Lincoln Hospital

About: Lincoln Hospital is a healthcare organization based out in New York, New York, United States. It is known for research contribution in the topics: Population & Emergency department. The organization has 1033 authors who have published 929 publications receiving 14486 citations. The organization is also known as: Lincoln Medical and Mental Health Center & Lincoln Hospital.

An analysis of the robustness and fragility of the coagulation system

Abstract: The coagulation system (CS) is a complex, inter-connected biological system with major physiological and pathological roles. Adaptive mechanisms such as ubiquitous feedback and feedforward loops create non-linear relationships among its individual components and render the study of this biology at a molecular and cellular level nearly impossible. Computational modeling aims to overcome limitations of current analytical methods through in silico simulation of these complex interplays. We present herein an Agent Based Modeling and Simulation (ABMS) approach for simulating these complex interactions. Our ABMS approach utilizes a subset of 48 rules to define the interactions among 24 enzymes and factors of the CS. These rules simulate the interaction of each “agent”, such as substrates, enzymes, and cofactors, on a two-dimensional grid of ~3,000 cells and ~500,000 agents. Our ABMS method demonstrates the robustness of the physiologic CS system over large ranges of tissue factor (TF) concentrations. The system also demonstrates fragility as complete coagulation occurs at sufficiently high concentrations of TF. Removal of individual coagulation inhibitors from the physiologic system results in system fragility at relatively lower TF concentrations. The complete removal of coagulation inhibitors leads to a system that is incapable of controlling coagulation at all TF concentrations. The synergistic effects of the inhibitory pathways create an intricate regulatory mechanism that allows sufficient clot formation while preventing system wide activation of the CS; a robust system emerges. Introduction

Case 1: A Newborn with Absence of Right Forearm, Preauricular Pit, and an Infantile Hemangioma

Abstract: A female infant is born at 35 weeks’ gestation to a 19-year-old Hispanic woman and a 21-year-old Hispanic man. The infant has a birthweight of 2,710 g (10th–25th percentile), length of 46.5 cm (10th–25th percentile), and head circumference of 34.1 cm (10th–25th percentile). Apgar scores at 1 and 5 minutes are 9 and 9, respectively. Her physical examination is remarkable for bilateral ear pits, absence of distal two-thirds of the right forearm and hand, and a stump with rudimentary fingers (Fig 1). Good range of motion was observed at the right elbow and shoulder. The left upper extremity and both lower extremities are normal. All her limbs have a good range of motion. No other dysmorphic features are present and the rest of her physical examination findings are unremarkable. A right extremity radiograph shows congenital absence of the right hand, with hypoplastic right forearm bones and a normal right humerus (Fig 2). Her nursery stay is uneventful and the patient is discharged with her mother. Figure 1. Physical findings seen in our patient. A. Hypoplastic right arm with absence of distal two-thirds of the right forearm and hand, with rudimentary fingers. B. Bilateral preauricular pits that were also present in the patient’s father. C. A superficial hemangioma in the vaginal area. Figure 2. A right arm radiograph shows congenital absence …

Utility of Exercise Stress Testing in Pediatric Patients with T-Wave Inversions

Abstract: T-wave inversions (TWI) in inferolateral electrocardiogram (ECG) leads (II, III, aVF, V5–V6) are often suggestive of cardiac pathology in adult patients. They are a common reason of additional testing in pediatric patients. The goal of the study is to determine correlation of exercise stress test T-wave response with diagnosis of cardiac pathology. This is a retrospective review of pediatric patients < 21 years with the finding of baseline TWI in inferior (II, III, avF) and/or lateral (V5–V6) leads on 12-lead ECG. All patients underwent treadmill exercise stress test (EST) and an echocardiogram within 1 year of each other. Demographics, baseline ECG findings, echocardiogram results, and EST data were recorded. T-wave reversion was considered complete if T waves demonstrated normalization during exercise, partial if there was minimal improvement, and no response if there was no change or worsening of inversions. In our cohort of 72 patients with a mean age 14.6 (± 2.9) years and 61% males, 59 (82%) had a structurally normal heart. Thirteen patients had evidence of structural or functional heart disease. Of the 59 patients, 83% had either complete or partial T-wave response. Among the 13 patients with heart disease, two patients had genetic testing consistent with risk for hypertrophic cardiomyopathy and had complete and partial response on EST. Exercise stress testing for TWI in pediatric patients has low sensitivity and specificity for the diagnosis of cardiac disease and routine use in this patient population may not be indicated.

Case 1: Neurologic Effects on a Newborn Exposed to Marijuana in Pregnancy

Abstract: An early term male neonate was born at 38 weeks of gestation by cesarean delivery due to a category 2 fetal heart tracing found in his 22-year-old mother, who did not receive prenatal care. Prenatal history is significant for maternal marijuana use, cigarette smoking, and group B Streptococcus colonization. At delivery, the infant is vigorous with Apgar scores of 9 and 9 at 1 and 5 minutes, respectively, birthweight of 2,640 g, and no dysmorphic features noted on physical examination. Prenatal marijuana exposure is confirmed by maternal and infant urine toxicology results. In the first postnatal day, despite several attempts at feeding, a poor suck and feeding pattern are noted. The neonate is transferred to the NICU for feeding and further evaluation. In the NICU, the …