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Showing papers by "University of Medicine and Dentistry of New Jersey published in 2021"


Journal ArticleDOI
26 Mar 2021
TL;DR: In this article, the authors examined whether subarachnoid haemorrhage (SAH) hospitalisations and ruptured aneurysm coiling interventions demonstrated similar declines during the COVID-19 pandemic.
Abstract: BACKGROUND: During the COVID-19 pandemic, decreased volumes of stroke admissions and mechanical thrombectomy were reported. The study's objective was to examine whether subarachnoid haemorrhage (SAH) hospitalisations and ruptured aneurysm coiling interventions demonstrated similar declines. METHODS: We conducted a cross-sectional, retrospective, observational study across 6 continents, 37 countries and 140 comprehensive stroke centres. Patients with the diagnosis of SAH, aneurysmal SAH, ruptured aneurysm coiling interventions and COVID-19 were identified by prospective aneurysm databases or by International Classification of Diseases, 10th Revision, codes. The 3-month cumulative volume, monthly volumes for SAH hospitalisations and ruptured aneurysm coiling procedures were compared for the period before (1 year and immediately before) and during the pandemic, defined as 1 March-31 May 2020. The prior 1-year control period (1 March-31 May 2019) was obtained to account for seasonal variation. FINDINGS: There was a significant decline in SAH hospitalisations, with 2044 admissions in the 3 months immediately before and 1585 admissions during the pandemic, representing a relative decline of 22.5% (95% CI -24.3% to -20.7%, p<0.0001). Embolisation of ruptured aneurysms declined with 1170-1035 procedures, respectively, representing an 11.5% (95%CI -13.5% to -9.8%, p=0.002) relative drop. Subgroup analysis was noted for aneurysmal SAH hospitalisation decline from 834 to 626 hospitalisations, a 24.9% relative decline (95% CI -28.0% to -22.1%, p<0.0001). A relative increase in ruptured aneurysm coiling was noted in low coiling volume hospitals of 41.1% (95% CI 32.3% to 50.6%, p=0.008) despite a decrease in SAH admissions in this tertile. INTERPRETATION: There was a relative decrease in the volume of SAH hospitalisations, aneurysmal SAH hospitalisations and ruptured aneurysm embolisations during the COVID-19 pandemic. These findings in SAH are consistent with a decrease in other emergencies, such as stroke and myocardial infarction.

28 citations


Journal ArticleDOI
TL;DR: This study proposes a novel adaptive pattern learning framework with a new online feature extraction approach to achieve personalized online prospective seizure prediction and achieves impressive prediction results for 10 patients with epilepsy using longterm EEG recordings.
Abstract: The sudden and spontaneous occurrence of epileptic seizures can impose a significant burden on patients with epilepsy. If seizure onset can be prospectively predicted, it could greatly improve the life of patients with epilepsy and also open new therapeutic avenues for epilepsy treatment. However, discovering effective predictive patterns from massive brainwave signals is still a challenging problem. The prediction of epileptic seizures is still in its early stage. Most existing studies actually investigated the predictability of seizures offline instead of a truly prospective online prediction, and also the high inter-individual variability was not fully considered in prediction. In this study, we propose a novel adaptive pattern learning framework with a new online feature extraction approach to achieve personalized online prospective seizure prediction. In particular, a two-level online feature extraction approach is applied to monitor intracranial electroencephalogram (EEG) signals and construct a pattern library incrementally. Three prediction rules were developed and evaluated based on the continuously-updated patient-specific pattern library for each patient, including the adaptive probabilistic prediction (APP), adaptive linear-discriminant-analysis-based prediction (ALP), and adaptive Naive Bayes-based prediction (ANBP). The proposed online pattern learning and prediction system achieved impressive prediction results for 10 patients with epilepsy using long-term EEG recordings. The best testing prediction accuracy averaged over the 10 patients were 79, 78, and 82 percent for the APP, ALP, and ANBP prediction scheme, respectively. The experimental results confirmed that the proposed adaptive prediction framework offers a promising practical tool to solve the challenging seizure prediction problem.

23 citations


Journal ArticleDOI
19 Mar 2021-Stroke
TL;DR: The Tigertriever as discussed by the authors is a radially adjustable, fully visible, stentriever that permits the operator to align radial expansion with target vessel diameters, and it has been used in a multicenter trial compared with established stent retrievers.
Abstract: Background and Purpose: The Tigertriever is a novel, radially adjustable, fully visible, stentriever that permits the operator to align radial expansion with target vessel diameters. This multicenter trial compared the Tigertriever’s effectiveness and safety compared with established stent retrievers.

21 citations


Journal ArticleDOI
TL;DR: Taghavi et al. as discussed by the authors examined the influence of prehospital procedures (PHP) on outcomes in penetrating trauma patients in urban locations where transport to trauma center is not prolonged.
Abstract: Author(s): Taghavi, Sharven; Maher, Zoe; Goldberg, Amy J; Chang, Grace; Mendiola, Michelle; Anderson, Christofer; Ninokawa, Scott; Tatebe, Leah C; Maluso, Patrick; Raza, Shariq; Keating, Jane J; Burruss, Sigrid; Reeves, Matthew; Coleman, Lauren E; Shatz, David V; Goldenberg-Sandau, Anna; Bhupathi, Apoorva; Spalding, M Chance; LaRiccia, Aimee; Bird, Emily; Noorbakhsh, Matthew R; Babowice, James; Nelson, Marsha C; Jacobson, Lewis E; Williams, Jamie; Vella, Michael; Dellonte, Kate; Hayward, Thomas Z; Holler, Emma; Lieser, Mark J; Berne, John D; Mederos, Dalier R; Askari, Reza; Okafor, Barbara U; Haut, Elliott R; Etchill, Eric W; Fang, Raymond; Roche, Samantha L; Whittenburg, Laura; Bernard, Andrew C; Haan, James M; Lightwine, Kelly L; Norwood, Scott H; Murry, Jason; Gamber, Mark A; Carrick, Matthew M; Bugaev, Nikolay; Tatar, Antony; Duchesne, Juan; Tatum, Danielle | Abstract: BackgroundPrehospital procedures (PHP) by emergency medical services (EMS) are performed regularly in penetrating trauma patients despite previous studies demonstrating no benefit. We sought to examine the influence of PHPs on outcomes in penetrating trauma patients in urban locations where transport to trauma center is not prolonged. We hypothesized that patients without PHPs would have better outcomes than those undergoing PHP.MethodsThis was an Eastern Association for the Surgery of Trauma-sponsored, multicenter, prospective, observational trial of adults (18+ years) with penetrating trauma to the torso and/or proximal extremity presenting at 25 urban trauma centers. The impact of PHPs and transport mechanism on in-hospital mortality were examined.ResultsOf 2,284 patients included, 1,386 (60.7%) underwent PHP. The patients were primarily Black (n = 1,527, 66.9%) males (n = 1,986, 87.5%) injured by gunshot wound (n = 1,510, 66.0%) with 34.1% (n = 726) having New Injury Severity Score of ≥16. A total of 1,427 patients (62.5%) were transported by Advanced Life Support EMS, 17.2% (n = 392) by private vehicle, 13.7% (n = 312) by police, and 6.7% (n = 153) by Basic Life Support EMS. Of the PHP patients, 69.1% received PHP on scene, 59.9% received PHP in route, and 29.0% received PHP both on scene and in route. Initial scene vitals differed between groups, but initial emergency department vitals did not. Receipt of ≥1 PHP increased mortality odds (odds ratio [OR], 1.36; 95% confidence interval [CI], 1.01-1.83; p = 0.04). Logistic regression showed increased mortality with each PHP, whether on scene or during transport. Subset analysis of specific PHP revealed that intubation (OR, 10.76; 95% CI, 4.02-28.78; p l 0.001), C-spine immobilization (OR, 5.80; 95% CI, 1.85-18.26; p l 0.01), and pleural decompression (OR, 3.70; 95% CI, 1.33-10.28; p = 0.01) had the highest odds of mortality after adjusting for multiple variables.ConclusionPrehospital procedures in penetrating trauma patients impart no survival advantage and may be harmful in urban settings, even when performed during transport. Therefore, PHP should be forgone in lieu of immediate transport to improve patient outcomes.Level of evidencePrognostic, level III.

19 citations


Journal ArticleDOI
TL;DR: Programmed cell death inhibitors, such as pembrolizumab, can provide great benefit to patients but can also be associated with rare but serious adverse events, so providers should continually weigh the benefits versus harm in using these products and monitor patients closely for such adverse events.
Abstract: Purpose:This case report describes myasthenia gravis-like symptoms after treatment with a programmed cell death 1 inhibitor, pembrolizumab, the treatment modalities utilized, and associated patient...

6 citations


Journal ArticleDOI
TL;DR: In this paper, the authors focus on general strategies for overcoming the data bottleneck for the application of artificial intelligence in pathology, including transfer learning, zero-shot learning, Siamese networks, one-class models, generative networks, and reinforcement learning.
Abstract: The need for huge data sets represents a bottleneck for the application of artificial intelligence. Substantially fewer annotated target lesions than normal tissues for comparison present an additional problem in the field of pathology. Organic brains overcome these limitations by utilizing large numbers of specialized neural nets arranged in both linear and parallel fashion, with each solving a restricted classification problem. They rely on local Hebbian error corrections as compared to the nonlocal back-propagation used in most artificial neural nets, and leverage reinforcement. For these reasons, even toddlers are able to classify objects after only a few examples. Rather than provide an overview of current AI research in pathology, this review focuses on general strategies for overcoming the data bottleneck. These include transfer learning, zero-shot learning, Siamese networks, one-class models, generative networks, and reinforcement learning. Neither an extensive mathematic background nor advanced programing skills are needed to make these subjects accessible to pathologists. However, some familiarity with the basic principles of deep learning, briefly reviewed here, is expected to be useful in understanding both the current limitations of machine learning and determining ways to address them.

5 citations


Posted ContentDOI
11 Jan 2021-bioRxiv
TL;DR: In this paper, the effect of speciation on the cytotoxic effects of porphyrins was investigated. And the authors showed that porphrin formation is reversible in nature, and that nanostructure size modulates protein oxidation and aggregation potential.
Abstract: Porphyrias are caused by genetic defects in the heme biosynthetic pathway and are associated with accumulation of high levels of porphyrins that become cytotoxic. Porphyrins, due to their amphipathic nature, spontaneously associate into different nanostructures but very little is known about the effect of porphyrin speciation on the cytotoxic effects of porphyrins. Previously we demonstrated the unique ability of fluorescent biological porphyrins, including protoporphyrin IX (PP-IX), to cause organelle selective protein aggregation, which we posit to be a major mechanism by which porphyrins exerts their cytotoxic effect. Herein, we tested the hypothesis that PP-IX-mediated protein aggregation is modulated by different PP-IX nanostructures via a mechanism that depends on their oxidizing potential and protein binding ability. We demonstrate that PP-IX nanostructure formation is reversible in nature, and that nanostructure size modulates consequent protein oxidation and aggregation potential. We also show that albumin, the most abundant serum protein, preferentially binds PP-IX dimers and enhances their oxidizing ability. Additionally, extracellular albumin protects from intracellular porphyrinogenic stress and protein aggregation by acting as a PP-IX sponge. This work highlights the importance of PP-IX speciation in the context of the porphyrias, and offers insights into potential novel therapeutic approaches.

3 citations


Journal ArticleDOI
TL;DR: Cost-effectiveness analysis is a way to understand the value of a health care intervention in terms of assessing the money spent to produce beneficial outcomes as discussed by the authors, which is used by various stakeholders for such purposes because health care resources and financing may be scarce, depending on the economy, and certain interventions may be costly to produce such outcomes compared with other options.

3 citations



Journal ArticleDOI
TL;DR: Salen et al. as mentioned in this paper defined metabolic and genetic defects in these disorders and proposed a method to diagnose and treat them using dietary cholesterol supplementing and oral bile acid therapy.

1 citations



Journal ArticleDOI
29 Jul 2021-Cancer
TL;DR: In this article, the authors reassessed their previous evaluation of familial aggregation of cancer in 348 high-risk Taiwanese multiplex families with 2 or more NASC cases enrolled between 1980 and 2003.
Abstract: Background Genetic and environmental factors are important determinants of nasopharyngeal carcinoma (NPC). NPC is associated with Epstein-Barr virus (EBV) infection. Studies have reported familial aggregation of NPC, but evidence has been mixed for elevated rates of cancers other than NPC. Methods The authors reassessed their previous evaluation of familial aggregation of cancer in 348 high-risk Taiwanese multiplex families with 2 or more NPC cases enrolled between 1980 and 2003. Participants were linked to the Taiwan National Cancer Registry and National Death Registry to identify cancers. Results In all, 2590 individuals contributed 37,959 person-years over an average of 15 years of follow-up; 314 incident cancers were identified. The authors computed multiple primary standardized incidence ratios (MP-SIRs) to evaluate the overall risk and the risk of infection-associated, EBV-associated, and individual cancers. The overall MP-SIR was 1.24 (95% confidence interval [CI], 1.10-1.38). The exclusion of excess NPC risk led to an overall MP-SIR of 1.11 (95% CI, 0.98-1.25). Similarly, the risk of cancers associated with infectious agents was driven by the excess in NPC, and its exclusion led to an MP-SIR of 1.22 (95% CI, 0.99-1.48) for infection-associated cancers and to an MP-SIR of 1.18 (95% CI, 0.72-1.82) for EBV-associated cancers. The authors observed a significant excess of second cancers among NPC cases (oral cancer, mouth cancer, tongue cancer, gum cancer, nasal cavity cancer, bone cancer, and non-Hodgkin lymphoma). Conclusions This reassessment of the largest NPC multiplex family study confirms the presence of NPC coaggregation within families in Taiwan but does not provide evidence for a broader familial syndrome involving NPC and other tumors. Among NPC cases, elevated rates of secondary cancers, mostly at the, head and neck and hematopoietic cancers suggest radiation treatment effects on subsequent cancer risk.

Journal ArticleDOI
Abstract: The goal of this review is to highlight the important clinical considerations that impact the facial aging process and discuss current assessment tools that are available to help guide the clinician on appropriate facial rejuvenation modalities. Extrinsic and intrinsic factors and their effects on facial aging continue to be studied. Ethnic and racial backgrounds play a critical role in the facial aging process. Gender’s impact on facial aging is explored. Several assessment tools have been developed to examine various subunits of the face, and other assessments have been created that account for the patient’s ethnic background. Facial aging is a dynamic and complex process. Understanding facial aging requires understanding changes in all layers of facial tissues as well as extrinsic and intrinsic factors that can affect the process, along with ethnic differences. Using appropriate assessment tools can help guide the clinician toward optimal treatment modalities.