Publications by authors named "Vivek Singh"

425 Publications

Prediction of Patient Height and Weight With a 3-Dimensional Camera.

J Comput Assist Tomogr 2021 May-Jun 01;45(3):427-430

From the Department of Radiology, NYU Langone Health, New York, NY.

Objective: The aim of this study was to determine accuracy of height and weight prediction by a 3-dimensional (3D) camera.

Methods: A total of 453 patients whose computed tomography imaging used a 3D camera from December 19, 2018 to March 19, 2019 were retrospectively identified. An image of each patient was taken before the computed tomography by a 3D camera mounted to the ceiling. Using infrared imaging and machine learning algorithms, patient height and weight were estimated from this 3D camera image. A total of 363 images were used for training. The test set consisted of 90 images. The height and weight estimates were compared with true height and weight to determine absolute and percent error. A value of P < 0.05 indicated statistical significance.

Results: There was 2.0% (SD, 1.4) error in height estimation by the 3D camera, corresponding to 3.35 cm (SD, 2.39) absolute deviation (P = 1, n = 86). Weight estimation error was 5.1% (SD, 4.3), corresponding to 3.99 kg (SD, 3.11) absolute error (P = 0.74, n = 90).

Conclusion: Pictures obtained from a 3D camera can accurately predict patient height and weight.
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http://dx.doi.org/10.1097/RCT.0000000000001166DOI Listing
July 2021

Postoperative venous thromboembolism event increases risk of readmissions and reoperation following total joint arthroplasty: a propensity-matched cohort study.

Eur J Orthop Surg Traumatol 2021 Jul 14. Epub 2021 Jul 14.

Department of Orthopaedic Surgery, Division of Adult Reconstruction, NYU Langone Health, 301 East 17th Street, New York, NY, 10003, USA.

Purpose: The clinical impact of postoperative venous thromboembolism (VTE) following total joint arthroplasty (TJA) remains unclear. In this study, we evaluate the effect of VTE following TJA on postoperative outcomes including discharge disposition, readmission rates, and revision rates.

Methods: We retrospectively reviewed all patients over the age of 18 who underwent primary, elective THA or TKA between 2013 and 2020. Patients were stratified into two cohorts based on whether or not they had a VTE following their procedure. Baseline patient demographics and clinical outcomes such as readmissions and revisions were collected. Propensity score matching was performed to limit significant demographic differences, while independent sample t-tests and Pearson's chi-squared test were used to compare outcomes of interest between the groups.

Results: After propensity score matching, there were 109 patients in each cohort, representing a total of 218 patients for the matched comparison. Prior to matching, the VTE cohort was noted to have a significantly higher BMI than the non-VTE cohort (32.22 ± 6.27 vs 30.93 ± 32.04 kg/m, p = 0.032). All other patient demographics were similar. Compared to the non-VTE cohort, the VTE cohort was less likely to be discharged home (66.1% vs 80.7%; p = 0.021), had a higher rate of 90-day all-cause readmissions (27.5% vs 9.2%, p = 0.001), and a higher two-year revision rate (11.0% vs 0.9%, p = 0.003).

Conclusion: Patients with postoperative VTE were less likely to be discharged home and had higher 90-day readmission and two-year revision rates. Therefore, mitigating perioperative risk factors, initiating appropriate long-term anticoagulation, and maintaining close follow-up for patients with postoperative VTE may play significant roles in decreasing hospital costs and the economic burden to the healthcare system.

Level Of Evidence Iii: Retrospective Cohort Study.
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http://dx.doi.org/10.1007/s00590-021-03071-4DOI Listing
July 2021

Versatility and accuracy of a novel image-free robotic-assisted system for total knee arthroplasty.

Arch Orthop Trauma Surg 2021 Jul 13. Epub 2021 Jul 13.

Department of Orthopedic Surgery, NYU Langone Health, 301 East 17th Street, New York, NY, 10003, USA.

Introduction: Technological advances alongside increased demand for knee replacement surgery have led to the development of a novel image-free bed rail-mounted robotic-assisted system for total knee arthroplasty (TKA). The device is capable of real-time tracking to accommodate for leg motion during bone resection allowing for precise control and positioning of the bone saw in the planned resection plane. The purpose of this study is to discuss the versatility and accuracy of this novel image-free robotic-assisted technology in TKA.

Methods And Materials: The novel robotic-assisted system underwent a stepwise assessment to verify its versatility and accuracy. First, functional accuracy was bench tested to evaluate predetermined surgical plans independent of user variability and anatomic variability compared to conventional instrumentation. This was followed by assessments utilizing cadaveric specimens for resection accuracy, implant positioning, and soft tissue involvement.

Results: Test bench accuracy revealed overall pooled linear positional accuracy of 0.326 ± 0.249 mm and pooled angular positional accuracy of 0.365 ± 0.611°. Resection errors for both robotic and conventional cohorts ranged between 0.6° and 1.9°. Concerning coronal alignment, 33/40 robotic specimen were within ± 1° and 38/40 within ± 3° of the femoral varus-valgus target, compared with 17/40 and 37/40 with conventional instrumentation, respectively. Twenty-four of the 40 robotic specimens were within ± 1° and 40/40 within ± 3° of the tibial varus-valgus target compared with 15/40 and 32/40 with conventional instrumentation, respectively. Soft tissue structures were uncompromised in all robotic-assisted cases. Conventional instruments revealed two cases of partial cleavage of the posterior cruciate ligament and two instances of a compromised posterior medial capsule. There were no significant differences between the two techniques concerning the samples that were uncompromised and fully functional (40/40 vs. 38/40, p = 0.49).

Conclusion: The novel image-free robotic-assisted surgical system demonstrates excellent benchtop accuracy to aid bony resection in cadaveric specimens. It offers notable improvement in coronal implant alignment compared to conventional instrumentation.
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http://dx.doi.org/10.1007/s00402-021-04049-xDOI Listing
July 2021

Repeated aspiration and sclerotherapy to manage recurrent spinal epidermoid cyst.

BMJ Case Rep 2021 Jul 12;14(7). Epub 2021 Jul 12.

Interventional Radiology, Apollomedics Super Speciality Hospitals, Lucknow, Uttar Pradesh, India.

Spinal epidermoid cysts are rare lesions and epidermoid cyst in intramedullary location is even rarer. Surgical excision is the mainstay of treatment; however, in cases of recurrence, repeat surgery becomes quite difficult. Treatment of recurrent intramedullary epidermoid cyst by surgery alone is a challenge. We managed one such rare case with repeated aspiration and sclerotherapy. Here, we have highlighted hypertonic saline sclerotherapy as a promising tool to treat recurrent spinal epidermoid cysts.
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http://dx.doi.org/10.1136/bcr-2020-239730DOI Listing
July 2021

High-Resolution Optical Coherence Tomography Angiography Characteristics of Limbal Stem Cell Deficiency.

Diagnostics (Basel) 2021 Jun 21;11(6). Epub 2021 Jun 21.

The Cornea Institute, L V Prasad Eye Institute, Hyderabad 500034, Telangana, India.

This study aimed to identify the anterior segment high-resolution optical coherence tomography (HR-OCT) and HR-OCT angiography (HR-OCTA) features suggestive of limbal stem cell deficiency (LSCD) as confirmed by both impression cytology (IC) and in vivo confocal microscopy (IVCM). This was a single-centre prospective cross-sectional study including 24 eyes of 22 patients with clinical suspicion of LSCD based on peripheral superficial corneal vascularisation and scarring. On IC and IVCM, performed and interpreted by blinded observers, 12 eyes each were diagnosed with and without LSCD. Additionally, 10 eyes of 5 healthy volunteers with no ocular pathology were also imaged. The 136 HR-OCT/A images of these 34 eyes were analysed with respect to 12 imaging parameters; the parameters most suggestive of LSCD were identified and the sensitivity and specificity were calculated. In the LSCD group, the most common aetiology was ocular chemical burns (83%), whereas in the non-LSCD group, the most common aetiology was viral keratitis (67%). Multiple logistic regression analysis revealed that mean epithelial reflectivity, mean stromal reflectivity, and mean superficial vascular density were the parameters that were diagnostic of LSCD on HR-OCT/A ( < 0.0001). A ratio of the mean epithelial reflectivity to stromal reflectivity of >1.29 corresponded with a high sensitivity (91.7%) and specificity (98.75%); while a mean superficial vascular density score of >0.38 corresponded with a sensitivity of 97.9% and specificity of 73.8%. In conclusion, HR-OCT/A as a non-invasive imaging modality could prove to be a useful tool for confirming the diagnosis of LSCD, with potential clinical and research applications.
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http://dx.doi.org/10.3390/diagnostics11061130DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8233779PMC
June 2021

Indian Academy of Pediatrics Position Paper on Nurturing Care for Early Childhood Development.

Indian Pediatr 2021 Jun 28. Epub 2021 Jun 28.

President, IAP, Mumbai, Maharashtra. Correspondence to: Dr Piyush Gupta, Professor and Head, Department of Pediatrics, University College of Medical Sciences, Delhi 110 095.

Early childhood development (ECD) refers to the physical, motor, socio-emotional, cognitive, and linguistic development of a young child. The 'Countdown to 2030' global distribution of 'children at risk of poor development' indicates the need for urgent action and investment in ECD. Nurturing care enhances ECD, even in the presence of adversities. Strategic actions should exist at multiple levels: the family, community, health care providers and government. Previously, child health related policies and programs of the Government of India functioned in isolation, but have recently, they have started demonstrating multi-sectoral collaboration. Nonetheless, the status of ECD in India is far from optimal. There is strong evidence that parenting programs improve outcomes related to ECD. This is dependent on key programmatic areas (timing, duration, frequency, intensity, modality, content, etc.), in addition to political will, funding, partnership, and plans for scaling up. Each country must implement its unique ECD program that is need-based and customized to their stakeholder community. Barriers like inadequate sensitization of the community and low competency of health care providers need to be overcome. IAP firmly believes that responsive parenting interventions revolving around nurturing care should be incorporated in office practice. This paper outlines IAP's position on ECD, and its recommendations for pediatricians and policy makers. It also presents the roadmap in partnership with other stakeholders in maternal, neonatal, and child health; Federation of Obstetric and Gynaecological Societies of India (FOGSI), National Neonatology Forum (NNF), World Health Organization (WHO), and United Nation Children Fund (UNICEF).
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June 2021

Extra-axial tentorial medulloblastoma: a rare presentation of a common posterior fossa tumour.

BMJ Case Rep 2021 Jun 28;14(6). Epub 2021 Jun 28.

Radiodiagnosis, SGPGIMS, Lucknow, Uttar Pradesh, India

Medulloblastoma is a common paediatric posterior fossa tumour typically presenting as midline intra-axial mass involving the cerebellar vermis and/or roof of fourth ventricle with typical radiological features. These can be extra-axial in extremely rare instances with less than 50 cases reported so far in literature. We present a case of 18-year-old boy presenting with ataxia and headache. MRI showed dural mass (involving the left tentorium cerebellum) with typical imaging features of extra-axial lesion. The patient underwent near total excision of the tumour. Histopathology along with immunohistochemistry revealed the mass to be medulloblastoma. We present this case to highlight rarity of this location for medulloblastoma and the importance of considering this in the differential diagnosis of atypical posterior fossa extra-axial lesions. This can help in performing other relevant preoperative workup similar on the lines of medulloblastoma and planning of relevant management.
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http://dx.doi.org/10.1136/bcr-2021-242865DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8240586PMC
June 2021

Genetic Association and Role of Surgery for the Treatment of Lower Limb Deformities in Diastrophic Dysplasia: A Case Report.

J Orthop Case Rep 2021 Feb;11(2):81-85

Department of Pediatrics, All India Institute of medical Sciences, Rishikesh, Uttarakhand, India.

Introduction: Diastrophic dysplasia (DTD) results from SCN26A2 gene mutation, with autosomal recessive inheritance and widely variable phenotype. The gene has been mapped to chromosome 5q32-q33.1.

Case Report: We present a case of a 4-year-old female with short stature, bilateral feet and knee deformity, and dysplastic facies. SCN26A2 mutations were seen in patient as well as parents. She underwent multiple orthopedic procedures involving metatarsals, gastrosoleus, and distal femur. Based on typical clinical features, DTD was suspected. Genetic studies of patient and parents provided the exact diagnosis in this case.

Conclusion: Genetic diagnosis and family counseling are important caveat of management. Key features like ear abnormalities help to suspect diagnosis which requires a high index of suspicion. Associated bony and soft-tissue abnormalities of lower limb may require surgical intervention for improvement of gait, functions, and cosmesis.
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http://dx.doi.org/10.13107/jocr.2021.v11.i02.2036DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8180322PMC
February 2021

Complications and visual outcomes of cataract surgery in patients with pseudoexfoliation.

Int Ophthalmol 2021 Jul 15;41(7):2303-2314. Epub 2021 Jun 15.

Cataract & Refractive Surgery Services, L V Prasad Eye Institute, Hyderabad, India.

Purpose: To compare outcomes of cataract surgery performed by ophthalmic trainees and consultants in patients associated with pseudoexfoliation (PXF) METHODS: Retrospective review of medical records of all patients with PXF who had undergone cataract surgery from January 2016 to December 2018 at L V Prasad Eye Institute, Hyderabad, India, were analysed RESULTS: A total of 914 eyes were included in the study; surgeries on 501 (54.8%) eyes with PXF were performed by trainees, while 413 (45.2%) were performed by consultants. Posterior capsule rupture (PCR) with vitreous loss (VL) occurred in significantly fewer eyes operated on by consultants (n = 8, 1.9%) than those operated on by trainees (n = 23, 4.5%) (p = 0.002). Eyes that underwent small incision cataract surgery (n = 100, 21.2%) had a significantly greater number of complications than those that underwent phacoemulsification (n = 31, 7.1%) (p = 0.00001). Multivariate logistic regression analysis shows that chances of a complication are higher when operated on by a trainee (OR = 1.59, 95% CI: 1.09-2.34, p = 0.02).The mean logMAR corrected distance visual acuity of patients one month post-surgery was significantly higher for patients in the consultant group (0.15 ± 0.3) than for those in the trainee group (0.2 ± 0.4) (p = 0.003).

Conclusion: Patients with PXF operated on by trainees for cataract had a relatively higher risk of developing PCR with VL and had poorer visual outcomes than those operated on by consultants.
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http://dx.doi.org/10.1007/s10792-021-01752-xDOI Listing
July 2021

Diagnostic added value of interictal magnetic source imaging in presurgical evaluation of persons with epilepsy: A prospective blinded study.

Eur J Neurol 2021 Jun 14. Epub 2021 Jun 14.

Neurosurgery, All India Institute of Medical Sciences, New Delhi, India.

Background And Purpose: In presurgical evaluation for epilepsy surgery, information is sourced from various imaging modalities to accurately localize the epileptogenic zone. Magnetoencephalography (MEG) is a newer noninvasive technique for localization. However, there is limited literature to evaluate if MEG provides additional advantage over the conventional imaging modalities in clinical decision making. The objective of this study was to assess the diagnostic added value of MEG in decision making before epilepsy surgery.

Method: This was a prospective observational study. Patients underwent 3 h of recording in a MEG scanner, and the resulting localizations were compared with other complimentary investigations. Added value of MEG (considered separately from high-density electroencephalography) was defined as the frequency of cases in which (i) the information provided by magnetic source imaging (MSI) avoided implantation of intracranial electrodes and the patient was directly cleared for surgery, and (ii) MSI indicated additional substrates for implantation of intracranial electrodes. Postoperative seizure freedom was used as the diagnostic reference by which to measure the localizing accuracy of MSI.

Results: A total of 102 patients underwent epilepsy surgery. MEG provided nonredundant information, which contributed to deciding the course of surgery in 33% of the patients, and prevented intracranial recordings in 19%. A total of 76% of the patients underwent surgical resection in sublobes concordant with MSI localization, and the diagnostic odds ratio for good (Engel I) outcome in these patients was 2.3 (95% confidence interval 0.68, 7.86; p = 0.183) after long-term follow-up of 36 months.

Conclusion: Magnetic source imaging yields additional useful information which can significantly alter as well as improve the surgical strategy for persons with epilepsy.
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http://dx.doi.org/10.1111/ene.14935DOI Listing
June 2021

Role of Platelet Rich Plasma in Chronic Plantar Fasciitis: A Prospective Study.

Indian J Orthop 2021 May 6;55(Suppl 1):142-148. Epub 2020 Oct 6.

Department of Orthopaedics, All India Institute of Medical Sciences, Virbhadra Marg, Rishikesh, 248201 India.

Introduction: Autologous platelet rich plasma (PRP) local injection has been recently proposed as a treatment of plantar fasciitis. The autologous PRP does not have much side effects compared to steroid injections. So far PRP injections have shown promising results in various studies. This study assessed the efficacy of a single local injection of PRP in chronic unilateral plantar fasciitis through a prospective case series.

Methodology: A hospital-based prospective case series of 30 unilateral plantar fasciitis patients with symptom duration of 6 months or more were included in the study. All patients included in the study were assessed clinically and by visual analogue score for heel pain, AHS component of AOFAS and FADI scores before injection and at 6 and 12 week follow-up. USG measurement of plantar fascia thickness was done at pre-injection and at 12 weeks follow-up. All patients were observed for 12 weeks.

Results: The mean age was 39 years (range 20-55 years). The pre-injection VAS score for heel pain was 6.5 ± 1.1 which improved to 2.7 ± 0.5 and 1.8 ± 0.8 at 6 and 12 week respectively and difference was significant ( < 0.001). The baseline FADI and AHS component of AOFAS scores were 53.1 ± 9.0 and 72.2 ± 5.7 which improved to 65.5 ± 5.3 and 76.1 ± 4.5 at 6 weeks and, 77.9 ± 4.4 and 85.7 ± 4.6 at 12 weeks respectively which was significant ( < 0.001). The baseline mean plantar fascia thickness was 4.9 ± 0.3 mm which was significantly ( < 0.001) reduced to 3.9 ± 0.3 mm at 12 weeks post PRP injection. All pairwise comparisons by the post-hoc Wilcoxon signed rank test with -value adjustment were also significant.

Conclusion: The short-term results of single dose PRP injections shows clinical and statistically significant improvements in VAS for heel pain, functional outcome scores and plantar fascia thickness measured by USG. This study concludes that local PRP injection is a viable management option for chronic plantar fasciitis.
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http://dx.doi.org/10.1007/s43465-020-00261-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8149543PMC
May 2021

Histopathological Characteristics of Limbal Stem Cell Deficiency Secondary to Chronic Vernal Keratoconjunctivitis.

Cornea 2021 Jun 9. Epub 2021 Jun 9.

The Cornea Institute, L V Prasad Eye Institute, Hyderabad, India; Center for Ocular Regeneration (CORE), L V Prasad Eye Institute, Hyderabad, India; and Ophthalmic Pathology Laboratory, L V Prasad Eye Institute, Hyderabad, India.

Purpose: To describe the histopathological characteristics of limbal stem cell deficiency (LSCD) due to chronic vernal keratoconjunctivitis (VKC).

Methods: This retrospective study included 14 eyes of 13 patients who underwent simple limbal epithelial transplantation for total LSCD from 2017 to 2018. The histological characteristics of the excised fibrovascular pannus were compared between 2 groups of 7 eyes, each with LSCD due to VKC and chemical burns (CB). Histological characteristics and type of inflammation were studied using special stains and immunohistochemistry. Fisher exact test was used to detect the statistical significance of the histological differences between both groups.

Results: Epithelial hypertrophy, epithelial downgrowth, and eosinophilic infiltration were noted in all eyes in the VKC group (7/7, 100%). Epithelial hypertrophy was noted in 3 of the 7 (42.8%) eyes in the CB group, whereas epithelial downgrowth and eosinophilic infiltrates were absent. The average chronic inflammatory score of the pannus (5.28) was higher in VKC than in CB (3.85; P = 0.1080). The presence of goblet cells was higher in the CB group (5/7, 1.4%) than in the VKC group (3/4, 2.8%), although not statistically significant. Other histological differences between the groups were not statistically significant.

Conclusions: The histopathological features of LSCD in VKC reveal some distinctive characteristics. These include the presence of epithelial downgrowth, eosinophilic infiltration, and epithelial solid and cystic implants. Although this information may be used to establish the diagnostic criteria for VKC as the cause of LSCD, further studies are needed to elucidate the reasons behind these unique findings.
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http://dx.doi.org/10.1097/ICO.0000000000002775DOI Listing
June 2021

Unusual Surface Texture, Dimensions and Morphology Variations of Chiral and Single Crystals*.

Angew Chem Int Ed Engl 2021 Jun 11. Epub 2021 Jun 11.

Department of Molecular Chemistry and Materials Science, Weizmann Institute of Science, Rehovot, 7610001, Israel.

We demonstrate here a unique metallo-organic material where the appearance and the internal crystal structure are in contradiction. The egg-shaped (ovoid) crystals have a brain-like texture. Although these micro-sized crystals are monodispersed; like fingerprints their grainy surfaces are never exactly alike. Remarkably, our X-ray and electron diffraction studies unexpectedly revealed that these structures are single-crystals comprising a continuous coordination network of two differently shaped homochiral channels. By using the same building blocks under different reaction conditions, a rare series of crystals have been obtained that are uniquely rounded in their shape. In stark contrast to the brain-like crystals, these isostructural and monodispersed crystals have a comparatively smooth appearance. The sizes of these crystals vary by several orders of magnitude.
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http://dx.doi.org/10.1002/anie.202105772DOI Listing
June 2021

Autonomous Robotic Point-of-Care Ultrasound Imaging for Monitoring of COVID-19-Induced Pulmonary Diseases.

Front Robot AI 2021 25;8:645756. Epub 2021 May 25.

Laboratory for Computational Sensing and Robotics, Department of Mechanical Engineering, Johns Hopkins University, Baltimore, MD, United States.

The COVID-19 pandemic has emerged as a serious global health crisis, with the predominant morbidity and mortality linked to pulmonary involvement. Point-of-Care ultrasound (POCUS) scanning, becoming one of the primary determinative methods for its diagnosis and staging, requires, however, close contact of healthcare workers with patients, therefore increasing the risk of infection. This work thus proposes an autonomous robotic solution that enables POCUS scanning of COVID-19 patients' lungs for diagnosis and staging. An algorithm was developed for approximating the optimal position of an ultrasound probe on a patient from prior CT scans to reach predefined lung infiltrates. In the absence of prior CT scans, a deep learning method was developed for predicting 3D landmark positions of a human ribcage given a torso surface model. The landmarks, combined with the surface model, are subsequently used for estimating optimal ultrasound probe position on the patient for imaging infiltrates. These algorithms, combined with a force-displacement profile collection methodology, enabled the system to successfully image all points of interest in a simulated experimental setup with an average accuracy of 20.6 ± 14.7 mm using prior CT scans, and 19.8 ± 16.9 mm using only ribcage landmark estimation. A study on a full torso ultrasound phantom showed that autonomously acquired ultrasound images were 100% interpretable when using force feedback with prior CT and 88% with landmark estimation, compared to 75 and 58% without force feedback, respectively. This demonstrates the preliminary feasibility of the system, and its potential for offering a solution to help mitigate the spread of COVID-19 in vulnerable environments.
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http://dx.doi.org/10.3389/frobt.2021.645756DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8185340PMC
May 2021

Does racial background influence outcomes following total joint arthroplasty?

J Clin Orthop Trauma 2021 Aug 21;19:139-146. Epub 2021 May 21.

Department of Orthopedic Surgery, NYU Langone Health, New York, NY, United States.

Background: The purpose of this study is to assess whether racial differences influence patient-reported outcome measures (PROMs) following primary total hip (THA) and knee (TKA) arthroplasty.

Methods: We retrospectively reviewed patients who underwent primary THA or TKA from 2016 to 2020 with available PROMs. Both THA and TKA patients were separated into three groups based on their ethnicity: Caucasian, African-American, and other races. Patient demographics, clinical data, and PROMs at various time-periods were collected and compared. Demographic differences were assessed using chi-square and ANOVA. Univariate ANCOVA was utilized to compare outcomes and PROMs while accounting for demographic differences.

Results: This study included 1999 THA patients and 1375 TKA patients. In the THA cohort, 1636 (82%) were Caucasian, 177 (9%) were African-American, and 186 (9%) were of other races. In the TKA cohort, 864 (63%) were Caucasian, 236 (17%) were African-American, and 275 (20%) were of other races. Surgical-time significantly differed between the groups that underwent THA (88.4vs.100.5vs.96.1; p < 0.001) with African-Americans requiring the longest operative time. Length-of-stay significantly differed in both THA (1.5vs.1.9vs.1.8; p < 0.001) and TKA (2.1vs.2.5vs.2.3; p < 0.001) cohorts, with African-Americans having the longest stay. Caucasians reported significantly higher PROM scores compared to non-Caucasians in both cohorts. All-cause emergency-department (ED) visits, 90-day postoperative events (readmissions&revisions), and discharge-disposition did not statistically differ in both cohorts.

Conclusion: Non-Caucasian patients demonstrated lower PROM scores when compared to Caucasian patients following TJA although the differences may not be clinically relevant. LOS was significantly longer for African-Americans in both THA and TKA cohorts. Further investigation identifying racial disparity interventions is warranted.

Level Of Evidence: Prognostic Level III.
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http://dx.doi.org/10.1016/j.jcot.2021.05.017DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8167263PMC
August 2021

Development of a Patient-Centered Software System to Facilitate Effective Management of Bipolar Disorder.

Psychopharmacol Bull 2021 Mar;51(2):8-19

Bowden, M.D., Emeritus Professor, Department of Psychiatry, University of Texas Health Science Center at San Antonio, San Antonio, Texas. Priesmeyer, PhD., Jurica Professor of Management, Department of Management and Marketing, St Mary's University, San Antonio, Texas. Tohen, M.D., Dr.P.H., M.B.A, University Distinguished Professor and Chairman, Department of Psychiatry and Behavioral Sciences, University of New Mexico Health Sciences Center, Albuquerque, New Mexico. Singh, M.D., Deceased. Calabrese, M.D., Director, Mood Disorders Program, UH Cleveland Medical Center Case Western Reserve University School of Medicine, Cleveland, Ohio. Ketter, M.D, Emeritus Professor, Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California. Nierenberg, M.D., Director, Dauten Family Center for Bipolar Treatment Innovation Massachusetts General Hospital, Harvard Medical School. Thase, M.D., Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania. Gregg Siegel, M.S, Biomedical Development Corporation, San Antonio, Texas. Leslie H. Siegel, M.F.A, Biomedical Development Corporation, San Antonio, Texas. Mintz, PhD., Department of Psychiatry, University of Texas Health Science Center at San Antonio, San Antonio, Texas. Mallakh, M.D., Mood Disorders Research Program, Depression Center, Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, Louisville, Kentucky. McElroy, M.D., Professor of Psychiatry and Behavioral Neuroscience, University of Cincinnati, Cincinnati, Ohio. Martinez, M.D., Professor and Mary Avis Weir Chair in Psychiatry, Director, Adult Mood Disorders Program, Co-Director, Mind, Brain, and Behavior, Department of Psychiatry and Behavioral Sciences University of Texas Health Science Center San Antonio, San Antonio, Texas.

Objective: Self-management of bipolar disorder (BD) is an important component of treatment.

Methods: We developed a patient-centered computational software system based on concepts from nonlinear systems (chaos) theory with mobile access to assist in managing BD known as KIOS. KIOS tracks interacting symptoms to determine theprecise state of a BD patient. Once the patient's state is identified and the trajectory of the patient established, specific advice is generated to help manage the course of the disease. KIOS also provides analytics that can be used by clinicians and researchers to track outcomes and the course of illness. A 12-week field test was completed.

Results: In 20 BD subjects, use of KIOS was associated with improvements in primary symptom categories of BD. Usability and generated advice were rated as a median of 6 out of a maximum of 7.

Conclusions: The KIOS focus on change illuminates problems in the same way that humans experience them, implying that the future state will be consequent to changes made to impact the current state. Randomized clinical trial is indicated.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8146566PMC
March 2021

Failure to Meet Same-Day Discharge is Not a Predictor of Adverse Outcomes.

Arch Orthop Trauma Surg 2021 Jun 1. Epub 2021 Jun 1.

Department of Orthopedic Surgery, NYU Langone Health, The New York Hip Institute, 485 Madison Ave. 8th Floor, New York, USA.

Introduction: As more centers introduce same-day discharge (SDD) total joint arthroplasty (TJA) programs, it is vital to understand the factors associated with successful outpatient TJA and whether outcomes vary for those that failed SDD. The purpose of this study is to compare outcomes of patients that are successfully discharged home the day of surgery to those that fail-to-launch (FTL) and require a longer in-hospital stay.

Materials And Methods: We retrospectively reviewed all patients who enrolled in our institution's SDD TJA program from 2015 to 2020. Patients were stratified into two cohorts based on whether they were successfully SDD or FTL. Outcomes of interest included discharge disposition, 90-day readmissions, 90-day revisions, surgical time, and patient-reported outcome measures (PROMs) as assessed by the FJS-12 (3 months, 1 year, and 2 years), HOOS, JR, and KOOS, JR (preoperatively, 3 months, and 1 year). Demographic differences were assessed with chi-square and Mann-Whitney U tests. Outcomes were compared using multilinear regressions, controlling for demographic differences.

Results: A total of 1491 patients were included. Of these, 1384 (93%) were successfully SDD while 107 (7%) FTL and required a longer length-of-stay. Patients who FTL were more likely to be non-married (p = 0.007) and ASA class III (p = 0.017) compared to those who were successfully SDD. Surgical time was significantly longer for those who FTL compared to those who were successfully SDD (100.86 vs. 83.42 min; p < 0.001). Discharge disposition (p = 0.100), 90-day readmissions (p = 0.897), 90-day revisions (p = 0.997), and all PROM scores both preoperatively and postoperatively did not significantly differ between the two cohorts.

Conclusion: Our results support the notion that FTL is not a predictor of adverse outcomes as patients who FTL achieved similar outcomes as those who were successfully SDD. The findings of this study can aid orthopedic surgeons to educate their patients who wish to participate in a similar program, as well as patients that have concerns after they failed to go home on the day of surgery.

Level Iii Evidence: Retrospective Cohort Study.
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http://dx.doi.org/10.1007/s00402-021-03983-0DOI Listing
June 2021

Impact of Preoperative Opioid Use on Patient Outcomes Following Primary Total Hip Arthroplasty.

Orthopedics 2021 Mar-Apr;44(2):77-84. Epub 2021 Mar 1.

The purpose of this study was to investigate whether preoperative opioid use had any effect on clinical outcomes and patient-reported outcome measures (PROMs) before and after primary, elective total hip arthroplasty (THA). The authors retrospectively reviewed 793 patients who underwent primary THA from November 2018 to March 2020 with available PROMs. Patients were stratified into two groups based on whether or not they were taking opioids preoperatively. Demographics, clinical data, and PROMs (Forgotten Joint Score-12 [FJS-12], Hip disability and Osteoarthritis Outcome Score for Joint Replacement [HOOS, JR], and Veterans RAND 12 [VR-12] Physical Component Score [PCS] and Mental Component Score [MCS]) were collected at various time periods. Demographic differences were assessed with chi-square and independent sample tests. Clinical data and PROMs were compared using multilinear regressions. Seventy-five (10%) patients were preoperative opioid users and 718 (90%) were not. Preoperative opioid users had a longer stay (1.37 vs 1.07 days; =.030), a longer surgical time (102.44 vs 90.20 minutes; =.001), and higher all-cause postoperative emergency department visits (6.7% vs 2.1%; =.033) compared with patients not taking opioids preoperatively. Preoperative HOOS, JR (46.63 vs 51.26; =.009), VR-12 PCS (27.79 vs 31.53; <.001), and VR-12 MCS (46.24 vs 49.33; =.044) were significantly lower for preoperative opioid users, but 3-month and 1-year postoperative scores were not statistically different. At 3 months and 1 year, FJS-12 scores did not differ significantly. Mean improvement preoperatively to 1 year in HOOS, JR values exceeded the minimal clinically important difference, with preoperative opioid users experiencing a greater improvement (36.50 vs 33.11; =.008). Preoperative opioid users had a longer stay, a longer surgical time, and higher all-cause emergency department visits compared with preoperatively opioid naïve patients. Although preoperative opioid users reported significantly lower preoperative PROMs, they did not statistically differ postoperatively, which indicates a larger delta improvement and similar benefits following THA. [. 2021;44(2):77-84.].
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http://dx.doi.org/10.3928/01477447-20210217-03DOI Listing
July 2021

Presence of back pain prior total knee arthroplasty and its effects on short-term patient-reported outcome measures.

Eur J Orthop Surg Traumatol 2021 May 26. Epub 2021 May 26.

Department of Orthopedic Surgery, NYU Langone Health, 301 East 17th Street, New York, NY, 10003, USA.

Purpose: Back pain may both decrease patient satisfaction after TKA and confound outcome assessment in satisfied patients. Our primary objective was to determine whether preoperative back pain is associated with differences in postoperative patient-reported outcome measures (PROMs).

Methods: We retrospectively reviewed 234 primary TKA patients who completed PROMs preoperatively and 12 weeks postoperatively, which included a back pain questionnaire, the Knee Injury and Osteoarthritis Outcome Score for Joint Replacement (KOOS JR) and the Forgotten Joint Score-12 (FJS-12). Cohorts were defined based on the severity of preoperative back pain (none, mild, moderate and severe) and compared. Demographics were compared using ANOVA and Chi-square analysis. Univariate ANCOVA analysis was utilized to compare PROMs while accounting for significant demographic differences.

Results: Both preoperative KOOS JR scores (none: 47.90, mild: 47.61, moderate: 44.61 and severe: 38.70; p = 0.013) and 12-week postoperative KOOS JR scores (none: 61.24, mild: 64.94, moderate: 57.48 and severe: 57.01; p = 0.012) had a statistically significant inverse relationship with regard to the intensity of preoperative back pain. Although FJS-12 scores at the 12-week postoperative period trended lower with increasing levels of preoperative back pain (p = 0.362), it did not reach statistical significance. Patients who reported severe back pain preoperatively achieved the largest delta improvement from baseline compared to those with lesser pain intensity (p = 0.003). Patients who had a 2-grade improvement in their back pain achieved significantly higher KOOS JR scores 12 weeks postoperatively compared to patients with either 1-grade or no improvement (63.53 vs. 55.98; p = 0.042). Both preoperative (47.99 vs. 41.11; p = 0.003) and 12-week postoperative (64.06 vs. 55.73; p < 0.001) KOOS JR scores were statistically higher for those who reported mild or no back pain pre-and postoperatively than those who reported moderate or severe back pain pre-and postoperatively.

Conclusion: Knee pain and back pain both exert negative effects on outcome instruments designed to measure pain and function. Although mean improvement from pre- to postoperative KOOS JR scores for patients with severe pre-existing back pain was higher than their counterparts, this statistical difference is likely not clinically significant. This implies that all patients may experience similar benefits from TKA despite the presence or absence of back pain. Attempts to measure TKA outcomes using PROMs should seek to control for lumbago and other sources of body pain. Level of Evidence IIIRetrospective Cohort Study.
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http://dx.doi.org/10.1007/s00590-021-03010-3DOI Listing
May 2021

Effect of Marital Status on Outcomes Following Total Joint Arthroplasty.

Arch Orthop Trauma Surg 2021 May 25. Epub 2021 May 25.

Department of Orthopedic Surgery, NYU Langone Health, 301 East 17th Street, New York, NY, 10003, USA.

Introduction: The purpose of this study is to investigate whether the specific socioeconomic factor such as marital status has any effect on clinical outcomes and patient-reported outcome measures (PROMs) after primary total hip (THA) and knee (TKA) arthroplasty.

Materials And Methods: We retrospectively reviewed patients who underwent primary THA or TKA from January 2019 to August 2019 who answered all PROM questionnaires. Both THA and TKA patients were separated into two groups based on their marital status at the time of surgery (married vs. non-married). Demographics, clinical data, and PROMs (FJS-12, HOOS, JR, KOOS, JR, and VR-12 PCS&MCS) were collected at various time-periods. Demographic differences were assessed using chi-square and independent sample t tests. Clinical data and mean PROMs were compared using multilinear regressions while accounting for demographic differences.

Results: This study included 389 patients who underwent primary THA and 193 that underwent primary TKA. In the THA cohort, 256 (66%) patients were married and 133 (34%) were non-married. In the TKA cohort, there were 117 (61%) married patients and 76 (39%) non-married patients. Length of stay was significantly shorter for married patients in both the THA (1.30 vs. 1.64; p = 0.002) and TKA (1.89 vs. 2.36; p = 0.024) cohorts. Surgical-time, all-cause emergency department visits, discharge disposition, and 90-day all-cause adverse events (readmissions/revisions) did not statistically differ between both cohorts. Both HOOS, JR and KOOS, JR score improvements from baseline to 1-year did not statistically differ for the THA and TKA cohorts, respectively. Although VR-12 PCS (p = 0.012) and MCS (p = 0.004) score improvement from baseline to 1-year statistically differed for the THA cohort, they did not for the TKA cohort.

Conclusion: Total joint arthroplasty may yield similar clinical benefits in all patients irrespective of their marital status. Although some PROMs statistically differed among married and non-married patients, the differences are likely not clinically significant. Surgeons should continue to assess levels of psychosocial support in their patients prior to undergoing TJA to optimize outcomes.

Level Of Evidence: III, Retrospective Cohort Study.
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http://dx.doi.org/10.1007/s00402-021-03914-zDOI Listing
May 2021

The Holstein-Lewis humerus shaft fracture in children: are they different from adults?

J Pediatr Orthop B 2021 May 20. Epub 2021 May 20.

Department of Orthopaedic Surgery, Cincinnati Children's Hospital Medical Center Department of Surgery, University of Cincinnati, Cincinnati, Ohio Department of Orthopaedics, Washington Orthopaedic Center, Olympia, Washington, USA.

Spiral fractures in the distal third humerus shaft (Holstein-Lewis fracture pattern) have been associated with high risk of radial nerve palsy in adults and surgical treatment is recommended as the treatment of choice to remove the entrapped nerve from the fracture site. But this association and treatment approach has not been evaluated in pediatric humerus shaft fractures. In a retrospective study, 38 pediatric patients with Holstein-Lewis fracture configuration were identified after a review of radiographs of 1609 patients with humerus shaft fracture. Age at initial presentation, sex, mechanism of injury, side involved, presence of any associated injuries, neurovascular status, radial nerve status, fracture management, and any complications were noted. Thiry-three (86.8%) patients with mean age 10.1 ± 3.7 years were successfully treated by closed methods. Five patients (13.2%) with mean age 15.2 ± 2.6 years underwent surgical treatment. Contrary to adults, no children/adolescents had radial nerve palsy at presentation. Radiographic healing was acceptable in all cases at latest follow-up. Holstein-Lewis fracture behaves differently in children with no increased risk of radial nerve palsy. Majority can be treated conservatively. The thick periosteum in children may offer protection to the radial nerve and may be responsible for the success of closed treatment.
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http://dx.doi.org/10.1097/BPB.0000000000000863DOI Listing
May 2021

Traumatic dissecting pathology of posterior cerebral artery: a report of two cases-aneurysm and pial arteriovenous fistula.

BMJ Case Rep 2021 May 20;14(5). Epub 2021 May 20.

Radiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India.

We present two cases of 17-year-old man and 10-year-old boy presenting with subarachnoid haemorrhage and a history of road traffic accident. One patient had dissecting aneurysm of the posterior cerebral artery (PCA), and the other patient had partially thrombosed aneurysm on CT angiography. On digital subtraction angiography of the second patient, there was formation of PCA pontomesencephalic vein pial arteriovenous fistula (PAVF). Both the patients underwent endovascular treatment: stent-assisted coiling for aneurysm and coiling with parent vessel occlusion for PAVF. There were no procedural complications. Follow-up angiography showed no residual aneurysm or fistula. Trauma is one of the recognised causes of dissection, and intracranial dissections can present as stenotic lesions, aneurysms or fistulas, depending on the pathology. Traumatic dissecting PCA aneurysm has been reported in only two case reports previously, and post-traumatic PAVF in PCA has not been reported.
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http://dx.doi.org/10.1136/bcr-2020-237722DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8141424PMC
May 2021

Management of Physeal Fractures: A Review Article.

Indian J Orthop 2021 Jun 13;55(3):525-538. Epub 2021 Jan 13.

Department of Orthopaedic Surgery, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, 3333 Burnet Avenue, Cincinnati, OH 45229 USA.

Background: Physis is the weakest structure in the skeleton of a child and a frequent site of an injury or fracture. A physeal fracture presents a unique challenge in the management as the sequalae of such an injury could lead to growth disturbances.

Methods: In this review, mainly focussing on traumatic physeal injuries, the authors discuss the applied anatomy, different fracture patterns, clinical assessment and management of physeal fractures in children.

Results: Discussion on acute physeal injuries as well as physeal arrest and approach to its management is presented. Past attempts for treatment of physeal injuries and recent advances in their management is also discussed.

Conclusion: The ideal approach to treat physeal injuries should take into account the location of injury, age of the patient, fracture type and growth potential of the involved physis. Prompt diagnosis and physeal-respecting treatment techniques are important.
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http://dx.doi.org/10.1007/s43465-020-00338-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8081798PMC
June 2021

Current perspectives of limbal-derived stem cells and its application in ocular surface regeneration and limbal stem cell transplantation.

Stem Cells Transl Med 2021 Aug 5;10(8):1121-1128. Epub 2021 May 5.

Department of Cornea and Uveitis, Dr. Shroff's Charity Eye Hospital, New Delhi, India.

Limbal stem cells are involved in replenishing and maintaining the epithelium of the cornea. Damage to the limbus due to chemical/physical injury, infections, or genetic disorders leads to limbal stem cell deficiency (LSCD) with partial or total vision loss. Presently, LSCD is treated by transplanting limbal stem cells from the healthy eye of the recipient, living-related, or cadaveric donors. This review discusses limbal-derived stem cells, the importance of extracellular matrix in stem cell niche maintenance, the historical perspective of treating LSCD, including related advantages and limitations, and our experience of limbal stem cell transplantation over the decades.
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http://dx.doi.org/10.1002/sctm.20-0408DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8284782PMC
August 2021

A Novel Machine Learning Predictive Tool Assessing Outpatient or Inpatient Designation for Medicare Patients Undergoing Total Hip Arthroplasty.

Arthroplast Today 2021 Apr 13;8:194-199. Epub 2021 Apr 13.

New York University Langone Orthopaedic Hospital, New York, NY.

Background: The Centers for Medicare and Medicaid Services removed total hip arthroplasty (THA) from the inpatient-only list. This has created significant confusion regarding which patients qualify for an inpatient designation. The purpose of this study is to develop and validate a novel predictive tool for preoperatively objectively determining "outpatient" vs "inpatient" status for THA in the Medicare population.

Methods: A cohort of Medicare patients undergoing primary THA between January 2017 and September 2019 was retrospectively reviewed. A machine learning model was trained using 80% of the THA patients, and the remaining 20% was used for testing the model performance in terms of accuracy and the average area under the receiver operating characteristic curve. Feature importance was obtained for each feature used in the model.

Results: One thousand ninety-one patients had outpatient stays, and 318 qualified for inpatient designation. Significant associations were demonstrated between inpatient designations and the following: higher BMI, increased patient age, better preoperative functional scores, higher American Society of Anesthesiologist Physical Status Classification, higher Modified Frailty Index, higher Charlson Comorbidity Index, female gender, and numerous comorbidities. The XGBoost model for predicting an inpatient or outpatient stay was 78.7% accurate with the area under the receiver operating characteristic curve to be 81.5%.

Conclusions: Using readily available key baseline characteristics, functional scores and comorbidities, this machine-learning model accurately predicts an "outpatient" or "inpatient" stay after THA in the Medicare population. BMI, age, functional scores, and American Society of Anesthesiologist Physical Status Classification had the highest influence on this predictive model.
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http://dx.doi.org/10.1016/j.artd.2021.03.001DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8076615PMC
April 2021

Preoperative Prediction of Gartland IV Supracondylar Fractures of Humerus: Is it Possible?

Rev Bras Ortop (Sao Paulo) 2021 Apr 31;56(2):230-234. Epub 2021 Mar 31.

Departamento de Ortopedia, All India Institute of Medical Sciences, Rishikesh, Índia.

 The present study aims to identify preoperative characteristics of the patient, of the injury, as well as of imaging, which would point towards a type IV fracture. The present study shall help the operating team to predict more accurately the type IV pattern preoperatively, leading to improved counselling of the caregivers, planning of surgery, as well as preparedness regarding open reduction, if such situation arises.  A retrospective study was conducted, including patients that met the following criteria: 1) age < 16 years old; 2) Gartland type-III and type-IV supracondylar fractures; and 3) with complete records. Demographic data like age, gender, laterality, mode of injury, hospital duration of the injury, history of previous attempts of closed reduction, open/closed fracture, distal neurovascular status, and radiographic data like angulation, translation, osseous apposition and fracture comminution were collected.  Hospital duration of the injury and previous attempts of closed reduction were the factors that had a statistically significant difference among types III and IV fractures (  < 0.05). A diagnosis of type IV supracondylar fractures was significantly more likely in the presence of valgus angulation of the distal fragment ≥ 17° (odds ratio [OR] = 20.22; 95% confidence interval [CI] = 3.45-118.65). Flexion angulation ≥ 10° (OR = 5.32; 95% CI = 0.24-119.88) of the distal fragment predicted Gartland type IV with a sensitivity of 41% and a specificity of 100%.  The preoperative evaluation of suspected Gartland IV fractures can help the operating surgeon in predicting such injuries. Nonradiographic factors like increased hospital duration of the injury, attempts at previously closed reduction, and radiographic parameters like valgus and flexion angulation were more likely to be associated with type IV fractures. Level of evidence III.
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http://dx.doi.org/10.1055/s-0040-1722578DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8075635PMC
April 2021

Human Cadaveric Donor Cornea Derived Extra Cellular Matrix Microparticles for Minimally Invasive Healing/Regeneration of Corneal Wounds.

Biomolecules 2021 04 2;11(4). Epub 2021 Apr 2.

Brien Holden Eye Research Center, LV Prasad Eye Institute, Hyderabad, Telangana 500034, India.

Biological materials derived from extracellular matrix (ECM) proteins have garnered interest as their composition is very similar to that of native tissue. Herein, we report the use of human cornea derived decellularized ECM (dECM) microparticles dispersed in human fibrin sealant as an accessible therapeutic alternative for corneal anterior stromal reconstruction. dECM microparticles had good particle size distribution (≤10 µm) and retained the majority of corneal ECM components found in native tissue. Fibrin-dECM hydrogels exhibited compressive modulus of 70.83 ± 9.17 kPa matching that of native tissue, maximum burst pressure of 34.3 ± 3.7 kPa, and demonstrated a short crosslinking time of ~17 min. The fibrin-dECM hydrogels were found to be biodegradable, cytocompatible, non-mutagenic, non-sensitive, non-irritant, and supported the growth and maintained the phenotype of encapsulated human corneal stem cells (hCSCs) in vitro. In a rabbit model of anterior lamellar keratectomy, fibrin-dECM bio-adhesives promoted corneal re-epithelialization within 14 days, induced stromal tissue repair, and displayed integration with corneal tissues in vivo. Overall, our results suggest that the incorporation of cornea tissue-derived ECM microparticles in fibrin hydrogels is non-toxic, safe, and shows tremendous promise as a minimally invasive therapeutic approach for the treatment of superficial corneal epithelial wounds and anterior stromal injuries.
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http://dx.doi.org/10.3390/biom11040532DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8066719PMC
April 2021

Growth-Temperature Dependent Unpassivated Oxygen Bonds Determine the Gas Sensing Abilities of Chemical Vapor Deposition-Grown CuO Thin Films.

ACS Appl Mater Interfaces 2021 May 29;13(18):21936-21943. Epub 2021 Apr 29.

Centre for Nanoscience and Engineering, Indian Institute of Science, Bangalore, Karnataka 560012, India.

CuO is a multifunctional metal oxide excellent for chemiresistive gas sensors. In this work, we report CuO-based NO sensors fabricated chemical vapor deposition (CVD). CVD allows great control on composition, stoichiometry, impurity, roughness, and grain size of films. This endows sensors with high selectivity, responsivity, sensitivity, and repeatability, low hysteresis, and quick recovery. All these are achieved without the need of expensive and unscalable nanostructures, or heterojunctions, with a technologically mature CVD. Films deposited at very low temperatures (≤350 °C) are sensitive but slow due to traps and small grains. Films deposited at high temperatures (≥550 °C) are not hysteretic but suffer from low sensitivity and slow response due to lack of surface states. Films deposited at optimum temperatures (350-450 °C) combine the best aspects of both regimes to yield NO sensors with a response of 300 % at 5 ppm, sensitivity limit of 300 ppb, hysteresis of <20%, repeatable performance, and recovery time of ∼1 min. The work demonstrates that CVD might be a more effective way to deposit oxide films for gas sensors.
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http://dx.doi.org/10.1021/acsami.1c01085DOI Listing
May 2021
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