calibration, and data security should be addressed.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/jgs.16985DOI Listing
February 2021

Biocompatible and fluorescent water based NIR emitting CdTe quantum dot probes for biomedical applications.

Spectrochim Acta A Mol Biomol Spectrosc 2021 Mar 16;248:119206. Epub 2020 Nov 16.

Nanotechnology Laboratory, Department of Physics and Materials Science, Jaypee University of Information Technology, Waknaghat, Solan 173234, India. Electronic address:

Proficient fluorescent-characteristics, cytotoxicity-behavior and antimicrobial-activity of near-infrared-emitting (NIR) CdTe quantum dots (QDs) were studied sumptuously as these QDs are having an excellence in deep-tissue dissemination of light. These, NIR-emitting QDs were synthesized using aqueous method, utilizing 3-mercaptopropionic-acid (3-MPA) as a stabilizer; it controls leakage of Cd and Te ions from CdTe QDs. However, encapsulation by polymers also prevents the same by seizing toxic consequence of prepared QDs which was confirmed from cytotoxicity studies. Therefore, easy modification according to biological environment of these encapsulated CdTe QDs can serve in bio imaging and distribution. Antimicrobial study investigated the toxic effects of QDs against bacterial strains and support cytotoxicity studies and showing maximum 26 mm zone of inhibition against bacterial strain. These, NIR fluorescent QDs possess many attractive optical properties over the standard fluorescent probes (organic dyes) and can replace these dyes, as there is no specific dye which works in NIR range.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.saa.2020.119206DOI Listing
March 2021

Clinical informatics during the COVID-19 pandemic: Lessons learned and implications for emergency department and inpatient operations.

J Am Med Inform Assoc 2021 03;28(4):879-889

Department of Emergency Medicine, NewYork-Presbyterian Hospital/Weill Cornell Medical Center, New York, New York, USA.

In response to a pandemic, hospital leaders can use clinical informatics to aid clinical decision making, virtualizing medical care, coordinating communication, and defining workflow and compliance. Clinical informatics procedures need to be implemented nimbly, with governance measures in place to properly oversee and guide novel patient care pathways, diagnostic and treatment workflows, and provider education and communication. The authors' experience recommends (1) creating flexible order sets that adapt to evolving guidelines that meet needs across specialties, (2) enhancing and supporting inherent telemedicine capability, (3) electronically enabling novel workflows quickly and suspending noncritical administrative or billing functions in the electronic health record, and (4) using communication platforms based on tiered urgency that do not compromise security and privacy.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1093/jamia/ocaa311DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7799016PMC
March 2021

Module to facilitate self-directed learning among medical undergraduates: Development and implementation.

J Educ Health Promot 2020 28;9:231. Epub 2020 Sep 28.

Department of Community Medicine, University College of Medical Sciences, Delhi, India.

Context: Currently, self-directed learning (SDL) is emphasized in medical institutions all over the world. The skills of SDL enable one to be a lifelong learner, a necessity to cope up with fast-expanding medical knowledge.

Aims: This study aims to develop and implement an "SDL" module for medical undergraduates and find out their perception about the same.

Settings And Design: A cross-sectional study using a mixed-method design (having both qualitative and quantitative components) was conducted in the Department of Community Medicine, UCMS, Delhi, India.

Methods: A module was developed following an extensive literature review and focus group discussions with the teaching staff of the institute. First-semester undergraduate students were invited to participate in the study and asked for feedback using a semi-structured questionnaire.

Statistical Analysis: Quantitative data were expressed in mean, range, and frequency. For qualitative data, thematic analysis was performed.

Results: The module was implemented with 160 students, in November for 10 hour distributed over 5 weeks. Feedback could be obtained from 130 students. Sixty-seven percent of students were satisfied and 66% reported as motivated to study the allotted topic further. Qualitative analysis showed that though the students liked the learning process based on this module, they also felt facilitators could have been more active in imparting knowledge and skills.

Conclusions: To make learners equipped with the ability to learn throughout a professional learning course, SDL as a learning tool should be introduced in the medical undergraduate curriculum.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.4103/jehp.jehp_125_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7652079PMC
September 2020

Modeling Hearing Loss Progression and Asymmetry in the Older Old: A National Population-Based Study.

Laryngoscope 2021 04 8;131(4):879-884. Epub 2020 Nov 8.

Department of Otolaryngology-Head and Neck Surgery, Columbia University Vagelos College of Physicians and Surgeons, NewYork-Presbyterian/Columbia University Irving Medical Center, New York, NY, USA.

Objective: The progression and asymmetry of age-related hearing loss has not been well characterized in those 80 years of age and older because public datasets mask upper extremes of age to protect anonymity. We aim to characterize the progression, severity, and asymmetry of hearing loss in those 80 years of age and older using a representative, national database.

Methods: Cross-sectional, multicentered U.S. epidemiologic analysis using the National Health and Nutrition Examination Survey (NHANES) 2005 to 2006, 2009 to 2010, and 2011 to 2012 cycles. Subjects included noninstitutionalized, civilian adults aged 80 years and older (n = 621). Federal security clearance was granted to access publicly restricted age data. Outcome measures included pure-tone average (PTA) air conduction thresholds and the 4-frequency PTA.

Results: Six hundred and twenty-one subjects were 80 years old or older (mean = 84.2 years, range = 80-104 years), representing 10,600,197 Americans. The average PTA was 38.9 dB (95% confidence interval [CI] = 37.8, 40.0). Hearing loss exhibited constant acceleration across the adult lifespan at a rate of 0.0052 dB/year (95% CI = 0.0049, 0.0055). This model predicted mean PTA within 2 dB of accuracy for most ages between 20 and 100 years. From age 80 years to approximately 100 years, the average PTA difference between the better and worse ear was 6.75 dB (95% CI = 5.8, 7.1). This asymmetry was relatively constant (i.e., nonsignificant linear regression coefficient of asymmetry over age = 0.07 [95% CI = -0.01, 0.2]).

Conclusion: Hearing loss steadily and predictably accelerates across the adult lifespan to at least age 100 years, becoming near universal. These population-level statistics will guide treatment and policy recommendations for hearing health in the older old.

Level Of Evidence: 3 Laryngoscope, 131:879-884, 2021.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/lary.28971DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7990690PMC
April 2021

Pearls and Pitfalls in Endoscopic Ear Surgery.

Otolaryngol Clin North Am 2021 Feb 2;54(1):201-209. Epub 2020 Nov 2.

Department of Otolaryngology-Head and Neck Surgery, Columbia University Vagelos College of Physicians and Surgeons, NewYork-Presbyterian/Columbia University Irving Medical Center, 180 Fort Washington Avenue, HP8, New York, NY 10032, USA. Electronic address:

"Endoscopic ear surgery (EES) has become increasingly popular due to numerous visualization benefits, including angled optics that enable the surgeon to see and dissect around corners. These advantages help the surgeon overcome the visualization limitations of microscopic ear surgery, reducing the need for a post-auricular incision and bone removal. This chapter discusses useful pearls and pitfalls of EES, technical tips and ergonomic strategies, so the learner can understand and solve common obstacles faced when learning EES and incorporate it into his or her practice."
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.otc.2020.09.016DOI Listing
February 2021

Short-term Hydroxychloroquine in COVID-19 Infection in People With or Without Metabolic Syndrome - Clearing Safety Issues and Good Clinical Practice.

Eur Endocrinol 2020 Oct 6;16(2):109-112. Epub 2020 Oct 6.

Department of Pulmonary Medicine, Le Crest Hospital, Ghaziabad, Uttar Pradesh, India.

Hydroxychloroquine has been used in rheumatology for decades. This review highlights the mechanistic, clinical and safety data with regards to hydroxychloroquine use in novel coronavirus disease (COVID-19) in people with or without metabolic syndrome. PubMed and Medline were searched for articles published from January 1970 to March 2020 using the terms 'COVID-19', 'corona-virus 2019', 'hydroxychloroquine', 'hypertension', 'diabetes', 'cardiac disease', 'retina' and 'kidney disease'. Hypertension, diabetes and cardiovascular disease are the three most common comorbidities in people with COVID-19, meaning that such people have greater morbidity and mortality. Mechanistically, hydroxychloroquine inhibits SARS-CoV-2 virus uptake into cells by inhibiting angiotensin-converting enzyme 2 glycosylation. This inhibits lysosome activation and the associated cytokine storm, thus reducing the risk of acute respiratory distress syndrome and multiple organ dysfunction syndrome, which is the primary cause of death. Small, in-human studies have shown hydroxychloroquine to improve outcomes in COVID-19, either alone or in combination with azathioprine and other antiviral medications. Retina safety is not an issue with short term use of hydroxychloroquine in COVID-19. Dose reduction is warranted when glomerular filtration rate is <50 mL/min. Cardiac monitoring is warranted in people with established cardiac disease, and cardiac rhythm should be closely monitored when hydroxychloroquine is used with azithromycin, lopinavir, ritonavir or remdesivir. Anti-diabetes medication doses may need to be reduced during treatment with hydroxychloroquine. While we await data from large, in-human trials, short-term use of hydroxychloroquine in COVID-19 is justified, as this molecule has stood the test of time with regards to use in humans for other indications.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.17925/EE.2020.16.2.109DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7572159PMC
October 2020

Motor neuroprosthesis implanted with neurointerventional surgery improves capacity for activities of daily living tasks in severe paralysis: first in-human experience.

J Neurointerv Surg 2021 Feb 28;13(2):102-108. Epub 2020 Oct 28.

Vascular Bionics Laboratory, Departments of Medicine, Neurology and Surgery, Melbourne Brain Centre at the Royal Melbourne Hospital, The University of Melbourne, Melbourne, Victoria, Australia.

Background: Implantable brain-computer interfaces (BCIs), functioning as motor neuroprostheses, have the potential to restore voluntary motor impulses to control digital devices and improve functional independence in patients with severe paralysis due to brain, spinal cord, peripheral nerve or muscle dysfunction. However, reports to date have had limited clinical translation.

Methods: Two participants with amyotrophic lateral sclerosis (ALS) underwent implant in a single-arm, open-label, prospective, early feasibility study. Using a minimally invasive neurointervention procedure, a novel endovascular Stentrode BCI was implanted in the superior sagittal sinus adjacent to primary motor cortex. The participants undertook machine-learning-assisted training to use wirelessly transmitted electrocorticography signal associated with attempted movements to control multiple mouse-click actions, including zoom and left-click. Used in combination with an eye-tracker for cursor navigation, participants achieved Windows 10 operating system control to conduct instrumental activities of daily living (IADL) tasks.

Results: Unsupervised home use commenced from day 86 onwards for participant 1, and day 71 for participant 2. Participant 1 achieved a typing task average click selection accuracy of 92.63% (100.00%, 87.50%-100.00%) (trial mean (median, Q1-Q3)) at a rate of 13.81 (13.44, 10.96-16.09) correct characters per minute (CCPM) with predictive text disabled. Participant 2 achieved an average click selection accuracy of 93.18% (100.00%, 88.19%-100.00%) at 20.10 (17.73, 12.27-26.50) CCPM. Completion of IADL tasks including text messaging, online shopping and managing finances independently was demonstrated in both participants.

Conclusion: We describe the first-in-human experience of a minimally invasive, fully implanted, wireless, ambulatory motor neuroprosthesis using an endovascular stent-electrode array to transmit electrocorticography signals from the motor cortex for multiple command control of digital devices in two participants with flaccid upper limb paralysis.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1136/neurintsurg-2020-016862DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7848062PMC
February 2021

The nano-bio interactions of rare-earth doped BaF nanophosphors shape the developmental processes of zebrafish.

Biomater Sci 2020 Dec 28;8(23):6730-6740. Epub 2020 Oct 28.

School of Chemical Science and Technology, Department of Chemistry, Dr. Harisingh Gour University (A Central University), Sagar-470003, M.P., India.

Nanoparticles with biomedical applications should be evaluated for their biocompatibility. Rare-earth doped nanoparticles with unique spectral properties are superior in vivo optical probes in comparison with quantum dots and organic dyes, however, studies describing their nano-bio interactions are still limited. Here, we have evaluated the nano-bio interactions of green-synthesized, phase-pure BaF nanoparticles doped with rare-earth (RE = Ce/Tb) ions using larval zebrafish. We found that zebrafish can tolerate a wide concentration range of these nanoparticles, as the maximal lethality was observed at very high concentrations (more than 200 mg L) upon five days of continuous exposure. At a concentration of 10 mg L, at which Zn, Ti and Ag nanoparticles are reported to be lethal to developing zebrafish, continuous exposure to our nanoparticles for four days produced no developmental anomalies, craniofacial defects, cardiac toxicity or behavioural abnormalities in the developing zebrafish larvae. We have also found that the doping of rare-earth ions has no major effect on these biomarkers. Interestingly, the function of acetylcholinesterase (AChE) and the cellular metabolic activity of whole zebrafish larvae remained unchanged, even during continuous exposure to these nanoparticles at 150 mg L for four days; however, severe developmental toxicities were evident at this high concentration. Based on these results, we can conclude that the biocompatibility of rare-earth doped nanoparticles is concentration dependent. Not all biomarkers are sensitive to these nanoparticles. The high concentration-dependent toxicity occurs through a mechanism distinct from changes in the metabolic or AChE activity. The significance of these findings lies in using these nanoparticles for bioimaging applications and biomarker studies, especially for prolonged exposure times.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1039/d0bm01282cDOI Listing
December 2020

Generation of Inexpensive, Highly Labeled Probes for Fluorescence Hybridization (FISH).

STAR Protoc 2020 Jun 3;1(1):100006. Epub 2020 Jun 3.

Cell Fate and Nuclear Organization Laboratory, Institute for Cell Biology, University of Bern, Baltzerstrasse 4, CH 3012 Bern.

DNA-FISH remains the method of choice to visualize genomic regions ranging from a single locus to entire chromosomes. Current methods to generate probes rely on expensive kits that vary in labeling efficiency and are limited by the size and/or amount of starting material and by the choice of fluorophores. Here we describe a protocol to prepare inexpensive ($20) DNA-FISH probes using an isothermal polymerase, incorporating labeled nucleotides while amplifying minute amounts of any template (PCR fragments/BAC/YAC/fosmids). For complete details on the use and execution of this protocol, please refer to Grosmaire et al. (2019) and Sharma et al. (2014).
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.xpro.2019.100006DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7580238PMC
June 2020

Differential effects of peritoneal and hemodialysis on circulating regulatory T cells one month post initiation of renal replacement therapy.

Clin Nephrol 2021 Jan;95(1):37-44

Backgroundː Chronic kidney disease stage G5 (CKD G5) patients show an activated but impaired immune system. One function of the FOXP3 regulatory T (Treg) cells is to preserve tolerance to self while maintaining the ability to fight infectious agents. The aim of this pilot study is to evaluate longitudinal changes in Treg cells before and 1 month after the first dialysis treatment. Materials and methodsː CKD G5 patients not yet on dialysis were enrolled and started on hemodialysis (HD) or peritoneal dialysis (PD). Tregs were analyzed by flow cytometry at two time points: T0 (before the first dialysis treatment) and T1 (1 month after the first dialysis session). Wilcoxon test for dependent samples was used to compare the mean percentage difference between T0 and T1: Δ% = 100 × [(T1 - T0) / T0]. Resultsː 21 patients were enrolled: 8 on HD and 13 on PD. The proportion of total lymphocytes (low side scatter lymphocyte gate) and T lymphocytes (in the CD3CD4 gate) did not change significantly 1 month after the start of dialysis in both groups. Treg cells (as CD25FOXP3, FOXP3, or CD25CD127), analyzed as percentage of the lymphocyte gate, showed a significant increase post PD (CD25FOXP3: median = 35.92; p = 0.0425; FOXP3: median = 30.85; p = 0.0479 and CD25CD127: median = 23.71; p = 0.0215). The same populations, did not change 1 month after the first dialysis session. Conclusionː Our study is the first to evaluate longitudinal effects of dialysis on Treg cells in uremia and suggests that PD was more effective in increasing Treg levels 1 month post initiation of dialysis and may contribute to improvement of inflammatory status. Thus, PD may contribute to better outcomes for patients with renal dysfunction, also maintaining homeostasis of peritoneal and renal tissues.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.5414/CN110158DOI Listing
January 2021